Orbital Mass With Features of Both Kimura Disease and Immunoglobulin G4-Related Disease.

Kimura disease has been known as a chronic inflammatory disease of unknown etiology, since the first report in 1937 and characterized by an increased eosinophil fraction in peripheral blood, increased serum immunoglobulin E (IgE) levels, and lymphoid granuloma with eosinophilic infiltration on histopathological examination. The authors present a 30-year-old man who visited their clinic with a 3-month history of protrusion and conjunctival injection of the right eye. Surgical mass resection was performed, and initial histopathology revealed Kimura disease. Additional immunohistochemical examination revealed IgG4-related disease in another hospital, which showed more than 80 IgG4-positive plasma cells per high-power field and an IgG4+/IgG+ ratio more than 40%. There are histopathological similarities, and several reports have suggested a relationship between Kimura disease and IgG4-related disease. Thus, it is difficult to classify them as completely different diseases. Kimura disease and IgG4 can be considered a part of a clinical spectrum of abnormal immune reactions.

Effect of Focal Laser Photocoagulation on the Ganglion Cell Complex Thickness in Acute Central Serous Chorioretinopathy.

This study investigated the changes in the ganglion cell complex (GCC) of patients with acute central serous chorioretinopathy (CSC) following focal laser photocoagulation (FLP) and sought to determine its correlation with visual acuity (VA). Our retrospective study was conducted on 30 patients diagnosed with acute CSC between January 2015 and April 2022, who underwent FLP within 3 months of symptom onset. The study assessed GCC changes by measuring the thickness of its inner retinal layers-retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) using optical coherence tomography (OCT). GCC thickness was compared between the affected and unaffected eyes and a healthy control group. VA was also assessed at baseline and at 1, 3, and 6 months post-treatment. VA showed significant improvement from 0.20 ± 0.14 at baseline to 0.10 ± 0.12 logMAR at 6 months post-treatment (p = 0.003). There was no significant change in GCC thickness over the 6-month period. No significant differences in GCC thickness were observed when comparing CSC eyes with fellow eyes or with normal controls at any time point. Final VA was significantly related only to baseline VA, with no correlation found with other factors, including RNFL, GCL, and IPL thickness. In summary, for patients with acute CSC undergoing FLP, our findings indicate that there is no significant change in GCC thickness detectable by OCT before and after the resolution of subretinal fluid (SRF), despite improvements in VA post-laser treatment. This suggests that any potential impact of FLP on GCC thickness may be minimal and not discernible with the current measurement methods, such as OCT, emphasizing that VA improvements may be primarily associated with alterations in the outer retina rather than the inner retina. Further studies with extended follow-up durations are warranted to evaluate any potential long-term changes in GCC.

Novel technique to appose flaps using the BioGlue in the external dacryocystorhinostomy.

PURPOSE: To introduce the sutureless technique to appose flaps using the BioGlue composed of bovine serum albumin (45%) and glutaraldehyde (10%) in the external dacryocystorhinostomy (DCR). METHODS: The clinical chart was reviewed, retrospectively. The authors studied 31 case series of 30 patients who underwent the external DCR using the BioGlue in the step of apposing flaps. Instead of the suture technique, BioGlue was applied to appose flaps. Other steps were performed in the similar fashion to the conventional external DCR. And also, authors studied 31 case series of 30 patients who underwent the external DCR with conventional suture technique. RESULTS: Mean follow-up period is 12.5 months in study group and 12.6 months in control group. During mean follow up, 3 cases of membrane formation were observed, and patency of the anastomosis was kept well established in 28 cases (90%) in both groups. CONCLUSIONS: Sutureless apposition of flaps using the BioGlue can be an alternative method for the conventional suture technique in the external DCR. Also, it is easy and safe procedure to perform.

Aflaquinolones A-G: secondary metabolites from marine and fungicolous isolates of Aspergillus spp.

Seven new compounds (aflaquinolones A-G; 1-7) containing dihydroquinolin-2-one and terpenoid units have been isolated from two different fungal sources. Two of these metabolites (1 and 2) were obtained from a Hawaiian fungicolous isolate of Aspergillus sp. (section Flavipedes; MYC-2048 = NRRL 58570), while the others were obtained from a marine Aspergillus isolate (SF-5044) collected in Korea. The structures of these compounds were determined mainly by analysis of NMR and MS data. Relative and absolute configurations were assigned on the basis of NOESY data and (1)H NMR J-values, comparison of calculated and experimental ECD spectra, and analysis of a Mosher's ester derivative of 2. Several known compounds, including alantrypinone, aspochalasins I and J, methyl 3,4,5-trimethoxy-2((2-((3-pyridinylcarbonyl)amino)benzoyl)amino)benzoate, and trans-dehydrocurvularin were also encountered in the extract of the Hawaiian isolate.

