Prevalence and risk factors of chronic rhinosinusitis in South Korea according to diagnostic criteria.

BACKGROUND: We aimed to compare the prevalence and risk factors of chronic rhinosinusitis (CRS) using two different diagnostic criteria with the same statistical data from the Korean National Health and Nutrition Examination Survey in 2009. METHODS: Symptom-based CRS was defined as CRS diagnosed by questionnaires related to nasal symptoms. Endoscopy-based CRS was defined based on endoscopic findings and nasal symptoms of symptom-based CRS. RESULTS: The overall prevalence of CRS based on the different diagnostic criteria was as follows: symptom-based CRS was 10.78% (797 of 7,394) and endoscopy-based CRS was 1.20% (88 of 7,343). Comparing symptom-based CRS to endoscopy-based CRS showed slight agreement (kappa = 0.183 (0.150-0.216, 95% confidence interval)). Allergic rhinitis was identified as a common risk factor for CRS based on the two diagnostic criteria. CONCLUSIONS: The prevalence and risk factors of CRS were quite different from each other according to the different criteria, even in the same population. Therefore, it would be important to consider what specific diagnostic criteria have been adopted in the studies comparing the prevalence of CRS.

Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS.

Initially, a set of guidelines for the use of ultrasound contrast agents was published in 2004 dealing only with liver applications. A second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some non-liver applications. Time has moved on, and the need for international guidelines on the use of CEUS in the liver has become apparent. The present document describes the third iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS) using contrast specific imaging techniques. This joint WFUMB-EFSUMB initiative has implicated experts from major leading ultrasound societies worldwide. These liver CEUS guidelines are simultaneously published in the official journals of both organizing federations (i.e., Ultrasound in Medicine and Biology for WFUMB and Ultraschall in der Medizin/European Journal of Ultrasound for EFSUMB). These guidelines and recommendations provide general advice on the use of all currently clinically available ultrasound contrast agents (UCA). They are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis and improve the management of patients worldwide.

Guest editor's introduction: hepatocellular nodules in liver cirrhosis: imaging update 2011.

These review articles will enhance the knowledge of radiologists about current imaging modalities and various contrast agents for the detection and characterization hepatocellular nodules including hepatocellular carcinoma (HCC) in liver cirrhosis, and new concepts of imaging findings, and enable to understand these nodules more completely and thus accurately diagnose HCC.

Switching bipolar hepatic radiofrequency ablation using internally cooled wet electrodes: comparison with consecutive monopolar and switching monopolar modes.

OBJECTIVE: To evaluate whether switching bipolar radiofrequency ablation (SB-RFA) using three internally cooled wet (ICW) electrodes can induce coagulations >5 cm in porcine livers with better efficiency than consecutive monopolar (CM) or switching monopolar (SM) modes. METHODS: A total of 60 coagulations were made in 15 in vivo porcine livers using three 17-gauge ICW electrodes and a multichannel radiofrequency (RF) generator. RF energy (approximately 200 W) was applied in CM mode (Group A, n = 20) for 24 min, SM mode for 12 min (Group B, n = 20) or switching bipolar (SB) mode for 12 min (Group C, n = 20) in in vivo porcine livers. Thereafter, the delivered RFA energy, as well as the shape and dimension of coagulations were compared among the groups. RESULTS: Spherical- or oval-shaped ablations were created in 30% (6/20), 85% (17/20) and 90% (18/20) of coagulations in the CM, SM and SB groups, respectively (p = 0.003). SB-RFA created ablations >5 cm in minimum diameter (Dmin) in 65% (13/20) of porcine livers, whereas SM- or CM-RFA created ablations >5 cm in only 25% (5/20) and 20% (4/20) of porcine livers, respectively (p = 0.03). The mean Dmin of coagulations was significantly larger in Group C than in Groups A and B (5.1 ± 0.9, 3.9 ± 1.2 and 4.4 ± 1.0 cm, respectively, p = 0.002) at a lower delivered RF energy level (76.8 ± 14.3, 120.9 ± 24.5 and 114.2 ± 18.3 kJ, respectively, p < 0.001). CONCLUSION: SB-RFA using three ICW electrodes can create coagulations >5 cm in diameter with better efficiency than do SM- or CM-RFA. ADVANCES IN KNOWLEDGE: SB-RFA can create large, regular ablation zones with better time-energy efficiency than do CM- or SM-RFA.

