[A case of anterior ischemic optic neuropathy after uneventful cataract surgery in a diabetic patient].

A diabetic patient complained of sudden visual field defect on the third day after cataract surgery. The fundus examination showed optic disc edema in the left eye, which was diagnosed as anterior ischemic optic neuropathy by optical coherence tomography and visual field examinations. The optic neuropathy was induced by the excessive application of tropicamide phenylephrine eye drops by herself before cataract surgery. After timely treatment, the patient's vision and visual field recovered well.

[The fundus autofluorescence of retinal astrocytic hamartomas in tuberous sclerosis complex].

Objective: To investigate the autofluorescence findings of retinal astrocytic hamartoma (RAH) in patients with tuberous sclerosis complex (TSC). Methods: It was a retrospective case series study. Twenty-three patients (35 eyes) who were referred to Department of Internal Medicine and Department of Ophthalmology, Peking Union Medical College Hospital between November 2012 and June 2018 with established TSC-associated RAH diagnosis were included. The findings of fundus autofluorescence, fundus photos and spectral-domain optical coherence tomography (SD-OCT) were retrospectively reviewed. RAH lesions were classified into three types based on the morphology shown in fundus photos. The fundus autofluorescence features of TSC-associated RAH were described. The Welch's test and Fisher's exact test were used for statistical analysis. Results: The patients were 8 males and 15 females aged (28±9) years old (range, 15-55 years). Seventy-two RAH lesions were examined, including 59 type 1 RAHs, 7 type 2 RAHs and 6 type 3 RAHs. According to fundus autofluorescence, type 1 RAHs could be further divided into reduced, speckled and background autofluorescence patterns, among which the hypoautofluorescence pattern accounted for the majority (69.5%, 41/59), while the speckled pattern was usually accompanied by outer retinal disorganization and discontinuation of photoreceptor outer segment as revealed by SD-OCT. No significant difference was revealed in tumor thickness for reduced, speckled and background autofluorescence patterns of type 1 RAHs [(490.2±97.9) vs. (589.2±221.6) vs. (463.0±76.2) µm respectively, F=1.426, P=0.283]. Among type 1 RAHs, the number of reduced autofluorescence pattern lesions found in perifoveal, peripapillary, inferonasal, inferotemporal, superonasal, superotemporal quadrants were 9, 4, 4, 7, 4, 13 respectively, while that of speckled autofluorescence pattern lesions were 3, 0, 3, 2, 3, 2 and background autoflurorescence pattern lesions 3, 0, 1, 1, 0, 0. No significant difference was revealed in location distribution (P=0.452) either. Type 2 RAHs featured numerous hyperautofluorescent spots or plaques, and calcification in type 2 RAHs varied in autofluorescence intensity. Type 3 RAHs, combining the features of type 1 and 2 RAHs, were characterized by central hyperautofluorescent spots and hypoautoflurescent rim, but the area of hyperautofluorescence was smaller than that of calcification as shown in fundus photos. Conclusions: In TSC, the fundus autofluorescence of RAHs varies from hypoautofluorescence to hyperautofluorescence patterns according to RAH types. The retinal involvement and calcification degree of TSC-associated RAHs could be reflected on the autofluorescence, which was beneficial to the full assessment. (Chin J Ophthalmol, 2020, 56: 211-216).

[The ocular involvement in the transthyretin-related familial amyloid polyneuropathy].

Transthyretin (TTR)-related familial amyloid polyneuropathy (FAP), which is caused by mutant TTR, is a rare but fatal autosomal dominant disease. TTR is synthesized by the liver (95%) , the choroid plexus of the brain and the retinal pigment epithelium. FAP leads to peripheral neuropathy, and the main ocular manifestations are vitreous opacity (yellowish cotton-like), secondary glaucoma and keratoconjunctivitis sicca. Liver transplantation has proven to be the most effective treatment for TTR-FAP. Nowadays, tafamidis is the only drug approved for TTR-FAP (early stage). However, neither liver transplantation nor tafamidis is capable to halt the progression of ocular involvement. Panretinal photocoagulation could damage the retinal pigment epithelium, and thus prevent the progression. Recent investigations on TTR-FAP and its ocular involvement are reviewed in this article. (Chin J Ophthalmol, 2017, 53: 783-785).

