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David Barnes
David Barnes

Anterior



Anterior generally appears in either medical or scholarly contexts. Anatomy books refer to the anterior lobe of the brain, the anterior cerebral artery, the anterior facial vein, etc. Scholar and lawyers may use anterior to mean "earlier in time or order". For example, supporters of states' rights point out that the individual states enjoyed certain rights anterior to their joining the union. And prenuptial agreements are designed to protect the assets that one or both parties acquired anterior to the marriage.




Anterior



Aim: The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction.


The U.S. Food and Drug Administration (FDA) recommends that health care providers give clear, step-by-step instructions to patients who, in a health care setting, are self-collecting anterior nares (nasal) samples for SARS-CoV-2 testing. Without proper instructions, patients may not collect an adequate sample for testing, which may decrease the sensitivity of the test.


The FDA recommends health care providers provide visual (written or video) step-by-step instructions, in addition to verbal instructions, to patients who, in a health care setting, are self-collecting anterior nares (nasal) samples for SARS-CoV-2 testing. Written instructions may be provided on paper or electronically and health care providers can access publicly available written instructions to give to patients. Two examples of written instructions are available from Audere's HealthPulse communication or the Centers for Disease Control and Prevention. When available, video or animated instructions may provide added clarity for patients. For example, Lower Nasal Swab Collection instructions, which was developed by Audere, contains an animation to demonstrate proper technique. Audere, a Washington State nonprofit corporation, has granted a general right of reference to any organization who wishes to access and use these instructions for lower nasal swabs administered at a testing site. These recommendations apply specifically to patients who are self-collecting in a health care setting. Any test being used with home collected specimens, and the corresponding home collection kits, must be specifically authorized for such use in an Emergency Use Authorization.


Anterior nares specimens have numerous benefits as compared to other upper respiratory specimens such as nasopharyngeal specimens. They are less invasive and generally more comfortable for patients, they can be self-collected by adult patients, and they can decrease the risk of exposure to health care providers. There is scientific evidence1 that SARS-CoV-2 testing utilizing anterior nares specimens has a similar performance to testing that utilizes nasopharyngeal specimens, provided that a good quality anterior nares specimen is collected. Without clear instructions, however, patients who, in a health care setting, are self-collecting anterior nares (nasal) samples may not collect an adequate sample for testing, which may decrease the sensitivity of the test. Health care providers have a critical role in helping patients perform self-collection accurately.


The FDA is providing recommendations for health care providers on the best way to provide clear instructions to patients that are self-collecting anterior nares (nasal) samples in a health care setting for SARS-CoV-2 testing.


Your pelvic floor consists of muscles, ligaments and connective tissues that support your bladder and other pelvic organs. The connections between your pelvic organs and ligaments can weaken over time, or as a result of trauma from childbirth or chronic straining. When this happens, your bladder can slip down lower than usual and bulge into your vagina (anterior prolapse).


Objective: To provide certified athletic trainers, physicians, and other health care and fitness professionals with recommendations based on current evidence regarding the prevention of noncontact and indirect-contact anterior cruciate ligament (ACL) injuries in athletes and physically active individuals.


Complex problem-solving and planning involve the most anterior part of the frontal lobes including the fronto-polar prefrontal cortex (FPPC), which is especially well developed in humans compared with other primates. The specific role of this region in human cognition, however, is poorly understood. Here we show, using functional magnetic resonance imaging, that bilateral regions in the FPPC alone are selectively activated when subjects have to keep in mind a main goal while performing concurrent (sub)goals. Neither keeping in mind a goal over time (working memory) nor successively allocating attentional resources between alternative goals (dual-task performance) could by themselves activate these regions. Our results indicate that the FPPC selectively mediates the human ability to hold in mind goals while exploring and processing secondary goals, a process generally required in planning and reasoning.


Anterior capsule fibrosis and phimosis, commonly described as anterior capsule contraction syndrome (ACCS), is the centripetal constriction and fibrosis of the capsulorhexis following cataract removal. This is a painless condition that remains asymptomatic unless the constriction progresses into the visual axis potentially resulting in decreased visual acuity, pseudophacodonesis and occasionally intraocular lens dislocation. Treatment consists primarily of Nd:YAG relaxing of the anterior capsulotomy of encroaching tissue and recurrence is rare.


