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Gen Miura, Takayuki Baba, Toshiyuki Oshitari, Shuichi Yamamoto Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan Purpose: The aim of this study is to determine the effect of pupil size of eyes with cataracts on the flicker electroretinograms (ERGs) elicited and recorded with the RETeval system.Patients and methods: Forty-one eyes of 41 patients (mean age, 76.5±7.3 years) that had grade 2 nuclear or cortical cataract without any other abnormalities were studied. Flicker ERGs were recorded before and after mydriatic drops instillation. The ERGs were elicited by the white light delivered at the frequency of 28.3 Hz and intensities of 2, 8, and 32 Td-s. The amplitudes and the implicit times of the flicker ERGs before and after mydriasis were compared.Results: There were no significant differences between the amplitudes before and after mydriasis (P=0.35, 2 Td-s; P=0.31, 8 Td-s; P=0.50, 32 Td-s). There were also no significant differences between the implicit times before and after mydriasis (P=0.86, 2 Td-s; P=0.98, 8 Td-s; P=0.95, 32 Td-s). The mean amplitudes and implicit times of the nuclear and cortical cataracts groups before the mydriasis were also not significantly different from those after mydriasis for all stimulus intensities.Conclusion: The lack of significant differences in the amplitudes and the implicit times of the flicker ERG of cataractous eyes before and after mydriasis indicated that the RETeval flicker ERGs in cataractous eyes is less affected by the pupil diameter. With our earlier study, it was assumed that the effect of cataracts on the RETeval flicker ERGs was due to the opacity of the crystalline lens, and the influence of the cataract would not be reduced or increased by mydriasis. Keywords: electroretinogram, ERG, flicker ERG, cataract, RETeval

Toxoplasma is a common parasite worldwide that mainly affects the brain, lungs and eyes. Although toxoplasmic encephalitis is a lethal disease without treatment, past case reports show most patients with systemic lupus erythematosus who developed toxoplasmic encephalitis were misdiagnosed and treated as neuropsychiatric systemic lupus erythematosus, which led to unfavorable outcomes. We herein describe a case of disseminated toxoplasmosis affecting all the above organs with atypical symptoms, which developed with exacerbation of systemic lupus erythematosus. She had initially manifested with retinochoroiditis without vitritis, mild cognitive impairment and an isolated lung mass. These are completely different from the classic symptoms of toxoplasmosis that have been reported in patients with HIV infection and/or those after hematopoietic transplantation. Our case, together with previously reported cases, suggests the manifestation of toxoplasmosis that develops in systemic lupus erythematosus patients can be different from that seen in conventional cases and varies between individual patients. Our case highlights both the difficulty in and the importance of diagnosing toxoplasmosis in patients with systemic lupus erythematosus and provides helpful information to identify this rare, devastating, yet treatable disease. [ABSTRACT FROM AUTHOR]

This study retrospectively investigated the good parameters on thallium-201 chloride (201Tl) SPECT for early assessment of the therapeutic effects in patients with non-small cell lung cancer. Based on tumor response as determined by chest CT scan about 9 weeks after the end of irradiation with adjuvant chemotherapy, the subjects were divided to the responder group (tumor regression > 50%, n = 13) and non-responder group (tumor regression < 50%, n = 13). 201Tl SPECT was performed before and at the halfway through the course of therapy (average tumor dose, 27.4 Gy +/- 4.5) in all the patients. SPECT was conducted twice 15 min (early scan) and 120 min (delayed scan) after intravenous injection of 148 MBq (4 mCi) of 201Tl. Tumor-to-contralateral normal lung tissue count ratios on both scans were calculated as early and delayed uptake ratios (EUR and DUR), and a retention index (RI) was also derived from these ratios. In the responder group, a significant decrease in DUR and RI halfway through the therapy was observed compared to pretreatment (2.6 +/- 0.6 vs. 3.5 +/- 1.0; p < 0.01, and -2.3% +/- 25.5 vs. 37.4% +/- 17.8; p < 0.001, respectively), even though EUR did not change significantly (N.S.). By contrast, in the non-responder group, there were no significant changes in any of these parameters (N.S.). When comparing DUR and RI for the two groups halfway through the therapy, DUR and RI were significantly lower in the responder group (both; p < 0.01), but no significant difference was noted in EUR (N.S.), and the percent reduction in tumor size did not correlate with the percent decrease in DUR or RI (N.S.). These results indicate that the extent of decrease in DUR and RI after therapy can be a useful parameter for early assessment of the therapeutic effects in patients with non-small cell lung cancer. [ABSTRACT FROM AUTHOR]

