Validity of Radiograph-Based Infrapatellar Fat Pad Opacity Grading for Assessing Knee Synovitis: Correlation With Contrast-Enhanced MRI.

OBJECTIVE: The purpose of this study was to determine the validity of infrapatellar fat pad (IPFP) opacity grading based on lateral knee radiography for assessing knee synovitis using correlation with contrast-enhanced (CE) MRI. MATERIALS AND METHODS: Retrospective reviews of radiographs and CE knee MR images from 79 patients were independently performed by two radiologists. They evaluated IPFP opacity alteration (IPFPCR) and joint effusion grades on lateral knee conventional radiographs, IPFP signal intensity alteration (IPFPMR) and joint effusion grades on CE MR images, and synovitis (SYNMR) grade in nine divided regions, three compartments (parapatellar, periligamentous, perimeniscal), and the whole knee on CE MR images. Correlations between radiographic grades and MRI assessments were evaluated using Spearman correlation tests, and the correlation coefficients (ρ) were compared. Interobserver agreement was evaluated using weighted kappa values. RESULTS: The IPFPCR grade was very highly correlated with the IPFPMR grade (ρ = 0.906, p < 0.001) and highly correlated with SYNMR grades from four regions (suprapatellar, infrapatellar, intercondylar, lateral parapatellar recess), the parapatellar compartment, and the whole knee (ρ = 0.614-0.740, all p < 0.001). The IPFPCR grade was moderately correlated with the SYNMR grades of the remaining five regions and two compartments (ρ = 0.457-0.547, all p < 0.001). The differences between correlation coefficients for SYNMR grades and the IPFPCR and IPFPMR grades were not statistically significant (p = 0.290-1.0). Interobserver reliabilities were excellent or good for IPFPCR, IPFPMR, and SYNMR grades (κ = 0.661-1.000). CONCLUSION: IPFPCR grade assessment enables valid evaluation and reporting of knee synovitis, especially in the parapatellar compartment and the whole knee.

Topographical and sex variations in the T2 relaxation times of articular cartilage in the ankle joints of healthy young adults using 3.0T MRI.

PURPOSE: To prospectively evaluate topographical and sex variations in the T2 relaxation values of tibiotalar cartilage (TTC) of healthy young adults. MATERIALS AND METHODS: Sagittal 8-echo multiecho spin-echo T2 maps of TTC were acquired using a 3.0T MR in 25 male and 25 female healthy young adult participants. Quantitative measurements of T2 values in tibial cartilage (TBC) and talar cartilage (TLC) were obtained from three zones (anterior zone, AZ; middle zone, MZ; and posterior zone, PZ) and from four compartments (medial compartment, MC; midmedial compartment, MMC; midlateral compartment, MLC; and lateral compartment, LC) of TBC and TLC in the sagittal plane. RESULTS: The T2 values of AZ (for TBC, 29.31 msec; for TLC, 35.81 msec) and MZ (for TBC, 28.56 msec; for TLC, 36.12 msec) in males were significantly higher than those in females (for AZ of TBC, 26.99 msec; for AZ of TLC, 33.56 msec; for MZ of TBC, 25.88 msec; for MZ of TLC, 31.85 msec) (for TBC, AZ, P = 0.009, MZ, P = 0.002; for TLC, AZ, P = 0.047, MZ, P = 0.001). Except for MMC and MLC of TBC (MMC, P = 0.02, MLC, P = 0.03), TTC T2 values did not differ significantly between these compartment in either group (for TBC, MC, P = 0.27, LC, P = 0.37; for TLC, MC, P = 0.26, MMC, P = 0.08, MLC, P = 0.30, LC, P = 0.10). CONCLUSION: We found significant sex and topographic variations among TTC T2 values of healthy young adults. Acknowledgment of the significant topographical and sex variations in cartilage T2 values may minimize misinterpretation of ankle joint TTC T2 mapping data.

Henoch-Schonlein purpura: ultrasonography of scrotal and penile involvement.

Testicular or scrotal involvement has been reported in children with Henoch-Schonlein purpura (HSP), but there are very few reports on penile involvement. We report the initial and follow-up ultrasonographic findings of scrotal and penile involvement of HSP in a 5-year-old boy. On ultrasonography, scrotal soft tissue thickening and epididymal swelling with increased vascularity were noted, and on the penis, a focal mass-like lesion appeared on the dorsal surface of the distal penis, having a hypoechoic mass-like appearance without visible vascular flow on a Doppler study. After 2 days of treatment, follow-up ultrasonography showed normal scrotum and penis with a resolved soft tissue mass-like lesion. Therefore, we think that HSP ultrasonographic findings involving the scrotum and penis might help to diagnose scrotal and penile involvement in a case of HSP and to avoid unnecessary medication and/or surgical procedures.

