Effect of Muscularity and Fatty Infiltration of Paraspinal Muscles on Outcome of Lumbar Interbody Fusion

Background@#Lumbar paraspinal muscles play an important role in maintaining global spinal alignment and are associated with lower back pain; however, only a few studies on the effect of the paraspinal muscles on the surgical outcome exist. Therefore, this study aimed to analyze the association of preoperative muscularity and fatty infiltration (FI) of paraspinal muscles with the outcome of lumbar interbody fusion. @*Methods@#Postoperative clinical and radiographic outcomes were analyzed in 206 patients who underwent surgery for a degenerative lumbar disease. The preoperative diagnosis was spinal stenosis or low-grade spondylolisthesis, and the surgery performed was posterior lumbar interbody fusion or minimally invasive transforaminal lumbar interbody fusion.Indications for surgery were a complaint of severe radiating pain that did not improve with conservative treatment and neurological symptoms accompanied by lower extremity motor weakness. Patients with fractures, infections, tumors, or a history of lumbar surgery were excluded from this study. Clinical outcome measures included functional status, measured using the Oswestry disability index (ODI) and visual analog scale (VAS) score for lower back and leg pain. Other radiographic parameters included measures of spinal alignment, including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, C7 sagittal vertical axis, and pelvic incidence-lumbar lordosis mismatch. Lumbar muscularity (LM) and FI were measured preoperatively using a lumbar magnetic resonance image (MRI). @*Results@#The high LM group showed more significant improvement in VAS score for lower back pain than the low LM group. In contrast, the VAS score for leg pain demonstrated no statistical significance. The high LM group showed more significant improvement in ODI postoperatively than the medium group. The severe FI group showed more significant improvement in ODI postoperatively, whereas the less severe FI group showed more significant improvement in the sagittal balance postoperatively. @*Conclusion@#Patients with high LM and mild FI ratio observed on preoperative MRI demonstrated more favorable clinical and radiographic outcomes after lumbar interbody fusion. Therefore, preoperative paraspinal muscle condition should be considered when planning lumbar interbody fusion.

An Updated Overview of Low Back Pain Management

We aimed to determine the recommendation level for the treatment of acute and chronic low back pain (LBP). A systematic review (SR) of the literature was performed and all English-language articles that discuss acute and chronic LBP, including MEDLINE and the Cochrane Database of Systematic Reviews, were searched. Of the 873 searched literature reports, 259 articles, including 131 clinical trials, 115 SRs, nine meta-analyses, and four clinical guidelines were analyzed. In these articles, high-quality randomized controlled trials, SRs, and used well-written clinical guidelines were reviewed. The results indicated multiple acute and chronic LBP treatment methods in the literature, and these reports when reviewed included general behavior, pharmacological therapy, psychological therapy, specific exercise, active rehabilitation and educational interventions, manual therapy, physical modalities, and invasive procedures. The Trial conclusions and SRs were classified into four categories of A, B, C, and D. If there were not enough high-quality articles, it was designated as “I” (insufficient). This review and summary of guidelines may be beneficial for physicians to better understand and make recommendations in primary care.

Osteogenic Response of MC3T3-E1 and Raw264.7 in the 3DEncapsulated Co-Culture Environment

BACKGROUND@#Three-dimensional (3D) in vitro cultures recapitulate the physiological microenvironment and exhibit high concordance with in vivo conditions. Improving co-culture models with different kind of cell types cultured on a 3D scaffold can closely mimic the in vivo environment. In this study, we examined the osteogenic response of pre-osteoblast MC3T3-E1 cells and Raw264.7 mouse monocytes in a 3D-encapsulated co-culture environment composed of the Cellrix®3D culture system, which provides a physiologically relevant environment. @*METHODS@#The Cellrix® 3D Bio-Gel scaffolds were used to individually culture or co-culture two type cells in 3D microenvironment. Under 3D culture conditions, osteoblastic behavior was evaluated with an ALP assay and staining. ACP assay and TRAP staining were used as osteoclastic behavior indicator. @*RESULTS@#Treatment with osteoblastic induction factors (?3F) and RANKL had on positively effect on alkaline phosphatase activity but significantly inhibited to acid phosphatase activity during osteoclastic differentiation in 3D coculture. Interestingly, alkaline phosphatase activity or acid phosphatase activity in 3D co-culture was stimulated with opposite differentiation factors at an early stage of differentiation. We guess that these effects may be related to RANK– RANKL signaling, which is important in osteoblast regulation of osteoclasts. @*CONCLUSION@#In this study, the osteogenic response of 3D encapsulated pre-osteoblast MC3T3-E1 cells and mouse monocyte Raw264.7 cells was successfully demonstrated. Our 3D culture conditions will be able to provide a foundation for developing a high-throughput in vitro bone model to study the effects of various drugs and other agents on molecular pathways.

