Two-hole assisted phaco-chop technique: a more efficient method for safe nucleofractis vertical chopping.

PURPOSE: To evaluate the use of the two-hole technique in augmenting the efficiency of surgeons-in-training when performing the phaco-chop technique. We hypothesized that drilling two holes in opposite angles to each other adjacent to the capsulorhexis would mimic a new lens equator. The phaco-tip and the chopper can be inserted into these holes at appropriate depths and may sandwich and fracture the lens more easily than conventional methods. METHODS: The two-hole technique described above was performed by three first-year surgeons before they performed the standard phaco-chop technique. We collected data of their first 8 cases and analyzed a total of 64 cases: 16, divide-and-conquer; 24, two-hole method; 24, phaco-chop. The main outcome measures included the cumulative dissipated energy (CDE) and case ultrasound time (UST) with different phacoemulsification techniques. RESULTS: The young practicing surgeons eventually performed the standard phaco-chop more safely after repeated practice using the two-hole method. The drilling of holes enabled deep and effortless impaling of the nucleus. Although there was no significant difference in the CDE among the techniques, there was a significant difference in the UST (P < 0.05). CONCLUSION: The two-hole method enabled surgeons-in-training to acquire standard phaco-chop skills more efficiently. However, further studies with higher statistical power will be needed to validate these findings. Additionally, a variation of this technique, the four-hole method, is applicable even for experienced surgeons in cases of a hardened nucleus.

Factory-Made Elastic Silicone Sheet as an Alternative for the Posterior Capsule of the Lens During Phacoemulsification for Dislocated/Subluxated Lenses.

BACKGROUND: We previously reported a novel technique using an elastic silicone bowl, which was handmade from a phaco test chamber, to salvage dislocated lenses and perform phacoemulsification and aspiration (PEA) on the bowl. However, creating the bowl was challenging. METHODS: A factory-made elastic silicone sheet (ESS), a ready-to-use alternative for the posterior capsule of the lens, was prepared. We used this sheet to salvage and support the dislocated/subluxated lenses in 11 eyes of nine patients. RESULTS: We could use a sheet immediately after we opened the package. In all the cases, we could insert a sheet beneath the lens and PEA performed at the center of the operative field. There was only one incident where the lens could not be placed onto the disc at the first attempt, but the lens was eventually salvaged. There was no risk of rupture during PEA, and the ESS could be removed completely without any complications. CONCLUSION: The factory-made ESS described here can be used for salvaging dislocated/subluxated lenses and safely performing PEA.

Multinuclear NMR Studies on Lewis Acid-Lewis Base Interactions between Bis(pentafluorophenyl)borinic Acid and Uranyl ß-Diketonato Complexes in Toluene.

