Replacement of the retrohepatic inferior vena cava (IVC) after concurrent resection of IVC and tumor-bearing liver is regarded as a feasible living donor liver transplantation (LDLT) technique to cope with tumors around the IVC. This method can make the resection extent of LDLT comparable to that of deceased-donor liver transplantation. We present one pediatric LDLT case with IVC replacement using an enlarged iliac vein conduit to treat advanced hepatoblastoma. The patient was a 33-monthold and 12 kg-weighing girl suffering from large multiple hepatoblastomas invading the retrohepatic IVC. At 2-month waiting after deciding LDLT, we obtained a coldstored iliac vein graft and LDLT was performed with the father’s left lateral section graft. A 1.3 cm-wide and 10 cm-long iliac vein was transformed to be a 2 cm-wide and 5 cm-long vein graft through a double-barrel unification venoplasty. The left lateral section graft was implanted along the standard procedure of LDLT. The patient recovered uneventfully and is undergoing scheduled adjuvant chemotherapy. IVC replacement with vein homograft is a feasible option for LDLT in pediatric patients with advanced liver malignancy.

Purpose: Vessel wall imaging (VWI) for carotid plaque is better for detecting unstable carotid plaque such as intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thin/ruptured fibrous cap. However, the role of VWI before carotid artery stenting (CAS) is unclear. Thus, this study aimed to determine the findings of symptomatic carotid stenosis before CAS on angiography and carotid VWI and to evaluate the imaging findings associated with post-procedural clinical events after CAS. Materials and Methods: This retrospective study included 173 consecutive patients who underwent carotid VWI, CAS, and post-procedural diffusion-weighted imaging (DWI) after CAS. Findings of unstable plaque on carotid VWI and unstable findings on angiography were analyzed. We also analyzed the incidence of post-procedural clinical events, any stroke, myocardial infarction (MI), and death within 30 days of CAS. Results: Of 173 patients, 101 (58.4%) had initial ischemic symptoms and positive findings on DWI. Symptomatic patients were significantly higher in patients with IPH than in patients without IPH (62.4% vs. 45.8%, P=0.031). Degree of stenosis, thrombus of the stenotic lesion, flow delay of internal carotid artery, and flow arrest by filter thrombus had significantly higher prevalence in the symptomatic group. Twenty patients (11.6%) had post-procedural clinical events such as any stroke, clinical symptoms, and/or MI. Hyperlipidemia and intraluminal thrombus on angiography were identified as significant factors influencing post-procedural events after CAS. Conclusion An intraluminal thrombus on angiography was identified as a significant factor influencing post-procedural clinical events after CAS.

Background/Aims: A full colonoscopy is currently required in children and adolescents with colorectal polyps, because of their potential of neoplastic transformation and complications such as intussusception. We aimed to analyze the associations of polyp characteristics in children and adolescents with colorectal polyps. Based on these findings, we also aimed to reevaluate the necessity of conducting a full colonoscopy. Methods: Pediatric patients <18 years of age who had undergone a colonoscopic polypectomy and those with <5 colorectal polyps were included in this multicenter, retrospective study. Baseline clinicodemographics, colonoscopic and histologic findings were investigated. Results: A total of 91 patients were included. Multivariate logistic regression analysis showed that polyp size was the only factor associated with the presence of any polyps located proximal to the splenic flexure (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.28 to 4.28; p=0.007). Furthermore, polyp location proximal to the splenic flexure and sessile morphology were associated with the presence of any adenomatous polyp (OR, 8.51; 95% CI, 1.43 to 68.65; p=0.023; OR, 18.41; 95% CI, 3.45 to 173.81; p=0.002, respectively). Conclusions In children and adolescents presenting with <5 colorectal polyps, polyp size and the presence of any adenomatous polyp were positively associated with polyp location proximal to the splenic flexure. This finding supports the necessity of a full colonoscopic exam in pediatric patients with colorectal polyps for the detection of polyps before the occurrence of complications such as intussusception or neoplastic transformation.

