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Objective@#The cutaneous manifestation of decompression sickness (DCS) known as cutis marmorata (CM) is generally mild, but it is often accompanied by severe DCS or may be a prognostic sign. We aimed to analyze the clinical course of patients with CM to improve our understanding of CM. @*Methods@#From January 2016 to December 2020, a retrospective cohort single-center study was conducted on patients with acute DCS who underwent emergency recompression therapy. We analyzed their data and the clinical outcomes after recompression therapy. In addition, we reviewed relevant literature. @*Results@#A total of 341 people were enrolled during the study period. Of them 94 (27.6%) patients presented with CM and the symptoms appeared at an average of about 60.5 minutes after surfacing. Among the CM patients, 76.6% had accompanying DCS type II, and in 23.4%, had accompanying DCS type I (P=0.011). With single recompression therapy, 88.3% of patients with CM immediately recovered. Among these 95.4% of patients with DCS type I and 86.1% with DCS type II recovered immediately. However, there were no statistical differences in the immediate treatment outcomes according to the delay time from the onset of symptoms to recompression therapy, accompanying symptomatic DCS classification, and recompression modalities. Ultimately, all the patients recovered from CM. @*Conclusion@#CM by itself can be considered a mild DCS in terms of treatment progress, but prompt treatment is required to prevent complications. In addition, greater focus is needed on other accompanying DCS symptoms in patients with CM, and the treatment method should be determined accordingly.
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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.
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Purpose@#To determine the clinical outcomes after exchange of diffractive multifocal intraocular lenses (IOLs) with monofocal IOLs for patients who complained of dysphotopsia after cataract surgery. @*Methods@#We exchanged the IOLs of patients who visited our clinic complaining that dysphotopsia had not improved after they underwent phacoemulsification and diffractive multifocal IOL implants in local eye clinics. We evaluated the corrected distance visual acuity (CDVA) before and after operation, the type of preoperative dysphotopsia, postoperative dysphotopsia status, patient satisfaction, and all complications. @*Results@#We enrolled 35 eyes of 27 patients and observed them for 5.7 ± 3.6 months. After 1 month, the CDVA significantly (p < 0.001) improved from 0.131 ± 0.131 logarithm of the minimal angle resolution (logMAR) preoperatively to 0.0328 ± 0.0900 logMAR postoperatively. Patient satisfaction graded on a scale from 1 (very dissatisfied) to 5 (excellent) significantly (p < 0.001) increased from 1.17 ± 0.382 preoperatively to 4.09 ± 0.818 postoperatively. No vision-threatening complications developed. Postoperative cystoid macular edema developed in one eye but resolved after intravitreal bevacizumab (Avastin®, Genetech, Inc, San Francisco, CA, USA) injections. @*Conclusions@#IOL exchange surgery relatively safely improves the vision of patients suffering from dysphotopsia attributable to the characteristics of diffractive multifocal IOLs.
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Purpose@#To compare the effectiveness of warm saline and anti-fog solution for preventing fogging of a non-contact wide-field viewing system during vitrectomy. @*Methods@#Five liters of water at 36°C were placed in a transparent container. The fogging areas of wide-field lenses were microscopically measured. We created three groups: lenses soaked in normal saline at 25°C for 1 minute (control), lenses soaked in normal saline at 50°C for 1 minute (warm saline), and lenses that were wiped with a sponge soaked in anti-fog solution (ULTRASTOP pro med. Solution, Sigmapharm, Vienna, Austria) after prior soaking in normal saline at 25°C for 1 minute (anti-fog). Images of fogged areas were acquired at 10 seconds and 1, 3, and 5 minutes. Extent of fogged areas and central lens invasion were determined. All experiments were repeated 10 times. @*Results@#In the control group, the entire areas were always completely fogged. The average fog coverage values were 4.34 ± 1.28, 6.30 ± 1.38, 56.00 ± 25.01, and 93.81 ± 5.88% at 10 seconds and 1, 3, and 5 minutes in the warm saline group and 4.74 ± 0.57, 7.35 ± 0.96, 10.13 ± 1.09, and 11.74 ± 1.74% in the anti-fog group, respectively. There were significant differences at 3 and 5 minutes (p = 0.029, p = 0.012). Fogging of the central lens was detected in 8 tests after 3 minutes and all 10 tests after 5 minutes in the warm saline group, but no fogging was detected in the anti-fog group. @*Conclusions@#Application of an anti-fog solution to a wide-field viewing lens prevents lens fogging during vitrectomy.
