Is there a clinical difference in paediatric congenital cholesteatoma according to age?

OBJECTIVE: This study aimed to analyse surgical outcomes of paediatric patients with congenital cholesteatoma according to age. METHOD: This was a retrospective study reviewing the records of 186 children (136 boys and 50 girls) from August 1993 to January 2016. Patients were divided into three age groups (equal to or less than 3 years, over 3 and less than 7 years, and 7 to 15 years). RESULTS: There were significant differences in chief complaints, location of cholesteatoma in the middle ear, computed tomography findings, operation methods, ossicular erosion and type of cholesteatoma sac among the three groups. In addition, older age, open type cholesteatoma, ossicular erosion and mastoid invasion of cholesteatoma increased the recurrence rate after surgery. However, despite higher pre-operative air-bone gap in older children, hearing can be improved enough after proper surgery with ossicular reconstruction. CONCLUSION: Delayed detection of paediatric cholesteatoma can lead to extensive disease and the need for an aggressive operation, which can result in worse hearing outcomes and an increased recurrence risk.

Incidence of oral anticoagulant interruption among stroke patients with atrial fibrillation and subsequent stroke.

BACKGROUND AND PURPOSE: We analyzed the incidence and causes of oral anticoagulant (OAC) cessation and subsequent stroke after OAC withdrawal in a cohort of Korean stroke patients with atrial fibrillation. METHODS: The Korean Atrial Fibrillation Evaluation Registry in Ischemic Stroke patients (K-ATTENTION) is a multicenter cohort study, merging stroke registries from 11 tertiary centers in Korea. The number of OAC interruption episodes and the reasons were reviewed from hospital records. Stroke after OAC withdrawal was defined when a patient experienced ischaemic stroke within 31 days after OAC withdrawal. Clinical variables were compared between patients who experienced stroke recurrence during OAC interruption and those who did not experience recurrence. RESULTS: Among 3213 stroke patients with atrial fibrillation, a total of 329 episodes of OAC interruption were detected in 229 patients after index stroke (mean age 72.9 ± 8.3 years, 113 female patients). The most frequent reason for OAC withdrawal was poor compliance [103 episodes (31.3%)] followed by extracranial bleeding [96 episodes (29.2%)]. Stroke after OAC withdrawal was noted in 13 patients. Mean age, vascular risk factor profile and mean CHA2 DS2 -VASc score were not significantly different between patients with and without recurrent stroke. CONCLUSIONS: A considerable number of stroke patients with atrial fibrillation experienced temporary interruption of OAC after index stroke, which was associated with stroke recurrence of 4.0 cases per 100 interruption episodes.

Anti-inflammatory effects of simvastatin in nonsteroidal anti-inflammatory drugs-induced small bowel injury.

Small bowel injury can occur as the result of a multifaceted process that includes increased acid secretion, generation of reactive oxygen species, and cyclooxygenase inhibition. However, no effective medication for small bowel ulceration is available. Simvastatin is an important lipid-lowering agent with anti-inflammatory activity. We aimed to validate the effects of simvastatin in vitro and in vivo. In presence or absence of simvastatin, IEC-6 small bowel cell line with 50 ng/ml of tumor nectosis factor α (TNF-α) was investigated by western blotting, qRT-PCR, and DCF-DA assay. In addition, an in vivo study of nonsteroidal anti-inflammatory drugs (NSAID)-induced small bowel inflammation was performed using 7-week-old specific-pathogen-free (SPF) male C57BL/6 mice. Simvastatin treatment reduced the mRNA levels of interleukin-6 and interleukin-8 by approximately 50% in TNF-α-stimulated IEC-6 cells. Treatment with a combination of 50 ng/ml TNF-α and µM simvastatin decreased activation of Akt, IκBα, and nuclear factor-κB p65 level in IEC-6 cells. By DCF-DA staining, intracellular reactive oxygen species (ROS) production was increased in TNF-α-stimulated cells, and treatment with simvastatin decreased the level of ROS. In addition, in vivo mouse model of NSAID-induced small bowel inflammation, the administration of simvastatin reduced the number of small bowel hemorrhagic lesions and the level of ROS production as determined by gross examination and 8-hydroxydeoxyguanosine immunohistochemistry of small bowel tissue, respectively. Simvastatin reduced NSAID-induced injuries by both suppression of ROS generation and modulation of inflammatory cytokines in vitro and in vivo. Therefore, simvastatin, an HMG-CoA reductase inhibitor, has potential as a prophylactic and therapeutic agent for NSAID-induced small bowel injury.

