Endolichenic Fungal Community Analysis by Pure Culture Isolation and Metabarcoding: A Case Study of Parmotrema tinctorum

Lichen is a symbiotic mutualism of mycobiont and photobiont that harbors diverse organisms including endolichenic fungi (ELF). Despite the taxonomic and ecological significance of ELF, no comparative investigation of an ELF community involving isolation of a pure culture and high-throughput sequencing has been conducted. Thus, we analyzed the ELF community in Parmotrema tinctorum by culture and metabarcoding. Alpha diversity of the ELF community was notably greater in metabarcoding than in culture-based analysis. Taxonomic proportions of the ELF community estimated by metabarcoding and by culture analyses showed remarkable differences: Sordariomycetes was the most dominant fungal class in culture-based analysis, while Dothideomycetes was the most abundant in metabarcoding analysis. Thirty-seven operational taxonomic units (OTUs) were commonly observed by cultureand metabarcoding-based analyses but relative abundances differed: most of common OTUs were underrepresented in metabarcoding. The ELF community differed in lichen segments and thalli in metabarcoding analysis. Dissimilarity of ELF community intra lichen thallus increased with thallus segment distance; inter-thallus ELF community dissimilarity was significantly greater than intra-thallus ELF community dissimilarity. Finally, we tested how many fungal sequence reads would be needed to ELF diversity with relationship assays between numbers of lichen segments and saturation patterns of OTU richness and sample coverage. At least 6000 sequence reads per lichen thallus were sufficient for prediction of overall ELF community diversity and 50,000 reads per thallus were enough to observe rare taxa of ELF.

Massive Retinal Hemorrhage during Epiretinal Membrane Peeling in Patient with Iron Deficiency Anemia

Purpose@#To report a case of massive retinal hemorrhage during epiretinal membrane (ERM) peeling in a patient with iron deficiency anemia (IDA).Case summary: A 59-year-old female presented with gradually decreasing visual acuity and dysmorphopsia in the right eye for several months. She had a history of chronic IDA due to subtotal gastrectomy from gastric cancer 20 years prior. The patient was diagnosed as having macular ERM and underwent vitrectomy. During ERM peeling with intraocular forceps, we found a massive retinal hemorrhage which was presumed to have originated from the superotemporal branched retinal artery. After hemostasis, the operation was completed without critical complications. However, 2 months after surgery, the patient presented with decreased visual acuity once again. In fundus examination, diffuse macular tractional ERM was evident in the proximity of the previous intraoperative hemorrhage site. The patient underwent tractional membrane and internal limiting membrane removal surgery. The patient is currently undergoing follow-up without complications to date following the second surgery. @*Conclusions@#Our case study describes a patient having experienced massive retinal hemorrhage presumably having originated from a superotemporal branched retinal artery during ERM peeling. We speculate that the endothelial cells of retinal vessels are more vulnerable than normal in patients with severe chronic IDA.

Massive Retinal Hemorrhage during Epiretinal Membrane Peeling in Patient with Iron Deficiency Anemia

Purpose@#To report a case of massive retinal hemorrhage during epiretinal membrane (ERM) peeling in a patient with iron deficiency anemia (IDA).Case summary: A 59-year-old female presented with gradually decreasing visual acuity and dysmorphopsia in the right eye for several months. She had a history of chronic IDA due to subtotal gastrectomy from gastric cancer 20 years prior. The patient was diagnosed as having macular ERM and underwent vitrectomy. During ERM peeling with intraocular forceps, we found a massive retinal hemorrhage which was presumed to have originated from the superotemporal branched retinal artery. After hemostasis, the operation was completed without critical complications. However, 2 months after surgery, the patient presented with decreased visual acuity once again. In fundus examination, diffuse macular tractional ERM was evident in the proximity of the previous intraoperative hemorrhage site. The patient underwent tractional membrane and internal limiting membrane removal surgery. The patient is currently undergoing follow-up without complications to date following the second surgery. @*Conclusions@#Our case study describes a patient having experienced massive retinal hemorrhage presumably having originated from a superotemporal branched retinal artery during ERM peeling. We speculate that the endothelial cells of retinal vessels are more vulnerable than normal in patients with severe chronic IDA.

