Post-treatment Visual Acuity Prediction Using Deep Learning in Age-related Macular Degeneration

Purpose@#To develop a deep learning model to predict visual acuity (VA) outcomes after 12 months of anti-vascular endothelial growth factor (anti-VEGF) treatment. @*Methods@#A total of 330 treatment-naive eyes of neovascular age-related macular degeneration patients, who underwent anti-VEGF therapy between 2007 and 2020 at Konkuk University medical center, were included. The network was trained using VA at baseline, VA after three loading doses of anti-VEGF, and treatment regimen data. It was also trained using 12,300 augmented optical coherence tomography (OCT) B-scan images at baseline and after three loading doses of anti-VEGF. We generated five deep learning models using sequentially input data (VA and OCT B-scan images at baseline and after three loading doses, and treatment regimen). Prediction of VA at 12 months was performed using deep learning algorithms, such as convolutional neural network and multilayer perceptron. The outcomes were dichotomized based on whether the decremental change in VA during the 12 months of treatment was more or less than logarithm of the minimum angle of resolution 0.3. Predictive efficiency was assessed by comparing the performance of deep learning models. @*Results@#The best performing model was trained using input data, including VA at baseline and after three loading doses, treatment regimen, and OCT B-scan images at baseline and after three loading doses. The decremental outcome in VA after 12 months of anti-VEGF treatment was predicted as an area under the curve (AUC) of 0.79. The addition of OCT images at baseline and after three loading doses as input data improved the AUC, sensitivity, and negative predictive value (AUC 0.74-0.79, 0.58-0.86, and 0.90-0.95, respectively). @*Conclusions@#Our deep learning model showed relatively good performance in classifying good or poor post-treatment VA based on combined clinical information including numerical and image data.

Chemokine Receptor Profiles of T Cells in Patients with Age-Related Macular Degeneration

Purpose@#To evaluate the expression of multiple chemokine receptors in peripheral blood T cells from patients with age-related macular degeneration (AMD). @*Materials and Methods@#Peripheral blood mononuclear cells and/or aqueous humor were obtained from 24 AMD patients and 24 age- and sex-matched healthy controls. Chemokine receptor expression on T cells from peripheral blood was determined by multicolor flow cytometry. The levels of chemokines and cytokines in the aqueous humor from 12 AMD patients and six healthy controls were assessed. @*Results@#AMD patients had increased expressions of CCR4 in CD4 + T cells (p=0.007) and CRTh2 in CD8 + T cells (p=0.002), and decreased expressions of CXCR3 in CD4+T cells (p=0.029) and CXCR3, CCR5, and CX 3CR1 in CD8+T cells (p=0.005, 0.019, and 0.007, respectively). Monocyte chemoattractant protein-1 levels were increased in the aqueous humor from AMD patients (p=0.018), while the levels of interleukin (IL)-4 and IL-22 were significantly decreased compared to controls (p=0.018 and 0.041, respectively). @*Conclusion@#The chemokine receptor profiles of T cells are altered in AMD patients compared to healthy controls without noticeable associations with chemokine levels in the aqueous humor. Further evaluation is needed to clarify the role of these alterations in AMD pathogenesis.

Choroidal Neovascularization and Haller Vessel Morphology Associated with Vision and Treatment Number after 1 Year in Age-related Macular Degeneration

Purpose@#The present study aimed to quantify various factors of vessel morphology, including vessel diameter, length, and complexity (fractal dimension and lacunarity) of both choroidal neovascularization (CNV) and en face Haller vessels using optical coherence tomography angiography (OCTA) and en face structural optical coherence tomography in typical neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) and to identify factors associated with visual acuity (VA) loss and number of injections within a year after the day of OCTA. @*Methods@#We retrospectively analyzed 43 eyes of nAMD patients and 33 eyes of PCV patients whose OCTA was performed at least 12 months after an initial anti-vascular endothelial growth factor treatment. Quantitative parameters, including vessel area, vessel diameter, vessel length, fractal dimension, and lacunarity were analyzed from en face images of CNV and Haller vessels. Clinical information, including logarithm of the minimum angle of resolution visual acuity and injection number of anti-vascular endothelial growth factor were acquired after 12 months from OCTA date. Using logistic regression analyses, parameters associated with logarithm of the minimum angle of resolution VA loss of 0.2 or more (VA loss group) and a number of injections of four or more (unstable group) after 12 months were analyzed. @*Results@#In typical nAMD, the VA loss group was associated with a smaller number of intersections of Haller vessels. The unstable group was associated with an increased lacunarity of CNV in typical nAMD. In PCV, both VA loss and unstable groups were associated with a higher maximal diameter of Haller vessels. @*Conclusions@#VA loss and injection number of nAMD and PCV 12 months after OCTA imaging were associated with different morphological parameters of CNV and Haller vessels. Therefore, quantitative analyses of both CNV and Haller vessels from OCTA and en face optical coherence tomography might provide prognostic information about visual outcome and injection frequency within 12 months after OCTA imaging.

