The Value of 18F-FDG PET/MRI in Detecting Lumbar Radiculopathy for Selective Percutaneous Endoscopic Discectomy: a Case Report.

Magnetic resonance imaging (MRI) is the most popular imaging modality for investigating intervertebral disc herniation. However, it has a high chance for identifying incidental findings that are morphologically or structurally abnormal but not responsible for patients' symptoms. Although a previous study suggested that 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) may help identify neuroinflammation in lumbar radiculopathy, there is currently no direct evidence obtained from surgery. Here, we describe the case of a 32-year-old man with low back pain and right leg paresthesia for 7 months. MRI demonstrated disc herniation at the L3-L4, L4-L5 and L5-S1 levels, causing bilateral L5 and left S1 root compression. 18F-FDG PET/MRI demonstrated increased 18F-FDG uptake at the right L5 root, which was compatible with the patient's symptoms. Transforaminal percutaneous endoscopic lumbar discectomy (PELD) was performed. Intraoperative images revealed a swollen nerve root at the right L5 after removal of the herniated disc. After surgery, the patient experienced immediate pain relief and had no recurrence at the 6-month follow-up. When performing PELD in patients with multilevel radiculopathy identified on MRI, the use of 18F-FDG PET/MRI can help in accurate localization of the symptomatic roots and minimize surgical incision and soft-tissue injury.

Evaluation of retinal microvasculature in exotropia with abnormal binocular vision by optical coherence tomography angiography.

BACKGROUND: To explore the retinal microvasculature in large-angle concomitant exotropia patients with abnormal binocular vision using optical coherence tomography angiography (OCTA) analysis. METHODS: OCTA images of 52 healthy and 100 strabismic eyes were analyzed to quantify the retinal thickness (RT), superficial capillary plexus (SCP), deep capillary plexus (DCP), and foveal avascular zone (FAZ). Paired t-tests were performed to compare differences between the two groups, the dominant eye and the deviated eye in the exotropia group, respectively. A p-value < 0.01 was considered significant. RESULTS: The mean angle of deviation was 79.38 [± 25.64] (prism diopters, PD). There were significant differences in the DCP in deviated eyes between the exotropia group and the control group (fovea: p = 0.007; temporal: p = 0.014; nasal: p = 0.028; inferior: p = 0.013). The temporal SCP in the exotropia group was significantly higher than in the control group in deviated eyes (p = 0.020). No significant difference was found between dominant eyes and strabismic eyes (p > 0.01). CONCLUSIONS: The study showed that OCTA revealed subnormal DCP in patients with large-angle exotropia and abnormal binocularity which may be related to retinal suppression. Changes in the macular microvasculature may provide valuable insights into the development of strabismus. Further studies are needed to determine the clinical relevance of this finding. TRIAL REGISTRATION: This trial is registered as ChiCTR2100052577 at www.Chictr.org.cn .

Effect of bilateral inferior oblique partial myectomy on V pattern exotropia with inferior oblique overaction.

PURPOSE: To compare the effect of bilateral inferior oblique partial myectomy on V-pattern exotropia patients with bilateral symmetric inferior oblique overaction (IOOA) and asymmetric IOOA. METHODS: This was a retrospective study including 53 V-pattern exotropia patients with bilateral IOOA of all grades who underwent bilateral inferior oblique partial myectomy. Success was defined as the elimination of the IOOA and the collapse of the V pattern at the final follow-up. The fovea-disc angle (FDA) and V-pattern exotropia were compared before and after surgery. RESULTS: This study included 53 V-pattern exotropia patients, containing 29 patients with symmetric IOOA (Group I) and 24 patients with asymmetric IOOA (Group II). The last follow-up ranged from 3 to 16 months (mean of 5 months). After myectomy, 3 eyes in Group I and 2 eyes in Group II were observed with residual grade 1 IOOA. The surgical success rates of IOOA correction in Group I and Group II were 96% and 95%, respectively. The difference was not statistically significant (P = 0.808). V-pattern exotropia collapsed with residual 2 (min. 0, max. 6) PD for Group I and 2 (min. 0, max. 10) PD for Group II, and there was a statistically significant difference between pre- and postoperative V-pattern exotropia in the two groups (P = 0.000). No inferior oblique (IO) underaction or antielevation syndrome (AES) was found in either group. The average preoperative FDA of the right eye and the left eye was (8.93 ± 4.34)° and (10.86 ± 4.27)° in Group I and (9.08 ± 4.92)° and (11.00 ± 5.69)° in Group II. There was a significant difference in preoperative FDA between the right eye and the left eye in the two groups (Group I p = 0.029; Group II p = 0.038). CONCLUSIONS: Bilateral inferior oblique partial myectomy can bring "symmetric" effectiveness in the correction of IOOA and FDA. It can potentially be used as a safe and successful treatment for V-pattern exotropia with bilateral IOOA. In addition, the FDA may be a promising index for evaluating fundus extorsion.

