Publications by authors named "Joo Yeon Kim"

137 Publications

Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018.

JAMA 2021 07;326(2):154-164

AcademyHealth, Washington, DC.

Importance: There is limited information about trends in the treatment of opioid use disorder (OUD) among Medicaid enrollees.

Objective: To examine the use of medications for OUD and potential indicators of quality of care in multiple states.

Design, Setting, And Participants: Exploratory serial cross-sectional study of 1 024 301 Medicaid enrollees in 11 states aged 12 through 64 years (not eligible for Medicare) with International Classification of Diseases, Ninth Revision (ICD-9 or ICD-10) codes for OUD from 2014 through 2018. Each state used generalized estimating equations to estimate associations between enrollee characteristics and outcome measure prevalence, subsequently pooled to generate global estimates using random effects meta-analyses.

Exposures: Calendar year, demographic characteristics, eligibility groups, and comorbidities.

Main Outcomes And Measures: Use of medications for OUD (buprenorphine, methadone, or naltrexone); potential indicators of good quality (OUD medication continuity for 180 days, behavioral health counseling, urine drug tests); potential indicators of poor quality (prescribing of opioid analgesics and benzodiazepines).

Results: In 2018, 41.7% of Medicaid enrollees with OUD were aged 21 through 34 years, 51.2% were female, 76.1% were non-Hispanic White, 50.7% were eligible through Medicaid expansion, and 50.6% had other substance use disorders. Prevalence of OUD increased in these 11 states from 3.3% (290 628 of 8 737 082) in 2014 to 5.0% (527 983 of 10 585 790) in 2018. The pooled prevalence of enrollees with OUD receiving medication treatment increased from 47.8% in 2014 (range across states, 35.3% to 74.5%) to 57.1% in 2018 (range, 45.7% to 71.7%). The overall prevalence of enrollees receiving 180 days of continuous medications for OUD did not significantly change from the 2014-2015 to 2017-2018 periods (-0.01 prevalence difference, 95% CI, -0.03 to 0.02) with state variability in trend (90% prediction interval, -0.08 to 0.06). Non-Hispanic Black enrollees had lower OUD medication use than White enrollees (prevalence ratio [PR], 0.72; 95% CI, 0.64 to 0.81; P < .001; 90% prediction interval, 0.52 to 1.00). Pregnant women had higher use of OUD medications (PR, 1.18; 95% CI, 1.11-1.25; P < .001; 90% prediction interval, 1.01-1.38) and medication continuity (PR, 1.14; 95% CI, 1.10-1.17, P < .001; 90% prediction interval, 1.06-1.22) than did other eligibility groups.

Conclusions And Relevance: Among US Medicaid enrollees in 11 states, the prevalence of medication use for treatment of opioid use disorder increased from 2014 through 2018. The pattern in other states requires further research.
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http://dx.doi.org/10.1001/jama.2021.7374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278273PMC
July 2021

The role of right temporo-parietal junction in stimulus evaluation.

Brain Cogn 2021 Jun 23;152:105770. Epub 2021 Jun 23.

Department of Psychology, Chungnam National University, Daejeon, Republic of Korea. Electronic address:

A predominant model of the temporo-parietal junction (TPJ) claims that this region is critical for attentional orienting/reorienting toward an unexpected, but behaviorally significant stimulus. However, recent studies have suggested that the TPJ is also involved in the process of evaluating stimulus, especially matching between external sensory inputs and internal representations. While some studies provide evidence for the involvement of the TPJ in stimulus evaluation, the nature of the evaluative process mediated by the TPJ remains unclear. To address this issue, we tested whether the TPJ activation amplitude and its peak latency is proportional to the demand of the evaluative process. We found that when the amount of sensory evidence for the matching process was abundant, the TPJ was transiently activated. Importantly, the TPJ activation showed a greater and more sustained pattern while the sensory evidence was accumulating for a longer period of time. These findings suggest that the TPJ function is associated with the evaluative process of matching sensory inputs with internal representations, as well as attentional reorienting.
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http://dx.doi.org/10.1016/j.bandc.2021.105770DOI Listing
June 2021

Corneal endothelial cell changes and surgical results after Ahmed glaucoma valve implantation: ciliary sulcus versus anterior chamber tube placement.

Sci Rep 2021 Jun 21;11(1):12986. Epub 2021 Jun 21.

Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

We compared the changes in corneal endothelial cells and surgical outcomes after Ahmed glaucoma valve (AGV) implantation with the valve tip inserted either into ciliary sulcus (CS) or anterior chamber (AC). We retrospectively reviewed the medical records of patients treated with CS AGV (n = 24) and AC AGV (n = 38). We compared the preoperative and postoperative central corneal endothelial cell density (ECD), endothelial cell coefficient of variation (CV), best-corrected visual acuity, intraocular pressure (IOP), number of glaucoma medications, and postoperative complications in the two groups. Both groups had similar baseline characteristics and follow-up period. At the last follow-up, the AC AGV group had significantly higher mean monthly ECD loss (17.47 ± 11.50 cells/mm vs. 6.40 ± 7.69 cells/mm, p < 0.0001) and greater proportion of mean monthly ECD loss than the CS AGV group (0.84 ± 0.53 vs. 0.36 ± 0.39%, p < 0.0001). Both groups had similar mean monthly CV changes. The qualified success rates at 2 years were 83.3% and 76.3% for the CS AGV and AC AGV groups, respectively. Although similar surgical outcomes including visual acuity, IOP, number of glaucoma medications, and postoperative complications were obtained following CS AGV and AC AGV, corneal ECD loss was higher in the AC AGV group. Thus, CS AGV may be a better surgical option than AC AGV.
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http://dx.doi.org/10.1038/s41598-021-92420-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8217260PMC
June 2021

Glaucoma Progression after Delivery in Patients with Open-Angle Glaucoma Who Discontinued Glaucoma Medication during Pregnancy.

J Clin Med 2021 May 19;10(10). Epub 2021 May 19.

Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.

