Hepatitis B and C virus prevalence in a rural area of South Korea: the role of acupuncture

A cross-sectional study evaluated the prevalence of and the risk factors for hepatitis C and B viruses among 700 adults above the age of 40 years in a rural area of South Korea. Seropositivity for hepatitis C virus antibody (11.0%, 95% confidence interval: 8.7-13.6) was higher than that for hepatitis B surface antigen (4.4%, 95% confidence interval: 3.0-6.2). Anti-hepatitis C virus seropositivity was associated with a history of repeated acupuncture (odds ratio=2.1, 95% confidence interval: 1.1-4.0), and blood transfusion (odds ratio=5.5, 95% confidence interval: 1.6-19.3) before 1992 when hepatitis C virus screening in blood donors became mandatory. Hepatitis C virus 2a was the most prevalent genotype, followed by 1b. Hepatitis C virus risk attributable to acupuncture was 38% (9% for men and 55% for women). Safer acupuncture practice has become a priority for hepatitis C virus prevention in South Korea.

Dopamine transporter density is decreased in parkinsonian patients with a history of manganese exposure: what does it mean?

Manganese (Mn) exposure can cause parkinsonism. Pathological changes occur mostly in the pallidum and striatum. Two patients with a long history of occupational Mn exposure presented with Mn-induced parkinsonism. In one patient, magnetic resonance imaging (MRI) showed findings consistent with Mn exposure, and Mn concentration was increased in the blood and urine. However, this patient's clinical features were typical of idiopathic Parkinson disease (PD). Previous pathological and positron emission tomography studies indicate that striatal dopamine transporter density is normal in Mn-induced parkinsonism, whereas it is decreased in PD. Therefore, we performed [(123)I]-(1r)-2 beta-carboxymethoxy-3beta-(4-iodophenyl)tropane ([(123)I]-beta-CIT) single-photon emission computed tomography. Severe reduction of striatal beta-CIT binding was indicated, which is consistent with PD. We propose three interpretations: (1) the patients have PD, and Mn exposure is incidental; (2) Mn induces selective degeneration of presynaptic dopaminergic nerve terminals, thereby causing parkinsonism; or (3) Mn exposure acts as a risk of PD in these patients. Our results and careful review of previous studies indicate that the axiom that Mn causes parkinsonism by pallidal lesion may be over-simplified; Mn exposure and parkinsonism may be more complex than previously thought. Further studies are required to elucidate the relationship between Mn and various forms of parkinsonism.

Synthesis of 188 Re-labelled long chain alkyl diaminedithiol for therapy of liver cancer

Radioisotope-labelled lipiodol has been used in the therapy of liver cancer. Recently a lipiodol solution of 188Re-labelled diaminedithiol (DD) has been reported to show a high uptake in the liver cancer. We synthesized long-chain alkyl DD derivatives to improve their uptake and retention in tissue. As the length of the alkyl chain increased, tissue uptake and retention also increased due to hydrophobic interaction with lipiodol. Among the synthesized compounds, the lipiodol solution of 188Re-HDD, the DD derivative with the longest side chain (C16), is a promising agent for therapy of liver cancer.

Geographical distribution and accumulation features of organochlorine residues in bivalves from coastal areas of South Korea

As a part of Mussel Watch Program in Korea, the contamination levels and accumulation features of polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) were assessed for 82 bivalve samples collected from 66 sites along the entire coast of Korea. The dry weight based sigmaPCBs and sigmaOCPs ranged from 4.4 ng g(-1) to 422.0 ng g(-1) (geometric mean = 36.9 ng g(-1)) and from 9.95 ng g(-1) to 131.37 (34.88) ng g(-1), respectively. PCB was predominant in Korean coast, followed by DDTs, HCHs, and Chlordanes. From the observed log normal distribution of PCB and each OCP, low- and high-levels were defined as geometric mean +/- 1 S.D., respectively. The levels at the sites near urban and/or industrial areas often exceeded the high-levels and the spatial distributions of sigmaDDTs and sigmaCHLs were correlated with that of sigmaPCBs, indicating terrestrial input pathways. Even distribution of sigmaHCHs suggested a possibility of atmospheric input pathway of HCHs. The observed isomer ratios of DDTs, HCHs, and CHLs indicated that aging has occurred.

Granulocytic sarcoma in MLL-positive infant acute myelogenous leukemia: fluorescence in situ hybridization study of childhood acute myelogenous leukemia for detecting MLL rearrangement

Granulocytic sarcoma is considered to be rare and its frequent occurrence is associated with specific genetic changes such as t(8;21). To investigate an association between MLL (mixed lineage leukemia or myeloid-lymphoid leukemia) rearrangement and granulocytic sarcoma, we applied fluorescence in situ hybridization for detection of the 11q23/MLL rearrangements on the bone marrow cells of 40 patients with childhood acute myelogenous leukemia (AML). Nine (22.5%) of 40 patients exhibited MLL rearrangements. Three (33.3%) of these nine patients had granulocytic sarcoma and were younger than 12 months of age. Of these three patients one presented as granulocytic sarcoma of both testes with cerebrospinal fluid involvement, the second case presented in the form of an abdominal mass, and the third as a periorbital granulocytic sarcoma. On the other hand, no granulocytic sarcomas were found among MLL-negative patients. It is likely that MLL-positive infant AML may predispose granulocytic sarcoma. Regarding the findings of our study and those of other reports, we would guess that the incidence of granulocytic sarcoma in pediatric MLL-positive AML may be equal to or greater than the 18 to 24% described in AML with t(8;21). Further investigations designed to identify 11q23/MLL abnormalities of leukemic cells or extramedullary tumor may be helpful for the precise diagnosis of granulocytic sarcoma.

Functional neuroimaging in epilepsy: FDG PET and ictal SPECT

Epileptogenic zones can be localized by F-18 fluorodeoxyglucose positron emission tomography (FDG PET) and ictal single-photon emission computed tomography(SPECT). In medial temporal lobe epilepsy, the diagnostic sensitivity of FDG PET or ictal SPECT is excellent, however, the sensitivity of MRI is so high that the incremental sensitivity by FDG PET or ictal SPECT has yet to be proven. When MRI findings are ambiguous or normal, or discordant with those of ictal EEG, FDG PET and ictal SPECT are helpful for localization without the need for invasive ictal EEG. In neocortical epilepsy, the sensitivities of FDG PET or ictal SPECT are fair. However, because almost a half of the patients are normal on MRI, FDG PET and ictal SPECT are helpful for localization or at least for lateralization in these non-lesional epilepsies in order to guide the subdural insertion of electrodes. Interpretation of FDG PET has been recently advanced by voxel-based analysis and automatic volume of interest analysis based on a population template. Both analytical methods confirmed the performance of previous visual interpretation results. Ictal SPECT was analyzed using subtraction methods(coregistered to MRI) and voxel-based analysis. Rapidity of injection of tracers, HMPAO versus ECD, and repeated ictal SPECT, which remain the technical issues of ictal SPECT, are detailed.

Diagnostic performance of [18F]FDG-PET and ictal [99mTc]-HMPAO SPECT in occipital lobe epilepsy

PURPOSE

We investigated whether interictal F-18 fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) or ictal [99mTc]-HMPAO single-photon emission computed tomography (SPECT) was useful to find epileptogenic zones in occipital lobe epilepsy (OLE).

METHODS

We reviewed visually and quantified patterns of hypometabolism in interictal [18F]FDG-PET and those of hyperperfusion in ictal SPECT in 17 OLE patients (27 plus minus 6.8 years old; M/F, 10/7; injection time, 30 plus minus 17 s). OLE was diagnosed based on invasive electroencephalography, surgery, and postsurgical outcome (Engel class I in all at an average of 26 months after surgery).

RESULTS

Epileptogenic zones were correctly localized in nine (60%) of 15 patients by interictal [18F]FDG-PET, and asymmetric indices corroborated visual diagnosis. Epileptogenic hemispheres were correctly lateralized in 14 (93%) of 15 patients on [18F]FDG-PET. Epileptogenic hemispheres were correctly lateralized in 13 (76%) of 17 patients using ictal SPECT, but localization was possible in only five (29%) patients. Interictal [18F]FDG-PET was helpful in two of the patients who showed no abnormality on magnetic resonance imaging (MRI) and no possible localization with ictal SPECT.

