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Predictors of Success of Selective Laser Trabeculoplasty Adjusted for Intraocular Pressure Variations (단안 선택적 레이저섬유주성형술에서 안압 변동을 보정한 성공예측인자의 분석)

  • Lee, Jun Seok;Lee, Chong Eun;Seo, Sam;Lee, Kyoo Won
    • Journal of The Korean Ophthalmological Society
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    • v.59 no.12
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    • pp.1166-1172
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    • 2018
  • Purpose: To investigate the efficacy, and identify predictors of success of selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG) patients after adjusting for intraocular pressure (IOP) changes in the untreated fellow eye. Methods: This retrospective chart review included 52 eyes of 52 OAG patients who underwent SLT in one eye and were followed-up for at least 1 year after the procedure. The IOP was measured before the treatment, at 1, 2, and 3 months posttreatment, and every 3 months thereafter. To account for the possible influence of IOP fluctuations on laser outcomes, post-laser IOP values of the treated eye of each patient were also analyzed, after adjusting for IOP changes in the untreated fellow eye. Success was defined as an IOP decrease ${\geq}20%$ of the pretreatment IOP. The success rate was determined based on Kaplan-Meier survival analysis and factors predictive of success were analyzed using the Cox proportional hazard model. Results: The mean pretreatment IOP was $23.17{\pm}6.96mmHg$. The mean IOP reduction was $5.59{\pm}4.78mmHg$ (29.7%) and the success rate was 65.4% at 1 year. The adjusted mean IOP reduction was $4.70{\pm}4.67mmHg$ (23.9%) and the adjusted success rate was 53.9%. Pretreatment IOP was associated with SLT success; the higher the pretreatment IOP, the greater the post-laser IOP reduction (p = 0.025). Age and mean deviation index did not show a significant association with SLT success (p = 0.066 and p = 0.464, respectively). Conclusions: SLT is a safe and effective alternative method of IOP reduction in OAG patients. Herein, pretreatment IOP was the only factor significantly associated with SLT success. IOP fluctuations of the untreated eye should be considered for a better understanding of the impact of treatment.

Inter-Rater Reliability of Carotid Intima-Media Thickness Measurements in a Multicenter Cohort Study (다기관 코호트 연구에서 경동맥 내막-중막 두께 측정의 측정자간 신뢰도 평가)

  • Lee, Jung Hyun;Choi, Dong Phil;Shim, Jee-Seon;Kim, Dae Jung;Park, Sung-Ha;Kim, Hyeon Chang
    • Journal of health informatics and statistics
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    • v.41 no.1
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    • pp.49-56
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    • 2016
  • Objectives: Carotid intima-media thickness (CIMT) and the presence of carotid artery plaque are widely used as preclinical markers of atherosclerosis. Due to operator dependency in measuring CIMT, it is important to evaluate the reliability of measuring CIMT and plaque between centers in a multicenter study. The purpose of this study is to evaluate the inter-rater reliability of CIMT and plaque presence among three clinical centers of the Cardiovascular and Metabolic Disease Etiology Research Center (CMERC). Methods: Twenty people without known cardiovascular disease (age 37-64) were enrolled during 2014-2015, and their left and right carotid arteries were examined repeatedly with ultrasonography for CIMT measurements at three clinical centers according to a predetermined protocol. Maximum and mean values of CIMT at distal common carotid artery were recorded. Plaque presence at a carotid artery was checked by an operator. The reliability of CIMT and carotid plaque presence was assessed using an intraclass correlation coefficient (ICC) and kappa statistics, respectively. Results: Calculated ICC was 0.647 (95% CI: 0.487-0.779) for maximum CIMT, and 0.758 (95% CI: 0.632- 0.854) for mean CIMT. In Bland Altman plot, most observed values were distributed within mean difference ${\pm}1.96$ SD ranges. Kappa statistics of plaque presence between two centers were 0.304 (center 1 and 2), 0.507 (center 1 and 3), and 0.606 (center 2 and 3), respectively, while Fleiss kappa for overall agreement was 0.445. Conclusions: The inter-rater reliability of CIMT measurements among three clinical centers turned out to be high, and the agreement of measuring carotid plaque presence was fair.

