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Introduction: Adverse childhood experiences (ACEs) constitute a signifcant global mental health burden. Prior studies typically investigated the impact of ACEs on mental health using a cumulative risk approach; most ACEs studies were also conducted in Western settings. Purpose: This study aimed to examine ACEs using a pattern-based approach and assess their associations with mental health outcomes by early adulthood in East Asia. Methods: The present study included measures of exposure to 13 categories of ACEs, depression, anxiety, maladjustment, and posttraumatic stress in a sample of 1346 university students from Hong Kong, China, Taiwan, and Japan. Results: Latent class analysis indicated three distinct patterns of ACE exposure: Class 1: Low ACEs (76.0%); Class 2: Household Violence (20.6%); and Class 3: Household Dysfunction (3.4%). Those representing Class 3 had signifcantly more ACEs compared with those in Classes 1 or 2. Controlling for age and sex, those in Class 2 reported signifcantly higher depression and maladjustment symptoms compared with those in Class 1; both Classes 2 and 3 had signifcantly higher anxiety symptoms and odds for meeting diagnostic criteria for posttraumatic stress disorders compared with those in Class 1. Conclusions: Study fndings suggest that young adults’ mental health, at least under certain contexts, is more closely linked with the nature and pattern of ACE co-occurrence, rather than the number of ACEs.

The free vibrations of rectangular FGM plates with through internal cracks are investigated using the Ritz method. Three-dimensional elasticity theory is employed, and new sets of admissible functions for the displacement fields are proposed to enhance the effectiveness of the Ritz method in modeling the behaviors of cracked plates. The proposed admissible functions accurately describe the stress singularities at the fronts of the crack and display displacement discontinuities across the crack. The correctness and validity of the present approach are established through comprehensive convergence studies and comparisons with published results for homogeneous cracked plates, based on various plate theories. The locally effective material properties of FGM in the thickness direction are estimated by a simple power law. The effects of the volume fraction of the constituents of FGM and the thickness-to-length ratio on the frequencies are investigated. Frequency data for FGM square plates with three types of boundary conditions along the four side faces and with internal cracks of various crack lengths, positions and orientations are tabulated for the first time.

This study presents an X-band complementary metal-oxide semiconductor-based frequency-modulation continuous-wave (FMCW) sensor system for transportation management. The proposed sensor system has two antennas, one to transmit signals and the other to receive them. The complete radio frequency (RF) transceiver is based on standard 0.18 µm one-poly six-metal (1P6M) CMOS technology with a chip area of 1.68 mm×1.6 mm. Two planar leaky-mode antenna arrays with a gain of 18 dB are also designed. Experimental results indicate that the isolation between two antenna arrays that are 5.0 mm apart exceeds 42.0 dB at 10.5 GHz. The prototype of the FMCW sensor system is used in the range measurement of multiple lanes for the transportation management system (TMS). The major contribution of this study is that it integrates a 0.18 µm CMOS transceiver and antenna arrays into an FMCW RF front end, and employs an IF amplifier and a digital signal processor to demonstrate that the beat frequencies are linear. Measurements made in field tests agree closely with the simulation results.

Various palatal flap procedures based on the greater palatine vessels have been advocated for the repair of oroantral communications (OACs). However, when the defect is located in the third molar region, difficulty is encountered in using the palatal flap because rotation is hindered by the vascular pedicle. In this study, we used random palatal flaps to repair OACs in the third molar area in 21 patients. The vascular pedicles were ligated and severed in all cases in order to evaluate whether it was necessary to preserve the greater palatine vessels when using the palatal rotation flap (PRF). The repair was successful in 16 cases (76.2%). The length/width ratio of the flap was the most important factor determining the outcome. The ratios were 2.23±0.12 and 2.40±0.14 in the success and failure groups, respectively and their difference was statistically significant ( P 0.05). Other clinical parameters such as age, gender, antral infection, tooth displacement into the sinus and duration of the communication had no influence on the outcome ( P> 0.05). The study showed that the PRF with the appropriate length/width ratio can safely be used in a random fashion. This provided another option in the repair of oroantral communications of difficult locations such as in the tuberosity area.

Purpose To determine the incidence and clinical outcome of acute ischemic cholecystitis after transarterial chemoembolization (TACE) of hepatocellular carcinoma. Materials and methods In this ethics board-approved study, a retrospective review of 355 TACE procedures performed in 246 patients during a 5-year period was performed. The review of postintervention computed tomography (CT) reports for findings indicative of acute cholecystitis identified 12 patients (4.9%). In these patients, all CT scans, laboratory results (white blood cell count, alkaline phosphatase level, total bilirubin level), and clinical reports were analyzed to assess imaging findings and outcomes at the following time points: before TACE, within the first week after the procedure, as well as 1 and 6 months post-TACE. Results In 11 of 12 cases, the dominant finding on CT was new gallbladder wall thickening of up to 12 mm, which developed within 24 hours in 10 patients and within the first month after TACE in 1 patient. Gallbladder wall thickening persisted in 1 patient for at least 6 months. Eleven of 12 patients showed deposition of Lipiodol in the gallbladder wall. In 1 patient, the dominant finding on CT was pericholecystic stranding that resolved on follow-up CT after 1 month. None of the patients demonstrated gas in the gallbladder wall, significant pericholecystic fluid, abdominal or liver abscesses. Blood work results revealed transient increase in white blood cell count, alkaline phosphatase level, and total bilirubin level, not different from that seen after TACE in patients without CT evidence of cholecystitis. Clinical reports documented transient right upper quadrant pain for a few days and up to 1 month in 1 case with eventual symptom relief. None of the cases required surgical or radiological intervention. All but 1 case demonstrated normal gallbladder wall thickness after 6 months. Conclusions Acute ischemic cholecystitis is not an uncommon complication after TACE. However, it is self-limiting and does not seem to require any intervention or surgery.

