Rapidly growing juvenile xanthogranuloma in an adult: a case report

Juvenile xanthogranuloma is a benign tumor made up of non-Langerhans histiocytes that predominantly occurs in infancy and early childhood. Juvenile xanthogranuloma can be differentiated from xanthoma by the distribution of the lesions and the absence of lipid abnormalities. It usually develops on the trunk and upper and lower extremities. Histologically, xanthogranulomas show a mixed cellular dermal infiltration with histiocytes, lymphocytes, eosinophils and Touton-type multinucleated giant cells. Classically, juvenile xanthogranuloma is a disease that largely affects infants and children. We describe a rare case of juvenile xanthogranuloma that suddenly developed in the axillary region of a male adult.

Analysis of emergency residents health status and affected factors by 2019 Korean Emergency Medicine Resident Survey (KEMRS)

Objective@#Emergency medicine residents are expected to exhibit a poor health status due to excessive working hours and high stress. Because much of patient care depends on them, their health conditions will have a significant impact on patient outcomes. Our study was designed to analyze the health status of emergency medicine residents and the affecting factors using the 2019 Korean Emergency Medicine Residents Survey (KEMRS) results. @*Methods@#The study evaluated the self-rated health-defined percentage of responders who thought they were in good health. Based on this response, the influencing factors were categorized statistically. These factors included personal characteristics, lifestyle (drinking, smoking, eating, sleeping, and exercise), and emotional stress. @*Results@#Of a total of 384 respondents, 176 (46%) thought they were in good health. Participants who perceived themselves to be unhealthy included residents who were married, female, and those in the 3rd grade. Drinking and smoking were not perceived to affect health status, but regular exercise and proper eating patterns were seen to be positive influencing factors. Daytime sleepiness, depressive moods, and personal well-being were correlated with health status. @*Conclusion@#While personal characteristics and emotional problems cannot be changed easily, lifestyle changes can be made for better health. The health conditions of emergency residents have not been considered a matter of importance thus far. To overcome their health problems, responsible improvements in schedules and a program of long-term follow-ups need to be implemented, followed by training programs.

KOBIO, the First Web-based Korean Biologics Registry Operated With a Unified Platform Among Distinct Disease Entities

The KOrean College of Rheumatology BIOlogics and targeted therapy (KOBIO) registry is a nationwide observational cohort that captures detailed data on exposure of patients to biologic and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs). This registry was launched in December 2012 with an aim to prospectively investigate clinical manifestations and outcomes of patients with rheumatoid arthritis (RA), ankylosing spondylitis, and psoriatic arthritis who initiated a biologic or targeted synthetic DMARD or switched to another. Demographic data, disease activity, current treatment, adverse events, terms based on Medical Dictionary for Regulatory Activities, and so on are registered for patients who are then followed up annually in a web-based unified platform. The KOBIO registry also recruits and collects data of patients with RA on conventional DMARDs for comparison. As of today, more than 5,500 patients were enrolled from 47 academic and community Rheumatology centers across Korea. The KOBIO registry has evolved to become a powerful database for clinical research to improve clinical outcomes and quality of treatment.

Differentiation between Glioblastoma and Solitary Metastasis: Morphologic Assessment by Conventional Brain MR Imaging and Diffusion-Weighted Imaging

Purpose@#Differentiating between glioblastoma and solitary metastasis is very important for the planning of further workup and treatment. We assessed the ability of various morphological parameters using conventional MRI and diffusion-based techniques to distinguish between glioblastomas and solitary metastases in tumoral and peritumoral regions. @*Materials and Methods@#We included 38 patients with solitary brain tumors (21 glioblastomas, 17 solitary metastases). To find out if there were differences in the morphologic parameters of enhancing tumors, we analyzed their shape, margins, and enhancement patterns on postcontrast T1-weighted images. During analyses of peritumoral regions, we assessed the extent of peritumoral non-enhancing lesion on T2- and postcontrast T1-weighted images. We also aimed to detect peritumoral neoplastic cell infiltration by visual assessment of T2-weighted and diffusionbased images, including DWI, ADC maps, and exponential DWI, and evaluated which sequence depicted peritumoral neoplastic cell infiltration most clearly. @*Results@#The shapes, margins, and enhancement patterns of tumors all significantly differentiated glioblastomas from metastases. Glioblastomas had an irregular shape, ill-defined margins, and a heterogeneous enhancement pattern; on the other hand, metastases had an ovoid or round shape, well-defined margins, and homogeneous enhancement. Metastases had significantly more extensive peritumoral T2 high signal intensity than glioblastomas had. In visual assessment of peritumoral neoplastic cell infiltration using T2-weighted and diffusion-based images, all sequences differed significantly between the two groups. Exponential DWI had the highest sensitivity for the diagnosis of both glioblastoma (100%) and metastasis (70.6%). A combination of exponential DWI and ADC maps was optimal for the depiction of peritumoral neoplastic cell infiltration in glioblastoma. @*Conclusion@#In the differentiation of glioblastoma from solitary metastatic lesions, visual morphologic assessment of tumoral and peritumoral regions using conventional MRI and diffusion-based techniques can also offer diagnostic information.

