Purpose: This study reports a case of meibomian gland dysfunction associated with bortezomib, which is a treatment of choice for multiple myeloma.Case summary: A 59‐year‐old female patient presented to our hospital with a complaint of dryness that had worsened for 2 months and eye discharges that were difficult to remove even after washing her face. The patient had been diagnosed with multiple myeloma 5 months prior and had undergone four cycles of bortezomib therapy. Slit‐lamp microscopy revealed a number of pouting of the meibomian gland (MG) orifices in both eyes. Meibography revealed that more than one‐third and less than twothirds of the total MG area of both upper lids were lost and more than two‐thirds of the total MG area of both lower lids were lost. No clinically significant improvements were noted at 8 months despite thorough eyelid hygiene therapy, including warm compresses, topical antibiotics, steroids, and artificial tears. However, when the patient revisited our clinic 2 months after completing bortezomib treatment, the subjective symptoms had improved and all of the pouting of MG orifices had disappeared. There was no significant difference in the MG dropout area for either eye compared with the observations from a previous visit during bortezomib treatment. Conclusions Clinicians should be aware that MG dysfunction may occur or worsen in patients receiving bortezomib treatment and should consider this when establishing a treatment plan for meibomian dysfunction or when educating patients.

Purpose: This study investigated metabolic health status as a risk factor for female bladder cancer using the National Health Checkups databases of Korea. Materials and Methods: We defined obesity if body mass index was ≥25 kg/m2 and normal weight as <25 kg/m2. Metabolic unhealthiness was defined when 3 or more criteria of metabolic syndrome were met. A total of 11,461,618 women who took National health Checkups between 2009 and 2012 were categorized as metabolic healthy normal weight (MHNW), metabolic unhealthy normal weight (MuHNW), metabolic health obese (MHO), and metabolic unhealthy obese (MuHO). Multivariable-adjusted Cox regression was done to analyze the hazard ratio of bladder cancer. Results: The mean age was 48±11.55 years and body mass index was 23.19±2.13 kg/m2. During 5.4±1.1 years of follow-up, 3,893 patients were newly diagnosed with bladder cancer. Compared to MHNW group, the hazard ratio of MuHNW group and MuHO group were 1.237 and 1.288, respectively, while 0.997 in the MHO group. As the number of metabolic unhealthy criteria increased, the cumulative incidence of bladder cancer increased. Conclusions As a result of a large-scale study conducted on the female population in Korea, the risk of bladder cancer increased with metabolic unhealthiness. Even with normal weight, if metabolically unhealthy, the risk of bladder cancer increased. The greater the degree of metabolic unhealthiness, the higher the risk of bladder cancer. Education on metabolic healthiness concerning female bladder cancer is necessary.

BACKGROUND/AIMS: GC7101, an extract of Lonicera Flos, is a novel developing drug for reflux esophagitis and functional dyspepsia. However, the drug's exact pharmacological mechanism of action remains unclear. This study assessed the effects of GC7101 on gastrointestinal (GI) motor function. METHODS: We used male guinea pigs to evaluate the effects of GC7101 on GI motility. The contraction of antral circular muscle in the presence of different doses of GC7101 was measured in a tissue bath. The prokinetic effects of GC7101 were tested using the charcoal transit assay from the pylorus to the most distal point of migration of charcoal mixture. To clarify the mechanism of action of GC7101, atropine, dopamine and the selective 5-hydroxytryptamine 4 receptor antagonist, GR113808 were used. RESULTS: The maximal amplitude of circular muscle contraction was induced by 5 mg mL(-1) GC7101. The area under the curve of contraction was significantly increased at 5 mg mL(-1) GC7101. Addition of 10(-6) M atropine, 10(-8) M dopamine or 10(-7) M GR 113808 to GC7101 5 mg mL(-1) decreased the amplitude and area under curve compared to GC7101 5 mg mL(-1) alone. GC7101 accelerated GI transit in a dose dependent manner except 100 mg kg(-1). Delayed GI transit caused by atropine, dopamine and GR 113808 was restored by GC7101 50 mg kg(-1). CONCLUSIONS: GC7101, an extract of Lonicera Flos, exerts a gastric prokinetic effect in guinea pig through cholinergic, antidopaminergic and serotonergic mechanisms. Therefore, GC7101 might be a novel drug for the treatment of functional dyspepsia.
Animals ; Area Under Curve ; Atropine ; Baths ; Charcoal ; Dopamine ; Dyspepsia ; Esophagitis, Peptic ; Gastrointestinal Motility ; Guinea Pigs ; Humans ; Lonicera ; Male ; Muscle Contraction ; Pylorus ; Serotonin

