OBJECTIVE: To determine whether fragment removal on in vitro fertilization (IVF) day 2 improved the subsequent development and pregnancy outcomes of fragmented embryos compared to similar-grade embryos without fragment removal. METHODS: This study was a retrospective analysis involving 191 IVF cycles in which all embryos had over 10% fragmentation (grade 3 or 4) on day 2 of the IVF-embryo transfer cycle from March 2015 to December 2017. IVF cycles were divided into the fragment removal group (n=87) and the no fragment removal group (n=104) as a control cohort. Before fragment removal, embryos with fragmentation on day 2 were incubated in Ca2+- and Mg2+-free biopsy medium under paraffin oil for 30 minutes. Microsurgical fragment removal was performed with later-assisted hatching and a handmade suction micropipette that had an outer diameter of 30 µm. RESULTS: There were no significant differences in the characteristics of the patients between the control and the fragment removal groups. After fragment removal and subsequent in vitro culture for 24 hours, the number of blastomeres (7.1±1.7 vs. 6.9±1.6) was comparable between the transferred embryos in the two groups, but the morphological grade of the embryos in the fragment removal group (1.9±0.7) was significantly higher than that of the control group (3.1±0.5, p < 0.01). The clinical pregnancy (43.7%) and implantation rates (25.8%) in the fragment removal group were significantly higher than those in the control group (28.8% and 14.0%, respectively; p < 0.05). CONCLUSION: Early fragment removal on day 2 significantly improved the subsequent development and pregnancy outcomes of fragmented embryos.
Biopsy ; Blastomeres ; Cohort Studies ; Embryonic Structures* ; Female ; Fertilization in Vitro* ; Humans* ; In Vitro Techniques* ; Paraffin ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies ; Suction

OBJECTIVE: Correlations between semen parameters and sperm DNA fragmentation index (DFI) were investigated to identify characteristics of sperm without DNA damage that could be used in selecting sperm for intracytoplasmic sperm injection (ICSI). Pregnancy outcomes were compared to determine whether in vitro fertilization (IVF) or ICSI is a better choice for patients who have sperm with a high-DFI. METHODS: Semen analysis was carried out in 388 patients who visited our IVF center for the first time to investigate correlations between sperm DFI and semen parameters. In addition, 1,102 IVF cycles in 867 patients were carried out in the present study; 921 cycles in the low-DFI group (DFI <30%) and 181 cycles in the high-DFI group (DFI ≥30%). Both the low- and high-DFI groups were subdivided into IVF and ICSI cycle groups. RESULTS: Sperm DFI showed significant inverse correlations with sperm motility (r=−0.435, p<0.001) and morphology (r=−0.153, p<0.05). Sperm DFI also showed significant correlations with rapid motility (r=−0.436, p<0.001), and the kinetic parameters of average-path velocity (r=−0.403) and linearity (r=−0.412). Although there was no significant difference in the pregnancy rates between IVF (48.6%) and ICSI (44.8%) in the low-DFI group, the pregnancy rate of ICSI cycles (44.8%, p<0.05) was significantly higher than IVF cycles (25.0%) in the high-DFI group. No significant difference was observed in the abortion rates between the low-DFI (52 of 921, 5.6%) and high-DFI groups (7 of 181, 3.8%). CONCLUSION: ICSI is a better choice than IVF for improving the pregnancy outcomes of patients who have sperm with a high DFI.
Abortion, Induced ; DNA Damage ; DNA Fragmentation* ; DNA* ; Female ; Fertilization in Vitro ; Humans ; Pregnancy Outcome ; Pregnancy Rate* ; Pregnancy* ; Semen ; Semen Analysis ; Sperm Injections, Intracytoplasmic* ; Sperm Motility ; Spermatozoa*

