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1.  Use of transient elastography to predict de novo recurrence after radiofrequency ablation for hepatocellular carcinoma 
OncoTargets and therapy  2015;8:347-356.
Liver stiffness (LS) measurement using transient elastography can accurately assess the degree of liver fibrosis, which is associated with the risk of the development of hepatocellular carcinoma (HCC). We investigated whether LS values could predict HCC de novo recurrence after radiofrequency ablation (RFA).
This retrospective, multicenter study analyzed 111 patients with HCC who underwent RFA and LS measurement using transient elastography between May 2005 and April 2011. All patients were followed until March 2013 to monitor for HCC recurrence.
This study included 76 men and 35 women with a mean age of 62.4 years, and the mean LS value was 21.2 kPa. During the follow-up period (median 22.4 months), 47 (42.3%) patients experienced HCC de novo recurrence, and 18 (16.2%) died. Patients with recurrence had significantly more frequent liver cirrhosis, more frequent history of previous treatment for HCC, higher total bilirubin, larger spleen size, larger total tumor size, higher tumor number, higher LS values, and lower platelet counts than those without recurrence (all P<0.05). On multivariate analysis, together with previous anti-HCC treatment history, patients with LS values >13.0 kPa were at significantly greater risk for recurrence after RFA, with a hazard ratio (HR) of 3.115 (95% confidence interval [CI], 1.238–7.842, P<0.05). Moreover, LS values independently predicted the mortality after RFA, with a HR of 9.834 (95% CI, 1.148–84.211, P<0.05), together with total bilirubin.
Our data suggest that LS measurement is a useful predictor of HCC de novo recurrence and overall survival after RFA.
PMCID: PMC4322870  PMID: 25678801
hepatocellular carcinoma; radiofrequency ablation; recurrence; liver stiffness; fibroscan
2.  Factors Affecting the Accuracy of Controlled Attenuation Parameter (CAP) in Assessing Hepatic Steatosis in Patients with Chronic Liver Disease 
PLoS ONE  2014;9(6):e98689.
Background & Aims
Controlled attenuation parameter (CAP) can measure hepatic steatosis. However, factors affecting its accuracy have not been described yet. This study investigated predictors of discordance between liver biopsy (LB) and CAP.
A total of 161 consecutive patients with chronic liver disease who underwent LB and CAP were enrolled prospectively. Histological steatosis was graded as S0 (<5%), S1 (5–33%), S2 (34–66%), and S3 (>66% of hepatocytes). Cutoff CAP values were calculated from our cohort (250, 301, and 325 dB/m for ≥S1, ≥S2, and S3). Discordance was defined as a discrepancy of at least two steatosis stages between LB and CAP.
The median age (102 males and 59 females) was 49 years. Repartition of histological steatosis was as follows; S0 26.1% (n = 42), S1 49.7% (n = 80), S2 20.5% (n = 33), and S3 3.7% (n = 6). In multivariate linear regression analysis, CAP value was independently associated with steatosis grade along with body mass index (BMI) and interquartile range/median of CAP value (IQR/MCAP) (all P<0.05). Discordance was identified in 13 (8.1%) patients. In multivariate analysis, histological S3 (odd ratio [OR], 9.573; 95% confidence interval [CI], 1.207–75.931; P = 0.033) and CAP value (OR, 1.020; 95% CI, 1.006–1.034; P = 0.006) were significantly associated with discordance, when adjusting for BMI, IQR/MCAP, and necroinflammation, reflected by histological activity or ALT level.
Patients with high grade steatosis or high CAP values have a higher risk of discordance between LB and CAP. Further studies are needed to improve the accuracy of CAP interpretation, especially in patients with higher CAP values.
PMCID: PMC4046989  PMID: 24901649
3.  Prognostic Implications of Serum Lipid Metabolism over Time during Sepsis 
BioMed Research International  2015;2015:789298.
Background. Despite extensive research and an improved standard of care, sepsis remains a disorder with a high mortality rate. Sepsis is accompanied by severe metabolic alterations. Methods. We evaluated 117 patients with sepsis (severe sepsis [n = 19] and septic shock [n = 98]) who were admitted to the intensive care unit. Serum cholesterol, triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), free fatty acid (FFA), and apolipoprotein (Apo) A-I levels were measured on days 0, 1, 3, and 7. Results. Nonsurvivors had low levels of cholesterol, TG, HDL, LDL, and Apo A-I on days 0, 1, 3, and 7. In a linear mixed model analysis, the variations in TG, LDL, FFA, and Apo A-I levels over time differed significantly between the groups (p = 0.043, p = 0.020, p = 0.005, and p = 0.015, resp.). According to multivariate analysis, TG levels and SOFA scores were associated with mortality on days 0 and 1 (p = 0.018 and p = 0.008, resp.). Conclusions. Our study illustrated that TG levels are associated with mortality in patients with sepsis. This may be attributable to alterations in serum lipid metabolism during sepsis, thus modulating the host response to inflammation in critically ill patients.
