Fibrotic remodeling and tissue regeneration mechanisms define the therapeutic potential of human muscular progenitors

Fibrosis is an intrinsic biological reaction toward the challenges of tissue injury that is implicated in the wound-healing process. Although it is useful to efficiently mitigate the damage, progression of fibrosis is responsible for the morbidity and mortality occurring in a variety of diseases. Because of lacking effective treatments, there is an emerging need for exploring antifibrotic strategies. Cell therapy based on stem/progenitor cells is regarded as a promising approach for treating fibrotic diseases. Appropriate selection of cellular sources is required for beneficial results. Muscle precursor cells (MPCs) are specialized progenitors harvested from skeletal muscle for conducting muscle regeneration. Whether they are also effective in regulating fibrosis has seldom been explored and merits further investigation. MPCs were successfully harvested from all human samples regardless of demographic backgrounds. The extracellular matrices remodeling was enhanced through the paracrine effects mediated by MPCs. The suppression effects on fibrosis were confirmed in vivo when MPCs were transplanted into the diseased animals with oral submucous fibrosis. The data shown here revealed the potential of MPCs to be employed to simultaneously regulate both processes of fibrosis and tissue regeneration, supporting them as the promising cell candidates for development of the cell therapy for antifibrosis and tissue regeneration.

Protective behaviours of near work and time outdoors in myopia prevalence and progression in myopic children: a 2-year prospective population study

AIM

To investigate the protective behaviours of longer near work distance, discontinuing near work and more time outdoors in recess from parent self-report in the myopia prevalence and progression among myopic children aged 9-11 years.

METHODS

Myopia Investigation study in Taipei is a longitudinal population-based study that enrolled elementary school students in Taipei. We provided vision and refraction examination every 6 months. Spherical equivalent (SE) of cycloplegic refraction ≤-0.50 Diopter (D) is defined as myopia. Total 10 743 (70.4%) students completed 2-year refraction data and questionnaire. The myopia prevalence and progression (difference of SE) in baseline, 6, 12, 18 and 24 months were compared by generalised estimating equations.

RESULTS

Children with persistent protective behaviour had significant lower prevalence of myopia. The protective impact was statistically significant from 6 to 24 months. In 2 years follow-up, risk ratio after adjusting the background variables and the other two behaviours in near work distance, near work time and outdoor time were 0.71, 0.89 and 0.77. In SE analysis, after adjusting the other two behaviours, near work distance >30 cm (-0.7 vs -1.04 D; p<0.001), discontinuing near work every 30 min (-0.77 vs -0.96 D, p=0.005) and more time outdoors in recess from parent self-report (-0.75 vs -0.98 D; p=0.012) revealed protective impacts on diminishing myopia progression from 6 to 24 months.

CONCLUSION

In myopic children aged around 10 years in Taipei, longer distance in near work, discontinuing near work every 30 min and more outdoor time from parent self-report are protective behaviours in myopia prevalence and progression in 6-24 months.

Salispheres from Different Major Salivary Glands for Glandular Regeneration

Dysfunctional salivary glands (SGs) are a clinical challenge due to the lack of effective treatments. Cell therapy with stem/progenitor cells may improve this situation by providing promising therapeutic solutions. Therefore, exploring abundant cellular sources is important. Three major pairs of SGs are located in different anatomic regions: the parotid glands, the submandibular glands, and the sublingual glands. Although SG stem/progenitor cells can be isolated and cultivated from all major SGs as salispheres, the differences among SG origins remain unclear. In this study, salispheres were successfully isolated from all major SGs. The salispheres demonstrated unique cellular features that originated from their native tissues. The characteristic expression profiles and cellular features of SG stem cells were demonstrated in all salispheres. When they were transplanted into irradiated animals, the salispheres were all capable of improving the saliva secretion that was disrupted by irradiation. Typical histologic structures could be observed in most parts of the treated glands, and the fibrotic environments of irradiated submandibular glands were remodeled by all salispheres regardless of origins. This study characterized the cellular features and in vivo effects of salispheres that were derived from different anatomic origins. The results suggest the possibility of functional redundancy among distinct pairs of major SGs, which is useful for the design of cell therapy to treat dysfunctional glandular organs.

