Tuberculosis (TB) of the genitourinary system is a rare form of extrapulmonary TB. Testicular TB is particularly uncommon among kidney transplantation (KT) recipients. Diagnosing testicular TB is challenging due to the nonspecific nature of clinical presentations and ambiguous imaging results. In this report, we describe a case involving a 36-year-old male KT recipient who presented with left scrotal pain. He had undergone a living donor KT 8 years prior and was receiving tacrolimus, mycophenolate mofetil, and prednisolone. Laboratory tests revealed anemia, leukocytosis, and elevated inflammatory markers. Computed tomography showed left scrotal wall thickening and enlargement, suggestive of a left testicular abscess. We discontinued mycophenolate mofetil and administered intravenous antibiotics. Additionally, we performed an incision and drainage of the abscess. However, there was no improvement in his clinical course. Consequently, we performed a radical left orchiectomy. The biopsy revealed extensive chronic granulomatous inflammation with caseous necrosis, consistent with tuberculous orchiepididymitis. A quadruple anti-TB regimen was administered, leading to an improvement in the patient's condition. To the best of our knowledge, this is the first reported case of testicular TB without other organ involvement in KT recipients. Including testicular TB in the differential diagnosis of testicular infections and masses is necessary to avoid unnecessary surgical procedures.

Cytomegalovirus (CMV) is the most important opportunistic viral pathogen in solid organ transplant (SOT) recipients.The Korean guideline for the prevention of CMV infection in SOT recipients was developed jointly by the Korean Society for Infectious Diseases and the Korean Society of Transplantation. CMV serostatus of both donors and recipients should be screened before transplantation to best assess the risk of CMV infection after SOT. Seronegative recipients receiving organs from seropositive donors face the highest risk, followed by seropositive recipients. Either antiviral prophylaxis or preemptive therapy can be used to prevent CMV infection. While both strategies have been demonstrated to prevent CMV infection post-transplant, each has its own advantages and disadvantages. CMV serostatus, transplant organ, other risk factors, and practical issues should be considered for the selection of preventive measures. There is no universal viral load threshold to guide treatment in preemptive therapy. Each institution should define and validate its own threshold.Valganciclovir is the favored agent for both prophylaxis and preemptive therapy. The evaluation of CMV-specific cellmediated immunity and the monitoring of viral load kinetics are gaining interest, but there was insufficient evidence to issue recommendations. Specific considerations on pediatric transplant recipients are included.

Fast spin echo (FSE) in magnetic resonance imaging has long been a main workhorse in clinical routines due to its versatile image contrast and robustness in improving magnetic field inhomogeneities. Nevertheless, the conventional high flip angle strategy limits its imaging efficiency, including high energy deposition to subjects, prolonged imaging time due to a necessarily short echo train, and substantial signal modulation along the echo train. Particularly, achieving high resolution T1-weighted imaging within a reasonable imaging time is challenging due to a very short echo train. In this review, we introduce T1-optimized single-slab 3D FSE imaging with variable refocusing flip angles as a promising solution to the above problems with its clinical applications. We provide a general description of a single-slab 3D pulse sequence and introduce its T1-optimized version with the required configuration of radio frequency and gradient pulses. Subsequently, the T1-weighted single-slab 3D FSE is investigated for signal evolution along the echo train, image contrasts, and flow sensitivity. Given the characteristics of high T1-weighted contrast and flow sensitivity, we demonstrate the clinical application of the single-slab 3D FSE, including high resolution structural imaging, as an alternative to conventional magnetization prepared spoiled gradient echo, highly tumor-targeted contrast-enhanced imaging for efficient detection of small metastases, and high-resolution vessel wall imaging for stroke diagnosis.

