BACKGROUND Fixed esotropia in high myopia,characterized by irreversible inward ocular deviation and abduction limitation,presents unique therapeutic challenges for athletes requiring precise binocular coordination.The...BACKGROUND Fixed esotropia in high myopia,characterized by irreversible inward ocular deviation and abduction limitation,presents unique therapeutic challenges for athletes requiring precise binocular coordination.The combination of Yokoyama surgery and medial rectus muscle recession has been proposed as an advanced technique addresses both myopia-induced globe displacement and muscular imbalance offering potential advantages over conventional strabismus surgery in this population.AIM To investigate the effects of the modified Yokoyama surgery coupled with medial rectus muscle recession in restoring ocular motility and correcting esotropia among athletes with high myopia and fixed esotropia.METHODS A retrospective study analyzed 30 highly myopia athletes(57 eyes)with fixed esotropia treated at our hospital from January 2022 to April 2024.The participants were allocated into two groups based on the surgical method:The traditional group(n=15,29 eyes)received conventional strabismus surgery,and the combined group(n=15,28 eyes)underwent modified Yokoyama surgery in combination with medial rectus muscle recession.Eye movement improvement,esotropia alleviation,and complications were compared preoperatively and at 1,3,and 6 months post-treatment.RESULTS Both surgical groups exhibited similar baseline scores(traditional:-4.04±0.38 vs combined:-4.12±0.45,P>0.05),showing severe preoperative limitations in ocular motility.Following the intervention,the combined group achieved significantly better outcomes at both 1 month(combined:-2.25±0.28 vs traditional:-2.67±0.32)and 3 months(combined:-1.48±0.28 vs traditional:-1.76±0.43),with statistically significant improvements(P<0.05).However,by 6 months,no significant difference was observed between the two groups(combined:-0.93±0.13;traditional:-1.03±0.18;P>0.05).Prior to treatment,all patients in both groups exhibited a compensatory head posture(CHP).Following treatment,the incidence of CHP decreased to 6.67%in the combined group and 20.00%in the traditional group,both reductions being significant compared to pretreatment levels(P<0.05).Nevertheless,the difference in CHP incidence between the two groups after treatment was not significant(P>0.05).The rates of improvement in esotropia showed an increasing trend in both groups at 1 month(46.43%vs 34.48%),3 months(78.57%vs 51.728%),and 6 months(100.00%vs 89.66%)post-treatment.Notably,the combined group had a significantly higher improvement rate than the traditional group at the 3-month follow-up(P<0.05).No significant difference was observed in the esotropia improvement rates between the two groups at 1 and 6 months post-treatment(P>0.05).The combined group experienced slightly lower but not significant(combined group:0.00%vs traditional:3.45%)as opposed to the traditional group(3.45%;P>0.05).CONCLUSION The combination of modified Yokoyama surgery and medial rectus muscle recession provides effective and safe approach to improving in eye movement and esotropia in athletes with high myopia and fixed esotropia,offering reliable clinical benefits.展开更多
目的:心力衰竭(heart failure,HF)是住院患者死亡的重要原因。本研究旨在探究营养炎症风险评分(nutrition-inflammation risk score,NIRS)及其列线图模型对老年心力衰竭患者30d死亡率的预测价值。方法:本研究回顾性分析2018年1月至2020...目的:心力衰竭(heart failure,HF)是住院患者死亡的重要原因。本研究旨在探究营养炎症风险评分(nutrition-inflammation risk score,NIRS)及其列线图模型对老年心力衰竭患者30d死亡率的预测价值。方法:本研究回顾性分析2018年1月至2020年6月,青岛市胶州中心医院收治的老年HF患者。根据患者30d的存活情况,分为死亡组和存活组。采用单因素分析和多因素Logistic回归构建NIRS和死亡预测模型。采用ROC分析、校准曲线和决策曲线评估老年HF患者死亡预测列线图模型的预测能力、校准能力和临床净获益。结果:本研究共纳入797例老年HF患者,164例(20.6%)老年HF患者在30d内死亡。NIRS由预后营养指数(prognosis nutrition index,PNI)、HGB-白蛋白-淋巴细胞-血小板(hemoglobin,albumin,lymphocyte,platelet,HALP)评分、单核细胞-高密度脂蛋白比值(monocyte to high density lipoprotein ratio,MHR)和CRP-白蛋白比值(C-reaction protein to albumin ratio,CAR)组成。多因素Logstic回归结果表明,NIRS(OR=11.867,95%CI:7.681~18.333,P<0.001)、高血压(OR=1.935,95%CI:1.18~3.175,P<0.001)和慢性阻塞性肺疾病(OR=4.306,95%CI:2.611~7.1,P<0.001)是老年HF患者30d死亡的危险因素。此外,老年HF患者30d死亡列线图模型ACU为0.855;校准曲线显示该模型预测概率与实际概率基本吻合;决策曲线显示该模型净获益良好。结论:INRS是老年HF患者30d死亡的独立预测因素。此外,老年HF患者30d死亡列线图模型可个体化预测老年HF患者30d内的死亡风险,帮助临床医生早期识别死亡高风险个体。展开更多
