A case of WAGR syndrome in association with developmental glaucoma requiring bilateral Baerveldt glaucoma implants and subsequent tube repositioning

Glaucoma drainage device implantation is efficacious for the treatment of pediatric glaucoma patients when multiple angle surgeries fail. However, tube touching of the corneal endothelium is one of the major postoperative complications to deal with. A 15-month-old male patient with Wilms’ tumor, aniridia, genitourinary anomalies, and mental retardation (WAGR) syndrome was diagnosed with bilateral developmental glaucoma. He underwent Baerveldt glaucoma implant (BGI) surgeries in both eyes after multiple failed trabeculotomies. The tube in his right eye was touching the cornea 15 months after BGI surgery. To avoid corneal endothelium damage, BGI tube repositioning with scleral fixation was performed without serious complications. The bilateral BGI surgeries achieved successful intraocular pressure reduction for over 2 years and tube repositioning with scleral fixation of BGI tube was successful for BGI tube malposition. Although careful attention to intraocular pressure and tube malposition is essential after glaucoma drainage device implantation, especially in pediatric cases, BGI surgery is effective in the management of developmental glaucoma following unsuccessful angle surgeries

Higher prevalence of obstructive airway disease in patients with thoracic or abdominal aortic aneurysm

AbstractBackground and Aim: The risk factors of aortic aneurysm (AA) are comparable with those described for chronic obstructive pulmonary disease. This study was performed to determine whether patients with AA have a higher than average prevalence of obstructive airway disease. Methods: We performed pulmonary function tests in 240 consecutive patients (182 men and 58 women; age, 70 ± 10 years) with thoracic or abdominal AA. The results were compared with those in individuals without obvious cardiovascular disease (control) and in patients with coronary artery disease who were matched for age, gender, smoking status, and other atherosclerotic risk factors. Results: Patients in the AA group had a lower forced expiratory volume in 1 second/forced vital capacity (%) and carbon monoxide diffusing capacity (%/predicted value) than did the control group (P < .01). The proportion of patients with airway obstruction, defined as forced expiratory volume in 1 second/forced vital capacity of 70% or less, was higher in the AA group (100/240; 42%) than in the control (51/223; 23%) and coronary artery disease (43/238; 18%) groups. Multiple logistic regression analysis results revealed that the presence of an AA and male gender were associated with a higher risk of airway obstruction (odds ratio, 2.928; 95% CI, 1.722 to 4.979; and odds ratio, 1.622; 95% CI, 1.055 to 2.493, respectively). Conclusion: These data suggest that AA may be a risk factor indicative of the presence of chronic obstructive pulmonary disease. A higher prevalence of depressed pulmonary function should be suspected as a preoperative risk in presence of thoracic or abdominal AA as compared with other types of cardiovascular disorders. (J Vasc Surg 2002;36:35-40.

THE TRANSITON ABOUT TRAFFIC SYSTEM OF BICYCLES

本研究は，自転車の普及や法的整備の歴史から，道路通行システムにおける自転車の位置付けと通行実態の変遷を明らかにすることで，自転車の歩道通行の常態化や双方向通行の要因について一示唆を得ることを目指す．まず，各法制度の変遷から，1970年と1978年の道路交通法改正が自転車の位置付けの変化点であることを明らかにした．次に，1960年から1985年の自転車通行状況を写した写真や映像資料からデータベースを作成し自転車の道路通行実態の変遷を把握した結果，改正前は自転車の車道・左側走行が浸透していたが，1970年の道路交通法改正後に歩道走行が出現し，1978年の道路交通法改正後に車道走行が減少し歩道走行が増加したことがわかった．また，利用目的と道路交通法に基づいた道路通行システムやルールの曖昧さと周知不足が，自転車の歩道通行の常態化や双方向通行の要因である可能性を示唆した．The aim of this study is to understand the transition and the actual condition on the traffic system of bicycles by the spread of bicycles and the change of the legal system, in order to consider the factor that brought the current bicycle traffic situation. As a result, it is cleared that, as a transition about traffic system of bicycles, the revision of the Road Traffic Act in 1970 and 1978 became a point of change in the positioning of bicycles, and it brought the present bicycle traffic situation. To understand the actual condition of bicycle traffic system, a database was built from photograph and video materials during the perion of 1960 to 1985 . The actual condition of the traffic system of the bicycle, the bicycle roadway, bicycling on the left side had penetrated before the revised period, but from the beginning of revision period, bicycling on the sidewalk and on right side of the roadway had appeared. It was revealed that bicycling on the roadway decreased and on the sidewalk increased, as bicycling on the sidewalk was permitted in the second revised period. In addition, the authors suggested that the lack of understanding or discordance with the characteristics of bicyle as avehicle on the bicycle traffic system and rules based on the Road Traffic Act may be factors wich brought the bicycling on the sidewalk and two way running