RNA sequence analysis identified bone morphogenetic protein-2 (BMP2) as a biomarker underlying form deprivation myopia.

Purpose: Form deprivation myopia (FDM) is an urgent public issue characterized by pathological changes, but the underlying mechanism remained unclear. The aim was to investigate bone morphogenetic proteins (BMPs) utilizing the pathogenesis of FDM. Material and methods: Gene expression omnibus (GEO) database was used to analyze one mRNA profile (GSE89325) of FDM. Sixteen retina samples (8 FDM and 8 controls) were randomly divided into seven groups for differential gene expression analysis in R. software. The gene pathway and protein-protein interaction (PPI) analysis were performed by the DAVID and STRING databases. Cytoscape was used to draw the PPI network. The gene ontology (GO) enrichment and Kyoto encyclopedia of genes and Genomes (KEGG) analysis were determined to achieve gene annotation and visualization. Results: A total of 18420 differentially expressed genes (DEGs) were identified associated with FDM. The only non-significant gene (BEND6) was separately analyzed between two groups. Thirteen hub genes were discovered, ACVR1, ACVR2A, ACVR2B, RGMB, BMPR2, BMPR1A, BMP2, BMPR1B, CHRD, PTH, PTH1R, PTHLH, and WNT9A. The expression alteration in FDM were mainly enriched in cytokine-cytokine, and neuroactive ligand receptor interaction pathways. BMP2 was the key gene in myopia progression. Conclusions: Of clinical perspective, our findings reveal that expression of BMP2 as an underlying mechanism of FDM, providing an insight for therapeutic interventions.

Kearns-Sayre syndrome with a novel large-scale deletion: a case report.

BACKGROUND: Kearns-Sayre syndrome (KSS) is a rare, multisystem mitochondrial encephalomyopathy. We report a case of KSS with a novel 7.6-kb deletion as assessed through a long-range polymerase chain reaction (PCR) study in the blood. In addition, optical coherence tomography angiography (OCTA) confirmed deep retinal capillary atrophy for the first time. CASE PRESENTATION: A 13-year-old patient presented with progressive vision loss and difficulty with eye opening and was diagnosed with progressive external ophthalmoplegia and retinitis pigmentosa (RP). The patient also experienced heart block, vestibular dysfunction, growth retardation and multiple demyelinating lesions. A long-range PCR study in the blood revealed a large-scale Chrm: 6341-13,993 deletion, which was first reported and broadened the genetic spectrum of this disease. The patient underwent complete ophthalmic examination, medical history review and gene detection, resulting in a confirmation of the diagnosis of KSS. The patient was given a pair of applicable glasses to wear and was followed up every 3 months. An implantable pacemaker was also installed based on the advice of the physician. CONCLUSIONS: We reported a novel large-scale deletion in the mitochondrial DNA of KSS, and OCTA was used for the first time to confirm deep retinal capillary atrophy. Furthermore, because ophthalmic symptoms are often the primary manifestation of KSS, the relationship between ophthalmology and mitochondrial diseases should be emphasised.

Vessel Density and Retinal Thickness from Optical Coherence Tomography Angiography as New Indexes in Adolescent Myopia.

