Deep-learning classification of teat-end conditions in Holstein cattle.

As a means of preventing mastitis, deep learning for classifying teat-end conditions in dairy cows has not yet been optimized. By using 1426 digital images of dairy cow udders, the extent of teat-end hyperkeratosis was assessed using a four-point scale. Several deep-learning networks based on the transfer learning approach have been used to evaluate the conditions of the teat ends displayed in the digital images. The images of the teat ends were partitioned into training (70 %) and validation datasets (15 %); afterwards, the network was evaluated based on the remaining test dataset (15 %). The results demonstrated that eight different ImageNet models consistently achieved high accuracy (80.3-86.6 %). The areas under the receiver operating characteristic curves for the normal, smooth, rough, and very rough classification scores in the test data set ranged from 0.825 to 0.999. Thus, improved accuracy in image-based classification of teat tissue conditions in dairy cattle using deep learning requires more training images. This method could help farmers reduce the risks of intramammary infections, decrease the use of antimicrobials, and better manage costs associated with mastitis detection and treatment.

Analysis of disease burden in patients with hereditary angioedema from Japan by patient-reported outcomes.

Hereditary angioedema (HAE) symptoms can vary greatly. Disease burden evaluation is essential for providing adequate treatments for patients. Patient-reported outcome measures (PROMs), including the 12-Item Short Form Health Survey (SF-12), the Angioedema Quality of Life (AE-QoL), the Hospital Anxiety and Depression Scale (HADS), and the Work Productivity and Activity Impairment: Specific Health Problem (WPAI:SHP) questionnaires, were collected in 2021, before modern medications for long-term prophylaxis (LTP) of HAE were licensed in Japan. Patients also reported their HAE attack frequency as "annual" (several attacks annually), "monthly" (several attacks monthly) or "weekly" (several attacks weekly). Multiple linear regression analyses were conducted on the relationship between independent parameters (sex, age, attack frequency, HAE type, and HADS scores) and dependent parameters (AE-QoL and SF-12 scores). Fifty-four patients reported PROMs. All PROMs showed substantial health-related quality of life (HRQoL) impairment. Overall, the higher the attack frequencies, the greater the reported impairment in the PROMs tended to be. In multiple linear regression analyses, higher AE-QoL Fatigue/Mood and Fears/Shame domain scores (greater impairment) were associated with higher HADS anxiety subscale scores; higher AE-QoL total scores (greater HRQoL impairment) and lower SF-12 Physical and Mental Health Composite scores (greater general health impairment) were associated with higher HADS depression subscale scores. Patients with monthly or weekly HAE attacks reported numerically low absenteeism and numerically high presenteeism and work productivity loss as measured by the WPAI:SHP questionnaire. In this study, conducted before modern LTP options were available in Japan, patients with HAE reported notable impairment in HRQoL and work productivity. Weekly or monthly HAE attack frequencies were associated with a high disease burden. Furthermore, a substantial number of patients reported notable fatigue/mood impairment as measured by the AE-QoL and depression as measured by the HADS regardless of attack frequency. These results provide a basis for future studies evaluating the effect of LTP on the clinical manifestations and HRQoL in patients with HAE.

Effect of 2% meloxicam injection in Holstein dairy cows on acute clinical mastitis without systemic symptoms.

This study aimed the efficacy of meloxicam (MX) in treating acute clinical mastitis (ACM) without systemic symptoms in Holstein cows by studying improvement in udder pain, changes in prostaglandin E2(PGE2) and bradykinin (BK) levels in the milk, and milk yield (MY) after healing. Forty-two cows with ACM were randomly assigned to the MX treatment group (T group; n=21) and the control group (C group; n=21). At onset of illness (day 0), the T group received a 0.5 mg/kg subcutaneous (SC) injection of MX whereas the C group received 15 mL SC of saline solution as a placebo. Udder tenderness (UT) was measured, and milk samples were collected on days 0-3. There was little change in the MY of the T group before and after healing, whereas MY in the C group was significantly lower than after healing. UT on day 3 in the T group was significantly lower than that in the C group. PGE2 levels significantly decreased from day 0 to day 3 in both groups. A significant negative correlation between PGE2 and linear score was observed on day 1 in the T group, but not in the C group. In ACM without systemic symptoms, the administration MX may be useful for restoring MY and reducing udder pain after healing.

