Joubert syndrome presenting bilateral peroneal neuropathies: A case report.

RATIONALE: Joubert syndrome (JS) is a rare genetic disorder that presents with various neurological symptoms, primarily involving central nervous system dysfunction. Considering the etiology of JS, peripheral nervous system abnormalities cannot be excluded; however, cases of JS accompanied by peripheral nervous system abnormalities have not yet been reported. Distinct radiological findings on brain magnetic resonance imaging were considered essential for the diagnosis of JS. However, recently, cases of JS with normal or nearly normal brain morphology have been reported. To date, there is no consensus on the most appropriate diagnostic method for JS when imaging-based diagnostic approach is challenging. This report describes the case of an adult patient who exhibited bilateral peroneal neuropathies and was finally diagnosed with JS through genetic testing. PATIENT CONCERNS AND DIAGNOSIS: A 27-year-old man visited our outpatient clinic due to a gait disturbance that started at a very young age. The patient exhibited difficulty maintaining balance, especially when walking slowly. Oculomotor apraxia was observed on ophthalmic evaluation. During diagnostic workups, including brain imaging and direct DNA sequencing, no conclusive findings were detected. Only nerve conduction studies revealed profound bilateral peroneal neuropathies. We performed whole genome sequencing to obtain a proper diagnosis and identify the gene mutation responsible for JS. LESSONS: This case represents the first instance of peripheral nerve dysfunction in JS. Further research is needed to explore the association between JS and peripheral nervous system abnormalities. Detailed genetic testing may serve as a valuable tool for diagnosing JS when no prominent abnormalities are detected in brain imaging studies.

Immunogenicity and Potential for Intraocular Inflammation of Intravitreal Anti-VEGF Drugs.

Background: Concerns of intraocular inflammation associated with intravitreal administration of anti-VEGF drugs have been risen and the exact mechanism is not yet elucidated. Objective: To explore the relationship between immunogenicity and intraocular inflammation in intravitreal anti-VEGF drugs. Methods: This review examines the immunogenicity of individual intravitreal anti-VEGF drugs and their potential link to intraocular inflammation. Results: We suggest that the main cause of intraocular inflammation is the presence of pre-existing and treatment-induced antidrug antibodies, along with considerations related to the molecular structure, which includes the drug's format and size. Conclusions: Researchers and clinicians involved in the advancement of new anti-VEGF drugs should take into consideration the factors related to intraocular inflammation that have been discussed.

Low Molecular Weight Collagen Peptide (LMWCP) Promotes Hair Growth by Activating the Wnt/GSK-3ß/ß-Catenin Signaling Pathway.

Low molecular weight collagen peptide (LMWCP) is a collagen hydrolysate derived from fish. We investigated the effects of LMWCP on hair growth using human dermal papilla cells (hDPCs), human hair follicles (hHFs), patch assay, and telogenic C57BL/6 mice, while also examining the underlying mechanisms of its action. LMWCP promoted proliferation and mitochondrial potential, and the secretion of hair growth-related factors, such as EGF, HB-EGF, FGF-4, and FGF-6 in hDPCs. Patch assay showed that LMWCP increased the neogeneration of new HFs in a dose-dependent manner. This result correlated with an increase in the expression of dermal papilla (DP) signature genes such as, ALPL, SHH, FGF7, and BMP-2. LMWCP upregulated phosphorylation of glycogen synthase kinase-3ß (GSK-3ß) and ß-catenin, and nuclear translocation of ß-catenin, and it increased the expression of Wnt3a, LEF1, VEGF, ALP, and ß-catenin. LMWCP promoted the growth of hHFs and increased the expression of ß-catenin and VEGF. Oral administration of LMWCP to mice significantly stimulated hair growth. The expression of Wnt3a, ß-catenin, PCNA, Cyclin D1, and VEGF was also elevated in the back skin of the mice. Furthermore, LMWCP increased the expression of cytokeratin and Keratin Type I and II. Collectively, these findings demonstrate that LMWCP has the potential to increase hair growth via activating the Wnt/ß-catenin signaling pathway.

