Association of Plasma Creatine With Inflammation and Cognitive Function in Persons With and Without Alzheimer’s Disease

Objective@#Creatine, energy buffer in high energy demanding systems including muscle and brain, may play a beneficial role against neuroinflammation in Alzheimer’s disease (AD), and thus be a potential biomarker. This study aimed to compare the levels of plasma creatine between persons with and without AD and investigate associations of plasma creatine levels with cognitive function and blood-based inflammatory markers. @*Methods@#We classified elderly participants by cognitive statuses: normal cognition (NC, n=17), mild cognitive impairment (MCI,n=21), and AD (n=21). To assess cognitive function and inflammatory condition, we performed neuropsychological tests and mea-sured plasma C-reactive protein (CRP) levels, respectively. @*Results@#Plasma creatine levels were comparable among participants with AD, MCI, and NC. In overall participants, plasma cre-atine levels were not associated with neuropsychological test scores, but negatively associated with plasma CRP levels. In AD group, plasma creatine levels were negatively associated with neuropsychological test scores and, although not significant, CRP levels (p=0.086). In participants without AD (NC plus MCI), these associations disappeared. @*Conclusion@#Plasma creatine levels may not be useful as a biomarker indicating cognitive statuses. However, our results suggest that, in AD, plasma levels of creatine might reflect the extent of neuroinflammation as well as cognitive deterioration.

Population Pharmacokinetics of Cyclosporine after Hematopoietic Stem Cell Transplantation in Pediatric Patients

BACKGROUND: Cyclosporine is an immunosuppressive agent used to treat and prevent graft versus host reaction (GVHR)-a complication associated with stem cell transplantation. This study aimed to develop a population pharmacokinetic model of cyclosporine and investigate factors affecting cyclosporine clearance in pediatric hematopoietic stem cell transplant patients. METHODS: A total of 650 cyclosporine concentrations recorded in 65 patients who underwent hematopoietic stem cell transplantation were used. Data including age, sex, weight, height, body surface area (BSA), type of disease, chemotherapy before stem cell transplantation, type of donor, serum creatinine levels, total bilirubin concentration, hematocrit value, and type of concomitant antifungal agents and methylprednisolone used were retrospectively collected. Data related to cyclosporine dosage, administration time, and blood concentration were also collected. All data were analyzed using the non-linear mixed effect model; a two-compartment model with first-order elimination was used. RESULTS: The population pharmacokinetic model of cyclosporine using the NONMEM program was as follows: CL (L/h) = 5.9 × (BSA / 1.2)0.9, V2 (L) = 54.5, Q (L/h) = 3.5, V3 (L) = 1080.0, ka (h-1) = 0.000377. BSA was selected as a covariate of cyclosporine clearance, which increased with an increase in BSA. CONCLUSION: A population pharmacokinetic model for Korean pediatric hematopoietic stem cell transplant patients was developed, and the important factor affecting cyclosporine clearance was found to be BSA. The model might contribute to the development of the most appropriate dosing regimen for cyclosporine. Further studies on population pharmacokinetics should be carried out, prospectively targeting pediatric patients.

A Report of the Body Composition and Life Styles in Incheon area : Data Source from the Public Service Event of the Incheon Dietetic Association

Among the diverse factors causing obesity, the life styles and the food habits are very important. This study has carried out to evaluate the association between the habit of living and the Body Composition in 132 male and 313 female of 20-75 years old people in Incheon. The research tools are questionnaires of 6 items of life styles(Smoking, Drinking, Frequency of exercises, Normal Activity Degree, Favorite food, Degree of salt ingestion) and a height and Body Composition. The statistical results are as follows : 38% of male and 23% of female were over the normal range(Korean Society of Obesity 2004). Although the tendency of average BMI are increasing, there was no significant difference in comparison of the average BMI according to the age in male. But, the percentage of Body Fat, the Visceral Fat Area and the WHR, there was statistical significance according to age in male. The middle aged group(between 40~50 years) and older group(over 60 years) were over the normal range. In female, there were significant difference in comparison of the average BMI, the percentage of Body Fat, the WHR, the Visceral Fat Area and the Fitness Score. Especially, in the old female group, the BMI and the WHR score were over the normal range. The BMI: There was positive correlation with the Percent Body Fat(r=0.796, r=0.839, p=0.000), the Body Fat Mass(r= 0.891, r=0.932, p=0.000) and the WHR(r=0.783, r=0.902, p=0.000). Frequency of Exercises, Normal activity Degree, Favorite food, Degree of salt ingestion : There was significant difference in comparison of sex(P<0.05). The results of this study hope to provide an opportunity to further examine the relationship of the Healthy Behavior to Body Composition and obesity.

