Influence of pterygium size on corneal higher-order aberration evaluated using anterior-segment optical coherence tomography

BackgroundThe prospective observation study aimed to evaluate changes in corneal higher-order aberrations induced by advancement of pterygium using an anterior-segment optical coherence tomography (AS-OCT) and Zernike aberration analysis.MethodsThe corneal topography of 284 eyes with primary pterygia originating from the nasal region was measured using an AS-OCT (SS-1000, Tomey). With anterior corneal elevation data, Zernike polynomial coefficients were calculated in diameters of 1.0, 3.0, and 5.0 mm, and the coma, spherical, coma-like, spherical-like, and total higher-order aberrations were obtained. Pterygium size was also measured as a ratio of positions of the pterygium end with respect to the corneal diameter and categorized in eight classes: less than 15%, 15–20%, 20–25%, 25–30%, 30–35%, 35–40%, 40–45, and 45% or larger. Increases in the aberrations were analyzed with reference to those in eyes with pterygium size < 15%.ResultsThe mean age of the participants was 69.3 years, and the pterygium size ranged from 2 to 57% (mean: 28.8%). The coma aberration significantly increased when the pterygium size was 45% or larger in 1.0 and 3.0 mm diameters and over 25–30% in 5.0 mm diameter. Similar increases were found in the pterygium sizes exceeding 45, 40, and 25%, respectively, in the coma-like, spherical-like, and total higher-order aberrations. On contrast, there was no increase in the spherical aberration.ConclusionIncreases in higher-order aberrations reflected the pterygium size, and significant aberrations were induced in 5.0 mm diameter when the end exceeded 25% of corneal diameter. The use of AS-OCT and Zernike analysis could enable objective grading of pterygium advancement based on changes in corneal optics

The presence of chronic diseases contributes to the occurrence risk factors for gynecological cancers in Japan

The aim of the present study was to determine whether chronic diseases (CD), such as hypertension, diabetes mellitus, dyslipidemia, heart diseases and cerebrovascular diseases, are occurrence risk factors and affect the survival of patients with gynecological cancers (GC). The correlations between CD and the characteristics and survival of 1,590 GC patients [685 with cervical cancer (CC), 613 with endometrial cancer (EM) and 292 with ovarian cancer (OV)] were investigated in the present study. Of the CD patients, 189 had CC (27.6%), 265 had EM (43.2%) and 72 had OV (24.7%). The incidence of CD increased with age in GC patients. The number of CD patients aged ≥70 years, was 8.6‑fold higher in the CC group, 3.0‑fold higher in the EM group, and 9.6‑fold higher in the OV group compared with those aged 24% of the occurrence risk factors in GC patients in Japan

Comparison Between the CASIA SS-1000 and Pentacam in Measuring Corneal Curvatures and Corneal Thickness Maps

PURPOSE: To compare the intra-device repeatability and inter-device reproducibility between two anterior segment imaging instruments, the CASIA SS-1000 (Tomey Corp., Nagoya, Japan) and Pentacam (OCULUS, Arlington, WA) in measuring anterior segment parameters. METHODS: Single-center, prospective clinical trial. Participants ≥20 years of age were included. One eye was randomly selected, each imaged by three CASIA SS-1000 devices and three Pentacam devices by three different examiners. Each photographer operated a pair of devices, one CASIA SS-1000 and one Pentacam. The image order for each participant was determined by a random permutation table. Three images were taken from each device. A total of 18 images were taken for each eye. Ratios of the standard deviations, referenced as (CASIA/Pentacam), were calculated to compare the repeatability and reproducibility of the two imaging instruments. RESULTS: In all, 66 participants with a mean age of 46.4 years (±21.7) were enrolled in the study. All repeatability ratios and intra-device variability were less than 1 (anterior corneal curvature: flat = 0.86, steep = 0.85; posterior corneal curvature: flat = 0.43, steep = 0.61; and map: thinnest = 0.22; central = 0.24, 2 mm = 0.26, 4 mm = 0.27, and 6 mm = 0.30). All reproducibility ratios, which measure the inter-device variability, were less than 1 (anterior corneal curvature: flat = 0.58, steep = 0.73; posterior corneal curvature: flat = 0.25, steep = 0.31; and pachymetry map: thinnest = 0.20; central = 0.20; 2 mm = 0.20; 4 mm = 0.19; and 6 mm = 0.22). A ratio of less than 1 indicates that the CASIA SS-1000 has more consistent measurements. CONCLUSIONS: The CASIA SS-1000 was found to have better repeatability and reproducibility compared to the Pentacam for both corneal curvature and pachymetry maps. This greater consistency may require further study to determine whether the decreased variability can be translated into improved clinical results

