Publications by authors named "Jae-Myung Kim"

69 Publications

Uncommon cause of trigeminal neuritis and central nervous system involvement by herpes labialis: a case report.

BMC Neurol 2022 Aug 5;22(1):294. Epub 2022 Aug 5.

Department of Neurology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 58128, South Korea.

Background: Trigeminal neuropathy is characterized by numbness in the region innervated by the trigeminal nerves, with or without neuropathic weakness in the muscles of mastication. Trigeminal neuritis is a form of trigeminal neuropathy in which the lesion is caused by an inflammation. Herein, we report a patient with trigeminal neuritis due to central nervous system (CNS) involvement of herpes labialis (HL) infection, which was successfully treated with anti-viral and anti-inflammatory agents.

Case Presentation: A young healthy female presented with numbness in the left hemiface for two weeks. She had a preceding typical HL infection on left facial lip one week before the sensory symptom onset. Brain magnetic resonance imaging revealed high signal intensities and asymmetrical thickening with enhancement along the cisternal segment of the left trigeminal nerve. Additionally, brain MR angiography showed multifocal stenoses in the M1 segment of the middle cerebral artery and the cavernous portion of the internal carotid artery. Cerebrospinal fluid (CSF) examination showed mild pleocytosis with normal protein level, glucose ratio, but CSF polymerase chain reaction assay for specific anti-viral antibodies including herpes simplex virus was negative, and CSF culture also did not identify a specific pathogen. The results of serologic testing including tumor markers and autoimmune markers were all unremarkable. A tentative diagnosis of trigeminal neuritis as a complication of HL involving the CNS was made considering the clinical, neuroradiological, and laboratory findings of the patient. Therefore, the patient was treated with intravenous methylprednisolone and acyclovir for 10 days. After the treatments, her sensory disturbance was markedly improved. Brain MRI at the 3-month follow-up also demonstrated improvement of previously identified high signal intensity lesions and multifocal intracerebral artery stenoses.

Conclusion: HL is usually a self-limiting, benign disease without complications, but rarely presents as trigeminal neuritis due to CNS involvement. Therefore, meticulous evaluation may be necessary if trigeminal neuritis or CNS involving symptoms occur after HL.
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http://dx.doi.org/10.1186/s12883-022-02823-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354343PMC
August 2022

Mucoepidermoid carcinoma of the breast: A case report and literature review focused on radiological findings.

Medicine (Baltimore) 2022 Jul 1;101(26):e29745. Epub 2022 Jul 1.

Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.

Rationale: Mucoepidermoid carcinoma (MEC) of the breast is a rare entity, with an estimated incidence of only 0.2% to 0.3% of all primary breast tumors. The radiological features of breast MEC have scarcely been investigated mainly because of its rarity. In this article, we present a case of breast MEC diagnosed at our hospital and review the literature, focusing on radiological findings and radiologic-pathologic correlations that could improve clinical management of this entity. To the best of our knowledge, our study is the first review of the literature that focuses on the radiological features of breast MEC.

Patient Concerns: A 47-year-old premenopausal woman presented with a painless palpable mass in the right breast.

Diagnosis: Mammography and ultrasonography revealed a mass with suspicious malignant features, which was categorized as Breast Imaging Reporting and Data System category 4c. A 14-gauge core-needle biopsy revealed an intermediate-grade MEC of the breast. The patient underwent breast magnetic resonance imaging and chest computed tomography for preoperative evaluation. Postoperative histopathological examination confirmed a diagnosis of intermediate-grade MEC. The clinical staging was T2N0M0.

Interventions: The patient underwent breast-conserving surgery, adjuvant chemotherapy, radiotherapy, and hormonal therapy.

Outcomes: No evidence of recurrence has been reported over 37 months.

Lessons: The imaging characteristics of breast MEC were variable, and there were no specific radiological features for diagnosis. The presence of cystic components on radiological imaging is likely to be an indicator of a low-grade tumor and better prognosis, although the number of reported cases is limited.
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http://dx.doi.org/10.1097/MD.0000000000029745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239627PMC
July 2022

Enhanced detection and serotyping of foot-and-mouth disease virus serotype O, A, and Asia1 using a novel multiplex real-time RT-PCR.

Transbound Emerg Dis 2022 May 25. Epub 2022 May 25.

Foot-and-Mouth-Disease Research Division, Animal and Plant Quarantine Agency, Gimcheon-si, Gyeongsangbuk-do, Republic of Korea.

