Optimal surgical timing in infantile exotropia.

OBJECTIVE: To evaluate age at surgery and duration of misalignment, which affect surgical outcomes of infantile exotropia in healthy children younger than 1 year. METHODS: The charts of 39 patients who have at least 1 year of follow-up period after surgery with a diagnosis of early-onset exotropia were reviewed retrospectively. Patients were divided into 2 groups (preoperative deviation [PD]): success (exodeviation ≤8 PD or esodeviation ≤5 PD at 1 year postoperatively without reoperation in the whole follow-up period) or failure (exodeviation >8 PD or esodeviation >5 PD at 1 year postoperatively, or reoperation for recurrence or overcorrection during the follow-up period). We evaluated the age at surgery and the duration of misalignment divided into 5 categories-before 6, 12, 18, 24, and 30 months-to suggest appropriate surgical timing affecting surgical outcome and compared between the 2 groups. RESULTS: Overall, 74% of the patients comprised the success group and 26% the failure group. There was no statistically significant difference in the age of alignment between 2 groups (p = 0.91). The mean duration of misalignment was 16.7 months in the success group and 20.1 months in the failure group, with no significant difference (p = 0.52). There were 4 patients (14%) with a misalignment duration of ≥24 months in the success group and 5 such patients (50%) in the failure group; the difference was statistically significant (p = 0.024). Therefore, with a duration of misalignment of up to 24 months as the reference level, the odds of having a successful outcome decreased significantly over 24 months, with the multiple logistic regression model yielding a risk estimate over 6-fold of failure (odds ratio 6.25; p = 0.024). CONCLUSIONS: The postoperative surgical outcome was influenced by the duration of the misalignment, rather than the age at surgery. Surgery within 24 months of misalignment favourably affected the percentage of patients who achieved successful outcome in the treatment of infantile exotropia.

Fluorinated polyimide gate dielectrics for the advancing the electrical stability of organic field-effect transistors.

Organic field-effect transistors (OFETs) that operated with good electrical stability were prepared by synthesizing fluorinated polyimide (PI) gate dielectrics based on 6FDA-PDA-PDA PI and 6FDA-CF3Bz-PDA PI. 6FDA-PDA-PDA PI and 6FDA-CF3Bz-PDA PI contain 6 and 18 fluorine atoms per repeat unit, respectively. These fluorinated polymers provided smooth surface topographies and surface energies that decreased as the number of fluorine atoms in the polymer backbone increased. These properties led to a better crystalline morphology in the semiconductor film grown over their surfaces. The number of fluorine atoms in the PI backbone increased, the field-effect mobility improved, and the threshold voltage shifted toward positive values (from -0.38 to +2.21 V) in the OFETs with pentacene and triethylsilylethynyl anthradithiophene. In addition, the highly fluorinated polyimide dielectric showed negligible hysteresis and a notable gate bias stability under both a N2 environment and ambient air.

Modified inferior oblique transposition considering the equator for primary inferior oblique overaction (IOOA) associated with dissociated vertical deviation (DVD).

PURPOSE: Inferior oblique anterior transposition (IOAT) should be done only in patients with inferior oblique overaction (IOOA) and dissociated vertical deviation (DVD) without fusional potential because the procedure can cause anti-elevation syndrome. This study reports the results of modified inferior oblique transposition onto the equator in 7 patients diagnosed with infantile exotropia or esotropia associated with IOOA and DVD. METHODS: We performed modified inferior oblique (IO) transposition onto or considering the equator on 7 patients who had infantile exotropia or esotropia associated with IOOA and DVD. Five patients had infantile exotropia, and the other two patients had infantile esotropia. Six patients had undergone bilateral rectus--Bilateral Lateral Rectus (BLR) or Bilateral Medial Rectus (BMR)--recession previously and one patient underwent BLR recession and IO transposition simultaneously. They had more than +1.5 IOOA with DVD in both eyes. IO was transposed vertically onto the equator in this study. The mean distance between the lateral border of the inferior rectus insertion and the equator was 5.6 mm (range: 4.5 to 6.5 mm). Three months after the operation, degree of IOOA and DVD in each eye was evaluated. RESULTS: IOOA and DVD were markedly reduced in all patients (+0.5 ∼+1 for IOOA postoperatively). Mild contralateral IOOA was noted but the motility disturbance was successfully corrected in all cases postoperatively. CONCLUSION: Bilateral IO transposition onto the equator could minimize antielevation and corrected IOOA and DVD successfully in patients with infantile exotropia or esotropia.

Change in the location of the equator and recessed muscles in young rabbit eyes.

