Comparative Evaluation of Fundus Image Interpretation Accuracy in Glaucoma Screening Among Different Physician Groups.

Purpose: To examine the variability in glaucoma screening using fundus images among physicians, including non-ophthalmologists. Patients and Methods: Sixty-nine eyes from 69 patients, including 25 eyes with glaucoma, were included from the Jikei University Hospital from July 2019 to December 2022. Fundus images were captured using TRC-NW8 (Topcon Corporation, Tokyo, Japan), and were interpreted by 10 non-ophthalmologists, 10 non-specialist ophthalmologists, and 9 specialists for diagnostic accuracy. We analyzed differences in diagnostic accuracy among the three groups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Kappa coefficient were compared, using the Kruskal-Wallis test followed by a post hoc Dunn's test. Results: The sensitivity and specificity were 0.22 and 0.92 for non-ophthalmologists, 0.49 and 0.83 for non-specialist ophthalmologists, and 0.68 and 0.87 for specialists, respectively. Both specialists and non-specialist ophthalmologists showed significantly higher sensitivity than non-ophthalmologists (Dunn's test, P<0.001 and P=0.031). There was no significant difference in specificity among the three groups (Kruskal-Wallis test, P=0.086). The PPV did not differ significantly between the groups (Kruskal-Wallis test, P=0.108), while the NPV was significantly higher in specialists compared to non-ophthalmologists (Dunn's test, P<0.001). Specialists also had a significantly higher Kappa coefficient than non-ophthalmologists and non-specialist ophthalmologists (Dunn's test, P<0.001 and P=0.024). Conclusion: Diagnostic accuracy varied significantly based on the physician's background.

Lens capsule pathological characteristics in cases of intraocular lens dislocation with atopic dermatitis.

PURPOSE: To explore lens capsule pathological characteristics in intraocular lens (IOL) dislocation after cataract surgery in patients with atopic dermatitis (AD). SETTING: University hospital department of ophthalmology. DESIGN: Case series with clinicopathological correlations. METHODS: Lens capsules and surrounding tissues excised during surgery from eyes with AD (AD group) and eyes without AD (non-AD group) with IOL dislocation were histologically evaluated. Hematoxylin and eosin staining was used to assess abnormal changes in lens epithelial cells (LECs). Masson trichrome staining distinguished the fibrous metaplasia around the lens capsule into high-density and low-density fibrosis. Capsular splitting (thinning) was identified in both stained preparations. RESULTS: The IOL dislocation morphology in the AD group (10 eyes of 10 patients) included 7 cases of capsular bag dislocation (CBD) and 3 cases of dead bag syndrome (DBS), with an average duration to IOL dislocation of 11.5 ± 5.6 years. All patients in the non-AD group (12 eyes of 12 patients) had CBD, averaging 10.2 ± 5.7 years to dislocation. Abnormal LECs, low-density fibrosis, and capsular splitting were observed in 9 (90), 9 (90), and 6 (60) of the patients in the AD group compared with 6 (50), 3 (25), and 2 (18), respectively, in the non-AD group (total n [%]). CONCLUSIONS: Compared with the non-AD group, the AD group exhibited higher frequencies of morphological changes in LECs, low-density fibrosis around the lens capsule, and capsular splitting characteristics of DBS. These results suggest LEC degeneration and increased lens capsule fragility occurred in patients with AD.

Associated factors of diabetic retinopathy by artificial intelligence evaluation of fundus images in Japan.