Continuous curvilinear capsulorhexis openings created in cataract surgery are known to contract slightly in non-pathologic eyes.[1] Anterior capsule fibrosis and phimosis is a condition that can occur after phacoemulsification and intraocular lens (IOL) implantation whereby the anterior capsulotomy excessively contracts and fibroses potentially obstructing the visual axis or causing late secondary complications to the IOL such as pseudophacodonesis and IOL tilt, decentration, or dislocation due to zonular laxity, weakness or dehiscence.


While the pathogenesis of ACCS is unknown, a possible cause involves populations of residual viable metaplastic lens epithelial cells (LECs) in or on the capsular bag present after cataract surgery that can undergo mesenchymal transition and differentiation to fiber-like cells.[2] Metaplasia and fibrosis of these cells contribute to the purse-string contracture and constriction or even complete closure of the anterior capsulotomy. This response may be exaggerated when there is an imbalance between centrifugal and centripetal forces that act on the zonules and the capsulorhexis perimeter.


The onset of decreased visual acuity in ACCS patients can range from 2 weeks to more than 3 months. [8][17]Capsule shrinkage and closure involves contraction of the fibrous membrane following fibrous metaplasia of LECs as well as LEC proliferation and outgrowth from the anterior capsule margin onto the IOL toward the center of the capsular opening,[2][18] likely mediated by LEC cytokine signaling.[19]


ACCS may be prevented by utilizing a larger capsulorhexis size,[1][6][7][21] meticulous LEC cleanup at the time of phacoemulsification,[22] [23] [24] or the use of anterior capsule Nd:YAG relaxing incisions in high risk patients soon after phacoemulsification.[11][25] Use of a can-opener capsulotomy rather than a continuous curvilinear capsulorhexis (CCC) is associated with less ACCS,[3] but is less practical with contemporary phacoemulsification.


The diagnosis of ACCS in post-op cataract patients is made on the basis of the presence of anterior capsule contraction confirmed with slitlamp biomicroscopy with or without decreased visual acuity compared to the postoperative best-corrected visual acuity (BCVA).


Most ophthalmologists perform Nd:YAG LASER anterior capsulotomy which is a simple and painless outpatient procedure.[20][30] [31] [32] Typically 4 or more approximately 1mm radial nicks placed onto the fibrotic anterior capsular annulus are effective in stopping the progression of contraction of the anterior capsule. The LASER is set to anterior focus and an energy of 1 to 3mJ. Radial Nick's are preferred, with care taken not to hit the IOL. Some surgeons have tried cutting out an annulus of capsule using the LASER, but it is not recommended as it deposits in the angle and often leads to raised intraocular pressure.


The prognosis for non-progression of contraction is very good after Nd:YAG anterior capsulotomy. Non-treatment places the eye at risk of pseudophacodonesis, IOL decentration, tilt, or dislocation, which may arise suddenly.


Above video by Dr John Davis Akkara, MD from India shows posterior capsulotomy and Anterior Capsular Phimosis Release by Radial LASER cuts using NdYAG LASER of 1064nm on. YAG III machine from Zeiss. The posterior capsulotomy is done at posterior focus and anterior using anterior focus. Energy is 1 to 3 mJ per shot titrated according to the response. Abraham capsulotomy lens with a central magnification button can be used, but was not used in this video.


The symptoms of anterior uveitis can be similar to those of other eye conditions. Therefore, a doctor of optometry will carefully examine the front and inside of the eye with a unique microscope using high magnification. A doctor of optometry may also perform or arrange for other diagnostic tests to help pinpoint the cause.


NB: The magnitude of reciprocal change in inferior leads is determined by the magnitude of ST elevation in I and aVL (as these leads are electrically opposite III and aVF), and hence may be minimal or absent in anterior STEMIs that do not involve high lateral leads.


Anterior STEMI usually results from occlusion of the left anterior descending artery (LAD). Anterior myocardial infarction carries the poorest prognosis of all infarct locations, due to the larger area of myocardium infarct size. 041b061a72


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