Predicting the Extent of Damage in the Humphrey Field Analyzer 24-2 Visual Fields Using 10-2 Test Results in Patients With Advanced Glaucoma.

Purpose: To predict Humphrey Field Analyzer 24-2 test (HFA 24-2) results using 10-2 results. Methods: A total of 175 advanced glaucoma eyes (175 patients) with HFA 24-2 mean deviation (MD24-2) of < -20 dB were prospectively followed up for five years using HFA 10-2 and 24-2 (twice and once in a year, respectively). Using all the HFA 24-2 and 10-2 test result pairs measured within three months (350 pairs from 85 eyes, training dataset), a formula to predict HFA 24-2 result using HFA 10-2 results was constructed using least absolute shrinkage and selection operator regression (LASSO). Using 90 different eyes (testing dataset), the absolute differences between the actual and LASSO-predicted MD24-2 and that between the slopes calculated using five actual and LASSO-predicted MD24-2 values, were adopted as the prediction error. Similar analyses were performed for the mean total deviation values (mTD) of the superior (or inferior) hemifield [hemi-mTDsup.24-2(-hemi-mTDinf.24-2)]. Results: The prediction error for the LASSO-predicted MD24-2 and its slope were 2.98 (standard deviation [SD] = 1.90) dB and 0.32 (0.33) dB/yr, respectively. The LASSO-predicted hemi-mTDsup.24-2 (hemi-mTDinf.24-2), and its slope were 3.02 (2.89) and 3.76 (2.72) dB, and 0.37 (0.41) and 0.44 (0.38) dB/year, respectively. These prediction errors were within two times SD of repeatability of the simulated stable HFA 24-2 VF parameter series. Conclusions: HFA 24-2 results could be predicted using the paired HFA 10-2 results with reasonable accuracy using LASSO in patients with advanced glaucoma. Translational Relevance: It is useful to predict HFA24-2 test from HFA10-2 test, when the former is not available, in advanced glaucoma.

Identifying central 10° visual subfield associated with future worsening of visual acuity in eyes with advanced glaucoma.

BACKGROUND/AIMS: To determine a cluster of test points: visual subfield (VSF) of Humphrey Field Analyzer 10-2 test (HFA 10-2) of which baseline sensitivities were associated with future worsening of visual acuity (VA) in eyes with advanced glaucoma. METHODS: A total of 175 advanced glaucoma eyes of 175 advanced glaucoma patients with well controlled intraocular pressure (IOP), a mean deviation of the Humphrey Field Analyzer 24-2 (HFA 24-2) test ≤ -20 decibels and best corrected VA ≥20/40, were included. At baseline, HFA 24-2 and HFA 10-2 tests were performed along with VA measurements. All patients underwent prospective follow-up of 5 years, and VA was measured every 6 months. The Cox proportional hazards model was used to identify visual field sensitivities associated with deterioration of VA and also blindness. RESULTS: Deterioration of VA and blindness were observed in 15.4% and 3.4% of the eyes, respectively. More negative total deviation (TD) values in the temporal papillomacular bundle VSF were significantly associated with deterioration in VA. Averages of the TD values in this area of the HFA 10-2 test had the most predictive power of future VA deterioration (OR: 0.92, p<0.001). A very similar tendency was observed for blindness. CONCLUSION: In advanced glaucoma eyes with well-controlled IOP, careful attention is needed when the mean TD values in the temporal papillomacular bundle VSF, measured with a HFA 10-2 test is deteriorated. TD values of this VSF indicate higher risks for future deterioration of VA and also blindness.

Factors Threatening Central Visual Function of Patients with Advanced Glaucoma: A Prospective Longitudinal Observational Study.

