Effect of laser suture lysis on filtration openings: a prospective three-dimensional anterior segment optical coherence tomography study.

PURPOSE: To investigate the effects of laser suture lysis (LSL) on filtration openings after trabeculectomy. METHODS: Prospective study analyzing the changes in the location and width of filtration openings, fluid cavity height, total bleb height, bleb wall thickness, and bleb wall intensity before and after LSL using three-dimensional anterior segment optical coherence tomography (3D AS-OCT). RESULTS: Fourteen patients had clear scleral flap image analysis. As five patients underwent LSL twice and two patients underwent LSL thrice, 23 comparison studies were possible. After LSL the intraocular pressure (IOP) decreased (P = 0.0015) from 20.5 ± 5.3 to 14.9 ± 6.4 mm Hg, and the fluid cavity height increased significantly from 0.2 ± 0.2 mm to 0.3 ± 0.1 mm (P = 0.0094). Other bleb parameters were not significantly different when comparing before and after LSL. When the IOP reduction ratio was > 25% following LSL, the width of the filtration openings on the LSL side, the total bleb height, and the fluid cavity height increased (P = 0.0273, 0.0342, and 0.0024, respectively). In multiple regression analysis the changes in fluid cavity height, the wall thickness, the wall intensity, and the width of the filtration opening were positively associated with the IOP reduction rate (P = 0.0428, 0.0226, 0.0420, and 0.0356, respectively). CONCLUSIONS: 3D AS-OCT allowed a detailed examination of the internal morphology of filtration blebs and openings before and after LSL. The changes in the internal morphology were closely associated with the success of LSL to decrease IOP.

How to reduce lethal infectious complications in ABO-incompatible kidney transplantation.

BACKGROUND: ABO-incompatible organ transplants are good options for expanding the living donor pool; however, the necessary pre-conditioning to remove ABO antibodies before surgery can evoke critical infectious complications after surgery. METHODS: Between February 2009 and July 2013, we performed ABO-incompatible kidney transplantation on 182 patients. We analyzed the first 85 patients for post-operative infectious complications in a cross-sectional cohort of patients (group 1, n = 85) who had received an ABO-incompatible kidney transplant and, in light of the results, amended the pre-conditioning (lower dose of rituximab, selective use of calcineurin inhibitors, anti-metabolite reduction, and prophylactic strategy) given to a prospective cohort (group 2, n = 97). RESULTS: The characteristics of the two groups did not differ significantly. Infectious complications decreased significantly in group 2, including cytomegalovirus (anti-genemia 64.7% vs 27.8%, P < .001) and BK viremia (35.2% vs 18.6%, P = .008). The acute rejection rate and death-censored graft survival were similar in both groups. Notably, with the modified protocol, there were no deaths (8.2% vs 0.0%, P = .03). CONCLUSIONS: Pre-conditioning for ABO-incompatible kidney transplantation is a prerequisite for successful outcome; its drawbacks can be limited with the use of a modified immunosuppressive strategy. If immunosuppression is modified according to host conditions, ABO-incompatible kidney transplantation can be performed safely with a successful graft outcome.

Initial central scotomas vs peripheral scotomas in normal-tension glaucoma: clinical characteristics and progression rates.

PURPOSE: To investigate clinical characteristics and progression rates of the initial central scotomas (ICS) compared with the initial peripheral scotomas (IPS) in normal-tension glaucoma (NTG) patients. METHODS: Among NTG patients showing a single hemifield defect and who performed more than five reliable standard visual field (VF) tests, medical records of ICS (involvement of ≥3 adjacent points with P<5% within the central 12° of fixation and one point with a P<0.01 within the central 6° of fixation) (n=32) or IPS (no VF abnormality within the central 6° of fixation) (n=34) were retrospectively analyzed. The changes of mean thresholds from 10 zones of the glaucoma hemifield test, central 6° and 12° zones, peripheral zones other than central 6° and 12°, and the entire hemifield were inspected. To calculate the progression rates, linear mixed-effect model was employed. RESULTS: There were no significant differences between the two groups in age, gender, ocular factors including baseline/mean treated intraocular pressure, and systemic factors including systolic or diastolic blood pressure/perfusion pressure, mean ocular perfusion pressure (all P>0.05). There were no significant differences in baseline mean deviation and pattern standard deviation (P>0.05) between the two groups, but VF index was significantly lower in ICS group than in IPS group (P=0.001). The progression rates between the two groups were not significantly different in all zones we investigated (all P>0.05). CONCLUSIONS: Newly diagnosed cases of NTG with ICS may not differ from those with IPS in clinical characteristics and progression rates under treatment.

