Development of a Culture-Common Formal Characteristics of Behavior - Temperament Markers Inventory (FCB-TMI-CC).

The goal was to create a brief temperament inventory grounded in the Regulative Theory of Temperament (FCB-TMI-CC), with a user-friendly, online applicability for studies in different cultures. As the regulative role of temperament is strongly revealed under meaningful stress, the study was planned within the time of the COVID-19 pandemic. To ensure high diversity in terms of culture, economic and environmental conditions, data from nine countries (Poland, United States of America, Italy, Japan, Argentina, South Korea, Ireland, United Kingdom and Kazakhstan) were utilized (min. N = 200 per country). Validation data were gathered on the level of COVID-19 stressors, posttraumatic stress disorder (PTSD), depression, anxiety and stress symptoms, and Big Five personality traits. Multigroup confirmatory factor analysis served as the basis for the inventory's construction. The final culture-common version includes 37 items (5-6 in each of the 7 scales) and covers the core aspects of temperament dimensions. Temperament structure was confirmed to be equivalent across measured cultures. The measurement is invariant at the level of factor loadings and the reliability (internal consistency) and theoretical validity of the scales were at least acceptable. Therefore, the FCB-TMI-CC may serve as a valuable tool for studying temperament across diverse cultures and facilitate cross-cultural comparisons.

Mother-Adolescent Discrepancies in Reporting Sleep Disturbances: Effects of Diagnosis and Mother's Occupation.

BACKGROUND: Sleep disturbances are common in children and adolescents. However, they are rarely diagnosed and treated because parents, who often report the symptoms, may fail to notice the problems. Factors that can affect parent-child discrepancy include child's diagnosis, parent's occupation, and child's sex. The current study retrospectively analyzed the effect of these factors on parent-child discrepancies of sleep disturbance scores. METHODS: Data for sleep-related items in Youth Self-Report (YSR) and Child Behavior Checklist (CBCL) from 2014 to 2020 August in South Korea were collected from psychiatric outpatient clinics at Konkuk University Medical Center and Soonchunhyang University Hospital. RESULTS: A three-way analysis of variance revealed main effect of diagnosis type and interaction between diagnosis type and mother's occupation. Discrepancies were greater for mood and anxiety disorders compared to conduct-related disorder. Interaction effect revealed greater discrepancies in mood disorders for reports completed by working mothers compared to homemaker mothers. CONCLUSION: The results of this study emphasize the need to explore with caution the self-reported sleep disturbances in adolescents, especially in those with mood disorders. The results also suggest that mother's occupation should be taken into account when evaluating sleep reports of parents and adolescents.

Epithelioid trophoblastic tumor presenting as an ovarian mass in a postmenopausal woman.

Epithelioid trophoblastic tumor (ETT) is a rare neoplasm derived from chorionic-type intermediate trophoblastic cells. Most cases of ETT are intrauterine and present during reproductive age. We report a case of ovarian ETT developing 47 yr after the patient's last pregnancy. A 75-yr-old woman transferred to our hospital because of multiple pulmonary masses which was diagnosed as sqaumous cell carcinoma in another hospital. PET-CT revealed a huge solid mass in the pelvic cavity, suspicious for ovarian malignancy. Serum ß-hCG was 57,971 mIU/mL. Hysterectomy and bilateral salpingo-oophorectomy were performed. Gross examination showed an enlarged right ovary, measuring 17×14×7 cm. The cut surface was yellow-tan and solid with extensive areas of necrosis. The uterus was unremarkable. The histologic finding was the same as the previous lung biopsy. The tumor consisted of monomorphic cells with abundant eosinophilic cytoplasm, forming solid sheets and nests. There was geographic tumor cell necrosis with hyaline materials. Immunohistochemically, cytokeratin 7 and p63 showed diffuse reactivity in the tumor cells. There was focal staining for ß-hCG. Ki-67 proliferative index was about 80%. This case indicates that ETT can rarely occur in postmenopausal women and to the best of our knowledge, our patient is the oldest reported case of ETT to date.

