Diagnostic Availability of Optical Coherence Angiography in Type 1 and 2 Choroidal Neovascularization

Purpose@#To report the availability of optical coherence tomography angiography (OCTA) when diagnosing type 1 and type 2 choroidal neovascularization (CNV) associated with age-related macular degeneration. @*Methods@#We conducted a retrospective chart review of 63 eyes of 59 patients who visited the outpatient clinic from April 2018 to January 2020 with treatment-naïve type 1/2 CNV associated with age-related macular degeneration. The CNV was diagnosed through fluorescein angiography and indocyanine green angiography on the appearance of hyperfluorescence and leakage at the late phase. The CNV type was classified by location using OCT. These results were compared with those of automatic and manual segmentations via OCTA. @*Results@#Of the 63 eyes, 45 eyes showed type 1 CNV and 18 eyes indicated type 2 CNV. Using the automatic segmented display of OCTA, type 1 CNV was identified in 29 of 45 eyes and type 2 CNV was confirmed in 17 of 18 eyes. In addition, when manual segmentation was performed, type 1 CNV was found in 41 of 45 eyes and type 2 CNV in 18 of 18 eyes. The sensitivity of diagnosis of type 1 CNV using only automatic segmentation in OCTA was 64.44%; the sensitivity increased to 91.11% when additional manual segmentation was performed (p < 0.001). For type 2 CNV, the sensitivity was 94.44% using automatic segmentation in OCTA and 100% with additional manual segmentation (p = 1.000). @*Conclusions@#Automatic segmentation of OCTA and OCT analyses enabled diagnosis of type 1 and type 2 CNV associated with age-related macular degeneration. The diagnosis accuracy or type 1 CNV improved significantly when manual segmentation was added.

Analyses of Tangential Retinal Displacement and Metamorphopsia after Idiopathic Epiretinal Membrane Surgery

Purpose@#To evaluate the correlation between tangential retinal displacement and the improvement of metamorphopsia after idiopathic epiretinal membrane surgery. @*Methods@#The medical records of 36 eyes from 36 patients with idiopathic epiretinal membrane who underwent pars plana vitrectomy and who were observed over 1 year between January 2017 and December 2018 were retrospectively reviewed. Preand postoperative visual acuity, vertical and horizontal metamorphopsia score using the M-CHART, vertical and horizontal retinal displacement, and the presence of an ectopic inner foveal layer (EIFL) using optical coherence tomography were investigated. @*Results@#Postoperatively, the ratios of vertical and horizontal retinal displacement were 12.11 ± 12.04% and 8.09 ± 11.43%, respectively. The postoperative horizontal metamorphopsia score significantly improved (p = 0.019) compared to preoperatively and there were no significant differences in the vertical metamorphopsia score (p = 0.790). There were no significant correlations between the ratio of the vertical retinal displacement and improvement of horizontal metamorphopsia score or between the ratio of the horizontal retinal displacement and improvement of vertical metamorphopsia score. The preoperative horizontal metamorphopsia score was significantly higher in patients with EIFL than in patients without EIFL (p = 0.021) as was the postoperative horizontal metamorphopsia score (p = 0.016). In the EIFL group, the disappeared EIFL group had significantly lower postoperative vertical (p = 0.001) and horizontal (p < 0.001) metamorphopsia scores compared to the persistent EIFL group. @*Conclusions@#Postoperative retinal displacement was not correlated with improvement in metamorphopsia. However, the presence of preoperative EIFL and postoperative changes affect the severity of postoperative metamorphopsia.

