Bacteriology of the conjunctiva in pre-cataract surgery patients with occluded nasolacrimal ducts and the operation outcomes in Japanese patients.

BACKGROUND: Contamination of the conjunctiva in association with nasolacrimal duct obstruction is by all accounts a risk factor for infectious endophthalmitis post-cataract surgery. METHODS: All patients who underwent cataract day surgery routinely received nasolacrimal duct syringing with normal saline at the Wakayama Medical University Hospital, Japan, from 2011 to 2013. The microorganisms isolated from conjunctival swab samples of patients with occluded nasolacrimal ducts and their susceptibility to antibiotics, as well as the operation outcomes in all the patients were retrospectively investigated. RESULTS: Nasolacrimal duct obstruction was observed in 125 eyes of 90 patients (3.3%; 42 eyes of 30 male individuals, and 83 eyes of 60 female individuals) from a total of 3754 eyes of 2384 patients by using irrigation samples of nasolacrimal ducts. The mean age of the subjects with duct obstruction was 79 ± 8.5 years.. In bacterial cultures of swabs from these 125 individuals, microbial growth was detected in 56 samples (i.e. 44.8%). Coagulase-negative Staphylococcus was detected in 28 eyes, and Corynebacterium species was detected in 17 eyes. Staphylococcus aureus, excluding methicillin-resistant S. aureus was detected in seven eyes with nasolacrimal duct obstruction. Methicillin-resistant S. aureus was isolated in two eyes with nasolacrimal duct obstruction. Each case was treated with topical antibiotics based on the results of antibiotic sensitivity tests. After culturing of cotton swab samples from the conjunctiva, and using direct micrography of bacteria every 2 or 3 days after starting treatment, and once the results were negative (consecutively tested three times), the patients received cataract surgery. In the current case series, bacteria were not detected in conjunctival swabs obtained consecutively three times for 3 weeks after starting topical antibiotics in 118 eyes from 125 eyes (94.4%), and later in the remaining patients. No patient required dacryocystorhinostomy to eliminate bacterial contamination in the conjunctiva following topical antibiotic therapy. No patient developed infectious endophthalmitis at least 1-year post-cataract surgery. CONCLUSIONS: All the patients receiving cataract day surgery underwent the operation after the elimination of conjunctival microorganism contamination in association with nasolacrimal duct obstruction by using appropriate topical antibiotics.

Effect of fucoxanthin alone and in combination with D-glucosamine hydrochloride on carrageenan/kaolin-induced experimental arthritis in rats.

The objective of the present study was to investigate the effect of the fucoxanthin (FUCO) alone and in combination with glucosamine hydrochloride (GAH) on carrageenan/kaolin-induced inflammatory arthritis model in rats and to explore its underlying mechanisms. Joint swelling, muscle weight ratio (%), histopathological examination and scoring, and proteoglycan degradation were examined. Pro-inflammatory interleukin (IL-1ß) and tumor necrosis (TNF-α) levels, cyclooxygenase-2 (COX-2), and inducible nitric oxide synthase(iNOS) protein expression and nitric oxide (NO) level in knee synovial tissue extract were analyzed using enzyme-linked immunosorbent assay, western blotting analysis, and Griess reagent assay, respectively. FUCO and FUCO + GAH not only may significantly reduce degrees of knee joint swelling and prevent against muscle atrophy, but also may significantly attenuate inflammation in synovial tissue, cartilage erosion, and proteoglycan loss. The efficacies of FUCO + GAH were stronger than that of GAH or FUCO. FUCO alone and FUCO + GAH can significantly inhibit upregulation of COX-2 and iNOS protein expressions, decrease of IL-1ß and TNF-α levels, and reduce NO production in knee synovial tissue extract. These results indicated that FUCO is an effective anti-arthritis agent through an antiinflammation mechanism. FUCO may enhance therapeutic effect of GAH on rat arthritis through mechanism of antiinflammation.

Immunohistochemical findings of lens capsules obtained from patients with dead bag syndrome.

