[Recurrence of macular edema complicating central retinal vein occlusion: Consider follow-up fluorescein angiography]. / Récidive de l'œdème maculaire compliquant l'occlusion veineuse centrale de la rétine : penser à refaire l'angiographie rétinienne à la fluorescéine.

PURPOSE: The goal of our study is to highlight, through a series of 4 cases, the importance of retinal fluorescein angiography in monitoring the retinal periphery in retinal vein occlusions, particularly in cases of recurrent macular edema. OBSERVATIONS: This is a series of 4 patients aged between 50 and 90 years with ischemic central retinal vein occlusions in 2 cases and branch retinal venous occlusions in 2 cases. Fluorescein angiography was performed in two of our patients, and optical coherent tomography in all cases, showing cystoid macular edema with an average macular thickness of 439µm. All patients received a complete etiological assessment and intravitreal anti-VEGF injections with an initially favorable course in all cases. A recurrence with aggravation of the edema compared to the initial appearance was observed in all cases, with a delay varying between 9 and 16 months (mean 11.25 months). Fundus examination revealed an increased number of retinal hemorrhages in each case, with the appearance of cotton wool spots in one case, suggesting ischemic conversion. This was confirmed by performing fluorescein angiography, which revealed large areas of retinal ischemia. Retinal photocogulation of the ischemic areas was thus indicated, along with a second series of intravitreal injections. CONCLUSION: Macular edema is the principal cause of visual acuity decline in retinal vein occlusions; its prognosis is similar to that of retinal venous occlusions in general, hampered by the possibility of ischemic conversion. The diagnosis of retinal vein occlusion is clinical and does not require angiography. This remains, however, a useful exam to better analyze the retinal periphery as well as for the detection of various modalities during spontaneous progression.

Occult pulmonary arterial hypertension in patients with previous pulmonary tuberculosis.

BACKGROUND: Pulmonary tuberculosis (TB) still causes a significant public healthcare burden. Despite successful treatment, TB can lead to permanent lung damage and pulmonary hypertension (PH). PH can also occur in the absence of significant lung damage, leading clinicians to question whether pulmonary TB may cause pulmonary arterial hypertension (PAH), an entity that has not been otherwise described. OBJECTIVES: To determine the prevalence of PAH in patients previously treated for TB. METHODS: We recruited 20 participants who were previously treated for TB and had no other underlying risk factors for the development of PH. The participants underwent electrocardiography (ECG), chest radiography, lung function tests and echocardiography (ECHO). Data from these non-invasive investigations were evaluated to determine findings that were suggestive of PH. RESULTS: At a median duration of 30 months from diagnosis of TB, no participant had echocardiography findings that were suggestive of PH (pulmonary artery pressure (PAP) ≥40 mmHg). However, there was a negative correlation between the time from diagnosis and right ventricular dysfunction assessed by measuring a tricuspid annular plane systolic excursion (r=-0.5136; p=0.0205). Furthermore, one-third of the participants (n=7) had one or more ECG features supporting PH and 85% of the participants (n=17) demonstrated at least one chest X-ray (CXR) feature of PH. CONCLUSION: Although our study did not demonstrate ECHO findings supporting PH, ECG and CXR modalities were suggestive. Therefore, future studies consisting of larger cohorts and including the use of other sensitive modalities such as computed tomography are warranted. Moreover, these studies will need to determine whether the entity of PAH secondary to previously treated pulmonary TB exists.

Three-dimensional printing of metals for biomedical applications.

Three-dimensional (3D) printing technology has received great attention in the past decades in both academia and industry because of its advantages such as customized fabrication, low manufacturing cost, unprecedented capability for complex geometry, and short fabrication period. 3D printing of metals with controllable structures represents a state-of-the-art technology that enables the development of metallic implants for biomedical applications. This review discusses currently existing 3D printing techniques and their applications in developing metallic medical implants and devices. Perspective about the current challenges and future directions for development of this technology is also presented.

The effect of L-arginine supplementation on body composition and performance in male athletes: a double-blinded randomized clinical trial.

This corrects the article DOI: 10.1038/ejcn.2016.266.

The effect of l-arginine supplementation on body composition and performance in male athletes: a double-blinded randomized clinical trial.

