Inverted internal limiting membrane flap technique as a useful procedure for macular hole-associated retinal detachment in highly myopic eyes

PurposeTo determine whether the inverted internal limiting membrane (ILM) flap technique contributes to high reattachment and closure rates in patients with macular hole-associated retinal detachment (MHRD).Patients and methodsIn all, 15 eyes of 15 patients with MHRD undergoing 25-gauge pars plana vitrectomy with the inverted ILM flap technique or ILM peeling. The patients were divided into the inverted ILM flap technique group (6 eyes) and ILM peeling group (9 eyes). The logarithm of minimal angle of resolution best-corrected visual acuity (BCVA) and retinal attachment and macular hole closure rates were compared between the two groups before and after surgery.ResultsNo significant differences were found in the pre- and postoperative BCVA at 1 and 3 months after surgery in either group (inverted ILM flap technique group, preoperatively 1.04±0.55, 1 month 0.95±0.30, 3 months 0.83±0.22; ILM peeling group, preoperatively 1.00±0.44, 1 month 1.05±0.38, 3 months 1.06±0.49; P>0.05, respectively). The postoperative BCVA at 6 months after surgery was significantly better in the inverted ILM flap technique group than in the ILM peeling group (inverted ILM flap technique group, 0.62±0.35; ILM peeling group, 1.02±0.41, P=0.045). The improvement in BCVA was significantly better in the inverted ILM flap technique group than in the ILM peeling group (inverted ILM flap technique group, -0.41±0.29; ILM peeling group, 0.02±0.36; P=0.021). The primary macular hole closure rates were 100% in the inverted ILM flap technique group and 55.5% in the ILM peeling group. The primary reattachment rates were 100% in the inverted ILM flap technique group and 55.5% in the ILM peeling group. The primary macular hole closure and reattachment rates were not significantly different in both groups (P=0.056, respectively).ConclusionThe inverted ILM flap technique is a useful procedure for MHRD in highly myopic eyes.

Analysis of an M/G/1/K/N queue

A steady-state analysis of an M/G/1 queue with a finite capacity (K) and a finite population (N) of customers is given. The queue size distribution in this M/G/1/K/N system can be derived from the known queue size distribution in the corresponding M/G/1//N system. The system throughput, the mean response time, and the blocking probability are then calculated. The joint distributions of the queue size and the remaining service times are used to obtain the distributions of the unfinished work in the service facility and the waiting time of an accepted customer.

Sojourn times in vacation and polling systems with Bernoulli feedback

We study sojourn times in M/G/1 multiple vacation systems and multiqueue cyclic-service (polling) systems with instantaneous Bernoulli feedback. Three service disciplines, exhaustive, gated, and 1-limited, are considered for both M/G/1 vacation and polling systems. The Laplace-Stieltjes transforms of the sojourn time distributions in the three vacation systems are derived. For polling systems, we provide explicit expressions for the mean sojourn times in symmetric cases. Furthermore a pseudo-conservation law with respect to the mean sojourn times is derived for a polling system with a mixture of the three service disciplines.

Cardiac tamponade due to systemic lupus erythematosus in patient with Prader-Willi syndrome after growth hormone therapy

We present a 16-year old girl with Prader-Willi syndrome who developed cardiac tamponade as an initial finding of systemic lupus erythematosus. Until one year prior to this episode, she had received growth hormone treatment for nine years. The association among Prader-Willi syndrome, growth hormone treatment and systemic lupus erythematosus is discussed. Lupus (2007) 16, 447—449.

