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Purpose@#Differences in the impact of obesity and metabolic health status on the risk of gallbladder polyp (GBP) remain uncertain. Herein, we aimed to compare the risk of GBP ≥5 mm among individuals with different phenotypes based on obesity and metabolic health status. @*Materials and Methods@#A cohort of 253485 asymptomatic adults who underwent abdominal ultrasonography screening were categorized into the following four groups according to obesity and metabolic health status: 1) metabolically healthy non-obese (MHNO), 2) metabolically unhealthy and non-obese (MUNO), 3) metabolically healthy but obese (MHO), and 4) metabolically unhealthy obese (MUO). @*Results@#The prevalences of GBP ≥5 mm were 2.4%, 3.1%, 3.7%, and 4.0% in the MHNO, MUNO, MHO, and MUO groups, respectively. The multivariable-adjusted odds ratio (OR) values for prevalence of GBP ≥5 mm by comparing the MUNO, MHO, and MUO with the MHNO group were 1.11 [95% confidence interval (CI), 1.04–1.19], 1.30 (95% CI, 1.15–1.47), and 1.37 (95% CI, 1.28– 1.45), respectively. The risk of GBP ≥5 mm in the MHO group was significantly higher than that in the MUNO group, but not significantly different from that in the MUO group. @*Conclusion@#Obesity and metabolic unhealthiness appear to be independent risk factors for the prevalence of GBP, and the impact of obesity is greater than that of metabolic unhealthiness, suggesting that maintaining both normal weight and metabolic health may help reduce the risk of GBP.
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Purpose@#To report our experience of fertility preservation (FP) in female cancer patients. @*Materials and Methods@#We retrospectively analyzed the medical records of female who underwent elective oocyte or embryo cryopreservation before cancer treatment between January 2015 and December 2020 at Asan Medical Center. We analyzed the type of cancer, the rate of reuse of cryopreserved oocytes or embryos, and fertility outcomes such as the resumption of menstruation or pregnancy. @*Results@#A total of 174 patients underwent 182 oocyte retrieval cycles after controlled ovarian stimulation for oocyte or embryo cryopreservation. The median age of patients was 33.0 (range 19–46) years, and the patients were most unmarried female (65.52%). The majority of patients were diagnosed with breast cancer (78.16%), and the remaining were diagnosed with gastrointestinal (6.33%) and hematologic malignancies (5.75%). The maturation rate of oocyte cryopreservation was 83.33%, and the fertilization rate of embryo cryopreservation was 72.07%. Of the 57 patients currently not undergoing cancer treatment, 34 resumed menstruating and 19 (33.33%, 19/57) returned to attempt a pregnancy. Among them, five patients succeeded in natural pregnancy.Eleven patients received frozen-thawed embryo transfer, and four patients succeeded in becoming pregnant (36.36%, 4/11). Only 6.3% of patients returned to use their gametes, and 93.7% of gametes are still in storage. @*Conclusion@#FP in cancer patients should be considered before cancer treatment. Through continuous research on oncofertility, it is necessary to consider how to increase the return rate and provide appropriate information to cancer patients of reproductive age.
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BACKGROUND@#To achieve optimal bone marrow engraftment during bone marrow transplantation, migration of donor bone marrow cells (BMCs) toward the recipient’s bone marrow is critical. Despite the enhanced engraftment of BMCs by co-administration of mesenchymal stem cells (MSCs), the efficiency can be variable depending on MSC donor. The purpose of this study is to examine the functional heterogeneity of tonsil-derived MSCs (TMSCs) and to identify a marker to evaluate efficacy for the enhancement of BMC migration. @*METHODS@#To examine the donor-to-donor variation of TMSCs in potentiating BMC migration, we isolated TMSCs from 25 independent donors. Transcriptome of TMSCs and proteome of conditioned medium derived from TMSC were analyzed. @*RESULTS@#Enhanced BMC migration by conditioned medium derived from TMSCs was variable depending on TMSC donor. The TMSCs derived from 25 donors showed distinct expression profiles compared with other cells, including fibroblasts, adipose-derived MSCs and bone marrow–derived MSCs. TMSCs were distributed in two categories: high- and low-efficacy groups for potentiating BMC migration. Transcriptome analysis of TMSCs and proteome profiles of conditioned medium derived from TMSCs revealed higher expression and secretion of matrix metalloproteinase (MMP) 1 in the high-efficacy group. MMP1 knockdown in TMSCs abrogated the supportive efficacy of conditioned medium derived from TMSC cultures in BMC migration. @*CONCLUSION@#These data suggest that secreted MMP1 can be used as a marker to evaluate the efficacy of TMSCs in enhancing BMC migration. Furthermore, the strategy of analyzing transcriptomes and proteomes of the MSCs may be useful to set the standard for donor variation.