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Purpose@#To compare the safety and consistency of manual capsulorhexis and precision pulse capsulotomy performed using pulsed energy during bilateral cataract surgery and to explore the differences in clinical outcomes. @*Methods@#A total of 101 patients with bilateral cataracts were selected. Precision pulse capsulotomy was performed on one eye and manual continuous curvilinear capsulorhexis on the other. The independent-samples t-test was used to compare the duration of continuous curvilinear capsulorhexis, incisional size and roundness, complications such as radial tears, the cumulative dissipated energy, the visual acuity after surgery, and the corneal epithelial cell count. @*Results@#There was no significant difference in the capsulorhexis time between the pulse energy and manual groups. The extent of capsulorhexis was significantly smaller and the circularity of capsulorhexis was higher in the former group. Complications occurred in two manual capsulorhexis patients but in no pulse energy capsulotomy patient. There was no significant between- group difference in any of postoperative visual acuity, best-corrected visual acuity, or the corneal endothelial cell count. @*Conclusions@#During bilateral cataract surgery on the same patients, precision capsulotomy using pulse energy afforded smaller and more circular capsulorhexis and fewer complications than did manual capsulorhexis. However, there was no significant between- group difference in the postoperative clinical outcomes.
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Purpose@#To analyze the clinical characteristics of patients with acute acquired comitant esotropia, evaluate the outcomes of augmented medial rectus muscle recession, and propose indicators for determining the appropriate surgical dosage. @*Methods@#Data of patients with acute acquired esotropia who underwent medial rectus recession between 2016 and 2022 were retrospectively analyzed. The amount of medial rectus muscle recession was 1-2 mm greater than for other types of esotropia. Surgical success was assessed by reference to the angle of deviation and diplopia status 6 months after surgery. We investigated the amount of additional recession required for favorable surgical outcomes, the characteristics of groups that required augmentation, and changes in surgical amount according to the deviation angle. @*Results@#A total of 38 patients were included; the average refractive error was -3.79 ± 3.11 diopters (D). Patient age at the time of surgery was 25.6 ± 18.2 years and the preoperative deviation angle was 38.1 ± 11.5 prism diopters (PD). The amount of medial rectus muscle recession was 6.25 ± 1.4 mm, i.e., 1.2 ± 1.0 mm greater than during other surgeries. The average augmentation was 24.1 ± 18.8%. The motor surgical success rate was 92.1% and the sensory success rate was 97.4%. The required augmentation was 26.9% for those with angles of deviation 40 PD. Patients who required augmentation > 25% were older, and the surgical effect was greater as the angle of deviation increased. @*Conclusions@#To ensure successful surgical outcomes of patients with acute acquired comitant esotropia, it is essential to increase the amount of medial rectus recession compared to that during other surgeries; the average augmentation was 24% in this study.
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Purpose@#We report a case of retinopathy related to bilateral hyperviscosity syndrome in a patient with Waldenström macroglobulinemia.Case summary: A 77-year-old male presented with reduced visual acuities of both eyes 2 months in duration. Fundus examination revealed extensive flame-shaped retinal hemorrhages and venous congestion. Optical coherence tomography (OCT) evidenced macular edema and OCT angiography (OCTA) indicated damage to the superficial and deep capillary plexi of retina and choriocapillaris and dilated large choroidal vessels. We diagnosed central retinal vein occlusion with macular edema and prescribed intravitreal bevacizumab and posterior subtenon triamcinolone injections, however, the edema did not improve. As retinopathy associated with hematological disease was thus suspected, we referred the patient to our department of hematology and oncology for further assessment. He was diagnosed with Waldenström macroglobulinemia. After initiation of chemotherapy, the retinal hemorrhage in and macular edema of both eyes decreased. After six chemotherapy cycles, the retinal hemorrhages resolved and the macular edema improved in both eyes. OCTA revealed that the choroidal vessel dilation also improved. @*Conclusions@#In elderly patients presenting with central retinal vein occlusions and macular edema of both eyes, it is important to assess whether the retinopathy is associated with a hyperviscosity syndrome linked to a hematological disease.