Morphometric Analysis of Distances between Sacral Hiatus and Conus Medullaris Using Magnetic Resonance Image in Korean Adult (자기공명영상을 이용한 한국 성인의 엉치뼈틈새와 척수원뿔 사이 거리 연구)

  • Park, Tai Soo;Hwang, Byeong-Wook;Park, Sang-Joon;Baek, Sun-Yong;Yoon, Sik
    • Anatomy & Biological Anthropology
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    • v.29 no.4
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    • pp.145-154
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    • 2016
  • The purpose of this study was to provide basic biometric data on Korean adults through magnetic resonance imaging (MRI)-based measurements of the distances between the apex of sacral hiatus (SH) and the termination of dural sac (DS), and between SH and conus medullaris (CM) because they are critical to the performance of epidural neuroplasty. A total of 200 patients(88 males and 112 females) with back pain, who had no spine fracture, significant spinal deformity, and spondyloisthesis were selected for this study. The subjects were of mean age 54.3 (20~84) years and mean height 161.3 cm (135~187). T2-weighted MRI images were used for correlation analysis to evaluate the relationships between the distances, and variables such as sex and height. In all patients, the mean distance between SH and DS was $62.8{\pm}9.4mm$ and the mean distance between SH and CM was $232.2{\pm}21.8mm$. The minimum distance and the maximum distance between SH and DS were 34.8 mm and 93.9 mm respectively, and the minimum distance and the maximum distance between SH and CM were 155.0 mm and 284.0 mm respectively. In female patients, both the distances between the SH and DS, and between SH and CM were shorter when compared to those of the male patients(p<0.05). Both the distances between SH and DS and between SH and CM showed a significant correlation with height(p<0.01). The results of this study will provide a useful biometric data on the distances between SH and DS and between SH and CM in Korean in ensuring clinical safety and in the development of more effective catheterization techniques for epidural neuroplasty in Korean.

Impact of Weather on Prevalence of Febrile Seizures in Children (소아의 열성경련에 날씨가 미치는 영향)

  • Woo, Jung Hee;Oh, Seok Bin;Yim, Chung Hyuk;Byeon, Jung Hye;Eun, Baik-Lin
    • Journal of the Korean Child Neurology Society
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    • v.26 no.4
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    • pp.227-232
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    • 2018
  • Purpose: Febrile seizure (FS) is the most common type of seizure in children between 6 months to 5 years of age. A family history of febrile seizures can increase the risk a child will have a FS. Yet, prevalence of FS regarding external environment has not been clearly proved. This study attempts to determine the association between prevalence of FS and weather. Methods: This study included medical records from the Korea National Health Insurance Review and Assessment Service. Data were collected from 29,240 children, born after 2004, diagnosed with FS who were admitted to one of the hospitals in Seoul, Korea, between January 2009 and December 2013. During the corresponding time period, data from the Korea Meteorological Administration on daily monitoring of four meteorological factors (sea-level pressure, amount of precipitation, humidity and temperature) were collected. The relationships of FS prevalence and each meteorological factor will be designed using Poisson generalized additive model (GAM). Also, the contributory effect of viral infections on FS prevalence and weather will be discussed. Results: The amount of precipitation was divided into two groups for comparison: one with less than 5 mm and the other with equal to or more than 5 mm. As a result of Poisson GAM, higher prevalence of FS showed a correlation with smaller amount of precipitation. Smoothing function was used to classify the relationships between three variables (sea-level pressure, humidity, and temperature) and prevalence of FS. FS prevalence was correlated with lower sea-level pressure and lower humidity. FS prevalence was high in two temperature ranges (-7 to $-1^{\circ}C$ and $18-21^{\circ}C$). Conclusion: Low sea-level pressure, small amount of precipitation, and low relative air humidity may increase FS prevalence risk.

Quality of Anticoagulation and Treatment Satisfaction in Patients with Non-Valvular Atrial Fibrillation Treated with Vitamin K Antagonist: Result from the KORean Atrial Fibrillation Investigation II

