Microbial keratitis in the subtropical region of Korea: a comprehensive 12-year retrospective review at a single referral center.

OBJECTIVES: To investigate the epidemiological characteristics and clinical outcomes of culture-proven bacterial and fungal keratitis at a single tertiary referral centre on Jeju Island, South Korea. DESIGN: A retrospective study design. SETTING: Data from a solitary referral centre on Jeju Island spanning January 2011 to December 2022. PARTICIPANTS: Among the 245 patients clinically diagnosed with infectious microbial keratitis, 110 individuals had culture-positive results. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the identification of causative microbial profiles and epidemiological characteristics, while the secondary outcome was the correlation of these factors with treatment outcomes. RESULTS: Of 245 patients, 110 (44.9%) had culture-positive infectious keratitis, showing 69 bacterial, 32 fungal, 4 superimposed bacterial and 5 cases with coinfection by bacteria and fungus. The most common pathogen was Pseudomonas species in 14.4% of the bacterial keratitis cases, followed by Staphylococcus epidermidis (9%), Staphylococcus aureus (8%) and Moraxella species (7%). The total treatment success rate for bacterial keratitis was 67.5%. The frequency of methicillin-resistant Staphylococcus on Jeju Island did increase during the study period. Fusarium species had the highest incidence at 22.2%, followed by Candida (16.7%) and Colletotrichum species (11.1%). 56.7% of fungal keratitis patients were successfully treated. An initial large corneal lesion (>3 mm) showed a statistically significant association with treatment failure. CONCLUSION: The incidence of Moraxella and Colletotrichum species in our study was higher than that reported in other districts with different climates and environments. The results reported here reflect the unique environmental features of Jeju Island, characterised by high humidity and temperatures.

Clinical Outcomes of MOK Pharmacopuncture in an Elderly Male Patient with Hypothyroidism-A Case Report and Literature Review.

Hypothyroidism is more common in women and individuals between 30 and 50 years old. This case report depicts the clinical outcomes of MOK pharmacopuncture, a type of Korean medicine treatment, for an elderly male patient with hypothyroidism who was on long-term L-thyroxine (LT4) therapy but still felt chronically lethargic and tired and was generally in poor health. A 72-year-old Korean man has been on LT4 since being diagnosed with hypothyroidism 16 years ago and has tried to discontinue hormone supplements in the past. The patient was treated with MOK pharmacopuncture, mainly at the ST10 acupoint, twice a week for four months. Following the treatment, the T3, free-T4, and TPO Ab levels and thyroiditis status on ultrasound showed improvement. Additionally, there were a normalization of ESR levels, an enhancement in the quality of life, a reduction in depression scores, an improvement in the antioxidant status, and an alleviation of major symptoms when compared to pre-treatment conditions. This case report demonstrates the potential of MOK pharmacopuncture as a complementary treatment for an elderly man with hypothyroidism who had a poor quality of life due to fatigue and lethargy despite LT4 treatment.

Novel limbal dermoid surgery for visual acuity and cosmesis improvement: A 7-year retrospective review.

BACKGROUND: To report a long-term outcome of the novel combined surgical method of complete excision, corneal tattooing, and a sutureless limbal conjunctival autograft for limbal dermoid. METHODS: All patients who were referred to our clinic for limbal dermoid, and underwent a combined surgery of complete excision, corneal tattooing, and a sutureless limbal conjunctival autograft were retrospectively reviewed. The surgery was performed by one surgeon, and all clinical information was obtained during a seven-year follow up period. In all patients, surgical outcomes of cosmesis, best corrected visual acuity (BCVA), spherical equivalent (SE), and corneal/ocular astigmatism were obtained and compared preoperatively and postoperatively. RESULTS: During seven years, 24 patients (24 eyes) with limbal dermoid were finally enrolled. The mean age was 10.1±8.9 years old. The surgery resulted in an improved appearing ocular surface in all cases without any complications. There was no statistical difference in BCVA, corneal and ocular astigmatism between preoperatively and postoperatively (p = 0.231, 0.156 and 0.475, respectively). The mean SE was 0.12±3.19D preoperatively, and -0.21±3.02 D postoperatively with statistical significance (p = 0.037). Mean follow up period was 54.50 ± 15.62 months. CONCLUSIONS: Based on the results of this study, our innovative surgical method which includes complete excision with corneal tattooing and limbal conjunctival autograft can be a simple and safe procedure that achieves long standing cosmesis with limbal dermoids.

