A Detailed Classification of Neurogenic Orthostatic Hypotension According to the Pattern of Orthostatic Blood Pressure Drop in Patients with Orthostatic Intolerance

Background@#To investigate the patterns of blood pressure (BP) decrement during the tilt, to compare the pattern of orthostatic hypotension (OH) and sympathetic index (SI) from the Valsalva maneuver (VM), and to identify whether the pattern of OH can predict the severity of autonomic failure. @*Methods@#From January 2015 to July 2017, 551 consecutive patients with neurogenic OH were enrolled. All patients performed a standardized battery of autonomic tests, including the head-up tilt (HUT) test and VM using Finometer devices for recording beat-to-beat BP. SIs were calculated from the VM. The composite autonomic severity score (CASS) adrenergic subscore was also obtained to evaluate the severity of sympathetic adrenergic failure. @*Results@#We classified OH into nine groups according to the patterns of orthostatic BP decrement during HUT. The two most common patterns of OH were classic stable OH (n=193) and classic OH with delayed normalization (n=102). Patients with classic stable OH and classic OH with delayed worsening had a more severe degree of sympathetic adrenergic failure as assessed with SI 5 and SI 4 from the VM, and a higher CASS adrenergic subscore than patients with other patterns of OH. There were no differences of autonomic parameters between the two delayed OH groups. @*Conclusions@#The different patterns of orthostatic BP decrement may reflect underlying different pathophysiologic mechanisms causing OH. The pattern of orthostatic BP decrement can help to predict the degree of sympathetic adrenergic autonomic failure.

Clinical Validation of a Deep Learning-Based Hybrid (Greulich-Pyle and Modified Tanner-Whitehouse) Method for Bone Age Assessment

Objective@#To evaluate the accuracy and clinical efficacy of a hybrid Greulich-Pyle (GP) and modified Tanner-Whitehouse (TW) artificial intelligence (AI) model for bone age assessment. @*Materials and Methods@#A deep learning-based model was trained on an open dataset of multiple ethnicities. A total of 102 hand radiographs (51 male and 51 female; mean age ± standard deviation = 10.95 ± 2.37 years) from a single institution were selected for external validation. Three human experts performed bone age assessments based on the GP atlas to develop a reference standard. Two study radiologists performed bone age assessments with and without AI model assistance in two separate sessions, for which the reading time was recorded. The performance of the AI software was assessed by comparing the mean absolute difference between the AI-calculated bone age and the reference standard. The reading time was compared between reading with and without AI using a paired t test. Furthermore, the reliability between the two study radiologists’ bone age assessments was assessed using intraclass correlation coefficients (ICCs), and the results were compared between reading with and without AI. @*Results@#The bone ages assessed by the experts and the AI model were not significantly different (11.39 ± 2.74 years and 11.35 ± 2.76 years, respectively, p = 0.31). The mean absolute difference was 0.39 years (95% confidence interval, 0.33– 0.45 years) between the automated AI assessment and the reference standard. The mean reading time of the two study radiologists was reduced from 54.29 to 35.37 seconds with AI model assistance (p < 0.001). The ICC of the two study radiologists slightly increased with AI model assistance (from 0.945 to 0.990). @*Conclusion@#The proposed AI model was accurate for assessing bone age. Furthermore, this model appeared to enhance the clinical efficacy by reducing the reading time and improving the inter-observer reliability.

Measurement of Tumor Pressure and Strategies of Imaging Tumor Pressure for Radioimmunotherapy / 대한핵의학회잡지

Tumor interstitial pressure is a fundamental feature of cancer biology. Elevation in tumor pressure affects the efficacy of cancer treatment and results in the heterogenous intratumoral distribution of drugs and macromolecules. Monoclonal antibodies (mAb) play a prominent role in cancer therapy and molecular nuclear imaging. Therapy using mAb labeled with radionuclides—also known as radioimmunotherapy (RIT)—is an effective form of cancer treatment. RIT is clinically effective for the treatment of lymphoma and other blood cancers; however, its clinical use for solid tumor was limited because their high interstitial pressure prevents mAb from penetrating into the tumor. This pressure can be decreased using anti-cancer drugs or additional external therapy. In this paper, we reviewed the intratumoral pressure using direct tumor-pressure measurement strategies, such as the wick-in-needle and pressure catheter transducer method, and indirect tumor-pressure measurement strategies via magnetic resonance.

