Korean dental hygiene students' perceptions and attitudes toward artificial intelligence: An online survey.

OBJECTIVES: This study investigated Korean dental hygiene students' perceptions and attitudes toward artificial intelligence (AI) and aimed to identify needs for education to strengthen professional competencies. METHODS: A 24-question online survey was conducted to the dental hygiene students from four Korean schools in 2021. The questionnaire included seven questions on basic characteristics and 17 AI-related questions on the student's attitudes toward AI, the confidence in AI, predictions about AI, and its future prospects. Responses were analyzed according to the frequencies and correlations between the participants' subjective level of knowledge about AI and questions using chi-square test. RESULTS: Invitations were sent out to 1310 students and 800 (61.1%) participated. Note that 44.2% of participants were interested in AI, and 93.1% accessed AI-related information through the internet. Participants expressed lower confidence in AI's diagnosis (14.8%) and judgment (8.1%) than in those of humans, and 21.9% believed AI would replace their job. The proportions of participants with positive perceptions of the usefulness and the potential for improvement of AI in dentistry were 65.5% and 55.4%, respectively. Participants from schools who had existing AI knowledge expressed higher demands for AI-related content as compared to those who did not (p < 0.05). CONCLUSION: Although dental hygiene students expressed low level of confidence in AI, they were interested in AI and had positive views of its application and potential for improvement. However, the fact they had little AI-related information from dental hygiene curriculum strongly suggests the need for AI-related lectures in schools to prepare for the future.

Comparison of factor structures of the Pittsburgh sleep quality index between mid- and late pregnancy among Korean women: a cross-sectional study.

BACKGROUND: Sleep disturbance in pregnant women needs to be accurately assessed in a timely manner during pregnancy, to receive assessment-driven accurate intervention. This study aims to compare the factor structure of the Pittsburgh Sleep Quality Index (PSQI) among women in mid- and late pregnancy and evaluate the psychometric features of the Korean version of the PSQI. METHODS: The survey questionnaire with the PSQI, Center for Epidemiological Studies Depression scale, and pregnancy stress, was completed by 281 women in mid- or late pregnancy. Exploratory factor analysis determined the best factor structure of the PSQI, and the Pearson correlation coefficient examined a convergent validity with depressive symptoms and pregnancy stress. Internal consistency was examined using Cronbach's alpha. RESULTS: In both mid- and late-pregnancy women, a two-factor structure model was identified. However, each factor's different components were named differently. For women in mid-pregnancy, it was named "quantitative sleep quality" and "subjective sleep quality," and for those in later stages of pregnancy, they were named "perceived sleep quality" and "daily disturbance." The PQSI score showed a significantly positive correlation between depressive symptoms and pregnancy stress in mid- (r = 0.57 and r = 0.39, respectively), and late pregnancy (r = 0.48 and 0.28, respectively). The overall Cronbach's alpha for the PSQI was 0.63. CONCLUSIONS: The Korean version of the PSQI demonstrated excellent construct and convergent validity, making it suitable to assess the sleep quality of women in middle to late stages of their pregnancy. The PSQI was found to have a two-factor structure in the mid-and late pregnancy, but the components were different. As sleep quality changes with each gestational stage, factors affecting it during mid- and late pregnancy need to be separately examined. It will make it easier for medical professionals to provide pregnant women sleeping irregularly, with the right kind of intervention.

The Effect of Alcohol Drinking on Metabolic Syndrome and Obesity in Koreans: Big Data Analysis.

The purpose of this study was to assess the effect of alcohol consumption on metabolic syndrome (MetS) and obesity in Koreans by analysis of big data from the National Health Insurance Service health checkup database. A total of 26,991,429 subjects aged 20 years or older were included. Alcohol consumption was divided into five groups: nondrinkers, ≤7.0 g/d, 7.1-14.0 g/d, 14.1-28.0 g/d, ≥28.1 g/d. Logistic regression analyses were performed after adjusting for age, exercise, smoking, and income. The odds ratios (ORs) of MetS and obesity in men and women were lowest at ≤7.0 g/d, similar to that of the nondrinkers at 7.1-14.0 g/d, and increased with the alcohol consumption. At 7.1-14.0 g/d in older men, the ORs of metabolic syndrome and obesity were similar to those in the nondrinkers, but the OR of obesity was slightly increased in older women. This study suggests that the risk of MetS and obesity may be higher in Korean men, women, and the elderly who drink more than 14 g/d than the nondrinkers. In people with obesity or abdominal obesity, or those who need to manage their blood pressure, glucose, or triglyceride, drinking more than 7 g/d may increase the risk of MetS.