Diffusion tensor imaging-demonstrated differences between hemiplegic and diplegic cerebral palsy with symmetric periventricular leukomalacia.

BACKGROUND AND PURPOSE: Patients with cerebral palsy have variable clinical presentations such as hemiplegic, diplegic, or quadriplegic patterns though they have PVL on conventional MR images. The authors investigated whether DTT can differentiate between hemiplegic and diplegic CP in patients presenting with symmetric PVL on conventional MR images. MATERIALS AND METHODS: One hundred thirteen consecutive pediatric patients with definite hemiplegic (59 patients; 30 boys, 29 girls; mean age, 34.19 months; range, 24-52 months) or diplegic (54 patients; 27 boys, 27 girls; mean age, 31.07 months; range, 24-48 months) symptoms and bilateral symmetric PVL on conventional brain MR imaging were recruited. The states of CSTs were examined by using DTT, and the asymmetries of right and left CSTs in the hemiplegic and diplegic groups were compared by using asymmetric anisotropy indexes and asymmetric mean diffusivity indexes. RESULTS: All patients in the hemiplegic group with asymmetric results exhibited disrupted integrities of more affected CSTs and sparing of less affected CSTs. However, diplegic patients revealed symmetric disrupted findings of the right and left CSTs at the upper periventricular level. Asymmetric anisotropy index and asymmetric mean diffusivity index values were significantly higher in the hemiplegic group than in the diplegic group (P < .05), and these results of DTT significantly corresponded with their typical clinical manifestation. CONCLUSIONS: DTT may be very useful for the detailed estimation of the CST state in patients with bilateral symmetric PVL.

Cloning of profilin (FcPFN) from the shrimp Fenneropenaeus chinensis, a highly expressed protein in white spot syndrome virus (WSSV)-infected shrimp.

We isolated and characterized the profilin (FcPFN) cDNA from hemocytes of Fenneropenaeus chinensis, a unique shrimp species from the Yellow Sea. The FcPFN cDNA consists of 830 bp and encodes a polypeptide of 125 amino acids, having a predicted isoelectric point of 5.06. The deduced amino acid sequence of FcPFN shows 36% and 90% amino acid sequence identity to the profilin genes of Pacific white shrimp Litopenaeus vannamei and black tiger shrimp Penaeus monodon, respectively. The FcPFN mRNA was highly expressed in hemocytes and hepatopancreas and moderately in muscle of normal shrimp. The higher expression of FcPFN mRNA is observed in shrimp infected with the white spot syndrome virus (WSSV), which is a major concern in all shrimp-growing regions of the world. These results suggest a potential role for FcPFN in viral host defense mechanisms.

Development of an effective method for dendritic cell immunotherapy of mouse melanoma.

Dendritic cell (DC) immunotherapy is a strong candidate for the treatment of incurable cancers especially malignant melanoma. Nevertheless, the proper guideline of DC immunotherapy does not exist. The absence of the guideline is also an obstacle to clinical trials of DC immunotherapy. So we conducted this study in order to develop an effective DC preparation method for immunotherapy in mouse malignant melanoma. Mouse bone marrow-derived DC were stimulated with tumour antigen alone or tumour antigen plus a cocktail (anti-CD40 antibody +TNF-alpha+ IL-1beta) for 8, 24 or 48 h and the characteristics of these DC, such as surface molecules (CD40, CD80, CD86, MHC class II, CCR7), cytokines(IL-12, IFN-gamma, and IL-10), DC-induced T cell proliferation in vitro, and the production of IFN-gamma by those cells, were evaluated. Mice with melanoma were then treated with DC stimulated with tumour antigen alone and tumour antigen plus cocktail for 8 or 48 h. The tumour size and survival rate of these mice were then evaluated. (1) Beneficial clinical effects such as a reduction of tumour size and an increased survival rate were best observed in the group treated with DC stimulated for 8 h with tumour antigen plus cocktail. (2) The single prominent characteristic of DC stimulated for 8 h with tumour antigen plus cocktail was an elevated IL-12 secretion. The cytokine IL-12 was not secreted by other DC. Consequently, proper production of IL-12 was found to be an important requirement for DC used in immunotherapy of mouse melanoma.

