Duchenne muscular dystrophy (DMD) is a progressive form of muscular dystrophy caused by mutations in the dystrophin gene. Patients with DMD are more likely to have cerebral infarction than normal populations, possibly due to low ejection fraction and cardiomyopathy, and also higher epilepsy prevalence. Careful history taking and neurological examination are needed for differentiating new symptoms from preexisting weakness in DMD. Here, we present a young male with DMD and acute ischemic stroke followed by recurrent seizures.

BACKGROUND: The over-prescription of acid-suppressive therapy for the provision of stress ulcer prophylaxis (SUP) in hospitalized patients has been identified in a proceeding study. OBJECTIVE: This study was conducted to evaluate clinicians' beliefs, knowledge and other factors that influence the over-prescribing of SUP in low-risk, non-intensive care unit (non-ICU) patients. METHOD: A cross-sectional survey consisting of multiple-choice queries and close-ended questions was distributed to healthcare personnel at a major teaching hospital in Korea. RESULTS: More than half of total respondents reported that they would continue SUP following patients discharge from the ICU (77.8%, 43.5%, and 39.7% in the physician, pharmacist, and nurse groups, respectively). Over 55% of physicians would also initiate non-ICU patients on SUP upon hospital admission, and 42.6% of physicians would even continue prophylaxis post hospital discharge. The mean knowledge score regarding SUP indications and side effects was higher in pharmacists compared to physicians and nurses (12.44, 7.40, and 7.28, respectively; p<0.001). High-prescribing behavior was associated with a prescriber's belief that SUP is effective for preventing bleeding (odds ratio 7.40; 95% confidence interval 1.57 to 31.94; p=0.012). Low knowledge score and computerized order set also showed statistically significant association with the overutilization of SUP.
Cross-Sectional Studies ; Surveys and Questionnaires ; Delivery of Health Care* ; Hemorrhage ; Hospitals, Teaching ; Humans ; Korea ; Pharmacists ; Ulcer*

BACKGROUND: The reports that obesity could be associated with upper gastrointestinal disorders such as gastritis, gastric ulcer, duodenal ulcer, reflux esophagitis have not been consistent. Therefore, we studied the association between esophagogastroduodenoscopic (EGD) findings and the related risk factors of obesity. METHODS: The study subjects include 2,210 adults who visited the Health Promotion Center of one university hospital from January 2006 to December 2006. All subjects had standard physical measurements as well as resting blood pressure, fasting blood glucose, HbA1c, serum lipids, and gastroendoscopic examination. BMI was classified into two groups (BMI > or = 23 kg/m2, normal; BMI < 23 kg/m2, overweight or obese). The study subjects were classified into four groups according to the EGD findings; normal, gastritis, gastric or duodenal ulcer, reflux esophagitis. RESULTS: Mean BMI of gastritis, gastric or duodenal ulcer, and reflux esophagitis groups were higher than normal group after adjusting age, sex, alcohol and smoking (P < 0.001). Gastritis risk (OR, 2.098; 95% CI, 1.195 to 3.682; P = 0.01), gastric or duodenal ulcer risk (OR, 2.562; 95% CI, 1.282 to 5.117; P = 0.008), and reflux esophagitis risk (OR, 2.856; 95% CI, 1.522 to 5.360; P = 0.001) were significantly higher in overweight and obesity group compare with normal weight group after adjusting age, sex, alcohol and smoking. CONCLUSION: We suggest that overweight or obesity is the risk factor of gastritis, gastric or duodenal ulcer, and reflux esophagitis.
Adult ; Blood Glucose ; Blood Pressure ; Duodenal Ulcer ; Esophagitis, Peptic ; Fasting ; Gastritis ; Health Promotion ; Humans ; Obesity ; Overweight ; Risk Factors ; Smoke ; Smoking ; Stomach Ulcer