Applications of Artificial Intelligence in Mammography from a Development and Validation Perspective

Mammography is the primary imaging modality for breast cancer detection; however, a high level of expertise is needed for its interpretation. To overcome this difficulty, artificial intelligence (AI) algorithms for breast cancer detection have recently been investigated. In this review, we describe the characteristics of AI algorithms compared to conventional computer-aided diagnosis software and share our thoughts on the best methods to develop and validate the algorithms. Additionally, several AI algorithms have introduced for triaging screening mammograms, breast density assessment, and prediction of breast cancer risk have been introduced.Finally, we emphasize the need for interest and guidance from radiologists regarding AI research in mammography, considering the possibility that AI will be introduced shortly into clinical practice.

Osteogenic Response of MC3T3-E1 and Raw264.7 in the 3DEncapsulated Co-Culture Environment

BACKGROUND@#Three-dimensional (3D) in vitro cultures recapitulate the physiological microenvironment and exhibit high concordance with in vivo conditions. Improving co-culture models with different kind of cell types cultured on a 3D scaffold can closely mimic the in vivo environment. In this study, we examined the osteogenic response of pre-osteoblast MC3T3-E1 cells and Raw264.7 mouse monocytes in a 3D-encapsulated co-culture environment composed of the Cellrix®3D culture system, which provides a physiologically relevant environment. @*METHODS@#The Cellrix® 3D Bio-Gel scaffolds were used to individually culture or co-culture two type cells in 3D microenvironment. Under 3D culture conditions, osteoblastic behavior was evaluated with an ALP assay and staining. ACP assay and TRAP staining were used as osteoclastic behavior indicator. @*RESULTS@#Treatment with osteoblastic induction factors (?3F) and RANKL had on positively effect on alkaline phosphatase activity but significantly inhibited to acid phosphatase activity during osteoclastic differentiation in 3D coculture. Interestingly, alkaline phosphatase activity or acid phosphatase activity in 3D co-culture was stimulated with opposite differentiation factors at an early stage of differentiation. We guess that these effects may be related to RANK– RANKL signaling, which is important in osteoblast regulation of osteoclasts. @*CONCLUSION@#In this study, the osteogenic response of 3D encapsulated pre-osteoblast MC3T3-E1 cells and mouse monocyte Raw264.7 cells was successfully demonstrated. Our 3D culture conditions will be able to provide a foundation for developing a high-throughput in vitro bone model to study the effects of various drugs and other agents on molecular pathways.

Application of Deep Convolutional Neural Networks in the Diagnosis of Subcutaneous Masses Using Ultrasonography: A Pilot Study / 대한피부과학회지

