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Mitsuya Otsuka, Naoki Tojo, Hitoshi Yamazaki, Tomoko Ueda-Consolvo, Atsushi Hayashi Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, JapanCorrespondence: Atsushi Hayashi, Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan, Tel +81-76-434-7363, Fax +81-76-434-5037, Email ahayashi@med.u-toyama.ac.jpPurpose: We compared the corneal endothelial cell loss between trabeculectomy (Trab) and Ex-Press® surgery (EXP) for low-intraocular pressure (IOP) glaucoma patients.Patients and Methods: This was a single-facility retrospective study. We analyzed the cases of patients with primary open-angle glaucoma (POAG) and pre-operative IOP ≤ 21 mmHg who had undergone Trab or EXP surgery and were followed for > 3 years. Noncontact specular microscopy was used to determine the corneal endothelial cell density (CED) before and after Trab or EXP surgery. We measured the CED at 12, 24, and 36 months post-surgery. We compared the CED values and CED survival ratio after both surgeries using paired t-tests.Results: We included 39 eyes that underwent Trab and 36 eyes that underwent EXP surgery. In the Trab group, the mean CED value had decreased from 2333 ± 399 at baseline to 2066 ± 587 cells/mm2 after 3 years. In the EXP group, the mean CED value had decreased from 2320 ± 393 at baseline to 2229 ± 460 cells/mm2 after 3 years. The survival ratio of CED at > 3 years was 89.3 ± 14.2% (Trab group) and 95.6 ± 11.1% (EXP group); compared to the Trab surgery, the EXP surgery thus significantly decreased the CED loss (p = 0.037). No case resulted in bullous keratopathy.Conclusion: Compared to trabeculectomy, Ex-Press® surgery appears to be a safer surgical method with regard to the endothelial cell loss risk.Keywords: Ex-Press, glaucoma, corneal endothelial cell, trabeculectomy

Naoya Takeichi,1 Haruna Yamazaki,1 Keisaku Fujimoto21Department of Biomedical Laboratory Sciences, Graduate School of Medicine, Shinshu University, Matsumoto, Nagano, Japan; 2Department of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, Matsumoto, Nagano, JapanObjective: To examine whether the parameters of impedance measured by the broadband frequency forced oscillation technique (FOT) were reflected by changes in lung compliance induced by emphysema and fibrosis, we retrospectively compared the parameters of FOT and pulmonary functions, including static lung compliance (Cst), in obstructive lung disease (OLD) and interstitial lung disease (ILD).Patients and methods: The data of 18 patients with OLD (16 with COPD, two with asthma COPD overlap), 11 with ILD, and 24 healthy volunteers, whose respiratory impedance was measured using a MostGraph-01 and other pulmonary functions including Cst and lung resistance (RL) were measured on the same day and were retrospectively collected and compared.Results: The parameters of resistance, reactance, and resonant frequency showed good correlations with ventilation unevenness (r=0.63, −0.89, 0.77, respectively) and lung elastic resistance (r=0.59, −0.80, 0.73, respectively) in all groups (N=53). These indices were significant determinants of increased respiratory resistance and more negative shift of respiratory reactance (Xrs) at lower frequency (P

Keisaku Fujimoto,1 Haruna Yamazaki,2 Akikazu Uematsu2 1Department of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, Matsumoto, Nagano, Japan; 2Department of Biomedical Laboratory Sciences, Graduate School of Medicine, Shinshu University, Matsumoto, Nagano, Japan Objective/background: This study was performed to evaluate the association of nocturnal autonomic nerve (AN) dysfunction, especially parasympathetic nerve (PN) function instability, and nocturnal oxygen desaturation (NOD) in patients with chronic lung diseases (CLD).Patients and methods: Twenty-nine stable CLD patients with irreversible pulmonary dysfunction and mild-to-moderate daytime hypoxemia, 13 CLD patients receiving long-term oxygen therapy (LTOT) with maintained SpO2 >90%, and 17 senior healthy volunteers underwent two-night examinations of nocturnal AN function by pulse rate variability (PRV) instead of heart rate variation using a photoelectrical plethysmograph simultaneously monitoring SpO2 and the presence of sleep disordered breathing at home. AN function was examined by instantaneous time–frequency analysis of PRV using a complex demodulation method.Results: There were no significant differences in mean low frequency/high frequency (HF) ratio (index of sympathetic nerve activity) or mean HF amplitude (index of PN activity) among controls and CLD patients with and without NOD (defined as SpO2

