Purpose: Esophagojejunal anastomotic leakage (EJAL) represents a severe postoperative complication following total or proximal gastrectomy. Treatment strategies include conservative management, endoscopic interventions, and surgery; however, comparative data remain limited. This study aimed to compare clinical outcomes of different strategies to identify the optimal approach based on anastomotic defect size. Materials and Methods: This retrospective study reviewed 100 patients diagnosed with EJAL between January 2015 and October 2024. Patients were categorized into four groups:conservative management, endoscopic vacuum-assisted closure (E-VAC), other endoscopic treatments, and surgery. The primary outcomes were leakage duration and length of hospital stay after EJAL diagnosis, whereas the secondary outcome was time to C-reactive protein normalization. Subgroup analyses were performed according to defect size. Results: Among the 100 patients, 76 were male and 24 were female, with a mean age of 65.7 years. Conservative treatment was the most common modality (53%), followed by other endoscopic treatments (19%), E-VAC (14%), and surgery (14%). In patients with a defect size <1 cm, conservative treatment was associated with significantly shorter leakage duration (P=0.035) and earlier resumption of diet (P=0.029) compared with endoscopic treatment.Among those with defects ≥2 cm, E-VAC demonstrated the most favorable median outcomes across all variables; however, statistical significance was not achieved because of the small sample size. Conclusions Conservative treatment appears to be the most effective treatment strategy for EJAL with anastomotic defects <1 cm. For larger defects (≥2 cm), E-VAC may offer clinical benefit, although further studies are needed to confirm its efficacy. These findings highlight the importance of individualized treatment selection based on defect size.

In the case of a patients who have lost the centric stop and have a staggered occlusion of the residual teeth, various movements occur when the denture is loaded.Implant placement is necessary to reinforce the retention, support, and stabilization elements to reduce denture movement. However, in this case, considering the patient’s age, aversion to surgery, and bone loss, implants were not placed and restoration was performed with a removable partial denture. In this case, it is important to set the correct mandibular position for restoration because the patient has a habit of chewing with the remaining teeth. In this case, a stable mandibular position was established using a gothic arch tracing, and good results were obtained by restoring with partial dentures, so this is reported.

Background: Dermatofibromas (DF) are fibrohistiocytic tumors of unknown etiology, and multiple DF (MDF) are relatively rare. MDF have been reported in the setting of autoimmune diseases, human immunodeficiency virus infection, or comorbidities treated with immunosuppressive drugs. Objective: The present study investigated whether underlying conditions with impaired immune function are associated with MDF. Methods: A total of 338 patients with DF was enrolled. We divided patients into two groups as MDF and solitary DF (SDF) groups. We retrospectively reviewed patient medical records and classified all patients by underlying diseases. Statistical significance of SDF and MDF for each conditions was analyzed. Results: The demographics and comorbidities were compared between MDF group (n=82) and SDF group (n=256). Among underlying conditions, systemic lupus erythematosus (SLE) (odds ratio, 10.397; 95% confidence interval, 2.743∼39.404; p＜0.001) was significantly associated with MDF over SDF. Vitiligo and post status of kidney transplant were related more highly to MDF (p=0.014; p=0.014, respectively) than to SDF. Presence of overall comorbidities, autoimmune diseases, and immunosuppressive drug use were associated with DF number (p＜0.001;p＜0.001; p＜0.001, respectively). Conclusion We propose an association between MDF and comorbidities, especially SLE and immunosuppressant use. MDF lesions seem to be impacted by compromised immune function. This is of significance since it is essential to search for associated conditions in patients presenting with MDF in dermatologic clinical settings.

