Background: Discontinuing growth hormone (GH) treatment during the transition to adulthood has been associated with adverse health outcomes in patients with childhood-onset growth hormone deficiency (CO-GHD). This study investigated the metabolic changes associated with interrupting GH treatment in adolescents with CO-GHD during the transition period. Methods: This study included 187 patients with CO-GHD who were confirmed to have adult GHD and were treated at six academic centers in Korea. Data on clinical parameters, including anthropometric measurements, metabolic profiles, and bone mineral density (BMD) at the end of childhood GH treatment, were collected at the time of re-evaluation for GHD and 1 year after treatment resumption. Results: Most patients (n=182, 97.3%) had organic GHD. The median age at treatment discontinuation and re-evaluation was 15.6 and 18.7 years, respectively. The median duration of treatment interruption was 2.8 years. During treatment discontinuation, body mass index Z-scores and total cholesterol, low-density lipoprotein, and non-high-density lipoprotein (HDL) cholesterol levels increased, whereas fasting glucose levels decreased. One year after GH treatment resumption, fasting glucose levels, HDL cholesterol levels, and femoral neck BMD increased significantly. Longer GH interruption (>2 years, 60.4%) resulted in worse lipid profiles at re-evaluation. The duration of interruption was positively correlated with fasting glucose and non-HDL cholesterol levels after adjusting for covariates. Conclusion GH treatment interruption during the transition period resulted in worse metabolic parameters, and a longer interruption period was correlated with poorer outcomes. GH treatment should be resumed early in patients with CO-GHD during the transition period.

Objective: Central nervous system involvement in coronavirus disease 2019 (COVID-19) has been increasingly reported. We performed a systematic review and meta-analysis to evaluate the incidence of radiologically demonstrated neurologic complications and detailed neuroimaging findings associated with COVID-19. Materials and Methods: A systematic literature search of MEDLINE/PubMed and EMBASE databases was performed up to September 17, 2020, and studies evaluating neuroimaging findings of COVID-19 using brain CT or MRI were included. Several cohort-based outcomes, including the proportion of patients with abnormal neuroimaging findings related to COVID-19 were evaluated. The proportion of patients showing specific neuroimaging findings was also assessed. Subgroup analyses were also conducted focusing on critically ill COVID-19 patients and results from studies that used MRI as the only imaging modality. Results: A total of 1394 COVID-19 patients who underwent neuroimaging from 17 studies were included; among them, 3.4% of the patients demonstrated COVID-19-related neuroimaging findings. Olfactory bulb abnormalities were the most commonly observed (23.1%). The predominant cerebral neuroimaging finding was white matter abnormality (17.6%), followed by acute/subacute ischemic infarction (16.0%), and encephalopathy (13.0%). Significantly more critically ill patients had COVID-19-related neuroimaging findings than other patients (9.1% vs. 1.6%; p = 0.029). The type of imaging modality used did not significantly affect the proportion of COVID-19-related neuroimaging findings. Conclusion Abnormal neuroimaging findings were occasionally observed in COVID-19 patients. Olfactory bulb abnormalities were the most commonly observed finding. Critically ill patients showed abnormal neuroimaging findings more frequently than the other patient groups. White matter abnormalities, ischemic infarctions, and encephalopathies were the common cerebral neuroimaging findings.

OBJECTIVE: We aimed to determine the optimized image-based surrogate endpoints (IBSEs) in targeted therapies for glioblastoma through a systematic review and meta-analysis of phase III randomized controlled trials (RCTs).MATERIALS AND METHODS: A systematic search of OVID-MEDLINE and EMBASE for phase III RCTs on glioblastoma was performed in December 2017. Data on overall survival (OS) and IBSEs, including progression-free survival (PFS), 6-month PFS (6moPFS), 12-month PFS (12moPFS), median PFS, and objective response rate (ORR) were extracted. Weighted linear regression analysis for the hazard ratio for OS and the hazard ratios or odds ratios for IBSEs was performed. The associations between IBSEs and OS were evaluated. Subgroup analyses according to disease stage (newly diagnosed glioblastoma versus recurrent glioblastoma), types of test treatment, and types of response assessment criteria were performed.RESULTS: Twenty-three phase III RCTs published between 2000 and 2017, including 8387 patients, met the inclusion criteria. OS showed strong correlations with PFS (standardized β coefficient [R] = 0.719), 6moPFS (R = 0.647), and 12moPFS (R = 0.638). OS showed no correlations with median PFS and ORR. In subgroup analysis according to types of therapies, PFS showed the highest correlations with OS in targeted therapies for cell cycle pathways (R = 0.913) and growth factor receptors and their downstream pathways (R = 0.962). 12moPFS showed the highest correlation with OS in antiangiogenic therapy (R = 0.821). The response assessment in neuro-oncology criteria provided higher correlation coefficients between OS and IBSEs than the Macdonald criteria.CONCLUSION: Overall, PFS is an optimized IBSE in targeted therapies for glioblastoma; however, 12moPFS is optimal in antiangiogenic therapy.