Introduction to in silico model for proarrhythmic risk assessment under the CiPA initiative

In 2005, the International Council for Harmonization (ICH) established cardiotoxicity assessment guidelines to identify the risk of Torsade de Pointes (TdP). It is focused on the blockade of the human ether-à-go-go-related gene (hERG) channel known to cause QT/QTc prolongation and the QT/QTc prolongation shown on the electrocardiogram. However, these biomarkers are not the direct risks of TdP with low specificity as the action potential is influenced by multiple channels along with the hERG channel. Comprehensive in vitro Proarrhythmia Assay (CiPA) initiative emerged to address limitations of the current model. The objective of CiPA is to develop a standardized in silico model of a human ventricular cell to quantitively evaluate the cardiac response for the cardiac toxicity risk and to come up with a metric for the TdP risk assessment. In silico working group under CiPA developed a standardized and reliable in silico model and a metric that can quantitatively evaluate cellular cardiac electrophysiologic activity. The implementation mainly consists of hERG fitting, Hill fitting, and action potential simulation. In this review, we explained how the in silico model of CiPA works, and briefly summarized current overall CiPA studies. We hope this review helps clinical pharmacologists to understand the underlying estimation process of CiPA in silico modeling.

The Role of digital subtraction angiography in the ventricular spot sign on the computed tomography angiography

OBJECTIVE: The spot sign on computed tomography angiography is little known about the relationship between the spot sign and the results of cerebral angiography We retrospectively analyzed the spot sign, digital subtraction angiography results, and other factors.MATERIAL AND METHODS: From December 2009 to May 2014, DSA was performed in 52 ICH patients with non-specific location or abnormalities on CTA findings. 26 of those patients, whose initial CTA showed the spot sign, were analyzed. Two groups, one with the spot sign in the ventricle (Group A) and others with the spot sign in another location (Group B) were statistically compared.RESULTS: The mean age of the study subjects was 46.9 years (range, 15 to 80 years) and the percentage of males was 53.8%. Thirteen of 26 patients had ICH without intraventricular hemorrhage, and 6 patients had co-existing IVH. In 17 cases, the DSA results were negative. Seven patients were diagnosed with pseudoaneurysms, and two cases showed developmental venous anomalies. Group A consisted of the 8 patients (30.8%) who showed the spot sign in a ventricle. The number of pseudoaneurysms was statistically significantly higher in Group A than in Group B (71.4% versus 28.6%; OR, 13.3; 95% CI, 1.7-103.8 P = 0.014). All three patients who underwent endovascular treatment were members of Group A (P = 0.022), whereas most (92.3%) of those in Group B underwent surgical evacuation. (P = 0.030).CONCLUSION: When CTA shows the spot sign in a ventricle, it is a clue that an existing underlying vascular lesion requires endovascular treatment.

Successful Mechanical Thrombectomy Using Solumbra Technique In a 35-year-old Man With Achondroplasia: a case report

BACKGROUND: Achondroplasia is one of the most common types of dwarfism and is inherited as an autosomal dominant disease. The patients with achondroplasia suffer from various complications such as craniofacial, central nervous system, spinal, respiratory and cardiac anomalies.CASE DESCRIPTION: We report a case of a 35-year-old man with achondroplasia who visited the emergency room with right hemiplegia and aphasia within 6 hours after onset. An Initial CT angiography showed the total occlusion of a left internal cerebral artery due to the thrombus. We treated the patient with endovascular thrombectomy using “Solumbra technique” with balloon guiding catheter. The procedure was successful and result was completely recanalized with Thrombolysis in Cerebral Infarction (TICI) scale 3 and the weakness also improved from grade II to grade IV.CONCLUSION: Acute ischemic stroke patients with achondroplasia could be treated with mechanical thrombectomy.

