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The purpose of this retrospective study was to evaluate whether tumor apparent diffusion coefficient (ADC) was correlated with pathologic biomarkers such as tumor cellularity, Ki67, tumor-infiltrating lymphocytes (TILs), and peritumoral lymphocytic infiltrate (PLI) in patients with estrogen receptor (ER)-positive breast cancer. The study was approved by the institutional review board and informed consent was waived. From July 2014 to December 2014, we reviewed 140 ER-positive tumors in 138 consecutive patients (range, 28-77 years; mean, 52 years) who underwent preoperative breast MRI and definitive surgery. All patients underwent diffusion-weighted imaging with a 3T scanner. Two radiologists drew the region of interest of the entire tumor and obtained the mean and pixel-based histogram of ADC. On pathology, two pathologists reviewed tumor cellularity, Ki67, TILs, and PLI. Multiple linear regression analysis was used to determine pathologic variables independently associated with ADC. Tumors with high tumor cellularity and high Ki67 had significantly lower ADCs than those with low tumor cellularity and low Ki67 (P0.05 for all). Tumors without PLI had significantly higher standard deviation than those with PLI (0.23 ± 0.08 versus 0.18 ± 0.05; P0.001). Median ADC was negatively correlated with tumor cellularity (r = -0.441), and Ki67 (r = -0.382). The standard deviation of ADC was also negatively correlated with the degree of PLI (r = -0.319). On multivariate linear regression analysis, tumor cellularity and Ki67 were independently associated with tumor ADC. Tumor ADC would be an MRI biomarker for the prediction of tumor aggressiveness indicators such as Ki67, tumor cellularity, and PLI in ER-positive breast cancer. Copyright © 2016 John WileySons, Ltd.

To validate a method for performing myocardial segmentation based on coronary anatomy using coronary CT angiography (CCTA). Coronary artery-based myocardial segmentation (CAMS) was developed for use with CCTA. To validate and compare this method with the conventional American Heart Association (AHA) classification, a single coronary occlusion model was prepared and validated using six pigs. The unstained occluded coronary territories of the specimens and corresponding arterial territories from CAMS and AHA segmentations were compared using slice-by-slice matching and 100 virtual myocardial columns. CAMS more precisely predicted ischaemic area than the AHA method, as indicated by 95% versus 76% (p

A low-profile antenna is designed for a WiBro vertical polarized signal. The proposed antenna is packaged and installed on the roof of a vehicle. The low-profile configuration is inspired from a zero-phase constant that realizes a horizontal magnetic loop current distribution equivalent to a vertical electric current distribution. With the proposed antenna, a wide bandwidth is achieved by overcoming the narrow bandwidth characteristics of an antenna with a zero-phase constant. The antenna was designed using a large conductive plate to simulate the vehicle roof in the electromagnetic simulation, thereby dramatically reducing simulation time. The results are comparable to the experimental results of an antenna on a vehicle's roof. The unpackaged and packaged antennas' radiation patterns are first measured in an anechoic chamber. Azimuth patterns are measured by installing the packaged antenna on the vehicle's roof. Simulations agree with experimental data where the vertically polarized signal is su...

The main problem in performing endoscopic submucosal dissection (ESD) of gastric neoplasms is that it is technically difficult, especially for beginners. A total of 51 patients were randomly assigned to undergo transnasal endoscope-assisted or routine ESD performed by two endoscopists inexperienced in ESD while supervised by one expert. Total procedure time (p = 0.330), complete resection rate (p = 0.977), and complication rate (p = 0.157) were similar for the patients who underwent transnasal endoscope-assisted and routine ESD, but bleeding control time was significantly longer in the transnasal endoscope-assisted ESD group (p = 0.002). Three and six patients in the transnasal endoscope-assisted and routine ESD groups, respectively, were “dropped out” during the procedures (p = 0.291). The endoscopists tended to regard the traction with the transnasal endoscope as more useful for large tumors (p = 0.062). Bleeding control in patients who underwent the transnasal endoscope-assisted ESD was significantly longer for patients with tumors located in the anterior wall, posterior wall, and lesser curvature of the stomach (p = 0.001). Transnasal endoscope-assisted ESD does not result in improved outcomes when performed by beginners, except for some large tumors. The traction method used by beginners was not superior to proper supervision and advice by an expert during ESD and allowing the expert to perform the procedure when the risk of complications is high or the procedure is delayed.

The current exploratory study investigates passengers’ perceptions of airline lounges by measuring the importance of attributes that determine usage and service quality in those facilities. Data collection was the result of a survey of airline lounge users at the Incheon International Airport, South Korea. The attributes that determine airline lounge usage categorize as: image and accessibility, atmosphere, food and beverage (F&B) service, and facility’s dimensions. Atmosphere and F&B service prove to be the most important dimensions affecting passengers’ use of the airline lounge. Service quality variables determining passengers’ perceptions of the airline lounge categorize as: atmosphere, F&B service, employee service, and facility’s dimensions. Among the service quality dimensions, F&B service was the strongest predictor of overall satisfaction and lounge revisit intention. Furthermore, the study considers the relationship of overall satisfaction and lounge revisit intention according to airline selection.

This study presents the Analytical Hierarchy Process (AHP) as a potential decision-making method for obtaining the relative weights of alternatives through pairwise comparison in the context of hierarchical structure. The aim of this study was to elicit prior strategies for brand communication for Korean restaurants overseas. We created a questionnaire and surveyed experts at government agencies, restaurant companies, and universities from October to November 2011. By applying the pairwise comparison matrix, relevance was perceived as a more important strategy evaluation criteria than effectiveness or urgency. The highest-ranked strategy was the `Identification of the BI and positioning of Korean restaurants` followed by `Development of Korean food content for overseas promotion`, `Development of locally customized Korean food recipes and new Korean menus`, `Development of marketing communication strategies for Korean restaurants by countries`, and `Development of Korean restaurant differentiation strategies`. The results of this study can be used for effective Korean food globalization by enhancing the competitiveness in the world market.

