INTRODUCTION: In this study, we compared sleep structure, EEG characteristic of pediatric obstructive sleep apnea (OSA) and normal controls which were matched in sex and age. METHODS: Fifteen children (male:female=4:11) who complained snoring and were suspected to have sleep apnea and their age and sex matched normal controls (male:female=5:10) have been done nocturnal polysomnography (NPSG). Sleep parameters, sleep apnea variables and relative spectral components of EEG from NPSG have been compared between both groups. RESULTS: Pediatric OSA group were distinguished from normal controls in terms of apnea index, respiratory disturbance index and nadir of oxyhemoglobulin desaturation. Pediatric OSA group showed increased percent of sleep stage 1, decreased rapid eye movement sleep percent and increased delta power in O1 EEG channel. However other sleep parameters and spectral powers were not different between two groups. CONCLUSION: In pediatric OSA group, sleep structure parameter disruption may be not prominent as the previous studies for adult OSA group because of including mild OSA data in diagnostic criteria. In addition, EEG changes might not be distinct due to low arousal index compared to adult OSA patients. We can observe general characteristics and particularity of pediatric OSA through this study.
Adult ; Apnea ; Arousal ; Child ; Electroencephalography ; Humans ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Sleep Stages ; Sleep, REM ; Snoring

BACKGROUND AND OBJECTIVES: Approximately 10–15% of children with Kawasaki disease (KD) do not respond to initial intravenous immunoglobulin (IVIG) and have higher risk for coronary artery lesion (CAL). The aim of this study was to identify predictive factors from laboratory findings in patients who do not respond to IVIG treatment and develop CAL from KD. METHODS: We retrospectively collected nationwide multicenter data from the Korean Society of Kawasaki Disease and included 5,151 patients with KD between 2012 and 2014 from 38 hospitals. RESULTS: Among 5,151 patients with KD, 524 patients belonged to the IVIG-resistant group. The patients in the IVIG-resistant group had a significantly higher serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level (1,573.91±3,166.46 vs. 940.62±2,326.10 pg/mL; p < 0.001) and a higher percentage of polymorphonuclear neutrophils (PMNs) (70.89±15.75% vs. 62.38±32.94%; p < 0.001). Multivariate logistic regression analyses revealed that significantly increased PMN, NT-proBNP, C-reactive protein (CRP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were the predictors of IVIG resistance (p < 0.05). Multivariate logistic regression analyses also showed that only CRP was associated with the risk of CAL (p < 0.01), while PMN, NT-proBNP, AST, and ALT were not. CONCLUSIONS: Elevated PMN, serum NT-proBNP, CRP, AST, and ALT levels are significantly associated with IVIG resistance in patients with KD. Moreover, serum CRP is significantly increased in patients with KD with CAL.
Alanine Transaminase ; Aspartate Aminotransferases ; C-Reactive Protein ; Child ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Logistic Models ; Mucocutaneous Lymph Node Syndrome ; Natriuretic Peptide, Brain ; Neutrophils ; Retrospective Studies

BACKGROUND AND OBJECTIVES: Approximately 10–15% of children with Kawasaki disease (KD) do not respond to initial intravenous immunoglobulin (IVIG) and have higher risk for coronary artery lesion (CAL). The aim of this study was to identify predictive factors from laboratory findings in patients who do not respond to IVIG treatment and develop CAL from KD. METHODS: We retrospectively collected nationwide multicenter data from the Korean Society of Kawasaki Disease and included 5,151 patients with KD between 2012 and 2014 from 38 hospitals. RESULTS: Among 5,151 patients with KD, 524 patients belonged to the IVIG-resistant group. The patients in the IVIG-resistant group had a significantly higher serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level (1,573.91±3,166.46 vs. 940.62±2,326.10 pg/mL; p < 0.001) and a higher percentage of polymorphonuclear neutrophils (PMNs) (70.89±15.75% vs. 62.38±32.94%; p < 0.001). Multivariate logistic regression analyses revealed that significantly increased PMN, NT-proBNP, C-reactive protein (CRP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were the predictors of IVIG resistance (p < 0.05). Multivariate logistic regression analyses also showed that only CRP was associated with the risk of CAL (p < 0.01), while PMN, NT-proBNP, AST, and ALT were not. CONCLUSIONS Elevated PMN, serum NT-proBNP, CRP, AST, and ALT levels are significantly associated with IVIG resistance in patients with KD. Moreover, serum CRP is significantly increased in patients with KD with CAL.

