Alteration of choroidal vascular structure in diabetic macular edema

Graefe's Archive for Clinical and Experimental Ophthalmology - The aim of this study was to analyze choroidal structures in healthy subjects and patients with/without diabetic macular edema...     

Multiple patterns of polymer gels in microspheres due to the interplay among phase separation,wetting, and gelation

We report the spontaneous patterning of polymer microgels by confining a polymer blend within microspheres. A poly(ethylene glycol) (PEG) and gelatin solution was confined inside water-in-oil (W/O) microdroplets coated with a layer of zwitterionic lipids: dioleoylphosphatidylethanolamine (PE) and dioleoylphosphatidylcholine (PC). The droplet confinement affected the kinetics of the phase separation, wetting, and gelation after a temperature quench, which determined the final microgel pattern. The gelatin-rich phase completely wetted to the PE membrane and formed a hollow microcapsule as a stable state in the PE droplets. Gelation during phase separation varied the relation between the droplet size and thickness of the capsule wall. In the case of the PC droplets, phase separation was completed only for the smaller droplets, wherein the microgel partially wetted the PC membrane and had a hemisphere shape. In addition, the temperature decrease below the gelation point increased the interfacial tension between the PEG/gelatin phases and triggered a dewetting transition. Interestingly, the accompanying shape deformation to minimize the interfacial area was only observed for the smaller PC droplets. The critical size decreased as the gelatin concentration increased, indicating the role of the gel elasticity as an inhibitor of the deformation. Furthermore, variously patterned microgels with spherically asymmetric shapes, such as discs and stars, were produced as kinetically trapped states by regulating the incubation time, polymer composition, and droplet size. These findings demonstrate a way to regulate the complex shapes of microgels using the interplay among phase separation, wetting, and gelation of confined polymer blends in microdroplets.The regulation of the 3D shapes of biopolymer gels at the mesoscale has numerous applications in the biomedical, cosmetic, and food materials industries, among others (1). Recently, top-down and bottom-up approaches have been reported to control the mesoscopic patterns of polymer gels. For example, photolithography and two-photon polymerization allow the regulation of gel patterns at the mesoscale (2–4). The advanced design of the molecules enables polymerization with a self-assembly and produces nonspherical microgels: spherical particles with a cavity, capsules, and cubic particles (5–7). However, these methods require highly specialized equipment and are generally difficult to adapt for biopolymer gels.Dynamical coupling between phase separation and sol–gel transition in polymer blends has also been investigated for the spontaneous formation of spherical microgels and a porous gel (8, 9). Ma et al. (10) and Choi et al. (11) confined aqueous two-phase systems (ATPSs) in microdroplets and fabricated microgels by selective polymerization. In such a confined space, phase separation accompanies wetting of a polymer to the substrate (12–15). Although the selective polymerization of phase-separated polymers in microdroplets has a great potential to produce variously shaped microgels, the dynamical coupling among the phase separation, wetting, and gelation of polymers in a confined space remains unclear (16). If it was better understood, the shapes of polymer microgels could be regulated in a self-organized manner.In the present work, we used gelatin, one of the most popular biopolymer gels, and poly(ethylene glycol) (PEG) as the desolvating agent because PEG leads to phase separation for various biopolymers, such as proteins and DNA (17). The gelatin/PEG solution was confined in water-in-oil (W/O) microdroplets coated by a lipid layer, wherein the phase separation and sol–gel transition of the gelatin occur with a decrease in the temperature (18–20). This process led to gelation after and during the phase separation in the presence of the interactions between the polymers and lipid membranes. We analyzed the pattern formation of the gelatin microgel as a function of the temperature history, droplet size, and polymer composition. We found that variously shaped microgels appeared as stable states and kinetically trapped states. These findings yield a method to regulate the shapes of polymer microgels using the interplay among the interfacial tensions, elastic properties of the gels, and interactions between the polymers and the surfaces of the droplets.     