The aim of this study was to determine whether tumor size, MRS parameters and apparent diffusion coefficient (ADC) measurements could be applied to predict pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC). Ninety patients with breast cancer (median size, 4.5 cm; range, 1.6–9.5 cm) were evaluated with single-voxel 1H MRS and dynamic contrast-enhanced MRI. Diffusion-weighted imaging was performed in 41 of these patients using a 1.5-T scanner before and after completion of NAC. Pre- and post-treatment measurements and changes in tumor size, MRS parameters [absolute and normalized total choline-containing compound (tCho) integral and tCho signal-to-noise ratio (SNR)] and ADCs in pCR versus non-pCR were compared using the nonparametric Mann–Whitney test. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of each parameter. After NAC, 30 patients (33%) showed pCR and 60 (67%) showed non-pCR. At pretreatment, ADC was the only significant parameter in differentiating between pCR and non-pCR [(0.83 ± 0.05) × 10–3 versus (0.97 ± 0.14) × 10–3 mm2/s] (p = 0.014). Post-treatment measurements after completion of NAC and changes in tumor size (both p

Circadian and Seasonal Variation in Early Repolarization Syndrome. Introduction: The circadian and seasonal patterns of ventricular tachyarrhythmia (VTA) in patients with early repolarization syndrome (ERS) have not been determined. We compared the timing of VTAs in patients with ERS and Brugada syndrome (BS). Methods and Results: We enrolled patients with ERS (n = 14) and BS (n = 53) who underwent implantable cardioverter defibrillator (ICD) implantation. The timing of VTAs, including cardiac arrest and appropriate shocks, was determined. During follow up of 6.4 ± 3.6 years in the ERS group and 5.0 ± 3.3 years in the BS group, 5 of 14 (36%) ERS and 10 of 53 (19%) BS patients experienced appropriate shocks (P = 0.37). Cardiac arrest showed a trend of nocturnal distribution peaking from midnight to early morning (P = 0.14 in ERS, P = 0.16 in BS). Circadian distribution of appropriate shocks showed a significant nocturnal peak in patients with ERS (P

* 연세대학교 식품영양학과, ** 한양여자대학교 식품영양과, *** 신구대학교 식품영양과, **** 서일대학교 식품영양과, ***** 상지대학교 식품영양학과 Abstract The purpose of this study was to investigate foodservice management practices in the child care centers and kindergartens. Interviews were held from May to July 2008 to understand the current situation concerning foodservices in Seoul and Gyeonggi provinces. Surveys were sent out from August 2008 to April 2009 to 1,478 child care centers and 299 kindergartens via the postal service. Among them, 203 child care centers(13.7%) and 64 kindergartens(21.4%) responded. One of the largest concerns while preparing the food was nutrition(68.7%, 69.8%, respectively) followed by sanitation(24.4%, 27.0%, respectively). The most frequently referred sources for planning the menu were the Seoul child care information center(55.4%) for child care centers and kindergarten related internet sites(39.0%) for the kindergartens. In general, the child care center principal was in charge of planning the menu(40.1%). Child care centers and kindergartens purchased ingredients mostly from large retailers(55.3% and 44.7%, respectively), whereas 46.0% and 56.3% of those did through foodservice suppliers. Dietitians were rarely employed at these facilities, and this may cause unprofessional foodservice management.

The aim of this study was to compare the American, Chinese, and Japanese consumers' usage behavior of marketing communication towards overseas Korean restaurants. The survey included both on and off-line method and self-administered questionnaires were written in three languages- English, Chinese and Japanese. The sample was collected from 5 hub cities for globalization of Korean food- LA, New York, Tokyo, Beijing, and Shanghai. The most important factor of searching for Korean restaurants-related information was 'the interaction' and the least one was 'the diversity'. The most commonly informed Korean restaurants-related content through the on and off-line media was 'the general information, such as location, telephone number, and operation hour'. Korean restaurants-related content that the respondents' most interested in was 'the information of menu and price'. Results of this study can expectedly be used from a practical point of view by providing empirical data of foreign consumers for effective marketing communication strategies of overseas Korean restaurants.

A low-profile planar vehicle antenna for the roof of a car is proposed for use with terrestrial services. Despite its low configuration, the proposed antenna can realize a vertical polarization. To demonstrate its performance, the proposed antenna is mounted on the roof of a mid-sized vehicle, and the radiation patterns are measured at three different positions. The omnidirectional patterns are observed in an azimuth plane with 2 dBi of peak gain at 2.3 GHz. © 2011 Wiley Periodicals, Inc. Microwave Opt Technol Lett 54:91–94, 2012; View this article online at wileyonlinelibrary.com. DOI 10.1002/mop.26513

Supplemental Digital Content is available in the text, Blood eosinophilia is a common clinical finding. Helminthic infections, including toxocariasis, are a common cause of eosinophilia; however, the clinical course of toxocariasis associated with eosinophilia is not fully understood. Thus, controversies exist regarding treatment indications. To evaluate the clinical features and natural course of various types of eosinophilia, with a particular focus on toxocariasis, we retrospectively reviewed the medical records of 1000 patients with peripheral blood eosinophilia who were referred to the allergy clinic at Asan Medical Center between 2007 and 2012. Clinical parameters and imaging study findings were evaluated. The treatment response to albendazole and resulting changes in eosinophilia and imaging studies were analyzed in patients diagnosed with toxocariasis. Among the 1000 subjects, toxocariasis was the most common cause of eosinophilia (n = 534; 53.4%), followed by allergic disease and adverse drug reactions. The majority of patients with toxocariasis were men, and they were mostly asymptomatic. More than one-third of patients (n = 215; 40.3%) with toxocariasis exhibited organ involvement, particularly hepatic involvement. In most cases of eosinophilia and organ involvement due to toxocariasis, the symptoms normalized regardless of treatment. Most cases of eosinophilia related to toxocariasis displayed a self-remitting course regardless of treatment. With the exception of several clinical situations, including ocular involvement, the clinical need for anti-helminthic therapy in toxocariasis is not that significant.

Background The purpose of this study was to document outcomes following withdrawal of a single inhaler (step-down) in chronic obstructive pulmonary disease (COPD) patients on triple therapy (long-acting muscarinic antagonist and a combination of long-acting β2-agonists and inhaled corticosteroid), which a common treatment strategy in clinical practice. Methods Through a retrospective observational study, COPD patients receiving triple therapy over 2 years (triple group; n=109) were compared with those who had undergone triple therapy for at least 1 year and subsequently, over 9 months, initiated inhaler withdrawal (step-down group, n=39). The index time was defined as the time of withdrawal in the stepdown group and as 1 year after the start of triple therapy in the triple group. Results Lung function at the index time was superior and the previous exacerbation frequency was lower in the stepdown group than in the triple group. Step-down resulted in aggravating disease symptoms, a reduced overall quality of life, decreasing exercise performance, and accelerated forced expiratory volume in 1 second (FEV1) decline (54.7±15.7 mL/yr vs. 10.7±7.1 mL/yr, p=0.007), but there was no observed increase in the frequency of exacerbations. Conclusion Withdrawal of a single inhaler during triple therapy in COPD patients should be conducted with caution as it may impair the exercise capacity and quality of life while accelerating FEV1 decline.