Background@#Ultrasonography is an effective noninvasive imaging modality for the diagnosis of subcutaneous masses. To date, few studies have reported skin ultrasonography using deep convolutional neural networks (DCNNs).We investigated the accuracy of DCNNs for the diagnosis of epidermal cysts, lipomas, and other subcutaneous masses. @*Objective@#The purpose of this study was to evaluate whether DCNNs could diagnose subcutaneous masses with ultrasonographic images at level of competence comparable to dermatologists. @*Methods@#We created a dataset of 1,361 skin ultrasonography images obtained from 202 patients diagnosed with epidermal cysts, lipomas, and other subcutaneous masses, to train the DCNNs using ResNet18. Performance was compared with another set of 93 ultrasonographic images (24 epidermal cysts, 25 lipomas, and 44 other subcutaneous masses) from open-access articles. @*Results@#The DCNNs yielded 87.10% classification accuracy and 86.10% F1-scores. The area under the curve, sensitivity, and specificity were 0.92 (95% confidence interval [CI] 0.86∼0.98), 75.00%, and 98.55% for epidermal cysts; 0.93 (95% CI 0.88∼0.98), 80.00%, and 94.12% for lipomas; and 0.97 (95% CI 0.93∼1.00), 97.73%, and 85.71% for other subcutaneous masses, respectively. Analysis using gradient-weighted class activation mapping revealed that the DCNNs could detect specific ultrasonographic findings of epidermal cysts and lipomas. @*Conclusion@#We propose that DCNNs combined with ultrasonography may aid in the diagnosis of subcutaneous masses in outpatient settings.

The Analysis of Retinal Capillary Network Using Optic Coherence Tomographic Angiogrphy after Acute Angle Closure

Purpose@#We evaluated changes in the retinal capillary networks of patient’s acute primary angle closure (APAC) who were successfully treated and who lacked glaucomatous alterations. @*Methods@#Twenty patients for whom unilateral episodes of APAC were successfully treated were included in this retrospective cross-sectional study. At an average of 8 weeks after APAC, the thicknesses of the circumpapillary retinal nerve fiber layer (RNFL) and the ganglion cell-inner plexiform layer (GCIPL) were measured via spectral domain optical coherence tomography. Circumpapillary and macular vessel densities, perfusion density (PD), and the area and perimeter of the foveal avascular zone (FAZ) were measured with the aid of OCT angiography (OCTA). We compared the values between APAC eyes and the fellow eyes. @*Results@#We found no significant differences between groups in the thickness of any RNFL or GCIPL sector, or in the circumpapillary vessel or perfusion density. However, within a radius of 0.5 mm from the fovea (the center), the vessel and perfusion densities were significantly lower in affected than in fellow eyes (p = 0.003, p = 0.046 respectively). The vascular factors of other macular sectors, and the FAZ area and perimeter did not differ between the groups. @*Conclusions@#Early reductions in macular vessel and perfusion densities were evident after effective APAC treatment. Therefore, follow-up must evaluate whether the blood flow reduction causes structural damage.

Coexisting Spine Lesions on Whole Spine T2 Sagittal MRI in Evaluating Spinal Degenerative Disease

Background@#Studies have reported on the usefulness of whole spine magnetic resonance imaging (MRI) in evaluating specific diseases such as spinal tuberculosis, spinal trauma, spondyloarthropathies, and multiple myeloma. In studies concerning degenerative spinal disease, sample sizes were small and some did not provide information on how symptomatic coexisting lesions were treated. We evaluated the types and prevalence of coexisting spine lesions found on whole spine T2 sagittal screening performed at the time of routine cervical and lumbar spine MRI and evaluated the efficacy of such screening in degenerative diseases of the cervical and lumbar spine. @*Methods@#We reviewed 1,757 and 2,266 consecutive cases where whole spine T2 sagittal screening had been performed with routine cervical and lumbar spine MRI, respectively, in patients with cervical and lumbar spinal degenerative diseases. Coexisting spine lesions were documented and statistical analysis was performed to investigate significant differences according to sex, age, and initial diagnosis. Electronic medical records were reviewed to determine whether additional interventions were necessary following such findings. @*Results@#We reviewed 1,252 and 1,689 consecutive cases of routine cervical and lumbar spine MRI respectively, with whole spine T2 sagittal screening. Of the 1,252, 419 (33.5%) patients with cervical spinal degenerative disease had coexisting lesions in the thoracolumbar spine.Patients with ligament ossification disease of the cervical spine showed a higher prevalence of coexisting spine lesions. Sixty of the 419 (14.3%) patients with coexisting spine lesions warranted additional intervention or surgical treatment. Four hundred and eighty-one of 1,689 (28.5%) patients with lumbar degenerative disease had coexisting spine lesions in the cervicothoracic spine. Forty-eight of the 481 (10.0%) patients with coexisting spine lesions warranted additional intervention. In both patient groups, older patients showed a significantly higher prevalence of coexisting spine lesions than younger patients. @*Conclusion@#Considering the minimal extra time and cost in performing whole spine screening, its application to routine spine MRI can be considered in evaluating cervical and lumbar spinal degenerative diseases.

