Influence of etching mode on bonding performance of self-adhesive flowable resin composites to bovine teeth

This study aimed to evaluate the bonding performance of self-adhesive flowable resin composites (SARs) to bovine teeth. Three SARs, one experimental, and two commercially available products, were used. The study parameters were shear bond strength (SBS), microleakage, and scanning electron microscopy (SEM) evaluation of bonding interfaces. The SBS of the materials was 14.1-15.1 MPa to enamel, 22.2-23.2 MPa to etched enamel, and 7.4-10.7 MPa to dentin. Specimens with pre-etching showed lower microleakage scores than those without pre-etching. SEM images of the interfaces of the materials showed excellent adaptation regardless of the substrate or etching mode. The study results indicate that enamel pre-etching can improve the bonding performance of SARs.

Scanning electron microscopy observation of dentin bond interfaces in different types of resin luting cements

This study aimed to observe and compare the resin luting cement (RLC)/dentin interfaces of different types of RLC systems with scanning electron microscopy (SEM). This study evaluated six self-adhesive resin luting cement systems (SARLCs), four systems combining a SARLC with a tooth primer (SARLCPs), and six conventional resin luting cement systems (CVRLCs). Cured resin composite rods were bonded to bovine dentin using RLCs in different etching modes. The morphological features at the interfaces were observed using SEM. Although all RLCs in etch-&-rinse (ER) mode showed a clear hybrid layer, most SARLCs had a thinner and more porous hybrid layer than the SARLCPs and CVRLCs. All SARLCPs with primer and CVRLCs showed a thin high-density layer below the primer layer in both etching modes. CVRLCs and SARLCPs with primer treatment systems may be more versatile and reliable when compared to simplified RLC systems.

Comparing Various Resin Luting Cement Systems in Different Etching Modes Through Bond Durability and Morphological Features

OBJECTIVES

This study aimed to investigate bond performance of various resin luting cement (RLC) systems on enamel and dentin in different etching modes and to compare the RLC-tooth interface morphology using scanning electron microscopy (SEM).

METHODS AND MATERIALS

The self-adhesive RLC systems used in combination with universal adhesives were as follows: Scotchbond Universal Adhesive Plus + RelyX Universal (3M Oral Care) and Clearfil Universal Bond Quick ER + SA Luting Multi (Kuraray Noritake Dental). These RLC systems were also used alone as self-adhesive RLC systems without universal adhesives (self-adhesive mode). The conventional RLC systems for comparison materials were as follows: BeautiBond Xtream + ResiCem EX (Shofu) and Tooth Primer + Panavia V5 (Kuraray Noritake Dental). Twelve specimens were prepared for each group to measure shear bond strength (SBS) in different etching modes. A stainless-steel rod was used as a substitute for indirect restorations. Bonded specimens were allocated to baseline (stored for 24 hours) and artificially aged (thermocycling [TC] for 10,000 cycles) groups. Representative treated tooth surfaces and RLC-tooth interfaces were observed using SEM.

RESULTS

Three-way analysis of variance (ANOVA) revealed that all the factors (etching mode, storage period, and RLC system) had a significant influence on the enamel SBS values (p<0.05). Enamel SBS was significantly higher in etch-&-rinse (ER) mode than in self-etch (SE) mode, regardless of RLC system or storage period. Three-way ANOVA showed that all the factors had a significant influence on the dentin SBS values (p<0.001). Most RLC systems showed significantly higher dentin SBS in SE mode than in ER mode, regardless of storage period. However, the combination with Scotchbond Universal Adhesive Plus and RelyX Universal showed no significant difference in SBS values between etching modes at the baseline and showed a significantly higher SBS value in ER mode than in SE mode after TC.

CONCLUSIONS

The self-adhesive RLC systems with universal adhesives tended to show higher enamel and dentin bond performance than the self-adhesive RLC systems alone. The morphology of treated tooth surfaces and resin cement-tooth interfaces were dependent on the RLC system and etching mode used. The RLC systems with primer application showed a thin, high-density layer above the intact dentin in both etching modes, suggesting chemical interaction.

Ontogenetic Expression of Aquaporins in the Kidney and Urinary Bladder of the Japanese Tree Frog, Dryophytes japonicus

For adult anuran amphibians, the kidney and urinary bladder play important osmoregulatory roles through water reabsorption. In the present study, we have examined ontogenetic expression of aquaporins, i.e., AQP2, AQPamU (AQP6ub, AQPa2U), and AQP3, in these organs using the Japanese tree frog, Dryophytes japonicus. Immunohistochemistry using the metamorphosing larvae at stages 40-43 localized AQP2 protein to the collecting ducts in the dorsal zone of the mesonephric kidney. At prometamorphic stages 40 and 41, labelling of AQP2 protein was observed in the apical/ subapical regions of the collecting duct cells. At climax stages 42 and 43, labels for AQP2 and AQP3 became observed in the apical/subapical regions and basolateral membrane of the collecting duct cells, respectively, as seen in the adults. As for the urinary bladder, immuno-positive labels for AQPamU were localized to the apical/subapical regions of granular cells in the mucosal epithelium at stages 40-43. On the other hand, AQP3 immunoreactivity was hardly observed in the urinary bladder at stage 40, and weakly appeared in many granular cells at stage 41. Thereafter, labels for AQP3 became evident along the basolateral membrane of granular cells at stages 42 and 43, together with AQPamU in the apical/subapical regions. These results suggest that the kidney and urinary bladder might be capable of water reabsorption, via AQP2, AQPamU, and AQP3, at stage 42, contributing to the acclimation of the tree frogs to terrestrial environments.

