Obstructive sleep apnea-related symptoms in Japanese people with Down syndrome.

This study evaluated the prevalence of obstructive sleep apnea-related symptoms and assessed the relationship with obesity or unusual sleep postures in Down syndrome patients in Japan. We obtained the demographic characteristics, sleep postures, and obstructive sleep apnea-related symptoms experienced by 90 people as reported by their caregivers. Although 71% reported snoring and 59% arousals, obstructive sleep apnea-related symptoms were not significantly different between obese and non-obese participants. The youngest age group had the fewest obstructive sleep apnea-related symptoms, especially symptoms of snoring. The odds for arousal, nocturia, and apnea tended to be higher in the unusual sleep-postures group. Unusual sleep postures were most frequent in the group 6-15 years of age. People with Down syndrome might sleep in unusual postures to avoid upper airway obstruction caused by other anatomical factors. For nurses and other health professionals working in mainstream service, it is important to screen all persons with Down syndrome for symptoms suggestive of obstructive sleep apnea, particularly those six years of age and older, and to refer them for further evaluation for sleep disorders.

Use of Ketotifen Fumarate-Eluting Daily Disposable Soft Contact Lens in Management of Ocular Allergy: Literature Review and Report of Two Cases.

We present two cases in which the drug-eluting daily disposable soft contact lens (DDSCL) Acuvue® TheravisionTM with Ketotifen (Johnson & Johnson Vision Care, Inc., Jacksonville, Florida, USA) (ATK), which contains the anti-allergic drug ketotifen fumarate, alleviated ocular allergic symptoms. Case 1 was a 57-year-old woman with a history of allergic conjunctivitis in the spring and fall. In the summer and winter, the patient used frequent replacement soft contact lenses, but in the allergy seasons, she used DDSCLs in combination with anti-allergic eye drops. She agreed to start wearing ATK lenses from before the next fall season. The lenses suppressed her allergic signs and symptoms, and she felt comfortable wearing them and continued their use throughout the season. Her symptoms were suppressed, providing her comforts that enabled uses of the CLs for some time. She successfully used the lenses again from the beginning of the next spring season. Case 2 was a 31-year-old woman with a history of cedar pollinosis. The patient previously used DDSCLs and was prescribed ATK lenses at her regular clinic. About one month later, she was referred to our department. With ATK lenses, she did not experience any subjective symptoms during the pollinosis season. At a subsequent visit, hyperemia had decreased compared with the initial visit. In these two cases, the use of ATK lenses from before until the end of both the spring and fall allergy seasons suppressed the symptoms of allergic conjunctivitis, allowing the patients to continue to wear contact lenses.

Refractive Correction After Penetrating Keratoplasty by a New Soft Contact Lens with a Special Design for Astigmatism: A Case Report.

YOUSOFT is a new soft contact lens (CL) specifically designed for the correction of astigmatism. It is a conventional FDA Group II soft contact lens (SCL) and the optical zone in its centre is thick, and on its rear surface it has a prism ballast structure to prevent rotation. This lens was prescribed for a 59-year-old male on the eye with irregular corneal astigmatism after receiving penetrating keratoplasty (PKP) for refractive correction, whose eye was difficult to wear hard CLs (HCLs). After following the directions in the fitting manual provided by the manufacturer, fitting was good in the right eye and corrected visual acuity was 20/25 in Snellen Chart. He could continue wearing without CL discomfortable YOUSOFT may be useful in patients who have received PKP.

[Long-acting carteolol hydrochloride 2% ophthalmic solution phase IV study--investigation of the effectiveness, safety and plasma concentration].