Presence of Embolic Source and Outcome in Central Retinal Artery Occlusion.

OBJECTIVES: The etiology of central retinal artery occlusion (CRAO) is unclear in approximately 50% of patients, suggesting pathomechanical heterogeneity; moreover, little is known about outcomes according to etiology. This study investigated whether the presence of an embolic source affects outcome in CRAO. METHODS: CRAO patients within 7 days of symptom onset were retrospectively enrolled. Clinical parameters, including initial and 1-month visual acuity, CRAO subtype, and brain images, were reviewed. CRAO etiology was categorized as CRAO with or without an embolic source (CRAO-E+ and CRAO-E-). Visual improvement was defined as a decrease in logarithm of the minimum angle of resolution ≥0.3 at 1 month. RESULTS: A total of 114 patients with CRAO were included. Visual improvement was noted in 40.4% of patients. Embolic sources were identified in 55.3% of patients, and visual improvement group rather than no improvement group was more commonly associated with the presence of an embolic source. In multivariable logistic regression analysis, CRAO-E+ independently predicted visual improvement (odds ratio 3.00, 95% CI 1.15-7.81, p = 0.025). DISCUSSION: CRAO-E+ was found to be associated with a better outcome. CRAO-E+ may be more prone to recanalization than that CRAO-E-.

Impacts of Daily Life and Job Satisfaction on Social Participation of Persons with Visual Impairment.

Objective: This study is aimed at providing baseline data for improving the social participation of persons with visual impairment by verifying the impacts of daily life satisfaction and job satisfaction on their social participation. Methods: This study utilized data from the 5th survey of the 2nd wave of the Panel Survey of Employment for the Disabled (PSED) provided by the Korea Employment Agency for Persons with Disabilities (KEAD). Of the 511 persons with visual impairment who participated in the panel survey, 151 people who met the inclusion criteria were selected as the research subjects. This study compared social participation, job satisfaction, and daily life satisfaction, which were validated by experts' review, consulting, and research at the KEAD. Results: Daily life satisfaction and job satisfaction of persons with visual impairment had positive correlations with social participation. Job satisfaction had a statistically significant impact on social participation. Additionally, the stability of employment and monthly income were the variables affecting social participation. Conclusion: The result drawn in this study can be applied as basic data related to the social participation of people with visual impairment.

Atypical progress of frozen shoulder after COVID-19 vaccination: A case report.

BACKGROUND: After vaccination was mandated worldwide, various adverse effects associated with the coronavirus disease 2019 (COVID-19) vaccination, including shoulder pain, have been reported. Here, we report a case of new-onset shoulder pain after BNT162b2 (Comirnaty, Pfizer-BioNTech) mRNA vaccination. CASE SUMMARY: A 50-year-old man visited our rehabilitation center with left shoulder range of motion (ROM) limitation that had persisted for more than 5 mo. The history included no specific noteworthy events, except vaccination. The pain in the patient's left deltoid muscle appeared 1 day after the second BNT162b2 vaccination and intensified to severe pain. The patient self-administered aspirin, with which the pain subsided immediately, whereas ROM limitation persisted. At the first visit, the patient complained of dull pain and ROM restriction of the left shoulder (flexion 130°, abduction 110°, and external rotation 40°). Among the diagnostic studies conducted for the evaluation of the shoulder, magnetic resonance imaging showed a thickened coracohumeral ligament. Nerve conduction studies and needle electromyography showed no electrodiagnostic abnormalities. The patient received comprehensive rehabilitation for 7 mo and had an overall improvement in pain and ROM of the left shoulder. CONCLUSION: In this case of severe shoulder pain after COVID-19 vaccination that subsided immediately with aspirin treatment, the exact cause and mechanism of pain are unclear. However, the clinical symptoms and diagnostic workups in our report suggest the possibility that the COVID-19 vaccination triggered an immunochemical response that resulted in shoulder pathology.

