Background/Aims: The protective effects of vitamin D and calcium on colorectal neoplasms are known. Bone mineral density (BMD) may be a reliable biomarker that reflects the long-term anticancer effect of vitamin D and calcium. This study aimed to evaluate the association between BMD and colorectal adenomas including high-risk adenoma. Methods: A multicenter, cross-sectional, case-control study was conducted among participants with average risk of colorectal cancer who underwent BMD and screening colonoscopy between 2015 and 2019. The main outcome was the detection of colorectal neoplasms. The variable under consideration was low BMD (osteopenia/osteoporosis). The logistic regression model included baseline demographics, components of metabolic syndrome, fatty liver disease status, and aspirin and multivitamin use. Results: A total of 2,109 subjects were enrolled. The mean age was 52.1±10.8 years and 42.6% were male. The adenoma detection rate was 43%. Colorectal adenoma and high-risk adenoma were both more prevalent in subjects with low BMD than those with normal BMD (48.2% vs 38.8% and 12.1% vs 9.1%). In the univariate analysis, old age, male sex, smoking, metabolic components, fatty liver, and osteoporosis were significantly associated with the risk of adenoma and high-risk adenoma. In the multivariate analysis, osteoporosis was independently associated with risk of colorectal adenoma (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.11 to 2.46; p=0.014) and high-risk adenoma (OR, 1.94; 95% CI, 1.14 to 3.29; p=0.014). Conclusions Osteoporosis is an independent risk factor of colorectal adenoma and high-risk adenoma

Refractory status asthmaticus represents the most severe clinical presentations of asthma, and it is typically associated with the presence of hypoxemia, hypercapnia, lactic acidosis, dynamic hyperventilation and altered state of consciousness. Several case reports have demonstrated extracorporeal membrane oxygenation (ECMO) as an alternative treatment method for patients with status asthmaticus that failed to respond to maximal conventional therapy. We experienced a case of pregnant woman with severe asthma attack not relieved by conventional treatment, in whom early administration of ECMO resulted in a good outcome. A 23-year-old woman at, 11 weeks of pregnancy, was admitted with acute asthma attack. Despite maximal rescue therapies with mechanical ventilation, her condition gradually deteriorated. Venovenous ECMO was initiated 4 hours from intubation and gas exchange with lung mechanics was rapidly recovered within hours. She was extubated 45 hours after initiation of ECMO and had successful weaning from ECMO 2 days after extubation. The patient had no complication and gave birth to a healthy baby at 37 weeks of gestation. This is the first case report in Korea on the successful use of ECMO in a pregnant woman with severe respiratory insufficiency due to status asthmaticus, who failed to respond to mechanical ventilation and maximum pharmacological treatment. Early ECMO application is a useful treatment option for patients with refractory status asthmaticus refractory to conventional therapy.

The brachial plexus palsy is a rare complication of a clavicle fracture, occurring in 0.5% to 9.0% of cases. This condition is caused by excessive callus formation, which can be recovered by a spur resection and surgical fixation. In contrast, only seven cases have been reported after surgical reduction and fixation. A case of progressive brachial plexus palsy was observed after fixation of the displaced nonunion of a clavicle fracture. The symptom were improved after removing the implant.
Bony Callus ; Brachial Plexus Neuropathies ; Brachial Plexus ; Clavicle ; Paralysis ; Thoracic Outlet Syndrome

