Evaluation of exhaust emissions of agricultural tractors using portable emissions measurement system in Korean paddy field.

Recently, diesel engine emissions have been designated as a first-class carcinogen by the World Health Organization (WHO). As such, problems with diesel engine emissions continue to increase around the world. This study aimed to analyze the emissions (CO, NOx, PM) of agricultural tractors during farming operations in order to build a reliable national inventory of air pollutant emissions. Emission data were collected using a portable emission measurement system during actual agricultural operation. The load factor (LF) of the engine was calculated using the collected engine information, the emission factor was analyzed using the LF and the measured emission. The LF was significantly different from the current standard value of 0.48, which is used in Korea to calculate exhaust emissions. The deviation ratio of the emission factor was 0.039 ~ 56.59 compared to Tier-4 emission regulation standards. Under many conditions, the calculated emission factor was higher than the emission limit. Thus, this study provides useful information for emission inventory construction through emission calculation under actual conditions and suggests the need to realize the currently applied emission factor.

Analysis of the Effect of Tillage Depth on the Working Performance of Tractor-Moldboard Plow System under Various Field Environments.

The purpose of this study was to analyze the tillage depth effect on the tractor-moldboard plow systems in various soil environments and tillage depths using a field load measurement system. A field load measurement system can measure the engine load, draft force, travel speed, wheel axle load, and tillage depth in real-time. In addition, measurement tests of soil properties in the soil layer were preceded to analyze the effect of field environments. The presented results show that moldboard plow at the same tillage depth had a wide range of influences on the tractor's working load and performance under various environments. As the draft force due to soil-tool interaction occurred in the range of 5.6-17.7 kN depending on the field environment, the overall mean engine torque and rear axle torque were up to 2.14 times and 1.67 times higher in hard and clayey soil, respectively, than in soft soil environments. In addition, the results showed tractive efficiency of 0.56-0.73 and were analyzed to have a lugging ability of 67.8% with a 44% maximum torque rise. The engine power requirement in hardpan was similar within 3.6-9.6%, but the power demand of the rear axle differed by up to 18.4%.

Traction Performance Evaluation of the Electric All-Wheel-Drive Tractor.

This study aims to design, develop, and evaluate the traction performance of an electric all-wheel-drive (AWD) tractor based on the power transmission and electric systems. The power transmission system includes the electric motor, helical gear reducer, planetary gear reducer, and tires. The electric system consists of a battery pack and charging system. An engine-generator and charger are installed to supply electric energy in emergency situations. The load measurement system consists of analog (current) and digital (battery voltage and rotational speed of the electric motor) components using a controller area network (CAN) bus. A traction test of the electric AWD tractor was performed towing a test vehicle. The output torques of the tractor motors during the traction test were calculated using the current and torque curves provided by the motor manufacturer. The agricultural work performance is verified by comparing the torque and rpm (T-N) curve of the motor with the reduction ratio applied. The traction is calculated using torque and specifications of the wheel, and traction performance is evaluated using tractive efficiency (TE) and dynamic ratio (DR). The results suggest a direction for the improvement of the electric drive system in agricultural research by comparison with the conventional tractor through the analysis of the agricultural performance and traction performance of the electric AWD tractor.

Weakly Supervised Crop Area Segmentation for an Autonomous Combine Harvester.

Machine vision with deep learning is a promising type of automatic visual perception for detecting and segmenting an object effectively; however, the scarcity of labelled datasets in agricultural fields prevents the application of deep learning to agriculture. For this reason, this study proposes weakly supervised crop area segmentation (WSCAS) to identify the uncut crop area efficiently for path guidance. Weakly supervised learning has advantage for training models because it entails less laborious annotation. The proposed method trains the classification model using area-specific images so that the target area can be segmented from the input image based on implicitly learned localization. This way makes the model implementation easy even with a small data scale. The performance of the proposed method was evaluated using recorded video frames that were then compared with previous deep-learning-based segmentation methods. The results showed that the proposed method can be conducted with the lowest inference time and that the crop area can be localized with an intersection over union of approximately 0.94. Additionally, the uncut crop edge could be detected for practical use based on the segmentation results with post-image processing such as with a Canny edge detector and Hough transformation. The proposed method showed the significant ability of using automatic perception in agricultural navigation to infer the crop area with real-time level speed and have localization comparable to existing semantic segmentation methods. It is expected that our method will be used as essential tool for the automatic path guidance system of a combine harvester.

