Developmental Trajectories of Attention in Normal Korean Population

OBJECTIVES: This study aimed to investigate the trajectory of change of diverse attention and working memory in Koreans from 4 to 40 years of age. METHODS: The data of 912 subjects from 4 to 15 years of age obtained from a previous standardization study of the computerized comprehensive attention test were merged with the newly obtained data of 150 subjects aged 16 to 40 years from this study. We evaluated the various kinds of attention, in which each subtest had five indicators. Working memory, with parameters such as number of correct responses and span, was also measured. RESULTS: Our findings indicated that attention developed as age increased, and it decreased or was maintained after a certain age. Selective and sustained attention developed rapidly in children and adolescents, until mid-teens or 20 s when it ceased development. Divided attention, however, developed up to approximately age 20. In addition, working memory developed until mid-teens or 20 s. CONCLUSION: We presented the standardized data on diverse kinds of attention and working memory in children, adolescents, and adults in Korea. We could recognize any patterns of change in attention and working memory with increasing age.

Development of the Computerized Mathematics Test in Korean Children and Adolescents

OBJECTIVES: This study was conducted in order to develop a computerized test to measure the level of mathematic achievement and related cognitive functions in children and adolescents in South Korea. METHODS: The computerized Comprehensive Learning Test-Mathematic (CLT-M) consists of the whole number computation test, enumeration of dot group test, number line estimation test, numeral comparing test (magnitude/distance), rapid automatized naming test, digit span test, and working memory test. To obtain the necessary data and to investigate the reliability and validity of this test, 399 children and adolescents from kindergarten to middle school were recruited. RESULTS: The internal consistency reliability of the CLT-M was high (Cronbach's alpha=0.76). Four factors explained 66.4% of the cumulative variances. In addition, the data for all of the CLT-M subtests were obtained. CONCLUSION: The computerized CLT-M can be used as a reliable and valid tool to evaluate the level of mathematical achievement and associated cognitive functions in Korean children and adolescents. This test can also be helpful to detect mathematical learning disabilities, including specific learning disorder with impairment in mathematics, in Korea.

Standardization of the Comprehensive Learning Test-Reading for the Diagnosis of Dyslexia in Korean Children and Adolescents

OBJECTIVES: The aim of this study was to develop the computerized Comprehensive Learning Test-Reading (CLT-R) to evaluate the cognitive processes and achievements related to their basic reading ability and identify dyslexia in children and adolescents in South Korea. We also obtained the normative data and evaluated the reliability and validity of the test. METHODS: We developed the CLT-R, including the word attack/nonword decoding, paragraph reading, sound blending, nonword repetition, rapid automatized naming, letter-sound matching, visual attention, orthography awareness, and digit span tests, for the purpose of diagnosing dyslexia. We investigated the reliability and validity of the tests and gathered the normative data from 399 subjects (male 48.9%), aged 5-14 years, from the last grade in kindergarten to middle school, dwelling in Seoul and Gyeonggi Province, South Korea. RESULTS: No statistical differences were observed between the means of the tests and retests of the CAT. The mean of the correlation coefficient of the test-retest scores was 0.85. According to the construct validity test calculated by principal constant analysis using the oblique rotation method, 4 factors explained 70.0% of the cumulative variances. In addition, the normative data were obtained for all of the CLT-R subtests. CONCLUSION: The computerized CLT-R can be used as a reliable and valid tool to evaluate the reading achievement and reading related cognitive process in Korean children and adolescents in schools, clinics, and research institutes.

Foreign body aspiration in 48 children: clinical manifestations and outcomes

PURPOSE: This study aimed to have a deeper insight into the clinical spectrum of foreign body aspiration in children and to prospect the further clinical implications of early diagnosis. METHODS: We conducted a retrospective medical chart review of 48 children with foreign bodies at The Catholic University of Korea, Seoul St. Mary's Hospital, between January 2009 and December 2013 in terms of age, sex, symptoms and signs, radiologic findings, and clinical courses. Patients were divided into 2 groups according to the time from aspiration to a definite diagnosis. The 2 groups were compared for clinical courses, radiologic findings, and the length of hospitalization. RESULTS: Approximately 85% of patients were 3 years of age or younger. About one-fifth of patients had no history of foreign body aspiration. Cough and coarse breathing sounds were the most common symptoms and signs. The most frequent radiologic finding was pulmonary air trapping (33.3%). The mostly commonly aspirated foreign body was peanut and detected in left main bronchus. Cough, sputum, and absence of aspiration history were more common in the delayed diagnosed group than in the early diagnosed group. CONCLUSION: Our results suggest that the number of accidents associated with foreign body aspiration can be reduced by keeping infants with nut formula under close observation and by conducting assertive bronchoscopic examination on children with delayed recovery from respiratory infections. After removal of foreign bodies, close monitoring and expectation of possible complications can prevent patients from a long hospital stay.