BACKGROUND/OBJECTIVE: Athletes used a lot of dietary supplements to achieve the more muscle mass and improve their athletic performance. The objective of this study was to investigate the effect of l-arginine supplementation on sport performance and body composition in male soccer players. SUBJECTS/METHODS: This double-blinded, randomized and placebo-controlled trial was conducted on 56 male soccer players, with age range of 16-35, who referred to sport clubs in Isfahan, Iran. Subjects were randomly assigned to either l-arginine or placebo groups. Athletes received daily either 2 g per day l-arginine supplement or the same amount of placebo (maltodextrin) for 45 days. Sport performance and also body mass index (BMI), body fat mass (BFM) and lean body mass (LBM) were measured at the beginning and end of the study. Also, 3-day dietary records were collected at three different time points (before, in the middle of, and at the end of the study). RESULTS: The mean age of subjects was 20.85±4.29 years. Sport performance (VO2 max) significantly increased in l-arginine supplementation group (4.12±6.07) compared with placebo group (1.23±3.36) (P=0.03). This increase remained significant even after adjustment of baseline values, physical activity and usual dietary intake of subjects throughout the study. No significant effect of l-arginine supplementation was found on weight, BMI, BFM and LBM. CONCLUSIONS: l-arginine supplementation (2 g per day) could increase the sport performance in male athletes, but had no effect on anthropometric measurements, including BMI, BFM and LBM. So, further studies are needed to shed light our findings.

Association of PDCD1 gene markers with susceptibility to thyroid cancer.

PURPOSE: PD-1 receptor is a co-signaling molecule with an important role in regulation of T-lymphocyte activity. Correlation between PD-1 gene (PDCD1) polymorphisms and some immune-related diseases has been reported before. In current study, we aimed to investigate the association of PD-1 polymorphisms at positions +7146 G/A (PD-1.3) and +7785 C/T (PD-1.5), as well as the emerged haplotypes with susceptibility to thyroid carcinoma. METHODS: One hundred five patients with confirmed thyroid cancer and 160 healthy individuals as control group were enrolled. Genotypes were identified using PCR-RFLP and nested PCR-RFLP methods. Results were analyzed by Arlequin and SPSS software packages. RESULTS: Analysis revealed a significant increase in the frequency of PD-1.5 mutant T allele and heterozygous CT genotype in patients with thyroid cancer in comparison with controls [79 (37.7%) vs. 71 (22.2%), and 51 (48.6%) vs. 51 (31.9%), p = 0.0001 and p = 0.009, receptively]. CC genotype at this position observed to be significantly higher among controls than the patients [99 (61.9%) vs. 40 (38.1%), p = 0.0002]. There were no significant differences in the frequencies of genotypes and alleles at locus PD-1.3 between patients and control group. Despite this, GT haplotype emerged from both positions (PD-1.3 G and PD-1.5 T) has also been observed with significant increased frequency between patients and controls [70 (36.8%) vs. 71 (22.2%), p = 0.0005]. CONCLUSION: As the first study to investigate two mentioned polymorphisms in thyroid cancer, current study confirmed the association of PD-1.5 C/T polymorphism and a haplotype resulted from both loci, PD-1.3 and PD-1.5, with susceptibility of Iranians to thyroid cancer.

Green synthesis of silver nanoparticles using Salvadora persica L. and its antibacterial activity.

The silver nanoparticles (AgNPs) shows special physicochemical properties, therefore they use many applications such as catalysis, health, electronic and optical. In this study, AgNPs was synthesized using aqueous extract of Salvadora persica bark. The synthesized AgNPs were characterized by UV-Vis spectroscopy, Powder X-ray diffraction (PXRD) and Transmission electron microscopy (TEM) methods. The optimal synthesis condition to prepare nanoparticles was determined as silver nitrate 3 mM, 5 ml of aqueous extract in the room temperature for 1 h. The TEM image of AgNPs showed the formation of spherical, non-uniform nanoparticles of mean size of 50 nm. The antibacterial activity of synthesized AgNPs was evaluated using disk diffusion, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) methods on Escherichia coli and Staphylococcus aureus bacteria. The MIC values of AgNPs were 100 and 400 µg/mL on E. coli and S. aureus, respectively. Also the MBC of AgNPs was 200 µg/mL for E. coli and there was no result observed for S. aureus bacteria. The results showed that synthesized nanoparticles have favorable antibacterial properties.

Mutagenic, antimutagenic, antioxidant, anti-lipoxygenase and antimicrobial activities of Scandix pecten-veneris L.

Scandix pecten-veneris L. or Shepherd's-needle is a weed species used in some countries for medicinal purposes. In this study S. pecten-veneris leaves were shade dried, powdered and extracted with methanol. The purpose of this study was to assay the in vitro mutagenic, antimutagenic, antioxidant, antilipoxygenase and antimicrobial activities of S. pecten-veneris leaf extract. The methanolic extract indicated no mutagenicity when tested with Salmonella typhimurium strains TA98 and TA100. Antimutagenic activity was reported with inhibition of mutagenicity in a concentration dependent fashion. The methanolic extract demonstrated antioxidant activity in the DPPH radical-scavenging test (IC50 = 4.57 mg/mL), comparable to ascorbic acid and BHT. Moreover, the extract presented a remarkable and potent inhibition against soybean lipoxygenase (IC50 = 641.57 µg/mL). The methanolic extract was examined for its antimicrobial powers against four different bacteria with MIC values >100. Our results introduced this plant as a useful factor for the treatment of cancer, inflammatory and infectious diseases.

