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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 1090-1093, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36085612

RESUMO

To explore the actual behavioral performance of subjects in multitasking training games, we designed a VR game including a Target-tracking task (TTT) of continuously moving "Player" to track "Targets" and a randomly appearing Color-discrimination task (CDT) requiring discriminating whether "Player" and "Monster" have the same color, and recorded subjects' pupillary changes to reflect mental effort. By analyzing the mean pupil diameter change (MPDC) of different groups, we found that the high group presented pupil dilation during the post-event stage, reflecting that they engaged in psychological processing of CDT during the event, whereas the low group had no pupil dilation during part of the post-event stage, reflecting the possibility of ignoring the appearance of CDT, and such behaviors hardly raise good expectations for training effect. Our study suggests that MPDC mirrors not only the actual behavior of the different groups treating the multitasking paradigm, but also the influence of game design.


Assuntos
Pupila , Registros , Humanos
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 2194-2198, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36085625

RESUMO

Objective measurement of gaze pattern and eye movement during untethered activity has important applications for neuroscience research and neurological disease detection. Current commercial eye-tracking tools rely on desk-top devices with infrared emitters and conventional frame-based cameras. Although wearable options do exist, the large power-consumption from their conventional cameras limit true long-term mobile usage. The query-driven Dynamic Vision Sensor (qDVS) is a neuromorphic camera which dramatically reduces power consumption by outputting only intensity-change threshold events, as opposed to full frames of intensity data. However, such hardware has not yet been implemented for on-body eye-tracking, but the feasibility can be demonstrated using a mathematical simulator to evaluate the eye-tracking ca-pabilities of the qDVS under controlled conditions. Specifically, a framework utilizing a realistic human eye model in the 3D graphics engine, Unity, is presented to enable the controlled and direct comparison of image-based gaze tracking methods. Eye-tracking based on qDVS frames was compared against two different conventional frame eye-tracking methods - the traditional ellipse pupil-fitting algorithm and a deep learning neural network inference model. Gaze accuracy from qDVS frames achieved an average of 93.2% for movement along the primary horizontal axis (pitch angle) and 93.1 % for movement along the primary vertical axis (yaw angle) under 4 different illumination conditions, demonstrating the feasibility for using qDVS hardware cameras for such applications. The quantitative framework for the direct comparison of eye tracking algorithms presented here is made open-source and can be extended to include other eye parameters, such as pupil dilation, reflection, motion artifact, and more.


Assuntos
Movimentos Oculares , Tecnologia de Rastreamento Ocular , Humanos , Movimento (Física) , Movimento , Pupila
3.
Artigo em Inglês | MEDLINE | ID: mdl-36078207

RESUMO

PURPOSE: We investigated ocular accommodative responses and pupil diameters under different light intensities in order to explore whether changes in light intensity aid effective accommodation function training. METHODS: A total of 29 emmetropic and myopic subjects (age range: 12-18 years) viewed a target in dynamic ambient light (luminance: 5, 100, 200, 500, 1000, 2000 and 3000 lux) and static ambient light (luminance: 1000 lux) at a 40 cm distance with refractive correction. Accommodation and pupil diameter were recorded using an open-field infrared autorefractor and an ultrasound biological microscope, respectively. RESULTS: The changes in the amplitude of accommodative response and pupil diameter under dynamic lighting were 1.01 ± 0.53 D and 2.80 ± 0.75 mm, respectively, whereas in static lighting, those values were 0.43 ± 0.24 D and 0.77 ± 0.27 mm, respectively. The amplitude of accommodation and pupil diameter change in dynamic lighting (t = 6.097, p < 0.001) was significantly larger than that under static lighting (t = 16.115, p < 0.001).The effects of light level on both accommodation and pupil diameter were significant (p < 0.001). CONCLUSION: Accommodation was positively correlated with light intensity. The difference was about 1.0 D in the range of 0-3000 lux, which may lay the foundation for accommodative training through light intervention.