The Pill Questionnaire (PillQ) has been proposed as a simple way to evaluate cognitive deficits and their impact on the daily lives of those with Parkinson’s disease (PD) by asking patients or caregivers about whether patients can independently manage their pills. We used the PillQ to investigate the association of ability to manage medication with cognition and activities of daily living (ADLs) in patients with PD. Patients were divided into two groups based on PillQ scores. The no-impact group was able to take their antiparkinsonian medication independently, and the impact group exhibited problems describing their treatment or taking their drugs independently. A total of 208 participants (93 men) were included. 111 patients (53.4%) were included in the no-impact group, and 97 (46.6%) were included in the impact group. The impact group showed significantly lower cognitive functioning, difficulties with the performance of ADLs, and severe motor dysfunction. PillQ scores were significantly correlated with Mini-Mental State Examination and the Montreal Cognitive Assessment, and Clinical Dementia Rating scores. Management of medication by PD patients is associated with cognitive function, and the PillQ is an easy and useful test for detecting cognitive impairment and its impact on daily life.

No abstract available.
Candidiasis* ; Paget Disease, Extramammary* ; Vulva

Meningiomas, one of the most common neoplasms of the central nervous system, may be encountered incidentally during autopsy. Most of these tumors, however, are benign and hence, are not considered as the chief cause of death. Further, sudden unexpected death caused by meningioma is very unusual. Moreover, the diagnosis of an incidental meningioma as the cause of sudden death may sometimes be difficult. In the present report, we describe an autopsy case of a sudden, unexpected death due to a large olfactory groove meningioma accompanied by severe cerebral edema and tonsillar herniation.
Autopsy ; Brain Edema ; Brain Neoplasms ; Cause of Death ; Central Nervous System ; Death, Sudden ; Diagnosis ; Encephalocele ; Meningioma*

The hyperosinophilic syndrome (HES) commonly involves liver and spleen but only a few literature has reported the imaging features. In this article, we present the imaging features of the liver and spleen in HES patients together with clinical and laboratory features. This study included 5 HES patients with hepatic involvement. Extensive laboratory tests including multiple hematologic, serologic, parasitologic, and immunologic examinations were performed. Imaging studies included CT, ultrasound (US) of upper abdomen and hepatosplenic scintigraphy. All patients were periodically examined by laboratory and imaging studies for 4 to 24 months. The common clinical presentations were weakness, mild fever, and dry cough. All patients revealed leukocytosis with eosinophilia of 40 to 80% and benign eosnophilic hyperplasia of the bone marrow. The percutaneous biopsy of the hepatic focal lesions performed in 2 patients showed numerous benign eosinophilic infiltrates and one of them revealed combined centrilobular necrosis of hepatocytes. All cases revealed hepatomegaly with multiple focal lesions on at least one of CT, US, or scintigraphy. These findings completely disappeared in 2 To 6 months following medication of corticosteroid or antihistamines. The HES involved the liver and CT, US, or scintigraphy. These findings completelydisappeared in 2 to 6 months following medication of corticosteroid or antihistamines. The HES involved the liver and CT, US, or scintigraphic studies showed hepatic multifocal lesions with hepatomegaly. Differential diagnoses of these findings should include metastatic disease, lymphoma, leukemia. candidiasis or other opportunistic infections.
Abdomen ; Biopsy ; Bone Marrow ; Candidiasis ; Cough ; Diagnosis, Differential ; Eosinophilia ; Eosinophils ; Fever ; Hepatocytes ; Hepatomegaly ; Histamine Antagonists ; Humans ; Hypereosinophilic Syndrome* ; Hyperplasia ; Leukemia ; Leukocytosis ; Liver ; Lymphoma ; Necrosis ; Opportunistic Infections ; Radionuclide Imaging ; Spleen ; Ultrasonography

