Surgical Punctal Occlusion; Combined Lacrimal Canaliculi Cauterization and Punctal Suturing for Severe Dry Eye.

Purpose: To evaluate the treatment outcome of surgical punctal occlusion with combined canaliculi ablation and punctal suturing in patients with severe dry eye. Methods: Eleven eyes of seven patients were diagnosed with severe dry eye with decreased lacrimal secretion and were refractory to treatment with various eye drops and/or had repeatedly experienced loss of punctal plugs, and continued to experience subjective symptoms received surgical punctal occlusion. In 20 puncta, lacrimal canaliculi ablation was performed along the entire length of the lacrimal canaliculus where a diathermy needle could be inserted. After resection of the annulus fibrosus in the peri-punctal area, tight cross-stitch suturing of the puncta was performed with 8-0 absorbent thread. Visual acuity, corneal staining score according to the area (A) and density (D) classification, and Schirmer tear test (STT); tear break up time (tBUT); and subjective symptoms assessed by the University of North Carolina (UNC) and Dry Eye Management Scale were compared before and one year after surgery. Results: Recanalization occurred in 1/20 puncta (5.0% at month 5) in 1/11 eyes. Student's t-test showed significant improvement at one year compared with preoperative values for LogMAR value (P = 0.019), corneal staining score A (P = 0.00003) and D (P = 0.0003), STT (P = 0.004), and subjective symptoms (P = 0.015). No change was shown in tBUT and no serious adverse event occurred. Conclusion: This improved, minimally invasive surgical procedure has a low recanalization rate and achieves both objective and subjective improvements at one year.

Refractive Correction After Penetrating Keratoplasty by a New Soft Contact Lens with a Special Design for Astigmatism: A Case Report.

YOUSOFT is a new soft contact lens (CL) specifically designed for the correction of astigmatism. It is a conventional FDA Group II soft contact lens (SCL) and the optical zone in its centre is thick, and on its rear surface it has a prism ballast structure to prevent rotation. This lens was prescribed for a 59-year-old male on the eye with irregular corneal astigmatism after receiving penetrating keratoplasty (PKP) for refractive correction, whose eye was difficult to wear hard CLs (HCLs). After following the directions in the fitting manual provided by the manufacturer, fitting was good in the right eye and corrected visual acuity was 20/25 in Snellen Chart. He could continue wearing without CL discomfortable YOUSOFT may be useful in patients who have received PKP.

RIOK2 Contributes to Cell Growth and Protein Synthesis in Human Oral Squamous Cell Carcinoma.

Ribosomes are responsible for the protein synthesis that maintains cellular homeostasis and is required for the rapid cellular division of cancer cells. However, the role of ribosome biogenesis mediators in the malignant behavior of tongue squamous cell carcinoma (TSCC) is unknown. In this study, we found that the expression of RIOK2, a key enzyme involved in the maturation steps of the pre-40S ribosomal complex, was significantly associated with poorer overall survival in patients with TSCC. Further, multivariate analysis revealed that RIOK2 is an independent prognostic factor (hazard ratio, 3.53; 95% confidence interval, 1.19-10.91). Inhibition of RIOK2 expression by siRNA decreased cell growth and S6 ribosomal protein expression in oral squamous cell carcinoma cell lines. RIOK2 knockdown also led to a significant decrease in the protein synthesis in cancer cells. RIOK2 has potential application as a novel therapeutic target for TSCC treatment.

BP180 Is a Prognostic Factor in Head and Neck Squamous Cell Carcinoma.

BACKGROUND/AIM: Prognosis plays a vital role in head and neck squamous cell carcinoma (HNSCC) patient management and decision-making. This study aimed to identify the role of BP180 as a prognostic factor in HNSCC. PATIENTS AND METHODS: Protein expression of bullous pemphigoid antigen II (BP180) was verified by immunohistochemistry (IHC) in a tissue microarray study of 202 cases. RESULTS: IHC analysis revealed that protein expression of BP180 among HNSCC patients differed significantly in the presence and absence of neural invasion, and according to T status in laryngeal and pharyngeal cancer subgroups. Overall survival and multivariate analysis showed that positive BP180-IHC and advanced clinical stage were significant independent positive predictors of mortality in HNSCC patients. In addition, in the oral cancer subgroup, independent positive predictors were positive BP180-IHC, advanced N status and neural invasion. In laryngeal and pharyngeal cancer subgroups, predictors were positive BP180-IHC and advanced clinical stage. CONCLUSION: BP180 is a prognostic factor in head and neck squamous cell carcinoma.

