OBJECTIVE: Impairment of spermatogenesis has been identified as an inevitable side effect of cancer treatment. Although estrogen treatment stimulates spermatogenic recovery from the impaired spermatogenesis by suppressing the intra-testicular testosterone (ITT) level, side effects of estrogen are still major impediments to its clinical application in humans. Soybeans are rich in genistein, which is a phytoestrogen that binds to estrogen receptors and has an estrogenic effect. We investigated the effects of genistein administration on ITT levels, testis weight, and recovery of spermatogenesis in rats treated with a chemotherapeutic agent, busulfan. METHODS: Busulfan was administered intraperitoneally to rats, and then a GnRH agonist was injected subcutaneously into the back, or genistein was administered orally. RESULTS: The weight of the testes was significantly reduced by the treatment with busulfan. The testis weight was partially restored after busulfan treatment by additional treatment with either the GnRH agonist or genistein. Busulfan also induced atrophy of a high percentage of the seminiferous tubules, but this percentage was decreased by additional treatment with either the GnRH agonist or genistein. Treatment with genistein was effective at suppressing and maintaining ITT levels comparable to that in the GnRH agonist group. CONCLUSION: Genistein effectively suppressed ITT levels and stimulated the recovery of spermatogenesis in rats treated with a chemotherapeutic drug. This suggests that genistein may be a substitute for estrogens, for helping humans to recover fertility after cancer therapy without the risk of side effects.
Animals ; Atrophy ; Busulfan ; Estrogens ; Fertility ; Genistein ; Gonadotropin-Releasing Hormone ; Humans ; Phytoestrogens ; Rats ; Receptors, Estrogen ; Seminiferous Tubules ; Soybeans ; Spermatogenesis ; Testis ; Testosterone

OBJECTIVE: The purpose of this study was to analyze the characteristics and factors of voluntary discharged patients after suicide attempt and analyze the effectiveness of follow-up measures. METHODS: Total 504 adult patients aged 14 years and over, who visited a local emergency medical center from September 1, 2013 to December 31, 2015 were enrolled and retrospectively reviewed. We analyzed the relationship with voluntary discharge group (VDG) among basic characteristics, suicidal attempt variables, outcome variables related to suicide attempts, and treatment related variables comparing with normal discharge group (NDG). RESULTS: Of the total 504 suicide attempts, three hundred eleven (61.7%) patients were VDG and 193 (38.2%) were NDG. The proportion of patients who completed the community service linkage were 18.7% (36/193) in NDG, compared with 7.7% (24/311) in VDG (p < 0.05). In addition, the ratio of the patients who visited psychiatric outpatient department in NDG were 57.0% (110/193), more than four times as likely as 14.5% (45/311) in VDG (p < 0.05). CONCLUSION: Over sixty percent of suicide attempters discharged against medical advice. Further various aspects of national supportive measures including strengthening case management service should be considered.
Adult ; Case Management ; Emergencies* ; Emergency Service, Hospital* ; Follow-Up Studies ; Humans ; Linear Energy Transfer* ; Outpatients ; Retrospective Studies ; Social Welfare ; Suicide ; Suicide, Attempted*

STUDY DESIGN: Retrospective study of prospectively-collected data.OBJECTIVES: To evaluate the radiological outcomes of direct lateral lumbar interbody fusion (DLIF).SUMMARY OF LITERATURE REVIEW: DLIF, as a minimally invasive spinal surgical procedure, is useful for degenerative spinal diseases. However, few reports have evaluated the clinical and radiological outcomes of DLIF in Korea.MATERIALS AND METHODS: We analyzed 44 patients who underwent DLIF at our hospital from September 2015 to September 2017. Of these patients, 89 segments were included in this study. We measured preoperative and postoperative radiological values including the disc height, central canal area, height of the foramen, and segmental sagittal angle on magnetic resonance imaging. We also measured patients' visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores as clinical parameters.RESULTS: Statistically significant improvements were found in the height of the left and right foramina (20.8% and 25.6%, respectively), the height of the intervertebral discs (86.0% and 84.3%, respectively), the cross-sectional area of the central nervous system (33.1%), lumbar lordosis, and the lumbar segmental angle (2.7° and 8.7°, respectively) after surgery. The VAS and ODI scores also showed significant improvements (65.7% and 67.7%, respectively) when compared with the preoperative level.CONCLUSIONS: DLIF was found to be effective for the treatment of diseases such as foraminal stenosis, degenerative spondylolisthesis, and adjacent segment diseases through indirect neuro-decompression of the bilateral foramina and central vertebrae.
Animals ; Central Nervous System ; Constriction, Pathologic ; Humans ; Intervertebral Disc ; Korea ; Lordosis ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Diseases ; Spinal Fusion ; Spinal Stenosis ; Spine ; Spondylolisthesis