PURPOSE: We investigated the effectiveness, safety and plasma concentration of long-acting carteolol hydrochloride 2% ophthalmic solution (LA) as compared with the original carteolol hydrochloride 2% ophthalmic solution(CA). METHODS: Patients with primary open angle glaucoma and ocular hypertension were randomized to 62 patients of LA group (LA once a day) and 62 patients of CA group (CA twice a day) in this multicenter, open-label trial. The intraocular pressure (IOP), pulse rate, blood pressure and plasma concentration were examined for 8 weeks. RESULTS: The IOP reduction and reduction rate were not significant at any point between the two groups. Systolic blood pressure decreased significantly in both groups, however, diastolic blood pressure decreased only in the CA group. The plasma concentration of the LA group was significantly lower than that of the CA group. CONCLUSIONS: The IOP reduction effect of the LA group was the same as the CA group. This study suggests that long-acting treatment with alginic acid can be useful for reducing systemic side effects.

Effect of water bath temperature on physiological parameters and subjective sensation in older people.

AIM: In Japan, the incidence of water bathing-related cardiopulmonary accidents among older people is high in winter. The purpose of the present study was to investigate alterations in physiological characteristics and subjective thermal sensations of older people when bathing in a cool environment. METHODS: We assessed the skin temperature, rectal temperature, blood pressure, pulse rate, body fluid loss (sweat and urine), and subjective thermal responses of 11 older healthy male and 10 young male volunteers throughout 42°C and 39°C bathing in a room at 20°C with 50% humidity. RESULTS: At 42°C bathing, the rectal temperature during bathing and in the post-bathing period were significantly lower in the older men than in the young men, and skin temperature during the post-bathing period decreased gradually in the older men. Systolic blood pressure and pulse rate immediately increased just after entering 42°C water and decreased during bathing in the older men. With the activities of dressing, systolic blood pressure increased followed by a decrease during the post-bathing period. Thus, double product (pulse rate × systolic blood pressure) increased during the bathing period. Although there was no significant difference in body fluid loss between the older and younger men in 42°C water, the older men produced significantly less sweat. The older men also reported feeling less warm after 42°C bathing, and feeling less cold during the post-bathing period after 39°C bathing. CONCLUSIONS: These results suggest that hot water bathing during cold seasons might induce more serious physiological changes in older people. Geriatr Gerontol Int 2017; 17: 2164-2170.

Enantiomer separation by reversed-phase liquid chromatography with novel hydrophobic phases composed of chiral cationic surfactants.

This paper describes enantiomer separation using four kinds of chiral stationary phases (CSPs) where quaternary ammonium surfactants containing L-valine diamide moieties into long alkyl chains were bound to silicagel supports by reversed phase liquid chromatography. Our aim was to examine hydrogen bonding association of the chiral moiety in hydrophobic phase brought about by aggregation of the micelle-forming surfactants on the surface. The following CSPs were thus derived from the vinyl-terminated chiral surfactants via hydrosilylation: CSP 1 from N-[3-(10-undecenoyl-L-valylamino)propyl]-N,N,N-trimethylammonium bromide, CSP 2 from N-[6-(10-undecenoyl-L-valylamino)hexyl]-N,N,N-trimethyl-ammonium bromide, CSP 3 from N-[3-(10-undecenoyl-L-valylamino)propyl]-N-octadecanyl-N,N-dimethyl-ammonium bromide and CSP 4 from N-[6-(10-undecenoyl-L-valylamino)hexyl]-N-octadecanyl-N,N-dimethylammonium bromide. The degree of hydrophobicity in the interfacial phase was observed by measuring pyrene fluorescence in aqueous media including an organic modifier. Retention of racemic N-acylleucine isopropyl esters was highest in CSP 4, followed by 3, 2, and 1. Largest alpha values toward enantiomer separation were observed for CSP 4 where the chiral moieties were kept through a hexamethylene unit apart from the polar head groups and to which another long alkyl chain was attached, as compared with those for CSP 4. In CSP 4, the chiral moiety to interact with enantiomeric solutes should be buried into the interfacial phase deeply in more extent than CSP 3. In a similar manner, CSP 2 has more effective for enantiomer separation than CSP 1. The interfacial phase of these CSPs was easily exposed to the bulk phase because of the affinity between the bulk phase and the polar head groups as well as their electrostatic repulsion. However, degree of the enantiomer separation can be controlled by the depth of the chiral moiety in the hydrophobic interfacial phase.

