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PURPOSE To examine the long-term refractive changes after stabilization of surgically induced changes (SICs) subsequent to cataract surgery. SETTING Private hospital. DESIGN Case-control study. METHODS Manifest refraction of 300 eyes of 300 patients that underwent phacoemulsification and 300 eyes of 300 age- and sex-matched patients without surgery was examined the day on which SICs stabilized (baseline) and ≥7 years postbaseline using an autorefractometer. Refraction was divided into 3 components: spherical power (M), vertical/horizontal astigmatism (J0), and oblique astigmatism (J45) using power vector analysis, and the components were compared between the 2 time-points and between groups. RESULTS In the surgery group, the mean M and J45 did not change significantly between baseline and ≥7 years postbaseline, but the J0 significantly decreased between the 2 time-points (P < .001), indicating an against-the-rule (ATR) shift. In the non-surgery group, the mean M significantly increased and J0 significantly decreased between the time-points (P < .001), whereas J45 did not change significantly. The mean change in M between the 2 time-points was significantly smaller in the surgery group (P < .001), whereas the changes in J0 and J45 did not differ significantly between the time-points. CONCLUSION Spherical power did not change and refractive astigmatism significantly changed toward ATR astigmatism during the more than 7-year follow-up after stabilization of SICs in pseudophakic eyes, while hyperopic and ATR shifts occurred in phakic eyes, and the astigmatic changes were comparable between pseudophakic and phakic eyes.

To compare the progression of posterior vitreous detachment (PVD) during aging among eyes of diabetics with diabetic retinopathy (DR), eyes of diabetics without DR, and eyes of nondiabetics. Prospective cross-sectional study. One-hundred thirty-three diabetic eyes with DR (DR group), 254 diabetic eyes without DR (non-DR group), and 577 nondiabetic eyes (nondiabetic group) were divided into four age categories: 1) 40-49 years, 2) 50-59 years, 3) 60-69 years, and 4) 70-79 years. The PVD state was examined using swept source-optical coherence tomography and classified into five stages: 0 (non PVD), 1 (paramacular PVD), 2 (perifoveal PVD), 3 (vitreofoveal separation), and 4 (complete PVD). The PVD stage significantly progressed in the DR, non-DR, and nondiabetic groups (p

AimsTo examine whether long-term corneal astigmatic changes after stabilisation of surgically induced astigmatism (SIA) following cataract surgery differ among eyes having against-the-rule (ATR), with-the-rule (WTR), and oblique astigmatism.MethodsAnterior corneal astigmatism of 390 eyes in 390 patients (130 eyes each having ATR, WTR and oblique astigmatism) who underwent phacoemulsification with a horizontal clear corneal or scleral incision and 390 eyes in 390 control patients without surgery were examined using an auto-keratometer on the day that SIA stabilised (baseline) and at ≥8 years post baseline. Changes in corneal astigmatism during the ≥8 years post baseline were decomposed to vertical/horizontal (Rx) and oblique astigmatism components (Ry), and compared among baseline types of astigmatism and between eyes with and without surgery.ResultsThe mean corneal astigmatic changes (Rx and Ry) showed an ATR shift of 0.2–0.3 D during the ≥8 years post baseline, which did not differ significantly among the ATR, WTR and oblique astigmatism groups in eyes with and without surgery. In the ATR, WTR and oblique groups, the mean Rx and Ry did not differ significantly between eyes with and without surgery. Double angle plots revealed an equivalent degree of ATR change in the ATR, WTR and oblique groups between eyes with and without surgery.ConclusionLong-term corneal astigmatic changes towards ATR astigmatism occurred to a similar extent in eyes having ATR, WTR, oblique astigmatism and were comparable between eyes with and without surgery, suggesting that astigmatism type need not be considered when planning astigmatism correction.

Ongoing aortic wall degeneration and subsequent aneurysm exclusion failure are major concerns after an endovascular aneurysm repair with a stent-graft. An ideal solution would be a drug therapy that targets the aortic wall and inhibits wall degeneration. Here, we described a novel drug delivery system, which allowed repetitively charging a graft with therapeutic drugs and releasing them to the aortic wall in vivo. The system was composed of a targeted graft, which was labeled with a small target molecule, and the target-recognizing nanocarrier, which contained suitable drugs. We developed the targeted graft by decorating a biotinylated polyester graft with neutravidin. We created the target-recognizing nanocarrier by conjugating drug-containing liposomes with biotinylated bio-nanocapsules. We successfully demonstrated that the target-recognizing nanocarriers could bind to the targeted graft, both in vitro and in blood vessels of live mice. Moreover, the drug released from our drug delivery system reduced the expression of matrix metalloproteinase-9 in mouse aortas. Thus, this hybrid system represents a first step toward an adjuvant therapy that might improve the long-term outcome of endovascular aneurysm repair.

