Looking for gall bladder disease in the patient's iris.

In alternative health care iridology is used as a diagnostic aid. The diagnosis of gall bladder disease was used to study its validity and interperformer consistency. The presence of an inflamed gall bladder containing gall stones is said to be easily recognised by certain signs in the lower lateral part of the iris of the right eye. Stereo colour slides were made of the right eye. Stereo colour slides were made of the right eye of 39 patients with this disease and 39 control subjects of the same sex and age. The slides were presented in a random order to five leading iridologists without supplementary information. The prevalence of the disease was estimated at 56%. The median validity was 51% with 54% sensitivity and 52% specificity. These results were close to chance validity (iota = 0.03). None of the iridologists reached a high validity. The median interperformer consistency was 60%. This was only slightly higher than chance consistency (kappa = 0.18). This study showed that iridology is not a useful diagnostic aid.     

Pseudoexfoliation syndrome and cataract surgery by phacoemulsification

Pseudoexfoliation syndrome is a systemic age-related disease in which abnormal extracellular material is produced and accumulates in many ocular tissues. Its ocular manifestations involve all of the structures of the anterior segment as well as conjunctiva and orbital structures. The presence of pseudoexfoliation should alert the physicians to the increased risks associated during and after cataract surgery. Increasing awareness of this condition are important in the detection and preoperative determination of patients inclined to be at greater risk for complications during surgery. Data regarding the rate of complications during phacoemulsification suggest a lower complication rate than with exstracapsular extraction but still greater than in eyes without pseudoexfoliation. Despite the existence of a higher number of intraoperative and postoperative complications, experience with the phacoemulsification technique together with the improvement of the apparatus and instruments used enable similar results to obtained in eyes with pseudoexfoliation syndrome as in eyes without this pathology.     

于俊生教授诊治慢性肾功能衰竭的经验

于俊生教授在多年临床经验基础上提出脾肾亏虚,痰湿、瘀血、浊毒潴留,少阳枢机不利是慢性肾功能衰竭的病机关键。慢性肾功能衰竭以脾肾亏虚为本,痰湿、瘀血、浊毒留蓄为标,以及在慢性肾功能衰竭中的致病特点和常见临床表现。于俊生教授治疗慢性肾功能衰竭的特点是重视肾脾胃功能的调理及兼顾活血化瘀、利湿泄浊解毒,标本兼治;辨病与辨证相结合,运用中医辨证论治理论,使病理进程减慢,肾功能得以改善。     

Concurrent cutaneous,visceral and ocular leishmaniasis caused by Leishmania (Viannia) braziliensis in a kidney transplant patient

Although cases of leishmaniasis co-infection have been described in acquired immunodeficiency syndrome patients as well as those who have undergone organ transplants, to our knowledge, the present report is the first documented case of simultaneous cutaneous, visceral and ocular leishmaniasis due to Leishmania (Viannia) braziliensis in a transplant patient. The patient had been using immunosuppressive drugs since receiving a transplanted kidney. The first clinical signs of leishmaniasis included fever, thoracic pain, hepatosplenomegaly, leucopenia and anemia. The cutaneous disease was revealed by the presence of amastigotes in the skin biopsy. After three months, the patient presented fever with conjunctive hyperemia, intense ocular pain and low visual acuity. Parasites isolated from iliac crest, aqueous humor and vitreous body were examined using a range of molecular techniques. The same strain of L. (V.) braziliensis was responsible for the different clinical manifestations. The immunosuppressive drugs probably contributed to the dissemination of Leishmania.     