Retinal vasculopathy in patients with systemic lupus erythematosus.

A retrospective case control study was conducted in the Peking Union Medical College Hospital. Medical records were reviewed for demographic data, clinical features, laboratory results, systemic lupus erythematosus (SLE) disease activity evaluations, and ophthalmic examinations to investigate the clinical characteristics and significance of retinal vasculopathy (RV) in Chinese patients with systemic lupus erythematosus. The prevalence of RV was approximately 0.66% (35/5298) in SLE patients. A total of 60 eyes were involved. The ocular presentations included decrease of visual acuity (48/60, 80%), visual field loss (7/60, 11.7%), and diplopia (3/60, 5%). Ophthalmic fundoscopic examination revealed cotton-wool spots (30/60, 50%), retinal vascular attenuation (31/60, 51.6%), and hemorrhages (41/60, 68.3%). Retinal angiogram showed that 72.7% (16/22) eyes had vaso-occlusion. The ophthalmic episodes could occur at any stage of SLE duration, with a median of 12 months (0-168 months) following SLE onset. Twenty-one (35%) eyes did not recover, or even worsened, during hospital stay. RV was found to be significantly associated with neuropsychiatric lesions (51.4% vs. 21.3%, p = .005) and hematological disturbance (62.9% vs. 34.3%, p = .005). SLE patients with RV had significantly higher SLE disease activity index scores than controls (19.9 ± 0.9 vs. 10.2 ± 0.7, p < .001). An inverse association of anti-SSA antibody with RV was detected (34.3% vs. 67.1%, p = .001). Nervous system disturbance (odds ratio (OR) = 4.340, 95% confidence interval (CI) 1.438, 13.094, p = .009) and leukocytopenia (OR = 6.385, 95% CI 1.916, 21.278, p = .003) were independent risk factors, while anti-SSA antibody positivity (OR = 0.249, 95% CI 0.087, 0.710, p = .009) was a protective factor for RV in SLE patients. In certain cases, RV is a threatening condition for SLE patients presenting with clinical ocular manifestations. Ophthalmo-fundoscopic detection is recommended as soon as SLE is diagnosed.

A simple method for detection of food foraging behavior in the rat: involvement of NMDA and dopamine receptors in the behavior.

Food foraging behavior involves food removing, hoarding, and competitive preying upon other animals. It is also associated with high cognitive functions such as investing effort into decision making, but no established laboratory model is available to detect the behaviors. In the present study, we have developed a novel laboratory rodent model to detect competitive, non-competitive, and no-hurdle foraging conditions that can mimic the corresponding environment in nature. We found that normal rats consistently foraged the food from a food container to the field and spread food into piles in the open field. There was no difference between male and female rats in the amount of foraged food in the competitive, non-competitive, and no-hurdle food foraging tests. The amount of foraged food was consistent each day for five consecutive days with a slight increase in following days. There was no significant difference in the amount of food foraged in the presence or absence of bedding materials. A dramatic decrease of foraged food was found in the rats after administration of haloperidol (dopamine D2 receptor antagonist) in the competitive, non-competitive, and no-hurdle food foraging tests. Treatment with MK-801 (non-competitive N-methy-D-aspartate receptor antagonist) reduced the foraged food in the competitive food foraging test, but did not affect the foraged food in the non-competitive and no-hurdle food foraging tests. Our study provides a simple but consistent analogue of natural food foraging behavior. Our study also suggests that dopaminergic and glutaminergic systems are differentially involved in the food foraging behaviors.

Induction of tumor necrosis-alpha, p38 and JNK in the spinal cord following acute heart injury in the rat model.

