Purpose: To differentiate a non-cancer-related temporary increase in prostate-specific antigen (PSA) triggering unnecessary biopsy, we intentionally delayed biopsy with a serial follow-up, then investigated the efficacy of this strategy in identifying a significant prostate cancer (PCa). Materials and Methods: Retrospective data of patients who initially presented with a suspicious level of serum PSA (3–20 ng/mL), managed using the delayed strategy, and then eventually underwent biopsy were obtained from 4 tertiary centers between 2018–2020. Results: The collected 271 subjects had a median (interquartile range) PSA, age, and prostate volume of 5.03 ng/mL (4.46–7.79 ng/mL), 67 years (61–73 years), and 38 g (28–50 g), respectively. During the delay period of 8 weeks (4–19 weeks), most were managed with alpha-blockers (85.6%, n=232). Ninety-four (34.7%) experienced a PSA decrease of 20.53% (8.82–38.16). Eventual biopsy revealed 115 PCa cases (42.5%) including 82 significant ones and 46 high-risk diseases. Men with a PSA decrease had a lower probability of PCa (31.9% vs. 48%, p=0.014), a significant disease (21.3% vs. 35.0%, p=0.026), and high-risk PCa (7.4% vs. 22.0%, p=0.002) than the PSA-elevated counterparts. However, the degree of PSA decrease was not associated with the presence or the severity of PCa. In patients with PSA normalization (≤3 ng/mL), though 4 patients of them (66%) had PCa including a single significant disease, none had high-risk disease. Conclusions About one-third of individuals initially indicated for transrectal biopsy experienced a decrease in PSA, and their chance for significant PCa was diminished. This retrospective study suggests PSA normalization could be an acceptable notion, though requires further investigation.

Objectives: Little is known about the platforms and functionalities of mobile-based personal health record (PHR) applications. The objective of this study was to investigate these two features of PHR systems. Methods: The unit of analysis was general hospitals with more than 100 beds. This study was based on a PHR survey conducted from May 1 to June 30, 2020 and the National Health Insurance administrative data as of March 31, 2020. The study considered the platform, Android and iPhone operation system (iOS), and types of functionalities of PHR systems. Among the 316 target hospitals, 103 hospitals had adopted PHR systems. A logistic regression analysis was used. Results: This study found that 103 hospitals had adopted mobile-based PHR systems for their patients. Sixty-four hospitals (62.1%) were adopting both Android and iOS, but 36 (35.0%) and 3 (2.9%) hospitals were adopting Android only or iOS only, respectively. The PHR systems of hospitals adopting both platforms were more likely to have functions for viewing prescriptions, clinical diagnostic test results, and upcoming appointment status compared to those adopting a single platform (p < 0.001). The number of beds (odds ratio [OR] = 1.004; confidence interval [CI], 1.001–1.007; p = 0.0029) and the number of computed tomography systems (CTs) per 100 beds (OR = 6.350; CI, 1.006–40.084; p = 0.0493) were significantly associated with the adoption of both platforms. Conclusions More than 60% of hospitals had adopted both Android and iOS platforms for their patients in Korea. Hospitals adopting both platforms had additional functionalities and significant association with the number of beds and CTs.

Objective: : The purpose of this study is identify the operation status of the neurosurgical care units (NCUs) in neurosurgical residency training hospitals nationwide and determine needed changes by comparing findings with those obtained from the Korean Neurosurgical Society (KNS) and Korean Society of Neurointensive Care Medicine (KNIC) survey of 2010.Method : This survey was conducted over 1 year in 86 neurosurgical residency training hospitals and two neurosurgery specialist hospitals and focused on the following areas : 1) the current status of the infrastructure and operating systems of NCUs in Korea, 2) barriers to installing neurointensivist team systems, 3) future roles of the KNS and KNIC, and 4) a handbook for physicians and practitioners in NCUs. We compared and analyzed the results of this survey with those from a KNIC survey of 2010. Results: : Seventy seven hospitals (87.5%) participated in the survey. Nineteen hospitals (24.7%) employed a neurointensivist or faculty member; Thirty seven hospitals (48.1%) reported high demand for neurointensivists, and 62 hospitals (80.5%) stated that the mandatory deployment of a neurointensivist improved the quality of patient care. Forty four hospitals (57.1%) believed that hiring neurointensivist would increase hospital costs, and in response to a question on potential earnings declines. In terms of potential solutions to these problems, 70 respondents (90.9%) maintained that additional fees were necessary for neurointensivists’ work, and 64 (83.1%) answered that direct support was needed of the personnel expenses for neurointensivists. Conclusion : We hope the results of this survey will guide successful implementation of neurointensivist systems across Korea.