In order to examine the possibility of Lewis acid-Lewis base (LA-LB) interactions between the boron atom of B(C6F5)2OH and the oxo groups ("yl" oxygen atoms) of uranyl ß-diketonato complexes, we have measured the 1H, 11B, 17O, 19F NMR and IR spectra of toluene solutions containing ß-diketonato complexes [UO2(acac)2DMSO or UO2(dfh)2DMSO, where acac = 2,4-pentanedionate, dfh = 1,1,1,2,2,6,6,7,7,7-decafluoroheptane-3,5-dionate, and DMSO = dimethyl sulfoxide] and B(C6F5)2OH. 11B and 17O NMR spectra of solutions containing UO2(dfh)2DMSO and B(C6F5)2OH showed no change in their chemical shifts regardless of the [B(C6F5)2OH]/[UO2(dfh)2DMSO] ratio. This indicates that there were no apparent interactions between B(C6F5)2OH and UO2(dfh)2DMSO. On the other hand, in the corresponding NMR spectra of solutions containing UO2(acac)2DMSO and B(C6F5)2OH, new signals were observed at a higher field than signals observed in the solutions containing only B(C6F5)2OH or UO2(acac)2DMSO, and their intensity changed with the [B(C6F5)2OH]/[UO2(acac)2DMSO] ratio. These results reveal that a complex with LA-LB interaction (B···O═U) between the boron atom of B(C6F5)2OH and the "yl" oxygen atom of UO2(acac)2DMSO was formed. IR spectra also supported such complex formation; i.e., the asymmetric O═U═O stretching band of UO2(acac)2DMSO was observed to shift from 897 to 810 cm-1 with the addition of B(C6F5)2OH. Moreover, 19F NMR spectra indicated that 1:1 and 2:1 LA-LB complexes exist in equilibrium, UO{OB(C6F5)2OH}(acac)2DMSO + B(C6F5)2OH = U{OB(C6F5)2OH}2(acac)2DMSO. The thermodynamic parameters for this equilibrium were obtained as K = (2.5 ± 0.6) × 102 M-1 (at 25 °C), ΔH = -42.4 ± 5.2 kJ mol-1, and ΔS = -96.7 ± 19.4 J K-1 mol-1. In 1H NMR spectra, the signal due to -CH groups of UO2(acac)2DMSO disappeared, and three signals due to the corresponding -CH groups newly appeared with an increase in the [B(C6F5)2OH]/[UO2(acac)2DMSO] ratio. From these phenomena, it is proposed that 1:1 and 2:1 LA-LB complexes having interactions between the -CH groups of acac and the -OH group of coordinated B(C6F5)2OH are formed depending on the [B(C6F5)2OH]/[UO2(acac)2DMSO] ratio.

Repairing iridodialysis by riveting with a double-flanged polypropylene suture.

Three patients with iridodialysis were recruited. A 6-0 polypropylene suture was cut to the proper length and flanged by cautery. A long (19.0 mm), ultrathin 30-gauge needle was inserted in the anterior chamber from the sclera around the iris and penetrated in the dialyzed iris, then exited through the cornea on the contralateral side. The flanged polypropylene suture was inserted in the needle from the unflanged side. After the 30-gauge needle was withdrawn, the flanged suture remained, passing the dialyzed iris and sclera. The unflanged ends of the polypropylene sutures were cut and flanged until each flange reached the sclera. It was easy to place multiple sutures. There were no cases of extrusion of the suture nor of the recurrence of iridodialysis up to 1 year. This technique is a good alternative to repair iridodialysis.

Intrascleral Fixation of an Intraocular Lens through the Pars Plana Prevents Corneal Endothelial Damage.

We report two cases of aphakia in whom an intraocular lens (IOL) was intrasclerally fixated through the pars plana to minimize further corneal endothelial damage. A modified lock-and-lead technique was used. A sclerotomy and scleral incision were made 2.5 mm from the limbus. A 24-G catheter needle was used for penetration of the leading haptic, and two ultrathin 30-G needles were used to bury the ends of the haptics. The scleral incision was sutured with 8-0 nylon. Corneal endothelial cells were preserved after surgery. Neither intra- nor postoperative complications were observed. Intrascleral fixation of an IOL through the pars plana effectively minimizes further damage to corneal endothelial cells in select cases.

Factors associated with the annual change in forced expiratory volume in 1 second of officially acknowledged victims of pollution-related illness in improved environments: a longitudinal study.

[Purpose] We examined factors affecting annual change in pulmonary function in residents previously exposed to air pollution in an area where pollution has been reduced and a long time period has elapsed. [Subjects and Methods] Data of 730 officially acknowledged victims of pollution-related illness from an annual survey during 2000 to 2009 were analyzed. The primary outcome was forced expiratory volume in 1 second (FEV1), along with factors such as age, body composition, smoking habits, respiratory symptoms, and classification of medical management (an index of the need for treatment). Multiple regression analyses were used to identify factors associated with the annual change in FEV1. [Results] Three significant factors were identified: smoking habit, classification of medical management, and gender. Smoking habits and classification of medical management had stronger effects on the annual change in FEV1 than gender. [Conclusion] With an improved environment, continuation of smoking accelerates the decline in FEV1.

