This report presents the latest statistics on the stroke population in South Korea, sourced from the Clinical Research Collaborations for Stroke in Korea-National Institute for Health (CRCS-K-NIH), a comprehensive, nationwide, multicenter stroke registry. The Korean cohort, unlike western populations, shows a male-to-female ratio of 1.5, attributed to lower risk factors in Korean women. The average ages for men and women are 67 and 73 years, respectively.Hypertension is the most common risk factor (67%), consistent with global trends, but there is a higher prevalence of diabetes (35%) and smoking (21%). The prevalence of atrial fibrillation (19%) is lower than in western populations, suggesting effective prevention strategies in the general population. A high incidence of large artery atherosclerosis (38%) is observed, likely due to prevalent intracranial arterial disease in East Asians and advanced imaging techniques.There has been a decrease in intravenous thrombolysis rates, from 12% in 2017–2019 to 10% in 2021, with no improvements in door-to-needle and door-to-puncture times, worsened by the coronavirus disease 2019 pandemic. While the use of aspirin plus clopidogrel for noncardioembolic stroke and direct oral anticoagulants for atrial fibrillation is well-established, the application of direct oral anticoagulants for non-atrial fibrillation cardioembolic strokes in the acute phase requires further research. The incidence of early neurological deterioration (13%) and the cumulative incidence of recurrent stroke at 3 months (3%) align with global figures. Favorable outcomes at 3 months (63%) are comparable internationally, yet the lack of improvement in dependency at 3 months highlights the need for advancements in acute stroke care.

Objective: To investigate whether reader training improves the performance and agreement of radiologists in interpreting unenhanced breast magnetic resonance imaging (MRI) scans using diffusion-weighted imaging (DWI). Materials and Methods: A study of 96 breasts (35 cancers, 24 benign, and 37 negative) in 48 asymptomatic women was performed between June 2019 and October 2020. High-resolution DWI with b-values of 0, 800, and 1200 sec/mm 2 was performed using a 3.0-T system. Sixteen breast radiologists independently reviewed the DWI, apparent diffusion coefficient maps, and T1-weighted MRI scans and recorded the Breast Imaging Reporting and Data System (BI-RADS) category for each breast. After a 2-h training session and a 5-month washout period, they re-evaluated the BI-RADS categories. A BI-RADS category of 4 (lesions with at least two suspicious criteria) or 5 (more than two suspicious criteria) was considered positive.The per-breast diagnostic performance of each reader was compared between the first and second reviews. Inter-reader agreement was evaluated using a multi-rater κ analysis and intraclass correlation coefficient (ICC). Results: Before training, the mean sensitivity, specificity, and accuracy of the 16 readers were 70.7% (95% confidence interval [CI]: 59.4–79.9), 90.8% (95% CI: 85.6–94.2), and 83.5% (95% CI: 78.6–87.4), respectively. After training, significant improvements in specificity (95.2%; 95% CI: 90.8–97.5; P = 0.001) and accuracy (85.9%; 95% CI: 80.9–89.8; P = 0.01) were observed, but no difference in sensitivity (69.8%; 95% CI: 58.1–79.4; P = 0.58) was observed. Regarding inter-reader agreement, the κ values were 0.57 (95% CI: 0.52–0.63) before training and 0.68 (95% CI: 0.62–0.74) after training, with a difference of 0.11 (95% CI: 0.02–0.18; P = 0.01). The ICC was 0.73 (95% CI: 0.69–0.74) before training and 0.79 (95% CI: 0.76–0.80) after training (P = 0.002). Conclusion Brief reader training improved the performance and agreement of interpretations by breast radiologists using unenhanced MRI with DWI.