Diagnostic Availability of Optical Coherence Angiography in Type 1 and 2 Choroidal Neovascularization

Purpose@#To report the availability of optical coherence tomography angiography (OCTA) when diagnosing type 1 and type 2 choroidal neovascularization (CNV) associated with age-related macular degeneration. @*Methods@#We conducted a retrospective chart review of 63 eyes of 59 patients who visited the outpatient clinic from April 2018 to January 2020 with treatment-naïve type 1/2 CNV associated with age-related macular degeneration. The CNV was diagnosed through fluorescein angiography and indocyanine green angiography on the appearance of hyperfluorescence and leakage at the late phase. The CNV type was classified by location using OCT. These results were compared with those of automatic and manual segmentations via OCTA. @*Results@#Of the 63 eyes, 45 eyes showed type 1 CNV and 18 eyes indicated type 2 CNV. Using the automatic segmented display of OCTA, type 1 CNV was identified in 29 of 45 eyes and type 2 CNV was confirmed in 17 of 18 eyes. In addition, when manual segmentation was performed, type 1 CNV was found in 41 of 45 eyes and type 2 CNV in 18 of 18 eyes. The sensitivity of diagnosis of type 1 CNV using only automatic segmentation in OCTA was 64.44%; the sensitivity increased to 91.11% when additional manual segmentation was performed (p < 0.001). For type 2 CNV, the sensitivity was 94.44% using automatic segmentation in OCTA and 100% with additional manual segmentation (p = 1.000). @*Conclusions@#Automatic segmentation of OCTA and OCT analyses enabled diagnosis of type 1 and type 2 CNV associated with age-related macular degeneration. The diagnosis accuracy or type 1 CNV improved significantly when manual segmentation was added.

Analyses of Tangential Retinal Displacement and Metamorphopsia after Idiopathic Epiretinal Membrane Surgery

Purpose@#To evaluate the correlation between tangential retinal displacement and the improvement of metamorphopsia after idiopathic epiretinal membrane surgery. @*Methods@#The medical records of 36 eyes from 36 patients with idiopathic epiretinal membrane who underwent pars plana vitrectomy and who were observed over 1 year between January 2017 and December 2018 were retrospectively reviewed. Preand postoperative visual acuity, vertical and horizontal metamorphopsia score using the M-CHART, vertical and horizontal retinal displacement, and the presence of an ectopic inner foveal layer (EIFL) using optical coherence tomography were investigated. @*Results@#Postoperatively, the ratios of vertical and horizontal retinal displacement were 12.11 ± 12.04% and 8.09 ± 11.43%, respectively. The postoperative horizontal metamorphopsia score significantly improved (p = 0.019) compared to preoperatively and there were no significant differences in the vertical metamorphopsia score (p = 0.790). There were no significant correlations between the ratio of the vertical retinal displacement and improvement of horizontal metamorphopsia score or between the ratio of the horizontal retinal displacement and improvement of vertical metamorphopsia score. The preoperative horizontal metamorphopsia score was significantly higher in patients with EIFL than in patients without EIFL (p = 0.021) as was the postoperative horizontal metamorphopsia score (p = 0.016). In the EIFL group, the disappeared EIFL group had significantly lower postoperative vertical (p = 0.001) and horizontal (p < 0.001) metamorphopsia scores compared to the persistent EIFL group. @*Conclusions@#Postoperative retinal displacement was not correlated with improvement in metamorphopsia. However, the presence of preoperative EIFL and postoperative changes affect the severity of postoperative metamorphopsia.

Predictors of Retinal Pigment Epithelial Tears in Exudative Macular Degeneration with High Pigment Epithelial Detachment

Purpose@#To evaluate the risk factors for retinal pigment epithelium (RPE) tear after intravitreal anti-vascular endothelial growth factor treatment in patients with exudative age-related macular degeneration, associated with high pigment epithelial detachment (PED) (>400 μm). @*Methods@#Fifty-five treatment-naive patients with high PED (>400 μm) and exudative age-related macular degeneration, treated with an initial series of 3 monthly loading injections between January 2013 and December 2017, were retrospectively included. @*Results@#The RPE tear rate was 16.4% (9/55). The areas affected by choroidal neovascularization and PED were significantly larger in the tear group compared with the no-tear group (p = 0.004, p = 0.029, respectively). The rate of intraretinal fluid (IRF) was 89% and 28% in the tear and no-tear groups, respectively (p = 0.001), and the subfoveal choroidal thickness was significantly thinner in the tear group (p = 0.003). There was no significant difference with respect to age, sex, laterality, underlying disease, baseline visual acuity, diagnosis, type of PED, or presence of subretinal fluid between the tear and no-tear groups. According to logistic regression analysis findings, the presence of IRF is associated with a higher risk of RPE tear (odds ratio = 20.3, p = 0.007). @*Conclusions@#The presence of IRF was associated with RPE tear development after intravitreal injection for exudative age-related macular degeneration.

