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Jun Shindo,1,2 Nozomi Matsumura,1 Jutaro Nakamura,2 Mizuki Asano,1 Tomoko Ohno,1 Nobuhisa Mizuki2 1Department of Ophthalmology, Kanagawa Children’s Medical Center, Yokohama, Kanagawa, 232-8555, Japan; 2Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, JapanCorrespondence: Jun Shindo, Department of Ophthalmology, Kanagawa Children’s Medical Center, Mutsukawa, Yokohama, Kanagawa, 232-8555, Japan, Tel +81 45 711 2351, Fax +81 45 721 3324, Email junjunon.nike.6228@gmail.comPurpose: This study aimed to investigate changes in corneal morphology following pediatric lower-lid epiblepharon surgery using a topographic modeling system 5 (TMS-5®).Patients and Methods: A randomized controlled trial compared two surgical interventions for pediatric epiblepharon: incisional (modified Hotz procedure with lid margin splitting) and nonincisional. Corneal topography analysis using the TMS-5® served as an outcome measure. The study included 89 eyes from 50 children aged 3– 12 years (mean age, 7.5 ± 2.4 years) diagnosed with moderate epiblepharon. Patients were randomly assigned to the incisional (45 eyes from 25 patients) or nonincisional (44 eyes from 25 patients) groups. Parameters including surface regularity index (SRI), Standard Deviation of Corneal Power (SDP), Irregular Astigmatism Index (IAI), and corneal astigmatism (CYL) were evaluated. The positive rate of Keratoconus Screening System (Keratoconus Index [KCI] and Keratoconus Severity Index [KSI]) was assessed.Results: The 6-month postoperative mean changes in corneal astigmatism were − 0.34 ± 0.96 D (p = 0.012) and − 0.21 ± 0.67 D (p = 0.22) in the incisional and nonincisional groups, respectively. Corneal astigmatism parameters significantly improved following both surgical procedures (p < 0.01). Preoperatively, 14.6% and 28.1% of patients were suspected of keratoconus using KCI and KSI, respectively, with a significantly reduced postoperative suspicion positivity rate (p < 0.01).Conclusion: Corneal astigmatism significantly improved in the incisional group. Both surgical methods improved the postoperative corneal surface smoothness, corneal refractive power variability, and irregular astigmatism. Patients with epiblepharon were occasionally suspected of keratoconus when assessed with TMS, with a higher frequency indicated by KSI.Keywords: topographic modeling system, epiblepharon, cornea, keratoconus, astigmatism

Jutaro Nakamura,1,2 Tomoko Ohno,2 Yuki Mizuki,1 Masaki Takeuchi,1 Nobuhisa Mizuki,1 Nozomi Matsumura1,2 1Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan; 2Department of Ophthalmology, Kanagawa Children’s Medical Center, Yokohama, Kanagawa, JapanCorrespondence: Jutaro Nakamura, Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Yokohama, Kanagawa, 236-0004, Japan, Tel +81-45-787-2683 ; Fax +81-45-781-9755, Email jutaro_n@yokohama-cu.ac.jpPurpose: This prospective observational study aimed to explore the diversity in lacrimal pathway morphology among patients with congenital nasolacrimal duct obstruction (CNLDO) by examining dacryocystography (DCG) images.Patients and Methods: The study included 64 patients who underwent DCG before undergoing general anesthesia probing for unilateral CNLDO. Several parameters were measured from the lateral view of the DCG images: (1) the lacrimal sac (LS) and the nasolacrimal duct (NLD) angle, (2) the angle formed by the superior orbital rim (SOR), LS, and the NLD, (3) LS length, and (4) bony NLD length. Additionally, frontal views of the DCG images were utilized to measure (5) LS–NLD angle and (6) LS angle concerning the midline.Results: The average age of the patients was 34.3 months. The mean ± standard deviation of the measurements of the above parameters was (1) − 1.2° ± 16.5° (range: − 44.6° ± 46.6°), (2) − 5.0° ± 10.3° (range: − 24.0° ± 19.0°), (3) 10.2 ± 2.4 mm (range: 6.5– 16.0 mm), (4) 8.0 ± 2.5 mm (range: 3.1– 14.8 mm), (5) 15.6° ± 11.2° (range: − 16.8° ± 41.0°), and (6) 15.1 ± 5.2° (range: 3.3°– 29.8°). All parameters, except for parameter (3), conformed to a normal distribution.Conclusion: This study provides valuable anthropometric data derived from DCG images, highlighting the substantial variability in lacrimal pathway morphology among patients with CNLDO. Furthermore, anatomical constraints made probing with a straight metal bougie anatomically infeasible in 25.0% of the patients included in this study.Plain Language Summary: Understanding the morphology of the lacrimal pathway is crucial for the successful probing treatments in patients with congenital nasolacrimal duct obstruction (CNLDO). This study represents an initial effort to quantify anthropometric parameters of the lacrimal drainage system through dacryocystography images, specifically aiming to highlight the limitations of blind probing procedure. The results underscore significant variations in the morphology of the lacrimal drainage system among patients, which could impact diagnostic approaches and treatment strategies. Additionally, the findings suggest that patients with CNLDO who do not respond to blind probing may have underlying anatomical complexities. Therefore, rather than relying on repeated blind probing, employing dacryoendoscopy-guided probing under direct visualization could offer a more effective therapeutic alternative for complicated cases of CNLDO.Keywords: anatomy, congenital nasolacrimal duct obstruction, dacryocystography, dacryoendoscopy, epiphora, lacrimal lavage, probing, radiology