Objectives: This study analyzed the diagnostic and therapeutic usefulness of selective nerve root block (SNRB) in patients with spinal stenosis who show inconsistencies between magnetic resonance imaging (MRI) and clinical findings (e.g., dermatomes).Summary of Literature Review: MRI is known to be highly accurate for diagnosing spinal stenosis, but few studies have investigated the diagnostic accuracy of MRI for spinal canal stenosis. In addition, the most suitable treatment of patients with inconsistent clinical and MRI findings has not been established. Methods: This single-center, retrospective cohort study was conducted among 93 patients treated between January 2013 and December 2018, who underwent at least two SNRBs for single-level spinal stenosis on MRI with clinical discrepancies. Seventeen patients who were diagnosed with other causes of pain (e.g., spondylolisthesis, sacroiliac joint dysfunction, lower leg arterial occlusion) were excluded. The first SNRB targeted the lesion found on MRI. One week later, patients were assessed using a visual analog scale (VAS) and a second procedure was performed on the dermatome-indicated level if there was no improvement. VAS scores were also obtained 3 months after the procedure. Results: In total, 45 patients had central stenosis and 31 patients had foraminal stenosis. The average VAS score before the SNRB was 7.4±1.4. After the first procedure, the average VAS score was 5.2±2.6. After the second procedure, the average VAS score was 2.4±1.3, and after 3 months, it was 3.6±1.9. Of the patients with foraminal stenosis, 77.4% did not respond to the first block (based on MRI), but responded well to the second procedure (based on clinical symptoms) (p<0.05). Conclusions SNRB targeting the level corresponding to clinical symptoms may be useful for locating the symptomatic nerve root and providing pain relief in patients with foraminal stenosis on MRI with discordant clinical findings.

Over the past few decades, interest in minimally invasive spine surgery (MISS) has increased tremendously due to its core principle of minimizing approach-related injury while providing outcomes similar to traditional open spine procedures. With technical and technological advancements, MISS has expanded its utility not only to simple spinal stenosis, but also to complex spinal pathologies such as metastasis, trauma, or adult spinal deformity. In this article, we review the techniques and technology in MISS and discuss the indications, benefits, and limitations of MISS.

OBJECTIVE: This study investigates the role of a burr hole and calvarial bone marrow-derived stem cells (BMSCs) in a transient ischemic brain injury model in the rat and postulates a possible mechanism for the efficacy of multiple cranial burr hole (MCBH) surgery in moyamoya disease (MMD). METHODS: Twenty Sprague-Dawley rats (250 g, male) were divided into four groups : normal control group (n=5), burr hole group (n=5), ischemia group (n=5), and ischemia+burr hole group (n=5). Focal ischemia was induced by the transient middle cerebral artery occlusion (MCAO). At one week after the ischemic injury, a 2 mm-sized cranial burr hole with small cortical incision was made on the ipsilateral (left) parietal area. Bromodeoxyuridine (BrdU, 50 mg/kg) was injected intraperitoneally, 2 times a day for 6 days after the burr hole trephination. At one week after the burr hole trephination, brains were harvested. Immunohistochemical stainings for BrdU, CD34, VEGF, and Doublecortin and Nestin were done. RESULTS: In the ischemia+burr hole group, BrdU (+), CD34 (+), and Doublecortin (+) cells were found in the cortical incision site below the burr hole. A number of cells with Nestin (+) or VEGF (+) were found in the cerebral parenchyma around the cortical incision site. In the other groups, BrdU (+), CD34 (+), Doublecortin (+), and Nestin (+) cells were not detected in the corresponding area. These findings suggest that BrdU (+) and CD34 (+) cells are bone marrow-derived stem cells, which may be derived from the calvarial bone marrow through the burr hole. The existence of CD34 (+) and VEGF (+) cells indicates increased angiogenesis, while the existence of Doublecortin (+), Nestin (+) cells indicates increased neurogenesis. CONCLUSION: Based on these findings, the BMSCs through burr holes seem to play an important role for the therapeutic effect of the MCBH surgery in MMD.
Animals ; Bone Marrow ; Brain Injuries ; Brain* ; Bromodeoxyuridine ; Infarction, Middle Cerebral Artery ; Ischemia ; Moyamoya Disease* ; Nestin ; Neurogenesis ; Rabeprazole ; Rats* ; Rats, Sprague-Dawley ; Stem Cells* ; Trephining ; Vascular Endothelial Growth Factor A

