An international collaborative evaluation of central serous chorioretinopathy: different therapeutic approaches and review of literature. The European Vitreoretinal Society central serous chorioretinopathy study

PURPOSE

To study and compare the efficacy of different therapeutic options for the treatment of central serous chorioretinopathy (CSCR).

METHODS

This is a nonrandomized, international multicentre study on 1719 patients (1861 eyes) diagnosed with CSCR, from 63 centres (24 countries). Reported data included different methods of treatment and both results of diagnostic examinations [fluorescein angiography and/or optical coherent tomography (OCT)] and best-corrected visual acuity (BCVA) before and after therapy. The duration of observation had a mean of 11 months but was extended in a minority of cases up to 7 years. The aim of this study is to evaluate the efficacy of the different therapeutic options of CSCR in terms of both visual (BCVA) and anatomic (OCT) improvement.

RESULTS

One thousand seven hundred nineteen patients (1861 eyes) diagnosed with CSCR were included. Treatments performed were nonsteroidal anti-inflammatory eye drops, laser photocoagulation, micropulse diode laser photocoagulation, photodynamic therapy (PDT; Standard PDT, Reduced-dose PDT, Reduced-fluence PDT), intravitreal (IVT) antivascular endothelial growth factor injection (VEGF), observation and other treatments. The list of the OTHERS included both combinations of the main proposed treatments or a variety of other treatments such as eplerenone, spironolactone, acetazolamide, beta-blockers, anti-anxiety drugs, aspirin, folic acid, methotrexate, statins, vitis vinifera extract medication and pars plana vitrectomy. The majority of the patients were men with a prevalence of 77%. The odds ratio (OR) showed a partial or complete resolution of fluid on OCT with any treatment as compared with observation. In univariate analysis, the anatomical result (improvement in subretinal fluid using OCT at 1 month) was favoured by age <60 years (p < 0.005), no previous observation (p < 0.0002), duration less than 3 months (p < 0.0001), absence of CSCR in the fellow eye (p = 0.04), leakage outside of the arcade (p = 0.05) and fluid height >500 μm (p = 0.03). The OR for obtaining partial or complete resolution showed that anti-VEGF and eyedrops were not statistically significant; whereas PDT (8.5), thermal laser (11.3) and micropulse laser (8.9) lead to better anatomical results with less variability. In univariate analysis, the functional result at 1 month was favoured by first episode (p = 0.04), height of subretinal fluid >500 μm (p < 0.0001) and short duration of observation (p = 0.02). Finally, there was no statistically significant difference among the treatments at 12 months.

CONCLUSION

Spontaneous resolution has been described in a high percentage of patients. Laser (micropulse and thermal) and PDT seem to lead to significant early anatomical improvement; however, there is little change beyond the first month of treatment. The real visual benefit needs further clarification.

Surface reconstruction and charge modulation in BaFe2As2 superconducting film

Whether or not epitaxially grown superconducting films have the same bulk-like superconducting properties is an important concern. We report the structure and the electronic properties of epitaxially grown Ba(Fe_1-x Co _x )₂As₂ films using scanning tunneling microscopy and scanning tunneling spectroscopy (STS). This film showed a different surface structure, [Formula: see text]R45° reconstruction, from those of as-cleaved surfaces from bulk crystals. The electronic structure of the grown film is different from that in bulk, and it is notable that the film exhibits the same superconducting transport properties. We found that the superconducting gap at the surface is screened at the Ba layer surface in STS measurements, and the charge density wave was observed at the surface in sample in the superconducting state.

