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Abstract This retrospective study evaluated the safety and efficacy of fluoroscopy-guided urethral catheterization in patients who failed blind or cystoscopy-assisted urethral catheterization. We utilized our institutional database between January 2011 and March 2023, and patients with failed blind or cystoscopy-assisted urethral catheterization and subsequent fluoroscopy-guided urethral catheterization were included. A 5-Fr catheter was inserted into the urethral orifice, and the retrograde urethrography (RGU) was acquired. Subsequently, the operator attempted to pass a hydrophilic guidewire to the urethra. If the guidewire and guiding catheter could be successfully passed into the bladder, but the urethral catheter failed pass due to urethral stricture, the operator determined either attempted again with a reduced catheter diameter or performed balloon dilation according to their preference. Finally, an appropriately sized urethral catheter was selected, and an endhole was created using an 18-gauge needle. The catheter was then inserted over the wire to position the tip in the bladder lumen and ballooned to secure it. We reviewed patients’ medical histories, the presence of hematuria, and RGU to determine urethral abnormalities. Procedure-related data were assessed. Study enrolled a total of 179 fluoroscopy-guided urethral catheterizations from 149 patients (all males; mean age, 73.3 ± 13.3 years). A total of 225 urethral strictures were confirmed in 141 patients, while eight patients had no strictures. Urethral rupture was confirmed in 62 patients, and hematuria occurred in 34 patients after blind or cystoscopy-assisted urethral catheterization failed. Technical and clinical success rates were 100%, and procedure-related complications were observed in four patients (2.2%). The mean time from request to urethral catheter insertion was 129.7 ± 127.8 min. The mean total fluoroscopy time was 3.5 ± 2.5 min and the mean total DAP was 25.4 ± 25.1 Gy cm2. Balloon dilation was performed in 77 patients. Total procedure time was 9.2 ± 7.6 min, and the mean procedure time without balloon dilation was 7.1 ± 5.7 min. Fluoroscopy-guided urethral catheterization is a safe and efficient alternative in patients where blind or cystoscopy-assisted urethral catheterization has failed or when cystoscopy-urethral catheterization cannot be performed.

Acupuncture is increasingly being used in Asian countries and is generally considered a relatively safe procedure. However, adverse events have been reported consistently. Therefore, clinicians should be aware of the possibility of acupuncture-related complications and should actively treat serious cases. We report a case of an acupuncture-induced large abscess in the retroperitoneal cavity and thigh muscles treated with percutaneous catheter drainage, surgical incision, and drainage.

Ortner’s or cardiovocal syndrome is hoarseness attributable to left recurrent laryngeal nerve (RLN) palsy associated with mechanical compression of the nerve by pathologically enlarged cardiovascular structures. Ortner’s syndrome is a rare condition, and to our knowledge, only a few cases have been reported in Korea. Furthermore, this condition is extremely uncommon in pediatric patients with thyrotoxicosis-related RLN paralysis. We report a case of reversible Ortner’s syndrome in an adolescent who presented with secondary pulmonary hypertension related to thyrotoxicosis.

PurposeThis study aimed to develop an algorithm for the automatic detecting chest percutaneous catheter drainage (PCD) and evaluating catheter positions on chest radiographs using deep learning.MethodsThis retrospective study included 1,217 chest radiographs (proper positioned: 937; malpositioned: 280) from a total of 960 patients underwent chest PCD from October 2017 to February 2023. The tip location of the chest PCD was annotated using bounding boxes and classified as proper positioned and malpositioned. The radiographs were randomly allocated into the training, validation sets (total: 1,094 radiographs; proper positioned: 853 radiographs; malpositioned: 241 radiographs), and test datasets (total: 123 radiographs; proper positioned: 84 radiographs; malpositioned: 39 radiographs). The selected AI model was used to detect the catheter tip of chest PCD and evaluate the catheter's position using the test dataset to distinguish between properly positioned and malpositioned cases. Its performance in detecting the catheter and assessing its position on chest radiographs was evaluated by per radiographs and per instances. The association between the position and function of the catheter during chest PCD was evaluated.ResultsIn per chest radiographs, the selected model's accuracy was 0.88. The sensitivity and specificity were 0.86 and 0.92, respectively. In per instance, the selected model's the mean Average Precision 50 (mAP50) was 0.86. The precision and recall were 0.90 and 0.79 respectively. Regarding the association between the position and function of the catheter during chest PCD, its sensitivity and specificity were 0.93 and 0.95, respectively.ConclusionThe artificial intelligence model for the automatic detection and evaluation of catheter position during chest PCD on chest radiographs demonstrated acceptable diagnostic performance and could assist radiologists and clinicians in the early detection of catheter malposition and malfunction during chest percutaneous catheter drainage.

Common femoral artery pseudoaneurysm is a potentially serious complication of peripheral angiography. There have been few prior reports of simultaneous pseudoaneurysm in both common femoral arteries after percutaneous access. Here we report the case of a 58-year-old male patient who presented with phlegmon or abscess a few days after bilateral femoral access, after which newly developed bilateral femoral pseudoaneurysm with wide neck was observed on CT angiography 2 months after infection treatment. Because the patient refused surgery for pseudoaneurysm, a stent-graft was inserted in the left side, and percutaneous thrombin injection under US guidance with balloon occlusion was performed for the right side. Most pseudoaneurysms occur immediately after the causative procedure. However, there have been some cases in which pseudoaneurysms may occur several weeks or months later; it is therefore necessary to check the risk factors and to carefully observe the hemostasis site.

