Ameliorating effect of 2'-Fucosyllactose and 6'-Sialyllactose on lipopolysaccharide-induced intestinal inflammation

Human milk oligosaccharides (HMO) affect gut microbiota during neonatal development, particularly with respect to the immune system. Bovine milk-based infant formulas have low oligosaccharide contents. Thus, efforts to fortify infant formulas with HMO are being undertaken. Two major HMO, 2'-fucosyllactose (2'-FL) and 6'-sialyllactose (6'-SL), exert anti-inflammatory effects; however, the associations between anti-inflammatory effects induced by 2'-FL and 6'-SL co-treatment and gut microbiota composition and metabolite modulation remain unclear. Therefore, in this study, we evaluated the effects of a mixture of these HMO. To determine the optimal HMO ratio for anti-inflammatory effects and elucidate its mode of action, LPS-induced inflammatory HT-29 epithelial cells and intestinal inflamed suckling mice were treated with various mixtures of 2'-FL and 6'-SL. 2'-FL:6'-SL ratio of 5:1 was identified as the most effective pre-treatment HMO mixture in vitro; thus, this ratio was selected and used for low, middle, and high-dose treatments for subsequent in vivo studies. In vivo, high-dose HMO treatment restored LPS-induced inflammation symptoms, such as body weight loss, colon length reduction, histological structural damage, and intestinal gene expression related to inflammatory responses. High-dose HMO was the only treatment that modulated the major phyla Bacteroidetes and Firmicutes and the genera Ihubacter, Mageeibacillus, and Saccharofermentans. These changes in microbial composition were correlated with intestinal inflammation-related gene expression and short-chain fatty acid production. To our knowledge, our study is the first to report the effects of Ihubacter, Mageeibacillus, and Saccharofermentans on short chain fatty acid levels, which can subsequently affect inflammatory cytokine and tight junction protein levels. Conclusively, the HMO mixture exerted anti-inflammatory effects through changes in microbiota and metabolite production. These findings suggested that supplementation of infant formula with HMO may benefit formula-fed infants by forming unique microbiota contributing to neonatal development.

Superimposition Study to Determine the Angular Arterial Distribution and Its Clinical Application

BACKGROUND

The purpose of this study was to determine the distribution of the angular artery (AA) in the medial canthal area with the aim of defining an arterial course to prevent AA injury during facial surgery in this region.

METHODS

The authors dissected 36 hemifaces of 18 cadavers. The horizontal distance from the vertical level through the medial canthus to the AAs was measured. The AA course of each specimen was then recorded, and all of them were then superimposed to determine the AA course. The diameter and depth of the AA around the medial canthal area were also investigated using ultrasonography on living subjects.

RESULTS

The horizontal distances from the medial canthus level and 2 cm below the medial canthus were 9.0 ± 2.0 mm (mean ± SD) and 1.9 ± 2.4 mm, respectively. The superimposed image demonstrated that most of the AAs were present inside the vertical line through the medial canthus. Ultrasonography indicated that the AA was 2.3 ± 0.9 mm below the skin and 1.7 ± 0.3 mm in diameter.

CONCLUSIONS

The AA course was relatively constant along the nasojugal fold. The AAs were most often present between the middle of the medial canthus and the facial midline, but were very scarce in both the medial and lateral thirds. Knowledge of the detailed course of the AA may help surgeons to avoid arterial injury and decrease the risk of surgical morbidities around the nasal root and medial canthal area.

Proteogenomic Analysis of Human Uterine Cervical Cancer (UCC) Reveals Treatment-Resistant Subtypes of UCC

PURPOSE/OBJECTIVE(S)

Locally advanced uterine cervical cancer (UCC) is treated by radiotherapy with concurrent chemotherapy, but heterogenous treatment responses are frequently observed. To better optimize therapeutic options based on molecular signatures, we performed proteogenomic analysis of UCC.

MATERIALS/METHODS

UCC tissue and blood samples were collected from patients who underwent primary radiotherapy ± chemotherapy at the National Cancer Center (NCC) in Korea from July 2004 to March 2020. Most samples were obtained via biopsy. Genomic DNA for WES was isolated from frozen biopsy tumor tissues and peripheral blood buffy-coat of patients. Both global proteome and phosphoproteome were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Whole exome sequencing, RNA sequencing, global proteomics and phosphoproteomics were performed using 253, 337, and 147 cervical cancer samples, respectively. Patient-derived xenograft were established using intratongue implantation using 2 primary cell lines from sub3 and sub5, and flow cytometric analysis was performed.

RESULTS

Fourteen significantly mutated genes (SMG) were found in our study cohort which include 5 newly identified SMGs. Mutation-phosphorylation analysis revealed association with apoptosis and actin cytoskeleton pathway. Proteogenomic analysis defined 6 molecular subtypes of UCC. Of those, 3 subtypes (i.e., Sub3, Sub5 and Sub6) were associated with treatment-resistant phenotypes. The cell-type deconvolution analysis suggested activated stroma with activation of cancer-associated fibroblast in Sub 3, while Sub5 showed low levels of activated stroma and high levels of myeloid immune cells. FACS analysis of UCC mouse models established from these 2 radio-resistant primary cell lines showed high component of PDGFRA+CAF infiltration in Sub 3, and high level of PVR+CD45+ immune cells mainly composed of polymorphonuclear myeloid-derived suppressor cells (PMN-MDSC) in Sub5. For Sub6, genes and/or protein signatures represented mucin-related processes (e.g., mucin glycosylation/sugar metabolism), which are linked to metastasis-associated Tn antigen production.

CONCLUSION

The proteogenomic analysis thus suggests potential targets for radiotherapy-resistant subtypes of UCC; secretory factors from activated stroma and cancer-associated fibroblast (Sub3); RHOA signaling, PVR, and PMN-MDSCs (Sub5), and keratin/chondroitin sulfate proteoglycan and Tn antigen production (Sub6). Our study shows the importance of proteogenomic analysis in unveiling the subtype specific molecular pathways of UCC that are beyond reach by genomic data alone. The validity of our molecular pathway and cellular signatures linking these pathways should be further validated through detailed functional experiments and in larger UCC cohorts.

Topography of the frontal branch of the facial nerve and its clinical implication for temporal direct browplasty

Due to anatomic proximity to the surgical site, iatrogenic trauma to the frontal branch of the facial nerve (FbFN) with resultant brow paralysis is a recognized major complication of temporal direct browplasty. This study was aimed to elucidate the course of the FbFN in the area superolateral to the brow in order to facilitate safer temporal direct browplasty by preventing facial nerve injury. Forty-five hemifaces from 32 embalmed Korean cadavers were dissected. A horizontal line connecting the tragion to lateral canthus was established. Then, an oblique line passing through the lateral canthus and 45° to the horizontal line was used as reference line. The mean distance from the lateral canthus to the points where the FbFN cross the reference line was measured. The angle between the FbFN and reference line at the crossing points were also recorded. After crossing the zygomatic arch, FbFN continues in an anteriorly inclining curve across the temporal region, passing near the lateral end of the brow as it heads toward frontalis muscles. During the course, the FbFN laying in the innominate fascial layer was divided into 3 branches. The anterior and posterior branch of FbFN crossed the reference line superiorly and laterally at 3 and 4 cm from the lateral canthus, respectively. In conclusion, the oculofacial surgeon must bring the dissection plane of the forehead tissue more superficially around the 3 cm superolaterally to the lateral canthus in the direction of 45° from the horizontal line in order to avoid nerve injury.

Reliability of synthetic diffusion-weighted imaging with a high b-value for paediatric abdominal MRI

AIM

To evaluate the reliability of synthetic diffusion-weighted imaging (DWI) using a high b-value in comparison to conventional DWI for paediatric abdominal MRI.

MATERIALS AND METHODS

Paediatric patients (<19 years old) who underwent liver or pancreatobiliary MRI with DWI using 10 b-values (b = 0, 25, 50, 75, 100, 200, 400, 600, 800, 1,500 s/mm2) from March to October 2021 were included in this retrospective study. Using the software, synthetic DWI using b = 1,500 s/mm2 was generated automatically by selecting the b-value required as output. Conventional and synthetic DWI values for b = 1,500 s/mm2 were measured at the liver, spleen, paraspinal muscle, and mass lesions, if present, and apparent diffusion coefficient (ADC) values were calculated using the mono-exponential model. Intraclass correlation coefficients (ICCs) were calculated to assess the reliability of conventional and synthetic DWI and ADC values with b = 1,500 s/mm2.