CT differentiation of 1-2-cm gallbladder polyps: benign vs malignant.

PURPOSE: To evaluate MDCT findings of 1-2-cm sized gallbladder (GB) polyps for differentiation between benign and malignant polyps. METHODS: Institutional review board approval was obtained, and informed consent was waived. Portal venous phase CT scans of 1-2-cm sized GB polyps caused by various pathologic conditions were retrospectively reviewed by two blinded observers. Among the 36 patients identified, 21 had benign polyps with the remaining 15 having malignant polyps. Size, margin, and shape of GB polyps were evaluated. Attenuation values of the polyps, including mean attenuation, maximum attenuation, and standard deviation, were recorded. As determined by visual inspection, the degree of polyp enhancement was evaluated. Using these CT findings, each of the two radiologists assessed and recorded individual diagnostic confidence for differentiating benign versus malignant polyps on a 5-point scale. The diagnostic performance of CT was evaluated using a receiver operating characteristic curve analysis. RESULTS: There was no significant difference in size between benign and malignant GB polyps. Ill-defined margin and sessile morphology were significantly associated with malignant polyp. There was a significant difference in mean and maximum attenuation values between benign and malignant GB polyps. Mean standard deviation value of malignant polyps was significantly higher than that of benign polyps. All malignant polyps showed either hyperenhancement or marked hyperenhancement. A z value for the diagnosis of malignant GB polyps was 0.905. CONCLUSION: Margin, shape, and enhancement degree are helpful in differentiating between benign and malignant polyps of 1-2-cm sizes.

Contribution of dysfunctional sleep-related cognitions on insomnia severity: a network perspective.

STUDY OBJECTIVES: Various models of insomnia stress the role of cognitive components, such as dysfunctional sleep-related beliefs, in maintenance and exacerbation of insomnia. This study aimed to use network analysis to identify the particular beliefs that are central and have strong associations with insomnia severity. In addition, we aimed to use a relative importance network to map out predictive pathways between types of dysfunctional beliefs and insomnia severity. METHODS: This study was a retrospective study, with data collected from 219 patients with insomnia. Patients' responses to the Dysfunctional Beliefs about Sleep Scale-16 (DBAS-16) and Insomnia Severity Index (ISI) were collected. All network analyses were performed using R Studio to produce 3 networks: (1) DBAS-16 network, (2) DBAS-16 and ISI network, and (3) relative importance network containing DBAS-16 subscales and ISI. RESULTS: Beliefs reflecting overestimation of negative consequences of sleep (eg, "insomnia is ruining life"), loss of ability (eg, "worry about losing abilities to sleep"), and unpredictability (eg, "can't predict sleep quality") were identified as most central and strongly associated with insomnia severity. Worry/helplessness about insomnia had the largest predictive value on insomnia severity, and also acted as a mediator between other subscales and insomnia severity. CONCLUSIONS: The results of our study suggest that overestimation of negative consequences, loss of ability, and unpredictability are key beliefs that exacerbate and maintain insomnia, thus supporting existing cognitive models of insomnia. CITATION: Cha EJ, Hong S, Kim S, Chung S, Jeon HJ. Contribution of dysfunctional sleep-related cognitions on insomnia severity: a network perspective. J Clin Sleep Med. 2024;20(5):743-751.

Network Analysis Revealed the Role of Helplessness as a Central Feature Among Late-Life Depressive Symptoms in Patients With Mild Cognitive Impairment and Early Stage Dementia.