This cross-sectional study aimed to investigate the promoting and inhibitory factors of diabetic retinopathy (DR) according to diabetes mellitus (DM) stage using standardized evaluation of fundus images by artificial intelligence (AI). A total of 30,167 participants underwent blood and fundus examinations at a health screening facility in Japan (2015-2016). Fundus photographs were screened by the AI software, RetCAD and DR scores (DRSs) were quantified. The presence of DR was determined by setting two cut-off values prioritizing sensitivity or specificity. DM was defined as four stages (no DM: DM0; advanced DM: DM3) based on treatment history and hemoglobin A1c (HbA1c) levels. Associated factors of DR were identified using logistic regression analysis. For cutoff values, multivariate analysis revealed age, sex, systolic blood pressure (SBP), smoking, urinary protein, and HbA1c level as positively associated with the risk of DR among all DM stages. In addition to glycemic control, SBP and Fibrosis-4 index might act as promoting factors for DR at all or an earlier DM stage. T-Bil, cholinesterase, and T-cho level might be protective factors at an advanced DM stage.

Inhibition of the uric acid efflux transporter ABCG2 enhances stimulating effect of soluble uric acid on IL-1ß production in murine macrophage-like J774.1 cells.

Soluble uric acid (UA) absorbed by cells through UA transporters (UATs) accumulates intracellularly, activates the NLRP3 inflammasome and thereby increases IL-1ß secretion. ABCG2 transporter excludes intracellular UA. However, it remains unknown whether ABCG2 inhibition leads to intracellular accumulation of UA and increases IL-1ß production. In this study, we examined whether genetic and pharmacological inhibition of ABCG2 could increase IL-1ß production in mouse macrophage-like J774.1 cells especially under hyperuricemic conditions. We determined mRNA and protein levels of pro-IL-1ß, mature IL-1ß, caspase-1 and several UATs in culture supernatants and lysates of J774.1 cells with or without soluble UA pretreatment. Knockdown experiments using an shRNA against ABCG2 and pharmacological experiments with an ABCG2 inhibitor were conducted. Extracellularly applied soluble UA increased protein levels of pro-IL-1ß, mature IL-1ß and caspase-1 in the culture supernatant from lipopolysaccharide (LPS)-primed and monosodium urate crystal (MSU)-stimulated J774.1 cells. J774.1 cells expressed UATs of ABCG2, GLUT9 and MRP4, and shRNA knockdown of ABCG2 increased protein levels of pro-IL-1ß and mature IL-1ß in the culture supernatant. Soluble UA increased mRNA and protein levels of ABCG2 in J774.1 cells without either LPS or MSU treatment. An ABCG2 inhibitor, febuxostat, but not a urate reabsorption inhibitor, dotinurad, enhanced IL-1ß production in cells pretreated with soluble UA. In conclusion, genetic and pharmacological inhibition of ABCG2 enhanced IL-1ß production especially under hyperuricemic conditions by increasing intracellularly accumulated soluble UA that activates the NLRP3 inflammasome and pro-IL-1ß transcription in macrophage-like J774.1 cells.

Lens thickness in atopic cataract: case-control study.

PURPOSE: To examine whether atopic cataracts are associated with thinner lenses. SETTING: Department of Ophthalmology, Jikei University Hospital, Tokyo, Japan. DESIGN: Retrospective matched case-control study. METHODS: 31 eyes with atopic cataracts, 62 with nonatopic cataracts, and 31 without cataracts were analyzed. Each group was matched for age (±4 years) and sex. RESULTS: The mean lens thickness (LT) was 3.76 ± 0.40 mm, 3.94 ± 0.49 mm, and 4.11 ± 0.40 mm in eyes with atopic cataracts, nonatopic cataracts, and normal lenses, respectively. Repeated-measures analysis of variance showed that the LT in the atopic cataract group was significantly thinner than that in the nonatopic cataract ( P = .036) and normal lens ( P < .001) groups. In multivariate logistic regression analysis, a thinner LT was negatively correlated with age (odds ratio [OR], 0.91; 95% CI, 0.86-0.96) and positively correlated with anterior subcapsular cataract (ASC) (OR, 5.61; 95% CI, 1.97-15.99). Atopy was not a significant factor. 24 (38.7%) of the 62 eyes with nonatopic cataracts and 24 (77.4%) of the 31 eyes with atopic cataracts had ASC. CONCLUSIONS: The lenses of eyes with atopic cataracts were thinner than those of controls. Atopic cataracts frequently present with anterior subcapsular opacity, which is associated with lens thinning.

