Maternal psychologic problems increased the risk of childhood atopic dermatitis

BACKGROUND

Little is known about the effect of postnatal maternal psychologic problems on the development of childhood atopic disorders.

OBJECTIVES

To assess the association between early life maternal psychologic problems and atopic dermatitis (AD) in children in a national birth cohort.

METHODS

We used multistage, stratified systematic sampling to recruit 24,200 mother-newborn pairs from the Taiwan national birth registration. Maternal psychologic problems and potential confounders were gathered by the standard questionnaire at 6 months old. At 3 years of age, information about the development of AD was assessed by International Study of Asthma and Allergies in Childhood via home interviews. Multiple logistic regression analysis was performed to estimate the association of postnatal maternal psychologic problems (postpartum depression (PPD) and maternal mental health index) and AD.

RESULTS

The prevalence of physician-diagnosed AD was 10.5%. PPD increased the risk of subsequent physician-diagnosed AD in children after adjusting for potential confounders and other maternal mental health index (aOR = 1.42, 95% CI = 1.21-1.66). We observed that the risk of AD associated with PPD was not confounded by other social demographic factors such as maternal AD, maternal education, family income, breastfeeding, day care, and number of siblings.

CONCLUSIONS

Postpartum depression increased the risk of childhood AD even when other maternal mental health index and social demographic factors are considered. Early intervention of PPD might be helpful for AD prevention.

Maternal employment and atopic dermatitis in children: a prospective cohort study

BACKGROUND

Considering the early onset of atopic dermatitis (AD), which most often arises in the first year of life, risk factors occurring very early in life must be considered. Little is known about the effects of maternal occupational exposure on the development of atopic disorders in children.

OBJECTIVES

The aim of this study was to evaluate associations between maternal employment and childhood AD.

METHODS

We used multistage stratified systematic sampling to recruit 24,200 mother-newborn pairs from the Taiwan national birth register. Information on maternal occupation categories, work stress, working time, shift work and potential confounders during pregnancy was gathered by questionnaires after birth. At 3 years of age, information on the development of AD was assessed by home interviews. Multiple logistic regression analysis was performed to estimate the association of maternal employment and AD.

RESULTS

Overall, 11,962 out of 19,381 mothers (61·7%) worked during pregnancy. The children of mothers who worked during pregnancy had an increased risk of AD compared with those whose mothers did not work [odds ratio (OR) 1·38, 95% confidence interval (CI) 1·25-1·53]. The children of mothers with a professional or technical occupation had a higher risk of AD (OR 1·64, 95% CI 1·44-1·87). The risk of AD was found to increase with maternal work stress during pregnancy in a dose-response manner (P(trend)<0·01). The mothers of children with AD had a longer working time than those without AD (P<0·0001). However, no significant association between AD and maternal shift work was found.

CONCLUSIONS

Working in professional or technical occupations increased the risk of childhood AD in addition to work stress during pregnancy.

Filaggrin polymorphism P478S, IgE level, and atopic phenotypes

BACKGROUND

Whether environmental exposures may modulate the effect of the skin barrier gene on atopic dermatitis (AD) remains to be elucidated.

OBJECTIVES

To determine whether filaggrin (FLG) variants can serve as a predictor for atopic disorders in Chinese individuals and if allergen exposures may modify the effect of FLG variants on AD by total IgE levels.

METHODS

In total, 116 children aged 2-5years with AD and 212 control subjects were analysed for the FLG variants using DNA sequencing. Multiple logistic regression models were performed to estimate the association among FLG polymorphisms and atopic phenotypes. Serum total IgE level, standing for the degree of allergen exposures, was later stratified to determine the effects of FLG polymorphisms on AD.

RESULTS

A significant difference in genotype frequency was found among AD cases and controls in FLG P478S polymorphism. FLG P478S GG genotype significantly increased the risk of AD [odds ratio (OR) 4·60, 95% confidence interval (CI) 1·88-11·24]. In addition, among subjects with AD, GG genotypes also significantly increased the risk of developing asthma (OR 4·68, 95% CI 1·37-16·03). Further, a similar result was obtained for allergic rhinitis (OR 3·23, 95% CI 1·01-10·30). Interestingly, the P478S GG genotype was significantly related to AD (OR 5·67, 95% CI 1·93-16·60) in children with IgE level ≥100 kU L(-1) . However, the association was not evident when IgE level was < 100 kU L(-1) .

