Assessment of the Effectiveness of Ultrasound-Guided Needle Aspiration of Lactating Breast Abscesses

Objective

To evaluate the effectiveness of ultrasound-guided needle aspiration in treating lactating breast abscesses.

Methods

This study was conducted in Bach Mai Hospital, from 6/2020 to 7/2021. Lactating patients with breast abscesses underwent ultrasound-guided aspiration followed by antibiotics therapy.

Results

There were 59 lactating patients with 82 breast abscesses. Most of the abscesses had heterogeneous echogenicity, no capsule, and a size smaller than 5cm. Bacterial culture results showed that 85.4% of cases were Methicillin-resistant Staphylococcus aureus. The number of aspirations was from 1 to 5. The cure rate was 91.5%, and 5.3% of these cases had a complication associated with galactocele after treatment.

Conclusion

Ultrasound-guided needle aspiration is a minimally invasive treatment option for lactating breast abscesses with a high complete cure rate and good cosmetic results.

P–428 Uterine infusion of autologous platelet rich plasma (PRP) before embryo transfer may improve the transfer outcomes in recurrent implantation failure and thin/scarred endometrium patients

Study question

Does the infusion of autologous platelet rich plasma (PRP) to the uterus improve the outcomes of embryo transfer of thin endometrial or recurrent implantation failure (RIF) patients?

Summary answer

Autologous PRP uterine infusion may improve the result of embryo transfer (ET) in RIF group and thin/scarred endometrial group.

What is known already

Autologous PRP has been proposed to improve the outcomes of various treatment procedures. In infertility, several trials have reported an improvement in endometrial thickness in patients having thin endometrium thus previously cancelled ET cycles. Uterine injection of PRP shortly before ET has been proposed to improve the results of ET in patients having RIF. Platelets in PRP would be activated via different pathways to release growth factors and cytokines. In this study, we applied our in-house-developed PRP extraction kits that use a mechanical activation/platelet breaking down method to infuse/inject into the uterine of the poor prognosis transfer patients.

Study design, size, duration

This study includes two phases: Phase 1 (04/2019–12/2019): we tested the safety and effectiveness of the PRP extraction kits in 30 volunteers regardless of the gender by derma-rolling process using PRP extracted by our kits. Phase 2 (02/2020–12/2020): 111 IVF patients who had thin/scarred endometrium previously having at least one cancelled ET cycle (group 1) or patients who had at least two implantation failure ETs (group 2) were enrolled in the study.

Participants/materials, setting, methods

20 mL blood was drawn from the vein. After centrifugation, PRP was filtrated through a filter to break down platelets releasing growth factors/cytokines. Firstly, 30 volunteers (average age of 34.4 ± 5.5) were derma-rolled on the facial skin twice (one week apart). Secondly, IVF group 1 was uterine-infused with 0.5 mL PRP on day 7/8 of the ET cycle, both groups were uterine-infused with 0.5 mL PRP two days (40–48 hours) before ET.

Main results and the role of chance

0.5 mL of PRP before filtering was measured and calculated to have 8–12 folds increase of platelet concentration. In phase 1, no side-effects or complications were recorded. The average skin pore size reduced by approximately 0.01 mm2 in all patients two weeks after treatment. In phase 2, the average age was 35.6 ± 6.1. Group 1 had 31 patients and group 2 had 99 ones. In group 1, five patient did not obtained improvement in endometrium then ET cycles were cancelled, one patient did not have blastocyst to transfer and 25 patients had endometrium of at least 7 mm thick before ET and ET (100 frozen ET) were carried on. One couple was not contactable. Out of 24 couples, 13 had biochemical pregnancy (54.2%) and 11 had clinical pregnancy (44.0%). Group 2 had 80 patients. One of them did not have embryo to transfer. 37/79 embryo transfers had biochemical pregnancy (46.8%) and 44.3% clinical pregnancy. No complication was recorded. In our cohort, several successful patients had more than 7 unsuccessful ETs previously. For reference, in 2020, our clinic had 4260 ETs in total, the clinical pregnancy rate was 60.1%, the average age was 31.82 years old.

Limitations, reasons for caution

Each case in phase 2 of this study had a complicated fertility medical history therefore it was impossible to select the control group. This study is descriptive only. The size of each group was relatively small requiring ongoing data recording.

Wider implications of the findings: This study support the idea that cytokines and growth factors in PRP may help to prepare endometrium for ET, safely and effectively.

