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Introduction: The use of YouTube® has spread among patients with chronic diseases such as multiple sclerosis (MS). These patients consult the available videos to learn more about their disease in terms of diagnosis and making decisions about treatments, including rehabilitation. The aim of this study was to evaluate the content, educational value, and quality analysis of MS videos about neurorehabilitation on YouTube® using quantitative instruments., Materials and Methods: A search was conducted on YouTube®. The first 30 videos that met the inclusion criteria were reviewed. The videos were classified according to the upload source and the content. All videos included in the review were assessed by the DISCERN questionnaire, the JAMA benchmark, the global quality scale (GQS) and the video information and quality index (VIQI)., Results: The mean scores were: 28.3 (±9.33) in DISCERN, 2 (±0.81) in JAMA, 2.57 (±1.22) in GQS, and 11.73 (±4.06) in VIQI. JAMA score statistically significantly differed according to upload source (p = 0.002), video content (p = 0.023) and the speaker (p = 0.002). The DISCERN, JAMA, GQS, and VIQI scores showed significant correlations with each other., Conclusions: The analyzed videos about neurorehabilitation in people with MS on YouTube® were quite old since the upload, with a moderate duration and number of views, but with a poor quality of the content, educational value, and quality analysis of the videos. Our research showed that there were statistically significant differences in terms of quality, transparency, and reliability of the information, depending on the upload source, video content and the speaker.

We present a co-axial acoustic-based optical coherence vibrometry probe (CoA-OCV) for vibro-acoustic resonance quantification in biological tissues. Sample vibrations were stimulated via a loudspeaker, and pre-compensation was used to calibrate the acoustic spectrum. Sample vibrations were measured via phase-sensitive swept-source optical coherence tomography (OCT). Resonance frequencies of corneal phantoms were measured at varying intraocular pressures (IOP), and dependencies on Young´s Modulus (E), phantom thickness and IOP were observed. Cycling IOP revealed hysteresis. For E = 0.3 MPa, resonance frequencies increased with IOP at a rate of 3.9, 3.7 and 3.5 Hz/mmHg for varied thicknesses and 1.7, 2.5 and 2.8 Hz/mmHg for E = 0.16 MPa. Resonance frequencies increased with thickness at a rate of 0.25 Hz/µm for E = 0.3 MPa, and 0.40 Hz/µm for E = 0.16 MPa. E showed the most predominant impact in the shift of the resonance frequencies. Full width at half maximum (FWHM) of the resonance modes increased with increasing thickness and decreased with increasing E. Only thickness and E contributed to the variance of FWHM. In rabbit corneas, resonance frequencies of 360-460 Hz were observed. The results of the current study demonstrate the feasibility of CoA-OCV for use in future OCT-V studies., (© 2022. The Author(s).)

We present the case of a 64-year-old woman from Romania with a medical history of obstructive sleep apnea-hypopnea syndrome, hepatic cirrhosis, COPD, and osteoarthritis. She smokes one pack of cigarettes per day. The patient is referred from the pulmonology department for an outpatient evaluation for an incidental finding of bilateral adrenal adenomas and progressive weight gain over the last five years. Cushing syndrome is detected during study of the adrenal adenomas and obesity. It is important to study recent-onset obesity in multimorbid patients as there could be other secondary causes in addition to the underlying diseases they present with. During the presentation of this clinical case, an essential, practical approach to the adrenal pathology is made., (Copyright © 2022 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Introduction: intravenous (IV) tranexamic acid (TXA) has shown its usefulness to prevent postsurgical anemia, but few studies have analyzed its topical administration. Seven years ago, we implemented a new topical administration (moistening three gauzes with 1.5 g of TXA) in our primary total hip arthroplasties (THA). The objective of this study was to compare blood loss, hospital stay and complications without the use of TXA, topical use or 10 mg/kg IV plus topical., Material and Methods: consecutive retrospective series of 274 patients undergoing CTA (mean 70 years [59-76], 59% women) operated from 2014 to 2019. Loss of hemoglobin and hematocrit, blood transfusions, hospital stay, thromboembolic complications were compared and 30-day mortality among three groups: non-tranexamic (44.2%), topical (45.6%), topical + IV (9.9%)., Results: after 24 and 48 hours, hemoglobin and hematocrit decreased less (p < 0.05) in patients treated with TXA (topical and/or IV). Blood transfusion was required in 32% of patients without TXA, 12% of those treated with topical TXA only (RR = 3.24 [95% CI: 1.69-6.20]), and 0% of patients who received IV TXA (p = 0.005) (RR = 4.07 [95% CI: 2.14-7.48]). Hospital stay was reduced three days with TXA (p < 0.001). We have not observed any adverse effects related to TXA., Conclusions: the use of TXA in CTA significantly reduces anemia, transfusions and hospital stay without increasing complications. Isolated topical TXA (hemostatic pads) is less effective than topical IV + topical use, but both significantly improve anemia, transfusions, and hospital stay compared to no use.

Influenza virus-associated encephalopathy/encephalitis is a rare entity in adults that can lead to severe neurological sequelae and even death. The clinical presentation can be quite diverse. This absence of a typical presentation along with the difficulty detecting the virus in the cerebrospinal fluid represents a diagnostic challenge. We present the case of a 79-year-old male with sudden onset of decreased consciousness and signs of right hemisphere damage. The presence of influenza A (H3N2) virus in respiratory sample along with compatible findings in cranial magnetic resonance led to the diagnosis. The patient died without responding to treatment with antivirals and immunomodulators and the anatomopathological study did not detect infectious agent. Early diagnostic suspicion is essential to establish adequate treatment and improve the prognosis., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Alzheimer's disease (AD) studies on animal models, and humans showed a tendency of the brain tissue to become hyperexcitable and hypersynchronized, causing neurodegeneration. However, we know little about either the onset of this phenomenon or its early effects on functional brain networks. We studied functional connectivity (FC) on 127 participants (92 middle-age relatives of AD patients and 35 age-matched nonrelatives) using magnetoencephalography. FC was estimated in the alpha band in areas known both for early amyloid accumulation and disrupted FC in MCI converters to AD. We found a frontoparietal network (anterior cingulate cortex, dorsal frontal, and precuneus) where relatives of AD patients showed hypersynchronization in high alpha (not modulated by APOE-ε4 genotype) in comparison to age-matched nonrelatives. These results represent the first evidence of neurophysiological events causing early network disruption in humans, opening a new perspective for intervention on the excitation/inhibition unbalance., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: To analyze the relation between cognitive impairment on arrival at hospital in patients older than 65 years with a hip fracture, and their mortality, medical and surgical complications, and functional outcomes., Patients and Methods: Observational study of a single-center prospective consecutive cohort of 955 patients older than 64 years diagnosed of hip fracture from December/2012 to December/2015. Average age was 86±7.2 (65-104) years and 725 (75.9%) were female. Fractures were extracapsular in 538 cases (56.3%) and intracapsular in 417 (43.7%). Patients were controlled clinically and radiographically in outpatient clinic after 1, 3, 6, and 12 months. Data about basal cognitive status, walking ability before the fracture, medical and surgical complications, functional outcomes and mortality were collected for the year following the fracture., Statistical Analysis: Bivariate analysis (Pearson, Fisher, Mann-Whitney, Wilcoxon) was applied to study statistically significant relations, and contingence coefficients (CC) were calculated., Results: Patients with cognitive impairment showed a higher overall mortality, (p = 0,000; CC=0,197) even after hospital discharge (p = 0.000; CC=0.198). Similarly, patients with dementia presented a higher rate of respiratory infections (p = 0,029; CC=0,093), urinary tract infections (p = 0,008; CC=0,108) and sepsis (p = 0,011; CC=0,105). On the contrary, we found no correlations between mental status and surgical complications, even for prosthesis dislocation (p = 0.136). Patients with dementia started from poorer functional situations (p = 0,000; CC=0,367) and ended follow-up with lower walking ability (p = 0,000; CC=0,43), but cognitive impairment did not relate statistically with a worse functional recovery (p = 0,304): that is, the proportion of patients who maintained their previous ability to walk was similar in both groups, those with altered mental status and those without it., Conclusions: Cognitive impairment is a risk factor for mortality in patients with a hip fracture. It is also a risk factor for suffering respiratory and urinary tract infection and sepsis. These two late risks factors have not been published previously. Functional recovery is not conditioned by cognitive impairment, although further studies need to be developed to evaluate the actual role of cognitive impairment on postoperative progression of patients., Competing Interests: Declaration of Competing Interest None, (Copyright © 2020. Published by Elsevier Ltd.)

