Clinicoradiological Features of Pulmonary Cryptococcosis in Immunocompetent Patients.

Purpose: To assess the clinicoradiological features of pulmonary cryptococcosis in immunocompetent patients. Materials and Methods: This retrospective study included immunocompetent patients who had been diagnosed with pulmonary cryptococcosis on the histopathologic exam and underwent chest CT between January 2008 and November 2019. Imaging features were divided into major imaging patterns, distributions, and ancillary imaging findings. Univariable analysis was performed to evaluate clinicoradiological features according to the presence of serum cryptococcal antigen. Results: Thirty-one patients were evaluated (mean age: 60 years, range: 19-78 years). A single nodular lesion confined to a single lobe was the most common imaging pattern (14/31, 45.2%). Serum cryptococcal antigen tests were performed in 19 patients (19/31, 61.3%). The presence of serum cryptococcal antigen was observed in six patients (6/19, 31.6%), all of whom showed a consolidation-dominant pattern. The presence of serum cryptococcal antigen was significantly associated with the consolidation-dominant pattern compared to those associated with a nodule-dominant pattern (p = 0.011). Conclusion: A combination of CT findings of consolidation and a positive serum cryptococcal antigen test may be helpful for diagnosing pulmonary cryptococcosis in immunocompetent patients.

[Pathophysiology and Role of Coronary CT Angiography in Stable Angina]. / ì•ˆì •í˜• 협심증의 병태생리 및 관상동맥 CT í˜ˆê´€ì¡°ì˜ìˆ ì˜ ì—­í• .

The clinical concept of coronary artery disease (CAD) has seen a paradigm shift over the last decade. CAD is mostly a progressive disease, and patients with CAD can develop acute coronary syndromes at any point in disease progression. In this clinical context, a new term, "chronic coronary syndrome," was published in the 2019 European Society of Cardiology guidelines, reflecting the importance of early diagnosis and active management. Recent advances have been made in the evaluation of CAD using coronary CT angiography (CCTA). The clinical usefulness of CCTA in patients with stable angina or chronic coronary syndrome begins with the detection of early asymptomatic CAD. The characterization of atherosclerotic plaque and its role in determining treatment strategies for CAD have been demonstrated for all stages of the disease. This review describes the pathophysiology of stable angina to aid in the understanding of the clinical applications of CCTA.

[Mediastinal Teratoma: A Pictorial Essay]. / ì¢ ê²©ë™ ê¸°í˜•ì¢ : 임상 화보.

The mediastinum is the most prevalent site of extragonadal teratomas. Patients with mediastinal mature teratomas are usually young adults, and the condition does not show significant sexual differences. Mediastinal teratomas are mostly located in the anterior mediastinum. Patients are usually asymptomatic, although they can have several complications when the teratomas become large or rupture. Most mediastinal teratomas can be diagnosed using CT. Diagnosing ruptured or malignant teratomas is challenging because of their atypical clinical and radiological presentations. In this article, we describe various manifestations of mediastinal teratomas, with an emphasis on radiologic features.

Clinical implication of interstitial lung abnormality in elderly patients with early-stage non-small cell lung cancer.

BACKGROUND: Interstitial lung abnormality (ILA) is closely related to lung cancer. This study aimed to assess whether the presence of ILA is associated with the clinicoradiological features of elderly patients (≥70 years) with early-stage non-small cell lung cancer (NSCLC). METHODS: Elderly patients who underwent surgical resection for stage I or II NSCLC with preserved lung function between 2012 and 2019 were retrospectively identified. ILA was evaluated using a three-point scale. Univariate analyses were performed for clinicoradiological features based on the presence of ILA. Logistic and linear regression analyses were performed for cancer staging and tumor size, respectively. RESULTS: A total of 254 patients were evaluated. The presence of ILA (score = 2) was significantly associated with male sex, current or former smoker status, higher pack-years of smoking, low forced expiratory volume in one second/forced vital capacity ratios and diffusing capacity of the lung for carbon monoxide, and presence of emphysema (≥5%). Tumor characteristics, such as lower lobe and outer one-third location, squamous cell carcinoma, and higher cancer stage (stage II) were significantly associated with ILA. The presence of ILA independently predicted a higher cancer stage (adjusted odds ratio, 1.81; 95% confidence interval, 1.10-2.96; p = 0.02) and a larger tumor size in linear regression analysis (p = 0.04). CONCLUSIONS: Patients with ILA showed clinicoradiological features similar to those of idiopathic pulmonary fibrosis in elderly patients with early-stage NSCLC. Identifying the clinical implications of ILA in early-stage lung cancer will guide clinicians in providing appropriate management for these patients.

