Association between dryness sensation and ocular surface temperature and conjunctival blood flow in soft contact lens wearers.

PURPOSE: To investigate the association between dryness, ocular surface temperature (OST), and conjunctival blood flow (CBF) in soft contact lens (SCL) wearers after airflow stimulation. METHODS: After recruiting 21 SCL wearers (mean age, 25.3 ± 4.2 years), subjects used two different daily disposable silicone hydrogel SCLs (narafilcon A and delefilcon A lenses). On three of four measurement days, excluding the first, OST, CBF, tear meniscus height (TMH), and non-invasive tear break-up time (NIBUT) were measured after airflow stimulation at a rate of 3 m/s for 10 min. The measurements were conducted without SCLs on the first and second days, and with different SCLs on the third and fourth days. Dryness was evaluated using the visual analogue scale (VAS). These parameters were compared between the two types of SCLs, and their association with the dryness sensation was then investigated. RESULTS: Dryness was significantly weakly correlated with OST (r = -0.375, p < 0.05) and CBF (r = 0.339, p < 0.05). TMH, NIBUT, and VAS scores for dryness with the delefilcon A lens (0.15 ± 0.05 mm, 3.7 ± 01.7 s and 29.4 ± 16.9) were significantly higher, longer, and lower, respectively, than those with the narafilcon A lens (0.12 ± 0.05 mm, 2.3 ± 1.7 s and 35.9 ± 17.0; p < 0.05, p < 0.01 and p < 0.01). The changes in the OST and CBF between with and without the delefilcon A lens (-0.36 ± 0.35 °C and 0.99 ± 0.19) were significantly small compared to the narafilcon A lens (-0.60 ± 0.42 °C and 1.11 ± 0.21; p < 0.01 for both comparisons). CONCLUSION: Dryness was correlated with OST and CBF, which indicates that when dryness was high, OST was low and CBF was high. These results suggest that OST and CBF assessments are effective for evaluating dryness sensation.

Cardiovascular Outcomes after Paclitaxel-Coated Balloon Angioplasty versus Drug-Eluting Stent Placement for Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.

Background: We conducted a systematic review and meta-analysis to examine the feasibility of paclitaxel-coated balloon (PCB) angioplasty for de novo lesions in patients with acute coronary syndrome (ACS) by comparing with drug-eluting stent (DES) placement. Methods: By a systematic literature search, nine (five randomized controlled, two retrospective propensity-score matched, and two retrospective baseline-balanced) studies comparing the midterm clinical and angiographic outcomes after PCB angioplasty and DES placement were included, yielding 974 and 1130 ACS cases in PCB and DES groups, respectively. Major adverse cardiac event (MACE) was defined as a composite of cardiac mortality (CM), all-cause mortality (ACM), myocardial infarction (MI), target vessel revascularization (TVR), and target lesion revascularization (TLR). Late luminal loss (LLL) and bleeding events (BLD) were also estimated. Results: The frequencies of MACE in PCB and DES groups were 8.42% and 10.62%, respectively. PCB angioplasty had no significant impacts on all of MACE (risk ratio: 0.90, 95%CI: 0.68-1.18, p = 0.44), CM, ACM, MI, TVR, TLR, BLD, and LLL, compared to DES placement in random-effects model. Conclusions: The present systematic review and meta-analysis showed the feasibility of PCB angioplasty for the de novo lesions in patients with ACS in comparison with DES placement by the emergent procedures.

Evaluating the relationship between ocular blood flow and systemic organ blood flow in hemorrhagic shock using a rabbit model.

