We have compared the computed tomographic(C. T.) findings with those of conventional roentgenogram(simple AP and lateral radiograms) in 18 cases of osteochondritis dissecans of the capitellum humeri available for review. Among the 18 cases, 2 cases of them had a lesion of osteochondritis dissecans on C. T. which, however, had not been found on conventional rentgenograms. Fro the 5 cases, which had not clearly found on conventional rentgenograms, 2 loose body on conventional view, 3 cases had different numbers and locations of loose body on C. T. films. On the bases of our findings, we recommend that C. T. is necessary in early detection and the determination of anatomical location and status of osteochondritis dissecans of capitellum.
Osteochondritis Dissecans ; Osteochondritis

Purpose: This study aimed to develop an untact visit service based on an application that can be utilized in the pediatric intensive care unit (PICU) during COVID-19. Methods: This study adopted the double diamond process of service design comprising the discovery, defining, and development stages. Results: We developed an untact visit service based on an application that considered the child’s status, schedule, photo, and video messages, and so on. Moreover, we derived a service flow regarding the required roles and the type of flow shown between each stakeholder. Conclusion Considering the ongoing pandemic, the untact visit service is designed to increase rapport and participation of parents, share the child’s information in real-time, and provide one-stop service without increasing healthcare providers’ work. It will be a useful visit service that can be applied and evaluated in various hospital settings and the PICU.

PURPOSE: The metalloproteinases (MMP) and their inhibitors (TIMP) have been suggested to play a role in tumor invasion and metastasis. There have been some dispute on the exact role of TIMP and MMP in tumor progression. The purpose of this study is to prove TIMP expression in relation with prevention of tumor progression including invasion or metastasis with MMP expression. MATERIALS AND METHODS: We have performed immunohistochemical staining of MMP-2, MMP-9 and TIMP-2 on 15 cases of benign prostatic hyperoplasia (BPH), and 30 cases of prostatic carcinomas which were classified as angio or neural invasion positive (PC-2) and negative group (PC-1). RESULTS: MMP-2, MMP-9, and TIMP-2 were not detected in BPH. PC-2 pateints had higher levels of collagenases than BPH, while PC-1 patients had higher levels of TIMP-2 and lower levels of MMP-2, MMP-9 than PC-2. Expression of TIMP-2 were inversely proportional to collagenases. CONCLUSION: We conclude that highly invasive prostatic carcinoma (PC-2) contained relatively high levels of MMP-2, MMP-9 and low amounts of TIMP-2. These results are discussed with respect to the possible role of MMPs and TIMP in prostatic tumor progression.
Adenocarcinoma* ; Collagenases ; Dissent and Disputes ; Humans ; Matrix Metalloproteinases ; Metalloproteases ; Neoplasm Metastasis ; Tissue Inhibitor of Metalloproteinase-2 ; Tissue Inhibitor of Metalloproteinases*

Purpose: To examine the mediating effects of parental efficacy on the relationship between participating in online parenting communities and health-promoting behaviors for children among first-time mothers with infants and toddlers. Methods: The participants were 174 first-time mothers who used online parenting communities. Data were collected through self-report online questionnaires. Descriptive statistics, independent t-test, 1-way analysis of variance, Pearson correlation coefficient and multiple linear regression analysis were performed. The significance of the mediating effect was verified using the Sobel test and PROCESS macro. Results: Significant predictors for health-promoting behaviors for children among first-time mothers were maternal age, maternity leave, monthly income, weekly use of online communities, daily use of online communities, satisfaction with online communities, and parental efficacy, which explained 51.0% of maternal health-promoting behaviors for children. Parental efficacy partially mediated the relationship between mothers’ satisfaction with using online communities and their health-promoting behaviors for children. Conclusion Interventions to enhance satisfaction with online parenting communities and parental efficacy should be developed to promote the health of infants and toddlers. Therefore, it is necessary to consider the needs of mothers for child rearing and health care, and develop online parenting communities that can provide qualitative health information and enable safe online interactions between mothers.

