Evaluation of shoulder pathology: three-dimensional enhanced T1 high-resolution isotropic volume excitation MR vs two-dimensional fast spin echo T2 fat saturation MR

OBJECTIVE

To evaluate the diagnostic accuracy of three-dimensional (3D) enhanced T1 high-resolution isotropic volume excitation (eTHRIVE) shoulder MR for the detection of rotator cuff tears, labral lesions and calcific tendonitis of the rotator cuff in comparison with two-dimensional (2D) fast spin echo T2 fat saturation (FS) MR.

METHODS

This retrospective study included 73 patients who underwent shoulder MRI using the eTHRIVE technique. Shoulder MR images were interpreted separately by two radiologists. They evaluated anatomic identification and image quality of the shoulder joint on routine MRI sequences (axial and oblique coronal T2 FS images) and compared them with the reformatted eTHRIVE images. The images were scored on a four-point scale (0, poor; 1, questionable; 2, adequate; 3, excellent) according to the degree of homogeneous and sufficient fat saturation to penetrate bone and soft tissue, visualization of the glenoid labrum and distinction of the supraspinatus tendon (SST). The diagnostic accuracy of eTHRIVE images compared with routine MRI sequences was evaluated in the setting of rotator cuff tears, glenoid labral injuries and calcific tendonitis of the SST.

RESULTS

Fat saturation scores for eTHRIVE were significantly higher than those of the T2 FS for both radiologists. The sensitivity and accuracy of the T2 FS in diagnosing rotor cuff tears were >90%, whereas sensitivity and accuracy of the eTHRIVE method were significantly lower. The sensitivity, specificity and accuracy of both images in diagnosing labral injuries and calcific tendonitis were similar and showed no significant differences. The specificity of both images for the diagnosis of labral injuries and calcific tendonitis was higher than the sensitivities.

CONCLUSION

The accuracy of 3D eTHRIVE imaging was comparable to that of 2D FSE T2 FS for the diagnosis of glenoid labral injury and calcific tendonitis of SST. The 3D eTHRIVE technique was superior to 2D FSE T2 FS in terms of fat saturation. Overall, 3D eTHRIVE was inferior to T2 FS in the evaluation of rotator cuff tears because of poor contrast between joint fluid and tendons.

ADVANCES IN KNOWLEDGE

The accuracy of 3D eTHRIVE imaging is comparable to that of 2D FSE T2 FS for the diagnosis of glenoid labral injury and calcific tendonitis of SST.

Comparison of therapeutic efficacy and safety of radiofrequency ablation of hepatocellular carcinomas between internally cooled 15-G and 17-G single electrodes

OBJECTIVE

To compare the ablation volume, local tumour progression rate and complication rate of radiofrequency ablation (RFA) for small hepatocellular carcinomas (HCCs) using 15-G and 17-G single electrodes.

METHODS

This retrospective study was approved by the institutional review board and informed consent was waived. We reviewed percutaneous RFA cases for HCCs using 15-G or 17-G electrodes without multiple overlapping ablations. A total of 36 pairs of HCCs matched according to tumour size and active tip length were included. We compared ablation volume and complication rate between the two electrode groups. Cumulative local tumour progression rates were estimated using the Kaplan–Meier method and compared using the log-rank test.

RESULTS

Tumour size and ablation time were not significantly different between the 15-G and 17-G groups (p50.661 and p50.793, respectively). However, ablation volume in the 15-G electrode group was larger than that in the 17-G group (14.465.4cm3 vs 8.762.5cm3; p,0.001). No statistical difference in complication rates between the two electrode groups was found. The 10- and 20-month local tumour progression rates were not significantly different between the two groups (2.8% and 5.6% vs 11.1% and 19.3%; p50.166).

CONCLUSION

Ablation volume by the 15-G electrode was larger than that by the 17-G electrode. However, local tumour progression rate and complication rate were not significantly different between the two electrode groups.

ADVANCES IN KNOWLEDGE

RFA of HCC using a 15-G electrode is useful to create larger ablation volumes than a 17-G electrode.

The usefulness of the oblique coronal plane in knee MRI on the evaluation of the posterior cruciate ligament

BACKGROUND

Imaging findings of posterior cruciate ligament (PCL) injury may be equivocal, particularly when the patient has suffered a partial ligament tear. Some PCLs are positioned more horizontally, making it difficult to diagnose injury based on routine imaging planes alone due to partial volume artifact.

PURPOSE

To evaluate the diagnostic accuracy of combining oblique coronal imaging (PCL view) with traditional orthogonal views for PCL evaluation.

MATERIAL AND METHODS

This retrospective study included 20 patients with PCL injury and 43 patients with intact PCL who underwent PCL view imaging. Anatomic identification of PCL pathology on the orthogonal magnetic resonance imaging (MRI) sequences and PCL views was evaluated. Subjective scoring of the PCL was performed by two radiologists who assessed the possibility of a PCL tear based on an entire length view, an entire width view, and margin sharpness according to a 4-point scale. Diagnostic accuracy using these two views was evaluated by calculating the sensitivity, specificity, and accuracy. Arthroscopic and clinical findings were used as the reference standard.

RESULTS

Total scores for the PCL view were higher than those of orthogonal views (P < 0.001). Both readers found that anatomic identification using the full width view and sharp margin to be superior using the PCL view compared with the orthogonal views (P < 0.001). The specificities and accuracies were higher in cases where an additional PCL view was provided, but did not show statistical significance.

CONCLUSION

PCL view provides better anatomic evaluation of the PCL and mild improvement in the specificity and accuracy.

Optimizing electrical activation of porcine oocytes by adjusting pre- and post-activation mannitol exposure times

Modifying electrical activation conditions have been used to improve in vitro embryo production and development in pigs. However, there is insufficient information about correlations of porcine embryo development with oocyte pre- and post-activation conditions. The purpose of this study was to compare the developmental rates of porcine oocytes subjected to different mannitol exposure times, either pre- or post-electrical activation, and to elucidate the reason for the optimal mannitol exposure time. Mannitol exposure times around activation were adjusted as 0, 1, 2 or 3 min. Blastocyst development were checked on day 7. Exposure of oocytes to mannitol for 1 or 2 min before electrical activation produced significantly higher blastocyst rates than exposure for 0 or 3 min. There was no significant difference in blastocyst rates when activated oocytes were exposed to mannitol for 0, 1, 2 or 3 min after electrical activation. While exposure of oocytes to mannitol for 1 min pre- and 3 min post-activation showed significantly higher blastocyst development than 0 min pre- and 0 min post-activation. It also showed higher maintenance of normal oocyte morphology than exposure for 0 min pre- and 0 min post-activation. In conclusion, exposure of oocytes to mannitol for 1 min pre- and 3 min post-activation seems to be optimal for producing higher in vitro blastocyst development of porcine parthenogenetic embryos. The higher blastocyst development is correlated with higher maintenance of normal morphology in oocytes exposed to mannitol for 1 min pre- and 3 min post-activation.

The impact of weight changes on nonalcoholic Fatty liver disease in adult men with normal weight

BACKGROUND

Although it is known that losing weight has an effect on the treatment of non-alcoholic fatty liver disease, the studies that show how losing weight affects the non-alcoholic fatty liver disease for the normal weight male adults are limited so far. In this study, we set body mass index as criteria and investigated how the weight changes for 4 years makes an impact on the risk of non-alcoholic fatty liver disease for the male adults who have the normal body mass index.

