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Koki Sakata, Takeshi Katsumoto, Tomoyuki Kumagai, Kei Shinoda Department of Ophthalmology, Saitama Medical University, Saitama, JapanCorrespondence: Kei Shinoda, Department of Ophthalmology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan, Tel +81-4-9276-1250, Fax +81-4-9295-8002, Email shinok@saitama-med.ac.jpPurpose: To determine whether 0.025% povidone-iodine (0.025% PI) in the irrigation solution during vitrectomy for endophthalmitis is safe.Methods: Two cases of bleb-associated endophthalmitis were treated with vitrectomy using 0.025% PI in the irrigation solution. The RETevel electroretinographic (ERG) system with skin electrodes was used to assess the physiology of the retina pre- and postoperatively.Case: Case 1 was a 46-year-old man who had atopic keratoconjunctivitis and underwent trabeculectomy with the creation of a bleb after there was a rise in the intraocular pressure. One month postoperatively, a mild filtering bleb-associated endophthalmitis developed, and the eye was treated with intravitreal and subconjunctival injections of vancomycin (VCM) and ceftazidime (CAZ). After three days, the fundus was not visible and B-mode echography showed an area of high brightness in the retina. Vitrectomy with irrigation with VCM and CAZ, and 0.025% PI was performed successfully. Pre- and postoperative ERGs showed an improvement in both the a- and b-wave amplitudes and the b/a ratio was stable at 2.0. Case 2 was a 63-year-old man who had undergone trabeculectomy for glaucoma. Five years later, the eye developed blebitis which was treated with topical and subconjunctival injections of VCM and CAZ. Three days later, vitreous opacities appeared and a high brightness area was seen in the B-mode echographic images. Vitrectomy with VCM and CAZ, and 0.025% PI irrigation was successfully performed. Comparisons of the pre- and postoperative ERGs found that the a- and b- wave amplitudes of the ERGs increased and the b/a ratio was stable at approximately 1.5.Conclusion: Vitrectomy with 0.025% PI irrigation is safe and ERG recordings with skin electrodes can be used to evaluate the pre- and postoperative retinal physiology safely.Plain Language Summary: We report our findings in two cases of bleb-related endophthalmitis that underwent pars plana vitrectomy (PPV) with irrigation with 0.025% povidone-iodine (PI)-Balanced Salt Solution (BSS) PLUS (Alcon Laboratories, Fort Worth, TX). The retinal function was evaluated by full-field electroretinograms (ERGs) recorded with skin electrodes before and after the vitrectomy.At present, there is no consensus on whether patients with bleb-related endophthalmitis should be treated with PPV or treated solely by intravitreal antibiotics. It was recently reported that vitrectomy using an irrigation solution containing 0.025% PI followed by postoperative antibiotics was effective and safe for the treatment of endogenous endophthalmitis and postoperative endophthalmitis. However, iodine is known to be retinotoxic depending on its concentration.Electroretinography is a useful method to evaluate the safety of medications because it represents the physiology of the entire retina. However, conventional recording procedures with contact lens electrodes cannot be used in eyes with bleb associated endophthalmitis. Therefore, we performed ERG using skin electrodes which were introduced relatively recently. As a result, electroretinographic response showed that retinal function was not altered after surgery in these two cases.Keywords: blebitis, electroretinography, bleb-related endophthalmitis, povidone iodine irrigation, vitrectomy

Azusa Ueda,1,2 Satoshi Kasagi,2 Ken-ichi Maeno,2,3 Ryo Naito,4– 6 Takiko Kumagai,1,2 Yuka Kimura,1,2 Mitsue Kato,1,2,4 Fusae Kawana,1,2,4 Yasuhiro Tomita,2,5,6 Koji Narui,2,4 Takatoshi Kasai2,4– 6 1Clinical Physiology, Toranomon Hospital, Tokyo, Japan; 2Department of Sleep Respiratory Medicine, Toranomon Hospital, Tokyo, Japan; 3Department of Cardiovascular Medicine, Japanese Red Cross Ise Hospital, Mie, Japan; 4Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; 5Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; 6Sleep and Sleep Disordered Breathing Center, Juntendo University Hospital, Tokyo, JapanCorrespondence: Satoshi KasagiSleep Respiratory Medicine, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan, Tel +81-3-3588-1111, Fax +81-3-3560-7815, Email s-kasagi@toranomon.gr.jpAim: Prolonged P-wave duration (PWD), which indicates atrial conduction delay, is a potent precursor of atrial fibrillation (AF) that may be induced by obstructive sleep apnea (OSA). The cardio-ankle vascular index (CAVI), which is an arterial stiffness parameter, is elevated in patients with OSA; moreover, an increased CAVI is associated with atrial conduction delay through left atrium enlargement in association with left ventricular diastolic dysfunction. We aimed to examine the relationship between the CAVI and PWD in patients with OSA.Methods: We included patients with a sinus rhythm who underwent overnight polysomnography. We measured the PWD and CAVI on standard 12-lead electrocardiograms; further, we analyzed the relationship between PWD and CAVI.Results: We analyzed data from 300 participants (men, 89.0%; mean age, 52.3 ± 13.1 years; and body mass index, 26.2 ± 3.9 kg/m2). The mean PWD was 104.4 ± 10.4 ms while the mean CAVI was 7.5 ± 1.5. PWD was significantly correlated with CAVI (r = 0.478, p < 0.001); additionally, PWD and CAVI were directly associated with OSA severity (p = 0.002 and p = 0.002, respectively). Multivariate regression analysis revealed an independent significant correlation of PWD and CAVI with OSA severity.Conclusion: In patients with OSA, an increase in arterial stiffness is associated with atrial conduction delay.Keywords: atrial fibrillation, cardio-ankle vascular index, obstructive sleep apnea, P-wave duration

