No abstract available.
Cytomegalovirus Infections*

OBJECTIVE: To devise a new method to measure the amount of soft tissue in pulmonary ground-glass opacity nodules, and to compare the use of this method with a previous volumetric measurement method by use of a phantom study. MATERIALS AND METHODS: Phantom nodules were prepared with material from fixed normal swine lung. Forty nodules, each with a diameter of 10 mm, were made with a variable mean attenuation. The reference-standard amount of soft tissue in the nodules was obtained by dividing the weight by the specific gravity. The imaging data on the phantom nodules were acquired with the use of a 16-channel multidetector CT scanner. The CT-measured amount of soft tissue of the nodules was calculated as follows: soft tissue amount = volume x (1 + mean attenuation value / 1,000). The relative percentage error (RPE) between the CT-measured amount of the soft tissue and the reference-standard amount of the soft tissue was also measured. The RPEs determined with use of the new method were compared with the RPEs determined with the current volumetric measurement method by the use of the paired t test. RESULTS: The CT-measured amount of soft tissue showed a strong correlation with the reference-standard amount of soft tissue (R(2) = 0.996, p < 0.01). The mean RPE of the CT-measured amount of soft tissue in the nodules was -7.79 +/- 1.88%. The mean RPE of the CT-measured volume was 114.78 +/- 51.02%, which was significantly greater than the RPE of the CT-measured amount of soft tissue (p < 0.01). CONCLUSION: The amount of soft tissue measured by the use of CT reflects the reference-standard amount of soft tissue in the ground-glass opacity nodules much more accurately than does the use of the CT-measured volume.
Animals ; Lung Neoplasms/*radiography ; Phantoms, Imaging ; Reference Standards ; Swine ; *Tomography, X-Ray Computed

Mesenteric pseudocyst has a fibrous cystic wall without an endothelial lining. It can develop from an inflammatory reaction or from trauma. This lesion is difficult to diagnose preoperatively, and it is rarely symptomatic except when it is complicated by bleeding, rupture or infection. A 66-year old male presented with generalized abdominal pain for 3 days. In his past medical history, an appendectomy was done forty years ago. Three months after the operation, a mass was palpated in the left lower quadrant and size of the mass had gradually increased. Physical examination revealed a distended abdomen with diffuse tenderness. The non-tender mass, which was about 10 cm in size, was palpated in the left lower abdomen. A simple abdominal x-ray showed a mechanical obstruction of the small bowel. A CT scan showed a 10x9 cm sized cystic mass with a partially enhancing cystic wall. Surgical exploration revealed the 13 cm sized mass in the distal ileum about 40 cm proximal from the ileocecal valve, and the adjacent ileum was obstructed by this mass. The mass was a thick walled cyst that contained a non-clotting bloody material. Histopathological examination indicated that the cyst wall was composed of fibrosis with neutrophil infiltration, but there was no specific endothelial lining. The final pathological diagnosis was a mesenteric pseudocyst. Mesenteric pseudocyst with obstruction is rare and difficult to diagnosis, but it should be included in the differential diagnosis in the case of intestinal obstruction with mass.
Abdomen ; Abdominal Pain ; Aged ; Appendectomy ; Diagnosis ; Diagnosis, Differential ; Fibrosis ; Hemorrhage ; Humans ; Ileocecal Valve ; Ileum ; Intestinal Obstruction* ; Male ; Neutrophil Infiltration ; Physical Examination ; Rupture ; Tomography, X-Ray Computed

