Recurrent Toxoplasma Retinitis Treated with Long-Term Oral Antibiotics

Purpose@#The purpose of this case was to report the inhibition of toxoplasma retinitis reactivation with long-term, low-dose antibiotics.Case summary: A 76-year-old woman complained of poor vision and floaters in her right eye. The corrected visual acuity (LogMAR) of the right eye was 0.5, and there was an area of yellow infiltration and dye leakage on the retinal fluorescein angiography images. Toxoplasma IgG were detected in the serum, the patient was diagnosed with toxoplasma retinitis, and the patient was advised oral trimethoprim-sulfamethoxazole, clindamycin, and steroids. Her visual acuity improved and the inflammation resolved. However, she again had decreased visual activity and retinal inflammation in her right eye after 5 months. The inflammation improved with oral steroids, but she was shifted to intravitreal dexamethasone because of the side effects of systemic steroids. Although the inflammation improved initially, there was worsening of inflammation (evidenced by vitreous opacity) after 2 months, which was treated with oral antibiotics. After vitrectomy for the removal of residual vitreous opacity, antibiotics were stopped because of the stable disease course. After discontinuation of the antibiotics, inflammation was noted again, and low-dose trimethoprim-sulfamethoxazole was administered. Low-dose antibiotics were continued for 5 months and the disease remained stable without any retinal inflammation. @*Conclusions@#Long-term, low-dose oral antibiotics may prevent reactivation of recurrent toxoplasma retinitis.

Thermoresponsive and Biodegradable Amphiphilic Block Copolymers with Pendant Functional Groups

BACKGROUND: To develop the biodegradability and thermoresponsive hydrogel, in this work we designed a pendant-functionalized, thermoresponsive, amphiphilic block copolymer. METHODS: Methoxy poly(ethylene glycol) (MPEG)-b-[poly(ε-caprolactone)-ran-poly(ε-caprolactone-3-one)-ran-polylactic acid] (MCL) and (MPEG-b-[PCL-ran-POD-ran-PLA]) [MCL-(CO)] block copolymers were prepared by ringopening polymerization of ε-caprolactone, OD and lactide monomers. The subsequent derivatization of MCL-(CO) provided MPEG-b-[PCL-ran-poly(ε-caprolactone-3-COOH)-ran-PLA] [MCL-(COOH)] with COOH pendant groups and MPEG-b-[PCL-ran-poly(ε-caprolactone-3-NH2)-ran-PLA] [MCL-(NH2)] with NH2 pendant groups. RESULTS: The measured segment ratios of MCL-(CO), MCL-(COOH), and MCL-(NH2) agreed well with the target ratios. The abundances of the COOH and NH2 groups in the MCL-(COOH) and MCL-(NH2) copolymers were determined by 1H- and 13C-nuclear magnetic resonance spectroscopy, and agreed well with the target abundances. MCL-(CO), MCL-(COOH), and MCL-(NH2) formed homogeneous, white, opaque emulsions at room temperature. Rheological analysis of the block copolymer suspensions indicated a solution-to-hydrogel phase transition as a function of temperature. The solution-to-hydrogel phase transitions and the biodegradation of MCL-(CO), MCL-(COOH), and MCL-(NH2) were affected by varying the type (ketone, COOH, or NH2) and abundance of the pendant groups. CONCLUSION: MCL-(CO), MCL-(COOH), and MCL-(NH2) with ketone, COOH, and NH2 pendant groups showed solution-to-hydrogel phase transitions and biodegradation behaviors that depended on both the type and number of pendant groups.

Effect of Drug Carrier Melting Points on Drug Release of Dexamethasone-Loaded Microspheres

Here, we examined the effect of melting point of drug carriers on drug release of dexamethasone (Dex)-loaded microspheres. We prepared poly(L-lactide-ran-ε-caprolactone) (PLC) copolymers with varying compositions of poly(εcaprolactone) (PCL) and poly(L-lactide) (PLLA). As the PLLA content increased, the melting points of PLC copolymers decreased from 61 to 43 ℃. PLC copolymers in vials solubilized at 40–50 ℃ according to the incorporation of PLLA into the PCL segment. Dexamethasone (Dex)-loaded PLC (MCxLy) microspheres were prepared by the oil-in-water (O/W) solvent evaporation/extraction method. The preparation yields were above 70%, and the mean particle size ranged from 30 to 90 µm. The MC(x)L(y) microspheres also showed controllable melting points in the range of 40–60 ℃. Dex-loaded MC(x)L(y) microspheres showed similar in vitro and in vivo sustained release patterns after the initial burst of Dex. The in vitro and in vivo order of the Dex release was MC₈₀L₂₀>MC₉₀L₁₀>MC₉₅L₅, which agreed well with the melting point order of the drug carrier. Using in vivo fluorescence imaging of fluorescein (FI)-loaded microspheres implanted in animals, we confirmed the sustained release of FI over an extended period. In vivo inflammation associated with the PLC microsphere implants was less pronounced than that associated with Poly(lactide-co-glycolide) (PLGA). In conclusion, we successfully demonstrated that it is possible to control Dex release using Dex-loaded MC(x)L(y) microspheres with different melting points.