Association between somatic cell count or morbidity of chronic subclinical mastitis and longevity in dairy herds in Eastern Hokkaido, Japan: a cross-sectional study.

An epidemiological analysis was conducted on production records in Hokkaido, Japan, to investigate the potential association between improved milk quality and longevity outcomes. The study found significant variations in herd somatic cell count levels and chronic subclinical mastitis morbidity based on geographical area and herd size. The analysis also revealed a positive correlation between herd somatic cell count and chronic subclinical mastitis morbidity. Although the hypothesis of a causal link between milk quality and longevity was examined, no such association was found. However, intensive assistance for identified high-risk areas and farms is expected to enhance overall milk quality.

Efficiency of immunocastration with an anti-gonadotropin-releasing hormone vaccine on cryptorchid bulls.

Cryptorchid bulls have low economic value owing to the effects of masculinization. Moreover, surgical removal of an ectopic testis is difficult in certain clinical cases. Recently, immunocastration has garnered popularity as a nonsurgical castration method in pig farming; however, the effects of immunocastration on cryptorchid bulls are yet to be yet. Herein, we investigated endocrine changes due to immunocastration in cryptorchid bulls and studied its effectiveness. This study included 13 Holstein bulls diagnosed with cryptorchidism and classified into two groups based on pubertal period: <8 months of age (pregroup) and ≥8 months of age (postgroup). Antigonadotropin-releasing hormone (GnRH) vaccine was used for immunocastration, and two vaccine doses were administered. Blood testosterone and anti-Müllerian hormone (AMH) levels were measured and analyzed for endocrine evaluation. The testosterone levels significantly decreased following the start of immunocastration in both groups, thereby confirming the efficacy of antiGnRH vaccination in cryptorchid bulls. The AMH levels significantly increased in the pregroup with two antiGnRH vaccination, suggesting a compensatory response via the neutralization of GnRH antibodies. The AMH levels did not significantly change in the postgroup, indicating the partial suppression of AMH secretion in Sertoli cells during sexual maturation and failure of Sertoli cell maturation. Thus, we successfully restrained the serum testosterone levels in cryptorchid bulls using antiGnRH vaccine. The testosterone levels are a useful indicator of the immunocastration effect on cryptorchid bulls. Hereafter, a vaccine program that can sustain the castration effect on cryptorchid bulls is necessary.

Physician awareness and understanding of primary immunodeficiency disorders: a web-based study in Japan.

Primary immunodeficiencies (PIDs)/Inborn errors of immunity (IEI) consist of a complex genetic group of disorders that cause susceptibility to infections, inflammation, immune dysregulation, autoimmunity, and malignancy. One of the key steps to reach an early diagnosis is improving knowledge of PID among the medical community. In this study, a web-based survey was conducted among 355 Japanese physicians, consisting of 121 pediatricians, 116 hematologists, and 118 general internal medicine physicians, to assess their awareness and knowledge about the diagnostic flow of PID. One of the major problems this study identified was the unawareness of optimal IgG trough levels among the physicians, while around half the physicians knew about the symptoms of PID. Results from the hypothetical case study revealed that over 70% of physicians considered PID after obtaining the past medical history of patients and 75.2% of physicians showed interest in gaining more knowledge about PID. The survey findings revealed that proper questioning to understand the exact medical history of patients may lead to basic immunological examination. There is a need to improve knowledge about PID, e.g., the '10 warning signs of PID' and '4 stages of testing for PID', and to motivate physicians to ensure earlier diagnosis of PID.

Cross-sectional web-based survey among haematologists and gastroenterologists in Japan to identify the key factors for early diagnosis of Gaucher disease.

