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

Subjective tinnitus can be defined as sound sensations (ringing or roaring) occurring in the absence of external auditory stimulus. It is one of the most widespread disorders of auditory system that might be caused by the peripheral auditory injury and insults to somatosensory levels. There were some theories in pathophysiology of tinnitus, such as change in biochemical systems, discordant dysfunction, and spontaneous hyperactivity of auditory tract or imbalance between inhibitory and excitatory transmitter actions of central auditory tracts. Theories related to neural plasticity and cortical reorganization have been recently introduced. Current understanding of pathophysiology in tinnitus is essential to therapeutic approaches. Although there were many studies addressing pathophysiology of tinnitus, controversies exist regarding the pathophysiology of tinnitus. The aim of this review was to review and summarize the recent studies related to pathophysiology of tinnitus.
Plastics ; Sensation ; Tinnitus*

In this comprehensive review, we discuss recent updates on tinnitus evaluation and treatment. Tinnitus evaluation commences with comprehensive medical history taking and audiological evaluation, which can provide valuable insight into the nature and extent of auditory disturbances. Additionally, tinnitus evaluation includes investigation of psychosomatic comorbidities to determine the intricate interplay between psychological factors and tinnitus perception. Various therapeutic approaches are available to minimize the burden of tinnitus. Cognitive behavioral therapy reshapes negative thought patterns and behaviors that are closely associated with tinnitus-induced distress. Acceptance and commitment therapy fosters mindfulness and value-aligned actions to address emotional effects. Tinnitus retraining therapy combines counseling and sound therapy for habituation. Tailor-made notched music therapy offers customized auditory experiences for symptom relief. Hearing aids and cochlear implants compensate for hearing loss and associated stress. Both neuromodulation and neurofeedback may be potentially useful. The role of pharmacotherapy and dietary supplements remains uncertain. Physiotherapy and head-neck manipulation relieve tinnitus associated with orofacial factors. Virtual reality, smartphone applications, and photobiomodulation may serve as novel therapeutic avenues. Although promising interventions are available, further research is warranted to confirm their effectiveness and long-term effects.

OBJECTIVES: "Internet-addiction" came into common use not only in clinical setting but also in everyday life. But, pathophysiology and diagnostic criteria of the internet addiction remain unknown. Because adolescents are in developing period, they might be vulnerable to the internet addiction, depression and sleep-related problem. The objectives of this study were to investigate the characteristics of internet addiction and its association with sleep pattern and depression in Korean adolescence. METHODS: Subjects were 799 middle and high school students in Seoul, Korea. We administered a self-reported questionnaire including socio-demographic data, Korean versions of Young's Internet Addiction Scale (YIAS), Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiologic Studies for Depression Scale (CES-D) and questions about internet using patterns. Data of 696 subjects were included in analysis. Chi-square tests were used to analyze proportional differences, and ANOVA with post-hoc tests were used to analyze differences among groups. Partial correlation analyses were performed to analyze the correlation of internet addiction with other variables (two-tailed, p<0.05). RESULTS: Of the 696 participants (grade 2 of middle school;M2 135 vs. grade 1 of high school;H1 238 vs. grade 2 of high school;H2 323), 2.0% (n=14) were internet-addicted (IA), 27.7% (n=193) were over-using (OU) and 70.3% (n=489) were not-addicted (NA). The mean scores of YIAS, PSQI and CES-D scores were 35.24+/-12.78, 5.53+/-3.04 and 16.72+/-8.69, respectively. In higher grade students, average total sleep time was shorter (M2 426.20+/-67.68 min. vs. H1 380.47+/-62.57 min. vs. H2 354.67+/-73.37 min., F=51.909, p<0.001), and PSQI (4.69+/-3.14 vs. 5.42+/-3.15 vs. 5.97+/-2.83, F=8.871, p<0.001) CES-D (13.53+/-8.37 vs. 16.96+/-8.24 vs. 17.87+/-8.84, F=12.373, p<0.001) scores were higher than those of lower grade students. Comparing variables among IA, OU and NA groups, computer using time not for study (96.36+/-63.31 min. vs. 134.92+/-86.79 min. vs. 213.57+/-136.87 min., F=34.287, p<0.001) and portable device using time not for study (84.22+/-79.11 min. vs. 96.97+/-91.89 min. vs. 152.31+/- 93.64 min., F=5.400, p=0.005) were different among groups. PSQI (5.26+/-2.97 vs. 6.08+/-2.97 vs. 7.50+/-4.41, F=8.218, p<0.001) and CES-D scores (15.40+/-8.08 vs. 19.05+/-8.42 vs. 30.43+/-13.69, F=32.692, p<0.001) were also different among groups. YIAS score were correlated with computer using time not for study (r=0.356, p<0.001) and portable device using time not for study (r=0.136, p<0.001). PSQI score (r=0.237, p<0.001) and CES-D score (r=0.332, p<0.001). YIAS score and PSQI score (r=0.131, p=0.001), YIAS and CES-D score (r=0.265, p<0.001), PSQI score and CES-D score (r=0.357, p<0.001) were correlated each other. CONCLUSION: These results suggested that adolescents' internet-addiction was correlated with not only computer and portable device using time not for study but also depression and sleep-related problems. We should pay attention to depression and sleep-related problems, when evaluating internet-addiction in adolescents.
Adolescent ; Depression ; Epidemiologic Studies ; Humans ; Internet ; Korea ; Porphyrins ; Surveys and Questionnaires