This study aimed to investigate the feasibility of utilizing noninvasive ocular blood flow measurements as potential indicators of systemic circulation in rabbits experiencing hemorrhagic shock. Using Laser speckle flowgraphy, ocular blood flow indices, relative flow volume (RFV), and mean blur rate in the choroidal area (MBR-CH) were assessed in New Zealand White rabbits (n = 10) subjected to controlled blood removal and return. Hemodynamic parameters and biochemical markers were monitored alongside ocular circulation during blood removal and return phases. Additionally, correlations between ocular parameters and systemic indices were examined. The results indicated that RFV and MBR-CH exhibited significant correlations with renal and intestinal blood flows, with stronger correlations observed during blood removal. Additionally, ocular blood flow changes closely mirrored systemic dynamics, suggesting their potential as real-time indicators of shock progression and recovery. These findings indicate that ocular blood flow measurements may serve as real-time indicators of the systemic circulation status during hemorrhagic shock, offering potential insights into shock management and guiding tailored interventions. Thus, noninvasive ocular blood flow evaluation holds promise as an innovative tool for assessing systemic circulation dynamics during hemorrhagic shock.

Reappraisal of a Renovated Cell-free and Concentrated Ascites Reinfusion Therapy for Malignant Ascites.

BACKGROUND/AIM: Cell-free and concentrated ascites reinfusion therapy (CART) was established for refractory ascites and renovated CART (Keisuke Matsusaki (KM) -CART) has been recently developed especially for malignant ascites; however, the actual clinical efficacy of KM-CART has been rarely reported. PATIENTS AND METHODS: We performed 226 KM-CART procedures in 104 patients with malignant ascites in three hospitals from August 2013 to September 2018. Medical records were retrospectively reviewed for ascites data, related complications, symptoms before and after each CART and prognosis after the first CART. The modified Glasgow Prognostic Score (mGPS) was reviewed before every procedure, as an indicator of nutritional status. RESULTS: Pancreatic cancer was the most common indication for the KM-CART procedure, followed by gastric cancer, hepatocellular carcinoma, ovarian cancer, and cholangiocarcinoma (five major diseases). The 50% survival times of these five major diseases after the first procedure were 25, 39, 31, 49, and 33 days, respectively. The mean survival time for all patients was 73.5 days, and 75.6 days for those with the five major diseases. All patients experienced symptomatic relief, and complications were rare. Repeated KM-CART was performed in 47.1% of the patients, most often in those with ovarian cancer (66.7%). Regarding the mGPS at the first CART procedure, 89% of patients were in the group with the poorest nutritional status. Patients who underwent KM-CART three or more times had longer survival than those who were treated once or twice. CONCLUSION: Repeated KM-CART provides a survival benefit for patients with malignant ascites, even in cases of poor nutritional status.

Measurement of Anions in Tear Fluid Using Ion Chromatography.

PURPOSE: Tear fluid (TF) contains a variety of electrolytes that exhibit a strong correlation with its osmotic pressure. These electrolytes are also related to the etiology of diseases on ocular surfaces such as dry eye syndromes and keratopathy. Although positive ions (cations) in TF have been investigated to understand their roles, negative ions (anions) have hardly been studied because applicable analytical methods are restricted to a few kinds. In this study, we established a method to analyze the anions involved in a sufficiently small amount of TF for in situ diagnosis of a single subject. METHODS: Twenty healthy volunteers (10 men and 10 women) were recruited. Anions in their TF were measured on a commercial ion chromatograph (IC-2010, Tosoh, Japan). Tear fluid (5 µL or more) was collected from each subject with a glass capillary, diluted with 300 µL of pure water, and conveyed to the chromatograph. We successfully monitored the concentrations of bromide, nitrate, phosphate, and sulfate anions (Br - , NO 3- , HPO 42- , and SO 42- , respectively) in TF. RESULTS: Br - and SO 42- were universally detected in all samples, whereas NO 3- was found in 35.0% and HPO 42- in 30.0% of them. The mean concentrations (mg/L) of each anion were Br - , 4.69 ± 0.96; NO 3- , 0.80 ± 0.68; HPO 42- , 17.48 ± 7.60; and SO 42- , 3.34 ± 2.54. As for SO 42- , no sex differences or diurnal variations were observed. CONCLUSIONS: We established an efficient protocol to quantitate various inorganic anions involved in a small amount of TF using a commercially available instrument. This is the first step to elucidate the role of anions in TF.