Influence of different curing modes on the bonding effectiveness of self-adhesive resin luting cements in combination with universal adhesives

OBJECTIVES

This study aimed to investigate the immediate dentin bond performance and bond durability of self-adhesive resin luting cements (RLCs) in combination with universal adhesives in different curing modes.

METHODS

Two self-adhesive RLCs were used with universal adhesives as primers. They were also used alone as self-adhesive RLCs. Two multiple-step RLC systems were used as comparison materials. To measure the shear bond strength (SBS) in different curing modes, 12 specimens were prepared for each group. Stainless-steel rods were bonded to bovine dentin, and the bonded specimens were assigned to the baseline group (stored for 24 h) and artificially aged group (thermal cycling [TC], 10,000 cycles). After each storage period, the SBS of the bonded specimens was measured. The Knoop hardness number (KHN) of the cured RLCs was measured with or without primer application in different curing modes at 24 h and after 10,000 TC. The representative RLC/dentin interfaces were observed using scanning electron microscopy (SEM).

RESULTS

Dentin SBS was significantly influenced by the RLC system but not by the curing mode. Self-adhesive RLCs alone showed significantly lower SBS values than self-adhesive RLCs with primer regardless of the curing mode or storage period. The storage period, curing mode, and RLC system significantly influenced the KHN.

SIGNIFICANCE

The use of universal adhesives as a primer may help enhance the immediate dentin bond performance and bond durability of self-adhesive RLCs.

Treatment of saliva contamination of resin core foundation before adhesive luting

This study aimed to evaluate the influence of surface pretreatment on the shear bond strength of resin luting cement to saliva-contaminated resin core foundation. The surface free energy (γS) of the adherent surfaces was examined. The two-way analysis of variance revealed that the surface pretreatment and storage conditions had a significant effect on the strength of the bond to resin core foundation. The γS values of the saliva-contaminated group were significantly lower than those of the other groups, and they tended to improve after surface pretreatment. The tendency of improvement in γS values differed depending on the type of pretreatment agents. Surface treatment with solutions containing functional monomers is effective in removing saliva contaminants from the resin core foundation surfaces and in creating an effective bonding surface for the resin luting cement.

Comparing the outcomes of laparoscopic proximal and laparoscopic total gastrectomy: A retrospective analysis of a single center in Japan

INTRODUCTION

Despite the increasing performance of laparoscopic proximal gastrectomy (LPG) for proximal gastric cancer and esophagogastric junction cancer, the benefit of LPG over laparoscopic total gastrectomy (LTG) remains to be established. Therefore, this study was conducted to compare postoperative outcomes between LPG and LTG.

METHODS

Data from 141 patients who underwent LPG or LTG for gastric neoplasm with curative intent between 2016 and 2022 were retrospectively reviewed. Clinicopathological findings, body weight changes, and serological nutritional markers during the postoperative course were evaluated.

RESULTS

LPG and LTG were performed in 78 patients and 63 patients, respectively. Patients' characteristics did not differ; however, tumor stages in patients who underwent LTG were more advanced than those who underwent LPG. The mean (± standard deviation) weight loss rate after 1 year was -13.5 (±6.9)% and -18.7 (±6.6)% for LPG and LTG, respectively (p < .01). LTG (OR: 3.326, p < .01), pT disease (OR: 3.000, p = .01), pN disease (OR: 2.708, p = .02), and postoperative chemotherapy (OR: 2.488, p = .05) were correlated with severe weight loss (16% or more) 1 year after surgery, then multivariate analysis identified LTG as an independent factor (p = .01). The mean (± standard deviation) serum total protein level of LPG was significantly higher than that of LTG at 3 months (6.8 ± 0.5 vs. 6.6 ± 0.4 g/dL, p = .02) and 1 year (6.9 ± 0.4 vs. 6.7 ± 0.5 g/dL, p = .01) postoperatively. No difference was observed in postoperative serum hemoglobin and albumin levels.

CONCLUSION

LPG more improved postoperative weight loss than LTG.