Wataru Inami, Masayuki Shibuya, Tomoyuki Kumagai, Jun Makita, Kei Shinoda Department of Ophthalmology, Saitama Medical University Faculty of Medicine, Saitama, JapanCorrespondence: Kei Shinoda, Department of Ophthalmology, Saitama Medical University Faculty of Medicine, Saitama, Japan, Tel +81-49-276-1250, Email shinodak@med.teikyo-u.ac.jpAbstract: Although intraocular lymphoma (IOL) mainly has have vitreous opacity and subretinal infiltration, its clinical symptoms are diverse. We report a case of IOL that mainly showed exudative retinal detachment in which analysis of IgH gene rearrangement (AIGHR) of the collected subretinal fluid sample was useful for diagnosis. A 77-year-old woman developed decreased left visual acuity for 1 month. She had been treated for dermatomyositis, diabetes mellitus, and right parotid tumor for 3 years. Visual acuity was 0.1 OD and counting fingers OS. Slit-lamp examination showed grade 4 (Emery-Little classification) nuclear cataract in both eyes and keratoprecipitates and tan vitreous opacity in the left eye. Fundoscopy details were unclear except for a vaguely observable optic nerve head due to yellow-brown vitreous opacity, which we judged as an old vitreous hemorrhage. Phacovitrectomy was performed and almost total retinal detachment was found, except for a part of the superior periphery. Since no retinal break was found and a wide range of thin membrane-like tissue was found on the surface of the retina, the surgeon suspected primary IOL and performed unplanned biopsy. The peripheral vitreous was collected as a sample, and then the subretinal fluid was collected through an intentional break to prevent mixing with other fluids. The subretinal strand was gently removed and collected. Cytology showed class III, the IL10/IL6 ratio was low, and AIGHR was positive. Postoperatively, fundus autofluorescence showed no abnormality, no leakage was observed on fluorescein and indocyanine green angiography, and the location of typical infiltration lesions under the retina was unclear. There were no positive findings on systemic examinations and a diagnosis of primary IOL was made. The main symptoms of this case were vitreous opacity and exudative retinal detachment, and AIGHR using subretinal fluid was useful for diagnosis.Keywords: primary intraocular lymphoma, exudative retinal detachment, IgH gene rearrangement, pars plana vitrectomy

Hidehiro Sugisawa,1 Yumiko Shimizu,2 Tamaki Kumagai,3 Kanji Shishido,4 Toshio Shinoda5 1International Graduate School for Advanced Studies, J. F. Oberlin University, Machida-city, Tokyo, Japan; 2The Jikei University School of Nursing, Chofu-city, Tokyo, Japan; 3Graduate School of Health Sciences at Odawara, International University of Health and Welfare, Odawara-city, Kanagawa, Japan; 4Kawasaki Clinic, Kawasaki-city, Kanagawa, Japan; 5Faculty of Medical and Health Sciences, Tsukuba International University, Tsuchiura-city, Ibaraki, JapanCorrespondence: Hidehiro Sugisawa, International Graduate School for Advanced Studies, J. F. Oberlin University, 3758, Machida-city, Tokyo, 194-0294, Japan, Tel/Fax +81(0)02-797-9847, Email sugisawa@obirin.ac.jpPurpose: This study analyzed the influence of financial strains over the life course before initiating hemodialysis on the health outcomes of older Japanese patients. This study was limited to financial strains over the life course before initiating hemodialysis to eliminate the influence of financial strains resulting from resignation from paid jobs. We examined which of the four life course models—pathway, latent, social mobility, and accumulation—were appropriate to describe the influences of financial strains over the life course on older patients’ health.Patients and Methods: Data were obtained from a cross-sectional survey of 6,644 outpatients in dialysis facilities across Japan. We selected participants aged 60 years and older at the time of the survey. Numbers of dialysis complications, activities of daily living (ADL) disability, and depressive symptoms were selected as health outcomes. Benchmark periods over the life course were constructed in three parts: less than 18 years (childhood), 18– 35 years (young adults), and 35– 50 years (middle-aged). We retrospectively measured financial strains over the life course.Results: Pathway models best described the influence of financial strains over the life course on the three types of health outcomes. Experiences of financial strains as young adults had a direct influence on ADL disability of older patients. This result supports latent models. Social mobility models (upward and downward mobility) and accumulation models explained the number of dialysis complications, ADL disability, and depressive symptoms in older patients.Conclusion: These results suggest that socioeconomic disadvantages over the life course before initiating hemodialysis were significantly associated with health outcomes in older patients.Keywords: socioeconomic status over the life course, latent models, social mobility models, accumulation models, pathway models

