Anemia, complicating the course of chronic kidney disease, is a significant parameter, whether interpreted as subjective impairment or an objective prognostic marker. Renal anemia is predominantly due to relative erythropoietin (EPO) deficiency. EPO inhibits apoptosis of erythrocyte precursors. Studies using EPO substitution have shown that increasing hemoglobin (Hb) levels up to 10–11 g/dL is associated with clinical improvement. However, it has not been unequivocally proven that further intensification of erythropoiesis stimulating agent (ESA) therapy actually leads to a comprehensive benefit for the patient, especially as ESAs are potentially associated with increased cerebro-cardiovascular events. Recently, new developments offer interesting options not only via stimulating erythropoeisis but also by employing additional mechanisms. The inhibition of activin, a member of the transforming growth factor superfamily, has the potential to correct anemia by stimulating liberation of mature erythrocyte forms and also to mitigate disturbed mineral and bone metabolism as well. Hypoxia-inducible factor prolyl hydroxylase inhibitors also show pleiotropic effects, which are at the focus of present research and have the potential of reducing mortality. However, conventional ESAs offer an extensive body of safety evidence, against which the newer substances should be measured. Carbamylated EPO is devoid of Hb augmenting effects whilst exerting promising tissue protective properties. Additionally, the role of hepcidin antagonists is discussed. An innovative new hemodialysis blood tube system, reducing blood contact with air, conveys a totally different and innocuous option to improve renal anemia by reducing mechanical hemolysis.
Activins ; Anemia* ; Apoptosis ; Erythrocytes ; Erythropoiesis* ; Erythropoietin ; Hematinics* ; Hemolysis ; Hepcidins ; Humans ; Metabolism ; Miners ; Mortality ; Prolyl-Hydroxylase Inhibitors ; Renal Dialysis ; Renal Insufficiency, Chronic ; Transforming Growth Factors

PURPOSE: Sildenafil citrate, is an oral tablet demonstrating efficacy for maintaining an erection in males with erectile dysfunction by inhibiting phosphodiesterase type 5 (PDE5). In the present study, we report 1 case of a transient color anomaly with visual field defect after an overdose of sildenafil citrate. CASE SUMMARY: One patient, a 39-year-old female, with no significant medical history other than previous major depressive disorder, visited an outpatient department due to the visual field defect that began after taking 30 tablets of sildenafil citrate (50 mg) 3 days earlier. A number of ophthalmologic tests were administered including visual acuity test, color vision test, fundus photography and the measurement of retinal structure with optical coherent tomography and her condition was monitored. The best corrected visual acuity was 1.0 in both right and left eyes in her first visit. The color anomaly and a central scotoma of both eyes were detected in the visual field test, while significant signs were not observed after evaluation using optical coherent tomography and fundus photography. After 5 weeks, the visual acuity was not affected, the color anomaly symptom disappeared and the focal visual field defect was present although improved. CONCLUSIONS: Transient color anomaly and persistent central scotoma caused by an overdose ingestion of sildenafil has not been reported in Korea, The related mechanisms may involve the inhibition of PDE5 on ganglion cells and bipolar cells in the retina and interruption of phosphodiesterase type 6 (PDE6) function in both rods and cones.
Adult ; Citric Acid* ; Color Vision ; Cyclic Nucleotide Phosphodiesterases, Type 6 ; Depressive Disorder, Major ; Eating ; Erectile Dysfunction ; Female ; Ganglion Cysts ; Humans ; Korea ; Male ; Outpatients ; Photography ; Photoreceptor Cells, Vertebrate ; Retina ; Retinaldehyde ; Scotoma ; Tablets ; Visual Acuity ; Visual Field Tests ; Visual Fields* ; Sildenafil Citrate

Chestnut honey contains various components such as phenolic compounds and alkaloids that exhibit antioxidant and anti-inflammatory activities. However, the composition and activity of chestnut honey significantly differ depending on its region of origin. In this study, the antioxidant activity of chestnut honey obtained from nine regions in Korea was evaluated by ABTS free radical scavenging assay. In addition, the phenolic acid content of each honey sample was analyzed using high-performance liquid chromatography (HPLC) and an ultraviolet (UV) detector. The antioxidant activity increased with the increasing concentration of chestnut honey samples. The major phenolic compounds in chestnut honey were observed to be gallic, p-coumaric, and ferulic acid. Altogether, the quantitative analysis of phenolic acids and evaluation of antioxidant activity in chestnut honey from different regions will contribute to establishing regional chestnut honey profiling in Korea and may provide preliminary data for collecting honey with various biological activities.