Antibody toolkit to investigate eEF1A methylation dynamics in mRNA translation elongation.

Protein synthesis is a fundamental step in gene expression, with modulation of mRNA translation at the elongation step emerging as an important regulatory node in shaping cellular proteomes. In this context, five distinct lysine methylation events on eukaryotic elongation factor 1A (eEF1A), a fundamental nonribosomal elongation factor, are proposed to influence mRNA translation elongation dynamics. However, a lack of affinity tools has hindered progress in fully understanding how eEF1A lysine methylation impacts protein synthesis. Here we develop and characterize a suite of selective antibodies to investigate eEF1A methylation and provide evidence that methylation levels decline in aged tissue. Determination of the methyl state and stoichiometry on eEF1A in various cell lines by mass spectrometry shows modest cell-to-cell variability. We also find by Western blot analysis that knockdown of individual eEF1A-specific lysine methyltransferases leads to depletion of the cognate lysine methylation event and indicates active crosstalk between different sites. Further, we find that the antibodies are specific in immunohistochemistry applications. Finally, application of the antibody toolkit suggests that several eEF1A methylation events decrease in aged muscle tissue. Together, our study provides a roadmap for leveraging methyl state and sequence-selective antibody reagents to accelerate discovery of eEF1A methylation-related functions and suggests a role for eEF1A methylation, via protein synthesis regulation, in aging biology.

Pharmacopuncture for nerve entrapment syndrome: A protocol for systematic review.

BACKGROUND: Nerve entrapment syndrome occurs when the nerves become compressed or entrapped and restricted. This study aims to evaluate the effectiveness and safety of pharmacopuncture in patients with nerve entrapment syndrome. METHODS: A search will be conducted from inception to August 2022 using the following 11 electronic databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database China National Knowledge Infrastructure, and 6 Korean databases. All randomized controlled trials (RCTs) evaluating pharmacopuncture treatment for various nerve entrapment syndromes will be considered, with no restrictions regarding the type of pharmacopuncture solution used. Two reviewers will perform the data extraction and quality assessment using a predefined data extraction form. The methodological quality of the included RCTs will be assessed using the Cochrane risk-of-bias tool. RESULTS: This systematic review will provide high-quality evidence to determine the efficacy and safety of pharmacopuncture therapy for nerve entrapment syndrome. CONCLUSION: Our findings will be informative for patients with nerve entrapment syndrome, as well as clinicians, policymakers, and researchers.

Computer-Aided Diagnosis Parameters of Invasive Carcinoma of No Special Type on 3T MRI: Correlation with Pathologic Immunohistochemical Markers.

Purpose: To investigate the correlation between computer-aided diagnosis (CAD) parameters in 3-tesla (T) MRI and pathologic immunohistochemical (IHC) markers in invasive carcinoma of no special type (NST). Materials and Methods: A total of 94 female who were diagnosed with NST carcinoma and underwent 3T MRI using CAD, from January 2018 to April 2019, were included. The relationship between angiovolume, curve peak, and early and late profiles of dynamic enhancement from CAD with pathologic IHC markers and molecular subtypes were retrospectively investigated using Dwass, Steel, Critchlow-Fligner multiple comparison analysis, and univariate binary logistic regression analysis. Results: In NST carcinoma, a higher angiovolume was observed in tumors of higher nuclear and histologic grades and in lymph node (LN) (+), estrogen receptor (ER) (-), progesterone receptor (PR) (-), human epidermal growth factor 2 (HER2) (+), and Ki-67 (+) tumors. A high rate of delayed washout and a low rate of delayed persistence were observed in Ki-67 (+) tumors. In the binary logistic regression analysis of NST carcinoma, a high angiovolume was significantly associated with a high nuclear and histologic grade, LN (+), ER (-), PR (-), HER2 (+) status, and non-luminal subtypes. A high rate of washout and a low rate of persistence were also significantly correlated with the Ki-67 (+) status. Conclusion: Angiovolume and delayed washout/persistent rate from CAD parameters in contrast enhanced breast MRI correlated with predictive IHC markers. These results suggest that CAD parameters could be used as clinical prognostic, predictive factors.

