Purpose: To determine the usefulness of measuring the tortuosity of retinal arteries using smartphone fundus photographs to quantify plus disease in retinopathy of prematurity (ROP) patients. Methods: Digital fundus photographs were taken with a smartphone of 116 eyes involving 58 premature infants. The tortuosity of retinal arteries named as the tortuosity index (TI) was measured with Image J software. Patients were classified into the treated and control groups and the TIs of the two groups were compared. A receiver operating characteristic curve was constructed and areas under the curve (AUC) were calculated to quantify the diagnostic utility of TI. Results: Fundus photographs of 98 eyes of 50 premature infants were analyzed; 38 eyes of 20 infants were the treated group and 60 eyes of 30 infants were the control group. The TI was 1.231 ± 0.156 in the treated group before treatment, which was significantly larger than 1.062 ± 0.019 in the control group. After treatment of the treated group, the TI was 1.100 ± 0.093, which was significantly smaller than before treatment. The AUC was 0.926, and using a cut-off value of 1.095, the sensitivity and specificity of TIs for requiring treatment were 85.1% and 95.5%, respectively. Conclusions The tortuosity of retinal arteries was measured by analyzing smartphone fundus photographs to quantify plus disease in ROP patients. This method may be helpful for screening, follow-up, and treatment decisions for ROP patients.

PURPOSE: The purpose of this study was to investigate the effect of hospital case volume on clinical outcomes in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: Data on 1,073 patients with cT1-4N0-3M0 NPC were collected from a multi-institutional retrospective database (KROG 11-06). All patients received definitive radiotherapy (RT) either with three-dimensional-conformal RT (3D-CRT) (n=576) or intensity-modulated RT (IMRT) (n=497). The patients were divided into two groups treated at high volume institution (HVI) (n=750) and low volume institution (LVI) (n=323), defined as patient volume ≥ 10 (median, 13; range, 10 to 18) and < 10 patients per year (median, 3; range, 2 to 6), respectively. Endpoints were overall survival (OS) and loco-regional progression-free survival (LRPFS). RESULTS: At a median follow-up of 56.7 months, the outcomes were significantly better in those treated at HVI than at LVI. For the 614 patients of propensity score-matched cohort, 5-year OS and LRPFS were consistently higher in the HVI group than in the LVI group (OS: 78.4% vs. 62.7%, p < 0.001; LRPFS: 86.2% vs. 65.8%, p < 0.001, respectively). According to RT modality, significant difference in 5-year OS was observed in patients receiving 3D-CRT (78.7% for HVI vs. 58.9% for LVI, p < 0.001) and not in those receiving IMRT (77.3% for HVI vs. 75.5% for LVI, p=0.170). CONCLUSION: A significant relationship was observed between HVI and LVI for the clinical outcomes of patients with NPC. However, the difference in outcome becomes insignificant in the IMRT era, probably due to the standardization of practice by education.
Cohort Studies ; Disease-Free Survival ; Education ; Follow-Up Studies ; Humans ; Nasopharyngeal Neoplasms ; Radiotherapy ; Radiotherapy, Intensity-Modulated ; Retrospective Studies* ; Treatment Outcome

BACKGROUND: Cervical cytology for uterine cervical cancer screening has transitioned from conventional smear (CS) to liquid-based cytology (LBC), which has many advantages. The aim of this study was to compare the proportion of unsatisfactory specimens from CS versus LBC at multiple institutions including general hospitals and commercial laboratories. METHODS: Each participating institution provided a minimum of 500 Papanicolaou (Pap) test results for analysis. Pap tests were classified according to the participating institution (commercial laboratory or general hospital) and the processing method (CS, ThinPrep, SurePath, or CellPrep). The causes of unsatisfactory results were classified as technical problems, scant cellularity, or complete obscuring factors. RESULTS: A total of 38,956 Pap test results from eight general hospitals and three commercial laboratories were analyzed. The mean unsatisfactory rate of LBC was significantly lower than that of CS (1.26% and 3.31%, p = .018). In the LBC method, samples from general hospitals had lower unsatisfactory rates than those from commercial laboratories (0.65% vs 2.89%, p = .006). The reasons for unsatisfactory results were heterogeneous in CS. On the other hand, 66.2% of unsatisfactory results in LBC were due to the scant cellularity. CONCLUSIONS: Unsatisfactory rate of cervical cancer screening test results varies according to the institution and the processing method. LBC has a significantly lower unsatisfactory rate than CS.
Hand ; Hospitals, General ; Mass Screening* ; Methods ; Papanicolaou Test ; Uterine Cervical Neoplasms*

