Differences in Brain Morphology between Hydrocephalus Ex Vacuo and Idiopathic Normal Pressure Hydrocephalus

Objective@#The distinction between idiopathic normal pressure hydrocephalus (iNPH) and hydrocephalus ex vacuo caused by encephalic volume loss remains to be established. This study aims to investigate radiological parameters as clinically useful tools to discriminate iNPH from hydrocephalus ex vacuo caused by Alzheimer’s disease (AD). @*Methods@#A total of 54 patients with ventriculomegaly (iNPH, 25; hydrocephalus ex vacuo, 29) were recruited in this study. Consequently, nine radiological parameters were compared between iNPH and hydrocephalus ex vacuo using magnetic resonance imaging (MRI). @*Results@#A small callosal angle (CA), the Sylvian fissure dilatation, and absence of narrowing of superior parietal sulci discriminated the iNPH group from the hydrocephalus ex vacuo group (p<0.05). The final binary logistic regression model included narrowing of superior parietal sulci, degrees of the CA, and height of the Sylvian fissure after controlling for age and global Clinical Dementia Rating (CDR). The composite score made from these three indicators (narrowing of superior parietal sulci, degrees of the CA, and height of the Sylvian fissure) was statistically different between iNPH and hydrocephalus ex vacuo. @*Conclusion@#The narrowing of the CA, dilatation of the Sylvain fissure, and narrowing of superior parietal sulci may be used as radiological key indices and noninvasive tools for the differential diagnosis of iNPH from hydrocephalus ex vacuo.

Differences in Brain Morphology between Hydrocephalus Ex Vacuo and Idiopathic Normal Pressure Hydrocephalus

Objective@#The distinction between idiopathic normal pressure hydrocephalus (iNPH) and hydrocephalus ex vacuo caused by encephalic volume loss remains to be established. This study aims to investigate radiological parameters as clinically useful tools to discriminate iNPH from hydrocephalus ex vacuo caused by Alzheimer’s disease (AD). @*Methods@#A total of 54 patients with ventriculomegaly (iNPH, 25; hydrocephalus ex vacuo, 29) were recruited in this study. Consequently, nine radiological parameters were compared between iNPH and hydrocephalus ex vacuo using magnetic resonance imaging (MRI). @*Results@#A small callosal angle (CA), the Sylvian fissure dilatation, and absence of narrowing of superior parietal sulci discriminated the iNPH group from the hydrocephalus ex vacuo group (p<0.05). The final binary logistic regression model included narrowing of superior parietal sulci, degrees of the CA, and height of the Sylvian fissure after controlling for age and global Clinical Dementia Rating (CDR). The composite score made from these three indicators (narrowing of superior parietal sulci, degrees of the CA, and height of the Sylvian fissure) was statistically different between iNPH and hydrocephalus ex vacuo. @*Conclusion@#The narrowing of the CA, dilatation of the Sylvain fissure, and narrowing of superior parietal sulci may be used as radiological key indices and noninvasive tools for the differential diagnosis of iNPH from hydrocephalus ex vacuo.

A Case of Frey's Syndrome Diagnosed and Followed Up Using the Quantitative Sudomotor Axon Reflex Test

No abstract available.

Higher glucagon-to-insulin ratio is associated with elevated glycated hemoglobin levels in type 2 diabetes patients

BACKGROUND/AIMS@#The importance of α-cell dysfunction in the pathogenesis of type 2 diabetes has re-emerged recently. However, data on whether relative glucagon excess is present in clinical settings are scarce. We aimed to investigate associations between glucagon-to-insulin ratio and various metabolic parameters.@*METHODS@#A total of 451 patients with type 2 diabetes naïve to insulin treatment were recruited. Using glucagon-to-insulin ratio, we divided subjects into quartiles according to both fasting and postprandial glucagon-to-insulin ratios.@*RESULTS@#The mean age of the subjects was 58 years, with a mean body mass index of 25 kg/m² The patients in the highest quartile of glucagon-to-insulin ratio had higher glycated hemoglobin (HbA1c) levels. HbA1c levels were positively correlated with both fasting and postprandial glucagon-to-insulin ratios. Subjects in the highest quartile of postprandial glucagon-to-insulin ratio were more likely to exhibit uncontrolled hyperglycemia, even after adjusting for confounding factors (odds ratio, 2.730; 95% confidence interval, 1.236 to 6.028; p for trend < 0.01).@*CONCLUSIONS@#Hyperglucagonemia relative to insulin could contribute to uncontrolled hyperglycemia in type 2 diabetes patients.

