Granulomatous Rosacea in Korean Patients: Diagnosis Based on Combining Clinical and Histological Findings.

BACKGROUND: Granulomatous rosacea (GR) is a rare inflammatory skin disease, which is considered a variant of rosacea, apart from other types of rosacea. OBJECTIVE: This study aimed to summarize the characteristics of Korean patients diagnosed with GR by combining clinical and histological findings. METHODS: Fifteen cases, both clinically and histologically consistent with GR, were selected and were subsequently analyzed to describe clinical and histological characteristics. RESULTS: A total of 20 patients showed granulomatous infiltration in skin biopsies, but only 15 of them were clinically consistent with GR. Five patients who showed granulomatous inflammation were clinically consistent with erythematotelangiectatic or papulopustular rosacea. Among 15 patients, 13 (86.7%) were female and 2 (13.3%) were male. The most frequently involved area was the cheek, and none of the patients showed extrafacial lesions. There seems to be a possibility that treatment duration may be associated with the treatment response. CONCLUSIONS: This study confirms clinical characteristics of GR based on the diagnosis combining both clinical and histological findings.

Gender difference exists in sagittal curvature of the distal femoral condyle morphology for osteoarthritic population.

PURPOSE: The aim of this study was to investigate gender-related differences in the sagittal curvature of the distal femoral condyle in the Korean osteoarthritic population METHODS: The sagittal curvatures of the distal femoral condyle of 1979 Korean patients (1680 female and 299 male) were evaluated using magnetic resonance imaging (MRI). MRI scans were obtained before total knee arthroplasty (TKA) in consecutive patients with end-stage osteoarthritis. The sagittal curvature of the distal medial and lateral femoral condyles was characterized with respect to the anterior, distal, and posterior circles. The diameter of each circle was measured. This study included 1873 varus and 106 valgus knees. RESULTS: The anterior, distal, and posterior diameters were significantly greater in the male patients than in the female patients (P < 0.05). In the male patients, the lateral diameter was significantly greater than the medial diameter in the anterior and posterior circles (P < 0.05). However, in the female patients, the lateral diameter was significantly greater only in the anterior circle. In both genders, the medial diameter was significantly greater than the lateral diameter of the distal circle (P < 0.05). For both the varus and valgus knees, the lateral diameter was greater than the medial diameter in the anterior circle. CONCLUSIONS: It has been concluded that the sagittal curvature of the femoral condyles in females is significantly different to their male counterparts. This study provides a reliable evaluation of the sagittal curvature of the femoral condyle in the Korean population. These gender-related differences in the sagittal curvature of the femoral condyle may require further investigation to determine surgical implications such as in TKA, and the existence of gender-related dimorphism in specific knee injuries and pathologies, such as ligament injuries and tibiofemoral problems. LEVEL OF EVIDENCE: III.

Morphologic difference and size mismatch in the medial and lateral tibial condyles exist with respect to gender for unicompartmental knee arthroplasty in the Korean population.

PURPOSE: The purpose of this study was to characterize the geometry of the proximal tibia in both genders in the Korean population. Anthropometric data on the medial and lateral tibial condyles of the osteoarthritic knees of 149 males and 814 females were obtained using three-dimensional magnetic resonance imaging. METHODS: In the medial and lateral proximal tibial condyles, the anteroposterior (AP) dimension, widest dimension (WD) at defined points, and condylar aspect ratio were evaluated. These measurements were compared with similar dimensions of the tibial components from five commonly used unicompartmental knee arthroplasty (UKA) designs in Korea. RESULTS: Both the AP dimension and WD in the medial and lateral tibial condyles of the male patients were significantly greater than those of the female patients (P < 0.05). In addition, the AP dimension and WD were greater in the medial than in the lateral tibial condyle (P < 0.05). There was WD overhang in three and two prostheses in the medial and lateral tibial condyles, respectively. A decrease in the condylar aspect ratio with an increasing AP dimension was found in the medial and lateral tibial condyles for both the male and female patients. CONCLUSIONS: Smaller medial and lateral tibial condylar dimensions are more frequent in Korean women than in Korean men. This study highlights the finding that conventional UKA designs lead to size mismatch in the Korean population and may indicate an important guideline on proper gender-specific UKA tibial prostheses with different WD/AP dimension aspect ratios. In addition, this study suggests that the shape of the medial tibial plateau is different to that of the lateral plateau, which can lead to a mediolateral overhang for medial UKA in an attempt to optimize the AP coverage. LEVEL OF EVIDENCE: III.