Changes in the Foveal Avascular Zone after Uncomplicated Cataract Surgery Based on Optical Coherence Tomography Angiography

Purpose@#To report changes in the foveal avascular zone (FAZ) after uncomplicated cataract surgery using optical coherence tomography (OCT) angiography. @*Methods@#The present study evaluated 39 eyes that underwent cataract surgery between April 2019 and June 2019. Central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) were measured by OCT. The area of the FAZ in the superficial vascular complex (SVC) and deep vascular complex (DVC) were measured using OCT angiography. @*Results@#In all eyes, except for five with cystoid macular edema, there was a statistically significant change in the CMT over time (p < 0.0001), and the CMT at 1 month postoperatively was significantly thicker than the preoperative CMT (p = 0.005). The SFCT was significantly thicker at 1 week and 1 month postoperatively relative to the preoperative values (p < 0.0001 and p = 0.004, respectively). The FAZ area in the SVC and DVC decreased significantly at 1 week and 1 month postoperatively compared with the preoperative values (p < 0.0001 and p = 0.007, respectively). In the five eyes that developed cystoid macular edema, the area of the FAZ in the DVC showed a significant increase at 1 month postoperatively compared with the preoperative value (p = 0.028). @*Conclusions@#The FAZ area in the SVC and DVC decreased postoperatively, suggesting that cataract surgery may affect perfusion in the macula.

Colonoscopic Removal of an Intrauterine Device That Had Perforated the Rectosigmoid Colon

The intrauterine device (IUD) is a widely used contraceptive method. One of the most serious and rare complications of using an IUD is colon perforation. We report a case of colonoscopic removal of an IUD that had perforated into the rectosigmoid colon in a 42-year-old woman who presented with no symptoms. Colonoscopy showed that the IUD had penetrated into rectosigmoid colon wall and that an arm of the IUD was embedded in the colon wall. We were able to remove the IUD easily by using colonoscopy. The endoscopic approach may be considered the first choice therapy for selected patients.

Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain

BACKGROUND AND OBJECTIVES: A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. SUBJECTS AND METHODS: Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were excluded and 108 were enrolled for the present study. The enrolled patients underwent complete numerical rating scale of chest pain and the symptom checklist for minor psychiatric disorders at the time of first outpatient visit. The non-CAD group consisted of patients with a normal stress test, coronary computed tomography angiogram, or coronary angiogram, and the CAD group included those with an abnormal coronary angiogram. RESULTS: Nineteen patients (17.6%) were diagnosed with CAD. No differences in the psychiatric characteristics were observed between the groups. "Feeling tense", "self-reproach", and "trouble falling asleep" were more frequently observed in the non-CAD (p=0.007; p=0.046; p=0.044) group. In a multiple linear regression analysis with a stepwise selection, somatization without chest pain in the non-CAD group and hypochondriasis in the CAD group were linearly associated with the intensity of chest pain (β=0.108, R2=0.092, p=0.004; β= -0.525, R2=0.290, p=0.010). CONCLUSION: No differences in psychiatric characteristics were observed between the groups. The intensity of chest pain was linearly associated with somatization without chest pain in the non-CAD group and inversely linearly associated with hypochondriasis in the CAD group.

