Direct gastric invasion from the liver metastasis of colorectal origin: A case report.

RATIONALE: Colorectal cancer is the third most common cancer diagnosed worldwide. At the time of diagnosis of colorectal cancer, one of the most common metastatic sites is liver. Gastric metastasis from colorectal origin is rare. Moreover, a direct invasion of the stomach, by hepatic metastasis from colorectal cancer, is particularly uncommon. PATIENT CONCERNS: A 56-year-old male patient with hematochezia was referred to our hospital. DIAGNOSIS: The patient was diagnosed with unresectable colorectal cancer because of the presence of >10 metastases involving both lobes of the liver. INTERVENTIONS AND OUTCOMES: After chemotherapy, the metastatic nodules in the liver nearly disappeared, except for a small nodule in segment VI. The patient underwent a radiofrequency ablation for the single lesion in the liver and laparoscopic low-anterior-resection for the primary tumor. Despite receiving various chemotherapy regimens, he experienced 6 recurrences, leading to 5 hepatectomies including a right hemi-hepatectomy, 1 pulmonary wedge resection, and 2 courses of radiation treatments. Lastly, a metastatic lesion in the liver was observed with invasion into the stomach. Subsequently, gastric wedge resection with resection of segments III and IV of the liver was performed. Direct invasion of the liver metastases into the stomach was confirmed histologically. LESSONS: The patient is still alive, with a good quality of life, even after more than 8 years since the initial diagnosis. In the last instance of metastatic recurrence, direct invasion from the liver metastases into the stomach was observed, which is rare, and there are currently no reported cases.

Single-incision bone bridge lateral meniscus allograft transplantation: preserving neurovascular safety with promising results for posterior horn distortion and graft maturation.

PURPOSE: This study aimed to investigate the graft maturation and safety of single-incision bone bridge lateral meniscus allograft transplantation (LMAT). METHODS: This study involved 35 patients who underwent LMAT between 2019 and 2020. All patients completed at least 2 years of follow-up (median 34 months; range 24-43) and underwent preoperative magnetic resonance imaging (MRI) to assess the trajectory safety of the leading suture passer and all-inside suture instrument (Fast-Fix). Graft status was evaluated according to the Stoller classification. RESULTS: Based on preoperative MRI measurements, the expected trajectory of the leading suture passer did not transect the common peroneal nerve (CPN), with the closest distance between the expected trajectory and CPN being 1.4 mm and the average distance being 6.8 ± 3.2 mm. The average distance from the lateral meniscal posterior horn (LMPH) to the popliteal neurovascular bundle (PNVB) was 7.4 ± 2.6 mm and the nearest was 4.8 mm. The expected trajectory of the all-inside suturing instrument did not transect the PNVB when the distance was at least 12 mm, from the most lateral margin of the posterior cruciate ligament (PCL). Grade 3 signal intensity in the posterior third of the allograft on MRI was observed in 6 of 35 (17.1%) patients. Amongst the grade 3 signal intensities in the posterior one-third of the allografts, 3 of the 35 (8.5%) LMATs had a distorted contour. CONCLUSION: The single-incision bone bridge LMAT technique introduced in this study is a convenient approach that preserves neurovascular safety and provides good results for the distortion of the posterior horn of the allograft and graft maturation. The safety zone for the penetrating devices during the procedure extended from 12 mm laterally to the most lateral margin of the PCL to the medial margin of the popliteal hiatus. LEVEL OF EVIDENCE: IV.

Screening obstructive sleep apnea patients via deep learning of knowledge distillation in the lateral cephalogram.

The lateral cephalogram in orthodontics is a valuable screening tool on undetected obstructive sleep apnea (OSA), which can lead to consequences of severe systematic disease. We hypothesized that a deep learning-based classifier might be able to differentiate OSA as anatomical features in lateral cephalogram. Moreover, since the imaging devices used by each hospital could be different, there is a need to overcome modality difference of radiography. Therefore, we proposed a deep learning model with knowledge distillation to classify patients into OSA and non-OSA groups using the lateral cephalogram and to overcome modality differences simultaneously. Lateral cephalograms of 500 OSA patients and 498 non-OSA patients from two different devices were included. ResNet-50 and ResNet-50 with a feature-based knowledge distillation models were trained and their performances of classification were compared. Through the knowledge distillation, area under receiver operating characteristic curve analysis and gradient-weighted class activation mapping of knowledge distillation model exhibits high performance without being deceived by features caused by modality differences. By checking the probability values predicting OSA, an improvement in overcoming the modality differences was observed, which could be applied in the actual clinical situation.