Assuntos
Acomodação Ocular , Iluminação , Adolescente , Criança , Humanos , Pupila/fisiologia , Refração Ocular , Testes Visuais
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 1968-1971, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36086244

RESUMO

Many studies in the literature attempt recognition of emotions through the use of videos or images, but very few have explored the role that sounds have in evoking emotions. In this study we have devised an experimental protocol for elicitation of emotions by using, separately and jointly, images and sounds from the widely used International Affective Pictures System and International Affective Digital Sounds databases. During the experiments we have recorded the skin conductance and pupillary signals and processed them with the goal of extracting indices linked to the autonomic nervous system, thus revealing specific patterns of behavior depending on the different stimulation modalities. Our results show that skin conductance helps discriminate emotions along the arousal dimension, whereas features derived from the pupillary signal are able to discriminate different states along both valence and arousal dimensions. In particular, the pupillary diameter was found to be significantly greater at increasing arousal and during elicitation of negative emotions in the phases of viewing images and images with sounds. In the sound-only phase, on the other hand, the power calculated in the high and very high frequency bands of the pupillary diameter were significantly greater at higher valence (valence ratings > 5). Clinical relevance- This study demonstrates the ability of physiological signals to assess specific emotional states by providing different activation patterns depending on the stimulation through images, sounds and images with sounds. The approach has high clinical relevance as it could be extended to evaluate mood disorders (e.g. depression, bipolar disorders, or just stress), or to use physiological patterns found for sounds in order to study whether hearing aids can lead to increased emotional perception.


Assuntos
Emoções , Pupila , Nível de Alerta/fisiologia , Sistema Nervoso Autônomo/fisiologia , Emoções/fisiologia , Resposta Galvânica da Pele , Pupila/fisiologia
5.
J Refract Surg ; 38(9): 587-594, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36098390

RESUMO

PURPOSE: To assess whether aqueous cytokine profiles and pupil size are altered when high capsulotomy energy is used in eyes undergoing femtosecond laser-assisted cataract surgery (FLACS), and if preoperative use of a topical non-steroidal anti-inflammatory drug (NSAID) has an effect on this. METHODS: This prospective study recruited 83 eyes (63 patients) that were allocated to four treatment groups: conventional phacoemulsification (n = 20 eyes); FLACS with 90% capsulotomy energy without NSAID pretreatment (n = 20 eyes); FLACS with 90% capsulotomy energy with NSAID pre-treatment (n = 21 eyes); and FLACS with 150% capsulotomy energy with NSAID pretreatment (n = 22 eyes). Aqueous humor was collected before and after phacoemulsification to assess cytokine profiles. Pupil size was measured before and after laser capsulotomy. RESULTS: FLACS increased aqueous concentrations of pros-taglandin E2 (PGE2), interferon γ (IFN-γ), and interleukin 6 (IL-6) compared to conventional phacoemulsification. However, when increasing capsulotomy energy from 90% to 150% (with topical NSAID pretreatment), there was no significant increase in aqueous concentrations of PGE2 (37.7 ± 21.7 vs 33.6 ± 27.6 pg/mL, P = .99), IFN-γ (3.6 ± 1.1 vs 3.6 ± 0.8 pg/mL, P = .99), or IL-6 (7.1 ± 2.9 vs 6.3 ± 2.4 pg/mL, P = .99). For 90% and 150% capsulotomy energy, there was significant miosis following laser capsulotomy. Increased PGE2 concentration was significantly correlated with a reduction in pupil area (r = -0.58, P < .001) and pupil diameter (r = -0.57, P < .001). However, when a topical NSAID was given preoperatively, there was no difference in the degree of miosis between the 90% and 150% capsulotomy energy groups. CONCLUSIONS: Pretreatment with a topical NSAID prevented a rise in PGE2, IFN-γ, and IL-6 levels and excessive miosis when a higher capsulotomy energy was used. When a topical NSAID is used preoperatively, it is safe to use higher capsulotomy energy settings (with a low pulse energy femtosecond laser system) to achieve a satisfactory capsulotomy. [J Refract Surg. 2022;38(9):587-594.].


