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Pseudoaneurysm-Induced Pain Following Ankle Arthroscopy: A Case Report and Literature Review
No full textBACKGROUND Arthroscopic surgery is esteemed for its arthroscopic lateral ligament repair to treating ankle ligament injuries, characterized by a low complication rate. Nevertheless, rare complications such as pseudoaneurysms require careful monitoring and a strategic approach to management during the postoperative follow-up period. This case report details a 42-year-old man with chronic instability in his left ankle. The aim of this paper is to present a case report and conduct a literature review on the rare complication of pseudoaneurysm following arthroscopic procedures. CASE REPORT A 42-year-old man with chronic instability in his left ankle was experiencing severe pain and limited motion following arthroscopic lateral ligament repair surgery. He was diagnosed with a pseudoaneurysm of the left anterior tibial artery and an intra-articular hematoma in the left ankle joint, indicated by MRI and Doppler ultrasound findings. Initial conservative management was followed by interventional procedures, including thrombin injection and balloon tamponade. After these interventions proved unsuccessful, surgical intervention for anterior tibial artery reconstruction and hematoma evacuation was performed. The surgical interventions resulted in the closure of the pseudoaneurysm and improvement in the patient's pain. CONCLUSIONS This case underscores the challenges involved in diagnosing and managing pseudoaneurysm and hematoma after ankle surgery, highlighting the necessity for thorough evaluation and a comprehensive treatment strategy
Convolutional neural network-based method for the real-time detection of reflex syncope during head-up tilt test
No full textBACKGROUND AND OBJECTIVES: Reflex syncope (RS) is the most common type of syncope caused by dysregulation of the autonomic nervous system. Diagnosing RS typically involves the head-up tilt test (HUTT), which tracks physiological signals such as blood pressure and electrocardiograms during postural changes. However, the HUTT is time-consuming and may trigger RS symptoms in patients. Therefore, a real-time monitoring system for RS risk assessment is necessary to enhance medical efficiency and patient convenience. Although several methods have been developed, most depend on manually extracted features from physiological signals, making them susceptible to feature extraction methods and signal noise. METHODS: This study introduces a deep learning-based method for real-time RS detection. This method removes the need for manually extracted features by employing an end-to-end architecture consisting of residual and squeeze-and-excitation blocks. The likelihood of RS occurrence was quantified using the proposed method by analyzing a raw blood pressure signal. RESULTS: Data from 1348 patients (1291 normal and 57 with RS) were used to develop and evaluate the proposed method. The area under the receiver operating characteristic curve was 0.972 for RS detection using ten-fold cross-validation. A threshold between zero and one can adjust the performance characteristics of the proposed method. At a threshold of 0.75, the method achieved sensitivity and specificity values of 94.74 and 94.27 %, respectively. Notably, the technique detected RS 165.35 s before its occurrence, on average. CONCLUSIONS: The proposed method outperformed conventional methods in RS detection. In addition to its excellent detection performance, this method only requires blood pressure monitoring, reducing reliance on the number of input signals and enhancing its applicability compared to procedures that require multiple signals. These advantages contribute to the development of safer, more convenient, and more efficient RS detection systems
Association between calcium channel blocker use and the risk of interstitial lung disease and idiopathic pulmonary fibrosis: A longitudinal cohort study