Purpose We compared the change in the state of posterior vitreous detachment (PVD) between highly myopic eyes and non-highly myopic eyes using age- and sex-matched patients. Methods Six hundred eyes of 600 patients with high myopia (axial length > 26.0 mm) or without high myopia were enrolled into each of six age categories with 50 eyes each: (1) 20 to 29 years, (2) 30 to 39 years, (3) 40 to 49 years, (4) 50 to 59 years, (5) 60 to 69 years, and (6) 70 to 79 years. The PVD status was evaluated using swept-source optical coherence tomography and classified into five stages: 0 (no PVD), 1 (paramacular PVD), 2 (perifoveal PVD), 3 (peripapillary PVD), and 4 (complete PVD). Results In the high myopia and non-high myopia groups, the mean PVD stage increased significantly with the age category (P < 0.0001). The PVD stage was significantly greater in the high myopia group than in the non-high myopia group in all age categories (P ≤ 0.0395). In the age groups of patients 50 to 59 years old and 60 to 69 years old, complete PVD was detected in 54.0% and 73.9% of eyes, respectively, in the high myopia group and in 14.0% and 44.0% of eyes, respectively, in the non-high myopia group. Abnormal PVD characteristics of pathologic myopia were detected in 1.7% of eyes in the high myopia group. Conclusions We precisely revealed, using age- and sex-matched patients, that partial PVD, including paramacular, perifoveal, and peripapillary PVD, and complete PVD develop at a significantly younger age in highly myopic eyes compared with non-highly myopic eyes, suggesting that PVD-related retinal pathologies occur younger in highly myopic patients.

To compare short-term changes in refractive prediction error (PE) after phacoemulsification among eyes receiving different types of single-piece acrylic intraocular lenses (IOLs).Randomized clinical trial.A total of 195 eyes of 195 patients scheduled for implantation of a single-piece acrylic IOL were randomly assigned to receive 1 of 3 IOLs: 1) an Alcon model SN60WF, 2) a Hoya model XY-1, or 3) an AMO model ZCB00V. Manifest spherical equivalent (MRSE) value, PE, and changes in PE were examined at 1 day and at 1 and 2 months postoperatively and were compared among groups.The mean MRSE and PE significantly changed toward myopia between 1 day and 2 months postoperatively in all groups (P.0001). The MRSE and PE did not differ significantly among groups at 1 day and 1 month postoperatively and were significantly smaller in the SN60WF group than in the XY-1 and ZCB00V groups at 2 months (P ≤ .0006). The PE change between 1 day and 2 months postoperatively was significantly smaller in the SN60WF group than in the other groups (P = .0062). IOL type and changes in anterior chamber depth and corneal curvature independently correlated with PE changes.The MRSE and PE showed a significant myopic change for 2 months postoperatively in eyes implanted with 1 of 3 types of single-piece acrylic IOLs and were significantly smaller in the SN60WF than in the XY-1 and ZCB00V groups. Changes in PE during the 2 postoperative months were smaller in the SN60WF IOLs than in the other IOLs, suggesting that postoperative refractive stability differs among single-piece acrylic IOLs.

AimTo compare changes in the shape and astigmatism of the total and posterior cornea between eyes with a nasal clear corneal incision (CCI) and eyes with a temporal CCI in cataract surgery.MethodsThe left eyes of 100 patients undergoing phacoemulsification were randomly assigned to undergo a 2.4 mm nasal (nasal CCI group) or temporal CCI (temporal CCI group). Corneal astigmatic changes were compared between groups using power vector analysis, and corneal shape changes were compared using videokeratography maps at 2 days, and at 2, 4 and 8 weeks postoperatively.ResultsThe mean J0and J45values of the total cornea were significantly greater in the nasal CCI group than in the temporal CCI group at 2 and 4 weeks postoperatively (p≤0.0392), but did not differ significantly between groups at 2 days and 8 weeks. The videokeratography maps revealed a wedge-shaped flattening in the total cornea and a steepening in the posterior cornea around the CCIs in both groups at 2 days postoperatively; those were more prominent in the nasal CCI group than in the temporal CCI group. The wound-related changes diminished by 8 weeks postoperatively in the total and posterior cornea, and were not markedly different between groups at 8 weeks postoperatively.ConclusionCorneal shape and astigmatic changes were comparable between groups at 8 weeks postoperatively, although the changes were greater after nasal CCI than after temporal CCI in the early postoperative periods, indicating that nasal or temporal CCI can be selected based on the surgeon’s preference.

Purpose To examine whether intraocular pressure (IOP) increases immediately after cataract surgery in eyes with pseudoexfoliation (PXF) syndrome and to assess whether orally administered acetazolamide can prevent the IOP elevation. Setting Hayashi Eye Hospital, Fukuoka, Japan. Design Prospective case series. Methods Patients with PXF syndrome scheduled for phacoemulsification were randomly assigned to 1 of 3 groups: (1) oral acetazolamide administered 1 hour preoperatively (preoperative administration group), (2) administered 3 hours postoperatively (postoperative administration group), and (3) not administered (no administration group). The IOP was measured using a rebound tonometer 1 hour preoperatively, upon completion of surgery, and at 1, 3, 5, 7, and 24 hours postoperatively. Results The study comprised 96 patients (96 eyes). The mean IOP increased at 3, 5, and 7 hours postoperatively in all groups. At 1 hour and 3 hours postoperatively, the IOP was significantly lower in the preoperative administration group than in the postoperative group and no administration group (P ≤ .001). At 5, 7, and 24 hours postoperatively, the IOP was significantly lower in the preoperative group and postoperative administration group than in the no administration group (P ≤. 045). An IOP spike higher than 25 mm Hg occurred less frequently in the preoperative administration group than in the postoperative administration group and the no administration group (P = .038). Conclusions Intraocular pressure increased at 3, 5, and 7 hours after cataract surgery in eyes with PXF syndrome. Oral acetazolamide administered 1 hour preoperatively reduced the IOP elevation throughout the 24-hour follow-up; acetazolamide administered 3 hours postoperatively reduced the elevation at 5 hours postoperatively and thereafter.

