Corneal endothelial cell protection during phacoemulsification: low- versus high-molecular-weight sodium hyaluronate

PURPOSE: To compare the efficacy of low- and high-molecular-weight sodium hyaluronate in protecting corneal endothelial cells during phacoemulsification. SETTING: Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan. METHODS: One hundred forty-nine eyes of 136 cataract patients were randomly assigned to have cataract surgery using sodium hyaluronate 1% with a low molecular weight (0.6 to 1.2 million d, Opegan) or sodium hyaluronate 1% with a high molecular weight (4 million d, Healon) during phacoemulsification. Each group was divided into 2 subgroups depending on the amount of ultrasound (% min) used during phacoemulsification, which was defined as the mean phacoemulsification energy (%) multiplied by phacoemulsification time (minutes). Corneal endothelial cell density was examined preoperatively and 3 months after surgery. The rate of cell loss was compared between the subgroups in the Opegan group and the Healon group. RESULTS: In the subgroups with ultrasound of 50% min or less, the mean rate of endothelial cell loss 3 months after surgery was 3.2% +/- 4.1% (SD) in the Opegan group and 5.9% +/- 5.3% in the Healon group (P =.0214). In the subgroups with ultrasound over 50% min, the mean rate of endothelial cell loss 3 months after surgery was 7.5% +/- 10.6% in the Opegan group and 14.8 +/- 9.0% in the Healon group (P =.0029). CONCLUSIONS: The results suggest that Opegan is more effective than Healon in protecting corneal endothelial cells during phacoemulsification regardless of the amount of ultrasound energy used.     

Anatomical location and number of metastatic lymph nodes for prognosis of non-small cell lung cancer

BackgroundThe nodal classification of lung cancer is determined by the anatomical location of metastatic lymph nodes (mLNs). However, prognosis can be heterogeneous at the same nodal stage, and the current classification system requires improvement. Therefore, we investigated the correlation between the number of mLNs and prognosis in patients with non-small cell lung cancer.MethodsUsing a multicenter database in Japan, we retrospectively reviewed the records of patients who underwent complete resection for lung cancer between 2010 and 2016. Kaplan-Meier curves were used to determine recurrence-free and overall survival. Multivariate analyses were performed using the Cox proportional hazards model.ResultsWe included 1,567 patients in this study. We could show a statistically significant difference in recurrence-free survival between pN2 patients with 1 mLN and pN2 patients with ≥2 mLNs (P=0.016). Patients with a combination of pN1 (≥4 mLNs) plus pN2 (1 mLN) had a poorer prognosis than pN1 patients (1-3 mLNs) (P=0.061) and a better prognosis than pN2 patients (≥2 mLNs) patients (P=0.007). Multivariate analysis showed that the number of mLNs was independently associated with cancer recurrence in patients with pN1 and pN2 disease (P=0.034 and 0.018, respectively).ConclusionsNodal classification that combines anatomical location and the number of mLNs may predict prognosis more accurately than the current classification system. Our study provides the concept that supports the subdivision of nodal classification in the upcoming revision of the tumor, node, and metastasis staging system.     

A study on the vascular proliferation in tissues around the tumor in breast cancer

In order to study the vascular proliferation in human breast cancer, blood vessels were counted, per square millimeter, in the tissue immediately around tumors. Mastectomized specimens of 84 patients with breast cancer and specimens from 10 patients with benign mammary diseases were stained by hematoxylin eosin and, where required, by the avidin biotin peroxidase complex method for laminin staining. The vascular density around the breast cancer tissue was 20.35 +/- 8.40/mm2, which was significantly higher than the value of 13.44 +/- 5.85/mm2 for noncancerous mammary tissues (p less than 0.001) or the value of 12.65 +/- 4.12/mm2 for benign mammary disease tissues (p less than 0.01). Among the breast cancers, noninvasive carcinoma had a higher vascular density (28.44 +/- 6.15/mm2) than invasive carcinoma (19.73 +/- 8.22/mm2, p less than 0.02). According to the Japan Mammary Cancer Society Classification of invasive ductal carcinoma, vascularity was higher in the papillotubular type of cancer than in the solid-tubular or scirrhous types of cancer (p less than 0.02), although the papillotubular type had the lowest rate of nodal metastasis and vascular invasion as compared with the scirrhous and solid-tubular types. The vascular density around the tumors did not change in association with an increase in tumor size and it was suggested that blood vessels around a tumor would increase almost in proportion to the square of the tumor diameter.     

Short latency activation of local circuit neurons in the cat somatosensory cortex

Intracellular horseradish peroxidase (HRP) study was performed in the cat primary somatosensory cortex (SI) under Nembutal anesthesia. Response properties of neurons were analysed with stimulation of the peripheral nerve (superficial radial nerve; SR) and thalamic ventrobasal nucleus (VB). A total number of 23 cells (15 in layers III and IV, 6 in layer V and 2 in layer VI) were identified morphologically as local circuit neurons with intracellular HRP staining. The latencies of SR-induced (7.7-8.5 ms) as well as VB-induced excitatory postsynaptic potentials (EPSPs) (1.3-1.5 ms) were significantly shorter than those of pyramidal neurons (9.1-10.6 ms for SR and 1.6-2.8 ms VB EPSPs). Morphological features of identified local circuit neurons are all, except one in layer VI, aspiny and presumed to be inhibitory in nature. The present study indicates that presumed inhibitory interneurons in the cat SI could be activated first by thalamic inputs among cortical neurons and set to inhibit the output cells for the sharp contrast in the sensory processing.     

