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Supplemental material, sj-docx-1-wso-10.1177_17474930231158211 for Optimal use of antithrombotic agents in ischemic stroke with atrial fibrillation and large artery atherosclerosis by Tae Jung Kim, Ji Sung Lee, Jae Sun Yoon, Mi Sun Oh, Ji-Woo Kim, Soo-Hyun Park, Keun-Hwa Jung, Hyun Young Kim, Jee-Hyun Kwon, Hye-Yeon Choi, Hahn Young Kim, Kyung Yoon Eah, Sang Won Han, Hyung-Geun Oh, Young-Jae Kim, Byoung-Soo Shin, Chang Hun Kim, Chi Kyung Kim, Jong-Moo Park, Kyung Bok Lee, Tai Hwan Park, Jun Lee, Man-Seok Park, Jay Chol Choi, Chulho Kim, Dong-Ick Shin, Soo Joo Lee, Dong-Eog Kim, Jae-Kwan Cha, Eung-Gyu Kim, Kyung-Ho Yu, Keun-Sik Hong, Young-Seok Lee, Ju-Hun Lee, Sung Il Sohn, Hee-Joon Bae, Young-Bae Lee, Jun Hong Lee, Joung-Ho Rha, Byung-Chul Lee, Dae-Il Chang, Sang-Bae Ko and Byung-Woo Yoon in International Journal of Stroke

Objectives. Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder characterized by recurrent epistaxis, telangiectasia, and visceral arteriovenous malformations (AVMs). Activin A receptor-like type 1 (ACVRL1/ALK1) and endoglin (ENG) are the principal genes whose mutations cause HHT. No multicenter study has yet investigated correlations between genetic variations and clinical outcomes in Korean HHT patients.Methods. Seventy-two members from 40 families suspected to have HHT based on symptoms were genetically screened for pathogenic variants of ACVRL1 and ENG. Patients with genetically diagnosed HHT were also evaluated.Results. In the HHT genetic screening, 42 patients from 24 of the 40 families had genetic variants that met the pathogenic criteria (pathogenic very strong, pathogenic strong, pathogenic moderate, or pathogenic supporting) based on the American College of Medical Genetics and Genomics Standards and Guidelines for either ENG or ACVRL1: 26 from 12 families (50%) for ENG, and 16 from 12 families (50%) for ACVRL1. Diagnostic screening of 42 genetically positive HHT patients based on the Curaçao criteria revealed that 24 patients (57%) were classified as having definite HHT, 17 (41%) as having probable HHT, and 1 (2%) as unlikely to have HHT. Epistaxis was the most common clinical presentation (38/42, 90%), followed by visceral AVMs (24/42, 57%) and telangiectasia (21/42, 50%). Five patients (12%) did not have a family history of HHT clinical symptoms.Conclusion. Only approximately half of patients with ACVRL1 or ENG genetic variants could be clinically diagnosed as having definite HHT, suggesting that genetic screening is important to confirm the diagnosis.

Purpose: The aim of this study was to determine the reliability and validity of the metacognition rating scale (MCRS), which is a revised version of the existing metacognition questionnaire (MCQ) with anger and anxiety added.Methods: A survey was conducted on 591 nursing students at colleges in North and South Gyeongsang Provinces, South Korea. The collected data were processed for the reliability and validity of the MCRS through Cronbach’s ⍺ and confirmatory factor analysis using SPSS 26.0.Results: Cronbach’s ⍺ for the reliability of MCRS was calculated at .88, .86, .77, .74, and .66 for five subfactors. Among the five subfactors, the first, second, third, and fifth factors showed high correlation in each of six items. Factor 4 was highly correlated in 5 out of 6 questions.Conclusion: The data confirm that the MCQ revised to include anger and anxiety is both reliable and valid for nursing students. Therefore, this scale can be used to identify the maladaptive metacognition of nursing students in stressful situations.

