A new parameter for assessing the thickness of the retinal nerve fiber layer for glaucoma diagnosis.

PURPOSE: To investigate a new method for assessing the thickness of the retinal nerve fiber layer thickness (NFLT) for glaucoma diagnosis, using scanning laser polarimetry. MATERIAL AND METHODS: Thirty eyes of thirty patients with ocular hypertension or glaucoma were examined using a scanning laser polarimeter. NFL T was measured in each of four 90-degree quadrants; superior (S), temporal (T), inferior (I) and nasal (N) along 1.5-disc diameters concentric from the disc margin. The new parameters S-N (meaning the thickness of the superior nerve fiber layer over the nasal one) etc. were compared with the conventional parameters (S, S/N, etc.). The correlations between these parameters and the mean threshold of the associated visual field test points were included in the comparison. RESULTS: The total thickness (sum of S, I, N and T), N and T did not correlate to the visual field, but S and I did. The new parameters were well correlated to the visual field, S-N giving the best correlation coefficient (rs = O. 782, p < O.0001), and sensitivity and specificity (the area under the receiver operating characteristic curves was 0.91). CONCLUSIONS: The nasal NFLT was the smallest part of individual variation and glaucomatous damage. The new parameters, based on the nasal NFLT, were good evaluators of the changes in glaucoma.     

Flomoxef Sodium and Levofloxacin Concentrations in Aqueous Humor

Aims: We intravenously administered flomoxef sodium (FMOX) 120 minutes before cataract surgery, topically administered levofloxacin (LVFX) into the eyes four times at 30-minute intervals before surgery, and measured the aqueous humor concentrations of these agents to investigate their penetration into the aqueous humor and their efficacy in the prevention of postoperative endophthalmitis. Methods: Sixty-eight patients who underwent cataract surgery at the Department of Ophthalmology, Yokohama City University School of Medicine, or its affiliate, Kanazawa Hospital, Yokohama, were enrolled in this study. They received one or both of the following: 1.0 g FMOX via a 20-minute intravenous drip and LVFX ophthalmic solution applied four times at 30-minute intervals, both beginning two hours before the operation. Aqueous humor was aspirated from the anterior chamber and assayed for FMOX and LVFX concentrations using high-performance liquid chromatography (HPLC). Results: The mean intraoperative FMOX and LVFX concentrations in the patients' aqueous humor were 1.21 ± 0.63 μ g/ml and 0.69 ± 0.47 μ g/ml, respectively. These concentrations sufficiently exceeded the MIC90 values against Staphylococcus epidermidis, S. aureus, and Propionibacterium acnes. Conclusions: The FMOX and LVFX concentrations in the aqueous humor sampling were adequate to kill bacteria in vitro. These drugs may have efficacy in the prevention of postoperative endophthalmitis in patients undergoing cataract surgery.     

Autopsy case of amebic granulomatous meningoencephalitis caused by Balamuthia mandrillaris in Japan

Balamuthia mandrillaris is a free-living ameba that causes amebic encephalitis. Herein, we report an autopsy case of Balamuthia encephalitis proven with polymerase chain reaction (PCR) and immunohistochemistry from paraffin-embedded brain biopsy specimens. A 68-year-old Japanese male presented at a hospital with progressive right hemiparesis approximately 3 months before his death. An open-brain biopsy specimen showed diffuse meningitis with massive coagulative necrosis. The perivascular spaces contained numerous lymphocytes, histiocytes and giant cells, although the etiology was not determined. The patient deteriorated into coma and died from cerebral herniation. Autopsy revealed abundant trophozoites and cysts in the subarachnoid and Virchow-Robin's spaces. Electron-micrographs of the amebic cysts showed a characteristic triple-walled envelope. The amebas were identified as Balamuthia mandrillaris based on immunohistochemical analysis from the autopsy and biopsy specimens. Primer sets designed to amplify approximately 200 bp bands of mitochondrial 16S rRNA gene of Balamuthia by PCR produced positive results from the biopsy specimens but negative results from the autopsy specimens. In summary, PCR to amplify shorter segments of DNA may be of diagnostic value in detecting suspected cases of balamuthiasis in formalin-fixed, paraffin-embedded specimens. Increased awareness and timely diagnosis of Balamuthia encephalitis might lead to earlier initiation of therapy and improved outcome.     

