Purpose: To present a case of oculomotor nerve atrophy complicated by herpes zoster ophthalmicus (HZO).Case summary: A 68-year-old man with a history of type 2 diabetes and dyslipidemia complained of diplopia and deviation in left eye. On examination, visual acuity was 20/25 in right eye and 20/20 in left eye. Prism and alternate cover tests revealed right exotropia and hypertropia in the primary position. Examination of ductions and versions showed limitation of adduction and depression in the right eye. On detailed history taking, we found that his symptoms started after suffering HZO on right side about 2 years ago. He was prescribed antiviral agents from a dermatology clinic and was told that all symptoms would improve after medication so he didn't undergo an ophthalmologic examination at that time. Magnetic resonance imaging confirmed that diffuse atrophy of oculomotor nerve in cistern along with atrophic changes of medial rectus and inferior rectus muscles in right eye. A diagnosis of strabismus complicated by HZO-induced oculomotor nerve atrophy was done. Conclusions Ophthalmoplegia secondary to HZO may not be self-limiting and have a poor prognosis resulting in cranial nerve atrophy. A detailed imaging investigation of extraocular muscle and cranial nerves along with thorough history taking are required for proper diagnosis and better prognosis.

The variant terminal trunk of the superior mesenteric artery (SMA) could be confused with the ileocolic artery (ICA) as it runs on the right side of the superior mesenteric vein. If the variant ileal branch of SMA is mistaken for the ICA, unintentional ligation could cause long-segment ischemia in the ileum. We encountered a rare case of ileal ischemia caused by unintentional ligation of the variant ileal branch of the SMA during laparoscopic right hemicolectomy, which was confirmed by indocyanine green (ICG) angiography and hyperspectral imaging (HSI). Intraoperative real-time perfusion monitoring using ICG angiography and tissue oxygen saturation monitoring using HSI could help detect segments of hypoperfusion and prevent hypoperfusion-related anastomotic complications.

Treatment for early colon cancer has progressed rapidly with endoscopic resection and minimally invasive surgery. Selection of patients without risk of lymph node metastasis is necessary before deciding on endoscopic resection for early colon cancer treatment. We aimed to review the optimal multidisciplinary treatment strategies for early colon cancer, including endoscopy and surgery.Current Concepts: Pathological risk factors include histologic grade of cancer cell differentiation, lymphovascular invasion, perineural invasion, tumor budding, and deep submucosal invasion. These risk factors for predicting lymph node metastasis are crucial for determining the treatment strategy of endoscopic excision and radical resection for early colon cancer. Prediction of the depth of invasion in early colon cancer using endoscopic optical assessments is vital to determine the appropriate treatment method for endoscopic or surgical resection. Furthermore, optical assessment of pit and vascular patterns is useful for estimating the depth of submucosal invasion using magnifying chromoendoscopy and narrow-band imaging endoscopy. Performing an endoscopic and pathologic evaluation of the risk factors for lymph node metastasis is imperative when selecting endoscopic or surgical resection. Endoscopic treatments include cold snare polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection. In addition, appropriate surgical treatment should be recommended for patients with early colon cancer with a high risk of lymph node metastasis.Discussion and Conclusion: A multidisciplinary approach should be recommended to establish an optimized treatment strategy, minimize the risk of complications, and obtain excellent oncologic outcomes via patienttailored treatment in patients with early colon cancer.

Background: Chronic kidney disease (CKD) has a negative impact on growth and development in children and is a risk factor for neurocognitive impairment; however, there is limited research on the cognitive function of children and adolescents with CKD. This study therefore aimed to investigate the mean intelligence and risk factors for low intelligence in children and adolescents with CKD. Methods: Eighty-one patients with CKD under 18 years old were included in the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD). Participants completed either the Wechsler Intelligence Scale for Children (6–16 years), or Wechsler Adult Intelligence Scale (> 16 years). Results: The mean full-scale intelligence quotient (IQ) was 91 ± 19; 24.7% of participants scored a full-scale IQ below 80. Participants with a short stature (height Z scores < −1.88), failure to thrive (weight Z scores < −1.65), more severe CKD stage (≥ IIIb), longer duration of CKD (≥ 5 years), and those who were Medicare or Medicaid beneficiaries, had significantly lower mean full-scale IQs. Conclusion On linear regression analysis, the association between the full-scale IQ, and longer duration of CKD and growth failure, remained significant after controlling for demographic and clinical variables. It is therefore necessary to investigate cognitive impairment in pediatric patients with CKD who exhibit growth failure or for a longer postmorbid period. It is believed that early interventions, such as kidney transplantation, will have a positive effect on IQ in children with CKD, as the disease negatively affects IQ due to poor glomerular filtration rate over time.

