Efficacy and safety of first-line or second-line selective laser trabeculoplasty for normal-tension glaucoma: a multicentre cohort study.

BACKGROUND/AIMS: This study aimed to investigate and compare the efficacy and safety of first-line and second-line selective laser trabeculoplasty (SLT) in Japanese patients with normal-tension glaucoma (NTG). METHODS: 100 patients with NTG were enrolled in this study. Patients were treated with SLT as a first-line or second-line treatment for NTG. Main outcome measures were intraocular pressure (IOP) reduction rate, outflow pressure improvement rate (ΔOP), success rate at 1 year and complications. Success was defined as ΔOP≥20% (criterion A) or an IOP reduction ≥20% (criterion B) without additional IOP-lowering eye-drops, repeat SLT or additional glaucoma surgeries. The incidence of transient IOP spike (>5 mm Hg from the pretreatment IOP), conjunctival hyperaemia, inflammation in the anterior chamber and visual impairment due to SLT were assessed. RESULTS: A total of 99 patients (99 eyes) were initially enrolled in this study, including 74 eyes assigned to the first-line SLT group and 25 eyes to the second-line SLT group. The mean IOP of 16.3±2.1 mm Hg before SLT decreased by 17.1%±9.5% to 13.4±1.9 mm Hg at 12 months after SLT in the first-line group (p<0.001), and the mean IOP of 15.4±1.5 mm Hg before SLT decreased by 12.7%±9.7% to 13.2±2.0 mm Hg at 12 months after SLT (p=0.005) in the second-line group. Both groups showed significant reductions in IOP. Higher pre-SLT IOP and thinner central corneal thickness were associated with greater IOP reduction. The success rate at 1 year was higher in the first-line compared with the second-line group, with lower pretreatment IOP and the use of IOP-lowering medication before SLT being associated with treatment failure. Most post-treatment complications were minor and transient. CONCLUSIONS: SLT may be an effective and safe treatment option for NTG, as either a first-line or second-line treatment. TRIAL REGISTRATION NUMBER: The study was registered in the UMIN-CTR (UMIN Test ID: UMIN R000044059).

In Vitro Characterization of Drug-Loaded Superabsorbent Polymer Microspheres: Absorption and Release Capacity of Contrast Material, Antibiotics and Analgesics.

PURPOSE: To examine the characteristics of drug-loaded superabsorbent polymer microspheres (SAP-MS) such as drug absorption, drug release, diameter, and visibility. MATERIALS AND METHODS: SAP-MS (HepaSphere150-200 µm; Merit Medical, South Jordan, UT, USA) were suspended in drug solutions: (a) cefazolin, (b) lidocaine, (c) iopamidol and cefazolin, (d) iopamidol and lidocaine, and (e) iopamidol, cefazolin, and lidocaine. The concentrations of drugs were measured, and the amount of each drug absorbed was calculated. Filtered drug-loaded SAP-MS were mixed with saline, and the drug release rates were calculated. The diameter changes of SAP-MS during absorption were observed. Radiography of drug-loaded SAP-MS was evaluated as radiopacity by contrast-to-noise ratio (CNR). RESULTS: The drug concentration did not change during absorption. The release rates increased for 10 min and then came to an equilibrium. The mean amounts of drug absorbed at 180 min and mean release rates at 24 h were (a) cefazolin: 265.4 mg, 64.2%; (b) lidocaine: 19.6 mg, 75.6%; (c) iopamidol: 830.2 mg, 22.5%; cefazolin: 137.6 mg, 21.2%; (d) iopamidol: 1620.6 mg, 78.5%; lidocaine: 13.5 mg, 81.4%; and (e) iopamidol: 643.7 mg, 52.9%; cefazolin: 194.0 mg, 51.6%; lidocaine: 5.3 mg, 58.4%. The diameter of SAP-MS increased for approximately 15 min. Finally, the diameters of SAP-MS were (a) 3.9 times, (b) 5.0 times, (c) 2.2 times, (d) 5.5 times, and (e) 3.6 times larger than the original size. Drug-loaded SAP-MS containing iopamidol were visible under X-ray imaging, with CNRs of (c) 3.0, (d) 9.0, and (e) 4.5. CONCLUSION: SAP-MS can absorb and release iopamidol, cefazolin, and lidocaine.

