ABSTRACT
Purpose@#We aimed to identify factors influencing smoking cessation success among cancer patients registered in an inpatient smoking cessation program at a single cancer center. @*Materials and Methods@#The electronic medical records of enrolled patients with solid cancer were retrospectively reviewed. We evaluated factors associated with 6-month smoking cessation. @*Results@#A total of 458 patients with cancer were included in this study. Their mean age was 62.9±10.3 years, and 56.3% of the participants had lung cancer. 193 (42.1%) had not yet begun their main treatment. The mean number of counseling sessions for the participants was 8.4±3.5, and 46 (10.0%) patients were prescribed smoking cessation medications. The 6-month smoking cessation success rate was 48.0%. Multivariate analysis showed that younger age (<65 years), cohabited status, early stage, and the number of counseling sessions were statistically significant factors affecting 6-month smoking cessation success (p<0.05). Initiation of a cessation program before cancer treatment was significantly associated with cessation success (odds ratio, 1.66; 95% confidence interval, 1.02–2.70; p=0.040). @*Conclusion@#Smoking cessation intervention must be considered when establishing a treatment plan immediately after a cancer diagnosis among smokers.
ABSTRACT
Purpose@#Infants in the neonatal intensive care unit (NICU) often show cardiorespiratory deterioration during gavage feeding. We aimed to determine whether slow infusion intermittent feeding (SIIF) can reduce respiratory deterioration during gavage feeding in preterm infants in the NICU. @*Methods@#Data on preterm infants whose gavage feeding method was changed to SIIF (1-hour infusion with an infusion pump and 2-hour rest within a 3-hour interval) from bolus gravity feeding (2- or 3-hour interval) due to feeding-associated cardiorespiratory deterioration were retrospectively reviewed. A significant cardiorespiratory event was defined as a saturation level below 80% or heart rate below 80 bpm. We compared the frequency of cardiorespiratory events and the level of respiratory support 24 hours before and after the application of SIIF. @*Results@#A total of 34 infants were enrolled and analyzed. The total frequency of desaturation or bradycardia significantly decreased after SIIF application (8.94 vs. 5.03, P=0.001). The frequency of feeding-related bradycardia and desaturation also significantly decreased (4.15 vs. 1.68, P=0.008). Out of 34 patients, 11 (32.4%) had a decreased level of ventilator support within 1 day after SIIF. The respiratory severity scores of the 10 patients who received invasive ventilator support decreased significantly after SIIF (5.24 vs. 4.59, P=0.032). @*Conclusion@#SIIF significantly decreased gavage feeding-associated cardiorespiratory events and reduced respiratory support in approximately one-third of subjects. Therefore, SIIF may be a therapeutic option for gavage feed-associated respiratory deterioration in preterm infants in the NICU.
ABSTRACT
Purpose@#We compared the clinical utilities of an amniotic contact lens and temporary amniotic membrane transplantation in patients with persistent corneal epithelial defects. @*Methods@#Patients diagnosed with persistent corneal epithelial defects from November 2019 to July 2022 were randomly assigned to either lens placement for 2 weeks or temporary transplantation for 1 week, and the outcomes were retrospectively analyzed. The best-corrected visual acuity, corneal sensation, tear film break-up time, and corneal opacity were measured before and after the interventions. The treatment success rates, recurrences, and other complications were analyzed during the follow-up period. @*Results@#We placed lenses in 32 patients (32 eyes) and 20 patients (20 eyes) underwent transplantation. In both groups, significant differences in best-corrected visual acuity, corneal sensation, tear film break-up time, and corneal opacity were apparent after intervention vs. before. None of the parameters showed any significant differences in terms of their rates of change. @*Conclusions@#In patients with persistent corneal epithelial defects, amniotic contact lens placement is an effective outpatient procedure and is not inferior to temporary amniotic membrane transplantation.