Uric acid regulates α-synuclein transmission in Parkinsonian models.

Ample evidence demonstrates that α-synuclein (α-syn) has a critical role in the pathogenesis of Parkinson's disease (PD) with evidence indicating that its propagation from one area of the brain to others may be the primary mechanism for disease progression. Uric acid (UA), a natural antioxidant, has been proposed as a potential disease modifying candidate in PD. In the present study, we investigated whether UA treatment modulates cell-to-cell transmission of extracellular α-syn and protects dopaminergic neurons in the α-syn-enriched model. In a cellular model, UA treatment decreased internalized cytosolic α-syn levels and neuron-to-neuron transmission of α-syn in donor-acceptor cell models by modulating dynamin-mediated and clathrin-mediated endocytosis. Moreover, UA elevation in α-syn-inoculated mice inhibited propagation of extracellular α-syn which decreased expression of phosphorylated α-syn in the dopaminergic neurons of the substantia nigra leading to their increased survival. UA treatment did not lead to change in markers related with autophagolysosomal and microglial activity under the same experimental conditions. These findings suggest UA may control the pathological conditions of PD via additive mechanisms which modulate the propagation of α-syn.

Effect of thermal aging on the transport and acoustic properties of partially reticulated polyurethane foams.

This study aims to investigate the acoustic effects of thermal aging on partially reticulated polyurethane (PU) foam. An accelerated test was performed under appropriate test conditions as determined by thermal analyses of the material. Measurements of the absorption coefficient showed that the performance of the partially reticulated PU foam can be significantly reduced by thermal aging. The transport parameters were evaluated to analyze the origin of this change in the absorption behavior. Sensitivity analyses revealed that a decrease in the static airflow resistivity had the greatest effect in terms of reducing the absorption coefficient owing to thermal aging. In addition, observation and characterization of the microstructure of the aged foam to determine the root cause of this acoustic degradation indicated that heat-induced damage to the membrane was the most important factor. To verify this assertion, a periodic unit cell model that mimicked the topology of the cellular structure was constructed, and the mechanism responsible for the change in the acoustic behavior was simulated. The results presented herein can be used as durability guidelines for maintaining the performances of partially reticulated PU foams that are employed in high-temperature environments.

CDCP1 Expression Is a Potential Biomarker of Poor Prognosis in Resected Stage I Non-Small-Cell Lung Cancer.

BACKGROUND: Although early-stage lung cancer has increased owing to the introduction of screening programs, high recurrence rate remains a critical concern. We aimed to explore biomarkers related to the prognosis of surgically resected non-small-cell lung cancer (NSCLC). METHODS: In this retrospective study, we collected medical records of patients with NSCLC and matched tissue microarray blocks from surgical specimens. Semiquantitative immunohistochemistry was performed for measuring the expression level of fibroblast activation protein-alpha (FAP-α), Jagged-1 (JAG1), and CUB-domain-containing protein 1 (CDCP1). RESULTS: A total of 453 patients who underwent complete resection between January 2011 and February 2012 were enrolled; 55.2% patients had stage I NSCLC, and 31.1% presented squamous cell carcinoma. Disease stage was a significant risk factor for recurrence and death, and age ≥ 65 years and male sex were associated with poor overall survival. FAP-a and JaG1 were not related to survivals, while CDCP1-expressing patients exhibited poor disease-free and overall survival. Moreover, CDCP1 expression in stage I NSCLC was significantly associated with recurrence. CONCLUSIONS: Old age, male sex, and high pathological stage were poor prognostic factors in patients with NSCLC who underwent surgical resection. Furthermore, CDCP1 expression could serve as a biomarker for poor prognosis in stage I NSCLC.

