Feasibility of artificial intelligence-driven interfractional monitoring of organ changes by mega-voltage computed tomography in intensity-modulated radiotherapy of prostate cancer

Purpose@#High-dose radiotherapy (RT) for localized prostate cancer requires careful consideration of target position changes and adjacent organs-at-risk (OARs), such as the rectum and bladder. Therefore, daily monitoring of target position and OAR changes is crucial in minimizing interfractional dosimetric uncertainties. For efficient monitoring of the internal condition of patients, we assessed the feasibility of an auto-segmentation of OARs on the daily acquired images, such as megavoltage computed tomography (MVCT), via a commercial artificial intelligence (AI)-based solution in this study. @*Materials and Methods@#We collected MVCT images weekly during the entire course of RT for 100 prostate cancer patients treated with the helical TomoTherapy system. Based on the manually contoured body outline, the bladder including prostate area, and rectal balloon regions for the 100 MVCT images, we trained the commercially available fully convolutional (FC)-DenseNet model and tested its auto-contouring performance. @*Results@#Based on the optimally determined hyperparameters, the FC-DenseNet model successfully auto-contoured all regions of interest showing high dice similarity coefficient (DSC) over 0.8 and a small mean surface distance (MSD) within 1.43 mm in reference to the manually contoured data. With this well-trained AI model, we have efficiently monitored the patient's internal condition through six MVCT scans, analyzing DSC, MSD, centroid, and volume differences. @*Conclusion@#We have verified the feasibility of utilizing a commercial AI-based model for auto-segmentation with low-quality daily MVCT images. In the future, we will establish a fast and accurate auto-segmentation and internal organ monitoring system for efficiently determining the time for adaptive replanning.

Atomoxetine and Fluoxetine Activate AMPK-ACC-CPT1 Pathway in Human SH-SY5Y and U-87 MG Cells

Objective@#Atomoxetine and fluoxetine are psychopharmacologic agents associated with loss of appetite and weight. Adenosine monophosphate-activated protein kinase (AMPK) is the cellular energy sensor that regulate metabolism and energy, being activated by fasting and inhibited by feeding in the hypothalamus. @*Methods@#Human brain cell lines (SH-SY5Y and U-87 MG cells) were used to study the outcome of atomoxetine and fluoxetine treatment in the activity of AMPK-acetyl-CoA carboxylase (ACC)- carnitine palmitoyl transferase 1 (CPT1) pathway and upstream regulation by calcium/calmodulin-dependent kinase kinase β (CaMKKβ) using immunoblotting and CPT1 enzymatic activity measures. @*Results@#Phosphorylation of AMPK and ACC increased significantly after atomoxetine and fluoxetine treatment in the first 30–60 minutes of treatment in the two cell lines. Activation of AMPK and inhibition of ACC was associated with an increase by 5-fold of mitochondrial CPT1 activity. Although the neuronal isoform CPT1C could be detected by immunoblotting, activity was not changed by the drug treatments. In addition, the increase in phospho-AMPK and phospho-ACC expression induced by atomoxetine was abolished by treatment with STO-609, a CaMKKβ inhibitor, indicating that AMPK-ACC-CPT1 pathway is activated through CaMKKβ phosphorylation. @*Conclusion@#These findings indicate that at the cellular level atomoxetine and fluoxetine treatments may activate AMPK-ACC-CPT1 pathways through CaMKKβ in human SH-SY5Y and U-87 MG cells.

Anti-obesity effect of Ramulus mori extracts and stilbenes in high fat dietfed C57BL/6J mouse / 한국영양학회지