Giant complex odontoma in the posterior mandible: A case report and literature review

Odontomas are considered a type of odontogenic hamartoma, and are generally reported not to exceed 3 cm in diameter. Some authors have referred to odontomas with a diameter exceeding 3 cm as giant odontomas. As hamartomas, giant odontomas generally show no signs or symptoms, but if they perforate the mucosa to become exposed in the oral cavity, oral and maxillofacial infections can result. Surgical removal and a histopathological examination may also be required to differentiate them from osteomas, cemento-osseous dysplasia, or mixed odontogenic tumors. This report presents the case of a 28-year-old woman with a giant odontoma in the right mandibular third molar area. Based on a review of the literature published since 2010, only 11 cases of “giant” or “large” odontomas have been reported, most of which were of the complex odontoma type. It was confirmed that they tend to occur in the right posterior mandible.

Cerebrospinal Fluid Lumbar Tapping Utilization for Suspected Ventriculoperitoneal Shunt Under-Drainage Malfunctions

OBJECTIVE: The diagnosis of shunt malfunction can be challenging since neuroimaging results are not always correlated with clinical outcomes. The purpose of this study was to evaluate the efficacy of a simple, minimally invasive cerebrospinal fluid (CSF) lumbar tapping test that predicts shunt under-drainage in hydrocephalus patients. METHODS: We retrospectively reviewed the clinical and radiological features of 48 patients who underwent routine CSF lumbar tapping after ventriculoperitoneal shunt (VPS) operation using a programmable shunting device. We compared shunt valve opening pressure and CSF lumbar tapping pressure to check under-drainage. RESULTS: The mean pressure difference between valve opening pressure and CSF lumbar tapping pressure of all patients were 2.21±24.57 mmH₂O. The frequency of CSF lumbar tapping was 2.06±1.26 times. Eighty five times lumbar tapping of 41 patients showed that their VPS function was normal which was consistent with clinical improvement and decreased ventricle size on computed tomography scan. The mean pressure difference in these patients was −3.69±19.20 mmH₂O. The mean frequency of CSF lumbar tapping was 2.07±1.25 times. Fourteen cases of 10 patients revealed suspected VPS malfunction which were consistent with radiological results and clinical symptoms, defined as changes in ventricle size and no clinical improvement. The mean pressure difference was 38.07±23.58 mmH₂O. The mean frequency of CSF lumbar tapping was 1.44±1.01 times. Pressure difference greater than 35 mmH₂O was shown in 2.35% of the normal VPS function group (2 of 85) whereas it was shown in 64.29% of the suspected VPS malfunction group (9 of 14). The difference was statistically significant (p=0.000001). Among 10 patients with under-drainage, 5 patients underwent shunt revision. The causes of the shunt malfunction included 3 cases of proximal occlusion and 2 cases of distal obstruction and valve malfunction. CONCLUSION: Under-drainage of CSF should be suspected if CSF lumbar tapping pressure is 35 mmH₂O higher than the valve opening pressure and shunt malfunction evaluation or adjustment of the valve opening pressure should be made.

Delayed Onset Purtscher's Retinopathy with Serous Retinal Detachment after Trauma in a Retinitis Pigmentosa

PURPOSE: To report a case of Purtscher's retinopathy accompanied by serous retinal detachment in a patient with retinitis pigmentosa (RP) who was referred to us for treatment of post-traumatic visual discomfort. CASE SUMMARY: A 36-year-old man with history of RP was referred to us with the chief complaint of bilateral visual discomfort after chest injury from a traffic accident. His corrected visual acuity was 0.3 and 0.6 in the right and left eyes, respectively. Fundus examination revealed findings characteristic of RP in both eyes, along with a lesion in the right eye, which was suspected to be a serous elevation of the macula, as well as suspected exudates near the optic nerves. Optical coherence tomography indicated serous retinal detachment in the right eye, and fluorescein angiography findings were characteristic of RP. Seven days later, the amount of cotton-wool exudate in the right eye had increased and was more distinct than at the initial examination, and retinal hemorrhage was observed. Based on the medical history and specific fundus findings, the patient was diagnosed with Purtscher's retinopathy. One month later, the serous retinal detachment in the right eye had improved, but the vision loss and total anopsia in the right eye persisted. CONCLUSIONS: The concomitant occurrence of RP and Purtscher's retinopathy is very rare. Moreover, the presence of accompanying serous retinal detachment and delayed onset of typical clinical symptoms are not present in typical Purtscher's retinopathy.