Seven-day triple therapy is sufficient to eradicate infection caused by Helicobacter pylori without 23S rRNA point mutation.

ABSTRACT: Tailored therapy based on dual priming oligonucleotide-based polymerase chain reaction (DPO-PCR) can be considered an alternative to overcome the low eradication rate in high clarithromycin-resistance areas. The triple therapy (TT) duration of the tailored approach in most studies was 7 days for patients without point mutation. However, recent western guidelines have recommended a treatment duration of 14 days. The aim of this study was to compare the success rate of 7 and 14 days of TT for eradicating Helicobacter pylori without point mutation, as determined by DPO-PCR.Between Feb 2016 and Feb 2019, medical records of patients who underwent DPO-PCR were reviewed. Patients without point mutation as determined by DPO-PCR were enrolled in this study. The eradication success rate and adverse events were evaluated.A total of 366 patients without A2142G and A2143G point mutation were enrolled. The success rates of 7-day and 14-day TT were 88.4% (168/190) and 85.9% (151/176) by intention to treat analysis (P = .453) and 90.8% (168/185) and 90.4% (151/167) by per-protocol analysis (P = .900), respectively. The adverse event rates showed no significant difference between the 2 groups.In patients without point mutation based on DPO-PCR results, 7-day TT is as effective as 14-day TT. Therefore, 7 days may be considered as a cost-effective treatment duration in Korea.

Toxicity of Canola-Derived Glucosinolate Degradation Products in Pigs-A Review.

Canola co-products are widely included in swine diets as sources of proteins. However, inclusion of canola co-products in diets for pigs is limited by toxicity of glucosinolate degradation products. Aliphatic and aromatic glucosinolates are two major classes of glucosinolates. Glucosinolate degradation products derived from aliphatic glucosinolates (progoitrin) include crambene, epithionitriles, and goitrin, whereas indole-3-acetonitrile, thiocyanate, and indole-3-carbinol are the major aromatic glucosinolates (glucobrassicin)-derived degradation products. At acidic pH (<5.7), progoitrin is degraded by myrosinases to crambene and epithionitriles in the presence of iron, regardless of the presence of epithiospecifier protein (ESP), whereas progoitrin is degraded by myrosinases to goitrin in the absence of ESP, regardless of the presence of iron at neutral pH (6.5). Indole-3-acetonitrile is the major degradation product derived from glucobrassicin in the absence of ESP, regardless of the presence of iron at acidic pH (<4.0), whereas thiocyanate and indole-3-carbinol are the major glucobrassicin-derived degradation products in the absence of ESP, regardless of the presence of iron at neutral pH (7.0). In conclusion, the composition of glucosinolate degradation products is affected by parent glucosinolate composition and hindgut pH. Thus, toxicity of canola co-product-derived glucosinolates can be potentially alleviated by modifying the hindgut pH of pigs.

Growth performance and gut health of Escherichia coli-challenged weaned pigs fed diets supplemented with a Bacillus subtilis direct-fed microbial.

