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Purpose@#To obtain an overview of the surgical practices for the management of intermittent exotropia among experienced surgeons. @*Methods@#We conducted a survey of members of the Korean Association for Pediatric Ophthalmology and Strabismus, who had experience of > 15 years in strabismus surgery, via e-mail. Surgical methods for basic-type intermittent exotropia, angle of deviation for determining the surgical dose, reasons for surgical dose adjustment, and the postoperative target angle of deviation were analyzed. @*Results@#Bilateral lateral rectus recession was preferred over unilateral recession and resection for basic-type intermittent exotropia with or without a dominant eye. The preoperative maximum angle of deviation was preferred for determining the surgical dose by 56% of the participants. Two-thirds of the participants preferred to reduce the surgical dose in specific circumstances, lateral incomitancy being the most common reason. In case of true divergence excess-type intermittent exotropia, 47.7% of the participants reduced the surgical dose. The most preferred target angle of deviation at 1 day postoperatively was 11-15 prism diopter esodeviation, as reported by 40% of the participants. @*Conclusions@#Although experienced surgeons had different surgical preferences for intermittent exotropia, a general trend was found. This survey may be a useful reference for beginners in strabismus surgery.
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Purpose@#To assess the diagnostic performances of diffusion-weighted imaging (DWI)-included non-contrast magnetic resonance imaging (MRI) compared to standard contrastenhanced MRI for infectious spondylitis. @*Materials and Methods@#This study involved 154 participants: a spondylitis group (n = 76) and a control group (n = 78) with Modic type 1 degeneration or recent compression fractures. Two readers independently reviewed paraspinal soft tissue signal change and abscess with 5-scale confidence scores based on two image sets: one featuring both non-contrast-enhanced MRI (NCEI) and DWI and the other consisting of NCEI and contrast-enhanced fat-suppressed T1-weighted imaging (CEFST1). The diagnostic performance of the two image sets was compared using McNemar tests for sensitivity, specificity, and area under the receiver operating characteristics (AUROC) analysis. Interobserver agreements (κ) for each images sets were also calculated. @*Results@#The sensitivity and specificity for infectious spondylitis were 90.8% and 69.2% for NCEI + DWI, 96.1% and 60.3% for NCEI + CEFST1 in reader 1, whereas it was 92.1% and 66.7% for NCEI + DWI, and 96.1% and 68.0% for NCEI + CEFST1 in reader 2. Sensitivities and specificities were not significantly different between NCEI + DWI and NCEI + CEFST1 (reader 1: p = 0.289, 0.065; reader 2: p = 0.250, > 0.999, respectively). However, the AUROC was not considerably different between the two modalities in only one reader (p = 0.306 in reader 1, p = 0.031 in reader 2). Interobserver agreement for infectious spondylitis was moderate (κ = 0.55) in NCEI + DWI and substantial (κ = 0.66) in NCEI + CEFST1. @*Conclusion@#Non-contrast enhanced MRI with additional DWI is as effective for diagnosing infectious spondylitis as a contrast-enhanced MRI.
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Evidence of the ethical appropriateness and clinical benefits of shared decision-making (SDM) are accumulating. This study aimed to not only identify physicians’ perspectives on SDM, and practices related to end-of-life care in particular, but also to gauge the effect of SDM education on physicians in Korea. Methods: A 14-item questionnaire survey using a modified Delphi process was delivered to nephrologists and internal medicine trainees at 17 university hospitals. Results: A total of 309 physicians completed the survey. Although respondents reported that 69.9% of their practical decisions were made using SDM, 59.9% reported that it is not being applied appropriately. Only 12.3% of respondents had received education on SDM as part of their training. The main obstacles to appropriate SDM were identified as lack of time (46.0%), educational materials and tools (29.4%), and education on SDM (24.3%). Although only a few respondents had received training on SDM, the proportion of those who thought they were using SDM appropriately in actual practice was high; the proportion of those who chose lack of time and education as factors that hindered the proper application of SDM was low. Conclusion: The majority of respondents believed that SDM was not being implemented properly in Korea, despite its use in actual practice. To improve the effectiveness of SDM in the Korean medical system, appropriate training programs and supplemental policies that guarantee sufficient application time are required.