The hyperosinophilic syndrome (HES) commonly involves liver and spleen but only a few literature has reported the imaging features. In this article, we present the imaging features of the liver and spleen in HES patients together with clinical and laboratory features. This study included 5 HES patients with hepatic involvement. Extensive laboratory tests including multiple hematologic, serologic, parasitologic, and immunologic examinations were performed. Imaging studies included CT, ultrasound (US) of upper abdomen and hepatosplenic scintigraphy. All patients were periodically examined by laboratory and imaging studies for 4 to 24 months. The common clinical presentations were weakness, mild fever, and dry cough. All patients revealed leukocytosis with eosinophilia of 40 to 80% and benign eosnophilic hyperplasia of the bone marrow. The percutaneous biopsy of the hepatic focal lesions performed in 2 patients showed numerous benign eosinophilic infiltrates and one of them revealed combined centrilobular necrosis of hepatocytes. All cases revealed hepatomegaly with multiple focal lesions on at least one of CT, US, or scintigraphy. These findings completely disappeared in 2 To 6 months following medication of corticosteroid or antihistamines. The HES involved the liver and CT, US, or scintigraphy. These findings completelydisappeared in 2 to 6 months following medication of corticosteroid or antihistamines. The HES involved the liver and CT, US, or scintigraphic studies showed hepatic multifocal lesions with hepatomegaly. Differential diagnoses of these findings should include metastatic disease, lymphoma, leukemia. candidiasis or other opportunistic infections.
Abdomen ; Biopsy ; Bone Marrow ; Candidiasis ; Cough ; Diagnosis, Differential ; Eosinophilia ; Eosinophils ; Fever ; Hepatocytes ; Hepatomegaly ; Histamine Antagonists ; Humans ; Hypereosinophilic Syndrome* ; Hyperplasia ; Leukemia ; Leukocytosis ; Liver ; Lymphoma ; Necrosis ; Opportunistic Infections ; Radionuclide Imaging ; Spleen ; Ultrasonography

Unlike the case of adult obstructive sleep apnea syndrome (OSAS), there was no consistent finding on the changes of sleep architecture in childhood OSAS. Further understanding of the sleep electroencephalogram (EEG) should be needed. Non-linear analysis of EEG is particularly useful in giving us a new perspective and in understanding the brain system. The objective of the current study is to compare the sleep architecture and the scaling exponent (alpha) from detrended fluctuation analysis (DFA) on sleep EEG between OSAS and normal children. Fifteen normal children (8 boys/7 girls, 6.0+/-2.2 years old) and twelve OSAS children (10 boys/2 girls, 6.4+/-3.4 years old) were studied with polysomnography (PSG). Sleep-related variables and OSAS severity indices were obtained. Scaling exponent of DFA were calculated from the EEG channels (C3/A2, C4/A1, O1/A2, and O2/A1), and compared between normal and OSAS children. No difference in sleep architecture was found between OSAS and normal controls except stage 1 sleep (%) and REM sleep latency (min). Stage 1 sleep (%) was significantly higher and REM latency was longer in OSAS group (9.3+/-4.3%, 181.5+/-59.9 min) than in controls (5.6+/-2.8%, 133.5+/-42.0 min). Scaling exponent (alpha) showed that sleep EEG of OSAS children also followed the 'longrange temporal correlation' characteristics. Value of alpha increased as sleep stages increased from stage 1 to stage 4. Value of alpha from C3/A2, C4/A1, O1/A2, O2/A1 were significantly lower in OSAS than in control (1.36+/-0.05 vs. 1.41+/-0.04, 1.37+/-0.04 vs. 1.41+/-0.04, 1.37+/-0.05 vs. 1.41+/-0.05, and 1.36+/-0.07 vs. 1.41+/-0.05, p<0.05). Higher stage 1 sleep (%) in OSAS children was consistent finding with OSAS adults. Lower 'alpha' in OSAS children suggests decrease of self-organized criticality or the decreased piling-up energy of brain system during sleep in OSAS children.
Adult ; Brain ; Child ; Electroencephalography ; Humans ; Polysomnography ; Sleep Apnea, Obstructive ; Sleep Stages ; Sleep, REM

Background & Objective: The MAPT H1 haplotype and SNCA single nucleotide polymorphism (SNP) rs356219 have been reported to have a synergistic effect on the risk of Parkinson’s disease (PD). Because the H1/H1 genotype has been reported to predominate in Korean population, we investigated the polymorphism of rs356219 in 878 PD patients and 559 controls. Methods: The SNCA SNP rs356219 was analyzed in 878 PD patients and in 559 healthy Korean subjects. Results: The G allele of SNCA SNP rs356219 was found to contribute to PD susceptibility with odds ratios (ORs) similar to those reported previously. However, the ORs were not as large as that of the SNCA rs356219 plus MAPT H1/H1 combination reported in the literature, which cast doubt on the existence of a synergistic effect between the two genotypes in our population. Conclusions: This study supports that the G allele of the SNCA SNP rs356219 contributes to PD susceptibility as reported previously, but it does not support the presence of a synergistic interaction between SNCA and MAPT.