Lifespan and Reproductive Senescence in a Free-Ranging Ring-Tailed Lemur (Lemur catta) Population at Berenty, Madagascar.

The lifespan and age-specific fecundity of female ring-tailed lemurs (Lemur catta) were estimated from a 24-year longitudinal dataset based on individual identification at Berenty Reserve, Madagascar. The mean lifespan of females in 10-year (1989-1998) birth cohorts was 4.9 ± 4.9 years (n = 77), and the longest recorded lifespan in the population was 20 years. The mortality rate of adult females increased to ≥20% at 10-11 years old and reached 33-50% at 12-15 years old. Although the birth rate of old females (12-17 years old) was 72.0%, slightly lower than that of prime adult females (4-11 years old), i.e. 80.2%, no significant difference was found between them. Half of the females who reached the age of 12 years gave birth in the last year of their life. The oldest mother to give birth was 17 years old. These results suggest that most females can maintain reproductive performance in their later life and that there is no evidence for a postreproductive lifespan in this species.

Heart rate recovery after the 6-min walk test is related to 6-min walk distance and percutaneous oxygen saturation recovery in patients with COPD.

Heart rate recovery (HRR) after maximal load exercise affects mortality in chronic obstructive pulmonary disease (COPD). However, the associations of clinical characteristics with HRR after the 6-min walk test (6MWT), which is defined as a submaximal load test, remain unclear. We showed that HRR in patients with COPD after 6MWT was related to 6-min walk distance and percutaneous oxygen saturation recovery. HRR after the 6MWT may be useful to assess exercise capacity in COPD.

Physical Function Traits of Long-term Officially Acknowledged Victims of Pollution-related Illnesses Compared with Elderly Patients with Chronic Obstructive Pulmonary Disease.

[Purpose] To examine the long-term effects of air pollution on the physical functioning of a group of officially acknowledged victims of pollution-related illnesses (Victims group) who were exposed to air pollution more than 50 years ago, we compared them with age-matched patients with chronic obstructive pulmonary disease (COPD group). [Subjects and Methods] The Victims group comprised 34 subjects and the COPD group 24, all of whom were aged over 65 years. Respiratory function, muscle strength, exercise capacity and physical activity were measured and compared between the groups. [Results] The Victims group had significantly higher forced expiratory volume in the first second (FEV1), proportion of predicted FEV1, proportion of predicted vital capacity (VC), and ratio of FEV1 to forced VC than the COPD group. Surprisingly, the muscle strength of the Victims group was significantly weaker, their incremental shuttle walking test distance was significantly shorter, and their physical activity was significantly less than those of the COPD group. [Conclusion] Although the pulmonary function of Victims was better than that of the COPD group, their physical functioning was worse. Exposure to air pollution 50 years ago appears to continue to adversely affect their physical function. It is particularly important to offer Victims rehabilitation to improve their exercise performance and physical activity.

Smoking aggravates the impaired pulmonary function of officially acknowledged female victims of air pollution of 40 years ago.

Air pollution due to industrial waste and tobacco smoke is detrimental to pulmonary function. However, the combined effects of air pollution and smoking on pulmonary function have not been investigated. We examined the combined effect of air pollution of 40 years ago and concurrent smoking on the pulmonary function of officially acknowledged female victims in Japan, because females are more susceptible to the adverse effects of both irritants than males. The subjects comprised 655 female victims living in one of two areas with air pollution of 40 years ago and 572 females living in an area without air pollution. All victims have been prescribed standard respiratory medications. Pulmonary function was measured in 2000 for air-pollution groups (130 smokers and 525 non-smokers; mean age, 68.4 years) and during the period of 2004 to 2013 for non-air-pollution groups (113 smokers and 459 non-smokers; mean age, 69.0 years). The smokers included both current smokers and ex-smokers. The victims with a history of smoking had significantly lower forced expiratory volume in 1 second (FEV1 % predicted) (mean, 74%) and significantly lower FEV1/forced vital capacity (FVC) (mean, 70%) than the other groups (P<0.001). Thus, smoking aggravates the pulmonary function in officially acknowledged female victims, despite the improved air pollution and the continuous medical care provided by the government. In conclusion, exposure to air pollution of 40 years ago and cigarette smoking are associated with reduced pulmonary function. These results highlight the importance of measures aimed at smoking cessation and limiting air pollution.