Bone densitometry in assessment of bone mineral density.

Osteoporosis is a serious disease characterized by low bone mineral density. Osteoporosis affects 24 million people annually and may be responsible for devastating hip, wrist and spinal fractures. Bone mineral density is considered the best predictor for osteoporotic fracture. Progress has been made toward noninvasive assessment of bone mineral density to provide early diagnosis of osteoporosis. A variety of methods are used to assess bone mineral density. These methods are presented and dual energy X-ray absorptiometry is discussed in detail.

Occupational asthma and rhinitis caused by multiple herbal agents in a pharmacist.

BACKGROUND: Herb agents have been widely used for centuries in the Orient and they have been cultivated throughout Asia. There have been a few cases of occupational allergy caused by herb materials. We report a case of occupational asthma and rhinitis caused by six herb materials in a pharmacist working at a pharmacy. OBJECTIVE: We sought the role of immediate hypersensitivity in herbal agent-induced asthma in a pharmacist. METHODS AND RESULTS: The patient had strong positive responses on skin prick test to extracts of six herb materials: Chunkung (Cnidii rhizoma), Banha (Pinellia ternata), Sanyak (Dioscorea radix), Kangwhal (Ostericum koreanum), Danggui (Angelica radix), and Kunkang (Zingiberis rhizoma). Bronchoprovocation tests showed an early asthmatic response to Danggui extract. Serum specific IgE antibodies to Chunkung, Banha, and Sanyak were detected by ELISA with no specific IgE bindings to Kangwhal, Danggui, and Kunkang extracts. Twelve percent sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and IgE immunoblotting revealed one IgE binding component (60 kD) within Chunkung extract, two (10, 25 kD) in Banha, and four (33, 34, 65, 98 kD) in Sanyak. Basophil histamine release test revealed that Danggui extract could release a greater amount of histamine from basophils in the patient than in a healthy control. CONCLUSIONS: Chunkung, Banha, and Sanyak may induce IgE-mediated bronchoconstriction in an exposed worker, and Danggui can cause bronchoconstriction by direct histamine-releasing effect from mast cells in a sensitized patient.

A Phase II study of high-dose tamoxifen in patients with hormone-refractory prostate cancer.

Micromolar concentrations of tamoxifen inhibit the activity of protein kinase C and were recently shown to inhibit prostate cancer cell growth in preclinical studies. Because micromolar concentrations can be attained with high-dose therapy, the clinical activity of high-dose tamoxifen was evaluated in patients with metastatic adenocarcinoma of the prostate. Between December 1993 and February 1997, 30 patients with hormone-refractory metastatic adenocarcinoma of the prostate were continuously administered tamoxifen at 160 mg/m2/day. Therapy was continued until disease progression. All study patients had failed prior treatment with combined androgen blockade, had castrate levels of testosterone, and were heavily pretreated, having received a median of three prior regimens. The average steady-state plasma concentration of tamoxifen was 2.96+/-1.32 microM (mean +/- SD). Grade 3 neurotoxicity was observed in 29% of patients and was rapidly reversible and readily managed with dose modification. Otherwise, grade 3 toxicities were rare. One partial response (80% decline in prostate-specific antigen) was observed (3.3%), whereas disease stabilization was observed in six patients (20%), for a combined partial response/stable disease response rate of 23%. Median time to progression was 2.1 months, and median survival time was 10.5 months. High-dose tamoxifen therapy was well tolerated and associated with micromolar concentrations of tamoxifen in human plasma, and it demonstrated activity, albeit limited, in a heavily pretreated patient cohort with hormone-refractory prostate cancer. These findings suggest that further investigation of the role of protein kinase C modulation in prostate cancer is warranted.

Pharmacokinetics of cisplatin administered by continuous hyperthermic peritoneal perfusion (CHPP) to patients with peritoneal carcinomatosis.