Percutaneous transhepatic biliary drainage (PTBD) has been an effective treatment to access the biliary tree, especially in case of endoscopically inaccessible biliary tree. In general, PTBD techniques are divided into two methods: fluoroscopy-guided PTBD and ultrasound (US)-guided PTBD. This study aimed to evaluate the effectiveness of US-guided PTBD, focusing on radiation exposure according to intrahepatic duct (IHD) dilatation degree, differences between right- and left-sided approaches and differences between benign and malignant biliary stenosis/obstruction. We evaluated technical success, clinical success, procedural data (the number of liver capsule punctures, procedural time, fluoroscopy time and radiation dose), and procedure-related complications. During the study period, a total of 123 patients with biliary stenosis/obstruction or bile leakage were initially eligible. We excluded 76 patients treated with only ERCP or initially treated with ERCP followed underwent PTBD insertion. Finally, a total of 50 procedures were performed in 47 patients. Of the 47 patients, 8 patients had anatomical alteration due to previous surgery, 6 patients refused ERCP, and 3 patients failed ERCP. For the remaining 30 patients, PTBD was performed on weekend or at night, 11 of whom had poor general condition, 10 patients underwent ERCP 3 to 4 days later after PTBD insertion, 6 patients improved after PTBD insertion without ERCP, 1 patient died, and 1 patient was referred to other hospital. Remaining 1 patient underwent surgery due to Mirizzi syndrome. All procedures were performed by two interventional radiologists. Technical success rate was 100%, clinical success was 94%, and the complication rate was 10%. Fluoroscopy time and the reported radiation dose were significantly lower in patients with dilated bile ducts than in those with non-dilated bile ducts, when biliary puncture under US guidance was performed initially. However, even in patients with non-dilated bile ducts undergoing initial trials of biliary puncture under US guidance, the fluoroscopy time and the reported radiation dose were low, based on current studies. No statistical significant differences were observed in terms of technical and dosimetry results according to right-sided and left-sided procedures and benign and malignant biliary stenosis/obstruction. Thus, US-guided PTBD was found to be a safe and effective technique that significantly reduced fluoroscopy time and radiation doses.

BackgroundThere are few reports of renal artery embolization (RAE) via transradial access (TRA) for renal hemorrhage, and none have compared outcomes of RAE via TRA and transfemoral access (TFA). The objective was to compare technical and clinical outcomes in patients undergoing RAE via TRA or TFA for iatrogenic renal hemorrhage.Materials and methodsThis study included 45 RAE procedures (16 TRA and 29 TFA) for iatrogenic renal hemorrhage in 43 patients performed at a tertiary referral center between October 2018 and December 2020. Information regarding underlying diseases, coagulation status, angiographic and embolization procedure details, technical and clinical successes, and complications were retrospectively evaluated.ResultsThere were no differences in demographics, underlying diseases, updated Charlson comorbidity scores, angiographic findings, and volume of contrast material between the TRA and TFA groups. By contrast, prothrombin time and international normalized ratio were significantly lower in the TRA than in the TFA group. Embolic materials differed significantly in the two groups. Procedure duration, fluoroscopy time, digital subtraction angiography number, and dose area product were slightly lower in the TRA than in the TFA group, but the differences were not statistically significant. Technical and clinical success rates in the TRA and TFA groups were 100% and 96.6%, and 100% and 96.6%, respectively. No patient in either group experienced procedure-related complications during a 4 week follow-up period.ConclusionRAE via TRA in the management of iatrogenic renal hemorrhage was safe and feasible, with similar procedure duration and radiation exposure to RAE via TFA. TRA may be an acceptable alternative to TFA in these patients.

Chronic intradiploic organizing hematoma of the skull is a rare lesion that usually presents as a progressively growing mass after head trauma, thus making it difficult to diagnose. To date, only nine cases that have been histopathologically confirmed as organizing hematoma of the skull have been reported in the literature. Herein, we describe a case of a chronic organizing hematoma involving the right parietal bone, presenting as a slowly growing mass in a 54-year-old man. The lesion was also visualized on magnetic resonance imaging (MRI) with a zero echo time sequence. In this case report, we emphasize that chronic intradiploic organizing hematoma should be considered in the differential diagnosis of a palpable scalp mass. We also highlight the importance of meticulous radiological review in the context of appropriate clinical suspicion and the usefulness of the zero TE sequence in evaluating calvarial lesions.

Objective: To evaluate the association between Non-alcoholic fatty liver disease (NAFLD) with renal stone disease detected on computed tomography (CT). Method: A total 1812 patients who underwent abdomen-pelvis CT in July 2015 were included in this study. The inclusion criteria for NAFLD were as follows: (i) lower average Hounsfield unit (HU) of hepatic right lobe, left medial and lateral segment when compared with that of spleen, (ii) patients who having urolithiasis in kidneys, ureters and urinary bladder, and (iii) patients underwent abdomen-pelvis CT including noncontrast image. The statistical significance of the association between NAFLD and renal stone disease was assessed using Chi Square Test. The Odds ratios and 95% CI were calculated to assess the propensity of renal stones disease for NAFLD by using Logistic Regression analysis. Results: The frequency of renal stone disease in patients with NAFLD was higher approximately 19% than those who having renal stone disease without NAFLD. In addition, the presence of NAFLD was linked with renal stone disease showing that detection rate of renal stone disease in patients with NAFLD was markedly high (odds ratio: 5, 95% CI, 3–8.2) (p

Background/Aims To evaluate the effectiveness and safety of direct acting antivirals (DAAs) available in chronic kidney disease (CKD) patients with hepatitis C virus (HCV) infection in Korea. Methods In a retrospective, multicenter cohort study, 362 patients were enrolled from 2015 to 2019. The effectiveness and safety of DAAs including glecaprevir/pibrentasvir, sofosubvir/ribavirin, ledipasvir/sofosbuvir, and daclatasvir/asunaprevir were analyzed for patients according to CKD stage. We evaluated sustained virologic response at week 12 after treatment (SVR12) as primary endpoint. The effectiveness and safety were also evaluated according to CKD stage. Results Among 362 patients, 307 patients completed DAAs treatment and follow-up period after end of treatment. The subjects comprised 87 patients (62 with CKD stage 3 and 25 with CKD stage (4–5), of whom 22 were undergoing hemodialysis). HCV patients with CKD stage 1 and 2 (estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.73 m2) showed SVR12 of 97.2% and 95.4% respectively. SVR12 of CKD stage 3 and 4–5 (eGFR < 60 mL/min/1.73 m2) patients was 91.9% and 91.6% respectively. Patients undergoing hemodialysis achieved SVR12 (90.9%). Treatment failure of DAAs in stage 1, 2, 3, and 4–5 was 2.8%, 2.7%, 1.6%, and 4%. DAAs showed good safety profile and did not affect deterioration of renal function. Conclusions DAAs shows comparable SVR12 and safety in CKD patients (stage 3, 4, and 5) with HCV compared with patients with stage 1 and 2. The effectiveness and safety of DAAs may be related to the treatment duration. Therefore, it is important to select adequate regimens of DAAs and to increase treatment adherence.