Immunoglobulin E to allergen components of house dust mite in Korean children with allergic disease

BACKGROUND: House dust mites (HDMs) are important sources of indoor allergens. Seventeen components have been identified from Dermatophagoides pteronyssinus (Der p). OBJECTIVE: Our aim was to define the prevalence of specific IgE to components of Der p in Korea and investigate the clinical features of them in children with allergic disease. METHODS: We performed a prospective evaluation of 80 HDM sensitized patients with history of allergic rhinitis (AR), atopic dermatitis (AD), asthma and urticaria (UC). Patients underwent ImmunoCAP for total IgE, Der p, Der f, Der p 1, Der p 2, and Der p 10. RESULTS: Seventy-nine patients had detectable serum IgE to Der p, 80 patients were sensitized to Der f, 66 patients were sensitized to Der p 1, 63 patients to Der p 2, and 7 patients were sensitized to Der p 10. Der p 1 specific IgE was significantly lower in the UC group compared with the AD and AR group. Total IgE was significantly higher in the Der p 10 sensitized group. Der p 10 serum IgE level was highly correlated with crab and shrimp specific IgE. There was a significant positive correlation between total IgE and specific IgE to Der p and its components and Der f. CONCLUSION: Sensitization to HDM and its components in Korea is similar to previous studies from temperate climate. The determination of Der p 1, Der p 2, and Der p 10 specific IgE helps in obtaining additional information in regards to allergic disease.

Effectiveness of premedication and rapid desensitization in hypersensitivity to L-asparaginase

PURPOSE: L-asparaginase is a crucial chemotherapeutic agent for the treatment of acute lymphoblastic leukemia. However, hypersensitivity to L-asparaginase is common which limits its clinical use. METHODS: We performed 44 cases of premedication and 3 cases of desensitization in 16 patients with hypersensitivity to L-asparaginase. RESULTS: With premedication, 33 cases completed L-asparaginase injection with no hypersensitivity reactions. Eleven cases showed mild hypersensitivity reactions, such as urticaria. Desensitization was performed in 3 cases: in 2 cases, desensitization was successful, and in 1 case the medication was switched to Erwinia asparaginase. CONCLUSION: Premedication and desensitization appear to be useful in helping patients receive desired doses of L-asparaginase in pediatric patients with acute lymphoblastic leukemia.

A randomized, double-blind study to evaluate the efficacy of ramosetron and palonosetron for prevention of postoperative nausea and vomiting after gynecological laparoscopic surgery / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication after anesthesia and surgery; 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists have been considered as a first-line therapy. Ramosetron and palonosetron are more recently developed drugs and have greater receptor affinity and a longer elimination half-life compared with older 5-HT3 receptor antagonists. The purpose of this study was to determine which drug is more effective for preventing PONV between ramosetron and palonosetron. METHODS: We enrolled 100 patients undergoing gynecological laparoscopic surgery into this study. The subjects were divided into ramosetron group and palonosetron group. The medications were provided immediately before the induction of anesthesia. The occurrence of nausea and vomiting, severity of nausea according to a visual analogue scale, and rescue anti-emetic drug use were monitored immediately after the end of surgery and at 0-6 h, 6-24 h, and 24-48 h post-surgery. RESULTS: The incidence of vomiting was significantly lower in the palonosetron group than in the ramosetron group during 0-6 h (6% vs 26%, P = 0.012) and 0-48 h (14% vs 34%, P = 0.034). The incidence of nausea and overall PONV, and the use of rescue antiemetic were not significantly different during all time intervals. The severity of nausea was not different between the two groups. CONCLUSIONS: In conclusion, the incidence of PONV between the ramosetron and the palonosetron group have not shown the difference during 0-48 h, although palonosetron results in a lower incidence of vomiting during 0-6 h post-surgery.

