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One of the alternatives for effective storage of irregularly produced renewable energy is hydrogen energy. In order to realize a hydrogen-based society, not only environmentally friendly production of hydrogen but also effective storage is very important. Underground hydrogen storage technology is a technology that has evolved from the technology for storing natural gas underground, and includes waste gas fields, salt domes, aquifers, and rock cavities. When stored underground, hydrogen is converted into high-pressure gaseous hydrogen, liquefied hydrogen, and ammonia. Liquefied hydrogen requires extremely low storage temperatures, and ammonia is a toxic substance that requires separate handling, and energy loss occurs during the conversion process. To compensate for this, research on liquefied hydrogen, such as multilayer insulation technology, is being conducted. Ammonia has successfully extracted high-purity hydrogen by developing a membrane reactor. Ammonia toxicity can be prevented by strengthening leak detection and blocking facilities. Among these, ammonia was found to be the most suitable for underground storage in terms of economic feasibility, environment, and commercialization.

Bezoars, including phytobezoars, trichobezoars, and pharmacobezoars, are accumulations of undigested substances in the gastrointestinal tract. We report three cases of gastric bezoars. Case 1: An 86-year-old woman presented with a one-month history of abdominal pain and vomiting. Esophagogastroduodenoscopy revealed gastric bezoars; consumption of 2 L of cola daily for 2 weeks resulted in complete disappearance of the bezoars. Case 2: An asymptomatic 63-year-old woman underwent esophagogastroduodenoscopy, which revealed a gastric bezoar. Cola spraying and endoscopic lithotomy were ineffective; therefore, the patient underwent laparoscopic removal of the bezoar for management of small bowel obstruction secondary to the bezoar fragments. Case 3: A 6-year-old girl with a history of pica underwent two laparoscopic surgeries 10 months apart for recurrent trichobezoars. We report our treatment approach in three patients who presented with gastric bezoars.

Background: The clinical application of canine mesenchymal stem cells (MSCs) necessitates efficient and safe culture methods to produce large quantities of cells. Traditionally, fetal bovine serum (FBS) has been used for MSC expansion, but it carries risks such as contamination and adverse immune responses. Methods: In this study, we investigate the efficacy and efficiency of canine allogeneic serum as an effective alternative to FBS for the in vitro culture of canine MSCs. We measured the population doubling time of canine MSCs in allogeneic serum conditions and utilized qRT-PCR, flowcytometric analysis, and cellular staining/color-metric assay for investigating its effects on cellular senescence during long-term culture and the expression of key pluripotency-related transcriptomes. Results: Our findings demonstrate that canine MSCs cultured with allogeneic serum exhibited enhanced proliferation rates, reduced cellular senescence, and lower apoptosis levels compared to those cultured with FBS. Additionally, the expression of key pluripotency-related transcription factors, including Oct4, Sox2, and Nanog, was increased in canine MSCs cultured with allogeneic serum. Conclusions: These results highlight the potential of canine allogeneic serum to provide a safer and more effective culture environment, supporting the large-scale expansion and maintenance of canine MSCs for clinical applications.

Background Dipeptidyl peptidase-4 (DPP4) inhibitors are frequently prescribed for patients with type 2 diabetes; however, their cost can pose a significant barrier for those with impaired kidney function. This study aimed to estimate the economic benefits of substituting non-renal dose-adjusted (NRDA) DPP4 inhibitors with renal dose-adjusted (RDA) DPP4 inhibitors in patients with both impaired kidney function and type 2 diabetes. Methods This retrospective cohort study was conducted from January 1, 2012 to December 31, 2018, using data obtained from common data models of five medical centers in Korea. Model 1 applied the prescription pattern of participants with preserved kidney function to those with impaired kidney function. In contrast, model 2 replaced all NRDA DPP4 inhibitors with RDA DPP4 inhibitors, adjusting the doses of RDA DPP4 inhibitors based on individual kidney function. The primary outcome was the cost difference between the two models. Results In total, 67,964,996 prescription records were analyzed. NRDA DPP4 inhibitors were more frequently prescribed to patients with impaired kidney function than in those with preserved kidney function (25.7%, 51.3%, 64.3%, and 71.6% in patients with estimated glomerular filtration rates [eGFRs] of ≥60,

Background: In healthy dentin conditions, odontoblasts have an important role such as protection from invasion of pathogens. In mammalian teeth, progenitors such as mesenchymal stem cells (MSCs) can migrate and differentiate into odontoblast-like cells, leading to the formation of reparative dentin. For differentiation using stem cells, it is crucial to provide conditions similar to the complex and intricate in vivo environment. The purpose of this study was to evaluate the potential of differentiation into odonto/osteoblasts, and compare co-culture with/without epithelial cells. Methods: MSCs and epithelial cells were successfully isolated from dental tissues. We investigated the influences of epithelial cells on the differentiation process of dental pulp stem cells into odonto/osteoblasts using co-culture systems. The differentiation potential with/without epithelial cells was analyzed for the expression of specific markers and calcium contents. Results: Differentiated odonto/osteoblast derived from dental pulp tissue-derived mesenchymal stem cells with/without epithelial cells were evaluated by qRT-PCR, immunostaining, calcium content, and ALP staining. The expression of odonto/osteoblast-specific markers, calcium content, and ALP staining intensity were significantly increased in differentiated cells. Moreover, the odonto/osteogenic differentiation capacity with epithelial cells co-culture was significantly higher than without epithelial cells co-culture. Conclusions: These results suggest that odonto/osteogenic differentiation co-cultured with epithelial cells has a more efficient application.

