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BACKGROUND The infusion of triolein emulsion (TE) induced increased vascular permeability and a negligible and temporary decrease in liver function without specific histopathological damage. AIM To assess changes in doxorubicin concentration according to the percentage of TE infused via a hepatic artery to study the vascular permeability in the rabbit liver. METHODS Thirty-nine healthy rabbits were divided into five groups according to the concentration of emulsified triolein infused into the hepatic arteries: Group 0, saline infusion (control group, n = 5); group 1, 0.3% TE (n = 13); group 2, 0.6% TE (n = 6); group 3, 0.9% TE (n = 8); and group 4, 1.5% TE (n = 6). Doxorubicin (2.4 mg/kg) was infused immediately after TE injection via the hepatic arteries. After 2 h, the livers were harvested, and doxorubicin concentrations were calculated fluorometrically. The doxorubicin concentrations were compared between TE groups and the control group, and the optimal concentrations within the TE groups were calculated. Statistical analysis was performed using the nonparametric Mann-Whitney U test and Kruskal–Wallis test. P < 0.05 were considered statistically significant. RESULTS In the liver, doxorubicin concentrations were 2.06, 2.07, 2.16 and 1.66 times higher in groups 1 through 4, respectively, and significantly higher in the TE groups than in the control group (all P < 0.05). However, there were no significant differences in the mean doxorubicin concentrations between the four TE groups (P = 0.642). In the lungs, the mean doxorubicin concentrations were not significantly different between the control and TE groups (P > 0.05). CONCLUSION TE infusion into the hepatic arteries significantly increased the doxorubicin concentration approximately twofold but was not different between the TE groups. These findings suggest that TE infusion might be a useful adjuvant treatment of liver cancers.

Background Medical students need to receive training in providing smoking cessation counseling to provide effective smoking cessation interventions to smokers when they become doctors. This study examined the smoking cessation education curricula and factors affecting counseling self-efficacy (CSE) in smoking cessation treatment among medical students. Methods In a multicenter cross-sectional study, we obtained demographic information, personal history of tobacco use and intention to quit smoking, exposure to secondhand smoke in the school premises during the past week, the experience of learning about tobacco in each medical school, tobacco-related medical knowledge, and self-efficacy in smoking cessation counseling on medical students of four Korean medical schools. Results Among 1,416 medical students eligible, 313 (22.1%) students completed a self-administered questionnaire. Only 20.3% of the students reported positive CSE on smoking cessation. The factors affecting positive CSE were scores of ≥ 60 on tobacco-related medical knowledge, smoking experience, and blended learning (p = 0.014, 0.005, and 0.015, respectively). Conclusion This study shows that high scores in tobacco-related medical knowledge and blended learning are correlated with positive CSE for smoking cessation counseling.

Triolein emulsion has been known to increase vascular permeability in the brain when it is infused into the carotid artery. The purpose of this study was to identify the morphologic mechanism of increased vascular permeability in brain induced by infusion of emulsified triolein into the carotid artery by transmission electron microscopy (TEM). Triolein emulsion was infused into the carotid artery of rats. TEM using lanthanum tracer was used to evaluate morphologic changes in endothelium with a focus on transcytotic vesicles and tight junction opening. The treat group showed multiple transcytotic vesicles containing lanthanum tracer within endothelium on TEM. TEM also revealed that lanthanum tracer entered neural interstitium through tight junctions between capillary endothelial cells infrequently in the treat group. No evidence of transcytotic vesicles containing lanthanum tracer or lanthanum leakage through tight junctions was observed in the control group. Transcytosis and the opening of tight junctions appears the pathway for vascular permeability enhancement by triolein. This result could be utilized in studies on the blood-brain barrier and by those searching for chemotherapeutic methods that deliver anti-tumor agents to normally drug inaccessible organs.