Interplay of charge density wave and multiband superconductivity in 2H-PdxTaSe2

2H-TaSe2 has been one of unique transition metal dichalcogenides exhibiting several phase transitions due to a delicate balance among competing electronic ground states. An unusual metallic state at high-T is sequentially followed by an incommensurate charge density wave (ICDW) state at ≈122 K and a commensurate charge density wave (CCDW) state at ≈90 K, and superconductivity at TC ~ 0.14 K. Upon systematic intercalation of Pd ions into TaSe2, we find that CCDW order is destabilized more rapidly than ICDW to indicate a hidden quantum phase transition point at x ~ 0.09-0.10. Moreover, TC shows a dramatic enhancement up to 3.3 K at x = 0.08, ~24 times of TC in 2H-TaSe2, in proportional to the density of states N(EF). Investigations of upper critical fields Hc2 in single crystals reveal evidences of multiband superconductivity as temperature-dependent anisotropy factor γH = , quasi-linear increase of , and an upward, positive-curvature in near TC. Furthermore, analysis of temperature-dependent electronic specific heat corroborates the presence of multiple superconducting gaps. Based on above findings and electronic phase diagram vs x, we propose that the increase of N(EF) and effective electron-phonon coupling in the vicinity of CDW quantum phase transition should be a key to the large enhancement of TC in PdxTaSe2.

Comparison of miniplates and biodegradable plates in reconstruction of the mandible with a fibular free flap

Miniplates and reconstruction plates are usually used to fix a fibular free flap, the gold standard in reconstruction of large segmental mandibular defects. Though biodegradable plates are used in orthognathic operations and repair of fractures nowadays, we know of no studies of the use of biodegradable plates in the reconstruction of segmental mandibular defects including a fibular free flap. We retrospectively reviewed 47 patients who had reconstruction of segmental mandibular defects with fibular free flaps during the past 10 years, and recorded clinical data and morbidity. We compared patients who had reconstruction of such defects with fibular free flaps and miniplates (n=26) with those in whom biodegradable plates had been used (n=21). There was no significant difference between miniplates and biodegradable plates with regard to overall complications (p=0.45) and failure of flaps (p=0.59). After confounding factors had been adjusted for with Cox's proportional hazards regression, there was no significant difference in the proportion of patients who developed a complication between the two groups (p=0.4). The type of plate does not seem to affect overall morbidity in reconstruction of the mandible with a fibular free flap.

Distinctive role of 6-month teriparatide treatment on intractable bisphosphonate-related osteonecrosis of the jaw

The administration of teriparatide (TPTD) in conjunction with periodontal care could provide faster and more favorable clinical outcomes in previously refractory bisphosphonate-related osteonecrosis of the jaws (BRONJ) cases compared to conventional dental care, combination of surgery and antimicrobial treatment. We also found that underlying vitamin D levels might influence the response to TPTD treatment.

INTRODUCTION

Treatment of BRONJ is quite challenging and there are no standard treatment modalities. In this retrospective, longitudinal study, we examined whether additional TPTD administration could be beneficial for the resolution of BRONJ lesions compared to conservative management, such as antimicrobial treatment with or without surgery, and also studied the factors influencing the response to TPTD.

METHODS

Twenty-four cases of intractable BRONJ were included: 15 subjects were assigned to the TPTD group and the other 9 subjects, who refused TPTD administration, were assigned to the non-TPTD group. All subjects in both groups continued calcium and vitamin D supplementation and the TPTD group additionally received a daily subcutaneous injection of 20 μg TPTD for 6 months.

RESULTS

While 60.0% of the non-TPTD group showed one stage of improvement in BRONJ, 40.0% of the group did not show any improvement in disease status. In the TPTD group, 62.5% of the treated subjects showed one stage of improvement and the other 37.5% demonstrated a marked improvement, including two stages of improvement or complete healing, and there was not a single case that did not improve. The clinical improvement of BRONJ was statistically better in the TPTD group after the 6-month treatment (p < 0.05). Moreover, patients with higher baseline serum 25(OH)D levels showed better clinical therapeutic outcomes with TPTD.

CONCLUSIONS

We observed the beneficial effects of TPTD on BRONJ, and subjects with optimal serum vitamin D concentrations seemed to reap the maximum therapeutic effects of TPTD. A prospective, randomized, controlled trial should be needed to further evaluate the therapeutic efficacy of TPTD in the resolution of BRONJ.

Oral bisphosphonate-related osteonecrosis of the jaw: the first report in Asia

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious side effect of bisphosphonate therapy. The incidence of BRONJ is known to be low among patients treated with oral bisphosphonates. We investigated the prevalence, demographics, clinical manifestations, and treatment outcome of 24 patients with oral BRONJ in Asian populations.