Objectives Epidemiological studies have shown an inverse association between Helicobacter pylori infection and ulcerative colitis (UC). In this study, we investigated the protective effects of H. pylori infection on the severity of UC. Methods This single-center study included 316 patients with newly diagnosed UC based on findings of colonoscopy and upper endoscopy for H. pylori evaluation between January 1994 and December 2015. Patients’ medical records were retrospectively reviewed, and severity of UC was assessed based on endoscopic findings, clinical symptoms, treatment regimens, and Mayo scores. Results The prevalence of H. pylori infection in patients with UC was 74/316 (23.4%). Based on upper endoscopic findings, the percentage of patients with duodenal ulcers was significantly higher in the H. pylori positive group than that in the H. pylori negative group (27.0% vs. 11.6%, p=0.022). Disease extent and endoscopic severity showed no significant intergroup difference (p=0.765 and p=0.803, respectively). Endoscopic severity was unaffected by the H. pylori infection status, based on the extent of endoscopically documented disease and endoscopic findings. Furthermore, UC-related symptom severity assessed on the basis of stool frequency, rectal bleeding severity, and rate of admission necessitated by UC aggravation was not associated with H. pylori infection (p=0.185, 0.144, and 0.182, respectively). Use of steroids as induction therapy for severe UC did not differ with regard to H. pylori infection (p=0.327). No intergroup difference was observed in disease severity of UC classified using the Mayo score (p=0.323). Conclusions H. pylori infection was detected in approximately 25.0% of patients with UC. However, the H. pylori infection status was not associated with the severity of UC based on endoscopic disease activity, patients’ symptoms, steroid use, or the Mayo clinic score.

Obesity increases gastroesophageal reflux disease through several factors. As a result, Barrett's esophagus, esophageal adenocarcinoma, and gastroesophageal junctional gastric cancer are increasing. Existing studies usually defined obesity by body mass index and analyzed the correlation. Recently, more studies have shown that central obesity is a more important variable in upper gastrointestinal diseases related to gastroesophageal reflux. Studies have reported that weight loss is effective in reducing gastroesophageal reflux symptoms. Obesity also affects functional gastrointestinal diseases. A significant correlation was shown in upper abdominal pain, reflux, vomiting, and diarrhea rather than lower abdominal diseases.

The rise of multidrug-resistant organisms represents a serious global public health concern. In Korea, the increasing prevalence of carbapenem-resistant Enterobacterales (CRE) is particularly concerning due to the difficulties associated with treatment. Data from the Korea Global Antimicrobial Resistance Surveillance System indicate a yearly increase in CRE cases, with carbapenemase-producing Enterobacterales being the predominant type. The capacity of CRE to resist multiple broad-spectrum antibiotics leads to higher medical costs and mortality rates, underscoring the need for urgent action. Effective prevention is crucial to curbing CRE outbreaks and transmission. Antimicrobial stewardship programs (ASPs) play a key role and require commitment from healthcare professionals to minimize unnecessary antibiotic use, as well as from policymakers to ensure adherence to ASP guidelines. Given the complexity of CRE transmission, ASP efforts must be integrated with infection control strategies for maximum effectiveness. These strategies include adherence to standard and contact precautions, environmental disinfection, preemptive isolation, and comprehensive education and training for healthcare personnel. Additionally, surveillance testing for patients at high risk for CRE and the use of real-time diagnostic kits can facilitate early detection and reduce further transmission. Strategies for the prevention of CRE infection should be tailored to specific healthcare settings. Ongoing research is essential to update and refine infection control guidelines and effectively prevent CRE outbreaks.

Objectives In this study, high-pressure soil washing was performed on in-situ gas station soils for the remediation of petroleum-contaminated gas station sites. Methods On-site gas station soils (GSS) collected from four different locations were subjected to high-pressure soil washing to analyze the amount of fine soil removal and TPH concentration after washing according to the cut-off size (0.075, 0.105 mm). In addition, the four GSS were evaluated for the relationship between the organic matter content of each soil and TPH removal efficiency. Furthermore, to evaluate the disintegration force of high-pressure soil washing technology to disperse soil aggregates, the particle size distribution of the soil before and after washing was evaluated and XRD analysis was performed. Results and Discussion As the cut-off size increased (0.075 mm → 0.105 mm), the removal rate of fine soil in the GSS increased, and the TPH concentration tended to decrease. With respect to the TPH Soil Contamination Warning Standard for Region 2 (800 mg/kg), only the GSS 3 was in compliance with the standard (630 mg/kg). There were no significant differences in fine soil removal rates among the soils, which was expected since all the soils tested represented the same sandy loam. Washing efficiencies by soil were relatively low for soils with relatively high organic matter content. The particle size distribution showed the largest particle reduction was in the 2-0.850 mm range after remediation, while soil particles increased in the 0.105-0.075 mm and

Purpose This study aimed to compare the diagnostic performance of cardiac CT and transthoracic echocardiogram (TTE) depending on the degree of valvular calcification and bicuspid aortic valve (BAV) subtype. Materials and Methods This retrospective study included 266 consecutive patients (106 with BAV and 160 with tricuspid aortic valve) who underwent cardiac CT and TTE before aortic valve replacement. Cardiac CT was used to evaluate the morphology of the aortic valve, and a calcium scoring scan was used to quantify valve calcium. The aortic valves were classified into fused and two-sinus types. The diagnostic accuracy of cardiac CT and TTE was calculated using a reference standard for intraoperative inspection. Results CT demonstrated significantly higher sensitivity, negative predictive value, and accuracy than TTE in detecting BAV (p < 0.001, p < 0.001, and p = 0.003, respectively). The TTE sensitivity tended to decrease as valvular calcification increased. The error rate of TTE for CT was 10.9% for the twosinus type of BAV and 28.3% for the fused type (p = 0.044). Conclusion Cardiac CT had a higher diagnostic performance in detecting BAV than TTE and may help diagnose BAV, particularly in patients with severe valvular calcification.

OBJECTIVES The purpose of this study was to compare the effects of 12-week online-delivered isometric and dynamic core stability exercises on functional movements, dynamic postural control, and core endurance in healthy young adults. METHODS This is a single-blind randomized controlled trial. Sixty young adults (age range: 19-34 years; 12 males, 48 females) participated in this study. They were randomly assigned to the isometric core exercise [ICE], dynamic core exercise [DCE], or control group. Participants in the ICE and DCE groups performed 40-60 min real-time online-delivered core exercise session via Zoom video conferencing application, twice a week for 12 weeks. Participants in the control group did not participate in exercise intervention. All participants were asked not to participate in other exercises for 12 weeks. The outcome measurements include the functional movement screen, Y-balance test (upper & lower), and core endurance tests (flexor, extensor, and lateral flexor of the trunk). RESULTS The results of this study showed significant improvement in core endurance, functional movement, and dynamic postural control of the upper body in the ICT and DCE groups compared with the control group. However, significant differences were not found between the ICE and DCE groups in all variables. CONCLUSIONS Both types of online-delivered core exercise programs have been shown to be effective in improving functional movement, dynamic posture control, and core endurance in young adults. In addition, since both types of exercise have been shown to be effective on core stability related variables, both types of exercise can be recommended for young adults. However, further studies are warranted to investigate the gender differences on the effects of the core stability exercises.

