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1.
Sci Rep ; 11(1): 1292, 2021 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-33446712

RESUMO

This retrospective, consecutive interventional study investigated the long-term clinical outcomes of combined vitrectomy with intraoperative dexamethasone implants for non-tractional refractory diabetic macular edema (DME). The study included 43 eyes from 39 participants with DME that had continued for more than 6 months despite repeated non-surgical treatment. Postoperative changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated over 3 years. A Kaplan-Meier curve was obtained for any additional non-surgical treatment, and the average number of non-surgical treatments required for DME before and after surgery was compared. Other postsurgical complications were also investigated. The logMAR BCVA improved from 0.526 ± 0.417 (20/67) preoperatively to 0.294 ± 0.374 (20/39) 3 years postoperatively (p < 0.001, generalized estimating equation). The CMT improved from 478 ± 122 µm preoperatively to 314 ± 90 µm 3 years postoperatively (p < 0.001, generalized estimating equation). Additional non-surgical treatment was not required for 29 (67%) eyes. The average number of annual non-surgical treatments decreased from 5.04 times preoperatively to 0.34 times postoperatively. Seventeen (40%) eyes developed temporary ocular hypertension after surgery, which normalized after antihypertensive eye drop instillation. In conclusion, vitrectomy combined with intraoperative dexamethasone implantation provides satisfactory long-term clinical outcomes for non-tractional refractory DME while reducing the number of intraocular injections for DME.

3.
Transl Vis Sci Technol ; 9(13): 15, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33344059

RESUMO

Purpose: To investigate the impact of the metabolic syndrome (METS) on the incidence of retinal vein occlusion (RVO). Methods: This is a retrospective cohort study using Korean National Health Insurance System data. 23,153,600 subjects without previous history of RVO underwent a National Health Screening Program examination between 2009 and 2012. They were monitored for RVO development (registration of diagnostic code for RVO) until 2015. Presence of METS was defined using the data from the National Health Screening Program examination according to the revised criteria of the National Cholesterol Education Program Adult Treatment Panel III. A multivariate adjusted Cox regression analysis was used to reveal hazard ratios and 95% confidence interval for RVO development in the presence of METS. Results: The age of the subjects was 47.64 ± 13.51 years. In this cohort, 11,747,439 (50.7%) were male, 11,406,161 (49.3%) were female, and 6,398,071 subjects (27.6%) were diagnosed with METS. The overall incidence of RVO was 0.947 per 1000 person-years. The adjusted hazard ratio of RVO in the presence of METS was 1.458 (95% confidence interval, 1.440-1.475; P < 0.001) after adjusting for age, sex, smoking status, alcohol consumption, physical activity, and income. Among all of the criteria for METS diagnosis, elevated blood pressure was the greatest risk for RVO development (adjusted hazard ratio, 1.610; 95% confidence interval, 1.589-1.631; P < 0.001). Conclusions: METS and each of diagnostic criteria was associated with an increased risk of RVO development. Elevated blood pressure seems to be especially important factors for RVO development. Translational Relevance: Our results provide information about the link between METS and RVO.

4.
Sci Rep ; 10(1): 20881, 2020 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-33257768

RESUMO

This study aimed to investigate morphological differences between idiopathic epiretinal membrane (ERM) and secondary ERM due to peripheral break (SEPB) and to identify clinical characteristics in eyes with SEPB to facilitate peripheral retinal examination. The retrospective cross-sectional study involved 93 consecutive eyes in 91 patients who underwent ERM removal surgery. Eyes were divided into two groups: the macular pucker group and the idiopathic ERM group. En-face Optical Coherence Tomography (OCT) images, fundus photographs, severity of metamorphopsia (M-score) and clinical characteristics of each group were compared. ERM extent and eccentricity (ratio of the shortest and longest distances from the foveal center to the boundary) were obtained through en-face OCT imaging. Fundus photographs were used to judge whether the membrane was turbid or not. Patients with SEPB were younger than patients with idiopathic ERM (61.3 ± 7.5 vs. 66.6 ± 8.3 years; p < 0.05). Preoperative M-score and myopic refractive error, axial length were also significantly higher in the macular pucker group than in the idiopathic ERM group (all p < 0.05). There was no difference in ERM extent between the two groups. The incidence of ERM eccentricity was 23 of the 34 eyes (67.6%) in the SEPB group and 26 of the 59 eyes (44.1%) in the idiopathic ERM group (p < 0.05). The incidence of turbid ERM was 18 of the 34 eyes (52.9%) in the SEPB group and 10 of the 59 eyes (16.9%) in the idiopathic ERM group (p < 0.01). The SEPB group, compared with the idiopathic ERM group, tended to have eccentric, turbid ERM at a younger age and with more severe metamorphopsia and myopic refractive error.