CONCLUSIONS

Our results suggest that the FLG P478S polymorphism may confer susceptibility to the development of AD among Chinese individuals and may be modified by IgE levels.

The association of clinical findings and exposure profiles with melamine associated nephrolithiasis

BACKGROUND

Little is known about the exposure profiles of melamine in children. We evaluated the association of clinical findings, exposure patterns and biomarkers with nephrolithiasis in children with potential exposure to melamine.

METHODS

A case-control study was conducted in children aged 0-16 years with potential exposure to contaminated dairy products. Cases were defined as nephrolithiasis detected by renal ultrasonography. On the basis of different brands of contaminated dairy products consumed, subjects were classified into high exposure, low exposure and control groups with estimated melamine exposure levels of higher than 2.5 ppm, 0.05-2.5 ppm and lower than detection limits <0.05 ppm. We measured urine melamine for those with nephrolithiasis and age-matched and gender-matched controls within the subset of the study population.

RESULTS

The duration of consumption of contaminated products was longer in children with nephrolithiasis in the high exposure group than in controls (median (IQR) 12.0 (3.3-24.0) vs 6.0 (4.0-7.0) months; p = 0.048). High melamine exposure levels were significantly associated with nephrolithiasis (OR 61.04 (95% CI 12.73 to 292.84)). The risk was found to increase with estimate melamine exposure levels (p for trend <0.001). Two among 10 affected subjects with nephrolithiasis showed elevated urine melamine levels. In comparison, levels of all 20 controls were lower than the detection limit.

CONCLUSIONS

The risk of melamine-associated nephrolithiasis was related to duration of consumption of contaminated products and estimated melamine exposure levels. Though urine melamine was not a sensitive test, it might serve as an exposure biomarker in melamine-associated nephrolithiasis.

Neuro-mediators as predictors of paediatric atopic dermatitis

BACKGROUND

Attempts to identify predictors of atopic dermatitis (AD) have focused on genetic and immunologic factors. However, the role of neuro-mediators remains to be elucidated.

OBJECTIVE

To evaluate nerve growth factor (NGF) and vaso-active intestinal peptide (VIP) in predicting paediatric AD and assess their correlation with intrinsic and extrinsic types of AD.

METHODS

We performed a nested case-control study in the prospective Taiwan birth panel cohort study. Cord and maternal plasma and questionnaires were gathered at birth. During follow-up, we identified 40 available AD cases, which were matched to 80 unaffected controls chosen from this cohort. The concentrations of IgE, NGF, and VIP in cord and maternal plasma of these subjects were performed by ELISA. Receiver-operating characteristic (ROC) curves were generated to see how well each biomarker could predict AD.

RESULTS

The NGF levels were significantly higher in AD patients than controls (mean+/-SD: 65.47+/-44.45 vs. 49.21+/-12.18 pg/mL for cord plasma and 89.68+/-41.04 vs. 66.96+/-23.05 pg/mL for maternal plasma) (P<0.05). VIP levels were also higher but not statistically significant. Plasma NGF may be a better biomarker than IgE in detecting paediatric AD (area under the ROC curve=0.65 vs. 0.61 for cord plasma and 0.69 vs. 0.61 for maternal plasma). Maternal NGF levels were significantly higher in patients with both intrinsic (96.18+/-48.15 pg/mL) and extrinsic (86.18+/-37.23 pg/mL) types of AD compared with controls (66.96+/-23.05 pg/mL) (P<0.05). We assessed a significant correlation between self-reported stress during pregnancy and maternal NGF levels (r=0.22, P=0.02).

CONCLUSION

Our results suggest that NGF is a good alternative biomarker in predicting children with a risk of AD.

Seroprevalence and risk factors for human papillomavirus in Taiwan

The aim of the study was to tailor a future Human papillomavirus (HPV) vaccine campaign and to help perform early primary prevention of HPV infection in Taiwan, where the incidence of cervical cancer is high. A cross-sectional survey was conducted of 826 female students, ages 10, 13, 16 and 19-22 years. A self-administered questionnaire was used to collect information on risk factors for HPV infection. Serum samples were tested for antibodies to HPV 16 capsids using a virus-like particle-based enzyme-linked immunosorbence assay. The age-adjusted odds ratio of HPV seropositivity was calculated for each risk factor by multiple logistic regression analysis. HPV 16 antibodies were detected in 13 (1.6%) of 826 participants. The HPV 16 seroprevalence was 0.35% (1/287), 0.85% (2/235), 3.2% (6/185) and 3.4% (4/119), respectively, for age groups of 10, 13, 16 and 19-22 years. In the multiple regression analysis, the history of having sexual activity was the most significant risk predictor for HPV 16 seropositivity. The seroprevalence of HPV 16 increased dramatically among high school seniors and university students, and was significantly associated with sexual activity. Vaccination against HPV is suggested to be undertaken in early adolescence, before 16 years of age and prior to sexual debut.

