Artificial-Intelligence-Assisted Detection of Metastatic Colorectal Cancer Cells in Ascitic Fluid.

Ascites cytology is a cost-effective test for metastatic colorectal cancer (CRC) in the abdominal cavity. However, metastatic carcinoma of the peritoneum is difficult to diagnose based on biopsy findings, and ascitic aspiration cytology has a low sensitivity and specificity and a high inter-observer variability. The aim of the present study was to apply artificial intelligence (AI) to classify benign and malignant cells in ascites cytology patch images of metastatic CRC using a deep convolutional neural network. Datasets were collected from The OPEN AI Dataset Project, a nationwide cytology dataset for AI research. The numbers of patch images used for training, validation, and testing were 56,560, 7068, and 6534, respectively. We evaluated 1041 patch images of benign and metastatic CRC in the ascitic fluid to compare the performance of pathologists and an AI algorithm, and to examine whether the diagnostic accuracy of pathologists improved with the assistance of AI. This AI method showed an accuracy, a sensitivity, and a specificity of 93.74%, 87.76%, and 99.75%, respectively, for the differential diagnosis of malignant and benign ascites. The diagnostic accuracy and sensitivity of the pathologist with the assistance of the proposed AI method increased from 86.8% to 90.5% and from 73.3% to 79.3%, respectively. The proposed deep learning method may assist pathologists with different levels of experience in diagnosing metastatic CRC cells of ascites.

Risk factors for overcorrection of severe hyponatremia: a post hoc analysis of the SALSA trial.

BACKGROUND: Hyponatremia overcorrection can result in irreversible neurologic impairment such as osmotic demyelination syndrome. Few prospective studies have identified patients undergoing hypertonic saline treatment with a high risk of hyponatremia overcorrection. METHODS: We conducted a post hoc analysis of a multicenter, prospective randomized controlled study, the SALSA trial, in 178 patients aged above 18 years with symptomatic hyponatremia (mean age, 73.1 years; mean serum sodium level, 118.2 mEq/L). Overcorrection was defined as an increase in serum sodium levels by >12 or 18 mEq/L within 24 or 48 hours, respectively. RESULTS: Among the 178 patients, 37 experienced hyponatremia overcorrection (20.8%), which was independently associated with initial serum sodium level (≤110, 110-115, 115-120, and 120-125 mEq/L with 7, 4, 2, and 0 points, respectively), chronic alcoholism (7 points), severe symptoms of hyponatremia (3 points), and initial potassium level (<3.0 mEq/L, 3 points). The NASK (hypoNatremia, Alcoholism, Severe symptoms, and hypoKalemia) score was derived from four risk factors for hyponatremia overcorrection and was significantly associated with overcorrection (odds ratio, 1.41; 95% confidence interval, 1.24-1.61; p < 0.01) with good discrimination (area under the receiver-operating characteristic [AUROC] curve, 0.76; 95% CI, 0.66-0.85; p < 0.01). The AUROC curve of the NASK score was statistically better compared with those of each risk factor. CONCLUSION: In treating patients with symptomatic hyponatremia, individuals with high hyponatremia overcorrection risks were predictable using a novel risk score summarizing baseline information.

Changes in duplex ultrasound parameters during maturation according to arteriovenous access types in incident hemodialysis patients.