PURPOSE: To identify risk factors for further deterioration of central visual function in advanced glaucoma eyes. DESIGN: Prospective, observational 5-year study. PARTICIPANTS: Advanced glaucoma patients with well-controlled intraocular pressure (IOP), mean deviation (MD) of the Humphrey Field Analyzer (HFA) 24-2 program ≤-20 dB and best-corrected visual acuity (BCVA) of 20/40. METHODS: The HFA 10-2 test and BCVA examination were performed every 6 months, and the HFA 24-2 test was performed every 12 months for 5 years. The Cox proportional hazards model was used to identify risk factors for deterioration of HFA 10-2 and 24-2 results and BCVA. MAIN OUTCOME MEASURES: Deterioration of HFA 10-2 results was defined by the presence of the same ≥3 points with negative total deviation slope ≤-1 dB/year at P < 0.01 on ≥3 consecutive tests, deterioration of HFA 24-2 results by an increase ≥2 in the Advanced Glaucoma Intervention Study score on ≥2 consecutive tests, and deterioration of BCVA by an increase of ≥0.2 logarithm of the minimum angle of resolution (logMAR) on ≥2 consecutive tests. RESULTS: A total of 175 eyes of 175 patients (mean age, 64.1 years; mean baseline IOP, 13.2 mmHg; mean BCVA, 0.02 logMAR; mean HFA 24-2 and 10-2 MD, -25.9 and -22.9 dB, respectively) were included. The probabilities of deterioration in HFA 10-2 and 24-2 results and BCVA were 0.269 ± 0.043 (standard error), 0.173 ± 0.031, and 0.194 ± 0.033, respectively, at 5 years. Lower BCVA at baseline (P = 0.012) was associated significantly with further deterioration of HFA 10-2 results. Better HFA 24-2 MD (P < 0.001) and use of systemic antihypertensive agents (P = 0.009) were associated significantly with further deterioration of HFA 24-2 results, and a greater ß-peripapillary atrophy area-to-disc area ratio (P < 0.001), use of systemic antihypertensive agents (P = 0.025), and lower BCVA (P = 0.042) were associated significantly with further deterioration of BCVA, respectively. CONCLUSIONS: In advanced glaucoma eyes with well-controlled IOP, BCVA, ß-peripapillary atrophy area-to-disc area ratio, and use of systemic antihypertensive agents were significant prognostic factors for further deterioration of central visual function.

Radiocesium concentrations in invertebrates and their environmental media at two distances from the Fukushima Dai-ichi Nuclear Power Plant during 3-6 years after the 2011 accident.

Activity concentrations of the radioactive cesium (134Cs and 137Cs) were investigated in invertebrates at two sites of moderately high and higher air radiation dose rates, 14 km and 11 km distances, respectively, from the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) from 2013 to 2016. At a14-km point, the 134+137Cs concentrations of soils in coniferous and broadleaf forests increased from 2013 to 2014, and thereafter declined until 2016. The 134+137Cs concentrations of the phytophagous beetle Anomala cuprea (Hope) rapidly decreased by 76.1% from 2013 to 2014, reflecting reduction in those of broadleaves. The 134+137Cs concentration levels of the carnivorous beetle Dolichus halensis (Schaller) showed a relatively low levels. The 137Cs concentrations of the necrophagous beetle Eusilpha japonica (Motshulsky) and coprophagous beetle Onthophagus lenzii (Harold) remained constant without reduction from 2013 to 2016. Average 134+137Cs concentrations throughout four years were the highest in the geophagous crustacean (Armadillidium vulgare Latreille), followed by necrophagous beetle and coprophagus beetle. The 134+137Cs concentrations in earthworms with gut contents were significantly correlated with those in soils at each habitat from 2014 to 2015 at a14-km point, and the concentration levels at an 11-km point in 2015 were remarkably high (898 kBq kg-1). Transfer factors (TFs) in earthworms ranged from 1.02 to 2.66 at a 14-km point and 0.66 to 5.0 at an11-km point. The transfer and chronological changes of radiocesium in invertebrates were discussed in relation to food habits through trophic levels in woodlands and pasturelands.

Predicting Humphrey 10-2 visual field from 24-2 visual field in eyes with advanced glaucoma.