Negative electronic compressibility and tunable spin splitting in WSe2

Tunable bandgaps, extraordinarily large exciton-binding energies, strong light-matter coupling and a locking of the electron spin with layer and valley pseudospins have established transition-metal dichalcogenides (TMDs) as a unique class of two-dimensional (2D) semiconductors with wide-ranging practical applications. Using angle-resolved photoemission (ARPES), we show here that doping electrons at the surface of the prototypical strong spin-orbit TMD WSe2, akin to applying a gate voltage in a transistor-type device, induces a counterintuitive lowering of the surface chemical potential concomitant with the formation of a multivalley 2D electron gas (2DEG). These measurements provide a direct spectroscopic signature of negative electronic compressibility (NEC), a result of electron-electron interactions, which we find persists to carrier densities approximately three orders of magnitude higher than in typical semiconductor 2DEGs that exhibit this effect. An accompanying tunable spin splitting of the valence bands further reveals a complex interplay between single-particle band-structure evolution and many-body interactions in electrostatically doped TMDs. Understanding and exploiting this will open up new opportunities for advanced electronic and quantum-logic devices.

Efficacy and Safety of Lixisenatide in Japanese Patients with Type 2 Diabetes Insufficiently Controlled with Basal Insulin±Sulfonylurea: A Subanalysis of the GetGoal-L-Asia Study

The aim of the study was to evaluate the efficacy and safety of once-daily lixisenatide 20 μg as add-on to basal insulin with or without sulfonylurea in Asian patients with type 2 diabetes mellitus. The study as a subanalysis of the 159 Japanese patients from the 24-week double-blind GetGoal-L-Asia study (NCT00866658) who received once-daily lixisenatide or placebo. The primary endpoint was change from baseline in HbA1c evaluated using analysis of covariance. Once-daily lixisenatide significantly reduced mean HbA1c [least squares mean difference vs. placebo - 1.1% (- 12 mmol/mol); p<0.0001]. Significantly more patients in the lixisenatide group reached HbA1c targets of < 7% (53 mmol/mol; 31.4 vs. 2.3% for placebo; p<0.0001) and ≤ 6.5% (48 mmol/mol; 12.9 vs. 1.2% for placebo; p=0.0028). Lixisenatide significantly reduced 2-h postprandial plasma glucose (least squares mean difference vs. placebo-8.64 mmol/l; p<0.0001), glucose excursion (least squares mean difference vs. placebo - 7.80 mmol/l; p<0.0001) and fasting plasma glucose (least squares mean difference vs. placebo - 0.96 mmol/l; p=0.0126). Body weight was reduced with lixisenatide but with no significant difference vs. placebo. Gastrointestinal adverse events were more frequent with lixisenatide (61.1 vs. 11.5% for placebo) but were generally transient and mild-to-moderate in intensity. The incidence of symptomatic hypoglycemia was 39.0 vs. 13.5% in patients receiving sulfonylureas and 32.3 vs. 22.9% in those not receiving sulfonylureas, for lixisenatide and placebo, respectively. In Japanese patients with type 2 diabetes mellitus, once-daily lixisenatide was well tolerated and led to significant and clinically relevant improvement in glycemic control, with a pronounced effect on postprandial plasma glucose.

Mesenteric malperfusion complicated with type A acute aortic dissection

Type A acute aortic dissection (AAAD), involving the ascending aorta, is one of life-threatening disorders. Emergent surgery, such as graft replacement of the aortic root, ascending aorta, aortic arch, or these combinations, is routinely performed to avoid sudden death due to free rupture, cardiac tamponade, or coronary obstruction. Even though appropriate surgery is immediately completed, however, operative mortality remains high, between 15% and 30%. Furthermore, mesenteric malperfusion, bringing about enteric ischemia, occurs unusually in AAAD with far and away higher mortality. In the present article, we reviewed contemporary evidence regarding incidence, mortality, and treatment of mesenteric malperfusion complicated with AAAD. The incidence and early mortality rate of mesenteric malperfusion complicated with AAAD was 4% and 68%, respectively. Patients with mesenteric malperfusion had a 9.7-fold risk of mortality relative to those without it. Evidence regarding optimal treatment of mesenteric malperfusion complicated with AAAD is very limited.

