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Background The relationship between hyperuricemia (HUA) and cardiovascular disease was observed in some epidemiological studies. However, the association between HUA and chronic coronary syndrome (CCS) after percutaneous coronary intervention (PCI) is not fully elucidated. Purpose The purpose of this study was to investigate the prognostic impact of HUA in patients with CCS after PCI. Methods This study is a retrospective, multicenter, observational study. We developed the Clinical Deep Data Accumulation System (CLIDAS), which consists of 6 university hospitals and the national cardiovascular center in Japan, directly obtains clinical data including patients background, laboratory data, echocardiogram, electrocardiogram, cardiac catheterization report, prescription, and long-term outcome from electronic medical records. A total of 9936 consecutive patients after PCI were analyzed. Of them, 5138 patients with CCS after PCI during April 2013 and March 2019 were analyzed, and divided into HUA group (patients with HUA at baseline, n=1724) and non-HUA group (patients without HUA at baseline, n=3414). HUA was defined as a serum uric acid levels ≥7.0 mg/dL for men or ≥6.0 mg/dL for women and/or taking urate-lowering drugs. The primary outcome was the major cardiovascular events (MACE) defined as being the composite of cardiovascular death, myocardial infarction, and hospitalization for heart failure. Results The median follow-up duration was 910 days (interquartile range: 307–1479 days). The proportion of male (78% vs. 78%) and age (71±11 vs. 71±10) were similar between the HUA and the non-HUA groups. The prevalence of hypertension (87% vs. 82%), atrial fibrillation (9% vs. 5%), and history of previous hospitalization for heart failure (15% vs. 6%) and baseline creatinine value (1.8±2.3 vs. 1.5±2.0 mg/dL) were significantly higher in the HUA group. In contrast, the prevalence of diabetes (43% vs. 48%) was significantly lower in the HUA group. The incidence of MACE was significantly higher in the HUA group than in the non-HUA group (13.1% vs. 6.4%, log rank P Conclusion The real-world database CLIDAS revealed that hyperuricemia was significantly associated with the increase of MACE in patients with CCS after PCI. This result sheds light on the significant role of urate in prediction of prognosis, suggesting the possibility of new therapeutic approaches using urate-lowering drugs or SGLT2 inhibitors for the CCS patients. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Jichi Medical University, Tochigi, Japan, and Kowa Co., Ltd

Purpose The purpose of this article is to report 3 cases of corneal allograft rejection that occurred in temporal proximity to administration of the zoster subunit vaccine (RZV). Methods Three cases of corneal transplant rejection that developed after RZV administration were identified. Clinical history, including existence of other risk factors, timing of rejection, corticosteroid therapy at the time of onset of rejection, and course were reviewed. Results The onset of symptoms occurred 5 weeks after the first RZV dose in 1 patient and 1 and 6 weeks after the second dose in the other 2 patients. Coexisting risk factors included history of endothelial keratoplasty in the fellow eye in 1 patient and previous failure of a penetrating keratoplasty because of rejection in a second patient. The third patient had a history of 1 episode of rejection in a previous graft that resolved and then experienced graft failure over several years. In 2 patients, rejection developed despite relatively high levels of topical steroid therapy: prednisolone acetate 1%, 4 × per day in 1 patient and difluprednate 0.05%, 3 × per day in a second patient. Conclusions RZV, which elicits a more robust immune reaction than the zoster live-attenuated vaccine, ZVL, may increase the risk of allograft rejection in immunocompetent patients with preexisting corneal endothelial or penetrating transplants. Based on the available data, it may be reasonable to increase the topical corticosteroid regimen before the first dose, until approximately 3 months after the second dose of ZVL.

Diabetes & Metabolism - In Press.Proof corrected by the author Available online since mardi 1 aout 2017

Purpose Microsporidial stromal keratitis is a rare form of infectious keratitis, with only 7 cases reported in the United States to date. This study was performed to evaluate risk factors, clinical features, and response to therapy. Methods A retrospective review of the medical records of all patients diagnosed with microsporidial stromal keratitis seen in the practices of the authors between 1999 and 2020 was performed. Diagnosis was determined by cytology or histopathology in corneal specimens. Risk factors, presence or absence of distinctive clinical features, and response to medical and surgical therapies were recorded. Results Nine patients-7M:2F, aged 7 to 99 years-with microsporidial stromal keratitis were identified. Exposures to recreational water and hymenopteran insect bites, both epidemiologically linked risk factors for systemic microsporidial infection, were identified in our patients. Presence of stromal edema with features of disciform keratitis and a distinctive granular keratitis were observed in 6 of 9 and 5 of 9 patients, respectively. Poor response to medical therapy was noted. Penetrating keratoplasty was effective in curing the infection. Final visual acuity was 20/40 or better in 6 of 9 patients. Conclusions In patients with slowly progressive keratitis, history of exposure to recreational water or hymenopteran insects should be sought. In patients with corneal edema consistent with disciform keratitis, with evolution to a granular keratitis, microsporidia should be considered in the differential diagnosis. In cases of established microsporidial stromal keratitis, penetrating keratoplasty should be considered if prompt response to medical therapy is not noted.

