Ocular Pain According to Needle Diameter during Intravitreal Injection

Purpose@#To compare the ocular pain scores and injection times of patients during 30 and 40-gauge intravitreal injection procedures. @*Methods@#This study was performed prospectively in patients who had not previously received intravitreal injection. Patients were randomly divided into two groups and intravitreal injections of bevacizumab, ranibizumab, and aflibercept were performed using a 30-gauge needle (30G Group) or a 40-gauge needle (40G group). The injection time defined as the time between conjunctival touching of the needle and finishing the hemostasis after needle removal was measured in each patient. Immediately after the injection, patients were asked to rate their pain level during the injection using a visual analogue scale (0, no pain; 10, unbearable pain). @*Results@#Sixty eyes of 60 patients were included in this study and 30 patients were assigned to each group. The mean injection times of the 30G and 40G groups were 42.00 ± 37.18 and 32.73 ± 14.58 seconds, respectively, with no significant difference (p = 0.212). The visual analogue scale, pain scores in the 30G and 40G groups were 3.50 ± 1.25 and 2.87 ± 1.01, respectively, with a significant difference (p = 0.035). @*Conclusions@#Intravitreal injection with a 40-gauge needle was less painful than that with a 30-gauge needle.

Relationship between Dominant Eye and Refractive Error in Myopic Anisometropia

PURPOSE: To investigate the relationship between dominant eye and refractive error in patients with myopic anisometropia. METHODS: This study population consisted of myopes less than 15 years old who were followed up for anisometropia defined as interocular difference of spherical equivalent (SE) ≥1.0 diopter (D). All patients underwent the hole-in-the-card test at far and near to determine ocular dominance. The data were analyzed for statistical significance using Fisher's exact test. RESULTS: A total of 102 eyes in 51 patients were analyzed. The mean age of the patients was 10.4 ± 1.4 years and 54.9% were male. The mean SE was −2.97 ± 1.95 D in the right eye and −3.02 ± 1.92 D in the left eye. The right eye was the dominant eye in 43.1% and 37.3% at distance and near, respectively. The agreement of dominancy between distant and near was 82.4%. The near dominant eyes showed statistically significant accordance with more myopic eyes (p = 0.009). On the other hand, there was no statistically significant relationship between more myopic eyes and distant dominant eyes (p = 0.09). CONCLUSIONS: The near dominant eye was more myopic eye in patients with myopic anisometropia. This was considered to be related with the lag of accommodation in dominant eye with near distance.

A Case of SmartPlug Partial Extrusion through Canalicular Mucosa

PURPOSE: To report a case of a SmartPlug that partially extruded through the canalicular mucosa. CASE SUMMARY: A 62-year-old female patient visited our Department of Ophthalmology for redness and discharge in her right eye that began worsening a week prior. The patient was diagnosed with severe dry eye syndrome via Sjogren's syndrome. The SmartPlug was inserted into her left lower punctum 12 years prior, and another plug was inserted in the right 9 years prior. Nothing notable was found in her history. The best corrected visual acuity and intraocular pressure at the initial visit was 1.0 and 14 mmHg, respectively, in both eyes. Swelling, erythema, and tenderness at the right lower punctum were identified. As we irrigated the lower lacrimal system, partial obstruction was suspected and a large amount of mucopurulent discharge in the conjunctival fornix with conjunctival injection was seen. Under the right lower punctum, a 1 × 1 mm yellowish foreign body was partially extruding from the canalicular mucosa. The foreign body was removed, and a round defect was left. The patient's symptom completely resolved after 4 weeks of topical antibiotics and ointment treatment. CONCLUSIONS: In patients who have a SmartPlug inserted prior to visits for redness and discharge, a SmartPlug plug extrusion should be considered.