PMCID: PMC4553311  PMID: 26351639
4.  Box-Shape Cervical Expansive Laminoplasty: Clinical and Radiological Outcomes 
Korean Journal of Spine  2014;11(3):152-156.
Box-shape cervical expansive laminoplasty is a procedure that utilizes a Miniplate® or Maxpacer® to achieve maximal canal expansion. This method is expected to show much larger canal expansion and good clinical outcome. So we investigated the clinical and radiological outcome of Box-shape cervical expansive laminoplasty.
Between June 2008 and July 2013, we performed cervical expansive laminoplasty in 87 and 48 patients using the Box-shape cervical expansive laminoplasty, respectively. We analyzed the clinical results of these operations using the Japanese Orthopedic Association (JOA) scoring system and by assessing the position of intralaminar screws with postoperative computed tomography (CT) at POD-6 months.
A total of 48 patients with ossification of the posterior longitudinal ligament (OPLL) (36 pts), cervical spondylotic myelopathy (CSM) (12 pts) were enrolled. Overall JOA scores improved from 11.49 to 14.22 at POD-6 months (OPLL: 11.32 -->14.3; CSM: 12-->14). Postoperative CT scans were performed in 39 patients at 177 levels for a total of 354 screws. The malpositioning rate of intralaminar screws was 3.4% and hardware-related neurologic complications did not occur.
Box-shape cervical expansive laminoplasty creates maximal spinal canal expansion and leads to improved cervical myelopathy. The use of intralaminar screws to fix the remodeled lamina-facet does not represent a significant difficulty.
PMCID: PMC4206966  PMID: 25346761
Open door laminoplasty; Double door laminoplasty; Intralaminar screw; Spinal canal area; Box-shape laminoplasty
5.  Therapeutic Effects of Acupuncture through Enhancement of Functional Angiogenesis and Granulogenesis in Rat Wound Healing 
Acupuncture regulates inflammation process and growth factors by increasing blood circulation in affected areas. In this study, we examined whether acupuncture has an effect on wound healing in injured rat. Rats were assigned randomly into two groups: control group and acupuncture group. Acupuncture treatment was carried out at 8 sites around the wounded area. We analyzed the wound area, inflammatory cytokines, proliferation of resident cells, and angiogenesis and induction of extracelluar matrix remodeling. At 7 days after-wounding the wound size in acupuncture-treat group was decreased more significantly compared to control group. In addition, the protein levels of proinflammatory cytokines such as tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were significantly decreased compared to the control at 2 and 7 days post-wounding. Also, we analyzed newly generated cells by performing immunostaining for PCNA and using several phenotype markers such as CD-31, α-SMA, and collagen type I. In acupuncture-treated group, PCNA-positive cell was increased and PCNA labeled CD-31-positive vessels, α-SMA- and collagen type I-positive fibroblastic cells, were increased compared to the control group at 7 days post-wounding. These results suggest that acupuncture may improve wound healing through decreasing pro-inflammatory response, increasing cell proliferation and angiogenesis, and inducing extracellular matrix remodeling.
PMCID: PMC3529882  PMID: 23304201
6.  Assessment of Collagen-Induced Arthritis Using Cyanine 5.5 Conjugated with Hydrophobically Modified Glycol Chitosan Nanoparticles: Correlation with 18F-Fluorodeoxyglucose Positron Emission Tomography Data 
Korean Journal of Radiology  2012;13(4):450-457.
To evaluate the potential and correlation between near-infrared fluorescence (NIRF) imaging using cyanine 5.5 conjugated with hydrophobically modified glycol chitosan nanoparticles (HGC-Cy5.5) and 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) imaging of collagen-induced arthritis (CIA).
Materials and Methods
We used 10 CIA and 3 normal mice. Nine days after the injecting collagen twice, microPET imaging was performed 40 minutes after the intravenous injection of 9.3 MBq 18F-FDG in 200 µL PBS. One day later, NIRF imaging was performed two hours after the intravenous injection of HGC-cy5.5 (5 mg/kg). We assessed the correlation between these two modalities in the knees and ankles of CIA mice.
The mean standardized uptake values of 18F-FDG for knees and ankles were 1.68 ± 0.76 and 0.79 ± 0.71, respectively, for CIA mice; and 0.57 ± 0.17 and 0.54 ± 0.20 respectively for control mice. From the NIRF images, the total photon counts per 30 mm2 for knees and ankles were 2.32 ± 1.54 × 105 and 2.75 ± 1.51 × 105, respectively, for CIA mice, and 1.22 ± 0.27 × 105 and 0.88 ± 0.24 × 105, respectively, for control mice. These two modalities showed a moderate correlation for knees (r = 0.604, p = 0.005) and ankles (r = 0.464, p = 0.039). Moreover, both HGC-Cy5.5 (p = 0.002) and 18F-FDG-PET (p = 0.005) imaging also showed statistically significant differences between CIA and normal mice.