An Unusual Case of Endogenous Klebsiella Pneumonia Endophthalmitis

PURPOSE: To report an unusual case of endogenous endophthalmitis in a patient with Klebsiella pneumoniae primary liver abscess. CASE SUMMARY: A-54-year-old man with diabetes mellitus and liver abscess was referred to us for consultation of visual loss in his left eye for 2 days. On the first examination, the patient's left visual acuity was hand motion and the left intraocular pressure was 13 mmHg. Vitreous opacity and inflammatory membrane were detected with increased echogenicity using ultrasonography. Vitectomy and intravitreous antibiotic injection were performed under the impression of endogenous endophthalmitis caused by liver abscess on the day of the first visit. Culture revealed Klebsiella pneumoniae from blood and liver abscess. After vitrectomy, the patient showed improvement. However, on the 20th and 40th postoperative days, the patient complained of blurred vision, and inflammation and hypopyon were observed in the anterior chamber. An intracameral antibiotic injection and anterior chamber washing were performed. The patient has not complained of any other symptoms to date. CONCLUSIONS: In this patient with endophthalmitis, inflammation and hypopyon in the anterior chamber were evident three times after vitrectomy. Ultimately, the inflammation was effectively controlled by intracameral antibiotic injection and anterior chamber washes.

A Case of Intractable Vernal Keratoconjunctivitis Treated by Papillectomy and Amniotic Membrane Transplantation

PURPOSE: To report a successful case of intractable vernal keratoconjunctivitis treated by papillectomy and amniotic membrane transplantation. CASE SUMMARY: A 20-year-old female patient presented with repeated vernal keratoconjunctivitis in both eyes since the age of 14. Despite medical therapy, she developed severe itching, burning and foreign body sensations, and limbal nodules with mutiple giant papillae of the upper tarsal plate. Surgical resection of the giant papillae and amniotic membrane transplantation in her left eye was performed. One month later, the same procedure was performed in her right eye. The patient's symptoms then improved. Neither recurrence nor serious complication were observed during the 6 months follow up period after surgery. CONCLUSIONS: In intractable vernal keratoconjunctivitis, papillectomy with amniotic membrane transplantation may potentially be a good treatment option for better clinical outcome and low recurrence rates.

Analysis of the Retinal Nerve Fiber Layer Thickness in Alzheimer Disease and Mild Cognitive Impairment

PURPOSE: To compare the retinal nerve fiber layer (RNFL) as well as the macula volume and thickness in the eyes of age-matched healthy controls with no cognitive disabilities with those of elderly people with mild cognitive impairment (MCI) or Alzheimer disease (AD). We used optical coherence tomography (OCT) to determine the effectiveness of the above quantities for early diagnosis of MCI or AD. METHODS: Ninety eyes were considered in this study, split between 30 normal eyes, 30 eyes from patients with MCI, and 30eyes from patients with AD. All subjects underwent ophthalmologic and cognitive examinations, and measurements of the RNFL thickness as well as macular volume and thickness were taken for all patients using OCT. RESULTS: The mean RNFL thickness upon OCT was significantly thinner in the AD group than in the MCI group (p = 0.01). The RNFL was thinner in the superior quadrant in patients with AD when compared to the healthy controls (p = 0.03). The RNFL thicknesses in the inferior, nasal, and temporal quadrants did not differ significantly between the groups. Measurements in the 12 clock-hour zones revealed that zone 11 had a significantly thinner RNFL in the AD group as compared with the healthy control group (p = 0.02). In zone 2, the MCI group had a significantly thinner RNFL than the AD group (p = 0.03). CONCLUSIONS: Our OCT findings revealed a neuroanatomic difference in the RNFL thickness among the three groups, i.e., the AD, MCI, and healthy control groups. This suggests that a change in average RNFL thickness could be a meaningful index for diagnosing early AD.