Astigmatic Correlation between the Automated Refractometry and Dual Scheimpflug Analyzer in Pseudophakic Eyes

PURPOSE: To examine the relationship between the refractive astigmatism by automated refractometry and the corneal astigmatism by a dual Scheimpflug analyzer in pseudophakic eyes. METHODS: Prospectively, 75 patients (100 eyes) were enrolled in the present study. Refractive astigmatism was obtained by automated refraction. Corneal astigmatism was obtained using automated keratometry (ARK-530A®) and dual Scheimpflug scanning analysis (Galilei G4®). All refractive values were converted to the power vector components J0 and J45 for comparison and regression analysis of refractive versus corneal astigmatism. Bland-Altman plots were created to estimate the agreement between measurements. RESULTS: The average astigmatism from each measurement was -1.11 ± 1.44 D (refractive astigmatism from automated refraction), -0.77 ± 1.06 D (corneal astigmatism from automated keratometry), -0.93 ± 1.02 D (simulated K from Galilei G4®), and -1.11 ± 1.48 D (total corneal power from Galilei G4®). Refractive J0 and keratometric J0 were significantly correlated (r = 0.557, p ≤ 0.001), as well as the corresponding J45 values (r = 0.655, p = 0.025). Refractive astigmatism and total corneal power components were also significantly correlated (J0: r = 0.618, p ≤ 0.001; J45: r = 0.608, p = 0.04). In the Bland-Altman plots, keratometric J0 and total corneal power J0 showed the best agreement. CONCLUSIONS: The accuracy of measurements for corneal refraction and astigmatism in pseudophakic eyes is higher using the dual Scheimpflug analyzer, especially for total corneal power. This value of astigmatism can take into account the refractive astigmatism of pseudophakic eyes and can be used in evaluating postoperative corneal astigmatism.

Comparison of Image Quality between Swept-Source and Spectral-Domain Optical Coherence Tomography According to Ocular Media Opacity

PURPOSE: To compare the image quality between swept-source optical coherence tomography (SS-OCT) and spectral domain optical coherence tomography (SD-OCT), especially in eyes with media opacity. METHODS: Forty eyes without media opacity and 60 eyes with media opacity (30 eyes with cataract, 20 eyes with vitreous opacity, and 10 eyes with corneal opacity) were included in this study. SD-OCT and SS-OCT 6 x 6 macular scans were taken by a single operator. For image quality analysis, a total of 200 OCT images were subjectively graded by two trained retina specialists and measured quantitatively using the image quality factor (QF) built into the OCT devices. RESULTS: Compared to conventional SD-OCT, SS-OCT had statistically significantly better subjective and objective grades in the normal group, as well as each of the media opacity groups (p-value < 0.001). In both the subjective and objective grades, there was no significant difference according to the types of media opacity (QF: p = 0.188, subject grading scale [SGS]: p = 0.635) and the degree of media opacity (Group I: 20 < or = QF < 50, Group II: 0 < or = QF < 20; QF: p = 0.088, SGS: p = 0.051) in the superiority of image quality of SS-OCT to SD-OCT. CONCLUSIONS: In this media opacity patient population, swept-source OCT is a superior diagnostic tool when compared with SD-OCT in both objective and subjective assessments, even in the ocular media opacity. This result may be useful in diagnosis and progression detection of retinal disease in media opacity eyes.

Evaluation of the Cortical Vitreous Using Swept-Source Optical Coherence Tomography in Normal Eyes

PURPOSE: To observe the shape of posterior vitreous spaces using swept-source optical coherence tomography (SS-OCT) in normal eyes. METHODS: The posterior vitreous of 80 eyes of 80 volunteers without ocular disease was imaged. The DRI OCT-1 Atlantis (Topcon, Oakland, NJ, USA) was used to acquire scans of the posterior vitreous over an 18 × 18-mm2 area using the 12-mm horizontal line scan protocol. The size of the premacularis bursa was measured by the aliper function of the OCT. RESULTS: A boat-shape bursa was found in most cases. The prevalence of detected bursa fell with further increases in the extent of posterior vitreous detachment. The mean width of the bursa premacularis was 7,679.1 µm and the mean depth was 471.4 µm. CONCLUSIONS: Deep range imaging optical coherence tomography will provide improvement for in vivo anatomic characterization of the cortical vitreous, and allow better visualization of the dimensions of the bursa premacularis.