Latent HIV-1 reactivation in transgenic mice requires cell cycle -dependent demethylation of CREB/ATF sites in the LTR.

OBJECTIVE: We previously produced a line of transgenic mice that carried the HIV-1 genome deficient in the gene. Although the HIV-1 genome in the lymphocytes was dormant under normal physiological conditions, it could be reactivated by lipopolysaccharide (LPS) administration via induction of interleukin-1alpha/beta and tumour necrosis factor-alpha. In this report, we analysed further the reactivation mechanism of the latent HIV-1 using this transgenic mouse model. DESIGN: and methods: Possible involvement of CpG methylation in HIV-1 latency was examined by treating transgenic lymphocytes with a demethylating agent, 5'-azacytidine. CpG methylation in the HIV-1 long terminal repeat (LTR) was analysed using the bisulfite genomic sequencing method. As previous studies suggested that CpG demethylation depended on the cell cycle progression, we analysed the relation between cell cycle progression and LPS-induced reactivation of HIV-1 by labelling lymphocytes with an intracellular fluorescein, carboxyfluorescein diacetate succinimidyl ester. RESULTS: We found that 5'-azacytidine enhanced HIV-1 expression ninefold compared to treatment with LPS alone. Furthermore, HIV-1 p24 induction by LPS was observed only in cells that had undergone cell division, while induction was prevented in cells in which cell cycle progression was blocked either by mimosine, aphidicolin, or nocodazole. LPS-induced HIV-1 reactivation was associated with demethylation of two CpG sites located in the CREB/ATF binding sites in the HIV-1 LTR in a cell cycle-dependent manner. CONCLUSIONS: These observations indicate that cell cycle progression-dependent demethylation of the CREB/ATF sites in the LTR is crucial for the reactivation of latent HIV-1 genome in transgenic mice.

Isolation of Xenopus laevis TFIID subunit p22 reveals two distinct structural regions.

A cDNA clone encoding a Xenopus laevis (Xl) homologue of the TATA box-binding factor TFIID subunit p22, which shows similarities to histones H2B and H3, was isolated and sequenced. The deduced 164-amino-acid (aa) sequence was compared to those of homologues cloned from human and Drosophila melanogaster (Dm). Analysis showed that the TFIID subunit p22 consists of an approx. 60-aa less-conserved N-terminus and approx. 100-aa highly-conserved C terminus.

Isolation and characterization of a cDNA encoding a novel human transcription factor TFIID subunit containing similarities with histones H2B and H3.

Using the yeast two-hybrid system, we isolated a human cDNA that encodes a protein (hp22) interacting with TATA box-binding factor TFIID subunit p80 containing similarity with histone H4. Sequence analysis showed that the open reading frame (ORF) specifies a 161-amino-acid (aa) polypeptide homologous to Drosophila melanogaster TFIID subunit p22 (dp22). Comparison of the aa sequence of human TFIID subunit p22 (hp22) with that of dp22 revealed that p22 is composed of two distinct regions; the less conserved N-terminal (20% identity) and the highly conserved C-terminal (65% identity) regions. Additionally, the C-terminal region was found to contain similarities with histones H2B and H3. Northern blot analysis showed mRNA corresponding to hp22 to be expressed in all tissues examined.

The effect of external electron beam on neointima in rat carotid artery injury model.

