Publications by authors named "Mi Sung Kim"

86 Publications

Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study.

Anesth Analg 2021 Jan 15. Epub 2021 Jan 15.

Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Background: Tools for the evaluation of gastric emptying have evolved over time. The purpose of this study was to show that the risk of pulmonary aspiration is not increased with carbohydrate drink, by demonstrating that the gastric antral cross-sectional area (CSA) of the NO-NPO group is either equivalent to or less than that of the NPO (nil per os) group.

Methods: Sixty-four patients scheduled for elective laparoscopic benign gynecologic surgery were enrolled and randomly assigned to the NPO group (n = 32) or the NO-NPO group (n = 32). After having a regular meal until midnight before surgery, the NPO group fasted until surgery, while the NO-NPO group ingested 400 mL of a carbohydrate drink at midnight and freely up to 2 hours before anesthesia. The primary outcome was the gastric antral CSA by gastric ultrasound in right lateral decubitus position (RLDP). Noninferiority was defined as a mean difference of CSA <2.8 cm2. Secondary outcomes included CSA in supine position, gastric volume (GV), GV per weight (GV/kg), GV/kg >1.5 mL/kg, and Perlas grade.

Results: CSA in RLDP was not different between the NPO group (6.25 ± 3.79 cm2) and the NO-NPO group (6.21 ± 2.48 cm2; P = .959). The mean difference of CSA in RLDP (NO-NPO group - NPO group) was 0.04 (95% confidence interval [CI], -1.56 to 1.64), which was within the noninferiority margin of 2.8 cm2. CSA was not different between the 2 groups (4.17 ± 2.34 cm2 in NPO group versus 4.28 ± 1.23 cm2 in NO-NPO group; P = .828). GV in NPO group (70 ± 56 mL) was not different from NO-NPO group (66 ± 36 mL; mean difference, 3.66; 95% CI, -20 to 27; P = .756). GV/kg in the NPO group (1.25 ± 1.00 mL/kg) was not different from the NO-NPO group (1.17 ± 0.67 mL/kg; P = .694). The incidence of GV/kg > 1.5 mL/kg was not different between NPO (31.3%) and NO-NPO group (21.9%; P = .768). The median (interquartile range) of the Perlas grade was 1 (0-1) in NPO group and 0.5 (0-1) in NO-NPO group (P = .871).

Conclusions: Preoperative carbohydrates ingested up to 2 hours before anesthesia do not delay gastric emptying compared to midnight fasting, as evaluated with gastric ultrasound.
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http://dx.doi.org/10.1213/ANE.0000000000005411DOI Listing
January 2021

Impacts on outcomes and management of preoperative magnetic resonance cholangiopancreatography in patients scheduled for laparoscopic cholecystectomy: for whom it should be considered?

Ann Surg Treat Res 2020 Oct 24;99(4):221-229. Epub 2020 Sep 24.

Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: We evaluated the impact of preoperative magnetic resonance cholangiopancreatography (MRCP) on patient outcomes, and found which patients should be considered for MRCP before cholecystectomy.

Methods: We performed retrospective analysis of 2,072 patients that underwent cholecystectomy for benign gallbladder disease from January 2014 to June 2017. Patients were grouped as CT only group (n = 737) and MRCP group (n = 1,335), including both CT and MRCP (n = 1,292) or MRCP only (n = 43). The main outcome measure was associated with complications after cholecystectomy, and the secondary outcomes were hospital stay, readmission, and events that could impact patient management due to addition of MRCP.

Results: There were no statistical differences in occurrence of intraoperative or postoperative complications or readmission rate between the 2 groups. Hospital stay was about 0.6 days longer in the MRCP group. However, MRCP group was more susceptible to complications due to underlying patient demographics (older age, higher frequency of diabetes, and higher level of the inflammatory markers). MRCP diagnosed common bile duct (CBD) stones in 6.5% of patients (84/1,292) without CBD stones in CT, and bile duct anomalies were identified in 41 patients (3.2%). Elevated γ-GT was the only independent factor for additional detection of CBD stones (adjusted odds ratio [OR], 2.89; P = 0.029) and subsequent biliary procedures (adjusted OR, 3.34; P = 0.018) when additional MRCP was performed.

Conclusion: MRCP is valuable for identification of bile duct variation and CBD stones. Preoperative MRCP can be considered, particularly in patients with elevated γ-GT, for proper preoperative management and avoidance of complications.
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http://dx.doi.org/10.4174/astr.2020.99.4.221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520229PMC
October 2020

Ultrasound evaluation of postsurgical shoulder after rotator cuff repair: comparison of clinical results.

Acta Radiol 2020 Aug 16:284185120948494. Epub 2020 Aug 16.

Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Background: The relationship between the imaging parameters on postoperative ultrasound (US) other than repaired tendon integrity with clinical outcome such as postoperative residual pain has not been well defined.

Purpose: To investigate whether the repaired tendon thickness and subdeltoid fluid collection after rotator cuff repair are correlated with early postoperative clinical outcome.

Material And Methods: This retrospective study included 54 patients who underwent repair of the arthroscopic rotator cuff either by suture-bridge or single-row technique and postoperative US. We assessed the relationship between the sonographic parameters, including repaired supraspinatus tendon thickness and subdeltoid fluid collection, with the clinical outcome represented by the Korean Shoulder Scoring system (KSS) score using correlation coefficients (R). Also, the subgroup analysis was done to assess the differences by surgical technique and patients' age.

Results: There was a significant inverse relationship between the amount of subdeltoid fluid collection and degree of self-assessed pain improvement of the patients ( < 0.05), although every KSS category showed statistically insignificant tendency of inverse relationship with the fluid thickness. However, there was no statistically significant relationship between the thickness of repaired supraspinatus tendon and KSS scores. In patients aged >60 years, a statistically significant inverse relationship between thickness of subdeltoid fluid collection and difference value of the KSS scores in category of function was observed with both interpreters ( = 0.015 and  = 0.04, respectively).

Conclusion: Subdeltoid fluid collection measured on US after repair of the arthroscopic rotator cuff in the early postoperative period has significant association with the patients' subjective clinical outcome.
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http://dx.doi.org/10.1177/0284185120948494DOI Listing
August 2020

Prevalence of significant hepatic fibrosis using magnetic resonance elastography in a health check-up clinic population.

