BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on pati...BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on patient presentation.Due to its low recurrence rate and minimal complications,MMAE has gained increasing acceptance among clinicians in recent years.This report presents a case of diplopia following MMAE due to the presence of a potential anastomotic artery,aiming to enhance awareness of this complication.CASE SUMMARY A 60-year-old male patient presented with a headache following head trauma,and cranial computed tomography revealed a left-sided CSDH.The patient underwent left MMAE;however,polyvinyl alcohol particles inadvertently flowed into the lacrimal artery through an anastomotic artery,resulting in diplopia due to impaired abduction of the left eye.The diplopia resolved by postoperative day 40.The patient’s headache resolved by postoperative day 7,and the hematoma completely resolved by postoperative day 108.CONCLUSION Potential anastomotic arteries in the middle meningeal artery(MMA)can lead to serious complications.Superselective angiography of the MMA or its branches prior to embolization is essential.Performing embolization distal to potential anastomotic sites can reduce risks,and the presence of an anastomosis may warrant coil embolization or termination of the procedure.展开更多
AIM:To develop different machine learning models to train and test diplopia images and data generated by the computerized diplopia test.METHODS:Diplopia images and data generated by computerized diplopia tests,along w...AIM:To develop different machine learning models to train and test diplopia images and data generated by the computerized diplopia test.METHODS:Diplopia images and data generated by computerized diplopia tests,along with patient medical records,were retrospectively collected from 3244 cases.Diagnostic models were constructed using logistic regression(LR),decision tree(DT),support vector machine(SVM),extreme gradient boosting(XGBoost),and deep learning(DL)algorithms.A total of 2757 diplopia images were randomly selected as training data,while the test dataset contained 487 diplopia images.The optimal diagnostic model was evaluated using test set accuracy,confusion matrix,and precision-recall curve(P-R curve).RESULTS:The test set accuracy of the LR,SVM,DT,XGBoost,DL(64 categories),and DL(6 binary classifications)algorithms was 0.762,0.811,0.818,0.812,0.858 and 0.858,respectively.The accuracy in the training set was 0.785,0.815,0.998,0.965,0.968,and 0.967,respectively.The weighted precision of LR,SVM,DT,XGBoost,DL(64 categories),and DL(6 binary classifications)algorithms was 0.74,0.77,0.83,0.80,0.85,and 0.85,respectively;weighted recall was 0.76,0.81,0.82,0.81,0.86,and 0.86,respectively;weighted F1 score was 0.74,0.79,0.82,0.80,0.85,and 0.85,respectively.CONCLUSION:In this study,the 7 machine learning algorithms all achieve automatic diagnosis of extraocular muscle palsy.The DL(64 categories)and DL(6 binary classifications)algorithms have a significant advantage over other machine learning algorithms regarding diagnostic accuracy on the test set,with a high level of consistency with clinical diagnoses made by physicians.Therefore,it can be used as a reference for diagnosis.展开更多
AIM： To estimate the adult reference values for measured deviations by a computerized diplopia test and testify the validity.METHODS： Totally 391 participants were recruited and taken the computerized diplopia test....AIM： To estimate the adult reference values for measured deviations by a computerized diplopia test and testify the validity.METHODS： Totally 391 participants were recruited and taken the computerized diplopia test. The plots and amplitude of deviations were recorded. The differences in different gender, age and visual acuity groups were analyzed respectively. Of 30 subjects were enrolled to testify the interobserver reliability. Another 46 subjects（including 26 normal subjects and 20 patients） were taken the test and theirs deviations were recorded to testify the validity of the reference value.RESULTS： The max horizontal and vertical deviations were 2.55° and 0.76° with normal corrected visual acuity while 3.88° and 1.46° for subjects with poor corrected vision. The differences between age groups was insignificant（Z =3.615, 4.758; P =0.461, 0.313 for horizontal and vertical