Purpose
The ocular surface in patients with atopic dermatitis (AD) is known to harbor an abundance of gram-positive cocci, particularly
Staphylococcus aureus (S. aureus)
. This study reviewed the ...results of microbial cultures from the conjunctiva in AD patients, with special attention to the levofloxacin susceptibility of
Staphylococci
.
Study design
Retrospective, single-center study.
Methods
This study involved 131 eyes of 112 Japanese patients with AD (87 men and 25 women, mean age: 40.4 ± 12.2 years) who underwent ocular surgery at Kyorin University Hospital. Bacterial isolates were collected from the conjunctival sacs in the preoperative period. Drug resistance to methicillin and levofloxacin was judged using the minimal inhibitory concentrations of oxacillin and levofloxacin determined by the broth dilution method.
Results
One hundred and fifty-seven strains were identified in 103 of the 131 eyes examined.
S. aureus
was isolated from 74 eyes (56.5%), followed by
Staphylococcus epidermidis
(
S. epidermidis
). In
S. aureus
, 11 strains (14.9%) were methicillin-resistant, and 18 (24.3%) were levofloxacin-resistant. In
S. epidermidis
, 15 strains (26.8%) were methicillin-resistant, and 17 (30.4%) were levofloxacin-resistant. No significant differences were observed in levofloxacin susceptibility with age, sex, previous ocular surgery, or duration of previous surgery. However, logistic multivariate analysis revealed that levofloxacin-resistant
Staphylococci
were concurrently resistant to methicillin, suggesting multidrug resistance.
Conclusion
Distinctive bacterial distribution and drug resistance need consideration in the managing of ocular disorders among patients with AD.
Introduction: With the increasing use of immune checkpoint inhibitors, ocular adverse events have gained attention. We describe a case of atypical keratitis presumably induced by atezolizumab, a ...programmed cell death ligand 1 inhibitor. Case Presentation: A 73-year-old Japanese woman developed ring-shaped marginal infiltrations with epithelial breakdown of the corneas in both eyes. The patient had advanced small cell lung cancer and had received intravenous carboplatin, etoposide, and atezolizumab. She was treated with topical administration of 0.1% sodium phosphate betamethasone and 0.5% moxifloxacin six times daily. On day 14 following initial presentation, marked reduction of bilateral corneal infiltration was observed. During the succeeding cycles of chemotherapy, marginal keratitis did not recur, and then, the topical steroid was gradually tapered. Conclusions: Cancer immunotherapy, including atezolizumab, may lead to active T-cell recruitment into the cornea, which result in autoimmune corneal keratitis. We believe that this report is informative to both ophthalmologists and oncologists involved in the treatment of patients receiving cancer immunotherapy.
The aim of this study was to report a case of Peters plus-like syndrome, which revealed to have an 8q21.11 microdeletion by copy number variation analysis using exome data.
A 6-month-old Japanese boy ...presented with bilateral corneal opacity since birth. The right eye maintained central corneal transparency with slightly inferior nasal and superior peripheral corneal opacities. The entire cornea was opacified in the left eye, particularly in the superior quadrants with vascularization, suggesting Peters anomaly. Identification of intraocular structures in the left eye was difficult; however, hypoplasia of the circumferential anterior iris stroma appeared bilaterally present, and no abnormalities were present in the posterior segment on funduscopic examination of the right eye and ultrasonography in the left eye. He had several facial malformations in addition to corneal opacity, but no other external abnormalities. General examination, including biochemical tests of blood and urine, physiological and imaging tests including abdominal echo, auditory brain stem response, brain computed tomography, and magnetic resonance imaging, showed no abnormalities. However, the patient showed intellectual disability and delayed motor development.
Although his karyotype was normal, copy number variation analysis using exome data and subsequent quantitative polymerase chain reaction identified a de novo 4.6-Mb deletion at 8q21.11q21.13; thus, the patient was diagnosed with 8q21.11 microdeletion syndrome.
We identified a de novo 4.6-Mb deletion at 8q21.11q21.13 in a patient with ophthalmic anterior segment dysgenesis and systemic complications, clinically diagnosed as Peters plus-like syndrome. Clinically, the 8q21.11 microdeletion syndrome shows a phenotype similar to that of Peters plus syndrome, and a genetic diagnosis is required.
To report the characteristics of a macular detachment associated with peripapillary intrachoroidal cavitation (ICC) and the outcomes of vitrectomy.
