PURPOSE: The goal of the present study was to compare the stability of the 3-piece (Tecnis ZA9003) and single-piece (AcrySof IQ) aspheric intraocular lenses (IOL) by testing decentration, tilt, anterior chamber depth, and refraction. METHODS: The subjects of this study consisted of 101 eyes who had undergone cataract surgeries with a 3-piece aspheric IOL (54 eyes) and with a single-piece aspheric IOL (47 eyes). The decentration, tilt, anterior chamber depth, and refraction were measured on postoperative day 1, 1 month, and 2 months, using an anterior eye segment analysis system (EAS-1000, Nidek, Japan). RESULTS: There was a statistically significant difference in the decentration on the postoperative day 1 (p = 0.04). However, there was no statistically significant difference on postoperative 1 month (p = 0.15) and 2 months (p = 0.13). There was no statistically significant difference in the tilt on postoperative day 1, 1 month, and 2 months. There was no statistically significant difference in the anterior chamber depth on postoperative day 1, 1 month, and 2 months. There was a statistically significant difference in the refraction on postoperative day 1 (p = 0.03). However, there was no statistically significant difference on postoperative 1 month (p = 0.07) and 2 months (p = 0.07). CONCLUSIONS: There was no statistically significant difference in the decentration, anterior chamber depth, and refraction between the 3-piece and single-piece aspheric IOL. Therefore, there is no difference between the 3-piece and single-piece aspheric IOL in the capsular bag stability until 2 months postoperatively.
Anterior Chamber ; Anterior Eye Segment ; Cataract ; Eye ; Lenses, Intraocular

No abstract available.
Down Syndrome* ; Heart Defects, Congenital*

Interstitial pneumonia is a heterogenous group of inflammatory and fibrosing lesions that manifest themselves as infiltrative lung disease. Of these, nonspecific interstitial pneumonia is characterized as a variable degree of interstitial inflammation with or without fibrosis and is distinguished from usual interstitial pneumonia and desquamative interstitial pneumonia, histologically. The influx of inflammatory cells and the responses of immune effector cells injury to the alveolar wall and these initial injuries results in alveolitis and fibrosis. Consequently, the gas exchange throughout the alveolar wall is impaired and the patients suffer from lung diseases of a restrictive pattern. The chief complaints represented are dyspnea and dry cough. We experienced a case of nonspecific interstitial pneumonia in a 10-year old girl. The patient had been healthy and had not been exposed to organic dusts or other toxic materials. The pathology of lung biopsy tissue showed that the alveoli were thickened by a mixture of chronic inflammatory cells and collagen type fibrosis. High resolution computed tomography(HRCT) found the patchy areas of ground-glass opacity with patchy consolidation and irregular reticular opacity, and diffuse distribution without zonal predominance. The forced vital capicity(FVC) was 31%, forced expiratory volume in one second (FEV1) 29% and FEV1/FVC 90%, so a restrictive pulmonary insufficiency was found.
Biopsy ; Child* ; Collagen ; Cough ; Dust ; Dyspnea ; Female ; Fibrosis ; Fluconazole ; Forced Expiratory Volume ; Humans ; Idiopathic Pulmonary Fibrosis ; Inflammation ; Lung ; Lung Diseases ; Lung Diseases, Interstitial* ; Pathology

PURPOSE: By identifying micro-organism in postoperative patients, we evaluated problems associated with the use of cephalosporin for the prevention of infection, and antibiotic choice in cases, in which causative micro-organisms cannot be islolated. MATERIALS AND METHODS: Eighteen patients, from January 1998 to May 2002, who received arthroplasty, were studied. All cases were administered preoperative first generation cephalosporin one hour before operation. All patients with infection had micro-organisms identified received an antibiotic sensitivity test. RESULTS: Gram positive cocci were identified in fifteen cases (83%) (staphylococcus was the most common (72%)), and there were eight cases (80%) in acute infections and seven (88%) in chronic. 78-83% were sensitive to vancomycin, teicoplanin and ciprofloxacin, but only 17% were sensitive to cephalothin. CONCLUSION: Staphylococcus was found to be the most common organism in postoperative infection, and ciprofloxacin was more effective than cephalosporin. Ciprofloxacin is considered to be an effective antibiotic in patients with unidentified causative organisms.
Arthroplasty ; Bacteria* ; Cephalothin ; Ciprofloxacin ; Gram-Positive Cocci ; Humans ; Staphylococcus ; Teicoplanin ; Vancomycin