Introduction: Gleason score biopsy undergrading (GSBU) can have an impact on the management and prognosis of patients with prostate cancer. We analyze the possible impact of time and other clinical and analytical factors in the appearance of GSBU in our series., Patients and Method: Ambispective, multicenter study of 1955 patients with localized prostate cancer undergoing radical prostatectomy between 2005 and 2018. Descriptive statistics and hypothesis testing are reported by univariate and multivariate analyses., Results: Mean age 63.69 (44-80) years, median PSA 8.70 ng / ml (1.23-99). GSBU was observed in 34.7% of the entire cohort. In 72.8% of the cases, the GSBU occurred in one consecutive Gleason score, with the progression from 3 + 3 to 3 + 4 being the most frequent (289 patients, 47.6%). Performing radical prostatectomy 90-180 days before or after the biopsy does not have an impact on its undergrading in any of the groups. In the univariate and multivariate analysis, the presence of tumor or pathological rectal examination in both lobes, the tumor load ≥50% of cylinders and a DPSA ≥0.20, showed independent discriminative capacity to select patients who presented GSBU., Conclusions: The time from biopsy to radical prostatectomy did not show impact on GSBU. The number of affected cylinders, bilateral tumor and DPSA are easily accessible parameters that can help us select patients with greater probability of presenting GSBU., (Copyright © 2019 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Although Kounis syndrome was described almost 3 decades ago, there has been a notable increase in the reports of cases of acute coronary syndromes developed in the context of allergic reactions, also known as Kounis syndrome. This article discusses the diagnostic possibility in the face of an acute biventricular failure in the course of an anaphylactic reaction during the intra-operative period of a cardiac valve surgery., (Copyright © 2018 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

We compared measured wave aberrations in pseudophakic eyes implanted with aspheric intraocular lenses (IOLs) with simulated aberrations from numerical ray tracing on customized computer eye models, built using quantitative 3-D OCT-based patient-specific ocular geometry. Experimental and simulated aberrations show high correlation (R = 0.93; p<0.0001) and similarity (RMS for high order aberrations discrepancies within 23.58%). This study shows that full OCT-based pseudophakic custom computer eye models allow understanding the relative contribution of optical geometrical and surgically-related factors to image quality, and are an excellent tool for characterizing and improving cataract surgery.

Arsenic is a highly toxic element that pollutes groundwater, being a major environmental problem worldwide, especially in the Bengal Basin. About 40% of patients in our outpatient clinics come from those countries, and there is no published data about their arsenic exposure. This study compares arsenic exposure between immigrant and native children. A total of 114 children (57 natives, 57 immigrants), aged 2 months to 16 years, were recruited and sociodemographic and environmental exposure data were recorded. Total arsenic in urine, hair, and nails and arsenic-speciated compounds in urine were determined. We did not find significant differences in total and inorganic arsenic levels in urine and hair, but in organic arsenic monomethylarsenic acid (MMA) and dimethylarsinous acid (DMA) in urine and in total arsenic in nails. However, these values were not in the toxic range. There were significant differences between longer than 5 years exposure and less than 5 years exposure (consumption of water from tube wells), with respect to inorganic and organic MMA arsenic in urine and total arsenic in nails. There was partial correlation between the duration of exposure and inorganic arsenic levels in urine. Immigrant children have higher arsenic levels than native children, but they are not toxic. At present, there is no need for specific arsenic screening or follow-up in immigrant children recently arrived in Spain from exposure high-risk countries.

PURPOSE: To reconstruct the gradient index (GRIN) profile of human crystalline lenses ex-vivo using Optical Coherence Tomography (OCT) imaging with an optimization technique and to study the dependence of the GRIN profile with age. METHODS: Cross-sectional images of nine isolated human crystalline lenses with ages ranging from 6 to 72 (post mortem time 1 to 4 days) were obtained using a custom-made OCT system. Lenses were extracted from whole cadaver globes and placed in a measurement chamber filled with preservation medium (DMEM). Lenses were imaged with the anterior surface up and then flipped over and imaged again, to obtain posterior lens surface profiles both undistorted and distorted by the refraction through the anterior crystalline lens and GRIN. The GRIN distribution of the lens was described with three variables by means of power function, with variables being the nucleus and surface index, and a power coefficient that describes the decay of the refractive index from the nucleus to the surface. An optimization method was used to search for the parameters that produced the best match of the distorted posterior surface. RESULTS: The distorted surface was simulated with accuracy around the resolution of the OCT system (under 15 µm). The reconstructed refractive index values ranged from 1.356 to 1.388 for the surface, and from 1.396 to 1.434 for the nucleus. The power coefficient ranged between 3 and 18. The power coefficient increased significantly with age, at a rate of 0.24 per year. CONCLUSION: Optical Coherence Tomography allowed optical, non-invasive measurement of the 2-D gradient index profile of the isolated human crystalline lens ex vivo. The age-dependent variation of the changes is consistent with previous data using magnetic resonance imaging, and the progressive formation of a refractive index plateau.