Measurement of Tumor Pressure and Strategies of Imaging Tumor Pressure for Radioimmunotherapy / 대한핵의학회잡지

Tumor interstitial pressure is a fundamental feature of cancer biology. Elevation in tumor pressure affects the efficacy of cancer treatment and results in the heterogenous intratumoral distribution of drugs and macromolecules. Monoclonal antibodies (mAb) play a prominent role in cancer therapy and molecular nuclear imaging. Therapy using mAb labeled with radionuclides—also known as radioimmunotherapy (RIT)—is an effective form of cancer treatment. RIT is clinically effective for the treatment of lymphoma and other blood cancers; however, its clinical use for solid tumor was limited because their high interstitial pressure prevents mAb from penetrating into the tumor. This pressure can be decreased using anti-cancer drugs or additional external therapy. In this paper, we reviewed the intratumoral pressure using direct tumor-pressure measurement strategies, such as the wick-in-needle and pressure catheter transducer method, and indirect tumor-pressure measurement strategies via magnetic resonance.

A Little-Known Brain Imaging Feature in Neuromyelitis Optica Spectrum Disorder: A Leukodystrophy-Like Pattern

No abstract available.

Correlations Between Values of Articulation Tests and Language Tests for Children With Articulation Disorder in Korea

OBJECTIVE: To evaluate correlations between values of articulation tests and language tests for children with articulation disorder in Korea. METHODS: Data of outpatients with chief complaint of an articulation problem were retrospectively collected. Patients who underwent Urimal Test of Articulation and Phonation (U-TAP) with Assessment of Phonology and Articulation for Children (APAC), Preschool Receptive-Expressive Language Scale (PRES), or Receptive and Expressive Vocabulary Test (REVT) simultaneously were identified. Patients whose word-level percentages of correct consonants in U-TAP (UTAP_wC) were more than 2 standard deviations below the mean as diagnostic criteria for articulation disorder were selected. Those whose receptive language age (P_RLA), expressive language age (P_ELA), or combined language age (P_CLA) in PRES was delayed more than 24 months compared to their chronological age in months as diagnostic criteria for language disorder were excluded. RESULTS: Thirty-three children aged 3–6 years were enrolled retrospectively. PRES and U-TAP showed significant correlations for most of value relationships. PRES and APAC showed significant correlations for all value relationships except for receptive language age. All values of REVT were significantly correlated with all values from U-TAP, but not with any value from APAC. Articulation tests U-TAP and APAC showed significant correlations between percentages of correct consonants. Language tests PRES and REVT showed significant correlations for all value relationships. CONCLUSION: This study suggests that articulation abilities and language abilities might be correlated in children with articulation disorder.

Isolated Dizziness with Subjective Visual Vertical Tilt in Acute Infarction of Temporo-Parieto-Occipital Junction

Pathological tilts of the subjective visual vertical (SVV) in the roll plane are most sensitive and frequent clinical vestibular signs of unilateral lesions extending from the labyrinths via the brainstem and thalamus to the cortex. SVV deviations in cortical lesion are usually related with the parietoinsular vestibular cortex or superior temporal gyrus. We report isolated dizziness with contralesional SVV tilt with a focal infarction restricted to the right temporo-parieto-occipital junction.

Coating rice with mulberry leaves rich in deoxynojirimycin ameliorates hyperglycemia and dyslipidemia in C57BL/KsJ db/db mice

BACKGROUND/OBJECTIVES: Mulberry leaf (ML) has been shown to have an inhibitory effect on α-glucosidase, and suppresses postprandial hyperglycemia, which may be related to its deoxynojirimycin (DNJ) content. This study was conducted to investigate the hypoglycemic and dyslipidemic effects of rice coated with ML rich in DNJ in a type 2 diabetes mouse model. MATERIALS/METHODS: The mice were divided into four groups (n = 8 each): non-diabetic normal control (NC); diabetic control (DM-C), fed with 10% polished rice powder (DM-R); and fed with 10% polished rice powder coated with DNJ-rich ML (DM-DNJR). RESULTS: Supplementation with DNJR for six weeks decreased levels of fasting blood glucose, plasma insulin, triglyceride, total cholesterol, and blood glycosylated hemoglobin; conversely, levels of glucagon-like peptide-1 and high-density lipoprotein-cholesterol showed an increase in the same treatment. In addition, weights of mesenteric, epididymal, and total adipose tissues decreased with DNJR supplementation, when compared with diabetic control db/db mice, while maltase, lactase, and sucrase activity in the small intestine were inhibited. The anti-diabetic effects were marginally greater in the DM-DNJR group than in the DM-R group. CONCLUSIONS: These results suggest that rice coated with ML rich in DNJ can reduce hyperglycemia and hyperlipidemia in db/db mice, and may prove useful for individuals with diabetes.