In this retrospective study, clinical characteristics and glaucoma progression of open-angle glaucoma (OAG) patients who discontinued intraocular pressure (IOP)-lowering medication during pregnancy were investigated. Glaucoma progression was determined using either serial visual field tests or optic disc/retinal nerve fiber layer (RNFL) photographs. Age, number of previous pregnancies, diagnosis, average IOP, IOP fluctuation, visual field mean deviation, pattern standard deviation, and RNFL thickness were examined, and their association with glaucoma progression was determined using linear regression analysis. Among 67 eyes (37 patients), 19 eyes (28.4%) exhibited glaucoma progression 13.95 ± 2.42 months after delivery. The progression group showed significantly higher mean IOP than the nonprogression group in the first, second, and third trimesters ( = 0.02, 0.001, and 0.04, respectively). The average IOP in the second and third trimesters and IOP fluctuation during the entire pregnancy were significantly associated with glaucoma progression according to a univariate analysis ( = 0.04, 0.031, and 0.026, respectively). In conclusion, IOP elevation during pregnancy is associated with glaucoma progression after delivery in patients who had discontinued medication during pregnancy. Therefore, close monitoring of glaucoma is necessary, particularly if patients discontinue medication during pregnancy, and appropriate intervention should be considered in case of increased IOP.
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http://dx.doi.org/10.3390/jcm10102190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159078PMC
May 2021

Outcomes associated with the use of medications for opioid use disorder during pregnancy.

Addiction 2021 May 25. Epub 2021 May 25.

Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA.

Aim: To test the effect of the duration of medication for opioid use disorder (MOUD) use during pregnancy on maternal, perinatal and neonatal outcomes.

Design: Retrospective cohort analysis of claims, encounter and pharmacy data.

Setting: Pennsylvania, USA.

Participants: We analyzed 13 320 pregnancies among 10 741 women with opioid use disorder aged 15-44 years enrolled in Pennsylvania Medicaid between 2009 and 2017.

Measurements: We examined five outcomes during pregnancy and for 12 weeks postpartum: (1) overdose, (2) postpartum MOUD continuation, (3) preterm birth (< 37 weeks gestation), (4) term low birth weight (< 2500 g at ≥ 37 weeks) and (5) neonatal abstinence syndrome (NAS). Our primary exposure was the duration (count of weeks) of any MOUD use, including methadone or buprenorphine, during pregnancy.

Findings: Among 13 320 pregnancies, 306 (2.3%) were complicated by an overdose, 1753 (13.2%) resulted in a preterm birth and 6787 (50.9%) continued MOUD postpartum. Among infants, 874 (7.6%) were low birth weight at term and 7706 (57.9%) were diagnosed with NAS. As the duration of MOUD use increased, we found a statistically significant decrease in the rate of overdose and preterm birth, a statistically significant increase in the rate of postpartum MOUD continuation and NAS and a decline in term low birth weight. Specifically, for each additional week of MOUD, the adjusted odds of overdose decreased by 2% [adjusted odds ratio (aOR) = 0.98; 95% confidence interval (CI) = 0.97, 0.99], preterm birth decreased by 1% (aOR = 0.99; 95% CI = 0.99, 1.00), postpartum MOUD continuation increased by 95% (aOR = 1.95; 95% CI = 1.87, 2.04) and NAS increased by 41% (aOR = 1.41; 95% CI = 1.35, 1.47). The odds of term low birth weight did not change (aOR = 1.00; 95% CI = 0.99, 1.00), although the rate declined with a longer duration of MOUD use during pregnancy.

Conclusions: Longer duration of medication for opioid use disorder use during pregnancy appears to be associated with improved maternal and perinatal outcomes.
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http://dx.doi.org/10.1111/add.15582DOI Listing
May 2021

Spatiotemporal contribution of neuromesodermal progenitor-derived neural cells in the elongation of developing mouse spinal cord.

Life Sci 2021 May 15;282:119393. Epub 2021 May 15.

Department of Anatomy and Division of Brain, Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea. Electronic address:

Aims: During vertebrate development, the posterior end of the embryo progressively elongates in a head-to-tail direction to form the body plan. Recent lineage tracing experiments revealed that bi-potent progenitors, called neuromesodermal progenitors (NMPs), produce caudal neural and mesodermal tissues during axial elongation. However, their precise location and contribution to spinal cord development remain elusive.

Main Methods: Here we used NMP-specific markers (Sox2 and BraT) and a genetic lineage tracing system to localize NMP progeny in vivo.

Key Findings: Sox2 and BraT double positive cells were initially located at the tail tip, but were later found in the caudal neural tube, which is a unique feature of mouse development. In the neural tube, they produced neural progenitors (NPCs) and contributed to the spinal cord gradually along the AP axis during axial elongation. Interestingly, NMP-derived NPCs preferentially contributed to the ventral side first and later to the dorsal side at the lumbar spinal cord level, which may be associated with atypical junctional neurulation in mice.

Significance: Our current observations detail the contribution of NMP progeny to spinal cord elongation and provide insights into how different species uniquely execute caudal morphogenesis.
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http://dx.doi.org/10.1016/j.lfs.2021.119393DOI Listing
May 2021

Four-Strand Hamstring Diamond Braid Technique for Anterior Cruciate Ligament Reconstruction.

Arthrosc Tech 2021 Apr 22;10(4):e1173-e1177. Epub 2021 Mar 22.

Advanced Orthopaedics and Sports Medicine, San Francisco, California, U.S.A.

Several factors affect the success of an anterior cruciate ligament reconstruction, including graft origin, type, and morphology. Hamstring and bone-patellar tendon-bone autografts are the most widely used, and there are many different techniques of graft preparation with each. In this Technical Note and accompanying video, a 4-strand hamstring autograft technique is described that uses a simple diamond-type braid to produce a more ovoid morphology with increased cross-sectional area. Increased graft diameters have been associated with higher success rates and more positive long-term outcomes. Therefore, this braiding construct may provide additional tensile strength with increased resistance to failure than grafts that are otherwise undersized using conventional techniques.
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http://dx.doi.org/10.1016/j.eats.2021.01.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085571PMC
April 2021

Arthroscopic Single Portal, Single Anchor Knotless Subscapularis Repair with Concomitant Tenodesis of the Long Head of the Biceps Tendon.