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Background/Aims@#We evaluated nailfold capillaroscopy (NFC) of interstitial pneumonia with autoimmune features (IPAF) and compared it with that of patients with connective tissue disease-interstitial lung disease (CTD-ILD) and idiopathic interstitial pneumonia (IIP). @*Methods@#Patients with newly diagnosed as ILD were evaluated using NFC. Baseline demographic, clinical, serological, and high-resolution CT findings were collected. NFC was semi-quantitatively scored with six domains ranging from 0 to 18. In addition, the overall patterns (sclerodermaon-scleroderma patterns) were determined. @*Results@#A total of 81 patients (31 with CTD-ILD, 18 with IPAF, and 32 with IIP) were included. The non-specific interstitial pneumonia pattern was the most common ILD pattern in the CTD-ILD and IPAF groups, whereas the usual interstitial pneumonia pattern was the most common in the IIP group. The semi-quantitative score of the CTD-ILD group was higher than that of the IPAF or IIP groups (5.8 vs 4.2 vs 3.0, p < 0.001, respectively). Giant capillaries and haemorrhages were more frequently present in the CTD-ILD and IPAF groups than in the IIP group. A scleroderma pattern was present in 27.8% of the IPAF group, whereas none of the IIP patients showed a scleroderma pattern. @*Conclusions@#NFC findings may be useful in classifying patients with ILD into CTD-ILD/IPAF/IIP.
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Background/Aims@#Obstructive sleep apnea (OSA) is prevalent in older patients with idiopathic pulmonary fibrosis (IPF); however, it is underrecognized. OSA is characterized by intermittent hypoxia (IH) and sleep fragmentation. In this study, we evaluated the effects of IH in an older mouse model of bleomycin-induced lung fibrosis. @*Methods@#Bleomycin-induced mice (C57BL/6, female) were randomly divided into four groups of young vs. old and room air (RA)-exposed vs. IH-exposed. Mice were exposed to RA or IH (20 cycles/h, FiO2 nadir 7 ± 0.5%, 8 h/day) for four weeks. The mice were sacrificed on day 28, and blood, bronchoalveolar lavage (BAL) fluid, and lung tissue samples were obtained. @*Results@#The bleomycin-induced IH-exposed (EBI) older group showed more severe inflammation, fibrosis, and oxidative stress than the other groups. The levels of inflammatory cytokines in the serum and BAL fluid increased in the EBI group. Hydroxyproline levels in the lung tissue increased markedly in the EBI group. @*Conclusions@#This study demonstrates the possible harmful impact of OSA in an elderly mouse model of lung fibrosis. This study further suggests that older patients with IPF and OSA may be more of a concern than younger patients with IPF. Further research is required in this area.
