Infections in the elderly are associated with high morbidity and mortality. Diagnosing infections in the elderly is challenging due to their atypical and subtle presentation. A high index of suspicion is often needed. Commonly encountered infections in the elderly include bacterial pneumonia, urinary tract infection, cellulitis and Herpes zoster. In addition, institutionalised elderly and those with multiple hospital admissions are at risk of infection with Multidrug-resistant Organisms (MROs); this can be difficult to manage. The purpose of this article is to look at some common infections in the elderly encountered in the home or nursing home, and review their management.

PURPOSE: This study was conducted to determine the distributions of the polyp detection rate (PDR) and the adenoma detection rate (ADR) according to age by analyzing the polypectomy results. METHODS: A total of 10,098 patients who underwent a colonoscopy in 2013 were included in this study. Chi-square and logistic regression statistical analyses were performed using SPSS ver. 19. RESULTS: The mean age of the patients was 52.7 years old (median, 54 +/- 12.52 years; range, 14 to 92 years). A total of 6,459 adenomatous polyps (61.7%) from a total of 10,462 polyps were eliminated. The PDR was 50.9% (5,136/10,098), and the. ADR was 35.4% (3,579/10,098). The male-to-female ratio was 51.3%:48.7%, with a male-to-female ADR ratio of 42.8% : 27.7% (P < 0.001). In the age distribution, the values of the ADR were 0% for patients in their 10's, 6.3% for those in their 20's, 14.0% for those in their 30's, 28.7% for those in their 40's, 38.4% for those in their 50's, 46.2% for those in their 60's, 55.8% for those in their 70's, 56.1% for those in their 80's, and 33.3% for those in their 90's. In males, the values of the ADR were 0%, 9.1%, 17.1%, 37.8%, 48.2%, 53.6%, 61.7%, 59.1%, and 33.3% for the same age distribution, and a steep increase was found between patients in their 30's and patients in their 40's. Significant (P < 0.001) factors influencing the ADR included sex, previous colonoscopy experience, polypectomy method, and age of more than 40 years. CONCLUSION: In considering the adenoma carcinoma sequence, 28.7% of people, especially 37.8% of males in their 40's showed adenomatous polyps. Whether an earlier first-time colonoscopy will have better results in preventing colorectal cancer should be investigated and discussed.
Adenoma* ; Adenomatous Polyps ; Age Distribution ; Colonic Polyps ; Colonoscopy* ; Colorectal Neoplasms ; Humans ; Logistic Models ; Male ; Mass Screening* ; Polyps

We describe a case of primary malignant melanoma in the fourth ventricle treated with surgery and fractionated high dose radiotherapy. A 27-year-old man was referred to our institution due to drowsy mentality, dysconjugated gaze, and pupil dilatation following vertigo and posterior neck pain. Preoperative magnetic resonance images revealed a fourth ventricular tumor extending to C2 level. The mass was high-signal intensity on T1-weighted image, low- on T2-weighted and homogeneous strong enhancement. Extraneural focus of primary site was not found. After grossly total removal in two staged operations, fractionated high dose radiotherapy was given(6300 cGy, 180cGy X 35 fraction). No tumor recurrence was seen for 12 months after operation. Aggressive treatment involving operative total tumor removal and combined radiotherapy is considered to increase the life span of the patient even with this type of tumor.
Adult ; Dilatation ; Fourth Ventricle* ; Humans ; Melanoma* ; Neck Pain ; Pupil ; Radiotherapy ; Recurrence ; Vertigo

INTRODUCTIONThe aims of this article were to review the role of surgical resection in the management of high-grade gliomas and to determine whether there is any survival benefit from surgical resection.

METHODSA literature review of the influence of surgical resection on outcome was carried out. Relevant original and review papers were obtained through a PubMed search using the following keywords: glioma, resection, prognosis and outcome.

RESULTSPresently, there is a lack of evidence to support a survival benefit with aggressive glioma resection, but this should not detract patients from undergoing surgery as there are many other clinical benefits of glioma excision. In addition, limiting surgical morbidity through the use of adjuvant techniques such as intraoperative magnetic resonance imaging (MRI), functional MRI and awake craniotomy is becoming increasingly important.

CONCLUSIONSIdeally, a randomised controlled trial would be the best way to resolve the issue of whether (and to what extent) surgical resection leads to improvements in patient outcome and survival, but this would not be ethical. The second best option would be well-controlled retrospective studies with a multivariate analysis of all potential confounding factors.