PURPOSE: Endovascular irradiation with either a gamma or a beta source has shown to reduce neointimal proliferation. However, the effect of external-beam radiation on neointimal hyperplasia is controversial. The objective of this study was to determine the effect of external-beam irradiation with different doses on neointimal hyperplasia in the rat carotid artery injury model. METHODS AND MATERIALS: Twenty-seven Sprague-Dawley rats underwent endothelial denudation injury by 2F Fogarty balloons on carotid artery. Immediately after the injury, rats were irradiated externally using 6-MeV electrons. Rats were grouped according to the radiation doses, 0 Gy as controls (n = 5), 5 Gy (n = 5), 10 Gy (n = 5), 15 Gy (n = 6), and 20 Gy (n = 6). Then, rats were sacrificed after 2 weeks and the carotid arteries were perfusion-fixed in paraformaldehyde. External elastic lamina (EEL) area, lumen area, maximal intimal thickness (MIT), and intimal area (IA) of the injured segments were measured on the basis of histomorphometry. RESULTS: In EEL and lumen area, there was no statistically significant difference between the irradiated groups and the controls. In MIT and IA, low-dose radiation (5 Gy and 10 Gy) did not induce any significant reduction. High-dose radiation (15 Gy and 20 Gy), however, reduced MIT and IA significantly. CONCLUSION: External electron beam reduced the intimal area, and the inhibition of neointimal proliferation was dependent upon radiation doses. This study suggests that the minimal effective dose for the inhibition of neointimal hyperplasia following denudation injury in the rat carotid model is between 10 Gy and 15 Gy.

Detection of extrapulmonary tuberculosis with gallium-67 scan and computed tomography.

We evaluated 23 patients with extrapulmonary tuberculosis (TB) with 67Ga imaging to assess its usefulness in the diagnosis of this condition. We performed computed tomography (CT) in 17 patients to assess CT features of extrapulmonary TB in comparison with findings from 67Ga scans. Nineteen of 23 patients (83%) had positive findings on 67Ga scans. One of five patients with tuberculous mediastinal lymphadenopathy, two patients with cervical lymphadenitis and a patient with renal TB had negative 67Ga scans. It was observed that the detection of previously unrecognized primary foci of TB, without concomitant pulmonary TB, was possible using 67Ga imaging in five patients (22%). The 67Ga scan was relatively sensitive for the localization of extrapulmonary TB. It is suggested that the 67Ga scan could serve as a screening method, when followed by CT and ultrasonography, for the initial detection of occult tuberculous lesions, especially in patients with prolonged fever.

Necrotic areas in VX2 carcinoma of rabbits. Correlation of magnetic resonance imaging and pathologic appearance.

RATIONALE AND OBJECTIVES: To assess the potential of magnetic resonance imaging (MRI) for evaluating the evolution of tumor necrosis, the authors evaluated 28 VX2 carcinomas inoculated in the thigh muscles of rabbits. METHODS: MRI of VX2 carcinomas at 2.0 T was done with spin-echo technique 1 week (14 tumors) and 3 weeks (14 tumors) after the inoculation of tumor cells. T1- and T2-weighted images were obtained with 500/30 and 2,500/80 sequences; the authors also performed enhanced T1-weighted images with contrast medium. MRI and histopathologic findings were compared. RESULTS: Enhanced T1-weighted images with gadolinium-DTPA (Gd-DTPA) (dimeglumine gadopentetate) could depict necrosis in almost all tumors (27/28) and were the most sensitive technique followed by T2- and T1-weighted images. T2-weighted images best permitted the evaluation of the characteristics of necrotic areas in VX2 carcinomas, followed by T1-weighted images with contrast enhancement, and unenhanced T1-weighted images. On T2-weighted images, low-intensity areas of necrotic areas correspond to areas of early necrosis, isointense areas corresponded to areas of intermediate necrosis, and high-intensity areas corresponded to the late phase of necrosis. CONCLUSIONS: MRI is useful in depicting necrosis and characterizing different phases of necrosis in VX2 carcinomas.

Comparison of harmonic and conventional power Doppler ultrasonography for assessment of slow flow in hyperechoic tissue: experimental study using a Doppler phantom.

