BACKGROUND: Ablative fractional carbon dioxide laser is widely used for the treatment of various scars including burn injuries. We applied ablative fractional CO2 laser on the skin graft scar of faces. METHODS: Fourteen patients between 2010 and 2013 who underwent facial skin graft were included in this study. The ablative fractional CO2 laser was applied to 7 patients in the laser therapy group. It was initiated at 5th week after the skin graft. Clinical photographs were taken, and Patient Scar Assessment Score (PAS) was obtained during every visit from a patient at the outpatient clinic and 4 weeks after the last laser treatment. In the untreated control group, clinical photographs and PAS were taken at 5th and 21st weeks after the skin graft. Vancouver Scar Scale (VSS) and Observer Scar Assessment score (OAS) was rated by single independent plastic surgeon with the clinical photographs. RESULTS: In the laser therapy group, VSS, PAS, and OAS improved after fractional laser treatment. In the untreated group, VSS was also improved by the natural process of scar maturation. However, the laser treated group showed significant improvement compared with the untreated group. CONCLUSIONS: The ablative fractional CO2 laser can be a viable option for the treatment of skin graft scar. Further study with sufficient patients and long term follow-up is necessary for definite conclusions.
Ambulatory Care Facilities ; Burns ; Cicatrix ; Contracture* ; Humans ; Laser Therapy ; Lasers, Gas* ; Skin* ; Transplants*

27-Hydroxycholesterol (27OHChol) has been reported to induce differentiation of monocytic cells into a mature dendritic cell phenotype. We examined the effect of methanol extract of Nardostachys chinensis (Nard) on 27OHChol-induced differentiation using THP-1, a human monocytic cell line. Treatment of monocytic cells with methanol extract of Nard resulted in decreased transcription and surface expression of CD80, CD83, and CD88 elevated by 27OHChol in a dose-dependent manner. Surface levels of MHC class I and II molecules elevated by 27OHChol were also reduced to basal levels by treatment with the Nard extract. Decreased endocytosis activity caused by 27OHChol was recovered by treatment with the Nard extract. CD197 expression and cell attachment were attenuated by the Nard extract. In addition, levels of transcription and surface expression of CD molecules involved in atherosclerosis, such as CD105, CD137, and CD166 upregulated by 27OHChol were significantly decreased by treatment with methanol extract of Nard. These results indicate that methanol extract of Nard down-regulates 27OHChol-induced differentiation of monocytic cells into a mature dendritic cell phenotype and expression of CD molecules associated with atherosclerosis. The current study suggests that biological activity of oxygenated cholesterol derivatives can be inhibited by herbal medication.
Atherosclerosis ; Cell Line ; Cholesterol ; Dendritic Cells ; Endocytosis ; Humans ; Methanol* ; Monocytes ; Nardostachys* ; Oxygen ; Phenotype

OBJECTIVE: To determine if measurement of the diameter of the solid component in subsolid nodules (SSNs) on low-dose unenhanced chest computed tomography (CT) is as accurate as on standard-dose enhanced CT in prediction of pathological size of invasive component of lung adenocarcinoma. MATERIALS AND METHODS: From February 2012 to October 2015, 114 SSNs were identified in 105 patients that underwent low-dose unenhanced and standard-dose enhanced CT pre-operatively. Three radiologists independently measured the largest diameter of the solid component. Intraclass correlation coefficients (ICCs) were used to assess inter-reader agreement. We estimated measurement differences between the size of solid component and that of invasive component. We measured diagnostic accuracy of the prediction of invasive adenocarcinoma using a size criterion of a solid component ≥ 6 mm, and compared them using a generalized linear mixed model. RESULTS: Inter-reader agreement was excellent (ICC, 0.84.0.89). The mean ± standard deviation of absolute measurement differences between the solid component and invasive component was 4 ± 4 mm in low-dose unenhanced CT and 5 ± 4 mm in standard-dose enhanced CT. Diagnostic accuracy was 81.3% (95% confidence interval, 76.7.85.3%) in low-dose unenhanced CT and 76.6% (71.8.81.0%) in standard-dose enhanced CT, with no statistically significant difference (p = 0.130). CONCLUSION: Measurement of the diameter of the solid component of SSNs on low-dose unenhanced chest CT was as accurate as on standard-dose enhanced CT for predicting the invasive component. Thus, low-dose unenhanced CT may be used safely in the evaluation of patients with SSNs.
Adenocarcinoma* ; Humans ; Lung* ; Thorax* ; Tomography, X-Ray Computed