RESULTS

Thirty paediatric patients (M:F = 22:8, mean 10.8 ± 3.1 years old) were included and four had tumours on abdominal MRI. ICC values were 0.906-0.995 between conventional and synthetic DWI and ADC with b = 1,500 s/mm2 in the liver, spleen and muscle. For mass lesions, ICC values were 0.997-0.999 for both synthetic DWI and ADC images.

CONCLUSIONS

Synthetic DWI and ADC values obtained using a high b-value showed excellent agreement with conventional DWI for the liver, spleen, muscle, and mass in paediatric MRI.

Recent advances in understanding DNA methylation of prostate cancer

Epigenetic modifications, such as DNA methylation, is widely studied in cancer. DNA methylation patterns have been shown to distinguish between benign and malignant tumors in various cancers, including prostate cancer. It may also contribute to oncogenesis, as it is frequently associated with downregulation of tumor suppressor genes. Aberrant patterns of DNA methylation, in particular the CpG island hypermethylator phenotype (CIMP), have shown associative evidence with distinct clinical features and outcomes, such as aggressive subtypes, higher Gleason score, prostate-specific antigen (PSA), and overall tumor stage, overall worse prognosis, as well as reduced survival. In prostate cancer, hypermethylation of specific genes is significantly different between tumor and normal tissues. Methylation patterns could distinguish between aggressive subtypes of prostate cancer, including neuroendocrine prostate cancer (NEPC) and castration resistant prostate adenocarcinoma. Further, DNA methylation is detectable in cell-free DNA (cfDNA) and is reflective of clinical outcome, making it a potential biomarker for prostate cancer. This review summarizes recent advances in understanding DNA methylation alterations in cancers with the focus on prostate cancer. We discuss the advanced methodology used for evaluating DNA methylation changes and the molecular regulators behind these changes. We also explore the clinical potential of DNA methylation as prostate cancer biomarkers and its potential for developing targeted treatment of CIMP subtype of prostate cancer.

Anatomical relationship between the inferior temporal septum and the temporal branch of the facial nerve for clinical applications

BACKGROUND

The inferior temporal septum (ITS) is a fibrous adhesion between the superficial temporal fascia and the superficial layer of the deep temporal fascia (sDTF). This study identified detailed anatomical relationship between the ITS and the temporal branch of the facial nerve (TBFN) for facial nerve preservation during temple interventions.

METHODS

Among 33 Korean cadavers, 43 sides of TBFNs in temporal regions were dissected after identifying the ITS between the superficial temporal fascia and sDTF through blunt dissection. The topography of the ITS and TBFN were investigated with reference to several facial landmarks. Regional relationships with the ITS and TBFN within the temporal fascial layers were histologically defined from five specimens.

RESULTS

At the level of the inferior orbital margin by the tragion, the mean distances from the lateral canthus to the anterior and posterior branches of the TBFN were 5 and 6.2 cm, respectively. At the lateral canthus level, the mean distance from the lateral canthus to the posterior branch of the TBFN was similar to that to the ITS, at 5.5 cm. At the superior orbital margin level, the posterior branch of the TBFN ran cranial to the ITS adjacent to the frontotemporal region. The TBFN ran through the sub-superficial temporal fascia layer and the nerve fibers located cranially, and within the ITS meshwork in the upper temporal compartment.

CONCLUSIONS

The area of caution during superficial temporal fascia interventions related to the TBFN was clearly identified in the upper temporal compartment, which is known to lack important structures.

LEVELS OF EVIDENCE

Basic science study.

Quality of life in intermittent exotropia for Korean children and their parents

BACKGROUND

Patients with strabismus are more likely to have mental health problems, including high rates of depressive symptoms and social phobia. Intermittent exotropia (IXT) typically occurs in early childhood and is more common in Asian populations. We aim to assess the health-related quality of life (HRQOL) concerns in children with intermittent exotropia (IXT) using the Intermittent Exotropia Questionaire (IXTQ), and their associations with the clinical severity of IXT and the parents' HRQOL concerns.

METHODS

IXT, defined as both distance and near exodeviation ≥ 10 prism diopters were eligible for inclusion. The final IXTQ score is calculated using the mean score for all items, and ranges from 0 (worst HRQOL) to 100 (best HRQOL). The correlations of child IXTQ scores with their deviation angle and stereoacuity were measured, as were those with their parent's IXTQ scores.

RESULTS

One hundred twenty-two children with IXT (aged 5-17 years) and one parent for each child completed the child and parent IXTQ, respectively. The greatest HRQOL concern for each child with IXT and their parent was "Worry about eyes" (frequency 88%, score 35.0 ± 27.8). Lower child IXTQ scores were associated with a larger distance (r = 0.24, p = 0.007) and near deviation angle (r = 0.2, p = 0.026). "It bothers me because I have to wait for my eyes to clear up" and "Waiting for their eyes to clear up" were more common in children with a larger deviation angle (both p < 0.05). The parent IXTQ scores (52.1 ± 25.3) were lower than the child ones (79.7 ± 15.8) and showed a positive correlation with child IXTQ scores (r = 0.26, p = 0.004). Lower parent IXTQ scores were associated with poor distance stereoacuity (r = 0.23, p = 0.01).

CONCLUSION

The HRQOL of IXT children was positively related to that of their parents. A larger deviation angle and worse distance stereoacuity function may predict more-negative impacts on children and their parents, respectively.

Bioactive peptides for boosting stem cell culture platform: Methods and applications

Peptides, short protein fragments, can emulate the functions of their full-length native counterparts. Peptides are considered potent recombinant protein alternatives due to their specificity, high stability, low production cost, and ability to be easily tailored and immobilized. Stem cell proliferation and differentiation processes are orchestrated by an intricate interaction between numerous growth factors and proteins and their target receptors and ligands. Various growth factors, functional proteins, and cellular matrix-derived peptides efficiently enhance stem cell adhesion, proliferation, and directed differentiation. For that, peptides can be immobilized on a culture plate or conjugated to scaffolds, such as hydrogels or synthetic matrices. In this review, we assess the applications of a variety of peptides in stem cell adhesion, culture, organoid assembly, proliferation, and differentiation, describing the shortcomings of recombinant proteins and their full-length counterparts. Furthermore, we discuss the challenges of peptide applications in stem cell culture and materials design, as well as provide a brief outlook on future directions to advance peptide applications in boosting stem cell quality and scalability for clinical applications in tissue regeneration.

Inhibition of angiotensin converting enzyme increases PKCβI isoform expression via activation of substance P and bradykinin receptors in cultured astrocytes of mice

BACKGROUND

Angiotensin-converting enzyme inhibitor (ACEi) inhibits the catalysis of angiotensin I to angiotensin II and the degradation of substance P (SP) and bradykinin (BK). While the possible relationship between ACEi and SP in nociceptive mice was recently suggested, the effect of ACEi on signal transduction in astrocytes remains unclear.

OBJECTIVES

This study examined whether ACE inhibition with captopril or enalapril modulates the levels of SP and BK in primary cultured astrocytes and whether this change modulates PKC isoforms (PKCα, PKCβI, and PKCε) expression in cultured astrocytes.

METHODS

Immunocytochemistry and Western blot analysis were performed to examine the changes in the levels of SP and BK and the expression of the PKC isoforms in primary cultured astrocytes, respectively.

RESULTS

The treatment of captopril or enalapril increased the immunoreactivity of SP and BK significantly in glial fibrillary acidic protein-positive cultured astrocytes. These increases were suppressed by a pretreatment with an angiotensin-converting enzyme. In addition, treatment with captopril increased the expression of the PKCβI isoform in cultured astrocytes, while there were no changes in the expression of the PKCα and PKCε isoforms after the captopril treatment. The captopril-induced increased expression of the PKCβI isoform was inhibited by a pretreatment with the neurokinin-1 receptor antagonist, L-733,060, the BK B1 receptor antagonist, R 715, or the BK B2 receptor antagonist, HOE 140.

CONCLUSIONS

These results suggest that ACE inhibition with captopril or enalapril increases the levels of SP and BK in cultured astrocytes and that the activation of SP and BK receptors mediates the captopril-induced increase in the expression of the PKCβI isoform.

Risk of consecutive esotropia after surgery for intermittent exotropia according to passive duction force

PURPOSE

To determine the relationship between consecutive esotropia (ET) and passive duction force (PDF) in patients with intermittent exotropia (XT).

