Purpose
Intraocular lymphoma is a rare disease with a poor prognosis. Early diagnosis and early treatment greatly influence the survival prognosis of this disease. This retrospective study aimed to ...clarify the clinical features of patients diagnosed with intraocular lymphoma, and the diagnostic significance of results from analysis of vitreous samples including cytology, cytokine measurements, and the IgH gene rearrangement test.
Methods
We reviewed 217 patients with intraocular lymphoma diagnosed at 25 medical institutions in Japan. Together with clinical observation, cytological analysis, determination of the levels of cytokines, and/or detection of IgH gene rearrangements were conducted using vitreous fluid specimens. The results were studied in conjunction with clinical findings of intraocular lymphoma. Survival curves were estimated by use of the Kaplan–Meier method.
Results
The subjects comprised 85 men and 132 women, with a mean age at first ophthalmological examination of 63.4 years. The mean observation period was 41.3 months. During the observation period, 69 patients had onset of lymphoma in one eye and 148 had onset in both eyes. Intraocular lymphoma with involvement of the central nervous system (CNS) was most common, found in 60.8 % of the patients, whereas intraocular lymphoma without involvement of other organs was found in 28.1 % of patients. With respect to onset patterns, 82.5 % of patients developed primary ocular lesions whereas 16.1 % developed primary CNS lesions preceding intraocular lymphoma. Blurred vision and ataxia were the most common ocular and extra-ocular symptoms that prompted patients to seek medical examination. Vitreous opacification was the most common ocular finding. The detection rates of malignant cytology, IL-10/IL-6 ratio greater than 1.0, and IgH gene rearrangements in vitreous specimens were 44.5, 91.7, and 80.6 %, respectively, of patients tested. IL-10/IL-6 ratio greater than 1.0 had the highest overall detection rate, and was extremely high (≥90 %) in patients with or without vitreous opacification. The 5-year survival rate was 61.1 %.
Conclusion
Cytokine analysis of vitreous biopsy had the highest detection rate for intraocular lymphoma. This supplementary diagnostic test should be performed frequently to confirm a diagnosis of intraocular lymphoma.
Patients with hemiplegia after stroke tend to bear weight on the non-paretic side and exhibit large postural sway during static standing and walking, which may increase their risk of falls. ...Improvement of the sitting posture balance in the early phase of rehabilitation by adjusting weight-bearing would minimize the risk of falls as early rehabilitation reportedly improves walking ability and prevents falls in later phases of rehabilitation or at discharge.
This study aimed to evaluate the effect of optokinetic stimulation (OKS) on shift of the weight-bearing (displacement of the center of pressure CoP) in patients with hemiplegia who are incapable of independent standing.
Quasi-experimental, cross-sectional study.
Rehabilitation hospital.
Patients with hemiplegia in the subacute phase after stroke (N.=37).
Standing and sitting balance tests were performed during OKS projected onto a screen. For OKS, a pattern of random dots was presented, which continuously moved in horizontal or torsional directions during both static standing and sitting conditions. Postural sway was assessed during standing and sitting by measuring the sway path, sway area, sway velocity, and mean displacement of CoP. The magnitude of the lateral change in CoP as an indicator of the weight-bearing shift was evaluated by subtraction of the mean CoP of the right-left axis component in the stationary condition from the mean CoP sway during OKS.
OKS induced a unilateral change of the mean CoP position in patients during both, sitting and static standing, indicating that OKS can shift the weight-bearing in patients after stroke, irrespective of the posture condition. Moreover, the same OKS approach evoked an analogous shift in patients with more severe symptoms, with impairment in independent standing.
OKS could induce a significant shift in weight balance in patients with hemiplegia after stroke who are incapable of independent standing, suggesting that the OKS approach can be applied to a broader spectrum of patients, including those with more severe symptoms.
OKS approach would improve exercise training in the early phase of rehabilitation of patients with hemiplegia after stroke.
ObjectiveThe fact that population with type 2 diabetes mellitus and bodyweight of patients are increasing but diabetes care is improving makes it important to explore the up-to-date rates of ...achieving treatment targets and prevalence of complications. We investigated the prevalence of microvascular/macrovascular complications and rates of achieving treatment targets through a large-scale multicenter-based cohort.Research design and methodsA cross-sectional nationwide survey was performed on 9956 subjects with type 2 diabetes mellitus who consecutively attended primary care clinics. The prevalence of nephropathy, retinopathy, neuropathy, and macrovascular complications and rates of achieving targets of glycated hemoglobin (HbA1c) <7.0%, blood pressure <130/80 mm Hg, and lipids of low-density/high-density lipoprotein cholesterol <3.1/≥1.0 mmol/L and non-high-density lipoprotein cholesterol <3.8 mmol/L were investigated.ResultsThe rates of achieving targets for HbA1c, blood pressure, and lipids were 52.9%, 46.8% and 65.5%, respectively. The prevalence of microvascular complications was ∼28% each, 6.4% of which had all microvascular complications, while that of macrovascular complications was 12.6%. With an increasing duration of diabetes, the rate of achieving target HbA1c decreased and the prevalence of each complication increased despite increased use of diabetes medication. The prevalence of each complication decreased according to the number achieving the 3 treatment targets and was lower in subjects without macrovascular complications than those with. Adjustments for considerable covariates exhibited that each complication was closely inter-related, and the achievement of each target was significantly associated with being free of each complication.ConclusionsAlmost half of the subjects examined did not meet the recommended targets. The risk of each complication was significantly affected by 1 on-target treatment (inversely) and the concomitance of another complication (directly). Total diabetes care including one-by-one management of modifiable risk factors and complications may be important for high-quality care. The future studies including more subjects and clinics with precise complication status are needed.