To compare changes in the shape and astigmatism of the total, anterior, and posterior cornea between eyes with long-length clear corneal incisions (CCIs) and eyes with short-length CCIs in cataract surgery.Hayashi Eye Hospital, Fukuoka, Japan.Prospective case series.Both eyes of patients having phacoemulsification with temporal CCIs were randomized to have a long-length (≥1.75 mm) or short-length (1.75 mm) CCI. Corneal astigmatic changes were decomposed to vertical/horizontal (Jackson cross-cylinder, axes at 180 degrees and 90 degrees [J0]) and oblique changes (Jackson cross-cylinder, axes at 45 degrees and 135 degrees [J45]) using power vector analysis. Corneal shape changes were assessed using the average of the difference map on videokeratography 2 days and 2, 4, and 8 weeks postoperatively.The mean J0 and J45 values of the total cornea in the 120 eyes evaluated were significantly greater in the long CCI group than in the short CCI group at all follow-ups (P ≤ .0290). The videokeratography showed a wedge-shaped flattening in the total and anterior cornea and a steepening in the posterior cornea around the CCI 2 days postoperatively in both groups. This wound-related flattening of the total and anterior cornea rapidly reduced but persisted until 8 weeks, whereas the steepening of the posterior cornea disappeared within 4 weeks. These changes extended closer to the central cornea in the long CCI group than in the short CCI group.Corneal astigmatic changes were significantly greater after long CCI than after short CCI. The wound-related shape changes occurred immediately postoperatively but rapidly diminished.

Purpose To examine how corneal astigmatism changes with age over 20 years after cataract surgery and to assess whether the changes differ from those in eyes that did not have surgery. Setting Hayashi Eye Hospital, Fukuoka, Japan. Design Retrospective case study. Methods Using an autokeratometer, corneal astigmatism was measured preoperatively, at baseline (the day the surgically induced astigmatism stabilized), and 10 years and 20 years after baseline. The change in corneal astigmatism between baseline and 10 years, 10 years and 20 years, and baseline and 20 years was determined using power vector analysis and compared between the time intervals and between groups. Results The study assessed 74 eyes that had phacoemulsification with a horizontal scleral incision more than 21 years ago (surgery group) and 68 eyes that did not have surgery (no-surgery group). The mean vertical/horizontal change in corneal astigmatism (J0) between baseline and 20 years was −0.64 diopter (D) in the surgery group and −0.49 D in the no-surgery group. The oblique change (J45) was −0.03 D in the surgery group and 0.07 D in the no-surgery group. Using multivariate comparison, the mean J0 and J45 values were not significantly different between baseline and 10 years or between 10 years and 20 years in both groups (P ≥ .2350). The J0 and J45 values were not significantly different between the 2 groups at any time interval (P ≥ .1331). Conclusions Corneal astigmatism continues to change toward against-the-rule astigmatism over 20 years after cataract surgery. This change was similar in eyes that did not have surgery.

To investigate the anatomical and functional changes in areas containing paravascular abnormalities (PVA) in eyes with epiretinal membrane (ERM) after surgery. Twenty-eight eyes with concurrent idiopathic ERM and PVA were enrolled in this prospective study. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and areas of PVA in the superficial and deep capillary levels detected on en face optical coherence tomography were measured preoperatively and 1, 3, and 6 months postoperatively. Retinal sensitivity in selected PVA lesions was evaluated by microperimetry preoperatively and 1 and 6 months postoperatively. The areas of PVA at the superficial capillary level before and 1, 3, and 6 months after surgery measured 1.65 ± 1.27, 0.44 ± 0.62, 0.40 ± 0.64, and 0.38 ± 0.62 mm2, respectively, while those at the deep capillary level measured 0.27 ± 0.57, 0.10 ± 0.26, 0.09 ± 0.29, and 0.05 ± 0.15 mm2, respectively. The areas of PVA in the superficial and deep capillary levels were significantly smaller postoperatively (all p

Background Alcohol abuse and adherence to atherogenic diet (AD; a low-carbohydrate-high-protein diet) have been positively associated with cardiovascular disease. In addition, it has been demonstrated clinically that dietary intake is increased on days when alcohol is consumed. Here, the additive effects of ethanol (EtOH) and AD on atherosclerosis, a major underlying cause of cardiovascular disease, were investigated in apolipoprotein E/low-density lipoprotein receptor double-knockout (KO) mice. The mechanisms, especially aortic oxidative stress damage, were highlighted. Methods Twelve-week-old male KO mice on AD with or without EtOH treatment were bred for 4 months. Age-matched male C57BL/6J mice on a standard chow diet without EtOH treatment served as controls. Analyses were conducted using ultrasound biomicroscopy, histopathological and fluorescence immunohistochemical examinations, Western blots, and polymerase chain reaction. Results KO mice on AD with EtOH treatment showed increases in aortic maximum intima media thickness, hypoechoic plaque formation, and mean Oil-Red-O content. These results were associated with enhanced ratio of aortic 8-hydroxy-2'-deoxyguanosine (8-OHdG)-immunopositive area to the metallothionein (MT) immunopositive area and suppression of AD-induced up-regulated aortic Mt1, Mt2, and upstream stimulatory factor 1 mRNA expressions. Moreover, 8-OHdG was expressed in the nuclei of CD31- and alpha smooth muscle actin-immunopositive cells, and the up-regulated mRNA expressions of aortic nitric oxide synthase 3 and platelet-derived growth factors were only observed in the KO mice on AD with EtOH treatment. Conclusions Alcohol abuse and adherence to AD may promote the shift of aortic oxidative stress and antioxidative stress balance toward oxidative stress predominance and reduced antioxidative stress, which may be partly due to the decrease in MT at the cell biological level and down-regulation of Mt at the gene level, which in turn could play a role in the up-regulation of endothelial dysfunction-related and vascular smooth muscle cell proliferation-related gene expression and the progression of atherosclerosis in mice with hyperlipidemia.

