Change in sense of food safety associated with social connectedness and information sources-A 10-year longitudinal survey before and after the Fukushima nuclear power plant accident

OBJECTIVES

This study analyzes the change in the sense of food safety over time, from 2 years before to 8 years after the Fukushima accident in 2011, and its association with social connectedness using cohort data, taking into account regional differences in Fukushima Prefecture.

STUDY DESIGN

Repeated cross-sectional data from Fukushima Prefectural Government from 2009 to 2018 were used.

METHODS

We randomly selected 1300 people every fiscal year (FY). The survey gathered data on age, gender, occupation, residential region, and the explanatory variables 'sense of social connectedness' and 'recovery-related information source' (information source). The prefecture was divided into three regions for the survey-Hamadori region, where the nuclear power plant is located, Nakadori region, where the air dose rate after the earthquake was high, and in Aizu, far from the nuclear power station but has suffered from harmful rumors.

RESULTS

Focusing on FY 2014, when the sense of safety first showed recovery, we performed a binominal logistic regression analysis with 'sense of safety' as the outcome and 'sense of social connectedness' and 'information source' as the explanatory variables. The sense of safety significantly decreased in all regions in 2011 relative to earlier years. The sense of food safety decreased markedly in Hamadori and Nakadori but started to improve 3 years after the earthquake and reached the pre-earthquake level in 2018. The effect sizes were larger in the Hamadori region and in Nakadori than in Aizu. In FY 2014, multivariate analysis found that a sense of food safety was significantly positively associated with a sense of social connectedness, whereas the use of information from newspapers and TV and word of mouth was negatively associated.

CONCLUSION

Although the recovery of a sense of food safety may take some time, a focus on social connectedness during recovery and scrutiny of information sources may facilitate recovery. Health communication has an important role when the provider sends information intelligibly and the recipient can distinguish good news from bad and link it to self-determination. It is necessary to improve literacy.

Trabeculotomy combined with phacoemulsification and implantation of intraocular lens for primary open-angle glaucoma

Retrospective study examined the surgical effects of lowering intraocular pressure of trabeculotomy combined with phacoemulsification and implantation of an intraocular lens. Included in the retrospective study were 96 eyes of 64 patients with primary open-angle glaucoma. Preoperative mean IOP was 25.6 mmHg. At final examination, the IOP was well-controlled at 21 mmHg or lower without medications in 32 of 96 eyes. In another 62 eyes, the IOP was well-controlled with antiglaucoma medications. The postoperative IOPs were in the high teens after surgery. The life table analysis using Kaplan-Meier methods showed that the success probability after phacoemulsification and implantation of intraocular lens, combined with trabeculotomy (PIT)-I and PIT-II, were 93.9% and 82.6% at 4 years, respectively. Postoperative visual acuity improved by more than two lines in 79 of the 96 eyes. In no case was the visual acuity decreased by more than two lines. Deterioration of the visual field was found in 4 eyes. There were no complications such as shallow anterior chamber, choroidal detachment, malignant glaucoma, hypotonic maculopathy, and endophthalmitis. This triple procedure should be performed in the early stages of glaucoma. Trabeculotomy is thought to relieve the resistance to aqueous outflow by mechanical cleavage of the trabecular meshwork and the inner layer of Schlemm's canal. This technique leads to aqueous outflow the from the opening of the internal trabecular meshwork to the collector channel. For this reason trabeculotomy was developed by a number of surgeons. Recently, however, trabeculotomy has not been selected for those patients with advanced stages of primary open-angle glaucoma because of the disadvantages such as transient intraocular pressure (IOP) elevation several days after surgery and somewhat higher levels (18 mmHg) of postoperative intraocular pressure (Fig. 1). To avoid the IOP spike (transient IOP elevation) after trabeculotomy, we reported previously that the new technique of trabeculotomy combined with outer sclerectomy was a useful surgical option. The results of our previous study indicated that the postoprative intraocular pressure levels after combined trabeculotomy and outer sclerectomy were significantly lower than that of trabeculotomy alone. On the other hand, trabeculotomy with mitomycin C is currently the standard filtration procedure for glaucoma. This technique, however causes severe postoperative complication such as hypotonic maculopathy, bleb leakage and late bleb infection. The major advantages of trabeculotomy preclude these severe complications resulting from creating progressive filtration of aqueous humor from the anterior chamber to the subconjunctival space. The recent advance of small-incision phacoemulsification procedure prompted phacoemulsification and implantation of intraocular lens and trabeculotomy. The theoretical advantages of smaller scleral, conjunctival incision, reduced stimuli to wound healing, and inflammation, could improve long-term IOP control in patients with glaucoma. Therefore several reports have been published on the surgical outcomes of combined trabeculotomy and modern phacoemulsification. These reports suggested that the combined trabeculotomy and a small-incision with intraocular lens implantation is effective in controlling IOP in patients with glaucoma.

