Purpose: Reduced central corneal thickness (CCT) is a risk factor for glaucoma progression and can impact intraocular pressure (IOP) measurement. Therefore, we investigated the glaucoma progression pattern and associated risk factors among individuals with normal-tension glaucoma (NTG) and reduced CCT. Methods: This retrospective study enrolled 187 eyes of 187 NTG patients with an open angle and a baseline IOP < 20 mmHg, adjusted for CCT. Reduced CCT was defined as < 500 µm thickness in both eyes. Patients with a history of corneal disease or surgery affecting CCT were excluded. We used Goldmann tonometry to measure baseline and CCT-corrected IOP (ccIOP; [IOP - [CCT - 545]/50 × 2.5]). The participants were divided into progressing and stable subgroups. Results: The mean CCT was 481.2 ± 17.5 µm and the mean follow-up period was 6.3 ± 2.5 years. The baseline IOP and ccIOP were 13.7 ± 2.4 and 16.6 ± 2.5 mmHg, respectively. The average visual field progression rate was -0.79 ± 1.26 dB/yr. Of the participants, 47 (26.6%) and 140 (73.4%) were in the progressing and stable group, respectively. Participants in the progressing group were older, had a higher baseline ccIOP, and had a higher proportion of pseudophakia than those in the stable group. Multivariate analysis showed that baseline ccIOP was a significant risk factor. Conclusions Individuals presenting with NTG and reduced CCT had a relatively stable glaucoma progression rate. However, glaucoma progression was associated with old age, pseudophakia, and high baseline IOP in individuals with reduced CCT. In particular, the only significant factor associated with glaucoma progression was ccIOP. Therefore, ccIOP is a clinically significant factor in individuals with NTG and reduced CCT.

Purpose: To report a rare case of eyelid lipoma. Case summary: A 41-year-old female presented with a palpable mass in her left upper eyelid. Diffuse hard mass was palpable at preaponeurotic fat layer of left upper eyelid, and there was no inflammatory sign. Under local anesthesia, a left upper eyelid mass partial excision was performed and a biopsy specimen was collected. The mass was yellower and harder than surrounding normal eyelid fat. A lipoma was diagnosed based on histopathological findings such as proliferation of mature adipocytes. Conclusions Lipoma is a benign tumor commonly found around trunk and limbs, but rarely occurs at eyelid. Eyelid lipoma should be considered as a differential diagnosis of diffuse mass at eyelid fat layer. Diagnosis and treatment can be achieved by partial excision and histopathological examination.

Purpose: To report a rare case of eyelid lipoma. Case summary: A 41-year-old female presented with a palpable mass in her left upper eyelid. Diffuse hard mass was palpable at preaponeurotic fat layer of left upper eyelid, and there was no inflammatory sign. Under local anesthesia, a left upper eyelid mass partial excision was performed and a biopsy specimen was collected. The mass was yellower and harder than surrounding normal eyelid fat. A lipoma was diagnosed based on histopathological findings such as proliferation of mature adipocytes. Conclusions Lipoma is a benign tumor commonly found around trunk and limbs, but rarely occurs at eyelid. Eyelid lipoma should be considered as a differential diagnosis of diffuse mass at eyelid fat layer. Diagnosis and treatment can be achieved by partial excision and histopathological examination.

STUDY DESIGN: Prospective study. OBJECTIVES: This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with 3 methods of pain control after posterior spinal decompression. SUMMARY OF LITERATURE REVIEW: Spinal surgery causes severe postoperative pain. Efficient and safe methods for postoperative analgesia after spinal surgery are necessary. MATERIALS AND METHODS: To determine the clinical symptoms and to assess improvements in postoperative pain, 52 patients in whom single-level posterior lumbar decompression was planned were randomly assigned to 3 groups. For postoperative pain control, 18 patients received a preoperative single-shot epidural injection (SEI), 16 patients received a postoperative continuous epidural injection (CEI), and 18 patients received only postoperative intravenous patient-controlled analgesia (IV-PCA). Patient ratings of pain intensity (visual analog scale score from 0 [no pain] to 10 [most severe pain]), nausea (from 0 [no nausea] to 5 [severe nausea]), and vomiting (from 0 [no vomiting] to 5 [severe vomiting]) were recorded immediately after the operation and at 4 hours, 12 hours, 1 day, and 2 days postoperatively. RESULTS: The CEI group showed significantly enhanced analgesic effects, followed by the SEI group and the IV PCA group (p < 0.05). PONV due to postoperative pain control was more severe in the IV PCA group than in the other 2 groups (p < 0.05). CONCLUSIONS: Continuous epidural injection (CEI) is effective for postoperative pain control and minimizes the occurrence of PONV after posterior spinal decompression.
Analgesia ; Analgesia, Patient-Controlled ; Decompression ; Humans ; Injections, Epidural ; Methods ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Prospective Studies ; Spinal Stenosis ; Vomiting

