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Objective. The Spontaneously Diabetic Torii (SDT) fatty rat, established by introducing the fa allele (obesity gene) of the Zucker fatty rat into the SDT rat genome, is a new model of obese type 2 diabetes. We studied the pathologic features of diabetic retinopathy (DR) in this animal. Methods. The eyes of SDT fatty, SDT (controls), and Sprague Dawley (SD) rats (normal controls) were enucleated at 8, 16, 24, 32, and 40 weeks of age (n=5‐6 for each rat type at each age). The retinal thicknesses, numbers of retinal folds, and choroidal thicknesses were evaluated. Immunostaining for glial fibrillary acidic protein (GFAP) and vascular endothelial growth factor (VEGF) was performed. Quantitative analyses of the immunopositive regions were performed using a cell-counting algorithm. Results. The retinas tended to be thicker in the SDT fatty rats and SDT rats than in the SD rats; the choroids tended to be thicker in the SDT fatty rats than in the SD rats. The retinal folds in the SDT fatty rats developed earlier and were more severe than in the SDT rats. Quantitative analyses showed that the GFAP- and VEGF-positive regions in the retinas of the SDT fatty rats were significantly larger than those of the SDT rats. Conclusions. SDT fatty rats developed more severe DR earlier than the SDT rats. The SDT fatty rats might be useful as a type 2 diabetes animal model to study DR.

STUDY OBJECTIVES: The objective of this study was to determine the efficacy of ramelteon in treating abnormal eating behavior in patients with sleep-related eating disorder and/or night eating syndrome. METHODS: We retrospectively reviewed the medical records of patients with sleep-related eating disorder/night eating syndrome at the Yoyogi Sleep Disorder Center from November 2013 to November 2018. We categorized patients as ramelteon treatment responders when the frequency of nighttime eating per week decreased to less than half of that before treatment. RESULTS: Forty-nine patients were included in the analysis. The mean frequency of eating behavior (per week) (standard deviation) at baseline and post-ramelteon treatment was significantly different, at 5.3 (2.2) and 3.2 (3.0), respectively (P < .001). Twenty-one patients (42.9%) were classified as responders. Adverse events, all of which were mild daytime somnolence, were observed in 5 patients. There were significantly more individuals using benzodiazepine derivatives and Z-drugs before treatment and those with coexisting delayed sleep-wake phase disorder in the responder group than in the nonresponder group (P < .001 and P < .05, respectively). The mean benzodiazepine derivatives and Z-drugs dose significantly decreased from baseline to post-ramelteon treatment within the responder group (P < .05). This trend was not observed in the nonresponder group. Meanwhile, the sleep midpoint of patients with sleep-related eating disorder/night eating syndrome and delayed sleep-wake phase disorder did not significantly change after treatment. CONCLUSIONS: Our results indicate that ramelteon is a candidate treatment for sleep-related eating disorder/night eating syndrome. The effects of ramelteon might have occurred primarily through the reduction in benzodiazepine derivatives and Z-drugs rather than through the improvement in sleep-wake rhythm dysregulation. CITATION: Matsui K, Kuriyama K, Kobayashi M, Inada K, Nishimura K, Inoue Y. The efficacy of add-on ramelteon and subsequent dose reduction of benzodiazepine derivatives/Z-drugs for the treatment of sleep-related eating disorder and night eating syndrome: a retrospective analysis of consecutive patients. J Clin Sleep Med. 2021;17(7):1475–1483.

Purpose To determine risk factors and clinical signs for severe Acanthamoeba keratitis (AK) by comparing severe cases with mild cases with good prognosis. Patients and methods We reviewed medical records of ten cases of AK (five males and five females) referred to our hospital and classified cases into two groups. One eye that required therapeutic keratoplasty and three eyes with a poor visual acuity (

