Cutaneous lymphoma is rare in cats. An 11-year-old spayed female Persian cat presented with crust, ulceration, and multiple nodules on the shoulder and forelimb for 2 months. Computed tomography revealed a diffuse, irregularly margined lesion in the dorsal cutis extending from cervical to thoracic vertebrae. Cytological evaluation predominantly revealed large round cells with multilobulated nuclei and basophilic cytoplasm. Histopathological examination confirmed round CD3+/PAX5- cells packed in the dermis. Thus, the diagnosis of non-epitheliotropic cutaneous lymphoma with a diffuse large T-cell type was made. The disease progressed rapidly for the next 2 weeks, and the owner elected humane euthanasia.

Hepatocellular carcinoma (HCC) is a cytotoxic chemotherapy-resistant tumor and most HCCs arise in a background of liver cirrhosis of various causes. Although the IMBrave150 trial showed remarkable advancements in the treatment of unresectable HCC with atezolizumab plus bevacizumab (AteBeva), therapeutic outcomes were unsatisfactory in more than half of the patients. Accordingly, many ongoing trials combine conventional modalities with new drugs such as immune checkpoint inhibitors for better treatment outcomes, and they are expected to benefit patients with limited responses to conventional treatment. Here, two patients with advanced stage HCC with preserved liver function and good performance status showed partial response after treatment with combination or sequential therapy of AteBeva, hepatic arterial infusion chemotherapy, radiation therapy, and transarterial chemoembolization. These findings indicate the efficacy of multidisciplinary treatment against advanced HCC. Additional studies are required to establish optimal treatment strategies.

Purpose: We investigated whether response classification after total thyroidectomy and radioactive iodine (RAI) therapy could be affected by serum levels of recombinant human thyrotropin (rhTSH)-stimulated thyroglobulin (Tg) measured at different time points in a follow-up of patients with papillary thyroid carcinoma (PTC). Methods: A total of 147 PTC patients underwent serum Tg measurement for response assessment 6 to 24 months after the first RAI therapy. Serum Tg levels were measured at 24 h (D1Tg) and 48–72 h (D2-3Tg) after the 2nd injection of rhTSH. Responses were classified into three categories based on serum Tg corresponding to the excellent response (ER-Tg), indeterminate response (IR-Tg), and biochemical incomplete response (BIR-Tg). The distribution pattern of response classification based on serum Tg at different time points (D1Tg vs. D2-3Tg) was compared. Results: Serum D2-3Tg level was higher than D1Tg level (0.339 ng/mL vs. 0.239 ng/mL, P < 0.001). The distribution of response categories was not significantly different between D1Tg-based and D2-3Tg-based classification. However, 8 of 103 (7.8%) patients and 3 of 40 (7.5%) patients initially categorized as ER-Tg and IR-Tg based on D1Tg, respectively, were reclassified to IR-Tg and BIR-Tg based on D2-3Tg, respectively. The optimal cutoff values of D1Tg for the change of response categories were 0.557 ng/mL (from ER-Tg to IR-Tg) and 6.845 ng/mL (from IR-Tg to BIR-Tg). Conclusion D1Tg measurement was sufficient to assess the therapeutic response in most patients with low level of D1Tg. Nevertheless, D2-3Tg measurement was still necessary in the patients with D1Tg higher than a certain level as response classification based on D2-3Tg could change.

Objective: To assess the incremental prognostic value of coronary computed tomography angiography (CCTA) in comparison toa clinical risk model (Framingham risk score, FRS) and coronary artery calcium score (CACS) for future cardiac events in ischemicstroke patients without chest pain. Materials and Methods: This retrospective study included 1418 patients with acute stroke who had no previous cardiac diseaseand underwent CCTA, including CACS. Stenosis degree and plaque types (high-risk, non-calcified, mixed, or calcified plaques) wereassessed as CCTA variables. High-risk plaque was defined when at least two of the following characteristics were observed:low-density plaque, positive remodeling, spotty calcification, or napkin-ring sign. We compared the incremental prognosticvalue of CCTA for major adverse cardiovascular events (MACE) over CACS and FRS. Results: The prevalence of any plaque and obstructive coronary artery disease (CAD) (stenosis ≥ 50%) were 70.7% and 30.2%,respectively. During the median follow-up period of 48 months, 108 patients (7.6%) experienced MACE. Increasing FRS, CACS,and stenosis degree were positively associated with MACE (all p< 0.05). Patients with high-risk plaque type showed the highestincidence of MACE, followed by non-calcified, mixed, and calcified plaque, respectively (log-rank p< 0.001). Among theprediction models for MACE, adding stenosis degree to FRS showed better discrimination and risk reclassification compared toFRS or the FRS + CACS model (all p< 0.05). Furthermore, incorporating plaque type in the prediction model significantly improvedreclassification (integrated discrimination improvement, 0.08; p= 0.023) and showed the highest discrimination index(C-statistics, 0.85). However, the addition of CACS on CCTA with FRS did not add to the prediction ability for MACE (p> 0.05). Conclusion Assessment of stenosis degree and plaque type using CCTA provided additional prognostic value over CACS andFRS to risk stratify stroke patients without prior history of CAD better.