ABSTRACT
Objectives@#. Endoscopic tympanoplasty (ET) provides minimally invasive transcanal access to the middle ear and improves middle ear visibility for the treatment of tympanic membrane (TM) perforations. However, the literature on surgical outcomes for large TM perforations is lacking and limited to small series. This study aimed to evaluate the clinical benefits of ET for large TM perforations. @*Methods@#. This retrospective cohort study was conducted at nine tertiary referral hospitals in South Korea, where 252 patients who underwent ET as primary surgery from September 2019 to August 2021 were included. The outcome measures included the graft success rate and pre- and postoperative audiometric data. @*Results@#. In 239 patients, the graft success rate of ET for large or subtotal perforations was 86.2% (206 patients), while the graft failure rate was 13.8% (33 patients). The graft failure rate was directly correlated with surgical techniques, including overlay and medial or lateral underlay tympanoplasty (P=0.027). Lateral underlay tympanoplasty showed the most favorable results. Sex, laterality, etiology, site and size of perforation, operation time, and graft materials did not vary significantly between the graft success and failure groups (P>0.05). The mean air-bone gap (ABG) improved significantly in both groups (graft success group: 10.0±0.6 dB and graft failure group: 7.7±0.3 dB; P<0.001). However, the ABG improvement did not significantly differ between the groups. Analysis of covariance revealed that the postoperative 500-Hz bone conduction threshold improved after successful ET (adjusted coefficient, –11.351; 95% confidence interval, –21.491 to –1.212; P=0.028). @*Conclusion@#. This study involved the largest population to date of large TM perforations treated by ET. The study findings suggest that ET is feasible and effective in treating large TM perforations.
ABSTRACT
Background/Aims@#Although rituximab, an antiCD20 monoclonal antibody, has dramatically improved the clinical outcomes of diffuse large B-cell lymphoma, rituximab resistance remains a challenge. @*Methods@#We developed a rituximab-resistant cell line (RRCL) by sequential exposure to gradually increasing concentrations of rituximab in a rituximab-sensitive cell line (RSCL). When the same dose of rituximab was administered, RRCL showed a smaller decrease in cell viability and apoptosis than RSCL. To determine the differences in gene expression between RSCL and RRCL, we performed next-generation sequencing. @*Results@#In total, 1,879 differentially expressed genes were identified, and in the over-representation analysis of Consensus-PathDB, mitogen-activated protein kinase (MAPK) signaling pathway showed statistical significance. MAPK13, which encodes the p38δ protein, was expressed more than four-fold in RRCL. Western blot analysis revealed that phosphop38 expression mainwas increased in RRCL, and when p38 inhibitor was administered, phosphop38 expression was significantly decreased. Therefore, we hypothesized that p38 MAPK activation was associated with rituximab resistance. Previous studies have suggested that p38 is associated with NF-κB activation. Deferasirox has been reported to inhibit NF-κB activity and suppress phosphorylation of the MAPK pathway. Furthermore, it also has cytotoxic effects on various cancers and synergistic effects in overcoming drug resistance. In this study, we confirmed that deferasirox induced dose-dependent cytotoxicity in both RSCL and RRCL, and the combination of deferasirox and rituximab showed a synergistic effect in RRCL at all combination concentrations. @*Conclusions@#We suggest that p38 MAPK, especially p38δ, activation is associated with rituximab resistance, and deferasirox may be a candidate to overcome rituximab resistance.
ABSTRACT
Periodic limb movement disorder (PLMD) is a sleep-related movement disorder characterized by involuntary, rhythmic limb movements during sleep. While PLMD itself is not considered life-threatening, its association with certain underlying health conditions raises concerns about mortality risks. PLMD has been found to be associated with cardiovascular diseases such as hypertension and cardiovascular disease. The fragmented sleep caused by the repetitive limb movements and associated arousals may contribute to sympathetic activation, chronic sleep disruption, sleep deprivation, and subsequent cardiovascular problems, which can increase mortality risks. The comorbidities and health factors commonly associated with PLMD, such as obesity, diabetes, and chronic kidney disease, may also contribute to increased mortality risks. PLMD is often observed alongside other neurological disorders, including restless legs syndrome (RLS) and Parkinson's disease. The presence of PLMD in these conditions may exacerbate the underlying health issues and potentially contribute to higher mortality rates. Further research is needed to elucidate the specific mechanisms linking PLMD to mortality risks and to develop targeted interventions that address these risks.