To evaluate associations between handgrip strength (HGS) and dietary nutrients, this study of a representative Korean population of 1553 adults aged &ge, 60 years (706 men and 847 women) analyzed data from the Korea National Health and Nutrition Examination Survey (2016). HGS was measured in both hands three times using a digital grip strength dynamometer. Dietary intake data were collected by the 24-h recall method through computer-assisted personal interviews. The study population had a mean age of 70.1 years, body mass index (BMI) of 24.2 kg/m2, and HGS of 35.7 kg in men, 21.2 kg in women. Total energy (r = 0.411), protein (r = 0.217), polyunsaturated fatty acid (PUFA) (r = 0.269), fiber (r = 0.272), and vitamin C (r = 0.098) were positively correlated with HGS. In multivariable regression analysis, PUFA (&beta, = 0.083) and vitamin C (&beta, = 0.003) were positively associated with HGS among women. Fiber (&beta, = 0.071) and vitamin C (&beta, = 0.006) showed a positive association with HGS among men. Community-dwelling older men and women with higher levels of PUFA, fiber, and vitamin C in their diet were more likely to have greater HGS even after adjusting for age, total calorie intake, BMI, chronic diseases and health-related habits.

To assess the frequencies of five health-related behaviors (smoking, alcohol consumption, body weight, sleep duration, and physical activity) in Korean adults with chronic hepatitis B.Data were obtained from the 2016 Korean National Health and Nutrition Examination Survey. In total, 5887 subjects (2568 males, 3319 females) over 19 years old were enrolled in this study. Interviews were performed to obtain information on demographic characteristics and medical conditions. A selfadministered questionnaire and medical examination were used to assess the smoking history, alcohol use, physical activity, sleep duration, and body weight of the subjects. Chronic hepatitis B was diagnosed based on detection of hepatitis B surface antigen (HBsAg). The subjects were categorized into HBsAg positive and negative groups, and a complex sampling analysis was conducted to compare the health behaviors between these groups.Among males, the current smoking rate in the HBsAg positive group was higher than that in the negative group (45.5%Our data demonstrate that a large proportion of Korean adults with chronic hepatitis B have poor health behaviors. Further studies are needed to confirm our results.

Previous studies have demonstrated that reduced heart rate variability (HRV) and hypovitaminosis D are associated with cardiovascular disease (CVD). However, few reports have investigated the effects of vitamin D on HRV. This cross-sectional study analyzed serum 25-hydroxyvitamin D (25(OH)D) and HRV indices using 5-min R-R interval recordings with an automatic three-channel electrocardiography in healthy subjects (103 males and 73 females). Standard deviation of N-N interval (SDNN), square root of mean squared differences of successive N-N intervals (RMSSD), total power (TP), very low frequency (VLF), low frequency (LF), and high frequency (HF) were reported. The mean age of subjects was 55.3 ± 11.3 years and the mean 25(OH)D level was 21.2 ± 9.9 ng/mL. In a multiple linear regression model, 25(OH)D was positively correlated with SDNN (β = 0.240, p &lt, 0.002), and LF (β = 0.144, p = 0.044). Vitamin D deficiency (25(OH)D &lt, 15 ng/mL) was associated with decreased SDNN (&lt, 30 m/s) (OR, 3.07, 95% confidence interval (CI), 1.32–7.14, p = 0.014) after adjusting for covariates. We found that lower 25(OH)D levels were associated with lower HRV, suggesting a possible explanation for the higher risk of CVD in populations with hypovitaminosis D.

Objectives: Colonoscopy is a popular tool for screening for colon cancer throughout the world. The incidence of polypectomy and follow-up colonoscopy are persistently increasing but the studies about follow-up test after polypectomy are still lack of its domestic sources. This study is designed to look into the recurrence rate of colon polyps and risk factors after polypectomy. Methods: This is a retrospective study by reviewing medical charts of 147 patients who underwent polypectomy and follow-up colonoscopy from Jan. 2000 to Mar. 2008. The Kudo classification was used to describe the polyps found in the colonoscopy. The follow-up period was defined as the term between polypectomy and the first colonoscopy follow up. Results: Seventy six point two percent of the enrolled patient were male and the mean age was 56.5 ± 8.1. Mean follow-up period was 24.9 ± 13.7 (6 - 65) months. The cumulative recurrence rate of 1 year was 11.6%. The rate of 2 years was 36.7% and that of 3 years was 55.8%. The number of polyps was the factor which statistically showed significant relation of its recurrence rate. The histological morphology characteristic of polyps could be one independent factor which may be associated to the recurrence of polyps. Conclusions: The importance of colonoscopy follow up after polypectomy was clearly emphasized through the cumulative recurrence rate of 55.8%. Therefore, there is a need for more domestic studies with a large number of patients about the recurrence of polyps after polypectomy.