PURPOSE: To investigate the quantification of metamorphopsia with a novel method that uses Monpack One (Metrovision, Perenchies, France) and to compare the relationship between metamorphopsia score and spectral-domain optical coherence tomography (SD-OCT) findings in patients with epiretinal membrane (ERM). METHODS: This study included 37 eyes of 35 patients with idiopathic ERM. We examined the patients using SD-OCT and quantified the degree of metamorphopsia using the Monpack One. On the topographic map of the Early Treatment Diabetic Retinopathy (ETDRS) grid, central retinal thickness at the fovea (1 mm), and parafovea (3 mm) was measured with the SD-OCT software. The correlation between these factors was analyzed. We repeated the metamorphopsia test twice in 22 eyes of 11 healthy subjects in order to calculate intraclass correlation coefficients (ICCs) and evaluate the reproducibility and reliability of the new metamorphopsia test. RESULTS: On the ETDRS grid, the retinal thickness (µm) of the central, superior, inferior, nasal, and temporal subfields was 495 ± 102, 428 ± 98, 454 ± 78, 434 ± 83, and 463 ± 95, respectively. The mean total metamorphopsia score was 24.8 ± 13.9, while those for the superior, inferior, nasal, and temporal subfields were 14.7 ± 9.1, 15.1 ± 8.6, 15.9 ± 8.9, and 14.6 ± 8.6, respectively. Linear regression analysis revealed that total metamorphopsia score was significantly related to central retinal thickness (p = 0.01). Moreover, each subfield of parafoveal retinal thickness positively correlated with metamorphopsia subfield score (p < 0.01–0.023). The ICCs for the metamorphopsia tests of the healthy individuals showed almost perfect repeatability (>0.9) in all subfields. CONCLUSIONS: The degree of metamorphopsia in ERM could be quantified objectively on each subfield using the Monpack One metamorphopsia test. The degree of metamorphopsia significantly correlated with retinal thickness measurements based on SD-OCT.
Diabetic Retinopathy ; Epiretinal Membrane* ; Humans ; Linear Models ; Retinaldehyde ; Tomography, Optical Coherence* ; Vision Disorders*

PURPOSE: To investigate the quantification of metamorphopsia with a novel method that uses Monpack One (Metrovision, Perenchies, France) and to compare the relationship between metamorphopsia score and spectral-domain optical coherence tomography (SD-OCT) findings in patients with epiretinal membrane (ERM). METHODS: This study included 37 eyes of 35 patients with idiopathic ERM. We examined the patients using SD-OCT and quantified the degree of metamorphopsia using the Monpack One. On the topographic map of the Early Treatment Diabetic Retinopathy (ETDRS) grid, central retinal thickness at the fovea (1 mm), and parafovea (3 mm) was measured with the SD-OCT software. The correlation between these factors was analyzed. We repeated the metamorphopsia test twice in 22 eyes of 11 healthy subjects in order to calculate intraclass correlation coefficients (ICCs) and evaluate the reproducibility and reliability of the new metamorphopsia test. RESULTS: On the ETDRS grid, the retinal thickness (µm) of the central, superior, inferior, nasal, and temporal subfields was 495 ± 102, 428 ± 98, 454 ± 78, 434 ± 83, and 463 ± 95, respectively. The mean total metamorphopsia score was 24.8 ± 13.9, while those for the superior, inferior, nasal, and temporal subfields were 14.7 ± 9.1, 15.1 ± 8.6, 15.9 ± 8.9, and 14.6 ± 8.6, respectively. Linear regression analysis revealed that total metamorphopsia score was significantly related to central retinal thickness (p = 0.01). Moreover, each subfield of parafoveal retinal thickness positively correlated with metamorphopsia subfield score (p < 0.01–0.023). The ICCs for the metamorphopsia tests of the healthy individuals showed almost perfect repeatability (>0.9) in all subfields. CONCLUSIONS: The degree of metamorphopsia in ERM could be quantified objectively on each subfield using the Monpack One metamorphopsia test. The degree of metamorphopsia significantly correlated with retinal thickness measurements based on SD-OCT.
Diabetic Retinopathy ; Epiretinal Membrane* ; Humans ; Linear Models ; Retinaldehyde ; Tomography, Optical Coherence* ; Vision Disorders*