PURPOSE: To evaluate and quantify blood perfusion and retinal thickness (RT) from the perspective of quadrants by optical coherence tomography angiography (OCTA) in adolescents with myopia and explore the relationship between axial elongation and related indexes of OCTA. METHODS: A total of 88 subjects (149 eyes) with different degrees of myopia were included in this cross-sectional study. Vessel density (VD) and RT of quadrants in macular and peripheral regions were measured through OCTA. RESULTS: The superficial VD (SVD) of the parainferior region was significantly correlated with axial length (AL) between the emmetropia (EM) group and high myopia (HI) group (P=0.012). There were significant differences in deep VD (DVD) in all quadrants, except for the foveal, perifoveal, and peri-inferior regions (P > 0.05). However, there were significant alterations in the whole, parainferior, and perinasal regions (P=0.030, 0.023, and 0.035) in the low-to-moderate myopia (L-M) group compared with those in the HI group. There were significant differences in the RT in all quadrants, except for the foveal, paratemporal, and paranasal regions (P > 0.05) between the EM and L-M groups and the foveal region (P > 0.05) between the EM and HI groups. Nevertheless, only RT in the peri-inferior region of the L-M and HI groups showed significant differences. AL was negatively correlated with SVD in the perifoveal and parainferior regions (r = -0.179, P=0.029; r = -0.227, P=0.005) and inversely correlated with DVD and RT in almost all quadrants, except for the foveal region (r = -0.020, P=0.811; r = 0.135, P=1.000). CONCLUSION: DVD and RT were closely associated with the severity of myopia and might be new indexes in assessing and detecting myopia development via OCTA.

Efficacy and Adverse Effects of Atropine for Myopia Control in Children: A Meta-Analysis of Randomised Controlled Trials.

OBJECTIVES: To explore the rebound effects and safety of atropine on accommodation amplitude in slowing myopia progression. METHODS: We conducted a meta-analysis to testify proper dosage of atropine in children with myopia. We searched in PubMed, EMBASE, Ovid, and the Cochrane Library up to March 30, 2021. We selected randomised controlled trials (RCTs) that evaluated the efficacy of atropine for controlling myopia progression in children. We performed the inverse variance random-effects model to pool the data using mean difference (MD) for continuous variables. Statistical heterogeneity was assessed using the I2 test. Additionally, we conducted subgroup analyses and sensitivity analyses. RESULTS: Seventeen RCTs involving 2955 participants were included. Myopia progression was significantly less in the atropine group than that of the control group, with MD = 0.38 D per year (95% confidence interval, 0.20 to 0.56). Less axial elongation was shown with MD = -0.19 mm per year (95% CI, -0.25 to -0.12). There was a statistically difference among various doses (p=0.00001). In addition, 1.0% atropine showed the rebound effect with MD = -0.54 D per year (95% CI, -0.81 to -0.26) and was more effective in the latter six months than in the former one. Less accommodation amplitude was shown in 0.01% atropine. CONCLUSION: The efficacy of atropine is dose dependent, and 0.01% atropine may be the optimal dose in slowing myopia progression in children with no accommodation dysfunction. A rebound effect is more prominent in high-dose atropine in the former cessation after discontinuation.

Comparison between binocular therapy and patching for treatment of amblyopia: a meta-analysis of randomised controlled trials.

Several studies have compared binocular therapy and patching for the treatment of amblyopia. However, most of them involved a small number of cases and reported controversial results. Thus, the benefit of binocular therapy remains to be confirmed. We conducted a meta-analysis to evaluate the efficacy of binocular therapy versus patching and to testify whether binocular therapy could become supplementary method in children with amblyopia. Randomised controlled trials that evaluated the efficacy of binocular therapy for amblyopia versus patching were identified using PubMed, Embase, Cochrane Library, Ovid, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. Data screening, extraction and quality assessment were performed independently by two researchers. Six trials were identified and analysed to compare binocular therapy (708 eyes) with patching (664 eyes) for change in best-corrected visual acuity and stereoacuity. Efficacy estimates were evaluated by standard mean difference (SMD) and 95% CI. The best-corrected visual acuity in binocular group was better than that of in patching group (SMD=-0.21 logarithm of the minimum angle of resolution (log MAR), 95% CI of -0.50 to 0.08 log MAR, p=0.003). The results showed statistically significant difference in the change of best-corrected visual acuity between the groups, but not in stereoacuity. Binocular therapy may be a promising treatment of conditions affecting visual acuity, and could be applied as a supplementary method to patching for amblyopia in clinical practice. The present analysis showed that some children with amblyopia may benefit from binocular therapy. Nevertheless, larger randomised controlled clinical trials are required to confirm these findings.