To compare intraocular pressure (IOP) immediately after cataract surgery, and surgically induced corneal astigmatism (SIA) and corneal shape changes between eyes with transconjunctival single-plane sclerocorneal incisions (TSSIs) and eyes with clear corneal incisions (CCIs). Bilateral eyes of 64 patients undergoing phacoemulsification were randomized to undergo 2.4-mm temporal TSSI or CCI. IOP was measured preoperatively, and in the immediate postoperative periods. SIA was determined using vector analysis, and corneal shape changes and irregular astigmatism were evaluated using a videokeratography preoperatively, and in the early postoperative periods. Wound hydration was performed in 23 eyes (35.9 %) of the TSSI group and in 60 (93.8 %) of the CCI group (P

PurposeTo examine whether intraocular lens (IOL) power prediction error (PE) after cataract surgery differs according to patient age.DesignProspective cohort study.MethodsWe consecutively enrolled 75 eyes of 75 patients 59 years of age or younger, and 150 eyes of 150 patients in each of 3 age groups (60–69, 70–79, and 80–89 years), for whom phacoemulsification and implantation of a single-piece acrylic IOL was planned. The IOL power was calculated using the optimized SRK/T formula. Objective refraction was measured using an autorefractometer at approximately 3 months postoperatively, and the mean arithmetic PE and median absolute PE were compared among age groups.ResultsThe mean preoperative refractive error predicted by the SRK/T formula was similar among age groups (P = .4179). The mean postoperative spherical equivalent was significantly more myopic in younger patients (P < .0001). Mean PE was −0.24 diopters (D) in those ≤59 years of age, −0.17 D in those 60–69 years of age, −0.11 D in those 70–79 years of age, and −0.05 D in those 80–89 years of age; the mean PE was less myopic in older patients (P = .0008). The median absolute PE did not differ significantly among groups (P = .6192). Mean PE was positively correlated with age (P < .0001). Multiple regression analysis revealed that age, preoperative axial length, average corneal curvature, and anterior chamber depth were independent predictors of the age-related difference in PE.ConclusionPE was less myopic by approximately 0.06 D per decade as age increased, suggesting that patient age should be considered when selecting IOL power.

An abdominal aortic aneurysm (AAA) is a localized dilatation of the infrarenal aorta. AAA is a multifactorial disease, and genetic and environmental factors play a part; smoking, male sex and a positive family history are the most important risk factors, and AAA is most common in men65 years of age. AAA results from changes in the aortic wall structure, including thinning of the media and adventitia due to the loss of vascular smooth muscle cells and degradation of the extracellular matrix. If the mechanical stress of the blood pressure acting on the wall exceeds the wall strength, the AAA ruptures, causing life-threatening intra-abdominal haemorrhage - the mortality for patients with ruptured AAA is 65-85%. Although AAAs of any size can rupture, the risk of rupture increases with diameter. Intact AAAs are typically asymptomatic, and in settings where screening programmes with ultrasonography are not implemented, most cases are diagnosed incidentally. Modern functional imaging techniques (PET, CT and MRI) may help to assess rupture risk. Elective repair of AAA with open surgery or endovascular aortic repair (EVAR) should be considered to prevent AAA rupture, although the morbidity and mortality associated with both techniques remain non-negligible.

An abdominal aortic aneurysm (AAA) is a localized dilatation of the infrarenal aorta. AAA is a multifactorial disease, and genetic and environmental factors play a part; smoking, male sex and a positive family history are the most important risk factors, and AAA is most common in men >65 years of age. AAA results from changes in the aortic wall structure, including thinning of the media and adventitia due to the loss of vascular smooth muscle cells and degradation of the extracellular matrix. If the mechanical stress of the blood pressure acting on the wall exceeds the wall strength, the AAA ruptures, causing life-threatening intra-abdominal haemorrhage — the mortality for patients with ruptured AAA is 65–85%. Although AAAs of any size can rupture, the risk of rupture increases with diameter. Intact AAAs are typically asymptomatic, and in settings where screening programmes with ultrasonography are not implemented, most cases are diagnosed incidentally. Modern functional imaging techniques (PET, CT and MRI) may help to assess rupture risk. Elective repair of AAA with open surgery or endovascular aortic repair (EVAR) should be considered to prevent AAA rupture, although the morbidity and mortality associated with both techniques remain non-negligible. An abdominal aortic aneurysm (AAA) is an enlargement of the abdominal aorta. As the AAA grows, the aortic wall becomes progressively thin, and the risk of rupture increases; AAA rupture causes severe intra-abdominal haemorrhage and has a very high mortality.