CONCLUSIONS

In OLE, ictal SPECT was helpful in lateralization, but less helpful in localization. Interictal [18F]FDG-PET was helpful in localization or lateralization of epileptogenic zones, even in patients with ambiguous MRI or ictal SPECT findings.

Disparity of perfusion and glucose metabolism of epileptogenic zones in temporal lobe epilepsy demonstrated by SPM/SPAM analysis on 15O water PET, [18F]FDG-PET, and [99mTc]-HMPAO SPECT

PURPOSE

To elucidate uncoupling of perfusion and metabolism and its significance in epilepsy, 15O water and 18F fluorodeoxyglucose (FDG) positron emission tomography (PET) and Tc-99m hexamethyl-propyleneamine-oxime (HMPAO) single-photon emission computed tomography (SPECT) were examined by SPM (statistical parametric mapping) and quantitation by using SPAM (statistical probabilistic anatomic map).

METHODS

[15O]water and [18F]FDG-PET, and [99mTc]-HMPAO SPECT were performed in 25 patients (SPECT in 17 of 25) with medial temporal lobe epilepsy. For volume of interest (VOI) count analysis, the normalized counts using VOI based on SPAM templates of PET and SPECT were compared with those of the normal controls. Perfusion or metabolism was found abnormal if the Z score was >2 for each VOI. For SPM analysis, the differences between each patient's image and a group of normal control images (t statistic for p < 0.01) on a voxel-by-voxel basis were examined to find significant decreases in perfusion or metabolism.

RESULTS

With SPAM VOI count analysis, areas of hypoperfusion were found in 13 patients in the epileptogenic temporal lobes by [15O]water PET and areas of hypometabolism in 21 patients by [18F]FDG-PET. With voxel-based SPM analysis, the epileptogenic zones were localized in 15 by [15O]water PET and in 23 patients by [18F]FDG-PET. The localization by [15O]water PET was concordant with that of [18F]FDG-PET. The areas of hypoperfusion on [15O]water PET were absent or smaller than the areas of hypometabolism on [18F]FDG-PET. Interictal [99mTc]-HMPAO SPECT revealed the hypoperfused zones in seven of 17 patients on visual assessment.

CONCLUSIONS

SPAM VOI count and SPM analysis of [15O]water and [18F]FDG-PET and [99mTc]-HMPAO SPECT revealed that in the same patients, the areas of hypoperfusion were concordant with but smaller than the areas of hypometabolism. Discordance of perfusion and metabolic abnormalities represents an uncoupling of perfusion and metabolism in the epileptogenic zones, and this might explain the lower diagnostic accuracy of perfusion imaging in temporal lobe epilepsy.

Biological nitrogen removal with enhanced phosphate uptake in a sequencing batch reactor using single sludge system

Simultaneous biological phosphorus and nitrogen removal with enhanced anoxic phosphate uptake was investigated in an anaerobic-aerobic-anoxic-aerobic sequencing batch reactor ((AO)2 SBR). Significant amounts of phosphorus-accumulation organisms (PAOs) capable of denitrification could be accumulated in a single sludge system coexisting with nitrifiers. The ratio of the anoxic phosphate uptake to the aerobic phosphate uptake capacity was increased from 11% to 64% by introducing an anoxic phase in an anaerobic aerobic SBR. The (AO)2 SBR system showed stable phosphorus and nitrogen removal performance. Average removal efficiencies of TOC, total nitrogen, and phosphorus were 92%, 88%, and 100%, respectively. It was found that nitrite (up to 10 mg NO2(-)-N/l) was not detrimental to the anoxic phosphate uptake and could serve as an electron acceptor like nitrate. In fact, the phosphate uptake rate was even faster in the presence of nitrite as an electron acceptor compared to the presence of nitrate. It was found that on-line sensor values of pH, ORP, and DO were somehow related with the dynamic behaviours of nutrient concentrations (NH4+, NO3-, and PO4(3-)) in the SBR. These on-line sensor values were used as real-time control parameters to adjust the duration of each operational phase in the (AO)2 SBR. The real-time controlled SBR exhibited better performance in the removal of phosphorus and nitrogen than the SBR with fixed-time operation.

Different patterns of lymphoscintigraphic findings in patients with intestinal lymphangiectasia

Technetium-99m antimony sulfide colloid lymphoscintigraphy conveniently demonstrates intestinal leakage of lymph in patients with intestinal lymphangiectasia. However, we found no intestinal radioactivity in some patients. We evaluated lymphoscintigraphic findings and compared them with clinical data. Technetium-99m antimony colloid lymphoscintigraphy was performed in 12 patients (age, 8.9+/-6.4 years; male:female=8:4) with histologically proven intestinal lymphangiectasia. After subcutaneous injection of 103.6 MBq of technetium-99m antimony colloid into the webs of both feet, sequential abdominal images were obtained up to 24 h post-injection. Four patients underwent technetium-99m methylene diphosphonate bone scintigraphy. Patients were divided into two groups according to the presence or absence of intestinal radioactivity. Five showed intestinal activity (Group 1), but seven did not (Group 2). No Group 1 patient had a history of ascites, while all Group 2 patients had ascites as the initial manifestation. Serum total protein and albumin levels were significantly lower in Group 1 patients than in Group 2 patients. In three Group 1 patients, technetium-99m methylene diphosphonate bone scintigraphy revealed intestinal radioactivity, while in one Group 2 patient this was not found. We observed two types of lymphoscintigraphic pattern in patients with intestinal lymphangiectasia. To clarify the exact pathophysiology, further study is required.

Correction of nasal valve stenosis with lateral suture suspension

OBJECTIVE

To evaluate the effectiveness of using suspension sutures to relieve obstructed nasal breathing caused by nasal valve stenosis. SUBJECTS, MATERIALS, AND METHODS: A nonrandomized pilot study of postrhinoplasty patients presenting with symptoms of obstructed nasal breathing was conducted in a private facial plastic surgery practice. All patients demonstrated nasal valve stenosis with a positive Cottle maneuver, clinically evident nasal valve collapse, and lack of response to efforts at reduction in turbinate size. Follow-up ranged from 7 to 12 months. Four men aged 31 to 58 years (mean age, 43 years) and 5 women aged 26 to 52 years (mean age, 39 years) were included in this study in a 1-year period. The nasal valve was suspended with 2 permanent sutures on each side, which were tunneled within the facial soft tissue to an infraorbital incision to lateralize the nasal valve complex and relieve nasal airway obstruction. Subjective self-assessment data for nasal airflow were collected. Preoperative and postoperative observation and photographic analysis provided objective data.

RESULTS

All patients exhibited improvement.

CONCLUSIONS

Relief of nasal valve stenosis can be achieved with suspension suture technique as described. It is effective and, in our experience, has been the most predictable means of achieving improvement in nasal obstruction secondary to nasal valve stenosis.

Eradication of severe neonatal systemic candidiasis with amphotericin B lipid complex

OBJECTIVE

To report the successful use of amphotericin B lipid complex in treating severe systemic candidiasis in a very-low-birth-weight infant.

CASE SUMMARY

A preterm female infant, born at 25 weeks' gestational age with a birth weight of 870 g, had received full supportive care in the neonatal intensive care unit (NICU), including mechanical ventilation, total parenteral nutrition, and placement of central venous catheters. At seven weeks of age, she developed severe disseminated candidiasis, which failed to respond to conventional amphotericin B and fluconazole therapy. Her progressive deterioration was reversed only after amphotericin B lipid complex (A-complex) was substituted for conventional amphotericin B. The improvement in her condition was impressive, and she made a full recovery without any adverse effect.

DISCUSSION

With increased reliance on invasive technologies for life support, systemic candida infections have become increasingly common among premature infants in the NICU. Such infections are potentially fatal for the high-risk neonate. A literature review shows limited documentation of the use of lipid-based formulations of amphotericin B, especially A-complex, in preterm infants. However, the collective experience with these products appears to show that they are effective and cause fewer adverse effects than conventional amphotericin B. The infant reported here had shown progressive deterioration from disseminated candidiasis until conventional amphotericin B therapy was replaced with A-complex. Her recovery corresponded to the clearance of the candidemia.