文摘BACKGROUND Fixed esotropia in high myopia,characterized by irreversible inward ocular deviation and abduction limitation,presents unique therapeutic challenges for athletes requiring precise binocular coordination.The combination of Yokoyama surgery and medial rectus muscle recession has been proposed as an advanced technique addresses both myopia-induced globe displacement and muscular imbalance offering potential advantages over conventional strabismus surgery in this population.AIM To investigate the effects of the modified Yokoyama surgery coupled with medial rectus muscle recession in restoring ocular motility and correcting esotropia among athletes with high myopia and fixed esotropia.METHODS A retrospective study analyzed 30 highly myopia athletes(57 eyes)with fixed esotropia treated at our hospital from January 2022 to April 2024.The participants were allocated into two groups based on the surgical method:The traditional group(n=15,29 eyes)received conventional strabismus surgery,and the combined group(n=15,28 eyes)underwent modified Yokoyama surgery in combination with medial rectus muscle recession.Eye movement improvement,esotropia alleviation,and complications were compared preoperatively and at 1,3,and 6 months post-treatment.RESULTS Both surgical groups exhibited similar baseline scores(traditional:-4.04±0.38 vs combined:-4.12±0.45,P>0.05),showing severe preoperative limitations in ocular motility.Following the intervention,the combined group achieved significantly better outcomes at both 1 month(combined:-2.25±0.28 vs traditional:-2.67±0.32)and 3 months(combined:-1.48±0.28 vs traditional:-1.76±0.43),with statistically significant improvements(P<0.05).However,by 6 months,no significant difference was observed between the two groups(combined:-0.93±0.13;traditional:-1.03±0.18;P>0.05).Prior to treatment,all patients in both groups exhibited a compensatory head posture(CHP).Following treatment,the incidence of CHP decreased to 6.67%in the combined group and 20.00%in the traditional group,both reductions being significant compared to pretreatment levels(P<0.05).Nevertheless,the difference in CHP incidence between the two groups after treatment was not significant(P>0.05).The rates of improvement in esotropia showed an increasing trend in both groups at 1 month(46.43%vs 34.48%),3 months(78.57%vs 51.728%),and 6 months(100.00%vs 89.66%)post-treatment.Notably,the combined group had a significantly higher improvement rate than the traditional group at the 3-month follow-up(P<0.05).No significant difference was observed in the esotropia improvement rates between the two groups at 1 and 6 months post-treatment(P>0.05).The combined group experienced slightly lower but not significant(combined group:0.00%vs traditional:3.45%)as opposed to the traditional group(3.45%;P>0.05).CONCLUSION The combination of modified Yokoyama surgery and medial rectus muscle recession provides effective and safe approach to improving in eye movement and esotropia in athletes with high myopia and fixed esotropia,offering reliable clinical benefits.
文摘目的:心力衰竭(heart failure,HF)是住院患者死亡的重要原因。本研究旨在探究营养炎症风险评分(nutrition-inflammation risk score,NIRS)及其列线图模型对老年心力衰竭患者30d死亡率的预测价值。方法:本研究回顾性分析2018年1月至2020年6月,青岛市胶州中心医院收治的老年HF患者。根据患者30d的存活情况,分为死亡组和存活组。采用单因素分析和多因素Logistic回归构建NIRS和死亡预测模型。采用ROC分析、校准曲线和决策曲线评估老年HF患者死亡预测列线图模型的预测能力、校准能力和临床净获益。结果:本研究共纳入797例老年HF患者,164例(20.6%)老年HF患者在30d内死亡。NIRS由预后营养指数(prognosis nutrition index,PNI)、HGB-白蛋白-淋巴细胞-血小板(hemoglobin,albumin,lymphocyte,platelet,HALP)评分、单核细胞-高密度脂蛋白比值(monocyte to high density lipoprotein ratio,MHR)和CRP-白蛋白比值(C-reaction protein to albumin ratio,CAR)组成。多因素Logstic回归结果表明,NIRS(OR=11.867,95%CI:7.681~18.333,P<0.001)、高血压(OR=1.935,95%CI:1.18~3.175,P<0.001)和慢性阻塞性肺疾病(OR=4.306,95%CI:2.611~7.1,P<0.001)是老年HF患者30d死亡的危险因素。此外,老年HF患者30d死亡列线图模型ACU为0.855;校准曲线显示该模型预测概率与实际概率基本吻合;决策曲线显示该模型净获益良好。结论:INRS是老年HF患者30d死亡的独立预测因素。此外,老年HF患者30d死亡列线图模型可个体化预测老年HF患者30d内的死亡风险,帮助临床医生早期识别死亡高风险个体。