We explored the annual risks of mild and severe preeclampsia (PE) among nulliparous women. Using the National Health Information Database of South Korea, 1,317,944 nulliparous women who gave live births were identified. Mild PE increased from 0.9% in 2010 to 1.4% in 2019 (P for trend=0.006), while severe PE decreased from 0.4% in 2010 to 0.3% in 2019 (P=0.049). The incidence of all types of PE (mild and severe) showed no linear change (P=0.514). Adjusted odds ratio (OR) of severe PE decreased in 2013 (0.68; 95% confidence interval [CI]: 0.60, 0.77) and beyond compared to that in 2010, while the OR of mild PE increased in 2017 (1.14; 95% CI: 1.06, 1.22) and beyond. Mild PE was found to be less likely to progress to the severe form since 2010; however, the overall risk of PE among women did not change.

This study reports on diffuse leptomeningeal glioneuronal tumor (DL-GNT) in a 29- year-old male. DLGNT is a rare central nervous system (CNS) tumor mostly seen in children and only few cases have been reported in adult patients. Our patient presented with a chronic headache that lasted for five months. MR imaging showed mild hydrocephalus, multiple rim-enhancing nodular lesions in the suprasellar cistern, diffuse leptomeningeal enhancement in the lumbosacral area, and multiple small non-enhancing cyst-appearing lesions not suppressed on fluid attenuated inversion recovery (FLAIR) images in the bilateral basal ganglia, thalami, and cerebral hemispheres. Under the impression of germ cell tumor with leptomeningeal seeding, the patient underwent trans-sphenoidal tumor removal. DL-GNT was pathologically confirmed and FGFR1 mutation was detected through a next-generation sequencing test. In conclusion, a combination of leptomeningeal enhancement and multiple parenchymal non-enhancing cyst-appearing lesions not suppressed on FLAIR images may be helpful for differential diagnosis despite overlapping imaging features with many other CNS diseases that have leptomeningeal enhancement.

With the widespread adoption of health check-ups, tumor markers are being used for screening healthy individuals without symptoms related to cancer. Although CA 19-9 is known to have diagnostic value when a patient presents with symptoms, the evidence for its clinical value as a cancer screening test in asymptomatic patients is still lacking. However, patients who experience an increase in CA 19-9 levels may feel anxious about the possibility of having cancer and may seek medical attention. If the CA 19-9 level is elevated, it may be necessary to consider initial testing for malignant tumors of the pancreas. It should be recognized that the level can also increase in malignant tumors of the gastrointestinal tract, thyroid, and reproductive organs. Since the CA 19-9 levels can also increase in various benign diseases, it is important to evaluate if there is an underlying benign disease through appropriate testing and follow-up to reduce patient anxiety and discontinue unnecessary follow-up tests.

Current studies have revealed the capacity of mesenchymal stem cells (MSCs) in term of immunomodulatory properties, and this distinct potential is downgraded according to the disease duration of patients-derived MSCs. In order to enhance the immunomodulatory and anti-tumorigenic properties of the rheumatoid arthritis (RA) joints-derived MSCs, we aggregate synovial fluid-derived MSCs from RA joints (RA-hMSCs) into 3D-spheroids by the use of hanging drop culture method. Cells were isolated from synovial fluids of RA joints with longstanding active status over 13 years. For aggregation of RA-hMSCs into 3D-spheroids, cells were plated in hanging drops in 30 μL of advanced DMEM (ADMEM) containing 25,000-30,000 cells/ drop and cultured for 48 h. To analyze the comparative immunomodulatory effects of 3D-spheroid and 2D monolayer cultured RA-hMSCs and then cells were cultured in ADMEM supplemented with 20% of synovial fluids of RA patients for 48 h and were evaluated by qRT-PCR for their expression of mRNA levels of inflammatory and antiinflammatory markers. Cellular aggregation of RA-hMSCs was observed and cells were aggregate into a single sphere. Following treatment of RA patient’s synovial fluids into the RA-hMSCs, spheroids formed RA-hMSCs showed significantly (p < 0.05) higher expression of TNFα stimulated gene/protein 6 (TSG-6) than the monolayer cultured RAhMSCs. Therefore, the 3D-spheroid culture methods of RA-hMSCs were more effective than 2D monolayer cultures in suppressing inflammatory response treated with 20% of RA-synovial fluids by expression of TNFα (TSG-6) according to the immune response and enhanced secretion of inflammatory factors.

Background Telomerase reverse transcriptase (TERT) promoter mutations are associated with increased recurrence and mortality in patients with thyroid carcinoma. Previous studies on TERT promoter mutations were retrospectively conducted on a limited number of patients. Methods We prospectively collected data on all consecutive patients who underwent thyroid carcinoma surgery between January 2019 and December 2020 at the Samsung Medical Center, Seoul, Korea. We included 2,092 patients with thyroid carcinoma. Results Of 2,092 patients, 72 patients (3.4%) had TERT promoter mutations. However, the frequency of TERT promoter mutations was 0.5% in papillary thyroid microcarcinoma (PTMC) ≤1 cm and it was 5.8% in papillary thyroid carcinoma (PTC) >1 cm. The frequency of TERT promoter mutations was significantly associated with older age at diagnosis (odds ratio [OR], 1.12; P

Most cardiac tumors are metastases, and primary cardiac tumors are rare; even among primary cardiac tumors, primary cardiac neuroendocrine tumors (NETs) are extremely rare. Herein, we report a case of a patient presenting a left atrial mass without past medical history. Because of the location and movement of the mass, as well as the patient’s cerebral infarction episode, the mass was initially suspected to be a thrombus. However, the mass was surgically diagnosed as NET.

