Journal of Yeungnam medical science最新文献

Ischemic monomelic neuropathy (IMN) is an uncommon complication of arteriovenous fistula (AVF) surgery that presents with pain, motor weakness, and sensory changes without critical ischemia. This report describes a rare case of successful IMN treatment after AVF surgery. A 61-year-old man with diabetic end-stage kidney disease was admitted for left brachiocephalic AVF surgery. Postoperatively, the patient complained of pain, motor weakness, and numbness in the left hand. However, the radial pulse remained palpable, and the overlying skin remained intact. A nerve conduction study above the wrist revealed reduced compound muscle action potential (CMAP) of the left ulnar nerve and no CMAP of the left median nerve. This study also showed the absence of sensory amplitude in both the left median and left ulnar nerves. Therefore, the patient was diagnosed with IMN. Proximalization of the arterial inflow surgery was performed to redistribute blood flow while maintaining the AVF. The patient's neurological symptoms resolved postoperatively. Various conditions can cause hand pain after AVF surgery; however, IMN has rarely been reported. A multidisciplinary approach is needed to avoid this rare complication in patients presenting with hand pain after AVF surgery.

Chronic myeloid leukemia (CML) typically progresses from a chronic phase to an accelerated phase, and eventually to a blast crisis, often involving the bone marrow and peripheral blood, if left untreated. Central nervous system (CNS) involvement is an uncommon manifestation of CML, particularly as an isolated CNS relapse. Here, we present a rare case of CML in lymphoid blast crisis with an isolated CNS relapse. A 46-year-old female with underlying CML in lymphoid blast crisis, previously treated with chemotherapy and tyrosine kinase inhibitors, presented with visual disturbances. Imaging and cerebrospinal fluid analysis confirmed leukemic infiltration of the CNS without evidence of a systemic disease. Isolated CNS involvement is an atypical complication of CML and presents significant therapeutic challenges owing to the blood-brain barrier, which limits the efficacy of systemic therapies. Subsequently, the patient was treated with intrathecal chemotherapy targeting the CNS. Despite aggressive treatment, CNS relapse remains a major concern due to the limited penetration of standard therapies into the CNS. This case underscores the importance of early recognition of CNS symptoms in CML patients, particularly in those with blast crisis, and highlights the need for tailored therapeutic strategies to manage this rare and challenging manifestation.

Hepatocellular carcinoma (HCC) is one of the most lethal malignancies worldwide, with poor prognosis owing to its high frequency of recurrence and metastasis. Moreover, most patients are diagnosed at an advanced stage owing to a lack of early detection markers. Exosomes, which are characterized by their cargos of stable intracellular messengers, such as DNA, RNA, proteins, and lipids, play a crucial role in regulating cell differentiation and HCC development. Recently, exosomal noncoding RNAs (ncRNAs), including microRNAs, long ncRNAs, and circular RNAs, have become increasingly important diagnostic, prognostic, and predictive markers of HCC. Herein, we discuss the clinical implications of exosomal ncRNAs, specifically those within the HCC regulatory network.

Background: Previous studies have demonstrated the inhibitory effect of hydrogen-rich water on biofilm formation. However, hydrogen-rich electrolyzed water (HEW) has not been evaluated as mouthwash, despite being economical, convenient, and biologically safe. We assessed the antibiofilm effects of HEW on Streptococcus mutans and its potential as a mouthwash.

Methods: The effect of HEW on S. mutans growth was assessed by measuring bacterial colony-forming units, and biofilm formation capacity was examined by crystal violet staining after culturing on a polystyrene plate. The effect of HEW on biofilm formation-related gene expression in S. mutans was assessed by real-time polymerase chain reaction. Finally, the effect of HEW on salivary S. mutans and plaque maturation was evaluated in 24 participants; after gargling with HEW twice daily, the salivary S. mutans count was quantified using a Caries Risk Test bacteria kit (Ivoclar Vivadent AG), and plaque maturation was compared using quantitative light-induced fluorescence imaging.

Results: Exposure to HEW resulted in no significant changes in S. mutans growth but a significant reduction in biofilm formation in vitro (p<0.001). Furthermore, the gene expression of glucosyltransferases (gtfB, gtfC) was significantly lower than that in the control group treated with tap water (p<0.05, p<0.01). S. mutans counts and plaque maturation were significantly lower in participants who gargled with HEW than in those who gargled with tap water (p<0.01).

Conclusion: Our data suggest that oral rinsing with HEW exerts antibiofilm effects on S. mutans, indicating that it can be used as a mouthwash to treat dental biofilm-dependent diseases.

Bronchial artery embolization (BAE) is an effective and minimally invasive procedure for managing massive or medically refractory hemoptysis. Despite its overall safety, BAE can be associated with complications, including nontarget embolization, with cerebral infarction being a rare but severe adverse event. We report a case of posterior circulation infarction, caused by unintended embolization of trisacryl gelatin microspheres via anastomosis between the left bronchial and left subclavian arteries, following BAE in a 45-year-old man with massive hemoptysis. After the BAE, the patient complained of nausea and vomiting. Magnetic resonance imaging (MRI) revealed multifocal bilateral posterior circulation infarctions. The patient was initially treated with aspirin. However, follow-up MRI the next day showed hemorrhagic transformation of the right thalamic infarct along with right lateral intraventricular hemorrhage. Consequently, aspirin was discontinued, and blood pressure was carefully managed. Seven days later, the patient's symptoms improved without any neurological sequelae. This case highlights the importance of superselective catheterization, meticulous angiographic assessment, and repeat angiography during embolization to minimize neurological complications. Anticoagulation therapy may be beneficial for the management of such complications.