AIMS: To predict Humphrey Field Analyzer Central 10-2 Swedish Interactive Threshold Algorithm-Standard test (HFA 10-2) results (Carl Zeiss Meditec, San Leandro, CA) from HFA 24-2 results of the same eyes with advanced glaucoma. METHODS: Training and testing HFA 24-2 and 10-2 data sets, respectively, consisted of 175 eyes (175 patients) and 44 eyes (44 patients) with open advanced glaucoma (mean deviation of HFA 24-2 ≤-20 dB). Using the training data set, the 68 total deviation (TD) values of the HFA 10-2 test points were predicted from those of the innermost 16 HFA 24-2 test points in the same eye, using image processing or various machine learning methods including bilinear interpolation (IP) as a standard for comparison. The absolute prediction error (PredError) was calculated by applying each method to the testing data set. RESULTS: The mean (SD) test-retest variability of the HFA 10-2 results in the testing data set was 2.1±1.0 dB, while the IP method yielded a PredError of 5.0±1.7 dB. Among the methods tested, support vector regression (SVR) provided a smallest PredError (4.0±1.5 dB). SVR predicted retinal sensitivity at HFA 10-2 test points in the preserved 'central isle' of advanced glaucoma from HFA 24-2 results of the same eye within an error range of about 25%, while error range was approximately twice of the test-retest variability. CONCLUSION: Applying SVR to HFA 24-2 results allowed us to predict TD values at HFA 10-2 test points of the same eye with advanced glaucoma with an error range of about 25%.

Construction of Two Box-Like Head-and-Face Shields by Japanese Origami Folding for Use During the COVID-19 Pandemic.

A worldwide shortage of personal protective equipment during the COVID-19 pandemic has led to the development of new alternatives. We introduce two new disposable box-like head-and-face shields constructed using Japanese origami-style folding. The design comprises a single sheet of thick paper and a shield made of a thin, transparent plastic sheet. The first design, Model 1, is a head-and-face shield designed to cover the wearer's head and neck. Model 2 was designed to solve the problem of heat and moisture buildup inside the shield. This version can be used as face shields for patients, and it allows clinicians to collect swabs from the nasopharynx for virus detection via polymerase chain reaction through pre-cut incisions near the nasal orifices. These two new box-like face shields are excellent alternatives to traditional face shields because of the low cost, compatibility with mass production, lightweight, and disposability.

Relationship between Vision-Related Quality of Life and Central 10° of the Binocular Integrated Visual Field in Advanced Glaucoma.

To investigate the relationships between sensitivity loss in various subfields of the central 10° of the binocular integrated visual field (IVF) and vision-related quality of life (VRQoL) in 172 patients with advanced glaucoma. Using the Random Forest algorithm, which controls for inter-correlations among various subfields of the IVF, we analysed the relationships among the Rasch analysis-derived person ability index (RADPAI), age, best-corrected visual acuity (BCVA), mean total deviations (mTDs) of eight quadrant subfields in the IVF measured with the Humphrey Field Analyzer (HFA) 10-2 program (10-2 IVF), and mTDs of the upper/lower hemifields in the IVF measured with the HFA 24-2 program (24-2 IVF). Significant contributors to RADPAIs were as follows: the inner and outer lower-right quadrants of the 10-2 IVF contributed to the dining and total tasks; the lower-left quadrant of the 10-2 IVF contributed to the walking, going out and total tasks; the lower hemifield of the 24-2 IVF contributed to the walking, going out, dining, miscellaneous and total tasks; and BCVA contributed more to the letter, sentence, dressing and miscellaneous tasks than to others. The impact of damage in different 10-2 IVF subfields differed significantly across daily tasks in patients with advanced glaucoma.

Development of a novel noninvasive system for measurement and imaging of the arterial phase oxygen density ratio in the retinal microcirculation.

PURPOSE: This study was conducted in order to develop a novel noninvasive system for measurement and imaging of the arterial oxygen density ratio (ODR) in the retinal microcirculation. METHODS: We developed a system composed of two digital cameras with two different filters, which were attached to a fundus camera capable of simultaneously obtaining two images. Actual measurements were performed on healthy volunteer eyes (n = 61). A new algorithm for ODR measurement and pixel-level imaging of erythrocytes was constructed from these data. The algorithm was based on the morphological closing operation and the line convergence index filter. For system calibration, we compared and verified the ODR values in arterioles and venules that were specified in advance for 56 eyes with reproducibility. In 10 additional volunteers, ODR measurements and imaging of the arterial phase in the retinal microcirculation corresponding to changes in oxygen saturation of the peripheral arteries at normal breathing and breath holding were performed. RESULTS: Estimation of incident light to erythrocytes and pixel-level ODR calculation were achieved using the algorithm. The mean ODR values of arterioles and venules were 0.77 ± 0.060 and 1.02 ± 0.067, respectively. It was possible to separate these regions, calibrate at the pixel level, and estimate the arterial phase. In each of the 10 volunteers, changes in the arterial phase ODR corresponding to changes in oxygen saturation of the peripheral arteries were observed before and after breath holding on ODR images. The mean ODR in 10 volunteers was increased by breath holding (p < 0.05). CONCLUSIONS: We developed a basic system for arterial phase ODR measurement and imaging of the retinal microcirculation. With further validation and development, this may provide a useful tool for evaluating retinal oxygen metabolism in the retinal microcirculation.