OBJECTIVE: It has been reported that depressive symptoms in older adults are different from those in younger adults, especially when accompanied by cognitive decline. However, few studies have investigated the network structure of depressive symptoms in this population. METHODS: The participants consisted of 627 older adults (>60 yr) who were diagnosed with mild cognitive impairment (MCI) or early stage dementia. Among them, 36.7% were male and the mean age was 76.20±7.71 years. The Korean form of Geriatric Depression Scale (KGDS) was used to evaluate their depressive symptoms and network analyses were performed using bootnet R-package to identify the central features among depressive symptoms. RESULTS: Of all the KGDS items, we found that KGDS 2 (often feel helpless) had the highest node strength followed by KGDS 21 (in good spirits), KGDS 14 (not confident at all), and KGDS 15 (cheerful and happy). In terms of node betweenness, KGDS 2 also showed the highest value. The edge weights of edges connected to node KGDS 2 were strongest in KGDS 3 (restless and fidgety) and KGDS 28 (easily get tired). CONCLUSION: In this study, we presented which symptoms are central among the elderly with MCI and early stage dementia. This result not only increases the understanding of depressive symptoms in this group but would also help determine target symptoms in the treatment program.

EZH2 expression in invasive lobular carcinoma of the breast.

BACKGROUND: Invasive lobular carcinoma (ILC) is the second most common histologic type of breast cancer, but the prognosis of ILC is still controversial. Enhancer of Zeste homolog 2 (EZH2), the catalytic subunit of the Polycomb repressive complex 2 (PRC2), is frequently overexpressed in various cancers. This study evaluated the relationship between clinicopathologic characteristics and EZH2 expression. METHODS: We retrospectively reviewed the medical records of 54 patients with ILC and selected 49 cases of ILC. Immunohistochemistry for EZH2 was undertaken. RESULTS: We defined ILC as discohesive cells with a linear or nonlinear growth pattern. No statistically significant difference was found for most variables, including multifocality, menstrual status, body mass index, tumor stage (pT), lymph node stage (pN), estrogen receptor, and progesterone receptor. In contrast, nuclear grade was statistically significant and EZH2 expression was associated with high nuclear grade. In total, 80% of nuclear grade 3 cases had an EZH2 score of 4, and 86% of nuclear grade 1 cases had EZH2 scores of 1 and 2. Our cases had a score of 3 for tubule formation and a score of 1 for mitosis, and so the histologic grading consisted of grades 1 (7 cases) and 2 (42 cases) depending on the nuclear grade. CONCLUSION: Although EZH2 could not predict survival in our study, EZH2 expression was associated with a high nuclear grade. Most ILCs have histologic grade 2 with nuclear grade 2 or 3. Therefore, our opinion is that if ILC is diagnosed by separating the classic type and variants and considering both EZH2 expression and nuclear grade, EZH2 overexpression could help and the Nottingham grading system would be more accurate prognostic factor.

Central features in health-related quality of life in older adults: network analysis using nationwide survey data.

BACKGROUND: Population ageing is a global phenomenon that necessitates consideration of health-related quality of life (HRQoL) in older adults. Previous studies have investigated related factors including mobility, social support and living situations. AIMS: This study aimed to provide a network perspective on factors related to HRQoL. METHOD: Cross-sectional nationwide data were obtained from the Korean National Health and Nutrition Examination Survey conducted from 2018 to 2020 for network analyses. Data for participants aged 65 years or above were analysed, resulting in a total of 4317 eligible cases. The variables included were EQ-5D (a measure of HRQoL), household income, education, living situation, subjective perceived health, Charlson Comorbidity Index (a measure of medical comorbidities), stress, exercise per week, alcohol consumption and smoking. Three networks were produced: (a) EQ-5D dimensions network, (2) EQ-5D dimensions, lifestyle and psychosocial factors network, and (3) overall EQ-5D index, lifestyle and psychosocial factors network. Node centralities, bridge centralities and edges of the networks were examined. RESULTS: The most central EQ-5D dimension was the ability to carry out usual activities. In the second network, subjective health, stress and anxiety/depression were revealed as nodes with high bridge centralities. Subjective health, exercise, and Charlson Comorbidity Index were nodes closely linked to the overall EQ-5D index. CONCLUSIONS: The results emphasise the importance of enhancing functional independence and subjective health cognition, increasing routine exercise and reducing stress as targets for interventions to improve HRQoL in older adults.