Advanced nonpenetrating trabeculectomy (advanced NPT) and combined surgery of advanced NPT and phacoemulsification and intraocular lens implantation

We have devised a new glaucoma surgery combining deep sclerectomy with nonpenetrating trabeculectomy (NPT); we call this surgery advanced NPT. We evaluated intraocular pressure (IOP) control, postoperative complication and visual acuity after combined advanced NPT and phacoemulsification and intraocular lens implantation (combined surgery), and advanced NPT alone. The mean preoperative IOP for the trabeculectomy only group was 22.4 +/- 6.3 mmHg(bleb+), 23.0 +/- 4.9 mmHg(bleb-), and that of the combined surgery group was 18.1 +/- 4.5 mmHg(bleb+), 18.5 +/- 2.6 mmHg(bleb-). Mean postoperative IOP for the two groups were 13.0 +/- 2.3 mmHg(bleb+), 15.0 +/- 1.5 mmHg(bleb-) and 12.9 +/- 2.7 mmHg(bleb+), 13.3 +/- 2.4 mmHg(bleb-), respectively. After 15 months, the success probability for postoperative IOP control were 63%(bleb+), 23%(bleb-) in the advanced NPT only group (<or=12 mmHg), and 60% in the advanced NPT only group, 70% in the combined surgery group (<or=14 mmHg) (Kaplan-Meier survival rate). In early complication, there were significantly fewer cases of shallow anterior chamber, hypertension, hypotension and anterior chamber inflamation in both groups than that of trabeculectomy. Nd:YAG goniopuncture was performed for purposes of better IOP control; preferred performance being within a month after surgery. Regarding visual acuity after either advanced NPT alone or combined surgery, an earlier recovery can be expected than with trabeculectomy. Advanced NPT and combined procedure is a reliable technique for glaucoma and cataract surgery.

Trabeculectomy combined with phacoemulsification and intraocular lens implantation

It has recently become popular to use mitomycin C (MMC) with trabeculectomy. MMC helps to maintain effective filtration and long-term intraocular pressure (IOP) control, while the use of laser suture lysis has improved the safety of this procedure. We evaluated the outcome of trabeculectomy alone and of trabeculectomy plus phacoemulsification (PEA) and intraocular lens (IOL) implantation, each supplemented with MMC. The mean preoperative IOP for the trabeculectomy alone group was 22.4 +/- 3.2 mmHg(bleb+), 25.3 +/- 2.6 mmHg(bleb-), and that of the combined surgery group was 22.4 +/- 2.8 mmHg(bleb+), 21.0 +/- 3.5 mmHg(bleb-). Mean postoperative IOP for the two groups were 13.3 +/- 2.7 mmHg(bleb+), 17.1 +/- 4.4 mmHg(bleb-) and 11.9 +/- 2.7 mmHg(bleb+), 16.4 +/- 3.4 mmHg(bleb-), respectively. After 4.5 years, the success probability for postoperative IOP control was 38%(bleb+), 3%(bleb-) in the trabeculectomy alone group and 53%(bleb+), 10%(bleb-) in the combined surgery group (<or=12 mmHg) and 65%(bleb+), 3%(bleb-) and 75%(bleb+), 10%(bleb-) (<or=14 mmHg)(Kaplan-Meier survival rate). With early complications, the frequency of shallow anterior chamber and choroidal detachment were significantly fewer in the combined surgery group. The combined surgery of PEA, IOL implantation and trabeculectomy is an effective procedure that offers visual rehabilitation, fewer early complications and good IOP control in patients with advanced, medically uncontrolled glaucoma and cataract.