Evaluation of New and Preexisting Epiretinal Membranes Following Glaucoma Filtration Surgery

Secondary epiretinal membranes (ERMs) can develop from various causes, including those associated with glaucoma treatments such as trabeculectomy (TLE) and EX-PRESS (EXP) insertion surgery. This study aimed to investigate the occurrence of new ERMs and changes in preexisting ERMs following TLE or EXP insertion. Between April 2018 and March 2019, 102 and 74 eyes that underwent primary and standalone TLE and EXP insertion, respectively, were evaluated. Of these, 48 eyes were included in the TLE group and 32 eyes were included in the EXP group. Optical coherence tomography (OCT) was used to assess preoperative and postoperative ERMs. In the TLE group, postoperative ERMs were observed in one (case 1) (3%) out of 34 eyes without preexisting ERMs and in one (case 2) (7%) out of 14 eyes with preexisting ERMs, showing an increase in ERM stage. In the EXP group, postoperative ERMs were observed in one (case 3) (5%) out of 22 eyes without preexisting ERMs and in one (case 4) (10%) out of 10 eyes with preexisting ERMs, showing a decrease in the ERM stage. Case 1 was a 58-year-old man with primary open-angle glaucoma (POAG) in the left eye who underwent TLE. Although no preoperative ERMs were observed, postoperative ERM was noted at the three-month follow-up. Case 2 was a 49-year-old man with POAG in the right eye who underwent TLE. Although ERM was observed preoperatively, ERM progressed at six months postoperatively. Case 3 was a 59-year-old woman with POAG in the right eye who underwent EXP insertion. No preoperative ERMs were observed, but an ERM was noted at the 15-month follow-up. Case 4 was a 72-year-old woman with steroid-induced glaucoma in the right eye who underwent EXP insertion surgery. A preoperative ERM was present, and the foveal pit was absent; however, the foveal pit was observed at the 12-month follow-up. Despite the low incidence of ERMs, filtration surgery may be associated with ERM development and the progression or regression of preexisting ERMs.

Influence of surface roughness of universal shade resin composites on color adjustment potential

This study aimed to determine the influence of surface roughness of the color adjustment potential restoration of universal resin composites. A structural colored resin composite (Omnichroma, OC) and a pigment-employed universal shade resin composite (Beautifil Unishade, BU) were used. Each resin composite was placed in a cavity to determine its ability to match the color of artificial teeth. The surface of the resin composites was polished with #800- or #2000-grit SiC paper before performing color measurements. One-way analysis of variance and Tukey post hoc tests were performed (α=0.05). The color difference (ΔE*ab) ranged from 2.5-3.9 for OC and 1.8-8.7 for BU. OC has a more stable color adjustment than BU. The color adjustment potential of universal resin composites was affected by the surface roughness of the restorations.

Randomized Multicenter Clinical Trial Comparing 0.1% Brimonidine/0.5% Timolol Versus 1% Dorzolamide/0.5% Timolol as Adjuncts to Prostaglandin Analogues: Aibeta Crossover Study

INTRODUCTION

This multicenter, randomized, comparative, and investigator-masked crossover clinical trial sought to compare the efficacy and tolerability of fixed combinations of 0.1% brimonidine/0.5% timolol (BTFC) versus 1% dorzolamide/0.5% timolol (DTFC) as adjunctive therapies to prostaglandin analogues.

METHODS

A total of 110 patients with open-angle glaucoma or ocular hypertension previously treated with prostaglandin analogue monotherapy were randomized to receive either BTFC or DTFC as adjunctive therapy for 8 weeks. These patients were then crossed over to the alternative treatment arm for another 8 weeks. The reduction in intraocular pressure (IOP) (primary outcome), occurrence of adverse events, ocular discomfort after instillation, and patient preference (secondary outcomes) were recorded through patient interviews.

RESULTS

BTFC instillation for 8 weeks reduced IOP by 3.55 mmHg, demonstrating non-inferiority to DTFC instillation (3.60 mmHg; P < 0.0001, mixed-effects model). Although adverse events were rare with both combinations, patients reported greater discomfort with DTFC than with BTFC (P < 0.0001). More patients preferred BTFC (P < 0.0001) over DTFC, as BTFC caused minimal or no eye irritation.

CONCLUSION

As BTFC offered better tolerability than DTFC with comparable reduction in IOP, we recommend it as an alternative for patients who experience ocular discomfort with DTFC-prostaglandin analogue combination therapy.

TRIAL REGISTRATION NUMBER

jRCTs051190125.

Whitening efficacy and tooth sensitivity in a combined in-office and at-home whitening protocol: A randomized controlled clinical trial

OBJECTIVE

This controlled randomized clinical trial determined the whitening efficacy and the intensity and absolute risk of tooth sensitivity in dual whitening when prefilled at-home whitening trays were used between in-office whitening intervals.