Estimation of Axle Torque for an Agricultural Tractor Using an Artificial Neural Network.

The objective of this study was to develop a model to estimate the axle torque (AT) of a tractor using an artificial neural network (ANN) based on a relatively low-cost sensor. ANN has proven to be useful in the case of nonlinear analysis, and it can be applied to consider nonlinear variables such as soil characteristics, unlike studies that only consider tractor major parameters, thus model performance and its implementation can be extended to a wider range. In this study, ANN-based models were compared with multiple linear regression (MLR)-based models for performance verification. The main input data were tractor engine parameters, major tractor parameters, and soil physical properties. Data of soil physical properties (i.e., soil moisture content and cone index) and major tractor parameters (i.e., engine torque, engine speed, specific fuel consumption, travel speed, tillage depth, and slip ratio) were collected during a tractor field experiment in four Korean paddy fields. The collected soil physical properties and major tractor parameter data were used to estimate the AT of the tractor by the MLR- and ANN-based models: 250 data points were used for developing and training the model were used, the 50 remaining data points were used to test the model estimation. The AT estimated with the developed MLR- and ANN-based models showed agreement with actual measured AT, with the R2 value ranging from 0.825 to 0.851 and from 0.857 to 0.904, respectively. These results suggest that the developed models are reliable in estimating tractor AT, while the ANN-based model showed better performance than the MLR-based model. This study can provide useful results as a simple method using ANNs based on relatively inexpensive sensors that can replace the existing complex tractor AT measurement method is emphasized.

Simulation of Design Factors of a Clutch Pack for Power-Shift Transmission for an Agricultural Tractor.

The objective of this study is the simulation of the most affected design factors and variables of the clutch pack for the power-shift transmission (PST) of a tractor based measured data. The simulation model, the mathematical model of sliding velocity, a moment of inertia, and clutch engagement pressure of clutch pack were developed using the powertrain and configurations of the real PST tractor. In this study, the sensor fusion method was used to precisely measure the proportional valve pressure by test bench, which was applied to the simulation model. The clutch engagement times were found 1.20 s at all temperatures for determined factors. The engagement pressures have a significant difference at various temperatures (25 to 100 °C) of the hydraulic oils after the 1.20 s but the most affected factors were satisfied with the simulation conditions that ensure the clutch engagement on time. Finally, this sensor fusion method is believed to be helpful in realizing precision agriculture through minimization of power loss and maximum energy efficiency of tractors.

Analysis of Tillage Depth and Gear Selection for Mechanical Load and Fuel Efficiency of an Agricultural Tractor Using an Agricultural Field Measuring System.

This study was conducted to analyze the effects of tillage depth and gear selection on the mechanical load and fuel efficiency of an agricultural tractor during plow tillage. In order to analyze these effects, we developed an agricultural field measuring system consisting of a load measurement part (wheel torque meter, proximity sensor, and real-time kinematic (RTK) global positioning system (GPS)) and a tillage depth measurement part (linear potentiometer and inclinometer). Field tests were carried out using moldboard plows with a maximum tillage depth of 20 cm and three gear selections (M2H, M3L, and M3H) in a rice stubble paddy field for plow tillage. The average travel speed and slip ratio had the lowest M2H and the highest M3L. M3H had the highest theoretical speed, but the travel speed was 0.13 km/h lower than M3L due to the reduction in the axle rotational speed at deep tillage depth. Regarding engine load, the higher the gear, the greater the torque and the lower the axle rotation speed. The front axle load was not significantly affected by the tillage depth as compared to other mechanical parts, except for the M3H gear. The rear axle load generated about twice the torque of the front wheel and overall, it tended to show a higher average rear axle torque at higher gear selection. The rear axle load and fuel rate were found to be most affected by the combination of the tillage depth and gear selection combination. Overall, field test results show that the M3H had the highest fuel efficiency and a high working speed while overcoming high loads at the same tillage depth. In conclusion, M3H is the most suitable gear stage for plow cultivation, and the higher the gear stage and the deeper the tillage depth during plowing, the higher the fuel efficiency. The results of this study will be useful for analyzing mechanical load and fuel efficiency during farm operations. In a future study, we will conduct load analysis studies in other farming operations that consider various soil mechanics factors as well as tillage depths and gear selections.