Environmental risk factors for early infantile atopic dermatitis

Previous studies of predictors of atopic dermatitis (AD) in Asia have had limited sample size and small numbers of variables focused primarily on family history or dietary exposures. The purpose of this study was to evaluate the influence of various environmental risk factors for early infantile AD. We used multistage, stratified systematic sampling to recruit 2048 mother-child pairs from the Taiwan national birth registration in 2003. Information on environmental risk factors for infant AD gathered by questionnaire were available from 1760 infants at 6 months of age. Multiple logistic regression was used to estimate adjusted odds ratios (aORs) and their 95% confidence intervals (CIs) for risk factors for AD after adjusting for potential confounders. AD was noted in 118 of 1760 (6.7%) of the infants. After adjusting for maternal age and education, family history of atopy, infant gender, and gestational age, fungi on walls of the house [aOR 2.14 (95% CI 1.41-3.22)] and frequent use of microwave oven at home [aOR 1.71 (95% CI 1.13-2.58)] increased the risk of early infantile AD. This study suggests that environmental factors do play a role in early infantile AD. Fungi, a kind of aeroallergen, are especially important in humid climate as in Taiwan and their impacts might be felt at the early infant stage. The hazards of microwave use should be paid more attention.

Juvenile dermatomyositis complicated with vasculitis and duodenal perforation

Duodenal perforation has been reported in patients taking steroids and non-steroidal anti-inflammatory drugs (NSAIDs). However, its association with juvenile dermatomyositis is extremely rare. A 4-year-old boy with dermatomyositis presented with intractable abdominal pain which was aggravated after steroid and NSAID therapies. A widespread retroperitoneal abscess was noted on abdominal computerized tomography. An emergency operation showed an ulcer and perforation at the junction of the third and fourth portions of the duodenum. Debridement of the necrotic tissue and repair of the perforation were performed. The postoperative course was complicated by an anastomotic leak, which was corrected by reanastomosis. In addition to intestinal vasculitis, duodenal vasculitis complicated with ulcers and perforation should be included in the differential diagnosis of a child with juvenile dermatomyositis presenting with abdominal complaints.

Clinical and specular microscopic manifestations of iridocorneal endothelial syndrome

PURPOSE

To investigate the correlation between the clinical pictures and the specular microscopic findings in patients with iridocorneal endothelial (ICE) syndrome.

METHODS

The records of 15 patients with ICE syndrome who presented at the National Taiwan University Hospital between 1993 and 1996 were examined. The medical history, clinical pictures of the cornea, iris and anterior chamber angle, intraocular pressure, specular microscopic findings, and the correlation between clinical and specular microscopic findings were assessed.

RESULTS

Endothelial changes in specular micrographs were found in all the patients, even in those patients with minimal angle involvement by peripheral anterior synechiae. Corneal decompensation resulting in corneal edema and bullae formation was the main cause of visual impairment. Neither ICE grading nor endothelial cell density correlated with corneal edema or intraocular pressure, but they correlated with the angle involvement in ICE syndrome. The intraocular pressure was difficult to control in 8 of these patients, even after treatment with anti-glaucoma agents and trabeculectomy, especially in the patients with Cogan-Reese syndrome.

CONCLUSION

Although specular microscopy provides an invaluable method for the diagnosis of ICE syndrome, it is not a reliable tool for predicting prognosis. Close follow-up of intraocular pressure and early detection of glaucoma are important steps to preserve visual functions in patients with ICE syndrome.

Immunohistochemical Study of Subepithelial Haze After Phototherapeutic Keratectomy

PURPOSE

Subepithelial haze is a frequent complication and is often the cause of regression after photorefractive keratectomy (PRK). The lack of understanding of this undesirable complication following PRK is in part due to the limited availability of suitable tissues for pathological studies.

