PHOTODYNAMIC THERAPY FOR SYMPTOMATIC SUBFOVEAL RETINAL PIGMENT EPITHELIAL DETACHMENT IN CENTRAL SEROUS CHORIORETINOPATHY: Outcomes and Prognostic Factors.

PURPOSE: To report the clinical outcomes of reduced-fluence photodynamic therapy (PDT) for symptomatic subfoveal retinal pigment epithelial detachment (RPED) in central serous chorioretinopathy and identify prognostic factors affecting treatment outcome. METHODS: This retrospective interventional study included 35 eyes of 35 patients with serous subfoveal RPED with choroidal hyperpermeability. Cases with evidence of age-related macular degeneration were excluded from the study. Reduced-fluence PDT was applied to each patient. Best-corrected visual acuity, anatomical resolution of RPED, subjective symptom improvement, and complications were analyzed. RESULTS: One month after reduced-fluence PDT, 28 eyes (80.0%) manifested complete resolution of subfoveal RPED. Among the patients whose eyes manifested complete resolution, 19 (67.9%) reported subjective vision improvement. This subjective improvement was significantly associated with the presence of dysmorphopsia at baseline. Logarithm of the minimal angle of resolution visual acuity improved from 0.15 (Snellen equivalent of 20/28) to 0.09 (20/25) between baseline and 3 months after PDT (P = 0.008). Older age and increased RPED height were independent risk factors of poor resolution of RPED after PDT. The mean follow-up period after treatment was 10.4 ± 13.6 months; recurrence of RPED did not occur in any case. CONCLUSION: Subfoveal RPED in central serous chorioretinopathy responded well to reduced-fluence PDT, especially in younger patients with less RPED. Dysmorphopsia, rather than decreased visual acuity, is a main symptomatic presentation in subfoveal RPED.

TYPICAL POLYPOIDAL CHOROIDAL VASCULOPATHY AND POLYPOIDAL CHOROIDAL NEOVASCULARIZATION.

PURPOSE: To compare typical polypoidal choroidal vasculopathy (T-PCV) and polypoidal choroidal neovascularization (P-CNV), which can be defined as two subtypes of PCV, and to elucidate the significance of the classification. METHODS: Seventy-seven patients diagnosed with PCV and followed up for more than 12 months were reviewed. The PCV cases were divided into a T-PCV group (n = 36) and a P-CNV group (n = 41) according to the presence of features of pachychoroid or age-related macular degeneration. Angiographic and tomographic characteristics and changes in vision during the follow-up period were compared between the two groups. RESULTS: Logarithm of the minimum angle of resolution visual acuity of T-PCV and P-CNV was 0.27 ± 0.31 and 0.62 ± 0.47 at baseline (P < 0.001) and 0.28 ± 0.41 and 0.54 ± 0.52 at the final visit (P = 0.006), respectively. A marginally higher rate of complete response to anti-vascular endothelial growth factor treatment was noted in the T-PCV group (47.2%) compared with the P-CNV group (26.8%) (P = 0.05). At the final visit, subfoveal fibrosis was noted in 11.1% of the T-PCV group and 39.0% of the P-CNV group (P = 0.009). CONCLUSION: The two subtypes of PCV, P-CNV and T-PCV, behave differently in terms of angiographic and tomographic manifestations and visual outcomes. Classifying PCVs would be helpful not only for pathogenic implications, but also for prognostic significance.

Comparative analysis of mean retinal thickness measured using SD-OCT in normal young or old age and glaucomatous eyes.

PURPOSE: To evaluate changes in macular thickness, ganglion cell layer/inner plexiform layer (GCL/IPL) thickness, and retinal nerve fiber layer (RNFL) thickness in normal eyes and glaucomatous eyes using spectral domain optical coherence tomography (SD-OCT). METHODS: We enrolled 89 eyes (all left eyes), including 45 (of 45 patients) eyes with glaucoma and 44 (of 44 patients) normal eyes. The data from macular measurements using spectral domain optical coherence tomography were analyzed according to groups divided by age and glaucoma status. The macular thickness analysis, GCL/IPL thickness, and RNFL thickness values determined by SD-OCT scans were compared among the groups. RESULTS: Mean macular thickness decreased significantly with age or glaucoma. Mean GCL/IPL thickness decreased significantly in glaucomatous eyes in all sectors but did not decrease with age. Mean RNFL thickness, which was divided into four quadrants (superior, nasal, inferior, and temporal), decreased significantly in glaucomatous eyes at all quadrants and decreased in the temporal quadrant with age in non-glaucomatous eyes. No significant differences were detected between eyes with normal tension glaucoma (NTG) and primary open angle glaucoma (POAG) in all sectors of mean GCL/IPL thickness, RNFL thickness, and macular thickness. CONCLUSIONS: No significant difference in mean thickness was detected between eyes with NTG and POAG. Some of the sectors of RNFL thickness decreased with age or glaucoma. GCL/IPL thickness, however, decreased in glaucomatous eyes but not with age. Therefore, GCL/IPL thickness is less influenced by age when monitoring patients with glaucoma or suspect glaucoma.