Background/Aims This study aimed to compare the efficacy of a recently developed clear-cut knife with that of widely used knives for endoscopic submucosal dissection (ESD) in early gastric cancer (EGC). Materials and Methods Data were collected retrospectively from the National Health Insurance Service Ilsan Hospital between May 2017 and April 2019. The study included 105 patients (108 lesions) with EGC who underwent ESD. Fifty-six EGCs were dissected using an insulation-tipped diathermic knife in combination with a needle knife, while 52 EGCs were dissected using a clear-cut knife, a single device with an integrated needle and an insulated-tipped knife. Oncologic outcomes and technical success were compared between the two groups. Results The distribution of the tumor locations, composition of the undifferentiated types of EGCs, and the size of EGCs (14.3±8.0 vs. 16.6±7.3 mm; P=0.130) were not significantly different between the groups. The complete (98.2% vs. 94.2%; P=0.273) and curative (87.5% vs. 88.5%; P=0.878) resection rates were not statistically different. Furthermore, no significant difference between the total procedure times (39±34.1 vs. 35.7±20.1 minutes; P=0.554), areas of the dissected specimen (858.6±406.5 vs. 980.3±393.8 mm2; P=0.119) and dissected areas per minute (32.4±17.9 vs. 35.5±16.2 mm2/min; P=0.345) were noted. Regarding complications, the overall perforation rates (3.6% vs. 4.0%) and bleeding rates (3.6% vs. 8.0%) were not statistically different. Conclusions The newly developed clear-cut knife is as useful as the combination of classical knives for ESD in EGC.

The unrecorded fungus Galactomyces pseudocandidus de Hoog & M.T. Sm. was isolated and cultured from an introduced species, Procambarus clarkii, in Korea. Two related species, Galactomyces citri-aurantii and Geotrichum candidum, have been reported, but no other Galactomyces spp. have been found in Korea. In this study, we isolated G. pseudocandidus from the digestive tract of American crayfish using RGY (river water-glucose-yeast) medium and then compared the morphological and molecular characteristics of this species with those of related species. As a result, we confirmed that G. pseudocandidus is an unrecorded fungus in Korea, so we described and reported the cultural characteristics and microstructures, such as conidia.

Intermittent fasting has become an increasingly popular strategy in losing weight and associated reduction in obesity-related medical complications. Overwhelming studies support metabolic improvements from intermittent fasting in blood glucose levels, cardiac and brain function, and other health benefits, in addition to weight loss. However, concerns have also been raised on side effects including muscle loss, ketosis, and electrolyte imbalance. Of particular concern, the effect of intermittent fasting on hormonal circadian rhythms has received little attention. Given the known importance of circadian hormonal changes to normal physiology, potential detrimental effects by dysregulation of hormonal changes deserve careful discussions. In this review, we describe the changes in circadian rhythms of hormones caused by intermittent fasting. We covered major hormones commonly pathophysiologically involved in clinical endocrinology, including insulin, thyroid hormones, and glucocorticoids. Given that intermittent fasting could alter both the level and frequency of hormone secretion, decisions on practicing intermittent fasting should take more considerations on potential detrimental consequences versus beneficial effects pertaining to individual health conditions.

Vedolizumab (VDZ) has been approved for the treatment of inflammatory bowel diseases (IBDs) in patients aged ≥18 years. We report a case of a pediatric patient with Crohn disease (CD) who was successfully treated with VDZ. A 16-year-old female developed severe active pulmonary tuberculosis (TB) during treatment with infliximab (IFX). IFX was stopped, and TB treatment was started. After a 6-month regimen of standard TB medication, her pulmonary TB was cured; however, gastrointestinal symptoms developed. Due to the concern of the patient and parents regarding TB reactivation on restarting treatment with IFX, VDZ was started off-label. After the second dose of VDZ, the patient was in clinical remission and her remission was continuously sustained. Ileocolonoscopy at 1-year after VDZ initiation revealed endoscopic healing. Therapeutic drug monitoring conducted during VDZ treatment showed negative antibodies to VDZ. No serious adverse events occurred during the VDZ treatment. This is the first case report in Korea demonstrating the safe and effective use of VDZ treatment in a pediatric CD patient. In cases that require recommencement of treatment with biologics after recovery of active pulmonary TB caused by anti-tumor necrosis factor agents, VDZ may be a good option even in pediatric IBD.

Background/Aims: The HBsAg levels have been used to monitor the chronic hepatitis B (CHB) treatment response to antiviral therapy. On the other hand, it is unclear if the HBsAg quantification levels at each treatment point differ according to the HBeAg status and drug in CHB patients. This study compared the changes in HBsAg in CHB patients according to the HBeAg status and treatment drugs. Methods: CHB patients with at least 1 year of follow-up treatment with one drug, either entecavir (ETV) or tenofovir (TDF), were enrolled in this study. The mean HBsAg levels were measured annually for up to 6 years. A linear mixed model was used to compare the HBsAg quantification levels during the follow-up period. An independent samples t-test was used to analyze the differences in the HBsAg quantification levels at each treatment time point. Results: Ninety-seven patients were enrolled in this study; 59 among them were HBeAg-positive. Two patients in the TDF group achieved HBsAg seroconversion. The HBsAg level decreased during the follow-up in the ETV and TDF groups. The HBsAg level was lower in the TDF group than the ETV group during the follow-up. On the other hand, subgroup analysis showed that this trend was the same only in the HBeAg-negative patients, not in the HBeAg-positive patients. In the HBeAg-negative patients, HBsAg level in the TDF group was significantly lower than that in the ETV group at 36, 48, and 72 months. The change in HBsAg level from the baseline increased at a decreasing rate during the follow-up in both groups. Furthermore, the change in the HBsAg level in the TDF group was significantly larger than that of the ETV group at 36 months in the HBeAg-negative patients. Conclusions: Although TDF might be more efficient than ETV in reducing the HBsAg level in HBeAg-negative patients in a few years, HBsAg seroconversion occurred very rarely. A further large-scale, long-term study will be needed to confirm the antiviral effects on the HBsAg level.