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Purpose@#To evaluate the long-term results of Boston type-I keratoprosthesis implantation in Korea. @*Methods@#Medical records of six patients (six eyes) who underwent Boston type-I keratoprosthesis implantation between August 2018 and November 2019 were retrospectively reviewed for more than 36 months. @*Results@#The mean follow-up period was 44.3 ± 7.0 months. Best corrected visual acuity (BCVA) improved significantly for all six eyes, from 2.33 ± 0.51 logarithm of the minimum angle of resolution (logMAR) to 0.67 ± 0.59 logMAR. The vision recovered immediately after the surgery in all patients. Retroprosthetic membrane developed in three of the patients, but the visual acuity remained unchanged. Anatomical success was achieved in all six eyes after Boston type-I keratoprosthesis implantation. @*Conclusions@#The long-term analysis of Boston type-I keratoprosthesis implantation showed a faster recovery and improved visual acuity compared with conventional penetrating keratoplasty. Without the use of systemic immunosuppressants, all six eyes showed long-term survival of the Boston keratoprosthesis. Boston type-I keratoprosthesis implantation may be used in patients with recurrent graft failure after keratoplasty. This was the first study investigating the long-term results of Boston keratoprosthesis implantation in Korean patients.
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Purpose@#To compare the refractive outcomes of closed C-loop and C-loop intraocular lenses (IOLs) following phacovitrectomy with gas tamponade. @*Methods@#Medical records of 42 patients (43 eyes) who underwent phacovitrectomy with gas tamponade for idiopathic macular holes between January 2021 and June 2022 were retrospectively reviewed. Closed C-loop (26 eyes; Eyelike K-flex Aspheric®, Koryo Eyetech, Seoul, Korea) and C-loop (17 eyes; Tecnis® ZCB00, Johnson & Johnson Vision, Santa Ana, CA, USA) IOLs were surgically implanted. The main outcome measures were postoperative prediction error and absolute error. @*Results@#There was no significant difference in mean absolute error at 5 months postoperatively (0.34 ± 0.24 diopters [D] and 0.30 ± 0.25 D in the closed C-loop and C-loop IOL groups, respectively; p = 0.502). The mean prediction error at 5 months postoperatively also showed no significant difference between the groups (-0.28 ± 0.30 D and -0.16 ± 0.36 D, respectively; p = 0.242). Myopic shift was observed in both groups. @*Conclusions@#There was no significant difference in refractive outcomes between closed C-loop IOLs and C-loop IOLs. A myopic shift was observed in both groups; this should be taken into consideration when calculating IOL power following phacovitrectomy with gas tamponade.
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Glossopharyngeal neuralgia is a condition characterized by lancinating pain in the tongue, soft palate, and pharynx. This condition can be caused by the combination of traction and compression of the glossopharyngeal nerve by tortuous vertebral and posterior inferior cerebellar arteries, which tug down and exert pressure on the nerve. Medical treatments including carbamazepine and gabapentin have been found to effectively manage glossopharyngeal neuralgia, even in cases with overt compression and traction of the nerve.
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Despite various advances in resuscitation science, the overall survival outcome remains very low in patients who sustain sudden cardiac death. Regardless of the cause of the collapse, multiple organ systems may be injured secondary to post-cardiac arrest syndrome. This column highlights the interventions that can be incorporated as a bundle of post-resuscitation care, to narrow the gap between return of spontaneous circulation (ROSC) and neurologically intact survival.Current Concepts: The post-cardiac arrest care algorithm presents treatment strategies and therapeutic goals to be considered in the initial stabilization stage, followed by investigating the cause of cardiac arrest and intensive care strategies to reduce additional brain damage. Immediately after ROSC, multimodal interventions required for post-ROSC care are bundled into a care regimen (treatment of the reversible cause, adequate seizure management, and glycemic control). It is also essential to establish definitive airway management to maintain normocapnic ventilation, prevent hyperoxia, and optimize hemodynamic management. Targeted temperature management after ROSC confers neuroprotection and leads to improved neurological outcomes.Discussion and Conclusion: Post-cardiac arrest care is also emphasized as a key element in the chain of survival. The interventions outlined could lead to more patients being discharged alive from the hospital, with good neurological function. In addition, continued management planning, such as secondary prevention and social rehabilitation for cardiac arrest survivors and neurological prognostication for patients who do not recover consciousness after a certain period, are included.
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Intratympanic injection has emerged as a novel approach to bypass the blood-labyrinth barrier and effectively deliver drugs into the inner ear. This technique is used for treatment of various inner ear diseases and overcomes the limitations of systemic drug therapy. In this paper, we provide an overview of the application of intratympanic injection using steroids and gentamicin and highlight the major diseases and summarize the reported efficacy of this approach.Current Concepts: Intratympanic steroid injections have been used for treatment of various inner ear diseases, including sudden sensorineural hearing loss, Ménière disease, and tinnitus. Therapeutic effects of steroids include reducing inflammation, modulating the immune response, improving cochlear blood flow, and maintaining ion homeostasis. Intratympanic gentamicin injections are primarily used to minimize hearing loss and control vertigo symptoms in patients with Ménière disease. Gentamicin selectively injures vestibular hair cells with minimal ototoxicity compared with other aminoglycoside antibiotics.Discussion and Conclusion: Intratympanic injections offer several advantages, including targeted drug delivery, minimal systemic adverse effects, and rapid action. Reportedly, intratympanic steroid injections used as primary or salvage treatment are associated with positive outcomes in patients with sudden sensorineural hearing loss. Ménière disease also shows positive outcomes following intratympanic steroid and gentamicin injections. However, studies have reported conflicting results, and further research is required to standardize dosing and administration protocols. Intratympanic injections are a promising therapeutic option, and ongoing research is essential to optimize their efficacy and safety.
