Microvascular Abnormalities on Optical Coherence Tomography Angiography in Macular Edema Associated With Branch Retinal Vein Occlusion

PURPOSE: To determine the ability of optical coherence tomography (OCT) angiography to image the microvascular structures compared with fluorescein angiography (FA) in patients with macular edema associated with branch retinal vein occlusion (BRVO).DESIGN: Retrospective, observational, consecutive case series.METHODS: Twenty-eight eyes of 27 patients (14 men, 13 women; mean age, 68.4 years) with macular edema associated with BRVO were enrolled.Simultaneous OCT angiography and FA were performed in all patients to evaluate the microvascular abnormalities and non-perfused areas.RESULTS: OCT angiography detected non-perfused areas in 28 eyes and FA in 18 eyes. The respective findings of superficial capillary telangiectasias by OCT angiography and FA were 13 and 11 eyes, for deep capillary telangiectasias 28 eyes and 11 eyes, for collateral vessels 18 eyes and 16 eyes, and for microaneurysms 13 eyes and 14 eyes. OCT angiography facilitated differential layer analysis of microaneurysms and collaterals in the retina.CONCLUSIONS: OCT angiography can visualize microvascular abnormalities equally well or better than FA in eyes with BRVO. Multimodal imaging using OCT angiography and FA can be a powerful tool to evaluate the pathology in BRVO

カンセツ リウマチ ニ タイスル メトトレキセート チリョウチュウ ニ コウド ノ ハンケッキュウ ゲンショウ オ キタシ シボウ シタ 5レイ ノ ケントウ

Background : Methotrexate （MTX） is placed as an anchor drug of treatment for rheumatoid arthritis （RA）. However, many cases suffered from side effects of MTX such as interstitial pneumonia and hematological toxicity. We investigated ５ cases that died of severe pancytopenia under treatment with low-dose MTX for RA. Methods : We reviewed the clinical features of ５ cases that developed severe pancytopenia and were transferred to Tokushima Prefectural Central Hospital under treatment with low-dose MTX for RA from ２０１１-２０１５. Results : All the cases were women, and were under treatment with low-dose MTX. The periods of medication of MTX were not clear. All the cases had renal insufficiency, and had a severe infection induced by pancytopenia and some cases developed disseminated intravascular coagulation （DIC）. At once we started intensive care, but all patients died in a short term. Conclusions : Women, the elderly, and renal insufficiency can be risk factors of severe pancytopenia induced by MTX even if low dosage. We should carefully treat these patients with MTX

Multiple myeloma with high adenosine deaminase expression

A 50-year-old man with immunoglobulin A type multiple myeloma (MM) was referred to our hospital after bortezomib therapy. He had high alkaline phosphatase and lactate dehydrogenase levels. Computed tomography showed osteolytic and osteoblastic bone lesions. Response to salvage chemotherapy was temporary, and he developed a right pleural effusion with high adenosine deaminase (ADA) levels. He died from bleeding associated with a pelvic bone fracture 9 months later. ADA mRNA expression and ADA secretion of the MM cells from the patient were higher than those from myeloma cell lines tested. Clinical relevance of high ADA expression in MM cells is warranted

Structural and Functional Analyses of Retinal Ischemia in Eyes with Retinal Vein Occlusion: Relationship with Macular Edema or Microaneurysm Formation