OBJECTIVE: Different angiographic protocols may influence the radiation dose and image quality. In this study, we aimed to investigate the effects of filtration and focal spot size on radiation dose and image quality for diagnostic cerebral angiography using an in-vitro model and in-vivo patient groups. MATERIALS AND METHODS: Radiation dose and image quality were analyzed by varying the filtration and focal spot size on digital subtraction angiography exposure protocols (1, inherent filtration + large focus; 2, inherent + small; 3, copper + large; 4, copper + small). For the in-vitro analysis, a phantom was used for comparison of radiation dose. For the in-vivo analysis, bilateral paired injections, and patient cohort groups were compared for radiation dose and image quality. Image quality analysis was performed in terms of contrast, sharpness, noise, and overall quality. RESULTS: In the in-vitro analysis, the mean air kerma (AK) and dose area product (DAP)/frame were significantly lower with added copper filtration (protocols 3 and 4). In the in-vivo bilateral paired injections, AK and DAP/frame were significantly lower with filtration, without significant difference in image quality. The patient cohort groups with added filtration (protocols 3 and 4) showed significant reduction of total AK and DAP/patient without compromise to the image quality. Variations in focal spot size showed no significant differences in radiation dose and image quality. CONCLUSION: Addition of filtration for angiographic exposure studies can result in significant total radiation dose reduction without loss of image quality. Focal spot size does not influence radiation dose and image quality. The routine angiographic protocol should be judiciously investigated and implemented.
Angiography, Digital Subtraction ; Cerebral Angiography* ; Cohort Studies ; Copper ; Filtration* ; Humans ; Noise ; Radiation Exposure

Herpes zoster (HZ) has been reported in immunocompetent children who received the varicella vaccine. In vaccinated children, HZ can be caused by vaccine-strain or by wild-type varicella-zoster virus (VZV). Like wild-type VZV, varicella vaccine virus can establish latency and reactivate as HZ. We report two cases of HZ in otherwise healthy 16- and 14-month-old boys who received varicella vaccine at 12 months of age. They presented with a vesicular rash on their upper extremities three to four months after varicella vaccination. In one case, a swab was obtained by abrading skin vesicles and VZV was detected in skin specimens by polymerase chain reaction. The VZV open-reading frame 62 was sequenced and single nucleotide polymorphism analysis confirmed that the virus from skin specimen was vaccinestrain. This is the first HZ case following varicella vaccination confirmed to be caused by vaccine-strain VZV in the immunocompetent children in Korea. Pediatricians should be aware of the potential for varicella vaccine virus reactivation in vaccinated young children.

Objective: Preoperative differential diagnosis of follicular-patterned lesions is challenging. This multicenter cohort study investigated the clinicoradiological characteristics relevant to the differential diagnosis of such lesions. Materials and Methods: From June to September 2015, 4787 thyroid nodules (≥ 1.0 cm) with a final diagnosis of benign follicular nodule (BN, n = 4461), follicular adenoma (FA, n = 136), follicular carcinoma (FC, n = 62), or follicular variant of papillary thyroid carcinoma (FVPTC, n = 128) collected from 26 institutions were analyzed. The clinicoradiological characteristics of the lesions were compared among the different histological types using multivariable logistic regression analyses. The relative importance of the characteristics that distinguished histological types was determined using a random forest algorithm. Results: Compared to BN (as the control group), the distinguishing features of follicular-patterned neoplasms (FA, FC, and FVPTC) were patient’s age (odds ratio [OR], 0.969 per 1-year increase), lesion diameter (OR, 1.054 per 1-mm increase), presence of solid composition (OR, 2.255), presence of hypoechogenicity (OR, 2.181), and presence of halo (OR, 1.761) (all p < 0.05). Compared to FA (as the control), FC differed with respect to lesion diameter (OR, 1.040 per 1-mm increase) and rim calcifications (OR, 17.054), while FVPTC differed with respect to patient age (OR, 0.966 per 1-year increase), lesion diameter (OR, 0.975 per 1-mm increase), macrocalcifications (OR, 3.647), and non-smooth margins (OR, 2.538) (all p < 0.05). The five important features for the differential diagnosis of follicular-patterned neoplasms (FA, FC, and FVPTC) from BN are maximal lesion diameter, composition, echogenicity, orientation, and patient’s age. The most important features distinguishing FC and FVPTC from FA are rim calcifications and macrocalcifications, respectively. Conclusion Although follicular-patterned lesions have overlapping clinical and radiological features, the distinguishing features identified in our large clinical cohort may provide valuable information for preoperative distinction between them and decision-making regarding their management.

Purpose: To compare the horizontal white-to-white (WTW) diameter measured using four devices. Methods: We measured the horizontal WTW diameter of 52 eyes of 52 patients using the IOL Master 500, ANTERION, OA-2000, and Pentacam HR devices. Repeated-measures analysis of variance was used to compare the measurements. Correlations between the measurements were evaluated using the Pearson correlation test. Agreement between measurements obtained using different instruments was confirmed using a Bland-Altman plot. Results: The mean horizontal WTW diameters obtained using IOL Master 500, ANTERION, OA-2000, and Pentacam HR were 11.65 ± 0.39, 11.52 ± 0.44, 11.51 ± 0.52, and 11.28 ± 0.41 mm, respectively. The horizontal WTW diameters obtained using IOL Master 500 and Pentacam HR were the largest and smallest, respectively. There was a statistically significant difference in mean diameter between IOL Master 500 and ANTERION (p = 0.03), as well as between Pentacam HR and the remaining three devices (all p < 0.001). There were positive correlations between the measurements obtained using the different devices (all r > 0.6, p < 0.001). The 95% limits of agreement between the measurements were 0.808-1.619 mm. Conclusions There were statistically significant differences in horizontal WTW diameter between IOL Master 500 and ANTERION, and between IOL Master 500 and Pentacam HR, but not between IOL Master 500 and OA-2000. Measurements obtained using IOL Master 500 and the remaining three devices are not interchangeable because of their low level of agreement.