Williams Syndrome with Ocular Manifestations

PURPOSE: To report two cases of Williams syndrome with ocular manifestations CASE SUMMARY: A 5-year-old boy who was diagnosed with Williams syndrome visited our hospital for ophthalmic examination. Best corrected visual acuity (BCVA) in both eyes was 0.6. He had myopic astigmatism and 8 prism diopters of esotropia. Oval-shaped pupil with a stellate pattern of the iris and increased retinal vascular tortuosity were seen in both eyes. Another case of an 8-year-old boy with Williams syndrome also had myopia in both eyes. BCVA was 0.7 in the right eye and 0.4 in the left eye. A stellate pattern of the iris and increased retinal vascular tortuosity were also seen in both eyes. CONCLUSIONS: Williams syndrome, deletion of 7q11.23, has ocular anomalies including a stellate pattern of the iris, refractive errors, amblyopia, and strabismus. Therefore, careful ophthalmic examination should be considered when children are diagnosed with Williams syndrome.

p53-dependent Fas expression is critical for Ginsenoside Rh2 triggered caspase-8 activation in HeLa cells

We have recently reported that Ginsenoside Rh2 (G-Rh2) induces the activation of two initiator caspases, caspase-8 and caspase-9 in human cancer cells. However, the molecular mechanism of its death-inducing function remains unclear. Here we show that G-Rh2 stimulated the activation of both caspase-8 and caspase-9 simultaneously in HeLa cells. Under G-Rh2 treatment, membrane death receptors Fas and TNFR1 are remarkably upregulated. However, the induced expression of Fas but not TNFR1 was contributed to the apoptosis process. Moreover, significant increases in Fas expression and caspase-8 activity temporally coincided with an increase in p53 expression in p53-non-mutated HeLa and SK-HEP-1 cells upon G-Rh2 treatment. In contrast, Fas expression and caspase-8 activity remained constant with G-Rh2 treatment in p53-mutated SW480 and PC-3 cells. In addition, siRNA-mediated knockdown of p53 diminished G-Rh2-induced Fas expression and caspase-8 activation. These results indicated that G-Rh2-triggered extrinsic apoptosis relies on p53-mediated Fas over-expression. In the intrinsic apoptotic pathway, G-Rh2 induced strong and immediate translocation of cytosolic BAK and BAX to the mitochondria, mitochondrial cytochrome c release, and subsequent caspase-9 activation both in HeLa and in SW480 cells. p53-mediated Fas expression and subsequent downstream caspase-8 activation as well as p53-independent caspase-9 activation all contribute to the activation of the downstream effector caspase-3/-7, leading to tumor cell death. Taken together, we suggest that G-Rh2 induces cancer cell apoptosis in a multi-path manner and is therefore a promising candidate for anti-tumor drug development.

Cdk2 acts upstream of mitochondrial permeability transition during paclitaxel-induced apoptosis

Sequential activation of cyclin-dependent kinases (Cdks) controls mammalian cell cycle. Here we demonstrate that the upregulation of cyclin-dependent kinase 2 (Cdk2) activity coincides with the loss of mitochondrial membrane potential (MMP) in paclitaxel-induced apoptosis. Ectopic expression of the dominant negative Cdk2 (Cdk2-dn) and a specific Cdk2 inhibitor, p21( WAF1/CIP1 ), effectively suppresses the loss of MMP, the release of cytochrome c, and subsequent activation of caspase-3 in paclitaxel-treated cells. Whereas forced activation of Cdk2 by overexpression of cyclin A dramatically promotes these events. We further show that Cdk2 activation status does not interfere with a procedure that lies downstream of cytochrome c release induced by Bax protein. These findings suggest that Cdk2 kinase can regulate apoptosis at earlier stages than mitochondrial permeability transition and cytochrome c release.