  • Oh, Seil;Kim, June-Soo;Oh, Yong-Seog;Shin, Dong-Gu;Pak, Hui-Nam;Hwang, Gyo-Seung;Choi, Kee-Joon;Kim, Jin-Bae;Lee, Man-Young;Park, Hyung-Wook;Kim, Dae-Kyeong;Jin, Eun-Sun;Park, Jaeseok;Oh, Il-Young;Shin, Dae-Hee;Park, Hyoung-Seob;Kim, Jun Hyung;Kim, Nam-Ho;Ahn, Min-Soo;Seo, Bo-Jeong;Kim, Young-Joo;Kang, Seongsik;Lee, Juneyoung;Kim, Young-Hoon
    • Journal of Korean Medical Science
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    • v.33 no.49
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    • pp.323.1-323.12
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    • 2018
  • Background: Vitamin K antagonist (VKA) to prevent thromboembolism in non-valvular atrial fibrillation (NVAF) patients has limitations such as drug interaction. This study investigated the clinical characteristics of Korean patients treated with VKA for stroke prevention and assessed quality of VKA therapy and treatment satisfaction. Methods: We conducted a multicenter, prospective, non-interventional study. Patients with $CHADS_2{\geq}1$ and treated with VKA (started within the last 3 months) were enrolled from April 2013 to March 2014. Demographic and clinical features including risk factors of stroke and VKA treatment information was collected at baseline. Treatment patterns and international normalized ratio (INR) level were evaluated during follow-up. Time in therapeutic range (TTR) > 60% indicated well-controlled INR. Treatment satisfaction on the VKA use was measured by Treatment Satisfaction Questionnaire for Medication (TSQM) after 3 months of follow-up. Results: A total of 877 patients (age, 67; male, 60%) were enrolled and followed up for one year. More than half of patients (56%) had $CHADS_2{\geq}2$ and 83.6% had $CHA_2DS_2-VASc{\geq}2$. A total of 852 patients had one or more INR measurement during their follow-up period. Among those patients, 25.5% discontinued VKA treatment during follow-up. Of all patients, 626 patients (73%) had poor-controlled INR (TTR < 60%) measure. Patients' treatment satisfaction measured with TSQM was 55.6 in global satisfaction domain. Conclusion: INR was poorly controlled in Korean NVAF patients treated with VKA. VKA users also showed low treatment satisfaction.

Clinical Characteristics and Prognosis of Fuchs Dystrophy According to COL8A2 Gene Mutation Status (COL8A2 유전자 돌연변이 유무에 따른 푹스이상증의 임상적 특징 및 예후)

  • Kim, Hyun-Ah;Whang, Woong-Joo;Lee, Jee Hye;Chae, Hyojin;Kim, Myungshin;Kim, Man Soo
    • Journal of The Korean Ophthalmological Society
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    • v.58 no.4
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    • pp.380-386
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    • 2017
  • Purpose: To compare the clinical characteristics and prognosis of Fuchs dystrophy patients according to COL8A2 gene mutation status. Methods: Eighty-one patients (162 eyes) initially diagnosed with Fuchs dystrophy from 1996 to 2015 were divided into two groups according to COL8A2 gene mutation status. Retrospective analysis was performed comparing gender, age at diagnosis, presence of family history, diabetes mellitus, symptoms of blurred vision in the morning, changes in central corneal thickness and endothelial cell density with time, need for corneal transplantation, and pre-operative corneal status in the two groups. Results: Of the 81 patients, 12 were shown to harbor a COL8A2 gene mutation. Individuals with mutation were significantly associated with presence of family history, diabetes mellitus, and blurred vision in the morning (p = 0.021, p = 0.024, p = 0.044, respectively). They also had significantly thicker central cornea and lower endothelial cell density at the time of diagnosis (p = 0.020, p = 0.005, respectively). The differences in central corneal thickness and endothelial cell density between the two eyes in one patient were significantly smaller in patients with gene mutation (p = 0.043, p = 0.022, respectively). Over a 5-year follow-up period, 60.0% of eyes in patients with gene mutation and 19.2% of eyes in patients without gene mutation underwent corneal transplantation, a significant difference between the two groups (p = 0.014). Conclusions: By testing for COL8A2 gene mutation, early binocular disease progression and the possible need for corneal transplantation in the future can be predicted among patients diagnosed with Fuchs dystrophy.

Choroidal Thickness in Thyroid-associated Ophthalmopathy between Normal Tension Glaucoma Using Optical Coherence Tomography (스펙트럼영역 빛간섭단층촬영으로 측정한 갑상선 안병증 환자와 녹내장환자의 맥락막 두께 분석)

  • Lee, Bo Young;La, Tae Yoon;Choi, Jin A
    • Journal of The Korean Ophthalmological Society
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    • v.58 no.8
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    • pp.960-967
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    • 2017
  • Purpose: To compare the macular choroidal thickness in patients with thyroid-associated ophthalmopathy (TAO) with those with normal tension glaucoma (NTG). Methods: A total of 70 normal eyes, 74 eyes with TAO and 60 eyes with NTG were enrolled in this study. All patients underwent spectral-domain optical coherence tomography (SD-OCT) (Cirrus HD-OCT, Carl Zeiss Meditec Inc., Dublin, CA, USA). Macular choroidal thickness was assessed using enhanced depth imaging. The average macular choroidal thickness was defined as the average value of three measurements: at the fovea and at the points located 1.5 mm in the nasal and temporal directions from the fovea. Generalized estimating equations were used to uncover factors affecting the average macular choroidal thickness. Results: The average, superior and inferior quadrant retinal nerve fiber layer thicknesses were significantly thinner in the NTG group compared with the TAO and control groups (p < 0.001). The average macular choroidal thickness of the TAO group, NTG group and controls was $281.01{\pm}60.06{\mu}m$, $241.66{\pm}55.00{\mu}m$ and $252.07{\pm}55.05{\mu}m$, respectively, which were significantly different (p = 0.013). The subfoveal, nasal and temporal side choroidal thicknesses were significantly thinner in the NTG group compared with the TAO group (p = 0.014, 0.012 and 0.034, respectively). Subjects with TAO were associated with a thicker average macular choroidal thickness compared with the NTG group after adjusting for age, sex, spherical equivalent and intraocular pressure (${\beta}=32.61$, p = 0.017). Conclusions: Macular choroidal thickness was significantly thicker in patients with TAO compared with those with NTG. Further evaluation is required to determine if a thick choroid in subjects with TAO has any role in glaucomatous optic neuropathy.

