Rhabdomyolysis is a complex medical condition in which insufficient energy supply to muscles results in the destruction of skeletal muscle and leakage of toxic intracellular substances into the systemic circulation. The common cause of rhabdomyolysis is a direct traumatic injury; however, it can also occur due to non-traumatic factors, including infection, toxins, and drugs. Rhabdomyolysis as an adverse effect of antipsychotic medication is not well understood. Peripheral neuropathy is a rare complication of rhabdomyolysis. Here, we present a case of a 22-year-old woman who presented to the emergency department with right thigh pain following an antipsychotic drug overdose and 3 days of loss of consciousness. There was no history of trauma to her leg. Physical examination, diagnostic testing, and imaging indicated a diagnosis of rhabdomyolysis and peripheral neuropathy. The patient underwent an incision with drainage, a muscle biopsy, and was treated with hydration, after which her condition improved, and she was discharged. Follow-up testing indicated lasting nerve injury. Peripheral neuropathy can occur even in patients with rhabdomyolysis without compartment syndrome. Awareness of this rare complication may help in initiating early interventions to minimize irreversible sequelae.

Background: To analyze the factors associated with women's vasomotor symptoms (VMS) using machine learning. Methods: Data on 3,298 women, aged 40–80 years, who attended their general health check-up from January 2010 to December 2012 were obtained from Korea University Anam Hospital in Seoul, Korea. Five machine learning methods were applied and compared for the prediction of VMS, measured by the Menopause Rating Scale. Variable importance, the effect of a variable on model performance, was used for identifying the major factors associated with VMS. Results: In terms of the mean squared error, the random forest (0.9326) was much better than linear regression (12.4856) and artificial neural networks with one, two, and three hidden layers (1.5576, 1.5184, and 1.5833, respectively). Based on the variable importance from the random forest, the most important factors associated with VMS were age, menopause age, thyroid-stimulating hormone, and monocyte, triglyceride, gamma glutamyl transferase, blood urea nitrogen, cancer antigen 19-9, C-reactive protein, and low-density lipoprotein cholesterol levels. Indeed, the following variables were ranked within the top 20 in terms of variable importance: cancer antigen 125, total cholesterol, insulin, free thyroxine, forced vital capacity, alanine aminotransferase, forced expired volume in 1 second, height, homeostatic model assessment for insulin resistance, and carcinoembryonic antigen. Conclusion Machine learning provides an invaluable decision support system for the prediction of VMS. For managing VMS, comprehensive consideration is needed regarding thyroid function, lipid profile, liver function, inflammation markers, insulin resistance, monocyte count, cancer antigens, and lung function.

Background: To analyze the factors associated with women's vasomotor symptoms (VMS) using machine learning. Methods: Data on 3,298 women, aged 40–80 years, who attended their general health check-up from January 2010 to December 2012 were obtained from Korea University Anam Hospital in Seoul, Korea. Five machine learning methods were applied and compared for the prediction of VMS, measured by the Menopause Rating Scale. Variable importance, the effect of a variable on model performance, was used for identifying the major factors associated with VMS. Results: In terms of the mean squared error, the random forest (0.9326) was much better than linear regression (12.4856) and artificial neural networks with one, two, and three hidden layers (1.5576, 1.5184, and 1.5833, respectively). Based on the variable importance from the random forest, the most important factors associated with VMS were age, menopause age, thyroid-stimulating hormone, and monocyte, triglyceride, gamma glutamyl transferase, blood urea nitrogen, cancer antigen 19-9, C-reactive protein, and low-density lipoprotein cholesterol levels. Indeed, the following variables were ranked within the top 20 in terms of variable importance: cancer antigen 125, total cholesterol, insulin, free thyroxine, forced vital capacity, alanine aminotransferase, forced expired volume in 1 second, height, homeostatic model assessment for insulin resistance, and carcinoembryonic antigen. Conclusion Machine learning provides an invaluable decision support system for the prediction of VMS. For managing VMS, comprehensive consideration is needed regarding thyroid function, lipid profile, liver function, inflammation markers, insulin resistance, monocyte count, cancer antigens, and lung function.