The Combination of D-dimer and Glasgow Prognostic Score Can Be Useful in Predicting VTE in Patients with Stage IIIC and IVA Ovarian Cancer

Cancer patients have increased risk of venous thromboembolism (VTE) that must be assessed before treatment. This study aimed to determine effective VTE biomarkers in gynecologic cancer (GC). We investigated the correlation between D-dimer levels, Khorana risk score (KRS), Glasgow prognostic score (GPS), and VTE in 1499 GC patients (583 cervical cancer (CC), 621 endometrial cancer (EC), and 295 ovarian cancer (OC) patients) treated at our institution between January 2008 and December 2019. χ2 and Mann–Whitney U-tests were used to determine statistical significance. We used receiver operating characteristic-curve analysis to evaluate the discriminatory ability of each parameter. D-dimer levels were significantly correlated with KRS and GPS in patients with GC. VTE was diagnosed in 11 CC (1.9%), 27 EC (4.3%), and 39 OC patients (13.2%). Optimal D-dimer cut-off values for VTE were 3.1, 3.2, and 3.9 μg/ml in CC, EC and OC patients, respectively. D-dimer could significantly predict VTE in all GC patients. Furthermore, D-dimer combined with GPS was more accurate in predicting VTE than other VTE biomarkers in stage IIIC and IVA OC (AUC: 0.846; p<0.001). This study demonstrates that combined D-dimer and GPS are useful in predicting VTE in patients with OC

Tumor size before image-guided brachytherapy is an important factor of local control after radiotherapy for cervical squamous cell carcinoma: analysis in cases using central shielding

We analyzed the local control (LC) of cervical squamous cell carcinoma treated by computed tomography (CT)-based image-guided brachytherapy (IGBT) using central shielding (CS). We also examined the value of tumor diameter before brachytherapy (BT) as a factor of LC. In total, 97 patients were analyzed between April 2016 and March 2020. Whole-pelvic (WP) radiotherapy (RT) with CS was performed, and the total pelvic sidewall dose was 50 or 50.4 Gy; IGBT was delivered in 3-4 fractions. The total dose was calculated as the biologically equivalent dose in 2 Gy fractions, and distribution was modified manually by graphical optimization. The median follow-up period was 31.8 months (6.3-63.2 months). The 1- and 2-year LC rates were 89% and 87%, respectively. The hazard ratio was 10.11 (95% confidence interval: 1.48-68.99) for local recurrence in those with a horizontal tumor diameter >= 4 cm compared to those with = 4 cm, different treatment strategies such as employing interstitial-BT for dose escalation may be necessary

Impaired bone quality characterized by apatite orientation under stress shielding following fixing of a fracture of the radius with a 3D printed Ti-6Al-4V custom-made bone plate in dogs

Custom-made implants have recently gained attention in veterinary medicine because of their ability to properly fit animal bones having a wide variety of shapes and sizes. The effect of custom-made implants on bone soundness and the regeneration process is not yet clear. We fabricated a 3D printed Ti-6Al-4V custom-made bone plate that fits the shape of the dog radius, and placed it into the radius where an osteotomy had been made. The preferential orientation of the apatite c-axis contributes to the mechanical integrity of the bone and is a reliable measure of bone quality. We determined this parameter as well as the bone shape and bone mineral density (BMD). The bone portion which lies parallel to the bone plate exhibited bone resorption, decreased BMD, and significant degradation of apatite orientation, relative to the portion outside the plate, at 7 months after the operation. This demonstrates the presence of stress shielding in which applied stress is not transmitted to bone due to the insertion of a stiff bone plate. This reduced stress condition clearly influences the bone regeneration process. The apatite orientation in the regenerated site remained different even after 7 months of regeneration, indicating insufficient mechanical function in the regenerated portion. This is the first study in which the apatite orientation and BMD of the radius were evaluated under conditions of stress shielding in dogs. Our results suggest that assessment of bone repair by radiography can indicate the degree of restoration of BMD, but not the apatite orientation.Impaired bone quality characterized by apatite orientation under stress shielding following fixing of a fracture of the radius with a 3D printed Ti-6Al-4V custom-made bone plate in dogs. Keiichiro Mie et al. PLOS ONE. 2020. 9(2) doi.org/10.1371/journal.pone.023767