Arthrosc Tech 2021 Apr 22;10(4):e1117-e1123. Epub 2021 Mar 22.

Advanced Orthopaedics and Sports Medicine, San Francisco, California, U.S.A.

Anterior shoulder pathology involving the subscapularis is often associated with the biceps tendon because both anatomic structures intersect the lesser tuberosity. Standard procedures for such pathology often involve simultaneous subscapularis repairs and biceps tenodesis. Single anterior portal subscapularis repairs have been emerging in the past 5 years because of cost-effectiveness and efficiency. Biceps tenodesis is a common procedure performed both open and arthroscopically. This technique takes advantage of the close relation between the long head of the biceps tendon and subscapularis tendon to restore the functional length-tension relation and preserve function through fixation using a single portal and a single knotless suture anchor.
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http://dx.doi.org/10.1016/j.eats.2021.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085439PMC
April 2021

Top-down control of attention under varying task loads.

Acta Psychol (Amst) 2021 May 20;216:103310. Epub 2021 Apr 20.

Department of Psychology, Chungnam National University, Daejeon, Republic of Korea. Electronic address:

The performance of a goal-directed task is often interrupted by task-irrelevant distractors. This distractor interference has well been demonstrated in a large body of studies employing the Eriksen flanker paradigm. A notable finding regarding this issue is that distractor interference is attenuated by increased perceptual load or the presence of non-target stimuli diluting distractors. Besides increased perceptual load or the presence of diluters, we hypothesized that either suppression of distractor or enhancement of target via top-down attentional control would also contribute to modulating distractor interference. To test this, we had participants identify a target stimulus while ignoring a distractor under three different conditions; under low load, only the target and distractor was presented, while under high load, the target was surrounded by non-target letters. In the dilution condition, the target was accompanied by non-targets, whose colors were distinct from the target. Importantly, following the task stimuli, a probe stimulus was presented either in the target location, non-target location, or distractor location. As results, under low load, attention was captured by the target stimulus in a bottom-up manner at the early stage of processing. By contrast, in the high load and dilution conditions, attention was focused on the target in a top-down manner. Taken together, we suggest that increasing perceptual load or presenting diluters incentivizes the establishment of top-down bias toward the target stimulus, which plays a role in attenuating distractor interference.
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http://dx.doi.org/10.1016/j.actpsy.2021.103310DOI Listing
May 2021

Mini-Open Achilles Repair With a Flat Braided Suture in a Low-Profile Configuration.

Arthrosc Tech 2021 Feb 16;10(2):e451-e455. Epub 2021 Jan 16.

Advanced Orthopaedics and Sports Medicine, San Francisco, California, U.S.A.

Achilles repair has evolved over the past 30 years, from large open procedures with high complication rates to shorter, less-invasive procedures with better outcomes. Percutaneous repair has comparable failure rates with open repairs, fewer complications, and faster recovery. However, percutaneous Achilles repairs risk sural nerve injury. A mini-open repair fuses the gap between percutaneous and open procedures, and this approach has the potential to mitigate nerve injury while maintaining the increased efficiency in procedure time and patient recovery. The purpose of this Technical Note and accompanying video is to outline the repair of the Achilles tendon using a mini open repair using a low-profile flat braided suture.
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http://dx.doi.org/10.1016/j.eats.2020.10.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917089PMC
February 2021

Distal Clavicle Excision for Acromioclavicular Joint Osteoarthritis Using a Fluoroscopic Kirschner Wire Guide.

Arthrosc Tech 2021 Feb 16;10(2):e359-e365. Epub 2021 Jan 16.

Advanced Orthopaedics and Sports Medicine, San Francisco, California, U.S.A.

Pathology of the acromioclavicular joint is common and often resistant to conservative treatment, requiring distal clavicle excision for definitive relief. First described as an open technique by Mumford and Gurd in 1941, distal clavicle excision has evolved greatly, with arthroscopic techniques currently predominating. No significant difference has been found in patient satisfaction or rate of complication between the techniques in a recent meta-analysis. Indeed, open excisions are still performed at a high rate, owing to the difficulty in technique and visualization with arthroscopic methods. One major critique of arthroscopic distal clavicle excision is difficulty safeguarding against under- and overexcision of the distal clavicle due to the lack of depth perception and visual reference points of the arthroscopic perspective. This Technical Note and accompanying video describe an indirect subacromial arthroscopic distal clavicle excision using a fluoroscopic Kirschner wire guide placed at the proximal border prior to resection to serve as a visual and mechanical reference to overexcision.
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http://dx.doi.org/10.1016/j.eats.2020.10.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917026PMC
February 2021

Combined Coracoclavicular and Acromioclavicular Joint Reconstruction with Allograft Using a Cerclage Tensioning System.

Arthrosc Tech 2021 Feb 16;10(2):e317-e323. Epub 2021 Jan 16.

Advanced Orthopaedics and Sports Medicine, San Francisco, California, U.S.A.

Acromioclavicular joint separations are common shoulder injuries, yet standard treatment practices vary. Popular surgical techniques include reconstruction using allografts or neighboring ligaments as well as repair using screws and sutures. This Technical Note and accompanying video describe both an acromioclavicular and coracoclavicular joint reconstruction using an allograft to replace native acromioclavicular ligament along with an AC joint reduction using a Suture Cerclage System to precisely control reduction and restore anatomic alignment.
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http://dx.doi.org/10.1016/j.eats.2020.10.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917031PMC
February 2021

Patterns of clinic switching and continuity of medication for opioid use disorder in a Medicaid-enrolled population.

Drug Alcohol Depend 2021 04 16;221:108633. Epub 2021 Feb 16.

University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management, 130 DeSoto Street, Pittsburgh, PA, 15261, United States.