Abdominal aortic aneurysm (AAA) is a life-threatening disease, and no disease-specific circulating biomarkers for AAA screening are currently available. We have identified a smooth muscle cell (SMC)-specific biomarker for AAA. We cultured aneurysmal tunica media that were collected from eight patients undergoing elective open-repair surgeries. Secreted proteins in culture medium were subjected to liquid chromatography/tandem mass spectrometry. Myosin heavy chain 11 (myosin-11) was identified as a SMC-specific protein in the tunica media-derived secretions of all patients. We then examined myosin-11 protein concentrations by ELISA in plasma samples from patients with AAA ( n = 35) and age-matched healthy control subjects ( n = 34). Circulating myosin-11 levels were significantly higher in patients with AAA than control subjects. The area under the receiver-operating characteristic curve (AUC) of myosin-11 was 0.77, with a specificity of 65% at a sensitivity of 91%. Multivariate logistic regression analysis showed a significant association between the myosin-11 level and presence of AAA. When the myosin-11 level was combined with hypertension, it improved the prediction of AAA (AUC 0.88) more than hypertension per se. We then investigated the correlation between aortic diameter and circulating myosin-11 levels using AAA serum samples from patients undergoing endovascular aneurysm repair ( n = 20). Circulating myosin-11 levels were significantly correlated with maximum aortic diameter. Furthermore, changes in myosin-11 concentrations from the baseline 12 mo after endovascular aneurysm repair were associated with those in aortic diameter. These data suggest that circulating levels of myosin-11, which is a SMC-specific myosin isoform, may be useful as a biomarker for AAA.NEW & NOTEWORTHY Extensive studies have revealed that inflammation- or proteolysis-related proteins are proposed as biomarkers for abdominal aortic aneurysm (AAA). Changes in these protein concentrations are not specific for smooth muscle, which is a major part of AAA pathologies. Hence, no disease-specific circulating markers for AAA are currently available. We found, using secretome-based proteomic analysis on human AAA tunica media, that myosin heavy chain 11 was associated with AAA. Circulating myosin heavy chain 11 may be a new tissue-specific AAA marker.

BACKGROUND AND OBJECTIVE: To compare the surgical outcomes of epiretinal membrane (ERM) treatment between eyes with and without an ectopic inner foveal layer (EIFL). PATIENTS AND METHODS: Seventy-seven ERM eyes of 76 consecutive patients were investigated retrospectively. Optical coherence tomography examinations and best-corrected visual acuity (BCVA) measurements were performed before and at 6 and 12 months after vitrectomy. RESULTS: In both eyes with and without an EIFL, the BCVAs at 6 and 12 months after vitrectomy were significantly better than those before vitrectomy ( P < .05), whereas the BCVAs 6 and 12 months after vitrectomy were significantly better in eyes without an EIFL than in those with an EIFL ( P = .014 and P = .019, respectively). CONCLUSIONS: Vitrectomy may be effective in improving visual acuity in eyes with ERMs with and without an EIFL. However, ERM surgery may be desirable before EIFL development to obtain a better prognosis. [ Ophthalmic Surg Lasers Imaging Retina. 2018;49:838–845.]

Purpose To compare corneal astigmatism and shape between male and female eyes in relationship to age. Setting Hayashi Eye Hospital, Fukuoka, Japan. Design Prospective case series. Methods Eyes of men and women in 5 age groups (40 to 49 years, 50 to 59 years, 60 to 69 years, 70 to 79 years, and ≥80 years) had videokeratographic evaluations using a Placido-Scheimpflug system. Corneal astigmatism decomposed to vertical–horizontal (J0) and oblique (J45) astigmatism components was compared between male and female eyes, and corneal shape changes were compared using videokeratography maps. Results The study comprised 1000 eyes (100 eyes of male patients and 100 eyes of female patients in each of the 5 age groups). The mean J0 of the total and anterior cornea were significantly smaller in male eyes than in female eyes in all age groups (P ≤ .0269) with no significant difference in the J45 between sexes, indicating greater against-the-rule (ATR) astigmatism in male eyes. The mean J0 of the posterior cornea did not differ significantly between sexes except in the 50 to 59 years group (P = .0105). The ATR astigmatic change per decade did not differ significantly between men and women. Videokeratography maps revealed that the total and anterior corneal shape changed to ATR astigmatism with age in both sexes, and that this ATR change began at a younger age in male eyes than in female eyes. The posterior corneal shape did not differ between sexes at any age. Conclusion Against-the-rule corneal astigmatism was greater and the ATR astigmatic change with age began earlier in the male eyes than in the female eyes, suggesting that target astigmatism should be determined separately for men and women when performing astigmatism correction.