METHODS

From January to December of 2004, among the normal weight male adults who had general check-up at the Health Promotion Center of Ulsan University Hospital, 180 people (average age, 47.4 ± 4.61 years) who were diagnosed with fatty liver through abdominal ultrasonography were included in this study and were observed according to the variety of data and ultrasonography after 4 years (2008). People who had a history of drinking more than 140 g of alcohol per week or who had a past medical history were excluded from the analysis. The weight change of subjects was calculated using the formula 'weight change = weight of 2008 (kg) - weight of 2004 (kg)' and classified into three groups, loss group (≤-3.0 kg), stable group (-2.9 to 2.9 kg), and gain group (≥3.0 kg). The odds for disappearance of non-alcoholic fatty liver disease in those three different groups were compared.

RESULTS

Among 180 subjects, compared with stable group (67.2%, 121 subjects), loss group (11.7%, 21 subjects) showed 18.37-fold increase in the odds of disappearance of non-alcoholic fatty liver disease (95% confidence interval [CI], 4.34 to 77.80) and gain group (21.1%, 38 subjects) showed 0.28-fold decrease in the odds of disappearance of non-alcoholic fatty liver disease (95% CI, 0.10 to 0.83).

CONCLUSION

Even for the normal weight people, losing weight has an effect on the improvement of non-alcoholic fatty liver disease.

Serpin peptidase inhibitor clade A member 1 is a biomarker of poor prognosis in gastric cancer

Background:

In a previous study, we reported that serpin peptidase inhibitor clade A member 1 (serpinA1) is upregulated in Snail-overexpressing gastric cancer. Although serpinA1 has been studied in several types of cancer, little is known about its roles and mechanisms of action. In this study, we examined the role of serpinA1 in the migration and invasion of gastric cancers and determined its underlying mechanism.

Methods:

Expression levels were assessed by western blot analyses and real-time PCR. Snail binding to serpinA1 promoter was analysed by chromatin immunoprecipitation (ChIP) assays. The roles of serpinA1 were studied using cell invasion and migration assays. In addition, the clinicopathologic and prognostic significance of serpinA1 expression were validated in 400 gastric cancer patients using immunohistochemical analysis.

Results:

Overexpression of Snail resulted in upregulation of serpinA1 in gastric cancer cell lines, AGS and MKN45, whereas knockdown of Snail inhibited serpinA1 expression. Chromatin immunoprecipitation analysis showed that overexpression of Snail increased Snail recruitment to the serpinA1 promoter. Overexpression of serpinA1 increased the migration and invasion of gastric cancer cells, whereas knockdown of serpinA1 decreased invasion and migration. Moreover, serpinA1 increased mRNA levels and release of metalloproteinase-8 in gastric cancer cells. Serpin peptidase inhibitor clade A member 1 was observed in the cytoplasm of tumour cells and the stroma by immunohistochemistry. Enhanced serpinA1 expression was significantly associated with increased tumour size, advanced T stage, perineural invasion, lymphovascular invasion, lymph node metastases, and shorter overall survival.

Conclusions:

Serpin peptidase inhibitor clade A member 1 induces the invasion and migration of gastric cancer cells and its expression is associated with the progression of gastric cancer. These results may provide a potential target to prevent invasion and metastasis in gastric cancer.

Long-term outcome of low-energy extracorporeal shock wave therapy for plantar fasciitis: comparative analysis according to ultrasonographic findings

Objective

To investigate the long-term effect of low-energy extracorporeal shock wave therapy (ESWT) for plantar fasciitis (PF) according to ultrasonography (US) findings.

Methods

Thirty feet of 25 patients with clinical diagnosis of PF were enrolled and divided into two groups (Apparent-US and Uncertain-US) according to US findings, such as plantar fascia thickening or hypoechogenicity. Inclusion criteria were symptom duration >6 months and a fair or poor grade in Roles-Maudsley score (RMS). ESWT (0.10 mJ/mm², 600 shocks) was given once a week for 6 weeks. Numeric rating scale (NRS) and RMS were evaluated prior to each ESWT session, at short-term follow-up (one week after all ESWT sessions) and long-term follow-up telephone interview (mean 24 months after ESWT). Good and excellent grade in RMS were considered as treatment success.

Results

Repeated measure ANOVA demonstrated that NRS significantly decreased with time after ESWT up to the long-term follow-up (time effect, p<0.001) without group-time interaction (p=0.641), indicating that ESWT equally decreased pain in both groups. Overall success rate was 63.3% (short-term follow-up) and 80.0% (long-term follow-up). In comparative analysis between groups, success rate of Apparent-US and Uncertain-US at short-term follow-up was 61.9% and 66.7%, respectively, and 85.7% and 66.7%, respectively, at long-term follow-up.

Conclusion

If other causes of heel pain are ruled out through meticulous physical examination and ultrasonography, low-energy ESWT in PF seems to be beneficial regardless of US findings. In terms of success rate, however, long-term outcome of Apparent-US appears to be superior to Uncertain-US.

Efficacy and safety of micafungin for the prophylaxis of invasive fungal infection during neutropenia in children and adolescents undergoing allogeneic hematopoietic SCT

The objective of this study was to evaluate the efficacy and safety of micafungin for the prevention of invasive fungal infection (IFI) during the neutropenic phase of allogeneic hematopoietic SCT (allo-HSCT) in children and adolescents. This was a prospective, multicenter, open-label, single-arm study. Micafungin was administered i.v. at a dose of 1 mg/kg/day (max 50 mg) from the beginning of conditioning until neutrophil engraftment. Treatment success was defined as the absence of proven, probable, possible or suspected IFI through to 4 weeks after therapy. From April 2010 to December 2011, 155 patients were enrolled from 11 institutions in Korea, and 147 patients were analyzed. Of the 147 patients, 121 (82.3%) completed the protocol without premature interruption. Of the 132 patients in whom micafungin efficacy could be evaluated, treatment success was achieved in 119 patients (90.2%). There was no proven fungal infection in any patient. The number of patients with probable, possible and suspected IFI was two, two and nine, respectively. Thirty-five patients (23.8%) experienced 109 adverse events (AEs) possibly related to micafungin. No patients experienced grade IV AEs. Two patients (1.4%) discontinued micafungin administration due to adverse effects. None of the deaths were related to the study drug.

A cohort study of MFN2 mutations and phenotypic spectrums in Charcot-Marie-Tooth disease 2A patients

Charcot-Marie-Tooth disease 2A (CMT2A) is the most common axonal form of peripheral neuropathy caused by a defect in the mitofusin 2 (MFN2) gene, which encodes an outer mitochondrial membrane GTPase. MFN2 mutations result in a large range of phenotypes. This study analyzed the prevalence of MFN2 mutation in Korean families with their assorted phenotypes (607 CMT families and 160 CMT2 families). Direct sequencing of the MFN2 coding exons or whole-exome sequencing has been applied to identify causative mutations. A total of 21 mutations were found in 36 CMT2 families. Comparative genotype-phenotype correlations impacting severity, onset age, and specific symptoms were assessed. Most mutations were seen in the GTPase domain (∼86%). A deletion mutation found in the transmembrane helices is reported for the first time, as well as five novel mutations at other domains. MFN2 mutations made up 5.9% of total CMT families, whereas 22.9% in CMT2 families, of which 27.8% occurred de novo. Interestingly, patient phenotypes ranged from mild to severe even for the same mutation, suggesting other factors influenced phenotype and penetrance. This CMT2A cohort study will be useful for molecular diagnosis and treatment of axonal neuropathy.