OBJECTIVES: To evaluate the radiological outcomes of direct lateral lumbar interbody fusion (DLIF).SUMMARY OF LITERATURE REVIEW: DLIF, as a minimally invasive spinal surgical procedure, is useful for degenerative spinal diseases. However, few reports have evaluated the clinical and radiological outcomes of DLIF in Korea. MATERIALS AND METHODS: We analyzed 44 patients who underwent DLIF at our hospital from September 2015 to September 2017. Of these patients, 89 segments were included in this study. We measured preoperative and postoperative radiological values including the disc height, central canal area, height of the foramen, and segmental sagittal angle on magnetic resonance imaging. We also measured patients' visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores as clinical parameters. RESULTS: Statistically significant improvements were found in the height of the left and right foramina (20.8% and 25.6%, respectively), the height of the intervertebral discs (86.0% and 84.3%, respectively), the cross-sectional area of the central nervous system (33.1%), lumbar lordosis, and the lumbar segmental angle (2.7° and 8.7°, respectively) after surgery. The VAS and ODI scores also showed significant improvements (65.7% and 67.7%, respectively) when compared with the preoperative level. CONCLUSIONS DLIF was found to be effective for the treatment of diseases such as foraminal stenosis, degenerative spondylolisthesis, and adjacent segment diseases through indirect neuro-decompression of the bilateral foramina and central vertebrae.

Background/Aims: Standard triple therapy (STT; proton pump inhibitor [PPI]+clarithromycin+amoxicillin) used for Helicobacter pylori (H. pylori) eradication has shown low treatment success rates in recent years, which is most likely attributable to increased clarithromycin resistance. In this study, we compared treatment success rates of tailored therapy (TT) using real-time polymerase chain reaction (RT-PCR) and empirical STT. Methods: This retrospective study included 650 patients with H. pylori infection, who visited Eunpyeong St. Mary’s Hospital in Korea; 343 patients received TT based on RT-PCR assays, and 307 patients received STT. Eradication success was defined as a negative 13C-urea breath test result 4~8 weeks after treatment completion. Patients who failed first-line therapy and those with clarithromycin resistance received bismuth-containing quadruple therapy (BQT; PPI+bismuth+metronidazole+tetracycline). Results: Intention-to-treat analysis showed that H. pylori eradication rates were higher in patients who received RT-PCR–based TT than in those who were treated using empirical STT (80.5% [190/236] vs. 70.4% [216/307], P=0.069). Per-protocol (PP) analysis showed similar results (84.4% [190/225] vs. 74.7% [216/289], P=0.007). PP analysis showed that 7-day TT treatment was associated with a higher eradication rate than that observed with 10- to 14-day STT (85.2% [178/209] vs. 73.8% [59/80], P=0.029). The clarithromycin resistance rate was 27.9% (87/312). The eradication success rate was 89.2% (74/83) in patients with clarithromycin resistance, who received BQT as first-line therapy. Conclusions The treatment success rate was higher in patients who received 7-day RT-PCR–based TT than in those who were administered 10- to 14-day empirical treatment.

As the coronavirus disease 2019 (COVID-19) outbreak is ongoing, the number of individuals to be tested for COVID-19 is rapidly increasing. For safe and efficient screening for COVID-19, drive-through (DT) screening centers have been designed and implemented in Korea. Herein, we present the overall concept, advantages, and limitations of the COVID-19 DT screening centers. The steps of the DT centers include registration, examination, specimen collection, and instructions. The entire service takes about 10 minutes for one testee without leaving his or her cars. Increased testing capacity over 100 tests per day and prevention of cross-infection between testees in the waiting space are the major advantages, while protection of staff from the outdoor atmosphere is challenging. It could be implemented in other countries to cope with the global COVID-19 outbreak and transformed according to their own situations.

Leucine rich glioma inactivated (LGI1) encephalitis is an uncommon neurological disorder rarely encountered in clinical practice.However, it is a potentially fatal autoimmune syndrome that can decrease the level of consciousness, possibly progressing to coma.Additionally, unless diagnosed and promptly treated, it can cause permanent cognitive impairment. Since LGI1 encephalitis can initially present with psychiatric symptoms, there can be delays in reaching a proper diagnosis. This report describes a case of a 47-yearold woman with LGI1 antibodies-associated limbic encephalitis who initially presented with psychosis. Her blood tests were normal and no MRI and EEG abnormalities were found. Cerebrospinal fluid analysis was negative for other possible infectious causes. Three months after admission, she was found to be LGI1 antibody positive. LGI1 encephalitis should be suspected in patients with symptoms such as memory loss, confusion, seizures, and psychiatric symptoms. Prompt diagnosis and treatment of LGI1 encephalitis are warranted because prognosis becomes worse when such actions are delayed.