Usefulness of peripherally inserted central catheter port system (PICC-PORT) implantation in the sitting position: a new technique for cases unsuitable for conventional implantation.

PURPOSE: Totally implantable central venous access port implantation is typically performed in the supine position. However, some patients cannot adopt the supine position due to severe pain and/or dyspnea. The present study evaluated the technical feasibility of peripherally inserted central catheter port system (PICC-PORT) implantation in the sitting position in such cases. MATERIALS AND METHODS: In the sitting position method, PICC-PORT implantation was performed with the patients seated on a videofluoroscopy chair positioned between the limbs of an angiographic C-arm and the operative upper arm positioned on an arm stand. From January 2019 to September 2021, eight patients underwent PICC-PORT implantations using this sitting method. We also evaluated 251 consecutive patients with conventional supine position PICC-PORT implantation as controls. Differences in technical success, procedure time and complications were retrospectively assessed between the two groups. RESULTS: Procedural success rates were 100% in both groups. Median procedure times in the sitting and conventional groups were 42 and 44 min, respectively. No complications were observed in the sitting group. There were no significant differences between the two groups in procedure time (p = 0.674) and complications (p = 1.000). CONCLUSION: Implantation of PICC-PORT in the sitting position is technically feasible and useful.

Pure ductal adenocarcinoma of the prostate protruding into the prostatic urethra: A case report of MRI findings and literature review.

Ductal adenocarcinoma of the prostate (DCa) is the histological variant of prostatic carcinoma. The macroscopic finding of DCa arising from primary duct by urethroscopy is papillary excrescences in the prostatic urethra. But the finding of MRI remains poorly understood, since there is no coherent report on the MRI finding of DCa arising from primary duct. We herein report a case of DCa arising from primary duct and forming papillary excrescences in the prostatic urethra. The patient was a male in his 70s and presented with gross hematuria a few days ago. Blood test showed elevated prostate specific antigen (PSA). Prostate MRI was performed. There were two lesions in the prostatic urethra and the right transition zone (TZ). On T 2-weighted image (T2WI), the lesion in the prostatic urethra was identifiable, but the lesion in the right TZ was difficult to identify. On diffusion-weighted image (DWI), both lesions showed hyperintense signal and could be identified, and there was continuity between them. Urethroscopy was performed, there was the lesion with papillary excrescences developing from the right dorsal side of prostatic urethra. Transurethral resection of the prostate was performed. The pathological diagnosis was DCa (pure type). A review of previous literature showed that DCa had a slightly hypointense signal on T2WI. It may be difficult to identify DCa in the TZ because DCa and the TZ show similar signals on T2WI. DWI may be useful to accurately assess DCa arising from primary duct.

Stent graft treatment for coronary sinus hemorrhage associated with esophageal cancer.

Hemorrhage arising from the coronary sinus is very rare and can be lethal. It has historically been treated surgically. The present patient had coronary sinus rupture secondary to esophageal cancer and an abscess in the pericardium. Due to her poor general status, this patient was contraindicated for surgery and underwent endovascular therapy. The hemorrhage was treated by stent graft deployment and the patient was temporarily discharged. Two months later, CT showed that the stent graft was occluded by thrombosis. The patient died without hemorrhage 2.5 months thereafter.

Short-Term Outcomes of Colorectal Stenting Using a Low Axial Force Self-Expandable Metal Stent for Malignant Colorectal Obstruction: A Japanese Multicenter Prospective Study.

(1) Background: Endoscopic colorectal stenting with high technical success and safety is essential in discussing the oncological outcomes for the management of malignant colorectal obstruction. Mechanical properties of self-expandable metal stents are usually considered to affect clinical outcomes. (2) Methods: A multicenter, prospective study was conducted in Japan. A self-expandable metal stent with low axial force was inserted endoscopically. The primary endpoint was clinical success, defined as the resolution of symptoms and radiological findings within 24 h. Secondary endpoints were technical success and adverse events. Short-term outcomes of 7 days were evaluated in this study. (3) Results: Two hundred and five consecutive patients were enrolled. Three patients were excluded, and the remaining 202 patients were evaluated. The technical and clinical success rates were 97.5% and 96.0%, respectively. Major stent-related adverse events included stent migration (1.0%), insufficient stent expansion (0.5%), and stent occlusion (0.5%). No colonic perforation was observed. There were two fatal cases (1%) which were not related to stent placement. (4) Conclusions: The placement of self-expandable metal stents with low axial force is safe with no perforation and showed high technical and clinical success rates in short-term outcomes for the management of malignant colorectal obstruction.

