In pre-surgical evaluation of pediatric epilepsy, the combined use of multiple imaging modalities for precise localization of the epileptogenic focus is a worthwhile endeavor. Advanced neuroimaging by high field Magnetic resonance imaging (MRI), diffusion tensor images, and MR spectroscopy have the potential to identify subtle lesions. 18F-FDG positron emission tomography and single photon emission tomography provide visualization of metabolic alterations of the brain in the ictal and interictal states. These techniques may have localizing value for patients which exhibit normal MRI scans. Functional MRI is helpful for non-invasively identifying areas of eloquent cortex. These advances are improving our ability to noninvasively detect epileptogenic foci which have gone undetected in the past and whose accurate localization is crucial for a favorable outcome following surgical resection.
Brain ; Diffusion ; Epilepsy ; Fluorodeoxyglucose F18 ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Neuroimaging ; Positron-Emission Tomography

Curriculum ; Education ; Humans ; Learning ; Lectures ; Methods ; Oral Hygiene ; Plastics

Spinocerebellar ataxia type 6 (SCA6) is classified as a CAG repeat disorder, where the number of expanded CAG repeats often undergoes meiotic instability, when transmitted from one generation to the next. However, in SCA6, both normal and expanded CAG repeats tend to remain stable during transmission due to its relatively small repeat numbers. We herein report de-novo expansion of CAG repeats in SCA6 gene in a 41-year-old female patient, whose parents had normal repeat numbers.

The purpose of this study was to evaluate trends in the sources of dietary sodium intake in a representative Korean population in the Korea National Health and Nutrition Examination Survey (KNHANES) conducted in 1998, 2001, 2005, 2007, 2008, 2009, and 2010. The study consisted of 53,570 men and women aged 7 years or older participating in the KNHANES during the corresponding years. Overall sodium intake and the mean percent contribution of each dish and food group to dietary sodium intake across 1998-2010 were calculated. The means of sodium intake ranged between 4,572.6-5,498.9 mg/d across 1998-2010. The major dish groups contributing to dietary sodium intake were kimchi (1,154.8-1,521.2 mg/d), noodles and dumplings (505.3-760.5 mg/d), soups (465.3-714.8 mg/d), and stews and casseroles (387.0-579.8 mg/d). The combined mean percent contribution from the top four dish groups contributing to dietary sodium intake showed a slight decrease over the period; 64.4% in 1998, 64.5% in 2001, 59.3% in 2005, 58.2% in 2007, 56.3% in 2008, 56.7% in 2009, and 54.4% in 2010. The major food groups contributing to dietary sodium intake were seasonings (1,852.9-2,435.9 mg/d), vegetables (1,425.6-1,792.1 mg/d), grains (482.2-778.1 mg/d), and fish and shellfish (257.2-351.4 mg/d). In addition, the combined mean percent contribution from the top four food groups showed a slight decrease over the period; 92.8% in 1998, 93.2% in 2001, 93.8% in 2005, 92.1% in 2007, 91.7% in 2008, 90.9% in 2009, and 90.7% in 2010. In summary, we did not observe a reduction in dietary sodium intake over time, however, the percent contributions from the top major dish groups or food groups to dietary sodium intake showed a decrease over the last decade.
Aged ; Edible Grain ; Female ; Humans ; Korea ; Male ; Nutrition Surveys ; Seasons ; Shellfish ; Sodium ; Sodium, Dietary ; Vegetables

