Duplicate Publication Rate Decline in Korean Medical Journals

The purpose of this study was to examine trends in duplicate publication in Korean medical articles indexed in the KoreaMed database from 2004 to 2009, before and after a campaign against scientific misconduct launched by the Korean Association of Medical Journal Editors in 2006. The study covered period from 2007 to 2012; and 5% of the articles indexed in KoreaMed were retrieved by random sampling. Three authors reviewed full texts of the retrieved articles. The pattern of duplicate publication, such as copy, salami slicing (fragmentation), and aggregation (imalas), was also determined. Before the launching ethics campaign, the national duplication rate in medical journals was relatively high: 5.9% in 2004, 6.0% in 2005, and 7.2% in 2006. However, duplication rate steadily declined to 4.5% in 2007, 2.8% in 2008, and 1.2 % in 2009. Of all duplicated articles, 53.4% were classified as copies, 27.8% as salami slicing, and 18.8% as aggregation (imalas). The decline in duplicate publication rate took place as a result of nationwide campaigns and monitoring by KoreaMed and KoreaMed Synapse, starting from 2006.

An Understanding of New Concepts and Publication Ethics in the Use of Online Medical Journals and their Database Web Sites

Nowadays, we have much more convenient access to every medical journal through web sites, compared to the paper-based publications of the past. Beyond simply reading, we can compose, submit, inspect, review, and store data through these web sites. Furthermore, medical journals do not operate independently, but are rather integrated through online journal databases: therefore, an era of ubiquitous access to medical information for any purpose, has arrived. Thousands of new papers are pouring out in the flood of information everyday, so that it is very important for authors to make their research outcomes known to science scholar online especially in the options or selections of his or her own purpose of study. Therefore, a thorough understanding of database usage is necessary in order to meet authors' and readers' goals. The Journal of the Korean Medical Association (JKMA) began operating an online database (www.kjma.org) in July 2010, to keep pace with international digital journal standards. Digital publication is a very encouraging improvement in meeting contemporary reader's' needs over the previous paper-based system. The tools and content of the journal web site will both be continuously updated. Our society ought to not only catch up with other society's but further develop our online presence in innovative ways. The authors here introduce and summarize the latest trends and ethical issues in online publication needed to manage and use the online medical databases appropriately.

Duplicate Publications in Korean Medical Journals Indexed in KoreaMed

Duplicate publication is considered unethical. It has several negative impacts. To estimate the frequency and characteristics of duplicate publications in Korean medical journals, we reviewed some portion of Korean journal articles. Among 9,030 articles that are original articles indexed in KoreaMed from January to December 2004, 455 articles (5%) were chosen by random sampling. PubMed, Google scholar, KMbase, and KoreaMed were searched by two librarians. Three authors reviewed titles, abstracts, and full text of index articles and suspected articles independently. Point of disagreement were reconciled by discussion. Criteria for a duplicate publication defined by editors of cardiothoracic journals and International Committee of Medical Journal Editors were used. A total of 455 articles were evaluated, of which 27 (5.93%) index articles were identified with 29 duplicate articles. Among 27 index articles, 1 was quadruple publication and 26 were double publications. Of 29 duplicated articles, 19 were classified as copy, 4 as fragmentation, and 6 as disaggregation. The proportion of duplicate publications in Korean medical journals appears to be higher than expected. Education on publication ethics to researchers is needed.

Author and Authorship in Reporting Medical Papers

There are many factors in ethical considerations in publication of medical papers. Among the several publication misconducts, authorship abuse is one of the common problems. An author is considered to be a person who has made substantive intellectual contributions to a published study, and authorship continues to have important academic, social, and financial implications. Several committees have recommended criteria for authorship. We reviewed the consideration of authorship credits to understand the appropriate reporting of authors in medical papers.

Ethical Issues of Multiple Publication

Duplicate publication is publishing of an article that is identical to or overlaps considerable parts with one that has been already published elsewhere. If one or more authors retain common authorship in two separate papers with the same context, the papers are considered to be duplicated, but not plagiarized. The corresponding author was usually the case, but the first author is changed frequently. The characteristics of duplicate publication in Korea are republication of paper in journals indexed in SCI database after publishing in Korean journal one or two years before. In almost all cases they are not cross referenced. In Korean cases of duplicate publication, duplicate submissions are not rare. Generally the title is modified, and the list of authors and the sample size undergo a minor change with trivial methodological changes. Multiple publications in Korean journals usually consist of fragmentation (salami slicing) publications and overlapping (imalas) publications. Duplicate publication is an unethical behavior because of the waste of resources such as valuable time of busy reviewers, editorial work and pages, space of indexing database, and delaying the publication time of other researcher's paper. Duplicate publication is a violation of international copyright law as well. Sometimes it can distort or overemphasize the results in meta-analysis studies because of overlapping of samples. To prevent duplicate publication, the editor should provide instructions regarding the journal's policy toward duplicate publication and should make authors to read the instruction in detail. Educational programs for the reviewers will reduce the incidence by letting them know why and how to detect duplicate publication.