Water shortages around the world pose a challenge to all living beings, as well as to humanity's abilityto sustain a high quality of life. Reverse osmosis (RO) technology, such as seawater desalination and wastewater reclamation, has become one solution for preventing water shortages. Improving the operation of RO facilities can increase water production. Kurita Water Industries Ltd. has more than 40 years' experience in engineering, operations and maintenance, and optimization of RO facilities, and today we assist RO operators to improve operating conditions with our KURIVERTER™ Treatment Program, which consists of unique chemicals for stable operation of RO systems. The treatment includes maintenance chemicals (for example, scale inhibitors and slime control agents) and emergency chemicals, such as membrane deterioration. This paper introduces case studies of KURIVERTER™ IK-110 with S.sensing™ B equipment to minimize biological fouling that causes downtime, and also the KURIVERTER™ RC series to recover deteriorated RO membrane performance. The key technology behind the KURIVERTER™ Treatment Program is our specialty product, the KURIVERTER™ IK-110 with S.sensing™ B. Using these technologies, an actual RO facility achieved a 14% production increase and a 28% unit cost reduction for permeate. The KURIVERTER™ RC series could recover damaged RO membranes at commercial plants and prolong their effectiveness for more than 3 months at a cost reduction of 60%.

PURPOSE To report the effect of topical antibiotics moxifloxacin 0.3% and gentamicin 0.3% on the clinical efficacy of topical antifungal agent voriconazole 1% in cases of culture- or biopsy-proven fungal keratitis. METHODS Two cases of fungal keratitis in which the addition of topical moxifloxacin or moxifloxacin and gentamicin led to an improved clinical response to topical voriconazole were reviewed retrospectively. RESULTS One patient with clinical resistance of his fungal keratitis to both topical voriconazole and natamycin had resolution of his keratitis with the addition of topical moxifloxacin and gentamicin to voriconazole. One patient who had a poor response to topical voriconazole had a dramatic response to the increase of the voriconazole regimen and addition of moxifloxacin. CONCLUSIONS In a subset of patients with fungal keratitis, the addition of topical moxifloxacin 0.3% or moxifloxacin 0.3% and gentamicin 0.3% may enhance the therapeutic effect of topical voriconazole 1%.

To report a case of polyquaternium-1 (Polyquad, PQ-1)-associated dendritiform keratopathy that developed after exposure to the tear substitute Systane (Alcon Laboratories, Inc, Fort Worth, TX).A retrospective review of the case was performed.Dendritiform keratopathy developed in the patient after an increase in the use of topical Systane from 4 times per day to every hour. Keratopathy resolved with discontinuation of Systane.Polyquaternium-1-associated dendritiform keratopathy can occur in patients who have previously tolerated the preservative. Because keratopathy seems to have developed and improved because of dose-dependent factors, the mechanism is more likely toxicity than hypersensitivity.

We aimed to verify the effectiveness of real-time reverse transcription (rRT) polymerase chain reaction (PCR) for detecting cases of modified measles (M-Me) and for predicting super-spreader candidates through the experience of a measles outbreak dominated by M-Me in Yamagata, Japan, during March–April 2017. We applied rRT-PCR to specimens from 35 cases of M-Me, nine cases of typical measles (T-Me) and nine cases of prodromal stage of T-Me (P-Me). From rRT-PCR among the M-Me cases, peripheral blood mononuclear cells (PBMC) showed the highest positive rate (80.0%), followed by throat swab (48.6%), urine (33.3%) and serum (3.1%). The negative result of PBMC in M-Me cases was recovered by the result of a throat swab. In specimens of PBMC, throat swab and urine, M-Me group showed the significantly higher cycle of threshold (i.e., lower viral load) in the rRT-PCR than T-Me and P-Me groups, respectively. Furthermore, three super-spreaders in T-Me or P-Me showed an extremely low cycle of threshold in their throat swab specimens. rRT-PCR using PBMC and throat swab might be helpful for clinical management and measles control by certain detection of M-Me cases and by predicting super-spreading events resulting from measles cases with the high viral load.

SUMMARYWe previously reported an association between human parechovirus type 3 (HPeV3) and epidemic myalgia with myositis in adults during summers in which an HPeV3 outbreak occurred in children. However, this disease association has not yet been reported elsewhere. We have since continued our surveillance to accumulate data on this disease association and to confirm whether myalgia occurs in children as well as adults. Between June and August 2014, we collected 380 specimens from children with infectious diseases. We also collected clinical specimens from two adult and three paediatric patients suspected of myalgia. We then performed virus isolation and reverse-transcription–PCR using the collected specimens. We detected HPeV3 in 26 children with infectious diseases, which we regarded as indicating an outbreak. We also confirmed HPeV3 infection in all patients suspected of myalgia. In particular the symptoms in two boys, complaining of myalgia and fever, closely matched the criteria for adult myalgia. Based on our findings from 2008, 2011 and 2014, we again urge that clinical consideration be given to the relationship between myalgia and HPeV3 infections during HPeV3 outbreaks in children. Furthermore, our observations from 2014 suggest that epidemic myalgia and myositis occur not only in adults but also in children.

Due to the rapid progress of technology and severe competition in market, recent industrial products are required to exhibit high quality and functionality. At the same time products are required to be environmentally conscious. Therefore it is important to achieve appropriate product reliability with minimum resource consumption. In the total product lifecycle there exist various kinds of disturbances which may deteriorate product quality and functionality. A reliability design method is proposed based on prediction of product behaviour deterioration and its influence on product functional failure. Effectiveness of the proposed method is evaluated by mechatronics product design.