Characteristics of the stand-to-sit motion in healthy older women†:†Evaluation of sitting impact by measurement of ground reaction forces.

Objectives : The aims of this study were to examine the biomechanics of StandTS movements in older adults and to identify their optimal StandTS motion by measuring sitting impact forces. Methods : Healthy older women (n = 17) and healthy young women (n = 18) were asked to perform SitTS and StandTS motions at a natural speed using a chair. We measured the ground reaction forces from the participants' feet and the chair, the angle of the trunk and ankle, vertical velocity, and postural muscle activities using a force plate, motion analyzer, and electromyography, respectively. Results : Sitting impact force was significantly greater in the older women than in the young women during the StandTS motion. There was a significant difference between the trunk angle and the ankle angle during the StandTS motion and sitting impact force had a significant negative correlation with the ankle joint motion in the older women. Conclusions : The ankle joint strategy was characterized by body sway resembling a single-segment-inverted pendulum and suggests that this response is less developed in the older adult. These results indicate that the ankle joint strategy may be an important factor involved in the sitting impact force. J. Med. Invest. 69 : 278-286, August, 2022.

Xanthinuria Type 1 with a Novel Mutation in Xanthine Dehydrogenase and a Normal Endothelial Function.

Whether or not extremely low levels of serum uric acid (SUA) in xanthinuria are associated with impairment of the endothelial function and exercise-induced acute kidney injury (EIAKI) is unclear. A 59-year-old woman without EIAKI or urolithiasis had undetectable levels of UA in serum and urine and elevated levels of hypoxanthine and xanthine in urine. A genetic analysis revealed homozygous mutations in the XDH gene [c.1585 C>T (p. Gln529*)]. Flow-mediated dilation was within the normal range. This is the first report of a case with extremely low levels of SUA, xanthinuria with novel mutations of xanthine dehydrogenase (XDH) and a normal endothelial function.

Hsp70 promotes maturation of uromodulin mutants that cause familial juvenile hyperuricemic nephropathy and suppresses cellular damage.

BACKGROUND: Familial juvenile hyperuricemic nephropathy (FJHN) is an autosomal dominant disorder caused by mutations in UMOD. Here we studied effects of genetic expression and pharmacological induction of Hsp70 on the UMOD mutants C112Y and C217G. METHODS: We expressed wild type (WT), C112Y and C217G in HEK293 cells and studied their maturation and cellular damage using western blot and flow cytometry. RESULTS: Expression of C112Y or C217G increased pro-apoptotic proteins, decreased anti-apoptotic proteins, and induced cellular apoptosis as examined by annexin V staining and flow cytometry. Overexpression of Hsp70 or administration of an Hsp70 inducer geranylgeranylacetone (GGA) promoted maturation of the mutant proteins, increased their secreted forms, normalized the levels of pro- and anti-apoptotic proteins and suppressed apoptosis. CONCLUSION: These findings indicated that Hsp70 enhanced maturation of C112Y and C217G and reduced cellular apoptosis, suggesting that Hsp70 induction might be of a therapeutic value for treatment of FJHN.

Factors Influencing Threshold Energy in Subthreshold Photocoagulation for Diabetic Macular Edema.