RATIONALE AND OBJECTIVES: Despite the advantages of depicting slow flow in small vessels, conventional power Doppler ultrasound (US) has a basic limitation, specifically that artifactual power Doppler signals mimic blood flow, especially in hyperechoic tissue. The purpose of this study was to compare harmonic power Doppler US with power Doppler US using a Doppler phantom under various parameter settings, focusing on the assessment of slow flow in the hyperechoic tissue. METHODS: While controlling the flow velocity (5 and 10 cm/s), pulse repetition frequency (500, 700, and 1,000 Hz), wall filter (low and medium), and Doppler gain (90%, 96%, and 100%), the authors performed both harmonic Doppler US and power Doppler US by using a Doppler phantom/flow control system. We measured and compared the relative intensities of the Doppler signals (0-250 scale) in both the vessels and hyperechoic tissue-mimicking materials with the two different imaging modalities. RESULTS: Power Doppler US with any combination of the four parameters evaluated depicted strong flow signals (mean, 213) that were superior to harmonic Doppler US (mean, 61). Relatively strong artifactual signals within the hyperechoic tissue-mimicking materials were noted on all power Doppler US studies (mean, 106) but nearly none on harmonic Doppler US (mean, 3). The contrast-to-noise ratio of harmonic Doppler US was significantly greater than that of power Doppler US. CONCLUSIONS: Harmonic Doppler US is more useful in assessing slow flow in hyperechoic tissue than power Doppler US because it produces fewer artifactual Doppler signals originating from stationary hyperechoic tissues, which can be misjudged as true signals on power Doppler US.

Influence of instrument settings on flow signal and background noise in power Doppler US. An experimental study using a flow phantom with hyperechoic background.

OBJECTIVE: To determine the influence of various power Doppler instrument settings on intensities of flow signal and background noise in flow with a tissue-equivalent phantom. METHODS: Power Doppler images were obtained with changing wall filter level (low, medium, high, and maximum), pulse repetition frequency (PRF; 500, 700, 1000, 1500, 3000, and 6000 Hz), and Doppler gain (60%, 70%, 80%, 90%, and 100%) at different flow velocities (13.3, 26.5, and 49.8 cm/sec). To make a quantitative comparison of different settings, the authors measured the intensities of flow signal and background noise in obtained power Doppler images using the scanner and a computer program, calculated signal-to-noise difference (SND; intensity of flow signal--intensity of background noise), and evaluated the relation between SND and power Doppler settings. RESULTS: The intensities of flow signal and background noise were proportional to flow velocity and power Doppler gain but were inversely proportional to PRF and wall filter level. At constant wall filter level (medium), changes of PRF and Doppler gain to the same directions resulted in a high SND. At constant PRF (1000 Hz), changes of wall filter and Doppler gain to the same directions also resulted in a high SND. However, at constant Doppler gain (80%), a high SND was obtained with changing wall filter level and PRF to the opposite directions. CONCLUSIONS: Three Doppler instrument settings--wall filter level, pulse repetition frequency, and Doppler gain--have reciprocal influences on SND.

Experimental hepatobiliary fascioliasis in rabbits: a radiology-pathology correlation.

RATIONALE AND OBJECTIVES: The authors sought to correlate the radiologic findings of hepatobiliary fascioliasis with pathologic features. METHODS: Serial ultrasound, computed tomography (CT), and magnetic resonance findings in seven rabbits with experimentally induced fascioliasis were obtained every other week. Direct cholangiogram was also obtained after the rabbits were killed. Radiology-pathology correlation was done in specimens. RESULTS: In the parenchymal phase (an acute phase of parenchymal invasion of a larva), CT showed subcapsular clustered areas of low attenuation. Magnetic resonance appearance was similar in shape but better than CT in characterizing the hemorrhagic nature of the lesion. Ultrasound findings were nonspecific in this phase. In the ductal phase (a stationary phase after residing in the bile duct), CT showed dilatation of central ducts with symmetric periportal hypoattenuation (periportal tracking). Magnetic resonance could not depict mild ductal dilatation. Ultrasound was most valuable in demonstrating the moving worm within the dilated duct. Pathologically, the hepatic parenchymal lesions consisted of a cluster of eosinophilic granulomas with hemorrhagic change (migratory tract of the flukes). Ductal changes were observed predominantly in the central bile ducts. Periportal lymphangiectasia was also noted. CONCLUSIONS: Computed tomography or magnetic resonance can demonstrate the characteristic evolutionary pattern of fascioliasis that reflects the unique life cycle of Fasciola hepatica. The role of ultrasound, although limited in the parenchymal phase, was most useful in the ductal phase in that it demonstrated the moving worms themselves.

