Relationship between Thyrotropin Binding Inhibitory Immunoglobulin and Strabismus-associated Thyroid Eye Disease Stability

Purpose@#To investigate the relationship between thyrotropin binding inhibitory immunoglobulin (TBII) and deviation angle stability in strabismus-associated thyroid eye disease. @*Methods@#A total of 25 strabismus-associated thyroid eye disease patients who were followed up for > 6 months without surgery were enrolled. To investigate the correlation between TBII levels and changes in the deviation angle, a test period of 6 months from the date of TBII measurement was established and 55 test units of the corresponding TBII levels were obtained. @*Results@#The deviation angle had a positive correlation with the TBII levels (r = 0.473, p < 0.001), but did not correlate with sex, age, and thyroid hormone levels. Changes in the horizontal, vertical, and total deviation angles were significantly greater in the high-TBII test units compared to the normal-TBII test units (p= 0.029, = 0.032, and = 0.009, respectively). @*Conclusions@#TBII levels were related to deviation angle stability in strabismus-associated thyroid eye disease. TBII may be a useful indicator for deviation angle stability in these patients over a period of 6 months.

The combined clinical impact of red blood cell distribution width and vascular calcification on cardiovascular events and mortality in patients with endstage kidney disease

Little is known about how the interaction between red blood cell distribution width (RDW) and vascular calcification (VC) affects cardiovascular (CV) events and mortality in end-stage kidney disease (ESKD) patients. This study investigated the combined prognostic effect of RDW and VC in ESKD patients starting dialysis. Methods: A retrospective single-center study of 582 ESKD patients was conducted. VC was assessed by calculating the aortic calcification index (ACI) using computed tomography. Patients were divided into low ACI-low RDW, low ACI-high RDW, high ACI-low RDW, and high ACI-high RDW groups based on median ACI (17.12) and RDW (14.3) values. The association between RDW and VC and the composite endpoint of CV events and death was analyzed. Results: During a median follow-up of 3.1 years (range, 1.5–5.5 years), 165 CV events (28.4%) and 124 deaths (21.4%) occurred. Cox regression showed that the low ACI-high RDW (adjusted hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.04–2.66; p = 0.03) and high ACI-low RDW (adjusted HR, 1.95; 95% CI, 1.21–3.14; p = 0.006) groups had a greater risk of CV events and death than the low ACI-low RDW group. The high ACI-high RDW group had the greatest risk (adjusted HR, 2.23; 95% CI, 1.42–3.52; p = 0.001). The effect of the interaction between ACI and RDW on CV events and mortality was statistically significant (p = 0.005). Conclusion: High RDW and VC interact to increase the risk of CV events and death in ESKD patients.

Restrictive Strabismus Developing after Conjunctivodacryocystorhinostomy

Purpose@#To report a case of diplopia caused by restrictive strabismus developing after conjunctivodacryocystorhinostomy (CDCR).Case summary: A 61-year-old female presented with persistent epiphora after failure to repair ipsilateral canalicular lacerations of the left eye caused by trauma occurred 25 years ago. CDCR was performed and the epiphora improved. Four months later, the patient presented with diplopia on the left gaze. An abduction limitation of -4 and a supraduction limitation of -3 were observed in the left eye. Therefore, Jones tube removal was performed 5 months after CDCR surgery. Two weeks later, as the limitations persisted, adhesiolysis of the conjunctiva and an amniotic membrane transplantation (AMT) were performed. This exposed a subconjunctival adhesion at the inferonasal conjunctiva; histopathological examination revealed fibrotic tissues. Three months later, the adhesions recurred and the patient was transferred to another hospital. Conjunctival adhesiolysis, AMT, and a 6.5 mm recession of medial rectus (MR) muscle were performed. One week later, exotropia occurred in the primary position, and the MR muscle of the left eye was advanced by 2 mm. Nine months after the final surgery, the primary gaze was orthotropia. The diplopia within the central 20° of visual field had disappeared. However, a levoelevation limitation of -1.5 remained in the left eye. @*Conclusions@#CDCR is the only treatment method for patients with occlusion of both the upper and lower proximal lacrimal canaliculi. However, rare complications such as restrictive strabismus with diplopia may occur. As preventing adhesion is difficult, sufficient patient notice is required prior to surgery.