The Effect of Depression on the Use of Medical Service: Focusing on Patients with Chronic Physical Illness among Middle-Aged and Elderly Women / 보건행정학회지

Background@#Patients with the chronic physical illness are more likely to experience depression, and the accompany of chronic physical illness and depression is particularly high in middle-aged and elderly women. Considering that depression is associated with somatization and the decline of therapeutic compliance when accompanied by chronic physical illness, middle-aged and elderly women who experience depression among chronic physical illness may increase their use of medical services. This study is to identify the effect of depression on the use of medical services, especially among middle-aged and elderly women with chronic physical illness. @*Methods@#This study used the 2016 Korean Health Panel. For analysis, it used T-test, negative binomial regression, and multivariate regression combining propensity score matching. @*Results@#First, depressive groups had a higher number of medical service utilization and total medical expenditure than the non-depressive group. Second, depression significantly increased medical service utilization (β=0.17, p=0.04) at the 5% significance level. Also, depression significantly increased total medical expenditure (β=0.37, p=0.08) at the 10% significance level. @*Conclusion@#For those who have chronic physical illness among middle-aged and elderly women, the experience of depression was confirmed to be a factor affecting the use of medical services. In the end, it is important to come up with policy countermeasures for middle-aged and elderly women accompanied by depression and chronic physical illness.

Association between Osteoporotic Vertebral Compression Fractures and Age, Bone Mineral Density, and European Quality of Life-5 Dimensions in Korean Postmenopausal Women:A Nationwide Cross-sectional Observational Study

Background@#The purpose of this study was to investigate the characteristics of osteoporotic vertebral compression fractures (OVCFs) in Korean postmenopausal women and the association between OVCFs and clinical factors such as age, bone mineral density (BMD), and quality of life. @*Methods@#According to the population distribution in four regions in Korea, 1,281 postmenopausal female patients were recruited from nationwide orthopedic outpatient clinics. Radiologic, asymptomatic, and within 3 months of OVCF groups were analyzed based on age, fracture location, and prevalence according to BMD. In addition, BMD, T-score, body mass index, and European Quality of Life-5 Dimensions (EQ-5D) were investigated in the three groups, and the differences between groups were compared and analyzed. @*Results@#The prevalence of radiologic OVCFs at the T11–L1 was 3.7 times higher in the 70s group (44.0%) than in the 50s group (11.9%). Femur and total hip BMD were significantly lower in patients with thoracolumbar junction fractures than in patients with L2–5 fractures, whereas no difference was observed in lumbar spine BMD. Of the three OVCF groups, the within 3 months of OVCF group had the lowest lumbar spine T-score of –2.445. The asymptomatic OVCF group also showed significantly lower lumbar spine T-score than did the group without radiologic OVCFs (p < 0.001). The EQ-5D showed a significant decrease in the radiologic OVCF group (p < 0.001) and within 3 months of OVCF group (p < 0.001). @*Conclusions@#The prevalence of OVCFs in the thoracolumbar junction rapidly increases with old age and low BMD in Korean postmenopausal women. Femur and total hip BMD are more predictive of thoracolumbar junction fractures than lumbar spine BMD.Patients with radiologic OVCFs had a significantly lower quality of life than no OVCF group. Therefore, this study shows it is important to treat and prevent osteoporosis before an OVCF occurs.