Bilateral Agenesis of the Internal Carotid Artery: Case Report

Unilateral or, particularly, bilateral congenital agenesis of the internal carotid artery is a rare anomaly. We report an occurrence of the condition, arising bilaterally, and report the findings of magnetic resonance imaging and magnetic resonance angiography.

Pulmonary Manifestations of Systemic Lupus Erythematosus

Pulmonary involvement is more common in systemic lupus erythematosus (SLE) than in any other connective tissue disease, and more than half of patients with SLE suffer from respiratory dysfunction during the course of their illness. Although sepsis and renal disease are the most common causes of death in SLE, lung disease is the predominant manifestation and is an indicator of overall prognosis. Respiratory disease may be due to direct involvement of the lung or as a secondary consequence of the effect of the disease on other organ systems.

SENSE (Sensitivity Encoding) for Diffusion Tensor Imaging of the Brain

PURPOSE: The sensitivity encoding (SENSE) technique is increasingly being used with clinical MRI scanners. The object of this study is to compare the normative human data and image quality of the diffusion tensor imaging (DTI) with sensitivity encoding (SENSE) and standard single-shot EPI techniques. MATERIALS AND METHODS: 16 normal volunteers underwent single-shot echo-planar DTI with both standard and SENSE sequences using a 1.5 T Philips Intera MR scanner (TR/TE=6755/74 or 5871/66 ms, echo train length 127 or 67, NEX=3, matrix=128x128, FOV=220x220 mm, slice thickness=4 mm, b value=600 s/mm2, six orthogonal diffusion gradients). The diffusion tensor-encoded MR images were transferred to a PC workstation and analyzed using in-house software. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) maps were calculated. The presence of artifacts (ghost susceptibility, eddy current) was graded with a two- or three-point scale. The ADC and FA values were measured in the major white matter tract and gray matter nuclei. The signal-to-noise ratio was also measured. Fisher's exact test and the Mann-Whitney test were used for the statistical analysis. RESULTS: With SENSE, the acquisition time was reduced from 2 min 57 sec to 1 min 22 sec for DTI. Susceptibility artifacts (around the brain stem and temporal base) and eddy current artifacts were significantly reduced on the SENSE DTI as compared with those on the standard DTI (p<0.05). No ghost artifacts were observed on the SENSE DTI, whereas such artifacts were observed in 14 cases (87.5%) on the standard DTI. The ADC value was not significantly different between the SENSE DTI and the standard DTI, whereas the FA values in the cerebral cortex and white matter were significantly higher on the SENSE DTI than on the standard DTI (p<0.05). The signal-to-noise ratio was 8.44 on the standard DTI and 11.40 on the standard DTI. CONCLUSION: The use of SENSE DTI significantly reduces the geometric distortion caused by artifacts, shortens the acquisition time, and allows a relatively high SNR to be maintained, but tends to erroneously increase the FA value of the tissue. Therefore, DTI with SENSE may provide better white matter fiber tracking and diffusivity indices when the imaging parameters for SENSE are optimized.

Measurement of Normal Intracranial Artery Diameter Using Three-dimensional Reconstruction Rotational Angiogram