5.
Retina ; 2020 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-33315827

RESUMO

PURPOSE: To investigate the incidence, risk factors, and clinical outcomes of complicated choroidal neovascularization (CNV) after reduced-fluence photodynamic therapy (PDT) for central serous chorioretinopathy (CSC). METHODS: This is a retrospective consecutive interventional study including 559 eyes from 520 patients treated by reduced-fluence PDT for CSC. The incidence of complicated CNV within 3 months after PDT was calculated. Baseline demographics and ocular findings were investigated to identify risk factors. The clinical course of complicated CNV was analyzed. RESULTS: Seven cases experienced development of active CNV after PDT within 3 months with a median interval of 4 weeks (range, 2-12 weeks). The incidence was estimated as 1.25% (95% CI, 0.55-2.62%). Complicated CNV developed in 6 among 138 eyes (4.35%) with flat irregular pigment epithelial detachment (PED) and in 1 among 421 eyes (0.24%) without flat irregular PED (p<0.001, Fisher's exact test). The median best-corrected visual acuity recovered from 20/100 at the time of CNV development to 20/20 after anti-vascular endothelial growth factor (VEGF) injections (median, 3 times). CONCLUSION: In about one percent, reduced-fluence PDT for CSC may be complicated by CNV, which can be well controlled with anti-VEGF injection. Flat irregular PED increases the risk of secondary CNV following PDT.

6.
J Clin Neurol ; 16(4): 633-645, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33029970

RESUMO

BACKGROUND AND PURPOSE: The Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is widely used for estimating the symptoms of Parkinson's disease. Translation and validation of the MDS-UPDRS is necessary for non-English speaking countries and regions. The aim of this study was to validate the Korean version of the MDS-UPDRS. METHODS: Altogether, 362 patients in 19 centers were recruited for this study. We translated the MDS-UPDRS to Korean using the translation-back translation method and cognitive pretesting. We performed both confirmatory and exploratory factor analyses to validate the scale. We calculated the comparative fit index (CFI) for confirmatory factor analysis, and used unweighted least squares for exploratory factor analysis. RESULTS: The CFI was higher than 0.90 for all parts of the scale. Exploratory factor analysis also showed that the Korean MDS-UPDRS has the same number of factors in each part as the English version. CONCLUSIONS: The Korean MDS-UPDRS has the same overall structure as the English MDS-UPDRS. Our translated scale can be designated as the official Korean MDS-UPDRS.

7.
Ophthalmology ; 2020 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-33121959

RESUMO

PURPOSE: To evaluate the clinical usefulness of a quantitative deep learning-derived vascular severity score for retinopathy of prematurity (ROP) by assessing its correlation with clinical ROP diagnosis and by measuring clinician agreement in applying a novel scale. DESIGN: Analysis of existing database of posterior pole fundus images and corresponding ophthalmoscopic examinations using 2 methods of assigning a quantitative scale to vascular severity. PARTICIPANTS: Images were from clinical examinations of patients in the Imaging and Informatics in ROP Consortium. Four ophthalmologists and 1 study coordinator evaluated vascular severity on a scale from 1 to 9. METHODS: A quantitative vascular severity score (1-9) was applied to each image using a deep learning algorithm. A database of 499 images was developed for assessment of interobserver agreement. MAIN OUTCOME MEASURES: Distribution of deep learning-derived vascular severity scores with the clinical assessment of zone (I, II, or III), stage (0, 1, 2, or 3), and extent (<3 clock hours, 3-6 clock hours, and >6 clock hours) of stage 3 evaluated using multivariate linear regression and weighted κ values and Pearson correlation coefficients for interobserver agreement on a 1-to-9 vascular severity scale. RESULTS: For deep learning analysis, a total of 6344 clinical examinations were analyzed. A higher deep learning-derived vascular severity score was associated with more posterior disease, higher disease stage, and higher extent of stage 3 disease (P < 0.001 for all). For a given ROP stage, the vascular severity score was higher in zone I than zones II or III (P < 0.001). Multivariate regression found zone, stage, and extent all were associated independently with the severity score (P < 0.001 for all). For interobserver agreement, the mean ± standard deviation weighted κ value was 0.67 ± 0.06, and the Pearson correlation coefficient ± standard deviation was 0.88 ± 0.04 on the use of a 1-to-9 vascular severity scale. CONCLUSIONS: A vascular severity scale for ROP seems feasible for clinical adoption; corresponds with zone, stage, extent of stage 3, and plus disease; and facilitates the use of objective technology such as deep learning to improve the consistency of ROP diagnosis.

