Introduction: The aim of this study was to investigate the clinical effectiveness, health related quality of life (HRQoL) and cost effectiveness of selective laser trabeculoplasty (SLT) compared to topical anti-glaucoma medications in step-up treatment of patients with primary open angle glaucoma (POAG). Methods: Seventeen POAG patients with suboptimal IOP control despite pre-existing topical medications were subjected to adjunct SLT (50 applications 180 degrees) or second line medical therapy. Current medications were continued, and patients were followed up for 6 months for degree of intraocular pressure (IOP) lowering. HRQoL was assessed using Glaucoma Quality of Life 36-item (GlauQoL-36), Assessment of Quality of Life-7D (AQoL-7D) and Vision related Quality of Life (VisQoL). Costs involved were calculated and compared to the effect (IOP reduction) achieved in each arm. Results: Ten patients were in the SLT group and 7 in the topical medication (MED) group. Mean baseline intraocular pressure (IOP) was 18.90±3.48mmHg in SLT group and 15.57±2.23mmHg in MED group. Mean reduction of IOP was 4.30±1.64mmHg in SLT group and 2.71±2.56 mmHg in MED group at 6 months which was not statistically significant (p=0.14) between two groups. All the HRQoL questionnaires did not show significant changes in the groups or between groups when compared baseline with 6-month post treatment (p-values ranging from 0.247 to 0.987). For every 1mmHg reduction in IOP, cost involved in MED group (RM53.61) was 165% of the cost involved in SLT group (RM32.56). Discussion and Conclusion: This study has shown that SLT was as effective clinically and tolerable as topical anti glaucoma medications and was possibly more cost effective in the step-up treatment of patients with POAG at 6 months follow- up.
selective laser traeculoplasty ; topical antiglaucoma, clinical effectiveness ; quality o0f life ; cost effectiveness ; primary open angle glaucoma ; prospective pilot cohort study

BACKGROUND: Recently, the prevalence of food allergies during childhood is increasing, with fruits being common allergens. However, data on allergens that cause fruit and vegetable allergies and pollen-food allergy syndrome (PFAS) in childhood are relatively few. This study aimed to examine the allergens in fruit and vegetable allergies in pediatric patients and to determine the association between fruit and vegetable allergies and PFAS.OBJECTIVE: This study aimed to examine the current status of fruit and vegetable allergies in Japanese children.METHODS: This was a multicenter case series observational study. The participants included children aged <15 years who developed allergic symptoms after eating fruits and vegetables and subsequently received treatment in the Pediatric Department of 6 hospitals in the Osaka Prefecture in Japan during the study period from August 2016 to July 2017. Participants' information was obtained using a questionnaire, and data were obtained by performing several types of allergy tests using blood samples.RESULTS: A total of 97 children (median age, 9 years; 56 males) were included in the study. Apple was the most common allergen, followed by peach, kiwi, cantaloupe, and watermelon. A total of 74 participants (76%) exhibited allergic symptoms due to PFAS; moreover, pathogenesis-related protein-10 (PR-10) was the most common allergen superfamily. On the contrary, in the group where neither PR-10 nor profilin was sensitized, kiwi and banana were the most common allergens, and the age of onset was lower than that in the PFAS group. Specific antibody titer was significantly associated with Birch for Bet v1 and latex for Bet v2 (r = 0.99 and r = 0.89).CONCLUSION: When we examine patients with fruit and vegetable allergies, we should first consider PFAS even in childhood specifically for children greater than 4 years old.
Age of Onset ; Allergens ; Asian Continental Ancestry Group ; Betula ; Child ; Citrullus ; Clinical Study ; Cucumis melo ; Eating ; Food Hypersensitivity ; Fruit ; Humans ; Hypersensitivity ; Japan ; Latex ; Musa ; Observational Study ; Prevalence ; Profilins ; Prunus persica ; Rhinitis ; Rhinitis, Allergic, Seasonal ; Vegetables