Multimodality Intravascular Imaging Assessment of Plaque Erosion versus Plaque Rupture in Patients with Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: We assessed plaque erosion of culprit lesions in patients with acute coronary syndrome in real world practice. SUBJECTS AND METHODS: Culprit lesion plaque rupture or plaque erosion was diagnosed with optical coherence tomography (OCT). Intravascular ultrasound (IVUS) was used to determine arterial remodeling. Positive remodeling was defined as a remodeling index (lesion/reference EEM [external elastic membrane area) >1.05. RESULTS: A total of 90 patients who had plaque rupture showing fibrous-cap discontinuity and ruptured cavity were enrolled. 36 patients showed definite OCT-plaque erosion, while 7 patients had probable OCT-plaque erosion. Overall, 26% (11/43) of definite/probable plaque erosion had non-ST elevation myocardial infarction (NSTEMI) while 35% (15/43) had ST elevation myocardial infarction (STEMI). Conversely, 14.5% (13/90) of plaque rupture had NSTEMI while 71% (64/90) had STEMI (p<0.0001). Among plaque erosion, white thrombus was seen in 55.8% (24/43) of patients and red thrombus in 27.9% (12/43) of patients. Compared to plaque erosion, plaque rupture more often showed positive remodeling (p=0.003) with a larger necrotic core area examined by virtual histology (VH)-IVUS, while negative remodeling was prominent in plaque erosion. Overall, 65% 28/43 of plaque erosions were located in the proximal 30 mm of a culprit vessel-similar to plaque ruptures (72%, 65/90, p=0.29). CONCLUSION: Although most of plaque erosions show nearly normal coronary angiogram, modest plaque burden with negative remodeling and an uncommon fibroatheroma might be the nature of plaque erosion. Multimodality intravascular imaging with OCT and VH-IVUS showed fundamentally different pathoanatomic substrates underlying plaque rupture and erosion.

Erratum: Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain

The first author's name was misspelled.

An Assay of Measuring Platelet Reactivity Using Monoclonal Antibody against Activated Platelet Glycoprotein IIb/IIIa in Patients Taking Clopidogrel

BACKGROUND AND OBJECTIVES: Residual platelet reactivity in patients who are taking clopidogrel is commonly measured with VerifyNow assay, which is based on the principle of light transmission aggregometry. However, to evaluate the residual platelet reactivity, it would be more accurate if the reactivity of platelet glycoprotein (GP) IIb/IIIa is directly monitored. In this study, PAC1, a monoclonal antibody against activated platelet GP IIb/IIIa, was used to measure the residual platelet reactivity. SUBJECTS AND METHODS: Twenty seven patients with coronary artery disease taking clopidogrel were enrolled. Platelets in whole blood were stained with fluorescein isothiocyanate (FITC)-conjugated PAC1. Mean fluorescence intensity (MFI) and % positive platelets (PP) were measured with flow cytometry, and the binding index (BI; MFI x %PP/100) was calculated. P2Y12 reaction unit (PRU) and % inhibition of VerifyNow assay were also measured in the usual manner. RESULTS: PRU of VerifyNow assay correlated significantly with MFI, %PP, and BI at 10 microM (r=0.59, 0.73, and 0.60, respectively, all p<0.005) and 20 microM of adenosine diphosphate (ADP; r=0.61, 0.75, and 0.63, respectively, all p<0.005). The % inhibition also correlated significantly with MFI, %PP, and BI at 10 microM (r=-0.60, -0.69, and -0.59, respectively, all p<0.005) and 20 microM of ADP (r=-0.63, -0.71, and -0.62, respectively, all p<0.005). CONCLUSION: Direct measurements of the reactivity of platelet GP IIb/IIIa were feasible using PAC1 and flow cytometry in patients taking clopidogrel. Further clinical studies are required to determine the cut-off values which would define high residual platelet reactivity in patients on this treatment protocol.

Multimodality Diagnostic Imaging in Unilateral Acute Idiopathic Maculopathy

PURPOSE: To report multimodality diagnostic imaging in a case of unilateral acute idiopathic maculopathy. CASE SUMMARY: A 32-year-old woman with reduced vision in the right eye had experienced fatigue and flu-like symptoms, including sore throat and fever a few days before. Her best corrected visual acuity (BCVA) was 1.0 in the right eye. There were no cells in the anterior chamber and vitreous. Fundus photographs of the right eye on presentation showed gray-white thickening of the fovea and retinal hemorrhage next to the fovea. Fluorescein angiography demonstrated ring-shaped mottled hyperfluorescence in the early phase and dye pooling in the late phase. Spectral-domain optical coherence tomography (OCT) showed abnormal hyper-reflective thickening at the level of the outer retina and retinal pigment epithelium (RPE) and detachment of the neurosensory retina in the foveal lesion. The inner segment/outer segment junction and photoreceptor elevation/disruption was noted. Nineteen months after onset, the BCVA of the right eye was 1.0 and fundus photographs showed increased retinal pigment hyperplasia, and residual RPE changes resembling a bull's eye maculopathy. The OCT of the right macula showed that the inner segment/outer segment junction elevation/disruption almost completely regressed. The patient was diagnosed with unilateral acute idiopathic maculopathy. CONCLUSIONS: We report a typical case with flu-like symptoms of unilateral acute idiopathic maculopathy. It is a very rare macular disease and a case such as ours with long-term follow-up using multimodality diagnostic imaging has not been previously reported.