The effects of Brassica juncea L. leaf extract on obesity and lipid profiles of rats fed a high-fat/high-cholesterol diet

BACKGROUND/OBJECTIVES: Obesity is a global health problem of significant importance which increases mortality. In place of anti-obesity drugs, natural products are being developed as alternative therapeutic materials. In this study, we investigated the effect of Brassica juncea L. leaf extract (BLE) on fat deposition and lipid profiles in high-fat, high-cholesterol diet (HFC)-induced obese rats. MATERIALS/METHODS: Male Sprague-Dawley rats were divided into four groups (n = 8 per group) according to diet: normal diet group (ND), high-fat/high-cholesterol diet group (HFC), HFC with 3% BLE diet group (HFC-A1), and HFC with 5% BLE diet group (HFC-A2). Each group was fed for 6 weeks. Rat body and adipose tissue weights, serum biochemical parameters, and tissue lipid contents were determined. The expression levels of mRNA and proteins involved in lipid and cholesterol metabolism were determined by reverse transcription polymerase chain reaction and western blot analysis, respectively. RESULTS: The HFC-A2 group showed significantly lower body weight gain and food efficiency ratio than the HFC group. BLE supplementation caused mesenteric, epididymal, and total adipose tissue weights to decrease. The serum levels of triglyceride, total cholesterol, and low-density lipoprotein cholesterol were significantly reduced, and high-density lipoprotein cholesterol was significantly increased in rats fed BLE. These results were related to lower glucose-6-phosphate dehydrogenase, acetyl-coA carboxylase, and fatty acid synthase mRNA expression, and to higher expression of the cholesterol 7α-hydroxylase and low density lipoprotein-receptor, as well as increased protein levels of peroxisome proliferator-activated receptor α. Histological analysis of the liver revealed decreased lipid droplets in HFC rats treated with BLE. CONCLUSIONS: Supplementation of HFC with 3% or 5% BLE inhibited body fat accumulation, improved lipid profiles, and modulated lipogenesis- and cholesterol metabolism-related gene and protein expression.

Relationships between job stress and caffeine intake in industrial workers / 한국영양학회지

PURPOSE: This study analyzed the degree of job stress and caffeine intake in workers in industrial positions in order to determine the relationships between job stress and caffeine intake. METHODS: For this purpose, this study conducted a survey targeting 361 blue collar workers working for K manufacturing company, Gwangju. RESULTS: The total score for job stress in subjects was 72.7 ± 6.8 points/100 points. According to job stress, subjects were categorized as follows: Q1 for the group who had the least stress; Q2 for the group who had little stress; Q3 for the group who had a lot of stress, and Q4 for the group who had the most stress. As for the effects of caffeine on health, 57.1% thought that caffeine is helpful and not harmful if taken properly while 17.3% responded that less caffeine consumption is better. Daily intake of caffeine according to stress was presented as: 172.0 ± 85.3 mg in Q1, 179.0 ± 83.7 mg in Q2, 187.9 ± 81.4 mg in Q3, and 214.2 ± 147.3 mg in Q4 (p < 0.05). The percentages of caffeine consumption compared to the daily safe limit in subjects were: 43.0 ± 21.3, 44.8 ± 20.9, 47.1 ± 20.4, and 53.6 ± 36.8% in Q1, Q2, Q3, and Q4, respectively (p < 0.05). Adverse effects such as nausea or vomiting from caffeine were most common in Q4 (p < 0.05) CONCLUSION: As a result, higher stress in blue collar workers working for K manufacturing company was associated with more caffeine consumption. Groups with a lot of stress (Q4) consumed approximately 50% of daily safe limit of caffeine. Considering the results above, this study suggests that further research on more precise caffeine intake and its effects is needed.

Effect of working patterns on eating habits in manufacturing workers of Gwangju area / 한국영양학회지

PURPOSE: This study was conducted to investigate and analyze the association between stress from shift and non-shift work as well as the effects living habits have on eating habits in order to identify why and how workers can improve their health and form proper eating habits for higher working efficiency. METHODS: The subjects of this study were 361 workers from K manufacturing company from April 7 to 11, 2014 and they were surveyed using a questionnaire. The subjects were divided into two groups according to working pattern: shift workers (n = 216) and non-shift workers (n = 110). RESULTS: In the general characteristics, there were significant differences in age, work career, work time, marriage, monthly income, and education levels between the two groups. For healthy behaviors, significant differences in subjective health status, moderate physical activity, drinking, smoking, and sleep time were observed between shift workers and non-shift workers. For eating habits, scores of non-shift workers having a regular mealtime, balanced meal composition, and vegetable and seaweed intakes were significantly higher than those of shift workers. The sum score of dietary habits in non-shift workers was also significantly lower than that in shift workers (p < 0.05). Total job stress score did not significantly differ between the two groups. CONCLUSION: The sum of eating habit scores according to work types was 16.1 ± 0.6 in non-shift workers and 14.0 ± 0.3 in shift workers. These results suggest that it is necessary to provide food suitable to characteristics of different workers according to work type which should be provided along with daily nutrition counseling to help subjects recognize their status.