Maintenance of the spheroid organization and properties of glandular progenitor cells by fabricated chitosan based biomaterials

Dysfunctional salivary gland (SG) is an unsolved clinical challenge, which is presented as xerostomia. Cell therapy is a promising treatment for restoring SG function. Salispheres are spheroid cellular organizations derived from SG stem cells. Benefitting from these cellular organizations, SG stem cells can be expanded to regenerate SG. During in vitro culture, the spontaneous reorganization of salispheres may change the features of residing SG stem cells. Therefore, it is imperative to explore ways to maintain the spheroid structure of salispheres during cell expansion in vitro. Herein, we explored biomaterial approaches using chitosan. Chitosan based biomaterials were fabricated in different forms to offer distinct interactive surfaces for cultured salispheres. The number and size of the salispheres increase in the chitosan-containing systems without increasing the incidence of spheroid cavitation. The effect of chitosan increases with high chitosan concentrations, which is optimum when chitosan is fabricated in a soluble form. The chitosan effect contributes to the regulation of the intercellular interactions and polarization within the spheroid structures. By retarding the process of salisphere cavitation, chitosan preserves the features of salivary gland progenitor cells in the cultured salispheres. The results suggest that the chitosan-containing system could effectively maintain the primitive structures and properties of salispheres during in vitro expansion, which demonstrates the potential application of salispheres for cell therapy of dysfunctional SG.

Correction: Maintenance of the spheroid organization and properties of glandular progenitor cells by fabricated chitosan based biomaterials

Correction for 'Maintenance of the spheroid organization and properties of glandular progenitor cells by fabricated chitosan based biomaterials' by Hao-Wei Lee et al., Biomater. Sci., 2018, DOI: 10.1039/c7bm00559h.

Intraocular pressure monitoring by rebound tonometry in children with myopia

BACKGROUND/PURPOSE:

Topical atropine treatment is generally accepted to retard the progression of myopia, but it is associated with side effects such as photophobia and elevation of intraocular pressure (IOP). IOP measurements in children are challenging. The traditional applanation tonometry by direct contact with the cornea will require patient's cooperation. The rebound tonometer, using a dynamic electromechanical method for measuring IOP, shows good correlation with traditional tonometry. The purpose of this study is to evaluate the IOP of myopic children under atropine treatment using rebound tonometer and to compare the characteristics between rebound tonometry and applanation tonometry.

METHODS:

This study is a prospective study measuring IOP by rebound tonometer in myopic children under regular low-dose atropine treatment. We recruited children with refraction error showing myopia over −0.5 D with 0.15%, 0.3%, or 0.5% atropine eye drops use every night or every other night for myopia control. Children with treatment duration of atropine <1 month were excluded from the study. IOP measurements were performed by applanation tonometer (Tono-Pen XL, Reichert) and rebound tonometer (ICARE). The reliability of rebound tonometer was analyzed with percentage. Comparison of IOP between rebound tonometer and applanation tonometry was presented.

RESULTS:

The rebound tonometry was well tolerated by all participants and caused no complaints, discomfort, or adverse events. Totally 42 myopic eyes of 42 subjects were included in the study. The average age of these participants was 10 years old, range from 5 to 16. Median = 10 years old. The average IOP of the right eye by rebound tonometer was 17.4 ± 3 mmHg, and 17.1 ± 3 mmHg by applanation tonometry. Nearly 19%, 33%, and 24% of difference of IOP readings between rebound tonometer and Tono-Pen applanation are within 0 mmHg, 1 mmHg, and 1–2 mmHg, respectively.

CONCLUSIONS:

Rebound tonometry has good correlation with applanation tonometry and 76.1% of differences between two tonometers are <2 mmHg. The advantage of drop-free rebound tonometry has made it easier to obtain IOP readings in myopia children under atropine treatment.