While carpal tunnel syndrome (CTS) is the most common entrapment neuropathy affecting the wrist, resulting in substantial physical, psychological, and economic effects, there is no gold standard therapy for CTS. In this case series study, we aimed to report CTS patients treated with Carthami Semen Pharmacopuncture (CSP) and electroacupuncture (EA) showing improvements in their symptoms, and the combinatorial effects of CSP and EA. We collected medical records of CTS outpatients who received CSP and EA at Chuk-u Acupuncture & Moxibustion Korean Medicine Clinic from August 2017 to September 2018. The outcome measures were the visual analog scale (VAS) for pain, paresthesia, the Korean version of the Boston carpal tunnel questionnaire (K-BCTQ) score, and changes in nocturnal pain, Tinel sign, and Phalen’s test. We included patient satisfaction at the completion of all treatments. 17 patients were included for this case series study. After treatment, VAS for pain decreased significantly from 50.41 ± 16.19 to 9.59 ± 9.46, VAS for paresthesia also decreased significantly from 63.50 ± 11.49 to 14.75 ± 12.97, and K-BCTQ symptom severity scale decreased from 2.48 ± 0.68 to 1.89 ± 0.70 (all p < 0.001). Nocturnal pain, Tinel signs, and Phalen’s test showed improvements after all the treatments. All the patients reported favorable overall satisfaction with the treatments, and 69.23% wanted future pharmacopuncture treatments if CTS recurred. No complications were detected. The combination of CSP and EA could be an effective and safe option in treating CTS.

Catastrophic antiphospholipid syndrome is a highly fatal condition characterized by widespread thromboembolism subsequent to a triggering factor (e.g., infection, trauma, and neoplasia) in antiphospholipid antibody-positive patients. This paper reports a case of a 29-year-old male without the underlying disease who developed extensive mesenteric thromboembolism and jejunal necrosis during the treatment for acute enteritis. The patient’s condition was improved with low-molecular-weight heparin and an intravenous Ig treatment with emergency surgery. The serum antiphospholipid (anticardiolipin IgM) and lupus anticoagulant antibody tests showed positive results. Acute infectious enterocolitis is generally considered a mild disease. On the other hand, aggressive evaluation and treatment should be considered if the clinical conditions do not improve and deteriorate rapidly despite appropriate antibiotic treatment because of the possibility of acute immunological complications, such as catastrophic antiphospholipid syndrome.

Programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) inhibition has revolutionized the treatment paradigm of urothelial carcinoma (UC). Several PD-L1 assays are conducted to formulate appropriate treatment decisions for PD-1/PD-L1 target therapy in UC. However, each assay has its own specific requirement of antibody clones, staining platforms, scoring algorithms, and cutoffs for the determination of PD-L1 status. These prove to be challenging constraints to pathology laboratories and pathologists. Thus, the present article comprehensively demonstrates the scoring algorithm used and differences observed in each assay (22C3, SP142, and SP263). Interestingly, the SP142 score algorithm considers only immune cells and not tumor cells (TCs). It remains controversial whether SP142 expressed only in TCs truly accounts for a negative PD-L1 case. Moreover, the scoring algorithm of each assay is complex and divergent, which can result in inter-observer heterogeneity. In this regard, the development of artificial intelligence for providing assistance to pathologists in obtaining more accurate and objective results has been actively researched. To facilitate efficiency of PD-L1 testing, several previous studies attempted to integrate and harmonize each assay in UC. The performance comparison of the various PD-L1 assays demonstrated in previous studies was encouraging, the exceptional concordance rate reported between 22C3 and SP263. Although these two assays may be used interchangeably, a clinically validated algorithm for each agent must be applied.

With the increasing incidence of pediatric inflammatory bowel disease (IBD) in children and its impact throughout life, transition care has become an important issue. In Korea, no guidelines have been proposed to support the transition from the pediatric clinic to the adult IBD clinic. This paper reviews the current issues related to IBD patient care during the transition from pediatrics to adults to identify the barriers and critical elements for a successful transition. Thus far, a multi-disciplinary pediatric/adult clinic or alternate visits between pediatric and adult health care providers is the best model for pediatric to adult IBD clinics. Self-reliance and independence of patients with pediatric IBD are also essential for a successful transition. In addition, the timing of the transition from a pediatric clinic to an adult IBD clinic should not be determined because the issue is not the chronological age but rather the individual maturity.

Glucagon-like peptide-1 (GLP-1) receptor agonists are efficacious glucose-lowering medications with salient benefits for body weight and cardiovascular events. This class of medications is now recommended as the top priority for patients with established cardiovascular disease or indicators of high risk. Until the advent of oral semaglutide, however, GLP-1 receptor agonists were available only in the form of subcutaneous injections. Aversion to needles, discomfort with self-injection, or skin problems at the injection site are commonly voiced problems in people with diabetes, and thus, attempts for non-invasive delivery strategies have continued. Herein, we review the evolution of GLP-1 therapy from its discovery and the development of currently approved drugs to the unprecedented endeavor to administer GLP-1 receptor agonists via the oral route. We focus on the pharmacokinetic and pharmacodynamic properties of the recently approved oral GLP-1 receptor agonist, oral semaglutide. Small molecule oral GLP-1 receptor agonists are currently in development, and we introduce how these chemicals have addressed the challenge posed by interactions with the large extracellular ligand binding domain of the GLP-1 receptor. We specifically discuss the structure and pharmacological properties of TT-OAD2, LY3502970, and PF-06882961, and envision an era where more patients could benefit from oral GLP-1 receptor agonist therapy.

Objectives: Ganglion cysts require a sustainable treatment that suppresses their frequent recurrence. This study aimed to explore the clinical effects of Scolopendra pharmacopuncture (SP) and electroacupuncture on ganglion cysts.Methods: We retrospectively reviewed the patient records and follow-up reports for 20 patients with wrist ganglion cysts who received SP and electroacupuncture from April 2016 to March 2017. The cyst diameter, recurrence, visual analog scale (VAS) scores for pain, the Korean version of the disabilities of arm, shoulder, and hand (K-DASH) score, and the Korean version of the patientrated wrist evaluation (K-PRWE) score before and after treatment were noted.Results: After treatment, the cyst diameter decreased significantly from 13.61 ± 6.41 mm to 5.15 ± 6.18 mm (p < 0.001), and VAS score for pain decreased from 1.31 ± 1.77 to 0.41 ± 0.33 (p = 0.021). Further, the K-DASH score decreased significantly from 8.97 ± 12.66 to 2.21 ± 7.39 (p = 0.016), and score for the function subscale of K-PRWE decreased from 11.37 ± 4.48 to 9.1 ± 3.67 (p = 0.046). No recurrences were reported from the followed-up patients. Any complication related to SP or electroacupuncture was not observed, except mild rash, itching, and swelling at the injection site in four patients.Conclusion: Combination of SP and electroacupuncture may be effective in treating ganglion cysts; further prospective studies with large population are needed to clarify the effect of SP and electroacupuncture.