A functional magnetic resonance imaging (FMRI) study of cue-induced smoking craving in virtual environments.

Smokers who are exposed to smoking-related cues show cardiovascular reactivity and smoking craving compared with their responses to neutral cues, and increased cue reactivity predicts decreased likelihood of successful cessation. Several brain imaging studies suggested four candidate brain regions that might differ in gray matter volumes and densities between smokers and nonsmokers. However, in these studies, smokers were only exposed to smoking-related objects. In our pilot study utilizing a virtual reality (VR) technique, virtual environments (VEs) were more immersive and evoked smoking craving more effectively than traditionally used methods. In this study, we sought to test whether smokers could experience cue-induced smoking craving inside the MRI scanner by using the VR system. The smoking cue reactivity scenario was based in part on our preliminary task and consisted of 2D and 3D (or VE) conditions. The group mean of participants had increased activity in the prefrontal cortex (PFC), left anterior cingulate gyrus (ACC), left supplementary motor area, left uncus, right inferior temporal gyrus, right lingual gyrus, and right precuneus in the 2D condition. Areas of differential activation in the 3D condition were as follows: left superior temporal gyrus, right superior frontal gyrus, and left inferior occipital gyrus in the 3D condition. This finding is consistent with those of previous studies of nicotine craving showing PFC and ACC activation. However, in the 3D condition, the PFC including the superior frontal gyrus as well as the superior temporal gyrus, inferior occipital gyrus, and cerebellum were activated. Therefore, in the 3D condition, participants seemed to have more attention, visual balance, and coordinating movement than in the 2D condition.

Plasmid-mediated, inducible AmpC beta-lactamase (DHA-1)-producing Enterobacteriaceae at a Korean hospital: wide dissemination in Klebsiella pneumoniae and Klebsiella oxytoca and emergence in Proteus mirabilis.

The aim of the study was to investigate the phenotypic and genetic characteristics of recently emerging cefoxitin-resistant and induction-positive isolates of Escherichia coli, Klebsiella species, and Proteus mirabilis. Strains of Enterobacteriaceae were isolated at a Korean tertiary care hospital between June and December 2002. Induction was tested using cefoxitin and aztreonam disks, the blaDHA allele was detected by PCR, and pulsed-field gel electrophoresis (PFGE) patterns were also analyzed. Among the cefoxitin-resistant isolates, 2.7% of E. coli, 21.1% of Klebsiella pneumoniae, 32.0% of Klebsiella oxytoca, and 8.3% of P. mirabilis isolates showed induction, and were blaDHA-1 allele positive. To the best of our knowledge, this is the first report of blaDHA-1 in P. mirabilis. The MICs of ceftazidime, cefotaxime, and aztreonam increased significantly by higher inoculum, suggesting that their clinical usefulness is limited. Presence of multiple PFGE patterns and identical patterns in some isolates suggest that the widely disseminated blaDHA-1 in Klebsiella species was because of both horizontal and clonal spread.

Experimental application of virtual reality for nicotine craving through cue exposure.

Research has shown that many smokers experience an increase in the desire to smoke when exposed to smoking-related cues. Cue exposure treatment (CET) refers to the manualized, repeated exposure to smoking-related cues, aimed at the reducing cue reactivity by extinction. In this study, we constructed a virtual reality system for evoking a desire of nicotine, which was based on the results of a Questionnaire of Nicotine-craving. And we investigated the effectiveness of the virtual reality system as compared to classical device (pictures). As a result, we reached the conclusion that virtual reality elicits more craving symptoms than the classical devices.

High prevalence of PER-1 extended-spectrum beta-lactamase-producing Acinetobacter spp. in Korea.

PER-1, an extended-spectrum beta-lactamase, has been reported only in Europe. We detected PER-1 in 53 of 97 acinetobacters in Korea, mainly in the sputum of intensive care unit patients. Pulsed-field gel electrophoresis analysis suggested that clonal spread had occurred. Only PCR reliably detected PER-1 producers. PER-1 producers may also exist in other Asian countries.