Chronic Effect of HotBalloon-Based Wide Planar Ablation on Epicardial Adipose Tissue in Persistent Atrial Fibrillation.

Background: Adverse atrial remodeling, including epicardial adipose tissue (EAT) deposition in the left atrium (LA), is implicated in atrial fibrillation (AF). Radiofrequency hotballoon (RHB) ablation can produce wide planar lesions because the balloon is highly compliant; however, chronic effects of RHB ablation on structural remodeling remain unknown. This clinical-experimental investigation characterized chronic effects of RHB ablation on EAT in persistent AF (PsAF). Methods and Results: The clinical study involved 91 patients (obese, n=30; non-obese, n=61) undergoing RHB ablation for PsAF. LA-EAT was assessed from computed tomography images obtained before ablation and 6 months later. Tissue effects of RHB ablation were explored in a chronic swine model. RHB ablation significantly reduced LA volume (mean [±SD] 177.7±29.7 vs. 138.4±29.6 mL; P<0.001) and LA-EAT volume (median [interquartile range] 22.0 [12.4-33.3] vs. 16.5 [7.9-25.8] mL; P<0.001). The reduction in EAT was significantly greater in the pulmonary vein (PV) antrum than in other LA regions (37.9% vs. 15.8%; P<0.001). The percentage reduction in PV antrum EAT was equivalent between obese and non-obese patients, as was the postablation success rate (73% vs. 70%; P=0.77). RHB ablation produced transmural lesions reaching the pigs' epicardial fat region. Conclusions: RHB-based planar-transmural lesions altered the structurally remodeled LA, including EAT. Further studies are needed to determine whether factors other than PV isolation contribute to the clinical success of RHB ablation.

Exosomes in ascites from patients with human pancreatic cancer enhance remote metastasis partially through endothelial-mesenchymal transition.

BACKGROUND: Despite advances in multidisciplinary treatment, the prognosis of pancreatic cancer remains poor. Since distant metastasis defines prognosis, elucidation of the mechanism of metastasis is important for improving survival. Exosomes are extracellular secretory vesicles and are responsible for intercellular communication. In this study, we investigated whether exosomes secreted by human pancreatic cancer cells are involved in promoting distant metastasis of cancer and the mechanism that underlies the promotion of metastasis. METHODS: Exosomes were isolated from ascites of a patient with pancreatic cancer and a patient with liver cirrhosis as a control. Three days after the administration of exosomes to nude mice, GFP-labeled human pancreatic cancer cells were injected via the spleen or tail vein, and then the liver and lungs were histologically analyzed. To elucidate the mechanism, vascular permeability was estimated using FITC-dextran in place of pancreatic cancer cells in vivo and human umbilical vascular endothelial cells (HUVECs) were used to analyze vascular permeability and the induction of endothelial-mesenchymal transition (EndMT) in vitro. RESULTS: Distant metastasis and vascular permeability were significantly enhanced in mice treated with exosomes from pancreatic cancer patients in comparison to exosomes from a control patient in vivo. In addition, exosomes from pancreatic cancer patients significantly enhanced vascular permeability and the induction of EndMT in HUVECs in vitro. CONCLUSION: Exosomes derived from pancreatic cancer cells form a pre-metastatic niche and promote the extravasation and colonization of pancreatic cancer cells to remote organs, partially through endothelial-mesenchymal transition.

Novel superpixel method to visualize fundus blood flow resistivity in healthy adults.