Asperlin from the marine-derived fungus Aspergillus sp. SF-5044 exerts anti-inflammatory effects through heme oxygenase-1 expression in murine macrophages.

Asperlin is a fungal metabolite isolated from Aspergillus sp. SF-5044. In the present study, we isolated asperlin from the marine-derived fungus Aspergillus sp. SF-5044 and demonstrated that it inhibited inducible nitric oxide synthase (iNOS) expression, reduced iNOS-derived NO, suppressed cyclooxygenase (COX)-2 expression, and reduced COX-derived prostaglandin (PG) E2 production in lipopolysaccharide (LPS)-stimulated RAW264.7 and murine peritoneal macrophages. Similarly, asperlin reduced the production of tumor necrosis factor (TNF)-α and interleukin (IL)-1ß. In addition, asperlin inhibited the phosphorylation and degradation of IκB-α, as well as the nuclear translocation of p65 caused by the stimulation of LPS in RAW264.7 macrophages. Furthermore, asperlin induced heme oxygenase (HO)-1 expression through nuclear translocation of nuclear factor E2-related factor 2 and increased HO activity in RAW264.7 macrophages. The effects of asperlin on the LPS-induced expression of iNOS and COX-2 and production of NO, PGE2, TNF-α, and IL-1ß were partially reversed by a HO-1 inhibitor, tin protoporphyrin. These findings suggest that asperlin-induced HO-1 expression plays a role in the anti-inflammatory effects of asperlin in macrophages.

Protuboxepins A and B and protubonines A and B from the marine-derived fungus Aspergillus sp. SF-5044.

Two new oxepin-containing (1 and 2) and two diketopiperazine-type alkaloids (3 and 4) have been isolated from an EtOAc extract of the marine-derived fungus Aspergillus sp. SF-5044. The structures of these metabolites were determined through analysis of NMR and MS data, along with Marfey's method. Compound 1 showed weak growth inhibitory activity against a small panel of cell lines.

Clinical characteristics of Demodex-associated recurrent hordeola: an observational, comparative study.

Our study evaluated the association between Demodex infestation and recurrent hordeola and examined the clinical features associated with these eyelid lesions. This was an observational, comparative study. We reviewed 250 patients and divided them into the recurrent hordeolum (n = 153) and control (n = 97) groups. Demodex infestation was detected by epilating eyelashes around the lesion/s and viewing them under a light microscope. Patient medical records and photographs were retrospectively analyzed to identify the clinical characteristics of Demodex-associated recurrent hordeola. Demodex was detected in 91 (59.5%) and 17 (17.5%) patients in the recurrent hordeolum and control groups (p < 0.001), respectively. In the recurrent hordeolum group, Demodex mites were found in 74 (68.5%) and 17 (37.8%) of the adult and pediatric patients (p < 0.001), respectively. Among patients with recurrent hordeola, patients in their 20s were most likely to have concomitant Demodex infestation. Patients with Demodex infestations were also more likely to develop recurrent lesions within a shorter period of time from the primary incision and curettage. The most common presentation of Demodex-associated recurrent lesions was external hordeola (67%) (p = 0.002). Demodex infestation may cause recurrent hordeola in adults and children. These mites may play a greater role in the development of lesions in adult patients. The strongest association between Demodex infestation and recurrent lesions was seen in patients in their 20s. Our results suggest that if the hordeola recur within a short period of time with the clinical characteristics of external location of eyelid, multiple numbers of lesions, or anterior blepharitis, eyelash epilation should be performed to identify the presence of Demodex mites.

Evaluation of Retromode Imaging for Use in Hydroxychloroquine Retinopathy.