BACKGROUND: Little is known about the changes in hemodynamic parameters during arteriovenous (AV) access maturation using duplex ultrasound according to radiocephalic fistula (RCF), brachiocephalic fistula (BCF), and AV graft (AVG) in incident hemodialysis (HD) patient. The objective of this study was to evaluate changes and differences in brachial artery flow rate (BAFR) and related parameters affecting maturation by duplex ultrasound in incident HD patients according to access type. METHODS: This study was an observational study conducted from March 2019 to October 2020. During the study period, 109 incident patients underwent new AV access creation, of which 100 were included in the study. The duplex ultrasound was performed on the day prior to access creation, further, day 1, 2 weeks, and 4 weeks later after access creation in incident HD patients. RESULTS: Among all the patients, 38 (38%) received BCF, while 26 (26%) underwent RCF. Of the patients with AVG, 18 (50%) had a forearm loop AVG. The overall mean age was 62.2 ± 13.8 years (range, 32-89). The BAFR increased about 6.9 times in the RCF, 17.4 times in the BCF, and 19.5 times in the AVG at day 1. The median BAFR measured on day 1 was 580.4 mL/min for RC, 1029.0 mL/min for BC, and 1133.0 mL/min for AVG. Relative to the values measured in week 4, the BAFR on day 1 was 69.5% in RCF, 90.6% in BCF, and 93.9% in AVG. The acceleration decreased most significantly on day 1(p < 0.05). The acceleration time increased significantly on day 1 (p < 0.05) and beyond during maturation in the RCF and BCF. The BAFR of the RCF had a significantly negative correlation with the pulsatility index. The BAFR of the BCF showed a significantly positive correlation with the systolic and diastolic blood pressure but negatively correlated with pulse rate. The BAFR of the AVG showed a significant positive correlation with the diameter of the outflow vein. CONCLUSIONS: There were differences in the clinical and duplex parameters during maturation according to access type. The most dramatic changes of duplex parameters were on the day after AV access creation regardless of AV access types. Though RCF had a lower BAFR rate compared to BCF and AVG, it already had a sufficient BAFR required for adequate HD treatment the day after creation. The BAFR of BCF was not different from that of AVG.

Assessing Compassion in Korean Population: Psychometric Properties of the Korean Version of Sussex-Oxford Compassion Scales.

A newly developed scale, the Sussex-Oxford Compassion Scale (SOCS) measures compassion for others and the self-based on an empirically supported five-elements definition of compassion: (a) recognizing suffering; (b) understanding the universality of suffering; (c) feeling for the person suffering; (d) tolerating uncomfortable feelings; and (e) motivation to act/acting to alleviate suffering. This study aimed to validate a Korean version of SOCS in a Korean adult sample. We administered the Sussex-Oxford Compassion Scale for Others (SOCS-O), the Sussex-Oxford Compassion Scale for the Self (SOCS-S), and other self-report measures of mindfulness, self-compassion, compassionate love, wellbeing, interpersonal reactivity, and mental health problems to analyze their psychometric properties. The findings support the five-factor hierarchical structure for the SOCS-O and SOCS-S, and as well as both scales' adequate psychometric properties of measurement invariance, interpretability, internal consistency, floor/ceiling effects, and convergent/discriminant validity.

Association between copeptin levels and treatment responses to hypertonic saline infusion in patients with symptomatic hyponatremia: a prospective cohort study.

BACKGROUND: Copeptin is secreted in equimolar amounts as arginine vasopressin, main hormone regulating body fluid homeostasis. A recent study reported a copeptin-based classification of osmoregulatory defects in syndromes of inappropriate antidiuresis that may aid in prediction of therapeutic success. We investigated usefulness of copeptin for differentiating etiologies of hyponatremia and predicting efficacy and safety of hypertonic saline treatment in hyponatremic patients. METHODS: We performed a multicenter, prospective cohort study of 100 inpatients with symptomatic hyponatremia (corrected serum sodium [sNa] ≤ 125 mmol/L) treated with hypertonic saline. Copeptin levels were measured at baseline and 24 hours after treatment initiation, and patients were classified as being below or above median of copeptin at baseline or at 24 hours, respectively. Correlations between target, under correction, and overcorrection rates of sNa within 24 hours/24-48 hours and copeptin levels at baseline/24 hours were analyzed. RESULTS: Mean sNa and median copeptin levels were 117.9 and 16.9 pmol/L, respectively. Ratio of copeptin-to-urine sodium allowed for an improved differentiation among some (insufficient effective circulatory volume), but not all hyponatremia etiologic subgroups. Patients with below-median copeptin levels at baseline achieved a higher target correction rate in 6/24 hours (odds ratio [OR], 2.97; p = 0.02/OR, 6.21; p = 0.006). Patients with below-median copeptin levels 24 hours after treatment showed a higher overcorrection rate in next 24 hours (OR, 18.00, p = 0.02). CONCLUSION: There is a limited diagnostic utility of copeptin for differential diagnosis of hyponatremia. However, copeptin might be useful for predicting responses to hypertonic saline treatment in hyponatremic patients.

