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Cranial-nerve disorders can be caused by a wide spectrum of diseases, including congenital, inflammatory, and tumorous diseases, and are often encountered in practice. However, the imaging of cranial-nerve disorders is challenging, and understanding the anatomical differences of each region is essential for conducting the best protocols and for detecting subtle changes in cranial nerves during magnetic resonance imaging (MRI) examinations. In this review we discuss which MRI techniques are best for observing normal and pathologic appearance, according to the different regions of the cranial nerves.
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Background/Aims@#Although anti-tumor necrosis factor (TNF) agents have been widely used to treat ulcerative colitis (UC), the real-world incidence of suboptimal response to anti-TNF agents has not been thoroughly investigated, especially among Asians. @*Methods@#Using the Korean National Health Insurance database, we collected data on UC patients who initiated anti-TNF agents between July 1, 2014, and June 30, 2017. We assessed suboptimal responses, including anti-TNF discontinuation or dose escalation, switching to other biologics, augmentation with a non-biologic therapy, and the requirement for colectomy. @*Results@#A total of 1,268 patients were included as new anti-TNF users (infliximab 713, adalimumab 433, golimumab 122). The proportion of patients who experienced at least one suboptimal response within 1 year among all patients was 63.5%, including 59.1%, 69.5%, and 68.0% of patients treated with infliximab, adalimumab, and golimumab, respectively. The cumulative incidences of at least one suboptimal response over time were 41.5%, 63.7%, 80.5%, and 87.1% at 6, 12, 24, and 36 months, respectively. Cox proportional hazards modeling revealed that adalimumab was associated with a higher risk of at least one suboptimal response (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.13 to 1.48), dose escalation (HR, 4.35; 95% CI, 2.97 to 6.38) and discontinuation (HR, 1.25; 95% CI, 1.03 to 1.52) than infliximab. Golimumab was associated with a higher risk of switching to other biologics than infliximab (HR, 1.78; 95% CI, 1.21 to 2.60). @*Conclusions@#More than half of Korean UC patients had suboptimal responses to anti-TNF agents within 1 year. UC patients treated with infliximab might be less prone to suboptimal responses than those treated with adalimumab or golimumab
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Objective@#To describe patterns of spontaneous reporting on adverse events following immunization (AEFIs) using the human papilloma virus (HPV) vaccine according to the Brighton Collaboration (BC) criteria. @*Methods@#We used the Korea Adverse Event Reporting System (KAERS) database including vaccinations between 2008 and 2017. To apply BC criteria, we classified 58 BC AEFIs into World Health Organization Adverse Reaction Terminology (WHO-ART) codes. We applied MedDRA standard medical queries that were pre-defined as five BC AEFIs. Terminology mapping between MedDRA and WHO-ART terms was performed by three researchers. Descriptive statistics of individual case safety reports were analyzed according to BC applicability.Disproportionality analyses were performed on each BC AEFI and each preferred AEFI term according to the case-noncase approach; reporting odds ratio (ROR) and 95% confidence intervals (CI) were calculated. @*Results@#Among the 30,266 reports of vaccinations between 2008 and 2017, 2,845 reports included the HPV vaccine. Of these reports, 1,511 (53.1%) included at least one BC AEFI. Reports from physicians or manufacturers included more BC AEFIs than from other reporters. Injection site reactions and fever were frequently reported in BC AEFIs; spontaneous abortion and ectopic pregnancy (ROR, 14.29 [95% CI, 4.30-47.49]) and vasculitic peripheral neuropathy (ROR, 8.57 [95% CI, 2.61-28.10]) showed the highest ROR. Among non-BC AEFIs, dizziness or myalgia were frequently reported; exposure during pregnancy (ROR, 23.95 [95% CI, 16.27-35.25]) and inappropriate schedule of administration (ROR, 22.89 [95% CI, 16.74-31.31]) showed the highest ROR. @*Conclusion@#BC criteria would be applicable for labeled AEFIs, whereas analyzing non-BC AEFIs would be useful for detecting unlabeled AEFIs.
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Objective@#To evaluate the effect of fascia penetration and develop a new technique for lateral femoral cutaneous nerve (LFCN) conduction studies based on the fascia penetration point (PP) identified using ultrasound. @*Methods@#The fascia PP of the LFCN was localized in 20 healthy subjects, and sensory nerve action potentials (SNAPs) were obtained at four different stimulation points—2 cm proximal to the PP (2PPP), PP, 2 cm distal to the PP (2DPP), and 4 cm distal to the PP (4DPP). We compared the stimulation technique based on the fascia penetration point (STBFP) with the conventional technique. @*Results@#The SNAP amplitude of the LFCN was significantly higher when stimulation was performed at the PP and 2DPP than at other stimulation points. Using the STBFP, SNAP responses were elicited in 38 of 40 legs, whereas they were elicited in 32 of 40 legs using the conventional technique (p=0.041). STBFP had a comparable SNAP amplitude and slightly delayed negative peak latency compared to the conventional technique. In terms of the time required, the time spent on STBFP showed a more consistent distribution than the time spent on the conventional technique (two-sample Kolmogorov–Smirnov test, p<0.05). @*Conclusion@#SNAP of the LFCN significantly changed near the fascia PP, and stimulation at PP and at 2DPP provided high amplitudes. STBFP can help increase the response rate and ensure stable and consistent procedure time of the LFCN conduction study.