Usefulness of the Icare ic200 Rebound Tonometer in Korean

Purpose@#To evaluate the efficacy of the Icare ic200 in clinical practice by comparing the intraocular pressure (IOP) measured with the Icare ic200 rebound tonometer to the IOP measured with the Goldmann applanation tonometer (GAT). @*Methods@#A total of 294 eyes of 294 Korean patients were included. IOP was measured with the Icare ic200 and then measured again with a GAT in all patients. We evaluated the degree of IOP agreement between the two tonometers and analyzed the diagnostic ability of the Icare ic200 for a reading ≥ 22 mmHg with the GAT. We also analyzed whether clinical factors including biometry affected the difference in IOP measured by the two tonometers. @*Results@#The IOP values measured with the Icare ic200 and GAT were strongly correlated (r = 0.875, p < 0.001). The IOP measured with the Icare ic200 was lower than the IOP measured with GAT. The mean difference was 3.07 ± 2.67 mmHg, and 95.24% of patients were distributed within the 95% limits of agreement (-2.16 to 8.30 mmHg) on Bland-Altman plots. The diagnostic ability of the Icare ic200 for IOP ≥ 22 mmHg was 0.959 (area under the receiver operating characterisitic). In multivariate regression analyses, older age (β = 0.034, p = 0.020) and greater corneal curvature (β = 0.213, p = 0.030) were correlated with larger IOP differences between the two tonometers. @*Conclusions@#Although the Icare ic200 was more consistent than the GAT with reasonable diagnostic ability for ≥ 22 mmHg, the IOP measured 3 mmHg lower than the GAT. Therefore, the Icare ic200 might be more useful as a screening test to increase IOP rather than replacing GAT in clinical practice.

Pediatric Kidney Transplantation

Pediatric kidney transplantation is the best option since it can achieve near normal glomerular filtration rate, adequate fluid balance, and autonomic endocrine function of the kidney in end-stage kidney disease. However, pediatric kidney transplantation is difficult because children are developing and growing, management and complications of pediatric kidney transplantation are different from those of adults. This review covers the current status of pediatric kidney transplantation in Korea, key considerations that must be taken before kidney transplantation in children, and management strategy of immunosuppression and common complications.

Usefulness of the Icare ic200 Rebound Tonometer in Korean

Purpose@#To evaluate the efficacy of the Icare ic200 in clinical practice by comparing the intraocular pressure (IOP) measured with the Icare ic200 rebound tonometer to the IOP measured with the Goldmann applanation tonometer (GAT). @*Methods@#A total of 294 eyes of 294 Korean patients were included. IOP was measured with the Icare ic200 and then measured again with a GAT in all patients. We evaluated the degree of IOP agreement between the two tonometers and analyzed the diagnostic ability of the Icare ic200 for a reading ≥ 22 mmHg with the GAT. We also analyzed whether clinical factors including biometry affected the difference in IOP measured by the two tonometers. @*Results@#The IOP values measured with the Icare ic200 and GAT were strongly correlated (r = 0.875, p < 0.001). The IOP measured with the Icare ic200 was lower than the IOP measured with GAT. The mean difference was 3.07 ± 2.67 mmHg, and 95.24% of patients were distributed within the 95% limits of agreement (-2.16 to 8.30 mmHg) on Bland-Altman plots. The diagnostic ability of the Icare ic200 for IOP ≥ 22 mmHg was 0.959 (area under the receiver operating characterisitic). In multivariate regression analyses, older age (β = 0.034, p = 0.020) and greater corneal curvature (β = 0.213, p = 0.030) were correlated with larger IOP differences between the two tonometers. @*Conclusions@#Although the Icare ic200 was more consistent than the GAT with reasonable diagnostic ability for ≥ 22 mmHg, the IOP measured 3 mmHg lower than the GAT. Therefore, the Icare ic200 might be more useful as a screening test to increase IOP rather than replacing GAT in clinical practice.