Introduction: Nutritional problems develop complications in geriatric patients and increase their morbidity and mortality. Hyperproteic nutritional supplements are one of the options to improve nutritional deficiencies., Objectives: To assess the beneficial effect and tolerance of one hyperproteic nutritional supplement (Ensure Plus High Protein, Abbott Laboratories, S.A.) in malnourished subjects over 65 years., Methods: Observational, prospective, open, multicenter study. We included malnourished subjects over 65 years living in nursing homes located in Spain. Malnutrition was considered as GNRI score < 92 or BMI < 19. Before inclusion, we obtained signed informed consent of patients or their relatives. All participants received Ensure Plus High Protein for 8 weeks. The primary endpoints were changes observed in weight, BMI and GNRI., Results: We analyzed 255 evaluable patients valid for intention-to-treat (ITT) analysis and 243 for the per-protocol (PP) analysis; 69% (n = 172) were female and 31% (n = 77) male. The average protein amount administered was 51 g/day. At the end of the study, statistically significant differences (p < 0.001) were found in weight, BMI and GNRI when compared to baseline, both in the ITT and the PP analysis. The average weight increase was (mean +/- SE) 2.86 +/- 0.13 kg for PP analysis; 80% of participants (n = 202) achieved a weight gain > 1 kg and 96 patients (39.5% PP analysis) had a weight gain > 7%., Conclusions: The addition of a hyperproteic oral nutritional supplement contributes positively in improving the nutritional status of our study malnourished geriatric patients in terms of significant increase in body weight, BMI and GNRI.

Aim: To assess the efficacy and tolerability of Helicobacter pylori first-line treatment (omeprazole-clarithromycin-metronidazole) and second-line rescue option (omeprazole-clarithromycin-levofloxacin) in patients allergic to penicillin., Patients: Prospective multicenter study including consecutive patients allergic to penicillin. Therapy regimens: First-line treatment (50 patients): Omeprazole (20mg b.i.d.), clarithromycin (500 mg b.i.d.) and metronidazole (500 mg b.i.d.) for 7 days. Second-line treatment (15 therapy failures out of the aforementioned 50 patients): Omeprazole (20mg b.i.d.), clarithromycin (500 mg b.i.d.) and levofloxacin (500 mg b.i.d.) for 10 days., Outcome Variable: Negative (13)C-urea breath test 8 weeks after completion of treatment., Results: (1) First-line treatment (omeprazole-clarithromycin-metronidazole): Per-protocol and intention-to-treat eradication rates were 55% (27/49; 95%CI=40-70%) and 54% (27/50; 95%CI=39-69%). Compliance with treatment and follow-up was complete in 98% of cases (one patient was not compliant due to nausea). Adverse events were reported in 5 patients (10%): 4 nausea, 1 diarrhoea. (2) Second-line treatment (omeprazole-clarithromycin-levofloxacin): Per-protocol and intention-to-treat eradication rates were both 73% (11/15; 95%CI=45-92%). Compliance with treatment and follow-up was complete in all the cases. Adverse events were reported in 4 patients (20%), which did not prevent the completion of treatment: Mild nausea (2 patients), and vomiting and myalgias/arthralgias (1 patient)., Conclusion: In H. pylori infected patients allergic to penicillin, the generally recommended first-line treatment with omeprazole, clarithromycin and metronidazole has low efficacy for curing the infection. On the other hand, a levofloxacin-containing regimen (together with omeprazole and clarithromycin) represents an encouraging second-line alternative in the presence of penicillin allergy., (Copyright (c) 2009 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Introduction: After the implantation of an intracardiac device for the closure of an atrial septal defect, most centres follow the guidelines for antibiotic prophylaxis to reduce the risk of infectious endocarditis, at least during the first 6 months after the implantation, if there is no evidence of residual shunt. The aim of this report is to evaluate the knowledge, fulfillment and adherence to the recommendations of our centre on the prevention of endocarditis, of the families of patients subjected to percutaneous closure of an ASD., Patients and Methods: We performed an observational retrospective study of 51 paediatric patients subjected to percutaneous closure of an ASD in the "Complejo Hospitalario Universitario de La Coruña", between 1999 and 2008., Results: A total of 51 procedures were performed, with an average of follow-up of 57.2 months. 75.7% of the families knew about the prophylaxis of endocarditis. This percentage was higher if less time had passed since the intervention and was also higher depending on the educational level of the parents. A total of 50% never stopped carrying out the endocarditis prophylaxis. In this case, a relationship was also observed, with the educational level of the parents and with the time passed since the intervention (P=0.004). The majority (73%) of the patients never had to carry out endocarditis prophylaxis., Conclusions: The latest guidelines on antibiotic prophylaxis of endocarditis are increasingly restrictive in their indications in order to promote a more rational use of antibiotics. More studies are needed on the indications of antibiotic prophylaxis in endocarditis in patients with an intracardiac device, in order to establish concrete or evidence-based guidelines. Meanwhile, it is our responsibility to avoid the indiscriminate application of antibiotics, and involve the families and other health professionals.

Background: Several 'rescue' therapies have been recommended to eradicate Helicobacter pylori, but they still fail in >20% of the cases, and these patients constitute a therapeutic dilemma., Aim: To evaluate the efficacy of different 'rescue' therapies empirically prescribed during 10 years to 500 patients in whom at least one eradication regimen had failed to cure H. pylori infection., Design: Prospective single-centre study., Patients: Consecutive patients in whom at least one eradication regimen had failed., Intervention: Rescue regimens included: (i) quadruple therapy with omeprazole-bismuth-tetracycline-metronidazole; (ii) ranitidine bismuth citrate-tetracycline-metronidazole; (iii) omeprazole-amoxicillin-levofloxacin; and (iv) omeprazole-amoxicillin-rifabutin. Antibiotic susceptibility was unknown (rescue regimens were chosen empirically)., Outcome: Eradication was defined as a negative (13)C-urea breath test 4-8 weeks after completing therapy., Results: Five hundred patients were included (76% functional dyspepsia, 24% peptic ulcer). Compliance rates with first-, second- and third-line regimens were 92%, 92%, and 95%, respectively. Adverse effects were reported by 30%, 37%, and 55% of the patients receiving second-, third-, and fourth-line regimens. Overall, H. pylori cure rates with the second-, third-, and fourth-line rescue regimens were 70%, 74%, and 76%, respectively. Cumulative H. pylori eradication rate with four successive treatments was 99.5%., Conclusion: It is possible to construct an overall treatment strategy to maximize H. pylori eradication, on the basis of administration of four consecutive empirical regimens; thus, performing bacterial culture even after a second or third eradication failure may not be necessary.

