Validation of a new technique using 4-0 nylon thread as a guide for tube insertion of the Ahmed glaucoma valve into the ciliary sulcus.

ABSTRACT: In this study, we validated the new technique for inserting the tube of the Ahmed glaucoma valve (AGV) into the ciliary sulcus. AGV tube insertion was performed by introducing a 4-0 nylon thread into the anterior chamber from the corneal incision on the opposite side of the AGV. The thread was placed in the lumen of a 23-G needle that was inserted into the sclera and ciliary sulcus from the AGV side. Withdrawing the 23-G needle, the thread was led out of the eye from the scleral wound, passing through the ciliary sulcus. The thread was then placed in the AGV tube lumen, and the tube was inserted through the scleral wound into the ciliary sulcus by using the thread as a guide, as per the Seldinger technique. In all seven eyes, the tube was precisely inserted into the ciliary sulcus without serious intraoperative complications such as vitreous straying of the tube.

A CASE OF EALES DISEASE OBSERVED BY WIDEFIELD OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

PURPOSE: The purpose of this study was to report a 30-year-old woman with Eales disease, showing bilateral proliferative tissue. The retinal vessels were evaluated using widefield optical coherence tomography angiography (widefield OCTA), which has a wider angle of view compared with conventional instruments. METHODS: This is a case report. RESULTS: Widefield OCTA showed an extensive nonperfusion area and A-V shunt in both eyes and a vascular structure in the left eye that appeared to be retinal neovascularization. Ultra-widefield fluorescein angiography revealed no filling delay in the early phase, a vast nonperfusion area from the midperiphery to the ora serrata in bilateral eyes, and retinal neovascularization in the left eye. Based on the results of ultra-widefield angiography, OCTA examination, and systemic examination, a diagnosis of Eales disease was finally made after all the differential diseases had been excluded. CONCLUSION: In a patient with Eales disease, the peripheral nonperfusion area and retinal neovascularization that were consistent with the ultra-widefield angiography findings were noninvasively confirmed by widefield OCTA. Widefield OCTA is useful in the detection of peripheral changes of the fundus.

A case of Elschnig's spots observed using optical coherence tomography-angiography after stenting for internal carotid artery dissection.

PURPOSE: We report the case of a 28-year-old man who developed Elschnig's spots after stenting for an internal carotid artery dissection using optical coherence tomography angiography (OCTA). METHODS: A case report. RESULTS: The patient developed a visual field defect in the left eye immediately after endovascular stenting for left internal carotid artery dissection. Fundus examination revealed white lesions and numerous mottled orange-red lesions in the posterior pole and mid-periphery of the left eye. Indocyanine green angiography revealed mottled hypofluorescein areas in the early and late stages, coinciding with the orange-red lesions. OCTA showed flow void areas in the choriocapillaris layer, consistent with the orange-red lesions, which were diagnosed as Elschnig's spots associated with choroidal circulatory failure. The spots disappeared approximately 2 months after surgery, and the flow void on OCTA also disappeared. CONCLUSION: We report a case of Elschnig's spots associated with transient choroidal circulatory failure after stenting for internal carotid artery dissection. OCTA detected improved circulation at the level of the choriocapillaris with the disappearance of Elschnig's spots.

An examination of the relationship between satisfaction with overactive bladder (OAB) treatment and the doctor-patient gender: A questionnaire-based single-institution study.

Overactive bladder (OAB) significantly reduces quality of life. The primary goal of this study was to determine whether the gender combination of patient and physician may be associated with satisfaction with OAB treatment. This questionnaire survey was conducted at Jyoban Hospital. We considered the adult patients aged 18 years or older who attended the outpatient office of the urology department of the hospital, were diagnosed with OAB and had been taking anticholinergics or ß3-receptor stimulants, or both, for at least 3 months. In addition to the OAB treatment satisfaction, the questionnaire covered OABSS, IPSS, oral medications, effectiveness of OAB treatment, response to OAB symptoms, and the medium and extent of information collection. A total of 147 patients participated in the study. In summary, 91 (61.9%) were male, and the mean age was 73.5 years. Compared to when the gender of doctor and patient was not the same, female patients tended to be significantly more satisfied when they were treated by female doctors (OR 10.79, 95% CI 1.27-92.05). On the other hand, no similar trend was observed when male patients were treated by male doctors (OR 1.26, 95% CI 0.25-6.34). In the present study, which examined doctor-patient gender combinations in satisfaction with OAB treatment, as hypothesized, satisfaction was higher for female doctor-female patient combinations compared to different doctor-patient genders. A notable fact was that similar associations were not observed among the male doctor-patient combination. This means that an embarrassment of female patients could be stronger than male patients particularly in disclosing urinary symptoms to healthcare providers. The percentage of female urologists in Japan is only 8.2%, and it will be necessary to further promote the recruitment of female doctors in urology fields in order to encourage female patients with OAB to more actively visit doctors.