Pediatric Kidney Transplantation

Pediatric kidney transplantation is the best option since it can achieve near normal glomerular filtration rate, adequate fluid balance, and autonomic endocrine function of the kidney in end-stage kidney disease. However, pediatric kidney transplantation is difficult because children are developing and growing, management and complications of pediatric kidney transplantation are different from those of adults. This review covers the current status of pediatric kidney transplantation in Korea, key considerations that must be taken before kidney transplantation in children, and management strategy of immunosuppression and common complications.

A Position Statement of the Utilization and Support Status of Continuous Glucose Monitoring in Korea / 임상당뇨병

The accuracy and convenience of continuous glucose monitoring (CGM), which efficiently evaluates glycemic variability and hypoglycemia, are improving. There are two types of CGM: professional CGM and personal CGM. Personal CGM is subdivided into real-time CGM (rt-CGM) and intermittently scanned CGM (isCGM). CGM is being emphasized in both domestic and foreign diabetes management guidelines. Regardless of age or type of diabetes, CGM is useful for diabetic patients undergoing multiple insulin injection therapy or using an insulin pump. rt-CGM is recommended for all adults with type 1 diabetes (T1D), and can also be used in type 2 diabetes (T2D) treatments using multiple insulin injections. In some cases, short-term or intermittent use of CGM may be helpful for patients with T2D who use insulin therapy other than multiple insulin injections and/or oral hypoglycemic agents. CGM can help to achieve A1C targets in diabetes patients during pregnancy. CGM is a safe and cost-effective alternative to self-monitoring blood glucose in T1D and some T2D patients. CGM used in diabetes management works optimally with proper education, training, and follow up. To achieve the activation of CGM and its associated benefits, it is necessary to secure sufficient repetitive training and time for data analysis, management, and education. Various supports such as compensation, insurance coverage expansion, and reimbursement are required to increase the effectiveness of CGM while considering the scale of benefit recipients, policy priorities, and financial requirements.

Strong association between herpes simplex virus-1 and chemotherapy-induced oral mucositisin patients with hematologic malignancies

Background/Aims@#A link between oral cavity infections and chemotherapy-induced oral mucositis (CIOM) in patients with hematological malignancies (HMs) undergoing intensive chemotherapy (IC) or hematopoietic stem cell transplantation (HSCT) has been suggested. However, conclusive data are lacking, and there are no current guidelines for the prophylactic use of antimicrobials to prevent CIOM in these populations. @*Methods@#The relationships between herpes simplex virus (HSV) reactivation and Candida colonization in the oral cavity and CIOM in patients with HMs undergoing IC or HSCT were evaluated. Patients aged ≥ 19 years with HMs undergoing IC or HSCT were enrolled. Each patient was evaluated for HSV and Candida in the oral cavity along with CIOM at baseline and during the 2nd, 3rd, and 4th weeks. @*Results@#Seventy presentations among 56 patients were analyzed. CIOM was observed in 23 presentations (32.9%), with a higher incidence associated with HSCT (17 of 35 presentations, 48.6%) than with IC (six of 35 presentations, 8.6%). The reactivation of HSV-1 was significantly associated with an increased incidence of CIOM after adjusting for age, sex, type of disease, and treatment stage. A higher HSV-1 viral load was associated with an increased incidence of CIOM. The presence of Candida was not associated with CIOM. @*Conclusions@#HSV-1 reactivation in the oral cavity was highly associated with CIOM in patients with HMs undergoing high-dose chemotherapy.

