Background: The proximal humerus, a common site for osteoporotic fractures, is frequently overlooked in osteoporosis evaluations. This study aimed to evaluate the relationship between the conventional bone mineral density (BMD) measurement (at the lumbar spine and femur) and the BMD measurement at both proximal humeri (the asymptomatic side and the side with a rotator cuff tear [RCT]) in patients with unilateral RCT. Furthermore, we investigated clinical features indicative of osteoporosis in RCT patients and assessed the utility of proximal humerus BMD measurements. Methods: From April 2020 to September 2020, 87 patients who underwent arthroscopic repairs for unilateral RCTs were examined for age, onset, body mass index, menopause duration, passive range of motion, global fatty degeneration index, and RCT and retraction size. The regions of interest (ROIs) for the conventional BMD included the lumbar spine, femur neck, femur trochanter, and total femur. For the proximal humerus BMD, the ROIs included the head, lesser tuberosity, greater tuberosity (medial, middle, and lateral rows), and total humerus. Results: The conventional BMD of the lumbar spine, femur neck, femur trochanter, and femur total were 1.090, 0.856, 0.781, and 0.945 g/cm2 , respectively. The head, lesser tuberosity, greater tuberosity (medial, middle, and lateral rows), and total BMD of the asymptomatic-side proximal humerus were 0.547, 0.544, 0.697, 0.642, 0.554, and 0.610 g/cm2 , respectively. The average of proximal humerus BMD was significantly lower than that of conventional BMD (p < 0.001). All ROIs BMD of the RCT-side proximal humerus were 0.497, 0.507, 0.619, 0.598, 0.517, and 0.560 g/cm2 . There was no correlation between the conventional BMD and each proximal humerus BMD. All ROI BMD of the RCT-side proximal humerus was not significant in the multiple regression analysis with age, onset, body mass index, passive range of motion, global fatty degeneration index, and RCT and retraction size (p > 0.05). Conclusions The proximal humerus BMD showed a completely different trend from that of conventional BMD and had no significant association with clinical features. Therefore, the proximal humerus BMD needs to be measured separately from the conventional BMD, as it may provide important information before rotator cuff repair surgery.

Background/Aims: H2 receptor antagonists (H2RA) have been used to treat gastritis by inhibiting gastric acid. Proton pump inhibitors (PPIs) are more potent acid suppressants than H2RA.However, the efficacy and safety of low-dose PPI for treating gastritis remain unclear. The aim was to investigate the efficacy and safety of low-dose PPI for treating gastritis. Methods: A double-blind, noninferiority, multicenter, phase 3 clinical trial randomly assigned 476 patients with endoscopic erosive gastritis to a group using esomeprazole 10 mg (DW1903) daily and a group using famotidine 20 mg (DW1903R1) daily for 2 weeks. The full-analysis set included 319 patients (DW1903, n=159; DW1903R1, n=160) and the per-protocol set included 298 patients (DW1903, n=147; DW1903R1, n=151). The primary endpoint (erosion improvement rate) and secondary endpoint (erosion and edema cure rates, improvement rates of hemorrhage, erythema, and symptoms) were assessed after the treatment. Adverse events were compared. Results: According to the full-analysis set, the erosion improvement rates in the DW1903 and DW1903R1 groups were 59.8% and 58.8%, respectively. According to the per-protocol analysis, the erosion improvement rates in the DW1903 and DW1903R1 groups were 61.9% and 59.6%, respectively. Secondary endpoints were not significantly different between two groups except that the hemorrhagic improvement rate was higher in DW1903 with statistical tendency. The number of adverse events were not statistically different. Conclusions DW1903 of a low-dose PPI was not inferior to DW1903R1 of H2RA. Thus, lowdose PPI can be a novel option for treating gastritis (ClinicalTrials.gov Identifier: NCT05163756).