Application of Deep Convolutional Neural Networks in the Diagnosis of Subcutaneous Masses Using Ultrasonography: A Pilot Study / 대한피부과학회지

Background@#Ultrasonography is an effective noninvasive imaging modality for the diagnosis of subcutaneous masses. To date, few studies have reported skin ultrasonography using deep convolutional neural networks (DCNNs).We investigated the accuracy of DCNNs for the diagnosis of epidermal cysts, lipomas, and other subcutaneous masses. @*Objective@#The purpose of this study was to evaluate whether DCNNs could diagnose subcutaneous masses with ultrasonographic images at level of competence comparable to dermatologists. @*Methods@#We created a dataset of 1,361 skin ultrasonography images obtained from 202 patients diagnosed with epidermal cysts, lipomas, and other subcutaneous masses, to train the DCNNs using ResNet18. Performance was compared with another set of 93 ultrasonographic images (24 epidermal cysts, 25 lipomas, and 44 other subcutaneous masses) from open-access articles. @*Results@#The DCNNs yielded 87.10% classification accuracy and 86.10% F1-scores. The area under the curve, sensitivity, and specificity were 0.92 (95% confidence interval [CI] 0.86∼0.98), 75.00%, and 98.55% for epidermal cysts; 0.93 (95% CI 0.88∼0.98), 80.00%, and 94.12% for lipomas; and 0.97 (95% CI 0.93∼1.00), 97.73%, and 85.71% for other subcutaneous masses, respectively. Analysis using gradient-weighted class activation mapping revealed that the DCNNs could detect specific ultrasonographic findings of epidermal cysts and lipomas. @*Conclusion@#We propose that DCNNs combined with ultrasonography may aid in the diagnosis of subcutaneous masses in outpatient settings.

The Analysis of Retinal Capillary Network Using Optic Coherence Tomographic Angiogrphy after Acute Angle Closure

Purpose@#We evaluated changes in the retinal capillary networks of patient’s acute primary angle closure (APAC) who were successfully treated and who lacked glaucomatous alterations. @*Methods@#Twenty patients for whom unilateral episodes of APAC were successfully treated were included in this retrospective cross-sectional study. At an average of 8 weeks after APAC, the thicknesses of the circumpapillary retinal nerve fiber layer (RNFL) and the ganglion cell-inner plexiform layer (GCIPL) were measured via spectral domain optical coherence tomography. Circumpapillary and macular vessel densities, perfusion density (PD), and the area and perimeter of the foveal avascular zone (FAZ) were measured with the aid of OCT angiography (OCTA). We compared the values between APAC eyes and the fellow eyes. @*Results@#We found no significant differences between groups in the thickness of any RNFL or GCIPL sector, or in the circumpapillary vessel or perfusion density. However, within a radius of 0.5 mm from the fovea (the center), the vessel and perfusion densities were significantly lower in affected than in fellow eyes (p = 0.003, p = 0.046 respectively). The vascular factors of other macular sectors, and the FAZ area and perimeter did not differ between the groups. @*Conclusions@#Early reductions in macular vessel and perfusion densities were evident after effective APAC treatment. Therefore, follow-up must evaluate whether the blood flow reduction causes structural damage.

Coexisting Spine Lesions on Whole Spine T2 Sagittal MRI in Evaluating Spinal Degenerative Disease