We aimed to perform superpixel segmentation of ocular blood flow maps obtained using laser speckle flowgraphy (LSFG) and investigate the effects of systemic parameters such as body weight, height, and sex on ocular blood flow resistivity. We studied 757 healthy participants (583 men, 174 women). We calculated the average beat strength over mean blur rate (BOM) as a LSFG resistivity index, as a function of age and sex using ordinary regions of interest (ROI) centered on the optic nerve head (ONH), the retinal vessels region and tissue around the ONH, and the choroid (CHD). We compared the ROI and superpixel-based methods, which are segmented based on image processing, for calculating the BOM. The sex differences in the BOM for the ONH, retinal-vessels region and tissue region of the ONH and CHD were significant for individuals aged ≤ 50 years (P < 0.01) but not those > 50 years old (P > 0.05). The average BOMs calculated using the ROI and superpixel methods were strongly correlated in the ONH (coefficient = 0.87, R2 = 0.8, P < 0.0001, n = 5465). In summary, a superpixel-segmented BOM map is suitable for two-dimensional visualization of ocular blood flow resistivity.

Diagnostic Ability of a Smartphone App for Dry Eye Disease: Protocol for a Multicenter, Open-Label, Prospective, and Cross-sectional Study.

BACKGROUND: Dry eye disease (DED) is one of the most common ocular surface diseases. Numerous patients with DED remain undiagnosed and inadequately treated, experiencing various subjective symptoms and a decrease in quality of life and work productivity. A mobile health smartphone app, namely, the DEA01, has been developed as a noninvasive, noncontact, and remote screening device, in the context of an ongoing paradigm shift in the health care system, to facilitate a diagnosis of DED. OBJECTIVE: This study aimed to evaluate the capabilities of the DEA01 smartphone app to facilitate a DED diagnosis. METHODS: In this multicenter, open-label, prospective, and cross-sectional study, the test method will involve using the DEA01 smartphone app to collect and evaluate DED symptoms, based on the Japanese version of the Ocular Surface Disease Index (J-OSDI), and to measure the maximum blink interval (MBI). The standard method will then involve a paper-based J-OSDI evaluation of subjective symptoms of DED and tear film breakup time (TFBUT) measurement in an in-person encounter. We will allocate 220 patients to DED and non-DED groups, based on the standard method. The primary outcome will be the sensitivity and specificity of the DED diagnosis according to the test method. Secondary outcomes will be the validity and reliability of the test method. The concordance rate, positive and negative predictive values, and the likelihood ratio between the test and standard methods will be assessed. The area under the curve of the test method will be evaluated using a receiver operating characteristic curve. The internal consistency of the app-based J-OSDI and the correlation between the app-based J-OSDI and paper-based J-OSDI will be assessed. A DED diagnosis cutoff value for the app-based MBI will be determined using a receiver operating characteristic curve. The app-based MBI will be assessed to determine a correlation between a slit lamp-based MBI and TFBUT. Adverse events and DEA01 failure data will be collected. Operability and usability will be assessed using a 5-point Likert scale questionnaire. RESULTS: Patient enrollment will start in February 2023 and end in July 2023. The findings will be analyzed in August 2023, and the results will be reported from March 2024 onward. CONCLUSIONS: This study may have implications in identifying a noninvasive, noncontact route to facilitate a diagnosis of DED. The DEA01 may enable a comprehensive diagnostic evaluation within a telemedicine setting and facilitate early intervention for undiagnosed patients with DED confronting health care access barriers. TRIAL REGISTRATION: Japan Registry of Clinical Trials jRCTs032220524; https://jrct.niph.go.jp/latest-detail/jRCTs032220524. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/45218.

Ocular blood flow evaluation by laser speckle flowgraphy in pediatric patients with anisometropia.