Trial registration number

Not applicable

Investigation of ANN architecture for predicting shear strength of fiber reinforcement bars concrete beams

In this paper, an extensive simulation program is conducted to find out the optimal ANN model to predict the shear strength of fiber-reinforced polymer (FRP) concrete beams containing both flexural and shear reinforcements. For acquiring this purpose, an experimental database containing 125 samples is collected from the literature and used to find the best architecture of ANN. In this database, the input variables consist of 9 inputs, such as the ratio of the beam width, the effective depth, the shear span to the effective depth, the compressive strength of concrete, the longitudinal FRP reinforcement ratio, the modulus of elasticity of longitudinal FRP reinforcement, the FRP shear reinforcement ratio, the tensile strength of FRP shear reinforcement, the modulus of elasticity of FRP shear reinforcement. Thereafter, the selection of the appropriate architecture of ANN model is performed and evaluated by common statistical measurements. The results show that the optimal ANN model is a highly efficient predictor of the shear strength of FRP concrete beams with a maximum R2 value of 0.9634 on the training part and an R2 of 0.9577 on the testing part, using the best architecture. In addition, a sensitivity analysis using the optimal ANN model over 500 Monte Carlo simulations is performed to interpret the influence of reinforcement type on the stability and accuracy of ANN model in predicting shear strength. The results of this investigation could facilitate and enhance the use of ANN model in different real-world problems in the field of civil engineering.

Molecular typing of conjunctivitis-causing adenoviruses in Hanoi, Vietnam from 2017 to 2019 and complete genome analysis of the most prevalent type (HAdV-8)

Adenoviral conjunctivitis is a common epidemic worldwide. In Vietnam, up to 80,000 patients are infected with adenoviral conjunctivitis annually. However, there are few investigations on the pathogenic adenoviruses that cause conjunctivitis. In total, 120 eye-swab samples were collected from patients with viral conjunctivitis symptoms in Hanoi, Vietnam from 2017 to 2019. Human adenoviruse (HAdV) was detected in 67 samples (55.83%) using polymerase chain reaction amplification of at least one of three HAdV-specific marker genes (hexon, penton, and fiber). Of the 67 HAdV samples, 46 samples could be analyzed by all three marker genes. DNA sequence analysis and phylogenetic tree building based on the three marker genes from the 46 HAdV samples revealed five different HAdV types associated with conjunctivitis in Hanoi, including HAdV-3 (4.3%), HAdV-4 (2.2%), HAdV-8 (89.1%), HAdV-37 (2.2%), and a potential recombinant type between types HAdV-8 and HAdV-3 (2.2%). This showed that HAdV-8 was the most common type identified in Hanoi. Complete genome analysis of HAdV-8 isolated from a Vietnamese patient (VN2017) using Sanger sequencing revealed 34 unique nucleotide changes, indicating that the adenovirus continuously accumulates new mutations. Hence, continuous surveillance of HAdV-8 changes in Vietnam is necessary in the future.

Chitosan-MnO2 nanocomposite for effective removal of Cr (VI) from aqueous solution

In this report, the adsorption of Cr(VI) onto MnO₂/CS nanocomposite material from aqueous solution is investigated. All the factors, which affect the adsorption, such as pH, adsorption time, Cr(VI) initial concentration and adsorbent dosage, are also examined. The results obtained show that the Cr(VI) uptake is strongly affected by pH and ion strength. Analysis within the nonlinear isotherm models indicates that the Sips isotherm combining with the Langmuir and Freundlich models offer the best fit to the experimental data due to the obtained highest R² and smallest RMSE and χ² values. The calculated Langmuir monolayer adsorption capacity is 61.56 mg g^-1 at pH of 2.0 and adsorption time of 120 min. Moreover, the mechanism studies by combining theoretical models with analytical spectroscopies reveal that the electrostatic attraction plays the important role to the uptake of Cr(VI) onto MnO₂/CS nanocomposite. Therefore, the present nanocomposite material can be applied to remove total Cr from wastewater produced by the galvanized manufacturing factory with a relatively high efficiency.

Parametric Investigation of Particle Swarm Optimization to Improve the Performance of the Adaptive Neuro-Fuzzy Inference System in Determining the Buckling Capacity of Circular Opening Steel Beams

In this paper, the main objectives are to investigate and select the most suitable parameters used in particle swarm optimization (PSO), namely the number of rules (n_rule), population size (n_pop), initial weight (w_ini), personal learning coefficient (c₁), global learning coefficient (c₂), and velocity limits (f_v), in order to improve the performance of the adaptive neuro-fuzzy inference system in determining the buckling capacity of circular opening steel beams. This is an important mechanical property in terms of the safety of structures under subjected loads. An available database of 3645 data samples was used for generation of training (70%) and testing (30%) datasets. Monte Carlo simulations, which are natural variability generators, were used in the training phase of the algorithm. Various statistical measurements, such as root mean square error (RMSE), mean absolute error (MAE), Willmott's index of agreement (IA), and Pearson's coefficient of correlation (R), were used to evaluate the performance of the models. The results of the study show that the performance of ANFIS optimized by PSO (ANFIS-PSO) is suitable for determining the buckling capacity of circular opening steel beams, but is very sensitive under different PSO investigation and selection parameters. The findings of this study show that n_rule = 10, n_pop = 50, w_ini = 0.1 to 0.4, c₁ = [1, 1.4], c₂ = [1.8, 2], f_v = 0.1, which are the most suitable selection values to ensure the best performance for ANFIS-PSO. In short, this study might help in selection of suitable PSO parameters for optimization of the ANFIS model.