The Political Background of the Installation of the Crown Prince During the Period of King Munjong in the Goryeo Dynasty (고려 문종대 왕태자(王太子) 책봉(冊封)과 태자(太子) 관련 제도(制度) 정비의 의미)

  • Kim, Seon-mi
    • Journal of Korean Historical Folklife
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    • no.45
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    • pp.263-289
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    • 2014
  • King Munjong(文宗), the eleventh King of the Goryeo Dynasty, was the son of King Hyeonjong(顯宗), the eighth king, and the younger stepbrother(異母弟) of King Jeongjong(靖宗), the 10th king. Although King Jeongjong had four sons, he abdicated the throne to King Munjong. King Taejo(太祖) had opened the possibility for sons other than the eldest son to succeed to the throne. When King Jeongjong died, his sons were children under the age of 10 years. In the early period of the Goryeo Dynasty, when kings had young sons, there were precedents of abdicating the throne to their grown-up younger brothers. In addition, King Jeongjong and Munjong had an identical blood background. During the period, Goryeo people also naturally accepted the fact that a former king's younger brother succeeded to the throne. In this background, King Munjong ascended the throne. However, King Munjong did not ascend the throne after identifying state affairs with politic power. Therefore, he needed to increase his authority as the king. Moreover, as the sons of King Jeongjong had grown up, they could stir up trouble in future succession to the throne. Therefore, King Munjong intended to concentrate power on himself and remove trouble in future succession to the throne by selecting his son as successor to the throne. After the installation of Wangtaeja(王太子, the Crown Prince), King Munjong expanded and organized Donggunggwan(東宮官, the establishment of Secretariat of Wangtaeja) and carried out various rituals related to Wangtaeja. The control system for Donggunggwan was completed institutionally in 1068. At this time, the newly organized Donggunggwan was operated as a miniature version of the central government office. In addition, the ritual for the installation of Taeja, which was held in 1054, complied with regulated procedures. After the ritual of the installation, a ceremony to congratulate on Jangheungjeol(長興節, the birthday of Wangtaeja) was held in 1056. In 1064, the wedding ritual of Taeja took place, and the ritual for Taeja regulated in Yeji(禮志) of "Goryeosa(高麗史)" was carried out. In addition, the installation of Wangtaeja was made known overseas, and the Taeja of Goryeo was proclaimed by the Kitan three times. Such various measures played an important role in strengthening the status of Taeja as the man of authority next to the king. Later, Taeja demonstrated his status as the man of authority following the king by participating in state affairs on behalf of King Munjong who was not able to move about freely in his later years.

A Study on Giving Verbs 'kureru' and 'kudasaru': by Analyzing Dialogues of Female Speakers in Novels of the Edo Period, Meiji Period and the Taisho Period- (수수동사 'くれる·くださる'에 관한 고찰 - 에도기부터 다이쇼기의 작품속의 여성화자의 사용례를 중심으로-)