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Background@#The purpose of this study was to investigate the effects of dental hygiene students’ communication ability and conflict management types on adaptation to college life improve adaptation to college life and to suggest strategies to play a role as a professional dental hygienist in clinical practice. @*Methods@#The subjects of this study were selected by random sample extraction of dental hygiene students from two colleges in Gyeonggi and one Chungcheong area. The survey was conducted online for dental hygiene students from July 20 to October 31, 2020. In order to comply with research ethics, this study was investigated with the consent of the subjects. The sample was analyzed for the final 351. @*Results@#Dental hygiene students’ communication ability was 3.74 points, conflict management types was 3.01 points, and adaptation to college life was 3.30 points. In the type of conflict management according to the general characteristics, the problem-solving method, the avoidance method, the compromise method, and the concession method showed statistically significant differences in major satisfaction. Among the types of conflict management, the highest positive correlation (r=0.613) was shown in the relationship between the problem-solving method and the compromise method. Factors influencing the adaptation to college life were concentration, forced method, self-disclosure, conversational coherence, and social relaxation. @*Conclusion@#This study is significant in that it derives sub-areas of communication ability and conflict management types that influence adaptation to college life. In the future, there is a need to improve the quality of dental hygienists by continuously conducting research on the types of conflict management targeting dental hygienists, and responding more proactively and actively to conflict situations in the clinical field.
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Background@#The purpose of this study is to identify the gender sensitivity and gender role stereotypes of students in dental hygiene and to provide basic data to expand social awareness of equal gender sensitivity and gender role in dental hygiene and students by identifying the degree of correlation. @*Methods@#The purpose of this study was to study dental hygiene students at colleges in Gyeonggi and Chungcheong areas. The survey was conducted from April 1 to April 30, 2021. The final sample was analyzed on 157 subjects. T-test and ANOVA analysis were performed to compare gender sensitivity and gender role stereotypes according to general characteristics. Equal variances were tested using the Levene statistic, and significant differences between groups were identified through Scheffe’s post hoc analysis. Pearson’s correlation analysis was performed to confirm the correlation between gender sensitivity and gender role stereotypes. @*Results@#Gender sensitivity was 2.69 and gender role stereotypes were 1.83. Among the sub-areas of gender sensitivity, gender role openness was the highest at 2.86, and non-violence was the lowest at 2.50. As for gender role stereotypes, social stereotypes were the highest among sub-areas at 1.71. Among the general characteristics, there was a statistically significant difference in gender sensitivity according to the presence or absence of opposite sex friends (p=0.011). The gender identity openness of gender sensitivity and the physical sub-areas of gender role stereotypes showed the highest positive correlation(r=0.955). Among the sub-areas of gender sensitivity, gender role openness and domestic stereotypes showed the lowest negative correlation (r=−0.404) among the sub-areas of gender role stereotypes. @*Conclusion@#Dental hygiene students should be able to critically analyze and solve problems of not only sexual violence but also gender discrimination and imbalance in social life. For this, environmental factors such as school education and professor guidance must be strengthened.