PURPOSE: To analyze the influence of preoperative corneal endothelial status on postoperative corneal endothelium density after cataract surgery. METHODS: We evaluated 228 eyes of 158 patients who underwent cataract surgery. Corneal endothelial status and central corneal thickness were measured before surgery and 1 day, 1 month, 3 months and 6 months after surgery. Patients were classified by preoperative endothelial cell density (three groups) and their coefficients of variation and hexagonality (two groups). Clinical parameters, including corneal endothelial cell losses, visual acuity, intraocular pressure, spherical equivalent refraction and central corneal thickness were measured to compare the intergroup indices. RESULTS: There were no significant differences in corneal endothelial cell losses at 1 day, 1 month, 3 months and 6 months after surgery in any of the groups based on corneal endothelial cell density. There were increases in corneal thickness at 1 day and 1 month after surgery that were significantly higher in the low-endothelial cell density group than the 2,000-2,500 cells/mm² cell density group (p < 0.05), but there were no differences after the 3-month time point. There were no significant differences in clinical parameters for the coefficient of variation and hexagonality groups until 6 months after surgery. CONCLUSIONS: We observed reversible corneal edema in the low endothelial group; however, there were no significant intergroup differences in corneal endothelial cell loss due to preoperative corneal endothelial status. Our results suggest that cataract surgery is relatively safe for patients with morphologically abnormal corneal endothelium and/or low endothelial density; the safety is primarily due to improved equipment and surgery techniques.
Cataract* ; Cell Count ; Corneal Edema ; Corneal Endothelial Cell Loss ; Endothelial Cells ; Endothelium, Corneal* ; Humans ; Intraocular Pressure ; Phacoemulsification ; Visual Acuity

OBJECTIVE: Prostate cancer is the most common cancer in men and localized prostate adenocarcinoma has multiple treatment options. In this study, the objective was to review the outcome of patients that were treated with HDR brachytherapy as monotherapy in all prostate adenocarcinoma patients at the St Luke's Medical Center.

MATERIALS AND METHODS: Thirty three (33) patients who underwent HDR prostate brachytherapy as monotherapy for prostate adenocarcinoma in a single institution for the past 5 years received 38 Gy in 4 fractions. The charts of these patients were reviewed to determine biochemical control using the Phoenix criteria and ASTRO definition, and toxicity.

RESULTS: Patients showed good biochemical control, with 92.16% meeting the target PSA value of 2 ng/mL or less and a 96.51% without consecutive rise of PSA post brachytherapy. There was also minimal toxicity, with no report of gastrointestinal toxicity and 9.1% rate of temporary genitourinary toxicity.

CONCLUSION: Good biochemical control of prostate adenocarcinoma was achieved with the use of HDR brachytherapy as monotherapy, with a minimal toxicity profile.