BACKGROUND: Gaucher disease (GD) is a rare, inherited metabolic disorder resulting from glucocerebrosidase deficiency. Patients benefit from early treatment as complications can arise from delayed diagnosis. AIMS: To measure GD awareness among Japanese haematologists and gastroenterologists, who are the specialists most likely to encounter patients with symptoms recognised in the Gaucher Earlier Diagnosis Consensus (GED-C), such as hepatosplenomegaly and thrombocytopenia. Additionally, we aimed to determine key signs from the GED-C associated with early diagnosis. METHODS: A quantitative web survey assessed Japanese haematologists and gastroenterologists for their (i) basic awareness of GD, (ii) explicit awareness of GD signs, (iii) explicit awareness of GD treatments and (iv) accuracy in suspecting GD in model patients. RESULTS: Survey results from 160 haematologists and 166 gastroenterologists indicated that more than 50% of haematologists were aware of GD symptoms, diagnostic criteria and/or treatments, and 38% of them had experienced or suspected GD. The majority of gastroenterologists were unaware of GD or knew the disease only by name, with 20% experiencing or suspecting GD in practice. Almost 70% of haematologists knew of enzyme replacement therapy, while 47% of gastroenterologists were not aware of any treatments for GD. Of the GED-C items, an awareness of bone-associated signs was correlated with accurate GD diagnosis in model patients and this awareness was greater among haematologists than gastroenterologists. CONCLUSIONS: The present study showed that haematologists had greater awareness of GD than gastroenterologists, and that bone pain may be a key sign of GD to enhance early diagnosis.

Postmortem magnetic resonance imaging findings of tricuspid atresia with ventricular and atrial septal defects and subvalvular pulmonic stenosis in a Japanese native Noma horse.

The necropsy of a 2-day-old Noma horse that died of weakness showed an enlarged cardiac base and a narrow cardiac apex, suggesting cardiac malformation. The excised heart underwent imaging to investigate its luminal structure. On three-dimensional magnetic resonance imaging, the right atrium and right ventricle were discontinuous. The right atrium communicated with the left atrium and the left ventricle communicated with the right ventricle. The lumen narrowed near the pulmonary artery valve. Since the same findings were observed on gross examination, the foal was diagnosed with tricuspid atresia with ventricular and atrial septal defects, along with subvalvular pulmonic stenosis.

An observational study to investigate the relationship between plasma glucosylsphingosine (lyso-Gb1) concentration and treatment outcomes of patients with Gaucher disease in Japan.

BACKGROUND: Gaucher disease (GD) is an autosomal recessive disease caused by GBA1 mutations resulting in glucosylceramide accumulation in macrophages. GD is characterized by hepatosplenomegaly, anemia, thrombocytopenia, bone complications, and neurological complications. Glucosylsphingosine (lyso-Gb1), a deacylated form of glucosylceramide, has been identified as a promising biomarker for the diagnosis and treatment response in GD. The aim of this study was to examine the relationship between plasma lyso-Gb1 and therapeutic goals for GD (improvements in hepatomegaly, splenomegaly, anemia, thrombocytopenia, bone pain, and bone crisis), as well as disease type and GBA1 mutation type, in Japanese patients with GD receiving velaglucerase alfa, an enzyme replacement therapy (ERT). Furthermore, this study compared the plasma lyso-Gb1 concentration observed in Japanese patients included in this study with that observed in a previous non-Japanese clinical study. RESULTS: This non-interventional, open-label, multicenter observational cohort study (October 2020 to March 2021) included a total of 20 patients (of any age) with GD (type 1: n = 8; type 2: n = 9; type 3: n = 3) treated with velaglucerase alfa for ≥ 3 months. Median (minimum-maximum) duration of velaglucerase alfa treatment was 49.5 (3-107) months. A total of 14 (70.0%) patients achieved all therapeutic goals (i.e., 100% achievement; improvements in hepatomegaly, splenomegaly, anemia, thrombocytopenia, bone pain, and bone crisis). Overall, median (minimum-maximum) lyso-Gb1 concentration was 24.3 (2.1-150) ng/mL. Although not statistically significant, numerically lower plasma lyso-Gb1 concentrations were observed in patients with 100% achievement compared with those without; no statistically significant difference in plasma lyso-Gb1 concentration was observed between patients with different disease type or mutation type. Furthermore, lyso-Gb1 concentrations observed in Japanese patients were numerically lower than that observed in a previous study of non-Japanese patients with GD receiving ERT. CONCLUSIONS: In this study, high achievement rates of therapeutic goals with low lyso-Gb1 concentration were observed, demonstrating a correlation between therapeutic goals and lower plasma lyso-Gb1 concentration in Japanese patients with GD treated with velaglucerase alfa. This study further suggests that plasma lyso-Gb1 concentration may be a useful biomarker for treatment response in patients with GD.