Purpose To describe dendritiform keratopathy associated with exposure to polyquaternium-1, a common preservative found in contact lens solutions and tear replacement products. Design Case series. Participants Sixteen patients who demonstrated dendritiform keratopathy during topical ophthalmic exposure to polyquaternium-1. Methods Records were reviewed of all patients diagnosed with dendritiform keratopathy between 1999 and 2014 who had documented exposure to contact lens care disinfecting solutions or artificial tear solutions containing polyquaternium-1. Patients were excluded who had coexisting potential causes for dendritiform keratopathy, such as prior herpes simplex keratitis, varicella-zoster viral keratitis, the linear form of Thygeson's superficial keratitis, epithelial regeneration line, Acanthamoeba keratitis, mucus plaque keratopathy, medication-related keratopathy, or limbal stem cell deficiency characterized by conjunctivalization of the corneal epithelium. Main Outcome Measures Effect of discontinuation of exposure to polyquaternium-1 on the dendritiform keratopathy. Results Sixteen patients demonstrated dendritiform keratopathy after exposure to the preservative polyquaternium-1. Thirteen patients had a history of recent exposure to contact lens disinfecting solutions (Opti-Free, Equate) containing polyquaternium-1. Three patients used a tear replacement product (Systane) containing a polyquaternium-1 preservative. Four patients were treated with antiviral medications for presumed herpes simplex keratitis; 4 patients underwent diagnostic testing for Acanthamoeba keratitis. Two additional patients were diagnosed sequentially with herpes simplex keratitis, then Acanthamoeba keratitis before referral. All dendritiform lesions resolved within 2 to 6 weeks after elimination of exposure to polyquaternium-1. Conclusions Ophthalmic products containing polyquaternium-1 may cause dendritiform keratopathy that may be confused with infections of the superficial cornea, such as herpes simplex virus keratitis or Acanthamoeba keratitis.

Terpolymers were synthesized by copolymerization of epichlorohydrin with ethylene oxide (EO) and allyl glycidyl ether. The terpolymers were crosslinked by sulfur curing. Conductivity of the crosslinked terpolymer compositions was investigated for application to an electrophotographic system. The composition containing 71 mol % EO units in the terpolymer gave high and stable conductivity over a wide range from low temperature and low humidity to high temperature and high humidity conditions. The conductivity of crosslinked terpolymer composition satisfied Ohm's law against the applied voltage from 10 to 1000 V, which is necessary for the electrophotographic system. The conductivity increased by the addition of a small amount of electrolyte. The staining ascribable to the migration of electrolyte was not observed, when 3 parts per hundred rubber by weight of octadecyltrimethylammonium perchlorate was doped to the crosslinked terpolymer composition whose EO content in the terpolymer was 71 mol %. © 2005 Wiley Periodicals, Inc. J Appl Polym Sci 98: 825–830, 2005

High molecular weight poly[epichlorohydrin-co-(ethylene oxides)] [P(EH/EO)s] composed of high ethylene oxide (EO) content were synthesized by a coordination anionic polymerization of epichlorohydrin (EH) and EO and were used as matrixes for polymer solid electrolytes. The glass-transition temperature of P(EH/EO)s was linearly shifted to the low temperature with the increase of EO content. The melting temperature attributable to the EO crystalline phase was detected in P(EH/EO)s having EO units of >81 mol %, but their heat of fusion was small. The temperature dependence of ionic conductivity of the P(EH/EO)s doped with LiClO4 was expressed by WLF equation. P(EH/EO), whose EO content was 81 mol %, showed the highest ionic conductivity at 30°C when LiClO4 was doped in the concentration of [Li]/[–O–] = 0.05, and it was 2.2 × 10−5S/cm at 30°C. © 2004 Wiley Periodicals, Inc. J Appl Polym Sci 95: 178–184, 2005

Nocardial conjunctivitis associated with silicone tubing is an extremely rare finding. The authors present a case of a 52-year-old woman with previous dacryocystorhinostomy and silicone tube placement 3 years prior who presented with OD redness and discharge for 1 week. On examination, the patient was noted to have mucoid discharge and crusting surrounding the silicone tube. The tube debris was sampled, and the culture was positive for Nocardia nova complex sensitive to trimethoprim/sulfamethoxazole and amikacin. Silicone tube colonization and N. nova complex conjunctivitis are both rare but should be considered in the differential diagnosis of patients with indwelling silicone tubes presenting with chronic conjunctivitis resistant to fluoroquinolones and tobramycin.

PURPOSE The purpose of this study was to report an unusual pattern of immunoglobulin deposition in the corneas of a patient with dysproteinemia. METHODS Clinical examination, slit lamp examination, a deep lamellar corneal biopsy, and serum and aqueous protein electrophoresis were obtained. RESULTS Slit lamp evaluation revealed amorphous, cloud-like opacities in the midperiphery at the level of deep stroma and Descemet's membrane. Electron microscopy demonstrated deep lamellar extracellular deposits consistent with immunoglobin. The serum protein electrophoresis revealed a monoclonal IgG kappa band, but the aqueous electrophoresis showed no bands in the gamma region. CONCLUSION This case documents a rare pattern of immunoglobulin deposition in the corneas in a patient with gammopathy. Despite its deep corneal distribution, the analysis of the aqueous specimen suggests that the source of the immunoglobulin is through a route other than from the aqueous.

The morphology, dynamic mechanical properties and ionic conductivity of high molecular mass comb-shaped poly(oxyethylene)s with tri(oxyethylene) side chains (TECs) were investigated, when LiClO4 was doped at the concentration of [Li]/[ —O—] = 0.05 ∼ 0.15. The samples were TEC-11 and TEC-18, the contents of tri(oxyethylene) side chain of which were 11 and 18 mol%, respectively. With increasing salt concentration, the glass transition temperature increased and the melting temperature decreased followed by the disappearance of the melting point. By adding the salt at the concentration of [Li]/[—O—] = 0.10 or 0.15, an alternative structure was suggested to be formed although the poly(oxyethylene) matrix was completely amorphous. Due to the morphological characteristics of TECs and the concentration of the salt, both TEC-11 and TEC-18 exhibit the high ionic conductivities of 10−4 S/cm at 30°C, when the salt was doped at the concentration of [Li]/[—O—] = 0.10. The high molecular mass, over 106, of TECs gave rubbery electrolyte films without chemically crosslinked structure. The addition of the salt to TECs decreased the shear storage modulus at room temperature and expanded the temperature range of the rubbery plateau region within the range of salt concentrations studied here.

