Purpose: We report two cases of non-arteritic ischemic optic neuropathy (NAION) following extracorporeal membrane oxygenation (ECMO) treatment.Case summary: (Case 1) A 36-year-old man underwent ECMO treatment. Upon regaining consciousness, he complained of a darkened peripheral visual field and was subsequently referred to an ophthalmologist. His best-corrected visual acuity was 0.9 in the right eye and 0.8 in the left eye. The intraocular pressure measured 12 mmHg in the right eye and 10 mmHg in the left eye; color vision was normal. A visual field test demonstrated concentric visual field defects in both eyes, and a fundus examination revealed a pale optic disc. Optical coherence tomography (OCT) indicated a decrease in retinal nerve fiber layer (RNFL) thickness. (Case 2) A 48-year-old woman underwent ECMO treatment. After regaining consciousness, she reported decreased vision in her right eye. Her best-corrected visual acuity was limited to hand motion in the right eye and was 1.2 in the left eye. A relative afferent pupillary defect in the right eye was observed. Color vision in the right eye was compromised, and a fundus examination revealed a pale optic disc. A visual field test demonstrated total visual field defect in the right eye, while OCT showed decreases in both the RNFL thickness and the ganglion cell-inner plexiform layer thickness of the right eye. Magnetic resonance imaging (MRI) revealed high signal intensity and abnormal enhancement in the right retrobulbar optic nerve. Conclusions In cases where vision loss and visual field defects are observed following ECMO treatment, differential diagnoses for ischemic optic neuropathy are warranted.

Migraine is a neurological disorder characterized by recurrent and disabling severe headaches. Although several anticonvulsant drugs that block voltage-dependent Na⁺ channels are widely used for migraine, far less is known about the therapeutic actions of carbamazepine on migraine. In the present study, therefore, we characterized the effects of carbamazepine on tetrodotoxin-resistant (TTX-R) Na⁺ channels in acutely isolated rat dural afferent neurons, which were identified by the fluorescent dye DiI. The TTX-R Na⁺ currents were measured in medium-sized DiIpositive neurons using the whole-cell patch clamp technique in the voltage-clamp mode. While carbamazepine had little effect on the peak amplitude of transient Na⁺ currents, it strongly inhibited steady-state currents of transient as well as persistent Na⁺ currents in a concentration-dependent manner. Carbamazepine had only minor effects on the voltage-activation relationship, the voltage-inactivation relationship, and the use-dependent inhibition of TTX-R Na⁺ channels. However, carbamazepine changed the inactivation kinetics of TTX-R Na⁺ channels, significantly accelerating the development of inactivation and delaying the recovery from inactivation. In the current-clamp mode, carbamazepine decreased the number of action potentials without changing the action potential threshold. Given that the sensitization of dural afferent neurons by inflammatory mediators triggers acute migraine headaches and that inflammatory mediators potentiate TTX-R Na⁺ currents, the present results suggest that carbamazepine may be useful for the treatment of migraine headaches.
Action Potentials ; Animals ; Anticonvulsants ; Carbamazepine* ; Headache ; Kinetics ; Migraine Disorders ; Nervous System Diseases ; Neurons* ; Neurons, Afferent ; Rats ; Sodium Channels ; Trigeminal Ganglion*

The effects of acidic pH on several voltage-dependent ion channels, such as voltage-dependent K⁺ and Ca²⁺ channels, and hyperpolarization-gated and cyclic nucleotide-activated cation (HCN) channels, were examined using a whole-cell patch clamp technique on mechanically isolated rat mesencephalic trigeminal nucleus neurons. The application of a pH 6.5 solution had no effect on the peak amplitude of voltage-dependent K⁺ currents. A pH 6.0 solution slightly, but significantly inhibited the peak amplitude of voltage-dependent K⁺ currents. The pH 6.0 also shifted both the current-voltage and conductance-voltage relationships to the depolarization range. The application of a pH 6.5 solution scarcely affected the peak amplitude of membrane currents mediated by HCN channels, which were profoundly inhibited by the general HCN channel blocker Cs⁺ (1 mM). However, the pH 6.0 solution slightly, but significantly inhibited the peak amplitude of HCN-mediated currents. Although the pH 6.0 solution showed complex modulation of the current-voltage and conductance-voltage relationships, the midpoint voltages for the activation of HCN channels were not changed by acidic pH. On the other hand, voltage-dependent Ca²⁺ channels were significantly inhibited by an acidic pH. The application of an acidic pH solution significantly shifted the current-voltage and conductance-voltage relationships to the depolarization range. The modulation of several voltage-dependent ion channels by an acidic pH might affect the excitability of mesencephalic trigeminal nucleus neurons, and thus physiological functions mediated by the mesencephalic trigeminal nucleus could be affected in acidic pH conditions.
Acidosis ; Animals ; Hand ; Hydrogen-Ion Concentration* ; Ion Channels* ; Membranes ; Neurons* ; Proprioception ; Rats* ; Tegmentum Mesencephali