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Purpose@#To describe a patient with posterior ischemic optic neuropathy (PION) after cervical spine surgery who recovered after treatment.Case summary: A 51-year-old woman presented with eye pain and decreased visual acuity in the left eye, which had begun 8 hours after cervical spine surgery in the prone position. Her best-corrected visual acuity (BCVA) was 20/20 in the right eye and hand motion in the left eye; a relative afferent pupillary defect was present in the left eye. Ductions and versions were normal with pain in the left eye. The results of slit lamp examination, fundoscopic examination, fluorescein angiography, and optical coherence tomography were unremarkable in both eyes. Brain and orbital magnetic resonance imaging showed no abnormal findings in the visual pathway, such as brain infarction or intracranial artery stenosis. The patient was diagnosed with PION in the left eye. Because postoperative anemia had developed with a rapid decrease in hemoglobin from 14.7 g/dL to 9.9 g/dL, red blood cell (RBC) transfusion was performed together with intravenous high-dose steroid therapy and subcutaneous epoetin alfa injection. After 3 weeks, the patient’s BCVA improved to 20/22 in the left eye. @*Conclusions@#Unilateral PION developed after cervical spine surgery in the prone position. Visual improvement was observed after RBC transfusion, intravenous high-steroid therapy, and subcutaneous epoetin alfa injection.
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Intussusception and acute appendicitis are common emergency conditions in children. They should be promptly differentiated in pediatric patients presenting with suggestive symptoms.However, both diseases may occur simultaneously. Herein, we present two cases of intussusception of the appendix accompanied with appendicitis.
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Purpose@#To report a rare case of optic perineuritis as the presenting sign of sarcoidosis. Case summary: A 57-year-old man presented with decreased visual acuity and pain with extraocular movement in his left eye starting 2 weeks earlier. He had a history of asymptomatic optic perineuritis in that eye 18 months previously, which had improved after 1 month on oral prednisolone. His best corrected visual acuity had decreased to 20/50 and he also had relative afferent pupillary defect and color vision defects in the left eye. Slit lamp examination results were normal. There were no inflammatory reactions in the anterior chamber or vitreous. Fundoscopy showed optic disc edema. Orbital magnetic resonance imaging showed diffuse enhancement surrounding the left optic nerve. The serum levels of eosinophil cationic protein and angiotensin- converting enzyme were markedly increased. A chest radiograph showed bilateral hilar lymph node enlargement. A biopsy via endobronchial ultrasound-guided transbronchial needle aspiration revealed multifocal non-caseating granulomas. Acid fast bacilli stain showed no evidence of tuberculosis. Based on these findings, he was diagnosed with sarcoidosis. After treatment with high-dose intravenous methylprednisolone and subsequent tapering with oral prednisolone for 6 months, the visual acuity improved. @*Conclusions@#Optic perineuritis can be the initial sign of sarcoidosis. Therefore, sarcoidosis should be considered in the differential diagnosis of optic perineuritis.
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Purpose@#This study examined whether there are seasonal variations in the number of plantar fasciitis cases from the database of the Korean Health Insurance Review & Assessment Service and an internet search of the volume data related to plantar fasciitis and whether there are correlations between variations. @*Materials and Methods@#The number of plantar fasciitis cases per month was acquired from the Korean Health Insurance Review & Assessment Service from January 2016 to December 2019. The monthly internet relative search volumes for the keywords ‘‘plantar fasciitis” and ‘‘heel pain” were collected during the same period from DataLab, an internet search query trend service provided by the Korean portal website, Naver. Cosinor analysis was performed to confirm the seasonality of the monthly number of cases and relative search volumes, and Pearson and Spearman correlation analysis was conducted to assess the correlation between them. @*Results@#The number of cases with plantar fasciitis and the relative search volume for the keywords “plantar fasciitis” and “heel pain” all showed significant seasonality (p<0.001), with the highest in the summer and the lowest in the winter. The number of cases with plantar fasciitis was correlated significantly with the relative search volumes of the keywords “plantar fasciitis” (r=0.632; p<0.001) and “heel pain” (r=0.791; p<0.001), respectively. @*Conclusion@#Both the number of cases with plantar fasciitis and the internet search data for related keywords showed seasonality, which was the highest in summer. The number of cases showed a significant correlation with the internet search data for the seasonality of plantar fasciitis. Internet big data could be a complementary resource for researching and monitoring plantar fasciitis.