METHODS

We examined the expression of various extracellular components in the cornea of a 46-year-old man who underwent phototherapeutic keratectomy (PTK) to remove a central corneal scar secondary to trauma. The patient subsequently underwent penetrating keratoplasty. A scar-free region containing an area of slight subepithelial haze adjacent to normal cornea was used for immunohistochemical staining with antibodies directed against cytoskeletal proteins, ie, vimentin, desmin and smooth muscle actin, and the extracellular components, laminin, heparan sulfate, keratan sulfate, and collagen types III, IV, V, and VII.

RESULTS

Immunohistochemistry revealed that basal epithelial cells expressed components of basement membrane. The stromal fibroblasts within the haze tissue were labeled by anti-smooth muscle actin antibodies, a characteristic of myofibroblasts, which synthesized and secreted extracellular matrix components that contributed to the formation of the disorganized collagenous matrix and may account for subepithelial haze.

CONCLUSIONS

The expression patterns for the cytoskeletal proteins and extracellular components indicated that the formation of subepithelial haze is a process of tissue remodeling, involving both corneal basal epithelial cells and keratocytes during wound repair.

Changing indications for penetrating keratoplasty in Taiwan from 1987 to 1999

PURPOSE

To determine the leading indications for penetrating keratoplasty and to identify changing trends in these indications during the past 12 years.

METHODS

We retrospectively performed a chart review of the hospital records of all patients undergoing penetrating keratoplasty at the National Taiwan University Hospital during a 12-year period (1987-1999). When possible, the clinical indication was corroborated by the pathologic report.

RESULTS

A total of 770 corneal transplants were performed. The leading indications for penetrating keratoplasty. in order of decreasing frequency, were corneal scars (27.9%), regraft (21.0%), acute necrotizing and ulcerative keratitis (17.9%), pseudophakic or aphakic bullous keratopathy (17.6%), Fuchs' dystrophy (4.5%), and keratoconus (2.5%). A trend of increasing frequency of regraft and acute necrotizing and ulcerative keratitis, a decreasing frequency of corneal scar, and an initially decreasing then increasing frequency of pseudophakic and aphakic bullous keratopathy were found during the 12-year study period. Acute necrotizing and ulcerative keratitis was found to be the most frequent indication for regraft.

CONCLUSION

In this series, corneal scars, regraft, and acute necrotizing and ulcerative keratitis were the leading indications for penetrating keratoplasty. A changing incidence of pseudophakic and aphakic bullous keratopathy noted during the study period was related to the type of intraocular lens implanted and the method of cataract surgery performed. This study found a comparatively high frequency of acute necrotizing and ulcerative keratitis and an extremely low frequency of keratoconus compared with previous reports.

Impression cytology of pterygium

The purpose of this study was to study the morphology and cytokeratin expression in the epithelia of pterygia. Impression cytology and immunohistochemical staining with antikeratin antibodies were performed in 32 eyes of 16 patients with pterygia. TUNEL stain and electron microscopy were also performed in surgical specimens ofpterygium. Squamous metaplasia-like epithelial cells were found in all specimens of impression cytology, especially in the head part. These specimens had positive immunostaining by antipancytokeratin antibodies, but not by anti-K12 AK2 mAb. Goblet cells were found around the area of these abnormal epithelial cells. TUNEL-positive cells were found in the epithelia of the pterygial head, but not in the body of pterygia and normal conjunctiva. The expressional patterns of keratin by these epithelial cells ofpterygia are consistent with the notion that they are derived from conjunctival epithelium and mimic the process of squamous metaplasia.

Mechanism of abnormal elastin gene expression in the pinguecular part of pterygia

