Search

Dual left anterior descending artery (LAD) is a rare congenital coronary artery anomaly with a prevalence of approximately 1% in the general population. To date, 10 types of dual LAD artery anomalies have been reported. Among these, type 4 is one of the rarest. Knowledge and recognition of the dual LAD artery are important for correct diagnosis and planning of coronary bypass surgery and percutaneous coronary intervention. We report a case of a 59-year-old male with type 4 dual LAD artery who presented with dyspepsia and sweating for several months and had approximately 50%–70% stenosis in a major diagonal branch off the short LAD artery.

Objective We aimed to determine whether ovarian-preserving surgery for adnexal torsion helps preserve ovarian function without increasing the risk of postoperative complications. Methods We retrospectively evaluated 71 women who were surgically diagnosed with adnexal torsion between January 2015 and December 2019 at Severance Hospital, Yonsei University College of Medicine (ovarian preservation group, 56; oophorectomy, 15). Serum anti-Müllerian hormone (AMH) levels measured within 6 months before surgery were compared to levels measured 6–24 months after surgery. Surgical findings and postoperative complications were compared between the groups. Results There was a borderline significant difference in the decrease in serum AMH levels between the oophorectomy group and ovarian preservation group before and after surgery. There were no significant differences between the groups in terms of fever, infection, or duration of admission. Discoloration of the twisted ovary was found in 27.3% and 33.3% of the patients in the ovarian preservation and oophorectomy groups, respectively. There was no difference in the decrease in serum AMH levels between patients with and those without discoloration. Conclusion Ovarian-preserving surgery may not increase postoperative complications in patients with adnexal torsion, even if a twisted mass is suspected to be necrotic. Moreover, the ovarian reserve may not be affected by torsion if the ovary is preserved. Conservative ovarian surgery can be safely performed to preserve the reproductive potential of women with adnexal torsion and cystic masses.

Objectives This study aims to contribute to establishing the regional effective management of fine particulate matter by evaluating the chemical characteristics and contribution of fine particulate matter, and the accuracy of predictive model of fine particulate matter through the measurement of water-soluble inorganic ions (WSIIs) and electrical conductivity for fine particulate matter generated in Pohang. Methods PM10 and PM2.5 samples were simultaneously collected using a low volume air sampler from April to November 2022. For sample analysis, cations of Ca2+, Mg2+, K+, NH4+, Na+ and anions of Cl-, NO3-, SO42-, and electrical conductivity were measured after pretreatment by ultrasonic extraction. Results and Discussion The average concentrations of WSIIs for PM10 and PM2.5 in Pohang were 12.1μg/m3 and 8.5μg/m3, respectively, accounting for 35.5% and 50.0% of each fine particulate matter. The sum of NH4+, NO3-, SO42- concentration was found to account for the majority of 71% and 78% of WSIIs in PM10 and PM2.5, respectively. The PM2.5/PM10 ratios for NH4+, K+, and SO42- were 95%, 89%, and 81%, respectively, mostly present in PM2.5. The average ratio of PM2.5/PM10 for NO3- was 54%, but it rose sharply to 79% in November when the temperature was low, indicating an increase in contribution to the generation of PM2.5 in winter. During the sampling period excluding April and July, the ion balance for cations and anions was relatively good at a 1:1 ratio and showed chemical properties of fine particulate matter close to neutral. A regression model was evaluated for the measured electrical conductivity of WSIIs and the concentration of fine particulate matter. The MAE and RMSE values for PM2.5 were 1.8μg/m3 and 2.4μg/m3, respectively, which were lower than PM10 (MAE 7.5 μg/m3, RMSE 10.3μg/m3), indicating high precision and accuracy. Conclusion This study confirmed the origin of fine particulate matter generated in Pohang through WSIIs analysis, and suggested that the measured electrical conductivity of WSIIs could be used as a key parameter for measuring the concentration of fine particulate matter.

Background This study evaluated the efficacy and safety of add-on gemigliptin in patients with type 2 diabetes mellitus (T2DM) who had inadequate glycemic control with metformin and dapagliflozin. Methods In this randomized, placebo-controlled, parallel-group, double-blind, phase III study, 315 patients were randomized to receive either gemigliptin 50 mg (n=159) or placebo (n=156) with metformin and dapagliflozin for 24 weeks. After the 24-week treatment, patients who received the placebo were switched to gemigliptin, and all patients were treated with gemigliptin for an additional 28 weeks. Results The baseline characteristics were similar between the two groups, except for body mass index. At week 24, the least squares mean difference (standard error) in hemoglobin A1c (HbA1c) changes was –0.66% (0.07) with a 95% confidence interval of –0.80% to –0.52%, demonstrating superior HbA1c reduction in the gemigliptin group. After week 24, the HbA1c level significantly decreased in the placebo group as gemigliptin was administered, whereas the efficacy of HbA1c reduction was maintained up to week 52 in the gemigliptin group. The safety profiles were similar: the incidence rates of treatment-emergent adverse events up to week 24 were 27.67% and 29.22% in the gemigliptin and placebo groups, respectively. The safety profiles after week 24 were similar to those up to week 24 in both groups, and no new safety findings, including hypoglycemia, were noted. Conclusion Add-on gemigliptin was well tolerated, providing comparable safety profiles and superior efficacy in glycemic control over placebo for long-term use in patients with T2DM who had poor glycemic control with metformin and dapagliflozin.