This study was conducted to investigate the effects of a direct-fed microbial (DFM) product (Bacillus subtilis strain DSM 32540) in weaned pigs challenged with K88 strain of Escherichia coli on growth performance and indicators of gut health. A total of 21 weaned pigs [initial body weight (BW) = 8.19 kg] were housed individually in pens and fed three diets (seven replicates per diet) for 21 d in a completely randomized design. The three diets were a corn-soybean meal-based basal diet without feed additives, a basal diet with 0.25% antibiotics (neo-Oxy 10-10; neomycin + oxytetracycline), or a basal diet with 0.05% DFM. All pigs were orally challenged with a subclinical dose (6.7 × 108 CFU/mL) of K88 strain of E. coli on day 3 of the study (3 d after weaning). Feed intake and BW data were collected on days 0, 3, 7, 14, and 21. Fecal scores were recorded daily. On day 21, pigs were sacrificed to determine various indicators of gut health. Supplementation of the basal diet with antibiotics or DFM did not affect the overall (days 0-21) growth performance of pigs. However, antibiotics or DFM supplementation increased (P = 0.010) gain:feed (G:F) of pigs during the post-E. coli challenge period (days 3-21) by 23% and 24%, respectively. The G:F for the DFM-supplemented diet did not differ from that for the antibiotics-supplemented diet. The frequency of diarrhea for pigs fed a diet with antibiotics or DFM tended to be lower (P = 0.071) than that of pigs fed the basal diet. The jejunal villous height (VH) and the VH to crypt depth ratio (VH:CD) were increased (P < 0.001) by 33% and 35%, respectively, due to the inclusion of antibiotics in the basal diet and by 43% and 41%, respectively due to the inclusion of DFM in the basal diet. The VH and VH:CD for the DFM-supplemented diet were greater (P < 0.05) than those for the antibiotics-supplemented diet. Ileal VH was increased (P < 0.05) by 46% due to the inclusion of DFM in the basal diet. The empty weight of small intestine, cecum, or colon relative to live BW was unaffected by dietary antibiotics or DFM supplementation. In conclusion, the addition of DFM to the basal diet improved the feed efficiency of E. coli-challenged weaned pigs to a value similar to that of the antibiotics-supplemented diet and increased jejunal VH and VH:CD ratio to values greater than those for the antibiotics-supplemented diet. Thus, under E. coli challenge, the test DFM product may replace the use of antibiotics as a growth promoter in diets for weaned pigs to improve feed efficiency and gut integrity.

Soybean meal allergenic protein degradation and gut health of piglets fed protease-supplemented diets.

Two experiments were conducted to determine the effects of protease supplementation on degradation of soybean meal (SBM) allergenic proteins (glycinin and ß-conglycinin) and gut health of weaned pigs fed soybean meal-based diets. In experiment 1, 2 SBM samples from 2 different sources were subjected to porcine in vitro gastric degradation to determine the effects of protease (at 15,000 U/kg of feedstuff) on degradation of the soybean allergenic proteins. In experiment 2, 48 weaned pigs (body weight = 6.66 kg) were obtained in 2 batches of 24 pigs each. Pigs were individually housed in metabolic crates and fed 4 diets (12 pigs/diet). The diets were corn-based diet with SBM 1 or SBM 2 without or with protease at 15,000 U/kg of diet in 2 × 2 factorial arrangement. Diets were fed for 10 d and pigs were sacrificed on day 10 for measurement of small intestinal histomorphology, permeability of small intestine mounted in Ussing chambers, and serum concentration of pro-inflammatory cytokines. Two SBM sources (SBM 1 and SBM 2) contained 46.9% or 47.7% CP, 14.0% or 14.6% glycinin, and 9.90% or 10.3% ß-conglycinin, respectively. Protease and SBM source did not interact on any of the response criteria measured in the current study. Protease supplementation tended to increase (P = 0.069) the in vitro gastric degradation of glycinin. Protease supplementation tended to reduce (P = 0.099) fluorescein isothiocyanate dextran 4,000 Da (which is a marker probe for intestinal permeability) flow in jejunum, and reduced (P = 0.037) serum TNF-α concentration. Protease did not affect small intestinal histomorphology. In conclusion, protease tended to increase gastric degradation of glycinin and reduce gut permeability, and serum concentration of pro-inflammatory cytokines, indicating that the protease used in the current study can be added to SBM-based diets for weanling pigs to improve gut health.

Estimation and uncertainty analysis of fluid-acoustic parameters of porous materials using microstructural properties.

This study quantified the microstructure of polyurethane foams and elucidated its relationship to fluid-acoustic parameters. The complex morphology derived from the three-dimensional images obtained by micro-computed tomography was analyzed using digital image processing and represented by a pore network model (PNM) and a distance map model. The PNM describes the fluid phase of a porous medium with equivalent spherical pores and circular throats, whereas the distance map model describes the solid phase with the average frame thickness. The porous materials were then modeled by six representative microstructural parameters that describe the geometry and topology of the fluid and solid phases. These parameters were pore radius, throat radius, distance between adjacent pores, coordination number, pore inclination angle, and frame thickness. Semi-phenomenological and empirical approaches were proposed to relate the microstructural properties to the fluid-acoustic parameters. These models effectively described the acoustic parameters and sound absorption performance of six different polyurethane foams. Since the representative microstructural parameters were obtained from small sample volumes of a heterogeneous material, notable variations were observed across different regions of the sample. Hence, this study quantified the effect of the uncertainty in each microstructural parameter on the resulting acoustic parameters using global sensitivity analysis.