Network structure of insomnia symptoms in shift workers compared to non-shift workers.

Insomnia is a commonly occurring sleep problem in shift workers. So far, no studies have investigated how insomnia symptoms present differently in shift workers and non-shift workers. The purpose of this study was to compare the network structures and centrality indices of shift and non-shift workers using network analysis and network comparison test. Participants included 1339 hospital employees, where 542 were shift workers and 797 were non-shift workers. Overall, a significant difference between network structures were observed. In particular, daytime dysfunction emerged as a strongly connected symptom in shift workers, as evidenced by strength centrality. Increased use of sleeping medication and decreased habitual sleep efficiency were more strongly associated with increased daytime dysfunction in shift workers. Sleep latency and sleep quality were also more strongly linked in shift workers. These results are in part attributable to differing causes of insomnia in shift and non-shift workers. Furthermore, the results indicate that shift workers are more vulnerable and susceptible to changes in sleep-related indices, such as sleep efficiency and latency. The findings suggest that certain insomnia symptoms are more consequential in shift workers, emphasizing the need for a differentiated approach in treating insomnia according to shift work.

Identifying the Bridge Between Anxiety Response to COVID-19 and Depression Symptoms in General Population: A Network Analysis.

BACKGROUND: Previous studies have suggested links between anxiety response to the novel coronavirus (COVID-19) and depression symptoms in general population. However, a symptom-level investigation has not been reported. OBJECTIVE: This study aimed to use network analysis to identify central symptoms and bridge symptoms that link COVID-19 anxiety and depression. METHODS: Data from 1788 participants were analyzed. Coronavirus anxiety and depression symptoms were measured using the Stress and Anxiety to Viral Epidemics-6 Items Scale and the Patient Health Questionnaire-9, respectively. Network analysis was performed using R. RESULTS: The results revealed 'thoughts of suicide or self-harm' from Patient Health Questionnaire-9 and 'worry about others avoiding me' from Stress and Anxiety to Viral Epidemics-6 Items Scale as bridge symptoms. Findings suggest direct relationship between fear of social isolation and thoughts of suicide or self-harm. 'Feeling tired with little energy' and 'trouble concentrating' are strongly linked to 'thoughts of suicide or self-harm', suggesting these symptoms as risk factors for suicidal or self-injurious thoughts during the pandemic. CONCLUSIONS: The findings suggest fear of social isolation as a risk factor for developing thoughts of suicide or self-harm. These results should be taken into account during evaluation of risk of suicide or mental health interventions for the pandemic.

Central Symptoms of Insomnia in Relation to Depression and COVID-19 Anxiety in General Population: A Network Analysis.

BACKGROUND: Insomnia is prevalent among the general population, and studies have shown an increase in insomnia symptoms during the novel coronavirus (COVID-19) pandemic. Despite numerous studies of insomnia, few studies have investigated insomnia symptoms in detail. In this study, we used network analysis to investigate interactions between insomnia symptoms in the general population. Furthermore, given the effect of COVID-19 on mental health, we also investigated how anxiety response to COVID-19 and depression related to insomnia symptoms. METHODS: Data from 785 non-infected participants were used. The Insomnia Severity Index (ISI), Stress and Anxiety to Viral Epidemics-6 Scale (SAVE-6), and Patient Health Questionnaire-9 (PHQ-9) were used to measure insomnia symptoms, anxiety response to COVID-19, and depression, respectively. Network analysis was performed using R Studio. Centrality indices and edge weights were obtained, and each index was evaluated using bootstrapping methods. RESULTS: The network revealed ISI7 (worry about current sleep pattern) to be the most central insomnia symptom. ISI7 was strongly connected to SAVE-6 total score, and ISI2 (difficulty staying asleep) was strongly connected to PHQ-9 total score. CONCLUSION: High centrality of ISI7 supports the role of dysfunctional cognitions in etiological models of insomnia and thus the cognitive behavioral therapy for insomnia. The relationship between ISI7 and SAVE-6 is explained by transposition of worry and fear of contracting COVID-19 to worry about sleep patterns. The link between ISI2 and PHQ-9 necessitate further investigations of whether specific symptoms of insomnia are more associated with depression.

