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Purpose: The aim of this study was to compare the outcomes of vitrectomy in granulomatous uveitis and nongranulomatous uveitis insufficiently managed by immunosuppressive therapy. Methods: Thirty-eight eyes with granulomatous uveitis and 17 eyes with nongranulomatous uveitis that underwent vitrectomy for ocular complications between July 2006 and August 2012 were reviewed retrospectively. Visual acuity and ocular inflammation scores before and 6 months after surgery were compared. Patients treated with vitrectomy alone and those in whom vitrectomy was combined with phacoemulsification were analyzed separately. Results: The mean visual acuity improved significantly both in granulomatous and nongranulomatous uveitis. In granulomatous uveitis, the mean inflammation scores decreased significantly both in the anterior segment and in the posterior segment. In nongranulomatous uveitis, the mean inflammation score in the posterior segment decreased significantly, although it did not change in the anterior segment. Conclusion: Vitrectomy was effective for treating ocular complications both in granulomatous uveitis and nongranulomatous uveitis, with favorable outcomes of improved visual acuity and decreased uveitis activity. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a rare disorder that sometimes causes sudden subretinal and/or vitreous hemorrhage. Choroidal neovascularization is involved in the pathogenesis, but the etiology is unknown. Treatments with photocoagulation, cryopexy, and intravitreal bevacizumab injection have been reported. However, the therapeutic effect of intravitreal injection with ranibizumab for PEHCR is unclear. A 70-year-old woman visited our department because of sudden loss of superior visual field in her left eye. She had a history of surgical removal of hematoma due to subretinal hemorrhage associated with age-related macular degeneration 5 years ago. Peripheral subretinal hemorrhage was observed in the left eye, and fluorescein and indocyanine green angiography revealed choroidal neovascularization in the subretinal hemorrhagic region. PEHCR was diagnosed. Considering her past history, intravitreal ranibizumab injection was used for treatment. After three injections in the left eye, subretinal hemorrhage and choroidal neovascularization resolved completely. No recurrence was observed during 1 year of follow-up. This case demonstrates that intravitreal injection of ranibizumab is an effective treatment for PEHCR with subretinal hemorrhage. [ABSTRACT FROM AUTHOR]

B1 cells have different origin and function from conventional B (B2) cells and are considered to be involved in autoantibody production in the development of autoimmune disease. We found that B1 cells preferentially accumulated in the target organs including thymus in aged BWF1 mice, a murine model for systemic lupus erythematosus, and that B lymphocyte chemoattractant (BLC/CXCL13) expression was increased in the thymus before the onset of lupus nephritis, while stromal cell-derived factor-1 (SDF-1/CXCL12) and secondary lymphoid tissue chemokine (SLC/CCL21) expression remained unchanged. Adhesion molecules such as peripheral node addressin (PNAd), ICAM-1, and VCAM-1 were also expressed on endothelial cells in the enlarged thymic perivascular space (PVS) in aged BWF1 mice. BLC protein and PNAd were co-localized on these high-endothelial-venules-like vessels in enlarged PVS. B1 cells expressed higher level of costimulatory molecules and showed a potent antigen-presenting activity in allogeneic mixed lymphocyte reaction comparable to splenic dendritic cells. Interestingly, B1 cells stimulated proliferation of autologous thymic CD4 T cells in the presence of IL-2. These results indicate that aberrant B1 cell trafficking into the thymus due to ectopic high expression of BLC may result in an activation of self-reactive T cells in the development of murine lupus. [ABSTRACT FROM AUTHOR]

