Ocular blood flow evaluation by laser speckle flowgraphy in pediatric patients with anisometropia.

Purpose: To determine the differences and reproducibility of blood flow among hyperopic anisometropic, fellow, and control eyes. Methods: We retrospectively studied 38 eyes of 19 patients with hyperopic anisometropia (8.2 ± 3.0 years of age) and 13 eyes of eight control patients (6.8 ± 1.9 years). We measured the optic nerve head (ONH) and choroidal circulation using laser speckle flowgraphy (LSFG) and analyzed the choroidal mean blur rate (MBR-choroid), MBR-A (mean of all values in ONH), MBR-V (vessel mean), MBR-T (tissue mean), and sample size (sample), which are thought to reflect the ONH area ratio, area ratio of the blood stream (ARBS). We then assessed the coefficient of variation (COV) and intraclass correlation coefficient (ICC) and compared the differences among amblyopic, fellow, and control eyes in MBR, sample, and ARBS. Results: The ONH, MBR-A, MBR-T, and ARBS of amblyopic eyes were significantly higher than those of fellow eyes (P < 0.01, P < 0.05, and P < 0.05, respectively), and control eyes (MBR-A and ARBS, P < 0.05, for both comparisons). The sample-T (size of tissue component) in amblyopic eyes was significantly smaller than that in fellow and control eyes (P < 0.05). Blood flow in the choroid did not differ significantly between the eyes. The COVs of the MBR, sample, and ARBS were all ≤10%. All ICCs were ≥0.7. The COVs of pulse waveform parameter fluctuation, blowout score (BOS), blowout time (BOT), and resistivity index (RI) in the ONH and choroid were ≤10%. Conclusion: The MBR value of the LSFG in children exhibited reproducibility. Thus, this method can be used in clinical studies. The MBR values of the ONH in amblyopic eyes were significantly high. It has been suggested that measuring ONH blood flow using LSFG could detect the anisometropic amblyopic eyes.

Prevalence of Myopia and Its Associated Factors Among Japanese Preschool Children.

Purpose: To investigate the prevalence of myopia and factors associated with spherical equivalent (SE), axial length (AL), and axial length to corneal radius of curvature (AL/CR) ratio among Japanese preschool children. Study Design: Prospective observational study. Methods: This cross-sectional study evaluated subjects aged 4-6 years from a preschool. Non-cycloplegic autorefraction was measured using the Spot Vision Screener, while AL and corneal radius (CR) were measured using the Myopia Master. Parental myopia and environmental factors were investigated using the myopia-related factor questionnaire. The worse eye with higher myopic SE was chosen for analysis, and multiple linear regression models was performed using AL, SE, and AL/CR ratio as dependent variables. Results: A total of 457 out of 514 participants (239 males, 52.3%) aged 4-6 years (mean 4.77 ± 0.65 years) were included. The mean SE was 0.13 ± 0.63 D, AL was 22.35 ± 0.67 mm, CR was 7.76 ± 0.25 mm, and AL/CR ratio was 2.88 ± 0.72. The overall prevalence of myopia and high myopia were 2.9 and 0.2%, respectively. Multiple regression analysis showed that myopic SE was significantly associated with male sex (ß = -0.14, p = 0.02) and parental myopia (ß = -0.15, p = 0.04). Meanwhile, longer AL was significantly associated with older age (ß = 0.13, p = 0.02), male sex (ß = 0.44, p < 0.001), parental myopia (ß = 0.24, p = 0.01), and screen time (including smartphones, tablets, and computers) (>1 h, ß = 0.14, p = 0.04). A higher AL/CR was significantly associated with older age (ß = 0.02, p < 0.001), male sex (ß = 0.03, p < 0.001), ratio and parental myopia (ß = 0.03, p = 0.02). Conclusion: The prevalence of myopia and high myopia were 2.9 and 0.2%, respectively, among Japanese preschool children in 2021. Longer AL was associated with older age, male sex, parental myopia, and screen time in children aged 4-6 years. Children with a high risk of myopia can be identified early based on parental myopia information for early prevention.

Risk factors for early-onset high myopia after treatment for retinopathy of prematurity.