High molecular mass copolymers (P(EH/EO)s) were synthesized by coordination anionic polymerization of ethylene oxide (EO) and epichlorohydrin (EH), and P(EH/EO)s were used for the preparation of the ion-conducting matrix. The copolymers having EO unit contents of less than 63 mol% were amorphous, and subjected to the complexation with lithium perchlorate. The temperature dependence of ionic conductivity of the P(EH/EO)/LiClO4 complexes was expressed by the Williams–Landel–Ferry equation. Optimal conductivity was observed as a function of salt concentration. This is the result of two contradictory factors: the increase of glass transition temperature (negative for the ionic conductivity) and the increase of carrier number (positive for the ionic conductivity) with increasing lithium perchlorate concentration. The ionic conductivity strongly depended on EO unit contents in the copolymers. The introduction of EO units to poly(epichlorohydrin) main chain increased the ionic conductivity as did the addition of 20 wt% poly(oxyethylene) glycol monomethylether of molecular mass 750. © 2000 Society of Chemical Industry

Conjunctival entrapment of cilia is form of ocular irritation that to our knowledge has not yet been described. Scarring predisposes the conjunctiva to this phenomenon by creating blind recesses in which loose cilia can become entrapped. Once caught, the rigid cilia can act as a mechanical irritant or act as a nidus for microbial growth. We present herein three patients with entrapped cilia and discuss their pathophysiology and management. The symptoms in all three patients resolved with conjunctivoplasty and removal of the cilia.

Novel high molecular weight comb-shaped polyethers were synthesized and used as the matrix of a polymer solid electrolyte. Both the main chain and the side chain of these polyethers consist of oxyethylene units. The new polyethers possess film-forming properties, because the weight-average molecular weights were over 106. The short side chains of oxyethylene units gave rise to less crystallization of poly(oxyethylene) segments and to an increase of ionic conductivity when doped with lithium perchlorate. © 1997 SCI.

To report 5 cases of culture-proven fungal keratitis that resolved with moxifloxacin monotherapy.Case reports and review of medical literature. Five patients with fungal keratitis were treated with topical moxifloxacin.All 5 patients had resolution of their infection with topical moxifloxacin monotherapy.Topical fluoroquinolone agents may have significant antifungal properties. However, the vast majority of fungal keratitis patients cannot be cured with fluoroquinolone monotherapy. An initial response of keratitis to topical fluoroquinolone therapy should not lead to the assumption that the infection is bacterial because the possibility of fungal infection cannot be ruled out on that basis.

Purpose: To evaluate the efficacy of oral acyclovir in treating stromal keratitis caused by herpes simplex virus (HSV) in patients receiving concomitant topical corticosteroids and trifluridine. Methods: The authors performed a randomized, double-masked, placebo-controlled, multicenter trial in 104 patients with HSV stromal keratitis without accompanying HSV epithelial keratitis. Sample size was chosen so that a 5%, one-tailed test would have an 80% chance of detecting a doubling of the median time to treatment failure. Patients were randomized to receive a 10-week course of either oral acyclovir (400 mg 5 times daily, n=51) or placebo (n = 53). All patients also received a standard regimen of topical prednisolone phosphate and trifluridine. Ophthalmologic examinations were performed weekly during the 10-week treatment period, every 2 weeks for an additional 6 weeks, and at 6 months after entry into the trial. Results: The median time to treatment failure (defined as worsening or no improvement of stromal keratitis or an adverse event) was 84 days (95% confidence interval, 69-93 days) for the acyclovir group and 62 days (95% confidence interval, 57-90 days) for the placebo group. By 16 weeks, 38 patients (75%) in the acyclovir group and 39 patients (74%) in the placebo group had failed treatment. Also by that time, the keratitis had resolved with trial medications, and there was no subsequent worsening in nine patients (18%) in the acyclovir group and ten (19%) in the placebo group. None of these results were significantly different between the two groups. However, visual acuity improved over 6 months in significantly more patients in the acyclovir group than in the placebo group. Conclusion: There was no statistically or clinically significant beneficial effect of oral acyclovir in treating HSV stromal keratitis in patients receiving concomitant topical corticosteroids and trifluridine with regard to time to treatment failure, proportion of patients who failed treatment, proportion of patients whose keratitis resolved, time to resolution, or 6-month best-corrected visual acuity. Visual acuity improved over 6 months in more patients in the acyclovir group than in the placebo group.

Background: Infectious crystalline keratopathy is a distinctive clinical entity characterized by bacterial replication within the cornea without inflammation. The authors report on a patient with infectious crystalline keratopathy due to Streptococcus pneumoniae serotype 11F. They used this isolate to study the contribution of the pneumococcal polysaccharide capsule to the pathogenesis of the infectious crystalline keratopathy. Methods: Aliquots containing 10 6 colony-forming units of pneumococci serotype 11F, serogroup 9 or 15, were inoculated into New Zealand white rabbit corneas. The corneas were examined at 24, 48, and 72 hours. Representative corneas were excised at 24 hours and processed for histopathologic analysis. Results: Pauci-inflammatory crystalline lesions developed in all corneas inoculated with the serotype 11F ocular isolate by 24 hours. Suppurative keratitis developed in control corneas inoculated with serogroup 9 or 15 pneumococci. The nonocular 11F isolates produced lesions with some features compatible with infectious crystalline keratopathy. Conclusion: Different pneumococcal serotypes vary in their ability to produce infectious crystalline keratopathy. Because serotype differences reflect differences in the antigenic polysaccharides of the bacterial capsule, this study suggests that properties of the pneumococcal capsule may influence the initial development of infectious crystalline keratopathy.