8.
Ann Surg Treat Res ; 99(3): 180-187, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32908850

RESUMO

Purpose: Tenofovir disoproxil fumarate is accepted as an effective and tolerable drug for treatment of HBV, similar to entecavir. However, there are some concerns about the nephrotoxicity of tenofovir. The aim of this study is to compare the renal-function change of liver recipients who received tenofovir or entecavir for HBV. Methods: Among 468 patients with HBV who underwent liver transplantation at Samsung Medical Center between January 2008 and December 2015, the patients treated with tenofovir (n = 39) or entecavir (n = 429) were reviewed retrospectively. Baseline characteristics and renal-function change after 1 month, 1 year, and 2 years were compared. Propensity-score matching was performed for 37 patients using tenofovir and 132 patients using entecavir. We also analyzed risk factors of renal dysfunction. Results: Age, preoperative creatinine, estimated glomerular filtration rate (e-GFR), and hepatic encephalopathy score showed statistical difference between the tenofovir and entecavir groups. The proportion of patients with 'decreased renal function (e-GFR < 60 mL/min/1.73 m2)' was higher in the tenofovir group than in the entecavir group (33.3% vs. 12.4% at postoperative one year, P < 0.005). After propensity-score matching, there was no statistical difference in preoperative characteristics. Postoperative 1-, 2-, and 3-year e-GFR and creatinine showed no statistical difference in either group. On multivariate analysis, only preoperative high e-GFR showed a protective effect on renal-function change (odds ratio, 0.97; P < 0.001), and there was no aggravating factor. Conclusion: Tenofovir disoproxil fumarate does not induce renal dysfunction in liver-transplanted patients with HBV more than does entecavir.

9.
Proc Natl Acad Sci U S A ; 117(33): 20316-20324, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32737163

RESUMO

Xyloglucan (XyG) is an abundant component of the primary cell walls of most plants. While the structure of XyG has been well studied, much remains to be learned about its biosynthesis. Here we employed reverse genetics to investigate the role of Arabidopsis cellulose synthase like-C (CSLC) proteins in XyG biosynthesis. We found that single mutants containing a T-DNA in each of the five Arabidopsis CSLC genes had normal levels of XyG. However, higher-order cslc mutants had significantly reduced XyG levels, and a mutant with disruptions in all five CSLC genes had no detectable XyG. The higher-order mutants grew with mild tissue-specific phenotypes. Despite the apparent lack of XyG, the cslc quintuple mutant did not display significant alteration of gene expression at the whole-genome level, excluding transcriptional compensation. The quintuple mutant could be complemented by each of the five CSLC genes, supporting the conclusion that each of them encodes a XyG glucan synthase. Phylogenetic analyses indicated that the CSLC genes are widespread in the plant kingdom and evolved from an ancient family. These results establish the role of the CSLC genes in XyG biosynthesis, and the mutants described here provide valuable tools with which to study both the molecular details of XyG biosynthesis and the role of XyG in plant cell wall structure and function.


Assuntos
Proteínas de Arabidopsis/metabolismo , Arabidopsis/metabolismo , Parede Celular/metabolismo , Glucanos/biossíntese , Glucosiltransferases/metabolismo , Células Vegetais/metabolismo , Xilanos/biossíntese , Arabidopsis/genética , Proteínas de Arabidopsis/genética , Regulação Enzimológica da Expressão Gênica , Regulação da Expressão Gênica de Plantas , Glucosiltransferases/genética , Mutação , Filogenia
10.
Transl Vis Sci Technol ; 9(2): 10, 2020 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-32704416