PURPOSE: To study the changes in the location of the equator and the new insertion of extraocular muscle after recession surgery in a rabbit model. METHOD: An experimental study was performed in ten eyes of five rabbits. Eyes were divided into two groups according to the amount of recession. In right eyes, 5 mm superior recti (SR) muscle recession, approximately 2 mm posterior to the equator, was performed (5 mm recession group), while in the left eyes, 3 mm recession was performed to the location of the equator (3 mm recession group). We measured the distance of the equator from the limbus, as well as the distance between the superior rectus insertion and the equator. The preoperative measurements were compared with the results 2 months after the surgery. The change in location of the superior rectus and the equator was compared between the two eyes. RESULT: The recessed SR muscle did not show any significant change in location in both groups (p = 0.18 and 0.16 respectively). However, the location of the equator of rabbit eye showed movement of about 1 mm posterior to the initial location with the growth of the eyeballs (p = 0.04 and 0.03, respectively). CONCLUSION: The location of the equator moved posteriorly at 2 months postoperatively in young rabbit model while the insertion of the recessed SR did not show any significant movement.

3D asthenopia in horizontal deviation.

PURPOSE: This study was conducted to investigate the asthenopic symptoms in patients with exotropia and esotropia while watching stereoscopic 3D (S3D) television (TV). METHODS: A total 77 subjects who more than 9 years of age were enrolled in this study. We divided them into three groups; Thirty-four patients with exodeviation (Exo group), 11 patients with esodeviation (Eso group) and 32 volunteers with normal binocular vision (control group). The S3D images were shown to all patients with S3D high-definition TV for a period of 20 min. Best corrected visual acuity, refractive errors, angle of strabismus, stereopsis test and history of strabismus surgery, were evaluated. After watching S3D TV for 20 min, a survey of subjective symptoms was conducted with a questionnaire to evaluate the degree of S3D perception and asthenopic symptoms such as headache, dizziness and ocular fatigue while watching 3D TV. RESULTS: The mean amounts of deviation in the Exo group and Eso group were 11.2 PD and 7.73PD, respectively. Mean stereoacuity was 102.7 arc sec in the the Exo group and 1389.1 arc sec in the Eso group. In the control group, it was 41.9 arc sec. Twenty-nine patients in the Exo group showed excellent stereopsis (≤60 arc sec at near), but all 11 subjects of the Eso group showed 140 arc sec or worse and showed more decreased 3D perception than the Exo and the control group (p < 0.001, Kruskal-Wallis test). The Exo group reported more eye fatigue (p < 0.001, Kruskal-Wallis test) than the Eso and the control group. However, the scores of ocular fatigue in the patients who had undergone corrective surgery were less than in the patients who had not in the Exo group (p < 0.001, Kruskal-Wallis test) and the amount of exodeviation was not correlated with the asthenopic symptoms (dizziness, r = 0.034, p = 0.33; headache, r = 0.320, p = 0.119; eye fatigue, r = 0.135, p = 0.519, Spearman rank correlation test, respectively). CONCLUSION: Symptoms of 3D asthenopia were related to the presence of exodeviation but not to esodeviation. This may indicate that S3D symptoms are closely related to the convergence demand.

Influence of IL1B polymorphism on CpG island hypermethylation in Helicobacter pylori-infected gastric cancer.

Helicobacter pylori infection can induce aberrant CpG island hypermethylation in gastric mucosal epithelial cells. Single nucleotide polymorphisms of proinflammatory cytokine genes encoding for interleukin 1B (IL1B), IL6, and IL8 have been demonstrated to be associated with an increased risk of gastric cancer. To identify the influence of host genetic factors in CpG island hypermethylation induced by H. pylori infection, we analyzed H. pylori-infected chronic gastritis (n = 111) and gastric cancer samples (n = 78) for the methylation status of eight genes previously shown to be hypermethylated in chronic gastritis and single nucleotide polymorphisms of IL1B, IL6, and IL8. The methylation levels were then compared between different genotypes. Gastric cancers from patients with the IL1B-511T/T allele showed significantly higher methylation levels in five genes as compared with gastric cancers from IL1B-511 C carriers (P < 0.05). An increased level of hypermethylation in association with the IL1B-511T/T allele was observed in chronic gastritis samples, but the association was not statistically significant. These findings suggest that the IL1B-511T/T allele is associated with enhanced hypermethylation of multiple CpG island loci, which might contribute to an increase in the risk for gastric cancer in individuals with H. pylori infection and IL1B-511T/T allele.

Prognostic implications of and relationship between CpG island hypermethylation and repetitive DNA hypomethylation in hepatocellular carcinoma.