PURPOSE: To evaluate the distribution of normal intracranial artery diameter according to sex and age, using three-dimensional reconstruction rotational angiography. MATERIALS AND METHODS: One hundred and twenty-five adults with normal intracranial arteries who underwent 3D rotational angiography (n=177) were included in this study. The arterial diameter was measured at four sites of the internal carotid artery (cavernous, paraophthalmic, supraclinoid, and distal), that of the middle cerebral artery at two (proximal and distal), and that of the anterior cerebral artery at one (middle). For each sex and age group ( or = 60 years), the mean diameter of the artery at these seven sites was calculated, and differences analysed. In addition, the middle cerebral artery diameter was compared between a younger group ( or = 50 years). RESULTS: The mean diameter at each site for each sex was as follows: male (mean+/-SD): 4.61+/-0.69, 3.96+/- 0.60, 3.48+/-0.45, 3.61+/-0.50, 2.44+/-0.32, 2.44+/-0.37, 1.81+/-0.32; female: 4.29+/-0.57, 3.83+/-0.56, 3.37+/-0.56, 3.52+/-0.48, 2.32+/-0.37, 2.30+/-0.36, 1.76+/-0.34. For those in their 40s, the diameter at five sites (all four sites of the internal cerebral artery and a distal middle cerebral artery) was significantly greater in males than in females. For other age groups, however, the difference between the sexes was absent, or was significant at only one (cavernous internal cerebral artery for those in their 30s) or two (proximal and distal middle cerebral artery for those in their 50s) of the seven sites. In the older age group, the diameter of the proximal middle cerbral artery was 2.59+/-0.35 mm in males and 2.38+/-0.37 mm in females. For the distal middle cerebral artery, the corresponding figures were 2.63+/-0.43 and 2.39+/-0.35 mm, respectively. For both sexes, the differences between the two age groups were significant. CONCLUSION: For those in their 40s, the normal diameter of the intracranial artery at most arterial sites was significantly greater in males than in females. The normal diameter of the middle cerebral artery was significantly greater or tended to be greater among the older group than the younger group (for males and females, respectively, 2.59+/-0.35 mm and 2.38+/-0.37 mm at the proxinal site, and 2.63+/-0.43 mm and 2.39+/-0.35 mm at the distal site).

A Phantom Study for Revealing Factors Related to Image Distortion of Three-Dimensional Reconstruction Rotational Angiogram

PURPOSE: To determine, by means of a phantom study, the distortion-related factors and appropriate iodine concentration for three-dimensional reconstruction rotational angiography. MATERIALS AND METHODS: Four phantoms were created: crossed metal rods, one metal rod, one contrast rod, and a contrast rod under water. Iodine concentrations were 300, 250, 200, and 150 Img/ml, respectively. For each phantom, rotational angiography was performed in the rotational, right-angled (90 degree to rotational), intermedial (45 degree), close to rotational (20 degree), and close to right-angled (70 degree) planes. Two-dimensional projection images were transferred to a workstation at which 3D images were produced using the volume rendering technique. Image quality in each plane was evaluated in terms of opacity, homogeneity, and margin sharpness, which were graded as low, intermediate or high by two neuroradiologists who used images obtained in the right-angled plane as the standard reference. The same assessors evaluated in terms of the same parameters, cross-sectional images obtained at the central, intermedial, and peripheral portions of one metal rod positioned in the right-angled, close to right-angled, and intermedial planes, and in order to compare the values at different sites, one neuroradiologist measured the horizontal and vertical diameters of each cut image. RESULTS: Three-dimensional images of all four phantoms were high quality in the close to right-angled and intermedial plane, but in the rotational and close to rotational plane were degraded. In particular, metal rod images obtained in the rotational plane were poor for all three items. In these two planes, image quality was better for the contrast rod than the metal rod, and at 200 and 250 Img/ml concentrations than at 300 and 150 Img/ml concentrations. There was no significant difference in image quality, nor in measured values of the diameter between cut images. CONCLUSION: A three-dimensional image was more distorted when a linear object was placed at a lesser angle to the rotational plane and when inherent X-ray attenuation was greater, a finding which must be closely related to the beam-hardening artifact. Distortion was least at 200-250 Img/ml of iodine concentration, the concentration thought to be most appropriate for in-vitro 3D angiography.

Pineal Germinoma with Extracranial Metastases: Case Report

Pineal germinoma is the commonest pineal region tumor of childhood and adolescence. Metastatic germinoma most commonly occurs via the cerebrospinal fluid (CSF), and it is usually limited to the cerebrospinal axis. Extacranial hematogenous metastasis is known to be very rare. We report here on a case of pineal germinoma with gradual extracranial metastases that occurred both through the CSF pathway and by hematogenous spread. The patient had multifocal CSF seeding after his surgery for pineal germinoma, and the left iliac metastasis and lung metastasis then occurred.

With High hopes for Reverse of the JKMA

No abstract available.