NIRF imaging using HGC-Cy5.5 was moderately correlated with 18F-FDG-PET imaging in the CIA model. As such, HGC-Cy5.5 imaging can be used for the early detection of rheumatoid arthritis.
PMCID: PMC3384827  PMID: 22778567
HGC-Cy5.5; 18F-FDG PET; Near-infrared fluorescence imaging; Rheumatoid arthritis
7.  Evaluation of the Chondromalacia Patella Using a Microscopy Coil: Comparison of the Two-Dimensional Fast Spin Echo Techniques and the Three-Dimensional Fast Field Echo Techniques 
Korean Journal of Radiology  2011;12(1):78-88.
We wanted to compare the two-dimensional (2D) fast spin echo (FSE) techniques and the three-dimensional (3D) fast field echo techniques for the evaluation of the chondromalacia patella using a microscopy coil.
Materials and Methods
Twenty five patients who underwent total knee arthroplasty were included in this study. Preoperative MRI evaluation of the patella was performed using a microscopy coil (47 mm). The proton density-weighted fast spin echo images (PD), the fat-suppressed PD images (FS-PD), the intermediate weighted-fat suppressed fast spin echo images (iw-FS-FSE), the 3D balanced-fast field echo images (B-FFE), the 3D water selective cartilage scan (WATS-c) and the 3D water selective fluid scan (WATS-f) were obtained on a 1.5T MRI scanner. The patellar cartilage was evaluated in nine areas: the superior, middle and the inferior portions that were subdivided into the medial, central and lateral facets in a total of 215 areas. Employing the Noyes grading system, the MRI grade 0-I, II and III lesions were compared using the gross and microscopic findings. The sensitivity, specificity and accuracy were evaluated for each sequence. The significance of the differences for the individual sequences was calculated using the McNemar test.
The gross and microscopic findings demonstrated 167 grade 0-I lesions, 40 grade II lesions and eight grade III lesions. Iw-FS-FSE had the highest accuracy (sensitivity/specificity/accuracy = 88%/98%/96%), followed by FS-PD (78%/98%/93%, respectively), PD (76%/98%/93%, respectively), B-FFE (71%/100%/93%, respectively), WATS-c (67%/100%/92%, respectively) and WATS-f (58%/99%/89%, respectively). There were statistically significant differences for the iw-FS-FSE and WATS-f and for the PD-FS and WATS-f (p < 0.01).
The iw-FS-FSE images obtained with a microscopy coil show best diagnostic performance among the 2D and 3D GRE images for evaluating the chondromalacia patella.
PMCID: PMC3017887  PMID: 21228943
Cartilage; Magnetic resonance (MR); Knee; Histopathologic correlation
8.  Carcinoma of the middle bile duct: Is bile duct segmental resection appropriate? 
AIM: To compare survival between bile duct segmental resection (BDSR) and pancreaticoduodenectomy (PD) for treating distal bile duct cancers.
METHODS: Retrospective analysis was conducted for 45 patients in a BDSR group and for 149 patients in a PD group.
RESULTS: The T-stage (P < 0.001), lymph node invasion (P = 0.010) and tumor differentiation (P = 0.005) were significant prognostic factors in the BDSR group. The 3- and 5-year overall survival rates for the BDSR group and PD group were 51.7% and 36.6%, respectively and 46.0% and 38.1%, respectively (P = 0.099). The BDSR group and PD group did not show any significant difference in survival when this was adjusted for the TNM stage. The 3- and 5-year survival rates were: stage Ia [BDSR (100.0% and 100.0%) vs PD (76.9% and 68.4%) (P = 0.226)]; stage Ib [BDSR (55.8% and 32.6%) vs PD (59.3% and 59.3%) (P = 0.942)]; stage IIb [BDSR (19.2% and 19.2%) vs PD (31.9% and 14.2%) (P = 0.669)].
CONCLUSION: BDSR can be justified as an alternative radical operation for patients with middle bile duct in selected patients with no adjacent organ invasion and resection margin is negative.
PMCID: PMC2795184  PMID: 20014461
Bile duct cancer; Segmental resection; Pancreaticoduodenectomy
9.  Evaluation of Tumor Angiogenesis with a Second-Generation US Contrast Medium in a Rat Breast Tumor Model 
Korean Journal of Radiology  2008;9(3):243-249.