BACKGROUND AND PURPOSE: Neurointerventional therapy of cerebrovascular disease is a greatly expanding field across many specialty disciplines. The goal of this study was to analyze the characteristics and trends of scientific publications that focused on neurointervention during the past decade. MATERIALS AND METHODS: A bibliometric evaluation of neurointerventional research published between 2003 and 2012 was conducted by using the PubMed data base. Analyzed parameters included the year of publication, type of document, language of the article, topic, declared funding, country of origin, type of collaboration between disciplines, the first author9s specialty, and subject category and the Impact Factor of the publishing journal. RESULTS: Between 2003 and 2012, a total of 2123 articles were published, of which 1107 (52.1%) were original articles, 1948 (91.8%) were written in English, 192 (9.0%) received funding, 661 (31.1%) were published by the United States, and 1060 (49.9%) resulted from interdisciplinary collaboration. Neurosurgery departments produced the most articles (n = 910, 42.9%), followed by radiology (n = 747, 35.2%) and neurology (n = 270, 12.7%). The time-trend analysis in the number of publications demonstrated slow growth from 2003 to 2012, with an average annual growth rate of +6.0%. CONCLUSIONS: The fields of neurosurgery, radiology, and neurology have contributed substantially to neurointervention research. Slow growth, high interdisciplinary collaboration, and a low level of funding are peculiar characteristics of research in this field.

Vitamin D deficiency is a known risk factor of breast cancer. An association between vitamin D and breast density has been suggested; however, it remains controversial. The aim of this study was to determine the association between serum 25-hydroxyvitamin D [25(OH)D] level and mammographic density. Subjects in our study included 517 patients who visited the health promotion center of the University Hospital. Mammographic density was classified using the American College of Radiology, Breast Imaging Reporting and Data System. Analysis of variance was performed to clarify the association of serum 25(OH)D level and mammographic density, and odds ratio was calculated by ordinal logistic regression analysis. The mean serum 25(OH)D level was 14.3 ± 7.0 ng/mL in all subjects. In correlation analysis, weak negative correlation was observed between serum 25(OH)D level and mammographic density groups (r = -0.09, P = 0.049). However, ordinal logistic regression analysis showed no statistically significant association between serum 25(OH)D level and mammographic density (odds ratio: 0.75, 95% confidence interval: 0.50-1.13). Results of our study showed that there is no significant association between serum 25(OH)D level and mammographic density. It is thought to be an another mechanism of serum 25(OH)D level on breast cancer risk in addition to breast density.

Objectives: Busan is reported to have the highest mortality rate among 16 provinces in Korea, as well as considerable health inequality across its districts. This study sought to examine overall and cause-specific mortality and deprivation at the town level in Busan, thereby identifying towns and causes of deaths to be targeted for improving overall health and alleviating health inequality. Methods: Standardized mortality ratios (SMRs) for all-cause and four specific leading causes of death were calculated at the town level in Busan for the years 2005 through 2008. To construct a deprivation index, principal components and factor analysis were adopted, using 10% sample data from the 2005 census. Geographic information system (GIS) mapping techniques were applied to compare spatial distributions between the deprivation index and SMRs. We fitted the Gaussian conditional autoregressive model (CAR) to estimate the relative risks of mortality by deprivation level, controlling for both the heterogeneity effect and spatial autocorrelation. Results: The SMRs of towns in Busan averaged 100.3, ranging from 70.7 to 139.8. In old inner cities and towns reclaimed for replaced households, the deprivation index and SMRs were relatively high. CAR modeling showed that gaps in SMRs for heart disease, cerebrovascular disease, and physical injury were particularly high. Conclusions: Our findings indicate that more deprived towns are likely to have higher mortality, in particular from cardiovascular disease and physical injury. To improve overall health status and address health inequality, such deprived towns should be targeted.