Thwarted belongingness and perceived burdensomeness in Korean college students: Psychometric properties and cultural considerations for the interpersonal needs Questionnaire-10.

The present study aimed to validate a Korean version of the Interpersonal Needs Questionnaire in a college student sample. Three hundred and one students completed the scale and other measures of suicidal ideation, loneliness, interpersonal support, responsibility to family, meaning in life, fearlessness about death, anxiety and depression. Results revealed that the scale has two-factor structure (thwarted belongingness and perceived burdensomeness) and it also has good internal consistency, convergent validity and discriminant validity. Cultural comparisons showed that the levels of thwarted belongingness in Korean college students were higher than those in the U.S. college students.

Preliminary Validation of a Korean Version of the Acquired Capability for Suicide Scale-Fearlessness About Death.

The interpersonal-psychological theory of suicide proposes that the desire for suicide must be accompanied by the capability to do so in order for an individual to engage in suicidal behavior. The Acquired Capability for Suicide Scale-Fearlessness about Death (ACSS-FAD) measures fearlessness about death, a core component of the capability for suicide. This study aimed to validate a Korean version of the ACSS-FAD in a college student sample. We administered the ACSS-FAD and measures of suicide ideation, fear of suicide, death anxiety, pain anxiety, and depression in a sample of Korean college students (N = 301) and analyzed its reliability, factor structure, invariance across genders, convergent validity, and discriminant validity. The one-factor model achieved satisfactory model fit. Across genders, partial metric invariance and partial scalar invariance were established. The results also revealed that the ACSS-FAD has good internal consistency, convergent validity (positive correlations with fear of suicide, death anxiety, and pain anxiety), and discriminant validity (no relation with depression). The Korean version of the ACSS-FAD presents adequate psychometric properties and may be considered to be a promising instrument for measuring fearlessness about death in college students.

Extracellular Fluid/Intracellular Fluid Volume Ratio as a Novel Risk Indicator for All-Cause Mortality and Cardiovascular Disease in Hemodialysis Patients.

BACKGROUND: In hemodialysis patients, fluid overload and malnutrition are accompanied by extracellular fluid (ECF) expansion and intracellular fluid (ICF) depletion, respectively. We investigated the relationship between ECF/ICF ratio (as an integrated marker reflecting both fluid overload and malnutrition) and survival and cardiovascular disease (CVD) in the context of malnutrition-inflammation-arteriosclerosis (MIA) complex. METHODS: Seventy-seven patients from a single hemodialysis unit were prospectively enrolled. The ECF/ICF volume was measured by segmental multi-frequency bioimpedance analysis. MIA and volume status were measured by serum albumin, C-reactive protein (CRP), pulse wave velocity (PWV) and plasma B-type natriuretic peptide (BNP), respectively. RESULTS: The mean ECF/ICF ratio was 0.56±0.06 and the cut-off value for maximum discrimination of survival was 0.57. Compared with the low ECF/ICF group, the high ECF/ICF group (ratio≥0.57, 42%) had higher all-cause mortality, CVD, CRP, PWV, and BNP, but lower serum albumin. During the 5-year follow-up, 24 all-cause mortality and 38 CVD occurred (18 and 24, respectively, in the high ECF/ICF group versus 6 and 14 respectively in the low ECF/ICF group, P<0.001). In the adjusted Cox analysis, the ECF/ICF ratio nullifies the effects of the MIA and volume status on survival and CVD and was an independent predictor of all-cause mortality and CVD: hazard ratio (95% confidence interval); 1.12 (1.01-1.25) and 1.09 (1.01-1.18) for a 0.01 increase in the ECF/ICF ratio. The degree of malnutrition (albumin), inflammation (CRP), arteriosclerosis (PWV), and fluid overload (BNP) were correlated well with the ECF/ICF ratio. CONCLUSIONS: Hemodialysis patients with high ECF/ICF ratio are not only fluid overloaded, but malnourished and have stiff artery with more inflammation. The ECF/ICF ratio is highly related to the MIA complex, and is a major risk indicator for all-cause mortality and CVD.

