Progression of Impending Central Retinal Vein Occlusion to the Ischemic Variant Following Intravitreal Bevacizumab

A 60-year-old woman who had experienced two episodes of amaurosis fugax in her right eye presented with vision loss. Two weeks earlier, at a private clinic, she was diagnosed with impending central retinal vein occlusion (CRVO) of the right eye and received an intravitreal injection of bevacizumab. Two weeks after this injection she was diagnosed with ischemic CRVO. At 11-weeks post-presentation, extremely ischemic features were observed with fluorescein angiographic findings of severe vascular attenuation and extensive retinal capillary obliteration. At 22-weeks post-presentation she was diagnosed with neovascular glaucoma; she experienced no visual improvement over the following several months

Reaction Intensity Partitioning: A New Perspective of the National Fire Danger Rating System Energy Release Component

The Rothermel fire spread model provides the scientific basis for the US National Fire Danger Rating System (NFDRS) and several other important fire management applications. This study proposes a new perspective of the model that partitions the reaction intensity function and Energy Release Component (ERC) equations as an alternative that simplifies calculations while providing more insight into the temporal variability of the energy release component of fire danger. We compare the theoretical maximum reaction intensities and corresponding ERCs across 1978, 1988 and 2016 NFDRS fuel models as they are currently computed and as they would be computed under the proposed scheme. The advantages and disadvantages of the new approach are discussed. More study is required to determine its operational implications

Guideline Development for the Evaluation of Visual Impairment in Korea

This guideline is developed to provide criteria for evaluating permanent impairment of the visual system as it affects an individual`s ability to perform activities of daily living. This new assessment system is based on the 5th and 6th edition of American Medical Association and McBride impairment assessment system but revised on the consideration of Korean culture and simple application. This evaluation of impairment is based on an assessment of visual acuity and visual field. Especially it weighs binocular vision and binocular visual fields and the binocular vision and binocular visual fields provide 50% of weight and the right and left eye each contribute 25%. A further adjustment of the impairment rating is included at the final step of this evaluation. Functional deficits for individual adjustments include diplopia, problem of accommodation, abnormality of eyelids, tearing, cosmetic problems from cornea opacity, glare, aphakia, and dark-adaptation. The adjustment can be added to impairment rating up to 15%. Further study is necessary to revise and update of this disability evaluation that have potential problems in actual application.COLEBRANDER A, 2003, DISABILITY EVALUATIO, pCH36FUHR PS, 2003, VISUAL IMPAIR RES, V5, P137COCCHIARELLA L, 2001, GUIDES EVALUATION PECOLENBRANDER A, 2001, DUANES CLIN OPHTHALM, V5, pCH51*INT LOW VIS C INT, 1999, GUID EV VIS IMPCOLENBRANDER A, 1994, LOW VISION RES NEW D, P542DOYLE D, 1993, OXFORD TXB PALLIATIV, P109MCBRIDE DE, 1968, INJURY EYE DISABILIT, P465

Complete Atrioventricular Block-Induced Torsade de Pointes, Manifested by Epilepsy

Complete atrioventricular (AV) block is frequently regarded as a cause of informed syncopal attacks, even though the escape rhythm is maintained. Torsade de pointes (TdP) may be a significant complication of AV block associated with QT prolongation. Here, we report the case of a 42-year-old female who was referred to our hospital due to recurrent seizure-like attacks while taking anti-convulsant drugs at a psychiatric hospital. TdP with a long QT interval (corrected QT = 0.591 seconds) was observed on an electrocardiogram (ECG) taken in the emergency department. The patient's drug history revealed olanzapine as the suspicious agent. Even after the medication was stopped, however, the QT interval remained within an abnormal range and multiple episodes of TdP and related seizure-like symptoms were found via ECG monitoring. A permanent pacemaker was thus implanted, and the ventricular rate was set at over 80 beats/min. There was no recurrence of tachyarrhythmia or other symptoms

Taurodeoxycholate Increases the Number of Myeloid-Derived Suppressor Cells That Ameliorate Sepsis in Mice

