PURPOSE: To compare the anatomical and visual outcomes in idiopathic macular hole surgery with or without indocyanine green (ICG)-stained internal limiting membrane (ILM) peeling. METHODS: Thirty-six eyes of 36 patients who underwent idiopathic macular hole surgery were included. Follow-up period was longer than 6 months. In the initial 16 eyes, no ILM peeling was performed (non-ILM peeling group). The subsequent 20 eyes underwent surgery with ICG-stained ILM peeling (ILM peeling group). RESULTS: There were no significant differences in the age, sex, hole size, symptom duration and preoperative best-corrected visual acuity between the two groups. The anatomical closure rates were 95% (19/20eyes) and 75% (12/16eyes) in the ILM peeling and non-ILM peeling groups, respectively (Fisher's exact test, p=0.15). Visual improvement of two or more lines occurred in 35% (7/20eyes) in the ILM peeling group and 43.8% (7/16eyes) in the non-ILM peeling group (Chi-square test, p=0.59). CONCLUSIONS: ICG stained ILM peeling was not statistically significant for anatomic and functional success in idiopathic macular hole surgery. Further studies of the toxicity of ICG and the result of ILM peeling should be performed.
Follow-Up Studies ; Humans ; Indocyanine Green ; Membranes* ; Retinal Perforations* ; Visual Acuity

Innate immune cells sense and respond to the cytoplasmic infection of bacterial pathogens through NLRP3, NLRC4 or AIM2 inflammasome depending on the unique molecular pattern of invading pathogens. The infection of flagellin- or type III secretion system (T3SS)-containing Gram-negative bacteria such as Salmonella enterica serovar Typhimurium (S. typhimurium) or Pseudomonas aeruginosa (P. aeruginosa) triggers NLRC4-dependent caspase-1 activation leading to the secretion of proinflammatory cytokines such as interleukin-1-beta (IL-1beta) and IL-18. Previous studies have shown that apoptosis-associated speck-like protein containing a CARD (ASC) is also required for Salmonella-induced caspase-1 activation, but it is still unclear how ASC contributes to the activation of NLRC4 inflammasome in response to S. typhimurium infection. In this study, we demonstrate that S. typhimurium triggers the formation of ASC oligomer in a potassium depletion-independent manner as determined by in vitro crosslinking and in situ fluorescence imaging. Remarkably, inhibition of potassium efflux failed to block Salmonella-promoted caspase-1 activation and macrophage cell death. These results collectively suggest that ASC is substantially oligomerized to facilitate the activation of caspase-1 in response to S. typhimurium infection. Contrary to NLRP3 inflammasome, intracellular potassium depletion is not critical for NLRC4 inflammasome signaling by S. typhimurium.
Cell Death ; Cytokines ; Cytoplasm ; Gram-Negative Bacteria ; Interleukin-18 ; Macrophages ; Optical Imaging ; Potassium ; Pseudomonas aeruginosa ; Salmonella ; Salmonella enterica

The association between lung injury and exposure to humidifier disinfectant (HD) containing a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) has been controversial in South Korea. This study conducts a literature review in order to evaluate the likelihood of CMIT/MIT reaching the lower part of the respiratory tract and causing lung injury. A literature review focused on the inhalation risk of HD containing a mixture of CMIT and MIT. The major contents included the physicochemical properties of CMIT and MIT contained in HDs and methodological reviews on substance analysis, toxicity tests and clinical cases. HD products marketed in South Korea have been reported to contain approximately 1–2% CMIT and 0.2–0.6% MIT along with magnesium nitrate (20–25%), magnesium chloride (0.2–1.0%), and water (70–75%). The types of CMIT and MIT dispersed into the air and deposited in the respiratory tract are assumed to be either gaseous substances or nanoparticles mixed with magnesium salts. The result of the literature review including clinical cases of lung injury among CMIT/MIT HD product users, demonstrated that these chemicals likely reach the lower respiratory tract and accordingly cause lung injury.A number of humidifier disinfectant-associated lung injury cases with clinical evidence should be prioritized in risk assessment of HD containing CMIT and MIT, even though there might be insufficient evidence in all related areas, including inhalation exposure assessment studies, animal testing, and epidemiological studies.

