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PurposeTrend analysis of visual field (VF) global indices may underestimate the rate of progression in severe glaucoma because of the influence of test points without detectable sensitivity. To test this hypothesis, we compared the rates of change of VF global indices with and without exclusion of undetectable points at various disease stages.Materials and methodsSix hundred and forty-eight eyes of 366 glaucoma patients with 8 or more reliable 30-2 standard automated perimetry over more than 2 years were enrolled. We calculated targeted mean total deviation (TMTD) by averaging total deviation except points which were consistently undetectable in 3 baseline tests. Eyes were classified as early (≥-6 dB), moderate (-6 dB to -12 dB), advanced (-12 dB to -20 dB), and severe (

Aim: The impact of cognitive dysfunction‐associated activities of daily living (ADL) on mortality and rehospitalization for heart failure has not yet been evaluated. Methods: We retrospectively evaluated DASC‐21, the incidence of all‐cause mortality, and rehospitalization for heart failure after discharge in 329 older patients with heart failure. Results: The mean age was 85.1 ± 7.4 years (62.6% women). There were 110 cases of death from any cause (33.4%) during 25.5 ± 16.1 months of follow‐up and 166 cases of rehospitalization from heart failure (50.5%) during 16.1 ± 15.2 months of follow‐up. The DASC‐21 score was not significantly associated with an increased risk of all‐cause mortality or rehospitalization. For each item of the DASC‐21 questionnaire, defective route‐finding (item 6) (HR = 2.631, P = 0.003), common sense and capacity for judgement (item 9) (HR = 1.717, P = 0.040), instrumental ADL (IADL) for shopping (item 10) (HR = 1.771, P = 0.020), and IADL for meal preparation (item 14) (HR = 1.790, P = 0.019) were significantly associated with an increased risk of all‐cause mortality. Disabilities in route finding (HR = 2.257, P = 0.005), IADL for shopping (HR = 1.632, P = 0.016), and IADL for transportation (HR = 1.537, P = 0.033) were significant risk factors for rehospitalization due to heart failure. Even in the multivariate‐adjusted model, disability in defective route‐finding was significantly associated with an increased risk of all‐cause mortality (hazard ratio [HR] = 2.148, 95% confidence interval [CI] 1.090–4.236; P = 0.027) and of rehospitalization for heart failure (HR = 2.138, 95% CI 1.153–3.963, P = 0.016). Conclusions: In older patients hospitalized for heart failure, route disability was associated with all‐cause mortality and rehospitalization for heart failure after discharge. Geriatr Gerontol Int 2024; 24: 1130–1136. [ABSTRACT FROM AUTHOR]

ObjectiveTo measure the parapapillary atrophy (PPA) area in en face images obtained with swept-source optical coherence tomography (SS-OCT), and to evaluate its relationship to glaucoma, myopia, and age in non-highly myopic subjects.DesignRetrospective, cross-sectional study.ParticipantsFifty eyes of 30 subjects with open-angle glaucoma (G group) and forty-three eyes of 26 healthy control subjects (C group). Eyes with high myopia (spherical equivalent refractive error ≤ -8 diopters or axial length ≥ 26.5 mm) were excluded.MethodsMean age ± standard deviation was 59.9 ± 12.4 years. The beta zone and the gamma zone PPA areas were measured in en face images reconstructed from three-dimensional SS-OCT images. Relationship between the PPA areas and patient characteristics such as glaucoma, axial length, and age was statistically evaluated using multivariate mixed-effects models.Main outcome measuresAreas of the beta zone and the gamma zone PPA measured on en face OCT images.ResultsAverage ± standard deviation area of the beta and the gamma zone was 0.64 ± 0.79 and 0.16 ± 0.30 mm2, respectively. In multivariate models, the gamma zone significantly correlated with axial length (P = 0.001) but not with glaucoma (P = 0.944). In contrast, the beta zone significantly correlated with age (P = 0.0249) and glaucoma (P = 0.014).ConclusionsEn face images reconstructed from 3D SS-OCT data facilitated measurements of the beta and the gamma PPA zones even in eyes with optic disc distortion. The OCT-defined beta zone is associated with glaucoma and age, whereas the gamma zone correlated with myopia but not with glaucoma. This study confirmed the clinical usefulness of OCT-based classification of the PPA zones in distinguishing glaucomatous damage of the optic nerve from myopic damage in non-highly myopic eyes.