Background/Aims Sarcopenia is an independent prognostic factor of liver cirrhosis (LC). However, the association between LC-related systemic inflammation and sarcopenia is unclear. Methods Sprague-Dawley rats were treated with thioacetamide (TAA) or saline as a control. Rifaximin was administered to TAA-induced LC rats. Enzyme-linked immunosorbent assay was performed to measure inflammatory mediators in rat serum. RT-PCR was performed to measure the molecular expression in tissues. Hematoxylin and eosin (H&E) staining and immunohistochemistry were performed to investigate tissue pathology. Serum tumor necrosis factor-α levels, liver stiffness (LS), and the L3 skeletal muscle index (L3SMI) were measured in 60 patients with chronic liver disease. Results LC and sarcopenia were successfully induced by TAA. Serum TNF-α levels were increased in LC rats and correlated with myostatin expression, muscle weight, and myofiber diameter. The expression of intestinal occludin and zona occludens-1 was reduced in LC rats and associated with serum TNF-α levels and sarcopenia. In patients with LS ≥7 kPa or sarcopenia, serum TNF-α levels were significantly increased, which was also confirmed when we raised the LS cutoff to 10 kPa. The L3SMI was inversely correlated with serum TNF-α levels in patients with LS ≥7 kPa. TNF-α was reduced by rifaximin, which might have resulted in reduced expression of muscular MuRF1 and myostatin and improvements in myofiber diameters within muscle tissues. Conclusions These results suggest that serum TNF-α is associated with LC-related sarcopenia. Rifaximin might be effective in reducing serum TNF-α levels and improving sarcopenia in LC, but these results need to be validated in future studies.

Background/Aims: Bile duct invasion (BDI) is rarely observed in patients with advanced hepatocellular carcinoma (HCC), leading to hyperbilirubinemia. However, the efficacy of pretreatment biliary drainage for HCC patients with BDI and obstructive jaundice is currently unclear. Thus, the aim of this study was to assess the effect of biliary drainage on the prognosis of these patients. Methods: We retrospectively enrolled a total of 200 HCC patients with BDI from multicenter cohorts. Patients without obstructive jaundice (n=99) and those who did not undergo HCC treatment (n=37) were excluded from further analysis. Finally, 64 patients with obstructive jaundice (43 subjected to drainage and 21 not subjected to drainage) were included. Propensity score matching was then conducted. Results: The biliary drainage group showed longer overall survival (median 10.13 months vs 4.43 months, p=0.004) and progression-free survival durations (median 7.00 months vs 1.97 months, p<0.001) than the non-drainage group. Multivariate analysis showed that biliary drainage was a significantly favorable prognostic factor for overall survival (hazard ratio, 0.42; p=0.006) and progression-free survival (hazard ratio, 0.30; p<0.001). Furthermore, in the evaluation of first response after HCC treatment, biliary drainage was beneficial (p=0.005). Remarkably, the durations of overall survival (p=0.032) and progression-free survival (p=0.004) were similar after propensity score matching. Conclusions: Biliary drainage is an independent favorable prognostic factor for HCC patients with BDI and obstructive jaundice. Therefore, biliary drainage should be contemplated in the treatment of advanced HCC with BDI to improve survival outcomes [ABSTRACT FROM AUTHOR]

The Korean Bronchoesophagological Society appointed a task force to develop a clinical practice guideline for tracheostomy. The task force conducted a systematic search of the Embase, Medline, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to key questions. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. An external expert review and a Delphi questionnaire were conducted to reach a consensus regarding the recommendations. Accordingly, the committee developed 18 evidence-based recommendations, which are grouped into seven categories. These recommendations are intended to assist clinicians in performing tracheostomy and in the management of tracheostomized patients.

In this study, we aimed to detect and characterize ex vivo virus-specific CD8+ T cells in patients with immune-tolerant hepatitis B virus (HBV) infection. We investigated a Korean chronic hepatitis B cohort composed of 15 patients in the immune-tolerant phase, 17 in the immune-active phase, and 13 under antiviral treatment. We performed enzyme-linked immunospot (ELISpot) assays ex vivo and intracellular cytokine staining after in vitro culture. We also performed ex vivo multimer staining assays and examined the expression of programmed death-1 (PD-1) and CD127 in pentamer-positive cells. Ex vivo ELISpot revealed that HBV-specific T cell function was weaker in immune-tolerant patients than in those under antiviral treatment. In vitro culture of peripheral blood mononuclear cells for 10 days revealed that HBV-specific CD8+ T cells produced interferon-γ in some immune-tolerant patients. We detected HBV-specific CD8+ T cells ex vivo (using the HBV core18−27 pentamer) in patients from all three groups. The PD-1+ subset of pentamer+ CD8+ T cells was smaller ex vivo in the immune-tolerant phase than in the immune-active phase or under antiviral treatment. Interestingly, the proportion of PD-1+ CD8+ T cells in HBV-specific CD8+ T cells correlated with patient age when all enrolled patients were analyzed. Overall, HBV-specific CD8+ T cells are present in patients considered as immune-tolerant, although their ex vivo functionality is significantly weaker than that in patients under antiviral treatment (P < 0.05). Despite the high viral load, the proportion of PD-1 expression in HBV-specific CD8+ T cells is lower in the immune-tolerant phase than in other phases. Our results indicate appropriate stimulation may enhance the effector function of HBV-specific CD8+ T cells in patients considered as being in the immune-tolerant phase.

