Purpose: To report an iris metastasis associated with non-small-cell lung cancer (NLC) confirmed via repeat aqueous humor cytology.Case summary: A 53-year-old female presented to our ophthalmology outpatient department with complaints of vision impairment and pain in the left eye 1 month in duration. In ophthalmologic examinations, the best-corrected visual acuities were 20/20 oculus dexter (OD) and 20/32 oculus sinister (OS). The intraocular pressures measured using standard Goldmann applanation tonometery were 12 mmHg OD and 42 mmHg OS. Slit-lamp examination revealed multiple iris nodules in the left eye. Thirteen months prior, the patient had been diagnosed with NLC and was on chemotherapy. Despite the maximal tolerated medical therapy, the intraocular pressure was not controlled. As an iris metastasis was suspected, anterior chamber paracentesis was performed for aqueous humor sampling. Cytological analysis did not reveal malignant cells. One week later, aqueous humor sampling was repeated. Malignant cells were histopathologically confirmed. Given the ocular metastasis, the oncologists changed the chemotherapy regimen. Conclusions When an NLC patient exhibits iris nodules, repeat aqueous humor cytology can confirm an iris metastasis.

The management of children with intersex or micropenis is an ongoing challenge to clinicians. Topics including the recent surgical developments and controversies of management are reviewed. In feminizing genitoplasty, clitoroplasty is done as early as the first few months of life, however there are controversy in vaginal reconstruction for high vaginal confluence. In the patients with complete androgen insensitivity the testes are left intact until after puberty, so that hormone replacement therapy may be delayed. The sex assignment and surgical management of patients with intersex is very complex and should be made by the intersex team and family. Micropenis should be diagnosed by measuring stretched penile length and differentiated from buried penis which has basically normal penile size. In most boys with small penis, the size of penis reaches the normal range through a catch-up growth after puberty. Therefore close observation is a general rule in management of small penis. However low dose androgen treatment can be applied without complication in children with micropenis, especially who have severe psychological stress.
Child ; Genital Diseases, Male ; Hormone Replacement Therapy ; Humans ; Male ; Penis ; Puberty ; Reference Values ; Stress, Psychological ; Testis

BACKGROUND: Empirical use of fresh frozen plasma (FFP) in perioperative blood transfusion leads to high wastage of FFP. However, coordination of many related clinical departments is difficult. Therefore, quality improvement (QI) activities for establishment of appropriate use of FFP are needed. METHODS: Departments of surgery (all surgery departments except ophthalmology) and the departments of anesthesiology, clinical pathology, and nurses met each month from March, 2011 to October, 2011. Each department investigated the number of FFP usages, wastage, and coagulation tests. Primary measured variables and objectives were decrease of 50% of FFP wastage rate compared with the previous year and 50% increase of coagulation testing before using FFP. Secondary measured variables were total amount of FFP usage and report time for coagulation tests. RESULTS: After the QI activities (March, 2011~October, 2011), FFP wastage decreased, from 71.5 units during the second half of 2010 to 37.8 units during the second half of 2011 (-47.1%). Rate of coagulation testing before using FFP more than doubled during the second half of 2011 (57%) compared with the second half of 2010 (25%). The rate of less than 30 minutes report time for coagulation testing increased from 60% to 75%. FFP transfusion per 1,000 surgical cases decreased to from 190 units to 118 units. CONCLUSION: Rate of FFP wastage and transfusion decreased and rate of performance of the blood coagulation test was enhanced through education and training on transfusion and QI activities.
Anesthesiology ; Blood Coagulation Tests ; Blood Transfusion ; Pathology, Clinical ; Plasma ; Qi ; Quality Improvement