Background: Many persons with opioid use disorder (OUD) initiate medication for opioid use disorder (MOUD) with one clinic and switch to another clinic during their course of treatment. These switches may occur for referrals or for unplanned reasons. It is unknown, however, what effect switching MOUD clinics has on continuity of MOUD treatment or on overdoses.

Objective: To examine patterns of switching MOUD clinics and its association with the proportion of days covered (PDC) by MOUD, and opioid-related overdose.

Design: Cross-sectional retrospective analysis of Pennsylvania Medicaid claims data.

Main Measures: MOUD clinic switches (i.e., filling a MOUD prescription from a prescriber located in a different clinic than the previous prescriber), PDC, and opioid-related overdose.

Results: Among 14,107 enrollees, 43.2 % switched clinics for MOUD at least once during the 270 day period. In multivariate regression results, enrollees who were Non-Hispanic black (IRR = 1.43; 95 % CI = 1.24-1.65; p < 0.001), had previous methadone use (IRR = 1.32; 95 % CI = 1.13-1.55; p < 0.001), and a higher total number of office visits (IRR = 1.01; CI = 1.01-1.01; p < 0.001) had more switches. The number of clinic switches was positively associated with PDC (OR = 1.12; 95 % CI = 1.10-1.13). In secondary analyses, we found that switches for only one MOUD fill were associated with lower PDC (OR = 0.97; 95 % CI = 0.95-0.99), while switches for more than one MOUD fill were associated with higher PDC (OR = 1.40; 95 % CI = 1.36-1.44). We did not observe a relationship between opioid-related overdose and clinic switches.

Conclusions: Lack of prescriber continuity for receiving MOUD may not be problematic as it is for other conditions, insofar as it is related to overdose and PDC.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108633DOI Listing
April 2021

Healthcare Patterns of Pregnant Women and Children Affected by OUD in 9 State Medicaid Populations.

J Addict Med 2021 Feb 5. Epub 2021 Feb 5.

Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (MJ, JYK, JMD); Muskie School of Public Service, University of Southern Maine, Portland, ME (KAA); Department of Health Policy, Management, and Leadership, West Virginia University School of Public Health, Morgantown, WV (LA); Department of Maternal and Child Health, University of North Carolina-Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC (AA); Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA (AJB); Ohio Colleges of Medicine Government Resource Center, Columbus, OH (DC, RM); School of Social Work, University of North Carolina-Chapel Hill, Chapel Hill, NC (PL); The Hilltop Institute, University of Maryland Baltimore County, Baltimore, MD (SM); Office of Health Affairs, West Virginia University Health Sciences Center, Morgantown, WV (NP); Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY (JT); Departments of Psychiatry and Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI (KZ); Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI (KZ).

Objectives: State Medicaid programs are the largest single provider of healthcare for pregnant persons with opioid use disorder (OUD). Our objective was to provide comparable, multistate measures estimating the burden of OUD in pregnancy, medication for OUD (MOUD) in pregnancy, and related neonatal and child outcomes.

Methods: Drawing on the Medicaid Outcomes Distributed Research Network (MODRN), we accessed administrative healthcare data for 1.6 million pregnancies and 1.3 million live births in 9 state Medicaid populations from 2014 to 2017. We analyzed within- and between-state prevalences and time trends in the following outcomes: diagnosis of OUD in pregnancy, initiation, and continuity of MOUD in pregnancy, Neonatal Opioid Withdrawal Syndrome (NOWS), and well-child visit utilization among children with NOWS.

Results: OUD diagnosis increased from 49.6 per 1000 to 54.1 per 1000 pregnancies, and the percentage of those with any MOUD in pregnancy increased from 53.4% to 57.9%, during our study time period. State-specific percentages of 180-day continuity of MOUD ranged from 41.2% to 84.5%. The rate of neonates diagnosed with NOWS increased from 32.7 to 37.0 per 1000 live births. State-specific percentages of children diagnosed with NOWS who had the recommended well-child visits in the first 15 months ranged from 39.3% to 62.5%.

Conclusions: Medicaid data, which allow for longitudinal surveillance of care across different settings, can be used to monitor OUD and related pregnancy and child health outcomes. Findings highlight the need for public health efforts to improve care for pregnant persons and children affected by OUD.
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http://dx.doi.org/10.1097/ADM.0000000000000780DOI Listing
February 2021

Implication of the Association of Fibrinogen Citrullination and Osteoclastogenesis in Bone Destruction in Rheumatoid Arthritis.

Cells 2020 12 20;9(12). Epub 2020 Dec 20.

Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.

Immune complexes containing citrullinated fibrinogen are present in the sera and synovium of rheumatoid arthritis patients and potentially contribute to synovitis. However, fibrinogen can inhibit the osteoclastogenesis of precursor cells. We investigated the direct effect of citrullinated fibrinogen on osteoclastogenesis to understand the role of citrullination on bone erosion of rheumatoid arthritis patients. We evaluated the fibrinogen citrullination sites using mass spectrometry and quantified osteoclast-related protein and gene expression levels by Western blotting, microarray, and real-time polymerase chain reaction. Differences in spectral peaks were noted between fibrinogen and citrullinated fibrinogen at five sites in α-chains, two sites in β-chains, and one site in a γ-chain. Transcriptome changes induced by fibrinogen and citrullinated fibrinogen were identified and differentially expressed genes grouped into three distinctive modules. Fibrinogen was then citrullinated in vitro using peptidylarginine deiminase. When increasing doses of soluble fibrinogen and citrullinated fibrinogen were applied to human CD14+ monocytes, citrullination restored osteoclastogenesis-associated changes, including NF-ATc1 and ß3-integrin. Finally, citrullination rescued the number of osteoclasts by restoring fibrinogen-induced suppression of osteoclastogenesis. Taken together, the results indicate that the inhibitory function of fibrinogen on osteoclastogenesis is reversed by citrullination and suggest that citrullinated fibrinogen may contribute to erosive bone destruction in rheumatoid arthritis.
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http://dx.doi.org/10.3390/cells9122720DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766778PMC
December 2020

Relationship between N95 Amplitude of Pattern Electroretinogram and Optical Coherence Tomography Angiography in Open-Angle Glaucoma.