The medical records of 69 eyes of 61 patients who ...underwent vitrectomy for macular detachment or macular retinoschisis but without vitreomacular traction or optic disc pit were reviewed. Optical coherence tomography was used to determine the morphology of the ICC. The outcomes of vitrectomy including the creation of a posterior vitreous detachment and internal limiting membrane peeling were evaluated.
An ICC was detected in 3 of 3 eyes without pathologic myopia but none in 66 eyes with pathologic myopia (P < 0.0001). Myopic peripapillary conus was present in all 3 eyes, tilted disc in 2 eyes (67%), posterior staphyloma in 1 eye (33%), and no preoperative posterior vitreous detachment in all eyes. Optical coherence tomography detected a connection between the vitreous cavity and the ICC in two eyes with pit-like splitting and between the subretinal space and the ICC in two eyes. The macular detachment was resolved 5 months to 6 months postoperatively with improvement of vision.
A macular detachment with ICC can be present in nonpathological myopic eyes. Vitreous surgery to create a posterior vitreous detachment with internal limiting membrane peeling may help resolve the macular detachment.
To evaluate efficacy of ultra-wide angle fundus imaging without mydriasis for health screening.
The judgment rate and the detection rate of ocular diseases in 1160 eyes of 580 patients (Optos group) ...who underwent ophthalmic screening with Optos 200Tx ultra-wide field scanning laser ophthalmoscope without mydriasis from May 2013 to April 2014 were compared with those of 774 eyes of 387 patients who underwent ophthalmic screening with mydriasis (Mydriasis group).
The judgment could be made in 1156 eyes (99.7%) in the Optos group except for 4 eyes because of severe cataracts in 3 eyes and a corneal inlay to correct presbyopia in one eye. The judgment could be made in all eyes in the Mydriasis group. Peripheral retinal lesions could be detected in the Optos group including 2 eyes with retinal breaks, but the detection rate of peripheral retinal lesions including chorioretinal atrophy and retinal detachment was significantly higher in the Mydriasis group.
Optos wide-angle fundus imaging can detect peripheral retinal lesion even without mydriasis and can be considered useful for health screening because of its convenience.
IntroductionWith the increasing use of immune checkpoint inhibitors, ocular adverse events have gained attention. We describe a case of atypical keratitis presumably induced by atezolizumab, a ...programmed cell death ligand 1 inhibitor.Case PresentationA 73-year-old Japanese woman developed ring-shaped marginal infiltrations with epithelial breakdown of the corneas in both eyes. The patient had advanced small cell lung cancer and had received intravenous carboplatin, etoposide, and atezolizumab. She was treated with topical administration of 0.1% sodium phosphate betamethasone and 0.5% moxifloxacin six times daily. On day 14 following initial presentation, marked reduction of bilateral corneal infiltration was observed. During the succeeding cycles of chemotherapy, marginal keratitis did not recur, and then, the topical steroid was gradually tapered.ConclusionsCancer immunotherapy, including atezolizumab, may lead to active T-cell recruitment into the cornea, which result in autoimmune corneal keratitis. We believe that this report is informative to both ophthalmologists and oncologists involved in the treatment of patients receiving cancer immunotherapy.
Background
Differentiating between bipolar disorder (BD) and major depressive disorder (MDD) during the depressive episode is an important clinical challenge. Reward system abnormalities have ...received much attention as one of the biological underpinnings of BD and MDD, but few studies have directly compared these abnormalities in remitted and depressed states.
Methods
This was a functional MRI study using the Monetary Incentive Delay task in 65 patients (BD n = 33, MDD n = 32) and 33 healthy controls (HC). Regions of interest (ROI) analysis with 21 ROIs related to reward anticipation and 17 ROIs related to gain outcome were implemented, as well as whole‐brain analysis. The difference in the dimensional effect of depression on brain activation was also examined.
Results
Relative to the HC group, BD patients showed significantly decreased activation during reward anticipation in the anterior cingulate cortex, anterior insula (AI), and putamen, and MDD patients showed significantly decreased activation in the AI and brainstem. The dimensional effect of depression severity showed a trend‐level difference between BD and MDD in the right brainstem and left AI.
Conclusions
The current study showed a possible differential effect of depression on the reward system between MDD and BD. Further studies on reward systems might offer reliable markers to distinguish between MDD and BD patients in the depressive phase.
