Analysis of higher-order aberrations in a large clinical population

Purpose: To use a large wavefront database of a clinical population to investigate relationships between refractions and higher order aberrations and between aberrations of right and left eyes. Methods: Third and fourth-order aberration coefficients and higher-order root-mean-squared aberrations (HO RMS), scaled to a pupil size of 4.5 mm diameter, were analysed in a population of about 24,000 patients from Carl Zeiss Vision's European wavefront database. Correlations were determined between the aberrations and the variables of refraction, near addition and cylinder. Results: Most aberration coefficients were significantly dependent upon these variables, but the proportions of aberrations that could be explained by these factors were less than 2% except for spherical aberration (12%), horizontal coma (9%) and HO RMS (7%). Near addition was the major contributor for horizontal coma (8.5% out of 9.5%) and spherical equivalent was the major contributor for spherical aberration (7.7% out of 11.6%). Interocular correlations were highly significant for all aberration coefficients, varying between 0.16 and 0.81. Anisometropia was a variable of significance for three aberrations (vertical coma, secondary astigmatism and tetrafoil), but little importance can be placed on this because of the small proportions of aberrations that can be explained by refraction (all less than 1.0 %). Conclusions: Most third- and fourth-order aberration coefficients were significantly dependent upon spherical equivalent, near addition and cylinder, but only horizontal coma (9%) and spherical aberration (12%) showed dependencies of greater than 2%. Interocular correlations were highly significant for all aberration coefficients, but anisometropia had little influence on aberration coefficients.

Optical and biomechanical factors, associated with near work and myopia

Near work may play an important role in the development of myopia in the younger population. The prevalence of myopia has also been found to be higher in occupations that involve substantial near work tasks, for example in microscopists and textile workers. When nearwork is performed, it typically involves accommodation, convergence and downward gaze. A number of previous studies have examined the effects of accommodation and convergence on changes in the optics and biometrics of the eye in primary gaze. However, little is known about the influence of accommodation on the eye in downward gaze. This thesis is primarily concerned with investigating the changes in the eye during near work in downward gaze under natural viewing conditions. To measure wavefront aberrations in downward gaze under natural viewing conditions, we modified a commercial Shack-Hartmann wavefront sensor by adding a relay lens system to allow on-axis ocular aberration measurements in primary gaze and downward gaze, with binocular fixation. Measurements with the modified wavefront sensor in primary and downward gaze were validated against a conventional aberrometer using both a model eye and in 9 human subjects. We then conducted an experiment to investigate changes in ocular aberrations associated with accommodation in downward gaze over 10 mins in groups of both myopes (n = 14) and emmetropes (n =12) using the modified Shack-Hartmann wavefront sensor. During the distance accommodation task, small but significant changes in refractive power (myopic shift) and higher order aberrations were observed in downward gaze compared to primary gaze. Accommodation caused greater changes in higher order aberrations (in particular coma and spherical aberration) in downward gaze than primary gaze, and there was evidence that the changes in certain aberrations with accommodation over time were different in downward gaze compared to primary gaze. There were no obvious systematic differences in higher order aberrations between refractive error groups during accommodation or downward gaze for fixed pupils. However, myopes exhibited a significantly greater change in higher order aberrations (in particular spherical aberration) than emmetropes for natural pupils after 10 mins of a near task (5 D accommodation) in downward gaze. These findings indicated that ocular aberrations change from primary to downward gaze, particularly with accommodation. To understand the mechanism underlying these changes in greater detail, we then extended this work to examine the characteristics of the corneal optics, internal optics, anterior biometrics and axial length of the eye during a near task, in downward gaze, over 10 mins. Twenty young adult subjects (10 emmetropes and 10 myopes) participated in this study. To measure corneal topography and ocular biometrics in downward gaze, a rotating Scheimpflug camera and an optical biometer were inclined on a custom built, height and tilt adjustable table. We found that both corneal optics and internal optics change with downward gaze, resulting in a myopic shift (~0.10 D) in the spherical power of the eye. The changes in corneal optics appear to be due to eyelid pressure on the anterior surface of the cornea, whereas the changes in the internal optics (an increase in axial length and a decrease in anterior chamber depth) may be associated with movement of the crystalline lens, under the action of gravity, and the influence of altered biomechanical forces from the extraocular muscles on the globe with downward gaze. Changes in axial length with accommodation were significantly greater in downward gaze than primary gaze (p < 0.05), indicating an increased effect of the mechanical forces from the ciliary muscle and extraocular muscles. A subsequent study was conducted to investigate the changes in anterior biometrics, axial length and choroidal thickness in nine cardinal gaze directions under the actions of the extraocular muscles. Ocular biometry measurements were obtained from 30 young adults (10 emmetropes, 10 low myopes and 10 moderate myopes) through a rotating prism with 15° deviation, along the foveal axis, using a non-contact optical biometer in each of nine different cardinal directions of gaze, over 5 mins. There was a significant influence of gaze angle and time on axial length (both p < 0.001), with the greatest axial elongation (+18 ± 8 μm) occurring with infero-nasal gaze (p < 0.001) and a slight decrease in axial length in superior gaze (−12 ± 17 μm) compared with primary gaze (p < 0.001). There was a significant correlation between refractive error (spherical equivalent refraction) and the mean change in axial length in the infero-nasal gaze direction (Pearson's R2 = 0.71, p < 0.001). To further investigate the relative effect of gravity and extraocular muscle force on the axial length, we measured axial length in 15° and 25° downward gaze with the biometer inclined on a tilting table that allowed gaze shifts to occur with either full head turn but no eye turn (reflects the effect of gravity), or full eye turn with no head turn (reflects the effect of extraocular muscle forces). We observed a significant axial elongation in 15° and 25° downward gaze in the full eye turn condition. However, axial length did not change significantly in downward gaze over 5 mins (p > 0.05) in the full head turn condition. The elongation of the axial length in downward gaze appears to be due to the influence of the extraocular muscles, since the effect was not present when head turn was used instead of eye turn. The findings of these experiments collectively show the dynamic characteristics of the optics and biometrics of the eye in downward gaze during a near task, over time. These were small but significant differences between myopic and emmetropic eyes in both the optical and biomechanical changes associated with shifts of gaze direction. These differences between myopes and emmetropes could arise as a consequence of excessive eye growth associated with myopia. However the potentially additive effects of repeated or long lasting near work activities employing infero-nasal gaze could also act to promote elongation of the eye due to optical and/or biomechanical stimuli.