Risky Lifestyle Behaviors among Gastric Cancer Survivors Compared with Matched Non-cancer Controls: Results from Baseline Result of Community Based Cohort Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study investigated the prevalence of smoking, drinking, and physical inactivity and the associated factors of these behaviors in gastric cancer survivors. MATERIALS AND METHODS: The baseline data from the nationwide cohort study was used. Four hundred thirty-seven gastric cancer survivors who survived ≥ 2 years from diagnosis and reported completion of treatment were matched with 4,370 controls according to age, sex, education, and household income. RESULTS: The prevalence rates of current smoking and drinking among gastric cancer survivors were 8.7% and 38.3%, which were significantly lower than those among matched controls (p ≤ 0.001), but the prevalence rates of physical inactivity were not significantly different (55.8% vs. 59.9%, p=0.248). In gastric cancer survivors, ≥ 5 years since cancer diagnosis and current drinking contributed to more current smoking; otherwise, age increment and femalewere associatedwith lower current smoking. Thosewith household income ≥ $2,000 and current smokers were more likely to drink and female showed less drinking. Female, currently employed state, and self-rated health status were associated with more physical inactivity. CONCLUSION: Although gastric cancer survivors showed better health behaviors than controls, suggesting that the diagnosis of cancer may motivate individuals towards healthy behaviors, their current prevalence rates of smoking and drinking were still high, and more than 50% of them were physically inactive. Tailored interventions to improve their health behaviors considering associated factors for the gastric cancer survivors are necessary.

Significance of Microalbuminuria in Relation to Subclinical Coronary Atherosclerosis in Asymptomatic Nonhypertensive, Nondiabetic Subjects

We aimed to investigate the significance of microalbuminuria and its relationship with subclinical atherosclerosis in nonhypertensive and nondiabetic patients, by using coronary artery computed tomography (CT). A total of 1,318 nonhypertensive and nondiabetic subjects who had taken coronary artery CT and measured spot urine albumin to creatinine ratio (UACR) were evaluated. The atherosclerotic changes of coronary arteries were greater in subjects with microalbuminuria, reflected by coronary artery calcium score (CACS) and significant coronary artery stenosis (CACS > or = 100 in 15.3% vs 7.6% and stenosis > or = 50% in 11.5% vs 4.9% of patients with vs without microalbuminuria, P = 0.008 and P = 0.011, respectively). Among various parameters that are known as a risk factor or possible biomarkers of coronary artery disease, presence of microalbuminuria, age and Framingham risk score were significantly related to coronary artery stenosis. Among them the presence of microalbuminuria showed stronger correlation than others to the coronary artery stenosis detected by CT, even after adjusting confounding factors (OR 3.397, 95% confidence interval 1.138 to 10.140, P = 0.028). The presence of microalbuminuria by UACR was significantly associated with presence of coronary artery stenosis > or = 50% in asymptomatic, nonhypertensive and nondiabetic general population. Our study suggests that the presence of microalbuminuria may imply subclinical coronary artery disease, even in asymptomatic population.

Evaluation of the Xpert Clostridium difficile Assay for the Diagnosis of Clostridium difficile Infection

Infection with Clostridium difficile is a growing concern because of the increasing prevalence and spread of nosocomial infections. Emergence of the hypervirulent 027/NAP1/BI strain is also notable. Existing diagnostic methods have low sensitivity or are time-consuming. Therefore, establishing a rapid and accurate microbiological diagnostic assay is needed. We evaluated the Xpert C. difficile assay (Xpert CD assay; Cepheid, USA) to detect toxigenic C. difficile. This assay is a real-time multiplex PCR assay that can be used to detect toxigenic C. difficile strains and differentiate the C. difficile presumptive 027/NAP1/BI strain. A total of 253 loose stool specimens were collected and toxigenic cultures, VIDAS C. difficile A & B assays (VIDAS CDAB assay; bioMerieux, France), and the Xpert CD assay were performed. In comparison to toxigenic cultures, the sensitivity, specificity, and positive and negative predictive values were 100%, 94.6%, 83.1%, and 100%, respectively, for the Xpert CD assay and 40.8%, 98.0%, 100%, and 88.9%, respectively, for VIDAS CDAB assay. Because of the low prevalence of the PCR ribotype 027 in Korea, the evaluation of the usefulness of the Xpert CD assay for screening for the 027 strain was limited. The Xpert CD assay provides great sensitivity in diagnosing toxigenic C. difficile infection. In addition, this method has excellent usability because it is simple and fast.