Purpose: To evaluate the role of performing photocoagulation up to ora serrata during vitrectomy in preventing recurrent vitreous hemorrhage (VH) in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). Methods: This retrospective, nonrandomized study included 60 eyes from 60 patients who had undergone PPV for VH due to PDR. These patients were divided into two groups: group 1, those who underwent photocoagulation up to ora serrata using the scleral indentation technique during surgery; and group 2, those who did not undergo scleral indentation when photocoagulation and underwent photocoagulation up to vortex veins. Their hospital records were analyzed to investigate the recurrence rate of VH, the time until recurrence of VH after surgery, logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) measured before surgery and at 1, 2, and 3 years after surgery, and the occurrence of complications such as neovascular glaucoma (NVG) during follow-up. Results: Group 1 exhibited lower recurrence rate of VH (2 of 30 [6.7%] vs. 10 of 30 [33.3%], p = 0.01) and lower occurrence of postoperative NVG (2 of 30 [6.7%] vs. 8 of 30 [26.7%], p = 0.038) compared with group 2. There were no statistically significant differences in logMAR BCVA measured at 1, 2, and 3 years between the two groups (at 1 year: 0.54 ± 0.43 vs. 0.54 ± 0.44, p = 0.954; at 2 years: 0.48 ± 0.47 vs. 0.55 ± 0.64, p = 0.235; at 3 years: 0.51 ± 0.50 vs. 0.61 ± 0.77, p = 0.200). Logistic regression analysis showed that among several factors that could affect recurrence rate of VH, only range of photocoagulation performed was a statistically significant factor (odds ratio, 0.119; 95% confidence interval, 0.022–0.659; p = 0.015). Conclusions Photocoagulation treatment over a wider range with scleral indentation could be a beneficial adjunct procedure for preventing postoperative recurrent VH following diabetic vitrectomy.

OBJECTIVE: This study aimed to describe the occupational hazards perceived by sanitary inspectors (SIs) from the City of Manila (Manila) and Quezon City (QC) as they perform their administrative and technical roles.

METHODS: Hazards and control measures were identified using self-administered questionnaires distributed among Sls of Manila and QC from November to December 2010.

RESULTS: The most frequently perceived hazards are slips, trips and falls, and verbal assault seen consistently present among 8 out of 9 roles. Harsh climatic condition on the other hand is the hazard perceived to be the riskiest as seen consistently in 8 out of 9 roles. Of the respondents, 28% did not receive formal training in the field of sanitary inspection and 64% did not have work shifts as administrative control measures; 90% said that personal protective equipment (PPE) were not made available to them and were not used by them.

CONCLUSION AND RECOMMENDATIONS: The most frequently perceived hazards encountered by SIs are slips, trips and falls, harsh climatic conditions, unwarranted complaints, and verbal assault. On the other hand, harsh climatic conditions, unwarranted complaints, and slips, trips and falls are the occupational hazards which are consistently present and perceived to pose the most risk in more than five roles. Provision of PPE and improvement in the implementation of administrative control measures is recommended. Moreover, further studies involving SIs' actual experiences, SIs from rural areas and control measures present in the workplace are suggested.

Background: Autoencoder (AE) is one of the deep learning techniques that uses an artificial neural network to reconstruct its input data in the output layer. We constructed a novel supervised AE model and tested its performance in the prediction of a co-existence of the disease of interest only using diagnostic codes. Methods: Diagnostic codes of one million randomly sampled patients listed in the Korean National Health Information Database in 2019 were used to train, validate, and test the prediction model. The first used AE solely for a feature engineering tool for an input of a classifier. Supervised Multi-Layer Perceptron (sMLP) was added to train a classifier to predict a binary level with latent representation as an input (AE + sMLP). The second model simultaneously updated the parameters in the AE and the connected MLP classifier during the learning process (End-to-End Supervised AE [EEsAE]). We tested the performances of these two models against baseline models, eXtreme Gradient Boosting (XGB) and naïve Bayes, in the prediction of co-existing gastric cancer diagnosis. Results: The proposed EEsAE model yielded the highest F1-score and highest area under the curve (0.86). The EEsAE and AE + sMLP gave the highest recalls. XGB yielded the highest precision. Ablation study revealed that iron deficiency anemia, gastroesophageal reflux disease, essential hypertension, gastric ulcers, benign prostate hyperplasia, and shoulder lesion were the top 6 most influential diagnoses on performance. Conclusion A novel EEsAE model showed promising performance in the prediction of a disease of interest.