[The relationship between death from renal insufficiency and diuretic therapy among older adults at two nursing homes catering atomic bomb survivors].

AIM: In Geriatrics Gerontology International we previously reported the efficacy of reducing diuretics to prevent falls and fractures in older adults. We have since noticed another important problem, regarding the diuretic therapy for older adults with decreased muscle and water volumes. We performed a study on renal insufficiency and diuretic therapy in an attempt to confirm the need for case control study between standard diuretic therapy administered, according to guidelines and "NY-mode" diuretic therapy, which involves the administration of the mineral-corticoid receptor inhibitor spironolactone at 12.5 mg orally every other day. METHODS: We reviewed the causes of death among 1,855 residents living at 2 atomic bomb survivors nursing homes, with a focus on the death certification and diuretic therapy status of 48 older adults who died due to renal insufficiency. We also evaluated the relationship between the estimated glomerular filtration rate of 407 residents using serum creatinine data and the level of independence in daily life of disabled older adults. RESULTS: We found that deaths due to chronic renal insufficiency were concentrated within certain period in two nursing homes examined and in patients receiving standard diuretic therapy (continuous daily loop diuretics or combination of loop diuretics with mineral-corticoid receptor inhibitor). Older adults with a relatively low level of independence in daily life showed a relatively higher estimated glomerular filtration rate, depending on their muscle volume. CONCLUSION: These results suggest the need for a case control study of standard diuretic therapy and "NY-mode" therapy among older adults with decreased muscle and water volumes to not only prevent falls and fall-related fractures but also protect the kidney from damage.

Hepatic reduction of carbamoyl-PROXYL in ferric nitrilotriacetate induced iron overloaded mice: an in vivo ESR study.

Reduction of a nitroxyl radical, carbamoyl-PROXYL in association of free radical production and hepatic glutathione (GSH) was investigated in iron overloaded mice using an in vivo L-band electron spin resonance (ESR) spectrometer. Significant increases in hepatic iron, lipid peroxidation and decrease in hepatic GSH were observed in mice intraperitoneally (i.p.) administrated with ferric nitrilotriacetate (Fe(III)-NTA, a total 45 µmol/mouse over a period of 3 weeks). Free radical production in iron overloaded mice was evidenced by significantly enhanced rate constant of ESR signal decay of carbamoyl-PROXYL, which was slightly reduced by treatment with iron chelator, deferoxamine. Moreover, the rate constant of ESR signal decay was negatively correlated with hepatic GSH level (r=-0.586, p<0.001). On the other hand, hepatic GSH-depletion (>80%) in mice through daily i.p. injection and drinking water supplementation of L-buthionine-[S,R]-sulfoximine (BSO) significantly retarded ESR signal decay, while there were no changes in serum aspartate aminotransferase and liver thiobarbituric acid-reactive substances levels. In conclusion, GSH plays two distinguish roles on ESR signal decay of carbamoyl-PROXYL, as an antioxidant and as a reducing agent, dependently on its concentration. Therefore, it should be taken into account in the interpretation of free radical production in each specific experimental setting.

Physical Activity and Its Diurnal Fluctuations Vary by Non-Motor Symptoms in Patients with Parkinson's Disease: An Exploratory Study.

Background: This exploratory study investigated the association between non-motor symptoms (NMS) and both physical activity and diurnal activity patterns in patients with Parkinson's disease (PwPD). Methods: Participants included PwPD with modified Hoehn and Yahr stages 1−3. The presence of NMS was assessed with Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part I. Physical activity was measured using a waist-mounted triaxial accelerometer. Logistic regression analyses evaluated associations between NMS and physical activity; furthermore, diurnal fluctuation in physical activity due to NMS was examined by ANCOVA. Results: Forty-five PwPD were included in the study. Among the domains of NMS, pain and other sensations (OR, 8.36; 95% CI, 1.59−43.94) and fatigue (OR, 14.26; 95% CI, 1.85−109.90) were associated with low daily step count (<4200 steps/day). Analysis by time of day showed no characteristic variability in physical activity but had constant effect sizes for pain and other sensations (p = 0.20, ES = 0.36) and fatigue (p = 0.08, ES = 0.38). Conclusion: Our exploratory study suggested that PwPD with pain and other sensations and fatigue recorded lower step counts than their asymptomatic counterparts. Therefore, PwPD with pain and fatigue may need more support in promoting physical activity.

Improved visualization of Henle fiber layer by changing the measurement beam angle on optical coherence tomography.

