Acute post-cardiopulmonary bypass left atrial thrombosis after mitral valvuloplasty and left atrial thrombectomy

A patient with mitral stenosis and multiple left atrial thrombi underwent valvuloplasty and thrombectomy. While closing the sternum after completing the cardiopulmonary bypass, a new left atrial thrombus was detected by transesophageal echocardiography. We used heparin for the prevention of new thrombus formation and closed the wound after meticulous bleeding control. Three months later, there was no residual thrombus in the left atrium according to the echocardiographic study

Simultaneous Aortic and Tricuspid Valve Endocarditis due to Complication of Sinus of Valsalva Rupture

We experienced a case of ruptured aneurysm of the sinus of Valsalva, and this resulted in simultaneous aortic and tricuspid valve endocarditis through a shunt. The echocardiography showed a ruptured sinus of Valsalva aneurysm to the right atrium with a shunt. The aortic non-coronary cusp was fibro-thickened with vegetation. Vegetations of the septal leaflet and the anterior leaflet of the tricuspid valve were also found. The blood culture grew Enterococcus garllinarum. We replaced both tricuspid and aortic valve with successful surgical result

Idh2

Acrolein is known to be involved in acute lung injury and other pulmonary diseases. A number of studies have suggested that acrolein-induced toxic effects are associated with depletion of antioxidants, such as reduced glutathione and protein thiols, and production of reactive oxygen species. Mitochondrial NADP+-dependent isocitrate dehydrogenase (idh2) regulates mitochondrial redox balance and reduces oxidative stress-induced cell injury via generation of NADPH. Therefore, we evaluated the role of idh2 in acrolein-induced lung injury using idh2 short hairpin RNA- (shRNA-) transfected Lewis lung carcinoma (LLC) cells and idh2-deficient (idh2−/−) mice. Downregulation of idh2 expression increased susceptibility to acrolein via induction of apoptotic cell death due to elevated mitochondrial oxidative stress. Idh2 deficiency also promoted acrolein-induced lung injury in idh2 knockout mice through the disruption of mitochondrial redox status. In addition, acrolein-induced toxicity in idh2 shRNA-transfected LLC cells and in idh2 knockout mice was ameliorated by the antioxidant, N-acetylcysteine, through attenuation of oxidative stress resulting from idh2 deficiency. In conclusion, idh2 deficiency leads to mitochondrial redox environment deterioration, which causes acrolein-mediated apoptosis of LLC cells and acrolein-induced lung injury in idh2−/− mice. The present study supports the central role of idh2 deficiency in inducing oxidative stress resulting from acrolein-induced disruption of mitochondrial redox status in the lung

Induction FOLFIRINOX followed by stereotactic body radiation therapy in locally advanced pancreatic cancer

IntroductionFOLFIRINOX (the combination of 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) is the preferred systemic regimen for locally advanced pancreatic cancer (LAPC). Furthermore, stereotactic body radiation therapy (SBRT) is a promising treatment option for achieving local control in these patients. However, clinical outcomes in patients with LAPC treated using FOLFIRINOX followed by SBRT have not been clarified. Therefore, we aimed to evaluate clinical outcomes of induction FOLFIRINOX treatment followed by SBRT in patients with LAPC.MethodsTo this end, we retrospectively reviewed the medical records of patients with LAPC treated with induction FOLFIRINOX followed by SBRT in a single tertiary hospital. We evaluated overall survival (OS), progression-free survival (PFS), resection rate, SBRT-related adverse events, and prognostic factors affecting survival.ResultsFifty patients were treated with induction FOLFIRINOX for a median of 8 cycles (range: 3–28), which was followed by SBRT. The median OS and PFS were 26.4 (95% confidence interval [CI]: 22.4–30.3) and 16.7 months (95% CI: 13.0–20.3), respectively. Nine patients underwent conversion surgery (eight achieved R0) and showed better OS than those who did not (not reached vs. 24.1 months, p = 0.022). During a follow-up period of 23.6 months, three cases of grade 3 gastrointestinal bleeding at the pseudoaneurysm site were noted, which were managed successfully. Analysis of the factors affecting clinical outcomes revealed that a high radiation dose (≥ 35 Gy) resulted in a higher rate of conversion surgery (25% [8/32] vs. 5.6% [1/18], respectively) and was an independent favorable prognostic factor for OS in the adjusted analysis (hazard ratio: 2.024, 95% CI: 1.042–3.930, p = 0.037).ConclusionOur findings suggest that induction FOLFIRINOX followed by SBRT in patients with LAPC results in better survival with manageable toxicities. A high total SBRT dose was associated with a high rate of conversion surgery and could afford better survival