BACKGROUND: It is still not known whether the spinal cytokine signaling pathways are involved in the pathophysiologic mechanism of the acute phase of heart disease. This study examines the expression pattern of tumor necrosis factor-alpha (TNF-alpha) and its two related mitogenic-activated protein kinases, p38 and Jun-N-terminal kinase (JNK), in the spinal cord in response to acute cardiac injury (ACI). METHODS: The ACI rat model was established by intra-myocardial injection of formalin. At the indicated times after the establishment of ACI, the thoracic segments of the spinal cord were harvested and Western blot was performed to determine the expression of TNF-alpha, p38 and JNK. The localization of the cytokine and the kinases was determined by immunohistochemistry and double immunofluorescence. RESULTS: In response to ACI, TNF-alpha protein was up-regulated and reached a peak level at 6 h after ACI. The up-regulated TNF-alpha was distributed in all the laminae in the spinal cord and mainly localized in the neurons, as determined by immunohistochemistry and double immunofluorescence. In response to ACI, p38 and JNK were also up-regulated in the spinal cord. The expression profiles of p38 and JNK were similar to that of activated TNF-alpha following ACI. CONCLUSIONS: This study shows that cardiac injury can induce the activation of spinal TNF-alpha, p38 and JNK. The activated spinal cytokine signaling may contribute to disease progression in the acute phase of cardiac injury in clinical practice.

Differential expression of cytokines in the rat heart in response to sustained volume overload.

OBJECTIVE: The present study aimed to investigate whether sustained volume overload is capable of inducing persistent upregulation of cardiac cytokines including tumor necrosis factor alpha (TNF)-alpha, interleukin (IL)-1beta, interleukin (IL)-6 and transforming growth factor (TGF)-beta(1). METHODS AND RESULTS: Volume overload-induced heart hypertrophy in rats was established by aortacaval fistula, and the cardiac cytokines were measured in the myocardium from 1 to 4 weeks after operation. In the post-fistula rats, cardiac IL-1beta and IL-6 gene and protein levels were upregulated throughout the time of measurement. Immunohistochemistry demonstrated that IL-1beta and IL-6 immunoreactive cells were widely distributed in the myocardium in the earlier time intervals, and mainly localized in the regions close to the endocardium in the later time intervals. The cardiac IL-1beta immunoreactive cells were mainly localized in the blood vessels whereas the IL-6 positive cells were composed of non-myocytes and cardiomyocytes. TGF-beta(1) positive staining was increased in the myocardium up to 3 weeks after aortacaval fistula and then decreased to basal levels thereafter. In contrast to the activation of cardiac IL-1beta and IL-6 in response to volume overload, TNF-alpha expression appeared unaltered in response to sustained volume overload in the transcription and protein levels. CONCLUSION: The results of the present study indicate that sustained volume overload is capable of inducing persistent upregulation of some cardiac cytokines. In addition, the differential expressions of TNF-alpha, IL-1beta and IL-6 suggest that the induction of IL-6 and IL-1beta is independent of TNF-alpha mediated pathways in this animal model.

Induction of cytokine expression in rat post-ischemic sinoatrial node (SAN).

The aim of this study was to determine the spatial and temporal expression of various pro-inflammatory cytokines in the peri-sinoatrial nodal area after atrial infarction. Rats were subjected to permanent atrial infarction, in particular, sinoatrial node (SAN) infarction and sacrificed at various time points up to 7 days. Real-time polymerase chain reaction analysis demonstrated that mRNA levels of tumor necrosis factor alpha (TNF-alpha), interleukin-1beta, interleukin-6, and transforming growth factor beta 1 (TGF-beta(1)) were upregulated in the peri-sinoatrial nodal area after atrial infarction. Immunostaining for TNF-alpha and TGF-beta(1) proteins revealed that both cytokines were expressed persistently up to 7 days after atrial infarction around the peri-sinoatrial nodal area. Furthermore, the infiltrating inflammatory cells immunoreactive for both cytokines were predominant within the infarct SAN. In situ hybridization analysis showed that TNF-alpha gene expression was enhanced in the inflammatory cells and myocardium within the peri-sinoatrial nodal area in response to the infarction. These results provide evidence for the local expression of cytokines in the post-ischemic peri-sinoatrial nodal area, suggesting that the upregulation of the cytokines might be associated with the atrial arrhythmia observed after acute myocardial infarction.

