Ohno K.,Jikei University School of Medicine
Cornea | Year: 2011
Purpose: To report visual, wavefront, and topographic outcomes in 5 post-penetrating keratoplasty patients who underwent customized aspheric topography-guided photorefractive keratectomy for high astigmatism or severe higher-order aberrations. Methods: A chart review was performed for data collection. The custom aspheric transition zone ablation algorithm (CATz) with the CX III excimer was used for all treatments. Ablations were calculated based on corneal elevation data. Phototherapeutic keratectomy was the first step of the procedure. Visual acuity, corneal higher-order wavefront aberrations (Zernike sixth order and 4-mm diameter), corneal topography, and patient satisfaction were evaluated preoperatively and at the last visit postoperatively (range, 3 months to 4.5 years). The paired t test was used for statistical comparison of higher-order aberrations, with P < 0.05 indicating statistical significance. Results: The mean spherical equivalent was ĝ̂'4.50 diopters (D) (range, ĝ̂'9.50 to +3.25 D) preoperatively and ĝ̂'1.00 D (range, ĝ̂'3.25 to +0.25 D) at the final visit. The mean cylinder was ĝ̂'7.00 D (range, ĝ̂'4.75 to ĝ̂'9.00 D) preoperatively and ĝ̂'1.25 D (range, ĝ̂'0.50 to ĝ̂'2.50 D) postoperatively. Postoperative uncorrected distance visual acuity increased in all eyes. No eyes lost corrected distance visual acuity postoperatively. There was a statistically significant decrease in higher-order corneal spherical aberration postoperatively (P ≤ 0.02). Four patients were very satisfiedor satisfied with the postoperative outcome, and 1 patient was somewhat satisfied. All patients reported reduced symptoms postoperatively. Conclusions: Phototherapeutic keratectomy with CATz was effective as a single-step treatment for severe higher-order aberrations or moderate astigmatism after penetrating keratoplasty. © 2011 by Lippincott Williams & Wilkins.
Uchino S.,Jikei University School of Medicine
Current Opinion in Critical Care | Year: 2010
Purpose of Review: To summarize the history and current findings for creatinine as a renal biomarker and try to predict its future, looking at new biomarkers for kidneys (neutrophil gelatinase-associated lipocalin and cystatin C) and comparing current development to other diseases (troponins and procalcitonin). Recent Findings: In general, biomarkers are used for diagnosis, severity classification, outcome prediction, and most importantly, outcome modification. Creatinine can be used for the first three (except for outcome modification). Multiple clinical studies have shown that new renal biomarkers, especially neutrophil gelatinase-associated lipocalin and cystatin C, can diagnose acute kidney injury more rapidly and accurately, have a better relationship with disease severity, and predict outcome of patients with acute kidney injury more accurately, than creatinine. However, to prove the true superiority of the new renal biomarkers to creatinine, more clinical studies will be required. Such studies include interventional ones that can improve outcome (especially mortality) of patients with acute kidney injury and ones showing relationship of the markers with beneficial effects of specific interventions. Summary: Unless enough evidence accumulates, considering the history, familiarity, and recent findings related to outcome, creatinine will continue to be used and dominate in clinical practice. © 2010 Wolters Kluwer Health | Lippincott Williams &Wilkins.
Yokoyama M.,Jikei University School of Medicine
Journal of Experimental and Clinical Medicine | Year: 2011
Polymeric micelles are assemblies of synthetic polymers and have been studied and developed as drug carriers for targeting solid tumors. Physicochemical characters and medical advantages of the polymeric micelle carrier systems are summarized, followed by an explanation of their recent application for contrast agent targeting. In the final section, future perspectives on the polymeric micelle carrier systems for tumor targeting are discussed, including a novel combination of contrast agent targeting and drug targeting that achieves tumor-specific image diagnosis and tumor-selective chemotherapy, respectively. © 2011.
Ohashi T.,Jikei University School of Medicine
Pediatric Endocrinology Reviews | Year: 2012
Enzyme replacement therapy (ERT) has been approved for 6 lysosomal storage diseases (LSDs) worldwide including Japan. These diseases include Gaucher disease (GD), Fabry disease, mucopolysaccharidosis (MPS) types I, II, and VI, and Pompe disease (PD). The efficacy and safety of ERT for LSDs has been confirmed by extensive clinical trials. However, there are still obstacles to successful ERT, such as immune reactions against the infused enzyme, mistargeting of enzymes rather than lysosomes, and intractable tissues. Regarding immune reactions, a negative impact of antibody formation on therapeutic effect has been reported for GD, Fabry disease, MPS type I, and PD. In PD, mistargeting of the enzyme was reported in a mouse model due to autophagic build up. Another challenge is intractable tissues, such as the brain and bone, which are key tissues in LSDs. Thus, control of immune reactions against therapeutic enzymes and control of autophagic build up are key issues to maximize the efficacy of ERT. Finally, the development of a new enzyme that effectively targets the brain and bone is very important to improve the quality of life of patients with LSDs.
Onda S.,Jikei University School of Medicine
Journal of hepato-biliary-pancreatic sciences | Year: 2013
We have reported the utility of an image display system using augmented reality (AR) technology in hepatobiliary surgery under laparotomy. Among several procedures, we herein report a system using a novel short rigid scope and stereo-scope, both designed specifically for open abdominal navigation surgery, and their clinical application for hepatobiliary and pancreatic surgery. The 3D reconstructed images were obtained from preoperative computed tomography data. In our specialized operating room, after paired-point matching registration, the reconstructed images are overlaid onto the operative field images captured by the short rigid scopes. The scopes, which are compact and sterilizable, can be used in the operative field. The stereo-scope provides depth information. Eight patients underwent operations using this system, including hepatectomy in two, distal pancreatectomy in three, and pancreaticoduodenectomy in three patients. The stereo-scope was used in five patients. All eight operations were performed safely using the novel short rigid scopes, and stereo images were acquired in all five patients for whom the stereo-scope was used. The scopes were user friendly, and the intraoperative time requirement for our system was reduced compared with the conventional method. The novel short rigid scope and stereo-scope seem to be suitable for clinical use in open abdominal navigation surgery. In hepatobiliary and pancreatic surgery, our novel system may improve the safety, accuracy and efficiency of operations.