GNUV201, a novel human/mouse cross-reactive and low pH-selective anti-PD-1 monoclonal antibody for cancer immunotherapy.

BACKGROUND: Several PD-1 antibodies approved as anti-cancer therapies work by blocking the interaction of PD-1 with its ligand PD-L1, thus restoring anti-cancer T cell activities. These PD-1 antibodies lack inter-species cross-reactivity, necessitating surrogate antibodies for preclinical studies, which may limit the predictability and translatability of the studies. RESULTS: To overcome this limitation, we have developed an inter-species cross-reactive PD-1 antibody, GNUV201, by utilizing an enhanced diversity mouse platform (SHINE MOUSE™). GNUV201 equally binds to human PD-1 and mouse PD-1, equally inhibits the binding of human PD-1/PD-L1 and mouse PD-1/PD-L1, and effectively suppresses tumor growth in syngeneic mouse models. The epitope of GNUV201 mapped to the "FG loop" of hPD-1, distinct from those of Keytruda® ("C'D loop") and Opdivo® (N-term). Notably, the structural feature where the protruding epitope loop fits into GNUV201's binding pocket supports the enhanced binding affinity due to slower dissociation (8.7 times slower than Keytruda®). Furthermore, GNUV201 shows a stronger binding affinity at pH 6.0 (5.6 times strong than at pH 7.4), which mimics the hypoxic and acidic tumor microenvironment (TME). This phenomenon is not observed with marketed antibodies (Keytruda®, Opdivo®), implying that GNUV201 achieves more selective binding to and better occupancy on PD-1 in the TME. CONCLUSIONS: In summary, GNUV201 exhibited enhanced affinity for PD-1 with slow dissociation and preferential binding in TME-mimicking low pH. Human/monkey/mouse inter-species cross-reactivity of GNUV201 could enable more predictable and translatable efficacy and toxicity preclinical studies. These results suggest that GNUV201 could be an ideal antibody candidate for anti-cancer drug development.

Impact of COVID-19 on ophthalmic medical access during successive waves: Demographics, disease factors, and wave locations.

BACKGROUND: The coronavirus disease (COVID-19) pandemic significantly impacted medical care, including ophthalmology. This study aimed to identify factors associated with reduced ophthalmic medical access during the pandemic. METHODS: This nationwide population-based cohort study analysed South Korean health insurance claims data from January 2019 to November 2021. Outpatient visits and surgeries for age-related macular degeneration, cataract, diabetic retinopathy, glaucoma, and retinal detachment during the two pandemic waves were compared with those in the non-pandemic period. Poisson regression was used to estimate incidence rate ratios and changes in outpatient visits and surgeries between waves concerning patient age, sex, residential location, and health insurance type. RESULTS: Outpatient visits for five eye diseases decreased in the first wave (0.733-0.985, P < 0.001). In the second wave, only outpatient visits for age-related macular degeneration, cataract, and glaucoma decreased (0.754, 0.878, and 0.874, respectively, all P < 0.001). Age-related macular degeneration, cataract, and glaucoma surgeries were significantly reduced in the first wave (0.829, P < 0.001; 0.836, P < 0.001; 0.904, P = 0.030, respectively). Age-related macular degeneration (0.852) and cataract (0.716) surgeries dropped in the second wave. Women and elderly (>65 years) patients curtailed outpatient visits and surgeries more throughout the pandemic and were less resilient during the second wave. Wave location was also related to outpatient visits and surgeries. CONCLUSIONS: The COVID-19 pandemic decreased outpatient visits and surgeries for eye diseases, with more significant impact on women, older patients, and those residing near wave locations. These findings can inform healthcare policies to minimise future pandemic impacts on healthcare delivery.

Construction of Asbestos Slate Deep-Learning Training-Data Model Based on Drone Images.