MATERIALS AND METHODS

An in-office whitening agent containing 35% hydrogen peroxide was used. A prefilled tray with a whitening agent containing 6% hydrogen peroxide was used for at-home whitening. Sixty-six subjects were randomly assigned to three groups. Group I: at-home whitening was performed 10 times between the in-office whitening treatments. Group II: at-home whitening was performed five times between the in-office whitening treatments. Group III: only in-office whitening was performed. The tooth color changes were evaluated using a spectrophotometer. A visual analog scale was used to express the pain intensity.

RESULTS

All the groups showed increased ΔE*ab, ΔE00 , and ΔWID with increased whitening sessions. Group I at the 3rd whitening session showed significantly higher ΔE*ab, ΔE00 , and ΔWID than group III. Tooth sensitivity showed higher values up to 24 h after whitening.

CONCLUSIONS

Although dual whitening with the prefilled tray and in-office whitening had higher whitening ability than in-office whitening alone, the intensity and absolute risk of tooth sensitivity was similar.

CLINICAL RELEVANCE

The dual whitening might produce faster and stronger whitening effects than in-office whitening alone.

Right Coronary Artery with an Intramural and Interarterial Course as a Unique Cause of Myocardial Ischemia: The Unroofing Method Might Still Be the Best Solution

A 39-year-old man was admitted because of cardiac arrest. Emergent coronary angiography revealed a preserved coronary blood flow; however, multiple-row detector computed tomography (MDCT) revealed that the proximal right coronary artery (RCA) was running inside the aortic wall, creating proximal stenosis without atherosclerotic changes. Surgical intervention with unroofing was performed; however, postoperative stenosis of the proximal RCA required additional coronary artery bypass grafting (CABG). Intraoperative findings during CABG did not reveal hematoma or coronary dissection. However, MDCT one year after CABG depicted improvement of the RCA and graft stenoses, suggesting that the post-unroof stenosis may have been caused by an inflammatory reaction after surgical intervention.

Bond durability of a two-step adhesive with a universal-adhesive-derived primer in different etching modes under different degradation conditions

This study investigated the enamel and dentin bond durability of a two-step adhesive system, using a universal adhesive-derived primer (G2-Bond Universal [GU]), and compared it with the two conventional, two-step, self-etch adhesive systems (Clearfil SE Bond 2 [CS] and OptiBond XTR [OX]) under thermal cycling (TC) and long-term water storage (WS). The shear bond strengths to bovine enamel and dentin were determined using the etch-and-rinse and self-etch modes. Twelve specimens per test group were prepared and further divided into the following subgroups: 1) subjected to TC, 2) long-term WS, and 3) WS for 24 h (baseline). The enamel and dentin bond durability of GU was superior to those of CS and OX in different etching modes and under different degradation conditions. The latest two-step adhesive system, which utilizes universal adhesives' benefits in its primer, might offer durable clinical bonding performances and can be widely used in a clinical setting.

Efficacy and safety of a fixed combination of 1% brinzolamide and 0.1% brimonidine as treatment for glaucoma: a retrospective study focusing on the number of ingredients

OBJECTIVE

To evaluate the intraocular pressure (IOP)-lowering effect based on the number of ingredients and survival rate due to adverse reactions of brinzolamide (1%)/brimonidine (0.1%) fixed combination (BBFC).

METHODS AND ANALYSIS

Among 424 patients newly administered BBFC from June 2020 to May 2021, 406 were retrospectively evaluated for adverse reactions and 299 were evaluated for the IOP-lowering effect of BBFC. Among those evaluated for IOP, group A (n=86) included patients whose treatment was changed to BBFC from other two ingredients, Group B (n=90) included patients who added one ingredient by switching to BBFC, and group C (n=123) included patients who added BBFC in addition to other drugs.

RESULTS

The mean IOP (mm Hg) at BBFC initiation and at 3, 6 and 12 months after BBFC initiation was 14.1, 14.0, 14.3 and 13.8 in group A, 15.9, 14.4, 13.8 and 14.5 in group B and 17.2, 14.0, 14.1 and 14.9 in group C, respectively. Group A showed no significant difference in mean IOP from baseline to any time point after BBFC initiation, whereas groups B and C showed significant IOP reductions at all time points. Seventy-three (18%) patients discontinued treatment due to adverse reactions. The survival rate was 72% at 12 months after the start of BBFC when discontinuation due to adverse reactions was defined as failure.

CONCLUSION

Using BBFC, sustained IOP or decreasing IOP were observed depending on the number of ingredients. Drop-outs due to the adverse reactions should also be given attention.

Effect of idiopathic epiretinal membrane on macular ganglion cell complex measurement in eyes with glaucoma

Background/objectives

Co-existing idiopathic epiretinal membrane (ERM) and glaucoma complicate the estimation of glaucoma severity via optical coherence tomography (OCT). We investigated the effect of ERM and a new associated parameter, SUKIMA (space between the ERM and retinal surface), on ganglion cell complex (GCC) thickness in eyes with glaucoma, based on a matched comparison of visual field defects.