Effects of window and threshold levels on the accuracy of three-dimensional rendering techniques in coronary artery electron-beam CT angiography.

RATIONALE AND OBJECTIVES: The authors performed this study to evaluate the effect of window level and gray-scale threshold on the demonstration of coronary artery lumina at three-dimensional electron-beam computed tomographic (CT) angiography. MATERIALS AND METHODS: Forty-four coronary artery branches in postmortem pigs were evaluated with electron-beam CT angiography, and the findings were compared with those from conventional angiography. Images from electron-beam CT angiography were reconstructed with maximal intensity projection (MIP), multiplanar reformation (MPR), and shaded-surface display (SSD). Four categories of window level and gray-scale threshold were evaluated. RESULTS: Three-dimensional electron-beam CT angiography accurately depicted the luminal diameters of the coronary arteries compared with conventional angiography (r = 0.83-0.90, P < .0001). The length of lumina visualized at electron-beam CT angiography was significantly shorter than that visualized with conventional angiography (P < .001). The use of MPR enabled visualization of longer segments of coronary arteries than did the use of MIP or SSD (P < .05). The higher the window level and gray-scale threshold used, the smaller the coronary luminal diameters measured (P < .05). The most accurate window level and gray-scale threshold (82.6 HU +/- 29.8 and 89.5 HU +/- 29.7, respectively) were found to correspond to the attenuation of the lumina (275.8 HU +/- 58.8). Results of simple linear regression showed a strong correlation between luminal attenuation and window level (r = 0.89, P < .0001) or gray-scale threshold (r = 0.95, P < .0001). CONCLUSION: Electron-beam CT angiography shows promise in the visualization of coronary artery lumina. For accurate display of lumina, a proper window level and gray-scale threshold for three-dimensional rendering techniques should be determined and used on the basis of the attenuation of the target vessel.

Coronary artery stenoses: a phantom study using contrast enhanced three-dimensional electron beam tomography.

This paper evaluated the accuracy of electron beam tomographic angiography (EBA) with conventional coronary arteriography (CCA) using four graded artificial stenoses in a postmortem swine coronary phantom model. The sensitivity, specificity, and accuracy of EBA for diagnosing significant stenosis (> or =50% stenosis) were 94.3%, 96.7%, and 95.8%, respectively. The diagnostic accuracy of EBA had no significant difference with CCA (chi(2)=0.0162; P>.05). EBA three-dimensional (3D) procedures had high interobserver reproducibility (k=.92-.95, P>.05). Maximum intensity projection (MIP) was the most sensitive and curved planar reformation (CPR) was the most accurate 3D procedure for quantitatively identifying coronary stenosis. EBA yields promising results concerning the visualization of coronary artery stenosis with high accuracy for stenoses >50%.

Evaluation of coronary artery bypass graft patency using three-dimensional reconstruction and flow study on electron beam tomography.

OBJECTIVES: To establish and evaluate two protocols for the noninvasive visualization and assessment of coronary artery bypass graft (CABG) patency on electron beam tomography (EBT). METHODS: Two hundred fourteen consecutive patients who underwent CABG surgery were scanned using both EBT angiography with three-dimensional reconstruction and EBT flow study with time-density curve analysis. RESULTS: There was a total of 589 CABGs evaluated in this study (10 grafts were excluded because of artifacts); 133 (98.5%) of 135 arterial grafts were patent, 345 (77.7%) of 444 saphenous vein grafts were patent. Within 5 years or 5-10 years after surgery, arterial graft patency exceeded venous graft patency (p<0.001). Three-dimensional EBT angiography achieved higher sensitivity, specificity, and accuracy (97.7%, 94.1%, and 96.7%, respectively) than EBT flow study (88.4%, 82.4%, and 85.2%, respectively) for evaluating occlusion or patency of CABGs. The intragraft flow of patent arterial and venous grafts were 4.9+/-2.2 ml/min/g and 6.9+/-2.8 ml/min/g, respectively (p<0.001). CONCLUSION: The combination of EBT three-dimensional reconstruction and flow study can be more effectively performed in the assessment of CABG anatomy and quantification of patent CABG flow.