Effects of in ovo injection with selenium on immune and antioxidant responses during experimental necrotic enteritis in broiler chickens

This study was conducted to investigate the effects of in ovo injection of Se on modulating the immune system and antioxidant responses in broiler chickens with experimental necrotic enteritis. Broiler eggs were injected at 18 d of embryo age with either 100 μL of PBS alone or sodium selenite (Na2SeO3) in PBS, providing 0 (SS0), 10 (SS10), or 20 (SS20) μg of Se/egg. At 14 d posthatch, PBS-treated and uninfected chickens were kept as the control group, whereas the remaining chickens were orally infected with 1.0 × 10(4) sporulated oocysts of Eimeria maxima (SS0, SS10, SS20). At 18 d posthatch, E. maxima-infected chickens were orally infected with 1.0 × 10(9) cfu of Clostridium perfringens. Infected control SS0 group showed significantly decreased BW compared with the uninfected control. However, SS20 group showed significantly increased BW compared with the infected control SS0 group, whereas the BW were similar among uninfected control and infected SS10 and SS20 groups. The SS10 group showed significantly lower intestinal lesions compared with the SS0 group, and oocyst production was decreased in both SS10 and SS20 groups. Serum malondialdehyde level and catalase activity were also decreased in both SS10 and SS20 groups, whereas the superoxide dismutase level was significantly lower in the SS10 group compared with the SS0 group. The SS20 group showed significantly higher levels of transcripts for IL-1β and IL-6 in intestine, and SS10 and SS20 groups had higher levels of transcripts for IL-8 and inducible nitric oxide synthase expression and decreased glutathione peroxidase 7 mRNA levels compared with the SS0 group. The SS10 and SS20 groups also showed increased serum antibody levels to C. perfringens α-toxin and NetB toxin compared with the SS0 group. These collective results suggest that the injection of Se into the amniotic cavity of developing eggs may be beneficial for enhancing immune and antioxidant responses in the hatched chickens exposed to the necrotic enteritis-causing pathogens.

Delta neutrophil index as an early marker for differential diagnosis of adult-onset Still's disease and sepsis

PURPOSE

To investigate clinical implications of delta neutrophil index (DNI) to discriminate adult onset Still's disease (AOSD) from sepsis.

MATERIALS AND METHODS

We reviewed the medical records of 13 patients with AOSD and 33 gender and age-matched patients with sepsis. In all subjects, microbial tests were performed to exclude or confirm sepsis. All laboratory data were measured two or three times during the first 3 days and represented by their mean levels. DNI was measured automatically by ADVIA 2120 for the first 3 days.

RESULTS

There were no significant differences in white blood cell counts, neutrophil proportion, erythrocyte sedimentation rate and C-reactive protein between two groups. AOSD patients had notably lower DNI than sepsis patients regardless of the presence of bacteremia or not. However, both DNI and ferritin were not significant independent factors for predicting sepsis in the multivariate logistic regression analysis. Meanwhile, the area under the receiver operating characteristic curve (AUROC) of DNI was slightly higher than that of ferritin. When we set DNI of 2.75% as the cut-off value for predicting sepsis, 11 (84.6%) of AOSD patients had a DNI value below 2.75% and 2 (15.4%) of them had a DNI over 2.75% (relative risk for sepsis 176).

CONCLUSION

We suggest that DNI may be a useful marker for differential diagnosis of AOSD from sepsis in the early phase as supplementary to ferritin.

Whole blood interferon-γ release assay is insufficient for the diagnosis of sputum smear negative pulmonary tuberculosis

PURPOSE

We investigated the value of an interferon-γ release assay (IGRA) for the diagnosis of active pulmonary tuberculosis (PTB) among sputum smear negative PTB suspects in an environment with intermediate burden of PTB and high Bacillus Calmette-Guerin (BCG) vaccination rate.

MATERIALS AND METHODS

We retrospectively reviewed IGRA, medical records, chest PA and CT scan of PTB suspects seen at Gangnam Severance Hospital, Seoul, Korea from Oct. 2007 to Apr. 2013. "Active PTB" was diagnosed when 1) M. tuberculosis culture positive, 2) confirmation by pathologic examination; or 3) clinical findings compatible with TB.

RESULTS

Of 224 sputum smear negative PTB suspects, 94 were confirmed as having active PTB. There were no statistically significant differences in the diagnostic yield of IGRA between immunocompromised and immunocompetent sputum smear negative PTB suspects. IGRA did show superior sensitivity [81.9%, 95% confidence interval (CI); 74.13-89.70%] in the diagnosis of sputum smear negative PTB when compared with chest high-resolution computed tomography (HRCT), tuberculin skin test (TST), and chest X-ray (p<0.001). Also, IGRA showed highest negative predictive value (82.7%, 95% CI; 75.16-90.15%) when compared with HRCT, TST and chest X-ray (p=0.023). However, combining the results of IGRA with those of HRCT, TST, or both did not increase any diagnostic parameters.

CONCLUSION

Failure to increase diagnostic yields by combination with other diagnostic modalities suggests that additional enforcement with IGRA may be insufficient to exclude other diagnoses in sputum smear negative PTB suspects and to screen active PTB in an environment with intermediate TB prevalence and a high BCG vaccination rate.

Clinical significance of an increased cochlear 3D fluid-attenuated inversion recovery signal intensity on an MR imaging examination in patients with acoustic neuroma

BACKGROUND AND PURPOSE

The increased cochlear signal on FLAIR images in patients with acoustic neuroma is explained by an increased concentration of protein in the perilymphatic space. However, there is still debate whether there is a correlation between the increased cochlear FLAIR signal and the degree of hearing disturbance in patients with acoustic neuroma. Our aim was to investigate the clinical significance of an increased cochlear 3D FLAIR signal in patients with acoustic neuroma according to acoustic neuroma extent in a large patient cohort.

MATERIALS AND METHODS

This retrospective study enrolled 102 patients with acoustic neuroma, who were divided into 2 groups based on tumor location; 22 tumors were confined to the internal auditory canal and 80 extended to the cerebellopontine angle cistern. Pure tone audiometry results and hearing symptoms were obtained from medical records. The relative signal intensity of the entire cochlea to the corresponding brain stem was calculated by placing regions of interest on 3D FLAIR images. Statistical analysis was performed to compare the cochlear relative signal intensity between the internal auditory canal acoustic neuroma and the cerebellopontine angle acoustic neuroma. The correlation between the cochlear relative signal intensity and the presence of hearing symptoms or the pure tone audiometry results was investigated.

RESULTS

The internal auditory canal acoustic neuroma cochlea had a significantly lower relative signal intensity than the cerebellopontine angle acoustic neuroma cochlea (0.42±0.15 versus 0.60±0.17, P<.001). The relative signal intensity correlated with the audiometric findings in patients with internal auditory canal acoustic neuroma (r=0.471, P=.027) but not in patients with cerebellopontine angle acoustic neuroma (P=.427). Neither internal auditory canal acoustic neuroma nor cerebellopontine angle acoustic neuroma showed significant relative signal intensity differences, regardless of the presence of hearing symptoms (P>.5).

CONCLUSIONS

The cochlear signal on FLAIR images may be an additional parameter to use when monitoring the degree of functional impairment during follow-up of patients with small acoustic neuromas confined to the internal auditory canals.

Effects of Temperature and Packaging on the Growth Kinetics of Clostridium perfringens in Ready-to-eat Jokbal (Pig's Trotters)

Ready-to-eat (RTE) Jokbal (Pig's trotter), which consists of pig's feet cooked in soy sauce and various spices, is a very popular and widely sold in Korean retail markets. Commercially, the anaerobically packed Jokbal have also become a popular RTE food in several convenience stores. This study evaluates the effects of storage temperature and packaging methods for the growth of C. perfringens in Jokbal. Growth kinetic parameters of C. perfringens in aerobically and anaerobically packed Jokbals are determined at each temperature by the modified Gompertz equation. The lag time, specific growth rate, and maximum population density of C. perfringens are being analyzed as a function of temperature and packaging method. The minimum growth temperature of C. perfringens in aerobically and anaerobically packed Jokbal is 24℃ and 18℃, respectively. The C. perfringens in Jokbal did not grow under conditions of over 50℃ regardless of the packaging methods, indicating that the holding temperature of Jokbal in markets must be maintained at above 50℃ or below 18℃. Growth of C. perfringens in anaerobically packed Jokbal is faster than in aerobically packed Jokbal when stored under the same conditions. This indicates that there are a higher risks associated with C. perfringens for anaerobically packed meat products.