Interocular corneal symmetry in refractive error groups

Purpose: To examine between eye differences in corneal higher order aberrations and topographical characteristics in a range of refractive error groups. Methods: One hundred and seventy subjects were recruited including; 50 emmetropic isometropes, 48 myopic isometropes (spherical equivalent anisometropia ≤ 0.75 D), 50 myopic anisometropes (spherical equivalent anisometropia ≥ 1.00 D) and 22 keratoconics. The corneal topography of each eye was captured using the E300 videokeratoscope (Medmont, Victoria, Australia) and analyzed using custom written software. All left eye data were rotated about the vertical midline to account for enantiomorphism. Corneal height data were used to calculate the corneal wavefront error using a ray tracing procedure and fit with Zernike polynomials (up to and including the eighth radial order). The wavefront was centred on the line of sight by using the pupil offset value from the pupil detection function in the videokeratoscope. Refractive power maps were analysed to assess corneal sphero-cylindrical power vectors. Differences between the more myopic (or more advanced eye for keratoconics) and the less myopic (advanced) eye were examined. Results: Over a 6 mm diameter, the cornea of the more myopic eye was significantly steeper (refractive power vector M) compared to the fellow eye in both anisometropes (0.10 ± 0.27 D steeper, p = 0.01) and keratoconics (2.54 ± 2.32 D steeper, p < 0.001) while no significant interocular difference was observed for isometropic emmetropes (-0.03 ± 0.32 D) or isometropic myopes (0.02 ± 0.30 D) (both p > 0.05). In keratoconic eyes, the between eye difference in corneal refractive power was greatest inferiorly (associated with cone location). Similarly, in myopic anisometropes, the more myopic eye displayed a central region of significant inferior corneal steepening (0.15 ± 0.42 D steeper) relative to the fellow eye (p = 0.01). Significant interocular differences in higher order aberrations were only observed in the keratoconic group for; vertical trefoil C(3,-3), horizontal coma C(3,1) secondary astigmatism along 45 C(4, -2) (p < 0.05) and vertical coma C(3,-1) (p < 0.001). The interocular difference in vertical pupil decentration (relative to the corneal vertex normal) increased with between eye asymmetry in refraction (isometropia 0.00 ± 0.09, anisometropia 0.03 ± 0.15 and keratoconus 0.08 ± 0.16 mm) as did the interocular difference in corneal vertical coma C (3,-1) (isometropia -0.006 ± 0.142, anisometropia -0.037 ± 0.195 and keratoconus -1.243 ± 0.936 μm) but only reached statistical significance for pair-wise comparisons between the isometropic and keratoconic groups. Conclusions: There is a high degree of corneal symmetry between the fellow eyes of myopic and emmetropic isometropes. Interocular differences in corneal topography and higher order aberrations are more apparent in myopic anisometropes and keratoconics due to regional (primarily inferior) differences in topography and between eye differences in vertical pupil decentration relative to the corneal vertex normal. Interocular asymmetries in corneal optics appear to be associated with anisometropic refractive development.