Surgically-induced astigmatism following single-site phacotrabeculectomy, phacotrabeculotomy and advanced non-penetrating phacotrabeculectomy

We study surgically-induced astigmatism following three kinds of glaucoma surgeries combined with cataract surgery with 6 months of follow-up. The mean surgically-induced astigmatism at 6 months postoperatively was 1.92 +/- 1.87 diopters in phacotrabeculectomy (n = 45), 0.72 +/- 0.40 diopters in advanced non-penetrating phacotrabeculectomy (n = 40) and 0.76 +/- 0.47 diopters in phacotrabeculotomy (n = 49), which appeared to be stabilized by 3 months. Each group revealed a tendency of "with the wound" induced astigmatism. Phacotrabeculectomy could induce greater surgically-induced astigmatism than advanced non-penetrating phacotrabeculectomy and phacotrabeculotomy.

Characterization of the small subgenomic RNA of Soybean dwarf virus

We have characterized a small subgenomic RNA of Japanese strains of Soybean dwarf virus (SbDV). Northern blot analyses of SbDV-infected plants showed that the small RNA contained the 3' terminal sequence of the genome and was detected in four typical Japanese SbDV strains, YS, YP, DS and DP. In the case of SbDV-DS, the RNA was 220 nucleotides in length and was transcribed from the 3' terminal region of the genome. This RNA appeared at a similar time to genomic RNA and a large sgRNA, and thereafter persisted in the infected plant. Since no conserved open reading frame (ORF) among the strains was postulated in the 3' terminal region, the small subgenomic RNA may have some regulatory roles in SbDV infections.

Comparison of complete nucleotide sequences of genomic RNAs of four Soybean dwarf virus strains that differ in their vector specificity and symptom production

Soybean dwarf virus (SbDV) is divided into four strains, namely YS, YP, DS and DP. YS and YP cause yellowing in soybeans, while DS and DP cause dwarfing. YS and DS are transmitted by Aulacorthum solani, while YP and DP are transmitted by Acyrthosiphon pisum. To clarify the taxonomic relationship between the four strains and to classify SbDV into an appropriate genus in the Luteoviridae, we determined the complete nucleotide sequences of genomic RNAs of four isolates belonging to each of the strains. The genomes of the four isolates had a chimeric form between Barley yellow dwarf virus-PAV and poleroviruses, and the genome organizations were similar to the Australian isolate SbDV Tas-1. In all of the non-coding regions and ORFs, nucleotide and deduced amino acid sequence identity between the same symptom-type strains was higher than that between the different symptom-type strains. However, in the N-terminal half of the readthrough domain (RTD) the deduced amino acid identity between the same aphid transmissibility-type strains was higher than that between the different aphid transmissibility-type strains. These data suggest that the N-terminal half of the RTD is closely related to the aphid transmission specificity, and that the present strains were generated from ancestral Y and D strains by mutations and strong selection pressures of efficient aphid transmission. Therefore, we propose that SbDV should be classified into a new genus in the family Luteoviridae and that the four strains described should be regarded as different strains of the same virus, rather than as distinct virus species.

EXAFS study of phase transitions in KIO3

The iodine K-edge EXAFS study of KIO3 was performed to clarify local structural changes on the successive phase transitions. The pair-distribution function of three oxygen atoms in an oxygen octahedron is almost independent on temperature like a covalent bond, whereas that of the other three is gradually reduced with increasing temperature like an ionic bond. The result indicates that iodine and oxygen atoms exist as an IO3- molecule in a pseudo-perovskite-type structure. The anomalous behavior in the Debye-Waller factor for the latter pair-distribution function appears around 50 K, which is associated with the orientational glass transition.

EXAFS study of glass transition in K1-x(NH4)xI

The iodine K-edge EXAFS study of K1-x(NH4)xI mixed crystals was performed to clarify the local structure of the dipole glass associated with the random reorientational freezing of ammnonium ions. The pair-distribution function of the nearest iodine-iodine ions is strongly reduced with increasing ammonium concentration. The reduction originates in the local distortion of lattice induced by the short-range antiferroelectric order of ammonium ions. We discuss the relationship between the reorientational freezing of ammonium ions and the local distortion of lattice in comparison with the results of X-ray diffraction measurements.