We obtained a dataset through beach and submarine topography surveys around Hujeoung coast in Uljin. We conducted the beach and submarine topography surveys using small vessels from July 8 to July 11, 2016. The surveying instruments used for the surveys were Shipborne Mobile LiDAR System and Multi-beam Echo Sounder (Kongsberg EM3001). The beach topography was observed up to about 6 m from the shoreline. The width of the beach is about 30 m to 40 m. In the southeast of the survey area, there is an exposed rock with a depth of about 20 m. The area around the rock has sandy sediments. Datasets of the Hujeong coast area can be used for continuous monitoring to development of coastal erosion control system.

Transanastomotic pancreatic duct stent placement during reconstruction following pancreaticoduodenectomy is widely performed to prevent postoperative pancreatic fistulas and duct stenosis. However, stent-related complications, such as stent occlusion and migration, may occur. Here, we report a rare case of a migrated pancreatic duct plastic stent. After pylorus-preserving pancreaticoduodenectomy, the stent migrated to the jejunum and served as a nidus of the stent–stone complex, which developed jejunal obstruction. The stent–stone complex was removed by explorative laparotomy.

Gold thread therapy (GTT) continuously stimulates acupoints and is used to treat chronic conditions/diseases such as chronic lumbar pain. During the procedure gold thread is embedded into the skin and although gold thread is medically pure, GTT is an irreversible treatment where there is limited evidence on its safety. Here, we report a case of a 79-year-old woman being treated for low back pain who developed side effects following moving cupping therapy at a site of GTT (performed in the 1970s). Adverse reactions causing radiating pain persisted more than at least 9 days following moving cupping therapy. The symptoms of pain were evaluated using the numerical rating scale, and changes in tenderness and the state of bruising was recorded. Low back pain improved but the radiating low leg pain did not improve. This case highlights the need for caution when performing moving cupping therapy where GTT has been previously performed.

Anthracnose crown rot (ACR) has been observed in greenhouses during the nursery and harvest seasons in Gangwon Province, Korea. Infected plants showed black leaf spot, dark sunken pink conidial masses on petioles, wilting, and eventually death. Five isolates were obtained from the lesions of strawberry plants and were identified as a Colletotrichum gloeosporioides species complex based on their cultural and morphological characteristics. Multilocus sequence analysis of actin, calmodulin, chitin synthase, glyceraldehyde-3-phophate dehydrogenase genes, and internal transcribed spacer rDNA regions showed that the isolates formed a monophyletic group with the type strain of C. siamense. Pathogenicity tests were performed on the isolate, and Koch’s postulates were performed to verify the relationship between Colletotrichum sp. and the strawberry plant variety Seolhyang. The isolate was pathogenic to strawberry plants, which exhibited typical ACR symptoms. Based on morphological characteristics, pathogenicity, and DNA sequence analyses, the fungus isolated in Korea was identified as C. siamense. This is first time C. siamense has been confirmed in ever-bearing strawberry varieties in Korea.

Background Muscle atrophy is caused by an imbalance between muscle growth and wasting. Delta-like 1 homolog (DLK1), a protein that modulates adipogenesis and muscle development, is a crucial regulator of myogenic programming. Thus, we investigated the effect of exogenous DLK1 on muscular atrophy. Methods We used muscular atrophy mouse model induced by dexamethasone (Dex). The mice were randomly divided into three groups: (1) control group, (2) Dex-induced muscle atrophy group, and (3) Dex-induced muscle atrophy group treated with DLK1. The effects of DLK1 were also investigated in an in vitro model using C2C12 myotubes. Results Dex-induced muscular atrophy in mice was associated with increased expression of muscle atrophy markers and decreased expression of muscle differentiation markers, while DLK1 treatment attenuated these degenerative changes together with reduced expression of the muscle growth inhibitor, myostatin. In addition, electron microscopy revealed that DLK1 treatment improved mitochondrial dynamics in the Dex-induced atrophy model. In the in vitro model of muscle atrophy, normalized expression of muscle differentiation markers by DLK1 treatment was mitigated by myostatin knockdown, implying that DLK1 attenuates muscle atrophy through the myostatin pathway. Conclusion DLK1 treatment inhibited muscular atrophy by suppressing myostatin-driven signaling and improving mitochondrial biogenesis. Thus, DLK1 might be a promising candidate to treat sarcopenia, characterized by muscle atrophy and degeneration.

Powdery mildew and two-spotted spider mite are detrimental to strawberry plants and are controlled with traditional pesticides. To accommodate consumer demand, eco-friendly methods of pest control are required. Strawberries were cultivated (in soil and in a hydroponic system) for two years, and ultraviolet B (UV-B) irradiation was used as an alternative pest control during the harvesting season. Three varieties were grown (Seolhyang, Kingsberry, and Durihyang), and four UV-B lamp/mulch (black, green, and light reflection sheet [LRS]) combinations were used during harvesting: UV-B+black or green mulch, UV-B+black or green+LRS, no UV-B+black or green, and no UV-B+black or green+LRS. In all varieties, powdery mildew was 65% more controlled when UV-B irradiation was used. The adult two-spotted spider mite density was lowest in the UV-B lamp+black or green+LRS treatments. Therefore, UV-B irradiation during the strawberry harvesting season could effectively control powdery mildew and two-spotted spider mite with little side effect on the plants.

