Objective: This study was conducted to evaluate the effects of menopausal hormone therapy (MHT) on the progression of non-alcoholic fatty liver disease (NAFLD) in postmenopausal women. Materials and Methods: We included 515 women who received MHT for 12 months. Changes in NAFLD was evaluated by ultrasonography (progressiono progression) were compared before and after 12 months of MHT based on the route of estrogen administration (transdermal/oral). In addition, changes in NAFLD according to estrogen dose and type of progestogen were evaluated. Results: Baseline characteristics did not differ between patients who received transdermal (n=82) vs. oral (n=433) MHT. After 12 months of transdermal MHT, the prevalence of NAFLD decreased from 23.2% to 18.3% and the progression of NAFLD was observed in 3.7% patients, but this was not significantly different from those taking oral MHT. NAFLD progression was more common in women who had NAFLD at baseline and who received on oral MHT regimen compared to transdermal regimen (12.4% vs. 5.3%), however, differences were not statistically significant. In the oral MHT group, progression of NAFLD was significantly more common in standard-dose than low-dose (P=0.039). There was no significant difference in NAFLD progression according to the type of progestogen in patients using standard dose of estrogen. Conclusion Our findings suggest that the route of estrogen administration and oral dose of estrogen might affect progression of NAFLD in women with NAFLD at baseline.

Gossypiboma refers to a mass usually made of cotton (e.g., surgical gauze or sponge) that is accidentally left in a patient’s body during surgery. We report the case of a 54-year-old multigravida menopausal woman who previously underwent cesarean section to deliver her second child. She was referred to our medical center after a 7 cm right ovarian mass with malignant potential was discovered. A diagnostic laparotomy was performed then confirmed the presence of a 10 cm gossypiboma attached to a metallic ring. This case is an alarming example highlighting the importance of adequate intraoperative counting of gauze and radiologic evaluation of chronic pelvic pain.

Guillain-Barre syndrome (GBS) is an immune-mediated acute polyradiculoneuropathy and commonly occurs after a preceding infection or immunization sequalae. Following the severe acute respiratory syndrome-coronavirus-2 virus pandemic with co-introduction of massive vaccinations, several GBS cases associated with coronavirus disease 2019 (COVID-19) infection per se or after vaccination for COVID-19 were reported internationally. Herein, we report two cases of Korean GBS presenting with tetraplegia after two different COVID-19 vaccinations (42-year old man by AstraZeneca and 48-year woman by Pfizer vaccines) within four weeks after vaccination. The patients were diagnosed with clinical examination, serial electromyography, and compatible laboratory results and improved after comprehensive rehabilitative treatment and intravenous immunoglobulin therapy. Furthermore, we performed an electrodiagnostic follow-up study of each case to examine their unique characteristics.

Background: The present study was to compare the potential impact of remifentanil-based propofol-supplemented anesthesia regimen vs. conventional sevoflurane-sufentanil balanced anesthesia on postoperative recovery of consciousness indicated by c) values in patients undergoing cardiac surgery. Methods: Patients undergoing cardiac surgery were randomly allocated to get the remifentanil-based propofol-supplemented anesthesia employing target-controlled infusion (TCI) of remifentanil and propofol (Group-PR, n = 15) or a balanced-anesthesia employing sevoflurane-inhalation and TCI-sufentanil (Group-C, n = 19). In Group-PR, plasma concentration (Cp) of TCI-remifentanil was fixed at 20 ng/ml, and the effect-site concentration of TCI-propofol was adjusted within 0.8–2.0 μg/ml to maintain BIS value of 40–60. In Group-C, sevoflurane dosage was adjusted within 1–1.5 minimum alveolar concentration to maintain BIS of 40–60, and Cp of TCI-sufentanil was fixed at 0.4 ng/ml. The inter-group difference in the time for achieving postoperative BIS > 80 (T-BIS80) in the intensive care unit was determined as the primary outcome. The inter-group difference in the extubation time was determined as the secondary outcome. Results: T-BIS80, was shorter in Group-PR than Group-C (121.4 ± 64.9 min vs. 182.9 ± 85.1 min, respectively; the difference of means –61.5 min; 95% CI –115.7 to –7.4 min; effect size 0.812; P = 0.027). The extubation time was shorter in Group-PR than in Group-C (434.7 ± 131.3 min vs. 946.6 ± 393.3 min, respectively, P < 0.001). Conclusions Compared with the conventional sevoflurane-sufentanil balanced anesthesia, the remifentanil-based propofol-supplemented anesthesia showed significantly faster postoperative conscious recovery in patients undergoing cardiac surgery.

