PURPOSE: To evaluate the effect of gadoxetic acid on the measurement of the stiffness value of MR elastography (MRE) used to evaluate hepatic fibrosis (HF). MATERIALS AND METHODS: MRE was obtained in 32 patients with clinically suspected chronic liver disease, both before and after injection of gadoxetic acid. Two independent reviewers measured the stiffness values of the liver parenchyma on elastograms. The mean liver stiffness values were compared in the pre- and post-contrast MREs using the paired t-test. Intra-rater and inter-rater correlation was assessed using the intraclass correlation coefficient (ICC). The accuracy, sensitivity, and specificity of both pre- and post-contrast MREs was evaluated for the diagnosis of significant HF (> or = F2) using cut off value of 3.1 kPa. RESULTS: There were no significant differences in the stiffness values of the liver parenchyma on pre- and post-contrast MREs (p = 0.15 and 0.38 for each reader, respectively). Regarding intra-rater correlation, excellent agreement was noted on rater 1(ICC = 0.998) and rater 2 (ICC = 0.996). Excellent correlation regarding the measured stiffness values was noted on both pre- and post-contrast MREs (ICC = 0.988 for pre-contrast, ICC = 0.993 for post-contrast). The accuracy, sensitivity, and specificity of the pre- and post-contrast MREs for differentiating significant HF (> or = F2) from < or = F1 were same as 71%, 60%, and 100%, respectively. CONCLUSION: As there was no significant difference in the stiffness measurements seen on MREs before and after administration of gadoxetic acids, it is therefore acceptable to perform MRE after contrast injection in order to evaluate HF.
Elasticity Imaging Techniques ; Fibrosis ; Gadolinium DTPA ; Humans ; Liver ; Liver Diseases ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Sensitivity and Specificity

BACKGROUND: The etiology of porokeratosis (PK) remains unknown, but immunosuppression is known to be a factor in the pathogenesis of PK and it may also exacerbate PK. OBJECTIVE: The aim of this study was to examine the clinical characteristics of PK associated with immunosuppressive therapy in renal transplant recipients. METHODS: A total of 9 renal transplant patients diagnosed with biopsy-proven PK from January 2001 to December 2006 were enrolled. The authors analyzed the patient and medication histories, clinical characteristics, and associated diseases. RESULTS: The ages of the 9 patients ranged from 38 to 67 years (mean 52 years). All received multi-drug regimens comprised of two or three immunosuppressive agents (steroids, cyclosporine, mycophenolate mofetil, azathioprine and/or tacrolimus). Times between transplantation and the onset of PK ranged from 2 to 9 years (mean 4.1 years). No family history of PK or a history of intense sun-exposure was elicited. The number of the lesions was less than ten in 8 of the 9. Lesions were mainly located in the extremities, though some affected the trunk or neck (3). Three patients had disseminated superficial actinic PK (DSAP), PK Mibelli, or both types. Associated diseases included verruca (4), recurrent herpes simplex (1), actinic keratosis (1), and cutaneous B cell lymphoma (1). CONCLUSION: The three clinical patterns of PK occurred equally in our patients, namely, coexistent PK Mibelli and DSAP, or the DSAP and Mibelli types as independent forms. Our findings support the notion that the different variants of PK be viewed as parts of a heterogeneous clinical spectrum. Further studies are needed in order to establish the clinical patterns of PK in immunosuppressed patients.
Actins ; Azathioprine ; Cyclosporine ; Extremities ; Herpes Simplex ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Keratosis, Actinic ; Kidney Transplantation ; Lymphoma, B-Cell ; Methylmethacrylates ; Mycophenolic Acid ; Neck ; Polystyrenes ; Porokeratosis ; Transplants ; Warts

Palisaded neutrophilic granulomatous dermatitis (PNGD) is an unusual entity that has been described under several different names including, linear subcutaneous bands, interstitial dermatitis with cutaneous cords and arthritis, rheumatoid papules and Churg-Strauss granuloma. The condition is seen in patients with rheumatoid arthritis and other connective tissue diseases. PNGD shows variable clinical manifestations and represents a histologic spectrum, starting with early vasculitic lesions, then palisaded granulomatous lesions and dermal fibrosis with minimal leukocytoclastic debris in the late stage lesions. We report an unusual case of a 49-year old woman with rheumatoid arthritis who presented with multiple acral nodules. The histologic examination revealed palisaded neutrophilic granulomatous dermatitis.
Arthritis, Rheumatoid* ; Connective Tissue Diseases ; Dermatitis* ; Female ; Fibrosis ; Granuloma ; Humans ; Middle Aged ; Neutrophils*

Abscesses of the epidural and subdural spine are relatively rare, but can rapidly progress and cause paraplegia; the mortality rate is high despite improvements in treatment method. In particular, the reoccurrence of subdural abscesses after treatment of an epidural abscess is extremely rare. We experienced a case in which the subdural abscess reoccurred after spinal decompression and drainage of an epidural abscess combined with a dural tear. We report this rare case with a review of the relevant literatures.
Abscess ; Decompression ; Drainage ; Epidural Abscess ; Humans ; Spine

