Impact of examinees' stereopsis and near visual acuity on laparoscopic virtual reality performance.

PURPOSE: Laparoscopic surgery represents specific challenges, such as the reduction of a three-dimensional anatomic environment to two dimensions. The aim of this study was to investigate the impact of the loss of the third dimension on laparoscopic virtual reality (VR) performance. METHODS: We compared a group of examinees with impaired stereopsis (group 1, n = 28) to a group with accurate stereopsis (group 2, n = 29). The primary outcome was the difference between the mean total score (MTS) of all tasks taken together and the performance in task 3 (eye-hand coordination), which was a priori considered to be the most dependent on intact stereopsis. RESULTS: The MTS and performance in task 3 tended to be slightly, but not significantly, better in group 2 than in group 1 [MTS: -0.12 (95 % CI -0.32, 0.08; p = 0.234); task 3: -0.09 (95 % CI -0.29, 0.11; p = 0.385)]. The difference of MTS between simulated impaired stereopsis between group 2 (by attaching an eye patch on the adominant eye in the 2nd run) and the first run of group 1 was not significant (MTS: p = 0.981; task 3: p = 0.527). CONCLUSION: We were unable to demonstrate an impact of impaired examinees' stereopsis on laparoscopic VR performance. Individuals with accurate stereopsis seem to be able to compensate for the loss of the third dimension in laparoscopic VR simulations

A Method of Solution of the Two Dimensional Hydrodynamical Problems with Free Surface

Background and purpose: The role of lifestyle and dietary habits and antecedent events has not been clearly identified in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Methods: Information was collected about modifiable environmental factors and antecedent infections and vaccinations in patients with CIDP included in an Italian CIDP Database. Only patients who reported not having changed their diet or the lifestyle habits investigated in the study after the appearance of CIDP were included. The partners of patients with CIDP were chosen as controls. Gender-matched analysis was performed with randomly selected controls with a 1:1 ratio of patients and controls. Results: Dietary and lifestyle data of 323 patients and 266 controls were available. A total of 195 cases and 195 sex-matched controls were used in the analysis. Patients eating rice at least three times per week or eating fish at least once per week appeared to be at decreased risk of acquiring CIDP. Data on antecedent events were collected in 411 patients. Antecedent events within 1\u201342 days before CIDP onset were reported by 15.5% of the patients, including infections in 12% and vaccinations in 1.5%. Patients with CIDP and antecedent infections more often had an acute onset of CIDP and cranial nerve involvement than those without these antecedent events. Conclusions: The results of this preliminary study seem to indicate that some dietary habits may influence the risk of CIDP and that antecedent infections may have an impact on the onset and clinical presentation of the disease

Relevance of diagnostic investigations in chronic inflammatory demyelinating poliradiculoneuropathy: Data from the Italian CIDP database

The objective of our work was to report the clinical features and the relevance of diagnostic investigations in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We retrospectively reviewed data from patients with a clinical diagnosis of CIDP included in a national database. Among the 500 included patients with a clinical diagnosis of CIDP, 437 patients (87%) fulfilled the European Federation of Neurological Societies and Peripheral Nerve Society criteria for CIDP (definite in 407, probable in 26, possible in four). In 352 patients (86%) motor nerve conduction abnormalities consistent with demyelination were sufficient for the diagnosis of definite CIDP. In 55 patients, this diagnosis required the addition of one or two (from probable or from possible CIDP, respectively) supportive tests, while in 20 cases they improved the diagnosis from possible to probable CIDP, seven patients did not change diagnosis. Considering these 85 patients, cerebrospinal fluid studies were performed in 79 cases (93%) upgrading the certainty of diagnosis in 59% of examined patients. Sensory nerve conduction studies (NCS) were performed in 85% of patients with an improvement of diagnosis in 32% of cases. Nerve biopsy and ultrasound and magnetic resonance imaging (US/MRI) exams resulted positive in about 40% of examined patients, but they were performed in few patients (7 patients and 16 patients, respectively). A response to the therapy was present in 84% of treated patients (n = 77), contributing to support the diagnosis in 40 patients in whom the other supportive criteria were not sufficient. In most patients with CIDP the diagnosis is possible solely with motor NCS while other investigations may help improving the diagnosis in a minority of patients

Impact of environmental factors and physical activity on disability and quality of life in CIDP

A few observational studies and randomized trials suggest that exercise and rehabilitation may improve activity limitation and quality of life (QoL) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), but the impact of other modifiable factors on the severity of the disease is not well understood. Using a structured questionnaire, we collected data on lifestyle and dietary habits of the patients included in the Italian CIDP database to investigate the possible influence of modifiable lifestyle factors on disability and QoL. Questionnaire data were available for 323 patients. The effect of lifestyle and dietary exposures on impairment, disability and QoL was evaluated using logistic regression models, adjusting for age, sex, disease duration, physical activity and smoking. Physical activity was associated with lower sensory impairment by the ISS scale, less disability by the INCAT and RODS scale and a better QoL in all the domains of EURO-QoL scale with the exception of anxiety/depression. None of the other parameters had an impact on these scales. This study adds evidence to the possible role of physical activity in improving symptom severity, disability and QoL in patients with CIDP. None of the other environmental factors investigated appeared to have an impact on the severity and health perception of CIDP

Chronic inflammatory demyelinating polyradiculoneuropathy: can a diagnosis be made in patients not fulfilling electrodiagnostic criteria?