Surgical strategies for removal of intra- and extraforaminal dumbbell-shaped schwannomas in the subaxial cervical spine.

PURPOSE: Spinal dumbbell-shaped schwannoma is common neoplasm, usually occurring in the cervical spine. Posterior or anterolateral approaches are frequently used to remove this benign tumor. We analyzed how much amount of tumor could be possible to be totally removed with posterior approach. METHOD: Surgery was performed on 41 cases of cervical, dumbbell-shaped subaxial schwannomas with both intra- and extraforaminal involvement. The same surgeon performed all the procedures. Mean follow-up was 42.5 months (24-108 months). A combined anterolateral and posterior approach was used if the extraforaminal tumor was larger than 10 mm. A posterior approach and unilateral facet removal were used if it was smaller than 10 mm. We performed MRI and serial dynamic X-rays for postoperative 2 years. RESULTS: We used the posterior approach with facetectomy in 35 cases and the combined approach in six. Complete removal was achieved with the combined approach in all six, and with the posterior approach in 28 of 35 cases. With the posterior approach, the extraforaminal dimension of totally resected tumors ranged from 3 to 5.4 mm. Subtotal resection was limited to extraforaminal tumors larger than 5.7 mm. On follow-up, instability on dynamic X-ray was not observed before 24 months in any patient after unilateral facetectomy. CONCLUSION: Total removal of intra- and extraforaminal cervical subaxial schwannomas could be possible using a posterior approach with facet removal if the size of extraforaminal tumor was less than 5.4 mm.

Progression of lumbar spinal stenosis is influenced by polymorphism of thrombospondin 2 gene in the Korean population.

PURPOSE: The aim of this study is to determine the contribution of thrombospondin 2 (THBS2) polymorphisms to the development and progression of lumbar spinal stenosis (LSS) in the Korean population. METHODS: We studied 148 symptomatic patients with radiographically proven LSS and 157 volunteers with no history of back problems from our institution. Magnetic resonance images were obtained for all the patients and controls. Quantitative image evaluation for LSS was performed to evaluate the severity of LSS. All patients and controls were genotyped for THBS2 allele variations using a polymerase chain reaction-based technique. RESULTS: We found no causal single nucleotide polymorphism (SNPs) in THBS2 that were significantly associated with LSS. Two SNPs (rs6422747, rs6422748) were over-represented in controls [P = 0.042, odds ratio [OR] = 0.55 and P = 0.042, OR = 0.55, respectively]. Haplotype analysis showed that the ''AGAGACG'' haplotype (HAP4) and ''AAGGACG'' haplotype (HAP5) were over-represented in severe LSS patients (P = 0.0147, OR = 2.02 and P = 0.0137, OR = 2.48, respectively). In addition, the ''AAAGGGG'' haplotype (HAP1) was over-represented in controls (P = 0.0068, OR = 0.30). CONCLUSIONS: Although no SNPs in THBS2 were associated with LSS, haplotypes (HAP4 and HAP5) were significantly associated with progression of LSS in the Korean population, whereas another haplotype (HAP1) may play a protective role against LSS development.

A parasitological study on the possible toilet ruins of the Japanese colonial period in Korea.

In the past decade, experts have conducted parasitological research on archaeological specimens in Korea to collect historical parasite infection data. In these studies, parasitologists successfully described the infection pattern of each parasite species in history. However, in the first half of the 20th century, archaeoparasitological reports have been scant. In 2021, we conducted a parasitological examination of a toilet-like structure that emerged in the early 20th century. This structure was built by stacking 2 wooden barrels; and in the study samples, we found ancient Trichuris trichiura, Ascaris lumbricoides (unfertilized), and Taenia spp. eggs and therefore proposed a higher possibility that the barrels could have been used as a toilet at the time. To understand how the antihelminthic campaign since the 1960s helped reduce parasite infection rates in Korea, more research should focus on early-20th-century toilet ruins.