MR Imaging Findings of Synovial Sarcoma: Emphasis on Signal

PURPOSE: To determine the MR imaging findings of synovial sarcoma, with emphasis on the signal characteristicsof pathologically correlated T2-weighted images. MATERIALS AND METHODS: MR images of 14 cases ofpathologically-proven synovial sarcomas were retrospectively reviewed and correlated with the histopathologicfindings. We analyzed the signal intensity of T1- and T2-weighted images and the incidence of triple signalintensity, and evaluated the frequency of fluid-fluid levels, internal fibrous septa, calcification, the invasionof bone or neurovascular bundles and the involvement of joint capsules, as well as the size, location and marginof the tumors and pattern of contrast enhancement. RESULTS: Necrosis, cystic change or hemorrhage was suggested in11 cases, ten of which showed triple signal intensity, and in all cases, was pathologically confirmed. Fluid-fluidlevels were found in three cases and internal septa in ten. In four cases, maximum diameter was less than 5cm, andin nine, was greater than this. No mass was detected in one case. The tumor was located in the low extremity(n=9),pelvic girdle and hip joint area(n=2), scapular(n=1), shoulder joint area(n=1), and scalp(n=1). Eleven casesshowed a relatively well-defined margin and nine showed lobulation. Except in the area of necrosis and cysticchange, the pattern of contrast enhancement was diffuse and inhomogenous. Bony invasion was detected in two cases,neurovascular encasement in four, calcification in four, and joint capsule invasion in four. CONCLUSION: OnT2-weighted images, synovial sarcoma frequently showed triple signal intensity and internal septa with fluid-fluidlevels ; this was induced by cystic changes due to necrosis and hemorrhage.

Pyogenic Spondylitis: MR Imaging Findings

PURPOSE: To prevent permanent neurologic deficit and/or spinal deformity in pyogenic spondylitis earlydiagnosis and prompt treatment are essential. The purpose of this study is to determine the MR imaging findings ofpyogenic spondylitis. MATERIALS AND METHODS: In 31 patients with pathologically or clinically proven pyogenicspondylitis, MR images(31, T1-weighted ; 30, T2-weighted ; 31, Gd-enhanced T1-weighted) were retrospectivelyanalyzed. Analysis focused on the signal intensity and enhancement pattern of involved vertebral bodies andintervertebral discs, as well as paravertebral soft tissue abnormality. RESULTS: A total of 77 vertebral bodies(mean, 2.5 per patient) were involved. Signal intensity was low in 58 of 77 T1-weighted images, high in 63 of 75T2-weighted images and in 72 of 77 contrast-enhanced T1-weighted images, enhancement was diffuse. A total of 47intervertebral discs were involved. Signal intensity was low or intermediate in all 47 T1-weighted images, andhigh or intermediate in 38/46 T2-weighted images ; in 24 of 38 contrast-enhanced T1-weighted images, signalintensity was peripheral, and in 14, enhancement was diffuse. Twenty-six patients showed diffusely enhancedparavertebral soft tissue abnormality and in 14, the largest diameter was less than 1cm. CONCLUSION: With regardto vertebral bodies, MR imaging findings of pyogenic spondylitis are low signal intensity on T1-weighted images,and high or intermediate signal intensity on T2-weighted images, together with diffuse enhancement. Forintervertebral discs, signal intensity was low on T1-weighted images, high on T2-weighted images, and peripheralor diffuse enhancement was seen. Diffusely enhanced small paravertebral soft tissue abnormality was also present.

Gastritis Cystica Profunda: A case report

Gastritis cystica profunda is an uncommon benign mass that usually occurs on the gastric side of the site of a gastroenterostomy, but has also been known to develop in which has not been operated on. We report the case of stomach a 51-years-old man with pathologically proven gastritis cystica profunda. This patient had not undergone gastric surgery and CT showed a well-defined, 3 cm sized, cystic mass at the gastric antrum.

Orbital Blowout Fracture: MR Findings

PURPOSE: To access the usefulness of magnetic resonance(MR) in the evaluation of orbital blowout fracture. MATERIALS AND METHODS: Fourteen patients with orbital blow out fractures diagnosed by plain radiography(n = 8) or computed tomography(CT)(n = 6) were examined with MR. Twenty blowout fractures including six patients with two lesions were presented and the fracture site of the orbit was the medial wall in 11 cases and the orbital floor innine cases. MR images in nine cases of six patients could be compared with CT scans. On MR images, were trospectively evaluated the presence of fracture, herniation of orbital fat, abnormality of extraocular muscle, intraorbital hematoma and intrasinus hemorrhage. In nine cases we also compared these findings with CT scans. RESULTS: Eighteen orbital blowout fractures with fat herniation could be diagnosed on MR images. In only nine of these 18 cases, the fracture itself could be seen on MR images as a disruption of the orbital wall, which produce a signal void. But two blow out fractures without orbital fat herniation, seen on CT, were not detected on MRimages. Twenty abnormalities of extraocular muscle in 18 cases were depicted on MR images. There were nosignificant differences between MR and CT in the evaluation of orbital fat herniation and extraocular muscle abnormality ; however, in one case oblique sagittal MR images provided more useful information about the status ofthe inferior rectus muscle. Intraorbital hematoma was detected by MR in three patients. We were able to establish the presence of intraorbital hematoma by using the different signal intensities from fat or muscle on T1- and/or T2-weighted images. MR was found to be superior to CT in one case of intraorbital hematoma because of the iso-density of hematoma compared to muscle. MR also detected intrasinus hemorrhage which on T1-weighted images revealed high signal intensity in ten cases. MR was more valuable in demonstrating intrasinus hemorrhage in onecase where a CT scan showed only hypodense fluid. CONCLUSION: MR is a useful diagnostic modality in the evaluation of orbital blowout fracture with orbital fat herniation. Compared with CT, it also provides more valuable information about associated extraocular muscle abnormality, subacute hemorrhage in the orbit and paranasal sinus.