RESUMO

Purpose: Retinopathy of prematurity (ROP), a leading cause of childhood blindness, is diagnosed by clinical ophthalmoscopic examinations or reading retinal images. Plus disease, defined as abnormal tortuosity and dilation of the posterior retinal blood vessels, is the most important feature to determine treatment-requiring ROP. We aimed to create a complete, publicly available and feature-extraction-based pipeline, I-ROP ASSIST, that achieves convolutional neural network (CNN)-like performance when diagnosing plus disease from retinal images. Methods: We developed two datasets containing 100 and 5512 posterior retinal images, respectively. After segmenting retinal vessels, we detected the vessel centerlines. Then, we extracted features relevant to ROP, including tortuosity and dilation measures, and used these features in the classifiers including logistic regression, support vector machine and neural networks to assess a severity score for the input. We tested our system with fivefold cross-validation and calculated the area under the curve (AUC) metric for each classifier and dataset. Results: For predicting plus versus not-plus categories, we achieved 99% and 94% AUC on the first and second datasets, respectively. For predicting pre-plus or worse versus normal categories, we achieved 99% and 88% AUC on the first and second datasets, respectively. The CNN method achieved 98% and 94% for predicting two categories on the second dataset. Conclusions: Our system combining automatic retinal vessel segmentation, tracing, feature extraction and classification is able to diagnose plus disease in ROP with CNN-like performance. Translational Relevance: The high performance of I-ROP ASSIST suggests potential applications in automated and objective diagnosis of plus disease.

12.
Sci Rep ; 10(1): 10512, 2020 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-32601344

RESUMO

We aimed to evaluate the association between obesity and the incidence of retinal vein occlusion (RVO) with and without diabetes mellitus (DM).This is a retrospective cohort study using Korean National Health Insurance System data. The participants were 23,061,531 adults older than 20 years who received a health examination at least once between 2009 and 2012, and all patients were observed for RVO development until 2015. We used a multivariate adjusted Cox regression analysis to evaluate the association between RVO and body mass index (BMI) with and without DM. The analysis were evaluated via a hazard ratio (HR) and 95% confidence interval (CI). The age-, sex-, and multivariable-adjusted HRs for RVO were stratified by BMI. This population-based study revealed evidence that obesity has a different effect on the incidence of RVO in the presence and absence of DM.In people with DM, a lower BMI was associated with an increased risk of RVO, and a higher BMI was associated with a lower risk for RVO. In people without DM, the correlation was reversed: a lower BMI was associated with a lower risk for RVO and vice versa.


Assuntos
Índice de Massa Corporal , Diabetes Mellitus Tipo 2/complicações , Obesidade/complicações , Oclusão da Veia Retiniana/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Oclusão da Veia Retiniana/etiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
13.
J Clin Med ; 9(5)2020 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-32370265

RESUMO

The objective of this study was to compare outcomes between basiliximab and low-dose r-ATG in living donor kidney transplantation recipients with low immunological risk. Patients in the low-dose r-ATG group received 1.5 mg/kg of r-ATG for 3 days (total 4.5 mg/kg). Graft survival, patient survival, acute rejection, de novo donor specific antibody (DSA), estimated glomerular filtration rate (e-GFR) changes, and infection status were compared. Among 268 patients, 37 received r-ATG, and 231 received basiliximab. There was no noticeable difference in the graft failure rate (r-ATG vs. basiliximab: 2.7% vs. 4.8%) or rejection (51.4% vs. 45.9%). de novo DSA was more frequent in the r-ATG group (11.4% vs. 2.4%, p = 0.017). e-GFR changes did not differ noticeably between groups. Although most infections showed no noticeable differences between groups, more patients in the r-ATG group had cytomegalovirus (CMV) antigenemia and serum polyomavirus (BK virus) (73.0% vs. 51.9%, p = 0.032 in CMV; 37.8% vs. 15.6%, p = 0.002 in BK), which did not aggravate graft failure. Living donor kidney transplantation patients who received low-dose r-ATG and patients who received basiliximab showed comparable outcomes in terms of graft survival, function, and overall infections. Although CMV antigenemia, BK viremia were more frequent in the r-ATG group, those factors didn't change the graft outcomes.