Background@#Studies have reported on the usefulness of whole spine magnetic resonance imaging (MRI) in evaluating specific diseases such as spinal tuberculosis, spinal trauma, spondyloarthropathies, and multiple myeloma. In studies concerning degenerative spinal disease, sample sizes were small and some did not provide information on how symptomatic coexisting lesions were treated. We evaluated the types and prevalence of coexisting spine lesions found on whole spine T2 sagittal screening performed at the time of routine cervical and lumbar spine MRI and evaluated the efficacy of such screening in degenerative diseases of the cervical and lumbar spine. @*Methods@#We reviewed 1,757 and 2,266 consecutive cases where whole spine T2 sagittal screening had been performed with routine cervical and lumbar spine MRI, respectively, in patients with cervical and lumbar spinal degenerative diseases. Coexisting spine lesions were documented and statistical analysis was performed to investigate significant differences according to sex, age, and initial diagnosis. Electronic medical records were reviewed to determine whether additional interventions were necessary following such findings. @*Results@#We reviewed 1,252 and 1,689 consecutive cases of routine cervical and lumbar spine MRI respectively, with whole spine T2 sagittal screening. Of the 1,252, 419 (33.5%) patients with cervical spinal degenerative disease had coexisting lesions in the thoracolumbar spine.Patients with ligament ossification disease of the cervical spine showed a higher prevalence of coexisting spine lesions. Sixty of the 419 (14.3%) patients with coexisting spine lesions warranted additional intervention or surgical treatment. Four hundred and eighty-one of 1,689 (28.5%) patients with lumbar degenerative disease had coexisting spine lesions in the cervicothoracic spine. Forty-eight of the 481 (10.0%) patients with coexisting spine lesions warranted additional intervention. In both patient groups, older patients showed a significantly higher prevalence of coexisting spine lesions than younger patients. @*Conclusion@#Considering the minimal extra time and cost in performing whole spine screening, its application to routine spine MRI can be considered in evaluating cervical and lumbar spinal degenerative diseases.

The Effect of Depression on the Use of Medical Service: Focusing on Patients with Chronic Physical Illness among Middle-Aged and Elderly Women / 보건행정학회지

Background@#Patients with the chronic physical illness are more likely to experience depression, and the accompany of chronic physical illness and depression is particularly high in middle-aged and elderly women. Considering that depression is associated with somatization and the decline of therapeutic compliance when accompanied by chronic physical illness, middle-aged and elderly women who experience depression among chronic physical illness may increase their use of medical services. This study is to identify the effect of depression on the use of medical services, especially among middle-aged and elderly women with chronic physical illness. @*Methods@#This study used the 2016 Korean Health Panel. For analysis, it used T-test, negative binomial regression, and multivariate regression combining propensity score matching. @*Results@#First, depressive groups had a higher number of medical service utilization and total medical expenditure than the non-depressive group. Second, depression significantly increased medical service utilization (β=0.17, p=0.04) at the 5% significance level. Also, depression significantly increased total medical expenditure (β=0.37, p=0.08) at the 10% significance level. @*Conclusion@#For those who have chronic physical illness among middle-aged and elderly women, the experience of depression was confirmed to be a factor affecting the use of medical services. In the end, it is important to come up with policy countermeasures for middle-aged and elderly women accompanied by depression and chronic physical illness.

Association between Osteoporotic Vertebral Compression Fractures and Age, Bone Mineral Density, and European Quality of Life-5 Dimensions in Korean Postmenopausal Women:A Nationwide Cross-sectional Observational Study

Background@#The purpose of this study was to investigate the characteristics of osteoporotic vertebral compression fractures (OVCFs) in Korean postmenopausal women and the association between OVCFs and clinical factors such as age, bone mineral density (BMD), and quality of life. @*Methods@#According to the population distribution in four regions in Korea, 1,281 postmenopausal female patients were recruited from nationwide orthopedic outpatient clinics. Radiologic, asymptomatic, and within 3 months of OVCF groups were analyzed based on age, fracture location, and prevalence according to BMD. In addition, BMD, T-score, body mass index, and European Quality of Life-5 Dimensions (EQ-5D) were investigated in the three groups, and the differences between groups were compared and analyzed. @*Results@#The prevalence of radiologic OVCFs at the T11–L1 was 3.7 times higher in the 70s group (44.0%) than in the 50s group (11.9%). Femur and total hip BMD were significantly lower in patients with thoracolumbar junction fractures than in patients with L2–5 fractures, whereas no difference was observed in lumbar spine BMD. Of the three OVCF groups, the within 3 months of OVCF group had the lowest lumbar spine T-score of –2.445. The asymptomatic OVCF group also showed significantly lower lumbar spine T-score than did the group without radiologic OVCFs (p < 0.001). The EQ-5D showed a significant decrease in the radiologic OVCF group (p < 0.001) and within 3 months of OVCF group (p < 0.001). @*Conclusions@#The prevalence of OVCFs in the thoracolumbar junction rapidly increases with old age and low BMD in Korean postmenopausal women. Femur and total hip BMD are more predictive of thoracolumbar junction fractures than lumbar spine BMD.Patients with radiologic OVCFs had a significantly lower quality of life than no OVCF group. Therefore, this study shows it is important to treat and prevent osteoporosis before an OVCF occurs.