Electron beam tomography with three-dimensional reconstruction in the diagnosis of aortic diseases.

BACKGROUND: This study was performed to evaluate the protocols of electron beam tomographic angiography and three-dimensional reconstruction for assessing the diagnostic value of aortic diseases. EXPERIMENTAL DESIGN: Retrospective and comparative study. SETTINGS: University hospital. PATIENTS: Between 1996 and 1998, 189 cases who underwent electron beam tomographic angiography and diagnosed with aortic diseases were analyzed retrospectively. The results were compared with surgical and pathological findings in 68 cases. Electron beam tomographic angiography was used single-slice-scanning with ECG-triggering for screening of the thoracic aorta, continuous-volume-scanning, permitted by continuous X-ray exposure with table incremention, was performed for the abdominal aorta scanning without ECG-triggering. Three-dimensional reconstructions were performed with shaded-surface display, multiplanar reformatting and/or maximum intensity projection methods. RESULTS: Electron beam tomography angiography with ECG-triggered sections of single-slice-scanning improved the image quality of the ascending aorta without motion artifacts. Continuous-volume-scanning was suitable for screening of the abdominal aorta because of minimizing exposure time (10-14 sec) and saving contrast media (total contrast material of 45.5+/-6.6 ml was needed). One hundred eighty-nine cases were diagnosed with aortic dissection (97 cases), aortic aneurysm (26 cases), pseudoaneurysm (8 cases), Marfan's syndrome (39 cases), Takayasu's arteritis (5 cases) and congenital aortic malformations (14 cases). Electron beam tomography results were compared with the findings of surgery (as gold standard) in 68 cases, the diagnostic accuracy was 97% (2 cases with aortic aneurysm were erroneously diagnosed with pseudoaneurysm). CONCLUSIONS: Electrocardiographically triggered, contrast-enhanced electron beam tomography is feasible for the diagnosis of all kinds of aortic diseases, with excellent three-dimensional images competitive in quality with conventional selective aortic angiography or digital subtraction angiography.

Role of transesophageal echocardiography in pre- and post-percutaneous balloon mitral valvuloplasty.

Transesophageal echocardiogram (TEE) was performed in 33 consecutive patients with both rheumatic mitral stenosis and chronic atrial fibrillation to evaluate the usefulness of this technique for the detection of left atrial thrombi, mitral regurgitation before percutaneous balloon mitral valvuloplasty and iatrogenic atrial septal defect after the procedure. TEE correctly identified thrombi in 10 (30%) patients and significant mitral regurgitation in 5 patients who underwent surgical intervention. The remaining 18 patients underwent percutaneous balloon mitral valvuloplasty without evidence of systemic embolic event and obtained adequate outcome. Transesophageal color doppler echocardiography demonstrated left-to-right shunting flow through atrial septum in 5 of 7(71%) patients 3 days after the procedure and repeated TEE in 2 of these 5 patients showed no shunting after 6 months. In conclusion, TEE plays a definite role in the selection of patients for balloon mitral valvuloplasty and assessment of iatrogenic atrial septal defect.

[Primary pericardial mesothelioma: a report of four cases].

Pericardial mesothelioma is an uncommon variety of primary malignant cardio-pericardial tumors. Four cases with pericardial mesothelioma proved by surgery and pathology are reported in this paper. The pathologic and clinical characteristics, and the imaging diagnosis of this entity are briefly discussed.