Background Diabetes is a leading cause of death that is responsible for 1.6 million annual deaths worldwide. However, the life expectancy and age at death of people with diabetes have been a matter of debate. Methods The National Health Insurance Service claims database, merged with death records from the National Statistical Information Service in Korea from 2006 to 2018, was analyzed. Results In total, 1,432,567 deaths were collected. The overall age at death increased by 0.44 and 0.26 year/year in the diabetes and control populations, respectively. The disparity in the mean age at death between the diabetes and control populations narrowed from 5.2 years in 2006 to 3.0 years in 2018 (P

With the ongoing coronavirus disease 2019 (COVID-19) pandemic, there is an increasing interest in the sequelae and care in recovered patients. Although the long-term sequelae of COVID-19 are still unknown, recently published reports suggest that some of the patients have persistent symptoms and show radiologic abnormalities after discharge. Herein, we present cases of four patients with previous COVID-19 infection manifesting pulmonary sequelae, including pulmonary fibrosis or organizing pneumonia pattern with persistent dyspnea after recovery.

Purpose The purpose of this study was to compare the gait variables and the relative risk of falling between elderly Korean women that fall and do not fall based on the walking speed during flat walking and in the presence of obstacles. Methods The study included 148 women, aged 65 years or older (22 fallers, aged 75.05±5.38 years; 126 non-fallers, aged 71.80±5.14 years). The gait variables were measured in a space of 9 m×1 m, and obstacle walking was measured while crossing obstacles measuring, 5 cm and 30 cm. A t-test, correlation analysis, and logistic regression analysis were performed to compare the gait variables to determine if there was a fall and to analyze the relationship and the risk ratio of a fall at a walking speed. Results Out of 148 participants, 22 participants (14.9%), fell while walking. During flat ground walking, right step length (p

Background Electronic moxibustion has the advantage of temperature control and maintenance, and overcomes the limitations of the existing moxibustion process without the use of the combustion process. However, as the application of electronic moxibustion in clinical practice has increased, safety issues are emerging. Methods Clinical cases of electronic moxibustion treatment for knee osteoarthritis where burns occurred were collected. In addition, adverse events reported in clinical studies using electronic moxibustion for patients with knee osteoarthritis were collected from studies retrieved from Korean and international databases. Results There were 3 cases of superficial 2nd degree burns retrospectively collected through chart reviews. Among the selected 5 studies for literature review, 2 studies reported adverse events which were burns milder than those reported in these 3 cases in this retrospective case review. Conclusions Since the risk of superficial 2nd degree burn was discovered in the cases reviewed, further research on safe electronic moxibustion treatment is required without compromising the effectiveness of moxibustion.

This study aimed to analyze the status of adverse events (AEs) in the treatment of musculoskeletal conditions/diseases using thread embedding acupuncture (TEA). Five electronic databases were searched to retrieve data on clinical studies published in the last 5 years (2016 to 2021). Of the 151 studies retrieved, 22 studies analyzed AEs and were selected for this review. There were no AEs reported in 6 studies (27.3%); of the remaining 16 studies, 4 studies (18.2%) reported AEs that were not related to TEA. The most common AEs reported in the Chinese studies were redness of skin with/without swelling and tingling sensation, and in the Korean studies they were stiffness, a foreign body sensation, and bruising. The percentage of patients with AE experience was 5.1% in the Chinese studies and 19.9% in the Korean studies. The discrepancies between the findings in the Chinese and Korean studies may be attribute to differences in the diameter of needles, thread materials, TEA treatment procedure, and evaluation methods for AEs. Most of the reported AEs were of a mild status and did not last for a long time. However, further research on the clinical course after TEA treatment is needed.

Hemorrhage after pancreaticobiliary surgery is an infrequent but fatal complication. It is primarily caused by rupture of the pseudoaneurysm, and treatment options include endovascular coil embolization or endovascular stent-graft placement. Herein, we report a case of migration of an arterial stent-graft that was placed in the common hepatic artery to treat pseudoaneurysm after pylorus-preserving pancreaticoduodenectomy. The stent-graft migrated to the jejunum and was eventually excreted from the body.

Persistent trigeminal artery (PTA) represent an unusual remnant of the fetal carotid-basilar anastomosis. Persistent trigeminal artery variant (PTAV) is a rare anastomosis between the internal carotid artery and cerebellar artery, without an interposing basilar artery segment. We report the case of 49-year-old female with an incidentally discovered, rare variation of PTA that directly terminated in the ipsilateral superior cerebellar artery. The variation was observed on CT angiography, digital subtraction angiography, and MR angiography. Additionally, we reviewed the embryogenesis of PTA and PTAV and discussed the clinical implications of this variation.

PURPOSE The purpose of this study is to analyze the different prevalence of ischemia of Korea adults, and to compare the Health-Related Quality of Life (HRQoL), annual personal medical use and expenses according to physical activity and ischemia status. METHODS The 2018 Korea Medical Panel data was used (13,791 adults and 604 ischemia). Physical activity was measured with IPAQ and converted to MET-minutes per week. The physical activity group was classified as less than 600 MET-min per week in the inactive group, 600-3,000 MET-min per week in the minimally active group, and 3,000 MET-min more per week in the active group. RESULTS The prevalence of ischemia was low in the inactive group compared to the minimally active group and the active group (OR=0.75, p.05) compared to the active group (32.5±32.1 days) respectively. Within the group with ischemia, the medical expenses of inactive group were 5.2% lower (p>.05) and minimally active group was 33.9% lower (p

