Objective: This study aimed to evaluate the safety and efficacy of intranodal lymphangiography and thoracic duct embolization (TDE) for chyle leakage (CL) after thyroid surgery. Materials and Methods: Fourteen patients who underwent intranodal lymphangiography and TDE for CL after thyroid surgery were included in this retrospective study. Among the 14 patients, 13 underwent bilateral total thyroidectomy with neck dissection (central compartment neck dissection [CCND], n = 13; left modified radical neck dissection (MRND), n = 11;bilateral MRND, n = 2), and one patient underwent left hemithyroidectomy with CCND. Ten patients (76.9%) had high-output CL (> 500 mL/d). Before the procedure, surgical intervention was attempted in three patients (thoracic duct ligation, n = 1;lymphatic leakage site ligation, n = 2). Lymphangiographic findings, technical and clinical successes, and complications were analyzed. Technical success was defined as the successful embolization of the thoracic duct after access to the lymphatic duct via the transabdominal route. Clinical success was defined as the resolution of CL or surgical drain removal. Results: On lymphangiography, ethiodized oil leakage near the surgical bed was identified in 12 of 14 patients (85.7%). The technical success rate of TDE was 78.6% (11/14). Transabdominal antegrade access was not feasible due to the inability to visualize the identifiable cisterna chyli or a prominent lumbar lymphatic duct. Among patients who underwent a technically successful TDE, the clinical success rate was 90.1% (10/11). The median time from the procedure to drain removal was 3 days (with a range of 1–13 days) for the 13 patients who underwent surgical drainage. No CL recurrence was observed during the follow-up period (ranging from 2–44 months; median, 8 months). There were no complications, except for one case of chylothorax that developed after TDE. Conclusion TDE appears to be a safe and effective minimally invasive treatment option for CL after thyroid surgery, with acceptable technical and clinical success rates.

Objective: To evaluate the role of percutaneous pancreatic stent placement in postoperative pancreaticojejunostomy stenosis (PJS). Materials and Methods: This retrospective single-center study included seven procedures in five patients (four males and one female; median age, 63 years) who underwent percutaneous pancreatic stent placement for postoperative PJS between January 2005 and December 2021. The patients were referred to interventional radiology because of unfavorable anatomy or bowel abnormalities. The pancreatic duct was accessed under ultrasound and/or computed tomography guidance. A stent was placed after balloon dilatation of the PJS. Moreover, plastic stents were placed for the first two procedures, whereas bare-metal stents were used for the remaining five procedures. Technical success was defined as the successful placement of stents for the PJS, meanwhile, clinical success was defined as the normalization of pancreatic enzymes without recurrence of pancreatitis. Results: Pancreatic duct access and stent placement were successfully performed in all patients (technical success rate: 100%).All the procedures initially yielded clinical success. However, recurrence of pancreatitis was observed after two procedures that used plastic stents because of stent migration at 0.3 and 3 months after the procedure. In contrast, no instances of recurrent pancreatitis were noted after metal stent placement for a follow-up duration of 1–36 months. No serious procedure-related adverse events were observed. Conclusion Percutaneous pancreatic stent placement may be a viable option for patients with postoperative PJS in whom an endoscopic approach is not feasible. Metal stents may be considered over plastic stents for the management of PJS, considering the possible lower stent migration and infeasibility of frequent endoscopic stent exchange due to the altered anatomy.