Keisaku Fujimoto,1 Haruna Yamazaki,2 Midori Ura,2 Yoshiaki Kitaguchi3 1Department of Clinical Laboratory Sciences, School of Health Sciences, 2Department of Biomedical Laboratory Science, Graduate School of Medicine, 3First Department of Internal Medicine, School of Medicine, Shinshu University, Matsumoto, Japan Background and objective: The difference in efficacy of long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) for dynamic lung hyperinflation (DLH) in COPD is unclear. The purpose of this study was to elucidate the difference in efficacy of LAMA and LABA alone and the combination thereof for DLH. Subjects and methods: Thirty stable patients were enrolled and randomly divided into two groups following baseline measurements. One group was treated with 5 µg tiotropium (Respimat inhaler) for 4 weeks following a 4-week treatment with 150 µg indacaterol, while the other group was treated with indacaterol for 4 weeks following a 4-week treatment with tiotropium. For both groups, these treatments were followed by a combination of the two drugs for 4 weeks. Pulmonary function tests, including DLH evaluated by metronome-paced incremental hyperventilation and exercise tolerance evaluated by the shuttle-walk test, were performed at the end of each treatment period. Results: In total, 23 patients completed this study. Both tiotropium and indacaterol alone significantly increased forced expiratory volume in 1 second, exercise tolerance, and improved health status. Tiotropium significantly improved DLH, but indacaterol did not. The combination therapy resulted in further improvements in lung function and exercise tolerance, but not in DLH. Conclusion: The efficacy of tiotropium in inhibiting DLH following metronome-paced incremental hyperventilation may be superior to that of 150 µg indacaterol, although the effects on airflow obstruction were the same, and the combination therapy showed further improvement in airflow obstruction, but not in DLH. Keywords: bronchodilator agents, clinical respiratory medicine, COPD, respiratory function tests, quality of life

Yuzhu Chai1, Hiroko Yamazaki1, Akihide Kondo2, Toshiyuki Oshitari3, Shuichi Yamamoto31Department of Ophthalmology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, 2Department of Neurosurgery, Juntendo University, School of Medicine, Tokyo, 3Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, JapanAbstract: We present detailed ophthalmic findings in a case of tuberculum sellae meningioma with acute visual symptoms due to optic canal involvement. A 62-year-old Japanese woman reported a 1-week history of headaches and blurred vision in her left eye. Her visual acuity was 0.3 in the left eye with no ophthalmoscopic abnormalities. A relative afferent pupillary defect and inferior temporal field defect were found in the left eye. Pattern visual evoked potentials were undetectable in the left eye. Enhanced magnetic resonance imaging showed a 9 mm intracranial lesion around the left optic nerve anterior to the chiasm. She was diagnosed with granulomatous inflammation because of the increased cell counts and protein concentration in the cerebrospinal fluid. She was treated with steroid pulse therapy, and her visual acuity and visual field defect improved to normal in 3 weeks. However, 16 months after the onset, she suffered from headaches again and had a complete loss of vision in her left eye. There was no response to steroid pulse therapy. Enhanced magnetic resonance imaging revealed that the lesion had extended into the left optic canal, and emergency tumor removal surgery was carried out. The histopathological diagnosis was meningioma. One month after the surgery, her left visual acuity improved to 1.2, and her visual field was almost normal. Pattern visual evoked potentials were present but had a prolonged P100 latency of 170 ms. A thinning of the ganglion cell complex was detected by optical coherence tomography. Ophthalmologists should be aware that a small tuberculum sellae meningioma can cause acute visual symptoms due to optic canal involvement. Early consultation with a neurosurgeon is necessary. Visual evoked potentials and optical coherence tomography are sensitive and helpful in following patients with optic nerve compression.Keywords: optic nerve compression, tuberculum sellae meningioma, optic canal involvement, pattern visual evoked potentials, optical coherence tomography