Assuntos
Catarata , Terapia a Laser , Anti-Inflamatórios não Esteroides/uso terapêutico , Catarata/etiologia , Humanos , Interleucina-6/farmacologia , Terapia a Laser/efeitos adversos , Lasers , Miose , Estudos Prospectivos , Prostaglandinas E/farmacologia , Pupila
6.
Proc Biol Sci ; 289(1982): 20221545, 2022 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-36100024

RESUMO

The locus coeruleus (LC), a nucleus in the pons of the brainstem, plays a significant role in attention and cognitive control. Here, we use an adapted auditory oddball paradigm and measured the pupil dilation response, to provide a marker of LC activity in humans. In Experiment 1, we show event-related pupil responses to rare auditory events which were further elevated by task relevant. In Experiment 2, by asking participants to silently count the number of oddballs, we demonstrated that the task-relevance elevation was not a result of the generation or execution of the manual response. In Experiment 3, we observed two separate effects of reward on the pupil response. First, we found an overall increase in pupil area in the high compared to the low-reward blocks: a sustained effect reminiscent of the tonic changes that occur in LC. Second, we found elevated event-related pupil responses to behaviourally relevant stimuli in the high-reward condition compared with the low-reward condition, consistent with phasic changes in LC in response to a stimulus. These results highlight the complexity of the relationship between the pupil response and reward, and the inferred role of LC in both top-down and bottom-up cognitive control.


Assuntos
Locus Cerúleo , Pupila , Atenção/fisiologia , Humanos , Locus Cerúleo/fisiologia , Pupila/fisiologia , Recompensa
7.
Indian J Med Res ; 155(3&4): 364-372, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36124511

RESUMO

Background & objectives: Ocular hypertelorism constitutes an important component of many clinical syndromes. It is typically recommended to use inter-pupillary distance (IPD) for objective evaluation of ocular hypo/hypertelorism. Barring infancy, there is a scarcity of data on this anthropometric parameter relating to the ocular apparatus. This study aims to study auxological dynamics of IPD in children of Indian origin. Methods: A total of 3622 ( 2239 males and, 1383 females) normal, healthy Indian children of North-western origin, aged one month to 14 yr comprised the sample for this study. Inner and outer-canthal distance were measured using standardized anthropometric techniques. None of the children who participated in this study had craniofacial dysmorphism or any body deformity. Mean (standard deviation SD) and percentiles were calculated for IPD in male and female subjects at different age levels. Results: IPD increased from 4.68±0.21 to 6.19±0.36 cm in males and from 4.59±0.26 to 6.08±0.25 cm in females between one month and 14 yr of age. Boys in general, possessed larger IPD than girls, however, the gender differences became significant (P≤0.05) at 10, 11, 16-18 and 22-24 months, respectively, and five and 10 yr of age, respectively. Interpretation & conclusions: The results of this study suggest that the patients having IPD less than the 3rd percentile should be treated as cases of hypotelorism while, those exceeding 97th percentile as cases of hypertelorism. The use of percentile grids presented for IPD may be used to detect ocular hypotelorism and hypertelorism in male and female children to corroborate diagnosis of different syndromes.


Assuntos
Hipertelorismo , Criança , Face , Feminino , Humanos , Masculino , Pupila , Valores de Referência , Síndrome
8.
Philos Trans R Soc Lond B Biol Sci ; 377(1863): 20210183, 2022 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-36126669

RESUMO

People make rapid inferences about others' thoughts and intentions. For example, they observe facial movements and pupil size of others and unwittingly make use of this information when deciding whether to trust someone or not. However, whether spontaneous mimicry depends on visual awareness of the stimulus and whether these processes underlie trust decisions is still unknown. To investigate whether visual awareness modulates the relationship between emotional expressions, mimicry and trust, participants played a series of trust games and saw either their partners' faces with a neutral, happy or fearful expression, or their partners' eyes in which the pupil size was large, medium or small. Subjects' trust investments, facial movements and pupil responses were measured. In half of the trials, the stimuli were rendered invisible by continuous flash suppression. Results showed that facial expressions were mimicked and influenced trust decisions during the conscious condition, but not during the unconscious (suppressed) condition. The opposite was found for pupil size, which influenced trust decisions during states of unawareness. These results suggest that the neurobiological pathway linking the observation of facial expressions to mimicry and trust is predominantly conscious, whereas partner pupil size influences trust primarily when presented unconsciously. This article is part of the theme issue 'Cracking the laugh code: laughter through the lens of biology, psychology and neuroscience'.