Urrets-Zavalia Syndrome Following Trabeculectomy

PURPOSE: We report a case of Urrets-Zavalia syndrome with a fixed dilated pupil after an uneventful trabeculectomy.CASE SUMMARY: Trabeculectomy was performed on a 51-year-old male who had a history of recurrent uveitis in the left eye, with uncontrolled intraocular pressure despite maximally-tolerated medial therapy. There was no unexpected event during surgery. Topical 1% atropine was used for only 2 days after surgery. In the early postoperative period, 1% prednisolone and 0.3% ofloxacin were given four times a day, then gradually reduced. One month later, only 1% prednisolone was given once a day. Intraocular pressure in his left eye was well controlled from 8–14 mmHg after surgery. One month after surgery, the pupils remained dilated. There was no reaction to topical 2% pilocarpine and no relative afferent pupillary defect or posterior synechia.CONCLUSIONS: Our case, although rare, suggests that Urrets-Zavalia syndrome should be considered in patients with well-controlled intraocular pressure after uneventful trabeculectomy.

Two Cases of Epibulbar Osseous Choristoma

Purpose@#To report two cases of epibulbar osseous choristoma and a review of the literature.Case summary: A 26-year-old male and a 50-year-old female without any past medical history or history of ocular trauma were referred to our clinic due to an incidental epibulbar mass. The masses were located in superotemporal subconjunctiva and inferotemporal subconjunctiva, respectively, and excisional biopsies were performed. The masses revealed epibulbar osseous choristoma. There was no recurrence of disease or postoperative complication. @*Conclusions@#When asymptomatic subconjunctival or an extraocular mass especially located at the temporal side is found, epibulbar osseous choristoma should always be considered.

Two Cases of Epibulbar Osseous Choristoma

Purpose@#To report two cases of epibulbar osseous choristoma and a review of the literature.Case summary: A 26-year-old male and a 50-year-old female without any past medical history or history of ocular trauma were referred to our clinic due to an incidental epibulbar mass. The masses were located in superotemporal subconjunctiva and inferotemporal subconjunctiva, respectively, and excisional biopsies were performed. The masses revealed epibulbar osseous choristoma. There was no recurrence of disease or postoperative complication. @*Conclusions@#When asymptomatic subconjunctival or an extraocular mass especially located at the temporal side is found, epibulbar osseous choristoma should always be considered.

Transition of Simulation-Based Learning in Nursing Schools: A Concept Analysis / 중환자간호학회지

PURPOSE: The purpose of this study was to identify the attributes, antecedents, and consequences of the transition of simulation-based learning (SBL) in nursing schools.METHODS: The study was conducted in accordance with Walker and Avant's conceptual analysis process. We searched MEDLINE, CINAHL, EMBASE, Google Scholar, and RISS (Korean Education and Research Information Service) databases, resulting in nine studies for an in-depth review.RESULTS: The attributes of transition of SBL include (1) preparing for a professional role, (2) practicing in a real clinical setting, and (3) progressing toward expected competency. Antecedents of the concept include novice status, changing roles, clinical experience in controlled settings, and expected competency in the clinical setting.CONCLUSION: The transition of SBL includes the important feature of progression toward expected competency. Further research is needed to identify graduate nurses' experiences during this transition to establish a strategy for improving it and developing a measurement tool that reflects attributes of the concept.

A Lacrimal Punctal Keratinizing Cyst of the Lower Lid

PURPOSE: We report an unusual case of a keratinizing cyst on the lacrimal punctum. CASE SUMMARY: A 49-year-old female presented with an outpouching punctal mass at the left lower lid that occurred a week prior to her visit. Histopathological examination revealed a cyst filled with keratin arranged in lamina and surrounding the bacterial colony. The epithelial wall was composed of multilaminar, keratinizing squamous epithelium without goblet cells. The features were consistent with a keratinizing cyst. There was no recurrence at 4 months after the excision, and the punctum was patent. CONCLUSIONS: Keratinizing cyst should be considered as a differential diagnosis of the cystic mass of the punctum. Because it has an excellent prognosis after surgical resection, complete resection should be performed if a keratinizing cyst is suspected.