Fabrication of zero valent iron (ZVI) nanotube film via potentiostatic anodization and electroreduction.

Zero valent iron has been successfully used for the degradation of a wide range of contaminants. However, this reaction of using ZVI particle produces a large quantity of iron sludge. To solve the problem, we report the synthesis of self-organized nanoporous zero valent iron film treated with anodization and electro-reduction of iron foil. The iron nanotubes were fabricated in 1 M Na(2)SO(4) + 0.5 wt% NaF electrolyte by supplying constant electric currents of 50 mV/s, and holding the potential at 20, 40 and 60 V for 20 min. Nanoporous shape was produced by anodic oxidation of iron film. After anodizing process, electro-reduction of nanoporous iron film converted crystallization iron oxide to zero valent iron. Electro-reduction process was carried out by electro-reducing with powersupply to and holding the potential at 20 V for 20 min. The surface of iron nanotube film was examined by BET and the thickness of the oxidized films was evaluated by scanning electron microscope (SEM). The crystalline structures of the fabricated films were evaluated using X-ray diffraction (XRD).

Vitrectomy Combined with Intraoperative Dexamethasone Implant for the Management of Refractory Diabetic Macular Edema.

PURPOSE: To evaluate the 1-year results of vitrectomy performed in combination with intraoperative dexamethasone implant for tractional and nontractional refractory diabetic macular edema (DME). METHODS: Thirteen eyes from 13 subjects who were diagnosed with tractional DME and 17 eyes from 17 subjects who were diagnosed with nontractional refractory DME underwent vitrectomy and dexamethasone implant injection. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) during the one year following vitrectomy were evaluated in each group. Additionally, changes in intraocular pressure and other complications were investigated postoperatively. RESULTS: In eyes with tractional DME, a statistically significant improvement in BCVA was noted at 3, 6, and 12 months, and a statistically significant improvement in CMT was noted at 1, 3, 6, and 12 months from baseline after vitrectomy (p < 0.05). In eyes with nontractional refractory DME, a statistically significant improvement in BCVA was noted at 12 months, but there were no significant improvements in CMT despite the tendency to decrease from baseline. Sixteen (53.3%) of the 30 eyes included in this study showed intraocular pressure elevation, which was addressed using antiglaucoma medication, and there were no other severe complications. CONCLUSIONS: Vitrectomy combined with intraoperative dexamethasone implant may be safe and effective in treating DME, especially tractional DME. In this study, patients with nontractional DME required more additional treatments and time for anatomical and functional improvement compared to patients with tractional DME.

Intravitreal aflibercept for active polypoidal choroidal vasculopathy without active polyps.

The purpose of this study was to evaluate the efficacy of intravitreal aflibercept for active polypoidal choroidal vasculopathy (PCV) without active polyps and to identify prognostic factors. We enrolled 40 eyes from 40 patients who manifested PCV with exudation but without active polyps after prior treatment with photodynamic therapy (PDT) and/or anti-vascular endothelial growth factor (VEGF) other than aflibercept. Participants were initially given three consecutive intravitreal injections of aflibercept at 1-month intervals, followed by injections every 2 months in the maintenance phase. Spectral-domain optical coherence tomographic and indocyanine green angiographic features were assessed to determine associations between anatomical parameters and visual outcomes 14 months later. Mean visual acuity improved from 61.5 ± 11.1 letters at baseline to 68.1 ± 13.6 letters at 14 months (P = 0.001). Better vision and a smaller branching vascular network at baseline and 1 month after three monthly injections (visit 4) were associated with better final vision (P < 0.001). The presence of an inner retinal cyst at visit 4 was significantly related to worse final vision (P = 0.011). Intravitreal aflibercept improved the visual and anatomical outcomes of PCV with exudation from BVN after pre-treatment with PDT and/or anti-VEGF other than aflibercept. Better vision, smaller lesion size, and absence of an inner retinal cyst after induction therapy may predict better visual outcome.

Carboxymethyl chitosan-modified magnetic-cored dendrimer as an amphoteric adsorbent.