Efficacy of ezetimibe as monotherapy or combination therapy in hypercholesterolemic patients with and without diabetes

Ezetimibe selectively inhibits dietary and biliary cholesterol absorption and reduces serum cholesterol levels when administered alone (monotherapy) and along with common lipid-regulating agents (combination therapy). To evaluate the effect of ezetimibe therapy on the lipid profile, glucose metabolism, and levels of cholesterol absorption and synthesis markers, we administered 10 mg ezetimibe to 50 hypercholesterolemic patients with or without diabetes. The serum levels of low-density lipoprotein cholesterol and total cholesterol were significantly reduced at 4 and 12 weeks of ezetimibe therapy in diabetic patients of both the monotherapy and combination-therapy groups and in nondiabetic patients of the combination-therapy group. The serum levels of the cholesterol absorption markers were significantly reduced, while those of the cholesterol synthesis markers were significantly increased at 12 weeks of ezetimibe therapy. No significant differences were noted in the values of the parameters of glucose metabolism in all patients. We also investigated the clinical characteristics of patients who exhibited a good response to ezetimibe (ezetimibe responders) ; however, multivariate regression analysis did not reveal a correlation between ezetimibe efficacy and patient characteristics such as gender, age, BMI, diabetic condition, method of ezetimibe administration, and the initial absolute values of cholesterol absorption/synthesis markers levels. In conclusion, ezetimibe therapy significantly improved the lipid profile without disturbing glucose metabolism. We were unable to identify the specific characteristics of ezetimibe responders among our subjects. However, we may interpret this result as suggesting that ezetimibe can be used in any population to lower low-density lipoprotein cholesterol levels

P-NETG2に対しPRRTを施行した4例に関する検討

In June 2021, 177Lu-oxodotreotide, a PRRT, was approved by insurance for unresectable or recurrent NETs. We investigated the efficacy and safety of PRRT in four patients with P-NETs at our hospital. All patients were confirmed to be positive for somatostatin receptors by using octreoscan. PRRT treatment was then performed and retrospectively evaluated for efficacy and safety. PRRT was administered as lutetium oxodotreotide（177Lu） at 7.4 GBq per dose over 30 - minutes for up to 1 - 4 doses at 8 - week intervals. Efficacy was evaluated using RECIST v1. 1. Adverse effects were evaluated by CTCAE（v5.0 JCOG）. The mean patient age was 60±12.0 years, and all patients were male. Three patients had a PS of 0, and one patient had a PS of 1 or higher. Metastatic organs were the liver in four patients and intra-abdominal lymph nodes in one patient, all of whom were Stage IV. Three patients underwent transarterial embolization. 177Lu-DOTATOC PRRT was administered every 8 weeks, and a total of four courses were administered in two patients, three courses in one patient, and one course in one patient. One patient had grade 2 thrombocytopenia after one course, and the second course was administered at a half dose（3.7 GBq）. The overall response rate（ORR） was 25%, with one PR and two SD. The median PFS was 9 months（95% Cl, 8-NA）, and the median overall survival from diagnosis was 119 months（95%Cl, 31 - NA）. Adverse events during PRRT included leukopenia in two patients（one G3, one G2）, lymphopenia in one patient（one G3）, thrombocytopenia in two patients（two G2, one G3）, creatinine increase in one patient（one G2）, and skin rash in one patient. In conclusion, PRRT is expected to be highly effective and safe compared with conventional therapy for neuroendocrine tumors with unresectable or distant metastases