Background: Dendritic cells (DCs) play a central role in immune responses and may be useful adjuvants for tumor vaccine therapy. We previously reported that F4/80[sup -]B220[sup -] CD11c[sup +] DC precursors expressing the CC chemokine receptors CCR1 and CCR5 are mobilized rapidly into the circulation in mice injected with Propionibacterium acnes and are recruited into inflammatory tissue by macrophage inflammatory protein 1α (MIP-1α), which binds to CCR1 and CCR5. Here we investigate the mechanisms of DC precursor mobilization and the antitumor effect of these cells in mice. Methods: Numbers of DC precursors in peripheral blood were determined in P. acnes-treated mice (groups of 10 C57BL/B6 [B6] wild-type mice, CCR1[sup -/-] mice, CCR5[sup -/-] mice, and B6 mice treated with antibody to MIP-1α or control antibody) and in B6 mice injected with recombinant MIP-1α. MIP-1α-mobilized DC precursors matured by treatment with granulocyte-macrophage colony-stimulating factor, interleukin 4, and tumor necrosis factor-α and pulsed with B16 melanoma lysates were assayed for their ability to confer protective immunity against tumor challenge in vivo and to induce cytotoxic T lymphocytes against B16 tumor cells in vitro. Results: The recruitment of DC precursors into the circulation by P. aches administration was higher in B6 mice (12.6%, 95% confidence interval [CI] = 9.1% to 16.1%) than in CCR1[sup -/-] (9.0%, 95% CI = 7.5% to 10.5%), CCR5[sup -/-] (6.3%, 95% CI = 5.2% to 7.3%), or anti-MIP-1α antibody-treated (6.6%, 95% CI = 5.7% to 7.5%) mice. Injection of MIP-1α also mobilized DC precursors into the circulation (13.1%, 95% CI = 10.8% to 15.6%). Matured MIP-α-mobilized-DC precursors pulsed with B16 tumor lysates elicited B16-specific antitumor immunity in vitro and in vivo. Conclusions: MIP-1α and its receptors are important in recruiting DC precursors into the circulation. DC precursors mobilized rapidly by MIP-1α may provide sufficient useful DC precursors for DC-based vaccination in cancer treatment. [ABSTRACT FROM AUTHOR]

In an effort to generate an A.CA mouse expressing E, the Ea gene has been introduced into A. CA mice which lack the major histocompatibility complex (MHC) class II E molecule. Flow cytometric analysis shows cell surface expression of the Eα chain on lymphocytes and macrophages in the transgenic mice. Analysis of T-cell receptor ( Tcr) genes deleted in some E-expressing mouse strains demonstrates that T cells expressing Tcrb-VS are partially deleted in these transgenic mice while those expressing Tcrb-V8 and Tcrb-11 are not. In addition, the expressed Eα chain can promote Mycoplasma arthriditis mitogen (MAM)-induced T-cell proliferation. The expression of the Ea chain, presumably as an A ßEα heterodimer, can alter the peripheral T-cell repertoire and T-cell reactivity to a microbial superantigen. [ABSTRACT FROM AUTHOR]

Purpose: We describe the clinical findings in a Japanese patient with unilateral traumatic optic neuropathy (TON) who underwent steroid pulse therapy followed by optic canal decompression surgery. The optic nerve function was assessed longitudinally and quantitatively by Goldmann visual fields (GVFs). This was accomplished by measuring the area of each isopter and scotoma, and the findings were compared with the visual acuities recorded during the course of the resolution of the TON. Case Presentation: A 70‐year‐old man suffered from TON in his left eye after falling from a 3 m cliff. On examination at the Saitama Medical University Hospital, his decimal best corrected visual acuity (BCVA) in his left eye was 0.2. Computed tomography revealed a fracture of the lateral wall of the left orbit, but no obvious optic canal fracture was observed. Steroid pulse therapy was started, and optic nerve decompression surgery was performed. After steroid administration, there was a slight improvement in the visual acuity, and a response in the I/3e isopter was present (area 17.76 deg2). However, the V/4e area decreased from 539.35 to 359.36 deg2. Three days after the optic canal decompression surgery, the decimal visual acuity improved to 0.6, and the V/4e area and I/3e area increased to 1122.52 and 46.88 deg2, respectively. Postoperatively, there was a marked improvement in the size of the GVFs that corresponded to the improved visual acuity. The visual acuity of the left eye was 0.8 after 6 months, and the GVF was still not completely normal. Conclusions: Our findings showed the course of recovery of the visual acuity and visual field in an eye with TON. The quantification of GVF was helpful in assessing the course of recovery after the treatments. The new quantitative index of the GVFs may be helpful in evaluating the effectiveness of treatments for optic nerve disorders. [ABSTRACT FROM AUTHOR]