Effects of self-efficacy, self-esteem, and disability acceptance on the social participation of people with physical disabilities: Focusing on COVID-19 pandemic.

PURPOSE: The objective of this study was to understand the effects of self-efficacy, self-esteem, and the degree of disability acceptance of people with physical disabilities living in COVID-19 pandemic on their social participation. METHODS: Among the 4577 registered disabled people who participated in the 2nd wave of the Panel Survey of Employment for the Disabled (PSED), 1682 people with physical disabilities who faithfully answered all the survey items were selected as the final study subjects. This study used the variables of social participation, self-efficacy, self-esteem, and disability acceptance, which were validated by experts' review and consulting and research at the Korea Employment Agency for Persons with Disability. Pearson's correlation analysis and multiple linear regression analysis were performed to identify variables that could predict the social participation of the study subjects. RESULTS: The self-efficacy, self-esteem, and the degree of disability acceptance of people with physical disabilities were positively correlated with social participation. The results of this study showed that self-efficacy, self-esteem, the degree of disability acceptance, economic activity, and education level explained 22.4% of social participation. CONCLUSIONS: It was found that self-efficacy, self-esteem, and the degree of disability acceptance of people with physical disabilities were important variables affecting social participation. These psychoemotional variables shall be considered for intervention approaches to improve the social participation of people with physical disabilities in the future.

Colorimetric screening of elevated urinary mercury levels by a novel Hg2+-selective probe of resorufin phosphinothioate.

Urinary mercury levels are the most reliable indicators of mercury exposure but identifying them requires complex techniques and heavy instruments. In this research, we reported a simple and convenient urinary mercury analysis method using a readily available office scanner. Probe MP-1 synthesized by the reaction of resorufin and dimethylthiophosphinoyl chloride revealed Hg2+-selective chromogenic and fluorescent signaling behavior. Signaling was realized through Hg2+-induced deprotection of the phosphinothioate protecting group in the resorufin-based probe MP-1 to yield the parent fluorochrome. A pronounced colorimetric response of color change from light yellow to pink alongside a turn-on type fluorescence enhancement was perceived exclusively toward Hg2+ ions over other metal ions and anions. The colorimetry provided a more advantageous ratiometric approach than the simple fluorometric analysis exhibiting an off-on type response, with a detection limit of 12 nM (2.4 ppb). The Hg2+ signaling of the MP-1 probe was not disturbed by the presence of coexisting metal ions and anions. The sensitive and convenient diagnosis of clinically important neurological symptoms and fatal inorganic mercury levels in urine was successfully demonstrated using a standard office scanner.

Protective Effect of Ribes nigrum Extract against Blue Light-Induced Retinal Degeneration In Vitro and In Vivo.

Although blackcurrant has several health benefits, such as antioxidant and anti-inflammatory properties, its effects on the retina remain unclear. In this study, we investigated the efficacy of black currant extract (BCE) in an in vitro and in vivo model of dry age-related macular degeneration (AMD) induced by blue light. Dry macular degeneration is characterized by the abnormal accumulation of lipofuscin (e.g., N-retinylidene-N-retinylethanolamine, A2E) in the retina. Blue light (BL) significantly decreased the viability of A2E-laden human retinal pigment epithelial cells (ARPE-19). However, BCE treatment protected ARPE-19 cells from A2E and BL. A2E, which is oxidized by blue light, generates reactive oxygen species in RPE cells. Treatment with BCE significantly decreased (80.8%) reactive oxygen species levels induced by A2E and BL in a concentration-dependent manner. BCE inhibited A2E accumulation in ARPE-19 cells and significantly downregulated the expression of genes increased by A2E and BL in ARPE-19 cells. In vivo, oral administration of BCE (25-100 mg/kg) ameliorated ocular lesions of BL-induced retinal damage in a mouse model and rescued the thickness of the whole retina, photoreceptor segment layer, outer nuclear layer, and inner nuclear layer. The decrease in the number of nuclei in the outer nuclear layer induced by BL was also rescued by BCE. Additionally, BCE administration rescued (40.0%) the BL-induced reduction in the expression level of superoxide dismutase 1. Taken together, our results suggest that BCE may have preventive and therapeutic effects on dry AMD through its antioxidant activity and inhibition of lipofuscin accumulation in the retina.