Background Standardized procedures for the clinical application of fire cupping methods have not been established. In particular, the pressure parameters have not been fully characterized and described. Therefore, using various materials, this study investigated the pressure range exerted during fire cupping therapy. Methods In this study, 3 differently sized (small, medium, large) glass and bamboo cups were used in the cotton ball fire cupping procedure to measure the pressure inside the cup applied to a human skin model. The pressure in each cup was measured 15 times for a total of 90 measurements. Results A small bamboo cup had the minimum overall pressure (−305.4 mmHg), whereas the large glass cup exerted the maximum pressure (−401.3 mmHg), followed by the medium glass cup, large bamboo cup, small glass cup, and medium bamboo cup. The average pressure exerted by the cotton ball method for all cups ranged from −348.715 mmHg to −358.694 mmHg (95% confidence interval). Overall, the glass cups had a greater pressure than the bamboo cups in all groups (p < 0.001). Among the glass cups used, the larger the size of the cup, the higher the average pressure detected (−381.947 mmHg to −391.973 mmHg; p < 0.05). Conclusion Large glass cups which are widely used in clinical practice, when used in the fire cupping method exerted pressure ranging from −381.947 mmHg to −391.973 mmHg (95% CI).

Background Cupping is widely used in Korean medicine, but there is a risk of bacterial infection if the suction pump (used for inducing negative pressure) and the patients’ skin are not separated. This study aimed to investigate the effect of layer cupping by comparing the pressure changes between layer cupping and conventional cupping. Methods To evaluate pressure changes the study was designed with 3 types of conditions applied to a skin model: (1) a Dongbang cup with a manual or motor suction pump (conventional cupping); (2) layer cupping with 2 Dongbang cups; and (3) layer cupping with a cup made by 3D printing and a Dongbang cup. Results When a manual suction pump was used (conventional cupping), the pressure did not decrease steadily, and in 1 section there was an increase in pressure. When layer cupping was used, the pressure in the lower cup (which would be directly applied to the patient’s skin), decreased steadily. Conclusion In the pressure change graph for layer cupping in this skin model, the pressure in the lower cup (which would be placed on the patient’s skin) steadily decreased, and reached equilibrium. Therefore, the layer cupping model may help to reduce the risks of bacterial infection.

Purpose To analyze the success and complication rates and factors associated with technical failure of the ultrasound (US)-guided percutaneous thrombin injection of femoral artery pseudoaneurysms caused by vascular access. Materials and Methods Records of 30 patients with post-catheterization femoral artery pseudoaneurysms who had been treated with US-guided percutaneous thrombin injections in the department of radiology between March 2009 and June 2019 were retrospectively analyzed. The lesion was diagnosed based on US or contrast-enhanced CT. The characteristics of the patients and their lesions were analyzed. Results The mean patient age was 67.8 years. The mean diameter of the pseudoaneurysmal sac was 20.88 mm (5–40 mm). Twenty patients (66.6%) obtained complete thrombosis after the primary injection, while 10 patients (33.3%) obtained partial thrombosis. The number of patients with a low platelet count (< 130 k/μL) was significantly higher in the partial thrombosis group than in the complete thrombosis group (p = 0.02). No substantial procedure-related complications were found in any patient. Conclusion The US-guided percutaneous thrombin injection is considered an initial treatment option for pseudoaneurysms caused by vascular access because of its safety and efficacy.

Various anomalous origins of the vertebral arteries (VAs) have been reported. However, anomalous origins of the bilateral VAs arising directly from the aortic arch are extremely rare. We encountered a 60-year-old male who developed sudden-onset right hemiparesis with an incidentally discovered rare origins of the bilateral VAs from aortic arch. CT angiography demonstrated the right VA originating from the aortic arch distal to the left subclavian artery and left VA originating from the aortic arch between the left common carotid artery and the left subclavian artery. The possible embryological mechanism of this variant was also reviewed. If the VA can not be found in the usual position during the procedure, a rare variant of the VA with anomalous origin should be considered. Understanding these variations is important to avoid unexpected events during endovascular procedures or surgery.

OBJECTIVES This study was conducted to figure out the effects of kendo training on the activity of brainwaves by analyzing changes in brainwaves during chudan-no-kamae and three-movement-striking, which are basic movements of kendo, in elementary school students who undergo kendo training and comparing left and right side brainwave activities to find out differences. METHODS This study was conducted with 29 male elementary school students living in K City who were experts in kendo with a career as an athlete or a kendo training period not shorter than six months. The brainwave activity was measured by measuring and analyzing brainwaves at eight regions at the prefrontal lobe, the frontal lobe, the temporal lobe, and the occipital lobe using brainwave measuring equipment. Brainwaves were measured for 5 minutes in a sitting position in a stable state and were also measured for 5 minutes after 15 minutes of the chudan-no-kamae movement, which is aiming at the opponent with the point of the sword while moving along eight moving lines of the opponents, and for 5 minutes after 15 minutes of three striking movements. RESULTS Alpha waves showed higher brainwave activity during the stable state than during the kendo movements (three striking movements, chudan-no-kamae) while SMR, M-beta, and H-beta showed higher brainwave activity after kendo movements than during the resting state. The asymmetry between the left and right sides increased after the movements compared to during the resting state. CONCLUSIONS These results are considered attributable to kendo training that partly increased their concentration thereby increasing brainwave activity. However, it is unclear that kendo training will be helpful for concentration through physical activities and brain activity in this study. Therefore, further study should be conducted with the measurement of factors related to emotional aspects, concentration, and brainwaves according to kendo training.