The detection of asbestos roof slate by drone is necessary to avoid the safety risks and costs associated with visual inspection. Moreover, the use of deep-learning models increases the speed as well as reduces the cost of analyzing the images provided by the drone. In this study, we developed a comprehensive learning model using supervised and unsupervised classification techniques for the accurate classification of roof slate. We ensured the accuracy of our model using a low altitude of 100 m, which led to a ground sampling distance of 3 cm/pixel. Furthermore, we ensured that the model was comprehensive by including images captured under a variety of light and meteorological conditions and from a variety of angles. After applying the two classification methods to develop the learning dataset and employing the as-developed model for classification, 12 images were misclassified out of 475. Visual inspection and an adjustment of the classification system were performed, and the model was updated to precisely classify all 475 images. These results show that supervised and unsupervised classification can be used together to improve the accuracy of a deep-learning model for the detection of asbestos roof slate.

Shoulder outcome scoring systems have substantial ceiling effects 2 years after arthroscopic rotator cuff repair.

PURPOSE: Previous studies show no difference in clinical outcomes between patients with healed and structurally failed rotator cuff repairs. The objective of this study was to assess ceiling effects when reporting surgical outcomes of arthroscopic rotator cuff repair using four of the currently most popular clinical shoulder outcome scoring systems. METHODS: Ninety-two patients who underwent arthroscopic rotator cuff repair were examined. The simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) shoulder rating scale, and Constant-Murley shoulder score were completed 2 years postoperatively. Demographic data of the subjects were analysed using descriptive statistics. The ceiling effects in the outcome data assessed for each scale were estimated based on two previously reported definitions. RESULTS: The number of patients with the maximum possible score was 31 (33.7%) with the SST, 26 (28.3%) with the ASES score, 28 (30.4%) with the UCLA scale, and 18 (19.6%) with the Constant-Murley score. The standardised distance of the outcome data assessed by the SST, ASES score, UCLA scale, and Constant-Murley scores were 0.92, 0.97, 0.96, and 1.18, respectively. CONCLUSION: The SST, ASES score, and UCLA scale evaluated at 2 years postoperatively have substantial ceiling effects showing that the proportion of patients with the maximum possible score is > 20%, and the standardised distance is < 1.0. Researchers should be aware of possible biases due to ceiling effects when interpreting the results of studies investigating the surgical outcomes of arthroscopic rotator cuff repair. It could increase the likelihood of a type II error. LEVEL OF EVIDENCE: IV.

Gallic acid attenuates blood-spinal cord barrier disruption by inhibiting Jmjd3 expression and activation after spinal cord injury.

After spinal cord injury (SCI), blood-spinal cord barrier (BSCB) disruption results in secondary injury including apoptotic cell death of neurons and oligodendrocytes, thereby leads to permanent neurological deficits. Recently, we reported that the histone H3K27me3 demethylase Jmjd3 plays a role in regulating BSCB integrity after SCI. Here, we investigated whether gallic acid (GA), a natural phenolic compound that is known to be anti-inflammatory, regulates Jmjd3 expression and activation, thereby attenuates BSCB disruption following the inflammatory response and improves functional recovery after SCI. Rats were contused at T9 and treated with GA (50 mg/kg) via intraperitoneal injection immediately, 6 h and 12 h after SCI, and further treated for 7 d with the same dose once a day. To elucidate the underlying mechanism, we evaluated Jmjd3 activity and expression, and assessed BSCB permeability by Evans blue assay after SCI. GA significantly inhibited Jmjd3 expression and activation after injury both in vitro and in vivo. GA also attenuated the expression and activation of matrix metalloprotease-9, which is well known to disrupt the BSCB after SCI. Consistent with these findings, GA attenuated BSCB disruption and reduced the infiltration of neutrophils and macrophages compared with the vehicle control. Finally, GA significantly alleviated apoptotic cell death of neurons and oligodendrocytes and improved behavior functions. Based on these data, we propose that GA can exert a neuroprotective effect by inhibiting Jmjd3 activity and expression followed the downregulation of matrix metalloprotease-9, eventually attenuating BSCB disruption after SCI.