Aliment Pharmacol Ther 2020 02;51(3):388-396

Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.

Background: Significant hepatic fibrosis is associated with higher mortality. However, data on the estimated prevalence of liver fibrosis in the general population are scarce.

Aim: To use magnetic resonance elastography (MRE) to investigate the prevalence of hepatic fibrosis in a Korean health check-up clinic cohort.

Methods: We enrolled 2170 participants at our health check-up clinic between January 2015 and May 2018, all of whom had MR with chemical shift technique and MRE. The primary objective was to estimate the prevalence of liver fibrosis. For generalisation, sex- and age-standardised prevalence was calculated based on the Korean Statistical Information Service (KOSIS) during the period 2015-2018.

Results: The prevalence of F2 (≥3.0 kPa) and F3 (≥3.6 kPa) in the overall cohort was 5.1% and 1.3% respectively (sex- and age-adjusted prevalence of 3.8% and 1.3%). Non-alcoholic fatty liver disease (NAFLD) prevalence (>5% fat fraction) was 27.7% in the average risk population (after excluding alcohol use and viral hepatitis), and the prevalence of significant and advanced fibrosis in NAFLD participants was 8.0% and 1.5% respectively. In participants with diabetes, 12.5% had ≥F2 and 4.3% ≥F3. In participants with NAFLD plus diabetes, 24.1% had ≥F2 and 6.0% ≥F3. On multivariate analysis, only age, insulin, diabetes and fatty liver on MR were independently associated with significant fibrosis.

Conclusions: In a Korean health check-up clinic setting, the prevalence of significant and advanced liver fibrosis was 5.1% and 1.3% (sex- and age-adjusted prevalence of 3.8% and 1.3%). The prevalence of advanced liver fibrosis was five times higher for diabetic participants with NAFLD.
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http://dx.doi.org/10.1111/apt.15626DOI Listing
February 2020

Evaluation of Gastric Emptying Time of a Rice-Based Meal Using Serial Sonography.

Biomed Res Int 2019 28;2019:5917085. Epub 2019 Oct 28.

Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

The aim of this prospective study was to evaluate the gastric emptying time of a rice-based meal by serial ultrasonography of the stomach. After baseline ultrasonographic assessment of ten fasted healthy volunteers, volunteers ingested standardized 420 g, 536 kcal rice-based meal (bibimbap), and serial evaluations were performed every hour until the stomach became empty. At baseline, all the participants had an empty stomach. The average time of complete gastric emptying of the rice-based meal was 5.8 ± 0.8 h (95% confidence interval (CI), 5.0 h to 6.5 h). Since the first postintake cross-sectional area (CSA) measurement, a decrease was observed, and CSA was maintained until postprandial 3-4 h ( > 0.05). It declined rapidly 4 h after meal intake (=0.031), reaching the nadir at approximately 6 h after meal intake. The gastric CSA and hunger score showed a positive correlation (correlation  = 0.616, < 0). The rice-based meal is emptied after 5.8 ± 0.8 h on average in healthy volunteers. Based on our results, 6.5 h (upper limit of CI) of fasting after the ingestion of a rice-based meal would be a safe preoperative fasting time, and this is in accordance with the current guidelines for preoperative fasting.
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http://dx.doi.org/10.1155/2019/5917085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6855072PMC
April 2020

Types of posterolateral corner injury associated with both bundle and selective-bundle ACL tears.

Acta Radiol 2019 May 1:284185119842833. Epub 2019 May 1.

2 Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Background: It is unknown whether a selective-bundle tear of the anterior cruciate ligament (ACL) shows a different prevalence of posterolateral corner (PLC) injury than a both-bundle tear.

Purpose: The prevalence of injury of PLC stabilizer in relation to the type of combined ACL tear (both-bundle and selective-bundle tears) has been investigated.

Material And Methods: This retrospective study included 94 patients who were diagnosed with an ACL tear after knee joint magnetic resonance imaging and underwent arthroscopic surgery. We compared the prevalence of each lesion in relation to the type of ACL injury and the type of selective-bundle tear. We used Fischer exact tests to compare the prevalence of each lesion in relation to the type of ACL injury and the type of selective-bundle tear.

Results: Both-bundle tears occurred in 55 cases (56%) and selective-bundle tears in 39 cases (44%). The most common PLC injury with an ACL tear was inferior popliteomeniscal fascicle (PMF) injury, followed by superior PMF injury. The prevalence of each PLC injury was higher for both-bundle tears than selective-bundle tears, with the exception of popliteus tendon injury diagnosed by reader 1 (P.H.J). However, these differences were statistically significant for superior PMF injury only ( p < 0.05). The prevalence of PLC injury was unrelated to the type of selective-bundle tear (anteromedial vs posterolateral).

Conclusion: Superior PMF injury is more common in both-bundle tears than selective-bundle tears. There is no statistically significant difference in the prevalence of PLC injury between both-bundle tears and selective-bundle tears.
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http://dx.doi.org/10.1177/0284185119842833DOI Listing
May 2019

The usefulness of the oblique coronal plane of three-dimensional isotropic T2-weighted fast spin-echo (VISTA) knee MRI in the evaluation of posterior cruciate ligament reconstruction with allograft: Comparison with the oblique coronal plane of two-dimensional fast spin-echo T2-weighted sequences.

Eur J Radiol 2019 May 16;114:105-110. Epub 2019 Mar 16.

Department of Radiology, Myongji hospital, Republic of Korea.

Purpose: We compared two imaging techniques to assess whether 3D VISTA imaging could replace 2D FSE in diagnosing PCL reconstruction complications.

Materials And Methods: This retrospective study included 40 patients who underwent surgery of PCL reconstruction and follow-up knee MRI (3D VISTA and 2D FSE) for evaluation of PCL graft integrity. Each image was interpreted independently by two radiologists without knowledge of radiologic reports or clinical history. The diagnostic performance of the 2D FSE PCL view, 3D VISTA PCL view, orthogonal 2D FSE image, and combined sequences were evaluated in terms of sensitivity, specificity, and accuracy for diagnosing complications of PCL graft. The reference diagnoses were made arthroscopically or clinically.