OBJECTIVES: Exposure to second-hand smoke varied by smoking rate in the workplace and no-smoking policies. The purpose of this study was to estimate the status of second-hand smoke exposure by occupation through urine cotinine analysis in Busan, Ulsan, and Kyeongnam provinces. METHODS: Data was obtained from the National Institute of Environmental Research of Korea as 'The 2008 Korea National Survey for Environmental Pollutants in Human Body'. We selected 629 non-smokers who lived in Busan, Ulsan and Gyeongnam provinces. General and occupational characteristics were gathered using a structured questionnaire. Urine cotinine concentrations were analyzed by a gas chromatograph-mass selective detector. Statistical analysis was carried out using the Chi-square test, Student t-test and ANOVA. RESULTS: The geometric mean (geometric standard deviation) of urine cotinine concentration was 17.11 (2.74) ng/ml. The urine cotinine concentration of the middle school graduate group (18.47 (2.86) ng/ml) was higher than the college graduate group (15.64 (2.60) ng/ml, p=0.212). Also, the cotinine concentration of current drinkers (18.98 (2.47) ng/ml) was higher than non-drinkers (16.15 (2.88) ng/ml, p=0.054). The proportion who smelled smoke was higher in workers (38.5%) than in non-workers (29.7%, p=0.02). Therefore, urine cotinine concentration was higher in workers (17.29 (2.66) ng/ml) than in non-workers (16.97 (2.81) ng/ml) but not at a statistically significant amount (p=0.826). In addition, cotinine concentration between the group who smelled smoke (20.45 (2.42) ng/ml) and the group who did not smelled smoke (15.53 (2.78) ng/ml) was significantly different (p=0.016) in workers but not in non-workers (17.08 (2.42) ng/ml vs 16.92 (2.98) ng/ml, p=0.942). According to the National Center for Health Statistics occupational categories in the US and the Korea Standard Classification of Occupations, the urine cotinine concentration of white collar workers such as technical workers and administrators, professional specialists, and managers was higher (18.01 (2.55) ng/ml) than that of blue collar workers such as plant and machine operators and assemblers, elementary occupations, and craft and related trades workers (15.36 (3.48) ng/ml). CONCLUSIONS: The workplace is an important contributor to second-hand smoke exposure in Busan, Ulsan and Kyeongnam provinces. Unlike in advanced countries, where anti-smoking policies have been implemented, urine cotinine concentration in people in Busan, Ulsan and Kyeongnam provinces was higher in the white collar group than in the blue collar group. This result might be due to a higher indoor second-hand smoking rate of workplaces in these areas. Further studies are needed to evaluate the correlation between regional characteristics of industries, anti-smoking policies in the workplace, smoking rates and urine cotinine concentrations of workers.
Administrative Personnel ; Cotinine ; Environmental Pollutants ; Humans ; Korea ; National Center for Health Statistics (U.S.) ; Occupations ; Plants ; Questionnaires ; Smell ; Smoke ; Smoking ; Specialization