Objective: To investigate the feasibility of using a deep learning-based analysis of auscultation data to predict significant stenosis of arteriovenous fistulas (AVF) in patients undergoing hemodialysis requiring percutaneous transluminal angioplasty (PTA). Materials and Methods: Forty patients (24 male and 16 female; median age, 62.5 years) with dysfunctional native AVF were prospectively recruited. Digital sounds from the AVF shunt were recorded using a wireless electronic stethoscope before (pre-PTA) and after PTA (post-PTA), and the audio files were subsequently converted to mel spectrograms, which were used to construct various deep convolutional neural network (DCNN) models (DenseNet201, EfficientNetB5, and ResNet50). The performance of these models for diagnosing ≥ 50% AVF stenosis was assessed and compared. The ground truth for the presence of ≥ 50% AVF stenosis was obtained using digital subtraction angiography. Gradient-weighted class activation mapping (Grad-CAM) was used to produce visual explanations for DCNN model decisions. Results: Eighty audio files were obtained from the 40 recruited patients and pooled for the study. Mel spectrograms of “pre-PTA” shunt sounds showed patterns corresponding to abnormal high-pitched bruits with systolic accentuation observed in patients with stenotic AVF. The ResNet50 and EfficientNetB5 models yielded an area under the receiver operating characteristic curve of 0.99 and 0.98, respectively, at optimized epochs for predicting ≥ 50% AVF stenosis. However, GradCAM heatmaps revealed that only ResNet50 highlighted areas relevant to AVF stenosis in the mel spectrogram. Conclusion Mel spectrogram-based DCNN models, particularly ResNet50, successfully predicted the presence of significant AVF stenosis requiring PTA in this feasibility study and may potentially be used in AVF surveillance.

PURPOSE: This study aims to examine the levels of the perception and work performance of patient safety based on the healthcare accreditation criteria among long-term care hospital nurses. METHODS: A cross-sectional study was performed using questionnaires. Out of 205 criteria, 39 items relevant to patient safety were selectively adapted for this study. Data were analyzed with descriptive statistics, t-test, ANOVA, and Pearson correlation coefficient. RESULTS: The mean scores of perception and work performance were 4.36 and 4.24 out of 5, respectively, and the difference between them was significantly different (t=5.78, P<.001). The two variables were both significantly higher among those nurses who were older, married, head nurses, had many nursing experiences, and aware of Healthcare Accreditation than the other nurses. Positive correlations were observed between perception and work performance in all three sub-systems. The relations between these two in the patient care system was the most highly correlated (r=.894, P<.001). The lowest scores of perception and work performances were fire-related criteria (i.e., reporting). CONCLUSION: Overall, subject's perception proves to be higher than their work performance. It is necessary to develop some viable environment and training programs to enhance their work performance up to the level of their perception of patient safety.
Accreditation ; Cross-Sectional Studies ; Delivery of Health Care ; Education ; Humans ; Long-Term Care* ; Nursing ; Nursing, Supervisory ; Patient Care ; Patient Safety* ; Work Performance*

PURPOSE: To evaluate the change of visual quality after wearing orthokeratology lenses overnight. METHODS: This study included 13 patients (24 eyes) who wore orthokeratology lenses for the first time. Visual quality was assessed with the optical quality analysis system (OQAS) using the double-pass technique. The value of modulation transfer function (MTF) cutoff, Strehl ratio, and objective scatter index (OSI) were measured at baseline and 4 weeks after wearing the lenses. RESULTS: The mean spherical equivalent decreased from -2.70 +/- 1.03 diopters (D) to 0.03 +/- 0.36 D after 4 weeks of wearing orthokeratology lenses and uncorrected visual acuity improved from log MAR 0.88 +/- 0.17 to log MAR 0.03 +/- 0.04. The MTF cutoff decreased from 38.20 +/- 11.01 to 34.79 +/- 10.30 and the Strehl ratio decreased from 0.24 +/- 0.07 to 0.21 +/- 0.07 but without statistical significance. The OSI significantly increased from 0.38 +/- 0.19 to 0.72 +/- 0.40 after wearing orthokeratology lenses. CONCLUSIONS: Orthokeratology lenses were effective for correction of myopia and astigmatism. The OSI increased after wearing the lenses, but MFT cutoff and Strehl ratios were not affected.
Astigmatism ; Humans ; Myopia ; Visual Acuity