CONCLUSIONS

With favorable results and increasing experience with lipid-based formulations of amphotericin B, it is reasonable to consider these new formulations as therapy for candidemia in preterm infants who are at a high risk of nephrotoxicity or who have failed conventional therapy.

Comparison between anisometropic and strabismic amblyopia using functional magnetic resonance imaging

AIMS

To assess calcarine activation with functional magnetic resonance imaging (fMRI) in patients with anisometropic and strabismic amblyopia.

METHODS

14 amblyopes (eight anisometropic and six strabismic) were studied with fMRI using stimuli of checkerboards of various checker sizes and temporal frequencies. While T2* weighted MRI were obtained every 3 seconds for 6 minutes, patients viewed the stimuli monocularly with either the amblyopic or sound eye.

RESULTS

Amblyopic eyes showed reduced calcarine activation compared with contralateral sound eyes in fMRI in all subjects. The calcarine activation from amblyopic eyes in anisometropic amblyopes was more suppressed at higher spatial frequencies, while that from amblyopic eyes in strabismic amblyopes was more suppressed at lower spatial frequencies.

CONCLUSION

These results suggest that fMRI is a useful tool for the study of amblyopia in humans. The calcarine activation via amblyopic eyes because of anisometropia or strabismus has different temporospatial characteristics, which suggests differences in the neurophysiological mechanisms between two types of amblyopia.

Cigarette smoke extract induces endothelin-1 via protein kinase C in pulmonary artery endothelial cells

We examined the mechanism of endothelin (ET)-1 regulation by cigarette smoke extract (CSE) and the effect of platelets on CSE-induced stimulation of ET-1 gene expression in human and bovine pulmonary artery endothelial cells (PAECs). Our data show that CSE (1%) induces ET-1 gene expression (after 1 h) and ET-1 peptide synthesis (after 4 h) in bovine PAECs. The induction of preproET-1 mRNA level was due to de novo transcription, and new protein synthesis was not required for this induction. The protein kinase C inhibitors staurosporine (10(-8) mol/l) and calphostin C (10(-7) mol/l) abolished the induction of ET-1 gene expression by CSE in bovine and human PAECs. Although a lower concentration of platelets (10(6) cells/ml in bovine PAECs; 10(7) cells/ml in human PAECs) did not significantly alter ET-1 gene expression in PAECs, incubation of platelets with CSE (1%) and PAECs produced a significant increase in preproET-1 mRNA and ET-1 peptide compared with the values in the presence of CSE (1%) alone. CSE (1%) induced platelet aggregation and increased the expression of platelet membrane glycoproteins ex vivo. Thus our data suggest that CSE stimulates ET-1 gene expression via PKC in PAECs. CSE and platelets showed a synergistic effect on ET-1 gene expression, possibly through the activation of platelets by CSE.

Genistein, a soy isoflavone, is a potent alpha-glucosidase inhibitor

Genistein is an isoflavone that is known to be contained in soybean. It was proved that genistein plays a pivotal role in homeostasis in the human body. In the course of screening for useful alpha-glucosidase inhibitors, we isolated and identified genistein as a candidate for alpha-glucosidase inhibitor from fermentation broths of a Streptomyces sp. Genistein was shown to be a reversible, slow-binding, non-competitive inhibitor of yeast alpha-glucosidase with a K(i) value of 5.7x10(-8) M when the enzyme mixture was pretreated with genistein. These results show a possibility that genistein could be a useful tool for metabolic disorders.

Quantification of F-18 FDG PET images in temporal lobe epilepsy patients using probabilistic brain atlas

A probabilistic atlas of the human brain (Statistical Probabilistic Anatomical Maps: SPAM) was developed by the international consortium for brain mapping (ICBM). It is a good frame for calculating volume of interest (VOI) in many fields of brain images. After calculating the counts in VOI using the product of probability of SPAM images and counts in FDG images, asymmetric indices (AI) were calculated and used for finding epileptogenic zones in mesial temporal lobe epilepsy (mTLE). FDG PET images from 18 surgically confirmed mTLE patients and 22 age-matched controls were spatially normalized to the average brain MRI template of ICBM. Counts from normalized PET images were multiplied with the probability of 12 VOIs from SPAM images in both temporal lobes. Finally AI were calculated on each pair of VOIs, and compared with visual assessment. If AI of mTLE patients were not within 2.9 standard deviation from those of normal control group (P < 0.008; Bonferroni correction for P < 0.05), epileptogenic zones were considered to be found successfully. The counts of VOIs in the normal control group were symmetric (AI < 4.3%, paired t test P > 0.05) except for those of the inferior temporal gyrus (P < 0.001). By AIs in six pairs of VOIs, PET in mTLE had deficit on one side (P < 0.05). Lateralization was correct in only 14/18 of patients by AI, but 17/18 were consistent with visual inspection. In three patients with normal AI, PET images were symmetric on visual inspection. The asymmetric indices obtained by taking the product of the statistical probability anatomical map and FDG PET, correlated well with visual assessment in mTLE patients. SPAM is useful for the quantification of VOIs in functional images.

Thrombogenicity of radiofrequency ablation procedures: what factors influence thrombin generation?

AIMS

Thromboembolic complications have been reported after radiofrequency ablation but the low incidence of overt clinical events has been a limitation to the study of factors affecting thrombogenic risk. The aim of this study was to determine whether radiofrequency ablation has a procoagulant effect and to examine variables that affect thrombio generation.

METHODS AND RESULTS

Thirty-seven consecutive patients who underwent radiofrequency ablation were studied prospectively. Blood samples were assayed for thrombin-antithrombin III (TAT) and d-dimer (DD) at five different time points: (1) baseline; (2) after sheath insertion; (3) after electrophysiological study but before radiofrequency ablation; (4) at completion of the procedure; and (5) 24 h post-procedure. TAT levels were within the normal range at baseline and increased significantly after sheath insertion from 2.1 +/- 1.2 microg l(-1) to 13.3 +/- 16.0 microg l(-1) (P<0.01). Levels increased further to 24.0 +/- 19.9 microg l(-1) (P<0.01) after electrophysiological study but did not increase after radiofrequency ablation. TAT normalized at 24 h. DD increased significantly from baseline values (230.2 +/- 176.8 ng ml(-1)) to 285.4 +/- 237.4 ng ml(-1) (P=0.019) after sheath insertion. There was a further significant increase after electrophysiological study to 423.4 +/- 324.3 ng ml(-1) (P<0.01), and a slight but non-significant increase to 464.4 +/- 307.4 ng ml(-1) after radiofrequency ablation (P=0.159). DD remained elevated at 24 h. Procedure duration was the only variable that correlated with the relative increase in TAT and DD. The patients with the longest procedure durations had more catheters inserted, more radiofrequency applications and largely consisted of accessory bypass tract-mediated tachycardias. Heparin administration significantly blunted the relative increase in TAT after radiofrequency ablation (P=0.005).

CONCLUSION

Radiofrequency ablation procedures confer an increased risk of thrombosis. Catheterization and diagnostic study contribute largely to the thrombogenic stimulus. Thrombogenicity is increased in prolonged, complex procedures and is decreased in patients who have been administered heparin during the procedure.