We studied the potential of myopic corneal refractive laser surgery to induce myopia (axial elongation) and potential interactions between aberrations (generally resulting from the procedure) and myopia development in chicks (Gallus domesticus). Ten white Leghorn chicks were monolaterally treated one day post-hatching with photorefractive keratectomy (PRK), with a nominal dioptric change of -9.9 D (imposed hyperopia). Axial length was measured using an adapted ultrasonic biometer; corneal radius of curvature was measured using a custom-built videokeratometer and spherical error and high order aberrations were measured using custom-built Hartmann-Shack aberrometer post-operatively on days 9, 12, 14 and 16 after hatching. Two-weeks after surgery, there were no significant differences in corneal radius of curvature between treated and control eyes. Astigmatism increased on average by a factor of 2.6 and 3rd and higher order aberrations by a factor of 4.3 after PRK. Both treated and control eyes were close to emmetropia, and no axial elongation was found in the treated eyes. The inability of the refractive procedure to achieve significant reductions in the corneal power could be attributed to the biomechanical properties of the chick eye. High order aberrations induced significant contrast decrease (by a factor of 1.7 at 4.5c/deg). However, reduced image quality neither produced myopic refractive error nor axial elongation in the treated eyes. Both normal and treated eyes emmetropized, indicating that increased amounts of aberrations do not appear to be a risk factor for myopia.

We compared experimental wave aberrations in pseudophakic eyes with aspheric intraocular lenses (IOLs) to simulate aberrations from numerical ray tracing on customized computer eye models using corneal topography, angle lambda, ocular biometry, IOL geometry, and IOL tilt and decentration measured on the same eyes. We found high correlations between real and simulated aberrations even for the eye with only the cornea, and these increased on average when the IOL geometry and position were included. Relevant individual aberrations were well predicted by the complete eye model. Corneal spherical aberration and horizontal coma were compensated by the IOL, and in 58.3% of the cases IOL tilt and decentration contributed to compensation of horizontal coma. We conclude that customized computer eye models are a good representation of real eyes with IOLs and allow understanding of the relative contribution of optical, geometrical and surgically-related factors to image quality. Corneal spherical aberration is reduced by aspheric IOLs, although other corneal high order aberrations are still a major contributor to total aberrations in pseudophakic eyes. Tilt and decentration of the IOLs represent a relatively minor contribution of the overall optical quality of the eye.

Background: In patients with a first eradication failure, a second (rescue) therapy still fails in > 20% of cases., Aim: To compare rifabutin and levofloxacin rescue regimens in patients with two consecutive Helicobacter pylori eradication failures., Methods: Patients, in whom first treatment with omeprazole-clarithromycin-amoxicillin and a second trial with omeprazole-bismuth-tetracycline-metronidazole (or ranitidine bismuth citrate with these antibiotics) had failed, received 10 days of treatment with either rifabutin (150 mg b.d.) or levofloxacin (500 mg b.d.), plus amoxicillin (1 g b.d.) and omeprazole (20 mg b.d.). Cure rates were evaluated by the (13)C-urea breath test., Results: Twenty patients received rifabutin, and 20 levofloxacin. All the patients returned for follow-up. Compliance in the rifabutin group was 100%. Four patients in the levofloxacin group did not take the medication correctly (in two cases due to adverse effects: myalgia and rash). Side effects in the rifabutin and levofloxacin groups were reported in 60% and 50% of the cases, respectively. Five patients (25%) treated with rifabutin presented with leucopenia, and six (30%) treated with levofloxacin presented with myalgias. Per-protocol cure rates were 45% (95% confidence interval, 26-66%) in the rifabutin group, and 81% (57-93%) in the levofloxacin group (P < 0.05). Intention-to-treat cure rates were, 45% (26-66%) and 85% (64-95%), respectively (P < 0.01)., Conclusions: After two previous H. pylori eradication failures, a 10-day triple levofloxacin-based rescue regimen is more effective than the same regimen with rifabutin.

Wave aberrations degrade the optical quality of the eye relative to the diffraction limit, but there are situations in which having slightly aberrated optics can provide some relative visual benefits. This fact led us to consider whether interactions among aberrations in the eye's wavefront produce an advantage for image quality relative to wavefronts with randomized combinations of aberrations with the same total RMS error. Total ocular wave aberrations from two experimental groups and corneal wave aberrations from one group were measured and expressed as Zernike polynomial expansions through the seventh-order. In a series of Monte Carlo simulations, modulation transfer functions (MTFs) for the measured wave aberrations were compared to distributions of artificial MTFs for wavefronts created by randomizing the sign or orientation of the aberrations, while maintaining the RMS error within each Zernike order. In a control condition, "synthetic" model eyes were produced by choosing each individual aberration term at random from individuals in the experimental group, and again MTFs were compared for original and randomized signs. Results were summarized by the MTF ratio: real MTF/mean simulated MTF, as a function of spatial frequency. For a 6mm pupil, the mean MTF ratio for total ocular aberrations was greater than 1.0 up to 60 cycles per degree, suggesting that the eye's aberrations are not independent and that there may be a positive functional consequences to their interrelations. This positive relation did not hold for corneal aberrations alone, or for the synthetic eyes.

We performed measurements of refraction (with retinoscopy), axial length (with ultrasound biometry) and ocular aberrations (with a custom-built Hartmann-Shack aberrometer) on seven awake White-Leghorn chicks occluded monolaterally with diffusers for two weeks. Treatment started on the first day after hatching (day 0) and measurements were conducted on several days between day 0 and 13. Non-occluded eyes experienced normal emmetropization (decreasing hyperopia at 0.2 +/- 0.09 D/day and increasing axial length at 0.05 +/- 0.03 mm/day), while occluded eyes developed axial myopia (1.50 +/- 0.2 D/day and 0.12 +/- 0.02 mm/day). Interocular differences in refraction and axial length by day 13 were on average 17.43 D and 0.86 mm, respectively. Monochromatic high order aberrations decreased with age in both eyes. Average RMS (for 1.5 mm pupil diameter) decreased from 0.11 +/- 0.03 at day 0 to 0.06 +/- 0.03 microm (day 13) in occluded eyes, and from 0.12 +/- 0.05 to 0.03 +/- 0.01 microm in non-occluded eyes. MTF-based optical quality metrics also show an improvement with age. However, while this improvement occurs in both eyes, after day 8 myopic eyes tend to show significantly higher amounts of aberrations (and consequently worse best-corrected optical quality) than normal eyes. The degradation imposed by aberrations is small compared to that imposed by defocus and the diffuser. These results suggest a decrease of aberrations during development which does not seem to be visually guided. Myopic eyes showed slightly worse optical quality than normal eyes, suggesting that the geometrical changes resulting from excessive ocular axial growth also affect the optical quality of the ocular components.

This paper addresses the concept, measurement and applications of wave aberrations. The ocular optics is not perfect. Apart from conventional low order aberrations (such as defocus and astigmatism) retinal images are degraded by other high order aberrations. Aberrometers typically measure ray deviations at the retinal plane, as a function of pupil position, i.e. local derivatives of the wave aberration. The paper discusses state of the art technology to measure the aberrations of the eye (cornea and crystalline lens), both monochromatic and polychromatic. The aberrometers described include the Hartmann-Shack wavefront sensor, laser ray tracing, spatially resolved refractometer or the corneal aberrations. This technology has been used to advance our understanding on several visual mechanisms, ocular conditions, and corrective methods. Applications include accommodation, myopia, aging, myopia, keratoconus, corneal refractive surgery, cataract surgery or contact lenses.