Late-infantile GM1 gangliosidosis: A case report.

RATIONALE: Monosialotetrahexosylganglioside (GM1) gangliosidosis is a rare lysosomal storage disorder caused by the deficiency of ß-galactosidase. Because clinical symptoms of GM1 gangliosidosis overlap with other neurodevelopmental disorders, the diagnosis of this disease is not easy, specifically in late infantile GM1 gangliosidosis. This report described a case of late-infantile GM1 gangliosidosis mistaken for juvenile idiopathic arthritis. PATIENT CONCERNS: A 16-year-old girl was referred to our hospital due to persistent multiple joint deformities and mental retardation, which could not be explained by juvenile idiopathic arthritis. DIAGNOSIS: We made a diagnosis of late infantile GM1 gangliosidosis through enzyme assays and genetic testing after a skeletal survey. INTERVENTIONS: The patient underwent cervical domeplasty and laminectomy for cord compression and received rehabilitation treatment. OUTCOMES: The patient is receiving multidisciplinary care at a tertiary center for variable skeletal disease and conditions associated with GM1 gangliosidosis. LESSONS: Late infantile GM1 gangliosidosis should be considered in the differential diagnosis of progressive neurologic decline and skeletal dysostosis.

Predictive Value of Interstitial Lung Abnormalities for Postoperative Pulmonary Complications in Elderly Patients with Early-stage Lung Cancer.

PURPOSE: Identifying pretreatment interstitial lung abnormalities (ILAs) is important because of their predictive value for complications after lung cancer treatment. This study aimed to assess the predictive value of ILAs for postoperative pulmonary complications (PPCs) in elderly patients undergoing curative resection for early-stage non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Elderly patients (age ≥ 70 years) who underwent curative resection for pathologic stage I or II NSCLC with normal preoperative spirometry results (pre-bronchodilator forced expiratory volume in 1 s to forced vital capacity [FVC] ratio > 0.70 and FVC ≥ 80% of the predicted value) between January 2012 and December 2019 were retrospectively identified. Univariable and multivariable regression analyses were performed to assess risk factors for PPCs. The Kaplan-Meier method and log-rank test were used to analyze the relationship between ILAs and postoperative mortality. One-way analysis of variance was performed to assess the correlation between ILAs and hospital stay duration. RESULTS: A total of 262 patients (median age, 73 [interquartile range, 71-76] years; 132 male) were evaluated. A multivariable logistic regression model revealed that, among several relevant risk factors, fibrotic ILAs independently predicted both overall PPCs (adjusted odds ratio [OR], 4.84; 95% confidence interval [CI], 1.35-17.38; p=0.016) and major PPCs (adjusted OR, 8.72; 95% CI, 1.71-44.38; p=0.009). Fibrotic ILAs were significantly associated with higher postoperative mortality and longer hospital stay (F=5.21, p=0.006). CONCLUSION: Pretreatment fibrotic ILAs are associated with PPCs, higher postoperative mortality, and longer hospital stay.

Audiologic outcomes and complications of active middle ear implantation in older adults.