This study aims to develop and evaluate an automated manual transmission (AMT) for agricultural tractors with high efficiency and high convenience by using electric actuators. An AMT system to control manual-type shuttle gearboxes and transmissions for tractors is developed by adding a shuttle shifting actuator, a clutch actuator, and a control system to a conventional manual transmission (MT). The clutch actuator is designed using an electric motor and a reduction gear. The AMT control system is developed and experimental tests are conducted to evaluate the performance of the AMT. The results of the performance of the actuator position control demonstrate that the shuttle shifting actuator and clutch actuator are controlled appropriately, achieving a maximum overshoot of less than 5% and 0%, a settling time of less than 0.500 s and 1.50 s, and a steady-state error of less than 1% and 1%, respectively. The performance of the automatic forward and reverse control demonstrates a shift control time of less than 2.50 s and target revolutions per minute (RPM) reaching time of less than 3.00 s. Thus, AMT systems for tractors can be easily developed by applying shuttle shifting actuators, clutch actuators, and a control system to conventional manual transmissions.

This study aimed to identify the efficiency of mechanical flower thinning (MFT) and its influence on apple fruit quality. In the first experiment, ‘Arisoo’ apple flowers were subjected to MFT with one hundred sixty-two (half) and three hundred twenty-four (full) strings at the same rotor (300 rpm) and tractor (6 km/h) speeds. Hand thinning was performed as a control. The number of removed flowers in each terminal and lateral flower cluster was slightly higher in MFT with full-strings than that of MFT with half-strings. The fruit set rate was lower in MFT with full-strings than that of MFT with half-strings. However, the use of full-strings during mechanical thinning increased the leaf damage rate compared to half-strings. Except a* value, MFT with full-strings improved flesh firmness, soluble solids content (SSC) and titratable acidity (TA), and reduced starch pattern index of fruits at harvest compared to the control. In the second experiment, ‘Fuji’ apple flowers were subjected to chemical thinning, MFT (300 rpm, 6 km/h), and MFT + chemical thinning treatments and compared with hand thinning (control). The thinning efficiency of MFT was similar to that of chemical thinning and MFT + chemical thinning treatments in terms of the removal of flowers and fruit set rates. Compared to the control, MFT, chemical thinning, and their combined treatments improved flesh firmness and SSC of fruits at harvest. TA was highest in the chemical thinning treatment compared to other thinning treatments. However, fruit size, weight, and a* value were unaffected by any treatment. In conclusion, the use of full-strings during MFT achieved optimal results in ‘Arisoo’ apples. In ‘Fuji’ apples, MFT treatment alone achieved effective results and the addition of chemical thinning after MFT had no supportive role in thinning efficiency and fruit quality [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to evaluate the added value of cone-beam computed tomography (CBCT) for detecting hepatocellular carcinomas (HCC) and feeding arteries during transcatheter arterial chemoembolization (TACE). Material and methods: Seventy-six patients underwent TACE and CBCT. We subcategorized patients into groups I (61 patients: possible superselection of tumor/feeding arteries) and II (15 patients: limited superselection of tumor/feeding arteries). We evaluated fluoroscopy time and radiation dose during TACE. Two blinded radiologists independently performed an interval reading based on digital subtraction angiography (DSA) imaging only and DSA combined with CBCT in group I. Result: The mean total fluoroscopy time was 1456.3 ± 605.6 s. The mean dose–area product (DAP), mean DAP of CBCT, and mean ratio of DAP of CBCT to total DAP was 137.1 ± 69.2 Gy cm2, 18.3 ± 7.1 Gy cm2, and 13.3%, respectively. The sensitivity for detecting HCC increased after the additional CBCT reading, from 69.6% to 97.3% and 69.6% to 96.4% for readers 1 and 2, respectively. The sensitivity for detecting feeding arteries increased from 60.3% to 96.6% and 63.8% to 97.4% for readers 1 and 2, respectively. Conclusions: CBCT can increase sensitivity for detecting HCCs and feeding arteries without significantly increasing the radiation exposure. [ABSTRACT FROM AUTHOR]

There are some reports of renal vein thrombosis associated with acute pyelonephritis, but a case of renal artery thrombosis in acute pyelonephritis has not been reported yet. Here we report a case of renal artery thrombosis which developed in a patient with acute pyelonephritis complicated with sepsis-induced disseminated intravascular coagulation (DIC). A 65-year-old woman with diabetes was diagnosed with acute pyelonephritis complicated with sepsis. Escherichia coli was isolated from both blood and urine cultures. When treated with antibiotics, her condition gradually improved. She suddenly complained of severe right flank pain without fever in the recovery phase. A computed tomography scan revealed right renal artery thrombosis with concomitant renal infarction. Prophylactic anticoagulation therapy was not suggested because of sustained thrombocytopenia and increased risk of bleeding. Flank pain resolved with conservative treatment and perfusion of infarcted kidney improved at the time of discharge. To our knowledge, this is the first case of renal artery thrombosis related to acute pyelonephritis with sepsis-induced DIC.