Objective — The metabolic syndrome is associated with increased risk of cardiovascular disease. It is important to examine the relation of the metabolic syndrome with the early stages of atherosclerosis. We sought to determine the impact of the metabolic syndrome, defined with International Diabetes Federation criteria, on arterial pulse wave velocity. Methods and results — Four hundred fifty-eight Korean adults (aged 26-77 years) were recruited into this cross-sectional study. Subjects were not taking any drugs other than antihypertensive or antidiabetic medication. All subjects were examined for body mass index, blood pressure, lipid profile, hs-CRP, uric acid, cystatin C, fasting glucose, and brachial-ankle pulse wave velocity. The prevalence of the metabolic syndrome by International Diabetes Federation definition was 20.7%.A positive correlation was observed between blood pressure, total cholesterol, triglycerides, uric acid, cystatin C, waist circumference, fasting glucose, and the brachial-ankle pulse wave velocity (P < 0.05). Subjects with metabolic syndrome had significantly higher arterial pulse wave velocity than subjects without metabolic syndrome. Multivariate logistic regression analysis adjusted for sex, age, and current smoking status showed that metabolic syndrome was associated with increased risk of high arterial pulse wave velocity (odds ratio: 3.31) (P < 0.05). Conclusions — Metabolic syndrome is associated with arterial stiffness by arterial pulse wave velocity. Monitoring of arterial pulse wave velocity in patients with metabolic syndrome may be helpful in identifying persons at high risk for subclinical atherosclerosis.

We previously demonstrated that zinc plus arachidonic acid (ZA) treatment lowered blood glucose levels in streptozotocin-induced diabetic rats, genetically diabetic obese (ob/ob) mice, and genetically diabetic, non-obese Goto-Kakizaki rats. However, plasma insulin levels did not increase with ZA treatment, suggesting that ZA lowers blood glucose levels not by stimulating pancreatic insulin secretion. However, it is unclear whether these agents lower blood glucose levels by decreasing hepatic glucose output (HGO) or by increasing glucose utilization in peripheral tissues, or both. In order to determine ZA target organ of insulin action, we divided 18 Sprague- Dawley rats weighing ~130 g into 3 groups (6 rats per group) and treated them for four weeks with: (1) Control diet (regular rat chow), (2) High fructose (60.0%) diet only, and (3) the same fructose diet plus zinc (10 mg/L) and arachidonic acid (50 mg/L) containing drinking water. After 4 weeks, insulin action was assessed using the hyperinsulinemic euglycemic clamp technique. Food intake and body weights were comparable in all three groups of rats throughout the study period. Plasma glucose and insulin concentrations, glucose uptake, and HGO in the basal state were all the same in these three rat groups. During the clamp study, fructose-treated and fructose+ZA treated rat groups did not exhibit any detectable change on insulin-mediated glucose uptake com- pared to controls. High fructose feeding impaired insulin mediated suppression of HGO, compared to controls during clamp (4.39 vs. 2.35 mg/kg/min; p

Background: Acupuncture has been reported to be beneficial for both acute and chronic migraine, albeit controversies about efficacy exist. Migraine may be caused by an imbalance in blood flow; acupuncture manipulations may be able to restore the balance, thereby reducing various symptoms of migraine. Objective: To study blood flow in extracranial arteries with a new protocol of flow quantification with fast-low angle shot after performing Korean Hand Acupuncture therapy on migraine patients. Design, Setting, and Participants: The study included 40 healthy volunteers (20 men and 20 women, mean age 33 years), and 40 with a history of migraine headaches without aura (10 men and 30 women, mean age 38 years). The study was performed at Pusan National University Hospital (Medical Center), Pusan, Korea, from June 2004 to February 2007. Intervention: Flow quantification with fast-low angle shot (FLASH) was performed with a 1.5-T MRI machine on participants attached with 4 gold-coated KHT (Korean Hand The...