Higher-order aberrations and anisometropia

Purpose/aim Myopia incidence is increasing around the world. Myopisation is considered to be caused by a variety of factors. One consideration is whether higher-order aberrations (HOA) influence myopisation. More knowledge of optics in anisometropic eyes might give further insight into the development of refractive error. Materials and methods To analyse the possible influence of HOA on refractive error development, we compared HOA between anisometropes and isometropes. We analysed HOA up to the 4th order for both eyes of 20 anisometropes (mean age: 43 ± 17 years) and 20 isometropes (mean age: 33 ±17 years). HOA were measured with the Shack-Hartman i.Profiler (Carl Zeiss, Germany) and were recalculated for a 4 mm pupil. Mean spherical equivalent (MSE) was based on the subjective refraction. Anisometropia was defined as ≥1D interocular difference in MSE. The mean absolute differences between right and left eyes in spherical equivalent were 0.28 ± 0.21 D in the isometropic group and 2.81 ± 2.04 D in the anisometropic group. Interocular differences in HOA were compared with the interocular difference in MSE using correlations. Results For isometropes oblique trefoil, vertical coma, horizontal coma and spherical aberration showed significant correlations between the two eyes. In anisometropes all analysed higher-order aberrations correlated significantly between the two eyes except oblique secondary astigmatism and secondary astigmatism. When analysing anisometropes and isometropes separately, no significant correlations were found between interocular differences of higher-order aberrations and MSE. For isometropes and anisometropes combined, tetrafoil correlated significantly with MSE in left eyes. Conclusions The present study could not show that interocular differences of higher-order aberrations increase with increasing interocular difference in MSE.

Stability of corneal topography and wavefront aberrations in young Singaporeans

Purpose To investigate the differences between and variations across time in corneal topography and ocular wavefront aberrations in young Singaporean myopes and emmetropes. Methods We used a videokeratoscope and wavefront sensor to measure the ocular surface topography and wavefront aberrations of the total eye optics in the morning, mid-day and late afternoon on two separate days. Topography data were used to derive the corneal surface wavefront aberrations. Both the corneal and total wavefronts were analysed up to the 4th radial order of the Zernike polynomial expansion, and were centred on the entrance pupil (5 mm). The participants included 12 young progressing myopes, 13 young stable myopes and 15 young age-matched emmetropes. Results For all subjects considered together there were significant changes in some of the aberrations terms across the day, such as spherical aberration ( ) and vertical coma ( ) (repeated measures ANOVA, p<0.05). The magnitude of positive spherical aberration ( ) was significantly lower in the progressing myope group than that of the stable myopes (p=0.04) and emmetrope group (p=0.02). There were also significant interactions between refractive group and time of day for with/against-the-rule astigmatism ( ). Significantly lower 4th order RMS of ocular wavefront aberrations were found in the progressing myope group compared with the stable myopes and emmetropes (p<0.01). Conclusions These differences and variations in the corneal and total aberrations may have significance for our understanding of refractive error development and for clinical applications requiring accurate wavefront measurements.