BACKGROUND: Penile cancer is a rare malignancy associated with high rates of mortality and morbidity. Currently, the efficacy of adjuvant treatment (AT), including radiotherapy and chemotherapy, for penile cancer remains unclear. Therefore, we investigated the prognostic factors for treatment outcomes and the efficacy of AT in consecutive patients who underwent penectomy for penile cancer at multiple Korean institutions between 1999 and 2013. METHODS: AT was defined as the administration of chemotherapy, radiotherapy, or both within 12 months after initial treatment. All patients were divided into two groups according to the AT status. RESULTS: Forty-three patients (median age 67.0 years) with a median follow-up after penectomy of 26.4 (interquartile range: 12.0–62.8) months were enrolled. Patients with AT had a significantly higher pathologic stage. However, no differences in age, histologic grade, or type of surgery were identified according to the presence of AT. The 3- and 5-year cancer-specific survival (CSS) rates were 79.0% and 33.0%, respectively. In a multivariate analysis, American Joint Committee on Cancer (AJCC) stage ≥ III disease was an independent predictor of CSS and recurrence-free survival (RFS). However, AT was not associated with CSS and RFS. The type of primary surgical treatment and inguinal lymph node dissection at diagnosis were also not significantly associated with overall survival, CSS, or RFS. CONCLUSION: AJCC stage ≥ III disease, which mainly reflects lymph node positivity, is a significant prognosticator in patients with penile cancer. By contrast, AT does not seem to affect CSS and RFS.
Chemotherapy, Adjuvant ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Joints ; Lymph Node Excision ; Lymph Nodes ; Male ; Mortality ; Multivariate Analysis ; Penile Neoplasms* ; Prognosis ; Radiotherapy ; Radiotherapy, Adjuvant

BACKGROUND/AIMS: Stress has a role in the pathogenesis of functional dyspepsia (FD) and influences food intake in humans and animals. Prokinetic drugs have been used in FD, and some of these drugs reverse the feeding inhibition (FI) induced by acute restraint stress in rats. We aimed to evaluate the effect of DA-9701 on FI induced by acute restraint in rats. MATERIALS AND METHODS: Male Sprague-Dawley rats were divided into 6 groups: Control (no stress), Stress+vehicle, and Stress+DA-9701 at doses of 1, 3, 10, and 30 mg/kg (n=6~7). DA-9701 or vehicle was administered through gastric gavage 45 minutes before stress. After 60 minutes of stress, pre-weighed chow was given and the weight of remaining food was measured 30 and 60 minutes later. The effect of DA-9701 on FI was compared after pretreatment with WAY100635, a 5HT1A antagonist. RESULTS: The restraint stress group had significantly less food intake than the control group. After feeding, rats given 1 and 3 mg/kg of DA-9701 showed increased food intake at 60 minutes, but this was not statistically significant. Rats given 10 mg/kg of DA-9701 showed significantly increased food intake at 30 minutes and 60 minutes (P < 0.05). Interestingly, rats given 30 mg/kg of DA-9701 showed a significant decrease in food intake, similar to that of the vehicle group. The beneficial effect of 10 mg/kg of DA-9701 on FI was abolished by the pretreatment with WAY100635. CONCLUSIONS: Acute restraint stress reduced food intake in rats and pretreatment with DA-9701 improved stress-induced FI.
Animals ; Dyspepsia ; Eating ; Humans ; Male ; Rats ; Rats, Sprague-Dawley ; Stress, Physiological