Rho-associated kinase 1 inhibition is synthetically lethal with von Hippel-Lindau deficiency in clear cell renal cell carcinoma

Clear Cell Renal Cell Carcinoma (CC-RCC) is the most lethal of all genitourinary cancers. The functional loss of the von Hippel-Lindau (VHL) gene occurs in 90% of CC-RCC, driving cancer progression. The objective of this study was to identify chemical compounds that are synthetically lethal with VHL deficiency in CC-RCC. An annotated chemical library, the Library of Pharmacologically Active Compounds (LOPAC), was screened in parallel on VHL-deficient RCC4 cells and RCC4VHL cells with re-introduced VHL cDNA. The ROCK inhibitor, Y-27632, was identified and validated for selective targeting of VHL-deficient CC-RCC in multiple genetic backgrounds by clonogenic assays. Downregulation of ROCK1 by siRNA selectively reduced the colony forming ability of VHL-deficient CC-RCC, thus mimicking the effect of Y-27632 treatment, whereas downregulation of ROCK2 had no effect. In addition, two other ROCK inhibitors, RKI 1447 and GSK 429286, selectively targeted VHL-deficient CC-RCC. CC-RCC treatment with ROCK inhibitors is cytotoxic and cytostatic based on BrdU assay, Propidium Iodide (PI) staining, and growth curves; and blocks cell migration based on transwell assay. Importantly, knockdown of Hypoxia Inducible Factor (HIF) β in the VHL-deficient CC-RCC had a protective effect against Y-27632 treatment, mimicking VHL reintroduction. On the other hand, CC-RCCVHL cells were sensitized to Y-27632 treatment in hypoxia (2% O₂). These results suggest that synthetic lethality between ROCK inhibition and VHL deficiency is dependent on HIF activation. Moreover, HIF1α or HIF2α overexpression in CC-RCCVHL cells is sufficient to sensitize them to ROCK inhibition. Finally, Y-27632 treatment inhibited growth of subcutaneous 786-OT1 CC-RCC tumors in mice. Thus, ROCK inhibitors represent potential therapeutics for VHL-deficient CC-RCC.

Fixed-combination brinzolamide 1%/brimonidine 0.2% vs monotherapy with brinzolamide or brimonidine in patients with open-angle glaucoma or ocular hypertension: results of a pooled analysis of two phase 3 studies

Purpose

To describe pooled efficacy and safety data from two phase 3 studies comparing brinzolamide 1%/brimonidine 0.2% fixed combination (BBFC) with its component medications, brinzolamide and brimonidine, in patients with open-angle glaucoma or ocular hypertension.

Methods

Data were pooled from two nearly identical clinical trials comparing BBFC with its component medications, each given three times daily. The 3-month efficacy outcome was mean intraocular pressure (IOP) at 0800, 1000, 1500, and 1700 hours. Safety outcomes included adverse events (AEs), best-corrected visual acuity, examination of ocular structures, pachymetry, perimetry, and vital signs.

Results

A total of 1350 patients were enrolled and included in this analysis (BBFC, n=437; brinzolamide, n=458; brimonidine, n=455). Baseline mean IOP levels were similar among the three treatment groups. At 3 months, mean IOP of the BBFC group was significantly lower than that of either monotherapy group (P<0.0001) at all the four time points. A total of 272 patients (20.1%) experienced at least one treatment-related AE (BBFC, 24.6% brinzolamide, 18.7% brimonidine, 17.4%), the majority of which were ocular AEs. One serious AE, moderate intensity chest pain, was considered related to brinzolamide treatment and resulted in study discontinuation.

Conclusions

This analysis strengthens the conclusions drawn from the two individual phase 3 studies showing that, in patients with open-angle glaucoma or ocular hypertension, BBFC had significantly superior IOP-lowering activity compared with either brinzolamide or brimonidine alone and a safety profile consistent with that of its individual components.

Oxy-cope rearrangements of bicyclo[3.2.0]heptenones. Synthesis of bicyclo[4.2.1]non-1(4)-en-6-ones and bicyclo[5.2. 1]dec-1(10)-en-5-ones

6-exo-Methylbicyclo[3.2.0]hepten-7-ones and their 2-alkylidene analogues are readily prepared from dialkyl squarates. These compounds undergo facial oxy-Cope ring expansions upon treatment with vinyllithium; the former leads to bicyclo[4.2. 1]non-1(4)-en-6-ones and the latter to the first examples of bicyclo[5.2.1]dec-1(10)-en-5-ones, compounds having exceptionally strained bridgehead double bonds. The transformations are controlled by the 6-exo-methyl group in the starting material along with the substituent at position-1 (bridgehead) which force attack of the lithium reagent from the concave face of the starting material, thus allowing the cyclopentenyl or alkylidene groups to participate in the sigmatropic event.