Early administration of neuraminidase inhibitors in adult patients hospitalized for influenza does not benefit survival: a retrospective cohort study.

The administration of neuraminidase inhibitors (NAIs) within 2 days after the onset of symptoms (early NAI therapy) has been shown to reduce mortality in adult patients with severe influenza. However, there is no sufficiently solid evidence supporting the effectiveness of early NAI therapy on mortality. We reviewed the clinical data from 506 adult patients who were hospitalized for influenza between March 2010 and March 2014, to investigate the impact of early NAI therapy on mortality. Nearly one-third of the study patients were infected with influenza B (influenza A, influenza B, and co-infection of both in 68.8%, 28.1%, and 3.2%, respectively), and were diagnosed using the polymerase chain reaction (PCR) method (33.6%). Less than half (233, 46.0%) had received early NAI therapy. Patients with early NAI therapy were admitted to the hospital earlier, more frequently infected with influenza A, and more frequently diagnosed using rapid influenza detection tests compared to those without early NAI therapy. Although patients without early NAI therapy presented with more serious clinical manifestations, such as an initial symptom of dyspnea, pneumonia, and intensive care unit admission, than those with early NAI therapy, the in-hospital mortality of the former (2.9%, 8/273) did not differ from that of the latter (3.4%, 8/233) (p = 0.75). We did not find a reduction in mortality associated with early NAI therapy in adult patients hospitalized for influenza. Further clinical studies including a large number of influenza B-infected patients with virus identification using PCR methodology rather than viral culture may be required to confirm the beneficial impact of early NAI therapy on mortality.

Simultaneous removal of rotavirus and adenovirus from artificial ground water using hydrochar derived from swine feces.

Hydrothermal carbonization technology can convert fecal waste into a valuable carbonaceous product referred to as hydrochar. We investigated the potential of fecal waste-derived hydrochar as an adsorbent for virus removal in water treatment. Swine feces was hydrothermally treated under two conditions: at 180 °C for 2 h and 230 °C for 7 h. The resulting solid products (hydrochar) were evaluated as virus adsorbents in water treatment. Simultaneous removal of pathogenic rotavirus (RV) and human adenovirus (HAdV) was investigated using a sand column set-up of 10 cm bed height with and without hydrochar supplement (1.5%, w/w). The removal efficiency of both viruses in a hydrochar-amended column was >3 log (complete removal). The amount of virus released in deionized water when flushed into the virus-retaining columns indicated that the secondary energy minimum played a more important role in RV retention than that of HAdV. Zeta-potential and hydrophobicity measurements on hydrochar materials indicated that the improved virus removal performance of hydrochar-amended columns was induced by the provision of extra hydrophobic surfaces. This study provides evidence that fecal waste-derived hydrochar can be used as a competent virus adsorbent.

The prevalence and impact of sarcopenia on degenerative lumbar spinal stenosis.

AIMS: The purpose of this study was to investigate the prevalence of sarcopenia and to examine its impact on patients with degenerative lumbar spinal stenosis (DLSS). PATIENTS AND METHODS: This case-control study included two groups: one group consisting of patients with DLSS and a second group of control subjects without low back or neck pain and related leg pain. Five control cases were randomly selected and matched by age and gender (n = 77 cases and n = 385 controls) for each DLSS case. Appendicular muscle mass, hand-grip strength, sit-to-stand test, timed up and go (TUG) test, and clinical outcomes, including the Oswestry Disability Index (ODI) scores and the EuroQol EQ-5D were compared between the two groups. RESULTS: The prevalence of sarcopenia, as defined by hand-grip strength, was significantly higher in the DLSS group (24%) when compared with the age- and gender-matched control group (12%) (p = 0.004). In the DLSS group, the sarcopenia subgroup demonstrated inferior results for the TUG test and ODI scores when compared with the non-sarcopenia subgroup (p = 0.006 and p = 0.039, respectively) after adjusting for age and gender. CONCLUSION: This study demonstrated a higher prevalence of sarcopenia in patients with DLSS and highlighted its negative effect on clinical outcomes. Cite this article: Bone Joint J 2016;98-B:1093-8.