Hidehiro Sugisawa,1 Toshio Shinoda,2 Yumiko Shimizu,3 Tamaki Kumagai,4 Hiroaki Sugisaki,5 Seiji Ohira6,† 1Department of Gerontology, Graduate School of Gerontology, J. F. Oberlin University, Tokyo, 2Department of Medical Care Technology, Faculty of Medical and Health Science, Tsukuba International University, Tsuchiura, 3Department of Community Health Nursing, The Jikei University School of Nursing, Chofu, 4Department of Fundamental Nursing, Graduate School of Nursing, Osaka City University, Osaka, 5Hachioji Azumacho Clinic, Hachioji, Tokyo, 6Sapporo Kita Clinic, Sapporo, Hokkai-do, Japan †Professor Dr. Seiji Ohira passed away on September 5, 2017 Background: This study aimed to investigate the levels of unmet needs for home and ­community-based services (HCBS) evaluated by case managers (CMs) among disabled patients on hemodialysis (DPHD) and to examine factors related to unmet needs. Unmet needs for HCBS were defined as situations in which patients do not use or underuse HCBS despite needing them. Candidates for the factors relating to unmet needs for HCBS included three dimensions: predisposing, enabling, and need factors.Methods: Self-administrated questionnaires were collected from 391 CMs of DPHD certified with long-term care insurance. These were introduced by the dialysis facilities that a member of the Japanese Association of Dialysis Physicians belonged to. CMs were asked questions about their management of each individual case. HCBS included home help, visiting nursing, daycare, and short stay.Results: The prevalence of unmet needs for each HCBS ranged from 32% for home help to 48% for short stay. Barriers to service usage in the patients were associated with unmet needs for all four services. The patients with more severe cognitive malfunction were more likely to have unmet needs for visiting nursing and short stay. Heavier burden with caregiving was associated with more likelihood of unmet needs for home help and short stay.Conclusion: CMs need to monitor unmet needs after coordinating HCBS for DPHD and need to encourage HBCS use among patients with impaired cognitive function and caregivers with heavier caregiving burdens. Keywords: disabled hemodialysis patients, long-term care, home and community-based services, Andersen’s behavioral model, barriers to service usage, Japan

Hidehiro Sugisawa,1 Yumiko Shimizu,2 Tamaki Kumagai,3 Hiroaki Sugisaki,4 Seiji Ohira,5 Toshio Shinoda6 1Graduate School of Gerontology, J.F. Oberlin University, Machida, 2Faculty of Nursing, The Jikei University School of Medicine, Chofu, 3School of Nursing, Osaka City University, Osaka, 4Hachioji Azumacho Clinic, Hachioji, 5Sapporo Kita Clinic, Sapporo, 6Kawakita General Hospital, Suginami, Japan Study purpose: Whether or not socioeconomic status (SES)-related differences in the health of hemodialysis patients differ by age, period, and birth cohort remains unclear. We examined whether SES-related gaps in physical and mental health change with age, period, and birth cohort for hemodialysis patients. Methods: Data were obtained from repeated cross-sectional surveys conducted in 1996, 2001, 2006, and 2011, with members of a national patients’ association as participants. We used raking adjustment to create a database which had similar characteristics to the total sample of dialysis patients in Japan. SES was assessed using family size-adjusted income levels. We divided patients into three groups based on their income levels: below the first quartile, over the second quartile and under the third quartile, and over the fourth quartile. We used the number of dialysis complications as a physical health indicator and depressive symptoms as a mental health indicator. We used a cross-classified random-effects model that estimated fixed effects of age categories and period as level-1 factors, and random effects of birth cohort as level-2 factors. Results: Relative risk of dialysis complications in respondents below the first quartile compared with ones over the fourth quartile was reduced in age categories >60 years. Mean differences in depressive symptoms between respondents below the first quartile and ones over the fourth quartile peaked in the 50- to 59-year-old age group, and were reduced in age groups >60 years. In addition, mean differences varied across periods, widening from 1996 to 2006. There were no significant birth cohort effects on income differences for dialysis complications or ­depressive symptoms. Conclusion: The number of dialysis complications and depressive symptoms in dialysis patients were affected by income differences, and the degree of these differences changed with age category and period. Keywords: complications, depressive symptoms, cross classified random effects model, income status, raking adjustment