Background Pressure changes related to temperature variation during cupping may lead to dropout. This study aimed to investigate pressure changes related to temperature variations in the cup during the cupping procedure. Methods Changes in temperature and pressure were measured for 15 minutes after the procedure was performed using the alcohol rub method with glass cups and with the addition of infrared irradiation. Changes in temperature and pressure were also measured for 15 minutes after pumping 3 times using the valve suction method, and with the addition of infrared irradiation. Results In a comparison between the alcohol rub method with glass cups and with the addition of infrared irradiation, the negative pressure increased over time in the absence of infrared irradiation, whereas it decreased when performed with infrared irradiation p = 0.094. However, in a comparison between pumping 3 times using the valve suction method, and with the addition of infrared irradiation, the negative pressure decreased in both cases, but this was more significant with infrared irradiation p = 0.172. There was a significantly higher temperature in the glass cups (p = 0.004) and the valve cups (p = 0.001) exposed to infrared radiation, compared with no infrared irradiation. Conclusion The reduction in negative pressure inside the cups exposed to infrared radiation was greater than without infrared irradiation. Temperature increases inside the cup can lead to the risk of dropout.

OBJECTIVES The purpose of this study is to compare the difference in the prevalence of hyperlipidemia according to the level of physical activity in adults, and to compare the difference between annual personal medical expenses, hospitalization, emergency and outpatient use depending on the level of physical activity for hyperlipidemia patients. METHODS The 2018 Korea medical panel data was used (14,489 adults and 2,559 Hyperlipidemia). Physical activity was measured with short form of IPAQ and converted to MET-minutes per week. The days of hospitalization, and personal medical expenses were compared, and frequency analysis, logistic regression, ANOVA and chi-square were performed. RESULTS The prevalence of hyperlipidemia based on the inactive group were decreased both minimally active group (OR = 0.94) and the active group (OR = 0.74, p

Background The aim of this study was to evaluate clinical outcomes in coronavirus disease 2019 (COVID-19) positive patients with type 2 diabetes compared to those without diabetes in Korea. Methods We extracted claims data for patients diagnosed with COVID-19 from the National Health Insurance Service database in Korea from January 20, 2020 to March 31, 2020. We followed up this cohort until death from COVID-19 or discharge from hospital. Results A total of 5,473 patients diagnosed with COVID-19 were analyzed, including 495 with type 2 diabetes and 4,978 without diabetes. Patients with type 2 diabetes were more likely to be treated in the intensive care unit (ICU) (P

Purpose This study tells about my life about the past time when I studied for the teacher certification examination, using autoethnography. Methods It primarily used personal memories and diaries. The collected data was analyzed by applying longitudinal coding method through technical categories. Results The finding of this study is described in a chronological order as follows. The first part is about my unstable ego formed in my puberty period just like riding a roller coaster. It mainly features the process of choosing a career path when I was in school and the important starting point that made me today. The second part describes about my life after entering the department of physical education. I joined the military only to flee from a fruitless college life where I was wearing an unbefitting mask to hide myself from the world that is completely beyond my control. In the military, I was lucky to realize how to apply my major to set up my career path by coincidence. The third part is about the process of finding a genuine meaning of being a physical education teacher through a transitional period experienced after returning to school and form a stable self. Lastly, passing teacher certification examination with undaunted struggles boosted my self-esteem and self-efficacy and solidified my self-identity in the end. In addition, it is possible to get a glimpse of the attitudes that teachers need to have for a teaching career in the last part. Conclusions What I want to say throughout my descriptive story is that preparing for the teacher certification examination itself is a great challenge as well as a courageous decision for the candidates, but it is an attainable goal if they try with all their heart.

Mesenteric venous thrombophlebitis secondary to inflammatory processes such as diverticulitis and appendicitis is a rare disease; however, it can nonetheless cause bowel ischemia and infarctions. Radiologic diagnosis is vital for mesenteric venous thrombophlebitis complicated with diverticulitis due to its non-specific clinical presentation and very low incidence. We report a case of a 61-year-old woman with superior mesenteric vein thrombosis and ileocecal diverticulitis on CT, which was resolved after treatment with a combination of antibiotic therapy and right hemicolectomy.

Hepatic hydrothorax is a transudative pleural effusion that complicates advanced liver cirrhosis. Patients refractory to medical treatment plus salt restriction and diuretics are considered to have refractory hepatic hydrothorax and may require transjugular intrahepatic portosystemic shunt (TIPS) or liver transplant. Successful antiviral therapy reduces the incidence of some complications of cirrhosis secondary to HCV infection. We report a case of hepatic hydrothorax in a 55-year-old female patient with HCV cirrhosis, which exhibited a spontaneous decrease in pleural effusion after direct antiviral agent (DAA) therapy. In cases of HCV cirrhosis, DAAs are worth administering before treatment by TIPS or liver transplantation.

This is a systematic review of the clinical use of cupping therapy. Four domestic databases and 2 foreign databases were searched. Studies that reported the cupping pressure used during cupping therapy were included in this study. The types of cupping, cupping site, pressure, and duration of cupping were the main parameters analyzed. A total of 27 studies, including 24 experimental studies were analyzed. There were 12 constant negative pressure (domestic) studies with a range between 60 mmHg and 600 mmHg. There were 5 maximum negative pressure (domestic) studies and the maximum negative pressure was 620 mmHg. Three studies used a maximum negative pressure of 600 mmHg. There were 4 constant negative pressure (foreign) studies with a range between 75 mmHg to 750 mmHg. There were 3 maximum negative pressure (foreign) studies with a maximum pressure of 420 mmHg. The studies differed with regards to the materials used and the amount of pressure applied. Many studies had limited information and therefore generalizability of the results in this review is limited. Further experimental studies are required to establish the correlation between cupping pressure and treatment effects so that cupping therapy can be standardised.