Gastric Calcifying Fibrous Tumor: An Easy Misdiagnosis as Gastrointestinal Stromal Tumor-A Systemic Review.

Background and Objectives: Calcifying fibrous tumor (CFT) in the stomach is extremely rare and is easily misdiagnosed as a gastrointestinal stromal tumor (GIST). This study aims to determine the best method to differentiate between gastric CFT and GIST after a systemic review and meta-analysis. Materials and Methods: A systematic search of articles using electronic databases (MEDLINE, EMBASE, and LILACS) was conducted and resulted in 162 articles with 272 CFT cases published from January 1988 to September 2019. Results: Of these cases, 272 patients, 60 patients with gastric CFT (32 men and 28 women, mean age 49.2 years) were analyzed. The mean tumor size was 2.4 cm in patients with gastric CFT. Both endoscopic ultrasound (EUS) and computed tomography (CT) findings revealed well-defined (100% vs. 77.8%), heterogeneous (100% vs. 77.8%), iso-hypoechoic (71.4% vs. 33.3%), and calcified (85.7% vs. 77.8%) lesions, respectively. The majority of patients (53.3%) were symptomatic, with the most common symptom being abdominal discomfort (55.6%). None of the patients with gastric CFT showed recurrence after treatment, and most patients received nonendoscopic treatment (56%, n = 28/50). Both age and tumor size were statistically significant in patients with gastric CFT than GIST (49.2 vs. 65.0 years and 2.4 vs. 6.0 cm; both p < 0.001). The ratio of children among patients with CFT (5%) and GIST (0.05%) was also significantly different (p = 0.037). The calcification rates of gastric CFT had significantly higher calcification rates than GIST on images of EUS and CT (85.7% vs. 3.6% and 77.8% vs. 3.6%; both p < 0.001). Conclusions: Compared with patients with GIST, patients with gastric CFT were younger, had smaller tumor size, and were symptomatic. Furthermore, gastric CFT was well-defined, heterogeneous in the third layer, and had high calcification rates on the images.

Pyogenic Baker cyst in a patient with psoriatic arthritis during etanercept therapy.

Patients with psoriatic arthritis (PsA) are at increased risk of infection due to disease course or treatment-related immunodeficiency. We describe a patient with a 10-year history of PsA, with arthritis of the right knee and pain and edema in the right calf, treated with the TNFa inhibitor etanercept for 6 months. Ultrasound showed accumulation of hypoechoic fluid, which was aspirated and was positive for staphylococcus and aspergillus. The patient recovered after surgical drainage and four weeks of antibiotic and antifungal therapy.

Phenotypes of trypsin- and collagenase-prepared bovine corneal endothelial cells in the presence of a selective Rho kinase inhibitor, Y-27632.

PURPOSE: To optimize isolation of viable bovine corneal endothelial cells (BCECs), we evaluated the effectiveness of various preparation protocols. This entailed comparing the effects of collagenase A and trypsin in the presence and absence of a Rho kinase inhibitor, Y-27632, on proliferation and tight junctional and cytoskeletal integrity during their expansion. METHODS: 5-bromo-2'-deoxyuridine (BrdU) incorporation evaluated cell proliferation. Western blot analysis evaluated F-actin, zonule occludin, and ZO-1 associated nucleic acid binding protein (ZONAB) and RhoA expression. Rho A pulldown assay evaluated Rho A activity. RESULTS: In the trypsin (TrypLE)-prepared BCECs, BrdU incorporation decreased whereas nuclear ZONAB expression increased and became stable from day 3 to 7. In contrast, in the collagenase-A-prepared BCECs, we observed preserved ZO-1 integrity, invariant nuclear ZONAB expression, and dense cortical F-actin expression, and BrdU incorporation was invariant from days 1 to 7. Y-27632 did not increase BrdU incorporation and nuclear ZONAB expression in the TrypLE-prepared and the collagenase-A-prepared BCECs. Moreover, Y-27632 increased irregular cellular morphology and downregulated the expression of ZO-1 in the collagenase-A-prepared BCECs from days 1 to 7. Y-27632 inhibited RhoA activation irrespective of whether the cells were isolated with trypsin or collagenase A. CONCLUSIONS: It is preferable to isolate BCECs with collagenase A and expand them without Y-27632. With this protocol, proliferative activity and tight junctional and cytoskeletal integrity are better preserved than if trypsin is used in the presence or absence of Y-27632.