Leucine rich glioma inactivated (LGI1) encephalitis is an uncommon neurological disorder rarely encountered in clinical practice.However, it is a potentially fatal autoimmune syndrome that can decrease the level of consciousness, possibly progressing to coma.Additionally, unless diagnosed and promptly treated, it can cause permanent cognitive impairment. Since LGI1 encephalitis can initially present with psychiatric symptoms, there can be delays in reaching a proper diagnosis. This report describes a case of a 47-yearold woman with LGI1 antibodies-associated limbic encephalitis who initially presented with psychosis. Her blood tests were normal and no MRI and EEG abnormalities were found. Cerebrospinal fluid analysis was negative for other possible infectious causes. Three months after admission, she was found to be LGI1 antibody positive. LGI1 encephalitis should be suspected in patients with symptoms such as memory loss, confusion, seizures, and psychiatric symptoms. Prompt diagnosis and treatment of LGI1 encephalitis are warranted because prognosis becomes worse when such actions are delayed.

Background/Aims: Based on the Kyoto classification of gastritis, mucosal atrophy, endoscopic intestinal metaplasia, fold enlargement, nodularity, and diffuse redness may be associated with gastric cancer and Helicobacter pylori (H. pylori) infection. In this study, we investigated the association between Kyoto scores based on the aforementioned five variables and current H. pylori infection. Materials and Methods: We reviewed medical records of consecutive patients who underwent endoscopic biopsies between January and June 2019. The study included 687 patients (370 and 317 patients with H. pylori-negative and -positive results, respectively). The Kyoto score was evaluated by the endoscopist who performed the test and was reconfirmed by another endoscopist. The total Kyoto score was analyzed using a receiver operating characteristic (ROC) curve for each score from 0 to 8. Multivariate analysis was used to determine the variables associated with H. pylori infection. Results: The maximum value of the Youden index (which reflects the ideal cut-off score of the Kyoto score on the ROC curve) was a Kyoto score of 2 points (Youden index 0.5905). Nodularity (OR 24.69, 95% CI 8.57~71.16, P<0.001) and diffuse redness (1 point: OR 18.29, 95% CI 10.29~32.52, P<0.001 and 2 points: OR 30.82, 95% CI 14.07~67.52, P<0.001) showed the highest OR on multivariate analysis. Conclusions A Kyoto classification cut-off score of 2 points was suggestive of H. pylori infection, and mucosal nodularity and diffuse redness were most significantly associated with the risk of infection.

Purpose: Acellular dermal matrix (ADM) supports tissue expanders or implants in implant-based breast reconstruction. The characteristics of ADM tissue are defined by the manufacturing procedure, such as decellularization, preservation, and sterilization, and are directly related to clinical outcomes. This study aimed to compare the properties of a new pre-hydrated-ADM (H-ADM-low) obtained using a decellularization reagent reduction process with a low concentration of detergent with those of radiation-sterilized H-ADM and freeze-dried ADM (FD-ADM). Methods: ADMs were evaluated in terms of structure, mechanical quality, and cytotoxicity using histochemical staining, tensile strength testing, and in vitro cell viability analysis. Results: The tissue structure of H-ADM-low (CGDERM ONE-STEP) was similar to that of native skin despite complete decellularization. By contrast, in FD-ADM, the tissue structure was damaged by the freeze-drying process, and radiation-sterilized H-ADM showed a compact fibrillar arrangement. Furthermore, matrix components such as collagen and elastin were preserved in H-ADM-low, whereas a loss of elastin fibers with fragmented distribution was observed in radiation-sterilized H-ADMs. H-ADM-low's tensile strength (58.84 MPa) was significantly greater than that of FD-ADM (38.60 MPa) and comparable with that of radiationsterilized H-ADMs. The residual detergent content in H-ADM-low (47.45 mg/L) was 2.67-fold lower than that of H-ADM decellularized with a conventional detergent concentration (126.99 mg/mL), and this finding was consistent with the cell viability results (90.7% and 70.7%, respectively), indicating that H-ADM-low has very low cytotoxicity. Conclusions H-ADM-low produced through aseptic processes retains the original tissue structure, demonstrates excellent mechanical properties, and does not affect cell viability.Therefore, this newer H-ADM is suitable for use in implant-based breast reconstruction.