Background/Aims: The risk for colonoscopic postpolypec-tomy bleeding (PPB) in patients with chronic liver disease (CLD) remains unclear. We determined the incidence and risk factors for colonoscopic PPB in patients with CLD, espe-cially those with liver cirrhosis. Methods: We retrospectively reviewed the medical records of patients with CLD who un-derwent colonoscopic polypectomy at Seoul National Univer-sity Hospital between 2011 and 2014. The study endpoints were immediate and delayed PPB. Results: A total of 1,267 consecutive patients with CLD were included in the study. Im-mediate PPB occurred significantly more often in the ChildPugh (CP) B or C cirrhosis group (17.5%) than in the CP-A (6.3%) and chronic hepatitis (4.6%) groups (p<0.001). More-over, the incidence of delayed PPB in the CP-B or C cirrhosis group (4.4%) was significantly higher than that in the CP-A (0.7%) and chronic hepatitis (0.2%) groups (p<0.001). The independent risk factors for immediate PPB were CP-B or C cirrhosis (p=0.011), a platelet count <50,000/μL (p<0.001), 3 or more polyps (p=0.017), endoscopic mucosal resection or submucosal dissection (p<0.001), and polypectomy per-formed by trainees (p<0.001). The independent risk factors for delayed PPB were CP-B or C cirrhosis (p=0.009), and pol-yps >10 mm in size (p=0.010). Conclusions Patients with CP-B or C cirrhosis had an increased risk for bleeding fol-lowing colonoscopic polypectomy.

STUDY DESIGN: A noninterventional, multicenter, cross-sectional study. PURPOSE: We investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: Among patients with CLBP, 20%–55% had NP. METHODS: Patients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4 < 4) groups. RESULTS: A total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%–43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; p < 0.01), in patients who had pain based on radiological and neurological findings (59.0%; p < 0.01), and in patients who had severe pain (49.0%; p < 0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; p < 0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; p < 0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (β=−0.1; p < 0.01) and higher QBPDS (β=7.0; p < 0.01) scores than those without NP. CONCLUSIONS: NP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.
Adult* ; Back Pain ; Cross-Sectional Studies ; Diagnosis ; Hospitals, General ; Humans ; Linear Models ; Low Back Pain* ; Male ; Neuralgia* ; Prevalence* ; Quality of Life ; Visual Analog Scale

Destruction of dopaminergic neurons in the substantia nigra pars compacta (SNpc) is a common pathophysiology of Parkinson's disease (PD). Characteristics of PD patients include bradykinesia, muscle rigidity, tremor at rest and disturbances in balance. For about four decades, PD animal models have been produced by toxin-induced or gene-modified techniques. However, in mice, none of the gene-modified models showed all 4 major criteria of PD. Moreover, distinguishing between PD model pigs and normal pigs has not been well established. Therefore, we planned to produce a pig model for PD by chronic subcutaneous administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), neurotoxin. Changes in behavioral patterns of pigs were thoroughly evaluated and a new motor scoring system was established for this porcine model that was based on the Unified Parkinson's Disease Rating Scale (UPDRS) in human PD patients. In summary, this motor scoring system could be helpful to analyze the porcine PD model and to confirm the pathology prior to further examinations, such as positron emission tomography-computed tomography (PET-CT), which is expensive, and invasive immunohistochemistry (IHC) of the brain.
1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine* ; Animals ; Brain ; Dopaminergic Neurons ; Electrons ; Humans ; Hypokinesia ; Immunohistochemistry ; Injections, Subcutaneous* ; Mice ; Models, Animal ; Muscle Rigidity ; Parkinson Disease* ; Pathology ; Substantia Nigra ; Swine ; Tremor

Acute esophageal necrosis is a rare clinical entity characterized by the endoscopic finding of extensive black discoloration of the esophageal mucosa. Acute esophageal necrosis in a patient with diabetic ketoacidosis has rarely been reported. We report a case of acute esophageal necrosis in a patient with diabetic ketoacidosis. The patient had coffee ground emesis and, after an esophagogastroduodenoscopy with mucosal biopsy, acute esophageal necrosis was diagnosed. The patient was treated conservatively with an intravenous proton pump inhibitor and oral sucralfate without any complications.
Biopsy ; Coffee ; Diabetes Mellitus ; Diabetic Ketoacidosis ; Endoscopy, Digestive System ; Esophagus ; Humans ; Mucous Membrane ; Necrosis ; Proton Pumps ; Sucralfate ; Vomiting