OBJECTIVES: This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with 3 methods of pain control after posterior spinal decompression.SUMMARY OF LITERATURE REVIEW: Spinal surgery causes severe postoperative pain. Efficient and safe methods for postoperative analgesia after spinal surgery are necessary. MATERIALS AND METHODS: To determine the clinical symptoms and to assess improvements in postoperative pain, 52 patients in whom single-level posterior lumbar decompression was planned were randomly assigned to 3 groups. For postoperative pain control, 18 patients received a preoperative single-shot epidural injection (SEI), 16 patients received a postoperative continuous epidural injection (CEI), and 18 patients received only postoperative intravenous patient-controlled analgesia (IV-PCA). Patient ratings of pain intensity (visual analog scale score from 0 [no pain] to 10 [most severe pain]), nausea (from 0 [no nausea] to 5 [severe nausea]), and vomiting (from 0 [no vomiting] to 5 [severe vomiting]) were recorded immediately after the operation and at 4 hours, 12 hours, 1 day, and 2 days postoperatively. RESULTS: The CEI group showed significantly enhanced analgesic effects, followed by the SEI group and the IV PCA group (p < 0.05). PONV due to postoperative pain control was more severe in the IV PCA group than in the other 2 groups (p < 0.05). CONCLUSIONS Continuous epidural injection (CEI) is effective for postoperative pain control and minimizes the occurrence of PONV after posterior spinal decompression.

Helicobacter pylori infection is associated with chronic gastritis, peptic ulcer, and gastric cancer. There is evidence that IL-1beta is associated with the development of gastric cancer. Therefore, downregulation of H. pylori-mediated IL-1beta production may be a way to prevent gastric cancer. Withaferin A (WA), a withanolide purified from Withania somnifera, is known to exert anti-inflammatory and anti-tumor effects. In the present study, we explored the inhibitory activity of WA on H. pylori-induced production of IL-1beta in murine bone marrow-derived dendritic cells (BMDCs) and the underlying cellular mechanism. Co-treatment with WA decreased IL-1beta production by H. pylori in BMDCs in a dose-dependent manner. H. pylori-induced gene expression of IL-1beta and NLRP3 (NOD-like receptor family, pyrin domain containing 3) were also suppressed by WA treatment. Moreover, IkappaB-alpha phosphorylation by H. pylori infection was suppressed by WA in BMDCs. Western blot analysis revealed that H. pylori induced cleavage of caspase-1 and IL-1beta, as well as increased procaspase-1 and pro IL-1beta protein levels, and that both were suppressed by co-treatment with WA. Finally, we determined whether WA can directly inhibit ac tivation of the NLRP3 inflammasome. NLRP3 activators induced IL-1beta secretion in LPS-primed macrophages, which was inhibited by WA in a dose-dependent manner, whereas IL-6 production was not affected by WA. Moreover, cleavage of IL-1beta and caspase-1 by NLRP3 activators was also dose-dependently inhibited by WA. These findings suggest that WA can inhibit IL-1beta production by H. pylori in dendritic cells and can be used as a new preventive and therapeutic agent for gastric cancer.
Blotting, Western ; Caspase 1 ; Dendritic Cells* ; Down-Regulation ; Gastritis ; Gene Expression ; Helicobacter pylori ; Helicobacter* ; Humans ; Interleukin-1beta ; Interleukin-6 ; Macrophages ; NF-kappa B* ; Peptic Ulcer ; Phosphorylation ; Stomach Neoplasms ; Withania

TGF-beta induces IgA class switching by B cells. We previously reported that Smad3 and Smad4, pivotal TGF-beta signal-transducing transcription factors, mediate germline (GL) alpha transcription induced by TGF-beta1, resulting in IgA switching by mouse B cells. Post-translational sumoylation of Smad3 and Smad4 regulates TGF-beta-induced transcriptional activation in certain cell types. In the present study, we investigated the effect of sumoylation on TGF-beta1-induced, Smad3/4-mediated GLalpha transcription and IgA switching by mouse B cell line, CH12F3-2A. Overexpression of small ubiquitin-like modifier (SUMO)-1, SUMO-2 or SUMO-3 did not affect TGF-beta1-induced, Smad3/4-mediated GLalpha promoter activity, expression of endogenous GLalpha transcripts, surface IgA expression, and IgA production. Next, we tested the effect of the E3 ligase PIASy on TGF-beta1-induced, Smad3/4-mediated GLalpha promoter activity. We found that PIASy overexpression suppresses the GLalpha promoter activity in cooperation with histone deacetylase 1. Taken together, these results suggest that SUMO itself does not affect regulation of GLalpha transcription and IgA switching induced by TGF-beta1/Smad3/4, while PIASy acts as a repressor.
Animals ; B-Lymphocytes* ; Cell Line ; Histone Deacetylase 1 ; Immunoglobulin A ; Immunoglobulin Class Switching ; Mice ; Small Ubiquitin-Related Modifier Proteins* ; SUMO-1 Protein* ; Sumoylation ; Transcription Factors ; Transcriptional Activation ; Transforming Growth Factor beta ; Transforming Growth Factor beta1 ; Ubiquitin-Protein Ligases