Shigeki Minami,1 Chika Sakimura,1 Junji Irie,2 Yukiko Tokai,3 Hitoshi Okubo,4 Tsuyoshi Ohno5 1Department of Breast and Endocrine Surgery, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan; 2Department of Pathology, Nagasaki Harbor Medical Center, Nagasaki, Japan; 3Department of Breast Surgery, Imamura Women’s Clinic, Nagasaki, Japan; 4Okubo Breast Clinic, Nagasaki, Japan; 5Ohno Breast and Thyroid Clinic, Nagasaki, JapanCorrespondence: Shigeki MinamiDepartment of Breast and Endocrine Surgery, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki 850-8555, JapanTel +81-95-822-3251Fax +81-95-826-8798Email br9-origam@umin.netBackground: The axillary lymph node status is an important prognostic factor of breast cancer. This study explores the predictive factors for sentinel lymph node (SLN) metastasis among the preoperative clinicopathological features, including impaired glucose tolerance (IGT).Methods: This study comprised patients diagnosed with breast cancer who underwent surgery at Nagasaki Harbor Medical Center between April 2014 and December 2019. The factors assessed using univariate and multivariate analyses were the clinicopathological data of these cancers, including the patient age, gender, menstrual status, breast or ovarian cancer family history, body mass index, glycosylated hemoglobin, clinical tumor size, nipple-tumor distance (NTD), tumor histology, histological grade, node status, estrogen receptor, progesterone receptor, human epidermal growth factor receptor type 2 status, and Ki67 labeling index.Results: In the cohort of 313 cases, the ratio of SLN metastasis was 17.3%. A univariate analysis found that the tumor size, NTD, IGT, and clinical tumor stage were associated with SLN metastasis. In a multivariable analysis, the tumor size, NTD, and IGT were associated with SLN metastasis. The receiver operating characteristic curve showed a sensitivity and specificity of 61.1% and 65.6%, respectively, at a cut-off of 1.7 cm for the tumor size (area under the curve [AUC]: 0.664; 95% confidence interval: 0.592– 0.736), and a sensitivity and specificity of 60.4% and 62.9%, respectively, at a cut-off of 2.0 cm for NTD (AUC: 0.651; 95% confidence interval: 0.571– 0.731) to predict the risk of SLN metastasis.Conclusion: T1 and T2 breast cancer patients with a larger tumor size, tumor located closer to the nipple, and IGT have a higher risk of SLN metastases than others.Keywords: breast cancer, sentinel lymph node metastasis, predictive factor, nipple-tumor distance, impaired glucose tolerance