Tumor angiogenesis is an important factor for tumor growth, treatment response and prognosis. Noninvasive imaging methods for the evaluation of tumor angiogenesis have been studied, but a method for the quantification of tumor angiogenesis has not been established. This study was designed to evaluate tumor angiogenesis in a rat breast tumor model by the use of a contrast-enhanced ultrasound (US) examination with a second-generation US contrast agent.
Materials and Methods
The alkylating agent 19N-ethyl-N-nitrosourea (ENU) was injected into the intraperitoneal cavity of 30-day-old female Sprague-Dawley rats. Three to four months later, breast tumors were detected along the mammary lines of the rats. A total of 17 breast tumors larger than 1 cm in nine rats were evaluated by gray-scale US, color Doppler US and contrast-enhanced US using SonoVue. The results were recorded as digital video images; time-intensity curves and hemodynamic parameters were analyzed. Pathological breast tumor specimens were obtained just after the US examinations. The tumor specimens were stained with hematoxylin and eosin (H & E) and the expression of CD31, an endothelial cell marker, was determined by immunohistochemical staining. We also evaluated the pathological diagnosis of the tumors and the microvessel density (MVD). Spearman's correlation and the Kruskal-Wallis test were used for the analysis.
The pathological diagnoses were 11 invasive ductal carcinomas and six benign intraductal epithelial proliferations. The MVD did not correlate with the pathological diagnosis. However, blood volume (BV) showed a statistically significant correlation with MVD (Spearman's correlation, p < 0.05).
Contrast-enhanced US using a second-generation US contrast material was useful for the evaluation of tumor angiogenesis of breast tumors in the rat.
PMCID: PMC2627259  PMID: 18525227
Breast neoplasms; Breast, US; Contrast media; Experimental study
10.  Spinal Epidural Abscess with Pyogenic Arthritis of Facet Joint Treated with Antibiotic-Bone Cement Beads - A Case Report - 
Asian Spine Journal  2007;1(1):61-64.
Most epidural abscesses are a secondary lesion of pyogenic spondylodiscitis. An epidural abscess associated with pyogenic arthritis of the facet joint is quite rare. To the best of our knowledge, there is no report of the use of antibiotic-cement beads in the surgical treatment of an epidural abscess. This paper reports a 63-year-old male who sustained a 1-week history of radiating pain to both lower extremities combined with lower back pain. MRI revealed space-occupying lesions, which were located in both sides of the anterior epidural space of L4, and CT scans showed irregular widening and bony erosion of the facet joints of L4-5. A staphylococcal infection was identified after a posterior decompression and an open drainage. Antibiotic- bone cement beads were used as a local controller of the infection and as a spacer or an indicator for the second operation. An intravenous injection of anti-staphylococcal antibiotics resolved the back pain and radicular pain and normalized the laboratory findings. We point out not only the association of an epidural abscess with facet joint infection, but also the possible indication of antibiotic-bone cement beads in the treatment of epidural abscesses.
PMCID: PMC2857502  PMID: 20411156
Epidural abscess; Facet joint infection; Lumbar spine; Antibiotic-bone cement bead
11.  Prognostic Factors of Clinical Outcomes in Patients with Spontaneous Thalamic Hemorrhage 
Intracerebral hemorrhage (ICH) is a well-known condition, but ICH restricted to the thalamus is less widely studied. We investigated the prognostic factors of thalamic ICHs.
Seventy patients from January 2009 to November 2014 were retrospectively reviewed. Patients who demonstrated spontaneous ICH primarily affecting the thalamus on initial brain computed tomography (CT) were enrolled. Patients were categorized into 2 groups based on their Glasgow Outcome Scale (GOS) scores. Various presumptive prognostic factors were analyzed to investigate relationships between various clinical characteristics and outcomes.
Of the enrolled patients, 39 showed a GOS of 4–5, and were categorized as the good outcome group, while another 31 patients showed a GOS of 1–3 and were categorized as the poor outcome group. Initial GCS score, calculated volume of hematoma, presence of intraventricular hemorrhage (IVH), coexisting complications, hydrocephalus, performance of external ventricular drainage, and modified Graeb’s scores of patients with IVH were significantly different between the 2 groups. In multivariate analysis, among the factors above, initial GCS score (P=0.002, Odds ratio [OR]=1.761, Confidence interval [CI]=1.223–2.536) and the existence of systemic complications (P=0.015, OR=0.059, CI=0.006–0.573) were independently associated with clinical outcomes. Calculated hematoma volume showed a borderline relationship with outcomes (P=0.079, OR=0.920, CI=0.839–1.010).
Initial GCS score and the existence of systemic complications were strong predictive factors for prognosis of thalamic ICH. Calculated hematoma volume also had predictive value for clinical outcomes.
