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Yu Monden, Chikako Nagashima, Noriko Yokote, Fumi Hotokezaka, Satoshi Maeda, Kensuke Sasaki, Ryoji Yamakawa, Shigeo Yoshida Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, JapanCorrespondence: Yu MondenDepartment of Ophthalmology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830 0011, JapanTel +81-942-317574Fax +81-942-370324Email you@med.kurume-u.ac.jpPurpose: The aim of this study was to evaluate the clinical outcomes of management of recurrent pterygium with severe symblepharon using mitomycin C, double amniotic membrane transplantation, cryopreserved limbal allograft, and a conjunctival flap.Patients and Methods: This retrospective case series included 10 eyes of 10 patients with recurrent pterygium with severe symblepharon. Eight patients have diplopia in primary gaze. All patients underwent pterygium excision, application of mitomycin C (MMC), double amniotic membrane transplantation (AMT), cryopreserved limbal allograft (CLA) transplantation, and placement of a conjunctival flap. Outcome measures were visual acuity, astigmatism, and recurrence. Recurrence was defined as the presence of fibrovascular proliferative tissue crossing the limbus.Results: The patients’ mean age was 73.8 years. The mean follow-up period was 3.0 years. The mean preoperative and postoperative best-corrected visual acuities (logMAR conversion) were 0.43 and 0.30, respectively. The mean preoperative and postoperative astigmatism were – 3.89 diopters and – 1.54 diopters, respectively, and there was a significant difference. No recurrence occurred in any of the eyes. Symblepharon was released in all eyes. Diplopia in primary gaze was resolved in all eyes.Conclusion: Management of recurrent pterygium with severe symblepharon using MMC, double AMT, CLA, and a conjunctival flap was an effective treatment.Keywords: pterygium, symblepharon, limbal allograft, amnion, mitomycin C

Masatoshi Haruta, Hiroyuki Ohshima, Ryoji Yamakawa Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan Purpose: This study aimed to demonstrate the clinical usefulness of measuring the macular ganglion cell complex (GCC) for the early detection of axonal loss in eyes with bilateral ­retrobulbar optic neuropathies.Patients and methods: We retrospectively reviewed the medical records of three patients with bilateral toxic, ischemic, or infiltrative retrobulbar optic neuropathy.Results: No relative afferent pupillary defect was detected in any patients. The results of the fundus examinations were unremarkable at the initial presentation except for slight optic disk pallor in the right eye of Case 3. Magnetic resonance imaging showed no abnormal findings in Cases 1 and 2. Measurement of the macular GCC clarified the presence of axonal loss in all three cases with diagnostic uncertainty. Although reduction in the macular GCC thickness was not observed initially in Case 2, it became evident later when both optic disks still appeared normal.Conclusion: A reduction in the macular GCC thickness seemed to precede the appearance of optic disk pallor and occurs regardless of toxic, ischemic, or infiltrative retrobulbar optic neuropathy. The current case series suggested that measurement of the macular GCC facilitated early differentiation between bilateral retrobulbar optic neuropathy and nonorganic visual loss, which can otherwise be challenging in some cases. Keywords: infiltrative optic neuropathy, ischemic optic neuropathy, magnetic resonance imaging, optic disk pallor, optical coherence tomography, toxic optic neuropathy

Yu Monden, Fumi Hotokezaka, Ryoji Yamakawa Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, Japan Purpose: The aim of this study was to evaluate the clinical outcomes of surgery for recurrent pterygia using mitomycin C (MMC), double amniotic membrane transplantation (AMT), and a large conjunctival flap.Patients and methods: This retrospective case series included 31 eyes in 31 patients with recurrent pterygia. All patients underwent pterygium excision, application of MMC, double AMT, and placement of a large conjunctival flap. Outcome measures were visual acuity, astigmatism, and recurrence. Recurrence was defined as the presence of fibrovascular proliferative tissue crossing the limbus.Results: The patients’ mean age was 68.2 years. The mean follow-up period was 3.6 years. The mean preoperative and postoperative best-corrected visual acuities (logMAR conversion) were 0.23 and 0.13, respectively. There was a significant difference between the mean preoperative (−3.85 D) and postoperative (−2.22 D) astigmatism. The recurrence rate was 3.2% (1/31 cases).Conclusion: Surgical pterygium excision with application of MMC, double AMT, and placement of a large conjunctival flap was an effective treatment for recurrent pterygia. Keywords: pterygium, amnion, MMC