Background/Aims: Hepatobiliary scintigraphy (HBS) is used to evaluate bile excretion. This study aimed to evaluate biliary excretion during endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using HBS. Methods: We retrospectively evaluated 78 consecutive patients with malignant extrahepatic biliary obstruction, who underwent HBS after EUS-HGS between April 2015 and July 2022. The peak time and decay rate were scored with 0, 1, or 2 points based on thresholds of 20 and 35 minutes, and 10% and 50%, respectively. A total score of 4 or 3 was considered indicative of good bile excretion, whereas scores of 2, 1, or 0 indicated poor bile excretion. Results: The good and poor bile excretion groups included 40 and 38 cases, respectively. The group with good bile excretion had a significantly longer time to recurrent biliary obstruction compared to the poor bile excretion group (not reached vs. 124 days, p=0.026). Multivariate analysis identified the site of obstruction as a significant factor influencing good bile excretion (odds ratio, 3.39; 95% confidence interval, 1.01–11.4, p=0.049), with superior bile excretion observed in cases involving upper biliary obstruction compared to middle or lower biliary obstruction. Conclusions: In patients with malignant biliary obstruction who underwent HGS, the site of obstruction is significantly associated with stent patency. [ABSTRACT FROM AUTHOR]

Background: Duodenal duplication cysts in adults are rare, and a preoperative diagnosis remains difficult because clinical manifestations are nonspecific and variable. We describe a case of a duodenal duplication cyst mimicking a pancreatic pseudocyst with repeated intracystic hemorrhage. Case presentation: A 47-year-old male who complained of upper abdominal pain and vomiting was referred to our hospital. He was a heavy drinker and had a past history of hospitalization for alcoholic chronic pancreatitis. Plain abdominal computed tomography (CT) showed a cystic lesion of 7 cm in size in the lumen near the second part of the duodenum. The cystic lesion showed high density inside. Gastrointestinal endoscopy revealed that the lumen of the duodenum was deformed by a submucosal tumor-like mass and the endoscope could not pass through it, but active bleeding was not seen in the lumen of the duodenum. On the fourth day of hospitalization, anemia progressed and contrast-enhanced CT demonstrated a high-density spot on the wall of the cystic lesion. A pancreatic pseudocyst complicated with intracystic hemorrhage was preliminarily considered. Angiography was immediately performed, and a pseudoaneurysm was identified in the branch of the anterior superior pancreaticoduodenal artery (ASPDA). Transcatheter arterial embolization (TAE) was performed. Anemia did not progress after that, and follow-up CT showed reduction in the size of the cystic lesion. Afterward, the same symptoms recurred twice and surgical treatment was performed for the pancreatic pseudocyst with repeated intracystic hemorrhage. Macroscopically, a cystic mass of 5 cm in size was adjacent to the second part of the duodenum on the pancreas side. A pinhole-sized communication was identified between the cyst and the duodenum lumen. Microscopically, the cyst wall was composed of gastric mucosa and shared a common proper muscle layer with the duodenum. Chronic ulcers and erosions were seen in the cyst. Based on these findings, a diagnosis of duodenal duplication cyst was made. Conclusions: Duodenal duplication cysts in adults have seldom been reported and should be considered as a differential diagnosis for a patient with a cystic lesion adjoining the duodenum. [ABSTRACT FROM AUTHOR]

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a highly accurate method for diagnosing pancreatic neuroendocrine tumors (PNETs); however, some PNETs are difficult to diagnose. Recently, the efficacy of needle-based confocal laser endomicroscopy (nCLE) in diagnosing solid pancreatic masses has been reported. However, the efficacy of nCLE in the diagnosis of PNETs remains unknown and only a small number of cases have been reported. Hence, this study aimed to evaluate the efficacy of nCLE in the diagnosis of PNETs. Methods: This single-center retrospective study evaluated 30 consecutive patients with suspected PNETs on contrast-enhanced computed tomography, who consented to nCLE combined with EUS-FNA and were diagnosed using EUS-FNA or surgical resection. The diagnostic criteria for PNETs using nCLE were based on the nesting and trabecular and glandular arrangement of tumor cell clusters surrounded by capillary vessels and fibrosis, as reported in previous studies. Results: The diagnosis using nCLE was classified into three categories: misdiagnosis in three cases (10%), non-diagnostic in six cases (20%), and diagnostic in 21 cases (70%). nCLE was able to diagnose PNET in one of the two cases with inconclusive EUS-FNA. Conclusions: Although further development of the resolution and optimization of the diagnostic criteria are required, nCLE may constitute a useful diagnostic option in cases of inconclusive EUS-FNA for PNETs. [ABSTRACT FROM AUTHOR]