Purpose: Spontaneous enophthalmos and hypoglobus, in the absence of other symptoms and unrelated to trauma or surgery, may be alarming to both physician and patient. The authors describe the clinicopathologic features of a benign syndrome ("silent sinus syndrome") with this constellation of features and discuss the possible pathophysiology. Methods: A multicenter retrospective search for similar clinical cases was performed. All clinical records, computed tomographs, and pathology reports for each case were reviewed at one center. A literature search for similar cases also was conducted. Results: Nineteen cases of a new syndrome are presented. This syndrome affects individuals at approximately the fourth decade of life (average age, 36 years; range, 29–46 years); is characterized by bone resorption and remodeling of the orbital floor due to otherwise asymptomatic maxillary sinus disease; is associated with ipsilateral maxillary sinus hypoplasia; and is not fully explained by any previously described, classic cystic lesion of the maxillary antrum. Conclusion: Enophthalmos and hypoglobus unassociated with prior trauma, surgery, or other symptoms may represent "silent sinus syndrome," which is ipsilateral maxillary sinus hypoplasia and orbital floor resorption.

Purpose To evaluate the prevalence, predisposing factors, and outcomes of bacterial and fungal scleritis. Methods We reviewed the clinical findings, therapeutic interventions, and visual outcomes of patients with suppurative scleral inflammation without preceding microbial keratitis who had microorganisms isolated from scleral scrapings. Design Retrospective interventional case series. Results Of 349 patients with scleritis diagnosed from 1999 to 2009, 6 adults (1.7%) presented with suppurative inflammation of the anterior sclera due to Pseudomonas aeruginosa (2), Streptococcus pneumoniae (2), Staphylococcus aureus (1), and Scedosporium apiospermum/Pseudallescheria boydii (1). Each had ocular surgery of the affected eye before presentation. Intraocular extension occurred in 2 eyes. After local and systemic antimicrobial therapy, all improved without evisceration or enucleation, and 4 attained vision of 20/60 or better. Conclusions Bacterial or fungal scleritis is an uncommon ocular infection that can belatedly follow anterior segment procedures. Antimicrobial therapy and surgical intervention can successfully control progressive suppuration and reduce vision-limiting complications.

Objective To study the epidemiology, clinical observations, and microbiologic characteristics of fungal keratitis at tertiary eye care centers in the United States. Design Retrospective multicenter case series. Participants Fungal keratitis cases presenting to participating tertiary eye care centers. Methods Charts were reviewed for all fungal keratitis cases confirmed by culture, histology, or confocal microscopy between January 1, 2001, and December 31, 2007, at 11 tertiary clinical sites in the United States. Main Outcome Measures Frequency of potential predisposing factors and associations between these factors and fungal species. Results A total of 733 cases of fungal keratitis were identified. Most cases were confirmed by culture from corneal scraping (n = 693) or biopsies (n = 19); 16 cases were diagnosed by microscopic examination of corneal scraping alone; and 5 cases were diagnosed by confocal microscopy alone. Some 268 of 733 cases (37%) were associated with refractive contact lens wear, 180 of 733 cases (25%) were associated with ocular trauma, and 209 of 733 cases (29%) were associated with ocular surface disease. No predisposing factor was identified in 76 cases (10%). Filamentous fungi were identified in 141 of 180 ocular trauma cases (78%) and in 231 of 268 refractive contact lens-associated cases (86%). Yeast was the causative organism in 111 of 209 cases (53%) associated with ocular surface disease. Yeast accounted for few cases of fungal keratitis associated with refractive contact-lens wear (20 cases), therapeutic contact-lens wear (11 cases), or ocular trauma (21 cases). Surgical intervention was undertaken in 26% of cases and was most frequently performed for fungal keratitis associated with ocular surface disease (44%). Surgical intervention was more likely in cases associated with filamentous fungi ( P = 0.03). Among contact lens wearers, delay in diagnosis of 2 or more weeks increased the likelihood of surgery (age-adjusted odds ratio=2.2; 95% confidence interval, 1.2–4.2). Conclusions Trauma, contact lens wear, and ocular surface disease predispose patients to developing fungal keratitis. Filamentous fungi are most frequently the causative organism for fungal keratitis associated with trauma or contact lens wear, whereas yeast is most frequently the causative organism in patients with ocular surface disease. Delay in diagnosis increases the likelihood of surgical intervention for contact lens-associated fungal keratitis. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.

The authors retrospectively analyzed the visual outcome and incidence of complications of 181 consecutive cases of phacoemulsification performed by eight third-year ophthalmology residents. A posterior chamber intraocular lens was implanted in 179 of these eyes. Vitreous loss occurred in 5.5% of cases. The overall incidence of posterior capsule rupture was 9.9%; of the 18 posterior capsular ruptures, 72% were detected during cortical removal and 22% during nuclear emulsification. Postoperative follow-up for 177 eyes was at least 2 months, and 70% were followed for 6 months or longer. Final best corrected visual acuity of 20/40 or better was obtained in 92.6% of eyes. These results are comparable with previous reports of residents' experience in performing planned extracapsular cataract extraction. With appropriate training and faculty supervision, residents learning to perform phacoemulsification and intraocular lens implantation can achieve acceptable results.