Background: We aimed to evaluate the clinical efficacy of cervical epidural block (CEB) in enhancing upper extremity (UE) muscle strength in patients with cervical disc herniation (CDH).

Methods: Ten patients with CDH underwent a single CEB session. Follow-up assessments were conducted weekly for 2 weeks through outpatient visits. Handgrip strength on the affected side (AHGS) and the interlateral difference in handgrip strength (DHGS) between the affected and unaffected sides were measured using a dynamometer before, immediately after, 1 and 2 weeks after CEB. Neck pain and radiating UE pain were assessed using a visual analog scale (VAS) at baseline and 2 weeks posttreatment.

Results: The median patient age was 46.4 years (range, 35-78 years). The affected disc levels were C5-6 in five patients, C6-7 in three, and C5-6-7 in two. The left side was affected in six patients and the right in four. The mean VAS score for neck pain decreased from 7.2 to 2.9, whereas that for radiating UE pain decreased from 6.3 to 2.8 after treatment. Both the AHGS and DHGS improved significantly compared to the baseline values at all posttreatment times. However, no significant differences were observed among the posttreatment time points. These findings remained consistent even after adjusting for age and sex.

Conclusion: CEB may offer therapeutic benefits by alleviating pain and improving UE muscle weakness in patients with CDH. However, further large-scale prospective studies are required to validate these preliminary results and determine the long-term efficacy of CEB in managing CDH.

Background: Despite the increasing use of continuous glucose monitoring (CGM) systems, limited data exist on their perceived benefits and challenges among patients and healthcare providers. This study explored CGM-related experiences in South Korea.

Methods: An anonymous online survey was conducted between January and December 2021 at four university hospitals. Respondents included patients with diabetes mellitus (DM), physicians, and DM education nurses. The survey assessed the use of CGM, its benefits, and barriers. Most devices were first-generation CGMs: FreeStyle Libre 1 (Abbott Diabetes Care), Dexcom G6 (Dexcom Inc.), and Medtronic Guardian 3 (Medtronic MiniMed).

Results: Among 1,010 patients (33.4% with type 1 DM [T1DM], 63.6% with type 2 DM [T2DM], and 3.1% others; mean age, 51.4±14.6 years), 92.7% found CGM helpful. Although 59.6% reported discomfort, 81.9% intended to continue using CGM, indicating that perceived benefits outweighed barriers. The key advantages were glucose monitoring without finger pricks (T1DM, 57.9%; T2DM, 56.2%) and maintenance of target glucose levels. Discomfort was related to discomfort during activities (53.8%), skin problems (45.0%), and pain (43.0%). Healthcare provider recommendations were associated with reduced discomfort (adjusted odds ratio, 0.36; 95% confidence interval, 0.21-0.60). Physicians (n=29) cited high costs as the main barrier (T1DM, 58.9%; T2DM, 64.8%); only 51.9% and 14.5% prescribed CGM for T1DM and T2DM, respectively. Insulin adjustment and glucose control were the main reasons for prescription, while cost (89.3%) and limited consultation time (67.9%) were barriers. DM educators (n=9) reported heavy workloads, with training and follow-up times averaging 31.7±7.5 minutes and 21.7±9.7 minutes, respectively; 77.8% of DM educators identified frequent patient inquiries as their greatest burden.

Conclusion: CGM provides significant clinical benefits but is limited by discomfort, costs, and educational burden. Sustained adoption requires device improvements, insurance support, and workforce expansion.

Accurate measurement of the foot contact area is crucial for diagnosing pes planus (flatfoot) and pes cavus (high arch), which significantly affect pressure distribution across the plantar surface. This study aimed to develop a program using ChatGPT-4 to automate foot contact area measurements using a podoscope, thereby enhancing diagnostic precision. A 53-year-old female volunteer stood on a podoscope to capture images of her feet, which were processed to isolate the foot contours and measure the contact areas. A program developed utilizing ChatCPT-4 was designed to outline the feet, detect contact areas, and calculate their sizes and ratios. The results demonstrated clear visualization of foot contours with automated calculation of the contact area and its ratio to the total foot area. The entire foot area measured 1,091,381.00 pixels, with a contact area of 604,252.50 pixels. The ratio of the ground contact area to the entire foot area was calculated as 55.37%. This method, which employs advanced image-processing techniques powered by ChatGPT-4, demonstrates the potential for integrating artificial intelligence into clinical applications. This approach could improve diagnostic precision and patient outcomes through personalized treatment strategies.

Well-differentiated hepatocellular lesions (WDHLs) are liver tumors or nonneoplastic lesions in which the cells closely resemble normal hepatocytes. These lesions often include focal nodular hyperplasia, hepatocellular adenoma, macroregenerative nodule, dysplastic nodule, and well-differentiated hepatocellular carcinoma. The diagnosis of these lesions remains challenging because of their morphological similarities, particularly when examined using needle biopsy. The accurate diagnosis of WDHLs is crucial for patient management and prognosis. This review addresses the histopathological characteristics and diagnostic approaches of WDHLs.