Differences in clinical manifestations and outcomes between adult and child patients with Henoch-Schönlein purpura

We aimed to investigate differences in clinical manifestations and outcomes between adult and child patients with Henoch-Schönlein purpura (HSP), and to analyze the factors associated with poor prognosis for HSP nephritis. This retrospective 10-yr study enrolled 160 patients with HSP who visited Severance Hospital. Purpura was mostly detected in lower extremities, but purpura in upper extremities was more frequently observed in adults than children (41.7% vs 19.3%). Children had a greater frequency of arthralgia (55.4% vs 27.1%), while adults had a greater frequency of diarrhea (20% vs 1.6%). Anemia, elevated C-reactive protein, and level of IgA were more frequently observed in adults (25% vs 7.1%, 65.6% vs 38.4%, 26.3% vs 3.5%). Renal involvement in adults was more severe than in children (79.2% vs 30.4%). Chronic renal failure showed a significant difference in outcomes of HSP between adults (10.4%) and children (1.8%) after a follow up period of an average of 27 months. Furthermore, renal insufficiency at diagnosis was significantly related to the progression to chronic renal failure. Our results showed several differences in the clinical features of HSP between adults and children. Adults with HSP had a higher frequency of renal insufficiency and worse renal outcomes than children. Renal insufficiency at diagnosis might be of predictive value for the progression to chronic renal failure in HSP patients.

The usefulness of the korean version of penn state worry questionnaire for screening generalized anxiety disorder: a receiver operating characteristic analysis

OBJECTIVE

Excessive worry about minor matters and a state in which this worry is experienced as uncontrollable are known to be key symptoms of generalized anxiety disorder (GAD). Given the importance of pathological worry in GAD, the need for psychometrically sound measures of this construct has increased. The purpose of this study was to investigate the usefulness of the Korean version of Penn State Worry Questionnaire (K-PSWQ) for screening GAD.

METHODS

Two hundred and forty six patients were initially screened, from which 102 GAD patients and 118 patients with anxiety disorder not otherwise specified (anxiety disorder NOS) were finally enrolled. Patients were diagnosed by a structured clinical interview for the DSM-IV Axis I. We also enrolled 114 control subjects who had no medical or psychiatric history. Pathological worry in both patients and control subjects were assessed at baseline using the PSWQ and we estimated optimal cutoff score by the receiver operating characteristic (ROC) analysis.

RESULTS

We found that in the first ROC analysis, a score of 53 could simultaneously optimize sensitivity and specificity in order to discriminate GAD patients from control subjects. From the second receiver operating characteristic analysis, when both sensitivity and specificity were optimized, we can suggest a score of 61 as being the cutoff for differentiating GAD patients from patients with anxiety disorder NOS.

CONCLUSION

The Korean version of PSWQ is a useful method for screening GAD patients, although ethnic and cultural differences may affect the cutoff score of PSWQ for GAD.

Microbial inactivation by cupric ion in combination with H2O2: role of reactive oxidants

The cupric ion mediated inactivation of Escherichia coli was enhanced by the presence of hydrogen peroxide (H2O2), with increasing inactivation efficacy observed in response to increasing concentrations of H2O2. The biocidal activity of the Cu(II)/H2O2 system is believed to result from the oxidative stress caused by reactive oxidants such as the hydroxyl radical ((•)OH), cupryl species (Cu(III)), and the superoxide radical (O2(•-)), which are produced via the catalytic decomposition of H2O2. In E. coli cells treated with Cu(II) and H2O2, the intracellular level of (•)OH and Cu(III) increased significantly, leading to complete disruption of cell membranes. On the basis of experimental observations made using an (•)OH scavenger, copper-chelating agents, and superoxide dismutase, it is concluded that Cu(III) is the predominant species responsible for the death of E. coli cells. It was also found that the production of Cu(III) was promoted by the reactions of copper with intracellular O2(•-). MS2 coliphage was found to be even more susceptible than E. coli to the oxidative stress induced by the Cu(II)/H2O2 system.

Removal characteristics of engineered nanoparticles by activated sludge

Environmental release of engineered nanoparticles (NPs) has been on the rise due to the increased use of NPs in commercial products. In addition, the fate of NPs in sewage treatment processes may play an important role in determining the environmental release pathway of NPs. In this study, we investigated the removal of engineered NPs (AgNPs, TiO2NPs, and SiO2NPs) using activated sludge by evaluating the effects of several important factors of the NPs, including physicochemical properties, contact time between NPs and activated sludge, aquatic chemistry of sewage, and the presence of extracellular polymeric substances (EPS) in the activated sludge. For all three types of NPs tested, a considerable amount of NPs were removed after exposure to activated sludge in a time-dependent manner; nevertheless, the removal efficiencies depended on the type of NPs and seemed to be affected by the NP stability relative to the hydrodynamic diameter (HDD) and zeta potential. In addition, the presences of both ionic compounds and EPS significantly enhanced the NP removal efficiency, indicating that the instability of the NPs resulting from the ionic strength in sewage and entrapment of NP by EPS played an important role in NP removal by activated sludge. These results suggest that the removal efficiencies can be affected by the operating conditions of the activated sludge process and the conditions of the activated sludge; therefore, these factors should be considered when developing approaches to sufficiently remove NPs from sewage treatment plants.

Real-time detection of DNA cleavage induced by [M(2,2'-bipyridine)2(NO3)](NO3) (M=Cu(II), Zn(II) and Cd(II)) complexes using linear dichroism technique

The catalytic effect of [M(2,2'-bipyridine)2(NO3)](NO3) (M(bpy)2, M=Cu(II), Zn(II) and Cd(II)) on the super-coiled and double stranded DNA (scDNA and dsDNA) was examined by electrophoresis and a real-time detection linear dichroism (LD) technique. Although the Cu(bpy)2 complex effectively cleaved both types of DNA, the other two complexes were inactive. This was explained by the electrochemical properties of the metal complexes. The Cu(bpy)2 complex exhibited a redox potential at -0.222V with a peak to peak separation of 0.201V, whereas the other two metal complexes did not undergo any redox reaction. Both electrophoresis and LD measurements revealed the superoxide radical, ·O2(-), to be responsible for DNA cleavage. A kinetic study using the LD technique showed that the cleavage of dsDNA consisted of two first order reactions. The fast reaction is believed to reflect the cleavage of one strand, whereas the slow reaction involves the cleavage of the complementary strand at or near the first cleaved site.

Temperature evolution of itinerant ferromagnetism in SrRuO3 probed by optical spectroscopy

The temperature (T) dependence of the optical conductivity spectra σ(ω) of a single crystal SrRuO(3) thin film is studied over a T range from 5 to 450 K. We observed significant T dependence of the spectral weights of the charge transfer and interband d-d transitions across the ferromagnetic Curie temperature (T(c) ∼ 150 K). Such T dependence was attributed to the increase in the Ru spin moment, which is consistent with the results of density functional theory calculations. T scans of σ(Ω,T) at fixed frequencies Ω reveal a clear T(2) dependence below T(c), demonstrating that the Stoner mechanism is involved in the evolution of the electronic structure. In addition, σ(Ω,T) continues to evolve at temperatures above T(c), indicating that the local spin moment persists in the paramagnetic state. This suggests that SrRuO(3) is an intriguing oxide system with itinerant ferromagnetism.