Fiber Optic Plasmonic Sensors Based on Nanodome Arrays with Nanogaps.

In this study, a high-performance fiber optic surface plasmon resonance (FO-SPR) sensor using a dome array with nanogaps (DANG) is proposed for label-free real-time detection of biomolecules. A novel and simple method using polymer beads enables high sensitivity by allowing hotspots with nanometer spacing between the Au dome and the surrounding film. The nanodome structure, which comprises a polymer core and a Au shell, induces a localized surface plasmon, expands the sensing area, and extensively enhances the electromagnetic field. The refractive index sensitivity of the FO-SPR sensor with nanostructures, i.e., with nanogaps and nanodomes, was found to be 7.8 times higher than that of the FO-SPR sensor without nanostructures. The proposed sensor achieved a low detection limit of 38 fg/mL while quantifying thyroglobulin antibody-antigen interactions and exhibited excellent selectivity. In addition, it helped detect serum samples with a 103% recovery rate.

Association Between Retinal Layer Thickness and Cognitive Decline in Older Adults.

Importance: Retinal layer thickness is hypothesized to be related to cognitive function in patients with mild cognitive impairment (MCI) and Alzheimer disease (AD). However, longitudinal cohort studies of the healthy older population are scarce. Objective: To investigate the association between retinal layer thickness and cognitive impairment and future cognitive decline in a community-based population cohort. Design, Setting, and Participants: A total of 430 randomly sampled community-dwelling Korean individuals 60 years or older participated in the baseline assessment (mean [SD], 76.3 [6.6] years) 215 of whom completed a mean (SD) of 5.4 (0.6) years (range, 4.1-6.2 years) of follow-up. Using spectral-domain optical coherence tomography, the study team assessed the thickness of 6 retinal layers in the macular region, the peripapillary retinal nerve fiber layers (RNFLs), and the subfoveal choroid at baseline. Exposures: Age, sex, education, diabetes, hypertension, and apolipoprotein E4 gene status. Main Outcomes and Measures: Retinal layer thickness and cognitive function test scores were analyzed. Results: This study included 430 participants (female, 208 [48.6%]). Baseline macular RNFL thickness was associated with baseline Consortium to Establish a Registry for Alzheimer's Disease (CERAD) score (coefficient [ß] = 0.077; 95% CI, 0.054-0.100; P = .04 for total macular area) and Mini-Mental State Examination (MMSE) score (coefficient [ß] = 0.082; 95% CI, 0.063-0.101; P = .03 for total macular area). A thinner baseline total macular RNFL thickness (lowest quartile, <231 µm) was associated with a larger decline in the CERAD and MMSE scores during the follow-up period (P = .003 and P = .01, respectively). Furthermore, participants with baseline total macular RNFL thickness below the lowest quartile cutoff value presented a greater decline in cognitive scores and a higher prevalence of cognitive impairment and Alzheimer disease than those with RNFL thickness above the lowest quartile cutoff value. Conclusions and Relevance: In this study, macular RNFL thickness could be used as a prognostic biomarker of long-term cognitive decline in adults 60 years or older. However, to confirm these results, further large-scale population-based studies should be performed.

High-performance biosensor using a sandwich assay via antibody-conjugated gold nanoparticles and fiber-optic localized surface plasmon resonance.