INTRODUCTION

The long-term safety of oral bisphosphonates is clinically important considering the rare but potentially serious complications such as bisphosphonate-related osteonecrosis of the jaw (BRONJ) versus the effect of reducing and preventing osteoporotic fracture. The incidence of BRONJ is known to be low among patients treated with oral bisphosphonates around the world. However, the prevalence in those taking oral bisphosphonates for osteoporosis in Asian populations is unknown. Moreover, a recent article, showing that the majority of reported patients who received alendronate were Asian American, raised concern about the prevalence of oral BRONJ in Asian populations. The objective of this study was to investigate the estimated prevalence, clinical characteristics, and treatment outcome of oral BRONJ in Asian populations.

METHODS

From October 2005 to December 2008, a retrospective review of medical charts identified 24 patients receiving oral bisphosphonates diagnosed as BRONJ at the Department of Oral and Maxillofacial Surgery, Yonsei University Dental Hospital, Seoul, South Korea.

RESULTS

The estimated prevalence of oral BRONJ was 0.05-0.07%. The average oral bisphosphonate treatment duration was 43.1 months (range, 5-120 months). Treatment with oral antibiotics and/or surgery including sequestrectomy or alveolectomy showed relatively favorable results.

CONCLUSIONS

The prevalence of oral BRONJ in Korea is similar to that reported previously in Western populations. We suggest that recognition of BRONJ and appropriate management pre- and post-dental surgery might reduce the frequency of BRONJ among patients receiving oral bisphosphonates.

Spontaneous bone formation on the maxillary sinus floor in association with an extraction socket

A case is reported of spontaneous bone formation on the maxillary sinus floor associated with the extraction socket of a maxillary impacted tooth. An impacted maxillary second premolar of a 20-year-old male had been pushed into the maxillary sinus during surgical extraction. The tooth was removed using the sinus elevation technique. After 5 months of healing, the space between the sinus floor and the socket was filled with new bone. Later, implant surgery was successfully carried out without any sinus augmentation. Osteogenic activity of sinus mucosa and the blood clot in the extraction socket beneath the elevated sinus would have been important factors in this spontaneous bone formation.

Methoxy[meso-5,10,15,20-tetrakis(2,6-difluorophenyl)porphyrinato]iron(III), [Fe(TDFPP)(OCH3)]

The crystal structure of the title compound, [Fe(C(44)H(20)F(8)N(4))(CH(3)O)], has been determined. The Fe atom lies 0.485 (1) A out of the plane of the four N atoms to which it is coordinated and from the inversion centre at the origin of the unit cell. The methoxy group is axially coordinated to the Fe atom with O-Fe-N angles of 106.3 (2) and 102.4 (2) degrees, a C-O-Fe angle of 128.3 (5) degrees and an Fe-O distance of 1.788 (5) A. Difluorophenyl rings are tilted from the porphyrin (por) plane with torsion angles of -68.1 (6) and 77.7 (5) degrees across the two C(por)-C-C-C(ar) systems.

Zinc tetrakis(N-methyl-4'-pyridyl) porphyrinato is an effective inhibitor of stimulant-induced activation of RAW 264.7 cells