Soichiro Hanada,1 Shota Wada,1 Takeshi Ohno,1 Hirochiyo Sawaguchi,1 Masato Muraki,1 Yuji Tohda2 1Department of Respiratory Medicine and Allergology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, 2Department of Respiratory Medicine and Allergology, Kinki University Faculty of Medicine, Osakasayama, Japan Background: Tiotropium (Spiriva) is an inhaled muscarinic antagonist for patients with chronic obstructive pulmonary disease (COPD), and is available in two forms: the HandiHaler and the Respimat inhaler. The aim of this study was to investigate the handling of and preference for each device immediately after switching from the HandiHaler to the Respimat and 2–3 years after the switch.Materials and methods: The study comprised two surveys. A questionnaire was first administered to 57 patients with COPD (male:female 52:5, mean age 73.6±7.1 years) 8 weeks after switching from the HandiHaler (18 µg) to the Respimat (5 µg). A second similar but simplified questionnaire was administered to 39 of these patients who continued to use the Respimat and were available for follow-up after more than 2 years. Pulmonary function was also measured during each period.Results: In the first survey, 17.5% of patients preferred the HandiHaler, and 45.6% preferred the Respimat. There were no significant changes in pulmonary function or in the incidence of adverse events after the switch. In the second survey, performed 2–3 years later, the self-assessed handling of the Respimat had significantly improved, and the number of patients who preferred the Respimat had increased to 79.5%.Conclusion: The efficacy of the Respimat was similar to that of the HandiHaler. This was clear immediately after the switch, even in elderly patients with COPD who were long-term users of the HandiHaler. The preference for the Respimat increased with continued use. Keywords: chronic obstructive pulmonary disease, tiotropium, HandiHaler, Respimat, questionnaire, pulmonary function

Takeshi Ohno,1 Shota Wada,1 Souichirou Hanada,1 Hirochiyo Sawaguchi,1 Masato Muraki,1 Yuji Tohda21Department of Respiratory Medicine and Allergology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan; 2Department of Respiratory Medicine and Allergology, Kinki University School of Medicine, Osakasayama, JapanBackground: Indacaterol is a novel, once-daily, inhaled, long-acting β2-agonist for patients with chronic obstructive pulmonary disease (COPD). The study objective was to evaluate the efficacy of indacaterol on quality of life and pulmonary function in patients with COPD in a real-world setting, and also to evaluate its inhaler device (Breezhaler®), which is important for both adherence and management.Methods: Twenty-eight outpatients with COPD were treated with indacaterol (150 µg once daily for 8 weeks), and the effects on pulmonary function were evaluated using a questionnaire survey with the modified Medical Research Council (mMRC) dyspnea scale and COPD assessment test (CAT) before and after treatment. Similar investigations were also performed separately among different baseline medications. Moreover, original questionnaire surveys for indacaterol and its device were performed.Results: Overall, mMRC dyspnea scale and CAT scores significantly improved (1.96±1.04 to 1.57±1.07 and 17.39±8.23 to 12.82±8.42, respectively; P