A Case of Pulmonary Fibrosis with Microscopic Polyangiitis / 결핵및호흡기질환

A 65-year-old woman was admitted due to poor oral intake and a dry cough over the previous 3 months. The physical examination was remarkable for bibasilar crackles, and plain chest radiography showed reticulation in both lower lung fields. A pulmonary function test demonstrated a restrictive pattern with a reduced diffusing capacity of the lung for carbon monoxide. High resolution computed tomography showed reticulation and honey-combing in both peripheral lung zones, which was consistent with usual interstitial pneumonia pattern. Her skin showed livedo reticularis. The erythrocyte sedimentation rate and C-reactive protein level were elevated, and hematuria was noted on urinary analysis. A serologic test for auto-antibodies showed seropositivity for Myeloperoxidase-Anti-neutrophil cytoplasmic antibody (MPO-ANCA). A kidney biopsy was performed and showed focal segmental glomerulosclerosis. She was diagnosed as having pulmonary fibrosis with microscopic polyangiitis (MPA) and treated with high dose steroids. Here we report a case of pulmonary fibrosis coexistent with microscopic polyangiitis.

Proteasome-Inhibitor-Based Primary Therapy for Antibody-Mediated Rejection in a Renal Transplant Recipient / 대한내과학회지

Donor-specific anti-human leukocyte antigen antibodies (DSA) following kidney transplantation predict the evolution of humoral rejection and reduced graft survival. Rapid, complete elimination of DSA during antibody-mediated rejection (AMR) is rarely achieved with traditional antihumoral therapies. We report the case of a 39-year-old female who was admitted for increasing azotemia and diagnosed with AMR based on diffusely positive histological changes on C4d immunostaining. In this case, bortezomib reversed the histological changes and induced a reduction in DSA. Proteasome-inhibitor-based combination therapy is a potential means for rapid DSA elimination in antibody-mediated rejection in renal transplant recipients.

Proteasome-Inhibitor-Based Primary Therapy for Antibody-Mediated Rejection in a Renal Transplant Recipient / 대한내과학회지

Donor-specific anti-human leukocyte antigen antibodies (DSA) following kidney transplantation predict the evolution of humoral rejection and reduced graft survival. Rapid, complete elimination of DSA during antibody-mediated rejection (AMR) is rarely achieved with traditional antihumoral therapies. We report the case of a 39-year-old female who was admitted for increasing azotemia and diagnosed with AMR based on diffusely positive histological changes on C4d immunostaining. In this case, bortezomib reversed the histological changes and induced a reduction in DSA. Proteasome-inhibitor-based combination therapy is a potential means for rapid DSA elimination in antibody-mediated rejection in renal transplant recipients.

Successful general anesthesia for cervical spine fusion in a patient with spondyloepiphyseal dysplasia congenita: A case report

Spondyloepiphyseal dysplasia congenita (SEDC) is a kind of skeletal dysplasia, inheritable condition. The clinical features of SEDC are dwarfism, myopia with or without retinal detachment, coxa vara, thoracic dysplasia with respiratory failure and laryngotracheal stenosis. A point of particular concern to anesthetists is odontoid hypoplasia which, combined with ligamentous laxity, leads to atlantoaxial instability. We report successful general anesthesia for cervical spine fusion of a patient with SEDC.

Comparison of Liquid-based (SurePath(TM)) and Conventional Preparations in Thyroid Fine Needle Aspiration

BACKGROUND: The aim of this study was to evaluate differences in cytologic findings between conventional preparation (CP) and SurePath(TM) liquid-based preparation (LBP) in thyroid fine needle aspiration (FNA). METHODS: We analyzed cytological features on a total of 182 thyroid FNAs (83 CP and 99 LBP) that were histologically confirmed as nodular hyperplasia (NH) or papillary carcinoma (PAC). RESULTS: LBP was superior in cellular preservation and cellularity than CP. Interestingly, in LBP, cellularity of NH was similarly high compared to that of PAC. The three-dimensional pattern was more prominent in LBP than in CP. The presence of follicle structures was more frequently found in LBP than in CP in the PAC group. Dispersed single cells in the background were more prominent in LBP than in CP. In the PAC group, contrast of the nuclear membrane was more distinctive in CP than in LBP. CONCLUSIONS: In thyroid FNA, LBP is better for cellular preservation, cellularity, background and nuclear detail than CP. However, some features in LBP such as high cellularity in NH, prominent dispersed single cells, and frequent follicle patterns were unfamiliar findings in CP. Hence, we should be aware of these cytomorphologic features in LBP to make a proper diagnosis.