J Clin Med 2020 Nov 27;9(12). Epub 2020 Nov 27.

Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.

Purpose: The pattern electroretinogram (PERG) is useful to detect retinal ganglion cell (RGC) damage in patients with glaucoma. Optical coherence tomography angiography (OCTA) measures retinal vessel density (VD), which is known to be reduced in glaucoma. There may be correlations between parameters of the PERG and OCTA in open-angle glaucoma (OAG).

Methods: In total, 95 eyes of 95 OAG patients and 102 eyes of 102 normal controls were included in this study. N35, P50, and N95 latency along with P50 and N95 amplitude were obtained using the PERG. Retinal VD was measured around the peripapillary and macular area according to the ETDRS grid (concentric circles with diameters of 1, 3, and 6 mm), which is named a center (≤1 mm), an inner (1-3 mm), an outer (3-6 mm), and a full (≤6 mm) area. Pearson correlation analysis was done between parameters, and partial correlation analysis was done after adjusting confounding factors.

Results: P50 amplitude, N95 amplitude, and VD of most measured areas were significantly lower in the OAG group compared to the normal group. N95 amplitude showed a statistically significant correlation with parameters of optical coherence tomography and visual field, peripapillary outer and full VD, and macular outer and full VD even after adjusting confounding factors. There was no significant correlation between parameters in the normal group.

Conclusions: N95 amplitude was associated with structural and functional change including VD reduction in OAG. Microvascular alterations may be associated with dysfunctional changes of RGC recorded by the PERG in OAG.
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http://dx.doi.org/10.3390/jcm9123854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759986PMC
November 2020

Stress Estimation through Deep Rock Core Diametrical Deformation and Joint Roughness Assessment Using X-ray CT Imaging.

Sensors (Basel) 2020 Nov 28;20(23). Epub 2020 Nov 28.

Department of Energy & Resources Engineering, Korea Maritime and Ocean University, 727, Taejongro, Yeongdo-gu, Busan 49112, Korea.

In-situ stress estimation plays an important role on the success of an underground project. However, no method is error-free, and therefore a combination of methods is desirable. In this study, the in-situ stresses for a geothermal project have been assessed through the analysis of a deep rock core taken at 4.2 km, using the diametrical core deformation analysis (DCDA) method that relates the diametrical core expansion after stress relief with the stresses assuming elastic deformation. The extracted granodiorite core sample of 100 mm of diameter was intersected with a closed joint at a dip angle of 80.8° with respect to the vertical coring direction. The core sample was scanned using an industrial X-ray computed tomography (CT), and the diametrical deformation measurements were computed with CT slices. Results from using the DCDA method indicated an average horizontal stress difference of 13.3 MPa, similar to that reported for a nearby exploration well. Furthermore, the stress orientations were compared with the orientation of maximum roughness values. The results indicated a correlation between the orientation of the maximum horizontal stress and the orientation of the minimum joint roughness coefficient, implying a possible tracking of stress orientation using joint roughness anisotropy.
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http://dx.doi.org/10.3390/s20236802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730807PMC
November 2020

Anteroposterior Wnt-RA Gradient Defines Adhesion and Migration Properties of Neural Progenitors in Developing Spinal Cord.

Stem Cell Reports 2020 10 24;15(4):898-911. Epub 2020 Sep 24.

Department of Anatomy, Brain Korea 21 Plus Program, Korea University College of Medicine, Seoul, 02841, Korea. Electronic address:

Mammalian embryos exhibit a transition from head morphogenesis to trunk elongation to meet the demand of axial elongation. The caudal neural tube (NT) is formed with neural progenitors (NPCs) derived from neuromesodermal progenitors localized at the tail tip. However, the molecular and cellular basis of elongating NT morphogenesis is yet elusive. Here, we provide evidence that caudal NPCs exhibit strong adhesion affinity that is gradually decreased along the anteroposterior (AP) axis in mouse embryonic spinal cord and human cellular models. Strong cell-cell adhesion causes collective migration, allowing AP alignment of NPCs depending on their birthdate. We further validated that this axial adhesion gradient is associated with the extracellular matrix and is under the control of graded Wnt signaling emanating from tail buds and antagonistic retinoic acid (RA) signaling. These results suggest that progressive reduction of NPC adhesion along the AP axis is under the control of Wnt-RA molecular networks, which is essential for a proper elongation of the spinal cord.
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http://dx.doi.org/10.1016/j.stemcr.2020.08.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7562945PMC
October 2020

Mid-Term Results of Totally Thoracoscopic Ablation in Patients with Recurrent Atrial Fibrillation after Catheter Ablation.

Korean J Thorac Cardiovasc Surg 2020 Oct;53(5):270-276

Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: We investigated the impact of previous catheter ablation (CA) on the midterm outcomes of totally thoracoscopic ablation in patients with lone atrial fibrillation (AF).

Methods: Between February 2012 and July 2018, 332 patients underwent totally thoracoscopic ablation for the treatment of AF (persistent AF; n=264, 80%). The patients were stratified into CA (n=47, 14%) and non-CA (nCA; n=285, 86%) groups according to their CA history.

Results: All the baseline clinical characteristics and risk factors were similar between the groups except for age, percentage of male patients, prevalence of paroxysmal AF, prior percutaneous coronary intervention, and left atrial volume index (LAVI). No significant intergroup differences were observed in the incidence of early and late complications. At late follow-up, normal sinus rhythm was observed in 92% (43 of 47) of the patients in the CA group and 85% (242 of 285) of the patients in the nCA group (p=0.268). The rate of freedom from AF recurrence at 5 years was 55.3%±11.0% in the CA group, which was similar to that in the nCA group (55.7%±5.1%, p=0.690). In Cox regression analysis, preoperative brain natriuretic peptide levels and LAVI were associated with AF recurrence, but CA history was not significant.