14.
JAMA Ophthalmol ; 138(7): 732-739, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32379286

RESUMO

Importance: The neuroprotective action of sex hormones has been described. Data on the association between 5α-reductase inhibitor (5-ARI), a male sex hormone antagonist, and macular abnormalities are lacking to date. Objective: To assess the association between the use of 5-ARI for treatment of benign prostate hypertrophy and/or androgenic alopecia in men and macular abnormalities on optical coherence tomography imaging. Design, Setting, and Participants: This retrospective case-control, cross-sectional study included electronic health record data from 31 male patients who showed foveal cavitation on spectral-domain optical coherence tomography imaging from January 1, 2016, to June 30, 2019. Exposures: Receipt of 5-ARI for at least 2 years as treatment of benign prostate hypertrophy and/or androgenic alopecia. Main Outcomes and Measures: Clinical data and multimodal imaging findings and the proportion of 5-ARI users. Results: Among 31 male patients with foveal cavitation, 5-ARI was used for 10 of 14 patients (71.4%) with macular abnormalities of unknown origin and for 2 of 17 patients (11.8%) with macular abnormalities of well-known specific origin (P = .001). The mean age of these 14 patients was 74.7 years (range, 60.1-88.0 years). In the 15 eyes of 10 patients who had received 5-ARI for macular abnormalities of unknown origin, mean (SD) age was 72.8 (7.5) years, mean (SD) length of time receiving 5-ARI was 72.3 (39.2) months, and mean (SD) logMAR visual acuity was 0.08 (0.10) (Snellen equivalents, 20/24 [20/25]). Optical coherence tomography imaging showed a disease spectrum ranging from tiny foveal cavitation to an impending macular hole. Of the total male patients, 80.0% (8 of 10) had no symptoms. Conclusions and Relevance: The findings suggest that macular abnormalities associated with 5-ARI are characterized by cystoid abnormalities and foveal cavitation in male patients, which may progress to outer foveal defect and macular hole. These macular abnormalities associated with a male sex hormone antagonist suggested by this investigation warrant further corroboration.

15.
Biochem Biophys Res Commun ; 527(3): 646-653, 2020 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-32423806

RESUMO

Neutrophil extracellular trap (NET) is one of the first-line defenses against microbes. Under certain circumstances, however, it also plays an aggravating factor in diverse inflammation-related diseases including cancers and vascular diseases. Our aim is to develop a new method to detect NET in cells and tissues using a DNA-specific fluorescence probe CDr15. CDr15 was characterized to be impermeable to the cell membranes and to emit a strong fluorescence in association with extracellular DNAs in NET. Due to these properties, CDr15 was successfully shown to quantify NETs in vitro and to be applicable for real-time monitoring NET formation in PMA-stimulated neutrophils. Even in formaldehyde-fixed tumor specimens, CDr15 could detect NETs spreading around cancer cells. Compared with DAPI and SYTOX DNA dyes, CDr15 showed a lower level of background fluorescence and a higher specificity in NET detection. Based on these results, we propose CDr15 as a novel marker of NET to be applicable in experimental and clinical studies.

16.
J Clin Neurol ; 16(2): 245-253, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32319241

RESUMO

BACKGROUND AND PURPOSE: Impulse-control disorder is an important nonmotor symptom of Parkinson's disease (PD) that can lead to financial and social problems, and be related to a poor quality of life. A nationwide multicenter prospective study was performed with the aim of validating the Korean Version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale (K-QUIP-RS). METHODS: The K-QUIP-RS was constructed using forward and backward translation, and pretesting of the prefinal version. PD patients on stable medical condition were recruited from 27 movement-disorder clinics. Participants were assessed using the K-QUIP-RS and evaluated for parkinsonian motor and nonmotor statuses and for PD-related quality of life using a predefined evaluation battery. The test-retest reliability of the K-QUIP-RS was assessed over an interval of 10-14 days, and correlations between the KQUIP-RS and other clinical scales were analyzed. RESULTS: This study enrolled 136 patients. The internal consistency of the K-QUIP-RS was indicated by a Cronbach's α coefficient of 0.846, as was the test-retest reliability by a Guttman split-half coefficient of 0.808. The total K-QUIP-RS score was positively correlated with the scores for depression and motivation items on the Unified PD Rating Scale (UPDRS), Montgomery-Asberg Depression Scale, and Rapid-Eye-Movement Sleep-Behavior-Disorders Questionnaire. The total K-QUIP-RS score was also correlated with the scores on part II of the UPDRS and the PD Quality of Life-39 questionnaire, and the dopaminergic medication dose. CONCLUSIONS: The K-QUIP-RS appears to be a reliable assessment tool for impulse-control and related behavioral disturbances in the Korean PD population.