PURPOSE: To investigate the extracellular matrix and cellular components in lens capsules extracted from patients with dead bag syndrome (DBS) through immunohistochemistry. SETTING: Department of Ophthalmology, Wakayama Medical University School of Medicine, Wakayama, Japan, and Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. DESIGN: Immunohistochemical experimental study. METHODS: 9 capsular bag specimens from DBS cases, as well as 2 control specimens from late-postoperative in-the-bag intraocular lens dislocation cases related to previous vitrectomy, pseudoexfoliation, and blunt trauma were included. They were processed for histopathology; unstained sections were obtained from each one and analyzed by immunohistochemistry targeting collagen type IV, laminin, vimentin, collagen type I, and fibronectin. RESULTS: Immunohistochemistry in DBS showed lens capsule stained for basement membrane components. The outer part of the anterior capsule that was split from the inner part was more markedly stained for type IV collagen as compared with the posterior part. Faint staining for fibrous posterior capsular opacification (PCO) components, for example, collagen type I and fibronectin, was detected in limited areas, but the major portion of the capsule was free from these components. Small spotty vimentin-positive materials, suggesting the presence of cell debris, were also detected in limited samples. CONCLUSIONS: Small amounts of fibrotic PCO components were detected in capsules extracted from patients with DBS, but their major parts were free from PCO components. Current findings suggest small amounts of lens epithelial cells were present after surgery and secreted fibrous components before undergoing cell death process.

Cost-effectiveness of pertussis booster vaccination for preschool children in Japan.

INTRODUCTION: Japan currently recommends four doses of the diphtheria-tetanus-acellular pertussis (DTaP) vaccine in its routine vaccination program, but the introduction of a fifth dose is currently under consideration. An objective of the booster vaccination is to prevent severe cases of pertussis in infants through herd immunity. Thus, the aim of this analysis was to demonstrate the cost-effectiveness of a fifth-dose of the DTaP vaccine for 6-year-old children, taking herd immunity for unvaccinated infants into account. METHOD: An economic model analysis was conducted comparing the cost and effectiveness of the two strategies based on quality-adjusted life years (QALYs). We evaluated the incremental cost-effectiveness ratio (ICER) of the booster strategy to the no booster strategy. This model contained two sub-models: one for children aged 6 years or older and one for infants under 3 months old. Herd immunity for infants is modeled as when siblings in the same family are infected. RESULTS: The ICER was JPY 71,605,491 (USD 656,931) per QALY gained from the societal perspective, and 7.10% of incremental QALYs (0.0000934) were from a reduction in infant infection. In the sensitivity analysis, no variables moved the ICER under the threshold (JPY 5,000,000 per QALY gained), and the duration of pertussis disease and the incidence rate of pertussis had a significant impact on the ICER. When the disease burden of pertussis decreased, the booster strategy resulted in fewer QALYs gained and greater costs compared with the no booster strategy. CONCLUSION: The introduction of a DTaP booster vaccination to the routine immunization schedule can be expected to reduce the number of pertussis cases in the target population. However, our study showed that adding a booster vaccination for 6-year-old children to the schedule in Japan would not be cost-effective in terms of achieving herd immunity among unvaccinated infants.

Abdominal aortic thrombus formation in a neonate with an interrupted aortic arch.

We note the risk of paradoxical embolism in patients with congenital heart defects with a right-to-left shunt. These patients should be managed to ensure that abdominal aortic thrombi are not overlooked when their clinical conditions change.

A Case of Repeating Transient Increase in Intraocular Pressure by Instability of an Intraocular Lens Implanted in the Capsular Bag.

We observed repeated episodes of rapid increases in intraocular pressure (IOP) considered to be caused by an in-the-bag intraocular lens (IOL) instability in a patient with an implanted IOL. As acute glaucoma attack-like increase in IOP was noted in the left eye on November 8, she was admitted to Wakayama Medical University Hospital. The findings at the first examination included an IOP of 62 mm Hg, instability of a PMMA one-piece IOL, shallow anterior chamber, narrow angle, moderate mydriasis, and loss of pupillary light reaction in the left avitreous eye. On November 15, a 6-mm Hg increase in IOP was observed during 60-min dark room prone provocative testing. After the first examination, the patient perceived pain and reduced visual acuity of the left eye and emergently consulted our hospital twice. Despite miosis, normalization of the anterior chamber depth and IOP with widening of the angle were achieved by resting in the supine position. These episodes were thought to be caused by instability and anterior shift of the IOL. On January 17, 2018, suture fixation of the in-the-bag IOL was performed. The IOL was fixed by transscleral suturing of the bilateral supporting parts to the sclera. Recurrence of sudden ophthalmalgia, instability of the in-the-bag IOL, and an increase in IOP have not been observed for 1 year after surgical treatment. Instability of an in-the-bag IOL caused repeated acute angle-closure glaucoma-like attacks. The situation was well treated by suturing and fixing the haptics of IOL to the sclera.