In contrast to previous work, the distribution of cholinesterase was found to be ubiquitous in plant leaves. Cholinesterase activity was detected in 91% of the 70 species surveyed from 50 higher plants and three families of ferns. A radiometric assay was used to determine the hydrolysis of acetylcholine by leaf tissue slices in the presence and absence of 29 μM diisopropyl phosphofluoridate. The results obtained using this inhibitor as a criterion for cholinesterase activity were found to be consistent with previous studies using neostigmine as the inhibitor although there were some quantitative differences between the inhibitors. With some of the tested plants acetyl-β-methylcholine was also hydrolyzed, indicating that acetylcholinesterase rather than pseudocholinesterase was present at least in these cases. These findings demonstrate that the relative activity of cholinesterase in leaves can serve as an indicator of organophosphorous anticholinesterase contamination of the environment. [ABSTRACT FROM AUTHOR]

Purpose: To gauge the value of low-vision-specific function and activities of daily living measures (LVFAM) in the assessment of Patient Reported Outcomes (PRO) of Retinitis Pigmentosa (RP)., Study Design: Prospective observation study., Methods: The May-July 2023 Visual activities of daily living (ADL) Survey of the low-vision-specific function and activities of daily living measure (LVFAM) was conducted on 15 RP patients attending our Ophthalmology outpatient clinic. We used the better corrected visual acuity, and the better Mean Deviation (MD) values of the central 10 degrees of Humphrey's visual field as macular sensitivity, and examined the total scores after Rasch Analysis for each of the low-vision-specific function of Daily Living (LVFDL) and the low-vision-specific activities of Daily Living (LVADL) among LVFAM, as well as the relationship between the items., Results: Age 26-78 (mean 60.8), 5 men and 10 women, corrected visual acuity of 0.01-1.0 (mean 0.45) in the better eye, macular sensitivity of 3.47-40.00 (mean 18.60) dB, mean 52.2 for LVFDL and 66.4 for LVADL. The correlations were positive for visual acuity and LVFDL and LVADL, and negative for macular sensitivity, LVFDL and LVADL. In addition, four items were scored 0 by at least 5 (33%) of the LVFDL respondents, and two items were scored 1 by at least 5 (33%) of the LVADL respondents, suggesting that the results differed by question items., Conclusion: The LVFAM was useful not only for the total score but also for each question item in the development strategy of PROs in RP with no treatment., (© 2024. The Author(s).)

Motor imagery is a higher-order cognitive brain function that mentally simulates movements without performing the actual physical one. Although motor imagery has attracted the interest of many researchers, and mental practice utilizing motor imagery has been widely used in sports training and post-stroke rehabilitation, neural bases that determine individual differences in motor imagery ability are not well understood. In this study, using controllability of motor imagery (CMI) test that can objectively evaluate individual ability to manipulate one's imaginary postures, we examined structural and functional features characterizing the brains of individuals with higher controllability of motor imagery, by analyzing T1-weighted structural MRI data obtained from 89 participants and functional MRI data obtained from 28 of 89 participants. The higher CMI test scorers had larger volume in the bilateral superior frontoparietal white matter regions. The CMI test activated the bilateral dorsal premotor cortex (PMD) and superior parietal lobule (SPL); specifically, the left PMD and/or the right SPL enhanced functional coupling with the visual body, somatosensory, and motor/kinesthetic areas in the higher scorers. Hence, controllability of motor imagery is higher for those who well-develop superior frontoparietal network, and for those whose this network accesses these sensory areas to predict the expected multisensory experiences during motor imagery. This study elucidated for the first time the structural and functional features characterizing the brains of individuals with higher controllability of motor imagery, and advanced understanding of individual differences in motor imagery ability., (© 2024. The Author(s).)