Corynebacterium ocular infection after Baerveldt glaucoma implant surgery: treatment involving immediate tube withdrawal and temporary subconjunctival tube placement: a case report.

BACKGROUND: We report a case of Corynebacterium endophthalmitis secondary to tube exposure following Baerveldt glaucoma implant surgery that was successfully treated with prompt tube withdrawal and temporary subconjunctival tube placement without removing the glaucoma drainage device. CASE PRESENTATION: A 65-year-old Japanese man with secondary glaucoma underwent glaucoma drainage device surgery with a donor scleral patch graft in the inferonasal quadrant of his right eye. Ten months after surgery, he presented with tube exposure due to dehiscence of the overlying conjunctiva and erosion of the scleral patch graft. Eleven days later, mild inflammation was found in the anterior chamber and anterior vitreous body, with the root of the tube surrounded by a plaque at the site of insertion in the anterior chamber. He was diagnosed with infectious endophthalmitis secondary to tube exposure. Two days later, since medical therapy was ineffective, the tube was withdrawn from the anterior chamber and irrigated with a polyvinyl alcohol-iodine solution, and the tube was tucked into the subconjunctival space. Complete resolution of the infection was achieved 1.5 months later. The tube was reinserted nasally into the anterior chamber and covered with a scleral patch graft and a free limbal conjunctival autograft. Thereafter, there has been no recurrence of infection or tube exposure. Twenty eight months after tube reinsertion, his right best-corrected visual acuity was 20/50 and intraocular pressure was 12 mmHg. CONCLUSION: Prompt tube withdrawal and temporary subconjunctival tube placement followed by tube reinsertion may be effective for endophthalmitis associated with tube exposure after glaucoma drainage device surgery.

Evaluation of Blood-filling Patterns in Schlemm Canal for Trabectome Surgery.

PRéCIS:: Regardless of the blood-filling patterns in Schlemm canal (SC) before the trabecular meshwork (TM) ablation, the trabectome surgery, combined with phacoemulsification, is effective for mild to moderate primary open-angle glaucoma patients. PURPOSE: The purpose of this study was to evaluate the association between trabectome surgery outcomes and the blood filling patterns in SC before TM ablation. MATERIALS AND METHODS: This retrospective cohort study included 105 eyes of 84 Japanese primary open-angle glaucoma patients who had undergone trabectome surgery in combination with cataract surgery. Provocative gonioscopy was performed before TM ablation to classify the blood filling patterns in SC into 3 groups: no filling (group 1); patchy/irregular filling (group 2); and complete filling (group 3). The subjects were divided into 3 groups according to the blood filling patterns and the trabectome surgery outcomes were compared, including intraocular pressure (IOP), the percentage reduction in IOP, surgical success rate, and the number of glaucoma medications. Success was defined by IOP ≤15 mm Hg and a >20% reduction in IOP with/without glaucoma medication, and without additional glaucoma surgery after trabectome surgery combined with cataract surgery. RESULTS: Twenty-four eyes were assigned to group 1, 48 to group 2, and 33 to group 3. Between-group analyses showed no significant intergroup differences in age (P=0.213), preoperative mean deviation (P=0.505), preoperative and postoperative IOP (P=0.941 and 0.458, respectively), preoperative and postoperative number of glaucoma medications (P=0.805 and 0.077, respectively), percentage IOP reduction (P=0.256), and success rates (P=0.540). CONCLUSION: Trabectome surgery is effective for mild to moderate primary open-angle glaucoma patients, independent of the blood-filling patterns in SC before the TM ablation.

In vitro evaluation of radiopacity of contrast-loaded superabsorbent polymer microspheres (SAP-MS) with static imaging and flow model.