PURPOSE: To compare three, motion-resistant, T1-weighted MR sequences on the hepatobiliary phase for gadoxetic acid-enhanced MR imaging of the liver. MATERIALS AND METHODS: In this retrospective study, 79 patients underwent gadoxetic acid-enhanced, 3T liver MR imaging. Fifty-nine were examined using a standard protocol, and 20 were examined using a motion-resistant protocol. During the hepatocyte-specific phase, three MR sequences were acquired: 1) gradient recalled echo (GRE) with controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA); 2) radial GRE with the interleaved angle-bisection scheme (ILAB); and 3) radial GRE with golden-angle scheme (GA). Two readers independently assessed images with motion artifacts, streaking artifacts, liver-edge sharpness, hepatic vessel clarity, lesion conspicuity, and overall image quality, using a 5-point scale. The images were assessed by measurement of liver signal-to-noise ratio (SNR), and tumor-to-liver contrast-to-noise ratio (CNR). The results were compared, using repeated post-hoc, paired t-tests with Bonferroni correction and the Wilcoxon signed rank test with Bonferroni correction. RESULTS: In the qualitative analysis of cooperative patients, the results for CAIPIRINHA had significantly higher ratings for streak artifacts, liver-edge sharpness, hepatic vessel clarity, and overall image quality as compared to, radial GRE, (P < 0.016). In the imaging of uncooperative patients, higher scores were recorded for ILAB and GA with respect to all of the qualitative assessments, except for streak artifact, compared with CAIPIRINHA (P < 0.016). However, no significant differences were found between ILAB and GA. For quantitative analysis in uncooperative patients, the mean liver SNR and lesion-to-liver CNR with radial GRE were significantly higher than those of CAIPIRINHA (P < 0.016). CONCLUSION: In uncooperative patients, the use of the radial GRE sequence can improve the image quality compared to GRE imaging with CAIPIRINHA, despite the data acquisition methods used. The GRE imaging with CAIPIRINHA is applicable for patients without breath-holding difficulties.
Acceleration ; Artifacts ; Humans ; Liver* ; Magnetic Resonance Imaging* ; Retrospective Studies ; Signal-To-Noise Ratio

PURPOSE: To compare three, motion-resistant, T1-weighted MR sequences on the hepatobiliary phase for gadoxetic acid-enhanced MR imaging of the liver. MATERIALS AND METHODS: In this retrospective study, 79 patients underwent gadoxetic acid-enhanced, 3T liver MR imaging. Fifty-nine were examined using a standard protocol, and 20 were examined using a motion-resistant protocol. During the hepatocyte-specific phase, three MR sequences were acquired: 1) gradient recalled echo (GRE) with controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA); 2) radial GRE with the interleaved angle-bisection scheme (ILAB); and 3) radial GRE with golden-angle scheme (GA). Two readers independently assessed images with motion artifacts, streaking artifacts, liver-edge sharpness, hepatic vessel clarity, lesion conspicuity, and overall image quality, using a 5-point scale. The images were assessed by measurement of liver signal-to-noise ratio (SNR), and tumor-to-liver contrast-to-noise ratio (CNR). The results were compared, using repeated post-hoc, paired t-tests with Bonferroni correction and the Wilcoxon signed rank test with Bonferroni correction. RESULTS: In the qualitative analysis of cooperative patients, the results for CAIPIRINHA had significantly higher ratings for streak artifacts, liver-edge sharpness, hepatic vessel clarity, and overall image quality as compared to, radial GRE, (P < 0.016). In the imaging of uncooperative patients, higher scores were recorded for ILAB and GA with respect to all of the qualitative assessments, except for streak artifact, compared with CAIPIRINHA (P < 0.016). However, no significant differences were found between ILAB and GA. For quantitative analysis in uncooperative patients, the mean liver SNR and lesion-to-liver CNR with radial GRE were significantly higher than those of CAIPIRINHA (P < 0.016). CONCLUSION: In uncooperative patients, the use of the radial GRE sequence can improve the image quality compared to GRE imaging with CAIPIRINHA, despite the data acquisition methods used. The GRE imaging with CAIPIRINHA is applicable for patients without breath-holding difficulties.
Acceleration ; Artifacts ; Humans ; Liver* ; Magnetic Resonance Imaging* ; Retrospective Studies ; Signal-To-Noise Ratio