Background: Ultrasonography is an effective noninvasive imaging modality for the diagnosis of subcutaneous masses. To date, few studies have reported skin ultrasonography using deep convolutional neural networks (DCNNs).We investigated the accuracy of DCNNs for the diagnosis of epidermal cysts, lipomas, and other subcutaneous masses. Objective: The purpose of this study was to evaluate whether DCNNs could diagnose subcutaneous masses with ultrasonographic images at level of competence comparable to dermatologists. Methods: We created a dataset of 1,361 skin ultrasonography images obtained from 202 patients diagnosed with epidermal cysts, lipomas, and other subcutaneous masses, to train the DCNNs using ResNet18. Performance was compared with another set of 93 ultrasonographic images (24 epidermal cysts, 25 lipomas, and 44 other subcutaneous masses) from open-access articles. Results: The DCNNs yielded 87.10% classification accuracy and 86.10% F1-scores. The area under the curve, sensitivity, and specificity were 0.92 (95% confidence interval [CI] 0.86∼0.98), 75.00%, and 98.55% for epidermal cysts; 0.93 (95% CI 0.88∼0.98), 80.00%, and 94.12% for lipomas; and 0.97 (95% CI 0.93∼1.00), 97.73%, and 85.71% for other subcutaneous masses, respectively. Analysis using gradient-weighted class activation mapping revealed that the DCNNs could detect specific ultrasonographic findings of epidermal cysts and lipomas. Conclusion We propose that DCNNs combined with ultrasonography may aid in the diagnosis of subcutaneous masses in outpatient settings.

Background: Ultrasonography is an effective noninvasive imaging modality for the diagnosis of subcutaneous masses. To date, few studies have reported skin ultrasonography using deep convolutional neural networks (DCNNs).We investigated the accuracy of DCNNs for the diagnosis of epidermal cysts, lipomas, and other subcutaneous masses. Objective: The purpose of this study was to evaluate whether DCNNs could diagnose subcutaneous masses with ultrasonographic images at level of competence comparable to dermatologists. Methods: We created a dataset of 1,361 skin ultrasonography images obtained from 202 patients diagnosed with epidermal cysts, lipomas, and other subcutaneous masses, to train the DCNNs using ResNet18. Performance was compared with another set of 93 ultrasonographic images (24 epidermal cysts, 25 lipomas, and 44 other subcutaneous masses) from open-access articles. Results: The DCNNs yielded 87.10% classification accuracy and 86.10% F1-scores. The area under the curve, sensitivity, and specificity were 0.92 (95% confidence interval [CI] 0.86∼0.98), 75.00%, and 98.55% for epidermal cysts; 0.93 (95% CI 0.88∼0.98), 80.00%, and 94.12% for lipomas; and 0.97 (95% CI 0.93∼1.00), 97.73%, and 85.71% for other subcutaneous masses, respectively. Analysis using gradient-weighted class activation mapping revealed that the DCNNs could detect specific ultrasonographic findings of epidermal cysts and lipomas. Conclusion We propose that DCNNs combined with ultrasonography may aid in the diagnosis of subcutaneous masses in outpatient settings.

Objectives: Our study aimed to analyze the demographic and clinical characteristics of children and adolescents during their first visit to psychiatric outpatient departments for the management of suicidal ideation and behavior, and to compare the changes before and in 2012 or later. Methods: This multicenter study was conducted at five university hospitals in a metropolitan area in South Korea. Medical records of patients aged 6–18 years were retrospectively reviewed from January 2009 to December 2016. Patients were analyzed by classifying them into suicidal and non-suicidal groups based on their visit to the hospital for management of suicidal ideation or suicide attempt and other mental problems, respectively. Results: There were differences in the year of visit, diagnosis, education level, and referral sources between patients in the suicidal and non-suicidal groups. Multiple regression analysis was conducted based on the sex, education level, referral by school, and diagnosis of depression in patients in the suicidal group, which revealed significant association. Conclusion Suicide-related problems were significantly associated with the sex, education level, referral by school, and a diagnosis of depression in the patients. A well-connected referral system would be necessary for professional mental health management of high-risk children and adolescents.

Sparganosis is a rare parasitic infection that can infect the abdominal wall, extremities, urogenital system, and/or central nervous system. Because the incidence of sparganosis is less than 2% of all reported cases of sparganosis, early diagnosis of sparganosis is difficult. Breast sparganosis has characteristic radiologic findings. Complete surgical removal is the treatment of choice and has the benefit of producing a definite diagnosis. Herein, we would report a case of recurrent breast sparganosis that occurred two years after surgical excision of worms from the ipsilateral breast.