Nutrient digestibility of multi-enzyme supplemented low-energy and AA diets for grower pigs1.

A study was conducted to determine effects of supplementing multi-enzyme on apparent ileal digestibility (AID) of energy and AA; and apparent total tract digestibility (ATTD) of energy for pigs fed low-energy and AA diets. Eight ileal-cannulated barrows (initial BW: 38.7 ± 2.75 kg) were fed four diets in a replicated 4 × 4 Latin square design to give 8 replicates per diet. Diets were positive control (PC) diet, negative control (NC) diet without or with multi-enzyme at 0.5 or 1.0 g/kg. The PC diet was formulated to meet or exceed NRC (2012) nutrient recommendations for grower pigs (25 to 50 kg), except for Ca and digestible P, which were lower than NRC (2012) recommendations by 0.13 and 0.17 percentage points, respectively, due to phytase supplementation at 1,000 FTU/kg. The NC diet was formulated to be lower in NE by 75 kcal/kg and standardized ileal digestible AA content by a mean of 3%. These reductions were achieved by partial replacement of corn and soybean meal (SBM) and complete replacement of soybean oil and monocalcium phosphate in PC diet with 25% corn distillers dried grains with solubles (DDGS) and 3.6% soybean hulls. Multi-enzyme at 1.0 g/kg supplied 1,900 U of xylanase, 300 U of ß-glucanase, 1,300 U of cellulase, 11,500 U of amylase, 120 U of mannanase, 850 U of pectinase, 6,000 U of protease, and 700 U of invertase per kilogram of diet. The AID of GE, N, most AA, most component sugars of nonstarch polysaccharides (NSP) and P; ATTD of GE for PC diet was greater (P < 0.05) than those for NC diets. An increase in dietary level of multi-enzyme from 0 to 1.0 g/kg resulted in a linear increase (P < 0.05) in AID of Ile by 4.3%, and tended to linearly increase (P < 0.10) AID of Leu, Met, Phe, and Val by a mean of 3.4%. Increasing dietary multi-enzyme from 0 to 1.0 g/kg linearly increased (P < 0.05) AID of total NSP and P by 53.7% and 19.2%, respectively; ATTD of GE by 8.4% and DE and NE values by 8.8% and 8.2%, respectively; tended to linearly increase (P < 0.10) AID of GE by 8.1%. The NE values for NC diet with multi-enzyme at 1.0 g/kg tended to be greater (P < 0.10) than that for PC diet (2,337 vs. 2,222 kcal/kg of DM). In conclusion, multi-enzyme supplementation improved energy and nutrient digestibilities of a corn-SBM-corn DDGS-based diet, implying that the multi-enzyme fed in the current study can be used to enhance energy and nutrient utilization of low-energy AA diets for grower pigs.

Nutritive value of enzyme-supplemented carinata meal for growing pigs.