Results: The sensitivities of the 3D VISTA PCL view were similar to those of the 2D PCL view. The sensitivities of the combination of the orthogonal view and the 3D VISTA PCL view were also similar to those of the combination of the orthogonal view and the 2D PCL view. The specificities and accuracies of each image exhibited similar results. There was no statistically significant difference in diagnostic performance between the 3D VISTA PCL view and the 2D PCL view (solitary or combined with the orthogonal view).

Conclusions: The diagnostic performance of the PCL views on 3D VISTA images is comparable to that of 2D FSE images in the diagnosis of PCL graft complications.
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http://dx.doi.org/10.1016/j.ejrad.2019.03.009DOI Listing
May 2019

An initial experience with the use of whole body MRI for cancer screening and regular health checks.

PLoS One 2018 21;13(11):e0206681. Epub 2018 Nov 21.

Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea.

Objectives: We evaluated the utility of whole-body MRI (WB MRI) for cancer screening and other regular health evaluations.

Methods: This retrospective study included 229 patients who underwent whole-body MRI as part of a routine health examination and cancer screening. The WB MRIs and radiologic reports were evaluated by a musculoskeletal radiologist, a neuroradiologist, and an abdominal radiologist. The consensus of their findings was characterized into three categories, as follows: suspicion of malignancy (category I); need for follow-up (category II); and no need for follow-up (category III). Any correlations between the abnormal findings and each study group were evaluated using the Mann-Whitney U test and chi-square test.

Results: There were six category I lesions, among which two cases were found to involve malignancy. The most common category II findings were annular tears of the disc (14% of category II findings) and severe disc bulging or protrusion, followed by shoulder bursitis and uterine myoma. The most common category III finding was mild disc bulging or protrusion (47% of category III findings).

Conclusions: WB MRI can be used in cancer screening and for regular health evaluations. WB MRI not only provides information about potential malignancy, but also provides information regarding nonmalignant abnormalities that require further evaluation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206681PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248944PMC
April 2019

Biliary Taeniasis with Cholecystitis: An Unusual Case of Infection with a Literature Review.

Am J Trop Med Hyg 2019 01;100(1):135-139

Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Taeniasis is a cosmopolitan helminthic disease caused by species, which included , , and . These parasites typically infect the small intestine, but cases of aberrant migration have been reported. We treated a 70-year-old man who presented with vomiting and colicky abdominal pain. On physical examination, Murphy's sign was positive, and laboratory findings indicated severe inflammation. Computed tomography and magnetic resonance cholangiopancreatography revealed typical features of cholecystitis. An 82-cm-long, slender and degenerated, parasite-like organism was aspirated through a percutaneous transhepatic gallbladder drainage tube. After extensive washing of the organism, we detected yellowish-brown colored, spherical 37.9 × 33.8-µm-sized taenid eggs with thick transverse striations. Hematoxylin-eosin-stained worm sections also contained Taeniidae eggs. Polymerase chain reaction amplification of DNA extracted from the worm with species-specific cytochrome c1 () primer sets detected a specific fragment. Because of sustained high fever combined with inflammatory signs, the patient underwent laparoscopic cholecystectomy and inflamed gallbladder removal. A histopathologic specimen demonstrated chronic reactive cholecystitis. The patient's fever and leukocytosis rapidly resolved after surgery. We experienced an uncommon case of biliary taeniasis representing cholecystitis caused by adult worm of .
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http://dx.doi.org/10.4269/ajtmh.18-0633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335898PMC
January 2019

Diagnostic performance and useful findings of ultrasound re-evaluation for patients with equivocal CT features of acute appendicitis.

Br J Radiol 2018 Feb 9;91(1082):20170529. Epub 2017 Nov 9.

3 Department of Nuclear Medicine , Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine , Seoul, Republic of Korea.

Objective: To evaluate the diagnostic performance of ultrasound and to determine which ultrasound findings are useful to differentiate appendicitis from non-appendicitis in patients who underwent ultrasound re-evaluation owing to equivocal CT features of acute appendicitis.

Methods: 62 patients who underwent CT examinations for suspected appendicitis followed by ultrasound re-evaluation owing to equivocal CT findings were included. Equivocal CT findings were considered based on the presence of only one or two findings among the CT criteria, and ultrasound re-evaluation was done based on a predefined structured report form. The diagnostic performance of ultrasound and independent variables to discriminate appendicitis from non-appendicitis were assessed.

Results: There were 27 patients in the appendicitis group. The overall diagnostic performance of ultrasound re-evaluation was sensitivity of 96.3%, specificity of 91.2% and accuracy of 91.9%. In terms of the performance of individual ultrasound findings, probe-induced tenderness showed the highest accuracy (86.7%) with sensitivity of 74% and specificity of 97%, followed by non-compressibility (accuracy 71.7%, sensitivity 85.2% and specificity 60.6%). The independent ultrasound findings for discriminating appendicitis were non-compressibility (p = 0.002) and increased flow on the appendiceal wall (p = 0.001).

Conclusion: Ultrasound re-evaluation can be used to improve diagnostic accuracy in cases with equivocal CT features for diagnosing appendicitis. The presence of non-compressibility and increased vascular flow on the appendix wall are useful ultrasound findings to discriminate appendicitis from non-appendicitis. Advances in knowledge: Ultrasound re-evaluation is useful to discriminate appendicitis from non-appendicitis when CT features are inconclusive.
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http://dx.doi.org/10.1259/bjr.20170529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965797PMC
February 2018

Autophagy Is Pro-Senescence When Seen in Close-Up, but Anti-Senescence in Long-Shot.

Mol Cells 2017 Sep 20;40(9):607-612. Epub 2017 Sep 20.

School of Biological Sciences, Seoul National University, Seoul 08826, Korea.

When mammalian cells and animals face a variety of internal or external stresses, they need to make homeostatic changes so as to cope with various stresses. To this end, mammalian cells are equipped with two critical stress responses, autophagy and cellular senescence. Autophagy and cellular senescence share a number of stimuli including telomere shortening, DNA damage, oncogenic stress and oxidative stress, suggesting their intimate relationship. Autophagy is originally thought to suppress cellular senescence by removing damaged macromolecules or organelles, yet recent studies also indicated that autophagy promotes cellular senescence by facilitating the synthesis of senescence-associated secretory proteins. These seemingly opposite roles of autophagy may reflect a complex picture of autophagic regulation on cellular senescence, including different types of autophagy or a unique spatiotemporal activation of autophagy. Thus, a better understanding of autophagy process will lead us to not only elucidate the conundrum how autophagy plays dual roles in the regulation of cellular senescence but also helps the development of new therapeutic strategies for many human diseases associated with cellular senescence. We address the pro-senescence and anti-senescence roles of autophagy while focusing on the potential mechanistic aspects of this complex relationship between autophagy and cellular senescence.
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http://dx.doi.org/10.14348/molcells.2017.0151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5638768PMC
September 2017

Meaningful standard of reference for appendiceal perforation: pathology, surgery, or both?