During cancer progression, cancer cells are repeatedly exposed to metabolic stress conditions in a resource-limited environment which they must escape. Increasing evidence indicates the importance of nicotinamide adenine dinucleotide phosphate (NADPH) homeostasis in the survival of cancer cells under metabolic stress conditions, such as metabolic resource limitation and therapeutic intervention. NADPH is essential for scavenging of reactive oxygen species (ROS) mainly derived from oxidative phosphorylation required for ATP generation. Thus, metabolic reprogramming of NADPH homeostasis is an important step in cancer progression as well as in combinational therapeutic approaches. In mammalian, the pentose phosphate pathway (PPP) and one-carbon metabolism are major sources of NADPH production. In this review, we focus on the importance of glucose flux control towards PPP regulated by oncogenic pathways and the potential therein for metabolic targeting as a cancer therapy. We also summarize the role of Snail (Snai1), an important regulator of the epithelial mesenchymal transition (EMT), in controlling glucose flux towards PPP and thus potentiating cancer cell survival under oxidative and metabolic stress.
Adenosine Triphosphate ; Cell Survival ; Epithelial-Mesenchymal Transition ; Glucose ; Glucosephosphate Dehydrogenase ; Homeostasis ; Metabolism ; NADP ; Oxidative Phosphorylation ; Pentose Phosphate Pathway ; Reactive Oxygen Species ; Snails ; Stress, Physiological ; United Nations

Fimasartan, a new angiotensin II receptor antagonist, reduces myocyte damage and stabilizes atherosclerotic plaque through its anti-inflammatory effect in animal studies. We investigated the protective effects of pretreatment with fimasartan on ischemia-reperfusion injury (IRI) in a mouse model of ischemic renal damage. C57BL/6 mice were pretreated with or without 5 (IR-F5) or 10 (IR-F10) mg/kg/day fimasartan for 3 days. Renal ischemia was induced by clamping bilateral renal vascular pedicles for 30 min. Histology, pro-inflammatory cytokines, and apoptosis assays were evaluated 24 h after IRI. Compared to the untreated group, blood urea nitrogen and serum creatinine levels were significantly lower in the IR-F10 group. IR-F10 kidneys showed less tubular necrosis and interstitial fibrosis than untreated kidneys. The expression of F4/80, a macrophage infiltration marker, and tumor necrosis factor (TNF)-α, decreased in the IR-F10 group. High-dose fimasartan treatment attenuated the upregulation of TNF-α, interleukin (IL)-1β, and IL-6 in ischemic kidneys. Fewer TUNEL positive cells were observed in IR-F10 compared to control mice. Fimasartan caused a significant decrease in caspase-3 activity and the level of Bax, and increased the Bcl-2 level. Fimasartan preserved renal function and tubular architecture from IRI in a mouse ischemic renal injury model. Fimasartan also attenuated upregulation of inflammatory cytokines and decreased apoptosis of renal tubular cells. Our results suggest that fimasartan inhibited the process of tubular injury by preventing apoptosis induced by the inflammatory pathway.
Animals ; Apoptosis* ; Blood Urea Nitrogen ; Caspase 3 ; Constriction ; Creatinine ; Cytokines ; Fibrosis ; In Situ Nick-End Labeling ; Interleukin-6 ; Interleukins ; Ischemia ; Kidney ; Macrophages ; Mice ; Muscle Cells ; Necrosis ; Plaque, Atherosclerotic ; Receptors, Angiotensin ; Reperfusion Injury* ; Tumor Necrosis Factor-alpha ; Up-Regulation

Craniocerebral gunshot injuries (CGIs) are extremely seldom happened in Korea because possession of individual firearm is illegal. So, CGIs are rarely encountered by Korean neurosurgeons or Korean trauma surgeons, though in other developing countries or Unites states of America their cases are indefatigably increasing. Management goal should focus on early aggressive, vigorous resuscitation. The treatments consist of immediate life salvage through correction of coagulopathy, intracranial decompression, prevention of infection and preservation of nervous tissue. There have been few studies involving penetrating CGIs in Korea. Here we present a case of penetrating gunshot wound in Korea. We present a 58-year-old man who was unintentionally shot by his colleague with a shotgun. The patients underwent computed tomography (CT) for assessment of intracranial injury. The bullet passed through the left parietal bone and right lateral ventricle and exited through the posterior auricular right temporal bone. After CT scan, he arrested and the cardiopulmonary resuscitation was conducted immediately. But we were unable to resuscitate him. This case report underscores the importance of the initial clinical exam and CT studies along with adequate resuscitation to make the appropriate management decision. Physicians should be familiar with the various injury patterns and imaging findings which are poor prognostic indicators.