Carinata meal is increasingly available for livestock feeding. However, the effects of supplemental phytase and fiber degrading enzymes on nutritive value of carinata meal for pigs have not been reported. Objective of the study was to evaluate the standardized ileal digestibility (SID) of amino acid (AA), and digestible energy (DE) and net energy (NE) values of phytase- and fiber-degrading enzymes-supplemented carinata meal for growing pigs. Ten ileal-cannulated pigs (initial body weight = 53.9 ± 4.76 kg) were fed 4 diets in a replicated 4 × 4 Latin square design with two additional columns to give 10 replicates per diet. Diets included a corn-soybean meal (SBM)-based basal diet, basal diet with 25% carinata meal, basal diet with 25% carinata meal plus phytase at 2,000 FTU/kg and multi-carbohydrase at 0.2 g/kg, and in addition a nitrogen-free diet. The multicarbohydrase supplied 4 units of xylanase, 10 units of ß-glucanase, and 1,000 units of pectinase per kilogram of diet. The ratio of corn to SBM and soybean oil in carinata meal-containing diets was identical to that in the corn-SBM-based basal diet to allow calculation of AA and energy digestibility of carinata meal by the difference method. On a dry matter basis, carinata meal contained 50.2% crude protein, 0.88% ether extract, 15.37% acid detergent fiber, 1.82% Lys, 0.96% Met, 1.89% Thr, and 0.64% Trp, respectively. The SID of Lys, Met, Thr, and Trp for carinata meal were 51.4%, 82.2%, 65.9%, and 85.9%, respectively. The DE and NE values for carinata meal were 3,427 and 1,828 kcal/kg of dry matter, respectively. Supplementation of a combination of phytase and multicarbohydrase did not affect the apparent ileal digestibility of AA and SID of AA for the corn-SBM-carinata meal-based diet, and for the carinata meal. However, the combination of phytase and multicarbohydrase did improve (P < 0.05) apparent total tract digestibility, and DE and NE values for carinata meal by 9.4%, 9.5%, and 12.4%, respectively. In conclusion, the enzymes used in the current study could be added in carinata meal-based diets for growing pigs to improve the energy value.

Growth performance, organ weights, and blood parameters of nursery pigs fed diets containing increasing levels of cold-pressed canola cake.

Oilseed cakes have high oil content, and thus their inclusion in swine can lead to reduced dietary inclusion of oil, and hence reduced cost of feed. An experiment was conducted to determine effects of including Brassica napus-derived cold-pressed canola cake (CPCC) in diets for nursery pigs on growth performance, organ weights relative to live body weight (BW), and blood parameters. A total of 160 pigs (initial BW: 7.8 ± 0.9 kg), which had been weaned at 21 d of age were housed in 40 pens (4 pigs/pen) and fed 4 diets (10 pens/diet) in a randomized complete block design for 35 d. The 4 diets were corn-soybean meal (SBM)-based basal diet and the basal diet with corn and SBM replaced by 20, 30, or 40% of CPCC. The diets were fed in 2 phases, Phase 1 from day 0 to 14 and Phase 2 from day 14 to 35; and were formulated to meet NRC (2012) nutrient recommendations for nursery pigs and to have the same net energy, standardized ileal digestible amino acid, and digestible P contents. Increasing inclusion of CPCC in diets was achieved by partial replacement of corn, SBM, limestone, and mono-calcium phosphate. Growth performance was determined by phase. On day 35, 1 pig from each pen was euthanized for determining organ weights and blood parameters. The CPCC contained 7.63% moisture, and on a dry matter basis, it (CPCC) contained 39.6% crude protein, 2.32% Lys, 0.74% Met, 1.63% Thr, 0.50% Trp, 16.0% ether extract, 20.7% neutral detergent fiber, and 14.9 µmol/g of glucosinolates. Increasing dietary CPCC from 0 to 40% linearly reduced (P < 0.05) overall (day 0 to 35) average daily gain and average daily feed intake (0.440 to 0.288 kg/d and 0.739 to 0.522 kg/d, respectively). Increasing dietary CPCC from 0 to 40% resulted in a linear increase (P < 0.05) in liver weight by 0.1 g/kg of BW and in thyroid gland weight by 2.2 mg/kg of BW, but in a linear reduction (P < 0.05) in serum tetraiodothyronine (T4) level by 0.2 ng/mL for each 1% increase in CPCC at 35 d of age. No differences were observed in heart and kidney weights relative to live BW, and in serum triiodothyronine (T3) concentration. In conclusion, increasing dietary CPCC from 0 to 40% by reducing corn and SBM levels resulted in depressed growth performance, increased metabolic activity in liver and thyroid gland, and reduced serum T4 level of pigs. Thus, the amounts of CPCC included in nursery pig diets should be based on targeted growth performance and cost of other feedstuffs in relation to that of CPCC.