METHODS

The study enrolled 70 patients in whom PDF was measured under general anesthesia prior to XT surgery. The preferred eye for fixation (PE) and the nonpreferred eye for fixation (NPE) were determined using a cover-uncover test. The patients were subdivided into two groups according to the angle of deviation at 1 month postoperation: (1) consecutive ET (CET group), >10 prism diopters (PD) of ET; and (2) non-CET (NCET group), ≤10 ET or residual exodeviation. The relative PDF of the medial rectus muscle (MRM) was obtained by subtracting the ipsilateral PDF of the lateral rectus muscle (LRM) from the PDF of the MRM.

RESULTS

The PDFs for the LRM in the PE in the CET and NCET groups were 47.28 g and 58.59 g, respectively (p = 0.147), and 56.18 g and 46.59 g for the MRM (p = 0.11), and in the NPE were 59.84 g and 55.25 g, respectively, for the LRM (p = 0.993), and 49.12 g and 50.53 g, respectively, for the MRM (p = 0.81). However, in the PE, the PDF in the MRM was larger in the CET group than in the NCET group (p = 0.045), which was positively associated with the postoperatively overcorrected angle of deviation (p = 0.017).

CONCLUSIONS

An increased relative PDF in the MRM in the PE was a risk factor for consecutive ET after XT surgery. Quantitative evaluation of the PDF could be considered when planning strabismus surgery to achieve the desired surgical outcome.

The Orphan GPR50 Receptor Regulates the Aggressiveness of Breast Cancer Stem-like Cells via Targeting the NF-kB Signaling Pathway

The expression of GPR50 in CSLC and several breast cancer cell lines was assessed by RT-PCR and online platform (UALCAN, GEPIA, and R2 gene analysis). The role of GPR50 in driving CSLC, sphere formation, cell proliferation, and migration was performed using shGPR50 gene knockdown, and the role of GPR50-regulated signaling pathways was examined by Western blotting and Luciferase Assay. Herein, we confirmed that the expression of G protein-coupled receptor 50 (GPR50) in cancer stem-like cells (CSLC) is higher than that in other cancer cells. We examined that the knockdown of GPR50 in CSLC led to decreased cancer properties, such as sphere formation, cell proliferation, migration, and stemness. GPR50 silencing downregulates NF-kB signaling, which is involved in sphere formation and aggressiveness of CSLC. In addition, we demonstrated that GPR50 also regulates ADAM-17 activity by activating NOTCH signaling pathways through the AKT/SP1 axis in CSLC. Overall, we demonstrated a novel GPR50-mediated regulation of the NF-κB-Notch signaling pathway, which can provide insights into CSLC progression and prognosis, and NF-κB-NOTCH-based CSLC treatment strategies.

A cross-sectional study of ophthalmologic examination findings in 5385 Koreans presenting with intermittent exotropia

The Korean Intermittent Exotropia Multicenter Study (KIEMS) was a retrospective, cross-sectional and multicenter study for the investigation of intermittent exotropia involved 65 strabismus specialists from 53 institutions in Korea. Purpose of this study was to present ophthalmologic findings of intermittent exotropia from the KIEMS. Consecutive patients with intermittent exotropia of ≥ 8 prism diopters (PD) at distance or near fixation were included. Best-corrected visual acuity, cycloplegic refraction data, angles of deviation at several cardinal positions, ocular dominance, fusion control, oblique muscle function, and binocular sensory outcomes were collected. A total of 5385 participants (2793 females; age 8.2 years) were included. Non-dominant eye was more myopic than the dominant eye (- 0.60 vs. - 0.47 diopters, P < 0.001). Mean exodeviation angles were 23.5 PD at distance and 25.0 PD at near fixation. Basic type (86.2%) was the most, followed by convergence insufficiency (9.4%) and divergence excess (4.4%) types. Alternating ocular dominance and good fusion control were more common at near than at distance fixation. Good stereopsis at 40 cm was observed in 49.3% in Titmus stereo test (≤ 60 arcsec) and in 71.0% in Randot stereo test (≤ 63 arcsec). Intermittent exotropia was mostly diagnosed in childhood and patients with the condition showed relatively good binocular functions. This study may provide objective findings of intermittent exotropia in a most reliable way, given that the study included a large study population and investigated comprehensive ophthalmology examinations.

Treatment outcomes of modified argon laser photocoagulation for conjunctivochalasis

To determine the effectiveness of conjunctivoplasty using a modified argon laser photocoagulation method on patients with conjunctivochalasis (CCh). This study included 25 cases of symptomatic inferior CCh. After staining the surface of a redundant conjunctiva using a dark-purple marker, low-energy argon laser photocoagulation (500 μm spot size for 0.5 seconds at power 300 mW) was applied under topical anesthesia for a mean of 80 times. The patients were aged 67.6 ± 7.1 years (mean ± standard deviation). During a mean follow-up period of 7.8 months (range of 6-12 months), the CCh grades of 21 eyes (84%) decreased after laser conjunctivoplasty. Calculated reduction rates of grades 1, 2, and 3 were 90%, 75%, and 67%, respectively. Patient subjective symptoms were improved in 80% of cases. No postoperative complications such as conjunctival scarring or persistent ocular irritation were observed. Our modified argon laser photocoagulation method employs staining the conjunctival surface to increase the thermal laser energy absorbed by the target. This novel technique is simple and effective for treating mild-to-moderate-grade CCh in outpatient clinics.

Non-Arteritic Ischemic Optic Neuropathy Following COVID-19 Vaccination in Korea: A Case Series

BACKGROUND

To report the clinical manifestations of non-arteritic anterior ischemic optic neuropathy (NAION) cases after coronavirus disease 2019 (COVID-19) vaccination in Korea.

METHODS

This multicenter retrospective study included patients diagnosed with NAION within 42 days of COVID-19 vaccination. We collected data on vaccinations, demographic features, presence of vascular risk factors, ocular findings, and visual outcomes of patients with NAION.

RESULTS

The study included 16 eyes of 14 patients (6 men, 8 women) with a mean age of 63.5 ± 9.1 (range, 43-77) years. The most common underlying disease was hypertension, accounting for 28.6% of patients with NAION. Seven patients (50.0%) had no vascular risk factors for NAION. The mean time from vaccination to onset was 13.8 ± 14.2 (range, 1-41) days. All 16 eyes had disc swelling at initial presentation, and 3 of them (18.8%) had peripapillary intraretinal and/or subretinal fluid with severe disc swelling. Peripapillary hemorrhage was found in 50% of the patients, and one (6.3%) patient had peripapillary cotton-wool spots. In eight fellow eyes for which we were able to review the fundus photographs, the horizontal cup/disc ratio was less than 0.25 in four eyes (50.0%). The mean visual acuity was logMAR 0.6 ± 0.7 at the initial presentation and logMAR 0.7 ± 0.8 at the final visit.

CONCLUSION

Only 64% of patients with NAION after COVID-19 vaccination have known vascular and ocular risk factors relevant to ischemic optic neuropathy. This suggests that COVID-19 vaccination may increase the risk of NAION. However, overall clinical features and visual outcomes of the NAION patients after COVID-19 vaccination were similar to those of typical NAION.

MAO-B Inhibitor, KDS2010, Alleviates Spinal Nerve Ligation-induced Neuropathic Pain in Rats Through Competitively Blocking the BDNF/TrkB/NR2B Signaling

MAO-B inhibitors have been implicated to reverse neuropathic pain behaviors. Our previous study has demonstrated that KDS2010 (KDS), a newly developed reversible MAO-B inhibitor, could attenuate Paclitaxel (PTX)-induced tactile hypersensitivity in mice through suppressing reactive oxidant species (ROS)-decreased inhibitory GABA synaptic transmission in the spinal cord. In this study, we evaluated the analgesic effect of KDS under a new approach, in which KDS acts on dorsal horn sensory neurons to reduce excitatory transmission. Oral administration of KDS effectively enhanced mechanical thresholds in the spinal nerve ligation (SNL) induced neuropathic pain in rats. Moreover, we discovered that although treatment with KDS increased brain-derived neurotrophic factor (BDNF) levels, KDS inhibited Tropomyosin receptor kinase B (TrkB) receptor activation, suppressing increased p-NR2B-induced hyperexcitability in spinal dorsal horn sensory neurons after nerve injury. In addition, KDS showed its anti-inflammatory effects by reducing microgliosis and astrogliosis and the activation of MAPK and NF-ᴋB inflammatory pathways in these glial cells. The levels of ROS production in the spinal cords after the SNL procedure were also decreased with KDS treatment. Taken together, our results suggest that KDS may represent a promising therapeutic option for treating neuropathic pain. PERSPECTIVE: Our study provides evidence suggesting the mechanisms by which KDS, a novel MAO-B inhibitor, can be effective in pain relief. KDS, by targeting multiple mechanisms involved in BDNF/TrkB/NR2B-related excitatory transmission and neuroinflammation, may represent the next future of pain medicine.