Ann Surg Treat Res 2017 Aug 28;93(2):88-97. Epub 2017 Jul 28.

Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Purpose: This retrospective study was aimed to determine if appendiceal perforation identified pathologically but not surgically is clinically meaningful.

Methods: The study consists of 2 parts. First, we reviewed 74 studies addressing appendiceal perforation published in 2012 and 2013. Second, in a cross-sectional study, we classified 1,438 adolescents and adults (mean age, 29.3 ± 8.4 years; 785 men) with confirmed appendicitis as "nonperforation" (n = 1,083, group 1), "pathologically-identified perforation" (n = 55, group 2), "surgically-identified perforation" (n = 202, group 3), or "pathologically- and surgically-identified perforation" (n = 98, group 4). The 4 groups were compared for the frequency of laparoscopic appendectomy and the length of hospital stay using multivariable logistic regression analyses.

Results: The reference standard for appendiceal perforation was frequently missing or inconsistent in the previous studies. Laparoscopic appendectomies were less frequent in groups 3 (52.5%, P = 0.001) and 4 (65%, P = 0.040) than in group 1 (70.7%), while group 2 (73%, P = 0.125) did not significantly differ from group 1. Median hospital stays were 2.9, 3.0, 5.1, and 6.0 days for groups 1-4, respectively. Prolonged hospital stay (≥3.7 days) was more frequent in groups 3 (77.7%, P < 0.001) and 4 (89%, P < 0.001) than in group 1 (23.4%), while group 2 (35%, P = 0.070) did not significantly differ from group 1.

Conclusion: We recommend using surgical rather than pathologic findings as the reference standard for the presence of appendiceal perforation in future investigations.
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http://dx.doi.org/10.4174/astr.2017.93.2.88DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566752PMC
August 2017

Cryptogenic multifocal ulcerous stenosing enteritis: Radiologic features and clinical behavior.

World J Gastroenterol 2017 Jul;23(25):4615-4623

Jiyoung Hwang, Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, South Korea.

Aim: To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior.

Methods: Twenty pathologically and clinically confirmed CMUSE patients (males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series (SBS; = 25), computed tomography (CT) enterography ( = 21), magnetic resonance (MR) enterography ( = 2), and abdominopelvic CT ( = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during follow-up period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated.

Results: The main symptoms were abdominal pain ( = 12) and anemia ( = 10). All patients showed small bowel strictures ( = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum ( = 47) or jejunum ( = 5). Strictures showed short-length (mean: 10.44 mm) and circumferential bowel wall thickening (mean: 5.56 mm) with layered enhancement ( = 48) that were also noted on initial SBS ( = 36) with shallow ulcers ( = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on follow-up SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence (median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures.

Conclusion: Under characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.
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http://dx.doi.org/10.3748/wjg.v23.i25.4615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5504377PMC
July 2017

Radiation dose reduction in multidetector CT in fracture evaluation.

Br J Radiol 2017 Aug 14;90(1077):20170240. Epub 2017 Jul 14.

Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital , Seoul , Republic of Korea.

Objective: To evaluate whether multidetector CT with low-dose radiation (low-dose CT) of joints can be useful when evaluating fractures.

Methods: Our study included CT scans of 398 patients, 103 shoulder cases, 109 wrist cases, 98 pelvis cases and 88 ankle cases. There were 191 females and 207 males. The low-dose CTs were performed using identical voltage and parameters with the exception of decreased (half of standard dose) tube current. Low-dose and standard-dose images were compared with regards to objective image quality, subjective evaluation of image quality and diagnostic performance for the fractures.

Results: There was no significant difference of image noise between standard-dose CT and low-dose CT in every joint (p > 0.05). Each mean value of subjective score did not show significant difference according to the dosage of the CT scan. There were no statistically significant differences in the sensitivity (96-100%), specificity (95.2-100%) or accuracy (97.9-100%) between standard-dose CT and low-dose CT (p values, 0.1336-1.000).

Conclusion: The evaluation of extremities for fractures using low-dose CT can reduce radiation exposure by about 50% compared with standard-dose CT without affecting image quality or diagnostic performance. Advances in knowledge: Low-dose CT of the extremities (shoulder, pelvis, ankle and wrist) can reduce radiation dose by about 50% compared with standard-dose CT and does not significantly affect image quality or diagnostic performance in fracture detection.
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http://dx.doi.org/10.1259/bjr.20170240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858798PMC
August 2017

Impact of high-grade obstruction on outcomes in patients with appendiceal inflammatory masses managed by nonoperative treatment.

Ann Surg Treat Res 2017 Jun 29;92(6):429-435. Epub 2017 May 29.

Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: To retrospectively assess the impact of high-grade obstructions identified on initial CT on outcomes of patients with appendiceal inflammatory masses managed by nonoperative treatment.

Methods: Institutional Review Boards approved this retrospective study and informed consent was waived. Included were 52 consecutive patients diagnosed with appendiceal inflammatory masses by CT scan and managed by nonoperative treatment. The main outcome measure was treatment failure and secondary outcomes were complications and initial and total hospital stay. Patient demographics, inflammatory markers, and CT findings for presence of an appendiceal inflammatory mass and high-grade obstruction were assessed. Patients with and without high-grade obstruction were compared for patient characteristics and outcomes using Fisher exact test and Student t-test.

Results: Among 52 patients, 14 (27%) had high-grade obstruction on CT examination at presentation. No significant differences were observed in patient characteristics (P > 0.05), treatment failure (P = 0.33), complications (P = 0.29), or initial (P = 0.73) or total (P = 0.72) hospitalization between patients with and without high-grade obstruction.