Tobacco use among designated air pollution victims and its association with lung function and respiratory symptoms: a retrospective cross-sectional study.

OBJECTIVES: We sought to elucidate the long-term association of tobacco use and respiratory health in designated pollution victims with and without obstructive pulmonary defects. DESIGN: A retrospective cross-sectional study. SETTING: The register of pollution victims in Kurashiki, Japan. PARTICIPANTS: 730 individuals over 65 years of age previously diagnosed with pollution-related respiratory disease. Patients were classified into four groups according to their smoking status and whether they had obstructive pulmonary disease. We then compared the prevalence of respiratory symptoms and lung function over time between groups. PRIMARY OUTCOME MEASURES: Spirometry was performed and a respiratory health questionnaire completed in the same season each year for up to 30 years. RESULTS: Rates of smoking and respiratory disease were high in our sample. Although respiratory function in non-smoking patients did not completely recover, the annual rate of change in lung function was within the normal range (p<0.01). However, smokers had worse lung function and were more likely to report more severe pulmonary symptoms (p<0.01). CONCLUSIONS: Patients' respiratory function did not fully recover despite improved air quality. Our results suggest that, in the context of exposure to air pollution, tobacco use causes additional loss of lung function and exacerbates respiratory symptoms.

Pulmonary rehabilitation improves exercise capacity and dyspnea in air pollution-related respiratory disease.

Air pollution in Japan caused respiratory disease, such as chronic bronchitis and asthma, in many individuals in the 1960s. Although air pollution has decreased, many victims of air pollution-related respiratory disease are limited in their activities of daily living because of respiratory symptoms. The purpose of this study was to evaluate the efficacy of pulmonary rehabilitation in victims of air pollution-related chronic bronchitis or asthma. Subjects were enrolled in a 12-week (2-week inpatient followed by 10-week outpatient) pulmonary rehabilitation program. The program comprised conditioning, strength training, endurance training, and patient education. We assessed the Modified Medical Research Council (MMRC) dyspnea grade, pulmonary function, peripheral muscle force, incremental shuttle walk distance (ISWD), and physical activity at baseline and immediately after the program. Twenty-nine subjects (mean age 74.2 ± 10.1 years, 11 males) completed the program, including 11 subjects with COPD and 18 subjects with asthma. Following rehabilitation, the participants (n = 29) showed significant improvements in MMRC dyspnea grade, vital capacity % predicted, quadriceps force and ISWD (all P < 0.05). Sub-group analyses revealed that all these variables were significantly improved in subjects with asthma. In contrast, subjects with COPD showed significant improvements only in quadriceps force and ISWD (both P < 0.05). Thus, pulmonary rehabilitation is an effective method of improving exercise capacity and dyspnea in officially acknowledged victims of air pollution-related asthma. In conclusion, we recommend that patients with chronic bronchitis or asthma, resulting from exposure to air pollution, are referred for pulmonary rehabilitation.

Longitudinal study of respiratory function and symptoms in a non-smoking group of long-term officially-acknowledged victims of pollution-related illness.