Micro-abnormalities in the retina and choroid induced by anti-CTLA4 treatment.

Anti-Cytotoxic T-Lymphocyte Associated protein 4 agents, such as ipilimumab, are widely applied to various cancers. However, they cause immune-related adverse effects throughout the body, including the eye. This study examined whether ipilimumab induces retinal and choroidal abnormalities in rodents, and investigated potential underlying mechanisms. Female wild-type mice were injected with ipilimumab three times/week for 5 weeks. The mice underwent optical coherence tomography (OCT) on the first day of the 6th week. Retinal function and morphology were evaluated by light microscopy, immunohistochemistry and electroretinography (ERG). On OCT, the lines indicating the ellipsoid and interdigitation were obscure in treated mice, suggesting outer retina destruction. Haematoxylin-eosin staining revealed destruction, shortening, and outer segment vacuolization. Treated mice exhibited weaker, fragmented rhodamine peanut agglutinin staining in outer photoreceptor structures. The choroid of treated mice showed severe infiltration of CD45-positive cells. In addition, CD8-positive cells invaded into the outer retina. On ERG, rod, maximum responses of combined rods and cones, and cone response wave amplitudes were significantly reduced in treated mice. Ipilimumab may induce impairments in outer photoreceptor architecture accompanied with CD8- positive infiltration in the retina and CD45-positive cell infiltration in the choroid, which may contribute to retinal function deterioration.

Surfactants alter mosquito's flight and physical condition.

Mosquitoes carry lethal pathogens for humans and hundreds of thousands of people are killed by mosquito-borne diseases every year. Therefore, controlling mosquitoes is essential to protect the lives of people around the world. Insecticides are highly effective in controlling mosquitoes and have been used extensively worldwide. However, they have potentially harmful effects on biodiversity and environment, and some mosquitoes are resistant to insecticide ingredients and survive upon their application. Therefore, there is a demand for a method to control mosquitoes without using conventional insecticide ingredients. Here, we used Aedes albopictus to test whether solutions with low surface tension, particularly surfactant solutions can alter mosquito behavior by spreading over the hydrophobic cuticle of mosquitoes. We found that solutions with low surface tension indeed attached to mosquitoes flying or resting on the wall, and made them fall. In addition, solutions with yet lower surface tension covered the mosquito surface more quickly and widely, knocking down or killing mosquitoes. These results suggest that surfactants such as sodium dioctyl sulfosuccinate can be used to alter mosquito behavior without relying on conventional insecticides.

Vortex vein congestion in the monkey eye: A possible animal model of pachychoroid.

PURPOSE: To create vortex vein congestion in the monkey eye as a possible pachychoroid model. METHODS: We ligated superotemporal and inferotemporal vortex veins at the surface of the sclera in monkey eyes. Optical coherence tomography (OCT) and indocyanine green angiography (ICGA) were performed before and 2, 7, and 28 days after the vortex vein ligations to investigate changes in vortex vein morphology and alterations in choroidal blood flow. RESULTS: Before the vortex vein ligations, en face OCT and ICGA images showed well organized vortex veins as well as horizontal and vertical watershed zones. Two days after the vortex vein ligations, dilatation of the superotemporal and inferotemporal vortex veins as well as intervortex venous anastomoses were seen on en face OCT and ICGA images. B-mode OCT images showed choroidal thickening associated with dilatation of the outer choroidal vessels. Moreover, video ICGA revealed choriocapillaris filling delay and pulsatile flow in the dilated vortex veins. At 7 and 28 days after we ligated the vortex veins, these findings were reduced, except for the intervortex venous anastomoses. CONCLUSIONS: We created a monkey model of vortex vein congestion by ligating two vortex veins. This animal model demonstrated pachychoroid-related findings, indicating that vortex vein congestion is involved in the pathogenesis of pachychoroid. However, remodeling of the choroidal drainage route via intervortex venous anastomosis appeared to compensate for the vortex vein congestion created in this model.

Maternal hypothyroidism is associated with M-opsin developmental delay.