Purpose: To study the structural and functional changes of retinal ischemia and investigate their association with macular edema (ME) or microaneurysm (MA) formation in eyes with retinal vein occlusion (RVO). Methods: Sixty eyes of 30 patients (27 eyes with branch [b]RVO, 3 with central RVO, and 30 fellow eyes) were retrospectively reviewed. Optical coherence tomography (OCT), OCT angiography (OCTA), and microperimetry were performed simultaneously to measure retinal thickness and sensitivity. The presence of ME or MA was also assessed using OCT and fluorescein angiography. Results: The mean retinal sensitivity in the nonperfused areas (NPAs) deteriorated, and this was significantly (r = –0.379, p = 0.0391*) and inversely correlated with duration from disease onset. ME and MA were unlikely to be observed around the area where the retinal sensitivity decreased. In the NPAs, the mean retinal thickness of the superficial capillary plexus (SCP) (p < 0.0001), deep capillary plexus (DCP) (p = 0.0323), and outer retina (p = 0.0008) were significantly thinner than those in the fellow eyes, respectively. Multivariate regression analysis revealed that the thicknesses of the DCP (β: 0.3107, p = 0.0007) and outer retina (β: 0.3482, p = 0.0001) were the independent correlative factors of the retinal sensitivity, but that SCP thickness was not. Conclusion: Deep retinal thinning in NPAs was correlated significantly with a decreased retinal sensitivity, which might be a negative predictor of ME and MA in eyes with RVO

Preliminary in vivo evaluation of a needle insertion manipulator for central venous catheterization

Central venous catheterization is associated with potential complications secondary to accidental puncture, including venous bleeding and pneumothorax. We developed a system that avoids these complications and simplifies the procedure using a robot to provide puncture assistance. We herein report a puncture experiment conducted in vivo in a porcine to evaluate the manipulator. The right and left jugular veins of a pig were punctured five times each through both opened and unopened skin at a puncture angle and speed. A venous placement rate of 80% was obtained with opened skin. A much lower rate of 40% was obtained with unopened skin. One of five attempts in opened skin was unsuccessful, likely because of the stick-slip phenomenon. This system was effective for jugular venous puncture of opened skin. Future studies should focus on puncture conditions that facilitate needle placement, inhibit the stick-slip phenomenon, and minimize needle bending due to the presence of skin. © 2014 Kobayashi et al.; licensee Springer.1

Feasibility of an AI-Based Measure of the Hand Motions of Expert and Novice Surgeons

This study investigated whether parameters derived from hand motions of expert and novice surgeons accurately and objectively reflect laparoscopic surgical skill levels using an artificial intelligence system consisting of a three-layer chaos neural network. Sixty-seven surgeons (23 experts and 44 novices) performed a laparoscopic skill assessment task while their hand motions were recorded using a magnetic tracking sensor. Eight parameters evaluated as measures of skill in a previous study were used as inputs to the neural network. Optimization of the neural network was achieved after seven trials with a training dataset of 38 surgeons, with a correct judgment ratio of 0.99. The neural network that prospectively worked with the remaining 29 surgeons had a correct judgment rate of 79% for distinguishing between expert and novice surgeons. In conclusion, our artificial intelligence system distinguished between expert and novice surgeons among surgeons with unknown skill levels

Anaplastic lymphoma kinase-positive anaplastic large cell lymphoma diagnosed in a 90-year-old Japanese woman with simultaneous rearrangements of T-cell receptor and immunoglobulin genes: A case report

Anaplastic lymphoma kinase-positive (ALK+) anaplastic large cell lymphoma (ALCL) is a T-cell lymphoma consisting of large lymphoid cells expressing ALK and CD30. It frequently occurs in patients younger than 30 years. However, this case reports a 90-year-old Japanese woman with ALK+ ALCL. The clinicopathological and genetic results of our case are presented. Although the clinical diagnosis suggested lymphoma with enlarged left supraclavicular and axillary lymph nodes and high levels of soluble interleukin 2 receptors, the initial pathological diagnosis suggested metastasis of undifferentiated carcinoma. This is attributed to the cohesive growth with fibrous stroma and immunohistochemical findings, which were positive for epithelial membrane antigen and negative for leukocyte common antigen. Additional immunohistochemistry revealed positivity for ALK and CD30, and Southern blot analysis demonstrated the rearrangement of T-cell receptor and immunoglobulin genes. Pathologists should include ALCL as a differential diagnosis when epithelial membrane antigen-positive large tumor cells lack pancytokeratins and leukocyte common antigen. Moreover, the occurrence of ALK+ ALCL should not be overlooked in older patients