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Purpose@#This study aimed to evaluate the use of active surgical co-management (SCM) by medical hospitalists for urology inpatient care. @*Materials and Methods@#Since March 2019, a hospitalist-SCM program was implemented at a tertiary-care medical center, and a retrospective cohort study was conducted among co-managed urology inpatients. We assessed the clinical outcomes of urology inpatients who received SCM and compared passive SCM (co-management of patients by hospitalists only on request; March 2019 to June 2020) with active SCM (co-management of patients based on active screening by hospitalists; July 2020 to October 2021). We also evaluated the perceptions of patients who received SCM toward inpatient care quality, safety, and subjective satisfaction with inpatient care at discharge or when transferred to other wards. @*Results@#We assessed 525 patients. Compared with the passive SCM group (n=205), patients in the active SCM group (n=320) required co-management for a significantly shorter duration (p=0.012) and tended to have a shorter length of stay at the urology ward (p=0.062) and less frequent unplanned readmissions within 30 days of discharge (p=0.095) while triggering significantly fewer events of rapid response team activation (p=0.002). No differences were found in the proportion of patients transferred to the intensive care unit, in-hospital mortality rates, or inpatient care questionnaire scores. @*Conclusion@#Active surveillance and co-management of urology inpatients by medical hospitalists can improve the quality and efficacy of inpatient care without compromising subjective inpatient satisfaction.
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Purpose@#It is unclear if a second or third arterial graft can improve clinical outcomes in coronary artery bypass graft surgery. We compared the outcomes of bilateral internal thoracic artery (BITA) plus radial artery (RA) grafting versus left internal thoracic artery (LITA) plus RA grafting after off-pump coronary artery bypass grafting. @*Materials and Methods@#Between January 2009 and December 2020, a total of 3007 patients with three-vessel coronary artery disease who underwent off-pump coronary artery bypass were analyzed. Among them, 971 patients received total arterial grafting using LITA. We divided the patients into two groups [group A, BITA+RA grafting (n=227) and group B, LITA+RA grafting (n=744)], and compared the survival and major adverse cardiac and cerebrovascular event (MACCE) rates between the two groups at 10 years. @*Results@#After risk adjustment with inverse probability treatment weighting methods, the freedom from all-cause mortality was 93.1% and 88.3% in groups A and B, respectively (p=0.140). The freedom from MACCE rates were 68.3% and 89.0%, respectively (p<0.0001). LITA plus RA grafting [hazard ratio (HR): 1.3, 95% confidence interval (CI): 1.05–2.37, p=0.025] and incomplete revascularization (HR 1.2, 95% CI: 0.70–2.15, p=0.046) were significant risk factors for MACCEs in multivariable Cox regression analysis. @*Conclusion@#The rates of MACCEs were lower with LITA plus RA grafting than with BITA plus RA grafting in total arterial revascularization. Furthermore, complete revascularization improved long-term outcomes following total arterial grafting.
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Purpose@#Treatment with dopamine agonists (DAs) has been the first-line standard treatment for prolactinoma, and surgery has been reserved for drug intolerance and resistance for several decades. We evaluated whether surgery plays a primary role in prolactinoma management. @*Materials and Methods@#We conducted a retrospective study of 210 prolactinoma patients who had received surgical treatment at our institution. We analyzed the treatment outcomes according to tumor extent, sex, and preoperative DA medication. @*Results@#Overall hormonal remission was achieved in 164 patients (78.1%), and complete removal was achieved in 194 patients (92.4%). When the tumors were completely removed, the remission rate increased to 84.5%. Anterior pituitary function was normalized or improved in 94.6% of patients, whereas only 4.1% of patients showed worsening of hormone control. Hormonal remission was higher in patients who had not received DA preoperatively than in those who had received preoperative DA treatment. Smaller tumor size (<1 cm), no invasion into the cavernous sinus, and female sex were predictors of good surgical outcomes. @*Conclusion@#Although DAs remain the first-line standard treatment for prolactinomas, surgery can be an excellent option and should be considered as an alternative primary treatment modality when patients are predicted to achieve a good surgical outcome.