Cystic pilomatrixoma of the wrist mimicking a ganglion cyst in a child

We describe a patient with a cystic pilomatrixoma mimicking a ganglion cyst on ultrasound. A 9-year-old boy had a subcutaneous mass on his left wrist. Ultrasound displayed a well-defined, multilobulated anechoic mass containing a few internal septa between the extensor pollicis longus and the extensor carpi radialis longus tendons. Sonographic findings suggested that the mass was a ganglion cyst. After excisional biopsy, histopathologic examination confirmed the diagnosis of pilomatrixoma.

Differentiating xanthogranulomatous cholecystitis from wall-thickening type of gallbladder cancer: added value of diffusion-weighted MRI

AIM

To evaluate the benefit of diffusion-weighted imaging (DWI) in differentiating xanthogranulomatous cholecystitis from the wall-thickening type of gallbladder cancer.

MATERIALS AND METHODS

This retrospective study was approved by the institutional review board. Fourteen patients with xanthogranulomatous cholecystitis and 19 patients with the wall-thickening type of gallbladder cancer were included. Qualitative (visual diffusion restriction compared to liver parenchyma) and quantitative [apparent diffusion coefficient (ADC)] analyses were performed. Conventional MRI findings including dynamic enhancement pattern between the two groups were also analysed. Two observers independently reviewed conventional magnetic resonance imaging (MRI) images and subsequently reviewed combined conventional MRI and DWI images. Pairwise comparison of the receiver operating characteristic (ROC) curves was used to compare diagnostic performances.

RESULTS

In conventional MRI findings, xanthogranulomatous cholecystitis showed significant continuity of enhancing mucosal line [79% (11/14) versus 26% (5/19), p = 0.003] and intramural T2-high signal intensity [64% (9/14) versus 21% (4/19), p = 0.012] compared to the wall-thickening type of gallbladder cancer. The enhancement pattern of gallbladder cancer compared to liver parenchyma showed earlier onset than that of xanthogranulomatous cholecystitis (p = 0.001). Diffusion restriction was more frequently seen in the wall-thickening type of gallbladder cancer (68%, 13/19) than in xanthogranulomatous cholecystitis (7%, 1/14; p < 0.001). The mean ADC value of xanthogranulomatous cholecystitis was higher than that of the wall-thickening type of gallbladder cancer with statistical significance (1.637 × 10(-3) mm(2)/s versus 1.076 × 10(-3) mm(2)/s, p = 0.005). Diagnostic performance [area under ROC curve (Az)] of both observers improved significantly after additional review of DWI; Az improved from 0.737 to 0.930 (p = 0.027) for observer 1 and from 0.675 to 0.938 (p = 0.008) for observer 2.

CONCLUSION

Addition of DWI to conventional MRI improves discrimination between xanthogranulomatous cholecystitis and the wall-thickening type of gallbladder cancer.

Change in cytokines in patients with warts after contact immunotherapy with squaric acid dibutylester

BACKGROUND

A wart is a skin lesion caused by infection with human papillomavirus (HPV). Contact immunotherapy is one of the many therapeutic options that have been used to treat warts; however, the effectiveness of contact immunotherapy differs from patient to patient, and the cause of this variation in clinical response is unclear.

AIM

To assess cytokine changes in patients after contact immunotherapy with squaric acid dibutylester (SADBE).

METHODS

In total, 21 patients with warts and 9 healthy control subjects were enrolled in the study. The frequencies of CD3+ T cells expressing interleukin (IL)-4, IL-10, IL-12, tumour necrosis factor-α and interferon-γ were measured by flow cytometry analysis of peripheral blood at baseline in both patients and controls, and after SADBE treatment in patients.

RESULTS

Lower expression of IL-4 and higher expression of IL-12 in CD3+ T cells were found in patients compared with controls. The percentage of CD3+/IL-4+ T cells significantly increased after contact immunotherapy in all responders, but was significantly higher in those with an excellent response, who also had a significantly higher percentage of CD3+/IL-10+ T cells. The patients with an excellent response also had a significant decrease in the percentage of CD3+/IL-12+ T cells, and the percentage of CD3+/IL-4+ T cells normalized.

CONCLUSIONS

Response to contact immunotherapy can vary depending on the types of cytokine changes produced by treatment. An excessive shift to a Th2 pattern and increased IL-10 production after contact immunotherapy may hinder clearance of HPV.

Two cases of refractory thrombocytopenia in systemic lupus erythematosus that responded to intravenous low-dose cyclophosphamide

Treatment of thrombocytopenia in systemic lupus erythematosus (SLE) is considered in cases of current bleeding, severe bruising, or a platelet count below 50,000/µL. Corticosteroid is the first choice of medication for inducing remission, and immunosuppressive agents can be added when thrombocytopenia is refractory to corticosteroid or recurs despite it. We presented two SLE patients with thrombocytopenia who successfully induced remission after intravenous administration of low-dose cyclophosphamide (CYC) (500 mg fixed dose, biweekly for 3 months), followed by azathioprine (AZA) or mycophenolate mofetil (MMF). Both patients developed severe thrombocytopenia in SLE that did not respond to pulsed methylprednisolone therapy, and started the intravenous low-dose CYC therapy. In case 1, the platelet count increased to 50,000/µL after the first CYC infusion, and remission was maintained with low dose prednisolone and AZA. The case 2 achieved remission after three cycles of CYC, and the remission continued with low dose prednisolone and MMF.

Enhanced payload of lipid nanocarriers using supersaturated solution prepared by solvent-mediated method

With the aim to effectively enhance the payload for nanocarriers, supersaturated deltamethrin (SSD) solution was prepared using the solvent-mediated method to produce lipid nanocarriers by a combination method of homogenization and sonication. In this study, deltamethrin was used as an active ingredient, corn oil was used as a lipid medium, soybean lecithin and Tween-80 were used as surfactants. At 25°C, the solubility of deltamethrin in SSD solution prepared by solvent-mediated method was 3.4 times and 1.5 times higher than that in saturated deltamethrin (SD) solution and that in SSD solution prepared by thermal-mediated method, respectively. Therefore, compared to the use of SD solution for the production of nanocarriers, the use of SSD solution significantly enhanced the payload, while keeping the encapsulation efficiency high. Particularly, nanocarriers produced from SSD solution prepared by solvent-mediated method had the higher payload of 2.1 times and 4.4 times compared with preparations using SSD solution prepared by thermal-mediated method and SD solution, respectively.

A study of snack consumption, night-eating habits, and nutrient intake in gestational diabetes mellitus

This study was performed to identify dietary behavior such as snack consumption, night-eating and nutrients intake associated with gestational diabetes mellitus (GDM). The study was conducted on 219 normal glucose tolerance (NGT) subjects and 44 GDM subjects by using a questionnaire including dietary behavior, food frequency and 3-day food record. The mean age, OGTT, and delivery weight of GDM subjects were statistically higher than those in NGT. A larger proportion of NGT subjects consumed black coffee (49.8%) while the majority of GDM subjects (61.4%) drank mixed coffee with sugar and cream. Dairy products were the most frequently consumed snack item in NGT subjects (40.7%), while fruits were most frequently consumed food item in GDM subjects (34.4%). Many of NGT subjects (49.8%) answered that they hardly took night-eating snacks whereas most of GDM subjects (61.4%) took night-eating snacks more than once a week. For change of taste preference, the proportion of NGT subjects who showed less preference for salty taste (33.3%) or greasy taste (16.9%) was higher than that of GDM subjects (11.4%). Nutrient intakes of energy, fat, cholesterol, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), carbohydrate, vitamin B₁, vitamin B₂, vitamin C, and vitamin E in GDM group were significantly higher than those in NGT group. Nutrient densities of SFA and vitamin C in GDM group were higher and nutrient density of calcium was lower than those in NGT group. Taken together, it is recommended to reduce night-eating snack and choose less salty and fatty foods, black-coffee rather than coffee with cream and sugar, and more dairy products to prevent GDM.