Objectives: This study aimed to. offer some fundamental evidences for the stroke management policy by investigating the trends of medical care utilization and regionalization in stroke inpatients. Methods: We used the National Health Insurance claims and registry data for stroke inpatients from 1998 to 2005. Among all stroke inpatient claims data, self-employed insured and their dependents were only included in this study. The classification of stroke was based on ICD-10(I60-I69) and its subtype was divided by hemorrhage(I60-I62) and infarction(I63-I64) type. To evaluate regionalization of medical care utilization, relevance index was calculated by regions. The regions were classified 8 large catchment areas and 163 self authorized areas. Results: The overall medical care utilization rate of stroke inpatient has been increased, especially infarction subtype. Among medical care institutions, the utilization of hospital has been the most rapidly increased. Although considered annual rate of interest, total medical cost of stroke inpatients has been increased, Totally, more than 84% of stroke inpatient were admitted to medical care institutions in their own large catchment area during 1998-2005. The relevance indices in their own large catchment area (self sufficiency rates) were more than 70% in most areas regardless of stroke subtype except Chungbuk catchment area. Self sufficiency rates of stroke inpatients among 163 self authorized areas in 1998 and 2005 were 84.2% and 83.1% in metropolitan, 46.7% and 45.5% in urban, and 19.5% and 22.6% in rural areas, respectively. Conclusion: Stroke management policy for improvement of distribution at the district level, especially in rural areas, may be helpful for reducing regional inequality in stroke.

Atopy is a growing problem for Korean children. Since eicosapentaenoic acid is a precursor of less active inflammatory eicosanoids, n-3 polyunsaturated fatty acids (PUFA) may have a protective effect on atopy. This study was undertaken to determine whether n-3 PUFA in red blood cells (RBC) is lower in atopic than in non-atopic preschoolers. Three hundred and eight Korean children aged 4-6 years were enrolled. Total RBC fatty acid composition was measured by gas chromatography. The prevalence of atopic dermatitis, allergic rhinitis, or asthma was 29%. Total RBC n-3 PUFA were lower in preschoolers with atopy than controls (9.8 +/- 1.2 vs. 11.4 +/- 1.6%; P0.05), while n-6 PUFA (33.0 +/- 1.4 vs. 32.2 +/- 1.0%; P0.05) and n-6/n-3 PUFA ratio (3.4 +/- 0.6 vs. 2.8 +/- 0.5; P0.05) were greater. The following factors were also associated with an increase in atopy: higher saturated fatty acids (39.6 +/- 1.4 vs. 40.6 +/- 1.9; P0.05) and arachidonic acid (15.3 +/- 1.6 vs. 16.0 +/- 2.9; P0.05), and lower total PUFA (43.8 +/- 0.7 vs. 42.8 +/- 1.4; P0.05) and omega-3 index (EPA + DHA; 9.1 +/- 0.8 vs. 7.8 +/- 0.5; P0.05) in RBC. Maternal history of atopy was a significant (P0.05) risk factor, while lactation was not. The results suggest that a reduced content of n-3 PUFA in the RBC membrane could play a role in early children atopy.

BACKGROUND Triolein emulsion infusion into the carotid artery has been reported to induce temporary and reversible opening of the blood-brain barrier by increasing vascular permeability. OBJECTIVE To evaluate the effect of triolein emulsion infusion on brain permeance by anticancer agents. METHODS In the doxorubicin study. 2.4 mg/kg doxorubicin was injected immediately after triolein emulsion (1%, 1.5%, and 2%) infusion into rabbit carotid arteries. Two hours later, bilateral hemispheres and eyeballs were harvested, and doxorubicin concentrations were measured fluorometrically. Doxorubicin ratios of ipsilateral/contralateral hemispheres were compared with those of doxorubicin controls by use of the Kruskal-Wallis test followed by the Dunn test. In the cisplatin study, 10 mg/kg cisplatin was injected immediately after 2% triolein emulsion infusion into rat carotid arteries. Ipsilateral hemispheres were harvested 2, 6, 12, 24, and 36 hours after treatment. Time-dependent cisplatin concentrations were determined by liquid chromatography/electrospray ionization-tandem mass spectrometry/mass spectrometry. RESULTS Doxorubicin concentrations were significantly higher in ipsilateral hemispheres and eyeballs in all 3 triolein treatment groups than in doxorubicin controls. In the cisplatin study, cisplatin concentrations in the ipsilateral hemispheres peaked at 6 hours after infusion of cisplatin. CONCLUSION Brain permeance to anticancer agents was increased by triolein emulsion infusion, which suggests that triolein infusion might be a useful adjuvant treatment for brain tumors.