Summary Fluid loss is significant for the standard fracturing fluids without adding solid materials. One method to reduce fluid loss is to add silica flour, although it reduces fracture conductivity. Other methods are to use wall-building polymers. However, the fluid loss is still significant, and complete removal of wall-building materials is not possible, even with breakers. We found that powder, granular, and fibrous materials made of polyglycolic acid (PGA) or polylactic acid (PLA) are very suitable for fluid-loss agents because PGA is stronger than steel and PLA is as strong as rock, although they dissolve as liquid acids after applications. Fluid-loss tests are conducted with the standard American Petroleum Institute slot tester and filtrate-loss tester, mixing powders, grains, and fiber, all made of PGA or PLA in fracturing polymer fluids. The ratio of grains, powder, and fiber is optimized to minimize fluid loss for porous media and fractured porous media. Then, the changes of particle size are measured under heated conditions. Fracture-simulation studies are also conducted with a 3D fracture-boundary element model to compare the fluid efficiency of the fracturing fluids with and without the PLA and PGA particles. The results show that the capability of preventing fluid loss and plugging microcracks is maintained for the porous filters and small slots within a reasonable time period. For short-term applications less than 3 hours, both PGA and PLA fluid-loss agents are stable when the temperature is less than 212°F. Mixing these materials often provides more-efficient properties to reduce fluid loss and to bridge microcracks. No residues are left after experiments if the fracturing fluid is kept heated for 24 hours. The amount of the PGA and PLA fluid-loss agents required to reduce the fluid loss is not significant. Hence, their field applications are feasible, judging the cost and the benefit. The advantage in using these materials is that they turn from solid to liquid after applications so that no formation damage and no proppant-conductivity damage occur. The fluid loss is also significantly reduced with the powder particles. In addition, because the PGA and PLA materials are degradable, solids with arbitrary sizes and shapes may be used as long as they control fluid loss and plug fine fractures. Their applications are not only limited to reducing fluid loss, but one may also use them for engineering fracture design to enhance the fracture conductivity.

HMG-CoA (3-hydroxy-3-methylglutaryl-coenzyme A) reductase inhibitors (statins) have been suggested to attenuate abdominal aortic aneurysm (AAA) growth. However, the effects of statins in human AAA tissues are not fully elucidated. The aim of this study was to investigate the direct effects of statins on proinflammatory molecules in human AAA walls in ex vivo culture. Simvastatin strongly inhibited the activation of nuclear factor (NF)-κB induced by tumor necrosis factor (TNF)-α in human AAA walls, but showed little effect on c-jun N-terminal kinase (JNK) activation. Simvastatin, as well as pitavastatin significantly reduced the secretion of matrix metalloproteinase (MMP)-9, monocyte chemoattractant protein (MCP)-2 and epithelial neutrophil-activating peptide (CXCL5) under both basal and TNF-α-stimulated conditions. Similar to statins, the Rac1 inhibitor NSC23766 significantly inhibited the activation of NF-κB, accompanied by a decreased secretion of MMP-9, MCP-2 and CXCL5. Moreover, the effect of simvastatin and the JNK inhibitor SP600125 was additive in inhibiting the secretion of MMP-9, MCP-2 and CXCL5. These findings indicate that statins preferentially inhibit the Rac1/NF-κB pathway to suppress MMP-9 and chemokine secretion in human AAA, suggesting a mechanism for the potential effect of statins in attenuating AAA progression.

AIM Angiotensin Ⅱ(Ang Ⅱ) produces reactive oxygen species (ROS), thus contributing to the development of cardiac hypertrophy and subsequent heart failure, and stimulates the expression of monocyte chemoattractant protein-1 (MCP-1). In addition, Toll-like receptor 4 (TLR4) is involved in the upregulation of MCP-1. In order to clarify whether TLR4 is involved in the onset of cardiac dysfunction caused by Ang Ⅱ stimulation, we investigated the effects of TLR4 on oxidative stress, the MCP-1 expression and cardiac dysfunction in mice with Ang Ⅱ-induced hypertension. METHODS TLR4-deficient (Tlr4(lps-d)) and wild-type (WT) mice were randomized into groups treated with Ang Ⅱ, norepinephrine (NE) or a subdepressor dose of the Ang Ⅱreceptor blocker irbesartan (IRB) and Ang Ⅱ for two weeks. RESULTS Ang Ⅱ and NE similarly increased systolic blood pressure in all drug-treated groups compared to that observed in the control group among both WT and Tlr4(lps-d) mice (p＜0.05). In the WT mice, Ang Ⅱ induced cardiac hypertrophy as well as vascular remodeling and perivascular fibrosis of the intramyocardial arteries and monocyte/macrophage infiltration in the heart (p＜0.05). Furthermore, Ang Ⅱ treatment decreased the left ventricular diastolic function and resulted in a greater left ventricular end-systolic dimension (p＜0.05) in addition to producing a five-fold increase in the NADPH oxidase activity, ROS content and MCP-1 expression (p＜0.05). In contrast, the Tlr4(lps-d) mice showed little effects of Ang Ⅱ on these indices. In the WT mice, IRB treatment reversed these changes compared to that seen in the mice treated with Ang Ⅱ alone. NE produced little effect on any of the indices in either the WT or Tlr4(lps-d) mice. CONCLUSIONS TLR4 may be involved in the processes underlying the increased oxidative stress, selectively activated MCP-1 expression and cardiac hypertrophy and dysfunction seen in cases of Ang Ⅱ- induced hypertension.

Background: Abdominal aortic aneurysm (AAA), a common disease involving the segmen-tal expansion and rupture of the aorta, has a high mortality rate. Therapeutic options for AAA are cur-rently limited to surgical repair to prevent catastrophic rupture. Non-surgical approaches, particularly pharmacotherapy, are lacking for the treatment of AAA. Objective: We review both basic and clinical studies and discuss the current challenges to developing medical therapy that reduces AAA progression. Results: Studies using animal models of AAA progression and human AAA explant cultures have identified several potential targets for preventing AAA growth. However, no clinical studies have con-vincingly confirmed the efficacy of any pharmacologic treatment against the growth of AAA. Thus, there is as yet no strong recommendation regarding pharmacotherapy to reduce the risk of AAA pro-gression and rupture. Conclusion: This review identifies concerns that need to be addressed for the field to progress and dis-cusses the challenges that must be overcome in order to develop effective pharmacotherapy to reduce AAA progression in the future.