Objectives: This study examined the effects of nutrition counseling by the nutrition care process (NCP) on diet therapy practice and glycemic control in patients with type 2 diabetes mellitus. Methods: The survey was conducted on 49 patients whose hemoglobin A1c (HbA1c) level ranged from 6.5% to below 10% among patients aged 30∼60s with type 2 diabetes mellitus. Nutrition counseling by the NCP process was carried out twice: first nutrition counseling and follow up counseling. The questionnaires were composed of 54 questions in five fields (general characteristics, health-related behaviors, diet therapyrelated items, dietary life, diet therapy-related knowledge, diet therapy-related barriers). Nutrition intervention in nutrition counseling was performed based on the individualized diagnosis of NCP. Results: All the subjects practiced self-monitoring of their blood glucose levels, regular exercise, and diet therapy after NCP-based nutrition counseling. Diet therapy-related knowledge and practice by the subjects were improved after nutrition counseling. While the intake of boiled white rice decreased, the intake of boiled brown rice and barley rice in the subjects increased significantly. After nutrition counseling, the weight and HbA1c of the subjects decreased. Conclusions These results suggest that personalized nutrition counseling by NCP process is effective for diet therapy compliance and glycemic control of type 2 diabetic patients.

BACKGROUND: Heart transplantation (HTx) can be a life-saving procedure for patients in whom single ventricle palliation or one-and-a-half (1½) ventricle repair has failed. However, the presence of a previous bidirectional cavopulmonary shunt (BCS) necessitates extensive pulmonary artery angioplasty, which may lead to worse outcomes. We sought to assess the post-HTx outcomes in patients with a previous BCS, and to assess the technical feasibility of leaving the BCS in place during HTx. METHODS: From 1992 to 2017, 11 HTx were performed in patients failing from Fontan (n=7), BCS (n=3), or 1½ ventricle (n=1) physiology at Asan Medical Center. The median age at HTx was 12.0 years (range, 3–24 years). Three patients (27.3%) underwent HTx without taking down the previous BCS. RESULTS: No early mortality was observed. One patient died of acute rejection 3.5 years after HTx. The overall survival rate was 91% at 2 years. In the 3 patients without BCS take-down, the median anastomosis time was 65 minutes (range, 54–68 minutes), which was shorter than in the patients with BCS take-down (93 minutes; range, 62–128 minutes), while the postoperative central venous pressure (CVP) was comparable to the preoperative CVP. CONCLUSION: Transplantation can be successfully performed in patients with end-stage congenital heart disease after single ventricle palliation or 1½ ventricle repair. Leaving the BCS in place during HTx may simplify the operative procedure without causing significant adverse outcomes.
Angioplasty ; Central Venous Pressure ; Chungcheongnam-do ; Fontan Procedure ; Heart Defects, Congenital ; Heart Transplantation* ; Heart* ; Humans ; Mortality ; Physiology ; Pulmonary Artery* ; Surgical Procedures, Operative ; Survival Rate ; Vena Cava, Superior*

PURPOSE: This study was to identify the effectiveness of high-intensity laser therapy on pain and function of a frozen shoulder. METHODS: Thirty patients were assigned to two groups: the experimental group (n=15) and the control group (n=15). Both groups received traditional therapy for 4 weeks, 3 days a week. The experimental group, however, received an additional high intensity laser therapy. Pain was measured using the visual analogue scale (VAS). The functional ability was measured using the patient specific functional scale (PSFS). A paired t-test was used to determine any differences before and after the treatment, and an independent t-test was used to determine any differences between treatment groups. RESULTS: Both groups showed a statistically significant difference for VAS and PSFS score (p<0.05). In comparison between two groups, more experimental group than control group statistically significant difference (p<0.05). CONCLUSION: There seems to be a positive effect on pain and function of frozen shoulder from using high intensity laser therapy.
Bursitis* ; Humans ; Laser Therapy*

PURPOSE: This study was conducted to determine how a manual therapy (joint mobilization and flexion-distraction technique) would affect pain and function with the chronic low back pain. METHODS: Thirty patients were assigned to either the experimental group (n=15) or the control group (n=15). Patients in the experimental group performed joint mobilization and flexion-distraction technique. Patients in the control group performed spinal decompression therapy. Both exercises were performed for three days per week, for a period of six weeks. Pain was measured by the visual analogue scale (VAS) and functional disability was measured using the Oswestry disability index (ODI). A paired t-test was used for identify differences before and after treatment, and an independent t-test was used to identify differences between treatment groups. RESULTS: In the within group comparison, the experimental group and control group differed significantly for all variables (p<0.05). However, no significant differences were observed in any variables between groups (p>0.05). CONCLUSION: The above results confirmed that it is necessary to confirm the various benefits of therapy with the joint mobilization and the flexion-distraction technique. The findings of the concerned study will be useful to doctors applying therapy to treat patients with the chronic low back pain.
Decompression ; Exercise ; Humans ; Joints ; Low Back Pain* ; Musculoskeletal Manipulations*

PURPOSE: The purpose of this study was to examine the effects of spinal decompression therapy on pain and disability in patients with chronic low back pain. METHODS: Twenty patients with chronic low back pain were divided into an experimental group (spinal decompression therapy, n=10) and a control group (conservative physical therapy, n=10). Both groups were treated three times a week over a four-week period. RESULTS: The comparison of between-group changes post-treatment revealed statistically significant lower levels of pain and disability in the experimental group than the control group. The comparison of within each group changes before and after the treatment showed statistically significant declines in pain and disability indexes of both groups. CONCLUSION: Spinal decompression therapy may be an effective intervention for improving pain and disability in patients with chronic low back pain.
Decompression* ; Humans ; Low Back Pain*