  • Yang, JungSoon
    • Cross-Cultural Studies
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    • v.31
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    • pp.371-394
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    • 2013
  • This study aims to know word forms and usages according to personal relationships of 'Kureru Kudasaru' by analyzing dialogues of female speakers. Novels of the Meiji period when there were attempts of a language revolution were mainly used for this study as well as novels of the Edo Period and the Taisho Period. Firstly, the number of examples according to gender differences in the novels was as follows. In case of 'Kureru', female speakers showed a high usage rate in the novels of the Edo period. 'Kureru' was mostly connected with female languages such as 'Naharu', 'Namasu', 'Nansu'. These expressions were not used in the novels of the Meiji Period and the Taisho Period. Although 'Okureru' and 'Okurenasaru' were used in the novels of the Meiji Period, the number of examples of 'Kureru' by female speakers was decreased in the novels of the Meiji Period and the Taisho Period. 'Kudasaru' was predominantly used by female speakers. Especially, female speakers used clearly to show vertical relationships in the novels of the Edo Period and"Doseishoseikatagi"of Meiji 10s. After"Ukigumo", the usage rate of female speakers was decreased but the usage rate of male speakers was increased. Gender differences became gradually smaller. Female speakers in the novels were increased from geisha and relatives such as wife, sister, mother and children to young women, teacher and student. Aspects of benefactive verbs' usages could be summarized as follows. Female speakers at licensed quarters used clearer and more typical expressions according to vertical relationships and gender differences in the novels of The Edo Period than the novels of The Meiji Period and the Taisho Period. In the novels of the Meiji Period, female speakers in a sophisticated social group used benefactive verbs to show strong respect and concern for the other person. In the novels of the Taisho Period, female speakers used benefactive verbs to show respect and concern for the other person according to their areas of outside activities. In the novels of the Meiji Period, female speakers used 'Okureru' when the other person was younger than them and was socially and psychologically close to them. Also, 'O~Nasaru' which was one of respect expressions was used by female speakers. Female speakers used it to older people in the Edo period but they also used it to younger people in the Meiji Period. Examples were not shown in the novels of the Taisho Period. Usages of 'Kureru' 'Kudasaru' according to vertical relationships were as follows. If 'a giver' was an older person, 'Kureru' with respect expressions 'Nasaru' 'Nansu' 'Namasu' was used more than 'Kudasaru' in the novels of the Edo Period. However, many examples of 'Kudasaru' were shown on the novels of the Meiji Period and the Taisho period. In the novels of the Meiji Period, 'Okureru' and 'Okurenasaru' which were expressions included in 'Kureru' were shown. Female speakers used them to older people who were socially and psychologically close to them like family. There were not many examples of 'a giver' and 'a receiver' around the same age. However, 'Kureru' and 'Okureru' were used in a younger group and 'Kudasaru' was used in an older group in the novels of the Meiji Period. If 'a giver' was an younger person, 'Kureru' was mainly used in the novels of the Edo period and "Doseishoseikatagi"in Meiji 10s. However, 'Kudasaru' was used many times in the novels of the latter Meiji Period and the Taisho Period.

The Practice of Funerary and Ancestor Memorial Service and the Theory of Jongbeob in the Eighteenth Century: Focusing on Seongho Lee Ik (星湖 李瀷)'s Discussion on Seungjung (承重) and Yiphu (立後) (18세기 상(喪)·제례(祭禮) 실천과 종통(宗統)의 이상 - 성호(星湖) 이익(李瀷)의 승중(承重)·입후(立後) 논의를 중심으로 -)

  • Kim, Nam Yi
    • (The)Study of the Eastern Classic
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    • no.35
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    • pp.387-414
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    • 2009
  • This paper looks into the Confucius customs of Yiphu and Seungjung, that is respectively a problem of deciding the successor of the family and a matter of establishing Jongtong (宗統: the proper inheritance line of the family), especially concerning the funerary and ancestor memorial services through Seongho Lee Ik's discussion on proprieties, whose Yeahak (禮學: Studies on Proprieties) is representative of the eighteenth century Yeahak. Seongho Lee Ik sees that there is one penetrating principle that should apply the same concerning Jongtong, regardless whether it is for the state or for a family or whether it is for the royal family or for the gentry in or out of the state service. To establish this one penetrating principle, he emphasizes the manners that fit one's circumstance and social standing, proposed as the theory and practice of 'Seoin-garyea (庶人家禮: Proper customs that even common people with no official titles can practice in marking their important life events like coming-of-age, marriage, and death)'. These two aspects of Seongho seem at odds with each other at a glance. Yet given that he considers that keeping proprietary manners for their own social standings would help secure the fundamental social order, which is of supreme importance to him, it makes sense. Next, the most problematic issues about Seongjung and Yiphu are the timing when one can declare the 'absence of the patriarch' and the manner how one substitutes oneself for the absent patriarch. Seongho sees that it is one thing to 'inherit the Jongtong' and it is another to 'become a next patriarch'. Basically, he does not separate the problem of Jongtong by one's social standings. The real situation involved can be different based on one's social standing, he readily acknowledges. Yet, 'the unchangeable ethical principle between the father and the son' would prevail over the same regardless of classes, he insists. This attitude of his is in line with his philosophy of proprieties and his practical guidance that proposes 'Seoin-Garyea' with an appeal to establish fundamental social order based on the practice of proper manners in accordance of one's social standing as he philosophizes the rules of Jongtong on the base of the one penetrating principle.