The cause and effect relationship between serum uric acid levels and hypertension can be difficult to evaluate because antihypertensive drugs sometimes affect uric acid levels. This cross-sectional ...study investigated the relationship between serum uric acid levels and hypertension in a general, healthy Japanese population who were not receiving medication for hyperuricemia or hypertension. We retrospectively analyzed the medical records of 90 143 Japanese people (men, 49.1%; age, 46.3±12.0 years) undergoing an annual medical examination at St Luke's International Hospital Center for Preventive Medicine, Tokyo, between January 2004 and June 2010. Of these individuals, 82 722 (91.8%) who had never taken medications for gout, hyperuricemia or hypertension were enrolled. We compared the participant characteristics and prevalence of diastolic hypertension (⩾90 mm Hg) and/or systolic hypertension (⩾140 mm Hg) by serum uric acid quartile. The odds ratio (OR) of hypertension was 1.20 for each 1 mg dl(-1) increase in serum uric acid level after adjustment for age, sex, body mass index (BMI), dyslipidemia, diabetes, smoking and estimated glomerular filtration rate (eGFR). Compared with the lowest serum uric acid quartile, participants in the highest quartile had a 3.7-fold higher OR for hypertension. After adjustment for age, BMI, dyslipidemia, diabetes, smoking and eGFR, these ORs were 1.79 (1.62-1.98) in the total study population, 1.58 (1.44-1.75) in men and 1.60 (1.39-1.84) in women. The results were similar for both systolic and diastolic hypertension. Elevated serum uric acid levels may be as important as obesity, dyslipidemia, diabetes, smoking and reduced kidney function for the development of hypertension and should be considered in hypertension prevention programs.
To compare parameters after 1-piece and 3-piece intraocular lens (IOL) implantation.
Moorfields West End Clinic, London, United Kingdom, and Hanusch Hospital, Vienna, Austria.
Prospective randomized ...controlled trial.
Each eye of patients having bilateral surgery for age-related cataract was randomized to have implantation of a 1-piece IOL (Tecnis ZCB00) or a 3-piece IOL (Tecnis ZA9003). Changes in visual acuity, refraction, and anterior chamber depth (ACD) were evaluated during a 2-year follow-up. Intraocular lens tilt and decentration were evaluated using a Purkinje meter. Regeneratory posterior capsule opacification (PCO) was analyzed using retroillumination photographs in Automated Quantification of After-Cataract image-analysis software.
This study comprised 100 eyes of 50 patients. No statistically significant differences were found in IOL tilt or decentration between groups (P≥.06). Minimal but statistically significant changes were observed in the vertical tilt component 12 months postoperatively in the 3-piece IOL group (P<.01). The tilt and decentration components did not correlate with changes in sphere or the regeneratory PCO score (r = 0.38, P≥.06). The ACD decreased significantly between 1 day and 1 month postoperatively in both groups (P<.01), with no significant changes afterward (P≥.22). The anterior chamber was significantly deeper in the 1-piece group at all follow-up visits (P<.01).
Both the 1-piece IOL and the 3-piece IOL showed excellent positional stability in the capsular bag, resulting in good clinical outcomes. Regeneratory PCO levels were low and comparable between the IOLs.
No author has a financial or proprietary interest in any material or method mentioned.
Little is known about the outcomes and indications of chronic total occlusion percutaneous coronary intervention (CTO-PCI), other than in high-volume centers. We sought to provide a real-world ...overview of the clinical outcomes and appropriateness of PCI for CTO. The analysis included 4,950 consecutive PCIs for nonacute indications registered in the multicenter Japanese PCI registry in collaboration with the US National Cardiovascular Data Registry (Cath-PCI). Data included demographics, clinical outcomes (procedural success and complication rates), and the indication appropriateness, based on the 2012 appropriate use criteria for revascularization. The overall procedural success and major adverse cardiac event rates of 501 cases with CTO-PCI (10.1%) were 76% and 3.2%, respectively. Based on the criteria, mapping failures occurred in 2,521 procedures; the remaining 2,429 PCIs were successfully mapped. The CTO-PCIs were performed for more appropriate indications than PCIs for lesions without CTO. The rate of inappropriate indications was significantly lower in CTO-PCIs than in non–CTO-PCIs (23.0% vs 31.4%, p = 0.04). Only 17% of CTO-PCIs were directly assigned to CTO-specific scenarios because such scenarios are only intended for “Lone” CTO; the rest of the CTO-PCI cases were secondarily mapped to non-CTO–specific scenarios. In conclusion, as many as 10% of the elective PCIs were performed for CTO lesions in a contemporary multicenter Japanese PCI registry; CTO-PCI was associated with lower procedural success and higher complication rates than non–CTO-PCI. Its indication was relatively appropriate; however, our findings emphasize the need for more rigorous evaluation in terms of the present insufficient CTO-related clinical scenarios.
To evaluate whether a new capsular bag-refilling procedure provides some accommodation in monkey eyes and to assess the difference in accommodation with different volumes of capsular bag refilling.
...Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan.
Experimental study.