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Background/Aims@#We aimed to determine whether hepatitis B virus (HBV) or hepatitis C virus (HCV) infection remains an important risk factor for gallbladder polyps (GBPs) in the current context of reduced prevalence of these infections. @*Methods@#The cohort included 392,913 asymptomatic adults who underwent abdominal ultrasonography (US). @*Results@#The prevalence of GBP sized ≥ 5 mm, ≥ 10 mm, and overall (< 5, 5–9 and ≥ 10 mm) was 2.9%, 0.1%, and 12.8%, respectively. The prevalence of hepatitis B surface antigen (HBsAg), hepatitis B core antibody (HBcAb), and hepatitis C antibody (anti-HCV) positivity was 3.2%, 26.7%, and 0.1%, respectively. The GBP risk was significantly increased in HBsAg-positive individuals, with an adjusted odds ratio of 1.66 (95% confidence interval, 1.49–1.85) for GBP ≥ 5 mm, 2.39 (1.53–3.75) for GBP ≥ 10 mm, and 1.49 (1.41–1.59) for overall, whereas there was no significant association between anti-HCV positivity and GBP risk. The GBP risk did not increase significantly in individuals who tested negative for HBsAg but positive for HBcAb. @*Conclusions@#The presence of HBsAg may be an independent risk factor for GBP development in the current context of a indecreasing prevalence of HBsAg positivity. A more comprehensive evaluation of GBP during abdominal US surveillance of HBsAg-positive individuals may be necessary.
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Colonic interposition is the main procedure used in esophageal reconstruction. We report a rare case of simultaneous treatment of an anastomotic site stricture and a neoplasm in the interpositioned colon. A 69-year-old female visited our outpatient clinic with symptoms of progressive dysphagia for 1 year. At the age of 30 years, the patient underwent esophagectomy with retrosternal colonic interposition because of severe esophageal burns after chemical ingestion. Upper gastrointestinal endoscopy revealed stricture at the anastomosis site and a 10-mm flat elevated high-grade dysplasia in the interpositioned colon. First, through-the-scope balloon dilatation was performed for strictures. However, stenosis was observed during the second upper gastrointestinal endoscopy session.Therefore, a second session of through-the-scope balloon dilatation was performed, and simultaneously, endoscopic submucosal dissection was also successfully performed. After 2 months of follow-up, stenosis persisted; consequently, balloon dilatation was performed. No recurrence of neoplasm was confirmed endoscopically. Through-the-scope balloon dilatation of the stricture site and simultaneous endoscopic submucosal dissection of the neoplasm in the interpositioned colon were successfully performed.
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Nodular histiocytic/mesothelial hyperplasia (NHMH) is a very rare condition. It is generally thought to be associated with repeated mechanical or chemical stimulation. This study reported NHMH with papillary growth pattern in the ovary following high-intensity focused ultrasound (HIFU) treatment for uterine leiomyoma and adenomyosis. A 48-year-old female, who had a history of undergoing HIFU treatment 7 times for adenomyosis and leiomyoma of the uterus 6 months ago, was referred to the hospital. After the hysterectomy and right salpingo-oophorectomy, the patient was confirmedly diagnosed with nodular histiocytic and mesothelial hyperplasia with the papillary growth pattern of the right ovary. This benign reactive inflammatory lesion of the mesothelium mimicking malignancy must be kept in mind to avoid unnecessary treatment.
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Background@#Some working conditions may pose a higher physical or psychological demand to pregnant women leading to increased risks of pregnancy complications. @*Objectives@#We assessed the association of woman's employment status and the industrial classification with obstetric complications. @*Methods@#We conducted a national population study using the National Health Information Service database of Republic of Korea. Our analysis encompassed 1,316,310 women who experienced first-order live births in 2010–2019. We collected data on the employment status and the industrial classification of women, as well as their diagnoses of preeclampsia (PE) and gestational diabetes mellitus (GDM) classified as A1 (well controlled by diet) or A2 (requiring medication). We calculated odds ratios (aORs) of complications per employment, and each industrial classification was adjusted for individual risk factors. @*Results@#Most (64.7%) were in employment during pregnancy. Manufacturing (16.4%) and the health and social (16.2%) work represented the most prevalent industries. The health and social work exhibited a higher risk of PE (aOR = 1.11, 95% confidence interval [CI]: 1.03–1.21), while the manufacturing industry demonstrated a higher risk of class A2 GDM (1.20, 95% CI: 1.03–1.41) than financial intermediation. When analyzing both classes of GDM, women who worked in public administration and defense/social security showed higher risk of class A1 GDM (1.04, 95% CI: 1.01, 1.07). When comparing high-risk industries with nonemployment, the health and social work showed a comparable risk of PE (1.02, 95% CI: 0.97, 1.07). @*Conclusion@#Employment was associated with overall lower risks of obstetric complications. Health and social service work can counteract the healthy worker effect in relation to PE. This highlights the importance of further elucidating specific occupational risk factors within the high-risk industries.