Elastodysplasia and elastodystrophy are two known manifestations in the conjunctival, ie, pinguecular, part of pterygia. But the mechanisms are still not understood. The purpose of this study is to investigate the mechanism of enhanced elastin gene expression in fibroblasts from the pinguecular part of pterygia, which is related to abnormal elastic fiber expression in the pinguecular part of pterygia. Elastin in surgical specimens of normal conjunctiva and the pinguecular part of pterygia from age-matched patients was detected by immunohistochemical staining. Northern hybridization and quantification of radiolabeled tropoelastin were performed in conjunctival fibroblasts cultured under different doses of ultraviolet (UV) B irradiation, and in cultured pinguecular fibroblasts from pterygia. In vitro translation was also performed to analyze the tropoelastin production in rabbit reticulocyte lysate. The level of tropoelastin in reticulolysates from UV-treated conjunctival and pinguecular fibroblasts of pterygia was higher than in normal conjunctival fibroblasts. The coding sequence and 3'- untranslated region of tropoelastin mRNAs were amplified by reverse transcription-polymerase chain reaction, and mutations were checked by DNA sequencing. Immunohistochemical staining revealed elastin in pinguecular subepithelial connective tissues of pterygia, but not in normal conjunctiva. Tropoelastin mRNA levels were not elevated in cultured pinguecular or conjunctival fibroblasts with or without ultraviolet B irradiation. However, tropoelastin synthesis was enhanced in culture medium of pinguecular and UV-irradiated conjunctival fibroblasts, but not in normal conjunctival fibroblasts. Direct DNA sequencing revealed mutations in the 3'-untranslated region but not in the coding sequence of tropoelastin mRNA, in both pinguecular and UV-irradiated conjunctival fibroblasts. The increased expression of tropoelastin in pinguecular and UV-irradiated fibroblasts is not a result of increased levels of steady-state mRNA, but is a result of posttranscriptional modification of tropoelastin.

Smoking status, disease duration, and educational level in females, are related to asthma school participation

Limited data is available on those who do not want to attend an asthma school. Two hundred and forty-five asthmatics aged 18-65 yrs with an FEV1 >50% predicted who had been seen at our outpatient asthma clinic within the last 3 yrs were invited to participate in an asthma school. The patients were contacted by phone by a nurse, offered a 2 day asthma school without personal costs. Altogether 78% of those contacted answered positively. In a logistic regression analysis including sex, age, smoking status, educational level, asthma duration and own opinion of the disease, the-adjusted odds ratio (OR) for nonsmokers wanting to participate versus smokers was 4.0 (95% confidence interval (CI): 1.8-8.3). The corresponding figure for patients with a recent asthma attack was 3.4 (95% CI: 1.5-7.6) compared to those without. For every 10 yr duration of disease the OR for wanting to take part in the asthma school increased by 1.6 (95% CI: 1.0-2.3). When analysing males and females separately, highly educated females were less willing to take part, while an opposite tendency was present in males. In conclusion those interested in taking part in an asthma school were characterized by highly motivated nonsmokers with long duration of disease and with a recent asthma attack, and not being highly educated females.

Surgical results of photorefractive keratectomy with different operative modes

PURPOSE

To compare the predictability, efficacy, and safety of photorefractive keratectomy (PRK) using different operative modes.

SETTING

National Taiwan University Hospital, Taipei, Taiwan.

METHODS

One hundred fifty-three eyes of 80 patients who had PRK for myopia with a follow-up of at least 6 months were studied. All patients were sequentially assigned to 1 of the following surgical modes: mode 1: PRK with the Summit OmniMed excimer laser; mode 2: PRK with the Summit Apex Plus laser; mode 3: PRK with the Summit Apex Plus laser with anti-central-island pretreatment.

RESULTS

Six months after treatment, a homogeneous topographic pattern was seen in 76% of mode 1 eyes, 70% of mode 2 eyes, and 88% of mode 3 eyes. In the low myopia group (< or =-6.0 diopters [D]), the mean residual refractive error was -0.79 D +/- 0.59 (SD) in mode 1, -0.94 +/- 1.02 D in mode 2, and -0.31 +/- 0.42 D in mode 3. In the high myopia group (>-6.0 D), it was -1.93 +/- 1.51 D, -1.54 +/- 0.88 D, and -0.70 +/- 0.81 D, respectively. Uncorrected visual acuity of 20/25 or better was achieved in 81% of mode 1 eyes, 56% of mode 2 eyes, and 89% of mode 3 eyes in the low myopia group, and in 48%, 28%, and 72%, respectively, in the high myopia group.

CONCLUSIONS

Photorefractive keratectomy appears to be a predictable and effective procedure. The best results were achieved with the Summit Apex Plus laser with anti-central-island pretreatment, followed by the Summit OmniMed laser. The Summit Apex Plus laser without anti-central-island pretreatment produced less satisfactory results.

Effect of tear film stability on fluctuation of vision after photorefractive keratectomy

PURPOSE

To evaluate the difference in tear film break-up between normal eyes and eyes after photorefractive keratectomy (PRK) and its impact on quality of vision in PRK eyes.