Evaluation of the Cortical Vitreous Using Swept-Source Optical Coherence Tomography in Normal Eyes

PURPOSE: To observe the shape of posterior vitreous spaces using swept-source optical coherence tomography (SS-OCT) in normal eyes. METHODS: The posterior vitreous of 80 eyes of 80 volunteers without ocular disease was imaged. The DRI OCT-1 Atlantis (Topcon, Oakland, NJ, USA) was used to acquire scans of the posterior vitreous over an 18 × 18-mm2 area using the 12-mm horizontal line scan protocol. The size of the premacularis bursa was measured by the aliper function of the OCT. RESULTS: A boat-shape bursa was found in most cases. The prevalence of detected bursa fell with further increases in the extent of posterior vitreous detachment. The mean width of the bursa premacularis was 7,679.1 µm and the mean depth was 471.4 µm. CONCLUSIONS: Deep range imaging optical coherence tomography will provide improvement for in vivo anatomic characterization of the cortical vitreous, and allow better visualization of the dimensions of the bursa premacularis.

Comparison of Ocular Biometry and Postoperative Refraction in Cataract Patients between Galilei-G6(R) and IOL Master(R)

PURPOSE: To compare the axial lengths, anterior chamber depths, and keratometric measurements and to predict postoperative refractions of Dual Scheimpflug analyzer Galilei G6(R) and intra ocular lens (IOL) Master(R). METHODS: A total of 50 eyes in 50 patients who received cataract surgery were included in the present study. The axial length, anterior chamber depth, and keratometry were measured using 2 types of partial coherence interferometries (Galilei G6(R) and IOL Master(R)). The SRK/T formula was used to calculate IOL power and the predictive error which subtracts predictive refraction from postoperative refraction was compared between the ocular biometry devices. RESULTS: Axial lengths were 23.36 +/- 0.80 mm and 23.36 +/- 0.90 mm measured by Galilei G6(R) and IOL Master(R), respectively. Axial length measured by Galilei G6(R) was not statistically significant compared with IOL Master(R) (p = 0.321). The anterior chamber depth and keratometry were 3.22 +/- 0.35 mm and 44.29 +/- 1.40 D measured by Galilei G6(R) and 3.11 +/- 0.46 mm and 44.39 +/- 1.41 D measured by IOL Master(R), respectively. The differences of anterior chamber depth and keratometry between the 2 devices were statistically significant (p < 0.001 and p = 0.028, respectively). The mean absolute prediction errors were 0.45 +/- 0.37 D and 0.49 +/- 0.39 D in Galilei G6(R) and IOL Master(R), respectively and was not statistically significantly different (p = 0.423). CONCLUSIONS: The ocular biometric measurements and prediction of postoperative refraction using Galilei G6(R) were as accurate as with IOL Master(R).

Effect of Integrated Personalized Health Care System on Middle-Aged and Elderly Women's Health / 대한의료정보학회지

OBJECTIVES: Body weight, body mass index (BMI), body fat, and blood pressure are important indicators of a person's health. In this experimental study, we evaluated the effectiveness of an integrated personalized health care system, Health Improvement and Management System (HIMS)-everyday, which instantly provides subjects with biofeedback on their measured body weight, BMI, body fat and blood pressure using a database that stores subjects-customized information. METHODS: The subjects of this study used the system once or twice a week for 8 weeks. We analyzed the changes in their body weight, BMI, body fat, and blood pressure according to their respective usage of the system, and analyzed the changes in their perceived health status and health promoting behavior accordingly. RESULTS: Subjects' body weight, BMI, and blood pressure decreased significantly with respect to their individual usage of the system. Subjects who used the system more frequently showed significant improvement in their body weight, BMI, and body fat. However, subjects' perceived health status and health promoting behavior did not improve significantly. CONCLUSIONS: The study showed that the biofeedback-based personalized health care system was effective in controlling middle-aged and elderly women' body weight, BMI, body fat, and blood pressure.