Objective: To investigate the histopathological characteristics of patients with lupus nephritis in the 2018 revised International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification and assess the prognostic factors. Methods: This study enrolled 92 patients with lupus nephritis, who had conventional treatment and renal biopsy. Each renal tissue was evaluated according to 2018 ISN/RPS classification, and quantified apoptotic regulator protein, the B-cell lymphoma-2 protein (Bcl-2), expressions in selected lymphocyte subsets were measured using novel computational approaches using multicolor confocal images. Histopathological characteristics and prognostic factors of end-stage renal disease (ESRD) and chronic kidney disease (CKD) were compared. Follow-up data were obtained, and survival analysis was conducted. Results: During follow-up period (average: 74.3 months), 16 and 18 patients progressed ESRD and CKD, respectively. Multivariable analysis of age, sex, disease activity and pathological features in ISN/RPS demonstrated the extent of interstitial inflammation (grade 0~3) was significantly associated with both ESRD and CKD. When interstitial inflammation was divided into mild (grade 0, 1) and severe (grade 2, 3), Cox regression analysis showed that patients with severe interstitial inflammation were significantly increased risk of both ESRD and CKD (hazard ratio: 4.67 and 3.8, respectively). Bcl-2 expression in CD4+ and CD20 cells was significantly higher in the severe interstitial inflammation group compared to in mild interstitial inflammation patients (p=0.006 and 0.010, respectively). Conclusion The extent of interstitial inflammation can predict clinical renal outcomes. Significantly elevated Bcl-2 expression in both CD4+ and CD20 cells was found in severe interstitial inflammation compared with mild interstitial inflammation.

No abstract available.
Lutein* ; Plasma*

No abstract available.
Toluene*

Salmonella-triggered reactive arthritis appears one to three weeks after the onset of salmonella infection and presents with asymmetric, usually migratory, oligo- or polyarthritis. The course is usually self-limiting and symptoms last two to six months. We experienced a 10-year-old male patient who presented to a local pediatric center with long-lasting fever and right ankle joint pain. The pain migrated to the left ankle joint, both wrists, and both knees and he was diagnosed as juvenile rheumatoid arthritis and was medicated with NSAIDs and corticosteroid. In the meantime, 20 days prior to the transfer to our hospital he was febrile with nausea and abdominal pain and the antibody titer of S. typhi O Ag by Widal test was 1 : 320, and an antibiotic therapy was followed. Soon after, the fever subsided but the migrating joint symptoms continued and he was transferred to our hospital. Widal tests were weekly checked and the antibody titers of S. typhi O Ag were 1 : 160, 1 : 320, 1 : 320, 1 : 160, 1 : 160, respectively. ESR was 55 mm/hr, CRP 9.18 mg/dl, HLA-B27 positive and his endoscopic findings of the colon showed mild lymphoid hyperplasia and mucosal nodularities in the cecum and ileocecal area. Stool cultures and duodenal juice culture for Salmonella and Shigella were all negative. He was treated with ibuprofen and bactrim and the joint symptoms were gradually mitigated. After discharge, he maintained mildly elevated CRP levels and antibody levels by Widal tests, but was free from symptoms except for several episodes of finger pains for 11 months.
Abdominal Pain ; Ankle Joint ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis ; Arthritis, Juvenile* ; Arthritis, Reactive* ; Cecum ; Child* ; Colon ; Fever ; Fingers ; HLA-B27 Antigen ; Humans ; Hyperplasia ; Ibuprofen ; Joints ; Knee ; Male ; Nausea ; Salmonella ; Salmonella Infections ; Shigella ; Trimethoprim, Sulfamethoxazole Drug Combination ; Wrist