Can Ultrasonography Be Useful in Planning Surgery for De Quervain Tenosynovitis?: A Prospective Study With Emphasis on Detection of the Superficial Radial Nerve and Dominant Pathologic Tendon.

OBJECTIVES: We performed preoperative ultrasonography (US) to detect the anatomic course of the superficial radial nerve (SRN) and dominant pathologic tendon of the first extensor compartment in de Quervain tenosynovitis. METHODS: We prospectively studied 27 patients (29 wrists) with de Quervain tenosynovitis who underwent surgical release of the first extensor compartment. Preoperatively, US was performed to evaluate the presence of the dominant pathologic tendon and the septum in the subcompartment, number of SRNs in the area of the surgical incision, and anatomic running course of the SRN. These variables were also checked intraoperatively. Cohen κ statistics were calculated to investigate agreement between US and surgical field findings. RESULTS: There were 7 men and 20 women (mean age, 47.8 years; range, 26-67 years). For the dominant pathologic tendon, there were 2 cases (6.9%) of an abductor pollicis longus, 11 cases (37.9%) of an extensor pollicis brevis, and 16 cases (55.2 %) of a nondominant tendon (κ = 0.94). For the subcompartment, there were 10 cases (34.5%) without a septum, 8 (27.6%) with an incomplete septum, and 11 (37.9%) with a complete septum (κ = 0.95). Most SRNs crossed over the first extensor compartment (κ = 0.78). CONCLUSIONS: Preoperative US can be useful in detecting the anatomic running course of the SRN and dominant pathologic tendon before surgery for de Quervain tenosynovitis. Classifying the anatomic course of the SRN could be essential to planning surgery, and it could be helpful to prevent injury of the SRN during surgery.

Residual rotation of forearm amputation: cadaveric study.

BACKGROUND: The purpose of this study was to investigate residual rotation of patients with forearm amputation and the contribution of involved muscle to residual rotation. METHODS: Testing was performed using five fresh-frozen cadaveric specimens prepared by isolating muscles involved in forearm rotation. Amputation was implemented at 25 cm (wrist disarticulation), 18 cm, or 10 cm from the tip of olecranon. Supination and pronation in the amputation stump were simulated with traction of involved muscle (supinator, biceps brachii, pronator teres, pronator quadratus) using an electric actuator. The degree of rotation was examined at 30°, 60°, 90°, and 120° in flexion of elbow. RESULTS: Average rotation of 25 cm forearm stump was 148° (SD: 23.1). The rotation was decreased to 117.5° (SD: 26.6) at 18 cm forearm stump. It was further decreased to 63° (SD 31.5) at 10 cm forearm stump. Tendency of disorganized rotation was observed in close proximity of the amputation site to the elbow. Full residual pronation was achieved with traction of each pronator teres and pronator quadratus. Although traction of supinator could implement residual supination, the contribution of biceps brachii ranged from 4 to 88% according to the degree of flexion. CONCLUSIONS: Close proximity of the amputation site to the elbow decreased the residual rotation significantly compared to residual rotation of wrist disarticulation. The preservation of pronosupination was 80% at 18 cm forearm stump. Although the pronator teres and the pronator quadratus could make a full residual pronation separately, the supinator was essential to a residual supination.

Caffeoyl-Prolyl-Histidine Amide Inhibits Fyn and Alleviates Atopic Dermatitis-Like Phenotypes via Suppression of NF-κB Activation.