Hajime Yamazaki, Junichi Nishiyama, Toshiyasu SuzukiDepartment of Anesthesiology, Surgical Science, Tokai University School of Medicine, Kanagawa, JapanBackground: Stellate ganglion block (SGB) is a widely used procedure for treatment of pain in the head and upper body, but the clinical signs used to verify the effectiveness of SGB can be ambiguous or variable in some patients. We observed the chronological changes in perfusion index (PI) from pulse oximetry to determine if these changes correlated with the clinical signs associated with an effective SGB. We hypothesized that PI could provide an easy method to assess the effectiveness of SGB.Method: We compared the chronologies in PI on the treated and untreated sides of 21 patients in whom treatment by SGB was found to be effective. The SGB was performed by administering 6 mL of 1% mepivacaine. The effectiveness of the SGB was confirmed on the basis of clinical signs. Additionally, in two patients we tested whether increased PI on the treatment side correlated with increased microcirculation as measured by laser-Doppler blood flowmetry.Results: On the side treated by SGB, PI increased 61.4% in the earlobe and 60.5% from baseline values in the upper limbs, at 5 minutes after initiation of the procedure. Differences in PI before and after treatment were significant at both sites. No time-course increases in PI were found on the untreated side at either site. Following SGB, increases in PI correlated with increases in blood flow as measured by laser-Doppler flowmetry.Conclusion: PI increased in the earlobe and upper limbs on the treated side of 21 patients who received an effective SGB but not on the untreated side. The positive correlations between changes in PI and both presence of clinical signs and changes in blood flow in the skin microcirculation indicate a sympatholytic effect, suggesting that the PI could be useful in determination of the efficacy of SGB.Keywords: stellate ganglion block, pulse oximetry, peripheral perfusion, perfusion index, skin microcirculation

Yuzhu Chai1, Hiroko Yamazaki1, Kaoru Fujinami2, Kazushige Tsunoda2, Shuichi Yamamoto31Department of Ophthalmology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan; 2National Institute of Sensory Organs, Tokyo, Japan; 3Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, JapanAbstract: Electrophysiological and morphological findings were studied in a case of acute zonal occult outer retinopathy (AZOOR) showing abnormal pattern visual evoked potentials (VEPs) at the onset and significant functional recovery in the natural course. A 21-year-old woman presented with acute onset of photopsia and a large scotoma in the right eye of 2 weeks duration. Her visual acuity was 20/20 in both eyes with no ophthalmoscopic and fluorescein angiographic abnormalities. However, a relative afferent pupillary defect and an enlarged blind spot were found in the right eye. The pattern VEPs were severely reduced when the right eye was stimulated. The amplitudes of both rod and cone full-field electroretinographics (ERGs) were reduced in the right eye. The amplitudes of the multifocal ERGs were reduced in the area of the enlarged blind spot. Irregularities in the inner segment/outer segment (IS/OS) line of the photoreceptors were observed over the nasal fovea by optical coherence tomography (OCT). The patient was followed without treatment. The enlarged blind spot disappeared in 3 months after the onset. At 5 months, reappearance of the IS/OS line was detected by OCT. At 6 months, the P100 recovered to normal values. At 1 year, the reduced full-field ERGs were almost normal size and the multifocal ERGs in the area corresponding to the enlarged blind spot were also improved. ERG findings are crucial for differentiating AZOOR from retrobulbar neuritis, especially in patients with abnormal pattern VEPs. The pattern VEPs, full-field ERGs, multifocal ERGs, and OCT images can be abnormal in the early phase of AZOOR, but they can all improve during the natural course.Keywords: AZOOR, pattern VEP, full-field ERG, multifocal ERG, OCT

Total cross section for the double neutral pion photoproduction off the proton is presented in the incident photon energy range of 0.58 to 1.15 GeV. The data were accumulated in the years 2009–2010, recorded by a 4π EM calorimeter at ELPH, named FOREST. The number of recorded events obtained during this period is 1.6×109 for a hydrogen target. Two neutral pions are reconstructed via detecting their decay products, four gammas (2π0 → 4γ). Compared to the previous results obtained by other groups, our data are in good agreement with theirs within error bars.

The photoproduction of K0 and Λ on the deuteron was measured in order to investigate the γn → K0Λ reaction process near the threshold (Eγ = 0.8-1.1 GeV). K0 and Λ events were clearly seen in the π+π− and the pπ− invariant mass spectra, respectively. The momentum spectra of the γd → K0X and the γd → ΛX reactions were derived. Additionally, the energy dependence of the integral cross section for the Λ production was also obtained. The K0 momentum spectra were in agreement with the previous results within statistical errors. The angular distribution of the γn → K0Λ reaction in the center of mass system was extracted and it had the backward distribution. The total cross section of the γn → K0Λ reaction, which was estimated by subtracting the contribution of K+Λ process from the Λ production on the deuteron, was almost the same as that of the γp → K+Λ.