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1.
Article in English | WPRIM | ID: wpr-916999

ABSTRACT

Mitral regurgitation (MR) is the most common heart disease in small-breed dogs. Mitral repair, which comprise artificial chorda tendineae implantation and mitral annuloplasty, has become the mainstay of treatment in the veterinary field. We report on two small dogs who underwent mitral repair surgery for MR. A Hegar dilator was used during mitral annuloplasty for accurate and reproducible surgery. In both cases, mitral regurgitant flow almost disappeared after surgery, and clinical signs improved. The treatment regimen was terminated 3 months after the surgery. We concluded that using a Hegar dilator may facilitate mitral valve repair surgery.

2.
Journal of Stroke ; : 166-175, 2022.
Article in English | WPRIM | ID: wpr-915930

ABSTRACT

Antithrombotic therapy is a cornerstone of acute ischemic stroke (AIS) management and secondary stroke prevention. Since the first version of the Korean Clinical Practice Guideline (CPG) for stroke was issued in 2009, significant progress has been made in antithrombotic therapy for patients with AIS, including dual antiplatelet therapy in acute minor ischemic stroke or high-risk transient ischemic stroke and early oral anticoagulation in AIS with atrial fibrillation. The evidence is widely accepted by stroke experts and has changed clinical practice. Accordingly, the CPG Committee of the Korean Stroke Society (KSS) decided to update the Korean Stroke CPG for antithrombotic therapy for AIS. The writing members of the CPG committee of the KSS reviewed recent evidence, including clinical trials and relevant literature, and revised recommendations. A total of 35 experts were invited from the KSS to reach a consensus on the revised recommendations. The current guideline update aims to assist healthcare providers in making well-informed decisions and improving the quality of acute stroke care. However, the ultimate treatment decision should be made using a holistic approach, considering the specific medical conditions of individual patients.

3.
Article in Korean | WPRIM | ID: wpr-901492

ABSTRACT

Central obesity carries more metabolic risks compared with total obesity assessed by Body mass index (BMI). Also, there’s paradoxical relationship between BMI and all-cause mortality in overweight group (23 kg/㎡ ≤ BMI < 25 kg/㎡). The aim of this study is to assess relationship between waist-to-height ratio (WHtR) and lifestyle-related diseases such as metabolic syndrome, hypertension, and type 2 diabetes in overweight group, and to find the most predictable and useful obesity index for screening lifestyle-related diseases.A total of 3,994 overweight (23 kg/㎡ ≤ BMI < 25 kg/㎡) adults from the Korea National Health and Nutrition Examination Survey, 2013-2015 (KNHANES VI) were included. We assessed the relationship between WHtR and metabolic syndrome components using multiple regression analysis, and assessed the relationship between abdominal obesity (WHtR ≥ 0.5) and lifestyle-related diseases using complex samples logistic regression analysis. Also, to find the most useful index to predict lifestyle-related diseases, we calculated the areas under the Receiver operating characteristic (ROC) curves.WHtR was significantly related to metabolic syndrome components. Odds ratios of metabolic syndrome, hypertension and type 2 diabetes were 2.187, 1.445, 2.463 in abdominal obese group (WHtR ≥ 0.5), respectively. Area under the curve of WHtR was the most significantly highest among those of obesity indices.WHtR is a simple and useful obesity index to predict lifestyle-related diseases in overweight Korean adults. Further investigations for other obesity indices are needed to predict lifestyle-related diseases better.

4.
Keimyung Medical Journal ; : 98-107, 2021.
Article in English | WPRIM | ID: wpr-917026

ABSTRACT

In Korea, skipping breakfast is of concern as an unhealthy dietary habit. While the relationship between skipping breakfast and overweight and obesity has been established in children and adolescents in Europe, studies on this topic in Korean adolescents are scarce. Therefore, we investigated the relationship between body mass index (BMI) and skipping breakfast in Korean adolescents. Data from the 13th Korea Youth Risk Behavior Web-based Survey (2017) were analyzed. This anonymous, self-administered online questionnaire examined health behaviors including smoking, drinking, obesity, eating habits, sleep duration, and physical activity in Korean youth. Questions included those on general characteristics, such as economic status, parental education level, etc. This study included data from 56,933 adolescents aged 12–18 years. Skipping breakfast was defined as consuming breakfast fewer than five times per week. BMI, health behaviors, and general characteristics were compared between the breakfast-skipping and control groups. The skipping-breakfast and control groups comprised 25,836 (45.4%) and 31,097 (54.6%) subjects, respectively. BMI was significantly higher in the breakfast-skipping group than that in the control group (21.6 ± 3.24 kg/m2 vs. 21.4 ± 3.26 kg/m2, p < 0.001). Among the normal-weight and overweight groups, 44.9% and 47.3% skipped breakfast, respectively (p < 0.001). After adjusting for health behaviors and general characteristics, the risk of overweight was higher in those who skipped breakfast than that in the control group (odds ratio; 1.125, 95% confidence interval; 1.077–1.176).Skipping breakfast was related to overweight in Korean adolescents. Therefore, longitudinal research is needed to determine whether skipping breakfast is associated with overweight.