Conclusion: Totally thoracoscopic ablation was safe and effective in treating AF irrespective of CA history. A history of CA did not appear to affect the procedural complexity.
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http://dx.doi.org/10.5090/kjtcs.19.059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553833PMC
October 2020

Fibrovascular pigment epithelial detachment in eyes with subretinal hemorrhage secondary to neovascular AMD or PCV: a morphologic predictor associated with poor treatment outcomes.

Sci Rep 2020 09 10;10(1):14943. Epub 2020 Sep 10.

Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4gaYoungdeungpo-gu, Seoul, 150-034, South Korea.

To evaluate the influence of fibrovascular pigment epithelial detachment (FVPED) on treatment outcomes in eyes with subretinal hemorrhage secondary to neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). This retrospective study included 83 eyes diagnosed with fovea-involving submacular hemorrhage secondary to neovascular AMD or PCV. All the patients were treated with intravitreal anti-vascular endothelial growth factor. Eyes showing definite FVPED, which involves the subfoveal region, were included in the FVPED group. Eyes without subfoveal PED, shallow irregular PEDs, or serous/hemorrhagic PED were stratified to the non-FVPED group. The best-corrected visual acuity (BCVA) at diagnosis, at 3 months, at 12 months, and lesion re-activation after initial treatment were compared between the two groups. The mean size of hemorrhage was 8.6 ± 7.6 disc diameter areas. In the FVPED group, the mean logarithm of minimal angle of resolution BCVA was 1.11 ± 0.49 at diagnosis, 0.89 ± 0.58 at 3 months, and 1.05 ± 0.63 at 12 months. In the non-FVPED group, the values were 0.97 ± 0.56, 0.56 ± 0.55, and 0.45 ± 0.50, respectively. The BCVA at 3 months (P = 0.036) and at 12 months (P < 0.001) was significantly worse in the FVPED group than in the non-FVPED group. In addition, the incidence of lesion reactivation was greater in the FVPED group (83.3%) than in the non-FVPED group (38.5%) (P < 0.001). The presence of subfoveal FVPED was associated with a high incidence of lesion re-activation and poor treatment outcomes in eyes with subretinal hemorrhage. This result suggests that different treatment strategies are needed between eyes with and without FVPED.
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http://dx.doi.org/10.1038/s41598-020-72030-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483711PMC
September 2020

A Case of Extranodal Rosai-Dorfman Disease Presenting as an Isolated Mass on the Base of the Tongue in a 57-Year-old Woman.

Am J Case Rep 2020 Jul 28;21:e925716. Epub 2020 Jul 28.

Department of Otorhinolaryngology-Head and Neck Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.

BACKGROUND Rosai-Dorfman disease (RDD), is a rare, benign, proliferative, histiocytic disorder characterized by persistent massive lymphadenopathy, which mimics malignant tumors. Diagnosis of extranodal RDD without lymphadenopathy is difficult due to its unusual clinical manifestation and lack of typical histopathologic features. Hence, it requires both a high degree of clinical suspicion and careful histopathologic examination. CASE REPORT A 57-year-old woman presented with an isolated mass on the base of the tongue (BOT) without lymphadenopathy. Laryngoscopic examination revealed a mass on the midline of the BOT. The patient underwent complete surgical excision via suspension laryngoscopy with a CO₂ laser. Based on the histopathologic features, including numerous histiocytic infiltrations with emperipolesis and cytoplasmic expression of S100 and CD68 in histiocytes, the diagnosis was confirmed as extranodal RDD. No further treatment was required, and follow-up evaluation revealed no evidence of recurrence. CONCLUSIONS Because no ideal therapeutic approach is available for RDD, treatment should be tailored to the clinical manifestations. To prevent airway obstruction and recurrence, surgery is considered an appropriate option in cases of localized RDD arising on the upper respiratory tract. We report an extremely rare case of extranodal RDD without lymphadenopathy in the BOT, and provide a detailed discussion of its clinical and histopathologic features and treatment with a brief review of the relevant literature.
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http://dx.doi.org/10.12659/AJCR.925716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414834PMC
July 2020

Coxsackievirus A6-induced Hand-Foot-and-Mouth Disease Mimicking Stevens-Johnson Syndrome in an Immunocompetent Adult.

Infect Chemother 2020 Dec 27;52(4):634-640. Epub 2020 Jul 27.

Division of Infectious Disease, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Korea.

Hand-foot-and-mouth disease, a highly contagious viral infection, occurs more common in children than in adults. However, there was a recent outbreak of Coxsackievirus A6-induced infection with an atypical presentation among the adult population. Stevens-Johnson syndrome is a severe mucocutaneous disease characterized by extensive necrosis and detachment of the epidermis, and this condition is commonly caused by medications. Herein, we describe a 30-year-old male patient taking allopurinol for the management of gout. The patient presented with numerous erythematous papules, vesicles, and patches with mucosal eruptions on the whole body, oral mucositis, and fever, and he was finally diagnosed with hand-foot-and-mouth disease.
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http://dx.doi.org/10.3947/ic.2020.52.4.634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779988PMC
December 2020

The Role of Orthography in Lexical Processing of the Phonological Variants in Second Language.

J Psycholinguist Res 2021 Apr;50(2):437-445

Verum Liberal College, Catholic Kwandong University, 24 Beomil-ro, 579 Beon-gil, Gangneung-si, Gangwon-do, 25601, Korea.

There is evidence that orthographic knowledge can influence on-line spoken-word recognition. Interestingly, when graphic and phonetic codes are not congruent due to the application of phonological alternation processes, people report hearing sounds that are matched to graphic (underlying), not phonetic codes (Hallé et al. in J Mem Lang 43:618-639, 2000). It is, however, not known whether the same effect arises in the processing of a non-native language (L2). In the present study, advanced Mandarin learners of Korean as well as native Korean listeners performed a phoneme monitoring task using words undergoing obstruent nasalization in Korean. The results showed that orthographic information dominated the phonetic judgments of the native Korean listeners, while the Mandarin learners' judgments relied more on the phonetic input. These results suggest that even the lexical access of highly experienced L2 learners differs from that of native speakers and that advanced learners still have difficulty employing orthographic information to access the L2 lexicon.
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http://dx.doi.org/10.1007/s10936-020-09725-4DOI Listing
April 2021

Risk Factors Associated with Structural Progression in Normal-Tension Glaucoma: Intraocular Pressure, Systemic Blood Pressure, and Myopia.