Choroidal Neovascularization and Haller Vessel Morphology Associated with Vision and Treatment Number after 1 Year in Age-related Macular Degeneration

Purpose@#The present study aimed to quantify various factors of vessel morphology, including vessel diameter, length, and complexity (fractal dimension and lacunarity) of both choroidal neovascularization (CNV) and en face Haller vessels using optical coherence tomography angiography (OCTA) and en face structural optical coherence tomography in typical neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) and to identify factors associated with visual acuity (VA) loss and number of injections within a year after the day of OCTA. @*Methods@#We retrospectively analyzed 43 eyes of nAMD patients and 33 eyes of PCV patients whose OCTA was performed at least 12 months after an initial anti-vascular endothelial growth factor treatment. Quantitative parameters, including vessel area, vessel diameter, vessel length, fractal dimension, and lacunarity were analyzed from en face images of CNV and Haller vessels. Clinical information, including logarithm of the minimum angle of resolution visual acuity and injection number of anti-vascular endothelial growth factor were acquired after 12 months from OCTA date. Using logistic regression analyses, parameters associated with logarithm of the minimum angle of resolution VA loss of 0.2 or more (VA loss group) and a number of injections of four or more (unstable group) after 12 months were analyzed. @*Results@#In typical nAMD, the VA loss group was associated with a smaller number of intersections of Haller vessels. The unstable group was associated with an increased lacunarity of CNV in typical nAMD. In PCV, both VA loss and unstable groups were associated with a higher maximal diameter of Haller vessels. @*Conclusions@#VA loss and injection number of nAMD and PCV 12 months after OCTA imaging were associated with different morphological parameters of CNV and Haller vessels. Therefore, quantitative analyses of both CNV and Haller vessels from OCTA and en face optical coherence tomography might provide prognostic information about visual outcome and injection frequency within 12 months after OCTA imaging.

Two-dimensional Quantitative Effects of Anti-vascular Endothelial Growth Factor and Dexamethasone Implants on Retinal Vein Occlusion

Purpose@#We quantitatively analyzed the therapeutic effects of intravitreal anti-vascular endothelial growth factor (anti-VEGF) and dexamethasone implants used to treat macular edema caused by retinal vein occlusion. @*Methods@#Eighty-three patients with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) with macular edema treated from February 2009 to August 2019 via anti-VEGF injections or dexamethasone implants were enrolled. The medical records of 83 eyes were retrospectively analyzed. Horizontal B-scan spectral domain optical coherence tomography images spanning the foveal center were obtained before treatment and 1 month later. These were analyzed with the aid of Image J software and the numbers of pixels corresponding to intraretinal and subretinal fluids calculated. @*Results@#In patients with BRVO, the retinal fluid changes were identical 1 month after injection in both the anti-VEGF injection and the dexamethasone implant groups. For CRVO cases, the dexamethasone implant group exhibited a significantly higher loss of retinal fluid and thus a greater reduction in retinal edema than the anti-VEGF group. Linear regression analysis revealed that in BRVO cases poor final visual acuity was associated with a large amount of fluid at baseline and poor visual acuity 1 and 3 months after treatment. In CRVO cases, poor final visual acuity was associated with a large change in the intraretinal fluid level and poor visual acuity 3 months after treatment. @*Conclusions@#The extent of anatomical and visual acuity improvement did not differ between the anti-VEGF injection and the dexamethasone injection groups with BRVO. For CRVO patients, the short-term anatomical improvement was significantly greater in the latter group, but the extent of vision improvement was significantly higher in the former group.