Evaluation and validation of the Core Lower Urinary Tract Symptom Score as an outcome assessment tool for the treatment of benign prostatic hyperplasia: Effects of the α1‐adrenoreceptor antagonist silodosin

We investigated the Core Lower Urinary Tract Symptom Score as an outcome assessment tool for the treatment of lower urinary tract symptoms using silodosin. In addition, the ability of the Core Lower Urinary Tract Symptom Score to detect overactive bladder in male patients with lower urinary tract symptoms was examined. The present study included 241 males with benign prostatic hyperplasia treated at 31 medical facilities between June 2009 and December 2010. All patients were given silodosin, and the effects of silodosin intake were measured using four questionnaires: the Core Lower Urinary Tract Symptom Score, International Prostate Symptom Score, Overactive Bladder Symptom Score and Quality‐of‐Life index. The efficacy of silodosin for treating lower urinary tract symptoms was validated according to the total scores of all four questionnaires weighted equally (P < 0.05). Spearman's ρ among the Core Lower Urinary Tract Symptom Score, International Prostate Symptom Score and Overactive Bladder Symptom Score showed a mild‐high correlation. However, the correlation between the baseline values of the Core Lower Urinary Tract Symptom Score and Quality‐of‐Life index was low in the groups with benign prostatic hyperplasia (ρ = 0.314) and benign prostatic hyperplasia/overactive bladder (ρ = 0.244). Our findings showed the Core Lower Urinary Tract Symptom Score, both its total score and each subscore, is able to show the efficacy of silodosin, similar to other questionnaires. The Core Lower Urinary Tract Symptom Score is also useful for identifying overactive bladder symptoms in patients with benign prostatic hyperplasia. As the Core Lower Urinary Tract Symptom Score does not correlate well with the Quality‐of‐Life index, these two questionnaires might be better used in combination to assess treatment outcomes.     

Comparison of nifekalant and amiodarone for resuscitation of out-of-hospital cardiopulmonary arrest resulting from shock-resistant ventricular fibrillation

Purpose

Nifekalant is a pure potassium channel blocker that has been used to treat ventricular tachyarrhythmias since 1999 in Japan. Intravenous amiodarone was approved later than nifekalant in Japan, and it is still unclear which of the two agents is superior. The aim of this study was to compare the efficacy of nifekalant and amiodarone for resuscitation of out-of-hospital cardiopulmonary arrest caused by shock-resistant ventricular fibrillation.

Methods

From December 2005 to January 2011, ambulance services transported 283 out-of-hospital cardiopulmonary arrest patients to our hospital. Of these, 25 patients were treated with nifekalant or amiodarone in response to ventricular fibrillation that was resistant to two or more shocks. We undertook a retrospective analysis of these 25 patients.

Results

We enrolled 20 men and 5 women with a mean age (± standard deviation) of 61.1 ± 16.4 years. All 25 patients were treated with tracheal intubation and intravenous epinephrine. Fourteen patients received nifekalant and 11 patients received amiodarone. The rates of return of spontaneous circulation (ROSC) (nifekalant, 5/14, versus amiodarone, 4/11; P = 0.97) and survival to discharge (nifekalant, 4/14, versus amiodarone, 2/11; P = 0.89) were not significantly different between the two groups. The time from nifekalant or amiodarone administration to ROSC was 6.0 ± 6.6 and 20.3 ± 10.0 min, respectively, which was significantly different (P < 0.05).

Conclusion

In this small sample size study, nifekalant, compared with amiodarone, is equally effective for ROSC and survival to discharge after shock-resistant ventricular fibrillation and can achieve ROSC more quickly. Further prospective studies are needed to confirm our results.     

Bacillus Calmette–Guérin treatment of urothelial carcinoma arising in the ileal neobladder after radical cystectomy

In January 2005, a 66‐year‐old man underwent radical cystectomy and ileal neobladder reconstruction for invasive bladder cancer. A total of 3 years after the cystectomy, left‐side ureteral cancer was diagnosed, and a nephroureterectomy was carried out in May 2008. In October 2011, he complained of asymptomatic macroscopic hematuria. We detected multiple papillary pedunculated and broad‐based tumors in the left side and the dome of the neobladder. The patient underwent transurethral resection of the bladder tumor, and a pathological diagnosis of high‐grade pTa urothelial carcinoma was made. A total of 4 months later, tumors recurred in the right side and anterior wall of the neobladder. We carried out transurethral resection of the bladder tumor again; the pathological diagnosis was high‐grade pTa urothelial carcinoma with carcinoma in situ. Bacillus Calmette–Guérin instillation was carried out seven times into the neobladder, without any severe side‐effects. Tumor recurrence was not observed up to 8 months after bacillus Calmette–Guérin treatment.