5.
Article in Korean | WPRIM | ID: wpr-917024

ABSTRACT

This study was performed to select the proper assessing methods for learning outcomes in undergraduate education of medical humanities (MH), and to evaluate whether student assessments in MH curricula are related to the graduate outcomes (GO)and/or periodic phase outcomes (PO). We searched the reasonable assessing methods for GO and PO of MH curricula of Keimyung University School of Medicine (KUSM). The outcomes are composed of six competencies including patient care, communication, patient support, professionalism, problem solving and research, and self-development. Then, we analyzed whether student assessments carried out during formal MH curricula properly achieved their PO, furthermore their GO. Four competencies including communication, patient support, professionalism, self-development were lightened to be closely related to outcomes for MH. Only the component of problem solving was settled to be related to MH in the competency of problem solving and research. The competency of patient care was excluded from the relationship with MH. The assessing methods for the GO and three PO recommended from educational experts, and there were various available assessing methods based on medical situations and clinical contexts including direct observation of clinical skills, 360 degree feedback, peer review, self-assessment, project-based assessment, portfolio-based assessment, discussion & presentation-based assessment, log-based assessment. For the outcome-achieving from formal MH curricula, the MH programs of phase-1 (1st and 2nd grades) almost accomplished the PO of communication, patient supporting and professionalism, and considerably accomplished the PO of problem solving and self-development. The MH programs of phase-2 (3rd and 4th grades) accomplished considerably their PO as the competencies of professionalism and problem solving, and partially as communication, patient supporting and self-development. However, as only one program, public health law, was provided for MH program in phase-3 (5th and 6th grades), the extra methods to evaluate their MH outcomes are needed. Many assessing methods can be available for the most MH competencies consisting of the GO of KUSM, and the proper assessing methods for each MH competency should be selected based on programs and learning contexts in MH education. While formal MH curricula of the school variously accomplished the MH competencies of GO according to periodic phases of curricula, it is recommended to enhance the feasibility and effectiveness of evaluation for GO in MH curricula of the school.

6.
Article in Korean | WPRIM | ID: wpr-917023

ABSTRACT

Coronavirus disease 2019 (COVID-19) vaccination is necessary to prevent infection, morbidity, and mortality. In addition to the usual post-inoculation hypersensitivity reactions including headaches, muscle and joint pain, and fever, especially after the second shot, the mRNA vaccine has risk of inflammation in the heart and heart lining of some recipients, mostly younger people. And the adenovirus vector vaccine can induce rare immune thrombocytopenia. Vaccination should be encouraged according to the information about the effectiveness and safety in individual situation.

7.
Article in Korean | WPRIM | ID: wpr-916415

ABSTRACT

Purpose@#To evaluate the efficacy of early neuroimaging in patients with acute isolated 3rd, 4th, and 6th nerve palsy. @*Methods@#Neuroimaging tests were performed in patients >50 years old with acute isolated 3rd, 4th, and 6th nerve palsy. The frequencies and types of abnormal findings were evaluated. All patients were divided into ischemic and non-ischemic groups and differences in clinical characteristics between groups were analyzed. @*Results@#Of the 55 patients, nine (16.4%) had abnormal findings on brain imaging. Among 26 patients with 6th nerve palsy, four (15.4%) were found to have a cause including brain tumor, cerebrovascular compression, carotid cavernous fistula. Superior oblique muscle atrophy was found in two of 19 patients (10.5%) with 4th nerve palsy. Three of 10 patients (30%) with 3rd nerve palsy had abnormal findings and there were cases of pituitary apoplexy, posterior communicating, and cerebrovascular compression. @*Conclusions@#In patients with acute isolated oculomotor paralysis, early neuroimaging tests play an important role in differential diagnosis and evaluation of causes that may lead to mortality.