Effect of Feedback-Based Weight Management System on Body Weight Change / 대한의료정보학회지

OBJECTIVE: Body weight is an important indicator of a person's health status. In this study, we evaluated the effectiveness of the body weight management system, HIMS (Health Improvement and Management System)-Diet, which instantly provides users with feedback on their measured weight using the database that stores the user.customized information. METHODS: The participants of this experimental study used the system two or three times a week for 10 weeks. We analyzed the changes in their body weight and body mass index (BMI) according to their respective usage of the system. RESULTS: Participants' body weight and BMI decreased with respect to their individual usage of the system. Participants that used the system frequently for a longer time period improved significantly in their body weight and BMI. CONCLUSION: The experimental study showed that the body weight management system, HIMS-Diet, was effective in controlling people's body weight.

Effectiveness of Personalized Exercise Prescriptions Generated from HIMS / 대한의료정보학회지

OBJECTIVE: People can accomplish their objectives of exercise only when they exercise in moderation, meaning according to the personalized exercise prescriptions that are adjusted to their health status and fitness level. In this study, we evaluated the effectiveness of the personalized exercise prescriptions generated from HIMS(Health Improvement and Management System). METHODS: Subjects of experimental study exercised in their daily life according to their exercise prescriptions generated from HIMS for 10 weeks. We compared and analyzed the difference of their physical and psycho-social health status between before and after 10 weeks of exercise. RESULTS: Subjects' heart rate and blood pressure was improved meaningfully after 10 weeks of exercise. Subjects' body fat and agility was improved meaningfully after 5 weeks of exercise. Subjects' psycho-social health was improved meaningfully after 5 and 10 weeks of exercise. CONCLUSION: The experimental study showed that the personalized exercise prescriptions generated from HIMS were effective to improve and maintain the health and wellness.

A XML-based Model for Integration of Individual Health Information / 대한의료정보학회지

OBJECTIVE: For disease prevention and health promotion, it is important that individual health information is managed continuously and can be retrieved easily when necessary. We propose a model for integrated management of diverse individual health information that is generated and managed in heterogeneous Health Information System(HIS)s at hospitals or health centers. METHODS: We use XML and relational database together to represent the health information structurally and manage it flexibly. In order to show the effectiveness of our method, we developed a prototype of Intermediate System for integration and analysed the result. RESULTS: The Intermediate System for integration provides the schema of health information, represents the information in forms of XML strings by the subjects, and stores each XML string as one field of relational database. In each heterogeneous HIS, there is an adaptor that transforms the health information into XML according to the schema. The messages for transmission between each HIS and Intermediate System are represented in XML. CONCLUSION: The experimental study shows that using relational database and XML together provides a flexible, extensible and structured way of representing complex, dynamic, structurally-variant and large-scale information, on the premise that the database tables are partitioned or distributed according to the status of server.

Three Kinds of Problem-Based Learning Formulas Experienced in Konkuk University College of Medicine / 한국의학교육

We performed three kinds of problem-based learning (PBL) formulas in all of forty-one 3rd grade students after the final examination of the first semester from June 28, 1999 to July 9, 1999 at Konkuk University College of Medicine to investigate which formula is the most efficient and helpful in medical education and polyclinic course. The PBL formulas applied were the typical face-to-face PBL accompanied by mini-lecture (Type I) or by distribution of the guidelines without lecture (Type II) and cyber PBL using web-based module and discussion over cyber space (Type III). Response of students was surveyed using some questionnaires and the evaluation results of each PBL were analyzed with Pearson's correlation test. All participating students were satisfied with the face-to-face PBL especially in applying time of PBL, using discussion to solve the problem, and studying with tutors. In cyber PBL, in spite of excellency of the contents, limitations in discussion over cyber space and computer skills, misunderstanding of computer system, and additional cost for private PC rent seemed to decrease the satisfaction with this PBL. Experience in Type II PBL was turned out to be the most helpful and discussion among fellow students in PBL to be the most useful experience for incoming polyclinic course. There were no significant correlations between the evaluation results of face-to-face PBL and cyber PBL or between the evaluation results of each type of PBL and the average credit of that semester, suggesting that evaluation of the newly acquired knowledge through PBL using tools such as Triple Jump, OSCE (objective structured clinical examination), and MEQ (modified essay question) should be included in assesment of academic achievement in addition to the evaluation of activities during PBL.