Two-dimensional Quantitative Effects of Anti-vascular Endothelial Growth Factor and Dexamethasone Implants on Retinal Vein Occlusion

Purpose@#We quantitatively analyzed the therapeutic effects of intravitreal anti-vascular endothelial growth factor (anti-VEGF) and dexamethasone implants used to treat macular edema caused by retinal vein occlusion. @*Methods@#Eighty-three patients with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) with macular edema treated from February 2009 to August 2019 via anti-VEGF injections or dexamethasone implants were enrolled. The medical records of 83 eyes were retrospectively analyzed. Horizontal B-scan spectral domain optical coherence tomography images spanning the foveal center were obtained before treatment and 1 month later. These were analyzed with the aid of Image J software and the numbers of pixels corresponding to intraretinal and subretinal fluids calculated. @*Results@#In patients with BRVO, the retinal fluid changes were identical 1 month after injection in both the anti-VEGF injection and the dexamethasone implant groups. For CRVO cases, the dexamethasone implant group exhibited a significantly higher loss of retinal fluid and thus a greater reduction in retinal edema than the anti-VEGF group. Linear regression analysis revealed that in BRVO cases poor final visual acuity was associated with a large amount of fluid at baseline and poor visual acuity 1 and 3 months after treatment. In CRVO cases, poor final visual acuity was associated with a large change in the intraretinal fluid level and poor visual acuity 3 months after treatment. @*Conclusions@#The extent of anatomical and visual acuity improvement did not differ between the anti-VEGF injection and the dexamethasone injection groups with BRVO. For CRVO patients, the short-term anatomical improvement was significantly greater in the latter group, but the extent of vision improvement was significantly higher in the former group.

Possibility of pharmacokinetic drug interaction between a DPP-4 inhibitor and a SGLT2 inhibitor

Type 2 diabetes mellitus is a multifactorial condition characterized by high level of sugar in the blood. To control hyperglycemia, combination therapy is recommended if monotherapy fails to achieve glycemic control. The combination of a dipeptidyl peptidase-4 (DPP-4) inhibitor and a sodium-glucose cotransporter type 2 (SGLT2) inhibitor is a promising option of the combination therapies in terms of safety as well as efficacy. Despite of the value of combination therapy of these two agents, the pharmacokinetic drug interactions between these two classes of agents have been evaluated in a few drugs. Thus, we reviewed the potential pharmacokinetic drug interaction based on the in vitro metabolism- and transporter-mediated drug interaction information as well as drug interaction studies in human, between a DPP-4 inhibitor and a SGLT2 inhibitor which are marketed in South Korea.

Risk of Metabolic and Cardiovascular Risk Factors in Individuals with Autonomic Imbalance Measured by Heart Rate Variability

Background@#Studies have reported that reduced autonomic nervous system activity could result in a suboptimal health condition and various diseases, further increasing the mortality rate. The present study aimed to determine the difference in risk factors for metabolic and cardiovascular diseases in patients with reduced or unstable autonomic activity according to heart rate variability test results. @*Methods@#We recorded blood pressure, physical measurements (body mass index and waist circumference), fasting blood glucose, and blood lipid status. Indicators representative of autonomic nerve functionality (total power [TP], standard deviation of the normal-to-normal intervals [SDNN], low-frequency band [LF], high-frequency band [HF]) were measured using a 5-minute heart rate variability test. Each indicator was divided into quartiles. @*Results@#In men, the risk of abdominal obesity was high in the group with a low TP. In the group with a low SDNN, TP, and LF, the risk of a blood pressure increase was high. When LH and HF were low, there was a high risk of increased fasting blood sugar, whereas when LH was low, there was a high risk of hypertriglyceridemia. Women with SDNN loss had higher odds ratios for abdominal obesity and low high-density lipoprotein cholesterolemia. @*Conclusions@#These results indicate a higher risk of having risk factors for metabolic and cardiovascular diseases, such as abdominal obesity, elevated blood pressure, hyperglycemia, hypertriglyceridemia, and low high-density lipoprotein cholesterolemia in a group with reduced autonomic activity measured by heart rate variability. Women with a low SDNN had a 4.51-fold higher risk of abdominal obesity than women with a high SDNN, showing the greatest value of the heart rate variability indices.