Purpose: To determine the differences and reproducibility of blood flow among hyperopic anisometropic, fellow, and control eyes. Methods: We retrospectively studied 38 eyes of 19 patients with hyperopic anisometropia (8.2 ± 3.0 years of age) and 13 eyes of eight control patients (6.8 ± 1.9 years). We measured the optic nerve head (ONH) and choroidal circulation using laser speckle flowgraphy (LSFG) and analyzed the choroidal mean blur rate (MBR-choroid), MBR-A (mean of all values in ONH), MBR-V (vessel mean), MBR-T (tissue mean), and sample size (sample), which are thought to reflect the ONH area ratio, area ratio of the blood stream (ARBS). We then assessed the coefficient of variation (COV) and intraclass correlation coefficient (ICC) and compared the differences among amblyopic, fellow, and control eyes in MBR, sample, and ARBS. Results: The ONH, MBR-A, MBR-T, and ARBS of amblyopic eyes were significantly higher than those of fellow eyes (P < 0.01, P < 0.05, and P < 0.05, respectively), and control eyes (MBR-A and ARBS, P < 0.05, for both comparisons). The sample-T (size of tissue component) in amblyopic eyes was significantly smaller than that in fellow and control eyes (P < 0.05). Blood flow in the choroid did not differ significantly between the eyes. The COVs of the MBR, sample, and ARBS were all ≤10%. All ICCs were ≥0.7. The COVs of pulse waveform parameter fluctuation, blowout score (BOS), blowout time (BOT), and resistivity index (RI) in the ONH and choroid were ≤10%. Conclusion: The MBR value of the LSFG in children exhibited reproducibility. Thus, this method can be used in clinical studies. The MBR values of the ONH in amblyopic eyes were significantly high. It has been suggested that measuring ONH blood flow using LSFG could detect the anisometropic amblyopic eyes.

Long-term Outcomes after Steroid Pulse Therapy in Patients with Type 1 Autoimmune Pancreatitis.

Objective Steroid pulse therapy is a regimen involving the intravenous administration of supra-pharmacological doses of corticosteroids in the short term. It is used to treat various inflammatory and autoimmune conditions. However, the strengths and limitations of steroid pulse therapy for induction of remission in type 1 autoimmune pancreatitis (AIP) are unknown. Methods Depending on the steroid therapy regimen administered, the 104 patients with type 1 AIP included in this retrospective study were divided into three groups: conventional oral prednisolone (PSL) regimen (PSL group), intravenous methylprednisolone (IVMP) pulse followed by oral PSL regimen (Pulse+PSL group), and IVMP pulse-alone regimen (Pulse-alone group). We then examined the relapse rate and adverse events among the three groups. Results The Kaplan-Meier estimates of the relapse rate at 36 months after steroid therapy were 13.6% in the PSL group, 13.3% in the Pulse+PSL group, and 46.2% in the Pulse-alone group. The log-rank test revealed that the relapse-free survival in the Pulse-alone group was significantly shorter than that in the PSL (p=0.024) and Pulse+PSL groups (p=0.014). The exacerbation of glucose tolerance after steroid therapy was less frequently observed in the Pulse-alone group (0%) than in the PSL group (17%, p=0.050) and Pulse+PSL groups (26%, p=0.011). Conclusion Although treatment with IVMP pulse alone resulted in unsatisfactory relapse prevention outcomes compared with conventional steroid therapy, the IVMP pulse-alone regimen might be an alternative treatment strategy for type 1 AIP from the perspective of avoiding adverse events from steroids.

A pediatric case of congenital stromal corneal dystrophy caused by the novel variant c.953del of the DCN gene.

We report a 1-year-old girl with congenital stromal corneal dystrophy confirmed by genetic analysis. The ocular phenotype included diffuse opacity over the corneal stroma bilaterally. We performed a genetic analysis to provide counseling to the parents regarding the recurrence rate. Whole exome sequencing was performed on her and her parents, and a novel de novo variant, NM_001920.5: c.953del, p.(Asn318Thrfs*10), in the DCN gene was identified in the patient.

Association between mask-associated dry eye (MADE) and corneal sensations.