Single-slab three-dimensional (3D) fast spin echo (FSE) imaging with very long echo trains and its variants are used for producing clinical T 2-weighted image contrast. Singleslab 3D FSE imaging with variable refocusing flip angle management strategies permit very long echo trains and, thus, can highly enhance 3D encoding efficiencies. For the flexible control of imaging slabs, both nonselective and selective types of T 2-weighted single-slab 3D FSE imaging are described in this review. For clinical applications requiring high lesion sensitivity, the single-slab 3D FSE can be modified to accommodate phasesensitive dual acquisition to enable the attenuation of cerebrospinal fluid (CSF) signals without using conventional long inversion recovery. This approach can be further extended to suppress both CSF and white matter signals for high resolution gray matter-only imaging. Lastly, the single-slab 3D gradient and spin echo (GRASE), which incorporates multiple echoes with phase encoding blips between neighboring refocusing pulses in single-slab 3D FSE imaging, is presented as an effective means for minimizing energy deposition on human tissues and enhancing imaging efficiency. Chemical shift encoding can be applied with single-slab 3D GRASE imaging to efficiently differentiate between fat and water in the presence of magnetic field inhomogeneities.

Basiliximab (BSX) and antithymocyte globulins (ATGs), are two major immunosuppressive agents commonly used as induction therapy for kidney transplant (KT) recipients. The superiority of ATG over BSX has not been well established, especially in elderly KT recipients with low immunological risk. Methods: A total of 847 elderly (≥60 years old), low-risk KT patients in the Korean Organ Transplantation Registry were propensity score-matched at a 1:2 ratio and compared according to ATG or BSX induction therapy. The primary outcome was patient and graft survival and biopsy-proven acute cellular rejection. The secondary outcome was graft function, BK virus nephropathy, infection, cancer, new-onset diabetes mellitus after transplantation (NODAT), and delayed graft function. Results: In total, 165 patients in the ATG group were matched with 298 patients in the BSX group with average ages of 64.3 and 64.2 years, respectively. During a follow-up of 28.5 ± 10.4 months, the cumulative probabilities of death-censored graft failure at 3 years posttransplantation were 1.3% and 1.4% in ATG and BSX groups, respectively, without a significant difference (p = 0.72). The cumulative probability of NODAT at 3 years posttransplantation was significantly higher in the BSX group (35.6% vs. 21.6%, p = 0.02). The median tacrolimus trough level was significantly lower at 6 months after KT in the ATG group (5.7 ng/mL vs. 6.4 ng/mL, p = 0.001). There were no differences in the other evaluated outcomes. Conclusion: Compared with BSX, in elderly, low-risk KT patients, ATG reduced tacrolimus and steroid requirements without differences in all-cause mortality, rejection, or infection, resulting in a reduced NODAT incidence.

Recent several reports have demonstrated that periodontitis is prevalent and adversely affects the survival in patients with chronic kidney disease (CKD) or end-stage kidney disease. However, its impact on transplant outcomes remains uncertain. Methods: This retrospective cohort study included 136 and 167 patients, respectively, who underwent living donor kidney transplantation (KT) at Seoul National University Hospital from July 2012 to August 2016 and Korea University Hospital from April 2008 to October 2018. We divided patients into three groups according to stages of periodontitis based on a new classification system. Results: Patients with severe periodontitis were older, had a higher prevalence of diabetes, a higher body mass index and C-reactive protein level, a lower cardiac output, and were more likely to be smokers, indicating its association with chronic systemic inflammation. After KT, stage IV periodontitis was independently associated with a lower incidence of acute T cell-mediated rejection, suggesting the possible effect of periodontitis on immune function. However, 1-year and 3-year estimated glomerular filtration rates were not different. Among the KT recipients followed up more than 3 years, new-onset cardiovascular disease occurred in nine patients, and coronary artery disease occurred more frequently in patients with stage IV periodontitis. However, diabetes was the independent predictor of new-onset coronary artery disease in multivariate logistic regression analysis. Conclusion: Our findings showed that periodontitis might be an important player in determining posttransplant outcomes in recipients. Further interventional trials to test whether treating periodontitis could modify transplant outcome are needed.

On 11 February, 2020, the World Health Organization announced that COVID-19 was a novel coronavirus disease first detected in Wuhan, Hubei Province, China. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The complete clinical picture is not fully known. Illness ranges from mild to fatal. The common symptoms include fever, cough, and dyspnea usually developing 2-14 days after exposure. However, diarrhea was present in a few patients with COVID-19. We report a case of COVID-19 mimicking acute colitis.