First trimester surgical abortion is an effective and safe procedure. Although its failure is uncommon, congenital uterine anomaly may be considered as one of the etiologic factors in such cases. Here, we report a rare case of surgical abortion failure that was successfully managed by operative hysteroscopy-assisted dilatation and evacuation (D&E) under ultrasound guidance in a woman with complete uterine septum. The patient was referred to Severance Hospital after two consecutive surgical abortion failures even under ultrasound guidance. A missed abortion in a left-sided hemicavity of septate uterus was noted on ultrasonography. Ultrasound-guided D&E was unsuccessful because the curette could not reach the uterine cavity with the gestational sac. Operative hysteroscopy revealed insufficient communication with the left-sided cavity just above the cervical internal os of the uterine septum. After widening the communication, ultrasound-guided D&E was successfully performed.

High-altitude cerebral edema (HACE) is a rare life-threatening condition observed in individuals who climb high altitudes. This report describes the case of a 38-year-old man who recently climbed a 5000-m-high mountain, showing the following radiologic findings at 3 different anatomical locations: 1) increased T2 signal intensity (SI) without restricted diffusion, with full recovery in the posterior limb of the left internal capsule; 2) increased T2 SI with restricted diffusion, with full recovery in the splenium of the corpus callosum; and 3) increased T2 SI with restricted diffusion and microbleeds, resulting in bilateral encephalomalacia in the globus pallidus. Herein, we report the concurrent typical and atypical radiologic findings of this rare condition caused by vasogenic and cytotoxic edema.

ObjectiveThis study was aimed at identifying a correlation between polycystic ovarian morphology (PCOM) and the severity of primary dysmenorrhea in young Korean women.MethodsA total of 592 patients who visited a tertiary hospital from March 2008 to March 2015 for dysmenorrhea were examined. After excluding those with secondary causes of menstrual pain (for example, myoma, adenomyosis, endometriosis, and pelvic inflammatory disease), 361 women were recruited and retrospectively analyzed. Severe dysmenorrhea was defined as a visual analog scale (VAS) score ≥6.ResultsThe mean patient age was 23.0±4.0 years, the average menstrual cycle length was 34.4±23.7 days, and the average pain intensity was VAS 6.7±0.1 at baseline. PCOM was assessed by ultrasound in 54 women (15%). Patients with severe menstrual pain were more likely to have irregular menstrual cycles (P=0.03) and heavy menstrual flow (P=0.01) than those with mild menstrual pain. After adjusting for weight, height, menstrual cycle interval, and menstrual flow in the logistic regression analysis, PCOM (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.05–4.97; P=0.04) and heavy menstrual flow (OR, 1.85; 95% CI, 1.05–3.28; P=0.04) were found to be significant independent factors influencing pain.ConclusionOur study shows that PCOM may have a correlation with the severity of primary dysmenorrhea. Since PCOM may play a role in the development of menstrual pain, patients with PCOM should be under active surveillance with resources for prompt pain management readily available. It may also be necessary to further investigate the molecular mechanisms of pain development in primary dysmenorrhea.

BackgroundHyperglycemic crisis is a metabolic emergency associated with diabetes mellitus. However, accurate epidemiologic information on cases of hyperglycemic crisis in Korea remains scarce. We evaluated trends in hyperglycemic crisis hospitalizations and in- and out-of-hospital mortality in Korea. We also predicted future trends.MethodsWe extracted claims data with hyperglycemic crisis as the principal diagnosis from the National Health Insurance Service database in Korea from January 2004 to December 2013. We investigated the numbers of claims with hyperglycemic crisis and identified trends in hyperglycemic crisis based on those claims data. We predicted future trends by statistical estimation.ResultsThe total annual number of claims of hyperglycemic crisis increased from 2,674 in 2004 to 5,540 in 2013. Statistical analysis revealed an increasing trend in hyperglycemic crisis hospitalizations (P for trend

OBJECTIVES The purpose of this paper is to analyze the differences in the prevalence of diabetes mellitus, in relation to the physical activity grade and to compare differences in, personal medical expenses, the days of hospitalization, inpatient, outpatient and emergency. METHODS The medical panel data of Korea used in 2016, with a total of 13,523 adults and 1,404 diabetes mellitus patients. Physical activity level measured with IPAQ questionnaire, and displayed as MET-minutes per week. The days of hospitalization, personal medical expenses, using of inpatient, outpatient and emergency investigated, and frequency analysis, logistic regression, ANOVA, and Chi-square performed. RESULTS The prevalence of diabetes mellitus based on inactive group was reduced both minimally active group (odds ratio [OR] = 0.81) and active group (OR = 0.73, p

A 51-year-old perimenopausal female patient presented with hirsutism and voice thickening which was started approximately one and a half years ago. Her initial hormone assay revealed elevated plasma testosterone, 5a-dihydrotestosterone, and dehydroepiandrosterone (DHEA) levels and therefore androgen-secreting tumor was first suspected. However, the lesion was inconspicuous on transvaginal sonography, abdominal-pelvic computed tomography (CT) scan, and pelvic magnetic resonance (MRI) imaging. Consequently, 18F-fluorodeoxyglucose (FDG) positron emission tomography-CT was performed, which localized the lesion as a focal FDG uptake within the right adnexa. Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed, and although visible gross mass lesions were not observed intraoperatively, pure Leydig cell tumor was pathologically confirmed within the right ovary. Plasma testosterone, 5a-dihydrotestosterone, and DHEA levels were normalized postoperatively. Clinical signs of virilization were also significantly resolved after 3-months of follow-up.

