Cellulitis and deep vein thrombosis (DVT) have similar symptoms (lower extremity pain, erythema, and swelling) and there is the potential for misdiagnosis. In cases of cellulitis, DVT should be ruled out, as the symptoms of cellulitis might mask those of DVT, leading to serious complications such as pulmonary thromboembolism. The reported incidence of DVT in patients with cellulitis is low, especially patients with progression to pulmonary thromboembolism. We present a case of pulmonary thromboembolism following cellulitis of the lower leg in a 54-year-old male.
Cellulitis* ; Diagnostic Errors ; Erythema ; Extremities ; Humans ; Incidence ; Leg* ; Male ; Masks ; Middle Aged ; Pulmonary Embolism ; Venous Thrombosis*

PURPOSE: The purpose of this study was to analyze the questions in the hip and pelvis section of the Korean Orthopaedic In-Training Examination (KOITE). MATERIALS AND METHODS: We analyzed all KOITE questions pertaining to hip and pelvis surgery between 2010 and 2014. A thorough analysis of the contents was performed after categorizing as tested topics, imaging modalities used, taxonomic classification, and recommended references. We also analyzed the scores of the hip and pelvis section of the KOITE. RESULTS: Seventy-five of five-hundred questions (weight, 15.0%) were related to the hip and pelvis. Trauma including fracture and dislocation (26/75, 34.7%) was asked more commonly than disease and basics. The description-only questions (65/75, 86.7%) were the most frequently asked. According to taxonomic classification, taxonomy 3 (decision; 39/75, 52.0%) was most frequently asked. Campbell's Operative Orthopedics (52/75, 69.3%) was the reference that covered most of the questions. CONCLUSION: This analysis of the hip and pelvis section of KOITE could be used for resident training programs in teaching hospitals.
Classification ; Dislocations ; Education ; Hip* ; Hospitals, Teaching ; Orthopedics* ; Pelvis*

We report on five cases of skin metastasis according to the breast cancer (BC) subtype. Two cases of HER2 positive BC showed only skin metastasis after immediate postoperative period and rapid clinical response to targeted therapy. Another two cases of triple negative BC showed thyroid and lung metastasis in addition to skin metastasis, and their response of cytotoxic chemotherapy was not definite. The other hormone positive BC showed skin metastasis only, with a longer, slower, less progressive pattern than other subtypes. Most cases of skin metastasis were detected at terminal stage of malignancy and were considered to have a limited survival period. However, some BC patients can survive longer if the targeted agents are effective. Therefore, physicians should provide detailed follow up of BC after curative treatment and understand the metastatic pattern of BC according to the subtype.
Breast Neoplasms* ; Drug Therapy ; Humans ; Lung ; Neoplasm Metastasis* ; Postoperative Period ; Skin Neoplasms ; Skin* ; Thyroid Gland

We report a case of a 46-year-old woman whose right ventricular out-flow tract was moderately obstructed by a heavily calcified pericardial ring. It was passing over the base of pulmonary artery and mid-portion of left ventricle but the other parts of the pericardium was mildly fibrotic. The pericardium and calcified ring were completely removed under cardiopulmonary bypass. The patient was recovered uneventfully and we could not find the specific cause of calcified pericardial ring.
Cardiopulmonary Bypass ; Female ; Heart Ventricles ; Humans ; Middle Aged ; Pericarditis, Constrictive ; Pericardium ; Pulmonary Artery