Characterization of a Novel Monoclonal Antibody (27H2) Recognizing Human CD34 Class III Epitope

BACKGROUND: Monoclonal antibodies (mAbs) recognizing Class III epitope of CD34 are essential for flow cytometric diagnosis of leukemia. METHODS: 27H2 mAb was developed from a mouse alternatively immunized with human acute leukemia cell lines, KG1 and Molm-1. Using flow cytometric analysis of various leukemic cell lines and peripheral blood, immunohistochemical study of frozen tonsil, we characterized 27H2 mAb. Antigen immunoprecipitated with 27H2 mAb immunobloted with anti-CD34 mAb. A case of bone marrow sample of acute lymphoblastic leukemia (ALL) patient was obtained at CBNU Hospital. For epitope identification enzyme treatment with neuraminidase and O-sialoglycoprotein endopeptidase (OSGE) and blocking assay with known classIII mAb (HPCA-2) were done. RESULTS: Only KG1 and Molm-1 revealed positive immunoreactivity. Immunohistochemical staining disclosed strong membranous immunoreactivity on high endothelial venules. Antigen immunoprecipitated by 27H2 mAb showed approximately 100 kDa sized band immunoblotted with anti-CD34 under non-reducing conditions. Epitope recognized by 27H2 mAb disclosed resistancy to both neuraminidase and OSGE treatment and completely blocked with known class III mAb preincubation. CD34 positive leukemic cells in BM of pre B cell ALL patient detected by FITC-conjugated 27H2 and HPCA-2 were identified with similar sensitivity. CONCLUSION: A novel murine mAb recognizing class III epitope of human CD34 with high affinity, which is useful for flow cytometric diagnosis of leukemia, was developed.

The Relationship between Prognostic Factors and the Expression Pattern of Fascin and E-cadherin in Renal Cell Carcinoma

BACKGROUND: Fascin is associated with motility in various transformed cells. Overexpression of fascin is known to aid in the progression of some cancers and is associated with a poor prognosis. E-cadherin is a major protein of epithelial cells and its expression is involved in the regulation of cell proliferation and differentiation. The aim of this study was to determine the expression pattern for fascin and E-cadherin and how it is related to the prognostic factors for renal cell carcinoma (RCC). METHODS: The expression of fascin and E-cadherin was evaluated in 208 RCCs including 175 clear cell, 20 papillary, and 9 chromophobe types using tissue array analysis. RESULTS: The expression of fascin increased as the tumor stage (p=0.00) and Fuhrman grade (p=0.00) increased. A high positive rate of expression for fascin was observed in cases with sarcomatoid changes (p=0.27). E-cadherin expression was seen in the distal tubules and collecting ducts of normal kidneys with a membranous pattern. The positive rate of expression for E-cadherin increased as the Fuhrman grade increased (1, 0%; 2, 23.2%; 3, 34.9%; and 4, 53.8%, p=0.00). An inverse correlation in RCCs was observed in the expression of fascin and E-cadherin (p=0.026, r=-0.158). CONCLUSIONS: In patients with RCC, the increased expression of fascin and E-cadherin was positively correlated to poor prognostic factors such as a higher Fuhrman nuclear grade and advanced pTNM stage.