Validation of Molecular and Genomic Biomarkers of Retinal Drug Efficacy: Use of Ocular Fluid Sampling to Evaluate VEGF

The use of tissue- and cell-based methods in developing drugs for retinal diseases is inefficient. Consequently, many aspects of ocular drug therapy for retinal diseases are poorly understood. Biomarkers as prognostic indicators of change are needed to optimize the use of drugs. VEGF is considered an important target of drug therapy and VEGF levels in tissue are indicative of solid tumor growth. However, since many aspects of VEGF as a biomarker of ocular disease have not been validated, it has been difficult to ascertain without invasive procedures whether VEGF in the eye is a biomarker of response to drug therapy. Using published papers, registered clinical trials, and proteomic databases we assessed the earlier evidence for VEGF as an exploratory biomarker of proliferative and vasculopathic disease of the retina and asked whether the molecule has been rigorously validated in clinical trials. The emerging use of aqueous humor sampling has made it possible to explore biomarkers in oculo, and determine whether they are predictive of drug efficacy. We present data supporting the use of aqueous humor to validate drug-signaling pathways and biomarkers in the eye. In addition, we recommend convening a collaborative congress to help standardize the identification, validation, and use of biomarkers in retinal disease.     

Ocular manifestations of sickle hemoglobinopathies

Sickle cell disease is a hereditary disorder that is characterized by the production of structurally abnormal hemoglobin molecules. Clinical manifestations depend upon the amount and types of abnormal hemoglobin present. This paper reviews the genetic and molecular basis of sickle hemoglobinopathies and thalassemias including sickle cell anemia, SC disease, sickle cell-Beta Thalassemia and sickle trait. The systemic and ocular manifestations of these diseases are presented. Treatment regimens pertaining to hyphema, proliferative retinopathy, vitreous hemorrhage and retinal detachment are also discussed.     

A study to compare the oral health impact profile and satisfaction before and after having replacement complete dentures constructed by either the copy or the conventional technique

Aims: To assess the oral health impact profile (OHIP) on edentulous subjects who needed to have their dentures replaced either by a copy technique or a conventional technique, and to determine whether any change in the subjects’ assessment of their original and replacement dentures impacted on oral health related quality of life parameters. Background: The OHIP is an instrument used to measure subjects’ perceptions of the social impact of oral disorders on their well being. Changes in the OHIP may occur when subjects need to have their complete dentures replaced. Furthermore, it is possible that the method by which the dentures are constructed may impact on this. Methods: A total of 65 edentulous subjects were studied. Thirty‐three subjects had their dentures constructed by a copy technique and 32 by a conventional technique. Subjects completed the OHIP‐14 questionnaires before and after being provided with a set of replacement complete dentures. They also assessed specific features of the upper and lower dentures. Responses were recorded on a Likert scale. Results: For many subjects, the responses in the before treatment questionnaires were at the lower end of the Likert scale, indicating that there were no major impacts on oral health related quality of life parameters. There were no major differences between the copy denture subjects and the conventional denture subjects in relation to the change in OHIP scores before and after treatment. Generally subjects expressed improved satisfaction with the new lower denture. However, for the copy denture group there were significant improvements for all seven assessments compared with only five out of seven assessments for subjects in the conventional group. Conclusion: For these groups of edentulous subjects, although they may need dentures to be replaced after a period of wear, this does not necessarily have significant impacts on oral health related quality of life parameters. It seems likely that this is the main reason why the provision of new dentures by either a copying or conventional technique did not result in major changes to the OHIP.     

Alport Syndrome mutations in type IV tropocollagen alter molecular structure and nanomechanical properties

Alport Syndrome is a genetic disease characterized by breakdown of the glomerular basement membrane (GBM) around blood vessels in the kidney, leading to kidney failure in most patients. It is the second most inherited kidney disease in the US, and many other symptoms are associated with the disease, including hearing loss and ocular lesions. Here we probe the molecular level structure–property relationships of this disease using a bottom-up computational materiomics approach implemented through large-scale molecular dynamics simulation. Since the GBM is under constant mechanical loading due to blood flow, changes in mechanical properties due to amino acid mutations may be critical in the symptomatic GBM breakdown seen in Alport Syndrome patients. Through full-atomistic simulations in explicit solvent, the effects of single-residue glycine substitution mutations of varying clinical severity are studied in short segments of type IV tropocollagen molecules. The segments with physiological amino acid sequences are equilibrated and then subjected to tensile loading. Major changes are observed at the single molecule level of the mutated sequence, including a bent shape of the structures after equilibration (with the kink located at the mutation site) and a significant alteration of the molecules’ stress–strain responses and stiffnesses. These results suggest that localized structural changes at amino acid level induce severe alterations of the molecular properties. Our study opens a new approach in pursuing a bottom-up multi-scale analysis of this disease.     

