Purpose: To evaluate the effects of intravenous steroid therapy on the clinical activity score (CAS), exophthalmos, margin-reflex distance 1 (MRD1), and autoantibody levels in patients with thyroid eye disease. Methods: In this retrospective observational study, we enrolled 83 patients diagnosed with thyroid eye disease treated with intravenous steroid therapy. We assessed exophthalmos, MRD1, CAS, thyroid-stimulating antibody (TSAb), and thyroid-stimulating hormone receptor antibody (TSHR Ab) levels at baseline, 6 and 12 weeks after initiating therapy, and 2 months after therapy termination. Additionally, baseline serum selenium levels were examined to determine their impact on treatment efficacy. Results: TSAb, TSHRAb, and CAS levels showed a continuous decline from 443.22 to 341.03 specimen-to-reference control ratio (SRR%), 22.18 to 7.91 IU/L, and 3.37 to 1.88, respectively (p < 0.0001), up to 2 months following therapy termination. Exophthalmos did not show significant changes at any assessed time point up to 2 months after therapy termination. MRD1 decreased until 12 weeks after therapy initiation but showed no significant change 2 months later. No correlation was found between baseline serum selenium levels and changes in exophthalmos, MRD1, TSAb, TSHR Ab, or CAS. Conclusions Intravenous steroid therapy was effective in reducing TSAb, TSHR Ab, and CAS levels up to 2 months after therapy termination. However, it had limited positive impact on exophthalmos or eyelid retraction. Baseline selenium levels did not correlate with the changes in any of the examined parameters.

Dysphagia is a common problem in children with a tracheostomy tube. Such children are at risk of malnutrition, developmental problems, increased medical complications, and pose an increased burden on their caregivers. Therefore, proper evaluation and dysphagia rehabilitation are necessary for children with a tracheostomy tube.Also, as many such children experience serious complications, it is necessary to consider decannulation as early as possible, soon after the indication for tracheostomy placement is resolved. Decannulation should be performed safely as per the appropriate protocol.

The Committee of Education of the Korean Diabetes Association discussed the need to develop the Diabetes Education Recognition Program. In 2011, the current certification program was reviewed and a survey was conducted to improve the Diabetes Education Recognition Program. This improved program will be a standard for qualified diabetes education for diabetes educators and institutes, and will ultimately become a national standard for diabetes education.
Academies and Institutes ; Certification ; Diabetes Mellitus ; Patient Education as Topic

OBJECTIVE: The purpose of this study is to evaluate the role of cold knife conization in the diagnosis and management of cervical neoplasia. METHODS: Cold knife conization was performed in total 163 patients from January 1992 to December 2003. The results of PAP smear and colposcopy-directed biopsy were compared with the pathologic diagnosis of conization. And we evaluated the rate of positive margin and the presence of residual lesion. And then, we reviewed the pregnancy outcome after conization. RESULTS: The rate of agreement between PAP cytology and conization was 45.4%, and the rate of agreement between colposcopy-directed biopsy and conization was 65.6%. Hysterectomy was done in 102 patients (62.6%). The positive rate of resection margin was 19.6%. The incidence of residual lesion after conization was 31.2% in margin (+) and 1.4% in margin (-). We evaluated 7 cases of pregnancy after conization. CONCLUSION: Cervical conization as surgical treatment was effective in cervical neoplasia patients, especially young patients, with continuous follow-up.
Biopsy ; Conization* ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Incidence ; Pregnancy ; Pregnancy Outcome

Infantile hepatic hemangioma is benign vascular tumor and the most common liver tumor in infants. Small hepatic hemangioma is usually asymptomatic and seldom require therapy. Giant hepatic hemangioma, defined as more than 4 cm in diameter, is rare, but can lead to life-threatening complications such as consumptive coagulopathy, anemia, hemorrhage after tumor rupture and congestive heart failure due to arteriovenous shunting. Neonatal mortality rate is about 70-90%. The differential diagnosis of a fetal liver mass includes hemangioma, hepatoblastoma, and mesenchymal harmatoma. Although hepatic hemangioma represents the most common tumor of the liver in infant, the prenatal diagnosis of this condition has been rarely reported in the literature. we experienced a case of fetal hepatic hemangioma by prenatal sonography and report our case with a brief review of literature.
Anemia ; Diagnosis* ; Diagnosis, Differential ; Heart Failure ; Hemangioma* ; Hemorrhage ; Hepatoblastoma ; Humans ; Infant ; Infant Mortality ; Liver ; Prenatal Diagnosis ; Rupture ; Ultrasonography*

