Three-dimensional linear and volumetric computed tomography analysis of the frontal sinus / 대한해부학회지

The frontal sinus is one of the four paranasal sinuses in humans, and knowledge of its anatomy is important when performing surgery involving the frontal bone or sinus. Although many studies have measured the frontal sinus using radiography and computed tomography (CT), few studies have evaluated by using three-dimensional (3D) analysis. The purpose of this study was to analyze the frontal sinus using 3D reconstruction analysis and determine the differences in linear and volumetric measurements between sexes, sides, and ages. The sample comprised 281 facial CT scans: 173 and 108 from males and females, respectively. The width, height, and length of each frontal sinus and total volume were all larger in males than in females. Almost all linear and volumetric measurements were larger in young adults than in older for both sexes, but not all of the differences were statistically significant. Linear and volumetric measurements were larger for males than females regardless of age group. There were no statistically significant differences between the right and left sides except the width in males. The size of the frontal sinus was strongly influenced by sex and age. The measurements reported here might be useful for improving surgical procedures involving the frontal sinus.

Association between vasomotor symptoms and sarcopenia assessed by L3 skeletal muscle index among Korean menopausal women

Objective@#To evaluate the association between vasomotor symptoms, skeletal muscle index, and sarcopenia in menopausal women. @*Methods@#This cross-sectional study included 295 Korean menopausal women aged 40–65 years who underwent abdominal computed tomography during routine health checkups between January 2014 and May 2016. The cross-sectional areas of adipose and skeletal muscles were measured at the L3 level using computed tomography. The skeletal muscle index is defined as the sum of the skeletal muscle area (cm2 )/height 2 (m2). Sarcopenia was identified by a skeletal muscle index of ＜ 34.9 cm2 /m2 . Vasomotor symptoms were assessed using the Menopause Rating Scale. @*Results@#The mean age of the participants was 54.93 ± 6.20 years. Vasomotor symptoms were reported in 160 women (54.2%). Sarcopenia was more prevalent in women without vasomotor symptoms (18.5%) than in those with (6.9%). Multivariate logistic regression showed that the prevalence of sarcopenia was inversely associated with the prevalence of vasomotor symptoms (odds ratio, 0.32; 95% confidence interval, 0.15–0.67). Moreover, the paraspinal muscle index was positively associated with the prevalence of vasomotor symptoms (odds ratio, 1.06; 95% confidence interval, 1.01–1.11) after adjusting for age, body mass index, waist circumference, adipose tissue area, history of hormone therapy, systolic and diastolic blood pressures, total cholesterol, insulin resistance, alcohol intake, and exercise. @*Conclusions@#Vasomotor symptoms are less common in women with sarcopenia than in those without, and are positively associated with paraspinal muscle mass in Korean menopausal women. Further longitudinal studies are required to investigate the causal relationships and underlying mechanisms.

Decision support system for the prognostication of sarcopenia in adult women: Machine learning analysis using Korean National Health and Nutrition Examination Survey data

Background@#We used machine learning and population-based data for analyzing the determinants of sarcopenia in adult women and developing its decision support systems for various subgroups. @*Methods@#All data was acquired from the Korea National Health and Nutrition Examination Survey, and women 18 years and older were included in this research. The variables were selected based on female characteristics and the ability to be acquired in a survey format, and were ranked by importance using Random Forest. From this ranking, four main variables were selected, age, menopause age, menarche age and number of pregnancy. A decision supporting system was constructed based on a tree randomly selected from Random Forest. @*Results@#We defined sarcopenia as -2SD below the appendicular skeletal mass (ASM) index reference of 0.5136, and 89.87% (n = 8,610) were found non-sarcopenic and 10.13% (n = 971) were found sarcopenic. The subjects were divided into 6 groups based on menopausal status and BMI. The obese postmenopausal women had the highest number of sarcopenia, whereas the non-obese premenopausal women had the least number of sarcopenic subjects. In non-obese premenopausal women, which was considered to be at the lowest risk for sarcopenia, the most determining variable was the menarche age, followed by age and number of pregnancies. In obese and postmenopausal women, which was considered to be at the highest risk for sarcopenia, the most influential factor was the menopausal age, followed by age and menarche age. @*Conclusions@#We identified the major determinants of sarcopenia using machine learning and population-based data. This study demonstrated the strengths of the random forest as an effective decision support system for each stratified subgroup to find its own optimal cut-off points for the major variables of sarcopenia.