Relationships between the age and blood test results or body sizes in Noma horses.

The objective of this study is to analyze the relationships between the age and blood test results or body sizes in Noma horses by using the results of periodical health examination. Out of 45 hematological or physical items examined, statistically significant, but loose correlations were observed in 14 items. Red blood cell count, activities of aspartate aminotransferase, alkaline phosphatase, and creatinine kinase, concentrations of calcium and inorganic phosphorus decreased with aging. Conversely, mean corpuscular volume, mean corpuscular hemoglobin, lipase activity, γ-globulin and chloride concentrations, body height, chest circumference and cannon bone circumference increased with aging. The changes in a few items seemed unique to Noma horse. However, most age-related changes found in this study might be considered as a common trend in horse breeds rather than distinctive characteristic in Noma horse.

An anatomical study of the skull, the dorsal and ventral nasal conchal bullae and paranasal sinuses in normal Noma horses: Computed tomographic anatomical and morphometric findings.

Noma horses have the smallest body size among native Japanese horses and are classified as pony breeds by their size. Additionally, the Japanese horse breeds are classified into a single lineage, which includes Mongolian horses. Great intraspecific differences reportedly exist in the head shapes of domesticated horses, which have been investigated in various horse breeds. The present study aimed to evaluate the size of the nasal conchal bullae, and the paranasal sinuses of Noma horses in relation to the skull dimensions using computed tomography. Reconstructed images of the heads of five adult Noma horses were used. Skull and paranasal sinus parameters were measured and analysed in relation to each other and were compared with the data in the literature on the skulls of various horse breeds. In comparison with pony breed, Shetland ponies and donkeys had a shorter nasal length than cranial length, while Noma horses had a longer nasal length than cranial length, similar to the larger breeds. In the nasal conchal bullae, Shetland ponies showed a negative correlation between the head and bullae size, while Noma horses, similar to larger breeds, had a positive correlation. In conclusion, our findings suggest that Noma horses, despite having a body size that belongs to the pony breed, had a distinguishing ratio of the skull and paranasal sinuses similar to that of the larger breeds. Our results provide information on the physiological morphology of the head and comparative anatomy based on genetic diversity in horses.

The relationships between environmental parameters in livestock pen and physiological parameters of Holstein dairy cows.

There has been an increase in temperature and the incidence of extreme weather events, such as heat wave, due to global warming, which has promoted the incidence of livestock diseases. Therefore, it is important to examine the effect of changes in environmental parameters on livestock performance. The aim of this study was to examine the relationship between ambient environmental conditions in livestock pen and the physiological parameters of Holstein dairy cows. The results showed that there was a decrease in the red blood cell counts, hemoglobin concentrations, and mean corpuscular hemoglobin concentration of the cows with increasing pen temperature, wet bulb globe temperature (WBGT), and temperature humidity index (THI). Additionally, high daily variation in temperature caused a decrease in the serum albumin levels of the cows. Moreover, the lowest serum calcium, inorganic phosphorus, and magnesium concentrations were observed in November, and were negatively correlated with the 24-hr temperature, WBGT, and THI range of the pen prior to sampling. Multiple regression analysis showed a positive correlation between serum cortisol concentration and 24-hr WBGT range of the pen prior to samplings and packed cell volume. However, serum cortisol and total protein concentrations were negatively correlated. Overall, the findings of the study suggest that large variation in temperature induced stress in the cows, which could be overcome by increased water consumption and improved protein digestion and absorption by the animals, and the addition of minerals, such as calcium to the diet.