On 11 February, 2020, the World Health Organization announced that COVID-19 was a novel coronavirus disease first detected in Wuhan, Hubei Province, China. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The complete clinical picture is not fully known. Illness ranges from mild to fatal. The common symptoms include fever, cough, and dyspnea usually developing 2-14 days after exposure. However, diarrhea was present in a few patients with COVID-19. We report a case of COVID-19 mimicking acute colitis.

BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is a rare but near-fatal complication of peritoneal dialysis (PD). Despite the high mortality rate of EPS, the surgical treatment strategy of severe EPS is yet to be established.METHODS: We retrospectively analyzed outcomes of patients with EPS who underwent enterolysis for intractable EPS at Seoul National University Hospital between 2001 and 2018. EPS was diagnosed based on the clinical symptoms and radiological findings of abdominal computed tomography (CT). CT scans were scored according to an EPS scoring system that assessed peritoneal thickening and calcification as well as bowel thickening, tethering, loculation, and dilatation.RESULTS: Thirteen patients (nine males and four females; age, 48 [29–63] years) underwent enterolysis for severe EPS. PD duration (11 [6–21] years) was not associated with survival. Two patients were newly diagnosed with EPS following kidney transplantation. Five patients died of infectious complications immediately after the surgery. Eight patients survived after the first surgery; however, five of them underwent reoperation but died of persistent infection, fistula formation, or adhesive bowel obstruction. Four young (< 60 years) male patients with relatively low CT scan scores (< 13) survived for > 2 years after the first surgery. Median survival duration from EPS diagnosis was 22 (1.3–184) months and that from the first surgery was 9 (0.3–153) months.CONCLUSION: The high mortality rate of EPS suggests the importance of appropriate surgical intervention in young symptomatic male EPS patients with relatively low CT scan scores.
Adhesives ; Diagnosis ; Dilatation ; Female ; Fistula ; Humans ; Kidney Transplantation ; Korea ; Male ; Mortality ; Peritoneal Dialysis ; Peritoneal Fibrosis ; Reoperation ; Retrospective Studies ; Seoul ; Tomography, X-Ray Computed

OBJECTIVES: This research was conducted to identify the consumers' food choice factors that affect the consumers' replacement of soft drinks with carbonated water. METHODS: The present study used secondary data from a consumer panel survey conducted by the Rural Development Administration of Korea, and the data included the panel members' purchase records based on their monthly spending receipts. The survey asked the participants about their food choice factors and their personal responsibility for their health. This survey included independent variables for the consumers' food purchase factors. As a dependent variable, two types of groups were defined. The replacement group included those people who increased their purchase of carbonated water and decreased their purchase of soft drinks. The non-replacement group included those people who did not change their purchase patterns or they increased their purchase of soft drinks and they decreased their purchase of carbonated water. Logistic regression analysis was conducted to determine the consumers' food choice factors that were associated with replacing soft drinks with carbonated water. RESULTS: The replacement group was significantly associated with (1) a younger age (OR=0.953), (2) being a housewife (OR=2.03), (3) higher income (OR=1.001) and (4) less concern about price (OR=0.819) when purchasing food. This group also showed (5) higher enjoyment (OR=1.328) when choosing food and (6) they took greater responsibly for their personal health (OR=1.233). CONCLUSIONS: This research is the first study to mainly focus on soft drinks and carbonated water. The result of this research showed that young, health-conscious consumers with a higher income and who are more interested in food have more possibilities to replace soft drinks with carbonated water. These research findings may be applied to consumers who have characteristics that are similar to the young health-conscious consumers and the results can help to suggest ways to reduce sugar intake and improve public health. However, this research has a limitation due to the application of secondary data. Therefore, a future study is needed to develop detailed survey questions about food choice factors and to extend these factors to all beverages, including soft drinks made with sugar substitutes, so as to reflect the growth of alternative industries that use artificial sweeteners or different types of sugar to make commercially available drinks.
Beverages ; Carbon ; Carbonated Beverages ; Carbonated Water ; Consumer Behavior ; Humans ; Korea ; Logistic Models ; Public Health ; Social Planning ; Sweetening Agents