The Fornix: Functional Anatomy, Normal Neuroimaging, and Various Pathological Conditions

The fornix is the major white-matter outflow tract from the hippocampus; it has a significant role in cognitive function. It is readily imaged via magnetic resonance imaging; its main parts are the crura, commissure, body, and columns. In this pictorial essay, we describe and illustrate the functional and imaging anatomy of the fornix and limbic system, as well as various disease entities involving the fornix.

KOBIO, the First Web-based Korean Biologics Registry Operated With a Unified Platform Among Distinct Disease Entities

The KOrean College of Rheumatology BIOlogics and targeted therapy (KOBIO) registry is a nationwide observational cohort that captures detailed data on exposure of patients to biologic and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs). This registry was launched in December 2012 with an aim to prospectively investigate clinical manifestations and outcomes of patients with rheumatoid arthritis (RA), ankylosing spondylitis, and psoriatic arthritis who initiated a biologic or targeted synthetic DMARD or switched to another. Demographic data, disease activity, current treatment, adverse events, terms based on Medical Dictionary for Regulatory Activities, and so on are registered for patients who are then followed up annually in a web-based unified platform. The KOBIO registry also recruits and collects data of patients with RA on conventional DMARDs for comparison. As of today, more than 5,500 patients were enrolled from 47 academic and community Rheumatology centers across Korea. The KOBIO registry has evolved to become a powerful database for clinical research to improve clinical outcomes and quality of treatment.

Differentiation between Glioblastoma and Solitary Metastasis: Morphologic Assessment by Conventional Brain MR Imaging and Diffusion-Weighted Imaging

Purpose@#Differentiating between glioblastoma and solitary metastasis is very important for the planning of further workup and treatment. We assessed the ability of various morphological parameters using conventional MRI and diffusion-based techniques to distinguish between glioblastomas and solitary metastases in tumoral and peritumoral regions. @*Materials and Methods@#We included 38 patients with solitary brain tumors (21 glioblastomas, 17 solitary metastases). To find out if there were differences in the morphologic parameters of enhancing tumors, we analyzed their shape, margins, and enhancement patterns on postcontrast T1-weighted images. During analyses of peritumoral regions, we assessed the extent of peritumoral non-enhancing lesion on T2- and postcontrast T1-weighted images. We also aimed to detect peritumoral neoplastic cell infiltration by visual assessment of T2-weighted and diffusionbased images, including DWI, ADC maps, and exponential DWI, and evaluated which sequence depicted peritumoral neoplastic cell infiltration most clearly. @*Results@#The shapes, margins, and enhancement patterns of tumors all significantly differentiated glioblastomas from metastases. Glioblastomas had an irregular shape, ill-defined margins, and a heterogeneous enhancement pattern; on the other hand, metastases had an ovoid or round shape, well-defined margins, and homogeneous enhancement. Metastases had significantly more extensive peritumoral T2 high signal intensity than glioblastomas had. In visual assessment of peritumoral neoplastic cell infiltration using T2-weighted and diffusion-based images, all sequences differed significantly between the two groups. Exponential DWI had the highest sensitivity for the diagnosis of both glioblastoma (100%) and metastasis (70.6%). A combination of exponential DWI and ADC maps was optimal for the depiction of peritumoral neoplastic cell infiltration in glioblastoma. @*Conclusion@#In the differentiation of glioblastoma from solitary metastatic lesions, visual morphologic assessment of tumoral and peritumoral regions using conventional MRI and diffusion-based techniques can also offer diagnostic information.