Gender differences exist in rotational anatomy of the distal femur in osteoarthritic knees using MRI.

PURPOSE: Optimal rotational alignment of the femoral component is essential for total knee arthroplasty (TKA). The femoral transepicondylar axis (TEA), Whiteside's line (WSL), and posterior condylar axis (PCA) are various intra-operative references that can be used to determine femoral rotation, and each has advantages and disadvantages. This study aimed to define the rotational anatomy of the distal femur and investigate its relationship with gender in osteoarthritic knees. METHODS: Magnetic resonance imaging (MRI) was obtained from 1522 patients (1298 females and 224 males) with end-stage knee osteoarthritis prior to TKA. MRI was constructed into three-dimensional models. The angles between the TEA and WSL, WSL and PCA, and TEA and PCA were calculated for each patient. In addition, gender differences in femoral rotation were evaluated. RESULTS: The PCA was 2.2° ± 1.0° internally rotated relative to the TEA. WSL was 1.2° ± 2.8° externally rotated relative to the TEA. The WSL to TEA relationship exhibited greater variability than the PCA to TEA relationship. PCA was more internally rotated and WSL was more externally rotated relative to TEA in female group than male group. Based on the standard reference rules of 3° external rotation from the PCA that has been conventionally used, 15.7% of patients showed external rotation lower 1° or greater than 5° external rotation from the PCA. In the mean external rotation of the TEA from the PCA (2.2°) from this population; however, the percentage of patients showing ± 2° from their TEA dropped to 5.1% of patients. CONCLUSION: Gender difference and variability exist in distal femoral rotational anatomy. These data can be useful in consideration of femoral anatomy variability and gender difference. The same cutting angle may lead to malrotation of the femoral component. LEVEL OF EVIDENCE: Consecutive patients, level III.

Difference in coronal curvature of the medial and lateral femoral condyle morphology by gender in implant design for total knee arthroplasty.

PURPOSE: The purpose of this study was to investigate the morphometric data obtained from the three-dimensional magnetic resonance images of ethnic Korean knee osteoarthritis, and to evaluate the morphological differences between the coronal curvature of the female and male femoral condyles. METHODS: The differences in coronal curvature of the femoral condyle morphology of 1990 patients (1689 females and 301 males) were evaluated in three dimensions. A close-fit diameter was, respectively, generated on the medial and lateral femoral condyle articular surfaces, and these diameters reflect the coronal diameter of the femoral condyle curvature. These measurements were compared with those of the femoral design of five different commonly used total knee arthroplasty (TKA) implant designs. RESULTS: The average diameter of the curvature of the medial condyles was significantly larger than that of the lateral condyles (P < 0.05). This trend was found in the male and female groups. In addition, the average diameter of the curvature of the femoral condyles was found to significantly differ between males and females (P < 0.05). For four TKA implant designs, the average diameter of the coronal curvature of femoral condyle was smaller than that obtained via our measurements, whereas one TKA implant design yielded a smaller average diameter. Furthermore, the medial and lateral coronal curvatures of the femoral condyle were symmetric in all TKA implant designs. CONCLUSION: The study provided a reliable and consistent evaluation of the coronal curvature of femoral condyles in the Korean population. These results showed that a gender-specific or asymmetric femoral component design is required to regenerate the coronal curvature of the femoral condyles for ethnically Korean males and females.

Morphometric study of gender difference in osteoarthritis posterior tibial slope using three-dimensional magnetic resonance imaging.