PURPOSE: To report on the application of retromode imaging using infrared lasers to eyes with hydroxychloroquine (HCQ) retinopathy, and to compare retromode images with those acquired via conventional objective screening imaging modalities-optical coherence tomography (OCT) and fundus autofluorescence (FAF). DESIGN: Diagnostic validity assessment. METHODS: Setting: Institutional. PATIENT POPULATION: Sixty-two eyes of 31 patients with systemic lupus erythematosus or rheumatoid arthritis who were treated with HCQ and developed HCQ retinopathy (patient group), 270 eyes of 135 patients with the same diseases who were treated with HCQ but exhibit no retinopathy (HCQ-taking control group), and 162 eyes of 81 normal controls (normal control group). OBSERVATION PROCEDURES: Diagnosis of HCQ retinopathy was performed with screening tests recommended by the American Academy of Ophthalmology, including OCT, FAF, and visual field examination. Retromode imaging, using confocal scanning laser ophthalmoscopy, was performed for the patient group and both control groups. The findings on retromode imaging were correlated with outer retinal changes on OCT B-scan images, then compared with the FAF findings. The sensitivity and specificity of retromode imaging were calculated. MAIN OUTCOME MEASURES: Findings of retromode imaging and sensitivity/specificity of the imaging. RESULTS: All patients with HCQ retinopathy showed a parafoveal or pericentral ring-shaped or round area of decreased reflectance with prominent deep choroidal vessels, resulting in 100% sensitivity for the detection of retinopathy. Specificity of the imaging was 73.0% and 76.4% in the HCQ-taking control group and both control groups, respectively. Compared to FAF, retromode imaging enabled the detection of photoreceptor defects with greater sensitivity, particularly in eyes with early retinopathy. However, FAF provided additional information on the status of the retinal pigment epithelium, which could not be discriminated from photoreceptor defects in retromode imaging. CONCLUSIONS: Retromode imaging may be useful for detecting HCQ retinopathy. However, its excellent sensitivity but limited specificity is suggestive of a supplementary role in screening HCQ retinopathy, particularly for early detection.

Lateral tarsoligamentous sling: A successful treatment for involutional entropion in Asians as a modified lateral tarsal strip.

OBJECTIVE: To compare the effectiveness of the Quickert suture (Q-suture) with that of the lateral tarsoligamentous sling in treating lower eyelid involutional entropion in Asians. METHOD: We reviewed the charts of all patients who underwent repair of an involutional lower eyelid entropion in Hangil Eye Hospital between September 2011 and March 2016. A single surgeon (S. C. Kim) performed the procedure in every case. Patients underwent either Q-suturing or lateral tarsoligamentous sling. We analyzed the results using Mann-Whitney and Chi-square tests, as well as Kaplan-Meier survival analysis. A p-value of <0.05 was considered to indicate significance. RESULTS: A total of 50 patients (61 eyes) were included in the study. Of the 50 patients, 24 (30 eyelids) received Q-suture and 26 patients (31 eyelids) underwent lateral tarsoligamentous sling. In all patients who underwent lateral tarsoligamentous sling, the entropion was successfully corrected and did not recur. Furthermore, none of the patients experienced any significant postoperative complications. In contrast, entropion recurred in 16 (36.67%) of the patients who underwent Q-suture (mean of 10.88 ± 9.02 months after surgery). The recurrence rate was not significantly correlated with age (p = 0.093); it was higher in men than in women, although this was not a significant difference (46.67% vs 26.6.7%; p = 0.175 by Chi-squared test). Kaplan-Meier survival analysis showed that the recurrence rate after Q-suture differed significantly from that after lateral tarsoligamentous sling (36.67% vs 0%, respectively; p = 0.007). CONCLUSION: This study suggests that lateral tarsoligamentous sling is an effective surgical method for correcting lower eyelid involutional entropion; the technique is not associated with recurrence or significant complications in Asians.

Unique features of bovine lymphocytes exposed to a staphylococcal enterotoxin.

We previously demonstrated that stimulation of bovine peripheral blood mononuclear cells (PBMCs) with staphylococcal enterotoxin C (SEC), led to an inversion of the CD4(+):CD8(+)T cell ratio and generation of an atypical CD8(+)T cell subpopulation expressing CD26. In the present study, we examined T cell apoptosis and proliferation profiles of PBMC subpopulations in cultures stimulated with SEC. Unlike when stimulated with concanavalin A, nucleic acid synthesis in bovine PBMC cultures stimulated with SEC was low during the first four days but increased greatly on day 5. In contrast, nucleic acid synthesis in human PBMC cultures stimulated with SEC increased continuously. To investigate the mechanism of delayed bovine T cell proliferation, various cell phenotypes were monitored. The inversion of the bovine CD4(+):CD8(+)T cell ratio in PBMC cultures stimulated by SEC was associated with higher proliferation and lower apoptosis of CD8(+)T cells compared to CD4(+)T cells. The mRNA levels for interleukin (IL)-4 and IL-13 were sustained over 4 days but IL-12 mRNA levels dropped to background on day 2. These data suggest that SEC induces a prolonged Th-2- biased microenvironment, and together with the inversion of the bovine CD4(+):CD8(+)T cell ratios in bovine PBMC cultures with SEC, may in part explain the inability of the mammary immune system to establish an effective response to Staphylococcus aureus infections.