Background: Helicobacter pylori eradication is a challenge in patients allergic to penicillin, especially those who have failed a first-eradication trial., Aim: To assess the efficacy and tolerability of H. pylori first-line treatment and rescue options in patients allergic to penicillin., Methods: Prospective single centre study including 40 consecutive treatments administered to patients allergic to penicillin. Therapy regimens: First-line (12 patients) omeprazole, clarithromycin and metronidazole for 7 days; second-line (17 patients) ranitidine bismuth citrate, tetracycline and metronidazole for 7 days; third-line (nine patients) rifabutin, clarithromycin and omeprazole for 10 days; and fourth-line (two patients) levofloxacin, clarithromycin and omeprazole for 10 days., Outcome Variable: a negative (13)C-urea breath test 8 weeks after completion of treatment., Results: Per-protocol/intention-to-treat eradication rates were: first-line (64/58%); second-line (ranitidine bismuth citrate; 53/47%); third-line (rifabutin; 17/11%) and fourth-line regimen (levofloxacin; 100/100%). Compliance with treatment was generally good, except with the rifabutin-based regimen, which presented adverse effects in 89% of the patients, including four cases of myelotoxicity., Conclusions: H. pylori-infected patients who are allergic to penicillin may be treated with a first-line treatment combining a proton-pump inhibitor, clarithromycin and metronidazole. Rescue options may include a regimen with ranitidine bismuth citrate, tetracycline and metronidazole. A levofloxacin-based rescue regimen (with proton-pump inhibitor and clarithromycin) may also represent an alternative, even when two or more consecutive eradication treatments have previously failed. However, rifabutin + clarithromycin + proton-pump inhibitor regimen is ineffective and poorly tolerated.

Ingestion of a foreign body containing lead in children carries the additional risk of acute lead poisoning secondary to dissolution and absorption of the ingested lead in the acid environment of the stomach. We report the case of a 3-year-old girl who ingested a lead sinker. The patient was asymptomatic but therapy with a proton pump inhibitor (omeprazole) was empirically started on admission and the foreign body was removed from the stomach by emergency endoscopy within 6 hours of ingestion. Despite the quick removal, blood lead levels (drawn 3 hours after ingestion) exceeded 40 .g/dl. The patient completely recovered and continues to do well after 1 year of follow-up. This case reveals that acute elevations of blood lead concentrations may occur rapidly after ingestion of lead foreign bodies. Even in the absence of symptoms, lead foreign body ingestion in children should prompt lead screening and initiation of appropriate treatment.

Introduction: Bacterial tracheitis is a cause of severe upper respiratory airway obstruction. It has been considered a rare entity whose clinical and epidemiological features are not well known., Patients and Methods: The medical records of children diagnosed with bacterial tracheitis and admitted to our pediatric intensive care unit (PICU) from June 1992 to May 2004 (12 years) were analyzed. The following variables were recorded: age, sex, personal history, need for endotracheal intubation, duration of intubation, isolated bacteria, antibiotic treatment, steroid administration, and length of stay in the PICU., Results: Twelve patients (six girls and six boys) were included in this study. Age ranged from 1 month to 13 years (median 24 months). Four children had a history of acute laryngotracheitis, one had Down syndrome and another had interauricular communication. All patients needed orotracheal intubation for 2 to 72 hours (median 48 hours). All patients received empirical antibiotic therapy: cephalosporins in 11 children (91 %) (in association with vancomycin or teicoplanin in four of them) and erythromycin in one (9 %). Corticosteroids were administered in nine patients (75 %). Bacterial pathogens were isolated from tracheal secretion culture in seven children (58 %) and the most common was Staphylococcus aureus (42 %). Three children (25 %) developed lobar pneumonia and one developed congestive cardiac insufficiency as a complication of bacterial tracheitis. In all patients, clinical outcome was satisfactory., Conclusions: Although the absolute frequency of bacterial tracheitis is low, in our environment this entity represents a considerable cause of severe upper respiratory airway obstruction secondary to an infectious process. Therefore, it should be considered in patients who present with stridor and fever. If the correct treatment is provided, the prognosis is generally good.

Background: Burnout syndrome (BS) is a chronic adaptation disorder that provokes serious problems in occupational behavior., Objective: In the present study we assessed the prevalence of burnout syndrome in pediatric healthcare workers., Design: Cross-sectional, descriptive study., Material and Methods: In November 2002, the Maslach Burnout Inventory was given to 127 staff members (doctors, nurses and nurse assistants) working in a pediatrics department. The questionnaire includes 22 items that explore three aspects of BS: a) emotional exhaustion; b) depersonalization, and c) personal achievement., Results: The questionnaire was completed by 93 staff members (73.2 % of the whole sample; 83 % women and 17 % men). The mean age was 38.6 +/- 10.2 years and the median number of years worked was 10 (range: 1-37 years). Twenty-nine percent were pediatricians, 50.5 % were nurses and 20.5 % were nurse assistants. A total of 20.8 % had a high level of BS, 19.8 % had a moderate level and 59.4 % showed a low level. When sub-scales were applied, the results showed that 67.7 % of respondents presented a low level of personal achievement, 14.5 % had high scores of emotional exhaustion and 23.9 % obtained high scores in the depersonalization scale., Conclusions: BS is present in a significant percentage of hospital workers attending pediatric patients. In our sample, the most notable component of BS was the lack of personal achievement. This finding alerted us to the eventual presence of negative attitudes toward self and professional activity, as well as to the loss of interest in pediatric care, low productivity and diminished self-esteem. We believe that specific strategies should be implemented to attenuate the factors influencing the development of BS in pediatric health staff.

Introduction: Tumours originating in the facial nerve are extremely rare and their therapeutic approach requires the aid of specialists from a number of disciplines., Aims: Our aim was to analyse the cases treated in our centre over a five-year period., Patients and Methods: All the subjects submitted to surgical interventions to treat facial nerve tumours between January 1992 and December 1996 were evaluated retrospectively. Data recorded from all patients included age, sex, side affected, time prior to diagnosis, presenting symptom and symptoms observed at the time of diagnosis, previous history of disorders affecting the facial nerve and associated neurological symptoms. We also noted the location of the lesion, the surgical technique used, pathology findings, post-operative complications, length of post-operative stay in hospital, facial sequelae and surgical repair procedures used on the facial nerves involved in the intervention., Results: Six cases, with a mean age of 29 years (range: 16-46 years), were treated. Three of the patients were males (50%). Symptoms of the disease included facial palsy (4), neurosensory hypoacusis (1) and tinnitus (1). All six individuals (100%) had alterations affecting facial functioning in the course of the disease. The pathological diagnosis was schwannoma in four cases and hemangioma in the other two. Neural grafts were carried out in three patients and some kind of deficit was observed at the end of the follow-up in all the cases., Conclusions: Facial nerve tumours are very infrequent. An early diagnosis is needed to diminish the facial sequelae following surgery performed to treat this clinical entity.