Posterior tibial slope (PTS) is an important parameter of sagittal alignment associated with postoperative stability and kinematics after total knee arthroplasty (TKA). However, data are limited regarding the innate gender differences in PTS in Koreans. The current study separately measured the PTS of the medial and lateral tibial plateau on magnetic resonance images of 511 patients with knee joint osteoarthritis who had Kellgren and Lawrence grade 3 and 4 (430 women, 81 men) and compared the measurements between and within the genders. The tibia was then rotated to the tibial plateau with the tibial centroid axis and the PTS was evaluated from best-fit planes on the surface of the proximal tibia and individually for the medial, lateral, and overall plateaus. The average overall PTS was 10.0° ± 3.5°. The average overall PTS of the female and male patients was 10.2° ± 3.4° and 8.8° ± 4.0°, respectively. The average medial PTS was 10.4° ± 4.0°, significantly greater than the mean lateral PTS of 8.7° ± 3.9° (P < 0.05). The average medial and lateral tibial slopes for female patients were 10.7° ± 3.8° and 8.8° ± 3.8°, respectively, while the average medial and lateral tibial slopes for male patients were 8.9° ± 4.8° and 7.9° ± 4.7°, respectively. The medial and overall PTS were significantly greater in female patients than in male patients (P < 0.05). The results showed a gender difference in PTS and that medial PTS was greater than lateral PTS. These findings have clinical relevance in knee reconstructive surgery for determining ideal placement of the posterior slope tibial component. Surgeons should be aware of variability and gender differences in the tibial slope of patients undergoing TKA.

Gender difference in bowing of the sagittal femoral morphology measurement using magnetic resonance imaging.

The importance of femoral sagittal bowing on total knee arthroplasty (TKA) has not been actively discussed. Femoral sagittal bowing can lead to cortex damage, fractures, or femoral malalignment. Therefore, the purpose of this study was to evaluate femoral sagittal bowing at different segments of the femur in the Korean population, and to discuss the implications on total knee arthroplasty. Differences in the morphology of femoral sagittal bowing for 978 patients-829 women and 148 men-were evaluated using magnetic resonance imaging. The angle between the femoral mechanical axis and the anterior cortex line was measured for all the patients. In addition, the gender difference in femoral sagittal bowing was investigated. The angle of femoral sagittal bowing with the mechanical axis was 2.8˚ ± 2.2˚. The angles for femoral sagittal bowing were 2.9˚ ± 2.2˚ and 2.3˚ ± 2.6˚ for females and males, respectively. Thus, a gender difference was found in the femoral sagittal bowing (p < 0.05). Excessive sagittal bowing of the femur can affect the final sagittal position of the femoral component, and this has implications for implant design selection. We recommend that surgeons accurately perform pre-operative evaluation of femoral bowing to prevent potential malalignment, rotation, and abnormal stresses between the femur and implant.

Clinical and Genetic Characteristics Analysis of Korean Patients with Stargardt Disease Using Targeted Exome Sequencing.

PURPOSE: To investigate genetic mutations in Korean patients with Stargardt disease (STGD) using exome sequencing, and to analyze the correlations between genetic mutations and clinical phenotypes. METHODS: Peripheral venous blood was obtained from 24 clinically diagnosed Korean STGD patients, followed by extraction of genomic DNAs. Using exome sequencing we investigated gene mutations for the adenosine triphosphate-binding cassette, subfamily A, member 4 (ABCA4) elongation of very-long-chain fatty acids 4 (ELOVL4), and prominin 1 (PROM1), and confirmed gene mutations by the direct sequencing of polymerase chain reaction products. RESULTS: ABCA4 mutations were confirmed in 17 of 24 patients, and 12 novel mutations were identified. ELOVL4 and PROM1 gene mutations were not identified in this study. We also identified 16 previously reported mutations related to STGD1. In patients whose disease symptoms occurred before 20 years of age, visual acuity was poorer and atrophic flecks were more frequently found. In addition, more ABCA4 mutations were found in patients who had choroidal silence or atrophic flecks. CONCLUSIONS: Novel ABCA4 gene mutations were found in Korean patients with STGD1. This study will facilitate better understanding of the relationships between ABCA4 gene mutations and clinical symptoms in Korean patients.