We assessed the validity of using a sheet-shaped body vibrometer (SBV) as a portable monitoring device for obstructive sleep apnea (OSA) screening. Seventy consecutive patients with suspected OSA underwent simultaneous in-laboratory polysomnography (PSG) and SBV. We evaluated the screening accuracy of the respiratory event index (REI) obtained with the SBV, using the REI based on either the estimated total sleep time (REI_eTST) or time in bed (REI_TIB); these were compared to the apnea-hypopnea index (AHI) obtained via PSG. Bland-Altman plots indicated that the mean difference between REI_eTST and AHI was lower than that between REI_TIB and AHI (1.2 ± 19.8 vs. 6.5 ± 16.8). For AHI ≥ 15, the sensitivity and specificity at an optimal REI_eTST of 17.0 were 90.9% and 76.9%, whereas those at an optimal REI_TIB of 15.9 were 86.4% and 80.8%, respectively; moreover, for AHI ≥ 30, these values at an optimal REI_eTST of 26.0 were 89.5% and 88.2%, whereas those at an optimal REI_TIB of 23.8 were 84.2% and 92.2%, respectively. The optimal cutoff values of REIs for AHI of ≥ 5 were markedly different from those for AHI obtained via PSG (REI_eTST, 14.9; REI_TIB, 15.0), but close to those for AHI of ≥ 15; both had good sensitivities and specificities. REIs obtained via SBV performed well in moderate-to-severe, but not mild, OSA screening; REI_eTST showed a slightly higher sensitivity and a relatively closer value to the AHI obtained via PSG when compared to REI_TIB. We consider the SBV less acceptable for screening mild cases than more severe cases.

Positional obstructive sleep apnea (P-OSA) is a clinically common phenotype of OSA, which can be treated effectively with mandibular advancement devices (MADs). We hypothesized that the efficacy of an MAD is comparable to that of nasal continuous positive airway pressure (nCPAP) in P-OSA patients.Among patients diagnosed with OSA at a single sleep center from January 2008 to May 2014, male subjects with moderate OSA were recruited and stringently categorized as having P-OSA when the ratio of their lateral apnea-hypopnea index (AHI) to supine AHI was ≤ 0.5, their lateral sleep time was60 minutes, and their lateral REM sleep time was longer than 10 minutes. Treatment efficacy was compared between P-OSA subjects with an MAD (n = 34) and those with nCPAP (n = 34) after matching for age, body-mass index, and baseline AHI.There were no significant differences in baseline AHI (MAD: nCPAP = 20.6 ± 3.9/h: 21.3 ± 1.7/h, p = 0.35) or in follow-up AHI (MAD: nCPAP = 4.7 ± 3.5/h: 3.4 ± 3.7/h, p = 0.12) between the 2 treatment groups, and hence MADs lowered the AHI to the same extent as nCPAP.These findings suggest that an MAD is as efficacious as nCPAP for P-OSA patients. MAD treatment for this specific phenotype may be a promising patient-tailored and first-line approach to OSA.A commentary on this article appears in this issue on page 1079.

AIM: The aim of this study was to develop and validate a Japanese version of the Athens Insomnia Scale (AIS-J). METHODS: The AIS-J was created using a back-translation design. A total of 477 outpatients with chronic insomnia and 163 individuals from the general community were recruited. Participants were asked to complete the AIS-J along with two other insomnia scales - Japanese versions of the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. RESULTS: The AIS-J consisted of a two-factor structure: 'nocturnal sleep problem' (items 1-5) and 'daytime dysfunction' (items 6-8). Internal consistencycoefficients ranged from 0.78 to 0.88. Correlations between the AIS-J and the aforementioned authorized scales were 0.81 and 0.85, respectively. Scores on the AIS-J were significantly higher for the insomnia group than for the control group. The AIS-J cut-off value for identifying pathological insomnia was estimated at 6 points or more, and the AIS-J-nocturnal cut-off value was estimated at 4 points or more. CONCLUSIONS: The AIS-J has sufficient validity and diagnostic utility. Language: en