Caffeic acid (CA) is produced from a variety of plants and has diverse biological functions, including anti-inflammation activity. It has been recently demonstrated that caffeoyl-prolyl-histidine amide (CA-PH), which is CA conjugated with proline-histidine dipeptide, relieves atopic dermatitis (AD)-like phenotypes in mouse. In this study, we investigated the molecular mechanism underlying CA-PH-mediated alleviation of AD-like phenotypes using cell line and AD mouse models. We confirmed that CA-PH suppresses AD-like phenotypes, such as increased epidermal thickening, infiltration of mast cells, and dysregulated gene expression of cytokines. CA-PH suppressed up-regulation of cytokine expression through inhibition of nuclear translocation of NF-κB. Using a CA-PH affinity pull-down assay, we found that CA-PH binds to Fyn. In silico molecular docking and enzyme kinetic studies revealed that CA-PH binds to the ATP binding site and inhibits Fyn competitively with ATP. CA-PH further suppressed spleen tyrosine kinase (SYK)/inhibitor of nuclear factor kappa B kinase (IKK)/inhibitor of nuclear factor kappa B (IκB) signaling, which is required for nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) activation. In addition, chronic application of CA-PH, in contrast with that of glucocorticoids, did not induce up-regulation of regulated in development and DNA damage response 1 (REDD1), reduction of mammalian target of rapamycin (mTOR) signaling, or skin atrophy. Thus, our study suggests that CA-PH treatment may help to reduce skin inflammation via down-regulation of NF-κB activation, and Fyn may be a new therapeutic target of inflammatory skin diseases, such as AD.

Surgical trends in elderly patients with proximal humeral fractures in South Korea: a population-based study.

BACKGROUND: It is known that there are large regional variations in treatment methods for the management of proximal humeral fractures. The objective of this study was to investigate the national surgical trends in elderly patients with proximal humeral fractures in South Korea. METHODS: We analyzed the Korean Health Insurance Review and Assessment Service database from 2008 to 2016. International Classification of Diseases, 10th revision codes and procedure codes were used to identify patients aged ≥65 years with proximal humeral fractures. RESULTS: A total of 69,120 proximal humeral fractures were identified from 2008 to 2016. The overall operative rate for proximal humeral fractures increased steadily from 24.6% in 2008 to 36.8% in 2016 (p < 0.001). The rate of cases treated with open reduction and internal fixation tended to increase each year, from 71.5% of the overall surgeries in 2008 to 85.6% in 2016; conversely, the rate of cases treated with closed reduction and internal fixation tended to decrease from 19.9% in 2008 to 4.5% in 2016. In terms of type of arthroplasty procedure, the rate of cases treated with reverse shoulder arthroplasty tended to increase significantly each year, from 8.2% of the overall arthroplasty procedures in 2008 to 52.0% in 2016 (p < 0.001). The proportion of reverse shoulder arthroplasty was shown to increase especially in patients aged 80 years or older. CONCLUSION: Overall, our findings indicated that surgical treatment of proximal humeral fractures, particularly by open reduction and internal fixation, continues to increase; in terms of type of arthroplasty procedure, the rate of cases treated with reverse shoulder arthroplasty tended to increase.

The Epidemiology of Dupuytren's Disease in Korea: a Nationwide Population-based Study.

BACKGROUND: To date, there have been few reports on the nationwide population-based epidemiology of Dupuytren's disease (DD). We investigated the prevalence and incidence of DD in Korea using the large dataset provided by the Korean Health Insurance Review and Assessment Service. This study is the second nationwide epidemiological study of DD after the study in Taiwan. METHODS: Records of patients diagnosed with DD between 2007 and 2014 were extracted from the large dataset by diagnostic code searching (International Classification of Disease 10th revision code M72.0) and were included in the study. We calculated the prevalence and incidence of DD based on the total population of Korea provided by the Korean Statistical Information Service. Diseases associated with DD and the trends in surgery for DD were also analyzed. RESULTS: A total 16,630 patients were diagnosed with DD during the study period. The mean annual prevalence was 32.2 per 100,000 population (41.8 per 100,000 for men; 22.5 per 100,000 for women). The mean annual incidence was 1.09 per 100,000 population (1.80 per 100,000 for men; 0.38 per 100,000 for women). The common diseases associated with DD were hypertension (30.5%), diabetes mellitus (26.7%), hyperlipidemia (20.4%), ischemic heart disease (7.9%), and cerebrovascular disease (4.6%). The mean annual proportion of the patients who had surgery for DD was 5.24% of all DD patients. CONCLUSION: The prevalence and incidence of DD in Korea were 100-1,000 times lower than those in western countries; however, it was slightly larger than that in Taiwan.