Gender-related morphological differences in sulcus angle and condylar height for the femoral trochlea using magnetic resonance imaging.

PURPOSE: This study aimed to elucidate the primary differences in trochlear morphology between men and women utilizing three-dimensional magnetic resonance image reconstruction of the femoral trochlea. METHODS: Differences in anthropometric femoral trochlea data of 975 patients (825 women, 150 men) were evaluated. The following morphological parameters were measured at three flexion angles (15°, 30°, and 45°) of the femoral trochlea: the sulcus angle, condylar height, and the trochlear groove orientation and mediolateral groove position. RESULTS: The sulcus angle was significantly greater in women than in men at 15° and 45° flexions (P < 0.05). However, there was no gender difference found in the sulcus angle at 30° flexion. Medial and lateral condylar height values were greater in men than in women for the three flexion angles (P < 0.01). The trochlear groove orientation and mediolateral groove position showed no gender-related differences. CONCLUSIONS: Magnetic resonance image reconstruction demonstrated that measurement of trochlear morphology varied significantly between men and women. This study provides guidelines for the design of a suitable femoral component for total knee arthroplasty, considering gender-specific differences in the Korean population. Biomechanical guidelines for total knee arthroplasty in Korean individuals can be optimized using our finding, so as the risk of patellar dislocation to be decreased. Surgeons should be aware of gender differences in femoral trochlear to optimize choice of implant. LEVEL OF EVIDENCE: III.

Gender differences in morphology exist in posterior condylar offsets of the knee in Korean population.

PURPOSE: This study aimed to analyze the morphometric data from magnetic resonance images of arthritic knees in Korean adults, and to identify the existence of morphological differences of femoral posterior condylar offset (PCO) between genders. METHODS: The differences in anthropometric PCO data in 975 patients (825 female and 150 male) were evaluated. The distances from the anterior and posterior femoral shaft cortex line to the most posterior femoral condyle tangent line were defined as the anterior-posterior dimension (AP) and the PCO. The PCO ratio (PCOR) was calculated as PCO/AP. RESULTS: The medial PCO was greater than the lateral PCO (26.3 ± 2.2 vs. 24.3 ± 2.3 mm, p < 0.01). This difference was observed in both female patients (medial: 26.2 ± 2.2 mm vs. lateral: 24.2 ± 2.2 mm, p < 0.01) and male patients (medial: 26.8 ± 2.3 mm vs. lateral: 24.8 ± 2.4 mm, p < 0.01). The medial and lateral PCO values were also greater in male patients than in female ones (p < 0.01). In contrast, PCOR was greater in female patients than in male ones, both in the medial and lateral femoral condyles (p < 0.01). CONCLUSIONS: It was shown that medial and lateral PCO and PCOR were asymmetric, and that there was gender difference in Korean population in our study. In addition, our data showed that the PCOR of contemporary TKAs may be small for Asian patients that may not be sufficient to meet the needs of the Korean patient population. These results confirm that a gender-specific femoral component design is necessary to recreate the PCO for male and female Asian populations. LEVEL OF EVIDENCE: Non-consecutive patients, Level III.

Predicting Successful Recanalization in Patients with Native Coronary Chronic Total Occlusion: The Busan CTO Score.