Assuntos
Expressão Facial , Confiança , Estado de Consciência , Humanos , Pupila/fisiologia
9.
J Refract Surg ; 38(8): 497-501, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35947002

RESUMO

PURPOSE: To investigate extended depth of focus intraocular lenses (EDOF IOLs), intended to extend the depth of field after cataract surgery in a comparative study at the optical bench. METHODS: An optical bench with either green or white light was used for this study. The artificial cornea used exhibited a spherical aberration of 0.2 µm. Examinations of the following lenses with a pupil opening of 3 and 4.5 mm were carried out: AcrySof IQ Vivity (Alcon Laboratories, Inc), Isopure (PhysIOL), Tecnis Eyhance (Johnson & Johnson), Vivinex Impress (Hoya Surgical Optics), and xact (Santen). RESULTS: Using green light and a pupil aperture of 3 mm, the AcrySof IQ Vivity showed the highest light energy for the intermediate area, whereas the Isopure and Vivinex Impress provided the highest energy for distance vision. Under the same examination conditions with a pupil opening of 4.5 mm, all lenses showed a low light distribution for the intermediate range. Regarding light distribution for distance, the Tecnis Eyhance had the highest light intensity. Using white light, the curves became much wider and more similar to each other. CONCLUSIONS: The five EDOF lenses investigated differ mainly by their different weighting of energy between the far and intermediate ranges. [J Refract Surg. 2022;38(8):497-501.].


Assuntos
Percepção de Profundidade , Lentes Intraoculares , Percepção de Profundidade/fisiologia , Humanos , Óptica e Fotônica , Desenho de Prótese , Pupila/fisiologia , Visão Ocular
10.
PLoS One ; 17(8): e0272564, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35926070

RESUMO

The traffic environment of an extra-long expressway tunnel is more complex than that of a long tunnel, which increases the driving risk. The visual load of drivers can be used to evaluate driving safety and comfort. To reveal drivers' visual load characteristics at the entrance and exit of extra-long tunnels on mountainous expressways, this study conducted vehicle tests with 12 drivers at Gonghe extra-long tunnel on the Yu-Xiang expressway in the Wulong District. An eye tracker, non-contact multifunctional velocimetry, illuminometer, and other test equipment were used to record drivers' pupil areas, velocity, and illuminance when entering and leaving the tunnel. The change characteristics of drivers' pupil areas were studied. The maximum transient velocity value (MTPA) of the pupil area was selected as an index to evaluate the visual load degree. Based on velocity and illuminance coupling, a visual load model was constructed using the optimized support vector machine (GA-SVM). The influence of velocity and illuminance on the MTPA in the tunnel's approach, entrance, exit, and departure section was analyzed. The results show that drivers' psychological tension order at the entrance and exit is entrance section ≈ exit section > departure section > approach section. In the approach section, the visual load is mainly affected by environmental illumination. In the entrance and exit sections, the visual load is positively correlated with velocity and negatively correlated with illuminance, and velocity has a greater impact on visual load. In the tunnel departure section, the two variables synergistically influence the driving visual load. The research results provide theoretical support for the safety design and management of extra-long tunnel entrances and exits.