Robotic single-site staging operation for early-stage endometrial cancer: initial experience at a single institution

OBJECTIVE: The aims of this study were to introduce surgical guidelines, and to evaluate the feasibility and safety of a robotic single-site staging (RSSS) operation for early-stage endometrial cancer. METHODS: Patients with a preoperative diagnosis of endometrial cancer (International Federation of Gynecology and Obstetrics stages IA to IB) from endometrial curettage and preoperative imaging studies were selected at Dongsan Medical Center from March 2014 to November 2015. All surgical procedures, including hysterectomy, salpingo-oophorectomy, bilateral pelvic node dissection, and cytology aspiration, were performed by robotic single-site instruments (da Vinci Si® surgical system; Intuitive Surgical, Sunnyvale, CA, USA). RESULTS: A total of 15 women with early-stage endometrial cancer underwent the RSSS operation. The median patient age and body mass index were 53 years (range, 37–70 years) and 25.4 kg/m2 (range, 18.3–46.4 kg/m2). The median docking time, console time, and total operative time were 8 minutes (range, 4–15 minutes), 75 minutes (range, 55–115 minutes), and 155 minutes (range, 125–190 minutes), respectively. The median retrieval of both pelvic lymph nodes was 9 (range, 6–15). There were no conversions to laparoscopy or laparotomy. CONCLUSION: The RSSS operation is feasible and safe in patients with early-stage endometrial cancer. In this study, operative times were reasonable, and the surgical procedure was well-tolerated by the patients. Further evaluation of patients with early-stage endometrial cancer should be performed in large-scale comparative studies using the laparoendoscopic, single-site staging operation to confirm the safety and benefits of the RSSS operation for early-stage endometrial cancer.

Identification of Compound Heterozygous EYS Variants in a Korean Patient with Retinitis Pigmentosa

No abstract available.

Prognostic Factors for Functional and Anatomic Outcomes in Patients with Diabetic Macular Edema Treated with Dexamethasone Implant

PURPOSE: To investigate the prognostic factors of visual and anatomic outcomes in patients with diabetic macular edema (DME) treated with intravitreal injection of dexamethasone implant. METHODS: We retrospectively studied 32 eyes of 31 patients with DME for best-corrected visual acuity (BCVA), central macular thickness, and height and width of both intraretinal fluid (IRF) and subretinal fluid. Logistic regression analysis was used to examine correlations between the baseline characteristics and outcomes at 3 and 6 months. RESULTS: Baseline predictor of BCVA ≥20 / 40 at month 3 was short height of baseline IRF (p = 0.02), while good baseline BCVA was a predictor for month 6 (p = 0.01). Predictors of improvement in logarithm of minimum angle of resolution BCVA 0.2 at month 3 were the absence of baseline IRF and poor baseline BCVA (p = 0.02 and p = 0.009, respectively), while poor baseline BCVA was the sole predictor at month 6 (p = 0.01). Predictor of central macular thickness ≤300 µm at month 3 was younger age (p = 0.03), while the absence of IRF was the predictor for BCVA improvement at month 6 (p = 0.02). BCVA ≤20 / 100 at month 3 was predicted by poor baseline BCVA (p = 0.01), and increased width of total IRF was the predictor at month 6 (p = 0.02). Predictor of loss of logarithm of minimum angle of resolution BCVA 0.2 at month 6 was increased width of total IRF at baseline (p = 0.04). Additional injection within 6 months was negatively associated with the presence of baseline DME (p = 0.03). CONCLUSIONS: The visual and anatomical outcome of DME treatment with dexamethasone implant can be predicted by baseline visual acuity and IRF morphology.

Association of Coffee Consumption with Sarcopenia in Korean Elderly Men: Analysis Using the Korea National Health and Nutrition Examination Survey, 2008–2011 / 가정의학회지

BACKGROUND: Sarcopenia is an age-related loss of muscle mass and strength. Coffee has antioxidant and anti-inflammatory properties that have been shown to be inversely related to the mechanism of sarcopenia. While there have been some studies on the effect of coffee on sarcopenia in animals, studies on the topic in humans are rare. Therefore, we investigated this relationship in elderly Korean men. METHODS: The cross-sectional data were derived from the 2008–2011 Korea National Health and Nutrition Examination Survey. After applying the exclusion criteria, the study sample consisted of 1,781 men who were at least 60 years of age. Study participants were identified as having sarcopenia if their appendicular skeletal muscle mass divided by height squared was less than two standard deviations below the gender-specific mean of this value for young adults. Daily coffee consumption amounts were categorized as <1 cup, 1 cup, 2 cups, and ≥3 cups. RESULTS: Compared to the group of individuals who drank less than one cup of coffee a day, people who consumed at least 3 cups (adjusted odds ratio, 0.43; 95% confidence interval, 0.20 to 0.94) showed significantly decreased sarcopenia; however, the decrease was not significant when the daily coffee consumption was 1 or 2 cups. In multivariate logistic regression models, significant associations were observed between sarcopenia and coffee consumption (P for trend=0.039). CONCLUSION: The results of this study suggest that consuming at least 3 cups of coffee per day was associated with a lower prevalence of sarcopenia in elderly Korean elderly men.

