Differences between the Results Assessed by Slit Lamp Examination and Anterior Segment Photography in Terms of Cataract Grading

Purpose@#We compared the cataract grades with slit lamp examination and anterior segment photography using the Lens Opacities Classification System (LOCS) III criteria. We also explored the effect of a yellow filter on the photographic results. @*Methods@#Eighty eyes with cataracts were examined by three inspectors (1, 2, and 3). Anterior segment photographs taken by inspector 1 were divided into two groups depending on whether cortical opacity or nuclear sclerosis predominated. In each group, the cataract grades determined by inspector 1 on slit lamp examination and anterior segment photography were compared. Also, after randomly assigning the anterior segment photographs taken by inspector 1 to inspectors 2 and 3, the cataract grades of these photographs were compared to the grades of photographs taken by all inspectors using a yellow filter. @*Results@#The average cortical opacity evaluated by inspector 1 on slit lamp examination (3.48 ± 0.91) was significantly higher than that apparent on anterior segment photographs (2.35 ± 0.77) (p < 0.001). In the photographs, the average cortical opacity when a yellow filter was used was significantly higher for both inspectors 1 (p < 0.001) and 2 (p = 0.022) than when the filter was absent. The average extent of nuclear sclerosis evaluated by inspector 1 on slit lamp examination (4.08 ± 0.94) was significantly higher than that of anterior segment photography (3.73 ± 1.24) (p = 0.042). @*Conclusions@#Cataract evaluation via anterior segment photography underestimates the extent of damage compared to direct slit lamp examination. However, use of a yellow filter during photography aids cataract evaluation, especially cortical opacity.

Why Have the Republic of Korea, Taiwan, and Singapore Coped Well with COVID-19 and What Are the Lessons Learned from Their Experiences?

This study investigated how three Asian countries–Republic of Korea (ROK), Republic of China (Taiwan), and Singapore–considered as standouts, responded to the coronavirus disease 2019 (COVID-19) in terms of governance system, health sector innovation, and social distancing to draw lessons that other countries can learn from. The countries were commonly in success of the response in early stage of the pandemic thanks to their effective and efficient strategies paired with advanced information and communications technology (ICT). Consequently, the three jurisdictions reported lower confirmed cases as well as fatality rate of the infectious disease compared to other high-income countries. In addition, the countries’ previous experiences with other pandemics, including influenza A, Middle East respiratory syndrome, and severe acute respiratory syndrome, enabled them to establish resilient public health systems and gain public acceptance to governmental control or surveillance during national infectious disease-related crises outbreaks. Advanced ICT infrastructure and digital technology were used as effective tools for testing, tracing, and treatment of the pandemic in collaboration with the private sector as a crucial player. The ROK, Taiwan, and Singapore adopted different strategies between containment and mitigation policy to flatten the epidemic curves effectively according to their own situation and judgement. Despite the exemplary aspect of the three nations in coping with the COVID-19 pandemic, a few limitations were also observed in terms of vaccination and unequal consequences of the pandemic among people. These should be further discussed in order to be prepared for future pandemics.

Regional Gray Matter Volume Related to High Occupational Stress in Firefighters

Background@#Firefighters inevitably encounter emotionally and physically stressful situations at work. Even firefighters without diagnosed post-traumatic stress disorder receive clinical attention because the nature of the profession exposes them to repetitive trauma and high occupational stress. This study investigated gray matter abnormalities related to high occupational stress in firefighters using voxel-based morphometry (VBM) and surface-based morphometry (SBM). @*Methods@#We assessed 115 subjects (112 males and 3 females) using magnetic resonance imaging and evaluated occupational stress by the Korean Occupational Stress Scale-26 (KOSS-26). Subjects were classified into highly or lowly stressed groups based on the median value of the KOSS-26. @*Results@#In VBM analysis, we found that firefighters with high occupational stress had lower gray matter volume (GMV) in both sides of the insula, the left amygdala, the right medial prefrontal cortex (mPFC), and the anterior cingulate cortex than firefighters with low occupational stress. In SBM analysis based on regions of interest, the GMV of the bilateral insula and right mPFC were also lower in the highly stressed group. Within the highly stressed group, low GMV of the insula was significantly correlated with the length of service (left: r = −0.347, P = 0.009; right: r = −0.333, P = 0.012). @*Conclusion@#Our findings suggest that regional GMV abnormalities are related to occupational stress. Regional gray matter abnormalities and related emotional dysregulation may contribute to firefighter susceptibility to burnout.