Tropical vegetation is a major source of global land surface evapotranspiration, and can thus play a major role in global hydrological cycles and global atmospheric circulation. Accurate prediction of tropical evapotranspiration is critical to our understanding of these processes under changing climate. We examined the controls on evapotranspiration in tropical vegetation at 21 pan-tropical eddy covariance sites, conducted a comprehensive and systematic evaluation of 13 evapotranspiration models at these sites, and assessed the ability to scale up model estimates of evapotranspiration for the test region of Amazonia. Net radiation was the strongest determinant of evapotranspiration (mean evaporative fraction was 0.72) and explained 87% of the variance in monthly evapotranspiration across the sites. Vapor pressure deficit was the strongest residual predictor (14%), followed by normalized difference vegetation index (9%), precipitation (6%) and wind speed (4%). The radiation-based evapotranspiration models performed best overall for three reasons: (1) the vegetation was largely decoupled from atmospheric turbulent transfer (calculated from Ω decoupling factor), especially at the wetter sites; (2) the resistance-based models were hindered by difficulty in consistently characterizing canopy (and stomatal) resistance in the highly diverse vegetation; (3) the temperature-based models inadequately captured the variability in tropical evapotranspiration. We evaluated the potential to predict regional evapotranspiration for one test region: Amazonia. We estimated an Amazonia-wide evapotranspiration of 1370mmyr-1, but this value is dependent on assumptions about energy balance closure for the tropical eddy covariance sites; a lower value (1096mmyr-1) is considered in discussion on the use of flux data to validate and interpolate models. © 2009 The Authors Journal compilation © 2009 Blackwell Publishing Ltd.

In use of clayey soils for reclamation, the stability against slip and future consolidation settlement should be examined during and after reclamation. For these purposes, a practical reclamation management system has been developed based on three types of analysis: artificial intelligence (AI) estimation of soil properties such as compression index, consolidation coefficient and undrained shear strength, deposition shape analysis; and consolidation settlement analysis for clayey soils dumped from a hopper barge. The AI estimation of soil properties is characterized by use of a convolutional neural network (CNN) based on information such as soil source, wet density, and photographed image obtained before reclamation works. In this study, the validity of each analysis model has been verified on an actual reclamation project by use of measured data such as deposition shape of dumped soils on the seabed, soil properties in the reclaimed ground and consolidation settlement after reclamation and soil improvement. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: The population of the obese is increasing worldwide. Prevention and improvement of obesity are indispensable for decreasing the risk of metabolic disorders. We have recently shown that obesity and fatty liver are reduced by a plant-derived lactic acid bacterium, Pediococcus pentosaceus LP28 (LP28), in high-fat diet-induced obese mice. The aim of the present clinical study is to prove that LP28 is effective for reducing body fat and body weight, as shown in the experiment using mice. SUBJECTS/METHODS: The clinical trial was carried out as a double-blind, randomized, placebo-controlled study comprising 62 subjects (20-70 years of age, BMI 25-30 kg/[m.sup.2]). These subjects were randomly assigned to three groups that received living LP28, heat-killed LP28 or a placebo powder, administered orally once a day for 12 weeks. RESULTS: Heat-killed LP28 reduced BMI (0.45 kg/[m.sup.2], 95% CI (0.04, 0.86), P = 0.035), body fat percentage (1.11%, (0.39, 1.82), P = 0.002), body fat mass (1.17 kg (0.43, 1.92), P = 0.004) and waist circumference (2.84 cm (0.74, 4.93), P = 0.009) when compared with a placebo group. Fasting plasma glucose, HbA1c, fasting insulin, HOMA-IR and serum lipids levels did not change by either living LP28 or heat-killed LP28 intake. CONCLUSIONS: Heat-killed LP28 displays an antiobesity effect that reduces BMI, body fat and waist circumference, suggesting that the plant-derived lactic acid bacterium LP28 would be a promising preventive of metabolic syndrome. European Journal of Clinical Nutrition (2016) 70, 582-587; doi: 10.1038/ejcn.2016.17; published online 9 March 2016, INTRODUCTION The numbers of overweight and obese people are now increasing in advanced and emerging nations. The World Health Organization (WHO) indicates that obesity has nearly doubled worldwide since 1980, [...]