8.
Article in Korean | WPRIM | ID: wpr-916306

ABSTRACT

A 48-year-old man came with a left-sided headache that was compatible with diagnostic criteria of cluster headache. Left oculomotor nerve palsy developed 2 weeks after headache onset. Magnetic resonance imaging showed wall thickening and enhancement by contrast material in the lateral aspect of the left cavernous sinus, consistent with a possible inflammatory lesion. The patient reported the almost complete remission of the pain and diplopia after steroid therapy. We speculate that Tolosa-Hunt syndrome should be included as a cause of cluster-like headaches.

9.
Article in English | WPRIM | ID: wpr-875209

ABSTRACT

Background@#The incidence of depression in middle-aged adults is increasing and has been affected by physiological changes and various sociodemographic factors. The present study aimed to examine the longitudinal relationship between depression and changes in the family developmental stage based on child independence in South Korean middle-aged adults living with children. @*Methods@#This study included 1,593 people in the age group of 45-64 years who participated in the first survey of the Korean longitudinal study of aging in 2006. Participants did not have depression, lived with unmarried children, and responded to Center for Epidemiologic Studies Depression 10 scale and child-related questions in the 7th survey (2018). The chi-squared test, t-test, and Mann-Whitney U test were used to compare differences in depression according to general characteristics and family developmental stage. The generalized estimating equation model was used to longitudinally examine the effect of changes in the family developmental stage on the incidence of depression from the 1st to the 7th survey. @*Results@#Changes in the family developmental stage based on child independence have a significant effect on the incidence of depression in middle-aged adults (P=0.000). In addition, in the generalized estimating equation model, the longitudinal association between changes in the family developmental stage and the incidence of depression was confirmed. @*Conclusions@#Therefore, confirming the independence of children as an important factor is essential in the management of depression in middle-aged adults.

10.
Article in Korean | WPRIM | ID: wpr-875043

ABSTRACT

More than 50% of all patients with ischemic stroke initially present with mild symptoms. Despite the mild clinical presentation, a high percentage of these patients develop stroke progression with consequent disability, recurrent stroke, or death at follow-up. Intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 hours has been proven to be an effective treatment for acute ischemic stroke, but the risk-benefit ratio of this therapeutic approach remains still unclear in patients with mild stroke. Many patients with mild stroke are frequently excluded from thrombolysis. Large artery occlusion is an important predictor of early neurological deterioration or poor outcomes in patients with mild ischemic stroke. However, current guidelines do not recommend endovascular thrombectomy in patients with National Institutes of Health Stroke Scale score of <6 points. Some previous retrospective cohort studies have reported that endovascular thrombectomy showed promising results in cases of acute mild ischemic stroke with large vessel occlusion. Treatment decisions in patients with mild ischemic stroke should be individualized depending on clinical and radiological features. In this review, we discuss the prognosis of mild strokes, efficacy of intravenous thrombolysis and endovascular thrombectomy, and the role of neurovascular imaging in treatment decision making in this patient population.

11.
Article in English | WPRIM | ID: wpr-874537

ABSTRACT

Background@#Protease-activated protein-2 (PAR2) has been reported to regulate hepatic insulin resistance condition in type 2 diabetes mice. However, the mechanism of lipid metabolism through PAR2 in obesity mice have not yet been examined. In liver, Forkhead box O1 (FoxO1) activity induces peroxisome proliferator-activated receptor γ (PPARγ), leading to accumulation of lipids and hyperlipidemia. Hyperlipidemia significantly influence hepatic steatoses, but the mechanisms underlying PAR2 signaling are complex and have not yet been elucidated. @*Methods@#To examine the modulatory action of FoxO1 and its altered interaction with PPARγ, we utilized db/db mice and PAR2-knockout (KO) mice administered with high-fat diet (HFD). @*Results@#Here, we demonstrated that PAR2 was overexpressed and regulated downstream gene expressions in db/db but not in db+ mice. The interaction between PAR2/β-arrestin and Akt was also greater in db/db mice. The Akt inhibition increased FoxO1 activity and subsequently PPARγ gene in the livers that led to hepatic lipid accumulation. Our data showed that FoxO1 was negatively controlled by Akt signaling and consequently, the activity of a major lipogenesis-associated transcription factors such as PPARγ increased, leading to hepatic lipid accumulation through the PAR2 pathway under hyperglycemic conditions in mice. Furthermore, the association between PPARγ and FoxO1 was increased in hepatic steatosis condition in db/db mice. However, HFD-fed PAR2-KO mice showed suppressed FoxO1-induced hepatic lipid accumulation compared with HFD-fed control groups. @*Conclusion@#Collectively, our results provide evidence that the interaction of FoxO1 with PPARγ promotes hepatic steatosis in mice. This might be due to defects in PAR2/β-arrestin-mediated Akt signaling in diabetic and HFD-fed mice.