The Effect of Adalimumab on Refractory Uveitis

Purpose@#To assess the efficacy and safety of Adalimumab (Humira®, AbbVie, Chicago, IL, USA) for repeated refractory uveitis during systemic steroid or immunosuppressive therapy. @*Methods@#We retrospectively reviewed clinical records on 30 eyes of 18 patients with non-infectious refractory uveitis who underwent Adalimumab injection therapy from December 2017 to July 2019. The therapeutic effect was assessed based on intraocular inflammation grade, central macular thickness, and best corrected visual acuity, and the efficacy was assessed based on control of inflammation and macular edema, as well as corticosteroid sparing effects. The safety was assessed based on adverse events. @*Results@#The mean duration of uveitis at baseline was 55.4 months (13-121 months) and the mean follow-up was 9.2 months (6-18 months). All 30 eyes of 18 patients stopped using systemic steroids and maintained clinical quiescence. Anterior chamber inflammation, vitreous inflammation, and best corrected visual acuity showed significant improvement, and there was no difference in central macular thickness. Uveitis recurred in 5 eyes, but 4 eyes showed controlled inflammation after single posterior sub-tenon steroid injection. One eye was controlled after methotrexate co-administration. Ulticaria (two patients) and injection- site reaction (one patient) were reported as adverse events. @*Conclusions@#Adalimumab is an effective treatment for decreasing inflammatory activity and reducing corticosteroid burden in refractory uveitis.

Macular Pigment Optical Density in the Korean Population: a Cross Sectional Study

50 years) showed lower MPOD than younger (30–49 years) subjects. But, in the healthy population, the estimated MPOD values exhibited a decreasing trend with age, but there were no significant differences according to age, after excluding patients with AMD. MPOD was significantly lower in patients with AMD than in aged healthy controls. Furthermore, hypertension, dyslipidemia, and smoking were identified as risk factors for AMD.CONCLUSION: MPOD measured with MPSII® reflects the MP density in healthy individuals and patients with dry AMD. Aging was not significantly associated with low MPOD in healthy population, but the presence of dry AMD was significantly associated with low MPOD. Then, low MPOD may be a risk factor for development of dry AMD. Furthermore, routine screening with MPS II® for ages 50 and older is thought to help detect early low MPOD and identify individuals who should take supplements.

Silicone Tube Intubation with Lacrimal Endoscopy and Endonasal Dacryocystorhinostomy in Adult Nasolacrimal Duct Obstruction

Purpose@#To compare the success rate of silicone tube intubation using a lacrimal endoscope with that of endonasal dacryocystorhinostomy in adult acquired nasolacrimal duct obstruction with no canalicular obstruction. @*Methods@#Retrospective cross-sectional study including 21 patients (31 eyes) treated with silicone tube intubation using lacrimal micro-endoscope and 29 patients (37 eyes) who underwent endonasal dacryocystorhinostomy. We examined lacrimal irrigation, probing, and fluorescein dye disappearance before surgery. A total of 3 months after surgery, the silicone tube was removed. The success rates were determined based on symptoms and the results of lacrimal irrigation. @*Results@#For silicone tube intubation in the lacrimal endoscopy group, success rates 3 and 6 months after surgery were 87.1% and 71.0%, respectively. In the endonasal dacryocystorhinostomy group, they were 91.9% and 81.1%, respectively. There was no significant difference in success rates 3 and 6 months after surgery (p = 0.517 and p = 0.327, respectively). However, a significantly higher success rate (81.8%) was observed in the endonasal dacryocystorhinostomy group compared with the silicone tube intubation using lacrimal micro-endoscope group (66.7%) at 6 months after surgery if the patient had total regurgitation upon preoperative examination of lacrimal irrigation (p = 0.028). @*Conclusions@#There was no significant difference in success rates between silicone tube intubation using lacrimal endoscope and endonasal dacryocystorhinostomy in adult acquired nasolacrimal duct obstruction with no canalicular obstruction, although there was a lower success rate in patients with total nasolacrimal duct obstruction. Silicone tube intubation using lacrimal endoscope may reduce the frequencies and complications of unnecessary invasive operations and general anesthesia.

