Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.

Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.

Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.

OBJECTIVES: To investigate awareness and experience of menopausal symptom and hormone therapy in Korean postmenopausal women. METHODS: A total of 570 postmenopausal women were accepted our survey. The women filled out the questionnaires composed of medical and surgical history, menopausal age and symptom, demand of treatment on menopausal symptom, and personal method for overcoming the symptom. Also, we make inquiries about experience of hormone therapy, concern about hormone therapy, improvement of menopausal symptom after therapy, adverse effect, and cause of cease the therapy. RESULTS: According to the survey, 80% (456/570) of the women experienced menopausal symptom. When they felt the symptom at first, 47% (213/570) of women was 46-50 years old. The most common menopausal symptom was hot flushes (141/570). A number of Korean women regarded that menopause was a natural process of ageing (69%). Eighty two % of women thought to need to have treatment on menopausal symptom. However, only half (43%) visited doctor. The most concerned disease after menopause they had answered was osteoporosis (60%) but only 22% of women were taken regular check-up of bone mineral density. The common causes were unwilling to do treatment were concern about adverse effect (51%) and indefinite fear of cancer (32%). Moreover, many women got diverse information about menopause from the mass media than professional advice. CONCLUSION: Only a minority of Korean postmenopausal women with menopausal symptoms had taken a hormone therapy. We should provide appropriate education and counsel to Korean peri-menopause women.
Bone Density ; Education ; Female ; Humans ; Mass Media ; Menopause ; Osteoporosis ; Surveys and Questionnaires

We attempted to investigate the reason why the students got a worse grade in gross anatomy and the way how we can improve upon the teaching method since there were gaps between teaching and learning under recently changed integration curriculum. General characteristics of students and exploratory factors to testify the validity were compared between year 2011 and 2012. Students were asked to complete a short survey with a Likert scale. The results were as follows: although the percentage of acceptable items was similar between professors, professor C preferred questions with adequate item discrimination and inappropriate item difficulty whereas professor Y preferred adequate item discrimination and appropriate item difficulty with statistical significance (P<0.01). The survey revealed that 26.5% of total students gave up the exam on gross anatomy of professor Y irrespective of years. These results suggested that students were affected by the corrected item difficulty rather than item discrimination in order to obtain academic achievement. Therefore, professors in a team-teaching subject should reach a consensus on an item difficulty with proper teaching methods.
Consensus ; Curriculum ; Discrimination (Psychology) ; Humans ; Learning ; Schools, Medical* ; Self-Assessment* ; Teaching

Anatomical variations of the inferior mesenteric artery are extremely uncommon, since the inferior mesenteric artery is regularly diverged at the level of the third lumbar vertebra. We found a rare case in which the inferior mesenteric artery arose from the superior mesenteric artery. The findings were made during a routine dissection of the cadaver of an 82-yr-old Korean woman. This is the tenth report on this anomaly, the second female and the first Korean. The superior mesenteric artery normally arising from abdominal aorta sent the inferior mesenteric artery as the second branch. The longitudinal anastomosis vessels between the superior mesenteric artery and inferior mesenteric artery survived to form the common mesenteric artery. This anatomical variation concerning the common mesenteric artery is of clinical importance, performing procedures containing the superior mesenteric artery.
Aged, 80 and over ; Aorta, Abdominal/abnormalities ; Female ; Humans ; Mesenteric Artery, Inferior/*abnormalities/anatomy & histology ; Mesenteric Artery, Superior/*abnormalities/anatomy & histology ; Republic of Korea

Bronchiolitis obliterans (BO) or bronchiolitis obliterans organizing pneumonia (BOOP) is one of manifestations of graft-versus-host disease (GVHD), a complication of hematopoietic stem cell transplantation (HSCT). Recently there are reports about thoracic air-leakage syndrome (TALS), but real incidence, clinical course, and implications of TALS remain unclear. Retrospective review of 18 TALS patients among 2,177 patients who received allogeneic HSCT between January 2000 to July 2007 was done. Clinical manifestations, treatments, and outcomes of TALS were reviewed. The incidence of TALS was 0.83% (18/2,177). The onset of TALS was mean 425.9+/-417.8 days (60-1,825 days) after HSCT, and the duration was mean 16.3+/-21 days (2-90 days). The most common types of TALS were spontaneous pneumothroax (n=14), followed by subcutaneous emphysema (n=6), pneumomediastinum (n=5), interstitial emphysema (n=2), and pneumopericardium (n=1). TALS persisted in six patients, who died during the same hospitalization. The 12 patients recovered from TALS, but only 2 survived, while others died due to aggravation of GVHD. TALS may complicate BO/BOOP and be an initial manifestation of BO/BOOP. TALS is hard to be resolved, and even after the recovery, patients die because of aggravation of GVHD. We suggest specifically in HSCT patients, when once developed, TALS seems hard to be cured, and as a result, be related to high fatality.
Adolescent ; Adult ; Comorbidity ; Female ; Graft vs Host Disease/*mortality/*surgery ; Hematopoietic Stem Cell Transplantation/*mortality ; Hemothorax/*mortality ; Humans ; Incidence ; Korea ; Male ; Middle Aged ; Pneumothorax/*mortality ; Prognosis ; Risk Assessment ; Risk Factors ; Survival Analysis ; Survival Rate ; Syndrome ; Treatment Outcome ; Young Adult