PURPOSE: The outer plexiform layer (OPL) includes the photoreceptor synapse layer and Henle fiber layer (HFL) in the macular area. We attempted to improve optical coherence tomography imaging of the HFL by changing the angle of the measurement beam. METHODS: Thirteen normal eyes underwent spectral domain optical coherence tomography. To focus the angle of the measurement beam perpendicular to the obliquely oriented HFL, the beam in the optical coherence tomography system was aimed at the periphery of the pupil. RESULTS: The cross-sectional image of the macular area was inclined right or left if the beam entered from the periphery of the pupil. The reflectivity of the OPL increased because of strong backscattering of light in the half of the macula that was tilted down in cross-sectional images. On the opposite side, the reflectivity of HFL (the outer two-thirds of the OPL) decreased compared with that of the outer nuclear layer, but the photoreceptor synapse layer (the inner one-third of the OPL) remained highly reflective. The mean thicknesses of the OPL that could be visualized 1.0 mm and 1.5 mm from the central fovea were 73.7 ± 7.0 µm and 64.1 ± 8.2 µm, respectively. CONCLUSION: Positioning the measurement beam perpendicular to HFL enhanced visualization performance.

Correlation between visual acuity and foveal microstructural changes in diabetic macular edema.

PURPOSE: The purpose of this study was to investigate the correlation between best-corrected visual acuity and foveal microstructural changes of the external limiting membrane and the junction between the inner and outer segments of the photoreceptors in diabetic macular edema. METHODS: The authors performed spectral-domain optical coherence tomography in all eyes. The authors defined central subfield thickness as the average retinal thickness of the 1-mm central scanned area. The length of disruption of the external limiting membrane and the inner and outer segments of the photoreceptors in the fovea (1.8 mm in diameter) were measured and graded according to their length as follows: 1) >1.4 mm; 2) >0.4 mm but <1.4 mm; or 3) <0.4 mm. RESULTS: The best-corrected visual acuity was strongly associated with the external limiting membrane (r = 0.66) and inner and outer segments of the photoreceptor (r = 0.68) scores, whereas best-corrected visual acuity was weakly and negatively correlated with central subfield thickness (r = -0.23). CONCLUSION: Spectral-domain optical coherence tomography showed that the integrity of the external limiting membrane and inner and outer segments of the photoreceptors was more strongly correlated with best-corrected visual acuity when compared with central subfield thickness in diabetic macular edema.

[Sensitivity and specificity of combined use of Ala score and CIScore in the diagnosis of dementia with Lewy bodies].

Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are two major types of dementia. Due to shared signs and symptoms, accurate diagnosis of these dementia subtypes is a clinical challenge. We assessed the sensitivity and specificity of the combined use of neuropsychological testing and brain imaging data for the differential diagnosis of these conditions. The study population included 77 patients with either AD or DLB. Ala score was calculated from Mini-Mental State Exam subscores, and the cingulate island sign score (CIScore) was obtained from image analysis of brain perfusion single-photon emission computed tomography. Correlation between Ala score and CIScore values was observed in the subgroup of patients aged ≤79 years (r = 0.485, P = 0.002), and the scatter plot revealed that 70% of DLB patients were within the range of cut-off values for DLB. In the group aged ≥80 years, there was poor correlation between the Ala and CIScores (r = 0.285, P = 0.083), the average CIScore exceeded the cut-off value, and the scatter plot showed lower sensitivity, illustrating the challenge of discriminating AD from DLB in an older patient population. The concurrent use of Ala score and CIScore enhanced the specificity and the area under the curve in both subgroups, indicating the improved ability of these tests to aid in the differential diagnosis of AD from DLB. Our findings suggest that the use of these methodologies in routine medical practice may increase the sensitivity and specificity of the diagnosis of dementia subtypes.

Tomographic features of serous retinal detachment with multilobular dye pooling in acute Vogt-Koyanagi-Harada disease.

PURPOSE: To clarify the morphologic background of serous retinal detachment with multilobular dye pooling on fluorescein angiography (FA) in acute Vogt-Koyanagi-Harada (VKH) disease. DESIGN: Retrospective uncontrolled case series. METHODS: setting: Institutional study. study population: Ten eyes of five patients aged 16 to 52 years (average age, 31 years) with VKH disease who presented with a serous retinal detachment. observation procedures: Clinical examination and optical coherence tomography (OCT). main outcome measures: Findings on OCT and FA. RESULTS: All eyes had multilobular dye pooling with a dark rim on late-phase FA. OCT revealed subretinal septa that divided the subretinal space into several compartments. The subretinal septum lay on the retinal pigment epithelium (RPE) in the foveal area, forming the posterior wall of the subfoveal compartment while it detached from the RPE in the perifoveal area, which served as a lateral wall between the subfoveal and perifoveal compartments. The dark rims of each area of subretinal dye pooling corresponded to the subretinal septa. Soon after steroid pulse therapy, the subretinal septa resolved completely in all eyes. CONCLUSION: Subretinal septa caused multilobular dye pooling in serous retinal detachment associated with acute VKH disease. We assume that the subretinal septa are comprised of inflammatory products such as fibrin, which immediately resolve after steroid pulse therapy.