Deglitching procedure for XAFS

A computer program for eliminating artifacts such as glitches and Bragg peaks of the polarized XAFS spectra is presented. It permits to easily locate and to eliminate from the EXAFS spectra the additional signals originated from the Bragg scattering by crystalline samples. The test of the procedure on the spectra with specially introduced artifacts and on the experimental polarized XAFS spectra showed its high effectiveness.

Polarized XAFS study of high-temperature phases of NaNbO3

Temperature dependence of the Nb displacement relative to the center of oxygen octahedron in NaNbO3 has been studied by polarized Nb K XAFS. Spectra were measured at two orientations of a single crystalline sample. Room temperature EXAFS data are in a good agreement with earlier X-ray diffraction data: Nb antiferroelectric displacements were found to be orthogonal to the b axis. Analysis of the temperature dependent EXAFS data didn't reveal any abrupt changes of Nb-O distances in the phase transition points. In all high-temperature paraelectric phases Nb appeared to be displaced to the off-center positions. Displacements, orthogonal to b axis, remained almost constant, while displacement along b axis gradually increased with temperature, so that in the cubic phase the displacements along all axes became equal. This shows, that disorder plays an important role in the high temperature phases. The above results are supported also by the analysis of the pre-edge structure, - the integral intensity of the pre-edge peak was temperature-independent when the polarization vector of the X-rays was orthogonal to b axis and gradually increased with temperature when the polarization was parallel to b.

Surgical effects of combined trabeculotomy and sinusotomy compared to trabeculotomy alone

PURPOSE

To elucidate long-term surgical results and problems of combined trabeculotomy and sinusotomy in comparison with trabeculotomy alone.

METHODS

The study included 91 glaucomatous eyes in 57 patients with primary open angle glaucoma, who underwent either combined trabeculotomy and sinusotomy (40 eyes) or trabeculotomy alone (51 eyes). The mean follow-up period (+/-standard deviation) was 46.1+/-10.4 months (range: 30 to 60 months).

RESULTS

At the final examination, in 37 (93%) of the 40 eyes after combined trabeculotomy and sinusotomy and in 40 (78%) of the 51 eyes after trabeculotomy alone, intraocular pressures were well controlled. The mean intraocular pressures at the end of the first postoperative year were 15.6+/-3.0 mmHg in the 40 eyes after the combined procedure, and 17.8+/-3.1 mmHg in the 51 eyes after trabeculotomy alone (p=0.0001, unpaired t-test). Complications included Descemet's membrane detachment in 1 eye (3%) and 4 eyes (8%), and transient elevation of intraocular pressure to higher than 30 mmHg (IOP spike) in 6 eyes (15%) and 11 eyes (22%), respectively, after the combined procedure and trabeculotomy alone.

CONCLUSION

Combined trabeculotomy and sinusotomy is a useful surgical modality for the treatment of primary open angle glaucoma to obtain lower intraocular pressure levels than those after trabeculotomy alone.

Extracapsular cataract extraction with a sutureless incision for dense cataracts

PURPOSE

To evaluate the use of extracapsular cataract extraction (ECCE) via a sutureless incision for dense cataracts.

SETTING

Nagata Eye Clinic, Nara, Japan.

METHODS

This retrospective study comprised 51 eyes of 45 consecutive patients with dense cataracts who had ECCE with a sutureless incision between January 1996 and April 1998. A scleral incision from 6.0 to 8.5 mm was made at 12 o'clock or between 9 and 12 o'clock (oblique incision). Measures of outcome included postoperative visual acuity, surgically induced astigmatism (polar value method and vector analysis), complications, and changes in corneal endothelial cell density and morphology.

RESULTS

Self-sealing was achieved in 45 eyes (88.2%), but additional sutures were required in 6 (11.8%). Intraoperative complications included posterior capsule rupture in 3 eyes (5.9%) and iris prolapse in 2 (3.9%). Corneal flattening against the preoperative steep meridian was observed in the 12 o'clock incision group (0.24 diopter [D] +/- 1.23 [SD]) and in the oblique incision group (0.17 +/- 0.89 D). By vector analysis, the surgically induced vector was 1.41 +/- 0.72 D in the 12 o'clock incision group and 1.02 +/- 0.66 D in the oblique incision group. After surgery, the mean cell loss was 8.2% +/- 12.5%. There were no significant differences, however, between other preoperative and postoperative morphometric indexes.