BACKGROUND: Air pollution is known to be a leading cause of respiratory symptoms. Many cross-sectional studies reported that air pollution caused respiratory disease in Japanese individuals in the 1960s. Japan has laws regulating air pollution levels and providing compensation for victims of pollution-related respiratory disease. However, long-term changes in respiratory function and symptoms in individuals who were exposed to air pollution in the 1960s have not been well studied. This study aimed to investigate longitudinal respiratory function and symptoms in older, non-smoking, long-term officially-acknowledged victims of pollution-related illness. METHODS: The study included 563 officially-acknowledged victims of pollution-related illness living in Kurashiki, Okayama who were aged ≥ 65 years in 2009. Data were retrospectively collected from yearly respiratory symptom questionnaires and spirometry examinations conducted from 2000 to 2009. RESULTS: Respiratory function declined significantly from 2000 to 2009 (p < 0.01), but the mean annual changes were relatively small. The change in mean vital capacity was -40.5 ml/year in males and -32.7 ml/year in females, and the change in mean forced expiratory volume in 1 second was -27.6 ml/year in males and -23.9 ml/year in females. Dyspnea was the only symptom that worsened significantly from 2000 to 2009 in both sexes (males: p < 0.05, females: p < 0.01). CONCLUSIONS: Our results suggest that the high concentrations of air pollutants around 1970 resulted in a decrease in respiratory function and an increase in respiratory symptoms in the study population. From 2000 to 2009, the mean annual changes in respiratory function were within the normal range, even though the severity of dyspnea worsened. The changes in respiratory function and symptoms over the study period were probably due to aging. The laws governing air pollution levels and providing compensation for officially-acknowledged victims of pollution-related illness in Japan may be effective for respiratory disease cause by pollution.

Air pollution irreversibly impairs lung function: a twenty-year follow-up of officially acknowledged victims in Japan.

Lung function is one of the strongest determinants of cardiopulmonary health and longevity. Long-term exposure to air pollution has been associated with decreased lung function. We undertook a retrospective study to compare the long-term consequences of air pollution in two areas of Japan: Mizushima, Okayama Prefecture and Kitakyushu, Fukuoka Prefecture. Industrialization began in Mizushima in the 1940s, whereas it began in Kitakyushu in the early 1900s. In Kitakyushu, levels of nitrogen dioxide have been higher compared to the Mizushima area. The subjects comprised 623 officially acknowledged victims of pollution-related illness (489 from Mizushima and 134 from Kitakyushu). All subjects were lifetime non-smokers and aged 65 years or older at the time of their last medical examination in 2009. Demographic data including diagnosed lung diseases and lung function at the time of certification assessment performed between 1973 and 1988 were obtained. The subjects from Kitakyushu were significantly younger (47.1 vs. 51.0 years, p < 0.001) and a higher percentage had asthma (91.2 vs. 36.8%, p < 0.001) compared to those from Mizushima. Furthermore, all measures of lung function were significantly lower in Kitakyushu group at the time of the certification assessment (p < 0.001) and at the follow-up (p < 0.001). However, no significant differences were observed in the annual mean decline in lung function between the two groups, despite the overall decrease in air pollution. In conclusion, the normal lung function is not restored even after improvement of air pollution. It is essential for every city to prevent air pollution.

The relationship between female rank and reproductive parameters of the ringtailed lemur: a preliminary analysis.

We used data from a 13-year field study of wild ringtailed lemurs to analyze the relationship between female rank and reproductive parameters. In medium and small groups there were no significant differences in birth rate, infant mortality rate, and the number of surviving infants between the female rank categories. On the other hand, in large sized groups low-ranked females had a smaller number of surviving infants than middle-ranked females. This suggests that in large sized groups, within-group competition lowered the values of reproductive parameters of low-ranked females. On the other hand, high and low-ranked females of small sized groups tended to have a smaller number of surviving infants than high-ranked females of medium sized groups and middle-ranked females of large sized groups. Between-group competition should lower the values of their reproductive parameters. In sum, these results fit the expectation from Wrangham's (1980) inter group feeding competition model.

Influence of group size on reproductive success of female ring-tailed lemurs: distinguishing between IGFC and PFC hypotheses.

Based on data obtained over a period of 11 years from female ring-tailed lemurs (Lemur catta), we analyzed the correlation between group size and female reproductive parameters. The birth rate and mean number of surviving infants 1 year after birth per adult female generated an inverted U-shaped curve when plotted against group size (although not significant) and number of adult female members. Infant mortality rate did not have a consistent correlation with group size and number of adult female members. Thus, our findings were similar to the predictions of Wrangham's inter-group feeding competition hypothesis.