17.
Int J Mol Sci ; 21(8)2020 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-32290442

RESUMO

Reactive oxygen species (ROS) is major risk factor in neuronal diseases including ischemia. Although biliverdin reductase A (BLVRA) plays a pivotal role in cell survival via its antioxidant function, its role in hippocampal neuronal (HT-22) cells and animal ischemic injury is not clearly understood yet. In this study, the effects of transducible fusion protein Tat-BLVRA on H2O2-induced HT-22 cell death and in an animal ischemia model were investigated. Transduced Tat-BLVRA markedly inhibited cell death, DNA fragmentation, and generation of ROS. Transduced Tat-BLVRA inhibited the apoptosis and mitogen activated protein kinase (MAPK) signaling pathway and it passed through the blood-brain barrier (BBB) and significantly prevented hippocampal cell death in an ischemic model. These results suggest that Tat-BLVRA provides a possibility as a therapeutic molecule for ischemia.


Assuntos
Apoptose/efeitos dos fármacos , Produtos do Gene tat , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Oxirredutases atuantes sobre Doadores de Grupo CH-CH , Células Piramidais/efeitos dos fármacos , Células Piramidais/metabolismo , Proteínas Recombinantes de Fusão/farmacologia , Animais , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/etiologia , Isquemia Encefálica/metabolismo , Isquemia Encefálica/patologia , Linhagem Celular , Modelos Animais de Doenças , Produtos do Gene tat/genética , Gerbillinae , Peróxido de Hidrogênio/metabolismo , Masculino , Fármacos Neuroprotetores/farmacologia , Oxirredutases atuantes sobre Doadores de Grupo CH-CH/genética , Espécies Reativas de Oxigênio/metabolismo , Proteínas Recombinantes de Fusão/genética
18.
Ophthalmology ; 127(8): 1105-1112, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32197913

RESUMO

PURPOSE: Aggressive posterior retinopathy of prematurity (AP-ROP) is a vision-threatening disease with a significant rate of progression to retinal detachment. The purpose of this study was to characterize AP-ROP quantitatively by demographics, rate of disease progression, and a deep learning-based vascular severity score. DESIGN: Retrospective analysis. PARTICIPANTS: The Imaging and Informatics in ROP cohort from 8 North American centers, consisting of 947 patients and 5945 clinical eye examinations with fundus images, was used. Pretreatment eyes were categorized by disease severity: none, mild, type 2 or pre-plus, treatment-requiring (TR) without AP-ROP, TR with AP-ROP. Analyses compared TR with AP-ROP and TR without AP-ROP to investigate differences between AP-ROP and other TR disease. METHODS: A reference standard diagnosis was generated for each eye examination using previously published methods combining 3 independent image-based gradings and 1 ophthalmoscopic grading. All fundus images were analyzed using a previously published deep learning system and were assigned a score from 1 through 9. MAIN OUTCOME MEASURES: Birth weight, gestational age, postmenstrual age, and vascular severity score. RESULTS: Infants who demonstrated AP-ROP were more premature by birth weight (617 g vs. 679 g; P = 0.01) and gestational age (24.3 weeks vs. 25.0 weeks; P < 0.01) and reached peak severity at an earlier postmenstrual age (34.7 weeks vs. 36.9 weeks; P < 0.001) compared with infants with TR without AP-ROP. The mean vascular severity score was greatest in TR with AP-ROP infants compared with TR without AP-ROP infants (8.79 vs. 7.19; P < 0.001). Analyzing the severity score over time, the rate of progression was fastest in infants with AP-ROP (P < 0.002 at 30-32 weeks). CONCLUSIONS: Premature infants in North America with AP-ROP are born younger and demonstrate disease earlier than infants with less severe ROP. Disease severity is quantifiable with a deep learning-based score, which correlates with clinically identified categories of disease, including AP-ROP. The rate of progression to peak disease is greatest in eyes that demonstrate AP-ROP compared with other treatment-requiring eyes. Analysis of quantitative characteristics of AP-ROP may help improve diagnosis and treatment of an aggressive, vision-threatening form of ROP.