PMCID: PMC4566943  PMID: 26343784
Glasgow Outcome Scale; Intracranial Hemorrhage, Hypertensive; Prognosis; Thalamus
13.  Extensive Bilateral Lemierre Syndrome due to Methicillin-Resistant Staphylococcus epidermidis in a Patient with Lung Adenocarcinoma 
Lemierre syndrome (LS) is a septic thrombophlebitis of the internal jugular vein (IJV) following an oropharyngeal infection. LS is commonly caused by normal anaerobic flora and treated with appropriate antibiotics and anticoagulation therapy. Although the incidence of disease is very rare, 15% cases of LS are fatal even in the antibiotic era because of disseminated septic thromboemboli. We reported a case of extensive bilateral LS due to methicillin-resistant Staphylococcus epidermidis in a 63-year-old female with lung adenocarcinoma. Initial examination revealed a retropharyngeal abscess; hence, intravenous ceftriaxone and steroid were initiated empirically. However, pulmonary thromboembolism developed and methicillin-resistant S. epidermidis was identified in the bacterial culture. Despite intensive antibiotic and anticoagulation therapies, extensive septic thrombophlebitis involving the bilateral IJV and superior vena cava developed. Adjunctive catheter-directed thrombolysis and superior vena cava stenting were performed and the patient received antibiotic therapy for an additional 4 weeks, resulting in complete recovery.
PMCID: PMC4499602  PMID: 26175788
Lemierre Syndrome; Lung Adenocarcinoma; Methicillin Resistance; Staphylococcus epidermidis
14.  Characteristics of pork belly consumption in South Korea and their health implication 
Fresh pork belly is a highly popular meat in South Korea, accounting for 59 % of the approximately 100 g of meat per capita that is consumed daily. Fresh pork belly offers not only high-quality protein from the lean cuts but also substantial micronutrients including fat-soluble vitamins and minerals. However, fresh pork belly generally consists of about 30 % fat, with saturated fatty acids representing half of this value. Excessive consumption of saturated fatty acids increases total cholesterol, low-density lipoprotein-cholesterol, and triglycerides while decreasing high-density lipoprotein-cholesterol, raising concerns about an increased risk of hyperlipidemia, followed by cardiovascular diseases. In this review, we discuss the consumption and production trends in South Korea, the general characteristics, and health issues related to fresh pork belly to delineate the features of pork production and consumer welfare.
PMCID: PMC4540268  PMID: 26290742
Pork belly; Pork preference; Pork belly production; Saturated fatty acids; Dyslipidemia; Cardiovascular disease
15.  Characteristics of the Thermal Degradation of Glucose and Maltose Solutions 
In order to investigate the thermal degradation of glucose and maltose solutions after high temperature and high pressure (HTHP) treatment, the samples were treated at temperatures of 110, 120, 130, 140, and 150°C for 1, 2, 3, 4, and 5 h in an apparatus for HTHP treatment. Glucose and maltose solutions (20% w/w) were prepared by weighing glucose and maltose and adding distilled water in the desired proportion. Chromaticity, pH, organic acids, 5-hydroxymethylfurfural (HMF), free sugar contents, electron donating ability (EDA), and ascorbic acid equivalent antioxidant capacity (AEAC) were evaluated. With increasing heating temperatures and times, the L-, a-, and b-values decreased. The pH and free sugar contents decreased, and organic acids and HMF contents increased with greater temperatures and times. EDA (%) and the AEAC of the heating sugars increased with the increases in temperatures and times.
PMCID: PMC4500512  PMID: 26175997
glucose; maltose; thermal degradation; antioxidant activity; 5-hydroxymethylfurfural
16.  Physicochemical Properties of β-Glucan from Acid Hydrolyzed Barley 
This study was performed to investigate changes in the content and purity, as well as physical characteristics of β-glucan extracted from acid hydrolyzed whole grain barleys. Waxy and non-waxy barleys (Hordeum vulgare) were hydrolyzed with different concentrations of HCl (0.1~0.5 N) for 1 h. As the HCl concentration increased, the contents of total and soluble β-glucan from acid hydrolyzed barley decreased. However the ratio of soluble/total β-glucan content and purities of β-glucan significantly increased. The ratio of β-(1→4)/β-(1→3) linkages, molecular weight, and viscosity of soluble β-glucan of raw barleys were 2.28~2.52, 6.0~7.0×105 g/mol, and 12.8~32.8 centipoise (cP). Those of isolated soluble β-glucan were significantly decreased to 2.05~2.15, 6.6~7.8×103 g/mol, and 3.6~4.2 cP, respectively, with increasing acid concentration. The re-solubility of raw barley β-glucan was about 50%, but increased to 97% with increasing acid concentration. Acid hydrolysis was shown to be an effective method to produce β-glucan with high ratio of soluble β-glucan content, purity, water solubility, and low viscosity.