To determine the risk of mask-associated dry eye (MADE), we investigated the fluorescein tear break-up time (FBUT), ocular surface temperature and blood flow, along with corneal sensitivity, in mask wearers. We enrolled 60 mask wearers (mean age, 27.1 ± 5.2 years) and then measured FBUT, corneal temperature and conjunctival blood flow without wearing masks (no mask), with masks, and with taped masks. We defined MADE as the condition in which dry eye symptoms appeared and the FBUT with mask was less than 5 s. The FBUT with a mask was significantly shorter compared to the no mask and taped mask groups (P < 0.01 and P < 0.05). The corneal temperature difference and conjunctival blood flow difference were significantly higher after wearing a mask than after wearing a taped mask (P < 0.01). Of the 60 subjects, 13 were diagnosed with MADE. Pain sensitivity and the Ocular Surface Disease Index (P < 0.05 and P < 0.01) were significantly higher in the MADE group, with the FBUT without masks (P < 0.05) significantly shorter than in the non-MADE group. MADE may be associated with corneal hypersensitivity. Wearing masks decreased FBUT and increased ocular surface temperature and blood flow. Taping the top edge of masks prevented these changes. Fitting masks properly may reduce MADE risk.

Is creation of a fully circumferential lesion set necessary for laser balloon ablation-based pulmonary vein isolation?

BACKGROUND: Despite reports of remote pulmonary vein (PV) stenosis after visually guided laser balloon (VGLB) ablation, circumferential (360°) lesion sets are routinely performed. This study aimed to determine whether fully circumferential lesion creations are required for all PVs to achieve PV isolations (PVIs) and to determine PV's vulnerability to chronic-phase stenosis. METHODS: Fifty-one patients with paroxysmal atrial fibrillation underwent mapping-guided PVIs using circular mapping catheters. VGLB ablation was performed circumferentially beginning at the 12 o'clock position and continued clockwise or counterclockwise. PVIs obtained within the bounds of the first half of the circumferential lesion (≤ 180°) were defined as "early PVIs." RESULTS: "Early PVIs" were documented in real time for 39% (80/204) of the PVs and at a significantly greater frequency among lower PVs than upper PVs (60.1% vs. 17.6%; p < 0.0001). The PV sleeve length, PV diameter, and isolation of ipsilateral PVs within a semicircular lesion set were identified as predictors of an "early PVI" phenomenon. The amount of energy delivered to the lower PVs was significantly less than that to the upper PVs (5553 [5089-6188] vs. 3559 [2793-4380] J; p < 0.0001), but the incidence of narrowing of the lower PVs at 6 months was comparable to that of the upper PVs (p = 0.73). CONCLUSION: Our study revealed electrical isolations of more than 60% of the lower PVs while creating the first half of the circumferential lesions. Crosstalk via the carina region was presumably involved due to the preceding upper PVI. Further study is needed to determine whether energy delivery adjustments are needed for lower PVs to avoid chronic narrowing.

Evaluating the Differences Between Fluorescein Tear Break-up Time and Noninvasive Measurement Techniques.

OBJECTIVES: To compare fluorescein tear break-up time (BUT) and noninvasive BUT measured using interferometry and corneal topography. METHODS: We investigated 34 eyes of 34 patients with dry eye (mean age 39.2±8.3 years) and 16 eyes of 16 non-dry eye subjects (33.5±6.5 years). Tear film stability was measured using fluorescein BUT, noninvasive BUT (NIBUT)-DR1 with an interferometer, and noninvasive keratographic BUT (NIKBUT)-first and average using corneal topography. Correlations between fluorescein BUT and noninvasive BUT parameters were determined statistically. The noninvasive BUTs were compared between the dry eye and non-dry eye groups. The agreement between fluorescein and noninvasive BUTs was described using Bland-Altman analysis. RESULTS: Fluorescein BUT was significantly correlated with NIBUT-DR1, NIKBUT-first, and NIKBUT-average. The Bland-Altman analysis revealed bias and 95% limits of agreement between fluorescein BUT and noninvasive BUTs as follows: NIBUT-DR1: 2.07 s, -5.33 to 9.46 s; NIKBUT-first: 3.39 s, -5.46 to 12.24 s; NIKBUT-average: 6.61 s, -1.58 to 14.79 s. The noninvasive BUTs were significantly different between the two groups. When NIBUT-DR1, NIKBUT-first, and NIKBUT-average with Bland-Altman correction were used as an index for dry eye, the cut-off values were 7.1, 8.4, and 11.6 s, respectively. The sensitivities were 0.735, 0.818, and 0.727 and specificities were 0.500, 0.437, and 0.562, respectively. CONCLUSION: Fluorescein BUT and noninvasive BUTs were significantly correlated, and noninvasive BUTs had higher values than fluorescein BUT. Considering the differences between fluorescein BUT and noninvasive BUTs, noninvasive methods can be used as effective tool for diagnosing dry eye.

