Giant retinal pigment epithelial tear following photodynamic therapy for the bullous variant of central serous chorioretinopathy: A case report.

RATIONALE: The bullous variant of central serous chorioretinopathy (CSC) is a severe form of chronic CSC. Patients with the bullous variant of CSC have an increased risk of experiencing multiple pigment epithelial detachments (PEDs) and retinal pigment epithelium (RPE) tears. Photodynamic therapy (PDT) is a treatment for the bullous variant of CSC. RPE tear is a possible postoperative complication of PDT for eyes with PEDs. To our knowledge, no cases of giant RPE tears following PDT for the bullous variant of CSC have been reported previously. This case report presents the first instance of a giant RPE tear after half-time PDT for the bullous variant of CSC, accompanied by a series of images depicting the tear development. PATIENT CONCERNS: A 63-year-old male patient presented with rapidly deteriorating vision in his left eye over a 3-month period. He also reported a previous episode of vision loss in his right eye 2 years prior. Best-corrected visual acuity (BCVA) in the left eye was 0.2. DIAGNOSIS: The right eye was diagnosed with chronic non-bullous CSC, while the left eye was diagnosed with the bullous variant of CSC with a large PED. INTERVENTIONS: Half-time PDT was administered to the left eye. OUTCOMES: One month after half-time PDT, a giant RPE tear exceeding 3 clock-hours in size was confirmed in the lower temporal quadrant of the left eye. Three months after the initial half-time PDT, a second half-time PDT was performed owing to recurrent retinal detachment. Two months after the second half-time PDT, the retinal detachment resolved, and BCVA improved to 0.4, 6 months after the second half-time PDT. LESSONS: In cases where the bullous variant of CSC is complicated by extensive PED, clinicians should consider the potential development of a giant RPE tear as a treatment complication.

Association Between Workplace Social Support and Use of Health-Promoting Wearable Devices: A Prospective Cohort Study of Japanese Employees.

We examined the relationship between workplace environmental factors, including support from supervisors and colleagues, and the continued use of a wearable device meant to promote occupational health. One hundred employees at a Japanese manufacturing company participated in a 3-month study, and information related to their physical health status was recorded by a wearable device. We analyzed the results using the χ2 test and logistic regression analysis. We found that men aged 40-49 years and employees reporting low support from supervisors and colleagues were significantly more likely to be continuing device users. Participants with low workplace support had adjusted odds ratios approximately two to three times higher than those with high levels of support, which was significant. Employees with low workplace support were able to communicate at work, access appropriate support, and enthusiastically participate in occupational health promotion with little psychological difficulty in using the device. Occupational health promotion using wearable devices can complement traditional face-to-face occupational health promotion.

A case of concurrent occurrence of carcinoma showing thymus-like differentiation and follicular variant of papillary thyroid cancer in the same thyroid.

Carcinoma showing thymus-like differentiation (CASTLE) is a rare thyroid cancer. This is the first report of a case of concurrent occurrence of CASTLE with papillary thyroid carcinoma (PTC). A 66-year-old male patient had hoarseness with right vocal cord paralysis. Ultrasonography revealed a hypoechoic nodule in the inferior pole of the right thyroid lobe. Ultrasound-guided fine-needle aspiration cytology suggested differentiated thyroid cancer. The patient underwent total thyroidectomy with neck dissection. Pathological examination revealed two different thyroid cancers: a CASTLE and a follicular variant of PTC. Postoperative radiation therapy was performed. The patient was still alive after 5 year following the initial treatment without evidence of recurrence. The oncological management of patients with concurrent occurrence of different thyroid cancers should consider the biological behavior of both tumors.

A Rare Case of Thyroid Carcinoma Showing Thymus-Like Differentiation in a Young Adult.

Thyroid carcinoma showing thymus-like differentiation (CASTLE) is thought to originate from ectopic thymic tissue or remnants of the developing thymus within or adjacent to the thyroid. This case report describes a mass located on the left thyroid of a 28-year-old man. Fine-needle aspiration cytology revealed a number of lymphoid cells without atypia that were similar to those seen in a malignant lymphoma of the thyroid, and surgery was performed. Based on additional histopathological findings, the tumor was finally diagnosed as a CASTLE. It is difficult to diagnose this neoplasm using fine-needle aspiration cytology. However, it is possible to differentially diagnose CASTLE based on its histological features. CD5 is useful for diagnosing CASTLE with immunohistochemical staining.

Identification of citrullinated cellular fibronectin in synovial fluid from patients with rheumatoid arthritis.

OBJECTIVES: Cellular fibronectin (cFn) has been implicated in the pathogenesis of rheumatoid arthritis (RA), and we previously demonstrated the presence of citrullinated cFn in rheumatoid synovial tissues. The present study aimed to investigate whether citrullinated cFn can be detected in the plasma or synovial fluid of RA patients. METHODS: Twenty-five rheumatoid arthritis synovial fluid (RASF), seven osteoarthritis synovial fluid (OASF) and 12 plasma samples from RA patients were examined. Citrullination of cFn was determined by immunoprecipitation (IP), western blotting and enzyme-linked immunosorbent assay (ELISA), in which peptidyl-citrulline within cFn was detected using a specific anti-cFn monoclonal antibody in combination with anti-modified citrulline antibody after chemical modification. RESULTS: Levels of citrullination associated with cFn, as determined by ELISA, were significantly higher in RASF than in OASF samples. IP and western blotting detected citrullinated cFn in RASF but not in plasma samples from RA patients. Levels of total cFn were elevated in RASF compared with OASF, and 24 out of 25 RASF samples were positive for anti-CCP antibody. However, no correlation was observed between levels of citrullinated cFn and those of total cFn or anti-CCP antibody in RASF. On the other hand, a significant positive correlation was observed between the levels of matrix metalloproteinase-3 (MMP-3) and cFn citrullination in RASF. CONCLUSIONS: Citrullinated cFn appears to be produced within the affected joint and might be involved in the pathogenesis of rheumatoid synovitis.