Fluorodeoxyglucose positron emission tomography for detection of recurrent or metastatic breast cancer

Fluorodeoxyglucose-positron emission tomography (FDG-PET) is a noninvasive imaging technique capable of identifying primary tumors and metastases with high sensitivity and accuracy. The aim of this study was to evaluate the diagnostic accuracy of whole-body FDG-PET imaging for the detection of recurrent or metastatic breast cancer after surgery. Whole-body FDG-PET imaging was performed on 27 patients with suspected recurrent breast carcinoma. PET images were evaluated qualitatively for each patient and lesion. FDG-PET scans showed that there were 61 reference sites of malignant or benign lesions in 27 patients. In a patient-based analysis, FDG-PET scans correctly identified 16 of 17 patients with recurrent or metastatic disease and 8 of 10 without recurrence, resulting in a sensitivity, specificity, and accuracy of 94%, 80%, and 89%, respectively. In a lesion-based analysis, FDG-PET scans correctly identified 46 of 48 lesion sites with recurrent or metastatic disease and 11 of 13 without recurrence. The overall sensitivity, specificity, and accuracy for all lesion sites were 96%, 85%, and 93%, respectively. FDG-PET scans revealed unsuspected recurrent or metastatic diseases in 8 of 27 (30%) of patients and 11 of 20 (55%) distant metastatic lesions. In 13 patients treatment was altered by the outcome of the PET scan. We concluded that whole-body FDG-PET scan is a useful diagnostic imaging modality for detecting recurrent or metastatic breast carcinoma in patients suspected of having recurrent disease after primary surgery.

Neuroimaging findings of cortical dyslamination with cytomegaly

PURPOSE

Our aims were to identify (a) the characteristic magnetic resonance imaging (MRI) findings of cortical dyslamination with cytomegaly, including dysplastic and destructive lesions; (b) the relationship between MRI findings and pathologic characteristics; (c) the diagnostic role of functional neuroimaging studies in patients with these pathologies.

METHODS

The series consisted of 23 adult patients who had proven cortical dyslamination with cytomegaly. The abnormalities found on MRI were subdivided according to the patterns of involvement. They also were compared with the patients' pathologic characteristics. With visual qualitative analysis, [18F]fluorodeoxyglucose with positron emission tomography (FDG-PET), and ictal single-photon emission computed tomography (SPECT), observations were classified as localizing, lateralizing, nonlateralizing, false-localizing, and false-lateralizing. The standard for correct localization of neuroimages was defined to be the resected lobe.

RESULTS

Focal abnormalities were found in 14 cases by MRI. Six cases showed typical MRI findings of focal cortical dysplasia, with focal areas of cortical thickening with or without poor grey-white matter differentiation. Focal subcortical high signal intensities on T2-weighted images occurred in two cases. Six patients had the focal destructive pattern. Three of eight cases with normal MRI and four of eight cases with the nondestructive cortical dysplasia pattern had balloon cells. However, these were not found in six patients with the destructive MRI pattern. FDG-PET localized the pathologic lobe in 13 (65%) of 20 cases, and ictal SPECT achieved this in 11 (61.1%) of 18 cases. FDG-PET and ictal SPECT also correctly localized the pathologic lobe in four and two cases with normal MRI, respectively.

CONCLUSIONS

Two distinct patterns of abnormal MRI were found in the pathology of cortical dyslamination with cytomegaly. These dysplastic and destructive patterns might reflect different pathogeneses, such as the time of insult. FDG-PET and ictal SPECT have confirmatory and independent diagnostic roles in localizing epileptogenic foci.

Amelanotic choroidal nevus and melanoma: cytology, tumor size, and pigmentation as prognostic indicators

BACKGROUND

Choroidal nevi are fairly common lesions of the posterior pole that can sometimes transform into melanoma, and it is thought that most choroidal melanomas arise from preexisting nevi. Occasionally, these lesions present as nonpigmented or amelanotic variations of their pigmented counterparts. Recent studies suggest a relationship between tumor pigmentation and risk of growth and metastasis, with a better prognosis for lightly pigmented or amelanotic lesions.

CASE REPORTS

A case of an amelanotic choroidal nevus and melanoma are presented. In Case 1, a 26-year-old white female was found to have a large amelanotic nevus in the right eye. After 7 years of periodic observation, the lesion has not changed. In Case 2, a 51-year-old white male was diagnosed with a large amelanotic melanoma in the left eye. Due to extensive involvement of the optic nerve, the patient underwent enucleation. Histological evaluation confirmed the lesion as a mixed-cell type malignant amelanotic melanoma.

CONCLUSION

Management of choroidal nevi generally consists of periodic observation, and the most widely accepted management of choroidal melanoma is observation, radiotherapy, and transpupillary thermotherapy or enucleation. The therapeutic modality of choice for melanoma will vary depending on the size, growth, and location of the lesion. In addition, recent studies suggest an association between heavy tumor pigmentation, tumor size, cell type, and risk of metastasis. Although many variables will influence the final treatment option, pigmentation of the lesion should also be considered.

Survival, morbidity, and resource use of infants of 25 weeks' gestational age or less

OBJECTIVE

The objective of this study was to examine survival, morbidity, and resource use in a large cohort of extremely preterm infants.

STUDY DESIGN

We examined all (n = 754) neonatal intensive care unit admissions born at < or =25 weeks' gestation and inborn deliveries (n = 949) between 22 and 25 weeks' gestation at 17 Canadian neonatal intensive care units.

RESULTS

The overall survival rate was 63%, with a range from 14% at 22 weeks' gestation to 76% at 25 weeks' gestation. There was a high incidence of chronic lung disease (33%-51%), > or =grade 3 intraventricular hemorrhage (0%-16%), necrotizing enterocolitis (0%-14%), > or =stage 3 retinopathy of prematurity (27%-55%), nosocomial infection (25%-39%), and multiple gestation (18%-46%). Extremely preterm infants comprise 4% of neonatal intensive care unit admissions but account for 22% of deaths, 20%-60% of major morbidities, 11% of patient days, and 10%-35% of major procedures. Outborn infants had a higher incidence of chronic lung disease, severe retinopathy of prematurity, and intraventricular hemorrhage.

CONCLUSION

Extremely preterm infants have a high incidence of mortality and morbidity and consume disproportionate amounts of neonatal intensive care unit resources.

Thermoreversible gelation of biodegradable poly(epsilon-caprolactone) and poly(ethylene glycol) multiblock copolymers in aqueous solutions

The multiblock copolymers composed of poly(ethylene glycol)s (PEGs) and biodegradable poly(epsilon-caprolactone)s (PCLs) were synthesized through one-step condensation copolymerization with hexamethylene diisocyanate (HDI) as a coupling agent. The typical phase diagram of these multiblock copolymers in aqueous solution displayed a critical gel concentration (CGC) and an upper phase-transition temperature, which were mainly determined by the PEG/PCL block ratio, the PEG or PCL block lengths and the molecular weight. With decreasing PEG/PCL block ratio, the CGC decreased with an elevated sol-gel transition temperature on account of the enhanced hydrophobicity. The HDI/Diols ratio was used to control the molecular weight. At high molecular weights, the CGC decreased, related to the enhanced aggregation of PCL blocks and physical crosslinkage between PCL block domains due to the increased number of PCL blocks in each molecule. For the sample containing the long PCL(2000) block (M(n), 2000), the CGC dropped dramatically due to the high hydrophobicity and the poor compatibility between PCL and PEG. The dynamic phase transition process was observed by combining optical microscopy (OM) and differential scanning calorimetry (DSC) in a certain heating/cooling rate. Finally, a possible phase separation-induced gelation mechanism is suggested.

Immunophenotypic and cytogenetic changes in acute leukaemia at relapse

To gain more insight into the immunophenotypic and cytogenetic changes in acute leukaemia at relapse, 99 Korean patients treated at a single institution were studied: acute myelogenous leukaemia (AML, n=46), acute lymphoblastic leukaemia (ALL, n=44) and biphenotypic and mixed leukaemia (n=9). Immunophenotypic changes at relapse were observed in 51 of 99 patients (51.5%) with almost even distribution in AML and ALL. Overall expression of aberrant markers on leukaemic cells was more frequent at relapse than at initial diagnosis (P < 0.05), and this finding was most prominent in B lineage ALL (41.4% versus 10.3%, P=0.007). Gain of aberrant CD13 or CD33 at relapse of B lineage ALL was most frequently observed. Cytogenetic changes at relapse were observed in 28 of 46 patients (60.8%). The initially abnormal karyotypes were more frequently associated with clonal changes at relapse compared to initially normal karyotypes (78.3% versus 43.5%, P=0.016). Cytogenetic changes were more frequent in B lineage ALL than in AML (90% versus 47.8%, P=0.05). In ALL, patients showing cytogenetic changes at relapse were significantly younger than those showing no changes (mean age of 15.0 versus 38.8, P=0.002), whereas in AML there was no significant difference between the two groups. In conclusion, the gain of aberrant markers and cytogenetic changes at relapse, which are suggestive of clonal instability, are more prevalent in B lineage ALL compared to AML, and lymphoid leukaemic cells of younger patients are more susceptible to clonal changes at relapse.

