Photodynamic Therapy for Subretinal New Vessels

Photodynamic therapy (PDT) involves the induction of endothelial cell death or occlusion of blood vessels. On the basis of this mechanism of action, PDT is used in the treatment of predominant classic choroidal neovascularization (CNV), if the classic component is over 50%, and in myopic CNV. This study describes 2 cases of distinctive, abnormal, large, subretinal new vessels that are thought to have originated from the choroids. Diminishment of the new vessels was observed following treatment with PDT

Takayasu's Arteritis Treated by Percutaneous Transluminal Angioplasty with Stenting in the Descending Aorta

A 17-yr-old young woman was referred to our hospital with a 2-yr history of claudication of the lower extremities and severe arterial hypertension. Physical examination revealed significantly different blood pressures between both arms (160/92 and 180/95 mmHg) and legs (92/61 and 82/57 mmHg). The hematological and biochemical values were within their normal ranges, except for the increased erythrocyte sedimentation rate (83 mm/hr) and C-reactive protein (6.19 mg/L). On 3-dimensional computed tomographic angiography, the ascending aorta, the aortic arch and its branches, and the thoracic and, descending aorta, but not the renal artery, were shown to be stenotic. The diagnosis of type IIb Takayasu's arteritis was made according to the new angiographic classification of Takayasu's arteritis, Takyasu conference 1994. Percutaneous transluminal angioplasty with stenting was performed on the thoracic and abdominal aorta. After the interventional procedures, the upper extremity blood pressure improved from 162/101 mmHg to 132/85 mmHg, respectively. She has been free of claudication and there have been no cardiac events during 2-yr of clinical follow-up

Conventional versus modified nipple sparing mastectomy in immediate breast reconstruction: Complications, aesthetic, and patient-reported outcomes

Background: Nipple-sparing mastectomy (NSM) followed by immediate breast reconstruction (IBR) is the optimal surgical treatment for breast cancer. However, investigations are ongoing to improve the surgical technique to achieve better results. This study aimed to evaluate the outcomes of modified NSM (m-NSM), which preserves the anterior lamellar fat layer, in patients who underwent IBR. Methods: All patients who underwent modified NSM (m-NSM) or conventional NSM (c-NSM) followed by IBR using autologous tissue or implants were retrospectively reviewed between January 2014 and January 2021. Two mastectomy types were compared in terms of postoperative complications and aesthetic outcomes using panel assessment scores by physicians and reported outcomes using Breast-Q. In addition, postoperative evaluations of the thickness of mastectomy flap was performed using CT scan images. Results: A total of 516 patients (580 breasts) with NSM (143 breasts with c-NSM and 437 breasts with m-NSM) followed by IBR were reviewed. The mean +/- SD flap thickness was 8.48 +/- 1.81 mm in patients who underwent m-NSM, while it was 6.32 +/- 1.15 mm in the c-NSM cohort (p = 0.02). The overall major complications rate was lower in the m-NSM group (3.0% vs. 9.0%, p < 0.013). Ischemic complications of the mastectomy flap and nipple-areolar complex (NAC) were more in c-NSM, although the difference was not statistically significant. The mean panel assessment scores were higher in the m-NSM group (3.14 (good) and 2.38 (fair) in the m-NSM and c-NSM groups, respectively; p < 0.001). Moreover, m-NSM was associated with greater improvements in psychosocial (p < 0.001) and sexual (p = 0.007) well-being. Conclusion: Preserving the anterior lamellar fat in NSM was associated with thicker mastectomy flap, overall lower rates of complications, including ischemia of the mastectomy flap and nipple-areolar complex, and was associated with better aesthetic outcomes and improved quality of life.Y

Independent Prognostic Utility of 11 C-Pittsburgh Compound B Positron Emission Tomography in Light-Chain Cardiac Amyloidosis Patients

© 2022 Society of Nuclear Medicine Inc.. All rights reserved.11C-Pittsburgh compound B positron emission tomography/computed tomography (11C-PiB PET/CT) visualizes the amount of myocardial amyloid deposit and can be used to prognosticate patients with light-chain (AL) cardiac amyloidosis (CA). However, whether 11C-PiB PET/CT has any independent additional prognostic value beyond the commonly used biomarkers remains unknown. Methods: This was a prospective cohort of 58 consecutive patients with ALCA who underwent 11C-PiB PET/CT. Patients were stratified into 2 groups based on a visual assessment on whether there was a myocardial 11C-PiB uptake or not on PET/CT. The primary endpoint was 1-year overall mortality. The independent prognostic utility of 11C-PiB PET/CT was analyzed using net reclassification improvement and integrated discrimination improvement. Results: Among the 58 patients enrolled, 35 patients had a positive myocardial 11C-PiB uptake on PET/CT. Patients with a positive myocardial 11C-PiB PET uptake had a worse 1-year overall survival rate than those with a negative uptake (81.8% vs. 45.5%, P=0.003 by log-rank test). In the multivariate analysis, a positive myocardial 11C-PiB uptake on PET/CT was an independent predictor of 1-year mortality (adjusted hazard ratio 3.382, 95% confidence interval 1.011–11.316, P=0.048). In each subgroup analysis of patients with troponin I ≥0.1 ng/mL, N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥1,800 pg/mL, and the difference between free light chains (dFLC) ≥180 mg/mL, the three commonly used biomarkers and its thresholds for staging in AL amyloidosis, Kaplan-Meier curves showed that the patients with a positive myocardial 11C-PiB uptake on PET/CT had a worse prognosis than those with a negative myocardial 11C-PiB uptake, respectively. Additionally, when the result of 11C-PiB PET/CT was added to these three biomarkers, the performance of 1-year mortality prediction significantly improved by net reclassification improvement (11C-PiB PET/CT added to troponin I, 0.861; NT-proBNP, 0.914; dFLC, 0.987) and by integrated discrimination improvement (0.200, 0.156, and 0.108, respectively). Conclusion: 11C-PiB PET/CT is a strong independent predictor of 1-year overall mortality and provides incremental prognostic benefits beyond the three commonly used biomarkers of AL amyloidosis staging. Considering the recent developments of numerous amyloid-targeting molecular imaging agents, further investigations are warranted on whether PET/CT should be included in the risk stratification for patients with ALCA.N

The Serum Uric Acid Level Is Related to the More Severe Renal Histopathology of Female IgA Nephropathy Patients

Hyperuricemia is a significant risk factor for cardiovascular morbidity and chronic kidney disease progression. IgA nephropathy (IgAN) is a well-known primary glomerular nephropathy. Hyperuricemia is associated with a poor prognosis in IgAN patients. We evaluated the association of hyperuricemia with the histopathological severity of IgAN in male and female patients; 658 patients diagnosed with IgAN via kidney biopsy were initially included. Baseline patient data were collected by eight university hospitals affiliated with the College of Medicine of the Catholic University of Korea. Pathological features were independently evaluated by eight expert pathologists working in the hospitals, and the consensus was reached. Of the initial 658 patients, 517 were finally included (253 males and 264 females). Hyperuricemia was defined as a serum uric acid (UA) level >7.0 mg/dL for males and >5.6 mg/dL for females; 108 (42.7%) males and 95 (35.9%) females exhibited hyperuricemia. Compared to the patients with normal UA levels, the global glomerulosclerosis, segmental sclerosis, mesangial matrix expansion (MME), endocapillary proliferation (ECP), interstitial fibrosis (IF), and tubular atrophy (TA) scores were higher in hyperuricemic males and females. In multivariable linear regression, the serum UA level correlated significantly with the MME, ECP, IF, and TA scores of female IgAN patients only