CONCLUSION

This fast, safe, and inexpensive technique may be a viable treatment for dense cataracts with large, hard nuclei.

First results from the crystal structure analysis beamline at SPring-8

Results from the first measurements at the crystal structure analysis beamline (BL02B1) at SPring-8 are presented. The capabilities of this beamline are also discussed.

[The long-term cystic bleb appearance and safety after trabeculectomy with mitomycin C]

The clinical appearance of cystic blebs and the incidence of bleb infection were retrospectively evaluated in 215 trabeculectomies with mitomycin C. The incidence of cystic bleb formation in trabeculectomy was 79% (169/215). The cumulative incidence of the cystic bleb survival when using the Kaplan-Meier method was 73% in the 50th month after surgery. The incidence of large cystic bleb survival was better than that of small and localized cystic blebs. There was statistically significant difference. The incidence of cystic bleb survival without Seidel phenomenon and bleb infection was 96% in the first year after surgery and 91% in the third year. Bleb infections occurred in two of 169 eyes (1.2%). Bleb infection was successfully treated and there were no cases of endophthalmitis. The large cystic blebs had a higher incidence of bleb infection than the small ones. In one of 25 eyes treated with antibiotic eye drops after surgery, the Seidel test was positive and bleb infection occurred. The Seidel test was positive in 5 of 96 eyes in which antibiotic eye drops were not used and bleb infection occurred in one of these 5 eyes.

Nicotinamide derivatives as a new class of gastric (H+/K+)-ATPase inhibitors. III. Synthesis and gastric antisecretory activity of 2-[(2- and 4-aminobenzyl, and alpha-methylbenzyl)sulfinyl]-N-(4-pyridinyl) -3-pyridinecarboxamides

A new series of 2-[(2-aminobenzyl, 4-aminobenzyl, and alpha-methylbenzyl) sulfinyl]-N-(4-pyridinyl)-3-pyridinecarboxamides. was synthesized and evaluated for gastric antisecretory activities. Several of the compounds synthesized exhibited potent inhibitory activities against [14C]aminopyrine accumulation stimulated by dibutyryl cyclic AMP in isolated rabbit parietal cells and histamine-induced gastric acid secretion in pylorus-ligated rats by intraduodenal administration. In particular, the more polar diastereoisomer of 2-[(4-methoxy-alpha-methylbenzyl)sulfinyl] -N-(4-pyridinyl)-3-pyridinecarboxamide (13b) showed in vivo inhibitory activity equivalent or superior to that of omeprazole and was a more selective (H+/K+)-ATPase inhibitor than omeprazole.

Nicotinamide derivatives as a new class of gastric (H+/K+)-ATPase inhibitors II. Synthesis and structure-activity relationships of 2[(2,4-dimethoxybenzyl)sulfinyl]-N-(4-pyridinyl)pyridine-3-carboxamides

Members of a new series of 2-[(2,4-dimethoxybenzyl)sulfinyl]-N-(4-pyridinyl)pyridine-3-carboxamides were synthesized and evaluated for their gastric antisecretory activity and the ability to inhibit cytochrome P450-dependent O-dealkylation of 7-ethoxycoumarin (7-EC) in rat liver microsomes. Several of the compounds synthesized exhibited potent inhibitory activities against both [14C]aminopyrine accumulation stimulated by dibutyryl cyclic AMP in isolated rabbit parietal cells and histamine-induced gastric acid secretion in pylorus-ligated rats when administered intraduodenally; their inhibitory activities were equivalent to or superior to those of the parent compound [2- [(2,4-dimethoxybenzyl)sulfinyl]-N-(4-pyridinyl)pyridine-3-carboxamide] and omeprazole. Among the compounds having potent antisecretory activity in vitro and in vivo, 2-[(2,4-dimethoxybenzyl)sulfinyl]-N-(2,5-dimethyl-4-pyridinyl) pyridine-3-carboxamide and 2-[(2,4-dimethoxybenzyl)sulfinyl]-N-(2,6-dimethyl-4-pyridinyl)pyridine-3 - carboxamide in particular showed lower inhibitory activity against the 7-EC deethylase than omeprazole. It seems probable that, unlike omeprazole, these compounds do not interact with a metabolism of other drugs in vivo. These compounds, therefore, are considered to be more promising candidate agents for treating acid-related gastrointestinal disorders than the parent compound reported previously.