Population-based cross-sectional study on insulin resistance and insulin-secretory capacity in Japanese school children.

AIMS/INTRODUCTION: Little information is available regarding the status of insulin resistance (IR) and insulin deficiency (ID), as well as their relationship with obesity in children using the homeostasis model assessment (HOMA) in a population-based setting. MATERIALS AND METHODS: The study included a total of 445 ninth-grade children participating in health check-up programs implemented in Tsunan Town, Niigata, Japan (boys/girls, 252/193 [participation rates: 98.1/95.5%]). HOMA of insulin resistance ≥2.5 was defined as IR, and HOMA of ß-cell function <40 defined as ID. RESULTS: The medians (25-75th percentiles) of HOMA of insulin resistance, HOMA of ß-cell function, Disposition Index and body mass index in boys were 1.2 (0.8-1.7), 64 (44-93), 52 (43-64) and 19.2 (18.0-20.7) kg/m2 , respectively, vs 1.5 (1.0-2.0), 86 (63-120), 60 (50-74) and 20.4 (18.9-22.0) kg/m2 , respectively, in girls. The HOMA of insulin resistance, HOMA of ß-cell function and Disposition Index values were significantly higher in the girls (P = 0.002, P < 0.001 and P < 0.001, respectively). Those with IR accounted for a significantly higher proportion of girls than boys (15.5/8.7%; P = 0.027); those with obesity accounted for 9.9/10.7% (boys/girls); and those with IR and obesity accounted for 2.4/4.7%. Those with ID accounted for a significantly higher proportion of boys than girls (20.6/8.8%; P = 0.001), whereas those with ID and obesity accounted for a very small proportion of either group (0.4/0.5%). CONCLUSIONS: The presence of IR was higher among the girls. In contrast, ID was more frequent among the boys. The infrequent presence of ID among children might support the presence of non-obese type 2 diabetes adults in Japan.

Infectious disease during hospitalization is the major causative factor for prolonged hospitalization: multivariate analysis of diagnosis procedure combination (DPC) data of 20,876 cases in Japan.

This study aimed to evaluate causative factors for prolonged hospitalization based on hospitalization status, type of hospital ward, and comorbidities, specifically diabetes mellitus and infectious diseases, in 20,876 patients hospitalized in Saga University Hospital from April 1, 2012, to February 28, 2015. Prolonged hospitalization was defined as hospital days exceeding period 3 in the diagnosis procedure combination system. Among all factors, causative (risk) factors for prolonged hospitalization were evaluated by multiple logistic regression analysis. Multivariate analysis indicated causative factors for prolonged hospitalization were aging, comorbid diabetes mellitus, time spent in the intensive care unit, and infectious diseases contracted during hospitalization. The risk factors for contracting infectious diseases during hospitalization were aging, male sex, comorbid diabetes mellitus, and increased number of days spent in period 3 in the diagnosis procedure combination code. These data indicated that critical factors for discharge from hospital within an appropriate time frame were prevention of infectious diseases during hospitalization, and a fast and effective therapeutic approach to patients in the intensive care unit.

Feasibility of using gelatin-microbial transglutaminase complex to repair experimental retinal detachment in rabbit eyes.

BACKGROUND: To investigate the effect of using gelatin-microbial transglutaminase (gelatin-mTG) complex for treating experimental retinal detachment. METHODS: Vitrectomy with artificial posterior vitreous detachment (PVD) followed by induction of a retinal tear and detachment was performed in rabbit eyes. Gelatin-mTG complex or gelatin alone (control) was placed on the retinal tears. Fundus examination using optical coherence tomography (OCT) was performed after the surgery. Vitrectomy with PVD alone was also performed in additional rabbits. After application of the gelatin-mTG complex on the normal retinal surface, the electroretinogram (ERG) was measured 7 days after surgery. RESULTS: Gelatin-mTG complex covered the retinal tear for more than 7 days after the vitrectomy, with less prominent inflammation. Reattachment of the retina occurred in all treated eyes. In contrast, massive fibrin materials were observed at 1 day after the surgery in the control group. In addition, OCT showed that all of the gelatin disappeared by day 3. Local retinal detachment remained in three of the eyes. As demonstrated by the ERG, gelatin-mTG complex had no harmful effects on retinal function. CONCLUSIONS: The results indicate that gelatin-mTG complex continues to adhere and seal retinal tears for at least several days after administration without any inflammatory reaction.

