Diagnosis of Infectious Spondylitis Using Non-Contrast Enhanced MRI With Axial Diffusion-Weighted Images: Comparison With Gadolinium-Enhanced MRI

Purpose@#To assess the diagnostic performances of diffusion-weighted imaging (DWI)-included non-contrast magnetic resonance imaging (MRI) compared to standard contrastenhanced MRI for infectious spondylitis. @*Materials and Methods@#This study involved 154 participants: a spondylitis group (n = 76) and a control group (n = 78) with Modic type 1 degeneration or recent compression fractures. Two readers independently reviewed paraspinal soft tissue signal change and abscess with 5-scale confidence scores based on two image sets: one featuring both non-contrast-enhanced MRI (NCEI) and DWI and the other consisting of NCEI and contrast-enhanced fat-suppressed T1-weighted imaging (CEFST1). The diagnostic performance of the two image sets was compared using McNemar tests for sensitivity, specificity, and area under the receiver operating characteristics (AUROC) analysis. Interobserver agreements (κ) for each images sets were also calculated. @*Results@#The sensitivity and specificity for infectious spondylitis were 90.8% and 69.2% for NCEI + DWI, 96.1% and 60.3% for NCEI + CEFST1 in reader 1, whereas it was 92.1% and 66.7% for NCEI + DWI, and 96.1% and 68.0% for NCEI + CEFST1 in reader 2. Sensitivities and specificities were not significantly different between NCEI + DWI and NCEI + CEFST1 (reader 1: p = 0.289, 0.065; reader 2: p = 0.250, > 0.999, respectively). However, the AUROC was not considerably different between the two modalities in only one reader (p = 0.306 in reader 1, p = 0.031 in reader 2). Interobserver agreement for infectious spondylitis was moderate (κ = 0.55) in NCEI + DWI and substantial (κ = 0.66) in NCEI + CEFST1. @*Conclusion@#Non-contrast enhanced MRI with additional DWI is as effective for diagnosing infectious spondylitis as a contrast-enhanced MRI.

Survey of Surgical Management in Intermittent Exotropia

Purpose@#To obtain an overview of the surgical practices for the management of intermittent exotropia among experienced surgeons. @*Methods@#We conducted a survey of members of the Korean Association for Pediatric Ophthalmology and Strabismus, who had experience of > 15 years in strabismus surgery, via e-mail. Surgical methods for basic-type intermittent exotropia, angle of deviation for determining the surgical dose, reasons for surgical dose adjustment, and the postoperative target angle of deviation were analyzed. @*Results@#Bilateral lateral rectus recession was preferred over unilateral recession and resection for basic-type intermittent exotropia with or without a dominant eye. The preoperative maximum angle of deviation was preferred for determining the surgical dose by 56% of the participants. Two-thirds of the participants preferred to reduce the surgical dose in specific circumstances, lateral incomitancy being the most common reason. In case of true divergence excess-type intermittent exotropia, 47.7% of the participants reduced the surgical dose. The most preferred target angle of deviation at 1 day postoperatively was 11-15 prism diopter esodeviation, as reported by 40% of the participants. @*Conclusions@#Although experienced surgeons had different surgical preferences for intermittent exotropia, a general trend was found. This survey may be a useful reference for beginners in strabismus surgery.

Effect of shared decision-making education on physicians’ perceptions and practices of end-of-life care in Korea

Evidence of the ethical appropriateness and clinical benefits of shared decision-making (SDM) are accumulating. This study aimed to not only identify physicians’ perspectives on SDM, and practices related to end-of-life care in particular, but also to gauge the effect of SDM education on physicians in Korea. Methods: A 14-item questionnaire survey using a modified Delphi process was delivered to nephrologists and internal medicine trainees at 17 university hospitals. Results: A total of 309 physicians completed the survey. Although respondents reported that 69.9% of their practical decisions were made using SDM, 59.9% reported that it is not being applied appropriately. Only 12.3% of respondents had received education on SDM as part of their training. The main obstacles to appropriate SDM were identified as lack of time (46.0%), educational materials and tools (29.4%), and education on SDM (24.3%). Although only a few respondents had received training on SDM, the proportion of those who thought they were using SDM appropriately in actual practice was high; the proportion of those who chose lack of time and education as factors that hindered the proper application of SDM was low. Conclusion: The majority of respondents believed that SDM was not being implemented properly in Korea, despite its use in actual practice. To improve the effectiveness of SDM in the Korean medical system, appropriate training programs and supplemental policies that guarantee sufficient application time are required.