Background/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is a standard diagnostic method for biliary tract cancer (BTC), and samples obtained in this manner may be used for comprehensive genomic profiling (CGP). This study evaluated the utility of EUS-TA for CGP in a clinical setting and determined the factors associated with the adequacy of CGP in patients with BTC. Methods: CGP was attempted for 105 samples from 94 patients with BTC at the Aichi Cancer Center, Japan, from October 2019 to April 2022. Results: Overall, 77.1% (81/105) of the samples were adequate for CGP. For 22-G or 19-G fine-needle biopsy (FNB), the sample adequacy was 85.7% (36/42), which was similar to that of surgical specimens (94%, p=0.45). Univariate analysis revealed that 22-G or larger FNB needle usage (86%, p=0.003), the target primary lesions (88%, p=0.015), a target size ≥30 mm (100%, p=0.0013), and number of punctures (90%, p=0.016) were significantly positively associated with CGP sample adequacy. Conclusions: EUS-TA is useful for CGP tissue sampling in patients with BTC. In particular, the use of 22-G or larger FNB needles may allow for specimen adequacy comparable to that of surgical specimens. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the association between axial length and crystalline lens biometry with and without accommodation using the CASIA2 swept-source (SS) optical coherence tomography (OCT) system on the anterior segment. Study design: Intervention study. Methods: Individuals aged 20 to 39 years were enrolled for SS-OCT imaging at 2 separate visits within 1 week. Each eye was imaged under accommodation stimuli with different amplitudes (0 D, -1 D, -3 D, -5 D, and -7 D). The anterior and posterior lens curvature radii and lens thicknesses were measured. The participants were divided into 4 groups according to axial length. Results: Forty-eight participants (96 eyes) were initially enrolled. All 96 eyes were included in the analyses, as they met the eligibility criteria and each had proper OCT images. The mean participant age was 25.9 ± 4.3 years, and the mean spherical error was -3.5 ± 2.5 D. The mean axial length was 25.1 ± 1.2 mm. Multivariate analysis revealed that the anterior curvature radius became flatter and the lens thickness became thicker as the axial length increased (all P <.01). Furthermore, axial length independently contributed to the shape of the lens after adjusting for the effects of age and accommodation stimuli. Conclusion: Axial length was associated with lens shape after adjusting for age and accommodation stimuli. These measurements can provide a glimpse of dynamic lens biometry changes, which may help us better understand the role of lenses in various physiologic changes, including accommodation and myopia. [ABSTRACT FROM AUTHOR]

Objectives: Endoscopic ultrasound‐guided fine‐needle aspiration and fine‐needle biopsy (EUS‐FNA/FNB) is not fully established as a pathological sampling tool for gallbladder lesions due to limited evidence. We therefore aimed to clarify the effectiveness and safety of this procedure in a large‐population cohort. Methods: This study retrospectively evaluated the diagnostic yield of EUS‐FNA/FNB for accurately differentiating between benign and malignant gallbladder lesions. Puncture targets included the gallbladder mass, lymph node, and liver mass. Adverse events and factors associated with diagnostic accuracy were analyzed as well. Results: In 187 patients with gallbladder lesions undergoing EUS‐FNA/FNB, 18 benign lesions and 169 malignant lesions were identified. Overall sampling adequacy was 98% (184/187). The diagnostic accuracy of EUS‐FNA/FNB was 97% (182/187), sensitivity was 97% (164/169), and specificity was 100% (18/18). A single postprocedural complication (minor bleeding) was recorded in one patient. In the 169 cases of malignancy, 203 sites were punctured for pathological sampling of the primary mass (n = 94), lymph node (n = 79), and metastatic liver mass (n = 30). No significant difference was found for diagnostic accuracy among the puncture sites (P = 0.70). In cases having specimens obtained from the primary mass, the accuracy of those targeting liver invasion sites was significantly higher than that of other sites (98% vs. 83%, P < 0.01). Conclusion: EUS‐FNA/FNB demonstrated clinical usefulness and safety for the pathological diagnosis of gallbladder lesions, with high diagnostic yield and a low incidence of adverse events. Targeting the site of liver infiltration may improve the diagnostic rate of EUS‐FNA/FNB in the primary mass. [ABSTRACT FROM AUTHOR]