Bone mineral density among Korean females aged 20-50 years: influence of age at menarche (The Korea National Health and Nutrition Examination Survey 2008-2011).

To evaluate a possible correlation between bone mineral density (BMD) and age at menarche, the present study used the BMD dataset of the Korea National Health and Nutrition Examination Survey IV-V (KNHANES IV-V). Age at menarche had a small but significant association with BMD of the lumbar spine in premenopausal Korean females, aged 20-50 years. INTRODUCTION: To investigate any correlation between bone mineral density (BMD) and age at menarche in Korean females using data from the fourth and fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-V; 2008-2011). METHODS: In total, 37,753 individuals participated in health examination surveys between 2008 and 2011. A total of 5032 premenopausal females aged 20-50 years were eligible. Age, height, weight, and age at menarche were assessed. RESULTS: Results from the univariate linear regression and analysis of covariance (ANCOVA) indicated that age (per 1 year), height (per 1 cm), weight (per 1 kg), exercise (per 1 day/week), familial osteoporosis history (yes), parity (n = 0 to ≥4), and menarche age distribution were associated with BMD of the total femur, femur neck, and lumbar spine. After stratifying the bone area and adjusting for age, parity, alcohol intake, smoking, exercise, and familial osteoporosis history, no effect was seen for the total femur or femur neck. Age at menarche 16~17 and ≥18 years groups were associated with BMD of the lumbar spine only. CONCLUSIONS: Age at menarche had a small but significant association with BMD of the lumbar spine in premenopausal Korean females, aged 20-50 years. Females with late menarche may achieve lower peak bone mass at some skeletal sites, which may put them at greater risk for osteoporosis in later life.

Ectopic pregnancy occurring in the remnant tube of a previous adnexectomy: a case report.

Ectopic pregnancy occurring in the same region is a comparatively rare disease, but sometimes it is very serious to patients if it is delayed. The authors present a case of spontaneous ectopic pregnancy occurring in the ipsilateral salpingectomy stump of a previous adnexectomy that was successfully removed via laparoscopic surgery without complication. This case may support the idea of intrauterine transmigration of a fertilized egg as an etiology of spontaneous ectopic pregnancy. Thus, the potential for ectopic pregnancy in the tubal remnant in cases of previous salpingectomy or adnexectomy needs to be carefully considered.

Effects of ß-Glucan on the Release of Nitric Oxide by Macrophages Stimulated with Lipopolysaccharide.

This research analyzed the effect of ß-glucan that is expected to alleviate the production of the inflammatory mediator in macrophagocytes, which are processed by the lipopolysaccharide (LPS) of Escherichia. The incubated layer was used for a nitric oxide (NO) analysis. The DNA-binding activation of the small unit of nuclear factor-κB was measured using the enzyme-linked immunosorbent assay-based kit. In the RAW264.7 cells that were vitalized by Escherichia coli (E. coli) LPS, the ß-glucan inhibited both the combatant and rendering phases of the inducible NO synthase (iNOS)-derived NO. ß-Glucan increased the expression of the heme oxygenase-1 (HO-1) in the cells that were stimulated by E. coli LPS, and the HO-1 activation was inhibited by the tin protoporphyrin IX (SnPP). This shows that the NO production induced by LPS is related to the inhibition effect of ß-glucan. The phosphorylation of c-Jun N-terminal kinases (JNK) and the p38 induced by the LPS were not influenced by the ß-glucan, and the inhibitory κB-α (IκB-α) decomposition was not influenced either. Instead, ß-glucan remarkably inhibited the phosphorylation of the signal transducer and activator of transcription-1 (STAT1) that was induced by the E. coli LPS. Overall, the ß-glucan inhibited the production of NO in macrophagocytes that was vitalized by the E .coli LPS through the HO-1 induction and the STAT1 pathways inhibition in this research. As the host immune response control by ß-glucan weakens the progress of the inflammatory disease, ß-glucan can be used as an effective immunomodulator.

Decreased Bcl-6 and increased Blimp-1 in the peritoneal cavity of patients with endometriosis.