Bile acids (BAs) control metabolism and inflammation by interacting with several receptors. Here, we report that intravenous infusion of taurodeoxycholate (TDCA) decreases serum pro-inflammatory cytokines, normalizes hypotension, protects against renal injury, and prolongs mouse survival during sepsis. TDCA increases the number of granulocytic myeloid-derived suppressor cells (MDSCLT) distinctive from MDSCs obtained without TDCA treatment (MDSCL) in the spleen of septic mice. FACS-sorted MDSCLT cells suppress T-cell proliferation and confer protection against sepsis when adoptively transferred better than MDSCL. Proteogenomic analysis indicated that TDCA controls chromatin silencing, alternative splicing, and translation of the immune proteome of MDSCLT, which increases the expression of anti-inflammatory molecules such as oncostatin, lactoferrin and CD244. TDCA also decreases the expression of pro-inflammatory molecules such as neutrophil elastase. These findings suggest that TDCA globally edits the proteome to increase the number of MDSCLT cells and affect their immune-regulatory functions to resolve systemic inflammation during sepsis

Clinical Significance of Crescent Formation in IgA Nephropathy – a Multicenter Validation Study

Background/Aims: Additional validation study was warranted to confirm the clinical significance of C score, which was recently added to the Oxford classification for immunoglobulin A nephropathy (IgAN). Methods: We performed a multicenter retrospective cohort study in four hospitals in Korea. Patients who had biopsied glomeruli less than eight or inadequate follow-up information were excluded. Clinicopathologic parameters, including the degree of cellular or fibrocellular crescents, were collected and included in multivariable models for Cox regression analysis. The main outcome was a composite renal outcome, defined as a merge of progression to end-stage renal disease (ESRD) and halving of estimated glomerular filtration rate (eGFR) from baseline. Results: Among included 3,380 biopsy-confirmed IgAN patients, there were 664 (19.6%) patients with C1 and 60 (1.8%) patients with C2 scores in the study population. Although C0 and C1 patients shared similar baseline characteristics, C2 patients frequently had more clinicopathologic risk factors for poor prognosis of IgAN. Both C1 [adjusted HR 1.33 (1.11-1.58), P=0.002] and C2 [adjusted HR 2.24 (1.46-3.43), P< 0.001] scores were associated with an increased risk of the composite outcome. C2 was a strong predictive parameter associated with both progression to ESRD and halving of eGFR, whereas C1 was mainly associated with the increased risk of halving of eGFR. Notably, the proportion of crescent showed a linear association with the risk of adverse renal outcome. Conclusion: The C score in the Oxford classification is a valid predictive parameter for IgAN prognosis. Additional clinical attention is necessary for IgAN patients with identified cellular or fibrocellular crescents

Treatment Outcomes of Clevudine versus Lamivudine at Week 48 in Naïve Patients with HBeAg Positive Chronic Hepatitis B

The authors assessed the efficacy and antiviral resistance of 48-week clevudine therapy versus lamivudine in treatment of naïve patients with HBeAg positive chronic hepatitis B. In this retrospective study, a total of 116 HBeAg positive patients, who received 30 mg of clevudine once daily (n=53) or 100 mg of lamivudine once daily (n=63) for 48 weeks, were included. At week 48, clevudine therapy produced a significantly greater mean reductions in serum HBV DNA levels from baseline than lamivudine therapy (-5.2 vs. -4.2 log10IU/mL; P=0.005). Furthermore, a significantly higher proportion of patients on clevudine achieved negative serum HBV DNA by PCR (<13 IU/mL) at week 48 (60.4% vs. 38.1%; P=0.025). The incidence of virologic breakthrough in the clevudine group was significantly lower than in the lamivudine group (9.4% vs. 25.4%; P=0.031). However, rates of alanine aminotransferase normalization and HBeAg loss or seroconversion were similar in the two groups (83.0% vs. 81.0%, 11.3% vs. 11.1%; P=0.813, 1.000, respectively). In conclusion, clevudine is more potent for viral suppression and lower for antiviral resistance at week 48 than lamivudine in treatment of naïve patients with HBeAg positive chronic hepatitis B