Anatomy is an essential subject for dental hygienists. As such, in order to form academic systems for dental hygiene program, we cannot ignore research related to basic dental hygiene, which is related to the main competency of a dental hygienist. This research focused on the operation status of the curriculum related to gross anatomy of the head and neck led by the department of dental hygiene and was performed in order to propose a new direction regarding academics. This research analyzed the offering status of the anatomy curriculum using shared information, released by both the Association of Korean Dental Hygienist and the homepage website of the national dental hygiene, as a foundation. In addition, we conducted a survey of 21 (25.6%) professors out of 82 dental hygiene institutions in the nation. The fill-in survey was composed in order to obtain knowledge on each department's offering and operation system of the anatomy curriculum, general characteristics of professor and demand for the anatomy education. The SPSS 20.0 Program was used to analyze all of the materials with the exception of operation statuses of anatomic curriculums constructed via open questions. Nationally, the subject related to the gross anatomy was opened in Semester 2 during the first year 56.2% of the time, and the oral anatomy class recorded the highest percentage of 45.3%. The general trend of the professors who participated in this research was the highest recording of 85.0% for holders of dental hygiene license. Those who acquired doctoral degrees were found to be 17 individuals (85.0%) and 45.0% majored in health science. The operation methods of anatomic practices were revealed to be models, drawings, and audiovisuals while external practices failed to meet even the half-point of the study. The consensus opinion has indicated the need for a integrated education with clinical subjects, cadaver practices, developments of educational media, and standardization of anatomic terminology. Standardization of educational contents and systemization of practices are necessary for the improvement of anatomic studies of students studying dental hygiene. Cultivating anatomy specialists and sharing activities between academia are required for long-term development. We expect this research to contribute to overall quality improvement and the dental hygiene profession through the establishment of majors.
Cadaver ; Consensus ; Curriculum ; Dental Hygienists ; Education* ; Head ; Humans ; Licensure ; Neck ; Oral Hygiene* ; Quality Improvement ; Specialization

PURPOSE: The objective of the study was to report the neurological manifestations and response to high-dose immunoglobulin (IVIG) therapy in children with enterovirus 71 (EV 71) infections. METHODS: Eleven patients who had the primary clinical marker for enteroviral infection-herpangina or hand-foot-mouth-disease (HFMD) followed by acute neurological manifestations were admitted to Ajou University Hospital from June to September, 2009. All patients were positive for enterovirus (EV) as indicated by reverse transcription polymerase chain reaction (RT-PCR). Among them, EV 71 was confirmed by semi-nested PCR in five patients. All patients received IVIG soon after admission. RESULTS: The mean age of the patients who were EV 71 positive was 2.5 years (range, 4 months to 5.3 years). Five neurological complications associated with EV 71 infection were identified: meningoencephalitis (3 patients); acute cerebellar ataxia (1 pationt); and complex febrile seizure in another patient. Three patients (60%) had HFMD, and two(40%) had herpangina. None of the patients had neurological sequelae at follow-up. CONCLUSION: EV 71 infection should be suspected in young children with epidemic HFMD or herpangina complicated by a variety of neurological manifestations. We have reported the response to high dose IVIG therapy in children with EV 71 infection.
Biomarkers ; Cerebellar Ataxia ; Child ; Enterovirus ; Herpangina ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Meningoencephalitis ; Neurologic Manifestations ; Polymerase Chain Reaction ; Reverse Transcription ; Seizures, Febrile

PURPOSE: This study aimed to examine the excretion of various urinary proteins in children with a history of urinary tract infection(UTI), with or without vesicoureteral reflux(VUR) or reflux nephropathy, and to identify means of predicting the severity of VUR or the presence of reflux nephropathy as indicated by these markers, and to know how these markers are changed after resolution of VUR. METHODS: We studied 30 children with previous UTI, without VUR and renal scarring(group I), 12 children with VUR, without evidence of renal scarring(group II), and 34 children with VUR and renal scarring(group III). 24-hour or 12-hour urine beta2 microglobulin(beta2 MG), microalbumin and N- acetyl-beta-D-glucosaminidase(NAG) were measured in each child. Urinary protein excretions were analyzed according to the degree of VUR(mild VUR : a grade reflux I-III, severe VUR : a grade reflux IV-V). Cases of bilateral VUR were graded by the higher grade of reflux detected. A total of 46 children with primary VUR were followed. Among these patients, VUR was completely resolved in 16 children. Voiding cystourethrography(VCUG) and DMSA scan were performed every year. Values for urinary markers were estimated every year. RESULTS: 24 or 12 hour urine microalbumin and NAG excretions were significantly increased in group III compared to group I(microalbumin : 27.7+/-26.0 mg/gCr vs 15.0+/-10.7 mg/gCr, P<0.05, NAG : 15.2+/-18.7 U/gCr vs 3.4+/-2.2 U/gCr, P<0.05). Urinary beta2 MG excretions were not significantly different between groups. Urinary NAG excretions were elevated in the group of children with severe VUR compared to mild VUR(26.8+/-27.1 U/gCr vs 7.6+/-3.8 U/gCr, P<0.05). After resolution of VUR, urinary microalbumin and NAG excretions were decreased(P<0.05). CONCLUSION: Urinary microalbumin and NAG may be useful clinical indicators to predict the presence of reflux nephropathy and the resolution of VUR. Especially, urinary NAG excretions may be used as a possible method to predict the severity of VUR.
Child* ; Humans ; Succimer ; Urinary Tract ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