In the present study, we investigated anti-cancer effect of snake venom activated NK cells (NK-92MI) in lung cancer cell lines. We used snake venom (4 microg/ml) treated NK-92MI cells to co-culture with lung cancer cells. There was a further decrease in cancer cell growth up to 65% and 70% in A549 and NCI-H460 cell lines respectively, whereas 30-40% was decreased in cancer cell growth by snake venom or NK-92MI alone treatment. We further found that the expression of various apoptotic proteins such as that Bax, and cleaved caspase-3 as well as the expression of various death receptor proteins like DR3, DR4 and Fas was also further increased. Moreover, consistent with cancer cell growth inhibition, the DNA binding activity of NF-kappaB was also further inhibited after treatment of snake venom activated NK-92MI cells. Thus, the present data showed that activated NK cells could further inhibit lung cancer cell growth.
Caspase 3 ; Cell Line ; Coculture Techniques ; DNA ; Killer Cells, Natural* ; Lung Neoplasms* ; NF-kappa B* ; Snake Venoms*

BACKGROUND: The persistence of infection by high-risk human papillomavirus (HPV) may lead to cervical cancer. Recently, the American Society for Colposcopy and Cervical Pathology (ASCCP) announced that oncogenic HPV screening and the PAP smear are the main methods of screening for cervical cancer. The goal of this study was to investigate the prevalence and genotyping of HPV, as well as the risk of cervical dysplasia. METHODS: HPV genotyping was conducted by a commercial chip assay. Cervical dysplasia was retrospectively reviewed using electronic medical records. The study participants were grouped together according to cervical dysplasia status: 'no dysplasia,' 'atypical squamous cells of undetermined significance (ASCUS),' 'low-grade squamous intraepithelial lesion (LSIL),' and 'high-grade squamous intraepithelial lesion (HSIL).' The HPV prevalence and genotyping were analyzed according to the cervical dysplasia group. RESULTS: The overall prevalence of HPV was 17.6% (91 out of 518 patients). HPV-18 (2.3%), HPV-16 (2.1%), and HPV-58 (1.2%) were the three most frequent genotypes. The prevalence of HPV infection and the high-risk HPV positive rate was higher in the ASCUS, LSIL, and HSIL groups than in the no dysplasia group (P<0.05). CONCLUSION: In this study, basic data regarding the prevalence and distribution of HPV genotypes were obtained. Since HPV vaccination has been actively encouraged among Korean women, a change in the prevalence of HPV and cervical dysplasia is expected in the future. This study provided basic data describing the prevalence of HPV and its genotypes in the pre-HPV vaccination era.
Colposcopy ; Electronic Health Records ; Female ; Genotype ; Human papillomavirus 16 ; Human papillomavirus 18 ; Humans ; Mass Screening ; Papillomavirus Infections ; Prevalence ; Retrospective Studies ; Uterine Cervical Neoplasms ; Vaccination