Objectives: Effects of aging and leisure time physical activity (LPA) might influence the effect of occupational physical activity (OPA) on risk for cardiovascular disease (CVD). This study was conducted to determine whether OPA affects CVD after controlling the effects of LPA and other risk factors for CVD such as job stress. Methods: Participants were 131 male Korean manual workers. Tests for heart rate variability (HRV) were conducted for five minutes in the morning at work. We defined OPA as the combined concept of relative heart rate ratio (RHR), evaluated using a heart rate monitor. Results: Whereas high OPA was not related to any HRV items in the younger age group, high OPA was associated with an increased number of low-value cases among all HRV items in older workers. Exercise had beneficial effects only in the younger group. After controlling for exercise and other risk factors, the odds ratios of the root-mean square of the difference of successive normal R-R intervals (rMSSD) and high frequency band power (HF) among the older age and high OPA group compared with the younger age and low OPA group were 64.0 and 18.5, respectively. Social support and shift work were independent risk factors in HRV. Conclusions: OPA in aging workers increases CVD risks. This study provides support for the need for protection of aging workers from physical work overload, and indicates the need for further study of optimal limits of OPA.

Purpose: This study aimed to evaluate the relationship between intraocular pressure (IOP) and age and obesity, adjusted for systemic health parameters such as sex and mean blood pressure, in a Korean population. Methods: A total of 13 212 healthy participants underwent automated multiphasic tests, including tonometry, automated perimetry, fundus photography, blood pressure and body mass index (BMI). Six age groups were used, divided by decades ranging from 20−29 years to 70+ years. The association between IOP and systemic health para­meters was examined using cross-sectional analysis. Results: The median age of participants was 47.6 years (range 20−84 years), and 6684 (50.6%) of participants were men. The mean IOP of participants was 15.5 mmHg. The mean IOP, blood pressure and BMI values were significantly higher in men than in women (P 21 mmHg without signs of glaucomatous visual field loss or optic disc damage, was 6.1% in men and 2.5% in women. Intraocular pressure was associated with mean blood pressure, sex, age and BMI by multiple regression analysis (P

Background Shift work is associated with health problems, including metabolic syndrome. This study investigated the association between shift work and metabolic syndrome in young workers. Methods A total of 3,317 subjects aged 20-40 years enrolled in the 2011-2012 Korean National Health and Nutrition Examination Survey were divided into shift and day workers. We conducted a cross-sectional study and calculated odds ratios using multivariate logistic regression analysis in order to examine the association between shift work and metabolic syndrome. Results The prevalence of metabolic syndrome was 14.3% and 7.1% among male and female shift workers, respectively. After adjusting for confounding factors, shift work was associated with metabolic syndrome in female workers (odds ratio, 2.53; 95% confidence interval, 1.12 to 5.70). Conclusion Shift work was associated with metabolic syndrome in young women. Timely efforts are necessary to manage metabolic syndrome in the workplace.