To determine whether magnetic resonance (MR) enterography performed with diffusion-weighted imaging (DWI) without intravenous contrast material is noninferior to contrast material-enhanced (CE) MR enterography for the evaluation of small-bowel inflammation in Crohn disease.Institutional review board approval and informed consent were obtained for this prospective noninferiority study. Fifty consecutive adults suspected of having Crohn disease underwent clinical assessment, MR enterography, and ileocolonoscopy within 1 week. MR enterography included conventional imaging and DWI (b = 900 sec/mm(2)). In 44 patients with Crohn disease, 171 small-bowel segments that were generally well distended and showed a wide range of findings, from normalcy to severe inflammation (34 men, 10 women; mean age ± standard deviation, 26.9 years ± 6.1), were selected for analysis. Image sets consisting of (a) T2-weighted sequences with DWI and (b) T2-weighted sequences with CE T1-weighted sequences were reviewed by using a crossover design with blinding and randomization. Statistical analyses included noninferiority testing regarding proportional agreement between DWI and CE MR enterography for the identification of bowel inflammation with a noninferiority margin of 80%, correlation between DWI and CE MR enterography scores of bowel inflammation severity, and comparison of accuracy between DWI and CE MR enterography for the diagnosis of terminal ileal inflammation by using endoscopic findings as the reference standard.The agreement between DWI and CE MR enterography for the identification of bowel inflammation was 91.8% (157 of 171 segments; one-sided 95% confidence interval: ≥88.4%). The correlation coefficient between DWI and CE MR enterography scores was 0.937 (P.001). DWI and CE MR enterography did not differ significantly regarding the sensitivity and specificity for the diagnosis of terminal ileal inflammation (P.999). DWI and CE MR enterography concurred in the diagnosis of penetrating complications in five of eight segments.DWI MR enterography was noninferior to CE MR enterography for the evaluation of inflammation in Crohn disease in generally well-distended small bowel, except for the diagnosis of penetration.

BACKGROUND Breast cancer diagnosed in young women may be more aggressive, with higher rates of local and distant recurrence compared to the disease in older women. Epidemiologic evidence suggests that Korean women have a lower incidence of breast cancer than women in the United States, but that they present at a younger age than their American counterparts. We sought to compare risk factors and management of young women with breast cancer in Boston, Massachusetts (US) with those in Seoul, South Korea (KR). MATERIALS AND METHODS A retrospective review was performed of consecutive patients less than 35 years old with a diagnosis of breast cancer at academic cancer centers in the US and KR from 2000-2005. Patient data were obtained by chart review. Demographic, tumor and treatment characteristics were compared utilizing Pearson's chi- square or Wilcoxon rank-sum tests where appropriate. All differences were assessed as significant at the 0.05 level. RESULTS 205 patients from the US and 309 from KR were analyzed. Patients in US were more likely to have hormone receptor positive breast cancer, while patients in KR had a higher rate of triple negative lesions. Patients in US had a higher mean body mass index and more often reported use of birth control pills, while those in the KR were less likely to have a sentinel node procedure performed or to receive post mastectomy radiation. CONCLUSIONS Patients under 35 diagnosed with breast cancer in the US and KR differ with respect to demographics, tumor characteristics and management. Although rates of breast conservation and mastectomy were similar, US patients were more likely to receive post mastectomy radiation. The lower use of sentinel node biopsy is explained by the later adoption of the technique in KR. Further evaluation is necessary to evaluate recurrence rates and survival in the setting of differing disease subtypes in these patients.

Purpose. To analyze causes and prognosis of acute-onset preoperatively unknown origin vitreous hemorrhage (VH).Methods. This study included patients who underwent vitrectomy for acute-onset preoperatively unknown origin VH. The underlying causes of VH, which were identified after vitrectomy, were analyzed. And overall visual prognosis of unknown origin VH was analyzed. Risk scoring system was developed to predict visual prognosis after vitrectomy.Results. 169 eyes were included. Among these, retinal vein occlusion (RVO), retinal break, and age-related macular degeneration (AMD) were identified in 74 (43.8%), 50 (29.6%), and 21 (12.4%) patients, respectively. After vitrectomy, logMAR BCVA significantly improved from1.93±0.59to0.47±0.71. However, postoperative BCVA in AMD eyes were significantly poorer than others. Poor visual prognosis after vitrectomy was associated with old age, poor preoperative vision in both eyes, and drusen in the fellow eye.Conclusions. RVO, retinal break, and AMD are the most common causes of acute-onset preoperatively unknown origin VH and the most common causes of VH change with age. The visual prognosis of unknown origin VH is relatively good, except among AMD patients. Older patients with poor preoperative BCVA in both eyes and patients with AMD in the fellow eye are at a higher risk of poor visual prognosis following vitrectomy.

Intubation in patients with respiratory failure can be avoided by high-flow nasal cannula (HFNC) use. However, it is unclear whether waiting until HFNC fails, which would delay intubation, has adverse effects. The present retrospective observational study assessed overall ICU mortality and other hospital outcomes of patients who received HFNC therapy that failed. All consecutive patients in one tertiary hospital who received HFNC therapy that failed and who then required intubation between January 2013 and March 2014 were enrolled and classified according to whether intubation started early (within 48 h) or late (at least 48 h) after commencing HFNC. Of the 175 enrolled patients, 130 (74.3 %) and 45 (25.7 %) were intubated before and after 48 h of HFNC, respectively. The groups were similar in terms of most baseline characteristics. The early intubated patients had better overall ICU mortality (39.2 vs. 66.7 %; P = 0.001) than late intubated patients. A similar pattern was seen with extubation success (37.7 vs. 15.6 %; P = 0.006), ventilator weaning (55.4 vs. 28.9 %; P = 0.002), and ventilator-free days (8.6 ± 10.1 vs. 3.6 ± 7.5; P = 0.011). In propensity-adjusted and -matched analysis, early intubation was also associated with better overall ICU mortality [adjusted odds ratio (OR) = 0.317, P = 0.005; matched OR = 0.369, P = 0.046]. Failure of HFNC might cause delayed intubation and worse clinical outcomes in patients with respiratory failure. Large prospective and randomized controlled studies on HFNC failure are needed to draw a definitive conclusion.