Clinical outcomes of submucosal colorectal cancer diagnosed after endoscopic resection: a focus on the need for surgery.

BACKGROUND/AIMS: We aimed to investigate the proportion of and risk factors for residual cancer and/or lymph node metastasis after surgery was performed because of high-risk pathological features in endoscopic resection specimen of suspected superficial submucosal colorectal cancer (SSMC). METHODS: We reviewed medical records of 497 patients (58.8 ± 9.8 years, 331 males) undergoing endoscopic resection of suspected SSMC. High-risk pathological features included: deep submucosal cancer invasion ≥ 1,000 µm; positive lymphovascular and/or perineural invasion; poorly differentiated adenocarcinoma; and positive resection margin. We investigated the occurrence of additional surgery and residual cancer and/or lymph node involvement in the surgical specimen. RESULTS: En bloc resection was performed in 447 patients (89.9%). High-risk pathological features were detected in 372 patients (74.8%). Additional surgery was performed in 336 of 372 patients with high-risk pathological features. Of these, 47 surgical specimens (14.0%) showed residual cancer and/or lymph node metastasis. Piecemeal resection was more common in those with residual cancer and/or lymph node involvement than those without (9/47 [19.1%] vs. 24/289 [8.3%], P= 0.032). Positive resection margin was also significantly associated with positive residual cancer and/or lymph node involvement. As the number of high-risk pathological features increased, the risk of regional lymph node metastasis increased proportionally (P= 0.002). CONCLUSIONS: High-risk pathological features were frequently detected after endoscopic resection of suspected SSMC while residual cancer and/or lymph node metastasis were not commonly present in the additional surgical specimen. Further optimized strategy for proper endoscopic management of suspected SSMC is necessary.

Development of a Real-Time Tillage Depth Measurement System for Agricultural Tractors: Application to the Effect Analysis of Tillage Depth on Draft Force during Plow Tillage.

The objectives of this study were to develop a real-time tillage depth measurement system for agricultural tractor performance analysis and then to validate these configured systems through soil non-penetration tests and field experiment during plow tillage. The real-time tillage depth measurement system was developed by using a sensor fusion method, consisting of a linear potentiometer, inclinometer, and optical distance sensor to measure the vertical penetration depth of the attached implement. In addition, a draft force measurement system was developed using six-component load cells, and an accuracy of 98.9% was verified through a static load test. As a result of the soil non-penetration tests, it was confirmed that sensor fusion type A, consisting of a linear potentiometer and inclinometer, was 6.34-11.76% more accurate than sensor fusion type B, consisting of an optical distance sensor and inclinometer. Therefore, sensor fusion type A was used during field testing as it was found to be more suitable for use in severe working environments. To verify the accuracy of the real-time tillage depth measurement system, a linear regression analysis was performed between the measured draft and the predicted values calculated using the American Society of Agricultural and Biological Engineers (ASABE) standards-based equation. Experimental data such as traveling speed and draft force showed that it was significantly affected by tillage depth, and the coefficient of determination value at M3-Low was 0.847, which is relatively higher than M3-High. In addition, the regression analysis of the integrated data showed an R-square value of 0.715, which is an improvement compared to the accuracy of the ASABE standard prediction formula. In conclusion, the effect of tillage depth on draft force of agricultural tractors during plow tillage was analyzed by the simultaneous operation of the proposed real-time tillage depth measurement system and draft force measurement system. In addition, system accuracy is higher than the predicted accuracy of ±40% based on the ASABE standard equation, which is considered to be useful for various agricultural machinery research fields. In future studies, real-time tillage depth measurement systems can be used in tractor power train design and to ensure component reliability, in accordance with agricultural working conditions, by predicting draft force and axle loads depending on the tillage depth during tillage operations.