Diagnostic Ability of Retinal Nerve Fiber Layer Thickness Deviation Map for Localized and Diffuse Retinal Nerve Fiber Layer Defects.

Purpose. To evaluate the diagnostic ability of the retinal nerve fiber layer (RNFL) deviation map for glaucoma with localized or diffuse RNFL defects. Methods. Eyes of 139 glaucoma patients and 165 healthy subjects were enrolled. All participants were imaged with Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA, USA). A RNFL defect was defined as at least 10 contiguous red (<1% level) superpixels in RNFL deviation map. The area, location, and angular width of RNFL defects were automatically measured. We compared sensitivities, specificities, and area under the receiver operating characteristic curves (AUCs) of RNFL deviation map and circumpapillary RNFL thickness for localized and diffuse RNFL defects. Subgroup analysis was performed according to the severity of glaucoma. Results. For localized defects, the area of RNFL defects (AUC, 0.991; sensitivity, 97%; specificity, 90%) in deviation map showed a higher diagnostic performance (p = 0.002) than the best circumpapillary RNFL parameter (inferior RNFL thickness; AUC, 0.914; sensitivity, 79%; specificity, 92%). For diffuse defects, there was no significant difference between the RNFL deviation map and circumpapillary RNFL parameters. In mild glaucoma with localized defect, RNFL deviation map showed a better diagnostic performance than circumpapillary RNFL measurement. Conclusions. RNFL deviation map is a useful tool for evaluating glaucoma regardless of localized or diffuse defect type and has advantages over circumpapillary RNFL measurement for detecting localized RNFL defects.

En face choroidal vascular feature imaging in acute and chronic central serous chorioretinopathy using swept source optical coherence tomography.

AIMS: To evaluate the variable depth tomographic features of choroidal vasculature in acute and chronic central serous chorioretinopathy (CSC) using swept source optical coherence tomography (SS-OCT) en face imaging. METHODS: We retrospectively reviewed the en face SS-OCT images of 29 patients that presented with acute (12 eyes) or chronic (17 eyes) CSC. All of the patient eyes underwent 6×6 macular scans with SS-OCT (DRI OCT-1, Topcon, Tokyo, Japan), fluorescein angiography and indocyanine green angiography. The en face image was used to investigate the choroidal vasculature of each layer. Moreover, we determined that some parts corresponded to choriocapillaris and Sattler's layer attenuation, whereas choroidal vessel dilatation was associated with Haller's layer. RESULTS: At Haller's layer level, choroidal vessel dilatation was observed in 11 of 12 acute CSC (91.7%) and 15 of 17 chronic CSC (88.2%). In acute CSC, choroidal vessel dilatation was divided into focal (9/11; 81.8%) and diffuse (2/11; 18.2%) patterns. The chronic CSC cases demonstrated different patterns of choroidal vessel dilatation: focal (5/15; 33.3%) and diffuse (10/15; 66.6%). Ten of the acute CSC eyes (83.3%) and 14 of the chronic CSC eyes (82.4%) were found to have obscured choriocapillaris and Sattler's layers on en face imaging. CONCLUSIONS: En face imaging of SS-OCT is useful when combined with angiography in CSC for evaluating choroidal vessel dilatation at Haller's layer and to identify obscured upper layers. We identified different choroidal vessel dilatation patterns between acute and chronic CSC. These findings might be useful for pathophysiological understanding of CSC.

Macular Choroidal Thickness and Volume Measured by Swept-source Optical Coherence Tomography in Healthy Korean Children.

