PURPOSE: In order to make an accurate diagnosis, we investigated clinical manifestations and ocular findings in children with ocular myasthenia gravis that can be easily misdiagnosed. METHODS: The medical records of 7 boys and 18 girls under the age of 15 years with ocular myasthenia gravis were reviewed retrospectively. The mean follow-up period was 37 months. RESULTS: The mean age at onset was 37 months. Ptosis was found in 22 patients(88%), strabismus in 21 patients(84%) and amblyopia in 5 patients(20%). Exotropia combined with vertical heterotropia was the most frequent type of strabismus. Ocular motility abnormality was found in 17 patients(68%). The limitation of supraduction or infraduction was most frequently observed. The manifestations of strabismus and ocular motility abnormality were variable and frequently changed during follow-up period. Prednisolone was used more often than pyridostigmine as a maintenance therapy. Ptosis was more responsive to drug therapy than strabismus. CONCLUSIONS: The main ocular findings in ocular myasthenic children were ptosis and exotropia that was not commonly found in Caucasian children. Vertical heterotropia as well as ptosis were commonly accompanied with the horizontal heterotropia. The type and angle of strabismus as well as ocular motility in duction/version were variable during follow-up period
Amblyopia ; Child* ; Diagnosis ; Drug Therapy ; Exotropia ; Female ; Follow-Up Studies ; Humans ; Medical Records ; Myasthenia Gravis* ; Prednisolone ; Pyridostigmine Bromide ; Retrospective Studies ; Strabismus

OBJECTIVES: Occupational stress management is particularly important for successful business operations, since occupational stress adversely affects workers’ health, eventually lowering their productivity. Therefore, this study aimed to investigate the correlation between occupational stress and health-related productivity loss (HRPL) among Korean workers. METHODS: In 2021, 1,078 workers participated in a web-based questionnaire survey. HRPL was measured using the Work Productivity and Activity Impairment Questionnaire, and occupational stress was measured using the Korean Occupational Stress Scale-Short Form. The occupational stress level was divided into tertiles (low, intermediate, and high), and the low occupational stress group was used as the reference group. Using a generalised linear model, differences in labour productivity loss according to the level of occupational stress were tested after adjusting for demographic characteristics such as age, gender, education level, household income, occupation, and underlying medical conditions. RESULTS: Non-parametric regression analysis of HRPL according to occupational stress showed a direct association between occupational stress and HRPL. A statistically significant difference was observed in HRPL between participants with intermediate and high occupational stress and those with low occupational stress. CONCLUSIONS Our results support the hypothesis that high occupational stress is associated with decreased labour productivity.

Background: Creutzfeldt-Jakob disease (CJD) is a rare and a rapidly progressive, invariably fatal neurodegenerative disorder believed to be caused by an abnormal isoform of a cellular glycoprotein known as the prion protein. The disease develops in very different ways, such as sporadic, genetic, and iatrogenic. We aim to identify the incidence of CJD genotypes registered in the statutory infectious disease surveillance system from 2017 to 2023 and analyze the types and characteristics of domestic pathogenic CJD genotypes to serve as a basis for preventing transmission. Methods: We analyzed the characteristics of hereditary CDJ among subjects reported through the Korean Centers for Disease Control and Prevention's statutory infectious disease surveillance system from 2017 to 2023. Results: In total, six pathogenic genotypes were identified in Korean patients, with P102L belonging to Gerstmann-Sträussler-Scheinker syndrome being the most common (16, 30.2%), followed by V180I (13, 24.5%), M232R (10, 18.9%), and E200K (seven, 18.9%), which are highly prevalent in Asia, and D178N (six, 11.3%) and V203I (one, 1.9%), which belong to fatal familial insomnia. Conclusions The significance of this study lies in the identification of P102L as the predominant genotype observed among individuals in their 30s and 40s in Korea. Moreover, it highlights that the occurrence of visual symptoms at an early stage is more prevalent in this age group compared to individuals over 50. Therefore, if a young individual reports a subjective decline in visual acuity not adequately accounted for by structural abnormalities of the eye, it becomes imperative to confirm the presence of CJD before undergoing ophthalmic procedures (such as corneal or retinal surgery), as these procedures involve high-risk organs for CJD transmission.