Data supporting chitosan facilitates structure formation of the salivary gland by regulating the basement membrane components

To investigate the role of basement membrane (BM) in chitosan-mediated morphogenesis of the salivary glands, the embryonic submandibular gland (SMG) experimental model was used. Chitosan promotes branching at distinct stages in SMG morphogenesis. When enzymes such as type IV collagenase, dispase, and cathepsin B were used to digest the BM components, the morphogenetic effect mediated by chitosan disappeared. Immunofluorescence revealed that the corresponding receptors for BM components, including CD49c, CD49f, CD29, and dystroglycan, were locally enriched at the epithelial-mesenchymal junction around BM areas. The functional roles of laminin α1 and α5 in SMG branching were explored via siRNA knockdown, and suppression was confirmed at both the RNA and protein levels (Yang and Hsiao, Biomaterials, http://dx.doi.org/10.1016/j.biomaterials.2015.06.028, 2015). This data article demonstrates the experimental approaches to investigate the role of basement membrane in the structure formation of the salivary gland engineered by biomaterials.

Chitosan facilitates structure formation of the salivary gland by regulating the basement membrane components

Tissue structure is important for inherent physiological function and should be recapitulated during tissue engineering for regenerative purposes. The salivary gland is a branched organ that is responsible for saliva secretion and regulation. The salivary glands develop from epithelial-mesenchymal interactions, and depend on the support of the basement membrane (BM). Chitosan-based biomaterials have been demonstrated to be competent in facilitating the formation of salivary gland tissue structure. However, the underlying mechanisms have remained elusive. In the developing submandibular gland (SMG), the chitosan effect was found to diminish when collagen and laminin were removed from cultured SMG explants. Chitosan increased the expression of BM components including collagen, laminin, and heparan sulfate proteoglycan, and also facilitated BM components and the corresponding receptors to be expressed in tissue-specific patterns beneficial for SMG branching. The chitosan effect decreased when either laminin components or receptors were inhibited, as well when the downstream signaling was blocked. Our results revealed that chitosan promotes salivary glands branching through the BM. By regulating BM components and receptors, chitosan efficiently stimulated downstream signaling to facilitate salivary gland branching. The present study revealed the underlying mechanism of the chitosan effect in engineering SMG structure formation.

Controlling branching structure formation of the salivary gland by the degree of chitosan deacetylation

The salivary gland is characterized by ramified epithelial branches, a specific tissue structure responsible for saliva production and regulation. To regenerate the salivary gland function, it is important to establish the tissue structure. Chitosan is a deacetylated derivative of chitin with wide biomedical applications. Because of its deacetylated nature, chitosan has different properties when prepared with different degrees of deacetylation (DDA). However, the impact of chitosan DDA on the effect of regulating tissue structure formation remains unexplored. In this study, the embryonic murine submandibular gland (SMG) was used as a model to investigate the role of chitosan DDA in regulating tissue structure formation of the salivary gland. When chitin substrates with different DDA were used, the branching numbers of cultured SMG explants changed. Similar effects were observed in the culture with chitosan prepared using different degrees of acetylation. The mRNA expressions of type I and type III collagen were elevated in SMG explants with enhanced branching morphogenesis, as was the protein level. In addition to the amounts of collagen, type I and type III collagen fibers were spatially present in the epithelial-mesenchymal junction of developing branches in the culture with chitosan of a specific range of DDA. The branch-promoting effect of chitosan DDA was abolished when SMG explants were treated with collagenase, both early in the stage of branch initiation and with the establishment of the branching structure. The branch-promoting effect of chitosan DDA disappeared when antisense oligonucleotides were applied to specifically block type III collagen. This study demonstrates for the first time that DDA of chitosan affects tissue structure formation. The different proportions of side-chain components of chitin derivatives regulate structural formation of cultured SMG, indicating that DDA is an important parameter using chitosan as a biomaterial for tissue structure formation of the salivary glands.