PMCID: PMC4500513  PMID: 26175998
barley; β-glucan; acid hydrolysis; molecular weight; viscosity
17.  Comparison of the effects of acute exercise after overnight fasting and breakfast on energy substrate and hormone levels in obese men 
Journal of Physical Therapy Science  2015;27(6):1929-1932.
[Purpose] We compared the effects of acute aerobic exercise following overnight fasting and breakfast on energy substrate and hormone levels in obese male college students. [Subjects and Methods] This crossover study recruited 10 obese male college students with a body mass index >25 kg/m2 or >20% body fat. One week post-recruitment, the subjects exercised in the morning after an overnight fast. At 2 weeks, they exercised post-breakfast. Energy substrate (glucose, free fatty acid) and metabolic hormone (insulin, growth hormone, and cortisol) levels were measured immediately before and after exercise and at 60 min post-exercise. [Results] We observed interaction effects between the measurement time and exercise treatment for glucose; significant differences between measurement times and between exercise treatments for free fatty acids; interaction effects between the measurement time and exercise treatment for insulin and significant differences in the measurement time; significance differences between measurement times and between exercise treatments for growth hormone; and significant differences between measurement times and between exercise treatments for cortisol. [Conclusion] Morning exercise following an overnight fast can be more effective in reducing body fat than post-prandial exercise. However, increased cortisol levels following exercise after overnight fasting may negatively affect long-term weight loss in obese men.
PMCID: PMC4500013  PMID: 26180350
Exercise; Energy substrates; Metabolic hormone
18.  Multiple Schwannomas of the Spine: Review of the Schwannomatosis or Congenital Neurilemmomatosis: A Case Report 
Korean Journal of Spine  2015;12(2):91-94.
Schwannomas are the most common benign nerve sheath tumors originating in Schwann cells. With special conditions like neurofibromatosis type 2 or entity called schwannomatosis, patients develop multiple schwannomas. But in clinical setting, distinguishing schwannomatosis from neurofibromatosis type 2 is challengeable. We describe 58-year-old male who presented with severe neuropathic pain, from schwannomatosis featuring multiple schwannomas of spine and trunk, and underwent surgical treatment. We demonstrate his radiologic and clinical findings, and discuss about important clinical features of this condition. To confirm schwannomatosis, we performed brain magnetic resonance imaging, and took his familial history. Staged surgery was done for pathological confirmation and relief of the pain. Schwannomatosis and neurofibromatosis type 2 are similar but different disease. There are diagnostic hallmarks of these conditions, including familial history, pathology, and brain imaging. Because of different prognosis, the two diseases must be distinguished, so diagnostic tests that are mentioned above should be performed in caution.
PMCID: PMC4513176  PMID: 26217390
Neurofibromatosis type 2; Schwannoma; Schwannomatosis; Spine
19.  Comparison of CT-Determined Pulmonary Artery Diameter, Aortic Diameter, and Their Ratio in Healthy and Diverse Clinical Conditions 
PLoS ONE  2015;10(5):e0126646.
The main pulmonary artery diameter (mPA), aortic diameter (Ao), and the mPA/Ao ratio, easily measured using chest computed tomography (CT), provide information that enables the diagnosis and evaluation of cardiopulmonary diseases. Here, we used CT to determine the sex- and age-specific distribution of normal reference values for mPA, Ao, and mPA/Ao ratio in an adult Korean population.
Data from non-contrast, ECG-gated, coronary-calcium-scoring CT images of 2,547 individuals who visited the Health Screening Center of the Severance Hospital were analyzed. Healthy individuals (n = 813) included those who do not have hypertension, diabetes, asthma, obstructive lung disease, ischemic heart disease, stroke, smoking, obesity, and abnormal CT findings. Both mPA and Ao were measured at the level of bifurcation of the main pulmonary artery.
The mean mPA and Ao were 25.9 mm and 30.0 mm in healthy participants, respectively, while the mean mPA/Ao ratio was 0.87. Medical conditions associated with a larger mPA were male, obesity, smoking history, hypertension, and diabetes. A larger mPA/Ao ratio was associated with female, the obese, non-smoker, normotensive, and normal serum level of lipids, while a smaller mPA/Ao ratio was associated with older age. In healthy individuals, the 90th percentile sex-specific mPA, Ao, and mPA/Ao ratio were, 31.3 mm (95% CI 29.9–32.2), 36.8 mm (95% CI 35.7–37.5), and 1.05 (95% CI 0.99–1.07) in males, and 29.6 mm (95% CI 29.1–30.2), 34.5 mm (95% CI 34.1–34.9), and 1.03 (95% CI 1.02–1.06) in females, respectively.
In the Korean population, the mean mPA reference values in male and female were 26.5 mm and 25.8 mm, respectively, while the mean mPA/Ao ratio was 0.87. These values were influenced by a variety of underlying medical conditions.