Purpose: Although advancements in medical treatments have been made, approximately half of patients with intestinal Crohn’s disease (CD) require intestinal resections during their lifetime. It is well-known that the nutritional status of CD patients can impact postoperative morbidity. The objective of this study was to evaluate the clinical significance of prognostic nutritional index (PNI) in patients with intestinal CD who underwent primary bowel resection. Materials and Methods: We retrospectively investigated patients who were diagnosed with CD and underwent intestinal surgery at Severance Hospital between January 2005 and October 2018. The patients were divided into two groups: PNI ≤40 (n=150) and PNI >40 (n=77). We assessed the clinical significance of PNI in terms of the incidence of postoperative infectious complications (PICs) and the postoperative recurrence of CD. Results: The low PNI group had significantly higher rates of infectious complications (32.0% vs. 10.4%, p=0.001) compared to the high PNI group. Multivariable analysis identified low PNI (≤40) and longer operation time (>180 min) as independent risk factors associated with PICs [odds ratio (OR)=2.754, 95% confidence interval (CI)=1.140–6.649, p=0.024; OR=2.986, 95% CI=1.451–6.143, p=0.003]. PICs were significantly associated with surgical recurrence (hazard ratio=2.217, 95% CI=1.064–4.617, p=0.034). Conclusion Preoperative PNI could serve as a predictive factor for PICs in CD patients who undergo intestinal resection. Additionally, PICs are significantly associated with a higher risk of surgical recurrence in CD.

Background: There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. Methods: Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. Results: Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI;additionally, age (65–74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. Conclusions Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.

Background: The best treatment for isolated greater tuberosity (GT) fractures is still controversial. Although previous studies have suggested surgical options, they are either unable to provide firm fixation or present with a variety of complications. Methods: We retrospectively studied the records of patients with isolated GT fractures who underwent open reduction and internal fixation using a 3.5-mm locking hook plate between January 2016 and January 2018. The surgical indication was an at least 5-mm displacement of the GT as observed in either simple radiography or three-dimensional computed tomography. Clinical outcomes were assessed using the following five parameters shortly before implant removal and at the final follow-up: visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Shoulder Rating Scale of the University of California, Los Angeles (UCLA), Constant-Murley score, and range of motion. Results: Twenty-one patients with a mean age of 64 years were included. Bone union was achieved within 12–20 weeks of the first surgery in all patients. Implant removal was performed between 13 and 22 weeks after surgery. At the final follow-up, the mean VAS pain score, forward flexion, abduction, external rotation, internal rotation, ASES score, UCLA score, and ConstantMurley score were significantly better when compared to outcomes shortly before implant removal (p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.003, p < 0.001, p < 0.001, and p < 0.001, respectively). Conclusions The 3.5-mm locking hook plate provided sufficient stability and led to satisfactory clinical and radiological outcomes for isolated GT fractures. However, the hook plate may irritate the rotator cuff, and postoperative stiffness may be inevitable.Therefore, second surgery for implant removal is necessary after bone union is achieved.

Background: The best treatment for isolated greater tuberosity (GT) fractures is still controversial. Although previous studies have suggested surgical options, they are either unable to provide firm fixation or present with a variety of complications. Methods: We retrospectively studied the records of patients with isolated GT fractures who underwent open reduction and internal fixation using a 3.5-mm locking hook plate between January 2016 and January 2018. The surgical indication was an at least 5-mm displacement of the GT as observed in either simple radiography or three-dimensional computed tomography. Clinical outcomes were assessed using the following five parameters shortly before implant removal and at the final follow-up: visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Shoulder Rating Scale of the University of California, Los Angeles (UCLA), Constant-Murley score, and range of motion. Results: Twenty-one patients with a mean age of 64 years were included. Bone union was achieved within 12–20 weeks of the first surgery in all patients. Implant removal was performed between 13 and 22 weeks after surgery. At the final follow-up, the mean VAS pain score, forward flexion, abduction, external rotation, internal rotation, ASES score, UCLA score, and ConstantMurley score were significantly better when compared to outcomes shortly before implant removal (p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.003, p < 0.001, p < 0.001, and p < 0.001, respectively). Conclusions The 3.5-mm locking hook plate provided sufficient stability and led to satisfactory clinical and radiological outcomes for isolated GT fractures. However, the hook plate may irritate the rotator cuff, and postoperative stiffness may be inevitable.Therefore, second surgery for implant removal is necessary after bone union is achieved.