Nicotinamide derivatives as a new class of gastric H+/K(+)-ATPase inhibitors. 1. Synthesis and structure-activity relationships of N-substituted 2-(benzhydryl- and benzylsulfinyl)nicotinamides

A new series of N-Substituted 2-(benzhydryl- and benzylsulfinyl)nicotinamides 7 and 8 were synthesized. Upon acid activation in the acidic environment of the parietal cell, these compounds are converted into their active forms, 2,3-dihydro-3-oxoisothiazolo[5,4-b]pyridines 5, which inhibit gastric H+/K(+)-ATPase. Inhibitory activities against [14C]aminopyrine accumulation stimulated by dibutyryl cAMP in isolated rabbit parietal cells in vitro and histamine-induced gastric acid secretion in pylorus-ligated rats by intraduodenal administration in vivo were evaluated, and the structure-activity relationships were examined. Among the compounds synthesized, 2-[(2,4-dimethoxybenzyl)sulfinyl]-N-(4-pyridyl)nicotinamide (8b) showed potent inhibitory activities in vitro and in vivo equivalent to those of omeprazole, a typical H+/K(+)-ATPase inhibitor. Moreover, 8b was much more stable at neutral and weakly acidic pH than omeprazole, lansoprazole, and pantoprazole. Compound 8b is considered to be a promising agent for treating acid-related gastrointestinal disorders.

[Surgical effects of trabeculotomy combined with sinusotomy in advanced glaucoma patients controlled in normal intraocular pressure of 15 mmHg or higher]

Trabeculotomy combined with sinusotomy was performed in 30 eyes with advanced open angle glaucoma, whose intraocular pressure (IOP) had been controlled in their high teens with only topical medications. The mean pre- and postoperative IOP levels were 18.2 +/- 1.2 mmHg (mean +/- standard deviation) and 13.2 +/- 1.2 mmHg and the pressure reduction was 4.6 +/- 2.4 mmHg. Average pressure reduction was 28.8 +/- 9.3% and pressure reduction of 30% or more was obtained in 45% of the treated eyes. The pre- and postoperative medication scores were 4.47 +/- 1.50 and 3.07 +/- 1.17, respectively. There was statistically significant difference between the pre- and postoperative medication score. We had no cases in which the IOP reduction was greater than 9 mmHg and postoperative IOP was 9 mmHg or less. A 3-line drop in visual acuity was seen in only one eye. Twenty two of 30 eyes (73%) were controlled at 14 mmHg or less with medications at the last examination. These results show that trabeculotomy combined with sinusotomy in effective, and this procedure can be considered as an alternative choice for surgical treatment in advanced glaucoma.

[Intraocular pressure decrease after phacoemulsification-aspiration+ intraocular lens implantation in primary open angle glaucoma eyes]

Phacoemulsification-aspiration and intraocular lens implantation (PEA + IOL) were carried out in 40 primary open angle glaucoma (POAG) eyes without history of surgery and 53 control (cataract only) eyes. Postoperative change in intraocular pressure (IOP) was evaluated over a long period (at least 18 months, average follow-up period 34 months). The postoperative IOP was significantly lower than the preoperative level in every group from 6 months to 3 years. An IOP decrease of 1.5 mmHg was maintained for 3 years in the control group. A decrease of 2.5 mmHg was stable for 3 years in the good POAG group in which preoperative IOP was controlled (< or = 20 mmHg) with medication. IOP decrease in the poor POAG group in which preoperative IOP was over 21 mmHg with medication, was 5.5 mmHg, and was maintained for 3 years. Medication did not differ significantly before or after the operation. These results imply that in POAG an IOP decrease can be expected after PEA + IOL.