Diagnostic Accuracy and Evaluation of Myocardial Viability by Cardiac Magnetic Resonance Imaging in Acute Myocardial Infarction: A Comparison with Thallium-201 Myocardial SPECT

PURPOSE: To assess the usefulness of cardiac MR imaging (MRI) in the diagnosis of acute myocardial infarction and in the assessment of myocardial viability in comparision with Tl-201 SPECT. MATERIALS AND METHODS: We retrospectively studied 17 patients who complained of chest pain and dyspnea with cardiac MRI . The patients were evaluated for the presence or absence of high signal intensity on T2-weighted image (T2WI), abnormal wall motion on 2D - FIESTA, perfusion defect on Gd-DTPA enhanced T1WI, and delayed myocardial enhancement on 15-minutes delay Gd-DTPA enhanced T1WI. The results were correlated with the images on Tl-201 SPECT, taken at rest and stress, through which reversibility of perfusion defect was assessed. RESULTS: Both cardiac MRI and Tl-201 SPECT proved to be useful methods for diagnosing acute myocardial infarction. In order of decreasing correspondence, T2WI, Tl-201 SPECT, delayed enhancement study, and wall motion images all showed significant statistical correlation with the clinical diagnosis of myocardial infarction. Perfusion MRI, on the other hand, showed no significant statistical difference was found between Tl-201 SPECT and cardiac MRI. The results on T2WI showed high accordance with those on Tl-201 SPECT, while delayed myocardial enhancement and wall motion studies showed no agreement with Tl-201 SPECT. CONCLUSION: Cardiac MRI is useful method for diagnosis of acute myocardiac infarction. With respect to the assessment of myocardial viability, the results obtained on cardiac MRI showed high agreement with those on Tl-201 SPECT. However, further study is necessary at this point for standardization and establishment of the methods for assessing myocardial viability on cardiac MRI.

Pulmonary Complications in Renal Transplantation

PURPOSE: To evaluate the radiographic and CT findings of pulmonary complications other than pulmonary edema arising from renal transplantation. MATERIALS AND METHODS: Among 393 patients who had undergone renal transplantation at our hospital during a previous ten-year period, 23 with pulmonary complications other than pulmonary edema were included in this study. The complications involved were infection caused by CMV (n=6), bacteria (n=4), fungus (n=4), tuberculosis (n=2), varicella (n=1) or chlamydia (n=1), and malignancy involving lung cancer (n=4) or Kaposi's sarcoma (n=1). Two chest radiologists reviewed all images. RESULTS: The complications manifesting mainly as pulmonary nodules were lung cancer(4/4), tuberculosis (1/2), and Kaposi's sarcoma(1/1). Pulmonary consolidation was a main feature in bacterial infection(4/4), fungal infection(3/4), tuberculosis(1/2), chlamydial infection(1/1), and varicellar pneumonia(1/1). Ground-glass attenuation was a main CT feature in CMV pneumonia(4/6), and increased interstitial marking was a predominant radiographic feature in CMV pneumonia(2/6). CONCLUSION: The main radiologic features described above can be helpful for differential diagnosis of the pulmonary complications of renal transplantation.

Human Tail: A Case Report

Human tail is a rare congenital anomaly in which a lesion protrudes from the lumbosacrococcygeal region. We encountered a case of human tail involving an intradural lipoma and tethered cord, occurring in a 1-day -old female who presented with an 8 cm-sized tail shown by MRI to arise from the S3-4 level. The cauda equina and film terminale were entrapped by the lipoma, but there were no bony abnormalities.

Sclerosing Stromal Tumor of the Ovary: A Case Report

Sclerosing stromal tumor of the ovary is a rare benign neoplasm, with distinctive clinical and pathologic features. It occurs predominantly in females during the second and third decades of life. Histologically, it is composed of cellular and acellular collagenized areas, and edematous stromal areas, and at ultrasonography and computed tomography is seen as a distinctive mixed solid and cystic mass lesion. We report a case of sclerosing stromal tumor of the ovary in a 15-year-old girl with a history of menorrhagia since menarche. Ultrasonography revealed the tumor as a well-defined, lobulated, heterogenous echogenic pelvic mass, while at CT, a huge pelvic mass 9x9x10 cm in size, was seen. This comprised a well-enhanced internal solid portion, a capsule, septa, and a non-enhanced cystic portion.