Assuntos
Condução de Veículo , Acidentes de Trânsito/prevenção & controle , Condução de Veículo/psicologia , Iluminação , Estimulação Luminosa , Pupila , Segurança
12.
J Vis ; 22(9): 7, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35998063

RESUMO

To this day, the most popular method of choice for testing visual field defects (VFDs) is subjective standard automated perimetry. However, a need has arisen for an objective, and less time-consuming method. Pupil perimetry (PP), which uses pupil responses to onsets of bright stimuli as indications of visual sensitivity, fulfills these requirements. It is currently unclear which PP method most accurately detects VFDs. Hence, the purpose of this study is to compare three PP methods for measuring pupil responsiveness. Unifocal (UPP), flicker (FPP), and multifocal PP (MPP) were compared by monocularly testing the inner 60 degrees of vision at 44 wedge-shaped locations. The visual field (VF) sensitivity of 18 healthy adult participants (mean age and SD 23.7 ± 3.0 years) was assessed, each under three different artificially simulated scotomas for approximately 4.5 minutes each (i.e. stimulus was not or only partially present) conditions: quadrantanopia, a 20-, and 10-degree diameter scotoma. Stimuli that were fully present on the screen evoked strongest, partially present stimuli evoked weaker, and absent stimuli evoked the weakest pupil responses in all methods. However, the pupil responses in FPP showed stronger discriminative power for present versus absent trials (median d-prime = 6.26 ± 2.49, area under the curve [AUC] = 1.0 ± 0) and MPP performed better for fully present versus partially present trials (median d-prime = 1.19 ± 0.62, AUC = 0.80 ± 0.11). We conducted the first in-depth comparison of three PP methods. Gaze-contingent FPP had best discriminative power for large (absolute) scotomas, whereas MPP performed slightly better with small (relative) scotomas.


Assuntos
Pupila , Testes de Campo Visual , Adulto , Humanos , Pupila/fisiologia , Escotoma , Transtornos da Visão/diagnóstico , Testes de Campo Visual/métodos , Campos Visuais
13.
Int Ophthalmol ; 42(9): 2645-2649, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35947252

RESUMO

PURPOSE: To compare the pupil size of the original mydriasis and repeat mydriasis at the pupil shrinkage stage. METHODS: Randomized prospective study. In total, 60 eyes of 30 patients aged 50-70 with age-related cataracts were included. Pupil sizes were measured by the Sirius system before mydriasis, after the first batch of mydriasis, and after the second batch of mydriasis which was 5 h later. Statistical analysis was performed using MedCalc statistical software version 20.0.3 RESULTS: The pupil size of the second batch of mydriasis 5 h later was smaller than the first batch of mydriasis (3.94 ± 0.88 mm vs 5.12 ± 0.96 mm, P < 0.0001). CONCLUSIONS: Less efficiency repeat mydriasis several hours later compared with original mydriasis in our study suggests that preparation of mydriasis at an appropriate time is necessary for ophthalmological operations. The effect of repeat mydriasis again by tropicamide at the shrinkage stage still needs to be explored.


Assuntos
Midríase , Midriáticos , Pupila , Dilatação , Humanos , Fenilefrina , Estudos Prospectivos , Pupila/fisiologia , Tropicamida
14.
Int J Psychophysiol ; 180: 68-78, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35914548

RESUMO

Considering the suspected involvement of the autonomic nervous system (ANS) in several neurodevelopmental disorders, a description of its tonus in typical populations and of its maturation between childhood and adulthood is necessary. We aimed to arrive at a better understanding of the maturation of the sympathetic (SNS) and parasympathetic (PNS) tonus by comparing children and adults at rest, via recordings of multiple ANS indices. We recorded simultaneously pupil diameter, electrodermal activity (EDA) and cardiac activity (RR interval and HRV: heart rate variability) in 29 children (6-12 years old) and 30 adults (20-42 years old) during a 5-min rest period. Children exhibited lower RR intervals, higher LF peak frequencies, and lower LF/HF (low frequency/high frequency) ratios compared to adults. Children also produced more spontaneous EDA peaks, reflected in a larger EDA AUC (area under the curve), in comparison with adults. Finally, children displayed a larger median pupil diameter and a higher pupillary hippus frequency than adults. Our results converged towards higher SNS and PNS tones in children compared to adults. Childhood would thus be characterized by a high autonomic tone, possibly reflecting a physiological state compatible with developmental acquisitions.