For real-time and high-sensitivity analysis of low-concentration targets, a sandwich immunoassay using second antibody-second gold nanoparticle (2nd Ab-2nd AuNP) conjugates was combined with fiber-optic localized surface plasmon resonance (FO LSPR). An FO LSPR format was constructed by immobilizing AuNPs on a fiber-optic cross-section for compactness, portability, and ease of handling. In addition, it was combined with a microfluidic system to ensure reproducibility and reliability of measurements. A detection limit of 97.6 fg/mL (148 aM) was obtained for thyroglobulin (Tg) without a sandwich assay. The detection limit was enhanced by approximately 15 times (6.6 fg/mL, 10 aM) when a sandwich strategy was performed with a 2nd Ab-2nd AuNP signal amplifier to further improve the responsivity. Additionally, the good selectivity of the proposed method was confirmed against the unpaired antigen. To evaluate its practical applicability in the field, an FO LSPR biosensor boosted with a sandwich assay using antibody-functionalized AuNPs was applied to detect Tg contained in patient serum, and the results were compared and verified with those of a commercial radioimmunoassay kit. Based on the above results, the signal-enhancing immunoassay with FO LSPR will contribute to the development of optical biosensors for early diagnosis and preventive applications.

Laser and anti-vascular endothelial growth factor treatment for drusenoid pigment epithelial detachment in age-related macular degeneration: 24-month outcomes.

PURPOSE: After the 12-month interim safety analysis, we investigated the 24-month primary endpoint outcomes of drusenoid pigment epithelial detachment (dPED) after laser and intravitreal anti-VEGF treatment. METHODS: Twenty-one patients with treatment-naïve bilateral intermediate AMD with dPED and visual acuity ≤ 83 letters (Snellen 20/23) were enrolled. The subject eye received low-energy PASCAL® laser (532 nm) treatment, and the fellow eye was used as the control. Intravitreal injections were administered at 3-month intervals from baseline to 12 months. Treatment outcomes, safety and development of advanced AMD lesions were analyzed. RESULTS: The mean drusen area and dPED height were significantly reduced (17.3 ± 2.7% vs. 112.8 ± 3.1%, P < 0.001 and 11.8 ± 4.7% vs. 119.1 ± 4.6%, P < 0.001, respectively) and the mean BCVA improved (5.11 ± 1.35 vs. 0.83 ± 1.03 letters, P = 0.014) in the study eyes compared to those in the control eyes. Development of parafoveal iRORA (nGA) (67%, 12 of 18 eyes) and cRORA (GA) (22%, 4 of 18 eyes) was observed in the study eyes, whereas three cases of iRORA and cRORA in the control eyes (17%, 3 of 18 eyes; P = 0.010 and P = 0.791, respectively). CONCLUSIONS: Laser and anti-VEGF treatment may be a potential treatment option for intermediate AMD with dPED. However, considering the relatively high rate of secondary iRORA and cRORA development, long-term follow-up is mandatory to clarify the safety and efficacy of this treatment.

Clinical characteristics and outcomes of Korean patients with sarcoidosis.

Sarcoidosis is a systemic granulomatous disorder of unknown cause involving multiple organs. Its clinical presentation and prognosis vary among races. We identified the clinical characteristics and outcomes of Korean patients with sarcoidosis. Clinical data of 367 Korean patients with biopsy-proven sarcoidosis diagnosed in 2001-2017 were retrospectively analyzed. Treatment responses included improvement, stability, or progression based on changes in pulmonary sarcoidosis on chest images. The mean age was 47.4 years, and 67.3% of patients were women. The median follow-up period was 80 months. The highest prevalence was observed in individuals aged 50-59 years (30-39 years in men, 50-59 years in women), and the number of diagnoses showed an increasing trend. Lung involvement was the most common (93.5%), followed by the skin, eyes, and extrathoracic lymph nodes. Among patients with lung involvement and a follow-up period of ≥ 3 months, 66.8%, 31.0%, and 2.2% showed improvement, stability, and progression, respectively. Eleven patients (2.9%) died, and the 5-year survival rate was 99%. The number of diagnosed cases showed an increasing trend, and the mean age at diagnosis was increased compared with that in previous reports. Organ involvement was similar to that of Westerners, although the prognosis appeared better.