Background Although smoking is the most important and modifiable cause of chronic obstructive pulmonary disease (COPD), other risk factors including asthma and tuberculosis (TB) are also associated. It is common for COPD patients to have more than one of these risk factors. The aims of this study were to determine the prevalence of airflow limitation (FEV1/FVC

It remains difficult to differentiate between chronic obstructive pulmonary disease (COPD) and asthma in clinical practice, especially in a primary care setting. The purpose of this study was to develop a new scoring system for differentiating between COPD and asthma, and to evaluate its effectiveness.First, to identify important variables differentiating COPD from asthma, the data of 197 patients with COPD and 138 patients with asthma were assessed retrospectively. Secondly, a scoring system that was based on these variables was then developed, and its performance was internally validated using a bootstrapping-based method. Thirdly, the scoring system was externally validated using prospectively collected data from patients with COPD (n = 104) or asthma (n = 96).The final scoring system was composed of the four variables: age of onset of breathlessness (40 years, 0 points; 40-60 years, 2 points;60 years, 4 points), continuous breathlessness (no, 0 points; yes, 1 point), diurnal variation of breathlessness (yes, 0 points; no, 1 point) and emphysematous change in chest X-ray (no, 0 points; yes, 1 point). The patients were classified by their total score into three categories: 0-2 points, probable asthma; 3-4 points, difficult-to-differentiate; 5-7 points, probable COPD. The new scoring system performed well in the external validation dataset (area under the curve, 0.86; 95% confidence interval: 0.813-0.911; P 0.001).The new scoring system that was developed in this study may be a useful tool for differentiating between COPD and asthma in primary care.

It is generally known that pregnancy in asthmatic patients increases the risk of asthma exacerbations and poor perinatal outcomes. However, the effect of pregnancy in asthmatic patients on health care use is not known well. In addition, its effect on perinatal outcomes is still controversial because of study limitations caused by ethical issues. National Health Insurance claim data are an ideal resource for studying real-world health care use patterns of asthma.We sought to evaluate the effect of pregnancy on asthma in terms of asthma-related health care use and prescription patterns in concert with the effect of asthma exacerbations on adverse pregnancy outcomes.Among all asthmatic patients in the Korean National Health Insurance claim database from January 2009 to December 2013, pregnant women who delivered in 2011 with pre-existing asthma were enrolled. Analyses included asthma-related health care use and prescription patterns compared between pregnant asthmatic women and nonpregnant female asthmatic control subjects, as well as within the pregnant subjects from before pregnancy throughout postpartum periods. In addition, the association between asthma exacerbation during pregnancy and adverse pregnancy outcomes was assessed.A total of 3,357 pregnant asthmatic patients were compared with 50,355 nonpregnant asthmatic patients, and 10,311 pregnant patients were included to determine the effect of asthma exacerbations on adverse pregnancy outcome in the study. Pregnant asthmatic patients underwent more asthma-related hospitalizations (1.3% vs 0.8%, P = .005) but had significantly fewer outpatient visits and prescriptions for most asthma medications than nonpregnant asthmatic patients. The proportion of patients ever hospitalized gradually increased throughout pregnancy (first trimester, 0.2%; second trimester, 0.5%; and third trimester, 0.7%; P = .018). The prevalence of asthma exacerbation during pregnancy was 5.3%, and the patients who had acute exacerbation during pregnancy had significantly higher asthma-related health care use in terms of hospitalization, intensive care unit admission, and emergency department and outpatient visits within 1 year before delivery than those who had not. However, asthma exacerbation during pregnancy was not significantly related to adverse perinatal outcomes, except for cesarean section (27.1% vs 18.9%, P.001). All exacerbations were managed with systemic corticosteroids, and the patients who ever experienced acute exacerbations maintained asthma medications, including inhaled corticosteroid-based inhalers, throughout the pregnancy period.Pregnancy profoundly affects asthma-related health care use but to a different degree depending on whether the patient experienced an exacerbation. Asthma exacerbation during pregnancy is not associated with adverse pregnancy outcomes while managed appropriately with systemic corticosteroids. However, further studies are needed to clarify the effect of asthma control on perinatal outcome and delivery method.

Although the prevalence of both metabolic syndrome (MetS) and fractures increases with advancing age, studies on possible associations between these conditions in men are limited and the results are inconsistent.The objective of the study was to clarify the impact of MetS on the male risk of incident fractures.This was a large, longitudinal study with an average 3-year follow-up period.Korean men (n = 16 078) aged 50 years or older who had undergone comprehensive routine health examinations participated in the study.Incident fractures found after baseline examinations were identified using selected International Classification of Diseases, tenth revision, codes in the nationwide claims database of the Health Insurance Review and Assessment Service of Korea.In total, 158 men (1.0%) developed incident fractures. The fracture event rates for subjects with and without MetS were 26.2 and 35.7 per 10 000 person-years, respectively. After adjustment for potential confounders, subjects with MetS had a much lower risk of incident fractures than subjects without MetS (hazard ratio 0.662, 95% confidence interval 0.445-0.986). Furthermore, subjects with three and four or more MetS components had a 49.4% and 50.4% lower risk, respectively, of incident fractures compared with the subjects without any MetS components. Importantly, additional adjustment for body mass index eliminated the statistical significance of these associations.Our current results indicate that the beneficial effects of MetS in reducing fracture risk could be explained by the general obesity that accompanies MetS, although other related factors, such as greater padding effect, peripheral aromatization, or adipokine changes, may also contribute.

Occult breast cancer (OBC) accounts for 0.3-1.0% of all breast cancers and is a rare presentation of the disease. The present retrospective study examined the overall survival and prognostic factors associated with OBC in Korea.The study included 142 OBC patients identified from the Korean Breast Cancer Society cancer registry from January 1990 to December 2009. All patients had pathologically positive axillary lymph nodes (N1-N3) and pathologically and radiologically negative in-breast lesions (T0/Tx) based on a retrospective review of the database.No statistically significant differences in overall survival were observed between patients undergoing axillary lymph node dissection (ALND) only (80.8%), breast conserving surgery (BCS) with ALND (98.0%), and mastectomy with ALND (92.5%) with P-value of 0.061. Nodal status was a significant prognostic factor (P = 0.004) on univariate analysis. When compared with T1 patients group, T0/TxN1 patients showed better survival than T1N1 patients (hazard ratio [HR] 0.253; 95% confidence interval, 0.104-0.618; P = 0.003), but T0/TxN2, T0/TxN3 patients showed similar survival to T1N2, T1N3 patients.OBC patients treated with ALND only showed comparable outcomes to those undergoing ALND combined with BCS or mastectomy. Nodal status may be an independent predictor of poor outcome in OBC patients.

