No abstract available.

Background: Preoperative verification of fracture morphology is essential for determining the definitive fixation strategy in the management of a pilon fracture. This study aimed to determine the correlation between fibular injury patterns and fracture morphologies and introduce clinical implications. Methods: Computed tomography scans of 96 pilon fractures were retrospectively analyzed and divided into three types: intact fibula, simple fracture, and multifragment fracture. The principal fracture line and comminution zones were illustrated on a plafond template and diagrammatized on a 6 × 6 grid using PowerPoint software as fracture mapping. Correlations between fibular injury patterns and fracture morphologies, including comminution zones and principal fracture lines, were analyzed. Results: The thickest comminution zone was most often located in the anterolateral quadrant. According to fibular injury patterns, the comminution zone of the multifragment group was placed two grids more lateral than that of other groups. Lateral exits of the principal fracture line in the multifragment group were much more concentrated within the fibular incisura. Conclusions In pilon fractures, a more complex fibular fracture pattern was related to the valgus position. Moreover, the articular fracture pattern of pilon fractures differed according to coronal angulation and fibular fracture pattern. These differences should influence the operative approach and placement of the plate.

Myasthenia gravis and autoimmune thyroid disorders often overlap. It is known that hyperthyroidism occurs in 2~17.5% of patients with myasthenia gravis. Thyrotoxicosis may influence the clinical course of myasthenia gravis. Overlapping clinical features may cause diagnostic confusion when Graves' disease and myasthenia gravis co-exist. Thus, various tests may be needed to distinguish these two diseases. It is clinically important to screen patients with myasthenia gravis for the co-existence of autoimmune thyroid disorders and vice versa. We cared for a patient with Graves' disease associated with ocular myasthenia gravis who presented with fluctuating double vision and ptosis. Ocular myasthenia gravis was diagnosed by electrophysiologic study and presence of acetylcholine receptor antibody. The patient had a favorable clinical and laboratory response to treatment with an anticholinesterase (pyridostigmine) and an antithyroid drug (propylthiouracil), and he had minimal symptoms at the 9-month follow-up examination.
Acetylcholine ; Diplopia ; Follow-Up Studies ; Graves Disease ; Humans ; Hyperthyroidism ; Myasthenia Gravis ; Thyroid Gland ; Thyrotoxicosis

University life can be stressful for even the most satisfied students. Especially medical school students have higher levels of stress. To manage their stress level and social connection, they are using SNS. The purpose of this study was to investigate the effect of SNS on medical students by analysis of SNS use pattern of medical students. In the analysis of the first grade of Medicine, 51 students (58.6%) posted on Facebook in the past year and posted a total of 1,452 articles (average: 28.5). We analyzed the content of the posts and found that most of them were celebrating a birthday (50%) or confirming their regards (18%). Next, there were other people's posts (10%) and travel posts (6%). Besides, there were profile photo upload (3%), school life (3%), romance (2%) or family (1%). Female students (16 times / 17 students) changed the profile pictures more frequently than male students (18 times / 34 students) (p = 0.003). There was no statistical significance in all items except for the change of profile picture according to sex. On the other hand, the analysis of the content of the share showed that most of the contents shared about humor (42%), food (15%) and music (14%). Most of the medical students used SNS primarily for social activities, not for educational purposes. Based on this analysis, there should be more research on how SNS can help medical students during medical education.
Education, Medical ; Female ; Hand ; Humans ; Male ; Music ; Schools, Medical ; Students, Medical*

BACKGROUND/AIMS: We analyzed chronological changes in hemoglobin according to renal function changes over a 5-year follow-up period. METHODS: We enrolled 5,266 adults with a glomerular filtration rate (GFR) > or = 60 mL/min/1.73 m2 at an initial examination at a routine health check-up; a follow-up examination was conducted 5 years later. We categorized the subjects according to GFR ratio (groups 1, 2, and 3, defined as GFRratio > or = 1.00, 0.75 to 0.99, and < 0.75, respectively). RESULTS: The mean hemoglobin level in subjects with a GFR of 60 to 74 was higher than in those with a GFR of 75 to 89 or > or = 90 mL/min/1.73 m2 at the initial examination (all p < 0.001). Among females and males, the frequencies of increased hemoglobin were 46.8% and 40.6% in the GFRratio group 1, 52.4% and 46.1% in group 2, and 59.6% and 52.5% in group 3 over the 5-year period, respectively (all p < 0.001). With multiple logistic regression, group 3 showed 1.594-fold (95% confidence interval [CI], 1.127 to 2.225) and 1.353-fold (95% CI, 1.000 to 1.830) higher likelihoods of increased hemoglobin over the 5-year follow-up period in females and males, respectively. The estimated difference in hemoglobin level was highest in group 3 in both genders. These findings were more evident in subgroups without metabolic syndrome, diabetes mellitus, hypertension, or GFR less than 90 mL/min/1.73 m2. CONCLUSIONS: Among a population with GFR > or = 60 mL/min/1.73 m2, a mild decrease in GFR over a 5-year follow-up period was associated with an increase in hemoglobin levels.
Adult ; Aged ; Biological Markers/blood ; Chi-Square Distribution ; Disease Progression ; Female ; Follow-Up Studies ; *Glomerular Filtration Rate ; Hemoglobins/*metabolism ; Humans ; Kidney/*physiopathology ; Kidney Diseases/blood/diagnosis/*physiopathology ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Republic of Korea ; Time Factors ; Up-Regulation