Eyelid Myxoma in Carney Syndrome

PURPOSE: To report a case of eyelid myxoma in Carney syndrome. CASE SUMMARY: A 24-year-old male presented with a 4-year history of a slowly growing nodule at the right upper eyelid. The patient underwent surgical excision five times for the eyelid nodule, which recurred at the same site. He was diagnosed with Carney syndrome. The eyelid lesion was pinkish and lobulated, and the surface was firm and soft. The nodule was completely excised and a histopathological examination revealed a myxoid matrix containing spindle- or stellate-shaped cells and many thin-walled vessels. The nodule was diagnosed as myxoma. There was no recurrence at 13 months after surgery. CONCLUSIONS: Myxoma rarely involves the eyelid, but it should be considered in the differential diagnosis of multiple recurrent nodules of the eyelid. Complete excision is important if clinically suspected, and regular follow-up is needed after surgery. In addition, a thorough systemic evaluation, including echocardiography, should be performed to find any evidence of Carney syndrome.

Ketogenic Diet and Glucose Control / 임상당뇨병

There is not a set percentage of calories from carbohydrate, protein, and fat for all people with diabetes. It is recommended that diet be individualized according to each patient's eating patterns, preferences, and metabolic goals. Overweight or obese patients with diabetes could improve their insulin sensitivity, glycemia, blood pressure and dyslipidemia via weight loss. Therefore, various dietary patterns have been tried for weight and glucose control. The Ketogenic diet includes very low-carbohydrate and high fat and is known to be effective for weight loss in a short period of time. Short-term studies have demonstrated the effects of the Ketogenic diet on weight loss and glycemic control improvement, but long-term studies are not yet sufficient. In addition, various side effects such as hypoglycemia and nutritional imbalances are concerns, so there is a lack of evidence with respect to recommending this diet as nutrition therapy for diabetics.

Knowledge of and Compliance with Neutropenic Diet in Patients with Hematologic Malignancy undergoing Chemotherapy

PURPOSE: This study aimed to investigate knowledge of and compliance with the neutropenic diet in hemato-oncology patients undergoing chemotherapy. METHODS: 123 hemato-oncology patients who had more than one chemotherapy participated in this study. Data were collected with a self-administered questionnaire from July 21 to September 26, 2014, and analyzed with SPSS 21.0 program using descriptive statistics, t-test, ANOVA and Pearson's correlation. RESULTS: The average of score for the neutropenic diet was 60.9 out of 100 points and mean compliance score was 69.5 out of 100 percent scale. For preventing infection, patients were found to be stricter in their intake of restricted foods than acceptable foods during neutropenia. There were significant correlations between the knowledge of and compliance with the neutropenic diet in patients receiving chemotherapy (r=.53, p<.001). CONCLUSION: It is necessary to nursing assessment and education should include a periodic assessment of nutritional status and risk evaluation of neutropenia and bacterial infections. This study recommended nursing research to establish a recommendation criterion for a restrictive neutropenic diet and less restrictive food safety education programs for cancer patients.

Renal involvement in children and adolescents with inflammatory bowel disease / 소아과