Conclusion: For patients who were managed by nonoperative treatment for appendiceal inflammatory masses, the presence of high-grade obstruction identified on initial CT scan did not significantly affect outcomes of treatment failure, complications, and initial and total hospitalization.
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http://dx.doi.org/10.4174/astr.2017.92.6.429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453876PMC
June 2017

ChREBP regulates fructose-induced glucose production independently of insulin signaling.

J Clin Invest 2016 11 26;126(11):4372-4386. Epub 2016 Sep 26.

Obese, insulin-resistant states are characterized by a paradoxical pathogenic condition in which the liver appears to be selectively insulin resistant. Specifically, insulin fails to suppress glucose production, yet successfully stimulates de novo lipogenesis. The mechanisms underlying this dysregulation remain controversial. Here, we hypothesized that carbohydrate-responsive element-binding protein (ChREBP), a transcriptional activator of glycolytic and lipogenic genes, plays a central role in this paradox. Administration of fructose increased hepatic hexose-phosphate levels, activated ChREBP, and caused glucose intolerance, hyperinsulinemia, hypertriglyceridemia, and hepatic steatosis in mice. Activation of ChREBP was required for the increased expression of glycolytic and lipogenic genes as well as glucose-6-phosphatase (G6pc) that was associated with the effects of fructose administration. We found that fructose-induced G6PC activity is a major determinant of hepatic glucose production and reduces hepatic glucose-6-phosphate levels to complete a homeostatic loop. Moreover, fructose activated ChREBP and induced G6pc in the absence of Foxo1a, indicating that carbohydrate-induced activation of ChREBP and G6PC dominates over the suppressive effects of insulin to enhance glucose production. This ChREBP/G6PC signaling axis is conserved in humans. Together, these findings support a carbohydrate-mediated, ChREBP-driven mechanism that contributes to hepatic insulin resistance.
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http://dx.doi.org/10.1172/JCI81993DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096918PMC
November 2016

Progranulin as a predictive factor of response to chemotherapy in advanced biliary tract carcinoma.

Cancer Chemother Pharmacol 2016 Nov 15;78(5):1085-1092. Epub 2016 Oct 15.

Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Korea.

Purpose: Progranulin (PGRN), characterized as an autocrine growth and survival factor, is known to stimulate the proliferation and survival of several cancer cell types. However, little is known about the prognostic role of PGRN in advanced biliary tract cancers (BTCs).

Methods: A retrospective analysis was performed on patients with advanced BTC who received palliative chemotherapy between July 2004 and November 2014. PGRN expression was immunohistochemically evaluated according to staining intensity of tumor and peritumoral cells.

Results: A total of 80 patients (39 intrahepatic, 26 extrahepatic, and 18 gallbladder tumors) were analyzed. The median age was 64 years (range 31-79), and 48 patients (60 %) were male. Thirty-five patients (44 %) had high tumor PGRN expression (PGRN positive), and there was a trend of poorer response to chemotherapy in patients with PGRN-positive tumor in terms of overall response rate (7 vs. 18 %). With a median follow-up duration of 17.7 months (range 4.9-35.1), PGRN-positive patients had worse progression-free survival (PFS) with a median of 2.7 months compared to 5.0 months for PGRN-negative patients (P = 0.023). After adjusting for possible confounding factors including sex, age, performance status, disease status, and chemotherapy agent, multivariate analysis showed that PGRN-positive tumor was a prognostic factor independently associated with poor PFS (hazard ratio 1.69, 95 % CI 1.02-2.81; P = 0.044).

Conclusion: PGRN overexpression was significantly associated with poor PFS in advanced BTCs. PGRN expression by IHC analysis might help predict treatment outcomes and provide a new target for molecular therapy.
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http://dx.doi.org/10.1007/s00280-016-3170-zDOI Listing
November 2016

Single-Shot Echo-Planar Diffusion-Weighted MR Imaging at 3T and 1.5T for Differentiation of Benign Vertebral Fracture Edema and Tumor Infiltration.

Korean J Radiol 2016 Sep-Oct;17(5):590-7. Epub 2016 Aug 23.

Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.

Objective: To compare the apparent diffusion coefficient (ADC) value using single-shot echo-planar imaging sequences at 3T and 1.5T for differentiation of benign fracture edema and tumor infiltration of the vertebral body.

Materials And Methods: A total of 46 spinal examinations were included in the 1.5T MRI group, and a total of 40 spinal examinations were included in the 3T MRI group. The ADC values of the lesion were measured and calculated. The diagnostic performance of the conventional MR image containing sagittal T2-weighted fat saturated image and each diffusion weighted image (DWI) with an ADC value with different b values were evaluated.

Results: The mean ADC value of the benign lesions was higher than that of the malignant lesions on 1.5T and 3T (p < 0.05). The sensitivity of the diagnostic performance was higher with an additional DWI in both 1.5T and 3T, but the sensitivities were similar with the addition of b values of 400 and 1000. The specificities of the diagnostic performances did not show significant differences (p value > 0.05). The diagnostic accuracies were higher when either of the DWIs (b values of 400 and 1000) was added to routine MR image for 1.5T and 3T. Statistical differences between 1.5T and 3T or between b values of 400 and 1000 were not seen.

Conclusion: The ADC values of the benign lesions were significantly higher than those of the malignant lesions on 1.5T and 3T. There was no statistically significant difference in the diagnostic performances when either of the DWIs (b values of 400 and 1000) was added to the routine MR image for 1.5T and 3T.
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http://dx.doi.org/10.3348/kjr.2016.17.5.590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007386PMC
August 2017

Usefulness of the oblique view of three-dimensional isotropic T2-weighted fast spin-echo (VISTA) in the evaluation of anterior cruciate ligament reconstruction.

Clin Imaging 2016 Jul-Aug;40(4):610-6. Epub 2016 Feb 6.

Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.

Background: To compare the diagnostic performance of the oblique sagittal and oblique coronal views of the anterior cruciate ligament (ACL) on three-dimensional (3D) volume isotropic turbo spin-echo acquisition (VISTA) images with two-dimensional (2D) fast spin-echo (FSE) T2-weighted images in the diagnosis of complications in ACL reconstruction.

Materials And Methods: This retrospective study included 74 patients. Both sequences were independently interpreted by two radiologists.

Result: There were no statistically significant differences in the sensitivity, specificity, or accuracy between the two images.