Visual rehabilitation in low-moderate keratoconus : intracorneal ring segment implantation followed by same-day topography-guided photorefractive keratectomy and collagen cross linking

AIM: To present the results of same-day topography-guided photorefractive keratectomy (TG-PRK) and corneal collagen crosslinking (CXL) after previous intrastromal corneal ring segment (ISCR) implantation for keratoconus. METHODS: An experimental clinical study on twenty-one eyes of 19 patients aged, 27.1±6.6 years (range: 19 – 43 years), with low to moderate keratoconus who were selected to undergo customized TG-PRK immediately followed by same-day CXL, 9 months after ISCR implantation in a university ophthalmology clinic. Refraction, uncorrected (UDVA) and corrected distance visual acuities (CDVA), keratometry (K) values, central corneal thickness (CCT) and coma were assessed 3 months after TG/PRK and CXL. RESULTS: After TG-PRK/CXL: the mean UDVA (logMAR) improved significantly from 0.66±0.41 to 0.20±0.25 (P<0.05); K flat value decreased from: 48.44±3.66 D to 43.71±1.95 D; K steep value decreased from 45.61±2.40 D to 41.56±2.05D; K average also decreased from 42.42±2.07 D to 47.00±2.66 D (P<0.05 for all). The mean sphere and cylinder decreased significantly post-surgery from, -3.10±2.99 D to -0.11±0.93 D and from, -3.68±1.53 to -1.11±0.75D respectively, while the CDVA, CCT and coma showed no significant changes. Compared to post-ISCR, significant reductions (P ˂ 0.05 or all) in all K-values, sphere and cylinder were observed after TG-PRK/CXL. CONCLUSION: Same-day combined topography-guided PRK and corneal crosslinking following placement of ICRS is a safe and potentially effective option in treating low-moderate keratoconus. It significantly improved all visual acuity, reduced keratometry, sphere and astigmatism, but caused no change in central corneal thickness and coma.

Effects of pupil center shift on ocular aberrations

Purpose: To investigate effects of pupil shifts, occurring with changes in luminance and accommodation stimuli, on refraction components and higher-order aberrations. Method: Participants were young and older groups (n=20, 22±2 years, age range 18–25 years; n=19, 49±4 years, 45–58 years). Aberrations/refractions at 4 mm and 3 mm diameters were compared between centered and decentered pupils for low (background 0.01cd/m², 0D), and high (6100cd/m², 4D or 6D) stimuli. Decentration was the difference between pupil centers for low and high stimuli. Clinical important changes with decentration were: M ±0.50D or ±0.25D, J180 and J45 ±0.25D or ±0.125D, HORMS ±0.05m, C(3, 1) ±0.05m, C(4, 0) ±0.05m. Results: Because of small pupil shifts in most participants (mean 0.26mm), there were few important changes in most refraction components and higher-order aberration terms. However, M changed by >0.25 D for a third of participants with 4mm pupils. When determining refractions from 2nd-6th order aberration coefficients, the more stringent criteria gave 76/ 534 (14%) possible important changes. Some participants had large pupil shifts with considerable aberration changes. Comparisons at the high stimulus were possible for only 11 participants because of small pupils. When refractions were determined from 2nd order aberration coefficients only, there were only 35 (7%) important changes for the more stringent criteria. Conclusion: Usually pupil shifts with changes in stimulus conditions have little influence on aberrations, but they can with high shifts. The number of aberrations orders that are considered as contributing to refraction influences the proportion of cases that might be considered clinically important.

One-year clinical outcomes of a two-step surgical management for keratoconus-topography-guided photorefractive keratectomy/cross-linking after intrastromal corneal ring implantation

PURPOSE - To present the results of same-day topography-guided photorefractive keratectomy (TG-PRK) and corneal collagen cross-linking (CXL) after intrastromal corneal ring (ISCR) implantation in patients with keratoconus. METHODS - Thirty-three patients (41 eyes) aged between 19 and 45 years were included in this prospective study. All patients underwent a femtosecond laser-enabled (Intralase FS; Abbott Medical Optics, Inc.) placement of intracorneal ring segments (Kerarings; Mediphacos, Brazil). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and keratometry readings remained stable for 6 months. Same-day PRK and CXL was subsequently performed in all patients. RESULTS - After 12 months of completion of the procedure, mean UDVA in log of minimal angle of resolution was significantly improved (0.74±0.54-0.10±0.16); CDVA did not improve significantly but 85% of eyes maintained or gained multiple lines of CDVA; mean refraction spherical equivalent improved (from -3.03±1.98 to -0.04±0.99 D), all keratometry readings were significantly reduced, from preoperative values, but coma did not vary significantly from preoperative values. Central corneal thickness and corneal thickness at the thinnest point were significantly (P<0.0001) reduced from 519.76±29.33 and 501.87±31.50 preoperatively to 464.71±36.79 and 436.55±47.42 postoperatively, respectively. Safety and efficacy indices were 0.97 and 0.88, respectively. From 6 months up until more than 1 year of follow-up, further significant improvement was observed only for UDVA (P<0.0001). CONCLUSIONS - Same-day combined TG-PRK and CXL after ISCR implantation is a safe and effective option for improving visual acuity and visual function, and it halts the progression of the keratoconus. The improvements recorded after 6 months of follow-up were maintained or improved upon 1 year after the procedure.

