Background and Objectives: To analyze mapping changes in dynamic range (DR) and neural response threshold (NRT) as prognostic factors for cochlear implant (CI). To analyze whether postoperative speech perception performance could be predicted using DR change and initial NRT. Subjects and Methods: The speech comprehension data of 33 patients with CI were retrospectively analyzed after 1, 3, 6, and 12 months of device use. All subjects were adult, postlingually hearing-impaired, and Cochlear Nucleus CI users. Speech perception performance was evaluated using aided pure tone audiometry, consonant, vowel, one-word, two-word, and sentence tests. Results: The averages of initial NRT and DR changes were 197.8±25.9 CU (104–236) and 22.2±18.4 CU (-15–79), respectively. The initial DR was 40.8±16.6 CU. The postoperative DR was 50.3±16.4 CU at 3 months, 58±12.3 CU at 6 months, and 62.9±10.4 CU at 12 months. A gradual increase of DR was observed during the first year of CI. Compared with the initial DR, significant increases in DR were observed at 3 (p<0.05), 6 (p<0.001), and 12 (p<0.001) months. Compared with initial speech performance outcomes, a significant gain in all performance outcomes was achieved at 12 months (p<0.001). Conclusions Patients with low NRT after CI surgery could initially set DR to a wider range and had better final speech perception outcomes. Conversely, patients with high NRT after CI surgery had to set up a gradual increase in DR while adjusting the T-C level, and the final speech perception outcomes were worse. DR and NRT, the main CI mapping variables, can help predict prognosis related to speech perception outcomes after CI surgery. In conclusion, the post-CI speech perception is better with a lower initial NRT, wider final DR, or younger age.

Background: The single vitrified-warmed blastocyst transfer (SVBT) cycle has been increasingly utilized for assisted reproductive technology. Women of advanced maternal age (AMA) comprise a significant portion of patients who have undergone ‘freeze-all’ cycles. This study investigated the association between the post-warming extended culture duration and pregnancy outcomes in patients of AMA. Methods: This retrospective cohort study analyzed the outcomes of 697 SVBT cycles between January 2016 and December 2017. The cycles were divided into 3 groups based on the age of the female partners: group I: < 35 years (n = 407), group II: 35–37 years (n = 176); and group III, 38–40 years (n = 114). Data are shown as the mean ± standard error of the mean. Data were analyzed using one-way ANOVA followed by Duncan’s multiple range test. Statistical significance was set at P < 0.001. Results: The blastocyst rate, clinical pregnancy rate, and live birth rate (LBR) was significantly lower in the AMA groups. However, there were no significant differences in LBR in the transfer between the AMA and younger groups according to blastocyst morphology and post-warming extended culture duration. Conclusion Post-warming extended culture of blastocysts is not harmful to patients of AMA. It could be a useful parameter in clinical counseling and decision making for fertility treatments.

BACKGROUND: The standard morphological evaluation has been widely used for embryo selection, but it has limitations. This study aimed to investigate the correlation between morphologic grading and euploidy rate of in vitro fertilization (IVF) preimplantation genetic screening (PGS) and compare the pregnancy rates in young and old ages. METHODS: This is a retrospective study using the medical records of patients who underwent IVF procedures with PGS between January 2016 and February 2017 in a single center. The embryo grades were categorized into 4 groups: excellent, good, fair, and poor. Basic characteristics, euploidy rates, clinical pregnancy (CP) rates and ongoing pregnancy rates were analyzed. RESULTS: The excellent group had significantly higher rate of euploid embryos than fair group (47.82% vs. 29.33%; P = 0.023) and poor group (47.82% vs. 29.60%; P = 0.005). When the four groups were recategorized into two groups (excellent and good vs. fair and poor), they also showed significant difference in euploidy rates (44.52% vs. 29.53%; P = 0.002). When the patients were divided into two groups by age 35, the CP rates for those under and over 35 years old were 44.74% and 47.83%, respectively, which showed no significant difference. CONCLUSION: The significant differences among the euploidy rates of different morphologic embryo grades demonstrated the positive correlations between the morphologic grading of the embryo and the euploidy rate of PGS. Additionally, there was no significant difference between the younger and older patients' CP rates. These findings emphasize the fact that old age patients might benefit from PGS whatever the indication of PGS is.
Blastocyst* ; Embryonic Structures ; Fertilization in Vitro* ; Genetic Testing* ; Humans ; In Vitro Techniques* ; Medical Records ; Pregnancy ; Pregnancy Rate ; Retrospective Studies