The effect of COVID-19 pandemic on sleep-related problems in adults and elderly citizens: An infodemiology study using relative search volume data.

COVID-19 has had a substantial national impact in South Korea, causing negative psychological responses including sleep-related problems. Literature indicates sleep problems among the general population have been reported to be as high as around 35.7% during the first 8 months of COVID-19. Therefore, the aim of this study was to investigate the impact of COVID-19 pandemic on sleep problems among the general population using relative search volume (RSV) data, and whether there are any differences by age and time periods spanning before and during the pandemic. RSV data was collected from the most commonly used search engine in South Korea, NAVER. Search terms were grouped into 4 categories: insomnia, other sleep disorders, sleeping pills, and sleeping pill side effects. Time points were divided into 4 periods, each 7 months long: 7 months before COVID-19 (T0), first confirmed COVID-19 case to 7 months after (T1), 7 to 14 months (T2), and 14 to 21 months (T3). A 2x4 factorial Analysis of Variance was conducted to investigate main effects and interactions between age and time periods. Main effects and interaction effects of age and time periods were significant for all search term groups. For all search terms, both age groups showed dramatic increase from T0 to T1. In age group 60 or above, RSV continued to increase for other sleep disorders and sleeping pill. Insomnia and sleeping pill side effects showed decreasing trend at T3. In general, sudden increase in RSV after occurrence of COVID-19 followed by slow decline were observed. However, for age group 60 or above, RSV values of other sleep disorders and sleeping pills continued to increase, suggesting slower recovery of psychological impact with increasing age. Overall, the results underscore the importance of implementing preventive measures for monitoring sleep problems during the pandemic, especially in the elderly.

A network analysis of panic symptoms in relation to depression and anxiety sensitivity in patients with panic disorder.

BACKGROUND: Panic disorder is an anxiety disorder presenting panic attacks as a defining feature, with cognitive and behavioral symptoms that are associated with the panic attacks. Recently, the use of network analysis is increasing to determine the symptoms and mutual reinforcing patterns that conceptualize a mental disorder. This study aimed to improve our understanding of panic disorder by estimating a network structure of its symptoms. METHOD: Data from 257 patients diagnosed with panic disorder who visited the outpatient psychiatric clinic from 2018 to 2020 were collected. Panic attacks, cognitive and behavioral symptoms concerning the panic attacks, depression, and anxiety sensitivity dimensions such as fear of cardiovascular symptom, fear of publicly observable anxiety reaction, fear of respiratory symptom, and fear of cognitive dyscontrol were computed. Bootstrapping was applied to estimate the 95% confidence intervals for each edges. RESULTS: The resulting network indicated fear of cognitive dyscontrol, impairment in social functioning, phobic avoidance of situations, and panic-focused anticipatory anxiety to be central symptoms in panic disorder. Interestingly, panic attacks and distress during panic did not emerge as central. Depression was strongly linked to fear of cognitive dyscontrol. LIMITATIONS: The sample size limits network comparison tests between those with comorbid depression or agoraphobia. In addition, the cross-sectional design limits the opportunity to draw causal conclusions regarding the symptoms. CONCLUSIONS: These results have implications in etiology of panic disorder and support the efficaciousness of Cognitive Behavioral Therapy. Future network analyses may employ longitudinal designs to investigate causal relationships between the symptoms.

Interlayer structure and magnetic field-induced orientation of modified nanoclays in polymer aqueous solution.

