Background: Although, being underweight is commonly associated with osteoporosis and sarcopenia, its association with vertebral fractures (VFs), is less well researched. We investigated the influence of cumulative, chronic periods of low weight and changes in body weight on VF development. Methods: We used a nationwide, population-based database with data on people (> 40 years) who attended three health screenings between January 1, 2007, and December 31, 2009 to assess the incidence of new VFs. Cox proportional hazard analyses were used to establish the hazard ratios (HRs) for new VFs based on the degree of body mass index (BMI), the cumulative numbers of underweight participants, and temporal change in weight. Results: Of the 561,779 individuals in this analysis, 5,354 (1.0%) people were diagnosed three times, 3,672 (0.7%) were diagnosed twice, and 6,929 (1.2%) were diagnosed once. The fully adjusted HR for VFs in underweight individuals was 1.213. Underweight individuals diagnosed only once, twice, or three times had an adjusted HR of 0.904, 1.443, and 1.256, respectively. Although the adjusted HR was higher in adults who were consistently underweight, there was no difference in those who experienced a temporal change in body weight. BMI, age, sex, and household income were significantly associated with VF incidence. Conclusion Low weight is a risk factor for VFs in the general population. Given the significant correlation between cumulative periods of low weight and the risk of VFs, it is necessary to treat underweight patients before a VF to prevent its development and other osteoporotic fractures.

Objective: The purpose of this study was to analyze the current situation concerning professionalism among emergency physicians in South Korea by conducting a survey regarding their perceptions and experiences of unprofessional behavior. Methods: In October 2018, the authors evaluated the responses to a questionnaire administered to 548 emergency physicians at 28 university hospitals. The participants described their perceptions and experiences concerning 45 unprofessional behaviors classified into the following five categories: patient care, communication with colleagues, professionalism at work, research, and violent behavior and abusive language. Furthermore, the responses were analyzed by position (resident vs. faculty). Descriptive statistics were generated on the general characteristics of the study participants. To compare differences in responses by position and sex, the chi-square and Fisher exact tests were performed. Results: Of the 548 individuals invited to participate in this study, 253 responded (response rate, 46.2%). In 34 out of 45 questionnaires, more than half of participants reported having experienced unprofessional behavior despite their negative perceptions. Eleven perception questions and 38 experience questions for unprofessional behavior showed differences by position. Conclusion Most emergency physicians were well aware of what constituted unprofessional behavior; nevertheless, many had engaged in or observed such behavior.

Background/Aims: Several noninvasive scoring systems have been developed to determine the risk of advanced fibrosis in nonalcoholic fatty liver disease (NAFLD). We examined the diagnostic accuracy of the fibrosis-4 (FIB-4) score and NAFLD fibrosis score (NFS) in patients with biopsy-proven NAFLD. Methods: For this meta-analysis, various databases including PubMed (MEDLINE), EMBASE, OVID Medline and the Cochrane Library were systematically searched. After the acquired abstracts were reviewed by two investigators, manuscripts were chosen for a full-text examination. Results: Thirty-six studies evaluating biopsy-proven NAFLD were selected for meta-analysis. A total of 14,992 patients were analyzed. The lower cutoff sensitivity of the FIB-4 score predicting histological fibrosis stage 3 or more (≥F3) was 69%, with specificity of 64%, positive likelihood ratio (LR+) of 1.96, and negative likelihood ratio (LR–) of 0.47. The low baseline sensitivity of the NFS score predicting ≥F3 was 70%, with a specificity of 61%, LR+ of 1.83, and LR– of 0.48. The area under the receiver operating characteristic curve (AUC) values of the FIB-4 score predicting ≥F3 and ≥F2 were 76% and 68%, respectively. The AUC values of the NFS score predicting ≥F3 and ≥F2 were 74% and 60%, respectively. Conclusions The FIB-4 or NFS test can be used to predict the degree of liver fibrosis in NAFLD, and the diagnostic accuracy resulted as relatively high in fibrosis stages of F3 or higher.

Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted diffusion (CHANTER) syndrome is characterized by an altered mental status. The acute MRI lesions show abnormal restricted diffusion imaging bilaterally and symmetrically in the cerebellum, hippocampus, and basal nuclei. This syndrome is an unknown syndrome and is presumed to be mainly an opioidinduced toxidrome. Here, we present a case study wherein we show that it can also be caused by an antidepressant overdose.

Background/Aims: In ulcerative colitis (UC) patients, Escherichia coli Nissle 1917 (EcN) is equivalent to mesalazine for preventing disease relapse; however, evidence of the ability of EcN to increase health-related quality of life or induce remission remains scarce. We investigated the efficacy of EcN as an add-on therapy for UC. Methods: In this multicentre, double-blind, randomised, placebo-controlled study, a total of 133 UC patients were randomly assigned to receive either EcN or placebo once daily for 8 weeks. Inflammatory bowel disease questionnaire (IBDQ) scores (primary endpoint) and clinical remission and response rates (secondary endpoints) were compared (Clinical trial registration number: NCT04969679). Results: In total, 118 patients (EcN, 58; placebo, 60) completed the study. The number of patients reaching the primary endpoint did not differ between the EcN and placebo groups (30 [51.7%] vs. 31 [51.7%]; per-protocol analysis, p = 1.0; intention-to-treat analysis, p = 0.86). However, significantly fewer patients in the EcN group exhibited a decreased IBDQ score (1 [1.7%] vs. 8 [13.3%]; per-protocol analysis, p = 0.03; intention- to-treat analysis, p = 0.02). Moreover, a significantly higher number of patients in the EcN group displayed clinical response at 4 weeks (23 [39.7%] vs. 13 [21.7%], p = 0.04) and endoscopic remission at 8 weeks (26 [46.4%] vs. 16 [27.1%], p = 0.03). Conclusions Although the number of patients reaching the primary endpoint did not differ between the EcN and placebo groups, EcN was found to be safe and effective in preventing the exacerbation of IBDQ scores and achieving clinical responses and endoscopic remission in patients with mild-to-moderate UC.