Correlation Analysis Between Cervicovaginal Cytologic and Histopathologic Diagnoses in Cervical Squamous Cell Neoplasm

BACKGROUND: The aim of this study was to confirm the usefulness of cervicovaginal smears in the screening of squamous cell neoplasms of the uterine cervix by comparative analysis between the cytologic diagnosis of cervicovaginal smears and the histologic diagnosis of tissue specimens. METHODS: We selected 743 patients who had both cervicovaginal smears and histologic evaluations of the uterine cervix by colposcopic biopsy, conization, or hysterectomy at the Kangbuk Samsung Medical Center between January 2005 and December 2007. RESULTS: The accuracy rate of cervicovaginal smears and histologic diagnoses was 93.0% (691/743) and showed a high correspondence (kappa value, 0.770, p-value, 0.000). The false-negative and false-positive rates were 0.5% (6/484) and 17.8% (46/259), respectively. The sampling and interpretation errors were identified in four and two cases of six false-negative cases and 29 and 17 cases of 46 false-positive cases, respectively. In screening high grade squamous cell neoplasms, there were no false-negative cases and only one false-positive case which resulted from sampling error. The false-negative rate of cervicovaginal smears and the false-positive rate in high-grade squamous cell neoplsams were very low. CONCLUSIONS: The cervicovaginal smear is a powerful tool for screening of cervical squamous cell neoplasms.

Standardization of the Comprehensive Attention Test for the Korean Children and Adolescents

OBJECTIVES: This study was conducted in order to develop and obtain the normative data of the computerized Comprehensive Attention Test (CAT) in Korean children and adolescents. It also aimed to evaluate the reliability and validity of the CAT. METHODS: We developed the computerized CAT which includes the selective attention task, the sustained attention to response task, the flanker task, the divided attention task, and the spatial working memory task. We investigated the testretest reliability and the construction validity of this computerized version by using the data from 21 children, and gathered the normative data of 912 subjects, aged 4 to 15 years, dwelling in the Metropolitan Seoul area in 2008. RESULTS: No statistical differences between means of the tests and retests of the CAT were observed. The mean of the correlation coefficient of the test-retest scores was 0.715. The results from the factor analyses explained 51.7% of the cumulative variance. In addition, the normative data for all of the CAT subtests were obtained. CONCLUSION: The computerized CAT can be used as a reliable and valid tool in both clinical and research settings for Korean children and adolescents with or without neuropsychiatric conditions such as attention deficit.

Distal hereditary motor neuropathy in Korean patients with a small heat shock protein 27 mutation

Distal hereditary motor neuropathy (dHMN) is a heterogeneous disorder characterized by degeneration of motor nerves in the absence of sensory abnormalities. Recently, mutations in the small heat shock protein 27 (HSP27) gene were found to cause dHMN type II or Charcot-Marie-Tooth disease type 2F (CMT2F). The authors studied 151 Korean axonal CMT or dHMN families, and found a large Korean dHMN type II family with the Ser135Phe mutation in HSP27. This mutation was inherited in an autosomal dominant manner, and was well associated with familial members with the dHMN phenotype. This mutation site is located in the ?-crystallin domain and is highly conserved between different species. The frequency of this HSP27 mutation in Koreans was 0.6%. Magnetic resonance imaging analysis revealed that fatty infiltrations tended to progressively extend distal to proximal muscles in lower extremities. In addition, fatty infiltrations in thigh muscles progressed to affect posterior and anterior compartments but to lesser extents in medial compartment, which differs from CMT1A patients presenting with severe involvements of posterior and medial compartments but less involvement of anterior compartment. The authors describe the clinical and neuroimaging findings of the first Korean dHMN patients with the HSP27 Ser135Phe mutation. To our knowledge, this is the first report of the neuroimaging findings of dHMN type II.

Cytologic Features of Folliculars Adenoma and Follicular Carcinoma of the Thyroid: A Study on the Likelihood of Cytologic Diagnosis by Fine Needle Aspiration Cytology / 대한세포병리학회지

Fine-needle aspiration cytology (FNAC) cannot differentiate follicular adenoma from follicular carcinoma since this distinction can only be based on the presence of capsular or vascular invasion, and this cannot be detected on a cytologic smear. The goal of this study was to define the diagnostic cytologic findings of follicular neoplasm and the possibility of diagnosing follicular neoplasm by performing FNAC. The cases of histologically diagnosed follicular adenoma and follicular carcinoma on the thyroidectomy specimens were retrieved. Among them, the cases with preoperative FNAC that was done within 3 months of the operation were finally selected. Then we reviewed the FNAC and histologic slides of 19 cases: 9 follicular adenomas and 10 follicular carcinomas. Our results suggest that for cases of follicular neoplasm, the aspirates show high or abundant cellularity, frequent follicle formation and occasional cellular atypism of the follicular cells. However, the atypism is more pronounced and more frequently noticed in the cases of follicular carcinoma, which reveals more higher anisocytosis (7/10, 70%), nuclear pleomorphism (9/10, 90%), coarse clumping of chromatin (8/10, 80%) and cellular overlapping (8/10, 80%).