Aim: We investigated whether the Dementia Assessment Sheet for Community‐based Integrated Care System‐21 Items (DASC‐21), a questionnaire that assesses cognitive function, including activities of daily living (ADL), was predictive of in‐hospital death and prolonged hospital stay in elderly patients hospitalized for heart failure. Methods: We retrospectively assessed the DASC‐21 score at the time of admission, in‐hospital death, length of hospital stay, and change in the Barthel index in 399 patients hospitalized for heart failure between 2016 and 2019. Results: The mean patient age was 85.8 ± 7.7 years (61.3% women). The median DASC‐21 score was 38 (64.7% higher than 31). On multivariate logistic regression analysis, a higher DASC‐21 score was associated with an increased risk of in‐hospital death (odds ratio [OR] = 1.045 per 1 point increase, 95% confidence interval [CI]: 1.010–1.081, P = 0.012), even after adjusting for confounding factors, including atrial fibrillation, ejection fraction, and B‐type natriuretic peptide. Difficulties (3 or 4) with the self‐management of medication in instrumental ADL inside the home (OR = 3.28, 95% CI: 1.05–10.28, P = 0.042), toileting (OR = 3.66, 95% CI: 1.19–11.29, P = 0.024), grooming (OR = 6.47, 95% CI: 2.00–20.96, P = 0.002), eating (OR = 7.96, 95% CI: 2.49–25.45, P < 0.001), and mobility in physical ADL (OR = 5.99, 95% CI: 1.85–19.35, P = 0.003) were identified as risk factors for in‐hospital death. Patients in the highest tertile of the DASC‐21 score had a significantly longer hospital stay (P = 0.006) and a greater reduction in the Barthel index (P < 0.001). Conclusions: In elderly patients hospitalized for heart failure, higher DASC‐21 scores were associated with an increased risk of in‐hospital death, prolonged hospital stay, and impaired ADL. Geriatr Gerontol Int 2024; 24: 546–553. [ABSTRACT FROM AUTHOR]

We are pleased to bring you the 5th edition of the Glaucoma Clinical Practice Guidelines. Clinical practice guidelines are based on evidence (scientific grounds). It is a document that presents the treatment that is the most appropriate for the patient. "Glaucoma Clinical Guidelines" was first published in 2003. This was the first guideline for glaucoma treatment in Japan. The principle of glaucoma treatment is to lower intraocular pressure. Means for lowering intraocular pressure includes drugs, lasers, and surgery; Glaucoma is a disease that should be considered as a complex syndrome rather than a single condition. Therefore, the actual medical treatment is not as simple as one word. This time we set the Clinical Questionnaire with a focus on glaucoma treatment. We hope that you will take advantage of the 5th edition. [ABSTRACT FROM AUTHOR]

Abstract Background Chronic kidney disease (CKD) is associated with cardiovascular events. Adipocyte fatty acid-binding protein (A-FABP) plays an important role in atherosclerosis. We investigated whether plasma A-FABP is involved in renal function in patients with stable angina pectoris. Methods A total of 221 patients with significant coronary artery stenosis were enrolled after coronary angiography. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2. The severity of coronary stenosis was assessed using a modified Gensini score and coronary angiography. Serum A-FABP levels were determined by enzyme-linked immunosorbent assay. Results Serum A-FABP levels were significantly correlated with both eGFR (r = -0.41, p < 0.01) and the severity of coronary artery stenosis (r = 0.16, p = 0.02), and these relationships remained significant after adjusting for confounding factors. The prevalence of CKD and multi-vessel disease was significantly higher among patients with serum A-FABP levels above the median value of 20.3 ng/ml than among patients with serum A-FABP levels below the median value (57% vs. 27%, p < 0.01 and 64% vs. 48%, p = 0.02, respectively). Multivariate analysis revealed that the presence of three-vessel disease in comparison with single-vessel disease was independently associated with the higher A-FABP (per doubling) (odds ratio; 2.26, 95% confidential interval; 1.28-3.98, p < 0.01) and tended to be associated with the lower eGFR (p = 0.06). Conclusion Serum A-FABP may have a significant role in the interplay between renal dysfunction and coronary atherosclerosis.

Abstract Background Adipocyte fatty acid-binding protein (A-FABP) has been reported to play critical roles in the development of atherosclerosis. We investigated whether an increased in plasma A-FABP level can be independently associated with the presence of coronary artery disease (CAD). Methods Two hundred eleven consecutive male patients (mean age: 66 years, range: 33-87 years) were enrolled from inpatients who underwent coronary angiography. Age-matched male subjects (n = 211) having no evidence of CAD served as controls. Plasma A-FABP levels were measured by enzyme-linked immunosorbent assays. Results Plasma A-FABP levels in CAD patients were significantly higher than in control subjects (median [IQR], 20.6 [15.7-27.8] ng/mL vs. 15.1 [11.7-19.9] ng/mL, p < 0.01). Multivariate logistic regression analysis revealed that an increased plasma A-FABP level was independently associated with the presence of CAD in all subjects (adjusted odds ratio: 1.76, 95% confidence interval: 1.14 to 2.70, p = 0.01). Furthermore, sub-analysis based on age showed that this association remained significant in subjects aged < 65 years (adjusted odds ratio: 3.06, 95% confidence interval: 1.34 to 6.98, p < 0.01), but not in subjects aged ≥65 years. Conclusions Increased plasma A-FABP in non-elderly men had a significant association with the presence of CAD, independent of established CAD risk factors.