STUDY DESIGN: Retrospective clinical study.PURPOSE: To evaluate clinical results of the M6 cervical prosthesis.OVERVIEW OF LITERATURE: Cervical disk prostheses have been developed to preserve motion and reduce degeneration in adjacent segments in degenerative disk diseases.METHODS: A retrospective evaluation was performed on 43 patients who received the M6 cervical disk prosthesis between 2012 and 2016. Standard and dynamic radiographs, computed tomography, and magnetic resonance imaging were used to evaluate all the patients preoperatively and postoperatively. The Neck Disability Index (NDI) and Visual Analog Scale (VAS) scores were examined in evaluating the clinical and functional results of patients with collapsed disk herniation who had received the M6 cervical prosthesis and to evaluate whether the core structure of the prosthesis protects motion.RESULTS: The mean follow-up period was 34.12±6.70 months. Radiologically, the preoperative cervical segment ROM was measured as a mean of 5.77°±2.19° preoperatively and 8.49°±2.37° at the inal postoperative follow-up examination. In the patients with a preoperative disk height of <4 mm, the segmental ROM increased from 4.53°±2.79° preoperatively to 7.2°±3.18° postoperatively. In the patients with a preoperative disk height of >4 mm, the cervical segment ROM increased from 6.4°±1.45° preoperatively to 8.6°±2.02° at the inal postoperative follow-up examination. The NDI scores reduced from 53.86±9.77 preoperatively to 22.69±7.26 postoperatively and the VAS scores reduced from 8.74±0.58 to 1.88±1.14. During follow-up in any patient, no collapse of the levels at which surgery was performed was observed. No heterotopic ossiication or implant failure was recorded in any patient during the follow-up period.CONCLUSIONS: The M6 new-generation cervical disk prosthesis had few complications. No heterotopic ossiication was observed in any patient, and lexion-extension ROM was maintained in all the patients, indicating the M6 prosthesis as a promising alternative.
Clinical Study ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Neck ; Prostheses and Implants ; Retrospective Studies ; Visual Analog Scale

PURPOSE: The purpose of this study was to evaluate whether eye dominance changes after conventional pseudophakic monovision, and to identify factors that affect changes in eye dominance. METHODS: This retrospective study included 70 patients who underwent bilateral conventional monovision cataract surgery. Patients were divided into two groups based on whether they experienced a change in the dominant eye. We compared patients' uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best-corrected visual acuity (BCVA), spherical equivalent, stereopsis, and time interval between cataract surgeries. RESULTS: The mean age was 71.26 ± 10.84 (range, 25–90) years, mean interval between surgery in each eye was 118.46 ± 183.50 (range, 17–1,018) days, and mean postoperative diopter difference was 1.16 ± 0.53 (range, 0.00–2.75) diopters. After bilateral cataract surgery, 22 patients (31.43%) experienced a change in eye dominance, whereas 48 patients (68.57%) experienced no change. There were no differences in the time interval between cataract surgeries, preoperative UCDVA and UCNVA, pre- and postoperative BCVA, or stereopsis in either group. Patients who experienced a change in eye dominance showed smaller differences between preoperative and postoperative spherical equivalent, compared with patients who experienced no change in eye dominance (t-test, p < 0.05). CONCLUSIONS: Twenty-two (31.43%) patients whose nondominant eyes were targeted for near vision showed altered eye dominance after conventional monovision cataract surgery. Eye dominance shows greater plasticity in patients with smaller differences between preoperative and postoperative spherical equivalent.
Cataract ; Clinical Study ; Depth Perception ; Dominance, Ocular ; Humans ; Plastics ; Presbyopia ; Retrospective Studies ; Visual Acuity

BACKGROUND: This study aimed to determine the optimal location of local anesthetic injection in the interspace between the popliteal artery and posterior capsule of the knee (iPACK), using the anatomical pattern of the articular branch of tibial nerve (ABTN). We hypothesized that injection at the level of ABTN forming a popliteal plexus would mainly spread throughout the popliteal fossa without contacting the tibial or peroneal nerves. METHODS: The anatomical study included 30 soft cadavers. Ultrasound-guided dye injection was performed in legs of 10 cadavers after identifying the position of the ABTN and surrounding structures, followed by dissection to assess its spread. Clinical study was conducted in 15 patients undergoing total knee arthroplasty (TKA) with ultrasound-guided injection in the iPACK. All patients also received continuous adductor canal block. Sensorimotor function of the tibial and common peroneal nerves was determined. RESULTS: In the distal portion of the popliteal fossa, the tibial nerve and popliteal vessels ran superficially and closely together. The trajectory of ABTN ran lateral to the popliteal vasculature, forming a plexus towards the posterior capsule of the knee below the medial side of the upper edge of lateral femoral condyle. In cadavers, the ABTN and surrounding area of the popliteal plexus were stained with dye after injection. In the clinical study, no patients experienced complete motor or sensory blocks. CONCLUSIONS: We described a modified iPACK technique injection at the level of the ABTN forming the popliteal plexus, and it may constitute an optional anesthetic regimen to promote early ambulation following TKA.
Arthroplasty, Replacement, Knee ; Cadaver ; Clinical Study ; Early Ambulation ; Humans ; Knee ; Leg ; Pain, Postoperative ; Peroneal Nerve ; Popliteal Artery ; Tibial Nerve