BACKGROUND: The optimal strategy to manage chronic total occlusion (CTO) remains unclear. The Japanese CTO multicenter registry (J-CTO) score is an established tool for predicting successful recanalization. However, it does not take into account nonangiographic predictors for final technique success. In the present study, we designed and tested a scoring model called the Busan single-center CTO registry (B-CTO) score combining clinical and angiographic characteristics to predict successful CTO recanalization in Korean patients. METHODS: Prospectively enrolled CTO patients (n = 438) undergoing coronary intervention (1999-2015) were assessed. The B-CTO score comprises 6 independent predictors: age 60-74 years and lesion length ≥20 mm were assigned 1 point each, while age ≥75 years, female gender, lesion location in the right coronary artery, blunt stump, and bending >45° were assigned 2 points each. For each predictor, the points assigned were based on the associated odds ratio by multivariate analysis. The lesions were classified into 4 groups according to the summation of points scored to assess the probability of successful CTO recanalization: easy (score 0-1), intermediate (score 2-3), difficult (score 4-5), and very difficult (score ≥6). CTO opening was designated as the primary endpoint regardless of the interventional era or the skill of the operator. RESULTS: The final success rate for B-CTO was 81.1%. The probability of successful recanalization for patient groups classified as easy (n = 64), intermediate (n = 148), difficult (n = 134), and very difficult (n = 92) was 95.3, 86.5, 79.1 and 65.2%, respectively (p for trend <0.001). When compared to the J-CTO, the B-CTO score demonstrated a significant improvement in discrimination as indicated by the area under the receiver-operator characteristic curve (AUC 0.083; 95% CI 0.025-0.141), with a positive integrated discrimination improvement of 0.042 and a net reclassification improvement of 56.0%. CONCLUSIONS: The B-CTO score has been designed and validated in Korean patients with native coronary CTO and is an improved tool for predicting successful recanalization. Wider application of the B-CTO score remains to be explored.

A multicenter, randomized, open-label pilot trial assessing the efficacy and safety of etanercept 50 mg twice weekly followed by etanercept 25 mg twice weekly, the combination of etanercept 25 mg twice weekly and acitretin, and acitretin alone in patients with moderate to severe psoriasis.

BACKGROUND: Etanercept, a soluble tumor necrosis factor receptor, and acitretin have been shown to be effective in treating psoriasis. Acitretin is widely used in Korea. However, the combination of etanercept plus acitretin has not been evaluated among Korean patients with psoriasis. The objective of this study was to investigate the efficacy and safety of combination therapy with etanercept and acitretin in patients with moderate to severe plaque psoriasis. METHODS: Sixty patients with psoriasis were randomized to receive etanercept 50 mg twice weekly (BIW) for 12 weeks followed by etanercept 25 mg BIW for 12 weeks (ETN-ETN); etanercept 25 mg BIW plus acitretin 10 mg twice daily (BID) for 24 weeks (ETN-ACT); or acitretin 10 mg BID for 24 weeks (ACT). The primary efficacy measurement was the proportion of patients achieving 75 % improvement in Psoriasis Area and Severity Index (PASI 75) at week 24. Secondary end points included 50 % improvement in PASI (PASI 50) at week 24 and clear/almost-clear by Physician Global Assessment (PGA) at each visit through week 24. RESULTS: The proportions of patients achieving PASI 75, PASI 50, and PGA clear/almost-clear at week 24 in the ETN-ETN (52.4, 71.4, and 52.4 %, respectively) and ETN-ACT groups (57.9, 84.2, and 52.6 %, respectively) were higher than in the ACT group (22.2, 44.4, and 16.7 %, respectively). The incidence of adverse events was similar across all arms. This was an open-label study with a small number of patients. CONCLUSION: In Korean patients with moderate to severe plaque psoriasis, etanercept alone or in combination with acitretin was more effective than acitretin. All treatments were well tolerated throughout the study. TRIAL REGISTRATION: This study was registered on July 7, 2009 at ClinicalTrials.gov, NCT00936065 .

Proteomic analysis of cardiovascular disease-associated proteins in Korean patients with moderate-to-severe atopic dermatitis.