Trajectories of Depressive Symptoms and Anxiety during Pregnancy and Associations with Pregnancy Stress.

The purposes of this study were to investigate the trajectory groups of depressive symptoms and anxiety in women during pregnancy and to identify the factors associated with those groups. Participants were recruited from the outpatient clinic of a women's health hospital in Seoul, Korea. Pregnant women (n = 136) completed a survey questionnaire that included questions on depressive symptoms, anxiety, and pregnancy stress; additionally, their saliva was tested for cortisol hormone levels three times during their pregnancies. The group-based trajectory modeling approach was used to identify latent trajectory groups. Ordinal logistic regressions were used to explore the association of latent trajectory groups with sociodemographic factors and pregnancy stress. Three trajectory groups of depressive symptoms were identified: low-stable (70%), moderate-stable (25%), and increased (5%). Four trajectory groups of anxiety were identified: very low-stable (10%), low-stable (67%), moderate-stable (18%), and high-stable (5%). The only factor associated with both the depressive symptoms and anxiety trajectory groups was pregnancy stress (p < 0.001). Most participants showed stable emotional status; however, some participants experienced higher levels of depressive symptoms and anxiety related to higher pregnancy stress. These pregnant women may need additional care from healthcare providers to promote their wellbeing during pregnancy.

Cluster Analysis of the Combined Association of Sleep and Physical Activity with Healthy Behavior and Psychological Health in Pregnant Women.

The purposes of the study were to (1) identify clusters based on patterns of sleep quality and duration and physical activity levels of healthy Korean pregnant women, and (2) subsequently investigate the association of identified clusters with pre-pregnancy healthy behaviors, depressive symptoms, and pregnancy stress. Two hundred eighty-four pregnant women participated in the study while attending a prenatal education program provided by a tertiary hospital in Seoul, Korea. The survey questionnaire consisted of the Pittsburg Sleep Quality Index, the International Physical Activity Questionnaire, and the Center for Epidemiologic Studies Depression scale. We used the Latent GOLD to identify distinct clusters and the chi-square test and ANOVA to compare clusters. We identified three clusters: 'good sleeper' (63.4%), 'poor sleeper' (24.6%), and 'low activity' (12.0%). Women in the good-sleeper cluster were more likely to have higher education and income levels and reported more healthy behaviors before pregnancy. Poor-sleeper and low-activity clusters were more likely to report higher scores in depressive symptoms and pregnancy stress (p < 0.001 and p = 0.005, respectively). Tailored intervention for pregnant women who are physically inactive or sleep poorly may promote their psychological well-being as well as bringing good obstetric outcomes.

Delayed Motor Development and Infant Obesity as Risk Factors for Severe Deformational Plagiocephaly: A Matched Case-Control Study.

The prevalence of deformational plagiocephaly (DP) has increased since the recommendation of positioning infants to their back during sleeping and is affected by various biological and environmental factors. This study aimed to investigate associations between DP and perinatal or infant characteristics, including obesity. This case-control study included 135 infants (81 males) aged 2-12 months who were diagnosed with DP using calculated cranial vault asymmetric index and cranial index and 135 age- and sex-matched controls. Motor development was evaluated using the Alberta Infant Motor Scale, and obesity was defined by body mass index. Univariate and multivariate logistic regression models were used to assess potential risk factors for DP and its severity. One hundred thirty-five infants with DP were divided into the following three subgroups according to severity indicated by the cranial vault asymmetry index: mild to moderate group (n = 87, 64.4%), severe group (n = 48, 35.6%), and a combined plagiocephaly and brachycephaly group (n = 79, 58.5%). Independent risk factors significantly associated with development of DP were bottle-only feeding (adjusted odds ratio (aOR) = 4.65; 95% CI: 2.70-8.00), little tummy time when awake (aOR = 3.51, 95% CI: 1.71-7.21), delay of motor development (aOR = 2.85, 95% CI: 1.08-7.49), and obesity at diagnosis (aOR = 2.45, 95% CI: 1.02-5.90). Among these risk factors, delay of motor development (aOR = 4.91, 95% CI: 1.46-16.51) and obesity at diagnosis (aOR = 4.10, 95% CI: 1.42-11.90) were particularly related to severe DP. In conclusion, this study confirms that DP risk is positively associated with bottle-only feeding, infrequent tummy time, and delayed development of motor milestones. Notably, this study demonstrates infant obesity as a new risk factor for DP. Our findings suggest that obesity should be identified early and managed comprehensively in infants with DP.