Pneumonia following endoscopic procedures may affect the clinical course and prolong hospital stay. To investigate the incidence and risk factors for pneumonia after endoscopic resection (ER) for gastric neoplasm. Subjects who underwent ER for gastric neoplasm at the Asan Medical Center from January 1997 to March 2013 were included. To investigate risk factors, control patients were randomly selected from these subjects. Of the 7,149 subjects who underwent ER for gastric neoplasm, 44 (0.62 %) developed pneumonia. The median age of these 44 patients was 68 years (range 31–82 years), and the male to female ratio was 3:1. Twenty-five of the pneumonia patients (56.8 %) were smokers, and 8 (18.2 %) had underlying pulmonary diseases. The median procedure time was 23 min (range 2–126 min), and pathologic diagnoses included adenocarcinoma (n = 29), dysplasia (n = 10), and hyperplastic polyp (n = 5). Compared with the control group, smoking (current smoker vs. never smoker, odds ratio [OR] 2.366, p = 0.021), total procedure time (OR 1.011, p = 0.048), and hemostasis time (OR 1.026, p = 0.028) were risk factors for the development of pneumonia. In multivariate analysis, age >65 years (OR 2.073, p = 0.031), smoking (current smoker vs. never smoker, OR 2.324, p = 0.023), and hemostasis time (OR 1.025, p = 0.038) were independent risk factors. All patients recovered from pneumonia, and the duration of hospital stay did not differ between patients with pneumonia and the control group (p = 0.077). Whereas old age, smoking, and longer hemostasis time are risk factors for pneumonia, its incidence after ER is not associated with clinically significant adverse outcomes.

In this large longitudinal study of 16,078 Korean men aged 50 years or older, we observed that baseline elevation of serum uric acid level significantly associated with a lower risk of incident fractures at osteoporosis-related sites during an average follow-up period of 3 years. Male osteoporosis and related fractures are becoming recognized as important public health concerns. Oxidative stress has detrimental effects on bone metabolism, and serum uric acid (UA) is known to be a strong endogenous antioxidant. In the present study, we performed a large longitudinal study with an average follow-up period of 3 years to clarify the role of UA on the risk of incident osteoporotic fractures (OFs). A total of 16,078 Korean men aged 50 years or older who had undergone comprehensive routine health examinations were enrolled. Incident fractures at osteoporosis-related sites (e.g., hip, spine, distal radius, and proximal humerus) that occurred after the baseline examinations were identified from the nationwide claims database of the Health Insurance Review and Assessment Service of Korea by using selected International Classification of Diseases, 10th revision codes. In total, 158 (1.0 %) men developed incident OFs. The event rate was 33.1 per 10,000 person-years. Subjects without incident OFs had 6.0 % higher serum UA levels than subjects with OFs (P = 0.001). Multivariable-adjusted Cox proportional hazard analyses adjusted for age, body mass index, glomerular filtration rate, lifestyle factors, medical and drug histories, and the presence of baseline radiological vertebral fractures revealed that the hazard ratio per standard deviation increase of baseline UA levels for the development of incident OFs was 0.829 (95 % CI = 0.695–0.989, P = 0.038). These data provide the epidemiological evidence that serum UA may act as a protective factor against the development of incident OFs in Korean men.

To evaluate the diagnostic performance of an apparent diffusion coefficient (ADC) and quantitative kinetic parameters in patients with newly diagnosed breast cancer.We enrolled 169 lesions in 89 patients with breast cancer who underwent dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI). Comparisons between benign and malignant lesions were performed for lesion type (mass or nonmass-like enhancement), size (≥1cm or1cm), ADC, kinetic parameters and the presence of a US correlate.There were 63 benign and 106 malignant lesions. The mean size and initial peak enhancement of the benign lesions were significantly lower than those of malignant lesions (P0.001 for both). The ADC of the benign lesions was significantly higher than that of malignant lesions (1.42×10(-3)mm(2)/sec vs. 1.04×10(-3)mm(2)/sec; P0.001). The area under the receiver operating characteristic curve (AUC) for predicting malignancy was 0.87 for the combined parameters of size, ADC, and initial peak enhancement, which was higher than those of each parameter.Combination of quantitative kinetic parameters and ADC showed higher diagnostic performance for predicting malignancy than each parameter alone for the evaluation of patients with breast cancer.

Background National Health Insurance (NHI) claim records could provide valuable data for epidemiological studies of asthma in Korea. The aim of this study is to estimate the prevalence of adult asthma and to investigate asthma-related healthcare use and prescription patterns in Korea over 5 years. Methods National Health Insurance claim records from January 1, 2006 to December 31, 2010 were analyzed in a retrospective, population-based study. Outcome measures included asthma prevalence, healthcare use, and prescription patterns over time, by type of hospital, and by medical specialty. Additionally, we assessed differences in healthcare use between newly diagnosed and previously diagnosed patients in 2009. Results Over 5 years, the prevalence of asthma among Korean adults increased from 4944 to 5707 cases per 100 000 population (from 3760 to 4445 in men and from 6108 to 6951 in women). Asthma-related outpatient visits decreased from 4.82 ± 8.02 to 3.44 ± 5.50. Approximately 3% of all patients were hospitalized and 2.4% received asthma-related emergency treatment each year. Pulmonary function tests were performed in 10–11% of patients an average of 1.3 times per year. Newly diagnosed patients experienced fewer asthma-related hospitalizations (1.78% vs 4.35%) and emergency department visits (0.80% vs 2.11%) than the previously diagnosed group. Prescriptions of inhaled corticosteroids-based inhalers were maintained with about 20% of average of all types of hospitals. Conclusions The prevalence of asthma in Korea has increased over a recent 5-year period, and asthma is still suboptimally controlled. Public health strategies are needed to improve the management of asthma in adults.

Second primary malignancies (SPMs) are common in patients with head and neck squamous cell carcinoma (HNSCC) and have a negative impact on their survival. This study aimed to evaluate risk factors for SPM occurrence and cause-specific mortality in Asian HNSCC patients.A retrospective cohort study.University teaching hospital.Nine hundred and thirty-seven patients without previous cancer history who were treated between 2000 and 2009 and followed for at least 2 years.Confirmation of SPMs was performed by histopathology. The cumulative probability of a SPM among survivors of index HNSCC was calculated using a competing risk model. Univariate and multivariate analyses were utilized to determine factors predictive of SPM occurrence and cause-specific mortality.Of 937 patients, cumulative incidence of SPMs was 7.2% at 0 to 6 months (synchronous), 17.9% at 5 years, and 23.1% at 10 years after index tumor diagnosis. In multivariate analyses, old age (60 years) (P = .002), hypopharyngeal index tumor site (P = .001), and heavy drinker (P = .001) were independently associated with the development of SPMs, and hypopharyngeal index tumor site were independent variables for SPM-specific survival (P.001). Cumulative incidence function of SPM-specific mortality according to index tumor sites was significantly higher in the hypopharynx than other sites (P = .011).Elderly patients, hypopharyngeal index cancer patients, or heavy drinkers may require careful surveillance for the development of SPMs. Our results may help identify and properly manage Asian patients at high risk of SPMs.