Reduction of diuretics and analysis of water and muscle volumes to prevent falls and fall-related fractures in older adults.

AIM: In an attempt to decrease the incidence of falls and fall-related fractures at a special geriatric nursing home, we endeavored to reduce diuretic doses, and examined the relationship between the effectiveness of this approach with the body compositions and activities of daily living of the study cohort. METHODS: We enrolled 93 participants living in the community, 60 residents of an intermediate geriatric nursing home and 50 residents of the 100-bed Kandayama Yasuragien special geriatric nursing home. We recorded body composition using a multifrequency bioelectrical impedance analyzer. Daily loop diuretic and other diuretic regimens of those in the special geriatric nursing home were reduced or replaced with "NY-mode" diuretic therapy, namely, spironolactone 12.5 mg orally once on alternate days. RESULTS: The incidence of falls fell from 53 in 2011 to 29 in 2012, and there were no fall-related proximal femoral fractures for 3 years after the introduction of NY-mode diuretic therapy. We also found statistically significant differences in muscle and intracellular water volumes in our elderly participants: those with higher care requirements or lower levels of independence had lower muscle or water volumes. CONCLUSIONS: We found that reducing or replacing daily diuretics with NY-mode therapy appeared to reduce the incidence of falls and fall-related proximal femoral fracture, likely by preserving intracellular and extracellular body water volumes. Low-dose spironolactone (12.5 mg on alternate days) appears to be an effective means of treating elderly individuals with chronic heart failure or other edematous states, while preventing falls and fall-related fractures. Geriatr Gerontol Int 2017; 17: 262-269.

Resolution of diabetic cystoid macular edema associated with spontaneous vitreofoveal separation.

PURPOSE: To report spontaneous resolution of diabetic cystoid macular edema (CME) associated with spontaneous vitreofoveal separation. DESIGN: Interventional case series. METHODS: Optical coherence tomography (OCT) was performed on three eyes of three diabetic patients with CME before and after vitreofoveal separation. RESULTS: In all three eyes, OCT showed cystic changes at the fovea with a slightly detached posterior hyaloid, which remained attached to the optic disk and the fovea. After spontaneous separation of the hyaloid at the fovea, there was resolution of the cystic cavities and restoration of the foveal depression. CONCLUSIONS: In some eyes of diabetic patients, CME is caused by a vitreous traction. Resolution of CME may occur after spontaneous vitreofoveal separation.

[Neoadjuvant intraarterial chemotherapy with nedaplatin, peplomycin and mitomycin C for advanced cervical cancer].

The aim of the present study was to examine the usefulness of neoadjuvant intraarterial chemotherapy (NAC) using nedaplatin as key drug to improve the prognosis in case of advanced cervical cancer. Twenty-five cases of advanced cervical cancer (15 cases of stage II with high risks, 10 of stage III, referred to as the 254-S group) treated by NAC using nedaplatin, mitomycin C and peplomycin were compared with 30 cases (22 cases of stage II with high risks, 8 of stage III, referred to as the CDDP group) treated using cisplatin and mitomycin C which is the conventional regimen, in terms of measurable response, pathological response, rate of lymph node metastasis, cumulative survival rate, side effects and relapse style. According to the evaluation by measurable responses, the response rate was 90% (CR 52%) in the 254-S group and 75% (CR 15%) in the CDDP group. For pathological response of the specimen, the CR rate was 16% in the 254-S group and 23% in the CDDP group. The rate of lymph node metastasis extracted surgically was 33% and 41%, respectively. The cumulative survival rate in the 254-S group was about 10% better than in the CDDP group, but no significant difference was found. Leucopenia of both groups was of the same grade. In the 254-S group, although thrombocytopenia was more critical than in the CDDP group, there was a slight tendency to kidney toxicity. The locoregional recurrence rate was 12% in the 254-S group and 30% in the CDDP group. The distant metastasis rate was 16% and 27%, respectively. Although neoadjuvant intraarterial chemotherapy using nedaplatin as a key drug was useful to improve the prognosis of advanced cervical cancer, measures against recurrence outside the pelvis and individualization of medical treatment were considered to lead to a further improvement of the prognosis.

Movement of intraretinal fluid from distant branch retinal vein occlusion to the submacular space.