BACKGROUND: Rosacea is a relatively common inflammatory skin disease characterized by central facial erythema that persists for several months or longer. Experimental studies have demonstrated that rosacea compromises the epidermal barrier protection against allergens and irritants, rendering rosacea patients susceptible to contact hypersensitivity and skin irritation. OBJECTIVE: This study aimed to investigate allergic and irritant reactions to topical agents and cosmetics in rosacea patients using patch tests. METHODS: Rosacea signs and subtypes of 40 patients were recorded and subjective symptoms and clinical experiences related to topical agents and cosmetics were assessed using a questionnaire. Patch tests were performed in these patients using the Korean Standard Series (Chemotechnique Diagnostics, Sweden), the TRUE test® (Mekos Laboratories ApS, Denmark), and 26 selected fragrance and 31 cosmetic antigens (TROLAB, Germany). RESULTS: Of 40 patch-tested patients, 26 (65%) showed at least 1 positive reaction and 13 (32.5%) showed 2 or more positive reactions. The most common allergens were nickel (II) sulfate (50%), cobalt chloride (10%), epoxy resin (7.7%), and thimerosal (7.5%). Thirteen patients (32.5%) experienced irritant patch test reactions. There were no significant differences in allergic or irritant positive reactions between mild, moderate, and severe cases of rosacea or between rosacea subtypes. Irritant reactions were more common in fair-skinned participants. CONCLUSION: Different topical medications are used in the treatment of rosacea patients. Exacerbation of rosacea may be caused by a hypersensitivity reaction or irritation induced by the topical agent or by cosmetics.
Allergens ; Clinical Study ; Cobalt ; Dermatitis, Contact ; Erythema ; Humans ; Hypersensitivity ; Irritants ; Nickel ; Patch Tests ; Rosacea ; Skin ; Skin Diseases ; Thimerosal

BACKGROUND: The development of a safe and convenient agent that can promote hair growth in patients with androgenetic alopecia remains challenging. OBJECTIVE: This study was designed to investigate the efficacy of a newly developed hair tonic containing a human umbilical cord blood mesenchymal stem cell (hUCB-MSC)-derived conditioned medium in promoting hair growth. METHODS: This double-blind, placebo-controlled clinical study investigated the efficacy of a hair tonic containing an hUCB-MSC-derived conditioned medium in 30 patients with patterned hair loss. Treatment efficacy was determined using phototrichograms to evaluate the density, diameter, and hair growth rate at baseline levels and after 4, 8, and 16 weeks of treatment. RESULTS: The hair density in the group treated with the hair tonic significantly increased from 125.2 to 134.6 hairs/cm2 (p<0.05). In this same group, the thickness of hair also increased from 0.083 to 0.110 mm (p<0.05). Additionally, the hair growth rate increased from 0.285 to 0.338 mm/day (p<0.05). No severe adverse reactions were reported. CONCLUSION: A hair tonic containing an hUCB-MSC-derived conditioned medium could be a new effective alternative to treat patients with androgenetic alopecia.
Alopecia ; Clinical Study ; Culture Media, Conditioned ; Fetal Blood ; Hair Preparations ; Hair ; Humans ; Mesenchymal Stromal Cells ; Treatment Outcome ; Umbilical Cord

BACKGROUND: Acne is a common inflammatory skin disease that involves the seborrheic area, developing not only in adolescence but also in adulthood. Abnormal epidermal barrier function in acne is reported and suspected as a risk factor that leads to sensitive skin through a few experimental studies. Impaired skin barrier function against environmental factors and irritants may play a role in increasing sensitivity of the skin in patients with acne. OBJECTIVE: This study aimed to investigate the clinical characteristics of patients with acne and analyze the association between acne and sensitive skin. METHODS: Acne severity and history of treatments were recorded and subjective symptoms of sensitive skin with aggravating factors were analyzed through a questionnaire. Acne severity was determined using the Investigator's Global Assessment scale of acne severity and Global Acne Grading System. The score and severity of sensitive skin were determined using the Baumann skin-type test. RESULTS: Of 100 patients with acne, 76% were actually confirmed to have sensitive skin. However, there was no significant association between acne severity and severity of sensitive skin (p=0.805). The most common aggravating factor of sensitive skin was washing the face (60%), followed by cosmetics use (56%) and hot weather (55%). The most common symptom of sensitive skin was itching (55%), which was proven as the only factor associated with severity of sensitive skin (p=0.016). CONCLUSION: Cosmetics use on the face is a noticeable important aggravating factor of sensitive skin, which can provoke itching, which is proven as the only symptom significantly related with severity of sensitive skin. Therefore, in the treatment of acne with sensitive skin, proper use of moisturizers and careful washing are required, and it is important to avoid hot weather and excessive sun exposure and carefully choose cosmetics.
Acne Vulgaris ; Adolescent ; Clinical Study ; Humans ; Irritants ; Pruritus ; Risk Factors ; Skin Diseases ; Skin ; Solar System ; Weather