Ileocolic Intussusception Accompanied with Inflamed Appendix: 2 Case Reports

Intussusception and acute appendicitis are common emergency conditions in children. They should be promptly differentiated in pediatric patients presenting with suggestive symptoms.However, both diseases may occur simultaneously. Herein, we present two cases of intussusception of the appendix accompanied with appendicitis.

Optic Perineuritis as a Presenting Sign of Sarcoidosis

Purpose@#To report a rare case of optic perineuritis as the presenting sign of sarcoidosis. Case summary: A 57-year-old man presented with decreased visual acuity and pain with extraocular movement in his left eye starting 2 weeks earlier. He had a history of asymptomatic optic perineuritis in that eye 18 months previously, which had improved after 1 month on oral prednisolone. His best corrected visual acuity had decreased to 20/50 and he also had relative afferent pupillary defect and color vision defects in the left eye. Slit lamp examination results were normal. There were no inflammatory reactions in the anterior chamber or vitreous. Fundoscopy showed optic disc edema. Orbital magnetic resonance imaging showed diffuse enhancement surrounding the left optic nerve. The serum levels of eosinophil cationic protein and angiotensin- converting enzyme were markedly increased. A chest radiograph showed bilateral hilar lymph node enlargement. A biopsy via endobronchial ultrasound-guided transbronchial needle aspiration revealed multifocal non-caseating granulomas. Acid fast bacilli stain showed no evidence of tuberculosis. Based on these findings, he was diagnosed with sarcoidosis. After treatment with high-dose intravenous methylprednisolone and subsequent tapering with oral prednisolone for 6 months, the visual acuity improved. @*Conclusions@#Optic perineuritis can be the initial sign of sarcoidosis. Therefore, sarcoidosis should be considered in the differential diagnosis of optic perineuritis.

Correlation between Internet Search Query Data and the Health Insurance Review & Assessment Service Data for Seasonality of Plantar Fasciitis / 대한족부족관절학회지

Purpose@#This study examined whether there are seasonal variations in the number of plantar fasciitis cases from the database of the Korean Health Insurance Review & Assessment Service and an internet search of the volume data related to plantar fasciitis and whether there are correlations between variations. @*Materials and Methods@#The number of plantar fasciitis cases per month was acquired from the Korean Health Insurance Review & Assessment Service from January 2016 to December 2019. The monthly internet relative search volumes for the keywords ‘‘plantar fasciitis” and ‘‘heel pain” were collected during the same period from DataLab, an internet search query trend service provided by the Korean portal website, Naver. Cosinor analysis was performed to confirm the seasonality of the monthly number of cases and relative search volumes, and Pearson and Spearman correlation analysis was conducted to assess the correlation between them. @*Results@#The number of cases with plantar fasciitis and the relative search volume for the keywords “plantar fasciitis” and “heel pain” all showed significant seasonality (p<0.001), with the highest in the summer and the lowest in the winter. The number of cases with plantar fasciitis was correlated significantly with the relative search volumes of the keywords “plantar fasciitis” (r=0.632; p<0.001) and “heel pain” (r=0.791; p<0.001), respectively. @*Conclusion@#Both the number of cases with plantar fasciitis and the internet search data for related keywords showed seasonality, which was the highest in summer. The number of cases showed a significant correlation with the internet search data for the seasonality of plantar fasciitis. Internet big data could be a complementary resource for researching and monitoring plantar fasciitis.