Management of the COVID-19 Pandemic in the Republic of Korea from the Perspective of Governance and Public-Private Partnership

The government of the Republic of Korea (ROK) has established relevant laws and a master plan for infectious disease control and prevention based on their experiences with past epidemics. In addition, the Ministry of Health and Welfare has designed a standard manual for risk management that involves pan-governmental crisis management systems. This national infectious disease management system is constantly being supplemented and developed in face of infectious disease-related crises. In this study, we set out to present directions for infectious disease prevention and flow of management and governance between central and local governments to ensure systematic quarantine activities in the ROK. During the coronavirus disease 2019 (COVID-19) pandemic, public-private partnerships have been established to collect, provide, process, and disseminate information for effective quarantine. This has enabled the development and rapid approval of test kits, the tracking of cases, and the allocation of appropriate resources for patient treatment. Additionally, the Infectious Disease Control Agency has actively utilized information and communication technology platforms to disclose information necessary in real-time for COVID-19 quarantine and management. Overall, these efforts have played an important role in epidemiological investigations, patient management, and quarantine in the early stages of the COVID-19 pandemic.

Clusters of Toxoplasmosis in Ganghwa-gun, Cheorwon-gun, and Goseong-gun, Korea

We find out the clusters with high toxoplasmosis risk to discuss the geographical pattern in Gyodong-myeon and Samsan-myeon of Ganghwa-gun, Cheorwon-gun, and Goseong-gun, Korea. Seroepidemiological data of toxoplasmosis surveyed using rapid diagnostic tests for the residents in the areas in 2019 were analyzed to detect clusters of the infection. The cluster was investigated using the SaTScan program which is based on Kulldorff’s scan statistic. The clusters were found with P-values in each region analyzed in the program, and the risk and patient incidence of specific areas can be examined by the values such as relative risk and log likelihood ratio. Jiseok-ri and Insa-ri were found to be a cluster in Gyodong-myeon and Seokmo-ri was the cluster in Samsan-myeon. Yangji-ri and Igil-ri were found to be a cluster in Cheorwon-gun and Madal-ri and Baebong-ri were the cluster in Goseong-gun. This findings can be used to monitor and prevent toxoplasmosis infections occurring in vulnerable areas.

The Normative Retinal and Choroidal Thicknesses of the Rabbit as Revealed by Spectral Domain Optical Coherence Tomography

Purpose@#We used spectral domain optical coherence tomography (SD-OCT) to assess the retinal and choroidal thicknesses of the rabbit, a commonly used animal model of ophthalmic disease. We report normative datasets. @*Methods@#Semi-automated measurements were made on 15 normal right eyes of New Zealand white rabbits. Total retinal, inner retinal layer, outer retinal layer, choroidal, ganglion cell layer, ganglion cell complex, inner nuclear layer, and outer nuclear layer thicknesses were measured at fixed distances (0, 1, 2, 3, 4, and 5 mm) below the optic nerve head. @*Results@#Total retinal layer (Pearson’s correlation coefficient [CC] = -0.778, p < 0.05), inner retinal layer (CC = -0.710, p < 0.05), outer retinal layer (CC = -0.495, p < 0.05), ganglion cell complex (CC = -0.292, p < 0.05), ganglion cell layer (CC = -0.284, p < 0.05), and outer nuclear layer thicknesses (CC = -0.760, p < 0.05) decreased with the distance from the optic nerve head. Inner nuclear layer thickness correlated negatively with the distance from the optic nerve head, but the correlation coefficient was low (CC = -0.263, p < 0.05). Choroidal thickness increased with the distance from the optic nerve head (CC = 0.511, p < 0.05). @*Conclusions@#Rabbit retinal thicknesses were measured and analyzed by the distance from the optic nerve head. The datasets will serve as standards when using rabbits.