BACKGROUND: The reports that obesity could be associated with upper gastrointestinal disorders such as gastritis, gastric ulcer, duodenal ulcer, reflux esophagitis have not been consistent. Therefore, we studied the association between esophagogastroduodenoscopic (EGD) findings and the related risk factors of obesity. METHODS: The study subjects include 2,210 adults who visited the Health Promotion Center of one university hospital from January 2006 to December 2006. All subjects had standard physical measurements as well as resting blood pressure, fasting blood glucose, HbA1c, serum lipids, and gastroendoscopic examination. BMI was classified into two groups (BMI > or = 23 kg/m2, normal; BMI < 23 kg/m2, overweight or obese). The study subjects were classified into four groups according to the EGD findings; normal, gastritis, gastric or duodenal ulcer, reflux esophagitis. RESULTS: Mean BMI of gastritis, gastric or duodenal ulcer, and reflux esophagitis groups were higher than normal group after adjusting age, sex, alcohol and smoking (P < 0.001). Gastritis risk (OR, 2.098; 95% CI, 1.195 to 3.682; P = 0.01), gastric or duodenal ulcer risk (OR, 2.562; 95% CI, 1.282 to 5.117; P = 0.008), and reflux esophagitis risk (OR, 2.856; 95% CI, 1.522 to 5.360; P = 0.001) were significantly higher in overweight and obesity group compare with normal weight group after adjusting age, sex, alcohol and smoking. CONCLUSION: We suggest that overweight or obesity is the risk factor of gastritis, gastric or duodenal ulcer, and reflux esophagitis.
Adult ; Blood Glucose ; Blood Pressure ; Duodenal Ulcer ; Esophagitis, Peptic ; Fasting ; Gastritis ; Health Promotion ; Humans ; Obesity ; Overweight ; Risk Factors ; Smoke ; Smoking ; Stomach Ulcer

Hormone receptor–positive (HR+) disease is the most frequently diagnosed subtype of breast cancer. Among tumor subtypes, natural course of HR+ breast cancer is indolent with favorable prognosis compared to other subtypes such as human epidermal growth factor protein 2–positive disease and triple-negative disease. HR+ tumors are dependent on steroid hormone signaling and endocrine therapy is the main treatment option. Recently, the discovery of cyclin-dependent kinase 4/6 inhibitors and their synergistic effects with endocrine therapy has dramatically improved treatment outcome of advanced HR+ breast cancer. The demonstrated efficacy of additional nonhormonal agents, such as targeted therapy against mammalian target of rapamycin and phosphatidylinositol 3-kinase signaling, poly(ADP-ribose) polymerase inhibitors, antibody-drug conjugates, and immunotherapeutic agents have further expanded the available therapeutic options. This article reviews the latest advancements in the treatment of HR+ breast cancer, and in doing so discusses not only the development of currently available treatment regimens but also emerging therapies that invite future research opportunities in the field.

Anti-LGI1 (leucine-rich glioma inactivated-1) antibody encephalitis is one of autoimmune encephalitis. We report a 66-year-old man who presented with frequent, brief dystonic seizures which involve predominantly ipsilateral face and arm without cognitive impairment. Brain MRI showed normal finding. Serum and CSF tests revealed anti-LGI1 antibody. His symptom was not relieved by antiepileptic drugs, but completely controlled after immunotherapy. This case indicates that recognition of the brief, dystonic seizures should do tests for anti-LGI1 antibodies.
Aged ; Antibodies ; Anticonvulsants ; Arm ; Brain ; Encephalitis* ; Glioma ; Humans ; Immunotherapy ; Magnetic Resonance Imaging ; Potassium Channels, Voltage-Gated ; Seizures*