BACKGROUND AND OBJECTIVES: Recently, mandibular advancement device (MAD) has been used widely used for the treatment of obstructive sleep apnea (OSA) because it can effectively reduce the collapsibility of upper airway during sleep. Although MAD is widely prescribed by otorhinolaryngologists, several studies described its complications arising from the anterior placement of the mandible with long-term use. However, there is still a lack of studies on long-term complications in Korean patients. SUBJECTS AND METHOD: Retrospectively, we included a total of 57 OSA patients in the study. In this study, all enrolled OSA patients had used MAD over two years with more than 4 hours/day. Dental consulting and cephalometric analysis were conducted to identify the change of dental and skeletal findings at two different times (baseline and after 2 year). RESULTS: The dental findings showed that the overbite and overjet were significantly decreased. Additionally, the proclination of the lower incisors were increased significantly, whereas there was no significant change on the retroclination of the upper incisors. Three patients showed a change of malocclusion type. On the analysis of skeletal findings, we found a significant increase in the sella turcica central point-nasion-supramental point angle and a decrease in the subspinal point-nasion-supramental point angle. Moreover, the anterior lower facial height and anterior facial height were significant increased. CONCLUSION: Consistent with Western studies, our findings suggest that the long-term use of MAD could induce changes in dental and skeletal morphologies in Korean OSA patients. Therefore, clinicians should thoroughly evaluate potential changes in dental and skeletal morphologies when they prescribe MAD to patients with OSA.
Humans ; Incisor ; Malocclusion ; Mandible ; Mandibular Advancement* ; Methods ; Overbite ; Retrospective Studies ; Sella Turcica ; Sleep Apnea, Obstructive*

BACKGROUND AND OBJECTIVES: Application of automatic positive airway pressure (APAP) is regarded as the primary therapy for patients with obstructive sleep apnea syndrome (OSAS). However, a low adherence rate is a major problem with APAP treatment in OSAS patients. Therefore, the aim of the present study is to assess factors related to good adherence of APAP therapy in OSAS Korean patients. MATERIALS AND METHOD: Of 112 consecutive newly diagnosed moderate to severe OSAS patients, 70 were enrolled in this study. All patients received APAP therapy for 2 weeks, along with reinforcing intervention, consisting of motivational reinforcement and technical support. All APAP therapy involved a device rental service. After 2 weeks of treatment, patients had to choose the kind of treatment for OSAS [APAP therapy (good adherence) or alternative treatment options (poor adherence)]. RESULTS: After 6 months, the adherence rate to APAP therapy was 35.7% (n=25). No statistically significant difference was observed between the good and poor adherence groups with regard to snoring intensity, apnea-hypopnea index, and mean O2 saturation after adjusting for age, sex, body mass index, marital status, and socioeconomic status. However, we found that excessive daytime sleepiness and lowest O2 saturation were significantly associated with good adherence [adjusted odds ratios (ORs)=9.515 and 2.327] after adjusting for age, sex, body mass index, marital status, and socioeconomic status. CONCLUSION: Our findings suggest that excessive daytime sleepiness and lowest O2 saturation are important factors to identify good adherence to APAP treatment in Korean OSAS patients.
Acetaminophen ; Body Mass Index ; Humans ; Marital Status ; Odds Ratio ; Sleep Apnea, Obstructive* ; Snoring ; Social Class

OBJECTIVES: The clinical features of various facial deformities in Korean leprosy patients were evaluated according to the type of leprosy. METHODS: One hundred ninety six patients with leprosy were examined for various facial deformities using a nasal speculum, endoscope, and digital camera. The frequency and severity of external nasal deformities and septal perforations were evaluated according to the type of leprosy. Eye deformities, ear deformities, and facial palsy were also assessed. RESULTS: Seventy-one patients (36.2%) displayed external nasal deformities: 28 minimal contractures, three cartilage contractures, two bony-cartilage contractures, and 38 skin defects. The external nasal deformity and severe form deformity in lepromatous types were more frequent compared to other types (P<0.05 for each variable). Twenty-three patients (9%) displayed septal perforations, among whom 11 had cartilaginous perforations and 12 had bony-cartilaginous perforations. The frequency of septal and bony-cartilaginous perforations did not differ significantly between the types of leprosy (P>0.05 for each variable). Sixty-one patients (31.1%) had eye deformities and 19 patients (9.7%) had facial nerve palsy, common in the borderline type. No cases of ear deformities were observed. CONCLUSION: Korean patients had characteristic deformities according to the type of leprosy. They were different from those seen in the prior analyses of Caucasian populations.
Cartilage ; Congenital Abnormalities ; Contracture ; Ear ; Endoscopes ; Eye ; Facial Nerve ; Facial Paralysis ; Humans ; Leprosy ; Paralysis ; Skin ; Surgical Instruments