Background: Cardiovascular diseases (CVDs) have been associated with atopic dermatitis (AD), including in Korean patients. Previous studies on AD have primarily focused on patients of European ancestry, while the Asian endotype exhibits distinct characteristics. This study aimed to characterize the blood proteomic signature of Korean patients with moderate-to-severe AD, with an emphasis on proteins related to CVDs. Methods: A total of 78 participants, including 39 patients with moderate-to-severe AD and 39 age- and sex-matched healthy controls, were enrolled. Blood proteomics analysis was performed using the Olink CVD II panel, which measures the expression levels of 92 proteins associated with CVDs. Results: Unsupervised hierarchical clustering revealed 44 upregulated and 5 downregulated proteins in AD patients compared to healthy controls. Principal component analysis (PCA) effectively distinguished AD patients from healthy subjects based on the complete set of proteins or the subset of upregulated proteins. A multiple linear regression model comprising CCL17 and FGF21 showed a strong correlation with disease severity (R = 0.619). Correlation analysis identified 25 highly correlated proteins, including STK4, ITGB1BP2, and DECR1, which were newly found to be upregulated in Korean AD patients. Pathway analysis highlighted the involvement of these proteins in vascular system, inflammation, and lipid metabolism pathways. Conclusion: The blood proteomic profile of moderate-to-severe AD patients in Korea differed from healthy controls using the CVD II panel. This study provides potential biomarkers for the AD-CVD association and insights into the pathways contributing to this relationship in the Korean population.

Medio-Lateral and Flexion-Extension Gap Imbalances in Mechanically Aligned Total Knee Arthroplasty Using Measured Resection Technique in Korean Patients: 3D Simulation.

BACKGROUND: It is well known that the measured resection (MR) technique in mechanically aligned (MA) total knee arthroplasty (TKA) generates significant gap imbalances, but little is known about whether this applies to the knees of Asian patients. The aim of this study was to evaluate the medio-lateral and flexion-extension gap imbalances and to find the most optimal posterior femoral condyle resection method for operating on the knees of Asian patients. METHODS: In total, 738 magnetic resonance imaging (MRI) scans of consecutive patients who underwent TKA were obtained. Four posterior femoral condylar resection methods were used: alignment by the surgical transepicondylar axis (TEA), Whiteside's line (WSL), 3° external rotation to the posterior condylar axis (PCA), and flexion-extension axis (FEA). RESULTS: For the medial compartments, there were significant differences between the flexion and extension gaps in the varus knee group in all four methods, but there were no differences between the flexion and extension gaps in the valgus knee group. For the lateral compartment, all the methods showed significant differences except for WSL of the valgus knee group and FEA of the varus knee group. CONCLUSIONS: In Asian patients, the use of the MA MR technique inevitably leads to medio-lateral or flexion-extension imbalances. Therefore, surgeons should consider which methods can minimize imbalances and choose the best method within the technically possible range.

Gender-Based Quantitative Analysis of the Grand Piano Sign in Mechanically Aligned Total Knee Arthroplasty in Asians.

In mechanically aligned (MA) total knee arthroplasty (TKA), the grand piano sign helps surgeons to further ensure the proper external rotation of the femoral component. The goal of this study was to determine the sex-related differences in the shape of the anterior resection surface using 3D magnetic resonance imaging (MRI) models. MRI scans were performed on 267 consecutive patients (202 women and 65 men) with osteoarthritis who underwent TKA in order to reconstruct a 3D model. Virtual anterior condylar resection was performed based on the surgical transepicondylar axis (sTEA), Whiteside's line (WSL), and flexion-extension axis (FEA). On the anterior resection surface, both lateral length (LatL) and medial length (MedL) were measured, and the ratio between the two (MedL/LatL) was calculated. The mediolateral width of the distal femur (ML) and anterior resection surface (M'L') were measured, and the ratio between the M'L' and ML (M'L'/ML) was calculated. Both the lateral deviation (LD) and the ratio between LD and ML (LD/ML) were also determined. Morphological classification of the anterior resection surface was conducted based on the presence of a definite medial peak. When based on the sTEA or WSL, the MedL/LatL of female subjects was significantly greater than that of male subjects (p < 0.001 and p < 0.05, respectively). The MedL/LatL of the FEA was consistently larger than that obtained using the sTEA or WSL. Among female subjects, the MedL/LatL of the sTEA was significantly greater than that of the WSL, although this was not the case in either the total study population or the male subjects alone. When based on the sTEA, the M'L'/ML was statistically greater in the female subjects (p < 0.01). The LD was greater in the male subjects (p < 0.01), but there was no difference between the male and female subjects when comparing the LD/ML (p = 0.93). The proportion of double- and single-peak types was not significantly different between the sexes (p = 0.196). Surgeons should be aware that the shape of the anterior resection surface may differ depending on the sex of the patient. The results of this study provide more consistent surgical outcomes as well as fundamental anatomical data for designing suitable prostheses applicable to the Korean population.