Comparison of single-port laparoscopy and laparotomy in early ovarian cancer surgical staging

Objectives@#The aims of this study were to assess the feasibility of single-port laparoscopic surgical staging (SPLS) in early ovarian cancer and to compare the surgical outcomes of SPLS with those of staging laparotomy. @*Methods@#Between January 2014 and December 2018, 40 patients underwent SPLS and 41 patients underwent staging laparotomy at Yonsei Cancer Center. The patients were diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I ovarian cancer. Variables such as patient age, body mass index (BMI), tumor size, FIGO stage, and perioperative surgical outcomes and survival outcomes of SPLS and laparotomy were compared. @*Results@#The total operation time was similar between the 2 groups (SPLS: 201.4 vs. laparotomy: 203.0 minutes, P=0.806). The median tumor diameters in the SPLS and laparotomy groups were 11.0 (2.5–28 cm) and 15.4 (6–40 cm), respectively (P=0.001). The SPLS group had lower tumor spillage rate (5.0% vs. 19.5%, P=0.047), less intraoperative blood loss (102.0 vs. 371.5 mL, P<0.001), less postoperative pain, and shorter postoperative hospital stay (5 vs. 9.5 days, P<0.001). The intraoperative major complication rate was similar between groups (2.5% vs. 4.9%, P=0.571). There was no significant difference in progression-free survival between the 2 groups (P=0.945). There were no deaths in either group. @*Conclusion@#SPLS is feasible in early ovarian cancer and has better perioperative surgical outcomes, in some aspects, than staging laparotomy without compromising survival outcomes. SPLS could be performed in patients suspected to have early ovarian cancer.

Primary Epithelioid Hemangioendothelioma of the Central Nervous System: A Case Report

Primary epithelioid hemangioendothelioma (EHE) of the central nervous system is an extremely rare sarcoma of vascular origin. Imaging findings have been reported for few cases. Herein, we present a case of intracranial EHE manifesting as spontaneous intracranial hemorrhage. The tumor presented as a well-demarcated hemorrhagic lesion. It had a peripheral location, and showed signs of two-layered target-like mild enhancement in the early phase and gradual fill-in delayed enhancement on MRI.

Glioneuronal Tumor with Neuropil-Like Islands in the Cerebellum: A Case Report

Glioneuronal tumor with neuropil-like islands (GTNI) is a rare and novel mixed neuronal-glial tumor that typically affects the supratentorial cerebral hemispheres of adult patients. It is extremely rare for GTNIs to be in the spine of pediatric and adolescent patients, and there have been no reports of infratentorial GTNIs. We report a case of an elderly patient with an anaplastic, infratentorial GTNI that occurred in the cerebellum, including describing MRI features of our case.

Anti-Inflammatory Effect of Violapyrones B and C from a Marine-derived Streptomyces sp

Recently, we reported violapyrones B, C, H and I, unusual 3, 4, 6-trisubstituted alpha-pyrone derivatives, from the culture broth of the marine Streptomyces sp. 112CH148. In previous studies, violapyrones have been shown to have antibacterial and antitumor activities. However, the anti-inflammatory effect of violapyrones has not been reported yet. As part of our ongoing study for the discovery of bioactive metabolites from marine microorganisms, we found that violapyrones also have anti-inflammatory activity. In this study, we investigated the effect of violapyrones on LPS-induced inflammatory responses in vitro. Violapyrones B and C did not affect the viability of RAW 264.7 cells at concentrations up to 25 microM. However, violapyrones B and C inhibited the production of NO compared to the LPS-induced control. In addition, violapyrones B and C down-regulated the expression of iNOS protein in LPS-stimulated RAW 264.7 cells. To the best of our knowledge, this is the first report on the anti-inflammatory activity of violapyrones B and C.

Impact of ENPP1 K121Q on Change of Insulin Resistance after Web-Based Intervention in Korean Men with Diabetes and Impaired Fasting Glucose

Ectoenzyme nucleotide pyrophosphate phosphodiesterase 1 (ENPP1) gene has been studied in relation to type 2 diabetes mellitus (T2DM) and insulin resistance (IR). We hypothesized that the difference in genotype may be one of the factors that affect the outcome of intervention. We genotyped 448 men with fasting glucose> or =5.6 mM/L, including 371 in subjects with K allele (KK) (69 control group [CG]; and 302 intervention group [IG]) and 77 in subjects with Q allele (KQ+QQ) (13 CG and 64 IG). The web-based intervention based on a lifestyle modification was delivered by e-mail once a month for 10 months. In the KK, IG demonstrated significantly decreased levels of fasting serum insulin (FSI) as compared to CG and homeostasis model of assessment of insulin resistance (HOMA-IR). In the KQ+QQ IG group, hemoglobin A1c (HbA1c), FSI and HOMA-IR were significantly decreased, and showed further reduction in the HOMA-IR than KQ+QQ CG. After analysis of covariance, K121Q did significantly influence the change of HbA1c in CG after appropriate adjustment. In a multivariate model, BMI change predicted HOMA-IR change (adjusted beta=0.801; P=0.022) in KK IG subjects with T2DM. ENPP1 K121Q did not influence the change in IR. However, individuals with T2DM carrying the K121 variant are very responsive to the effect of BMI reduction on HOMA-IR.