Liposarcoma located in the scrotum is a very rare, and to our knowledge, only a few cases have been described in the radiologic literature. Clinically, scrotal liposarcoma manifests as a painless, slow-growing mass, which can be misdiagnosed as inguinal hernia, scrotal hydrocele or lipoma. Here, we present a case of scrotal liposarcoma. On CT and MRI, it manifested as a predominant fat-containing mass with heterogeneously enhancing soft tissue.

Percutaneous endoscopic gastrostomy (PEG) is widely used to provide nutritional support for patients with dysphagia and/or disturbed consciousness preventing oral ingestion, and PEG tube placement is a relatively safe and convenient non-surgical procedure performed under local anesthesia. However, the prevention of PEG-insertion-related complications is important. A 64-year-old man with recurrent pneumonia underwent tracheostomy and nasogastric tube placement for nutritional support and opted for PEG tube insertion for long-term nutrition. However, during the insertion procedure, needle puncture had to be attempted twice before successful PEG tube placement was achieved, and a day after the procedure his hemoglobin had fallen and he developed hypotension. Abdominal computed tomography revealed injury to a pancreatic branch of the superior mesenteric artery (SMA) associated with bleeding, hemoperitoneum, and pancreatitis. Transarterial embolization was performed using a microcatheter to treat hemorrhage from the injured branch of the SMA, and the acute pancreatitis was treated using antibiotics and supportive care. The patient was discharged after an uneventful recovery. Clinicians should be mindful of possible pancreatic injury and bleeding after PEG tube insertion. Possible complications, such as visceral injuries or bleeding, should be considered in patients requiring multiple puncture attempts during a PEG procedure.

During laparoscopic cholecystectomy, a surgical clip is used to control the cystic duct and cystic artery. In the past, metallic clips were usually used, but over recent years, interest in the use of Hem-o-lok clips has increased. Surgical clip migration into the common bile duct (CBD) after laparoscopic cholecystectomy has rarely been reported and the majority of reported cases involved metallic clips. In this report, we describe the case of a 53-year-old woman who presented with abdominal pain caused by migration of a Hem-o-lok clip into the CBD. The patient had undergone laparoscopic cholecystectomy 10 months previously. Abdominal CT revealed an indistinct, minute, radiation-impermeable object in the distal CBD. The object was successfully removed by sphincterotomy via ERCP using a stone basket and was identified as a Hem-o-lok clip.

PURPOSE The purpose of this study is to compare the differences between ACSM equation and energy expedition equipment of college students during walking and running, and to analyze the correlation. METHODS The subjects were 36 college students (19 male, 17 female) and they performed walking (4 km/hr, 2%) and running (9.0 km/hr, 2%) for 10 minutes. Energy consumption was measured using ACSM equation, Caltrac, Polar, Omron, Lifecorder, and Pacer. The paired t-test, correlation and ANOVA were conducted. RESULTS For GEE, all 3 equipments overestimated from 116.1% to 123.4% (p

OBJECTIVES The purpose of this study is to compare the differences in the prevalence of hypertension in relation to the physical activity grade and to analyze differences in the days of hospitalization of hypertension patients, drug expenses and personal medical expenses. METHODS The Korea medical panel data was used in 2016, with a total of 13,276 adults and 3,470 hypertension patients. Physical activity was measured with IPAQ and converted to MET-minutes per week. The days of hospitalization, monthly average for hypertension drug expenses, and personal medical expenses were investigated, and frequency analysis, logistic regression, and ANOVA were performed. RESULTS The prevalence of hypertension based on the inactive group were decreased both minimally active group (odds ratio [OR] = 0.89) and the active group (OR = 0.77, p

Anterior mediastinal teratomas are congenital tumors containing derivatives of all three germ layers. They usually grow slowly and are often detected incidentally by imaging studies. We describe the case of a 38-year-old man with an anterior mediastinal teratoma extending to the anterior neck, which resulted in a cystic neck mass.

BackgroundEzetimibe-statin combination therapy has been found to reduce low density lipoprotein cholesterol levels and the risk of major adverse cardiovascular events (MACEs) in large trials. We sought to examine the differential effect of ezetimibe on MACEs when added to statins according to the presence of diabetes.MethodsRandomized clinical trials with a sample size of at least 50 participants and at least 24 weeks of follow-up that compared ezetimibe-statin combination therapy with a statin- or placebo-controlled arm and reported at least one MACE, stratified by diabetes status, were included in the meta-analysis and meta-regression.ResultsA total of seven trials with 28,191 enrolled patients (mean age, 63.6 years; 75.1% men; 7,298 with diabetes [25.9%]; mean follow-up, 5 years) were analysed. MACEs stratified by diabetes were obtained from the published data (two trials) or through direct contact (five trials). No significant heterogeneity was observed among studies (I2=14.7%, P=0.293). Ezetimibe was associated with a greater reduction of MACE risk in subjects with diabetes than in those without diabetes (pooled relative risk, 0.84 vs. 0.93; Pheterogeneity=0.012). In the meta-regression analysis, the presence of diabetes was associated with a greater reduction of MACE risk when ezetimibe was added to statins (β=0.87, P=0.038).ConclusionEzetimibe-statin combination therapy was associated with greater cardiovascular benefits in patients with diabetes than in those without diabetes. Our findings suggest that ezetimibe-statin combination therapy might be a useful strategy in patients with diabetes at a residual risk of MACEs.