Background: Venipuncture is one of the one of the most commonly performed, minimally-invasive procedures; however, it may lead to peripheral nerve injury. Here, we describe the diagnosis, treatment, and prognosis of two self-reported cases of nerve injury during venipuncture with the aim of drawing attention to possible needle-related nerve injuries.Case: Two anesthesiologists in our hospital experienced an injury of the lateral antebrachial cutaneous branch of the musculocutaneous nerve during venipuncture. Immediately, they underwent ultrasound examinations and nerve blocks with oral medication, resulting in full recovery.Conclusions: Ultrasonography is important for the early and confirmative diagnosis of a nerve injury during venipuncture, and for immediate treatment with a nerve block. Moreover, it is imperative for both the practitioner and the patient to be aware of the possible complication of nerve injury after venipuncture.

Background: A midshaft clavicle fracture is a common fracture that typically responds well to open reduction and internal fixation (ORIF). However, refracture can occur after implant removal (IR). This study aimed to analyze the rate of refracture and related factors after removal of the locking compression plate (LCP) for displaced midshaft clavicle fractures. Methods: We retrospectively reviewed the medical records of 201 patients who had undergone ORIF with LCP for midshaft clavicle fractures after IR after bony union from January 2011 to May 2018 at our institute. We evaluated basic demographic characteristics and radiographic parameters. All patients were treated with an LCP for primary fracture. The patients were divided into two groups: a refracture group that experienced a second fracture within 1 year after IR and a no-fracture group.Results: There were four cases (1.99%) of refracture; three were treated conservatively, while one was treated surgically. All patients achieved bony union. The average interval between refracture and IR was 64 days (range, 6–210 days). There was a significant difference in classification of fractures (AO Foundation/Orthopaedic Trauma Association [AO/OTA] classification) between the two groups. However, other patient demographics and radiographic measurements between refracture and IR, such as bone diameter, showed no significant difference between the two groups. Conclusions: This study showed that one in 50 patients suffered from refracture after removal of the LCP. Thus, if patients desire IR, the surgeon should explain that there is a relatively higher possibility of refracture for cases with simple or segmental fractures than for other types of fracture.

Relapsing polychondritis (RP) is a rare, progressive immune-mediated systemic inflammatory disease of unknown etiology, characterized by recurrent inflammation of cartilaginous structures. Approximately 30% of RP cases are associated with other autoimmune diseases. However, the co-occurrence of RP and Crohn's disease (CD) has rarely been reported. Herein, we present a 35-year-old woman diagnosed with RP and CD, who was refractory to initial conventional medications, including azathioprine and glucocorticoid, but who subsequently responded to infliximab (IFX). For both diseases, remission was sustained with IFX. There has been no previous report regarding the successful treatment of co-existing RP and CD with IFX.

Background/aims Small bowel malignancies often present a diagnostic challenge due to their relative rarity and nonspecific clinical symptoms. However, technical developments in endoscopic instruments, including video capsule endoscopy (VCE) and enteroscopy, have allowed for the visualization of the entire small bowel. This study aimed to investigate the clinicopathological features of small bowel malignant tumors diagnosed by VCE and double-balloon enteroscopy (DBE) in a single tertiary center. Methods We retrospectively analyzed VCE and DBE findings from Korea University Guro Hospital from January 2010 through September 2018. Results A total of 510 VCE and 126 DBE examinations were performed in 478 patients. Small bowel malignancies were diagnosed in 28 patients (15 males; mean age, 61.0 years; range, 42 to 81 years). Among them, 8 had lymphoma, 8 had primary adenocarcinoma, 7 had gastrointestinal stromal tumor (GIST) and 5 had metastatic cancer. Abdominal pain and obstructive symptoms were the most common findings in metastatic cancers (4/5, 80%). On the other hand, obscure gastrointestinal bleeding was the most common symptom of GIST (6/7, 85.7%) and adenocarcinoma (3/8, 37.5%). Conclusions Approximately 6% of the patients who underwent either VCE or DBE were diagnosed with small bowel malignancy. These findings demonstrated the different clinical characteristics among small bowel malignancies and merit further study.