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic tumor (GTT) that has different behavior in disease process. The hysterectomy is general for PSTT, but hysterectomy is undesirable for patients who wish to remain fertile. We planned to preserve fertility of a young patient by first administering EMA/CO (Etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) chemotherapy and then performing an open uterine surgery to remove residual tumor. The patient who attempted primary chemotherapy for PSTT must be undergone a hysterectomy because this conservative regimen showed sign of chemoresistance. We report a case of chemoresistant PSTT with trial to preserve fertility with a brief review of literatures.
Dactinomycin ; Drug Therapy ; Fertility ; Humans ; Hysterectomy ; Methotrexate ; Neoplasm, Residual ; Trophoblastic Neoplasms ; Trophoblastic Tumor, Placental Site*

Unlike other retinal cells, oligodendrocytes originate from the ventral midline of the third ventricle, and migrate to the retina at embryonic day 10 (E10) through the optic chiasm and the optic nerve in the bird. Recent studies have demonstrated that sonic hedgehog (shh), a differentiation factor for oligodendrocytes, was secreted by ganglion cells in the developing retina, indicating that microenvironment of the retina is sufficient for the generation of oligo-dendrocytes. Furthermore, it was revealed that uncommitted progenitors could differentiate into all cell types in the murine retina. On the basis of these reports, we proposed that a subpopulation of oligodendrocytes might generate in the retina in situ of the chick embryo. In order to verify our hypothesis, we injected the intraretinal space of chick embryos with a replication-defective retroviral vector (LZ12), and identified oligodendrocytes among LZ12-incorporated cells. Plp/dm-20 and pdgfr-alpha, oligodendrocyte specific transcripts were already expressed in the E5 retina. The expression of shh transcripts was also detected in the same stage. Analysis of the retina with intraretinal space injection demonstrated many clones consisting of various cell types arranged vertically through the retina. In addition, we found a few clones that had O4 +/-oligodendrocytes. In case of third ventricle injection, we found that LZ12-incorporated cells occurred in rows, the typical shape of interfascicular oligodendrocytes in the optic nerve, and were located in the nerve fiber layer adjacent to the ganglion cells in the retina. These cells were also labeled with TfBP antibody. These results indicate that retinal oligodendrocytes of birds are differentiated from retinal precursor cells, together with undifferentiated cells adjacent to the third ventricle.
Animals ; Birds ; Chick Embryo ; Chickens* ; Clone Cells ; Embryonic Structures* ; Ganglion Cysts ; Hedgehogs ; Nerve Fibers ; Oligodendroglia* ; Optic Chiasm ; Optic Nerve ; Retina ; Retinaldehyde* ; Third Ventricle ; Zidovudine

We have previously demonstrated that transferrin binding protein (TfBP) is a reliable marker for mature oligoden-drocytes (OLGs) in the avian central nervous system (CNS). Unlike mammalian CNS in which OLGs are generated largely postnatally, avian OLGs are differentiated during embryonic development of CNS. In this study, several aspects of TfBP(+/-) OLG development were immunohistochemically examined in the embryonic chick cerebellum : (1) change in shapes of immature cells with respect to time and to location within the cerebellum, (2) possible sites of origin, and (3) pathways of precursor cell migration. Our results indicate that TfBP expression gradually increases and extends from the deep portion of the white matter to gray matter with proportion to progress of cerebellar development. A few TfBP? cells were first observed in the deep portion of the cerebellum at E9. At E13, TfBP(+/-) cells were distributed evenly within the white matter. At E17, many TfBP(+/-) OLGs were located at granular layer and at the near place of Purkinje cell layer. At E20, a large number of TfBP cells appeared at the granular layer with a few in the molecular layer. Our data demonstrated distinct patterns of morphology and location of TfBP(+/-) OLGs in the cerebellum during development and suggest a role of TfBP in OLG development.
Animals ; Carrier Proteins ; Cell Movement ; Central Nervous System ; Cerebellum* ; Chick Embryo ; Embryonic Development ; Female ; Oligodendroglia ; Pregnancy ; Transferrin