Rapid and accurate detection and serotyping of foot-and-mouth disease (FMD) virus (FMDV) is essential for implementing control policies against emergent FMD outbreaks. Current serotyping assays, such as VP1 reverse transcription-polymerase chain reaction (RT-PCR)/sequencing (VP1 RT-PCR/sequencing) and antigen detection enzyme-linked immunosorbent assay (ELISA), have problems with increasing serotyping failure of FMDVs from FMD outbreaks. This study was conducted to develop a multiplex real-time RT-PCR for specific detection and differential serotyping of FMDV serotype O, A, and Asia 1 directly from field clinical samples. Primers and probes were designed based on 571 VP1 coding region sequences originated from seven pools. Multiplex real-time RT-PCR using these primers and probes demonstrated serotype-specific detection with enhanced sensitivity compared to VP1 RT-PCR/sequencing for reference FMDV (n = 24). Complete serotyping conformity between the developed multiplex real-time RT-PCR and previous VP1 RT-PCR/sequencing was demonstrated using FMDV field viruses (n = 113) prepared in cell culture. For FMDV field clinical samples (n = 55), the serotyping rates of multiplex real-time RT-PCR and VP1 RT-PCR/sequencing were 92.7% (51/55) and 72.7% (40/55), respectively. Moreover, the developed multiplex real-time RT-PCR demonstrated improved FMDV detection (up to 33.3%) and serotyping (up to 67.7%) capabilities for saliva samples when compared with 3D real-time RT-PCR and VP1 RT-PCR/sequencing, during 10 days of challenge infection with FMDV serotype O, A, and Asia 1. Collectively, this study suggests that the newly developed multiplex real-time RT-PCR assay may be useful for the detection and differential serotyping of FMDV serotype O, A, and Asia 1 in the field.
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http://dx.doi.org/10.1111/tbed.14603DOI Listing
May 2022

Comparison of the Oncological Outcomes of Open versus Laparoscopic Surgery for T2 Gallbladder Cancer: A Propensity-Score-Matched Analysis.

J Clin Med 2022 May 8;11(9). Epub 2022 May 8.

Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea.

Although laparoscopic treatment for T1 gallbladder cancer (GBC) has been described previously, the differences in oncologic outcomes between laparoscopic and conventional open surgery for T2 GBC have not been investigated. We aimed to assess the role of laparoscopic surgery using retrospectively collected data for 81 patients with T2 GBC who underwent surgical resection between January 2010 and December 2017. Eligible patients were classified into "laparoscopic" and "open" groups. Propensity-score matching was performed in a 1:1 ratio. The effects of surgery type on surgical and oncological outcomes were investigated. After propensity-score matching, 19 patients were included in the open and laparoscopic surgery groups. The median follow-up durations were 70 and 26 months in the open and laparoscopic groups, respectively. The operative time (316.8 ± 80.3 vs. 218.9 ± 145.0 min, = 0.016) and length of postoperative hospital stay (14.4 ± 6.0 vs. 8.4 ± 5.9 days, = 0.004) were significantly shorter in the laparoscopic group. The three-year overall (86.3% vs. 88.9%, = 0.660) and disease-free (76.4% vs. 60.2%, = 0.448) survival rates were similar between the groups. Propensity-score matching showed that laparoscopic surgery for T2 GBC yielded similar long-term oncological outcomes and favorable short-term outcomes in comparison with open surgery. Laparoscopic treatment should be considered in patients with T2 GBC.
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http://dx.doi.org/10.3390/jcm11092644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9099510PMC
May 2022

Septic cavernous sinus thrombosis after minor head trauma: A case report.

Medicine (Baltimore) 2022 Mar 11;101(10):e29057. Epub 2022 Mar 11.

Department of Neurology, Chonnam National University Medical School & Hospital, Gwangju, South Korea.

Rationale: Septic cavernous sinus thrombosis (SCST) is a rare but life-threatening condition that commonly arises from infections, including paranasal sinusitis, otitis media, and skin infection. Meanwhile, head trauma as a predisposing factor of SCST has been scarcely reported. We report a case of SCST complicated by meningitis after minor head trauma, even in the absence of identifiable fractures.

Patient Concerns And Diagnosis: A 77-year-old female presented with diplopia combined with ocular pain and headache lasting a week. She had a recent blunt head trauma 2 weeks before the diplopia onset. The trauma was not accompanied by identifiable skull fractures, bleeding, or loss of consciousness. Neurological examination revealed incomplete ptosis, eyelid swelling, and medial and vertical gaze limitations of both eyes. Gadolinium-enhanced brain magnetic resonance imaging demonstrated multifocal thrombotic filling defects, including those of the cavernous sinus, sinusitis involving the sphenoid and ethmoid sinuses, and otomastoiditis. The cerebrospinal fluid assay result was compatible with bacterial meningitis. A tentative diagnosis of SCST complicated by bacterial meningitis and multifocal cerebral venous thrombosis was made based on clinical, laboratory, and neuroradiologic findings.

Intervention: Intravenous triple antibiotic therapy (vancomycin, ceftriaxone, and ampicillin) for 2 weeks combined with methylprednisolone (1 g/d for 5 days) was administered. Despite the initial treatment, carotid-cavernous fistula was newly developed during hospitalization. Therefore, coil embolization was performed successfully for the treatment of carotid-cavernous fistula.

Outcomes: The symptoms of the patient including diplopia gradually improved during the 8-month follow-up period.

Lessons: Minor head trauma is a rare but possible cause of SCST. Early recognition and prompt treatment are essential for improving outcomes. Moreover, close observation is warranted, even if apparent serious complications were absent during initial evaluations in minor head trauma.
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http://dx.doi.org/10.1097/MD.0000000000029057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8913101PMC
March 2022

Update on the medial longitudinal fasciculus syndrome.

Neurol Sci 2022 Jun 8;43(6):3533-3540. Epub 2022 Mar 8.

Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea.