BackgroundA recent animal study showed that parathyroid hormone-related peptide (PTHrP) is associated with cancer cachexia by promoting adipose tissue browning, and we previously demonstrated that PTHrP predicts weight loss (WL) in patients with cancer. In this study, we investigated whether prediction of WL by PTHrP is influenced by clinical factors such as serum albumin, corrected calcium levels, cancer stage, and performance status (PS).MethodsA cohort of 219 patients with cancer whose PTHrP level was measured was enrolled and followed for body weight (BW) changes. Subjects were divided into two groups by serum albumin (cutoff value, 3.7 g/dL), corrected calcium (cutoff value, 10.5 mg/dL), cancer stage (stage 1 to 3 or 4), or PS (Eastern Cooperative Oncology Group 0 to 1 or 2 to 4), respectively. Clinically significant WL was defined as either percent of BW change (% BW)

The diffuse midline glioma H3 K27M-mutant was only added recently to the World Health Organization (WHO) Classification of Tumours of the Central Nervous System. While similar tumors are found in the midline, this particular mutation represents the majority of diffuse gliomas in the brainstem. Classified by WHO as grade IV tumors, these are aggressive and bear a poor prognosis for the patient. This report describes a case involving a 37-year-old woman with a histologically confirmed diffuse midline glioma H3 K27M-mutant in the bilateral thalamus and midbrain. The following discussion describes typical characteristics observed with computed tomography and magnetic resonance imaging. Given the rarity of diffuse intrinsic pontine gliomas in adults and the general lack of studies investigating this poorly understood entity, we report critical findings for contribution to the existing scarce literature on the topic.

Colonoscopy is a commonly performed endoscopic procedure. Although it is generally considered to be safe, serious complications, such as colorectal perforation, can occur. Most colonic perforations are intraperitoneal and cause pneumoperitoneum with acute abdominal pain as the initial symptom. However, extraperitoneal perforations with pneumoretroperitoneum may happen, albeit rarely, with atypical initial symptoms. We report a rare case of rectosigmoid perforation occurring after diagnostic colonoscopy that developed into pneumoretroperitoneum, pneumomediastinum, pneumothorax, and subcutaneous emphysema, with a change in voice and neck swelling as the initial symptoms. The patient was successfully treated with endoscopic closure of the perforation and conservative management.

BackgroundAlthough the beneficial effects of statin treatment in dyslipidemia and atherosclerosis have been well studied, there is limited information regarding the renal effects of statins in diabetic nephropathy. We aimed to investigate whether, and which, statins affected renal function in Asian patients with diabetes.MethodsWe enrolled 484 patients with diabetes who received statin treatment for more than 12 months. We included patients treated with moderate-intensity dose statin treatment (atorvastatin 10 to 20 mg/day or rosuvastatin 5 to 10 mg/day). The primary outcome was a change in estimated glomerular filtration rate (eGFR) during the 12-month statin treatment, and rapid renal decline was defined as a >3% reduction in eGFR in a 1-year period.ResultsIn both statin treatment groups, patients showed improved serum lipid levels and significantly reduced eGFRs (from 80.3 to 78.8 mL/min/1.73 m2 for atorvastatin [P=0.012], from 79.1 to 76.1 mL/min/1.73 m2 for rosuvastatin [P=0.001]). A more rapid eGFR decline was observed in the rosuvastatin group than in the atorvastatin group (48.7% vs. 38.6%, P=0.029). Multiple logistic regression analyses demonstrated more rapid renal function loss in the rosuvastatin group than in the atorvastatin group after adjustment for other confounding factors (odds ratio, 1.60; 95% confidence interval, 1.06 to 2.42).ConclusionThese results suggest that a moderate-intensity dose of atorvastatin has fewer detrimental effects on renal function than that of rosuvastatin.

Background This study aimed to present our 5-year experience of extracorporeal cardiopulmonary resuscitation (ECPR) performed by emergency physicians. Methods We retrospectively analyzed 58 patients who underwent ECPR between January 2010 and December 2014. The primary parameter analyzed was survival to hospital discharge. The secondary parameters analyzed were neurologic outcome at hospital discharge, cannulation time, and ECPR-related complications. Results Thirty-one patients (53.4%) were successfully weaned from extracorporeal membrane oxygenation, and 18 (31.0%) survived to hospital discharge. Twelve patients (20.7%) were discharged with good neurologic outcomes. The median cannulation time was 25.0 min (interquartile range 20.0-31.0 min). Nineteen patients (32.8%) had ECPR-related complications, the most frequent being distal limb ischemia. Regarding the initial presentation, 52 patients (83.9%) collapsed due to a cardiac etiology, and acute myocardial infarction (33/62, 53.2%) was the most common cause of cardiac arrest. Conclusions The survival to hospital discharge rate for cardiac arrest patients who underwent ECPR conducted by an emergency physician was within the acceptable limits. The cannulation time and complications following ECPR were comparable to those found in previous studies.

Persistent trigeminal artery (PTA) is a rare condition that represents a remnant fetal anastomosis between the carotid artery and basilar artery. PTA typically arises from precavernous portion of the internal carotid artery (ICA) to the basilar artery. Variations of PTA extending from the ICA and directly terminating as cerebellar arteries without jointing basilar artery are particularly rare. We presented the extremely rare case of the variations of PTA, which directly terminate in the ipsilateral anterior inferior cerebellar artery. In addition, we reviewed the embryogenesis and clinical implication of this anomaly.