Effect of interleukin (IL)-12 and IL-15 on activated natural killer (ANK) and antibody-dependent cellular cytotoxicity (ADCC) in HIV infection

The ability of IL-12 and IL-15 to enhance natural killer (NK) activity and antibody-dependent cellular cytotoxicity (ADCC) of mononuclear cells (MNCs) from HIV+ children and their mothers was investigated. MNCs from HIV+ patients were deficient in NK and ADCC activity compared to control MNCs against several target cells. Overnight incubation with IL-15 or IL-12 augmented NK activity of MNCs from both patients and controls, and the combination of IL-12 and IL-15 resulted in the greatest enhancement. ADCC in HIV+ patients against gp120-coated CEM.NKR cells or chicken erythrocytes could also be enhanced by IL-2 or IL-15 in overnight cultures. Culturing MNCs with either IL-2 or IL-15 for 1 week increased the NK activity in patients to levels of controls treated with these cytokines. However, the response to the combination of IL-12 and IL-15 was less than that to IL-15 alone in 1-week cultures. Culturing MNCs with IL-2 and IL-15 for 1 week also increased the percentage of CD16+/CD56+ cells in both patients and controls. Thus, IL-15 can restore the deficient NK activity in patients and may be a candidate for immunomodulative therapy in HIV+ patients.

Interleukin (IL)-15 enhances antibody-dependent cellular cytotoxicity and natural killer activity in neonatal cells

Interleukin (IL)-15 is a novel cytokine that is very similar to IL-2 in receptor specificity and biological activities. We compared the ability of IL-15 and IL-12 to enhance the cytotoxicity of neonatal (cord blood) and adult mononuclear cells (MNC) in both natural killer (NK) and antibody-dependent cellular cytotoxicity (ADCC) assays. Incubation with IL-15 (10 ng/ml) or IL-12 (1 ng/ml) for 18 h enhanced the NK activity (using K562 target cells) of both cord and adult MNC, increasing cord cell cytotoxicity threefold. Similar enhancement was seen in ADCC assays using erythrocyte targets and NK-resistant CEM cells coated with HIV gp-120 antigen. Incubation of cord cells with IL-15 or IL-12 for 1 week increased both NK and ADCC, although the combination produced less of an effect than either cytokine alone. IL-15 also increased the percentage of CD16+/CD56+ cells after 1 week incubation. This enhancement of NK and ADCC activities and the number of NK cells by IL-15 suggests it may be clinically useful in treating immunodeficient patients.

Complications of Baerveldt glaucoma drainage implants

OBJECTIVES

To report the incidence and identify risk factors of postoperative complications after Baerveldt glaucoma drainage implantation.

METHODS

A retrospective review of the medical records of all patients at the Bascom Palmer Eye Institute, Miami, Fla, who underwent placement of a Baerveldt glaucoma drainage implant from October 1, 1992, through October 31, 1996, to determine demographic characteristics, preoperative and postoperative intraocular pressures, and complications. Variables were analyzed using the Student t test and Fisher exact test to determine the association between delayed postoperative suprachoroidal hemorrhage and various potential risk factors.

RESULTS

A total of 107 eyes of 103 patients were identified. Suprachoroidal hemorrhage occurred in 4 eyes (4%), with onset ranging from 3 to 33 days after implantation. Two eyes (2%) had choroidal effusions requiring surgical drainage, and 20 eyes (19%) had low choroidal effusions requiring only close observation. Tube blockage was observed in 5 eyes (5%). Four eyes (4%) had aqueous misdirection, 2 eyes (2%) had corneal decompensation, and 1 eye (1%) each had endophthalmitis, tube migration, corneal ulcer, hyphema, and implant migration. Patients who were older (P=.04) or had postoperative choroidal effusions (P=.03), low intraocular pressure immediately after the tube opened (P=.03), hypertension (P= .08), or atherosclerosis (P=.09) were more likely to develop suprachoroidal hemorrhage.

CONCLUSIONS

A lower incidence of serious postoperative complications was observed in Baerveldt implantations in this study when compared with a recent report. Risk factors for serious complications were similar to trabeculectomy.