Development of a model (SWNano) to assess the fate and transport of TiO2 engineered nanoparticles in sewer networks.

A new model, SWNano (Sewer-Water Nano), has been developed in the present study that quantitatively simulates the spatio-temporal changes in the concentrations of TiO2 ENPs of dispersed and aggregated forms in the sewage water and sediment of a sewer network. As a brief example of SWNano applications, a small section of the entire sewer network of Seoul, Korea, was chosen to study where the sewage water was experimentally characterized. The predictions of SWNano present important findings that i) heteroaggregation is the most significant process following the advective transport among the fate and transport processes in the sewer pipes, ii) the heteroaggregation of TiO2 ENPs with SPMs in the sewage water can substantially (a few % to more than 50%) reduce the freely dispersed TiO2 ENPs depending on the magnitude of attachment efficiency, and iii) accurate determination of attachment efficiency is of critical importance in predicting the quantity of individual forms of ENPs exiting the sewer system. The predictions strongly suggest that the fate and transport of TiO2 ENPs in the sewer networks be taken into account to improve the assessment of exposure to TiO2 ENPs in the aquatic ecosystems, which warrants further development and use of models like SWNano.

Incidence and Prevalence of Central Precocious Puberty in Korea: An Epidemiologic Study Based on a National Database.

OBJECTIVES: To investigate the prevalence and incidence of central precocious puberty in Korea using claims data provided by the Health Insurance Review and Assessment Service in Korea as the population-based epidemiologic study. STUDY DESIGN: In this national registry-based, longitudinal, epidemiologic study, patients who were registered with an International Classifications of Diseases, Tenth Revision diagnosis of central precocious puberty (E22.8 according to International Classifications of Diseases, Tenth Revision) and treated with gonadotropin-releasing hormone agonist were included. We assessed the age- and sex-specific prevalence and incidence rates of central precocious puberty in Korea from 2008 to 2014. RESULTS: A total of 37 890 girls and 1220 boys were newly registered with a diagnosis of central precocious puberty from 2008 to 2014. The overall incidence of central precocious puberty during the study period was 122.8 per 100 000 persons (girls, 262.8; boys, 7.0). The overall prevalence of central precocious puberty during the study period was 193.2 per 100 000 persons (girls, 410.6; boys, 10.9). The incidence and prevalence of central precocious puberty steeply increased during the study period in both girls and boys. CONCLUSIONS: This epidemiologic study, based on a national registry that included Korean children, demonstrated that the incidence and prevalence rates of central precocious puberty were high and increased steeply during the study period. Further investigations to determine the underlying causes for this rapid increase in central precocious puberty are needed.

Serum alanine aminotransferase levels are closely associated with metabolic disturbances in apparently healthy young adolescents independent of obesity.

PURPOSE: Liver metabolism plays a pivotal role in the development of metabolic disorders. We aimed to investigate the clinical and laboratory risk factors associated with alanine aminotransferase (ALT) levels in young adolescents from an urban population in Korea. METHODS: A population of 120 apparently healthy adolescents aged 12-13 years was included in the cross-sectional design study; 58 were overweight or obese and 62 were of normal weight. We estimated anthropometric and laboratory measurements, including waist-to-height ratio, blood pressure, insulin sensitivity, aspartate aminotransferases (AST), ALT, and lipid profiles. RESULTS: The mean ages of the overweight or obese and normal weight participants were 12.9±0.3 and 13.0±0.3 years, respectively. Height, weight, body mass index, waist circumference, waist-to-height ratio, systolic and diastolic blood pressure, AST, ALT, total cholesterol, low-density lipoprotein-cholesterol, triglyceride, insulin, and the homeostatic model assessment of insulin resistance (HOMA-IR) score were significantly higher and the high-density lipoprotein-cholesterol and quantitative insulin-sensitivity check index were significantly lower in the overweight/obese participants in comparison to the normal-weight participants (all P<0.05). In multivariate linear regression analysis, waist-to-height ratio, systolic blood pressure, and HOMA-IR score were independently and positively associated with serum ALT levels. CONCLUSION: Screening for ALT levels in adolescents may help to differentiate those at risk of metabolic abnormalities and thus prevent disease progression at an early age.