No full textIntroduction: Ca2+ signaling in fibroblasts would be one of the important mediators of lung fibrosis. This study investigated the relationship between calcium channel blocker usage and the risk of developing interstitial lung disease and idiopathic pulmonary fibrosis. Material and methods: This cohort study used data from the Korean National Health Screening Cohort spanned from January 1, 2004, to December 31, 2015. The study included 394,142 participants. CCB usage, as a time-dependent variable assessed every two years, was categorized by medication status (ever-users and never-users) and further divided into five groups based on cumulative defined daily dose: <182.5, 182.5–365.0, 365.0–547.5, and ≥547.5. Incidence rates of ILD and IPF among CCB users compared to never-users, analyzed using time-dependent Cox regression models. Results: The incidence rates were 27.7 per 100,000 person-years for ILD and 15.0 per 100,000 person-years for IPF among never-users, compared to 19.5 per 100,000 person-years for ILD and 13.9 per 100,000 person-years for IPF among ever-users. The adjusted hazard ratios (aHRs) were 0.68 [95 % confidence interval (CI), 0.55–0.83] for ILD and 0.69 (95 % CI, 0.54–0.88) for IPF. Increasing categories of CCB usage were significantly associated with a lower risk of ILD [aHRs: 1.23 (95 % CI, 0.97–1.56), 1.20 (0.85–1.71), 0.49 (0.30–0.81), and 0.27(0.19–0.39)] and IPF [aHRs: 1.21 (95 % confidence interval, 0.89–1.64), 1.45 (0.96–2.20), 0.83 (0.52–1.33), and 0.25 (0.16–0.38)], compared to never-users. Conclusions: This study found that individuals using CCBs had a significantly lower risk of interstitial lung disease and idiopathic pulmonary fibrosis compared to never-users in a dose-response manner
Lymph node metastasis following chemoradiotherapy in advanced rectal cancer: ypT2-focused analyses of total mesorectal excision specimens
No full textBackground: Non-radical management is an option for good responders to neoadjuvant chemoradiotherapy in mid-to-low rectal cancer. This study aimed to analyze risk factors for lymph node metastasis in patients with ypT2 rectal cancer, exploring the possibility of non-radical management. Methods: We included patients with ypT2 rectal cancer who received neoadjuvant chemoradiotherapy followed by total mesorectal excision between January 2004 and December 2022. Clinicopathological parameters were evaluated to identify risk factors for lymph node metastasis. Results: Among the 198 patients, 158 (79.8%) had ypT2N0 and 40 (20.2%) had ypT2N+. In univariable analyses, the risk factors of lymph node metastasis were perineural invasion (48.0% vs. 16.3% without perineural invasion, P < 0.001), female sex (30.0% vs. 14.8% with male sex, P = 0.011), and clinically positive nodes after neoadjuvant chemoradiotherapy (32.6% vs. 16.4% with negative nodes, P = 0.017). These factors were confirmed as independent risk factors in multivariable analyses: perineural invasion (odds ratio [OR]: 4.50; 95% confidence interval [CI]: 1.79–11.29; P < 0.001), female sex (OR: 2.62; 95% CI: 1.24–5.52; P = 0.012) and clinical node involvement after neoadjuvant chemoradiotherapy (OR: 2.28; 95% CI: 1.03–5.05; P = 0.012). The rate of lymph node metastasis in patients with ypT2 rectal cancer without any of these three risk factors was 12.5%. Conclusions: This study revealed a high probability of lymph node metastasis in patients with ypT2 rectal cancer, even in the absence of identifiable risk factors. We confirm that lymph node metastasis should be considered in ypT2 rectal cancer
Association of urinary levels of trace metals with type 2 diabetes and obesity in postmenopausal women in Korea: A community-based cohort study
No full textSeveral toxic metals have been associated with metabolic diseases like obesity and diabetes mellitus (DM) in humans. However, knowledge regarding the influence of many trace elements, especially in combination with essential elements is limited. This study aims to address this research gap by investigating the associations of both non-essential and essential inorganic trace elements in urine with DM and obesity, employing a group of postmenopausal women (n = 851) from the Korean Genome and Epidemiology Study (KoGES) cohort. Urine samples were collected during 2017–2018, and were analyzed for 19 trace elements using inductively coupled plasma–mass spectrometry and an automatic mercury analyzer. Outcomes of interest were metabolic diseases (DM and obesity) and DM-related traits (insulin resistance and β-cell function). After adjustment of covariates, such as age, alcohol consumption, smoking status, educational level, and daily energy intake, urinary Zn, Ni, Tl, and U levels were associated with the prevalence of DM and homeostatic model assessment (HOMA) for insulin resistance (IR) in the postmenopausal women. In the whole mixture model, however, no significant association was observed for the prevalence of DM. Urinary levels of Zn were negatively associated with HOMA of β-cell function (HOMA-β), positively correlated with HbA1c levels, HOMA-IR, and prevalent DM. In addition, urinary Zn, Co, Tl, and Cs were positively associated with obesity (body mass index ≥25 kg/m2). The present observation shows that several individual elements and their mixtures may be associated with the prevalence of DM, IR, or obesity