Prognostic Value of Labyrinthine 3D-FLAIR Abnormalities in Idiopathic Sudden Sensorineural Hearing Loss.

BACKGROUND AND PURPOSE: According to recent research, modern MR imaging can detect the presense of abnormalities on labyrinthine. Our aim was to report the patterns and prognostic role of abnormal findings on labyrinthine imaging in patients with sudden sensorineural hearing loss. MATERIALS AND METHODS: This study comprised 113 patients who were diagnosed with unilateral sudden sensorineural hearing loss and underwent 3T MR imaging, including pre-/postcontrast 3D fluid-attenuated inversion recovery and T1-weighted imaging. We analyzed abnormalities on MR imaging and correlated them with audiometric results. RESULTS: Thirty-one (27%) patients showed abnormal findings on labyrinthine MR imaging in the affected ear. The initial/final hearing levels of the MRI+ group (91 ± 25/73 ± 27 dB hearing loss) were significantly worse than those of the MRI- group (69 ± 30/48 ± 24 dB hearing loss). The incidence of abnormalities on labyrinthine MR imaging was significantly lower (3 of 40, 8%) in 40 patients with initial mild-to-moderate hearing loss than in those with profound hearing loss (16 of 34, 47%). Considering hearing improvement by the Siegel criteria, the rate of complete or partial recovery was significantly higher in the MRI- group (34%) than in the MRI+ group (10%). In patients with initial severe or profound hearing loss, the MRI- group showed greater hearing improvement (38 ± 21 dB) than the MRI+ group (23 ± 22 dB). CONCLUSIONS: Abnormalities on labyrinthine MR imaging were found in 27% of patients with sudden sensorineural hearing loss. The initial hearing loss was worse in the MRI+ group than in the MRI- group. In patients with initial severe and profound hearing loss, the presence of abnormalities on labyrinthine MR imaging indicated a poor prognosis.

Neutropenia and neutrophil-to-lymphocyte ratio in a healthy Korean population: race and sex should be considered.

INTRODUCTION: We evaluated the prevalence and severity of asymptomatic neutropenia in a healthy Korean population according to sex and age. We explored normal neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in an asymptomatic Korean population and the association of these ratios with biomarkers related to inflammation, rheumatoid disease, and glucose metabolism. METHODS: We analyzed complete blood cell counts in 83 740 subjects who participated in a routine health check-up program. NLR and PLR were compared to age, rheumatoid factor, C-reactive protein (CRP), erythrocyte sedimentation rate, hemoglobin A1c, and fasting glucose levels. RESULTS: Of the entire study population, 7.48% exhibited neutropenia; 8.61% of females and 6.69% of males. The neutropenia was more severe in females compared to males (P < 0.01). Median NLR and PLR values were 1.53 and 121.07, respectively. An inverse relationship was observed between NLR and age, but no differences were seen between sexes. CRP, erythrocyte sedimentation rate, and fasting glucose level were significantly correlated with NLR. CONCLUSION: Our data indicate that the normal range of absolute neutrophil counts should be adjusted and cutoff values for neutropenia should be re-established according to sex and race. NLR and PLR cutoff values for disease evaluation should be established separately according to race and age.

Removal of rotavirus and adenovirus from artificial ground water using hydrochar derived from sewage sludge.