Diagnosis of microsporidial keratitis with in vivo confocal microscopy

As a rare cause of microbial keratitis, microsporidial keratitis (MK) is first described in a patient with acquired immunodeficiency syndrome. As increased use of topical steroid creates a localized immunosuppressive environment of the eyes, MK occurs more commonly than expected in immunocompetent patients nowadays. Owing to initial insidious growth of pathogens and nonspecific ocular symptoms of infected patients, its frequent misdiagnosis has posed a major clinical challenge in recent decades. Without appropriate treatments, MK can progress deeply into corneal stroma, anterior and posterior segments, subsequently deteriorating vision severely and ultimately requiring corneal transplant. Related risk factors for the occurrence of MK in immunocompetent individuals include contact lens wear, topical steroid use, previous corneal trauma, and a history of laser refractive surgery. The conventional standard of MK diagnosis is based on a tissue biopsy by superficial corneal scrapping. In vivo confocal laser scanning microscopy can obtain images through the cornea in a plane paralleling to the vertical axis. This approach provides an effective method of identifying tissue layers that correspond to corneal histologic structures. This current study investigates the efficacy of \textit{in vivo} confocal laser scanning microscopy in diagnosing MK in immunocompetent patients. The clinical presentations of enrolled patients, including features of slit lamp biomicroscopy and the histopathological results of corneal scrapping, were described. In these patients, the confocal microscopy identified multiple small intracellular hyper-reflective dots in the cytoplasm of corneal epithelial cells and stromal keratocytes. Additionally, the confocal microscopic images clearly revealed the enhanced cytoplasm of cell with intracellular round hyper-reflective dots. The size and morphology of hyper-reflective dots were compatible with the spores of microsporidia found in corneal tissue. Moreover, vision recovered after topical use of antimicrobial medicine. This observation suggests that in vivo confocal laser scanning microscopy provides a rapid, non-invasive, and high resolution scheme for diagnosing MK. In addition to diminishing the risk of secondary infection from epithelial defect created by superficial debridement, this approach facilitates early diagnosis and appropriate treatments. Furthermore, from a series of images taken during the clinical courses, this method is highly promising for use in monitoring treatment effects and identifying the recurrence of MK.

An alternative way to think about glaucoma screening, using a questionnaire as a tool, Chinese version

RATIONALE, AIMS AND OBJECTIVES

To develop a short screening test for the detection of preclinical glaucoma.

METHOD

This case-control study involved 690 participants aged 40 years or older: 338 patients with glaucoma or suspected glaucoma and 352 patients without glaucoma, who served as a control group. All participants were interviewed by a single trained research assistant. Patients' basic demographic and clinical information, past ophthalmic history and responses on the National Eye Institute 25-item Visual Function Questionnaire were collected. Two glaucoma-trained ophthalmologists examined all the participants using standard procedures to make a diagnosis. The biostatistical differences between the two groups were determined.

RESULTS

Five items were selected for glaucoma screening: 'Sense of worse vision compared with those of the same age', 'Ocular pain or discomfort during the past 6 months', 'History of cataract', 'Family history of glaucoma' and 'Hyperopia'. A score of 2 or more was used to define a group of positive cases with the most appropriate values for sensitivity (79.0%), specificity (76.7%) and predictive power (a positive predictive value of 76.5% and a negative predictive value of 79.2%).

CONCLUSION

A five-item instrument was developed to detect preclinical glaucoma. Anyone with a score of 2 or more may need further ophthalmic examination and treatment.