ABSTRACT
Objective@#The suicide rate in Korea was the highest among countries in the Organisation for Economic Co-operation and Development in 2019. In a previous study, higher intake of vegetables and fruits was associated with a lower risk of suicidal ideation, and carotene-rich fruits and vegetables lowered the risk of depression. This study aimed to examine the direct relationship between carotene intake and suicidal ideation, adjusting for the effect on depression. @*Methods@#This study used data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted in 2012, 2013, and 2015. Carotene intake was assessed through a food intake frequency survey with a 24-hour recall. Suicidal ideation and depression were assessed using the mental health section of the KNHANES. We applied logistic regression to assess the relationship between carotene intake and suicidal ideation, adjusting for potential confounders. @*Results@#A total of 5,480 females aged 19–64 years were included in this study. Carotene intake was significantly lower in the suicidal ideation group (3,034.5±1,756.4 μg/day) than in the nonsuicidal ideation group (3,225.4±1,795.1 μg/day) (p=0.015). We found a significant inverse association between carotene intake and the risk of suicidal ideation after adjusting for potential confounders (odds ratio=0.934, 95% confidence interval=0.873–0.999). @*Conclusion@#These results suggest that carotene intake may be inversely associated with the risk of suicidal ideation. Our findings may inform the development of new nutritional interventions to prevent increases in the risk of suicide worldwide.
ABSTRACT
Objective@#This study aimed to identify the factors affecting posttraumatic stress disorder (PTSD) symptom remission prospectively through a 1-year follow-up of sexual assault (SA) victims. @*Methods@#A total 65 female SA victims who visited the crisis intervention center were included. Self-administered questionnaires regarding PTSD symptoms and PTSD related prognostic factors were conducted at both recruitment (T1) and 1 year after recruitment (T2). The multivariate analyses were used to determine the significant predictors of PTSD remissionon-remission state 1 year after SA. @*Results@#In logistic regression analysis, both anxiety and secondary victimization were identified as significant factors explaining the results on PTSD remissionon-remission state at T2 (Beck’s Anxiety Inventory [BAI], p=0.003; Secondary Victimization Questionnaire, p=0.024). In a linear mixed analysis, both depression and anxiety were found to be significant variables leading to changes in Posttraumatic Diagnostic Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition from T1 to T2 (BAI, p<0.001; Center for Epidemiological Studies Depression Scale, p<0.001). @*Conclusion@#Depression, anxiety symptoms, and secondary victimization after SA were associated with PTSD symptom non-remission 1 year after SA.
ABSTRACT
A case of persistent Ralstonia mannitolilytica bacteremia in the neonatal intensive care unit prompted source investigation due to its rarity. After an extensive investigation, a contaminated ultrasonic nebulizer was identified as the source, and the infection was controlled by removing the source. This study emphasizes the importance of further investigations, even in single cases of rare pathogens.
ABSTRACT
Purpose@#The ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) is considered a predictive marker of preeclampsia. However, the relationship between the sFlt-1/PlGF ratio and perinatal and neonatal outcomes remains unknown. This study aimed to determine the associations of the sFlt-1/PlGF ratio with perinatal and neonatal outcomes in newborns born to mothers with preeclampsia. @*Methods@#This retrospective cohort study reviewed singleton neonates born to mothers with preeclampsia who underwent testing for the sFlt-1/PlGF ratio. We investigated the relationship between maternal sFlt-1/PlGF ratios and gestational age (GA), birth weight (Bwt), Bwt z-score, morbidities, and mortality of neonates born to mothers tested for the sFlt-1/PlGF ratio. Maternal sFlt-1/PlGF ratios examined within 30 days before delivery were used for analysis. Neonatal morbidities and mortality were investigated only in preterm infants born earlier than 32 weeks GA. @*Results@#A total of 225 neonates were included, of which 163 (72.4%) were preterm infants. GA (R=– 0.577, p<0.001), Bwt (R=–0.713, p<0.001), and Bwt z-score (R=–0.608, p<0.001) exhibited significant negative correlations with the sFlt-1/PlGF ratios. Among the 50 preterm infants born earlier than 32 weeks GA, neonatal morbidities were not significantly associated with the sFlt-1/PlGF ratio after adjusting for GA and Bwt. @*Conclusion@#In mothers with preeclampsia, a higher sFlt-1/PlGF ratio was associated with the delivery of newborns with lower GA and lower Bwt. However, this ratio was not associated with increased morbidity or mortality in premature infants born earlier than 32 weeks GA.