Interinstitutional Comparison of Vancomycin Area Under the Concentration–Time Curve Estimation in Korea: Need for Standardized Operational Protocols for Therapeutic Drug Monitoring Consultation
No full textVancomycin, a vital antibiotic for treating gram-positive bacterial infections, requires therapeutic drug monitoring (TDM) because of its substantial pharmacokinetic variability. While traditional TDM relies on steady-state trough concentrations, recent guidelines advocate the area under the concentration–time curve (AUC) as the target index. However, detailed protocols for AUC estimation are lacking, leading to potential discrepancies among institutions. We surveyed medical institutions in Korea regarding vancomycin TDM, including AUC estimation. Nineteen participants responded to the TDM case challenge under three patient scenarios. For an ordinary patient in Case 1, the overall CV for AUC values was 0.4% when both trough and peak concentrations were included in the AUC calculation and 1.9% when utilizing only the trough concentration. For Case 2, an older patient with obesity, the corresponding CV was 6.6%. For Case 3 with multiple trough concentrations, the CV was 15.6%, reflecting variations in the selective use of data. Although the agreements in Case 1 were good, significant variability in AUC estimation was noted in cases involving atypical patient characteristics or old TDM data. Our study provides insight into the current status of vancomycin TDM in Korea and underscores the need for standardized operational protocols for AUC estimation
NKX6.3 modulation of mitotic dynamics and genomic stability in gastric carcinogenesis
No full textBACKGROUND: Gastric cancer remains a significant global health challenge, characterized by poor prognosis and high mortality rates. Mitotic integrity and genomic stability are crucial in maintaining cellular homeostasis and preventing tumorigenesis. The transcription factor NKX6.3 has emerged as a potential regulator of these processes in gastric epithelial cells, prompting an investigation into its role in gastric cancer development. METHODS: We employed a combination of in vitro and in vivo techniques to elucidate the impact of NKX6.3 depletion on mitotic dynamics and genomic stability in gastric epithelial cells. Quantitative real-time PCR and Western blot analyses were conducted to assess the expression of mitosis-related genes and proteins. Flow cytometry was utilized to evaluate cell cycle distribution, while immunofluorescence microscopy enabled the visualization of mitotic abnormalities. Statistical analyses, including Student's t-test and ANOVA, were performed to determine the significance of our findings. RESULTS: Our results demonstrate that NKX6.3 depletion leads to significant mitotic defects, characterized by increased chromosome misalignment and lagging chromosomes during anaphase. These abnormalities corresponded with elevated levels of genomic instability markers, indicating compromised genomic integrity. Furthermore, the loss of NKX6.3 resulted in altered expression of key regulatory proteins involved in mitosis and DNA repair pathways, suggesting a mechanistic link between NKX6.3 and the maintenance of genomic stability in gastric epithelial cells. Depletion of NKX6.3 resulted in accelerated cell cycle progression and the formation of abnormal mitotic figures, leading to genomic instability characterized by increased DNA content and structural abnormalities. In both in vitro and xenograft models, the depletion of NKX6.3 significantly upregulated AurkA and TPX2, which correlated with gains in DNA copy number. An inverse relationship was observed between NKX6.3 expression and the levels of AurkA and TPX2 in human gastric cancer tissues. CONCLUSIONS: This study highlights the essential role of NKX6.3 in regulating mitotic integrity and genomic stability in gastric carcinogenesis. The findings suggest that targeting NKX6.3 may offer a novel therapeutic strategy for improving treatment outcomes in gastric cancer by restoring mitotic fidelity and genomic stability. TRIAL REGISTRATION: This study was not registered
Reinforcement of Transdural Angiogenesis: A Novel Approach to Treating Ischemic Stroke With Cerebral Perfusion Impairment