Invest Ophthalmol Vis Sci 2020 07;61(8):35

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Purpose: To determine risk factors associated with structural progression in medically treated normal-tension glaucoma (NTG).

Methods: This retrospective cohort study included 166 NTG patients (average age, 56.5 years; average mean deviation, -4.2 dB). The structural progression endpoint was determined by optical coherence tomography; significant thickness differences in the peripapillary retinal nerve fiber layer (RNFL) or macular ganglion cell inner plexiform layer (GCIPL) that exceeded baseline test-retest variability were identified with event-based guided-progression analysis. Intraocular pressure and systemic blood pressure (BP) were measured at each visit throughout the follow-up period, and the risk for progression was evaluated with Cox regression. Myopic disc features and antihypertensives were also analyzed. Tree analysis was used to determine the cutoff values and elucidate influential risk factors.

Results: Structural progression, defined as progressive peripapillary RNFL or macular GCIPL thinning, was identified in 62 eyes. Occurrence of disc hemorrhages, presence of diabetes, and lower minimum systolic BP were associated with progression (hazard ratio [HR]: 2.116, P = 0.005; HR: 1.998, P = 0.031; HR: 0.968, P = 0.005; respectively). The cutoff value derived from the tree analysis of minimum systolic BP was 108 mm Hg. The tree analysis revealed systolic and diastolic BP to be the most influential risk factors for progressive peripapillary RFNL thinning and progressive macular GCIPL thinning, respectively.

Conclusions: Low BP measured during follow-up correlated with structural progression in medically treated NTG eyes, indicating that the evaluation of hypotension is required during the management of NTG patients. The tree analysis identified BP target values that may help prevent glaucoma progression.
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http://dx.doi.org/10.1167/iovs.61.8.35DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425752PMC
July 2020

Factors associated with macular vessel density measured by optical coherence tomography angiography in healthy and glaucomatous eyes.

Jpn J Ophthalmol 2020 Sep 9;64(5):524-532. Epub 2020 Jul 9.

Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.

Purpose: To investigate factors associated with macular vessel density and to analyze their effects according to glaucoma stage.

Study Design: Retrospective cross-sectional study.

Methods: A total of 72 healthy eyes and 147 open-angle glaucomatous eyes were studied. All eyes underwent optical coherence tomography and visual field examinations. Clinical variables were compared according to the glaucoma stage. Relationships between macular vessel density (mVD) and other variables were analyzed using linear regression and segmented analyses.

Results: Age (P = 0.010) and signal strength (P < 0.001) were associated with macular vessel density in healthy eyes. In glaucomatous eyes, age, signal strength, ganglion cell-inner plexiform layer (GCIPL) thickness, and mean deviation (MD) correlated with macular vessel density (all P ≤ 0.005). When analyzed by glaucoma stage, age correlated with macular vessel density in early (P = 0.017 and all P ≤ 0.012, respectively) and moderate (P = 0.002 and all P ≤ 0.001, respectively) glaucoma. Conversely, GCIPL thickness was associated with macular vessel density (P = 0.004). According to segmented analysis between MD and mVD, the MD value at the change point for mVD was -17.92 dB, which was much lower than that for GCIPL thickness (-5.83 dB).

Conclusion: Signal strength was the most significant factor associated with macular vessel density in healthy and glaucomatous eyes. Other than signal strength, factors associated with macular vessel density of glaucomatous eyes vary according to the glaucoma stage. The segmented analysis suggests that mVD could be better than GCIPL thickness in predicting MD changes in moderate-to-advanced glaucoma.
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http://dx.doi.org/10.1007/s10384-020-00757-wDOI Listing
September 2020

Diagnostic ability of vessel density measured by spectral-domain optical coherence tomography angiography for glaucoma in patients with high myopia.

Sci Rep 2020 02 20;10(1):3027. Epub 2020 Feb 20.

Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.

Although early glaucoma detection is important to prevent visual loss due to disease progression, its clinical diagnosis in highly myopic eyes is still difficult. Many studies using optical coherence tomography (OCT) angiography (OCTA) reported decreased vessel density (VD) in glaucomatous eyes compared to normal eyes. We evaluated the diagnostic ability of peripapillary VD and macular VD measured by OCTA, comparing them with conventional valuables such as peripapillary retinal nerve fibre layer (RNFL) thickness and macular ganglion cell-inner plexiform layer (GCIPL) thickness measured by OCT. We also calculated the average VD ratio (VDR) (average outer macular VD/average inner macular VD), superior VDR (superior outer macular VD/average inner macular VD), and inferior VDR (inferior outer macular VD/average inner macular VD). Totally, 169 eyes from 169 subjects were enrolled. Among OCTA measurements, the best diagnostic parameters were average VDR (AUROC: 0.852 and 0.909) and inferior VDR (AUROC: 0.820 and 0.941) in nonhighly and highly myopic eyes, respectively. Inferior VDR showed better diagnostic ability than most of the other OCT measurements including peripapillary RNFL thickness and macular GCIPL thickness in highly myopic eyes. Accordingly, OCTA measurements can be useful for diagnosing glaucoma in highly myopic eyes, especially when using calculated indices such as average VDR or inferior VDR.
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http://dx.doi.org/10.1038/s41598-020-60051-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7033250PMC
February 2020

Five-Year Outcomes Among Medicaid-Enrolled Children With In Utero Opioid Exposure.

Health Aff (Millwood) 2020 02;39(2):247-255

Debra L. Bogen is a professor in the Department of Pediatrics, University of Pittsburgh School of Medicine.

