No abstract available.
Humans ; Infant* ; Streptococcal Infections*

PURPOSE: Brain surface intensity model (BSIM)-based cortical thickness analysis does not require complicated 3D segmentation of brain gray/white matters. Instead, this technique uses the local intensity profile to compute cortical thickness. The aim of the present study was to evaluate intra-rater and inter-rater reliability of BSIM-based cortical thickness analysis using images from elderly participants. MATERIALS AND METHODS: Fifteen healthy elderly participants (ages, 55-84 years) were included in this study. High-resolution 3D T1-spoiled gradient recalled-echo (SPGR) images were obtained using 3T MRI. BSIM-based processing steps included an inhomogeneity correction, intensity normalization, skull stripping, atlas registration, extraction of intensity profiles, and calculation of cortical thickness. Processing steps were automatic, with the exception of semiautomatic skull stripping. Individual cortical thicknesses were compared to a database indicating mean cortical thickness of healthy adults, in order to produce Z-score thinning maps. Intra-class correlation coefficients (ICCs) were calculated in order to evaluate inter-rater and intra-rater reliabilities. RESULTS: ICCs for intra-rater reliability were excellent, ranging from 0.751-0.940 in brain regions except the right occipital, left anterior cingulate, and left and right cerebellum (ICCs = 0.65-0.741). Although ICCs for inter-rater reliability were fair to excellent in most regions, poor inter-rater correlations were observed for the cingulate and occipital regions. Processing time, including manual skull stripping, was 17.07 +/- 3.43 min. Z-score maps for all participants indicated that cortical thicknesses were not significantly different from those in the comparison databases of healthy adults. CONCLUSION: BSIM-based cortical thickness measurements provide acceptable intra-rater and inter-rater reliability. We therefore suggest BSIM-based cortical thickness analysis as an adjunct clinical tool to detect cortical atrophy.
Adult ; Aged ; Atrophy ; Brain* ; Cerebellum ; Humans ; Magnetic Resonance Imaging* ; Skull

BACKGROUND: Takotsubo cardiomyopathy is characterized by clinical features similar to those of acute myocardial ischemia, but without angiographic evidence of obstructive coronary artery disease. We present a patient with takotsubo cardiomyopathy following acute infarction involving the left insular cortex. CASE REPORT: A 52-year-old man was admitted with acute infarction of the left middle cerebral artery territory and acute chest pain. Acute myocardial infarction was suspected because of elevated serum troponin levels and hypokinesia of the left ventricle on echocardiography. However, a subsequent coronary angiography revealed no stenosis within the coronary arteries or ballooning of the apical left ventricle. CONCLUSIONS: We postulated that catecholamine imbalance due to the insular lesion could be responsible for these interesting features.
Cerebral Infarction ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Echocardiography ; Heart Ventricles ; Humans ; Hypokinesia ; Infarction ; Middle Aged ; Middle Cerebral Artery ; Myocardial Infarction ; Myocardial Ischemia ; Takotsubo Cardiomyopathy ; Troponin

Purpose: We aimed to identify the factors associated with the repeated febrile seizures (RFS), defined as recurrent seizures during the same febrile illness. Methods: We reviewed the medical records of children with febrile seizure who visited 4 academic emergency departments from October 2016 through September 2018. Differences were identified in variables regarding clinical and laboratory characteristics between the children with and without RFS. The RFS was the primary outcome. Logistic regression was conducted to identify factors associated with the occurrence of RFS. Results: Among 1,551 children, 922 were included in the study, of whom, 198 (21.5%) underwent RFS. Of the children with RFS, 188 (94.9%) underwent the recurrences within the initial 24 hours. Logistic regression showed focal seizure (adjusted odds ratio, 6.67; 95% confidence interval, 2.37-18.82), venous pH < 7.31 (5.89; 3.13-11.08), and postictal drowsiness > 30 minutes (1.90; 1.30-2.78) as the factors for RFS. Conclusion In children with febrile seizure, focal seizure, acidosis, and prolonged postictal state may be independent risk factors for RFS. These findings may be informed to healthcare professionals and parents caring for children with febrile seizure.