One proposed mechanism for the development of silica-induced fibrosis is prolonged pulmonary inflammation and lung damage resulting from the secretion of reactive mediators from alveolar macrophages. Metalloporphyrins have antioxidative and antiinflammatory activities. However, the molecular basis for the antiinflammatory action of zinc tetrakis(N-methyl-4'-pyridyl) porphyrinato (ZnTMPyP) has not been elucidated. The objective of this study was to determine whether ZnTMPyP exhibited the ability to inhibit the production of reactive oxygen species (ROS), the activation of NF-kappaB, or the secretion of IL-1 in RAW 264.7 cells, and whether such inhibitory activity was related to the ROS-scavenging ability of ZnTMPyP. The results indicate that, although ZnTMPyP is not cytotoxic to RAW 264.7 cells, it is a potent inhibitor in ROS production by RAW 264.7 cells in response to various stimulants, such as silica, zymosan, or phorbol myristate acetate. ZnTMPyP is also effective in reducing stimulant-induced DNA-binding activity of NF-kappaB and silica-induced tyrosine phosphorylation of IkappaB-alpha. ZnTMPyP also inhibits LPS-induced IL-1 production. However, ZnTMPyP exhibits relatively weak ability to directly scavenge hyroxyl or superoxide radicals. On the basis of effective concentrations of ZnTMPyP, these results suggest that ZnTMPyP directly acts as an inhibitor of cellular activation in addition to exhibiting an antioxidant effect. Therefore, it is suggested that further studies concerning the effects of ZnTMPyP using in vivo oxidative stress models or its effects on the cytotoxic process of human diseases associated with lung inflammation and injury are warranted. In addition, ZnTMPyP may be a useful tool to investigate the molecular mechanisms involved in stimulant-induced signal pathways.

A ferric-cyanide-bridged one-dimensional dirhodium complex with (18-crown-6)potassium cations

The crystal structure of the title compound, catena-poly[bis[aqua(18-crown-6)potassium] diaqua(18-crown-6)potassium [[tetra-mu-benzoato-2:3 kappa(8)O:O'-mu-cyano-1:2 kappa(2)C:N-tetracyano-1 kappa C-irondirhodium(Rh-Rh)]-mu-cyano-1 kappa C:3' kappa N] octahydrate], [K(18-crown-6)(H(2)O)](2)[K(18-crown-6)(H(2)O)(2)][FeRh(2)(C(7)H(5)O(2))(4)(CN)(6)] x 8H(2)O, where (18-crown-6) is 1,4,7,10,13,16-hexaoxacyclooctadecane (C(12)H(24)O(6)), has been determined. Ferric cyanides connect the dirhodium units to form a one-dimensional chain compound. [K(18-crown-6-ether)(H(2)O)(2)] cations (with inversion symmetry) and [K(18-crown-6-ether)(H(2)O)] cations (in general positions) are located between the chains.

Augmented death in immunostimulated astrocytes deprived of glucose: inhibition by an iron porphyrin FeTMPyP

The present study shows that under glucose-deprived conditions immunostimulated astrocytes rapidly undergo death due to their increased susceptibility to endogenously produced peroxynitrite. Fe(III)tetrakis(N-methyl-4'-pyridyl)porphyrin (FeTMPyP), but not the structurally related compounds ZnTMPyP and H(2)TMPyP, prevented the death in glucose-deprived immunostimulated astrocytes. Consistently, FeTMPyP, not ZnTMPyP and H(2)TMPyP, completely blocked the elevation of nitrotyrosine immunoreactivity (a marker of peroxynitrite) and the depolarization of the mitochondrial transmembrane potential in glucose-deprived immunostimulated astrocytes. The present data suggest that peroxynitrite may be associated with glial cell death during metabolic deterioration in the cerebral ischemic penumbra.

Protection by a manganese porphyrin of endogenous peroxynitrite-induced death of glial cells via inhibition of mitochondrial transmembrane potential decrease

In the cerebral ischemic penumbra, progressive metabolic deterioration eventually leads to death of glial cells. The exact mechanism for the death of glial cells is unclear. Here we report that under glucose-deprived conditions immunostimulated glial cells rapidly underwent death via production of large amounts of peroxynitrite. The cell-permeable Mn(III)tetrakis(N-methyl-4'-pyridyl)porphyrin (MnTMPyP) caused a concentration-dependent attenuation of the increased death in glucose-deprived immunostimulated glial cells. The structurally related compound H(2)TMPyP, which lacks metals, did not attenuate this augmented cell death. MnTMPyP prevented the elevation in nitrotyrosine immunoreactivity (a marker of ONOO(-)) in glucose-deprived immunostimulated glial cells. In glucose-deprived glial cells, MnTMPyP also completely blocked the augmented death and nitrotyrosine immunoreactivity induced by the ONOO(-)-producing reagent 3-morpholinosydnonimine (SIN-1). The mitochondrial transmembrane potential (MTP), as measured using the dye JC-1, was rapidly decreased in immunostimulated or SIN-1-treated glial cells deprived of glucose. MnTMPyP, but not H(2)TMPyP, blocked the depolarization of MTP in those glial cells. The present data, at least in part, provide evidence for how glial cells die in the postischemic and/or recurrent ischemic brain.

