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Masaya Ogasawara,1 Masahiro Takeshima,1 Shumpei Kosaka,2 Aya Imanishi,1 Yu Itoh,1 Dai Fujiwara,1 Kazuhisa Yoshizawa,1 Norio Ozaki,3 Kazuyuki Nakagome,4 Kazuo Mishima1 1Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan; 2Department of Psychiatry, Akita Prefectural Center for Rehabilitation and Psychiatric Medicine, Daisen, Japan; 3Department of Pathophysiology of Mental Disorders, Nagoya University Graduate School of Medicine, Nagoya, Japan; 4Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, JapanCorrespondence: Kazuo Mishima, Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan, Tel +81-18-884-6122, Fax +81-18-884-6445, Email clocksclub@gmail.comPurpose: Sleep-tracking devices have performed well in recent studies that evaluated their use in healthy adults by comparing them with the gold standard sleep assessment technique, polysomnography (PSG). These devices have not been validated for use in patients with psychiatric disorders. Therefore, we tested the performance of three sleep-tracking devices against PSG in patients with psychiatric disorders.Patients and methods: In total, 52 patients (32 women; 48.1 ± 17.2 years, mean ± SD; 18 patients diagnosed with schizophrenia, 19 with depressive disorder, 3 with bipolar disorder, and 12 with sleep disorder cases) were tested in a sleep laboratory with PSG, along with portable electroencephalography (EEG) device (Sleepgraph), actigraphy (MTN-220/221) and consumer sleep-tracking device (Fitbit Sense).Results: Epoch-by-epoch sensitivity (for sleep) and specificity (for wake), respectively, were as follows: Sleepgraph (0.95, 0.76), Fitbit Sense (0.95, 0.45) and MTN-220/221 (0.93, 0.40). Portable EEG (Sleepgraph) had the best sleep stage-tracking performance. Sleep-wake summary metrics demonstrated lower performance on poor sleep (ice, shorter total sleep time, lower sleep efficiency, longer sleep latency, longer wake after sleep onset).Conclusion: Devices demonstrated similar sleep-wake detecting performance as compared with previous studies that evaluated sleep in healthy adults. Consumer sleep device may exhibit poor sleep stage-tracking performance in patients with psychiatric disorders due to factors that affect the sleep determination algorithm, such as changes in autonomic nervous system activity. However, Sleepgraph, a portable EEG device, demonstrated higher performance in mental disorders than the Fitbit Sense and actigraphy.Keywords: polysomnography, actigraphy, portable EEG, consumer sleep technologies, psychiatric patients

Kazuhisa Yoshizawa,1 Masahiro Takeshima,2 Sayaka Ishino,3 Masaya Ogasawara,2 Dai Fujiwara,2 Yu Itoh,2 Aya Imanishi,2 Hidenobu Ohta,2 Kazuo Mishima2 1Department of Psychiatry, Akita Prefectural Center for Rehabilitation and Psychiatric Medicine, Daisen City, Akita, 019-2492, Japan; 2Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita City, Akita, 010-8543, Japan; 3Department of Neuropsychiatry, Sugawara Hospital, Yurihonjo City, Akita, 015-0012, JapanCorrespondence: Masahiro TakeshimaDepartment of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita City, Akita, 010-8543, JapanTel +81-18-884-6122Fax +81-18-884-6445Email m.takeshima@med.akita-u.ac.jpPurpose: A major depressive episode is a risk factor for venous thromboembolism (VTE) in psychiatric inpatients. However, it is unclear whether the severity of depressive symptoms or duration of the current depressive episode is associated with VTE. Further, the VTE prevalence among hospitalized patients with a major depressive episode receiving electroconvulsive therapy is unknown. This retrospective study examined factors associated with VTE among hospitalized patients with a major depressive episode and estimated the prevalence of VTE in such patients who underwent electroconvulsive therapy.Patients and Methods: Patients with a major depressive episode hospitalized in the Department of Neuropsychiatry at Akita University Hospital between January 2018 and December 2020 were included. Data from the first week of hospitalization were extracted from medical records. VTE was diagnosed based on the findings of computed tomography. To evaluate whether the severity of depressive symptoms or duration of the current depressive episode was associated with VTE, logistic regression analysis was conducted after adjusting for covariates with known VTE risk factors (antidepressants, antipsychotics, and physical comorbidities).Results: We analyzed 133 patients; of these, 14 were diagnosed with asymptomatic VTE. The severity of depressive symptoms (odds ratio: 1.220, 95% confidence interval: 1.081– 1.377, p = 0.001) was significantly associated with VTE. The prevalence of VTE among those receiving electroconvulsive therapy was 35% (7/20).Conclusion: The prevalence of VTE was 35% among patients receiving in-hospital electroconvulsive therapy for a major depressive episode. VTE should be considered for hospitalized patients with severe depressive symptoms and patients receiving in-hospital electroconvulsive therapy for a major depressive episode.Keywords: bipolar depression, depressive symptoms, electroconvulsive therapy, unipolar depression, venous thromboembolism

