Validation of red dichromatic imaging score (RDI score) to evaluate the severity of ulcerative colitis.

BACKGROUND: Red dichromatic imaging (RDI) is a new imaging technology that has been closely correlated with the activity index of ulcerative colitis (UC). Although the RDI score has been developed no study has validated a correlation between the RDI score and the activity index of UC. Therefore, this study aims to validate the RDI score prospectively. METHODS: A total of 34 patients with UC in whom colonoscopy was scheduled between May 2019 and October 2021 at our hospital were enrolled prospectively. MES, UCEIS, RDI scores, and Nancy index were evaluated in a blinded fashion. We evaluated the correlation between RDI and WLI scores using still images with histology. RESULTS: We analyzed 191 sites of colorectum. RDI score showed the positive correlation with UCEIS (r = 0.74 P < 0.0001) and MES (r = 0.78 P < 0.0001). RDI score also showed the positive correlation with Nancy index (r = 0.63 P < 0.0001). RDI score was more strongly correlated with Nancy index than UCEIS (r = 0.51) and MES (r = 0.48). CONCLUSIONS: When comparing still images of RDI and WLI scores, we showed RDI had a higher correlation to histology than WLI. CLINICAL TRIAL ID: The University Hospital Medical Information Network (UMIN000041750).

The role of endoscopy in the management of gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is a common disease that may cause a huge economic burden. Endoscopy is performed not only to rule out other organic diseases but also to diagnose reflux esophagitis or Barrett's esophagus. Non-erosive GERD (non-erosive reflux disease [NERD]) is called endoscopy-negative GERD; however, GERD-related findings could be obtained through histological assessment, image-enhanced endoscopy, and new endoscopic modalities in patients with NERD. Moreover, endoscopy is useful to stratify the risk for the development of GERD. In addition, endoscopic treatments have been developed. These techniques could significantly improve patients' quality of life as well as symptoms.

Endoscopic tissue shielding with polyglycolic acid sheet, fibrin glue, and endoclip for perforation during balloon dilation for esophageal stricture after endoscopic submucosal dissection.

Esophageal endoscopic submucosal dissection can cause esophageal strictures. Endoscopic balloon dilation is the standard treatment for esophageal strictures, but has complications, including perforation, and sometimes requires surgery. We report a case of perforation during endoscopic balloon dilation for esophageal stricture secondary to esophageal submucosal dissection that was successfully treated conservatively. A 66-year-old man with superficial carcinoma in the upper thoracic esophagus underwent circumferential endoscopic submucosal dissection with local steroid injections. Endoscopic balloon dilation was performed weekly for esophageal stricture. However, during the sixth procedure, an attempt to increase the size of the balloon to 13.5 mm resulted in perforation. The patient was treated conservatively using polyglycolic acid sheet with fibrin glue at the perforation site, which was fixed using an endoclip. However, the esophageal stricture persisted after the perforation was closed and Endoscopic balloon dilation was carefully repeated twice weekly up to a maximum of 17 mm, and the endoscope was able to pass through, and associated symptoms improved. This report indicates that endoscopic tissue shielding using polyglycolic acid sheet with fibrin glue and endoclip to correct perforation, followed by additional endoscopic balloon dilation, is an alternative to surgery.

The feasibility of a fully synthetic and self-assembled peptide solution as submucosal injection material: a preliminary animal study.

BACKGROUND AND AIM: An injection solution is required to create a submucosal cushion (SMC) for safe endoscopic resection procedures. The aim of this preliminary animal study was to clarify the safety and efficacy of a novel fully synthetic and self-assembled peptide (FSSP) solution as a submucosal injection material (SMIM). METHOD: To compare the submucosal-lifting properties, 0.3% FSSP, Eleview®, sodium hyaluronate acid solution (SHA) and normal saline (NS) were randomly injected using an injection needle into the submucosa of exposed stomach and colon in five living dogs in a blind fashion. The mean height, and volume of SMCs were measured using a digital caliper immediately and 10, 20, 30, and 40 min after injecting each solution. All resected specimens were examined histopathologically. RESULTS: In both the colon and stomach, ANOVA for repeated measures showed the significant interaction between time and solution for the time-dependent change in the height. In the colon, FSSP created significantly higher SMC than NS 20 min after injection (p = .0015) and Eleview® and NS 40 min after injection (p = .0009 and p = .0002). Furthermore, FSSP and SHA tended to maintain height and volume when compared to the other two solutions. In the stomach, FSSP and SHA tended to maintain height and volume when compared to the other two solutions. There were no significant differences between the histopathological finding and the injecting solutions used. CONCLUSION: FSSP seems to be useful as a SMIM for endoscopic resection especially in the colon. Further studies are needed prior to clinical use of FSSP.

Depletion of radio-resistant regulatory T cells enhances antitumor immunity during recovery from lymphopenia.