PURPOSE: This study aims to determine the relationship between CpG island DNA hypermethylation and global genomic DNA hypomethylation and their prognostic implications in hepatocellular carcinoma. The association of DNA methylation changes with clinicopathologic factors and the chronological ordering of DNA methylation changes along multistep hepatocarcinogenesis were also assessed. EXPERIMENTAL DESIGN: Hepatocellular carcinoma (n = 20) and nonneoplastic liver samples (n = 72) were analyzed for their methylation status at 41 CpG island loci and 3 repetitive DNA elements (LINE-1, ALU, and SAT2) using MethyLight or combined bisulfite restriction analysis. After selection of 19 CpG island loci showing cancer-specific DNA methylation, another set of 99 hepatocellular carcinoma samples was analyzed for these loci. RESULTS: The number of methylated genes in hepatocellular carcinoma was significantly higher in hepatocellular carcinoma patients with a cirrhotic liver than in hepatocellular carcinoma patients with a noncirrhotic liver (9.9 versus 7.0, P = 0.001). Hepatocellular carcinoma from female patients showed a higher number of methylated genes than hepatocellular carcinoma from male patients (11.2 versus 8.4, P = 0.006). The genes CRABP1 and SYK showed significant association between CpG island hypermethylation and patients' poor survival. SAT2 hypomethylation occurred earlier than LINE-1 or ALU hypomethylation along the multistep hepatocarcinogenesis. Depending on the type of CpG island locus, a direct, inverse, or no relationship between CpG island hypermethylation and repetitive DNA hypomethylation was observed in hepatocellular carcinomas. CONCLUSION: The varying relationships between the hypermethylation of individual CpG island loci and the hypomethylation of repetitive elements suggests that they are not mechanically linked. SYK and CRABP1 hypermethylation may serve as useful tumor markers for prognostication of hepatocellular carcinoma patients.

CpG island methylator phenotype in colorectal cancers: comparison of the new and classic CpG island methylator phenotype marker panels.

CONTEXT: CpG island methylator phenotype (CIMP) designates a subset of colorectal cancers featuring concordant hypermethylation of multiple promoter CpG islands. Little is known about the clinical outcome or histologic characteristics of CIMP-positive colorectal cancers defined by recently identified CpG island methylator phenotype panels. OBJECTIVE: To investigate and compare the molecular and clinicopathologic features of CIMP-positive colorectal cancers defined by classic (p16, hMLH1, MINT1, MINT2, MINT31) and new (CACNA1G, IGF2, NEUROG1, RUNX3, SOCS1) CIMP panels. DESIGN: We analyzed 130 colorectal cancers for hypermethylation of both panels using methylation-specific polymerase chain reaction. RESULTS: With at least 2 markers methylated, both classic (39/130; 23.1%) and new (23.1%) CIMP-positive colorectal cancers were significantly associated with proximal tumor location, microsatellite instability, and BRAF mutation (all P values were less than .05). The new panel outperformed the classic panel in detecting these features. With at least 3 markers methylated, new CIMP-positive colorectal cancers (16.9%) were closely associated with proximal tumor location, low frequency of KRAS mutation, and high frequency of BRAF mutation (all P values were less than .05), whereas classic CIMP-positive colorectal cancers (18.5%) were closely associated with proximal tumor location, frequent microsatellite instability, and frequent BRAF mutation (all P values were less than .05). Analyzing a combination of CIMP and microsatellite instability status, CIMP-positive/microsatellite instability-negative colorectal cancers had the worst clinical outcomes. CONCLUSIONS: Whereas the classic panel outperformed in predicting clinical outcome, the new panel was superior in detecting known clinicopathologic features of CIMP but inferior in prognostication power.

Helicobacter pylori-infection-associated CpG island hypermethylation in the stomach and its possible association with polycomb repressive marks.

Helicobacter pylori infection can induce CpG island (CGI) hypermethylation in gastric mucosa. Recently, genes occupied by Polycomb proteins in embryonic stem cells were shown to be vulnerable to aberrant DNA hypermethylation in cancers. To explore the relationship between H. pylori infection and DNA methylation changes in neoplastic and non-neoplastic stomach, we analyzed 25 CGIs and repetitive DNA elements from 82 chronic gastritis and 69 gastric carcinomas. Twenty-three CGIs showed significantly higher methylation levels in H. pylori-negative gastric carcinoma (n = 28) than in H. pylori-negative chronic gastritis (n = 39; P < 0.05), indicating cancer-associated methylation. Eight CGIs exhibited significantly higher methylation levels in H. pylori-positive chronic gastritis (n = 43) than in H. pylori-negative chronic gastritis (n = 39; P < 0.05). Six CGIs showed both cancer-associated and H. pylori-associated hypermethylation. Six (75%) of the eight H. pylori-associated hypermethylated genes contained at least one of three repressive marks (Suzl2 occupancy, Eed occupancy, histone H3 K27 trimethylation), whereas 31% of the remaining cancer-associated hypermethylated genes had at least one mark. The findings suggest that H. pylori infection strongly induces CGI hypermethylation in gastric epithelial cells and that susceptibility to H. pylori-induced DNA hypermethylation may be determined by Polycomb repressive marks in stem or progenitor cells.