Since a serum level of alanine aminotransferase (ALT) exceeding that of aspartate aminotransferase (AST) suggests hyperalimentary fatty liver, we examined its prevalence among and the clinical ...characteristics of afflicted type 2 diabetic patients as well as the effect of antidiabetic agents on AST/ALT with the CoDiC-MS database prepared by the Japan Diabetes Clinical Data Management study group (JDDM). AST<ALT patients accounted for 37.5 % of 12,710 participants. These patients tended to be more frequently male, younger, and have higher values of body mass index, HbA1c, serum triglyceride, serum C peptide immunoreactivity, and HOMA-IR and lower values of FIB-4 index and rates of diabetic complications than AST≥ALT patients. Pioglitazone and sodium-glucose cotransporter 2 inhibitors remarkably reduced the ALT level, and 24.9 % of AST<ALT patients became AST≥ALT 1 year after starting these prescriptions. A multiple comparison test indicated that these patients tended to be more frequently female, older, and have a longer duration of diabetes mellitus, lower AST and HSI values and higher body mass index, γ-glutamyl transpeptidase, and FIB-4 index values than others.
Treating neuropathic pain is a critical clinical issue. Although numerous therapies have been proposed, effective treatments have not been established. Therefore, safe and feasible treatment methods ...are urgently needed. In this study, we investigated the therapeutic effects of autologous intrathecal administration of bone-marrow-derived mononuclear cells (MNCs) on neuropathic pain. We generated a mouse model of neuropathic pain by transecting the spinal nerve and evaluated neuropathic pain by measuring the mechanical threshold in the following 14 days. Mice in the MNC injection group had a higher mechanical threshold than those in the buffer group. We assessed the effect of MNC treatment on the dorsal root ganglia and spinal cord by immunohistochemistry, mRNA expression, and cytokine assay. The migration and accumulation of microglia were significantly suppressed in the MNC group, and the mRNA expression of inflammatory cytokines such as interleukin (IL)-6, IL-1β, and tumor necrosis factor alpha (TNF-α) was markedly downregulated. Furthermore, MNC administration tended to suppress various cytokines in the cerebrospinal fluid of the model mice. In conclusion, our results suggest that intrathecal injection of MNCs relieves neuropathic pain and might be a promising cell therapy for the treatment of this condition.
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Neuropathic pain is an intractable disease. Takamura et al. established a treatment method for neuropathic pain by intrathecal administration of bone marrow derived-mononuclear cells (MNCs) in a spinal nerve transection mouse model. MNC injection relieves neuropathic pain by the suppression of microglial activation and inflammatory cytokine expression.
Aims/Introduction
To investigate the current status of achieved blood pressure levels in association with the number of antihypertensive drug classes as of 2013, and to explore the clinical ...correlates with achievement of target blood pressure in a large‐scale cohort of Japanese individuals with type 2 diabetes.
Materials and Methods
A nationwide survey was carried out including 12,811 individuals with type 2 diabetes. Participants were divided by achieved blood pressure, <130/80 or 140/90 mmHg, and the number of drug classes taken.
Results
The percentages achieving a blood pressure of <130/80 or 140/90 mmHg were 52.0% and 86.1%, respectively. The prevalence of hypertension, if defined as ≥130/80 mmHg or treated, became 67.9%. Among participants taking antihypertensive drugs, a blood pressure of <130/80 or <140/90 mmHg was 46.7% and 83.2%, respectively. The percentages of <130/80 mmHg were 55.9% without drugs, 47.1% on one drug, 42.5% on two drugs, 47.2% on three drugs and 56.8% on four or more drugs, respectively. The most prescribed drugs were renin–angiotensin system inhibitors, followed by calcium channel blockers, diuretics and beta‐blockers. The multiple logistic regression analysis showed that a blood pressure <130/80 mmHg was associated with lower values in age, body mass index, albuminuria and glomerular filtration rate, higher proportions on targets for glycosylated hemoglobin A1c and lipids, and less retinopathy.