A nationwide, multicenter retrospective study on the effectiveness and safety of eribulin in Korean breast cancer patients (REMARK).

PURPOSE: Approval of eribulin for metastatic breast cancer was based on data primarily from Western patients, and there is a paucity of data on the effectiveness and safety of eribulin for Asian patients. To determine the effectiveness and safety of eribulin in Korean women with breast cancer in a real-world setting, we conducted a nationwide, multicenter, retrospective study. METHODS: Patients with locally advanced or metastatic breast cancer who were treated with eribulin in 14 centers throughout Korea were included in this study. Eribulin was generally administered at a dose of 1.23 mg/m2 (equivalent to 1.4 mg/m2 eribulin mesylate) by intravenous infusion for 2-5 min, or as a diluted solution, on Days 1 and 8 of every 21-day cycle. The primary endpoint was progression-free survival (PFS) rate at 6 months. Secondary endpoints included median PFS, overall survival (OS), time-to-treatment failure (TTF), tumor response rate, and incidence of hematologic treatment-emergent adverse events (TEAEs). RESULTS: The safety and full analysis populations included 398 and 360 (38 had no efficacy data) patients, respectively. The PFS rate at 6 months was 37.8%. Median PFS, OS, and TTF were 134, 631, and 120 days, respectively. Objective response rate, clinical benefit rate, and disease control rate were 18.1%, 50.6%, and 49.4%, respectively. Hematologic TEAEs were reported in 65.1% of patients; neutropenia (56.8%) and anemia (11.3%) were most common. CONCLUSION: Real-world effectiveness and safety of eribulin in Korean breast cancer patients were consistent with previous reports; no new safety concerns were identified.

The femoral trochlear anterior line is a better alternative intra-operative reference compared to femoral anterior tangent line for femoral rotation in both genders in total knee arthroplasty.

PURPOSE: To determine the most reliable reference axis for the femoral component rotation in TKA patients by comparing the trochlear anterior line (TAL) and the femoral anterior tangent line (FAT). To evaluate the variability of each anatomic parameter in a Korean population. METHODS: Magnetic resonance images (MRIs) were taken for 500 patients (400 females and 100 males) with knee joint osteoarthritis who had Kellgren and Lawrence grade 3 and 4 prior to TKA in our institution between February 2016 and September 2017. It was investigated that whether significant differences in variance and gender exist for TAL and FAT. RESULTS: TAL and the FAT were internally rotated by 5.1° ± 3.1° and 6.8° ± 6.1°, respectively, about the Transepicondylar axis (TEA). Although no gender-related differences were found for the TAL, they were found for the FAT. The variance of the TAL with respect to the TEA was significantly smaller compared with that for the FAT and thus exhibited a more consistent distribution. In addition, such a trend was found for both genders. CONCLUSIONS: The results show that the TAL is a favorable index for appropriate rotational alignment of the femoral component in TKA.

Effect of the presence of the articular cartilage on the femoral component rotation in total knee arthroplasty in female and varus osteoarthritis knees.

