Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is characterized by chondrocalcinosis, which mainly affects the knees, wrists, pelvis, and rarely, the spine. According to previous reports, CPPD crystal deposits display heterogeneous enhancement on MRI. When combined with inflammation of the surrounding soft tissue, strong enhancement by CPPD crystal deposition may appear similar to imaging features of other conditions such as infectious spondylitis. In these conditions, CT plays an important role in differential diagnosis. Here, we present a case of CPPD crystal deposition disease in the ligamentum flavum of the cervical spine that showed intense enhancement on MRI.

Purpose: Ankle sprains are among the most common musculoskeletal injuries, and many videos have been shared with patients through YouTube. YouTube allows the easy sharing of information, but there are accuracy and reliability issues due to the lack of verification processes for video producers. This study evaluated ankle sprain videos on YouTube and the correlation between the video scores and viewer preferences using “the number of likes and views”. Materials and Methods: For analysis, the words “ankle sprains”, “ankle exercise”, and “ankle rehabilitation” were searched on YouTube. Only videos taken in Korean were analyzed, and videos with less than 10,000 views and for commercial purposes were excluded. For 31 videos, two orthopedic surgeons and one orthopedic resident used one evaluation tool to evaluate the video quality with up to 30 points for subcategories. The scores between each evaluator were then averaged to evaluate the video quality. To reflect the viewer preferences, “the number of likes and views” were analyzed, and the relationship between the video score and “the number of likes and views” of the video was analyzed statistically. Results: The average score for the video was 9.33. The average scores for subcategories were anatomy and symptoms, 0.90; biomechanics and trauma-mechanism, 0.61; imaging quality, 0.95; clinical evaluation and physical examination, 0.61; treatment, 1.41; rehabilitation, 2.39; prevention and after effects, 0.89; and overall video quality, 1.61. The average of “the number of views” was 50,218.35 times, and “the number of likes” was 893.77 times. No correlation was observed between the video scores and “the number of likes and views”. Conclusion Most videos posted on YouTube did not provide high-quality medical information on ankle sprain, and there was no correlation between the video scores and viewer preferences. This suggests that incorrect medical information is being transmitted to patients, which can be harmful. Therefore, it is necessary to present the latest trend treatment and rehabilitation protocols for ankle sprains in an expert council and promote it through various channels.

Background: Upper gastrointestinal endoscopy is becoming a common technique used by primary care physicians, so appropriate education using adummy is beneficial for the trainees. However, because dummies are expensive, only a few hospitals have dummies. In this study, we investigatedwhether a simplified upper gastrointestinal endoscopic simulator created using recycled materials can be useful in endoscopic education. Methods: The simplified upper gastrointestinal endoscopic simulator was prepared using materials that were readily available around us. Focus groupinterviews were conducted with five family medicine trainees for 60 minutes using a semi-structured questionnaire. All conversations were recordedand transcribed after they provided informed consent. Data were analyzed using qualitative analysis methods. Results: Family medicine trainees believe that upper gastrointestinal endoscopic training is essential for primary care physicians and can be helpful intheir job after training. However, they were concerned about the possibility of endoscopic complications and difficulty in endoscopy operation. Allof them said that the simplified upper gastrointestinal endoscopic simulator helped reduce their fear and also helped them become familiar withanatomic positions. The simplified upper gastrointestinal endoscopic simulator also aroused their interest and motivated them to learn. Conclusion Overall, the simplified upper gastrointestinal endoscopy simulator seemed helpful for trainees of upper gastrointestinal endoscopy. Theuse of a simplified upper gastrointestinal endoscopy simulator could be considered in training hospitals that do not have enough financial resources.Further quantitative studies are needed to generate further evidence.

OBJECTIVE: To evaluate the safety and potential efficacy of "recombinant human growth hormone (rhGH)" on the functional recovery of completed stroke patients. METHOD: Completed stroke patients were recruited. All participants were randomly assigned to the GH group (rhGH injection and rehabilitative therapy) or the control group (only rehabilitative therapy). Above all, they were closely monitored for safety. Further, for the efficacy measurement, Korean Modified Barthel Index (K-MBI), Manual Muscle strength Test (MMT), and Fugl-Meyer assessment (FMA) were assessed to determine the changes of functional recovery during 6-months of the study period. Along with it, diffusion tensor image was taken as the baseline, and a followed-up study to observe the changes in diffusion tensor tractography (DTT), during the period, and one patient in the GH group was also examined with functional MRI (fMRI). Index of fatigue on 5 point scale for the study period was also assessed. RESULTS: Twenty-two patients were enrolled, and 15 completed the study and were included in the analysis. No harmful adverse events were observed in the GH group. By comparison between the groups, the GH group showed more improvement in K-MBI than the control group (p<0.05). DTT showed less decrement of fibers in the GH group than in the control group, without statistical significance. fMRI showed an increment in the activated area. Patients in the GH group expressed no fatigue at all, during the study period (p=0.00). CONCLUSION: The administration of rhGH in long term resulted in the improvement in K-MBI, and subjectively less tiredness during the injection period.
Diffusion ; Fatigue ; Growth Hormone ; Human Growth Hormone ; Humans ; Insulin-Like Growth Factor I ; Magnetic Resonance Imaging ; Muscle Strength ; Stroke