A nationwide cross-sectional study on congenital heart diseases and symptoms of sleep-disordered breathing among Japanese Down's syndrome people.

OBJECTIVE: It is well known that people with Down's syndrome (DS) frequently complicate with congenital heart diseases (CHDs). Patients with heart diseases often have sleep-disordered breathing as a co-morbidity (SDB) which worsens the heart diseases. However, the relationship between SDB and CHDs in DS people has not yet been fully elucidated. The aim of this study was to establish the association between SDB and CHDs in DS people using data from a large nationwide questionnaire survey in Japan. METHODS: We conducted a cross-sectional questionnaire survey of a randomly selected sample of 2,000 DS people and their caregivers throughout Japan to examine the associations between observed signs of SDB and CHDs in DS people. The questionnaire included the presence of SDB symptoms (snoring, apnea, arousal, nocturia, and napping) and CHDs (the presence and types of CHDs). RESULTS: Of the 1,222 replies received from the caregivers, 650 reported complications of some type of CHDs. The observed apnea tended to be higher among DS people with CHDs than those without CHDs (OR=1.28, 95% CI=0.97-1.70, p=0.09). DS people with tetralogy of Fallot reported significantly more frequent apnea than those without CHDs (OR=3.10, 95% CI=1.36-7.05, p<0.01). CONCLUSION: SDB prevailed among DS people with severe CHDs, such as tetralogy of Fallot. Careful attention to the signs of SDB in such patients may lead to earlier clinical intervention removing the vicious cycle between SDB and CHDs.

Safety and efficacy of a fixed versus unfixed brinzolamide/timolol combination in Japanese patients with open-angle glaucoma or ocular hypertension.

BACKGROUND: The purpose of this study was to assess the safety and efficacy of fixed-combination brinzolamide 1%/timolol 0.5% (BRINZ/TIM-FC) compared with concomitant brinzolamide 1% and timolol 0.5% (BRINZ + TIM) in Japanese patients with open-angle glaucoma (primary open-angle, exfoliation, pigmentary) or ocular hypertension. METHODS: This randomized, double-masked, multicenter, parallel-group, positive-control, Phase III study was conducted in Japan and included patients aged ≥20 years. Baseline intraocular pressure was assessed after 4 weeks of treatment with timolol 0.5%. Patients were randomized to twice-daily BRINZ/TIM-FC or BRINZ + TIM for 8 weeks (treatment phase). The primary endpoint was mean intraocular pressure reduction from baseline to week 8 at 11 am, at which time noninferiority of BRINZ/TIM-FC versus BRINZ + TIM was evaluated. Data were analyzed using repeated-measures analysis of covariance and t-tests. Adverse events and ophthalmic/physiologic variables were assessed. RESULTS: In total, 319 patients of mean age 64±12 years were enrolled in the treatment phase. BRINZ/TIM-FC and BRINZ + TIM were associated with reductions in mean intraocular pressure from baseline throughout the study (ranges -2.5 to -3.4 mmHg and -2.7 to -3.3 mmHg, respectively). Mean between-group differences in intraocular pressure reduction ranged from 0 to -0.3 mmHg; the upper limit of the 97.5% confidence interval for week 8 at 11 am was <1.1 mmHg, indicating noninferiority of BRINZ/TIM-FC. Treatment-related adverse events were observed in 3% and 12% of patients receiving BRINZ/TIM-FC and BRINZ + TIM, respectively. No substantial changes in other safety parameters were reported. CONCLUSION: Twice-daily BRINZ/TIM-FC reduced intraocular pressure by levels similar to concomitant BRINZ + TIM in Japanese patients with open-angle glaucoma or ocular hypertension and was noninferior to BRINZ + TIM. Both treatments were well tolerated.