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Associated with Mediastinal Schwannoma.

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hypo-osmotic hyponatremia. There are several etiologies of SIADH including neuroendocrine tumor, pulmonary disease, infection, trauma, and medications. Here, we report a case of SIADH associated with a schwannoma involving the mediastinum in a 75-year-old woman who presented with nausea, vomiting, and general weakness. Laboratory testing showed hypo-osmolar hyponatremia, with a serum sodium level of 102mmol/L, serum osmolality of 221mOsm/kg, urine osmolality of 382mOsm/kg, urine sodium of 55 mmol/L, and plasma antidiuretic hormone (ADH) of 4.40 pg/mL. Chest computed tomography identified a 1.5-cm-sized solid enhancing nodule in the right lower paratracheal area. A biopsy specimen was obtained by video-assisted thoracoscopic surgery, which was diagnosed on pathology as a schwannoma. The hyponatremia was completely resolved after schwannoma resection and plasma ADH level decreased from 4.40 pg/mL to 0.86 pg/mL. This case highlights the importance of suspecting and identifying the underlying cause of SIADH when faced with refractory or recurrent hyponatremia, and that on possibility is mediastinal schwannoma.

Testing an affective judgment model of distress tolerance in college heavy drinkers.

INTRODUCTION: The objective of this study was to examine the relation between affects linked to avoidance/withstanding options and distress tolerance in heavy drinkers. It has been suggested that the expected rewards of taking withstanding options and the expected punishments of taking avoidance options could have an influence on judgment regarding withstanding ongoing distress. However, there are no studies that have tested this hypothesis. Thus, we measured the affects linked to each option and examined their relations with distress tolerance based on the theoretical/empirical evidence that proves that affects reflect the expected rewards and punishments of certain options. We hypothesized that affects linked to avoidance/withstanding options are closely related to distress tolerance in heavy drinkers. METHODS: Forty heavy drinkers completed a self-report measure that assessed the affective associations of options and took a behavioral task indexing distress tolerance. RESULTS: Hierarchical regression analyses revealed that affects linked to avoidance/withstanding options are closely associated with distress tolerance, even after controlling for negative emotional experiences and alcohol use problems. CONCLUSIONS: Our findings indicate that affects linked to avoidance/withstanding options may have an important influence on distress tolerance and therefore deserve further explorations.

Psychometric Properties of a Short Korean Version of the Revised Obsessive Intrusion Inventory.

OBJECTIVE: The Revised Obsessive Intrusion Inventory (ROII) is a 52-item scale that evaluates obsessional intrusive thoughts. The aim of the present study was to validate a short, 20-item Korean version of the ROII (ROII-20). METHODS: Of the 1125 participants who completed the ROII-20, 895 participants completed the scale to examine the factor structure of the scale. A subgroup of these participants (n=53) completed the scale twice to determine test-retest reliability. To establish external validity, 230 participants completed the scale and other questionnaires. RESULTS: Exploratory factor analyses suggested a hierarchical model comprising two higher order factors of autogenous obsessions (resulting from aggressive thoughts and sexual thoughts) and reactive obsessions (resulting from thoughts about contamination, thoughts about accidents, and thoughts about dirt). Confirmatory factor analyses supported this model. The results indicated good internal consistency and test-retest reliability. External validity was supported by relationships with obsessive-compulsive symptoms and general distress. CONCLUSION: The ROII-20 presents good psychometric properties and may be considered as a promising instrument for measuring obsessional intrusions.