A Study on Bleeding after Shortening the Bed Rest Time of Pediatric Hemato-oncologic Patients after Bone Marrow Examination / 임상간호연구

Purpose@#The purpose of our study was to identify the bleeding risk factors and to validate the safety of shortening the bed rest time after bone marrow examination in pediatric hemato-oncologic patients. @*Methods@#From July 2019 to September 2020, 145 patients were enrolled from a single center. Medical records were reviewed retrospectively. Descriptive statistics were presented, and the data were analyzed using x2 -test, Fisher’s exact test, and a logistic regression. @*Results@#After two hours of bed rest, most of the patients (91.7%) did not have bleeding complications, and only 8.3% of the patients had a minor bleeding. The rate of major bleeding complications, including hematoma, retroperitoneal hemorrhage rate was zero. The bleeding complications was frequently found on bilateral procedures than unilateral procedures and the difference were statistically significant (p<.05). @*Conclusion@#Two hours of bed rest time after bone marrow examination could be safe and adequate in pediatric hemato-oncologic patients.

Lymphomatoid Granulomatosis Involving the Lung and Brain in a Child: A Case Report

Lymphomatoid granulomatosis (LG) is a rare B-cell type angiocentric lymphoproliferative disease that can progress to extranodal lymphoma with high mortality. It most commonly affects the lungs, although extrapulmonary systems, including the brain and skin, can also be involved. LG in pediatric patients has been very rarely reported in the literature with limited imaging features. Herein, we report a pediatric case of LG involving the lung and brain with characteristic imaging findings.

Visual Field Ratio According to Distance in the Near Tangent Screen Test

Purpose@#We evaluated the normative range of visual field ratio according to distance in the near tangent screen test performed in adults. @*Methods@#Adults above 18 years of age were prospectively recruited and underwent the near tangent screen test between February and August 2020. We developed a near tangent screen testing device, which was used at 10 and 20 cm distances from the screen. The tangent ratios (TRs), defined as the ratio of the visual field at the further distance to that at the closer distance, were analyzed according to the eight meridians, and the normative value of the TR in adults was deduced. @*Results@#The experiment was performed for 80 eyes of 40 adults. Their average age was 30.9 ± 7.0 years (range, 21-48). The mean TRs were 0.95 ± 0.10 and 0.97 ± 0.10 for the right and left eyes, respectively, so the visual field in either eye did not differ significantly according to distance. The average TR value for the eight meridians was 0.96 ± 0.10 (range, 0.73-1.23), and the TR did not show any significant difference among the eight meridians. The far and near visual fields did not intersect or overlap in any meridian, showing a TR value larger than 0.5. @*Conclusions@#Under the near tangent screen test, the visual fields in normal adults did not differ according to the test distance.

Correlation between Internet Search Query Data and the Health Insurance Review & Assessment Service Data for Seasonality of Plantar Fasciitis / 대한족부족관절학회지

Purpose@#This study examined whether there are seasonal variations in the number of plantar fasciitis cases from the database of the Korean Health Insurance Review & Assessment Service and an internet search of the volume data related to plantar fasciitis and whether there are correlations between variations. @*Materials and Methods@#The number of plantar fasciitis cases per month was acquired from the Korean Health Insurance Review & Assessment Service from January 2016 to December 2019. The monthly internet relative search volumes for the keywords ‘‘plantar fasciitis” and ‘‘heel pain” were collected during the same period from DataLab, an internet search query trend service provided by the Korean portal website, Naver. Cosinor analysis was performed to confirm the seasonality of the monthly number of cases and relative search volumes, and Pearson and Spearman correlation analysis was conducted to assess the correlation between them. @*Results@#The number of cases with plantar fasciitis and the relative search volume for the keywords “plantar fasciitis” and “heel pain” all showed significant seasonality (p<0.001), with the highest in the summer and the lowest in the winter. The number of cases with plantar fasciitis was correlated significantly with the relative search volumes of the keywords “plantar fasciitis” (r=0.632; p<0.001) and “heel pain” (r=0.791; p<0.001), respectively. @*Conclusion@#Both the number of cases with plantar fasciitis and the internet search data for related keywords showed seasonality, which was the highest in summer. The number of cases showed a significant correlation with the internet search data for the seasonality of plantar fasciitis. Internet big data could be a complementary resource for researching and monitoring plantar fasciitis.