Interobserver Variation in Interpretation of Mammograms: Focused on Findings Suggestive of Malignancy

PURPOSE: To evaluate the inter observer variation in interpretation of the mammographic findings suggesting malignancy. MATERIALS AND METHODS: Sixty-two mammograms of proven breast cancer were retrospectively analyzed by5 radiologists based on the 15 findings that suggest malignancy. Using kappa value, the degree of interobserver agreement was calculated. RESULTS: There were fair to excellent interobserver agreements for 5 findings which were clustered microcalcifications(k=0.7642), ductal calcifications (k=0.5463), lobulated mass(k=0.4539), asymmetric breast parenchyma (k=0.4487) and nipple retraction(k=0.4061). The finding in which kappa value was lessthan 0.2 were intramammary lymph node(k=0.1572), duct ectasia(k=0.1453), phleomorphic calcifications(k=0.1309), architectural distortion(k=0.1247) and stellate mass(k=0.0200). CONCLUSION: The most reliable finding suggesting breast cancer was clustered microcalcifications.

Cervical Tuberculous Lymphadenitis: MR Features

PURPOSE: To characterize the magnetic resonance (MR) imaging features of cervical tuberculous lymphadenitis. MATERIALS AND METHODS: The cervical MR images of 14 patients with pathologically or clinically proven cervical tuberculous lymphadenitis were retrospectively analyzed. T1- and T2-weighted or proton density images and contrast enhanced MR images were obtained in all patients. RESULTS: Most patient had multiple (n=12), unilateral lesions (n=l0), 8 mm to 45 mm in size, round (n=46) or ovoid (n=46) in shape and all with smooth and well-defined margins mostly at internal jugular chain(N2: 41, N3: 2, N4: 21 ). The signal intensities of the most lymph nodes were isointense or slightly hyperintense on T1 -weighted images, and hyperintense (all) with variable homogeneity on T2-weighted and/or proton density images. After contrast enhancement most showed characteristic thin peripheral rim enhancement (n=71). CONCLUSION: The characteristic MR features of cervical tuberculous lymphadenitis would be multiple, unilateral enlarged lymph nodes which show iso or slightly increased signal intensity on T1 -weighted image, high signal intensity on T2-weighted and/or proton density image and peripheral rim enhancement.

MR Portography

PURPOSE: We performed this study to evaluate the usefulness and the limitation of magnetic resonance angiography in imaging portal vein and hepatic vein. MATERIALS AND METHODS: Magnetic resonance portography was performed in five normal subjects and seven patients with hepatomas, two patients with Budd-Chiari syndromes, one patient with liver cirrhosis and one patient with hepatic metastasis from stomach cancer. Magnetic resonance angiography was done with a 1.5-T Scanner. Breath-hold two-dimensional time-of flight images with spoiled gradient echo technique were acquired. Scan parameters were 34/8/40degrees(TR ms/TE ms/flip angle). The portal vein and the hepatic vein were selectively imaged by applying two presaturation bands. These images were then postprocessed by a maximum intensity projection algorithm. MRA findings were compared with ultrasonography in all cases of the hepatic disease, and conventional angiography (SMA portography) in four cases. RESULTS: In normal subjects, the splenic vein, intrahepatic and extrahepatic portions of the portal vein, and the hepatic veins were well visualized. In the patients with hepatic diseases, the varices (4 cases), the splenorenal shunts (2 cases), and the recanalized umbilical vein (1 case) were demonstrated. There were portal vein thrombosis in the cases of hepatomas and hepatic metastasis. In the cases of Budd-Chiari syndrome, the hepatic veins were not visualized and there were inferior vena cava obstructions with multiple collateral vessels. CONCLUSION: Compared with ultrasonography, MRP may be useful in evaluation of varices, splenorenal shunts, and other collaterals, though less accurate than conventional angiography. MRP can be useful as a noninvasive screening alternative in the evaluation of portal vein and hepatic veins.