PURPOSE: This study evaluated the benefits of adjuvant chemotherapy on elderly patients with advanced gastric cancer (AGC) using meta-analysis of well-designed randomized controlled clinical studies. MATERIALS AND METHODS: PubMed, Embase, and Cochrane were searched to retrieve clinical studies evaluating the benefits of adjuvant chemotherapy in the elderly with AGC. Hazards ratios (HRs) with 95% confidence intervals (CIs) were pooled across studies using a fixed-effects model. RESULTS: Two studies were included in this meta-analysis to estimate HR for the overall survival (OS), and relapse-free survival (RFS) between adjuvant chemotherapy and surgery in elderly and non-elderly patients. HR for OS in the elderly and non-elderly was 0.745 (95% CI, 0.552 to 1.006, p=0.055) and 0.636 (95% CI, 0.522 to 0.776; p < 0.001), respectively, which showed no heterogeneity regarding HR between the two groups (p(interaction)=0.389). HR for RFS in the elderly and non-elderly was 0.613 (95% CI, 0.466 to 0.806; p < 0.001) and 0.633 (95% CI, 0.533 to 0.753; p < 0.001), respectively (p(interaction)=0.846). CONCLUSION: Meta-analysis suggests that the benefit of adjuvant chemotherapy to the elderly is not big enough to reach statistical significance while the HR for OS is less than 1 (0.745) and no heterogeneity are observed regarding the HR between the elderly and non-elderly patients.
Aged* ; Chemotherapy, Adjuvant* ; Humans ; Population Characteristics ; Stomach Neoplasms*

OBJECTIVES: Asia sand dust (ASD) is known to cause various human diseases including respiratory infection. The aim of this study was to examine the effect of ASD on inflammatory response in human middle ear epithelial cells (HMEECs) in vitro and in vivo. METHODS: Cell viability was assessed using the cell counting kit-8 assay. The mRNA levels of various genes including COX-2, TNF-a, MUC 5AC, MUC 5B, TP53, BAX, BCL-2, NOX4, and SOD1 were analyzed using semiquantitative realtime polymerase chain reaction. COX-2 protein levels were determined by western blot analysis. Sprague Dawley rats were used for in vivo investigations of inflammatory reactions in the middle ear epithelium as a result of ASD injection. RESULTS: We observed dose-dependent decrease in HMEEC viability. ASD exposure significantly increased COX-2, TNF-a, MUC5AC, and MUC5B mRNA expression. Also, ASD affected the mRNA levels of apoptosis- and oxidative stress-related genes. Western blot analysis revealed a dose-dependent increase in COX-2 production. Animal studies also demonstrated an ASD-induced inflammatory response in the middle ear epithelium. CONCLUSION: Environmental ASD exposure can result in the development of otitis media.
Animals ; Asia ; Asian Continental Ancestry Group* ; Blotting, Western ; Cell Count ; Cell Survival ; Cyclooxygenase 2 ; Dust* ; Ear, Middle* ; Epithelial Cells ; Epithelium ; Gene Expression* ; Humans ; In Vitro Techniques ; Mucins* ; Otitis Media ; Polymerase Chain Reaction ; Rats, Sprague-Dawley ; RNA, Messenger

BACKGROUND: Mycobacterium tuberculosis is one of the most clinically significant infectious agents. Especially during mass outbreaks, accurate identification and monitoring are required. The proportion of Beijing family members is very high among infecting strains, and spoligotyping is not suitable for strain typing. Therefore, we studied the homogeneity of isolates using the mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) method and identified its utility for carrying out molecular epidemiologic analysis. METHODS: Eighty-one clinical M. tuberculosis isolates that had previously been analyzed by spoligotyping were used in this study. We used the 12 standard MIRU loci and further four exact tandem repeat (ETR) loci (ETR-A, -B, -C, and -F). Four strains each of randomly selected Beijing and Beijing-like families were subjected to IS6110- restriction fragment length polymorphism analysis. RESULTS: All 81 samples showed amplification products of all VNTR loci, and all of them showed differences in at least one locus. The calculation of the Hunter-Gaston diversity index (HGDI) for MIRU-VNTR gave the value of 0.965. Discriminatory index in the six loci (MIRU-10, -16, -26, -31, -39, and ETR-F) were found to be highly discriminated (HGDI >0.6). Beijing and Beijing-like family isolates were discriminated into different MIRU-VNTR types. CONCLUSIONS: MIRU-VNTR analysis by using well-selected loci can be useful in discriminating the clinical M. tuberculosis isolates in areas where the Beijing family is predominant.
Bacterial Typing Techniques/*methods ; DNA, Bacterial/analysis ; Genotype ; Humans ; *Minisatellite Repeats ; Mycobacterium tuberculosis/*classification/genetics/isolation & purification ; Polymerase Chain Reaction ; Republic of Korea ; Tuberculosis/diagnosis/*microbiology