A Study on Bleeding after Shortening the Bed Rest Time of Pediatric Hemato-oncologic Patients after Bone Marrow Examination / 임상간호연구

Purpose@#The purpose of our study was to identify the bleeding risk factors and to validate the safety of shortening the bed rest time after bone marrow examination in pediatric hemato-oncologic patients. @*Methods@#From July 2019 to September 2020, 145 patients were enrolled from a single center. Medical records were reviewed retrospectively. Descriptive statistics were presented, and the data were analyzed using x2 -test, Fisher’s exact test, and a logistic regression. @*Results@#After two hours of bed rest, most of the patients (91.7%) did not have bleeding complications, and only 8.3% of the patients had a minor bleeding. The rate of major bleeding complications, including hematoma, retroperitoneal hemorrhage rate was zero. The bleeding complications was frequently found on bilateral procedures than unilateral procedures and the difference were statistically significant (p<.05). @*Conclusion@#Two hours of bed rest time after bone marrow examination could be safe and adequate in pediatric hemato-oncologic patients.

Posterior Ischemic Optic Neuropathy after Cervical Spine Surgery

Purpose@#To describe a patient with posterior ischemic optic neuropathy (PION) after cervical spine surgery who recovered after treatment.Case summary: A 51-year-old woman presented with eye pain and decreased visual acuity in the left eye, which had begun 8 hours after cervical spine surgery in the prone position. Her best-corrected visual acuity (BCVA) was 20/20 in the right eye and hand motion in the left eye; a relative afferent pupillary defect was present in the left eye. Ductions and versions were normal with pain in the left eye. The results of slit lamp examination, fundoscopic examination, fluorescein angiography, and optical coherence tomography were unremarkable in both eyes. Brain and orbital magnetic resonance imaging showed no abnormal findings in the visual pathway, such as brain infarction or intracranial artery stenosis. The patient was diagnosed with PION in the left eye. Because postoperative anemia had developed with a rapid decrease in hemoglobin from 14.7 g/dL to 9.9 g/dL, red blood cell (RBC) transfusion was performed together with intravenous high-dose steroid therapy and subcutaneous epoetin alfa injection. After 3 weeks, the patient’s BCVA improved to 20/22 in the left eye. @*Conclusions@#Unilateral PION developed after cervical spine surgery in the prone position. Visual improvement was observed after RBC transfusion, intravenous high-steroid therapy, and subcutaneous epoetin alfa injection.

The Influence of Dental Hygiene Student’s Communication Ability and Conflict Management Types on Adaptation to College Life / 치위생과학회지

Background@#The purpose of this study was to investigate the effects of dental hygiene students’ communication ability and conflict management types on adaptation to college life improve adaptation to college life and to suggest strategies to play a role as a professional dental hygienist in clinical practice. @*Methods@#The subjects of this study were selected by random sample extraction of dental hygiene students from two colleges in Gyeonggi and one Chungcheong area. The survey was conducted online for dental hygiene students from July 20 to October 31, 2020. In order to comply with research ethics, this study was investigated with the consent of the subjects. The sample was analyzed for the final 351. @*Results@#Dental hygiene students’ communication ability was 3.74 points, conflict management types was 3.01 points, and adaptation to college life was 3.30 points. In the type of conflict management according to the general characteristics, the problem-solving method, the avoidance method, the compromise method, and the concession method showed statistically significant differences in major satisfaction. Among the types of conflict management, the highest positive correlation (r=0.613) was shown in the relationship between the problem-solving method and the compromise method. Factors influencing the adaptation to college life were concentration, forced method, self-disclosure, conversational coherence, and social relaxation. @*Conclusion@#This study is significant in that it derives sub-areas of communication ability and conflict management types that influence adaptation to college life. In the future, there is a need to improve the quality of dental hygienists by continuously conducting research on the types of conflict management targeting dental hygienists, and responding more proactively and actively to conflict situations in the clinical field.