respectively）. The max horizontal deviation of female was smaller than male（Z =-2.177; P =0.029）,but the difference in max vertical deviation was insignificant（Z =-1.296; P =0.195）. The mean difference between observers were both-0.1°, with 95% confidence limits（CI） of-1.4° and 1.6° in max horizontal deviations while-2.1° and 1.8° in max vertical deviation. The mean deviation of 26 normal subjects was 1.02° ±0.84° for horizontal and 0.47° ±0.30° for vertical which both within the range of reference values. The mean deviation of 20 patients was 13.51°±11.69° for horizontal and 8.34°±8.58°for vertical which both beyond the reference range.CONCLUSION： The max amplitude of horizontal and vertical deviation is pointed as the numerical parameters of computerized diplopia test. The reference values are different between normal corrected visual acuity and poor corrected vision. These values may useful for evaluating patients with diplopia in veriety conditions during clinical practice.展开更多
Different antiepileptic drugs(AEDs) may cause similar adverse effects,one of which is diplopia.However,the AEDs causing diplopia and the dose-response effect of each drug remains uncertain.In this study,we compared se...Different antiepileptic drugs(AEDs) may cause similar adverse effects,one of which is diplopia.However,the AEDs causing diplopia and the dose-response effect of each drug remains uncertain.In this study,we compared several second-generation AEDs to find out whether they would contribute to the risk of diplopia and their effect-causing dose.A meta-analysis was performed on 19 studies in agreement with our inclusion criteria.The results showed that eight commonly used second-generation AEDs(gabapentin,levetiracetam,oxcarbazepine,lamotrigine,pregabalin,topiramate,vigabatrin and zonisamide) could cause diplopia.The reported odds ratios(ORs) ranged from 1.406 to 7.996.Ranking risks from the highest to the lowest ORs of the eight AEDs of any dose resulted in the following order:use of oxcarbazepine(7.996),levetiracetam(7.472),lamotrigine(5.258),vigabatrin(3.562),pregabalin(3.048),topiramate(2.660),gabapentin(1.966),zonisamide(1.406).Taking into account the ORs above,we can conclude that second-generation AEDs of any dose may cause diplopia.However,the levetiracetam-caused diplopia needs to be further studied according to the data(OR,7.472;95% confidence interval,0.375-148.772).These findings ask for better concerns about patients’ quality of life when giving antiepileptic treatments.展开更多
We introduce a new interpretation and quantitative method for computerized diplopia test. By comparing this new method to the Hess screen test, we validate its applicability among 304 patients with ocular motor nerve ...We introduce a new interpretation and quantitative method for computerized diplopia test. By comparing this new method to the Hess screen test, we validate its applicability among 304 patients with ocular motor nerve palsy. This new method shows great assistant value as the Hess screen test in making accurate diagnosis and quantitative evaluation the severity of diplopia. Furthermore, it is more convenient and suitable for daily clinical use.展开更多
Intracranial metastasis of liver cancer is rare,and diplopia as the first manifestation is even more rare.This article aims to introduce a patient with sudden diplopia in a middle-aged man.Physical examination reveale...Intracranial metastasis of liver cancer is rare,and diplopia as the first manifestation is even more rare.This article aims to introduce a patient with sudden diplopia in a middle-aged man.Physical examination revealed left abductor nerve palsy,craniocerebral magnetic resonance imaging(MRI)showed intracranial metastatic tumor,and positron emission tomography-computer tomography(PET-CT)tracing of the original lesion detected the primary liver cancer.This paper provides clinical data for intracranial metastasis of primary liver cancer and the possible pathogenesis and mechanism of sudden diplopia.展开更多