Arrangements of the intravenous parallel infusions with anti-reflux valves decreasing occlusion alarm delay / 대한마취과학회지

BACKGROUND: The methods of arrangement of combined intravenous parallel infusions using anti-reflux valve (ARV), with and without anti-syphon valve (ASV) that could decrease occlusion alarm delay were investigated. METHODS: Occlusion challenge tests were mainly performed as bench experiments of four kinds of multiple parallel infusions (10 ml/h and 50 ml/h infusions), which were connected at the proximal or distal portion of ARV, with or without ASV. Alarm threshold was set to 1000 mmHg. Occlusion alarm delays and the compliances of the infusion systems were compared among groups. RESULTS: Without ASV, compared to 10 ml/h infusion alone distal to anti-reflux valve, 50 ml/h infusion distal to anti-reflux valve reduced the mean alarm delay from 416 +/- 7 s to 81 +/- 3 s (P < 0.001). Compared to 50 ml/h infusion alone, combined 10 ml/h and 50 ml/h infusion distal to ARV prolonged the alarm delay from 81 +/- 3 s to 133 +/- 6 s (P < 0.001). However, combined infusions distal to ARV with ASV significantly reduced the alarm delay from 133 +/- 6 s to 74 +/- 5 s (P < 0.001), and also reduced the compliance of the infusion system from 2.31 +/- 0.12 to 1.20 +/- 0.08 microl/mmHg (P < 0.001). CONCLUSIONS: The infusion setup of faster infusion rate, lower compliant system using ASV could effectively decrease occlusion alarm delay during multiple intravenous parallel infusions using ARV.

A Case of Neuromyelitis Optica Misdiagnosed as Cervicogenic Headache

Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system associated with longitudinally extensive myelitis and optic neuritis. It is characterized by relapses that lead to blindness and paralysis sequelaes. But, this is rare disease; therefore high clinical suspicion for a correct diagnosis and proper examinations are not easy. However, early diagnosis is essential to prevent sequelae. We report the case of NMO with headache. A 30-year male patient who suffered headache visited our pain clinic because of aggravated pain despite treatment. The cause of the pain was revealed as NMO by more detailed previous history and examination.

Comparison of health outcomes according to intervention compliance in male Korean workers with metabolic syndrome

This study examined how achievement of session goals contributes to outcomes of subjects after participation in a 12-week lifestyle intervention program in men with metabolic syndrome (MetS). Thirty office workers with MetS, aged 47.2 +/- 6.6 years, participated in this study, from March to July, 2011. The intervention program included face-to-face counseling five times during the 12-week period. Counselors and subjects designed session goals for each round. The average of the goal achievement rate was calculated based on compliance for each round. The subjects were divided into three groups according to their tertiles of achievement rate: Low-compliance group (LC, 70%). Anthropometry, biochemical index, and nutrient intake were examined at baseline and at the end of the 12-week intervention program. After the intervention, diastolic blood pressure (DBP) showed a significant decrease in the LC group, and waist circumference (WC) showed a significant decrease in the MC group. Systolic blood pressure (SBP), DBP, and low-density lipoprotein cholesterol (LDL) showed a significant decrease in the HI group. Changes in SBP and DBP were significantly lower in the HC group than in the MC group (p < 0.05, p < 0.01). Changes in LDL were significantly lower in the HC group than in the MC group (p < 0.05). Results for intake of total energy, protein, fat, and sodium, as well as rates of carbohydrate and fat intake, showed a significant decrease in all participants (p < 0.05). The change in fiber was significantly higher in the HC group than in the MC group (p < 0.05). The change of fruit serving size showed a significant increase in the HC group (p < 0.01). The number of risk factors for MetS showed a significant decrease in the LC and HC groups (p < 0.05), however, no significant mean differences were observed among the three groups. In conclusion, participation in this intervention program resulted in positive effects on risk factors for MetS, nutrient intake, and dietary habits, especially in the High-compliance group.