Structural changes and orientation of organically modified montmorillonite (Mt) were investigated by employing synchrotron small-angle X-ray scattering. Mt was modified with various cationic compound [3-(methacryloylamino)propyl]-trimethyl ammonium chloride (MPTC) contents (1.5, 3, 6, 12, and 18 CEC (cation exchange capacity) per 1 CEC of Mt). There are two types of modified Mt structures, lateral monolayer and paraffin type monolayer, in accordance with the MPTC contents. A paraffin-type monolayer is more dominant than a lateral monolayer for efficient packing of MPTC between Mt layers as the MPTC contents increase. In 10 wt% of the modified Mt series oriented in 1 M of polyacrylamide aqueous solution using a magnetic field (1.2 Tesla), the modified Mt series oriented parallel to the magnetic field within 200 s.

Tailoring biomimetic polymer networks towards an unprecedented combination of versatile mechanical characteristics.

Biomimetic polymeric materials, adopting the basic molecular design principles of biological materials, have been extensively studied in recent years but it is still challenging to combine assorted mechanical characteristics in a single material. Here, we present a simple and effective strategy to prepare mechanically robust yet resilient biomimetic polymer networks by utilizing dual noncovalent and covalent cross-linkings. Tailoring the dual cross-links consisting of thiourea noncovalent interactions and epoxy-amine covalent linkages in the biomimetic polymer networks enables a rare combination of excellent elastic modulus (1.1 GPa), yield stress (39 MPa), extensibility (320%), as well as complete strain and performance recovery after deformation at room temperature. The biomimetic polymer networks also exhibit highly adaptive mechanical properties in response to multiple-stimuli including strain rate, temperature, light, and solvent.

PCDHGA12 methylation biomarker in bronchial washing specimens as an adjunctive diagnostic tool to bronchoscopy in lung cancer.

The use of bronchoscopy is central to the diagnosis of lung cancer. However, the sensitivity of bronchoscopy is low. In addition, bronchial washing cytology, which is a routine adjunctive test, does not significantly improve the performance of bronchoscopy owing to its low sensitivity. To enhance the diagnostic performance of bronchoscopy, the protocadherin GA12 (PCDHGA12) methylation biomarker in bronchial washings was introduced as a novel adjunctive diagnostic test. A total of 98 patients who underwent bronchoscopy owing to suspicion of lung cancer were analyzed. Cytological examination and PCDHGA12 methylation biomarker testing of the bronchial washing fluid were performed. The performance of the tests was analyzed. The final diagnosis in 60 patients was lung cancer and in 38 patients was benign disease. The PCDHGA12 methylation biomarker had a sensitivity of 75.0%, a specificity of 78.9% and a positive predictive value (PPV) of 84.9%, whereas cytological assessment had a sensitivity of 45.0%, a specificity of 92.1% and a PPV of 90%. Patients with positive PCDHGA12 methylation test had an odds ratio for lung cancer of 11.25 (confidence interval, 4.25-29.8) compared with negative subjects. The combination of the two tests exhibited an increased sensitivity (83.3%), a specificity of 71.1% and a PPV of 82.0%. Furthermore, considering the non-diagnostic bronchoscopy group alone, the test demonstrated a sensitivity of 61.9% and a specificity of 78.9%. The results of the present study demonstrated that PCDHGA12 methylation, as a lung cancer biomarker in bronchial washings, may be a used as an adjunctive test to bronchoscopy.

[Expression of caveolin in hepatocellular carcinoma: association with unpaired artery formation and radiologic findings].