AIMS: To determine the pathogenic virus removal performance of an adsorbent produced from hydrothermal carbonization of sewage sludge. METHODS AND RESULTS: The removal of human pathogenic rotavirus and adenovirus was investigated with columns of 10 cm saturated sand with and without amendments of 1·5% (w/w) hydrochar. Virus concentrations were determined with reverse transcription (RT) quantitative polymerase chain reaction (qPCR). The experiments with sand showed 1 log removal, while the columns with 1·5% (w/w) hydrochar amendment showed 2 to >3 log removal for both viruses. Deionized (DI) water flushing into the virus-retaining columns revealed that the secondary energy minimum played a larger role in the attachment of rotavirus onto hydrochar surfaces than adenovirus. Improved virus removal may be attributed to the introduction of hydrophobic and/or meso-macro surface structures of the hydrochar providing favourable attachment sites for viruses. CONCLUSIONS: Hydrochar amended sand beds showed improved virus removal efficiencies exceeding 99·6% corresponding to 2·4 log removal. The addition of humic acid in the influent did not hinder the adsorptive removal of viruses. SIGNIFICANCE AND IMPACT OF THE STUDY: This study suggests that hydrochar derived from sewage sludge can be used as an adsorbent for virus removal in water treatment.

Coagulase-negative staphylococcal bacteremia: risk factors for mortality and impact of initial appropriate antimicrobial therapy on outcome.

It is uncertain whether an initial inappropriate empirical antibiotic treatment of coagulase-negative staphylococci (CoNS) bacteremia adversely affects the outcome. A retrospective cohort study of CoNS bacteremia was performed at the Dongguk University Ilsan Hospital during a 3-year period. During the study period, 109 patients with CoNS bacteremia were enrolled. The median age of the patients was 72 years and most (96%, 105/109) had one or more comorbid diseases. Among the participants, 29% (32/109) received an appropriate empirical antimicrobial therapy. The 30-day mortality was 24% (26/109) and CoNS bacteremia-related mortality was 14% (15/109). There was no difference in the CoNS bacteremia-related mortality between the group with an inappropriate empirical treatment (13%, 10/77) and that with an appropriate treatment (16%, 5/32) (p = 0.46). In the multivariate analysis using the Cox regression analysis method, Pitt bacteremia scores [hazard ratio (HR) 1.48; 95% confidence interval (CI) 1.09-2.01; p = 0.01] and retention of eradicable focus (HR 5.0; 95% CI 1.39-17.9; p = 0.01) were found to be associated with CoNS bacteremia-related mortality. The results suggest that inappropriate empirical therapy might not necessarily be associated with the 30-day mortality or CoNS bacteremia-related mortality. Conversely, Pitt bacteremia scores and retention of eradicable focus were associated with poor outcomes.

A cost-effectiveness analysis of teledietetics in short-, intermediate-, and long-term weight reduction.

INTRODUCTION: To evaluate the effectiveness of teledietetics in weight loss for 24 weeks and the cost-effectiveness of weight loss between face-to-face and teledietetics services. METHODS: The study was conducted at a community health center and a community dietetics clinic. The study was a quasiexperimental design. Fifty adults aged 20-50 with a BMI ≥23 participated in the study. The face-to-face (FD) group received 12 dietary counselling sessions and recorded their diet in a log book. The teledietetics (TD) group attended three group nutrition seminars and recorded their diet on a Web-based platform. Changes in variables were compared using an independent t-test. Direct and indirect costs were applied to compute cost-effectiveness ratios. RESULTS: At week 6, the FD group showed greater reductions in all variables than did the TD group. At week 12, the effects reversed. At week 24, the accumulated reductions in weight and fat in the TD group were significantly higher than those in the FD group (all at p < 0.0001). The observed direct costs for 1% weight loss and 1% fat loss were USD 28.24 and USD17.09, respectively. DISCUSSION: A dietetic service delivered as a teledietetics model is more cost-effective than the face-to-face dietetics model in weight reduction.

Group B streptococcal bacteremia in non-pregnant adults: results from two Korean centers.