The pharmacokinetics of cisplatin administered by continuous hyperthermic peritoneal perfusion (CHPP) was characterized in patients with peritoneal carcinomatosis. Cisplatin was added into the perfusate with escalating doses from 100 mg/m2 to 400 mg/m2. The hyperthermic perfusion was maintained for 90 minutes with a flow rate of 1.5 L/min and a target peritoneal temperature of 42.5 degrees C after a tumor debulking procedure. Samples of both the perfusate and blood were obtained during the perfusion and 30 minutes after the perfusion. Cisplatin plasma and perfusate concentrations were determined by flameless atomic absorption spectrometry with a lower limit of detection of 2 ng/ml and a coefficient of variation (CV) < 10%. Fifty-six patients were enrolled in the study. The mean (+/- SD) percentage of cisplatin present in the perfusate at the completion of perfusion was 27.8% +/- 20% of the total dose. The maximum cisplatin concentrations in the perfusate were 10 times higher than those in plasma. The area under the concentration-time curve (AUC) of the perfusate was 13 times higher than the AUC of plasma. A two-compartment model with an additional peritoneal cavity compartment fits to the data best based on the Akaike information criterion. However, the interpatient variability was considerably high (CV < 100%). In conclusion, cisplatin administered by hyperthermic peritoneal perfusion resulted in a pharmacological advantage by obtaining higher and direct drug exposure to the tumor in the peritoneal cavity while limiting systemic absorption and toxicity. Using a complex two-compartment model, the authors were able to characterize the pharmacokinetics of cisplatin given intraperitoneally via this technique.

Substrate transport and cocaine binding of human dopamine transporter is reduced by substitution of carboxyl tail with that of bovine dopamine transporter.

A chimeric dopamine transporter (DAT) cDNA encoding mutant human DAT (hDAT) protein in which the intracellular carboxyl-terminal tail is replaced by that of the bovine dopamine transporter (bDAT) was constructed. The chimeric hDAT cDNA was expressed in COS-7 cells, and [3H]dopamine and [3H]MPP+ uptake and [3H]CFT binding capacities were assessed. Substrate transport and ligand binding of bDAT were reduced by 32-43% as a result of substitution of the carboxyl tail in hDAT, suggesting that the functional characteristics of bDAT arise from differences in the carboxyl tail between human and bovine DAT. Thus, it appears that the sequences encoded within the carboxyl terminal of DAT would be one of the important determinants for its functions.

Neuroleptic drugs alter the dopamine transporter-mediated uptake and release of dopamine: a possible mechanism for drug-induced tardive dyskinesia.

A bovine dopamine transporter (bDAT) cDNA was transfected into CV-1 cells, a cell line that lacks vesicular storage and release mechanisms. Using this cell line, the effects of neuroleptic drugs on DAT-mediated uptake and release of dopamine (DA) were examined. All of the neuroleptic drugs tested, inhibited DA uptakes in DAT expressing cells, and most of them were shown to promote spontaneous release of DA at the same time. These results imply that neuroleptic drugs would cause an overflow of DA in the synaptic cleft of extrapyramidal dopaminergic neurons, which could be one of the possible mechanisms of drug-induced tardive dyskinesia.

False lateralization of seizure perceived by a patient with infarction of the right parietal lobe who showed the neglect syndrome.

A 66-year-old right-handed man developed seizures characterized by an electric sensation and convulsive movements involving the left arm, which sometimes secondarily generalized. The patient, however, reported that the seizures occurred in his right arm. Neurological examination showed many features of left hemineglect, including allesthesia, secondary to acute infarction of the right parietal lobe. Although allesthetic response was not documented during the seizure, it is likely that sensory symptoms of the seizures were localized inappropriately or that he had false memory for lateralization of seizures. In this case, the neglect syndrome caused by infarction of the right parietal lobe extended to symptoms of the seizure itself.

Histopathologic and ultrastructural findings of photocoagulation lesions produced by transpupillary diode laser in the rabbit retina.

Transpupillary retinal photocoagulations were performed on ten eyes of five pigmented rabbits using a diode laser (Nidek Co., LTD, Aichi, Japan) emitting infrared radiation at 800 nm wavelength. A histological and an ultrastructural study on the treated eyes were done at 1, 3, 5, and 7 days after retinal photocoagulations. The purpose of this study was to observe the sequential changes in the retina and the choroid following transpupillary diode laser retinal photocoagulations at the parameters of laser power which produced a grayish white retinal discoloration with distinct white center. It seemed that the lesion was grade 3 retinal photocoagulation by Tso et al's classification. It appeared that the parameters necessary to produce grade 3 photocoagulation lesions were 160 mW power, and 0.2 second duration at 200 microns size. In general, with an agreement to other reports, histologic study of the diode laser lesions showed that the outer retina was damaged more severely than the inner retina. However, on day 1 after laser treatment, the alterations were more profound in the inner retina than in the outer retina and an occasional swelling of the axons in the nerve fiber layer was observed on the ultrastructural study. The results observed have not been found in other previous studies and suggest that the inner retina might be injured directly by 800 nm wavelength diode laser radiations. Thus we could conclude that 800 nm wavelength diode radiation might be absorbed by melanin pigment and also by other chromophores contained in inner retinal tissues. Further studies must follow to verify the laser-tissue interactions in diode laser retinal photocoagulations.