Purpose@#Obesity is a risk factor for various adult diseases such as type 2 diabetes, cardio-cerebrovascular disease, and cancer. With an increasing obesity population worldwide, the prevention of obesity with natural components has emerged as an alternative health care strategy. Ramulus mori (Sangzhi, RM) is widely used as a traditional herbal medicine in East Asia. It contains various phytochemicals, including stilbenes and 2-arylbenzofurans. In this study, we compared the anti-obesity effects of RM extracts and its major stilbene components (mulberroside A [MSA] and oxyresveratrol [ORT]) in high fat diet (HFD)-fed obese mice. @*Methods@#Five week-old, male C57BL/6J mice were grouped into 7 experimental groups: normal diet (ND), HFD, HFD + 1% RM water extracts (MW), HFD + 0.1% MSA, HFD + 1% RM ethanol extracts (ME), HFD + 0.1% ORT, and HFD + 1% Garcinia cambogia extracts (GC) as a positive control. All mice were fed experimental diet for 13 weeks. @*Results@#Compared to the HFD group, total body weight and weekly body weight gain were significantly decreased in the ME, ORT, and GC groups. Glucose tolerance level was significantly decreased in all experimental groups, whereas plasma insulin level was decreased in MSA, ME, ORT and GC groups. Plasma glucose, triglyceride (TG), and total cholesterol levels were significantly decreased, whereas high-density lipoprotein cholesterol levels were increased in the MSA, ORT, and GC groups. Hepatic TG accumulation was also significantly decreased in the MSA, ME, ORT, and GC groups. Adipose tissue weight and size of adipocytes were significantly decreased in the MSA, ME and ORT groups, and were comparable to values obtained in the GC group. The levels of adiponectin and SREBP1c mRNA expressions were increased in the ORT and GC groups. @*Conclusion@#These results indicate that ME, ORT and MSA exert significant anti-obesity effect, and have the potential to be developed as a weight control ingredient of functional foods.

Anti-obesity effect of Ramulus mori extracts and stilbenes in high fat dietfed C57BL/6J mouse / 한국영양학회지

Purpose@#Obesity is a risk factor for various adult diseases such as type 2 diabetes, cardio-cerebrovascular disease, and cancer. With an increasing obesity population worldwide, the prevention of obesity with natural components has emerged as an alternative health care strategy. Ramulus mori (Sangzhi, RM) is widely used as a traditional herbal medicine in East Asia. It contains various phytochemicals, including stilbenes and 2-arylbenzofurans. In this study, we compared the anti-obesity effects of RM extracts and its major stilbene components (mulberroside A [MSA] and oxyresveratrol [ORT]) in high fat diet (HFD)-fed obese mice. @*Methods@#Five week-old, male C57BL/6J mice were grouped into 7 experimental groups: normal diet (ND), HFD, HFD + 1% RM water extracts (MW), HFD + 0.1% MSA, HFD + 1% RM ethanol extracts (ME), HFD + 0.1% ORT, and HFD + 1% Garcinia cambogia extracts (GC) as a positive control. All mice were fed experimental diet for 13 weeks. @*Results@#Compared to the HFD group, total body weight and weekly body weight gain were significantly decreased in the ME, ORT, and GC groups. Glucose tolerance level was significantly decreased in all experimental groups, whereas plasma insulin level was decreased in MSA, ME, ORT and GC groups. Plasma glucose, triglyceride (TG), and total cholesterol levels were significantly decreased, whereas high-density lipoprotein cholesterol levels were increased in the MSA, ORT, and GC groups. Hepatic TG accumulation was also significantly decreased in the MSA, ME, ORT, and GC groups. Adipose tissue weight and size of adipocytes were significantly decreased in the MSA, ME and ORT groups, and were comparable to values obtained in the GC group. The levels of adiponectin and SREBP1c mRNA expressions were increased in the ORT and GC groups. @*Conclusion@#These results indicate that ME, ORT and MSA exert significant anti-obesity effect, and have the potential to be developed as a weight control ingredient of functional foods.

Improving Perception and Satisfaction on Middle and High School Foodservice: The Role of Student Participation Program in Serving School Meals / 대한지역사회영양학회지

OBJECTIVES: We evaluated the extent to which implementation of student participation programs in serving school meals impacts student perception and satisfaction with school foodservice in middle and high school settings. METHODS: Students' perception of management and satisfaction with quality attributes of school foodservice were assessed by questionnaire methods and compared by the program implementation status of student participation in serving school meals. Correlation and multiple regression analyses were performed to identify factors affecting perception and satisfaction. RESULTS: The overall mean score for perception regarding the management of school foodservice was low (3.53 out of 10 points) and middle school students showed a higher mean score than high school students (4.10 vs. 2.94 points). In both middle and high schools, student perception was significantly higher in schools implementing the program. The average score for student satisfaction with the quality of school foodservice was 3.50 out of 5 points. Similarly, we observed a significantly higher satisfaction among middle versus high school students (3.93 vs. 3.04 points) and in schools implementing the program versus those that were not. Overall, student participation in serving school meals resulted in increases in satisfaction with school foodservice of 0.269 and 0.466 points among middle and high school students, respectively. CONCLUSIONS: Implementation of student participation in serving school meals could be used as a strategy to improve perception and satisfaction of students with their school foodservice. Establishment of guidelines of student serving participation programs encompassing different perspectives from students, dietitians and school faculties are warranted.