The Risk Factors for Hydrocephalus and Subdural Hygroma after Decompressive Craniectomy in Head Injured Patients

OBJECTIVE: The present study aims to investigate 1) the risk factors for hydrocephalus and subdural hygroma (SDG) occurring after decompressive craniectomy (DC), and 2) the association between the type of SDG and hydrocephalus. METHODS: We retrospectively reviewed the clinical and radiological features of 92 patients who underwent DC procedures after severe head injuries. The risk factors for developing post-traumatic hydrocephalus (PTH) and SDG were analyzed. Types of SDGs were classified according to location and their relationship with hydrocephalus was investigated. RESULTS: Ultimately, 26.09% (24/92) of these patients developed PTH. In the univariate analyses, hydrocephalus was statically associated with large bone flap diameter, large craniectomy area, bilateral craniectomy, intraventricular hemorrhage, contralateral or interhemisheric SDGs, and delayed cranioplasty. However, in the multivariate analysis, only large craniectomy area (adjusted OR=4.66; p=0.0239) and contralateral SDG (adjusted OR=6.62; p=0.0105) were significant independent risk factors for developing hydrocephalus after DC. The incidence of overall SDGs after DC was 55.43% (51/92). Subgroup analysis results were separated by SDG types. Statistically significant associations between hydrocephalus were found in multivariate analysis in the contralateral (adjusted OR=5.58; p=0.0074) and interhemispheric (adjusted OR=17.63; p=0.0113) types. CONCLUSION: For patients who are subjected to DC following severe head trauma, hydrocephalus is associated with a large craniectomy area and contralateral SDG. For SDGs after DC that occur on the interhemispherical or controlateral side of the craniectomy, careful follow-up monitoring for the potential progression into hydrocephalus is needed.

Tentorial Dural Arteriovenous Fistula Treated Using Transarterial Onyx Embolization

Tentorial dural arteriovenous fistula (DAVF) is a rare vascular disease, which has high risk of intracranial hemorrhage. We present two cases of tentorial DAVF which were successfully treated with single trial of transarterial embolization using Onyx. We briefly reviewed the types of the tentorial DAVF and strategies of treatment.

Assessment of the Optimal Site of Femoral Artery Puncture and Angiographic Anatomical Study of the Common Femoral Artery

OBJECTIVE: The purpose of this study was to evaluate demographic and clinical factors affecting the common femoral artery diameter and length, and anatomical relationship between the femoral head and the common femoral artery during angiography. METHODS: We retrospectively reviewed 109 femoral angiograms. We collected the clinical data of the patients and estimated the common femoral artery diameter and length. We divided the areas in the angiogram from cephalic to caudal direction (zone 0 to 5). The lowest levels of the inferior epigastric artery loop and points of the common femoral artery bifurcation were checked. RESULTS: The luminal diameter of the common femoral artery was 6.19+/-1.20 mm. Height, weight, body surface area, as well as common femoral artery diameter were significantly greater in men than in women (p<0.005). The length of the common femoral artery was 27.59+/-8.87 mm. Height, weight and body surface area showed strong positive relationships with common femoral artery diameter. All of the inferior epigastric artery loops were located above the center of the femoral head. The point of common femoral artery bifurcation was above the center of the femoral head in 4.59% of femoral angiograms. CONCLUSIONS: Males and patients with a high body surface area have a larger common femoral artery diameter. The cumulative probability of optimal targeting between the lowest margin of the inferior epigastric artery loop and the common femoral artery bifurcation is the highest in zone 3 puncture.

Clinical Usefulness of UBM in the Sitting Position in Anterior Chamber Depth and Angle Measurements

PURPOSE: We compared the measurements of anterior chamber depth (ACD) and anterior chamber angle (ACA) using ultrasound biomicroscopy (UBM) in the sitting position compared with IOL Master(R), Pentacam(R), and Spectralis optical coherence tomography (OCT) to evaluate the clinical usefulness of UBM in the sitting position. METHODS: We evaluated 92 eyes in 47 healthy adults. ACD was measured by IOL Master(R), Pentacam(R), and UBM. ACA was measured using Pentacam(R), UBM, and Spectralis OCT. UBM was performed in the sitting position using bag/balloon technology. Measured values were compared statistically. RESULTS: ACD measured by IOL Master(R), Pentacam(R), and UBM was 3.57 +/- 0.32 microm, 3.64 +/- 0.33 microm and 3.51 +/- 0.32 microm, respectively. UBM measurements of ACD were significantly shallower than with the other methods (p 0.8, p 0.05). There was strong correlation between UBM and Spectralis OCT (r = 0.957) but moderate correlation between Pentacam(R) and UBM and Pentacam(R) and Spectralis OCT (r = 0.557, 0.571, respectively, p < 0.05). Specifically, ACA of the superior quadrant showed a low correlation between Pentacam(R) and UBM and Pentacam(R) and Spectralis OCT (r = 0.257, 0.295, respectively). CONCLUSIONS: ACD measured by UBM in the sitting position was shallower compared to the other methods; however, ACD measured by IOL Master(R), Pentacam(R), and UBM showed significant correlations among the methods. The mean ACA measured by Pentacam(R), UBM, and Spectralis OCT showed no significant differences. Due to the high correlation of ACA measurements between UBM and Spectralis OCT in the present study, UBM is expected to be a good tool for measuring anterior segment parameters.