Subjects/methods

We retrospectively recruited 41 eyes from 34 glaucoma patients with idiopathic ERM and 41 eyes from 41 glaucoma patients without ERM as controls (matched by age, axial length, and mean visual field deviation). The thicknesses of GCC layers [retinal nerve fiber layer (RNFL), ganglion cell layer + inner plexiform layer (GCIPL), and GCC (RNFL + GCIPL)] were measured with swept-source OCT. We investigated the presence of SUKIMA and its effect on GCC measurements.

Results

RNFL, GCIPL, and GCC were thicker in ERM (+) eyes than in control eyes (31.0 ± 12.3 μm vs. 22.7 ± 10.8 μm, 62.6 ± 12.2 μm vs. 53.8 ± 5.9 μm, and 91.8 ± 16.6 μm vs. 76.8 ± 13.3 μm, respectively; P &lt; 0.01). Eyes in the ERM-associated SUKIMA (+) group had thicker GCIPL and GCC than those in the ERM-associated SUKIMA (−) and control groups (P &lt; 0.01).

Conclusion

ERM-associated SUKIMA affects GCC thickness and can result in underestimations of glaucoma severity. We should check for the presence of ERM using a B mode scan as well as check for the SKIMA sign.

Persistent corneal blood staining after microhook trabeculotomy: A case report

INTRODUCTION

Hyphema, that is, massive anterior chamber hemorrhage, is one of the major complications after a recent minimally invasive glaucoma surgery. Hyphema along with high intraocular pressure increases the risk of corneal bloodstaining.

PATIENT CONCERNS

A 71-year-old female was receiving 0.1% fluorometholone drops in both eyes for severe dry eye. She was also receiving antiplatelet agents for platelet aggregation hyperactivity and prednisolone for interstitial pneumonia internally. Her right eye was suffering from increased intraocular pressure.

DIAGNOSIS

We diagnosed her right eye as steroid-induced glaucoma.

INTERVENTIONS

We performed microhook trabeculotomy.

OUTCOMES

At postoperative day 10, she had total anterior chamber hemorrhage and high intraocular pressure, and subsequently developed corneal blood staining at postoperative day 15, for which we performed anterior chamber cleaning. After that, we did not perform additional anterior chamber cleaning, and during the 1-year follow-up, a gradual improvement was noted in the entire cornea with reddish-brown opacity, from the periphery to the center. However, almost the entire pupil was still covered with opacity, and her visual acuity was at the light perception at the final visit.

LESSONS

Corneal bloodstaining takes a considerable time to resolve and causes severe vision loss. Special attention should be given to persistent corneal blood staining when hyphema and high intraocular pressure are observed after minimally invasive glaucoma surgeries.

The difficult symbolic construction of physicians’ and nurses’ experiences working in COVID-19 intensive care units: A qualitative study on reports at a university public hospital in Southeastern Brazil

Introduction

Humanistic studies that explore symbolic aspects of the experience of working on the COVID-19 frontline are necessary. Do these professionals have psychic time to symbolize such acute experiences? We expect these preliminary findings of this research provide subsidies for discussing psychological management in groups with these professionals.

Objectives

To interpret emotional meanings reported by physicians and nurses on their experiences of working at COVID-19 intensive care units.

Methods

Clinical-qualitative design. Data collection with semi-directed interviews with open-ended questions in-depth applied to a sample of six professionals, closed by theoretical information saturation, in a Brazilian university general hospital. Trigger question: “Talk about psychological meanings of your experience in face of management of patients with COVID-19 at ICU”. Data treatment by the Seven Steps of the Clinical-Qualitative Content Analysis. Theoretical framework of Medical Psychology using Balintian concepts.

Results

We raised 3 categories. (1) Psychic time and absence of symbolization in face of the pandemic; (2) Denial as a defense or psychosocial adaptation mechanisms; (3) Tensions and family support: triggers of ambivalent emotional experiences.

Conclusions

Raw experience of COVID-19 pandemic did not allow for realization of symbolization. Psychological defenses are manifested, either to maintain balance or to deny the existence of dangers related to mental health. Presence of families and health team confirm that the feeling of loneliness is avoided. Anxieties related to the fear of contamination are recurrent. There is dual relationship regarding the emotional experiences of health professionals, but the data point to importance of looking at how these individuals perceive and experience the pandemic.

Disclosure

No significant relationships.

Comparison of Surgical Outcomes Between Microhook Ab Interno Trabeculotomy and Goniotomy with the Kahook Dual Blade in Combination with Phacoemulsification: A Retrospective, Comparative Case Series

PURPOSE

To study surgical outcomes of patients with a minimum of 6 months of follow-up after undergoing combined phacoemulsification with either microhook ab interno trabeculotomy (μLOT-Phaco) or goniotomy using the Kahook Dual Blade (KDB-Phaco).