Aortoduodenal syndrome

Duodenal obstruction caused by abdominal aortic aneurysm (AAA), i.e. "aortoduodenal syndrome," first described by Osler in 1905 is a rare clinical entity, with only several dozens of cases reported in the literature. In the present paper, we systematically searched literature and reviewed them. Databases including MEDLINE and EMBASE were searched from January 1981 to April 2014 using Web-based search engines (PubMed and OVID). Eighteen papers reported 21 cases with aortoduodenal syndrome. Mean age of patients was 74.5±8.4 years, 71.4% of patients were men, and mean AAA diameter was 7.2±2.1 cm. We also discussed confusion between aortoduodenal syndrome and "superior mesenteric artery syndrome" associated with AAA.

A contemporary meta-analysis of the association of diabetes with abdominal aortic aneurysm

AIM

Aim of the present study was to determine whether diabetes is independently and inversely associated with prevalence of abdominal aortic aneurysm (AAA). We performed a meta-analysis of contemporary literature in which adjusted (but not unadjusted) relative risk estimates are available.

METHODS

MEDLINE and EMBASE were searched from January 1999 to April 2014 using Web-based search engines (PubMed and OVID). Studies considered for inclusion met the following criteria: the design was a prospective-cohort, population-screening, or case-control study; the study population was individuals with and without diabetes or AAA; and outcomes included adjusted (but not unadjusted) relative risks for prevalence/incidence of AAA in patients with diabetes versus subjects without diabetes. Study-specific adjusted relative risk estimate were combined using inverse variance-weighted average of logarithmic odds ratios (or hazard ratios) in the random-effects model.

RESULTS

Of 324 potentially relevant articles screened initially, 13 eligible studies were identified and included. A pooled analysis of all the 13 studies demonstrated that diabetes was significantly associated with lower prevalence of AAA (odds ratio, 0.59; 95% confidence interval, 0.52 to 0.67; P<0.00001). When data from 6 prospective-cohort, 5 population-screening, and 2 case-control studies were separately pooled, diabetes was also significantly associated with lower prevalence of AAA (P for subgroup differences =0.05).

CONCLUSION

Diabetes appears to be inversely associated with prevalence of AAA.

A meta-analysis of the association of obesity with abdominal aortic aneurysm presence

AIM

The aim of this paper was to determine whether obesity is associated with abdominal aortic aneurysm (AAA) presence. We performed the first meta-analysis of currently available studies.

METHODS

MEDLINE and EMBASE were searched through January 2014. Eligible studies were comparative studies comparing body mass index (BMI) in patients with AAA to that in subjects without AAA or estimating a relative risk of AAA prevalence for subjects with obesity (high BMI).

RESULTS

Of 183 potentially relevant articles screened initially, 19 eligible studies enrolling 29,120 patients with AAA and 3,163,575 subjects without AAA were identified and included. A pooled analysis demonstrated no statistically significant difference between BMI in the AAA group and that in the control group: mean difference, 0.46 kg/m2; 95% confidence interval, -0.07 to 1.00 kg/m2; P=0.09. Another pooled analysis demonstrated that obesity was unassociated with a statistically significant increase in AAA prevalence: odds ratio, 1.07; 95% confidence interval, 0.94 to 1.22; P=0.30. There was no evidence of significant publication bias: P=0.69 and 0.90 for mean difference and odds ratio, respectively.

CONCLUSION

Obesity appears to be unassociated with AAA presence.

A meta-analysis of circulating homocysteine levels in subjects with versus without abdominal aortic aneurysm