A retrospective comparison of outcome in IB2 and IIA cervical cancer patients treated with primary concurrent chemoradiation versus radical hysterectomy with or without tailored adjuvant therapy

OBJECTIVE: The aim of our study is to compare the overall survival (OS), progression-free survival (PFS), and treatment-related morbidities between primary concurrent chemoradiation therapy (CCRT) vs. radical hysterectomy (RH) with or without tailored adjuvant therapy in patients with stages IB2 and IIA cervical cancer. METHODS: This was a retrospective study of 113 patients with IB2 or IIA cervical cancer treated with either primary CCRT (n=49) or RH (n=64) with or without tailored adjuvant therapy between 2002 and 2011 at Keimyung University Dongsan Medical Center. Patients in RH group was divided into those undergoing surgery alone (n=26) and those undergoing surgery with adjuvant therapy (n=38). RESULTS: The median follow up period was 66 months. The 5-year OS by treatment modality was 88.7% for the 64 patients in the RH group and 72.8% for 49 patients in the CCRT group (P=0.044). The 5-year PFS was 82.3% and 65.6% after RH group and CCRT group (P=0.048), respectively. Grade 3–4 complication was less frequent after RH alone (7.7%) than RH with adjuvant therapy (34.2%) or CCRT group (28.6%) (P=0.047). CONCLUSION: The RH group seems to be superior to the CCRT group in oncologic outcomes. However, considering the selection bias including tumor size, lymph node meta, and parametrial invasion in pretreatment magnetic resonance imaging, both treatment modalities are reasonable and feasible in cervical cancer IB2 and IIA. It is important to choose the appropriate treatment modality considering the age and general condition of the patient. Randomized controlled study is needed to confirm the result of our study and determine the optimal treatment.

Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis

OBJECTIVE: Adenomyosis and endometriosis are relatively common gynecological diseases that exhibit many common features. This study identified gynecological and non-gynecological diseases that exhibited comorbidity with adenomyosis and endometriosis in Korean women. METHODS: We used Health Insurance Review and Assessment data from 2009 to 2011 and searched for adenomyosis and endometriosis (coded as N80.1 and D25 in International Classification of Disease, 10th revision [ICD-10], respectively). We selected records from patients who had independent disease occurrences in each year, and comorbidities were estimated using Fisher's exact test. We computed each year's similarities and combined 3 years' results using Fisher's P-value summation method. RESULTS: A total of 61,516 patients' data were collected during the study period. The prevalence of adenomyosis and endometriosis were similar each year: 12.4% and 9.3% in 2009, 12.5% and 9.4% in 2010 and 13.3% and 9.1% in 2011, respectively. Meta-analysis revealed that 31 ICD-10 codes were significantly related with adenomyosis, and 44 ICD-10 codes were related with endometriosis. Gynecological diseases, such as leiomyoma and benign ovarian tumor, were significantly related to adenomyosis and endometriosis. Non-gynecological diseases, such as anemia and hypercholesterolemia, were also related to adenomyosis and endometriosis. CONCLUSION: We must monitor for the presence of gynecological and non-gynecological diseases with co-morbidities during evaluations and follow-up of patients with adenomyosis or endometriosis.