The Fornix: Functional Anatomy, Normal Neuroimaging, and Various Pathological Conditions

The fornix is the major white-matter outflow tract from the hippocampus; it has a significant role in cognitive function. It is readily imaged via magnetic resonance imaging; its main parts are the crura, commissure, body, and columns. In this pictorial essay, we describe and illustrate the functional and imaging anatomy of the fornix and limbic system, as well as various disease entities involving the fornix.

Emergency medicine residents’ needs assessment for education and training using nationwide survey

Objective@#This study was conducted to identify the needs assessment for education and training of emergency medicine (EM) residents. @*Methods@#The results of a national survey of EM residents of the Korean Society of Emergency Medicine in 2019 were used. Education was one of the five categories in the survey. The preferred learning methods and their perceived importance and ability to perform in nine competencies were assessed. The Borich’s needs assessment model was used to analyze their needs. @*Results@#Among 591 EM residents, 382 responded, and 371 responses were finally analyzed. Regarding the learning methods, junior residents preferred in-hospital conferences, staff lectures, internet resources, and textbooks. Overall, medical knowledge and procedural skills were the most important, and research was less important to recognize. Medical knowledge showed the highest rank in the needs assessment in all years, and ethics and professionalism showed the lowest ranks. The needs for procedural skills were higher in junior years but lower in senior years. @*Conclusion@#These results will form the basis for the design of training programs to meet the educational needs of EM residents for each grade. Furthermore, an analysis of the educational needs should be done periodically according to the changes and demands of the times.

Biologic therapies for the treatment of rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the synovial joints. If left untreated, persistent synovial inflammation can lead to cartilage and bone destruction, ultimately causing significant longterm disability and mortality. However, since the late 1990s, the combined use of methotrexate, a synthetic diseasemodifying antirheumatic drug (DMARD), and a biological DMARD has revolutionized the treatment of RA. As of 2021, the Korea Food and Drug Administration has approved seven biological DMARDs for RA treatment: four tumor necrosis factor-alpha inhibitors (infliximab, etanercept, adalimumab, and golimumab) and three non-tumor necrosis factor biological products (abatacept, rituximab, and tocilizumab). Although the use of biological products has allowed significant advances in the treatment of RA, there are certain drawbacks, such as high cost, increased infection risk, and the necessity for parenteral route product administration. Therefore, discontinuation of biological DMARD use without a resulting disease flare is the next treatment goal and a desirable result from the standpoint of risk reduction and cost-effectiveness, especially for patients with clinical remission. It is still unclear which biological product is the best. Clinicians must, therefore, personalize the sequence and strategy of treatment by considering patient characteristics, disease activity, comorbidity, and economic condition

Discovery and Functional Study of a Novel Genomic Locus Homologous to Bα-Mating-Type Sublocus of Lentinula edodes

The interaction of mating pheromone and pheromone receptor from the B mating-type locus is the first step in the activation of the mushroom mating signal transduction pathway.The B mating-type locus of Lentinula edodes is composed of Bα and Bβ subloci, each of which contains genes for mating pheromone and pheromone receptor. Allelic variations in both subloci generate multiple B mating-types through which L. edodes maintains genetic diversity. In addition to the B mating-type locus, our genomic sequence analysis revealed the presence of a novel chromosomal locus 43.3 kb away from the B mating-type locus, containing genes for a pair of mating pheromones (LPHBN1 and PHBN2) and a pheromone receptor (RCBN). The new locus (Bα-N) was homologous to the Bα sublocus, but unlike the multiallelic Bα sublocus, it was highly conserved across the wild and cultivated strains. The interactions of RcbN with various mating pheromones from the B and Bα-N mating-type loci were investigated using yeast model that replaced endogenous yeast mating pheromone receptor STE2 with RCBN. The yeast mating signal transduction pathway was only activated in the presence of PHBN1 or PHBN2 in the RcbN producing yeast, indicating that RcbN interacts with self-pheromones (PHBN1 and PHBN2), not with pheromones from the B matingtype locus. The biological function of the Bα-N locus was suggested to control the expression of A mating-type genes, as evidenced by the increased expression of two A-genes HD1 and HD2 upon the treatment of synthetic PHBN1 and PHBN2 peptides to the monokaryotic strain of L. edodes.