PURPOSE: The incidence of inflammatory bowel disease (IBD) is rapidly increasing, and several reports have described the renal complications of IBD. We sought to evaluate the clinical manifestations of renal complications in children with IBD in order to enable early detection and prompt treatment of the complications. METHODS: We retrospectively reviewed the medical records of 456 children and adolescents aged < 20 years who had been diagnosed with IBD since 2000. We analyzed patient age, sex, medication use, IBD disease activity, and clinical manifestations of renal symptoms. RESULTS: Our study comprising 456 children with IBD included 299 boys (65.6%) and 157 girls (34.4%). The study included 346 children with Crohn disease and 110 children with ulcerative colitis. The incidence of kidney-related symptoms was 14.7%, which was significantly higher than that in normal children. We observed 26 children (38.8%) with isolated hematuria, 30 children (44.8%) with isolated proteinuria, and 11 children (16.4%) with hematuria and concomitant proteinuria. A renal biopsy was performed in 7 children. Histopathological examination revealed immunoglobulin A nephropathy in 5 children (71.4%). All children presented with mild disease and well-controlled disease activity of IBD. CONCLUSION: Children with IBD are more likely to show kidney-related symptoms than healthy children and adolescents are. Therefore, regular screening of urine and evaluation of renal function in such children are necessary for early detection of renal complications.

Lysophosphatidic acid enhances breast cancer cells-mediated osteoclastogenesis

Lysophosphatidic acid (LPA) is known to play a critical role in breast cancer metastasis to bone. In this study, we tried to investigate any role of LPA in the regulation of osteoclastogenic cytokines from breast cancer cells and the possibility of these secretory factors in affecting osteoclastogenesis. Effect of secreted cytokines on osteoclastogenesis was analyzed by treating conditioned media from LPA-stimulated breast cancer cells to differentiating osteoclasts. Result demonstrated that IL-8 and IL-11 expression were upregulated in LPA-treated MDA-MB-231 cells. IL-8 was induced in both MDA-MB-231 and MDA-MB-468, however, IL-11 was induced only in MDA-MB-231, suggesting differential LPARs participation in the expression of these cytokines. Expression of IL-8 but not IL-11 was suppressed by inhibitors of PI3K, NFkB, ROCK and PKC pathways. In the case of PKC activation, it was observed that PKCδ and PKCμ might regulate LPA-induced expression of IL-11 and IL-8, respectively, by using specific PKC subtype inhibitors. Finally, conditioned Medium from LPA-stimulated breast cancer cells induced osteoclastogenesis. In conclusion, LPA induced the expression of osteolytic cytokines (IL-8 and IL-11) in breast cancer cells by involving different LPA receptors. Enhanced expression of IL-8 by LPA may be via ROCK, PKCu, PI3K, and NFkB signaling pathways, while enhanced expression of IL-11 might involve PKCδ signaling pathway. LPA has the ability to enhance breast cancer cells-mediated osteoclastogenesis by inducing the secretion of cytokines such as IL-8 and IL-11.

Optic Neuritis of Korean Adult

PURPOSE: The aim of the study was to describe the clinical features and characteristics of optic neuritis patients compared with those of patients enrolled in the Optic Neuritis Treatment Trial (ONTT). METHODS: We retrospectively included consecutive patients diagnosed with optic neuritis between 2006 and 2015. The inclusion criteria were the same as those of the ONTT; an acute or subacute unilateral visual symptom ≤8 days in duration, a relative afferent pupillary defect, and a visual field defect in the affected eye. RESULTS: The 41 patients (14 females, 27 males) were of mean age 32.7 years. The incidence of papilledema was 58.5%, thus higher than that of ONTT patients (p = 0.004), and the incidence of ocular pain was 75.6%, lower than that of ONTT patients (p = 0.002). Six months after intravenous methylprednisolone therapy, 29 of 32 eyes (90.6%) recovered visual acuity of ≥1.0 or better, and only one eye exhibited poor visual acuity (≤0.5). Orbital magnetic resonance imaging (MRI) was performed on 34 patients, and most (91.2%) exhibited optic nerve enhancement. The three patients who did not exhibit enhancement reported no pain. CONCLUSIONS: The clinical features of Korean optic neuritis patients differed from those of patients of the ONTT. Most patients exhibited optic nerve MRI enhancement associated with ocular pain. If enhancement of the optic nerve is lacking, diseases other than optic neuritis should be suspected because most optic nerves with neuritis exhibit enhancement on MRI.