BACKGROUND/AIM: Antimicrobials for nosocomial infections are generally chosen discriminately from community-acquired diseases from concerns for resistance to which the elderly are highly exposed. The elderly are affected frequently by acute cholecystitis (AC), for which appropriate antimicrobial therapy is particularly important. Also, cholecystectomy for elderly patients with co-morbidities is expectedly not as feasible as for uncomplicated young patients. Characteristics of hospital-acquired AC in the elderly patients were investigated in this study. METHODS: Records of patients over 65 years and older diagnosed with AC between March 2006 and February 2015 were reviewed retrospectively. Hospital-acquired AC was defined as development of AC in patients who were admitted for other disorders. Community-acquired AC was defined as presence of AC at the time of admission. Community-acquired AC group (CG) was used as a control group that was matched for age and sex with a ratio of 1:2. RESULTS: There were 40 patients in hospital-acquired AC group (HG) and 80 in CG. Demographics did not differ except higher prevalence of underlying illnesses in HG. Necessity to change initial antimicrobials for worsening conditions was more common in HG than in CG (20.0% vs. 2.5%, p < 0.01). Time to recovery was longer in HG (23.3 ± 5.6 days vs. 10.1 ± 0.7 days, p = 0.02). Rate of early cholecystectomy was lower (7.5% vs. 40.0%, p < 0.01) and that of open conversion was higher (20.0% vs. 6.3%, p = 0.02) in HG. CONCLUSIONS: For the elderly patients with hospital-acquired AC, antimicrobial and surgical management should be performed more meticulously since they showed distinct characteristics.
Aged* ; Cholecystectomy ; Cholecystitis, Acute* ; Cross Infection ; Demography ; Gallstones ; Humans ; Prevalence ; Retrospective Studies

PURPOSE: Hypertensive disorders of pregnancy increase morbidity and mortality of fetus and neonates. Recently some studies revealed that antihypertensive agents affected the neonatal outcomes. The aim of this study was to investigate the prognosis of preterm infants delivered from the mothers with hypertensive disorders who were treated with antihypertensive agents and magnesium sulfate. METHODS: This retrospective study was conducted on preterm infants who were delivered from normotensive mother (control, n=436) and antihypertensive drugs +/- magnesium sulfate treated mother (study, n=150) between January 2009 and December 2013. Study group were divided into two groups based on whether they received antihypertensive drugs only (n=110) and additional magnesium sulfate (n=40). We compared the characteristics of mothers and neonatal outcomes. RESULTS: Study group had shorter gestational age (32.2+/-3.5 weeks vs. 33.7+/-3.0 weeks, P=0.000) and lower birth weight (1,810.5 +/- 689.2 g, 2,212.1 +/- 604.9 g, P=0.000), and higher rate of small for gestational age infants (22% vs 11%, P=0.000). One minute and 5 minutes Apgar score were lower, but duration of hospital days, oxygen supplement and mechanical ventilation were longer in study group. Respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, retinopathy of prematurity, intraventricular hemorrhage occurred more in study group than control. The group treated with magnesium sulfate together with antihypertensive agent had lower 1 minute and 5 minutes Apgar score than the group taken antihypertensive agent only. CONCLUSIONS: Mothers with hypertensive disorders have increased the risk of preterm delivery, low birth weight, and high neonatal morbidity rate. Therefore it is important to predict and manage possible complication. Moreover, if magnesium sulfate is taken, careful neonatal monitoring is needed because of possible low Apgar score.
Antihypertensive Agents* ; Apgar Score ; Birth Weight ; Bronchopulmonary Dysplasia ; Ductus Arteriosus, Patent ; Fetus ; Gestational Age ; Hemorrhage ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature* ; Magnesium Sulfate ; Mortality ; Mothers* ; Oxygen ; Pregnancy* ; Prognosis ; Respiration, Artificial ; Retinopathy of Prematurity ; Retrospective Studies