Carboxymethyl chitosan-modified magnetic-cored dendrimers (CCMDs) were successfully synthesized in a three step method. The synthesized samples were characterized using X-ray diffraction, transmission electron microscopy, scanning electron microscopy, vibrating sample magnetometer, thermogravimetry analysis, zeta potential analyzer, X-ray photoelectron spectroscopy, surface area analysis, and Fourier transform infrared spectroscopy. The CCMD exhibited selective adsorption for anionic and cationic compounds at specific pH conditions. With the substitution of amino groups of MD with carboxymethyl chitosan moieties, the adsorption sites for cationic compounds were greatly increased. Since the adsorption onto CCMD was mainly electrostatic interaction, the adsorption of MB and MO was significantly affected by the pHs. The optimal adsorption pH values were 3 and 11 for MO and MB. The maximal adsorption of MO and MB on the CCMD at pH values of 3 and 11 were 20.85mgg(-1) and 96.31mgg(-1), respectively. Reuse of the CCMD as an adsorbent was experimentally tested through adsorption and desorption with simple pH control. More than 99% and 91% of the initial adsorption of MB and MO on the CCMD was maintained with five consecutive recycling.

Clinical Outcomes and Radiologic Changes After Microsurgical Bilateral Decompression by a Unilateral Approach in Patients With Lumbar Spinal Stenosis and Grade I Degenerative Spondylolisthesis With a Minimum 3-Year Follow-Up.

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the clinical outcomes and radiologic changes after microsurgical bilateral decompression via a unilateral approach in patients with lumbar spinal stenosis (LSS) and degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA: Satisfactory short-term results have been observed after minimally invasive decompressive procedures, but intermediate-term and long-term outcomes have not been assessed. It is not yet clear whether decompressive laminectomy with concomitant fusion is the optimal surgical treatment for spinal stenosis combined with mild DS. We, therefore, evaluated minimum 3-year clinical outcomes and radiologic changes in patients with LSS and grade 1 DS, who underwent microsurgical bilateral decompression via a unilateral approach, without fusion. METHODS: We assessed 21 consecutive patients who underwent surgery conducted by a single surgeon of our hospital, between 2005 and 2007. The Oswestry Disability Index was determined preoperatively, just before discharge, and at last follow-up. Plain dynamic x-rays were used to determine slip percentages. RESULTS: Average patient age and clinical and radiologic follow-up periods were 67 years, 49.3 months, and 18 months, respectively. Preoperative, immediate postoperative, and last follow-up average Oswestry Disability Indices were 59.52±9.00, 50.19±7.23, and 26.19±12.42, respectively. However, 1 patient experienced aggravated symptoms and later underwent a fusion procedure. Of the 22 levels with spondylolisthesis, 15 had no sagittal motion as the difference in slip percentage on dynamic x-rays, but 7 showed sagittal motion. Average slip percentages increased from 13.90±5.41% to 14.60±5.78% for levels without sagittal motion on dynamic x-ray, and from 13.12±3.48% to 18.58±4.55% for levels with sagittal motion. CONCLUSIONS: Despite small case series with retrospective design and the absence of a control group, our study suggests that bilateral decompression via a unilateral approach in patients with LSS and grade 1 DS showed good mid-term clinical outcomes, despite an increase in slip percentage.However, more marked increases in slippage were observed in patients with sagittal motion in spondylolisthesis levels on preoperative dynamic x-ray, than in patients without sagittal motion. Therefore, bilateral decompression via a unilateral approach can aggravate symptoms related to instability in patients with preoperative sagittal motion on dynamic x-ray, and needs a longer term follow-up than in our study.

Iron oxide nanotube layer fabricated with electrostatic anodization for heterogeneous Fenton like reaction.

Iron oxide nanotubes (INT) were fabricated with potentiostatic anodization of zero valent iron foil in 1M Na2SO4 containing 0.5wt% NH4F electrolyte, holding the potential at 20, 40, and 60V for 20min, respectively. Field emission scanning electron microscopy and X-ray diffractometry were used to evaluate the morphology and crystalline structure of the INT film. The potential of 40V for 20min was observed to be optimal to produce an optimal catalytic film. Cyanide dissolved in water was degraded through the Fenton-like reaction using the INT film with hydrogen peroxide (H2O2). In case of INT-40V in the presence of H2O2 3%, the first-order rate constant was found to be 1.7×10(-2)min(-1), and 1.2×10(-2)min(-1) with commercial hematite powder. Degradation of cyanide was much less with only H2O2. Therefore, this process proposed in this work can be an excellent alternative to traditional catalysts for Fenton-like reaction.