Uteroglobin gene polymorphisms affect the progression of immunoglobulin A nephropathy by modulating the level of uteroglobin expression

Uteroglobin (UG) is an anti-inflammatory/immunomodulatory protein. Targeted disruption of UG rendered mouse glomerulonephritis resembling immunoglobulin (Ig)A nephropathy (IgAN). Sequence analysis on exon 1 of UG showed several putative binding sites for transcription factors, and polymorphisms in this site might influence the expression level of UG as a competitive protein. We speculated that the single nucleotide polymorphism at the 38th nucleotide (A to G) from the transcription initiation site of UG exon 1 would impact the progression of IgA nephropathy (IgAN). Polymerase chain reaction-restriction fragment length polymorphism and single-strand conformation polymorphism were instituted to determine the genetic polymorphism. Luciferase assay was performed using the gene constructs containing a region 404-bp long located upstream of UG exon 1 initiation site to analyse whether this polymorphism would affect the expression level. UG polymorphism was distributed no differently in patients with IgAN (n = 111) compared to 60 healthy control subjects. An excess of A genotype was found in one patient having progressive disease (P = 0.03) and the risk for the disease progression increased as the number of A alleles increased (P for trend = 0.03) after follow-up for 116 months. The odds ratio for progression with the AA genotype was 4.9 (95% Cl = 1.0-23.9) compared to patients having the GG genotype. Significant interactive effects of hypertension and genetic polymorphisms of UG on the disease progression were observed (P for interaction = 0.001). In the luciferase assay, the gene construct with A at the 38th site showed a decreased activity of 74 +/- 8.4% compared to that showed by G gene construct. Our results suggest that polymorphism at the 5' UTR region of UG exon 1 is an important marker for the progression of IgAN and may modulate the level of protein expression.

2,2-Diphenyl-1-picrylhydrazyl hydrate, a stable free radical, is an alpha-glucosidase inhibitor

Glycosidases play a pivotal role in processing of various glycoproteins and glycolipids. It is well known that glycosidases are also involved in a variety of degenerative metabolic disorders such as cancer and AIDS. In order to develop potent alpha-glucosidase inhibitors, we first screened 2,2-diphenyl-1-picrylhydrazyl hydrate as a candidate. 2,2-Diphenyl-1-picrylhydrazyl hydrate was found to inhibit alpha- and beta-glucosidases as well as alpha- and beta-mannosidases. It was also shown to be a non-competitive inhibitor of yeast alpha-glucosidase with a Ki value of 1.1 x 10(-6) M. Taken together, we anticipate that 2,2-diphenyl-1-picrylhydrazyl hydrate may be a potent inhibitor for some incurable metabolic disorders including AIDS.

Binocularity and spatial frequency dependence of calcarine activation in two types of amblyopia

OBJECTIVE AND BACKGROUND

Strabismus and anisometropia early in life frequently causes monocular amblyopia. Activation of the visual cortex is compared between the two types of amblyopia to elucidate differences in the pathogenetic mechanism of the disease.

METHODS

Using an EPI gradient echo sequence in 1.5T MRI, calcarine activation by monocular viewing of checkerboard patterns with reversal was examined in terms of binocularity of the activation and dependence on the spatial frequency of the stimuli.

RESULTS

First, the proportion of voxels activated by both normal and amblyopic eye monocular stimulations is lower in the strabismic group than in the anisometropic group. Second, the activation by higher-spatial-frequency stimuli is reduced in the anisometropic group, but not in the strabismic group.

CONCLUSIONS

These findings from the human visual cortex are consistent with the view proposed based on animal research that the loss of binocular interaction and the undersampling of high-spatial-frequency components of visual stimuli are each one of the underlying changes in strabismic and anisometropic amblyopia, respectively.

Blind separation of cardiac components and extraction of input function from H(2)(15)O dynamic myocardial PET using independent component analysis

The independent component analysis (ICA) method is suggested to be useful for separation of the ventricles and the myocardium and for extraction of the left ventricular input function from the dynamic H(2)(15)O myocardial PET. The ICA-generated input function was validated with the sampling method, and the myocardial blood flow (MBF) calculated with this input function was compared with the microsphere results.

METHODS

We assumed that the elementary activities of the ventricular pools and the myocardium were spatially independent and that the mixture of them composed dynamic PET image frames. The independent components were estimated by recursively minimizing the mutual information (measure of dependence) between the components. The ICA-generated input functions were compared with invasively derived arterial blood samples. Moreover, the regional MBF calculated using the ICA-generated input functions and single-compartment model was correlated with the results obtained from the radiolabeled microspheres.

RESULTS

The ventricles and the myocardium were successfully separated in all cases within a short computation time (<15 s). The ICA-generated input functions displayed shapes similar to those obtained by arterial sampling except that they had a smoother tail than those obtained by sampling, which meant that ICA removed the statistical noise from the time--activity curves. The ICA-generated input function showed a longer time delay of peaks than those obtained by arterial sampling. MBFs estimated using the ICA-generated input functions ranged from 1.10 to approximately 2.52 mL/min/g at rest and from 1.69 to approximately 8.00 mL/min/g after stress and correlated well with those calculated with microspheres (y = 0.45 + 0.98x; r = 0.95, P < 0.000).

CONCLUSION

ICA, a rapid and reliable method for extraction of the pure physiologic components, was a valid and useful method for quantification of the regional MBF using H(2)(15)O PET.

An apparently sporadic case with parkin gene mutation in a Korean woman

OBJECTIVE

To report the clinical features and results of iodine I 123-2beta-carbomethoxy-3beta-(4-iodophenyl)-tropane (CIT) single photon emission computed tomography and molecular genetic analysis in a Korean woman with juvenile Parkinson disease with deletion in exon 4 of the parkin gene.

DESIGN

Case report with molecular genetic analysis.

PATIENT AND RESULTS

The patient had bradykinesia, postural imbalance, and postural tremor since the age of 12 years. She developed wearing off early in the disease course. The [(123)I]-2beta-carbomethoxy-3beta-(4-iodophenyl)-tropane single photon emission computed tomography showed severe reduction of specific striatal CIT binding, comparable to that of Parkinson disease. The polymerase chain reaction products from the parkin gene showed homozygous exon 4 deletion.

CONCLUSION

In this sporadic juvenile Parkinson disease case, severe nigrostriatal dopaminergic damage and homozygous exon 4 deletion in the parkin gene were demonstrated.

A Case of Primary MALT Lymphoma of the Breast

Primary malignant lymphoma of the breast is rare. The incidence of primary malignant lymphomas of the breast is 0.04% to 0.5% of all malignant tumors of the breast and 0.07% of all non-Hodgkin's lymphomas, and comprises 1.7% of extranodal malignant lymphomas that occur in Western countries. The incidence of mucosa- associated lymphoid tissue (MALT) lymphoma of the breast is reported to be between 0% and 75% of all primary malignant breast lymphomas in United States and Japan, but the incidence in Korea is unknown. MALT is characterized by indolent behavior and good has a prognosis. The authors report on a patient who has a primary MALT lymphoma of the breast. She was treated by surgical excision, which was followed by radiation therapy. Histologically, her lymphoma type transformed into a diffuse large B-cell tumor after 10months. She received combination chemotherapy and achieved a complete state of remission. She then underwent autologous peripheral blood stem cell transplantation along with high dose chemotherapy. To our knowledge, this is the first case report in the literature in Korea.

Comparative analysis of MR imaging, positron emission tomography, and ictal single-photon emission CT in patients with neocortical epilepsy

BACKGROUND AND PURPOSE

MR imaging, positron emission tomography (PET), and single-photon emission CT (SPECT) play important roles in presurgical localization of epileptic foci. However, comparative study of these imaging methods for cases of neocortical epilepsy has been limited. The purpose of this study was to compare the sensitivities of these three imaging methods for presurgical localization of neocortical epileptogenic foci.