The medial longitudinal fasciculus is a key structure for conjugate horizontal eye movements by relaying signals from the abducens internuclear neurons to the medial rectus subdivision of the contralateral oculomotor nucleus. Thus, lesions involving the medial longitudinal fasciculus give rise to a typical neuro-ophthalmological sign, the internuclear ophthalmoplegia, which is characterized by impaired adduction of the ipsilesional eye and dissociated abducting nystagmus of the contralateral eye during attempted contralesional horizontal gaze. In addition, medial longitudinal fasciculus lesions may produce various other ocular motor abnormalities since the medial longitudinal fasciculus also conveys the signals for the control of the vestibulo-ocular reflex and smooth pursuit. Other possible ocular motor abnormalities include spontaneous vertical-torsional nystagmus, contraversive ocular tilt reaction, and impaired vestibulo-ocular reflex, especially for the contralesional posterior canal. Recognition of the ocular motor findings observed in the medial longitudinal fasciculus syndrome would aid in detection and localization of potentially grave lesions involving the brainstem.
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http://dx.doi.org/10.1007/s10072-022-05967-3DOI Listing
June 2022

Is it really post-irradiation morphea or oleoma of the breast?-A case report and literature review.

Gland Surg 2021 Dec;10(12):3424-3430

Department of Pathology, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea.

We report the case of a 65-year-old woman who underwent breast-conserving surgery (BCS) and radiotherapy for breast cancer with hyperpigmentation and skin thickening of the treated breast site 10 years after the surgery. The patient was injected with a liquid foreign body in both breasts 30 years ago. Theses clinical features were considered scleroderma, post-irradiation morphea (PIM), and recurrent breast cancer for differential diagnosis. We performed breast magnetic resonance imaging (MRI), however, the patient had no abnormal findings. Owing to the pain, increased hyperpigmentation, and possibility of cancer recurrence, the patient underwent a simple mastectomy. The final pathologic diagnosis was oleoma with post-radiation fibrosis among drug-induced and toxic scleroderma-like disorders. The patient tolerated surgical therapy without complications. This case report highlight is that difficult to distinguish between PIM and oleoma in patients with a complex history. In this case, the patient had both a history of radiotherapy and a history of foreign body injection, making the clinical diagnosis difficult. PIM and oleoma are non-malignant but can impair a patient's quality of life owing to symptoms and the clinical presentation is similar to that of local recurrence of breast cancer. Thus, arriving at the correct diagnosis typically requires a multidisciplinary approach, including imaging follow-up, skin punch biopsy, or surgery for a definitive diagnosis.
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http://dx.doi.org/10.21037/gs-21-549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8749079PMC
December 2021

Ramsay Hunt Syndrome Presenting as Acute Unilateral Combined Peripheral and Central Vestibulopathies.

J Clin Neurol 2022 Jan;18(1):108-110

Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.

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http://dx.doi.org/10.3988/jcn.2022.18.1.108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8762492PMC
January 2022

Schwannoma of the breast presenting as a painful lump: A case report.

Medicine (Baltimore) 2021 Dec;100(49):e27903

Department of Pathology, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea.

Rationale: Schwannoma in the breast parenchyma is very unusual. It usually develops on the head, neck, and extensor surfaces of the upper and lower extremities.

Patient Concerns: We report a case of a 60-year-old woman with a palpable and painful mass. Clinically, she experienced neuropathic pain at the mass site.

Diagnoses: The tumor was a 1 cm, well-circumscribed mass, and revealed schwannoma on core needle biopsy.

Interventions: The patient underwent wide excision.

Outcomes: No postoperative complications were observed. A six-month follow-up revealed no recurrence.

Lessons Subsections: Although breast schwannoma is a very rare tumor, it is a very important consideration in case of a Breast Imaging-Report and Data System 4A lesion with a painful and palpable mass.
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http://dx.doi.org/10.1097/MD.0000000000027903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8663845PMC
December 2021

Identification of the O/ME-SA/Ind-2001e Sublineage of Foot-and-Mouth Disease Virus in Cambodia.

Front Vet Sci 2021 29;8:749966. Epub 2021 Oct 29.

Foot-and-Mouth Disease Research Division, Animal and Plant Quarantine Agency, Gimcheon-si, South Korea.

Foot-and-mouth (FMD) is endemic in Cambodia with numerous outbreaks in cattle, pigs and other susceptible animal species reported every year. Historically, these outbreaks were caused by the FMD virus (FMDV) of serotype O PanAsia and Mya-98 lineages and serotype A Sea-97 lineage. However, the trans-pool movement of FMDV between inter-pool regions or countries throughout FMD endemic regions has raised concerns regarding infection with the new genotype or serotype of FMDV in Cambodia. In this study, 19 sequences of VP1 coding region obtained from 33 clinical samples collected from FMDV-affected cattle farms in Cambodia during January to March 2019 were genetically characterized to identify the genotypes/lineages of FMDV. Phylogenetic analysis of VP1 coding sequences revealed that recent field viruses belonged to O/ME-SA/Ind-2001e (15.8%), O/ME-SA/PanAsia (52.7%), and A/ASIA/Sea-97 (31.5%). Besides, the field viruses of O/ME-SA/Ind-2001e in Cambodia showed 93.5-96.8% identity with the VP1 coding sequences of the same sublineage viruses from pool 1 and 2 surrounding Cambodia. This is the first report of O/ME-SA/Ind-2001e infection in Cambodia, suggesting that the trans-pool movement of the new genotype should be closely monitored for efficient control of FMD.
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http://dx.doi.org/10.3389/fvets.2021.749966DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8586198PMC
October 2021

The role of fluorodeoxyglucose-PET/computed tomography as a predictor of breast cancer characteristics and prognosis.