Assuntos
Diagnóstico por Imagem/métodos , Oftalmoscopia/métodos , Retinopatia da Prematuridade/diagnóstico , Telemedicina/métodos , Progressão da Doença , Feminino , Humanos , Incidência , Recém-Nascido , Masculino , América do Norte/epidemiologia , Retinopatia da Prematuridade/epidemiologia , Estudos Retrospectivos , Fatores de Risco
19.
BMC Cancer ; 20(1): 118, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32050941

RESUMO

BACKGROUND: Although shear wave elastography (SWE) is reported to be useful in detecting malignant thyroid nodules, it shows a wide range of cut-off values of elasticity index (EI) in detecting malignant nodules. The cause of discrepancy remains unclear. Fibrosis of the tumors is known to increase the EI in SWE, and matching of SWE and surgical histopathology has not been fully illustrated in thyroid cancer. We aimed to evaluate the reproducibility of the new total nodular region of interest (ROI) method excluding the subjective features of focal circular ROI placement and to determine the lesion that causes the elevation of EI on SWE and on histopathology. METHODS: A total of 29 thyroid cancers from 28 patients were included. We evaluated the reproducibility of EI in the new total nodular ROI using Q-Box Trace program and compared the EI in focal nodular ROI using a 3-mm circular area. We analyzed the correlation between fibrosis and EI. RESULT: The coefficient of variation (CV) of the intrarater assay was significantly lower in total nodular ROI than in focal nodular ROI within the image in rater 1 (1.7% vs. 13.4%, p < 0.001) and in rater 2 (1.4% vs. 16.9%, p < 0.001) and in different images in rater 1 (7.6% vs. 12.3%, p = 0.040) and in rater 2 (7.5% vs. 19.8%, p = 0.004). Moreover, CV of the interrater assay showed similar results (14.9% vs. 19%, p = 0.030). Interrater intraclass correlation coefficient showed better agreement in total nodular ROI than in focal nodular ROI (0.863 vs. 0.783). The degree of fibrosis on histopathology showed significant correlations with EI (EMean, p < 0.001; EMax, p = 0.027), and the location of fibrosis was concordant with the high EI area on SWE. CONCLUSION: Our study revealed that the new total nodular ROI method showed higher reproducibility and better agreement in intra- and interrater assay than the focal nodular ROI method, suggesting a valuable and standardized method in clinical practice. Moreover, our results showed that fibrosis in the histopathology increased EI on SWE and might lead to the discrepancy of the cut-off values in detecting thyroid cancer.


Assuntos
Técnicas de Imagem por Elasticidade , Elasticidade , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Biópsia , Técnicas de Imagem por Elasticidade/métodos , Técnicas de Imagem por Elasticidade/normas , Feminino , Fibrose , Humanos , Masculino , Reprodutibilidade dos Testes , Ultrassonografia
20.
J Clin Neurol ; 16(1): 66-74, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31942760

RESUMO

BACKGROUND AND PURPOSE: This study aimed to determine the clinimetric properties of the Korean version of Parkinson's Disease Sleep Scale-2 (K-PDSS-2) and whether distinct subtypes of sleep disturbance can be empirically identified in patients with Parkinson's disease (PD) using the cross-culturally validated K-PDSS-2. METHODS: The internal consistency, test-retest reliability, scale precision, and convergent validity of K-PDSS-2 were assessed in a nationwide, multicenter study of 122 patients with PD. Latent class analysis (LCA) was used to derive subgroups of patients who experienced similar patterns of sleep-related problems and nocturnal disabilities. RESULTS: The total K-PDSS-2 score was 11.67±9.87 (mean±standard deviation) at baseline and 12.61±11.17 at the retest. Cronbach's α coefficients of the total K-PDSS-2 scores at baseline and follow-up were 0.851 and 0.880, respectively. The intraclass correlation coefficients over the 2-week study period ranged from 0.672 to 0.848. The total K-PDSS-2 score was strongly correlated with health-related quality of life measures and other corresponding nonmotor scales. LCA revealed three distinct subtypes of sleep disturbance in the study patients: "less-troubled sleepers," "PD-related nocturnal difficulties," and "disturbed sleepers." CONCLUSIONS: K-PDSS-2 showed good clinimetric attributes in accordance with previous studies that employed the original version of the PDSS-2, therefore confirming the cross-cultural usefulness of the scale. This study has further documented the first application of an LCA approach for identifying subtypes of sleep disturbance in patients with PD.

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