NPFFR2 Contributes to the Malignancy of Hepatocellular Carcinoma Development by Activating RhoA/YAP Signaling

G protein-coupled receptors (GPCRs) are a diverse family of cell surface receptors implicated in various physiological functions, making them common targets for approved drugs. Many GPCRs are abnormally activated in cancers and have emerged as therapeutic targets for cancer. Neuropeptide FF receptor 2 (NPFFR2) is a GPCR that helps regulate pain and modulates the opioid system; however, its function remains unknown in cancers. Here, we found that NPFFR2 is significantly up-regulated in liver cancer and its expression is related to poor prognosis. Silencing of NPFFR2 reduced the malignancy of liver cancer cells by decreasing cell survival, invasion, and migration, while its overexpression increased invasion, migration, and anchorage-independent cell growth. Moreover, we found that the malignant function of NPFFR2 depends on RhoA and YAP signaling. Inhibition of Rho kinase activity completely restored the phenotypes induced by NPFFR2, and RhoA/F-Actin/YAP signaling was controlled by NPFFR2. These findings demonstrate that NPFFR2 may be a potential target for the treatment of hepatocellular carcinoma.

Modified argon laser therapy for benign tumor of the eyelid

Background

To report about the therapy of benign eyelid tumors with a modified argon laser technique as an alternative to surgery.

Methods

Nineteen benign tumors of the eyelid were included in this study. After staining the surface of the tumor with a violet marker, low-energy argon laser photoablation was performed. A mean number of 312 spots (spot size ranging from 150 to 500 μm) with a power of 200 to 400 mW, and a duration between 0.1 and 0.2 s were applied.

Results

The eyelid tumors were located mainly in the lower eyelid (58%). Dermal nevi and papilloma were the most frequently treated lesions. Over a mean follow-up period of 10.5 months (range 6–18 months), all eyelid tumors were successfully treated by a single session of laser therapy. All patients were satisfied with the laser therapy and the cosmetic result. No postoperative complications were observed. No relapses occurred during follow-up.

Conclusions

Our modified method of argon laser therapy utilizes the staining of the surface of the eyelid tumor to increase the amount of thermal laser energy absorbed by the target. This novel technique is simple and effective for treating benign eyelid tumors.

Lateral branches of the facial artery and its clinical implications

The facial artery is the main artery supplying blood to the face and is known to have facial branches of the inferior labial, superior labial, lateral nasal and angular arteries. These known major branches of facial artery run medially, however, there are sometimes branches of the facial artery heading laterally. The purpose of the present study was to investigate the lateral branches of the facial artery in face. We dissected facial branches of the facial artery in 74 cadaveric hemifaces. We investigated the presence of the lateral branches of the facial artery. Following parameters were investigated: lateral branch presence, the location of its origin, and the lateral branch diameter. Among the lateral branches, we evaluated the prevalence and diameter of the premasseteric branch. Lateral branches were observed in 48 of the 74 hemifaces (64.9%). The total number was 81 in the 48 hemifaces. The most common origin was between the inferior border of the mandible and inferior labial artery origin (42 of 81, 51.9%). The mean diameter of all lateral branches of the facial artery was 0.7 mm. Among the lateral branches, the premasseteric branches were present in 38 of 74 specimen (51.4%) and the mean diameter was 0.8 mm. The lateral branches of the facial artery may be registered in Terminologia Anatomica based on their prevalence. Accurate knowledge of the anatomy of the lateral branches of the facial artery is helpful for clinicians to avoid complications during facial procedures or maxillofacial surgeries.

Antiallodynic effects of KDS2010, a novel MAO-B inhibitor, via ROS-GABA inhibitory transmission in a paclitaxel-induced tactile hypersensitivity model

Monoamine oxidase (MAO) inhibitors have been investigated for the treatment of neuropathic pain. Here, we assessed the antiallodynic effects of a novel MAO-B inhibitor, KDS2010, on paclitaxel (PTX)-induced mechanical hypersensitivity. Oral administration of KDS2010 effectively relieved PTX-induced mechanical hypersensitivity in a dose-dependent manner. KDS2010 (25 mg/Kg) significantly prevented and suppressed PTX-induced pain responses with minimal effects on the body weight, motor activity, and working memory. KDS2010 significantly reduced reactive astrocytosis and reactive oxygen species (ROS) level in the L4–L6 spinal cord of PTX-treated mice. Furthermore, KDS2010 reversed the attenuation of GABAergic spontaneous inhibitory postsynaptic current (sIPSC) frequency in spinal dorsal horn neurons, although it failed to restore the reduced tonic GABA_A inhibition nor the increased GABA transporter 1 (GAT1) expression in PTX-treated mice. In addition, bath application of a reactive oxygen species (ROS) scavenger (PBN) restored the sIPSC frequency in PTX-treated mice but not in control and PTX + KDS2010-treated mice. These results indicated that the antiallodynic effect of KDS2010 is not due to a MAO-B-dependent GABA production. Finally, PBN alone also exerted a similar analgesic effect as KDS2010, but a co-treatment of PBN with KDS2010 showed no additive effect, suggesting that inhibition of MAO-B-dependent ROS production is responsible for the analgesic effect by KDS2010 on PTX-induced allodynia. Overall, KDS2010 attenuated PTX-induced pain behaviors by restoring the altered ROS level and GABAergic inhibitory signaling in the spinal cord, suggesting that KDS2010 is a promising therapeutic strategy for chemotherapy-induced peripheral neuropathy.

Topography of the orbital part of the lacrimal gland for treating epiphora using botulinum toxin injection

PURPOSE

To identify the location of the orbital part of the lacrimal gland using external landmarks to facilitate effective botulinum toxin A (BTX-A) injections for epiphora treatment.

METHODS

Dissections were performed on 45 hemifaces from 27 cadavers. The length, anterior protrusion, and thickness of the orbital part of the lacrimal gland were measured directly. The midpoint of the line running horizontal through the medial and lateral canthus was used as the horizontal reference point. Vertical lines perpendicular to the midpoint of the horizontal reference line were the vertical reference lines. The angles from the horizontal reference line to the lacrimal gland center and to the frontal tubercle were also measured.

RESULTS

The length and thickness of the lacrimal gland were 12.8 mm and 2.4 mm, respectively. The lacrimal gland had an anterior protrusion of 4.1 mm from the superolateral orbital margin. The superior and inferior margins of the lacrimal gland were located 35.7 degrees and 15.8 degrees from the two reference lines, respectively. The angle from the horizontal reference line to the lacrimal gland center was 35.1 degrees, which was similar to that to the frontal tubercle (34.4 degrees).

CONCLUSION

The orbital part of the lacrimal gland was more inferior in elderly subjects and the angle between the horizontal reference line and its center was 35.1 degrees, which was similar to the location of the frontal tubercle. The location of this tubercle can help clinicians to perform BTX-A injections into the lacrimal gland, thereby enhancing the effectiveness of epiphora treatment. This article is protected by copyright. All rights reserved.

High Therapeutic and Esthetic Properties of Extracellular Vesicles Produced from the Stem Cells and Their Spheroids Cultured from Ocular Surgery-Derived Waste Orbicularis Oculi Muscle Tissues

Extracellular vesicles (EVs) are paracrine factors that mediate stem cell therapeutics. We aimed at evaluating the possible therapeutic and esthetic applications of EVs prepared from the waste human facial tissue-derived orbicularis oculi muscle stem cells (OOM-SCs). OOM-SCs were isolated from the ocular tissues (from elders and youngsters) after upper eyelid blepharoplasty or epiblepharon surgeries. EVs were prepared from the OOM-SCs (OOM-SC-EVs) and their three-dimensional spheroids. OOM-SCs showed a spindle-like morphology with trilineage differentiation capacity, positive expression of CD105, CD 90, and CD73, and negative expression of CD45 and CD34, and their stem cell properties were compared with other adult mesenchymal stem cells. OOM-SC-EVs showed a high inhibitory effect on melanin synthesis in B16F10 cells by blocking tyrosinase activity. OOM-SC-EVs treatment led to a significant attenuation of senescence-associated changes, a decrease in reactive oxygen species generation, and an upregulation of antioxidant genes. We demonstrated the regeneration activity of OOM-SC-EVs in in vitro wound healing of normal human dermal fibroblasts and upregulation of anti-wrinkle-related genes and confirmed the therapeutic potential of OOM-SC-EVs in the healing of the in vivo wound model. Our study provides promising therapeutic and esthetic applications of OOM-SC-EVs, which can be obtained from the ocular surgery-derived waste human facial tissues.