Clinical Outcomes in Patients with Intermediate Coronary Stenoses: MINIATURE Investigators (Korea MultIceNter TrIal on Long-Term Clinical Outcome According to the Plaque Burden and Treatment Strategy in Lesions with MinimUm Lumen ARea lEss Than 4 mm2 Usin

BACKGROUND AND OBJECTIVES: We evaluated the two-year clinical outcomes in patients with angiographically intermediate lesions according to the plaque burden and treatment strategy. SUBJECTS AND METHODS: We prospectively enrolled patients with angiographically intermediate lesions (diameter stenosis 30-70%) with an intravascular ultrasound (IVUS) minimum lumen area (MLA) <4 mm2 with 50-70% plaque burden of 16 Korean percutaneous coronary intervention centers. Patients were divided into medical therapy group (n=85) and zotarolimus-eluting stent group (ZES; Resolute) group (n=74). We evaluated the incidences of two-year major adverse cardiovascular events (MACE). RESULTS: A two-year clinical follow-up was completed in 143 patients and MACE occurred in 12 patients. There were no significant differences in the incidences of death (1.3% vs. 3.0%, p=0.471), target vessel-related non-fatal myocardial infarction (0.0% vs. 0.0%, p=1.000) and target vessel revascularizations (7.8% vs. 4.5%, p=0.425) between medical and ZES groups. Independent predictors of two-year MACE included acute myocardial infarction {odds ratio (OR)=2.87; 95% confidence interval (CI) 1.43-6.12, p=0.014}, diabetes mellitus (OR=2.46; 95% CI 1.24-5.56, p=0.028) and non-statin therapy (OR=2.32; 95% CI 1.18-5.24, p=0.034). CONCLUSION: Medical therapy shows comparable results with ZES, and myocardial infarction, diabetes mellitus and non-statin therapy were associated with the occurrence of two-year MACE in patients with intermediate lesion with IVUS MLA <4 mm2 with 50-70% of plaque burden.

A Case of Bilateral Macular Hole in a Patient with Bilateral Macular Telangiectasia

PURPOSE: To report a case of bilateral macular holes in a patient with bilateral macular telangiectasia (Mac Tel). CASE SUMMARY: A 61-year-old male presented with decreased central vision in both eyes. His best corrected visual acuity (BCVA) was 0.8 in the right eye and 0.6 in the left eye. On fundoscopy, fluorescein angiography (FAG), and optical coherence tomography (OCT), he was diagnosed with Mac Tel type 2 combined with stage 1A of the right eye and stage 1B impending macular hole in the left eye. Two years and 8 months later, the BCVA of both eyes was unchanged. On fundoscopy, FAG and OCT, there were no definitive changes in both eyes. The patient was observed without treatment. CONCLUSIONS: Patients with Mac Tel type 2 may be predisposed to the development of a macular hole.