Observation of peripheral retina by topical endoscopic imaging method-a preliminary study.

INTRODUCTION: This study evaluated the usefulness of rigid endoscopy placed on the corneal surface to observe the peripheral retina. METHODS: The authors studied 15 eyes in 15 patients (12 men, 3 women; mean age 55.9 years; range 22-74 years) that underwent vitreous surgery at the Department of Ophthalmology at Saga University Hospital. With patients in a supine position, after topical anesthesia, an eye cup was placed between the eyelids and filled with hydroxyethyl cellulose solution and physiologic saline. With a rigid endoscope placed near the corneal surface, the target areas were then observed and recorded. The usefulness of rigid endoscopy to observe the peripheral retina was evaluated based on differences due to lens status and pupil size. RESULTS: In seven aphakic eyes, irrespective of pupil size, the peripheral retina could be observed up to the entire ora serrata (all quadrants). In eight eyes implanted with an intraocular lens, the observable area changed with pupil size and anterior capsulorrhexis size. CONCLUSION: This technique using rigid endoscopy was simple to manipulate and useful for observing and recording the peripheral retina. In particular, in aphakic eyes, irrespective of pupil size, the retina could be observed to the ora serrata.

Neuroprotective effect of small interfering RNA targeted to caspase-3 on rat retinal ganglion cell loss induced by ischemia and reperfusion injury.

PURPOSE: To investigate neuroprotective effects of siRNA targeted to caspase-3 against ischemia and reperfusion (I/R) injury in rat eyes. METHODS: Retinal ischemia was induced in Wistar rats by increasing the intraocular pressure (IOP) to 110 mmHg for 120 min. To examine the effect of siRNA on rat caspase-3, siRNA was injected into the vitreous cavity 24 h prior to induction of retinal ischemia. Eyes were removed at 2, 7 or 14 days later, and then analyzed for the number of retinal ganglion cells (RGCs), the retinal thickness and the amount of apoptosis of the retinal neural cells (as demonstrated by the TUNEL assay). The amount of caspase-3 mRNA was analyzed by rt-PCR. Differences between groups were evaluated by an unpaired t test. RESULTS: The numbers of RGCs in the saline and non-silencing siRNA controls were reduced significantly at 2 and 7 days after the I/R injury. RGCs were significantly retained in eyes pretreated with siRNA targeted to caspase-3 as compared to the control eyes at 2 days after the I/R injury. Inner retinal thickness in the control eyes was significantly thinner as compared to the treated eyes at 2 and 7 days after the I/R injury. After siRNA treatment, the amount of caspase-3 mRNA was significantly lower when compared to the saline control group. CONCLUSIONS: The injection of siRNA targeted to caspase-3 into the vitreous cavity of rat eyes may block caspase-3, and may thus be able to prevent retinal cell death associated with ischemic injury. As inhibition of the apoptosis pathway may provide a neuroprotective effect, examination of new strategies for treating these disorders needs to be undertaken.

Changes in choriocapillaris fenestration of rat eyes after intravitreal bevacizumab injection.

BACKGROUND: To examine the effects of anti-VEGF antibody (bevacizumab) on the number of fenestrations in rat choriocapillaris. METHODS: Twenty-four eyes from 24 male Wister rats were injected intravitreally with 0.125 mg of bevacizumab. The rats were perfusion fixated at 1, 3, 7, 14 or 28 days after injection. The surfaces of the choriocapillaris on the RPE side were observed using scanning electron microscopy. Four eyes treated with human IgG were used as controls. The area sieve plate and the number of fenestrations after the bevacizumab injection were measured and compared with controls. RESULTS: In the controls, the sieve plate area was 80.7% of the total choriocapillaris area. The number of fenestrations was 69.2 +/- 0.2 /microm(2) of the fenestrated area. While there were no changes in the fenestrated area for any of the time points after the bevacizumab treatment, the number of fenestrations was significantly reduced to 52.9 +/- 4.4 at day 1, 55.6 +/- 3.6 at day 3 and 53.6 +/- 8.6 /microm(2) of the luminal surface at day 7 (ANOVA, p < 0.05). CONCLUSIONS: In this study, intravitreal bevacizumab injection reduced fenestration of the normal choriocapillaris. These results indicate there is a latent risk inherent with bevacizumab treatment of normal choriocapillaris.