First success of catalytic epoxidation of olefins by an electron-rich iron(III) porphyrin complex and H2O2: imidazole effect on the activation of H2O2 by iron porphyrin complexes in aprotic solvent

An electron-rich iron(III) porphyrin complex (meso-tetramesitylporphinato)iron(III) chloride [Fe(TMP)Cl], was found to catalyze the epoxidation of olefins by aqueous 30% H2O2 when the reaction was carried out in the presence of 5-chloro-1-methylimidazole (5-Cl-1-Melm) in aprotic solvent. Epoxides were the predominant products with trace amounts of allylic oxidation products, indicating that Fenton-type oxidation reactions were not involved in the olefin epoxidation reactions. cis-Stilbene was stereospecifically oxidized to cis-stilbene oxide without giving isomerized trans-stilbene oxide product, demonstrating that neither hydroperoxy radical (HOO*) nor oxoiron(IV) porphyrin [(TMP)FeIV=O] was responsible for the olefin epoxidations. We also found that the reactivities of other iron(III) porphyrin complexes such as (meso-tetrakis(2,6-dichlorophenyl)porphinato)iron(III) chloride [Fe(TDCPP)Cl], (meso-tetrakis(2,6-difluorophenyl)porphinato)iron(III) chloride [Fe(TDFPP)Cl], and (meso-tetrakis(pentafluorophenyl)porphinato)iron(III) chloride [Fe(TPFPP)CI] were significantly affected by the presence of the imidazole in the epoxidation of olefins by H2O2. These iron porphyrin complexes did not yield cyclohexene oxide in the epoxidation of cyclohexene by H2O2 in the absence of 5-Cl-1-MeIm in aprotic solvent; however, addition of 5-Cl-1-MeIm to the reaction solutions gave high yields of cyclohexene oxide with the formation of trace amounts of allylic oxidation products. We proposed, on the basis of the results of mechanistic studies, that the role of the imidazole is to decelerate the O-O bond cleavage of an iron(III) hydroperoxide porphyrin (or H2O2-iron(II) porphyrin adduct) and that the intermediate transfers its oxygen to olefins prior to the O-O bond cleavage.

Synthesis and biological activity of KCB-328 and its analogues: novel class III antiarrhythmic agents with little reverse frequency dependence

A series of 3,4-dimethoxyphenethylamine derivatives was prepared, and their prolongation effects on effective refractory period of contractile response (ERPc) and action potential duration (APD) in isolated guinea-pig papillary muscles at 1 Hz and 3 Hz were examined. SAR studies led to the identification of KCB-328 (51) which is a novel class III antiarrhythmic agent with little reverse frequency dependence.

Base specific complex formation of norfloxacin with DNA

We examined the base specificity of the norfloxacin-DNA interaction by measuring the binding constant of norfloxacin to various synthetic polynucleotides, using the Stern-Volmer and the Benesi-Hildebrand methods. The equilibrium constants were largest for poly[d(G-C)2] and poly(dG).poly(dC), suggesting that norfloxacin binds preferentially to the G-C bases of calf thymus DNA. We also found that norfloxacin has a greater affinity for purine than for pyrimidine. The binding mode of norfloxacin to double-stranded polynucleotide was studied using circular and linear dichroism (CD and LD). When the norfloxacin was complexed to poly[d(G-C)2], poly(dG).poly(dC) and DNA, all of the complexes exhibited a similar weak, positive CD band and negative LD in the 300-350-nm region. A closer examination of the LD spectra suggests that the molecular plane of norfloxacin is near perpendicular relative to DNA helix axis that excludes the groove binding mode or surface binding of norfloxacin.