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Purpose@#The purpose of our study was to identify the bleeding risk factors and to validate the safety of shortening the bed rest time after bone marrow examination in pediatric hemato-oncologic patients. @*Methods@#From July 2019 to September 2020, 145 patients were enrolled from a single center. Medical records were reviewed retrospectively. Descriptive statistics were presented, and the data were analyzed using x2 -test, Fisher’s exact test, and a logistic regression. @*Results@#After two hours of bed rest, most of the patients (91.7%) did not have bleeding complications, and only 8.3% of the patients had a minor bleeding. The rate of major bleeding complications, including hematoma, retroperitoneal hemorrhage rate was zero. The bleeding complications was frequently found on bilateral procedures than unilateral procedures and the difference were statistically significant (p<.05). @*Conclusion@#Two hours of bed rest time after bone marrow examination could be safe and adequate in pediatric hemato-oncologic patients.
ABSTRACT
Intussusception and acute appendicitis are common emergency conditions in children. They should be promptly differentiated in pediatric patients presenting with suggestive symptoms.However, both diseases may occur simultaneously. Herein, we present two cases of intussusception of the appendix accompanied with appendicitis.
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Purpose@#To report a rare case of optic perineuritis as the presenting sign of sarcoidosis. Case summary: A 57-year-old man presented with decreased visual acuity and pain with extraocular movement in his left eye starting 2 weeks earlier. He had a history of asymptomatic optic perineuritis in that eye 18 months previously, which had improved after 1 month on oral prednisolone. His best corrected visual acuity had decreased to 20/50 and he also had relative afferent pupillary defect and color vision defects in the left eye. Slit lamp examination results were normal. There were no inflammatory reactions in the anterior chamber or vitreous. Fundoscopy showed optic disc edema. Orbital magnetic resonance imaging showed diffuse enhancement surrounding the left optic nerve. The serum levels of eosinophil cationic protein and angiotensin- converting enzyme were markedly increased. A chest radiograph showed bilateral hilar lymph node enlargement. A biopsy via endobronchial ultrasound-guided transbronchial needle aspiration revealed multifocal non-caseating granulomas. Acid fast bacilli stain showed no evidence of tuberculosis. Based on these findings, he was diagnosed with sarcoidosis. After treatment with high-dose intravenous methylprednisolone and subsequent tapering with oral prednisolone for 6 months, the visual acuity improved. @*Conclusions@#Optic perineuritis can be the initial sign of sarcoidosis. Therefore, sarcoidosis should be considered in the differential diagnosis of optic perineuritis.
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Purpose@#This study examined whether there are seasonal variations in the number of plantar fasciitis cases from the database of the Korean Health Insurance Review & Assessment Service and an internet search of the volume data related to plantar fasciitis and whether there are correlations between variations. @*Materials and Methods@#The number of plantar fasciitis cases per month was acquired from the Korean Health Insurance Review & Assessment Service from January 2016 to December 2019. The monthly internet relative search volumes for the keywords ‘‘plantar fasciitis” and ‘‘heel pain” were collected during the same period from DataLab, an internet search query trend service provided by the Korean portal website, Naver. Cosinor analysis was performed to confirm the seasonality of the monthly number of cases and relative search volumes, and Pearson and Spearman correlation analysis was conducted to assess the correlation between them. @*Results@#The number of cases with plantar fasciitis and the relative search volume for the keywords “plantar fasciitis” and “heel pain” all showed significant seasonality (p<0.001), with the highest in the summer and the lowest in the winter. The number of cases with plantar fasciitis was correlated significantly with the relative search volumes of the keywords “plantar fasciitis” (r=0.632; p<0.001) and “heel pain” (r=0.791; p<0.001), respectively. @*Conclusion@#Both the number of cases with plantar fasciitis and the internet search data for related keywords showed seasonality, which was the highest in summer. The number of cases showed a significant correlation with the internet search data for the seasonality of plantar fasciitis. Internet big data could be a complementary resource for researching and monitoring plantar fasciitis.