OBJECTIVES: Use of dietary supplements containing vitamins and minerals is growing in Korean adults, especially in pregnant and lactating women. Vitamin and mineral supplements are available in different composition and in a wide range of contents. The purposes of the study were to examine nutrient composition and content of vitamin and mineral supplements for pregnant and lactating women and assess their appropriateness as dietary supplements. METHODS: Information on the name, manufacturer, nutrient composition, and usage of vitamin and mineral supplements for pregnant and lactating women were obtained from the homepage of the Food Safety Information Portal managed by the Ministry of Food and Drug Safety, and Korean Index of Medical Specialties. A total of 264 products were identified. RESULTS: Among 264 products, 26.1% were single nutrient products, and 73.9% were multinutrient products. The most commonly included nutrient was iron (70.1%), folic acid (66.3%), vitamin B12 (45.8%), vitamin C (38.6%), and vitamin B6 (38.6%). Although more than 50% of products contained nutrients less than 150% of Recommended Nutrient Intakes or Adequate Intakes for daily use, some products contained inappropriately high amounts of nutrients. When a maximum daily dose of supplements was taken as described on the label, iron in 73 products (39.5%), folic acid in 14 products (8.0%) were likely to be consumed in amounts greater than Tolerable Upper Intake Levels. Most products were assessed as inappropriate for pregnant women due to the possibility of excessive intake of vitamins or minerals when compared with Dietary Reference Intakes. CONCLUSIONS: Pregnant and lactating women need to carefully select dietary supplements containing adequate amounts of vitamins and minerals. Nutritionists should provide guidelines regarding selection of appropriate vitamin and mineral supplements for pregnant and lactating women.
Adult ; Ascorbic Acid ; Dietary Supplements ; Female ; Folic Acid ; Food Safety ; Humans ; Iron ; Korea ; Minerals ; Miners ; Nutritionists ; Pregnant Women ; Recommended Dietary Allowances ; Vitamin B 12 ; Vitamin B 6 ; Vitamins

OBJECTIVES: Use of dietary supplements containing vitamins and minerals is growing in Korean adults, especially in pregnant and lactating women. Vitamin and mineral supplements are available in different composition and in a wide range of contents. The purposes of the study were to examine nutrient composition and content of vitamin and mineral supplements for pregnant and lactating women and assess their appropriateness as dietary supplements. METHODS: Information on the name, manufacturer, nutrient composition, and usage of vitamin and mineral supplements for pregnant and lactating women were obtained from the homepage of the Food Safety Information Portal managed by the Ministry of Food and Drug Safety, and Korean Index of Medical Specialties. A total of 264 products were identified. RESULTS: Among 264 products, 26.1% were single nutrient products, and 73.9% were multinutrient products. The most commonly included nutrient was iron (70.1%), folic acid (66.3%), vitamin B12 (45.8%), vitamin C (38.6%), and vitamin B6 (38.6%). Although more than 50% of products contained nutrients less than 150% of Recommended Nutrient Intakes or Adequate Intakes for daily use, some products contained inappropriately high amounts of nutrients. When a maximum daily dose of supplements was taken as described on the label, iron in 73 products (39.5%), folic acid in 14 products (8.0%) were likely to be consumed in amounts greater than Tolerable Upper Intake Levels. Most products were assessed as inappropriate for pregnant women due to the possibility of excessive intake of vitamins or minerals when compared with Dietary Reference Intakes. CONCLUSIONS: Pregnant and lactating women need to carefully select dietary supplements containing adequate amounts of vitamins and minerals. Nutritionists should provide guidelines regarding selection of appropriate vitamin and mineral supplements for pregnant and lactating women.
Adult ; Ascorbic Acid ; Dietary Supplements ; Female ; Folic Acid ; Food Safety ; Humans ; Iron ; Korea ; Minerals ; Miners ; Nutritionists ; Pregnant Women ; Recommended Dietary Allowances ; Vitamin B 12 ; Vitamin B 6 ; Vitamins

There is a considerable body of literature describing the trials of meditation as adjunctive treatment of psychiatry. Although meditation has included various concepts and activity through a long history, meditation used as a therapeutic intervention in psychiatry has usually been accepted as a kind of emotion and attention regulation training. The aim of this article was to review historical origin, clinical effectiveness, and neurobiological mechanism of meditation as treatment for psychiatric disorders. Meditation is originated from various types of religious tradition. In general, meditation is divided by the consciousness meditation and the awareness meditation. Concept of mindfulness-based therapy is mainly based on awareness meditation. In addition to two types of meditation, loving kindness meditation is developed and exercised in compassion-focused therapy. Neurobiological evidence suggests that meditation reduces stress-related autonomic and endocrine change. In addition, research using neuroimaging has provided biological evidence that a specific region of brain activity and connectivity is related to subjective experience of meditation. Clinical trials support the effectiveness of meditation for the treatment of anxiety, depression, and any other stress-related disorders. In the future, profound understanding of the neurobiological mechanism, clinical effectiveness, and side effects of meditation as treatment intervention of for psychiatric disorders would be provided for evidence based meditative practice.
Anxiety ; Brain ; Complementary Therapies ; Consciousness ; Depression ; Love ; Meditation* ; Mindfulness* ; Neuroimaging