This study was conducted to evaluate the ability of plants to purify indoor air by observing the effective reduction rate among pollutant types of particulate matter (PM) and volatile organic compounds (VOCs). PM and four types of VOCs were measured in a new building that is less than three years old and under three different conditions: before applying the plant, after applying the plant, and a room without a plant. The removal rate of each pollutant type due to the plant was also compared and analyzed. In the case of indoor PM, the removal effect was negligible because of outdoor influence. However, 9% of benzene, 75% of ethylbenzene, 72% of xylene, 75% of styrene, 50% of formaldehyde, 36% of acetaldehyde, 35% of acrolein with acetone, and 85% of toluene were reduced. The purification of indoor air by natural ventilation is meaningless because the ambient PM concentration has recently been high. However, contamination by gaseous materials such as VOCs can effectively be removed through the application of plants.
Acetaldehyde ; Acetone ; Acrolein ; Benzene ; Formaldehyde ; Particulate Matter* ; Plants ; Styrene ; Toluene ; Ventilation ; Volatile Organic Compounds* ; Xylenes

This study was conducted to evaluate the ability of plants to purify indoor air by observing the effective reduction rate among pollutant types of particulate matter (PM) and volatile organic compounds (VOCs). PM and four types of VOCs were measured in a new building that is less than three years old and under three different conditions: before applying the plant, after applying the plant, and a room without a plant. The removal rate of each pollutant type due to the plant was also compared and analyzed. In the case of indoor PM, the removal effect was negligible because of outdoor influence. However, 9% of benzene, 75% of ethylbenzene, 72% of xylene, 75% of styrene, 50% of formaldehyde, 36% of acetaldehyde, 35% of acrolein with acetone, and 85% of toluene were reduced. The purification of indoor air by natural ventilation is meaningless because the ambient PM concentration has recently been high. However, contamination by gaseous materials such as VOCs can effectively be removed through the application of plants.
Acetaldehyde ; Acetone ; Acrolein ; Benzene ; Formaldehyde ; Particulate Matter ; Plants ; Styrene ; Toluene ; Ventilation ; Volatile Organic Compounds ; Xylenes

BRAF inhibitors (e.g., vemurafenib) are widely used to treat metastatic melanoma with the BRAF V600E mutation. The initial response is often dramatic, but treatment resistance leads to disease progression in the majority of cases. Although secondary mutations in the mitogen-activated protein kinase signaling pathway are known to be responsible for this phenomenon, the molecular mechanisms governing acquired resistance are not known in more than half of patients. Here we report a genome- and transcriptome-wide study investigating the molecular mechanisms of acquired resistance to BRAF inhibitors. A microfluidic chip with a concentration gradient of vemurafenib was utilized to rapidly obtain therapy-resistant clones from two melanoma cell lines with the BRAF V600E mutation (A375 and SK-MEL-28). Exome and transcriptome data were produced from 13 resistant clones and analyzed to identify secondary mutations and gene expression changes. Various mechanisms, including phenotype switching and metabolic reprogramming, have been determined to contribute to resistance development differently for each clone. The roles of microphthalmia-associated transcription factor, the master transcription factor in melanocyte differentiation/dedifferentiation, were highlighted in terms of phenotype switching. Our study provides an omics-based comprehensive overview of the molecular mechanisms governing acquired resistance to BRAF inhibitor therapy.

BRAF inhibitors (e.g., vemurafenib) are widely used to treat metastatic melanoma with the BRAF V600E mutation. The initial response is often dramatic, but treatment resistance leads to disease progression in the majority of cases. Although secondary mutations in the mitogen-activated protein kinase signaling pathway are known to be responsible for this phenomenon, the molecular mechanisms governing acquired resistance are not known in more than half of patients. Here we report a genome- and transcriptome-wide study investigating the molecular mechanisms of acquired resistance to BRAF inhibitors. A microfluidic chip with a concentration gradient of vemurafenib was utilized to rapidly obtain therapy-resistant clones from two melanoma cell lines with the BRAF V600E mutation (A375 and SK-MEL-28). Exome and transcriptome data were produced from 13 resistant clones and analyzed to identify secondary mutations and gene expression changes. Various mechanisms, including phenotype switching and metabolic reprogramming, have been determined to contribute to resistance development differently for each clone. The roles of microphthalmia-associated transcription factor, the master transcription factor in melanocyte differentiation/dedifferentiation, were highlighted in terms of phenotype switching. Our study provides an omics-based comprehensive overview of the molecular mechanisms governing acquired resistance to BRAF inhibitor therapy.