Clinical significance of endothelial progenitor cells in patients with liver cirrhosis with or without hepatocellular carcinoma.

BACKGROUND AND OBJECTIVE: The role of endothelial progenitor cells in patients with cirrhosis has seldom been investigated. This study was conducted to assess the clinical significance of circulating endothelial progenitor cells in patients with liver cirrhosis with or without hepatocellular carcinoma. METHODS: A blood sample was collected once from patients with cirrhosis alone (n = 34) or cirrhosis and hepatocellular carcinoma (n = 46) and healthy controls (n = 27) for assessing levels of endothelial progenitor cells and vascular endothelial growth factor. Blood cells staining positive for CD34/CD133/KDR using flow cytometry were characterized as endothelial progenitor cells. Plasma vascular endothelial growth factor was quantified by ELISA. RESULTS: The levels of CD34/KDR-positive endothelial progenitor cells, CD133/KDR-positive endothelial progenitor cells, and vascular endothelial growth factor were higher in patients with cirrhosis ± hepatocellular carcinoma than in healthy controls (P = 0.017, P < 0.001 and P < 0.001, respectively). The levels of endothelial progenitor cells and vascular endothelial growth factor did not show statistical difference according to Child-Turcotte-Pugh class. There was a moderately significant correlation between vascular endothelial growth factor levels and hepatocellular carcinoma stage (ρ = 0.464, P = 0.001). Smoking, ascites, and portal vein thrombosis were independently related to lower levels of circulating CD34/KDR-positive endothelial progenitor cells, higher levels of CD133/KDR-positive endothelial progenitor cells, and higher levels of vascular endothelial growth factor, respectively (P = 0.041, P = 0.023, and P < 0.001, respectively). CONCLUSION: Circulating endothelial progenitor cells and plasma vascular endothelial growth factor levels were higher in patients with liver cirrhosis ± hepatocellular carcinoma compared to healthy controls. The increase in endothelial progenitor cells and vascular endothelial growth factor may have a possible role in the development of complications, especially ascites and portal vein thrombosis, or in progression of hepatocellular carcinoma.

Hepatitis C virus genotype affects survival in patients with hepatocellular carcinoma.

BACKGROUND: There is currently no evidence that hepatitis C virus (HCV) genotype affects survival in patients with hepatocellular carcinoma (HCC). This study aimed to investigate whether the HCV genotype affected the survival rate of patients with HCV-related HCC. METHODS: We performed a retrospective cohort study using the data of patients with HCV-related HCC evaluated at two centers in Korea between January 2005 and December 2016. Propensity score matching between genotype 2 patients and non-genotype 2 patients was performed to reduce bias. RESULTS: A total of 180 patients were enrolled. Of these, 86, 78, and 16 had genotype 1, genotype 2, and genotype 3 HCV-related HCC, respectively. The median age was 66.0 years, and the median overall survival was 28.6 months. In the entire cohort, patients with genotype 2 had a longer median overall survival (31.7 months) than patients with genotype 1 (28.7 months; P = 0.004) or genotype 3 (15.0 months; P = 0.003). In the propensity score-matched cohort, genotype 2 patients also showed a better survival rate than non-genotype 2 patients (P = 0.007). Genotype 2 patients also had a longer median decompensation-free survival than non-genotype 2 patients (P = 0.001). However, there was no significant difference in recurrence-free survival between genotype 2 and non-genotype 2 patients who underwent curative treatment (P = 0.077). In multivariate Cox regression analysis, non-genotype 2 (hazard ratio, 2.19; 95% confidence interval, 1.29-3.71) remained an independent risk factor for death. CONCLUSION: Among patients with HCV-related HCC, those with genotype 2 have better survival.

Primary Gastric Small Cell Carcinoma (Presenting as Linitis Plastica) Diagnosed Using Endoscopic Ultrasound-Guided Biopsy: A Case Report.