A rare case of dermoid cyst arising in the upper lip.

INTRODUCTION: Generally, dermoid cysts commonly arise from the anus and ovaries. Oral and maxillofacial lesions are most commonly observed in the midline of the floor of the mouth, and lesions arising from the upper lip are relatively rare. PRESENTATION OF CASE: A 50-year-old man was referred to our hospital due to swelling of the left upper lip. Clinical examination revealed an elevated alar base, Gerber protrusion and nasal deformity. Ultrasonography revealed a clearly defined 30-mm lesion with more hypoechoic bands. Meanwhile, magnetic resonance imaging revealed a 30-mm mass below the orbicularis oris of the left upper lip. The lesion had a homogeneous, low-signal intensity on T1-weighted imaging. Thus, based on these findings, a dermoid cyst was suspected. The lesion was then removed en bloc without the overlying skin while the patient was under general anaesthesia. Histopathological examination revealed a cystic cavity lined by an orthokeratinised stratified squamous epithelium. However, skin appendages were not found. Based on the clinical and histopathological features of the lesion, a diagnosis of epidermoid cyst was made. Swelling of the left upper lip, nasal deformity and Gerber protrusion significantly improved after surgery. CONCLUSION: Although dermoid cysts arising from the upper lip are rare, the diagnostic accuracy for dermoid cyst can be improved with the combined use of ultrasonography and other imaging modalities even though these lesions are difficult to distinguish from differential diagnosis.

Actinin-4 Expression Predicts Poor Disease-free Survival and Correlates with Delayed Lymph Node Metastasis in Patients with Completely Resected Oral Squamous Cell Carcinoma.

Oral squamous cell carcinoma is generally characterized by poor prognosis, and biomarkers are needed for development and selection of therapy. The purpose of this study was to assess expression of actinin-4, which has been implicated in cancer invasion and metastasis, to determine its viability as a prognostic indicator in oral squamous cell carcinoma. Clinical factors and tumor samples immunohistochemically stained for actinin-4 were retrospectively investigated in 55 patients who underwent curative surgery for oral squamous cell carcinoma. Overall survival and disease-free survival were estimated by Kaplan-Meier analysis. Significant differences were detected using the Pearson's chi-square and Fisher's exact tests. Univariate and multivariate analyses were performed with the Cox regression model. No association was found between expression of actinin-4 and clinical factors, including age or sex, or histopathological factors, including vascular invasion, lymphatic invasion, stage, mode of invasion, or histological atypicality. Expression of actinin-4 showed a positive correlation with delayed cervical lymph node metastasis. Disease-free survival was significantly lower in patients who were positive for expression of actinin-4 (p=0.010); overall survival showed no difference between patients with or without expression of actinin-4, however. The results revealed that actinin-4 was an independent prognostic factor for disease-free survival. Expression of actinin-4 showed a 73% sensitivity and 68% specificity for prediction of delayed cervical lymph node metastasis. In conclusion, actinin-4 may potentially be a useful biomarker for prediction of delayed cervical lymph node metastasis.

Visual outcome after emergency surgery for open globe eye injury in Japan.

BACKGROUND: Most patients with open globe eye injury are brought to hospital as emergency patients and usually require admission for emergency surgery. We analyzed the visual outcome in patients with open globe eye injury at our hospital over a 4-year period. PATIENTS AND METHODS: This study reviewed 40 eyes of 40 patients with open globe eye injury who were presented to Juntendo University Shizuoka Hospital and required emergency surgery during the 4 years from January 2010 to December 2014. Retrospective evaluation of the visual outcome was performed using data from the medical records, including assessment of the influence of sex, side of the eye injury, cause of injury, and site/severity of injury. RESULTS: The mean age (SD) at the time of the injury was 58.9 years (±25.1 years). There were 28 males (70.0%) and 12 females (30.0%). Statistically significant improvement in visual acuity after treatment was noted in the males (P=0.0015, Wilcoxon test), but not in the females. Twenty-five patients had injury to the right eye (62.5%) and 15 had injury to the left eye (37.5%). A significant improvement in visual acuity was achieved after treatment of injury to the right eye (P=0.021), but not the left eye (P=0.109). The most frequent cause of injury was an accident (15 eyes; 37.5%). The second most frequent cause was work-related injury (14 eyes; 35.0%), which only occurred in males, and the third cause was accident due to negligence (eleven eyes; 27.5%). Two patients developed sympathetic ophthalmia and one patient developed postoperative endophthalmitis. CONCLUSION: The majority of patients with open globe eye injury were male workers in Japan. The visual outcome of work-related injury was better than that of injury due to other causes. The visual outcome was also better if the right eye was injured compared with the left eye. Patients with injuries due to negligence were older than the other groups, and this finding might be characteristic of an aging society.

