Postoperative intravenous patient-controlled analgesia improves pain management after subcutaneous implantable defibrillator implantation.

Objective: Postoperative pain is a major issue with subcutaneous implantable cardioverter defibrillators (S-ICD). In 2020, we introduced intravenous patient-controlled analgesia (IV-PCA) in addition to the conventional, request-based analgesia for postoperative pain control in S-ICD. To determine the effect and safety, we quantitatively assessed the effect of IV-PCA after S-ICD surgery over conventional methods. Methods: During the study period, a total of 113 consecutive patients (age, 50.1 ± 15.5 years: males, 101) underwent a de novo S-ICD implantation under general anesthesia. While the postoperative pain was addressed with either request-based analgesia (by nonsteroid anti-inflammatory drugs, N = 68, dubbed as "PCA absent") or fentanyl-based IV-PCA in addition to the standard care (N = 45, dubbed as "PCA present"). The degree of postoperative pain from immediately after surgery to 1 week were retrospectively investigated by the numerical rating scale (NRS) divided into four groups at rest and during activity (0: no pain, 1-3: mild pain, 4-6: moderate pain, 7-10: severe pain). Results: Although IV-PCA was removed on Day 1, it was associated with continued better pain control compared to PCA absent group. At rest, the proportion of patients expressing pain (mild or more) was significantly lower in the PCA present group from Day 0 to Day 4. In contrast to at rest, a better pain control continued through the entire study period of 7 days. No serious adverse events were observed. A few patients experienced nausea in both groups and the inter-group difference was not found significant. Conclusion: IV-PCA suppresses postoperative pain in S-ICD without major safety concerns.

Birth weight and refractive state measured by Spot Vision Screener in children aged 40 months.

OBJECTIVES: Children with retinopathy of prematurity (ROP) often have myopia. Even without ROP, birth weight and refractive state are related immediately after birth, but this relationship is reduced with increasing age. Here, we examined whether refractive state and birth weight were associated in 40-month-old children. METHODS AND ANALYSIS: Of 541 children aged 40 months in Tsubame City, Japan, who underwent a medical examination between April 2018 and March 2019, this cross-sectional study enrolled 411 whose birth weights were available (76% of all).We measured the non-cycloplegic refraction using a Spot Vision Screener and correlated this with birth weight. Children were divided into three groups according to normal (2500-3500 g), high (>3500 g) or low (<2500 g) birth weights, and mean differences in spherical equivalent (SE) between the groups were analysed. RESULTS: The average SE for the right eye was 0.34 D (95% CI 0.28 to 0.40). Average birth weight was 3032.1 g (95% CI 2990.2 to 3073.9). Birth weight did not correlate with SE for the right eye (Pearson's correlation, r=-0.015, p=0.765) or with the degree of anisometropia (Pearson's correlation, r=-0.05, p=0.355). Furthermore, the mean SE showed no significant difference across the three groups of children with different birth weights (one-way analysis of variance, p=0.939). CONCLUSION: Data on refractive states and birth weight for 411 children of similar age in one Japanese city were analysed, showing that birth weight did not influence SE, J0, J45 and the absolute degree of anisometropia at about 40 months of age.

Reading performance in patients with glaucoma evaluated using the MNREAD charts.

BACKGROUND: Reading performance in glaucoma patients has yet to be studied. We hypothesized that glaucomatous visual field loss affects reading performance even in patients with good acuity and evaluated their reading performance quantitatively. METHODS: A cross-sectional, comparative, non-interventional study. Forty-nine patients with early-moderate glaucomatous visual field loss OU with visual acuity better than 1.0 in the better and 0.7 in the worse eye. Reading performance in glaucoma patients was examined by the Japanese version of the Minnesota Reading Acuity Chart (MNREAD) were compared to that of age-matched normal subjects (n = 30). RESULTS: The study subjects consisted of the 21 men and 28 women. The mean age was 53.3 ± 12.6 years. Diagnosis included primary open-angle glaucoma (n = 22), normal-tension glaucoma (n = 22), developmental glaucoma (n = 4) and exfoliation glaucoma (n = 1). Reading parameters of glaucoma patients examined by MNREAD were: maximum reading speed (MRS), 329.9 ± 55.4 characters per min.; critical print size (CPS), 0.24 ± 0.14 logMAR; reading acuity (RA), 0.02 ± 0.12 log MAR, significantly lower than those of normal subjects (MRS 363.0 ± 42.9, CPS 0.09 ± 0.13 logMAR, RA -0.13 ± 0.10 logMAR, P < 0.01 for three parameters by unpaired t test). CPS in glaucoma subjects was negatively correlated with mean deviation of Humphrey Field Analyzer 10-2 and 30-2 programs in the better eye (r = -0.402, P < 0.005; r = -0.304, P < 0.05; respectively, by linear regression analysis). CONCLUSIONS: The reading performance deteriorated even in glaucoma patients with good acuity.