Rapid Nitriding of Titanium Alloy with Fine Grains at Room Temperature.

Multifunctional surfaces are required to design safe engineering products for human lives. Heating in a nitrogen atmosphere (nitriding) improves the tribological properties but reduces the strength of titanium (Ti) alloys owing to grain coarsening. A rapid nitriding method for Ti alloys forms the nitrided layer on the surface of a Ti alloy by bombarding with commercially pure Ti fine particles with a nitrided phase at room temperature within a short period. Furthermore, fine grains of Ti alloy are formed in the nitrided layer because of the impact of the Ti particles. These results reveal that this room-temperature method resolves the trade-off between the rapid formation of a nitrided layer and the suppression of grain coarsening for Ti alloys.

Effect of seasons and sex on the physical, hematological, and blood biochemical parameters of Noma horses.

This study aimed to evaluate the influence of seasons and sex on body size and hematological and biochemistry parameters of Noma horses, a native Japanese breed. Body size was larger in winter than in summer. Laboratory testing variables, including erythrocytic parameters and urea nitrogen, total cholesterol, and creatinine kinase levels, were higher in winter, while the eosinophil count was higher in summer. These seasonal differences may be related to increased energy consumption of horses due to heat stress. The higher eosinophil counts may have been related to the dermatitis observed in summer. Stallions tended to have smaller bodies compared with mares. Future studies are necessary to investigate the effect of stress in seasonal and sex-based groups.

Forestomach developmental failure in an 11-month-old Japanese Black steer with severely retarded growth and chronic ruminal tympany.

This study reports findings from the pathological examination of the forestomach of an 11-month-old Japanese Black steer with severely retarded growth (41% of expected weight) and chronic ruminal tympany. The ruminal papillae were weakly formed (0.3-0.5 cm long) and unevenly distributed. The cellulae and cristae reticuli were underdeveloped; the cristae were 0.4-0.7 cm in height and milky white. The keratinized layer in the stratified squamous epithelium was thickened. Ruminal pH was 5.25, and ruminal volatile fatty acid concentration was 11.7 mM. The steer's severely retarded growth was considered to be caused by malnutrition due to developmental and functional failure of the forestomach.

Treatment of Thoracolumbar Spinal Fracture Accompanied by Diffuse Idiopathic Skeletal Hyperostosis Using Transdiscal Screws for Diffuse Idiopathic Skeletal Hyperostosis: Preliminary Results.

STUDY DESIGN: This retrospective case series enrolled 13 patients who underwent posterior fixation with both transdiscal screws for diffuse idiopathic skeletal hyperostosis (TSDs) and pedicle screws (PSs) to treat spinal injury accompanied by diffuse idiopathic skeletal hyperostosis (DISH). PURPOSE: To describe the usefulness, feasibility, and biomechanics of TSD. OVERVIEW OF LITERATURE: Vertebral bodies accompanied by DISH generally have lower bone mineral density than normal vertebral bodies because of the stress shielding effect. This phenomenon tends to makes screw fixation challenging. To our knowledge, solutions for this issue have not previously been reported. METHODS: Patients were assessed using the data on surgical time, estimated intraoperative blood loss, mean number of stabilized intervertebral segments, number of screws used, perioperative complications, union rate, and the three-level EuroQol five-dimensional questionnaire (EQ5D-3L) score at the final follow-up. The Hounsfield unit (HU) values of the screw trajectory area, and the actual intraoperative screw insertion torque of TSDs and PSs were also analyzed and compared. RESULTS: The surgical time and estimated intraoperative blood loss were 165.9±45.5 minutes and 71.0±53.4 mL, respectively. The mean number of stabilized intervertebral segments was 4.6±1.0. The number of screws used was 4.9±1.3 for TSDs and 3.0±1.4 for PSs. One death occurred after surgery. The union rate and EQ5D-3L scores were 100% and 0.608±0.128, respectively. The HU value and actual intraoperative screw insertion torque of TSDs were significantly better than those of PSs (p<0.001, p=0.033). CONCLUSIONS: We were able to achieve stable surgical outcomes using the combination of TSDs and PSs. The HU value and actual intraoperative screw insertion torque were significantly higher for TSDs than for PSs. Based on these results, when treating thoracolumbar spinal fractures accompanied by DISH in elderly populations, the TSD could be a stronger anchor than the PS.