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Purpose@#Anatomical landmarks can provide vital information on the distribution of nerves in the gastrocnemius muscle. We aimed to provide an anatomical perspective on appropriate locations for botulinum neurotoxin (BoNT) injections in the medial and lateral parts of the gastrocnemius for calf shaping. @*Materials and Methods@#A modified Sihler’s method was applied to both the medial and lateral parts of the gastrocnemius muscles (16 specimens). Intramuscular neural distributions were revealed by dissecting along a transverse line crossing the fibular head and superior margin of the calcaneal tuberosity. @*Results@#The intramuscular neural distribution for the medial and lateral parts of the gastrocnemius had the greatest arborized patterns in the 7/10–8/10 section of the medial head and 7.5/10–8.5/10 section of the lateral part of the gastrocnemius. @*Conclusion@#We propose that BoNT injections should be directed to the 7/10–8/10 section of the medial head and the 7.5/10– 8.5/10 section of the lateral part of the gastrocnemius. Following our guidelines, clinicians can ensure satisfactory results with the use of minimal doses to limit adverse effects, such as gait disturbance, antibody production, and bruising, due to multiple injections. The results can also be altered and applied to electromyography.
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BACKGROUND@#Breast cancer patients suffer from lowered quality of life (QoL) after surgery. Breast conservancy surgery (BCS) such as partial mastectomy is being practiced and studied as an alternative to solve this problem. This study confirmed breast tissue reconstruction in a pig model by fabricating a 3-dimensional (3D) printed Polycaprolactone spherical scaffold (PCL ball) to fit the tissue resected after partial mastectomy. @*METHODS@#A 3D printed Polycaprolactone spherical scaffold with a structure that can help adipose tissue regeneration was produced using computer-aided design (CAD). A physical property test was conducted for optimization. In order to enhance biocompatibility, collagen coating was applied and a comparative study was conducted for 3 months in a partial mastectomy pig model. @*RESULTS@#In order to identify adipose tissue and fibroglandular tissue, which mainly constitute breast tissue, the degree of adipose tissue and collagen regeneration was confirmed in a pig model after 3 months. As a result, it was confirmed that a lot of adipose tissue was regenerated in the PCL ball, whereas more collagen was regenerated in the collagen-coated Polycaprolactone spherical scaffold (PCL–COL ball). In addition, as a result of confirming the expression levels of TNF-a and IL-6, it was confirmed that PCL ball showed higher levels than PCL–COL ball. @*CONCLUSION@#Through this study, we were able to confirm the regeneration of adipose tissue through a 3-dimensional structure in a pig model. Studies were conducted on medium and large-sized animal models for the final purpose of clinical use and reconstruction of human breast tissue, and the possibility was confirmed.
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The subscapularis tendon is the largest and most powerful muscle in the rotator cuff, playing a more important role in raising the arm than the supraspinatus or infraspinatus tendon. Subscapularis tendon tears are uncommon, but when it does occur, symptoms are often minimal and diagnosis can be delayed until severe atrophy occurs, leading to weakness of the shoulder muscles. Therefore, early diagnosis and surgical repair of suspected subscapularis tendon injury in athletes is very important for achieving the best functional outcome. Shoulder injuries in professional boxers have been reported to account for only about 3% of all boxing injuries, but there is no specific research on the specific location of these injuries. In this study, the authors report on a case of isolated subscapularis tendon injury that occurred during sparring in a professional boxer and discuss the mechanism of injury and treatment outcomes along with a review of the literature.
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Background/Aims@#We performed a prospective study to determine the efficacy and safety of rituximab including chemotherapy in CD20-positive acute lymphoblastic leukemia (ALL). @*Methods@#Patients with newly diagnosed ALL, aged ≥ 15 years, were eligible for the study if their leukemic blast cells in bone marrow expressed CD20 ≥ 20% at the time of diagnosis. Patients received multiagent chemotherapy with rituximab. After achieving complete remission (CR), patients received five cycles of consolidation with concomitant rituximab. Rituximab was administered monthly from day 90 of transplantation for patients who received allogeneic hematopoietic cell transplantation. @*Results@#In patients with Philadelphia (Ph)-negative ALL, 39 of 41 achieved CR (95.1%), the 2- and 4-year relapse-free survival (RFS) rates were 50.4% and 35.7%, and the 2- and 4-year overall survival (OS) rates were 51.5% and 43.2%, respectively. In the group with Ph-positive ALL, all 32 patients achieved CR, the 2- and 4-year RFS rates were 60.7% and 52.1%, and the 2- and 4-year OS rates were 73.3% and 52.3%, respectively. In the Ph-negative ALL group, patients with higher CD20 positivity experienced more favorable RFS (p < 0.001) and OS (p = 0.06) than those with lower CD20 positivity. Patients who received ≥ 2 cycles of rituximab after transplantation had significantly improved RFS (hazard ratio [HR], 0.31; p = 0.049) and OS (HR, 0.29; p = 0.021) compared with those who received < 2 cycles. @*Conclusions@#The addition of rituximab to conventional chemotherapy for CD20-positive ALL is effective and tolerable (Clinicaltrials. gov NCT01429610).