Blood concentrations of lipopolysaccharide-binding protein, high-sensitivity C-reactive protein, tumor necrosis factor-α, and Interleukin-6 in relation to insulin resistance in young adolescents.

BACKGROUND: We assessed the association of insulin resistance as indicated by the homeostatic model assessment of insulin resistance (HOMA-IR) with inflammatory molecules, lipopolysaccharide-binding protein (LBP), high sensitivity C-reactive protein (hs-CRP), Tumor necrosis factor-α (TNF-α), and Interleukin-6 (IL-6) in urban young adolescents. METHODS: Seventy-six adolescents (36 subjects with HOMA-IR ≥ 2.6 and 40 subjects with HOMA-IR < 2.6) were included in the study. We assessed anthropometric and laboratory measures, such as BMI, blood pressure, insulin sensitivity, liver enzymes, and lipid profiles along with the aforementioned inflammatory biomarkers. The diagnostic accuracy of LBP, hs-CRP, TNF-α, and IL-6 for insulin resistance was evaluated by using the receiver operating characteristic (ROC) curve analysis. RESULTS: The mean age of the study subjects was 12.0 [12.0-13.0] y. Circulating LBP plasma concentration and hs-CRP were significantly increased in subjects with HOMA-IR ≥ 2.6 when compared with those with HOMA-IR < 2.6 (P < .0001). There was no difference in TNF-α or IL-6 concentrations between groups. Comparisons based on the area under the ROC curve for LBP, hs-CRP, TNF-α, and IL-6 with regard to insulin resistance (HOMA-IR ≥ 2.6) were 0.8384 (95% CI: 0.7380 to 0.9388), 0.7907 (95% CI: 0.6701 to 0.9113), 0.6207 (95% CI: 0.4770 to 0.7643), and 0.5763 (95% CI: 0.4285 to 0.7241), respectively. CONCLUSIONS: Among LBP, hs-CRP, TNF-α, and IL-6, plasma LBP has the greatest diagnostic accuracy for insulin resistance in young adolescents. Prospective studies are warranted to delineate the value of LBP in the prediction of insulin resistance.

Zonulin level, a marker of intestinal permeability, is increased in association with liver enzymes in young adolescents.

BACKGROUND: Zonulin is acknowledged as the only physiological mediator established to reversibly regulate intestinal permeability through modulation of intercellular tight junctions. We aimed to determine whether there are differences in zonulin levels between 74 subjects with overweight or obesity and 76 with normal-weight and to assess correlations of circulating zonulin levels with anthropometric measures and obesity-related biomarkers. METHODS: We assessed anthropometric and laboratory measures, including body mass index (BMI) z-score, blood pressure, liver enzymes, lipid profiles, and insulin resistance. Serum zonulin levels were measured using an enzyme-linked immunosorbent assay. RESULTS: The mean age of the participants was 12.8 ±â€¯1.5 years. Circulating serum zonulin levels were significantly increased in subjects with overweight/obesity compared with those of normal-weight (P = 0.03). Zonulin levels were significantly and positively associated with BMI z-score, alanine aminotransferase levels, triglyceride, fasting insulin, and insulin resistance as indicated by the homeostatic model assessment of insulin resistance (HOMA-IR) (all P < 0.05). In multivariate linear regression analysis, alanine aminotransferase was significantly and positively associated with circulating zonulin levels in adolescents with overweight or obesity (P < 0.01) after controlling for the effect of potential confounding factors. BMI z-score tended to be positively associated with serum zonulin levels in this subgroup analysis (P = 0.06). CONCLUSIONS: Serum zonulin is a biomarker associated with hepatic metabolic disturbances in young adolescents with overweight or obesity. The positive relationship suggests a potentially relevant pathophysiological mechanism linking zonulin to hepatic metabolism in this age group of young adolescents with overweight or obesity.