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Laundry detergent pod (LDP) exposure has been reported to be fatal in children younger than 2 years, leading to respiratory or central nervous system depression. While gastrointestinal irritation is the most common symptom, there are reported cases of severe acidosis with respiratory depression or pneumonia, resulting in mortality. To our best knowledge, there is no report on a case of LDP exposure presenting with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation support. Here, we present a case of a child with severe acute respiratory distress syndrome following LDP exposure, who was successfully treated with veno-pulmonary extracorporeal membrane oxygenation and steroids.
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BACKGROUND/OBJECTIVES@#The skin is the outermost organ of the human body and plays a protective role against external environmental damages, such as sunlight and pollution, which affect anti-oxidant defenses and skin inflammation, resulting in erythema or skin reddening, immunosuppression, and epidermal DNA damage.MATERIALS/METHODS: The present study aimed to investigate the potential protective effects of red orange complex H extract (ROC) against ultraviolet (UV)-induced skin photoaging in Skh:HR-2 mice. ROC was orally administered at doses of 20, 40, and 80 mg/ kg/day for 13 weeks, along with UV irradiation of the mice for 10 weeks. @*RESULTS@#ROC improved UV-induced skin barrier parameters, including erythema, melanin production, transepidermal water loss, elasticity, and wrinkle formation. Notably, ROC inhibited the mRNA expression of pro-inflammatory cytokines (interleukin 6 and tumor necrosis factor α) and melanogenesis. In addition, ROC recovered the UV-induced decrease in the hyaluronic acid and collagen levels by enhancing genes expression. Furthermore, ROC significantly downregulated the protein and mRNA expression of matrix metalloproteinases responsible for collagen degradation. These protective effects of ROC against photoaging are associated with the suppression of UV-induced phosphorylation of c-Jun NH2-terminal kinase and activator protein 1 activation. @*CONCLUSIONS@#Altogether, our findings suggest that the oral administration of ROC exerts potential protective activities against photoaging in UV-irradiated hairless mice.
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Necrotizing enterocolitis is a severe inflammatory disease of the intestine and is the main cause of death in infants, mostly occurring in premature infants. Intestinal obstruction may occur during the medical treatment of necrotizing enterocolitis. A common cause of intestinal obstruction is intestinal stricture, and entero-enteric fistulas may form in the proximal portion of the intestinal stricture. Several mechanisms may be suggested for the development of entero-enteric fistula. Intestinal ischemia and subsequent necrosis do not become intestinal perforation over time, causing an inflammatory reaction, and are attached to the adjacent intestine, forming a fistula. Alternatively, a subacute perforation may be sealed off by the adjacent intestine, resulting in fistula formation. Entero-enteric fistulas are closely related to distal stricture and occurs when there is a localized perforation rather than a generalized perforation. Fistulas can be diagnosed via contrast enema examination or distal loopogram, and surgical resection is required. Here, I report a case of a preterm infant with an entero-colonic fistula secondary to necrotizing enterocolitis. The patient had abdominal distention and bloody stool and was confirmed to have rotavius enteritis. Plain abdominal radiographs showed pneumatosis intestinalis. The patient received medical treatment for necrotizing enterocolitis. While the symptoms were improving, he vomited again, and intestinal obstruction was suspected. Gastrografin enema was performed due to intestinal obstruction, and an enterocolonic fistula was found.
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Trigeminal neuralgia (TN) is a highly disabling disorder characterized by very severe, brief, electric shocks, like recurrent episodes of facial pain. New diagnostic criteria classifying TN on the basis of the presence of trigeminal neurovascular conflict or an underlying neurological disorder can help better characterize patients and determine treatments. Magnetic resonance imaging using specific sequences should be a part of the diagnostic workup to detect a possible neurovascular contact and exclude secondary causes. Carbamazepine and oxcarbazepine are drugs of first choice for long-term treatment, whereas microvascular decompression is the first-line surgical management of medically refractory patients. This review aimed to review the classification, clinical features, pathophysiology, diagnostic approaches, and management of TN.
