Carotid artery stenting (CAS) is considered for patients with symptomatic carotid stenosis of 50% or greater. Following CAS, hemodynamic changes can alter the cerebral perfusion status. Furthermore, hypotension and bradycardia may occur due to the stimulation of carotid sinus baroreceptors. A more meticulous approach to these hemodynamic changes is required, especially in patients with bilateral carotid artery stenosis and concurrent multiple cerebrovascular stenoses. This report presents a case of posterior cerebral artery territory infarction that occurred after bilateral CAS.

Objective: The purpose of this study was to retrospectively analyze the trends in RT among dogs and cats treated at the S Animal Cancer Center in Korea from 2020 to 2023. Methods: A retrospective analysis was conducted on 376 animals (308 dogs and 68 cats) receiving RT for various tumors. Data collected included species, breed, sex, age, weight, tumor location, tumor type, RT protocols, and concurrent treatments. Results: The number of patients receiving RT increased from 59 in 2020 to 120 in 2023, reflecting a 103.4% increase over the study period. Sinonasal, intracranial, oral, genitourinary, and skin tumors were the most common, with stereotactic RT being most commonly used for sinonasal and intracranial tumors. Of the patients, 175 (46.5%) received RT alone, 96 (25.5%) with chemotherapy, 64 (17%) with surgery, and 41 (10.9%) with both surgery and chemotherapy. Thirty-one patients (8.2%) underwent multiple RT sessions, primarily for sinonasal tumors (11 cases). Conclusions and Relevance: This study provides the first systematic analysis of RT use in companion animals in Korea and establishes a foundational dataset for future work in veterinary radiation oncology. The findings highlight the growing clinical use of RT and underscore the need for further research to optimize treatment protocols and evaluate patient outcomes in Korean veterinary oncology.

A 4-month-old intact male Sapsaree dog was referred due to a history of postprandial regurgitation following consumption of solid food. Thoracic radiography revealed focal leftward displacement of the thoracic trachea at T1 to T4 vertebrae levels. Barium contrast radiography revealed focal dilation of the cranial thoracic esophagus at the heart base level. Persistent right aortic arch (PRAA) with an aberrant left subclavian artery branching from the patent ductus arteriosus was diagnosed by computed tomography angiography (CTA). Although barium contrast radiography can presumptive diagnose PRAA, CTA should be considered for identifying additional vascular anomalies, specific types, and surgical planning.

A 3-year-old spayed female Russian blue cat was presented for dyspnea, nasal discharge, and stertorous breathing. Plain thoracic radiography revealed no specific findings. Computed tomography (CT) was performed to differentiate upper airway tract disorders. It revealed the presence of an iso-attenuating mass measuring 10.0 × 7.9 × 15.6 mm, with mild homogeneous contrast enhancement occupying the rostral nasopharynx. The mass was surgically debulked via a longitudinal incision in the soft palate. Histopathological and immunohistochemistry analysis of the surgically excised mass revealed CD3–/ CD79a+ B cell lymphoma with an incomplete margin. The patient underwent hypofractionated radiation therapy, receiving a total of 36 Gray (Gy) in 6 Gy fractions over a six-week period. A follow-up CT examination was performed after 27 months of irradiation and the patient was confirmed to have achieved a complete response. There were no complications related to irradiation. The patient was alive for 40 months without recurrence. This study suggests that hypofractionated radiation therapy combined with surgical debulking could be considered as a treatment option for feline nasopharyngeal lymphoma.

A 13-year-old male neutered Miniature Pinscher presented with coughing and dyspnea. The dog had been coughing for the past 4 weeks. The patient had mild dehydration on physical examination, and muffled heart sounds were detected. Thoracic radiographs revealed pleural effusion, which was consistent with chylous effusion based on cytological and biochemical evaluations. Computed tomography (CT) lymphangiography, which was performed via intrametatarsal pad injection, revealed no evidence of thoracic duct rupture or obvious leakage. On CT angiography (CTA), an intraluminal filling defect was identified in the cranial vena cava (CrVC). CrVC thrombosis with secondary chylothorax was diagnosed based on CT lymphangiography and CTA. Clopidogrel, rivaroxaban, and recombinant tissue-plasminogen activator were prescribed. The follow-up CTA, 4 months after diagnosis, revealed a decrease in the thrombus, and no pleural effusion was identified. Although CrVC thrombosis is an uncommon presentation in veterinary patients, thrombus in the CrVC should be considered as a differential diagnosis of chylothorax in dogs. CT lymphangiography and CTA could be helpful in identifying and differentiating the underlying etiologies of chylothorax.

Background: The coronavirus disease-2019 (COVID-19) pandemic has contributed to the change in the epidemiology of many infectious diseases. This study aimed to establish the pre-pandemic epidemiology of pediatric invasive bacterial infection (IBI). Methods: A retrospective multicenter-based surveillance for pediatric IBIs has been maintained from 1996 to 2020 in Korea. IBIs caused by eight bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, Streptococcus agalactiae, Streptococcus pyogenes, Listeria monocytogenes, and Salmonella species) in immunocompetent children > 3 months of age were collected at 29 centers. The annual trend in the proportion of IBIs by each pathogen was analyzed. Results: A total of 2,195 episodes were identified during the 25-year period between 1996 and 2020. S. pneumoniae (42.4%), S. aureus (22.1%), and Salmonella species (21.0%) were common in children 3 to 59 months of age. In children ≥ 5 years of age, S. aureus (58.1%), followed by Salmonella species (14.8%) and S. pneumoniae (12.2%) were common. Excluding the year 2020, there was a trend toward a decrease in the relative proportions of S. pneumoniae (rs = −0.430, P = 0.036), H. influenzae (rs = −0.922, P < 0.001), while trend toward an increase in the relative proportion of S. aureus (rs = 0.850, P < 0.001), S. agalactiae (rs = 0.615, P = 0.001), and S. pyogenes (rs = 0.554, P = 0.005). Conclusion In the proportion of IBIs over a 24-year period between 1996 and 2019, we observed a decreasing trend for S. pneumoniae and H. influenzae and an increasing trend for S. aureus, S. agalactiae, and S. pyogenes in children > 3 months of age. These findings can be used as the baseline data to navigate the trend in the epidemiology of pediatric IBI in the post COVID-19 era.