Background: Gamma-glutamyltransferase (GGT) is positively associated with several cancer types. The objective of this study was to investigate the association between GGT and head and neck cancer (HNC) incidence in a cohort of 10 million people, considering effects of smoking and alcohol consumption. Methods: All data used in this study were obtained from the Korean National Health Insurance Service database. We analyzed subjects who underwent health check-ups in 2009 and monitored them until 2018 (n = 9,597,952). Using proportional hazards models, quartiles of GGT as independent predictors for HNC incidence were evaluated. Results: The overall incidence of HNC increased in the highest quartile [r-GPT ≥ 40 U/L; HR, 1.452; 95% confidence interval (CI), 1.354-1.557]. Among HNC cases, the HR for hypopharyngeal cancer (HR, 2.364; 95% CI, 1.818-3.074) was significantly higher. HRs for HNC (larynx, sino-nasal, oropharynx, oral cavity, and nasopharynx, except salivary glands) were also significant. Conclusions: Elevated GGT was associated with the risk of some types of HNCs, such as hypopharyngeal, laryngeal, sinonasal, oropharyngeal, oral cavity, and nasopharyngeal cancer. Impact: Results of this study have implications for etiologic investigations and preventive strategies. [ABSTRACT FROM AUTHOR]

BACKGROUND: High-risk human papillomavirus (HPV) is an oncogenic virus that causes oropharyngeal cancers, and it has a favorable outcome after the treatment. Unlike in oropharyngeal cancer, the prevalence and role of high-risk HPV in the etiology of hypopharyngeal squamous cell carcinoma (HPSCC) is uncertain. OBJECTIVE: The aim of the present study was to evaluate the effect and prognostic significance of high-risk HPV in patients with HPSCC. METHODS: The study included 64 subjects with HPSCC who underwent radical surgery with or without radiation-based adjuvant therapy. Primary tumor sites were the pyriform sinus in 42 patients, posterior pharyngeal wall in 19 patients, and postcricoid area in 3 patients. High-risk HPV in situ hybridization was performed to detect HPV infection. RESULTS: The positive rate of high-risk HPV in situ hybridization was 10.9% (7/64). There was a significant difference in the fraction of positive high-risk HPV among pyriform sinus cancer (16.7%), posterior pharyngeal wall cancer (0%), and postcricoid area cancer (0%) (p = 0.042). The laryngoscopic examination revealed a granulomatous and exophytic appearance in 85.7% (6/7) of patients with high-risk HPV-positive pyriform sinus cancer, but in only 31.4% (11/35) of patients with high-risk HPV-negative pyriform sinus cancer (p = 0.012). Significant correlations were found between positive high-risk HPV and younger age (p = 0.050) and non-smoking status (p = 0.017). HPV-positive patients had a significantly better disease-free survival (p = 0.026) and disease-specific survival (p = 0.047) than HPV-negative patients. CONCLUSIONS: High-risk HPV infection is significantly related to pyriform sinus cancer in patients with HPSCC.

BACKGROUND:Cell polarity genes including Crumbs (Crb) and Par complexes are essential for controlling photoreceptor morphogenesis. Among the Crb and Par complexes, Bazooka (Baz, Par-3 homolog) acts as a nodal component for other cell polarity proteins. Therefore, finding other genes interacting with Baz will help us to understand the cell polarity genes' role in photoreceptor morphogenesis. METHODOLOGY/PRINCIPAL FINDINGS:Here, we have found a genetic interaction between baz and centrosomin (cnn). Cnn is a core protein for centrosome which is a major microtubule-organizing center. We analyzed the effect of the cnn mutation on developing eyes to determine its role in photoreceptor morphogenesis. We found that Cnn is dispensable for retinal differentiation in eye imaginal discs during the larval stage. However, photoreceptors deficient in Cnn display dramatic morphogenesis defects including the mislocalization of Crumbs (Crb) and Bazooka (Baz) during mid-stage pupal eye development, suggesting that Cnn is specifically required for photoreceptor morphogenesis during pupal eye development. This role of Cnn in apical domain modulation was further supported by Cnn's gain-of-function phenotype. Cnn overexpression in photoreceptors caused the expansion of the apical Crb membrane domain, Baz and adherens junctions (AJs). CONCLUSIONS/SIGNIFICANCE:These results strongly suggest that the interaction of Baz and Cnn is essential for apical domain and AJ modulation during photoreceptor morphogenesis, but not for the initial photoreceptor differentiation in the Drosophila photoreceptor.

Purpose The incidence of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) has increased, and staging and optimal therapeutic approaches are challenging. A questionnaire survey was conducted to investigate the controversial treatment policy of stage T2 OPC according to the N category and determine the opinions of multidisciplinary experts in Korea. Materials and Methods Five OPC scenarios were developed by the Subcommittee on Oropharyngeal Treatment Guidelines of the Korean Society for Head and Neck Oncology and distributed to experts of multidisciplinary treatment hospitals. Results Sixty-five experts from 45 institutions responded. For the HPV-positive T2N0M0 scenario, 67.7% of respondents selected surgery followed by definitive concurrent chemoradiotherapy (CCRT) or radiotherapy alone. For the T2N1M0 HPV-positive scenario, there was a notable difference in the selection of primary treatment by expert specialty; 53.9% of respondents selected surgery and 39.8% selected definitive CCRT as the primary treatment. For the T2N3M0 advanced HPV-positive scenario, 50.0% of respondents selected CCRT and 33.3% considered induction chemotherapy (IC) as the primary treatment. CCRT and IC were significantly more frequently selected for the HPV-related OPC cases (p=0.010). The interdepartmental variability showed that the head and neck surgeons and medical oncologists favored surgery, whereas the radiation oncologists preferably selected definitive CCRT (p < 0.001). Conclusion In this study, surgery was preferred for lymph node-negative OPC, and as lymph node metastasis progressed, CCRT tended to be preferred, and IC was administered. Clinical practice patterns by stage and HPV status showed differences according to expert specialty. Multidisciplinary consensus guidelines will be essential in the future. [ABSTRACT FROM AUTHOR]

Background: Spontaneous hepatic rupture associated with the syndrome characterized by hemolysis, elevated liver enzymes, and a low platelet count (HELLP syndrome) is a rare and life-threatening condition, and only a few cases regarding the management of this condition through transcatheter arterial embolization (TAE) have been previously reported. Case summary: Herein, we report a case involving a 35-year-old pregnant woman who presented at 28 weeks of gestation with right upper quadrant pain, hypotension, and elevated levels of liver enzymes. Transabdominal ultrasound revealed fetal death. She required an emergency cesarean section, and hepatic rupture was identified after the fetus had been delivered. Hepatic packing and TAE were performed. The postprocedural course was uneventful, and the patient was discharged 14 days after she had been admitted to our hospital. Conclusions: Spontaneous hepatic rupture associated with HELLP syndrome is a very serious condition that requires prompt and decisive management. The high maternal and fetal mortality rates associated with this condition can be reduced through early accurate diagnosis and adequate management. The findings in the reported case indicate that TAE may be an attractive alternative to surgery for the management of spontaneous hepatic rupture associated with HELLP syndrome. [ABSTRACT FROM AUTHOR]