A Case of Gastric Mucormycosis Induced Necrotic Gastric Ulcer in Patients with Diabetic Ketoacidosis

Mucormycosis is a rare invasive disease with high mortality rates caused by fungi of the zygomycetes class and Mucorales order. Mucormycosis is manifested by a variety of clinical presentations according to the involved site and occurs in immunocompromised conditions such as diabetes mellitus and other conditions. Rhino-orbital-cerebral and pulmonary infection is known as commonly involved areas. Primary gastrointestinal mucormycosis is a very rare and life-threatening invasive fungal infection. Gastrointestinal mucormycosis may occur in any alimentary tract, with the stomach being most involved part. The early diagnosis and appropriate treatment including surgical debridement of involved tissues and antifungal agents is needed to improve survival rates. We report a case of gastric mucormycosis successfully treated with radical debridement and antifungal agents in a 45-year-old man with diabetic ketoacidosis.

Major Trauma induced Left Ventricular Thrombus after Acute Myocardial Infarction

Left Ventricular Thrombus (LVT) formation after acute myocardial infarction is a serious complication. And the most feared complication of LVT is the systemic thromboembolic events, especially to the brain. Nowadays patients with acute myocardial infarction are treated with primary PCI and more aggressive anticoagulation therapies, resulting in the lower incidence of LVT. Early detection of LVT is very important, and echocardiography is the definitive test for detecting intracardiac thrombus. However, the need for serial echocardiography remains controversial. In this case report, we describe a 55-year-old man with major trauma induced LVT after acute myocardial infarction who underwent successful therapy.

Efficacy and Safety of Pancreatobiliary Endoscopic Procedures during Pregnancy

BACKGROUND/AIMS: Endoscopic therapy with endoscopic retrograde cholangiopancreatography (ERCP) has been suggested as an effective diagnostic and therapeutic tool for biliary and pancreatic disorders during pregnancy. In this report, we describe our experiences with pancreatobiliary endoscopic procedures during pregnancy. METHODS: We reviewed ERCP and endoscopic ultrasonography (EUS) procedures that were performed at a single tertiary care referral center between January 2002 and October 2013. Medical records were reviewed for the procedure indication, the duration of fluoroscopy, postprocedure complications, etc. Pregnancy outcomes and fetal complications were identified by chart review and phone calls to patients. RESULTS: A total of 10 ER-CPs and five EUSs were performed in 13 pregnant patients: four of whom underwent the procedure in the first trimester, eight in the second trimester, and one in the third trimester. Indications for endoscopic therapy included gallstone pancreatitis, obstructive jaundice with common bile duct (CBD) stone, asymptomatic CBD stone, pancreatic cyst, choledochal cyst, and acute cholecystitis. Only one patient had a complication, which was postprocedural hyperamylasemia. Two patients underwent an artificial abortion, one according to her own decision and the other due to an adverse drug reaction. CONCLUSIONS: ERCP seems to be effective and safe for pregnant women. Additionally, EUS can be an alternative to ERCP during pregnancy.

Long-Term Survival after T-cell Lymphoblastic Lymphoma Treated with One Cycle of Hyper-CVAD Regimen / Journal of the Korean Cancer Association, 대한암학회지

T-lymphoblastic lymphoma (T-LBL) is a rare form of aggressive non-Hodgkin's lymphoma. The standard approach for management of T-LBL involves intensive multiagent chemotherapy regimens for induction and consolidation phases with central nervous system prophylaxis and a maintenance phase lasting 12-18 months. We report on a case of long-term survival after one cycle of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) and high-dose methotrexate. A 30-year-old woman diagnosed with T-LBL with a large mediastinal mass underwent one cycle of hyper-CVAD. Four days after the start of treatment, the mediastinal mass was markedly reduced. Treatment continued with one cycle of consolidation chemotherapy, comprising high-dose methotrexate and high-dose cytarabine. The patient then refused all further chemotherapeutic treatment. Seven years have passed without relapse.