Enhancement of antibody-dependent cellular cytotoxicity of neonatal cells by interleukin-2 (IL-2) and IL-12

Newborn infants are more susceptible to infections due in part to deficiencies in the cytotoxic functions of their lymphocytes. We investigated the ability of interleukin-2 (IL-2) and IL-12 to enhance the cytotoxicity of neonatal (cord blood) and adult mononuclear cells (MNCs) in both natural killer (NK) cell and antibody-dependent cellular cytotoxicity (ADCC) assays. The cytotoxic activity of cord blood MNCs was less than 50% that of adult MNCs in most assays prior to exposure to cytokines. Incubation with IL-2 (100 U/ml) or IL-12 (1 ng/ml) for 18 h increased the NK cell activity (using K562 target cells) of both cord blood and adult MNCs, and the combination of IL-2 and IL-12 increased cord blood cytotoxicity threefold, making the cytotoxicity of cord blood cells equivalent to that of adult cells treated with the same cytokines. In ADCC assays with chicken erythrocyte targets, the combination of IL-2 and IL-12 increased the cytotoxicities of both cord blood and adult MNCs, with greater enhancement again seen with cord blood cells. In assays with NK cell-resistant CEM cells coated with human immunodeficiency virus (HV) gp120 antigen in the presence of hyperimmune anti-HIV immunoglobulin, ADCC of cord blood MNCs was about 50% that of adult MNCs; ADCC of cord blood MNCs increased two- to threefold with the addition of IL-2 and IL-12, whereas ADCC of adult MNCs did not increase. Incubation of cord blood cells, but not adult cells, with IL-2 or IL-12 for 1 week increased the percentage of CD16+/CD56+ cells two- to fivefold and enhanced ADCC activity. Thus, IL-2 and IL-12 greatly enhance both the NK cell and ADCC activities of neonatal MNCs and increase the number of NK cells in longer-term culture.

Results of intraoperative 5-fluorouracil or lower dose mitomycin-C administration on initial trabeculectomy surgery

PURPOSE

This study was conducted to review outcomes in eyes following primary trabeculectomy supplemented intraoperatively with 5-fluorouracil (5-FU) or lower dose mitomycin-C (MMC).

PATIENTS AND METHODS

We retrospectively reviewed the medical records of 73 eyes of 63 patients with progressive, far advanced open angle glaucoma who had undergone initial trabeculectomy with intraoperative application of 5-FU, 50 mg/mL for 5 min (N = 37), or MMC, 200 micrograms/mL for 3-5 min (N = 36), and with at least 12 months follow-up.

RESULTS

Mean preoperative intraocular pressures (IOPs) in the MMC and 5-FU groups were 24.3 +/- 7.6 and 24.6 +/- 9.3 mm Hg, respectively. Postoperatively, IOPs were similar at 6-month interval follow-up examinations in the MMC and 5-FU groups. At an average follow-up of 20.9 months, mean final visit postoperative IOPs were 10.2 +/- 3.6 (p < 0.001) and 9.7 +/- 3.4 mm Hg (p < 0.001) in the MMC and 5-FU groups, respectively, requiring an average of 0.25 and 0.22 antiglaucoma medications per eye, respectively. Interval follow-up complications were similar between groups and included four bleb leaks in the MMC group, and three bleb leaks in the 5-FU group. Visual acuity remained stable in 71 of 73 eyes.

CONCLUSIONS

Both antifibrosis agents provide good intermediate term IOP control and may be appropriate for use in those eyes requiring final "target" IOPs in the low teens or single digits.

Human immunodeficiency virus (HIV) type-1 GP120-specific cell-mediated cytotoxicity (CMC) and natural killer (NK) activity in HIV-infected (HIV+) subjects: enhancement with interleukin-2(IL-2), IL-12, and IL-15

Cell-mediated cytotoxicity (CMC), as mediated by cytophilic antibody to human immunodeficiency virus (HIV) antigens, may be an important defense in HIV-infected (HIV+) patients in response to the virus. In this study the ability of interleukin (IL)-2, IL-12, and IL-15 to enhance natural killer (NK) and gp120-specific CMC of mononuclear cells (MNCs) from HIV+ children and adults was examined. NK activity against K562 cells was deficient in HIV+ patients compared to controls and could be enhanced by IL-2, IL-12, or IL-15, with the combinations of IL-2 + IL-12 and IL-12 + IL-15 producing more cytotoxicity than individual cytokines. Gp120-specific CMC was significantly higher in patients than in controls. It could be increased by IL-2, IL-12, and IL-15 and further by combining IL-2 and IL-12. When an exogenous source of antibody in the form of hyperimmune HIV-specific immunoglobulin (HIVIG) was present, the response of control MNCs was much higher than that of patients, although gp120-specific cytotoxicity of patients' MNCs was significantly enhanced (two- to threefold) by the addition of HIVIG. This increment in cytotoxicity due to HIVIG, however, could not be further augmented by cytokines in controls or patients. Our findings suggest multiple cytokine administration to boost NK cell function, together with passive immunotherapy, might offer a new therapeutic approach to benefit HIV+ patients.