METHODS

We studied 117 consecutive patients who underwent surgery for intractable neocortical epilepsy. The pathologic substrates were neuronal migration disorder (n = 77), tumor (n = 15), and others (n = 25). MR imaging was compared retrospectively with (18)F-fluorodeoxyglucose PET and ictal technetium-99m hexamethylpropyleneamine oxime SPECT regarding their capability to correctly localize the epileptogenic foci. The pathologic findings were used as the standard of reference.

RESULTS

Overall, MR imaging, PET, and ictal SPECT correctly localized the lesions for 59.8%, 77.7%, and 70.3% of the patients, respectively, with a 38% concordance rate among the three methods. PET was most sensitive (71-100%) in detecting all substrates. MR imaging was as sensitive (100%) as PET in detecting tumor but was least sensitive (48.1%) in detecting neuronal migration disorder. Ictal SPECT was more sensitive (75.8%) than MR imaging in detecting neuronal migration disorder. Patients with imaging abnormalities achieved good outcomes in 81.4% of the cases, in contrast to 59.5% for those without imaging abnormalities (P <.05).

CONCLUSION

PET and ictal SPECT were overall more sensitive than was MR imaging, despite the low concordance rate and variable sensitivity depending on substrates. The detection of abnormalities by MR imaging was associated with good outcome. PET or ictal SPECT can be well used as complementary tools, particularly in cases of negative MR imaging findings.

Enhanced biological phosphorus removal in an anaerobic-aerobic sequencing batch reactor: characteristics of carbon metabolism

Carbon metabolism of activated sludge performing enhanced biological phosphorus removal (EBPR) was investigated in a sequencing batch reactor (SBR), where glucose and acetate were supplied as carbon sources. There have been reports that EBPR often failed because of outgrowth of G-bacteria, which are able to use glycogen (or glucose) alone instead of glycogen and polyphosphate as an internal energy storage pool for the anaerobic uptake and storage of acetate. However, in this experiment, complete EBPR was achieved without proliferation of G-bacteria despite the supply of glucose in addition to the acetate. Additional one-cycle SBR operation was carried out to investigate the detailed metabolism of glucose and acetate. Acetate-using, phosphorus-accumulating organisms (PAOs) could use glucose as a source for the anaerobic polyhydroxyalkanoate (PHA) synthesis from acetate. However, glucose and acetate were metabolized separately through independent metabolic pathways by respective microorganisms: acetate-using PAOs, lactate-producing organisms (LPOs), and lactate-using PAOs. Glucose was rapidly converted to lactic acid by LPOs before acetate-using PAOs used the glucose as an energy source for the anaerobic PHA synthesis from acetate and the lactateusing PAOs anaerobically synthesized PHA from lactate at the expense of polyphosphate. The EBPR was accomplished by acetate-using PAOs and lactate-using PAOs independently when glucose acetate were supplied together.

Reproducibility of an automatic quantitation of regional myocardial wall motion and systolic thickening on gated 99mTc-sestamibi myocardial SPECT

We investigated the reproducibility of an automatic quantitative algorithm for measuring regional myocardial wall motion and systolic thickening.

METHODS

99mTc-sestamibi gated myocardial SPECT with dipyridamole stress was performed twice consecutively on 31 patients with known or suspected coronary artery disease, with the patients in the same position for each scan. With AutoQUANT software, segmental wall motion and systolic thickening were quantified automatically and expressed in millimeters and percentage increase, respectively, for 20 segments. Afterward, the correlation and agreement between repeated measurements were investigated, and the influences of wall location, perfusion grade, and partitioning of the myocardium on reproducibility were evaluated by ANOVA and t testing.

RESULTS

High correlations (r = 0.95 for wall motion and 0.88 for systolic thickening) and good agreements (weighted kappa = 0.81 and 0.71, respectively) were obtained from repeated measurements on consecutive gated SPECT. Changes in wall location and perfusion grade did not cause significant differences between repeated measurements (P > 0.05 in ANOVA and t testing), but a change in partitioning did. On Bland-Altman analysis, 2 SDs for repeated wall motion and for systolic thickening were 2.0 mm and 20%, respectively.

CONCLUSION

The automatic quantitative algorithm for myocardial SPECT provided by AutoQUANT software has good reproducibility under diverse conditions. A change of motion > 2.0 mm or a change of systolic thickening > 20% can be regarded as significant during a follow-up study using this software.

Epstein-Barr virus-associated peripheral T-cell lymphoma in adults with hydroa vacciniforme-like lesions

We describe two Korean adult patients who had necrotizing papulovesicles mainly on their faces. Skin biopsy specimens showed perivascular and periadnexal infiltrate of atypical lymphoid cells with vasculitis in the dermis and subcutaneous tissue. In situ hybridization demonstrated a latent infection of Epstein-Barr virus in the majority of lymphoid cells in the dermis. These patients were diagnosed as having T-cell lymphoma. Interestingly, large granular lymphocytosis was found in the peripheral blood of Case 2.

Relationship between expression of the sodium/iodide symporter and 131I uptake in recurrent lesions of differentiated thyroid carcinoma

The sodium/iodide symporter (NIS) is known to be responsible for the active accumulation of iodide within the thyroid gland. We evaluated the relationship between the expression of NIS in primary or lymph node lesions and iodine-131 uptake in recurrent lesions of differentiated thyroid cancer. In 67 patients with differentiated thyroid cancer (5 follicular and 62 papillary carcinomas), the expression of NIS was analysed by immunohistochemical staining using polyclonal antibodies against human NIS. We used paraffin block tissues of primary tumours or metastatic lesions, and also assessed 131I uptake in recurrent lesions of thyroid cancer on post-operative 131I whole-body scan. Immunohistochemical staining was positive in 22 patients (32.8%), including 2 of 5 follicular and 20 of 62 papillary carcinomas. Recurrence was confirmed in 40 patients pathologically or clinically by serum thyroglobulin, 131I scan, fluorine-18 fluorodeoxyglucose positron emission tomography and/or computed tomography. Among these 40 patients, 28 showed positive uptake on 131I scan. Fourteen tumour specimens out of 28 (50%) were positive by NIS immunohistochemical staining. The remaining 12 patients with recurrent cancer showed negative 131I scans, and all specimens were negative by NIS immunohistochemical staining. Thus, NIS immunohistochemical staining predicted 131I uptake in recurrent cancer with a 100% positive predictive value and a 46.2% negative predictive value. There was no difference in the positivity of NIS according to the site of recurrence on 131I scan. Outcome of 131I therapy could be assessed in 22 of the 28 patients who showed 131I uptake in recurrent lesions. Patients with positive NIS immunostaining responded to 131I therapy better than did patients with negative immunostaining (P<0.05). In conclusion, NIS immunohistochemical staining showed a high positive predictive value in predicting iodine uptake. Positive immunohistochemical staining of human NIS in primary or lymph node lesions may predict 131I accumulation and effectiveness of 131I therapy in recurrent lesions.

Enhanced biological phosphorus removal in an anaerobic-aerobic sequencing batch reactor: effect of pH

Enhanced biological phosphorus removal (EBPR) is not always successfully achieved in activated-sludge processes by anaerobic-aerobic operation. It has been reported that the deterioration of EBPR has been caused by domination of glycogen-accumulating organisms (GAOs) in microbial sludge. After repeated operation of a sequencing batch reactor (SBR) supplied with acetate as a sole carbon source, it was found that an operational variable, pH, could be a tool to control the competition between GAOs and polyphosphate-accumulating organisms PAOs, which could mediate the success of EBPR. When anaerobic phase pH in the SBR was controlled at 7.0, GAOs dominated the culture, resulting in failure of EBPR. Without pH control, the pH during the anaerobic phase increased to 8.4 as a result of denitrification and acetate uptake. In this relatively high pH condition, almost complete EBPR was achieved. In this report, the mechanism of pH effect on the competition between GAOs and PAOs was elucidated through a characterization of activated sludge using previously proposed biochemical models.