PURPOSE: Endovascular therapy (ET) for peripheral arterial occlusive disease has increased dramatically in the past decade. ET is currently being performed by different specialists with available resources, with some of these resources being far superior to others, yet there have been no studies comparing the interventional outcomes according to the varying resources. The aim of this study was to analyze the outcomes of ET for superficial femoral artery (SFA) atherosclerosis using a mobile C-arm, in comparison to a historical control group. METHODS: Between March 2009 and December 2010, ET for SFA atherosclerosis was performed in 54 limbs from 47 patients using a mobile C-arm in the operation theater (mobile group). In contrast, a historical group for comparison consisted of 60 patients, for whom ET for SFA atherosclerosis was performed in 76 limbs using a fixed C-arm in the angiographic suite, between July 2003 and May 2008 (fixed group). The outcomes of ET for both groups were retrospectively analyzed by a medical chart review. RESULTS: There was no statistically significant difference in gender, age, risk factors, Trans-Atlantic Inter-Society Consensus (TASC) classification, intervention type, and postoperative blood creatinine levels between the two groups. However, procedural time was statistically higher in the mobile group. Patency rates at 1 year were 68.3% and 68.1% in the fixed and mobile group, respectively, which was not statistically significant. Subgroup analysis of 1 year patency rates for TASC A, B lesions and TASC C, D lesions were also similar. CONCLUSION: ET using the mobile C-arm in the operating theater is as effective as using the fixed C-arm, in the treatment of SFA atherosclerosis in terms of the technical success, patency, and early postoperative outcomes.
Arterial Occlusive Diseases ; Atherosclerosis ; Consensus ; Creatinine ; Endovascular Procedures ; Extremities ; Femoral Artery ; Humans ; Peripheral Arterial Disease ; Retrospective Studies ; Risk Factors ; Specialization

Background: To evaluate binocular function and clinical features in patients with esotropia (ET) accompanied by congenital ptosis. Methods: Clinical records of 44 ET patients with congenital ptosis (ET-ptosis group) and 71 age-matched ET patients without ptosis (ET only group) who presented for eye examination between January 2016 and December 2021 were retrospectively reviewed. Best-corrected visual acuity (BCVA), magnitude of esodeviation and stereopsis at the first visit were reviewed. Stereopsis and other clinical features of the two groups were compared. Results: The mean (±standard deviation) age of overall patients was 5.7 (±1.9) years. The margin reflex distance 1 (MRD1) of patients with ptosis was greater than 0 but less than or equal to 2, indicating that mild ptosis was included. There was no significant difference in the distribution of age, sex, spherical equivalent refractive errors, BCVA, or magnitude of ET (at distance or near) between the two groups (all p>0.05). Furthermore, stereopsis and the number of patients with amblyopia did not differ significantly between the two groups. The magnitudes of esodeviation, near stereopsis and BCVA did not differ significantly between the 0Conclusions In patients with ET and congenital mild ptosis, stereopsis and visual acuity were not different from those in ET only patients. The presence of coexisting mild ptosis might not have a further deleterious impact on binocular function in ET patients.

Background: To evaluate binocular function and clinical features in patients with esotropia (ET) accompanied by congenital ptosis. Methods: Clinical records of 44 ET patients with congenital ptosis (ET-ptosis group) and 71 age-matched ET patients without ptosis (ET only group) who presented for eye examination between January 2016 and December 2021 were retrospectively reviewed. Best-corrected visual acuity (BCVA), magnitude of esodeviation and stereopsis at the first visit were reviewed. Stereopsis and other clinical features of the two groups were compared. Results: The mean (±standard deviation) age of overall patients was 5.7 (±1.9) years. The margin reflex distance 1 (MRD1) of patients with ptosis was greater than 0 but less than or equal to 2, indicating that mild ptosis was included. There was no significant difference in the distribution of age, sex, spherical equivalent refractive errors, BCVA, or magnitude of ET (at distance or near) between the two groups (all p>0.05). Furthermore, stereopsis and the number of patients with amblyopia did not differ significantly between the two groups. The magnitudes of esodeviation, near stereopsis and BCVA did not differ significantly between the 0Conclusions In patients with ET and congenital mild ptosis, stereopsis and visual acuity were not different from those in ET only patients. The presence of coexisting mild ptosis might not have a further deleterious impact on binocular function in ET patients.