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Various symptomatic complaints, including dysphagia, have been reported by patients with whiplash injury, which greatly impacts their life. There are few reports on the treatment and progression of dysphagia following whiplash injuries. This case report describes a patient who presented with delayed dysphagia after a whiplash injury. A 37-year-old female visited the Department of Rehabilitation Medicine of our institution and presented with delayed dysphagia one year after a traffic accident. At the time of the accident, the patient was diagnosed with a whiplash injury and had no symptoms of dysphagia. A videofluoroscopic swallowing study revealed decreased laryngeal elevation and impaired upper esophageal sphincter opening in the pharyngeal phase. The Penetration-Aspiration Scale score was 3 for pureed food and 7 for liquid food. Laryngeal needle electromyography showed abnormal spontaneous activity in both cricothyroid muscles. The patient underwent swallowing rehabilitation for oropharyngeal dysphagia. There were recurrences of improvement and deterioration during the treatment period. However, after five months, problems related to swallowing improved until there were no complaints. Our study indicates a differentiated treatment approach and the importance of continuous rehabilitation for dysphagia after a whiplash injury.
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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.
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Objective@#Renal involvement in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) can lead to severe renal dysfunction requiring dialysis at diagnosis. We aimed to study the clinical and pathologic characteristics of patients with AAV dependent on dialysis at presentation and the long-term renal outcomes of patients who recovered from dialysis. @*Methods@#This retrospective study analyzed data of patients diagnosed with AAV who were on dialysis from July 2005 to May 2021 at a single tertiary center in Korea. @*Results@#Thirty-four patients were included in the study (median age: 64.5 years, females: 61.8%), of which 13 discontinued and 21 continued dialysis. The proportion of normal glomeruli (p<0.001) and interstitial fibrosis (p=0.024) showed significant differences between both groups. Multivariable analysis showed that the proportion of normal glomeruli was associated with dialysis discontinuation (odds ratio=1.29, 95% confidence interval 0.99~1.68, p=0.063), although without statistical significance. Treatment modalities, including plasmapheresis, did not show significance with dialysis discontinuation. In the follow-up analysis of 13 patients who had discontinued dialysis for a median of 81 months, 12 did not require dialysis, and their glomerular filtration rate values significantly increased at follow-up time compared to when they stopped dialysis (37.5 [28.5~45.5] vs. 24.0 [18.5~30.0] mL/ min/1.73 m²; p=0.008). @*Conclusion@#Approximately 38% of AAV patients on dialysis discontinued dialysis, and the recovered patients had improved renal function without dialysis during longer follow-up. Patients with AAV on dialysis should be given the possibility of dialysis discontinuation and renal recovery, especially those with normal glomeruli in kidney pathology.
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Purpose@#The purpose of the study was to analyze the priorities for educational content regarding precautions to be taken to prevent safety accidents for employees in school foodservice using the Borich priority formula and the Locus for Focus model. @*Methods@#A survey was conducted in February 2019 on 194 employees in elementary school and 122 employees in middle- and high school foodservice in the Jeonbuk area. Demographic characteristics, status of safety accidents, safety education, and their importance and performance levels were assessed using a self-administered questionnaire. The priorities for the educational content on precautions to prevent safety accidents were based on a 3-step analysis method, including the paired sample t-test, Borich priority formula, and the Locus for Focus Model. @*Results@#The average perceived importance of the precautions to be taken against safety accidents of employees in elementary-, middle-, and high schools was higher compared to the average performance of the employees (p < 0.001). The top priority for elementary school employees was caution against falls during the cleaning of the gas hood and the trench in the kitchen. In addition, ‘awareness of chemical signs’ was added as one of the top priorities of middle- and high school employees. The second highest priority items were ‘do stretching’, ‘safely adjusting workbench height’, ‘keeping the right attitude’, ‘using assistive devices when moving heavy things’, and ‘checking the material safety data sheet’, which were the same for all elementary, middle- and high school employees. @*Conclusion@#Thus, to improve the educational preparedness of employees in the area of safety precautions, eight safety/accident prevention items should be included in the safety education program.