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Purpose@#The purpose of our study was to identify the bleeding risk factors and to validate the safety of shortening the bed rest time after bone marrow examination in pediatric hemato-oncologic patients. @*Methods@#From July 2019 to September 2020, 145 patients were enrolled from a single center. Medical records were reviewed retrospectively. Descriptive statistics were presented, and the data were analyzed using x2 -test, Fisher’s exact test, and a logistic regression. @*Results@#After two hours of bed rest, most of the patients (91.7%) did not have bleeding complications, and only 8.3% of the patients had a minor bleeding. The rate of major bleeding complications, including hematoma, retroperitoneal hemorrhage rate was zero. The bleeding complications was frequently found on bilateral procedures than unilateral procedures and the difference were statistically significant (p<.05). @*Conclusion@#Two hours of bed rest time after bone marrow examination could be safe and adequate in pediatric hemato-oncologic patients.
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Lymphomatoid granulomatosis (LG) is a rare B-cell type angiocentric lymphoproliferative disease that can progress to extranodal lymphoma with high mortality. It most commonly affects the lungs, although extrapulmonary systems, including the brain and skin, can also be involved. LG in pediatric patients has been very rarely reported in the literature with limited imaging features. Herein, we report a pediatric case of LG involving the lung and brain with characteristic imaging findings.
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Purpose@#We evaluated the normative range of visual field ratio according to distance in the near tangent screen test performed in adults. @*Methods@#Adults above 18 years of age were prospectively recruited and underwent the near tangent screen test between February and August 2020. We developed a near tangent screen testing device, which was used at 10 and 20 cm distances from the screen. The tangent ratios (TRs), defined as the ratio of the visual field at the further distance to that at the closer distance, were analyzed according to the eight meridians, and the normative value of the TR in adults was deduced. @*Results@#The experiment was performed for 80 eyes of 40 adults. Their average age was 30.9 ± 7.0 years (range, 21-48). The mean TRs were 0.95 ± 0.10 and 0.97 ± 0.10 for the right and left eyes, respectively, so the visual field in either eye did not differ significantly according to distance. The average TR value for the eight meridians was 0.96 ± 0.10 (range, 0.73-1.23), and the TR did not show any significant difference among the eight meridians. The far and near visual fields did not intersect or overlap in any meridian, showing a TR value larger than 0.5. @*Conclusions@#Under the near tangent screen test, the visual fields in normal adults did not differ according to the test distance.
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Central diabetes insipidus (CDI) is extremely rare in neonates, especially in extremely-low-birth-weight infants, and most cases are secondary to conditions, such as ischemic or hemorrhagic brain damage. Here, we report a case of CDI in a 530-g infant born at 23+3 weeks of gestation, with suspected ectopic posterior pituitary gland. Hypernatremia was noticed at 33+6 weeks of postmenstrual age, and it persisted with in creased volumes of diluted urine, despite adequate sodium intake. Serum and urine osmolality returned to the normal range after administration of a desmopressin injection. The bright spot of the posterior pituitary was absent, and brain magnetic resonance imaging suggested an ectopic posterior pituitary gland. At the time of writing this manuscript, the patient was on oral desmopressin medication without complications at the corrected age of 8 months. Through this report, we emphasize that although CDI is extremely rare in premature infants, it should be suspected when hypernatremia and polyuria that are unexplained by other causes are noted.