Conclusions
In type 2 diabetes, hypertension is common, and just 52% achieved <130/80 mmHg, indicating a difficulty in blood pressure lowering. This was correlated with difficulties in glycemic and lipid management, obesity, and vascular complications, implying this clustering to be a serious problem.
A nationwide large‐scale survey was performed to investigate the current status of achieved blood pressure levels in association with the number of antihypertensive drugs. The percentages achieving a blood pressure of <130/80 or 140/90 mmHg were 52.0% and 86.1%, respectively. A difficulty in blood pressure lowering was correlated with difficulties in glycemic and lipid management, obesity, and vascular complications, implying these clustering to be a serious problem.
To report the clinical and histopathological features of malignant eyelid tumor cases treated in our clinic. We also compared the differences in the frequency of malignant eyelid tumor in various ...regions of Japan and worldwide.
Retrospectively, we studied the records of the 38 cases of malignant eyelid tumor treated in Yamagata University Hospital over the last 17 years. The statistical comparison with various countries was based on reports of case studies in those countries.
Data from our clinic: Among the total of 38 cases, 15 cases (39.5%) were diagnosed as basal cell carcinoma, 11 cases (28.9%) as sebaceous gland carcinoma, and 4 cases (10.5%) as squamous cell carcinoma. In addition, three cases were malignant melanoma, two adenocarcinoma, one Merkel cell carcinoma, one malignant peripheral nerve sheath tumor, and one malignant lymphoma. The ages of patients ranged from 45 to 92 years (mean, 72.0 +/- 12.4 years). Most of the cases were treated by complete resection of the tumors and eyelid reconstruction. Radiation or cryotherapy were added when required. The prognosis of the cases with basal cell carcinoma and squamous cell carcinoma was good, and that of the other tumors was relatively poor. During the same period, in Caucasians, basal cell carcinoma constituted about 80%-90% of the malignant eyelid tumors, whereas in Japan and Asian countries, basal cell carcinoma, sebaceous gland carcinoma, and squamous cell carcinoma each constituted about 20%-40%.
A racial difference in the incidence of basal cell carcinoma, sebaceous gland carcinoma, and squamous cell carcinoma can be considered in making a diagnosis.
Purpose: Various protein contents such as enzymes, growth factors, and structural components are responsible for biological
activities in organs. We have created a map of vitreous proteins and ...developed a proteome analysis of human vitreous samples
to understand the underlying molecular mechanism and to provide clues to new therapeutic approaches in eyes with proliferative
diabetic retinopathy (PDR). Methods: Vitreous and serum samples were obtained from subjects with idiopathic macular hole (MH,
26 cases) and PDR (33 cases). The expressed proteins in the samples were separated by two-dimensional (2-D) polyacrylamide
gel electrophoresis. Protein spots were visualized by silver staining, and their expression patterns were analyzed. Some protein
spots of concern were excised from the 2-D gels, digested in situ with trypsin, and analyzed by mass spectrometry. Results: More than 400 spots were detected on 2-D gels of MH cases, of which
78 spots were successfully analyzed. The spots corresponded to peptide fragments of 18 proteins, including pigment epithelium-derived
factor, prostaglandin-D2 synthase, and interphotoreceptor retinoid-binding protein. These were not identified in the corresponding
serum samples. These proteins were also expressed in PDR samples, with no distinct tendency to increase or decrease compared
with the MH samples. More than 600 spots were detected on 2-D gels of PDR cases, of which 141 spots were successfully analyzed.
The spots corresponded to peptide fragments of 38 proteins. Enolase and catalase were identified among four detected spots.
Neither was found in MH vitreous or in PDR serum samples. Conclusion: A map of protein expression was made in human vitreous
from eyes with MH and PDR. In the PDR eyes, the increased protein expression observed was due to barrier dysfunction and/or
production in the eye. Proteome analysis was useful in systematic screening of various protein expression in human vitreous
samples.
Purpose
The conjunctiva maintains the health of the ocular surface by protecting the eye from pathogen invasion, injury, and dryness. In this study, we investigated the regulation of hyaluronan (HA) ...synthesis by cytokines in conjunctiva-derived cells.
Methods
Cultured primary cells derived from human conjunctivas that had been removed as surgical specimens were transfected with an immortalizing gene (human papilloma virus 16 E6/E7). To compare the biological features of the primary and immortalized cells, we assessed their morphological features and gene expression patterns. We also examined the effects of inflammatory cytokines on hyaluronan synthase (HAS) expression and HA production.
Results
Three conjunctiva-derived cell strains were established and could be passaged up to 15 times. All strains expressed β2MG and KRT13 transcripts, highly expressed in conjunctival epithelial cells. HA production and expression of the three HAS isoforms were detected in the cell strains; however, cytokine treatment had no significant effect on HA production or HAS isoform expression.
Conclusions
We succeeded in deriving three human cell strains from conjunctival tissue. In the conjunctiva-derived cell strains, HA production and HAS mRNA expression were stable and were not changed by either TGF-β or PDGF-BB.
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