BACKGROUND: A latent cytomegalovirus (CMV) cause chronic inflammation through undesirable inflation of cell-mediated immune response. CMV immunoglobulin G has been associated with cardiovascular disease and type 1 diabetes mellitus. We evaluated impact of CMV diseases on new-onset type 2 diabetes mellitus (T2DM).METHODS: From the Korean Health Insurance Review and Assessment Service claim database of entire population with 50 million, we retrieved 576 adult case group with CMV diseases diagnosed with International Statistical Classification of Diseases and Related-Health Problems 10th Revision (ICD-10) B25 code between 2010 and 2014 after exclusion of patients with T2DM to 2006. The 2,880 control patients without T2DM from 2006 to cohort entry point were selected between 2010 and 2014 by age, sex matching with case group. The subjects without new-onset T2DM were followed until 2015. T2DM, hypertension (HTN), dyslipidemia (DYS), and end-stage renal disease (ESRD) were coded as ICD-10.RESULTS: The frequency of new-onset T2DM in case group was significantly higher than that in control (5.6% vs. 2.2%, P<0.001). The group with T2DM (n=95) had higher incidence of CMV diseases than the group without T2DM (n=3,361) (33.7% vs. 16.2%, P<0.001). In multivariate regression model adjusted by age, sex, lower income, HTN, and DYS, the incidence rate (IR) of T2DM in case group was significantly higher than that in the control group (IR per 1,000, 19.0 vs. 7.3; odds ratio, 2.1; 95% confidence interval, 1.3 to 3.2). The co-existence of HTN, DYS, and ESRD with CMV diseases did not influence the IR of T2DM.CONCLUSION: CMV diseases increase the patients' risk of developing T2DM.
Adult ; Cardiovascular Diseases ; Case-Control Studies ; Classification ; Cohort Studies ; Cytomegalovirus ; Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Humans ; Hypertension ; Immunoglobulin G ; Incidence ; Inflammation ; Inflation, Economic ; Insurance, Health ; International Classification of Diseases ; Kidney Failure, Chronic ; Odds Ratio

PURPOSE: To report a case of progressive outer retinal necrosis treated by combined intravitreal foscarnet and ganciclovir. CASE SUMMARY: A 11-year-old male with a history of chemotherapy and cord blood transplantation due to precursor T-cell leukemia developed Herpes zoster lesion on his forehead and rapidly progressing peripheral retinal necrosis without vasculitis in the right eye. Varicella-Zoster virus was confirmed in his cerebrospinal fluid using polymerase chain reaction (PCR); and the patient was diagnosed with progressive outer retinal necrosis. Despite combined treatment with intravenous acyclovir and foscarnet and intravitreal foscarnet, retinal necrosis progressed to retinal detachment and total retinal necrosis. During follow-up, new retinal necrosis was observed in his left eye. The patient was started on combined intravenous and intravitreal foscarnet and ganciclovir; retinal necrosis in the left eye regressed and posterior pole was spared. With subsequent oral valganciclovir and intravitreal foscarnet and ganciclovir, the remaining retina was preserved with maintained vision.
Acyclovir ; Cerebrospinal Fluid ; Child ; Drug Therapy ; Fetal Blood ; Follow-Up Studies ; Forehead ; Foscarnet* ; Ganciclovir* ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Leukemia, T-Cell ; Male ; Necrosis* ; Polymerase Chain Reaction ; Retina ; Retinal Detachment ; Retinaldehyde* ; Vasculitis

A 5-year-old Korean boy was admitted with dyspnea, intermittent cyanosis and finger clubbing. He was diagnosed to be suffering measles pneumonia 3 years ago. Plain radiograph showed collapse of the right lung, mediastinal shifting and infiltration on both lower lung fields. High resolution computerized tomography revealed a central bronchiectasis with mosaic hyperinflation. All of the clinical information indicated that the severity of illness score was 4 of bronchiolitis obliterans (BO). The bronchoalveolar lavage cellular profile showed predominant neutrophilia. BO with finger clubbing has been rarely reported previously in childhood. We report a case of BO with finger clubbing in children with regard to clinical presentation of measles complicated pneumonia.
Bronchiectasis ; Bronchiolitis Obliterans* ; Bronchiolitis* ; Bronchoalveolar Lavage ; Child ; Child, Preschool ; Cyanosis ; Dyspnea ; Fingers* ; Humans ; Lung ; Male ; Measles* ; Pneumonia