COMPARISON OF PLGA, PCL, AND CHITOSAN IN SALIVARY GLAND BRANCHING MORPHOGENESIS

Branching morphogenesis is a fundamental morphogenetic process in generating glandular tissues. Although the mechanism of branching morphogenesis has been well-explored in the salivary gland development, its interaction with different biodegradable materials has never been investigated. For the purpose of salivary gland regeneration, recapitulation of morphogenetic processes on biodegradable materials might be requisite. Toward this aim, biodegradable biomaterials including poly-lactic-co-glycolic acid (PLGA), poly-epsilon-caprolactone (PCL), and chitosan were examined in the submandibular gland (SMG) culture systems to elucidate their possible impact on salivary morphogenesis. It was found that when SMG explants were cultured on PLGA and PCL, the explants failed to form well-developed branching phenotypes with limited cell migration (5.6 ± 8.8 μm; 10.0 ± 14.1 μm) and decreasing cell viability (56.9% ± 12.5%; 50.3% ± 8.1%). On the contrary, explants cultured on chitosan showed well-developed branches, which were superior in number to those on the control substrata, without any alteration of the morphogenetic phenotypes. Furthermore, the increased cell migration (267.8 ± 45.2 μm) and explants viability (146.8% ± 18.4%) along with the greater deposition of type III collagen, altogether account for better SMG morphogenesis on chitosan. According to the results, it was found that branching morphogenesis of SMG was affected by different biodegradable materials. Chitosan might be an appropriate biodegradable material for salivary morphogenesis, and has applicable potential in the regeneration of salivary tissue.

Home assessment of diurnal intraocular pressure in healthy children using the Icare rebound tonometer

BACKGROUND

Although intraocular pressure (IOP) is known to vary with the circadian cycle in nonglaucomatous and glaucomatous eyes of adults, the clinical assessment of IOP often relies on periodic measurements obtained at office visits during daytime hours. Little has been reported on diurnal IOP patterns in healthy children. The purpose of this study was to evaluate diurnal IOP in normal eyes of healthy children with the Icare rebound tonometer and when recorded by a parent at home.

METHODS

This was a prospective study of IOP in normal eyes of healthy children. Children were recruited from a pediatric eye clinic. A parent was instructed on the use of the Icare rebound tonometer by a study physician and demonstrated proficiency its use in the clinic, at which time a masked IOP reading was also made with Goldmann applanation by a different study clinician. Home IOPs were then obtained and recorded 6 times daily at 2- to 3-hours intervals during 2 consecutive days by a parent.

RESULTS

A total of 22 normal eyes (of 11 children) were included. We found that children without glaucoma demonstrate mean diurnal IOP fluctuation of 4-6 mm Hg, with similar IOP between right and left eyes, fair repeatability between consecutive days, and a tendency for higher early morning and lower late evening IOP.

CONCLUSIONS

Healthy children without glaucoma demonstrate some diurnal fluctuation in IOP, comparable with that reported in nonglaucomatous eyes of adults. This information should prove as comparative for assessment of IOP fluctuation in children with known or suspected glaucoma.

Home tonometry for management of pediatric glaucoma

PURPOSE

To use iCare rebound tonometry in the home setting for documentation of diurnal intraocular pressure (IOP) fluctuations in children.

DESIGN

Nonrandomized, prospective clinical study.

METHODS

Pediatric ophthalmology clinic patients were recruited between October 2009 and February 2010 who were able to cooperate with IOP measurement by iCare rebound tonometry and whose caregiver was willing and able to obtain iCare measurements at home. The child's IOP was measured first by iCare tonometry followed by a second method (Goldmann applanation [GAT]). The caregiver was instructed on the use of the iCare tonometer. The subject's IOP was measured by the caregiver at home at designated time periods for at least 2 consecutive days.

RESULTS

Seventeen children (17 eyes) with known or suspected glaucoma and 11 normal children were included. Excellent reliability was obtained by caregivers in 70% of iCare measurements. Mean difference between iCare and GAT in clinic was 2.0 ± 4.0 mm Hg, P = .08. Daily IOP fluctuation occurred in both subjects with glaucoma and normal subjects. In children with known or suspected glaucoma, relative peak and trough IOPs occurred in the early morning (45%) and late evening (43.5%), respectively. Comparison of the peak IOP measured at home vs in the clinic was >6 mm Hg in 5 of 16 subjects (31%) and affected glaucoma management in several subjects.

CONCLUSIONS

In selected children with glaucoma, home tonometry by iCare rebound tonometry was reliable, easily performed by caregivers, and well tolerated, and offered IOP information valuable in clinical management.