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Spinal and bulbar muscular atrophy (Kennedy disease) is an X-linked, adult-onset motor neuron disease characterized by slow, progressive weakness of the bulbar and extremity muscles with CAG triplet repeat expansion in the androgen receptor gene. Hirayama disease (HD) is characterized by the juvenile onset of asymmetric weakness and amyotrophy of the hand and is most common in males in Asia. We report a patient with atypical Kennedy disease presenting with asymmetric hand weakness and atrophy typical of HD.
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Background@#The purpose of this study was to describe the distinct cognitive trajectories for 8 years according to living arrangement among community-dwelling older adults using the Korean longitudinal study of ageing. @*Methods@#We analyzed data from a final sample of 3,049 community-dwelling older adults aged 65 years or older who participated in at least three cognitive function measures in an 8-year period (2012-2020). Cognitive function was assessed by Korean mini mental state examination. Latent class growth model analysis was applied to determine the number and shape of trajectories of older adults according to living arrangement.Multinomial logistic regression analysis was used to determine risk factors for cognitive function trajectories. @*Results@#We identified five trajectory patterns in cognitive function among older adults living alone; ‘high-stable (35.6%)’, ‘high-declining (32.5%)’, ‘moderate-steep declining (6.2%)’, ‘low-stable (18.9%)’, and ‘low declining (6.8%)’. In older adults living with family, there were four trajectory patterns; ‘high-stable (46.4%)’, ‘high-declining (32.0%)’, ‘low-stable (15.9%)’, and ‘low-declining (5.7%)’. Age, instrumental activities of daily living, and depression were common factors of cognitive changes in both older adults living alone and those living with family members. However, monthly incomes was only associated with the risk of cognitive function in older adults living alone. @*Conclusions@#We found that cognitive function trajectories among older adults may differ depending on the type of living arrangement. Therefore, further studies and health policies are required for avoiding cognitive impairment by living arrangement among older adults based on the results of this study.
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Background@#Obesity is a major cause of diabetes and hypertension. Previous studies have analyzed the effects of obesity on diabetes and hypertension by comparing non-obese and obese groups. Here, we investigated the effects of obesity type through comparison between obesity types in obese adults. @*Methods@#The sample comprised 8,914 adults, classified as obese according to body mass index criteria or waist circumference criteria, selected from the Korean National Health and Nutrition Examination Survey (2016-2020). Obesity was classified as abdominal obesity-only, general obesity-only, and abdominal and general obesity. The effects of obesity type on diabetes and hypertension were analyzed using logistic regression model. @*Results@#12.78% of participants exhibited abdominal obesity-only, 22.35% had general obesity-only, and 64.78% had both types. The proportion of patients aged ≥60 years was 57.52% in the abdominal obesity-only group, while 17.12% in the general obesity-only group. The general obesity-only group had a lower incidence of diabetes than the abdominal obesity-only group (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.47-0.77), and the abdominal and general obesity group had a higher incidence of hypertension than the abdominal obesity-only group (OR, 1.82; 95% CI, 1.54-2.15). @*Conclusions@#Abdominal obesity has a stronger association with diabetes than general obesity, and the risk of hypertension is greatest when both obesity types coexist. Individuals with abdominal obesity-only are likely to be excluded from obesity management, especially when aged ≥60 years. The risk of hypertension is much greater when abdominal and general obesity coexist, emphasizing the need to use both body mass index and waist circumference to define obesity.
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The ABO blood type was discovered by Karl Landsteiner in 1901. The frequency of occurrence of the ABO blood type in Korea was reported in the journal of the Joseon Medical Association in 1922. The status of 54 transfusions at one medical clinic in 1924 was reported at a medical congress in 1925. Many direct transfusion cases in Korea were identified by a literature search for articles published during the 1920s.