BackgroundChronic idiopathic urticaria (CIU) is a common cutaneous disorder but the influence of initial treatment modality on long-term control is not known. The aim of this study was to evaluate clinical features, and the influence of initial treatment modality on long-term control.Methods and results641 CIU patients were enrolled from the allergy clinic in a tertiary referral hospital. Disease duration, aggravating factors and treatment modality at each visit were evaluated. Times required to reach a controlled state were analyzed according to initial treatment modality, using Kaplan-Meier survival curves, the Cox proportional-hazards model, and propensity scores. Female to male ratio was 1.7: 1; mean age at onset was 40.5 years. The most common aggravating factors were food (33.5%), stress (31.5%) and fatigue (21.6%). Most patients (82.2%) used H1-antihistamines alone as initial treatment while 17% used a combination treatment with oral corticosteroids. There was no significant difference in the time taken to reach a controlled state between patients treated with single vs multiple H1-antihistamines or between those who received H1-antihistamine monotherapy vs. a combination therapy with oral corticosteroids.ConclusionThe time required to control CIU is not reduced by use of multiple H1-antihistamines or oral corticosteroids in the initial treatment.

Although many epidemiologic studies have shown that Helicobacter pylori (H. pylori) eradication has prophylactic effects on gastric cancer, their results are less clear in high-risk populations. We conducted this study to examine whether H. pylori eradication would affect the occurrence of metachronous gastric cancer after endoscopic resection in patients with early gastric cancer.We retrospectively analyzed 2,089 adults who underwent endoscopic resection of gastric low-grade neoplasia, high-grade neoplasia, or differentiated invasive neoplasia from 2004 to 2008 at Asan Medical Center. Of these, a total of 1,007 patients with early gastric cancer were enrolled in this study. We evaluated the demographic data, the pathology, and the incidence of metachronous recurrence by dividing them into three groups: those without active H. pylori infection (Hp negative group, n=340), those who successfully underwent H. pylori eradication (eradicated group, n=485), and those who failed or did not undergo H. pylori eradication (noneradicated group, n=182).Metachronous recurrence was diagnosed in 75 patients, including 17 in the Hp, 34 in the eradicated, and 24 in the noneradicated groups. Median time to metachronous recurrence was 18 months (range, 7-75 months). The incidence of metachronous gastric cancer was 10.9 cases per 1,000 person-years in the Hp negative group, 14.7 cases per 1,000 person-years in the eradicated group, and 29.7 cases per 1,000 person-years in the noneradicated group. The hazard ratios in the noneradicated group compared with the Hp negative and eradicated groups were 2.5 (P0.01) and 1.9 (P=0.02), respectively. H. pylori eradication reduced metachronous recurrence of gastric neoplasm, which was also shown in the secondary analysis of 1,487 patients with low-grade neoplasia and early gastric cancer.Successful H. pylori eradication may reduce the occurrence of metachronous gastric cancer after endoscopic resection in patients with early gastric cancer.

To evaluate the performance of Cirrus spectral domain optical coherence tomography (SD-OCT)-guided progression analysis (GPA) software to detect progression of retinal nerve fiber layer (RNFL) thinning in glaucoma patients.This retrospective cohort study included 272 eyes of 154 glaucoma patients. Median follow-up time was 2.2 years, during which time data from at least four good-quality OCT examinations were collected. Glaucomatous eyes were classified as either early or advanced group according to visual field (VF) severity. Reference standard of glaucoma progression was defined by expert assessment of optic disc/RNFL photographs or VF GPA data, or visual field index (VFI) linear regression analysis. Sensitivity and specificity of OCT GPA, and agreement between OCT GPA findings and each reference standard strategy were estimated.Fifty-three eyes (19.5%) showed progression by at least one of the reference standard strategies, while OCT GPA detected progression in 36 eyes (13.2%). When expert assessment of optic disc/RNFL photographs and/or VF analysis was used as the reference standard, the sensitivity and specificity of OCT GPA employed to detect glaucoma progression were 20.8% and 88.6%. Agreement between OCT GPA and either optic disc/RNFL photographic evaluation or VF analysis was poor (κ = 0.12 and 0.03, respectively). RNFL photographic assessment in early stage glaucoma showed best agreement with OCT GPA in terms of progression detection.The Cirrus OCT GPA detected a considerable number of eyes exhibiting glaucoma progression. OCT GPA may be useful for progression detection in earlier stage of glaucoma to complement other reference standard strategies.

To evaluate the diagnostic performance of automated breast ultrasound (ABUS) after breast magnetic resonance imaging (MRI) as a replacement for hand-held second-look ultrasound (HH-SLUS), we evaluated 58 consecutive patients with breast cancer who had additional suspicious lesions on breast MRI. All patients underwent HH-SLUS and ABUS. Three breast radiologists evaluated the detectability, location, characteristics and conspicuity of lesions on ABUS. We also evaluated inter-observer variability and compared the results with HH-SLUS results. Eighty additional suspicious lesions were identified on breast MRI. Fifteen of the 80 lesions (19%) were not detected on HH-SLUS. Eight of the 15 lesions (53%) were detected on ABUS, whereas the remaining 7 were not detected on ABUS. Among the 65 lesions detected on HH-SLUS, only 3 lesions were not detected on ABUS. The intra-class correlation coefficients for lesion location and size all exceeded 0.70, indicating high reliability. Moderate to fair agreement was found for mass shape, orientation, margin and Breast Imaging Reporting and Data System (BI-RADS) final assessment. Therefore, ABUS can reliably detect additional suspicious lesions identified on breast MRI and may help in the decision on biopsy guidance method (US vs. MRI) as a replacement tool for HH-SLUS.

To evaluate and compare the utility of ganglion cell complex with peripapillary retinal nerve fibre layer and optic nerve head measurements for detection of localized defects in patients with preperimetric glaucoma using spectral-domain optical coherence tomography.Prospective study.Preperimetric glaucoma patients.A total of 105 eyes with preperimetric glaucoma and 68 age- and refractive error-matched control eyes were enrolled. The ability to detect localized retinal nerve fibre layer defects by RTVue-100 spectral-domain optical coherence tomography (Optovue, Inc., Fremont, CA, USA) was assessed calculating the areas under receiver operating characteristic curves.The ability to detect localized retinal nerve fibre layer defects by spectral-domain optical coherence tomography.Global volume loss and superior ganglion cell complex thickness showed the largest area under receiver operating characteristic curve values (both areas under receiver operating characteristic curves 0.84, P0.001) among ganglion cell complex parameters. Average peripapillary retinal nerve fibre layer thickness afforded the best diagnostic capability (area under receiver operating characteristic curve 0.89, P0.001), whereas among optic nerve head parameters, the horizontal cup:disc ratio yielded the highest area under receiver operating characteristic curve (0.85, P0.001). No statistical difference was evident between the areas under receiver operating characteristic curves of the most informative parameters when the data were gathered from the three different sites (ganglion cell complex, peripapillary retinal nerve fibre layer, and optic nerve head) (P0.02).Ganglion cell complex thickness was significantly reduced in eyes with preperimetric glaucoma. Ganglion cell complex imaging using spectral-domain optical coherence tomography may be a useful ancillary modality for detection of early macular changes in glaucomatous eyes with localized retinal nerve fibre layer defects.