Purpose: To investigate the effect of diplopia on the daily life of patients after strabismus surgery and to explore appropriate nursing care measures.Methods:.A total of 200 patients who developed postoperative diplo...Purpose: To investigate the effect of diplopia on the daily life of patients after strabismus surgery and to explore appropriate nursing care measures.Methods:.A total of 200 patients who developed postoperative diplopia underwent telephone follow-up to evaluate the influence of diplopia on their daily lives..SPSS 19.0 statistical software was utilized for data analysis.Results: Postoperative diplopia affected patients' physical activity(49%), attention(39.2%), work and study(24.5%),emotions.(19.5%),.and housework performance.(17%),whereas it did not influence the quality of sleep. Potential risk factors associated with diplopia, such as duration of diplopia,gender, and age, were analyzed by uni- and multivariate regression analysis. Quality of life was significantly and negatively correlated with the duration of diplopia, but not correlated with gender or age.Conclusion:.Postoperative diplopia affects the quality of life in partial patients..The nursing staff should provide nursing care, health education, and explicit instructions to the patients after discharge. In addition, nursing care should be sustained by subsequent telephone follow-up.展开更多
Chronic subdural hematoma is essentially managed by surgical intervention.In recent times,middle meningeal artery embolisation has emerged as a less invasive procedure in such cases.The use of fine catheters to select...Chronic subdural hematoma is essentially managed by surgical intervention.In recent times,middle meningeal artery embolisation has emerged as a less invasive procedure in such cases.The use of fine catheters to selectively embolise the specific involved branches of the middle meningeal artery using polyvinyl alcohol particles looks promising;however,the presence of anastomotic arteries can result in reflux and embolisation of these atypical branches,causing a myriad of complications.There is a need to identify these abnormal vessels in time to have a positive outcome with the least complications.展开更多
While secondary solid cancer into the eye orbit is rare,it is the most common site for primary metastasis in female breast cancer.We report a case of a sixty-six years old woman presenting to her optician with complai...While secondary solid cancer into the eye orbit is rare,it is the most common site for primary metastasis in female breast cancer.We report a case of a sixty-six years old woman presenting to her optician with complaints of double vision.Magnetic resonance imaging revealed an invasive lesion in the superior and medial rectus muscles of the right orbit,biopsy of which confirmed this as an infiltrating breast carcinoma.Investigation of the primary lesion showed an advanced invasive ductal carcinoma of the right breast.She was then treated with radiotherapy to the orbit and a non steroidal aromatase inhibitor Anastrozol(Arimidex®).We herein review and discuss the literature,epidemiology,mechanism of tumor spread,the“seed and soil”theory,clinical presentation,pathology,and management of this uncommon presentation.展开更多
文摘BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on patient presentation.Due to its low recurrence rate and minimal complications,MMAE has gained increasing acceptance among clinicians in recent years.This report presents a case of diplopia following MMAE due to the presence of a potential anastomotic artery,aiming to enhance awareness of this complication.CASE SUMMARY A 60-year-old male patient presented with a headache following head trauma,and cranial computed tomography revealed a left-sided CSDH.The patient underwent left MMAE;however,polyvinyl alcohol particles inadvertently flowed into the lacrimal artery through an anastomotic artery,resulting in diplopia due to impaired abduction of the left eye.The diplopia resolved by postoperative day 40.The patient’s headache resolved by postoperative day 7,and the hematoma completely resolved by postoperative day 108.CONCLUSION Potential anastomotic arteries in the middle meningeal artery(MMA)can lead to serious complications.Superselective angiography of the MMA or its branches prior to embolization is essential.Performing embolization distal to potential anastomotic sites can reduce risks,and the presence of an anastomosis may warrant coil embolization or termination of the procedure.
基金Supported by National Natural Science Foundation of China(No.82074524)Harbin Medical University Graduate Research and Practice Innovation Project(No.YJSCX2023-50HYD).