Microphthalmos with cyst--case presentation.

The author has experienced a case of microphthalmos with large orbital cyst in a 4 months old female, that was found at the time of birth. To facilitate fitting a cosmetic prosthesis, the microphthalmos with cyst was removed surgically. On serial section I could find an area of discontinuation of the sclera that was suspected to be the defective closure of the embryonic cleft. Some aberrant retinal tissue was found in the wall of the cyst, and markedly disorganized ocular tissue forming a tumor-like mass filled the microphthalmic eyeball. In view of these histopathologic findings I could draw the conclusion that developmental failure of the embryonic eyeball and consequential proliferation of the embryonic neuroepithelial cells occurred at an early developmental stage causing the formation of microphthalmos with cyst.

Collagen shields and intraocular drug delivery: concentration of gentamicin in the aqueous and vitreous of a rabbit eye after lensectomy and vitrectomy.

Five albino New Zealand rabbits underwent bilateral lensectomy and vitrectomy. All left eyes were fitted with a collagen shield that had been soaked for 5 min in 2.0 mL of gentamicin solution (40 mg/mL for IV use). Right eyes were treated with fortified gentamicin drops (13.6 mg/mL) every 30 min for 12 hrs. Aqueous and vitreous specimens were obtained at the following time intervals: 1, 2, 4, 8, 12 and 24 hrs. We found the gentamicin concentrations to be higher in the aqueous of all eyes treated with fortified gentamicin drops. Only those eyes treated with fortified gentamicin drops attained a therapeutic drug level (4 micrograms-9 micrograms/mL) in the aqueous. Therapeutic drug levels were not attained in the vitreous of either treatment group.

A case of intrapericardial extralobar pulmonary sequestration--first case in Korea.

Extralobar pulmonary sequestration, known as accessory lung, is a rare congenital anomaly and intrapericardial lung sequestration is extremely rare. To the best of our knowledge, only four reported cases were intrapericardial. We report a case with intrapericardial extralobar pulmonary sequestration confirmed by operation and morphologic basis.

Effect of chronic ethanol consumption on selenium status and utilization in rats.

Effects of chronic ingestion of 2 levels of alcohol on selenium (Se) utilization were determined in initially Se-depleted rats. Male weanling rats were fed ad lib a Se deficient (0.012 mg/kg) basal diet for 4 weeks and then were meal-fed low or marginally adequate Se in the form of high Se yeast for 4 weeks. During Se repletion, ethanol, which replaced medium-chain triglycerides in the diet, provided 10 or 20 percent of food energy. The basal diet provided 80% of food energy as well as adequate protein, vitamins and minerals. In rats given adequate Se moderate chronic ethanol consumption did not influence Se absorption or retention, but increasing ethanol level raised Se in liver and whole blood in a linear fashion and in kidney in a quadratic manner. In this rat model measures of Se status were reduced by low Se intake, not chronic moderate ethanol ingestion.

The effect of aminoguanidine on the blood-retinal barrier in streptozocin-induced diabetic rats.

The effect of aminoguanidine hydrochloride (AG) on the blood-retinal barrier was studied in rats with streptozocin-induced diabetes. Half of the rats were given AG (100 mg/kg/day) while the remainder received no treatment. Vitreous fluorophotometry was performed on all rats before STZ injection and 2 weeks after induction of diabetes mellitus. Two weeks after STZ injection the mean 60-minute vitreous fluorescein concentration following dye injection had increased more in the nontreated group than in the AG-treated group, suggesting that AG may have some beneficial effect on the breakdown of the blood-retinal barrier.

Height, an important factor in the latency of somatosensory evoked potentials.

In a study of the relationship between height and the somatosensory evoked potentials (SEPs) in 24 normal individuals, we found significant linear correlations between height and the latencies of major peaks along the pathway in the median, ulnar, and first, third, and fifth digital SEPs. Thus, we conclude that the measured latency should be compared with the expected latency according to the subject's height before it is interpreted as normal or abnormal.