Comparison of point-source pollutant loadings to soil and groundwater for 72 chemical substances.

Fate and transport of 72 chemicals in soil and groundwater were assessed by using a multiphase compositional model (CompFlow Bio) because some of the chemicals are non-aqueous phase liquids or solids in the original form. One metric ton of chemicals were assumed to leak in a stylized facility. Scenarios of both surface spills and subsurface leaks were considered. Simulation results showed that the fate and transport of chemicals above the water table affected the fate and transport of chemicals below the water table, and vice versa. Surface spill scenarios caused much less concentrations than subsurface leak scenarios because leaching amounts into the subsurface environment were small (at most 6% of the 1 t spill for methylamine). Then, simulation results were applied to assess point-source pollutant loadings to soil and groundwater above and below the water table, respectively, by multiplying concentrations, impact areas, and durations. These three components correspond to the intensity of contamination, mobility, and persistency in the assessment of pollutant loading, respectively. Assessment results showed that the pollutant loadings in soil and groundwater were linearly related (r 2 = 0.64). The pollutant loadings were negatively related with zero-order and first-order decay rates in both soil (r = - 0.5 and - 0.6, respectively) and groundwater (- 1.0 and - 0.8, respectively). In addition, this study scientifically defended that the soil partitioning coefficient (K d) significantly affected the pollutant loadings in soil (r = 0.6) and the maximum masses in groundwater (r = - 0.9). However, K d was not a representative factor for chemical transportability unlike the expectation in chemical ranking systems of soil and groundwater pollutants. The pollutant loadings estimated using a physics-based hydrogeological model provided a more rational ranking for exposure assessment, compared to the summation of persistency and transportability scores in the chemical ranking systems. In the surface spill scenario, the pollutant loadings were zeros for all chemicals, except methylamine to soil whose pollutant loading was smaller than that in the subsurface leak scenario by 4 orders of magnitude. The maximum mass and the average mass multiplied by duration in soil greatly depended on leaching fluxes (r = 1.0 and 0.9, respectively), while the effect of leaching fluxes diminished below the water table. The contribution of this work is that a physics-based numerical model was used to quantitatively compare the subsurface pollutant loading in a chemical accident for 72 chemical substances, which can scientifically defend a simpler and more qualitative assessment of pollutant loadings. Besides, this study assessed pollutant loadings to soil (unsaturated zone) and groundwater (saturated zone) all together and discussed their interactions.

A boy with 46,X,+mar presenting gynecomastia and short stature.

A 15-year-old boy was referred due to gynecomastia and short stature. He was overweight and showed the knuckle-dimple sign on the left hand, a short fourth toe on the left foot, and male external genitalia with a small phallus. His levels of estradiol and follicle-stimulating hormone were increased, and his testosterone concentration was normal. Other hormonal tests were within the normal range. Radiographs showed short fourth and fifth metacarpals and fourth metatarsal bones. The karyotype was reported as 46,X,+mar, and the marker chromosome was shown to originate from the Y chromosome, which was identified by fluorescence in situ hybridization. Polymerase chain reaction and direct sequencing were used to clarify the deleted loci of the Y chromosome by making use of Y-specific sequence-tagged sites (STSs). The sex-determining region Y and centromere were verified, and there were microdeletions on the long arm of the Y chromosome. The azoospermia factor (AZF) b region was partially deleted, and AZFa and AZFc were completely deleted. Two STS probes of sY143 and the Y chromosome RNA recognition motif in AZFb showed positive signals corresponding to Yq11.223. The karyotype of the patient was interpreted as 46,X,der(Y)del(Y)(q11.21q11.222)del(Y)(q11.23qter). Herein, we report a rare case of a boy presenting with gynecomastia and short stature with 46, X, +mar, which originated from the Y chromosome, which was identified to have Yq microdeletions.

