Kanto Central Hospital

Pulmonary vein isolation (PVI) is now a cornerstone of treatment for atrial fibrillation. The unipolar voltage map analysis could determine the thick atrial wall areas of the pulmonary vein. However, the benefit of utilizing a unipolar voltage map in routine PVI is unknown. Twenty-seven cases received conventional PVI and 21 cases received the unipolar-voltage-map-guided ablation. Total RF points were decreased from 97 to 70 points in average for the unipolar-guided group. The one-year recurrence rate in paroxysmal atrial fibrillation was 42.1% in the conventional group and 33.3% in the unipolar voltage map-guided group.

Summary:Lip lift is a versatile procedure to shorten the upper lip and improve the morphology and proportion of the lip. It is commonly performed as part of facial rejuvenation in Western patients, whereas in Asian countries, younger people tend to desire a lip lift because a shorter upper lip is considered more attractive. The lip lift carries a risk of an unfavorable aesthetic outcome when underlying skeletal deformities, such as maxillary protrusion and vertical excess, are not addressed, resulting in an undesirable degree of dental exposure. This article described our experience of integrating orthognathic surgery into subnasal lip lift surgery to harmonize the facial profile, highlighting the methods to achieve an ideal dental show with lip lift. Orthognathic surgery was first performed to correct the skeletal deformity. Subnasal lip lift with bull’s horn-type skin excision and orbicularis oris muscle resection was then performed as a staged procedure. The degree of Cupid’s bow elevation was determined by the amount of skin excised, and incisor show was determined by the amount of muscle resected. Seventeen patients underwent this combination approach, and the upper lip was successfully shortened with appropriate proportions and dental show. Overall, the aesthetic results were pleasing, with high patient satisfaction. Integrating orthognathic surgery into a lip lift aids in the enhancement of perioral aesthetics. Preexisting skeletal deformities need to be diagnosed before the lip lift and should be corrected when indicated.

Background:The meniscus-bone angle (MBA), defined as the angle formed by the lateral meniscus with respect to the lateral tibial slope, has recently been identified as an intrinsic factor associated with primary anterior cruciate ligament (ACL) injuries. However, no studies have investigated the influence of MBA and other intrinsic factors excluding the influence of extrinsic factors, especially the level of sports activity.Purpose/Hypothesis:The purpose was to evaluate the intrinsic factors of primary ACL injury while controlling for the effect of sports activity level. It was hypothesized that the MBA would be a significant factor associated with ACL deficiency, irrespective of the sports activity level.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 143 knees in 139 patients with ACL injuries (group A) and matched controls (matched by age, sex, and Tegner Activity Scale score), 143 knees in 143 patients without ACL injuries (group N), were evaluated. Patient height, body weight, body mass index, lateral posterior tibial slope angle (LPTSA), medial posterior tibial slope angle (MPTSA), MBA of the lateral meniscus, and relative posterior inclination angle (RPIA; MBA – LPTSA) were evaluated between the 2 groups.Results:The MBA (group A: 22.3°± 4.5°; group N: 29.1°± 3.7°) and RPIA (group A: 15.0°± 6.1°; group N: 24.1°± 4.1°) were significantly (P < .001) smaller in group A, whereas LPTSA (group A: 7.3°± 3.4°; group N: 5.0°± 2.7°) and MPTSA (group A: 7.1°± 3.0°; group N: 5.6°± 2.4°) were significantly (P < .001) larger. Logistic regression analysis with ACL injury as the dependent variable showed significant differences in MBA (OR, 0.645; 95% CI, 0.579-0.718; P < .01) and LPTSA (OR, 1.3; 95% CI, 1.14-1.48; P < .001) between the 2 groups. The receiver operating characteristic curves for the MBA showed a sensitivity of 76.2% and a specificity of 83.9% with the cutoff value of 25.2° (area under the curve, 0.88).Conclusion:A low MBA with a cutoff value of 25.2° was the most significant independent factor associated with primary ACL injury when controlling for differences in sports activity level.

