Purpose: Vessel wall imaging (VWI) for carotid plaque is better for detecting unstable carotid plaque such as intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thin/ruptured fibrous cap. However, the role of VWI before carotid artery stenting (CAS) is unclear. Thus, this study aimed to determine the findings of symptomatic carotid stenosis before CAS on angiography and carotid VWI and to evaluate the imaging findings associated with post-procedural clinical events after CAS. Materials and Methods: This retrospective study included 173 consecutive patients who underwent carotid VWI, CAS, and post-procedural diffusion-weighted imaging (DWI) after CAS. Findings of unstable plaque on carotid VWI and unstable findings on angiography were analyzed. We also analyzed the incidence of post-procedural clinical events, any stroke, myocardial infarction (MI), and death within 30 days of CAS. Results: Of 173 patients, 101 (58.4%) had initial ischemic symptoms and positive findings on DWI. Symptomatic patients were significantly higher in patients with IPH than in patients without IPH (62.4% vs. 45.8%, P=0.031). Degree of stenosis, thrombus of the stenotic lesion, flow delay of internal carotid artery, and flow arrest by filter thrombus had significantly higher prevalence in the symptomatic group. Twenty patients (11.6%) had post-procedural clinical events such as any stroke, clinical symptoms, and/or MI. Hyperlipidemia and intraluminal thrombus on angiography were identified as significant factors influencing post-procedural events after CAS. Conclusion An intraluminal thrombus on angiography was identified as a significant factor influencing post-procedural clinical events after CAS.

Hypothalamic hamartomas (HHs) are nonneoplastic mass lesions located in the hypothalamus that can cause central precocious puberty (CPP) and/or gelastic seizures. Seckel syndrome 5 (OMIM210600, SCKL5) is a rare autosomal recessive genetic spectrum disorder characterized by intrauterine growth retardation, proportionate osteodysplastic primordial dwarfism, a wide range of intellectual disability, "bird-headed" facial features, and microcephaly with various structural brain abnormalities. Two siblings presented with short stature and small head circumference and were diagnosed with SCKL 5. The younger sister had HH with CPP and experienced a slipped capital femoral epiphysis during treatment. The 2 siblings had the same genetic variant but showed different phenotypes, which has not been reported previously; this study also as presents the first cases of SCKL5 diagnosed by genetic confirmation in Korea.

OBJECTIVES: It is increasingly thought that the human cerebellum plays an important role in emotion and cognition. Although recent evidence suggests that the cerebellum may also be implicated in fear learning, only a limited number of studies have investigated the cerebellar abnormalities in panic disorder. The aim of this study was to evaluate the cerebellar gray matter deficits and their clinical correlations among patients with panic disorder. METHODS: Using a voxel-based morphometry approach with a high-resolution spatially unbiased infratentorial template, regional cerebellar gray matter density was compared between 23 patients with panic disorder and 33 healthy individuals. RESULTS: The gray matter density in the right posterior-superior (lobule Crus I) and left posterior-inferior (lobules Crus II, VIIb, VIIIa) cerebellum was significantly reduced in the panic disorder group compared to healthy individuals (p < 0.05, false discovery rate corrected, extent threshold = 100 voxels). Additionally, the gray matter reduction in the left posterior-inferior cerebellum (lobule VIIIa) was significantly associated with greater panic symptom severity (r = -0.55, p = 0.007). CONCLUSIONS: Our findings suggest that the gray matter deficits in the posterior cerebellum may be involved in the pathogenesis of panic disorder. Further studies are needed to provide a comprehensive understanding of the cerebro-cerebellar network in panic disorder.
Cerebellum* ; Cognition ; Humans ; Learning ; Panic ; Panic Disorder*

Of total 1,438 specimens of patients with diarrhea in Seoul, 2011, 217 samples (15%) were found pathogenic Escherichia coli that included 192 strains (89%) of enterotoxigenic E. coli (ETEC) and enteroaggregative E. coli (EAEC). The highest isolation rate for ETEC and EAEC was found in August and September. Sixty two pathogenic E. coli strains (34 ETEC and 28 EAEC strains) were selected from 175 strains (94 ETEC and 81 EAEC strains) isolated in August and September. Of 94 strains characterized for ETEC phenotype, 76 (81%) expressed heat-stable toxin (ST) only. Antimicrobial susceptibility test was carried out by using sixteen types of antibiotics. A high level of antimicrobial resistance to tetracycline (57%), ampicillin and ticarcillin (54%) was observed among EAEC isolates while the highest resistance rate of ETEC was found for nalidixic acid (47%), followed by tetracycline (32%). As to the antimicrobial susceptibility test, EAEC showed the complicated multi-drug resistant patterns in which the resistance was higher than ETEC. Pulsed-field gel electrophoresis (PFGE) was carried out to examine the genetic relatedness among ETEC and EAEC isolates. Except for 11 strains, 51 strains were divided by eight pulsotypes. In PFGE analysis, isolates from foodborne disease outbreaks in August and September 2011 showed close relation.
Ampicillin ; Anti-Bacterial Agents ; Diarrhea ; Disease Outbreaks ; Electrophoresis, Gel, Pulsed-Field ; Enterotoxigenic Escherichia coli ; Escherichia coli ; Foodborne Diseases ; Humans ; Nalidixic Acid ; Phenotype ; Tetracycline ; Ticarcillin