Background and Objectives: Human mesenchymal stem cells (MSCs) are emerging as a treatment for atopic dermatitis (AD), a chronic inflammatory skin disorder that affects a large number of people across the world. Treatment of AD using human umbilical cord blood-derived MSCs (hUCB-MSCs) has recently been studied. However, the mechanism underlying their effect needs to be studied continuously. Thus, the objective of this study was to investigate the immunomodulatory effect of epidermal growth factor (EGF) secreted by hUCB-MSCs on AD. Methods: and Results: To explore the mechanism involved in the therapeutic effect of MSCs for AD, a secretome array was performed using culture medium of hUCB-MSCs. Among the list of genes common for epithelium development and skin diseases, we focused on the function of EGF. To elucidate the effect of EGF secreted by hUCB-MSCs, EGF was downregulated in hUCB-MSCs using EGF-targeting small interfering RNA. These cells were then co-cultured with keratinocytes, Th2 cells, and mast cells. Depletion of EGF disrupted immunomodulatory effects of hUCB-MSCs on these AD-related inflammatory cells. In a Dermatophagoides farinae-induced AD mouse model, subcutaneous injection of hUCB-MSCs ameliorated gross scoring, histopathologic damage, and mast cell infiltration. It also significantly reduced levels of inflammatory cytokines including interleukin (IL)-4, tumor necrosis factor (TNF)-α, thymus and activation-regulated chemokine (TARC), and IL-22, as well as IgE levels. These therapeutic effects were significantly attenuated at all evaluation points in mice injected with EGF-depleted hUCB-MSCs. Conclusions EGF secreted by hUCB-MSCs can improve AD by regulating inflammatory responses of keratinocytes, Th2 cells, and mast cells.

BACKGROUND: Co-administration of two or more antimicrobials with anti-anaerobic activity is not recommended except in certain circumstances. We therefore conducted an intervention to reduce unnecessary double anaerobic coverage (DAC) prescription. MATERIALS AND METHODS: The intervention consisted of education using an institutional intranet and prospective audits and feedback provided through collaboration between a pharmacist and an infectious diseases physician in Seoul National University Bundang Hospital, a tertiary hospital in Seongnam, Republic of Korea, in 2013. The study period was 1 year which contained 6 months of pre-intervention period and 6 months of intervention period. To estimate the overall effect of the intervention, we compared the monthly number of patients receiving unnecessary DAC for more than 3 days and the proportion of patients receiving unnecessary DAC for more than 3 days among all patients receiving DAC. RESULTS: The average monthly number of patients receiving unnecessary DAC for more than 3 days after screening decreased by 73.9% in the intervention period from 26.8 to 7.0. Wilcoxon rank sum test revealed there was a significant statistical difference in the monthly number of patients receiving unnecessary DAC for more than 3 days (P = 0.005). The proportion of patients receiving unnecessary DAC for more than 3 days after screening among all patients identified as receiving necessary or unnecessary DAC also decreased by 67.8% in the intervention period from 42.3% to 13.6% (P < 0.001). CONCLUSION: The multidisciplinary antimicrobial stewardship program with combined methods reduced unnecessary DAC prescription successfully.
Bacteria, Anaerobic ; Communicable Diseases ; Computer Communication Networks ; Cooperative Behavior ; Education ; Gyeonggi-do ; Humans ; Inappropriate Prescribing ; Mass Screening ; Pharmacists ; Prescriptions* ; Republic of Korea ; Seoul ; Tertiary Care Centers

BACKGROUND: Children with Down syndrome (DS) have a 10- to 20-fold increased risk of developing leukemia. However, in some patients, leukemia does not become apparent despite significant number of blast cells in the peripheral blood. This condition is called Transient myeloproliferative disorder (TMD), and is a disease entity unique to DS newborns and defined as the morphologic detection of blasts in DS less than three months of age. The present study investigated whether there was a difference between leukemia and TMD, and determined prognostic and risk factors.METHODS: We collected blood samples from 317 patients of 433 DS confirmed patients. We found 18 patients who had blast cells in their peripheral blood.RESULTS: Twelve patients were positive for blasts during the neonate period, and only one patient progressed to leukemia. The other 11 patients were later diagnosed with TMD. Six more patients were later diagnosed with leukemia, therefore, 7 patients were diagnosed with leukemia in total. All patients diagnosed with leukemia had anemia at the time of diagnosis, which was not found in TMD patients. All leukemia patients developed their disease after three months of life. Acute Myeloid Leukemia (AML) patients had additional chromosome mutation to trisomy 21 when they were diagnosed.CONCLUSION: In patients with Down Syndrome, anemia at diagnosis and age of onset could be helpful in distinguishing TMD from acute leukemia. Cancerous mutations in the chromosomes of peripheral and marrow blast cells of Down syndrome patients may foreshadow acute leukemia.
Age of Onset ; Anemia ; Bone Marrow ; Child ; Diagnosis ; Down Syndrome ; Humans ; Infant, Newborn ; Leukemia ; Leukemia, Myeloid, Acute ; Myeloproliferative Disorders ; Risk Factors