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Paecilomyces tenuipes is a very popular entomopathogenic fungus and is considered as a health food in China. The fruiting body cultivated in barley grain contained spirotenuipesine A and B and trichothecane mycotoxins. P. tenuipe is indicated as a promising source for producing various biologically active substances including trichothecanes.

Background/Aims: Despite the presence of several diagnosis scales for delirium, no prediction scale that is specific for postoperative delirium after abdominal surgery is available. We sought to create a novel delirium prediction system that is specific for abdominal surgery. Methods: This study included 213 consecutive patients who required management in the surgical ICU following abdominal surgery. The Neelon and Champagne (NEECHAM) Confusion score was monitored throughout the postoperative course and patients with low NEECHAM score ( ⩽ 26) were diagnosed as having delirium. Results: Seventy-three patients (34%) were categorized in the delirium group. Multivariate analyses indicated that an age >70 years, hypertension, those undergoing hepatopancreatobiliary or upper gastrointestinal surgeries, a serum albumin level <2.5 g/dl on postoperative day (POD) 3 or 5 and a ⩾ 6 mEq/l gap in the serum sodium level between the preoperative value and that on POD 3 were independently associated with a low NEECHAM score ( ⩽ 26). When the presence of each risk was counted as 1 point, 21 patients had ⩾ 4 points and 15 of them (71%) had low NEECHAM score. Conclusion: The scoring system combining multiple risk factors may be useful for predicting patients with an elevated risk for postoperative delirium after abdominal surgery. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effects of nilvadipine on the progression of central visual field defect in retinitis pigmentosa (RP). Design: Prospective, randomized, nonmasked, single-center trial. Methods: Patients with RP were randomly divided into a treated group receiving oral nilvadipine at 4 mg/day for ≥30 months and a control group receiving tocopherol nicotinate at 300 mg/day, helenien at 15 mg/day or no medication for the same periods. Progression of RP was evaluated using the 10-2 SITA Fast Program of the Humphrey Visual Field Analyzer, and regression coefficients calculated from the time courses of mean deviation (MD slope) were compared between groups. Results: Nineteen patients in the treated group and 14 patients in the control group completed the follow-up for ≥30 months. The mean (±standard deviation) duration of observation was 48.8 ± 11.8 months (median 48 months, range 30-66 months) for the treated group and 49.2 ± 18.1 months (median 48 months, range 30-90 months) for the control group (p = 0.94). Mean (±standard error of the mean, SEM) regression coefficients of the averaged MD values for the initial 30 months were -0.35 ± 0.17 dB/year in the treated group and -0.75 ± 0.06 dB/year in the control group (p < 0.01). Mean (±SEM) MD slopes for total observational periods were -0.49 ± 0.17 dB/year in the treated group and -0.89 ± 0.16 dB/year in the control group (mean ± SEM, p = 0.042). Conclusion: Nilvadipine at 4 mg/day significantly retarded progression of central visual field defects in RP in this small patient series. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Entomopathogenic fungi forming fruiting bodies have been employed as tonics and antitussives from ancient times. Paecilomyces tenuipes, which is also called Isaria japonica, is a very popular entomopathogenic fungus and is often considered a health food in northeast Asian countries such as China, Korea, and Japan. We cultivated the fruiting bodies of Paecilomyces tenuipes. Among the large-scale cultivations, fruiting body grown in barley grain contained two novel spirocyclic trichothecane derivatives, spirotenuipesine A (1) and B (2), and known trichothecane mycotoxins. Compounds 1 and 2 showed potent activity in neurotrophic factor biosynthesis in glial cells. The isolation of these compounds indicated that P. tenuipes is a promising source for producing various biologically active substances including trichothecanes. It is noteworthy that trichothecane mycotoxins are present in Paecilomyces tenuipes, which is typically used in medicinal health food. [ABSTRACT FROM AUTHOR]

Current antipsychotics used to treat schizophrenia have associated problems, including serious side effects and treatment resistance. We recently identified a significant association of schizophrenia with exonic copy number variations in the Rho GTPase activating protein 10 (ARHGAP10) gene using genome-wide analysis. ARHGAP10 encodes a RhoGAP superfamily member that is involved in small GTPase signaling. In mice, Arhgap10 gene variations result in RhoA/Rho-kinase pathway activation. We evaluated the pharmacokinetics of fasudil and hydroxyfasudil using liquid chromatography-tandem mass spectrometry in mice. The antipsychotic effects of fasudil on hyperlocomotion, social interaction deficits, prepulse inhibition deficits, and novel object recognition deficits were also investigated in a MK-801-treated pharmacological mouse schizophrenia model. Fasudil and its major metabolite, hydroxyfasudil, were detected in the brain at concentrations above their respective K i values for Rho-kinase after intraperitoneal injection of 10 mg kg−1 fasudil. Fasudil improved the hyperlocomotion, social interaction deficits, prepulse inhibition deficits, and novel object recognition deficits in MK-801-treated mice in a dose-dependent manner. Following oral administration of fasudil, brain hydroxyfasudil was detected at concentration above the K i value for Rho-kinase whilst fasudil was undetectable. MK-801-induced hyperlocomotion was also improved by oral fasudil administration. These results suggest that fasudil has antipsychotic-like effects on the MK-801-treated pharmacological mouse schizophrenia model. There are two isoforms in Rho-kinase, and further investigation is needed to clarify the isoforms involved in the antipsychotic-like effects of fasudil in the MK-801-treated mouse schizophrenia model. [Display omitted] • Fasudil and hydroxyfasudil concentrations reached K i values for Rho-kinase with fasudil (10 mg kg−1, i.p.). • Fasudil improved MK-801-induced deficits in locomotion, social behavior, prepulse inhibition and novel object recognition. • Fasudil may have antipsychotic-like effects comparable to haloperidol and clozapine in schizophrenia. [ABSTRACT FROM AUTHOR]