BACKGROUND: A few studies have reported the use of middle ear implants (MEIs) in older adults. OBJECTIVES: To evaluate the audiologic outcomes and postoperative complications of MEIs in older adults. METHODS: This retrospective study reviewed audiologic data and medical records from a single referral centre. We identified 34 patients aged ≥65 years who underwent middle ear implantation using the Vibrant SoundbridgeTM device. Preoperative audiometric testing and postoperative aided audiometric testing were performed to evaluate the functional hearing gain at 1 year postoperatively. Patients were divided into 2 groups depending on whether they underwent explantation because of poor hearing benefit. RESULTS: Follow-up duration ranged from <1 to 5.3 years. The functional gain with MEIs significantly improved relative to the preoperative air conduction thresholds at 0.5, 1, 2, and 4 kHz. Eight patients underwent explantation and 7 lost their external audio processor devices. Those who removed their implants because of the poor hearing (group 1) showed significantly worse hearing thresholds at 1 kHz and speech discrimination scores than the others (group 2). CONCLUSIONS AND SIGNIFICANCE: MEIs for auditory rehabilitation can provide improved speech recognition and significant functional gains in older adults. Patients must be given appropriate preoperative explanations regarding the expected outcomes.

Blastic plasmacytoid dendritic cell neoplasm of the breast: A case report and review of the literature.

RATIONALE: Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an uncommon and aggressive hematologic malignancy that arises from plasmacytoid dendritic cells. BPDCN typically presents with skin lesions with or without involvement of lymph nodes, peripheral blood, or bone marrow. However, breast involvement of BPDCN is rare and there has been no report describing the radiologic features of BPDCN within breast parenchyma. PATIENT CONCERNS: We report a case of a 47-year-old woman who presented with an incidentally detected hypermetabolic breast lesion on PET/CT with concurrent right cheek plaque. DIAGNOSES: Skin biopsy was performed for the right cheek plaque. Mammography and breast ultrasonography were performed to evaluate the breast lesion. The lesion was depicted as a 2.5 cm sized focal asymmetry on mammogram and an irregular heterogeneous echoic mass within the mammary zone of the right upper outer breast. Core needle biopsy was performed for the breast lesion. Histologic diagnosis of the two lesions was BPDCN. INTERVENTIONS: The patient was treated with induction and consolidation chemotherapy and received allogenic peripheral blood stem cell transplantation. OUTCOMES: The patient remains in complete remission state without relapse at 34 months since initial diagnosis. LESSONS: This is the first case of BPDCN manifested as a breast parenchymal mass and assessed by diagnostic breast imaging tools (mammography and ultrasonography). This case report is significant for BPDCN within the breast parenchyma and presenting rare radiologic description of BPDCN.

[Invasive Ductal Carcinoma Originating from a Borderline Phyllodes Tumor in a Young Female: A Case Report]. / ì Šì€ 여성의 경계성 ì—½ìƒì¢ ì–‘ì—ì„œ 생긴 침윤성 ìœ ê´€ì•”: 증례 ë³´ê³ .

Phyllodes tumors of the breast are relatively rare fibroepithelial tumors that account for less than 1% of primary breast neoplasms. Phyllodes tumors have epithelial and stromal components and they originate from the periductal stroma. They are classified as benign, borderline, or malignant. Carcinomatous differentiation of the epithelial components of phyllodes tumors is rare, and their imaging features have not been accurately described. Herein, we report a rare case of invasive ductal carcinoma originating from a borderline phyllodes tumor in a 21-year-old female with radiologic and pathologic findings.

Tumor Seeding after Percutaneous Transthoracic Needle Biopsy of Metastatic Pulmonary Ameloblastoma.

Percutaneous transthoracic needle biopsy (PTNB) is a minimally-invasive procedure that is an indispensable tool for evaluating pulmonary lesions. Though extremely rare, tumor seeding of the pleura and chest wall can occur as a complication. Given that the breast is located anterior to the thorax, needle tracking through the breast is inevitable when PTNB is performed using the anterior approach. We describe tumor seeding of metastatic pulmonary ameloblastoma in the pectoralis muscle layer of the breast along the needle track of PTNB in a 51-year-old female presenting with a palpable lump in the right breast.

[Direct MR Arthrography of the Hip: Diagnosis and Pitfalls of Acetabular Labral Lesions]. / ê³ ê´€ì ˆ ì§ì ‘ ìžê¸°ê³µëª ê´€ì ˆì¡°ì˜ìˆ : 비구순 병변의 진단 및 í•¨ì •.