The ovine fatty acid-binding protein type 3 gene has been chosen as a functional candidate gene for milk traits. Two different single nucleotide polymorphisms (SNPs) of ovine FABP3 gene have been tested in a daughter design comprising 13 families. No association was found between estimated breeding values for milk yield, protein and fat contents (FC) and genotypes across families using anova and transmission disequilibrium test (TDT). In within-family analysis, one family showed a significant effect for FC. These results could indicate linkage disequilibrium between the FABP3 gene and a quantitative trait loci (QTL) for FC, with the heterozygous genotype associated with a positive effect in this trait.

On the basis of comparisons between cattle and sheep genome mapping information the ovine alpha-amylase gene was examined as a possible genetic marker for milk traits in sheep. The objective of the present study was to isolate, map and determine whether this gene is a candidate gene for milk traits. DNA fragments (832 and 2360 bp) corresponding to two different AMY genes were isolated, and one SNP in intron 3 and one GTG deletion in exon 3 of the 2360 bp DNA fragment were found. The 2360 bp ovine AMY DNA fragment was located on chromosome 1 by linkage mapping using the International Mapping Flock. No association was found between estimated breeding values for milk yield, protein and fat contents and AMY genotypes in a daughter design comprising 13 Manchega families with an average of 29 daughters (12-62) per sire.

Aim: Even with the current most effective Helicobacter pylori treatment regimens, approximately 20% of patients do not eradicate the infection. Several "rescue" therapies have been recommended, but they still fail to eradicate H. pylori in approximately 20-30% of the cases. Our aim was to evaluate the efficacy of different rescue therapies prescribed to patients in whom two consecutive H. pylori eradication regimens had failed., Methods: Design. Prospective single-centre study. Patients. Consecutive patients in whom two eradication regimens had failed to eradicate H. pylori. Intervention. Third eradication regimens included: (1) omeprazole-amoxicillin-clarithromycin for 7 days; (2) quadruple therapy with omeprazole-bismuth-tetracycline-metronidazole for 7 days; (3) omeprazole-amoxicillin-clarithromycin-bismuth for 14 days; and (4) omeprazole-amoxicillin-rifabutin for 14 days. H. pylori antibiotic susceptibility was unknown and, therefore, rescue regimens were chosen empirically. In no case, was the same regimen repeated. Outcome. H. pylori eradication was defined as a negative in 13C-urea breath test 8 weeks after completing the therapy., Results: Forty-eight patients were included (mean age 45 years, 44% males, 82% with peptic ulcer and 18% with functional dyspepsia). No patient was lost from follow-up. Adverse effects were described in 21% of the patients. One patient receiving omeprazole, amoxicillin and rifabutin was removed from medication due to adverse effects (vomiting). Overall, mean H. pylori eradication with third therapy after failure of two eradication treatments was 34/48 (71%; 95% confidence interval 57-82%) by intention-to-treat and 34/47 (72%; 95% confidence interval 58-83%) by per-protocol., Conclusion: It seems that performing culture even after a second eradication failure may not be necessary, as it is possible to construct an overall strategy to maximise H. pylori eradication, based on the different possibilities of empirical treatment.

To assess the possible influence of atmospheric factors on the incidence of Bell's palsy, a retrospective case review of patients seen between 1 January 1992 and 30 June 1996, was designed. The population included all Bell's palsy patients in whom the exact date of onset of paralysis (day, month, year) was known. The following parameters were registered daily by the Spanish National Service of Meteorology throughout the period of survey: temperature, atmospheric pressure and air pollutants (total number of particles and levels of SO2, CO, O3, NO2, NO, CH4 and total organic carbon). The only factor significantly related to Bell's palsy was temperature (P = 0.0164). Lower temperatures were associated with a higher incidence of Bell's palsy. A relationship between atmospheric pressure and/or air pollutants and Bell's palsy was not found.

Purpose: To evaluate the optical aberrations induced by LASIK refractive surgery for myopia on the anterior surface of the cornea and the entire optical system of the eye., Methods: Total and corneal aberrations were measured in a group of 14 eyes (preoperative myopia ranging from -2.5 to -13 D) before and after LASIK surgery. Total aberrations were measured using a laser ray-tracing technique. Corneal aberrations were obtained from corneal elevation maps measured using a corneal system and custom software. Corneal and total wave aberrations were described as Zernike polynomial expansions. Root-mean-square (RMS) wavefront error was used as a global optical quality metric., Results: Total and corneal aberrations (third-order and higher) showed a statistically significant increase after LASIK myopia surgery, by a factor of 1.92 (total) and 3.72 (corneal), on average. This increase was more pronounced in patients with the highest preoperative myopia. There is a good correlation (r = 0.97, P < 0.0001) between the aberrations induced in the entire optical system and those induced in the anterior corneal surface. However, the anterior corneal spherical aberration increased more than the total spherical aberration, suggesting also a change in the spherical aberration of the posterior corneal surface. Pupil centration and internal optical aberrations, which are not accounted for in corneal topography, play an important role in evaluating individual surgical outcomes., Conclusions: Because LASIK surgery induces changes in the anterior corneal surface, most changes in the total aberration pattern can be attributed to changes in the anterior corneal aberrations. However, because of individual interactions of the aberrations in the ocular components, a combination of corneal and total aberration measurements is critical to understanding individual outcomes, and by extension, to designing custom ablation algorithms. This comparison also reveals changes in the internal aberrations, consistent with the posterior corneal changes reported using scanning slit corneal topography.

Schematic eye models have typically been used to explain the average monochromatic and chromatic imaging properties of the eye. Both monochromatic aberrations and transverse chromatic aberration are known to vary widely across subjects. However, to our knowledge, the ability of schematic eye models to predict these individual variations has not been tested experimentally. We used a spatially resolved refractometer to measure the monochromatic aberrations and the optical transverse chromatic aberration (oTCA) in a group of 15 eyes. By recording the 1st and 4th Purkinje images for five directions of gaze, we also estimated the tilt, misalignment of ocular surfaces (front surface of the cornea and back surface of the lens) and off-axis position of the fovea (angle alpha), as well as pupil centration. We conclude that, contrary to expectations none of those factors are major contributors to the variability in monochromatic aberrations and oTCA in this group of eyes. Simulations show that corneal curvature and corneal conicity are also unlikely to account for the observed relation between monochromatic aberrations and oTCA. Our results suggest an important contribution of corneal irregularities to those aberrations.

