BACKGROUND: The Korean-Mini-Mental Status Examination (K-MMSE) is a dementia-screening test that can be easily applied in both community and clinical settings. However, in 20% to 30% of cases, the K-MMSE produces a false negative response. This suggests that it is necessary to evaluate the accuracy of K-MMSE as a screening test for dementia, which can be achieved through comparison of K-MMSE and Seoul Neuropsychological Screening Battery (SNSB)-II results. METHODS: The study included 713 subjects (male 534, female 179; mean age, 69.3±6.9 years). All subjects were assessed using K-MMSE and SNSB-II tests, the results of which were divided into normal and abnormal in 15 percentile standards. RESULTS: The sensitivity of the K-MMSE was 48.7%, with a specificity of 89.9%. The incidence of false positive and negative results totaled 10.1% and 51.2%, respectively. In addition, the positive predictive value of the K-MMSE was 87.1%, while the negative predictive value was 55.6%. The false-negative group showed cognitive impairments in regions of memory and executive function. Subsequently, in the false-positive group, subjects demonstrated reduced performance in memory recall, time orientation, attention, and calculation of K-MMSE items. CONCLUSION: The results obtained in the study suggest that cognitive function might still be impaired even if an individual obtained a normal score on the K-MMSE. If the K-MMSE is combined with tests of memory or executive function, the accuracy of dementia diagnosis could be greatly improved.
Cognition ; Cognition Disorders ; Dementia ; Diagnosis ; Executive Function ; Female ; Humans ; Incidence ; Mass Screening* ; Memory ; Sensitivity and Specificity ; Seoul*

Primary aldosteronism is characterized by hypokalemic metabolic alkalosis, low plasma renin activity, elevated plasma aldosterone level and can be suspected in the patients with hypertension and unexplained hypokalemia. Small adrenal cortical adenomas are responsible for this syndrome in most cases. The incidence of thyrotoxic periodic paralysis ranges from 1.9 to 6.2 % in Japan. Thyrotoxic periodic paralysis usually subsides following treatment of hyperthyroidism and has good prognosis. A 56 year-old man presented with hyperthyroidism, hypertension and recurrent hypokalemia. During the treatment of hyperthyroidism, he repeatedly experienced weakness of both lower extremities. Hormonal evaluation was performed and he was found to have a 2*2*1.5 cm sized right adrenal tumor by abdominal computerized topography(CT). After right adrenalectomy, hypokalemic periodic paralysis was improved. Both thyroid and adrenal function should be comprehensively investigated in periodic paralysis. In conclusion, physicians must be aware of the possibility of primary aldosteronism in hyperthyroid patients with hypokalemic periodic paralysis. We report a case of aldosteronoma complicated with hyperthyroidism and literatures are reviewed.
Adrenalectomy ; Adrenocortical Adenoma ; Aldosterone ; Alkalosis ; Humans ; Hyperaldosteronism ; Hypertension ; Hyperthyroidism* ; Hypokalemia ; Hypokalemic Periodic Paralysis ; Incidence ; Japan ; Lower Extremity ; Middle Aged ; Paralysis ; Plasma ; Prognosis ; Renin ; Thyroid Gland

OBJECTIVES: The individual's ability to recognize and describe emotion in self and others is an important concept of many psychiatric disorders. The purpose of this study was to investigate emotional awareness deficits in patients with alcohol dependence. METHODS: 55 male inpatients with alcohol dependence and 28 male normal controls were evaluated by the Korean version of the Levels of Emotional Awareness Scale (LEAS-K), the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20K), the Openness Experience Inventory (OEI) and the Beck Depression Inventory (BDI). The LEAS-K is an objective measure to assess the ability to be aware of one's own or another's emotions and the TAS-20 is the most widely used subjective measure of alexithymia. Scores of these scales were compared between two groups using ANCOVA controlling age and BDI scores. RESULTS: The LEAS-K scores were significantly lower in alcohol-dependent patients than normal controls. The TAS-20K total scores, factor 1 (Difficulty to Identifying Feeling, DIF) and factor 3 (Externally Oriented Thinking, EOT) were significantly higher in alcohol-dependent patients than normal controls. In contrast to the LEAS-K, the TAS-20K scores correlated significantly with the BDI scores. CONCLUSION: Emotional awareness is impaired in alcohol-dependent patients and it may not be related with depressive mood. Additional studies are needed to explore the significance of alexithymia, especially impaired emotional awareness, and its relationship to depressive mood in patients with alcohol dependence.
Affective Symptoms ; Alcoholism ; Depression ; Humans ; Inpatients ; Male ; Thinking ; Weights and Measures