Ginsenoside-Rp1 inhibits platelet activation and thrombus formation via impaired glycoprotein VI signalling pathway, tyrosine phosphorylation and MAPK activation

BACKGROUND AND PURPOSE

Ginsenosides are the main constituents for the pharmacological effects of Panax ginseng. Such effects of ginsenosides including cardioprotective and anti-platelet activities have shown stability and bioavailability limitations. However, information on the anti-platelet activity of ginsenoside-Rp1 (G-Rp1), a stable derivative of ginsenoside-Rg3, is scarce. We examined the ability of G-Rp1 to modulate agonist-induced platelet activation.

EXPERIMENTAL APPROACH

G-Rp1 in vitro and ex vivo effects on agonist-induced platelet-aggregation, granule-secretion, [Ca(2+) ](i) mobilization, integrin-α(IIb) β(3) activation were examined. Vasodilator-stimulated phosphoprotein (VASP) and MAPK expressions and levels of tyrosine phosphorylation of the glycoprotein VI (GPVI) signalling pathway components were also studied. G-Rp1 effects on arteriovenous shunt thrombus formation in rats or tail bleeding time and ex vivo coagulation time in mice were determined. KEY RESULT: G-Rp1 markedly inhibited platelet aggregation induced by collagen, thrombin or ADP. While G-Rp1 elevated cAMP levels, it dose-dependently suppressed collagen-induced ATP-release, thromboxane secretion, p-selectin expression, [Ca(2+) ](i) mobilization and α(IIb) β(3) activation and attenuated p38(MAPK) and ERK2 activation. Furthermore, G-Rp1 inhibited tyrosine phosphorylation of multiple components (Fyn, Lyn, Syk, LAT, PI3K and PLCγ2) of the GPVI signalling pathway. G-Rp1 inhibited in vivo thrombus formation and ex vivo platelet aggregation and ATP secretion without affecting tail bleeding time and coagulation time, respectively.

CONCLUSION AND IMPLICATIONS

G-Rp1 inhibits collagen-induced platelet activation and thrombus formation through modulation of early GPVI signalling events, and this effect involves VASP stimulation, and ERK2 and p38(-MAPK) inhibition. These data suggest that G-Rp1 may have therapeutic potential for the treatment of cardiovascular diseases involving aberrant platelet activation.

Surgical strategies for non-functioning pancreatic neuroendocrine tumours

BACKGROUND

The purpose of this study was to identify management strategies for non-functioning pancreatic neuroendocrine tumours (NF-PNETs) by analysis of surgical outcomes at a single institution.

METHODS

Archived records of patients with NF-PNETs who underwent surgery between 1994 and 2010 were reviewed.

RESULTS

Among 125 patients, the median tumour size was 2·5 (range 0·15-20·5) cm. Of the 51 NF-PNETs with a diameter of no more than 2 cm, 12 (24 per cent) were diagnosed as carcinoma. Overall 20 patients (16·0 per cent) had metastases to the lymph nodes. The minimum size of the tumour with lymph node metastasis was 1·2 cm. Having a NF-PNET of 2 cm or larger significantly increased the probability of a poorly differentiated carcinoma (P = 0·006), and having a NF-PNET of at least 2·5 cm significantly increased the probability of lymph node metastasis (P = 0·048). The 5-year cumulative survival rate after curative resection was 89·7 per cent. During a median follow-up of 31·5 months, there were 27 recurrences (23·1 per cent) and 13 disease-specific deaths (11·1 per cent) among the 117 patients who had an R0 resection. All patients who underwent repeat operations were alive without additional recurrence after a mean(s.d.) follow-up of 27·1(18·0) months.

CONCLUSION

Curative surgery should be performed for control of primary NF-PNETs. Lymph node dissection for NF-PNETs of 2·5 cm or larger and at least node sampling for tumours with a diameter of 1 cm or more are recommended. Debulking surgery should be considered for advanced tumours.

Intracranial metastases: spectrum of MR imaging findings

Intracranial metastatic lesions arise through a number of routes. Therefore, they can involve any part of the central nervous system and their imaging appearances vary. Magnetic resonance imaging (MRI) plays a key role in lesion detection, lesion delineation, and differentiation of metastases from other intracranial disease processes. This article is a reasoned pictorial review illustrating the many faces of intracranial metastatic lesions based on the location - intra-axial metastases, calvarial metastases, dural metastases, leptomeningeal metastases, secondary invasion of the meninges by metastatic disease involving the calvarium and skull base, direct or perineural intracranial extension of head and neck neoplasm, and other unusual manifestations of intracranial metastases. We also review the role of advanced MRI to distinguish metastases from high-grade gliomas, tumor-mimicking lesions such as brain abscesses, and delayed post-radiation changes in radiosurgically treated patients.

Association of CXCL1 promoter polymorphism with ischaemic stroke in Korean population

This is a pilot study analysing association of chemokine gene polymorphisms (CXCL1, rs3117604; CXCL2, rs3806792; CCL2, rs2857656 and rs3760396; CCL5, rs2107538) in Korean patients with ischemic stroke (IS) (n = 120) and age-matched controls (n = 267). The CXCL1 gene and particularly T allele of rs3117604 was associated with IS.

Leflunomide increases the risk of silent liver fibrosis in patients with rheumatoid arthritis receiving methotrexate

Introduction

We identified silent liver fibrosis in patients with rheumatoid arthritis (RA) using transient elastography, and investigated medication that correlated with abnormal liver stiffness measurement (LSM) values.

Methods

We consecutively enrolled 105 patients with RA taking methotrexate over 24 weeks with normal liver functions and no history of underlying chronic liver disease. Blood tests were performed, and body mass index and metabolic syndrome were assessed. We checked LSM values, and adopted 5.3 kPa as the cutoff for abnormal LSM values. The cumulative doses of medications including methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, prednisolone, meloxicam, and celecoxib were calculated.

Results

The median age of patients (20 men and 85 women) was 52.4 years. The median LSM value was 4.7 kPa and 24 (22.9%) patients had abnormal LSM values. Gamma-glutamyltranspeptidase levels and the cumulative doses of leflunomide and prednisolone significantly correlated with LSM values (P<0.05). The cumulative dose of leflunomide, but not methotrexate, was significantly higher in patients with abnormal LSM values than that in patients with normal LSM values (P = 0.008). When RA patients receiving leflunomide plus methotrexate were classified into two groups according to the optimal cutoff cumulative dose of leflunomide (19,170 mg), abnormal LSM values were more frequently identified in patients with high cumulative dose of leflunomide (odds ratio, 12.750; P<0.001).

Conclusions

The cumulative dose of leflunomide was the only independent predictor of abnormal LSM values in patients with RA who had received methotrexate for more than six months.