Macular Pigment Optical Density in the Korean Population: a Cross Sectional Study

BACKGROUND@#To evaluate the macular pigment optical density (MPOD) with age in the Korean population using the Macular Pigment Screener II (MPSII®).@*METHODS@#One hundred and twenty-six eyes were retrospectively reviewed. MPOD was measured using MPSII®, which uses a heterochromatic flicker photometry method, and the estimated values were analyzed. Spearman's correlation test was used to evaluate correlations between MPOD and age. The association between MPOD and age was determined using a simple linear regression analysis. MPODs among the four groups were compared via the post hoc analysis with Bonferroni correction, MPODs between the age-related macular degeneration (AMD) group and aged-matched healthy subjects were compared via the Mann-Whitney U test. Other risk factors for AMD were identified via a logistic regression analysis.@*RESULTS@#Estimated MPOD decreased significantly with increasing age in the general population. In the simple regression analysis, a statistically significant linear regression model was observed, and the estimated values of MPOD decreased by −0.005 as age increased by 1 year. Aged (> 50 years) showed lower MPOD than younger (30–49 years) subjects. But, in the healthy population, the estimated MPOD values exhibited a decreasing trend with age, but there were no significant differences according to age, after excluding patients with AMD. MPOD was significantly lower in patients with AMD than in aged healthy controls. Furthermore, hypertension, dyslipidemia, and smoking were identified as risk factors for AMD.@*CONCLUSION@#MPOD measured with MPSII® reflects the MP density in healthy individuals and patients with dry AMD. Aging was not significantly associated with low MPOD in healthy population, but the presence of dry AMD was significantly associated with low MPOD. Then, low MPOD may be a risk factor for development of dry AMD. Furthermore, routine screening with MPS II® for ages 50 and older is thought to help detect early low MPOD and identify individuals who should take supplements.

Silicone Tube Intubation with Lacrimal Endoscopy and Endonasal Dacryocystorhinostomy in Adult Nasolacrimal Duct Obstruction

Purpose@#To compare the success rate of silicone tube intubation using a lacrimal endoscope with that of endonasal dacryocystorhinostomy in adult acquired nasolacrimal duct obstruction with no canalicular obstruction. @*Methods@#Retrospective cross-sectional study including 21 patients (31 eyes) treated with silicone tube intubation using lacrimal micro-endoscope and 29 patients (37 eyes) who underwent endonasal dacryocystorhinostomy. We examined lacrimal irrigation, probing, and fluorescein dye disappearance before surgery. A total of 3 months after surgery, the silicone tube was removed. The success rates were determined based on symptoms and the results of lacrimal irrigation. @*Results@#For silicone tube intubation in the lacrimal endoscopy group, success rates 3 and 6 months after surgery were 87.1% and 71.0%, respectively. In the endonasal dacryocystorhinostomy group, they were 91.9% and 81.1%, respectively. There was no significant difference in success rates 3 and 6 months after surgery (p = 0.517 and p = 0.327, respectively). However, a significantly higher success rate (81.8%) was observed in the endonasal dacryocystorhinostomy group compared with the silicone tube intubation using lacrimal micro-endoscope group (66.7%) at 6 months after surgery if the patient had total regurgitation upon preoperative examination of lacrimal irrigation (p = 0.028). @*Conclusions@#There was no significant difference in success rates between silicone tube intubation using lacrimal endoscope and endonasal dacryocystorhinostomy in adult acquired nasolacrimal duct obstruction with no canalicular obstruction, although there was a lower success rate in patients with total nasolacrimal duct obstruction. Silicone tube intubation using lacrimal endoscope may reduce the frequencies and complications of unnecessary invasive operations and general anesthesia.