A 2-month-old boy with hemolytic anemia and reticulocytopenia following intravenous immunoglobulin therapy for Kawasaki disease: a case report and literature review.

Herein, we report a rare case of hemolytic anemia with reticulocytopenia following intravenous immunoglobulin therapy in a young infant treated for Kawasaki disease. A 2-month-old boy presented with fever lasting 3 days, conjunctival injection, strawberry tongue, erythematous edema of the hands, and macular rash, symptoms and signs suggestive of incomplete Kawasaki disease. His fever resolved 8 days after treatment with aspirin and high dose infusion of intravenous immunoglobulin. The hemoglobin and hematocrit decreased from 9.7 g/dL and 27.1% to 7.4 g/dL and 21.3%, respectively. The patient had normocytic hypochromic anemia with anisocytosis, poikilocytosis, immature neutrophils, and nucleated red blood cells. The direct antiglobulin test result was positive, and the reticulocyte count was 1.39%. The patient had an uneventful recovery. However, reticulocytopenia persisted 1 month after discharge.

Ultrasound measurement of pediatric visceral fat thickness: correlations with metabolic and liver profiles.

PURPOSE: Abdominal obesity is a fundamental factor underlying the development of metabolic syndrome. Because of radiation exposure and cost, computed tomography or dual-energy X-ray absorptiometry to evaluate abdominal adiposity are not appropriate in children. Authors evaluated whether ultrasound results could be an indicator of insulin resistance and nonalcoholic fatty liver disease (NAFLD). METHODS: We enrolled 73 subjects (aged 6-16 years) who were evaluated abdominal adiposity by ultrasound. Subcutaneous fat thickness was defined as the measurement from the skin-fat interface to the linea alba, and visceral fat thickness (VFT) was defined as the thickness from the linea alba to the aorta. Anthropometric and biochemical metabolic parameters were also collected and compared. The subjects who met 2 criteria, radiologic confirmed fatty liver and alanine aminotransferase >40, were diagnosed with NAFLD. RESULTS: There was a strong positive correlation between VFT and obesity. VFT was highly correlated with the homeostasis model assessment for insulin resistance score (r=0.403, P<0.001). The area under the curve for VFT as a predictor of NAFLD was 0.875 (95% confidence interval [CI], 0.787-0.964). VFT of 34.3 mm was found to be the discriminating cutoff for NAFLD (sensitivity, 84.6%; specificity, 71.2%, respectively). CONCLUSION: Ultrasound could be useful in measuring VFT and assessing abdominal adiposity in children. Moreover, increased VFT might be an appropriate prognostic factor for insulin resistance and NAFLD.

Lipopolysaccharide-binding protein plasma levels as a biomarker of obesity-related insulin resistance in adolescents.

PURPOSE: Lipopolysaccharide-binding protein (LBP) is a 65-kDa acute phase protein, derived from the liver, which is present in high concentrations in plasma. Data regarding the association between circulating plasma LBP levels and obesity-related biomarkers in the pediatric population are scarce. We aimed to determine whether there was a difference in plasma LBP levels between overweight/obese and normal-weight adolescents and to assess the correlation of circulating LBP levels with anthropometric measures and obesity-related biomarkers, including insulin resistance, liver enzyme levels, and lipid profiles. METHODS: The study included 87 adolescents aged 12-13 years; 44 were overweight/obese and 43 were of normal-weight. We assessed anthropometric and laboratory measures, including body mass index (BMI), blood pressure, insulin resistance, liver enzyme levels, and lipid profiles. Plasma LBP levels were measured using an enzyme-linked immunosorbent assay. RESULTS: The mean age of the participants was 12.9±0.3 years. Circulating plasma LBP levels were significantly increased in overweight/obese participants compared with those in normal-weight participants (7.8±1.9 µg/mL vs. 6.0±1.6 µg/mL, P<0.001). LBP levels were significantly and positively associated with BMI, systolic blood pressure, aspartate aminotransferase, alanine aminotransferase, total cholesterol, low density lipoprotein-cholesterol, fasting glucose and insulin, and insulin resistance as indicated by the homeostatic model assessment of insulin resistance (HOMA-IR) (all P<0.05). In multivariate linear regression analysis, BMI and HOMA-IR were independently and positively associated with plasma LBP levels. CONCLUSION: LBP is an inflammatory biomarker associated with BMI and obesity-related insulin resistance in adolescents. The positive correlation between these parameters suggests a potentially relevant pathophysiological mechanism linking LBP to obesity-related insulin resistance in adolescents.