METHODS

This retrospective comparative case series examined 22 μLOT-Phaco eyes and 81 KDB-Phaco eyes that underwent surgery between December 2016 and October 2018. Data collected from medical records included pre- and postoperative intraocular pressure (IOP), number of IOP-lowering medications and complication occurrence. Potential risk factors for failure were determined by Cox proportional hazards regression analysis. Surgical failure was defined as an IOP of > 20 mmHg, < 20% reduction in preoperative IOP or additional glaucoma surgery. Kaplan-Meier survival analysis was used to assess success rates. Score matching used a genetic algorithm consisting of type of glaucoma.

RESULTS

Of 81 KDB-Phaco eyes, 22 eyes were matched to 22 μLOT-Phaco eyes. Mean IOP in the μLOT-Phaco group decreased from 24.7 ± 6.4 mmHg at baseline to 14.4 ± 3.0 mmHg (P < 0.01) and 13.0 ± 2.5 mmHg (P < 0.01) at 6 and 12 months, respectively. Mean IOP in the KDB-Phaco group decreased from 23.2 ± 5.4 mmHg to 15.8 ± 3.3 mmHg (P < 0.001) and 16.7 ± 2.1 mmHg (P < 0.001), respectively. Mean number of preoperative IOP-lowering medications in the μLOT-Phaco group at baseline was 3.7 ± 1.0, which decreased to 1.4 ± 1.5 (P < 0.01) at 12 months, while in the KDB-Phaco group it decreased from a baseline value of 3.3 ± 1.2 to 1.1 ± 1.4 (P < 0.01). Probability of qualified success at 12 months in the μLOT-Phaco and KDB-Phaco groups was 71.8% and 62.2%, respectively (P = 0.75). Similar postoperative complications were found between the groups.

CONCLUSIONS

Use of μLOT-Phaco and KDB-Phaco resulted in comparable IOPs and reductions in the number of medications.

Peroxiredoxins are involved in the pathogenesis of multiple sclerosis and neuromyelitis optica spectrum disorder

Peroxiredoxins (PRXs) are intracellular anti-oxidative enzymes but work as inflammatory amplifiers under the extracellular condition. To date, the function of PRXs in the pathogenesis of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) is not fully understood. The aim of this study was to investigate whether PRXs play a role in the pathogenesis of MS and NMOSD. We analyzed levels of PRXs (PRX1, PRX5 and PRX6) in the cerebrospinal fluid (CSF) and serum of 16 patients with MS, 16 patients with NMOSD and 15 patients with other neurological disorders (ONDs). We identified potential correlations between significantly elevated PRXs levels and the clinical variables in patients with MS and NMOSD. Additionally, pathological analyses of PRXs (PRX1-6) in the central nervous system (CNS) were performed using the experimental autoimmune encephalomyelitis (EAE), animal model of MS. We found that serum levels of PRX5 and PRX6 in patients with MS and NMOSD were higher compared with those in patients with ONDs (P < 0·05). Furthermore, high levels of PRX5 and PRX6 were partly associated with blood-brain barrier dysfunction and disease duration in NMOSD patients. No significant elevation was found in CSF PRXs levels of MS and NMOSD. Spinal cords from EAE mice showed remarkable PRX5 staining, especially in CD45⁺ infiltrating cells. In conclusion, PRX5 and PRX6 may play a role in the pathogeneses of MS and NMOSD.

Evaluation of Automatic Monitoring of Instillation Adherence Using Eye Dropper Bottle Sensor and Deep Learning in Patients With Glaucoma

Purpose

We developed and evaluated an eye dropper bottle sensor system comprising motion sensor with automatic motion waveform analysis using deep learning (DL) to accurately measure adherence of patients with antiglaucoma ophthalmic solution therapy.

Methods

We enrolled 20 patients with open-angle glaucoma who were treated with either latanoprost ophthalmic solution 0.005% or latanoprost-timolol maleate fixed combination ophthalmic solution in both eyes. An eye dropper bottle sensor was installed at patients' homes, and they were asked to instill the medication and manually record each instillation time for 3 days. Waveform data were automatically collected from the eye dropper bottle sensor and judged as a complete instillation by the DL instillation assessment model. We compared the instillation times captured on the waveform data with those on each patient's record form. In addition, we also calculated instillation movement duration from Waveform data.

Results

The developed eye bottle sensor detected all 60 instillation events (100%). Mean difference between patient and eye bottle sensor recorded time was 1 ± 1.22 (range, 0–3) minutes. Additionally, mean instillation movement duration was 16.1 ± 14.4 (range, 4–43) seconds. Two-way ANOVA revealed a significant difference in instillation movement duration among patients (P < 0.001) and across days (P < 0.001).

Conclusion

The eye dropper bottle sensor system developed by us can be used for automatic monitoring of instillation adherence in patients with glaucoma.

Translational Relevance

We believe that our eye dropper bottle sensor system will accurately measure adherence of all glaucoma patients as well as help glaucoma treatment.