PURPOSE: To identify prognostic factors associated with a favorable outcome after vitrectomy for patients with macular epiretinal membrane (ERM). METHODS: The authors retrospectively reviewed the records of 63 patients (64 eyes) with macular ERM, who were treated by vitrectomy between 2003 and 2008, and followed for more than 6 months. RESULTS: The mean follow-up period was 13.21 +/- 9.11 months and the mean best corrected visual acuity after vitrectomy was log MAR 0.32 +/- 0.34. Univariate analysis revealed the patients in the group with a postoperative log MAR of 0.3 or better had better preoperative visual acuity and shorter symptom duration; multivariate analysis revealed the same results. In 24 eyes, intraretinal structures which contained pseudoholes, intraretinal cysts, retinal folds and vitreoretinal traction were analyzed with Cirrus HD-OCT, however, there was no correlation with visual acuity after vitrectomy. CONCLUSIONS: The present study demonstrated vitrectomy for macular ERM resulted in favorable visual improvement. The preoperative visual acuity and symptom duration were a significant prognostic factor.
Epiretinal Membrane ; Eye ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Retinaldehyde ; Retrospective Studies ; Traction ; Visual Acuity ; Vitrectomy

PURPOSE: To report the case of a patient with ciliochoroidal detachment after brief exposure to patterned scanning laser photocoagulation. CASE SUMMARY: We examined a 62-year-old woman with early proliferative diabetic retinopathy and observed neovascularization and macular edema upon fundus examination. The patient underwent patterned scanning laser photocoagulation with an exposure time of 0.03 sec over the entire retina in a single pass. In vivo, the ciliary body and choroid were examined using ultrasound biomicroscopy (UBM), before, immediately after, 3 and 7 days after panretinal photocoagulation. Ciliochoroidal detachment was observed 3 days after panretinal photocoagulation and spontaneously disappeared by 7 days after photocoagulation. The change in IOP coincident with ciliochoroidal detachment were not significant. CONCLUSIONS: Ciliochoroidal detachment after panretinal photocoagulation may lead to complications such as angle-closure glaucoma. Patterned scanning laser photocoagulation with short exposure time should be practiced only with careful attention to the possible development of cilochoroidal detachment.
Choroid ; Ciliary Body ; Diabetic Retinopathy ; Female ; Glaucoma, Angle-Closure ; Humans ; Light Coagulation ; Macular Edema ; Microscopy, Acoustic ; Middle Aged ; Retina

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.
Adult ; alpha-Thalassemia ; Anemia, Hemolytic, Congenital* ; beta-Thalassemia ; Bilirubin ; Cell Membrane ; Diagnosis ; Elliptocytosis, Hereditary ; Erythrocyte Indices ; Female ; Hemoglobinopathies ; Humans ; Internal Medicine ; Jaundice ; Korea* ; L-Lactate Dehydrogenase ; Male ; Oxidoreductases ; Pallor ; Pathology, Molecular ; Pediatrics ; Phosphopyruvate Hydratase ; Prevalence ; Pyruvate Kinase ; Reticulocyte Count ; Retrospective Studies* ; Sex Ratio ; Surveys and Questionnaires

Recurrent pregnancy loss (RPL) is defined as three or more consecutive spontaneous abortions. It affects about 1% of couples attempting pregnancy. Most of these pregnancy losses are unrecognized. Among the pregnancies that are clinically recognized, loss occurs in 15% before 20 weeks of gestation. Only about 50% of women with RPL have an identifiable etiology. Genetic abnormalities are responsible for RPL in 2~4% of these couples, most with balanced translocation. Luteal phase defect might be present in 25~30% of women with RPL; however, progesterone supplementation for miscarriage prevention has not been adequately studied. Uterine abnormalities might also result in RPL. Inherited thrombophilias appear to be associated with fetal death, and antenatal thromboprophylaxis might be beneficial for some women with an inherited thrombophilia. Antiphospholipid syndrome is known to cause RPL, and antenatal thromboprophylaxis reduces the risk of miscarriage. The evidence on alloimmune incompatibility as a cause of RPL is preliminary and no immunotherapy has been shown to be effective in the prevention of miscarriage. Recently a series of new factors that exhibit an association with RPL have been identified, and they might exhibit an additive or multiplicative effect on the RPL risk.
Abortion, Spontaneous ; Antiphospholipid Syndrome ; Family Characteristics ; Female ; Fetal Death ; Humans ; Immunotherapy ; Luteal Phase ; Pregnancy* ; Progesterone ; Thrombophilia