Renal Subcapsular Hematoma after Percutaneous Transfemoral Angiography

Vascular complications after percutaneous angiography include hematoma, pseudoaneurysm, arteriovenous fistula, thromboembolism, arterial laceration and infection. Hematomas may occur in the groin, thigh, retroperitoneal, intraperitoneal, or abdominal wall. A 54-year-old female underwent percutaneous transfemoral angiography for the evaluation of cerebral aneurysm. Renal subcapsular hematoma developed 3 hours after the procedure. Renal subcapsular hematoma after percutaneous angiography is very rare. We investigated the possible causes of renal subcapsular hematoma. To avoid this rare complication, we need to perform guide-wire passage carefully from the beginning of the procedure under full visual monitoring.

Effects of Macular Ischemia and Early Treatment on Visual Outcome in Branch Retinal Vein Occlusion

PURPOSE: To evaluate the effects of macular ischemia and early treatment on the visual outcomes of patients with branch retinal vein occlusion (BRVO). METHODS: This study retrospectively reviewed the records of 42 patients who were treated with an intravitreal bevacizumab injection for BRVO, repeated 3 times at 6-week intervals and were whose data available for a follow-up period of at least 4 years. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) results before treatment and at 6, 12, 24, 36 and 48 months after the 3 serial injections, were measured. We assessed macular ischemia, time to the first treatment, and the relationship of these with BCVA. RESULTS: Mean BCVA (log MAR) was significantly improved from 0.67 +/- 0.43 at baseline to 0.30 +/- 0.30 at 48 months (p 6 weeks) treatment groups in BCVA and mean change in BCVA after 48 months. There was statistically significant (p 6 weeks) treatment groups with macular ischemia in BCVA after 48 months. CONCLUSIONS: In patients with BRVO, a significant visual improvement was maintained after intravitreal bevacizumab injections, despite the presence of macular ischemia. Early treatment (within 6 weeks) is more effective for maintaining and improving visual acuity. Similar results in the macular ischemia group confirmed the importance of early treatment.

Tracheoesophageal Fistula: A Fatal Complication of Endotracheal Intubation / 대한신경손상학회지

Tracheoesophageal fistula (TEF) is a rare disease which develops as a result of congenital or acquired causes. We report on two TEF female stroke patients with associated endotracheal intubation. Endotracheal intubation was kept for 13-14 days because of decreased mentality by intracranial hemorrhage. Recurrent pneumonia was a predominant symptom. Computed tomography and bronchoscopy were used to diagnose TEF. Both patients expired by sepsis and recurrent pneumonia before definite TEF treatment. The excessive dilatation of the cuff balloon of the endotracheal tube was considered one of the main causes of TEF. Prevention is most important and early treatment is required in this fatal disease.

Tracheoesophageal Fistula: A Fatal Complication of Endotracheal Intubation / 대한신경손상학회지

Tracheoesophageal fistula (TEF) is a rare disease which develops as a result of congenital or acquired causes. We report on two TEF female stroke patients with associated endotracheal intubation. Endotracheal intubation was kept for 13-14 days because of decreased mentality by intracranial hemorrhage. Recurrent pneumonia was a predominant symptom. Computed tomography and bronchoscopy were used to diagnose TEF. Both patients expired by sepsis and recurrent pneumonia before definite TEF treatment. The excessive dilatation of the cuff balloon of the endotracheal tube was considered one of the main causes of TEF. Prevention is most important and early treatment is required in this fatal disease.