PURPOSE: This study was conducted in order to evaluate effect and efficiency of selective spinal nerve root block for neuropathic pain patients with lower leg radiating pain. MATERIALS AND METHODS: A total of 113 patients were evaluated and follow-up periods were a minimum of 12 months. They were divided into two groups: group A included 41 patients with neuropathic pain and group B included 72 patients with simple lower leg radiating pain. RESULTS: Fourteen (34.1%) patients in group A and 45 (62.5%) patients in group B had favorable results for selective spinal nerve block (p<0.05). Visual analog scale (VAS) was improved from 7.57 to 5.23 at 12 months in group A and from 7.11 to 3.49 at 12 months in group B. CONCLUSION: The initial treatment period for group A was significantly later than in group B. For patients with neuropathic pain and radiculopathy, early assessment was recommended and early selective spinal nerve block could be a good treatment option for neuropathic pain patients.
Follow-Up Studies ; Humans ; Leg ; Neuralgia* ; Radiculopathy* ; Spinal Nerve Roots* ; Spinal Nerves ; Visual Analog Scale

PURPOSE: To analyze serum markers in proximal femur fracture patients, which are known to be accompanied with osteophorosis or metabolic diseases, and consider it as predictive factor and to study how it affects on the fracture form. MATERIALS AND METHODS: Vit. D3 known as serum marker of Vit. D, 25(OH)D, and 1,25(OH)2D of 152 patients from April, 2013 to March, 2014 who visited our hospital and diagnosed as proximal femur fracture(Femur neck fracture 73, Intertrochanteric fracture 79) were analyzed. Also, serum calcium level corrected by serum protein, phosphate, creatinine, alkaline phosphatase, estradiol, IGF-1, and PTH were compared and analyzed. RESULTS: Femur neck fracture group showed significantly low value of D3, 25(OH)D, and 1,25(OH)2D (P-value<0.05) as the values were 37.72+/-7.21 pg/mL, 27.05+/-8.43 ng/mL, 25.05+/-6.78 pg/mL in femur neck fracture group, and 40.36+/-6.97 pg/mL, 29.54+/-9.12 ng/mL, 28.87+/-7.43 pg/mL in intertrochanteric fracture group respectively. The number of patients who were diagnosed as hypovitaminosis D. due to serum 25(OH)D value lower than 30ng/ml were significantly high in femur neck fracture group as the numbers were 56 in femur neck fracture, and 44 in intertrochanteric fracture. Serum calcium level corrected by serum protein, phosphate, creatinine, alkaline phosphatase, estradiol, IGF-1 and PTH level showed no significant difference between two groups. CONCLUSION: Serum 25(OH)D level was decreased in proximal femur fracture patiens, and was lower as the patient was older and BMD was lower. Therefore it is thought that proximal femur fracture is affected by vitamin D metabolism.
Alkaline Phosphatase ; Biomarkers ; Calcium ; Creatinine ; Estradiol ; Femoral Neck Fractures ; Femur ; Humans ; Insulin-Like Growth Factor I ; Metabolic Diseases ; Metabolism ; Neck ; Vitamin D

Aluminum nanoparticles (Al-NPs) are one of the most widely used nanomaterial in cosmetics and medical materials. For this reason, Al-NP exposure is very likely to occur via inhalation in the environment and the workplace. Nevertheless, little is known about the mechanism of Al-NP neurotoxicity via inhalation exposure. In this study, we investigated the effect AL-NPs on the brain. Rats were exposed to Al-NPs by nasal instillation at 1 mg/kg body weight (low exposure group), 20 mg/kg body weight (moderate exposure group), and 40 mg/kg body weight (high exposure group), for a total of 3 times, with a 24-hr interval after each exposure. Inductively coupled plasma mass spectrometry (ICP-MS) analysis indicated that the presence of aluminum was increased in a dose-dependent manner in the olfactory bulb (OFB) and the brain. In microarray analysis, the regulation of mitogen-activated protein kinases (MAPK) activity (GO: 0043405), including Ptprc, P2rx7, Map2k4, Trib3, Trib1, and Fgd4 was significantly over-expressed in the treated mice than in the controls (p = 0.0027). Moreover, Al-NPs induced the activation of ERK1 and p38 MAPK protein expression in the brain, but did not alter the protein expression of JNK, when compared to the control. These data demonstrate that the nasal exposure of Al-NPs can permeate the brain via the olfactory bulb and modulate the gene and protein expression of MAPK and its activity.
Aluminum* ; Animals ; Body Weight ; Brain* ; Inhalation ; Inhalation Exposure ; Mass Spectrometry ; Mice ; Microarray Analysis ; Mitogen-Activated Protein Kinases ; Nanoparticles* ; Nanostructures ; Olfactory Bulb ; p38 Mitogen-Activated Protein Kinases ; Plasma ; Rats*