Concerns a hexapod walking robot designed for use in living and working spaces where it is necessary to ascend and descend structures such as stairs. It is designed to carry loads while always maintaining horizontal balance. It has eight CPUs for controlling the movement of twenty driving motors and for detecting attitude and its environment. It can move around autonomously as well as according to the operator's commands. The robot's configuration, structure and mechanism, and intelligence, are discussed

PURPOSE To describe a patient with a history of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) who has experienced two episodes of noninfectious corneal ulceration with perforation that has been successfully managed with nonsurgical therapy. METHODS Case report. RESULTS An 18-year-old male with a history of APECED has been followed up with recurrent keratoconjunctivitis and episodes of microbial keratitis since 4 years of age. Ophthalmic complications have included two episodes of sterile corneal ulceration associated with corneal perforation. These episodes of stromal ulceration associated with a flat anterior chamber were managed with a bandage contact lens, topical antibiotics, and a topical cycloplegic agent. In one instance, addition of cyclosporine led to reformation of the anterior chamber and arrest of the ulcerative process. CONCLUSION Sterile corneal ulceration and perforation associated with APECED may be managed medically to avoid surgical intervention, which has been reported to lead to a poor outcome.

Purpose To identify characteristics associated with cataract occurring during the course of Acanthamoeba keratitis. Design Retrospective observational case series. Participants Eighty-one laboratory-confirmed patients with Acanthamoeba keratitis. Methods Review of clinical records. Main Outcome Measures Development of cataract during management of Acanthamoeba keratitis. Results Rapidly progressive crystalline lens opacification occurred in 9 eyes within 4 to 15 weeks after diagnosis of Acanthamoeba keratitis. Three were associated with inflammatory complications, including anterior scleritis (2 eyes) and iridocyclitis (1 eye). Six others had the abrupt onset of a dense cataract, including 5 with iris atrophy, that occurred during the initial 6 months of therapy with chlorhexidine, a diamidine, and adjunctive corticosteroid. Extracapsular cataract extraction was performed with or after penetrating keratoplasty. Secondary glaucoma developed in 6 of 9 eyes subsequent to iris atrophy (4 eyes) or a cyclitic membrane (2 eyes), and 3 eyes underwent trabeculectomy. Conclusions Cataract may occur and progress during the management of Acanthamoeba keratitis in association with anterior segment inflammation, iris atrophy, and secondary glaucoma.

Purpose To report the clinico-pathologic features of corneal deposits in a patient with multiple myeloma with surgical intervention and follow-up. Design Interventional case report. Methods We reviewed the patient's chart and the relevant literature on immunoglobulin corneal deposits and its prognosis. Results A 52-year-old man with a history of multiple myeloma underwent penetrating keratoplasty sequentially for decreased vision in both eyes secondary to abnormal corneal deposits. Pathologic examination of the keratectomy specimens, including immunohistochemistry and transmission electron microscopy, revealed IgG-kappa immunoglobulin deposits in the predescemetic region in both corneas. After keratoplasty, he regained excellent vision in both eyes, which was maintained at the end of 18 months of follow-up in both eyes despite early signs of recurrence in the right eye. His systemic condition was well controlled during the period of follow-up. Conclusion Corneal deposits in multiple myeloma are well described in the literature, but there are few reports regarding the prognosis and visual function after penetrating keratoplasty. Our report shows that when the systemic condition is well controlled, penetrating keratoplasty has an excellent prognosis in these patients.

Purpose To describe the spectrum and recurrence of herpes simplex virus (HSV) keratitis in children and adolescents. Design Retrospective cohort study. Methods Twenty-three patients younger than age 16 years were diagnosed with HSV keratitis at one institution. Results All children presented with dendritic or punctate epithelial keratitis, and stromal keratitis occurred concurrently with epithelial keratitis in 14 patients (61%). Six patients (26%) had bilateral HSV keratitis. Eleven patients (48%) developed recurrent HSV keratitis at a median of 15 months after the first documented episode. Amblyopia occurred in three children. Conclusion Children with herpetic keratitis may have bilateral ocular involvement and are at risk for recurrent keratitis and amblyopia.

An advanced coke plant total control system developed at Sumitomo Metals is described. It has two main control functions. One is a coal blending ratio control system to attain target coke quality under the planned operating conditions. The other is a coke oven temperature control system to attain the target pushing-out coke temperature under the charged blended coal and coking time. The coke quality is controlled by the goal programming method using a theoretical coking model and an online coal dilatation sensor. The coke temperature is controlled by a heat transfer model in the coke chamber and an optimal regulator based on an autoregressive model. This total control system has been applied at the Wakayama Steel Works, and as a result the coke oven heat consumption and coal cost for the production of coke for iron making use have decreased markedly. >

Whether coronary artery lesion successfully dilated by balloon angioplasty should be stented or not is unclear. The purpose of this study is to evaluate the provisional stent implantation method assessing residual ischemia by pressure wire.Thirty-one patients with de-novo lesions suitable for stenting were enrolled in a pressure wire guided provisional stent study. The pressure wire was used to assess the fractional flow reserve(FFR) before and after balloon angioplasty. When the FFR after angioplasty was less than 0.75, stent implantation was planned. Patients with lesions consisting of an intermediate stenosis proximal to the target lesion, chronic total occlusion, bypass graft and left main lesion were excluded from the study. Stent implantation was permitted even if the FFR was more than 0.75 when the operator thought stenting was necessary. Medical treatment was given with aspirin 162 mg/day, cilostazol 200 mg/day for 6 months and additional ticlopidine 200 mg/day for a month after stenting the lesion.Target vessel was the left anterior descending coronary artery in 19 lesions, the right coronary artery in 3, and the circumflex coronary artery in 9. Stent implantation was performed in seven (23%) of 31 lesions and the other 24(77%) lesions were treated with only balloon angioplasty. The FFR before intervention was 0.58 +/- 0.16, and improved to 0.87 +/- 0.07 (p0.0001). Percentage diameter stenosis before intervention was 70.7 +/- 12.6% and improved to 20.1 +/- 13.3% (p0.0001) after intervention. There was no major cardiac event (death, coronary artery bypass grafting, myocardial infarction, stent thrombosis). Six months follow-up angiography was performed in 27 patients (87%). Angiographic restenosis (percentage diameter stenosisor = 50%) was found in four patients (15%). A new lesion was found in two patients. Target vessel revascularization was performed in six patients (21%).Lesions successfully dilated by balloon angioplasty with FFRor = 0.75 do not require stenting.