Comparison of phrenic nerve injury and its effect on the extrapulmonary vein structures with cryoballoon and hot-balloon ablation systems: considering the lesion created on the superior vena cava as a surrogate marker.

Preventing phrenic nerve injury (PNI) during balloon-based ablation is essential. The superior vena cava-right atrial (SVC-RA) junction is located just opposite the balloon position during right superior pulmonary vein (RSPV) ablation, and the phrenic nerve runs nearby on the lateral side. We compared the occurrence of PNI between the two balloon-based ablation systems and also the lesions created at the SVC-RA junction, which were expected to represent the effect on extra-PV structures. Cryoballoon ablation (CBA, n = 110) and hot-balloon ablation (HBA, n = 90) were performed in atrial fibrillation patients. High-density maps of the SVC-RA junction were created in 93 patients (CBA = 53, HBA = 40), and the damaged area (< 1.0 mV) was determined as an "SVC lesion". CBA had a higher occurrence of transient PNI (7.3% vs 1.1%, p = 0.035), but all recovered during the 6-month follow-up. An apparent SVC lesion was documented in 43% of the patients (40/93), and all patients with PNI had this lesion. CBA created a frequent (CBA vs HBA = 55% vs 28%, p = 0.008) and wider (0.8[0.4-1.7] cm2 vs 0.5[0.3-0.7] cm2, p = 0.005) SVC lesion than HBA. A multivariate analysis revealed that the use of a CBA system was a predictive factor of the occurrence of SVC lesions. CBA had a higher occurrence of transient PNI but not a permanent form. Every patient with PNI had lesions on the SVC-RA junction, and CBA revealed more substantial ablation effects at the SVC-RA junction than HBA. This may be caused by the different characteristics of the two balloon-based ablation systems and their balloon positions.

Metrics of high cofluctuation and entropy to describe control of cardiac function in the stellate ganglion.

Stellate ganglia within the intrathoracic cardiac control system receive and integrate central, peripheral, and cardiopulmonary information to produce postganglionic cardiac sympathetic inputs. Pathological anatomical and structural remodeling occurs within the neurons of the stellate ganglion (SG) in the setting of heart failure (HF). A large proportion of SG neurons function as interneurons whose networking capabilities are largely unknown. Current therapies are limited to targeting sympathetic activity at the cardiac level or surgical interventions such as stellectomy, to treat HF. Future therapies that target the SG will require understanding of their networking capabilities to modify any pathological remodeling. We observe SG networking by examining cofluctuation and specificity of SG networked activity to cardiac cycle phases. We investigate network processing of cardiopulmonary transduction by SG neuronal populations in porcine with chronic pacing-induced HF and control subjects during extended in-vivo extracellular microelectrode recordings. We find that information processing and cardiac control in chronic HF by the SG, relative to controls, exhibits: (i) more frequent, short-lived, high magnitude cofluctuations, (ii) greater variation in neural specificity to cardiac cycles, and (iii) neural network activity and cardiac control linkage that depends on disease state and cofluctuation magnitude.

Prevalence of Myopia and Its Associated Factors Among Japanese Preschool Children.

