“In solid organ transplantation, the compatibility between recipient and donor relies on testing prior to transplantation as a major determinant for the successful transplant outcomes. This ...compatibility testing depends on the detection of donor-specific antibodies (DSAs) present in the recipient. Indeed, sensitized transplant candidates are at higher risk of allograft rejection and graft loss compared to non-sensitized individuals. Most of the laboratories in India have adopted test algorithms for the appropriate risk stratification of transplants, namely: 1) donor cell-based flow-cytometric cross-match (FCXM) assay with patient’s serum to detect DSAs; 2) HLA-coated beads to detect anti-HLA antibodies; and 3) complement-dependent cytotoxicity crossmatch (CDCXM) with donor cells to detect cytotoxic antibodies. In the risk stratification strategy, laboratories generally accept a DSA median fluorescence index (MFI) of 1000 MFI or lower MFI (low-MFI) as a negative value and clear the patient for the transplant. We present two cases of live-related donor kidney transplants (LDKTs) with low-MFI pre-transplant DSA values who experienced an early acute antibody-mediated rejection (ABMR) as a result of an anamnestic antibody response by DSA against HLA class II antibodies. These results were confirmed by retesting of both pre-transplant and post-transplant archived sera from patients and freshly obtained donor cells. Our examples indicate a possible ABMR in patients with low MFI pre-transplant DSA. Reclassification of low vs. high-risk may be appropriate for sensitized patients with low-MFI DSA.”
•Sensitized transplant candidates are at higher risk of allograft rejection, compared to non-sensitized individuals.•There is a possibility of ABMR in patients with low MFI pre-transplant DSA.•Reclassification of low vs. high-risk may be appropriate for sensitized patients with low-MFI DSA.”
ABSTRACTGa–prostate-specific membrane antigen (PSMA) PET/CT imaging is a relatively new imaging technique used to evaluate the extent of disease in prostate carcinoma. Various other neoplasms may ...also express PSMA and show uptake on PSMA PET/CT scan. We report a case of a 62-year-old man who had a PSMA PET/CT scan for restaging of prostate carcinoma. A PSMA-avid thyroid lesion was identified, and subsequent tissue sampling confirmed the diagnosis of follicular thyroid adenoma. It is important to be aware of this possibility to avoid scan misinterpretation. Tissue biopsy of PSMA-avid thyroid lesions should be considered to exclude a primary thyroid neoplasm.
Purpose To assess whether the pseudoexfoliation syndrome (PXS) is associated with the long-term incidence of cataract or cataract surgery. Design Population-based cohort study. Methods The Blue ...Mountains Eye Study examined 3654 persons 49 years of age and older at baseline; 2564 were re-examined after 5 or 10 years, or both. PXS was recorded at the baseline eye examination by an ophthalmologist. Masked graders assessed lens photographs using the Wisconsin Cataract Grading System. Generalized estimating equation regression models were used to examine the association between PXS and cataract by eye. Results Eyes with PXS had a significantly greater prevalence of cortical cataract ( P = .02) and nuclear cataract ( P < .0001) than eyes without PXS. The association between PXS and cortical cataract, however, did not persist after further adjustment for age, gender, smoking, diabetes, steroid use, myopia, socioeconomic status, and open-angle glaucoma (odds ratio OR, 0.89; 95% confidence interval CI, 0.53 to 1.46), whereas the association between PXS and nuclear cataract persisted after adjustment for the above confounders (OR, 1.90; 95% CI, 1.04 to 3.48). In addition, significant associations were found between the presence of PXS at baseline and the 10-year incidence of either nuclear cataract ( P < .0001) or cataract surgery ( P < .0001). These associations persisted after adjustment for the potential confounders listed above (OR, 3.25; 95% CI, 1.38 to 7.65; and OR, 4.09; 95% CI, 2.25 to 7.44; respectively). No significant cross-sectional or longitudinal associations were found between PXS and posterior subcapsular cataract. Conclusions Long-term follow-up data from this population-based older cohort suggest that the presence of PXS is associated with an increased risk of nuclear cataract and cataract surgery.