Background/Aims: Sedation has become a standard practice for patients undergoing gastrointestinal (GI) endoscopy. However, considering the serious cardiopulmonary adverse events associated with sedatives, it is important to identify patients at high risk. Machine learning can generate reasonable prediction for a wide range of medical conditions. This study aimed to evaluate the risk factors associated with sedation during GI endoscopy and develop a predictive model for hypoxia during endoscopy under sedation. Methods: This prospective observational study enrolled 446 patients who underwent sedative endoscopy at the Korea University Ansan Hospital. Clinical data were used as predictor variables to construct predictive models using the random forest method that is a machine learning algorithm. Results: Seventy-two of the 446 patients (16.1%) experienced life-threatening hypoxia requiring immediate medical intervention. Patients who developed hypoxia had higher body weight, body mass index (BMI), neck circumference, and Mallampati scores. Propofol alone and higher initial and total dose of propofol were significantly associated with hypoxia during sedative endoscopy. Among these variables, high BMI, neck circumference, and Mallampati score were independent risk factors for hypoxia. The area under the receiver operating characteristic curve for the random forest-based predictive model for hypoxia during sedative endoscopy was 0.82 (95% confidence interval, 0.79–0.86) and displayed a moderate discriminatory power. Conclusions High BMI, neck circumference, and Mallampati score were independently associated with hypoxia during sedative endoscopy. We constructed a model with acceptable performance for predicting hypoxia during sedative endoscopy.

No abstract available.
Biphasic Insulins

Serious cytomegalovirus (CMV) infection occurs frequently in immunocompromised patients and is a common cause of death. Although primary infection in immunocompetent hosts is normally subclinical, mononucleosis-like syndrome that is characterized by malaise, protracted fever, mild liver function abnormalities, and lymphocytosis with atypical lymphocytes occurs in -10% of patients. Rarely fulminant infection may develop. In both the United States and the United Kingdom, ganciclovir and foscarnet are recommended for the treatment of serious CMV infections in immunocompromised patients. In contrast, there are no recommendations for treatment of severe CMV disease in immunocompetent patients. We describe a case of 45-year-old woman with CMV pneumonia with a fatal outcome for whom there was no evidence of prior immunodeficiency.
Cause of Death ; Cytomegalovirus* ; Fatal Outcome ; Female ; Fever ; Foscarnet ; Ganciclovir ; Great Britain ; Humans ; Immunocompromised Host ; Liver ; Lymphocytes ; Lymphocytosis ; Middle Aged ; Pneumonia* ; United States

OBJECTIVE: To investigate the effects of the hypoxia inducible factor-1 (HIF-1) activation-mimicking agent cobalt chloride (CoCl2) on the osteogenic differentiation of human mesenchymal stem cells (hMSCs) and elucidate the underlying molecular mechanisms. STUDY DESIGN: The dose and exposure periods for CoCl2 in hMSCs were optimized by cell viability assays. After confirmation of CoCl2-induced HIF-1alpha and vascular endothelial growth factor expression in these cells by RT-PCR, the effects of temporary preconditioning with CoCl2 on hMSC osteogenic differentiation were evaluated by RT-PCR analysis of osteogenic gene expression, an alkaline phosphatase (ALP) activity assay and by alizarin red S staining. RESULTS: Variable CoCl2 dosages (up to 500 microM) and exposure times (up to 7 days) on hMSC had little effect on hMSC survival. After CoCl2 treatment of hMSCs at 100 microM for 24 or 48 hours, followed by culture in osteogenic differentiating media, several osteogenic markers such as Runx-2, osteocalcin and osteopontin, bone sialoprotein mRNA expression level were found to be up-regulated. Moreover, ALP activity was increased in these treated cells in which an accelerated osteogenic capacity was also verified by alizarin red S staining. CONCLUSIONS: The osteogenic differentiation potential of hMSCs could be preserved and even enhanced by CoCl2 treatment.
Alkaline Phosphatase ; Anoxia ; Anthraquinones ; Cell Survival ; Cobalt ; Durapatite ; Gene Expression ; Humans ; Integrin-Binding Sialoprotein ; Mesenchymal Stromal Cells ; Osteocalcin ; Osteopontin ; RNA, Messenger ; Vascular Endothelial Growth Factor A