We report two cases of surgical removal of a retained subfoveal perfluorocarbon liquid (PFCL) bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade. Two patients underwent pars plana vitrectomy with PFCL injection for rhegmatogenous retinal detachment. In both cases, a retained subfoveal PFCL bubble was noticed postoperatively by funduscopy and optical coherence tomography. Both patients underwent surgical removal of the subfoveal PFCL through a therapeutic macular hole and gas tamponade. The therapeutic macular holes were completely closed by gas tamponade and the procedure yielded a good visual outcome (best-corrected visual acuity of 20 / 40 in both cases). In one case, additional intravitreal PFCL injection onto the macula reduced the size of the therapeutic macular hole and preserved the retinal structures in the macula. Surgical removal of a retained subfoveal PFCL bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade provides an effective treatment option.
Aged ; Female ; Fluorocarbons/*administration & dosage ; Follow-Up Studies ; Fovea Centralis ; Humans ; Intravitreal Injections ; Retinal Perforations/diagnosis/physiopathology/*surgery ; Suction/*methods ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy/*methods

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.
Aged ; Angiography ; Choroid ; Ethnic Groups ; Eye ; Female ; Fluorescein ; Humans ; Hypertension ; Incidence ; Korea ; Macular Degeneration ; Male ; Membranes ; Photography ; Retinaldehyde ; Smoke ; Smoking ; Specialization

Cervical necrotizing fasciitis is a rare but life-threatening soft tissue infection primarily affecting the superficial and deep fascial planes. If proper treatment is delayed, the infection may cause extensive necrosis of overlying skin, destroying fascia, adipose tissue and muscle and producing severe systemic toxicity. So the key to the successful outcome is early recognition and rapid initiation of definitive radical debridement. The authors report, along with a literature review, one case of necrotizing fasciitis spreading into the anterior chest wall.
Adipose Tissue ; Debridement ; Fascia ; Fasciitis, Necrotizing ; Muscles ; Necrosis ; Skin ; Soft Tissue Infections ; Thoracic Wall ; Thorax

Genital HPV infection is the most common sexually transmitted infection, but the majority of infections are self-limited. However, persistent infection with high-risk types can cause cervical cancer in women, which is the most common female genital cancer in Korea. In addition, HPV infection is the cause of genital warts and is associated with other anogenital cancers. The HPV vaccine is composed of the HPV L1 protein, the major capsid protein of HPV. Expression of the L1 protein in yeast using recombinant DNA technology produces noninfectious virus-like particles (VLP) that resemble HPV virions. The quadrivalent HPV vaccine is a mixture of four HPV type-specific VLPs prepared from the L1 proteins of HPV 6, 11, 16, and 18 combined with an aluminum adjuvant. Clinical trials indicate that the vaccine has high efficacy in preventing persistent HPV infection, cervical cancer precursor lesions, vaginal and vulvar cancer precursor lesions, and genital warts caused by HPV types 6, 11, 16, or 18 among females who have not already been infected with the respective HPV type. The recommended age for primary vaccination of Korean females is 15-17 years, considering sexual debut and duration of protection of the vaccine. Vaccine can be administered as young as age 9 years. Catch-up vaccination is recommended for females aged 18-26 years who have not been previously vaccinated. Vaccination is not a substitute for routine cervical cancer screening, and vaccinated females should have cervical cancer screening as recommended.
Aluminum ; Capsid Proteins ; Colposcopy* ; Condylomata Acuminata ; DNA, Recombinant ; Female ; Human papillomavirus 6 ; Humans* ; Korea ; Mass Screening ; Uterine Cervical Neoplasms ; Vaccination ; Virion ; Vulvar Neoplasms ; Yeasts

Appendiceal mucocele is a cystic dilatation of the appendiceal lumen with mucus, which may be caused by either benign or malignant diseases. In this report, five cases of appendiceal mucocele are reported, three of which had a preoperative diagnosis of mucocele, whereas the others were found incidentally during the operation under the diagnosis of intussusception and periappendiceal abscess. All five patients underwent surgical resections, including one ileocecal resection and four right hemicolectomies. Histopathology revealed a mucinous cystadenoma in four cases, and a mucinous cystadenocarcinoma in one. There was no disease-related death during 18 months of follow-up.
Abscess ; Appendix ; Cystadenocarcinoma, Mucinous ; Cystadenoma, Mucinous ; Diagnosis ; Dilatation ; Follow-Up Studies ; Humans ; Intussusception ; Mucocele* ; Mucus