Quantification of regional myocardial blood flow using dynamic H2(15)O PET and factor analysis

Because the use of factor analysis has been proposed for extracting pure physiologic temporal or spatial information from dynamic nuclear medicine images, factor analysis should be capable of robustly estimating regional myocardial blood flow (rMBF) using H2(15)O PET without additional C15O PET, which is a cumbersome procedure for patients. Therefore, we measured rMBF using time-activity curves (TACs) obtained from factor analysis of dynamic myocardial H2(15)O PET images without the aid of C15O PET.

METHODS

H2(15)O PET of six healthy dogs at rest and during stress was performed simultaneously with microsphere studies using 85Sr, 46Sc, and 113SN: We performed factor analysis in two steps after reorienting and masking the images to include only the cardiac region. The first step discriminated each factor in the spatial distribution and acquired the input functions, and the second step extracted regional-tissue TACS: Image-derived input functions obtained by factor analysis were compared with those obtained by the sampling method. rMBF calculated using a compartmental model with tissue TACs from the second step of the factor analysis was compared with rMBF measured by microsphere studies.

RESULTS

Factor analysis was successful for all the dynamic H2(15)O PET images. The input functions obtained by factor analysis were nearly equal to those obtained by arterial blood sampling, except for the expected delay. The correlation between rMBF obtained by factor analysis and rMBF obtained by microsphere studies was good (r = 0.95). The correlation between rMBF obtained by the region-of-interest method and rMBF obtained by microsphere studies was also good (r = 0.93).

CONCLUSION

rMBF can be measured robustly by factor analysis using dynamic myocardial H2(15)O PET images without additional C15O blood-pool PET.

Lateralizing ability of single-voxel proton mr spectroscopy in hippocampal sclerosis: comparison with mr imaging and positron emission tomography

BACKGROUND AND PURPOSE

Proton MR spectroscopy (MRS) is still in the early stages in the evaluation of epilepsy, and comparisons with MR imaging and positron emission tomography (PET) in the same patients have rarely been documented. The purpose of this study was to evaluate the lateralizing ability of single-voxel MRS in comparison with MR imaging and PET in patients with hippocampal sclerosis.

METHODS

Thirty-three patients with intractable temporal lobe epilepsy whose MR imaging diagnosis was unilateral hippocampal sclerosis and who underwent anterior temporal lobectomy and had good postsurgical outcome over 1-year follow-up were included in the study. MR spectra were obtained from the hippocampus bilaterally, using the point-resolved spectroscopy sequence. Metabolite ratios of NAA/Cho and NAA/Cr were calculated from the relative peak height measurements. An NAA/Cho ratio of 0.8 or less and an NAA/Cr ratio of 1.0 or less were regarded as abnormal. The MRS results were compared retrospectively with those of MR imaging and PET as to the ability to lateralize the epileptogenic focus.

RESULTS

The sensitivity of MRS and PET (concordance with MR imaging) was 85% each in the lateralization of the ipsilateral lesion side. Bilateral abnormalities were seen in 30% of the patients. False-lateralization rates for MRS and PET were 3% and 6%, respectively. The concordance rate of MRS and PET was 73%, when comparing the results of the ipsilateral lesion side.

CONCLUSION

MRS may be used as an adjunct tool in the evaluation of hippocampal sclerosis, like PET, although its sensitivity has to be improved and the clinical significance of bilateral abnormality is still to be determined.

The morning tea break ritual: a case study

Many nursing scholars have examined the negative effects of rituals in nursing practice, and have argued for nurses to abolish these ritual practices; however, rituals remain resilient. There must be reasons that nurses are keeping these rituals alive. This study aimed to explore the meanings of the 'morning tea break ritual' to a group of nurses in a medical ward. The study employed an ethnographic methodology and found that the morning tea break ritual provided time, space and an environment where nurses can ventilate their feelings and gain each other's support. Thus, the morning tea break ritual has positive contribution to nurses' work and both nurses and patients are the beneficiaries of this ritual act.

Low incidence of TEL/AML1 fusion and TEL deletion in Korean childhood acute leukemia by extra-signal fluorescence in situ hybridization

TEL/AML1 fusion in acute leukemia results from cryptic translocation of chromosome 12 and 21, the presence of which suggests a favorable prognosis. The incidence of TEL/AML1 fusion in B-lineage ALL is approximately 25%, but the incidence in Korea has not yet been reported. To investigate the incidence of TEL/AML1 fusion and TEL deletion, bone marrow specimens from 77 Korean children with newly diagnosed acute leukemia were analyzed by FISH. We applied extra-signal FISH to discriminate a true TEL/AML1 fusion from a false-positive fusion signal. To determine the cut-off value of the TEL/AML1 fusion signal, 20 normal bone marrow specimens and 28 normal peripheral blood specimens were also analyzed. The frequency of patients with TEL/AML1 fusion was 13.3% (4 cases) among 30 B-lineage ALL and 9.5% among 42 ALL. One TEL/AML1 fusion-positive patient was also found among 4 acute biphenotypic leukemias. TEL/AML1 fusion was not found in any samples from patients with T-lineage ALL or AML. The incidence of TEL deletion was 6.7% (2 cases) among 30 B-lineage ALL and 4.8% among 42 ALL. The incidences of TEL/AML1 fusion and TEL deletion in Korean children with acute leukemia appear to be lower than those in other countries, suggesting a racial difference.

Structural characterization of n-butyl-isocyanide complexes of cytochromes P450nor and P450cam

Alkyl-isocyanides are able to bind to both ferric and ferrous iron of the heme in cytochrome P450, and the resulting complexes exhibit characteristic optical absorption spectra. While the ferric complex gives a single Soret band at 430 nm, the ferrous complex shows double Soret bands at 430 and 450 nm. The ratio of intensities of the double Soret bands in the ferrous isocyanide complex of P450 varies, as a function of pH, ionic strength, and the origin of the enzyme. To understand the structural origin of these characteristic spectral features, we examined the crystallographic and spectrophotometric properties of the isocyanide complexes of Pseudomonas putida cytochrome P450cam and Fusarium oxysporum cytochorme P450nor, since ferrous isocyanide complex of P450cam gives a single Soret band at 453 nm, while that of P450nor gives one at 427 nm. Corresponding to the optical spectra, we observed C-N stretching of a ferrous iron-bound isocyanide at 2145 and 2116 cm(-1) for P450nor and P450cam, respectively. The crystal structures of the ferric and ferrous n-butyl isocyanide complexes of P450cam and P450nor were determined. The coordination structure of the fifth Cys thiolate was indistinguishable for the two P450s, but the coordination geometry of the isocyanide was different for the case of P450cam [d(Fe-C) = 1.86 A, angleFe-C-N = 159 degrees ] versus P450nor [d(Fe-C) = 1.85 A, angleFe-C-N = 175 degrees ]. Another difference in the structures was the chemical environment of the heme pocket. In the case of P450cam, the iron-bound isocyanide is surrounded by some hydrophobic side chains, while, for P450nor, it is surrounded by polar groups including several water molecules. On the basis of these observations, we proposed that the steric factors and/or the polarity of the environment surrounding the iron-bound isocyanide significantly effect on the resonance structure of the heme(Fe)-isocyanide moiety and that differences in these two factors are responsible for the spectral characteristics for P450s.

Hahella chejuensis gen. nov., sp. nov., an extracellular-polysaccharide-producing marine bacterium

A bacterial strain, designated 96CJ10356T, which produced abundant extracellular polysaccharides and red pigment was isolated from marine sediment collected from Marado, Cheju Island, Republic of Korea. The organism is Gram-negative, aerobic, rod-shaped and motile. Growth was not observed in the absence of NaCl, and was optimal at an NaCl concentration of 2%. The strain contained oxidase and catalase, and was able to hydrolyse aesculin and gelatin. The major cellular fatty acids were saturated or monounsaturated straight-chain fatty acids. An almost complete 16S rDNA sequence of the test strain was determined. Phylogenetic analysis based on the neighbour-joining and Fitch-Margoliash methods indicated that the organism formed a distinct phyletic line within the gamma Proteobacteria. This relationship was also supported by sequence comparison, as no valid bacterial species showed more than 90% sequence homology with the isolate. It is clear from polyphasic evidence that the isolate merits the status of genus in the gamma subclass of the Proteobacteria, and the name Hahella chejuensis gen. nov., sp. nov. is proposed for the marine isolate 96CJ10356T (= KCTC 2396T = IMSNU 11157T).