Effects of luteolin on chemical induced colon carcinogenesis in high fat diet-fed obese mouse / 한국영양학회지

PURPOSE: Colorectal cancer, which is one of the most commonly diagnosed cancers in developing and developed countries, is highly associated with obesity. The association is largely attributed to changes to western style diets in those countries containing high-fat and high-energy. Luteolin (LUT) is a known potent inhibitor of inflammation, obesity, and cancer. In this study, we investigated the effects of LUT on chemical-induced colon carcinogenesis in high fat diet (HFD)-fed obese mice. METHODS: Five-week-old male C57BL/6 mice received a single intraperitoneal injection of azoxymethane (AOM) at a dose of 12.5 mg/kg body weight. Mice were then divided into four groups (n = 10) that received one of the following diets for 11 weeks after the AOM injection: normal diet (ND); HFD; HFD with 0.0025% LUT (HFD LL); HFD with 0.005% LUT (HFD HL). One week after AOM injection, animals received 1~2% dextran sodium sulfate in their drinking water over three cycles consisting of five consecutive days each that were separated by 16 days. RESULTS: Body weight, ratio of colon weight/length, and tumor multiplicity increased significantly in the HFD group compared to the ND group. Luteolin supplementation of the HFD significantly reduced the ratio of colon weight/length and colon tumors, but not body weight. The levels of plasma TNF-α and colonic expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 protein increased in response to HFD, but were suppressed by LUT supplementation. Immunohistochemistry analysis also showed that iNOS expression was decreased by LUT. CONCLUSION: Consumption of LUT may reduce the risk of obesity-associated colorectal cancer by suppression of colonic inflammation.

Goal Attainment Rate for Parameters of Metabolic Adjustment in Elderly Patients with Type 2 Diabetes Taking a Hypoglycemic Agent / 임상당뇨병

BACKGROUND: This study aimed to investigate the goal attainment rates for hemoglobin A1c (HbA1c), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) in elderly patients with type 2 diabetes. METHODS: The subjects were 762 over 65 years old patients with type 2 diabetes taking a hypoglycemic agent. Data were collected by reviewing medical records and included general characteristics, biochemical tests, prescribed pharmacologic agents, and complications. RESULTS: The goal attainment rates (mean value) for HbA1c, BP, and LDL-C were 50.4% (7.3% ± 1.2%), 78.9% (126.0 ± 15.1/72.1 ± 10.0 mm Hg), and 60.6% (88.6 ± 29.9 mg/dL). Diabetes-related complications for retinopathy, nephropathy, neuropathy, and cardio-cerebral vascular disease were 36.3%, 37.2%, 23.6%, and 31.9%, respectively. Life habit-related variables positively associated with goal attainment were not drinking alcohol and exercise for HbA1c, not smoking for BP and not drinking alcohol for LDL-C. Metabolic adjustment indicator-related significant variables for complications were HbA1c in retinopathy, BP in nephropathy, and LDL-C in cardio-cerebral disease. CONCLUSION: We found that goal attainment rates for parameters of metabolic adjustment were not high in elderly patients with type 2 diabetes. Thus, diabetes educators should be concerned about metabolic adjustment indicators. Also, case management guidelines according to elderly patient health and functional status should be developed to help manage metabolic adjustment.