Purpose To confirm the prophylactic effect of oral acetazolamide against increased intraocular pressure (IOP) in the period immediately after cataract surgery in eyes with primary open-angle glaucoma (POAG) and to evaluate the appropriate administration time of oral acetazolamide to prevent IOP elevation. Design Randomized clinical study. Participants Ninety eyes of 90 patients with well-controlled POAG scheduled for phacoemulsification. Methods Eyes were assigned randomly to 1 of 3 groups: (1) oral acetazolamide (500 mg) administration 1 hour preoperatively, (2) oral acetazolamide (500 mg) administration 3 hours postoperatively, or (3) no acetazolamide administration. Intraocular pressure was measured using a rebound tonometer 1 hour preoperatively, at the conclusion of surgery (adjusted in the range between 15 and 25 mmHg), and 1, 3, 5, 7, and 24 hours postoperatively. The incidence of eyes with IOP elevation more than 100% above the preoperative IOP was compared. Main Outcome Measures Postoperative IOP and incidence of eyes with marked IOP elevation. Results Mean IOP 1 hour preoperatively and that at the conclusion of surgery did not differ significantly among groups. In all groups, mean IOP was significantly elevated from 3 to 7 hours postoperatively, and then decreased at 24 hours. At 1 and 3 hours postoperatively, mean IOP was significantly lower in the group receiving oral acetazolamide preoperatively than in the other 2 groups (postoperative administration or no administration; P ≤ 0.0031). At 5, 7, and 24 hours postoperatively, the IOP was significantly lower in both the preoperative and postoperative administration groups than in the nonadministration group ( P ≤ 0.0224). Intraocular pressure elevation of more than 100% occurred in 1 eye (3.3%) in the preoperative administration group, 7 eyes (23.3%) in the postoperative administration group, and 8 eyes (26.6%) in the nonadministration group; the incidence was significantly lower in the preoperative administration group ( P = 0.0459). Conclusions Eyes with POAG experienced short-term IOP elevation from 3 to 7 hours after phacoemulsification. Oral acetazolamide administration 1 hour preoperatively significantly reduced the IOP elevation from 1 to 24 hours, while administration 3 hours postoperatively reduced the IOP elevation at 5 hours or more after surgery.

We sought to examine changes in intraocular pressure (IOP) in the immediate period after clear corneal micro-incision cataract surgery (MICS) and after small-incision cataract surgery (SICS). Sixty-eight eyes of 34 patients scheduled for coaxial phacoemulsification were randomized into one of two groups: (a) eyes that were to undergo a 2.0-mm MICS, and (b) a 2.65-mm SICS. At the conclusion of surgery, the IOP was adjusted to the range between 15–40 mmHg with stromal hydration. The IOP was measured using a rebound tonometer preoperatively, at the conclusion of surgery, and at 3, 6, 9, 12, and 15 min postoperatively. The Seidel test and anterior segment-optical coherence tomography were performed at 20 min postoperatively. Mean IOP at the conclusion of surgery was 27.7 ± 4.7 mmHg in the MICS group and 29.7 ± 5.1 mmHg in the SICS group (p = 0.1239). In both groups, mean IOP decreased to the preoperative level within 9 min postoperatively and did not change significantly for up to 15 min. Mean IOP was similar between the MICS and SICS groups throughout the observation period (p ≥ 0.1239). Hypotony (≤10 mmHg), positive Seidel test, and loss of wound coaptation were not detected in all eyes. After adjusting the IOP to a relatively high level at the conclusion of surgery, the IOP decreased within 9 min and was stable within 15 min without hypotony. The IOP was comparable between eyes after MICS and SICS, and both incisions virtually closed within 20 min postoperatively.

Background In the tumor microenvironment, factors inhibiting the targeting of cancer cells by activated T cells have recently been noted. B7-H3 belongs to the B7 superfamily of immune regulatory ligands and plays an important role in the adaptive immune response of co-inhibitory/stimulatory factors in regulating T cells. However, the degree to which B7-H3 directly affects tumor immune evasion mechanisms remains unclear, particularly in patients with breast cancer. Regulatory T cells (Tregs) are known as a key player in the inhibition of immune mechanisms. The present study demonstrated that expression of B7-H3 on tumor cells and the number of Tregs in the tumor microenvironment independently affected prognosis in breast cancer patients. Methods We immunohistochemically investigated the presence of B7-H3 and forkhead box P3 (Foxp3)-positive Tregs in pathological specimens from 90 patients with breast cancer. Results Positive B7-H3 expression was associated with shorter recurrence-free survival (RFS) (p = 0.014). A higher percentage of Foxp3-positive cells also correlated with shorter RFS (p = 0.039). Multivariate analysis showed B7-H3 as an independent factor on RFS. Foxp3 expression in tumor-infiltrating lymphocytes (TILs) correlated significantly with larger tumor size (>2 cm), expression of human epidermal growth factor receptor 2 (HER2), and higher nuclear grade (p = 0.003, p

