Dedicated sellar magnetic resonance imaging protocols without contrast enhancement in girls with central precocious puberty: prevalence of pathologic lesions and clinical correlation

ABSTRACT Objective: Contrast-enhanced brain magnetic resonance imaging (MRI) is routinely performed in children with central precocious puberty (CPP). We evaluated the value of a dedicated sellar MRI protocol without contrast enhancement in girls with CPP. Subjects and methods: This study included 261 girls diagnosed with CPP. We performed sellar MRI scanning without gadolinium enhancement of the hypothalamic-pituitary area (HPA) at the pituitary level, including additional T2-weighted imaging of whole-brain scans to check for other lesions. We evaluated the prevalence of intracranial lesions via this MR protocol. In addition,the correlation between the clinical parameters and morphology of the pituitary gland on the images was assessed. Results: Intracranial lesions were detected in 17 (6.5%) of the 261 girls. Of the 17 girls with abnormalities, 16 (94.1%) had findings in brain areas other than the HPA. The weight, height, Tanner stage of patients were significantly (p < 0.05) higher in the group with greater pituitary height. Patient weight and height, Tanner stage of breast development, and luteinizing hormone (LH) levels were significantly (p < 0.05) greater in those with a higher pituitary grade as determined on sellar MRI. Conclusion: A dedicated unenhanced sellar MRI protocol provides valuable information on brain lesions and pituitary morphology. We found a significantly low prevalence of brain lesions among girls with CPP. Analysis of the height or shape of the pituitary gland on sellar MRI revealed significant correlations with the weight, height, Tanner stage, and LH levels of the patients.

Dedicated sellar magnetic resonance imaging protocols without contrast enhancement in girls with central precocious puberty: prevalence of pathologic lesions and clinical correlation.

OBJECTIVE: Contrast-enhanced brain magnetic resonance imaging (MRI) is routinely performed in children with central precocious puberty (CPP). We evaluated the value of a dedicated sellar MRI protocol without contrast enhancement in girls with CPP. METHODS: This study included 261 girls diagnosed with CPP. We performed sellar MRI scanning without gadolinium enhancement of the hypothalamic-pituitary area (HPA) at the pituitary level, including additional T2-weighted imaging of whole-brain scans to check for other lesions. We evaluated the prevalence of intracranial lesions via this MR protocol. In addition,the correlation between the clinical parameters and morphology of the pituitary gland on the images was assessed. RESULTS: Intracranial lesions were detected in 17 (6.5%) of the 261 girls. Of the 17 girls with abnormalities, 16 (94.1%) had findings in brain areas other than the HPA. The weight, height, Tanner stage of patients were significantly (p < 0.05) higher in the group with greater pituitary height. Patient weight and height, Tanner stage of breast development, and luteinizing hormone (LH) levels were significantly (p < 0.05) greater in those with a higher pituitary grade as determined on sellar MRI. CONCLUSION: A dedicated unenhanced sellar MRI protocol provides valuable information on brain lesions and pituitary morphology. We found a significantly low prevalence of brain lesions among girls with CPP. Analysis of the height or shape of the pituitary gland on sellar MRI revealed significant correlations with the weight, height, Tanner stage, and LH levels of the patients.

Bacteremia due to Rahnella aquatilis in a Patient with a Chemoport.

Rahnella aquatilis, a saprophytic organism, is a member of the Enterobacteriaceae family. The natural habitat of this organism is fresh water, and it is rarely found in clinical specimens. Clinical conditions ascribed to this organism include bacteremia, respiratory infection, urinary tract infection, wound infection in an immunocompromised host, and infective endocarditis in patients with congenital heart diseases. Here, we report a case of bacteremia due to R. aquatilis in a woman with breast cancer who had received chemotherapy through a chemoport. To our knowledge, this is the second case of bacteremia caused by this organism in a patient with cancer in Korea.

Massive Duodenal Bleeding after the Migration of Endovascular Coils into the Small Bowel.

Among gastrointestinal emergencies, acute upper gastrointestinal bleeding remains a challenging clinical problem owing to significant patient morbidity and costs involved in management. Endoscopic hemostatic therapy is the mainstay of treatment and decreases the incidence of re-bleeding, the need for surgery, morbidity, and mortality. However, in 8%-15% of patients with upper gastrointestinal bleeding, endoscopic hemostatic therapy does not successfully control bleeding. Trans-arterial coil embolization is an effective alternative treatment for endoscopic hemostatic failure; however, this procedure can induce adverse outcomes, such as non-target vessel occlusion, vessel dissection and perforation, and coil migration. Coil migration is rare but causes severe complications, such as re-bleeding and bowel ischemia. However, in most cases, coil migration is local and involves spontaneous healing without serious complications. Here, we report the case of a patient who underwent trans-arterial coil embolization of the gastroduodenal artery with the purpose of controlling massive duodenal bleeding, resulting in a fatal outcome caused by coil migration.