Tearing of the acetabular labrum is a common cause of chronic hip pain. MR arthrography (MRA) of the hip is the imaging procedure of choice for the evaluation of acetabular labrum. Familiarity with the various imaging findings of MRA of the hip allows recognition of normal variants and differentiation from true pathologic conditions. This article comprehensively reviews the technical aspects and interpretation of MRA of the hip. The appearances of normal and abnormal labra in MRA are discussed. Potential pitfalls in labral tear interpretation, such as sulci around the hip, normal variants of the labrum and plicae, and osseocartilaginous and soft tissue lesions identified on MRA of the hip are also described.

18F-fluorodeoxyglucose uptake on PET/computed tomography in association with androgen receptor expression and other clinicopathologic factors in surgically resected triple-negative breast cancer.

OBJECTIVE: To evaluate whether androgen receptor expression in triple-negative breast cancer (TNBC) is associated with F-fluorodeoxyglucose (FDG) uptake and to identify predictive factors of F-FDG uptake in TNBC. METHODS: We retrospectively assessed data of 156 surgically resected primary TNBC in 156 consecutive patients who underwent F-FDG PET/computed tomography between July 2013 and May 2017. Clinicopathologic features, including androgen receptor expression, were categorized and the distribution of maximum standardized uptake value (SUVmax) was compared between the groups. We also evaluated the correlations between the predictive factors and SUVmax. RESULTS: Median SUVmax was higher in the androgen receptor-negative group than in the androgen receptor-positive group (8.8 vs. 7.1, P = 0.026) with negative correlation between androgen receptor and SUVmax (P = 0.041, correlation coefficient (r) = -0.163). On multivariate regression analysis, tumor size (>20 mm), histological grade, Ki-67 (≥14%), and the presence of ductal carcinoma in situ (DCIS) were significantly associated with SUVmax (P < 0.001, P = 0.012, P = 0.017 and P = 0.021, respectively). Tumor size, histological grade and Ki-67 were positively correlated with SUVmax (P < 0.001, r = 0.450; P = 0.004, r = 0.228; P = 0.001, r = 0.269, respectively), while the presence of DCIS showed negative correlation with SUVmax (P < 0.001, r = -0.292). CONCLUSION: Androgen receptor-positive TNBC showed lower F-FDG uptake than androgen receptor-negative triple-TNBC. Tumor size, histological grade, Ki-67 and the presence of DCIS significantly influenced F-FDG uptake in TNBC.

Fusarium species causing invasive fungal pneumonia in an immunocompetent patient: a case report.

Fusarium is a large genus of filamentous fungi that are rarely associated with disease in humans. In the clinical setting, Fusarium species are often difficult to distinguish from other fungal organisms, particularly Aspergillus species. Invasive fungal pneumonia caused by Fusarium species has rarely been reported, especially in immunocompetent patients. In this study, we reported a case of invasive Fusarium pneumonia in a previously healthy 68-year-old woman. The disease was initially misdiagnosed as invasive Aspergillus pneumonia because of the similarity in radiologic and histopathologic findings between these conditions. After Fusarium was identified via microbiological analysis, the antifungal agent was changed, and the patient recovered fully.

Phenolic-enriched blueberry-leaf extract attenuates glucose homeostasis, pancreatic ß-cell function, and insulin sensitivity in high-fat diet-induced diabetic mice.

Blueberry fruit exhibits strong antioxidant activity owing to the presence of anthocyanin. As blueberry-leaf extract (BLE) contains chlorogenic acid and flavonol glycosides, we hypothesized that phenolic-enriched BLE would improve glucose homeostasis and insulin sensitivity. In this study, we examined whether BLE administration decreases the glucose levels and enhances the pancreatic function in mice with high-fat diet (HFD)-induced obesity and diabetes. C57BL/6J mice were divided into the following four groups: control diet (CD), HFD (60 kcal% fat diet), BLE (HFD with 1% BLE wt/wt diet), and yerba mate extract (YME; HFD with 0.5% YME wt/wt diet). Dietary BLE and YME reduced glucose tolerance, body weight, and plasma glucose, glycated hemoglobin, insulin, homeostasis model assessment of insulin resistance, triglyceride (TG), and non-esterified fatty acid levels. Compared with those of the HFD group, BLE was found to significantly reduce the pancreatic islet size and insulin content. Moreover, it increased the mRNA levels of pancreatic ß-cell proliferation-related genes, Ngn3, MafA, Pax4, Ins1, and Ins2, and pancreatic insulin signaling-related genes, IRS-1, IRS-2, PIK3ca, PDK1, PKCε, and GLUT-2, and decreased the transcriptional expression of the ß-cell apoptosis-related gene, FoxO1. Both BLE and YME improved insulin sensitivity by inhibiting TG synthesis and enhancing lipid utilization in the liver and white adipose tissue (WAT). In pancreatic MIN6 ß-cells, BLE and its main component (chlorogenic acid) increased ß-cell proliferation and promoted insulin signaling. Overall, BLE enriched with phenolic compounds has the capacity to prevent HFD-induced glucose tolerance and hyperglycemia by improving the pancreatic ß-cell function.