Correlation between Dental Hygiene Student’s Gender Sensitivity and Gender Role Stereotypes / 치위생과학회지

Background@#The purpose of this study is to identify the gender sensitivity and gender role stereotypes of students in dental hygiene and to provide basic data to expand social awareness of equal gender sensitivity and gender role in dental hygiene and students by identifying the degree of correlation. @*Methods@#The purpose of this study was to study dental hygiene students at colleges in Gyeonggi and Chungcheong areas. The survey was conducted from April 1 to April 30, 2021. The final sample was analyzed on 157 subjects. T-test and ANOVA analysis were performed to compare gender sensitivity and gender role stereotypes according to general characteristics. Equal variances were tested using the Levene statistic, and significant differences between groups were identified through Scheffe’s post hoc analysis. Pearson’s correlation analysis was performed to confirm the correlation between gender sensitivity and gender role stereotypes. @*Results@#Gender sensitivity was 2.69 and gender role stereotypes were 1.83. Among the sub-areas of gender sensitivity, gender role openness was the highest at 2.86, and non-violence was the lowest at 2.50. As for gender role stereotypes, social stereotypes were the highest among sub-areas at 1.71. Among the general characteristics, there was a statistically significant difference in gender sensitivity according to the presence or absence of opposite sex friends (p=0.011). The gender identity openness of gender sensitivity and the physical sub-areas of gender role stereotypes showed the highest positive correlation(r=0.955). Among the sub-areas of gender sensitivity, gender role openness and domestic stereotypes showed the lowest negative correlation (r=−0.404) among the sub-areas of gender role stereotypes. @*Conclusion@#Dental hygiene students should be able to critically analyze and solve problems of not only sexual violence but also gender discrimination and imbalance in social life. For this, environmental factors such as school education and professor guidance must be strengthened.

Ileocolic Intussusception Accompanied with Inflamed Appendix: 2 Case Reports

Intussusception and acute appendicitis are common emergency conditions in children. They should be promptly differentiated in pediatric patients presenting with suggestive symptoms.However, both diseases may occur simultaneously. Herein, we present two cases of intussusception of the appendix accompanied with appendicitis.

Optic Perineuritis as a Presenting Sign of Sarcoidosis

Purpose@#To report a rare case of optic perineuritis as the presenting sign of sarcoidosis. Case summary: A 57-year-old man presented with decreased visual acuity and pain with extraocular movement in his left eye starting 2 weeks earlier. He had a history of asymptomatic optic perineuritis in that eye 18 months previously, which had improved after 1 month on oral prednisolone. His best corrected visual acuity had decreased to 20/50 and he also had relative afferent pupillary defect and color vision defects in the left eye. Slit lamp examination results were normal. There were no inflammatory reactions in the anterior chamber or vitreous. Fundoscopy showed optic disc edema. Orbital magnetic resonance imaging showed diffuse enhancement surrounding the left optic nerve. The serum levels of eosinophil cationic protein and angiotensin- converting enzyme were markedly increased. A chest radiograph showed bilateral hilar lymph node enlargement. A biopsy via endobronchial ultrasound-guided transbronchial needle aspiration revealed multifocal non-caseating granulomas. Acid fast bacilli stain showed no evidence of tuberculosis. Based on these findings, he was diagnosed with sarcoidosis. After treatment with high-dose intravenous methylprednisolone and subsequent tapering with oral prednisolone for 6 months, the visual acuity improved. @*Conclusions@#Optic perineuritis can be the initial sign of sarcoidosis. Therefore, sarcoidosis should be considered in the differential diagnosis of optic perineuritis.

Health-related Quality of Life of Children and Adolescents after Hematopoietic Stem Cell Transplantation

Purpose@#This study aimed to determine the level of health-related quality of life (HRQoL) of children and adolescents who received hematopoietic stem cell transplantation (HSCT) and to examine factors influencing HRQoL. @*Methods@#This cross-sectional descriptive study involved 85 participants aged 10 to 19 years who received treatment from 3 months to 5 years after HSCT. Symptom experiences, stress and coping, self-esteem, social support, and HRQoL were measured. Descriptive analysis, the independent t-test, one-way analysis of variance, Pearson correlation analysis, and stepwise multiple regression were used for data analysis. @*Results@#The mean HRQoL score was 72.26 points out of 100. HRQoL showed statistically significant correlations with symptom experiences, stress, self-esteem, social support, satisfaction with peer relationships, and perceived attentiveness of the medical team. The most influential predictors of HRQoL were symptom experiences (β=-.51, p<.001) and satisfaction with peer relationships (β=.32, p<.001). @*Conclusion@#The experiences of different symptoms by children and adolescents who receive HSCT must be considered. In addition, nursing interventions, such as self-help meetings with peer groups, should be provided to improve their HRQoL.