Masatoshi Haruta, Yumiko Yoshida, Ryoji Yamakawa Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan Background: Endogenous bacterial endophthalmitis is a rare but potentially devastating intraocular infection that can have severe sight-threatening complications. Most patients with endogenous bacterial endophthalmitis have underlying infectious conditions, such as diabetes or malignancy, which predispose them to infection. Case report: A 1-year-old girl presented with cloudiness of the right eye. Ocular examination showed a cloudy cornea in the right eye with conjunctival injection and hypopyon. The intraocular pressure was 43 mmHg, and the fundus could not be visualized. She had an 8-day history of fever, and cerebrospinal fluid analysis showed typical findings of bacterial meningitis. She was clinically diagnosed with bacterial meningitis and endophthalmitis in the right eye and was treated with intravenous, topical, and intravitreal antibiotics and vitrectomy. Haemophilus influenzae was isolated from the blood and cerebrospinal fluid cultures, but not from the aqueous and vitreous cultures. Four months later, her pediatrician diagnosed Streptococcus pneumoniae meningitis, but she had no clinical signs of endophthalmitis. Seven years after the initial presentation, the best-corrected visual acuity was 20/40 in the right eye. Discussion: Endophthalmitis caused by H. influenzae is generally associated with poor visual outcomes; however, the patient in the current case responded well to the treatment. The patient had recurrent bacterial meningitis caused by H. influenzae and S. pneumoniae within a 4-month period. Magnetic resonance imaging was performed to search for underlying infectious causes and revealed that the patient had an extremely small spleen for her age. Because the spleen is critical for clearing encapsulated bacteria such as H. influenzae or S. pneumoniae, we ­speculated that hyposplenism led to the bloodstream infection of H. influenza and then endogenous ­endophthalmitis in the right eye. Keywords: intravitreal antibiotics, meningitis, Streptococcus pneumoniae, vitrectomy

Toru Urano,1 Masataka Kasaoka,1 Kimitaka Sagawa,2 Ryoji Yamakawa1 1Department of Ophthalmology, Kurume University School of Medicine, 2Department of Laboratory Medicine, Kurume University Hospital, Kurume, Japan Purpose: To compare the degree of surgical-field contamination in cataract surgeries between a new draping method using a lid speculum with a drape (LiDrape®) and a conventional draping method. Methods: Cataract surgery was performed on 21 eyes using LiDrape® (LiDrape® group) and on 22 eyes using a conventional draping method (conventional group). Contamination was evaluated by bacterial culture of conjunctival sac scrapings and ocular surface irrigation fluid. Conjunctival sac scrapings were collected before and after application of preoperative antibiotics. Ocular surface irrigation fluid was collected before incision placement and during surgery. Bacterial detection rate and types of organisms isolated at these four time points were examined. Results: Bacterial detection rates were significantly decreased in the LiDrape® group at all time points after the application of antibiotics compared with preapplication. Regarding between-group comparisons, the bacterial detection rate in the LiDrape® group was only significantly lower than that in the conventional group in the intraoperative sample. Propionibacterium acnes was the most common organism isolated from ocular surface irrigation fluid. The number of P. acnes in the intraoperative sample was significantly lower in the LiDrape® group compared with the conventional group. There were no significant differences in detection rates for other bacteria between the groups. Conclusion: LiDrape® was as effective as conventional draping for preventing surgical-field contamination. The number of P. acnes during surgery was significantly lower in the LiDrape® group compared with the conventional group, suggesting that LiDrape® may contribute to the prevention of postoperative infection.Keywords: LiDrape®, cataract surgery, surgical field contamination, Propionibacterium acnes