Comparison of contrast-enhanced fundamental imaging, second-harmonic imaging, and pulse-inversion harmonic imaging.

RATIONALE AND OBJECTIVES: To investigate the feasibility of recent contrast-specific ultrasound techniques in depicting vascular flow and the effects of changing the output power of the transducer and insonation mode on contrast enhancement, the authors performed an experimental study with a flow phantom. METHODS: While changing the mechanical index and the sound insonation mode (continuous and intermittent), images were obtained with three contrast-enhanced ultrasound techniques: fundamental, second-harmonic, and pulse-inversion harmonic imaging (PIHI) after a bolus injection of microbubble contrast agent. The images were compared on a time-intensity curve. RESULTS: In assessing fixed flow (10 cm/s), PIHI showed the best depiction of flow signal. In intermittent scanning, increases in the mechanical index caused stronger flow signals and longer enhancement duration in all techniques. However, continuous scanning revealed poor depiction of flow signal regardless of the technique or changes in the mechanical index because of significant bubble destruction. CONCLUSIONS: Microbubble-enhanced PIHI with intermittent scanning at a high mechanical index can depict vascular flow highly effectively without shortening the duration of enhancement.

Intratumoral vascularity of experimentally induced VX2 carcinoma: comparison of color Doppler sonography, power Doppler sonography, and microangiography.

RATIONALE AND OBJECTIVES: Tumor vascularity is useful for characterizing tumors and determining tumor management. The recent development of power Doppler sonography has enhanced the sensitivity of color Doppler imaging in the detection of blood flow because of low power noise and less angle dependence. The purpose of this study was to compare the capability of color and power Doppler sonography with that of microangiography for showing tumor vascularity of VX2 carcinoma. METHODS: Color and power Doppler sonography was performed on VX2 carcinomas in the rabbit thighs, and their findings were correlated with those of microangiography. For qualitative analysis, tumor vascularity was categorized into four items including distribution of tumor vessels, crowdedness of vessels, small vessels, (> or = 0.1 mm), and micro-vessels (< 0.1 mm). Tumor blood flow signals of color Doppler sonography and power Doppler sonography were graded as 3, 2, 1, and 0 and were compared with tumor vascularity on microangiography. For quantitative analysis, percentages of tumor vascular area per tumor area on each study were compared. RESULTS: The mean scores of tumor vascularity on power Doppler sonography were 2.87, 2.73, 2.93, and 2.73 in tumor vascular distribution, crowdedness of vessels, small vessels, and micro-vessels, respectively. Those on color Doppler sonography were 2.4, 2.2, 2.8, and 1.67, respectively. Power Doppler sonography was statistically superior to color Doppler sonography in displaying tumor vascular distribution (P < 0.05) and micro-vessels (P < 0.01). The means and medians of percentages of tumor vascular area per tumor area were 22.7% and 23.5% on microangiography, 17.9% and 21.4% on color Doppler sonography, and 36.4% and 34.7 % on power Doppler sonography, respectively. Percentages of tumor vascular area per tumor area on both color Doppler sonography (r = 0.70) and power Doppler sonography (r = 0.84) were well correlated with those on microangiography. CONCLUSIONS: Power Doppler sonography can demonstrate the tumor vascularity on microangiography relatively well, however, it tends to overestimate the blood flow signals. Color Doppler sonography may have some limitations in imaging tumor vascular distribution and micro-vessels and tends to underestimate tumor vascularity, but can display the blood flow direction. Therefore, power Doppler and color Doppler sonography could complement each other in demonstrating the tumor vascularity.