Recently, medical applications of radiation have been widely spread. However, exposure of medical staffs is sometimes not focused on because treatment of patients is the first priority. It is thus important to decrease exposure for them as much as possible. The purpose of this study is to develop a system which can measure energy spectrum and dose of gamma-rays at the same time in real time in medical application spots. As a result, the medical staff could be guided to aware the risk of radiation and finally the exposure dose to them could be suppressed substantially. We first decided to use a CsI(Tl) scintillator as the gamma-ray detection device. A Multi-Pixel Photon Counter (MPPC) was attached to the scintillator to detect gamma-ray signals. Pulse height spectra were measured with several standard gamma-ray sources. The detection efficiency and energy resolution were deduced from the measured results and the detection efficiency was compared with the calculation result by MCNP5. After evaluating the response function, the energy spectrum was derived with the spectrum type Bayesian estimation and the sequential Bayesian estimation procedure. From the result, it was confirmed that the sequential Bayesian estimation could be applied to real time measurement of gamma-ray energy spectrum and dose.

The loss of dopaminergic (DA) neurons in the substantia nigra (SN) is a major pathophysiological feature of patients with Parkinson's disease (PD). As nigral DA neurons contain both neuromelanin (NM) and dopamine transporter (DAT), decreased intensities in both NM-sensitive MRI and DAT PET reflect decreased DA neuronal density. This study demonstrates that a more specific metric for the nigral DA neuronal density can be derived with multimodal MRI and PET. Participants were 11 clinically diagnosed PD patients and 10 age and gender matched healthy controls (HCs). Two quantities, the NM-related index (RNM) and the binding potential of the radiotracer [18F]FE-PE2I to DAT (BPND) in SN, were measured for each subject using MRI and PET, respectively. Principal component analysis (PCA) was applied to the multimodal data set to estimate principal components. One of the components, PCP, corresponds to a basis vector oriented in a direction where both BPND and RNM increase. The ability of BPND, RNM and PCP to discriminate between HC and PD groups was compared. Correlation analyses between the motor score of the unified Parkinson's disease rating scale and each metric were also performed. PCP, BPND and RNM for PD patients were significantly lower than those for HCs (F = 16.26, P

The aim of this study was to develop and validate a Japanese version of the Athens Insomnia Scale (AIS-J).The AIS-J was created using a back-translation design. A total of 477 outpatients with chronic insomnia and 163 individuals from the general community were recruited. Participants were asked to complete the AIS-J along with two other insomnia scales - Japanese versions of the Pittsburgh Sleep Quality Index and the Insomnia Severity Index.The AIS-J consisted of a two-factor structure: 'nocturnal sleep problem' (items 1-5) and 'daytime dysfunction' (items 6-8). Internal consistencycoefficients ranged from 0.78 to 0.88. Correlations between the AIS-J and the aforementioned authorized scales were 0.81 and 0.85, respectively. Scores on the AIS-J were significantly higher for the insomnia group than for the control group. The AIS-J cut-off value for identifying pathological insomnia was estimated at 6 points or more, and the AIS-J-nocturnal cut-off value was estimated at 4 points or more.The AIS-J has sufficient validity and diagnostic utility.

Patients with less severe obstructive sleep apnoea (OSA) are usually prescribed oral appliances and/or smaller optimal nasal continuous positive airway pressure (P(nCPAP)) in nCPAP therapy. We hypothesised that OSA patients with greater P(nCPAP) would not respond favourably to oral appliances. Oral appliances were inserted in nCPAP users after washing-out the nCPAP effect. Follow-up polysomnography was undertaken with the adjusted oral appliance in place. The predictability of P(nCPAP) was evaluated with receiver-operating characteristic (ROC) curves. The median baseline apnoea/hypopnoea index (AHI) was reduced with the oral appliance from 36 to 12 events.h(-1) in 35 patients. When responders were defined as patients showing a follow-up AHI of5 events.h(-1) with50% reduction in baseline AHI, the area under the ROC curve for P(nCPAP) was 0.76. The best cut-off value of P(nCPAP) turned out to be 10.5 cmH(2)O with a high negative predictive value (0.93) and a low negative likelihood ratio (0.18). OSA patients with a P(nCPAP) of10.5 cmH( 2)O are unlikely to respond to oral appliance therapy. This prediction is clinically helpful to both OSA patients and medical personnel in discussing oral appliances as a temporary substitute and/or alternative for nCPAP.