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Objective@#To describe patterns of spontaneous reporting on adverse events following immunization (AEFIs) using the human papilloma virus (HPV) vaccine according to the Brighton Collaboration (BC) criteria. @*Methods@#We used the Korea Adverse Event Reporting System (KAERS) database including vaccinations between 2008 and 2017. To apply BC criteria, we classified 58 BC AEFIs into World Health Organization Adverse Reaction Terminology (WHO-ART) codes. We applied MedDRA standard medical queries that were pre-defined as five BC AEFIs. Terminology mapping between MedDRA and WHO-ART terms was performed by three researchers. Descriptive statistics of individual case safety reports were analyzed according to BC applicability.Disproportionality analyses were performed on each BC AEFI and each preferred AEFI term according to the case-noncase approach; reporting odds ratio (ROR) and 95% confidence intervals (CI) were calculated. @*Results@#Among the 30,266 reports of vaccinations between 2008 and 2017, 2,845 reports included the HPV vaccine. Of these reports, 1,511 (53.1%) included at least one BC AEFI. Reports from physicians or manufacturers included more BC AEFIs than from other reporters. Injection site reactions and fever were frequently reported in BC AEFIs; spontaneous abortion and ectopic pregnancy (ROR, 14.29 [95% CI, 4.30-47.49]) and vasculitic peripheral neuropathy (ROR, 8.57 [95% CI, 2.61-28.10]) showed the highest ROR. Among non-BC AEFIs, dizziness or myalgia were frequently reported; exposure during pregnancy (ROR, 23.95 [95% CI, 16.27-35.25]) and inappropriate schedule of administration (ROR, 22.89 [95% CI, 16.74-31.31]) showed the highest ROR. @*Conclusion@#BC criteria would be applicable for labeled AEFIs, whereas analyzing non-BC AEFIs would be useful for detecting unlabeled AEFIs.
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Objective@#To evaluate the effect of fascia penetration and develop a new technique for lateral femoral cutaneous nerve (LFCN) conduction studies based on the fascia penetration point (PP) identified using ultrasound. @*Methods@#The fascia PP of the LFCN was localized in 20 healthy subjects, and sensory nerve action potentials (SNAPs) were obtained at four different stimulation points—2 cm proximal to the PP (2PPP), PP, 2 cm distal to the PP (2DPP), and 4 cm distal to the PP (4DPP). We compared the stimulation technique based on the fascia penetration point (STBFP) with the conventional technique. @*Results@#The SNAP amplitude of the LFCN was significantly higher when stimulation was performed at the PP and 2DPP than at other stimulation points. Using the STBFP, SNAP responses were elicited in 38 of 40 legs, whereas they were elicited in 32 of 40 legs using the conventional technique (p=0.041). STBFP had a comparable SNAP amplitude and slightly delayed negative peak latency compared to the conventional technique. In terms of the time required, the time spent on STBFP showed a more consistent distribution than the time spent on the conventional technique (two-sample Kolmogorov–Smirnov test, p<0.05). @*Conclusion@#SNAP of the LFCN significantly changed near the fascia PP, and stimulation at PP and at 2DPP provided high amplitudes. STBFP can help increase the response rate and ensure stable and consistent procedure time of the LFCN conduction study.
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Duodenal perforation can occur due to complications caused by ulcers, other inflammation or by the instrument used during the procedure such as endoscopy, endoscopic retrograde cholangiopancreatography (ERCP); however, its incidence is not high. Most cases of perforation of the lateral wall of the duodenum are acute and require immediate surgical or endoscopic treatment. Cases of chronic duodenal perforation are rarely reported. This report presents the case of a previous perforation that was discovered unexpectedly during ERCP in a patient with cholangitis due to common bile duct stones. The time of occurrence of the perforation was unknown. After medical treatment, the patient was able to return to daily life. We have reported this case along with a literature review.
Subject(s)
Humans , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis , Common Bile Duct , Duodenum , Endoscopy , Incidence , Inflammation , UlcerABSTRACT
We hereby report a case on bronchogenic cyst which is initially non-infected, then becomes infected after bronchoscopic ultrasound (US)-guided transesophageal fine-needle aspiration (FNA). The non-infected bronchogenic cyst appears to be filled with relatively echogenic materials on US, and the aspirate is a whitish jelly-like fluid. Upon contrast-enhanced MRI of the infected bronchogenic cyst, a T1-weighted image shows low signal intensity and a T2-weighted image shows high signal intensity, with no enhancements of the cyst contents, but enhancements of the thickened cystic wall. The patient then undergo video-assisted thoracic surgery 14 days after the FNA. The cystic mass is known to be completely removed, and the aspirate is yellowish and purulent. To understand the image findings that pertain to the gross appearance of the cyst contents will help to diagnose bronchogenic cysts in the future.