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Gout is the most common form of arthritis, with the prevalence increasing worldwide. The present treatment guidelines provide recommendations for the appropriate treatment of acute gout, management during the inter-critical period, and prevention of chronic complications. The guidelines were developed based on evidence-based medicine and draft recommendations finalized after expert consensus. These guidelines are designed to provide clinicians with clinical evidence to enable efficient treatment of gout.
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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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Achalasia, a rare motility disorder of the esophagus, is generally accepted as a premalignant disorder. This paper presents the case of a 72-year-old male with achalasia and synchronous superficial esophageal cancer who experienced dysphagia symptoms for five years. As achalasia is associated with an increased risk of esophageal cancer, both can be treated simultaneously if detected at the time of diagnosis. Achalasia and synchronous esophageal cancer are rarely detected and treated endoscopically. This paper reports a case of concurrent successful treatment.
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Colorectal strictures are uncommon in patients with ulcerative colitis (UC). An extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma is rarely involved in the colon but may be associated with inflammatory bowel diseases. A 41-year-old female with a six-year history of UC presented with a severe stricture of the sigmoid colon that prevented the passage of a colonoscope. A histological examination revealed non-specific inflammation and fibrosis without dysplasia or cancer.Despite conventional treatment, including mesalazine and azathioprine for one year after that visit, the stricture persisted. In addition, diffuse, edematous exudative inflammation and multiple shallow ulcers were observed in the distal rectum, revealing a MALT lymphoma testing positive for CD20, CD43, CD5, and Bcl-2, but negative for CD3, CD10, CD23, and cyclin-D1. Four weekly doses of rituximab were administered. Follow-up colonoscopy performed one month after treatment revealed slight improvement in the rectal lesion without remnant histological evidence of a MALT lymphoma. In addition, the stricture showed marked improvement, and the colonoscope could pass easily through the stricture site. This is the first case report on an improvement of a severe sigmoid colon stricture in a patient with UC after rituximab treatment for a concomitant rectal MALT lymphoma.
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Background/Aims@#Gastrointestinal (GI) bezoars are relatively rare diseases with clinical characteristics and treatment modalities that depend on the location of the bezoars. This study evaluated the clinical characteristics and treatment outcomes in patients with GI bezoars. @*Methods@#Seventy-five patients diagnosed with GI bezoars were enrolled in this study. Data were collected on the demographic and clinical characteristics and the characteristics of the bezoars, such as type, size, location, treatment modality, and clinical outcomes. @*Results@#Among the 75 patients (mean age 71.2 years, 38 males), 32 (42.6%) had a history of intra-abdominal surgery. Hypertension (43%) and diabetes (30%) were common morbidities. The common location of the bezoars was the stomach in 33 (44%) and the small intestine in 33 (44%). Non-surgical management, including adequate hydration, chemical dissolution, and endoscopic removal, was successful in 2/2 patients with esophageal bezoars, 26/33 patients with gastric bezoars, 7/9 patients with duodenal bezoars, and 20/33 patients with small intestinal bezoars. The remaining patients had undergone surgical management. @*Conclusions@#The management of GI bezoars requires multidisciplinary approaches, including the appropriate correction of fluid and electrolyte imbalances, chemical dissolution, and endoscopic and surgical treatments. (Korean J Gastroenterol 2023;81:253-258)
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Background/Aims@#To investigate the risk of metabolic syndrome and fatty liver diseases in gastric cancer survivors compared to non-cancer subjects. @*Methods@#The data from the health screening registry of the Gangnam Severance Hospital from 2014–2019 was used. Ninety-one gastric cancer survivors and a propensity-score-matching 445 non-cancer subjects were analyzed. Gastric cancer survivors were divided into those with surgical treatment (OpGC, n=66) and non-surgical treatment (non-OpGC, n=25). Metabolic syndrome, fatty liver by ultrasonography, and metabolic dysfunction-associated fatty liver disease (MAFLD) were assessed. @*Results@#Metabolic syndrome was in 15.4% of gastric cancer survivors (OpGC; 13.6%, non-OpGC; 20.0%). Fatty liver by ultrasonography was in 35.2% in gastric cancer survivors (OpGC; 30.3%, non-OpGC: 48.0%). MAFLD was in 27.5% of gastric cancer survivor (OpGC; 21.2%, non-OpGC; 44.0%). After adjusting for age, sex, smoking, and alcohol, the risk of metabolic syndrome was lower in OpGC than in non-cancer subjects (OR, 0.372; 95% CI, 0.176-0.786, p=0.010). After adjusting, OpGC showed lower risks of fatty liver by ultrasonography (OR, 0.545; 95% CI, 0.306-0.970, p=0.039) and MAFLD (OR, 0.375; 95% CI, 0.197-0.711, p=0.003) than did non-cancer subjects. There were no significant differences in the risks of metabolic syndrome and fatty liver diseases between non-OpGC and non-cancer subjects. @*Conclusions@#OpGC showed lower risks of metabolic syndrome, fatty liver by ultrasonography, and MAFLD than non-cancer subjects, but there were no significant differences in the risks between non-OpGC and non-cancer subjects. Further studies on metabolic syndrome and fatty liver diseases in gastric cancer survivors are warranted.