Effects of Heat-Treatment on Photoluminescence Spectra and Photocatalytic Properties of Solution-Combusted ZnO Nanopowders.

ZnO nanopowders were prepared by a solution combustion method (SCM). The SCM ZnO nanopowders were heat-treated at 200, 400, 500, or 700 °C for 30 min in air and the photoluminescence (PL) of the nanopowders was evaluated. Two strong PL emission peaks are generally recognized as the unique PL signature of ZnO, one is from the band-edge emission and the other corresponds to green emission. The green emission is derived from crystalline defects, and is a critical obstacle for the electrooptical applications of ZnO. Surprisingly, the PL spectra of the SCM ZnO powders showed a single sharp peak near 390 nm. Furthermore, the intensity of this blue emission doubled when the synthesized ZnO powder was heat-treated at 400 °C. The green emission appeared for the sample treated at 500 °C, and was the highest for that treated at 700 °C. To comfirm the photocatalytic activity of the ZnO powder heat-treated at 400 °C, the removal of Ag ions from a used photofilm developer was evaluated, with complete removal within 10 min. The removal of the Ag ions by the ZnO powder heat-treated at 400 °C was more than two orders of magnitude faster than that achieved with the SCM ZnO powder. The relation between PL and photocatalytic activity was explained in terms of recombination of the photogenerated electrons. These results might be very useful for highly efficient photocatalyst applications.

Photoluminescence and Electrical Properties of ZnO Nanopowders Prepared by a Solution Combustion Method for Optoelectronic Device Application.

Nano-sized powders of ZnO phosphor were prepared by a solution combustion method (SCM). The ZnO powder prepared using Zn(OH)2 and glycine as the oxidant and fuel, respectively, (fuel/oxidant = 0.8), show good powder characteristics such as an average grain size of 30 nm and specific surface area of 120 m²/g. Single-phase ZnO powders were obtained regardless of the fuel/ oxidant ratio. The photoluminescence spectra of the obtained ZnO powders show a single sharp peak near 390 nm corresponding to a deep blue color. This was confirmed by cathodoluminescence measurement and CIE color coordinate values. The PL spectra, powder characteristics and electrical properties show very good consistency. Furthermore, the electron carrier concentration of the ZnO nanopowders prepared by SCM is more than 3 orders of magnitude higher than that of the purest ZnO single crystal, which is commercially available. These powders could be potentially applied as blue phosphors of displays such as A.C. powder electroluminescent devices and plasma display panels.

Interrater reliability and intrarater reliability of lateral scapular slide tests of females in their 20s.

[Purpose] The purpose of the present study was to examine the intrarater reliability and intrarater reliability of lateral scapular slide tests among young females. [Subjects and Methods] A total of 60 female students in U University in Gyeongsangbuk-do, South Korea participated in this study. Lateral scapular slide tests (LSST) were conducted to identify interrater & intrarater reliability. In the LSSTs, the distance from the inferior angle of the scapula to thoracic vertebral spinous process T8 was measured in three positions (shoulder joint 0°, 45°, and 90° abduction) using tape measures. [Results] Intrarater reliability is shown to be moderate with scores not lower than 0.7 in left positions 1 and 3 and is shown to be excellent with scores not lower than 0.9 in the remaining positions. Interrater reliability is shown to be excellent with scores not lower than 0.9 in all three left and right positions. [Conclusion] LSST is sufficiently high to be accepted as an objective tool in the results of general previous studies. In addition, it can be considered useful at clinics because the measuring tool and method are simple.

Development of Epidural and Paraspinal Abscesses after Insufficient Evaluation and Treatment of Acute Pyelonephritis Caused by Staphylococcus aureus.