Purpose: We aimed to identify the factors associated with the repeated febrile seizures (RFS), defined as recurrent seizures during the same febrile illness. Methods: We reviewed the medical records of children with febrile seizure who visited 4 academic emergency departments from October 2016 through September 2018. Differences were identified in variables regarding clinical and laboratory characteristics between the children with and without RFS. The RFS was the primary outcome. Logistic regression was conducted to identify factors associated with the occurrence of RFS. Results: Among 1,551 children, 922 were included in the study, of whom, 198 (21.5%) underwent RFS. Of the children with RFS, 188 (94.9%) underwent the recurrences within the initial 24 hours. Logistic regression showed focal seizure (adjusted odds ratio, 6.67; 95% confidence interval, 2.37-18.82), venous pH < 7.31 (5.89; 3.13-11.08), and postictal drowsiness > 30 minutes (1.90; 1.30-2.78) as the factors for RFS. Conclusion In children with febrile seizure, focal seizure, acidosis, and prolonged postictal state may be independent risk factors for RFS. These findings may be informed to healthcare professionals and parents caring for children with febrile seizure.

OBJECTIVE: Neuromelanin loss of substantia nigra (SN) can be visualized as a T1 signal reduction on T1-weighted high-resolution imaging. We investigated whether volumetric analysis of T1 hyperintensity for SN could be used to differentiate between Parkinson's disease dementia (PDD), Alzheimer's disease (AD) and age-matched controls. MATERIALS AND METHODS: This retrospective study enrolled 10 patients with PDD, 18 patients with AD, and 13 age-matched healthy elderly controls. MR imaging was performed at 3 tesla. To measure the T1 hyperintense area of SN, we obtained an axial thin section high-resolution T1-weighted fast spin echo sequence. The volumes of interest for the T1 hyperintense SN were drawn onto heavily T1-weighted FSE sequences through midbrain level, using the MIPAV software. The measurement differences were tested using the Kruskal-Wallis test followed by a post hoc comparison. RESULTS: A comparison of the three groups showed significant differences in terms of volume of T1 hyperintensity (p < 0.001, Bonferroni corrected). The volume of T1 hyperintensity was significantly lower in PDD than in AD and normal controls (p < 0.005, Bonferroni corrected). However, the volume of T1 hyperintensity was not different between AD and normal controls (p = 0.136, Bonferroni corrected). CONCLUSION: The volumetric measurement of the T1 hyperintensity of SN can be an imaging marker for evaluating neuromelanin loss in neurodegenerative diseases and a differential in PDD and AD cases.
Aged ; Alzheimer Disease* ; Dementia* ; Humans ; Magnetic Resonance Imaging ; Mesencephalon ; Neurodegenerative Diseases ; Parkinson Disease* ; Parkinsonian Disorders ; Retrospective Studies ; Substantia Nigra*

The purpose of this study was to propose a method for the effective management of toothbrush contamination. Toothbrush microbial contamination was analyzed according to the duration of toothbrush use, frequency of toothbrush use per day, and toothbrush storage location. We also analyzed the microbial reduction effect of vinegar, antimicrobial mouth rinse, bamboo salt, and baking soda, which are sterilization materials that can be easily used every day. We collected 45 toothbrushes from university dormitories from May to June 2018. To determine the degree of microbiological contamination with general bacteria, coliform bacteria, and Staphylococcus aureus, bristle samples were cultured at 36oC for 24 hours using 3M™ Petrifilm plates and then measured based on Petrifilm evaluation criteria. Toothbrush microorganisms were analyzed according to the duration of use, frequency of use per day, storage location, and effect of each sterilization material. General bacteria, coliforms, and S. aureus contamination increased with frequency and duration of use (p <0.05). In particular, S. aureus showed a statistically significant increase to 36.15 CFU/ml after 1 month, 504.23 CFU/ml after 2 months, and 2,386.67 CFU/ml after 3 months (p <0.05). We found that 1% vinegar was the most effective substance for reducing general bacteria, coliforms, and S. aureus. In addition, 1% antimicrobial mouth rinse solution applied for 5 minutes was the most effective in reducing S. aureus. It is crucial to recognize the importance of toothbrush care and store toothbrushes in a dry place and replace them periodically. We recommend use of vinegar and antimicrobial mouth rinse solution to disinfect toothbrushes. These should be applied as a 1% solution for at least 1 minute. Proper care of toothbrushes is important in maintaining oral health as well as overall health. Instructions on toothbrush care should be given when teaching children or adults how to brush teeth.
Acetic Acid ; Adult ; Bacteria ; Child ; Humans ; Methods ; Mouth ; Oral Health ; Oral Hygiene ; Sodium Bicarbonate ; Staphylococcus aureus ; Sterilization ; Tooth ; Toothbrushing