PURPOSE OF INVESTIGATION: The authors investigated the expression patterns of interleukin (IL)-lß and tumor necrosis factor (TNF)-α, cytokines associated with peritoneal inflammatory reactions, and of B cell leukemia lymphoma (Bcl)-6 and B lymphocyte inducer of maturation program (Blimp)-1, transcriptional factors associated with immunoglobulin (Ig) production; the concentrations of Igs, and their correlation, in patients with and without endometriosis. MATERIALS AND METHODS: The authors analyzed the peritoneal fluid of 98 patients, 46 with endometriosis, and 52 with benign tumors. RESULTS: IL-1 and TNF-α mRNAs and IgG and IgA concentrations were higher in the endometriosis group, but the differences were not statistically significant. However, Bcl-6 mRNA level was significantly lower and Blimp-1 mRNA level was significantly higher in the endometriosis group with significant correlations among transcriptional factors, Igs, and cytokines (p < 0.05). CONCLUSION: Peritoneal immune responses in patients with endometriosis may be due to increased IgG and IgA concentrations, as well as to changes in expression of proinflammatory cytokines and transcriptional factors.

Paraneoplastic arthritis mimicking rheumatoid arthritis in cervical cancer.

Paraneoplastic arthritis, a subcategory ofparaneoplastic syndrome, presents in a similar manner to rheumatic disorder and usually precedes the detection of the primary tumor by years. Herein, the authors report a case of a patient who was diagnosed with parane- oplastic rheumatoid arthritis (RA)-like arthritis with synchronous cervical cancer. A 38-year-old nulligravida woman was admitted to the gynecology department with a three-month history of irregular vaginal spotting accompanied by severe multiple joint pain. She had a one-year history of RA, for which she had been receiving treatment. During the early stage of treatment, her symptoms were slightly improved by RA treatment; however, after eight months of treatment, she showed absolute resistance to RA treatments and complained of a profuse vaginal discharge with severe foul odor. After colposcopy-directed punch biopsy, she was diagnosed with Stage IIA2 squamous cell carcinoma of the cervix. She underwent radical hysterectomy with lymphadenectomy without complications. After treatment, the multiple joint pain associated with paraneoplastic arthritis spontaneously disappeared. There was no evidence of malignancy according to the follow-up cervical cytology report, magnetic resonance imaging, and positron emission tomography-computed tomography.

Attitudes and practices of Korean gynecologists towards hormone replacement therapy in endometrial cancer survivors.

PURPOSE: To investigate the attitudes of Korean gynecologists towards prescribing hormone replacement therapy (HRT) after treatment for endometrial cancer. MATERIALS AND METHODS: A questionnaire, addressing attitudes towards HRT and treatment strategies for patients previously treated for endometrial cancer, was distributed to 163 Korean gynecologists. RESULTS: Of the 163 gynecologists that were sent this questionnaire, 98 (60.1%) responded. Among the respondents, 81 (82.7%) had previously prescribed HRT to patients with endometrial cancer. Of the latter, 75 (92.6%) had prescribed HRT to patients with Stage I, and more than half to patients with Stage II, endometrial cancer. Of the respondents who had prescribed HRT, 33 (40.7%) did so without regard for cancer-cell type and 33 (40.7%) began patients on HRT more than two years after endometrial cancer treatment. Tibolone was the most commonly prescribed drug (61.9%). The most common reason not to prescribe HRT was fear of cancer recurrence (38.1%). CONCLUSION: Most of the Korean gynecologists surveyed had experience prescribing HRT to endometrial cancer patients. Although HRT is not actively recommended, HRT given post-therapy to endometrial cancer patients is considered acceptable.

ß-Amyloid burden in healthy aging: regional distribution and cognitive consequences.

OBJECTIVE: Several lines of evidence suggest that pathologic changes underlying Alzheimer disease (AD) begin years prior to the clinical expression of the disease, underscoring the need for studies of cognitively healthy adults to capture these early changes. The overall goal of the current study was to map the cortical distribution of ß-amyloid (Aß) in a healthy adult lifespan sample (aged 30-89), and to assess the relationship between elevated amyloid and cognitive performance across multiple domains. METHODS: A total of 137 well-screened and cognitively normal adults underwent Aß PET imaging with radiotracer (18)F-florbetapir. Aß load was estimated from 8 cortical regions. Participants were genotyped for APOE and tested for processing speed, working memory, fluid reasoning, episodic memory, and verbal ability. RESULTS: Aß deposition is distributed differentially across the cortex and progresses at varying rates with age across cortical brain regions. A subset of cognitively normal adults aged 60 and over show markedly elevated deposition, and also had a higher rate of APOE ε4 (38%) than nonelevated adults (19%). Aß burden was linked to poorer cognitive performance on measures of processing speed, working memory, and reasoning. CONCLUSIONS: Even in a highly selected lifespan sample of adults, Aß deposition is apparent in some adults and is influenced by APOE status. Greater amyloid burden was related to deleterious effects on cognition, suggesting that subtle cognitive changes accrue as amyloid progresses.