Shunsuke Nojiri,1 Atsunori Kusakabe,1 Kei Fujiwara,1 Noboru Shinkai,1 Kentaro Matsuura,1 Etsuko Iio,1 Tomokatsu Miyaki,1 Tomoyuki Nomura,2 Satoshi Sobue,3 Hitoshi Sano,4 Izumi Hasegawa,5 Tomoyoshi Ohno,5 Yoshitsugu Takahashi,6 Etsuro Orito,7 Takashi Joh11Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, 2Inabe General Hospital, Inabe, 3Kasugai Municipal Hospital, Kasugai, 4Tajimi Prefectural Hospital, Tajimi, 5Social Chukyo Insurance Hospital, Nagoya, 6Chita Kousei Hospital, Aichi-ken, 7Nagoya Daini Red Cross Hospital, Showa-ku, JapanBackground: Sorafenib has been approved in the indication of unresectable hepatocellular carcinoma, but there are many cases in which administration of the drug is discontinued due to severe side effects. In this study, we compared the characteristics of patients who continued and discontinued sorafenib.Methods: Ninety-six patients (75 men and 21 women) were initiated on sorafenib from July 2009 through September 2011. The patient characteristics of interest included gender, age, etiology, Child-Pugh classification, treatment history and frequency, and levels of α-fetoprotein, des-gamma-carboxy prothrombin, aspartate amino acid transferase, and alanine aminotransferase. Duration of administration of sorafenib and reasons for its discontinuation were compared.Results: Median overall survival was 11.8 months. Discontinuation of sorafenib within 90 days was identified as an independent prognostic factor for overall survival on multivariate analysis (P < 0.0001). Transarterial chemoembolization performed six times or more (P = 0.013) was also identified as an independent factor contributing to discontinuation of sorafenib within 90 days in multivariate analysis. Patients who received sorafenib for ≥90 days had significantly longer overall survival than those who discontinued it (P < 0.0001).Conclusion: Prolonged treatment with sorafenib is an important factor in achieving extended overall survival. We recommend starting sorafenib before latent liver damage has occurred as a result of too many transarterial chemoembolization procedures.Keywords: sorafenib, hepatocellular continuation, discontinuation, efficacy

Tetsuro Ohno, Mitsuhiro Yanai, Hiroyuki Ando, Yoshitaka Toyomasu, Atsushi Ogawa, Hiroki Morita, Kyoichi Ogata, Erito Mochiki, Takayuki Asao, Hiroyuki KuwanoDepartment of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, JapanBackground: The aim of this study was to investigate the effects of Rikkunshito on ghrelin secretion and on cisplatin-induced anorexia in humans.Methods: The study was performed as a crossover design, and ten unresectable or relapsed gastric cancer patients were randomly divided into two groups. Group A (n = 5) was started on Rikkunshito (2.5 g three times daily, orally) from the first course of chemotherapy and followed by a second course without Rikkunshito. A treatment with reversed order was performed for Group B (n = 5). All patients received combined chemotherapy with S-1 plus cisplatin. The primary endpoint was the amount of oral intake, and the categories of scales of anorexia, nausea, and vomiting; secondary endpoints included the plasma concentration of acylated ghrelin.Results: In the Rikkunshito-on period, no decrease of the plasma concentration of acylated ghrelin induced by cisplatin was observed. The average oral intake in the Rikkunshito-on period was significantly larger than that in the Rikkunshito-off period, and the grade of anorexia was significantly lower in the Rikkunshito-on period than in the Rikkunshito-off period.Conclusion: Rikkunshito appeared to prevent anorexia induced by cisplatin, resulting in effective prophylactic administration of chemotherapy with cisplatin, and patients could continue their treatments on schedule.Keywords: Rikkunshito, cisplatin, ghrelin, anorexia, stomach cancer

We investigated a metal-oxide-semiconductor interface of dry-oxidized (000 1 ¯ ) 4H-SiC, which was known as the most electrically deteriorated SiC MOSFET, by electrically detected magnetic resonance (EDMR) and observed a signal with an isotropic g factor (2.0024) and magnetic-field angular dependent signal widths. Judging from the g factor, the signal comes from sp2-bonded carbon clusters. In addition, we found that the angular dependence of EDMR signal widths was caused by two-dimensional dipolar broadening with exchange interaction between electron spins. However, the density of electron spins or carbon clusters was 5.4 × 1013 cm−2, which was not high enough for exchange interaction. Therefore, we propose inhomogeneous distribution of carbon clusters in the interface. At the interface, π* peaks from sp2-bonded carbon atoms were detected by electron energy loss spectroscopy. Scanning the electron beams along the interface revealed uneven existence of the π* peaks, which also proved that the sp2-bonded carbon atoms were distributed inhomogeneously in the interface. In addition, we found the formation of sp2-bonded carbon clusters at 4H-SiC(000 1 ¯ )/SiO2 interfaces and interaction between π-conjugate electron spins on the carbon clusters by first principles calculation. Such carbon clusters generated electrically active states widely in the energy gap of 4H-SiC. The states result in the Fermi level pinning of the MOSFET. [ABSTRACT FROM AUTHOR]