Genetic modifiers of polycystic kidney disease in intersubspecific KAT2J mutants.

Polycystic kidney disease (PKD) is a genetically heterogeneous disorder. In addition to the many PKD-causative loci mapped in mouse and human, a number of reports indicate that modifier loci greatly influence the course of disease progression. Recently we reported a new mouse mutation, kat2J, on chromosome (Chr) 8 that causes late-onset PKD and anemia. During the mapping studies it was noted that the severity of PKD in the mutant (C57BL/6J-kat2J/+ x CAST/Ei)F2 generation was more variable than that in the parental C57BL/6J strain. This suggested that genetic background or modifier genes alter the clinical manifestations and progression of PKD. Genome scans using molecular markers revealed three loci that affect the severity of PKD. The CAST-derived modifier on Chr 1 affects both kidney weight and hematocrit. The CAST-derived modifier on Chr 19 affects kidney weight, and the C57BL/6J-derived modifier on Chr 2 affects hematocrit. Additional modifier loci are noted that interact with and modulate the effects of these three loci. The mapping of these modifier genes and their eventual identification will help to uncover factors that can delay disease progression. These, in turn, could be used to design suitable modes of therapy for various forms of human PKD.     

Sarcoidosis presenting with an unusual erythematous rash and persistent hypercalcemia.

Sarcoidosis is a multisystem disease that often presents with constitutional symptoms and ocular and skin manifestations. The chest roentgenogram may show no abnormalities or only diffuse interstitial disease. The serum calcium level is uncommonly persistently elevated and responds rapidly to low-dose corticosteroid therapy. The level of 1,25-dihydroxyvitamin D is often elevated, and the level of parathyroid hormone is almost always suppressed. Skin manifestations vary considerably and may appear in an unusual fashion. A skin biopsy may often be essential in the diagnosis of sarcoidosis.     

Renal co-morbidity in patients with rheumatic diseases

Renal co-morbidity is common in patients with rheumatic disease based on regular assessment of serum and urine parameters of renal function. When patients present with both arthritis and renal abnormalities the following questions have to be addressed. Is kidney disease a complication of rheumatic disease or its management, or are they both manifestations of a single systemic autoimmune disease? Is rheumatic disease a complication of kidney disease and its management? How do rheumatic disease and kidney disease affect each other even when they are unrelated? The present review provides an overview of how to address these questions in daily practice.     

Renal co-morbidity in patients with rheumatic diseases

Renal co-morbidity is common in patients with rheumatic disease based on regular assessment of serum and urine parameters of renal function. When patients present with both arthritis and renal abnormalities the following questions have to be addressed. Is kidney disease a complication of rheumatic disease or its management, or are they both manifestations of a single systemic autoimmune disease? Is rheumatic disease a complication of kidney disease and its management? How do rheumatic disease and kidney disease affect each other even when they are unrelated? The present review provides an overview of how to address these questions in daily practice.     