PURPOSE: With the emergence of next-generation sequencing (NGS) technology, profiling a wide range of genomic alterations has become a possibility resulting in improved implementation of targeted cancer therapy. In Asian populations, the prevalence and spectrum of clinically actionable genetic alterations has not yet been determined because of a lack of studies examining high-throughput cancer genomic data. MATERIALS AND METHODS: To address this issue, 1,071 tumor samples were collected from five major cancer institutes in Korea and analyzed using targeted NGS at a centralized laboratory. Samples were either fresh frozen or formalin-fixed, paraffin embedded (FFPE) and the quality and yield of extracted genomic DNA was assessed. In order to estimate the effect of sample condition on the quality of sequencing results, tissue preparation method, specimen type (resected or biopsied) and tissue storage time were compared. RESULTS: We detected 7,360 non-synonymous point mutations, 1,164 small insertions and deletions, 3,173 copy number alterations, and 462 structural variants. Fifty-four percent of tumors had one or more clinically relevant genetic mutation. The distribution of actionable variants was variable among different genes. Fresh frozen tissues, surgically resected specimens, and recently obtained specimens generated superior sequencing results over FFPE tissues, biopsied specimens, and tissues with long storage duration. CONCLUSION: In order to overcome, challenges involved in bringing NGS testing into routine clinical use, a centralized laboratory model was designed that could improve the NGS workflows, provide appropriate turnaround times and control costs with goal of enabling precision medicine.
Academies and Institutes ; Asian Continental Ancestry Group ; DNA ; Humans ; Korea ; Methods ; Paraffin ; Point Mutation ; Precision Medicine ; Prevalence

Primitive neuroectodermal tumor (PNET) arising primarily in the lung is an extremely rare and aggressive malignancy with poor chances of patient survival. We present a case of long-term survival by a 29-year-old woman with PNET diagnosed after a hertological and immunohertochemical examination of a biopsy specimen obtained by performing video-assisted thoracic surgery. The patient underwent a left lower lung lobe lobectomy and 6 cycles of adjuvant chemotherapy. The patient has been free of any symptoms of the recurrence of the disease for 6 years after treatment completion.
Adult ; Biopsy ; Chemotherapy, Adjuvant ; Female ; Humans ; Lung* ; Neuroectodermal Tumors, Primitive* ; Recurrence ; Sarcoma, Ewing ; Thoracic Surgery, Video-Assisted

BACKGROUND: Although phenotypic heterogeneity of psoriasis is suggested by the alternate activation of either T-helper (Th)1-related or Th17-related cytokines, little is known about the mRNA levels of inflammatory cytokines. OBJECTIVE: To investigate whether there is differential expression of Th1-related and Th17-related inflammatory cytokine genes 1) between psoriatic patients and healthy controls, and 2) between patients with different psoriasis phenotypes. METHODS: Twenty-five patients with psoriasis (10 with guttate psoriasis and 15 with plaque psoriasis) and 5 healthy volunteers were enrolled in this study. The mRNA levels of circulating cytokines (interleukin [IL]-2, IL-12p40, interferon-γ, IL-17A, IL-22, and IL-23R) were measured by real-time reverse transcription polymerase chain reaction. RESULTS: The comparison between psoriatic and healthy control samples revealed that IL-12p40, IL-17A, and IL-22 mRNA levels were significantly higher (approximately 4∼6 folds) in the patients with psoriasis. The mRNA levels of these six cytokines in the blood did not differ between the guttate and plaque psoriasis groups. CONCLUSION: We found that the mRNA levels of blood inflammatory cytokines (IL-12p40, IL-17A, and IL-22) were significantly elevated in patients with psoriasis compared to the levels in healthy controls, but they did not significantly differ between patients with guttate and plaque type psoriasis.
Cytokines* ; Gene Expression* ; Healthy Volunteers ; Humans ; Interleukin-12 Subunit p40 ; Interleukin-17 ; Phenotype ; Polymerase Chain Reaction ; Population Characteristics ; Psoriasis ; Reverse Transcription ; RNA, Messenger

Protein losing enteropathy (PLE) due to systemic lupus erythematosus (SLE) is relatively uncommon. PLE may be appeared sequentially after the diagnosis of SLE or concurrently with SLE. In most of concurrent cases, PLE was diagnosed one of various symptoms of SLE. Cases of PLE as the initial and only clinical presentation of SLE have been rarely reported. We described a 30-year old woman with general edema and abdominal distension was diagnosed PLE after stool alpha 1 antitrypsin clearance test. Her symptoms were getting worse even though the treatment with intravenous albumin. She was finally diagnosed PLE associated with SLE by additional laboratory findings (positive antinuclear antibody and anti-dsDNA IgG and low C3, C4 and CH50). She was treated with high dose of steroids and her symptoms were improved.
alpha 1-Antitrypsin ; Antibodies, Antinuclear ; Diagnosis ; Edema ; Female ; Humans ; Immunoglobulin G ; Lupus Erythematosus, Systemic* ; Protein-Losing Enteropathies* ; Steroids