Cytotoxic lymphodepletion therapies augment antitumor immune responses. The generation and therapeutic efficacy of antitumor effector T cells (T(E)s) are enhanced during recovery from lymphopenia. Although the effects of lymphodepletion on naive T cells (T(N)s) and T(E)s have been studied extensively, the influence of lymphodepletion on suppressor cells remains poorly understood. In this study, we demonstrate a significant increase of CD4(+)CD25(+)Foxp3(+) regulatory T cells (Tregs) in sublethally irradiated lymphopenic mice. These radio-resistant Tregs inhibited the induction of T(E)s in tumor-draining lymph-nodes (TDLNs) during recovery from lymphopenia. The transfer of T(N)s into lymphopenic tumor-bearing mice resulted in some antitumor effects; however, Treg depletion after whole-body irradiation and reconstitution strongly inhibited tumor progression. Further analyses revealed that tumor-specific T cells were primed from the transferred T(N)s, whereas the Tregs originated from irradiated recipient cells. As in irradiated lymphopenic mice, a high percentage of Tregs was observed in cyclophosphamide-treated lymphopenic mice. The inhibition of Tregs in cyclophosphamide-treated mice significantly reduced tumor growth. These results indicate that the Tregs that survive cytotoxic therapies suppress antitumor immunity during recovery from lymphopenia and suggest that approaches to deplete radio and chemo-resistant Tregs can enhance cancer immunotherapies.

Surgical outcomes of epiretinal membrane removal after successful pars plana vitrectomy for retinal diseases.

PURPOSE: To evaluate visual outcomes after a removal of an epiretinal membrane (ERM) secondary to rhegmatogenous retinal detachment (RRD), proliferative vitreoretinopathy (PVR), or proliferative diabetic retinopathy (PDR). METHODS: The medical charts of 51 consecutive patients who underwent PPV to remove an ERM were reviewed in an institutional setting. The preoperative best-corrected visual acuity (BCVA) was evaluated to determine if it was a possible predictor of the postoperative BCVA. The visual outcomes in the RRD, PVR, and PDR groups were compared. Follow-up periods ranged from 13 to 90 months (mean, 40.9 months). RESULTS: After the ERM was removed, the postoperative BCVA improved significantly by 0.471 logarithm of the minimum angle of resolution units for all groups (t=8.99; P<0.001). The postoperative BCVA improved by two or more lines in 43 eyes (84.3%). Patient age and the preoperative BCVA significantly correlated with the visual improvement (P=0.0082 and P=0.035, respectively). CONCLUSION: The BCVA improves after removal of an ERM following PPV for eyes with RRD, PVR, or PDR. Patient age and preoperative BCVA correlated with the visual improvement after the ERM removal.

Crystallin distribution in Bruch's membrane-choroid complex from AMD and age-matched donor eyes.

Crystallins were consistently found in a recent proteomic analysis of drusen from age-related macular degeneration (AMD) donor eyes. Here we compare the distribution of several crystallins in drusen, Bruch's membrane and choroid from AMD and non-AMD age-matched control eyes. Immunohistochemistry and Western blots of tissue samples were performed using antibodies to alphaA- and alphaB-crystallins. Bruch's membrane, drusen and the subjacent choroidal connective tissue from AMD tissues showed greater immunoreactivity for alphaA- and alphaB-crystallins than were observed in normal age-matched control tissues. Western blots also demonstrated more intense alphaA- and alphaB-crystallin signals from AMD tissues than were present in age-matched controls. These data indicate that alphaA- and alphaB-crystallins accumulate in Bruch's membrane and choroidal connective tissues to a greater degree in AMD than in normal aging. These findings suggest that the accumulation of these small heat shock proteins at this critical interface below the RPE reflects a disease-related stress response manifested during the progression of AMD.

Wide-angle viewing lens for vitrectomy.

PURPOSE: To report a new wide-angle viewing contact lens for vitrectomy. DESIGN: New surgical instrument. METHODS: The new wide-angle viewing lens is made of glass and polymethyl methacrylate without a plastic rim. The diameter is reduced to 16.2 mm. In addition to a smaller diameter than the currently available lens, the new lens is partially cut to reduce the lens diameter. RESULTS: A smaller diameter makes it possible to eliminate contact between surgical instruments and the wide-angle lens. Instruments can be inserted through sclerotomies without removing the wide-angle lens. The optical properties are otherwise identical to the standard wide-angle lens. CONCLUSION: The new wide-angle viewing lens may be easier to use in vitreous surgery.

Sub-retinal hemorrhage during internal limiting membrane peeling for a macular hole.

PURPOSE: To report the occurrence of sub-retinal hemorrhage during peeling of the internal limiting membrane (ILM). CASE REPORTS: In case 1, a three-port pars plana vitrectomy was performed on a 57-year-old woman with a macular hole. Following the staining of the ILM with indocyanine green, the ILM was peeled with forceps, and a sub-retinal and vitreous hemorrhage resulted from a vein during the peeling. The bleeding was stopped by elevating the intraocular pressure. The final visual acuity was 20/30. In case 2, similar procedures were performed on a 68-year-old woman with a macular hole. A sub-retinal hemorrhage occurred while peeling the ILM. The pre-operative visual acuity was 20/300, and final visual acuity was 20/200. CONCLUSIONS: Surgeons should be aware that sub-retinal and vitreous hemorrhage can be a complication of ILM peeling.