METHODS

Seventy-seven normal eyes and 76 eyes with no ocular pathology except refractive error that had PRK were enrolled. Tear film break-up time was determined under slit-lamp microscopy with fluorescent staining. Two videokeratographs (TMS-1) were taken before and immediately after tear film break-up. Surface asymmetry index, surface regularity index, and subtractive maps were analyzed to evaluate corneal topographic changes before and after tear film break-up.

RESULTS

The distribution of tear film break-up in the central cornea was different in PRK eyes than in normal eyes (P < .0001). Distributions of tear film break-up after PRK were localized more in the upper and lower temporal regions than in normal eyes; incidence of tear film break-up in the central cornea was decreased. There were no significant differences in tear film break-up between normal eyes and eyes after PRK (P = .69). Twelve PRK patients (24 eyes, 32%) experienced fluctuation of vision and fatigue during normal activities after PRK. We divided eyes after PRK into two groups (with and without fluctuation of vision) and found a statistically significant difference in surface asymmetry index before tear film break-up between the two groups (P = .0092).

CONCLUSION

The distribution of tear film break-up is changed after PRK. Eyes after PRK experienced more fluctuation of vision than normal eyes.

Outcomes of penetrating keratoplasty with imported donor corneas

PURPOSE

To analyze factors influencing the surgical success of penetrating keratoplasty and long-term graft survival when using imported donor corneas.

METHODS

Sixty-three donor corneas imported to Taipei from the Cincinnati Eye Bank from July 1992-June 1993 were used for penetrating keratoplasty. The corneal endothelium was examined using specular microscopy on arrival in Taiwan. The endothelial morphology and endothelial cell density (ECD) were compared with the photograph of the same cornea taken in the United States. The relationships of the surgical success rate with donor age, death to enucleation time, death to surgery time, and ECD were analyzed. The long-term graft survival and ECD of clear grafts were analyzed 4 years after surgery.

RESULTS

On specular microscopic examination. the imported corneas showed diminished endothelial reflection, blurred cellular borders, and increased dark areas, which were markedly different from the pictures of the corneal endothelium taken in the United States. The average ECD before transportation was 2,525+/-267/mm2 and decreased to 1,934+/-250/mm2 after transportation (p < 0.001), with an average endothelial cell loss of 590+/-247/mm2. The overall surgical success rate was 89% and did not correlate with any of the donor factors tested except death to surgery time. The surgical success rate decreased when the time from death to surgery was >7 days (p = 0.05), mainly because of poor reepithelialization. Four years after surgery, 24 grafts remained clear. The ECD had decreased by 72+/-5% in the clear grafts.

CONCLUSIONS

Our findings show that endothelial changes in imported donor corneas do occur after transportation, but the surgical success rate may not be influenced significantly if the penetrating keratoplasty is performed within 7 days after donor death. However, the ECD in the clear grafts 4 years after surgery is low.

Influence of destruction of retina-RPE complex on the proliferation of scleral chondrocytes in chicks

We studied the role of the retina-retinal pigment epithelium (RPE) complex in the proliferation of scleral chondrocytes in chicks. Seventy-two chicks were allocated to one of four groups: intravitreal gentamicin (400 microg) injection (destruction of retina-RPE complex); intravitreal gentamicin injection with goggling; goggling only (form-deprivation myopia); and intravitreal saline injection (control). The chicks were killed and retina-RPE complexes were harvested under a microscope. Retina-RPE complexes were then co-cultured with primary culture of first day scleral chondrocytes in Transwell-COL co-culture systems (Costar), with two different pore sizes (0.4 and 3.0 microm) and serum-deprivation medium. An MTT assay was performed at A550 after 4 days. In the 0.4 microm pore size system, the absorbency at A550 showed no differences between groups. However, in the 3.0 microm pore size system, the absorbency at A550s in the intravitreal gentamicin groups was significantly lower than in the control and the goggle groups (p<0.05), indicating that destruction of the retina-RPE complex inhibited chondrocyte proliferation. The absorbency in the goggle group was higher than in the control group (p<0.05). These results indicate that the retina-RPE complex exerts a positive effect on the proliferation of scleral chondrocytes via a molecule sized between 0.4.and 3.0 microm in diameter.