BACKGROUND: With a rapidly aging population, more elderly patients are being hospitalized than before. Thus, a comprehensive geriatric assessment medium is needed to carefully evaluate geriatric patients. The author's university hospital has a geriatric medicine team to where patients are referred for comprehensive evaluations. Their services will be introduced here. METHODS: From December 2010 to January 2012, the team performed comprehensive geriatric assessments comprising of a thorough review of systems, physical examination, and surveys, and reviewed past medical records of the elderly hospitalized patients aged 65 or over, referred from the Department of Orthopedics. RESULTS: Of total 58 patients, 4 patients (6.9%) had severe dysfunction in the activities of daily living with the score of 16 or higher. Twenty-two patients (73.3%) had cognitive impairment or dementia upon assessing cognitive function after excluding those previously diagnosed with dementia or those within 5 days after surgery, thus predisposed to delirium who had tested mini mental state examination for cognitive function level test. Fifteen patients (31.3%) had mild depression, while four (8.3%) had moderate depression; and 37 patients (67.3%) were at moderate risk and five (9.1%) were at high risk for developing delirium. CONCLUSION: A comprehensive evaluation of the functional status of elderly hospitalized patients was helpful in detecting medical problems other than the initial diagnosis. A significant proportion of the elderly patients we assessed were suspected to have cognitive impairment.
Activities of Daily Living ; Aged* ; Aging ; Delirium ; Dementia ; Depression ; Diagnosis ; Geriatric Assessment* ; Humans ; Inpatients* ; Medical Records ; Orthopedics* ; Physical Examination

OBJECTIVES: The aim of this study was to investigate the expression of 7 different sirtuin genes (SIRT1-SIRT7) in human dental pulp cells (HDPCs), and to determine the role of SIRTs in the odontoblastic differentiation potential of HDPCs. MATERIALS AND METHODS: HDPCs were isolated from freshly extracted third molar teeth of healthy patients and cultulred in odontoblastic differentiation inducing media. Osteocalcin (OCN) and dentin sialophosphoprotein (DSPP) expression was analyzed to evaluate the odontoblastic differentiation of HDPCs by reverse transcription-polymerase chain reaction (RT-PCR), while alizarin red staining was used for the mineralization assay. To investigate the expression of SIRTs during odontoblastic differentiation of HDPCs, real time PCR was also performed with RT-PCR. RESULTS: During the culture of HDPCs in the differentiation inducing media, OCN, and DSPP mRNA expressions were increased. Mineralized nodule formation was also increased in the 14 days culture. All seven SIRT genes were expressed during the odontogenic induction period. SIRT4 expression was increased in a time-dependent manner. CONCLUSIONS: Our study identified the expression of seven different SIRT genes in HDPCs, and revealed that SIRT4 could exert an influence on the odontoblast differentiation process. Further studies are needed to determine the effects of other SIRTs on the odontogenic potential of HDPCs.
Dental Pulp* ; Dentin ; Gene Expression* ; Humans* ; Molar, Third ; Odontoblasts* ; Osteocalcin ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Tooth