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Background@#Optimizing endotracheal tube (ETT) shape is important for successful videolaryngoscope-aided intubation. This prospective randomized controlled study aimed to compare the tube-handling time between a C-curved and hockey stick-shaped stylet in infants and neonates using the C-MAC® videolaryngoscope Miller blade. @*Methods@#A total of 110 infants (age < 1 year) were randomly assigned to either the hockey stick-curved stylet group (group H, n = 53) or the C-curved stylet group (group C, n = 57). The primary outcome was tube handling time after glottis visualization and the secondary outcomes were the total intubation time, incidence of successful intubation, initial tube tip location at the laryngeal inlet, and numerical rating scale for ease of intubation. @*Results@#Tube insertion time and total intubation duration (both in seconds) were significantly shorter in group C than in group H (13.3 ± 8.9 vs. 25.1 ± 27.0, P = 0.002; 19.9 ± 9.4 vs. 32.8 ± 27.1, P = 0.001, respectively). Group C displayed a higher rate of intubation success within 30 s than group H (87.7% vs. 69.8%, P = 0.029). The initial tube tip was located at the center in 34 children in group C (59.6%) and 12 children in group H (26.1%, P < 0.001). Laryngoscope operators rated intubation as easier when provided with a C-curved stylet. @*Conclusions@#In neonates and infants, modification of the ETT shape into a C-curve may reduce tube handling time compared to the conventional hockey stick-shaped tube during intubation using a C-MAC® video laryngoscope Miller blade.
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Background@#Although fiberoptic-guided endotracheal intubation using a supraglottic airway device (SAD) is a good alternative for the management of difficult airways, its learning curve for residents has not been evaluated in pediatric patients. We aimed to train residents using a pediatric manikin and obtain learning curves to evaluate the efficiency of the training. @*Methods@#We conducted a single-armed prospective study with anesthesiology residents. Plain endotracheal tube (ETT) intubation guided by a fiberoptic bronchoscope through Ambu® AuraGainTM was demonstrated in a pediatric manikin to the participants before training. The procedure was divided into four steps: SAD insertion, vocal cord identification, carina identification, and ETT insertion into the trachea. The results and elapsed procedure times of each trial were recorded. The learning curves for the participants were constructed and analyzed using the cumulative sum method. @*Results@#All the 30 participants acquired proficiency at the end of practice between eight and 25 trials. The overall success rate for the procedure was 92.8%, and above 80% for all participants. Mean ± standard deviation procedure time was 71.3 ± 50.7 s. The 4th step accounted for 86.2% and 48.0% of the total failures and procedure time, respectively. The procedure time rapidly decreased in the 2nd trial; a modest decline was observed thereafter. @*Conclusions@#Trainees can obtain proficiency for fiberoptic-guided intubation through SAD within 25 times when using pediatric manikin. Effect of the training on performance in actual clinical situation should be studied.
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Background@#Direct insertion of a double-lumen tube (DLT) using a flexible fiberoptic bronchoscope (FOB) is an option for DLT intubation. The difficult process of fiberoptic intubation is that the different properties of polyvinyl chloride and silicone DLTs may affect railroading differently. Therefore, we aimed to compare intubation using polyvinyl chloride and silicone DLTs over an FOB. @*Methods@#Patients aged 19–75 years who required one-lung ventilation under general anesthesia were enrolled in this study. After induction of anesthesia, the anesthesiologist intubated the DLT using FOB. The primary outcome was the difficulty of railroading over the flexible FOB scaled into five grades (I, II-1, II-2, III, and IV). Additionally, the intubation time and mucosal damage were recorded. @*Results@#A total of 46 patients participated in this study, 23 each in the silicone and polyvinyl groups. The difficulty of railroading over the FOB was significantly different between the two groups (P < 0.001). In the silicone group, the grades of difficulty in railroading were limited to I and II-1; 20 patients (87%) presented no difficulty in advancing the tube. In contrast, in the polyvinyl group, 13 patients (57%) had scores of II-2 and III. Both the intubation time and mucosal damage were significantly better in the silicone group than in the polyvinyl group. @*Conclusions@#Intubation using a silicone DLT over an FOB was easier and faster than that with a polyvinyl chloride DLT with lesser trauma around the glottis.