Assuntos
Sistema Nervoso Autônomo , Pupila , Adulto , Sistema Nervoso Autônomo/fisiologia , Cafeína , Criança , Frequência Cardíaca/fisiologia , Humanos , Pupila/fisiologia , Adulto Jovem
15.
Behav Res Ther ; 157: 104164, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35994954

RESUMO

Notwithstanding the success of CBT, it is relatively unknown how individuals can better profit from corrective learning experiences. Various theories postulate that prediction errors - the difference between what is occurring and what is expected - are the driving force of associative (re)learning. While prediction errors are typically operationalized as violations of cognitive outcome expectancies, direct physiological indices of prediction errors could capture potentially more essential automatic and emotional processes in associative learning. Although physiological responses have previously been suggested to reflect prediction errors, it remains elusive if these measures actually predict changes in subsequent conditioned responding. In three fear-conditioning experiments, we compared pupil dilation and skin conductance responses to unexpected outcomes - unconditioned stimulus (US) presentations or omissions - with expected outcomes, and tested whether outcome responses predicted actual changes in subsequent conditioned responding. We found evidence for increased physiological responses to unexpected outcomes, but the results were inconsistent across experiments. Furthermore, only pupil responses to US presentations consistently predicted an increase in conditioned responding, making it difficult to reconcile our findings with associative learning models. Both pupil dilation and skin conductance can thus index unexpected outcomes, but the relationship of these responses to future learning is not evident and requires further investigation.


Assuntos
Condicionamento Clássico , Pupila , Condicionamento Clássico/fisiologia , Emoções , Medo/fisiologia , Resposta Galvânica da Pele , Humanos , Aprendizagem/fisiologia , Pupila/fisiologia
16.
BMC Anesthesiol ; 22(1): 274, 2022 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-36045336

RESUMO

BACKGROUND: Individuals affected by autonomic dysfunction are at a higher risk of developing hypotension following anesthesia induction. Dynamic pupillometry has previously been employed as a means of assessing autonomic function. This prospective observational study was developed to determine whether pupillary light reflex (PLR) parameters can reliably predict post-induction hypotension (PIH). METHODS: This study enrolled patients with lower ASA status (I-II) undergoing elective surgery. PLR recordings for these patients prior to anesthesia induction were made with an infrared pupil camcorder, with a computer being used to assess Average Constriction Velocity (ACV), Maximum Constriction Velocity (MCV), and Constriction Ratio (CR). PIH was defined by a > 30% reduction in mean arterial pressure (MAP) or any MAP recording < 65 mmHg for at least 1 min from the time of induction until 10 minutes following intubation. Patients were stratified into PIH and non-PIH groups based on whether or not they developed hypotension. RESULTS: This study enrolled 61 total patients, of whom 31 (50.8%) exhibited one or more hypotensive episodes. Patients in the PIH group exhibited significantly smaller ACV (P = 0.003) and MCV values (P < 0.001), as well as a higher CR (P = 0.003). Following adjustment for certain factors (Model 2), MCV was identified as a protective factor for PIH (Odds Ratio: 0.369). Receiver operating characteristic (ROC) analyses revealed that relative to CR (AUC: 0.695, 95% CI: 0.563-0.806; P = 0.004), the reciprocal of MCV (1/MCV) offered greater value as a predictor of PIH (AUC: 0.803,95%CI: 0.681-0.894; P < 0.001). CONCLUSION: These results indicate that pupil maximum constriction velocity is a reliable predictor of post-induction hypotension in individuals of ASA I-II status undergoing elective surgery. TRIAL REGISTRATION: This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2200057164, registration date: 01/03/2022).