Background: The usage of social networks is a central part of daily life. In addition to many advantages, subjective impairments and negative consequences due to an excessive, uncontrolled use are increasingly being reported. Parallels to other internet-related addictive behavior and substance use disorders suggest that constructs, such as impulsiveness, the experience of craving and impairments in inhibitory control are risk factors for the development and maintenance of a problematic social network use. Material and methods: In this experimental study consisting of 64 participants aged between 18–59 years, an auditory cue-reactivity paradigm and a modified version of the stop-signal task were used to address cue reactivity and inhibitory control. Questionnaires were used to measure craving and impulsiveness as well as the symptom severity of problematic social network use. Results: The results show that the tendency towards a problematic use is related to greater impulsiveness and craving experiences. The inhibitory control as well as the interaction between the different constructs could not contribute further to variance explanation of symptom severity. Conclusion: The results illustrate the importance of impulsiveness and the experience of craving in developing and maintaining a problematic use of social networks. In addition, the specificity of certain stimuli with respect to the possible conflict and responding character and the associated relevance of specific cognitive components should be examined in further studies. Hintergrund Die Nutzung sozialer Netzwerke ist ein zentraler Bestandteil des Alltags. Neben vielen Vorteilen wird jedoch zunehmend von subjektiven Beeinträchtigungen und negativen Konsequenzen aufgrund einer exzessiven, unkontrollierten Nutzung berichtet. Parallelen zu anderen internetbezogenen Verhaltenssüchten und substanzgebundenen Störungen lassen vermuten, dass Konstrukte wie Impulsivität, das Erleben von Craving und eine beeinträchtige Inhibitionskontrolle ebenfalls Risikofaktoren bei der Entwicklung und Aufrechterhaltung einer problematischen Nutzung sozialer Netzwerke darstellen. Material und Methode In der vorliegenden Experimentalstudie mit 64 Teilnehmenden im Alter von 18 bis 59 Jahren wurden ein auditives „Cue-reactivity“-Paradigma sowie eine modifizierte Version der Stopp-Signal-Aufgabe zur Erfassung von Reizreaktivität und Inhibitionskontrolle eingesetzt. Zur Erhebung von Craving, Impulsivität und der Symptomschwere einer problematischen Nutzung sozialer Netzwerke wurden Fragebogen verwendet. Ergebnisse Die Ergebnisse zeigen, dass die Tendenz einer problematischen Nutzung mit einer höheren Impulsivität und Craving einhergeht. Die Inhibitionskontrolle sowie die Interaktion zwischen den verschiedenen Konstrukten konnten keine weitere Beiträge zur Varianzaufklärung der Symptomschwere leisten. Schlussfolgerung Die Ergebnisse illustrieren die Bedeutsamkeit von Impulsivität und Craving bei der Entwicklung und Aufrechterhaltung einer problematischen Nutzung sozialer Netzwerke. Darüber hinaus gilt es, die Spezifität der einzelnen Reize hinsichtlich des möglichen Konfliktpotenzials und Aufforderungscharakters sowie die damit einhergehende Relevanz spezifischer kognitiver Komponenten in weiteren Studien zu prüfen.

Green tea polyphenol (–)-epigallocatechin-3-gallate (EGCG) is a potent antioxidant with protective effects against neurotoxicity. However, it is currently unclear whether EGCG protects neuronal cells against radiation-induced damage. Therefore, the objective of this study was to investigate the effects of EGCG on ultraviolet (UV)-induced oxidative stress and apoptosis in PC12 cells. The effects of UV irradiation included apoptotic cell death, which was associated with DNA fragmentation, reactive oxygen species (ROS) production, enhanced caspase-3 and caspase-9 activity, and poly (ADP-ribose) polymerase cleavage. UV irradiation also increased the Bax/Bcl-2 ratio and mitochondrial pathway-associated cytochrome c expression. However, pretreatment with EGCG before UV exposure markedly decreased UV-induced DNA fragmentation and ROS production. Furthermore, the UV irradiationinduced increase in Bax/Bcl-2 ratio, cytochrome c upregulation, and caspase-3 and caspase-9 activation were each ameliorated by EGCG pretreatment. Additionally, EGCG suppressed UV-induced phosphorylation of p38 and rescued UV-downregulated phosphorylation of ERK. Taken together, these results suggest that EGCG prevents UV irradiationinduced apoptosis in PC12 cells by scavenging ROS and inhibiting the mitochondrial pathways known to play a crucial role in apoptosis. In addition, EGCG inhibits UV-induced apoptosis via JNK inactivation and ERK activation in PC12 cells. Thus, EGCG represents a potential neuroprotective agent that could be applied to prevent neuronal cell death induced by UV irradiation.