Yu Monden,1 Shohaku Yamamoto,1 Ryoji Yamakawa,1 Atsuko Sunada,2 Seishi Asari,3 Koichi Makimura,4 Yoshitsugu Inoue5 1Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, 2Laboratory for Clinical Investigation, 3Department of Infection Control and Prevention, Osaka University Hospital, Osaka, 4Teikyo University Institute of Medical Mycology, Tokyo, 5Division of Ophthalmology and Visual Sciences, Tottori University Faculty of Medicine, Tottori, Japan Purpose: To report the isolation of Pestalotiopsis clavispora from the cornea of a patient with recurrent keratitis. Case report: A 73-year-old male gardener presented with conjunctival injection and an oval infiltrate with feathery margins in the temporal half of the cornea in the right eye. His ocular history in the right eye included cataract surgery, five episodes of herpes simplex keratitis, three glaucoma surgeries, and bullous keratopathy. He had been treated with corticosteroids for years. Light microscopy of corneal scrapings revealed a filamentous fungus, and fungal keratitis was diagnosed. Treatment with topical voriconazole and pimaricin ointment was commenced. One month later, the infiltrate resolved. The antifungal agents were discontinued 7 months later, and keratitis relapsed 4 days after the discontinuation. The fungus was isolated and identified by molecular techniques as P. clavispora. Based on the results of antifungal susceptibility testing, treatment with topical and intravenous micafungin was initiated. The corneal infiltrate resolved 1 month after the relapse. Conclusion: Molecular identification of the pathogen, and antifungal susceptibility testing, are useful in treating patients with fungal keratitis caused by a rare human pathogen. Keywords: fungal keratitis, Pestalotiopsis clavispora, plant pathogen, molecular identification, antifungal susceptibility test

Toru Urano,1 Masataka Kasaoka,1 Ryoji Yamakawa,1 YukihikoTamai,2 Shoichiro Nakamura21Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan; 2Hakko Co, Ltd, Nagano, JapanPurpose: To evaluate the clinical use of a newly-developed disposable lid speculum with a drape.Methods: LiDrape® is a cylindrical device that consists of two flexible rings of polyacetal resin with a transparent elastic silicone sheet attached to the rings. The novel device holds the eyelids between the rings, and a hole in the center of the device provides a surgical field. We used the novel device in cataract surgery (75 eyes), glaucoma surgery (eleven eyes), vitrectomy (ten eyes), and intravitreal injection (six eyes) and evaluated its clinical efficacy.Results: The LiDrape was easy to attach and detach. The novel device was not detached from the eye during surgery. No eyelashes or secretions from the meibomian glands were seen in the surgical field, and the drape provided a sufficient surgical field.Conclusions: The LiDrape functions as a lid speculum as well as a drape. Our results showed that the novel device is useful for ocular surgeries.Keywords: LiDrape, lid speculum, drape, endophthalmitis

Rika Kamada,1 Yu Monden,1 Koji Uehara,1 Ryoji Yamakawa,1 Kazuko Nishimura21Department of Ophthalmology, Kurume University School of Medicine, Kurume, Fukuoka, 2Medical Mycology Research Center, Chiba University and First Laboratories Co, Ltd, Kawasaki, Kanagawa, JapanAbstract: A rare case of fungal keratitis caused by Plectosporium tabacinum is reported. A 78-year-old female gardener presented with conjunctivitis and an oval infiltrate with irregular margins in the nasal half of the cornea in the right eye. Light microscopy of corneal scrapings revealed a filamentous fungus, and a diagnosis of fungal keratitis was made. The patient was admitted into our hospital on February 19, 2008. Treatment with topical miconazole, topical fluconazole, pimaricin ointment, intravenous miconazole, and corneal debridement was commenced. One week later, the infiltrate improved, but the central part of the infiltrate was still deep. Topical fluconazole was switched to topical voriconazole, and intravenous miconazole was switched to intravenous voriconazole. One month after admission, the causative organism was identified by morphology and molecular biological analysis as Plectosporium tabacinum. The corneal infiltrate resolved 3 months after admission. A stromal scar persisted for 3 months after the patient was discharged. This is the first detailed report of fungal keratitis caused by P. tabacinum. Voriconazole was effective in treating this refractory keratitis.Keywords: fungal keratitis, Plectosporium tabacinum, voriconazole, filamentous fungi