Assuntos
Hipotensão , Pupila , Anestesia Geral , Constrição , Humanos , Hipotensão/diagnóstico , Hipotensão/etiologia , Estudos Prospectivos
17.
PLoS One ; 17(7): e0272303, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35901103

RESUMO

BACKGROUND: Quantitative pupillometry is part of multimodal neuroprognostication of comatose patients after out-of-hospital cardiac arrest (OHCA). However, the reproducibility, repeatability, and reliability of quantitative pupillometry in this setting have not been investigated. METHODS: In a prospective blinded validation study, we compared manual and quantitative measurements of pupil size. Observer and device variability for all available parameters are expressed as mean difference (bias), limits of agreement (LoA), and reliability expressed as intraclass correlation coefficients (ICC) with a 95% confidence interval. RESULTS: Fifty-six unique quadrupled sets of measurement derived from 14 sedated and comatose patients (mean age 70±12 years) were included. For manually measured pupil size, inter-observer bias was -0.14±0.44 mm, LoA of -1.00 to 0.71 mm, and ICC at 0.92 (0.86-0.95). For quantitative pupillometry, we found bias at 0.03±0.17 mm, LoA of -0.31 to 0.36 mm and ICCs at 0.99. Quantitative pupillometry also yielded lower bias and LoA and higher ICC for intra-observer and inter-device measurements. Correlation between manual and automated pupillometry was better in larger pupils, and quantitative pupillometry had less variability and higher ICC, when assessing small pupils. Further, observers failed to detect 26% of the quantitatively estimated abnormal reactivity with manual assessment. We found ICC >0.91 for all quantitative pupillary response parameters (except for latency with ICC 0.81-0.91). CONCLUSION: Automated quantitative pupillometry has excellent reliability and twice the reproducibility and repeatability than manual pupillometry. This study further presents novel estimates of variability for all quantitative pupillary response parameters with excellent reliability.


Assuntos
Coma , Estado Terminal , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Pupila/fisiologia , Reprodutibilidade dos Testes
18.
Chin Med Sci J ; 37(2): 127-133, 2022 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-35796336

RESUMO

Objective To evaluate the efficacy and safety of prompt phacoemulsification, intraocular lens implantation, visco-goniosynechialysis, combined with pseudo-pupilloplasty for refractory acute primary angle closure (APAC) with atonic dilated pupil and to describe a feasible method of pupilloplasty. Methods A consecutive series of refractory APAC patients who had atonic dilated pupil and undergone prompt phacoemulsification combined with pseudo-pupilloplasty at our center were retrospectively analyzed. Pseudo-pupilloplasty referred to a method of pupilloplasty which included 4.5-mm capsulorhexis, postoperative opacification of anterior capsule residue, and ultimate pseudo-pupil formation. Preoperative and postoperative measurements included intraocular pressure (IOP), best corrected visual acuity (BCVA), and anterior chamber depth (ACD). Intraoperative and postoperative complications were documented. The process of pseudo-pupil formation was also observed. Results A total of 20 eyes of 19 APAC patients were followed up for 19.7 ± 9.8 months. IOP was lowered from preoperative 44.0 ± 9.8 mmHg to 15.5 ± 2.6 mmHg at final visit (t=11.945, P< 0.001). ACD was deepened from preoperative 1.77 ± 0.21 mm to 3.40 ± 0.20 mm at final visit (t=-27.711, P< 0.001). Twelve of 20 eyes had residual angle synechiae, whereas only 3 eyes needed anti-glaucoma medications. No severe complication was observed. All eyes had pseudo-pupil gradually formed within 3 months, accompanied with the gradual improvement of BCVA from preoperative 1.18 ± 0.55 to 0.58 ± 0.22, 0.26 ± 0.09, 0.11 ± 0.09, and 0.11 ± 0.09 at postoperative day 1, month 1, month 3, and last visit. Conclusions Prompt phacoemulsification-goniosynechialysis is effective and safe for refractory APAC with atonic dilated pupil. Pseudo-pupilloplasty is a feasible procedure for pupil reconstruction.