Management of the COVID-19 Pandemic in the Republic of Korea from the Perspective of Governance and Public-Private Partnership

The government of the Republic of Korea (ROK) has established relevant laws and a master plan for infectious disease control and prevention based on their experiences with past epidemics. In addition, the Ministry of Health and Welfare has designed a standard manual for risk management that involves pan-governmental crisis management systems. This national infectious disease management system is constantly being supplemented and developed in face of infectious disease-related crises. In this study, we set out to present directions for infectious disease prevention and flow of management and governance between central and local governments to ensure systematic quarantine activities in the ROK. During the coronavirus disease 2019 (COVID-19) pandemic, public-private partnerships have been established to collect, provide, process, and disseminate information for effective quarantine. This has enabled the development and rapid approval of test kits, the tracking of cases, and the allocation of appropriate resources for patient treatment. Additionally, the Infectious Disease Control Agency has actively utilized information and communication technology platforms to disclose information necessary in real-time for COVID-19 quarantine and management. Overall, these efforts have played an important role in epidemiological investigations, patient management, and quarantine in the early stages of the COVID-19 pandemic.

Clusters of Toxoplasmosis in Ganghwa-gun, Cheorwon-gun, and Goseong-gun, Korea

We find out the clusters with high toxoplasmosis risk to discuss the geographical pattern in Gyodong-myeon and Samsan-myeon of Ganghwa-gun, Cheorwon-gun, and Goseong-gun, Korea. Seroepidemiological data of toxoplasmosis surveyed using rapid diagnostic tests for the residents in the areas in 2019 were analyzed to detect clusters of the infection. The cluster was investigated using the SaTScan program which is based on Kulldorff’s scan statistic. The clusters were found with P-values in each region analyzed in the program, and the risk and patient incidence of specific areas can be examined by the values such as relative risk and log likelihood ratio. Jiseok-ri and Insa-ri were found to be a cluster in Gyodong-myeon and Seokmo-ri was the cluster in Samsan-myeon. Yangji-ri and Igil-ri were found to be a cluster in Cheorwon-gun and Madal-ri and Baebong-ri were the cluster in Goseong-gun. This findings can be used to monitor and prevent toxoplasmosis infections occurring in vulnerable areas.

The Normative Retinal and Choroidal Thicknesses of the Rabbit as Revealed by Spectral Domain Optical Coherence Tomography

Purpose@#We used spectral domain optical coherence tomography (SD-OCT) to assess the retinal and choroidal thicknesses of the rabbit, a commonly used animal model of ophthalmic disease. We report normative datasets. @*Methods@#Semi-automated measurements were made on 15 normal right eyes of New Zealand white rabbits. Total retinal, inner retinal layer, outer retinal layer, choroidal, ganglion cell layer, ganglion cell complex, inner nuclear layer, and outer nuclear layer thicknesses were measured at fixed distances (0, 1, 2, 3, 4, and 5 mm) below the optic nerve head. @*Results@#Total retinal layer (Pearson’s correlation coefficient [CC] = -0.778, p < 0.05), inner retinal layer (CC = -0.710, p < 0.05), outer retinal layer (CC = -0.495, p < 0.05), ganglion cell complex (CC = -0.292, p < 0.05), ganglion cell layer (CC = -0.284, p < 0.05), and outer nuclear layer thicknesses (CC = -0.760, p < 0.05) decreased with the distance from the optic nerve head. Inner nuclear layer thickness correlated negatively with the distance from the optic nerve head, but the correlation coefficient was low (CC = -0.263, p < 0.05). Choroidal thickness increased with the distance from the optic nerve head (CC = 0.511, p < 0.05). @*Conclusions@#Rabbit retinal thicknesses were measured and analyzed by the distance from the optic nerve head. The datasets will serve as standards when using rabbits.