PURPOSE: Stent-assisted neck remodeling for wide-necked aneurysms requires long-term medication with antiplatelet agents. We describe here a temporary semi-jailing technique (SJT) for wide-necked aneurysms that avoids the need for antiplatelet medications. MATERIALS AND METHODS: Among 101 patients who underwent stent- and/or balloon-assisted embolizations, 3 wide-necked aneurysms, including 1 ruptured aneurysm, underwent the temporary SJT using Enterprise stents. Temporary SJTs were used due to resistance to antiplatelet agents prior to cardiac surgery or to a ruptured aneurysm with a wide neck. The aneurysms were located in the middle cerebral artery, the paraclinoid internal carotid artery segment, and the posterior communicating artery. RESULTS: Enterprise stents were retrieved after coiling without any change in coil mass stability. The final angiogram showed good patency of each parent artery, good stability of the coil mass and total occlusion of the aneurysm. None of the patients experienced any periprocedural or delayed neurological complications. While retrieving the stent from tortuous vessels, we experienced the jumping phenomenon associated with this device. CONCLUSION: Temporary SJTs have the advantage of stent retrieval, thus avoiding inevitable antiplatelet medication. However, care should be taken in tortuous vessels to avoid the jumping phenomenon associated with the device.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Carotid Artery, Internal ; Humans ; Imidazoles ; Intracranial Aneurysm ; Middle Cerebral Artery ; Neck ; Nitro Compounds ; Parents ; Platelet Aggregation Inhibitors ; Stents ; Thoracic Surgery

We studied the association of cytotoxic T lymphocyte antigen-4 gene (CTLA4) polymorphisms with the development of type 1 diabetes (T1D) in Korean children and adolescents. A total of 176 Korean subjects (92 females and 84 males) with childhood-onset T1D were studied. The A/G polymorphism at position 49 in CTLA4 exon 1 and the C/T polymorphism at position -318 in the CTLA4 promoter were analyzed by PCR-RFLP methods. The genotype and allele frequencies of the CTLA4 polymorphisms in the T1D patients were not different from those in the controls. These polymorphisms were not associated with the clinical characteristics or the development of autoimmune thyroid disease in the T1D patients. The frequency of the A allele was significantly higher in the patients that did not have two out of the three susceptible HLA-DRB1 alleles, which were DRB1*0301, *0405 and *09012, compared to the controls (P<0.05). These results suggest that CTLA4 polymorphisms do not directly confer any susceptibility to T1D. However, a CTLA4-mediated susceptibility effect on the development of T1D might be significant in children and adolescents that do not have susceptible HLA class II alleles.
Adolescent ; Alleles ; Antigens, CD/*genetics ; Asian Continental Ancestry Group/*genetics ; Child ; Child, Preschool ; Diabetes Mellitus, Type 1/*genetics ; Female ; Histocompatibility Antigens Class II/*genetics ; Humans ; Korea ; Male ; *Polymorphism, Genetic

PURPOSE: To design a reliable and quick lesion volume estimation method for hyperintensities on diffusion-weighted images (DWI) for the evaluation of hyperacute stroke. MATERIALS AND METHODS: Twenty patients with obvious high signal lesions seen on DWI in the middle cerebral artery territory due to acute ischemia were enrolled to evaluate the performance of four tentatively designed semi-quantitative methods: the 25-area method, the 20-area method, the 10-area method, and the modified 10-area method. Two radiologists performed the volume analyses using these methods. Intraclass correlation coefficients were calculated to compare the correlation between the reference values and the measured values and to evaluate the interobserver agreement of each method. RESULTS: For the correlation between the measured value and the reference value, the performance of the modified 10-area method was the most powerful, with a value of 0.8981 and 0.8090 for observer 1 and 2, respectively. The interobserver agreement was satisfactory for both the 25-area method and the modified 10-area method, with a value of 0.9212 (95% CI: 0.8123-0.9681) and 0.9063 (95% CI: 0.7790-0.9618), respectively. CONCLUSION: The performance of the modified 10-area method was satisfactory for both lesion volume estimation and interobserver correlation in the evaluation of an acute cerebral infarction by the use of DWI.
Cerebral Infarction* ; Humans ; Ischemia ; Middle Cerebral Artery ; Reference Values ; Stroke