The Queensland liver transplant programme: The first two years

Orthotopic liver transplantation began in Brisbane in January 1985. During the first two years of the programme an assessment committee evaluated 55 patients (38 adults, 17 children). Patients were either accepted for transplantation, rejected as unsuitable or deferred for elective reassessment. All of the 10 adults who were rejected for transplantation because they had 'too advanced' disease died within four months of assessment. Six children who were accepted for transplantation died before a suitable donor liver could be found. In the first two years, 21 orthotopic liver transplantations were performed on 18 patients (adults, 13 patients; children, five patients). Fifteen of 21 grafts were procured from within Queensland. Twelve (67%) patients are alive at three to 23 months and all have been discharged from hospital. Deaths in adults were due to sepsis (three patients), aspiration pneumonitis (one patient), rejection and hepatic artery thrombosis (one patient) and the recurrence of a hepatocellular carcinoma five months after discharge from hospital (one patient). Two patients underwent a second transplantation procedure because of chronic rejection at four months and at 11 months, respectively, after the initial operation. One patient received a second transplant for primary graft failure at four days after the operation. A scoring system which considered the presence of pre-operative patient factors, such as coma, ascites, malnutrition and previous abdominal surgery, partly predicted the operative blood loss and patient survival. In conclusion, orthotopic liver transplantation is being performed in Australia with survival rates that are comparable with those of established overseas units.

Miniscleral lens wear influences corneal curvature and optics

Purpose Transient changes in corneal topography associated with soft and conventional or reverse geometry rigid contact lens wear have been well documented; however, only a few studies have examined the influence of scleral contact lens wear upon the cornea. Therefore, in this study, we examined the influence of modern miniscleral contact lenses, which land entirely on the sclera and overlying tissues, upon anterior corneal curvature and optics. Methods Anterior corneal topography and elevation data were acquired using Scheimpflug imaging (Pentacam HR, Oculus) immediately prior to and following 8 hours of miniscleral contact lens wear in 15 young healthy adults (mean age 22 ± 3 years, 8 East Asian, 7 Caucasian) with normal corneae. Corneal diurnal variations were accounted for using data collected on a dedicated measurement day without contact lens wear. Corneal clearance was quantified using an optical coherence tomographer (RS-3000, Nidek) following lens insertion and after 8 hours of lens wear. Results Although corneal clearance was maintained throughout the 8 hour lens wear period, significant corneal flattening (up to 0.08 ± 0.04 mm) was observed, primarily in the superior mid-peripheral cornea, which resulted in a slight increase in against-the-rule corneal astigmatism (mean +0.02/-0.15 x 94 for an 8 mm diameter). Higher order aberration terms of horizontal coma, vertical coma and spherical aberration all underwent significant changes for an 8 mm corneal diameter (p ≤ 0.01), which typically resulted in a decrease in RMS error values (mean change in total higher order RMS -0.035 ± 0.046 µm for an 8 mm diameter). There was no association between the magnitude of change in central or mid-peripheral corneal clearance during lens wear and the observed changes in corneal curvature (p > 0.05). However, Asian participants displayed a significantly greater reduction in corneal clearance (p = 0.04) and greater superior-nasal corneal flattening compared to Caucasians (p = 0.048). Conclusions Miniscleral contact lenses that vault the cornea induce significant changes in anterior corneal surface topography and higher order aberrations following 8 hours of lens wear. The region of greatest corneal flattening was observed in the superior-nasal mid-periphery, more so in Asian participants. Practitioners should be aware that corneal measurements obtained following miniscleral lens removal may mask underlying corneal steepening.