The authors present a rare of prenatally diagnosed congenital anaplastic astrocytoma. A 9-month-old boy had three recurrences despite two surgical resections and various chemotherapeutic regimens. He underwent the 3rd gross tumor removal at 11 months of age, followed by proton therapy, and now he remains disease-free for 3 yr without a significant neurocognitive dysfunction. This is the 1st case of a pediatric tumor treated by proton therapy in Korea, and proton therapy may be a treatment of choice for a congenital anaplastic astrocytoma in infants and young children, considering limitation of radiation therapy.
Astrocytoma/*diagnosis/radiotherapy/surgery ; Brain Neoplasms/*diagnosis/radiotherapy/surgery ; Disease-Free Survival ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Prenatal Diagnosis ; Proton Therapy ; Tomography, X-Ray Computed

Mycobacterium scrofulaceum is an environmental and slow-growing atypical mycobacterium. Emerging evidence suggests that M. scrofulaceum infection is associated with cervical lymphadenitis in children and pulmonary or systemic infections in immunocompromised adults. However, the nature of host innate immune responses to M. scrofulaceum remains unclear. In this study, we examined the innate immune responses in murine bone marrow-derived macrophages (BMDMs) infected with different M. scrofulaceum strains including ATCC type strains and two clinically isolated strains (rough and smooth types). All three strains resulted in the production of proinflammatory cytokines in BMDMs mediated through toll-like receptor-2 and the adaptor MyD88. Activation of MAPKs (extracellular signal-regulated kinase 1/2, and p38, and c-Jun N-terminal kinase) and nuclear receptor (NF)-kappaB together with intracellular reactive oxygen species generation were required for the expression of proinflammatory cytokines in BMDMs. In addition, the rough morphotypes of M. scrofulaceum clinical strains induced higher levels of proinflammatory cytokines, MAPK and NF-kappaB activation, and ROS production than other strains. When mice were infected with different M. scrofulaceum strains, those infected with the rough strain showed the greatest hepatosplenomegaly, granulomatous lesions, and immune cell infiltration in the lungs. Notably, the bacterial load was higher in mice infected with rough colonies than in mice infected with ATCC or smooth strains. Collectively, these data indicate that rough M. scrofulaceum induces higher inflammatory responses and virulence than ATCC or smooth strains.
Adult ; Animals ; Bacterial Load ; Child ; Cytokines ; Humans ; Immunity, Innate ; Lung ; Lymphadenitis ; Macrophages* ; Mice ; Mycobacterium scrofulaceum* ; NF-kappa B ; Nontuberculous Mycobacteria ; Phosphotransferases ; Reactive Oxygen Species ; Virulence

BACKGROUND: Cardiovascular disease is known as an important predictor of mortality, not only in patients undergoing dialysis treatment but also in those who are starting dialysis treatment. In addition, it is well known that cardiovascular morbidity is about twice higher in diabetic patients. In this study, MIBI and echocardiography were performed in patients starting dialysis treatment, and a comparison of these findings between diabetic (DM) and non-diabetic (Non-DM) patients was done. METHODS: Among the patients diagnosed as end- stage renal disease (ESRD) and started dialysis treatment at Severance Hospital, 77 patients underwent MIBI and echocardiography when they were clinically stable within 4 weeks after the initiation of dialysis. Clinical characteristics, laboratory findings, MIBI and echocardiographic findings of the 77 patients were analyzed. RESULTS: The mean age of the patients was 58.4+/-10.8 years with sex ratio of 1.1: 1. Of the 77 patients, 52 were DM and 25 were Non-DM. There were 30 patients (39.0%) with abnormal findings on MIBI scan, 26 with reVersible and 4 with fixed defects, and 69 patients (89.6%) with left ventricular hypertrophy (LVH) on echocardiography. DM group showed higher prevalence of myocardial perfusion defect than Non-DM group (48.1% vs. 20.0%, p< 0.05). There were no differences in the prevalence of LVH (92.3% vs. 84.0%) and in left ventricular ejection fraction (LVEF) (56.1+/-13.1% vs. 57.5+/-11.8%) between DM and Non-DM groups. LVEF was significantly lower in patients with abnormal findings on MIBI scan than those with normal MIBI finding. CONCLUSION: The majority of ESRD patients starting dialysis treatment accompanied LVH and myocardial perfusion defect was present in many cases especially in diabetic patients. Therefore, early evaluation and treatment of ischemic heart disease are mandatory in diabetic patients starting dialysis treatment for ESRD.
Cardiovascular Diseases ; Diabetes Mellitus ; Dialysis* ; Echocardiography* ; Humans ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic ; Mortality ; Myocardial Ischemia ; Perfusion ; Prevalence ; Sex Ratio ; Stroke Volume ; Technetium Tc 99m Sestamibi* ; Tomography, Emission-Computed, Single-Photon*