PURPOSE: To identify potential predictive factors of incidental prostate cancer (IPca) in patients considering tissue-ablation treatment for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: From the 11 centers, 1,613 men who underwent transurethral resection of the prostate (TURP) or open prostatectomy were included. Before surgery, prostate biopsy was performed in all patients with prostate-specific antigen (PSA) > or =4.0 ng/ml or with abnormal digital rectal examination (DRE) findings. The patients with prostate cancer preoperatively or with PSA >20 ng/ml were excluded. As predictive factors of IPca, age, body mass index, PSA, DRE, and transrectal ultrasonography (TRUS) findings, including total prostate volume (TPV), transition zone volume (TZV), and the presence of hypoechoic lesions, were reviewed. PSA density (PSAD) and PSAD in the transition zone (PSAD-TZV) were calculated. RESULTS: IPca was diagnosed in 78 patients (4.8%). DRE findings, PSA, and TZV were independent predictive factors in the multivariate analysis. In the receiver operating characteristic curve analysis of PSA, PSAD, and PSAD-TZV, the area under the curve (AUC) was the largest for PSAD-TZV (AUC, 0.685). CONCLUSIONS: IPca was detected in 4.8% of the population studied. In addition to DRE findings, the combination of TZV and PSA can be useful predictive factors of IPca in patients considering tissue-ablation treatment as well as TURP.
Biopsy ; Body Mass Index ; Cyanoacrylates ; Digital Rectal Examination ; Humans ; Male ; Multivariate Analysis ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Hyperplasia ; Prostatic Neoplasms ; ROC Curve ; Transurethral Resection of Prostate

PURPOSE: The reliability of test is determined by each items' characteristics. Item analysis is achieved by classical test theory and item response theory. The purpose of the study was to compare the discrimination indices with item response theory using the Rasch model. METHODS: Thirty-one 4th-year medical school students participated in the clinical course written examination, which included 22 A-type items and 3 R-type items. Point biserial correlation coefficient (C(pbs)) was compared to method of extreme group (D), biserial correlation coefficient (C(bs)), item-total correlation coefficient (C(it)), and corrected item-total correlation coeffcient (C(cit)). Rasch model was applied to estimate item difficulty and examinee's ability and to calculate item fit statistics using joint maximum likelihood. RESULTS: Explanatory power (r2) of Cpbs is decreased in the following order: C(cit) (1.00), C(it) (0.99), C(bs) (0.94), and D (0.45). The ranges of difficulty logit and standard error and ability logit and standard error were -0.82 to 0.80 and 0.37 to 0.76, -3.69 to 3.19 and 0.45 to 1.03, respectively. Item 9 and 23 have outfit > or =1.3. Student 1, 5, 7, 18, 26, 30, and 32 have fit > or =1.3. CONCLUSION: C(pbs), C(cit), and C(it) are good discrimination parameters. Rasch model can estimate item difficulty parameter and examinee's ability parameter with standard error. The fit statistics can identify bad items and unpredictable examinee's responses.
Discrimination (Psychology) ; Humans ; Joints ; Schools, Medical

We investigated the seasonality of Anopheles mosquitoes, including its species composition, density, parity, and population densities of mosquitoes infected with the parasite in Ganghwa-do (Island), a vivax malaria endemic area in the Republic of Korea. Mosquitoes were collected periodically with a dry-ice-tent trap and a blacklight trap during the mosquito season (April-October) in 2008. Anopheles sinensis (94.9%) was the most abundant species collected, followed by Anopheles belenrae (3.8%), Anopheles pullus (1.2%), and Anopheles lesteri (0.1%). Hibernating Anopheles mosquitoes were also collected from December 2007 to March 2008. An. pullus (72.1%) was the most frequently collected, followed by An. sinensis (18.4%) and An. belenrae (9.5%). The composition of Anopheles species differed between the mosquito season and hibernation seasons. The parous rate fluctuated from 0% to 92.9%, and the highest rate was recorded on 10 September 2008. Sporozoite infections were detected by PCR in the head and thorax of female Anopheles mosquitoes. The annual sporozoite rate of mosquitoes was 0.11% (2 of 1,845 mosquitoes). The 2 mosquitoes that tested positive for sporozoites were An. sinensis. Malarial infections in anopheline mosquitoes from a population pool were also tried irrespective of the mosquito species. Nine of 2,331 pools of Anopheles mosquitoes were positive. From our study, it can be concluded that An. sinensis, which was the predominant vector species and confirmed as sporozoite-infected, plays an important role in malaria transmission in Ganghwa-do.
Animals ; Anopheles/*classification ; *Disease Vectors ; *Endemic Diseases ; Head/parasitology ; Malaria/*epidemiology/*transmission ; Plasmodium/isolation & purification ; Population Dynamics ; Republic of Korea/epidemiology ; Seasons ; Thorax/parasitology