Induced higher-order aberrations after laser in situ keratomileusis (LASIK) performed with wavefront-guided IntraLase femtosecond laser in moderate to high astigmatism

Background Wavefront-guided Laser-assisted in situ keratomileusis (LASIK) is a widespread and effective surgical treatment for myopia and astigmatic correction but whether it induces higher-order aberrations remains controversial. The study was designed to evaluate the changes in higher-order aberrations after wavefront-guided ablation with IntraLase femtosecond laser in moderate to high astigmatism. Methods Twenty-three eyes of 15 patients with moderate to high astigmatism (mean cylinder, −3.22 ± 0.59 dioptres) aged between 19 and 35 years (mean age, 25.6 ± 4.9 years) were included in this prospective study. Subjects with cylinder ≥ 1.5 and ≤2.75 D were classified as moderate astigmatism while high astigmatism was ≥3.00 D. All patients underwent a femtosecond laser–enabled (150-kHz IntraLase iFS; Abbott Medical Optics Inc) wavefront-guided ablation. Uncorrected (UDVA), corrected (CDVA) distance visual acuity in logMAR, keratometry, central corneal thickness (CCT) and higher-order aberrations (HOAs) over a 6 mm pupil, were assessed before and 6 months, postoperatively. The relationship between postoperative change in HOA and preoperative mean spherical equivalent refraction, mean astigmatism, and postoperative CCT were tested. Results At the last follow-up, the mean UDVA was increased (P < 0.0001) but CDVA remained unchanged (P = 0.48) and no eyes lost ≥2 lines of CDVA. Mean spherical equivalent refraction was reduced (P < 0.0001) and was within ±0.50 D range in 61 % of eyes. The average corneal curvature was flatter by 4 D and CCT was reduced by 83 μm (P < 0.0001, for all), postoperatively. Coma aberrations remained unchanged (P = 0.07) while the change in trefoil (P = 0.047) postoperatively, was not clinically significant. The 4th order HOAs (spherical aberration and secondary astigmatism) and the HOA root mean square (RMS) increased from −0.18 ± 0.07 μm, 0.04 ± 0.03 μm and 0.47 ± 0.11 μm, preoperatively, to 0.33 ± 0.19 μm (P = 0.004), 0.21 ± 0.09 μm (P < 0.0001) and 0.77 ± 0.27 μm (P < 0.0001), six months postoperatively. The change in spherical aberration after the procedure increased with an increase in the degree of preoperative myopia. Conclusions Wavefront-guided IntraLASIK offers a safe and effective option for vision and visual function improvement in astigmatism. Although, reduction of HOA is possible in a few eyes, spherical-like aberrations are increased in majority of the treated eyes.

Therapeutic hypothermia after cardiac arrest : Studies on neurological and cardiological outcome and prediction of outcome in hypothermia-treated patients resuscitated from out-of-hospital cardiac arrest