Perceived Stress Levels and Associated Factors in Adult Patients with Primary Open-angle Glaucoma: A Prospective Survey Study.

PURPOSE: To investigate adult primary open-angle glaucoma (POAG) patients' perceived stress levels and to examine the associations with their clinical characteristics. METHODS: Sixty-seven POAG patients, excluding those meeting the exclusion criteria (retinal or neurological disease diagnoses) comprised the study population. A validated questionnaire, namely Perceived Stress Scale-10 (PSS-10), was used to assess stress level. Additional data on glaucoma surgery history, medical benefit receipt, comorbidities, and daily antiglaucoma medication number were collected. The clinical characteristics of high (PSS-10 ≥15) and low stress (PSS-10 <15) patients and the risk factors associated with high stress level were subjected to a multivariable logistic regression analysis. RESULTS: The patients were 56.8 ± 12.6 years of age on average, and 29 (43.3%) were female. The mean PSS-10 level was 13.5 ± 5.3 (range, 1-27) for the entire patient group; 31 patients (46.3%) were in the high stress group. In the high stress group relative to the low stress group, best-corrected visual acuity in the better eye was lower (p = 0.044) and the visual field defects, in both eyes, were more severe (better eye, p = 0.005; worse eye, p = 0.026). A logistic regression analysis indicated that severe visual field defect in the better eye (odds ratio, 1.159; 95% confidence interval, 1.016-1.323; p = 0.028) and lower best-corrected visual acuity in the better eye (odds ratio, 4.707; 95% confidence interval, 0.580-6.189; p = 0.072) were both likely to associated with high stress level in patients with POAG. CONCLUSIONS: These findings suggest an association between severe visual function loss and higher mental stress level in POAG patients. Stress level, therefore, might be an important consideration in POAG patient management.

A warning system for urolithiasis via retrograde intrarenal surgery using machine learning: an experimental study.

BACKGROUND: To develop a warning system that can prevent or minimize laser exposure resulting in kidney and ureter damage during retrograde intrarenal surgery (RIRS) for urolithiasis. Our study builds on the hypothesis that shock waves of different degrees are delivered to the hand of the surgeon depending on whether the laser hits the stone or tissue. METHODS: A surgical environment was simulated for RIRS by filling the body of a raw whole chicken with water and stones from the human body. We developed an acceleration measurement system that recorded the power signal data for a number of hours, yielding distinguishable characteristics among three different states (idle state, stones, and tissue-laser interface) by conducting fast Fourier transform (FFT) analysis. A discrete wavelet transform (DWT) was used for feature extraction, and a random forest classification algorithm was applied to classify the current state of the laser-tissue interface. RESULTS: The result of the FFT showed that the magnitude spectrum is different within the frequency range of < 2500 Hz, indicating that the different states are distinguishable. Each recorded signal was cut in only 0.5-s increments and transformed using the DWT. The transformed data were entered into a random forest classifier to train the model. The test result was only measured with the dataset that was isolated from the training dataset. The maximum average test accuracy was > 95%. The procedure was repeated with random signal dummy data, resulting in an average accuracy of 33.33% and proving that the proposed method caused no bias. CONCLUSIONS: Our monitoring system receives the shockwave signals generated from the RIRS urolithiasis treatment procedure and generates the laser irradiance status by rapidly recognizing (in 0.5 s) the current laser exposure state with high accuracy (95%). We postulate that this can significantly minimize surgeon error during RIRS.