Transmyocardial laser revascularization (TMLR) is currently applied to provide clinical benefits in the patients with end-stage coronary artery disease. However, this method is so far indicated only for chronic status of ischemic heart disease. In this study, we have investigated in the canine model whether acute ischemic myocardium could be reperfused by TMLR using CO2 laser. A CO2 laser was used to create transmural myocardial channels. The ischemic areas of 3 cm in diameter were created on the left ventricle with multiple coronary ligations. Laser procedure was carried out 30 minutes after coronary ligation in TMLR group (n = 6), while laser treatment was not performed after coronary ligation in acute myocardial infarction (AMI) group (n = 6). The level of MB isozyme of creatinine kinase (CK-MB) derived from coronary sinus was measured at 0, 3, 6, 12, 18, 24, and 48 hours after coronary ligations, and the pattern of serial CK-MB changing was analyzed. Animals were sacrificed 48 hours after treatment and histologically investigated. The time to peak level of CK-MB in TMLR group appeared significantly earlier (13.0 +/- 2.4 hours) than that in AMI group (22.0 +/- 3.1 hours). The value of CK-MB of 24 hours after ligation in TMLR group (1985 +/- 805 IU/L) was significantly lower than that in AMI group (4759 +/- 778 IU/L). The channels on the gross section after 48 hours of TMLR were patent with some of fibrin network. Red blood cells were scattered in the lumens. It was suggested that acute ischemic myocardium was directly reperfused through the open laser channels from the left ventricular chamber in the canine model.

Transmyocardial laser revascularization (TMLR) using a CO2 laser is clinically attempted in end-stage ischemic heart disease that is not treated by conventional bypass grafting or transluminal angioplasty. Besides, clinical trials of TMLR using a Ho:YAG laser have started recently. In this study, we compared the degree of damage to normal myocardium using these 2 types of lasers. Hearts of adult mongrel dogs were exposed under general anesthesia. Dogs were divided into 2 groups; those with channels made in the left ventricle by CO2 laser (CO2 group, n = 5) and those with channels made by Ho:YAG laser (Ho:YAG group, n = 5). The chest was temporarily closed, then serum MB isozyme of creatinine kinase (CK-MB) and troponin T (TnT) were measured sequentially. Twenty-four hours after laser irradiation, hearts were isolated for pathological studies with hematoxylin-eosin and Masson's trichrome stains. The CO2 group produced CK-MB with a peak of 1162.2 +/- 462.2 IU/l and the Ho:YAG group 1804.0 +/- 992.4 IU/l after 12 hours, and there was a significant difference between two groups (p0.01). The CO2 group produced TnT with a peak of 1.2 +/- 0.4 ng/ml and the Ho:YAG group 11.6 +/- 4.1 ng/ml after 6 hours, and the peak value in Ho:YAG group was significantly higher than that in the CO2 group (p0.001). Thirty channels were confirmed histologically in the CO2 group, and the width of thermal damage layer around the channel lumen was 249 +/- 83 microns. Twenty-seven channels were confirmed histologically in the Ho:YAG group, and the width of thermal damage layer was 760 +/- 288 microns. Thermal damage in the Ho:YAG group was significant greater than that in the CO2 group (p0.01). We concluded that TMLR using a CO2 laser is more suitable for end-stage myocardial ischemia than a Ho:YAG laser in terms of myocardial damage.

Transmyocardial laser revascularization (TMLR) is an alternative surgical procedure for the patients with intractable coronary artery disease. Efficacy of the treatment has been established, however, the mechanism of TMLR is still controversial. In this study, we investigated the effect of TMLR on acute myocardial ischemia with pathological analysis. Under general anesthesia, the hearts of mongrel dogs were exposed. Then, the anterior descending branch of the left coronary artery was ligated to make the ischemic area on the left ventricle. Laser punctures were made 30 minutes after coronary ligation in the TMLR group (n = 5), and no further procedure was performed after coronary ligation in the AMI group (n = 5). One month after these operations, the hearts were extirpated for pathological studies. The avascular area and the viable area in the infarcted area were macroscopically separated by Evans blue dye and triphenyltetrazolium chloride (TTC) staining. Thickness of the left ventricular wall in the infarcted area was also measured and compared. Furthermore, all of the infarcted area and the lased area were microscopically examined with Masson's trichrome stain. The size of the infarcted area in the TMLR group was smaller than that in the AMI group. It was significantly different (p0.05) in the basal and apical regions. As a result, the ratio of the viable area by the avascular area was larger in the TMLR group than in the AMI group. It was significantly different (p0.05) in the apical region. In the basal region, the thickness of the left ventricle in the AMI group was thinner than that of untreated dogs (normal group: n = 5), and there was no difference between the normal group and the TMLR group. Whereas in the apical region, significant difference of the thickness was found among AMI, TMLR, and normal groups (p0.05). In conclusion, our study supported; 1) TMLR reduced overall infarcted size, and increased the viable area in the infarcted area, 2) TMLR prevented the thinning of the left ventricular wall.