The Korean Society of Nephrology (KSN) launched the official End-Stage Renal Disease (ESRD) Patient Registry in 1985 and the Internet online registry program was opened in 2001. The ESRD Registry Committee of KSN has collected data on dialysis therapy in Korea through the online registry program in the KSN Internet website. The increasing number of elderly people and diabetic patients in Korea has resulted in a very rapid increase in the number of ESRD patients. The total number of ESRD patients was 58,860 (hemodialysis [HD], 39,509; peritoneal dialysis [PD], 7309; and functioning kidney transplant [KT], 12,042). The prevalence of ESRD was 1144.4 patients per million population (PMP), and the proportion of renal replacement therapy was HD, 67.1%; PD, 12.4%; and KT, 20.5%. The number of new ESRD patients in 2010 was 9335 (HD, 7204; PD, 867; and KT, 1264; the incidence rate was 181.5 PMP). The primary causes of ESRD were diabetic nephropathy (45.2%), hypertensive nephrosclerosis (19.2%), and chronic glomerulonephritis (11.3%). The mean urea reduction ratio was 67.9% in male HD patients and 73.9% in female HD patients. The mean Kt/V was 1.394 in male patients and 1.659 in female patients. Five-year survival rates of male and female dialysis patients were 64.9% and 67.3%, respectively.
Aged ; Diabetic Nephropathies ; Dialysis ; Female ; Glomerulonephritis ; Humans ; Incidence ; Internet ; Kidney ; Kidney Failure, Chronic ; Korea ; Male ; Nephrology ; Nephrosclerosis ; Peritoneal Dialysis ; Prevalence ; Renal Dialysis ; Renal Replacement Therapy ; Survival Rate ; Transplants ; Urea

BACKGROUND/AIMS: Low-dose metronomic chemotherapy involves the frequent administration of comparatively low doses of cytotoxic agents with no extended breaks, and it may be as efficient as and less toxic than the conventional maximum tolerated dose therapy. This study evaluated the feasibility and therapeutic efficacy of metronomic chemotherapy in patients with advanced hepatocellular carcinoma (HCC) with major portal vein thrombosis (PVT). METHODS: Thirty consecutive HCC patients with major PVT with or without extrahepatic metastasis were prospectively allocated to metronomic chemotherapy consisting of epirubicin being infused through the correct hepatic artery at a dose of 30 mg/body surface area (BSA) every 4 weeks, and cisplatin (15 mg/BSA) and 5-fluorouracil (50 mg/BSA) every week for 3 weeks, with intervening 1 week breaks. The treatment response was assessed using response evaluation criteria in solid tumors (RECIST). RESULTS: In total, 116 cycles of metronomic chemotherapy were administered to the 30 patients, with a median of 3 cycles given to individual patients (range, 1-15 cycles). Six patients (20.0%) achieved a partial response and six patients (20.0%) had stable disease. The median time to disease progression and overall survival were 63 days (range, 26-631 days) and 162 days (95% confidence interval; range, 62-262 days), respectively. Overall survival was significantly associated with baseline alpha-fetoprotein level (P=0.001) and tumor response (P=0.005). The baseline alpha-fetoprotein level was significantly associated with the disease control rate (P=0.007). Adverse events were tolerable and managed successfully with conservative treatment. CONCLUSIONS: Metronomic chemotherapy may be a safe and useful palliative treatment in HCC patients with major PVT.
Administration, Metronomic ; Adult ; Aged ; Antineoplastic Agents/administration & dosage ; Carcinoma, Hepatocellular/complications/*drug therapy/mortality ; Cisplatin/administration & dosage ; Epirubicin/administration & dosage ; Female ; Fluorouracil/administration & dosage ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/complications/*drug therapy/mortality ; Male ; Middle Aged ; *Portal Vein ; Prognosis ; Tomography, X-Ray Computed ; Venous Thrombosis/complications/*diagnosis ; alpha-Fetoproteins/analysis