文摘AIM:To develop different machine learning models to train and test diplopia images and data generated by the computerized diplopia test.METHODS:Diplopia images and data generated by computerized diplopia tests,along with patient medical records,were retrospectively collected from 3244 cases.Diagnostic models were constructed using logistic regression(LR),decision tree(DT),support vector machine(SVM),extreme gradient boosting(XGBoost),and deep learning(DL)algorithms.A total of 2757 diplopia images were randomly selected as training data,while the test dataset contained 487 diplopia images.The optimal diagnostic model was evaluated using test set accuracy,confusion matrix,and precision-recall curve(P-R curve).RESULTS:The test set accuracy of the LR,SVM,DT,XGBoost,DL(64 categories),and DL(6 binary classifications)algorithms was 0.762,0.811,0.818,0.812,0.858 and 0.858,respectively.The accuracy in the training set was 0.785,0.815,0.998,0.965,0.968,and 0.967,respectively.The weighted precision of LR,SVM,DT,XGBoost,DL(64 categories),and DL(6 binary classifications)algorithms was 0.74,0.77,0.83,0.80,0.85,and 0.85,respectively;weighted recall was 0.76,0.81,0.82,0.81,0.86,and 0.86,respectively;weighted F1 score was 0.74,0.79,0.82,0.80,0.85,and 0.85,respectively.CONCLUSION:In this study,the 7 machine learning algorithms all achieve automatic diagnosis of extraocular muscle palsy.The DL(64 categories)and DL(6 binary classifications)algorithms have a significant advantage over other machine learning algorithms regarding diagnostic accuracy on the test set,with a high level of consistency with clinical diagnoses made by physicians.Therefore,it can be used as a reference for diagnosis.
基金Supported by Natural Science Foundation of China(No.81674052)Key Project of Natural Science Foundation of Heilongjiang Province(No.ZD201211)Project of innovational scientific research of Harbin Medical University(N0.2016LCZX49)
文摘AIM： To estimate the adult reference values for measured deviations by a computerized diplopia test and testify the validity.METHODS： Totally 391 participants were recruited and taken the computerized diplopia test. The plots and amplitude of deviations were recorded. The differences in different gender, age and visual acuity groups were analyzed respectively. Of 30 subjects were enrolled to testify the interobserver reliability. Another 46 subjects（including 26 normal subjects and 20 patients） were taken the test and theirs deviations were recorded to testify the validity of the reference value.RESULTS： The max horizontal and vertical deviations were 2.55° and 0.76° with normal corrected visual acuity while 3.88° and 1.46° for subjects with poor corrected vision. The differences between age groups was insignificant（Z =3.615, 4.758; P =0.461, 0.313 for horizontal and vertical respectively）. The max horizontal deviation of female was smaller than male（Z =-2.177; P =0.029）,but the difference in max vertical deviation was insignificant（Z =-1.296; P =0.195）. The mean difference between observers were both-0.1°, with 95% confidence limits（CI） of-1.4° and 1.6° in max horizontal deviations while-2.1° and 1.8° in max vertical deviation. The mean deviation of 26 normal subjects was 1.02° ±0.84° for horizontal and 0.47° ±0.30° for vertical which both within the range of reference values. The mean deviation of 20 patients was 13.51°±11.69° for horizontal and 8.34°±8.58°for vertical which both beyond the reference range.CONCLUSION： The max amplitude of horizontal and vertical deviation is pointed as the numerical parameters of computerized diplopia test. The reference values are different between normal corrected visual acuity and poor corrected vision. These values may useful for evaluating patients with diplopia in veriety conditions during clinical practice.