The effects of ofloxacin, ciprofloxacin and balofloxacin on the reactive oxygen species (ROS) levels generated by human neutrophils was examined in vitro; ROS generated in a cell-free, xanthine–xanthine oxidase system was also assessed. The species investigated were superoxide radical anion (O2−), hydrogen peroxide (H2O2) and hydroxyl radical (OH·). Both ofloxacin and ciprofloxacin markedly decreased the levels of O2−, H2O2 and OH· generated by human neutrophils. On the other hand, these drugs did not affect any of the ROS examined in the xanthine-xanthine oxidase system. Balofloxacin showed no significant effect on ROS generated by either system. The present study indicates that ofloxacin and ciprofloxacin may exert an anti-inflammatory action by reducing the potent ROS species excessively generated by neutrophils at the sites of inflammation.

Eight patients who developed interstitial pneumonia after surgery for primary lung cancer were reviewed to investigate its causes and the key points in treatment. These patients accounted for 1.8% of 633 operated lung cancer patients at our institution over the last 9 years. Risk factors such as bilateral recurrent laryngeal nerve palsy, preoperative chemoradiotherapy, and extensive mediastinal involvement were present in all of them. Pneumonia developed on the nonoperated side in all patients between the 2nd and 45th postoperative day (mean: 18 days). In most of the patients, faint reticular shadows initially appeared in the lower lobe of the nonoperated lung, rapidly spread to the upper lobe, and finally affected the whole lung. Among these eight patients, the initial five patients died because steroids were only administered after the pneumonia had become widespread, whereas the last three patients received early steroid therapy and were saved. The findings that 1) this pneumonia originated from the lower lobe of the nonoperated lung where blood flow is highest postoperatively, 2) the eosinophil count increased just before the onset of pneumonia, and 3) early steroid therapy and immunosuppressive therapy were effective suggest that an allergic or autoimmune mechanism may play some role in its development. When characteristic reticular shadows appear in the lower lobe on the nonoperated side in a lung cancer patient, even if not associated with any symptoms, an early diagnosis of interstitial pneumonia and initiation of steroid therapy is mandatory to ensure survival.

Purpose To report polymicrobial keratitis in a patient with herpetic stromal keratitis. The initial infecting organism, Burkholderia ambifaria, has not previously been reported to cause microbial keratitis. Methods Clinical evaluation and corneal culture were performed. Results A 59-year-old-man undergoing topical corticosteroid therapy for herpes simplex stromal keratitis developed corneal infection with B. ambifaria. The organism was reisolated 12 days after initiation of hourly therapy with topical levofloxacin 0.5%. At reculture Staphylococcus aureus and Enterococcus spp. were also isolated. The addition of topical amikacin and vancomycin led to resolution of the microbial keratitis. Conclusions Burkholderia ambifaria infected a compromised cornea, exhibited an unusual sensitivity profile, and remained viable after 12 days of therapy with an antibiotic to which it was sensitive by in vitro tests.

Purpose. To describe a case of microsporidia corneal infection in a HIV-negative patient who did not wear contact lenses. Method. Case report and review of literature. Results. This is the first case report of a human immunodeficiency virus-negative individual, a non-contact lens wearer, with microsporidia infection. Conclusion. Microsporidia keratoconjunctivitis may occur in healthy subjects with no antecedent contact lens wear.

Infectious crystalline keratopathy is a distinctive clinical entity characterized by bacterial replication within the corena without inflammation. The authors report on a patient with infectious crystalline keratopathy due to Streptococcus pneumoniae serotype 11F. They used this isolate to study the contribution of the pneumococcal polysaccharide capsule to the pathogenesis of the infectious crystalline keratopathy.Aliquots containing 10(6) colony-forming units of pneumococci serotype 11F, serogroup 9 or 15, were inoculated into New Zealand white rabbit corneas. The corneas were examined at 24, 48, and 72 hours. Representative corneas were excised at 24 hours and processed for histopathologic analysis.Pauci-inflammatory crystalline lesions developed in all corneas inoculated with the serotype 11F ocular isolate by 24 hours. Suppurative keratitis developed in control corneas inoculated with serogroup 9 or 15 pneumococci. The nonocular 11F isolates produced lesions with some features compatible with infectious crystalline keratopathy.Different pneumococcal serotypes vary in their ability to produce infectious crystalline keratopathy. Because serotype differences reflect differences in the antigenic polysaccharides of the bacterial capsule, this study suggests that properties of the pneumococcal capsule may influence the initial development of infectious crystalline keratopathy.

Spontaneous enophthalmos and hypoglobus, in the absence of other symptoms and unrelated to trauma or surgery, may be alarming to both physician and patient. The authors describe the clinicopathologic features of a benign syndrome ("silent sinus syndrome") with this constellation of features and discuss the possible pathophysiology.A multicenter retrospective search for similar clinical cases was performed. All clinical records, computed tomographs, and pathology reports for each case were reviewed at one center. A literature search for similar cases also was conducted.Nineteen cases of a new syndrome are presented. This syndrome affects individuals at approximately the fourth decade of life (average age, 36 years; range, 29-46 years); is characterized by bone resorption and remodeling of the orbital floor due to otherwise asymptomatic maxillary sinus disease; is associated with ipsilateral maxillary sinus hypoplasia; and is not fully explained by any previously described, classic cystic lesion of the maxillary antrum.Enophthalmos and hypoglobus unassociated with prior trauma, surgery, or other symptoms may represent "silent sinus syndrome," which is ipsilateral maxillary sinus hypoplasia and orbital floor resorption.