Background: A patient developed choroidal neovascularization (CNV) in one eye during treatment for bilateral recurrent central serous chorioretinopathy (CSC) and was intravitreously injected with bevacizumab; she developed multiple evanescent white dots and serous retinal detachment(SRD)., Case: A 50-year-old women had a history of CSC OD at the age of 29 years. On initial examination, CSC OD was noted, and multiple detachments of the retinal pigment epithelium OU were observed. While the CSC in the right eye was successfully treated by laser photocoagulation, it spread to both eyes following this episode. Examination of the right eye by optical coherence tomography (OCT) following the recurrence of the CSC showed slight elevation of the retinal pigment epithelial layer in the central fovea, but this finding disappeared with the resolution of the CSC. However, as the CSC combined with CNV (Gass type 2) recurred within 1 year, the patient was intravitreously injected with bevacizumab. On the day following the injection, SRD OD occurred, and on the 7th day following the injection many white lesions varying in size appeared in the deep layer of the retina, but they healed 3 weeks later, leaving only the CNV. The CNV was cured later by additional photodynamic therapy., Conclusion: Since the lesions of the fundus observed immediately after the bevacizumab administration resolved spontaneously without sequelae, they were retrospectively diagnosed as a white dot syndrome-like disease. The white dot syndrome-like disease is suggested as a rare complication of bevacizumab.

Purpose: Mycosis of the orbital apex is often fatal. We report case of orbital apex syndrome, which appeared to have been caused by hypertrophic pachymeningitis with positive systemic mycosis antigens treated with systemic corticosteroid combined with antimicrobiotic therapy., Case: A 57-year-old woman presented with disturbed ocular motility and visual disturbance of her left eye. She had rheumatoid arthritis. Magnetic resonance imaging(MRI) showed an abnormal blush in the left orbital apex and meningeal thickening in the cranial base, leading to the diagnosis of hypertrophic pachymeningitis. She also had candidemia. Systemic corticosteroids combined with antimicrobiotic therapy resulted in improved clinical ocular manifestations. She died 13 months later due to interstitial pneumonia., Conclusion: The diagnosis of this case was difficult because of the candidemia. But the effective steroid response indicates that the probable cause was hypertrophic pachymeningitis due to RA. To avoid complications, hypertrophic pachymeningitis associated with fungemia should be treated with corticosteroids combined with antimicrobiotic therapy.

Background: This is a report on a case of suspected orbital mucormycosis after hematological examination, for whom local administration of antifungal drugs was markedly effective., Case Report: A 65-year-old male developing phlegmon of the left orbit was seen at our clinic. Computed tomography revealed increased density of soft tissues and swollen external rectus muscle without any shadow of a tumor mass. The lesion was not responsive to the drip infusion of imipenem, or to oral administration of nonsteroid preparations, or to instillation of antibacterial drugs. Serum IgE levels were high, and it was suspected that the patient had orbital mycosis. After switching medication to fluconazole, injection and edema of the bulbar conjunctiva worsened, and a cable-shaped mass was palpable in the inferior margin of the orbit. Later, serum Mucor IgE antibody was found to be positive, so the patient was suspected to have mucormycosis. Medication was changed to a frequent instillation of Amphotericin B. Since edema of the bulbar conjunctiva improved, injection of the same drug under the Tenon's capsule was also given. One month after the hospital stay, the inflammatory findings of the left eye disappeared with a decrease in serum IgE levels and serum Mucor antibody., Conclusions: In cases where orbital mucormycosis is suspected, cure may be expected even by the local administration of Amphotericin B if the inflammation is localized in the anterior part of the orbit. In this disease, it is possible that examination of serum IgE and serum Mucor IgE antibody is useful for diagnosis and assessment of the clinical effects.

Purpose: We evaluated retrospectively the surgical outcome of trabeculectomy in patients with advanced glaucoma., Methods: We studied 18 eyes of 18 patients with advanced glaucoma (mean age: 71.2 years, mean follow-up period: 41.1 months). In each eye, the visual field was at stage 5 of Aulhorn-Greve's classification before surgery., Results: Two eyes showed extreme hypotony (< 2 mmHg) 3 days after surgery and lost the central visual field permanently. Another 2 of 4 eyes which could not be maintained below 15 mmHg showed a worsening of visual field disturbance within stage 5 of Aulhorn-Greve's classification. The final visual acuity was 0.7 or better in 9 eyes (50.0%), 0.1 or worse in 2 eyes (11.1%). The final intraocular pressure (IOP) was below 10 mmHg without and with medication in 8 eyes (44.4%) and 2 eyes (11.1%) respectively. The final IOP was below 15 mmHg without and with medication in 11 eyes (61.1%) and 3 eyes (16.7%) respectively. Postoperative complications were observed in 4 eyes (22.2%)., Conclusions: The cause of postoperative central visual field worsening was associated with extreme intraocular hypotony (2 mmHg) rather than IOP elevation due to bleb dysfunction. This surgery may be effective as 14 eyes (78%) were able to maintain visual acuity and the central visual field.