CT Findings of Esophageal Perforation

PURPOSE: To determine which CT findings are useful for the early diagnosis of esophageal perforation, and on the basis of these findings, to assess the accuracy of prediction of the perforation site. MATERIALS AND METHODS: A review of medical records indicated that between January 1995 and December 2001, 36 patients with esophageal perforation were admitted to our hospital. Thirteen of these [M:F=8:5; age: 28-69 (mean, 52.4) years], who had undergone CT chest scanning, were included in this study. The causes of esophageal perforation were trauma (n=5), infectious diseases (n=4), Boerhaave syndrome (n=1), lung cancer (n=1), esophageal cancer (n=1), and idiopathic (n=1). Two chest radiologists unaware of the clincal findings reviewed the CT scans and predicted whether the upper or lower esophagus was perforated. RESULTS: The most common CT finding was extraluminal air at the posterior mediastinum (n=11), while other findings included pulmonary consolidation (n=10), pleural effusion (n=7), discontinuity of the esophageal wall (n=6) and subcutaneous emphysema (n=4), fluid collection around the esophagus (n=4), esophageal wall thickening (n=4), pneumothorax (n=2), and lung abscess (n=2). The perforation site was accurately predicted in 76.9% of cases (10/13). CONCLUSION: The CT findings which help the diagnosis of esophageal perforation, and prediction of the sites at which it occurs, are extraluminal air or fluid collection, focal defect of the esophageal wall, and esophageal wall thickening.

Radiologic Findings of Childhood Lower Respiratory Tract Infection by Influenza Virus

PURPOSE: After the RS (respiratory syncytial) virus, the influenza virus is the most common cause of childhood lower respiratory tract infection. We assessed the radiologic findings of childhood lower respiratory tract infection by the influenza virus. MATERIALS AND METHODS: A total of 105 pediatric patients (76 males and 29 females; mean age, 2.4 years) with symptoms of respiratory tract infection were examined between March 1997 and April 2000. Nasopharyngeal aspirates were obtained and influenza virus infection was confirmed by direct or indirect immunofluorescent assays. Peribronchial infiltration, hyperinflation, atelectasis, pulmonary consolidation, and hilar lymphadenopathy were evaluated retrospectively at simple chest radiography. RESULTS: Bilateral perihilar peribronchial infiltration was noted in 78.1% of patients (n=82), hyperinflation in 63.8% (n=67), atelectasis in 3.8% (n=4; segmental 50%, lobar 50%), and pulmonary consolidation in 16.2% [n=17; segmental 70.6% (n=12), lobar 29.4% (n=5)]. Hilar lymphadenopathy was noted in one patient in whom there was no pleural effusion, and subglottic airway narrowing in 12 of 14 in whom the croup symptom complex was present. CONCLUSION: The major radiologic findings of influenza virus infection were bilateral perihilar peribronchial infiltration and hyperinflation. In some patients, upper respiratory tract infection was combined with subgolttic airway narrowing. Atelectasis or pleural effusion was rare.

Positional Shifting of HRCT Findings in Patients with Pulmonary Edema

PURPOSE: To assess the value of positional shifting to a gravity-dependent area, as revealed by HRCT, in differ-entiating pulmonary edema (PE) from other conditions. MATERIALS AND METHODS: Sixteen consecutive patients in whom plain radiographs suggested the presence of pulmonary edema but the clinical findings were indefinite underwent HRCT of the lung. For initial scanning they were in the supine position, and then in the prone position. Findings of ground-glass opacity, interlobular septal thickening and peribronchovascular interstitial thickening were analyzed in terms of the presence and degree of shifting to a gravity-dependent area, a grade of high, intermediate or low being assigned. RESULTS: PE was diagnosed in 8 of 16 cases, the remainder being designated as non-pulmonary edema (NPE). Ground-glass opacity was observed in all 16, while the degree of positional shifting was found to be high in ten (PE:NPE=6:4), intermediate in four (PE:NPE=2:2), and low in two (PE:NPE=0:2). There was no significant difference between the two groups (p > 0.05). Interlobular septal thickening was observed in all but two NPE cases; the degree of shifting was high in six (PE:NPE=6:0), intermediate in one (PE), and low in seven (PE:NPE=1:6). Shifting was significantly more prominent in PE than in NPE cases (p<0.05). Peribronchovas-cular interstitial thickening was positive in all PE cases and one NPE case, with no positional shifting. CONCLUSION: Positional shifting of interlobular septal thickening to a gravity-dependent area, as demonstrated by HRCT, is the most specific indicator of pulmonary edema.

Imaging Findings of Atypical Teratoid/Rhabdoid Tumor of Infancy & Childhood in CNS: Report of Two Cases

Atypical teratoid/rhabdoid tumor rarely occurs in the CNS, though is most common in infants under two years of age. It is characterized by unique histologic features, has an extremely aggressive natural course, and is located mainly in the infratentorial region. Radiologically, it is difficult to distinguish from primitive neuroectodermal tumor or medulloblastoma. We report the radiologic findings of two cases of atypical teratoid/rhabdoid tumor.