Morphological changes after lower eyelid epiblepharon surgery in Asian children

Background

This study aimed to determine the morphological changes in Asian lower eyelid epiblepharon patients after surgery.

Methods

The medical records of 59 patients who underwent lower eyelid epiblepharon repair were reviewed retrospectively. Eighty-nine patients who underwent strabismus surgery were set as the control group. The photographs for each group were analyzed based on the following factors: inferior half area (IHA) of the eye, eyelash angular direction (EAD), angle between the eyelashes and the cornea, marginal reflex distance 1 (MRD₁) and marginal reflex distance 2 (MRD₂).

Results

After surgery, the medial EAD changed from 92.45° ± 20.21° (mean ± SD) to 79.43° ± 23.31°, while the central and lateral EADs were unchanged. IHA increased from 36.33 ± 9.78 mm³ to 43.06 ± 10.57 mm³, and MRD₁ increased from 1.92 ± 0.99 mm to 2.50 ± 0.93 mm, whereas MRD₂ did not change. The mean angle between the eyelashes and the cornea increased from 39.64° to 72.19° immediately postoperatively, but had reduced to 58.75° 3 months later, followed by no further significant change at the 6-month and 9-month postoperative follow-ups.

Conclusions

There is morphological changes of the eyelid after lower eyelid epiblepharon surgery, with increases in the IHA and MRD_1. In addition, contact between the eyelashes and the cornea occurred mainly in the medial portion of the eyelid the position, which everted and stabilized over 3 months. Thus, follow-up observations are required for at least 3 months to properly evaluate the surgical outcome.

Bioluminescence Imaging of Matrix Metalloproteinases-2 and -9 Activities in Ethanol-injured Cornea of Mice

BACKGROUND/AIM

This study aimed to investigate the usefulness of in vivo bioluminescence imaging (BLI) to examine the role of matrix metalloproteinases (MMP)-2 and MMP-9 activation in the development and healing of ethanol-induced damage in the cornea of mice.

MATERIALS AND METHODS

Mouse corneal injury was induced by topical treatment with 20% ethanol. BLI was obtained from the ocular region of mice intravenously injected with an active-MMP-2/9 probe. In vivo results were validated in primary corneal epithelial cells.

RESULTS

BLI indicated that treatment of the eye with 20% ethanol elevated MMP-2/9 activity, which was inhibited by the application of eye drops (hyaluronic acid and serum). Treatment of corneal epithelial cells with 20% ethanol-increased the activities of MMP-2 and MMP-9, which were also inhibited by eye drops.

CONCLUSION

BLI can be applied in vivo in mice with corneal injury to examine the activity of MMPs and clarify the efficacy of eye drops.

Analysis of the Conjunctival Microbiome in Patients with Atopic Keratoconjunctivitis and Healthy Individuals

Background

Atopic dermatitis (AD) has been clarified that imbalance of bacterial and fungal communities in the skin and gut play key roles in immunologic dysfunction. Atopic keratoconjunctivitis (AKC), one of severe ophthalmic manifestation of AD, could be related with dysbiosis as same as AD.

Objective

In this case-control study, the roles of conjunctival microbial communities in AKC were evaluated by a comparative analysis with healthy controls (HCs).

Methods

16S rRNA sequencing was used to construct libraries of compositional information for a total of 30 volunteers including 20 patients with AKC and 10 HCs.

Results

In the results, variation in the conjunctival taxonomic composition was higher in patients with AKC than in the HC group. In an analysis of relative abundance at the genus level, some taxa significantly differed between groups, including Ralstonia, Staphylococcus, Pseudomonas, Proteus, Haemophilus, and Bifidobacterium (p<0.05). Beta diversity was significantly higher in patients with AKC than in HCs (PERMANOVA, p=0.004).

Conclusion

The results indicated that the diversity and composition of the microbiome differs between patients with AKC and HCs.

Measuring ocular torsion and its variations using different nonmydriatic fundus photographic methods

Purpose

To compare the variations in ocular torsion measurements made using different fundus photographic methods.

Methods

We enrolled subjects with three conditions: (1) patients with intermittent exotropia (IXT) (n = 44), (2) patients with unilateral superior oblique palsy (SOP) (n = 10), and (3) normal subjects as controls (n = 85). Ocular torsion was measured by disc-center–fovea angle (DFA) using three different imaging modalities: (1) conventional fundus photography (CFP) with a 45° field of view (FV), (2) wide-field fundus photography (WFP) with a 200° FV, and (3) optical coherence tomography (OCT) with a 55° FV.

Results

In the IXT group, the DFAs in the right and left eyes were 5.70±3.35° and 6.37±3.36°, respectively, for CFP, 8.39±5.24° and 8.61±3.67° for WFP, and 5.73±3.61° for 6.16±3.50° for OCT. In the SOP group, the DFAs in paretic and nonparetic eyes were 12.19±1.69° and 6.71±1.09°, respectively, for CFP, 14.29±2.36° and 8.23±3.31° for WFP, and 12.12±1.73° and 6.91±1.12° for OCT. In the control group, the DFAs in the right and left eyes were 5.39±2.65° and 5.71±3.16°, respectively, for CFP, 8.77±5.56° and 8.90±6.24° for WFP, and 5.27±2.67° and 5.72±3.20° for OCT. There was no difference between the results from CFP and OCT among the three groups. However, the torsional angle was larger when measured using WFP than the other two photographic methods (CFP and OCT) in all three groups (all p<0.05).

Conclusion

The ocular torsion measurement varies with the fundus photographic method used to measure it. Clinicians should be careful to avoid overestimating ocular extorsion when it is evaluated using WFP.

Novel compact device for clinically measuring extraocular muscle (EOM) tension

Accurate knowledge of extraocular muscle (EOM) tension is important for the diagnosis of and surgical planning for strabismus, such as choosing which eye to operate or determining the amount of muscle displacement. Previous evaluations of passive EOM tension have relied extensively on the experience and skill of ophthalmic surgeons, who generally perform such evaluations by gripping the eyeball and then pushing and pulling it. This methodology, named the forced duction test, has the significant limitation that the tension is felt subjectively via the forceps, with the results therefore not being quantifiable. Previous quantitative analyses have utilized several different types of equipment with implanted force transducers or have involved connecting the muscle tendon to a strain gauge. However, the associated equipment setups and recording systems are highly complex and rarely used outside research settings. This situation prompted the present study to develop a novel compact, quantifiable and clinically applicable device for measuring the passive tension in human EOMs for use in clinical practice. The device employs locking forceps and a tilting sensor to rule out effects of the gripping force and to compensate for changes in the force due to tilting, which improves the measurement accuracy. The performance of the device was investigated in 60 eyes of 30 consecutive anaesthetized patients immediately prior to ophthalmic surgery. The results showed that the measured EOM tension in each rectus muscles agreed with previous findings: 48.3 ± 14.5 g (0.82 ± 0.28 g/deg, mean ± SD) for the lateral rectus, 45.6 ± 13.2 g (0.82 ± 0.23 g/deg) for the medial rectus, 48.6 ± 14.7 g (0.71 ± 0.21 g/deg) for the inferior rectus and 53.4 ± 13.7 g (0.77 ± 0.25 g/deg) for the superior rectus.

New instrument for quantitative measurements of passive duction forces and its clinical implications

PURPOSE

Evaluating the passive duction force of the extraocular muscles is important for the diagnosis of and surgical planning for strabismus. This is especially relevant in patients with an observable limitation of duction movement. The purpose of this study was to validate passive duction forces in healthy subjects using a novel instrument.

METHODS

An instrument for making continuous quantitative measurements of passive duction forces was designed. Tension was measured as the eyeball was rotated horizontally or vertically from the resting position under general anesthesia 10 mm (50°) away from the direction of force to be tested (opposite side).