PURPOSE: To evaluate the thickness and volume of the choroid in healthy Korean children using swept-source optical coherence tomography. METHODS: We examined 80 eyes of 40 healthy children and teenagers (<18 years) using swept-source optical coherence tomography with a tunable long-wavelength laser source. A volumetric macular scan protocol using the Early Treatment Diabetic Retinopathy Study grid was used to construct a choroidal thickness map. We also examined 44 eyes of 35 healthy adult volunteers (≥18 years) and compared adult measurements with the findings in children. RESULTS: The mean age of the children and teenagers was 9.47 ± 3.80 (4 to 17) vs. 55.04 ± 12.63 years (36 to 70 years) in the adult group (p < 0.001, Student's t-test). Regarding the Early Treatment Diabetic Retinopathy Study subfields, the inner temporal subfield was the thickest (247.96 µm). The inner and outer nasal choroid were thinner (p = 0.004, p = 0.002, respectively) than the surrounding areas. The mean choroidal volumes of the inner and outer nasal areas were smaller (p = 0.004, p = 0.003, respectively) than those of all the other areas in each circle. Among the nine subfields, all areas in the children, except the outer nasal subfield, were thicker than those in adults (p < 0.05). Regression analysis showed that age, axial length, and refractive error correlated with subfoveal choroidal thickness (p < 0.05). CONCLUSIONS: Overall macular choroidal thickness and volume in children and teenagers were significantly greater than in adults. The nasal choroid was significantly thinner than the surrounding areas. The pediatric subfoveal choroid is prone to thinning with increasing age, axial length, and refractive error. These differences should be considered when choroidal thickness is evaluated in children with chorioretinal diseases.

Association between the duration of palliative care service and survival in terminal cancer patients.

PURPOSE: Preliminary studies of early palliative care showed improved quality of life, less medical cost, and better survival time. But, most terminal cancer patients tend to be referred to palliative care late. For the proper care of terminal cancer patients, it is necessary to refer to hospice and palliative care timely. The aim of this study is to analyze the effect of the duration of palliative care services on the survival in terminal cancer patients. METHODS: We reviewed 609 patients who had died from terminal cancer between January 2010 and December 2012. We analyzed correlations of age, first Palliative Performance Scale (PPS) level, duration of palliative care service, and survival time. The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. RESULTS: Duration of palliative care services was significantly correlated with survival time. In univariate Cox regression analysis, age, and each group of duration of palliative care service showed significant associations with survival. Final multivariate Cox regression model retained four parameters as independent prognostic factors for survival (age HR = 0.99 (p = 0.002), 1∼10 days HR = 2.64 (p < 0.001), 11∼30 days HR = 2.43 (p < 0.001), 31∼90 days HR = 1.87 (p < 0.001)). CONCLUSIONS: Shorter duration of palliative care services showed poor prognostic factor. Timely referral system from the end of chemotherapy is warranted.

Quantitative assessment of inferior oblique muscle overaction using photographs of the cardinal positions of gaze.

PURPOSE: To report a novel method for measuring the degree of inferior oblique muscle overaction and to investigate the correlation with other factors. DESIGN: Cross-sectional diagnostic study. METHODS: One hundred and forty-two eyes (120 patients) were enrolled in this study. Subjects underwent a full orthoptic examination and photographs were obtained in the cardinal positions of gaze. The images were processed using Photoshop and analyzed using the ImageJ program to measure the degree of inferior oblique muscle overaction. Reproducibility or interobserver variability was assessed by Bland-Altman plots and by calculation of the intraclass correlation coefficient (ICC). The correlation between the degree of inferior oblique muscle overaction and the associated factors was estimated with linear regression analysis. RESULTS: The mean angle of inferior oblique muscle overaction was 17.8 ± 10.1 degrees (range, 1.8-54.1 degrees). The 95% limit of agreement of interobserver variability for the degree of inferior oblique muscle overaction was ±1.76 degrees, and ICC was 0.98. The angle of inferior oblique muscle overaction showed significant correlation with the clinical grading scale (R = 0.549, P < .001) and with hypertropia in the adducted position (R = 0.300, P = .001). The mean angles of inferior oblique muscle overaction classified into grades 1, 2, 3, and 4 according to the clinical grading scale were 10.5 ± 9.1 degrees, 16.8 ± 7.8 degrees, 24.3 ± 8.8 degrees, and 40.0 ± 12.2 degrees, respectively (P < .001). CONCLUSIONS: We describe a new method for measuring the degree of inferior oblique muscle overaction using photographs of the cardinal positions. It has the potential to be a diagnostic tool that measures inferior oblique muscle overaction with minimal observer dependency.