BACKGROUND: Frailty is considered to be a clinical syndrome characterized by decreased physiological reserves associated with a greater risk of health-related problems, hospitalization, and death. The current study examined hospitalization, falls, cognitive decline and disability between robust, prefrail and frail elderly in one year. METHODS: 110 participants aged 65 or more who visited two senior welfare centers in Seoul from February 2008 to June 2008 were surveyed again from March 2009 to June 2009 with demographic characteristics, number of chronic diseases and medication, study of osteoporotic fractures (SOF) frailty index, instrumental activity of daily living (IADL), depression, mini-mental state examination-Korean version (MMSE-K), falling history and admission history within one year. These results were compared with participants' previous survey done one year ago. RESULTS: Among total 110 subjects, 48 (44%) robust, 30 (27%) prefrail, and 32 (29%) frail subjects changed to 26 (24%), 54 (49%), and 30 (27%) respectively over the year. There were statistical significances in age, number of chronic disease, depressive mood, MMSE, falls, hospitalization, IADL disability contributing to frailty (P < 0.05). Frailty defined by SOF frailty index was associated with greater risk of adverse outcomes. Frail subjects had a higher age-adjusted risk of cognitive function decline (odds ratio [OR], 3.57), disability (OR, 9.64), fall (OR, 5.42), and hospitalization (OR, 4.45; P < 0.005). CONCLUSION: The frailty index like SOF frailty index might predict risk of falls, disability, hospitalization, and cognitive decline in the elderly, emphasizing special attention to the individuals showing frailty in outpatient examination.
Aged ; Chronic Disease ; Depression ; Frail Elderly ; Hospitalization ; Humans ; Osteoporotic Fractures ; Outpatients ; Retrospective Studies

PURPOSE: To retrospectively analysis of results of operatively treatment for femoral neck fracture occurred in twenties to thirties. MATERIALS AND METHODS: 20 patients were selected whom we were able to follow up at least 2 years after internal fixation for femoral neck fracture in twenties to thirties from 1998 to 2005. Mean age was 32.2 (21~39) and average follow up period was 26.3 (24~45) months. According to preoperative X-ray, there were 6 cases for Garden classification stage I, 10 for stage II and 4 for stage III, and 7 cases for subcapital fracture, 9 for transcervical fracture, 4 for basicervical fracture. In all cases, operations were performed within 12 hours after the injury. The operations were done after satisfying reduction with the Garden alignment index, with three cannulated screws for internal fixation. Postoperative results were analyzed by clinical symptoms and radiological examinations during follow up periods. RESULTS: In immediately postoperative radiological examination, satisfying anatomical reduction with Garden alignment index was obtained in all cases, and unions were obtained within 4.5 months after the operation (3~6 month). Avascular necrosis of femoral head occurred in 7 cases of all patients (35.0%). The average time of occurrence of avascular necrosis of femoral head after operation was 10.7 months (9~15 months). Avascular necrosis was occutted 5 (31.3%) in fracture without displacement (Garden stage I, II), 2 (50.0%) in fracture with displacement (Garden stage III) and 4 in subcapital fracture, 3 in transcervical fracture. CONCLUSION: The incidence of avascular necrosis of femoral head after the operation for displaced and nondisplaced femoral neck fracture between twenties and forty years was no significant difference.
Displacement (Psychology) ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Head ; Humans ; Incidence ; Necrosis ; Retrospective Studies

PURPOSE: To analyze the causes of fixation failure of compression hip screw and evaluate outcomes of hip arthroplasty for reconstruction. MATERIALS AND METHODS: We reviewed 108 femoral intertrochanteric fractures that underwent compression hip screw between January 1997 and December 2007. Failure group (group I) contained 28 cases who had hip arthroplasty for failed compression hip screw and the control group (group II) contained 80 cases who had successive compression hip screw. We analyzed the causes of failure of compression hip screw and evaluated the results of hip arthroplasty for reconstruction. RESULTS: In group I, 21 cases (75%) were unstable fractures. Group II, 14 cases (17%) were unstable fractures. Tip-apex distance was 26.5 (18~35) mm in group I and 18.6 (8~22) mm in group II. Lateral wall fracture of greater trochanteric area was combined in 24 cases (85.7%) in group I and 9 cases (11.3%) in group II. Harris Hip Score improved from 33.5 (22~43) points to 84.2 (75~93) points after salvage hip arthroplasty. CONCLUSION: We considered the causes of failed compression hip screw to be fracture instability, increased tip-apex distance and presence of lateral wall fracture of greater trochanter. Hip arthroplasty was found to be a useful method for failed compression hip screw.
Arthroplasty ; Femur ; Hip ; Hip Fractures