RESULTS

Seventy eyes of 35 subjects were enrolled in this study (age range of 4-80 years and mean age of 36.3 years). The passive duction force was measured at 49.0 ± 15.3 g (mean ± standard deviation) for medial rotation, 44.8 ± 13.2 g for lateral rotation, 50.5 ± 14.8 g for superior rotation, and 53.5 ± 13.8 g for inferior rotation. The passive duction forces were similar for all gaze positions, but it was larger for inferior rotation than for lateral rotation (P = 0.009). The passive duction force was significantly larger for vertical rotation (51.9 ± 14.4 g) than for horizontal rotation (46.9 ± 14.4 g) (P = 0.006). The passive duction force did not differ significantly with sex (P = 0.355), side (P = 0.087), or age (P = 0.872).

CONCLUSIONS

These measurements of passive duction forces in a healthy population provide valuable information for diagnosing specific strabismic problems and could be useful for increasing the precision of strabismus surgery. Graphical abstract.

Intramuscular Nerves of the Inferior Rectus Muscle: Distribution and Characteristics

PURPOSE

Knowledge of the distribution of intramuscular nerves of the extraocular muscles is crucial for understanding their function. The purpose of this study was to elucidate the intramuscular distribution of the oculomotor nerve within the inferior rectus muscle (IRM) using Sihler's staining.

METHOD

Ninety-three IRM from 50 formalin-embalmed cadavers were investigated. The IRM including its branches of the oculomotor nerve was finely dissected from its origin to the point where it inserted into the sclera. The intramuscular nerve course was investigated after performing Sihler's whole-mount nerve staining technique that stains the nerves while rendering other soft tissues either translucent or transparent.

RESULTS

The oculomotor nerve enters the IRM around the distal one-fourth of the muscle and then divides into multiple smaller branches. The intramuscular nerve course finishes around the distal three-fifth of the IRM in gross observations. The types of branching patterns of the IRM could be divided into two subcategories based on whether or not topographic segregation was present: (1) no significant compartmental segregation (55.9% of cases) and (2) a several-zone pattern with possible segregation (44.1% of cases). Possible compartmentalization was less clear for the IRM, which contained overlapping mixed branches between different trunks.

CONCLUSION

Sihler's staining is a useful technique for visualizing the gross nerve distribution of the IRM. The new information about the nerve distribution and morphological features provided by this study will improve the understanding of the biomechanics of the IRM, and could be useful for strabismus surgery.

1068 Using Sleep to Avoid Inpatient PTSD Treatment

Introduction

During inpatient psychiatric treatment, mattress actigraphy can be used to track nightly sleep in a zero-burden fashion to examine its relationships with other markers of treatment progress. We report here on associations between actigraphic sleep parameters and treatment markers in combat veteran engaged in inpatient treatment for posttraumatic stress disorder. We focus first on sleep scheduling, the best-validated outcome available from actigraphic data.

Methods

140 combat veteran inpatients provided between 5 and 164 nights of mattress actigraphy over the course of their inpatient psychiatric hospitalizations. The sample was characterized by multiple traumas and a high prevalence of comorbid mood and substance use disorders. Approximately one-half of the sample had undergone objective screening for OSA and for this subsample AHI &lt; 20 was used as an inclusion criterion. Unscreened participants were required to have a BMI &lt; 35. Inclusion also required mean actigraphic SE &gt; 60%. The PTSD Checklist and Combat Exposure Scale were obtained at admission, from which a trauma load index was created by adding z-scores obtained from standardizing these scales.

Results

In a multiple regression analysis, after accounting for secular change in LOS, higher trauma loads (p &lt; 0.001) and earlier bed times (p = 0.001) were both significantly associated with shorter lengths of stay (LOS; F(3,137) = 10.4, p &lt; 0.001; adj. R-squared = 0.17). Trauma load and bed time did not interact (p = 0.7).

Conclusion

Avoidance is a criterial symptom of PTSD. Early bed times and early exits from treatment may both reflect the impact of syndromal avoidance on treatment, limiting its dosage and benefit. If so, prescribing later bed times may have utility in inpatient treatment programming.

Support

Award W81XWH-15-2-0005 from the Department of Defense, Military Operational Medicine Research Program and the Department of Veterans Affairs. This material is the result of work supported with resources and the use of facilities at the Palo Alto VA Medical Center.

Location of the infraorbital foramen with reference to soft tissue landmarks for regional nerve blocks during midface surgery

PURPOSE

An infraorbital nerve (ION) block is widely used to accomplish regional anesthesia during surgical procedures involving the midface region. This study aimed to elucidate the exact location of the infraorbital foramen (IOF) in relation to clinically useful soft-tissue landmarks for achieving an effective ION block.

METHODS

Forty-three hemifaces from 23 embalmed Korean cadavers were dissected. The lateral canthus, peak of Cupid's bow, medial limbus, and midline were used as reference points. The distances from the IOF to the midline and the lateral canthus were measured.

RESULTS

The IOF was located approximately 25 mm below the lateral canthus and 27 mm lateral to the midline. In all cases, the IOF was situated within 9.0 mm of the crossing point of the oblique line connecting the lateral canthus to the peak of Cupid's bow and the vertical line through the medial limbus.

CONCLUSION

Considering the spread of an anesthetic agent, injecting it into the crossing point of the oblique line through the lateral canthus to the peak of Cupid's bow and the vertical line through the medial limbus would successfully block the ION in most patients.

Case report of periorbital metastasis from rectal cancer

INTRODUCTION

Periorbital metastasis of colorectal cancer is rare. Therefore, herein, we report a patient with rectal cancer who presented with periorbital metastasis without any systemic metastasis.

PATIENT CONCERNS

The patient was a 57-year-old man who had a painless nodule on his left eyelid.

DIAGNOSIS

The patient presented with loose and frequent stools and was diagnosed with rectal adenocarcinoma via colonoscopic biopsy at the local clinic. Curative resection (low anterior resection with temporary ileostomy formation) was performed 4 weeks after completing chemoradiotherapy. The final TNM stage was yp stage T2N0M0. Eight months after the diagnosis of rectal cancer, a protruding lesion was noticed on the patient's left eyelid. Histologic evaluation of the nodule revealed metastatic adenocarcinoma of rectal cancer.

INTERVENTIONS

The patient received neoadjuvant chemoradiotherapy and curative resection for rectal cancer. After excision of the periorbital nodule, he received 5 cycles of chemotherapy.

OUTCOMES

The patient underwent regular follow-up because he was not able to endure chemotherapy; no recurrence has been observed 21 months after the diagnosis of rectal cancer. Histologic examination revealed metastatic adenocarcinoma of rectal cancer on the patient's left eyelid. However, consecutive imaging studies revealed no other metastatic lesions. Finally, the patient was diagnosed with a solitary periorbital metastasis of rectal cancer.

CONCLUSION

This case report helps in understanding the course of progression from rectal cancer to periorbital metastasis.

Position and size of the sphenoid door jamb in the lateral orbital wall for the orbital decompression

The aim of this study was to identify the three-dimensional topography of the sphenoid door jamb (SDJ) in the lateral orbital wall and to propose navigational guidelines for safe deep lateral decompression using surgical landmarks. The 120 orbits and SDJs of 60 subjects were three-dimensionally reconstructed using Mimics software. The mean volumes of the orbit and SDJ were 24.3 mm³ and 2.0 mm³, respectively. The mean distances from the lateral orbital margin (LOM) to the anterior and posterior margins of the SDJ were 13.2 and 36.3 mm, respectively. The mean distances from the superior orbital fissure to the LOM and to the posterior margin of the SDJ were 40.2 mm and 4.6 mm, respectively. The mean distances from the inferior orbital fissure (IOF) to the anterior and posterior margins of the SDJ were 3.8 mm and 20.5 mm, respectively. In the superior approach of the orbit, it can be predicted that the area up to 3 cm posterior from the LOM is safe, while 1 cm posterior from the safe zone could be a dangerous zone. In the inferior approach of the orbit, the safe area will be about 1 cm posterior from the anterior tip of the IOF, and the area up to 1 cm posterior from the safe zone should be approached with extreme care.