A central 3.0 to 4.0 mm continuous curvilinear capsulorhexis was created, after which phacoemulsification was performed in the usual manner. A new accommodating-membrane intraocular lens (IOL) for sealing the capsular opening was implanted in the capsular bag. Silicone polymers were injected beneath the IOL into the capsular bag through the delivery hole. In 3 study groups, each with 6 monkey eyes, the lens capsule was refilled with 0.080 mL of silicone polymers, corresponding to a 65% bag volume; 0.100 mL, corresponding to an 80% bag volume; or 0.125 mL, corresponding to a 100% bag volume. To calculate the accommodation amplitudes achieved, automated refractometry was performed before and 1 hour after topical pilocarpine 4.0% application preoperatively and 4 weeks postoperatively.
The refilling technique was successful without polymer leakage in all monkeys. Four weeks after surgery, the mean accommodation amplitudes were 2.56 diopters (D) ± 0.74 (SD), 2.42 ± 1.00 D, and 2.71 ± 0.63 D, respectively, in the 3 study groups.
The technique provided some accommodation in young monkey eyes. Leakage of the injectable silicone polymers and anterior capsule opacification in the visual axis were avoided. The results suggest that the capsular bag-refilling procedure warrants further study for possible clinical application.
All authors have a proprietary interest in the accommodating membrane IOL mentioned in the article.
To investigate whether the lens epithelial cells (LECs) at the capsular bend created by a sharp-edged intraocular lens (IOL) are in the G(0) phase of the cell cycle.
Nishi Eye Hospital, Osaka, Japan.
...A CeeOn Edge silicone IOL (AMO) with sharp edges was implanted in 1 eye and a PhacoFlex II silicone IOL (AMO) with rounded edges in the contralateral eye after standard cataract surgery in 6 rabbits. Immunohistochemical staining for the Ki-67 antibody was performed 1 day, 3, 4, and 7 weeks after surgery.
In eyes with the sharp-edged IOL, LECs with thin, elongated nuclei accumulated at, but did not extend beyond, the capsular bend and stained negative for the Ki-67 antibody, indicating that they were in the G(0) phase of the cell cycle. In contrast, in the eye with the round-edged IOL, continuous migration of a predominantly monolayer of LECs over the IOL and onto the posterior capsule occurred. These cells were Ki-67 positive, indicating that they were proliferating.
Lens epithelial cells at the capsular bend of sharp-edged IOLs were in the G(0) phase of the cell cycle, indicating that they were contact inhibited. These findings support the theory the sharp posterior optic edge of the IOL inhibits LEC migration, reducing formation of posterior capsule opacification. Whether these LECs can reactivate when the capsular bend is eliminated by later formation of a Soemmerring's ring requires further studies.
Abstract Background Venous congestion has come into focus as an important hemodynamic factor for worsening renal function (WRF) in patients with acute decompensated heart failure (ADHF). Serum ...alkaline phosphatase (ALP) was reported as a biological marker of liver congestion in ADHF. The purpose of this study was to determine whether ALP is a predictor of WRF in patients with ADHF. Methods We enrolled consecutive patients admitted to a single cardiovascular center with ADHF, and defined WRF as an increase in creatinine of >0.3 mg/dl during hospitalization and chronic kidney disease (CKD) as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 . The patients were classified into tertiles by ALP level (<203, 203–278, and >278 IU/L). Results A total of 972 patients (mean age, 76 ± 13 years; 54% male) were retrospectively analyzed. WRF was identified in 132 patients (13.6%). In multivariate logistic regression analysis, baseline CKD odds ratio (OR) 2.46, 95% confidence interval (CI) 1.48–4.08, p < 0.001, serum albumin (OR 0.52, 95% CI 0.35–0.77, p = 0.001), and diabetes (OR 2.07, 95% CI 1.37–3.12, p < 0.001) were associated with WRF. Compared with the lowest tertile (ALP <203 IU/L), an adjusted OR of WRF was 1.69 (95% CI 1.02–2.79, p = 0.04) in the middle tertile (ALP, 203–278 IU/L) and 1.95 (95% CI 1.20–3.21, p = 0.008) in the highest tertile (ALP >278 IU/L). Conclusion Serum ALP is an independent predictor of WRF in the clinical course of ADHF.
Previous models for contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) include procedure-related variables in addition to pre-procedural variables. We sought ...to develop a risk model for CI-AKI based on pre-procedural variables and compare its predictability with a conventional risk model and also to develop an integer score system based on selected variables. A total of 5,936 consecutive PCIs registered in the Japanese Cardiovascular Database were analyzed (derivation cohort, n = 3,957; validation cohort, n = 1,979). CI-AKI was defined as an increase in serum creatinine of 50% or 0.3 mg/dl compared with baseline. From the derivation cohort, 2 different CI-AKI risk models were generated using logistic regression analyses: a pre-procedural model and a conventional model including both pre-procedural and procedure-related variables. The predictabilities of the models were compared by c-statistics. An integer score was assigned to each variable in proportion to each estimated regression coefficient for the final model. In our derivation cohort, the proportion of CI-AKI was 9.0% (n = 358). Predictors for CI-AKI included older age, heart failure, diabetes, previous PCI, hypertension, higher baseline creatinine level, and acute coronary syndrome. Presence of procedure-related complications and insertion of intra-aortic balloon pumping were included as procedure-related variables in the conventional model. Both the conventional model (c-statistics 0.789) and the pre-procedural model (c-statistics 0.799) demonstrated reasonable discrimination. The integer risk-scoring method demonstrated good agreement between the expected and observed risks of CI-AKI in the validation cohort. In conclusion, the pre-procedural risk model for CI-AKI had acceptable discrimination compared with the conventional model and may aid in risk stratification of CI-AKI before PCI.