Background: Chronic kidney disease (CKD) has a negative impact on growth and development in children and is a risk factor for neurocognitive impairment; however, there is limited research on the cognitive function of children and adolescents with CKD. This study therefore aimed to investigate the mean intelligence and risk factors for low intelligence in children and adolescents with CKD. Methods: Eighty-one patients with CKD under 18 years old were included in the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD). Participants completed either the Wechsler Intelligence Scale for Children (6–16 years), or Wechsler Adult Intelligence Scale (> 16 years). Results: The mean full-scale intelligence quotient (IQ) was 91 ± 19; 24.7% of participants scored a full-scale IQ below 80. Participants with a short stature (height Z scores < −1.88), failure to thrive (weight Z scores < −1.65), more severe CKD stage (≥ IIIb), longer duration of CKD (≥ 5 years), and those who were Medicare or Medicaid beneficiaries, had significantly lower mean full-scale IQs. Conclusion On linear regression analysis, the association between the full-scale IQ, and longer duration of CKD and growth failure, remained significant after controlling for demographic and clinical variables. It is therefore necessary to investigate cognitive impairment in pediatric patients with CKD who exhibit growth failure or for a longer postmorbid period. It is believed that early interventions, such as kidney transplantation, will have a positive effect on IQ in children with CKD, as the disease negatively affects IQ due to poor glomerular filtration rate over time.

Streptococcus mutans and Streptococcus sobrinus play important roles in dental caries. Coptis chinensis is a natural product with antimicrobial activity against enterobacteria; however, its effects on oral streptococci are still unknown.Therefore, the effects of C. chinensis on the growth and biofilm formation of the representative cariogenic bacteria S. mutans and S. sobrinus were investigated for the possible use of C. chinensis as an anticaries agent. The C.chinensis extract was diluted with sterile distilled water, and 0.1–2.5% of the extract was used in the experiment. The effects of the C. chinensis extract on the growth and glucan formation of S. mutans and S. sobrinus were measured by viable cell counting and spectrophotometry at 650 nm absorbance, respectively. Crystal violet staining was also carried out to confirm the C. chinensis extract’s inhibitory effect on biofilm formation. The C. chinensis extract significantly inhibited the growth of S. mutans and S. sobrinus at concentrations of ≥ 0.3% as compared with the control group. The viable cell count of colonies decreased by 1.7-fold and 1.2-fold at 2.5% and 1.25%, respectively, compared with the control group. The biofilm formation of S. mutans and S. sobrinus was inhibited by > 20-fold at C.chinensis extract concentrations of ≥ 1.25% as compared with the control group. In summary, the C. chinensis extract inhibited the growth and biofilm and glucan formation of S. mutans and S. sobrinus. Therefore, C. chinensis might be a potential candidate for controlling dental caries.