BACKGROUND AND OBJECTIVES: Acute epiglottitis is a life-threatening condition that can result in airway obstruction. The present study reports clinical features, management and patient outcomes in an acute epiglottitis. SUBJECTS AND METHOD: Included in our retrospective study were 315 patients who were admitted with the diagnosis of acute epiglottitis between January 2006 and July to the department Otolaryngology-Head and Neck surgery, Hallym University Sacred Heart Hospital 2018. The diagnosis of acute epiglottitis was established by confirmation of inflamed epiglottis using laryngoscope or computed tomography. RESULTS: Among 315 patients, 89 cases (28%) and 83 cases (26%) were found in the fifth and fourth decades, respectively. The mean age of patients was 45.0±13.94 years. The male to female ratio was 1.33:1. A total of 75 patients (23.8%) had co-morbidities, with hypertension (13.6%) being the most common. Fever was relatively uncommon, whereas most patients complained of sore throat. Ceftriaxone was the most common empirical antibiotic regimen prescribed and the use of steroids did not affect the length of hospital stay. Nine patients required airway intervention, including eight who underwent endotracheal intubation and one emergency tracheostomy. In patients who need airway intervention, systolic blood pressure, body temperature, respiratory rate, heart rate, white blood cells and the proportion of dyspnea were significantly higher in comparison to the patients without airway intervention. CONCLUSION: Although acute epiglottitis often has nonspecific symptoms, it may lead to sudden dyspnea and unstable vital signs, so an in-depth understanding of this disease is needed.
Airway Obstruction ; Anti-Bacterial Agents ; Blood Pressure ; Body Temperature ; Ceftriaxone ; Clinical Study ; Diagnosis ; Dyspnea ; Emergencies ; Epiglottis ; Epiglottitis ; Female ; Fever ; Heart ; Heart Rate ; Humans ; Hypertension ; Intubation, Intratracheal ; Korea ; Laryngoscopes ; Length of Stay ; Leukocytes ; Male ; Methods ; Neck ; Pharyngitis ; Respiratory Rate ; Retrospective Studies ; Steroids ; Tracheostomy ; Vital Signs

OBJECTIVE: To compare image qualities between vendor-neutral and vendor-specific hybrid iterative reconstruction (IR) techniques for abdominopelvic computed tomography (CT) in young patients. MATERIALS AND METHODS: In phantom study, we used an anthropomorphic pediatric phantom, age-equivalent to 5-year-old, and reconstructed CT data using traditional filtered back projection (FBP), vendor-specific and vendor-neutral IR techniques (ClariCT; ClariPI) in various radiation doses. Noise, low-contrast detectability and subjective spatial resolution were compared between FBP, vendor-specific (i.e., iDose1 to 5; Philips Healthcare), and vendor-neutral (i.e., ClariCT1 to 5) IR techniques in phantom. In 43 patients (median, 14 years; age range 1–19 years), noise, contrast-to-noise ratio (CNR), and qualitative image quality scores of abdominopelvic CT were compared between FBP, iDose level 4 (iDose4), and ClariCT level 2 (ClariCT2), which showed most similar image quality to clinically used vendor-specific IR images (i.e., iDose4) in phantom study. Noise, CNR, and qualitative imaging scores were compared using one-way repeated measure analysis of variance. RESULTS: In phantom study, ClariCT2 showed noise level similar to iDose4 (14.68–7.66 Hounsfield unit [HU] vs. 14.78–6.99 HU at CT dose index volume range of 0.8–3.8 mGy). Subjective low-contrast detectability and spatial resolution were similar between ClariCT2 and iDose4. In clinical study, ClariCT2 was equivalent to iDose4 for noise (14.26–17.33 vs. 16.01–18.90) and CNR (3.55–5.24 vs. 3.20–4.60) (p > 0.05). For qualitative imaging scores, the overall image quality ([reader 1, reader 2]; 2.74 vs. 2.07, 3.02 vs. 2.28) and noise (2.88 vs. 2.23, 2.93 vs. 2.33) of ClariCT2 were superior to those of FBP (p < 0.05), and not different from those of iDose4 (2.74 vs. 2.72, 3.02 vs. 2.98; 2.88 vs. 2.77, 2.93 vs. 2.86) (p > 0.05). CONCLUSION: Vendor-neutral IR technique shows image quality similar to that of clinically used vendor-specific hybrid IR technique for abdominopelvic CT in young patients.
Abdomen ; Child, Preschool ; Clinical Study ; Humans ; Noise