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We performed a meta-analysis to investigate the effectiveness of telecardiac rehabilitation compared to center-based rehabilitation on cardiorespiratory fitness, blood pressure, blood lipids, body composition, and quality of life in patients with coronary heart disease.We searched the Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase, and Scopus databases and retrieved studies published until October 8, 2021. Randomized controlled trials were included to evaluate cardiorespiratory fitness, blood pressure, blood lipids, body composition, and quality of life after telecardiac rehabilitation and center-based rehabilitation in patients with coronary heart disease. The criteria of the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate the methodological quality of the studies. Funnel plot analysis and Egger test were performed to confirm the publication bias.A total of 8 studies, including 750 participants, reported the effectiveness of the telecardiac rehabilitation and center-based rehabilitation included in the analysis. Except for total cholesterol and mental quality of life (P.05), all parameters were not significantly different between telecardiac rehabilitation and center-based rehabilitation (P.05).Telecardiac rehabilitation was similar to the effects of center-based rehabilitation. The overall prognosis of patients with coronary heart disease can be improved by increasing patients' participation in cardiac rehabilitation through telerehabilitation.

Patients undergoing maintenance dialysis have a higher mortality rate associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and response rates to vaccination against SARS-CoV-2 vary from 29.6% to 96.4% in such patients. This study aimed to assess the immunogenicity of SARS-CoV-2 vaccination in Korean patients undergoing dialysis. We enrolled 70 SARS-CoV-2-vaccinated patients undergoing dialysis, with 11 healthcare workers serving as healthy control subjects. Thirty-two patients had received a third vaccination, whereas 38 had received 2 vaccinations. The healthy control subjects completed the second vaccination. Immunoglobulin G (IgG) antibodies targeting the receptor-binding domain of the S1 subunit of the SARS-CoV-2 spike protein were measured The vaccination responder rates were 86% (37/43), 96% (26/27), and 91% (10/11) in the patients undergoing hemodialysis and peritoneal dialysis and healthy controls, respectively. IgG antibody levels were significantly higher when a third dose was administered, independent of the type of vaccine or the time interval between vaccination and the subsequent blood sampling date. When a third dose of vaccine was administered, there was no difference in IgG antibody levels between those receiving cross-vaccination or a single vaccine. There was no significant difference in IgG antibodies between healthy controls and patients undergoing dialysis. Patients on dialysis exhibited a sufficient antibody-related response to vaccination against SARS-CoV-2, even in those receiving cross-vaccination, and the antibody titer was higher after a third vaccination. Therefore, it is necessary to administer a third vaccine dose to Korean patients undergoing dialysis.

Medical-related information rapidly spreads throughout the internet. However, these types of information often contain inaccurate information, which can lead to harmful misconceptions. In this study, we evaluated the reliability, quality, and accuracy of videos uploaded on YouTube that harbor claims on the effects of acupuncture on COVID-19 treatment. This is a cross-sectional study. Videos uploaded on YouTube up to February 17, 2022, were searched, and the keywords used were as follows: "acupuncture," "coronavirus," "COVID 19," "COVID-19," "Corona," "COVID," and "SARSCoV2." The top 50 videos in English were viewed and evaluated. The reliability of the videos was evaluated using the modified DISCERN scale, the content-quality was evaluated using the Global Quality Scale. The accuracy of the information in each video was evaluated as well. Of the 50 videos, only 8% were found to be reliable and 64% were of poor quality. Additionally, 98% of the videos were misleading. The mean modified DISCERN scores was 1.72 and the mean Global Quality Scale score was 2.06. Despite the videos being made by experts, their reliability, content-quality, and accuracy were found to be low. The spread of inaccurate information may result in the use of inappropriate and potentially harmful treatment methods for patients. Videos that contain medical information should be produced based on verified scientific evidence.

Tension-type headache (TTH) is the most common type of primary headache, and trigger point injection (TPI) is frequently used for controlling pain originating from TTHs. In the current report, we introduce a TPI technique involving 4 neck muscles (upper trapezius, splenius capitis, semispinalis capitis, and inferior oblique capitis) and a greater occipital nerve (GON) block within the same sonographic view for the treatment of TTHs.A 44-year-old woman complained with pressing and tightening, nonpulsating, recurrent headaches, mainly in the bilateral occipital area, lasting for approximately 6 months (numeric rating scale: 5). The patient had no nausea, vomiting, photophobia, or phonophobia.The patient was diagnosed as having a TTH.Under ultrasound (US) guidance, a mixed solution of 2 mL of 2% lidocaine and 5 mL of normal saline was injected layer-by-layer into the 4 target muscles of the neck (upper trapezius, splenius capitis, semispinalis capitis, and inferior oblique capitis) and near the right GON within the same sonographic view bilaterally.Two- and 4-week follow-ups after administration of the injections revealed no headache. Our US-guided 5-in-1 TPI technique is viable for treating patients with TTH.We believe that it can aid in reducing the procedure time and associated pain.