BACKGROUND AND OBJECTIVES: The vestibuloautonomic reflex controls respiration and blood pressure during locomotion. The purpose of this study was to investigate the role of the peripheral vestibular receptor in the control of blood pressure in sinoaortic denervated (SAD) rats. MATERIALS AND METHODS: The baroreceptor reflex was removed by SAD in labyrinthectomized rats. The expression of c-Fos protein in the vestibular nuclear complex, and other nuclei related to control of blood pressure, was measured following the induction of acute hypotension using sodium nitroprusside (SNP). RESULTS: The SNP induced acute hypotension, in intact labyrinthine rats, increased the expression of c-Fos protein in the supraoptic nucleus, paraventricular nucleus, rostral ventrolateral medulla, solitary nucleus, and vestibular nuclear complex. The expression of c-Fos protein, following the SNP induced acute hypotension in the SAD rats, increased the expression of c-Fos protein in the paraventricular nucleus, rostral ventrolateral medulla, and medial and inferior vestibular nuclei. The acute hypotension induced by SNP in a unilateral labyrinthectomy, with SAD, increased the expression of c-Fos protein in the contralesional vestibular nuclear complex, but decreased its expression in the ipsilesional vestibular nuclear complex. The acute hypotension induced by SNP in a bilateral labyrinthectomy, with SAD, showed only slight expression of c-Fos protein in the bilateral vestibular nuclear complex. CONCLUSION: These results suggest that the acute hypotension induced by SNP activates the vestibular nuclear neurons by decreasing the blood flow in the peripheral vestibular receptors, and that these in turn modulate blood pressure through activation of the catecholaminergic nervous system and neuroendocrine reflex.
Animals ; Baroreflex ; Blood Pressure* ; Hypotension ; Locomotion ; Nervous System ; Neurons ; Nitroprusside ; Paraventricular Hypothalamic Nucleus ; Pressoreceptors ; Rats* ; Reflex ; Respiration ; Solitary Nucleus ; Supraoptic Nucleus ; Vestibular Nuclei

Background: There are limited data regarding the extraintestinal manifestations (EIMs) associated with pediatric inflammatory bowel disease (IBD) in Korea. We aimed to investigate the clinical features and factors associated with the development of EIMs in Korean children and adolescents with IBD. Methods: This multicenter, retrospective study was conducted from 2010 to 2017. Baseline clinicodemographic, laboratory findings, disease activity, disease phenotypes, and EIMs were investigated. Results: A total of 172 patients were included. One-hundred thirty-seven (79.7%) had Crohn's disease (CD), and 35 (20.3%) had ulcerative colitis (UC). EIMs occurred in 42 patients (24.4%). EIMs developed in 34/137 diagnosed with CD (24.8%), and in 8/35 diagnosed with UC (22.9%), during a median follow-up duration of 3.2 (interquartile range, 1.9–5.4) years for CD and 3.0 (1.0–4.0) years for UC, respectively. Arthritis/arthralgia was most commonly observed (n = 15, 35.7%), followed by stomatitis/oral ulcer (n = 10, 23.8%), hepatitis (n = 5, 11.9%), nephritis (n = 4, 9.5%), pancreatitis (n = 2, 4.8%), erythema nodosum (n = 2, 4.8%), pyoderma gangrenosum (n = 1, 2.4%), primary sclerosing cholangitis (n = 1, 2.4%), uveitis (n = 1, 2.4%), and ankylosing spondylitis (n = 1, 2.4%). A significant difference in disease severity based on the Paris classification (P = 0.011) and ESR at diagnosis (P = 0.043) was observed between the EIM positive and negative group in patients with UC. According to logistic regression analyses, S1 disease severity based on the Paris classification was the only factor that was significantly associated with the development of EIMs (odds ratio, 16.57; 95% confidence interval, 2.18–287.39; P = 0.017). Conclusion Severe disease activity based on the Paris classification in pediatric patients with UC was significantly associated with EIM development. As disease severity in the Paris classification is a dynamic parameter, treatment should be focused on disease control to minimize the occurrence of EIMs in Korean children and adolescents with UC.