79noBackground and purpose: The aim was to identify the clinical and diagnostic investigations that may help to support a diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) in patients not fulfilling the European Federation of Neurological Societies and Peripheral Nerve Society (EFNS/PNS) electrodiagnostic criteria. Methods: The data from patients with a clinical diagnosis of CIDP included in a national database were retrospectively reviewed. Results: In all, 535 patients with a diagnosis of CIDP were included. This diagnosis fulfilled the EFNS/PNS criteria in 468 patients (87.2%) (definite in 430, probable in 33, possible in three, while two had chronic immune sensory polyradiculopathy). Sixty-seven patients had a medical history and clinical signs compatible with CIDP but electrodiagnostic studies did not fulfill the EFNS/PNS criteria for CIDP. These patients had similar clinical features and frequency of abnormal supportive criteria for the diagnosis of CIDP compared to patients fulfilling EFNS/PNS criteria. Two or more abnormal supportive criteria were present in 40 (61.2%) patients rising to 54 (80.6%) if a history of a relapsing course as a possible supportive criterion was also included. Increased cerebrospinal fluid proteins and response to immune therapy most frequently helped in supporting the diagnosis of CIDP. Response to therapy was similarly frequent in patients fulfilling or not EFNS/PNS criteria (87.3% vs. 85.9%). Conclusions: Patients with a clinical diagnosis of CIDP had similar clinical findings, frequency of abnormal supportive criteria and response to therapy compared to patients fulfilling EFNS/PNS criteria. The presence of abnormal supportive criteria may help in supporting the diagnosis of CIDP in patients with a medical history and clinical signs compatible with this diagnosis but non-diagnostic nerve conduction studies.nonenoneLiberatore G.; Manganelli F.; Doneddu P.E.; Cocito D.; Fazio R.; Briani C.; Filosto M.; Benedetti L.; Mazzeo A.; Antonini G.; Cosentino G.; Jann S.; Cortese A.; Marfia G.A.; Clerici A.M.; Siciliano G.; Carpo M.; Luigetti M.; Lauria G.; Rosso T.; Cavaletti G.; Santoro L.; Peci E.; Tronci S.; Ruiz M.; Cotti Piccinelli S.; Schenone A.; Leonardi L.; Toscano A.; Mataluni G.; Spina E.; Gentile L.; Nobile-Orazio E.; Doneddu P.E.; Liberatore G.; Gallia F.; Nobile-Orazio E.; Peci E.; Cocito D.; Tronci S.; Fazio R.; Manganelli F.; Santoro L.; Spina E.; Ruiz M.; Briani C.; Cotti Piccinelli S.; Filosto M.; Beronio A.; Benedetti L.; Toscano A.; Gentile L.; Mazzeo A.; Mataluni G.; Marfia G.A.; Piccolo L.; Cortese A.; Cosentino G.; Fierro B.; Verrengia E.P.; Jann S.; Bianchi E.; Beghi E.; Clerici A.M.; Scrascia F.; Carpo M.; Garnero M.; Schenone A.; Luigetti M.; Sabatelli M.; Dacci P.; Lauria G.; Leonardi L.; Antonini G.; Rosso T.; Schirinzi E.; Siciliano G.; Balducci C.; Cavaletti G.Liberatore, G.; Manganelli, F.; Doneddu, P. E.; Cocito, D.; Fazio, R.; Briani, C.; Filosto, M.; Benedetti, L.; Mazzeo, A.; Antonini, G.; Cosentino, G.; Jann, S.; Cortese, A.; Marfia, G. A.; Clerici, A. M.; Siciliano, G.; Carpo, M.; Luigetti, M.; Lauria, G.; Rosso, T.; Cavaletti, G.; Santoro, L.; Peci, E.; Tronci, S.; Ruiz, M.; Cotti Piccinelli, S.; Schenone, A.; Leonardi, L.; Toscano, A.; Mataluni, G.; Spina, E.; Gentile, L.; Nobile-Orazio, E.; Doneddu, P. E.; Liberatore, G.; Gallia, F.; Nobile-Orazio, E.; Peci, E.; Cocito, D.; Tronci, S.; Fazio, R.; Manganelli, F.; Santoro, L.; Spina, E.; Ruiz, M.; Briani, C.; Cotti Piccinelli, S.; Filosto, M.; Beronio, A.; Benedetti, L.; Toscano, A.; Gentile, L.; Mazzeo, A.; Mataluni, G.; Marfia, G. A.; Piccolo, L.; Cortese, A.; Cosentino, G.; Fierro, B.; Verrengia, E. P.; Jann, S.; Bianchi, E.; Beghi, E.; Clerici, A. M.; Scrascia, F.; Carpo, M.; Garnero, M.; Schenone, A.; Luigetti, M.; Sabatelli, M.; Dacci, P.; Lauria, G.; Leonardi, L.; Antonini, G.; Rosso, T.; Schirinzi, E.; Siciliano, G.; Balducci, C.; Cavaletti, G