Grid photocoagulation combined with intravitreal bevacizumab for recurrent macular edema associated with retinal vein occlusion

Purpose: To report the efficacy of grid photocoagulation combined with intravitreal bevacizumab (IVB) for macular edema recurring after previous IVBs associated with retinal vein occlusion (RVO).　　Methods: This retrospective study consisted of 19 eyes with branch retinal vein occlusion (BRVO) and nine eyes with central retinal vein occlusion (CRVO), which were treated with grid photocoagulation combined with IVB for recurrent macular edema after previous IVBs. The mean duration of total follow-up was 29.3 ± 5.8 months.　　Results: After this combination therapy, foveal thickness was reduced, significant with slight improvement in visual acuity (VA). At 1 month after treatment, although 25 of the 28 eyes showed complete resolution of the cystoid space, the macular edema recurred to some extent in 19 eyes. Compared with initial values, final foveal thickness was reduced significantly in both BRVO and CRVO groups (P < 0.001), but improvement in VA was significant only for eyes with BRVO (P = 0.012). The total number of IVB was 2.8 ± 0.7 for eyes with either BRVO or CRVO.　　Conclusion: Grid photocoagulation combined with IVB has a substantial effect on reducing recurrent macular edema associated with RVO, but the effect on visual acuity is limited

White dots as a novel marker of diabetic retinopathy severity in ultrawide field imaging

Purpose: To characterize white dots in diabetic retinopathy (DR) and their association with disease severity using ultra-wide-field scanning laser ophthalmoscopy. Methods: We randomly selected 125 eyes of 77 patients (25 eyes from individual categories of the international classification of DR severity) for which ultrawide field photographs were obtained. We characterized white dots, which were delineated by higher signal levels on green but not red laser images, and evaluated the relationship between the number of white dots and the international severity scale of DR. Results: Most white dots were located in nonperfused areas, and the number of total white dots was significantly correlated to that of dots in nonperfused areas. White dots corresponded to microaneurysms around the boundary between nonperfused areas and perfused areas or unknown lesions in nonperfused areas. Eyes with DR had significantly more white dots than those with no apparent retinopathy. The numbers of white dots in moderate nonproliferative diabetic retinopathy (NPDR) or more severe grades were significantly higher than in mild NPDR. The area under the receiver operating characteristics curve (AROC) analyses demonstrated that the number of white dots had the significance in the diagnosis of DR (0.908-0.986) and moderate NPDR or more severe grades (0.888-0.974). Conclusions: These data suggest the clinical relevance of white dots seen on ultrawide field images in the diagnosis of the severity of DR

Bilateral coronary ostial stenosis and aortic regurgitation in a patient with cardiovascular syphilis

AbstractCardiovascular syphilis is associated with the tertiary stage of syphilis infection; it involves the ascending aorta and can cause aortic aneurysm, aortic regurgitation, and coronary ostial stenosis. We report a surgical case of bilateral coronary ostial lesion and aortic regurgitation due to syphilitic aortitis.<Learning objective: Syphilitic aortitis involves the ascending aorta, resulting in aortic aneurysm, aortic regurgitation, and coronary ostial stenosis. Unlike atherosclerosis, coronary ostial stenosis is caused by aortic wall thickening, and coronary lesions distal to the ostia occur only rarely. After surgery, long-term follow up is mandatory as a result of aortic dilatation involving the sinuses of Valsalva, occurrence of prosthetic valve dehiscence, or graft failure caused by continuous infection of the aortic wall.

Existence of a Neuropathic Pain Component in Patients with Osteoarthritis of the Knee

∙ The authors have no financial conflicts of interest. © Copyright: Yonsei University College of Medicine 2012 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial Licens

学生の入試成績,メンタルヘルス調査,Grade Point Average,国家資格取得相互の関係

【要旨】2012年度から2014年度入学生の学生の入試成績，メンタルヘルス調査，Grade Point Average（GPA），国家資格取得相互の関係を統計学的に分析した。入学年度，性別，保護者居住地により，入試成績，GPA，国家資格取得に差があった。学生を取り巻く環境が，学修姿勢に影響していると考えた。退学・除籍した学生はGPAが有意に低かった。GPAの低い学生には学修意欲を高める刺激が必要であろう。在学中の国家試験受験で資格を得たかに強く関連する要因は，入試成績，GPA，性別であった。GPAは様々な試験に対する強さを示す指標といえるかもしれない。しかし，本学の使命は学生に国家資格を取得させることだけではない。資格取得に強く関連するGPAのみで学生を評価することには慎重であるべきである。学年間のGPAの相関とトレンドは学科により異なるが，他大学の調査ほど顕著ではなかった。Abstract: We analyzed statistically the relationships among admission examination score, mental health checkup, Grade Point Average (GPA) and acquisition of national certification in undergraduate students admitted to the classes of 2012 to 2014. The admission examination score, GPA, and acquisition of national certification showed statistical difference among admission year, sex and hometown environments (which might influence students’ willingness to study). The GPAs of dropout or retired students were low. For such students, more effective stimuli to promote motivation for study is necessary. Acquisition of the national certification was significantly related to admission examination score, GPA and sex. The GPA might be a strong indicator of skill at taking exams. The academic mission of the university, however, is not only to have students acquire national certification. There is the need for greater caution about assessing students only by their GPA, which is strongly related to national certification. Though there are some differences between academic departments, the relationships between the GPA by cohort year, and GPA trends, were less notable than in previous studies at other universities

