Seawater fish use an electrogenic boric acid transporter, Slc4a11A, for boric acid excretion by the kidney.

Boric acid is a vital micronutrient in animals; however, excess amounts are toxic to them. Little is known about whole-body boric acid homeostasis in animals. Seawater (SW) contains 0.4 mM boric acid, and since marine fish drink SW, their urinary system was used here as a model of the boric acid excretion system. We determined that the bladder urine of a euryhaline pufferfish (river pufferfish, Takifugu obscurus) acclimated to fresh water and SW contained 0.020 and 19 mM of boric acid, respectively (a 950-fold difference), indicating the presence of a powerful excretory renal system for boric acid. Slc4a11 is a potential animal homolog of the plant boron transporter BOR1; however, mammalian Slc4a11 mediates H+ (OH-) conductance but does not transport boric acid. We found that renal expression of the pufferfish paralog of Slc4a11, Slc4a11A, was markedly induced after transfer from fresh water to SW, and Slc4a11A was localized to the apical membrane of kidney tubules. When pufferfish Slc4a11A was expressed in Xenopus oocytes, exposure to media containing boric acid and a voltage clamp elicited whole-cell outward currents, a marked increase in pHi, and increased boron content. In addition, the activity of Slc4a11A was independent of extracellular Na+. These results indicate that pufferfish Slc4a11A is an electrogenic boric acid transporter that functions as a B(OH)4- uniporter, B(OH)3-OH- cotransporter, or B(OH)3/H+ exchanger. These observations suggest that Slc4a11A is involved in the kidney tubular secretion of boric acid in SW fish, probably induced by the negative membrane potential and low pH of urine.

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.

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.

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.

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.

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.

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.

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.

Cl- and H+ coupling properties and subcellular localizations of wildtype and disease-associated variants of the voltage-gated Cl-/H+ exchanger ClC-5.

Dent disease 1 (DD1) is caused by mutations in the CLCN5 gene encoding a voltage-gated electrogenic nCl-/H+ exchanger ClC-5. Using ion-selective microelectrodes and Xenopus oocytes, here we studied Cl-/H+ coupling properties of WT ClC-5 and four DD1-associated variants (S244L, R345W, Q629*, and T657S), along with trafficking and localization of ClC-5. WT ClC-5 had a 2Cl-/H+ exchange ratio at a Vh of +40 mV with a [Cl-]out of 104 mm, but the transport direction did not reverse with a [Cl-]out of 5 mm, indicating that ClC-5-mediated exchange of two Cl- out for one H+ in is not permissible. We hypothesized that ClC-5 and H+-ATPase are functionally coupled during H+-ATPase-mediated endosomal acidification, crucial for ClC-5 activation by depolarizing endosomes. ClC-5 transport that provides three net negative charges appeared self-inhibitory because of ClC-5's voltage-gated properties, but shunt conductance facilitated further H+-ATPase-mediated endosomal acidification. Thus, an on-and-off "burst" of ClC-5 activity was crucial for preventing Cl- exit from endosomes. The subcellular distribution of the ClC-5:S244L variant was comparable with that of WT ClC-5, but the variant had a much slower Cl- and H+ transport and displayed an altered stoichiometry of 1.6:1. The ClC-5:R345W variant exhibited slightly higher Cl-/H+ transport than ClC-5:S244L, but co-localized with early endosomes, suggesting decreased ClC-5:R345W membrane trafficking is perhaps in a fully functional form. The truncated ClC-5:Q629* variant displayed the lowest Cl-/H+ exchange and was retained in the endoplasmic reticulum and cis-Golgi, but not in early endosomes, suggesting the nonsense mutation affects ClC-5 maturation and trafficking.

Epidemiological Investigation for Outbreak of Clostridium perfringens Enteritis among Students at a College in 2018 / 農村醫學 地域保健

Purpose@#This study was conducted to provide the results of the epidemiological investigation for outbreak of Clostridium perfringens enteritis among students at a college in Sejong City. @*Methods@#This investigation was performed between May 25 and May 28, 2018. The Sejong City public health authority received a complaint which was about 40 university students experienced vomiting or diarrhea. We immediately set up an epidemiological investigation team and conducted a field epidemiological investigation. @*Results@#The overall incidence was 86 out of 153 (56.2%). The estimated risk exposure time was 12 o'clock on the previous day, and the cause was contaminated during distribution and storage of the lunch box provided for lunch on the day of the athletic competition, with 13 hours of average incubation period. The outbreak was closed on May 28, and the identified pathogen was Clostridium perfringens. @*Conclusions@#It was proposed that food poisoning by Clostridium perfringens was likely and contaminated during group meal.

Eosinophilic gastroenteritis in a child with gastric outlet obstruction mimicking superior mesenteric artery syndrome

Eosinophilic gastroenteritis (EGE) is known to have a low incidence among the pediatric population, but it can result in serious complications, such as gastric outlet obstruction. In previously published EGE cases with the obstruction in adults, surgeries were often performed. In this report, we present a 14-year-old girl who came to our facility with severe abdominal pain and vomiting. On the initial abdominal physical examination, diffuse tenderness and severe epigastric pain were noted. Computed tomography scan of the abdomen showed the findings of superior mesenteric artery (SMA) syndrome. However, she had no history of recent weight loss, and the medical history was inconsistent with SMA syndrome. We planned upper gastrointestinal series with barium, and then verified gastric outlet obstruction. We performed esophagogastroduodenoscopy and obtained a final diagnosis of EGE through mucosal biopsy specimen. Corticosteroids and anti-inflammatory medications were administered. Dietary modification and education were done as well. The symptoms resolved, and the follow-up esophagogastroduodenoscopy and ultrasonography showed improvements in the obstruction. Our case emphasizes that gastric outlet obstruction due to EGE must be carefully differentiated from SMA syndrome because of their similarities in clinical features and radiologic images. In doing so, we can avoid surgical intervention and perform medical/dietary treatment for gastric outlet obstruction.