BACKGROUND: Subthreshold photocoagulation is one of the treatments for diabetic macular edema. However, the range of adequate laser energy that can be used for subthreshold photocoagulation is very restricted. Therefore, determination of the titration settings for the threshold energy is an essential part of the subthreshold-photocoagulation procedure. This study examined factors influencing the threshold energy used in subthreshold photocoagulation for diabetic macular edema. METHODS: For 20 consecutive cases (29 eyes) who had received treatment using Endpoint Management (EpM) between April 2019 and June 2020 for persistent diabetic macular edema after completion of panretinal photocoagulation, multiple regression analysis was used to examine factors influencing threshold energy. RESULTS: Analysis evaluating all the surgical procedures (n=150) determined there was statistical significance for a history of vitrectomy and cataract surgery, central macular thickness, interval from completion of panretinal photocoagulation, superior 6 mm subfield, and nasal 6 mm subfield. Further analysis examined surgical procedures that had been done in patients with a history of vitrectomy and cataract surgery (n=116). This analysis showed that central macular thickness, axial length, interval from completion of panretinal photocoagulation, and HbA1c were all statistically significant factors. CONCLUSION: Threshold energy for diabetic macular edema was significantly influenced by a history of vitrectomy and cataract surgery, central macular thickness, and interval between the completion of panretinal photocoagulation and initial EpM. Transparency of ocular media and intraocular inflammation were speculated to be associated with these results.

Reconstruction of Photoreceptor Outer Layers after Steroid Therapy in Solar Retinopathy.

PURPOSE: To report the clinical course of solar retinopathy after steroid therapy. CASE PRESENTATION: A 45-year-old male gazed at the sun and noticed bilateral central scotoma and decreased vision after the episode. After 7 weeks from onset, ophthalmic examinations were firstly performed. Decimal best corrected visual acuity (BCVA) was decreased to 0.8 and 0.7 in the right and left eyes. Funduscopy showed a tiny, yellowish spot in the fovea bilaterally. Corresponding to the lesion, optical coherence tomography (OCT) images showed an elevated and blurred ellipsoid zone and loss of the interdigitation zone. A posterior sub-Tenon triamcinolone injection in the right eye and oral prednisolone therapy were performed as a medication. BCVA was improved to 1.2 and 1.0 in the right and left eyes at 9 weeks after medication. OCT images showed ellipsoid zone was gradually improved bilaterally, which became nearly normal at 4 weeks in the right eye and at 21 weeks in the left eye. The loss of the interdigitation zone remained at 12 weeks in the right eye and at 21 weeks at the left eye. CONCLUSIONS: We described a case with solar retinopathy who exhibited anatomical recovery of the photoreceptor outer layers by steroid therapy, started after 7 weeks from onset.

[SIGNIFICANT, TRANSIENT VISUAL DISTURBANCE AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY].

Visual disturbance following non-ophthalmologic surgery under general anesthesia is rare but can be devastating both socially and medicolegally. Immediate salvage intervention as well as prevention is of utmost importance since this can be a serious blow to patient's functional outcome postoperatively. We experienced a case of temporary but significant visual disturbance right after transperitoneal laparoscopic radical prostatectomy for localized prostate cancer. We need to raise our levels of vigilance to this condition since it can be avoided and prevented with immediate therapeutic intervention and decent clinical awareness.

Recurrent Lower Eyelid Ectropion After Graft Surgery Using Autogenous Palmaris Longus Tendon.

A 78-year-old male experienced right lower eyelid ectropion following right facial trauma from a fall 5 years ago, for which he underwent autogenous palmaris longus tendon graft surgery at another clinic. Recurrence was noted 3 years after surgery. On first examination, there was outward turning of the lateral half of the right lower eyelid margin. We performed a lateral tarsal strip procedure with removal of the graft. Intraoperatively, the lateral part of the graft was located along the inferior tarsal border, whereas the medial part was located on the tarsal surface. The lateral stump had bifurcated; 1 branch had passed through a bony hole drilled at the base of the rim; and both branches had been ligated together on the rim surface. The medial side had been fixed to the medial canthal tendon. Postoperatively, the apposition of eyelid and ocular surface was good, and the patient experienced no recurrence after 1 year.

Changes of posture and muscle activities in the trunk and legs during walking in patients with lumbar spinal stenosis after decompression surgery. A preliminary report.