T-shaped double-strip spoof surface plasmon polariton transmission lines and application to microwave resonators.

A microwave double-strip spoof surface plasmon polariton (DS SSPP) is proposed for high-speed interconnects and high-performance microwave circuits. Based on the dispersion analysis, a T-shaped double-strip structure is designed to provide strong surface- and slow-wave properties from very low to very high frequencies (~ 40 GHz). It allows the tight field confinement and greatly reduces the electromagnetic wave leakage. It exhibits broadband performance with reduced ripples in the insertion loss. It also shows more constant group delay and impedance than counterpart single-strip SSPP. The compact coaxial-to-microstrip-to-DS SSPP transition are designed using gradient grooves. The measurement shows that the DS SSPP lines can exhibit the lower coupling and lower insertion loss than the microstrip lines, so that the former is well-suited for the densely packed high-speed interconnects. The designed DS SSPP is utilized for high quality (Q)-factor microwave ring resonator. The measured unloaded Q-factor is 107.9 at the resonant frequency of 8.7 GHz, which is 1.3 times higher than the microstrip ring resonator. It is found to be caused by the reduction of the radiation loss, according to the loss analysis. The size is also reduced due to the short wavelength, occupying 56.8% of that of the microstrip ring resonator. Therefore, the proposed T-shaped DS SSPP can be also applied for high-performance miniaturized microwave circuits.

Trends in Utilization of Visual Field Tests for Glaucoma Patients: A Nationwide Study Using the Korean Health Insurance Review and Assessment Database.

PURPOSE: To analyze 10-year trends in utilization of visual field tests for adult glaucoma or glaucoma-suspect patients using the Korean Health Insurance Review and Assessment data. METHODS: Health claims for the years 2010 to 2019, as recorded via Korea's Health Insurance Review and Assessment service, were accessed. We identified glaucoma patients using the glaucoma diagnostic codes H40 (glaucoma) and H42 (glaucoma in other diseases classified elsewhere). For verification of the glaucoma diagnosis, information on any antiglaucoma medication prescriptions and ocular surgery history also was obtained. Visual field testing data was isolated using procedural codes E6690 (kinetic perimetry) and E6691 (standard automated perimetry [SAP]) performed in tertiary hospitals. Any changes in visual field test utilization were identified using regression trend analysis. RESULTS: From 2010 to 2019, the total number of SAP procedures performed in tertiary hospitals for either glaucoma or glaucoma-suspect patients increased gradually from 93,459 to 216,433. With regard to kinetic perimetry examinations, the total number decreased gradually from 6,364 to 3,792. The yearly average SAP number per patient showed a slight increase, from 1.168 to 1.248 (ß = 0.008, R2 = 0.669, p = 0.004). Meanwhile, the yearly average number of kinetic perimeter examinations per patient showed a significant decrease, from 1.093 to 0.940 (ß = -0.013, R2 = 0.580, p = 0.010). CONCLUSIONS: Between 2010 and 2019, the yearly average number of SAP procedures performed per glaucoma or glaucoma-suspect patient increased in Korea. Meanwhile, the yearly average number of kinetic perimetry examinations per patient significantly decreased.

A Single-Center Retrospective Study on the Effects of Korean Medicine in 342 Traffic Accident Cases.