Diagnoses of pyelonephritis caused by Staphylococcus aureus should be accompanied by investigations of concomitant bladder obstruction and metastatic infections, especially to the spine or heart. Complicated pyelonephritis due to S. aureus requires more than 2 weeks of antibiotics, which is the typically recommended treatment duration for pyelonephritis. We describe a patient who was diagnosed with complicated epidural and paraspinal abscesses after insufficient evaluation and treatment of acute pyelonephritis due to S. aureus. A 62-year-old man with type 2 diabetes was admitted with fever, increased urinary frequency, and left flank pain. He was diagnosed with acute pyelonephritis caused by S. aureus. His fever and flank pain subsided after 3 days of intravenous antibiotics. Evaluation of bladder obstruction and metastatic infection were not performed, as he declined further evaluation. The patient was discharged with oral antibiotics and was requested to attend weekly appointments but was lost to follow-up. One month later, the patient presented at the outpatient clinic with similar symptoms. Computed tomography showed recurrent pyelonephritis and a distended bladder. His flank pain persisted despite administration of an opioid agent. Therefore, magnetic resonance imaging was performed, revealing epidural and paraspinal abscesses. Ultrasound-guided aspiration of the paraspinal muscle layer was performed, and blood and percutaneous aspirated fluid cultures revealed S. aureus growth. The pattern of antimicrobial sensitivity was identical to that at his first admission. Following more than 4 weeks of antibiotics, magnetic resonance imaging showed the abscesses had decreased in size. The patient was discharged without neurologic sequelae and was provided with oral antibiotics.

Correlation among scapular asymmetry, neck pain, and neck disability index (NDI) in young women with slight neck pain.

[Purpose] This study aimed to investigate the correlations among scapular asymmetry, neck pain, and neck disability index in women in their 20s with slight neck pain. [Subjects and Methods] A total of 60 female students at U university in Gyeongsangbuk-do, South Korea, participated in this study. The lateral scapular slide test, which measures the distance between the thorax and scapula, was used to analyze the scapular asymmetry. The lateral scapular slide test was performed in three positions. The visual analogue scale and neck disability index were used to measure neck pain. [Results] In the lateral scapular slide test in position 3 (shoulder abduction at 90 degrees), the scapular left-right asymmetry and VAS showed a moderate positive linear relationship, with r=0.344. The VAS and NDI showed a moderate positive linear relationship, with r = 0.632. [Conclusion] Scapular asymmetry indicates imbalance of surrounding muscles of the scapula and is related to neck pain based on the results of measuring the distance from the thorax to the scapula.

Increased Detection of Colorectal Polyps in Screening Colonoscopy Using High Definition i-SCAN Compared with Standard White Light.

BACKGROUND/AIMS: The aim of this study was to evaluate the efficacy of high definition (HD) i-SCAN for colorectal polyp detection in screening colonoscopy. METHODS: We retrospectively analyzed the records of 501 patients who had undergone screening colonoscopy performed by three endoscopists with either HD i-SCAN (n=149) or standard white light (n=352) from January 2, 2014 through June 30, 2014. Patient information and inter-endoscopist variation as well as polyp number, endoscopic findings, and pathologic characteristics were reviewed. RESULTS: The detection rates of colorectal and neoplastic polyps were significantly higher using HD i-SCAN than standard white light colonoscopy (52% vs. 38.1%, p=0.004 for colorectal polyps; and 37.2% vs. 27.9%, p=0.041 for neoplastic polyps). Analysis of endoscopic findings revealed no difference in detected polyp size between HD i-SCAN and standard white light colonoscopy (4.59±2.35 mm vs. 4.82±2.81 mm, p=0.739), but non-protruding polyps were more commonly detected by i-SCAN than by standard white light colonoscopy (24.6% vs. 13.5%, p=0.007). CONCLUSIONS: Colonoscopy using HD i-SCAN had a significantly higher detection rate of colorectal polyps, including neoplastic polyps, because of improved sensitivity for detecting non-protruding lesions.

Abnormal sitting pressures of hemiplegic cerebral palsy children on a school chair.

[Purpose] The purpose of this study was to investigate the differences in symmetry of sitting posture between typical developmental (TD) children and hemi-cerebral palsy (CP) children. [Subjects and Methods] A school chair mounted on a force platform was used to assess the quiet-sitting pressure distribution of 10 TD and 10 CP children. [Results] The symmetry index of the TD children was significantly closer to zero than that of the CP children irrespective of the latter group's hemiparetic side. [Conclusions] Sitting posture on school chairs of CP children was more asymmetrical than that of TD children.

Effect of Hydrogen Post-Annealing on Transparent Conductive ITO/Ga2O3 Bi-Layer Films for Deep Ultraviolet Light-Emitting Diodes.

The effect of hydrogen post-annealing on the electrical and optical properties of ITO/Ga2O bi-layer films, deposited by RF magnetron sputtering, is investigated for potential applications to transparent conductive electrodes of ultraviolet (UV) light-emitting diodes. Three samples--an as-deposited sample and two samples post-annealed in N2 gas and N2-H2 gas mixture--were prepared and annealed at different temperatures ranging from 100 °C to 500 °C for comparison. Among these samples, the sample annealed at 300 °C in a mixture of N2 and H2 gases shows the lowest sheet resistance of 301.3 Ω/square and a high UV transmittance of 87.1% at 300 nm.