Rationale: Using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), we demonstrated blood-brain barrier (BBB) disruption following syncope. Patient concerns: A 45-year-old man experienced syncope with a chief complaint of syncope (duration: 1 minutes), 1 day before visiting a university hospital for examination. He had no history of medical problems and was not taking any medications. This episode was the first in his lifetime. Diagnoses: After syncope, the patient did not have any illnesses or symptoms, such as headache, cognitive deficits, or somnolence. Interventions: Cardiac evaluation did not reveal any abnormal findings. In addition, in conventional brain and chest computed tomography and brain MRI, no abnormal lesions were observed. Outcomes: DCE-MRI of the patient showed bright blue colored lines within the sulci throughout the cerebral cortex. The regions of interest, including bright blue colored lines, had significantly higher Ktrans values (6.86 times higher) than those in healthy control participants. These findings are indicative of BBB disruption of the vessels in the sulci. Lessons: Using DCE-MRI, we demonstrated BBB disruption following syncope. DCE-MRI is a useful tool for the detection of BBB disruption following syncope.

Pharmaceutical poisoning in children is almost unintentional and there are various types of drug out of curiosity. Understanding the attractive features and formulation of drugs related to poisoning in younger children may be helpful in treatment and prevention of poisoning. To investigate the impact of drug formulation on outcomes of pharmaceutical poisoning in young children. We retrospectively reviewed the data of pharmaceutical exposures among children who were registered in a Korean 23-center, emergency department (ED) based registry from 2011 to 2016. Our study was conducted on preschool children aged 0 to 7 years. According to the formulation and category of the ingested drugs, the exposures were divided into the “tablet and capsule (TAC)” and “syrup” groups. In the TAC group, we additionally recorded data on the shape, color, and size of the drugs. The ED outcomes, such as hospitalization and length of stay, were compared between the 2 groups. Among the 970 enrolled exposures, 674 (69.5%) were classified into the TAC group. In this group, hormones/hormone antagonists (18.5%) were the most commonly ingested, followed by central nervous system drugs (17.1%). In the syrup group, antihistamines (28.4%) were the most commonly ingested, followed by respiratory drugs (24.3%). The TAC group showed a higher hospitalization and transfer rate to tertiary centers than the counterpart (TAC, 18.0% vs syrup, 11.5%, P = .03) without a significant difference in the length of stay (TAC, 173.5 minutes [interquartile range, 95.0–304.0] vs syrup, 152.5 [77.5–272.0]; P = .08). No in-hospital mortality occurred in the exposures. Round-shaped and chromatic TACs, accounting for 91.7% (618) and 56.1% (378), respectively, were more commonly ingested. The median size of the TACs was less than 1.0 cm. Young children who visited the ED ingested TACs more frequently than syrups, particularly small, round-shaped, or chromatic drugs, leading to a higher hospitalization rate. Our findings can contribute to prevention strategies and safety education on childhood drug poisoning.

Introduction This study was conducted to better understand hemodialysis by reviewing the most-cited articles related to it. Methods We searched articles on the Web of Science and selected the 100 most frequently cited articles. Subsequently, we reviewed these articles and identified their characteristics. Results The 100 most frequently cited articles were published in 21 journals. The majority of these papers were published in the following journals: Kidney International (26 articles), New England Journal of Medicine (18 articles), Journal of the American Society of Nephrology (14 articles), and the American Journal of Kidney Disease (13 articles). The 100 most-cited articles were published in 25 countries. The United States of America was the country with the highest number of publications (65 articles). The University of Michigan was the institution with the highest number of articles (14 articles). FK Port was the author with the largest number of publications (13 articles). Conclusions This is the first study in the field of nephrology that provides a list of the 100 most-cited articles on hemodialysis. Through this study, clinicians will be able to recognize major academic interests and research trends in hemodialysis.