Background and objective: This study was conducted to assess the prevalence and clinical implications of parotid lesions detected incidentally during brain magnetic resonance imaging (MRI) examination. Materials and Methods: Between February 2016 and February 2021, we identified 86 lesions in the brain MRI reports of 84 patients that contained the words "parotid gland" or "PG". Of these, we finally included 49 lesions involving 45 patients following histopathological confirmation. Results: Based on the laboratory, radiological or histopathological findings, the prevalence of incidental parotid lesions was low (1.2%). Among the 45 study patients, 41 (91.1%) had unilateral lesions, and the majority of the lesions were located in the superficial lobe (40/49, 81.6%). The mean size of the parotid lesions was 1.3 cm ± 0.4 cm (range, 0.5 cm-2.8 cm). Of these, 46 parotid lesions (93.9%) were benign, whereas the remaining three lesions were malignant (6.1%). Conclusions: Despite the low prevalence and incidence of malignancy associated with incidental parotid lesions detected on brain MRI, the clinical implications are potentially significant. Therefore, clinical awareness and appropriate imaging work-up of these lesions are important for accurate diagnosis and timely management. [ABSTRACT FROM AUTHOR]

Background/Aims: According to the results of several studies, the outcome of hepatitis C virus (HCV) reactivation is not as severe as the outcome of hepatitis B virus reactivation. The aim of this study was to evaluate the effect of pharmacological immunosuppression on HCV reactivation. Methods: The medical records of patients who underwent systemic chemotherapy, corticosteroid therapy, or other immunosuppressive therapies between January 2008 and March 2015 were reviewed. Subsequently, 202 patients who were seropositive for the anti-HCV antibody were enrolled. Exclusion criteria were: unavailability of data on HCV RNA levels, a history of treatment for chronic hepatitis C, and the presence of liver diseases other than a chronic HCV infection. Results: Among the 120 patients enrolled in this study, hepatitis was present in 46 patients (38%). None of the patients were diagnosed with severe hepatitis. Enhanced replication of HCV was noted in nine (27%) of the 33 patients who had data available on both basal and follow-up HCV RNA loads. Reappearance of the HCV RNA from an undetectable state did not occur after treatment. The cumulative rate of enhanced HCV replication was 23% at 1 year and 30% at 2 years. Conclusions: Although enhanced HCV replication is relatively common in HCV-infected patients treated with chemotherapy or immunosuppressive therapy, it does not lead to serious sequelae. [ABSTRACT FROM AUTHOR]

Purpose: To analyze three-dimensional (3D) volume and histogram of thyroid gland on neck computed tomography (CT) for patients with Hashimoto’s thyroiditis. Materials and Methods: A total of 121 subjects who underwent neck CT between March 2013 and February 2014 were included in this study. These subjects were divided into the following two groups: 1) control group (n = 76); 2) Hashimoto’s thyroiditis group (n = 45). Non-enhanced and contrast-enhanced CT images were obtained. On contrast-enhanced images, the 3D volume of thyroid gland was semi-automatically calculated. On CT histogram, attenuation number, mean, median, standard deviation (SD), and coefficient of variation (CV) of thyroid gland were calculated. These values were compared between the two groups. Results: Total 3D volume of thyroid gland was 14.9 ± 4.8 cm3 in the control group, which was significantly (p = 0.002) lower than that (19.2 ± 8 cm3) in the Hashimoto’s thyroiditis group. On CT histogram, the mean, median, SD, and CV of thyroid gland on non-enhanced images were 95.8, 99.3, 21.7, and 0.226, respectively, in the control group and 72.2, 72.6, 19.6, and 0.28 in the Hashimoto’s thyroiditis group (p < 0.05). Histogram parameters on contrast-enhanced images were not significantly (p > 0.05) different. Median at cut-off value of 83 revealed the largest Az value (Az: 0.905; 95% confidence interval: 0.837-0.951; sensitivity: 84.4%; specificity: 85.5%). Conclusion: The Hashimoto’s thyroiditis group had larger volume but lower CT attenuation number with more prominent parenchymal heterogeneity of thyroid gland than the control group. [ABSTRACT FROM AUTHOR]

14 620 sets of patient dose data were obtained for 31 different models of computed tomography (CT) equipment (total 73) with 18 types of CT examination in Korea. Specific diagnostic reference levels (DRLs) for this study in terms of third quartile volumetric CT dose index in mGy [and dose-length product (DLP) in mGy.cm] are as follows: head, 53 (910); neck, 20 (770); chest, 14 (710); abdomen, 14 (1000); stomach, 14 (1000); liver, 14 (1700); pancreas, 14 (1700); kidney, 14 (2100); cervical spine, 30 (600); lumbar spine, 25 (760); hip, 17 (600); cardiac CT angiography, 45 (1250); head CT angiography, 43 (1900); liver CT angiography, 14 (1400) and thoraco-abdominal CT angiography, 16 (2000). In the present study, DRLs in terms of volumetric CT dose index were below previously published reference levels, partly because the newer CT equipments have improved technology that facilitates lower patient dose. Meanwhile, DRLs in terms of DLP were higher, because multi-phase scanning protocols with prolonged scan coverage have been widely used. [ABSTRACT FROM AUTHOR]

Schwannomas are benign mesenchymal spindle cell tumors arising from the Schwann cells that form the peripheral neural sheath. Several recent studies indicate that although reports of gastrointestinal schwannomas have increased with advanced technological developments in immunohistochemical staining, isolated colonic schwannomas are extremely rare. Moreover, it is known to be somewhat difficult to diagnose colonic schwannoma before surgical operation. In this paper, we report a case of isolated schwannoma that was incidentally discovered in the ascending colon, along with a review of few recent literatures. [ABSTRACT FROM AUTHOR]