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Chronic constipation is one of the most common digestive diseases encountered in clinical practice. Constipation manifests as a variety of symptoms, such as infrequent bowel movements, hard stools, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. During the diagnosis of chronic constipation, the Bristol Stool Form Scale, colonoscopy, and a digital rectal examination are useful for objective symptom evaluation and differential diagnosis of secondary constipation. Physiological tests for functional constipation have complementary roles and are recommended for patients who have failed to respond to treatment with available laxatives and those who are strongly suspected of having a defecatory disorder. As new evidence on the diagnosis and management of functional constipation emerged, the need to revise the previous guideline was suggested. Therefore, these evidence-based guidelines have proposed recommendations developed using a systematic review and meta-analysis of the treatment options available for functional constipation. The benefits and cautions of new pharmacological agents (such as lubiprostone and linaclotide) and conventional laxatives have been described through a meta-analysis. The guidelines consist of 34 recommendations, including 3 concerning the definition and epidemiology of functional constipation, 9 regarding diagnoses, and 22 regarding managements. Clinicians (including primary physicians, general health professionals, medical students, residents, and other healthcare professionals) and patients can refer to these guidelines to make informed decisions regarding the management of functional constipation.
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We aimed to develop a cloud-based telemedicine platform for patients with intracerebral hemorrhage (ICH) at local hospitals in rural and underserved areas in Gangwon-do using artificial intelligence and non-face-to-face collaboration treatment technology. This is a prospective and multi-center development project in which neurosurgeons from four university hospitals in Gangwondo will participate. Information technology experts will verify and improve the performance of the cloud-based telemedicine collaboration platform while treating ICH patients in the actual medical field. Problems identified will be resolved, and the function, performance, security, and safety of the telemedicine platform will be checked through an accredited certification authority. The project will be carried out over 4 years and consists of two phases. The first phase will be from April 2022 to December 2023, and the second phase will be from April 2024 to December 2025. The platform will be developed by dividing the work of the neurosurgeons and information technology experts by setting the order of items through mutual feedback. This article provides information on a project to develop a cloud-based telemedicine platform for acute ICH patients in Gangwon-do.
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Background@#The purpose of this study was to evaluate the effect of vanishing twin (VT) on maternal serum marker concentrations and nuchal translucency (NT). @*Methods@#This is a secondary analysis of a multicenter prospective cohort study in 12 institutions. Serum concentrations of pregnancy-associated plasma protein-A in the first trimester and alpha-fetoprotein (AFP), total human chorionic gonadotrophin, unconjugated estriol, and inhibin A in the second trimester were measured, and NT was measured between 10 and 14 weeks of gestation. @*Results@#Among 6,793 pregnant women, 5,381 women were measured for serum markers in the first or second trimester, including 65 cases in the VT group and 5,316 cases in the normal singleton group. The cases in the VT group had a higher median multiple of the median value of AFP and inhibin A than the normal singleton group. The values of other serum markers and NT were not different between the two groups. After the permutation test with adjustment,AFP and inhibin A remained significant differences. The frequency of abnormally increased AFP was also higher in the VT group than in the normal singleton group. @*Conclusion@#VT can be considered as an adjustment factor for risk assessment in the secondtrimester serum screening test.
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In recent years, significant translational research advances have been made in the upper gastrointestinal (GI) research field. Endoscopic evaluation is a reasonable option for acquiring upper GI tissue for research purposes because it has minimal risk and can be applied to unresectable gastric cancer. The optimal number of biopsy samples and sample storage is crucial and might influence results. Furthermore, the methods for sample acquisition can be applied differently according to the research purpose; however, there have been few reports on methods for sample collection from endoscopic biopsies. In this review, we suggested a protocol for collecting study samples for upper GI research, including microbiome, DNA, RNA, protein, single-cell RNA sequencing, and organoid culture, through a comprehensive literature review. For microbiome analysis, one or two pieces of biopsied material obtained using standard endoscopic forceps may be sufficient. Additionally, 5 mL of gastric fluid and 3–4 mL of saliva is recommended for microbiome analyses. At least one gastric biopsy tissue is necessary for most DNA or RNA analyses, while proteomics analysis may require at least 2–3 biopsy tissues. Single cell-RNA sequencing requires at least 3–5 tissues and additional 1–2 tissues, if possible. For successful organoid culture, multiple sampling is necessary to improve the quality of specimens.