PURPOSE: To evaluate the visual outcome and optical quality in eyes with diffractive multifocal intraocular lens (DMIOL) implantation after myopic refractive surgery. METHODS: Nineteen eyes (15 patients) were implanted with AcriSof ReSTOR(R) SN6AD1, the aspheric DMIOL after myopic refractive surgery (laser-assisted in situ keratomileusis [LASIK] 14 eyes, photorefractive keratectomy [PRK] 4 eyes, laser-assisted subepithelial keratomileusis [LASEK] 1 eye). Preoperative and postoperative visual acuities and manifest refraction were measured. Preoperative corneal higher-order aberrations (HOAs) were measured using Hartmann-Shack (H-S) aberrometer in dilated pupils, and optical qualities were measured 1 month postoperatively using H-S aberrometer and a double-pass system under mesopic conditions. Patient satisfaction was investigated using a questionnaire at 2 months postoperatively. RESULTS: Uncorrected distant and near visual acuities at postoperative 2 months were 0.11 +/- 0.19, and 0.19 +/- 0.12 (log MAR), respectively. Postoperative spherical equivalent (SE) of 16 eyes (84.2%) was within +/-0.50 diopters (D) and all eyes were within +/-1.00 D from emmetropia. Preoperative corneal and postoperative ocular spherical aberrations in a 4.0 mm pupil diameter were 0.08 +/- 0.08 and 0.07 +/- 0.07 (microm), respectively. Objective scatter index was 3.42 +/- 1.71 and modulation transfer function (MTF) cut-off value was 21.03 +/- 12.37 cpd. General satisfaction score was 3.52 +/- 0.96 points out of 5, and 8 patients (11 eyes) were not satisfied with DMIOL implantation. CONCLUSIONS: After DMIOL implantation in the eyes with previous myopic refractive surgery, postoperative SE was close to the target D, but optical qualities and patient satisfaction were poor.
Emmetropia ; Humans ; Keratectomy, Subepithelial, Laser-Assisted ; Lenses, Intraocular ; Patient Satisfaction ; Photorefractive Keratectomy ; Pupil ; Surveys and Questionnaires ; Refractive Surgical Procedures* ; Visual Acuity

PURPOSE: To evaluate the visual outcome and optical quality in eyes with diffractive multifocal intraocular lens (DMIOL) implantation after myopic refractive surgery. METHODS: Nineteen eyes (15 patients) were implanted with AcriSof ReSTOR(R) SN6AD1, the aspheric DMIOL after myopic refractive surgery (laser-assisted in situ keratomileusis [LASIK] 14 eyes, photorefractive keratectomy [PRK] 4 eyes, laser-assisted subepithelial keratomileusis [LASEK] 1 eye). Preoperative and postoperative visual acuities and manifest refraction were measured. Preoperative corneal higher-order aberrations (HOAs) were measured using Hartmann-Shack (H-S) aberrometer in dilated pupils, and optical qualities were measured 1 month postoperatively using H-S aberrometer and a double-pass system under mesopic conditions. Patient satisfaction was investigated using a questionnaire at 2 months postoperatively. RESULTS: Uncorrected distant and near visual acuities at postoperative 2 months were 0.11 +/- 0.19, and 0.19 +/- 0.12 (log MAR), respectively. Postoperative spherical equivalent (SE) of 16 eyes (84.2%) was within +/-0.50 diopters (D) and all eyes were within +/-1.00 D from emmetropia. Preoperative corneal and postoperative ocular spherical aberrations in a 4.0 mm pupil diameter were 0.08 +/- 0.08 and 0.07 +/- 0.07 (microm), respectively. Objective scatter index was 3.42 +/- 1.71 and modulation transfer function (MTF) cut-off value was 21.03 +/- 12.37 cpd. General satisfaction score was 3.52 +/- 0.96 points out of 5, and 8 patients (11 eyes) were not satisfied with DMIOL implantation. CONCLUSIONS: After DMIOL implantation in the eyes with previous myopic refractive surgery, postoperative SE was close to the target D, but optical qualities and patient satisfaction were poor.
Emmetropia ; Humans ; Keratectomy, Subepithelial, Laser-Assisted ; Lenses, Intraocular ; Patient Satisfaction ; Photorefractive Keratectomy ; Pupil ; Surveys and Questionnaires ; Refractive Surgical Procedures* ; Visual Acuity