Neovascular glaucoma after carotid endarterectomy

The authors examined a patient who had neovascular glaucoma (NVG) shortly after ipsilateral carotid endarterectomy and followed the patient's clinical course. The authors speculate that the sudden reperfusion after endarterectomy that occurs in patients with combined central retinal artery occlusion and carotid occlusive disease may enhance the circulation of preformed angiogenesis factors, leading to the development of neovascularization. The authors recommend frequent and careful surveillance of patients with central retinal artery occlusion associated with carotid occlusive disease if ipsilateral carotid endarterectomy is performed.

Long-term histologic studies of the Baerveldt implant in a rabbit model

PURPOSE

The Baerveldt glaucoma implant is an aqueous shunting device with large surface area that is installed through a single-quadrant conjunctival incision. A rabbit model of the Baerveldt implant was created to obtain serial histology and clinical information over 1 year.

METHODS

Modified versions of the Baerveldt implant (110 or 160 mm2) were implanted in 18 normal New Zealand white rabbit eyes. The rabbits were examined periodically and their intraocular pressures (IOPs) recorded. They were killed at monthly intervals to obtain histology of the bleb capsules.

RESULTS

Thin capsules were present at 1 month, which consisted of lamellar collagen deposition surrounded by a granulomatous reaction with multinucleate giant cells. Inflammatory cells (probably macrophages) were scattered on the inner bleb surface. The granulomatous reaction resolved after 4 months. Subsequently, capsule thickness and cellularity remained relatively stable, although the collagen stroma became less compact over time. Sixteen rabbit eyes had initial IOP reductions of > or = 3 mm Hg compared with fellow eyes, which persisted up to 4 weeks postoperatively. Seven eyes (39%) exhibited a hypertensive phase (IOP exceeded that of fellow eye by > or = 3 mm Hg) from 2 weeks to 3 months postoperatively.

CONCLUSION

The Baerveldt explant is surrounded by a fibrous capsule that matures over time. The bleb histology in the rabbit model is similar to that described with the Molteno implant in primates and humans, except for the eventual development of a fibroblastic inner lining in the rabbit model. This contrasts with primate and human models, in which the inner lining remains an open mesh.

Finasteride inhibits 5 alpha-reductase activity in human dermal fibroblasts: prediction of its therapeutic application in androgen-related skin diseases

BACKGROUND

The potential role of finasteride in treating androgen related skin disorders was investigated.

METHODS

Pooled human dermal fibroblasts were used to assess the effect of finasteride on the 5 alpha-reductase activity in skin tissue. Vmax and Km were estimated in the presence of 0, 10, and 200 nM finasteride.

RESULTS

Vmax values remain constant near 1.20 pmol/mg protein/h in the presence of increasing concentrations of finasteride; however, apparent Km increases from 0.27 nM at 0 nM finasteride to 0.31 nM and 0.44 nM at 10 nM and 200 nM finasteride, respectively. This suggests that finasteride competes with testosterone and has a high affinity for same binding site of the 5 alpha-reductase enzyme. Apparent Ki was estimated at 282 nM, indicating that a high concentration of finasteride is required to significantly suppress the enzyme activity.

CONCLUSIONS

This study confirms that finasteride inhibits the conversion of testosterone to dihydrotestosterone in human reticular dermal fibroblasts. Finasteride may have therapeutic potential in treating skin disorders influenced by the action of dihydrotestosterone.

Management of acne vulgaris

Acne vulgaris can affect both adolescents and adults. The pathogenesis of acne is multifactorial and involves overproduction of sebum, an abnormal follicular keratinization process, proliferation of Propionibacterium acnes, and hormonal and immunologic factors. Clinical manifestations of acne range from noninflammatory comedones to inflammatory papules, pustules and cysts. Current therapy allows the physician to select a variety of topical and/or systemic antibiotics, retinoids, and hormone agents aimed at specific pathogenic factors. Most treatment regimens require several weeks of consistent use to be effective. Sound patient education, a strong therapeutic alliance and modification of lifestyle factors are powerful adjuncts to medical management.

Decrease in skin-closing tension intraoperatively with suture tension adjustment reel, balloon expansion, and undermining

BACKGROUND

The biomechanical and viscoelastic properties of the skin enable it to be significantly stretched within a relatively short period of time. This property, called mechanical creep, is exploited in various surgical maneuvers for intraoperative closure of large surgical defects. The recently introduced Miami Suture Tension Adjustment Reel (S.T.A.R.) device permits both the precise sutured attachment of a linear cycled load to approximate the edges of widened surgical defects, and the easy measurement of wound edge tension across the defects.