Clinical Results of Autogenous Palmaris Longus Tendon Graft for Ruptures of Multiple Extensors in Rheumatoid Hands.

PURPOSE: The purpose of this study was to evaluate the clinical outcome of autogenous palmaris longus grafting for extensor tendon ruptures of 2 or more fingers in rheumatoid hands and to identify the factors related to the clinical outcome. METHODS: Between 2000 and 2013, a total 41 patients with advanced rheumatoid arthritis and multiple extensor tendon ruptures reconstructed with autogenous palmaris longus tendon grafts were reviewed. Extension lag at the metacarpophalangeal (MCP) joint, total active motion (TAM), and fingertip-to-palm (TTP) distance were evaluated at final follow-up. Simple regression analysis was done to determine the factors predictive of clinical outcome. RESULTS: The mean extension lag at the MCP joint of the reconstructed finger was 9° (range, 0°-90°; median, 0°). The mean TAM was 239° (range, 85°-280°; median, 260°), and the mean TTP distance was 5 mm (range, 0-50 mm; median, 0 mm). Simple regression analysis showed that only age was related to extension lag at the MCP joint and only arthritis of the MCP joint was related to TAM. CONCLUSIONS: In rheumatoid arthritis, extensor tendon reconstruction of multiple extensor tendon ruptures using autogenous palmaris longus tendon graft is a viable option to achieve a favorable clinical result. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Identification of novel OCT4 genetic variant associated with the risk of chronic hepatitis B in a Korean population.

BACKGROUND & AIMS: Hepatitis B viral infection is a serious risk factor for chronic hepatitis B (CHB), cirrhosis and hepatocellular carcinoma. Recently, several genome-wide association studies (GWASs) have been conducted to identify important genetic variant associated with the risk of CHB. In our previous GWAS, TCF19 was identified as one of the susceptibility genes for CHB risk (P=4.2×10-9 at rs1419881). In order to discover possible additional causal variants around TCF19, we performed an association study by genotyping single nucleotide polymorphisms (SNPs) in OCT4, a nearby gene to TCF19. METHODS: Nineteen OCT4 genetic variants were selected and genotyped in 3902 subjects (1046 CHB patients and 2856 population controls). RESULTS: Logistic regression analysis revealed that OCT4 rs1265163 showed the most significant association signal for the risk of CHB (OR=1.46, P=4.78×10-12 ). Linkage disequilibrium and conditional analysis confirmed rs1265163 in OCT4 as a novel genetic marker for CHB susceptibility. The genetic risk scores (GRSs) were calculated to visualize the combined genetic effects of all known CHB-associated loci, including OCT4 rs1265163, which had been identified in this study. Individuals with higher cumulative GRSs showed significantly increased ORs. The luciferase activity of rs885952, a tagging SNP of rs1265163, showed that OCT4 promoter activity was significantly different between the wild-type and SNP mutant form (P<.05). CONCLUSIONS: This follow-up study to our previous GWAS identified a possible causal genetic variant associated with the risk of CHB, and findings from this study may prove useful in the understanding of genetic susceptibility to CHB.

Biomechanical Properties of 3-Dimensional Printed Volar Locking Distal Radius Plate: Comparison With Conventional Volar Locking Plate.