ABSTRACT
Background@#Orthotopic liver transplantation is the only option for patients with end-stage liver disease and hepatocellular carcinoma. Post-transplant immunosuppressive therapy is important to prevent graft failure. We investigated the effectiveness of tacrolimus (FK506) and their mechanisms for liver transplant immune tolerance in an outbred rat LT model. @*Results@#To investigate the therapeutic effect of the FK506 on outbred rat LT model, FK506 and postoperative therapy were administered subcutaneously once or twice daily to transplanted rats. Histopathological and immunohistochemical analyses were conducted for all groups. The regulation of inflammatory cytokine signaling in the spleen was analyzed by flow cytometry. FK506 attenuated allograft rejection and increased survival in rat orthotopic liver transplantation models. The FK506-treated group had reduced serum levels of alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase. Furthermore, FK506 decreased the expression of inflammatory cytokines and the activation of pathogenic Th1 and Th17 cells in the liver. @*Conclusions@#Taken together, we revealed that FK506 ameliorated strong allograft rejection in outbred liver transplantation model by anti-inflammatory effect and inhibitory peroperty of pathogenic T cells.
ABSTRACT
Objective@#To assess whether computed tomography (CT) conversion across different scan parameters and manufacturers using a routable generative adversarial network (RouteGAN) can improve the accuracy and variability in quantifying interstitial lung disease (ILD) using a deep learning-based automated software. @*Materials and Methods@#This study included patients with ILD who underwent thin-section CT. Unmatched CT images obtained using scanners from four manufacturers (vendors A-D), standard- or low-radiation doses, and sharp or medium kernels were classified into groups 1–7 according to acquisition conditions. CT images in groups 2–7 were converted into the target CT sty le (Group 1: vendor A, standard dose, and sharp kernel) using a RouteGAN. ILD was quantified on original and converted CT images using a deep learning-based software (Aview, Coreline Soft). The accuracy of quantification was analyzed using the dice similarity coefficient (DSC) and pixel-wise overlap accuracy metrics against manual quantification by a radiologist. Five radiologists evaluated quantification accuracy using a 10-point visual scoring system. @*Results@#Three hundred and fifty CT slices from 150 patients (mean age: 67.6 ± 10.7 years; 56 females) were included. The overlap accuracies for quantifying total abnormalities in groups 2–7 improved after CT conversion (original vs. converted: 0.63vs. 0.68 for DSC, 0.66 vs. 0.70 for pixel-wise recall, and 0.68 vs. 0.73 for pixel-wise precision; P < 0.002 for all). The DSCs of fibrosis score, honeycombing, and reticulation significantly increased after CT conversion (0.32 vs. 0.64, 0.19 vs. 0.47, and 0.23 vs. 0.54, P < 0.002 for all), whereas those of ground-glass opacity, consolidation, and emphysema did not change significantly or decreased slightly. The radiologists’ scores were significantly higher (P < 0.001) and less variable on converted CT. @*Conclusion@#CT conversion using a RouteGAN can improve the accuracy and variability of CT images obtained using different scan parameters and manufacturers in deep learning-based quantification of ILD.