Patients with liver cirrhosis (LC) have impaired immunity and are, thus, predisposed to infection. Few studies have attempted to evaluate group B streptococcal (GBS) bacteremia in LC patients. A retrospective study of patients with GBS bacteremia was performed at the Dongguk University Ilsan Hospital and National Health Insurance Service Ilsan Hospital over a 13-year period (October 2000 to July 2013). During the study period, 97 patients with GBS bacteremia were enrolled. The median age of the patients was 67 years and 54 % were men. Among them, 23 (24 %) patients were classified as LC patients. The 30-day mortality rate of LC patients was significantly higher than that of patients with other diseases (26 % vs. 8 %, p = 0.03). The multivariate analysis indicated that LC was associated with an increased risk of 30-day mortality [hazard ratio (HR) 5.0; 95 % confidence interval (CI) 1.53-16.3; p = 0.008], as well as age (HR 1.07; 95 % CI 1.03-1.13; p = 0.02) and high Pitt bacteremia score (HR 1.23; 95 % CI 1.02-1.46; p = 0.03). The probability of survival at day 30 was significantly different for the Child-Pugh class C and the Child-Pugh classes A or B (44 % vs. 93 %, respectively; p = 0.01 by the log-rank test). The mortality rates of LC patients with GBS bacteremia were significantly higher than those of patients with other diseases. The severity of hepatic dysfunction plays an important role in the development of adverse events. Cirrhosis-specific scores such as the Child-Pugh class might be useful for predicting the prognosis of GBS bacteremia in LC patients.

Spin-induced band modifications of graphene through intercalation of magnetic iron atoms.

Intercalation of magnetic iron atoms through graphene formed on the SiC(0001) surface is found to induce significant changes in the electronic properties of graphene due mainly to the Fe-induced asymmetries in charge as well as spin distribution. From our synchrotron-based photoelectron spectroscopy data together with ab initio calculations, we observe that the Fe-induced charge asymmetry results in the formation of a quasi-free-standing bilayer graphene while the spin asymmetry drives multiple spin-split bands. We find that Fe adatoms are best intercalated upon annealing at 600 °C, exhibiting split linear π-bands, characteristic of a bilayer graphene, but much diffused. Subsequent changes in the C 1s, Si 2p, and Fe 3p core levels are consistently described in terms of Fe-intercalation. Our calculations together with a spin-dependent tight binding model ascribe the diffuse nature of the π-bands to the multiple spin-split bands originated from the spin-injected carbon atoms residing only in the lower graphene layer.

Genomic copy concentrations of selected waterborne viruses in a slum environment in Kampala, Uganda.

The presence of viruses in a slum environment where sanitation is poor is a major concern. However, little is known of their occurrence and genomic copy concentration in the slum environment. The main objective of this study was to determine the genomic copy concentrations of human adenoviruses F and G, Rotavirus (RV), Hepatitis A virus (HAV), Hepatitis E virus (HEV) and human adenovirus species A,C,D,E, and F (HAdV-ACDEF) in Bwaise III, a typical slum in Kampala, Uganda. Forty-one samples from surface water, grey water and ground water were collected from 30 sampling locations. The virus particles were recovered by glass wool filtration with elution using beef extract. DNA and RNA viruses were detected by the real time quantitative polymerase chain reaction (qPCR) and the reverse transcription-qPCR (RT-qPCR), respectively. HAdV-F and G were detected in 70.7% of the samples with concentrations up to 2.65 × 10(1) genomic copies per mL (gc mL(-1)). RV and HAV were detected in 60.9% and 17.1% of the samples, respectively. The maximum concentration of RV was 1.87 × 10(2)gc mL(-1). In addition, 78% of the samples tested positive for the HAdV-ACDEF, but all samples tested negative for HEV. These new data are essential for quantitative microbial risk assessment, and for understanding the effects of environmental pollution in slums.

Effects of celecoxib on hematoma and edema volumes in primary intracerebral hemorrhage: a multicenter randomized controlled trial.

BACKGROUND AND PURPOSE: We investigated the effect of celecoxib, a selective inhibitor of cyclo-oxygenase 2, in patients with intracerebral hemorrhage (ICH). METHODS: We conducted a multicenter, randomized, controlled, and open with blinded end-point trial of 44 Korean patients 18 years or older with ICH within 24 h of onset. The intervention group (n = 20) received celecoxib (400 mg twice a day) for 14 days. The control group (n = 24) received the standard medical treatment for ICH. The primary end-point was the number of patients with a change in the volume of perihematomal edema (PHE) from the 1st to the 7th ± 1 day (cut-off value, 20%). RESULTS: The time from onset to computed tomography scan slightly differed between groups (177 ± 160 min for control vs. 297 ± 305 min for the celecoxib group; P = 0.10). In the primary end-point analysis using cut-off values, there was a significant shift to reduced expansion of PHE in the celecoxib group (P = 0.005). With respect to the secondary end-points, there was also a significant shift to reduced expansion of ICH in the celecoxib group (P = 0.046). In addition, the expansion rate of PHE at follow-up tended to be higher in the control group than in the celecoxib group (90.6 ± 91.7% vs. 44.4 ± 64.9%; P = 0.058). CONCLUSIONS: In our small, pilot trial, administration of celecoxib in the acute stage of ICH was associated with a smaller expansion of PHE than that observed in controls.