PURPOSE: This study evaluated the biomechanical properties of a new volar locking plate made by 3-dimensional printing using titanium alloy powder and 2 conventional volar locking plates under static and dynamic loading conditions that were designed to replicate those seen during fracture healing and early postoperative rehabilitation. METHODS: For all plate designs, 12 fourth-generation synthetic composite radii were fitted with volar locking plates according to the manufacturers' technique after segmental osteotomy. Each specimen was first preloaded 10 N and then was loaded to 100 N, 200 N, and 300 N in phases at a rate of 2 N/s. Each construct was then dynamically loaded for 2,000 cycles of fatigue loading in each phase for a total 10,000 cycles. Finally, the constructs were loaded to a failure at a rate of 5 mm/min. RESULTS: All 3 plates showed increasing stiffness at higher loads. The 3-dimensional printed volar locking plate showed significantly higher stiffness at all dynamic loading tests compared with the 2 conventional volar locking plates. The 3-dimensional printed volar locking plate had the highest yield strength, which was significantly higher than those of 2 conventional volar locking plates. CONCLUSIONS: A 3-dimensional printed volar locking plate has similar stiffness to conventional plates in an experimental model of a severely comminuted distal radius fracture in which the anterior and posterior metaphyseal cortex are involved. CLINICAL RELEVANCE: These results support the potential clinical utility of 3-dimensional printed volar locking plates in which design can be modified according the fracture configuration and the anatomy of the radius.

Outcome of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fracture in patients with rheumatoid arthritis.

BACKGROUND: Osteoporosis and osteoporotic fractures are widely known as complications of rheumatoid arthritis. Kyphoplasty (KP) is known as an effective treatment modality for reducing pain and correcting kyphotic deformity in osteoporotic vertebral compression fracture (OVCF). However, cutcomes of KP in rheumatoid patients are not well known. The purpose of the study was to investigate the clinical and radiological outcomes of balloon KP on OVCF in patients with rheumatoid arthritis. METHODS: A total of 23 patients (31 vertebral bodies) with rheumatoid arthritis who received KP for OVCF and could be followed up for at least 1 year were examined. For clinical outcomes, visual analogue scale (VAS) and the Korean version of the Oswestry disability index (KODI) were evaluated. For radiological outcomes, changes in anterior vertebral height and local kyphotic angle were measured, alongside cement leakage, adjacent fracture, and the recollapse of cemented vertebra. RESULTS: The anterior vertebral height was significantly restored after surgery compared with prior to surgery (p < 0.001). Cement leakage was found in 14 cases (45.1 %), and disc space leakage was prevalent (50 %), while vascular cement leakage was found in one case. Adjacent fracture was found in 3 patients (11.5 %). VAS for lumbago showed a significant decrease (p < 0.001) after surgery (VAS = 2.4) compared with that before (VAS = 8.1); it was somewhat increased after the 1-year follow-up (VAS = 2.8; p = 0.223). KODI also decreased (48.8 %) after surgery compared with before (84.6 %). However, it increased somewhat (49.9 %) after the 1-year follow-up. CONCLUSION: KP on rheumatoid arthritis patients for OVCF was effective for reducing pain in the early stage and restoring vertebral body height. Recollapse of the treated vertebral body was found relatively frequently alongside the correction loss of local kyphotic angle.

Cyclo(phenylalanine-proline) induces DNA damage in mammalian cells via reactive oxygen species.

Cyclo(phenylalanine-proline) is produced by various organisms such as animals, plants, bacteria and fungi. It has diverse biological functions including anti-fungal activity, anti-bacterial activity and molecular signalling. However, a few studies have demonstrated the effect of cyclo(phenylalanine-proline) on the mammalian cellular processes, such as cell growth and apoptosis. In this study, we investigated whether cyclo(phenylalanine-proline) affects cellular responses associated with DNA damage in mammalian cells. We found that treatment of 1 mM cyclo(phenylalanine-proline) induces phosphorylation of H2AX (S139) through ATM-CHK2 activation as well as DNA double strand breaks. Gene expression analysis revealed that a subset of genes related to regulation of reactive oxygen species (ROS) scavenging and production is suppressed by the cyclo(phenylalanine-proline) treatment. We also found that cyclo(phenylalanine-proline) treatment induces perturbation of the mitochondrial membrane, resulting in increased ROS, especially superoxide, production. Collectively, our study suggests that cyclo(phenylalanine-proline) treatment induces DNA damage via elevation of ROS in mammalian cells. Our findings may help explain the mechanism underlying the bacterial infection-induced activation of DNA damage response in host mammalian cells.

Double-pass system assessing the optical quality of pseudophakic eyes.