OBJECTIVE

It was our purpose to compare the relative effects of linear load cycling with the S.T.A.R. device, spherical load cycling with balloon expander, and surgical undermining on the closing tension of surgical defects.

METHOD

Surgical wounds were created on the flanks of six pigs and these defects were closed by various methods of repair. The combination of undermining and the S.T.A.R. device ws also evaluated.

RESULTS

The average total decreases in skin closing tension were: undermining, 17.8 +/- 0.5%; balloon, 28.5 +/- 1.6%; S.T.A.R. device, 36.6 +/- 4.8%.

CONCLUSION

Our data showed that all three techniques were effective in lowering the tension required to approximate surgically created defects, with the S.T.A.R. device proving to be most effective. Undermining and the S.T.A.R. device also worked synergistically to decrease skin-closing tension.

Verruca vulgaris and radiation exposure are associated with squamous cell carcinoma of the finger

BACKGROUND

Factors associated with the development of squamous cell carcinoma (SCC) of the finger are verruca vulgaris, radiation exposure, burns, and arsenic ingestion.

OBJECTIVES

We wish to further document the relationship between human papillomavirus (HPV) and roentgen exposure to squamous cell carcinoma of the finger.

METHODS

A retrospective study of 32 cases of digital squamous cell carcinoma seen at UCLA Medical Center was performed.

RESULTS

Ten patients (31%) had histories of verrucae at the site of the carcinoma. Eight patients (25%) had histories of x-ray therapy to the hand.

CONCLUSION

Our study further supports the association of verruca vulgaris and radiation exposure in the development of squamous cell carcinoma of the finger.

Trabeculectomy and Molteno implantation for glaucomas associated with uveitis

PURPOSE

This study compares the outcomes of trabeculectomy and Molteno implantation in the treatment of glaucomas associated with uveitis.

METHODS

Forty-five patients with uveitis, who had undergone filtering surgery for glaucomas associated with uveitis, were reviewed retrospectively. Successful outcome was defined as final intraocular pressure (IOP) of 6 to 21 mmHg, with a minimum follow-up of 6 months without visually devastating complications or loss of light perception.

RESULTS

One- and two-year life-table success rates, respectively, were 81% and 73% with trabeculectomy (16 patients); 53% and 31% with combined trabeculectomy and first-stage (reserve) Molteno implantation (19 patients); and 79% and 79% with one-stage Molteno implantation (10 patients). In 11 patients who underwent second-stage Molteno implantation after trabeculectomy failure, 1- and 2-year life-table success rates were 79% and 79%, respectively. Complications included surgically treated choroidal effusions (1/45; 2%), choroidal hemorrhages (3/45; 7%), and chronic hypotony (3/45; 7%). Follow-up in all groups ranged from 5 to 70 months (mean +/- standard deviation, 28 +/- 17 months).

CONCLUSIONS

Trabeculectomy provides surprisingly good results in glaucomas associated with uveitis (modulation of wound healing with antimetabolites probably would afford an even higher success rate). However, when significant, immediate postoperative and/or moderate chronic postoperative inflammation is likely, aqueous drainage devices appear more likely to control IOP.

Incidence and management of glaucoma in Vogt-Koyanagi-Harada syndrome

BACKGROUND

The Vogt-Koyanagi-Harada syndrome is a bilateral panuveitis associated with neurologic and dermatologic manifestations.

METHODS

The authors reviewed the charts of all patients with Vogt-Koyanagi-Harada syndrome seen at their institution over the past decade to determine the incidence of glaucoma, as well as the results of medical and surgical therapy for glaucoma, in this group of patients.

FINDINGS

Of 42 patients diagnosed with Vogt-Koyanagi-Harada syndrome, evidence of glaucoma requiring either medical or surgical intervention occurred in 16 patients (38.1%). Of these, nine (56.3%) had open-angle glaucoma and seven (43.7%) had angle-closure secondary to pupillary block. In 5 (31.3%) of the 16 patients, medical therapy alone was sufficient to control intraocular pressure. Eleven patients (68.7%) required surgical intervention, consisting of laser iridotomy, surgical iridectomy, trabeculectomy with or without 5-fluorouracil, and/or Molteno implantation.

CONCLUSION

The relative success of each of these procedures in this group of patients is discussed. Glaucoma is a common complication in the Vogt-Koyanagi-Harada syndrome, and one that is often difficult to control.