An autopsy case of rest stomach cancer accompanied by tongue cancer

A case of rest stomach cancer, accompanied by tongue cancer, in a 57-year-old man is reported. The patient underwent a stomach resection 11 years earlier because of a discovered cancer. Most cases of rest stomach cancer appear after 10 years in cases of a stomach resection because of a stomach cancer. A double cancer, accompanied by tongue cancer, mostly occurs in people over 60 years old, and more than half such cases involve a cancer in the alimentary tract as well.     

New screening system for unruptured cerebral aneurysms--combination of an expert system and DSA examination.

We have designed a screening system to diagnose unruptured aneurysms, including the use of digital subtraction angiography (DSA). We surveyed 115 patients who had undergone clipping procedures after subarachnoid hemorrhage (SAH) and questioned them with regard to the subjective symptoms. Sixty-eight of 92 patients who returned the questionnaire reported, prior to rupture, headache, eye pain, and neck pain most frequently, and also impairment of extraocular movements, ptosis, visual field defects, and motor and sensory disturbances. Nineteen (47.5%) of 40 patients who had complete pain relief after surgery complained of headache from 1 week to 1 month before SAH. In addition, nine patients (22.5%) complained of headache for several years, and were also pain-free after surgery. For the indication of DSA, we employed an expert system based on fuzzy set theory. Seven groups of parameters are: Group 1, a basic questionnaire concerning age, sex, and past and family histories; Group 2, 15 warning signs selected on the basis of retrospective study; and Groups 3-7, detailed questions concerning each sign. Scoring weights assigned to each condition based on the results of the retrospective study, and threshold values were determined by several neurosurgeons. The certainty factors for intermediate hypotheses were calculated from these weights and threshold values and summed up, from which the conclusion was obtained. Twelve new cases of unruptured cerebral aneurysm were diagnosed using this screening system. This system may improve the ability to diagnose cerebral aneurysms before rupture.     

Elevated C-reactive protein levels in histological chorioamnionitis at term: impact of funisitis on term neonates

Objective: To compare clinical features and inflammatory effects for mothers and newborns between cases with or without funisitis among histlogical chorioamnionitis (HCA) at term.

Methods: We recruited 42 patients who were diagnosed with HCA at term. The women were classified into group HCA1/2 (HCA without funisitis, n?=?22) and group HCA3 (HCA with funisitis, n?=?20). Medical records and cardiotocograms were retrospectively reviewed to analyze predelivery maternal signs, abnormal FHR patterns, and neonatal outcomes. Differences between the two groups were evaluated using the Mann–Whitney U-test.

Results: The maternal CRP and WBC level of group HCA3 was observed to be significantly greater than that of group HCA1/2. Moreover, neonatal CRP levels at days 0, 1 and 2 of group HCA3 were significantly greater than of group HCA1/2. The ratios of abnormal FHR patterns of the two groups for recurrent late deceleration and prolonged deceleration were 26% and 43%, respectively, which was not statistically significant between the two groups.

Conclusion: We showed that HCA at term, particularly for funisitis, elevates the levels of maternal and neonatal CRP. Neonatal inflammatory signs, including elevated CRP levels, should be considered when managing cases of abnormal elevated CRP levels during labor at term.     

Photosynthetic characteristics of an amphibious plant, Eleocharis vivipara: Expression of C(4) and C(3) modes in contrasting environments

Eleocharis vivipara Link, a freshwater amphibious leafless plant belonging to the Cyperaceae can grow in both terrestrial and submersed aquatic conditions. Two forms of E. vivipara obtained from these contrasting environments were examined for the characteristics associated with C₄ and C₃ photosynthesis. In the terrestrial form (δ ¹³C values = -13.5 to -15.4‰, where ‰ is parts per thousand), the culms, which are photosynthetic organs, possess a Kranz-type anatomy typical of C₄ plants, and well-developed bundle-sheath cells contain numerous large chloroplasts. In the submersed form (δ ¹³C value = -25.9‰), the culms possess anatomical features characteristic of submersed aquatic plants, and the reduced bundle-sheath cells contain only a few small chloroplasts. ¹⁴C pulse-¹²C chase experiments showed that the terrestrial form and the submersed form fix carbon by way of the C₄ pathway, with aspartate (40%) and malate (35%) as the main primary products, and by way of the C₃ pathway, with 3-phosphoglyceric acid (53%) and sugar phosphates (14%) as the main primary products, respectively. The terrestrial form showed photosynthetic enzyme activities typical of the NAD-malic enzyme-C₄ subtype, whereas the submersed form showed decreased activities of key C₄ enzymes and an increased ribulose 1,5-bisphosphate carboxylase (EC 4.1.1.39) activity. These data suggest that this species can differentiate into the C₄ mode under terrestrial conditions and into the C₃ mode under submersed conditions.