Guaiasistanol: A new guaiane sesquiterpenoid from Teucrium persicum Boiss.

In this study, a new guaiane type skeleton sesquiterpenoid named guaiasistanol (6α, 10α-epoxy-4α-hydroxyguaiane) was isolated from chloroform part of the Teucrium persicum extract, also chrysothol. Spectroscopic means explained the structures. This compound was evaluated for inhibitory activity against acetylcholinesterase and it showed a moderate activity with 28% inhibition.

Acyclovir-resistant varicella-zoster virus keratitis in an immunocompetent patient.

Varicella-zoster virus (VZV) resistance to acyclovir (ACV) has only been reported in rare cases of immunocompromised patients. We report the first case of an immunocompetent patient with ACV-resistant VZV keratitis associated with a nucleotide deletion in the VZV thymidine kinase gene, leading to production of a truncated protein.

Intra-lesional 5 fluorouracil for the management of recurrent pterygium.

AIM: Recurrence is the most common complication arising from pterygium surgery. The aim of this study was to investigate the effectiveness of 5 fluorouracil (5FU) in halting the recurrence of pterygium after surgical excision. METHODS: A retrospective review of patients treated for pterygium recurrence was carried out. Patients with recurrent (secondary) pterygium were treated with multiple weekly intra-lesional injections of 0.1-0.2 ml (2.5-5 mg) 5FU post-operatively depending on the size of the recurrence. The treatment was started within 1 month from the date of recurrence. The time from surgery to start of recurrence, previous treatment modalities, and number of recurrences were documented. The number of injections required to induce arrest of progression and/or regression of vascularity and fleshiness of the pterygium and any complications related to 5FU treatment were examined. RESULTS: Fifteen eyes from 14 patients with recurrent pterygium treated with intra-lesional 5FU injections were analysed. Three of the 15 eyes had undergone a secondary excision and 12 had undergone a primary excision. In all, 93.3% of patients showed regression of the fibrovascular tissue (thickness and vascularity) and arrest of progression following a dose of 0.1-0.2 ml (2.5-5 mg) 5FU. Twelve eyes required three injections or fewer, whereas one patient required eight injections. This beneficial effect was maintained over an average follow-up period of 17 months. No complications from 5FU were observed. CONCLUSION: The use of weekly intra-lesional 5FU injections for the treatment of recurrent pterygium is safe and effective in limiting the progression and inducing the regression of recurrent pterygium. The number of injections can be tailored according to clinical need.

[Secondary opacification of hydrophilic acrylic intraocular lenses: report of two cases]. / Opacification secondaire d'implants intraoculaires acryliques hydrophiles : à propos de deux cas.

PURPOSE: To describe two cases of secondary opacification of hydrophilic acrylic IOLs after vitreoretinal surgery. METHODS: Analysis of IOL deposits with anterior segment optical coherence tomography (OCT Visante(®)) and high-frequency ultrasound biomicroscopy (CineScan HF, Quantel Medical(®)) was carried out preoperatively. The explanted IOLs were analyzed with optical and electron microscopy, and energy dispersive spectrometry (EDS). RESULTS: In both patients, the deposits were located on the surface and within the implant and were composed of calcium phosphate crystals. Vitreoretinal surgery performed a few months prior to the secondary opacification was identified as a risk factor. CONCLUSION: When a patient presents with a secondary opacification of the IOL involving the visual axis, explantation is sometimes necessary, fortunately with typically good functional recovery in the postoperative period. While this complication is rare and the exact pathophysiology poorly understood, it must be considered in a pseudophakic patient with an unexplained decrease in visual acuity who has undergone more than one intraocular procedure.

Rapid suture management of post-keratoplasty astigmatism.

AIM: Post-keratoplasty astigmatism is managed by topography-guided suture removal. This can take several weeks until satisfactory reduction in astigmatism is achieved. This study aimed to assess whether topography performed 30-40 min after the removal of the first pair of sutures would predict the next set of sutures requiring removal. METHODS: A prospective study of 20 consecutive penetrating keratoplasty patients was carried out. Topography guided suture removal in the steep meridian was carried out. Topography was repeated after 30-40 min and 4-6 weeks later. The tight sutures requiring removal were identified for each occasion and compared. The difference was considered insignificant if the axes of sutures requiring removal was <22.5 degrees. Paired t-test and chi (2) were performed for statistical analysis. RESULTS: In 85% of individuals, the 30-40 min topography gave an accurate indication of the next pair of sutures requiring removal. The difference in mean astigmatism at 30-40 min post suture removal (4.37+/-2.08 D) and at 4-6 weeks (4.24+1.97 D) was not significant (P=0.150). However, the difference between vector-corrected change of topographic astigmatism at 30-40 min after suture removal and at 4-6 weeks (1.72 D) was significant (P<0.001). Improved best-corrected visual acuity was seen in 50% of patients. CONCLUSION: This study showed that corneal topography performed 30-40 min after suture removal can identify the next set of sutures requiring removal. This can be used as a guide to remove more sutures at the same visit, thereby expediting post-keratoplasty visual rehabilitation and reducing the number of follow-up visits.

