Background: The Coronal Plane Alignment of the Knee (CPAK) classification system has been developed as a comprehensive system that describes 9 coronal plane phenotypes based on constitutional limb alignment and joint line obliquity (JLO). Due to the characteristics of Asian populations, which show more varus and wider distribution in lower limb alignment than other populations, modification of the boundaries of the arithmetic hip-knee-ankle angle (aHKA) and JLO should be considered. The purpose of this study was to determine the knee phenotype in a Korean population based on the original CPAK and modified CPAK classification systems. Methods: We reviewed prospectively collected data of 500 healthy and 500 osteoarthritic knees between 2021 and 2023 using radiographic analysis and divided them based on the modified CPAK classification system by widening the neutral boundaries of the aHKA to 0° ± 3° and using the actual JLO as a new variable. Using long-leg standing weight-bearing radiographs, 6 radiographic parameters were measured to evaluate the CPAK type: the mechanical HKA angle, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), aHKA, JLO, and actual JLO. Results: From 2 cohorts of 1,000 knees, the frequency distribution representing all CPAK types was different between the healthy and arthritic groups. The most common categories were type II (38.2%) in the healthy group and type I (53.8%) in the arthritic group based on the original CPAK classification. The left and upward shift in the distribution of knee phenotypes in the original classification was corrected evenly after re-establishing the boundaries of a neutral aHKA and the actual JLO. According to the modified CPAK classification system, the most common categories were type II (35.2%) in the healthy group and type I (38.0%) in the arthritic group. Conclusions Although the modified CPAK classification corrected the uneven distribution seen when applying the original classification system in a Korean population, the most common category was type I in Korean patients with osteoarthritic knees in both classification systems. Furthermore, there were different frequencies of knee phenotypes among healthy and arthritic knees.

Purpose: The introduction of immune checkpoint inhibitors represents a major advance in the treatment of lung cancer, allowing sustained recovery in a significant proportion of patients. Nivolumab is a monoclonal anti–programmed death cell protein 1 antibody licensed for the treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC) after prior chemotherapy. In this study, we describe the demographic and clinical outcomes of patients with advanced NSCLC treated with nivolumab in the Korean expanded access program. Materials and Methods: Previously treated patients with advanced non-squamous and squamous NSCLC patients received nivolumab at 3 mg/kg every 2 weeks up to 36 months. Efficacy data including investigator-assessed tumor response, progression data, survival, and safety data were collected. Results: Two hundred ninety-nine patients were treated across 36 Korean centers. The objective response rate and disease control rate were 18% and 49%, respectively; the median progression-free survival was 2.1 months (95% confidence interval [CI], 1.87 to 3.45), and the overall survival (OS) was 13.2 months (95% CI, 10.6 to 18.9). Patients with smoking history and patients who experienced immune-related adverse events showed a prolonged OS. Cox regression analysis identified smoking history, presence of immune-related adverse events as positive factors associated with OS, while liver metastasis was a negative factor associated with OS. The safety profile was generally comparable to previously reported data. Conclusion This real-world analysis supports the use of nivolumab for pretreated NSCLC patients, including those with an older age.

No abstract available.
Toll-Like Receptors*

BACKGROUND: Diagnosing a pulmonary embolism is difficult because its presenting symptoms are nonspecific and there are limitations with all of the objective tests. The D-dimer is known to be a marker of the lysis of intravascular cross-linked fibrin as a result of the activation of the endogenous fibrinolytic pathways, and the D-dimer assay is these an objective method for diagnosing a pulmonary embolism. This study assessed the benefits of the D-dimer test for diagnosing a pulmonary embolism using semiquantitative latex agglutination. METHODS: The latex agglutination results of 185 patients were retrospectively reviewed. The D-dimer test was performed at the time a pulmonary embolism was suspected. Ninety patients(group I) were diagnosis with PE through spiral chest CT or a chest CT angiogram, perfusion/ventilation scans, and/or pulmonary angiogram. Ninety-five patients (group II) were found not to have a pulmonary embolism through the above tests. RESULTS: The male to female ratio and mean age in groups I and II was 37:55, and 57 years old to 50:45 and 52 years old, respectively. When the cut off value for a positive D-dimer assay was set to 500 microgram, the sensitivity, positive predictive value, negative predictive value and specificity was 86.7%, 61.4%, 79.3%, and 48.4%, respectively. CONCLUSION: The semiquantitative latex agglutination method in the D-dimer test has a lower sensitivity and negative predictive value than the well known ELISA test particularly for small emboli. Therefore, this test is not a suitable screening test for excluding a pulmonary embolism.
Agglutination* ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Fibrin ; Humans ; Latex* ; Male ; Mass Screening ; Middle Aged ; Pulmonary Embolism* ; Retrospective Studies ; Tomography, X-Ray Computed

No abstract available.

No abstract available.