Aim: To evaluate whether eradication therapy is more effective in peptic ulcer disease (PUD) than in non-ulcer dyspepsia (NUD)., Methods: We retrospectively studied 481 patients with NUD (183 patients) or PUD (298 patients) infected with Helicobacter pylori included in several prospective clinical trials. Three eradication regimens were given: (1) proton pump inhibitor (PPI) plus clarithromycin, plus either amoxycillin or metronidazole for 7 days (297 patients); (2) ranitidine bismuth citrate (RBC) plus clarithromycin plus amoxycillin for 7 days (79 patients); and (3) RBC plus clarithromycin plus amoxycillin plus metronidazole for 5 days (105 patients). H. pylori eradication was defined as a negative 13C-urea breath test 4 weeks after completing treatment., Results: H. pylori eradication rates were 82% (95% CI 78-87%) with PPI plus two antibiotics for 7 days, 85% (95% CI 75-91%) with RBC plus two antibiotics for 7 days, and 91% (95% CI 86-97%) with RBC plus three antibiotics for 5 days (P < 0.05 compared with the first regimen). Overall, the H. pylori eradication rate in patients with NUD was 78% (95% CI 71-84%), while in patients with PUD it was 89% (95% CI 86-93%) (P < 0.001). Both the combination of PPI plus two antibiotics for 7 days and the combination of RBC plus three antibiotics for 5 days were more effective in PUD than in NUD patients. However, RBC plus clarithromycin plus amoxycillin for 7 days was equally effective in both diseases. RBC plus two antibiotics for 7 days achieved better results than the same therapy with PPI only in NUD patients (84% v. 59%, P < 0.01), but both regimens were similar when prescribed in PUD patients (86% v. 88%). In the multivariate analysis, the type of therapy, the diagnosis (NUD v. PUD), and the product variable of therapy (with RBC plus 2 antibiotics for 7 days) and diagnosis (interaction variable) were the only variables that influenced H. pylori eradication. The odds ratio (OR) for the effect of RBC versus PPI plus two antibiotics for 7 days in patients with NUD was 4 (95% CI 1.7-9.7; P < 0.01), whereas in patients with PUD no statistical significance was achieved (OR 0.79; 95% CI 0.2-3.9)., Conclusion: Overall, H. pylori eradication therapy is more effective in PUD than in NUD patients. This advantage of eradication therapies in PUD patients seems to be observed with 7-day PPI-based triple regimens, and with 5-day RBC-based quadruple therapy, while the 7-day RBC-based triple regimen seems to be equally effective in both diseases.

Purpose: To relate the change of ocular aberrations with the change of visual performance produced by standard laser in situ keratomileusis (LASIK) for myopia., Methods: Aberrations and visual performance were measured before and after surgery in 22 eyes. Total aberrations were measured using a laser ray tracing technique. Corneal aberrations were obtained using a commercial videokeratoscope and custom software. Visual performance was evaluated in terms of best spectacle-corrected contrast sensitivity and high-contrast visual acuity., Results: The amount of total and corneal aberrations increased with LASIK in all except two eyes. In general, the total and corneal aberration patterns were well-correlated after LASIK. However, the anterior corneal surface alone did not capture all the information (ie, possible changes induced on the posterior corneal surface or interactions between the different ocular components), which suggests that total aberrations are better predictors of visual performance. The decrease of the modulation transfer function (both in terms of area under the curve or as a function of spatial frequency) with LASIK accounted for most of the decrease in contrast sensitivity. High-resolution visual acuity was not very sensitive to the LASIK-induced changes in image quality., Conclusion: Wavefront and total aberration measurements, and in particular a combination of the two techniques, provide useful information for understanding the optical changes induced by standard refractive surgery. Predictions of the change in modulation transfer function derived from wave aberrations matched measurements of change in contrast sensitivity.

The enzyme acetyl-CoA carboxylase alpha (ACC-alpha) is rate-limiting for the synthesis of long-chain fatty acids de novo. As a first characterization of the bovine gene encoding this enzyme, we established the entire bovine ACC-alpha cDNA sequence (7041 bp) and used experiments with 5' rapid amplification of cDNA ends to determine the heterogeneous composition of 5' untranslated regions, as expressed from three different promoters (PI, PII and PIII). The individual locations of these promoters have been defined within an area comprising 35 kbp on Bos taurus chromosome 19 ('BTA19'), together with the segmentation of the first 14 exons. Primer extension analyses reveal that the nutritionally regulated PI initiates transcription from at least four sites. PI transcripts are much more abundant in adipose and mammary-gland tissues than in liver or lung. A 2.6 kb promoter fragment drives the expression of reporter genes only weakly in different model cells, irrespective of stimulation with insulin or dexamethasone. Thus bovine PI is basically repressed, like its analogue from rat. Finely graded deletions of PI map two separate elements, which have to be present together in cis to repress bovine PI. The distal component resides within a well-preserved Art2 retroposon element. Thus sequence, structure and evolutionary origin of the main repressor of PI in bovines are entirely different from its functional counterpart in rat, which had been identified as a (CA)(28) microsatellite. We show that, in different mammalian species, unrelated genome segments of different origins have been recruited to express as functionally homologous PI the ancient and otherwise highly conserved ACC-alpha-encoding gene.

Aim: The combination of a proton pump inhibitor (PPI) or ranitidine-bismuth-citrate (Rbc) and two antibiotics for 7-10 days are, at present, the preferred treatments in Helicobacter pylori eradication. However, therapies for fewer than 7 days have been scarcely evaluated and it is unknown whether the length of treatment can be shortened, without a lost of efficacy, if three instead of two antibiotics are used. The aim of our study was to evaluate the efficacy of Rbc plus three antibiotics for only 5 days in H. pylori eradication., Methods: We prospectively studied 80 patients (34% duodenal ulcer, 66% functional dyspepsia) infected by H. pylori. At endoscopy, biopsies were obtained for histological study and rapid urease test, and a 13C-urea breath test was carried out. Urea breath test was repeated 4 weeks after completing eradication treatment with Rbc [400 mg twice a day (bid)], amoxicillin (1 g bid), clarithromycin (500 mg bid) and metronidazole (500 mg bid). All drugs were administered together after breakfast and dinner for 5 days only, and no treatment was administered thereafter. Compliance with therapy was determined from the interrogatory and the recovery of empty envelopes of medications., Results: In 79 out of the 80 patients, H. pylori eradication success or failure was assessed after therapy (one patient was lost from follow-up). All but one of these 79 patients took all the medications (one patient stopped treatment on the day 3 due to nausea/vomiting). Per protocol eradication was achieved in 72/78 (92%; 95% CI, 84-96%) and in 72/80 (90%; 81-95%) by intention-to-treat. Therapy was more effective in patients with duodenal ulcer than in those with functional dyspepsia [100% (87-100%) vs. 85% (73-92%) by intention-to-treat; p <.05]. Adverse effects were described in ten patients (12%), and included the perception of a metallic taste (eight patients), nausea/vomiting (two patients, one of them abandoned the treatment due to this), and diarrhea (two patients)., Conclusion: The combination of Rbc, amoxicillin, clarithromycin and metronidazole for only 5 days represents a promising therapy for H. pylori infection, due to its high efficacy, simple posology, low cost and excellent tolerance.