12.
Article in Korean | WPRIM | ID: wpr-893788

ABSTRACT

Central obesity carries more metabolic risks compared with total obesity assessed by Body mass index (BMI). Also, there’s paradoxical relationship between BMI and all-cause mortality in overweight group (23 kg/㎡ ≤ BMI < 25 kg/㎡). The aim of this study is to assess relationship between waist-to-height ratio (WHtR) and lifestyle-related diseases such as metabolic syndrome, hypertension, and type 2 diabetes in overweight group, and to find the most predictable and useful obesity index for screening lifestyle-related diseases.A total of 3,994 overweight (23 kg/㎡ ≤ BMI < 25 kg/㎡) adults from the Korea National Health and Nutrition Examination Survey, 2013-2015 (KNHANES VI) were included. We assessed the relationship between WHtR and metabolic syndrome components using multiple regression analysis, and assessed the relationship between abdominal obesity (WHtR ≥ 0.5) and lifestyle-related diseases using complex samples logistic regression analysis. Also, to find the most useful index to predict lifestyle-related diseases, we calculated the areas under the Receiver operating characteristic (ROC) curves.WHtR was significantly related to metabolic syndrome components. Odds ratios of metabolic syndrome, hypertension and type 2 diabetes were 2.187, 1.445, 2.463 in abdominal obese group (WHtR ≥ 0.5), respectively. Area under the curve of WHtR was the most significantly highest among those of obesity indices.WHtR is a simple and useful obesity index to predict lifestyle-related diseases in overweight Korean adults. Further investigations for other obesity indices are needed to predict lifestyle-related diseases better.

13.
Article | WPRIM | ID: wpr-836455

ABSTRACT

The first massive outbreak of coronavirus disease 2019 (COVID-19) in Korea was controlled by fast diagnosis, isolation and triage systems. The development of therapeutic agents and vaccinations are going on, but many studies clarified the nature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this review, we will discuss the characteristics and spreading of SARS-CoV-2, and prognostic factors and diagnosis of COVID-19.

14.
Article in Korean | WPRIM | ID: wpr-834874

ABSTRACT

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headache with reversible vasoconstriction of the cerebral arteries. RCVS has been reported to occur in various clinical settings. However, RCVS triggered by blood transfusion is rare. A 50-year-old woman had severe anemia and received multiple blood transfusions. She developed thunderclap headache after transfusion. Cerebral artery vasoconstrictions were demonstrated by magnetic resonance angiography and transfemoral cerebral angiography. RCVS might be triggered by red blood cell transfusion in patients with severe anemia.

15.
Article | WPRIM | ID: wpr-834840

ABSTRACT

Secondary cluster-like headache has been reported in association with various underlying diseases. A 20-year-old man came with right-sided headache that started 1 month ago. Initially, his headache was compatible with diagnostic criteria of episodic cluster headache. Magnetic resonance imaging showed multiple enhancement lesions in right frontal bone and periorbital area. With bone marrow biopsy, we confirmed that B-lymphoblastic leukemia relapsed. We describe an unusual case with cluster-like headache caused by acute lymphocytic leukemia infiltration of periorbital tissue.

16.
Article | WPRIM | ID: wpr-834820

ABSTRACT

A 46-year-old man presented with a progressive headache lasting for 2 weeks. Initial lumbar puncture revealed a pressure of 31 cm H20 and 30 white cells. His symptoms had worsened despite the treatment of intracranial hypertension. Visual field exam showed marked peripheral constriction and the fundus showed marked papilledema. Cytological analysis of cerebrospinal fluid demonstrated positive for metastatic carcinoma. We report a case of a patient with meningeal carcinomatosis who developed isolated intracranial hypertension with papilledema.