[Long-term surgical effects of trabeculotomy combined with sinusotomy]

We retrospectively analyzed long-term effects of trabeculotomy combined with sinusotomy. We reviewed 29 eyes with primary open angle glaucoma and 6 eyes with psuedexfoliation glaucoma. The preoperative intraocular pressure was equal to or over 21 mmHg. All cases had been subjected to initial trabeculotomy combined with sinusotomy. The had been followed up for at least 3 years after surgery. The mean age was 57.8 years and the mean follow-up period was 40.5 months. The preoperative intraocular pressure was 24.3 +/- 5.9 mmHg (Mean +/- standard deviation) and the postoperative intraocular pressure was 15.8 +/- 3.8 mmHg. There was statistically significant difference between preoperative and postoperative intraocular pressure. The Kaplan-Meier life table method indicated a success rate at 50 months after surgery of 0.63 +/- 0.15, as defined by intraocular pressure of 20 mmHg or lower, and of 0.35 +/- 0.08 as defined by intraocular pressure equal to or lower than 14 mmHg. The success rate of filtering blebs was 0.10 +/- 0.05 at 50 months. Eleven of 35 eyes (37%) were controlled at equal to or below 14 mmHg and 20 of 35 (67%) eyes were controlled at equal to or lower than 16 mmHg at final postoperative intraocular pressure. The surgical results of trabeculotomy combined with sinusotomy remain effective in controlling intraocular pressure levels for long periods.

Development of potent serotonin-3 (5-HT3) receptor antagonists. II. Structrue-activity relationships of N-(1-benzyl-4-methylhexahydro-1H-1,4- diazepin-6-yl)carboxamides

Our studies on 4-amino-5-chloro-2-ethoxybenzamides led to the discovery that the N-(1,4-dimethylhexahydro-1H-1,4-diazepin-6-yl)benzamide 9 and the 1-benzyl-4-methylhexahydro-1H-1,4-diazepine analogue 10 are potent serotonin-3 (5-HT3) receptor antagonists. Structure-activity relationship (SAR) studies on the influence of the aromatic nucleus of 9 and 10 upon inhibition of the von Bezold-Jarisch reflex in rats are described. Heteroaromatic rings such as pyrrole, thiophene, furan, pyridine, pyridazine, 1,2-benzisoxazole, indole, quinoline, and isoquinoline rings showed weak 5-HT3 receptor antagonistic activity. Within this series, use of the 1H-indazole ring as an aromatic moiety led to a substantial increase of the activity; the 1H-indazolylcarboxamides 54, 57, 97, and 102 showed potent 5-HT3 receptor antagonistic activity. The optimal compound identified via extensive SAR studies was N-(1-benzyl-4-methylhexahydro-1H-1,4-diazepin-6-yl)-1H-indaz ole-3- carboxamide (54), whose effect was superior to that of the corresponding benzamide 10 and essentially equipotent to those of ondanbsetron (1) and granisetron (4).

[Surgical effects of trabeculotomy after long-term topical antiglaucoma medications]

We retrospectively analyzed the effects of long-term topical antiglaucoma therapy on the results of trabeculotomy. We studied 83 eyes with 76 primary open angle glaucoma and 7 eyes with capsular glaucoma, each of which had undergone trabeculotomy alone and none of which had a history of laser trabeculoplasty or glaucoma surgery. The outcome of trabeculotomy was assessed after a minimum follow-up of 12 months. Using a life-table method, there was no significant difference in the outcome of trabeculotomy between groups divided by duration and type of preoperative topical therapy. There was not statistically significant difference in the intraocular pressure reduction between the groups of long or short duration of topical therapy. We concluded that the duration and type of topical antiglaucoma medications had no significant effect on the outcome of trabeculotomy.

[Clinical study on total omentumectomy for ovarian cancer]

Omentumectomy as a basic surgical method at the site of metastasis of ovarian cancer was examined, and the importance of total omentumectomy was evaluated. Nineteen patients who underwent initial laparotomy and did not receive preoperative chemotherapy were examined histopathologically. 1. Omental metastasis was found in 9 of 19 patients (47%). 2. No significant correlation was seen between the maximum tumor diameter and omental metastasis. 3. No significant correlation was seen between the amount of ascites and omental metastasis. 4. Cytodiagnosis of the ascites and intraperitoneal lavage fluid showed significantly more omental metastasis in patients who tested positive. 5. Omentum in the upward direction from the teniae of the transverese colon showed a high incidence of metastasis. 6. Postoperative disturbances associated with total omentumectomy were mild. These results indicated that the omentum is the principle site of metastasis of ovarian cancer, and omentumectomy should be performed as total resection whenever possible since metastasis occurs in the upward direction because partial resection is not significant and postoperative disturbance is mild but there is the need for requiring further examination in the case of Ia stage.