Neurogenic intermittent claudication is a main symptom in lumbar spinal stenosis (LSS), and postural change is often observed during walking. This study aimed to identify the changes in posture and muscle activity in the trunk and legs during walking in patients with LSS by examining 6 patients who had undergone decompression surgery. None of them had significant paralysis. Gait analysis using Vicon motion capture system® with electromyographic recordings of the paravertebral muscles (PVM) and vastus lateralis muscle (VL) was performed preoperatively and 2 weeks postoperatively. Results showed that the thorax angle indicating the degree of trunk flexion after walking decreased significantly and the pelvic angle tended to decrease after surgery. However, there were no difference in the spine angle, which is a measure of the motion of the thoraco-lumbar spine among the evaluations. The knee angle increased significantly after surgery both at the beginning and at the end of walking, but the angles of the hip and ankle did not change significantly after surgery. Knee torques increased significantly after surgery both at the beginning and at the end of walking. The activity of the PVM decreased and that of the VL increased after surgery. The results indicate that patients with LSS walk in a forward-bending position without flexing the spine, which can be one of the neurologic symptoms. Increases in knee torque and VL activity seemed to reflect the increase of walking speed, and the decrease of PVM activity appeared to be caused by postural improvement after surgery.

Not Seeing is Believing: the Role of Invisibility in Human Lives.

Our life is full of invisibility that exerts power on our acts, relationships, and construction of the self. This paper discusses psychological processes in which invisibility plays an essential role, and constructs a typology of invisibility in society and in our lives. After a brief look at the crucial role of invisibility in prevailing theories of psychology, I first show how invisibility works in children's meaning constructions, the process in which their selves become clear for observers (the presentational self, Komatsu 2010). The development of children's meaning making is led by different types of invisibility concerning the children themselves. Second, I extend the discussion from the development of individuals to the role of socially regulated invisibility that controls our acts and relationships with others, introducing examples concerning religious belief in history. After these discussions, I present a hierarchical classification of invisibility from a simple spatial-temporal separation of concretely existing objects and ourselves to an abstract aspect of invisibility in which the object and its meaning are unclear.

Atypical presentation of primary intraocular lymphoma.

BACKGROUND: In 2014, Pang et al. reported three cases with vitelliform submaculopathy as a preceding lesion of primary intraocular lymphoma (PIOL). Here, we report a case with an atypical presentation of PIOL who initially presented with vitelliform submaculopathy, vitreous haze and preripheral retinal focus. CASE PRESENTATION: A 73-year-old female initially visited another hospital with a chief complaint of acute reduced vision in the right eye. Funduscopic examination of the right eye showed a yellowish retinal lesion at the fovea with vitreous haze and retinal foci scattered in the peripheral region. Spectral-domain optic coherence tomography (SD-OCT) revealed a hyperreflective subretinal debris above the retinal pigment epithelium (RPE) at the fovea, suggesting vitelliform submaculopathy. Vitrectomy was performed to improve visualization of the retinal lesions and for examination of PIOL. Vitreous cytology was class III and cytokine analysis of vitreous fluid showed increased IL-10 and an IL-10/IL-6 ratio >1, suggesting PIOL. Thereafter, there was a sub-RPE infiltration of presumed lymphoma in the nasal retina, and PCR analysis of anterior chamber fluid indicated IgH gene rearrangement, leading to diagnosis of PIOL. Three months later, there was complete disappearance of the vitelliform submacular lesion, with resultant disruption and thinning of the outer retinal layers on SD-OCT images. CONCLUSIONS: Clinicians should be aware of atypical manifestations of PIOL such as vitelliform submaculopathy and peripheral retinal foci with vitreous haze. The patient's unusual funduscopic changes are findings that have not reported in patients with PIOL.

[The relationship between perceived personality and Ieading/following roles in university students' close friendships, using Gitaigo personality scale].