Background: Delayed hemothorax (dHTX) can occur unexpectedly, even in patients who initially present without signs of hemothorax (HTX), potentially leading to death. We aimed to develop a predictive model for dHTX requiring intervention, specifically targeting those with no or occult HTX. Methods: This retrospective study was conducted at a level 1 trauma center. The primary outcome was the occurrence of dHTX requiring intervention in patients who had no HTX or occult HTX and did not undergo closed thoracostomy post-injury. To minimize overfitting, we employed the least absolute shrinkage and selection operator (LASSO) logistic regression model for feature selection. Thereafter, we developed a multivariable logistic regression (MLR) model and a nomogram. Results: In total, 688 patients were included in the study, with 64 cases of dHTX (9.3%).The LASSO and MLR analyses revealed that the depth of HTX (adjusted odds ratio [aOR], 3.79; 95% confidence interval [CI], 2.10–6.85; p<0.001) and the number of totally displaced rib fractures (RFX) (aOR, 1.90; 95% CI, 1.56–2.32; p<0.001) were significant predictors. Based on these parameters, we developed a nomogram to predict dHTX, with a sensitivity of 78.1%, a specificity of 76.0%, a positive predictive value of 25.0%, and a negative predictive value of 97.1% at the optimal cut-off value. The area under the receiver operating characteristic curve was 0.832. Conclusion The depth of HTX on initial chest computed tomography and the number of totally displaced RFX emerged as significant risk factors for dHTX. We propose a novel nomogram that is easily applicable in clinical settings.

Background: Creutzfeldt-Jakob disease (CJD) is a rare and a rapidly progressive, invariably fatal neurodegenerative disorder believed to be caused by an abnormal isoform of a cellular glycoprotein known as the prion protein. The disease develops in very different ways, such as sporadic, genetic, and iatrogenic. We aim to identify the incidence of CJD genotypes registered in the statutory infectious disease surveillance system from 2017 to 2023 and analyze the types and characteristics of domestic pathogenic CJD genotypes to serve as a basis for preventing transmission. Methods: We analyzed the characteristics of hereditary CDJ among subjects reported through the Korean Centers for Disease Control and Prevention's statutory infectious disease surveillance system from 2017 to 2023. Results: In total, six pathogenic genotypes were identified in Korean patients, with P102L belonging to Gerstmann-Sträussler-Scheinker syndrome being the most common (16, 30.2%), followed by V180I (13, 24.5%), M232R (10, 18.9%), and E200K (seven, 18.9%), which are highly prevalent in Asia, and D178N (six, 11.3%) and V203I (one, 1.9%), which belong to fatal familial insomnia. Conclusions The significance of this study lies in the identification of P102L as the predominant genotype observed among individuals in their 30s and 40s in Korea. Moreover, it highlights that the occurrence of visual symptoms at an early stage is more prevalent in this age group compared to individuals over 50. Therefore, if a young individual reports a subjective decline in visual acuity not adequately accounted for by structural abnormalities of the eye, it becomes imperative to confirm the presence of CJD before undergoing ophthalmic procedures (such as corneal or retinal surgery), as these procedures involve high-risk organs for CJD transmission.