Open cubital and carpal tunnel release using wide-awake technique: reduction of postoperative pain.

PURPOSE: This study aimed to compare the efficacy of and patient satisfaction with the wide-awake local anesthesia with no tourniquet (WALANT) technique in open cubital and carpal tunnel release surgery. METHODS: From January 2016 to February 2017, 20 cubital tunnel syndrome (CuTS) patients were in a wide-awake (WA) group and 22 in a general (GA) anesthesia group in . Also, 20 carpal tunnel syndrome (CTS) patients were in a WA group, 22 in a local anesthesia (LA) group, and 20 in a GA group. Injection pain, perioperative pain, and postoperative pain were assessed using a 10-point pain VAS. In CuTS, functional outcome on the "quick" Disabilities of the Arm, Shoulder, and Hand questionnaire were evaluated. In CTS, subjective outcomes were assessed using the Korean version of the Michigan Hand Outcomes Questionnaire. RESULTS: Both CuTS and CTS showed significant postoperative pain reduction in group WA. In CuTS, group WA had less pain than group GA up to 48 hours after surgery (P<0.05). Supplemental opioid injections were used on hospitalization day by 12% of group WA and 35% of group GA. In CTS, the postoperative VAS scores in group WA were lower during the first 24 hours than groups LA and GA (P<0.05). Opioid injections were used on hospitalization day by 5% of WA, 18% of LA, and 32% of group GA. There was no difference in postoperative functional outcomes according to anesthesia method in CuTS or CTS. CONCLUSION: Cubital and carpal tunnel surgery using the WALANT technique was comparable in function to other anesthesia methods and superior for pain. Immediate postoperative pain was much lower than other groups, which could reduce the use of opioids during hospitalization.

Arazyme Suppresses Hepatic Steatosis and Steatohepatitis in Diet-Induced Non-Alcoholic Fatty Liver Disease-Like Mouse Model.

Arazyme, a metalloprotease from the spider Nephila clavata, exerts hepatoprotective activity in CCL4-induced acute hepatic injury. This study investigated the hepatoprotective effects in high-fat diet (HFD)-induced non-alcoholic fatty liver disease-like C57BL/6J mice. The mice were randomly divided into four groups (n = 10/group): the normal diet group, the HFD group, the arazyme group (HFD with 0.025% arazyme), and the milk thistle (MT) group (HFD with 0.1% MT). Dietary supplementation of arazyme for 13 weeks significantly lowered plasma triglyceride (TG) and non-esterified fatty acid levels. Suppression of HFD-induced hepatic steatosis in the arazyme group was caused by the reduced hepatic TG and total cholesterol (TC) contents. Arazyme supplementation decreased hepatic lipogenesis-related gene expression, sterol regulatory element-binding transcription protein 1 (Srebf1), fatty acid synthase (Fas), acetyl-CoA carboxylase 1 (Acc1), stearoyl-CoA desaturase-1 (Scd1), Scd2, glycerol-3-phosphate acyltransferase (Gpam), diacylglycerol O-acyltransferase 1 (Dgat1), and Dgat2. Arazyme directly reduced palmitic acid (PA)-induced TG accumulation in HepG2 cells. Arazyme suppressed macrophage infiltration and tumor necrosis factor α (Tnfa), interleukin-1ß (Il1b), and chemokine-ligand-2 (Ccl2) expression in the liver, and inhibited secretion of TNFα and expression of inflammatory mediators, Tnfa, Il1b, Ccl2, Ccl3, Ccl4, and Ccl5, in PA-induced RAW264.7 cells. Arazyme effectively protected hepatic steatosis and steatohepatitis by inhibiting SREBP-1-mediated lipid accumulation and macrophage-mediated inflammation.