Intramuscular Nerve Distribution of the Inferior Oblique Muscle

Purpose: The intramuscular nerve distribution in the extraocular muscles is important for understanding their function. This study aimed to determine the intramuscular nerve distribution of the oculomotor nerve within the inferior oblique muscle (IO) using Sihler's staining.Method: Seventy-two IOs from 50 formalin-embalmed cadavers were investigated. The IO including its branch of the oculomotor nerve was finely dissected from its origin to its insertion point into the sclera. The total length of the muscle and its width were measured. The intramuscular nerve course was investigated after performing Sihler's staining, which is a whole-mount nerve-staining technique that stains the nerves while rendering other soft tissues either translucent or transparent.Results: The total length of the muscle and muscle width were 30.0 ± 2.8 mm (mean±standard deviation), 8.8 ± 1.2 mm, respectively. The oculomotor nerve enters the IO around the middle of the muscle and then divides into multiple smaller branches without distinct subdivisions. The intramuscular nerve distribution within the IO has a root-like arborization and supplies the entire width of the muscle. The Sihler's stained intramuscular nerve course (covering a length of 7.6 ± 1.2 mm) finishes around the distal one-third of the IO in gross observations.Conclusion: Sihler's staining is a useful technique for visualizing the gross nerve distribution of the IO. This new information about the nerve distribution and morphological features will improve the understanding of the biomechanics of the IO.

Mini-incisional entropion repair for correcting involutional entropion: Full description and surgical outcome

The aim of the study was to report the surgical outcome of mini-incisional correction method to treat involutional entropion.This is a retrospective interventional case series of 46 eyelids in 31 patients with involutional entropion and significant ocular irritation. In this technique, after turning the lower eyelid inside out, threads are introduced into it through the conjunctiva close to the inferior fornix. The lower lid retractor and tarsus are then connected using threads. These threads are applied at 3 locations of the lower eyelid and tightening them results in the eyelid being everted and the correction of entropion. Surgical success was defined as no contact between the eyelashes and the globe during forced closure of the eyelids. Surgical failure was defined as persistence of the eyelashes remaining in contact with the globe or cosmetic dissatisfaction.During the mean follow-up period of 22.1 months (range, 12-34 months), 43 of the eyelids (93.5%) were successfully corrected. Two patients (3 eyelids) experienced recurrence: 1 had involutional entropion combined with a cicatricial component, and the other had blepharospasm and apraxia of eyelid opening related to Parkinsonism. No postoperative complications such as overcorrection, suture-knot exposure, or ocular irritation were observed.Our mini-incisional entropion repair is based on reinforcement of the lower eyelid retractors using transconjunctival buried sutures. This technique is a quick, simple, and predictive for involutional entropion repair, and has a high success rate.

Cluh plays a pivotal role during adipogenesis by regulating the activity of mitochondria

Cluh is a cytosolic protein that is known to specifically bind the mRNAs of nuclear-encoded mitochondrial proteins and play critical roles in mitochondrial biogenesis. Here, we report the role of Cluh in adipogenesis. Our study shows that mRNA expression of Cluh is stimulated during adipogenesis, and that cAMP/Creb signalling increases its transcription. Cluh depletion impaired proper adipocyte differentiation, with reductions seen in lipid droplets and adipogenic marker gene expression. Interestingly, the inductions of the brown adipocyte-specific genes, Ucp1, Cidea and Cox7a1, are severely blocked by Cluh depletion during brown adipogenesis. Mitochondrial respiration and the stability of mRNAs encoding mitochondrial proteins are reduced by Cluh depletion during brown adipogenesis. These results suggest that Cluh, which is induced during adipogenesis, promotes the post-transcriptional regulation of mitochondrial proteins and supports differentiation.

Intramuscular Nerve Distribution in the Medial Rectus Muscle and Its Clinical Implications

PURPOSE

The intramuscular nerve distribution in the extraocular muscles may be crucial for understanding their physiological and pathological responses. This study aimed to determine the oculomotor nerve distribution in the medial rectus muscle (MR) using Sihler's staining.

METHOD

Thirty-seven MRs from 23 cadavers were investigated. The MR including the oculomotor nerve was finely dissected from its origin to its insertion point into the sclera. The total length of the muscle-belly, tendon length and maximum width of the muscle were measured. We evaluated the pattern of distribution and the length of the intramuscular nerve distribution by gross observation after performing Sihler's staining, which is a method for visualizing the distribution of nerve fibers without alteration of the nerve.

RESULTS

The total length of the muscle-belly, tendon length, and muscle width were 37.6 ± 4.6 mm, 4.4 ± 1.9 mm, and 10 ± 1.8 mm, respectively. The oculomotor nerve enters the MR at a mean of two-fifths along the muscle (24 ± 2.0 mm posterior to the insertion point) and then typically divides into a few branches (mean of 2.1). The intramuscular nerve distribution showed a Y-shaped ramification, forming the terminal nerve plexus, and its course typically finished at around 17 ± 1.5 mm posterior to the muscle insertion point by gross observation. The nerve plexus in the upper part generally coursed more distally than the lower part.

CONCLUSION

This new information regarding the nerve distribution pattern of MR will be helpful for understanding MR function and the diverse pathophysiology of strabismus.

Consistency of the lateral canthus as an anatomic landmark and its clinical implications

Successful oculofacial procedures require the availability of a reliable surgical and anatomic landmark. This study aimed to determine the usefulness of the lateral canthus as a surface landmark. Seventy-seven from 42 Korean cadavers were dissected. The horizontal distance from the lateral canthus to the lateral orbital margin and the vertical distances from the zygomaticofrontal suture and the inferior orbital margin to the lateral canthus were measured. The mean horizontal distance from the lateral canthus to the lateral orbital margin was 7.8 mm. Although the horizontal position of the lateral canthus appears to alter with age, the variation was only 2-3 mm. The mean vertical distances from the zygomaticofrontal suture and inferior orbital margin to the lateral canthus were 8.1 and 17.2 mm. The vertical position of the lateral canthus did not vary with age, being located inferiorly within a fingernail width from the zygomaticofrontal suture. The lateral canthus, which is easily accessible and supported by muscular and fibrous lateral orbital attachments, exhibits small anatomic variations. Thus, the lateral canthus could act as a reliable surface landmark for identifying the location of underlying structures and describing a lesion on the face. Clin. Anat. 32:630-634, 2019. © 2019 Wiley Periodicals, Inc.

Effects of ostium granulomas and intralesional steroid injections on the surgical outcome in endoscopic dacryocystorhinostomy

PURPOSE

To determine the effect of granuloma formation in the ostium and intralesional steroid injections (ISIs) on the surgical outcome after endoscopic dacryocystorhinostomy (DCR) in patients with primary acquired nasolacrimal duct obstruction (PANDO).

METHODS

One hundred and eighty-three cases involving 142 patients were enrolled. The ostium granulomas were classified according to their location relative to the internal common opening (superior, anterior, and posterior positions) and to the vicinity of the ostium (inner, edge, and extra types). If an ostium granuloma was observed during the follow-up and its size increased, ISIs were performed using 0.3 ml of 40 mg/ml triamcinolone acetonide. The surgical outcomes were compared between cases with and without ostium granulomas and also between each granuloma position and type.

RESULTS

Ostium granulomas occurred in 71 (38.8%) of the 183 cases, and an ISI was applied in 65 cases with a mean of 2.1 injections. All of the granulomas regressed successfully after ISIs, with the success rate not differing between the cases with (85.9%) and without (83.9%) granuloma. There was no association between granuloma location and surgical outcome. However, the functional outcome was worse (60%) for inner granulomas (which are located within the ostial base) than for extra (87.8%) and edge (98%) granulomas.

CONCLUSIONS

ISIs can be easily applied by a surgeon to help regress an ostium granuloma and improve the ostial patency after DCR. Inner ostium granulomas are associated with a worse functional outcome, and the initiation of an early corrective intervention such as an ISI should be considered.

Lacrimal gland pleomorphic adenoma and malignant epithelial tumours: clinical and imaging differences

AIMS

To investigate the clinical and imaging features of primary and recurrent lacrimal gland pleomorphic adenoma (LGPA), as well as lacrimal gland malignant epithelial tumours (LGMET).

METHODS

Retrospective comparative case series from September 2000 to September 2016 in a single tertiary institution. Medical records of cases with histopathologically proven primary LGPA (PLGPA), recurrent LGPA (RLGPA) and LGMET were reviewed.

RESULTS

Sixty-four patients with LGPA (55 primary and nine recurrent) and 36 patients with LGMET underwent surgical excision in the study period. There was no significant difference in terms of age, gender or laterality. In terms of symptom duration, that of LGMET (7.1 months) was significantly shorter than PLGPA (23.9 months), which in turn was significantly shorter than RLGPA (127.1 months). Proptosis was the most common presenting symptom among all three groups. On CT, LGMET and RLGPA were significantly more likely to have ill-defined margins (p<0.001) and be heterogeneous (p<0.001) than PLGPA. RLGPAs (56%) were significantly more likely to have calcification than LGMET (34%), which in turn was more likely to have calcification than PLGPA (13%); LGMET (40%) and RLGPA (33%) were significantly more likely to have bony invasion than PLGPA (2.2%). On MRI, LGMETs (55%) were significantly more likely to have a tail or wedge sign indicating infiltration into the posterior orbit than PLGPA (0%) or RLGPA (0%).