The Pilot Survey of the Perception on the Practice Pattern, Diagnosis, and Treatment on Korean Medicine Insomnia: Focusing on the Difference between Korean Medical Neuropsychiatry Specialists and Korean Medical General Practitioners

Introduction. This study aims to investigate the clinical practice states on the diagnosis and treatment for insomnia between Korean medical general practitioners (KMGPs) and Korean medical neuropsychiatry specialists (KMNPSs). Methods. We distributed questionnaires via email or in person to 1,017 KMGPs and via email to 165 KMNPSs. We collected and analyzed responses from 305 (30.00%) KMGPs and 53 (32.12%) KMNPSs. Results. Most KMGPs and KMNPSs responded that the number of new patients visiting the clinic for treatment of insomnia was less than 10 per month (78.2%). Frequently utilized therapies for insomnia are acupuncture and herbal decoctions. Particularly acupoint GV20 and Guipi decoction were chosen with the highest response rate. There was no difference between KMNPSs and KMGPs in the traditional Korean medical diagnosis methods. However, KMNPSs utilized more various methods to diagnose, treat, and evaluate insomnia and educated more actively sleep hygiene compared to KMGPs. Conclusions. This survey showed how insomnia is currently diagnosed and treated in Korean medical care settings. Moreover, we identified some differences between KMNPSs and KMGPs. Further research is required to explore the underlying reasons for these discrepancies among KMDs and to improve the quality of Korean medical clinical practice in treating insomnia

A Guidance and Control Law Design for Precision Automatic Take-off and Landing of Fixed-Wing UAVs

This paper presents an automatic take-off and landing control system (ATOLS) for fixed-wing UAVs. We propose a guidance and control system to satisfy the requirement for high-precision landing using arresting wires. For trajectory tracking, Line-of-Sight (LOS)-based longitudinal and lateral guidance laws are derived. For the design of inner loop controllers, linear models are identified directly from the flight data. In order to maintain the consistency of the control performance in the presence of flight regime changes during take-off and landing, the linear baseline controller is augmented with a compensator designed using L 1 adaptive control theory, which eliminates the need for conventional gain scheduling. The proposed control system is implemented on a scale Cessna UAV with an arresting hook for validation. The proposed take-off and landing system demonstrated a consistent performance in a series of test flight on a full-scale carrier model

Recurrent Uterine Cervical Carcinoma: Spectrum of Imaging Findings

Uterine cervical carcinoma is one of the most common malignant tumors occurring in females. After primary treatment, patients are usually followed up with CT or MRI and the findings of these modalities may be the first sign of recurrent disease. Because earlier additional treatment by chemotherapy or radiation therapy may improve the prognosis, the early detection of recurrent cervical carcinoma is clinically important. In this article, we review the CT and MR imaging findings of recurrent uterine cervical carcinoma, and assign them to one of four groups: a) recurrence at the primary site, involving the intrapelvic organs, b) extension to the pelvic side-wall, c) metastases to pelvic and extrapelvic lymph nodes, or d) metastases to distant organs. A further contribution of CT and MR imaging is the detection of hydronephrosis due to ureteral obstruction. The cases in each group are illustrated and discussed, and since an awareness of the spectrum of imaging findings of recurrent cervical carcinoma is likely to lead to its early detection, radiologists should be familiar with the information presented