Thyroid hormones are critical for the development of opsins involved in color vision. Hypothyroid mice show delayed M-opsin development and expanded distribution of S-opsin on the retina. However, the effects of maternal hypothyroidism on opsin development remain unknown. This study investigates the effects of congenital central hypothyroidism and maternal hypothyroidism on opsin development in thyrotropin-releasing hormone knockout (TRH-/-) mice. We examined the mRNA expression and protein distribution of S/M-opsin on postnatal days (P)12 and 17, as well as mRNA expression of type 2 and 3 iodothyronine deiodinase (DIO2 and DIO3, respectively) in the retina and type 1 iodothyronine deiodinase (DIO1) in the liver at P12 in TRH+/- mice born to TRH+/- or TRH-/- dams, and conducted S/M-opsin analysis in TRH+/+ or TRH-/- mice born to TRH+/- dams at P12, P17, and P30. M-opsin expression was lower in TRH+/- mice born to TRH-/- dams than in those born to TRH+/- dams, whereas S-opsin expression did not significantly differ between them. DIO1, DIO2, and DIO3 mRNA expression levels were not significantly different between the two groups; therefore, thyroid function in peripheral tissues in the pups was similar. S/M-opsin expression did not significantly differ between the TRH+/+ and TRH-/- mice born to TRH+/- dams on any postnatal day. These results demonstrate that maternal hypothyroidism causes M-opsin developmental delay during the early developmental stages of neonatal mice, and TRH-/- mice, a model of congenital central hypothyroidism, born to a euthyroid dam do not have delayed opsin development.

The Hypothalamic Paraventricular Nucleus Is the Center of the Hypothalamic-Pituitary-Thyroid Axis for Regulating Thyroid Hormone Levels.

Background: Thyrotropin-releasing hormone (TRH) was the first hypothalamic hormone isolated that stimulates pituitary thyrotropin (TSH) secretion. TRH was also later found to be a stimulator of pituitary prolactin and distributed throughout the brain, gastrointestinal tract, and pancreatic ß cells. We previously reported the development of TRH null mice (conventional TRHKO), which exhibit characteristic tertiary hypothyroidism and impaired glucose tolerance due to insufficient insulin secretion. Although in the past five decades many investigators, us included, have attempted to determine the hypothalamic nucleus responsible for the hypothalamic-pituitary-thyroid (HPT) axis, it remained obscure because of the broad expression of TRH. Methods: To determine the hypothalamic region functionally responsible for the HPT axis, we established paraventricular nucleus (PVN)-specific TRH knockout (PVN-TRHKO) mice by mating Trh floxed mice and single-minded homolog 1 (Sim1)-Cre transgenic mice. We originally confirmed that most Sim1 was expressed in the PVN using Sim1-Cre/tdTomato mice. Results: These PVN-TRHKO mice exhibited tertiary hypothyroidism similar to conventional TRHKO mice; however, they did not show the impaired glucose tolerance observed in the latter, suggesting that TRH from non-PVN sources is essential for glucose regulation. In addition, a severe reduction in prolactin expression was observed in the pituitary of PVN-TRHKO mice compared with that in TRHKO mice. Conclusions: These findings are conclusive evidence that the PVN is the center of the HPT axis for regulation of serum levels of thyroid hormones and that the serum TSH levels are not decreased in tertiary hypothyroidism. We also noted that TRH from the PVN regulated prolactin, whereas TRH from non-PVN sources regulated glucose metabolism.

ALTERATION OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN A PATIENT WITH OCULAR ISCHEMIC SYNDROME.

PURPOSE: To analyze optical coherence tomography angiography images in ocular ischemic syndrome (OIS) before and after carotid artery stenting. METHODS: We report the case of an 80-year-old man with a history of hypertension and diabetes mellitus who developed OIS in the right eye due to right internal carotid artery stenosis 2 years earlier. After visual acuity declined in the left eye 2 years later, a neurosurgeon discovered left internal carotid artery stenosis, which led to the diagnosis of OIS in the left eye as well. After carotid artery stenting, improvements were observed in both visual acuity and blood flow as assessed by laser speckle flowgraphy. The area of the foveal avascular zone and density of the retinal vessel at the level of the superficial and deep retinal layers were analyzed using optical coherence tomography angiography before and after treatment. RESULTS: Mean superficial foveal avascular zone area was 0.29 mm2 before treatment, decreasing by 29.97% to 0.20 mm2 after treatment. Mean deep foveal avascular zone area was 1.72 mm2 before treatment, decreasing by 20.35% to 1.37 mm2 after treatment. Superficial or deep vessel density increased by 33.4% and 34.3% after treatment, respectively. CONCLUSION: Optical coherence tomography angiography confirmed foveal avascular zone area reduction and increased vessel density in all retinal layers after carotid artery stenting for OIS. These findings suggest that optical coherence tomography angiography may be useful for evaluating blood flow and treatment efficacy in OIS.