Background
To assess the association between refractive errors and the 10‐year incidence of cataract and cataract surgery.
Design
Population‐based prospective study.
Participants
Three thousand six ...hundred fifty‐four persons aged 49+ years living in a well‐defined geographical region were examined at baseline; 2564 were re‐examined after 5 and/or 10 years.
Methods
Baseline refractive error was measured using autorefraction with subjective refinement. Lens photographs were taken at each visit and assessed using the Wisconsin Cataract Grading System.
Main Outcome Measures
Long‐term incidence of cataract and cataract surgery.
Results
Compared with emmetropia, high myopia was associated with increased incidence of nuclear cataract (adjusted odds ratio 3.01, 95% confidence intervals 1.35–6.71). Low (odds ratio 1.86, confidence interval 1.03–3.35) and high myopia (odds ratio 7.80, confidence interval 3.51–17.35) were significantly associated with higher incidence of posterior subcapsular cataract. Low, moderate and high myopia were associated with increased incidence of cataract surgery (odds ratio 2.54, confidence interval 1.76–3.68; odds ratio 2.61, confidence interval 1.45–4.69; and odds ratio 4.81, confidence interval 2.33–9.93, respectively). Either any (odds ratio 1.35, confidence interval 1.08–1.69) or moderate hyperopia (odds ratio 1.76, confidence interval 1.32–2.34) was associated with increased incidence of nuclear cataract.
Conclusion
Our longitudinal study confirms the association between myopia and an increased risk of nuclear and posterior subcapsular cataract. It also suggests that hyperopia may increase the risk of nuclear cataract.
ABSTRACTGa prostate-specific membrane antigen (PSMA) PET/CT is a relatively new and highly sensitive imaging modality used in staging metastatic prostate cancer. We report a case of a 65-year-old man ...with newly diagnosed prostate carcinoma who had a PSMA PET/CT scan for staging of his disease. A PSMA-avid right pelvic mass was identified anterior to the sacrum. Surgical removal and histopathological examination of this lesion revealed the diagnosis of schwannoma. It is important to be aware that schwannoma may also show avid uptake on PSMA PET/CT scan and may potentially lead to an incorrect diagnosis of metastatic prostate carcinoma.
To estimate the 10-year incidence of cataract and cataract surgery in an older Australian population.
Prospective population-based study.
Persons at least 49 years old living in 2 postcode areas west ...of Sydney, Australia.
Eye examinations were performed at baseline and at 5- and 10-year follow-up visits. Lens photographs were taken and graded by masked graders using the Wisconsin Cataract Grading System.
Incidences of nuclear cataract, cortical cataract, posterior subcapsular cataract (PSC), and cataract surgery.
Ten-year person-specific incidences were 36.0% for nuclear cataract, 28.0% for cortical cataract, 9.1% for PSC, and 17.8% for cataract surgery. Corresponding rates were 31.7%, 24.4%, 8.2%, and 14.4%, respectively, in men and 39.3%, 30.8%, 9.8%, and 20.1%, respectively, in women. The incidence for each type of cataract and cataract surgery was positively associated with age (P<0.0001). Women had a significantly higher incidence than men for nuclear cataract (P = 0.04), cortical cataract (P = 0.007), any cataract (P = 0.0006), and cataract surgery (P = 0.03) after adjusting for age. There was no significant gender difference for PSC. The mean age at cataract surgery was 75.8 years, and there was no significant gender difference (P = 0.9). Among persons who developed any cataract, 22% had more than one type and 1.3% had all 3 types present. Nuclear cataract and PSC were significantly associated with visual impairment (visual acuity worse than 20/40).
Age- and gender-specific cataract incidences in this study were similar to those reported from the U.S. Beaver Dam Eye Study. In this study, 72% of the participants were affected by cataract or had had cataract surgery over the 10-year follow-up period.