Our previous study demonstrated that patients with end-stage renal disease had decreased structural and functional brain connectivity, and there was a significant association between brain connectivity and cognitive function. The aim of this study was to evaluate the alterations of structural and functional connectivity using graph theoretical analysis in neurologically asymptomatic patients with relatively early-stage chronic kidney disease (CKD). We enrolled 18 neurologically asymptomatic patients with early CKD and 28 healthy controls. All the subjects underwent diffusion-tension imaging and resting functional magnetic resonance imaging. We calculated structural and functional connectivity based on diffusion-tension imaging and resting functional magnetic resonance imaging using a graph theoretical analysis. Then, we investigated differences of structural and functional connectivity between the CKD patients and the healthy controls. All the measures of structural connectivity were significantly different between the patients with CKD and healthy controls. The global efficiency, local efficiency, mean clustering coefficient, and small-worldness index were decreased, whereas the characteristic path length was increased in the patients with CKD compared with healthy controls. The structural betweenness centrality of the left calcarine and right posterior cingulum was also significantly different from that in healthy participants. However, all the measures of global functional connectivity in patients with CKD were not different from those in healthy controls. In patients with CKD, the functional betweenness centrality of the right insular cortex, right occipital pole, and right thalamus was significantly different from that in healthy participants. There are significant alterations of the global structural connectivity between the patients with CKD and the healthy subjects, whereas the global functional connectivity of the brain network is preserved. We find that the efficiency of the structural brain network is decreased in the patients with CKD.

Background: Artificial intelligence (AI) has had a significant impact on our lives and plays many roles in various fields. By analyzing the past 30 years of AI trends in the field of nephrology, using a bibliography, we wanted to know the areas of interest and future direction of AI in research related to the kidney. Methods: Using the Institute for Scientific Information Web of Knowledge database, we searched for articles published from 1990 to 2019 in January 2020 using the keywords AI; deep learning; machine learning; and kidney (or renal). The selected articles were reviewed manually at the points of citation analysis. Results: From 218 related articles, we selected the top fifty with 1188 citations in total. The most-cited article was cited 84 times and the least-cited one was cited 12 times. These articles were published in 40 journals. Expert Systems with Applications (three articles) and Kidney International (three articles) were the most cited journals. Forty articles were published in the 2010s, and seven articles were published in the 2000s. The top-fifty most cited articles originated from 17 countries; the USA contributed 16 articles, followed by Turkey with four articles. The main topics in the top fifty consisted of tumors (11), acute kidney injury (10), dialysis-related (5), kidney-transplant related (4), nephrotoxicity (4), glomerular disease (4), chronic kidney disease (3), polycystic kidney disease (2), kidney stone (2), kidney image (2), renal pathology (2), and glomerular filtration rate measure (1). Conclusions: After 2010, the interest in AI and its achievements increased enormously. To date, AIs have been investigated using data that are relatively easy to access, for example, radiologic images and laboratory results in the fields of tumor and acute kidney injury. In the near future, a deeper and wider range of information, such as genetic and personalized database, will help enrich nephrology fields with AI technology.

This retrospective study was aimed to determine the factors suggesting the need for computed tomography (CT) scanning when ultrasound (US) imaging results are negative or non-diagnostic in children suspicious for acute appendicitis in the emergency department. Patients less than 18 years old who underwent abdominal ultrasound and CT to rule out acute appendicitis were enrolled. Patients were classified into 2 groups: the false-negative group, in which patients had negative or non-diagnostic results on the initial US and a final diagnosis of acute appendicitis on the following abdominal CT, and the true-negative group, in which patients had negative or non-diagnostic US results and were negative on abdominal CT. Logistic regression and propensity score matching with the predicting factors were performed. The presence of vomiting (odds ratio (OR), 7.78; 95% confidence interval (CI), 1.92–41.04) and poor oral intake (OR, 4.67; 95% CI, 1.21–21.15) with a high white blood cell (WBC) count (OR 1.26; 95% CI, 1.09–2.37), segmented neutrophil ratio (OR, 1.09; 95% CI, 1.03–1.16), and C-reactive protein (CRP) (OR, 1.49; 95% CI, 1.09–2.37) were suggestive of the false-negative group. The propensity-matched population also showed significant associations with vomiting (OR, 7.86; 95% CI, 1.65–37.40) and poor oral intake (OR, 5.50; 95% CI, 1.28–23.69) with an elevated WBC count (OR, 1.27; 95% CI, 1.08–1.50), segmented neutrophil ratio (OR, 1.09; 95% CI, 1.03–1.16), and CRP (OR, 1.51; 95% CI, 1.03–2.22). A CT scan should be considered in children with suspected acute appendicitis if they have vomiting, high CRP, and high WBC count, despite negative or non-diagnostic US results.