The effect of intravitreal injection of atropine on the proliferation of scleral chondrocyte in vivo

Atropine was found to be effective in arresting the progression of myopia. However, the actual mechanism is still unclear. Thus, we tried to investigate the in vivo effect of atropine on the proliferation of scleral chondrocytes in chicks of form-deprivation myopia. Twenty chicks were equally divided into 4 groups which included intravitreal injection of normal saline (IVN), IVN with goggling (IVNG), intravitreal injection of atropine (1%) (IVA), and IVA with goggling (IVAG) groups. Intravenous injection of bromodeoxyuridine (BrdU) (30 mg/kg) from subaxillary vein was performed 2 hours before being sacrificed. The eyeballs were then fixed in 10% neutral-buffered formalin at 4 degrees C. Standard BrdU immunohistochemical staining was performed. The BrdU labeling index was obtained from the average of positive labelings of BrdU in scleral chondrocytes for every 100 counting cells in posterior poles and anterior scleral margins by two experienced technicians. The BrdU index on the anterior scleral margin of the IVAG group was less than that of the IVNG group. The index on the anterior scleral margin of the IVNG group was higher than the IVN group. Although the index on the posterior poles of the IVNG group was also higher than the IVN group, it was statistically not different. Also, no statistical difference was found between IVN and IVA on the anterior scleral margins or posterior poles. The index was significantly different on the anterior scleral margins, but not on the posterior pole among each group. Therefore, intravitreal injection of atropine could inhibit the proliferation of chondrocytes on the anterior margins of sclera, but not the posterior poles in form-deprivation myopia.

[Medication practice and personal knowledge of the disease among patients with obstructive lung disease]

250 patients with obstructive lung disease who had attended an out-patient clinic were assessed after reporting on individual medication practices and their personal knowledge of the disease. 56% of the patients reported using two types of asthma medicine. The use of three, four, and five or more antasthmatica was reported by 26%, 9% and 5%, respectively. 90% had been prescribed an inhalation corticosteroid. Of these, one in five reported using it only when required, whereas in the age group 18-34 years the corresponding figure was one in three (34%). Regardless of what medication the patients were using, 20% reported that they often forgot to take it, 20% that they stopped taking it when their asthma improved, and 38% that they did not think about what time of the day they took their medicine. These practices of taking medication occurred more frequently in the young than in older patients. Practices did not vary with either a person's sex, duration of disease, or the patient's personal assessment of the seriousness of the disease. Patients with a higher level of education seemed to have greater knowledge of their disease than those with only secondary education, as was also the case with nonsmokers compared to smokers.

Comparison of topical antibiotics for treating Mycobacterium chelonae keratitis in a rabbit model

PURPOSE

To investigate the effect of topical amikacin (25 mg/ml), imipenem (25 mg/ml), ciprofloxacin (3 mg/ml), clarithromycin (20 mg/ml), amikacin combined with ciprofloxacin, amikacin combined with imipenem, and amikacin combined with clarithromycin on Mycobacterium chelonae keratitis.

METHODS

Ninety New Zealand albino rabbits were infected with a strain of M. chelonae for which minimum inhibitory concentration indicated in vitro sensitivity to the above antibiotics. The rabbits were treated for one or two weeks. The treatment efficacy was judged by the size of stromal infiltrate and quantitative culture of the infected corneas.

RESULTS

The size of the stromal infiltrate showed no significant difference in treated eyes compared to the untreated, control eyes. However, all treatments significantly reduced the number of organisms in treated eyes compared to untreated, control eyes (all p-values < 0.05). No significant difference in treatment efficacy was found between individual treatment groups. In none of the cases were organisms eliminated from the infected eyes, even after 2 weeks of treatment.

CONCLUSIONS

The results suggest that topical amikacin, imipenem, ciprofloxacin and clarithromycin had some therapeutic effect on M. chelonae keratitis; however, amikacin combined with imipenem, ciprofloxacin, and clarithromycin showed no increased efficacy over single agent therapy during 2 weeks of treatment. Long term treatment may be required to eradicate M. chelonae.

Clinical features and outcome of Acanthamoeba keratitis

We retrospectively reviewed 11 patients with culture-proven Acanthamoeba keratitis who presented at the National Taiwan University Hospital between 1989 and 1996. We assessed predisposing factors, initial diagnosis, clinical presentation, treatment, and outcome. A history of contact lens-wear, poor contact lens hygiene, intractable eye pain, and ring infiltrates in the cornea were the most prominent characteristics and clinical manifestations. Acanthamoeba keratitis was often misdiagnosed, with herpetic keratitis (7/11) being the most common initial diagnosis from referring hospitals. These patients were usually treated on the basis of the inaccurate diagnosis for more than 1 month (range 1-8 mo) before referral. All patients ultimately received penetrating keratoplasty because of poor response to delayed medical treatment. We suggest that inadequate contact lens hygiene may be important in Acanthamoeba keratitis. This condition is often misdiagnosed and, as early diagnosis is a major factor for successful medical treatment in such patients, awareness in clinical practice is critical.