Determination of donepezil in human plasma using ultra performance liquid chromatography-tandem mass spectrometry

An ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed and validated for the quantification of donepezil in human plasma. Donepezil and donepezil-D4 were extracted from human plasma by liquid-liquid extraction using a mixture of hexane and ethyl acetate (70:30 v/v). The extracted samples were analyzed using a Thermo Hypersil Gold C18 column with 5% acetic acid in 20 mM ammonium acetate buffer (pH 3.3) and 100% acetonitrile as a mobile phase with the 60:40 (v:v) isocratic method, at a flow rate of 0.3 mL/min. The injection volume was 3 µL, and the total run time was 3 min. Inter- and intra-batch accuracies ranged from 98.0% to 110.0%, and the precision was below 8%. The developed method was successfully applied to the quantification of donepezil in human plasma. The mean (standard deviation) maximum concentration and the median (range) time to maximum concentration were 8.6 (2.0) ng/mL and 2.0 h (1.0~5.0 h), respectively, in healthy Koreans after oral administration of 5 mg donepezil.

Improving Perception and Satisfaction on Middle and High School Foodservice: The Role of Student Participation Program in Serving School Meals / 대한지역사회영양학회지

OBJECTIVES: We evaluated the extent to which implementation of student participation programs in serving school meals impacts student perception and satisfaction with school foodservice in middle and high school settings. METHODS: Students' perception of management and satisfaction with quality attributes of school foodservice were assessed by questionnaire methods and compared by the program implementation status of student participation in serving school meals. Correlation and multiple regression analyses were performed to identify factors affecting perception and satisfaction. RESULTS: The overall mean score for perception regarding the management of school foodservice was low (3.53 out of 10 points) and middle school students showed a higher mean score than high school students (4.10 vs. 2.94 points). In both middle and high schools, student perception was significantly higher in schools implementing the program. The average score for student satisfaction with the quality of school foodservice was 3.50 out of 5 points. Similarly, we observed a significantly higher satisfaction among middle versus high school students (3.93 vs. 3.04 points) and in schools implementing the program versus those that were not. Overall, student participation in serving school meals resulted in increases in satisfaction with school foodservice of 0.269 and 0.466 points among middle and high school students, respectively. CONCLUSIONS: Implementation of student participation in serving school meals could be used as a strategy to improve perception and satisfaction of students with their school foodservice. Establishment of guidelines of student serving participation programs encompassing different perspectives from students, dietitians and school faculties are warranted.

The Ability of the Acute Physiology and Chronic Health Evaluation (APACHE) IV Score to Predict Mortality in a Single Tertiary Hospital / 대한구급학회지

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion. METHODS: The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR). RESULTS: The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70). CONCLUSIONS: The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.

The Ability of the Acute Physiology and Chronic Health Evaluation (APACHE) IV Score to Predict Mortality in a Single Tertiary Hospital / 대한중환자의학회지

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion. METHODS: The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR). RESULTS: The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70). CONCLUSIONS: The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.

A Case of Dermatomyositis in a Patient with a Neuroendocrine Tumor at the Ampulla of Vater / 대한내과학회지

Dermatomyositis is an autoimmune disease characterized by chronic muscle inflammation that results in specific dermatological signs and decreased muscle strength. It is known to have a strong association with malignancy. Most neuroendocrine tumors arise from the gastrointestinal tract, with less than 1% of cases occurring at the ampulla of Vater. While cases of dermatomyositis associated with neuroendocrine tumors have been reported internationally, to date there have been no cases reported in Korea. This case report presents a 33-year-old male who had undergone pylorus-preserving pancreaticoduodenectomy for a neuroendocrine tumor located at the ampulla of Vater, and had been followed at the hospital after his procedure. Three years post-surgery, the patient developed serious muscle weakness in his upper-right and lower-left extremities, and was subsequently diagnosed with dermatomyositis. This paper presents the first domestic case of dermatomyositis developing in the context of a neuroendocrine tumor at the ampulla of Vater. A literature review on this subject follows in the discussion.

Non-Bacterial Thrombotic Endocarditis in a Patient with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is frequently associated with various extra-joint complications. Although rare, thromboembolic complications are associated with high morbidity and mortality. We experienced a very rare case of nonbacterial thrombotic endocarditis (NBTE) and subsequent embolic stroke in a patient with RA. A 72-year-old male with a 15-year history of RA suddenly developed neurologic symptoms of vomiting and dizziness. Brain magnetic resonance imaging revealed recently developed multiple cerebellar and cerebral lacunar infarctions. Echocardiography showed a pulsating mitral valve vegetation involving the posterior cusp of the mitral valve leaflet, which was confirmed as NBTE. Immediate anti-coagulation therapy was started. The NBTE lesion disappeared in follow-up echocardiography after 4 weeks of anti-coagulation treatment.