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In complete denture fabrication, accurate preliminary impressions are crucial for obtaining an accurate final impression. However, it can be challenging in cases of atypical arch shapes. This case report compares diagnostic casts made with a stock tray and an intraoral scanner (IOS) in a patient with an atypical arch shape.A 58-year-old edentulous male patient with long, narrow, atypical arches was referred to the Oral and Maxillofacial Surgery department for complete denture fabrication. Compared to the diagnostic cast obtained using IOS with adequately captured anatomical parameters, the primary model obtained using a stock tray showed prominent overextended flanges on the labial and buccal sides of the maxillary arch and less prominent overextended flanges in the mandibular arch with pressure spots in the posterior palatal seal area. The custom tray fabricated from such a model required additional adjustment resulting in increased chair time during the final impression procedure.
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Objective@#This study aimed to explore the feasibility of cognitive-behavioral model hypochondriasis regarding coronavirus disease-2019 (COVID-19) among firefighters. In addition, we examined the possible role of their grief reaction and intolerance of uncertainty in the model of COVID-related hypochondriasis. @*Methods@#An anonymous online survey was done on October 27–28, 2022, among firefighters who witnessed people’s death. Demographic characteristics were collected, and their psychological states were assessed using rating scales such as the Obsession with COVID-19 Scale (OCS), Coronavirus Reassurance-Seeking Behaviors Scale (CRBS), Fear of COVID-19 Scale (FCV-19S), Pandemic Grief Scale (PGS), and Intolerance of Uncertainty Scale–12 (IUS-12). @*Results@#Their OCS score was expected by the CRBS (β=0.30, p<0.001), FCV-19S (β=0.10, p<0.001), PGS (β=0.29, p<0.001), and IUS12 (β=0.04, p=0.024) (F=134.5, p<0.001). The COVID-related cognitive-behavioral model of hypochondriasis was feasible among firefighters who witnessed people’s death. Their pandemic grief reaction and intolerance of uncertainty directly influenced their preoccupation with coronavirus, and viral anxiety and coronavirus reassurance-seeking behavior mediated the relationship. @*Conclusion@#Firefighters’ viral anxiety and coronavirus reassurance-seeking behavior mediated the influence of pandemic grief reaction or intolerance of uncertainty on the preoccupation with coronavirus.
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Objective@#This study assessed the reliability and validity of the Stress and Anxiety to Viral Epidemics–9 items (SAVE-9) and Stress and Anxiety to Viral Epidemics–6 items (SAVE-6) scales for measuring viral anxiety among firefighters during the coronavirus disease-2019 pandemic. @*Methods@#An online survey was conducted among 304 firefighters assigned in Gyeonggi-do. The SAVE-9 scale, initially developed for healthcare workers, was adapted for firefighters. We compared it with the SAVE-6 scale designed for the general population among the firefighters sample. The confirmatory factor analysis (CFA) was conducted to explore the factor structure of both scales. Internal consistency reliability was checked using Cronbach’s alpha and McDonald’s omega. Convergent validity was assessed in accordance with the Patient Health Questionnaire–9 and Generalized Anxiety Disorder–7 scales. @*Results@#The SAVE-9 scale demonstrated a Cronbach alpha of 0.880, while the SAVE-6 scale yielded an alpha of 0.874. CFA indicated good model fits for both SAVE-9 and SAVE-6 scales among firefighters sample. The SAVE-9 and SAVE-6 comparably measures viral anxiety of firefighters. @*Conclusion@#Both of the SAVE-9 and SAVE-6 scales are reliable and valid instruments for assessing viral anxiety among firefighters during the pandemic.