No full textCerebral hypoperfusion plays a critical role in early neurological deterioration and long-term outcomes in patients with acute ischemic stroke, which remains a major global health challenge. This review explored transdural angiogenesis as a promising therapeutic strategy to restore cerebral perfusion in patients with ischemic stroke. The multiple burr hole procedure has been preliminarily used as an indirect revascularization method to induce transdural arteriogenesis. Theoretically, its efficacy could be enhanced by combining it with angiogenic boosters, such as erythropoietin. Recent clinical and preclinical studies have revealed that this combination therapy promotes angiogenesis and arteriogenesis, leading to successful revascularization across the dura mater and improved cerebral blood flow. This strategy may be particularly beneficial for high-risk patients with recurrent ischemic events, such as those with moyamoya disease or intracranial arterial occlusion, representing an effective strategy when conventional medical treatments are insufficient. This review highlights the potential of transdural angiogenesis enhancement as a novel intervention for ischemic stroke, offering an alternative to thrombolysis or endovascular treatment, particularly in acute stroke patients with impaired cerebral perfusion. This approach has the potential to bridge the treatment gap for patients outside the therapeutic window for acute stroke interventions. Although further research is required to refine this technique and validate its efficacy in broader clinical settings, early results have revealed promising outcomes at reducing stroke-related complications and improving patient prognosis. This review indicates that this novel strategy may offer hope for managing ischemic stroke and related conditions associated with significant cerebral hypoperfusion
알츠하이머병에서 항아밀로이드 단일클론항체 치료제에 의한 아밀로이드 관련 영상 이상: 표준 자기공명영상 프로토콜에 대한 전문가 권고안
No full textThe introduction of anti-amyloid therapies for Alzheimer's disease (AD), such as lecanemab (Lequembi((R))), which was recently approved in Korea, necessitates careful monitoring for amyloid-related imaging abnormalities (ARIA) using brain MRI. To optimize ARIA monitoring in Korean clinical settings, the Korean Society of Neuroradiology (KSNR) and the Age and Neurodegeneration Imaging (ANDI) Study Group proposed MRI protocol recommendations on essential MR sequences, MRI acquisition parameters, timing and condition of MRI examinations, and essential details to provide a scientific basis for maximizing the safety and efficacy of AD treatment. A customized, standardized MRI protocol focusing on Korea's healthcare environment can improve ARIA management and ensure patient safety through early detection of potential anti-amyloid therapy side effects, thereby enhancing treatment quality
Primary Cutaneous CD30+ Lymphoproliferative Disorders in South Korea: A Nationwide, Multi-Center, Retrospective, Clinical, and Prognostic Study
No full textBACKGROUND: Primary cutaneous CD30+ lymphoproliferative disorders (pcCD30-LPDs) are a diseases with various clinical and prognostic characteristics. OBJECTIVE: Increasing our knowledge of the clinical characteristics of pcCD30-LPDs and identifying potential prognostic variables in an Asian population. METHODS: Clinicopathological features and survival data of pcCD30-LPD cases obtained from 22 hospitals in South Korea were examined. RESULTS: A total of 413 cases of pcCD30-LPDs (lymphomatoid papulosis [LYP], n=237; primary cutaneous anaplastic large cell lymphoma [C-ALCL], n=176) were included. Ninety percent of LYP patients and roughly 50% of C-ALCL patients presented with multiple skin lesions. Both LYP and C-ALCL affected the lower limbs most frequently. Multiplicity and advanced T stage of LYP lesions were associated with a chronic course longer than 6 months. Clinical morphology with patch lesions and elevated serum lactate dehydrogenase were significantly associated with LPDs during follow-up in LYP patients. Extracutaneous involvement of C-ALCL occurred in 13.2% of patients. Lesions larger than 5 cm and increased serum lactate dehydrogenase were associated with a poor prognosis in C-ALCL. The survival of patients with C-ALCL was unaffected by the anatomical locations of skin lesions or other pathological factors. CONCLUSION: The multiplicity or size of skin lesions was associated with a chronic course of LYP and survival among patients with C-ALCL