Purpose To compare changes in intraocular pressure (IOP) immediately after clear corneal incision (CCI) cataract surgery between eyes in which IOP was adjusted to a high or normal range at the conclusion of surgery. Setting Hayashi Eye Hospital, Fukuoka, Japan. Design Comparative case series. Methods Either eye of patients scheduled for phacoemulsification was randomized to 1 of 2 groups as follows: eyes that were to be adjusted to (1) high IOP (22 to 40 mm Hg) or (2) normal IOP (10 to 21 mm Hg). The IOP was measured using a rebound tonometer preoperatively; at the conclusion of surgery; and 15, 30, 60, 120, and 180 minutes and 24 hours postoperatively. The Seidel test and anterior segment optical coherence tomography (AS-OCT) were performed. Results The mean IOP at the conclusion of surgery was 31.3 mm Hg in the high IOP group and 17.1 mm Hg in the normal IOP group. The IOP decreased to approximately 15 mm Hg by 15 minutes and did not change until 60 minutes in either group. The mean IOP did not differ significantly between groups throughout the observation period (P≥.0634). Hypotony of 5 mm Hg or less was not detected in any eye. The Seidel test was negative and based on AS-OCT, the wound was closed at 60 minutes in all eyes. Conclusions After adjusting IOP to a high or normal range, the IOP normalized within 15 minutes postoperatively and was stable for 24 hours. The wound was closed within 60 minutes postoperatively. Financial Disclosure The Hayashi Eye Hospital (Drs. Hayashi, Yoshida, Manabe, and Yoshimura) received a research grant for clinical trials of materials outside the submitted work sponsored by Alcon Japan Ltd., Santen Pharmaceutical Inc., Senjyu Pharmaceutical Ltd., Hoya Corp., Pfizer Japan, Inc., Novartis Pharma K.K., Wakamoto Pharmaceutical Ltd., Nitten Pharmaceutical Ltd., Japan Association of Health Service, and EBMs Ltd. Dr. Hayashi received lecture fees with or without travel expenses for materials outside the submitted work from Santen Pharmaceutical, Inc., Alcon Japan Ltd., and Pfizer Japan, Inc. No author has a financial or proprietary interest in any material or method mentioned.

Background The precise pathologic mechanisms underlying human thoracic aortic aneurysms (TAAs) remain uncertain, except that matrix metalloproteinase-9 (MMP-9) is considered a key enzyme for the degradation of extracellular matrix in aneurysm walls. The aim of this study was to elucidate the significance of the angiotensin II (AngII) pathway to MMP-9 production in human TAA walls. Methods and results We examined the activation of Smad2, a common downstream molecule of AngII and transforming growth factor β (TGF-β) pathways, and the expression of MMP-9 in human nonsyndromic TAA walls. We observed significant increases in Smad2 activation and MMP-9 expression, associated with disruption of elastic lamellae. Using human TAA walls in ex vivo culture, we investigated whether AngII and/or TGF-β pathways are essential for MMP-9 production. Unexpectedly, TGF-β receptor inhibitor had no effect on MMP-9 production. We used PD98059, an inhibitor of extracellular signal–regulated kinase (ERK) activation, and demonstrated that PD98059 dramatically reduced MMP-9 production with attenuation of Smad2 activation. Moreover, exogenous AngII resulted in increases in Smad2 activation and MMP-9 production, in an ERK-dependent manner. Conclusion Our findings indicate that the AngII/ERK pathway has an important role in the production of MMP-9 in human nonsyndromic TAA walls.

Purpose To compare binocular visual function in patients with unilateral cataract after monocular implantation of a multifocal intraocular lens (IOL) and after monocular implantation of a monofocal IOL. Setting Hayashi Eye Hospital, Fukuoka, Japan. Design Nonrandomized comparative study. Methods Patients with unilateral cataract scheduled for implantation of a diffractive multifocal IOL and age-matched patients scheduled for implantation of a monofocal IOL were recruited. Three months postoperatively, binocular visual acuity from far to near distances, binocular photopic or mesopic high- to low-contrast visual acuity with and without glare, and stereoacuity were examined. Results The mean binocular uncorrected near visual acuity or corrected near visual acuity at 0.3 m and uncorrected or corrected intermediate visual acuity at 0.5 m were significantly better in the multifocal group than in the monofocal group ( P ≤.0196), although there was no significant difference in uncorrected or corrected visual acuity at other distances. Binocular photopic contrast visual acuity and glare visual acuity at low contrasts and mesopic glare visual acuity were significantly worse in the multifocal group than in the monofocal group ( P ≤.0147). Near stereoacuity was similar between groups. Spectacle independence was significantly better in the multifocal group than in the monofocal group ( P ≤.0006). Conclusion Monocular implantation of a diffractive multifocal IOL in patients with unilateral cataract provided better binocular near and intermediate visual acuity and spectacle independence than monocular implantation of a monofocal IOL, although distance contrast sensitivity was worse with the multifocal IOL. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

本研究の目的は精神科で実践される看護技術についての国内の先行研究を分析し、そこから見えてくる傾向と今後の課題を明らかにすることである。精神科の看護技術に関する14の先行研究を分析した結果、精神科における看護技術の定義や概念は記されておらず、研究者ごとの解釈で看護技術を検討していた。今後の課題としては概念構築のために、1人の患者が入院から退院して、安定した地域生活の定着後のある時期までの期間を縦断的に追跡していく研究が必要である。もしくは、疾患の種類や病期、患者の属性等を統一した研究成果を蓄積し、その成果を体系化していくことが実現可能な研究デザインである。今後、精神障害者の社会復帰や自立、エンパワメントを目指す看護技術が特に重要になってくることが考えられる。よって、これまでの研究には含まれていなかった就労支援や余暇活動の充実の視点も含めていくことが必要である。