Although coagulase-negative staphyloccus is the most common organism causing peritonitis in peritoneal dialysis (PD) patients, only one case of PD peritonitis due to Staphylococcus auricularis, the normal flora of external auditory meatus, has been reported over the world. Here we add a case of PD peritonitis caused by methicillin-resistant Staphylococcus auricularis, which was successfully treated with vancomycin. A 79-year-old male PD patient was admitted because of abdominal pain and cloudy peritoneal fluid. At admission, the exit site was clear, and no rebound tenderness was noted although the abdominal wall was diffusely tender. Gram stain of the peritoneal fluid did not reveal any organism, but white blood cell count was 1,210/mm3, with 80% polymorphonuclear cells and 10% lymphocytes. Empirical antibiotic therapy was started with intraperitoneal cefazolin and ceftazidime. Over the next few days, however, the peritoneal fluid was still turbid and showed an elevated cell count. Then, the result of peritoneal fluid culture identified that the organism was oxacillin-resistant Staphylococcus auricularis. Thus the antibiotics were switched into vancomycin, and intraperitoneal vancomycin 1 gm was administered three times at 5 days' intervals to achieve completely clear peritoneal fluid. Staphylococcus auricularis should be considered as a new potential skin organism causing PD peritonitis.
Abdominal Pain ; Abdominal Wall ; Aged ; Anti-Bacterial Agents ; Ascitic Fluid ; Cefazolin ; Ceftazidime ; Cell Count ; Humans ; Leukocyte Count ; Lymphocytes ; Male ; Methicillin Resistance ; Peritoneal Dialysis ; Peritonitis ; Skin ; Staphylococcus ; Vancomycin

Maternal alcohol abuse is thought to be the common cause of mental retardation. Especially, continuous alcohol consumption during critical period of brain development induce fetal alcohol effects. In this study, the authors investigated the effects of maternal alcohol drinking on the postnatal changes of BDNF contents and patterns of BDNF-containing neuron in neonatal rat brain, and, the influence of maternal thyroxine treatment on the brain of pups of alcohol abused mother. Pregnant rats were divided into three groups. Alcohol-fed group (n=4) received 35 calories of liquid alcohol diet daily from gestation day 6; control pair-fed group (n=4) was fed a liquid diet in dextrin replaced alcohol isocalorically; alcohol+T4 group (n=4) received 35 calories liquid alcohol diet and exogenous thyroxine (5 microgram/kg/day) subcutaneously. The amount of BDNF was significantly higher in the alcohol+T4 group as compared to the alcohol group at P7, P14 and P21, especially, alcohol+T4-exposed pups showed a significant increase of BDNF at P7. The decrease in BDNF was found in alcohol group compared to control pair-fed group at all ages. In alcohol+T4 group, BDNF-containing Purkinje cells exhibited mature pattern and monolayer arrangement at P14. Alcohol+T4 group showed mature pattern and numerical increase of BDNF-containing cells in cerebral cortex, hypothalamus and hippocampus at P7. The BDNF immunoreactivity of hippocampus continued to show prominent configuration in alcohol+T4 group at P28. These results indicate that the increase of the BDNF-containing neurons and BDNF amount in pups of thyroxinesupplemented alcohol-exposed dams as compared to control pair-fed and alcohol-exposed pups at P7, presumably suggest the early postnatal growth stimulatory effect of the exogenously supplemented thyroxine. Therefore, the increase of BDNF synthesis caused by maternal administration of exogenous thyroxine may ameliorate fetal alcohol effects, one of the ill effects as a result of the dysthyroid state following maternal alcohol abuse.
Alcohol Drinking ; Alcoholism ; Animals ; Brain* ; Brain-Derived Neurotrophic Factor ; Cerebral Cortex ; Critical Period (Psychology) ; Diet ; Hippocampus ; Humans ; Hypothalamus ; Immunohistochemistry ; Intellectual Disability ; Mothers* ; Neurons* ; Pregnancy ; Purkinje Cells ; Rats ; Thyroxine*