Gastric bezoars are concretion of undigested material in the gastrointestinal tract. In the past, gastric bezoars were generally treated with surgical management. Recently, the efficacy of oral intake or endoscopic injection therapy with Coca-Cola has been reported. We report a case of a 47-year-old-man with huge gastric bezoar (4x2.5 cm) that was successfully removed by endoscopic fragmentation with Coca-Cola injection. Compared with a single endoscopic fragmentation therapy, the combination therapy with Coca-Cola injection shortened the procedure time and reduced the complication associated with fragmented bezoar.
Bezoars ; Cola ; Endoscopy ; Gastrointestinal Tract

BACKGROUND: Choice of anesthetics in patients with a history of nephrectomy is very important for anesthesiologists. It is important for the anesthesiologist to preserve the ipsilateral kidney function and minimize deleterious effects. This study was performed to compare anesthetic agents on postoperative renal and hepatic function in patients who underwent nephrectomy. METHODS: From 2008 to 2012, 116 patients who underwent nephrectomy in our hospital were evaluated through a retrospective study. Anesthesia was maintained with desflurane-remifentanil in the desflurane group (Group D), and propofol-remifentanil, using a target controlled infusion pump (Group T). In order to evaluate postoperative renal and hepatic function, blood urea nitrogen (BUN), serum creatinine (Cr), estimated glomerular filtration rate (eGFR), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) was measured preoperatively, postoperative day 1, 3 and 7. RESULTS: When compared to preoperative measures, Cr and BUN levels were elevated on postoperative day 1, 3 and 7 while eGFR was decreased in both groups. There was no significant difference between the two groups. AST and ALT were also mildly elevated on postoperative day 1, 3 and 7 in both groups. There was also no significant difference between the two groups. CONCLUSIONS: Anesthesia with desflurane-remifentanil or propofol-remifentanil alter postoperative renal and hepatic function with no significant difference between groups. Both desflurane and propofol may be chosen for general anesthesia undergoing nephrectomy patients.
Alanine Transaminase ; Anesthesia ; Anesthesia, General ; Anesthetics ; Aspartate Aminotransferases ; Blood Urea Nitrogen ; Creatinine ; Glomerular Filtration Rate ; Humans ; Infusion Pumps ; Isoflurane ; Kidney ; Nephrectomy* ; Propofol ; Retrospective Studies

BACKGROUND: Choice of anesthetics in patients with a history of nephrectomy is very important for anesthesiologists. It is important for the anesthesiologist to preserve the ipsilateral kidney function and minimize deleterious effects. This study was performed to compare anesthetic agents on postoperative renal and hepatic function in patients who underwent nephrectomy. METHODS: From 2008 to 2012, 116 patients who underwent nephrectomy in our hospital were evaluated through a retrospective study. Anesthesia was maintained with desflurane-remifentanil in the desflurane group (Group D), and propofol-remifentanil, using a target controlled infusion pump (Group T). In order to evaluate postoperative renal and hepatic function, blood urea nitrogen (BUN), serum creatinine (Cr), estimated glomerular filtration rate (eGFR), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) was measured preoperatively, postoperative day 1, 3 and 7. RESULTS: When compared to preoperative measures, Cr and BUN levels were elevated on postoperative day 1, 3 and 7 while eGFR was decreased in both groups. There was no significant difference between the two groups. AST and ALT were also mildly elevated on postoperative day 1, 3 and 7 in both groups. There was also no significant difference between the two groups. CONCLUSIONS: Anesthesia with desflurane-remifentanil or propofol-remifentanil alter postoperative renal and hepatic function with no significant difference between groups. Both desflurane and propofol may be chosen for general anesthesia undergoing nephrectomy patients.
Alanine Transaminase ; Anesthesia ; Anesthesia, General ; Anesthetics ; Aspartate Aminotransferases ; Blood Urea Nitrogen ; Creatinine ; Glomerular Filtration Rate ; Humans ; Infusion Pumps ; Isoflurane ; Kidney ; Nephrectomy* ; Propofol ; Retrospective Studies