Small cell carcinomas are the most aggressive, highly malignant neuroendocrine tumors; among these, gastric small cell carcinoma (GSCC) is extremely rare. Here we report a case of a patient with primary GSCC, presenting as linitis plastic, who was diagnosed using endoscopic ultrasound (EUS)-guided biopsy. With undiagnosed linitis plastica, an 80-year-old woman was referred to our institution. Abdominal computed tomography revealed irregular wall thickening extending from the gastric body to the antrum. Endoscopy suspected to have Borrmann type IV advanced gastric cancer. EUS of the stomach showed diffuse submucosal thickening of the gastric wall, mainly the antrum. EUS-guided bite-on-bite biopsy confirmed the diagnosis of GSCC. In general, GSCC is difficult to diagnose and careful examination is necessary to determine the therapeutic strategy; however, EUS is particularly helpful in the differential diagnosis of a lesion presenting as linitis plastica.

Hepatitis C virus genotype 3 was associated with the development of hepatocellular carcinoma in Korea.

Although hepatitis C virus (HCV) genotype 3 infection is thought to be an important risk factor for hepatocellular carcinoma (HCC), current evidence is limited because only a few Western studies have evaluated the occurrence of HCC in patients with HCV genotype 3 infection. We evaluated the impact of genotype 3 and non-3 on HCC incidence and on disease progression in chronic HCV patients; this is the first study reporting such findings in an Asian population. We performed a retrospective cohort study using the data of 1448 consecutive chronic HCV patients evaluated at three centres in Korea between January 2005 and December 2016. Of these, 604, 675 and 169 had genotype 1, genotype 2 and genotype 3 HCV infections, respectively. Over a mean follow-up period of 53.2 months, 75 and 143 patients of all the patients developed HCC and experienced disease progression, respectively. The incidences of HCC were 1.10, 0.92 and 2.50 per 100 person-years, and those of disease progression were 1.95, 1.62 and 6.72 per 100 person-years for HCV genotypes 1, 2 and 3, respectively. In multivariate Cox regression analysis, genotype 3 was associated with an increased risk of HCC (hazard ratio [HR] = 4.26, 95% confidence interval [CI] = 2.02-8.97) and an increased risk of disease progression (HR = 4.88, 95%; CI = 2.94-8.08). Our study proposes that HCV genotype 3 is an independent risk factor for HCC and disease progression in chronic HCV patients.

Clinical features and outcomes of abdominal tuberculosis in southeastern Korea: 12 years of experience.

BACKGROUND: Abdominal tuberculosis (TB) is an uncommon form of infection with Mycobacterium tuberculosis in Korea. In this study, we aimed to highlight the clinical features, diagnostic methods, and outcomes of abdominal TB over 12 years in Southeastern Korea. METHODS: A total of 139 patients diagnosed as having abdominal TB who received anti-TB medication from January 2005 to June 2016 were reviewed. Among them, 69 patients (49.6%) had luminal TB, 28 (20.1%) had peritoneal TB, 7 (5.0%) had nodal TB, 23 (16.5%) had visceral TB, and 12 (8.6%) had mixed TB. RESULTS: The most frequent symptoms were abdominal pain (34.5%) and abdominal distension (21.0%). Diagnosis of abdominal TB was confirmed using microbiologic and/or histologic methods in 76 patients (confirmed diagnosis), while the remaining 63 patients were diagnosed based on clinical presentation and radiologic imaging (clinical diagnosis). According to diagnostic method, frequency of clinical diagnosis was highest in patients with luminal (50.7%) or peritoneal (64.3%) TB, while frequency of microscopic diagnosis was highest in patients with visceral TB (68.2%), and frequency of histologic diagnosis was highest in patients with nodal TB (85.2%). Interestingly, most patients, except those with nodal TB, showed a good response to anti-TB agents, with 84.2% showing a complete response. The mortality rate was only 1.4% in the present study. CONCLUSIONS: Most patients responded very well to anti-TB therapy, and surgery was required in only a minority of cases of suspected abdominal TB.