How Does Chronic Back Pain Influence Quality of Life in Koreans: A Cross-Sectional Study

Study DesignA cross-sectional study.PurposeTo explore the impact of chronic low back pain (CLBP) on individuals' quality of life; to understand current treatment practices and level of satisfaction with treatment in patients with CLBP.Overview of LiteratureAssessing subjective, patient-reported outcomes such as quality of life is essential to health care research.MethodsInfluences of the CLBP were analyzed via a questionnaire, which contained the character of CLBP, effect of pain management, Korean version Oswestry Disability Index (K-ODI) and Korean version of 12-item Short Form Health Survey (SF-12v2).ResultsOf 3,121 subjects who responded, 67.3% had moderate to severe pain; 43.5% presented prolonged CLBP of more than two years; and 32.4% had suffered from sleep disturbance due to pain. 22.8% of the patients were not satisfied with current pain management. The mean K-ODI score was 37.63; and it was positively correlated with the mean pain intensity (r=0.6, p<0.001). The SF-12v2 result was negatively correlated with mean pain intensity (PCS: r=-0.5, p<0.001; MCS: r=-0.4, p<0.001) and also negatively correlated with the K-ODI score (PCS: r=-0.75, p<0.001; MCS: r=-0.5, p<0.001). The conformity between patients and doctors in pain assessment was fair (κ=0.2463).ConclusionsCLBP negatively affects quality of life. Of total 22.8% of the patients were not satisfied with current pain management. Such needs to be taken more seriously by doctors for improvement of satisfaction and quality of life in patients with CLBP

The Relationship between Subjective and Objective Parameters in CT Phantom Image Evaluation

Objective: To evaluate whether there is a relationship between subjective parameters determined by a reviewer (spatial resolution, low contrast resolution, and artifacts) and objective parameters (the CT number of water, noise, and image uniformity) in CT phantom image evaluations. Materials and Methods: We reviewed the CT results of phantom image evaluations conducted by Korean Institute for Accreditation of Medical Image (KIAMI) from May 2007 to June 2007. We compared the objective parameters against the pass or fail groups for the subjective parameters. We also evaluated whether there is a relationship between the artifact types and the other subjective parameters. Results: The mean noise value was significantly higher in the fail groups for the subjective parameters compared to the pass groups (p = 0.006). Specifically, noise and low contrast resolution were found to have a statistically significant positive correlation (r = 0. 183, p < 0.001). In the fail group for low contrast resolution, the failure due to artifacts was significantly higher than the pass group (p < 0.001). In contrast, no statistically significant differences were found for the mean CT number of water, noise, or image uniformity based on the types of artifacts. Conclusion: Subjective CT image parameters evaluated by a reviewer correlate with objectively measured parameters, especially noise. Therefore, a stricter noise standard might be able to improve the subjective parameters results, such as low contrast resolution.Park HJ, 2008, KOREAN J RADIOL, V9, P354, DOI 10.3348/kjr.2008.9.4.354IM TH, 2007, 1 KIAMI, P1*KIAMI DEP ED, 2006, WORKSH EX QUAL ASS P, P141*FLUK CORP, 2005, NUCL ASS 76 410 4130*KIAMI DEP ED, 2005, WORKSH EX QUAL ASS P, P13McCollough CH, 2004, MED PHYS, V31, P2423, DOI 10.1118/1.1769632MCCOLLOUGH CM, 2000, CATEGORICAL COURSE D, P189WIL R, 1998, CT IMAGE QUALITYEUCLID S, 1994, COMPUT TOMOGR, P174BETHESDA MD, 1988, 99 NCRPJUDY PF, 1977, 1 AAPM*ACR, CT ACCR PROGR REQ