We performed a prospective observational study comparing the efficacy and safety of low-dose ganciclovir (5 mg/kg/day) as initial preemptive therapy in allogeneic haematopoietic stem cell transplantation (HSCT) recipients with conventional-dose ganciclovir (10 mg/kg/day).All adult patients undergoing allogeneic HSCT were enrolled at a transplant centre over a 24 month period. The decision to use low-dose or conventional-dose ganciclovir was at the discretion of each attending haematologist. A logistic regression model with inverse probability of treatment weighting (IPTW) using propensity scores was performed to reduce the effect of the selection bias in assignment for ganciclovir preemptive therapy.Of the 252 HSCT recipients, 97 (38%) received preemptive ganciclovir therapy. Of these, 53 (55%) and 44 (45%) received low-dose and conventional-dose ganciclovir, respectively. The viral clearance rate was higher in the low-dose ganciclovir group [98% (52/53)] than in the conventional-dose ganciclovir group [86% (38/44), P = 0.04], while the low-dose ganciclovir group exhibited a longer viral clearance time (median 21.0 days) than the conventional-dose ganciclovir group (median 14.0 days, P = 0.05). The rate of discontinuation of therapy due to neutropenia or nephrotoxicity was similar in the two groups, although conventional-dose ganciclovir was changed to another regimen more frequently than low-dose ganciclovir. There were three cases of cytomegalovirus (CMV) disease in each group after the initial preemptive therapy. The logistic regression models using propensity scores also revealed that there were no significant differences in viral clearance, secondary episodes of CMV infection, CMV disease and overall mortality between the two groups.Low-dose ganciclovir appears to be safe, and to be at least as effective as conventional-dose ganciclovir for CMV viraemia in allogeneic HSCT recipients.

In order to effectively receive a signal, automotive antennas are generally mounted on proper positions such as a window, a bumper, or a roof. Especially, it is unavoidable that a roof mount antenna is protruded out of the roof of the vehicle in order to receive efficiently a vertical polarized signal. There is an increasing demand for cars to provide hidden internal antennas or reduced antenna's heights. Therefore, it is needed to design a low-profile roof mount antenna. In [1], a printed circuit board (PCB)-based antenna with 48 mm height is studied. A PIFA type antenna with 32 mm height is proposed in [2]. Recently, a hidden automotive antenna is proposed in [3]. However, its polarization is horizontal, not vertical polarization. It is physically difficult to receive vertical polarized signal with a horizontally-positioned antenna. In this paper, we propose a novel low-profile automotive antenna which is able to receive a vertically polarized signal. The proposed antenna possesses 8.2 mm low-height and 99 % high radiation efficiency. When it is mounted on the roof of the vehicle, its performances are experimentally investigated.

In order to reduce correlation between multiple antennas and enhance spatial efficiency, novel polarization diversity antennas based on metamaterials are proposed by overlapping two antennas; an electric loop antenna and a magnetic loop antenna. The electrical loop antenna is realized by a resonant wire antenna, while the magnetic loop antenna is realized by an open-ended CRLH TL with a metamaterial concept. Since the current distributions of two antennas are orthogonal each other, each one independently operates with polarization diversity, which leads to minimize correlation. The proposed antennas can produce maximum spatial efficiency by overlapping two antenna elements. In order to place the magnetic loop antenna inside the electric loop antenna, the magnetic loop antenna's size needs to be much smaller than 0.25λ×0.25λ, and thus spiral slots on the ground plane is used to reduce the size of magnetic loop antenna.

137 Background: The purpose of this study was to compare treatment outcomes between gonadotropin-releasing hormone (GnRH) agonist plus tamoxifen and adriamycin and cyclophosphamide (AC)-containing chemotherapy plus tamoxifen in hormone-responsive, premenopausal, node-negative, breast cancer patients. Methods: Among 7278 breast cancer patients who were diagnosed as breast cancer at Asan medical center, Seoul, Korea, 994 premenopausal women with node-negative, hormone receptor-positive, HER2-negative, T1-2 breast cancers were included in this retrospective cohort study: A median follow-up was 7.4 years (range, 0.5-11.4 years). 608 patients (61.2%) were treated with GnRH agonist together with tamoxifen, and 386 patients (38.8%) were treated with AC-containing chemotherapy with tamoxifen. The propensity score matching and inverse probability weighting was applied to original cohort based on patients’ age, operation method, nuclear and histologic grade, estrogen receptor and progesterone receptor positivity, T stage, Her2 positivity, and p53 positivity. In final analysis, 260 patients for each treatment arm were included. Results: In propensity matched cohorts (n = 520), a total of 34 patients had recurrence. There were 5 cancer-specific deaths and 12 overall deaths among total 520 patients. There were no survival differences for recurrence-free survival (p= 0.306), cancer-specific survival (p= 0.212), and overall survival (p= 0.102) between the two treatment groups. After applying inverse probability weighting, there were no survival differences for recurrence-free survival (p = 0.522), cancer-specific survival (p= 0.154). However, GnRH agonist with tamoxifen arm showed better overall survival than AC chemotherapy with tamoxifen arm (p= 0.021). Conclusions: Adding GnRH agonist to tamoxifen is a reasonable alternative to adding AC chemotherapy to tamoxifen in premenopausal, hormone-responsive, HER2-negative, lymph node-negative, T1-2, breast cancer patients.

The propensity score is defined as the probability of each individual study subject being assigned to a group of interest for comparison purposes. Propensity score adjustment is a method of ensuring an even distribution of confounders between groups, thereby increasing between group comparability. Propensity score analysis is therefore an increasingly applied statistical method in observational studies. The purpose of this article was to provide a step-by-step nonmathematical conceptual guide to propensity score analysis with particular emphasis on propensity score matching. A software program code used for propensity score matching was also presented.

Selenophosphate synthetase catalyzes the synthesis of selenophosphate which is a selenium donor for Sec biosynthesis. In Drosophila melanogaster, there are two types of selenophosphate synthetases designated dSPS1 and dSPS2, where dSPS2 is a selenoprotein. The mechanism of gene expression of dSPS2 as well as other selenoproteins in Drosophila has not been elucidated. Herein, we report an essential regulator system that regulates the transcription of the dSPS2 gene (dsps2). Through deletion/substitution mutagenesis, the downstream DNA replication-related element (DRE) located at +71 has been identified as an essential element for dsps2 promoter activity. Furthermore, double-stranded RNA interference (dsRNAi) experiments were performed to ablate transcription factors such as TBP, TRF1, TRF2 and DREF in Schneider cells. The dsRNAi experiments showed that dsps2 promoter activities in DREF- and TRF2-depleted cells were significantly decreased by 90% and 50%, respectively. However, the depletion of TBP or TRF1 did not affect the expression level of dsps2 even though there is a putative TATA box at -20. These results strongly suggest that the DRE/DREF system controls the basal level of transcription of dsps2 by interacting with TRF2.