Aggressive angiomyxoma of the vulva treated by using a gonadotropin-releasing hormone agonist: a case report.

A rare case of a 38-year-old woman with progesterone receptor-positive aggressive angiomyxoma is presented. She underwent local excision and was treated with a gonadotropin-releasing hormone agonist as adjuvant therapy, and is free of disease 20 months after.

The relationship between overweight and otitis media with effusion in children.

OBJECTIVE: To assess the relationship between pediatric otitis media with effusion (OME) and body mass index (BMI). METHODS: We assessed 140 children aged 2-7 years who underwent unilateral or bilateral ventilation tube insertion for treatment of OME (experimental group) and 190 children with no history of OME who underwent operations for conditions other than ear diseases during the same period. Each group was divided into four subgroups based on BMI by age and gender: underweight (BMI below normal limits; BMI ≤ 5 th percentile), normal (BMI within normal limits; 5th < BMI < 85th percentile), overweight (BMI over normal limits; 85 th ≤ BMI < 95th percentile) and obese ( BMI ≥ 95 th percentile). We explored differences in BMI, and serum triglycerides (TG) and total cholesterol (TC), between the experimental and control group, in comparison with values from those of standard body weight. RESULTS: The prevalence of obesity was significantly higher in the experimental than in the control group (P<0.05). BMI, TG and TC did not, however, differ significantly between groups, according to standard body weight. CONCLUSION: Pediatric obesity may have an effect on the development of OME, but pediatric overweight may be not associated with occurrence of OME.

A multilocus sequence analysis of the genus Xanthomonas.

A multilocus sequence analysis (MLSA) of strains representing all validly published Xanthomonas spp. (119 strains) was conducted using four genes; dnaK, fyuA, gyrB and rpoD, a total of 440 sequences. Xanthomonas spp. were divided into two groups similar to those indicated in earlier 16S rDNA comparative analyses, and they possibly represent distinct genera. The analysis clearly differentiated most species that have been established by DNA-DNA reassociation. A similarity matrix of the data indicated clear numerical differences that could form the basis for species differentiation in the future, as an alternative to DNA-DNA reassociation. Some species, X. cynarae, X. gardneri and X. hortorum, formed a single heterogeneous group that is in need of further investigation. X. gardneri appeared to be a synonym of X. cynarae. Recently proposed new species, X. alfalfae, X. citri, X. euvesicatoria, X. fuscans and X. perforans, were not clearly differentiated as species from X. axonopodis, and X. euvesicatoria and X. perforans are very probably synonyms. MLSA offers a powerful tool for further investigation of the classification of Xanthomonas. Based on the dataset produced, the method also offers a relatively simple way of identifying strains as members of known species, or of indicating their status as members of new species.

Antimicrobial resistance of Staphylococcus from otorrhea in chronic suppurative otitis media and comparison with results of all isolated Staphylococci.

Staphylococcus is one of the most important pathogenic bacteria in chronic suppurative otitis media (CSOM). The prevalence of pathogenic bacteria in patients with CSOM has not been compared with the prevalence rates in patients from other fields of medicine. We investigated the pathogenic bacteria in CSOM throughout Korea and annual isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) over 6 years. Routine culture results and susceptibility data of CSOM isolated from 2000 to 2005 were collected from six general hospitals in Korea, along with the results of all clinically isolated Staphylococci from one tertiary care teaching hospital. Of the 1,162 bacteria identified in 1,360 CSOM patients, 628 (54.0%) were Staphylococci in CSOM. Of the latter, 288 (45.9%) were MRSA, which accounted for 24.8% of identified bacteria. Of the 5,988 clinically isolated Staphylococci from one tertiary care hospital, 3,712 (61.9%) were MRSA. All MRSA isolated from CSOM patients were sensitive to vancomycin and teicoplanin, and 88.2% were sensitive to sulfamethoxazole/trimethoprim. In contrast, these strains showed little or no sensitivity to oxacillin, clindamycin, penicillin, and erythromycin. Annual MRSA isolation rates showed no tendencies to increase or decrease. MRSA was the most frequently identified Staphylococcus in patients with otorrhea. The isolation rate of MRSA has not changed over 6 years. Continuous and periodic surveillance of MRSA is necessary to reduce the spread of antibiotic-resistant pathogens and to guide appropriate antibacterial therapy.