PURPOSE: Childhood asthma has a considerable social impact and economic burden, especially in severe asthma. This study aimed to identify the proportion of childhood asthma severity and to evaluate associated factors for greater asthma severity. METHODS: This study was performed on 667 children aged 5–15 years with asthma from the nationwide 19 hospitals in the Korean childhood Asthma Study (KAS). Asthma was classified as mild intermittent, mild persistent, and moderate/severe persistent groups according to the National Asthma Education and Prevention Program recommendations. Multinomial logistic regression models were used to identify the associated factors for greater asthma severity. RESULTS: Mild persistent asthma was most prevalent (39.0%), followed by mild intermittent (37.6%), moderate persistent (22.8%), and severe persistent asthma (0.6%). Onset later than 6 years of age (adjusted odds ratio [aOR], 1.69 for mild persistent asthma; aOR, 1.92 for moderate/severe persistent asthma) tended to increase asthma severity. Exposure to environmental tobacco smoke (aOR, 1.53 for mild persistent asthma; aOR, 1.85 for moderate/severe persistent asthma), and current dog ownership with sensitization to dog dander (aOR, 5.86 for mild persistent asthma; aOR, 6.90 for moderate/severe persistent asthma) showed increasing trends with greater asthma severity. Lower maternal education levels (aOR, 2.32) and no usage of an air purifier in exposure to high levels of outdoor air pollution (aOR, 1.76) were associated with moderate/severe persistent asthma. CONCLUSIONS: Modification of identified environmental factors associated with greater asthma severity might help better control childhood asthma, thereby reducing the disease burden due to childhood asthma.
Air Filters ; Air Pollution ; Animals ; Asthma ; Child ; Dander ; Dogs ; Education ; Environmental Exposure ; Humans ; Logistic Models ; Odds Ratio ; Ownership ; Risk Factors ; Smoke ; Social Change ; Tobacco

A 7-year-old female mixed-breed dog was presented to a veterinary clinic for pyometra. During abdominal ultrasonography, an abnormal finding was noted in the gallbladder. A cholecystectomy was performed. Grossly, the gallbladder wall was thickened with a polypoid nodular projection into the lumen. Microscopically, the polyp consisted of a solid sheet of round to polygonal-shaped cells that formed small packets with fibrovascular septa. The neoplastic cells contained abundant cytoplasmic eosinophilic granules. Immunohistochemically, the neoplastic cells were positive to chromogranin A and neuron-specific enolase, whereas they were negative to vimentin and cytokeratin. This case was diagnosed as a primary gallbladder carcinoid tumor.

A 7-year-old Maltese was presented to a veterinary clinic for a history of anorexia, soft feces, and anemia. During abdominal sonography and computed tomography imaging, splenic mass was suspected. Laparotomy revealed the bloody ascites, and the enlarged spleen containing a large spherical mass. Microscopically, the splenic parenchyma was replaced by neoplastic cells with cytoplasmic vacuolation and abundant myxoid matrix. Cellular vacuolation and myxoid matrix were positive to Oil-Red-O and Alcian-blue stains. The neoplastic cells were positive to vimentin on immunohistochemistry. The case was diagnosed as myxoid liposarcoma. Based on a poor prognosis, the dog was euthanized three weeks after splenectomy.

OBJECTIVETo obtain fundamental information for the standardization of herbal medicine in Korea.

METHODSWe analyzed the herbal medicine prescription data of patients at the Pusan National University Korean Medicine Hospital from March 2010 to February 2013. We used the Dongui-Bogam (Dong Yi Bao Jian) to classify prescribed herbal medicines.

RESULTSThe study revealed that the most frequently prescribed herbal medicine was 'Liuwei Dihuang Pill (LWDHP, )' which was used for invigorating 'Shen (Kidndy)-yin'. 'LWDHP' was most frequently prescribed to male patients aged 50-59, 60-69, 70-79 and 80-89 years, and 'Xionggui Tiaoxue Decoction (XGTXD, )' was most frequently prescribed to female patients aged 30-39 and 40-49 years. According to the International Classification of Diseases (ICD) codes, 'Diseases of the musculoskeletal system and connective tissue' showed the highest prevalence. 'LWDHP' and 'XGTXD' was the most frequently prescribed in categories 5 and 3, respectively. Based on the percentage of prescriptions for each sex, 'Ziyin Jianghuo Decoction ()' was prescribed to mainly male patients, and 'XGTXD' with 'Guima Geban Decoction ()' were prescribed to mainly female patients.

CONCLUSIONThis study analysis successfully determined the frequency of a variety of herbal medicines, and many restorative herbal medicines were identified and frequently administered.

Adult ; Aged ; Cross-Sectional Studies ; Drug Prescriptions ; Electronic Health Records ; Female ; Herbal Medicine ; Hospitals ; Humans ; Male ; Medicine, Korean Traditional ; Middle Aged ; Phytotherapy ; Republic of Korea