The current exploratory study presents the Analytical Hierarchy Process (AHP) as a potential decision-making method to obtain the relative weights of alternatives through pairwise comparison in the context of hierarchical structure. The aim of this study was to elicit prior strategy to improve army military foodservice. Content analysis and seven times of in-depth interview from 13 officers of the Ministry of National Defense were conducted to develop the hierarchical structure for AHP analysis. Questionnaires were distributed to 61 foodservice managers and 39 dietitian and military foodservice officers. The highest-ranked strategy for improving military foodservice was the ‘renewal of the kitchen facilities’ (0.2578), followed by ‘enlargement of foodservice operating staffs’ (0.2345), ‘specialization of sanitation & foodservice management’ (0.2222), ‘Practical foodservice budget control’ (0.1394), and ‘menu variety & standardized recipe’ (0.1281). ‘Enlargement of foodservice facilities’ (0.3995), ‘increase the no. of kitchen police’ (0.3463), ‘sanitary & cooking training reinforcement of kitchen police’ (0.4445), ‘management of foodservice budget by total amount’ (0.5043), and ‘standardization of mass cooking’ (0.3571) were the highest overweight item in each strategy. The study also compared the relative weights of alternatives of foodservice managers with that of dietitians and military foodservice officers. Those two groups revealed some difference in their priority of important strategy regarding army military foodservice. The results of this study would provide the data for making a policy or compilation of the budget regarding army military foodservice. (Korean J Community Nutr 19(1) : 51~59, 2014)

PURPOSE To investigate the possibility of classifying angle closure eyes in terms of features provided by anterior segment optical coherence tomography (AS OCT). METHODS Angle closure (primary angle closure [PAC] or PAC glaucoma [PACG]) eyes diagnosed by gonioscopy were imaged using AS OCT under the same lighting conditions. Anterior chamber depth (ACD), anterior chamber width (ACW), iris cross-sectional area (IA), iris thickness at 750 μm from the scleral spur (IT750), iris curvature (IC), lens vault (LV), and anterior chamber area (ACA) were determined using Image J software (ver. 1.44). A hierarchical cluster analysis using Ward's method was performed using AS parameters obtained by AS OCT and axial length (AXL). RESULTS A hierarchical cluster analysis was performed on 166 angle closure eyes and produced two clusters. The first cluster (84 eyes) was characterized by higher ACD (2.24 mm), higher ACA (12.5 mm(2)), higher IT750 (0.44 mm), higher ACW (11.2 mm), lower LV (0.85 mm), and higher AXL (23.5 mm) compared with the second cluster (82 eyes, 1.82 mm, 9.5 mm(2), 0.38 mm, 10.8 mm, 1.1 mm, and 22.8 mm, respectively). The second cluster had essentially higher LV and lower ACA than the first cluster. Most parameters were significantly different between two clusters except IC (P = 0.76). CONCLUSIONS Our hierarchical cluster analysis indicated two clusters with quite different features existed in our total angle closure population. Our results suggest the possibility of subclassifying angle closure eyes according to AS OCT parameters.

PURPOSE We attempted to understand better the relationship between the macular visual field (VF) mean sensitivity (MS) assessed by standard automated perimetry (SAP) and the ganglion cell complex thickness (GCCT), and macular peripapillary retinal nerve fiber layer thickness (mpRNFLT) assessed by spectral domain optical coherence tomography (SD-OCT, RTVue-100) in open-angle glaucoma (OAG) patients. METHODS We enrolled in the study 217 OAG patients with baseline intraocular pressure (IOP) in the statistically normal range. GCCT and mpRNFLT measurements, using the ganglion cell complex (GCC) and the optic nerve head (ONH) modes of RTVue-100 OCT, were obtained for analysis. Macular VF sensitivity was recorded in the dB and 1/L scales. The relationship of the function (MS) and structure (GCCT, mpRNFLT) was sought globally and in two VF sectors (superior and inferior). RESULTS The relationship of the macular VF sensitivity (dB) to the GCC, and mpRNFL global (R(2) = 0.111, 0.127) and sectoral (superior R(2) = 0.358, 0.171; inferior R(2) = 0.227, 0.263) thicknesses were statistically significant (all P < 0.05). The relationship of the macular VF sensitivity to the GCCT differed significantly from that of the macular VF sensitivity to the mpRNFL in the superior VF sector (R(2) = 0.358 vs. 0.171, P < 0.05). CONCLUSIONS GCCT determined by SD-OCT (RTVue-100) showed a statistically significant structure-function association with macular VF, and the strength of the association was greater than that of the mpRNFL with macular VF in the superior central VF area.

PURPOSE. We evaluated the clinical use of segmented macular layer thickness measurement in terms of glaucoma diagnosis and the ability to detect progression, and to compare such outcomes to those by circumpapillary retinal nerve fiber layer (cRNFLT) and total macular thickness (TMT) measurements. METHODS. The study included 141 glaucomatous and 61 healthy eyes. All glaucomatous eyes were subjected to at least four spectral domain optical coherence tomography (SD-OCT) examinations (mean follow-up, 2.13 years). Segmented macular layers were the macular nerve fiber layer (NFL), ganglion cell and inner plexiform layer (GCA), and outer retinal layer (ORL; from outer plexiform layer to retinal pigment epithelium). Areas under receiver operating characteristic curves (AUCs) discriminating healthy from glaucomatous eyes were determined in baseline measurements. The sensitivity and specificity of these parameters in terms of glaucoma progression detection were determined, with reference to assessment of optic disc/retinal nerve fiber layer (RNFL) photographs/visual field (VF) deterioration as standard(s). RESULTS. GCA afforded the best diagnostic performance among three macular layers. The AUC of the GCA thickness (GCAT) was less than that of cRNFLT (0.869 vs. 0.953, P ¼ 0.018), but superior to that of TMT (0.790, P ¼ 0.05). Of the eyes, 38 showed progression during follow-up by standard methods. The sensitivities of TMT, GCAT, and cRNFLT values in terms of detection of progression were 14%, 8%, and 5%, respectively. CONCLUSIONS. Although baseline cRNFL measurement was optimal in terms of glaucoma diagnosis, the GCAT and TMT showed similar levels of sensitivity in progression detection. (Invest Ophthalmol Vis Sci. 2012;53:3817‐3826) DOI:10.1167/iovs.11-9369