CONCLUSION

Our study adds important information regarding differentiating clinical and radiological features between malignant and benign epithelial lacrimal gland tumours that would aid in their management.

Comparison of the Analgesic Effect of an Ice Cube versus 4% Lidocaine Cream in Intradermal Antibiotic Skin Testing

Objective

This study was performed to compare the analgesic effect of an ice cube with that of 4% lidocaine cream (L.M.X.4®) for intradermal skin testing.

Methods

In this prospective randomised study, healthy adult volunteers were divided into ice cube and lidocaine analgesic pretreatment groups. Randomisation was performed using a randomisation table in blocks of four. Intradermal skin testing was performed after applying ice in the ice cube group and 5 mg of lidocaine cream in the lidocaine group. After the intradermal skin test, the pain intensity was investigated using the visual analog scale (VAS) on questionnaires. We calculated that a minimum of 24 subjects were required for statistical power of 80% at a significance level of 0.05 (two-sided). The groups' VAS scores were compared using the Mann-Whitney U-test.

Results

The study population consisted of 35 volunteers: 17 in the ice cube group and 18 in the lidocaine group. There were no differences in demographic characteristics between the two groups. The median VAS score was 20 (interquartile range: 0-35) in the ice cube group and 70 (interquartile range: 50-80) in the lidocaine group (p<0.001).

Conclusions

The results suggested the utility of an ice cube as analgesic pretreatment for intradermal skin testing in the emergency department.

Modulation of hippocampal neuronal activity by So-ochim-tang-gamibang in mice subjected to chronic restraint stress

Background

So-ochim-tang-gamibang (SOCG) is a decoction formula which has been used to improve mental activity in traditional Korean medicine. The present study was performed to evaluate whether the treatment of SOCG was involved in activating hippocampal neurons in mice which were subjected to chronic restraint stress (CRS).

Methods

Mice were subjected to CRS for 2 weeks to induce depressive-like behaviors. SOCG was orally administered for the same period. mRNA expression in the hippocampus was analyzed by RT-PCR. Levels of serotonin receptor 5-HT1AR in the hippocampus were determined by western blotting and by immunofluorescence staining in coronal brain sections. Cultured neurons were prepared from the dorsal root ganglia (DRG) in mice to examine the effects of CRS and SOCG treatment on neurite outgrowth. Depressive-like behaviors of experimental animals were measured by open field test (OFT) and forced swimming test (FST).

Results

mRNA levels of serotonin 1A and 1B receptors (5-HT1AR and 5-HT1BR) were decreased in the hippocampus of CRS animals and increased by SOCG treatment. Signals of 5-HT1AR protein in CA3 pyramidal cells were decreased by CRS but elevated back to levels in control animals after SOCG treatment. Phospho-Erk1/2 protein in CA3 cells showed similar pattern of changes as in 5-HT1AR, suggesting coordinated regulation after SOCG treatment in CRS animals. Axonal growth-associated protein GAP-43 levels were also decreased by CRS and then increased by SOCG treatment. In vivo administration of SOCG improved neurite outgrowth of primary DRG neurons from CRS animals and also increased 5-HT1AR protein signals. Behavioral tests of open field and forced swimming showed that immobility time periods were significantly decreased by SOCG treatment.

Conclusions

Our data suggest that SOCG treatment may increase synaptic responsiveness to serotonergic neuronal inputs by upregulating 5-HT1AR in the hippocampal neurons.

Topography of the supraorbital nerve with reference to the lacrimal caruncle: danger zone for direct browplasty

PURPOSE

To elucidate the course of the supraorbital nerve (SON) with reference to the lacrimal caruncle in order to facilitate safer direct browplasty by preventing nerve injury.

METHODS

Thirty-four hemifaces from 18 embalmed Korean cadavers were dissected. A vertical line through the upmost point of the lacrimal caruncle and a horizontal line through the supraorbital margin were used as the horizontal and vertical reference positions, respectively. The course of the SON in the frontal view and the point at which it pierced the overlaying musculature were examined.

RESULTS

The SON divides into a superficial branch and a deep branch just after exiting the orbit. In all cases, the deep SON remains in the subgaleal plane deep to the corrugator and frontalis muscles. The superficial SON travels under the corrugator muscle dividing into three branches (medial, intermediate and lateral) and pierced the frontalis muscle at 19-32 mm above the supraorbital margin. However, in 11 cases (32%) the medial branch of the superficial SON pierced the lower portion of the corrugator muscle at 3.6 mm above the supraorbital margin and ran in front of the muscle along with the vertical line through the upmost point of the lacrimal caruncle.

CONCLUSIONS

One-third of the medial branch of the superficial SON without corrugator muscle protection is vulnerable to iatrogenic injury during direct browplasty. Therefore, the oculofacial surgeon must bring the dissection plane of the forehead tissue more superficially around the vertical line through the upmost point of the lacrimal caruncle in order to avoid nerve injury.

Factors associated with rhinostomy shape after endoscopic dacryocystorhinostomy

OBJECTIVE

To determine the factors associated with rhinostomy shape after endoscopic dacryocystorhinostomy (DCR) in patients with primary acquired nasolacrimal duct obstruction.

DESIGN

Retrospective comparative study.

SETTING

University hospital.

PARTICIPANTS

One hundred and two cases in 70 patients were included in the study.

MAIN OUTCOME MEASURE

All cases were classified into three groups according to the healed appearance of the rhinostomy: flat, ladle and ice scoop type. The flat shape was characterised by an opening with a flat surrounding and no clear border between the lacrimal sac and the nasal mucosa. The ladle shape had a depressed base without markings of a lacrimal sac. The ice scoop shape had a depressed base with a clear border between the lacrimal sac and the nasal mucosa. Anatomic success was defined as patency with syringing and endoscopic evidence of ostial patency. Functional success was defined as visualisation of fluorescein dye at the ostium and relief from epiphora. Clinical information and intra- and postoperative endoscopic video findings were compared between the three groups.

RESULTS

Of the 102 cases, 19 flat, 37 ladle and 46 ice scoop type rhinostomies were observed during the follow-up examinations. Among the variables studied, patient demographics and rhinostomy size and location did not differ between the three groups. However, intraoperative lacrimal sac findings (sac size, wall thickness and mobility), postoperative ostial shrinkage and rhinostomy movement were associated with postoperative rhinostomy shape (all P < 0.05). With regard to surgical outcomes, there were no differences in anatomical patency between the three groups. However, the flat group had a worse functional success rate (73.7%) than the ladle (91.9%) and ice scoop (97.8%) groups (P = 0.008). A higher degree of ostial shrinkage and poor rhinostomy movement was observed with the flat shape appearance, which had a small, thick and poorly mobile lacrimal sac.

CONCLUSIONS

Lacrimal sac characteristics play a prominent role in determining rhinostomy shape after endoscopic DCR. The rhinostomy shape, along with the degree of ostial shrinkage and rhinostomy movement, is predictive of functional success after endoscopic DCR.

Assessment of Normal Eyeball Protrusion Using Computed Tomographic Imaging and Three-Dimensional Reconstruction in Korean Adults

PURPOSE

The aim of the present study was to assess normal eyeball protrusion from the orbital rim using two- and three-dimensional images and demonstrate the better suitability of CT images for assessment of exophthalmos.

METHODS

The facial computed tomographic (CT) images of Korean adults were acquired in sagittal and transverse views. The CT images were used in reconstructing three-dimensional volume of faces using computer software. The protrusion distances from orbital rims and the diameters of eyeballs were measured in the two views of the CT image and three-dimensional volume of the face. Relative exophthalmometry was calculated by the difference in protrusion distance between the right and left sides.

RESULTS

The eyeball protrusion was 4.9 and 12.5 mm in sagittal and transverse views, respectively. The protrusion distances were 2.9 mm in the three-dimensional volume of face. There were no significant differences between right and left sides in the degree of protrusion, and the difference was within 2 mm in more than 90% of the subjects.

CONCLUSIONS

The results of the present study will provide reliable criteria for precise diagnosis and postoperative monitoring using CT imaging of diseases such as thyroid-associated ophthalmopathy and orbital tumors.