ABSTRACT
Background@#The relationship between serum vitamin D levels and depressive symptoms has not been consistent in previous studies in Korean women. Menopause is known to be related to depression and vitamin D. @*Methods@#This study included 11,573 women from the 5th Korea National Health and Nutrition Examination Survey. Serum vitamin D levels were divided into four groups according to quartiles, and depressive symptoms were collected into two groups. Multiple logistic regression analysis was conducted in each group of women before and after menopause. @*Results@#Compared with the highest vitamin D group, the lowest vitamin D group did not show significant differences in all females (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.78-1.22). In premenopausal women, compared to the first quartile, ORs were presented in the second quartile (OR, 0.75; 95% CI, 0.53-1.07), third quartile (OR, 0.70; 95% CI, 0.49-1.00) and fourth quartile (OR, 0.62; 95% CI, 0.43-0.92) respectively, and they were statistically significant (P=0.016). In postmenopausal women, compared to the first quartile, ORs were presented in the second quartile (OR, 1.06; 95% CI, 0.78-1.44), third quartile (OR, 1.18; 95% CI, 0.87-1.61), and fourth quartile (OR, 1.27; 95% CI, 0.98-1.66) respectively; however, they were not statistically significant (P=0.057). @*Conclusions@#Depression symptoms increased with a decrease in serum vitamin D in premenopausal women, but the opposite trend was observed in postmenopausal women. In future studies, if the relationship between blood vitamin D and depression is studied, the menopausal status of women can be used as an important criterion.
ABSTRACT
This study compared the effectiveness of self-propelling diatom microbubblers to clean dental appliances with commercial denture cleaning agents according to the Ministry of Food and Drug Safety’s guidelines. The microbubbler is made by doping diatoms with MnO2 nanosheets that can decompose hydrogen peroxide to generate oxygen bubbles. Artificial saliva is prepared in accordance with the criteria presented by the American Dental Association, dispensed, and dried in 96 well plates. Experimental groups include 10-15% NaOCl (positive control), distilled water (negative control), diatom microbubbler A (Aulacoseira, MnO2-polydopamine (PDA)-A), diatom microbubbler M (Melosira nummuloids, MnO2-sugar (S)-M), Polident (GlaxoSmithKline, Dungarvan, Ireland), Dentfix-forte (Helago-Phama GmbH&Co, Parchim, Germany). After washing, absorbance (OD 600) was measured. If the absorbance was 70% or higher, the condition was determined to have “cleaning power potency,”Statistical significance was evaluated by one-way ANOVA and Bonferroni correction to compare cleaning effects among groups (p<0.05).The average cleaning rates were 93.8±1.0% in NaOCl (positive control) and 79.1±1.5% in distilled water (negative control).With the diatom microbubbler A, the average cleaning rate was 79.8±4.5% in the 3% H 2O 2 2 mg/mL, 64.7±5.5% in 6% H 2O 2 2 mg/mL, and 81.9±7.9% in 6% H 2O 2 4 mg/mL. The diatom microbubbler M group showed average cleaning rates of 88.5±3.6% in 3% H2O2 2 mg/mL, 75.8±4.0% in 6% H2O2 2 mg/mL, and 84.5±4.5% in 6% H2O2 4 mg/mL. Finally, conventional denture cleaning agents showed average cleaning rates of 88.2±1.2% in Polident and 83.3±3.0% in Dentfix-forte. The positive control group had significant differences from all experimental groups, but the negative control group showed significant differences only in A2 and A3, M1 and M2, M3, Polident, and Dentfix-forte (F=190.141, p<0.001). Among all groups except the positive control group, MnO2 -S-M mixed with 3% H2O2 2 mg/mL showed the highest cleaning rate. As the results of this study show, diatom complexes exhibit cleaning effects compatible with conventional denture cleaning agents. Further studies need to be conducted to narrow down the specific optimal conditions of diatom microbubblers and maximize the cleaning effect.