BACKGROUND: Minimal invasive gynecologic surgery usually requires pneumoperitoneum and Trendelenburg positioning, which results in adverse effects on respiratory and hemodynamic parameters. The aim of this study was to investigate the effects of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) introduced sequentially in patients who underwent gynecological laparoscopy on respiratory mechanics, cardiovascular responses, and gas exchange. METHODS: Forty patients who were scheduled for gynecologic laparoscopic surgery were enrolled. Baseline ventilation of their lungs was performed with VCV with a tidal volume (TV) of 8 ml/kg ideal body weight (IBW). Forty minutes after pneumoperitoneum and Trendelenburg positioning, the ventilation mode was changed to PCV, and airway pressure was set to provide a TV of 8 ml/kg IBW without exceeding 35 cmH2O. Respiratory mechanics and hemodynamic and gas exchange parameters were recorded at 10 minutes after induction, 30 minutes after CO2 pneumoperitoneum and Trendelenburg positioning, 30 minutes after PCV, and 30 minutes after desufflation and supine position. RESULTS: After pneumoperitoneum and Trendelenburg positioning, there were significant increases in systolic blood pressure, diastolic blood pressure, central venous pressure, peak airway pressure (PAP), mean airway pressure (Pmean), whereas lung compliance and PaO2 significantly decreased. The decrease in PAP and increases of Pmean, lung compliance and PaO2 were observed during PCV compared with VCV (P < 0.05). There were no differences in hemodynamic parameters between VCV and PCV. CONCLUSIONS: Our results demonstrated that PCV may be an effective method of ventilation during gynecologic laparoscopy in terms of improved oxygenation and minimizing adverse respiratory mechanics.
Blood Pressure ; Central Venous Pressure ; Female ; Gynecologic Surgical Procedures ; Head-Down Tilt* ; Hemodynamics ; Humans ; Ideal Body Weight ; Laparoscopy* ; Lung ; Lung Compliance ; Oxygen ; Pneumoperitoneum ; Respiratory Mechanics ; Supine Position ; Tidal Volume ; Ventilation*

Purpose: The use of antiplatelet and/or anticoagulant therapies has become common. In rare cases, these therapies may increase the risk of dangerous postoperative bleeding. We investigated the association of antiplatelets and/or anticoagulants with postoperative major bleeding risk in laparoscopic gastric cancer surgery. Methods: We retrospectively enrolled 3,663 gastric cancer patients (antiplatelet/anticoagulant group, 518; control group, 3,145) who had undergone laparoscopic surgery between January 2012 and December 2017. To minimize selection bias, 508 patients in each group were matched using propensity score matching (PSM) method. The primary outcome was postoperative major bleeding. Secondary outcomes were intraoperative, postoperative transfusion and early complications. Results: After PSM, postoperative major bleeding occurred in 10 (2.0%) and 3 cases (0.6%) in the antiplatelets/ anticoagulants and control groups, respectively (P = 0.090). Intraoperative and postoperative transfusions were not significantly different between 2 groups (2.4% vs. 1.4%, P = 0.355 and 5.5% vs. 4.3%, P = 0.469). Early complications developed in 58 (11.4%) and 43 patients (8.5%) in the antiplatelets/anticoagulants and control groups, respectively (P = 0.142). The mean amounts of intraoperative and postoperative transfusions were not significantly different between the groups (366.67 ± 238.68 mL vs. 371.43 ± 138.01 mL, P = 0.962; 728.57 ± 642.25 mL vs. 508.09 ± 468.95 mL, P = 0.185). In multivariable analysis, male (P = 0.008) and advanced stage (III, IV) (P = 0.024) were independent significant risk factors for postoperative major bleeding. Conclusion Preoperative antiplatelets and/or anticoagulants administration did not significantly increase the risk of postoperative major bleeding after laparoscopic gastric cancer surgery.

Background: Several cases of pediatric acute hepatitis of unknown etiology related to adenoviral infections have been reported in Europe since January 2022. The aim of this study was to compare the incidence, severity, possible etiology, and prognosis of the disease with those in the past in Korea. Methods: The surveillance group collected data between May and November 2022 using a surveillance system. Acute hepatitis of unknown etiology was defined in patients aged < 16 years with a serum transaminase level > 500 IU/L, not due to hepatitis A-E or other underlying causes. For comparison, data from 18 university hospitals were retrospectively collected as a control group between January 2021 and April 2022. Results: We enrolled 270 patients (mean age, 5 years). The most common symptom was fever. However, the incidence was similar between 2021 and 2022. Liver function test results, number of patients with acute liver failure (ALF), liver transplantation (LT), death, and adenovirus detection rates did not differ between the two groups. None of the adenoviruspositive patients in either group experienced ALF, LT, or death. In the surveillance group, adenovirus-associated virus-2 was detected in four patients, one of whom underwent LT. Patients with an unknown etiology showed significantly higher bilirubin levels, a lower platelet count, and a higher LT rate than patients with a possible etiology. Conclusion The incidence of pediatric acute hepatitis of unknown etiology and adenovirus detection rate have not increased in Korea.