A patient with Cushing disease lateralizing a pituitary adenoma by inferior petrosal sinus sampling using desmopressin: a case report.

A 14-year-old girl was referred for evaluation of the etiology of Cushing syndrome. During the previous 2 years, she had experienced weight gain, secondary amenorrhea, growth retardation, and back pain. Random serum cortisol level, 24-hour urinary free cortisol excretion, and overnight and low-dose dexamethasone suppression tests suggested Cushing syndrome. Midnight adrenocorticotropic hormone (ACTH) level and high-dose dexamethasone suppression test confirmed Cushing disease. Pituitary magnetic resonance imaging was suspicious for microadenoma. To eliminate ectopic ACTH syndrome, and lateralize the pituitary tumor, inferior petrosal sinus sampling (IPSS) was performed by desmopressin use to stimulate ACTH. Finally, the patient was diagnosed with Cushing disease due to ACTH-secreting pituitary microadenoma, lateralized to the left side; subsequently underwent transsphenoidal surgery. Here we report a case of a 14-year-old girl diagnosed with Cushing disease with a pituitary tumor lateralized by IPSS using desmopressin, which is very rare in pediatric Cushing disease.

Male patients presenting with rapidly progressive puberty associated with malignant tumors.

In males, precocious puberty (PP) is defined as the development of secondary sexual characteristics before age 9 years. PP is usually idiopathic; though, organic abnormalities including tumors are more frequently found in male patients with PP. However, advanced puberty in male also can be an important clinical manifestation in tumors. We report 2 cases of rapidly progressive puberty in males, each associated with a germ-cell tumor. First, an 11-year-old boy presented with mild fever and weight loss for 1 month. Physical examination revealed a pubertal stage of G3P3 with 10-mL testes. Investigations revealed advanced bone age (16 years) with elevated basal luteinizing hormone and testosterone levels. An anterior mediastinal tumor was identified by chest radiography and computed tomography, and elevated α-fetoprotein (AFP) and ß-human chorionic gonadotropin (ß-hCG) levels were noted. Histopathologic analysis confirmed a yolk-sac tumor. Second, a 12-year-old boy presented with diplopia, polydipsia, and polyuria for 4 months. Physical examination revealed a pubertal stage of G3P3 with 8-mL testes. Bone age was advanced (16 years) and laboratory tests indicated panhypopituitarism with elevated testosterone level. A mixed germ-cell tumor was diagnosed with elevated AFP and ß-hCG levels. Of course, these patients also have other symptoms of suspecting tumors, however, rapidly progressive puberty can be the more earlier screening sign of tumors. Therefore, in male patients with accelerated or advanced puberty, malignancy should be considered, with evaluation of tumor markers. In addition, advanced puberty in male should be recognized more widely as a unique sign of neoplasm.

The stability of water- and fat-soluble vitamin in dentifrices according to pH level and storage type.

The purpose of this study is to evaluate the vitamin stabilities in dentifrices by analyzing various vitamins according to the level and storage temperature. The stabilities of water- and fat-soluble vitamins were investigated in buffer solution at different pH values (4, 7, 8, 10 and 11) for 14 days and in dentifrices at different pH (7 and 10) for 5 months at two temperature conditions (room and refrigeration temperature) by analyzing the remaining amounts using HPLC methods. In the buffer solution, the stability of vitamins B1 , B6 and C was increased as the pH values increased. Vitamins E and K showed poor stability at pH 4, and vitamin B3 showed poor stability at pH 11. In dentifrices, the storage temperature highly influenced vitamin stability, especially vitamins C and E, but the stabilities of vitamins B1 and C according to pH values did not correspond to the buffer solution tests. Vitamin B group was relatively stable in dentifrices, but vitamin C completely disappeared after 5 months. Vitamin K showed the least initial preservation rates. Vitamins were not detected in commercial dentifrices for adults and detected amounts were less than the advertised contents in dentifrices for children.