Objectives: ：Based on the fact that cognitive functions decline known as comorbid symptoms of depression can precede depression, this study seeks to observe the effects of depressive symptoms and anxiety symptoms on cognitive function in healthy subjects. Methods: ：To recruit 50 general populations to evaluate cognitive and clinical symptoms and to find out the effects of clinical symptoms on cognitive functions, Pearson correlation and multivariate regression were conducted. Correlation analysis of subdomain cognitive function was conducted for reliability analysis. Results: ：Trail making test-B that evaluates the execution function correlates with depressive symptoms (r=0.300, p=0.03) and age (r=0.323, p=0.02). Depressive symptoms (β=0.304, p=0.03) and age (β=0.335, p=0.01) were significantly related to Trail making test -B (Adjusted R2 =0.148). Subjective cognitive tests correlates with anxiety symptoms (r=0.434, p=0.002). In the correlation between cognitive functional items, Subjective cognitive tests was found to be correlated with other test except Spotter. Conclusions ：In this study, depressive symptoms contribute independently to executive functions in addition to demographic characteristics such as age and duration of education. Given that cognitive decline is a common long-term clinical outcome in depression, we expect active early intervention and evaluation of cognitive function to be helpful.

Although gastroesophageal damage is commonly induced by accidental drinking of a strong acid or alkali, damage due to the consumption of a vinegar beverage is not well known. We report a case of corrosive esophageal ulcer found in an adolescent consuming a vinegar drink daily. A 15-year-old male visited the emergency room presenting with hematemesis and severe epigastric pain. Multiple longitudinal ulcers, concurrent mucosal hemorrhage, and denuded mucosa were noted in the whole of the esophagus via an endoscopic examination. He had been drinking a vinegar beverage daily without sufficient dilution. The patient was treated with corticosteroid, antibiotic therapy, and mucosa protecting alginate medication and was asked to fast for a week. The follow-up endoscopy showed improvement of the esophageal injuries. Overall, continuous consumption of a vinegar beverage can result in acidic burns and destruction of the surface of the upper gastrointestinal tract. Therefore, vinegar beverages should be considered as corrosive agents.

Objectives: We investigated the impact of the coronavirus disease 2019 (COVID-19) pandemic on tuberculosis (TB) management in the Republic of Korea (ROK). Methods: This retrospective cross-sectional study used nationwide ROK TB notification data (98,346 cases) from 2017 to 2020. The median time from the onset of TB symptoms to treatment initiation and the compliance rates with the required timing for notification and individual case investigations were measured and compared across periods and regions affected by the COVID-19 epidemic. Results: TB diagnosis during the COVID-19 pandemic was delayed. The median time to TB treatment initiation (25 days) in 2020 increased by 3 days compared to that of the previous 3 years (22 days) (p<0.0001). In the outbreak in Seoul, Incheon, and Gyeonggi province during August, the time to TB diagnosis was 4 days longer than in the previous 3 years (p=0.0303). In the outbreak in Daegu and Gyeongbuk province from February to March 2020, the compliance rate with the required timing for individual case investigations was 2.2%p points lower than in other areas in 2020 (p=0.0148). For public health centers, the rate was 13%p lower than in other areas (80.3% vs. 93.3%, p=0.0003). Conclusion TB diagnoses during the COVID-19 pandemic in the ROK were delayed nationwide, especially for patients notified by public-private mix TB control hospitals. TB individual case investigations were delayed in regional COVID-19 outbreak areas (Daegu and Gyeongbuk province), especially in public health centers. Developing strategies to address this issue will be helpful for sustainable TB management during future outbreaks.