基金supported by grants from the National Natural Science Foundation of China (No. 30700244 and 81170022)
文摘Different antiepileptic drugs(AEDs) may cause similar adverse effects,one of which is diplopia.However,the AEDs causing diplopia and the dose-response effect of each drug remains uncertain.In this study,we compared several second-generation AEDs to find out whether they would contribute to the risk of diplopia and their effect-causing dose.A meta-analysis was performed on 19 studies in agreement with our inclusion criteria.The results showed that eight commonly used second-generation AEDs(gabapentin,levetiracetam,oxcarbazepine,lamotrigine,pregabalin,topiramate,vigabatrin and zonisamide) could cause diplopia.The reported odds ratios(ORs) ranged from 1.406 to 7.996.Ranking risks from the highest to the lowest ORs of the eight AEDs of any dose resulted in the following order:use of oxcarbazepine(7.996),levetiracetam(7.472),lamotrigine(5.258),vigabatrin(3.562),pregabalin(3.048),topiramate(2.660),gabapentin(1.966),zonisamide(1.406).Taking into account the ORs above,we can conclude that second-generation AEDs of any dose may cause diplopia.However,the levetiracetam-caused diplopia needs to be further studied according to the data(OR,7.472;95% confidence interval,0.375-148.772).These findings ask for better concerns about patients’ quality of life when giving antiepileptic treatments.
文摘We introduce a new interpretation and quantitative method for computerized diplopia test. By comparing this new method to the Hess screen test, we validate its applicability among 304 patients with ocular motor nerve palsy. This new method shows great assistant value as the Hess screen test in making accurate diagnosis and quantitative evaluation the severity of diplopia. Furthermore, it is more convenient and suitable for daily clinical use.
文摘Intracranial metastasis of liver cancer is rare,and diplopia as the first manifestation is even more rare.This article aims to introduce a patient with sudden diplopia in a middle-aged man.Physical examination revealed left abductor nerve palsy,craniocerebral magnetic resonance imaging(MRI)showed intracranial metastatic tumor,and positron emission tomography-computer tomography(PET-CT)tracing of the original lesion detected the primary liver cancer.This paper provides clinical data for intracranial metastasis of primary liver cancer and the possible pathogenesis and mechanism of sudden diplopia.
文摘Purpose: To investigate the effect of diplopia on the daily life of patients after strabismus surgery and to explore appropriate nursing care measures.Methods:.A total of 200 patients who developed postoperative diplopia underwent telephone follow-up to evaluate the influence of diplopia on their daily lives..SPSS 19.0 statistical software was utilized for data analysis.Results: Postoperative diplopia affected patients' physical activity(49%), attention(39.2%), work and study(24.5%),emotions.(19.5%),.and housework performance.(17%),whereas it did not influence the quality of sleep. Potential risk factors associated with diplopia, such as duration of diplopia,gender, and age, were analyzed by uni- and multivariate regression analysis. Quality of life was significantly and negatively correlated with the duration of diplopia, but not correlated with gender or age.Conclusion:.Postoperative diplopia affects the quality of life in partial patients..The nursing staff should provide nursing care, health education, and explicit instructions to the patients after discharge. In addition, nursing care should be sustained by subsequent telephone follow-up.
文摘Chronic subdural hematoma is essentially managed by surgical intervention.In recent times,middle meningeal artery embolisation has emerged as a less invasive procedure in such cases.The use of fine catheters to selectively embolise the specific involved branches of the middle meningeal artery using polyvinyl alcohol particles looks promising;however,the presence of anastomotic arteries can result in reflux and embolisation of these atypical branches,causing a myriad of complications.There is a need to identify these abnormal vessels in time to have a positive outcome with the least complications.
文摘While secondary solid cancer into the eye orbit is rare,it is the most common site for primary metastasis in female breast cancer.We report a case of a sixty-six years old woman presenting to her optician with complaints of double vision.Magnetic resonance imaging revealed an invasive lesion in the superior and medial rectus muscles of the right orbit,biopsy of which confirmed this as an infiltrating breast carcinoma.Investigation of the primary lesion showed an advanced invasive ductal carcinoma of the right breast.She was then treated with radiotherapy to the orbit and a non steroidal aromatase inhibitor Anastrozol(Arimidex®).We herein review and discuss the literature,epidemiology,mechanism of tumor spread,the“seed and soil”theory,clinical presentation,pathology,and management of this uncommon presentation.