When a gastric spindle cell tumor is observed, the possibility of synovial carcinoma, besides common mesenchymal tumor, should also be considered.The patient is a 51-year-old American woman who underwent medical check-up at a general hospital. Upper endoscopy showed a 2-cm sized mass covered with intact mucosa, and a central depression located on the posterior wall of the mid body. Biopsy of the mass showed focal atypical cells proliferation in mucosa on hematoxylineosin (HE) staining. Endoscopic ultrasound showed a 17-mm homogenously hypoechoic mass within the submucosal layer.After diagnostic endoscopic submucosal dissection was performed, HE and immunohistochemical staining showed synovial sarcoma (SS). To confirm the diagnosis, reverse transcriptase-polymerase chain reaction was performed, revealing a chimeric transcript of the SYT-SSX1 fusion gene. The diagnosis of primary gastric SS was confirmed because no evidence of possible primary lesions or metastatic lesions was observed. Therefore, the patient underwent distal gastrectomy.After surgery, the surgical specimen demonstrated no residual tumor cells. The patient received no adjuvant therapy, and there has been no evidence of local recurrence or distant metastasis for 2 months after the operation.When gastric subepithelial tumor is suspicious, we should also consider gastric SS.

Implementation of point-of-care ultrasonography (POCUS)-assisted physical examination (PE) in emergency departments (EDs) was conducted in the ED of an urban tertiary teaching hospital. This study examines the effect of POCUS implementation in emergency medicine departments by using a systematic education program on image acquisition to analyze decision making. Educating staff on POCUS involved a technique related to image acquisition and then accurately diagnosing subsequent POCUS results. The quasi-experimental, uncontrolled before-and-after study was performed to evaluate the education effect. POCUS orders for eligible patients, length of stay (LOS) in ED, and return visits (RVs) to ED between the “before” period (March 1, 2015 to February 28, 2016) and the “after” period (March 1, 2016 to February 28, 2017) were compared. Piecewise regression was used to assess trend differences of LOS and RVs between the periods. A total of 16,942 and 16,287 patients were included in the before and after periods of education, respectively. During the study periods, 966 (6%) and 2801 (18%) POCUS were ordered, respectively (rate difference = 12%; P

Introduction Video capsule endoscopy (VCE) is a useful tool to differentiate small intestinal bleeding, inflammatory bowel disease, and other small bowel disease. The most common adverse effect of VCE is capsule retention; the incidence varies greatly depending on the underlying disease, which is known to increase from 1.5% in healthy individuals to 21% in patients with small bowel Crohn disease. We report this case on a patient who had asymptomatic capsule retention for 12 months and experienced natural elimination with medication. Patient concerns A 21-year-old woman presented to the hospital with chronic abdominal pain and persistent diarrhea for 2 years. Diagnoses The patient was diagnosed with small bowel Crohn disease using VCE, and radiography revealed capsule retention. Intervention Symptoms of obstruction were not distinctive, it was decided to increase the dosages of azathioprine and infliximab to 50 and 500 mg (10 mg/kg), at 5 months after VCE. And at month 11 of capsule retention, she was admitted and started on a regimen of hydrocortisol 300 mg for 4 days and hydrocortisol injection 200 mg for 10 days. Outcomes At month 12, abdominal radiography in the clinic confirmed that the capsule had been naturally retrieved. Lessons Capsule retention could be initially treated conservatively with medication and if the treatment fails, it is recommended to remove the capsule surgically. But in the case of the clinical condition of the patient is favorable without symptoms of bowel obstruction, the medication should be continued and the patient followed up.

Rationale: Recently, pulsed radiofrequency (PRF) has been applied to alleviate neuropathic pain caused by various peripheral nerve pathologies. This report describes and discusses the cases of 2 patients with cubital tunnel syndrome who responded well to PRF for the management of neuropathic pain. Patient concerns: Patients 1 and 2 presented with numeric rating scale (NRS) scores of 4 and 3 for neuropathic pain due to right cubital tunnel syndrome, respectively. Diagnoses: Cubital tunnel syndrome was confirmed by nerve conduction study/electromyography. Interventions: PRF stimulation of the right ulnar nerve was performed at the medial epicondyle level under the guidance of ultrasound. Outcomes: At the 2-week and 1-, 2-, 3-, and 6-month follow-up assessments after the PRF procedure, the pain of patient 1 was completely relieved. In patient 2, at the 2-week follow-up, the pain was completely relieved, and at the 1-, 2-, 3-, and 6-month follow-up assessments, the NRS score was 1. No adverse effects were observed in either patient. Lessons: PRF on the ulnar nerve seems to be a useful tool for treating neuropathic pain due to cubital tunnel syndrome.