Masahiro Takeshima,1 Hiroyasu Ishikawa,1 Masaya Ogasawara,1 Munehiro Komatsu,2 Dai Fujiwara,1 Yu Itoh,2 Yuki Wada,3 Yuki Omori,4 Hidenobu Ohta,1 Kazuo Mishima1 1Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan; 2Department of Neuropsychiatry, Akita City Hospital, Akita, Japan; 3Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan; 4Department of Neuropsychiatry, Tokyo Metropolitan Geriatric Hospital, Tokyo, JapanCorrespondence: Masahiro TakeshimaDepartment of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita City, Akita, 010-8543, JapanTel +81-18-884-6122Fax +81-18-884-6445Email m.takeshima@med.akita-u.ac.jpPurpose: D-dimer has the advantage of excluding venous thromboembolism (VTE) due to its high sensitivity but is disadvantageous for diagnosing VTE due to its low specificity. A method to increase the usefulness of D-dimer in the diagnosis of VTE is warranted. This study aimed to investigate the usefulness of the combination of D-dimer and soluble fibrin monomer complex (SFMC), which has been suggested as a new candidate marker for VTE, in VTE diagnosis.Patients and Methods: This prospective study in 109 subjects was performed at a psychiatric department between August 1, 2017 and December 31, 2019. Subjects’ levels of D-dimer and SFMC were measured simultaneously. Plasma levels of D-dimer and SFMC were measured using NANOPIA® D-dimer and NANOPIA® SF. Subjects with positive D-dimer (≥ 1.0 μg/mL) results underwent contrast computed tomography for confirmation of VTE within 12 hours of D-dimer measurement. A receiver operating characteristic curve analysis was performed to examine the usefulness of SFMC for the diagnosis of VTE.Results: Only 109 of the 783 subjects without symptoms suggestive of VTE participated in the study. Out of 41 subjects with positive D-dimer results, 17 subjects were diagnosed with VTE. A receiver operating characteristic curve analysis was performed to determine cutoff values. The area under the curves was 0.848 for SFMC (p< 0.001, 95% CI 0.722 to 0.974), and the optimal cutoff value was 10.0 μg/mL (sensitivity 58.8%, specificity 100%, positive predictive value 100%, negative predictive value 77.4%).Conclusion: SFMC was useful for diagnosing VTE in the psychiatric patients with positive D-dimer results.Keywords: computed tomography, D-dimer, psychiatric patients, soluble fibrin monomer complex, venous thromboembolism

Hideto Sagara,1,2 Tetsuju Sekiryu,2 Hiroki Noji,2 Masashi Ogasawara,2 Kimihiro Imaizumi,2 Keiko Yago31The Marui Eye Clinic, Minamisoma, 2Department of Ophthalmology, School of Medicine, Fukushima Medical University. 3Northern Fukushima Medical Center, Fukushima, JapanAbstract: We present the case of a 47-year-old man who had bilateral proliferative diabetic retinopathy and neovascular glaucoma. Schirmer I test revealed tear secretions of 5 mm and 3 mm in the right and left eyes, respectively. Tear breakup times in the right and left eyes were 7 and 8 seconds, respectively. The ocular surface staining in both eyes was scored as Grade 1 as per the Oxford scheme. Retinal photocoagulation was performed for correction of the proliferative diabetic retinopathy and rubeosis iridis, which resolved with treatment. However, the intraocular pressure in the left eye could not be adequately controlled. Therefore, trabeculectomy with mitomycin C using limbal-based conjunctival flap was performed. Three hours after the surgery, the patient developed a large and diffuse filtering bleb, but no leakage occurred from the conjunctival scar. However, on the first postoperative day, leakage was noted and the conjunctiva was at the leakage point. The leakage resolved transiently, but recurred the next day. Severe keratoconjunctival epithelial failure was detected, and the patient was administrated 0.1% sodium hyaluronate eye drops six times daily. The epithelial failure improved, and many microcysts were detected on the bleb surface where the epithelial failure improved. The leakage resolved 2 days after initiation of the sodium hyaluronate eye drops. The microcysts disappeared and the bleb surface became smooth 1 month later.Keywords: trabeculectomy, bleb, bleb leak, microcyst, sodium hyaluronate