Suppression of Hyperglycemia and Hepatic Steatosis by Black-Soybean-Leaf Extract via Enhanced Adiponectin-Receptor Signaling and AMPK Activation.

Yellow-soybean-leaf extract includes kaempferol glycosides and pheophorbides that reduce obesity and plasma glucose levels. This study researched the molecular mechanisms underlying the glucose-lowering effect of the extract of black-soybean leaves (EBL), which mainly contains quercetin glycosides and isorhamnetin glycosides, in mice with high-fat-diet (HFD)-induced obesity and diabetes and in HepG2 cells. Twelve weeks of EBL supplementation decreased body weight and fasting glucose, glycated hemoglobin, insulin, triglyceride, and nonesterified fatty acid levels. Histological analyses manifested that EBL suppressed hepatic steatosis. Interestingly, EBL significantly improved plasma adiponectin levels and increased adiponectin-receptor-gene ( AdipoR1 and AdipoR2) expression in the liver. EBL restored the effects of HFD on hepatic AMP-activated protein kinase (AMPK) and on the family of peroxisome proliferator-activated receptors (PPARα, PPARδ, and PPARγ), which are associated with fatty acid metabolism and are downstream of the adiponectin receptors. Hence, EBL effectively diminished hyperglycemia and hepatic steatosis through enhancing adiponectin-induced signaling and AMPK activation in the liver.

Antioxidant Effects of Bioactive Compounds Isolated from Pressurized Steam-Treated Corni Fructus and Their Protective Effects Against UVB-Irradiated HS68 Cells.

This study evaluated the antioxidant and protective effects of bioactive compounds isolated from pressurized steam-treated Corni Fructus (PSC). We had previously tested the protective effects of the furan fraction containing 5-hydroxymethylfurfural (5-HMF), polyphenol fraction containing gallic acid, and iridoid glycoside fraction containing morroniside and loganin. We measured the potency of antioxidant activities of the bioactive compounds isolated from PSC via oxygen radical absorbance capacity (ORAC), 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging, and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical scavenging assays. One fraction in particular (named F-2) not only contained high amounts of phenolics but also had potent antioxidant activities. The protective effects of F-2 were evaluated by measuring the levels of the collagen-degrading enzyme, matrix metalloproteinase-1 (MMP-1), and the marker of collagen biosynthesis, procollagen type I C-peptide (PIP), in UVB-treated HS68 fibroblasts. MMP-1 levels decreased in an F-2 concentration-dependent manner, and PIP secretion from the cultured HS68 cells was significantly higher than that from the UVB-irradiated cultures alone. Further, F-2 attenuated UVB-induced MMP-1 and ameliorated UVB-downregulated collagen type I alpha 1 mRNA expression in HS68 cells. Therefore, F-2 isolated from PSC is a good candidate for the prevention of skin damage from free radicals in various skin conditions.

Fournier's gangrene associated with chronic kidney disease in a dog.

A dog was diagnosed with Fournier's gangrene associated with chronic kidney disease. Clinical features included crepitant scrotal inflammation that spread to the penis; the lesion exhibited liquefactive necrosis or purulent moist gangrene. This is the first description of Fournier's gangrene associated with chronic kidney disease in a dog.

Gangrène de Fournier associée à la maladie rénale chronique chez un chien. Un diagnostic de gangrène de Fournier a été posé en association avec une maladie rénale chronique. Les caractéristiques cliniques incluaient une inflammation scrotale crépitante qui s'est propagée au pénis; la lésion a manifesté une nécrose liquéfactrice ou une gangrène humide purulente. Il s'agit de la première description de gangrène de Fournier associée à une maladie rénale chronique chez un chien.(Traduit par Isabelle Vallières).