Ocular disease in patients with ANCA-positive vasculitis

Anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis—the term recently applied to Wegener's granulomatosis—is a rare multi-system inflammation characterized by necrotizing granulomas and vasculitis. We investigated the ocular manifestations of this disease in a group of patients drawn from five inflammatory eye disease clinics across the United States. Of 8,562 persons with ocular inflammation, 59 individuals were diagnosed with ANCA-positive vasculitis; 35 males and 21 females, aged 16 to 96 years, were included in this study. Ocular diagnoses were scleritis (75.0%), uveitis (17.9%), and other ocular inflammatory conditions (33.9%) including peripheral ulcerative keratitis and orbital pseudotumor. Mean duration of ocular disease was 4.6 years. Oral corticosteroids and other systemic immunosuppressive agents were used by 85.7% and 78.5% of patients, respectively. Over time, patients with ANCA-positive vasculitis experienced 2.75-fold higher mortality than other patients with inflammatory eye disease.     

Uveitis- a rare disease often associated with systemic diseases and infections- a systematic review of 2619 patients

ABSTRACT: BACKGROUND: Uveitis is an autoimmune disease of the eye that refers to any of a number of intraocular inflammatory conditions. Because it is a rare disease, uveitis is often overlooked, and the possible associations between uveitis and extra-ocular disease manifestations are not well known. The aim of this study was to characterise uveitis in a large sample of patients and to evaluate the relationship between uveitis and systemic diseases. METHODS: The present study is a cross-sectional study of a cohort of patients with uveitis. Records from consecutive uveitis patients who were seen by the Uveitis Service in the Department of Ophthalmology at the Medical University of Vienna between 1995 and 2009 were selected from the clinical databases. The cases were classified according to the Standardization of Uveitis Nomenclature Study Group criteria for uveitis. RESULTS: Data were available for 2619 patients, of whom 59.9% suffered from anterior, 14.8% from intermediate, 18.3% from posterior and 7.0% from panuveitis. 37.2% of all cases showed an association between uveitis and extra-organ diseases; diseases with primarily arthritic manifestations were seen in 10.1% of all cases, non-infectious systemic diseases (i.e., Behcet's disease, sarcoidosis or multiple sclerosis) in 8.4% and infectious uveitis in 18.7%. 49.4% of subjects suffering from anterior uveitis tested positively for the HLA-B27 antigen. In posterior uveitis cases 29% were caused by ocular toxoplasmosis and 17.7% by multifocal choroiditis. CONCLUSION: Ophthalmologists, rheumatologists, infectiologists, neurologists and general practitioners should be familiar with the differential diagnosis of uveitis. A better interdisciplinary approach could help in tailoring of the work-up, earlier diagnosis of co-existing diseases and management of uveitis patients.     

Prediction of quantitative intrathoracic fluid volume to diagnose pulmonary oedema using LabVIEW

Pulmonary oedema is a life-threatening disease that requires special attention in the area of research and clinical diagnosis. Computer-based techniques are rarely used to quantify the intrathoracic fluid volume (IFV) for diagnostic purposes. This paper discusses a software program developed to detect and diagnose pulmonary oedema using LabVIEW. The software runs on anthropometric dimensions and physiological parameters, mainly transthoracic electrical impedance (TEI). This technique is accurate and faster than existing manual techniques. The LabVIEW software was used to compute the parameters required to quantify IFV. An equation relating per cent control and IFV was obtained. The results of predicted TEI and measured TEI were compared with previously reported data to validate the developed program. It was found that the predicted values of TEI obtained from the computer-based technique were much closer to the measured values of TEI. Six new subjects were enrolled to measure and predict transthoracic impedance and hence to quantify IFV. A similar difference was also observed in the measured and predicted values of TEI for the new subjects.     

Prediction of quantitative intrathoracic fluid volume to diagnose pulmonary oedema using LabVIEW

Pulmonary oedema is a life-threatening disease that requires special attention in the area of research and clinical diagnosis. Computer-based techniques are rarely used to quantify the intrathoracic fluid volume (IFV) for diagnostic purposes. This paper discusses a software program developed to detect and diagnose pulmonary oedema using LabVIEW. The software runs on anthropometric dimensions and physiological parameters, mainly transthoracic electrical impedance (TEI). This technique is accurate and faster than existing manual techniques. The LabVIEW software was used to compute the parameters required to quantify IFV. An equation relating per cent control and IFV was obtained. The results of predicted TEI and measured TEI were compared with previously reported data to validate the developed program. It was found that the predicted values of TEI obtained from the computer-based technique were much closer to the measured values of TEI. Six new subjects were enrolled to measure and predict transthoracic impedance and hence to quantify IFV. A similar difference was also observed in the measured and predicted values of TEI for the new subjects.     