Does plate profile affect postoperative dysphagia following anterior cervical spine surgery?

Dysphagia following anterior cervical spine surgery is a significant problem. The risk factors for such dysphagia have not been established. We examined whether plate profile affected the incidence of dysphagia. This study enrolled 50 consecutive patients undergoing one-level corpectomy or one- or two-level discectomies with plate fixation performed by the same surgeon from 2004 to 2009. The anterior cervical plates used were either the Codman (Johnson and Johnson Professional Inc., Raynham, MA, USA; width 17.58 mm, thickness 2.69 mm; 27 patients) or the Zephir (Medtronic Sofamor Danek Inc., Memphis, TN, USA; width 15 mm, thickness 1.6 mm; 23 patients). Dysphagia was assessed via telephone interviews, and was classified as short-term (occurring within 6 months postoperatively) or persistent (persisting beyond 6 months postoperatively). The overall short-term and persistent dysphagia rates were 20% and 14%, respectively. The short-term and persistent dysphagia rates were 26% and 13% for the Zephir plate, and 14.8% and 14.8% for the Codman plate, and analysis showed that the rates were similar for both types of plate. Age and sex were not found to correlate with dysphagia. In patients undergoing anterior cervical spine surgery with plate fixation, we found that postoperative dysphagia did not correlate with plate profile up to a plate size of 17.58 mm wide and 2.69 mm thick. Dysphagia occurred at the same incidence in patients with a smaller plate that was 15 mm wide and 1.6 mm thick.

Nano zero-valent iron impregnated on titanium dioxide nanotube array film for both oxidation and reduction of methyl orange.

Here, we demonstrated that nano zero-valent iron (nZVI) impregnated onto self-organized TiO(2) nanotube thin films exhibits both oxidation and reduction capacities in addition to the possible electron transfer from TiO(2) to nZVI. The TiO(2) nanotubes were synthesized by anodization of titanium foil in a two-electrode system. Amorphous TiO(2) (amTiO(2)) nanotubes were annealed at 450 °C for 1 h to produce crystalline TiO(2) (crTiO(2)) nanotubes. The nZVI particles were immobilized on the TiO(2) array film by direct borohydride reduction. Field emission scanning electron microscopy (FE-SEM) analysis of the crystalline TiO(2) nanotube with nZVI (nZVI/crTiO(2)) indicated that the nZVI particles with a mean particle diameter of 28.38 ± 11.81 nm were uniformly distributed onto entire crTiO(2) nanotube surface with a mean pore diameter of 75.24 ± 17.66 nm and a mean length of 40.07 µm. Environmental applicability of our proposed nZVI/TiO(2) nanotube thin films was tested for methyl orange (MO) degradation in the aqueous system with and without oxygen. Since oxygen could facilitate the nZVI oxidation and inhibit electron transfer from crTiO(2) to nZVI surface, MO degradation by nZVI/crTiO(2) in the presence of oxygen was significantly suppressed whereas nZVI/crTiO(2) in the absence of oxygen enhanced MO degradation. MO degradation rate by each sample without oxygen were in following order: nZVI/crTiO(2) (k(obs) = 0.311 min(-1)) > nZVI/amTiO(2) (k(obs) = 0.164 min(-1)) > crTiO(2) (k(obs) = 0.068 min(-1)). This result can be explained with a synergistic effect of the significant reduction by highly-dispersed nZVI particles on TiO(2) nanotubes as well as the electron transfer from the conduction band of crTiO(2) to the nZVI on the crTiO(2) for the degradation of MO.

Delayed pharyngeal extrusion of an anterior odontoid screw.

A 27-year-old woman with a type II odontoid fracture was treated by anterior odontoid screw fixation. Radiographic union at the fracture site was obtained 3 months after surgery. Nearly 3 years after surgery, she presented at a local Ear, Nose, and Throat (ENT) clinic with a 2-month history of dysphagia. Laryngoscopy identified the head of the odontoid lag screw. Plain radiography showed that the head of the screw had migrated into the pharyngeal soft tissue. The atlantoaxial joint was stable, and computed tomography (CT) scans confirmed odontoid fracture fusion. The screw was found to be movable during endoscopy. The screw could be removed by using a transpharyngeal endoscopic approach under general anesthesia. The failure of the screw was considered to be due in part to malpositioning of the screw and in part to local infection. A transoropharyngeal endoscopic approach to remove the loose anterior odontoid screw was feasible.