Target cells differentiation techniques from stem cells are developed rapidly. Recently, direct conversion techniques are introduced in various categories. Unlike pluripotent stem cells, this technique enables direct differentiation into the other cell types such as neurons, cardiomyocytes, insulin-producing cells, and hepatocytes without going through the pluripotent stage. However, the function of these converted cells reserve an immature phenotype. Therefore, we modified the culture conditions of mouse direct converted hepatocytes (miHeps) to mature fetal characteristics, such as higher AFP and lower albumin (ALB) expression than primary hepatocytes. First, we generate miHeps from mouse embryonic fibroblasts (MEFs) with two transcription factors HNF4α and Foxa3. These cells indicate typical epithelial morphology and express hepatic proteins. To mature hepatic function, DMSO is treated during culture time for more than 7 days. After maturation, miHeps showed features of maturation such as exhibiting typical hepatocyte-like morphology, increased up-regulated ALB and CYP enzyme gene expression, down-regulated AFP expressions, and acquired hepatic function over time. Thus, our data provides a simple method to mature direct converted hepatocytes functionally and these cells enable them to move closer to generating functional hepatocytes.
Animals ; Dimethyl Sulfoxide ; Fibroblasts* ; Gene Expression ; Hepatocytes* ; Methods ; Mice ; Myocytes, Cardiac ; Neurons ; Phenotype ; Pluripotent Stem Cells ; Stem Cells ; Transcription Factors

Purpose: High-dose radiotherapy (RT) for localized prostate cancer requires careful consideration of target position changes and adjacent organs-at-risk (OARs), such as the rectum and bladder. Therefore, daily monitoring of target position and OAR changes is crucial in minimizing interfractional dosimetric uncertainties. For efficient monitoring of the internal condition of patients, we assessed the feasibility of an auto-segmentation of OARs on the daily acquired images, such as megavoltage computed tomography (MVCT), via a commercial artificial intelligence (AI)-based solution in this study. Materials and Methods: We collected MVCT images weekly during the entire course of RT for 100 prostate cancer patients treated with the helical TomoTherapy system. Based on the manually contoured body outline, the bladder including prostate area, and rectal balloon regions for the 100 MVCT images, we trained the commercially available fully convolutional (FC)-DenseNet model and tested its auto-contouring performance. Results: Based on the optimally determined hyperparameters, the FC-DenseNet model successfully auto-contoured all regions of interest showing high dice similarity coefficient (DSC) over 0.8 and a small mean surface distance (MSD) within 1.43 mm in reference to the manually contoured data. With this well-trained AI model, we have efficiently monitored the patient's internal condition through six MVCT scans, analyzing DSC, MSD, centroid, and volume differences. Conclusion We have verified the feasibility of utilizing a commercial AI-based model for auto-segmentation with low-quality daily MVCT images. In the future, we will establish a fast and accurate auto-segmentation and internal organ monitoring system for efficiently determining the time for adaptive replanning.

Transarterial chemoembolization (TACE) is a widely used hepatocellular carcinoma (HCC) treatment. Some cases of supraumbilical skin rash after TACE in patients with HCC have been reported. To the best of the authors’ knowledge, there are no reports on atypical, generalized rashes caused by doxorubicin systemic absorption after TACE. This paper presents the case of a 64-year-old male with HCC who developed generalized macules and patches one day after a successful TACE procedure. A histology examination of a skin biopsy of a dark reddish patch on the knee revealed severe interface dermatitis. He was treated with a topical steroid, and all skin rashes improved within a week with no side effects. This report presents this rare case with a literature review on skin rash after TACE.

Background: Postoperative sore throat (POST) is a complication that decreases patient satisfaction and increases postoperative complaints. The present study was conducted to investigate effects of gargling with dexamethasone, intravenous dexamethasone injection and the combination of the two on the incidence and severity of POST. Methods: Study participants were 96 patients who had undergone laparoscopic cholecystectomy, randomly allocated into three groups. Group G gargled with 0.05% dexamethasone solution and were infused intravenous 0.9% normal saline before general anesthesia; group I gargled with 0.9% normal saline and were infused intravenous 0.1 mg/kg dexamethasone; group GI gargled with 0.05% dexamethasone solution and were infused intravenous 0.1 mg/kg dexamethasone. The incidence and severity of POST, hoarseness and cough were evaluated and recorded at 1, 6, and 24 h after the surgery. Results: There were no significant differences in the total incidence of POST up to 24 postoperative hours among Group G, Group I and Group GI (P = 0.367, Group G incidence = 34.38%, [95% confidence interval, 95% CI = 17.92–50.83], Group I incidence = 18.75%, [95% CI = 5.23–32.27], Group GI incidence = 28.13%, [95% CI = 12.55–43.70]). The other outcomes were comparable among the groups. Conclusions In patients who had undergone laparoscopic cholecystectomy, gargling with 0.05% dexamethasone solution demonstrated the same POST prevention effect as intravenous injection of 0.1 mg/kg dexamethasone. The incidence and severity of POST were not significantly different between the combination of gargling with 0.05% dexamethasone solution and intravenous injection of 0.1 mg/kg dexamethasone and use of each of the preventive methods alone.