Expression pattern of sonic hedgehog and effect of topical mitomycin C on its expression in human ocular surface neoplasms.

PURPOSE: To examine if the cells of human ocular surface neoplasms express sonic hedgehog (Shh) and the effects of topical mitomycin C on its expression. METHODS: Conjunctival tissues obtained from two normal subjects, two patients with squamous cell carcinoma of the ocular surface (conjunctiva), and one patient with ocular epithelial dysplasia were used in this study. Histological sections were processed for light microscopic immunohistochemical analysis for Shh. RESULTS: Faint immunoreactivity for Shh was detected in basal epithelial cells of limbus, bulbar, and palpebral conjunctival epithelial cells. On the other hand, squamous cell carcinoma cells markedly expressed Shh with positive staining for Patched 1(Ptc), the cell surface receptor of Shh. Similar marked expression of Shh was detected in the patient with ocular epithelial dysplasia, and this Shh expression was almost eliminated following topical mitomycin C treatment. A cell culture experiment was conducted to examine the effect of mitomycin C on Shh expression in a cultured squamous cell carcinoma cell line. CONCLUSIONS: Conjunctival epithelium constitutively expresses a low level of Shh, and its expression increases during malignant conversion of epithelial cells. Reduction of Shh expression might be involved in the therapeutic efficacy of topical mitomycin C for ocular surface epithelial neoplasms.

Monosodium iodoacetate induces apoptosis via the mitochondrial pathway involving ROS production and caspase activation in rat chondrocytes in vitro.

Monosodium iodoacetate (MIA) is an inhibitor of glyceraldehyde-3-phosphate dehydrogenase activity, and causes dose-dependent cartilage degradation resembling the pathological changes of human osteoarthritis (OA). In this study, we assessed the apoptosis induced by MIA and clarified the underlying mechanisms using the primary rat chondrocytes. The apoptosis of primary rat chondrocytes was analyzed by flow cytometry. The levels of mitochondrial membrane potential (ΔΨm) were evaluated using fluorescence spectrophotometer. The production of reactive oxygen species (ROS) was determined by fluorescence spectrophotometer. Apoptosis-related protein cytochrome c and procaspase-3 expressions were examined by Western blotting. We found that MIA treatment induces apoptosis in chondrocytes, as confirmed by increases in the percent of apoptotic cells, up-regulation of cytochrome c and caspase-3 protein levels. Treatment with MIA increases ROS production and decreases the levels of ΔΨm. The antioxidant, N-acetylcysteine (NAC), significantly prevented the production of ROS, the reduction of ΔΨm, the release of cytochrome c and the activation of caspase-3. Further, NAC completely protected the cells from MIA-induced apoptosis. Together these observations suggest that the mechanisms of MIA-induced apoptosis are primarily via ROS production and mitochondria-mediated caspase-3 activation in primary rat chondrocytes.

Cell adhesion on explanted intraocular lenses: part 1: analysis of explanted IOLs.

PURPOSE: To determine whether cell adhesion on an intraocular lens (IOL) in Japanese patients is affected by the optic material. SETTING: Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan. DESIGN: Experimental study. METHODS: Intraocular lenses of various materials explanted from Japanese patients were histologically examined under light microscopy. Specimens included 271 poly(methyl methacrylate) (PMMA) IOLs, 117 hydrophobic soft acrylic IOLs, and 48 silicone IOLs. The mean cell adhesion on the central area of the anterior surface of each IOL material (referred to as cell number) was evaluated. RESULTS: The cell number in the PMMA group was significantly higher than that in the silicone group in the periods of 1 to 5, 6 to 11, and more than 24 months. Although the cell number in the silicone group was less than one-third and one-twentieth the cell number in the hydrophobic soft acrylic group in the periods 1 to 5 months and 6 to 11 months, respectively, the difference was not statistically significant. CONCLUSION: In Japanese patients, the cell adhesion on silicone IOLs was less than that on PMMA IOLs.