High-Speed Detection of the G894T Polymorphism in Exon 7 of the eNOS Gene by Real-Time Fluorescence PCR with the Light-Cycler

In endothelial cells nitric oxide (NO) is synthesized by endothelial-nitric oxide synthase (e-NOS), constitutively expressed and encoded by a 26-exon gene, located on chromosome 7q35-36. The prevalence of the T rare variant of the G894T polymorphism in exon 7 of the e-NOS gene (Glu-->Asp amino acid substitution) has been reported to be significantly higher in patients with coronary spasm and coronary artery disease. To date G894T polymorphism detection is performed by PCR-RFLP assay. In order to establish a high-speed genotyping method, we have taken advantage of the Light Cycler instrument, a thermal cycler that combines rapid-cycle DNA amplification with a real-time fluorescence monitoring. This technology is based on hybridization of the adjacent fluorescently labeled probes with PCR products. This methodology is considered more accurate and less time-consuming than conventional PCR-RFLP assay. To validate this technique we genotyped 270 healthy subjects. The results were consistent with those obtained from PCR-RFLP assay.     

Multiple sclerosis and neuro-ophthalmologic manifestations

The authors report clinical features of ocular manifestations in patients with multiple sclerosis (MS), those that affect the visual sensory system and those that affect the ocular motor system. Disturbances of visual sensory function may precede, manifest coincidentally or follow the neurologic manifestations. Visual disturbances are common in MS and often a result of acute demyelinating optic neuropathy. Careful examination of MS patients, who have never suffered optic neuritis, may also reveal asymptomatic visual loss. Asymptomatic visual loss seems to be a universal feature of MS. Patients with multiple sclerosis may develop disorders of fixation, ocular motility and ocular alignment. Disorders of ocular motor system are frequently the initial sign of multiple sclerosis and occur as its presenting sign weeks, month, or years before other neurologic symptoms and signs develop.     

Herpes zoster ophthalmicus

Herpes zoster is a common disease of both healthy adults and those who are immunocompromised. The purpose of this review is to present the current understanding of its epidemiology, virology, pathogenesis and treatment. A case report is included to emphasize the sometimes atypical presentation and possible secondary bacterial complications. Involvement of the ophthalmic branch of the trigeminal nerve can cause a host of ocular complications. Proper understanding of the nature of the disease process is essential for the management of both systemic and ocular manifestations of herpes zoster.     

Monitoring of lung tumour cell growth in artificial membranes

Morbidity of many tumour types is associated with invasion of tumour cells through the basement membrane and subsequent metastasis to vital organs. Tumour invasion is frequently detected late on as many patients present with advanced disease. The method of detecting invasion is through conventional histological staining techniques, which are time consuming and require processing of the sample. This can affect interpretation of the results. In this study, a new imaging technique, optical coherence tomography (OCT), was used to monitor lung tumour cell growth in two artificial membranes composed of either collagen type I or Matrigel. In parallel, standard histological section analysis was performed to validate the accuracy of the monitoring by OCT. Cross-sectional images from OCT revealed that lung tumour cells infiltrated only when low cell seeding density (5 x 10(5)) and low collagen concentration (1.5 mg/ml) were combined. The cells could be easily differentiated from the artificial membranes and appeared as either a brighter layer on the top of the membrane or brighter foci embedded within the darker membrane. These cell-membrane morphologies matched remarkably to the standard histological section images. Our results suggest that OCT has a great potential to become a useful tool for fast and robust imaging of cell growth in vivo and as a potential assessment of cell invasion.