Masatoshi Haruta, Rika Kamada, Yumi Umeno, Ryoji YamakawaDepartment of Ophthalmology, Kurume University School of Medicine, Kurume, Fukuoka, JapanBackground: The purpose of this study was to evaluate the efficacy of pars plana vitrectomy for the treatment of optic disc pit-associated maculopathy with or without preoperative posterior vitreous detachment.Methods: We reviewed the clinical records of four consecutive patients who underwent pars plana vitrectomy in one eye for the treatment of optic disc pit-associated maculopathy, with an emphasis on the preoperative condition of the posterior hyaloid membrane.Results: Two of four eyes were confirmed to have an attached posterior hyaloid membrane, which was subsequently removed during surgery. Following vitrectomy, these two eyes experienced an improvement in visual acuity with complete retinal attachment of the macula. However, the other two eyes, which already had a posterior vitreous detachment at the time of surgery, showed a decrease in visual acuity with persistent maculopathy postoperatively.Conclusion: Pars plana vitrectomy for optic disc pit-associated maculopathy was beneficial for improving visual acuity in two eyes without preoperative posterior vitreous detachment but not in two eyes with preoperative posterior vitreous detachment. Our study suggests that preoperative assessment of a posterior hyaloid membrane is clinically important in predicting the surgical outcome of optic disc pit-associated maculopathy.Keywords: gas tamponade, internal limiting membrane, macular hole, optical coherence tomography, posterior hyaloid membrane, retinal detachment

Yoshihiko Oono, Koji Uehara, Masatoshi Haruta, Ryoji YamakawaDepartment of Ophthalmology, Kurume University School of Medicine, Kurume, JapanPurpose: To describe the characteristics and surgical outcomes of pediatric rhegmatogenous retinal detachment.Methods: A retrospective study of pediatric patients (15 years old or younger) who had undergone primary surgery for rhegmatogenous retinal detachment was conducted. Patients were divided into five groups according to the predisposing factors: trauma (group 1), myopia (group 2), atopic dermatitis (group 3), congenital or developmental anomalies (group 4), and others (group 5).Results: A total of 48 eyes of 44 patients were included in this study. There were 18 eyes (37.5%) in group 1, twelve eyes (25.0%) in group 2, six eyes (12.5%) in group 3, five eyes (10.4%) in group 4, and seven eyes (14.6%) in group 5. The initial retinal reattachment rate was 89% in group 1, 100% in group 2, 83% in group 3, 20% in group 4, and 86% in group 5 (P = 0.002). The final retinal reattachment rate was 100% in group 1, 100% in group 2, 100% in group 3, 80% in group 4, and 86% in group 5 (P = 0.16). The frequency of visual acuity of 0.1 or better after surgery was 100% in group 1, 92% in group 2, 83% in group 3, 40% in group 4, and 71% in group 5 (P = 0.01).Conclusion: The overall surgical outcome was successful, but the patients in group 4 had the lowest initial reattachment rate and the worst visual prognosis.Keywords: children, detached retina, surgical outcome, predisposing factor

Yu Monden,1 Minoru Sugita,1 Ryoji Yamakawa,1 Kazuko Nishimura,21Department of Ophthalmology, Kurume University School of Medicine, Kurume, Fukuoka, Japan; 2Medical Mycology Research Center, Chiba University and First Laboratories Co Ltd, Kawasaki, Kanagawa, JapanBackground: Paecilomyces lilacinus is a saprobic fungus that occasionally causes keratitis in infected patients. Voriconazole, a triazole antifungal agent, is often administered to treat P. lilacinus keratitis, because it is resistant to many antifungal agents. However, some patients may not require voriconazole. Here, we report our experience of treating this infection and compare outcomes between patients treated with or without voriconazole.Subjects: We retrospectively reviewed four cases of infectious keratitis caused by P. lilacinus and compared treatment course and outcomes among the four cases.Observations: P. lilacinus was isolated from corneal cultures in all four cases. Three cases developed corneal perforation and underwent keratoplasty. Voriconazole was given in two cases with severe and refractory infection. Both required long-term treatment despite the effectiveness of voriconazole. They also had a medical history of diabetes and corticosteroid therapy. In two cases that were not treated with voriconazole, the eye conditions improved with a short treatment period (2–3 weeks). Neither of these cases had a medical history of diabetes, nor had they used corticosteroids.Conclusion: Although voriconazole is the most useful antifungal agent for treating P. lilacinus keratitis, this infection can be resolved by other treatments. Voriconazole should be offered to patients with diabetes and/or prior corticosteroid use.Keywords: Paecilomyces lilacinus, voriconazole, diabetes, corticosteroids