Nucl Med Commun 2022 Jan;43(1):108-113

Surgery, Gyeongsang National University Hospital, Jinju.

Purpose: Fluorodeoxyglucose-PET/computed tomography (FDG-PET/CT) affects the management of patients with breast cancer. Our study aimed to determine the predictive ability of characteristics such as lymph node involvement or subtype and the prognostic value of pretreatment FDG-PET/CT in breast cancer.

Method: A total of 270 patients who were confirmed with breast cancer histopathologically and underwent pretreatment FDG-PET/CT were enrolled in the study. Nuclear medicine specialists obtained the readings and measured the maximum standardized uptake value (SUVmax) of the images. Tumor and lymph node SUVmax were evaluated according to lymph node metastasis and subtype status. Survival outcomes were analyzed by the Kaplan-Meier method.

Results: The lymph node SUVmax and the lymph node/tumor SUVmax ratio were significantly higher in the subgroup of patients with lymph node metastasis than in those without lymph node metastasis. High cutoff lymph node SUVmax value and lymph node/tumor SUVmax ratio were confirmed as significant predictive factors in multivariate analysis. In a comparison of the tumor SUVmax values, the more biological aggressive subtype showed higher tumor SUVmax values. In survival analysis, tumor SUVmax and lymph node SUVmax were significant predisposing factors for disease-free survival in breast cancer. In subgroup analysis, tumor SUVmax was a more significant prognostic factor in patients who had breast cancer with tumor sizes of ≤2 cm. The lymph node SUVmax was more a significant prognostic factor in patients who had breast cancer with lymph node metastasis.

Conclusion: In this study, we showed that the SUVmax of FDG-PET/CT was a useful predictor of lymph node metastasis and breast cancer prognosis.
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http://dx.doi.org/10.1097/MNM.0000000000001476DOI Listing
January 2022

Family history of hand tremor in patients with early Parkinson's disease.

J Clin Neurosci 2021 Aug 9;90:161-164. Epub 2021 Jun 9.

Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, South Korea; National Research Center for Dementia, Gwangju, South Korea. Electronic address:

Some patients with Parkinson's disease (PD) report hand tremors in their relatives. This study aimed to compare the clinical characteristics of early PD in patients with and without a family history of hand tremor. This study included 337 early and drug-naïve patients with PD. The family history of hand tremor was obtained from the patients and their caregivers. Motor and non-motor symptoms of PD were assessed using the appropriate scales. A family history of hand tremor was present in 27 of 337 patients with PD (8.0%). Patients with a family history of hand tremor had significantly higher scores for rest tremors than those without. No significant differences were found in action tremor, bradykinesia, rigidity, gait, or posture scores between the two groups. The proportion of tremor-dominant subtypes was higher in patients with a family history of hand tremor than in those without (51.8% vs. 28.7%). Patients with PD, with a family history of hand tremor, had significantly lower scores in the urinary and sexual subdomains of the Non-Motor Symptoms Scale for PD than in those without. A family history of hand tremor affects the motor and non-motor symptoms in patients with early PD. It is necessary to investigate the family history of hand tremor in patients with PD.
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http://dx.doi.org/10.1016/j.jocn.2021.05.041DOI Listing
August 2021

Experience of Surgical Treatment in a Granular Cell Tumor in the Ascending Colon: A Case Report.

Ann Coloproctol 2021 Jul 6. Epub 2021 Jul 6.

Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.

We report a case about successful surgical treatment of a granular cell tumor in the ascending colon. A 36-year-old man underwent screening colonoscopy. An endoscopic examination revealed a 10-mm yellowish and hemispheric mass in the ascending colon, and lower endoscopic ultrasonography revealed a hypoechoic-to-isoechoic mass invaded the submucosal layer. The mass was suspected to be a colonic carcinoid tumor. Based on the preoperative evaluation, endoscopic complete resection was considered difficult. Therefore, the lesion was removed via laparoscopic right hemicolectomy. Histological examination revealed that the tumor consisted of nests of polygonal cells with abundant granular eosinophilic cytoplasm. Immunohistochemical staining revealed diffuse positivity for S100 and CD68. Therefore, the tumor was diagnosed as a granular cell tumor. We suggest that surgical resection should be considered if it is located in the thin-walled ascending colon prone to perforation, difficult to rule out malignant tumor due to submucosal invasion, or to remove endoscopically.
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http://dx.doi.org/10.3393/ac.2020.00836.0119DOI Listing
July 2021

Troponin Levels and Outcomes in Patients with Embolic Stroke of Undetermined Source.

J Stroke 2021 May 31;23(2):285-288. Epub 2021 May 31.

Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.

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http://dx.doi.org/10.5853/jos.2021.00010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189862PMC
May 2021

Anticoagulation versus Antiplatelet Therapy after Ischemic Stroke in the Patients with Atrial Fibrillation and Cerebral Microbleeds.