Somewhat conflicting reports have appeared about the significance of linear meningeal thickening and enhancement adjacent to peripherally located cranial mass lesions on contrast enhanced magnetic resonance images. Some authors consider this finding nearly diagnostic of meningioma. In an attempt to determine the specificity of this so-called tail sign, particularly with respect to meningioma, we retrospectively reviewed 16 cases from institutional records. From our results, the tail sign appears to be highly suggestive but not specific for meningioma.

To determine the efficacy of magnetic resonance (MR) imaging and myelography for the diagnosis of spinal cord compression due to metastatic disease, the authors prospectively examined 70 patients who had known or suspected spinal involvement by malignancy. Most MR examinations consisted of T1-weighted sagittal imaging of the entire spine, with additional sequences as needed for clarification. Extradural masses were found in 46 patients, 25 of whom had cord compression. For extradural masses causing cord compression, the sensitivity and specificity of MR imaging was .92 and .90, respectively, compared with .95 and .88 for myelography. For extradural masses without cord compression the sensitivity and specificity of MR imaging was .73 and .90, versus .49 and .88 for myelography. MR imaging was much more sensitive for metastases to bone (.90 vs .49), as expected. MR imaging is an acceptable alternative to myelography for diagnosing spinal cord compression and is preferable as a first study because it is noninvasive and better tolerated.

The study examined the effect of a dose of alcohol producing a mean blood alcohol content of 90 mg% on components of the scalp-recorded visually evoked potential (VEP) both with and without a visual discrimination task to control the level of attention, and the interaction of amplitudinal hemispheric asymmetry of the VEP with alcohol treatment and the discrimination task. Ingestion of ethyl alcohol producing a mean blood alcohol content of 90 mg% affected VEPs recorded from the central scalp by attenuating the overall amplitude of the later VEP components (60-200 msec) and by significantly reducing hemispheric asymmetry in the amplitude of these VEP components. Alcohol attenuates VEP components P90-N120 and N120-P180, and the task of counting flashes and attending to discriminate double flashes increased amplitude of VEP components N60-P90 and P90-N120 in control and placebo conditions. Several studies have reported that the VEP recorded from the right hemisphere of human beings is larger than the VEP recorded from the homologous location in the left hemisphere. Evoked potentials recorded under control and placebo conditions in this study also demonstrated a hemispheric asymmetry with right larger than left for component P90-N120. We also found a reliable alcohol by hemispheric asymmetry interaction. Alcohol selectively depressed the amplitude of the right hemisphere VEP (P90-N120) component to a significantly greater extent than the left hemisphere VEP was affected.

Hematologic malignancies of the paranasal sinuses are uncommon. Four young patients with ophthalmologic abnormalities as a chief complaint are presented. Lymphoma or leukemia should be considered in the differential diagnosis of destructive lesions in the paranasal sinuses, particularly in children and young adults.

A case of Budd-Chiari syndrome is presented in which computed tomography (CT) and ultrasonography suggested the correct diagnosis and excluded adjacent tumor as the cause of hepatic vein occlusion. The CT appearance in this case (homogeneously increased attenuation of an enlarged caudate lobe) differed from the appearance previously reported (patchy liver enhancement) in Budd-Chiari syndrome. Underlying mechanisms responsible for the different CT appearance are discussed.

Patients with successfully treated Hodgkin disease are at increased risk for the development of second malignancies. We present two cases of intracranial non-Hodgkin lymphoma that appeared following successful treatment of Hodgkin disease. The appearance of the lymphomas on computed tomographic images is shown, and possible predisposing factors, differential diagnosis, and clinical implications are discussed.

Two cases of prostatic carcinoma metastatic to the cranium that presented with clinical and radiographic features simulating meningioma are described. The literature was reviewed, and 13 similar cases were identified. From the data gathered, we conclude that metastatic prostate cancer should be considered in the differential diagnosis of elderly males who present with characteristic clinical and radiological features of meningioma and that the classical description of meningioma is not specific.