Atorvastatin is one of the most widely prescribed medications for dyslipidemia treatment. In Korea, post combined therapy with ezetimibe, a 73-year-old woman was reported by a community pharmacy to have experienced visual field defect, which recovered after drug discontinuation. She had never experienced this symptom before, and several studies have reported an association between use of statins and visual disorders such as blurred vision, diplopia, and cataract. Blockage of cholesterol accumulation, oxidative stress, or myopathy is expected to be a cause of this symptom. Naranjo scale, Korean causality assessment algorithm (Ver.2), and World Health Organization-Uppsala Monitoring Center (WHO-UMC) criteria were the three tools used to determine causality between the visual disorder and atorvastatin. The results represent ‘probable’, ‘certain’, and ‘probable/likely’ causality, respectively. Our results, in combination with a review of literature, indicate that ocular adverse effects are highly likely related to atorvastatin.
Aged ; Atorvastatin Calcium ; Cataract ; Cholesterol ; Diplopia ; Drug-Related Side Effects and Adverse Reactions ; Dyslipidemias ; Ezetimibe ; Female ; Global Health ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Korea ; Muscular Diseases ; Oxidative Stress ; Pharmacies ; Vision Disorders ; Visual Fields

BACKGROUND: The incidence of infectious diarrheal disease in Korea has decreased over the past decade, but traveler's diarrhea (TD) is increasing in frequency. We therefore investigated the distribution of the causative agents of TD. METHODS: A total of 132 rectal swab specimens were acquired from TD patients who entered the country via Gimhae International Airport. The specimens were screened for 12 bacterial pathogens by real-time PCR, and target pathogens were isolated from the PCR positive specimens using conventional microbiological isolation methods. RESULTS: A total of 93 specimens (70.5%) showed positive PCR screening results, and of these specimens, nine species and 50 isolates (37.9%), including Vibrio parahaemolyticus (18 isolates) and ETEC (17 isolates), were isolated. No specimens were PCR positive for Listeria monocytogenes or Campylobacter jejuni, and no pathogenic Bacillus cereus were isolated. CONCLUSION: Even though viruses and EAEC were not included as target pathogens, the high isolation rate of these pathogens in this study provides indirect evidence that most cases of pathogen-negative TD are caused by undetected bacterial agents. Furthermore, our study results confirm the effectiveness of real-time PCR-based screening methods. This study is the first report in Korea to demonstrate that ETEC and V. parahaemolyticus are the major causative pathogens of TD, and this knowledge can be used to help treat and prevent TD.
Airports ; Bacillus cereus ; Campylobacter jejuni ; Diarrhea ; Dysentery ; Enterotoxigenic Escherichia coli ; Humans ; Incidence ; Korea ; Listeria monocytogenes ; Mass Screening ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; Vibrio parahaemolyticus

This study was undertaken to assess the lateral ventricle, which was some portion of brain and related to congenital anomalies, from 1, 2, 4, and 8 months of age in healthy micropigs. They were induced general anesthesia and performed magnetic resonance imaging (MRI) with a 0.3 Tesla magnet. Each age group was evaluated by three subjects such as lateral ventricular volume, ventricular volume ratio and asymmetry. T1 weighted transverse images were acquired for calculation of lateral ventricular and corresponding brain parenchyma areas. The ratio of bilateral ventricle areas used to analyze the asymmetry. The mean ventricular volumes of each month were 676.74 +/- 25.58 mm3 (1 month-old), 630.64 +/- 143.84 mm3 (2 month-old), 992.12 +/- 106.03 mm3 (4 month-old) and 1172.62 +/- 237.57 mm3 (8 month-old), respectively. The ventricular volume ratio was the smallest at 2 month-old and re-increased from that age. The ratio was significantly different between 2 month-old and other age groups (p < 0.05). The value of bilateral area ratio showed within 1.5 in all experimental animals. Consequently the lateral ventricle showed a positive correlation with aging and symmetric shapes in both sides. The developmental pattern of the lateral ventricle provides basic data in micropigs as an experimental animal model for physiological and neurosurgical approach.
Aging ; Anesthesia, General ; Animals ; Brain ; Humans ; Lateral Ventricles ; Magnetic Resonance Imaging ; Magnets ; Models, Animal