To evaluate amoebicidal efficacy of various disinfectants, we treated ten ocular isolates of Acanthamoeba with polyhexamethylene biguanide(PHMB), chlorhexidine and hexamidine. Acanthamoeba cysts were collected from axenic nonnutrient agar plates from 4 week culture. Cyst suspension(100microliter) was inoculated on 96-well microplate with concentration of 105 cys/ml. Each well was treated with two-fold diluted hexamidine, PHMB and chlorhexidine(100microliter each, 8 and 48hrs). Each well was examined under the inverted microscope until 7 days after treatment. Minimal cysticidal concentration(MCC) of each disinfectant qas measured after five experiments. MCC of hexamidine, chlorhexidine and PHMB against ten ocular isolates ranged 6.07-500microgram/ml, 3.12-12.50microgram/ml, 1.17-4.68microgram/ml respectively in 48hr treatment. In 8hr treatment, MCC of PHMB and chlorhexidine ranged 4.42-12.50microgram/ml and 4.67-17.71microgram/ml, but hexamidine did not demonstrate cysticidal effect. For proper disinfection of contact lens, disinfectants having cysticidal efficacy should be included in the composition of contact lens solution. Among the currently used topical amoebicidal agents, PHMB showed the greatest cysticidal activity on ten ocular strains of Acanthamoeba in invitro study.
Acanthamoeba* ; Agar ; Chlorhexidine* ; Contact Lens Solutions ; Disinfectants ; Disinfection

OBJECTIVES: The poor survival rates among patients receiving surgery alone for stages II and III non-small cell lung cancer prompted several trials of adjuvant therapy after resection. We performed a prospective phase II study in patients with stage II-IIIA non-small cell lung cancer after resection to evaluate the feasibility, activity and toxicity of the postoperative sequential MVP chemotherapy and radiotherapy. METHODS: Between February 1991 and May 1995, 60 patients with resected stage II, IIIA non-small cell lung cancer received 2 cycles of MVP combination chemotherapy (Mitomycin-C 6 mg/m2, Vinblastine 6 mg/m2, Cisplatin 60 mg/m2) within 3 weeks after surgery, followed by thoracic irradiation (5,040 cGy after complete resection and 900 cGy booster to microscopically positive resection margin at 1.8 Gy per fraction) within 3-4 weeks after chemotherapy. RESULTS: Forty nine men and 11 women with a median age of 60.5 years (range 33-81 years) were included. During the median follow-up period of 828 days (61-2,015 days), 25 patients had developed recurrence. Among the 25 failures, 3 were local relapse only and 20 were distant metastasis only and 2 had both local and distant sites of recurrence. Three-year overall survival and event-free survival were 43% and 37%, respectively. Neutropenia of grade I-II was observed only in 13 patients. Eleven patient showed grade I-II radiation pneumonitis and 32 had grade I-II radiation esophagitis. CONCLUSION: Postoperative sequential MVP chemotherapy and radiotherapy in resected stage II-IIIA non-small cell lung cancer is well-tolerated and shows interesting activity.
Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Disease-Free Survival ; Drug Therapy* ; Drug Therapy, Combination ; Esophagitis ; Female ; Follow-Up Studies ; Humans ; Male ; Mitomycin* ; Neoplasm Metastasis ; Neutropenia ; Prospective Studies ; Radiation Pneumonitis ; Radiotherapy* ; Recurrence ; Survival Rate ; Vinblastine*

We analyzed 20 cases of traumatic carotid cavernous fistula(CCF) during the recent 10 years The results are summarized as follows: 1) In 18 cases(90%), the clinical symptoms & signs of CCF occurred within 2 months after trauma. 2) The sites of fistulae were common in horizontal segment(40%) and at the junction(30%) between horizontal segment and posterior ascending segment of cavernous portion of internal carotid artery. 3) The main draining veins of CCF were the superior ophthalmic vein(90%) and the inferior petrosal sinus(70%). 4) The methods of treatment were occlusion of fistula with balloon(9 cases), occlusion of cavernous ICA with balloon(2 cases), ligation of cervical ICA with Poppen's clamp(4 cases) and trapping(2 cases). Two patients were not treated and another patient was healed spontaneously. 5) The frequency and severity of complication was significantly decreased in cases treated by detachable balloon occlusion than by direct cervical ICA ligation or trapping procedures. 6) The procedure using the self-sealed goldvalve balloon was simple, but had a risk of premature separation and premature deflation.
Balloon Occlusion ; Carotid Artery, Internal ; Fistula* ; Humans ; Ligation ; Veins

We present a retrospective study on the patients with coma without mass lesion on CT scan after non-missile head injury. We reviewed various clinical and radiological features of these 53 cases and compared the outcome at one month with several variables which may affect the prognosis. The patients were selected by the following criteria;the patients had lost consciousness at least for 6 hours, the Glasgow coma scores were below B, and the CT scan did not demonstrate a mass lesion but might have small contusion, subarachnoid hemorrhage and pneumocephalus that caused no mass effect. Characteristic CT findings for the diffuse axonal injury-small intracerebral hemorrhage on corpus callosum, white mater, basal ganglia or around the third ventricle-were observed in only 21 of 53 cases(39.6%). Thus diffuse axonal injury can be diagnosed by clinical features not by the CT findings at present and the CT scan was required for ruling out any mass lesions. The mortality rate was 32.1%. However, 37.7% was remained in the vegetative state or severe disability. Only 30.2% could obtain functional recovery. The changes of pupil, duration of coma, Glasgow coma score, skull fracture and collapsed lateral ventricle on CT scan were identified as important features in determining the outcome(p<0.05). Age, systolic BP, PaO2 and obliteration of basal cistern and third ventricle on CT scan had no statistical significance.
Axons ; Basal Ganglia ; Cerebral Hemorrhage ; Coma* ; Consciousness ; Contusions ; Corpus Callosum ; Craniocerebral Trauma* ; Diffuse Axonal Injury ; Head* ; Humans ; Lateral Ventricles ; Mortality ; Persistent Vegetative State ; Pneumocephalus ; Prognosis ; Pupil ; Retrospective Studies ; Skull Fractures ; Subarachnoid Hemorrhage ; Third Ventricle ; Tomography, X-Ray Computed*