PURPOSE: Surgical techniques for total knee arthroplasty (TKA) require femoral rotational corrections that alter the position of the surface of the posterior femoral joint especially in kinematic alignment. However, preoperative planning of TKA based on computed tomography (CT), without knowing the femoral cartilage thickness, may cause post-surgery failures in femoral rotation. Therefore, this study aimed to evaluate the effects of posterior condyle cartilage thickness on rotational alignment in the femoral component. METHODS: Three-dimensional magnetic resonance imaging (MRI) scans were obtained for 139 male and 531 female osteoarthritis patients. The angles defined by the femoral posterior condylar axis (PCA) and the surgical transepicondylar axis (TEA) were evaluated with respect to the presence of cartilage. Additionally, these effects were evaluated with respect to patient gender and varus/valgus condition. RESULTS: In all patients, the angle between the TEA and PCA was significantly greater in the presence of cartilage than in the absence of cartilage. This result was also seen in female patients. However, there was no difference in the TEA/PCA angle in male patients based on the presence of cartilage. The TEA/PCA angle was significantly greater in the presence of cartilage than in the absence of cartilage in the female varus group. However, there were no differences in the TEA/PCA angle based on the presence of cartilage in the male varus/valgus and female valgus groups. Cartilage thickness in the posterior femoral condyle was significantly greater on the lateral side than on the medial side in all and male patients. However, there was no difference between the genders regarding cartilage thickness. CONCLUSION: Surgical planning for TKA based on CT does not consider articular cartilage and could lead to external malrotation of the femoral implant. Therefore, the effect of the remaining posterior condylar cartilage should be considered by surgeons to prevent over-rotation of the femoral component, especially in female varus knees.

The posterior cortical axis as an alternative reference for femoral component placement in total knee arthroplasty.

BACKGROUND: Although several reference axes have been established for determining femoral rotational alignment during total knee arthroplasty (TKA), the most accurate axis is undetermined. This study determines the relationship between the posterior cortical axis (PCA) and the trochlear anterior line (TAL) of the femur in relation to the epicondylar axis. METHODS: A total of 341 patients who underwent TKA for osteoarthritis were enrolled. Patients who had undergone previous bony surgery or replacement that might have changed the femoral geometry were excluded. Finally, 336 patients (200 females and 136 males) were included in the study. The angles between the transepicondylar axis (TEA) and TAL and TEA and the femoral PCA (FPCA) were evaluated. We also assessed whether there was any significant differences in variance and gender in these two angles. Student's t tests were used to determine the significance of coronal alignment and any gender-based differences. The variances between the TAL/TEA and FPCA/TEA angles were compared using F tests. RESULTS: The FPCA was externally rotated by 2.6° ± 3.6°, and the trochlear anterior line was internally rotated by 5.2° ± 5.5°, relative to the TEA. Gender-based differences were observed in the comparisons between anatomical references and TEA. CONCLUSIONS: The FPCA is a more conservative landmark than the TAL for intraoperative or postoperative approximation of the TEA. When conventional reference axes, such as the posterior condylar axis and the anteroposterior axis, are inaccurate, surgeons can refer to this alternative reference. These findings demonstrate that the FPCA may be useful for determining the rotational alignment of the femoral component before and during TKA.

The Effect of Topical Ganciclovir and Corticosteroid on Cytomegalovirus Corneal Endotheliitis in Korean Patients.

PURPOSE: To report long-term outcomes of topical ganciclovir (GCV) and corticosteroids in Korean patients with cytomegalovirus (CMV) corneal endotheliitis. METHODS: This retrospective study included 13 eyes from 13 patients with CMV corneal endotheliitis, with a follow-up period of 24.5 ± 8.2 months. The patients were consistently maintained with topical 2% GCV and 1% prednisolone acetate eyedrop. RESULTS: All patients demonstrated unilateral typical coin-shaped keratic precipitates (KPs) or linear KP, and positive CMV polymerase chain reaction of aqueous humor. After 2 weeks of treatment, all patients showed decrease of clinical signs. During the follow-up, four patients developed mild anterior chamber inflammation with increased intraocular pressure without typical coin-shaped KPs or edema, started to use the initial dose, and resolved the clinical signs. One patient showed recurrence of corneal edema twice, and was administered systemic valgancyclovir for 2 weeks upon second recurrence with resolution of clinical signs. CONCLUSION: Long-term maintenance therapy with topical GCV and corticosteroids are effective and maintain corneal endothelial function in Korean patients with CMV endotheliitis.