Icare rebound tonometry in children with known and suspected glaucoma

BACKGROUND

Accurate intraocular pressure (IOP) measurement, important in managing pediatric glaucoma, often presents challenges. The Icare rebound tonometer shows promise for screening healthy children and has been reported comparable with Goldmann applanation in adults with glaucoma. The purpose of this study was to evaluate the Icare tonometer against Goldmann applanation for clinic IOP measurement in pediatric glaucoma.

METHODS

This was a prospective study comparing Icare versus Goldmann tonometry in pediatric glaucoma. Children with known or suspected glaucoma were recruited from scheduled clinic visits. IOP was measured with the Icare tonometer by a clinician and subsequently measured with Goldmann applanation tonometry (GAT) by a different single masked clinician.

RESULTS

A total of 71 eyes of 71 children with known or suspected glaucoma were included. IOP by GAT ranged from 9 to 36 mm Hg. Icare readings ranged from 11 to 44 mm Hg. Mean difference between Icare and GAT was 2.3 ± SD 3.7 mm Hg, p < 0.0001. Icare IOPs were within ± 3 mm Hg of GAT in 63%. Icare IOPs were ≥GAT IOPs in 75%. The following factors were not associated with Icare IOPs greater than GAT: child's age, glaucoma diagnosis, strabismus, nystagmus, central corneal thickness, Icare instrument-reported reliability, number of glaucoma surgeries or medications, corneal abnormalities, and visual acuity.

CONCLUSIONS

IOP by Icare tonometry was within 3 mm Hg of IOP by GAT in 63% and greater than GAT in 75%. This device may be reasonable to estimate IOP in selected children with known or suspected glaucoma whose IOP cannot otherwise be obtained in clinic; however, correlation of Icare IOPs with clinical findings must continue to be considered in each case.

Characteristics of disc hemorrhage in primary angle-closure glaucoma

PURPOSE

To analyze the characteristics of disc hemorrhage in primary angle-closure glaucoma (PACG).

DESIGN

Retrospective noncomparative case series.

PARTICIPANTS

Patients seen in glaucoma clinics with PACG and a history of disc hemorrhage.

METHODS

Goldmann tonometry, gonioscopy, ophthalmoscopy, and automated perimetry.

MAIN OUTCOME MEASURES

Location, number of episodes, and duration of disc hemorrhage; comparison of intraocular pressure (IOP) and cup-to-disc ratio (CDR) in eyes with and fellow eyes without hemorrhage; and changes of CDR and visual fields (VFs) on follow-up.

RESULTS

The mean duration of follow-up was 109.2+/-63 months (range, 7-261). Of 770 patients with PACG, 44 (5.7%) had disc hemorrhage at some point in their history, of whom 30 (68%) had unilateral and 14 (32%) had bilateral hemorrhages, either alternately or simultaneously in both eyes. There were a total of 111 hemorrhages in 58 eyes, including 23 eyes (40%) with recurrent hemorrhages. Of the 111 total hemorrhages, 85 (77%) occurred in the inferotemporal and 19 (17%) in the superotemporal sector of the disc. Among 23 eyes with recurrent disc hemorrhages, 11 (48%) had recurrence in the same sector of the disc. The average duration of hemorrhages was 12.8+/-8.1 weeks. The IOP and CDR did not differ significantly between eyes with and fellow eyes without hemorrhage. For patients with unilateral disc hemorrhage, progressive changes in the CDR were found in both the eyes with and fellow eyes without disc hemorrhage, but VF defects worsened only in eyes with disc hemorrhage.

CONCLUSIONS

The incidence of disc hemorrhage in patients with PACG was 5.7% over 9 years of follow-up. Despite its relative infrequency, disc hemorrhage in PACG was associated with progression of glaucomatous optic neuropathy and VF defects.

Successful treatment of rhegmatogenous retinal detachment secondary to globe perforation during peribulbar injection in a case of sympathetic ophthalmia

Rhegmatogenous retinal detachment followed peribulbar injection in a patient with preexisting sympathetic ophthalmia. Inadvertent globe perforation resulted in subsequent rhegmatogenous retinal detachment. Scleral buckling and pars plana vitrectomy reattached the retina. The histopathology of the subretinal fibrotic tissue confirmed the diagnosis.