Radiofrequency catheter ablation of premature ventricular contractions from near the His-bundle

OBJECTIVE

This study aimed to investigate the effects of radiofrequency catheter ablation (RFCA) and clinical and electrophysiological characteristics in symptomatic patients with premature ventricular contractions (PVCs) from near the His-bundle (His-PVCs).

METHODS

The patient characteristics, prevalence of complications with any life style related disease (ALSRD) including hypertension, dyslipidemia, or diabetes mellitus, and/or cardiovascular disease (CVD) including coronary artery disease, cerebrovascular disease, renal dysfunction, or cardiomyopathy, clinical status, frequency of PVCs evaluated by 24hour Holter monitoring, echocardiography including the left ventricular diastolic dysfunction (LVDD) parameters, and electrophysiological findings were evaluated in 14 consecutive symptomatic patients with His-PVCs.

RESULTS

The prevalence of males, being elderly and/or slightly obese, current and/or history of smoking, ALSRD or CVD related complications, and LVDD probably resulting from ALSRD and/or CVD complications were higher in patients with His-PVCs. RFCA of His-PVCs steadily decreased the PVC frequency and improved the systolic function, LV dilation, and clinical status, but not the LVDD. There was a significant relationship between the accordance rate of the QRS polarity between sinus rhythm and His-PVCs and the distance between the successful ablation site and His-bundle.

CONCLUSION

The analysis of the QRS duration and accordance rate of the QRS polarity between sinus rhythm and His-PVCs before the RFCA may help to determine the distance between the origin of the PVCs and His-bundle. Further, the appropriate ablation catheter may be selected during the RFCA procedure. Finally, RFCA may be one of the most effective, feasible, and safest therapies for symptomatic patients with His-PVCs.

Paroxysmal Atrial Fibrillation in Patients Successfully Treated by Radiofrequency Catheter Ablation with Severely Compression, Lateral Displacement, and Clockwise Rotation of Their Hearts due to Severe Pectus Excavatum

Two cases with severe pectus excavatum and symptomatic atrial fibrillation (AF) underwent radiofrequency catheter ablation (RFCA). Their chest X-ray and computed tomography (CT) findings revealed lateral displacement and clockwise rotation of their hearts, and severe right atrial and mild right ventricular compression against the sternum, but no left atrium compression against the spinal column. The procedure was therefore carefully performed under guidance with CT, intra-cardiac echography, atriography, and a three-dimensions mapping system. Finally, the AF was successfully treated by RFCA without any complications. These findings underscore the importance of understanding cases of abnormal anatomy and carefully designing a strategy before performing any procedure.

A case of paroxysmal atrial fibrillation in a patient successfully treated by radiofrequency catheter ablation with a severely right-sided dislocation of the heart after a total right lung excision

A 72-year-old woman with symptomatic and drug-refractory paroxysmal atrial fibrillation (AF) underwent radiofrequency catheter ablation (RFCA). She had a history of a total right lung excision. Her chest X-ray and computed tomography (CT) revealed a severely sight-sided dislocation of the heart. Thus, the procedure was carefully performed under guidance of a CT, intracardiac echogram, atriography, and 3D mapping system. Finally, the AF was successfully treated by RFCA without any complications.

A case of premature ventricular complexes/ventricular tachycardia from the left ventricular outflow tract successfully ablated from the distal great cardiac vein

We experienced a 41-year-old male with premature ventricular complexes/ventricular tachycardia from the left coronary cusp and distal great cardiac vein of the left ventricular outflow tract successfully treated by radiofrequency catheter ablation utilizing a 3D mapping system (EnSiteNavX/Velocity™ Cardiac Mapping System, St. Jude Medical, St. Paul, MN, USA) without any complications. <Learning objective: The approach from the distal great cardiac vein should be considered as a potential approach and may be one of the effective strategies for ablation of left ventricular outflow tract-premature ventricular complexes/ventricular tachycardia (PVC/VTs). Radiofrequency catheter ablation of frequent PVC/VTs may improve the clinical status and cardiac function.>.

Clinical benefits of deep sedation with a supraglottic airway while monitoring the bispectral index during catheter ablation of atrial fibrillation

BACKGROUND

Pulmonary vein antrum isolation (PVAI) under sedation has proven to be a useful strategy for catheter ablation of atrial fibrillation (AF).

METHODS

To evaluate the clinical benefits of respiratory management using supraglottic airways (SGAs) under deep sedation while monitoring the bispectral (BIS) index during the PVAI and the durations from admission to the catheterization room to starting the radiofrequency energy delivery (Time α), and from starting the radiofrequency energy delivery to completion of the PVAI (Time β), X-ray time, frequency of dislocations of the three-dimensional maps (D3DM), procedure-related complications, and proportion of an AF-free rate 15 months after the PVAI (PAFFR) in patients who received deep sedation without SGAs (Group A: n=48) and those with SGAs (Group B: n=51) were evaluated.