Nursing Management in Diabetes during Pregnancy / 임상당뇨병

The ongoing epidemics of obesity and diabetes have led to higher incidence of gestational diabetes mellitus and pregestational diabetes. GDM is diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes. Therefore, women in whom diabetes is detected in the first trimester would be classified as having type 2 diabetes. Women with GDM should be screened for persistent diabetes or prediabetes at 6~12 weeks postpartum. All women of childbearing age with diabetes should be counseled about the importance of strict glycemic control prior to conception. During pregnancy, treatment with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers is contraindicated because their ability to cause fetal damage. Women with diabetes of any kind should be supported in attempts to breastfeed, as it is related to long-term metabolic benefit to both mother and child.

Extranodal natural killer/T-cell lymphoma of the tenosynovium of the hand

No abstract available.

Clinical and microbiological features of Providencia bacteremia: experience at a tertiary care hospital

BACKGROUND/AIMS: Providencia species frequently colonize urinary catheters and cause urinary tract infections (UTIs); however, bacteremia is uncommon and not well understood. We investigated the clinical features of Providencia bacteremia and the antibiotic susceptibility of Providencia species. METHODS: We identified cases of Providencia bacteremia from May 2001 to April 2013 at a tertiary care hospital. The medical records of pertinent patients were reviewed. RESULTS: Fourteen cases of Providencia bacteremia occurred; the incidence rate was 0.41 per 10,000 admissions. The median age of the patients was 64.5 years. Eleven cases (78.6%) were nosocomial infections and nine cases (64.3%) were polymicrobial bacteremia. The most common underlying conditions were cerebrovascular/neurologic disease (n = 10) and an indwelling urinary catheter (n = 10, 71.4%). A UTI was the most common source of bacteremia (n = 5, 35.7%). The overall mortality rate was 29% (n = 4); in each case, death occurred within 4 days of the onset of bacteremia. Primary bacteremia was more fatal than other types of bacteremia (mortality rate, 75% [3/4] vs. 10% [1/10], p = 0.041). The underlying disease severity, Acute Physiologic and Chronic Health Evaluation II scores, and Pitt bacteremia scores were significantly higher in nonsurvivors (p = 0.016, p =0.004, and p = 0.002, respectively). Susceptibility to cefepime, imipenem, and piperacillin/tazobactam was noted in 100%, 86%, and 86% of the isolates, respectively. CONCLUSIONS: Providencia bacteremia occurred frequently in elderly patients with cerebrovascular or neurologic disease. Although Providencia bacteremia is uncommon, it can be rapidly fatal and polymicrobial. These characteristics suggest that the selection of appropriate antibiotic therapy could be complicated in Providencia bacteremia.

Idiopathic Retroperitoneal Fibrosis Associated with Rheumatoid Arthritis in a Patient with Concomitant Chronic B Viral Hepatitis

Retroperitoneal fibrosis (RPF) is a rare, progressive disease characterized by chronic non specific inflammation of the retroperitoneum. Although the pathogenesis of idiopathic retroperitoneal fibrosis (IRF) remains unclear, IRF has been reported in association with autoimmune disorders. However, few cases of IRF associated with rheumatoid arthritis (RA) have been reported. We experienced a rare case of IRF in a patient with RA and chronic B viral hepatitis. A 39-year-old Korean man with RA and hepatitis B was referred to our hospital due to left hydronephrosis. An abdominal computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a diffuse infiltrating retroperitoneal mass around the abdominal aorta and left ureter. The patient underwent intraureteral stent insertion and was treated with corticosteroid. Three months later, the follow up abdominal CT showed that the retroperitoneal mass had decreased in size. Herein, we report the first case of coexistent IRF, RA, and chronic B viral hepatitis with a literature review.