Effect of post-voiding urine volume on progression of renal function decline in patients with type 2 diabetes.

Diabetic bladder dysfunction (DBD) is a common complication of type 2 diabetes mellitus (T2DM). The association between DBD and progression of diabetic nephropathy has not been clarified. In this study, we investigated the relationship between post-voiding residual urine (PVR) with decline in renal function in patients with type 2 diabetes. This retrospective study included 164 patients at a single center. We collected medical histories and laboratory findings of patients undergoing uroflowmetry from January 1, 2008 to October 30, 2013. Renal function was assessed by calculating the estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) study equation. We evaluated whether greater PVR was a risk factor for faster decline of GFR during a 1-year follow-up. The subjects' mean age was 65±12 years, duration of diabetes 12.8±8.8 years, baseline serum creatinine level 106.1±53.0 µmol/L, and eGFR was 64.6±25.2 mL/min/1.73 m(2). Mean PVR was 69.8±96.3 mL and in 17.7% of subjects, PVR>100 mL. In linear regression analysis, PVR was independently associated with GFR decrease (standardized ß coefficient=0.2, P=0.009). Multiple logistic analysis showed that subjects with PVR>100 mL had a 2.8-fold higher risk of an eGFR change during 1 year higher than the median value of all subjects (95% confidence interval, 1.1-6.8; P=0.03). Increased PVR was independently associated with a more rapid decline in renal function in patients with type 2 diabetes.

The association between an abnormal post-voiding urine volume and a lower estimated glomerular filtration rate in patients with type 2 diabetes with no voiding symptoms.

BACKGROUND/AIMS: Diabetic cystopathy is a frequent complication of diabetes mellitus. This study assessed the association between the post-voiding residual (PVR) urine volume and diabetic nephropathy in type 2 diabetics with no voiding symptoms. METHODS: This study investigated 42 patients with type 2 diabetes who were followed regularly at our outpatient clinic between July 1, 2008 and June 30, 2009. No patient had voiding problems or International Prostate Symptom Scores (IPSSs) ≥ 12. An urologist performed the urological evaluations and the PVR was measured using a bladder scan. A PVR > 50 mL on two consecutive voids was considered abnormal, which was the primary study outcome. RESULTS: The mean patient age was 60 ± 10 years; the IPSS score was 3.7 ± 3.3; and the diabetes duration was 11.9 ± 7.8 years. Seven of the 42 patients (16.7%) had a PVR > 50 mL. The presence of overt proteinuria or microalbuminuria was associated with an increased risk of a PVR > 50 mL (p < 0.01). Patients with a PVR > 50 mL had a significantly lower estimated glomerular filtration rate (eGFR) compared with those with a PVR ≤ 50 mL (59.2 ± 27.1 mL/min/1.73 m(2) vs. 28.7 ± 23.3 mL/min/1.73 m(2); p < 0.001). Multivariate logistic analysis revealed that a lower eGFR (odds ratio, 0.94; 95% confidence interval, 0.88 to 0.99; p = 0.04) was a significant risk factor for a PVR > 50 mL. CONCLUSIONS: Patients with diabetic nephropathy had a significantly higher PVR and a lower eGFR was associated with an abnormal PVR.

The prevention of contrast-induced nephropathy by simultaneous hemofiltration during coronary angiographic procedures: a comparison with periprocedural hemofiltration.