The neurofibroma in oral cavity is typically associated with neurofibromatosis. The solitary neurofibroma is commonly observed in skin. It is relatively rare in oral cavity and usually observed in the tongue, buccal mucosa, and vestibule. The rare types of solitary neurofibromas have been reported as a case report and they were in the inferior alveolar nerve, infratemporal fossa, maxilla, and palatal ginviva. In our hospital, the presented case was the first case as reported as solitary neurofibroma in the oral cavity. The prognosis after excision and the review of literatures were presented.
Mandibular Nerve ; Maxilla ; Mouth ; Mouth Mucosa ; Neurofibroma* ; Neurofibromatoses ; Prognosis ; Skin ; Tongue

PURPOSE: Febrile urinary tract infection (UTI) is one of the commonest bacterial infections in children. The purpose of this study is to investigate the clinical characteristics of the first episode of febrile UTI occurring in children over 5 years compared to those in infants younger than a year. METHODS: We retrospectively reviewed the medical records of 10 patients over 5 years, having febrile UTI, and 25 controls under 1 year. Clinical characteristics including symptoms at admission, the time interval between symptom onset and hospital visit and/or diagnosis, duration of fever, urinalysis, and other laboratory and imaging test results were compared between the two groups. RESULTS: Most patients in the control group showed only high fever at the time of presentation to the hospital. However, 60% of the case group had fever along with gastrointestinal (GI) symptoms such as abdominal and flank pain, vomiting, as well as relatively mild pyuria. The case group showed a longer duration between symptom onset and hospital visit and/or diagnosis. CONCLUSIONS: Delay in diagnosis and initiation of treatment of UTI increases the risk of permanent renal scarring and associated complications. Therefore, early diagnosis and treatment of febrile UTI is vital for very young infants, as well as children considering that febrile UTI could be an important cause of febrile illness in children over 5 years.
Bacterial Infections ; Child ; Cicatrix ; Diagnosis ; Early Diagnosis ; Fever ; Flank Pain ; Humans ; Infant ; Medical Records ; Pyuria ; Retrospective Studies ; Urinalysis ; Urinary Tract Infections ; Vomiting

OBJECTIVE: To investigate the feasibility of a rat model on hindlimb ischemia induced by embolization from the administration of polyvinyl alcohol (PVA) particles or N-butyl cyanoacrylate (NBCA). MATERIALS AND METHODS: Unilateral hindlimb ischemia was induced by embolization with NBCA (n = 4), PVA (n = 4) or surgical excision (n = 4) in a total of 12 Sprague-Dawley rats. On days 0, 7 and 14, the time-of-flight magnetic resonance angiography (TOF-MRA) and enhanced MRI were obtained as scheduled by using a 3T-MR scanner. The clinical ischemic index, volume change and degree of muscle necrosis observed on the enhanced MRI in the ischemic hindlimb were being compared among three groups using the analysis of variance. Vascular patency on TOF-MRA was evaluated and correlated with angiographic findings when using an inter-rater agreement test. RESULTS: There was a technical success rate of 100% for both the embolization and surgery groups. The clinical ischemic index did not significantly differ. On day 7, the ratios of the muscular infarctions were 0.436, 0.173 and 0 at thigh levels and 0.503, 0.337 and 0 at calf levels for the NBCA, PVA and surgery groups, respectively. In addition, the embolization group presented increased volume and then decreased volume on days 7 and 14, respectively. The surgery group presented a gradual volume decrease. Good correlation was shown between the TOF-MRA and angiographic findings (kappa value of 0.795). CONCLUSION: The examined hindlimb ischemia model using embolization with NBCA and PVA particles in rats is a feasible model for further research, and muscle necrosis was evident as compared with the surgical model.
Animals ; *Disease Models, Animal ; Embolization, Therapeutic/*adverse effects ; Enbucrilate/administration & dosage/*toxicity ; Feasibility Studies ; Hindlimb/*blood supply ; Injections, Intra-Arterial ; Ischemia/*chemically induced/diagnosis ; Magnetic Resonance Angiography/*methods ; Male ; Polyvinyl Alcohol/administration & dosage/*toxicity ; Rats ; Rats, Sprague-Dawley ; Tissue Adhesives/administration & dosage/toxicity