J Stroke 2021 May 31;23(2):273-276. Epub 2021 May 31.

Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.

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http://dx.doi.org/10.5853/jos.2020.04588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189857PMC
May 2021

Ileocolonic intussusception caused by epithelioid leiomyosarcoma of the ileum: a report of case and review of the literature.

Ann Coloproctol 2022 Apr 28;38(2):176-180. Epub 2021 May 28.

Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.

Small intestinal malignant tumor accounts for about 3% of all malignant tumors in the gastrointestinal tract, among which 13% are leiomyosarcoma (LMS). In addition, epithelioid LMS is of very rare occurrence. As small intestinal malignant tumors are initially asymptomatic and nonspecific, diagnosis is often delayed, and this can lead to large tumor at the time of detection and lead to intussusception. We observed ileocolonic intussusception in an 80-year-old male patient who was admitted to the hospital with a complaint of abdominal pain and palpable mass on right lower quadrant. The laparoscopic ileocecectomy was performed by the emergency operation because of obstruction. The pathologic examination revealed that the epithelioid LMS developed in the terminal ileum was the leading point of intussusception. To the best of our knowledge, laparoscopic surgery for ileocolonic intussusception with epithelioid LMS has not yet been reported.
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http://dx.doi.org/10.3393/ac.2020.12.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9021852PMC
April 2022

d-dimer Level as a Predictor of Recurrent Stroke in Patients With Embolic Stroke of Undetermined Source.

Stroke 2021 07 11;52(7):2292-2301. Epub 2021 May 11.

Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.).

Background And Purpose: This study aimed to investigate the value of d-dimer levels in predicting recurrent stroke in patients with embolic stroke of undetermined source. We also evaluated the underlying causes of recurrent stroke according to d-dimer levels.

Methods: A total of 1431 patients with undetermined source were enrolled in this study and divided into quartiles according to their baseline plasma d-dimer levels. The primary outcome measure was the occurrence of recurrent stroke (ischemic or hemorrhagic) in the year following the stroke event.

Results: The risk of recurrent stroke increased significantly with the increasing d-dimer quartile (log-rank P=0.001). Patients in the higher d-dimer quartiles had a higher probability of recurrent embolic stroke because of covert atrial fibrillation, hidden malignancy, or undetermined sources. Most recurrent strokes in Q3 and Q4 were embolic but not in Q1 or Q2. Multivariate analysis revealed that patients in Q3 and Q4 had a significantly increased risk of recurrent stroke compared with those in Q1 (hazard ratio, 3.12 [95% CI, 1.07−9.07], P=0.036; hazard ratio, 7.29 [95% CI, 2.59−20.52], P<0.001, respectively; Ptrend<0.001). Binary analyses showed a significant association between a high d-dimer level above normal range and the risk of recurrent stroke (hazard ratio, 2.48 [95% CI, 1.31−4.70], P=0.005). In subgroup analyses, a high d-dimer level was associated with a significantly higher risk of recurrent stroke in men than in women (P=0.039).

Conclusions: Our findings suggest that d-dimer levels can be a useful risk assessment biomarker for predicting recurrent stroke, especially embolic ischemic stroke, in patients with undetermined source.
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http://dx.doi.org/10.1161/STROKEAHA.120.033217DOI Listing
July 2021

Single-nucleotide polymorphism-based epidemiological analysis of Korean isolates.

J Vet Sci 2021 Mar;22(2):e24

Bacterial Disease Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Korea.

Background: Bovine tuberculosis (TB) is caused by , a well-known cause of zoonotic tuberculosis in cattle and deer, and has been investigated in many physiological and molecular studies. However, detailed genome-level studies of have not been performed in Korea.

Objectives: To survey whole genome-wide single-nucleotide polymorphism (SNP) variants in Korean field isolates and to define groups in Korea by comparing SNP typing with spoligotyping and variable number tandem repeat typing.

Methods: A total of 46 field isolates, isolated from laryngopharyngeal lymph nodes and lungs of Korean cattle, wild boar, and Korean water deer, were used to identify SNPs by performing whole-genome sequencing. SNP sites were confirmed via polymerase chain reaction using 87 primer pairs.

Results: We identified 34 SNP sites with different frequencies across isolates, and performed SNP typing and epidemiological analysis, which divided the 46 field isolates into 16 subtypes.

Conclusions: Through SNP analysis, detailed differences in samples with identical spoligotypes could be detected. SNP analysis is, therefore, a useful epidemiological tracing tool that could enable better management of bovine TB, thus preventing further outbreaks and reducing the impact of this disease.
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http://dx.doi.org/10.4142/jvs.2021.22.e24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007439PMC
March 2021

Positive estrogen receptor status is a poor prognostic factor in node-negative breast cancer: An observational study in Asian patients.

Medicine (Baltimore) 2021 Mar;100(11):e25000

Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.