BACKGROUND: Periprocedural (6 h pre- and 24 h post-angiography) hemofiltration appears to effectively prevent contrast-induced nephropathy (CIN) in chronic kidney disease (CKD) patients undergoing coronary angiography. However, this procedure over-uses medical resources, and the cessation of hemofiltration during coronary angiography results in persistent renal injury. In comparison, simultaneous hemofiltration performed only during coronary angiography requires fewer medical resources and can provide instantaneous protection against CIN. METHODS: Sixty-eight CKD patients (serum creatinine, 2.51±1.15 mg/dL) undergoing coronary angiography were randomized in a 1:2 ratio to receive either periprocedural (n=23) or simultaneous (n=45) hemofiltration. The expected CIN rate was similar for the two groups (41.3% versus 40.0%, p=0.769). RESULTS: On day 3 after contrast exposure, four and seven patients in the periprocedural and simultaneous groups, respectively experienced CIN (17.4% versus 15.6%, p=0.846). On days 5-30, seven and three patients in the periprocedural and simultaneous groups, respectively experienced CIN (30.4% versus 6.7%, p=0.009). The serum creatinine levels of patients in the periprocedural group transiently decreased on day 1 and persistently increased during days 5-30 compared with the simultaneous group. This difference between the two groups in terms of creatinine levels over time was statistically significant (F statistic=6.830; p=0.001, by ANCOVA). The cost of hemofiltration was doubled in the periprocedural group ($1066±83 versus $504±40, p<0.001). CONCLUSIONS: Simultaneous hemofiltration provide equal early (day 3) and better late-stage (days 5-30) renal protection against CIN at a significantly lower cost compared with periprocedural hemofiltration.

The removal of 1,4-dioxane from polyester manufacturing process wastewater using an up-flow Biological Aerated Filter (UBAF) packed with tire chips.

1,4-Dioxane is one of the by-products from the polyester manufacturing process, which has been carelessly discharged into water bodies and is a weak human carcinogen. In this study, a laboratory-scale, up-flow biological aerated filter (UBAF), packed with tire chips, was investigated for the treatment of 1,4-dioxane. The UBAF was fed with effluent, containing an average of 31 mg/L of 1,4-dioxane, discharged from an anaerobic treatment unit at H Co. in the Gumi Industrial Complex, South Korea. In the batch, a maximum of 99.5 % 1,4-dioxane was removed from an influent containing 25.6 mg/L. In the continuous mode, the optimal empty bed contact time (EBCT) and air to liquid flow rate (A:L) were 8.5 hours and 30:1, respectively. It was also found that the removal efficiency of 1,4-dioxane increased with increasing loading rate within the range 0.04 to 0.31 kg 1,4-dioxane/m(3)·day. However, as the COD:1,4-dioxane ratio was increased within the range 3 to 46 (mg/L COD)/(mg/L 1,4-dioxane), the removal efficiency unexpectedly decreased.

The malnutrition-inflammation-depression-arteriosclerosis complex is associated with an increased risk of cardiovascular disease and all-cause death in chronic hemodialysis patients.

BACKGROUND: In chronic hemodialysis patients, malnutrition, inflammation, depression and arteriosclerosis are pathogenetically associated suggesting the presence of malnutrition-inflammation-depression-arteriosclerosis (MIDA) complex acting as a risk factor for cardiovascular disease (CVD). METHODS: Nutritional status was assessed by serum albumin, subjective global assessment and normalized protein catabolic rate (nPCR). Inflammation was assessed by serum high-sensitivity C-reactive protein (hsCRP). Depression was assessed with the Beck Depression Inventory and DSM-IV criteria. The severity of arteriosclerosis was measured by pulse wave velocity (PWV). RESULTS: Among 81 hemodialysis patients, 44 (54.3%) had malnutrition (albumin <4.0 mg/dl with subjective global assessment score <6 and/or nPCR <1.0) and 39 (48.1%) had inflammation (hsCRP >1 mg/l). The prevalence of depression was 50.6% (n = 41). Fifty-nine (73.8%) had arteriosclerosis (measured PWV > expected PWV based on age/blood pressure/gender adjustment). The severity of the all four individual MIDA components correlated well with each other. The average number of the MIDA complication (MIDA score) was 2.27 ± 1.33. -During the 5-year follow-up, 40 cases of CVD and 26 cases of all-cause death occurred. In Cox analysis adjusted for -previous CVD, age, diabetes, blood pressure, pulse pressure, intradialytic hypotension, B-type natriuretic peptide, -hemoglobin and hemodialysis incompliance, the MIDA score was an independent predictor of CVD and all-cause death: hazard ratio (95% confidence interval); 1.89 (1.13-3.17) and 3.48 (1.32-9.21) for an increase of 1 MIDA score. CONCLUSIONS: This study suggests the presence of MIDA complex, which is composed of malnutrition, inflammation, depression and arteriosclerosis. The MIDA complex syndrome was an independent risk factor for CVD and all-cause death in chronic hemodialysis patients.