BACKGROUND: Cholera is a representative water-borne disease that is caused by V. cholera ctx (+). V. cholera El Tor was previously the primary pathogen, but after the seventh pandemic outbreak, it was replaced by a V. cholera El Tor variant with a classical phenotype and genotype. In this study, we investigated the genotypic and phenotypic characteristics of imported V. cholerae El Tor in Korea. METHODS: Forty-nine V. cholerae O1 El Tor strains isolated from 2004 to 2011 were used in this study. Polymerase chain reaction amplification of the ctxB and rstR genes was used for biotype determination. An antimicrobial susceptibility test was performed for phenotypic analysis, and pulse field gel electrophoresis (PFGE) was used for analysis of genetic relatedness. RESULTS: Classical ctxB genes were found in all of the isolates, while classical, El Tor, and combined rstR genes were found. Twenty strains showed antimicrobial resistance against streptomycin, sulfamethoxazole/trimethoprim, nalidixic acid, and ciprofloxacin. Based on PFGE, all isolates were grouped as cluster B. The country of origin and resistance pattern were highly related, although the time of influx and serogroup were not. CONCLUSION: Isolates of V. cholera El Tor imported since 2004 were hybrids of V. cholera El Tor, which has the classical ctxB gene and is considered to be a CTX prophage. The SXT element plays an important role in antimicrobial resistance. PFGE patterns, which can be used for analysis of imported V. cholera, revealed the relatedness of the resistant isolates.
Chimera ; Cholera ; Ciprofloxacin ; Electrophoresis ; Genotype ; Korea ; Nalidixic Acid ; Pandemics ; Phenotype ; Polymerase Chain Reaction ; Prophages ; Streptomycin ; Vibrio ; Vibrio cholerae ; Vibrio cholerae O1

Shigella is a common cause of bacterial enteritis worldwide. Shigella sonnei accounts for 90% of Shigella infections and Shigella flexneri is rarely reported in Korea. Although the incidence of Shigella infection has decreased, the incidence of organisms with antibiotic resistance has gradually increased in Korea. An outbreak of extended-spectrum β-lactamase (ESBL)-producing S. sonnei in children was reported in Korea; however, ESBL-producing S. flexneri has not yet been reported. We report the first two cases of multidrug-resistant CTX-M-14-producing S. flexneri infections in Korean children.
beta-Lactamases ; Child* ; Drug Resistance, Microbial ; Enteritis ; Humans ; Incidence ; Korea* ; Shigella flexneri* ; Shigella sonnei ; Shigella*

BACKGROUND: Extended-spectrum cephalosporins and fluoroquinolones are important antimicrobials for treating invasive salmonellosis, and emerging resistance to these antimicrobials is of paramount concern. METHODS: A total of 30 Salmonella spp. clinical isolates recovered in Gyeongsangbuk-do from 2012 to 2013 were characterized using antibiotic resistance profiles and pulsed-field gel electrophoresis (PFGE). RESULTS: A high prevalence of multidrug-resistant isolates, mainly showing an ampicillin, nalidixic acid, chloramphenicol resistance pattern, was observed. Four extended-spectrum beta-lactamase (ESBL)-producing isolates (3 CTX-M-15 isolates and 1 CTX-M-27 isolate) were found. The bla(CTX-M-27) gene was carried by an IncF conjugative plasmid in the S. Infantis isolate. The bla(CTX-M-15) gene were carried by an IncF (2 isolates) or IncHI2 (1 isolate) conjugative plasmid in S. Enteritidis. In addition, a single mutation of GyrA, Ser83Thr (1 isolates), Asp87Tyr (9 isolates), Asp87Gly (4 isolates), and Asp87Leu (3 isolates), was detected in nalidixic acid-resistant Salmonella spp. isolates. XbaI PFGE analysis of all isolates revealed more than 19 different pulsotypes. The most common S. Enteritidis PFGE pattern (SEGX01.003) was associated with a larger number of cases of invasive salmonellosis than all other patterns. CONCLUSION: The information from our study can assist in source attribution, outbreak investigations, and tailoring of interventions to maximize disease prevention.
Ampicillin ; beta-Lactamases ; Cephalosporins ; Chloramphenicol Resistance ; Drug Resistance ; Drug Resistance, Microbial ; Electrophoresis, Gel, Pulsed-Field ; Fluoroquinolones ; Gyeongsangbuk-do ; Nalidixic Acid ; Plasmids ; Prevalence ; Salmonella Infections ; Salmonella*