17.
Article | WPRIM | ID: wpr-834764

ABSTRACT

In the mass outbreak of the 2019 novel coronavirus disease pandemic, the Daegu Medical Association managed to control and reduce the number of victims in Daegu successfully. More than 6,000 people were diagnosed in this city within a four-week period, and both medical system breakdown and increasing mortality were imminent. However, we minimized fatalities despite this explosive outbreak in a short time. The collaboration between the Daegu Medical Association and the local government may provide a reference model for overcoming regional outbreaks in the global pandemic era. We can prevent the shortage of medical resources by recruiting volunteer doctors and nurses early through public awareness campaigns. We can overcome the first massive outbreak using several new diagnostic and therapeutic systems such as the drive-through diagnosis system, telephonic counseling for self-quarantine patients by volunteer doctors, and therapeutic living centers. Both sharing the process of collaboration with the public system and summarizing the factors can provide useful information for building effective response systems to cope with the ongoing local outbreak of COVID-19 and any future epidemics of infectious diseases.

18.
Article | WPRIM | ID: wpr-834026

ABSTRACT

Background@#There have been reports of neurolytic transversus abdominis plane (TAP) block using different agents such as alcohol or phenol for the treatment of chronic abdominal pain caused by malignant abdominal wall invasion. However, to date, there have been no reports on neurolytic abdominal wall blocks for pain with non-cancer-related origin in cancer patients. Case: We performed subcostal TAP neurolysis using ethanol in a patient with esophageal cancer with constant pain at the site of gastrostomy. After neurolysis, the patient’s overall pain decreased, with the exception of pain in the medial part of the gastrostomy site. We performed additional rectus sheath neurolysis using ethanol for the treatment of continuous pain at the medial site, and the effect of neurolysis has persisted for over 4 months. @*Conclusions@#Alcohol-based TAP neurolysis and rectus sheath neurolysis provide effective pain control in a cancer patient with chronic treatment-related pain involving the abdominal wall.

19.
Article | WPRIM | ID: wpr-833660

ABSTRACT

Background@#and Purpose: The importance of the specialized management of neurocritical patients is being increasingly recognized. We evaluated the impact of neurointensivist comanagement on the clinical outcomes (particularly the mortality rate) of neurocritical patients admitted to a semiclosed neurocritical-care unit (NCU). @*Methods@#We retrospectively included neurocritical patients admitted to the NCU between March 2015 and February 2018. We analyzed the clinical data and compared the outcomes between patients admitted before and after the initiation of neurointensivist co-management in March 2016. @*Results@#There were 1,785 patients admitted to the NCU during the study period. Patients younger than 18 years (n=28) or discharged within 48 hours (n=200) were excluded. The 1,557 remaining patients comprised 590 and 967 who were admitted to the NCU before and after the initiation of co-management, respectively. Patients admitted under neurointensivist co-management were older and had higher Acute Physiologic Assessment and Chronic Health Evaluation II scores. The 30-day mortality rate was significantly lower after neurointensivist co-management (p=0.042). A multivariate logistic regression analysis demonstrated that neurointensivist co-management significantly reduced mortality rates in the NCU and in the hospital overall [odds ratio=0.590 (p=0.002) and 0.585 (p=0.001), respectively]. @*Conclusions@#Despite the higher severity of the condition during neurointensivist co-management, co-management significantly improved clinical outcomes (including the mortality rate) in neurocritical patients.

20.
Article | WPRIM | ID: wpr-833494

ABSTRACT

Objective@#: The method of approach during transforaminal endoscopic lumbar discectomy (TELD) has been the subject of repeated study. However, the ideal entry point during TELD has not been studied in detail. Therefore, this study investigated the ideal entry point for avoiding complications using computed tomography (CT) scans obtained from patients in the prone position. @*Methods@#: Using CT scans obtained from patients in the prone position, we checked for retroperitoneal or visceral violations and measured the angles of approach with five conventional approach lines drawn on axial CT scans at each disc space level (L2–3, L3–4, and L4–5). We also determined the ideal entry point distance and approach angles for avoiding retroperitoneal or visceral violations.Correlation analysis was performed to identify the patient characteristics related to the ideal entry point properties. @*Results@#: We found that the far lateral approach at the L2–3 level resulted in high rates of visceral violation. However, rates of visceral violation at the L3–4 and L4–5 levels were remarkably low or absent. The ideal angles of approach decreased moving caudally along the spine, and the ideal entry point distances increased moving caudally along the spine. Weight, body mass index (BMI), and the depth of the posterior vertebral line from the skin were positively associated with the distance of the ideal entry point from the midline. @*Conclusion@#: We reviewed the risk of the extreme lateral approach by analyzing rates of retroperitoneal and visceral violations during well-known methods of approach. We suggested an ideal entry point at each level of the lumbar spine and found a positive correlation between the distance of the entry point to the midline and patient characteristics such as BMI, weight, and the depth of the posterior vertebral line from the skin.

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