We found an unrecorded endophytic fungus, Dermea piceina J.W. Groves, isolated from alpine conifer Abies koreana. Until now only one Dermea species, D. cerasi, has been reported in Korea. In this study, we compared morphological characteristics and DNA sequences, including internal transcribed spacer and 28S ribosomal DNA, of D. piceina isolated from A. koreana with those of related species. Here, we present morphological and molecular characters of this fungus for the first time in Korea.

Partial anomalous pulmonary venous return (PAPVR) is a rare congenital cardiac anomaly that can be difficult to detect and often remains undiagnosed. PAPVR is diagnosed using non-invasive imaging techniques such as echocardiography, CT, and MRI. Image data are reviewed on a 2-dimensional (D) monitor, which may not facilitate a good understanding of the complex 3D heart structure. In recent years, 3D printing technology, which allows the creation of physical cardiac models using source image datasets obtained from cardiac CT or MRI, has been increasingly used in the medical field. We report a case involving a 3D-printed model of PAPVR with a biatrial connection. This model demonstrated separate drainages of the right upper and middle pulmonary veins into the lower superior vena cava (SVC) and the junction between the SVC and the right atrium, respectively, with biatrial communication through the right middle pulmonary vein.

Homozygous mutations in NUDT15 R139C are known as the major factor associated with thiopurine-induced early leukopenia, particularly in Asian patients. Therefore, NUDT15 genotyping is currently recommended before thiopurine treatment to identify patients who are NUDT15 poor metabolizers and consider the use of an alternative immunomodulatory therapy. We report a case of a 12-year-old Korean girl with Crohn’s disease (CD), in whom thiopurine-induced leukopenia was prevented by initiation of azathioprine (AZA) therapy at a low dose (0.5 mg/kg/day) and early detection of significant hair loss and white blood cell (WBC) count decrease at 17 days from the start of AZA treatment. The WBC count dropped from 8,970/μL to 3,370/μL in 2 weeks, and AZA treatment was stopped because of concerns of potential leukopenia in the near future. Her WBC count recovered to 5,120/μL after 3 weeks. Gene analysis later revealed that she had a homozygous mutation in NUDT15 R139C, resulting in a poor metabolizing activity of NUDT15. In situations when NUDT15 genotyping is unavailable, initiation of AZA therapy at 0.5 mg/kg/day with close observation of hair loss and WBC counts within 2 weeks may be an alternative way to prevent thiopurine-induced early leukopenia in Asian children with CD.

In children and adolescents, acute pancreatitis is a rare cause of abdominal pain. The causes of pancreatitis in children are various including infection and drugs, but the overall cause of this condition in a pediatric patient is sometimes unknown. We describe a case of Burkitt lymphoma which showed acute pancreatitis findings as an initial presentation. In this case, a 16-year-old boy presented with abdominal pain in the left upper quadrant that had been present for one month. Pancreatitis was suspected due to high amylase and lipase and the computed tomography findings in the patient, which showed swelling and adjacent infiltration of the pancreas. However, initial treatments did not improve the patient's symptoms. The following imaging studies showed mass-like lesions involving the pancreas, distal duodenum and jejunum associated with mesenteric lymphadenopathy that suggested a lymphoma in this case. In the final analysis, the patient was diagnosed with Burkitt lymphoma which was seen on bone marrow biopsies and also found on the small bowel tissue biopsies.

This study focuses on the comparative and quantitative analysis of the epidemiologic trends and aspects of severe fever with thrombocytopenia syndrome (SFTS) outbreaks between Korea and Japan from 2013 to 2017. The following factors were analyzed; cumulative incidence rate (CIR), cases-fatality rate (CFR), and the epidemic aspects, including cases related to gender, male-to-female morbidity ratio (MFMR), age, seasonal, and geographical distributions. We observed 607 SFTS cases with CIR in Korea during the period 2013 to 2017 were as 0.24 per 100,000 populations and with a 127 fatal-cases (F.C.s), corresponding to a CFR of 20.9%, respectively. During the same period in Japan, 319 SFTS cases with a CIR of 0.05 and with 60 F.C.s to a CFR of 18.8% observed. When compared, the CIR of SFTS in Korea was significantly higher than in Japan (P

Background and Objectives This case series is aimed to introduce a new term, antrovestibular polyp (AVP), for an antral polyp herniating anteriorly toward the nasal vestibule and to describe an antral polyp direction of growth through the anterior and posterior fontanelles. Materials and Method This is a retrospective study involving review of patients who underwent surgery due to maxillary sinus polyp herniating anteriorly toward the nasal vestibular area or posteriorly toward the choana at a tertiary training hospital from January 2007 through July 2016. Their demographic data, computed tomography scan findings, and endoscopic evaluations were analyzed. Results This study included 49 subjects; 8 (16.33%, 6 males) with AVP and 41 (83.67%, 24 males) with antrochoanal polyps (ACP). The mean ages of AVP and ACP patients were 9 and 14.4 years, respectively (p=0.006). The subjects were identified as AVP when computed tomography scan showed an antral polyp directed anteriorly toward the nasal vestibular area, while polyps growing toward the choana were identified as ACP. Endoscopic review showed that AVP grew out through an accessory ostium located anterior to the uncinate process at the area of the anterior fontanelle, while ACP started from an accessory ostium of the posterior fontanelle or a widened maxillary natural ostium.