BACKGROUND: The purpose of this study was to evaluate change in glycosylated hemoglobin (HbA1c), side effects, and quality of life (QOL) after a 16-week treatment period with Biphasic insulin aspart 30/70 (BIasp30) in patients with type 2 diabetes mellitus (T2DM) who had been suboptimally controlled with oral antidiabetic drugs (OADs). METHODS: The study consisted of a 4-week titration period when concurrent OAD(s) were replaced with BIasp30 and followed by a 12-week maintenance period. All patients completed the Diabetes Treatment Satisfaction Questionnaire at the beginning and the end of the trial. Hypoglycemic episodes were recorded by the patient throughout the trial. RESULTS: Sixty patients were included, of whom 55 patients (92%) completed the full 16-week treatment period. Seven-point blood glucose was significantly improved as compared with the baseline, except for the postlunch blood glucose level. HbA1c at the end of period was significantly improved from 9.2% to 8.2% (P<0.001). Eleven percent (n=6) of patients achieved HbA1c values < or =6.5% and 22% (n=12) of patients achieved <7.0%. There were 3.4 episodes/patients-year of minor hypoglycemia and 0.05 episodes/patients-year of major hypoglycemia. QOL showed significant changes only in the acceptability of high blood glucose category (P=0.003). CONCLUSION: Treatment with once or twice daily BIasp30 may be an option for the patients with T2DM suboptimally controlled with OADs in Korea. However, considering the low number of patients achieving the HbA1c target and the high postlunch blood glucose levels, additional management with another modality may be required for optimal control.
Biphasic Insulins ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Hemoglobin A, Glycosylated ; Humans ; Hypoglycemia ; Hypoglycemic Agents ; Insulin Aspart ; Insulin, Isophane ; Korea ; Quality of Life

Purpose: Rapid sequence intubation (RSI) using sedatives and neuromuscular blocking agents (NMBAs) is recommended for pediatric emergency endotracheal intubation (ETI), but is not frequently performed in Korea. This study aimed to verify factors associated with the underuse of RSI medications. Materials and Methods: This multicenter retrospective study reviewed patients aged under 18 years who underwent an ETI within 24 hours of arrival at the emergency department between 2016 and 2019. Any cases of ETI during cardiopulmonary resuscitation were excluded. We investigated the characteristics of the patients, intubators, RSI medications, and outcomes. The study cases were classified into no-medication, sedative-only, and sedative-with-NMBA groups. Multivariable logistic regression analysis of RSI medication use was conducted. Results: A total of 334 cases with a median age of 3.4 years were included in this study. Sedatives and NMBAs were used in 63.8% and 32.9%, respectively. In comparing the no-medication (n=121), sedative-only (n=103), and sedative-with-NMBA (n=110) groups, patient age (median; 1.0 year vs. 2.8 years vs. 11.3 years; p<0.001), underlying medical conditions (77.7% vs. 56.3% vs. 36.4%; p<0.001), and pediatricians as intubators (76.9% vs. 54.4% vs. 17.3%; p<0.001) were different. The factors that influenced sedatives with NMBA use were patient age [for a year increment; adjusted odds ratio (aOR), 1.182; 95% confidence interval (CI), 1.120– 1.249], no underlying medical conditions (aOR, 2.109; 95% CI, 1.093–4.070), and intubators other than pediatricians (aOR, 5.123; 95% CI, 2.257–11.626). Conclusion RSI accounted for 32.9% of pediatric emergency ETI in Korea. The underuse of RSI medications is associated with younger patient age, underlying medical conditions, and pediatricians as intubators.