OBJECTIVES: In South Korea, traffic accident victims can be treated under automobile insurance coverage. Korean medicine (KM) clinics have reported the largest number of automobile insurance fee claims among medical institutions. This study investigated the status of the KM automobile insurance system in a single KM clinic. METHODS: We retrospectively surveyed the medical charts of 342 traffic accident patients treated at the Jisung KM clinic between January 2009 and June 2017. RESULTS: Most of the patients were men and in their 30s. The most common method of locating the clinic was an internet search. The most common traffic accident type was collision between vehicles (83.63%), with 70.76% of patients visiting during the most acute phase. The major disease codes included S434, M4836, F072, S0600, and S3350. The most frequent treatment period was within 1 month of the accident, and most patients received 10 or fewer treatments. The mean treatment duration and number of treatments were 37.68 ± 45.11 days and 11.68 ± 10.63 treatments, respectively. The initial pain numerical rating scale (NRS), 7.32 ± 0.96, decreased to 3.57 ± 1.40 at the end of treatment, with a symptom improvement score of 1.87 ± 0.60. Regarding sex, age, disease duration, location at the time of the accident, presence of additional and psychological symptoms, and chuna, there were statistically significant differences in treatment duration and number of treatments. A higher number of treatments and the longer treatment duration was associated with a higher initial NRS, lower post-treatment NRS, and better improvement score. Since the introduction of traffic accident (TA) pharmacopuncture, the rate of use of a single type of pharmacopuncture increased; however, no significant differences in treatment duration and number, NRS before and after treatment, and improvement score were observed between treatment groups before and after TA pharmacopuncture. No adverse reactions were observed for any treatment. CONCLUSION: This study confirmed the previous findings of a high treatment effect of KM under automobile insurance. We also observed significant correlations based on a detailed medical status, which may explain the increasing use of KM in the automobile insurance system. Additional multi-center studies in different regions are needed.

Ultraviolet photodissociation circular dichroism spectroscopy of protonated L-phenylalanyl-L-alanine in a cryogenic ion trap.

We obtained ultraviolet photodissociation (UVPD) circular dichroism (CD) spectra of protonated L-phenylalanyl-L-alanine (L-H+PheAla) near the origin band of the S0-S1 transition using cryogenic ion spectroscopy. Infrared (IR) ion-dip, IR-UV hole burning (HB) and UV-UV HB spectra showed that L-H+PheAla existed as two different conformers in a cryogenic ion trap, and they had nearly identical peptide backbones but different conformations in the Phe side chain. The UVPD CD spectra revealed that the two conformers had opposite CD signs and significantly different CD magnitudes from each other. These results demonstrate that the CD value of L-H+PheAla near the origin band is strongly influenced by the conformation of the Phe side chain.

Herbal medicine for the prevention of sarcopenia: A protocol for systematic review.

BACKGROUND: Sarcopenia is a syndrome characterized by a gradual and generalized loss of skeletal muscle mass and strength leading to physical disability, poor quality of life, and possible death. The disease impacts the steadily increasing aging population worldwide. In this systematic review protocol, we aim to investigate the effects and safety of herbal medicines on skeletal muscle health, specifically focusing on possible treatments for preventing sarcopenia. METHODS: Nine electronic databases will be comprehensively searched from inception to the present date. Clinical studies reporting on the effects and safety of herbal medicines associated with skeletal muscle health and the prevention of sarcopenia will be included. The primary outcome will be determined by five categories: anti-inflammatory and antioxidant efficacy, muscle damage prevention, anti-fatigue effect, muscle-atrophy prevention, and muscle regeneration and differentiation. Two independent researchers will perform the research selection, data extraction, and quality assessment processes. The Cochrane risk-of-bias tool will be used to assess the methodological quality and design of the included studies. We will place no restrictions on publication status or language, and the results of the systematic review will be disseminated electronically and in print by publication in a peer-reviewed journal. RESULTS: The present study will evaluate the effects and safety of herbal medicines for the prevention of sarcopenia. CONCLUSION: Our findings will provide guidance on the use of herbal medicines to prevent sarcopenia. This knowledge is valuable for elderly people, clinicians treating patients with sarcopenia, policy makers, and researchers. REGISTRATION NUMBER: Reviewregistry1113 (URL: https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/604a1e5ef176d2001b557750/).

Atypical Microbiological Feature of Infectious Endophthalmitis on Jeju Island: A 10-Year Study at a Single Tertiary Referral Center.