Pilocarpine-induced rat epilepsy model is an established animal model that mimics medial temporal lobe epilepsy in humans. The purpose of this study was to investigate neuroimaging abnormalities in various stages of epileptogenesis and to correlate them with seizure severity in pilocarpine-induced rat epilepsy model. Fifty male Sprague-Dawley rats were subject to continuous video and electroencephalographic monitoring after inducing status epilepticus (SE) and seizure severity was estimated by frequency and total durations of class 3 to 5 spontaneous recurrent seizures (SRS) by modified Racine's classification. The 7.0 Tesla magnetic resonance imaging (MRI) with high resolution flurodeoxyglucose positron emission tomography (FDG-PET) was performed at 3 hours, 1, 3, 7 days and 4 weeks after the initial insult. The initial SRS was observed 9.7±1.3 days after the pilocarpine injection. MRI revealed an abnormal T2 signal change with swelling in both hippocampi and amygdala in acute (day 1 after injection) and latent phases (days 3 and 7), in association with PET hypometabolism in these areas. Interestingly, the mean frequency of class 3 to 5 SRS was positively correlated with abnormal T2 signals in hippocampal area at 3 days. SRS duration became longer with more decreased glucose metabolism in both hippocampi and amygdala at 7 days after pilocarpine injection. This study indicates that development and severity of SRS at chronic phase could be closely related with structural and functional changes in hippocampus during the latent period, a pre-epileptic stage.
Amygdala ; Animals ; Classification ; Epilepsy* ; Epilepsy, Temporal Lobe ; Glucose ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Male ; Metabolism ; Models, Animal ; Neuroimaging ; Pilocarpine ; Positron-Emission Tomography ; Rats ; Rats, Sprague-Dawley ; Seizures ; Status Epilepticus

Background: Although poor oral health is a common comorbidity in individuals with airflow limitation (AFL), few studies have comprehensively evaluated this association. Furthermore, the association between oral health and the severity of AFL has not been well elucidated. Methods: Using a population-based nationwide survey, we classified individuals according to the presence or absence of AFL defined as pre-bronchodilator forced expiratory volume in 1 second/forced vital capacity < 0.7. Using multivariable logistic regression analyses, we evaluated the association between AFL severity and the number of remaining teeth; the presence of periodontitis; the Decayed, Missing, and Filled Teeth (DMFT) index; and denture wearing. Results: Among the 31,839 participants, 14% had AFL. Compared with the control group, the AFL group had a higher proportion of periodontitis (88.8% vs. 79.4%), complete denture (6.2% vs. 1.6%), and high DMFT index (37.3% vs. 27.8%) (P < 0.001 for all). In multivariable analyses, denture status: removable partial denture (adjusted odds ratio [aOR], 1.12; 95% confidence interval [95% CI], 1.04–1.20) and complete denture (aOR, 1.52; 95% CI, 1.01– 2.05), high DMFT index (aOR, 1.13; 95% CI, 1.02–1.24), and fewer permanent teeth (0–19;aOR, 1.32; 95% CI, 1.12–1.52) were significantly associated with AFL. Furthermore, those with severe to very severe AFL had a significantly higher proportion of complete denture (aOR, 2.41; 95% CI, 1.11–3.71) and fewer remaining teeth (0–19; aOR, 2.29; 95% CI, 1.57–3.01). Conclusion Denture wearing, high DMFT index, and fewer permanent teeth are significantly associated with AFL. Furthermore, a reduced number of permanent teeth (0–19) was significantly related to the severity of AFL. Therefore, physicians should pay attention to oral health in managing patients with AFL, such as chronic obstructive pulmonary disease.