Role of reactive oxygen species in Escherichia coli inactivation by cupric ion

This study demonstrated Escherichia coli inactivation by cupric ion (Cu[II]), focusing on intracellular generation and consumption of reactive oxygen species (ROS) including superoxide and hydroxyl radials. In the presence of Cu(II), intracellular superoxide levels of E. coli decreased in a concentration-dependent manner, indicating that superoxide radical was used to reduce Cu(II) to Cu(I) in cells. The variation in the hydroxyl radical level by adding Cu(II) was negligible. Molecular oxygen and hydroxyl radical scavengers did not affect the inactivation efficacy of E. coli by Cu(II), excluding the possibility that hydroxyl radicals induced by the copper-mediated reduction of oxygen contributed to the microbiocidal action of Cu(II). However, the inactivation of E. coli by Cu(II) was considerably inhibited and accelerated by a Cu(I)-chelating agent and a Cu(II)-reducing agent, respectively. Our results suggest that the microbiocidal action of Cu(II) is attributable to the cytotoxicity of cellularly generated Cu(I), which does not appear to be associated with oxidative damage by Cu(I)-driven ROS.

Sonographic appearances of soft tissue angioleiomyomas: differences from other circumscribed soft tissue hypervascular tumors

OBJECTIVES

The purpose of this study was to evaluate the sonographic features of angioleiomyomas with priority given to the vascular pattern to help in the differential diagnosis from other hypervascular soft tissue tumors.

METHODS

The inclusion criteria for this retrospective and nonblinded study were fulfilled in 33 patients with circumscribed hypervascular soft tissue tumors based on pathologic identification. Thirteen cases were angioleiomyomas; 9 cases were nonsubungual glomus tumors; and 11 cases were hemangiomas. Two musculoskeletal radiologists interpreted the results by consensus. Sonographic findings, including the shape, size, echogenicity, vascular pattern, and vascular density of the angioleiomyomas, were compared with those of the other hypervascular tumors. Vascular patterns were categorized into 3 vascular types: 1, several linear vessels clustered in the tumor with convergence to one point; 2, diffusely scattered irregular vessels in the tumor, and 3, one or more vessels that were centrally located. The vascularity of the mass was also categorized as rich (covering >50% of the area of the lesion), moderate (between 20% and 50%), and little (<20%).

RESULTS

All of the angioleiomyomas were hypoechoic (100% [13 of 13]), a statistically significant result (P = .001). The type 1 vascular pattern was observed in 69% of the angioleiomyomas (9 of 13; P = .029), and the statistically significant shape was round (38% [5 of 13]; P = .035).

CONCLUSIONS

Most angioleiomyomas reveal a homogeneously hypoechoic echo texture with a circumscribed margin and show straight and linear vessels in the tumor with convergence to one point on color Doppler sonography. These characteristics may be helpful when differentiating angioleiomyomas from other circumscribed hypervascular soft tissue tumors.

Accuracy of MR findings in characterizing peroneal tendons disorders in comparison with surgery

BACKGROUND

Previous studies have shown that magnetic resonance imaging (MRI) has a high sensitivity for peroneal tendon pathology but more studies with surgery as a reference standard are needed.

PURPOSE

To evaluate the accuracy of MRI compared to surgery for characterizing chronic peroneal tendon pathology.

MATERIAL AND METHODS

Ninety-seven patients (57 men, 40 women; mean age, 39 years; range, 15-64 years) with chronic lateral ankle instability underwent MRI followed by surgery, with a mean MR to surgery interval of 30 days. Sagittal, coronal, and axial T1-weighted spin-echo and fat-suppressed T2-weighted fast spin-echo images were obtained for all patients. Two blinded observers evaluated the MR images without clinical information, and the results were compared to surgical findings. The following peroneal injuries were observed: tendon split, interstitial tear, swelling of the tendon, fluid collection, superior peroneal retinaculum injury, and tendon dislocation.

RESULTS

Swelling of the peroneus longus tendon was the most common finding on MR imaging, followed by fluid collection and a split of the peroneus brevis tendon. Surgical findings showed that nine cases (9%) of interstitial tears were in the peroneus brevis and two cases (2%) were in the peroneus longus, with eight cases (8%) of splits in the peroneus brevis tendon. The sensitivity and specificity for detecting interstitial tears in the peroneus brevis were 44% and 99%, respectively. The sensitivity and specificity for detecting swelling in the peroneus brevis were 50% and 99%, respectively. The sensitivity and specificity for detecting interstitial tears for peroneus longus injuries were 50% and 96%, respectively. The sensitivity and specificity for detecting swelling in these injuries were and 100% and 96%, respectively.

CONCLUSION

MRI findings of chronic peroneal tendon pathology are diagnostically specific but not sensitive. MRI showed high sensitivity for diagnosing tendon swelling in the peroneus longus, but not in the peroneus brevis. MRI is sensitive but not specific for detecting negative findings.

Clinical significance of Staphylococcus aureus bacteremia in patients with liver cirrhosis

Patients with liver cirrhosis (LC) have impaired immunity and thus are predisposed to infections. Few studies have attempted to evaluate Staphylococcus aureus bacteremia (SAB) in LC patients. Therefore, this study prospectively evaluated the clinical characteristics and outcomes of 642 episodes of SAB from August 1, 2008 to September 31, 2010. Of 642 patients with SAB, 109 (17.0 %) were classified as LC patients whereas the remaining 533 (83.0 %) were classified as non-LC patients. The 30-day mortality rate of LC patients was significantly higher than that of patients with other diseases (32 % vs. 22 %, respectively; P = 0.047). The 30-day mortality rates of patients with MSSA bacteremia and MRSA bacteremia were not significantly different among LC patients (35.1 % with MSSA vs. 26.9 % with MRSA; P = 0.41). A univariate analysis of the 30-day mortality rate of LC patients with SAB for survivors and non-survivors showed that rapidly fatal or ultimately fatal according to the criteria of McCabe and Jackson (OR 5.0; 95 % CI 1.60-15.65), septic shock at initial presentation (OR 3.5; 95 % CI 1.18-10.39) and Child-Pugh class C (OR 2.8; 95 % CI 1.20-6.59) were associated with increased mortality. In contrast, the removal of the eradicable focus was associated with decreased mortality (OR 0.14; 95 % CI 0.04-0.52). Disease severity and liver dysfunction may be useful for predicting the prognosis of SAB in LC patients.

Modulation of the murine microbiome with a concomitant anti-obesity effect by Lactobacillus rhamnosus GG and Lactobacillus sakei NR28

The microbiota of the gastrointestinal tract (GIT) constitutes the major part of the total human microbiome and is considered to be an important regulator of human health and host metabolism. Numerous investigations in recent years have focused on the connection between the human microbiota and metabolic diseases such as obesity, type II diabetes and atherosclerosis. Yet, little is known about the impact of probiotic consumption on the GIT microbial population and the potential effect on chronic diseases. In this study, the modulation of the microbial community in the murine small intestine resulting from probiotic feeding was investigated and was found to be associated with an anti-obesity effect. Changes in the microbiota of the mouse faeces and small intestine were monitored using quantitative real-time PCR and by following the mRNA expression levels of various obesity-related biomarkers following probiotic feeding in a mouse model. Lactobacillus rhamnosus GG and Lactobacillus sakei NR28 (a putative probiotic strain isolated from kimchi) were administered at a daily level of approximately 1×10(8) viable bacteria per mouse (C57BL/6J mice) for up to three weeks. Feeding these strains resulted in a significant reduction of epididymal fat mass, as well as obesity-related biomarkers like acetyl-CoA carboxylase, fatty acid synthase, and stearoyl-CoA desaturase-1 in the liver. The total number and ratio of the microbial groups, i.e. Firmicutes, Bacteroidetes, Clostridium cluster I and XIVab, and Lactobacillus spp. were modulated in the small intestine, and the Firmicutes:Bacteroidetes ratio was decreased. In contrast, no noticeable effect of probiotic feeding could be detected on the faecal microbiota, neither quantitatively, nor with regard to the bacterial groups (Firmicutes, Bacteroidetes, Clostridium cluster I and XIVab, and Lactobacillus spp.) studied.