Erupted complex odontoma delayed eruption of permanent molar.

Odontomas, benign tumors that develop in the jaw, rarely erupt into the oral cavity. We report an erupted odontoma which delayed eruption of the first molar. The patient was a 10-year-old Japanese girl who came to our hospital due to delayed eruption of the right maxillary first molar. All the deciduous teeth had been shed. The second premolar on the right side had erupted, but not the first molar. Slight inflammation of the alveolar mucosa around the first molar had exposed a tooth-like, hard tissue. Panoramic radiography revealed a radiopaque mass indicating a lesion approximately 1 cm in diameter. The border of the image was clear, and part of the mass was situated close to the occlusal surface of the first molar. The root of the maxillary right first molar was only half-developed. A clinical diagnosis of odontoma was made. The odontoma was subsequently extracted, allowing the crown of the first molar to erupt almost 5 months later. The dental germ of the permanent tooth had been displaced by the odontoma. However, after the odontoma had been extracted, the permanent tooth was still able to erupt spontaneously, as eruptive force still remained. When the eruption of a tooth is significantly delayed, we believe that it is necessary to examine the area radiographically. If there is any radiographic evidence of a physical obstruction that might delay eruption, that obstruction should be removed before any problems can arise. Regular dental checkups at schools might improve our ability to detect evidence of delayed eruption earlier.

Severe headache complicated by vertical atlantoaxial subluxation in diffuse systemic sclerosis with crowned dens pattern calcification.

We report a 34-year-old female case of diffuse systemic sclerosis (SSc) with generalized ectopic calcification, who developed severe headache with vertical atlantoaxial subluxation (AAS) complicated by calcification around the odontoid process (crowned dens pattern calcification). Although a rare complication, AAS should be considered as a differential diagnosis of severe headache in SSc patients with extensive calcification.

Human erythrocyte nucleoside transporter ENT1 functions at ice-cold temperatures.

The functionality of human erythrocyte nucleoside transporter ENT1 was examined at ice-cold temperatures (ICT; measured temperature, 0.5-0.7 degrees C) using rightside-out membrane vesicles (ROVs). The uptake of uridine, an ENT1 substrate, showed saturation kinetics and was inhibited by S-(4-nitrobenzyl)-6-thioinosine (NBMPR), a specific ENT1 inhibitor, at both 23 degrees C and ICT. [3H]Uridine uptake was markedly trans-stimulated by preloading ROVs with unlabeled uridine or ribavirin, another ENT1 substrate, and the overshoot phenomenon was observed at ICT. Similarly, [3H]ribavirin uptake was markedly trans-stimulated by unlabeled ribavirin or uridine at ICT. The trans-stimulated uptake of [3H]uridine at ICT was inhibited by ENT1 inhibitors/substrates such as NBMPR, dipyridamole, adenosine, and ribavirin in a concentration-dependent manner. The inhibition of [3H]uridine uptake by NBMPR and dipyridamole at ICT was also observed in intact red blood cells. Like uridine uptake, [3H]D-glucose uptake by ROVs, which is mediated by facilitative glucose transporter GLUT1, was trans-stimulated by unlabeled D-glucose at ICT, and the overshoot phenomenon was observed. In contrast, the ability of ATP-dependent transport of 5-(and-6)-carboxy-2',7'-dichlorofluorescein via multidrug resistance-associated protein 5 in inside-out membrane vesicles disappeared at ICT. These results clearly indicate that human erythrocyte transporters such as ENT1 function even at very low temperatures near 0 degrees C. The significance of these findings in transporter research is discussed.

[Effect of motion correction associated with echo train length and number of blades in propeller MRI-computer simulation].

The PROPELLER (periodically rotated overlapping parallel lines with enhanced reconstruction) MRI method is available with a technique for motion correction. We studied changes in correction according to differences in echo train length (ETL) and number of blades, and measured correction accuracy according to linear translation and rotation, using computer simulation. A T(2)-weighted axial image of the head taken by FSE was utilized as the basic MR image. We reconstructed other images with differences in quantity of motion, ETL, and number of blades, also using computer simulation. After motion correction was performed, we measured correction accuracy with cross-correlation to the basic image. The method of motion correction was performed by the conversion of k-space data for each blade step using 2D Fourier-transform. After motion correction of the obtained image had been carried out, the image was converted to k-space data using reverse Fourier-transform. For data of 30 pixels with horizontal translation, cross-correlation coefficients for the stationary image were 0.6 for FSE without motion correction, 0.74 for the PROPELLER (ETL 8, blades 32) image without motion correction, and 0.99 for the PROPELLER (ETL 8, blades 32) image with motion correction. For data of 24 degrees with rotation, cross-correlation coefficients were 0.38 for FSE without motion correction, 0.53 for the PROPELLER (ETL 8, blades 32) image without motion correction, and 0.93 for the PROPELLER (ETL 8, blades 32) image with motion correction. The cross-correlation coefficient of liner translation is higher than its rotation. Correction accuracy was better with larger numbers of ETL than without motion correction. The spatial resolution of the image was decreased in the corrected image more by rotation than linear translation. This study indicated that the PR method was able to inspect the imaging technique with little influence on movement.