PURPOSE: To compare the optical quality measurements obtained from the double-pass system and ocular aberrations, subjective visual acuity, and contrast sensitivity score in pseudophakic eyes. METHODS: Three months after cataract surgery, modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scatter index, and objective pseudoaccommodation obtained from the double-pass system were compared with total aberration, higher-order aberration, and spherical aberration obtained from ray-tracing aberrometer. In addition, parameters of the double-pass system were compared with subjective visual acuity and the contrast sensitivity score. RESULTS: Forty eyes of 40 patients were included. The MTF cutoff frequency and Strehl ratio were negatively correlated with total aberration (r = -0.503, p = 0.003; r = -0.509, p = 0.003, respectively) and subjective visual acuity (r = -0.453, p = 0.007; r = -0.354, p = 0.040, respectively). The objective scatter index was positively correlated with total aberration (r = 0.451, p = 0.024) and subjective visual acuity (r = 0.516, p = 0.008). The MTF cutoff frequency showed a correlation with contrast sensitivity score under photopic and mesopic conditions. CONCLUSIONS: Optical quality parameters obtained from the double-pass system were correlated with ocular aberrations, subjective visual acuity, and contrast sensitivity score in pseudophakic eyes.

Ultrasonographic evaluation of the first extensor compartment of the wrist in de Quervain's disease.

BACKGROUND: This prospective cohort study was undertaken to explore the hypothesis that the retinaculum is thicker in de Quervain's disease and to identify another landmark for the presence of the intracompartmental septum. METHODS: A case group (60 wrists) comprised of Korean female patients with unilateral de Quervain's disease and a healthy control group (60 wrists) were evaluated by ultrasonography. The case group underwent surgery for extensor retinacular release, and surgical findings were used as the reference standard. The mean extensor retinacular thickness in the case and control groups was compared using a Wilcoxon rank-sum test. A receiver operation characteristic curve was constructed for the parameter. RESULTS: The mean thickness of the extensor retinaculum was 0.94 mm (SD 0.37) in the case group and 0.35 mm (SD 0.07) in the control group, and this difference was significant. The cutoff value of the extensor retinaculum for diagnosing de Quervain's disease was 0.45 mm (sensitivity 96.3%, specificity 93.3%). Bony crests were found in all cases of presence of the intracompartmental septum and could be classified into three types according to shape. CONCLUSIONS: We concluded that the extensor retinaculum is thicker in de Quervain's disease. And the bony crest on the radial styloid can be considered a new landmark for determining the presence of an intracompartmental septum. TYPE OF STUDY AND LEVEL OF EVIDENCE: Diagnostic, level II.

Comparison of optical quality parameters and ocular aberrations after wavefront-guided laser in-situ keratomileusis versus wavefront-guided laser epithelial keratomileusis for myopia.

BACKGROUND: To compare optical quality, ocular scattering, and higher-order aberrations (HOAs) after laser in-situ keratomileusis (LASIK) versus laser epithelial keratomileusis (LASEK). METHODS: A total of 47 eyes from 47 participants who had undergone LASIK (group I) or LASEK (group II) procedure at least 6 months prior were enrolled. Ocular aberrations and modulation transfer function (MTF) values measured using iTrace, a ray-tracing type aberrometer, were compared to MTF (modulation transfer function) cut-off values, Strehl ratio, and objective indices of scattering obtained using the Objective Quality Analysis System II (OQAS II). RESULTS: There was no significant correlation between the postoperative optical quality parameters and the HOAs between both groups. In group I, the MTF cut-off value was significantly correlated with cylinder refraction (p = 0.037), and the objective scattering index (OSI) was positively correlated with spherical equivalent (p = 0.023). In group II, there was a statistically significant correlation between the OSI and achieved refractive correction (p = 0.001). Regression analysis showed that the OSI was the most significant predictor of MTF cut-off values after refractive surgery. Additionally, MTF values measured by OQAS were significantly lower than those measured by iTrace without correlation. CONCLUSION: Optical quality after refractive surgery may be influenced by not only ocular aberrations but also by scattering. Even though the accuracies of the machines used in this study to measure optical quality have yet to be proven, this study showed limited correlation among the values measured using the two different machines after refractive surgery. Therefore, for more generalized evaluation of visual function after refractive surgery, more advanced optical devices still need to be developed.