RESULTS

There were no significant differences in patient characteristics, Time α (77±3 versus 78±2 min; p=0.816), complications of cardiac tamponade (2% versus 2%; p=0.966), or PAFFR (81% versus 88%; p=0.313) between the two groups. However, the Time β (84±4 versus 67±3; p=0.001), X-ray time (53±2 versus 34±2; p<0.001), and minor complications of nasal bleeding (25% versus 0%; p=0.001) were significantly shorter and lower in Group B than in Group A, in accordance with a reduction in the hypoxia (15% versus 0%; p=0.007) and D3DM (31% versus 8%; p=0.003).

CONCLUSIONS

These results may demonstrate the clinical benefits of deep sedation with SGAs while monitoring the BIS index without any hypoxia during PVAI in patients with AF.

Lactobacillus rhamnosus GG increases Toll-like receptor 3 gene expression in murine small intestine ex vivo and in vivo

Administration of Lactobacillus rhamnosus GG (LGG) has been reported to be therapeutically effective against acute secretory diarrhoea resulting from the structural and functional intestinal mucosal lesions induced by rotavirus infection; however, the underlying mechanisms remain to be completely elucidated. Because Toll-like receptor 3 (TLR3) plays a key role in the innate immune responses following the recognition of rotavirus, the present study examined whether LGG influences TLR3 gene expression in murine small intestine ex vivo and in vivo. We employed cultured intestinal organoids derived from small intestinal crypts as an ex vivo tissue model. LGG supplementation increased TLR3 mRNA levels in the intestinal organoids, as estimated by quantitative real-time polymerase chain reaction. Likewise, single and 7-day consecutive daily administrations of LGG increased TLR3 mRNA levels in the small intestine of C57BL/6N mice. The mRNA levels of other TLRs were not substantially altered both ex vivo and in vivo. In addition, LGG supplementation increased the mRNA levels of an antiviral type 1 interferon, interferon-α (IFN-α), and a neutrophil chemokine, CXCL1, upon stimulation with a synthetic TLR3 ligand, poly(I:C) in the intestinal organoids. LGG administration did not alter IFN-α and CXCL1 mRNA levels in the small intestine in vivo. Supplementation of other bacterial strains, Bifidobacterium bifidum and Lactobacillus paracasei, failed to increase TLR3 and poly(I:C)-stimulated CXCL1 mRNA levels ex vivo. We propose that upregulation of TLR3 gene expression may play a pivotal role in the therapeutic efficacy of LGG against rotavirus-associated diarrhoea. In addition, we demonstrated that intestinal organoids may be a promising ex vivo tissue model for investigating host-pathogen interactions and the antiviral action of probiotics in the intestinal epithelium.

The Ratio KL-6 to SLX in Serum for Prediction of the Occurrence of Drug-Induced Interstitial Lung Disease in Lung Cancer Patients with Idiopathic Interstitial Pneumonias Receiving Chemotherapy

We retrospectively evaluated whether the ratio KL-6 to SLX in serum (K/S ratio) before chemotherapy was a predictor for the occurrence of drug-induced interstitial lung disease (D-ILD) in lung cancer patients with idiopathic interstitial pneumonias (IIPs). D-ILD occurred in 8 of 20 IIPs-positive cases and in 14 of 100 IIPs-negative cases (40 vs. 14%, p = .015). In IIPs-positive cases, the high K/S ratio (>20) before first-line chemotherapy had a tendency to increase the risk of D-ILD (p = .085). Serum K/S ratio may be a useful predictor for the occurrence of D-ILD in lung cancer patients with IIPs.

Difference in benefit of chemotherapy between small cell lung cancer patients with interstitial pneumonia and patients with non-small cell lung cancer

BACKGROUND

It is not clear whether there is a difference in benefit of chemotherapy between small cell lung cancer (SCLC) patients with pre-existing idiopathic interstitial pneumonias (IIPs) and non-small cell lung cancer (NSCLC) patients with IIPs.

PATIENTS AND METHODS

We performed a retrospective study of the overall survival (OS) between advanced lung cancer patients with IIPs (n=28) and those without IIPs (n=145).

RESULTS

The OS in NSCLC patients with IIPs was shorter than in those without IIPs (median OS, 10.6 vs. 27.9 months, p=0.008) but the OS in SCLC patients with IIPs was not inferior to that of those without IIPs (12.7 vs. 14.8 months, p=0.835). Multivariate analysis showed that the small number of regimens increased the risk of mortality, instead of pre-existing IIPs.

CONCLUSION

The continuation of chemotherapy in SCLC patients with IIPs made it possible to have a similar prognosis to that in those without IIPs.

Importance of fluorescence lifetimes for efficient indoline dyes in dye-sensitized solar cells

To make a molecular design of efficient indoline dyes, fluorescence lifetimes should be longer than ca. 0.8 ns in chloroform, in addition to suitable HOMO and LUMO levels and bathochromic UV-vis absorption bands.