The outcome of the successfully resuscitated patient is mainly determined by the extent of hypoxic-ischemic cerebral injury, and hypothermia has multiple mechanisms of action in mitigating such injury. The present study was undertaken from 1997 to 2001 in Helsinki as a part of the European multicenter study Hypothermia after cardiac arrest (HACA) to test the neuroprotective effect of therapeutic hypothermia in patients resuscitated from out-of-hospital ventricular fibrillation (VF) cardiac arrest (CA). The aim of this substudy was to examine the neurological and cardiological outcome of these patients, and especially to study and develop methods for prediction of outcome in the hypothermia-treated patients. A total of 275 patients were randomized to the HACA trial in Europe. In Helsinki, 70 patients were enrolled in the study according to the inclusion criteria. Those randomized to hypothermia were actively cooled externally to a core temperature 33 ± 1ºC for 24 hours with a cooling device. Serum markers of ischemic neuronal injury, NSE and S-100B, were sampled at 24, 36, and 48 hours after CA. Somatosensory and brain stem auditory evoked potentials (SEPs and BAEPs) were recorded 24 to 28 hours after CA; 24-hour ambulatory electrocardiography recordings were performed three times during the first two weeks and arrhythmias and heart rate variability (HRV) were analyzed from the tapes. The clinical outcome was assessed 3 and 6 months after CA. Neuropsychological examinations were performed on the conscious survivors 3 months after the CA. Quantitative electroencephalography (Q-EEG) and auditory P300 event-related potentials were studied at the same time-point. Therapeutic hypothermia of 33ºC for 24 hours led to an increased chance of good neurological outcome and survival after out-of-hospital VF CA. In the HACA study, 55% of hypothermia-treated patients and 39% of normothermia-treated patients reached a good neurological outcome (p=0.009) at 6 months after CA. Use of therapeutic hypothermia was not associated with any increase in clinically significant arrhythmias. The levels of serum NSE, but not the levels of S-100B, were lower in hypothermia- than in normothermia-treated patients. A decrease in NSE values between 24 and 48 hours was associated with good outcome at 6 months after CA. Decreasing levels of serum NSE but not of S-100B over time may indicate selective attenuation of delayed neuronal death by therapeutic hypothermia, and the time-course of serum NSE between 24 and 48 hours after CA may help in clinical decision-making. In SEP recordings bilaterally absent N20 responses predicted permanent coma with a specificity of 100% in both treatment arms. Recording of BAEPs provided no additional benefit in outcome prediction. Preserved 24- to 48-hour HRV may be a predictor of favorable outcome in CA patients treated with hypothermia. At 3 months after CA, no differences appeared in any cognitive functions between the two groups: 67% of patients in the hypothermia and 44% patients in the normothermia group were cognitively intact or had only very mild impairment. No significant differences emerged in any of the Q-EEG parameters between the two groups. The amplitude of P300 potential was significantly higher in the hypothermia-treated group. These results give further support to the use of therapeutic hypothermia in patients with sudden out-of-hospital CA.

Establecimiento y caracterización dendrológica de cultivares clonales Spondia sp., en el arboretum Alain Meyrat de la Universidad Nacional Agraria

El presente trabajo se realizó en el Arboretum de la Universidad Nacional Agraria. El objetivo del estudio es identificar las características morfológicas de cada cultivar clónal como: largo de la hoja, número y largo de folíolo, ancho de la base y ápice, sobrevivencia, número y tamaño de rebrotes. La metodología consta de tres etapas: recorrido entre los municipios de Masaya y Granada para la obtención de el material vegetativo con una dimensión de 1.30 m de altura y 10cm de diámetro por estaca. Establecimiento de plantación de 10 cultivares de Spondia sp. para un total de 40 estacas con una distancia de 3 x 3 m. para un área total de 243m2. Toma de datos cada seis meses para realizar el análisis estadístico empleando el programa INFOSTAT y mediante el encadenamiento simple (Distancia Euclidiana) se dividieron los 9 cultivares en 4 grupos y se procedió a realizar un ANOVA obteniendo que los cultivares clónales presentan diferencia significativa (p<000.1) en cuanto a sus variables. Como resultados se obtiene una sobrevivencia del 100% en los cultivares clónales de jocote perro, jocote agosteño, jocote rosa y jocote diente de perro, siendo el jocote de cocer sabanero el que no sobrevivió. Dentro de las características morfológicas sobresaliente se identifica como el raquis más largo al jocote rosa, con un promedio de 23.4 cm y el de menor longitud con 13.8 es el jocote agosteño, el mayor promedio de folíolos por hoja lo tiene el jocote bejuco con 20 y el de menor promedio el jocote agosteño con 14. Entre las variables número y largo de foliolo, largo del raquis, ancho de la base y ápice mediante un ANOVA se obtuvo diferencia significativa (p<000.1). De acuerdo a los estudios morfológicos aplicados a los nueve cultivares clónales sobrevivientes se ubican dentro de la especie Spondias purpurea.

Composición e identificación de malezas en pasto estrella (Cynodon nemfluencis), Cofradía, Carretera vieja Tipitapa-Managua