Optic Nerve Head Morphology is Associated with the Initial Location of Structural Progression in Early Open Angle Glaucoma.

PRCIS: Glaucoma eyes with a small cup-to-disk ratio (CDR) tend to show retinal nerve fiber layer progression earlier than ganglion cell-inner plexiform layer progression. PURPOSE: To investigate the effects of clinical variables on the temporal relationship between macular ganglion cell-inner plexiform layer (mGCIPL) loss and peripapillary retinal nerve fiber layer (pRNFL) loss in glaucoma. METHODS: This retrospective observational study used medical records of patients diagnosed with open angle glaucoma. Structural change was determined using guided progression analysis software of Cirrus optical coherence tomography. Based on the time of detection of pRNFL and mGCIPL changes, eyes showing progressive layer loss were categorized into the pRNFL-first and mGCIPL-first groups. The association between sites of layer thinning and clinical variables such as major retinal arterial angles and several optic disk measurements, including disk area, average CDR, and vertical CDR, were analyzed. RESULTS: A total of 282 eyes were included in the study, of which 104 showed structural progression either in the mGCIPL or pRNFL. Out of these, 49 eyes showed the first progression in pRNFL, while 37 eyes showed the first progression in mGCIPL. The minimum mGCIPL thickness, pRNFL thickness, average CDR, vertical CDR, and location of progression were significantly different between the 2 groups ( P =0.041, P =0.034, P =0.015, P <0.001, and P <0.001, respectively). In multivariate analysis, average CDR and vertical CDR were significantly associated with the progression site ( P =0.033 and P =0.006, respectively). The structural changes in the inferoinferior area and the superior vulnerability zone were significantly associated with RNFL-first progression ( P <0.001 for both). CONCLUSION: The location of layer loss and CDR are related to the layer where loss is first detected (either pRNFL or mGCIPL) in open angle glaucoma.

Effect of Intraoperative Mitomycin C on the Surgical Outcomes of Ahmed Glaucoma Valve Implantation with Ciliary Sulcus Tube Placement.

PURPOSE: To evaluate the effect of intraoperative mitomycin C (MMC) on the surgical outcomes of ciliary sulcus (CS) Ahmed glaucoma valve (AGV) tube placement. METHODS: A retrospective review of medical records of 54 consecutive patients who underwent AGV implantation with tube placed in CS was performed. Consecutive cases operated without the use of intraoperative MMC from 2017 to 2019 were compared with consecutive cases operated with MMC from 2019 to 2021. Surgical failure was defined as intraocular pressure (IOP) exceeding 21 mmHg in two consecutive visits after postoperative 3 months or ≤30% IOP reduction, IOP ≤5 mmHg in two consecutive visits, or loss of light perception. Kaplan-Meier survival analysis and log-rank test were performed to compare the surgical failure rates. RESULTS: A total of 54 eyes of 54 patients were investigated. Mean follow-up period after AGV implantation was 1.4 ± 0.8 years. The MMC group showed significantly lower IOP during the 1st postoperative month (20.5 ± 8.6 mmHg vs. 15.8 ± 6.4 mmHg, p = 0.027), but the difference did not persist 6 months after the surgery (p = 0.805). The mean number of postoperative antiglaucoma medications was significantly lower in the MMC group in the 1st postoperative month (p = 0.047) but no difference was found at 6 months. No statistical difference was noted in the rates of postoperative complications. Kaplan-Meier survival analysis showed comparable survival rates between MMC group and no MMC group (p = 0.356). CONCLUSIONS: The intraoperative use of MMC significantly lowered IOP in the 1st postoperative month but did not increase 6 months success rates in patients receiving AGV tube placement in CS.