This study presents a comparison of different protocols for the synthesis of iron-loaded zeolites, and the results of their application, as well as that of zeolite-A (Z-A), to the removal of ammonium and phosphate from aqueous media. Zeolites prepared by three methods were evaluated: iron-incorporated zeolites (IIZ), iron-exchanged zeolites (IEZ), and iron-calcined zeolites (ICZ). The optimal iron content for preparing of IIZ, as determined via scanning electron microscopy and X-ray photoelectron spectroscopy analyses, expressed as molar ratio of SiO2:Al2O3:Fe, was below 0.05. Ammonia removal revealed that the iron-loaded zeolites have a higher removal capacity than that of Z-A due, not only to ion-exchange phenomena, but also via adsorption. Greater phosphate removal was achieved with IEZ than with ICZ; additionally, no sludge production was observed in this heterogeneous reaction, even though the coagulation process is generally accompanied by the production of a large amount of undesired chemical sludge. This study demonstrates that the developed synthetic iron-loaded zeolites can be applied as a heterogeneous nutrient-removal materials with no sludge production. [ABSTRACT FROM AUTHOR]

Traumatic lumbosacral spinal subdural hematoma due to anatomical and pathological causes is rare, compared to epidural hematoma. If the time of trauma cannot be determined, intracranial and intraspinal signal intensity according to lapse of time are not coincident, resulting in confusion in terms of differentiation. Fat suppression magnetic resonance image (MRI) and computed tomography (CT) are utilized for differentiation. The intention of this study is to report on a case where spinal subdural hematoma of unknown time of occurrence is differentiated from subdural lipoma by taking advantage of fat suppression MRI and CT in order to perform an early surgical decompression with auxiliary review of literature demonstrating good prognosis of the procedure [ABSTRACT FROM AUTHOR]

Abstract: There are some reports of renal vein thrombosis associated with acute pyelonephritis, but a case of renal artery thrombosis in acute pyelonephritis has not been reported yet. Here we report a case of renal artery thrombosis which developed in a patient with acute pyelonephritis complicated with sepsis-induced disseminated intravascular coagulation (DIC). A 65-year-old woman with diabetes was diagnosed with acute pyelonephritis complicated with sepsis. Escherichia coli was isolated from both blood and urine cultures. When treated with antibiotics, her condition gradually improved. She suddenly complained of severe right flank pain without fever in the recovery phase. A computed tomography scan revealed right renal artery thrombosis with concomitant renal infarction. Prophylactic anticoagulation therapy was not suggested because of sustained thrombocytopenia and increased risk of bleeding. Flank pain resolved with conservative treatment and perfusion of infarcted kidney improved at the time of discharge. To our knowledge, this is the first case of renal artery thrombosis related to acute pyelonephritis with sepsis-induced DIC. [Copyright &y& Elsevier]

Objective: To determine whether invasion of the pharyngeal constrictor muscle in early squamous cell carcinoma of the tonsil is correlated with lymph node metastasis. Design: Retrospective analysis of medical records and pathology specimens. Setting: Tertiary care referral center. Patients: Forty-eight patients who were diagnosed as having T2 squamous cell carcinoma of the tonsil and who underwent surgery. They were divided into 2 groups: an invasive group with invasion of the pharyngeal constrictor muscle and a noninvasive group without invasion of the pharyngeal constrictor muscle. Main Outcome Measures: Comparison of regional metastasis, 5-year locoregional recurrence, and 5-year disease- specific survival between the 2 groups. Results: Invasion of the pharyngeal constrictor muscle was found in 36 patients (75%) with T2 squamous cell carcinoma of the tonsil. The rate of lymph node metastasis, the mean (SD) number of positive nodes, and the mean (SD) lymph node density were 81%, 5.47 (9.27), and 0.15 (0.22) in the invasive group, respectively, and 50%, 1.33 (1.72), and 0.04 (0.04) in the noninvasive group, respectively (P=.04, P=.02, and P=.01, respectively). Five-year locoregional recurrence was significantly correlated with invasion of the pharyngeal constrictor muscle (P=.05) and with multiple lymph node metastasis (⩾5 nodes) (P=.04) in the univariate analyses. No factor was correlated with 5-year locoregional recurrence in the multivariate analysis. Five-year diseasespecific survival was significantly correlated with multiple lymph node metastasis (⩾5 nodes) in the univariate analyses (P=.009). Five-year disease-specific survival was not significantly correlated with any clinicopathological factor in the multivariate analysis. Conclusion: Higher risk for multiple lymph node metastasis and 5-year locoregional recurrence seems to be predicted in patients with extratonsillar invasion of the pharyngeal constrictor muscle, even in early squamous cell carcinoma of the tonsil. [ABSTRACT FROM AUTHOR]

Adipsic hypernatremia cause chronic hyperosmolality and hypernatremia through a combination of impaired thirst and osmotically stimulated antidiuretic hormone secretion. This syndrome can be grouped together as disorders of osmoreceptor dysfunction due to the various degrees of osmoreceptor destruction related with different types of intracranial lesions around the anterior hypothalamus, consistent with the location of primary osmoreceptor cells. Adipsic hypernatremia, associated with developmental disorder of corpus callosum, is very rare. Most cases are diagnosed at infancy and early childhood; the replacement of desmopressin is necessary. Herein, we report adipsic hypernatremia associated with anomalous corpus callosum in adult with mental retardation; they were treated with only free water without desmopressin. [ABSTRACT FROM AUTHOR]