Helicobacter pylori invades the gastric mucosa and translocates to the gastric lymph nodes

Helicobacter pylori has been considered to be non-invasive and to rarely infiltrate the gastric mucosa, even though there is an active Th1 immune response in the lamina propria of the H. pylori-infected stomach. To elucidate whether H. pylori invades the lamina propria and translocates to the gastric lymph nodes, we examined H. pylori in formalin-fixed and paraffin-embedded tissue sections of stomach and gastric lymph nodes obtained from 51 cancer patients using real-time PCR and immunohistochemistry (IHC) with a novel anti-H. pylori monoclonal antibody that recognizes lipopolysaccharides. Fresh gastric lymph nodes were used to culture for H. pylori. In 46 patients with H. pylori in the stomach, the bacterium was found in the lymph nodes from 21 patients by culture, 37 patients by PCR, and 29 patients by IHC. H. pylori captured by macrophages was found in the lamina propria of 39 patients. In the lymph nodes, the bacterium was found in many macrophages and a few interdigitating dendritic cells at the paracortical areas. H. pylori was also found in the intracellular canaliculi of parietal cells in 21 patients, but intracytoplasmic invasion into gastric epithelial cells was not identified. When compared to the commercially available anti-H. pylori antibodies, the novel antibody showed the highest sensitivity to detect H. pylori-positive macrophages, whereas no difference was found for H. pylori in the mucous layer. The H. pylori-positive macrophages in the lamina propria correlated with chronic gastritis as well as translocation of such cells to the lymph nodes. These results suggest that H. pylori-induced gastric epithelial damage allows the bacteria to invade the lamina propria and translocate to the gastric lymph nodes, which may chronically stimulate the immune system. The bacteria captured by macrophages, whether remaining alive or not, may contribute to the induction and development of H. pylori-induced chronic gastritis.     

Factors responsible for plaque formation of A/duck/Siberia/272/1998 (H13N6) influenza virus on MDCK cells

Many influenza A viruses form plaques on Madin-Darby canine kidney (MDCK) cells in the presence of trypsin. A/duck/Siberia/272/1998 (H13N6) (Sib272), however, does not form plaque on MDCK cells. After three blind passages of the strain on MDCK cells, plaque-forming variant was obtained and designated as A/duck/Siberia/272PF/1998 (H13N6) (Sib272PF). Genetic and functional analyses of Sib272 and Sib272PF revealed that amino acid substitutions, F3L of the HA2 subunit and T379K of the PB1, were responsible for plaque formation of Sib272PF by enhancing fusion and polymerase activities, respectively.     

Expression patterns of nectins and afadin during epithelial remodeling in the mouse embryo.

Cell-cell adhesion plays key roles in tissue morphogenesis and organogenesis. Nectins are Ca2+-independent immunoglobulin-like cell adhesion molecules connected to the actin cytoskeleton through afadin. Nectins play roles in a variety of cell-cell junctions in cooperation with or independently of cadherins. Here, we examined the cellular localization of nectins and afadin throughout primitive streak, neural plate, and early organogenesis stages of mouse development. Nectin and afadin localization coincided with a honeycomb-shaped meshwork of actin filaments at adherens junctions of polarized epithelia, including neuroepithelium, epithelial somites, and facial primordia. As organogenesis progressed, nectin-2 expression was maintained in general columnar epithelia, whereas nectin-1 and -3 became highly concentrated at sites of neural morphogenesis. Moreover, nectin-1 was highly expressed in keratinocytes of the skin, developing hair follicles, and epithelium of developing teeth. These results suggest that nectins and afadin are involved in dynamic epithelial remodeling during mouse development.