The Effect of Environmental Tobacco Smoke Exposure and Glutathione S-Transferase Polymorphism on Childhood Behavioral Development during Mid-Pregnancy and Early Childhood / 신경정신의학

OBJECTIVES: The author investigated the relationship between the environmental tobacco smoke exposure during mid-pregnancy and early childhood and neurobehavioral outcomes of preschool children and if there is any effect of the genetic polymorphism of glutathione S-transferase (GST) M1 and T1 on this relationship. METHODS: The participants were the pregnant women (week 24-28) who visited the obstetrics and gynecology department (between 2001 and 2004). They had been evaluated for their sociodemographic data including direct and environmental tobacco smoke exposure history and the urine specimen had been sampled for the measurement of cotinine. The offsprings' urine specimen and blood sampling had been done and the socioeconomic data including the environmental tobacco smoke exposure history was evaluated at age 3. The cotinine level of urine specimen was measured and GST polymorphism was analyzed. The offsprings completed Korean-Childhood Behavioral Check List (K-CBCL) at age 4-5. RESULTS: The environmental tobacco smoke exposure during mid-pregnancy based on urine cotinine level has a significant association with increased total score and externalizing problem score of K-CBCL (p<0.05). The environmental tobacco smoke exposure based on urine cotinine level at age 3 is associated increased total score, externalizing problem score and internalizing problem score of K-CBCL with no statistical significance. The environmental tobacco smoke exposure after controlling for tobacco smoke exposure during pregnancy, however, is significantly associated with the increased externalizing problem scores (p=0.04). The environmental tobacco smoke exposure is associated with increased total score, externalizing problem score and internalizing problem score of K-CBCL with GSTM1 null type or GSTT1 null type at age 3 although there was no statistical significance. CONCLUSION: The environmental tobacco smoking exposure during pregnancy and at early childhood is associated with childhood behavioral problems. The clinical implication of this study is that it is important to avoid the environmental tobacco smoke exposure during pregnancy and early childhood and to monitor the possible emergence of behavioral problems of children.

Socioeconomic Inequity in Self-Rated Health Status and Contribution of Health Behavioral Factors in Korea / 예방의학회지

OBJECTIVES: The study is investigated socioeconomic variations in self-rated health status and contribution of health behavioral factors in Korea. METHODS: A nationally representative sample (2,800 men and 3,230 women aged 20-64 years) from the 2005 Korea National Health and Nutrition Surveys was analyzed using logistic regression. RESULTS: Self-rated health was lower among lower socioeconomic groups compared with higher socioeconomic groups, with gender being irrelevant. This association was attenuated when health behavioral and socio-demographic factors were adjusted. When each health behavioral factor was considered separately, mediators such as smoking in men, and stress or exercise in women explained a large part of the decreased socioeconomic health inequalities. CONCLUSIONS: In Korea, subjective health inequalities arise from different socioeconomic status, but this difference is decreased by health behavioral factors. Therefore, socioeconomic inequity in self-rated health status can be corrected more effectively by promotional health behaviors.

Erectile Function and Cavernosal TGF-beta Expression in the OLETF Rats / 대한남성과학회지

PURPOSE: The mechanism of erectile dysfunction in type II non-insulin dependent diabetes mellitus (NIDDM) has not been well demonstrated. The aims of this study were to investigate erectile function and cavernosal TGF-beta expression in Otsuka Long-Evans Tokushima Fatty (OLETF) rats, which develop NIDDM naturally. MATERIALS AND METHODS: Twenty male OLETF rats and ten control LETO rats were included in this study. After 30 weeks, blood glucose levels and body weights were measured. Systemic arterial pressure and intracavernosal pressure were measured before and after pelvic nerve stimulation. Cross sections of the penis were processed for histologic and immunohistochemistry examinations. RESULTS: The mean body weights and mean blood glucose levels were significantly higher in the OLETF group (645.0 40.0 g; 130.8 55.6 mg/ml) compared to control group (538.0 14.4 g; 84.1 14.7 mg/ml), respectively (p<0.05). Nerve stimulation-induced peak intracavernosal pressure (mmHg) was significantly decreased in the OLETF group (41.3 15.4 mmHg) compared to control group (83.3 15.8 mmHg) (p<0.05). In the OLETF rats, the collagen connective tissue in the corpus cavernosum showed a dense and irregular arrangement. The immunoreactivity for TGF-beta 1 was prominent in collagen fibers, fibroblast and smooth muscle in the OLETF rats. CONCLUSIONS: In this study, OLETF rats showed significantly decreased erectile function compared with control rats, and histologic examination revealed cavernosal fibrosis and increased TGF-beta 1 expression. These results imply that the OLETF rat may be a good model to study the mechanism of erectile dysfunction in NIDDM.