Inadvertent Dural Puncture during Caudal Approach by the Introducer Needle for Epidural Adhesiolysis Caused by Anatomical Variation

There have been reports of abnormalities in the lumbosacral region involving a lower-than-normal termination of the dural sac, which is caused by disease or anatomical variation. Inadvertent dural puncture or other unexpected complications can occur during caudal epidural block or adhesiolysis in patients with these variations, but only a small number of case reports have described this issue. We report a case of dural puncture by the introducer needle before attempting caudal epidural adhesiolysis, which occurred even though the needle was not advanced upward after penetrating the sacrococcygeal ligament. Dural puncture was caused by a morphological abnormality in the lumbosacral region, with no pathological condition; the dural sac terminal was located more distally than normal. However, dural puncture could have been prevented if we had checked for such an abnormality in the magnetic resonance imaging (MRI) taken before the procedure.

Circadian regulation of low density lipoprotein receptor promoter activity by CLOCK/BMAL1, Hes1 and Hes6

Low density lipoprotein receptor (LDLR) plays an important role in the cholesterol homeostasis. We examined the possible circadian regulation of LDLR and mechanism(s) underlying it. In mice, blood glucose and plasma triglyceride, total and high density lipoprotein cholesterol varied distinctively throughout a day. In addition, LDLR mRNA oscillated in the liver in a functional clock-dependent manner. Accordingly, analysis of human LDLR promoter sequence revealed three putative E-boxes, raising the possible regulation of LDLR expression by E-box-binding transcription factors. To test this possibility, human LDLR promoter reporter constructs were transfected into HepG2 cells and the effects of CLOCK/BMAL1, Hes1, and Hes6 expression were analyzed. It was found that positive circadian transcription factor complex CLOCK/BMAL1 upregulated human LDLR promoter activity in a serum-independent manner, while Hes family members Hes1 and Hes6 downregulated it only under serum-depleted conditions. Both effects were mapped to proximal promoter region of human LDLR, where mutation or deletion of well-known sterol regulatory element (SRE) abolished only the repressive effect of Hes1. Interestingly, hes6 and hes1 mRNA oscillated in an anti-phasic manner in the wild-type but not in the per1-/-per2-/- mouse. Comparative analysis of mouse, rat and human hes6 genes revealed that three E-boxes are conserved among three species. Transfection and site-directed mutagenesis studies with hes6 reporter constructs confirmed that the third E-box in the exon IV is functionally induced by CLOCK/BMAL1. Taken together, these results suggest that LDLR expression is under circadian control involving CLOCK/BMAL1 and Hes family members Hes1 and Hes6.

Iron Deficiency Anemia due to Long-time Bloodletting Using Cupping / 가정의학회지

We report three cases of iron deficiency anemia due to long-time bloodletting using cupping. Case 1 was a 52-year-old man who sought evaluation at the Health Promotion Center in our hospital due to fatigue and dyspnea on exertion (DOE). There were no abnormal findings on his general health examination, except anemia. He has performed self-bloodletting for a long time with cupping on his back and extremities for fatigue, myalgias, or polyarthralgias. Case 2 was a 52-year-old woman with fatigue and DOE. The physical examination revealed a systolic murmur at her left lower anterior chest and pale conjunctiva. The initial hematocrit was 22.4% and the hemoglobin was 6.4 g/dL. She has self-bloodletted using cupping 2 to 3 times a week when she felt tired or had myalgias. Case 3 was a 35-year-old man with sudden onset fatigue and DOE. He had severe DOE during a challenging physical test. He frequently received bloodletting using cuppings on his back and extremities by a doctor of Oriental medicine. There were no abnormal findings on the general health examination, except anemia. All three patients were diagnosed with iron deficiency anemia due to chronic blood loss. We recommended stopping bloodletting using cupping and prescribed oral iron supplements.

Screening Wild Yeast Strains for Alcohol Fermentation from Various Fruits

Wild yeasts on the surface of various fruits including grapes were surveyed to obtain yeast strains suitable for fermenting a novel wine with higher alcohol content and supplemented with rice starch. We considered selected characteristics, such as tolerance to alcohol and osmotic pressure, capability of utilizing maltose, and starch hydrolysis. Among 637 putative yeast isolates, 115 strains exhibiting better growth in yeast-peptone-dextrose broth containing 30% dextrose, 7% alcohol, or 2% maltose were selected, as well as five alpha-amylase producers. Nucleotide sequence analysis of the 26S rDNA gene classified the strains into 13 species belonging to five genera; Pichia anomala was the most prevalent (41.7%), followed by Wickerhamomyces anomalus (19.2%), P. guilliermondii (15%), Candida spp. (5.8%), Kodamaea ohmeri (2.5%), and Metschnikowia spp. (2.5%). All of the alpha-amylase producers were Aureobasidium pullulans. Only one isolate (NK28) was identified as Saccharomyces cerevisiae. NK28 had all of the desired properties for the purpose of this study, except alpha-amylase production, and fermented alcohol better than commercial wine yeasts.