Abstract: This study evaluated the outcomes and prognostic factors for breast cancer according to initial lymph node (LN) status. Among patients with LN-negative breast cancer, we also focused on the prognostic value of estrogen receptor (ER) status.Medical records were retrospectively reviewed for 715 patients who underwent curative surgery for breast cancer between January 2005 and December 2015 at a single Korean institution. We evaluated factors that were associated with metastasis-free survival (MFS) according to LN status.Among the 715 patients (age: 28-87 years), 458 patients (64.1%) did not have axillary LN metastasis. Relative to patients without LN metastasis, patients with LN metastasis had larger tumor sizes and higher histological grades. Among patients with no LN metastasis, ER positivity was associated with non-significantly poorer MFS than ER negativity (mean survival: 138.90 months vs. 146.99 months, p = .17), and patients with LN-negative ER-positive disease had MFS rates of 91.7% at 5 years and 74.5% at 10 years. Among patients with LN-negative ER-positive disease, a poor prognosis was significantly associated with larger tumor size (≥2 cm, P = .03) and older age (≥50 years, P = .03).These results indicate that the risk of metastasis increases over time for patients with LN-negative ER-positive breast cancer, and especially for older patients or patients with larger tumors.
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http://dx.doi.org/10.1097/MD.0000000000025000DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982180PMC
March 2021

Laparoscopic Local Resection through Subserosal Dissection with Endoscopic Air-Insufflation for Submucosal Tumors Located Near the Esophagogastric Junction.

J Minim Invasive Surg 2020 Dec;23(4):172-178

Department of Surgery, Gyeongsang National University Hospital, College of Medicine, Gyeongsang National University, Jinju, Korea.

Purpose: A novel resection method, namely, laparoscopic local resection through subserosal dissection with endoscopic air-insuff lation (LRSDEA) was used for submucosal tumors located near the esophagogastric junction (SMT-EGJ) to avoid major gastric resection.

Methods: A total of 9 cases underwent LRSDEA. We sequentially performed: laparoscopic dissections around EGJ, subserosal dissections around SMTs using laparoscopic electrocautery and ultrasonic shears, and finally, enucleation of SMTs. During these procedures, intraoperative endoscopic tumor localization, as well as endoscopic air-insufflation allowed for safe resection. These procedures are shown in the supplementary video clip. The clinicopathological characteristics and surgical results were analyzed.

Results: All laparoscopic procedures were successfully performed without requiring a major gastrectomy. The mean operation time was 126.1 minutes, and estimated blood loss was 12.0 ml. There were no postoperative complications. Pathological diagnoses were 6 leiomyomas, 2 gastrointestinal stromal tumors, and 1 gastric duplication.

Conclusion: LRSDEA is an effective and safe treatment option for SMT-EGJ, as major resection of the stomach is avoided.
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http://dx.doi.org/10.7602/jmis.2020.23.4.172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8985622PMC
December 2020

Dynamic changes of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predicts breast cancer prognosis.

BMC Cancer 2020 Dec 7;20(1):1206. Epub 2020 Dec 7.

Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 11, Samjeongjaro, Seongsangu, Changwonsi, Republic of Korea, 51472.

Background: We aimed to identify whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are more useful predictors after initial intention to treat than at the time of diagnosis.

Methods: We collected the medical data of 533 patients. The results of the peripheral blood sampling before the primary treatments were labeled as initial cohort, and those obtained between 24 and 36 months after initial treatment were defined as the 2nd cohort. Delayed metastasis has been defined as distant metastasis 2 years after treatment, and survival outcome was estimated and compared across groups.

Results: Median follow-up duration was 74 months (24-162 months), and 53 patients experienced delayed metastasis. In univariate analysis, metastasis-free survival, patient age at diagnosis, tumor size, axillary lymph node metastasis, HER-2 status, initial NLR and PLR, and 2nd NLR and PLR were found to be significantly associated with delayed metastasis. However, in multivariate analysis, only the 2nd NLR and PLR were found to be significantly associated with delayed metastasis, excluding initial NLR and PLR. Metastasis-free survival was analyzed through the pattern changes of NLR or PLR. The results revealed that patients with continued low NLR and PLR values at pre- and post-treatment (low initial values and 2nd values) showed a significantly better prognosis than those with a change in value or continued high NLR and PLR.

Conclusions: We identified that patients with persistent high NLR and PLR after initial treatment have significant worse prognosis in terms of late metastasis. Therefore, these results suggest that NLR and PLR are more useful in predicting prognosis post-treatment.
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http://dx.doi.org/10.1186/s12885-020-07700-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720486PMC
December 2020

Microbleeds and Outcome in Patients With Acute Ischemic Stroke and Atrial Fibrillation Taking Anticoagulants.

Stroke 2020 12 8;51(12):3514-3522. Epub 2020 Oct 8.

Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea.

Background And Purpose: We investigated the impact of the presence, burden, and location of cerebral microbleeds (CMBs) on the risk of major adverse cerebrovascular and cardiovascular events (MACCE) in patients with acute ischemic stroke and atrial fibrillation treated with oral anticoagulants (OACs). We also examined whether the clinical effect of CMBs differs according to the type of OACs.

Methods: A total of 1742 patients with acute ischemic stroke and atrial fibrillation treated with OACs were enrolled in this cohort study. The primary composite outcome was the occurrence of MACCE (a composite of stroke, acute myocardial infarction, or vascular death) over a 2-year period according to CMB status.