Transforming growth factor-beta1 induces endothelin-1 in a bovine pulmonary artery endothelial cell line and rat lungs via cAMP

We investigated the mechanism of Endothelin-1 regulation by transforming growth factor-beta1 (TGF-beta1) in bovine pulmonary artery endothelial cells (BPAECs) and in isolated perfused rat lungs. Our data show that TGF-beta1 induces ET-1 gene expression and ET-1 peptide synthesis in BPAECs. The induction of preproET-1 mRNA level was due to de novo transcription, as well as mRNA stabilization, and new protein synthesis was not required for this induction. To investigate the role of cAMP-protein kinase A pathway in TGF-beta1-stimulated-ET-1 induction, we exposed BPAECs to various compounds which modulate this pathway. Dibutyryl-cAMP led to an increase in preproET-1 mRNA and Rp-cAMP abolished the induction of preproET-1 mRNA and ET-1 peptide by TGF-beta1. TGF-beta1 increased cAMP in BPAECs. Dexamethasone up-regulated preproET-1 mRNA expression and ET-1 peptide synthesis under basal and TGF-beta1-stimulated conditions. In isolated perfused rat lungs, TGF-beta1 increased preproET-1 mRNA abundance whereas Rp-cAMP inhibited the TGF-beta1-induced ET-1 gene activation. Thus our data suggest that TGF-beta1 stimulates ET-1 gene expression in BPAECs and in rat lungs via a cAMP dependent mechanism.

Lipiodol solution of a lipophilic agent, (188)Re-TDD, for the treatment of liver cancer

Radiolabeled lipiodol has been used for targeting liver cancer. We developed a lipiodol solution of (188)Re-TDD (2,2,9,9-tetramethyl-4,7-diaza-1,10-decanedithiol) and investigated its feasibility for the treatment of liver cancer. The lipiodol solution of (188)Re-TDD was well-retained in the lipiodol phase in vitro. After injection through the tail veins of mice, high lung-uptake was investigated which is evidence of embolizing activity. We also found high accumulation in hepatoma after injection through the hepatic arteries of hepatoma-bearing rats. In conclusion, the lipiodol solution of (188)Re-TDD is a promising agent for liver cancer therapy.

Incidence and clinical profile of extra-medial-temporal epilepsy with hippocampal atrophy

We tried to investigate the incidence and the clinical profile of intractable epilepsy with hippocampal atrophy and ictal onset zones located in areas other than the hippocampus (extra-medial-temporal epilepsy; EMTE). We included patients who had hippocampal atrophy confirmed by MRI but with extra-medial-temporal ictal onset zones as verified by invasive intracranial electrodes or video-EEG monitoring. The case histories, interictal EEG, ictal semiology, other MRI findings in addition to hippocampal atrophy, and results of ictal SPECT and PET scans were evaluated. Results were compared with those of surgically proven medial temporal lobe epilepsy with hippocampal atrophy recruited during the same period. 8.5% of the intractable epilepsy patients with hippocampal atrophy had extra-medial temporal epileptogenic zones. A history of encephalitis and hemiconvulsion-hemiparesis were significantly common in the EMTE group. Most of the interictal EEGs of EMTE patients showed extratemporal irritative zones. MRI, ictal SPECT, and FDG-PET seemed to be helpful at localizing the true epileptogenic zones. The predominant EMTE seizure type was focal motor seizure with secondary generalization. Some portion of intractable epilepsy patients with hippocampal atrophy had extra-medial-temporal epileptogenic foci and careful analysis of semiology and neuroimagings could yield clues to correct diagnosis.

F-18-fluorodeoxyglucose positron emission tomography as a presurgical evaluation modality for I-131 scan-negative thyroid carcinoma patients with local recurrence in cervical lymph nodes

BACKGROUND

F-18-labeled fluorodeoxyglucose-positron emission tomography (FDG-PET) has a supplementary role in localizing recurrent sites of differentiated thyroid carcinoma. We evaluated whether FDG-PET is feasible as a presurgical evaluation modality for I-131 scan-negative thyroid carcinoma patients.

METHODS

Preoperative FDG-PET results were compared with the pathologic findings of lymph nodes specimens of 22 papillary thyroid patients. All patients had thyroidectomy and I-131 ablation therapy beforehand and showed negative I-131 scans on follow-up studies.

RESULTS

In 85 cervical lymph node groups dissected, 56 lymph node groups revealed metastasis. The sensitivity and specificity of FDG PET for metastasis were 80% (45 of 56) and 83% (24 of 29), respectively. Among the pathologically positive 33 lymph nodes with normal size(< or =1 cm), FDG-PET detected 23 nodes. Serum thyroglobulin levels were elevated in 12 patients (sensitivity, 55%).

CONCLUSION

FDG-PET accurately detected the recurred cervical lymph nodes of differentiated thyroid carcinoma patients who showed negative I-131 scan. FDG-PET is suitable for the presurgical evaluation of these patients.

T-T interaction during thymic selection

During thymic development, immature thymocytes are selected through the interaction with self peptides loaded on self MHC molecules. Although there is a great deal of debates on how specifically thymocytes recognize self peptides during thymic selection, recent data suggest an important role of peptide diversity in selecting an adequate T-cell repertoire in the thymus. The findings that human T-cells, unlike mouse T-cells, express MHC class II molecules on their surfaces and can play as antigen presenting cells suggesting possible peripheral T-T interaction network has not been intensively studied so far. However, the facts that human thymocytes have surface expression of MHC class II molecules and thymocytes can be selected by thymocytes in in vitro re-aggregation culture system led us to propose a novel hypothesis - "T-T interaction during thymic selection". Our proposition is that peripheral T-T interaction through TCR-derived peptides might reflect the selection process in the thymus and that T-T interaction also plays an important role in thymic selection. This review deals with our thymic T-T interaction hypothesis and its implications on human T-cell development.

Different uptake of 99mTc-ECD adn 99mTc-HMPAO in the same brains: analysis by statistical parametric mapping

The purpose of this study was to investigate the differences between technetium-99m ethyl cysteinate dimer (99mTc-ECD) and technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) uptake in the same brains by means of statistical parametric mapping (SPM) analysis. We examined 20 patients (9 male, 11 female, mean age 62+/-12 years) using 99mTc-ECD and 99mTc-HMPAO single-photon emission tomography (SPET) and magnetic resonance imaging (MRI) of the brain less than 7 days after onset of stroke. MRI showed no cortical infarctions. Infarctions in the pons (6 patients) and medulla (1), ischaemic periventricular white matter lesions (13) and lacunar infarction (7) were found on MRI. Split-dose and sequential SPET techniques were used for 99mTc-ECD and 99mTc-HMPAO brain SPET, without repositioning of the patient. All of the SPET images were spatially transformed to standard space, smoothed and globally normalized. The differences between the 99mTc-ECD and 99mTc-HMPAO SPET images were statistically analysed using statistical parametric mapping (SPM) 96 software. The difference between two groups was considered significant at a threshold of uncorrected P values less than 0.01. Visual analysis showed no hypoperfused areas on either 99mTc-ECD or 99mTc-HMPAO SPET images. SPM analysis revealed significantly different uptake of 99mTc-ECD and 99mTc-HMPAO in the same brains. On the 99mTc-ECD SPET images, relatively higher uptake was observed in the frontal, parietal and occipital lobes, in the left superior temporal lobe and in the superior region of the cerebellum. On the 99mTc-HMPAO SPET images, relatively higher uptake was observed in the medial temporal lobes, thalami, periventricular white matter and brain stem. These differences in uptake of the two tracers in the same brains on SPM analysis suggest that interpretation of cerebral perfusion is possible using SPET with 99mTc-ECD and 99mTc-HMPAO.