Conclusion: The diagnostic performance of the two oblique views on 3D VISTA imaging was comparable to that of 2D FSE.
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http://dx.doi.org/10.1016/j.clinimag.2016.02.007DOI Listing
December 2016

Comparison of filtered back projection and iterative reconstruction in diagnosing appendicitis at 2-mSv CT.

Abdom Radiol (NY) 2016 07;41(7):1227-36

Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.

Purpose: To compare radiologists' diagnostic performance and confidence, and subjective image quality between filtered back projection (FBP) and iterative reconstruction (IR) at 2-mSv appendiceal CT.

Methods: The institutional review board approved this retrospective study and waived the requirement for informed consent. We included 107 adolescents and young adults (age, 29.8 ± 8.5 years; 64 females) undergoing 2-mSv CT for suspected appendicitis. Appendicitis was pathologically confirmed in 42 patients. Seven readers with different experience levels independently reviewed the CT images reconstructed using FBP and IR (iDose(4), Philips). They rated both the likelihood of appendicitis and subjective image quality on 5-point Likert scales. Diagnostic confidence was assessed using the likelihood of appendicitis, proportion of indeterminate interpretations, and 3-point normal appendix visualization score. We used receiver operating characteristic analyses, Wilcoxon's signed-rank tests, and McNemar's tests.

Results: The pooled area under the receiver operating characteristic curve (AUC) was 0.96 for both FBP and IR (95% CI for the difference, -0.02, 0.02; P = 0.73). The AUC difference was not significant in any of the individual readers (P ≥ 0.21). For the majority of the readers, the diagnostic confidence was not significantly different between the two reconstruction methods. Subjective image quality tended to be higher with IR for all readers (P ≤ 0.70), showing significant differences for four readers (P ≤ 0.040).

Conclusion: When diagnosing appendicitis at 2-mSv CT in adolescents and young adults, FBP and IR were comparable in radiologists' diagnostic performance and confidence while IR exhibited higher subjective image quality than FBP.
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http://dx.doi.org/10.1007/s00261-015-0632-4DOI Listing
July 2016

Usefulness of the quantitative evaluation of diffusion-weighted mri in the diagnosis of anterior cruciate ligament tears.

J Magn Reson Imaging 2016 11 15;44(5):1116-1122. Epub 2016 Apr 15.

Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital.

Purpose: To evaluate the usefulness of the diffusion-weighted imaging (DWI) in the diagnosis of anterior cruciate ligament (ACL) tear using the contrast-to-noise ratio (CNR) and apparent diffusion coefficient (ADC) values according to the different b values.

Materials And Methods: Institutional review board approval was acquired. We evaluated 74 patients (M:F = 43:31, mean age of 44 years) who underwent 3.0 Tesla knee MR with DWI because of the possibility of ACL tear due to trauma. Region of interest measurements were performed. We (two radiologists) measured the signals of the DWI and derived ADC values on the oblique sagittal DWI with b values of 0, 600, and 1000. The diagnostic accuracies of the conventional MR image and each DWI with an ADC value with a different b value were evaluated. The CNR and ADC values were compared using the Mann-Whitney U-test. The diagnostic performances of the various imaging methods were evaluated using the sensitivity, specificity, and accuracy for differentiating between normal and ACL injury as determined by the use of conventional MRI with additional DWIs with McNemar test. The arthroscopic or clinical findings were used as the reference standard.

Results: The mean CNRs of ligament tears with b values of 600 and 1000 were significantly higher than those of normal ligament (22 versus 7 and 9 versus 4, P value < 0.05). The sensitivities and the accuracies of the DWI were significantly lower than the conventional MRIs (P value < 0.001).

Conclusions: The CNRs of the torn ACL with each b value (600 and 1000) were significantly higher those of than normal ligament, although the ADC values of the torn ligament were not different from normal ligament. Addition of the DWI to the conventional MRI did not improve diagnostic performance. J. Magn. Reson. Imaging 2016;44:1116-1122.
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http://dx.doi.org/10.1002/jmri.25256DOI Listing
November 2016

Discordance between conventional ultrasonography and ElastPQ for assessing hepatic fibrosis in chronic hepatitis B: frequency and independent factors.

J Med Ultrason (2001) 2016 Apr 5;43(2):201-10. Epub 2015 Nov 5.

Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Purpose: To investigate the frequency of discordance and to identify factors associated with discordance between ultrasonographic and elastographic grades for assessing hepatic fibrosis in Asian patients with chronic hepatitis B.

Methods: Three hundred thirty-four patients with chronic hepatitis B for which both conventional ultrasonography and liver stiffness measurements using elastography were available were included. Patients were graded as 'normal', 'chronic liver disease', or 'liver cirrhosis' by ultrasonography, and as 'no significant fibrosis', 'significant fibrosis', or 'liver cirrhosis' by elastography, and the results of these two modalities were compared. Logistic regression analyses were performed to identify independent factors associated with discordant results.

Results: Of the 334 patients, 153 (45.8 %), 115 (34.4 %), and 66 (19.8 %) patients were 'normal', 'chronic liver disease', and 'liver cirrhosis', respectively, based on the ultrasonographic grades, and 290 (86.8 %), 29 (8.7 %), and 15 (4.5 %) patients were 'no significant fibrosis,' 'significant fibrosis', and 'liver cirrhosis', respectively, based on the elastographic values. Among them, 173 (51.8 %) showed discordance with respect to severity of hepatic fibrosis. In multivariable analysis, discordance was more frequent in patients with ultrasonographic grades of 'chronic liver disease' [adjusted odds ratio (AOR), 1924; P < 0.001] and 'liver cirrhosis' (AOR, 4498; P < 0.001), whereas patients with an elastographic grade of 'liver cirrhosis' showed a negative association with discordance (AOR, 0.002; P = 0.007).

Conclusion: There was a high rate of discordance between hepatic fibrosis grades determined by ultrasonography and elastography. Considering the accuracy of liver stiffness evaluation by elastography, conventional ultrasonography might overestimate hepatic fibrosis in chronic hepatitis B.
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http://dx.doi.org/10.1007/s10396-015-0684-7DOI Listing
April 2016

[Successful Management of Periampullary Diverticular Bleeding with Hemoclipping Using Side-viewing Endoscope during Endoscopic Retrograde Cholangiopancreatography].

Korean J Gastroenterol 2016 Mar;67(3):146-9

Gastroenterology &Hepatobiliary Center and Department of Internal Medicine, Cheongju St. Mary's Hospital, Cheongju, Korea.