Objective: Facial affect recognition is associated with neuropsychological status and psychiatric diseases. We hypothesized that facial affect recognition is associated with psychological status and perception of other affects. Methods: A total of 80 images depicting facial affect, including 20 Neutral, 20 Angry, 20 Fear, and 20 Sad, were screened for use in our research. A total of 100 healthy individuals were asked to rate these images using a 10-point Likert scale and complete psychological scales assessing the emotional statuses and cognitive functions. Results: The participants’ emotional state of aggression, attention, and impulsivity may have been associated with their interpretation of the Angry facial expressions. The participants often rated the Angry facial expressions as Fear. The participants rated Fear images as Angry or Sad. In response to a Sad facial expression, the participants reported psychological statuses of attention and impulsivity which were associated with the facial expression rating. The participants rated the Sad expression as Angry or Fear. Conclusion The psychological statuses of the participants were significantly correlated with their interpretation of facial affects. In particular, a psychological state of attention was often correlated with incorrect affect ratings. Attention and impulsivity could affect the rating of the sad facial expressions.

Fibroma of the tendon sheath is a benign slow-growing fibrous tumor. Although rare, cases occurring in the upper extremities usually involve the fingers. It appears as a well-defined, roundor oval-shaped mass originating from the flexor tendon. Abundant fibrous stroma makes fibromas appear as a low intensity mass in all MRI sequences. Most of the fibromas manifest as painless soft tissue masses. Herein, we report a case of fibroma of the tendon sheath with an unusual clinical presentation, triggering carpal tunnel syndrome during wrist movement.

OBJECTIVE: The aim of this study was to compare posterior tooth inclinations, occlusal force, and contact area of adults with different sagittal malocclusions. METHODS: Transverse skeletal parameters and posterior tooth inclinations were evaluated using cone beam computed tomography images, and occlusal force as well as contact area were assessed using pressure-sensitive films in 124 normodivergent adults. A linear mixed model was used to cluster posterior teeth into maxillary premolar, maxillary molar, mandibular premolar, and mandibular molar groups. Differences among Class I, II, and III groups were compared using an analysis of variance test and least significant difference post-hoc test. Correlations of posterior dental inclinations to occlusal function were analyzed using Pearson's correlation analysis. RESULTS: In male subjects, maxillary premolars and molars had the smallest inclinations in the Class II group while maxillary molars had the greatest inclinations in the Class III group. In female subjects, maxillary molars had the smallest inclinations in the Class II group, while maxillary premolars and molars had the greatest inclinations in the Class III group. Occlusal force and contact area were not significantly different among Class I, II, and III groups. CONCLUSIONS Premolar and molar inclinations showed compensatory inclinations to overcome anteroposterior skeletal discrepancy in the Class II and III groups; however, their occlusal force and contact area were similar to those of Class I group. In subjects with normodivergent facial patterns, although posterior tooth inclinations may vary, difference in occlusal function may be clinically insignificant in adults with Class I, II, and III malocclusions.

Background: This systematic review and meta-analysis aimed at investigating the current status and prevalence of sleep disturbance in Korean university students and provide evidence to develop appropriate strategies for improving sleep disturbance. Methods: Pooled prevalence of sleep disturbance in Korean university students was assessed using PubMed, CINAHL, Research Information Sharing Service, National Assembly Library, Korean studies Information Service System, and Korea Citation Index databases. A total of 1,843 studies were retrieved from the literature search, and 14 studies were included in the analysis. Statistical analysis was performed using comprehensive meta-analysis software. Results: The overall pooled prevalence was 48.9% (95% confidence interval [CI], 41.6-56.3%). Subgroup analyses revealed that the pooled prevalence rates were 59.2% (95% CI, 38.8-50.7%) in the Pittsburgh Sleep Quality Index (PSQI)-based and 26.0% (95% CI, 19.5-33.9%) in non-PSQI-based studies, 23.2% (95% CI, 15.6-33.1%) in low-quality and 56.9% (95% CI, 49.3-64.2%) in moderate-quality studies, 35.6% (95% CI, 33.4-37.8%) in studies published before 2010 and 51.4% (95% CI, 42.9-59.8%) in studies published since 2011. Conclusions The prevalence of sleep disturbance is higher in university students. Therefore, further studies are needed to identify sleep problems of university students and gain future-oriented insights to develop mediation strategies.