Microneurosurgical advances have greatly decreased the morbidity and mortality associated with ruptured intracranial aneurysms, particularly in patients with good clinical status. In patients with poor clinical status, the devastating effects of hemorrhage on the cerebral circulation can result in ischemia and infarction. Early neurosurgical clipping allows more aggressive postoperative management of delayed cerebral vasospasm with volume expansion and hypertension. Early surgery has shown a decreased incidence of delayed vasospasm if the clot surrounding the cerebral vasculature can be removed [8]. In patients with delayed cerebral vasospasm with an untreated aneurysm, treatment with hypertension and volume expansion can increase the risk of rehemorrhage. In the United States, as many as 11% of patients with ruptured aneurysms will die secondary to the ischemic consequences of vasospasm, and considerably more will be permanently disabled [7].

A symptomatic collection of spinal canalicular gas of degenerative origin was observed by computed tomography. Relief of symptoms followed gas aspiration. The collection involved the lateral recess. Such gas collections do not appear to represent benign, transient entities in all patients.

Tc-99m-MAA hepatic arterial perfusion scintigraphy ( HAPS ) using a totally implanted drug delivery system was employed for hepatic arterial chemotherapy in 147 patients (335 studies). Complete perfusion of the involved liver was seen in 88% of patients initially [more so in those with normal hepatic vascular anatomy (93%) than those with vascular variants (79%)] and remained good on follow-up. In 67 consecutive patients (95 studies), arteriovenous shunting to the lung ranged from 0.4 to 32% (mean, 6.2% +/- 4.1 S.D.). Uptake at the tip of the catheter was increased in 20% of patients, but good perfusion was usually maintained. A significant decrease in hepatic and/or extrahepatic perfusion associated with a "hot spot" at the tip of the catheter indicated hepatic arterial thrombosis. Extrahepatic perfusion was seen in 14% of cases, usually in the distribution of the stomach, small bowel, and spleen. Significant symptoms of drug toxicity were seen in 70% of patients with extrahepatic perfusion, compared to 19% of those without it.

Real-time sonography was performed during spinal surgery in eight adult patients with seven different types of lesions. Cervical, thoracic, and lumbar lesions were included. All were examined prior to dural opening, using the saline-filled wound for water-path imaging. Five extramedullary masses and two intramedullary cavities were well delineated, allowing optimal surgical access to be determined at the moment of approach. Sonography also was abnormal in one case of diffuse spinal cord expansion, but no tissue sonographically distinguishable from spinal cord substance could be identified. Adequacy of surgical treatment was evaluated by repeat sonography before dural closure in one case of extramedullary mass and two cases of intramedullary cavities. Sonography is both reliable and beneficial during surgery for a variety of intraspinal lesions.

Many materials have been utilized to embolize cerebral arteriovenous malformations (AVMs) preoperatively. Specific vascular anatomy with large feeding vessels deep to the nidus or aneurysms within feeding arteries favor the use of detachable balloons over other embolic agents. Detachable balloons allow test occlusion of a vascular pedicle before permanent occlusion and can obliterate aneurysms in feeding arteries. We describe 36 feeder arterial balloon occlusions performed in 31 patients. Twenty-nine patients subsequently had surgical resection. None of the patients developed normal perfusion pressure breakthrough or required blood transfusions. The preoperative balloon occlusion was judged by the neurosurgeon to decrease significantly the difficulty in surgical resection of the malformation. The remaining 2 patients underwent embolization before radiosurgery. One patient had aneurysms in the feeding artery, which was balloon-occluded to diminish the risk of hemorrhage. There were two neurological deficits and three asymptomatic arterial dissections related to the balloon procedure. Balloon occlusion of feeding arterial pedicles in selected cerebral AVMs may be a valuable surgical adjunct. (Neurosurgery 22:301-308, 1988)

The authors examined 19 patients with diffuse histiocytic lymphoma of the brain, including 8 with primary disease and 11 with secondary disease. Both primary disease and secondary disease involving the brainstem and deep nuclei exhibited the characteristic CT appearance, consisting of a large, solid, homogeneously enhanced mass with varying amounts of edema. However, most secondary lymphomas outside the brainstem and basal ganglia contained large areas of low attenuation consistent with necrosis. Multifocal lesions were seen only in patients with secondary lymphoma. Systemic chemotherapy for extracranial lymphoma had no effect on the CT appearance of intracranial lesions. The authors suggest that these "unusual" CT patterns are actually typical of a distinct subset of histiocytic lymphomas.

Eight patients who had facial nerve neuromas were examined, and the radiographic findings are reported. Thin section tomography, high resolution computed tomography, posterior fossa computed tomography, and cerebellopontine angle cisternography using Pantopaque (iophendylate) demonstrated bone erosions and soft tissue masses conforming to the course of the facial nerve. The lesions generally exhibited either a proximal or a distal pattern of nerve involvement. Radiologic imaging frequently permits a correct preoperative diagnosis and accurate definition of the extent of facial nerve neuromas, assessments that are important for proper patient management.

Inward buckling of the dura at C1-2 may occasionally occur with hyperextension of the neck and can result in a difficult or unsuccessful puncture when the posterior lateral C1-2 approach is used for cervical myelography. In this circumstance, placement of the head in a neutral or slightly flexed position may widen the posterior subarachnoid space and facilitate the needle puncture.

A patient with a vertically oriented fracture of the odontoid is described. We found no previous report of this type of fracture. In our patient CT was the best imaging modality for defining the anatomic extent of the fracture.