PURPOSE: To report the evaluation and comparison of true corneal power after corneal refractive surgery through ARK, Orbscan II(R), Pentacam and IOL master. METHODS: Target IOL (Intraocular lens) power calculated with the SRK/T formula using SMK (Sungmo Eye Hospital keratometry), which is a new method for measuring corneal refractive power, was compared with the back-calculated ideal IOL power after cataract surgery for 30 eyes that required cataract surgery and had previously undergone refractive surgery. Target IOL powers calculated using 4 systems were compared with IOL power calculated using the clinical history method for 64 eyes that had undergone refractive surgery. RESULTS: Using SMK with the SRK/T formula, the actual refraction was within +/-0.5 diopter (D) of the intended refraction for 63.8% of eyes and within +/-1.0 D for 90.9% of eyes. Compared with target IOL power calculated with the clinical history method, target IOL power calculated by SMK with the SRK/T formula had a difference of 1.95 +/- 0.86 D, which was similar to the results calculated by the Haigis-L formula and by TNP with Haigis. CONCLUSIONS: The method of IOL calculation using SMK with the SRK/T formula showed the best predictability in patients after corneal refractive surgery. Comparatively accurate results were produced in IOL power calculations using the Haigis-L formula, and the TNP with Haigis method.
Cataract* ; Humans ; Refractive Surgical Procedures

PURPOSE: To investigate the visual and anatomical results of surgical treatment for symptomatic lamellar macular hole. METHODS: Ten eyes of ten patients with decreased visual acuity and lamellar macular hole were diagnosed using optical coherence tomography (OCT). Pars plana vitrectomy, epiretinal membrane removal, internal limiting membrane peeling, and gas tamponade (5 eyes) were performed for the treatment of lamellar hole. The resolution of the lamellar hole was assessed in relation to each OCT image at baseline. RESULTS: The mean postoperative follow-up duration was 7.5 months, and best corrected visual acuity improved from log MAR 0.67 +/- 0.38 to log MAR 0.30 +/- 0.28. Central foveal thickness decreased from 441 +/- 184 microm to 291 +/- 64 microm. The OCT of all eyes demonstrated improvement in macular contour. However, retinal detachment in one eye occurred at two months after the operation and was reattached with gas tamponade and photocoagulation. CONCLUSIONS: Vitrectomy, epiretinal membrane removal and internal limiting membrane peeling showed benefit in the treatment of symptomatic lamellar macular hole. However, large and prospective studies are necessary regarding the surgical indication, time and procedure for lamella macular hole.
Epiretinal Membrane ; Eye ; Follow-Up Studies ; Humans ; Membranes ; Retinal Detachment ; Retinal Perforations ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy

PURPOSE: To study the short-term effect of intravitreal injection of bevacizumab in the treatment of macular edema secondary to retinal macroaneurysm. METHODS: Eight eyes of 9 patients who underwent consecutive intravitreal bevacizumab injections for macular edema secondary to retinal macroaneurysm were prospectively evaluated. Complete eye examination including the best corrected visual acuity (BCVA), fundus examination and optical coherence tomography (OCT) were performed at baseline and follow-up visits at 2, 4 and 6 months. RESULTS: The mean age was 73.6 +/- 6.9 years, and the mean study period was 7.3 +/- 2.6 months. At the final visit, BCVA improved from log MAR 1.92 +/- 0.67 to log MAR 0.87 +/- 0.57. The mean central macular thickness on OCT image decreased from 388 +/- 168 microm at the initial visit to 200 +/- 39 microm at the final visit. Three eyes without subretinal hemorrhage presented better visual outcome than eyes with subretinal hemorrhage. All eyes showed some decrease in angiographic leakage. No adverse side effects were observed following the injections. CONCLUSIONS: Intravitreal bevacizumab injection can be used as a selective alternative treatment modality for macular edema secondary to retinal macroaneurysm.
Antibodies, Monoclonal, Humanized ; Eye ; Follow-Up Studies ; Hemorrhage ; Humans ; Intravitreal Injections ; Macular Edema ; Prospective Studies ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Acuity ; Bevacizumab