OBJECTIVE: Ultrasonography has benefit in detecting soft tissue abnormalities within the joints, which cannot be assessed by conventional X-ray. In this study, we investigated the relationship between soft tissue and/or bony abnormalities on ultrasonography and biochemical markers of synovium and cartilage in knee osteoarthritis (OA) patients METHODS: Fifty-one knee OA patients who fulfilled the ACR criteria were enrolled in this study. Knee ultrasonography was performed in affected knee joints with a 12 MHz linear probe to assess the presence of effusion, synovial proliferation, capsular distension, length of osteophytes, and thickness of cartilage. At the same time, the serum levels of hyaluronic acid (HA) and cartilage oligomeric protein (COMP) were measured by ELISA and serum osteocalcin levels were determined by RIA. RESULTS: The patients with longer medial osteophytes showed higher levels of serum HA and COMP than those with shorter ones. Serum HA levels were significantly higher in patients with larger amount of effusion and/or synovial proliferation, suggesting inflammatory changes within the joint, than those without. In addition, the severity of capsular distention was also correlated well with serum HA and COMP levels. However, the length of lateral osteophytes and thickness of femoral cartilage were not correlated with serum HA or COMP levels. Serum osteocalcin levels did not show any association with above ultrasonographic parameters, either. CONCLUSIONS: Using knee ultrasonography, we demonstrated that serum HA and COMP levels were elevated in more severe OA patients than less severe patients. This result suggests that detailed pathologic changes in the soft tissue and/or bone of OA joints on ultrasonography are being directly reflected to biochemical markers measured in the peripheral blood.
Biomarkers* ; Cartilage* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hyaluronic Acid ; Joints ; Knee Joint ; Knee* ; Osteoarthritis, Knee* ; Osteocalcin ; Osteophyte ; Synovial Membrane* ; Ultrasonography*

It is well known that the hippocampal formation requires primary vestibular sensory information to generate spatial memory during self motion in human. The purpose of the present study was to evaluate the effect of unilateral deafferentation of vestibular sensory information on cFos and FosB proteins, a family of immediate early gene-related proteins known as metabolic marker for neural excitation in the hippocampal formation of rats. Adult Sprague-Dawley rats weighing 250 - 300 g were surgically ablated of the peripheral vestibular system in the inner ear and sacrificed at 2, 6, 24, 48, 72 hours after surgical operation. Immunohistochemical staining and Western blot method were adapted to see change in expression of cFos and FosB proteins in the hippocampal formation. A significant change of Fos B immunoreactivity was observed in granular cell layer of the dentate gyrus, CA1 subfield of the hipocampus at 2 hours after unilateral labyrinthectomy. Thereafter, the number of FosB like immunoreactive neurons in these areas increased rapidly, peaked at 48 hours post operatively time. Western blot for FosB protein supported further time-dependent change of FosB revealed by immunohistochemical staining. In addition, granular cell layer showed more significant expression of FosB LI neurons in the caudal dentate gyrus than the rostral one. In contrast, moderate number of cFos LI neurons was detected in polymorphic cell layer of the dentate gyrus, pyramidal cell layer of CA1, and subiculum but not in granular cell layer of the dentate gyrus at 2 hours after labyrinthectomy. The number of cFos LI neurons in the hippocampal formation was rapidly decreased at 6 hours and then returned to basal value 24 hours after operation. These results suggest that unilateral ablation of the peripheral vestibular sensory information elicit spatio-temporal differences of cFos and FosB expressions in the hippocampal formation of rats.
Adult ; Animals ; Blotting, Western ; Dentate Gyrus ; Ear, Inner ; Hippocampus* ; Humans ; Memory ; Neurons ; Pyramidal Cells ; Rats* ; Rats, Sprague-Dawley