BACKGROUND: To analyze the microbiological causes of infectious endophthalmitis on an isolated island over ten years. METHODS: A retrospective review of the medical records of 49 eyes clinically diagnosed with infectious endophthalmitis between January 2009 and December 2018 was done. The subjects were recruited from a single tertiary referral center on Jeju Island. The baseline characteristics of all subjects were investigated, and a culture examination was performed. The isolated pathogens were analyzed to determine how their microbiological features differed from those in regions with different geographical conditions. RESULTS: Of the 49 eyes, causative microorganisms were identified in 27 eyes (55.1%). Bacteria were found in 24 cases and fungi in 3 cases. Among the exogenous causes, Staphylococcus species (Staphylococcus aureus, S. epidermidis, and S. hominis) were the most common pathogens (7 cases). Achromobacter xylosoxidans was the second most common causative pathogen (4 cases) followed by Moraxella species (3 cases). The most frequent endogenous origin was due to Klebsiella pneumoniae (6 cases). The subjects were divided into two groups according to the treatment results and analyzed for predisposing factors related to visual outcomes. The presence of diabetes mellitus (P = 0.038) and initial visual acuity (P ≤ 0.001) were significant predisposing factors for visual outcomes. CONCLUSION: The causative microorganisms of endogenous endophthalmitis on Jeju Island were not different from those reported previously. However, isolated exogenous microorganisms were different from those reported in other studies from inland areas. A high incidence and atypical clinical features of Achromobacter xylosoxidans and Moraxella in exogenous endophthalmitis were observed, reflective of the distinct climatic features of Jeju Island: high humidity and temperature. Therefore, considering the causative microorganisms of exogenous endophthalmitis, it may be assumed that the causative microorganisms of exogenous endophthalmitis and its clinical manifestations differ according to the region.

Large-Area, Crosstalk-Free, Flexible Tactile Sensor Matrix Pixelated by Mesh Layers.

Tactile sensor arrays have attracted considerable attention for their use in diverse applications, such as advanced robotics and interactive human-machine interfaces. However, conventional tactile sensor arrays suffer from electrical crosstalk caused by current leakages between the tactile cells. The approaches that have been proposed thus far to overcome this issue require complex rectifier circuits or a serial fabrication process. This article reports a flexible tactile sensor array fabricated through a batch process using a mesh. A carbon nanotube-polydimethylsiloxane composite is used to form an array of sensing cells in the mesh through a simple "dip-coating" process and is cured into a concave shape. The contact area between the electrode and the composite changes significantly under pressure, resulting in an excellent sensitivity (5.61 kPa-1) over a wide range of pressure up to 600 kPa. The mesh separates the composite into the arranged sensing cells to prevent the electrical connection between adjacent cells and simultaneously connects each cell mechanically. Additionally, the sensor shows superior durability compared with previously reported tactile sensors because the mesh acts as a support beam. Furthermore, the tactile sensor array is successfully utilized as a Braille reader via information processing based on machine learning.

Non-Contact Measurement of Human Respiration and Heartbeat Using W-band Doppler Radar Sensor.

This paper presents a W-band continuous-wave (CW) Doppler radar sensor for non-contact measurement of human respiration and heartbeat. The very short wavelength of the W-band signal allows a high-precision detection of the displacement of the chest surface by the heartbeat as well as respiration. The CW signal at 94 GHz is transmitted through a high-gain horn antenna to the human chest at a distance of 1 m. The phase-modulated reflection signal is down-converted to the baseband by the quadrature mixer with an excellent amplitude and phase matches between I and Q channels, which makes the IQ mismatch correction in the digital domain unnecessary. The baseband I and Q data are digitized using data acquisition (DAQ) board. The arctangent demodulation with automatic phase unwrapping is applied to the low-pass filtered I and Q data to effectively solve the null point problem. A slow-varying DC component is rejected in the demodulated signal by the trend removal algorithm. Then, the respiration signal with a frequency of 0.27 Hz and a displacement of ~6.1 mm is retrieved by applying a low-pass filter. Finally, the respiration signal is removed by the band-pass filter and the heartbeat signal is extracted, showing a frequency of 1.35 Hz and a displacement of ~0.26 mm. The extracted respiration and heartbeat rates are very close to the manual measurement results. The demonstrated W-band CW radar sensors can be easily applied to find the angular location of the human body by using a phased array under a compact size.