Successful biliary cannulation by the rendezvous technique via percutaneous transhepatic gallbladder drainage: A report of two cases.

Reports of the rendezvous technique via percutaneous transhepatic gallbladder drainage are very rare because of difficulties with insertion of the guidewire from the gallbladder into the common bile duct. In particular, our report includes a case with distal common bile duct stricture. To our knowledge, such a case has never been previously reported.

Self-expanding metal stent procedure for afferent loop syndrome with ascending cholangitis caused by remnant gastric cancer: A case report.

RATIONALE: Self-expanding metal stent placement is a useful procedure for intestinal obstruction. Afferent loop syndrome after gastrectomy is an uncommon complication of gastroenterostomy reconstruction. Ascending cholangitis caused by afferent loop syndrome is a potential, but rare, complication. PATIENT CONCERNS: A 73-year-old man with abdominal pain and vomiting was admitted to the emergency room. His medical history was significant for subtotal gastrectomy with Billroth II anastomosis for benign gastric ulcer perforation 40 years prior. He had notable tenderness to palpation, particularly on the epigastric area, and a temperature of 39.0°C. DIAGNOSIS: Abdominal computed tomography revealed afferent loop syndrome with ascending cholangitis caused by remnant gastric cancer. INTERVENTIONS: Percutaneous catheter drainage for management of ascending cholangitis was performed on the day of admission. He was subsequently treated with self-expandable metal stent insertion into the stenotic lesion. OUTCOMES: After treatment with percutaneous transhepatic insertion of a self-expanding stent, the patient achieved complete resolution of symptoms. The patient died of disease progression 2 months later, without further recurrence of afferent loop syndrome. LESSONS: Our case shows that insertion of a metal stent via percutaneous transhepatic biliary drainage (PTBD) can effectively treat ascending cholangitis and resolve afferent loop syndrome in inoperable patients.

Clinical features of strabismus and nystagmus in bilateral congenital cataracts.

AIM: To evaluate the prevalence, clinical features, and the factors affecting onset of strabismus and nystagmus in patients with bilateral congenital cataracts. METHODS: This study evaluated 116 eyes of 58 patients who underwent lens removal for the treatment of bilateral congenital cataracts between January 1999 and January 2011. The presence and type of strabismus and nystagmus were determined before and after surgery. Type of strabismus and final visual acuity were compared in patients with and without nystagmus. Patients were divided into three groups (orthotropia/orthotropia, orthotropia/strabismus, and strabismus/strabismus) according to their preoperative and postoperative ocular alignment. Age at cataract surgery and associations of nystagmus and primary intraocular lens (IOL) implantation with strabismus were analyzed. RESULTS: Six patients (10.3%) had strabismus preoperatively and an additional 11 (19.0%) developed postoperative strabismus. Exotropia was more common than esotropia both preoperatively and postoperatively. Eighteen patients (31.0%) had postoperative nystagmus, with sensory nystagmus being the most common type. Of the 18 patients with nystagmus, 10 had strabismus, with exotropia being more common than esotropia. Postoperative visual acuity was poor in patients with nystagmus. Age at cataract surgery and rate of primary IOL implantation were significantly lower, and postoperative nystagmus was more common, in the orthotropia/strabismus group than in the other two groups. CONCLUSION: Exotropia and sensory nystagmus are common in patients with bilateral congenital cataracts. Age at cataract surgery and rate of IOL implantation are lower and nystagmus more common in patients with postoperative onset of strabismus. Nystagmus is associated with poor visual prognosis.

Effect of Ankle Range of Motion (ROM) and Lower-Extremity Muscle Strength on Static Balance Control Ability in Young Adults: A Regression Analysis.

