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Background: We have shown classical cardiac auscultation was superior to remote auscultation. We developed a phonocardiogram system to visualize sounds in remote auscultation., Objective: This study aimed to evaluate the effect of phonocardiograms on the diagnostic accuracy in remote auscultation using a cardiology patient simulator., Methods: In this open-label randomized controlled pilot trial, we randomly assigned physicians to the real-time remote auscultation group (control group) or the real-time remote auscultation with the phonocardiogram group (intervention group). Participants attended a training session in which they auscultated 15 sounds with the correct classification. After that, participants attended a test session where they had to classify 10 sounds. The control group auscultated the sounds remotely using an electronic stethoscope, an online medical program and a 4-K TV speaker without watching the TV screen. The intervention group performed auscultation like the control group but watched the phonocardiogram on the TV screen. The primary and secondary outcomes were the total test scores and each sound score, respectively., Results: A total of 24 participants were included. The total test score in the intervention group (80/120, 66.7%) was higher than that in the control group (66/120, 55.0%), although the difference was statistically insignificant ( P  = .06). The correct answer rates of each sound were not different. Valvular/irregular rhythm sounds were not misclassified as normal sounds in the intervention group., Conclusions: Using a phonocardiogram improved the total correct answer rate by more than 10% in remote auscultation, although statistically insignificant. The phonocardiogram could help physicians screen valvular/irregular rhythm sounds from normal sounds., Trial Registration: UMIN-CTR UMIN000045271; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000051710., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: The urgent need for telemedicine has become clear in the COVID-19 pandemic. To facilitate telemedicine, the development and improvement of remote examination systems are required. A system combining an electronic stethoscope and Bluetooth connectivity is a promising option for remote auscultation in clinics and hospitals. However, the utility of such systems remains unknown., Objective: This study was conducted to assess the utility of real-time auscultation using a Bluetooth-connected electronic stethoscope compared to that of classical auscultation, using lung and cardiology patient simulators., Methods: This was an open-label, randomized controlled trial including senior residents and faculty in the department of general internal medicine of a university hospital. The only exclusion criterion was a refusal to participate. This study consisted of 2 parts: lung auscultation and cardiac auscultation. Each part contained a tutorial session and a test session. All participants attended a tutorial session, in which they listened to 15 sounds on the simulator using a classic stethoscope and were told the correct classification. Thereafter, participants were randomly assigned to either the real-time remote auscultation group (intervention group) or the classical auscultation group (control group) for test sessions. In the test sessions, participants had to classify a series of 10 lung sounds and 10 cardiac sounds, depending on the study part. The intervention group listened to the sounds remotely using the electronic stethoscope, a Bluetooth transmitter, and a wireless, noise-canceling, stereo headset. The control group listened to the sounds directly using a traditional stethoscope. The primary outcome was the test score, and the secondary outcomes were the rates of correct answers for each sound., Results: In total, 20 participants were included. There were no differences in age, sex, and years from graduation between the 2 groups in each part. The overall test score of lung auscultation in the intervention group (80/110, 72.7%) was not different from that in the control group (71/90, 78.9%; P=.32). The only lung sound for which the correct answer rate differed between groups was that of pleural friction rubs (P=.03); it was lower in the intervention group (3/11, 27%) than in the control group (7/9, 78%). The overall test score for cardiac auscultation in the intervention group (50/60, 83.3%) was not different from that in the control group (119/140, 85.0%; P=.77). There was no cardiac sound for which the correct answer rate differed between groups., Conclusions: The utility of a real-time remote auscultation system using a Bluetooth-connected electronic stethoscope was comparable to that of direct auscultation using a classic stethoscope, except for classification of pleural friction rubs. This means that most of the real world's essential cardiopulmonary sounds could be classified by a real-time remote auscultation system using a Bluetooth-connected electronic stethoscope., Trial Registration: UMIN-CTR UMIN000040828; https://tinyurl.com/r24j2p6s and UMIN-CTR UMIN000041601; https://tinyurl.com/bsax3j5f., (©Takanobu Hirosawa, Yukinori Harada, Kohei Ikenoya, Shintaro Kakimoto, Yuki Aizawa, Taro Shimizu. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 27.07.2021.)

We herein report the findings of 2 cases of normotensive scleroderma renal crisis (SRC) that developed soon after the commencement of a glucocorticoid therapy. We also review 8 cases of normotensive SRC reported in Japan, including our cases. The common characteristics of these 8 cases are as follows: the recent onset of systemic sclerosis, the presence of diffuse skin sclerosis, the presence of myositis and/or serositis, a high titer of antinuclear antibody and positivity for anti-Scl-70 antibody. In 7 of the 8 patients, thrombotic microangiopathy developed within one month of starting the glucocorticoid treatment. We should be careful with the use of glucocorticoids in systemic sclerosis patients exhibiting these features in order to avoid cases of normotensive SRC.

Purpose: To study the functional changes in the macula of the retina in the early stage of retinitis pigmentosa (RP), by analyzing each component of the focal macular electroretinogram (fmERG)., Methods: fmERGs were recorded from 39 patients with RP with normal visual acuity (>1.0) under direct fundus observation using a modified infrared fundus camera and 5 degrees , 10 degrees , and 15 degrees stimulus spots. The amplitudes and implicit times of the a-wave, b-wave, and oscillatory potentials (OPs) in the patients with RP were compared to those from 30 age-similar normal control subjects., Results: The amplitudes of the different components of the fmERGs in patients with RP ranged from severely reduced to normal. The degree of amplitude reduction increased as the size of the stimulus spot increased in the patients with RP. The relative amplitudes of the OPs (67% of the mean in normal subjects) were better preserved than that of the b-wave (46%) and the a-wave (39%) in a 10 degrees spot in the patients with RP., Conclusions: The relative preservation of the OPs in the patients with RP could be due to either the buffering effect of the large receptive fields of the OP generators or to the retinal remodeling after the progressive loss of photoreceptors. Recordings of each component of fmERG can provide important information on the different layers of the central retina in RP eyes and can add to the understanding of the pathophysiology of RP.

Purpose: The photopic negative response (PhNR) is a negative component of the photopic electroretinogram (ERG) that is observed after the b-wave and is thought to originate mainly from the activity of ganglion cells and their axons. The purpose of this study was to determine whether there are subclinical functional changes in the inner retina after macular hole surgery, by recording the PhNR before and after surgery., Methods: In addition to the routine ophthalmic examinations, photopic ERGs were recorded in 16 eyes with an idiopathic macular hole, before and 3 months after surgery. Photopic ERGs were elicited by white Ganzfeld flashes on a rod-suppressing blue background. The amplitude of the PhNR and the a- and b-waves of the photopic ERGs before and after surgery were compared. PhNRs were also recorded in 14 eyes with epiretinal membrane, before and after surgery., Results: Macular holes were closed and visual acuities were improved without any serious complications in all eyes with a macular hole. The amplitude of the PhNR was significantly reduced after surgery (P < 0.05), whereas the amplitude of the photopic a- and b-waves were not significantly altered. For eyes with an epiretinal membrane, the mean amplitude of the PhNR was slightly decreased after the surgery, but the degree of reduction was only one half of that after macular hole surgery., Conclusions: These results suggest that there are some functional impairments in the inner retina after macular hole surgery, even though the patients did not show any reduction on subjective visual tests. The PhNR can be a useful clinical test to assess the inner retinal function objectively, before and after vitreoretinal surgery.