Background: Although international guidelines recommend palliative care approaches for many serious illnesses, the palliative needs of patients with serious illnesses other than cancer are often unmet, mainly due to insufficient prognosis-related discussion. We investigated physicians' and the general public's respective attitudes toward prognostic disclosure for several serious illnesses. Methods: We conducted a cross-sectional survey of 928 physicians, sourced from 12 hospitals and the Korean Medical Association, and 1,005 members of the general public, sourced from all 17 administrative divisions in Korea. Results: For most illnesses, most physicians (adjusted proportions – end-organ failure, 99.0%; incurable genetic or neurologic disease, 98.5%; acquired immune deficiency syndrome [AIDS], 98.4%; stroke or Parkinson's disease, 96.0%; and dementia, 89.6%) and members of the general public (end-organ failure, 92.0%; incurable genetic or neurologic disease, 92.5%; AIDS, 91.5%; stroke or Parkinson's disease, 92.1%; and dementia, 86.9%) wanted to be informed if they had a terminal prognosis. For physicians and the general public, the primary factor to consider when disclosing terminal status was “the patient's right to know his/her condition” (31.0%). Yet, the general public was less likely to prefer prognostic disclosure than physicians. Particularly, when their family members were patients, more than 10% of the general public did not want patients to be informed of their terminal prognosis. For the general public, the main reason for not disclosing prognosis was “psychological burden such as anxiety and depression” (35.8%), while for the physicians it was “disclosure would have no beneficial effect” (42.4%). Conclusion Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results.

Objectives: When administered soon after menopause, hormone therapy can prevent coronary heart diseases in women. To explore the mechanism underlying the cardioprotective actions of estrogen, we investigated the effects of 17β-estradiol (17β-E2) on the plasminogen activator system using cultured vascular smooth muscle cells (VSMCs). Methods: VSMCs were isolated from rat aortas. Protein expression of plasminogen activator inhibitor type 1 (PAI-1) and tissue-type plasminogen activator (t-PA) were evaluated using Western blotting and enzyme-linked immunosorbent assay, respectively. The enzyme activity of PAI-1 in a conditioned medium was assessed via reverse fibrin overlay zymography and that of t-PA was assessed via fibrin overlay zymography. Gene expression was quantified using real-time reverse transcription-polymerase chain reaction. Results: Following pre-treatment for 24 hours, 17β-E2 suppressed both protein expression and enzyme activity of PAI-1 stimulated by lysophosphatidylcholine (lysoPC) in a significant and dose-dependent manner at a near physiological concentration. Moreover, 17β-E2 (10−7 M) inhibited PAI-1 gene expression, and ICI 182,780—a specific estrogen receptor antagonist—blocked the effects of 17β-E2 on the PAI-1 protein. 17β-E2 did not affect t-PA secretion but significantly enhanced free t-PA activity through reduced binding to PAI-1. Furthermore, 17β-E2 suppressed intracellular reactive oxygen species production and nuclear factor-κB-mediated transcription. Conclusions In VSMCs stimulated with lysoPC, 17β-E2 reduced PAI-1 expression through a non-receptor-mediated mechanism via antioxidant activity as well as a receptor-mediated mechanism; however, it did not alter t-PA secretion. Of note, 17β-E2 suppressed PAI- 1 activity and concurrently enhanced t-PA activity, suggesting a beneficial influence on fibrinolysis.

BACKGROUND: Beyond its current function as a rescue therapy in acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) may be applied in ARDS patients with less severe hypoxemia to facilitate lung protective ventilation. The purpose of this study was to evaluate the efficacy of extended ECMO use in ARDS patients. METHODS: This study reviewed 223 adult patients who had been admitted to the intensive care units of 11 hospitals in Korea and subsequently treated using ECMO. Among them, the 62 who required ECMO for ARDS were analyzed. The patients were divided into two groups according to pre-ECMO arterial blood gas: an extended group (n=14) and a conventional group (n=48). RESULTS: Baseline characteristics were not different between the groups. The median arterial carbon dioxide tension/fraction of inspired oxygen (FiO2) ratio was higher (97 vs. 61, p<0.001) while the median FiO2 was lower (0.8 vs. 1.0, p<0.001) in the extended compared to the conventional group. The 60-day mortality was 21% in the extended group and 54% in the conventional group (p=0.03). Multivariate analysis indicated that the extended use of ECMO was independently associated with reduced 60-day mortality (odds ratio, 0.10; 95% confidence interval, 0.02–0.64; p=0.02). Lower median peak inspiratory pressure and median dynamic driving pressure were observed in the extended group 24 hours after ECMO support. CONCLUSION: Extended indications of ECMO implementation coupled with protective ventilator settings may improve the clinical outcome of patients with ARDS.
Adult ; Anoxia ; Carbon Dioxide ; Extracorporeal Membrane Oxygenation ; Humans ; Intensive Care Units ; Korea ; Lung ; Mortality ; Multicenter Studies as Topic ; Multivariate Analysis ; Oxygen ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Ventilation ; Ventilators, Mechanical

The authors regret that one co-author (Kyung-Hyo Kim) was missing in the article.