Immunosuppression by T regulatory cells in cows infected with Staphylococcal superantigen.

Our recent study has provided that the in vitro SEC-induced proliferation of bovine T cells is preceded by a period of a non-proliferative immunoregulation of T cells that may be associated with cytokine production regulated by type 1 or type 2 T cells. Inversion of CD4(+):CD8(+) T cell ratio and induction of CD8(+) T cells with immunoregulatory activity could increase the probability of intracellular survival of Staphylococcus aureus (S. aureus). The increase of activated CD8(+)(ACT2(+) BoCD8(+)) T cells in cows with mastitis caused by S. aureus may be associated with immune-regulatory function in the bovine mammary gland. The difference and similarity between bovine activated CD8(+) T cells (CD8(+)CD26(+)) and well-established human CD4(+)CD25(+) T regulatory (Tr) cells may help to reveal their unique immune regulatory system in the host infected with S. aureus.

Effect of laser in situ keratomileusis on retinal nerve fiber layer thickness measurements by scanning laser polarimetry.

PURPOSE: To determine the effect of laser in situ keratomileusis (LASIK) on retinal nerve fiber layer measurements by scanning laser polarimetry in a large clinical trial. SETTING: Asan Medical Center, University of Ulsan, Department of Ophthalmology, Seoul, Korea. METHODS: Scanning laser polarimetry measurements were performed in 59 eyes of 59 consecutive patients who had LASIK. The mean retardation values of the whole measurement ellipse and of the superior, inferior, temporal, and nasal sectors of the ellipse before and after LASIK were compared statistically. RESULTS: The mean spherical equivalent refractive error was -6.10 diopters (D) +/- 2.34 (SD) (range -1.19 to -15.50 D) preoperatively and -0.31 +/- 0.52 D (range +0.68 to -2.13 D) postoperatively. The mean ablation depth was 94.0 +/- 30.49 microm (range 28.0 to 161.1 microm). The mean postoperative retardation values of all the sectors and of the superior, temporal, inferior, and nasal sectors showed reduced nerve fiber layer thickness (P =.000, P =.000, P =.011, P =.000, and P=.002, respectively). CONCLUSION: Laser in situ keratomileusis affected nerve fiber layer thickness measurements by scanning laser polarimetry. The change in nerve fiber layer thickness was probably due to modification of the corneal architecture. This effect of keratorefractive surgery should be considered when using scanning laser polarimetry as a diagnostic and follow-up tool for glaucoma.

Lacrimal gland duct stones: misdiagnosed as chalazion in 3 cases.

OBJECTIVE: To report 3 cases of lacrimal gland duct stones misdiagnosed as chalazion. DESIGN: Retrospective case series. PARTICIPANTS: Three patients with lacrimal gland duct stones misdiagnosed as chalazion at a local clinic between 2010 and 2012. METHODS: A thorough review of clinical, imaging, and histopathologic manifestations. RESULTS: Clinical manifestations of lacrimal gland duct stones included conjunctival injection, lid swelling, tenderness, and ocular discharge, which are similar to chalazion symptoms. Computed tomography revealed a relatively well-defined, high-density mass near the lacrimal gland. Histopathologic examination of excised material revealed calcified amorphous stones. CONCLUSIONS: Intractable chalazion-like lesions at the lateral canthal area near the lacrimal gland should be carefully examined; imaging studies are required to confirm the presence of lacrimal gland duct stones, which require surgical removal.

Delayed spontaneous bleeding in the blind eye of a type a hemophilic patient.