Ethical problems in an emergency department (ED) are much more common than is usually recognized. But these difficult ethical dilemmas have not been dealt with by general medical ethicists. Most medical ethics guidelines tend to concentrate on chronic or at least relatively stable situations rather than on the acute, episodic cases that are typical in the ED. most ethical problems such as abortion, euthanasia, and professionalism can be solved after reflection and deliberation, and after a process of communication that reveals the values and interests of the patient or the patient's family. In contrast, when health care professionals in the ED recognize ethical problems, they often don't have enough time for an ethical consultation such as a Hospital Ethics Committee. Ethical principles such as autonomy, beneficence, nonmaleficence, and justice need to be applied to the unique setting of emergency medicine. Hence, it is necessary to develop ethics guidelines in emergency medicine and ethics education for health care professionals in emergency departments. At first, we collected cases involving ethical problems and reviewed the ethical and legal aspects of those cases. In this article, we summarize the ethical issues in emergency medicine, deal with actions in emergency medical services, and also consider the relationships between ethical issues and act on emergency medical services. We want to present the important factors that should be considered in ethical decision making within an emergency medicine department including patient decision making capacity, legal custody, and ethical principles.
Beneficence ; Decision Making ; Delivery of Health Care ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Ethicists ; Ethics Committees, Clinical ; Ethics, Medical ; Euthanasia ; Humans ; Jurisprudence ; Social Justice

The Dieulafoy's lesion is a rare cause of recurrent massive gastrointestinal bleeding in children. The bleeding results from an abnormally large submucosal artery that protrudes through a small mucosal defect. The lesion is commonly found on proximal stomach. Surgical intervention was believed to be the best treatment in the past, but recent advancement in endoscopy has made effective hemostasis possible. We report a case of a 9-year-old boy with underlying mycoplasma pneumonia with effusion who presented with massive upper gastrointestinal bleeding. Bleeding was controlled with endoscopic treatment by epinephrine and ethanol injection and the patient was successfully treated.
Arteries ; Child* ; Endoscopy ; Epinephrine ; Ethanol* ; Hemorrhage ; Hemostasis ; Humans ; Male ; Pneumonia, Mycoplasma ; Stomach

Background: The nose is located at the center of the face, and it is possible to determine race, sex, and the like. Research usingthe nasal index (NI) classification method to classify the shape of the nose is currently in progress. However, domestic research is required as most research is being conducted abroad. In this study, we used a 3D program to confirm the ratio of the nose shape of Koreans. Methods: One hundred patients (50 males and 50 females) in their 20s were evaluated (IRB approval no. DKUDH IRB 2020-01-007).Cone beam computed tomography was performed using the Mimics ver.22 (Materialise Co., Leuven, Belgium) 3D program to model the patient’s skull and soft tissues into three views: coronal, sagittal, and frontal. To confirm the ratio of measurement metrics, analysis was performed using the SPSS ver. 23.0 (IBM Co., Armonk, NY, USA) program. Results: Ten leptorrhine (long and narrow) type, 76 mesorrhine (moderate shape) type, and 14 platyrrhine (broad and short) type noses were observed. In addition, as a result of sex comparison, five males had the leptorrhine (long and narrow) type, 40 mesorrhine (moderate shape), and five platyrrhine (broad and short) types. For females, five patients had the leptorrhine (long and narrow) type, 36 patients had the mesorrhine (moderate shape) type, and nine patients had the platyrrhine (broad and short) type. Conclusion This study will be helpful when performing nose-related surgeries and procedures in clinical practice and for similarstudies in the future.

OBJECTIVE: To evaluate the dose effect of recombinant mouse granulocyte-macrophage colony-stimulating factor (rmGM-CSF) or brain-derived neurotrophic factor (BDNF) in culture medium on the development of in vitro fertilized mouse embryos. METHODS: Mature oocytes were retrieved from superovulated female BDF1 mice and inseminated by sperm from male BDF1 mice. On day 1, two-cell stage embryos were divided and cultured until day 5 in the embryo maintenance medium supplemented with 0, 1, 2, 5, or 10 ng/mL of rmGM-CSF or supplemented with 0, 5, 10, or 20 ng/mL of BDNF. Blastocyst formation rate and their cell numbers were assessed. RESULTS: The blastocyst formation rate and the total cell count in blastocyst was similar in all the rmGM-CSF treatment groups when compared with the control. However, the blastocyst formation rate and the total cell count was significantly higher in the group supplemented with 10 ng/mL of BDNF compared with the control (63.9%, 45.8+/-11.5 vs. 52.3%, 38.0+/-6.8; P<0.05, respectively). CONCLUSION: Supplementation of 10 ng/mL of BDNF enhanced the developmental potential of mouse preimplantation embryos, but supplementation of rmGM-CSF did not.
Animals ; Blastocyst* ; Brain-Derived Neurotrophic Factor* ; Cell Count ; Embryonic Structures ; Female ; Granulocyte-Macrophage Colony-Stimulating Factor* ; Humans ; Male ; Mice* ; Oocytes ; Spermatozoa