Abstract: This review aimed to investigate the effects of electroconvulsive therapy (ECT) on akathisia. We systematically searched MEDLINE and Embase and included case reports on akathisia caused by or treated with ECT. We identified and included 9 articles. Seven articles, representing 10 cases, reported that akathisia improved after ECT. Most cases (7 cases) were diagnosed with a mood disorder, and all 10 cases were treated with antipsychotics. Akathisia was regarded as tardive (3 cases) and severe (4 cases). Although treatments for akathisia, such as adjusting antipsychotics and adding medication for akathisia, were tried before ECT, ultimately none were effective. In all 10 cases, akathisia showed significant improvement after ECT, and nonantipsychotic psychotropics or low-dose antipsychotics were administered as post-ECT treatment. Two articles (5 cases) reported that akathisia occurred after ECT. Three of these cases were diagnosed with a mood disorder, and all 5 cases were treated with perphenazine and tricyclic antidepressants. Akathisia occurred multiple times after ECT, but it was transient. Despite attempts to manage the akathisia, including discontinuation of psychotropics, addition of medication for akathisia, and adjustment of stimulation electrode positions, the outcomes of the interventions were inconsistent. Nonetheless, no persistent akathisia was observed after the end of the ECT course. Although the effects of ECT on akathisia remain unclear because of the paucity of high-quality studies, ECT could be considered particularly for treatment-resistant, tardive, and/or severe akathisia comorbid with mood disorders. Conversely, clinicians should keep in mind that transient akathisia can develop following ECT., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Objectives : Faricimab is a vascular endothelial growth factor A and angiopoietin-2 bispecific antibody. It is a novel therapeutic approach distinct from previous anti-vascular endothelial growth factor agents. This study aimed to evaluate the efficacy of switching from aflibercept to faricimab in the treatment of diabetic macular edema (DME) refractory to aflibercept, with a specific focus on the resolution of macular edema. Materials and Methods : The medical records of 29 eyes of 21 patients with DME that were refractory to intravitreal injections of aflibercept (IVAs) and who had completed the clinical follow-up of at least four intravitreal injections of faricimab (IVFs) were reviewed. The central retinal thickness (CRT), best-corrected visual acuity (BCVA), and the mean period (weeks) until the next injection were measured after the second-to-last IVA, first-to-last IVA, last IVA, and first to fourth IVFs following the transition to IVF. Results : The mean time from the first IVF to the assessment of effectiveness was significantly shorter than the time to the last IVA; however, no significant difference was found in the time from the second, third, and fourth IVFs to the assessment. The mean CRTs after the first and second IVFs were not significantly different from the CRT after the last IVA, but the mean CRT after the third and fourth IVFs was significantly thinner than that after the last IVA ( p = 0.0025 and p = 0.0076, respectively). The mean BCVAs after the third and fourth IVFs significantly improved compared with that after the last IVA ( p = 0.0050 and p = 0.0052, respectively). Conclusions : When switching the treatment to IVF for eyes with IVA-resistant DME, better treatment outcomes are achieved if IVF is performed three or more times.

Blood purification therapy with cytokine-adsorbing hemofilters has been used to treat sepsis-associated hypercytokinemia. Polymethylmethacrylate (PMMA) hemofilters are frequently used for this purpose; however, adsorption and removal of teicoplanin, a therapeutic agent, have been reported. Similar concerns have been shared regarding daptomycin because its structure resembles that of teicoplanin; nevertheless, there have been no reported effects associated with daptomycin in this context. We studied the adsorption of daptomycin onto a PMMA hemofilter in vitro and investigated its adsorption onto hollow fiber membranes by adding cut PMMA membranes to a daptomycin solution. Additionally, the daptomycin solution was circulated in a dialysis circuit connected to a PMMA hemofilter, and changes in daptomycin content were examined. The daptomycin content decreased immediately after adding the hollow fiber membranes, similar to that observed for teicoplanin. The daptomycin content was lower than that of the standard reagent in the dialysis circuit model, reaching values below the measurement limit after 20 min. These results suggested that daptomycin was adsorbed and removed by the PMMA hemofilter. Encountering this effect during clinical use is plausible; therefore, daptomycin administration via a PMMA hemofilter should be avoided during blood purification therapy.

The paraovarian or paratubarian cysts are both situated in the broad ligament between the ovary and fallopian tube. The diagnosis of adnexal torsion is challenging since both symptoms and physical examination are nonspecific. In most cases, the patient presents abdominal pain, followed by nausea and vomiting. Imaging tests, such as ultrasound, are very useful to elucidate the cause of the symptoms in those patients., (Universidad Nacional de Córdoba)

Background: No effective treatment for NAION with strong evidence has been established till date. The aim of this investigator-led, prospective, non-randomized, open-label, uncontrolled multi-center exploratory clinical trial is to evaluate the efficacy and safety of transdermal electrical stimulation (TdES) using skin electrodes in patients with NAION., Methods: Five patients with monocular NAION underwent TdES (10-ms biphasic pulses, 1.0 mA, 20 Hz, 30 min) of the affected eye six times at 2-week intervals. The primary endpoint was the logarithm of the mini-mum angle of resolution (logMAR) visual acuity at 12 weeks compared with 0 weeks. The secondary endpoints were changes in the best-corrected logMAR visual acuity, Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity, and mean deviation (MD) of the Humphrey field analyzer (HFA) 10-2 and HFA Esterman test scores. Additionally, the safety of TdES was evaluated., Results: LogMAR visual acuity improved by ≥ 0.1 in two eyes, and ETDRS visual acu-ity improved by ≥ 5 characters in one eye. The mean change in logMAR visual acuity from week 0 showed an increasing trend. The mean MD of HFA 10-2 showed no obvious change, while HFA Esterman score improved in four eyes. All patients completed the study according to the protocol, and no treatment-related adverse events were observed., Conclusions: TdES treatment may have improved visual acuity and visual field in some patients. Further sham-controlled study in larger cohort is needed on its effectiveness., Trial Registration: UMIN, UMIN000036220. Registered 15 March, 2019, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr&#95;view.cgi?recptno=R000041261 ., (© 2023. Feinstein Institute for Medical Research.)