BACKGROUND/AIMS: Transnasal esophagogastroduodenoscopy (T-EGD) has been reported to be well tolerated and is known to reduce patient discomfort that occurs with conventional EGD (C-EGD) performed via an oral route. We aimed to evaluate factors that influence preferences for T-EGD as a surveillance EGD in a general medical checkup. MATERIALS AND METHODS: A total of 658 subjects (median age, 49 years; 45% men) underwent T-EGD procedures by 8 endoscopists using a 5.2-mm diameter endoscope. All examinees and endoscopists were asked to assess the T-EGD examinations using the post-endoscopy questionnaire. The post-endoscopy questionnaire included a 10-point visual analogue scale, which asked the patient to place a cross on the line according to examinee's or endoscopist's experience of the endoscopy procedure. Zero represented the worst experience and 10 the best experience. RESULTS: T-EGD was feasible in 96.6% of the subjects. Younger age (<35 years) and female sex were significant predictive factors for failure of the procedure. Older age (> or =35 years) or male examines preferred T-EGD as the modality for the next examination. The endoscopist's overall discomfort level was higher in the beginner group than in the expert group. CONCLUSIONS: The T-EGD may be better tolerated than C-EGD and offers a more comfortable surveillance endoscopic procedure to older (> or =35 years), male, or sedated C-EGD-experienced examinees in a general medical checkup. More experience with and education about T-EGD may help to improve the tolerance of the beginner group of endoscopists.
Education ; Endoscopes ; Endoscopy* ; Endoscopy, Digestive System* ; Female ; Humans ; Male ; Personal Satisfaction ; Surveys and Questionnaires

A 37-year-old male patient presented with a fever, chills, and abdominal pain. The patient was diagnosed with Typhoid fever based on blood culture, but did not clinically respond to standard antibiotic (Ceftriaxone) therapy. On day 9, leptospira serology was positive and doxycycline was added to the treatment strategy. With combination therapy, the patient recovered from the infection. In most cases, similar clinical presentations make the diagnosis of concurrent infections of febrile diseases difficult, and serious complications can develop as a consequence of delayed treatment. As with this case, if the patient initially has serious a medical condition caused by complications, and does not clinically respond to initial standard antibiotics therapy or has an unusual course of disease, concurrent infection must be considered.
Abdominal Pain ; Adult ; Anti-Bacterial Agents ; Chills ; Doxycycline ; Fever ; Humans ; Leptospira ; Leptospirosis ; Male ; Salmonella Infections ; Typhoid Fever

A 28-year-old male was admitted to our medical center with general myalgia and fever. After a series of tests, he was diagnosed with P. vivax malaria. On the 5th hospital day, the patient complained of tingling sensation on both hands and feet, which acutely progressed to ascending symmetric motor paralysis. Nerve conduction velocity test and cerebrospinal fluid analysis showed albumino-cytologic dissociation, suggesting polyradiculopathy, and thus he was diagnosed with Guillain-Barre syndrome. After 5-day treatment with intravenous immunoglobulin, and antificial ventilator therapy the patient fully recovered. In the literature, only 22 cases of Guillain-Barre syndrome associated with Plasmodium have been reported; 19 cases were caused by Plasmodium falciparum and 3 were by P. vivax. Herein, we report the first case of Guillain-Barre Syndrome associated with P. vivax malaria in Korea.
Adult ; Dissociative Disorders ; Fever ; Foot ; Guillain-Barre Syndrome ; Hand ; Humans ; Immunoglobulins ; Korea ; Malaria ; Malaria, Vivax ; Male ; Neural Conduction ; Paralysis ; Plasmodium ; Plasmodium falciparum ; Plasmodium vivax ; Polyradiculopathy ; Sensation ; Ventilators, Mechanical