OBJECTIVE: It is necessary to develop new guidelines to delineate the best ways of providing psychosocial care to ensure mental health following a disaster. METHODS: This study applied the scoping review method as a means of establishing evidence-based guidelines for disaster mental health services. A total of 440 literatures were selected through a scoping review of 20,864 documents. Twenty-three recognized experts were invited to participate in the survey and a two-round online Delphi survey was conducted. RESULTS: The concordance rate in the Delphi Round 1 was 95.1%. Six items were excluded and new items were formulated with experts’ suggestions. A total of 23 statements were slightly modified to clarify their meaning. In the Delphi Round 2, all items were met with consensus. The three items with the highest consensus among the experts were related to the protection of personal information and privacy. The item with the lowest consensus among experts was related to debriefing. Other items were related to establishing mental health support centers and suicide prevention activities. CONCLUSION 140 items were developed through scoping reviews based on evidence-based methodology. These items were used to describe the disaster mental health support identified in Delphi. The guideline will provide a foundation for effective preparation and response in disaster situations.

BACKGROUND/AIMS: In the management of choledocholithiasis, T-tube drainage was the most common treatment modality after common bile duct (CBD) exploration. However, the T-tube drainage has several problems and risk of complications such as abdominal discomfort, long duration of drainage, or bile leakage. We evaluated the effectiveness of primary closure of CBD after choledochotomy and the possibility of substitution for T-tube drainage. METHODS: Seventy six patients with choledocholithiasis who had undergone CBD exploration were enrolled in this study from January 1999 to March 2001. 20 patients among them had undergone primary closure of CBD with preoperative endoscopic nasobiliary drainage (ENBD) or percutaneous transhepatic biliary drainage (PTBD) in situ after exploration (primary closure group), 56 patients had undergone T-tube drainage (T-tube group). We compared the clinical characteristics and outcome between two groups. RESULTS: There was no difference in postoperative complication (19.6% vs. 20%), the mean amount of biliary drainage (326 ml/day vs. 320 ml/day) and the duration of hospitalization (11.6 day vs. 9.2 days) between the both groups. The duration of biliary drainage was significantly longer in the T-tube group (45.3 days) than in the primary closure group (9.2 days; p<0.01). The rate of remnant stone was higher in the T-tube group (32.1%) than the primary closure group (20%), there was not statistically significant. CONCLUSION: The primary closure of CBD with the preoperative biliary drainage was relatively safe and resulted in no difference of clinical outcome. Furthermore, this method induced going back early to normal life. These result suggest that the primary closure of CBD may be a feasible technique after choledochotomy when the patients are selected by specialized indications.
Bile ; Choledocholithiasis ; Common Bile Duct* ; Drainage* ; Hospitalization ; Humans ; Postoperative Complications

BACKGROUND/AIMS: The importance of α-cell dysfunction in the pathogenesis of type 2 diabetes has re-emerged recently. However, data on whether relative glucagon excess is present in clinical settings are scarce. We aimed to investigate associations between glucagon-to-insulin ratio and various metabolic parameters. METHODS: A total of 451 patients with type 2 diabetes naïve to insulin treatment were recruited. Using glucagon-to-insulin ratio, we divided subjects into quartiles according to both fasting and postprandial glucagon-to-insulin ratios. RESULTS: The mean age of the subjects was 58 years, with a mean body mass index of 25 kg/m² The patients in the highest quartile of glucagon-to-insulin ratio had higher glycated hemoglobin (HbA1c) levels. HbA1c levels were positively correlated with both fasting and postprandial glucagon-to-insulin ratios. Subjects in the highest quartile of postprandial glucagon-to-insulin ratio were more likely to exhibit uncontrolled hyperglycemia, even after adjusting for confounding factors (odds ratio, 2.730; 95% confidence interval, 1.236 to 6.028; p for trend < 0.01). CONCLUSIONS Hyperglucagonemia relative to insulin could contribute to uncontrolled hyperglycemia in type 2 diabetes patients.