A case of intestinal capillariasis in the Republic of Korea.

In 1991, we observed a Korean man infected by Capillaria philippinensis who had no history of traveling in known endemic areas. He had year-long diarrhea with severe loss of body weight. He enjoyed hunting and fishing and eating raw meat of game animals and fish. An open full-thickness biopsy of the ileum showed flat mucosal surface and sections of the round worm, and fecal examination revealed numerous elliptical helminth eggs. The worms and eggs were consistent with features of C. philippinensis. He was treated with albendazole and was cured. This is the first known case of intestinal capillariasis in the Republic of Korea.

Improved imaging of hepatic metastases with delayed pulse inversion harmonic imaging using a contrast agent SH U 508A: preliminary study.

To investigate the feasibility of delayed pulse-inversion harmonic imaging (PIHI) with the SH U 508A to improve imaging of hepatic metastases, we evaluated 20 patients with known hepatic metastases. Conventional ultrasound (US) was performed before administration, and PIHI was performed 5 min after a bolus injection of 4 G of microbubble contrast agent (300 mg/mL of SH U 508A). Intense, homogeneous enhancement in the liver parenchyma was seen in all patients on delayed PIHI. In 10 patients (50%), 1 or more focal liver lesions that were not seen on unenhanced imaging were detected on delayed PIHI. When comparing 55 lesions that were seen on both techniques, delayed PIHI was superior to unenhanced imaging in terms of lesion conspicuity and lesion-to-liver contrast (p < 0.001, respectively). Delayed PIHI with SH U 508A can improve conspicuity of hepatic metastases and reveal focal liver lesions that are not detected on unenhanced imaging.

Signal from hepatic hemangiomas on power Doppler US: real or artefactual?

To describe imaging findings of hepatic hemangiomas on power Doppler (PD) ultrasound (US) with revised Doppler parameters for preventing PD artefacts from stationary hyperechoic tissue, we prospectively evaluated 48 hemangiomas by PD US with predetermined PD settings to prevent artefactual signals from stationary hyperechoic tissue (pulse repetition frequency of 1000 Hz, medium wall filter, and PD gain of 60-85%). Intratumoral PD signals were not seen in 32 lesions (67%). Minimal (n = 15) or moderate (n = 1) intratumoral PD signals were seen in 16 lesions (33%) and were distributed in the peripheral portion only in 12 lesions (75%) and in the peripheral and central portion in 4 lesions (25%). Due to the lack of sensitivity of PD to detect slow flow in hemangiomas, PD US should no longer be used for the evaluation of echogenic liver masses caused by hemangiomas from other hypovascular malignant lesions of the liver.

Percutaneous removal of retained intrahepatic stones with a pre-shaped angulated catheter: review of 96 patients.

Intrahepatic biliary stone disease is prevalent in East Asia and there is a high frequency of retained intrahepatic stones after surgical treatment. Percutaneous removal of retained intrahepatic stones with a pre-shaped angulated catheter and a Dormier basket was attempted in a group of 96 patients who had a T-tube. Seventy-six had multiple intrahepatic stones, confined to one hepatic lobe in 52 patients. Stones were exclusively intrahepatic in 68 cases. Biliary strictures were present in 92 cases (95.8%). A combination of techniques was used including pre-shaped angulated catheters, irrigation suction, balloon dilatation of strictures, crushing of large stones and extracorporeal shockwave lithotripsy. Retained stones were completely removed in 48 cases, and incompletely removed in 22 cases. The overall success rate was 72.9%. There were only minor complications. No mortality or significant morbidity requiring hospitalization occurred. Angular deformity, stricture of bile ducts and impacted stones were the most frequent factors responsible for failure or incomplete removal of retained stones. Fluoroscopically guided percutaneous interventional procedures with a pre-shaped angulated catheter are useful complementary procedures to surgery for patients with intrahepatic stones. The major benefits of an individually angulated catheter are safety and easy access to small peripheral bile ducts.