OBJECTIVES: This study was designed to identify frontal lobe dysfunctions of schizophrenic group and to classify into subtypes accordingly. METHODS: Four neuropsychological tests (Wisconsin Card Sorting Test (WCST), Word Fluency Test, Ruff Figural Fluency Test and Grooved Pegboard Test) were administered to 93 schizophrenia or schizophreniform patients diagnosed with the Korean version of SCID. Ten measures (WCST Total Number of Errors, WCST Number of Categories Completed, WCST Conceptual Level Responses, WCST Trials to Complete First Category, WCST Perseverative Responses, GPT Dominant Hand RT, GPT Nondominant Hand RT, Letter Fluency raw score, Category Fluency raw score, RFFT Total Unique Designs) from the four tests were selected by statistical procedure. Latent factors embedded in the frontal lobe function of schizophrenic patients were extracted from the factor analysis, and hierarchical and K-means clustering procedures were used to identify subtypes. To examine the differences among the subtypes, demographic variables, K-WAIS and PANSS were used. RESULTS: (1) The subjects in this study showed significant impairments in the four neuropsychological tests. (2) Through factor analysis, three factors were extracted: Conceptualization, Motor and Fluency. (3) Three cluster solution was considered optimal by cluster analysis. The preserved cluster (n=42) comprised of patients who showed relatively high function in all three factors. This group showed relatively higher function than the other two clusters. However, even the performance of the preserved cluster was 1SD below the norm of the normal people. The conceptualization deficit cluster (n=25) comprised of patients with deficit in conceptualization function. This group was characterized by the clinical symptoms of poor impulse control and active social avoidance suggesting a deficit in the ability to actively organize stimuli utilizing the feedback from the external environment. And finally, the fluency deficit cluster (n=19) showed impairment in fluency. This group was characterized by impairments in the use of abstract-symbolic thinking and the ability to pay attention to relevant stimuli suggesting a severe deficit in the efficiency and flexibility of information withdrawal. These three subtypes didn't differ significantly in age, duration of illness and current dosage of antipsychotics. However, the three groups differed significantly in years of education, IQ and on five items of PANSS. CONCLUSION: This study shows that schizophrenia can be characterized by frontal lobe dysfunctions and divided into three subtypes according to the profile of the frontal lobe dysfunctions. These neurocognitive heterogeneity of schizophrenia, not related to age, duration of illness and dosage of antipsychotic, suggest that different strategies need to be developed in diagnosing and planning rehabilitation programs for schizophrenc patients.
Antipsychotic Agents ; Education ; Frontal Lobe* ; Hand ; Humans ; Neuropsychological Tests ; Pliability ; Population Characteristics ; Rehabilitation ; Schizophrenia* ; Thinking

PURPOSE: Hepatolithiasis results in septic cholangitis, biliary stricture, hepatic atrophy, hepatic abscess, irreversible liver cirrhosis, and cholangiocarcinoma. Hepatic resection for hepatolithiasis is regarded as a more effective treatment for achieving complete removal of stones and preventing recurrence. The purpose of this study was to determine the surgical outcome of hepatic resections for hepatolithiasis. METHODS: From March 2001 to December 2006, 54 patients underwent hepatic resections for hepatolithiasis at the Department of Surgery, Eulji University Hospital. A retrospective review of the surgical outcome was carried out. RESULTS: The hepatolithiasis was located in the left intrahepatic duct (34 cases), right intrahepatic duct (7 cases) or both (13 cases). The operative procedures were as follows: a left hepatectomy in 34 patients, a left lateral sectionectomy in eight, a right posterior sectionectomy in three, a left trisectionectomy in three, a right hepatectomy in five, and a segmentectomy in 1. The postoperative complications were intraabdominal abscess in 10 patients, wound infection in 4, pleural effusion in 3, internal bleeding in 2, T-tube site leakage in 2, hepatic failure and pneumonia in 1. The factors that affect these complications were analyzed. Preoperative percutaneous transhepatic biliary drainage (PTBD) and operative hepaticojejunostomy increased the frequency of postoperative complications; these findings were statistically significant (p=0.035, p=0.006, respectively). Two patients were diagnosed with cholagiocarcinoma. Five patients had remaining stones and five patients had recurrent stones. CONCLUSION: Hepatic resection is a safe and effective procedure for treating hepatolithiasis. If possible, bypass procedures such as hepaticoenterostomy should be avoided to reduce postoperative complications.
Abscess ; Atrophy ; Cholangiocarcinoma ; Cholangitis ; Constriction, Pathologic ; Drainage ; Hemorrhage ; Hepatectomy ; Humans ; Liver Abscess ; Liver Cirrhosis ; Liver Failure ; Mastectomy, Segmental ; Pleural Effusion ; Pneumonia ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative ; Wound Infection