The aim of this paper was to summarize the present evidence for an association between circulating total homocysteine (tHcy) levels and abdominal aortic aneurysm (AAA) presence, we performed a meta-analysis. MEDLINE and EMBASE were searched through December 2013. Search terms included homocysteine, hyperhomocysteinemia, hyperhomocysteinaemia, and abdominal aortic aneurysm. Eligible studies were case-control or population-screening studies reporting circulating tHcy levels in cases with AAA and subjects without AAA. For each study, data regarding plasma or serum tHcy levels in both the AAA and control groups were used to generate standardized mean differences (SMDs) and 95% confidence intervals (CIs). Further, adjusted and unadjusted odds ratios (ORs) with 95% CI of AAA incidence for subjects with hyperhomocysteinemia were extracted. Of 42 potentially relevant articles screened initially, 9 eligible studies enrolling 1643 cases with AAA and 5460 subjects without AAA were identified and included. A pooled analysis demonstrated significantly greater circulating tHcy levels in the AAA than control group (SMD, 0.58; 95% CI, 0.36 to 0.79; P<0.00001). Another pooled analysis demonstrated a statistically significant 3.1-fold increase in AAA incidence for subjects with hyperhomocysteinemia (OR, 3.07; 95% CI, 1.59 to 5.92; P=0.0008). In conclusion, greater circulating tHcy levels are associated with AAA presence.

A meta-analysis of the association of primary abdominal wall hernia with abdominal aortic aneurysm

AIM

Aim of the study was to determine whether primary abdominal wall hernia (AWH) is associated with abdominal aortic aneurysm (AAA) presence, we performed a meta-analysis of studies investigating the association with primary AWH and AAA.

METHODS

Medline and Embase were searched through January 2014 using Web-based search engines (PubMed and OVID). Studies considered for inclusion met the following criteria: the design was a comparative study; the study population was patients with AAA and subjects without AAA or patients with primary AWH and subjects without primary AWH; and outcomes included primary AWH incidence in both the AAA and control groups or AAA incidence in both the primary AWH and control groups. For each study, data regarding primary AWH incidence in both the AAA and control groups were used to generate unadjusted odds ratio (OR) and 95% confidence intervals (CIs).

RESULTS

Of 151 potentially relevant articles screened initially, 14 eligible studies were identified and included. A pooled analysis of all the 14 studies demonstrated significantly higher primary AWH incidence in the AAA group than that in the control group in the random-effects model (OR 2.32; 95% CI, 1.72 to 3.14; P for effect <0.00001; P for heterogeneity <0.00001). When data from 5 studies reporting adjusted ORs and other 9 studies were combined separately, primary AWH was significantly associated with AAA presence. Eliminating 3 large-size population-based studies did not substantially change the pooled estimate.

CONCLUSION

Primary AWH appears to be associated with AAA presence.

Hyperhoneycomb Iridate β-Li2IrO3 as a platform for Kitaev magnetism

A complex iridium oxide β-Li(2)IrO(3) crystallizes in a hyperhoneycomb structure, a three-dimensional analogue of honeycomb lattice, and is found to be a spin-orbital Mott insulator with J(eff)=1/2 moment. Ir ions are connected to the three neighboring Ir ions via Ir-O(2)-Ir bonding planes, which very likely gives rise to bond-dependent ferromagnetic interactions between the J(eff)=1/2 moments, an essential ingredient of Kitaev model with a spin liquid ground state. Dominant ferromagnetic interaction between J(eff)=1/2 moments is indeed confirmed by the temperature dependence of magnetic susceptibility χ(T) which shows a positive Curie-Weiss temperature θ(CW)∼+40  K. A magnetic ordering with a very small entropy change, likely associated with a noncollinear arrangement of J(eff)=1/2 moments, is observed at T(c)=38  K. With the application of magnetic field to the ordered state, a large moment of more than 0.35  μ(B)/Ir is induced above 3 T, a substantially polarized J(eff)=1/2 state. We argue that the close proximity to ferromagnetism and the presence of large fluctuations evidence that the ground state of hyperhoneycomb β-Li(2)IrO(3) is located in close proximity of a Kitaev spin liquid.

A large ovarian leiomyoma discovered incidentally in a 76-year-old woman: case report

BACKGROUND

Ovarian leiomyoma is very rare type of ovarian tumor. This benign tumor is seen in the pediatric age group to premenopausal women.