Construction of a CRISPR/Cas9-Mediated Genome Editing System in Lentinula edodes

CRISPR/Cas9 genome editing systems have been established in a broad range of eukaryotic species. Herein, we report the first method for genetic engineering in pyogo (shiitake) mushrooms (Lentinula edodes) using CRISPR/Cas9. For in vivo expression of guide RNAs (gRNAs) targeting the mating-type gene HD1 (LeA1), we identified an endogenous LeU6 promoter in the L. edodes genome. We constructed a plasmid containing the LeU6 and glyceraldehyde-3-phosphate dehydrogenase (LeGPD) promoters to express the Cas9 protein. Among the eight gRNAs we tested, three successfully disrupted the LeA1 locus. Although the CRISPRCas9–induced alleles did not affect mating with compatible monokaryotic strains, disruption of the transcription levels of the downstream genes of LeHD1 and LeHD2 was detected.Based on this result, we present the first report of a simple and powerful genetic manipulation tool using the CRISPR/Cas9 toolbox for the scientifically and industrially important edible mushroom, L. edodes.

Association of the First Antipsychotic Treatment Duration With the Re-Initiation of Treatment in Schizophrenia: A National Health Insurance Data-Based Study / 대한정신분열병학회지

Objectives@#The optimal duration of maintenance treatment for patients with first-episode schizophrenia (FES) remains unclear. We examined the first antipsychotic treatment duration and its association with re-initiation of treatment using a nationwide claim database. @*Methods@#Data from the Health Insurance Review and Assessment Service database in South Korea for 2007–2016 were used. Linear regression analysis and Cox proportional hazard models were used to evaluate the associations between the duration of the first antipsychotic treatment, time to re-initiation of treatment, and occurrence of treatment re-initiation. @*Results@#Of 30,143 patients with FES, 80.4% (n=24,231) received <2 years of the first antipsychotic treatment. In patients who discontinued treatment (n=23,030), the rate of treatment re-initiation was 74.2% (n=17,086). As the duration of the first antipsychotic treatment increased, the time to re-initiation of treatment decreased (β=-0.146, p<0.001); however, the rate of treatment re-initiation was relatively constant (hazard ratio=1.001, p<0.001). @*Conclusion@#Long-term antipsychotic treatment was not significantly associated with the rate of treatment re-initiation but showed a negative association with the time to re-initiation of treatment. Further research is needed to better understand the optimal treatment duration for FES.

How many emergency medicine residents reselect their specialty if they could?

Objective@#The 2019 Korean Emergency Medicine Residents Survey (KEMRS) is the first survey by the Korean Society of Emergency Medicine (KSEM) on the comprehensive satisfaction of their residents. Satisfaction is important not only for the personal well-being of the residents but also for patient safety. @*Methods@#A total of 622 emergency medicine residents were surveyed, using both a paper and email questionnaire from May to August of 2019. Factors related to satisfaction were analyzed. @*Results@#Of the responders, 66% said they would reapply for the emergency specialty and 51% said that they would reselect the same training hospital. The group of residents who said they would choose emergency medicine again felt that their expectations had been met and that they were comfortable with the choice of the specialty. They felt that the factors of satisfaction with their shift schedule and personal health played a more important role in their reselection of the training hospital than the workload. @*Conclusion@#The satisfaction levels of the Korean emergency residents were low. Thus, training hospitals should provide a reasonable working environment to increase their satisfaction. Also, it is important to create an environment where residents can feel rewarded and proud of the work they do.