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is becoming one of the common malignant tumors worldwide, and it is characterized by its high vascularity. Caveolin is the major structural protein in caveolae, which are small omega-shaped invaginations within the plasma membrane. Caveolin has been implicated in mitogenic signaling, oncogenesis and angiogenesis. The expression of caveolin-1 and -2 in HCC and its potential relationship with angiogenesis has not been examined. METHODS: Paraffin sections of 35 HCC specimens were immunostained with caveolin-1, caveolin-2, alpha-smooth muscle actin, and CD34 antibodies. In addition, the expression of caveolin-1 and -2 mRNA in HCC was examined. The relationship between the radiological findings and the number of unpaired arteries and microvessel density (MVD) was also investigated. RESULTS: Caveolin-1 and -2 were expressed in the sinusoidal endothelial cells in 20 out of 35, and 18 out of 35 HCC specimens, respectively. Caveolin-1 and -2 were also expressed in the smooth muscle cells of the unpaired arteries in 26 out of 35, and 18 out of 35 HCC specimens, respectively. Increased expression of caveolin-1 and -2 mRNA was detected in 26.7% and 33.3% of the tumor specimens, respectively, compared with the corresponding non-tumorous adjacent liver tissues. There was a significant correlation between expression of caveolin-1, -2 in the smooth muscle cells of unpaired arteries and the number of unpaired arteries. The number of unpaired arteries in HCCs was found to be associated with the degree of contrast enhancement in the arterial phase imaging. However, it did not correlate with the degree of MVD. CONCLUSIONS: These findings suggest that the expression of caveolin-1, -2 is associated with the formation of unpaired arteries in HCC. In addition, there is a correlation between the degree of contrast enhancement of the HCC in the arterial phase image and the number of unpaired arteries.

Highly anisotropic thermal conductivity of discotic nematic liquid crystalline films with homeotropic alignment.

Discotic nematic liquid crystal (DNLC) films are prepared by thermal treatment and a photo-crosslinking reaction inside sandwiched glass plates. The DNLC films exhibit outstanding in-plane thermal conductivity which is much larger than cross-plane thermal conductivity. The homeotropic alignment and higher crosslinking density of DNLCs in the films further increase the thermal conductivity anisotropy.

Clinicopathologic Characteristics and Mutational Status of Succinate Dehydrogenase Genes in Paraganglioma of the Urinary Bladder: A Multi-Institutional Korean Study.

CONTEXT: - Because of the limited number of available primary bladder paraganglioma (PBPG) cases, the rates of succinate dehydrogenase (SDH) mutations and the clinicopathologic characteristics of SDH-deficient tumors have not been fully studied. OBJECTIVE: - To define the clinicopathologic and molecular characteristics of PBPGs. DESIGN: - A total of 52 PBPGs were collected retrospectively. SDHA and SDHB immunohistochemical stains were performed. In cases of SDHB expression loss, mutation analyses of SDHB, SDHC, and SDHD were performed. RESULTS: - The clinicopathologic features were analyzed for 52 cases (M:F = 27:25), with a mean age of 56 years (range, 22-79 years). Tumor sizes were 0.5 to 8 cm (mean, 2.4 cm). Tumor necrosis was present in 5 of 52 cases (10%), involvement of muscularis propria in 41 (79%), and lymphovascular tumor invasion in 6 (12%). During a mean follow-up period of 41 months (range, 1-161 months), 3 of 52 patients (6%) developed metastases, but no one died from the disease. Immunohistochemistry for SDHA and SDHB showed that all cases were SDHA intact. Among them, 43 cases had intact SDHB, whereas 9 cases were SDHB deficient. Compared with the SDHB-intact cases, the SDHB-deficient cases were characterized by large tumor sizes (4.5 versus 1.9 cm; P < .001), a higher number of mitoses per 10 high-powered fields (2.6 versus 0.1; P = .002), and frequent lymphovascular tumor invasion (33% versus 7%; P = .02) and metastases (22% versus 2%; P = .02). Mutational analyses for SDHB, SDHC, and SDHD were performed in 9 SDHB-deficient cases. Among them, 6 cases were successfully sequenced and revealed SDHB mutations only. CONCLUSIONS: - Large tumor size, a higher number of mitoses, and the presence of lymphovascular tumor invasion and SDHB mutations suggest malignant paraganglioma.

Miniatured blood glucose measurement module interfaced with cellular phone.

Chronic diabetes requires systematic disease management that considers the patients' personal characteristics such as age and sex. The bureaucratic complexity of the Korean medical system lowers the efficiency of diabetes management. The present study developed a miniature blood glucose meter interfaced through the serial port of a cellular phone. The measured glucose level is displayed and efficiently managed by the customized GUI program run on the mobile platform. The present results demonstrate a new medical application example of mobile telecommunication technology.