Atopic allergic diseases (atopies) are recently becoming more common. Despite different sites of allergic inflammation, the sensitizing allergens can show cross-reactive effects, which raises the issues of atopic comorbidity. A combination of allergic rhinitis with food allergies, as well as asthma with food allergies, is becoming more frequent, but still not well understood. The aim of the work was to investigate food sensitization in the permanent allergic rhinitis and asthma and to assess relationships between this conditions and respiratory atopies, due to preferential sensitization to the dust mite Dermatophagoides pteronissinus. The study included 276 patients aged 18-60 years, both males and females, with perennial allergic rhinitis (n = 168) and bronchial asthma (n = 108). We determined blood concentrations of five specific IgE antibodies to food allergens from G8 group, as well as antibodies to the most significant Der p 1 allergen of dust mites Dermatophagoides pteronissinus, which are the leading source of sensitization in respiratory atopies. The data obtained were processed by descriptive statistics taking into account a distribution, calculation of non-parametric criteria, and correlation indexes. All patients were divided into three groups: (1) free of food allergies and sensitization symptoms (46%), (2) with absent clinical manifestations of food allergies, but latent food sensitization (26.1%), and (3) evidence of both symptoms and proven sensitization (27.9%). Thus, food sensitization was found in more than half of the cases of allergic rhinitis and asthma, An expected moderate correlation has been found between antibodies to shrimp and dust mite allergens. No association of IgE to Der p I with other food allergens was revealed. Meanwhile, a significantly higher frequency of clinical food allergies was found in asthma compared to allergic rhinitis. However, when accounting for a sum of subclinical and clinical sensitization, we did not reveal a significant difference between each other. This result may indicate a more reliable maintenance of allergic tolerance against food allergens, or a lack of factors for ceasing the tolerance condition at preclinical stage in allergic rhinitis, as compared to asthma.

Objective Although the management of coronavirus disease 2019 (COVID-19) has improved, chemoprevention remains a challenge. We recently identified that ursodeoxycholic acid (UDCA) is associated with subclinical infection with severe acute respiratory syndrome coronavirus, implying a reduction in the severity of COVID-19. We analyzed a large medical database to assess the utility of UDCA in the reduction of COVID-19 severity. Methods This retrospective observational study was conducted using a large-scale healthcare administrative claims database. We extracted data on patients who were diagnosed with either chronic hepatitis B or C. Among them, patients ≥50 years of age diagnosed with COVID-19 before December 2022 were analyzed. Patients were divided into two groups: those with or without a prescription of UDCA. The primary outcome was the in-hospital mortality rate. A propensity score-matching analysis was performed using logistic regression. Results A total of 6,413 patients diagnosed with COVID-19 (UDCA group, n =579; non-UDCA group, n =5,834) were analyzed. The median age was 73.0 (interquartile range, 64.0-81.0) years, and 57.8% of the patients were men. The UDCA group had significantly more complications with liver cirrhosis, hepatocellular carcinoma, type 2 diabetes, and hypertension. The UDCA group had a higher in-hospital mortality rate than the non-UDCA group, even after propensity score matching (7.4% vs. 4.3%, p=0.03), whereas there was no difference in the risks of hospitalization, oxygen therapy, or ventilation. Conclusion Although the observed increase in mortality among UDCA users could have been due to unmeasured confounding factors, UDCA did not reduce the severity of COVID-19 in viral hepatitis patients.

PurposeThe purpose of this study was to investigate the relationship among deep optic nerve head (ONH), lamina cribrosa (LC), and peripapillary sclera (pSc) configurations in healthy eyes.MethodsThis prospective cross-sectional study included 205 healthy eyes of 141 subjects. Multivariable linear mixed models identified factors associated with LC curvature index, prelaminar thickness (PLT), pSc angle, and LC depth (LCD). Explanatory variables included age, gender, intraocular pressure, axial length (AXL), visual field sensitivity, disc area, disc ovality, disc torsion, Bruch's membrane opening (BMO)-minimum rim width (MRW), BMO and anterior scleral canal opening (ASCO) area, peripapillary zone area with and without Bruch's membrane (PPZ+BM/–BM), and peripapillary choroidal thickness (pChT). A sub-analysis was conducted by dividing the eyes at the median AXL.ResultsLC curvature was flatter in eyes with large PPZ-BM, long AXL, and shallow LCD (P = 0.002, P = 0.015, and P = 0.042, respectively). Similar factors exhibited consistent effects in longer AXL eyes, whereas different factors, BMO-MRW, ASCO-area, and pSc-angle, were associated in shorter AXL eyes (P = 0.006, P = 0.012, and P = 0.018. respectively). PLT was thinner in eyes with thin BMO-MRW, large ASCO area, and young age (P < 0.001, P < 0.001, and P = 0.009, respectively). The pSc angle was steeper in eyes with long AXL and large PPZ+BM (P < 0.001). LCD was deeper in eyes with thick pChT, thin BMO-MRW, and small ASCO area (P < 0.001, P < 0.001, and P = 0.004, respectively).ConclusionsNovel associations between LC configurations with scleral canal size, PPZ+BM/–BM, and BMO-MRW were found after correction for confounding deep ONH morphologies. Given that these structures are associated with glaucomatous changes, these inter-structure correlations should be considered when distinguishing LC changes between healthy and glaucomatous eyes.