Clusters of Toxoplasmosis in Gyodong-Myeon and Samsan-Myeon, Ganghwa-Gun, Korea

The purpose of this study is to find out the clusters with high toxoplasmosis risk to discuss the geographical pattern in 2 islands of Gyodong-myeon and Samsan-myeon in Ganghwa-gun, Korea. Seroepidemiological data of toxoplasmosis surveyed using rapid diagnostic tests for the residents in 2 islands from 2010 to 2013 were analyzed to detect clusters of the infection. The cluster was investigated using the SatScan program which is based on Kulldorff’s scan statistic. The clusters were found with P-values in each region analyzed in the program, and the risk and patient incidence of specific areas can be examined by the values such as relative risk and log likelyhood ratio. Jiseok-ri was found to be a cluster in Gyodong-myeon and Ha-ri was the cluster in Samsan-myeon. This findings can be used to monitor and prevent toxoplasmosis infections occurring in vulnerable areas.

Cost-Effectiveness of Rate- and Rhythm-Control Drugs for Treating Atrial Fibrillation in Korea

PURPOSE: Although the economic and mortality burden of atrial fibrillation (AF) is substantial, it remains unclear which treatment strategies for rate and rhythm control are most cost-effective. Consequently, economic factors can play an adjunctive role in guiding treatment selection. MATERIALS AND METHODS: We built a Markov chain Monte Carlo model using the Korean Health Insurance Review & Assessment Service database. Drugs for rate control and rhythm control in AF were analyzed. Cost-effective therapies were selected using a cost-effectiveness ratio, calculated by net cost and quality-adjusted life years (QALY). RESULTS: In the National Health Insurance Service data, 268149 patients with prevalent AF (age ≥18 years) were identified between January 1, 2013 and December 31, 2015. Among them, 212459 and 55690 patients were taking drugs for rate and rhythm control, respectively. Atenolol cost $714/QALY. Among the rate-control medications, the cost of propranolol was lowest at $487/QALY, while that of carvedilol was highest at $1363/QALY. Among the rhythm-control medications, the cost of pilsicainide was lowest at $638/QALY, while that of amiodarone was highest at $986/QALY. Flecainide and propafenone cost $834 and $830/QALY, respectively. The cost-effectiveness threshold of all drugs was lower than $30000/QALY. Compared with atenolol, the rate-control drugs propranolol, betaxolol, bevantolol, bisoprolol, diltiazem, and verapamil, as well as the rhythm-control drugs sotalol, pilsicainide, flecainide, propafenone, and dronedarone, showed better incremental cost-effectiveness ratios. CONCLUSION: Propranolol and pilsicainide appear to be cost-effective in patients with AF in Korea assuming that drug usage or compliance is the same.

Effect of Burnout on Post-traumatic Stress Disorder Symptoms Among Firefighters in Korea: Data From the Firefighter Research on Enhancement of Safety & Health (FRESH) / 예방의학회지