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging disease caused by the SFTS virus (family Bunyaviridae, genus Phlebovirus). A 77-year-old female farmer was bitten by a tick and developed a fever 5 days later, resulting in admittance to the emergency room. The laboratory findings showed elevated liver enzyme levels, thrombocytopenia, and leukopenia. Lymphoma was suspected based on computed tomography results. After confirming SFTS virus infection via the polymerase chain reaction, a bone marrow biopsy revealed hemophagocytic lymphohistiocytosis (HLH). HLH is rarely observed in patients with SFTS and few studies have reported the presence of SFTS in bone marrow. Here, we report a case of SFTS that was initially mistaken for a lymphoma, and was accompanied by HLH.
Aged ; Biopsy ; Bone Marrow ; Bunyaviridae ; Emergency Service, Hospital ; Farmers ; Female ; Fever* ; Humans ; Leukopenia ; Liver ; Lymphohistiocytosis, Hemophagocytic* ; Lymphoma ; Polymerase Chain Reaction ; Thrombocytopenia* ; Ticks

Using the Korean public health insurance database, we analyzed patients diagnosed as benign prostatic hyperplasia (BPH) from 2004 to 2008. Age and year-specific amount and seasonal variation of hospital visits (HV), duration of treatment (DT), the total and per capita amount of insurance payment (TAIP, PCIP) were evaluated. A total of 12,088,995 HV were studied. Total HV increased 1.7 times and DT almost doubled in 2008 compared to those in 2004. HV, DT, and TAIP showed linearly increasing patterns year by year. In a time series analysis, HV increased in winter and demonstrated seasonality in a 12-month cycle. In a Poisson regression analysis, the annual variations of HV, DT, TAIP, and PCIP were different by age groups. In patients older than 40 yr, HV significantly increased 1.10-1.16 times compared to that of the previous year. DT markedly increased in their 60s and 80s patients. The rate of increase in PCIP was steeper in patients 50 yr and older than in the others.Health care utilization due to BPH was rapidly increasing in Korea and it was remarkable in the elderly population. Seasonal variation of HV demonstrated that health care utilization increased in winter.
Adult ; Aged ; Aged, 80 and over ; Cost of Illness ; Health Care Costs ; Humans ; Insurance, Health/*economics/statistics & numerical data ; Male ; Middle Aged ; Patient Acceptance of Health Care/*statistics & numerical data ; Prostatic Hyperplasia/*economics/*epidemiology/therapy ; Republic of Korea/epidemiology ; Retrospective Studies ; Seasons ; Young Adult

Using the Korean public health insurance database, we analyzed patients diagnosed as benign prostatic hyperplasia (BPH) from 2004 to 2008. Age and year-specific amount and seasonal variation of hospital visits (HV), duration of treatment (DT), the total and per capita amount of insurance payment (TAIP, PCIP) were evaluated. A total of 12,088,995 HV were studied. Total HV increased 1.7 times and DT almost doubled in 2008 compared to those in 2004. HV, DT, and TAIP showed linearly increasing patterns year by year. In a time series analysis, HV increased in winter and demonstrated seasonality in a 12-month cycle. In a Poisson regression analysis, the annual variations of HV, DT, TAIP, and PCIP were different by age groups. In patients older than 40 yr, HV significantly increased 1.10-1.16 times compared to that of the previous year. DT markedly increased in their 60s and 80s patients. The rate of increase in PCIP was steeper in patients 50 yr and older than in the others.Health care utilization due to BPH was rapidly increasing in Korea and it was remarkable in the elderly population. Seasonal variation of HV demonstrated that health care utilization increased in winter.
Adult ; Aged ; Aged, 80 and over ; Cost of Illness ; Health Care Costs ; Humans ; Insurance, Health/*economics/statistics & numerical data ; Male ; Middle Aged ; Patient Acceptance of Health Care/*statistics & numerical data ; Prostatic Hyperplasia/*economics/*epidemiology/therapy ; Republic of Korea/epidemiology ; Retrospective Studies ; Seasons ; Young Adult