PMCID: PMC4425684  PMID: 25955036
20.  Transgenic Alfalfa Plants Expressing the Sweetpotato Orange Gene Exhibit Enhanced Abiotic Stress Tolerance 
PLoS ONE  2015;10(5):e0126050.
Alfalfa (Medicago sativa L.), a perennial forage crop with high nutritional content, is widely distributed in various environments worldwide. We recently demonstrated that the sweetpotato Orange gene (IbOr) is involved in increasing carotenoid accumulation and enhancing resistance to multiple abiotic stresses. In this study, in an effort to improve the nutritional quality and environmental stress tolerance of alfalfa, we transferred the IbOr gene into alfalfa (cv. Xinjiang Daye) under the control of an oxidative stress-inducible peroxidase (SWPA2) promoter through Agrobacterium tumefaciens-mediated transformation. Among the 11 transgenic alfalfa lines (referred to as SOR plants), three lines (SOR2, SOR3, and SOR8) selected based on their IbOr transcript levels were examined for their tolerance to methyl viologen (MV)-induced oxidative stress in a leaf disc assay. The SOR plants exhibited less damage in response to MV-mediated oxidative stress and salt stress than non-transgenic plants. The SOR plants also exhibited enhanced tolerance to drought stress, along with higher total carotenoid levels. The results suggest that SOR alfalfa plants would be useful as forage crops with improved nutritional value and increased tolerance to multiple abiotic stresses, which would enhance the development of sustainable agriculture on marginal lands.
PMCID: PMC4422619  PMID: 25946429
21.  Effects of High-dose Atorvastatin Pretreatment in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Cardiac Magnetic Resonance Study 
Journal of Korean Medical Science  2015;30(4):435-441.
It is uncertain that atorvastatin pretreatment can reduce myocardial damage in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate the effects of atorvastatin pretreatment on infarct size measured by contrast-enhanced magnetic resonance imaging (CE-MRI) in STEMI patients. Patients undergoing primary PCI for STEMI within 12 hr after symptom onset were randomized to an atorvastatin group (n=30, 80 mg before PCI and for 5 days after PCI) or a control group (n=37, 10 mg daily after PCI). The primary end point was infarct size evaluated as the volume of delayed hyperenhancement by CE-MRI within 14 days after the index event. The median infarct size was 19% (IQR 11.1%-31.4%) in the atorvastatin group vs. 16.3% (7.2%-27.2%) in the control group (P=0.27). The myocardial salvage index (37.1% [26.9%-58.7%] vs. 46.9% [39.9-52.4], P=0.46) and area of microvascular obstruction (1.1% [0%-2.0%] vs. 0.7% [0%-1.8%], P=0.37) did not differ significantly between the groups. Frequency of the hemorrhagic and transmural infarctions was not significantly different in the 2 groups. Pretreatment with a high-dose atorvastatin followed by further treatment for 5 days in STEMI patients undergoing primary PCI failed to reduce the extent of myocardial damage or improve myocardial salvage.
Graphical Abstract
PMCID: PMC4366964  PMID: 25829811
Atorvastatin; Myocardial Infarction; Percutaneous Coronary Intervention
22.  Networked neural spheroid by neuro-bundle mimicking nervous system created by topology effect 
Molecular Brain  2015;8:17.
In most animals, the nervous system consists of the central nervous system (CNS) and the peripheral nervous system (PNS), the latter of which connects the CNS to all parts of the body. Damage and/or malfunction of the nervous system causes serious pathologies, including neurodegenerative disorders, spinal cord injury, and Alzheimer’s disease. Thus, not surprising, considerable research effort, both in vivo and in vitro, has been devoted to studying the nervous system and signal transmission through it. However, conventional in vitro cell culture systems do not enable control over diverse aspects of the neural microenvironment. Moreover, formation of certain nervous system growth patterns in vitro remains a challenge. In this study, we developed a deep hemispherical, microchannel-networked, concave array system and applied it to generate three-dimensional nerve-like neural bundles. The deep hemicylindrical channel network was easily fabricated by exploiting the meniscus induced by the surface tension of a liquid poly(dimethylsiloxane) (PDMS) prepolymer. Neurospheroids spontaneously aggregated in each deep concave microwell and were networked to neighboring spheroids through the deep hemicylindrical channel. Notably, two types of satellite spheroids also formed in deep hemispherical microchannels through self-aggregation and acted as an anchoring point to enhance formation of nerve-like networks with neighboring spheroids. During neural-network formation, neural progenitor cells successfully differentiated into glial and neuronal cells. These cells secreted laminin, forming an extracellular matrix around the host and satellite spheroids. Electrical stimuli were transmitted between networked neurospheroids in the resulting nerve-like neural bundle, as detected by imaging Ca2+ signals in responding cells.