Effect of shaking of corneal endothelial preservation

PURPOSE

To investigate the effect of shaking on corneal endothelial preservation.

METHODS

Thirty-six dog corneal buttons were obtained under standard eye bank procedure, after the animals had been sacrificed for cardiovascular experiments in the surgical department. They were equally divided into two groups. In Group I, buttons were put in Dexsol preservative medium and preserved at 4 degrees C. In Group II, buttons were put in Dexsol preservative medium and shaken in a shaking incubator at a speed of 5 rpm. at 4 degrees C for 10 h. After shaking, they were returned to a 4 degrees C refrigerator until examination. Three buttons from each group underwent specular microscopy, scanning electron microscopy (SEM), and alizarin red with trypan blue stain examinations on days 0, 1, 3, 5, 7 and 9, respectively.

RESULTS

In Group I, intercellular borders became blurred under specular microscopy, beginning on day 5. However, endothelial cell count did not change significantly until day 9. Intercellular digitations and wrinkling of intercellular borders were seen under alizarin red with trypan blue stain and SEM examination, beginning on day 3. Pleomorphism and ill-defined intercellular junctions were seen under SEM on day 7. There was no obvious denudement of the endothelial sheet, but a few scattered exfoliations were seen in Group I. In Group II, endothelial cell count did not decrease on day 1, but an endothelial image could not be obtained by specular microscopy 3 days after treatment. Alizarin red with trypan blue stain and SEM examination revealed that the endothelial cells were denuded from the Descemet's membrane three days after shaking. Severe stromal edema was seen under SEM five days after shaking.

CONCLUSIONS

The results showed that shaking had a detrimental effect on endothelial cell preservation. Vigorous shaking should be avoided during transportation of corneal buttons. It is advisable to perform penetrating keratoplasty as soon as possible upon receiving transported donor corneas.

The regulation of the scleral growth associated with deprivation myopia in chicks

The mechanism of axial elongation caused by experimental or clinical myopia is still unknown. We sought to explore the changes of scleral chondrocytes during myopia formation through the cell biology model. White Leghorn chicks were used for this study. The right eye was covered with a translucent goggle after hatching, and the left eye was left uncovered for control. The chicks were maintained on 12 hours light-dark cycle for two weeks, then sacrificed every other day and the eyeballs removed for study. Our results in the primary culture of scleral chondrocytes showed that the densities of chondrocytes on myopic eyes were significantly higher than those of the controlled non-myopic eyes, and 3H-thymidine incorporation rate also increased with the increasing of the concentration of fetal bovine serum. The PCNA index of chondrocytes in myopic eyes was also higher than that of the controlled non-myopic eyes. Thus, axial elongation of experimental myopia in the chick is the result of active tissue remodeling rather than passive scleral stretching alone.

Excimer laser photorefractive keratectomy for myopia

To evaluate the safety, effectiveness and stability of excimer laser photorefractive keratectomy (PRK) treatment, we studied its posttreatment results in 44 normal-sighted myopic eyes where a 193-nm emission wavelength excimer laser was used to correct myopia. The eyes were divided into three groups according to the preoperative refractive error and attempted correction: group I, preoperative myopia < or = 6.00 diopters (D), full correction; group II, preoperative myopia between 6.00 and 8.00 D, full correction; group III, preoperative myopia > 8.00 D, attempted correction of 8.00 D. Percentages of relative spherical equivalents (ie, observed spherical equivalent -- expected spherical equivalent) within +/- 1.0 D 3 months after treatment were 95% in group I, 64% in group II and 67% in group III. Uncorrected visual acuity of 20/40, or better, was achieved in 100% of eyes in group I, and 92% in group II at 6 months. Initial overcorrection followed by myopic regression was observed in all groups. The refractive outcome in our study was stable 3 months after surgery. Anterior stromal haze was mild and disappeared gradually 3 months postoperatively. The greater the diopter correction needed, the higher the grade of corneal haze (p < 0.01). There were no significant complications. The results of this study demonstrated that excimer laser PRK appears to be a reasonably predictable and stable procedure to correct low to moderate myopia.