Epiblepharon related to high body mass index in Korean children.

PURPOSE: To evaluate the clinical manifestations of epiblepharon in Korean children and the relationship between this condition and body mass index. METHODS: In a retrospective case-control study, 223 children 6 to 15 years of age treated surgically for epiblepharon were studied and compared with an age-matched control group of 264 children. Data on age, sex, weight, height, and recurrence were recorded. RESULTS: Mean age of the patients was 8.63 ± 4.43 years. Lower eyelids were commonly involved bilaterally. Chief complaints included ocular discomfort, eye rubbing, visual disturbances, photophobia, and epiphora. Minimal resection of orbicularis oculi with full-thickness eyelid rotatory suture for epiblepharon was performed on 223 patients. The body mass index in girls 12 to 15 years old with epiblepharon was significantly higher than that in children without epiblepharon (P < .05). There was a statistically significant correlation between the incidence of epiblepharon and obesity with aging in girls (P < .05). Reoperation was performed on 12 patients (4.4%) because of recurrence of corneal irritation with inverted eyelashes. Clinical factors such as sex, age, and body mass index did not affect the rate of recurrence. CONCLUSION: Epiblepharon is one of the most common eyelid abnormalities among Asian children. Obese Korean girls aged 12 to 15 years demonstrated symptomatic epiblepharon at a statistically significant level.

Canaliculitis with a papilloma-like mass caused by a temporary punctal plug.

Absorbable plugs are used before attempting permanent occlusion to observe whether the patient will be amenable to treatment for dry eye. Little is known about the complications of absorbable plugs. The authors present a case of canaliculitis with a papilloma-like mass caused by long-standing unabsorbed collagen plug that had been placed 3 years earlier. This is an uncommon clinical presentation that may be encountered in patients who have canaliculitis symptoms and a history of intracanalicular temporary plug placement.

Rapid analysis of plasma paraquat using sodium dithionite as a predictor of outcome in acute paraquat poisoning.

BACKGROUND: Paraquat poisoning can be lethal, and aggressive treatments might have little or no effect on severely poisoned patients. Accordingly, a convenient prognostic test is necessary to guide therapy for acute paraquat poisoning. Sodium dithionite reduces paraquat to a blue radical form in alkaline plasma with a paraquat detection sensitivity of 2.0 mg/L, which is a 100% lethal concentration at 10 to 12 hours postingestion. The prognostic utility of this simple reaction was examined prospectively. METHODS: Of 233 paraquat-poisoned patients, who were taken to the hospital within 12 hours after ingestion, the plasma samples obtained on arrival were tested using the sodium dithionite reaction. Standard saline containing 2.0 mg/L paraquat was used as the positive control. The test result was interpreted as being positive when the plasma test yielded a blue color darker than that of the positive control. The effects of aggressive treatment, including cyclophosphamide pulse and continuous venovenous hemofiltration, were evaluated retrospectively. RESULTS: The discharge survival rate was 41.6% (97 of 233). Ninety-seven of 142 patients with negative or equivocal plasma dithionite test survived. However, all 91 patients with positive plasma dithionite test died of multiorgan failure. Cyclophosphamide and/or continuous venovenous hemofiltration could not improve survival. CONCLUSIONS: In this single-center study, a positive plasma dithionite test was associated with 100% mortality, despite aggressive treatment. In contrast, negative or equivocal tests were associated with a 68% survival rate. It is believed that after further verification, this test can be used to guide therapy and predict the outcomes of patients suffering acute paraquat poisoning.