Background: Locked posterior fracture-dislocation of the shoulder (LPFDS) is a very rare injury that occurs predominantly in young patients following high-energy trauma. The long-term outcome of the treatment of this injury is often poor. This study sought to present the characteristics of injury, discuss the pathological anatomy, and to report the treatment outcomes of our case series. Methods: Between January 2012 and May 2018, a total of 234 patients who underwent surgical treatment for proximal humerus fractures were reviewed. Among them, six patients (mean age, 54.7 years; range, 35–76 years) with LPFDS were included in this study. Four patients were treated with open reduction and internal fixation (ORIF) with locking plates, one with hemiarthroplasty, and one with reverse total shoulder arthroplasty. Clinical results were evaluated by Constant, American Shoulder and Elbow Surgeons (ASES), and visual analog scale (VAS) scores and radiologic evaluation was conducted using follow-up radiographs. Results: The mean length of follow-up was 26.2 months (range, 12–54). The mean Constant, ASES, and VAS scores were 66.7, 65.5, and 2.2, respectively. Four patients who underwent ORIF achieved bony union, but avascular necrosis (AVN) of the humeral head was observed in two patients. No complications were observed in the patients who underwent arthroplasty surgery until final follow-up. Conclusions: In the treatment of LPFDS, replacement arthroplasty can produce predictable results. The approach of ORIF may be considered as a first choice of treatment in young patients but is sometimes correlated with postoperative complications such as AVN and the functional outcomes may be unpredictable. Therefore, patients should undergo careful diagnosis and treatment of this type of injury.

Although ulcerative colitis (UC) is confined to colonic and rectal mucosa in a continuous fashion, recent studies have also demonstrated the involvement of upper gastrointestinal tract as diagnostic endoscopy becomes more available and technically advanced. The pathogenesis of UC is not well established yet. It might be associated with an inappropriate response of host mucosal immune system to gut microflora. Although continuous and symmetric distribution of mucosal inflammation from rectum to colon is a typical pattern of UC, clinical feature and course of atypically distributed lesions in UC might also help us understand the pathogenesis of UC. Herein, we report a case of duodenal involvement of UC which successfully remitted after infliximab therapy. Endoscopic and pathologic findings before and after administration of anti-tumor necrosis factor suggest that the pathogenesis of upper gastrointestinal involvement of UC may be similar to that of colon involvement.

Purpose: This study evaluated the efficiency of preoperative ultrasound (US)-guided tattooing of the axillary lymph nodes with activated charcoal and the correlation between sonographically suspicious nodes and final histologic results by node-to-node analysis. The concordance rate between the tattooed nodes and sentinel nodes was also determined. Methods : : US-guided tattooing of sonographically suspicious axillary nodes was performed preoperatively by an injection of activated charcoal. The identification of black pigment and the concordance between the sentinel and tattooed nodes was evaluated. Results : : Regarding node-to-node analysis, the false-negative rate of US-fine needle aspiration (FNA) was 43.3%. The sensitivity and negative predictive values were 56.7% and 81.7%, respectively. The specificity and positive predictive values were 100%. The accuracy of US-FNA was 85.2%. In the final pathology, 45/125 patients (36.0%) had positive nodes, including two micrometastases. The false-negative rate of sentinel lymph node biopsy (SLNB) was 4.0%, but there were no skip metastases. The sensitivity and specificity of SLNB were 95.6% and 100%, respectively. The negative predictive value was 97.6%, and the positive predictive value was 100%. The accuracy of SLNB was 98.4%. In 117 of 125 patients (93.6%), there was concordance between the charcoal tattooed axillary lymph nodes and SLNs. Conclusion : : SLNB, in conjunction with US-guided tattooing of sonographically suspicious axillary lymph nodes, is a useful procedure to reduce the false-negative rate of SLNB and improve the accuracy of an intraoperative evaluation of axillary nodes in breast cancer patients. This paper proposes the concept of targeted axillary node biopsy with preoperative US-guided tattooing for the most accurate axillary staging in patients with breast cancer.