CASE

A 76-year-old woman had a huge leiomyoma (19 x 11 x 10 cm) of the right ovary. The preoperative diagnosis was difficult to distinguish from a broad ligament leiomyoma or ovarian cancer.

CONCLUSIONS

Although theses tumors are benign, its extreme rarity led us to report an additional and rather unusual case of ovarian leiomyoma, and to focus some attention on this type of tumor.

Premenstrual syndrome: management and pathophysiology

Premenstrual syndrome (PMS) is triggered by hormonal events ensuing after ovulation. The symptoms can begin in the early, mid, or late luteal phase and are not associated with defined concentrations of any specific gonadal or non-gonadal hormone. Women with PMS experience affective or somatic symptoms that cause severe dysfunction in social or occupational realms. Although evidence for a hormonal abnormality has not been established, the symptoms of the premenopausal disorders are related to the production of progesterone by the ovary. The progesterone metabolites may bind to a neurosteroid-binding site on the membrane of the neurotransmitters. Thus, ovulation suppression is an area of focus for diagnostic and treatment options. Many treatment studies have focused on suppression of ovulation with gonadotropin-releasing hormone analogs (GnRHa), high doses of transdermal estrogen, and bilateral oophorectomy all have positive evidence as treatment options for prevention of PMS. However, because of these limitations and their substantial intensive care, these do not appear to be appropriate methods for conventional treatment of PMS. Serotonergic antidepressants, selective serotonin reuptake inhibitors, are well-established, highly effective, and first-line pharmacologic therapy.

Spin-orbit fluctuations in frustrated heavy-fermion metal LiV(2)O(4)

Spin fluctuations were studied over a wide momentum (ℏQ) and energy (E) space in the frustrated d-electron heavy-fermion metal LiV_{2}O_{4} by time-of-flight inelastic neutron scattering. We observed the overall Q-E evolutions near the characteristic Q=0.6  Å^{-1}  peak and found another weak broad magnetic peak around 2.4  Å^{-1}. The data are described by a simple response function, a partially delocalized magnetic form factor, and antiferromagnetic short-range spatial correlations, indicating that heavy-fermion formation is attributable to spin-orbit fluctuations with orbital hybridization.

Meteorology in ruptured abdominal aortic aneurysm: an institutional study and a meta-analysis of published studies reporting atmospheric pressure

The aim of this paper was to determine whether weather factors including atmospheric pressure are associated with the occurrence of ruptured abdominal aortic aneurysm (RAAA). We investigated our institutional experiences of RAAA in more than 150 patients during 8 years. Further, we performed a meta-analysis of published studies reporting the influence of atmospheric pressure on RAAA. We retrospectively evaluated 152 patients who underwent surgery for RAAA (including ruptured iliac arterial aneurysm) at our institute between 1 January 2006 and 31 December 2013. Daily regional meteorological data (in the nearest weather station located 3.5 km from the hospital) were obtained online from Japan Meteorological Agency. To identify comparative studies of mean atmospheric pressure on the day with RAAA versus that on the day without RAAA, MEDLINE and EMBASE were searched through January 2014 using Web-based search engines (PubMed and OVID). Mean sea level atmospheric pressure, delta mean atmospheric pressure (difference between mean sea level atmospheric pressure on the day and that on the previous day), and sunshine duration on the day with RAAA were significantly lower than those on the day without RAAA: 1012.43±7.44 versus 1013.71±6.49 hPa, P=0.039, -1.18±5.15 versus 0.05±5.62 hPa, P=0.005; and 4.76±3.76 versus 5.47±3.88 h, P=0.026; respectively. A pooled analysis of 8 studies (including our institutional study) demonstrated that mean atmospheric pressure on the day with RAAA was significantly lower than that on the day without RAAA: standardized mean difference, -0.09; 95% confidence interval, -0.14 to -0.04; P=0.0009. Atmospheric pressure on the day with RAAA appears lower than that on the day without RAAA. Atmospheric pressure may be associated with the occurrence of RAAA.