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

OBJECTIVE: To investigate individual pretreatment serum human chorionic gonadotropin (hCG) cutoff value for medical treatment success with single-dose and multi-dose regimen of methotrexate in tubal ectopic pregnancy. METHODS: Eighty-five women who received methotrexate for the treatment of tubal ectopic pregnancy during 2003 to 2015 were selected. Fifty-three women received a single-dose regimen and 32 women received a multi-dose regimen. Medical treatment failure was defined as necessity of surgical treatment. The medical treatment success rate was estimated in both regimens and the pretreatment serum hCG titer to predict the success was assessed by receiver operating characteristics curve analysis. RESULTS: Pretreatment clinical and laboratory parameters were similar between group of single-dose regimen and multi-dose regimen. Treatment success rate was 64.2% in the single-dose regimen group and 71.9% in the multi-dose regimen group (P>0.05). Pretreatment serum hCG titer was an independent prognostic factor for treatment success in each regimen. Serum hCG cutoff value to predict the treatment success was 3,026 IU/L in single-dose regimen group and 3,711 IU/L in multi-dose regimen group. CONCLUSION: We recommend use of single-dose regimen when pretreatment serum hCG <3,026 IU/L but multi-dose regimen may be favored when initial serum hCG level between 3,026 and 3,711 IU/L.
Chorionic Gonadotropin* ; Female ; Humans* ; Methotrexate* ; Pregnancy ; Pregnancy, Ectopic* ; Pregnancy, Tubal ; ROC Curve ; Treatment Failure

This review focuses on the current options for fertility preservation in patients with high risk of premature ovarian failure. Available cryopreservation options include embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation. Ovarian tissue cryopreservation and transplantation has been tried for some time in animals, but only recently successful pregnancy and livebirth in human has been reported. Options of developing follicles and restoring fertility after ovarian tissue cryopreservation are autotransplantation, xenotransplantation, and tissue culture. This review discusses the merits and faults of each option and future directions for developing and standardizing the ovarian tissue cryopreservation and transplantation procedure, systemically covering previously published data.
Animals ; Autografts ; Cryopreservation* ; Embryonic Structures ; Fertility ; Fertility Preservation ; Humans ; Oocytes ; Pregnancy ; Primary Ovarian Insufficiency ; Transplantation, Heterologous

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

Clinicians and healthcare decision-makers conduct their clinical practice based on the results of clinical trials. However, some health problems remain unresolved; in such cases, further research is required. To ensure reliable research results, it is important to understand the study design and conduct well-designed clinical trials. Many study designs can be chosen within the two broad categories of observational and interventional. Clinical studies have a variety of designs, including case series, case-control, cross-sectional, and prospective and retrospective cohort studies. Well-designed clinical studies can clarify important differences between treatment options and provide data on long-term drug efficacy and safety. Interpreting the results of clinical trials can be difficult because weaknesses in research design, data collection methods, analytic methods, and reporting can compromise their value and usefulness. However, although randomized controlled trials are limited owing to ethical and practical issues, they are optimal for investigating the effects of therapy and establishing causality. Here we present an overview of different clinical research designs and review their advantages and limitations.