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Objective@#This study aimed to investigate the prevalence, clinical characteristics, and the correlates of nonsuicidal self-injury (NSSI) in firefighters. We also investigated the mediating role of NSSI frequency in the association between posttraumatic stress disorder (PTSD), depression, and suicidal behavior. @*Methods@#A total of 51,505 Korean firefighters completed a web-based self-reported survey, including demographic and occupational characteristics, NSSI, PTSD, depression, and suicidal behavior. Multivariable logistic regression analyses and serial mediation analyses were performed. @*Results@#The 1-year prevalence of NSSI was 4.67% in Korean firefighters. Female gender, the presence of recent traumatic experience, and PTSD and depression symptoms were correlated with NSSI. Serial mediation analyses revealed that NSSI frequency mediated the association between PTSD, depression, and suicidal behavior; it indicates more severe PTSD was sequentially associated with more severe depression symptoms and more frequent NSSI, leading to higher risk of suicidal behavior. @*Conclusion@#NSSI is prevalent and may play a significant mediating role when PTSD is associated with suicidal behavior in firefighters. Our results imply the need for screening and early intervention of NSSI in firefighters.
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Purpose@#This study aimed to identify the etiology and risk factors of community-acquired pneumonia (CAP) requiring hospitalization in Korean children during the coronavirus disease 2019 (COVID-19) pandemic. @*Methods@#Clinical information of children admitted with CAP to Seoul National University Children’s Hospital (SNUCH) between January 1, 2021, and February 28, 2022, was retrospectively collected and analyzed. In addition, the etiologic diagnosis and demographic data of children with CAP who were discharged at the other seven hospitals between January and February 2022 were collected. Pneumonia was diagnosed using strict criteria comprising clinical symptoms, physical examination findings, and chest radiographic findings. @*Results@#Among 91 children hospitalized with CAP at SNUCH during the 14-month period, 68.4% were aged <5 years and 79.1% had underlying diseases. Among the 95 CAP cases, respiratory assistance was required in 70.5%, and the use of a ventilator was required in 20.0%.A total of five patients expired, all of whom were either immunocompromised or had underlying neurological diseases. Neurological diseases and immunosuppression were significantly correlated with respiratory assistance (P=0.003) and death (P=0.014). A total of 55% of the detected respiratory pathogens were viruses, the most common of which was rhinovirus at 35.9%. Among the 169 children hospitalized for CAP at the eight institutions, ≥1 respiratory virus was detected in 92.3%, among which respiratory syncytial virus (79.8%) was the most prevalent. @*Conclusions@#Even during the COVID-19 pandemic, Korean children were hospitalized with CAP caused by seasonal respiratory viral pathogens. Although atypical and pyogenic bacteria were not detected, continuous clinical monitoring and further prospective studies should be conducted.
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In this study, we investigated the efficacy of Celtis choseniana Nakai (C. choseniana) as complementary herbal medicine to ameliorate androgenic alopecia (AGA). The effects of C. choseniana on AGA were evaluated using testosterone propionate-induced AGA mouse model and dihydrotestosterone-treated human hair follicle dermal papilla cells. In vivo, C. choseniana treatment deactivated androgen signaling by reducing the concentration of serum dihydrotestosterone level and expressions of 5α-reductase 2 and androgen receptor. Next, C. choseniana treatment increased the hair regrowth rate. Histological studies demonstrated that C. choseniana induced the anagen phase in testosterone propionate-induced AGA mouse model. Cellular proliferation was promoted by C. choseniana treatment via increasing the expression of proliferation factors, such as proliferating cell nuclear antigen and cyclin D1. Furthermore, C. choseniana treatment increased the expression of proteins related to the Wnt/β-catenin signaling pathway. In addition, dickkopf-1, a Wnt inhibitor, was downregulated with C. choseniana treatment. Likewise, C. choseniana treatment promoted cellular proliferation in vitro. This study demonstrated the inhibitory effect of C. choseniana on androgen-induced AGA. Moreover, C. choseniana induced activation of Wnt/β-catenin signaling, resulting in prolonged anagen and cellular proliferation. Therefore, we suggest that C. choseniana can be used as a therapeutic agent to alleviate AGA.
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The gut microbiota comprises a collection of microorganisms residing in the human digestive system, including bacteria, viruses, and fungi. These microbes have critical roles in food breakdown, immune system regulation, and the production of essential nutrients. Several lower gastrointestinal (GI) diseases, including inflammatory bowel disease, irritable bowel syndrome, and colorectal cancer, have been associated with dysbiosis, which refers to an imbalance in the gut microbiota. Additionally, the gut microbiome and its microbial compounds affect disease development and the host’s immune response. Alterations in the gut-brain axis microbiome are also implicated in lower GI diseases. Therefore, microbiome-based therapies that regulate the gut microbiota (e.g., fecal microbiota transplantation and probiotics) are essential for the prevention and treatment of these diseases. This review aims to highlight the significance of gut microbiota and microbiome-based therapies in managing lower GI diseases.