ABSTRACT
Objectives@#The aim of this study was to investigate temperament and character associated with resilience in patients with bipolar disorder (BD). @*Methods@#A total of 55 outpatients diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), and 55 healthy controls matched by age and sex with the BD group were recruited.All participants completed the Connor-Davidson Resilience Scale (CD-RISC) and Temperament and Character Inventory (TCI). Multiple linear regression analysis was performed by controlling for age, length of education, age of onset, number of depressive episodes, and number of hospitalizations to determine factors related to resilience. In addition, multiple regression analysis was performed using the interaction term to investigate whether temperament and character associated with resilience differed between the two groups. @*Results@#Patients with BD showed higher harm avoidance (p<0.001) and lower self-directedness (p<0.001) among the TCI dimensions compared to the control group. In multiple regression analysis, harm avoidance (β=-0.274, p=0.025) and self-directedness (β=0.431, p=0.002) were associated with resilience in patients with BD, while harm avoidance (β=-0.411, p=0.008), persistence (β=0.244, p=0.031), and cooperativeness (β=0.264, p=0.037) were associated with resilience in the control group. Self-directedness had a different relationship with resilience between the two groups (β=0.212, p=0.001). @*Conclusions@#The findings suggest that BD patients’ particular temperament and character are associated with resilience.Furthermore, temperament and character related to resilience differed between the BD group and the control group.
ABSTRACT
Purpose@#To explore the association between the visual and anatomical outcomes and the choroidal vascularity index (CVI) post-intravitreal injection in patients with macular edema associated with branch retinal vein occlusion (BRVO). @*Methods@#We conducted a retrospective review of medical records of 50 patients (27 eyes treated with anti-vascular endothelial growth factor and 23 eyes treated with a dexamethasone implant) with BRVO and macular edema who underwent intravitreal injections from January 2017 to October 2020. We measured the central macular thickness (CMT), subfoveal choroidal thickness, and CVI of the BRVO eyes and the fellow eyes using optical coherence tomography and then analyzed the correlation between these measurements and visual and anatomical outcomes. @*Results@#After six months of treatment, the best corrected visual acuity improved, and CMT decreased. Multiple linear regression analysis revealed that factors associated with best corrected visual acuity improvement at six months were fellow eye CVI (standardized β = 0.346, p = 0.008), ellipsoid zone integrity (standardized β = 0.398, p = 0.001), and initial best corrected visual acuity (standardized β = 0.590, p < 0.001). Initial CMT (standardized β = 0.563, p < 0.001) was the only factor associated with the decrease in CMT at six months. @*Conclusions@#In cases of severe macular edema, accurate evaluation of choroidal vessels can be challenging due to shadowing. We discovered that a larger CVI in the fellow eye was associated with greater visual improvement in patients with BRVO and macular edema. CVI could be a prognostic factor for predicting treatment outcomes in BRVO patients, suggesting that the choroidal vascular status may play a role in the pathophysiology of BRVO.
ABSTRACT
Objectives@#Following the coronavirus disease 2019 (COVID-19) pandemic, adolescents have experienced decreased physical activity and a decline in mental health. This study analyzed the association between changes in depressed mood after the COVID-19 pandemic and physical activity among adolescents. @*Methods@#The analysis was based on the results of the 17th Youth Health Behavior Online Survey conducted in 2021, which included 54848 middle and high school students in South Korea. Information on physical activity included low-intensity physical activity lasting >60 min/day, high-intensity physical activity, and strength training exercises. A logistic regression analysis was performed to evaluate the association between physical activity and changes in depression after the COVID-19 pandemic. @*Results@#After adjusting for sociodemographic characteristics and previous depression, adolescents who performed strength training exercises more than once per week had a 0.95-fold lower risk (odds ratio [OR]=0.948, 95% confidence interval [CI]=0.905–0.994, p= 0.027) of increasing depression after the COVID-19 pandemic, while the risk of decreasing depression increased by 1.22-fold (OR=1.215, 95% CI=1.131–1.305, p60 min/day and high-intensity physical activity. @*Conclusion@#Strength-training exercises are significantly associated with the prevention of depression among adolescents following the COVID-19 pandemic.