Effectiveness and Safety of Liraglutide Treatment in Patients with a Psychiatric Disorder / 신경정신의학

Objectives@#Liraglutide is a glucagon-like-peptide-1 receptor agonist which has been used as an anti-obesity drug. It was reported that patients might develop or worsen suicidal ideas and/or depression during liraglutide treatment, especially when it comes to patients with a psychiatric disorder. The purpose of this study was to evaluate the effectiveness and safety of liraglutide, especially in terms of the psychiatric adverse effects. @*Methods@#A retrospective chart review study was conducted on psychiatric patients prescribed liraglutide for more than one month from September 2018 to September 2020. Based on their medical records, we investigated the change in the weight and body mass index (BMI) of patients from the baseline to 6 months of receiving liraglutide treatment. Information on the adverse effects was also obtained, including psychiatric adverse effects such as insomnia, anxiety, depression, and suicidal ideation. A mixed linear model was used for assessing the time effect on change in weight and BMI. @*Results@#A total of 24 patients were included in the current study, and the most common psychiatric diagnosis included major depressive disorder (n=13, 54.2%). There was a significant change in weight (F=6.127, p=0.001) and BMI (F=6.749, p<0.001) during the liraglutide treatment. Worsening of depression and anxiety occurred in one patient but improved after the adjustment of psychiatric medications. @*Conclusion@#The current study found that liraglutide treatment in patients with a psychiatric disorder can be a safe and effective intervention for weight reduction.

Simplified disease activity changes in real-world practice: a nationwide observational study of seropositive rheumatoid arthritis patients with moderate-to-high disease activity

The objective of this study was to compare changes in the simplified disease activity index (SDAI) between biologic (b) and conventional (c) disease-modifying antirheumatic drugs (DMARD) users with seropositive rheumatoid arthritis (RA) in daily clinical practice. Methods: This was a nationwide multicenter observational study. Patients who had three or more active joint counts and abnormal inf lammatory marker in blood test were enrolled. The selection of DMARDs was determined by the attending rheumatologist. Clinical parameters, laboratory findings, and Health Assessment Questionnaire (HAQ) scores were obtained at baseline and at 6 and 12 months. Serial SDAI changes and clinical remission rate at 6 and 12 months were assessed. Results: A total of 850 patients participated in this study. The mean baseline SDAI score in bDMARD group was higher than that in cDMARD group (32.08 ± 12.98 vs 25.69 ± 10.97, p < 0.0001). Mean change of SDAI at 12 months was –19.0 in the bDMARD group and –12.6 in the cDMARD group (p < 0.0001). Clinical remission rates at 12 months in bDMARD and cDMARD groups were 15.4% and 14.6%, respectively. Patient global assessment and HAQ at 12 months were also significantly improved in both groups. Multivariate logistic regression showed that baseline HAQ score was the most notable factor associated with remission. Conclusions: There was a significant reduction in SDAI within 12 months after receiving DMARDs in Korean seropositive RA patients irrespective of bDMARD or cDMARD use in real-world practice. Clinical remission was achieved in those with lower baseline HAQ scores.

How many emergency medicine residents reselect their specialty if they could?

Objective@#The 2019 Korean Emergency Medicine Residents Survey (KEMRS) is the first survey by the Korean Society of Emergency Medicine (KSEM) on the comprehensive satisfaction of their residents. Satisfaction is important not only for the personal well-being of the residents but also for patient safety. @*Methods@#A total of 622 emergency medicine residents were surveyed, using both a paper and email questionnaire from May to August of 2019. Factors related to satisfaction were analyzed. @*Results@#Of the responders, 66% said they would reapply for the emergency specialty and 51% said that they would reselect the same training hospital. The group of residents who said they would choose emergency medicine again felt that their expectations had been met and that they were comfortable with the choice of the specialty. They felt that the factors of satisfaction with their shift schedule and personal health played a more important role in their reselection of the training hospital than the workload. @*Conclusion@#The satisfaction levels of the Korean emergency residents were low. Thus, training hospitals should provide a reasonable working environment to increase their satisfaction. Also, it is important to create an environment where residents can feel rewarded and proud of the work they do.

Effectiveness and Safety of Liraglutide Treatment in Patients with a Psychiatric Disorder / 신경정신의학