Hideto Sagara,1,2 Tomohiro Iida,2,3 Kimimori Saito,4 Hiroki Noji,2 Masashi Ogasawara,2 Hiroshi Oyamada21The Marui Eye Clinic, Fukushima, 2Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, 3Tokyo Women's Medical University, Tokyo, 4Matuki Eye Clinic, Fukushima, JapanBackground: Sodium hyaluronate and autologous serum eye drops are used to treat ocular surface disease (OSD) and are reported to prevent and treat late-onset bleb leaks following trabeculectomy with mitomycin C. In this study, we evaluated the efficacy of a combination of sodium hyaluronate and autologous serum eye drops and treatment for obstructive meibomian gland dysfunction as a therapy for late-onset bleb leaks after trabeculectomy with mitomycin C.Methods: This was a retrospective, interventional, nonsimultaneous study of 12 subjects (12 eyes) of mean age of 64.3 ± 18.3 years with OSD and apparent late-onset bleb leaks following trabeculectomy with mitomycin C between 1998 and 2008. We compared patients diagnosed with leakages before July 2005, who had been treated with separate eye drop solutions containing 0.1% sodium hyaluronate, 50% autologous serum, and 0.3% ofloxacin (sodium hyaluronate and autologous serum group, n = 7), with patients diagnosed from August 2005 to December 2008, who were treated with a combination of eye drops (0.1% sodium hyaluronate, 50% autologous serum, and 0.08% levofloxacin hydrate) and eyelid massage and warm compresses for obstructive meibomian gland dysfunction (combination eye drop group, n = 5).Results: Leakage was resolved in one patient (14.3%) in the separately treated sodium hyaluronate and autologous serum eye drop group and in five patients (100%) in the combination eye drop group (P = 0.015). The period after resolution of leakage with conservative treatment was 23 months in the one eye in the sodium hyaluronate and autologous serum group and 36–61 (mean 52.4 ± 10.1) months in the five eyes in the combination eye drop group.Conclusion: Late-onset bleb leaks following trabeculectomy with mitomycin C can be treated effectively using a combination of sodium hyaluronate and autologous serum eye drops, eyelid massage, and warm compresses. Furthermore, combining eye drops may improve patient adherence to the drug regimen by decreasing the frequency of administration.Keywords: ocular surface disease, bleb leak, trabeculectomy, sodium hyaluronate, autologous serum, meibomian gland dysfunction

Hypokalemic periodic paralysis (HPP) is a rare neuromuscular disease characterized by periodic attacks of acute muscle weakness concomitant with low serum potassium. To date, only one variant in the ATP1A2 , which encodes the α2 subunit of the Na+/K+ ATPase and is abundantly expressed in skeletal muscle and brain astrocytes, has been reported to cause primary HPP along with intellectual disability. The previous case did not present distinct pathological abnormalities. In this report, we describe a case of HPP in a child, highlighting unique pathological findings. Case presentation: The case is a 3-year-old girl. She had weak sucking ability and poor weight gain after birth. She had mild hypotonia, motor developmental delay and intellectual disability. The proximal muscles of her extremities showed atrophy and mild weakness, and Gowers' sign and gait disturbance were observed. She had no facial muscle involvement or joint contractures. From the age of 2 years and 2 months, she started to experience flaccid paralytic attacks every 4-5 days. The laboratory examination revealed hypokalemia during the attacks. Non-ictal potassium was normal and creatinine kinase was elevated at 200-600 U/L. Genetic analysis revealed a heterozygous variant c.2336G>A (p.S779N) of ATP1A2 , which is the same variant previously reported to cause HPP with intellectual disability. Muscle biopsy showed marked fiber size variation, scattered necrotic and regenerating fibers, increased internal nuclei and vacuoles. Interestingly, tubular aggregate like deposits were seen at the margins of the myofibers. Additionally, electron microscopy revealed severely fragmented nuclei with condensed chromatin, collapsed nuclear membrane, and nucleophagy. This case is the second report of ATP1A2 variant in HPP. The pathological findings, in particular nuclear abnormalities are remarkable, expanding the clinicopathological phenotype associated with ATP1A2 variant. [ABSTRACT FROM AUTHOR]

Autosomal recessive mutations in NEB cause a congenital myopathy typically with nemaline bodies, but the genotype-phenotype correlation in NEB -RM is not well understood. To investigate the genotype-phenotype relationships and clinicopathological characteristics in NEB -RM. We reviewed our database from congenital myopathy patients with two or more NEB variants and analyzed their clinicopathological features. We identified 85 patients with NEB -RM. We found two predominant variants: 31 patients had c.21522+3A>G and 35 had c.24684G>C. Importantly, none were homozygous or compound heterozygous for these variants. All patients with either variant also had additional truncating mutations. Notably, a healthy individual was found to be homozygous for c.24684G>C, suggesting these mutations might be mildly pathogenic. Therefore, we categorized 85 NEB -RM patients into three groups based on their genetic profiles: Group 1 with c.21522+3A>G (31 patients), Group 2 with c.24684G>C (35 patients), and Group 3 with two truncating mutations (19 patients). Group 1 and 2 typically developed symptoms after 1 year (27/31 and 27/35, respectively), whereas Group 3 presented with early-onset disease (<1 year in 15/19, p<0.0001). Respiratory involvements were more common in Group 2 (53% vs. 13% in Group 1, p=0.004), and facial muscle weakness was more prominent in Group 1 (68% vs. 31% in Group 2, p=0.01). Pathologically, nemaline bodies were less frequent in Group 1 (<25% in 7/15 patients, p=0.02) but were abundant in Group 3 (>75% in 6/11, p=0.06). Additionally, nemaline bodies are often scattered in muscle fibers in Group 1 (12/15, p=0.008) while they were often clustered at subsarcolemmal region in Group 2 (9/13, p=0.008). This study is the first to show genotype-phenotype correlations in NEB -RM, identifying two mildly pathogenic variants in Japanese patients with distinct clinicopathological features. [ABSTRACT FROM AUTHOR]