Background: Creutzfeldt-Jakob disease (CJD) is a rare and a rapidly progressive, invariably fatal neurodegenerative disorder believed to be caused by an abnormal isoform of a cellular glycoprotein known as the prion protein. The disease develops in very different ways, such as sporadic, genetic, and iatrogenic. We aim to identify the incidence of CJD genotypes registered in the statutory infectious disease surveillance system from 2017 to 2023 and analyze the types and characteristics of domestic pathogenic CJD genotypes to serve as a basis for preventing transmission. Methods: We analyzed the characteristics of hereditary CDJ among subjects reported through the Korean Centers for Disease Control and Prevention's statutory infectious disease surveillance system from 2017 to 2023. Results: In total, six pathogenic genotypes were identified in Korean patients, with P102L belonging to Gerstmann-Sträussler-Scheinker syndrome being the most common (16, 30.2%), followed by V180I (13, 24.5%), M232R (10, 18.9%), and E200K (seven, 18.9%), which are highly prevalent in Asia, and D178N (six, 11.3%) and V203I (one, 1.9%), which belong to fatal familial insomnia. Conclusions The significance of this study lies in the identification of P102L as the predominant genotype observed among individuals in their 30s and 40s in Korea. Moreover, it highlights that the occurrence of visual symptoms at an early stage is more prevalent in this age group compared to individuals over 50. Therefore, if a young individual reports a subjective decline in visual acuity not adequately accounted for by structural abnormalities of the eye, it becomes imperative to confirm the presence of CJD before undergoing ophthalmic procedures (such as corneal or retinal surgery), as these procedures involve high-risk organs for CJD transmission.

Background: Delayed hemothorax (dHTX) can occur unexpectedly, even in patients who initially present without signs of hemothorax (HTX), potentially leading to death. We aimed to develop a predictive model for dHTX requiring intervention, specifically targeting those with no or occult HTX. Methods: This retrospective study was conducted at a level 1 trauma center. The primary outcome was the occurrence of dHTX requiring intervention in patients who had no HTX or occult HTX and did not undergo closed thoracostomy post-injury. To minimize overfitting, we employed the least absolute shrinkage and selection operator (LASSO) logistic regression model for feature selection. Thereafter, we developed a multivariable logistic regression (MLR) model and a nomogram. Results: In total, 688 patients were included in the study, with 64 cases of dHTX (9.3%).The LASSO and MLR analyses revealed that the depth of HTX (adjusted odds ratio [aOR], 3.79; 95% confidence interval [CI], 2.10–6.85; p<0.001) and the number of totally displaced rib fractures (RFX) (aOR, 1.90; 95% CI, 1.56–2.32; p<0.001) were significant predictors. Based on these parameters, we developed a nomogram to predict dHTX, with a sensitivity of 78.1%, a specificity of 76.0%, a positive predictive value of 25.0%, and a negative predictive value of 97.1% at the optimal cut-off value. The area under the receiver operating characteristic curve was 0.832. Conclusion The depth of HTX on initial chest computed tomography and the number of totally displaced RFX emerged as significant risk factors for dHTX. We propose a novel nomogram that is easily applicable in clinical settings.

Background: Delayed hemothorax (dHTX) can occur unexpectedly, even in patients who initially present without signs of hemothorax (HTX), potentially leading to death. We aimed to develop a predictive model for dHTX requiring intervention, specifically targeting those with no or occult HTX. Methods: This retrospective study was conducted at a level 1 trauma center. The primary outcome was the occurrence of dHTX requiring intervention in patients who had no HTX or occult HTX and did not undergo closed thoracostomy post-injury. To minimize overfitting, we employed the least absolute shrinkage and selection operator (LASSO) logistic regression model for feature selection. Thereafter, we developed a multivariable logistic regression (MLR) model and a nomogram. Results: In total, 688 patients were included in the study, with 64 cases of dHTX (9.3%).The LASSO and MLR analyses revealed that the depth of HTX (adjusted odds ratio [aOR], 3.79; 95% confidence interval [CI], 2.10–6.85; p<0.001) and the number of totally displaced rib fractures (RFX) (aOR, 1.90; 95% CI, 1.56–2.32; p<0.001) were significant predictors. Based on these parameters, we developed a nomogram to predict dHTX, with a sensitivity of 78.1%, a specificity of 76.0%, a positive predictive value of 25.0%, and a negative predictive value of 97.1% at the optimal cut-off value. The area under the receiver operating characteristic curve was 0.832. Conclusion The depth of HTX on initial chest computed tomography and the number of totally displaced RFX emerged as significant risk factors for dHTX. We propose a novel nomogram that is easily applicable in clinical settings.