Proposal of the Implementation of an International Pharmacy Graduate Preliminary Examination / 보건의료교육평가

At present, graduates of international pharmacy schools can apply to take the Korean Pharmacist Licensing Examination after passing a review by the Accreditation Board of the Pharmacy Schools and Licenses. However, since the educational content of different schools and the roles of pharmacists differ from country to country, a preliminary examination might be necessary before the Pharmacist Licensing Examination. To prepare to implement a preliminary examination for foreign pharmacy graduates in Korea, we summarized the preliminary examinations used in four other countries and presented a proposal for a preliminary examination. Data were collected via the internet and through telephone interviews with appropriate persons. The proposal was revised after a public forum. There are preliminary examinations in the USA, Canada, Australia, and the United Kingdom, and these involve written, oral, practice, and English proficiency tests. We proposed that the Korean preliminary examination consist of a written test on basic pharmacy, a test in the Korean language, and an interview. The preliminary examination should include suitable items that effectively evaluate international graduates. Graduates of international pharmacy schools who have an ability equivalent to graduates of Korean pharmacy schools should be eligible to write the Korean Licensing Examination.

The inhibitory mechanism of aloe glycoprotein (NY945) on the mediator release in the guinea pig lung mast cell activated with antigen-antibody complexes

It has been reported that the glycoprotein extracted from Aloe has strong anti-inflammatory response. However, there has been no research report yet about the effect of Aloe on allergic hypersensitivity reactivity. By using guinea pig lung mast cells, this study aimed to examine the effects of Aloe glycoprotein (NY945) on the mediator releases caused by mast cell activation, and also aimed to assess the effects of NY945 on the mechanism of mediator releases in the mast cell activation. We partially purified mast cell from guinea pig lung tissues by using the enzyme digestion, the rough and the discontinuous density percoll gradient method. Mast cells were sensitized with IgG, (anti-OA) and challenged with ovalbumin. Histamine was assayed by fluorometric analyzer, leukotrienes by radioimmunoassay. The phospholipase D activity was assessed by the production of labeled phosphatidylalcohol. The amount of mass 1, 2-diacylglycerol (DAG) was measured by the (3H)-DAG produced when prelabeled with (3H)myristic acid. The phospholipid methylation was assessed by measuring the incorporation of the (3H)methyl moiety into phospholipids of cellular membranes. Pretreatment of NY945 (10 microgram) significantly decreased histamine and leukotrienes releases during mast cell activation. The decrease of histamine release was stronger than that of leukotriene during mast cell activation. The phospholipase D activity increased by the mast cell activation was decreased by the dose-dependent manner in the pretreatment of NY945. The amount of DAG produced by PLC activity was decreased by NY945 pretreatment. The amount of -mass 1, 2-diacylglycerol produced by activation of mast cells was decreased in the pretreatment of NY945. NY945 pretreatment strongly inhibited the incorporation of the (3H)-methyl moiety into phospholipids. The data suggest that NY945 purified from Aloe inhibits in part an increase of 1, 2-diacylglycerol which is produced by activating mast cells with antigen-antibody reactions, which is mediated via phosphatidylcholine-phospholipase D and phosphatidylinositol-phospholipase C systems, and then followed by the inhibition of histamine release. Furthermore, NY945 reduces the production of phosphatidylcholine by inhibiting the methyltransferase I and II, which decreases the conversion of phosphatidylcholine into arachidonic acid and inhibits the production of leukotrienes.

6 Cases of Salmonella Ostemyelitis / 대한정형외과학회잡지

Since Maisonneuve mentioned osteomyelitis complicated by typhoid fever for the first time in 1835, numerous investigators had reported salmonella osteomyelitis. The authors recently experienced six cases of salmonella osteomylitis: four cases in lumbar spine and the remainders in bones adjacent to elbow. Four cases were in adult male ranging from 18 to 35 years old and the others were in a male, age of thirteen and female, age of seven in elbow respectively. The two among four spondylitic cases and two cases of long bone ostemyelitis were surgically treated, and the other two spondylitic cases were conservatively treated. Salmonella osteomylitis was confirmed in surgically treated group by culture of pus obtained from pathologic lesion, and conservatively treated group was diagnosed by history, clinical manifestation, laboratory data and especially characteristic progress of roentgenographic change. The causative organisms were paratyphoid group D in all cases. Review of literature was done with report of six cases of salmonella osteomyelitis.