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths in South Korea. To decrease its mortality rate, its early detection is very important. Screening for HCC detection has been accepted as the management modality for patients with chronic liver disease. Reported herein is a case involving the marked rapid growth of HCC detected at an advanced stage in a screening test with a 3 months interval. A 49-year-old male patient with chronic hepatitis B was admitted to the hospital due to a liver mass detected on CT scan. The patient underwent a first CT scan 3 months earlier, and no tumor was detected. Follow-up CT scan was performed and showed a 9.1 cm HCC with portal vein thrombosis. Percutaneous liver biopsy was performed, and the diagnosis of hepatocellular carcinoma was confirmed. In the pertinent guidelines, the recommended screening interval for HCC is 6-12 months, but the screening interval and additional diagnostic methods should be considered due to the variation in the HCC growth rate according to the patient's clinical characteristics.
Biopsy ; Carcinoma, Hepatocellular ; Early Detection of Cancer ; Follow-Up Studies ; Hepatitis B, Chronic ; Humans ; Liver ; Liver Diseases ; Male ; Mass Screening ; Middle Aged ; Portal Vein ; Republic of Korea ; Thrombosis

BACKGROUND: The angle and depth from the insertion point to the brachial plexus (BP) and C6-7 intervertebral foramen (IF) was examined to prevent critical complications of an interscalene brachial plexus block (ISBPB), such as an epidural or subdural injection of local anesthetics and spinal cord injury. METHODS: Thirty patients (female = 12, male = 18), aged 20-64 years, undergoing shoulder or upper limb surgery were examined. ISBPB was performed at the interscalene groove intersecting the extended transverse line from the cricoid cartilage. A needle was then advanced towards the C6 transverse process (TP) and C6-7 IF under the C-arm fluoroscopic guidance. The depth and angle of the needle path intersecting the sagittal plane from the skin insertion point to BP, transverse process (TP) and IF were measured. RESULTS: The mean depth of the needle from the insertion point to BP, TP and IF were 2.6 +/- 0.3 cm, 3.2 +/- 0.4 cm, 3.7 +/- 0.3 cm in the female patients, and 2.7 +/- 0.3 cm, 3.6 +/- 0.5 cm, 4.1 +/- 0.3 cm in the male patients. The mean angle of the needle path at the same point was 56.0 +/- 7.2o (range, 42.0-65.0degrees), 54.2 +/- 5.8degrees, 53.7 +/- 4.4degrees in the female patients, and 59.3 +/-8.3degrees (45.0-75.0degrees), 54.0 +/- 6.3degrees, 54.9 +/- 4.2degrees in male patients. There were significant differences in the depth from the skin to the TP and IF between males and females. CONCLUSIONS: These findings are expected to provide a guideline for more accurate needle placement and successful block during ISBPB.
Aged ; Anesthetics, Local ; Brachial Plexus ; Cricoid Cartilage ; Epidural Space ; Female ; Humans ; Male ; Needles ; Shoulder ; Skin ; Spinal Cord ; Upper Extremity

BACKGROUND: The angle and depth from the insertion point to the brachial plexus (BP) and C6-7 intervertebral foramen (IF) was examined to prevent critical complications of an interscalene brachial plexus block (ISBPB), such as an epidural or subdural injection of local anesthetics and spinal cord injury. METHODS: Thirty patients (female = 12, male = 18), aged 20-64 years, undergoing shoulder or upper limb surgery were examined. ISBPB was performed at the interscalene groove intersecting the extended transverse line from the cricoid cartilage. A needle was then advanced towards the C6 transverse process (TP) and C6-7 IF under the C-arm fluoroscopic guidance. The depth and angle of the needle path intersecting the sagittal plane from the skin insertion point to BP, transverse process (TP) and IF were measured. RESULTS: The mean depth of the needle from the insertion point to BP, TP and IF were 2.6 +/- 0.3 cm, 3.2 +/- 0.4 cm, 3.7 +/- 0.3 cm in the female patients, and 2.7 +/- 0.3 cm, 3.6 +/- 0.5 cm, 4.1 +/- 0.3 cm in the male patients. The mean angle of the needle path at the same point was 56.0 +/- 7.2o (range, 42.0-65.0degrees), 54.2 +/- 5.8degrees, 53.7 +/- 4.4degrees in the female patients, and 59.3 +/-8.3degrees (45.0-75.0degrees), 54.0 +/- 6.3degrees, 54.9 +/- 4.2degrees in male patients. There were significant differences in the depth from the skin to the TP and IF between males and females. CONCLUSIONS: These findings are expected to provide a guideline for more accurate needle placement and successful block during ISBPB.
Aged ; Anesthetics, Local ; Brachial Plexus ; Cricoid Cartilage ; Epidural Space ; Female ; Humans ; Male ; Needles ; Shoulder ; Skin ; Spinal Cord ; Upper Extremity