Limited directed seed dispersal in the canopy as one of the determinants of the low hemi-epiphytic figs' recruitments in Bornean rainforests.

Ficus species are keystone plants in tropical rainforests, and hemi-epiphytic figs play a notably important role in forest ecosystems. Because hemi-epiphytic figs have strict germination requirements, germination and establishment stages regulate their populations. Despite the ecological importance of hemi-epiphytic figs in the rainforests, seed dispersal systems by fig-eating animals under natural conditions remain unknown because of the difficulty in tracing the destiny of dispersed seeds in the canopy. Therefore, seed dispersal effectiveness (SDE) has never been evaluated for hemi-epiphytic figs. We evaluated the SDE of hemi-epiphytic figs using qualitative and quantitative components by three relatively large-sized (> 3 kg) arboreal and volant animals in Bornean rainforests that largely depend on fig fruits in their diets: binturongs Arctictis binturong, Mueller's gibbons Hylobates muelleri, and helmeted hornbills Rhinoplax vigil. The SDE values of binturongs was by far the highest among the three study animals. Meanwhile, successful seed dispersal of hemi-epiphytic figs by gibbons and helmeted hornbills is aleatory and rare. Given that seed deposition determines the fate of hemi-epiphytic figs, the defecatory habits of binturongs, depositing feces on specific microsites in the canopy, is the most reliable dispersal method, compared to scattering feces from the air or upper canopy. We showed that reliable directed dispersal of hemi-epiphytic figs occurs in high and uneven canopy of Bornean rainforests. This type of dispersal is limited to specific animal species, and therefore it may become one of the main factors regulating low-success hemi-epiphytic fig recruitment in Bornean rainforests.

Evaluation of Montelukast for the Treatment of Children With Japanese Cedar Pollinosis Using an Artificial Exposure Chamber (OHIO Chamber).

Background: This study evaluated the efficacy of montelukast in reducing seasonal allergic rhinitis symptoms in Japanese children with Japanese cedar (JC) pollinosis induced in an artificial exposure chamber (OHIO Chamber). Methods: Pediatric patients aged 10 to 15 years sensitive to JC pollen entered a randomized, double-blind, single-site, crossover study. After confirmation of an allergic response to a JC pollen exposure for 3 hours in the OHIO Chamber during the screening period, subjects received either montelukast 5 mg chewable tablets or placebo for a 7-day treatment period, followed by a 3-hour pollen exposure in the chamber. After a 7-day washout period, subjects crossed over to the other treatment. Subjects were instructed to self-assess their nasal symptoms using 5-point scale for every 30 minutes. The primary end point was the change from baseline (just before entering the exposure chamber for each exposure) in total nasal symptom score (TNSS; the sum of nasal congestion, nasal discharge, and sneezing scores) over 3 hours of pollen exposure. Adverse events (AEs) were evaluated throughout the study. Results: A total of 220 subjects (median age, 12 years) received treatment. For TNSS, the between-group difference in the change (95% confidence interval) was -0.01 (-0.11 to 0.10); the change between placebo and montelukast 5 mg was not significant. TNSS in the screening and treatment periods after receiving placebo for 7 days was 1.58 and 1.31, respectively, suggesting a placebo response. On account of high placebo response, a post hoc analysis was conducted. The analysis in a subgroup of subjects who did not show placebo response demonstrated a difference in the efficacy between montelukast and placebo (nominal P < .037). The most common AE was positive urine protein (4.6% with montelukast vs 7.8% with placebo). Conclusions: Although montelukast was well tolerated, this study did not demonstrate a treatment difference between active drug and placebo in Japanese children exposed to JC pollen in the OHIO Chamber.Trial Registry: ClinicalTrials.gov, NCT01852812.