Collision tumors are extremely rare, and currently, no therapeutic protocols are established. A 64-year-old man presented to his physician with complaints of right chest and abdominal pain. The contrast-enhanced CT scan showed a mass measuring 3.6 cm around the gastric fundus. Esophagogastroduodenoscopy was performed and a semicircular longitudinal ulcerative mass was found at the distal esophagus. A mass measuring about 4 cm with central ulceration was noted at the cardia. The esophageal biopsy revealed positivity for a component of neuroendocrine carcinoma adjacent to a squamous cell carcinoma. PET-CT revealed a mass in the esophagus and cardia and several tumors in the whole liver, pancreas, and bone. The patient was finally diagnosed with a collision tumor of the esophagus with multiple metastases. In conclusion, patients with collision tumors must undergo active multidisciplinary management that will include pathologists and oncologists, who will decide on proper treatment strategies.

As a preclinical study, many researchers have been attempted to convert the porcine PSCs into several differentiated cells with transplantation of the differentiated cells into the pigs. Here, we attempted to derive neuronal progenitor cells from pig embryonic germ cells (EGCs). As a result, neuronal progenitor cells could be derived directly from pig embryonic germ cells through the serum-free floating culture of EB-like aggregates (SFEB) method. Treating retinoic acid was more efficient for inducing neuronal lineages from EGCs rather than inhibiting SMAD signaling. The differentiated cells expressed neuronal markers such as PAX6, NESTIN, and SOX1 as determined by qRT-PCR and immunostaining. These data indicated that pig EGCs could provide valid models for human therapy. Finally, it is suggested that developing transgenic pig for disease models as well as differentiation methods will provide basic preclinical data for human regenerative medicine and lead to the success of stem cell therapy.

Background/Aims: A switch to systemic therapy, such as sorafenib, should be considered for hepatocellular carcinoma (HCC) patients refractory to transarterial chemoembolization (TACE). On the other hand, treatment changes are difficult if the liver function worsens to Child-Pugh B or C. Therefore, predicting the risk factors for non-responsiveness to TACE and deteriorating liver function may be helpful. Methods: Newly diagnosed Child-Pugh A HCC patients who underwent TACE from January 2012 to June 2018 were included. After 1 year, this study evaluated whether there was a treatment response to TACE and whether the Child-Pugh class had worsened. Results: Among 121 patients, 65 were refractory and 56 responded to TACE. In multivariable logistic regression analysis, the tumor size, tumor number, and albumin at the time of the diagnosis of HCC were significant prognostic factors for the treatment response to TACE. Among 65 patients who presented TACE-refractoriness, 27 showed liver function deterioration from Child-Pugh class A to class B or C after TACE. In multivariable logistic regression analysis, bilirubin at the diagnosis of HCC was a significant prognostic factor for liver function deterioration. A predictive algorithm based on the regression equations revealed a sensitivity, specificity, positive predictive value, and negative predictive value of 74.1%, 74.5%, 45.5%, and 90.9%, respectively, for TACE-refractoriness and liver function deterioration. Conclusions: The prognostic model incorporating the tumor size, tumor number, albumin, and bilirubin at the diagnosis of HCC may help identify patients who show a poor response to TACE and aggravation of liver function after TACE, who may benefit from early switching into systemic therapy before liver function aggravation.

Jujube witches’ broom (JWB) disease is a high-risk plant disease that occurred on and devastated jujube orchards throughout South Korea in the 1950s. Recently, as the jujube cultivation area has been significantly increased nationwide, we investigated the disease in jujube orchards in the Boeun region to obtain basic information for proactively evaluating the risk of JWB outbreaks from 2017 to 2019. A field trial was conducted to evaluate the effect of the trunk injection of Sungbocycline (a. i. oxytetracycline calcium alkyl trimethyl ammonium 17%, OTC). The incidence of JWB disease was very low in Boeun, but it was gradually increased mainly in the area and on the farms where it had occurred previously. The trunk injection with OTC was most effective in the early stages of growth. However, even though the trees were treated with OTC, disease symptoms appeared in other healthy branches in severely affected trees. When the tree was first injected with OTC in June, the control efficacy of second injection was higher one month after the first injection than five months. These results suggest that early diagnosis based on various symptoms and early control based on them can be very effective in preventing JWB disease in advance and increasing control efficacy.

ObjectiveTo assess the clinical usefulness and diagnostic accuracy of ultrasonographic measurement of endometrial thickness (ET) in women with endometrial hyperplasia or cancer (EH+).MethodsThis retrospective cohort study included 29,995 consecutive women who underwent transvaginal ultrasonography (TVS) for an incidental finding of a thickened endometrium at the health screening and promotion center at Asan Medical Center between 2006 and 2010. Among 959 patients with endometrial abnormalities, 92 patients were included in this study. A total of 867 patients were excluded: 416 were lost to follow-up; 263 did not undergo endometrial biopsy; 155 had endometrial polyps; 17 had submucosal myomas; and 16 had insufficient tissue samples. Endometrial histology was the reference standard for calculating accuracy.ResultsOf the 92 patients, 78 (84.8%) had normal pathology, while 14 (15.2%) had endometrial pathology (EH+), including 5 patients (35.7%) with simple hyperplasia without atypia, 3 (21.4%) with complex hyperplasia, and 6 (42.9%) with endometrial carcinoma, all stage Ia. The area under the receiver-operating characteristic curve was 0.75 (95% confidence interval [CI], 0.593–0.906). The cut-off value for ET was 8 mm, indicating that TVS ET had a fair accuracy in diagnosing carcinoma, had a sensitivity of 100% (95% CI, 62.9–100.0%) and a specificity of 24.3% (95% CI, 15.2–36.3%).ConclusionTVS is useful for detecting EH+, with a cut-off value for ET of 8 mm having a high sensitivity for detecting endometrial pathologies and the ability to identify women highly unlikely to have EH+, thereby avoiding more invasive endometrial biopsy.

We present the case of a 71-year-old man who was diagnosed with amoebic encephalitis caused by Balamuthia mandrillaris. He had rheumatic arthritis for 30 years and had undergone continuous treatment with immunosuppressants. First, he complained of partial spasm from the left thigh to the left upper limb. Magnetic resonance imaging revealed multifocal enhancing nodules in the cortical and subcortical area of both cerebral hemispheres, which were suggestive of brain metastases. However, the patient developed fever with stuporous mentality and an open biopsy was performed immediately. Microscopically, numerous amoebic trophozoites, measuring 20 to 25 µm in size, with nuclei containing one to four nucleoli and some scattered cysts having a double-layered wall were noted in the background of hemorrhagic necrosis. Based on the microscopic findings, amoebic encephalitis caused by Balamuthia mandrillaris was diagnosed. The patient died on the 10th day after being admitted at the hospital. The diagnosis of amoebic encephalitis in the early stage is difficult for clinicians. Moreover, most cases undergo rapid deterioration, resulting in fatal consequences. In this report, we present the first case of B. mandrillaris amoebic encephalitis with fatal progression in a Korean patient.