PURPOSE: Breast cancer has a high prevalence in Korea. To achieve personalized therapy for breast cancer, long-term follow-up specimens are needed for next-generation sequencing (NGS) and multigene analysis. Formalin-fixed paraffin-embedded (FFPE) samples are easier to store than fresh frozen (FF) samples. The objective of this study was to optimize RNA extraction from FFPE blocks for NGS. METHODS: RNA quality from FF and FFPE tissues (n=5), expected RNA amount per unit area, the relationship between archiving time and quantity/quality of FFPE-extracted RNA (n=14), differences in quantitative real-time polymerase chain reaction (qRT-PCR) and NGS results, and comparisons of both techniques with tissue processing at different institutions (n=96) were determined in this study. RESULTS: The quality of RNA did not show any statistically significant difference between paired FF and FFPE specimens (p=0.49). Analysis of tumor cellularity gave an expected RNA amount of 33.25 ng/mm2. Archiving time affected RNA quality, showing a negative correlation with RNA integrity number and a positive correlation with threshold cycle. However, RNA from samples as old as 10 years showed a 100% success rate in qRT-PCR using short primers, showing that the effect of archiving time can be overcome by proper experiment design. NGS showed a higher success rate than qRT-PCR. Specimens from institution B (n=46), which were often stored in a refrigerator for more than 6 hours and fixed without slicing, showed lower success rates and worse results than specimens from the other institutes. CONCLUSION: Archived FFPE tissues can be used to extract RNA for NGS if they are properly processed before fixation. The expected amount of RNA per unit size calculated in this study will be useful for other researchers.
Academies and Institutes ; Breast Neoplasms ; Estrogens ; Follow-Up Studies ; Humans ; Korea ; Prevalence ; Real-Time Polymerase Chain Reaction ; RNA* ; Sequence Analysis

Malnutrition is common in the critically ill patients and known to cause a variety of negative clinical outcomes. However, various conventional methods for nutrition assessment have several limitations. We hypothesized that body composition data, as measured using bioelectrical impedance analysis (BIA), may have a significant role in evaluating nutritional status and predicting clinical outcomes in critically ill patients. We gathered clinical, biochemical, and BIA data from 66 critically ill patients admitted to an intensive care unit. Patients were divided into three nutritional status groups according to their serum albumin level and total lymphocyte counts. The BIA results, conventional indicators of nutrition status, and clinical outcomes were compared and analyzed retrospectively. Results showed that the BIA indices including phase angle (PhA), extracellular water (ECW), and ECW/total body water (TBW) were significantly associated with the severity of nutritional status. Particularly, PhA, an indicator of the health of the cell membrane, was higher in the well-nourished patient group, whereas the edema index (ECW/TBW) was higher in the severely malnourished patient group. PhA was positively associated with albumin and ECW/TBW was negatively associated with serum albumin, hemoglobin, and duration of mechanical ventilation. In non-survivors, PhA was significantly lower and both ECW/TBW and %TBW/fat free mass were higher than in survivors. In conclusion, several BIA indexes including PhA and ECW/TBW may be useful for nutritional assessment and represent significant prognostic factors in the care of critically ill patients.
Body Composition ; Body Water ; Cell Membrane ; Critical Illness* ; Edema ; Electric Impedance* ; Extracellular Fluid ; Humans ; Intensive Care Units ; Intracellular Fluid ; Lymphocyte Count ; Malnutrition ; Nutrition Assessment ; Nutritional Status* ; Respiration, Artificial ; Retrospective Studies ; Serum Albumin ; Survivors

Paraneoplastic encephalitis presenting with partial clonic seizure is rare. We report a 57-year-old man with clonic seizure in his left arm. He had past medical history of recurrent thymoma and thymomectomy. Magnetic resonance imaging showed multiple brain lesions, but none of them were congruent with the partial seizure. His symptoms and brain lesions resolved after steroid therapy. This is the first reported case extralimbic encephalitis presenting as partial seizure with invasive thymoma in Korea.
Arm ; Brain ; Encephalitis* ; Humans ; Korea ; Magnetic Resonance Imaging ; Middle Aged ; Nervous System ; Paraneoplastic Syndromes ; Seizures* ; Thymoma*

Paraneoplastic encephalitis presenting with partial clonic seizure is rare. We report a 57-year-old man with clonic seizure in his left arm. He had past medical history of recurrent thymoma and thymomectomy. Magnetic resonance imaging showed multiple brain lesions, but none of them were congruent with the partial seizure. His symptoms and brain lesions resolved after steroid therapy. This is the first reported case extralimbic encephalitis presenting as partial seizure with invasive thymoma in Korea.
Arm ; Brain ; Encephalitis* ; Humans ; Korea ; Magnetic Resonance Imaging ; Middle Aged ; Nervous System ; Paraneoplastic Syndromes ; Seizures* ; Thymoma*