To determine whether intra-arterial infusion of triolein emulsion has biochemical and histopathologic effect on rabbit liver.An emulsion of 0.2 mL triolein in 20 mL of saline was infused into either the hepatic arteries of nine rabbits (group 1) or the superior mesenteric arteries of 12 rabbits (group 2). Five rabbits infused with 20 mL of normal saline were used as a control group (group 3). The serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were measured to evaluate liver function in each group just before the infusion, at 2 h, day 1, day 4, and day 7 following infusion. Each rabbit in all of the groups was infused with Evans blue on day 7 to evaluate changes in vascular permeability, and obtain the stained area of the hepatic surface. If the stained area was not available, the anteroinferior portion of the right hepatic lobe was selected. The obtained tissues were examined by light, electron and confocal microscopy. The changes in AST and ALT levels at each time point were calculated and statistically analyzed using a mixed linear model. A P value0.05 was regarded as statistically significant.In group 1 (hepatic artery group), both the AST and ALT serum levels increased significantly on day 1 (P = 0.0016 and P0.0001, respectively) compared with the control group, followed by a decrease thereafter. In group 2 (portal vein group), the AST level increased on day 4 (P = 0.0095), while the ALT level increased significantly on day 1 (P0.0001), and decreased thereafter, as compared with the control. For the remainder of the examination days, there were no significant changes in the AST and ALT levels (P0.05). Only three rabbits in each group showed hepatic surface staining with the Evans blue dye. Light and electron microscopic findings showed no specific changes in the selected hepatic tissues. Confocal microscopic examination with transferase-mediated dUTP nick-end labeling stain revealed lack of hepatocyte apoptosis in any of the groups. There were no differences in the results between group 1 and group 2.Infusion of triolein emulsion into rabbit livers revealed a minimal transient decrease of liver function, and no specific histopathologic changes.

Toxicity and persistence of perfluorinated alkyl substances (PFASs) in human have raised considerable concern and several biomonitoring studies throughout the world reported the widespread occurrence of these compounds in human tissues. However, information regarding influence of geographic, lifestyle and demographic factor on PFAS levels in human blood tissues is limited. In this study, whole blood samples collected in 2006–2007 from 319 donors from suburban Seoul (Suwon and Yongin), Busan and Yeosu in Korea were analyzed for perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorononanoate (PFNA), perfluorohexane sulfonate (PFHxS) and perfluorooctane sulfonamide (PFOSA). Blood donors classified into seven age groups with ages ranging from 8 to 82 years, and different lifestyles and socio-economic status. PFOS (median = 4.15 ng/mL) was found at the highest concentration with a maximum concentration of 59.1 ng/mL. The concentrations of other PFASs were in the decreasing order of; PFOA (median = 1.30 ng/mL) > PFNA (median = 0.85 ng/mL) > PFHxS (median = 0.47 ng/mL) > PFOSA (median = 0.12 ng/mL). Geographical differences in the concentrations of five target PFASs were found. Significant positive relationships between PFAS concentrations and the age of the donors were found. Gender-related differences were found in the concentrations of PFOA, PFNA, PFHxS and PFOSA. No association was found between PFAS levels and several lifestyle factors and socio-economic status which included drinking habit, furniture/carpet in an indoor environment and monthly income. Occupation was an important determinant for PFNA and PFHxS concentrations in the whole blood. Except for PFOSA, significant associations were noted between PFASs concentrations and smoking habit. The results of this study provide information for further public health monitoring and safety management for PFASs in Korea.

Background and purpose Generalized cerebral ischaemia from cardiovascular dysfunction usually leads to presyncopal dizziness, but several studies reported a higher frequency of rotatory vertigo in cardiovascular patients. Whether generalized cerebral ischaemia due to cardiovascular disorders may produce objective vestibular dysfunction was investigated. Methods Thirty-three patients with orthostatic dizziness/vertigo due to profound orthostatic hypotension and 30 controls were recruited. All participants underwent recording of eye movements during two orthostatic challenging tests: the Schellong and the squatting−standing tests. Most patients had neuroimaging, and patients with abnormal eye movements were subjected to follow-up evaluations. Results Symptoms associated with orthostatic dizziness/vertigo included blurred vision, fainting and tinnitus. Ten (30%) of 33 patients developed rotatory vertigo and nystagmus during the Schellong (n = 5) or squatting−standing test (n = 5). Four of them showed pure downbeat nystagmus whilst five had downbeat and horizontal nystagmus with or without torsional component. Patients with orthostatic nystagmus had shorter duration of orthostatic intolerance than those without nystagmus (1.0 ± 1.6 vs. 11.0 ± 9.7 months, P