OBJECTIVES@#It is well-known that post-traumatic stress disorder (PTSD) among firefighters contributes to their job-related stress. However, the relationship between burnout and PTSD in firefighters has rarely been studied. This study therefore explored the association between burnout and its related factors, such as trauma and violence, and PTSD symptoms among firefighters in Korea.@*METHODS@#A total of 535 firefighters participated in the Firefighter Research on Enhancement of Safety & Health study at 3 university hospitals from 2016 to 2017. The 535 participants received a baseline health examination, including questionnaires assessing their mental health. A Web-based survey was also conducted to collect data on job-related stress, history of exposure to violence, burnout, and trauma experience. The associations among burnout, its related factors, and PTSD symptoms were investigated using structural equation modeling.@*RESULTS@#Job demands (β=0.411, p<0.001) and effort-reward balance (β=-0.290, p<0.001) were significantly related to burnout. Burnout (β=0.237, p<0.001) and violence (β=0.123, p=0.014) were significantly related to PTSD risk. Trauma (β=0.131, p=0.001) was significantly related to burnout; however, trauma was not directly associated with PTSD scores (β=0.085, p=0.081).@*CONCLUSIONS@#Our results show that burnout and psychological, sexual, and physical violence at the hands of clients directly affected participants’ PTSD symptoms. Burnout mediated the relationship between trauma experience and PTSD.

Short-term Effect of Ambient Air Pollution on Emergency Department Visits for Diabetic Coma in Seoul, Korea / 예방의학회지

OBJECTIVES: A positive association between air pollution and both the incidence and prevalence of diabetes mellitus (DM) has been reported in some epidemiologic and animal studies, but little research has evaluated the relationship between air pollution and diabetic coma. Diabetic coma is an acute complication of DM caused by diabetic ketoacidosis or hyperosmolar hyperglycemic state, which is characterized by extreme hyperglycemia accompanied by coma. We conducted a time-series study with a generalized additive model using a distributed-lag non-linear model to assess the association between ambient air pollution (particulate matter less than 10 μm in aerodynamic diameter, nitrogen dioxide [NO2], sulfur dioxide, carbon monoxide, and ozone) and emergency department (ED) visits for DM with coma in Seoul, Korea from 2005 to 2009. METHODS: The ED data and medical records from the 3 years previous to each diabetic coma event were obtained from the Health Insurance Review and Assessment Service to examine the relationship with air pollutants. RESULTS: Overall, the adjusted relative risks (RRs) for an interquartile range (IQR) increment of NO2 was statistically significant at lag 1 (RR, 1.125; 95% confidence interval [CI], 1.039 to 1.219) in a single-lag model and both lag 0-1 (RR, 1.120; 95% CI, 1.028 to 1.219) and lag 0-3 (RR, 1.092; 95% CI, 1.005 to 1.186) in a cumulative-lag model. In a subgroup analysis, significant positive RRs were found for females for per-IQR increments of NO2 at cumulative lag 0-3 (RR, 1.149; 95% CI, 1.022 to 1.291). CONCLUSIONS: The results of our study suggest that ambient air pollution, specifically NO2, is associated with ED visits for diabetic coma.

The efficacy of combination treatment of gabapentin and electro-acupuncture on paclitaxel-induced neuropathic pain

Paclitaxel, a chemotherapeutic drug, induces severe peripheral neuropathy. Gabapentin (GBT) is a first line agent used to treat neuropathic pain, and its effect is mediated by spinal noradrenergic and muscarinic cholinergic receptors. Electro-acupuncture (EA) is used for treating various types of pain via its action through spinal opioidergic and noradrenergic receptors. Here, we investigated whether combined treatment of these two agents could exert a synergistic effect on paclitaxel-induced cold and mechanical allodynia, which were assessed by the acetone drop test and von Frey filament assay, respectively. Significant signs of allodynia were observed after four paclitaxel injections (a cumulative dose of 8 mg/kg, i.p.). GBT (3, 30, and 100 mg/kg, i.p.) or EA (ST36, Zusanli) alone produced dose-dependent anti-allodynic effects. The medium and highest doses of GBT (30 and 100 mg/kg) provided a strong analgesic effect, but they induced motor dysfunction in Rota-rod tests. On the contrary, the lowest dose of GBT (3 mg/kg) did not induce motor weakness, but it provided a brief analgesic effect. The combination of the lowest dose of GBT and EA resulted in a greater and longer effect, without inducing motor dysfunction. This effect on mechanical allodynia was blocked by spinal opioidergic (naloxone, 20 μg), or noradrenergic (idazoxan, 10 μg) receptor antagonist, whereas on cold allodynia, only opioidergic receptor antagonist blocked the effect. In conclusion, the combination of the lowest dose of GBT and EA has a robust and enduring analgesic action against paclitaxel-induced neuropathic pain, and it should be considered as an alternative treatment method.