Con el objetivo de caracterizar la composición botánica de especies forrajera y no forrajera en sistemas de pastura de pasto estrella (Cynodon nlenfluencis), en la Hacienda Los Tercios, comarca Cofradía, km 16 ½ carretera Managua – Tipitapa, se realizó el presente trabajo. Para la ejecución del mismo y dada las posibilidades se seleccionaron dos condiciones, una con árboles y otra sin árboles, donde se realizó primeramente la determinación de la composición botánica, utilizando para ello el método del doble muestreo, simultáneamente se realizó la primera colecta de material vegetativo, el cual posteriormente fue identificado en el herbario de la UNA, herbario Nacional y a través de consultas con expertos en la materia (Botánicos). A cada una de las especies identificadas se les realizó fichas botánicas, que comprendieron nombre común, nombre científico, origen y distribución, características de las plantas, aptitudes forrajera y cuando fue posible si presentaba características anticualutativas o antinutricionales. Posteriormente se realizó una valoración técnica, para considerar el estado de dichas pasturas y las implicaciones económicas que estas podrían tener en manejo y recuperación. Se determinaron cuatro escenarios, 1) con árboles en el cerco; 2) con árboles en un 50%; 3) con árboles en un 75% y 4) con árboles en un 90%, registrándose coberturas vegetales que fluctuaron de 60 a 95%, y composición de las especies forrajeras en rangos similares. Se identificaron 16 familias, 25 géneros y 25 especies, dentro de los cuales destacaron por su mayor presencia las especies de escoba lisa (Sida cuta), bledo espinoso (Amaranthus espinosus), chilillo de gato (Achyranthes aspera), baba de culebra (Asclepia curasavica), flor amarilla (Melampodium divaricatum), dormilona (Mimosa pudica), espino de playa ( Phytecelobium dulce), catapanzas (Cucurbita spp), entre otras, también se considera como forajera a algunas especies leguminosa herbáceas como patito (Centrocema plumieri), centro (Centrocema pubescens), pega pega (Desmodium incatum, Desmodium spp), calopo (Calopogodium mucunoides; C. galactoides), Aeschynomene scabra y A. americana se observó una diversidad de especies, cuando existían árboles en el área de pasturas, minimizándose estas cuando no existían árboles. A través del análisis técnico – económico se determinó que los factores cobertura vegetal y porcentaje de malezas son de mucha importancia, en el manejo y productividad de las pasturas y que aun cuando se tenga pasturas de buen comportamiento productivo, se registran perdidas, lo cual indica que en las pasturas no todo es forrajero.

Jugo o vinagre de madera (savia de plantas)

La savia de las plantas denominada para efecto de este Proyecto de investigación Jugo ó vinagre de Madera , es el punto de partida y uno de los descubrimientos mas acertados en el campo de la investigación de nuevas tecnologías para el mejoramiento productivo de todos los cultivos. Esta investigación, ha conllevado un poco más de nueve años de observación y dos años de experimentación e investigación a nivel de los laboratorios. El documento está estructurado en cuatro aspectos: El Primero describe el procedimiento para la extracción de la savia de las plantas, como se denomina en la práctica Jugo ó vinagre de madera, en un segundo plano, se describe todo el proceso de investigación ó validación de la tecnología y el estudio mismo de sus componentes macros y micro elementos y los componentes estructurales de la sustancia. En un tercer plano está el análisis comparativo de los resultados y su relación directa con cada variable de la investigación. Por tratarse de una sustancia nueva y tan novedosa en términos prácticos, el estudio estuvo dirigido al descubrimiento de sus componentes orgánicos e inorgánicos, más que su funcionamiento lo que se ha venido observando por mucho más tiempo en forma práctica. Un cuarto aspecto abordado, se describe una exposición de resultados presentadas por el equipo investigador y particularmente a por los campesinos participantes con los que se llevó este proyecto. Los campesinos beneficiarios y experimentadores exponen a productores de otras comunidades los resultados productivos y comportamientos interesantes en términos de reacciones de las plantas a sobre dosis, desarrollo vegetativos por encimas de rangos normales de crecimientos y rendimientos propiamente dichos. Este cuarto aspecto es abordado mediante una memoria del día de campo celebrado a nivel institucional y a todas las comunidades beneficiadas por el Proyecto Auspiciado por FUNICA e INPRHU. En el día de campo se tuvo la oportunidad de observar plantas de café manejadas manejas de forma tradicional (químicamente) y plantas áreas y surcos manejados con jugo de madera en donde se puede observar la diferencia de crecimiento y reacciones bioquímicas de las en torno al desarrollo vegetativo, floración y 5 fructificación a escasos (8) ocho meses no plantas que poseen un tamaño inferior al metro y que los frutos se encuentran a una altura no mayor a los diez centímetros. Finalmente de expresan las conclusiones y recomendaciones en torno a esta investigación y posibles investigaciones en torno a tema de fertilización orgánica tomando como base el Jugo o Vinagre de madera.