Sohei Nakamura1, Naofumi Hikita2, Ryoji Yamakawa1, Fukuko Moriya3, Hirohisa Yano3, Emiko Furusato4, J Douglas Cameron5, Elisabeth J Rushing41Department of Ophthalmology, Kurume University School of Medicine, Kurume, 2Fukubiru Hikita Eye Clinic, 3Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan; 4Department of Neuropathology and Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC, 5Departments of Ophthalmology and Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, USABackground: Adenoma of the retinal pigment epithelium (RPE) is a rare intraocular tumor that can simulate other pigmented tumors such as choroidal melanoma. We report a case of non-pigmented adenoma of the RPE initially diagnosed as choroidal hemangioma.Case report: A 42-year-old woman presented to Kurume University Hospital in November 1992 with an orange-yellow tumor nasal to the optic disc in the left fundus. The tumor was 9.0 × 9.0 mm in diameter, 6.0 mm thick, and was characterized by high intensity on T1-weighted magnetic resonance imaging (MRI), low intensity on T2-weighted MRI, and enhancement on gadolinium MRI. Fluorescein angiography revealed early hypofluorescence and late hyperfluorescence of the tumor and retinal feeder vessels. By April 1996, exudate had developed around the tumor margins. The patient was treated with external beam radiation therapy (20 Gy) in July 1996, but the tumor did not diminish in size. Subsequently, she developed extensive loss of vision due to total retinal detachment. Accordingly, her left eye was enucleated in June 2005 because of severe ocular pain due to absolute glaucoma. Histopathological examination indicated that the tumor was contiguous with the normal surrounding RPE and was composed of cords and tubules of mostly non-pigmented spindle-shaped cells with round to oval nuclei and a small amount of cytoplasm containing melanin granules. The tumor cells were immunoreactive for vimentin, S-100 protein, and cytokeratin 18. The final diagnosis was adenoma of the RPE.Conclusion: Adenoma of the retinal pigment epithelium may be associated with incompetent vessels leading to serous retinal detachment and extensive visual loss, and may exhibit clinical characteristics similar to choroidal hemangioma.Keywords: adenoma, choroidal hemangioma, histopathology, retinal pigment epithelium

Purpose: To examine the short-term effect of Seprafilm for patching retinal breaks in experimental rhegmatogenous retinal detachment of rabbit eyes.Methods: Experimental retinal detachment with a break was made and repaired by fluid-gas exchange during vitreous surgery in 10 rabbit eyes. In seven eyes, Seprafilm was applied to cover iatrogenic retinal breaks entirely (study group) and in other three eyes operations were finished without Seprafilm application (control group). Funduscopic examination was carried out in both groups and in study group optical coherence tomography (OCT) was performed to observe Seprafilm on the retinal break. Eyes of study group were enucleated on 7th and 14th postoperative day for histological evaluation.Results: The funduscopic examination showed that the retina was reattached in all eyes of study group. Meanwhile all three eyes of control group resulted in proliferative vitreoretinopathy. OCT showed that Seprafilm adhered to the retina tightly. Funduscopic examination and OCT showed Seprafilm dissolved within 14 days. Histological examination revealed that Seprafilm adhered tightly to the retina and there was no inflammatory change at the Seprafilm application sites.Conclusions: In our small number of this study, Seprafilm was found to be beneficial to patch small and posteriorly located retinal breaks in vitreous surgery for rhegmatogenous retinal detachment. [ABSTRACT FROM AUTHOR]