BACKGROUND The purpose of this study was to investigate the effect of ankle ROM and lower-extremity muscle strength on static balance control ability in young adults. MATERIAL AND METHODS This study was conducted with 65 young adults, but 10 young adults dropped out during the measurement, so 55 young adults (male: 19, female: 36) completed the study. Postural sway (length and velocity) was measured with eyes open and closed, and ankle ROM (AROM and PROM of dorsiflexion and plantarflexion) and lower-extremity muscle strength (flexor and extensor of hip, knee, and ankle joint) were measured. Pearson correlation coefficient was used to examine the correlation between variables and static balance ability. Simple linear regression analysis and multiple linear regression analysis were used to examine the effect of variables on static balance ability. RESULTS In correlation analysis, plantarflexion ROM (AROM and PROM) and lower-extremity muscle strength (except hip extensor) were significantly correlated with postural sway (p<0.05). In simple correlation analysis, all variables that passed the correlation analysis procedure had significant influence (p<0.05). In multiple linear regression analysis, plantar flexion PROM with eyes open significantly influenced sway length (B=0.681) and sway velocity (B=0.011). CONCLUSIONS Lower-extremity muscle strength and ankle plantarflexion ROM influenced static balance control ability, with ankle plantarflexion PROM showing the greatest influence. Therefore, both contractile structures and non-contractile structures should be of interest when considering static balance control ability improvement.

Comparison of Concomitant Mesalamine and Immunomodulator Therapy and Immunomodulator Monotherapy for Crohn's Disease.

BACKGROUND: Although immunomodulators are increasingly used in Crohn's disease (CD), a significant number of gastroenterologists still use 5-aminosalicylate (5-ASA) in combination with azathioprine (AZA) or 6-mercaptopurine (6-MP); there is limited evidence regarding the benefit of concomitant 5-ASA with AZA/6-MP compared with AZA/6-MP monotherapy for the treatment of CD. STUDY DESIGN: A total of 106 patients who received AZA/6-MP for more than 3 months between January 1991 and May 2014 were identified retrospectively. Each patient was matched with 3 randomly selected controls who were treated with concomitant therapy during the same period. RESULTS: The cumulative probabilities of steroid use at 5 and 10 years were 24.9% and 75.8% in the 5-ASA + AZA/6-MP group and 31.2% and 87.8% in the AZA/6-MP group, respectively (P = 0.187). The cumulative probabilities of anti-TNF use, resectional surgery, and disease-related hospitalization were comparable between the groups. The younger age and the use of lower doses of immunomodulators were associated with higher requirement of rescue therapy. CONCLUSIONS: This study did not demonstrate that the concomitant use of 5-ASA with AZA/6-MP showed the proof or effect in terms of steroid requirements, anti-TNF use, resectional surgery, or disease-related hospitalization compared with that of AZA/6-MP alone.

Visual Outcome and Patient Satisfaction of Low-Power-Added Multifocal Intraocular Lens.

PURPOSE: To evaluate visual outcome and patient satisfaction following implantation of multifocal intraocular lenses (IOLs) with a +1.5 diopters (D) addition compared with monofocal IOLs. METHODS: This prospective, nonrandomized, comparative case series involved 48 eyes (24 patients) who underwent cataract surgery with implantation of low-power-added multifocal IOLs (LS313-MF15; multifocal group) and 48 eyes (24 patients) with conventional monofocal IOLs (CTS204; monofocal group). Visual acuity (VA), defocus curves, refraction, contrast sensitivity, glare, ocular optical quality, and scores in questionnaire were assessed 6 months postoperatively. RESULTS: Uncorrected VA at intermediate and near distance tended to be better in the multifocal group, with significant differences at 50 cm (P=0.03). The defocus curve showed significantly different VA at vergences of -1.5 and -2.0 D (P=0.02 and P=0.03, respectively). Results of postoperative refraction, contrast sensitivity, glare, and optical quality were similar (P>0.05), although coma-like aberration was higher in the multifocal group (P=0.04). Despite of similar levels of visual disturbances (P>0.05), disturbances in activities and spectacle use at intermediate working distance were significantly less frequent in the multifocal group (P=0.03 and P=0.04, respectively). Multifocal group showed significantly greater overall satisfaction (P=0.02). CONCLUSIONS: Low-power-added multifocal IOLs yielded better intermediate and near vision without increasing optical phenomena compared with monofocal IOLs.