Development of low cost two-step reverse transcription-quantitative polymerase chain reaction assays for rotavirus detection in foul surface water drains.

Commercial kits to determine RNA concentrations are expensive, and sometimes too expensive for laboratories working with tight budgets, especially those in developing countries. We developed, tested, and evaluated two home-made two-step reverse transcription-quantitative polymerase chain reaction assays aimed to detect rotavirus in surface water samples. A commercial one-step master kit was used for comparison. Our results indicated that the efficiency of the home-made assays was comparable to the commercial kit. Furthermore, the lowest detection limit of all assays corresponded to 10⁻°·² TCID50 (50 % tissue Culture Infective Dose) per ml. The home-made assays were able to detect rotavirus concentrations in complex surface waters in a slum area in Kampala (Uganda) and their performance was comparable to the commercial kit. The total costs of the two home-made assays was 11 times less than the selected commercial kit. Although preparing home-made assays is more time consuming, the assays can be useful for cases in which consumable costs are more important than personnel costs.

Microscopic schistocyte determination according to International Council for Standardization in Hematology recommendations in various diseases.

INTRODUCTION: Recently, a consensus report for microscopic schistocyte determination was prepared by International Council for Standardization in Hematology (ICSH). ICSH focused on diagnosis of thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS). We aimed to reanalyze schistocytes according to ICSH recommendations, to study diseases other than TTP/HUS related to the schistocytes, and to compare the percentage of schistocytes among the various diseases. METHODS: We retrieved all reported cases of peripheral blood (PB) smear in a single institution during 6 years. Schistocytes on 282 PB smears showing previous peripheral schistocytes and hemoglobin ≤10 g/dL were recounted according to ICSH recommendations. RESULTS: The schistocytes were frequently observed in patients with microangiopathic hemolytic anemia (MAHA), metastatic carcinoma, sepsis, chronic renal failure, preterm infant, and infection. Only two among 34 patients categorized as MAHA were diagnosed as TTP/HUS. Schistocytes were observed with other morphological changes in 169 of 170 cases with schistocyte ≤1% and in 102 of 112 with schistocyte >1%. The median schistocyte percentages of patients with hematologic malignancy, megaloblastic anemia, acute renal failure, and preterm infant were 1.20%, 1.30%, 1.35%, and 1.70%, respectively. CONCLUSION: Schistocytes were observed above 1% in many diseases other than TTP /HUS. Therefore, it is important to understand that schistocytes could be seen in various diseases, and in these cases, schistocytes were usually detected together with other red blood cell morphologic changes. These data support ICSH recommendation that a schistocyte count should be considered clinically meaningful if schistocytes represent the main morphological abnormality in the PB smear.

Recurrent deep vein thrombosis and pulmonary embolism in a patient with Klinefelter's syndrome.

Klinefelter's syndrome, which is characterized by small testes, gynecomastia, hypogonadism, and infertility, is the most common cause of primary testicular failure, and commonly has an XXY karyotype. Deep vein thrombosis and thomboembolic events are a rare occurrence in these patients. Although the exact mechanism is not completely understood, it is thought that increased thromboembolic risk in hypogonadic men can be explained by hypofibrinolysis resulting from androgen deficiency. We present the case of a 48-year-old man with Klinefelter's syndrome who experienced recurrent episodes of deep venous thrombosis and pulmonary embolism while undergoing therapeutic anticoagulation. Our report discusses this association and management of the prothrombotic state in patients with Klinefelter's syndrome.