Cell adhesion on explanted intraocular lenses part 2: experimental study of a surface-modified IOL in rabbits.

PURPOSE: To develop a hydrophobic acrylic IOL with a hydrophilic, anti-cell adhesive surface characteristic. SETTING: Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan. DESIGN: Experimental study. METHODS: Hydrophobic acrylic IOLs were coated with hydrophilic 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer and implanted in rabbit eyes following lens extraction. Cell adhesion on the IOL surface was histologically compared with that on an uncoated IOL under light microscopy. Specimens were also observed under scanning electron microscopy to examine the effects of MPC coating on cell morphology. RESULTS: Hydrophilic MPC coating reduced cell adhesion on acrylic IOLs at 1 month postoperatively. CONCLUSION: Coating an acrylic IOL with a hydrophilic polymer inhibited cell adhesion on the IOL surface.

Loss of expression of type IV collagen alpha5 and alpha6 chains in colorectal cancer associated with the hypermethylation of their promoter region.

Type IV collagen, a major component of the basement membrane (BM), is composed of six genetically distinct alpha(IV) chains, alpha1(IV) to alpha6(IV). Their genes are paired on three different chromosomes in a head-to-head arrangement. The alpha5(IV) gene (COL4A5) and the alpha6(IV) gene (COL4A6) are on chromosome Xq22 and are regulated by a bidirectional promoter. Loss of the alpha5(IV)/alpha6(IV) chains in epithelial BM occur in the early stage of cancer invasion. However, the regulatory mechanism of the specific loss of the alpha5(IV)/alpha6(IV) chains during cancer cell invasion is still undetermined. In the present study, we examined the expression of the alpha5(IV)/alpha6(IV) chains and the methylation profiles of the bidirectional promoter region of COL4A5/COL4A6 in colon cancer cell lines and colorectal tumor tissues. The expression of the alpha5(IV)/alpha6(IV) chains was down-regulated in colorectal cancer, and the loss of expression of the alpha5(IV)/alpha6(IV) chains was associated with the hypermethylation of their promoter region. In conclusion, the hypermethylation of the bidirectional promoter region of COL4A5/COL4A6 is one of the events that is responsible for the loss of expression of the alpha5(IV)/alpha6(IV) chains and the remodeling of the epithelial BM during cancer cell invasion.

A morphological study of the Petunia integrifolia complex (Solanaceae).

BACKGROUND AND AIMS: Petunia inflata has been treated taxonomically in various ways: it has been described as an independent species, treated as a synonym of P. integrifolia, and also regarded as a subspecies of P. integrifolia. The present study was designed to resolve the ambiguity involving the P. integrifolia complex (P. integrifolia plus P. inflata). METHODS: Tentative identification (either integrifolia group or inflata group) was carried out in the field based on the observation of live specimens at the restricted type localities. The accuracy of the tentative identification was later tested with principal component and cluster analyses of data obtained by measuring 21 morphological characters on cultivated live specimens sourced from 113 natural populations of the P. integrifolia complex in Argentina, Brazil, Paraguay and Uruguay. KEY RESULTS: There was a clear, statistically significant gap between the morphological measurements of the two groups, ensuring the accuracy of identification carried out in the field except for a probable hybrid swarm. Previously, the condition of the pedicel in the fruiting state was considered an important character distinguishing between these two groups; however, the condition of the pedicel was rather variable in the integrifolia group. The two groups were found to have geographically distinct distributions: the integrifolia group occurred in southern regions, whereas the inflata group occurred in northern regions. CONCLUSIONS: Based on the available evidence, it is suggested that the two groups are allopatric species, P. integrifolia and P. inflata, in agreement with the opinion of Fries (1911).