Angiography-guided percutaneous thrombin injection for haemostasis of active bleeding complicated by femoral access: a case report.

Active bleeding from a small branch of the femoral artery can occur after catheterisation and may be difficult to treat. Stent-graft placement or embolisation after catheterisation can be a useful solution. However, stent-graft placement is often challenging for the treatment of bleeding around bifurcations, and it may be limited by available stent-graft sizes during emergencies. Embolisation can also be difficult if the vessel diameter is too small to catheterise or if the branching angle is too acute. Thrombin injection is accepted as a safe and effective treatment for iatrogenic or traumatic pseudoaneurysm. However, large haematomas can deter ultrasonographic guidance. We herein report the successful treatment of active bleeding from a small branch of the superficial femoral artery after femoral access by percutaneous direct puncture under angiographic guidance and thrombin injection at the bleeding focus.

Traditional medicine treatment for thoracic outlet syndrome: A protocol for systematic review of randomized controlled trials.

BACKGROUND: Diagnosis of thoracic outlet syndrome (TOS) is challenging; however, proper evaluation and treatment ensure relief from symptoms in most patients. A comprehensive approach to treatment is important, considering the multifactorial etiology of TOS. The objective of this systematic review is to describe the methods for evaluating the effectiveness and safety of acupuncture-based traditional medicine treatments for TOS. METHODS: A total of 13 databases will be searched, from their inception to the present date, for studies that have investigated the treatment of TOS. Databases that will be included are MEDLINE, Embase, AMED, Cochrane Library, CINAHL, and 4 Korean, 2 Chinese, and 2 Japanese databases.We will include randomized controlled trials (RCTs) assessing acupuncture-based traditional medicine for the treatment of any type of TOS. All RCTs on traditional medicine with any form of acupuncture will be eligible for inclusion. The methodologic quality of the RCTs will be analyzed using the Cochrane Collaboration tool to assess the risk of bias, and the confidence in the cumulative evidence will be assessed using the grading of recommendations assessment, development, and evaluation instrument. ETHICS AND DISSEMINATION: The results of this systematic review will be published in a peer-reviewed journal and disseminated both electronically and in print. The review will be updated to inform and guide health care practices. TRIAL REGISTRATION NUMBER: PROSPERO 2020 CRD42020164869.

The 3-year outcomes of corneal tattooing for severely disfigured corneas.

BACKGROUND: To evaluate the efficacy of corneal tattooing for various clinical applications. METHODS: The medical charts of 62 eyes of 62 patients who underwent corneal tattooing between March 2016 and August 2017 were retrospectively reviewed. The causes of opacity and various methods of corneal tattooing were analyzed. RESULTS: Among our 62 patients, 38 were males and 24 were females. Average age was 48.47 ± 15.30 (range, 12-74) years old. The mean follow-up period was 40.19 ± 2.34 (range, 36-43) months. The most common causes of corneal opacity were ocular trauma (33 eyes, 53.2%), prior retinal surgery (9 eyes, 14.5%), congenital etiologies (8 eyes, 12.9%) and measles (5 eyes, 8.0%). The most common associated ocular findings were strabismus (23 eyes, 37.0%), phthisis bulbi (17 eyes, 27.4%) and band keratopathy (13 eyes, 20.9%). Cosmetic outcomes improved without serious complications in all cases. CONCLUSIONS: Corneal tattooing is a viable option with an expanding set of indications, such as discolored previous corneal tattoos, white pupil due to inoperable cataract with clear cornea and dense corneal opacities in blind eyes. Elective corneal tattooing seems to be a viable and convenient method to improve cosmesis with minimal complications and high patient satisfaction.