Background The 2016 World Health Organization (WHO) classification of central nervous system (CNS) tumors has been modified to incorporate the IDH mutation and 1p/19q co-deletion in the diagnosis of diffuse gliomas. In this study, we aimed to evaluate the feasibility and prognostic significance of the revised 2016 WHO classification of CNS tumors in Mongolian patients with diffuse gliomas. Methods A total of 124 cases of diffuse gliomas were collected, and tissue microarray blocks were made. IDH1 mutation was tested using immunohistochemistry, and 1p/19q co-deletion status was examined using fluorescence in situ hybridization analysis. Results According to the 2016 WHO classification, 124 cases of diffuse brain glioma were reclassified as follows: 10 oligodendroglioma, IDHmut and 1p/19q co-deleted; three anaplastic oligodendroglioma, IDHmut and 1p/19q co-deleted; 35 diffuse astrocytoma, IDHmut, 11 diffuse astrocytoma, IDHwt, not otherwise specified (NOS); 22 anaplastic astrocytoma, IDHmut, eight anaplastic astrocytoma, IDHwt, NOS; and 35 glioblastoma, IDHwt, NOS, respectively. The 2016 WHO classification presented better prognostic value for overall survival in patients with grade II tumors than traditional histological classification. Among patients with grade II tumors, those with oligodendroglioma IDHmut and 1p/19q co-deleted and diffuse astrocytoma IDHmut showed significantly higher survival than those with diffuse astrocytoma IDHwt, NOS (p

Pancreatic cancer is a dismal disease with a poor prognosis and is one of the most painful malignancies. Therefore, adequate pain control is essential to improving the patient’s quality of life. Pain in pancreatic cancer has complex pathophysiologic mechanisms and different characteristics. The choice of pain management modalities should be individualized depending on the pain characteristics using a multidisciplinary approach. The treatment options available include medical treatment, chemotherapy, celiac plexus/ganglion neurolysis, radiotherapy, and endoscopic technique. This review discusses the medical and interventional options, leading to optimal pain management in patients with pancreatic cancer.

ObjectiveWe evaluated the clinical characteristics of patients who underwent surgery after high intensity focused ultrasound (HIFU) to treat uterine leiomyoma.MethodsFrom June 2016 to September 2017, patients at our hospital who underwent HIFU to treat uterine leiomyoma prior to surgery were enrolled. All patients underwent pelvic magnetic resonance imaging (MRI) before and after HIFU. If 6 months had passed since the last pelvic MRI was performed, imaging was performed again before the operation.ResultsA total of 12 patients were analyzed. The median age was 45 (range, 28–51) years. The median body mass index was 24.9 (range, 18.1–29.2) kg/m2. The median size of the leiomyoma was 10.1 (range, 7.8–14.0) cm before HIFU, which changed to 8.75 (range, 5.9–14.8) cm after HIFU. The median size increased to 9.1 (range, 5.9–18.0) cm before the operation. Surgery was planned for several reasons, including an increase in the leiomyoma size (n=6), persistent symptoms (n=4), and newly developed lesion (n=2). The median interval between HIFU and surgery was 7 (range, 3–32) months. Ten of the 12 patients underwent laparoscopic surgery, while the others underwent laparotomy; 6 patients also underwent laparoscopic myomectomy, and 4 underwent hysterectomy. Histopathologic findings showed infarction-type necrosis surrounded by granulation tissue with the infiltration of lymphocytes and macrophages in all patients.ConclusionTreatment of leiomyoma with operative procedures should be considered in selected patients with tumor size greater than 10 cm, multiple tumors, and persistent symptoms after HIFU treatment.

Achalasia is a motility disorder of the esophagus characterized by absence of peristalsis and failure of relaxation of lower esophagus sphincter. The introduction of high resolution manometry (HRM) and per-oral endoscopic myotomy (POEM) has made a new chapter in diagnosis and treatment of achalasia. HRM allows classify according to the subtype of achalasia, and help predict prognosis and therapeutic response. POEM is a minimally invasive, effective option for treating achalasia. The management of achalasia required tailored application of various therapies such as botox injection, pneumatic balloon dilatation, POEM, or Heller’s myotomy. In this review, we state the important aspects of diagnosis as well as management of achalasia.

Background : /Aims: Surgical resection or ablation is recommended for the treatment of early hepatocellular carcinoma (HCC), whereas transarterial chemoembolization (TACE) is frequently used in early HCC ineligible for curative resection. We evaluated the clinical effects and safety of radiofrequency ablation (RFA) shortly after TACE in patients with Barcelona clinic liver cancer (BCLC) stage A HCC. Methods : : Sixty-seven BCLC stage A HCC patients who failed to achieve complete response to TACE as either a first line treatment and who subsequently received RFA at the Konkuk University Medical Center from January 2005 to December 2017 were included. Evaluation indices included treatment response, overall survival rate, recurrence-free survival, prognostic factors, and procedure-related complications. Results : : Median follow-up was 46.9 months. Fifty-four (80.6%) patients were of Child-Pugh class A, and 13 (19.4%) were of class B. Modified UICC stages were I in 10 (14.9%), II in 46 (68.7%), and III in 11 (16.4%) patients. In the 67 study subjects, cumulative recurrence-free survival rates were 86.8%, 55.9% and 29.7% at 1, 3, and 5 years, respectively, and overall survival rates were 100%, 93.4%, and 83.5% at 1, 3, and 5 years, respectively. Tumor size significantly predicted recurrence. No treatment-related death occurred. Conclusion : s: Combination of RFA was an efficient and safe treatment for BCLC stage A HCC patients that failed to achieve complete response to initial TACE. We suggest TACE plus RFA be considered as a curative option for early HCC patients ineligible for curative resection of RFA.