The Expression of p16 in Diffuse Large B-cell Lymphoma and Its Prognostic Implications

BACKGROUND: The molecular mechanisms that are responsible for the initiation and progression of diffuse large B-cell lymphoma are largely unknown. p16 is an inhibitor of cyclin-dependent kinase and its inactivation by methylation has been reported as a major tumorigenic mechanism in malignant tumors. The aim of this study was to analyze the correlation between the clinical data and the p16 protein expression in diffuse large B-cell lymphomas. METHODS: Tumor samples were obtained from 62 patients who were suffering with diffuse large B-cell lymphoma. To investigate the role of p16 in the pathogenesis and progression of diffuse large B-cell lymphoma, 62 cases of diffuse large B-cell lymphoma were examined for their expression of p16 via performing immunohistochemistry. The correlation of the p16 expression with the various clinicopathologic findings was also analyzed. RESULTS: p16 was expressed in all the cases of reactive lymphoid hyperplasia (100%) and in 40 cases (64.5%) out of the 62 cases of diffuse large B-cell lymphoma that we studied. The expression rate of p16 was 31.8% in the high risk group and 82.5% in the low risk group of diffuse large B-cell lymphoma. The expression rate of p16 in the fatal cases was 12.5%. For our results, the loss of a p16 expression in diffuse large B-cell lymphoma was noted, and especially in the high risk group (P=0.04). CONCLUSION: The loss of p16 appeared to be involved in the genesis or progression of diffuse large B-cell lymphoma. In addition, the loss of the p16 expression may play important roles for patients' progression into the high risk group and it may cause more mortality for those patients with diffuse large B-cell lymphoma. Deranged expressions and loss of the p16 expression may play an important role in the pathogenesis of diffuse large B-cell lymphoma.

The Usefulness of SurePath(TM) Liquid-Based Smear in Sono-Guided Thyroid Fine Needle Aspiration; a Comparison of a Conventional Smear and SurePath(TM) Liquid-Based Cytology / 대한세포병리학회지

Sono-guided fine needle aspiration (FNA) of the thyroid is widely used, but the aspirated samples are typically not well preserved and low cellularity makes diagnosis difficult in many cases. The object of the current study is to evaluate the adequacy and diagnostic accuracy of the use of SurePath(TM) liquid-based cytology (SP-LBC) in the sonoguided fine needle aspiration of the thyroid nodule and to compare its use with that of the use of a conventional smear (CS). A total of 172 sono-guided FNAs of thyroid nodules from April to June, 2006 were prepared by the use of the split method with either SP-LBC or CS; the samples were stained with the use of hematoxylin-eosin (H&E) and Papanicolaou (Pap) stains. A cyto-histological correlation was performed in 69 (30 SP and 39 CS) cases that had been histologically confirmed. The rate of producing unsatisfactory slides by the use of the SP-LBC method (9.3%) was less than that of the use of the CS method (20.9%). The diagnostic accuracy of the SP method (93.3%) was better than that of the CS method (85.3%). The sensitivity and specificity of the SP method (94.4% and 92.3%) was better than that of the CS method (83.3% and 70%), respectively (p<0.05). The CS of sono-guided aspirated specimens had some unavoidable limitations related to inadequate sampling such as a bloody background, low cellularity and an indication that some clinicians smeared many useless slides (averaging four to ten slides), and that most slides showed only blood that included few follicular cells. The SP method resulted in more thinly smeared slides and showed cleaner background and greater cellularity than the use of the CS method. Each follicular cell shows superior nuclear detail, and more distinct cytoplasmic features than with the use of the CS method. SP-LBC appears to be an easy, highly accurate, and reliable cytological method for employ for a diagnostic approach of thyroid disease and thyroid nodules. The SP-LBC method is a suitable alternative to the CS method to overcome diagnostic difficulties.