Background Appropriateness use criteria (AUC) are widely used to assess quality of care. American professional organizations and Japanese experts have both developed original AUC for percutaneous ...coronary intervention (PCI). However, rating discrepancies have not been investigated. Methods Patients registered in the Japanese multicenter PCI registry were analyzed. We assessed the appropriateness of PCI based on both the US and Japanese criteria and compared the ratings. A logistic regression analysis was performed to identify clinical predictors of inappropriate ratings under both standards. Results From a total of 4,950 nonacute, consecutive PCIs, 1,982 and 2,077 procedures could be successfully rated using the US and Japanese criteria, respectively. The major difference between the 2 criteria was the rating of “asymptomatic, low- or intermediate-risk patients, no lesion in the proximal left anterior descending coronary artery (PLAD)”; this scenario was deemed appropriate in the Japanese but not in the US criteria. As a consequence, the rate of inappropriate PCI using the Japanese criteria (5.2%) was substantially lower when compared with the rating using the US criteria (15%). Common clinical variables associated with “inappropriate” PCI were male, multivessel diseases, and lesions in the non-PLAD. Suboptimal antianginal medication was also a significant predictor of inappropriate PCI under the US but not under the Japanese criteria. Conclusions Significant and clinically relevant rating discrepancies were observed between the US and Japanese criteria-based assessments, owing largely to the ratings of asymptomatic, non–PLAD-related, low- or intermediate-risk cases.
Gender differences in clinical outcomes after percutaneous coronary intervention (PCI) among different age groups are controversial in the era of drug-eluting stents, especially among the Asian ...population who are at higher risk for bleeding complications.
We analyzed data from 10,220 patients who underwent PCI procedures performed at 14 Japanese hospitals from September 2008 to April 2013. A total of 2,106 (20.6%) patients were women. Women were older (72.7±9.7 vs 66.6±10.8 years, p<0.001), and had a lower body mass index (23.4±4.0 vs 24.3±3.5, p<0.001), with a higher prevalence of hypertension (p<0.001), hyperlipidemia (p<0.001), insulin-dependent diabetes (p<0.001), renal failure (p<0.001), and heart failure (p<0.001) compared with men. Men tended to have more bifurcation lesions (p = 0.003) and chronic totally occluded lesions (p<0.001) than women. Crude overall complications (14.8% vs 9.5%, p<0.001) and the rate of bleeding complications (5.3% vs 2.8%, p<0.001) were significantly higher in women than in men. On multivariate analysis in the total cohort, female sex was an independent predictor of overall complications (OR, 1.47; 95% CI, 1.26-1.71; p<0.001) and bleeding complications (OR, 1.74; 95% CI, 1.36-2.24; p<0.001) after adjustment for confounding variables. A similar trend was observed across the middle-aged group (≥55 and <75 years) and old age group (≥75 years).
Women are at higher risk than men for post-procedural complications after PCI, regardless of age.
To analyze fluctuations in corneal curvature over time.
Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
Case series.
A 3-piece IOL was implanted in 1 eye and a 1-piece IOL in ...the other eye through a 3.2 mm clear corneal temporal incision. Keratometry was performed preoperatively and at several points in time postoperatively. Differences between measurements were analyzed by power vectors. Statistical significance was assessed by monovariate, bivariate, and trivariate paired t tests. Acute angle shifts were determined as differences between meridians at 2 points in time.
Fifty patients were enrolled. From preoperatively to 1 year postoperatively, the changes in vector components (M, J0, J45) were, respectively, -0.02 diopter (D) ± 0.23 (SD) (P=.38), -0.07 ± 0.27 D (P=.02), and +0.04 ± 0.25 D (P=.14). Corresponding changes from 1 year to 2 years postoperatively were +0.01 ± 0.25 D (P=.73), +0.01 ± 0.23 D (P=.83), and +0.01 ± 0.16 D (P=.40). The meridian shift was -5 ± 32 degrees (P=.13) from preoperatively to postoperatively and +3 ± 22 degrees (P=.23) from 1 year to 2 years.
Surgically induced astigmatism was composed of slight flattening in the horizontal meridian and slight steepening in the oblique meridian but was insignificant in relation to random fluctuations, which were almost equally large between postoperative measurements 1 year apart. The fluctuations were not due to imprecision in measurement.
Dr. Norrby is a retiree from Abbott Medical Optics, Inc., and holder of a small amount of stock. Dr. Findl is scientific advisor to Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned.
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