Background This study evaluated the usefulness of judgment of central lymph node (LN) metastasis by surgeon's palpation in papillary thyroid cancer. Methods This study included 127 patients who underwent thyroidectomy and central compartment node dissection between October 2014 and February 2015. The criterion for suspicious LNs was hardness. Results Of the 20.5% (28/127) of suspicious for metastatic LNs according to surgeon determination, 92.8% (26/28) were confirmed to be metastatic in the final pathological examinations. Metastatic LNs were found in 38 (38.3%) of 99 patients without suspicious LNs, 29 of whom (76.3%) had micrometastases. The sensitivity, specificity, and positive and negative predictive values for the determination of LN metastasis by a surgeon were 40.6%, 96.8%, 92.9%, and 61.6%, respectively. Conclusion Determination of central LN metastasis by a surgeon's palpation may be useful to evaluate LNs owing to the high specificity and positive predictive values, especially in macrometastasis or high-risk LN disease.

Respiratory infections are very common and highly contagious. Respiratory infectious diseases affect not only the person infected but also the family members and the society. As medical sciences advance, several diseases have been conquered; however, the impact of novel infectious diseases on the society is enormous. As the clinical presentation of respiratory infections is similar regardless of the pathogen, the causative agent is not distinguishable by symptoms alone. Moreover, it is difficult to develop a cure because of the various viral mutations. Various respiratory infectious diseases ranging from influenza, which threaten the health of mankind globally, to the coronavirus disease 2019, which resulted in a pandemic, exist. Contrary to human expectations that development in health care and improvement in hygiene will conquer infectious diseases, humankind's health and social systems are threatened by novel infectious diseases. Owing to the development of transport and trading activity, the rate of spread of new infectious diseases is increasing. As respiratory infections can threaten the members of the global community at any time, investigations on preventing the transmission of these diseases as well as development of effective antivirals and vaccines are of utmost importance and require a worldwide effort.

Purpose: This study tried to provide a baseline information for increasing the rate of cancer screening in the elderly by examining the factors influencing cancer screening behavior in the elderly using Andersen’s model and health belief model. Methods: Participants included 259 elderly from D city, South Korea. The data were collected from July to August, 2019 using structured questionnaires including subjects’ characteristics, knowledge toward cancer screening and health belief variables. Results: The cancer screening rate of the subjects was 66.0%. There were significant differences in monthly income, perception of the National Cancer Screening Program (NCSP), death from cancer in a family member, cancer screening intention, knowledge toward cancer screening, perceived benefit and perceived barrier between two groups. The factors influencing cancer screening behaviors in the elderly were death from cancer in a family member, perception of the NCSP, perceived barrier. Conclusion: This results suggest to increase the rate of cancer screening in the elderly, it is necessary to develop NCSP promotion program and proper education program for the elderly. Additionally, we recommended the research identifying the specific perceived barriers of cancer screening behavior of the elderly. This study provides a reference for developing the policy measures and strategies to increase the cancer screening behavior of the elderly.

This study analyzed the longevity of preformed metal crowns (PMCs) in first permanent molars and evaluated factors influencing their survival during a long-term follow-up period. In all, 115 first permanent molars treated with PMCs between June 2008 and June 2018 were retrospectively analyzed. The overall combined success rate for the study group was 84.3%. The 5-year survival rate was 82.8%. Multivariate Cox regression analyses identified distal cavities and mandibular PMC placement as risk factors for restoration failure. Careful placement of PMCs at the final try-in stage augments the longevity of the crown.