An Experimental Trial of Web-based Problem Based Learning / 한국의학교육

In this paper, we present some results from an experimental web-based Problem-Based Learning(PBL) course, which was offered to 64 medical students in the first grade at Konkuk university for 7 weeks. For the course, we developed a web-based PBL module, which is composed of three sections. The first section includes the 8 stages of problem probing and solving in patient's care. In every stage, the students can browse all the data for the problem solving. The second section contains some problems for evaluating the academic achievement of the students who successfully passed in the first section. In the third section, some questionnaires are presented to survey the students response. The followings are the results. 1. Average score of the first section was 64.1+/-13.2. Most students participated in the course with integrity, and especially seven students(11%) were remarkable in their clinical reasoning. 2.The student's computer skill did not largely affect their academic achievements. However, it is desirable for the students to learn basic computer usage in advance. 3.A few students attended to the discussion through bulletin board facilities. Considering the importance of discussion in PBL, we need to devise a new way of attracting students in the discussion. 4. The survey showed that sixty five percent of the students thought that the lecture was effective and ninety one percent of them that it would be better if it is offered as a regular course during summer or winter vacations. Seventy five percent of students became to realize the importance of basic sciences such as biochemistry and physiology after this course. 5. There were many students who complained about the malfunctioning of the system. The system should be modified to be more reliable and robust. In conclusion, the web-based PBL course provided an effective way of learning in medical education. It also turned out to be used as an alternative of traditional PBL and especially useful for self study.

Development of Second Stage Software in the Anal Sphincter Control System Based on the Anal Electromyography, and Investigation of Therapeutic Outcome of the Patients withChronic

To eliminate the inconvenient shortcomings of our formerly designed system for the biofeedback treatment, the development of second stage software was indispensable. PURPOSE: The aims of current study were to supplement the prototype software, and to improve the application software for the database management system. Moreover, we assessed the practical value and outcome of biofeedback therapy for the patients with functional evacuation disorders by using the upgraded system. METHODS: A new system was worked out a design to be composed of Windows based GUI (graphical user interface), DB (database) management software, and networking system. Main software performs a signal processing and a protocol making mode to train pelvic sphincter. DB program administers patient profiles and the recorded signal data. Networking system was designed to execute RS-232C serial communication of signal data with use of fast ethernet LAN networking. To affirm the reproducibility of signal display for the clinical practice, system was applied to 5 healthy volunteers. To evaluate the practical appraisal, system was applied to 27 patients with functional evacuation disorders who were undertaken anorectal physiologic tests. Patient groups were categorized as nonrelaxing puborectalis group (group I, n=17), incontinencegroup (group II, n=10). Overall patients were underwent a mean 3.7 (range, 2~10) sessions of biofeedback treatment, and the outcome was analysed in the period of 5.8 (range, 3~12) months follow-up. RESULTS: Signal data not having drift or noise were adequately processed and displayed in a real time. Specifically, data upload with use of multi-processing overay display function was appropriately embodied. Overall data and profiles of patients groups were safely saved, sorted, and reproduced by using the upgrading database management software. Regarding to the therapeutic outcomes, 63 percent of 27 overall patients (12 of 17 patients in group I, 5 of 10 patients in group II) were improved. The subjective symptoms of 2 patients in group I were recurred in a period of 3 months follow-up. CONCLUSIONS: Hardware and software functions of upgraded system were applicable to the Windows environment of personal computer. A developed system with second stage software made it possible to perform biofeedback treatment. Specifically, current results could be useful for the improvement of the motivation and patient's willingness in the self-learning process of biofeedback treatment.

Development and Clinical Application of the Biofeedback Anal Sphincter Control System for the Treatment of Patients with Functional Defecation Disorders Author Ung-Chae

Biofeedback is the treatment of choice for functional defecation disorders such as idiopathic chronic constipation and neurogenic fecal incontinence. The pre-existing biofeedback systems have many disadvantages. The aims of current project are, first, to develop the biofeedback system into the application software in the Windows environment, and, second, to assess the possibility of clinical usage for patients with functional defecation disorders. The hardware and software of the BASCO (Biofeedback Anal Sphincter Control) system were based on the signal measurement and signal processing of anal sphincter EMG (Electromyography). BASCO system was applied to 5 normal healthy controls and 20 patients with functional defecation disorders. Patients group was categorized as constipation group (N1=15) and incontinence group (N2=5). With use of current system, EMG-based biofeedback therapy was performed, and the outcome was analysed. Anal EMG signal data was processed by the software, and displayed in the monitor of personal computer. The software of EMG-display and database management were adequately operated. In N1 group, a paradoxical elevation or equalized activity of anal EMG pattern was shown in the simulated defecation. In N2 group, low electrical activity was shown. These findings were used for the EMG-based biofeedback therapy as a pilot study. The clinical symptoms were improved in 12 of N1 group and 3 of N2 group in the period of 3.7 (range, 1~12) months follow-up. In Conclusion, newly-developed BASCO system was adequately operated in the volunteer and patients groups. The multi-tasking and multi-processing functions were adequately shown in the real time. Current results could be used for clinical appraisal. Specifically, this system could be used for the practical application of biofeedback therapy in the patients with chronic constipation or fecal incontinence.