Endogenous uveitis: experiences in Kaohsiung Veterans General Hospital

BACKGROUND

The distribution of uveitis varies in different parts of the world, which is attributed to geographic, alimentary or genetic factors. Epidemiological studies in uveitis may be extremely important in an effort to better understand the etiology of the disease and the classification of its subtypes. The purpose of this study was to determine the profile and characteristics of endogenous uveitis in southern Taiwan.

METHODS

Retrospective chart review ofthe patients diagnosed and treated as endogenous uveitis in Kaohsiung Veterans General Hospital from January 1991 to December 2000 was performed. Demographic data, past history, ophthalmic examination and other laboratory tests were recorded and analyzed.

RESULTS

One-hundred and sixty patients were collected, including 93 (58.1%) males and 67 (41.9%) female, with average age of 41.1 +/- 17.1 years (range 16-77), and mean follow-up period of 13.7 months. The diagnoses included 46 (28.8%) cases of acute anterior nongranulomatous uveitis (AAU), 26 (16.3%) cases of Vogt-Koyanagi-Harada (VKH) disease, 18 (11.3%) cases of intermediate uveitis, 14 (8.8%) cases of Behcet's disease, 26 (16.3%) cases of infectious origin, 7 (4.4%) cases of other diagnoses, and 23 (14.4%) undefined cases. Final visual acuity equal to or better than 0.5 was obtained in 78.2% of eyes of AAU, 65.4% of eyes of VKH disease, 48.1% of eyes of Behcet's disease, and 66.7% of eyes of intermediate uveitis.

CONCLUSIONS

Acute anterior nongranulomatous uveitis was the most common endogenous uveitis, while VKH was the most common panuveitis in this series. As infectious origin contributes a significant proportion of endogenous uveitis, infectious etiology should be considered in any type of uveitis that responds poorly to conventional treatment.

Risk factors for endogenous endophthalmitis secondary to Klebsiella pneumoniae liver abscess

BACKGROUND

To identify the risk factors for endogenous endophthalmitis secondary to Klebsiella pneumoniae (KP) liver abscess.

METHODS

Retrospective chart review of 200 patients with KP liver abscess from 1990 to 2000 was performed. Data variables included age, sex, past history, systemic condition, initial and final visual acuity, slit lamp biomicroscopy, intraocular pressure, fundus, course and treatment.

RESULTS

Extrahepatic metastasis developed in 44 patients, including 18 cases (23 eyes) of endophthalmitis. Seventeen eyes had final vision less than counting fingers. Diabetes had significant association with the development of extrahepatic metastasis (p = 0.045) and the poor visual outcome of endophthalmitis (p = 0.022), whereas, neither the initial vision nor vitrectomy was significantly related to the outcome of endophthalmitis.

CONCLUSIONS

The visual prognosis of endogenous endophthalmitis secondary to KP liver abscess is generally poor, and diabetes might be a significant risk factor for the poor visual outcome. Even when the initial vision is as bad as light perception only, some eyes can be saved. Both internists and ophthalmologists should be alert enough to detect and treat these patients early.

Primary antiphospholipid syndrome manifested as venous stasis retinopathy

Primary antiphospholipid syndrome is a condition in which antiphospholipid antibodies may be present without any associated medical disorder. Thrombosis is the hallmark of this syndrome. We report the case of a 22-year-old female with the chief complaint of floating spots in the right eye for two months. No underlying connective tissue disease or systemic disease was noted. Ophthalmic examination revealed retinal hemorrhage, retinal vein engorgement and optic disk swelling in the right eye only, and normal visual acuity in both eyes. Retinal fluorescein angiography showed venous stasis and branch vein leakage in the right eye. An antibody profile revealed the presence of immunoglobulin G anticardiolipin antibodies, which confirmed the diagnosis of primary antiphospholipid syndrome.