The health of women and children affected by opioid use disorder is a priority for state Medicaid programs. Little is known about longer-term outcomes among Medicaid-enrolled children exposed to opioids in utero. We examined well-child visit use and diagnoses of pediatric complex chronic conditions in the first five years of life among children with opioid exposure, tobacco exposure, or neither exposure in utero. The sample consisted of 82,329 maternal-child dyads in the Pennsylvania Medicaid program in which the children were born in the period 2008-11 and followed up for five years. Children with in utero opioid exposure had a lower predicted probability of recommended well-child visit use at age fifteen months (42.1 percent) compared to those with tobacco exposure (54.1 percent) and those with neither exposure (55.7 percent). Children with in utero opioid exposure had a predicted probability of being diagnosed with a pediatric complex chronic condition similar to that among children with tobacco exposure and those with neither exposure (20.4 percent, 18.7 percent, and 20.2 percent, respectively). Our findings were consistent when we examined a subgroup of opioid-exposed children identified as having neonatal opioid withdrawal symptoms.
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http://dx.doi.org/10.1377/hlthaff.2019.00740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328447PMC
February 2020

Protective effect of Lactobacillus casei HY2782 against particulate matter toxicity in human intestinal CCD-18Co cells and Caenorhabditis elegans.

Biotechnol Lett 2020 Apr 23;42(4):519-528. Epub 2020 Jan 23.

Natural Product Informatics Research Center, Korea Institute of Science and Technology, Gangneung, Gangwon-do, 25451, Republic of Korea.

Objectives: To investigate the preventive effect of Lactobacillus casei HY2782 on toxicity induced by particulate matter (PM, inhalable particles less than 10 μm in diameter) in human intestinal CCD-18Co cells and a model animal Caenorhabditis elegans.

Results: L. casei HY2782 treatment prevented PM-induced intestinal cell death via cellular reactive oxygen species production and membrane disruption attenuation. PM significantly decreased the total number of eggs laid and the body bending activity of C. elegans, demonstrating PM toxicity. L. casei HY2782 treatment restored the reproductive toxicity and decline in locomotion activity induced by PM in C. elegans. Overall, L. casei HY2782 attenuated PM toxicity in vitro in cultured intestinal cells and in vivo in the model nematode.

Conclusion: Our study provides a potential clue for developing L. casei HY2782 probiotics that attenuate PM-induced cellular and physiological toxicity; however, further in-depth preclinical trials using mammalian animal models and clinical trials are required.
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http://dx.doi.org/10.1007/s10529-020-02814-3DOI Listing
April 2020

Myeloid Sarcoma That Infiltrated a Preexisting Sebaceous Lymphadenoma in the Parotid Gland: Diagnostic Challenges and Literature Review.

Biomed Res Int 2019 22;2019:9869406. Epub 2019 Nov 22.

Department of Otorhinolaryngology-Head and Neck Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.

Myeloid sarcoma (MS) is a rarely encountered extramedullary localized tumor that is composed of immature myeloid cells. We reported an extremely rare case of MS with concurrent bone marrow (BM) involvement that invaded into a preexisting sebaceous lymphadenoma in the parotid gland and neck lymph nodes. Prompted by this case, we also present a literature review of MS invasion into salivary glands. A 62-year-old man was initially diagnosed with carcinoma that arose in a sebaceous lymphadenoma in the parotid gland, through a total parotidectomy with neck dissection. After an extensive histopathological review that included immunohistochemistry, a pathologic diagnosis of MS with infiltration into the sebaceous lymphadenoma with concurrent BM involvement was confirmed. MS is difficult to diagnose accurately; herein, we analyzed the clinical presentations and effectiveness of the various diagnostic methods with a review of the literature. There are 17 cases, including our case, reported in 13 studies. Of the cases in which the salivary glands were affected, 10 involved the parotid gland, six involved the submandibular gland, and one involved both. Isolated invasion of the salivary gland was found in one case of parotid gland invasion and three cases of submandibular gland invasion. In 13 cases, the salivary glands were affected by various other lesions. Although there were no incidences of isolated MS, six patients were diagnosed with secondary MS and eight patients with MS with BM involvement, including this case. The diagnosis of MS is difficult given its rarity, and a high index of suspicion and integrated radiologic and careful histopathologic evaluation are required. Most cases of MS infiltrating the salivary gland might be indicated by the possibility of BM involvement. MS with BM involvement predicts poor prognosis and the need for intensive systemic treatment.
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http://dx.doi.org/10.1155/2019/9869406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893249PMC
May 2020

Intravitreal aflibercept for submacular hemorrhage secondary to neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.

Graefes Arch Clin Exp Ophthalmol 2020 Jan 18;258(1):107-116. Epub 2019 Nov 18.

Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea.

Purpose: To evaluate the efficacy of intravitreal aflibercept monotherapy for submacular hemorrhage secondary to neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV).

Methods: This prospective, phase 4 clinical trial included 29 patients diagnosed with fovea-involving submacular hemorrhage secondary to neovascular AMD (7 patients) or PCV (22 patients). Patients were initially administered 3 monthly aflibercept injections, followed by 1 injection every 2 months. The primary outcome measure was changes in Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) during the 56-week study period. Other key outcome measures were the proportion of patients who exhibited changes in BCVA of ≥ 15 ETDRS letters from baseline and changes in central retinal thickness (CRT).

Results: The mean size of hemorrhage was 6.2 ± 4.8-disc-diameter area. The mean BCVA significantly improved from 52.9 ± 17.8 ETDRS letters at week 0 (baseline) to 71.8 ± 16.1 letters at week 56 (P < 0.001). At week 56, improvement in BCVA of ≥ 15 letters was noted in 16 patients (55.2%), whereas none of the patients experienced a loss of ≥ 15 letters. The mean CRT significantly decreased from 498.9 ± 194.2 μm at week 0 to 248.3 ± 45.0 μm at week 56 (P < 0.001). During the study period, retinal break developed in one patient.

Conclusions: Intravitreal aflibercept administered every 2 months after the 3 initial monthly doses was found to be an effective and safe treatment method for submacular hemorrhage secondary to neovascular AMD.
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http://dx.doi.org/10.1007/s00417-019-04474-0DOI Listing
January 2020
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