The purpose of the study was to investigate the effects of lipid-coated ZnO (LCZ) and the level of LCZ compared with ordinary zinc oxide (ZnO) on antioxidant defense system in the intestine and liver of piglets. A total of forty piglets (n=8) were fed a diet supplemented with 100 ppm Zn with ZnO (ZnO-1), 2,500 ppm Zn with ZnO (ZnO-2), 100 ppm Zn as LCZ (LCZ-1), 200 ppm Zn as LCZ (LCZ-2), or 400 ppm Zn as LCZ (LCZ-3) for 14-d, respectively. The LCZ-3 group resulted in higher (P < 0.05) mRNA expressions and activities of CuZn-superoxide dismutase (SOD), glutathione peroxidase (GPX), catalase (CAT), and glutathione S-transferase (GST) in jejunal mucosa compared with the ZnO-1 and LCZ-1 groups, while no difference was observed in the mRNA level of antioxidant genes between the ZnO-1 and ZnO-2 groups. Within the LCZ groups, the LCZ level linearly and quadratically (P < 0.01) increased antioxidant enzymes in the jejunum. The maximum response of jejunal antioxidant enzymes to Zn supplementation was achieved by 400 ppm of LCZ. Hepatic mRNA expression of antioxidant enzymes was unaffected by Zn source and level, while hepatic SOD and GST activities were greater (P < 0.05) in the LCZ-3 group than in the ZnO-1 group. No difference was observed in lipid peroxidation of the jejunum and liver and the total antioxidant power of plasma among groups. In conclusion, a supplementation with 400 ppm of LCZ resulted in a maximum increase in antioxidant enzymes, indicating that LCZ may affect antioxidant defense system more profoundly than ZnO.
Catalase ; Diet ; Glutathione Peroxidase ; Glutathione Transferase ; Intestine, Small* ; Intestines ; Jejunum ; Lipid Peroxidation ; Liver* ; Mucous Membrane ; Plasma ; RNA, Messenger ; Zinc Oxide ; Zinc*

Artery to artery embolism is one of the main causes of cerebral infarction, and it can originate from many locations. Here we report a case of cerebral infarction in which calcified cerebral emboli were detected in brain computed tomography (CT). The calcified emboli were thought to originate from a carotid plaque that showed calcification and ulceration. We present histologic and micro-CT findings of a carotid plaque as a source of artery to artery embolism.
Arteries* ; Brain ; Carotid Arteries* ; Cerebral Infarction ; Embolism* ; Intracranial Embolism ; Plaque, Atherosclerotic* ; Ulcer

Annual proficiency surveys were conducted in March, June, and September in 2015 by the Clinical Microbiology Subcommittee of the Korean Association of External Quality Assessment Service. The program covers the sections of bacteriology, advanced bacteriology and mycology, mycobacteriology, and parasitology. Each trial was composed of three sets of different combinations of five bacteria and yeasts. These sets were distributed among laboratories for Gram staining, culture, identification, and antimicrobial susceptibility tests. Five slides with fixed sputum smears were provided as part of each trial for acid-fast bacilli detection. The survey material distribution was section-based. Two survey materials were provided in each trial, while five specimens for mycobacterial culture and identification, five specimens for anti-tuberculosis susceptibility testing and two Mycobacterium tuberculosis strains for rapid detection of rifampin and isoniazid resistance were distributed in the March and June trials. Five virtual microscopy files for stool parasite examination were availed by registered participants in the June trial. Out of the 334 enrolled laboratories, 328 (98.2%), 328 (98.2%), and 329 (98.5%) submitted responses in trials I, II, and III, respectively. Identification of bacteria, namely, Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Vibrio fluvialis by more than 95% of participants was acceptable. Surveillance cultures for vancomycin-resistant enterococci and carbapenem-resistant Enterobacteriaceae were determined accurately by 75.8%–85.3% and 93.1% of the respondents, respectively. Species-level identification of Candida krusei, Candida lusitanae, and Candida guilliermondii was still low at 79.8%, 55.7%, and 42.7%, respectively. Disk diffusion method revealed an unacceptably high false-positive rate of resistance to glycopeptides in E. faecalis and to trimethoprim-sulfamethoxazole in S. pneumoniae. Advanced bacteriology trials revealed unsatisfactory results for species-level identification of moulds. Mycobacterial culture, identification and susceptibility testing, and molecular detection of rifampin and isoniazid resistance were performed exceedingly well by participants. Hymenolepsis diminuta could not be identified by participants, with a correct answer rate of only 46.5% and ‘no parasite seen’ answer rate of only 31.8% for negative specimens. Species-level identification of Candida and moulds was challenging for clinical microbiology laboratories. Disk diffusion method was found to be problematic in testing the susceptibility of microorganisms to glycopeptides and trimethoprim-sulfamethoxazole. Improvement is required in result interpretation of negative specimens in parasitology.
Bacteria ; Bacteriology ; Candida ; Diffusion ; Enterobacteriaceae ; Enterococcus faecalis ; Escherichia coli ; Glycopeptides ; Isoniazid ; Klebsiella pneumoniae ; Korea* ; Methods ; Microscopy ; Mycobacterium ; Mycobacterium tuberculosis ; Mycology ; Parasites ; Parasitology ; Pneumonia ; Pseudomonas aeruginosa ; Quality Control ; Rifampin ; Sputum ; Streptococcus pneumoniae ; Surveys and Questionnaires ; Trimethoprim, Sulfamethoxazole Drug Combination ; Vancomycin-Resistant Enterococci ; Vibrio ; Yeasts