Objective: Intractable massive oronasal bleeding can become a life-threatening condition. The success rate of conventional bleeding control methods other than transarterial embolization (TAE) is not expected to be high. We investigated the efficacy of Sengstaken-Blakemore tube (SBT) balloon tamponade in patients with sustained and intractable oronasal bleeding secondary to facial injury. Methods: This study is a retrospective chart review from traumatic patients with sustained and intractable oronasal bleeding who were admitted to the emergency center of Ajou University Hospital and Soonchunhyang University Bucheon Hospital from January 2014 to December 2016. Results: Twelve patients were included in the study, of whom nine (75%) were male. The median age was 31 years (range, 20–73 years). Bleeding was controlled in 11 of the 12 patients (91.7%) either temporarily or definitively. One patient without hemostasis underwent TAE. TAE was performed in an additional three patients out of the 11 patients with hemostasis who experienced continued nasal bleeding after the removal of SBTs. There were no complications from performing the procedure. Conclusion Using SBTs as a hemostatic tool will aid patients with life-threatening intractable oronasal bleeding. Furthermore, this method may be used in patients with continual and intractable oronasal bleeding after facial trauma as a bridging procedure from the emergency department or the intensive care unit to the interventional radiology.

Objective: Intractable massive oronasal bleeding can become a life-threatening condition. The success rate of conventional bleeding control methods other than transarterial embolization (TAE) is not expected to be high. We investigated the efficacy of Sengstaken-Blakemore tube (SBT) balloon tamponade in patients with sustained and intractable oronasal bleeding secondary to facial injury. Methods: This study is a retrospective chart review from traumatic patients with sustained and intractable oronasal bleeding who were admitted to the emergency center of Ajou University Hospital and Soonchunhyang University Bucheon Hospital from January 2014 to December 2016. Results: Twelve patients were included in the study, of whom nine (75%) were male. The median age was 31 years (range, 20–73 years). Bleeding was controlled in 11 of the 12 patients (91.7%) either temporarily or definitively. One patient without hemostasis underwent TAE. TAE was performed in an additional three patients out of the 11 patients with hemostasis who experienced continued nasal bleeding after the removal of SBTs. There were no complications from performing the procedure. Conclusion Using SBTs as a hemostatic tool will aid patients with life-threatening intractable oronasal bleeding. Furthermore, this method may be used in patients with continual and intractable oronasal bleeding after facial trauma as a bridging procedure from the emergency department or the intensive care unit to the interventional radiology.

Herbal products have been used for therapeutic purposes for a long time. However, many herbs can be toxic and even life-threatening. If refractory ventricular tachycardia (VT) is caused by herbal products and shows no response to conventional therapy, intravenous lipid emulsion (ILE) therapy can be considered. We report a case of herbal intoxication leading to refractory VT, which was successfully treated with ILE therapy. A 36-year-old woman with aplastic anemia presented with mental changes. She had taken an unknown herbal decoction three days before visiting the hospital. Soon after coming to the hospital, she went into cardiac arrest. Cardiopulmonary resuscitation was performed, and return of spontaneous circulation with VT was achieved. Synchronized cardioversion was then performed and amiodarone was administered. However, VT with pulse continued, so ILE therapy was attempted, which led to the resolution of VT.
Adult ; Amiodarone ; Anemia, Aplastic ; Cardiopulmonary Resuscitation ; Electric Countershock ; Fat Emulsions, Intravenous ; Female ; Heart Arrest ; Herb-Drug Interactions ; Humans ; Tachycardia, Ventricular

The alteration of alternative splicing patterns has an effect on the quantification of functional proteins, leading to phenotype variation. The splicing quantitative trait locus (sQTL) is one of the main genetic elements affecting splicing patterns. Here, we report the results of genome-wide sQTLs across 141 strains of Arabidopsis thaliana with publicly available next generation sequencing datasets. As a result, we found 1,694 candidate sQTLs in Arabidopsis thaliana at a false discovery rate of 0.01. Furthermore, among the candidate sQTLs, we found 25 sQTLs that overlapped with the list of previously examined trait-associated single nucleotide polymorphisms (SNPs). In summary, this sQTL analysis provides new insight into genetic elements affecting alternative splicing patterns in Arabidopsis thaliana and the mechanism of previously reported trait-associated SNPs.
Alternative Splicing ; Arabidopsis* ; Dataset ; Phenotype ; Polymorphism, Single Nucleotide ; Quantitative Trait Loci*