Assuntos
Glaucoma de Ângulo Fechado , Facoemulsificação , Doença Aguda , Glaucoma de Ângulo Fechado/complicações , Glaucoma de Ângulo Fechado/cirurgia , Humanos , Implante de Lente Intraocular/métodos , Pupila , Estudos Retrospectivos , Acuidade Visual
19.
Cells ; 11(14)2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35883649

RESUMO

Impaired cerebral autoregulation (CA) may increase the risk of brain hypoperfusion in septic patients. Sepsis dysregulates the autonomic nervous system (ANS), potentially affecting CA. ANS function can be assessed through the pupillary light reflex (PLR). The aim of this prospective, observational study was to investigate the association between CA and PLR in adult septic patients. Transcranial Doppler was used to assess CA and calculate estimated cerebral perfusion pressure (eCPP) and intracranial pressure (eICP). An automated pupillometer (AP) was used to record Neurological Pupil Index (NPi), constriction (CV) and dilation (DV) velocities. The primary outcome was the relationship between AP-derived variables with CA; the secondary outcome was the association between AP-derived variables with eCPP and/or eICP. Among 40 included patients, 21 (53%) had impaired CA, 22 (55%) had low eCPP (<60 mmHg) and 15 (38%) had high eICP (>16 mmHg). DV was lower in patients with impaired CA compared to others; DV predicted impaired CA with area under the curve, AUROC= 0.78 [95% Confidence Interval, CI 0.63-0.94]; DV < 2.2 mm/s had sensitivity 85% and specificity 69% for impaired CA. Patients with low eCPP or high eICP had lower NPi values than others. NPi was correlated with eCPP (r = 0.77, p < 0.01) and eICP (r = -0.87, p < 0.01). Automated pupillometry may play a role to assess brain hemodynamics in septic patients.


Assuntos
Isquemia Encefálica , Sepse , Adulto , Hemodinâmica , Humanos , Estudos Prospectivos , Pupila/fisiologia
20.
BMC Neurol ; 22(1): 273, 2022 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-35869429

RESUMO

BACKGROUND: Automated infrared pupillometry (AIP) and the Neurological Pupil index (NPi) provide an objective means of assessing and trending the pupillary light reflex (PLR) across a broad spectrum of neurological diseases. NPi quantifies the PLR and ranges from 0 to 5; in healthy individuals, the NPi of both eyes is expected to be ≥ 3.0 and symmetric. AIP values demonstrate emerging value as a prognostic tool with predictive properties that could allow practitioners to anticipate neurological deterioration and recovery. The presence of an NPi differential (a difference ≥ 0.7 between the left and right eye) is a potential sign of neurological abnormality. METHODS: We explored NPi differential by considering the modified Rankin Score at discharge (DC mRS) among patients admitted to neuroscience intensive care units (NSICU) of 4 U.S. and 1 Japanese hospitals and for two cohorts of brain injuries: stroke (including subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, and aneurysm, 1,200 total patients) and 185 traumatic brain injury (TBI) patients for a total of more than 54,000 pupillary measurements. RESULTS: Stroke patients with at least 1 occurrence of an NPi differential during their NSICU stay have higher DC mRS scores (3.9) compared to those without an NPi differential (2.7; P < .001). Patients with TBI and at least 1 occurrence of an NPi differential during their NSICU stay have higher discharge modified Rankin Scale scores (4.1) compared to those without an NPi differential (2.9; P < .001). When patients experience both abnormalities, abnormal (NPi < 3.0) and an NPi differential, the latter has an anticipatory relationship with respect to the former (P < .001 for z-score skewness analysis). Finally, our analysis confirmed ≥ 0.7 as the optimal cutoff value for the NPi differential (AUC = 0.71, P < .001). CONCLUSION: The NPi differential is an important factor that clinicians should consider when managing critically ill neurological injured patients admitted to the neurocritical care units. TRIAL REGISTRATION: NCT02804438 , Date of Registration: June 17, 2016.


Assuntos
Lesões Encefálicas Traumáticas , AVC Isquêmico , Acidente Vascular Cerebral , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Humanos , Alta do Paciente , Pupila , Reflexo Pupilar , Acidente Vascular Cerebral/complicações
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