The task of the present study was to investigate the relationship between parameters and factors predictive of voice quality and to suggest treatment guidelines for patients suffering from vocal polyps. In total, 158 patients diagnosed with vocal polyps and who received voice therapy were enrolled. Clinicomorphological factors such as size, location, color, and type of the polyp were evaluated. Perceptive and acoustic voice evaluation was conducted and the relationship of these voice parameters with clinicomorphological factors was analyzed. Additionally, factors favorable for voice therapy were investigated. GRBAS scale grade was closely related to acoustic parameters, such as jitter and shimmer. Univariate analysis showed the size of the polyp, the color of the vocal fold, a history of voice abuse, associated muscle tension dysphonia (MTD), and opposing reactive scar affected voice quality. In multivariate analysis, only the size of the polyp was associated with voice quality. The patients in whom the voice quality improved with voice therapy initially had smaller polyps and whitish-colored vocal folds. Results of the present study indicate that although the most influential factor on voice quality in vocal polyp patients was the size, several other factors should be considered in evaluating and treating vocal polyps. The size of the polyp and the color of the vocal fold are indicative of success or failure in voice therapy. [ABSTRACT FROM AUTHOR]

Background: Cell polarity genes including Crumbs (Crb) and Par complexes are essential for controlling photoreceptor morphogenesis. Among the Crb and Par complexes, Bazooka (Baz, Par-3 homolog) acts as a nodal component for other cell polarity proteins. Therefore, finding other genes interacting with Baz will help us to understand the cell polarity genes' role in photoreceptor morphogenesis. Methodology/Principal Findings: Here, we have found a genetic interaction between baz and centrosomin (cnn). Cnn is a core protein for centrosome which is a major microtubule-organizing center. We analyzed the effect of the cnn mutation on developing eyes to determine its role in photoreceptor morphogenesis. We found that Cnn is dispensable for retinal differentiation in eye imaginal discs during the larval stage. However, photoreceptors deficient in Cnn display dramatic morphogenesis defects including the mislocalization of Crumbs (Crb) and Bazooka (Baz) during mid-stage pupal eye development, suggesting that Cnn is specifically required for photoreceptor morphogenesis during pupal eye development. This role of Cnn in apical domain modulation was further supported by Cnn's gain-of-function phenotype. Cnn overexpression in photoreceptors caused the expansion of the apical Crb membrane domain, Baz and adherens junctions (AJs). Conclusions/Significance: These results strongly suggest that the interaction of Baz and Cnn is essential for apical domain and AJ modulation during photoreceptor morphogenesis, but not for the initial photoreceptor differentiation in the Drosophila photoreceptor. [ABSTRACT FROM AUTHOR]

Background: Mutations in spastin are the most common cause of hereditary spastin paraplegia, a neurodegenerative disease. In this study, the role of spastin was examined in Drosophila photoreceptor development. Methodology/Principal Findings: The spastin mutation in developing pupal eyes causes a mild mislocalization of the apical membrane domain at the distal section, but the apical domain was dramatically reduced at the proximal section of the developing pupal eye. Since the rhabdomeres in developing pupal eyes grow from distal to proximal, this phenotype strongly suggests that spastin is required for apical domain maintenance during rhabdomere elongation. This role of spastin in apical domain modulation was further supported by spastin's gain-of-function phenotype. Spastin overexpression in photoreceptors caused the expansion of the apical membrane domain from apical to basolateral in the developing photoreceptor. Although the localizations of the apical domain and adherens junctions (AJs) were severely expanded, there were no defects in cell polarity. Conclusions/Significance: These results strongly suggest that spastin is essential for apical domain biogenesis during rhabdomere elongation in Drosophila photoreceptor morphogenesis. [ABSTRACT FROM AUTHOR]

Soybean is a major source of protein meal in the world. Soybean kunitz trypsin inhibitor (SKTI) protein is a responsible for the inferior nutritional quality of unheated or incompletely heated soybean meal. The primary objective of this research was to identify DNA markers linked to the Ti locus controlling presence and absence of kunitz trypsin inhibitor protein. Two mapping populations were developed. Population 1 was derived from a cross between cultivar Jinpumkong2 ( TiTi) and C242 ( titi). Population 2 was made from a mating between cultivar Clark ( TiTi) and C242. The F1 plants were grown in the greenhouse to produce F2 seeds. Each F2 seed from F1 plants was analyzed electrophoretically to determine the presence of the SKTI protein band. One-thousand RAPD primers, 342 AFLP primer sets, and 35 SSR primers were used to map Ti locus in population 1 and 2. The presence of SKTI protein was dominant to the lack of a SKTI protein and kunitz trypsin inhibit protein band was controlled by a single locus. Twelve DNA markers (4 RAPD, 4 AFLP, and 3 SSR) and Ti locus were found to be genetically linked in population 1 consisted with 94 F2 individual plants. Three SSR markers (Satt409, Satt228, and Satt429) were linked with Ti locus within 10 cM. Satt228 marker was tightly linked with Ti locus. Satt228 marker was tightly linked within 0–3.7 cM of the Ti locus and may be useful in a marker assisted selection program. [ABSTRACT FROM AUTHOR]

Apicobasal cell polarity is crucial for morphogenesis of photoreceptor rhabdomeres and adherens junctions (AJs) in the Drosophila eye. Crumbs (Crb) is specifically localized to the apical membrane of photoreceptors, providing a positional cue for the organization of rhabdomeres and AJs. We show that the Crb complex consisting of Crb, Stardust (Sdt) and Discs-lost (Dlt) colocalizes with another protein complex containing Par-6 and atypical protein kinase C (aPKC) in the rhabdomere stalk of photoreceptors. Loss of each component of the Crb complex causes age-dependent mislocalization of Par-6 complex proteins, and ectopic expression of Crb intracellular domain is sufficient to recruit the Par-6 complex. We also show that the absence of Par-6 complex proteins results in severe mislocalization and loss of Crb complex. We further demonstrate that Dlt directly binds to Par-6, providing a molecular basis for the mutual dependence of the two complexes. These results suggest that the interaction of Crb and Par-6 complexes is required for the organization and maintenance of apical membranes and AJs of photoreceptors. [ABSTRACT FROM AUTHOR]