PURPOSE: We aimed to investigate organ-specific recurrence or the metastatic pattern of breast cancer according to biological subtypes and clinical characteristics. METHODS: We retrospectively analyzed the medical records of 168 patients with recurrent breast cancer who were diagnosed between January 1, 2000 and April 30, 2017. Four biological subtypes were classified according to estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 expression: luminal A, luminal B, HER2-enriched, and triple negative breast cancer (TNBC). To analyze recurrence patterns according to biological subtypes, we accessed clinical variables including age at diagnosis, TNM stage, type of surgery in the breast and axilla, histologic grade, nuclear grade, lymphatic, vascular, and neural invasion, Ki-67 expression and recurrence to distant organs. RESULTS: The biological subtypes of recurrent breast cancer comprised the following luminal A (n=33, 19.6%), luminal B (n=95, 56.5%), HER2 enriched (n=19, 11.3%), and TNBC (n=21, 12.5%). Luminal A (7.7%) and B (6.5%) subtypes were associated with the increased rate of local recurrence compared to HER2-enriched (2.4%) and TNBC subtypes (1.8%) (p=0.005). The bone (53.6%) was the most common metastatic organ, followed by the lung (34.5%), liver (29.8%), brain (17.9%), and other visceral organ (7.7%). Bone metastasis was commonly observed in individuals with luminal B (63.2%), HER2-enriched (57.9%), and luminal A (42.4%) subtypes (p=0.005). Most liver metastases occur in individuals with luminal B (40.0%) and HER2-enriched subtypes (31.6%) (p=0.002). CONCLUSION: Luminal B subtype was commonly observed in individuals with recurrent breast cancer, and the bone is the most common target organ for breast cancer metastasis, followed by the lungs and liver.
Axilla ; Brain ; Breast Neoplasms ; Breast ; Diagnosis ; Estrogens ; Humans ; Liver ; Lung ; Medical Records ; Neoplasm Metastasis ; Organ Specificity ; Phenobarbital ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Recurrence ; Retrospective Studies ; Triple Negative Breast Neoplasms

Breast cancer is the second leading cancer for Korean women and its incidence rate has been increasing annually. If early diagnosis were implemented with epidemiologic data, the women could easily assess breast cancer risk using internet. National Cancer Institute in the United States has released a Web-based Breast Cancer Risk Assessment Tool based on Gail model. However, it is inapplicable directly to Korean women since breast cancer risk is dependent on race. Also, it shows low accuracy (58%-59%). In this study, breast cancer discrimination models for Korean women are developed using only epidemiological case-control data (n = 4,574). The models are configured by different classification techniques: support vector machine, artificial neural network, and Bayesian network. A 1,000-time repeated random sub-sampling validation is performed for diverse parameter conditions, respectively. The performance is evaluated and compared as an area under the receiver operating characteristic curve (AUC). According to age group and classification techniques, AUC, accuracy, sensitivity, specificity, and calculation time of all models were calculated and compared. Although the support vector machine took the longest calculation time, the highest classification performance has been achieved in the case of women older than 50 yr (AUC = 64%). The proposed model is dependent on demographic characteristics, reproductive factors, and lifestyle habits without using any clinical or genetic test. It is expected that the model could be implemented as a web-based discrimination tool for breast cancer. This tool can encourage potential breast cancer prone women to go the hospital for diagnostic tests.
Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms/*diagnosis/*epidemiology ; Diagnosis, Computer-Assisted/*methods ; Early Detection of Cancer/*methods ; Female ; Humans ; *Machine Learning ; Middle Aged ; Pattern Recognition, Automated/methods ; Prevalence ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Assessment/methods ; Risk Factors ; Sensitivity and Specificity ; Women's Health/*statistics & numerical data