Current Status of Management in Type 2 Diabetes Mellitus at General Hospitals in South Korea

BACKGROUND: In Korea, the prevalence, complications, and mortality rate of diabetes are rapidly increasing. However, investigations on the actual condition of diabetes management are very limited due to lack of nation-wide research or multicenter study. Hence, we have minutely inquired the current status of diabetes management and achievement of glucose target goal in general hospital offering education program. That way, we are able to furnish data for policy making of diabetes education and draw up guideline which may allow us to reduce the morbidity and mortality of diabetes. METHODS: The subjects consisted of 2,610 patients with type 2 diabetes who visited the 13 general hospital in Seoul or Gyeonggi region from March 19 to May 29, 2013. General characteristics, associated diseases, complications, and management status were investigated. RESULTS: The mean age was 61.0+/-11.6 years, body mass index was 25.0+/-3.3 kg/m2, and family history of diabetes was 50.5%. The mean duration of diabetes was 10.7+/-7.9 years and 53% received education about diabetes. The prevalence of hypertension and dyslipidemia were 59.2% and 65.5%, respectively, and 18.3% of the subjects were accompanied by liver disease. Diabetic retinopathy appeared in 31.6%, nephropathy in 28.1%, and neuropathy in 19.9% of the subjects. The mean glycosylated hemoglobin (HbA1c) level was 7.3%+/-1.3% and the achieving rate based on Korean Diabetes Association guideline (HbA1c <6.5%) was 24.8%, blood pressure (130/80 mm Hg or less) was 49.4%, and low density lipoprotein cholesterol (<100 mg/dL) was 63.6%. The reaching rate to the target level in four parameters (blood glucose, blood pressure, lipids, and body weight) was 7.8%. CONCLUSION: The blood glucose control rate was lower than other parameters, and the implementation rate of diabetes education was only 53%. Thus more appropriate glucose control and systematic diabetes education are imperative.

Maternal and Neonatal Outcomes in Korean Women with Type 1 and Type 2 Diabetes

BACKGROUND: The purpose of this study was to evaluate maternal and neonatal outcomes in Korean women with type 1 diabetes and type 2 diabetes. METHODS: We performed a retrospective survey of 163 pregnancies in women with type 1 diabetes (n=13) and type 2 diabetes (n=150) treated from 2003 to 2010 at Cheil General Hospital & Women's Healthcare Center, Korea. We compared maternal characteristics as well as maternal and neonatal outcomes between groups. RESULTS: Differences in glycosylated hemoglobin between type 1 and type 2 diabetes were not significant. Birth weight (3,501+/-689.6 g vs. 3,366+/-531.4 g) and rate of major congenital malformations (7.7% vs. 5.6%) were not significantly different. However, women with type 1 diabetes had higher rates of preeclampsia (38.5% vs. 8.2%, P=0.006), large for gestational age (LGA; 46.2% vs. 20.4%, P=0.004), macrosomia (38.5% vs. 13.4%, P=0.032), and admission for neonatal care (41.7% vs. 14.8%, P=0.03) than women with type 2 diabetes. CONCLUSION: Maternal and neonatal outcomes for women with type 1 diabetes were poorer than for women with type 2 diabetes, especially preeclampsia, LGA, macrosomia and admission to the neonatal intensive care unit.

Knee Synovitis Mimicking a Septic Arthritis

Synovitis is the inflammation of the synovial membrane with unknown etiology which occurs in association with auto-immune inflammatory arthritis, mainly in rheumatoid arthritis. Synovitis manifesting as rapidly progressing monoarticular or pauciarticualr symptoms could make early diagnosis difficult, thus it could be misdiagnosed as other forms of arthritic diseases. We experienced a rare case of knee joint synovitis which initially manifested as mimicking a septic arthritis. A 58-year-old-male patient underwent renovascular embolization due to retroperitoneal hemorrhage which was developed after renal biopsy. Suddenly, the patient's left knee joint became swollen rapidly with redness and tenderness. Moreover, his right knee also became inflamed. Surgical irrigation and intravenous antibiotics had never worked on his knee joint inflammation, however administration of intermediate dose of steroid could decrease inflammatory signs dramatically. Synovitis in a large joint could be mistaken as a septic arthritis, delaying the right diagnosis. Thus, we report this case with literature review.