PURPOSE: To evaluate the radiopacity of contrast-loaded superabsorbent polymer microspheres (SAP-MS) under X-ray imaging. MATERIALS AND METHODS: SAP-MS were suspended in contrast material (iodixanol) and the diameter change was assessed. The diameter of contrast-loaded SAP-MS in saline was measured sequentially. Radiography of the contrast-loaded SAP-MS was evaluated as radiopacity by contrast-to-noise ratio and visibility by multiple reader scoring. Under digital subtraction angiography, contrast-loaded SAP-MS were injected into a flow model. The flow speed was 1-10 cm/s, and images were acquired at 1-7.5 frames per second using a pulse width of 10-85 ms. Images were assessed by multiple reader scoring. RESULTS: The diameter of SAP-MS increased to 4.0-5.0 times its original size for approximately 15 min. The diameter of contrast-loaded SAP-MS in saline further increased by 10-30% within several minutes and returned to the previous size. Radiopacity and visibility of contrast-loaded SAP-MS decreased in 30 min after mixing with saline. Visibility was better with slow flow speed and narrow pulse width. CONCLUSION: For effective observation, contrast-loaded SAP-MS should be kept in non-diluted contrast material until use. The conditions of slower flow and use of a narrow pulse width are recommended.

Analysis of predictive factors for R0 resection and immediate bleeding of cold snare polypectomy in colonoscopy.

BACKGROUND: Factors associated with efficacy and safety of cold snare polypectomy (CSP) are not well established. The aim is to elucidate the predictors of R0 resection and immediate bleeding of CSP. METHODS: We retrospectively reviewed a database of patients who underwent CSP for subcentimetric polyps at the University of Tokyo Hospital in Japan. Using the data regarding the characteristics of patients and polyps, such as location, size, and macroscopic appearance; use of narrow band imaging with magnification (NBI-M); and endoscopists' experience, we revealed the predictive factors associated with R0 resection and immediate post-CSP bleeding by univariate and multivariate analyses. RESULTS: In total, 399 polyps, in 200 patients without antithrombotics, were removed. Failure of tissue retrieval was noted in 4% of resected lesions. There was no intramucosal carcinoma observed. The overall rate of R0 resection was 46%. Multivariate analysis elucidated that the observation of the polyp with NBI-M was an independent predictor associated with R0 resection (odds ratio [OR] 1.90; p = 0.024). Although immediate post-CSP bleeding occurred in 19 polyps (4.8%), no delayed bleeding or perforation was observed. Multivariate analysis revealed protruded lesion as an independent risk factor for immediate bleeding (OR 3.54; p = 0.018). CONCLUSIONS: A higher rate of R0 resection with CSP can be achieved by performing colonoscopy with NBI-M, than with white-light imaging. Macroscopic protruding appearance of a polyp is a risk factor for immediate bleeding.

Impact of Cataract Surgery on Filtering Bleb Morphology Identified Via Swept-source 3-dimensional Anterior Segment Optical Coherence Tomography.

PRéCIS:: Analysis of filtering bleb morphology using swept-source 3-dimensional anterior segment optical coherence tomography (3D AS-OCT) indicates that phacoemulsification can negatively impact the morphology of preexisting filtering blebs. PURPOSE: To identify the cross-sectional morphologic changes in successful filtering blebs after phacoemulsification using swept-source 3D AS-OCT. MATERIALS AND METHODS: In total, 30 phakic eyes of 29 patients with successful filtering blebs after primary trabeculectomy were included in this retrospective cohort study. Success was defined as intraocular pressure (IOP)≤15 mm Hg and a>20% reduction in IOP without glaucoma medication or additional glaucoma surgery after trabeculectomy. The subjects were classified into 2 groups according to whether they had undergone phacoemulsification or not after trabeculectomy: a phaco group and a control group. Filtering blebs were examined using swept-source 3D AS-OCT and evaluated for quantitative parameters, including maximum bleb height, maximum bleb wall thickness, and the ratio of the hyporeflective space of the bleb wall. RESULTS: Sixteen eyes were assigned to the phaco group and 14 eyes to the control group. The eyes in the control group showed no significant differences in IOP or in any of the 3D AS-OCT parameters at any of the follow-up timepoints. In the phaco group, the mean IOP increased significantly after phacoemulsification (P=0.003). Furthermore, the eyes in the phaco group showed a significant decrease in maximum bleb height (P=0.030), maximum bleb wall thickness (P=0.006), and the ratio of the hyporeflective space of the bleb wall (P=0.011) between prephacoemulsification and 1-year postphacoemulsification. CONCLUSION: Phacoemulsification can have a negative impact on filtering bleb morphology, which may lead to an IOP increase.

Characteristics of early filtering blebs that predict successful trabeculectomy identified via three-dimensional anterior segment optical coherence tomography.