[Respiratory failure after nebulized terbutaline treatment in severely wheezy infants: report of three cases]

Subjective clinical observations have suggested that nebulized bronchodilators are helpful in the treatment of some wheezy infants. Although the role of beta 2-agonists in the management of acute asthma in infants and very young children remains controversial, the use of beta 2-adrenergic agents in this age group has been widespread. beta 2-agonists nebulization continues to be the first-line treatment for acute attack of asthma, irrespective of age, in some institutes, but their uses are not without side effect especially in young wheezy infants. We report three cases of respiratory failure occurred after treatment with nebulized beta 2 bronchodilator in infants with chronic lung disease and acute wheezing. All the 3 cases were victims of prematurity. Case 1 was a case of Wilson-Mikity syndrome; case 2 was a case of bronchopulmonary dysplasia; and case 3 was a case of repeatedly wheezing infant. All 3 cases had severely wheezy dyspnea with retraction before nebulized beta 2 bronchodilator treatment. Respiratory failure was found 5 to 10 minutes after the treatment. We suggest that it must be very careful in the treatment of severely wheezy infants with beta 2-agonist nebulization, especially in cases with histories of prematurity and chronic lung disease. It is necessary to carefully monitor the vital signs of the infants during beta 2 agonist nebulization.

[Fetus in fetu: report of a single case]

A five-year-old girl had been noted, since birth to have abdominal distension. There was no history of twinning or teratoma in the family. Physical examination discovered a 15 x 10 cm mass in the abdomen. Roentgenologic examination demonstrated the presence of an axial skeleton and long bones within the mass. MRI showed a retroperitoneal mass with components of cystic, bony and fatty tissues. When the mass was surgically removed from the retroperitoneal cavity, pathologic examination disclosed a parasitic fetus measuring 15.3 x 6.3 x 6.0 cm in size and suspended by a peduncle within a capsule. The fetus was covered with skin, sebaceous materials and black hair. There were bilateral and symmetric upper extremities with a flapper-like, deformed hand. No obvious genital organ was noted. Dissection of the midline, revealed a vertebral column with spinal cord. An atrophic skull bone containing cephalized glial tissue was noted. A thoracic cavity and scapular bone were found in the thoracic cage; however, no heart was noted. Gastrointestinal tract and kidney-like organs were seen within the abdominal cavity. Microscopically, there were glial tissues within the skull bone, spinal cord and vertebra. The upper extremities revealed two long bones surrounded by myxomatous and fibrous tissue. A well developed intestine and an ovary containing follicles with nearby lympy nodes were seen. The capsule showed fibrous tissue with calcification and hairs. It was distinguished from the teratoma by the presence of a vertebral axis and by an appropriate arrangement of other organs or limbs with respect to the axis, and corresponding to the generally recognized diagnostic criteria of fetus in fetu.

Ultrastructural alterations in cardiac muscle of diabetic BB Wistar rats

The cardiac muscle of BB Wistar rats suffering from diabetes for 8 and 16 weeks (8-Wk and 16-Wk of DM) were examined by light and electron microscopy. The diabetic rats were kept alive by injections of small doses of insulin and exhibited severe hyperglycaemia, glycosuria and weight loss. The heart/body weight ratio of all diabetic groups was greater than that of age matched controls. Over the experimental period, the left ventricular myocardium of the diabetic BB rats sustained damage that was progressively more serious with the duration of the diabetic state. In BB rats after 8-wk of diabetes the myocardium contained large numbers of lipid droplets and glycogen granules around mitochondria which showed patchy swelling, and slight loss of myofilaments. Disruption of mitochondrial membranes and extensive loss of myofilaments were seen in rats diabetic for 16 wk. In addition, dilatation of the sarcoplasmic reticulum-transverse tubular system, formation of a contraction band and myelin bodies and widening of the intercellular space at the fasciae adherens of the intercalated disc were characteristically observed in BB rats after 16-wk of diabetes. However, there were no evident alterations in the capillaries of any diabetic BB rats. Morphometric analyses showed the volume percentage of myofibrils in diabetic rats to be significantly decreased when compared with controls. The loss of myofibrillar elements may be a primary damage induced by insulin deficiency. The formation of contraction bands suggests Ca2+ overload caused by diabetic metabolic disturbances.