Probable synonymy of the nitrogen-fixing genus Azotobacter and the genus Pseudomonas.

The relationships of the genus Azotobacter, Azomonas macrocytogenes and the genus Pseudomonas were revealed by comparative analysis of partial 16S rRNA and atpD, carA and recA gene sequences and as concatenated nucleotide and peptide sequences. Sequence similarities of Azotobacter species and Azomonas macrocytogenes indicated that these may be considered to be synonyms at the molecular level. In addition, these species show an intimate relationship with species of Pseudomonas, especially P. aeruginosa (the type species of the genus). In terms of the current circumscription of the genus Pseudomonas, Azotobacter and Azomonas macrocytogenes should be considered for amalgamation with Pseudomonas. Azotobacter and Azomonas comprise nitrogen-fixing strains with large pleomorphic cells that form cysts, and peritrichous flagella insertion; characteristics not included in the current circumscription of Pseudomonas. The data are discussed in the light of whether lateral transfer of genes could be involved in the determination of significant morphological characteristics, thus leading to a problem that may be encountered more frequently: how to resolve classification of taxa based on conserved sequences with those based on their phenotype. More fundamentally, the results illuminate problems that will increasingly be encountered: by what criteria can taxa be delineated, what are the most appropriate methods for classification, and what are the proper assumptions of bacterial classification?

Relationships of plant pathogenic enterobacteria based on partial atpD, carA, and recA as individual and concatenated nucleotide and peptide sequences.

Relationships of the genera in the Enterobacteriaceae containing plant pathogenic species: Brenneria, Dickeya, Enterobacter, Erwinia, Pantoea, Pectobacterium, and Samsonia, were investigated by comparison of their nucleotide and peptide sequences of atpD, carA, recA, and the concatenated sequences. Erwinia spp. and Pantoea spp., with Pectobacterium cypripedii, formed a group distinct from other pathogenic taxa. Pectobacterium, Brenneria, Dickeya, and Samsonia formed a contiguous clade. Samsonia was usually concurrent with Pectobacterium. Most Brenneria were also close to Pectobacterium, suggesting that these three taxa might be better represented as a single genus. Brenneria quercina was not closely associated with other members of this genus and may represent a separate genus. The sequences representing Dickeya were distinct, further supporting the generic status of the taxon. Plant pathogenic Enterobacter spp. display such sequence variability that few definite conclusions as to their specific placement could be made. These data highlight the difficulty of drawing reliable and robust taxonomic conclusions based on comparative analysis of sequence data without some independent criterion to calibrate a scale for diversity.

Molecular and morphological characterization of Pyricularia and allied genera.

The phylogenetic relationships of Pyricularia species and species from related genera were established from sequences of the internal transcribed spacer ribosomal RNA gene. Phylogenetic analysis disclosed a consistent correlation with spore morphology. Most Pyricularia species studied, and two species of Dactylaria that have obpyriform conidia, fell within the Magnaporthaceae cluster with high bootstrap support. Pyricularia variabilis was more related to Dactylaria, Tumularia or Ochroconis species than to the Magnaporthaceae. Dactylaria and species of Nakataea, Ochroconis, Pyriculariopsis and Tumularia were distinct from the Magnaporthaceae, and the genus Dactylaria is polyphyletic. The combination of morphological and molecular characters, such as spore morphology and ITS ribosomal DNA sequences data, suggested that conidial shape could be a primary character to distinguish Pyricularia from related genera.

Cognitive function in fibromyalgia patients.