肘の内外反変形に伴う尺骨神経の伸長度変化に関する生体力学的研究

Background: Cubital tunnel syndrome can be caused by overtraction and dynamic compression in elbow deformities. The extent to which elbow deformities contribute to ulnar nerve strain is unknown. Here, we investigated ulnar nerve strain caused by cubitus valgus/varus deformity using fresh-frozen cadavers. Methods: We used six fresh-frozen cadaver upper extremities. A strain gauge was placed on the ulnar nerve 2 cm proximal to the medial epicondyle of the humerus. For the elbow deformity model, osteotomy was performed at the distal humerus, and plate fixation was performed to create cubitus valgus/varus deformities (10°, 20°, and 30°). Ulnar nerve strain caused by elbow flexion (0–125°) was measured in both the normal and deformity models. The strains at different elbow flexion angles within each model were compared, and the strains at elbow extension and at maximum elbow flexion were compared between the normal model and each elbow deformity model. However, in the cubitus varus model, the ulnar nerve deflected more than the measurable range of the strain gauge; elbow flexion of 60° or more were considered effective values. Statistical analysis of the strain values was performed with Friedman test, followed by the Williams’ test (the Shirley‒Williams’ test for non-parametric analysis). Results: In all models, ulnar nerve strain increased significantly from elbow extension to maximal flexion (control: 13.2%; cubitus valgus 10°: 13.6%; cubitus valgus 20°: 13.5%; cubitus valgus 30°: 12.2%; cubitus varus 10°: 8.3%; cubitus varus 20°: 8.2%; cubitus varus 30°: 6.3%, P < 0.001). The control and cubitus valgus models had similar values, but the cubitus varus models revealed that this deformity caused ulnar nerve relaxation. Conclusions: Ulnar nerve strain significantly increased during elbow flexion. No significant increase in strain 2 cm proximal to the medial epicondyle was observed in the cubitus valgus model. Major changes may have been observed in the measurement behind the medial epicondyle. In the cubitus varus model, the ulnar nerve was relaxed during elbow extension, but this effect was reduced by elbow flexion.博士（医学）・甲第865号・令和5年3月15

How to evaluate science problem solving in a computerized learning environment? Construction of an analyzing scheme

Περιέχει το πλήρες κείμενοThis paper describes the construction of a ‘computerized science problem solving’ scheme, which enables analysis and evaluation of the effectiveness of science problem-solving by junior high-school students working in a computerized learning environment. The scheme was based on observations of 187 students as they solved qualitative science problems taken from a specific computerized learning environment. Students were also interviewed before and after the problem solving. The scheme is presented on two levels. The large-scale comprises 11 main categories, each sub-divided into sub-categories to yield the detailed-level. The sub-categories were based on a repertoire of activities found in the observation protocols, and were approved by external judgement and a validation process. The detailed-level scheme enables evaluation and statistical analysis of the participants' problem-solving effectiveness, providing substantial evidence for the construct validity of the scheme, and demonstrating its potential as a valid analyzing and evaluative tool for computerized science problem solving

Expansion of retinal nerve fiber bundle narrowing in glaucoma: An adaptive optics scanning laser ophthalmoscopy study

Purpose: To investigate longitudinal changes in the retinal nerve fiber bundle in eyes with primary open angle glaucoma using adaptive optics scanning laser ophthalmoscopy. Methods: A prospective observational case series. Fourteen eyes from 12 patients with primary open angle glaucoma that exhibited retinal nerve fiber layer defects on fundus photography were imaged with adaptive optics scanning laser ophthalmoscopy over time. Results: The expansion of retinal nerve fiber bundle narrowing was observed on adaptive optics scanning laser ophthalmoscopy in 8 eyes (57.1%) over a period of 1.44 ± 0.42 years. Retinal nerve fiber bundle narrowing expanded horizontally in 2 eyes and vertically in 6 eyes. In 3 eyes, changes in the retinal nerve fiber layer were only detectable on adaptive optics scanning laser ophthalmoscopy images. Conclusions and Importance: The expansion of retinal nerve fiber bundle narrowing was observed using adaptive optics scanning laser ophthalmoscopy. Accordingly, this tool may be a useful tool for detecting glaucoma-related changes in retinal nerve fibers in a short time

Calcium Phosphate Composition Affects Ureteroscopic Laser Lithotripsy

The effects of stone composition on transurethral lithotripsy (TUL) have not been sufficiently elucidated. The purpose of this study was to identify how calcium phosphate stone composition impacts TUL. Two hundred eighty-nine cases of semi-rigid and/or flexible TUL for upper urinary tract calculi were reviewed retrospectively. Inclusion criteria were a preoperative assessment by noncontrast computed tomography (NCCT) and a stone composition analysis. Small stones and those without calcium composition were excluded. Stone core radiodensity (SCR) was measured by taking the average of the upper 3 of 5 points in the proximity of the center of the stone on NCCT. Fifty-three patients with calcium phosphate composition (CaP) and 118 patients with calcium oxalate and without phosphate composition were eligible for analysis. SCR was significantly higher in the CaP group (p<0.01). The CaP patient group needed a significantly longer operation time (p=0.014) and more laser energy (p=0.085), and tended to have a lower rate of complete lithotripsy (p=0.096) and higher incidence of postoperative pyelonephritis (p=0.181). Stones containing calcium phosphate are harder, demand more laser energy, and require a longer operating time. NCCT evaluation can estimate stone composition preoperatively, and may be a useful tool for predicting operative outcomes