Background and Objectives: Surgery for bilateral chronic otitis media (COM) is usually performed sequentially, not simultaneously. The main reason is to prevent iatrogenic bilateral conductive hearing loss during recovery period. However, with asymmetric hearing loss, the difference in patient inconvenience between sequential and simultaneous surgery may be the same. This study evaluates the efficacy of simultaneous COM surgery in patients with asymmetric hearing.Subjects Materials and Method From 2012 to 2018, 9 patients underwent simultaneous bilateral COM surgery. The period of patients’ hospital stay, the success rate of tympanoplasty, tolerability for operation, and hearing thresholds were analyzed statistically. Results: For the 8 same-day surgery patients, the mean hospital period was 4.4±0.7 days, which was much shorter than that of sequential surgery (8 days). Tympanoplasty was successful in all patients without complications. In the better side, the preoperative/postoperative mean air conduction thresholds (AC) were 62.97±12.89 dB/47.81±19.07 dB (p=0.017), the bone conduction thresholds (BC) were 46.72±10.31 dB/37.66±16.99 dB (p=0.161) and the air-bone gaps (ABG) were 16.25±8.81 dB/10.16±7.78 dB (p=0.176). In the worse side, the preoperative/ postoperative mean AC were 86.56±18.22 dB/72.18±29.43 dB (p=0.035), BC were 53.28± 11.10 dB/48.13±18.41 dB (p=0.173), and ABG were 33.28±11.22 dB/24.06±14.80 dB (p=0.500). In both ear, the postoperative AC and BC were better than or equivocal to those of the preoperative value, and the result was similar with each of the unilateral ear audiological results. Conclusion Despite the fact that there is no complete consensus to date, simultaneous bilateral COM surgery can be an option when patients have asymmetric hearing loss. Simultaneous bilateral COM surgery could save time, cost, and lead to similar results with sequential surgery, so it could be a considerable surgical option for patients with bilateral COM.

Purpose: First-year students can form a preconception based on life experiences before entering college and identifying learners’ existing characteristics can be useful foundation data for curriculum development. This study examines what preconceptions freshman students had about medicine before entering medical school. Methods: A total of 110 first-year students were asked about what preconceptions they had about “medicine”. A total of 1,124 data were used in the content analysis method. Results: The results were extracted into 5, and 12 twelve categories. On the theme of “scientific discipline”, the knowledge students had about general health was based on scant expertise and little evidence. Students perceived medicine as Western and scientific, considering Korean traditional medicine as unscientific. Students believed that “medical practice” should be a “disease treatment” and “patient-centered” approach rather than a “social responsibility”. In “the role of the doctor”, students were concerned about the doctor's being financially stable on the positive side, and about the high-intensity workload on the negative side. In “medical education”, students believed that studying medicine would be “hard and difficult” because of the “importance of memorizing” and “extensive study load”. In “specialty stereotype”, students had biases that were mostly concentrated on “psychiatry” and “surgery” Conclusion Perception of “medicine” has been revealed to a varied range of themes, but some have been inaccurate or unrealistic. These prejudices and groundless beliefs have a gap with the learning outcomes that students should achieve in the curriculum, and these preconceptions seem to have been influenced by South Korea’s unique cultural context.

Background: Non-alcoholic fatty liver disease fibrosis score (NFS) is a scoring system applied in clinical practice to predict advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). Evidence shows that progression of steatohepatitis and liver fibrosis reduces the production of verylow- density lipoprotein. The aim of this study was to identify the association of NFS and serum low-density lipoprotein cholesterol (LDL-C) levels and in adults with NAFLD. Methods: Data were gathered from 24,889 subjects who had visited a health promotion center. NFS was calculated to assess the severity of fibrosis in all the subjects. Serum LDL-C levels were measured using a direct method. Results: Serum LDL-C levels tended to decrease with increasing NFS quartiles (P for trend<0.01). NFS was one of the major determinants of serum LDL-C level after adjusting for age, sex, lifestyle-related factors, and other covariates. The estimated mean serum LDL-C level was significantly lower in the highest quartile of NFS than in the lowest quartile of NFS. Conclusion NFS had a negative association with serum LDL-C levels in adults with NAFLD. Elevated LDL-C level is not only a risk factor of cardiovascular disease but also a predictive indicator of NAFLD severity.