Effects on training and detraining on physical function, control of diabetes and anthropometrics in type 2 diabetes; a randomized controlled trial.

The purpose of this study was to investigate the effect of circuit exercise training and detraining, which is defined by termination of training without additional physical activities, in type 2 diabetic patients. Elderly with type 2 diabetes were divided into a group that exercised for 1 h three times a week for 12 weeks, followed by detraining for 8 weeks, or into a control group. Muscular strength, endurance, flexibility, agility, balance, body mass index (BMI), glycosylated hemoglobin (HbA1c), and blood lipid profile were measured. Of the 98 diabetic participants who joined this study, 37 patients completed the program (exercise group = 24, control group = 13). After training, muscular strength, flexibility, balance, agility, and endurance in the training group were significantly higher than at baseline and compared to the control group. HbA1c levels decreased in the training group. There was no significant improvement in BMI and blood lipid profile in either group. Flexibility and agility in the training group declined significantly after detraining. In spite of this decline, flexibility and agility were significantly higher compared to the baseline and to the control group. In type 2 diabetic patients, circuit training had a beneficial effect on the indices of physical function and glucose metabolism. Training resulted in good improvement; and during detraining, the effect of exercise training was maintained except in some parameters.

Impairment of balance in elderly subjects with type 2 diabetes.

[Purpose] The purpose of this study was to investigate balance among elderly subjects with type 2 diabetes. [Subjects and Methods] Twelve subjects with type 2 diabetes and 15 age-matched controls were examined. Balance was assessed by a computerized device while the subjects were standing. [Results] Subjects with diabetes exhibited significantly more sway than control subjects while standing on a balance platform. [Conclusion] Our findings suggest that diabetes impairs balance when compared with that in normal elderly subjects.

A comparison of gait characteristics in the elderly people, people with knee pain, and people who are walker dependent people.

[Purpose] The purpose of this study was to compare the gait parameters of age-matched people with a normal gait (≥ 65 years), age-matched people with knee pain, and age-matched people with walker dependent gait at a self-selected gait speed. [Methods] Subjects walked on even ground in bare feet and were allowed a natural arm swing on a 6-m walkway. Walker-dependent participants walked on a walkway without a walker. [Results] The kinematic and spatiotemporal gait characteristics were used to investigate the difference among the each group. Hip flexion, knee flexion, and stride width parameters were not different. The gait speed, stride length and time, hip and knee extension, and ankle flexion and extension parameters were significantly different. [Conclusion] A comparision of kinematic and spatiotemporal gait characteristics during gait may provide an insight into the gait pattern of normal elderly people, those with knee pain, and the walker-dependent elderly.

Balance improvement by strength training for the elderly.

[Purpose] Aging is associated with a progressive decline in overall muscle strength. Loss of lower limb strength leads to an increased risk of falls and a sedentary lifestyle. The purpose of this study was to investigate whether lower limb strengthening exercise leads to improved lower limb strength and balance function for the elderly. [Subjects] From a total of 74 respondents, 50 subjects were randomly assigned to either a training group (n = 30) or a control group (n = 20). The subjects ranged in age from 65 to 82 years. A randomized controlled trial compared the effects of strengthening exercise and balance function. [Methods] Leg extension and lower curl exercises were performed during the 12-week study. [Results] After training, the lower limb strength and balance of the individuals in the training group had significantly improved compared to the baseline. [Conclusion] Improvement in lower limb strength may lead to balance enhancement in neurologically intact older persons.

Alteration of mitochondrial DNA sequence and copy number in nasal polyp tissue.

This study was designed to investigate the possibility that mtDNA mutations might arise in inflammatory or chronically damaged nasal polyp tissue from 23 patients. Thirteen patients (57%) displayed nasal polyp tissue-specific mtDNA mutations in the hypervariable segment of the control region and cytochrome b gene, which were not found in the corresponding blood cells and/or adjacent normal tissue. Nasal polyp tissue-specific length heteroplasmic mutations were also detected in nucleotide position (np) 303-315 homopolymeric poly C track (39%), np 514-523 CA repeats (17%) and np 16184-16193 poly C track (30%). The average mtDNA copy number was about three times higher in nasal polyp tissue than in the corresponding peripheral blood cells and adjacent non-polyp tissues. The level of reactive oxygen species (ROS) was significantly higher in the nasal polyp tissues compared to those from the corresponding samples. High level of ROS in nasal polyp tissue may contribute to development of mtDNA mutations, which may play a crucial role in the vicious cycle of pathophysiology of nasal polyps.