Abstract Background Previous studies have shown the interaction between heredity and childhood stress or life events on the pathogenesis of major depression. We hypothesized that childhood abuse, ...affective temperaments, and adult stressful life events interact and influence depressive symptoms in the general adult population and tested this hypothesis in this study. Methods The 294 participants from the nonclinical general adult population were studied using the following self-administered questionnaire surveys: the Patient Health Questionnaire-9 (PHQ-9), Life Experiences Survey (LES), Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego auto-questionnaire (TEMPS-A), and Child Abuse and Trauma Scale (CATS). The data were analyzed with single and multiple regressions and structural equation modeling (Amos 20.0). Results Childhood abuse indirectly predicted the severity of the depressive symptoms through affective temperaments measured by TEMPS-A in the structural equation modeling. Four temperaments – depressive, cyclothymic, irritable, and anxious – directly predicted the severity of depressive symptoms and the negative appraisal of life events during the past year. The negative appraisal of life events during the past year mildly, but significantly, predicted the severity of depressive symptoms. Limitations The subjects of this study were nonclinical. The findings might not be generalized to patients with mood disorders. Conclusions This study suggests that childhood abuse, especially neglect, indirectly increased depressive symptoms through increased affective temperaments, which, in turn, increase the negative appraisal of stressful life events. An important role of affective temperaments in the effect of childhood abuse and stressful life events on depressive symptoms was suggested.
Although the measurement of hemoglobin A1c (HbA1c) using high-performance liquid chromatography (HPLC) is routinely used to estimate average blood glucose levels, it may not be accurately measured ...for various reasons, such as alteration of red blood cell lifespan and the existence of hemoglobin variants; including hemoglobin F (HbF). Here, we report cases of fulminant type 1 and type 2 diabetes mellitus in which HbA1c levels were unmeasurable because of increased labile HbA1c levels. Case 1 involved a 73-year-old man with fulminant type 1 diabetes mellitus, who was brought to our hospital with diabetic ketoacidosis. The patient’s blood glucose level was 994 mg/dL, and HbA1c was unmeasurable, which turned out to be 6.2% on the next day when the blood glucose level was normalized. Case 2 involved a 72-year-old man with type 2 diabetes mellitus, whose blood glucose level was 767 mg/dL, and HbA1c was unmeasurable, which turned out to be 17.9% the following day. In both cases, the chromatograms showed that the HbA1c peaks overlapped with large labile HbA1c peaks, which decreased the next day. It is important to keep in mind that HbA1c levels may not be accurately measured in cases of extreme hyperglycemia because of an increase in labile HbA1c, regardless of the absolute HbA1c level.
Hyperthymic temperament is cheerful action orientation, and is suggested to have a protective effect on depressive symptoms. Responsiveness for reward, which is diminished in depressive patients, is ...suggested to be related to hyperthymic temperament. Moreover, neural hypoactivation in the reward system in depressive patients is well known. However, only a few previous studies have investigated the neurobiological substrate of hyperthymic temperament. We investigated the relationship between hyperthymic temperament and responsiveness to monetary rewards at the neural level.
Healthy participants performed a modified version of the monetary incentive delay task in a functional magnetic resonance imaging scanner. We explored the brain regions where neural responsiveness for monetary reward was predicted by hyperthymic temperament.
Brain areas in the reward system were widely activated for reward anticipation. Activation in the left thalamus and left putamen was positively predicted by hyperthymic temperament. Conversely, activation in the ventral striatum and right insula was not modulated by hyperthymic temperament. No region activated for reward outcome was not modulated by hyperthymic temperament.
Behavioral responsiveness to reward was not predicted by hyperthymic temperament or neural activity. Moreover, we did not correct P values for multiple regression analysis, considering that this was an exploratory study.
We found a neurobiological foundation for the protective aspect of hyperthymic temperament against depression in the reward system. Our findings suggest that the hyperthymic temperament may modulate attentional or motor responses or optimal selection of behavior based on reward, rather than value representation.
•fMRI measurements were obtained during a monetary incentive delay task.•Brain areas involved in the reward system widely activated for reward anticipation.•Left thalamus/putamen activation was predicted by hyperthymic temperament.•Ventral striatum/right insula activation was not modulated by this temperament.•No region activated for reward outcome was not modulated by hyperthymic temperament.
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