Ultrasonography-guided ethanol ablation of predominantly solid thyroid nodules: a preliminary study for factors that predict the outcome

OBJECTIVES

The aim of this study was to evaluate the success rate in ultrasonography-guided ethanol ablation (EA) of benign, predominantly solid thyroid nodules and to assess the value of colour Doppler ultrasonography in prediction of its success.

METHODS

From January 2008 to June 2009, 30 predominantly solid thyroid nodules in 27 patients were enrolled. Differences in the success rate of EA were assessed according to nodule vascularity, nodule size, ratio of cystic component, amount of injected ethanol, degree of intranodular echo-staining just after ethanol injection and the number of EA sessions.

RESULTS

On follow-up ultrasonography after EA for treatment of thyroid nodules, 16 nodules showed an excellent response (90% or greater decrease in volume) and 2 nodules showed a good response (50-90% decrease in volume) on follow-up ultrasonography. However, 5 nodules showed an incomplete response (10-50% decrease in volume) and 7 nodules showed a poor response (10% or less decrease in volume). Statistical analysis revealed a significant association of nodule vascularity (p=0.002) and degree of intranodular echo-staining just after ethanol injection (p=0.003) with a successful outcome; however, no such association was observed with regard to nodule size, ratio of cystic component, amount of infused ethanol and the number of EA sessions. No serious complications were observed during or after EA.

CONCLUSION

The success rate of EA was 60%, and nodule vascularity and intranodular echo-staining on colour Doppler ultrasonography were useful in predicting the success rate of EA for benign, predominantly solid thyroid nodules.

Efficacy of ramosetron in the treatment of male patients with irritable bowel syndrome with diarrhea: a multicenter, randomized clinical trial, compared with mebeverine

BACKGROUND

The 5-HT(3) receptor antagonists are known to be effective for the treatment of diarrhea-predominant irritable bowel syndrome (IBS), but not widely used yet. The aim of this study was to compare the efficacy and safety of ramosetron, a 5-HT(3) receptor antagonist, and mebeverine in male patients with IBS with diarrhea (IBS-D).

METHODS

This study was performed in a multicenter, randomized, open-label design. Data of 343 male patients with IBS-D who were randomized to either a 4-week treatment of ramosetron 5μg once daily or a 4-week treatment of mebeverine 135 mg three times daily were analyzed by the intent-to-treat analysis. The primary efficacy parameter was the proportion of patients with adequate relief of IBS symptoms at the last week of treatment. The secondary endpoints were changes in each symptom score and the safety profiles.

KEY RESULTS

The responder rates for global IBS symptoms, abdominal pain/discomfort and abnormal bowel habits in the ramosetron and mebeverine groups significantly increased during the treatment period. The severity scores of abdominal pain/discomfort and urgency, the stool form score, and the stool frequency in both treatment arms were significantly reduced, compared with the baselines. There were no significant differences in the responder rates (37%vs 38% on ITT analysis) and adverse event profiles between the ramosetron and mebeverine groups. Neither severe constipation nor ischemic colitis was reported by ramosetron-treated patients.

CONCLUSIONS & INFERENCES

Ramosetron 5μg once daily is as effective as mebeverine three times daily in male patients with IBS-D.

Correlation of the apparent diffusion coefficiency values on diffusion-weighted imaging with prognostic factors for breast cancer

OBJECTIVE

The aim of this study was to correlate the apparent diffusion coefficient (ADC) value of breast cancer with prognostic factors.

METHODS

335 patients with invasive ductal carcinoma not otherwise specified (IDC NOS) and ductal carcinoma in situ (DCIS) who underwent breast MRI with diffusion-weighted imaging were included in this study. ADC of breast cancer was calculated using two b factors (0 and 1000 s mm(-2)). Mean ADCs of IDC NOS and DCIS were compared and evaluated. Among cases of IDC NOS, mean ADCs were compared with lymph node status, size and immunochemical prognostic factors using Student's t-test. ADC was also correlated with histological grade using the Kruskal-Wallis test.

RESULTS

Mean ADC of IDC NOS was significantly lower than that of DCIS (p<0.001). However, the mean ADC of histological grade of IDC NOS was not significantly different (p=0.564). Mean ADC of oestrogen receptor (ER)-positive or progesterone receptor (PR)-positive cancer was significantly lower than that of ER-negative or PR-negative cancer (p=0.003 vs p=0.032). Mean ADC of Ki-67 index-positive cancer was significantly lower than that of Ki-67 index-negative cancer (p=0.028). Mean ADC values of cancers with increased microvascular density (MVD) were significantly lower than those of cancer with no MVD increase (p=0.009). No correlations were observed between mean ADC value and human growth factor receptor 2 expression, tumour size and lymph node metastasis.

CONCLUSION

Low ADC value was correlated with positive expression of ER, PR, increased Ki-67 index, and increased MVD of breast cancer.

Immunophilin dysfunction and neuropathology

In case of nervous damages, like nervous system trauma or various neurodegenerative diseases such as dementia or Parkinson, several treatments are available to restore neurological function. In spite of these treatments, results are often insufficient or not satisfactory in many neurologic diseases, especially for central nervous system (CNS) lesions. To minimize neurological dysfunction, it is critical to reduce neuronal death, avoiding loss of the synaptic connections, and securing viable neurons to extend axons. Unfortunately, there are no effective strategies to fulfill these basic needs except for some cases of peripheral neural damage up to now. Rescue of damaged neurons, stimulation of neurogenesis and transplantation of nervous tissue are strategies proposed to prevent neurodegenerative disorders. A number of studies have recently reported successful axon regeneration and neurological recovery by using immunosuppressants, such as FK506. Immunosuppressants act as excellent agents for enhancing the rate and extent of axon regeneration and neurological recovery. FK506 and other neuroimmunophilin ligands (NILs) might reverse neuronal degeneration. In several animal models mimicking Parkinson's disease, dementia and surgical damage, NILs induces resprouting, by acting as neurotrophic agents and preventing nerve damage, although more studies are necessary to identify new NILs with neuroprotective action, but lacking the side immunological effects observed in the ligands analyzed to date. This review explores the new clinical role of immunosuppressants in the treatment of nerve surgery of autologous, allografts or xenografts. Results of studies regarding immunosuppressant treatment of nervous system trauma and neurodegenerative diseases, like neurogenic erectile dysfunction, will be here considered.

Effects of microencapsulated Allyl isothiocyanate (AITC) on the extension of the shelf-life of Kimchi

Allyl isothiocyanate (AITC) is a well-recognized antimicrobial agent but, application of AITC to food systems is limited due to its high volatility and strong odor. This study was performed to overcome the volatility of AITC by encapsulation using gum Arabic and chitosan and to investigate the effect of microencapsulated AITC as a natural additive on the shelf-life and quality of Kimchi. AITC loaded microparticles were prepared using gum Arabic and chitosan and were added to Kimchi at various concentrations (0-0.02%, w/w). The titratable acidity, pH, microbial changes, and sensory test of Kimchi were examined for 15days at different fermentation temperatures (4 and 10°C). The pH of Kimchi containing AITC microparticles was significantly higher than that of control and the higher the quantity of added AITC, the higher the pH became. The titratable acidity of Kimchi increased during storage especially, titratable acidity of control increased significantly higher than those of Kimchi with added AITC microparticles. The number of Leuconostoc and Lactobacillus species in Kimchi decreased with an increase in the concentration of AITC. The addition of AITC induced reduction of sour taste and improvement of the texture of Kimchi during fermentation. However, as the content of AITC increased, the scores of overall acceptability decreased due to the odor of AITC. These results indicate that addition of AITC (less than 0.1%) to Kimchi is an effective way of enhancing the shelf-life of Kimchi without reducing quality.