Montelukast in the treatment of perennial allergic rhinitis in paediatric Japanese patients; an open-label clinical trial.

Background: This study was conducted to evaluate the safety and tolerability, and population pharmacokinetics (PPK) of montelukast as well as efficacy in the treatment of perennial allergic rhinitis (PAR) in paediatric Japanese patients aged between 1 and 15 years. Methods: In this multi-centre, open-label trial, 87 paediatric Japanese patients with PAR received montelukast 4 mg oral granules (OG) for 4 weeks (1-5-year-olds, N = 15), 4 mg OG for 12 weeks (1-5-year-olds, N = 36), 5 mg chewable tablets (CT) for 12 weeks (6-9-year-olds, N = 18), or 5 mg CT for12 weeks (10-15-year-olds, N = 18). Clinical exams and laboratory assessments were conducted at study visits, and adverse events (AE) were monitored throughout the study up to 14 days after the last visit. Population pharmacokinetic approach was used to estimate AUC0-∞, Cmax, Tmax and apparent elimination half-life in each age group. Efficacy was assessed based on global evaluations by the subject's caregiver. Results: There were no serious AEs and one discontinuation due to an AE. The most common AEs in any of the treatment groups were nasopharyngitis, pharyngitis, and acute sinusitis. Montelukast exposure (AUC0-∞) was similar in the 1-5-year-old group and the 6-9-year-old group, but 19% lower in the 10-15-year-old group. Among all patients, the total proportion of patients whose global evaluation was "very much better" was 5.7% (week 2), 11.5% (week 4), and 16.9% (week 12) reflecting improvement in symptoms over time. Conclusion: Montelukast was generally well tolerated in Japanese children with PAR. AUC0-∞was similar in 1-5 and 6-9-year-olds, while a lower exposure was observed in the 10-15-year-old group likely due to differences in bodyweight. The exposure in Japanese paediatric patients was generally consistent with that in non-Japanese paediatric and adult patients. As assessed by the patients' caregivers, montelukast also demonstrated symptomatic improvement based on global evaluations of PAR.

A characteristic optic disc appearance associated with myopia in subjects with Graves' ophthalmopathy and in subjects with primary open-angle glaucoma.

PURPOSE: To determine if qualitatively defining the appearance of optic disc change was a valid characteristic of myopia in subjects with Graves' ophthalmopathy (GO) or primary open-angle glaucoma (POAG). METHODS: WE DEFINED TYPICAL TILT APPEARANCE AS THE SIMULTANEOUS PRESENCE OF THE FOLLOWING: an elliptical optic disc, a crescent, unequal sharpness of the cupping margin (horizontally), and nasally displaced vessels in the optic cup. Ninety-two eyes from 92 subjects each with GO or with POAG and no severe complications were included in the study after matching for spherical refractive errors. Using our definition of tilt appearance, two independent observers subjectively judged optic disc photographs. One observer repeated judgments in 70 randomly selected eyes and judgment reproducibility was assessed using kappa statistics. Tilt ratio was used as a quantitative parameter. RESULTS: The numbers of eyes judged as having a typical tilt appearance in the GO group and in the POAG group were 25 (27.2%) and 39 (42.4%), respectively, by one observer (P = 0.0297), and 12 (13%) and 44 (47.8%), respectively, by another observer (P < 0.0001). Intra- and interobserver reproducibility of tilt judgment were very good (kappa = 0.93) and good (kappa = 0.65), respectively. Tilt ratio did not significantly differ between the two groups. Analytical results including background factors were essentially the same for the two observers: multivariate logistic regression for one observer's judgment showed that the presence of the typical tilt appearance was associated with belonging to the glaucoma group (odds ratio [OR], 6.25; P = 0.0054), tilt ratio (OR per 0.01, 0.77; P < 0.0001), and spherical refractive error (OR per diopter, 0.80; P < 0.003). CONCLUSION: The optic disc feature we designated as typical tilt was associated with myopia, and its frequency was higher in subjects with POAG compared to those with GO.