OBJECTIVE: Umbilical cord blood is an effective alternative to bone marrow as a source of hematopoietic stem cells for transplantation. But the amount of collected umbilical cord blood and its contents are limited and obtaining an adequate volume of umbilical cord blood is essential for successful transplantation. The aim of this study was to identify factors that influence the volume of umbilical cord blood. METHODS: A retrospective analysis of the maternal, neonatal and placental factors that were obtained by medical record review was conducted. The variables that were evaluated for this study were mother's age, parity, gestational age, presence of maternal diabetes mellitus, route of delivery, multiple births, neonatal sex and birth weight, and placental weight. Total 484 deliveries were evaluated from March 2003 to April 2004. The statistical significance of observed differences was calculated using t-test and multiple regression analysis; p-value<0.05 was considered significant. RESULTS: Gestational age, neonatal birth weight, placental weight, parity, number of fetus and maternal diabetes mellitus were significantly associated with a greater volume of collected umbilical cord blood. Obstetric factors that influenced the total nucleated cell concentration were gestational age, neonatal birth weight, placental weight, number of fetus, and route of delivery. CONCLUSION: To prolong a gestational age as far as possible, at least beyond the 37 completed weeks of gestation, and modifying a method of vaginal delivery or cesarean section rather than conventional vaginal delivery method can increase significantly the volume of collected cord blood and the yield of the concentration of total nucleated cell.
Birth Weight ; Bone Marrow ; Cesarean Section ; Diabetes Mellitus ; Female ; Fetal Blood* ; Fetus ; Gestational Age ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Medical Records ; Multiple Birth Offspring ; Parity ; Postpartum Period* ; Pregnancy ; Retrospective Studies ; Umbilical Cord*

OBJECTIVE: To compare the efficacy of GnRH antagonist multi dose protocol in controlled ovarian hyperstimulation (COH) for IVF-ET or ICSI with GnRH agonist long protocol. METHODS: From January 2003 to December 2004, total of 583 cycles which underwent IVF-ET or ICSI using r-FSH were enrolled in this study. 447 cycles of the study group were performed in controlled ovarian hyperstimulation by using GnRH antagonist multi dose protocol and 136 cycles of the control group were performed by using GnRH long protocol. We compared patients characteristics, controlled ovarian hyperstimulation outcomes and IVF-ET outcomes between two groups. RESULTS: Patients characteristics and baseline hormone levels were not different between the two groups. The duration of stimulation was significantly shorter in study group comparing with control group (12.8+/-1.5 days vs 13.7+/-1.7 days, p<0.05). There were no differences between the two groups in the number of follicles, endometrial thickness and serum E2 level on hCG day. The pregnancy rate seemed to be lower in the study group (32.4% vs 35.4%), but the difference was not statistically significant. There were also no differences in number of oocytes retrieved, matured oocytes, fertilized oocytes and transferred embryos between two groups. CONCLUSION: GnRH antagonist multi dose protocol in COH might be a simple and effective method compared with GnRH agonist long protocol.
Embryonic Structures ; Gonadotropin-Releasing Hormone* ; Humans ; Oocytes ; Pregnancy Rate ; Sperm Injections, Intracytoplasmic

OBJECTIVE: To investigate the association of genetic background between MTHFR C677T genotype and infertile females with polycystic ovarian syndrome. MATERIALS AND METHODS: We compared 86 infertile females with polycystic ovarian syndrome (PCOS) with 100 healthy fertile females with one or more offspring. Pyrosequencing analysis for MTHFR C677T variation was performed on polymerase chain reaction (PCR) product of study group. To validate pyrosequencing data of C677T variation for randomly selected 50 samples, we compared the pyrosequencing result with the PCR-RFLP (Restriction Fragment Length Polymorphism) result of MTHFR C677T genotype. RESULTS: The prevalence of the C677T mutant homozygous (TT) was significantly lower (p=0.0085) in females with PCOS (8.14%) than in fertile females (21.00%). MTHFR 677 TT genotype had a decreased risk (3.7-fold) of PCOS compared with wild type (MTHFR 677 CC). CONCLUSION: Our data support a role for MTHFR mutant homozygous (677 TT) genotype in reducing risk in Korean infertile females with Polycystic ovarian syndrome.
Female* ; Genotype ; Humans ; Korea* ; Oxidoreductases* ; Polycystic Ovary Syndrome* ; Polymerase Chain Reaction ; Prevalence