Annual proficiency surveys were performed in March, June and September 2014 by clinical microbiology division of The Korean Association of Quality Assurance for Clinical Laboratory. Parasitology part has been newly incorporated in this survey. For each trial, three sets which were composed of different combinations of five bacteria and yeast were distributed for gram stain, culture, identification, and antimicrobial susceptibility tests of general bacteriology and five fixed sputum smear on slides were distributed for acid fast bacilli stain. Two advanced bacteriology survey materials for culture and identification of anaerobic bacteria and mold were distributed to the voluntary participants in every trial and five mycobacterial culture and identification specimens, five anti-tuberculosis susceptibility testing specimens, and two Mycobacterium tuberculosis strains for rapid detection of rifampin and isoniazid resistance were distributed to the voluntary participants in March and June trials. Five virtual microscopic slides for stool parasite examination were open for the registered participants in June trial. A total of 340 laboratories were enrolled and 330 (97.0%), 331 (97.4%), and 331 (97.4%) returned the results on trial I, II, and III, respectively. For bacterial identification, the percent acceptable identification of Burkholderia cepacia, Klebsiella pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae, Streptococcus agalactiae, Plesiomonas shigelloides, and Enterococcus faecalis were greater than 95%. Group C and group D Salmonella species challenged as the different sets of M1422 resulted in the acceptable rate lower than 95% because nine participants reported the identification of different sets. Surveillance cultures for methicillin-resistant S. aureus and vancomycin-resistant enterococci were correctly determined by 89.6% and 69.0% of the respondents, respectively. Correct identification to species level of Candida albicans, Candida auris, Candida glabrata, and Candida parapsilosis were 86.1%, 1.6%, 48.1%, and 83.8%. Vancomycin disk diffusion test in S. aureus, missing oxacillin screen or penicillin susceptibility test in S. pneumoniae and lack of reliable methods of quinolone resistance detection in Salmonella species caused unacceptable results in antimicrobial susceptibility testing. Advanced bacteriology trials revealed low performance in species identification of mold. Mycobacterial culture, identification and susceptibility test performance was kept in excellence. The performance of identification of stool parasites was acceptable >90% for detection of helminth eggs and amebic cysts but 28.6% false positive responses resulted from negative specimens. In conclusion, species-level identification of fungi of both candida species and mold were challenging to clinical microbiology laboratories. Vancomycin disk diffusion method for S. aureus and lack of proper penicillin susceptibility test for S. pneumoniae were still common cause of inaccurate results. Virtual microscopic survey has been successfully introduced in parasitology.
Bacteria ; Bacteria, Anaerobic ; Bacteriology ; Burkholderia cepacia ; Candida ; Candida albicans ; Candida glabrata ; Surveys and Questionnaires ; Diffusion ; Eggs ; Enterococcus faecalis ; Fungi ; Helminths ; Isoniazid ; Klebsiella pneumoniae ; Korea* ; Methicillin Resistance ; Mycobacterium tuberculosis ; Ovum ; Oxacillin ; Parasites ; Parasitology ; Penicillins ; Plesiomonas ; Pneumonia ; Pseudomonas aeruginosa ; Rifampin ; Salmonella ; Sputum ; Staphylococcus aureus ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Streptococcus pyogenes ; Vancomycin ; Yeasts