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Background@#Maintaining a skilled workforce by minimizing the turnover of competent dental hygienists is very important for securing dental competitiveness. Therefore, it is necessary to find a predictor of turnover and lower turnover intention. To understand dental hygienist turnover, it is necessary to study the resilience, a positive factor of personal characteristics and job embeddedness that induces residual tissue. The purpose of this study was to investigate the effect of dental hygienists’ job embeddedness and resilience on turnover intention. @*Methods@#A survey was conducted on licensed dental hygienists nationwide, from March 19 to July 19, 2020. T-test and one way ANOVA analysis were performed to compare the job embeddedness, resilience, and turnover intention according to the general characteristics. Pearson’s correlation analysis was performed to identify the correlation between job embeddedness, resilience, and turnover intention. Multiple regression analysis was performed to determine the effect on the turnover intention. @*Results@#Job embeddedness was the highest with link and resilience scoring 3.57 and 4.16, respectively. The turnover intention scored 3.53. Among the general characteristics, age, marriage, total dental clinic career, education degree, and position showed statistically significant differences in job embeddedness, resilience, and turnover intention. Suitability, link, and sacrifice of job embeddedness were shown to affect the degree of turnover intention, with an explanatory power of 26.2%. @*Conclusion@#In order to reduce the dental hygienists’ turnover intention, job embeddedness and resilience should be increased.Thus, measures should be undertaken for professional and systematic program development and human resources management.
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Purpose@#To investigate the effects of watching ultra-high-definition television (UHD TV) on subjective ocular fatigue and objective ocular surface indices. @*Methods@#A total of 76 volunteers were recruited for this study. Subjects watched UHD TV for 10 minutes at a viewing distance of 110 cm. Best-corrected visual acuity, refractive errors, tear break-up time, corneal staining grading, conjunctival redness grading by slit-lamp examination, tear meniscus measurement by anterior segment optical coherence tomography, and ocular symptom scores were obtained before and immediately after watching UHD TV. Subgroup analyses were conducted according to participant age (old age group >50 years vs. young age group ≤50 years) and dry-eye syndrome (presence vs.absence). The relationship between subjective and objective indices was evaluated. @*Results@#The mean age of subjects was 39.6 ± 12.4 years. Watching UHD TV induced a decrease in tear break-up time in the non-dry-eye group (p < 0.001) but not in the dry-eye group (p= 0.726). Corneal staining grades increased in all subgroups, and the changes were particularly larger in the older group (p = 0.038). The increase in ocular symptom scores was larger in the dry-eye group (p = 0.08) and in the older group (p = 0.016). The decrease in tear break-up time and ocular symptom scores after watching UHD TV was significantly correlated with tear break-up time. @*Conclusions@#Tear break-up time significantly decreased in non-dry-eye subjects after watching UHD TV. Subjective ocular discomfort increased significantly in subjects over the age of 50 and in participants with dry-eye syndrome.
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Background@#and Purpose: The findings of ophthalmic examinations have not been systematically investigated in visual snow syndrome. This study reviewed the abnormal neuroophthalmologic findings in a patient cohort with symptoms of visual snow syndrome. @*Methods@#We retrospectively reviewed 28 patients who were referred for symptoms of visual snow to a tertiary referral hospital from November 2016 to October 2019. We defined the findings of best corrected visual acuity (BCVA), visual field testing, pupillary light reflex, contrast sensitivity, full-field and multifocal electroretinography, and optical coherence tomography. @*Results@#Twenty patients (71%) were finally diagnosed as visual snow syndrome. Their additional visual symptoms included illusionary palinopsia (61%), enhanced entoptic phenomenon (65%), disturbance of night vision (44%), and photophobia (65%). A history of migraine was identified in ten patients (50%). The mean BCVA was less than 0.1 logarithm of the minimum angle of resolution, and electrophysiology showed normal retinal function in all patients. Contrast sensitivity was decreased in two of the seven patients tested. Medical treatment was applied to five patients which all turned out to be ineffective. Among the eight patients who were excluded, one was diagnosed with rod-cone dystrophy and another with idiopathic intracranial hypertension. @*Conclusions@#Neuro-ophthalmologic findings are mostly normal in patients with visual snow syndrome. Retinal or neurological diseases must be excluded as possible causes of visual snow.