False aneurysm of the radial artery: Unusual complication of both-bone forearm fracture in children: A case report.

False aneurysm or pseudo aneurysm of an artery in close proximity to fractured bone is a well-recognized entity, and fewer various cases, involving different sites have been reported in the literature. We report new case of a Moroccan's patient who had 10-year-old boy presented with a right non displaced both-bone forearm fracture; the patient was placed in a long arm splint. After, six weeks, the cast was removed. And a pulsatile mass on the volar-radial aspect of the forearm was decouvred. The mass was non-tender and the patient had radial and ulnar pulse. An Ultrasound and brachial angiography showed a false aneurysm of distal radial and the radial artery was ligated.In conclusion, pseudoaneurysm of the radial artery can be associated with any bone fracture despite non displacing fractures related to the elasticity of the bone in this age and orthopedic surgeons should be aware of this potential complication.

[Muscular tuberculosis: an unusual focus of Koch bacillus]. / La tuberculose musculaire isolée: localisation inhabituelle du bacille de Koch.

We report an exceptional case of tuberculosis in an 8-year-old girl. The focus of infection was situated in the anterior muscle compartment of the left thigh. Diagnosis was established on the basis of histological findings. A 12-month antituberculosis regimen was given. Outcome was good with no general or functional sequelae. Based on this case and data reported in the literature, we discuss the routes of dissemination of the Koch bacillus explaining this unusual sporadic localization.

[Centro-somatic staged tuberculous vertebral osteitis: a case report]. / L'ostéite tuberculeuse vertébrale centro-somatique étagée: á propos d'un cas.

Centro-somatic tuberculous vertebral osteitis is defined as tuberculous infection of the vertebral body with preserved integrity of the adjacent intervertabral disk. Other types of vertebral tuberculosis include Pott's spondylodiscitis and exceptional lesions of the posterior arch. We report a case of centro-somatic tuberculous vertebral osteitis in a 14-year-old boy who developed staged lesions of the L2 to S1 bodies, associated with a posterior epidural collection but without any deterioration of the intervertebral disk on plain x-rays and computed tomography. This atypical aspect of the lesions required a surgical biopsy which yielded a yellow-whitish fibro-oleagenous, friable product more suggestive of neoplasm than infection, but histology rectified the diagnosis, showing typical caseo-follicular tuberculosis. A 6-month anti-tuberculosis regimen was rapidly followed by symptom improvement. We emphasize the importance of modern imaging techniques for the diagnosis of vertebral lesions and for guided biopsy or drainage.

[An unusual localization of solitary bone cyst in a child: the lumbar spine]. / Une localisation inhabituelle du kyste osseux solitaire chez l'enfant: le rachis lombaire.

Solitary bone cysts involving the spine in children are extremely rare. We report such a lesion in a 7-year-old girl who presented with an expansible, bubbly cystic lesion of the third lumbar vertebra. The intraoperative findings and histologic examination indicated the diagnosis of a solitary bone cyst. She was treated successfully with curettage and bone grafting.

[Scoliosis and diastematomyelia: four cases and a review of the literature]. / Scoliose et diastématomyélie. A prpos de 4 cas et revue de la littérature.

We report four cases of scoliosis associated with diatematomyelia observed between 1984 and 1998. The patients were four girls aged 10 to 12 years. Skin lesions were found on the midline in 3 cases and 2 had a neurological disorder. A myeloscan was performed in two cases, tomomyelography in one and MRI in one. Three patients were operated on with good outcome. The fourth child is under orthopedic treatment. We reviewed the literature on scoliosis with diastematomyelia.

[Fibrocartilaginous mesenchymoma of bone. A case report]. / Mésenchymome fibrocartilagineux intraosseux. A propos d'un cas.

Fibrocartilaginous mesenchymoma of bone is a tumoral entity which is somewhat controversial. It has been delineated in 1984 by Dahlin and al. Fifteen cases have been reported in the literature. We report a new case which involves proximal humerus. X-ray data, microscopic findings and local recurrence indicate a low grade malignancy. Metastasis have never been reported. The main differential diagnosis are desmoplastic fibroma, fibrous dysplasia and fibrosarcoma with low grade malignancy. Treatment is surgical.