OBJECTIVE: To evaluate fibromyalgia (FM) patients for the presence of cognitive deficits and to test the hypothesis that abnormalities would fit a model of cognitive aging. METHODS: We studied 3 groups of patients: FM patients without concomitant depression and in the absence of medications known to affect cognitive function (n = 23), age- and education-matched controls (n = 23), and education-matched older controls who were individually matched to be 20 years older (+/- 3 years) than the FM patients (n = 22). We measured speed of information processing, working memory function, free recall, recognition memory, verbal fluency, and vocabulary. We correlated performance on cognitive tasks with FM symptoms, including depression, anxiety, pain, and fatigue. We also determined if memory complaints were correlated with cognitive performance. RESULTS: As expected, older controls performed more poorly than younger controls on speed of processing, working memory, free recall, and verbal fluency. FM patients performed more poorly than age-matched controls on all measures, with the exception of processing speed. FM patients performed much like older controls, except that they showed better speed of processing and poorer vocabulary. Impaired cognitive performance in FM patients correlated with pain complaints, but not with depressive or anxiety symptoms. FM patients reported more memory problems than did the older and younger controls, and these complaints correlated with poor cognitive performance. CONCLUSION: Cognitive impairment in FM patients, particularly memory and vocabulary deficits, are documented in the study. Nevertheless, the intact performance on measures of information processing speed suggests that the cognitive deficits are not global. FM patients' complaints about their memory are likely to be legitimate, since their memory function is not age appropriate.

Cognitive dysfunction in fibromyalgia.

Fibromyalgia is a puzzling syndrome of widespread musculoskeletal pain. In addition to pain, patients with fibromyalgia frequently report that cognitive function, memory, and mental alertness have declined. A small body of literature suggests that there is cognitive dysfunction in fibromyalgia. This article addresses several questions that physicians may have regarding cognitive function in their patients. These questions concern the types of cognitive tasks that are problematic for patients with fibromyalgia, the role of psychological factors such as depression and anxiety, the role of physical factors such as pain and fatigue, the nature of patients' perceptions of their cognitive abilities, and whether patients can be tested for cognitive dysfunction. Critical areas for further investigation are highlighted.

Weighted centroid neural network for edge preserving image compression.

An edge preserving image compression algorithm based on an unsupervised competitive neural network is proposed. The proposed neural network, the called weighted centroid neural network (WCNN), utilizes the characteristics of image blocks from edge areas. The mean/residual vector quantization (M/RVQ) scheme is utilized in this proposed approach as the framework of the proposed algorithm. The edge strength of image block data is utilized as a tool to allocate the proper code vectors in the proposed WCNN. The WCNN successfully allocates more code vectors to the image block data from edge area while it allocates less code vectors to the image black data from shade or non-edge area when compared to conventional neural networks based on VQ algorithm. As a result, a simple application of WCNN to an image compression problem gives improved edge characteristics in reconstructed images over conventional neural network based on VQ algorithms such as self-organizing map (SOM) and adaptive SOM.

Relationships within the Proteobacteria of plant pathogenic Acidovorax species and subspecies, Burkholderia species, and Herbaspirillum rubrisubalbicans by sequence analysis of 16S rDNA, numerical analysis and determinative tests.

Sequence data for 16S rDNA of the type strains of Acidovorax avenae subsp. avenae, A. avenae subsp. cattleyae, A. avenae subsp. citrulli, A. konjaci and Herbaspirillum rubrisubalbicans were compared with GenBank library accessions of Burkholderia spp., Comamonas sp., Ralstonia solanacearum and Variovorax sp. Maximum Parsimony analysis produced two clusters: 1. Acidovorax spp., Comamonas sp., and Variovorax sp. (all in the Comamonadaceae), and 2. Burkholderia spp., Ralstonia solanacearum, and Herbaspirillum rubrisubalbicans. Maximum Likelihood analysis produced only one cluster (of the Comamonadaceae). Using nutritional and laboratory tests, all Acidovorax spp., Burkholderia spp., and Herbaspirillum rubrisubalbicans were discriminated in distinct clusters at the species level, and could be identified by selected determinative tests. There were no phenotypic tests constituted as a circumscription of the genera and which permitted the allocation of strains to genera. Strain identification as species allowed allocation to genera only by inference. The nomenclatural implications of these data are discussed.