Expression of CD45 isoforms in fresh and IL-2-cultured tumor-infiltrating lymphocytes from basal cell carcinoma

Immunohistochemistry and flow cytometry analyses were performed to characterize the specific T cell subpopulations infiltrating basal cell carcinomas (BCC) and to determine their phenotypic response to in vitro expansion with IL-2. Tumor-infiltrating lymphocytes (TIL) within BCC predominantly expressed the CD45RO (activated or "memory") phenotype (65 +/- 3%) and the percentage of TIL expressing CD45RO consistently increased when cultured in vitro with IL-2 (85 +/- 5%). In comparison, fresh normal peripheral blood lymphocytes predominantly expressed the CD45RA (naive) phenotype (79 +/- 4%), but shifted to the expression of CD45RO following in vitro expansion in IL-2 (86 +/- 6%). To determine whether IL-2 alone, in the absence of antigen or mitogen, can promote naive lymphocytes to convert from the expression of the CD45RA isoform to the CD45RO isoform, we cultured purified CD45RA+ lymphocytes in IL-2. After three weeks in culture, 90% of the lymphocytes expressed exclusively CD45RO. We conclude that tumor-infiltrating lymphocytes from BCC predominantly express CD45RO and that this expression may represent specific antigen stimulation and/or in situ activation by cytokines.

Incidence and management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments

BACKGROUND

Intravitreal silicone oil injection used for managing complicated retinal detachments can be associated with elevated intraocular pressure (IOP). This study was undertaken to determine the incidence of glaucoma in patients who underwent silicone oil injection, as well as to evaluate the effectiveness of medical and surgical therapy in patients in whom glaucoma developed.

METHODS

The postoperative courses of 50 eyes of 47 consecutive patients who underwent pars plana vitrectomy and silicone oil injection for the management of complicated retinal detachments were reviewed retrospectively. The outcomes of patients who underwent silicone oil removal and/or glaucoma surgery also were evaluated.

RESULTS

The mean overall postoperative IOP before any glaucoma surgery was 16.7 +/- 9.3 mmHg (range, 0 to 45 mmHg), with a mean follow-up of 16.6 +/- 12.1 months (range, 2 to 51 months). Twenty-four (48%) eyes had postoperative IOPs of at least 25 mmHg and IOP elevations of at least 10 mmHg above the preoperative levels. Twenty-one (42%) eyes underwent complete removal of silicone oil and/or glaucoma surgery to effect IOP control. The IOPs were controlled to 21 mmHg or less (but > 5 mmHg) in 8 of 14 eyes that underwent removal of silicone oil alone, in 3 of 5 eyes that underwent Molteno implantation, and in 1 eye that underwent Nd:YAG transscleral cyclophotocoagulation, but not in 1 eye that underwent a modified Schocket procedure (mean follow-up, 13.5 +/- 11.0 months; range, 0.2 to 33 months).

CONCLUSION

Intraocular pressure elevation is a common occurrence after intravitreal silicone oil injection. The underlying mechanism may often be multifactorial in nature. Patients in whom uncontrolled IOP develops may benefit from aggressive medical and/or surgical treatment with silicone oil removal, glaucoma implants, or cyclodestructive procedures.

Estrogen receptors and the response to sex hormones in angiolymphoid hyperplasia with eosinophilia

BACKGROUND

Angiolymphoid hyperplasia (ALH) with eosinophilia is a benign rare tumor, characterized by marked proliferation of endothelial cells. The tumors are associated with extensive infiltrate of lymphocytes, histiocytes, and eosinophils, and occur on the head and neck of young adults. A variety of treatments have been attempted with frequent recurrences. We report two cases of ALH with eosinophilia that seemed to be dependent on sex hormones.

OBSERVATION

The first case is a patient with ALH that resolved after stopping treatment with birth control pills. Biopsy specimens of the tumor demonstrated increased level of estrogen and progesterone receptors compared with her normal skin. The second case is a patient with a previous lesion of ALH with eosinophilia, who during pregnancy had new lesions develop and whose primary lesion increased in size. All lesions decreased to half their original sizes after pregnancy.

CONCLUSION

Both of these cases suggest a role for hyperestrogen states with the presence of hormonal receptors. The response to sex hormones could contribute to the pathogenesis of the disease and may offer future alternative treatment modalities.

Cadmium uptake kinetics in human erythrocytes

Cross-membrane transport of cadmium in human erythrocytes was studied using 109Cd+(+) and liquid scintillation counting. Uptake rates were determined by depletion of radioactivity in the incubation medium and the amount of hemolyzate radioactivity taken up by the erythrocytes. Both saturable and nonsaturable components for cadmium transport were observed. The mean maximum uptake rate (Jmax) of the saturable component was 4.9 X 10(-6) mol/L/h. The transport constant (Kt) was estimated at 6.9 X 10(-5) mol/L. The diffusion constant (Kd) of the non-saturable component was 1.4 X 10(-2)/h. Both Jmax and Kt of cadmium generally decreased when Zn+(+) was present, with a biphasic response in the presence of Cu+(+). Kd of cadmium increased as Zn+(+) or Cu+(+) levels were increased. It is suggested that cadmium may penetrate human red cells via cation transport sites owing to its behavior as an analog of one or more nutrient species.