Acute appendicitis presenting as unusual left upper quadrant pain.

Appendicitis is the most common abdominal disease that requires surgery in the emergency ward. It usually presents as right lower quadrant pain, but may rarely present as left upper quadrant (LUQ) pain due to congenital anatomical abnormalities of the intestine. We report a patient who complained of persistent LUQ abdominal pain and was finally diagnosed by computed tomography (CT) as congenital intestinal malrotation complicated with acute appendicitis. It is important to include acute appendicitis in the differential diagnosis of patients who complain of LUQ abdominal pain. Abdominal CT can provide significant information that is useful in preoperative diagnosis and determination of proper treatment.

MRI features of lipoblastoma: differentiating from other palpable lipomatous tumor in pediatric patients.

The purpose of this study was to describe the magnetic resonance imaging (MRI) features of lipoblastomas in pediatric patients and to differentiate them from other palpable benign lipomatous tumors. The relatively specific MRI features of nonenhancing cystic change and enhancing soft tissue nodules seen in lipoblastoma may help to differentiate it from other types of lipomatous tumor in pediatric patients.

Micturitional headache in a young girl.

A 16-year-old girl came to our emergency department because of severe headache. For the past 3 years, she had presented at several emergency departments with a similar problem. When she was hospitalized for further investigation, she developed severe arterial hypertension for which an unusual cause was found by imaging of the abdomen.

Cerebral venous thrombosis initially presenting with left occipital hemorrhage and headache.

Cerebral venous thrombosis (CVT) can be difficult to diagnose because of its wide spectrum of clinical manifestations. In the present article, we report a 58-year-old man coming to our emergency department presenting with left temporal throbbing headache and right hemianopia. Computed tomography of the brain revealed acute hemorrhages over the left occipital area. Due to the unusual location of hemorrhage, magnetic resonance venography was performed, revealing absence of venous flow over the superior sagittal and transverse sinuses suggestive of CVT. He received anticoagulant therapy for 6 months and the headache subsided. We feel that a high index of clinical suspicion is needed to diagnose an intracerebral hemorrhage in an uncommon site caused by CVT, even if risk factors of CVT are not present, so that appropriate treatment can be initiated as promptly as possible. Failure to recognize the signs of CVT could result in inappropriate management and suboptimal secondary prophylaxis strategies, which could affect the patient's clinical outcome.

Denture mis-swallowing in the sliding esophageal hiatal hernia mimics esophageal perforation.

Mis-swallowing of a foreign body in the esophagus coexisting with sliding hernia might be misdiagnosed as esophageal perforation with mediastinal abscess. We report an 89-year-old woman, bedridden for a long period in a nursing home after a previous cerebrovascular accident, who was sent to our emergency department in a state of sepsis because she had swallowed a radio-opaque partial denture. The retention of the denture as an esophageal foreign body was complicated with mediastinitis and bilateral pleural effusion. The inability of the patient to give a reliable clinical history delayed the diagnosis. This report highlights the difficulty in precisely locating a partial denture because of conflicting radiologic findings and the coexistence of esophageal sliding hernia, all of which led to a misdiagnosis of possible esophageal perforation. A right posterolateral thoracotomy with gastrostomy was performed to remove the lower esophageal foreign body after esophagoscopy failed. The surgical finding of a coincidental sliding esophageal hiatal hernia correlated well with the clinical presentation. Managing such a complicated esophageal foreign body in this elderly patient was challenging.