Bortezomib Reduces Neointimal Hyperplasia in a Rat Carotid Artery Injury Model

BACKGROUND AND OBJECTIVES: The ubiquitin-proteasome system is the major intracellular protein degradation pathway in the eukaryotic cells. Bortezomib inhibits 26S proteasome-induced I-kappaBalpha degradation and suppresses nuclear factor-kappa B (NF-kappaB) activation. We examined the effect of bortezomib on neointima formation after of a rat carotid artery balloon injury. MATERIALS AND METHODS: After carotid artery balloon denudation, bortezomib was immediately administered by tail vein injection (systemic treatment) and by using an F-127 pluronic gel (perivascular treatment). Two weeks after the injury, we compared the degree of neointima formation in the carotid artery and the tissue expression patterns of NF-kappaB and I-kappaBalpha. RESULTS: The systemic treatment group exhibited a 29% reduction in neointima volume at two weeks after the balloon injury. On the western blot analysis, the bortezomib group exhibited an increased I-kappaBalpha expression, which suggested the inhibition of I-kappaBalpha degradation. On immunofluorescence analysis, the nuclear import of NF-kappaB was clearly decreased in the systemic bortezomib group. The perivascular bortezomib treatment group exhibited a significant reduction in the neointimal area (0.21+/-0.06 mm2 vs. 0.06+/-0.01 mm2, p<0.05), the neointima/media area ratio (1.43+/-0.72 vs. 0.47+/-0.16, p<0.05) and the % area stenosis (45.5+/-0.72% vs. 14.5+/-0.05%, p<0.05) compared with the control group. In situ vascular smooth muscle cell proliferation at 2 days after the injury was significantly inhibited (24.7+/-10.9% vs. 10.7+/-4.7%, p<0.05). CONCLUSION: Bortezomib suppressed NF-kappaB activation through the inhibition of I-kappaBalpha degradation, and significantly reduced neointima formation in a rat carotid artery injury model. These data suggested that bortezomib represented a new potent therapeutic agent for the prevention of restenosis.

Serum Thioredoxin 1 Level Has Close Relation with Myocardial Damage Amount in Acute Myocardial Infarction Patients

Thioredoxin-1 (Trx-1) is one of important anti-oxidative molecules to overcome the oxidative stress. The aim of the present study is to investigate the clinical relationship between serum concentration of Trx-1 on the pre-percutaneous coronary intervention (prePCI) and myocardial damage amount in the patients with acute myocardial infarction with the culprit lesion in only the left anterior descending artery on coronary angiography (n = 100). Initial value of creatine kinase (CK) was 368.3 +/- 531.4 U/L, and MB isoenzyme of CK (CK-MB) level was 22.92 +/- 33.8 ng/mL, and cardiac specific troponin T (cTnT) level was 0.61 +/- 1.6 ng/mL. Positive correlations were observed between prePCI Trx-1 level and initial CK (P = 0.005, r = 0.281), and cTnT (P < 0.001, r = 0.453), peak CK (P = 0.001, r = 0.316) in all patients, but the statistical relation was observed only in ST segment elevation myocardial infarction (STEMI) patients (P = 0.008, r = 0.329 for initial CK, P = 0.001, r = 0.498 for initial cTnT, P = 0.005, r = 0.349 for peak CK), not in Non-STEMI patients. Conclusively, we consider prePCI serum Trx-1 as a predictor for myocardial damage amount in patients with STEMI.

Aspirin Resistance in Patients with End-Stage Renal Disease / 대한신장학회지

PURPOSE: Patients with end-stage renal disease (ESRD) frequently undergo thrombotic cardiovascular events, but the relationship between increased thrombotic events and aspirin resistance is poorly defined in these patients. METHODS: Between December 2008 and November 2009, 59 ESRD patients who had taken aspirin alone or aspirin plus clopidogrel daily for > or =7 consecutive days were included. Aspirin resistance was measured using the VerifyNow Aspirin Assay and compared with that of patients with normal kidney function. Moreover, thrombotic cardiovascular events were examined in the ESRD patients. RESULTS: Aspirin reaction unit was 475+/-58 U in the ESRD patients compared with 443+/-62 U in patients with normal kidney function. Nineteen (11%) of 170 patients were aspirin resistant based on the criterion of aspirin reaction unit (> or =550). The prevalence of aspirin resistance was significantly higher in the ESRD patients than in control patients (20% vs. 6%, p=0.006). ESRD and the use of angiotensin- converting enzyme inhibitors were associated with aspirin resistance in the multivariate logistic regression analysis. After a mean follow-up of 18.6+/-7.5 months, the incidence of thrombotic cardiovascular events in the ESRD patients who had aspirin resistance was significantly higher than in the ESRD patients without aspirin resistance (75% vs. 38%, p=0.023). CONCLUSION: The incidence of aspirin resistance was higher in patients with ESRD than in patients with normal kidney function. In addition, ESRD and the use of angiotensin-converting enzyme inhibitors were significant predictors for aspirin resistance. Aspirin resistance was associated with increased thrombotic cardiovascular events in ESRD patients.