[Multicenter prospective study of retinopathy of prematurity--IV. Comparison with the data from University of Miami]

We investigated the records of 360 cases of retinopathy of prematurity (ROP) in 12 institutions in Japan (we treated the severe progressive "plus" disease by coagulation therapy), and compared them with data from University of Miami (Ophthalmology 94: 620-629, 1987), as representative of the natural course of ROP without coagulation therapy in those days. The timing of the first examination and the first positive diagnosis were later at University of Miami than in Japan. The time of maximal severity of the disease and occurrence of regression were also later the University of Miami than in Japan. In Japan, the first examination was performed at 29 weeks of postconceptional age or at 3 weeks after birth. At the University of Miami, the first examination was performed at 32 weeks of postconceptional age. If the severe progressive "plus" disease is to be properly treated by photo-coagulation or cryotherapy, it is essential to commence fundus examination earlier.

[Multicenter prospective study of retinopathy of prematurity--II. Optimum timing of the first examination]

We reviewed the records of 360 cases of retinopathy of prematurity (ROP) in 12 institutions in Japan, and investigated the optimum timing of the first examination. On the basis of the onset of ROP and the timing of the first treatment, the first ophthalmological examination should be performed 3 weeks after birth or 29 weeks of postconceptional age at the latest. Regarding the visibility of the fundus, there was little hazy media after 29 weeks of postconceptional age. Under the basic policy that the severe progressive "plus" disease should be properly treated, we concluded that the first ophthalmological examination should be performed 3 weeks after birth at the latest. When the gestational age at birth is less than 26 weeks, funduscopy at the post conceptional age of 29 weeks is advisable.

[Multicenter prospective study of retinopathy of prematurity--III. Timing of the coagulation therapy and the course of retinopathy of prematurity after coagulation]

We reviewed the records of 360 cases of retinopathy of prematurity (ROP) in 12 institutions in Japan, and investigated the timing of the coagulation therapy and the course of ROP after coagulation. The first coagulation therapy was performed at 9.6 weeks after birth and 35.9 weeks of postconceptional age on the average. The severity index in individual infants also showed that the disease became worse during the period from 32 to 36 weeks of postconceptional age. However, the fundus was clearly visible and there was no primary hazy media during this period. On the basis of the results of the timing of the first treatment, the visibility of the fundus, and the severity index in individual infants, we concluded that an ophthalmological examination with special care should be performed during the period from 32 to 36 weeks of postconceptional age.

Surgical effects of trabeculotomy ab externo on adult eyes with primary open angle glaucoma and pseudoexfoliation syndrome

OBJECTIVES

Retrospective and prospective studies examined the surgical effects in lowering intraocular pressure levels of trabeculotomy ab externo in adult eyes with either primary open angle glaucoma or pseudoexfoliation syndrome. We report the results of primary trabeculotomy as an intervention for glaucoma.

PATIENTS

Included in the retrospective study were 357 eyes of 227 patients with primary open angle glaucoma and 82 eyes of 65 patients with pseudoexfoliation syndrome, each of which underwent trabeculotomy ab externo alone and none of which had a history of laser or surgical treatment for ocular disease. Included in the prospective study were 33 eyes of 22 patients with primary open angle glaucoma and 17 eyes of 15 patients (older than 40 years) with pseudoexfoliation syndrome.

RESULTS

A life-table analysis for the retrospective study showed that the final success probability (mean +/- SE) at 5 years after surgery was 73.5% +/- 6.3% in eyes with pseudoexfoliation syndrome, which is significantly better than 58.0% +/- 3.1% in eyes with primary open angle glaucoma (P < .05). Also, the higher the preoperative intraocular pressure levels are, the less likely that the postoperative intraocular pressure levels will be brought under control (P < .01). Surgical outcome in the prospective study demonstrated success in 27 (79%) of 34 eyes after 3 years and in 16 (64%) of 25 eyes after 5 years, with medication. Complications included Descemet's membrane detachment (one eye), cyclodialysis (one eye), and decreased visual acuity due to progression of cataract (four eyes).

CONCLUSION

The surgical results of trabeculotomy ab externo remain effective in controlling intraocular pressure levels for a long time in selected patients. It thus appears that trabeculotomy ab externo can be considered as an alternative choice of surgical treatment in some cases of glaucoma.