Involvement of spinal muscarinic and serotonergic receptors in the anti-allodynic effect of electroacupuncture in rats with oxaliplatin-induced neuropathic pain

This study was performed to investigate whether the spinal cholinergic and serotonergic analgesic systems mediate the relieving effect of electroacupuncture (EA) on oxaliplatin-induced neuropathic cold allodynia in rats. The cold allodynia induced by an oxaliplatin injection (6 mg/kg, i.p.) was evaluated by immersing the rat's tail into cold water (4℃) and measuring the withdrawal latency. EA stimulation (2 Hz, 0.3-ms pulse duration, 0.2~0.3 mA) at the acupoint ST36, GV3, or LI11 all showed a significant anti-allodynic effect, which was stronger at ST36. The analgesic effect of EA at ST36 was blocked by intraperitoneal injection of muscarinic acetylcholine receptor antagonist (atropine, 1 mg/kg), but not by nicotinic (mecamylamine, 2 mg/kg) receptor antagonist. Furthermore, intrathecal administration of M(2) (methoctramine, 10 µg) and M(3) (4-DAMP, 10 µg) receptor antagonist, but not M(1) (pirenzepine, 10 µg) receptor antagonist, blocked the effect. Also, spinal administration of 5-HT(3) (MDL-72222, 12 µg) receptor antagonist, but not 5-HT(1A) (NAN-190, 15 µg) or 5-HT(2A) (ketanserin, 30 µg) receptor antagonist, prevented the anti-allodynic effect of EA. These results suggest that EA may have a signifi cant analgesic action against oxaliplatin-induced neuropathic pain, which is mediated by spinal cholinergic (M(2), M(3)) and serotonergic (5-HT(3)) receptors.

Neural circuit remodeling and structural plasticity in the cortex during chronic pain

Damage in the periphery or spinal cord induces maladaptive plastic changes along the somatosensory nervous system from the periphery to the cortex, often leading to chronic pain. Although the role of neural circuit remodeling and structural synaptic plasticity in the 'pain matrix' cortices in chronic pain has been thought as a secondary epiphenomenon to altered nociceptive signaling in the spinal cord, progress in whole brain imaging studies on human patients and animal models has suggested a possibility that plastic changes in cortical neural circuits may actively contribute to chronic pain symptoms. Furthermore, recent development in two-photon microscopy and fluorescence labeling techniques have enabled us to longitudinally trace the structural and functional changes in local circuits, single neurons and even individual synapses in the brain of living animals. These technical advances has started to reveal that cortical structural remodeling following tissue or nerve damage could rapidly occur within days, which are temporally correlated with functional plasticity of cortical circuits as well as the development and maintenance of chronic pain behavior, thereby modifying the previous concept that it takes much longer periods (e.g. months or years). In this review, we discuss the relation of neural circuit plasticity in the 'pain matrix' cortices, such as the anterior cingulate cortex, prefrontal cortex and primary somatosensory cortex, with chronic pain. We also introduce how to apply long-term in vivo two-photon imaging approaches for the study of pathophysiological mechanisms of chronic pain.