Purpose: This study aims to comprehensively assess the characteristics and effectiveness of immersive virtual reality (VR) or augmented reality (AR) in nursing education among nursing students and nurses. Methods: A thorough search was conducted in seven databases (PubMed, Embase, Cochrane Library, CINAHL, RISS, KMbase, and KoreaMed) for randomized controlled trials (RCTs) published in English or Korean before February 20, 2024. The quality of the included RCTs was assessed using the revised Cochrane Risk of Bias tool for randomized trials. A random-effects model was applied for the meta-analysis using Review Manager 5.4. Results: Out of the 15,840 studies extracted, ten were selected. Of those ten, the majority (six, 60%) were conducted on education dealing with specific nursing situations. In addition to the use of immersive VR or AR during nursing education, lectures, debriefing, and discussion processes were applied together, and device usage orientation was also provided. The meta-analyses showed that immersive VR or AR in nursing education significantly improved knowledge (standardized mean difference, SMD=2.64; 95% confidence interval, 95% CI=1.10~4.17) and skills (SMD=0.58, 95% CI=0.02~1.15). Conclusion Immersive VR or AR in nursing education can effectively enhance knowledge and skills. However, for their development and implementation, various factors should be considered, and these findings are expected to provide valuable evidence regarding that concern.

Acute graft-versus-host disease (GVHD) is a common complication associated with bone marrow transplantation. In the rare cases where it occurs after solid organ transplantation, including that of the liver, pancreas, or heart, it often has fatal outcomes. A 50-year old man developed whole-body flaccid vesiculobullous eruption 6 weeks after living donor liver transplantation. Skin biopsy revealed epidermal necrosis with vacuolization of the basal layer and lymphocytic infiltration in the dermis. Stomach erosions were found during an endoscopy, and a concurrent biopsy revealed severe epithelial necrosis. GVHD was diagnosed, with mixed chimerism confirmed using short tandem repeat testing. Immunosuppressive agent therapy was instituted, but the patient expired from hematologic complications and brain damage 6 weeks after treatment initiation. Skin lesions in GVHD generally appear with erythematous maculopapular eruption, but some atypical cutaneous manifestations could be unnoticed by physicians. This report describes miliaria crystallina-like eruption of acute GVHD after liver transplantation.

Background: Liver fibrosis is an early stage of liver cirrhosis. As a reversible lesion before cirrhosis, liver failure, and liver cancer, it has been a target for drug discovery. Many antifibrotic candidates have shown promising results in experimental animal models; however, due to adverse clinical reactions, most antifibrotic agents are still preclinical. Therefore, rodent models have been used to examine the histopathological differences between the control and treatment groups to evaluate the efficacy of anti-fibrotic agents in non-clinical research. In addition, with improvements in digital image analysis incorporating artificial intelligence (AI), a few researchers have developed an automated quantification of fibrosis. However, the performance of multiple deep learning algorithms for the optimal quantification of hepatic fibrosis has not been evaluated. Here, we investigated three different localization algorithms, mask R-CNN, DeepLabV3+, and SSD, to detect hepatic fibrosis. Results: 5750 images with 7503 annotations were trained using the three algorithms, and the model performance was evaluated in large-scale images and compared to the training images. The results showed that the precision values were comparable among the algorithms. However, there was a gap in the recall, leading to a difference in model accuracy. The mask R-CNN outperformed the recall value (0.93) and showed the closest prediction results to the annotation for detecting hepatic fibrosis among the algorithms. DeepLabV3+ also showed good performance; however, it had limitations in the misprediction of hepatic fibrosis as inflammatory cells and connective tissue. The trained SSD showed the lowest performance and was limited in predicting hepatic fibrosis compared to the other algorithms because of its low recall value (0.75). Conclusions We suggest it would be a more useful tool to apply segmentation algorithms in implementing AI algorithms to predict hepatic fibrosis in non-clinical studies.