PURPOSE: We wanted to evaluate the radiologic characteristics of nasal-type NK/T cell lymphomas. MATERIALS AND METHODS: We reviewed twenty-one cases of pathologically proven nasal-type NK/T-cell lymphomas. CT scans were obtained for 21 patients, MR image were obtained for 3 patients, and both CT and MR scans were obtained for 3 patients. The imaging features regarding patterns of the masses, extension to adjacent tissue, bony changes and the degree of contrast enhancement were evaluated. RESULTS: All of the 21 patients had diffuse mucosal thickening and 12 patients (12/21, 57%) also had polypoid masses. Nasal cavity lesions showed extension to the adjacent tissue in 20 cases (20/21, 95%). Adjacent bone erosion or destruction was noted in 14 cases (14/21, 67%) and the bone destruction was mild. CONCLUSION: Nasal-type NK/T-cell lymphomas revealed a tendency to involve the superficial soft tissue and to extend into the adjacent structures. The typical imaging features of nasal-type NK/T-cell lymphoma were diffuse infiltrative lesion with or without polypoid masses in the nasal cavity and frequently extension to adjacent soft tissue, and especially the subcutaneous tissue.
Humans ; Lymphoma* ; Nasal Cavity ; Skin* ; Subcutaneous Tissue* ; Tomography, X-Ray Computed

OBJECTIVE: Hyperdense lesions can frequently be observed on the CT obtained immediately after intra-arterial (IA) thrombolysis, and it is sometimes difficult to differentiate contrast extravasation from the hemorrhagic lesions. The purposes of this study are to classify the hyperdense lesions according to their morphologic features and to track the outcome of those lesions. MATERIALS AND METHODS: Among the 94 patients who suffered with anterior circulation ischemic stroke and who were treated with IA thrombolysis, 31 patients revealed hyperdense lesions on the CT obtained immediately after the procedure. The lesions were categorized into four types according to their volume, shape, location and density: cortical high density (HD), soft HD, metallic HD and diffuse HD. The follow-up images were obtained 3-5 days later in order to visualize the morphologic changes and hemorrhagic transformation of the lesions. RESULTS: Among the 31 patients with HD lesions, 18 (58%) showed hemorrhagic transformation of their lesion, and six of them were significant. All the cortical HD lesions (n = 4) revealed spontaneous resolution. Seven of the soft HD lesions (n = 13) showed spontaneous resolution, while the rest of the group showed hemorrhagic transformation. Among them the hemorrhage was significant in only two patients (2/6) who did not achieve successful recanalization. All the metallic HD lesions (n = 10) resulted in hemorrhagic transformation; among them, three cases (30%) with a maximum CT value more than 150 HU (Hounsfield unit) subsequently showed significant hemorrhagic transformation on the follow-up CT. There were four diffuse HD lesions, and two of them showed hemorrhagic transformation. CONCLUSION: The parenchymal hyperdense lesions observed on the CT obtained immediately after IA thrombolysis in ischemic stroke patients exhibited varying features and they were not always hemorrhagic. Most of the soft HD lesions were benign, and although all of the metallic HD lesions were hemorrhagic, some of them were ultimately found to be benign.
Treatment Outcome ; *Tomography, X-Ray Computed ; Thrombolytic Therapy/*methods ; Statistics, Nonparametric ; Retrospective Studies ; Middle Aged ; Male ; Magnetic Resonance Imaging ; Infusions, Intra-Arterial ; Humans ; Fibrinolytic Agents/therapeutic use ; Female ; Cerebrovascular Accident/*drug therapy/pathology/*radiography ; Brain Ischemia/*drug therapy/pathology/*radiography ; Aged ; Acute Disease

Neurological complications are a rare but important and significant source of information about morbidity and mortality in liver transplant patients. Based on the clinical and radiological findings of 21 patients, neurological complications were categorized into five main groups; focal hemorrhagic or occlusive complications (n=11); diffuse hypoxic-ischemic injury (n=3); hypertensive encephalopathy (n=1); central pontine or extra-pontine myelinolysis (n=4); and infection (n=2). Neurological manifestations varied according to the location of the lesion, although seizures were the most common manifestation. In this pictorial review, we illustrate the radiological findings, focusing on MR and CT images, of a spectrum of neurological complications following liver transplants, as well as their clinical correlations.
Central Nervous System ; Humans ; Hypertensive Encephalopathy ; Liver* ; Mortality ; Neurologic Manifestations ; Seizures