Phacoemulsification versus Combined Phacotrabeculectomy in Closed-Angle Patients with Re-Elevated Intraocular Pressure after Peripheral Iridotomy

PURPOSE: To investigate the clinical courses between phacoemulsification (PE) and PE with combined trabeculectomy (phacotrabeculectomy, PETL) in closed-angle patients with re-elevated intraocular pressure (IOP) after laser peripheral iridotomy (LPI). METHODS: Closed-angle patients whose IOP re-elevated between 19 and 38 mm Hg after LPI were included. Medical records of 26 patients in the PE group and 21 patients in the PETL group who were followed for more than 12 months after surgery were reviewed for clinical course. RESULTS: The IOP courses after surgery showed no statistical difference during the study period except at 1 and 7 days after surgery, in which IOP in the PETL group were lower than that in the PE group. The number of anti-glaucoma drugs also showed no significant difference except at 6 months, when the number was greater in the PE group. Success rates for IOP below 18 mm Hg at 3 years were 96.2% in the PE group, higher than the 69.8% in the PETL group (Log Rank test, p = 0.015). Postoperative complications were found in 2 patients in the PE group and in 8 patients in the PETL group (Fisher's exact test, p = 0.028). CONCLUSIONS: We suggest that PE is a viable surgical alternative to PETL in closed-angle patients who have mildly re-elevated IOP after LPI.

Never-Smoker Lung Cancer Is Increasing

PURPOSE: Lung cancer has been the leading cause of death in South Korea since the year 2000. Adenocarcinoma became the most frequent type in the national survey of lung cancer since year 2005. MATERIALS AND METHODS: We analyzed 5,456 cases with lung cancer from 2004 to 2012 in a community cancer center. The mean age was 69.9 years, and 78.9% was male. RESULTS: Adenocarcinoma (ADC, 40.8%) was the most frequent type, followed by squamous cell carcinoma (SQC, 36.4%), small cell carcinoma (SCC, 14.8%) and non-small cell lung cancer (NSCLC) not otherwise specified (8.1%). In male patients, SQC was the most frequent type (43.5%), while ADC showed highest incidence in females (72.6%). Anatomic stage at diagnosis in NSCLC was I (10.3%), II (5.8%), IIIA (15.7%), IIIB (19.2%), and IV (49.0%). In SCC, 41.7% was in limited stage and 58.3% was diagnosed in extensive stage. The proportion of never smoker has been increased from 19.1% in 2004~2008 to 25.4% in 2009~2012. Never-smokers are more likely to be female (68.2% vs. 4.0%, p<0.001), have ADC (69.9% vs. 31.3%, p<0.001), and manifest as stage IV disease (58.5% vs. 45.2%, p<0.001), compared to smokers. Among 1,908 cases whose initial treatment was recorded, 42.5% received chemotherapy, 25.7% received radiation treatment, 20.5% received surgery and the remaining 11.3% received supportive cares only or transferred to other health care facilities. CONCLUSION: In conclusion, proportion of lung cancer in never-smoker is increasing. As screening for smokers will miss this growing population, we need to discover biomarkers to find high risk population of lung cancer.

Abnormal Integrity of Corticocortical Tracts in Mild Cognitive Impairment: A Diffusion Tensor Imaging Study

Mild cognitive impairment (MCI) has been defined as a transitional state between normal aging and Alzheimer disease. Diffusion tensor imaging (DTI) can estimate the microstructural integrity of white matter tracts in MCI. We evaluated the microstructural changes in the white matter of MCI patients with DTI. We recruited 11 patients with MCI who met the working criteria of MCI and 11 elderly normal controls. The mean diffusivity (MD) and fractional anisotropy (FA) were measured in 26 regions of the brain with the regions of interest (ROIs) method. In the MCI patients, FA values were significantly decreased in the hippocampus, the posterior limb of the internal capsule, the splenium of corpus callosum, and in the superior and inferior longitudinal fasciculus compared to the control group. MD values were significantly increased in the hippocampus, the anterior and posterior limbs of the internal capsules, the splenium of the corpus callosum, the right frontal lobe, and in the superior and the inferior longitudinal fasciculus. Microstructural changes of several corticocortical tracts associated with cognition were identified in patients with MCI. FA and MD values of DTI may be used as novel biomarkers for the evaluation of neurodegenerative disorders.