園芸学部研究業績紹介(目次)

<p>Multivariable analysis to determine prognostic factors for surgical failure of 2^nd operated trabeculectomy using Cox proportional hazards regression models among the successful 1^st operated eyes.</p

第1084回千葉医学会例会・第21回千葉精神科集談会

<p>The comparison of the successful 2^nd operated eyes versus failed 2^nd operated eyes among successful 1^st operated eyes, Criterion C: n = 30.</p

Comparing Trabeculectomy Outcomes between First and Second Operated Eyes: A Multicenter Study.

OBJECTIVE:To compare surgical outcomes between the first and second operated eyes in patients who underwent trabeculectomy in both eyes. METHODS:This retrospective clinical cohort study at five clinical centers in Japan included 84 patients with open-angle glaucoma who underwent primary trabeculectomy in both eyes. The primary outcome was surgical success or failure, with failure being defined according to three criteria: 21 mmHg; Criterion B, IOP >18 mmHg; or Criterion C, IOP >15 mmHg. Cases of reoperation, a loss of light perception vision, or hypotony were also considered as "failures". RESULTS:There were no significant differences in success rate for any of the three criteria between the first and second operated eyes. For patients whose first trabeculectomy was successful, when the second trabeculectomy was performed ≥2 months after the first, the survival curves for all three criteria for the second trabeculectomy were significantly worse than those for patients waiting a shorter interval between trabeculectomies (Criterion A, 52.0% vs 83.6%, P = 0.0031; Criterion B, 51.5% vs 80.4%, P = 0.026; Criterion C, 51.1% vs 80.4%, P = 0.048). In multivariable analyses, a longer interval between trabeculectomies was a significant prognostic factor for surgical failure (Criterion A, P = 0.0055; Criterion B, P = 0.0023; Criterion C, P = 0.027). However, no dependency on the interval between trabeculectomies was found among patients whose first trabeculectomy failed. CONCLUSIONS:If the first trabeculectomy is successful, a long interval before the second trabeculectomy increases the risk of surgical failure in the second eye. This result has clinical implications for developing surgical strategies for patients with bilateral glaucoma

The transluminal attenuation gradient in coronary CT angiography

OBJECTIVE: Results of the use of the transluminal attenuation gradient (TAG) at coronary CT angiography (CCTA) to predict hemodynamically significant disease vary widely. This study tested whether diagnostic performance of TAG to predict fractional flow reserve (FFR) ≤ 0.8 is improved when applied separately to subsets of coronary arteries that carry similar physiological flow. METHODS: 28 patients with 64 × 0.5 mm CCTA and invasive FFR in ≥1 major coronary artery were retrospectively evaluated. Two readers assessed TAG in each artery. The receiver operating characteristic (ROC) area under the curve (AUC) was used to assess the diagnostic performance of TAG to detect hemodynamically significant disease following a clinical use rule [negative: FFR > 0.8 or ≤ 25% diameter stenosis (DS) at invasive catheter angiography; positive: FFR ≤ 0.8 or ≥ 90% DS at invasive catheter angiography]. ROC AUC was compared for all arteries pooled together, vs separately for arteries carrying similar physiological flow (Group 1: all left anterior descending plus right-dominant left circumflex; Group 2: right-dominant RCA plus left/co-dominant left circumflex). RESULTS: Of the 84 arteries, 30 had FFR measurements, 30 had ≤25% DS and 13 had ≥90% DS. 11 arteries with 26-89% DS and no FFR measurement were excluded. TAG interobserver reproducibility was excellent (Pearson r = 0.954, Bland-Altman bias: 0.224 Hounsfield unit cm). ROC AUC to detect hemodynamically significant disease was higher when considering arteries separately (Group 1 AUC = 0.841, p = 0.039; Group 2 AUC = 0.840, p = 0.188), than when pooling all arteries together (AUC = 0.661). CONCLUSION: Incorporating information on the physiology of coronary flow via the particular vessel interrogated and coronary dominance may improve the accuracy of TAG, a simple measurement that can be quickly performed at the time of CCTA interpretation to detect hemodynamically significant stenosis in individual coronary arteries. Advances in knowledge: The interpretation of TAG may benefit by incorporating information regarding which coronary artery is being interrogated

The transluminal attenuation gradient in coronary CT angiography for the detection of hemodynamically significant disease: can all arteries be treated equally?