PurposeTo examine the short-term effect of Seprafilm® for patching retinal breaks in experimental rhegmatogenous retinal detachment of rabbit eyes.MethodsExperimental retinal detachment with a break was made and repaired by fluid–gas exchange during vitreous surgery in 10 rabbit eyes. In seven eyes, Seprafilm® was applied to cover iatrogenic retinal breaks entirely (study group) and in other three eyes operations were finished without Seprafilm® application (control group). Funduscopic examination was carried out in both groups and in study group optical coherence tomography (OCT) was performed to observe Seprafilm® on the retinal break. Eyes of study group were enucleated on 7th and 14th postoperative day for histological evaluation.ResultsThe funduscopic examination showed that the retina was reattached in all eyes of study group. Meanwhile all three eyes of control group resulted in proliferative vitreoretinopathy. OCT showed that Seprafilm® adhered to the retina tightly. Funduscopic examination and OCT showed Seprafilm® dissolved within 14 days. Histological examination revealed that Seprafilm® adhered tightly to the retina and there was no inflammatory change at the Seprafilm® application sites.ConclusionsIn our small number of this study, Seprafilm® was found to be beneficial to patch small and posteriorly located retinal breaks in vitreous surgery for rhegmatogenous retinal detachment. [ABSTRACT FROM AUTHOR]

Subretinal strands in proliferative vitreoretinopathy removed during vitreous surgery in ten cases were studied histologically; tissue culture was taken from five of the ten cases to obtain more material for investigation. Tissue culture was successful in all five cases. The cultured tissue just next to the original strand preserved the characteristics of the original tissue, whereas the portion distal from the original strand did not. Definite and/or suspected retinal pigment epithelial cells (RPE) were found in seven of ten original strands and four of five samples of cultured material. RPE were considered to be a predominant component of subretinal strands. [ABSTRACT FROM AUTHOR]

Abstract: The H2 reactivity with the Cr surface intentionally modified by O2 or H2O preadsorption was quantitatively investigated compared to the clean surface prepared under UHV condition and at 298K by using volumetric method. The O2 preadsorption layers on the Cr surface remarkably decreased the reaction probability of H2 compared with the H2O preadsorption layers. The effect of O2 poisoning on the H2 reactivity was reduced by the presence of H chemisorption layers on the clean surface of Cr. [Copyright &y& Elsevier]

Several crustaceans including shrimps change the amount of specific free amino acids to regulate the osmotic pressure in their bodies. Kuruma shrimp Penaeus japonicus also increases the concentration of alanine (Ala) in the abdominal muscle following the increase of environmental salinity. In the present study, to elucidate the mechanisms of changes in Ala accumulation of kuruma shrimp depending on salinity, we cloned the gene encoding alanine aminotransferase (ALT), an enzyme involved in Ala biosynthesis, and examined its expression profile. It was found that the full-length kuruma shrimp ALT1 cDNA consisted of 3,301 bp, encoding 514 amino acids, and that all amino acid residues important for ALT activity were conserved. Phylogenetic analysis also indicated that the ALT gene cloned in this study was classified as ALT1. Moreover, we examined the expression levels of the ALT1 gene in the abdominal muscle and the hepatopancreas of kuruma shrimp acclimated at 17‰, 34‰, and 40‰ salinities, resulting that the mRNA levels of the ALT1 genes in both tissues of the shrimp acclimated at 40‰ were significantly higher than those at 17‰ for 12 h (p < 0.05). The mRNA levels of the ALT1 gene in the abdominal muscle of the shrimp acclimated for more than 24 h tended to increase following the increase of environmental salinity. These results indicate that ALT1 is responsible for the increase of free Ala concentration in the abdominal muscle of kuruma shrimp to regulate osmotic pressure at high salinity., (© 2024 Wiley Periodicals LLC.)

[Purpose] We evaluated the reliability of the measurement function of the Honda Walking Assist Device and investigated the effect of the device on walking improvements, and foot and ankle function, in hemiplegic stroke patients. [Participants and Methods] We recruited 16 hemiplegic stroke patients who performed 10-meter walk tests, twice without assistance and once with device assistance. Based on the rate of change of velocity, we divided the participants into two groups and compared the walking parameters, the toe grip strength, the cross tests, and the maximum step width. Two examiners assessed the 10-meter walk test results, and the authors calculated the intraclass correlation coefficients for walking speed, stride length, cadence, flexion, extension, and scissor angles. [Results] The intraclass correlation coefficients were greater than 0.70 for all the walking parameters we measured. The device increased hip joint movement but did not alter the maximum walking speed of the stroke patients. The patients in the group with a greater change in velocity displayed lower toe grip strength and decreased maximum step width and used orthoses more commonly. [Conclusion] The walking measurement function of the device was reliable. The immediate effect of the device in stroke patients may be influenced by the level of paralysis and the presence of an orthosis., Competing Interests: The authors have no conflicts of interest directly relevant to the content of this article., (2020©by the Society of Physical Therapy Science. Published by IPEC Inc.)