Clostridium perfringens food poisoning ranks among the most common gastrointestinal diseases in developed countries. In Korea, C. perfringens food poisoning gradually increases. Using PCR, 72 strains of C. perfringens isolated in Seoul, 2013 were tested for the presence of toxin genes. Of the tested strains, 32 isolates carried the cpe gene, 37 isolates carried the cpb2 gene and 3 isolates carried the cpe and cpb2 genes, respectively. 32 cpe-positive strains were isolated from the food poisoning patient, whereas among 37 cpb2-positive strains, 22 strains were isolated from asymptomatic person. To investigate epidemiological relationship between the isolates, Pulsed-filed gel electrophoresis (PFGE) was performed. The genetic relatedness of the isolates ranged from 55.9% to 100% and 47 distinct PFGE profiles were observed. The results show that the cpe-positive outbreak strains showed close genetic relation, whereas the cpb2-positive isolates revealed a wide genetic diversity.
Clostridium perfringens* ; Developed Countries ; Electrophoresis ; Foodborne Diseases* ; Gastrointestinal Diseases ; Genetic Variation ; Humans ; Korea ; Molecular Epidemiology* ; Polymerase Chain Reaction ; Seoul

Left ventricular assist device (LVAD) is a good treatment option for the patients ineligible for cardiac transplantation. Several studies have demonstrated that a ventricular assist device improves the quality of life and prognosis of the patients with end-stage heart failure. A 75-yr-old man debilitated with New York Heart Association (NYHA) functional class III-IV due to severe left ventricular systolic dysfunction received LVAD implantation as a destination therapy. The patient was discharged with improved functional status (NYHA functional class II) after appropriate cardiac rehabilitation and education about how to manage the device and potential emergency situations. This is the first case of successful continuous-flow LVAD implantation as a destination therapy in Korea.
Aged ; Dyspnea ; Echocardiography ; Heart Failure/*surgery ; *Heart-Assist Devices ; Humans ; Male ; Prosthesis Implantation ; Quality of Life ; Republic of Korea ; Treatment Outcome ; Ventricular Dysfunction, Left/*surgery

Alcohol dependence is a serious disorder that can be related with a number of potential health-related and social consequences. Cortical thickness measurements would provide important information on the cortical structural alterations in patients with alcohol dependence. Twenty-one patients with alcohol dependence and 22 healthy comparison subjects have been recruited and underwent high-resolution brain magnetic resonance (MR) imaging and clinical assessments. T1-weighted MR images were analyzed using the cortical thickness analysis program. Significantly thinner cortical thickness in patients with alcohol dependence than healthy comparison subjects was noted in the left superior frontal cortical region, correcting for multiple comparisons and adjusting with age and hemispheric average cortical thickness. There was a significant association between thickness in the cluster of the left superior frontal cortex and the duration of alcohol use. The prefrontal cortical region may particularly be vulnerable to chronic alcohol exposure. It is also possible that the pre-existing deficit in this region may have rendered individuals more susceptible to alcohol dependence.
Alcoholism ; Brain ; Cerebral Cortex ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging

Immunoglobulin A nephropathy (IgAN) is the most prevalent form of glomerulonephritis worldwide. Prediction of disease progression in IgAN can help to provide individualized treatment based on accurate risk stratification. Methods: We performed proton nuclear magnetic resonance-based metabolomics analyses of serum and urine samples from healthy controls, non-progressor (NP), and progressor (P) groups to identify metabolic profiles of IgAN disease progression. Metabolites that were significantly different between the NP and P groups were selected for pathway analysis. Subsequently, we analyzed multivariate area under the receiver operating characteristic (ROC) curves to evaluate the predictive power of metabolites associated with IgAN progression. Results: We observed several distinct metabolic fingerprints of the P group involving the following metabolic pathways: glycolipid metabolism; valine, leucine, and isoleucine biosynthesis; aminoacyl-transfer RNA biosynthesis; glycine, serine, and threonine metabolism; and glyoxylate and dicarboxylate metabolism. In multivariate ROC analyses, the combinations of serum glycerol, threonine, and proteinuria (area under the curve [AUC], 0.923; 95% confidence interval [CI], 0.667–1.000) and of urinary leucine, valine, and proteinuria (AUC, 0.912; 95% CI, 0.667–1.000) showed the highest discriminatory ability to predict IgAN disease progression. Conclusion: This study identified serum and urine metabolites profiles that can aid in the identification of progressive IgAN and proposed perturbed metabolic pathways associated with the identified metabolites.

Purpose: The purpose of this study was to understand the experience of exercise participation among patients following transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction surgery. Methods: A phenomenological method was used in this study. Exercise experiences for twelve patients, who had undergone TRAM flap breast reconstruction, were collected through focus group interviews. Results: The factors that contributed to exercise barriers in the experience of TRAM flap breast reconstruction patient exercise participation were categorized into 3 groups: ‘fear of exercise after surgery’, ‘weakened emotional condition’, and ‘lack of exercise information’. Exercise facilitators after TRAM flap breast reconstruction were also categorized into 3 groups: ‘desire to improve appearance’, ‘feasiable exercise program’, and ‘exercise experience’. Conclusion The results of this study reveal the exercise barriers and facilitators for patients following TRAM flap breast reconstruction, which should be considered to develop effective exercise programs.