OBJECTIVE:Results of the use of the transluminal attenuation gradient (TAG) at coronary CT angiography (CCTA) to predict hemodynamically significant disease vary widely. This study tested whether diagnostic performance of TAG to predict fractional flow reserve (FFR) ≤&nbsp;0.8 is improved when applied separately to subsets of coronary arteries that carry similar physiological flow. METHODS:28 patients with 64&nbsp;×&nbsp;0.5 mm CCTA and invasive FFR in ≥1 major coronary artery were retrospectively evaluated. Two readers assessed TAG in each artery. The receiver operating characteristic (ROC)&nbsp;area under the curve (AUC) was used to assess the diagnostic performance of TAG to detect hemodynamically significant disease following a clinical use rule [negative: FFR&nbsp;&gt;&nbsp;0.8 or ≤&nbsp;25% diameter stenosis (DS) at invasive catheter angiography; positive: FFR&nbsp;≤&nbsp;0.8 or ≥&nbsp;90% DS at invasive catheter angiography]. ROC AUC was compared for all arteries pooled together, vs separately for arteries carrying similar physiological flow (Group 1: all left anterior descending plus right-dominant left circumflex; Group 2: right-dominant RCA plus left/co-dominant left circumflex). RESULTS:Of the 84 arteries, 30 had FFR measurements, 30 had ≤25% DS and 13 had ≥90% DS. 11 arteries with 26-89% DS and no FFR measurement were excluded. TAG interobserver reproducibility was excellent (Pearson r&nbsp;=&nbsp;0.954, Bland-Altman bias: 0.224 Hounsfield unit&nbsp;cm-1). ROC AUC to detect hemodynamically significant disease was higher when considering arteries separately (Group 1 AUC&nbsp;=&nbsp;0.841, p&nbsp;=&nbsp;0.039; Group 2 AUC&nbsp;=&nbsp;0.840, p&nbsp;=&nbsp;0.188), than when pooling all arteries together (AUC&nbsp;=&nbsp;0.661). CONCLUSION:Incorporating information on the physiology of coronary flow via the particular vessel interrogated and coronary dominance may improve the accuracy of TAG, a simple measurement that can be quickly performed at the time of CCTA interpretation to detect hemodynamically significant stenosis in individual coronary arteries. Advances in knowledge: The interpretation of TAG may benefit by incorporating information regarding which coronary artery is being interrogated

Identification of Risk Factors for Coronary Artery Disease in Asymptomatic Patients with Type 2 Diabetes Mellitus

Background: Patients with diabetes mellitus (DM) are a high-risk group for coronary artery disease (CAD). In the present study, we investigated predictive factors to identify patients at high risk of CAD among asymptomatic patients with type 2 DM based on coronary computed tomographic angiography (CCTA) findings. Methods: A single-center prospective study was performed on 452 consecutive patients with type 2 DM who were provided with a weekly hospital-based diabetes education program between 3 October 2015, and 31 March 2020. A total of 161 consecutive asymptomatic patients (male/female: 111/50, age: 57.3 &plusmn; 9.3 years) with type 2 DM without any known CAD underwent CCTA. Based on conventional coronary risk factors and non-invasive examination, i.e., measurement of intima-media thickness, subcutaneous and visceral fat area, a stress electrocardiogram test, and the Agatston score, patients with obstructive CAD, CT-verified high-risk plaques (CT-HRP), and optimal revascularization within 90 days were evaluated. Results: Current smoking (OR, 4.069; 95% C.I., 1.578&ndash;10.493, p = 0.0037) and the Agatston score &ge;100 (OR, 18.034; 95% C.I., 6.337&ndash;51.324, p = 0.0001) were independent predictive factors for obstructive CAD, while current smoking (OR, 5.013; 95% C.I., 1.683&ndash;14.931, p = 0.0038) was an independent predictive factor for CT-HRP. Furthermore, insulin treatment (OR, 5.677; 95% C.I., 1.223&ndash;26.349, p = 0.0266) was the only predictive factor that correlated with optimal revascularization within 90 days. Conclusions: In asymptomatic patients with type 2 DM, current smoking, an Agatston score &ge;100, and insulin treatment were independent predictive factors of patients being at high-risk for CAD. However, non-invasive examinations except for Agatston score were not independent predictors of patients being at high risk of CAD