Anti-LRP4 Antibody-associated Myasthenia Gravis with a Rare Complication of Thymoma Successfully Treated by Thymectomy.

We herein report the case of a 65-year-old woman diagnosed with myasthenia gravis (MG) after complaining of double vision. The patient had anti-low-density lipoprotein receptor-related protein 4 (LRP4) antibody in her serum, although antibodies against the acetylcholine receptor and muscle-specific tyrosine kinase were not detected. Chest computed tomography showed an anterior mediastinal tumor with a high uptake on fluorodeoxyglucose-positron emission tomography. Endoscopic thymectomy successfully ameliorated her ocular symptoms and showed the lesion to be thymoma. The present case revealed that anti-LRP4 antibody-associated MG can be associated with thymoma, which has been regarded as a rare complication of this disease thus far.

Assessment of the cost effectiveness of compulsory testing of introduced animals and bulk tank milk testing for bovine viral diarrhea in Japan.

Bovine viral diarrhea (BVD) is a chronic disease of cattle caused by infection with BVD virus (BVDV) and can result in economic losses within the livestock industry. In Japan, the test and culling policy is a basic control measure, and implementation of an adequate vaccination program is recommended as a national policy. In addition, optional control measures, including compulsory testing of introduced animals and bulk tank milk (BTM) testing as a mass screening method, are used in several provinces, but their efficacy has not been completely assessed. We evaluated these control measures using the scenario tree model of BVD in Japan, developed in the previous study. The model outputs indicated that compulsory testing of all introduced cattle, rather than only heifers and/or non-vaccinated cattle, was cost effective and reduced the risk of BVDV introduction due to animal movement and that BTM testing could effectively monitor most part of the cattle population. Vaccination coverage and BVDV prevalence among introduced cattle could also affect the cost effectiveness of compulsory testing of targeted cattle, particularly under low vaccination coverage or high BVDV prevalence. However, even with the implementation of a highly effective monitoring scheme for many years, BVD risk could not be eliminated; it instead converged at a very low level (0.02%). Disease models with a cost-effective output could be a powerful tool in developing a control scheme for chronic animal diseases, including BVD, with the consent of relevant stakeholders.

Evaluation of control measures for bovine viral diarrhea implemented in Nemuro District, Hokkaido, Japan, using a scenario tree model.

A scenario tree model was developed to propose efficient bovine viral diarrhea (BVD) control measures. The model used field data in eastern Hokkaido where the risk of BVDV infection in cattle has been reduced by an eradication program including mass vaccination, individual tests prior to communal pasture grazing, herd screening tests using bulk milk, and outbreak investigations of newly infected herds. These four activities were then used as hypothesized control measures in the simulation. In each simulation, the numbers of cattle infected persistently and transiently with BVDV detected by clinical manifestations and diagnosis tests and of missed by all of the diagnosis tests were calculated, and the numbers were used as indicators to be compared for the efficacy of the control measures. The model outputs indicated that the adoption of mass vaccination decreased the number of missed BVD cattle, although it did not increase the number of detected BVD cattle. Under implementation of mass vaccination, the efficacy of individual tests on selected 20% of the young and adult cattle was equal to that of the herd screening test performed in all the herds. When the virus prevalence or the number of sensitive animals becomes low, the efficacy of herd screening test was superior to one of individual tests. Considering the model outputs together, the scenario tree model developed in the present study was useful to compare the efficacy of the control measures for BVD.

Analysis of functionalization degree of single-walled carbon nanotubes having various substituents.

Introducing substituents onto SWNT sidewalls increases their solubility and tunes their properties. Controlling the degree of functionalization is important because the addition of numerous functional groups on the sidewall degrades their intrinsic useful electronic properties. We examined the synthesis and characterization of sidewall-functionalized SWNTs in this study. The functionalized SWNTs ((1)R-SWNTs-(2)R) were prepared in a one-pot reaction of SWNTs with alkyllithium ((1)RLi) followed by alkyl bromide ((2)RBr). The functionalized SWNTs were characterized by the absorption and Raman spectroscopy and thermogravimetric analysis. Not only the total number of functional groups introduced on the SWNT sidewall (formula mass: (1)R = (2)R) but also the ratio of (2)R to (1)R in the functionalized SWNTs (formula mass: (1)R ≠ (2)R) having two different substituents were clarified using the relation between results of Raman spectroscopy and thermogravimetric analysis. Results show that the degree of functionalization of (2)R to (1)R in (1)R-SWNTs-(2)R can be well controlled by the bulkiness of the alkyl groups of (1)RLi and (2)RBr. Moreover, substituent effects of reductive alkylation and reductive silylation of SWNTs via Birch reduction were investigated.