PURPOSE: To investigate the prevalence of myopia and high myopia and the risk factors for high myopia in infants at 3 years of age with retinopathy of prematurity (ROP). STUDY DESIGN: Retrospective, observational. METHODS: We retrospectively analyzed all 89 preterm infants (178 eyes) with medical records of ROP between October 2008 and March 2018 at Toho University Medical Center Omori Hospital; these infants had a birth weight of less than 1,500 g and were followed up at least until 3 years of age. Cycloplegic autorefraction was performed to measure refractive outcomes. Multivariate analysis was performed to determine the risk factors for early-onset high myopia at 3 years of age. RESULTS: The prevalence of myopia and high myopia was significantly higher in the treated group (59.7% and 17.9%, respectively) than in the untreated group (19.7% and 0%, respectively) (p<0.001). Spherical equivalent (SE) at age 3 was more myopic in the treatment group (-1.72 ± 3.53 D) than in the untreated group (0.54 ± 1.08 D) (p<0.001). In the sub-analysis of the treatment group, there was a significant correlation between SE at age 3 and the number of laser shots (R2 = 0.36, p<0.001). Multivariate logistic analysis showed that the number of laser shots was an independent risk factor for early onset high myopia (p<0.05). CONCLUSION: The number of laser shots is an independent risk factor for early onset high myopia, and preterm infants who have undergone laser treatment for severe ROP should be considered for early optical correction with cycloplegic refractive examination.

Cell Adhesive Character of Phenylboronic Acid-Modified Insulin and Its Potential as Long-Acting Insulin.

Phenylboronic acid (PBA) derivatives have attracted substantial attention owing to their unique character of forming dynamic covalent bonds with polyol compounds. Recent studies have shown interactions between PBA and sugar chains on the cell surface; they have interesting applications for sensors and drug delivery systems. In this study, we prepared phenylboronic acid-modified insulin (PBA-Ins) to evaluate its glucose-lowering activity and cell adhesiveness. In the case of intravenous injection, PBA-Ins showed longer glucose-lowering activity than native insulin. We hypothesized that this prolonged effect was the result of the interaction between the PBA moiety and sugar chains on the cell surface. Red blood cells (RBCs) were used as a cell model, and we confirmed PBA-Ins's affinity for RBCs, which induced RBC agglutination. Interestingly, using an alternative PBA-Ins administration route markedly changed its glucose-lowering activity. Unlike the intravenous injection of PBA-Ins, the subcutaneous injection showed a small effect on glucose level, which indicated that a small amount of PBA-Ins was absorbed into the bloodstream. This suggested the importance of investigating the interaction between the PBA moiety and many types of cells, such as adipocytes, in subcutaneous tissues.

Evaluation of CYP2D6 Protein Expression and Activity in the Small Intestine to Determine Its Metabolic Capability in the Japanese Population.

CYP2D6 plays an important role in the metabolism of many drugs such as opioids and antidepressants. Polymorphisms of the CYP2D6 gene are widely observed in the Japanese population, and can affect the first-pass metabolism of orally administered drugs. Several CYP enzymes have been identified in the small intestine of Caucasians, but intestinal CYP enzymes have not been reported in the Japanese population, except for CYP3A4 and CYP2C19. In this study, we evaluated the CYP2D6 metabolic capacity by measurement of CYP2D6 mRNA and protein levels and activity in the small intestine of Japanese individuals. Normal jejunal tissues were obtained from 31 patients who had undergone pancreaticoduodenectomy, and the CYP2D6*10 variant was identified in these tissues. CYP2D6 mRNA and CYP2D6 protein levels were analyzed using real-time RT-PCR and Western blotting, respectively. Bufuralol 1'-hydroxylation, a marker of CYP2D6 activity, was analyzed using HPLC. Frequencies of the CYP2D6*1/*1, *1/*10, and *10/*10 genotypes in the jejunal tissue were 29.0% (n=9), 35.5% (n=11), and 35.5% (n=11), respectively. CYP2D6 protein and activity levels did not differ significantly between the genotypes. A positive correlation was found between CYP2D6 protein and activity levels. Furthermore, CYP2D6 protein levels and activity in the small intestine were significantly lower than those in the liver. These findings suggest that the metabolic capacity of CYP2D6 in the small intestine of the Japanese population has a relatively small effect on drug metabolism.

[Experience of participating in the 14th Nepal Cleft Lip and Palate Surgery Project].

Adventist Development and Relief Agency (ADRA) Japan, a non governmental organization (NGO), following an official request of Federal Democratic Republic of Nepal Government has organized Nepal Cleft Lip and Palate Surgery Project since 1995. We participated in the 14th Project as one of the anesthesiologists from 7th to 22nd November 2009 and performed general anesthesia with a Nepalese anesthetist without a medical license in Sheer Memorial Hospital. Use of unfamiliar anesthetic medications and limited medical devices made us understand the difficulty of anesthetic management. This valuable anesthetic experience will be useful for us in general anesthetic management in the future.

[Clinical anesthetic training at St. Vincent's Hospital, Melbourne Australia].

Anesthesia training system and operation theater management at St Vincent's hospital Melbourne in Australia, are very well organized, including tutorials, invitation lecture, transesophageal echocardiography conference as well as working hour, operation room, organization of comedical staffs such as nursing and technician staff, and day surgery and anesthesia. Good anesthesia training system and efficient operation theater management are necessary to establish better quality of medical services.