Interferon-Induced Ifit2/ISG54 Protects Mice from Lethal VSV Neuropathogenesis

Interferon protects mice from vesicular stomatitis virus (VSV) infection and pathogenesis; however, it is not known which of the numerous interferon-stimulated genes (ISG) mediate the antiviral effect. A prominent family of ISGs is the interferon-induced with tetratricopeptide repeats (Ifit) genes comprising three members in mice, Ifit1/ISG56, Ifit2/ISG54 and Ifit3/ISG49. Intranasal infection with a low dose of VSV is not lethal to wild-type mice and all three Ifit genes are induced in the central nervous system of the infected mice. We tested their potential contributions to the observed protection of wild-type mice from VSV pathogenesis, by taking advantage of the newly generated knockout mice lacking either Ifit2 or Ifit1. We observed that in Ifit2 knockout (Ifit2−/−) mice, intranasal VSV infection was uniformly lethal and death was preceded by neurological signs, such as ataxia and hind limb paralysis. In contrast, wild-type and Ifit1−/− mice were highly protected and survived without developing such disease. However, when VSV was injected intracranially, virus replication and survival were not significantly different between wild-type and Ifit2−/− mice. When administered intranasally, VSV entered the central nervous system through the olfactory bulbs, where it replicated equivalently in wild-type and Ifit2−/− mice and induced interferon-β. However, as the infection spread to other regions of the brain, VSV titers rose several hundred folds higher in Ifit2−/− mice as compared to wild-type mice. This was not caused by a broadened cell tropism in the brains of Ifit2−/− mice, where VSV still replicated selectively in neurons. Surprisingly, this advantage for VSV replication in the brains of Ifit2−/− mice was not observed in other organs, such as lung and liver. Pathogenesis by another neurotropic RNA virus, encephalomyocarditis virus, was not enhanced in the brains of Ifit2−/− mice. Our study provides a clear demonstration of tissue-, virus- and ISG-specific antiviral action of interferon

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

The Rabies Virus L Protein Catalyzes mRNA Capping with GDP Polyribonucleotidyltransferase Activity

The large (L) protein of rabies virus (RABV) plays multiple enzymatic roles in viral RNA synthesis and processing. However, none of its putative enzymatic activities have been directly demonstrated in vitro. In this study, we expressed and purified a recombinant form of the RABV L protein and verified its guanosine 5′-triphosphatase and GDP polyribonucleotidyltransferase (PRNTase) activities, which are essential for viral mRNA cap formation by the unconventional mechanism. The RABV L protein capped 5′-triphosphorylated but not 5′-diphosphorylated RABV mRNA-start sequences, 5′-AACA(C/U), with GDP to generate the 5′-terminal cap structure G(5′)ppp(5′)A. The 5′-AAC sequence in the substrate RNAs was found to be strictly essential for RNA capping with the RABV L protein. Furthermore, site-directed mutagenesis showed that some conserved amino acid residues (G1112, T1170, W1201, H1241, R1242, F1285, and Q1286) in the PRNTase motifs A to E of the RABV L protein are required for cap formation. These findings suggest that the putative PRNTase domain in the RABV L protein catalyzes the rhabdovirus-specific capping reaction involving covalent catalysis of the pRNA transfer to GDP, thus offering this domain as a target for developing anti-viral agents

Lamellar macular hole formation in chronic cystoid macular edema associated with retinal vein occlusion.

[Purpose]：To report the formation of a lamellar macular hole (LMH) in four eyes with chronic cystoid macular edema (CME) associated with retinal vein occlusion (RVO). 　[Methods]：We reviewed retrospectively the medical records of four patients with chronic CME associated with RVO, in whom LMH formation was observed by a series of examinations with optical coherence tomography.　 [Results]：All eyes showed a large chronic cystoid space in the fovea. Three eyes showed an epiretinal membrane, and one eye showed traction of a posterior hyaloid membrane to the fovea. The chronic cystoid space changed into an LMH by rupture of its inner wall due to traction. After formation of the LMH, the mean total foveal thickness decreased from 590 ± 131 to 95 ± 22 μm, equal to the thickness of the foveal photoreceptor layer before the formation of the LMH (mean 100 ± 23 μm). Visual acuity did not change substantially from before to after the formation of the LMH. 　　[Conclusions]：Chronic CME associated with RVO can transform into an LMH through the rupture of the inner wall of the foveal cystoid space. While this transformation is accompanied by a substantial reduction in macular thickness, it does not lead to changes in visual function