Purpose: To investigate the prevalence of myopia and factors associated with spherical equivalent (SE), axial length (AL), and axial length to corneal radius of curvature (AL/CR) ratio among Japanese preschool children. Study Design: Prospective observational study. Methods: This cross-sectional study evaluated subjects aged 4-6 years from a preschool. Non-cycloplegic autorefraction was measured using the Spot Vision Screener, while AL and corneal radius (CR) were measured using the Myopia Master. Parental myopia and environmental factors were investigated using the myopia-related factor questionnaire. The worse eye with higher myopic SE was chosen for analysis, and multiple linear regression models was performed using AL, SE, and AL/CR ratio as dependent variables. Results: A total of 457 out of 514 participants (239 males, 52.3%) aged 4-6 years (mean 4.77 ± 0.65 years) were included. The mean SE was 0.13 ± 0.63 D, AL was 22.35 ± 0.67 mm, CR was 7.76 ± 0.25 mm, and AL/CR ratio was 2.88 ± 0.72. The overall prevalence of myopia and high myopia were 2.9 and 0.2%, respectively. Multiple regression analysis showed that myopic SE was significantly associated with male sex (ß = -0.14, p = 0.02) and parental myopia (ß = -0.15, p = 0.04). Meanwhile, longer AL was significantly associated with older age (ß = 0.13, p = 0.02), male sex (ß = 0.44, p < 0.001), parental myopia (ß = 0.24, p = 0.01), and screen time (including smartphones, tablets, and computers) (>1 h, ß = 0.14, p = 0.04). A higher AL/CR was significantly associated with older age (ß = 0.02, p < 0.001), male sex (ß = 0.03, p < 0.001), ratio and parental myopia (ß = 0.03, p = 0.02). Conclusion: The prevalence of myopia and high myopia were 2.9 and 0.2%, respectively, among Japanese preschool children in 2021. Longer AL was associated with older age, male sex, parental myopia, and screen time in children aged 4-6 years. Children with a high risk of myopia can be identified early based on parental myopia information for early prevention.

Efficacy and Safety of the Long-Acting Diquafosol Ophthalmic Solution DE-089C in Patients with Dry Eye: A Randomized, Double-Masked, Placebo-Controlled Phase 3 Study.

INTRODUCTION: DE-089C is a newly developed long-acting formulation of diquafosol ophthalmic solution with less frequent administration (three times daily) than the currently approved and clinically used diquafosol ophthalmic solution (six times daily), hereinafter referred to as DQS. DE-089C is desirable for achieving better patient adherence in clinical practice for dry eye therapy. The objective of this study was to confirm the efficacy and safety of DE-089C in patients with dry eye compared to placebo. METHODS: This randomized, multicenter, double-masked, placebo-controlled, parallel-group phase 3 study was conducted in Japan. Patients with aqueous-deficient dry eye satisfying Schirmer's test I results ≤ 5 mm/5 min were included. A total of 337 patients with dry eye were randomized in an equal ratio to treatment with DE-089C or placebo ophthalmic solution, three times daily for 4 weeks. The primary endpoint for efficacy was change in fluorescein corneal staining score from baseline to week 4. The incidence of adverse drug reactions was investigated for safety evaluation. RESULTS: The background characteristics of patients in the two groups were similar. Primary endpoint of change in fluorescein corneal staining score at week 4 in the DE-089C group was significantly improved compared with the placebo group (least squares mean difference - 0.51, 95% CI - 0.754 to - 0.269, P < 0.0001). The secondary endpoint of the Lissamine green conjunctival staining score was also significantly improved in the DE-089C group compared to that in the placebo group, while other secondary endpoints were not achieved in this study. Commonly (incidence ≥ 1%) reported adverse drug reactions in the DE-089C group were eye irritation (3.6%) and eye discharge (1.8%) with mild severity, and the incidences of these two events were not higher than those in previous clinical studies on DQS. CONCLUSION: The efficacy and safety of DE-089C administered three times daily at half the dosage of DQS in patients with dry eye were confirmed in this study. TRIAL REGISTRATION: Japan Pharmaceutical Information Center ID, JapicCTI-205177.