Electronic supplementary material
The online version of this article (doi:10.1186/s13041-015-0109-y) contains supplementary material, which is available to authorized users.
PMCID: PMC4379946  PMID: 25888468
Neurospheroid; Neural spheroid networking; Deep hemicylindrical channel; Neural bundle; Nerve-like structure
23.  Altered Neural Basis of the Reality Processing and Its Relation to Cognitive Insight in Schizophrenia 
PLoS ONE  2015;10(3):e0120478.
It has been reported that reality evaluation and recognition are impaired in patients with schizophrenia and these impairments are related to the severity of psychotic symptoms. The current study aimed to investigate the neural basis of impairments in reality evaluation and recognition and their relationships with cognitive insight in schizophrenia. During functional magnetic resonance imaging, 20 patients with schizophrenia and 20 healthy controls performed a set of reality evaluation and recognition tasks, in which subjects judged whether scenes in a series of drawings were real or unreal and whether they were familiar or novel. During reality evaluation, patients showed decreased activity in various regions including the inferior parietal lobule, retrosplenial cortex and parahippocampal gyrus, compared with controls. Particularly, parahippocampal gyrus activity was correlated with the severity of positive symptoms in patients. During recognition, patients also exhibited decreased activity in various regions, including the dorsolateral prefrontal cortex, inferior parietal lobule and posterior cingulate cortex. Particularly, inferior parietal lobule activity and posterior cingulate cortex activity were correlated with cognitive insight in patients. These findings provide evidence that neural impairments in reality evaluation and recognition are related to psychotic symptoms. Anomalous appraisal of context by dysfunctions in the context network may contribute to impairments in the reality processing in schizophrenia, and abnormal declarative memory processes may be involved in cognitive insight in patients with schizophrenia.
PMCID: PMC4368728  PMID: 25793291
24.  6-Gingerol reduces Pseudomonas aeruginosa biofilm formation and virulence via quorum sensing inhibition 
Scientific Reports  2015;5:8656.
Pseudomonas aeruginosa is a well-known pathogenic bacterium that forms biofilms and produces virulence factors via quorum sensing (QS). Interfering with normal QS interactions between signal molecules and their cognate receptors is a developing strategy for attenuating its virulence. Here we tested the hypothesis that 6-gingerol, a pungent oil of fresh ginger, reduces biofilm formation and virulence by antagonistically binding to P. aeruginosa QS receptors. In silico studies demonstrated molecular binding occurs between 6-gingerol and the QS receptor LasR through hydrogen bonding and hydrophobic interactions. Experimentally 6-gingerol reduced biofilm formation, several virulence factors (e.g., exoprotease, rhamnolipid, and pyocyanin), and mice mortality. Further transcriptome analyses demonstrated that 6-gingerol successfully repressed QS-induced genes, specifically those related to the production of virulence factors. These results strongly support our hypothesis and offer insight into the molecular mechanism that caused QS gene repression.
PMCID: PMC4345325  PMID: 25728862
25.  Comparison of Radiation Exposure during Fluoroscopy-Guided Transforaminal Epidural Steroid Injections at Different Vertebral Levels 
Korean Journal of Radiology  2015;16(2):357-362.
To estimate and compare radiation exposure during transforaminal fluoroscopy-guided epidural steroid injection (TFESI) at different vertebral levels.
Materials and Methods
Fluoroscopy-guided TFESI was performed in 181 patients. The patients were categorized into three groups according to the injected lumbosacral nerve level of L2-4, L5, or S1. Fluoroscopy time (FT) and dose area product (DAP) were recorded for all patients; correlations between FT and DAP were determined at each level, and both FT and DAP were compared between the different vertebral levels.
The numbers of patients who received ESI at L2-4, L5, and S1 were 29, 123, and 29. Mean FT was 44 seconds at L2-4, 33.5 seconds at L5, and 37.7 seconds at S1. Mean DAP was 138.6 µGy·m2 at L2-4, 100.6 µGy·m2 at L5, and 72.1 µGy·m2 at S1. FT and DAP were positively correlated in each group (p values < 0.001). FT was significantly shorter at L5 than that at L2-4 (p = 0.004) but was not significantly different between S1 and L2-4 or L5 (p values = 0.286 and 0.532, respectively). DAP was significantly smaller at L5 and S1 than that at L2-4, but L5 and S1 were not significantly different. After correcting for FT, DAP was significantly smaller at S1 than that at either L2-4 or L5 (p values = 0.001 and 0.010).
The radiation dose was small during a single procedure of ESI and showed differences between different lumbosacral spine levels.
PMCID: PMC4347272  PMID: 25741198
Fluoroscopy; Epidural steroid injection; Dose area product; Fluoroscopy time

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