Zebrafish Larvae Model of Dilated Cardiomyopathy Induced by Terfenadine

BACKGROUND AND OBJECTIVES: Dilated cardiomyopathy can be the end-stage of severe cardiac disorders and directly affects the cardiac muscle, inducing cardiomegaly and heart failure (HF). Although a wide variety of animal models are available to study dilated cardiomyopathy, there is no model to assess dilated cardiomyopathy with non-invasive, simple, and large screening methods. METHODS: We developed a dilated cardiomyopathy model in zebrafish larvae using short duration terfenadine, a known cardiotoxic drug that induces ventricular size dilation. Fractional shortening of zebrafish hearts was calculated. RESULTS: We treated zebrafish with 5 to 10 µM terfenadine for 24 hours. In terfenadine-treated zebrafish, blood frequently pooled and clotted in the chamber, and circulation was remarkably reduced. Atria and ventricles were swollen, and fluid was deposited around the heart, mimicking edema. Cardiac contractility was significantly reduced, and ventricular area was significantly enlarged. Heart rate was markedly reduced even after terfenadine withdrawal. Acridine orange staining also showed that terfenadine increased cardiomyocyte apoptosis. A significant increase of natriuretic peptide B (NPPB) mRNA was found in terfenadine-treated zebrafish. A low dose of terfenadine (5–10 µM) did not show mortality in short-term treatment (24 hours). However, moderate dose (35–45 µM) terfenadine treatment reduced zebrafish survival within 1 hour. CONCLUSION: With advantages of rapid sample preparation procedure and transparent observation of the live heart, this model can potentially be applied to large-scale drug screening and toxicity assays for non-ischemic HF.

The effect of salinomycin on ovarian cancer stem-like cells

OBJECTIVE: The identification of cancer stem-like cells is a recent development in ovarian cancer. Compared to other cancer cells, cancer stem-like cells present more chemo-resistance and more aggressive characteristics. They play an important role in the recurrence and drug resistance of cancer. Therefore, the target therapy of cancer stem-like cell may become a promising and effective approach for ovarian cancer treatment. It may also help to provide novel diagnostic and therapeutic strategies. METHODS: The OVCAR3 cell line was cultured under serum-free conditions to produce floating spheres. The CD44⁺CD117⁺ cell line was isolated from the human ovarian cancer cell line OVCAR3 by using immune magnetic-activated cell sorting system. The expression of stemness genes such as OCT3/4, NANOG and SOX2 mRNA were determined by reverse transcription polymerase chain reaction. OVCAR3 parental and OVCAR3 CD44⁺CD117⁺ cells were grown in different doses of paclitaxel and salinomycin to evaluate the effect of salinomycin. And growth inhibition of OVCAR3 CD44+CD117+ cells by paclitaxel combined with salinomycin was determined by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. RESULTS: Tumor spheroids generated from the OVCAR3 cell line are shown to have highly enriched CD44 and CD117 expression. Treatment with a combination of paclitaxel and salinomycin demonstrated growth inhibition of OVCAR3 CD44+CD117+ cells. CONCLUSION: The present study is a detailed investigation on the expression of CD44 and CD117 in cancer stem cells and evaluates their specific tumorigenic characteristics in ovarian cancer. This study also demonstrates significant growth inhibition of cancer stem-like cells by paclitaxel combined with salinomycin. Identification of these cancer stem-like cell markers and growth inhibition effect of salinomycin may be the next step to the development of novel target therapy in ovarian cancer.

Evaluation of factors associated with drug-induced liver injury using electronic medical records

The causes and attributing factors of drug-induced liver injury (DILI) remain unclear as a result of exclusion-based diagnosis and low incidence. The aim of this study was to explore and evaluate potential drug-related causes and factors associated with DILI. Using electronic medical records (EMR) from the Seoul National University Bundang Hospital from 2003 to 2014, patients with DILI events were identified based on liver function test results. All patients with hepatic or biliary diseases were excluded. Patient characteristics, including demographics, clinical patterns, and severity of DILI were summarized and their associations were evaluated. Drugs frequently prescribed to patients exhibiting DILI within the month before their first DILI event compared to the total patient population were identified and the probabilities of hepatotoxicity associated with their use were assessed through examination of available reports. Among the 1,835 patients with laboratory test results, 1,023 were male and 1,053 were 65 years of age or older. Moderate DILI was dominant in older or male patients and cholestatic DILI tended to be more frequently identified in older patients of either sex. Cytarabine was the most frequently prescribed drug in DILI patients, followed by aprotinin and dopamine. Among the 30 most frequently prescribed drugs in DILI patients, 15 (50%) were identified as known hepatotoxic agents. In conclusion, this study evaluated differences in features of DILI among groups based on demographics and explored candidate drugs with possible associations with DILI, which has potential value reflecting real-world clinical practice.