Results: CMB presence was significantly associated with the risk of future MACCE (hazard ratio, 1.89 [95% CI, 1.23-2.88]; =0.003) after adjustment for confounders in patients with acute ischemic stroke and atrial fibrillation taking OACs. Patients with exactly 1 CMB had a similar rate of MACCE compared with those without CMBs (=0.461). However, patients with multiple CMBs (≥2), particularly high burden CMBs (≥5), had a significantly higher proportion of MACCE. Both CMB-positive groups with lobar and deep CMB had more frequent MACCE than the CMB-negative group, and the rate of MACCE was not different according to CMB location. In patients treated with warfarin, CMB was significantly associated with a risk of MACCE (=0.002), but not in patients treated with direct OACs (=0.517).

Conclusions: The study results indicate that the risk of future MACCE increased with increasing CMB burden in patients with AIS and atrial fibrillation taking OACs, while the anatomic location of CMBs did not influence the risk of future MACCE. This risk seemed to be more apparent in patients taking warfarin.
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http://dx.doi.org/10.1161/STROKEAHA.120.030300DOI Listing
December 2020

Cerebellar infarction presenting with isolated positional vertigo: differentiating factors for benign paroxysmal positional vertigo.

Neurol Sci 2021 Mar 28;42(3):1045-1052. Epub 2020 Jul 28.

Department of Neurology, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea.

Background: Isolated central positional vertigo (CPV) due to cerebellar infarction is often difficult to differentiate from benign paroxysmal positional vertigo (BPPV). Here, we aimed to evaluate whether vascular risk factors and serum vitamin D level can differentiate between positional vertigo types.

Methods: A total of 78 consecutive patients were consecutively enrolled from January 2017. All CPV patients had a National Institutes of Health Stroke Scale score of 0 and cerebellar infarctions confirmed by brain MR imaging. Vascular risk factors and serum 25-hydroxyvitamin D levels were compared between the two groups of patients.

Results: The proportion of men was higher in the CPV than in the BPPV group (p = 0.004). Atrial fibrillation was common in the CPV group on univariate analysis (p = 0.046). However, there were no independent differentiating factors between the two groups. The proportion of patients according to the number of risk factors was significantly different between the two groups (linear by linear association test, p = 0.02). The mean serum 25-hydroxyvitamin D level did not differ. Also, the proportions of vitamin D insufficiency and deficiency did not differ significantly between the two groups.

Conclusions: Increased number of vascular risk factors including male sex suggested more CPV than BPPV. However, the serum vitamin D level was below the normal range in both groups. Our results demonstrate that serum vitamin D level has little value in the differential diagnosis of positional vertigo. Efforts to identify differentiating factors are warranted, and accumulating evidences including our research may lead to a diagnostic algorithm for isolated positional vertigo.
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http://dx.doi.org/10.1007/s10072-020-04617-wDOI Listing
March 2021

Vestibular and Ocular Motor Properties in Lateral Medullary Stroke Critically Depend on the Level of the Medullary Lesion.

Front Neurol 2020 5;11:390. Epub 2020 Jun 5.

Faculty of Medicine, University of Zurich, Zurich, Switzerland.

Lateral medullary stroke (LMS) results in a characteristic pattern of brainstem signs including ocular motor and vestibular deficits. Thus, an impaired angular vestibulo-ocular reflex (aVOR) may be found if the vestibular nuclei are affected. We aimed to characterize the frequency and pattern of vestibular and ocular-motor deficits in patients with LMS. Patients with MR-confirmed acute/subacute unilateral LMS from a stroke registry were included and a bedside neuro-otological examination was performed. Video-oculography and video-based head-impulse testing (vHIT) was obtained and semicircular canal function was determined. The lesion location/extension as seen on MRI was rated and involvement of the vestibular nuclei was judged. Seventeen patients with LMS (age = 59.4 ± 14.3 years) were included. All patients had positive H.I.N.T.S. vHIT showed mild-to-moderate aVOR impairments in three patients (ipsilesional = 1; ipsilesional and contralesional = 1; contralesional = 1). Spontaneous nystagmus ( = 10/15 patients) was more often beating contralesionally than ipsilesionally (6 vs. 3) and was accompanied by upbeat nystagmus in four patients. Head-shaking nystagmus was noted in seven subjects, ipsilesionally beating in six and down-beating in one. On brain MRI, damage of the most caudal parts of the medial and/or inferior vestibular nucleus was noted in 13 patients. Only those two patients with lesions affecting the rostral medulla oblongata demonstrated an ipsilaterally impaired aVOR. While subtle ocular motor signs pointed to damage of the central-vestibular pathways in all 17 patients, aVOR deficits were infrequent, restricted to those patients with rostral medullary lesions and, if present, mild to moderate only. This can be explained by lesions located too far caudally and too far ventrally to substantially affect the vestibular nuclei.
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http://dx.doi.org/10.3389/fneur.2020.00390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325917PMC
June 2020

Recurrent alternating ophthalmoplegia with ipsilateral headache: unusual but possible manifestation of recurrent painful ophthalmoplegic neuropathy.

Neurol Sci 2020 11 5;41(11):3357-3360. Epub 2020 Jun 5.

Department of Neurology, Chonnam National University Hospital and Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea.

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http://dx.doi.org/10.1007/s10072-020-04502-6DOI Listing
November 2020

Introduction and Application of the Interferon-γ Assay in the National Bovine Tuberculosis Control Program in South Korea.