Background/Objectives: Patients with Parkinson's disease (PD) often have cold hands and experience frostbite. The diagnostic criteria for multiple system atrophy (MSA) also describe cold and discolored hands; however, in our clinical experience, the hands are relatively warm. These symptoms are thought to be caused by autonomic dysfunction; however, the detailed mechanisms and differences in cold hands between MSA and PD remain unclear. We aimed to identify an appropriate cold stimulation test to differentiate patients with PD and MSA using finger surface temperature (FST). Methods: We included a total of 34 patients, 27 with PD and 7 with MSA diagnosed at least 5 years after disease onset. After 15 min in a room with constant temperature and humidity, the patient's hand was placed in cold water at 4 °C for 10 s as the cold water stress test (10sec-CWST). FST was captured using a thermal imaging camera every minute for 15 min, and the recovery of FST was analyzed. The association between the clinical characteristics of each patient and the degree of FST recovery was examined. Results: All patients completed the 10sec-CWST without adverse events. Patients with PD showed a significantly slower recovery of FST after 7 min compared to those with MSA, with a maximum difference at 11 min (PD: 8.1 ± 0.6 °C; MSA: 10.5 ± 0.3 °C; p < 0.01). FST recovery at 11 min was negatively correlated with the degree of resting hand tremor (r = -0.585, p < 0.01). Conclusions: FST after 10sec-CWST may be a safe and efficient test to differentiate PD and MSA.

Atopic dermatitis (AD) is a chronic inflammatory skin condition with a multifactorial etiology. Herein, we report a case of a patient with AD undergoing long-term topical treatments who developed a dermatophyte infection following the administration of dupilumab. Dupilumab is known to enhance skin barrier function and induce changes in the skin microbiome. Notably, head and neck dermatitis caused by the overgrowth of Malassezia species due to dupilumab has been widely discussed. This phenomenon is thought to result from the suppression of T helper (Th)2 cytokines by dupilumab, leading to a decrease in the proportion of Staphylococcus aureus and a relative increase in fungal populations. Additionally, feedback activation of Th17 cytokines may trigger excessive inflammation against fungi, contributing to fungal infections. IL-13 plays critical roles in fungal colony formation, and tralokinumab, an IL-13 inhibitor, has shown potential efficacy in treating this head and neck dermatitis. While the relationship between microbiome changes and biologics like lebrikizumab and nemolizumab remains unexplored, investigating the differential effects of these therapies on the cutaneous microbiome could provide deeper insights into not only the unique characteristics of each biologic agent but also the roles of Th2 cytokines such as IL-4, IL-13, and IL-31 in the pathophysiology of AD. The present case underscores the importance of the comprehensive therapeutic approach for AD that accounts for microbiome dynamics and adapts to evolving skin changes throughout the course of treatment.

Abstract Pulmonary vein isolation (PVI) is now a cornerstone of treatment for atrial fibrillation. The unipolar voltage map analysis could determine the thick atrial wall areas of the pulmonary vein. However, the benefit of utilizing a unipolar voltage map in routine PVI is unknown. Twenty-seven cases received conventional PVI and 21 cases received the unipolar-voltage-map-guided ablation. Total RF points were decreased from 97 to 70 points in average for the unipolar-guided group. The 6 months recurrence rate was 33.3% in the conventional group and 14.3% in the unipolar voltage map-guided group.