BACKGROUND/AIMS: To identify the cross-sectional characteristics of filtering blebs at 2 weeks post-trabeculectomy associated with intraocular pressure (IOP) control at 1 year post-trabeculectomy. METHODS: Ninety-nine eyes of 94 patients who had undergone primary trabeculectomy were included in this retrospective consecutive case series study. Surgical success was defined as an IOP ≤15 mm Hg and a >20% reduction in IOP without glaucoma medication or additional glaucoma surgeries at 1 year post-trabeculectomy. Subjects were classified into two groups according to whether surgery was successful or unsuccessful. Blebs were examined using swept-source three-dimensional anterior segment optical coherence tomography and evaluated for quantitative parameters, including maximum height, maximum wall thickness and ratio of hyporeflective space of the wall, as well as qualitative parameters, including multiple parallel hyporeflective layers within the wall (striping phenomenon), decreased visibility of the sclera underlying the bleb (shading phenomenon) and cyst-like structures of the wall. RESULTS: Seventy-seven eyes (77.8%) were assigned to the successful group and 22 (22.2%) to the unsuccessful group. Univariate analysis showed significant differences between the groups regarding maximum bleb height (p=0.044), maximum bleb wall thickness (p=0.017) and the striping phenomenon of the bleb wall (p=0.007). Multivariate logistic regression analysis confirmed that the striping phenomenon at 2 weeks post-trabeculectomy was significantly associated with success at 1 year post-trabeculectomy (OR 3.405; 95% CI 1.059 to 10.947; p=0.040). CONCLUSION: Taller blebs with thicker walls that showed the striping phenomenon at 2 weeks post-trabeculectomy appeared to predict good IOP control at 1 year post-trabeculectomy.

Prevalence of pks-positive Escherichia coli in Japanese patients with or without colorectal cancer.

BACKGROUND: Recent studies show that some Escherichia coli strains possessing a gene cluster named the pks island might have a causative role in the development of human colorectal cancer (CRC). In several reports from Europe, they are found more prevalently in colon tissue specimens derived from CRC patients compared to those from controls. In this study we sought to clarify the difference in pks prevalence between CRC patients and non-CRC controls in the Japanese population, by using non-invasive sample collection technique during colonoscopy. METHODS: Colonic lavage samples were collected during diagnostic colonoscopy, and bacterial DNA within each sample was extracted. Fecal DNA samples were then examined for pks island genes using conventional qualitative PCR and real-time quantitative PCR. In some patients biopsy samples were also collected in the same session of colonoscopy, and the correlation between the pks status of the colonic lavage sample and the biopsy sample of the same patients was evaluated. RESULTS: Twelve out of thirteen patients (92%) showed the same pks status by colonic lavage sample and biopsy sample, suggesting the usefulness of colonic lavage samples as a surrogate for biopsy samples. A total of 98 colonic lavage samples were collected, which included 35 from CRC patients, 37 from adenoma patients, and 26 from controls. The pks-positive bacterial DNA was detected in 43, 51, and 46% of colonic lavage samples from CRC, adenoma, and control patients, respectively, and there was no significant difference among diseases. Real-time quantitative PCR showed no significant difference in the relative concentrations of pks-positive bacterial DNA among diseases. Age, gender, location of CRC, CRC staging, or k-ras gene status was not associated with pks prevalence. CONCLUSIONS: Although the method of collecting fecal DNA from colonic lavage samples was safe and technically feasible, factors other than pks-positive bacteria appear to play more important roles in CRC development in this cohort.

Diagnostic capability of colon capsule endoscopy for advanced colorectal cancer: A pilot study.

BACKGROUND AND AIM: Colon capsule endoscopy (CCE) is a safe and effective method for detecting lesions in the colon. However, the sensitivity of CCE in detecting advanced colorectal cancer (CRC) has not been sufficiently evaluated. Therefore, the aim of the present study was to assess the sensitivity of CCE in detecting advanced CRC. METHODS: Patients previously diagnosed with advanced CRC by conventional colonoscopy underwent CCE. Primary outcome measure was the sensitivity of CCE in detecting advanced CRC per patient and per lesion. Secondary parameters measured were the sensitivity of CCE in detecting polyps ≥6 mm and ≥10 mm in size in a per-lesion analysis and the safety of CCE. RESULTS: Of the 21 advanced CRC lesions in 20 patients, 17 were detected by CCE. The per-patient and per-lesion sensitivities of CCE for detecting advanced CRC lesions were 85% (95% confidence interval [CI]: 62-97%) and 81% (95% CI: 58-95%), respectively. All advanced CRC lesions were diagnosed in the accessible region by CCE while the capsule was still functional. A significant association was found between incomplete CCE and failure to diagnose advanced CRC. No severe adverse events occurred. CONCLUSION: The diagnostic capability of CCE in detecting advanced CRC was limited in cases of procedure incompletion. Refining procedures to increase CCE procedure completion rates are required to enhance CRC detection.