Purpose: Hyperglycemia accelerates the formation of advanced glycation end products (AGEs), a group of compounds formed via non-enzymatic glycation/glycoxidation. Type 2 diabetes mellitus (T2DM) is related to oxidative stress, resulting in some overgeneration of AGEs. The accumulation of AGEs in T2DM patients leads to increased inflammation, DNA damage, tissue damage, progression of diabetic microvascular disease, and nephropathy. Heme oxygenase-1 (HO-1) is an intracellular enzyme that catalyzes the oxidation of heme. Expression of HO-1 in the endothelium and in muscle monocytes/macrophages was upregulated upon exposure to reactive oxygen species or oxidized low-density lipoprotein. Cells activated by oxidative stress are reported to release HO-1 in the serum. In the current study, we discuss the oxidative status according to the level of AGEs and the association of HO-1 with AGEs or urinary DNA damage marker in type 2 diabetic Korean patients. Methods: This study enrolled 36 diabetic patients. Subjects were classified into two groups by serum AGEs level (Low AGEs group: < 0.85 ng/mL serum AGEs; High AGEs group: > 0.85 ng/ mL serum AGEs). Body composition was measured using bioelectrical impedance analysis. Blood and urinary parameters were measured using commercial kits. Results: No significant differences were observed in the general characteristics and body composition between the two groups. Serum HO-1 concentration was significantly higher in the High AGEs group than in the Low AGEs group. After adjustment of age and gender, a correlation was performed to assess the association between serum HO-1 and serum AGEs or urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG). Our results indicate that serum HO-1 is positively correlated with serum AGEs and urinary 8-OHdG. Conclusion Taken together, our results indicate that in diabetes patients, a high level of HO-1 is associated with a high concentration of AGEs and 8-OHdG, probably reflecting a protective response against oxidative stress.

Gastroesophageal reflux disorder (GERD) is the most common esophageal disorder in children. Achalasia occurs less commonly but has similar symptoms to GERD. A nine-year old boy presented with vomiting, heartburn, and nocturnal cough. The esophageal impedance-pH monitor revealed nonacidic GERD (all-refluxate clearance percent time of 20.9%). His symptoms persisted despite medical treatment for GERD, and he was lost to follow up. Four years later, he presented with heartburn, solid-food dysphagia, daily post-prandial vomiting, and failure to thrive. Endoscopy showed a severely dilated esophagus with candidiasis. High-resolution manometry was performed, and he was diagnosed with classic achalasia (also known as type I). His symptoms resolved after two pneumatic dilatation procedures, and his weight and height began to catch up to his peers. Clinicians might consider using high-resolution manometry in children with atypical GERD even after evaluation with an impedance-pH monitor.
Candidiasis ; Child* ; Cough ; Deglutition Disorders ; Dilatation ; Electric Impedance ; Endoscopy ; Esophageal Achalasia* ; Esophageal pH Monitoring ; Esophagus ; Failure to Thrive ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Lost to Follow-Up ; Male ; Manometry* ; Vomiting

Eosinophilic gastroenteritis is a rare disease characterized by prominent eosinophilic tissue infiltration of the gastrointestinal tract. Here, we report a case of eosinophilic gastroenteritis in an 18-year-old patient with prolonged nephrotic syndrome who presented with abdominal pain and peripheral hypereosinophilia. During the previous 2 years, he had visited local Emergency Department several times because of epigastric pain and nausea. He had been treated with steroid-dependent nephrotic syndrome since 3 years of age. Tests ruled out allergic and parasitic disease etiologies. Gastroduodenoscopy with biopsy revealed marked eosinophilic infiltration in the duodenum. Renal biopsy findings indicated minimal change disease spectrum without eosinophilic infiltration. The oral deflazacort dosage was increased, and the patient was discharged after abdominal pain resolved. To our knowledge, this is the first report of eosinophilic gastroenteritis in a patient with minimal change disease.
Abdominal Pain ; Adolescent* ; Biopsy ; Duodenum ; Emergency Service, Hospital ; Eosinophilia ; Eosinophils* ; Gastroenteritis* ; Gastrointestinal Tract ; Humans ; Male* ; Nausea ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Parasitic Diseases ; Rare Diseases