BACKGROUND: Extramacular branch retinal vein occlusion (BRVO) occasionally causes serous macular detachment. We studied the movement of extravasated fluid from BRVO lesions to the submacular space. METHODS: We examined nine eyes from nine patients with serous retinal detachment caused by extramacular BRVO. In addition to a comprehensive ophthalmic examination, optical coherence tomography was performed in all nine eyes. Six of the patients also underwent fluorescein angiography. RESULTS: Visual acuity ranged from 0.03 to 0.9 (median 0.5). All nine eyes showed localized macular detachment and retinal edema which extended from the extramacular BRVO to the macula. Fluorescein angiography revealed dye leakage in the extramacular area but no macular leakage in the six eyes examined. Optical coherence tomography revealed serous retinal detachment in the macula and intraretinal swelling, with low reflectivity in the outer retina extending from the distant BRVO toward the detached macula in all nine eyes. Six eyes were treated with laser photocoagulation, covering the entire area of BRVO, and the other three eyes were treated with intravitreal bevacizumab. Serous retinal detachment and retinal swelling resolved within 3 months of treatment in all nine eyes. CONCLUSION: Distant retinal vascular leakage appears to diffuse through the outer retina to the macula, then permeate into the subretinal space.

Dialysate purification after introduction of automated hot water disinfection system to central dialysis fluid delivery system.

Most dialysis clinics in Japan have mainly adopted the central dialysis fluid delivery system (CDDS) to provide constant treatment to many patients. Chemical disinfection is the major maintenance method of the CDDS. Our clinic introduced an automated hot water disinfection system that used the heat conduction effect to disinfect a reverse osmosis (RO) device and dialysis fluid supply equipment. Endotoxin level and the amount of viable bacteria often showed abnormal values before introduction of this system. After its introduction, weekly disinfection resulted in endotoxin levels and the amount of viable bacteria lower than measurement sensitivity. In hot water disinfection, water heated to 90°C in the RO tank flows into the dialysis fluid supply equipment. The maximum temperature inside the tank of the supply equipment is 86.3°C. (We confirmed that the temperature was maintained at 80°C or more for 10 minutes or more during the monitoring.) Dialysate purification was maintained even after introduction of the automated hot water disinfection system and the dialysate could be supplied stably by the CDDS. Therefore, this disinfection system might be very useful in terms of both cost and safety, and can be used for dialysis treatment of multiple patients.

Serous macular detachment in branch retinal vein occlusion.

PURPOSE: To evaluate the relationship between the extent of branch retinal vein occlusion (BRVO) and the incidence of serous retinal detachment (SRD) in the macular area. METHODS: One hundred nine eyes of 109 consecutive patients with BRVO comprised the study population. These eyes were characterized as having either macular BRVO or major BRVO. We compared the tomographic macular findings between the two groups. RESULTS: Thirty-nine eyes had macular BRVO, and 70 eyes had major BRVO. The incidence of SRD was higher in the group with major BRVO (63%) than in the group with macular BRVO (21%) (P < 0.001). The incidence of cystoid macular edema was similar in both groups (macular BRVO, 97%; and major BRVO, 90%). Foveal thickness of major BRVO (610 +/- 190 micro m) was significantly greater than that of macular BRVO (500 +/- 140 micro m) (P < 0.01). There was no significant difference in thickness of the neurosensory retina between the group with macular BRVO (450 +/- 120 micro m) and the group with major BRVO (480 +/- 140 micro m). CONCLUSIONS: Serous macular detachment occurs more frequently in major BRVO than in macular BRVO. Vascular leakage from congested retinal veins outside the macular area appears to be a major source of subretinal fluid at the fovea.

Serous macular detachment secondary to distant retinal vascular disorders.

PURPOSE: To report tomographic features of macular edema associated with distant retinal vascular disorders. METHODS: Six eyes with macular edema (three with extramacular branch retinal vein occlusion and three with Coats disease) underwent fluorescein angiography to detect dye leakage and optical coherence tomography to evaluate the macular features and measure the foveal height (distance between inner retinal surface and retinal pigment epithelium) and the retinal thickness (thickness of neurosensory retina) at the central fovea. RESULTS: Fluorescein angiography showed widespread nonperfusion and retinal vein staining in the eyes with a branch retinal vein occlusion not involving the macula. In eyes with Coats disease, nonperfused areas, telangiectatic retinal vessels, and aneurysms were seen in the peripheral fundus on fluorescein angiography. In one eye with Coats disease, telangiectatic vessels and aneurysms were seen in the nasal mid periphery of the optic disk. There was no dye leakage in the macular area in any eyes. Optical coherence tomography showed subretinal fluid and retinal swelling at the fovea in all eyes. The foveal height ranged from 300 to 697 microm (mean, 478 microm) and retinal thicknesses ranged from 170 to 280 microm (mean, 233 microm). CONCLUSION: Distant retinal vascular leakage causes serous retinal detachment in the macula. The macula is predisposed to collect subretinal fluid although retinal vascular leakage is far from the macula.