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

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

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

BACKGROUND: The zygoma is the most prominent portion of the face. Almost all simple zygomatic arch fractures are treated in a closed fashion with a Dingman elevator. However, the open approach should be considered for unstable zygomatic arch fractures. The coronal approach for a zygomatic arch fracture has complications. In this study, we introduce our method to reduce a special type of unstable zygomatic fracture. METHODS: We retrospectively reviewed zygomatic arch view and facial bone computed tomography scans of 424 patients who visited the Wonju Severance Christian Hospital from 2007 to 2010 with zygomaticomaxillary fractures, among whom 15 patients met the inclusion criteria. RESULTS: We used a Dingman elevator and K-wire simultaneously to manage this type of zygomatic arch fracture. Simple medial rotation force usually collapses the posterior fractured segment, and the fracture becomes unstable. Thus, the posterior fracture segment must be concurrently elevated with a Dingman elevator through Keen's approach with rotation force applied through the K-wire. All fractures were reduced without any instability using this method. CONCLUSION: We were able to reduce unstable and difficult zygomatic arch fractures without an open incision or any external fixation device.
Elevators and Escalators* ; External Fixators ; Facial Bones ; Facial Injuries ; Gangwon-do ; Humans ; Maxillofacial Injuries ; Retrospective Studies ; Zygoma* ; Zygomatic Fractures

BACKGROUND: The zygoma is the most prominent portion of the face. Almost all simple zygomatic arch fractures are treated in a closed fashion with a Dingman elevator. However, the open approach should be considered for unstable zygomatic arch fractures. The coronal approach for a zygomatic arch fracture has complications. In this study, we introduce our method to reduce a special type of unstable zygomatic fracture. METHODS: We retrospectively reviewed zygomatic arch view and facial bone computed tomography scans of 424 patients who visited the Wonju Severance Christian Hospital from 2007 to 2010 with zygomaticomaxillary fractures, among whom 15 patients met the inclusion criteria. RESULTS: We used a Dingman elevator and K-wire simultaneously to manage this type of zygomatic arch fracture. Simple medial rotation force usually collapses the posterior fractured segment, and the fracture becomes unstable. Thus, the posterior fracture segment must be concurrently elevated with a Dingman elevator through Keen's approach with rotation force applied through the K-wire. All fractures were reduced without any instability using this method. CONCLUSION: We were able to reduce unstable and difficult zygomatic arch fractures without an open incision or any external fixation device.
Elevators and Escalators* ; External Fixators ; Facial Bones ; Facial Injuries ; Gangwon-do ; Humans ; Maxillofacial Injuries ; Retrospective Studies ; Zygoma* ; Zygomatic Fractures

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

Background/Aims: The first autologous peripheral blood stem cell transplantation (ASCT) in Korea was performed for a small-cell lung cancer patient at Asan Medical Center (AMC) in 1993. Recently, lymphoma and myeloma have been the main indications; there has been progress in the treatments for these lymphoid malignancies. We explored the real-world experience of ASCT for lymphoma and myeloma at AMC over a 25-year period. Methods: We used the AMC ASCT registry, which has collected ASCT data prospectively since January 1993. Data for Hodgkin lymphoma, non-Hodgkin lymphoma, and multiple myeloma patients were analyzed. Patients transplanted up to December 2018 were included to assess adequate survival data. The ASCT time period was divided arbitrarily into 1994-1999, 2000-2009, and 2010-2018. In cases of multiple myeloma, we analyzed the 1st ASCT data only. Results: Survival of these lymphoid malignancy patients after ASCT has progressively improved. The increase in survival may be related to advances in various medical skills supporting ASCT. However, overall survival has improved much more than progression-free survival. This suggests that better salvage therapies after ASCT failure have mainly affected the improvement in overall survival. The hematopoietic cell transplantation-specific comorbidity index could not be used as a survival indicator in this analysis. Conclusions This real-world experience study showed that the survival of lymphoid malignancy patients treated with ASCT has improved over the past 25 years.