[Comparison between binocular and monocular reading ability and its relation with central visual field sensitivity in glaucoma patients].

PURPOSE: To evaluate binocular and monocular reading ability in glaucoma patients with good visual acuity and to examine its relationship with central visual field sensitivity. METHODS: Glaucoma patients(35 individuals, mean +/- SD : 51.8 +/- 12.9 years) with a decimal visual acuity in each eye of >or=1.0, reading ability was tested both binocular and monocular using Japanese version of Minnesota Reading Acuity Chart (MNREAD-J). Reading ability parameters were calculated for maximum reading speed (MRS), critical print size (CPS), and reading acuity (RA). The results were compared with those of people with normal vision; differences in reading ability under varied testing conditions and correlations between visual field sensitivity and each parameter were examined. RESULTS: Under binocular reading conditions, MRS, CPS, and RA were decreased significantly in glaucoma patients compared with normal controls (p = 0.00044, p = 0.00004, p = 0.00028, respectively). Under monocular reading conditions, glaucoma patient MRS and RA were decreased significantly in comparison with normal controls (p=0.00155, p= 0.00142). In glaucoma patients undergoing binocular reading tests, MRS was greatest in the paracentral bottom right quadrant of the worse eye (r = 0.41709, p= 0.04447). The CPS decreased in proportion to the extent of the difference between both eyes in the mean deviation value and the visual field sensitivity of the paracentral bottom left (r = 0.40693, p = 0.02699 and r=0.41478, p=0.02384). RA improved in proportion to the extent of the difference between both eyes in the visual field sensitivity of the upper left (r = 0.33557, p=0.04799). CONCLUSION: In glaucoma patients, binocular reading is not necessarily useful in cases of visual field sensitivity differences.

Establishment and characterization of a novel lymphangiosarcoma cell line (MO-LAS) compared with the hemangiosarcoma cell line (ISO-HAS).

The concept of "lymphangiosarcoma" remains obscure. Therefore, we reported a patient with lymphangiosarcoma, resistant to immunotherapy. The patient presented with impressive and discriminative features: clinically an ill-defined edematous lesion with lymphorrhea and pathologically atypical vascular channel formation without extravasation of blood, clearly distinguished from common angiosarcoma with hemorrhage. From this case, a lymphangiosarcoma cell line, MO-LAS, was established and its characteristics were compared with the hemangiosarcoma cell line, ISO-HAS. Flow cytometric analysis revealed that MO-LAS was negative for factor VIII-related antigen, but positive for CD31, D2-40, NZ-1, and vascular endothelial growth factor receptor-3 (VEGFR-3), similar to ISO-HAS. However, MO-LAS expressed a much higher level of homeobox gene PROX1, indicating a lymphatic phenotype, compared with ISO-HAS. Furthermore, MO-LAS showed a much lesser expression of oncogenes and much lower sensitivity against lymphokine-activated killer (LAK) cells. Lymphangiosarcoma may be difficult to recognize by the immune system. Conclusively, the establishment of MO-LAS, a novel angiosarcoma cell line bearing lymphatic characters, strongly suggests the entity of lymphangiosarcoma.

Effective use of flow-spoiled FBI and time-SLIP methods in the diagnostic study of an aberrant vessel of the head and neck: "left jugular venous steal by the right jugular vein".

Three-dimensional (3D) time-of-flight (TOF) is now commonly used in routine magnetic resonance angiography (MRA) studies of the head and neck. However, there are limits to its diagnostic abilities in the clinical field and, in some instances, a more invasive supplementary examination may be required. We incidentally discovered a patient with an aberrant vessel of the head and neck that ran alongside the left carotid artery and contained a constant, slowly pulsating efferent blood flow. 3D-TOF and carotid ultrasonography could not determine the nature and origin of this vessel. Additional studies using flow-spoiled fresh blood imaging (flow-spoiled FBI) and time spatial labeling inversion pulse (time-SLIP) methods were effective in determining that the vessel was the left jugular vein, and that the continuous venous reflux was a result of a venous steal by the right jugular vein. We show that by combining different MRA techniques we can effectively achieve diagnosis without resorting to more invasive examinations.