Subject(s)
Humans , Biopsy, Fine-Needle , Bronchogenic Cyst , Magnetic Resonance Imaging , Thoracic Surgery, Video-Assisted , UltrasonographyABSTRACT
Neonatal lupus is an uncommon autoimmune disease that results from transplacental passage of the maternal anti-SSA/Ro and/or anti-SSB/La antibodies. Pancytopenia or severe jaundice is a rare manifestation of neonatal lupus, respectively, and could be misdiagnosed with other neonatal illnesses, such as infection, hematologic disease, or hepatobiliary disease. Here, we report an unusual case of a premature newborn with severe neonatal lupus manifested with skin rash, fever, pancytopenia, and severe jaundice with abnormal liver function tests. His mother had been clinically asymptomatic before delivery; however, she revealed peripheral edema, bilateral pleural effusion, and ascites after delivery and diagnosed with systemic lupus erythematosus based on positive anti-nuclear and anti-cardiolipin antibodies, proteinuria, and serositis. The newborn and his mother had anti-SSA/Ro and anti-SSB/La antibodies. His pancytopenia and jaundice were progressively aggravated, and his illness was confused with neonatal sepsis or biliary obstruction. We decided to treat with high dose of corticosteroid and intravenous immunoglobulin, and he gradually recovered completely with the treatment. His corticosteroid was stopped at 5 months of age without relapse or complication.
Subject(s)
Humans , Infant, Newborn , Antibodies , Ascites , Autoimmune Diseases , Edema , Exanthema , Fever , Hematologic Diseases , Immunoglobulins , Jaundice , Liver Function Tests , Lupus Erythematosus, Systemic , Mothers , Pancytopenia , Pleural Effusion , Proteinuria , Recurrence , Sepsis , SerositisABSTRACT
Ultraviolet (UV) radiation is a major environmental factor that leads to acute and chronic reactions in the human skin. UV exposure induces wrinkle formation, DNA damage, and generation of reactive oxygen species (ROS). Most mechanistic studies of skin physiology and pharmacology related with UV-irradiated skin have focused on proteins and their related gene expression or single- targeted small molecules. The present study identified and analyzed the alteration of skin metabolites following UVB irradiation and topical retinyl palmitate (RP, 5%) treatment in hairless mice using direct analysis in real time (DART) time-of-flight mass spectrometry (TOF-MS) with multivariate analysis. Under the negative ion mode, the DART ion source successfully ionized various fatty acids including palmitoleic and linolenic acid. From DART-TOF-MS fingerprints measured in positive mode, the prominent dehydrated ion peak (m/z: 369, M+H-H2O) of cholesterol was characterized in all three groups. In positive mode, the discrimination among three groups was much clearer than that in negative mode by using multivariate analysis of orthogonal partial-least squares-discriminant analysis (OPLS-DA). DART-TOF-MS can ionize various small organic molecules in living tissues and is an efficient alternative analytical tool for acquiring full chemical fingerprints from living tissues without requiring sample preparation. DART-MS measurement of skin tissue with multivariate analysis proved to be a powerful method to discriminate between experimental groups and to find biomarkers for various experiment models in skin dermatological research.
Subject(s)
Animals , Humans , Mice , alpha-Linolenic Acid , Biomarkers , Cholesterol , Dermatoglyphics , Discrimination, Psychological , DNA Damage , Fatty Acids , Gene Expression , Mass Spectrometry , Metabolome , Mice, Hairless , Multivariate Analysis , Pharmacology , Reactive Oxygen Species , Skin Physiological Phenomena , SkinABSTRACT
Alcohol abuse and its medical and social consequences are a major health problem in many areas of the world. Korean red ginseng (KRG) has been traditionally used for the treatment of liver disease. This study was conducted to evaluate the hepatoprotective effects of KRG against hepatotoxicity in Sprague-Dawley rats treated with ethanol (EtOH). Administration of EtOH for 20 days induced significant changes in serum biochemical parameters (aspartate aminotransferase, alanine transaminase, and glucose) accompanied by histological changes in the liver tissue. Treatment with KRG prior to administration of EtOH inhibited the EtOH-induced biochemical and histological changes of the liver. In perfused rat livers, administration of EtOH caused an increase in lactate dehydrogenase (LDH) release into the perfusate and activated the pro-apoptotic Bax protein but inhibited the anti-apoptotic Bcl-2 protein. Pretreatment with KRG prior to administration of EtOH decreased the EtOH-induced LDH release and inhibition of Bcl-2 protein. These results suggest that KRG exerts anti-apoptotic effects and alleviated EtOH-induced liver injury in rats.