MicroRNAs (miRNAs) are recently discovered small RNA molecules usually resulting in translational repression and gene silencing. Despite the fact that specific cloning of small RNA's is a method in practice, computational identification of miRNA's has been a major focus recent days, since is a rapid process following AB initio and sequence alignment methods. Here we developed new software called MiRPI that aims to identify the highly conserved miRNAs without any mismatches from given fasta formatted gene sequences by using non-repeated miRNA dataset of the user's interest. The new window embedded with the software is used to identify the targets for inputted mature miRNAs in the mRNA sequences. Also MiRPI is designed to measure the precursor miRNA statistics, majorly focusing the Adjusted Minimum Folding free Energy (AMFE) and Minimum Folding free Energy Index (MFEI), the most important parameters in miRNA confirmation. MiRPI is developed by PERL (Practical Extraction and Report Language) and Tk (Tool kit widgets) scripting languages. It is user friendly, portable offline software that works in all windows OS, sized to 3 MB.
Clone Cells ; Cloning, Organism ; Gene Silencing ; MicroRNAs ; Repression, Psychology ; RNA ; RNA, Messenger ; Sequence Alignment

Rectus sheath hematoma (RSH) is a rare condition that's caused by a sudden disruption of the deep epigastric vessels or direct damage to the rectus abdominis muscle. This condition is associated with old age, childbirth, abdominal surgery, severe cough, severe sneezing, anticoagulation therapy and/or coagulation disorders. RSH is characterized by abdominal pain and an abdominal mass, so that this is often misdiagnosed as a surgical condition such as appendicitis, intraabdominal abscess, torsion of the ovary and ruptured abdominal aortic aneurysm; this can lead to unnecessary surgery. Thus, we have to be cautious not to miss RSH when a patient with predisposing factors is suffered from abdominal pain and an abdominal mass. We report here on a case of rectus sheath hematoma that was induced by severe cough in a patient who was taking warfarin.
Abdominal Pain ; Abscess ; Appendicitis ; Cough ; Female ; Hematoma ; Humans ; Muscles ; Ovary ; Parturition ; Rectus Abdominis ; Sneezing ; Unnecessary Procedures ; Warfarin

Intraoperative monitoring has been a valuable part in the cerebral aneurysm surgery. Insight into the nervous system and the relationship of the aneurysm to the adjacent structure during the surgery provide critical information to the surgeon allowing reversal or avoidance of neural insults and the complete clipping of the aneurysm. The goal of cerebral aneurysm surgery is to eliminate the risk of hemorrhage but not disrupt the surrounding vascular and neural structures. Several techniques including microvascular doppler ultrasonography, monitoring cerebral blood flow, evoked potentials, intraoperative angiography, endoscope assisted aneurysm surgery and neuronavigator system are used for the surveillance in the aneurysm surgery. The abnormal findings in these procedures can change surgical management during the surgery such as removal or readjustment of temporary or permanent clips and a decrease in brain retraction or manipulation. The additional feedback provided by intraoperative monitoring promises to improve the safety and efficacy of aneurysm surgery.
Aneurysm ; Angiography ; Brain ; Endoscopes ; Evoked Potentials ; Hemorrhage ; Intracranial Aneurysm* ; Monitoring, Intraoperative ; Nervous System ; Ultrasonography, Doppler

PURPOSE: We describe a 54-year-old woman with systemic lupus erythematosus (SLE) who suddenly presented with chorea and had positive antiphospholipid antibodies. F-18 FDG PET showed abnormally increased glucose metabolism in bilateral putamen and primary motor cotex. Tc-99m ECD SPECT also showed abnormally increased regional cerebral blood flow in bilateral putamen. She was treated with corticosteroid and aspirin after which the symptoms improved. Four months later, follow up F-18 FDG PET showed improvement with resolution of hypermetabolism in bilateral putamen. This case suggests that striatal hypermetabolism is associated with chorea in SLE.
Antibodies, Antiphospholipid ; Aspirin ; Chorea* ; Female ; Follow-Up Studies ; Glucose ; Humans ; Lupus Erythematosus, Systemic* ; Metabolism ; Middle Aged ; Putamen ; Tomography, Emission-Computed, Single-Photon

As the number of elderly people increases, the incidence of stroke, especially the hemorrhagic stroke, is increasing. A large-scale survey of the entire country pertaining to the incidence and demographic characteristics of hemorrhagic stroke in elderly is necessary. Through information garnered from a basic survey and clinical study, we must design a treatment program to reduce the mortality of elderly people through elucidating the specific properties of stroke pathophysiology.
Aged* ; Humans ; Incidence* ; Mortality ; Stroke*

Vertebral artery injury is a rare complication of anterior cervical approach. We report two patients who suffered injury to vertebral artery during anterior cervical spine surgery. The mechanism of injury, their operative management, and the subsequent outcome were assessed and relevant literatures reviewed. The awareness of the possibility of vertebral artery injury is most important to prevent and it's occurrence is best avoided by a thorough understanding of the anatomical relationships of the artery, the spinal canal, and the vertebral body and careful use of surgical instruments.
Arteries ; Humans ; Spinal Canal ; Spine* ; Surgical Instruments ; Vertebral Artery*