Low-Molecular-Weight Collagen Peptide Ameliorates Osteoarthritis Progression through Promoting Extracellular Matrix Synthesis by Chondrocytes in a Rabbit Anterior Cruciate Ligament Transection Model.

This study examined whether the oral administration of low-molecular-weight collagen peptide (LMCP) containing 3% Gly-Pro-Hyp with >15% tripeptide (Gly-X-Y) content could ameliorate osteoarthritis (OA) progression using a rabbit anterior cruciate ligament transection (ACLT) model of induced OA and chondrocytes isolated from a patient with OA. Oral LMCP administration (100 or 200 mg/kg/day) for 12 weeks ameliorated cartilage damage and reduced the loss of proteoglycan compared to the findings in the ACLT control group, resulting in dose-dependent (p < 0.05) improvements of the OARSI score in hematoxylin & eosin (H&E) and Safranin O staining. In microcomputed tomography analysis, LMCP also significantly (p < 0.05) suppressed the deterioration of the microstructure in tibial subchondral bone during OA progression. The elevation of IL-1ßand IL-6 concentrations in synovial fluid following OA induction was dose-dependently (p < 0.05) reduced by LMCP treatment. Furthermore, immunohistochemistry illustrated that LMCP significantly (p < 0.05) upregulated type II collagen and downregulated matrix metalloproteinase-13 in cartilage tissue. Consistent with the in vivo results, LMCP significantly (p < 0.05) increased the mRNA expression of COL2A1 and ACAN in chondrocytes isolated from a patient with OA regardless of the conditions for IL-1ßinduction. These findings suggest that LMCP has potential as a therapeutic treatment for OA that stimulates cartilage regeneration.

Design and validation of fiber optic localized surface plasmon resonance sensor for thyroglobulin immunoassay with high sensitivity and rapid detection.

A simple optical fiber sensor based on localized surface plasmon resonance was constructed for direct and rapid measurement of thyroglobulin (Tg). Specific tests for Tg in patients that have undergone thyroidectomy are limited because of insufficient sensitivity, complicated procedures, and in some cases, a long time to yield a result. A sensitive, fast, and simple method is necessary to relieve the psychological and physical burden of the patient. Various concentrations of Tg were measured in a microfluidic channel using an optical fiber sensor with gold nanoparticles. The sensor chip has a detection limit of 93.11 fg/mL with no specificity for other antigens. The potential applicability of the Tg sensing system was evaluated using arbitrary samples containing specific concentrations of Tg. Finally, the sensor can be employed to detect Tg in the patient's serum, with a good correlation when compared with the commercial kit.

Clinical and Genetic Characteristics of Korean Congenital Stationary Night Blindness Patients.

In this study, we investigated the clinical and genetic characteristics of 19 Korean patients with congenital stationary night blindness (CSNB) at two tertiary hospitals. Clinical evaluations, including fundus photography, spectral-domain optical coherence tomography, and electroretinography, were performed. Genetic analyses were conducted using targeted panel sequencing or whole exome sequencing. The median age was 5 (3-21) years at the initial examination, 2 (1-8) years at symptom onset, and 11 (5-28) years during the final visit. Genetic mutations were identified as CNGB1 and GNAT1 for the Riggs type (n = 2), TRPM1 and NYX for the complete type (n = 3), and CACNA1F (n = 14) for the incomplete type. Ten novel variants were identified, and best-corrected visual acuity (BCVA) and spherical equivalents (SE) were related to each type of CSNB. The Riggs and TRPM1 complete types presented mild myopia and good BCVA without strabismus and nystagmus, whereas the NYX complete and incomplete types showed mixed SE and poor BCVA with strabismus and nystagmus. This is the first case series of Korean patients with CSNB, and further studies with a larger number of subjects should be conducted to correlate the clinical and genetic aspects of CSNB.