Low prevalence of metabolic syndrome and its components in rural Japan.

Tsunan, Niigata is a non-westernized rural Japanese town, known for heavy snowfalls and as a rice-producing area, whose inhabitants have a long life expectancy. We investigated the prevalence of obesity, metabolic syndrome (MetS) and its components in Tsunan. A total of 1,155 men and women, 40-69 years of age were recruited from participants in the 2005 public-health program in Tsunan. Obesity was defined as body-mass index (BMI) >or= 25 kg/m(2). MetS was defined as BMI >or= 25 kg/m(2) as well as at least two of the following three items: (1) high glycosylated hemoglobin (HbA1c >or= 5.5%); (2) high blood pressure (HBP: systolic blood pressure >or= 130 mmHg or diastolic blood pressure >or= 85 mmHg), and (3) low high-density lipoprotein cholesterol (HDL-C < 40 mg/dL). If an individual was diagnosed with diabetes, hypertension, or dyslipidemia, each item was recorded as a positive finding. The prevalence of MetS and its components among Tsunan inhabitants were compared to the results of the 2005 Japanese nationwide survey. The prevalence of MetS was 4.6% in males and 4.2% in females. The prevalence of obesity, high HbA1c, HBP, and low HDL-C were 22.1/22.2%, 13.4/16.4%, 46.6/40.0%, and 9.2/3.9% in males/females, respectively. All values were significantly lower than the national results, except for the rate of female obesity. The lower prevalence of MetS and its components in Tsunan may be due to the consumption of traditional Japanese food, which is still commonly eaten there, and the higher levels of regular physical activity of farmers.

Atrial pacing failure following termination of atrial fibrillation by acute administration of disopyramide phosphate.

Atrial pacing failure occurred after termination of atrial fibrillation by acute administration of disopyramide phosphate in a 71-year-old woman implanted with an AAI pacemaker for sick sinus syndrome. The atrial pacing threshold showed an 810% increase; however, the serum concentration of disopyramide corresponded to therapeutic level. Infusion of the same dose of disopyramide phosphate used during the period of atrial pacing rhythm did not increase the atrial pacing threshold. In the present patient, we supposed that atrial pacing failure did not occur by the effect of disopyramide alone, but rather was a reciprocal action in response to atrial fibrillation.

Various routes of septal propagation in common atrial flutter.

INTRODUCTION: Although in the treatment of common atrial flutter, the isthmus between the tricuspid valve annulus and the eustachian ridge is often chosen as the site for conduction block by radiofrequency ablation, the precise path of the flutter circuit remains unknown. We therefore investigated the propagation of the atrial flutter wave front around the coronary sinus ostium and how its path is altered by application of radiofrequency current. METHODS AND RESULTS: To assess activation pattern, activation in the region surrounding the coronary sinus ostium was mapped using a deflectable decapolar catheter under basal conditions and while applying radiofrequency current to the septal isthmus, between the tricuspid valve annulus and the eustachian ridge. In five of eleven patients studied, the eustachian ridge side, below the coronary sinus ostium, was activated earlier, and the flutter wave exited from either the tricuspid valve annulus side or the eustachian ridge side, above the coronary sinus ostium. In four patients, a partial line of block created by applying radiofrequency current between the tricuspid valve annulus and the coronary sinus ostium or between the coronary sinus ostium and the eustachian ridge led to a shift in the direction of propagation of the flutter wave front from anterior to posterior or from posterior to anterior of the coronary sinus ostium, and prolongation of the cycle length. CONCLUSION: Application of radiofrequency current to the septal isthmus, between the tricuspid valve annulus and the eustachian ridge, can shift both the anterior and posterior propagation of flutter around the coronary sinus ostium.