Front Vet Sci 2020 28;7:222. Epub 2020 Apr 28.

Bacterial Disease Division, Animal and Plant Quarantine Agency, Gimcheon-si, South Korea.

Bovine tuberculosis is a chronic disease impacting both public health and the livestock industry. The interferon (IFN)-γ assay has been introduced as an ancillary test for diagnosing bovine tuberculosis to overcome limitations of the skin test. The objective of this study was to assess the IFN-γ assay in terms of diagnostics and as a nationwide surveillance program in South Korea. From 2012 to 2013, cattle ( = 120) with bovine tuberculosis and cattle ( = 426) from bovine tuberculosis free herds were subjected to the IFN-γ assay to evaluate the sensitivity and specificity of the assay, respectively, depending on various cut-offs (0-3.5). When optical density of the cut-off was 0.1, the sensitivity and specificity were found to be 81.7% (74.7-88.6) and 99.5% (98.9-100.0), respectively. After introducing the IFN-γ assay as part of the national control program, the IFN-γ assay and single caudal fold skin test data were collected from 47 regional veterinary services to compare the results of these two tests. Overall, the agreement between the IFN-γ assay and the single caudal fold skin test ( = 492,068) was 98.2%, and Cohen's kappa value for the two methods was 0.47. Serial and parallel use of the IFN-γ assay and skin test for the bovine tuberculosis control program were compared using samples ( = 91) from cattle confirmed as bovine tuberculosis positive in laboratories from 2014 to 2016. Parallel screening for bTB showed much higher sensitivity (86/91, 94.5%) than the following screening approaches: serial (47.2%, 43/91), single screening using CFT (63.7%, 58/91), or the IFN-γ assay (78.0%, 71/91). These results indicate that the IFN-γ assay and single caudal fold skin test are complementary to each other; therefore, parallel use of these two tests is considered a useful approach to reduce the prevalence of bovine tuberculosis in South Korea.
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http://dx.doi.org/10.3389/fvets.2020.00222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7198753PMC
April 2020

A rare case of pure osteosarcoma of breast with rapid developing pulmonary metastasis.

Breast J 2020 07 5;26(7):1392-1394. Epub 2020 Mar 5.

Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.

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http://dx.doi.org/10.1111/tbj.13786DOI Listing
July 2020

Olfactory Identification Test Using Familiar Distracters for Koreans.

Clin Exp Otorhinolaryngol 2020 May 28;13(2):209. Epub 2020 Feb 28.

Department of Otorhinolaryngology-Head & Neck Surgery, Konkuk University School of Medicine, Seoul, Korea.

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http://dx.doi.org/10.21053/ceo.2020.00178DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7248615PMC
May 2020

Exploring linearity of deep neural network trained QSM: QSMnet

Neuroimage 2020 05 7;211:116619. Epub 2020 Feb 7.

Laboratory for Imaging Science and Technology, Department of Electrical and Computer Engineering, Seoul National University, Seoul, South Korea. Electronic address:

Recently, deep neural network-powered quantitative susceptibility mapping (QSM), QSMnet, successfully performed ill-conditioned dipole inversion in QSM and generated high-quality susceptibility maps. In this paper, the network, which was trained by healthy volunteer data, is evaluated for hemorrhagic lesions that have substantially higher susceptibility than healthy tissues in order to test "linearity" of QSMnet for susceptibility. The results show that QSMnet underestimates susceptibility in hemorrhagic lesions, revealing degraded linearity of the network for the untrained susceptibility range. To overcome this limitation, a data augmentation method is proposed to generalize the network for a wider range of susceptibility. The newly trained network, which is referred to as QSMnet, is assessed in computer-simulated lesions with an extended susceptibility range (-1.4 ​ppm to +1.4 ​ppm) and also in twelve hemorrhagic patients. The simulation results demonstrate improved linearity of QSMnet over QSMnet (root mean square error of QSMnet: 0.04 ​ppm vs. QSMnet: 0.36 ​ppm). When applied to patient data, QSMnet maps show less noticeable artifacts to those of conventional QSM maps. Moreover, the susceptibility values of QSMnet in hemorrhagic lesions are better matched to those of the conventional QSM method than those of QSMnet when analyzed using linear regression (QSMnet: slope ​= ​1.05, intercept ​= ​-0.03, R ​= ​0.93; QSMnet: slope ​= ​0.68, intercept ​= ​0.06, R ​= ​0.86), consolidating improved linearity in QSMnet. This study demonstrates the importance of the trained data range in deep neural network-powered parametric mapping and suggests the data augmentation approach for generalization of network. The new network can be applicable for a wide range of susceptibility quantification.
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http://dx.doi.org/10.1016/j.neuroimage.2020.116619DOI Listing
May 2020

Oculopalatal Tremor With Dissociated Pendular Nystagmus in Bilateral Inferior Olivary Hypertrophy.

J Neuroophthalmol 2020 03;40(1):97-99

Department of Neurology (J-MK, KWK, T-SN, S-HL), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea; and Department of Neurology (J-YP), Ulsan University Hospital, and University of Ulsan College of Medicine, Ulsan, Korea.

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http://dx.doi.org/10.1097/WNO.0000000000000849DOI Listing
March 2020
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