Characteristics of successful filtering blebs at 1 year after trabeculectomy using swept-source three-dimensional anterior segment optical coherence tomography.

PURPOSE: To identify the cross-sectional characteristics of filtering blebs associated with intraocular pressure (IOP) control at 1 year after trabeculectomy with a square scleral flap and a fornix-based conjunctival flap. METHODS: A retrospective consecutive case series study was conducted. Eighty-four eyes of 79 patients who had undergone primary trabeculectomy were included. Surgical success was defined as IOP ≤15 mmHg and a >20% reduction in IOP without glaucoma medication and without additional glaucoma surgery at 1 year after trabeculectomy. The subjects were classified into two groups according to whether surgery was successful or unsuccessful. Filtering blebs were examined using swept-source three-dimensional anterior segment optical coherence tomography and evaluated for the following quantitative parameters: maximum bleb height, maximum bleb wall thickness, and ratio of hypo-reflective space of the bleb wall. RESULTS: Sixty-six eyes were determined to be successful and 18 eyes unsuccessful. Univariate analysis showed significant differences between the two groups regarding bleb height (P < 0.001), bleb wall thickness (P = 0.011), and ratio of hypo-reflective space of the bleb wall (P = 0.002). Multivariate logistic regression analysis confirmed that the bleb height was significantly associated with success in trabeculectomy [odds ratio 13.996 (95% confidence interval 1.184-165.420); P = 0.036]. CONCLUSION: A tall bleb with a thick hypo-reflective wall may be a feature of the well-functioning bleb.

Updated evidence on endoscopic resection of early gastric cancer from Japan.

BACKGROUND: Endoscopic resection for early gastric cancer (EGC) plays a central role in the treatment of EGC in Japan. However, there is still room for improvement, and it is necessary to summarize the recently obtained knowledge from Japan for further improvement. METHODS: We conducted a PubMed search to select relevant articles in the 5 years until September 18, 2016, using the keywords "gastric cancer" and "endoscopic treatment," "endoscopic submucosal dissection," "endoscopic mucosal resection," or "polypectomy" and filtering article types as "clinical study" or "clinical trial." RESULTS: Among the 329 articles selected automatically from the keywords "polypectomy" (1 article), "endoscopic mucosal resection" (29 articles), "endoscopic submucosal dissection" (77 articles), and "endoscopic treatment" (222 articles) in combination with "gastric cancer," 32 relevant articles from Japanese investigators were chosen. Seven articles were categorized into "equipment," 4 into "preparation and sedation," 17 into "complications and their prevention," and 4 into "therapeutic outcomes." Among them, CO2 insufflation, propofol sedation, and how to prevent post-endoscopic submucosal dissection (ESD) ulcer bleeding and achieve post-ESD ulcer healing were intensively investigated. Long-term outcomes of endoscopic mucosal resection and ESD were also reported as favorable outcomes. CONCLUSIONS: Endoscopic resection for EGC is still developing toward an ideal form, pursuing a more reliable, safer, and faster minimally invasive treatment.

Successful resolution of stromal keratitis and uveitis using canakinumab in a patient with chronic infantile neurologic, cutaneous, and articular syndrome: a case study.