Persistent corneal epithelial defect responding to rebamipide ophthalmic solution in a patient with diabetes.

OBJECTIVE: Rebamipide ophthalmic suspension was developed for the treatment of dry eyes and for other corneal diseases, promoting the secretion of both mucin in tear fluid and membrane-associated mucin, increasing the number of goblet cells, and restoring the barrier function of the corneal epithelium. We report a case of a persistent corneal epithelial defect in a patient with diabetes treated with topical application of rebamipide ophthalmic suspension. CASE PRESENTATION: A 73-year-old woman had a history of type 2 diabetes for 35 years and nonproliferative diabetic retinopathy for 23 years. She presented to our department with discharge and ophthalmalgia in the left eye. A corneal ulcer was detected, and culture of corneal scrapings was performed, with Staphylococcus aureus and Streptococcus canis being isolated. The infection was treated with levofloxacin eye drops and ofloxacin ophthalmic ointment based on the sensitivity profile of the isolate. However, a corneal epithelial defect persisted for approximately 2 months despite continuing treatment with 0.1% hyaluronic acid ophthalmic suspension and 0.3% ofloxacin eye ointment. Her hemoglobin A1c was 7.3%. The persistent corneal epithelial defect showed improvement at 2 weeks after treatment with rebamipide unit dose 2% ophthalmic suspension, and it did not recur even when vitrectomy was subsequently performed for vitreous hemorrhage due to progression of diabetic retinopathy. CONCLUSION: This is the first report about efficacy of rebamipide unit dose 2% ophthalmic suspension for presenting persistent corneal epithelial defect in a patient with diabetes. In the present case, the suggested mechanisms are the following: improving the corneal barrier function, stabilization of mucin on the keratoconjunctival epithelium, and improving the wettability and stability of the tear film, which resulted in the promotion of healing of the corneal epithelial defect in a short time period.

A case of atypical mucin balls wearing extended wear of silicone hydrogel lens for therapeutic use.

A 25-year-old man visited our hospital showing atopic conjunctivitis and corneal shield ulcer on his left eye. Although eye drops of 0.1% of betamethasone sodium phosphate and 0.1% of hyaluronic acid ophthalmic solution were prescribed, calcific corneal opacities developed. The corrected visual acuity decreased to 6/20 in Snellen chart. After corneal epithelial exfoliation, removal of calcific corneal opacity was scrubbed with MQA soaked in 0.05 M of ethylenediaminetetraacetic acid (EDTA). After washing the eye with 200 mL of physiological saline, a silicon hydrogel lens, PureVision (balafilcon A), was inserted to obtain pain relief for the therapeutic use. At postoperative day 11, mucin balls were found between cornea and contact lens and stained by rose bengal dye. One of them was atypically larger than usual, and the major axis was approximately 1.5 mm. Wearing lens was stopped, and all of mucin balls and corneal staining were disappeared at postoperative day. Little corneal opacity remained, and visual acuity after surgery recovered to 14/20 at five months.

In silico screening of protein-protein interactions with all-to-all rigid docking and clustering: an application to pathway analysis.

We propose a computational screening system of protein-protein interactions using tertiary structure data. Our system combines all-to-all protein docking and clustering to find interacting protein pairs. We tuned our prediction system by applying various parameters and clustering algorithms and succeeded in outperforming previous methods. This method was also applied to a biological pathway estimation problem to show its use in network level analysis. The structural data were collected from the Protein Data Bank, PDB. Then all-to-all docking among target protein structures was conducted using a conventional protein-protein docking software package, ZDOCK. The highest-ranked 2000 decoys were clustered based on structural similarity among the predicted docking forms. The features of generated clusters were analyzed to estimate the biological relevance of protein-protein interactions. Our system achieves a best F-measure value of 0.43 when applied to a subset of general protein-protein docking benchmark data. The same system was applied to protein data in a bacterial chemotaxis pathway, utilizing essentially the same parameter set as the benchmark data. We obtained 0.45 for the F-measure value. The proposed approach to computational PPI detection is a promising methodology for mediating between structural studies and systems biology by utilizing cumulative protein structure data for pathway analysis.