A Case of Different Organ Responses to Immunosuppressive Therapy In a Microscopic Polyangiitis Patient with Interstitial Lung Disease / 대한내과학회지

Microscopic polyangiitis (MPA) is an idiopathic autoimmune disease characterized by systemic vasculitis associated with antineutrophil cytoplasmic autoantibodies. Interstitial lung disease is a less recognized manifestation of MPA and has a poor prognosis. A 61-year-old man presented with persistent cough, sputum and dyspnea. Laboratory examination revealed microscopic hematuria and renal insufficiency. Perinuclear anti-neutrophil cytoplasmic autoantibodies were positive according to serological testing. Computed tomography scans showed bibasilar reticulation and honeycombing in a peripheral distribution. Therefore, renal biopsy was performed, and MPA was diagnosed. After treating with corticosteroids and immunosuppressive agents, the patient had a complete renal response but progressive interstitial lung disease. We report a case of MPA presenting with interstitial lung disease in which the patient experienced different responses in each organ.

Mycotic Abdominal Aortic Aneurysm Caused by Bacteroides Thetaiotaomicron and Acinetobacter Lwoffii: The First Case in Korea / 감염과화학요법

Mycotic aneurysms are uncommon, but are fatal without appropriate management. Previous reports have shown that anaerobes and gram-negative organisms are less common but more dangerous than other causative agents of mycotic aneurysm. We report the case of a 60-year-old man with poorly controlled diabetes mellitus and atherosclerosis in the aorta, and a 10-day of history of lower abdominal pain and fever. This man was diagnosed with an uncommon abdominal aorta mycotic aneurysm caused by Bacteroides thetaiotaomicron and Acinetobacter lwoffii. The aneurysm was successfully treated with antibiotics therapy and aorto-bi-external iliac artery bypass with debridement of the infected aortic wall. We present this case together with a review of the relevant literature.

Percutaneous Closure of an Iatrogenic Ventricular Septal Defect Following Concomitant Septal Myectomy at the Time of Aortic Valve Replacement

A 77-year-old female patient underwent aortic valve replacement (AVR) with concomitant septal myectomy and tricuspid annuloplasty. Her symptoms did not improve after a successful operation. Echocardiogram demonstrated the presence of an iatrogenic ventricular septal defect (VSD). It was muscular in location and not the usual AVR with membraneous type of VSD, suggesting a complication from the myectomy. Percutaneous closure of the VSD remained the only feasible option due to her poor overall medical status. A 14-mm Amplazter VSD occluder was deployed successfully, by means of the trans-septal technique. She has improved very well postoperatively.

Epigallocatechin gallate attenuates L-DOPA-induced apoptosis in rat PC12 cells

In this study, the protective effects of EGCG on L-3,4-dihydroxyphenylalanine (L-DOPA)-induced oxidative cell death in catecholaminergic PC12 cells, the in vitro model of Parkinson's disease, were investigated. Treatment with L-DOPA at concentrations higher than 150 microM caused cytotoxicity in PC12 cells, as determined using the 3-(4,5-dimetylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and flow cytometry detection. The apoptotic ratio was similar in cells treated with 100 microM EGCG plus 150 microM L-DOPA (5.02%) and the control (0.96%) (P > 0.05), and was lower than that of cells treated with L-DOPA only (32.24%, P < 0.05). The generation level of ROS (% of control) in cells treated with EGCG plus L-DOPA was lower than that in cells treated with L-DOPA only (123.90% vs 272.32%, P < 0.05). The optical density in production of TBARS in cells treated with L-DOPA only was higher than that in the control (0.27 +/- 0.05 vs 0.08 +/- 0.04, P < 0.05), and in cells treated with EGCG only (0.14 +/- 0.02, P < 0.05), and EGCG plus L-DOPA (0.13 +/- 0.02, P < 0.05). The intracellular level of GSH in cells treated with EGCG plus L-DOPA was higher than that in cells treated with L-DOPA only (233.25 +/- 16.44 vs 119.23 +/- 10.25, P < 0.05). These results suggest that EGCG protects against L-DOPA-induced oxidative apoptosis in PC12 cells, and might be a potent neuroprotective agent.

A Case of Spontaneous Remission of Acute Pulmonary Embolism / 결핵및호흡기질환

Acute pulmonary embolism (PE) ranges from asymptomatic to often fatal, incidentally discovered emboli to massive embolism causing immediate death. Acute PE may occur rapidly and unpredictably and may be difficult to diagnose. Mortality and complications can be reduced by prompt diagnosis and therapy. Untreated PE is associated with a mortality rate of approximately 30 percents. Most patients with PE have endogenous fibrinolysis, although it is not effective enough to prevent PE. A case of spontaneous remission of untreated acute PE has not previously been reported. Here we present a case of spontaneously resolved acute PE without any treatment.