BACKGROUND: Cryopyrin-associated periodic syndrome (CAPS) is a group of rare autoinflammatory diseases, and of these, chronic infantile neurologic, cutaneous, and articular/neonatal-onset multisystem inflammatory disease (CINCA/NOMID) syndrome has the most severe phenotype. Canakinumab, a monoclonal antibody that targets interleukin-1ß, has been shown to be an effective treatment for resolving systemic inflammation. However, its efficacy for treating ophthalmic symptoms of this disorder remains unclear. FINDINGS: A 64-year-old female reported episodes of nonpruritic urticaria, fever, aseptic meningitis, and bilateral sensorineural deafness. Her son had experienced similar symptoms. She was initially referred for ophthalmologic treatment for an infectious corneal ulcer. Examination of her right eye by slit lamp biomicroscopy showed diffuse conjunctival injection, corneal infiltrates, a corneal ulcer, and hypopyon. She was therefore treated aggressively with topical and systemic antibiotics in addition to antifungal medications. However, this was ineffective. Genetic analysis detected the heterozygous germline p.Asp303Asn mutation in the NLRP3 gene in both our patient and her son. She was therefore diagnosed with CINCA/NOMID syndrome based on her clinical manifestations. All of the patient's physical and ophthalmic symptoms were resolved within a few days after the initiation of canakinumab treatment. During an 18-month follow-up period, no adverse events or severe infections were observed. CONCLUSIONS: Our case report indicates that canakinumab is effective not only for the treatment of systemic inflammation but also for treating ophthalmic involvement, such as recurrent stromal keratitis and anterior uveitis.

Paecilomyces lilacinus-induced Scleritis Following Bleb-associated Endophthalmitis after Trabeculectomy.

Paecilomyces lilacinus (P. lilacinus) is a rare cause of fungal scleritis. We herein report a case of P. lilacinus-induced scleritis following bleb-associated endophthalmitis after trabeculectomy that was successfully treated with surgical excision of the affected sclera in combination with antifungal medication. An 85-year-old female underwent trabeculectomy of the left eye. A dellen formed in the corneal periphery due to limbal elevation of the filtering bleb and progressed to an infectious corneal ulcer, leading to blebitis. Eight days after the onset of blebitis, the patient was diagnosed with endophthalmitis, which resolved after vitrectomy. The growth of P. lilacinus was identified on swabs of the conjunctiva and the corneal specimen. Scleritis developed after the resolution of the endophthalmitis, and an early excision of the affected sclera, in addition to antifungal medication, resolved it completely. However, the scleritis recurred in a different region of the left eye. After 7 months of antifungal medication, the left eye showed no residual infection. When treating P. lilacinus-induced scleritis, surgical excision of the affected sclera has been shown to be an effective treatment strategy. Nevertheless, it is possible that the infection may recur in another part of the eyeball after the complete resolution of the primary lesion.

A model of rat embolic cerebral infarction with a quantifiable, autologous arterial blood clot.

We developed a novel model of a rat embolic cerebral infarction with a quantifiable autologous arterial blood clot. The left femoral artery had 0.15 ml of blood withdrawn and mixed with 10 units of thrombin in 50 µl saline. After 30 min, the clot was suctioned into a 4-French polyvinyl chloride tube. A 24-gage catheter was inserted up through the internal carotid artery via the external carotid artery stump. The 1-cm clot, at a volume of 7.2 mm3, was pushed and inserted into the internal carotid artery via the catheter. After withdrawing the catheter, the ICA blood flow recovered. We checked neurological status after 24 h (neurological free was 15, and worst was 1) and measured the infarction volume by the TTC method. Twelve rats were examined, and five sham-operated rats were included. Two rats were not able to achieve an 80% reduction in CBF. One rat died due to cerebral infarction. The success rate in producing infarction was 83%. The total infarction volume was 368.5 mm3±61.2 se. Median neurological score was 6. Hemorrhagic transformation was not detected. Sham-operated rats revealed no infarction and no neurological deficit. The volume of infarction correlated significantly with the neurological score. We conclude that this embolic stroke model is useful in producing a human, severe cardioembolic cerebral infarction.

Anchor-wire technique for multiple plastic biliary stents to prevent stent dislocation.

In endoscopic placement of multiple plastic biliary stents (PBSs), we sometimes experience proximal dislocation of the first PBS at the time of subsequent PBS insertion. We describe the case of a 79-year-old male with obstructive jaundice caused by cholangiocarcinoma who needed to receive multiple PBS placements for management of cholangitis. Although proximal dislocation of the first PBS was observed, we prevented the dislocation via our technique of using guidewire inserted from the distal end of the first PBS to the side hole as the anchor-wire. We could complete this technique only by inserting guidewire through the side hole of the first PBS during the process of releasing the first PBS and pulling out the guidewire and the inner sheath. It did not matter whether the anchor-wire went towards the third portion of the duodenum or the duodenal bulb. Here we introduce this "anchor-wire technique", which is useful for the prevention of PBS proximal dislocation in placing multiple PBSs.