The high degree of academic burnout experienced during academic life indicates that job skill levels during the first year following graduation are low, and the correlation with turnover intention is high. We investigated the effects of clinical practice stress and resilience on nursing students’ burnout, and searched for factors that can prevent or control burnout. We recruited a convenience sample of 202 nursing students. Academic burnout, general characteristics, clinical practice stress, and resilience were assessed via self-reported questionnaires. The mean total score of academic burnout was 44.0 points; exhaustion was the highest at 18.5 points, inefficacy was 15.9 points, and cynicism was 9.6 points. High levels of clinical practice stress affected academic burnout (β=0.194, p=0.003), while high resilience was a factor that lowered the degree of academic burnout (β=-0.449, p<0.001). Based on our results, factors affecting students’ experiences of academic burnout were clinical practice stress and resilience. We therefore propose the implementation of a new curriculum aimed at increasing satisfaction with the major, reducing clinical practice stress, and increasing resilience, including an efficient peer mentoring program for clinical practice.

BACKGROUND: Symptoms of subclinical hypothyroidism include depression, memory loss, myocardial contractility disorder, lipid metabolic disorder, and atherosclerosis. However, the relationship between subclinical hypothyroidism and depression has not been consistent. Therefore, the purpose of this study was to provide the scientific evidence for the relationship between subclinical hypothyroidism and depression. METHODS: This study was a meta-analysis of depression in subjects with subclinical hypothyroidism. The search engine of PubMed, EBSCO, ScienceDirect, and RISS was used to search the studies published since the 1990s. A total of 176 documents were retrieved from the literature search, and finally 10 studies were included in the analysis. Statistical analysis of effect sizes was performed using Comprehensive Meta-Analysis software version 2.2.064. RESULTS: Of the 10 studies, five studies reported that depression was associated with subclinical hypothyroidism. Two of these studies were on women and two were on the elderly. The effect size of depression in patients with subclinical hypothyroidism was 3.46 (95% confidence interval 0.20–0.74, P=0.001), and the subclinical hypothyroidism was significantly associated with depression. CONCLUSIONS This study showed that subclinical hypothyroidism is associated with depression. The results also suggest the need for regular screening of depressive symptoms of patients with subclinical hypothyroidism. Especially, elderly and women with subclinical hypothyroidism may be the main targets of depressive symptom.

In Korea, the Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act was enacted in February 2016 in order to ensure that the patient's self-determination in end-of-life care processes is respected. To enhance physicians' understanding of this act and to provide proper criteria for medical judgment in variety of clinical settings, consensus guidelines were published in November 2016. In this article, the characteristics of these guidelines and related issues regarding the definitions of ‘the end stage of disease’ and ‘last days of life’ and the criteria for medical judgment are presented and summarized. According to the guidelines, the term ‘end stage of disease’ refers to a state in which there is no possibility of a fundamental recovery and the symptoms are expected to worsen within months. The terms ‘the last days of life’ and ‘the final days of life’ refer to a state in which, despite treatment, the patient's condition is worsening and death is impending, with no possibility of recovery. The attending physician and another relevant specialist should both judge a patient's medical condition as either ‘end stage of disease’ for hospice/palliative care or ‘the last days of life’ for dying patient care according to the law. Caregivers should provide appropriate medical information to eligible patients for palliative or ‘end stage of disease’ care through advance care planning. Therefore, it is critically necessary that caregivers understand the legitimate process of hospice/palliative and dying patient care based on the patient's wishes and best interests. Physicians should apply these consensus guidelines to eligible patients considering their clinical course and the patients' wishes.