We undertook a study to identify the vestibular and hearing abnormalities associated with phenytoin toxicity. Since October 1977, 23 patients with phenytoin toxicity have been referred to the Department of Otorhinolaryngology by the Department of Neurology for electrooculographic (EOG) evaluation. (There have been no cases of serious phenytoin toxicity seen in our department since August 1989.) In addition to EOG, all patients had undergone otoscopic, audiometric, and neurologic examinations. We found that the most common pathologic findings detected by EOG were abnormalities in pursuit tracking. The most common signs found on clinical exploration were cerebellar dysfunction and facial palsy. EOG findings in patients with phenytoin toxicity are compatible with cerebellar disease.

Purpose: To investigate the relations between age and the optical aberrations of the whole eye. The eye's optical quality, as measured by the modulation transfer function (MTF), degrades with age, but the MTF does not provide a means to assess the contributions of individual aberrations, such as coma, spherical aberration, and other higher order aberrations to changes in optical quality. The method used in this study provides measures of individual aberrations and overall optical quality., Methods: Wave aberrations in 38 subjects were measured psychophysically using a spatially resolved refractometer. Data were fit with Zernike polynomials up to the seventh order to provide estimates of 35 individual aberration terms. MTFs and root mean square (RMS) wavefront errors were calculated. Subjects ranged in age from 22.9 to 64.5 years, with spherical equivalent corrections ranging from +0.5 to -6.0 D., Results: Overall RMS wavefront error (excluding tilts, astigmatism, and defocus) was significantly positively correlated with age (r = 0.33, P = 0.042). RMS error for the highest order aberrations measured (fifth through seventh order) showed a strong positive correlation with age (r = 0.57, P = 0.0002). Image quality, as quantified by the MTF, also degraded with age., Conclusions: Wave aberrations of the eye increase with age. This increase is consistent with the loss of contrast sensitivity with age observed by other investigators.

Purpose: To determine objectively the changes in the ocular aberrations (3rd order and above) induced by myopic LASIK refractive surgery and its impact on image quality., Methods: The ocular aberrations of 22 normal myopic eyes (preoperative refraction ranged from -13 to -2 D) were measured before (2.9 +/- 4.3 weeks) and after (7.7 +/- 3.2 weeks) LASIK refractive surgery using a laser ray tracing technique. A set of laser pencils is sequentially delivered onto the eye through different pupil locations. For each ray, the corresponding retinal image is collected on a CCD camera. The displacement of the image centroid with respect to a reference provides direct information of the ocular aberrations. Root-mean-square (RMS) wavefront error was taken as image quality metric., Results: RMS wavefront error increased significantly in all eyes but two after surgery. On average, LASIK induced a significant (P = 0.0003) 1.9-fold increase in the RMS error for a 6.5-mm pupil. The main contribution was due to the increase (fourfold, P < 0.0001) of spherical aberration. The increase in the RMS for a 3-mm pupil (1.7-fold) was also significant (P = 0.02). The modulation transfer (computed for 6.5-mm pupil) decreased on average by a factor of 2 for middle-high spatial frequencies., Conclusions: (1) Laser ray tracing is a well-suited, robust, and reliable technique for the evaluation of the change of ocular aberrations with refractive surgery. (2) Refractive surgery induces important amounts of 3rd and higher order aberrations. The largest increase occurs for spherical aberration. Decentration of the ablation pattern seems to generate 3rd order aberrations. (3) This result is important for the design of customized ablation algorithms, which should cancel existing preoperative aberrations while avoiding the generation of new aberrations.

Purpose: To compare quantitatively three techniques to measure the optical aberrations of the human eye: laser ray tracing (LRT), the Hartmann-Shack wavefront sensor (H-S), and the spatially resolved refractometer (SRR). LRT and H-S are objective imaging techniques, whereas SRR is psychophysical., Methods: Wave aberrations were measured in two normal subjects with all three techniques implemented in two different laboratories., Results: We compared the experimental variability of the results obtained with each technique with the overall variability across the three methods. For the two subjects measured (RMS wavefront error 0.5 microm and 0.9 microm, respectively), we found a close agreement; the average standard deviation of the Zernike coefficients within a given method was 0.07 microm, whereas the average global standard deviation across techniques was 0.09 microm, which is only slightly higher., Conclusions: There is a close match between the Zernike coefficients obtained by LRT, H-S, and SRR. Thus, all three techniques provide similar information concerning wave aberration when applied to normal human eyes. However, the methods are operationally different, and each has advantages and disadvantages depending on the particular application.

It is the committee's recommendation that the ophthalmic community use the line of sight as the reference axis for the purposes of calculating and measuring the ocular optical aberrations.

Aim: A combination of omeprazole plus amoxycillin (Amo) and clarithromycin (CIa) for 7 days has been studied extensively. However, the role of other proton pump inhibitors, such as pantoprazole (Pan), in this therapy is not well known. On the other hand, ranitidine bismuth citrate (RBC) also seems to be effective when combined with Amo and CIa. Our aim was to evaluate and to compare these two novel short-term triple therapies (Pan+Amo+Cla and RBC+Amo+Cla) for treatment of Helicobacter pylori., Methods: In a randomized clinical trial 150 consecutive patients (38 with duodenal ulcer, 112 with non-ulcer dyspepsia) infected by H. pylori were studied prospectively. Exclusion criteria were: previous H. pylori eradication therapy, gastroerosive drug use, gastric surgery, and associated diseases. One of two regimens was given for 7 days: Pan (40 mg b.i.d.), Amo (1 g b.i.d.), Cla (500 mg b.i.d.) (group Pan+Amo+Cla, n = 75); or RBC (400 mg b.i.d.), Amo (1 g b.i.d.), Cla (500 mg b.i.d.) (group RBC+Amo+Cla, n = 75). All drugs were administered together after meals. Compliance was evaluated by return tablet count. Data were analysed by univariate (chi2) and multivariate (multiple logistic regression) analysis. Eradication was defined as a negative 13C-urea breath test 1 month after completing therapy., Results: The distribution of studied variables (age, gender, smoking, duodenal ulcer/non-ulcer dyspepsia) was similar in both therapy groups. Per-protocol eradication was achieved in 48/71 (68%) in group Pan+Amo+Cla, and in 61/70 (87%) in group RBC+Amo+Cla (P= 0.01). Intention-to-treat (ITT) eradication was achieved in, respectively, 48/ 75 (64%) and in 61/75 (81%) (P= 0.03). The RBC+ Amo+Cla regimen was more effective than Pan+Amo+Cla in non-ulcer dyspepsia patients (ITT, 84% vs 58%; P = 0.005), but statistically significant differences were not demonstrated in duodenal ulcer patients (72% vs 80%). In the multivariate analysis the odds ratio for the effect of the type of therapy on H. pylori eradication in patients with non-ulcer dyspepsia was 3.8 (95% Cl, 1.6-9.3; P = 0.003). No relevant adverse effects were reported with any regimen., Conclusion: A RBC+Amo+Cla regimen for only 1 week is a promising therapy for H. pylori infection, due to its high efficacy, simple posology, and excellent tolerability. Combination of Pan with Amo and Cla, although effective in duodenal ulcer patients, but in non-ulcer dyspepsia has not achieved the favourable results previously reported with other proton pump inhibitors.