ABSTRACT
Objective@#: Bevacizumab is a feasible option for treating cerebral radiation necrosis (RN). We investigated the clinical outcome of RN after treatment with bevacizumab and factors related to the initial response and the sustained effect. @*Methods@#: Clinical data of 45 patients treated for symptomatic RN between September 2019 and February 2021 were retrospectively collected. Bevacizumab (7.5 mg/kg) was administered at 3-week intervals with a maximum four-cycle schedule. Changes in the lesions magnetic resonance image (MRI) scans were examined for the response evaluation. The subgroup analysis was performed based on the initial response and the long-term maintenance of the effect. @*Results@#: Of the 45 patients, 36 patients (80.0%) showed an initial response, and eight patients (17.8%) showed delayed worsening of the corresponding lesion. The non-responders showed a significantly higher incidence of diffusion restriction on MRI than the responders (100.0% vs. 25.0%, p<0.001). The delayed worsening group showed a significantly higher proportion of glioma pathology than the maintenance group (87.5% vs. 28.6%, p=0.005). Cumulative survival rates with sustained effect were significantly higher in the groups with non-glioma pathology (p=0.019) and the absence of diffusion restriction (p<0.001). Pathology of glioma and diffusion restriction in MRI were the independent risk factors for non-response or delayed worsening after initial response. @*Conclusion@#: The initial response of RN to bevacizumab was favorable, with improvement in four-fifths of the patients. However, a certain proportion of patients showed non-responsiveness or delayed exacerbations. Bevacizumab may be more effective in treating RN in patients with non-glioma pathology and without diffusion restriction in the MRI.
ABSTRACT
Background@#Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disorder characterized by uncontrolled terminal complement activation. Eculizumab, a monoclonal antibody C5 inhibitor was introduced in Korea in 2009 and has been the standard treatment option for PNH. @*Methods@#This study assessed the long-term efficacy/safety of eculizumab in PNH using real-world data from the Korean Health Insurance Review and Assessment Service. Eighty patients who initiated eculizumab from 2009–2020 were enrolled. @*Results@#At eculizumab initiation, the median age was 51.5 years, lactate dehydrogenase (LDH) 6.8 × upper limit of normal, and granulocyte clone size 93.0%. All patients had at least one PNH-related complication before eculizumab initiation, including renal failure (n = 36), smooth muscle spasm (n = 24), thromboembolism (n = 20), and pulmonary hypertension (n = 15). The median (range) duration of eculizumab treatment was 52.7 (1.0, 127.3) months (338.6 total treated patient-years). Despite high disease activity in the study population before treatment initiation, overall survival was 96.2% and LDH levels were stabilized in most patients during treatment. PNH-related complications at treatment initiation were resolved in 44.4% of patients with renal failure, 95.8% with smooth muscle spasm, 70.0% with thromboembolism, and 26.7% with pulmonary hypertension. Extravascular hemolysis occurred in 28.8% of patients (n = 23; 0.09 per patient-year) and breakthrough hemolysis in 18.8% (n = 15; 0.06 per patient-year). No treatment discontinuation cases related to eculizumab were observed. @*Conclusion@#These data provided evidence for the long-term efficacy and safety of eculizumab in Korean PNH patients with high disease burdens.
ABSTRACT
A 74-year-old female patient, who underwent surgery for a left distal tibiofibular fracture 40 years earlier, visited the hospital with an ankle varus deformity due to malunion. The patient complained of discomfort while walking due to the ankle and hindfoot varus deformity but did not complain of ankle pain. Therefore, correction using supramalleolar osteotomy was planned, and through virtual surgical simulation, it was predicted that a correction angle of 24° and an osteotomy gap open of 12 mm would be necessary. An osteotomy guide and an osteotomy gap block were made using three-dimensional (3D) printing to perform the osteotomy and correct the deformity according to the predicted goal. One year after surgery, it was observed that the ankle varus was corrected according to the surgical simulation, and the patient was able to walk comfortably. Thus, for correction of deformity, virtual surgical simulation and a 3D-printed osteotomy guide can be used to predict the target value for correction. This is useful for increasing the accuracy of correction of the deformity.