Purpose: To report a case of primary vitreoretinal lymphoma in which a macular hole developed after a diagnostic pars plana vitrectomy., Methods: A retrospective interventional case report., Results: A 65-year-old woman presented with worsening vision in the left eye. Fundus examination showed vitreous haze and multifocal, yellow-white infiltrates in the retina and under the retinal pigment epithelium in the left eye. She underwent a diagnostic pars plana vitrectomy in that eye. Undiluted vitreous specimen showed an increased interleukin-10 level (1,470 pg/mL) with an elevated interleukin-10 to interleukin-6 ratio of 15.1; cytologic analysis of the vitreous showed atypical lymphoid cells with large irregular nuclei and scanty cytoplasm. The retinal and sub-retinal pigment epithelial infiltrates responded well to intravitreal methotrexate injections, but a macular hole developed in the left eye. The second pars plana vitrectomy with internal limiting membrane peeling and 20% sulfur hexafluoride gas tamponade successfully closed the macular hole., Conclusion: Macular hole closure can be accomplished in eyes receiving intravitreal methotrexate injections for treating primary vitreoretinal lymphoma.

Objective: To evaluate the long-term safety and efficacy of subcutaneous tocilizumab (TCZ-SC) monotherapy administered weekly (qw) in patients with rheumatoid arthritis who had an inadequate response to TCZ-SC every other week (q2w). Methods: Patients who completed 12 weeks of double-blind treatment with either TCZ-SC q2w monotherapy or TCZ-SC qw monotherapy were switched to or continued to receive open-label treatment with TCZ-SC qw monotherapy for 40 weeks. Safety and efficacy were assessed. Subgroup analyses of Disease Activity Score based on 28 joints using erythrocyte sedimentation rate (DAS28-ESR) were performed at 12 weeks. Results: The incidence of adverse events was 464.4/100 patient-years (PY). The incidence of infection was 121.3/100 PY. The safety profile of TCZ-SC qw monotherapy was consistent with that of prior studies of TCZ. No additional safety concerns were observed. Improvement from baseline in DAS28-ESR was maintained at week 52 in patients who continued TCZ-SC qw and improved in patients who switched from TCZ-SC q2w to qw. At week 12, the efficacy of TCZ-SC qw monotherapy was greater than that of TCZ-SC q2w monotherapy irrespective of weight and BMI subgroups. Conclusion: The long-term weekly dosing of TCZ-SC monotherapy was well tolerated and efficacy was maintained over 52 weeks.

Portal vein invasion (PVI) is a major prognostic factor in hepatocellular carcinoma (HCC). The aim of the present study was to identify molecules that regulate PVI. Sections of cancerous tissue, paired noncancerous tissue and the PVI area were collected from 3 frozen HCC sections, using laser microdissection. The present study focused on 3 upregulated molecules, integrin β3 (ITGB3), secreted phosphoprotein 1 (SPP1) and regulator of G-protein signaling 5 (RGS5), and 2 molecules that were downregulated in PVI tissue compared with cancer tissue, metallothionein 1G (MT1G) and metallothionein 1H (MT1H), as determined by cDNA microarray analysis. Reverse transcription-quantitative polymerase chain reaction analysis of 32 HCC cases revealed that RGS5 mRNA levels were significantly increased and MT1 G and MT1H mRNA levels were significantly decreased in cancerous tissue compared with noncancerous tissue. However, there was no significant difference in ITGB3 and SPP1 expression. There were no significant differences between the expression of these molecules and any clinicopathologic factors, including PVI. Immunohistochemical staining for RGS5 in 60 HCC cases demonstrated that RGS5 protein levels were higher in cancerous tissue compared with paired noncancerous tissue in 63.3% of HCC cases. Furthermore, high expression of RGS5 in cancerous tissue was significantly associated with PVI and tended to be associated with intrahepatic metastasis. Confluent multinodular type was significantly more frequent in cases with high expression of RGS5 in the cancerous tissue. Therefore, RGS5 may be a useful prognostic biomarker as well as a potential target of molecular therapy to treat HCC.