Periampullary diverticulum is commonly found during endoscopy and can occur at any age although its prevalence increases with age. Periampullary diverticular bleeding is a rare and difficult to diagnose during clinical practice because of its unique appearance and location. This often can lead to massive bleeding and interfere with adequate bleeding control. Endoscopic management on duodenal diverticular bleeding is limited compared to colonic diverticular bleeding due to lack of experience. Herein, we report a case of active bleeding from a periampullary diverticulum during bile duct stone extraction diagnosed by side-viewing endoscope and successfully controlled using hemoclips without any complications.
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http://dx.doi.org/10.4166/kjg.2016.67.3.146DOI Listing
March 2016

Focal hepatic solid lesions incidentally detected on initial ultrasonography in 542 asymptomatic patients.

Abdom Radiol (NY) 2016 Feb;41(2):265-72

Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung dong, Jongno-gu, Seoul, 110-746, Korea.

Purpose: The purpose of this study is to evaluate the clinical significance of focal hepatic solid lesions incidentally detected on initial ultrasonography in asymptomatic patients.

Methods: From January 2009 to December 2009, 2670 initial ultrasonographies were performed in asymptomatic population. Of these 2670 initial examinations, 681 focal hepatic solid lesions in 542 patients (mean 39.4 years, range 23-73 years) were detected. Clinical information, ultrasonography features, and the outcome of these lesions were analyzed.

Results: Six hundred and seventy four lesions (99.0%) in 539 patients (99.4%) were benign, while seven lesions (1.0%) in three patients (0.6%) proved to be malignant. Risk factors significantly associated with malignant focal hepatic solid lesions were known history of malignancy, history of hepatitis, a positive result for the hepatitis B surface antigen, and abnormally elevated tumor markers. No malignancy was identified in patients without any one of these four risk factors. Ultrasonographic features of internal heterogeneous echotexture with peripheral hypoechoic rim showed significant associations with malignancy.

Conclusions: Focal hepatic solid lesions incidentally detected on initial ultrasonography were rarely malignant, especially in patients without these risk factors. Therefore, the knowledge of these risk factors and US features is important in order to make a differential diagnosis between benign and malignant focal hepatic lesions.
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http://dx.doi.org/10.1007/s00261-015-0567-9DOI Listing
February 2016

Initial Performance of Radiologists and Radiology Residents in Interpreting Low-Dose (2-mSv) Appendiceal CT.

AJR Am J Roentgenol 2015 Dec;205(6):W594-611

1 Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.

Objective: The objective of our study was to prospectively evaluate the initial diagnostic performance and learning curve of a community of radiologists and residents in interpreting 2-mSv appendiceal CT.

Subjects And Methods: We included 46 attending radiologists and 153 radiology residents from 22 hospitals who completed an online training course of 30 2-mSv CT cases. Appendicitis was confirmed in 14 cases. Most of the readers had limited (≤ 10 cases, n = 32) or no (n = 118) prior experience with low-dose appendiceal CT. The order of cases was randomized for each reader. A multireader multicase ROC analysis was performed. Generalized estimating equations were used to model the learning curves in diagnostic performance.

Results: Diagnostic performance gradually improved with years of training. The average AUC was 0.94 (95% CI, 0.90-0.98), 0.92 (0.88-0.96), 0.90 (0.85-0.96), and 0.86 (0.80-0.92) for the attending radiologists, senior residents, 2nd-year residents, and 1st-year residents, respectively. We did not observe any notable intrareader learning curves over the training course of the 30 cases except a decrease in reading time. Diagnostic accuracy and sensitivity were significantly affected by the reader training level and prior overall experience with appendiceal CT but not by the prior specific experience with low-dose appendiceal CT.

Conclusion: The learning curve is likely prolonged and forms gradually over years by overall radiology training and clinical experience in general rather than by experience with low-dose appendiceal CT specifically.
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http://dx.doi.org/10.2214/AJR.15.14513DOI Listing
December 2015

Multiple cystic lymphangiomas of the spleen: radiologic and histopathologic findings.

J Med Ultrason (2001) 2015 Jul 6;42(3):409-12. Epub 2015 Feb 6.

Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung dong, Jongno-Gu, Seoul, 110-746, South Korea.

Splenic cyst(s) may be noted as an incidental finding on conventional imaging techniques, or as a result of evaluation of a patient with left upper quadrant pain, left shoulder pain, abdominal enlargement, or splenomegaly. Lymphangioma of the spleen is an extremely rare and benign neoplasm in adults, which is characterized by cystic dilatation of the lymphatic vessels in splenic parenchyma. This report describes a case of multiple splenic lymphangiomas in a 41-year-old female. She underwent abdominal ultrasonography for a health check-up. She had no symptoms, and physical examination did not reveal any abnormalities apart from splenomegaly. Ultrasonography and computed tomography showed multiple variable-sized cysts replacing the normal parenchyma of the spleen. There were wall calcifications in several cysts. The patient underwent laparoscopic splenectomy, and the final diagnosis was multiple lymphangiomas of the spleen.
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http://dx.doi.org/10.1007/s10396-015-0612-xDOI Listing
July 2015

Dietary intake of vitamin K in relation to bone mineral density in Korea adults: The Korea National Health and Nutrition Examination Survey (2010-2011).

J Clin Biochem Nutr 2015 Nov 17;57(3):223-7. Epub 2015 Oct 17.

Department of Food and Nutrition, Wonkwang University, Iksandae-ro, Iksan, Jeonbuk 570-749, Korea.

Low vitamin K nutritional status has been associated with increased risk of fracture, however inconsistent results exist to support the role of vitamin K on bone mineral density depending on ethnic difference and gender. Our objective was to determine vitamin K intake in Korean adults, examine correlation between vitamin K intake and bone mineral density. This study analyzed raw data from the fifth Korea National Health and Nutrition Examination Survey for adults (2,785 men, 4,307 women) aged over 19 years. Cross-sectional analyses showed only positive association between vitamin K intake and femur bone mineral density in men after adjusting bone-related factors. However, women in high tertiles of vitamin K intake had a significantly higher bone mineral density both in femur and lumber as compared to women in lowest tertiles (p<0.05). The risk for osteoporosis was decreased as vitamin K intake increased in women, but this effect was not persisted after adjusting factors. The findings of this study indicate that low dietary vitamin K intake was associated with low bone mineral density in subjects. From these results we may suggest an increase in dietary vitamin K intakes for maintaining bone mineral density. (2010-02CON-21-C, 2011-02CON-06-C).
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http://dx.doi.org/10.3164/jcbn.14-98DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4639586PMC
November 2015

Peroneal tendon pathology evaluation using the oblique sagittal plane in ankle MR imaging.