Objectives@#Liraglutide is a glucagon-like-peptide-1 receptor agonist which has been used as an anti-obesity drug. It was reported that patients might develop or worsen suicidal ideas and/or depression during liraglutide treatment, especially when it comes to patients with a psychiatric disorder. The purpose of this study was to evaluate the effectiveness and safety of liraglutide, especially in terms of the psychiatric adverse effects. @*Methods@#A retrospective chart review study was conducted on psychiatric patients prescribed liraglutide for more than one month from September 2018 to September 2020. Based on their medical records, we investigated the change in the weight and body mass index (BMI) of patients from the baseline to 6 months of receiving liraglutide treatment. Information on the adverse effects was also obtained, including psychiatric adverse effects such as insomnia, anxiety, depression, and suicidal ideation. A mixed linear model was used for assessing the time effect on change in weight and BMI. @*Results@#A total of 24 patients were included in the current study, and the most common psychiatric diagnosis included major depressive disorder (n=13, 54.2%). There was a significant change in weight (F=6.127, p=0.001) and BMI (F=6.749, p<0.001) during the liraglutide treatment. Worsening of depression and anxiety occurred in one patient but improved after the adjustment of psychiatric medications. @*Conclusion@#The current study found that liraglutide treatment in patients with a psychiatric disorder can be a safe and effective intervention for weight reduction.

Standardized, musculoskeletal ultrasonographic reference values for healthy Korean adults

BACKGROUND/AIMS@#To define standard reference values for musculoskeletal ultrasonography (MSUS) in Korea.@*METHODS@#A total of 251 healthy adults were recruited for this study. Ultrasonography was performed by experienced rheumatologists who had undergone four appropriate training programs in Korea. A General Electric LOGIQ electronic ultrasound device fitted with a 12 MHz linear transducer was employed. Mean values ± standard deviations (SDs) were defined as standard reference values. Intraclass correlation coefficients was employed to evaluate the extent of inter- and intraobserver agreement when MSUS measurements were made.@*RESULTS@#The 251 study participants included 122 males. Mean subject age was 28.6 years. The average bone-to-capsule distance of the right-side second and third metacarpophalangeal (MCP) joints were 0.68 and 0.72 mm respectively, and those of the left-side joints 0.62 and 0.68 mm. The cartilage thicknesses of the right-side second and third MCP joints were 0.55 and 0.55 mm, and those of the left-side joints were 0.55 and 0.56 mm, respectively. The bone-to-capsule distances of the right and left wrists were 0.80 and 0.82 mm. In 12.4% of participants (31/251), the erosion score of the humeral head was 1.71. In the right-side knee joint, mean cartilage thicknesses of the medial and lateral condyles were 1.86 and 2.03 mm in longitudinal scans. High overall interobserver agreement was evident after appropriate training that included instruction on standard MSUS methodology.@*CONCLUSIONS@#We defined standard reference values for MSUS in healthy Korean adults. The reliabilities of interobserver agreements were high after appropriate training program.

Biomechanical demands comparison in 119 emergency medical services activities when using manual and powered stretcher carts: a scenario-based randomized cross-over simulation study

OBJECTIVE@#The purpose of this study was to compare the biomedical demands between a manual stretcher cart (Manual Cot) and a novel powered stretcher cart (Power Cot) during simulated routine stretcher handling activities.@*METHODS@#A randomized cross-over design mannequin simulation study was planned. Fourteen participants sequentially performed routine stretcher handling tasks, including unloading, lowering, raising, and loading tasks with the Manual Cot and Power Cot. The biomechanical workload of each participant was assessed by measuring the muscle activity of four muscles (bilateral L4/5 erector spinae and rectus femoris) through an 8-channel electromyogram (EMG) measurement system by attaching the surface EMG. The time required to perform each task was measured, and after the end of the simulation, the participants were given a subjective questionnaire consisting of seven items (five-point Likert scale) on the usefulness and usability of the two stretcher carts.@*RESULTS@#Fourteen participants, six males and eight females, performed four routine stretcher handling scenarios. The median total task times for the Manual Cot and Power Cot were similar (95 seconds; range, 49-105 vs. 94 seconds; range, 84–140; P=0.063). For the lowering, raising, and loading tasks, the effects of Power Cot were significantly lower than the normalized muscle voluntary contraction (%) cumulative sum of the back or thigh (P<0.05). Compared to Manual Cot, the use of Power Cot resulted in a decrease in total muscle activity of 18.0–63.5% in the back muscles and 6.7-83.9% in the thigh muscles during the task simulation. The participants preferred the Power Cot in terms of usefulness in subjective perceptions.@*CONCLUSION@#This simulation study identified that the Power Cot reduced the physical stress of emergency medical services workers without any significant performance time delay when performing stretcher-handling activities.