A 40-year-old man was complaining of severe left ocular pain and headache for the past 2 months. His left eye was traumatized and rendered blind about 20 years ago. He had no other medical problems and his preoperative laboratory tests were nonspecific. Evisceration of the left eye was performed for pain control and cosmetic improvement. However, postoperative progressive and prolonged eyelid swelling, bruising, and wound bleeding recurred. This patient was diagnosed with moderate factor VIII deficiency with a coagulation time within the normal range.

Enhanced carboxymethylcellulase production by a newly isolated marine bacterium, Cellulophaga lytica LBH-14, using rice bran.

The aim of this work was to establish the optimal conditions for production of carboxymethylcellulase (CMCase) by a newly isolated marine bacterium using response surface methodology (RSM). A microorganism producing CMCase, isolated from seawater, was identified as Cellulophaga lytica based 16S rDNA sequencing and the neighborjoining method. The optimal conditions of rice bran, ammonium chloride, and initial pH of the medium for cell growth were 100.0 g/l, 5.00 g/l, and 7.0, respectively, whereas those for production of CMCase were 79.9 g/l, 8.52 g/l, and 6.1. The optimal concentrations of K2HPO4, NaCl, MgSO4·7H2O, and (NH4)2SO4 for cell growth were 6.25, 0.62, 0.28, and 0.42 g/l, respectively, whereas those for production of CMCase were 3.72, 0.54, 0.70, and 0.34 g/l. The optimal temperature for cell growth and the CMCase production by C. lytica LBH-14 were 35 degrees C and 25 degrees C, respectively. The maximal production of CMCase under optimized condition for 3 days was 110.8 U/ml, which was 5.3 times higher than that before optimization. In this study, rice bran and ammonium chloride were developed as carbon and nitrogen sources for the production of CMCase by C. lytica LBH-14. The time for production of CMCase by a newly isolated marine bacterium with submerged fermentations reduced to 3 days, which resulted in enhanced productivity of CMCase and a decrease in its production cost.

Long-term staphylococcal enterotoxin C1 exposure induces soluble factor-mediated immunosuppression by bovine CD4+ and CD8+ T cells.

Regulatory T cells (T(regs)) help control the development and maintenance of protective immunity and can lead to aberrant immune responses to some pathogens. Several lines of evidence suggest that T(regs) are induced by exposure to superantigens (SAgs) in vitro or in vivo. In this study, bovine peripheral blood mononuclear cells (PBMC) were exposed in vitro to a relatively low dose (5 ng/ml) of staphylococcal enterotoxin C1 (SEC1) for up to 10 days. Upon stimulation, CD4+ and CD8+ T cells initially proliferated at similar rates. Subsequently, from days 6 through 10, most CD4+ and CD8+ T cells proliferated regardless of Vbeta specificity, but the proliferation of CD8+ T cells occurred more vigorously. The transcription of CD25 and CD152 genes increased, whereas that of interleukin-2 (IL-2) decreased. gammadelta T cells appeared to be unresponsive. An increase in the transcription of IL-10 and transforming growth factor beta (TGF-beta) genes in SEC1-stimulated cultures was attributed to the CD4+ CD25+ T-cell subpopulation. The expression of Foxp3 mRNA also increased and was accompanied by the upregulation of CD152 and the downregulation of IL-2 transcription, suggesting that cells in this subpopulation are T(regs). Functionally, SEC1-stimulated CD4+ T cells suppressed the proliferation of naive PBMC in response to heat-killed-fixed Staphylococcus aureus. The suppression was partially mediated by IL-10 and TGF-beta, another characteristic of certain types of T(regs.) The CD8+ T-cell population also suppressed naive PBMC through another mechanism not mediated by IL-10 or TGF-beta. These results provide further insight into the potential mechanisms by which SAgs could contribute to evasion of the immune response, affecting the outcome of infection or colonization.

Molecular characterization of bovine CD26 upregulated by a staphylococcal superantigen.

In this report, we describe the cloning, sequencing, and expression of the bovine orthologue of CD26 (BoCD26). Several monoclonal antibodies specific for a molecule, activation molecule 3 (ACT3), aberrantly expressed on superantigen-stimulated bovine CD8(+) lymphocytes, reacted with recombinant BoCD26 expressed in COS-7 and CHO cells. We also showed that human CD8(+) T cells stimulated by a superantigen expressed CD26 at high levels. These results demonstrate that ACT3 is identical to BoCD26 and suggest that CD26 upregulation on CD8(+) T cells is a general phenomenon of superantigens and not limited to their effects on bovine cells.