Mitochondria are key organelles involved in energy production, functioning as the metabolic hubs of cells. Recent findings emphasize the emerging role of the mitochondrion as a key intracellular signaling platform regulating innate immune and inflammatory responses. Several mitochondrial proteins and mitochondrial reactive oxygen species have emerged as central players orchestrating the innate immune responses to pathogens and damaging ligands. This review explores our current understanding of the roles played by mitochondria in regulation of innate immunity and inflammatory responses. Recent advances in our understanding of the relationship between autophagy, mitochondria, and inflammasome activation are also briefly discussed. A comprehensive understanding of mitochondrial role in toll-like receptor-mediated innate immune responses and NLRP3 inflammasome complex activation, will facilitate development of novel therapeutics to treat various infectious, inflammatory, and autoimmune disorders.
Autophagy ; Immunity, Innate* ; Inflammasomes ; Inflammation* ; Ligands ; Mitochondria ; Mitochondrial Proteins ; Organelles ; Reactive Oxygen Species

Early gastric cancer(EGC) is defined as carcinoma limited to the mucosa or submucosa, regardless of whether metastasis to lymph nodes have occurred, and the frequency of lymph node metastasis varies from 7 to 18%. The incidence of early gastric cancer has been increasing recently, probably with advance in the diagnostic procedure. Multiple gastric cancer, now cosidered to be a sort of multiple primary cancer by Moertels classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Multiple carcinoma was found in about 8.3% of 500 early gastric cancer cases at the National Cancer Center Hospital in Japan. In 77% of these, two lesions roexisted in the stomach. Coexistence of three lesions were found in 20% and more than four lesions in 3%. We report a case of multiple early gastric cancer of different histologic types in which two adenoma coexisted in the stomach.
Adenoma ; Classification ; Incidence ; Japan ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Stomach ; Stomach Neoplasms*

Early gastric cancer(EGC) is defined as carcinoma limited to the mucosa or submucosa, regardless of whether metastasis to lymph nodes have occurred, and the frequency of lymph node metastasis varies from 7 to 18%. The incidence of early gastric cancer has been increasing recently, probably with advance in the diagnostic procedure. Multiple gastric cancer, now cosidered to be a sort of multiple primary cancer by Moertels classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Multiple carcinoma was found in about 8.3% of 500 early gastric cancer cases at the National Cancer Center Hospital in Japan. In 77% of these, two lesions roexisted in the stomach. Coexistence of three lesions were found in 20% and more than four lesions in 3%. We report a case of multiple early gastric cancer of different histologic types in which two adenoma coexisted in the stomach.
Adenoma ; Classification ; Incidence ; Japan ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Stomach ; Stomach Neoplasms*

Purpose: Physician-modified endovascular stent grafts (PMEG) are a good treatment option for complex abdominal aortic aneurysms (AAAs), especially in high-risk patients not amenable to open repair, and when commercial fenestrated devices are not available. We report our single-center experience with PMEG for the treatment of complex AAAs. Methods: We retrospectively reviewed patients who underwent PMEG repair for AAA from November 2016 to September 2020 at our institution. Demographic data, anatomic characteristics, perioperative and postoperative outcomes, major adverse events, and 30-day mortality were analyzed. Results: We identified 12 patients who underwent PMEG for complex AAA. The mean age was 74 years and the mean maximal AAA diameter was 58.1 mm. Indications for treatment included 4 impending or contained ruptures, 2 mycotic aneurysms, and 6 symptomatic cases. The technical success rate was 91.7%. Aneurysm sac regression was observed in 7 patients (58.3%), including 2 cases of complete regression. There was 1 aneurysm-related mortality at 3 months due to mycotic aneurysm. Also, there was 1 postoperative complication case of transient renal failure requiring temporary dialysis. At 1 year, there was 1 branch occlusion from the initial failed cannulation case and 2 type 1A endoleaks, and there was 1 case of open explantation. Conclusion PMEG showed a low technical failure rate and acceptable midterm stent durability and sac stability, comparable to conventional endovascular aneurysm repair. Despite the small number of cases, there was a tendency for a high sac regression rate, although longer follow-up is needed.

Azathioprine (AZA) is widely used for the treatment of inflammatory bowel disease. Bone marrow suppression is a common side effect with AZA treatment. However, data from AZA trials has indicated that a leukocyte count less than 5,000/mm3 was a good predictor of induction and maintenance of remission. Moreover, there is evidence that eradication of sensitized leukocytes by leukapheresis or bone marrow transplantation improves inflammatory bowel disease. We report a case of a patient who had a chronic relapse of ulcerative colitis requiring the frequent use of systemic steroids, but presented prolonged remission following AZA-induced severe pancytopenia. Also colonoscopy showed accelerated healing of diffuse active ulcers following just recovery from pancytopenia.
Azathioprine ; Bone Marrow ; Bone Marrow Transplantation ; Colitis, Ulcerative ; Colonoscopy ; Humans ; Inflammatory Bowel Diseases ; Leukapheresis ; Leukocyte Count ; Leukocytes ; Pancytopenia ; Recurrence ; Steroids ; Ulcer