Changes in Fundus Autofluorescence after Anti-vascular Endothelial Growth Factor According to the Type of Choroidal Neovascularization in Age-related Macular Degeneration

PURPOSE: To describe the changes of fundus autofluorescence (FAF) in patients with age-related macular degeneration before and after intravitreal injection of anti-vascular endothelial growth factor according to the type of choroidal neovascularization (CNV) and to evaluate the correlation of FAF with spectral domain optical coherence tomography (SD-OCT) parameters and vision. METHODS: This was a retrospective study. Twenty-one treatment-naive patients with neovascular age-related macular degeneration were included. Study eyes were divided into two groups according to the type of CNV. Fourteen eyes were type 1 CNV and seven eyes were type 2 CNV. All eyes underwent a complete ophthalmologic examination, including an assessment of best-corrected visual acuity, SD-OCT, fluorescein angiography, and FAF imaging, before and 3 months after intravitreal anti-vascular endothelial growth factor injection. Gray scales of FAF image for CNV areas, delineated as in fluorescein angiography, were analyzed using the ImageJ program, which were adjusted by comparison with normal background areas. Correlation of changes in FAF with changes in SD-OCT parameters, including CNV thickness, photoreceptor inner and outer segment junction disruption length, external limiting membrane disruption length, central macular thickness, subretinal fluid, and intraretinal fluid were analyzed. RESULTS: Eyes with both type 1 and type 2 CNV showed reduced FAF before treatment. The mean gray scales (%) of type 1 and type 2 CNV were 52.20% and 42.55%, respectively. The background values were 106.72 and 96.86. After treatment, the mean gray scales (%) of type 1 CNV and type 2 CNV were changed to 57.61% (p = 0.005) and 57.93% (p = 0.008), respectively. After treatment, CNV thickness, central macular thickness, and inner and outer segment junction disruption length were decreased while FAF increased. CONCLUSIONS: FAF was noted to be reduced in eyes with newly diagnosed wet age-related macular degeneration, but increased after anti-vascular endothelial growth factor therapy regardless of CNV lesion type.

Triglyceride Is a Useful Surrogate Marker for Insulin Resistance in Korean Women with Polycystic Ovary Syndrome

PURPOSE: To evaluate lipid profiles and liver enzymes as surrogate markers used for recognizing insulin resistance in Korean women with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: 458 women with PCOS were divided into two groups: non-obese with a body mass index (BMI) or =25.0 kg/m2. Anthropometric measures and blood sampling for hormone assay, liver enzymes, lipid profiles and 75 g oral glucose tolerance test were performed. Insulin resistance was defined as homeostasis model assessment of insulin resistance (HOMA-IR)> or =2.5. Areas under the receiver operating characteristic (ROC) curves were used to compare the power of serum markers. Multiple linear regression analysis was used to evaluate the contribution of each confounding factor for HOMA-IR. RESULTS: In non-obese and obese groups, the ROC curve analyses demonstrated that the best marker for insulin resistance was triglyceride (TG), with the areas under the ROC curve of 0.617 and 0.837, respectively. Low-density lipoprotein cholesterol (LDL-C) was the significant marker for insulin resistance with areas under the ROC curve of 0.698 in obese group, but not significant in non-obese group. TG and LDL-C were significantly associated with HOMA-IR in both non-obese and obese PCOS women by multiple linear regression analysis. The optimal cut-off points of TG> or =68.5 was a marker for predicting insulin resistance in non-obese PCOS patients and TG> or =100.5 in obese group. CONCLUSION: TG can be used as a useful marker for insulin resistance in Korean women with PCOS, especially for obese patients.

Bone Mineral Density of Young Korean Women and Its Correlation with Thyroid Stimulating Hormone / 대한골다공증학회지

OBJECTIVES: The bone mineral density (BMD) of young aged women was not fully investigated because of the limited indication of BMD test. This study was to investigate mean Z-score of BMD in healthy young aged Korean women and to find out factors influencing the BMD score in her twenties and thirties. METHODS: A total 876 young aged (20-40 years) women who had taken dual energy X-ray absorptiometry (DXA) for BMD screening from 2010 to 2014 were analyzed retrospectively using demographic data including body mass index (BMI), waist circumference (WC), thyroid stimulating hormone (TSH), and serum lipid profile. We compared the two age groups, in her twenties and thirties, regarding BMD and other parameters.