Background: Due to the aging population in Korea, knee osteoarthritis (KOA) has become an increasingly common condition. Many patients with KOA prefer analgesics, herbal medicines, acupuncture, or exercise, rather than arthroscopic surgery or a knee replacement. Gyebutang (GB) granules are a herbal extract widely used to treat KOA in traditional Korean medicine, but there is insufficient evidence of its efficacy and safety.Methods: A multicenter, randomized, assessor-blinded, 2-armed parallel, controlled clinical trial has been designed to investigate the efficacy and safety of GB combined with acupuncture for the treatment of KOA. There will be 100 patients with KOA enrolled in the study from 3 traditional Korean medicine hospitals. The participants will be randomly allocated to an experimental group (GB and acupuncture) or a control group (celecoxib and acupuncture) in a 1:1 ratio. Both groups will receive acupuncture treatment once a week for 6 weeks; one group will receive GB and the other will receive celecoxib for the same duration.Results: The primary outcome will be the change of knee osteoarthritic pain, based on scores on a 100 mm visual analog scale. The secondary outcomes will be scores on a numeric rating scale, the Western Ontario and McMaster Universities osteoarthritis index, patient global assessment, European quality of life 5-dimension 5-level scale, and adverse events.Conclusion: The results of this study will provide evidence of efficacy and safety of GB as a treatment for patients with KOA.

Background Wolf-Hirschhorn syndrome (WHS) includes features such as growth restriction, mental retardation, congenital heart disease, convulsions as well as microcephaly and micrognathia. Thus, the anesthesiologists may have difficulties in airway management, neuromuscular relaxation, and in maintaining hemodynamic stability. Case A 24-year-old man with WHS underwent surgery for closed reduction and internal fixation of the right neck of femur. His face showed features typical of patients with WHS such as a prominent glabella, hypertelorism, micrognathia, low-set malformed ears, and a down-turned mouth. Since difficult airway management was expected, a video-assisted laryngoscope was used for successful intubation. The surgery terminated without any problems under total intravenous anesthesia. Conclusions A patient with WHS may have a variety of problems. Therefore, through careful evaluation of the airway, cardiovascular system, and cerebral nervous system and by making an appropriate anesthetic plan, anesthesiologists can perform a safe general anesthesia in patients with WHS.

Allergic rhinitis (AR), a common chronic disease, impairs patients’ quality of life (QoL). This study aimed to determine the effect of perceived stress on disease-related QoL in AR patients. There were 741 patients from eight medical centers of the Allergic Rhinitis Cohort (ARCO) study. Data on sociodemographics, chronic conditions, AR severity, perceived stress level and Rhinoconjunctivitis QoL Questionnaire (RQLQ) results, and laboratory test findings were collected. The relationship between perceived stress and total RQLQ was analyzed using multiple linear regression. Potential confounding variables were adjusted. A high perceived stress level was associated with a high total RQLQ, which reflected worsening disease-related QoL. The high stress level was associated with an increased total RQLQ of 1.210 (95% confidence interval, 0.831–1.589, p &lt, 0.0001) compared with the very low level. In the final model, the multiple regression-adjusted R2 for RQLQ in AR participants was 0.5279, and perceived stress levels contributed 4.08% in additional explanatory power to RQLQ in AR patients. In conclusion, perceived stress is a potentially modifiable risk factor for decreased disease-related QoL in patients with AR, which may be improved with stress management.

Background Randomized, controlled cardiovascular outcome trials may not be fully representative of the management of patients with type 2 diabetes across different geographic regions. We conducted analyses of data from the multinational CVD-REAL consortium to determine the association between initiation of sodium–glucose cotransporter-2 inhibitors (SGLT-2i) and cardiovascular outcomes, including subgroup analyses based on patient characteristics. Methods De-identified health records from 13 countries across three continents were used to identify patients newly-initiated on SGLT-2i or other glucose-lowering drugs (oGLDs). Propensity scores for SGLT-2i initiation were developed in each country, with 1:1 matching for oGLD initiation. In the matched groups hazard ratios (HRs) for hospitalization for heart failure (HHF), all-cause death (ACD), the composite of HHF or ACD, myocardial infarction (MI) and stroke were estimated by country, and pooled using a weighted meta-analysis. Multiple subgroup analyses were conducted across patient demographic and clinical characteristics to examine any heterogeneity in treatment effects. Results Following matching, 440,599 new users of SGLT-2i and oGLDs were included in each group. Mean follow-up time was 396 days for SGLT-2i initiation and 406 days for oGLDs initiation. SGLT-2i initiation was associated with a lower risk of HHF (HR: 0.66, 95%CI 0.58–0.75; p Conclusions This CVD-REAL study extends the findings from the SGLT-2i clinical trials to the broader setting of an ethnically and geographically diverse population, and across multiple subgroups. Trial registration NCT02993614