Based on the recently developed Gitaigo personality scale (Komatsu, Sakai, Nishioka, & Mukoyama, 2012), we investigated the relationship between perceived personality and leading/following roles in close friend dyads. Primary participants rated their own and one of their close friend's personality with Gitaigo personality scale. They also described who takes the role of leader in the relationship with the friend they rated. When one in the pair is reported as leader, the other is considered as follower. Subsidiary participants who were cited as close friends rated their own personality. Our analysis of the 215 pairs showed that the participants taking the role of follower were rated higher in the traits of Cowardliness and Mildness by the primary participants. Regarding Mildness, this tendency was also clear in subsidiary participants' self-ratings. Primary participants rated the Preciseness and Candidness of their friends lower if their friend was considered a follower. Gitaigo personality scale describes the perceived personality well, at least for several traits.

On the Dialectic Nature of Human Mind: The Dynamic Tension Between Sameness and non-Sameness.

Although our environments and ourselves are usually thought about as relatively stable over time, there is always a tension between sameness and non-sameness in our lives. Because any development is considered as emerging non-sameness, I report that the inquiry into the development of human mind must regard this tension as essential. In this paper, first I show that this tension is a highly relational and dynamic phenomenon that cannot be fixed or measured in numerical terms. Non-sameness is not only a result of development but also a ground that leads to further development in the future. After illustrating the function and regulation of the {same <> non-same} tension in development by analyzing an excerpt from a mother-child conversation, I explain that this tension, or more generally the dialectic nature, is within the core of psychological phenomena, in terms that were introduced to psychology by James Mark Baldwin a century ago. These discussions imply the importance of inquiring into the process of development that emerges from the dialectic tension and fluctuations of our movements and that is observable in various relationships, including the relationship between researchers and study participants.

Is the serum l-arginine level during early pregnancy a predictor of pregnancy-induced hypertension?

The objective of this study was to determine the concentration of serum l-arginine in healthy pregnant women and infant cord blood and to compare them with those in patients with pregnancy-induced hypertension (PIH). The serum concentration of l-arginine in normal pregnant women at early gestation (n = 186) was determined and analyzed based on maternal factors such as the age, pre-pregnancy body mass index (BMI), smoking and alcohol habits before pregnancy. Similarly, the concentration of cord blood of the newborns (n = 142) was also analyzed. These values were compared with those in the PIH group (n = 21). The potential risk factors for PIH were also estimated. The serum concentration of l-arginine at early gestation in normal pregnant women (88.65 ± 19.96 µM) was not affected by the maternal age and BMI before pregnancy. A lower l-arginine concentration at early gestation (<70 µM) significantly elevated PIH risk [adjusted odds ratio (OR) = 4.26, 95% CI 1.29-14.50]. In addition, either women with large body mass before pregnancy (BMI>25 kg/m(2)) or primipara women also showed a significant association with PIH risk [adjusted OR = 10.55 (2.95-40.68); 5.25 (1.72-19.15), respectively]. In conclusion, a lower l-arginine concentration at early gestation, overweight before pregnancy (BMI>25 kg/m(2)) and primipara could predict to the development of PIH.

[The gitaigo personality scale for description of self and others].

Gitaigo is a subtype of mimetic words (onomatopoeia) in the Japanese language, which can be regarded as words that imitate actions or states. This study develops a personality scale, with six subscales, using 60 gitaigo words as items for rating the personality of the self and others. We asked 1 054 participants to rate their own personality and 905 participants to rate a close friend's personality, using 158 gitaigo words as items to describe personality. We found that a six-factor model, found in our previous study, was also applicable to the present study of ratings of participants' own personality. We also found six groups of words in the ratings of close friends' personality, although the factor structure is slightly different from the self-rating factors. We selected ten words that exhibited high loadings for each of the six factors to develop a personality scale with six subscales showing high reliability. We named those factors: cowardliness, slowness, preciseness, irritableness, candidness, and frivolousness. The average scores for self-ratings were significantly lower for two subscales (preciseness and candidness) and higher for other four subscales compared to the rating of others.