Expression of Lectin like Oxidized Low Density Lipoprotein Receptor-1 in the Spontaneous Hypertensive Rat with High Cholesterol Diet

BACKGROUND: Lectin-like, oxidized, low-density lipoprotein receptorreceptors (LOX-1) recognizes recognize vascular oxidized low-density lipoprotein (LDL), which may play an important role in the pathogenesis of atherosclerosis. We investigated the expressions expression of LOX-1 and redox-regulating thyoredoxinthioredoxin systems in a hypertension and hypercholesterolemia rat model. METHODS: Spontaneously hypertensive rats (SHR) and Wistar-Kyoto rat (WKY) rats were fed with a normal cholesterol diet (NC) and a high cholesterol diet (HC) for 4 weeks. Plasma LDL cholesterol levels and blood pressure were measured at 1 and 4 weeks. Histological changes of atherosclerosis in the vessel was evaluated by hematoxylin and eosin staining and immunocytochemistry. The expressions expression of LOX-1 and thyoredoixnthioredoxin were measured by Western western blot analysis. RESULTS: In the SHR groupsgroup, blood pressure after 4 weeks was significantly higher than initial levels. LDL-cholesterol levels in the SHR-HC group were increased at 4 weeks (15.3 +/- 2.6 mg/dL vs. 20.2 +/- 2.6 mg/dL, p < 0.01) compared with the SHR-NC group. In oxyblot analysis, the degree of oxidative stress of in the SHR-HC group was significantly higher than in the SHR-NC group (p < 0.05). The expressions expression of LOX-1 and Trx were was significantly increased in the SHR-HC group compared with the SHR-NC group (p < 0.05) on western blot analysis. Focal overexpressions overexpression of LOX-1 were was observed at the intima layer of the thoracic aorta, and was which wereonly observed in the SHR-HC group. CONCLUSIONS: The expressions expression of LOX-1 and oxidative stress were was significantly increased in the "hypertension with hypercholesterol" rat model. These findings suggested suggest that LOX-1 and redox systems may play a certain role in development and progression of atherosclerosis.

Very Late Stent Thrombosis after Drug-Eluting Stent Implantation in a Patient without Aspirin and Clopidogrel Resistance

Very late stent thrombosis (VLST) after implantation of drug-eluting stent is rare, but very fatal complication after percutaneous coronary intervention. We report a case of VLST of a sirolimus-eluting Cypher(TM) stent (Cordis, Johnson and Johnson) presenting as acute ST elevation myocardial infarction at 26 months after deployment with continued combined dual antiplatelet medication of aspirin and clopidogrel. The patient did not show anti-platelet resistance.

Optical Coherence Tomography Findings in Best Disease

PURPOSE: To report the optical coherence tomography (OCT) findings of three cases in various stages of juvenile-onset vitelliform macular dystrophy (Best disease). CASE SUMMARY: Medical records of six eyes from three patients diagnosed with Best disease were reviewed retrospectively. We evaluated the clinical features of the fundus, the electro-oculogram, and the optical coherence tomography (OCT) results. In the fundi of the three patients with Best disease, the characteristic stages of vitelliform, pseudohypopyon, and scrambled egg appearance were identified. Optical coherence tomography findings in the eyes of the patients with Best disease showed two types of outer retina-choroid complex (ORCC) changes, including splitting with intervening hyporeflective areas and elevation over hyporeflective area. CONCLUSIONS: The OCT findings showed variable patterns according to the progression of Best disease. In the pseudohypopyon stage, both neurosensory detachment and retinal pigment epithelial detachment appearance were identified. The exact location of the resulting lesions seems to depend on the relative impediment of fluid movement caused by the mutation of bestrophin.