A diversity of synthetic cathinones has flooded the recreational drug marketplace worldwide. This variety is often a response to legal control actions for one specific compound (e.g. methcathinone) which has resulted in the emergence of closely related replacement. Based on recent trends, the nitrogen atom is one of the sites in the cathinone molecule being explored by designer type modifications. In this study, we designed and synthesized two new synthetic cathinones, (1) α-piperidinopropiophenone (PIPP) and (2) α-piperidinopentiothiophenone (PIVT), which have piperidine ring substituent on their nitrogen atom. Thereafter, we evaluated whether these two compounds have an abuse potential through the conditioned place preference (CPP) in mice and self-administration (SA) in rats. We also investigated whether the substances can induce locomotor sensitization in mice following 7 days daily injection and challenge. qRT-PCR analyses were conducted to determine their effects on dopamine-related genes in the striatum. PIPP (10 and 30 mg/kg) induced CPP in mice, but not PIVT. However, both synthetic cathinones were not self-administered by the rats and did not induce locomotor sensitization in mice. qRT-PCR analyses showed that PIPP, but not PIVT, reduced dopamine transporter gene expression in the striatum. These data indicate that PIPP, but not PIVT, has rewarding effects, which may be attributed to its ability to affect dopamine transporter gene expression. Altogether, this study suggests that PIPP may have abuse potential. Careful monitoring of this type of cathinone and related drugs are advocated.
Animals ; Dopamine Plasma Membrane Transport Proteins ; Gene Expression ; Mice ; Nitrogen ; Rats ; Reward

Epilepsy is a brain disorder that affects millions of people worldwide. It is characterized by recurrent and unpredictable seizures that are usually controlled with antiepileptic/anticonvulsive drugs. However, most antiepileptic drugs produce various side effects such as tolerance and sedation. Thus, there is a growing interest for alternative anticonvulsive drugs, preferably from natural or herbal sources. In this study, we evaluated the anticonvulsive effects of Rehmannia glutinosa (RG). The anticonvulsive effect of RG extract was evaluated using electroshock- and chemical-induced seizure tests in mice. To identify its probable mechanism of action, the effects of RG extract on Cl− influx was measured in vitro. We found that RG extract has anticonvulsive effects against electroshock-induced seizures, as indicated by an increased seizure threshold in mice. The RG extract also decreased the percentage of seizure responses induced by the GABAergic antagonist, pentylenetetrazole. These results suggest that the anticonvulsive effects of RG extract are mediated through a GABAergic mechanism. In support of this mechanism, our in vitro test showed that RG extract increases intracellular Cl− influx. Furthermore, RG extract did not show sedative and/or muscle relaxant effects in the open-field and rota-rod tests. Altogether, these results confirm that RG extract could be a herbal anticonvulsant and a potential alternative for clinical use.
Animals ; Anticonvulsants ; Brain Diseases ; Epilepsy ; gamma-Aminobutyric Acid* ; In Vitro Techniques ; Mice ; Pentylenetetrazole ; Rehmannia* ; Seizures* ; Water*

Recently, there has been a rise in the number of amphetamine derivatives that serve as substitutes for controlled substances (e.g. amphetamine and methamphetamine) on the global illegal drug market. These substances are capable of producing rewarding effects similar to their parent drug. In anticipation of the future rise of new and similar psychoactive substances, we designed and synthesized four novel amphetamine derivatives with N-benzyl, N-benzylamphetamine HCl (NBNA) substituent on the amine region, 1,4-dioxane ring, ethylenedioxy-amphetamine HCl (EDA), methyl, para-methylamphetamine HCl (PMEA), and naphthalene, 2-(aminopropyl) naphthalene HCl (2-APN) substituents on the phenyl site. Then, we evaluated their abuse potential in the conditioned place preference (CPP) test in mice and self-administration (SA) test in rats. We also investigated the psychostimulant properties of the novel drugs using the locomotor sensitization test in mice. Moreover, we performed qRT-PCR analyses to explore the effects of the novel drugs on the expression of D1 and D2 dopamine receptor genes in the striatum. NBNA, but not EDA, PMEA, and 2-APN, induced CPP and SA in rodents. None of the test drugs have produced locomotor sensitization. qRT-PCR analyses demonstrated that NBNA increased the expression of striatal D1 dopamine receptor genes. These data indicate that NBNA yields rewarding effects, suggesting potential for abuse. Continual observation for the rise of related substances is thus strongly encouraged.
Amphetamine* ; Animals ; Controlled Substances ; Humans ; Mice ; Parents ; Rats ; Receptors, Dopamine ; Reward ; Rodentia