A Fully Immersive Virtual Reality Method for Upper Limb Rehabilitation in Spinal Cord Injury

Objective@#To determine whether a fully immersive virtual reality (VR) intervention combined with conventional rehabilitation (CR) can improve upper limb function more than CR alone in patients with spinal cord injury (SCI), we conducted a prospective, randomized, controlled clinical trial. @*Methods@#Participants were randomly assigned to either the control group (CG; n=10) or experimental group (EG; n=10). The participants in the CG received 60 minutes of conventional therapy per day, 4 days per week for 4 weeks, whereas those in the EG received 30 minutes of VR training and 30 minutes of conventional therapy per day, 4 days per week for 4 weeks. The clinical outcome measures included Medical Research Council grade, the American Spinal Injury Association upper extremity motor score (ASIA-UEMS), and scores in the Hand Strength Test, Box and Block Test, Nine-Hole Peg Test, Action Research Arm Test, and Korean version of the Spinal Cord Independence Measure (K-SCIM). The assessments were performed at the beginning (T0) and end of the intervention (T1). @*Results@#Grip power and K-SCIM score significantly improved in the EG after the intervention. When comparing differences between the groups, elbow extensor, wrist extensor, ASIA-UEMS, grip power, lateral pinch power, and palmar pinch power were all significantly improved. @*Conclusion@#VR training of upper limb function after SCI can provide an acceptable adjunctive rehabilitation method without significant adverse effects.

Comparison of outcomes according to urine chemistry testing time for the causes of acute kidney injury patients admitted to the emergency room

Objective@#The rapid identification and treatment of an acute kidney injury (AKI) can help to restore the kidney function. To differentiate between pre-renal AKI and intrinsic AKI, a urine chemistry test was performed to determine the function of the renal tubules. On the other hand, there is no report showing that it is helpful to arrive at the hospital as early as possible and to perform these urine chemistry tests as soon as possible. @*Methods@#This study analyzed the timing of urinary chemistry tests in AKI patients who were admitted to the author’s hospital through the emergency departments (ED) in the last three years and divided into two groups. The early group was defined as patients who performed the test within three hours of arrival in the ED. The late group was defined as patients who were late or not. The prognostic factors were the change in 30-day estimated glomerular filtration rate (eGFR) and duration of hospital stay. @*Results@#The changes of eGFR after 30 days in each group were 41.6±27.57 mL/min/1.73 m2 (early group, n=92) vs. 30.39±26.37 mL/min/1.73 m2 (late group, n=180) (P=0.001). Early group patients were discharged more quickly than patients in the late group (hospital day, 11.49±10.14 vs. 13.84±10.53; P=0.041). @*Conclusion@#A urine chemistry test is a test to help determine the cause of AKI. Based on the results of urine chemistry performed within three hours after arrival at the hospital, patients with AKI who visited the emergency room had betterimproved kidney function and less hospitalization time than the patients who were late or untested at the time of treatment.

Central Diabetes Insipidus in an Extremely-Low-Birth-Weight Preterm Infant with Suspected Ectopic Posterior Lobe of the Pituitary Gland

Central diabetes insipidus (CDI) is extremely rare in neonates, especially in extremely-low-birth-weight infants, and most cases are secondary to conditions, such as ischemic or hemorrhagic brain damage. Here, we report a case of CDI in a 530-g infant born at 23+3 weeks of gestation, with suspected ectopic posterior pituitary gland. Hypernatremia was noticed at 33+6 weeks of postmenstrual age, and it persisted with in creased volumes of diluted urine, despite adequate sodium intake. Serum and urine osmolality returned to the normal range after administration of a desmopressin injection. The bright spot of the posterior pituitary was absent, and brain magnetic resonance imaging suggested an ectopic posterior pituitary gland. At the time of writing this manuscript, the patient was on oral desmopressin medication without complications at the corrected age of 8 months. Through this report, we emphasize that although CDI is extremely rare in premature infants, it should be suspected when hypernatremia and polyuria that are unexplained by other causes are noted.