Uveal metastasis from carcinoma is the most common cause of ocular malignancy in adults and represents an increasing problem in the context of an ageing population and enhanced survival of stage IV ...cancer patients. The reported prevalence of clinically evident uveal metastases in carcinoma patients ranges from 2% to 9%, with breast and lung cancer together accounting for between 71% and 92% of cases. Most patients (66–97%) have a known history of cancer and, although the majority have metastatic lesions elsewhere, up to 33% may present with an isolated ocular metastasis. These lesions may progress rapidly and are potentially sight‐threatening. Early diagnosis and appropriate timely treatment are therefore of paramount importance to maintain patients' quality of life. The diagnosis is usually clinical and detailed descriptions of symptomatology and physical characteristics are provided. In 21–50% of patients, involvement is bilateral. External beam radiotherapy (EBRT), chemotherapy, hormone and biological therapies, brachytherapy, transpupillary thermotherapy, laser photocoagulation/photodynamic therapy and enucleation are therapeutic modalities described in the literature for the management of uveal metastases. The strongest evidence favours timely EBRT for the management of sight‐threatening uveal metastases. The published evidence supporting EBRT for sight‐threatening uveal metastases was given a grade B (strong support for recommendation). Newer alternative therapies are emerging and may have a role in selected patients; however, there are unfortunately few large studies examining such treatments for carcinoma metastatic to the eye. The role of these modalities will be further clarified with the results of larger comparative trials.
Purpose To assess whether alcohol consumption is associated with the long-term incidence of cataract or cataract surgery. Design Population-based prospective cohort study. Methods A total of 3654 ...persons aged 49+ years were examined at baseline and 2564 were re-examined after 5 and/or 10 years. Lens photographs were taken at each visit and assessed using the Wisconsin Cataract Grading System by masked graders. An interviewer-administered questionnaire was used to collect information on alcohol consumption. Results No significant associations were observed between alcohol consumption and long-term risk of nuclear, cortical, and posterior subcapsular cataract. However, after adjusting for age, gender, smoking, diabetes, myopia, socioeconomic status, and steroid use, total alcohol consumption of over 2 standard drinks per day was associated with a significantly increased likelihood of cataract surgery, when compared to total daily alcohol consumption of 1 to 2 standard drinks (adjusted odds ratio OR 2.10, 95% confidence interval CI 1.16-3.81). Abstinence from alcohol was also associated with increased likelihood of cataract surgery when compared to a total alcohol consumption of 1 to 2 standard drinks per day (adjusted OR 2.36, 95% CI 1.25–4.46). Conclusion A U-shaped association of alcohol consumption with the long-term risk of cataract surgery was found in this older cohort: moderate consumption was associated with 50% lower cataract surgery incidence, compared either to abstinence or heavy alcohol consumption.
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Purpose: To assess the associations between fasting blood glucose and the long‐term incidence and progression of cataract.
Methods: A total of 3654 persons aged 49+ years were examined at ...baseline with fasting blood glucose measured, and 2454 re‐examined after 5 and/or 10 years. Lens photographs from each visit were used to assess cataract incidence and progression. Associations between baseline fasting blood glucose and incidence and progression of cortical, nuclear and posterior subcapsular (PSC) cataract were assessed using discrete logistic regression and change‐point models.
Results: After adjusting for potential confounders, baseline fasting blood glucose was associated with the 10‐year incidence of cortical cataract with a threshold at blood glucose level of 6.0 mm (odds ratio OR 1.79, 95% confidence interval CI 1.25–2.57 for fasting glucose ≥6.0 mm compared to fasting glucose <6.0 mm). Each 1.0 mm increase in fasting glucose was also associated with higher 5‐year progression of PSC (OR 1.25, 95% CI: 1.15–1.35), 10‐year progression of cortical (OR 1.14, 95% CI: 1.01–1.27) and nuclear (OR 1.20, 95% CI: 1.01–1.43) cataract, with no thresholds detected.
Conclusions: In this primarily nondiabetic older population, baseline fasting blood glucose was associated with the long‐term incidence of cortical cataract and long‐term progression of all three cataract subtypes.
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