Acta Radiol 2016 May 7;57(5):620-6. Epub 2015 Aug 7.

Department of Surgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.

Background: Because peroneal tendons course from the lateral side of the proximal fibula through the posterior side of the distal fibula, correct diagnosis of the tendon pathology on an orthogonal sagittal plane can be difficult.

Purpose: To evaluate the diagnostic usefulness of oblique sagittal imaging (peroneal view) for evaluation of peroneal tendon pathology.

Material And Methods: This retrospective study included 69 patients at our institution who underwent routine ankle magnetic resonance imaging (MRI) using the peroneal view. Twenty-three patients underwent arthroscopy. Anatomic identification of the peroneal tendons on orthogonal sagittal MRI sequences and peroneal views were evaluated. Two radiologists evaluated the peroneal tendons based on an entire length view, an entire width view, and margin sharpness using a 4-point scale. Diagnostic accuracy using orthogonal sagittal and peroneal views was evaluated by calculating sensitivity, specificity, and accuracy. Arthroscopic or clinical findings were used as the reference standard.

Results: Total anatomical scores on the peroneal view were higher than those of the orthogonal sagittal views (P < 0.001). Both readers were able to identify anatomy of the tendon using the full length, full width and sharp margin, and determined that the peroneal view was better when compared with the orthogonal sagittal views (P < 0.001). Although the sensitivity and accuracy of the peroneal view in the diagnosis of peroneal tendon injury were slightly higher than orthogonal view, the values were not statistically significant.

Conclusion: Peroneal views provide better anatomic evaluation of the peroneal tendons itself, although cannot show significant superiority in the diagnostic performances.
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http://dx.doi.org/10.1177/0284185115597264DOI Listing
May 2016

Pre-operative CT predictors associated with 30-day adverse events in patients with appendiceal inflammatory masses who underwent immediate appendectomies.

Abdom Imaging 2015 Oct;40(7):2263-71

Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 110-746, 108 Pyong dong, Jongro-gu, Seoul, Korea.

Purpose: To retrospectively evaluate pre-operative CT predictors that are associated with 30-day adverse events in patients who underwent immediate appendectomies for appendiceal inflammatory masses.

Methods: This retrospective study was approved by our institutional review board, and the requirement for informed consent was waived. One hundred forty-four consecutive patients who underwent immediate appendectomies and were diagnosed with appendiceal inflammatory masses by pre-operative CT from January 2005 to December 2013 at a tertiary hospital were included. The main outcome measure was 30-day adverse events. Patient demographics and data for inflammatory markers including leukocyte counts, segmented neutrophils, and C-reactive protein levels were collected by a single radiologist. Pre- and post-operative CT findings were evaluated for features of appendiceal inflammatory masses, associated findings, and post-operative adverse events by two radiologists in a blinded fashion with consensus to assess surgical and pathologic results, post-operative outcomes, and original CT interpretations. Appendiceal inflammatory masses were defined as complicated appendicitis with a phlegmon or an abscess that was identified on pre-operative CT exam. Factors associated with 30-day adverse events were assessed using logistic regression analysis.

Results: A total of 22 (15%) of the 144 patients (mean age [±SD] 44.6 ± 22.0 years, range 3-97 years) experienced 30-day adverse events: ten intra-abdominal abscesses, three wound infections, two cases of peritonitis, two small bowel obstructions, two intra-abdominal abscesses with peritonitis, one intra-abdominal abscess with wound infection, one intra-abdominal abscess with small bowel obstruction, and one case of peritonitis with small bowel obstruction. In univariate analysis, the presence of appendicolith (odds ratio [OR] 2.49, p = 0.048) and high-grade obstruction (OR 3.79; p = 0.01) were associated with adverse events. High-grade obstruction (adjusted OR 3.05; p = 0.04) was the only independent pre-operative predictor associated with 30-day adverse events in patients with appendiceal inflammatory masses.

Conclusions: High-grade obstruction was an independent pre-operative CT predictor associated with 30-day adverse events in patients who underwent immediate appendectomies for appendiceal inflammatory masses.
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http://dx.doi.org/10.1007/s00261-015-0478-9DOI Listing
October 2015

Modified thoracolumbar injury classification and severity score (TLICS) and its clinical usefulness.

Acta Radiol 2016 Jan 8;57(1):74-81. Epub 2015 Apr 8.

Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.

Background: Thoracolumbar injury classification and severity score (TLICS) is not very reliable for assessment of injury to the posterior ligament complex, even when scored by experts. It is not reasonable to score every compression fracture or burst fracture the same as there is great variety in the severity of compression fractures and burst fractures.

Purpose: To propose a modified TLICS (mTLICS) and evaluate the performance of the mTLICS system by measuring the agreement between scores determined by radiologists using both systems and actual treatment procedure delivered.

Material And Methods: We retrospectively evaluated 134 patients with acute lumbar and thoracic spinal trauma after undergoing magnetic resonance imaging (MRI) using new mTLICS and conventional TLICS system. Inter-observer agreements of TLICS and mTLICS scores were analyzed using the kappa statistic. Nonparametric correlation analysis was used to determine correlation (R) among each score and the surgical intervention.

Results: The mTLICS system showed slightly higher correlation than TLICS (Rs, TLICS, 0.592 and 0.613 vs. mTLICS, 0.628 and 0.639). If we consider a total maximal score of 4 to be a negative surgical indication, mTLICS showed significantly higher sensitivities than TLICS, and if we consider a total minimal score of 4 to be a positive surgical indication, mTLICS showed significantly higher specificities than TLICS.

Conclusion: The mTLICS score corrects deficiencies in the TLICS system that lead to ambiguity in the radiological diagnostic criteria. mTLICS is a more suitable scoring system than TLICS for predicting surgical management accurately, especially for morphological injuries.
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http://dx.doi.org/10.1177/0284185115580487DOI Listing
January 2016