Purpose: To analyze the effect on the morphologic characteristics of the corneal endothelium of the duration of soft contact lens wearing periods. Methods: Ninety soft contact lens wearers were divided into three groups: short-term users, for less than 5 years (n=60 eyes); intermediate-term users, from 6 years to 10 years (n=60); long-term users, for more than 10 years (n=60). Thirty non-contact lens wearers (60 eyes) were included as controls. All eyes were examined with a specular microscope. Analysis of covariance was used to detect any differences among the controls and the various soft contact lens subgroups. Results: There was a significant correlation between duration of soft contact lens use and morphologic changes of corneal endothelium. All soft contact lens subgroups had a significantly greater coefficient of variation in cell size than non-contact lens users . The proportion of hexagonal cells and the mean corneal endothelial cell density in those using soft contact lenses for more than 6 years were significantly lower than in the control group . Soft contact lens wear was significantly correlated with decreasing corneal endothelial cell densities with time. Conclusion: The coefficient of variation in cell size may be a sensitive indicator of early morphologic changes of the corneal endothelium. As the decrease in cell density among the contact lens subgroups was significantly associated with the duration of soft contact lens wearing periods, it will be useful to investigate endothelial cell density for evaluation of corneal endothelial function concerned with contact lens wearing.

The age-adjusted death rate from ischemic heart disease in Japan is the lowest among developed countries and the rates have decreased since 1970. The incidences of myocardial infarction in selected populations ranged between 0.12 and 2.56 per 1, 000 for middle-aged males, and between 0.00 and 1.52 per 1, 000 for females. The incidences of sudden death within 24 hours were from 0.00 to 1.58 per 1, 000 for males and from 0.00 to 0.76 per/1, 000 for females. The incidences in Japanese populations appeared to be far below those in Western populations. In the Cox proportional hazard regression model, hypertension and smoking were selected as independent risk factors for myocardial infarction in an agricultural district. It was noteworthy that the level of serum cholesterol was not associated with development of myocardial infarction in rural areas. No positive relation between dietary fat and serum cholesterol was observed in school children, suggesting that growth, sexual maturation and others might be confounding variables between them. The levels of serum cholesterol for females were more affected by menopause than those of blood pressures and body mass index. Although some polymorphisms in selected candidate genes appeared to be associated with some serum lipids and apolipoproteins, the effect of individual RFLP on the inter-individual variations in serum traits was relatively subtle in comparison with that of lifestyle factors. J Epidemiol, 1996 ; 6 : S49-S59.

AIM: To investigate the relationship between chronic viral hepatitis B (CVHB) and insulin resistance (IR) in Korean adults. METHODS: A total of 7880 adults (3851 men, 4029 women) who underwent a comprehensive medical examination were enrolled in this study. Subjects diagnosed with either diabetes mellitus, or any other disorder that could influence their insulin sensitivity, were rejected. Anthropometry, metabolic risk factors, hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B core antibody, fasting plasma glucose and insulin were measured for all subjects. Homeostasis model assessment (HOMA), quantitative insulin check index (QUICKI), and Mffm index were used for determining insulin sensitivity. Each participant was categorized into a negative, recovery, or CVHB group. To compare variables between groups, a t-test and/or one-way analysis of variance were used. Partial correlation coefficients were computed to present the association between insulin resistance and other variables. Multiple logistic regression analysis was used to assess the independent association between CVHB and IR. RESULTS: The mean age of men and women were 48.9 and 48.6 years, respectively. Subjects in the CVHB group had significantly higher waist circumference [(86.0 ± 7.7 cm vs 87.3 ± 7.8 cm, P = 0.004 in men), (78.3 ± 8.6 cm vs 80.5 ± 8.5 cm, P < 0.001 in women)], cystatin C [(0.96 ± 0.15 mg/dL vs 1.02 ± 0.22 mg/dL, P < 0.001 in men), (0.84 ± 0.15 mg/dL vs 0.90 ± 0.16 mg/dL, P < 0.001 in women)], fasting insulin [(5.47 ± 3.38 μU/mL vs 6.12 ± 4.62 μU/mL, P < 0.001 in men), (4.57 ± 2.82 μU/mL vs 5.06 ± 3.10 μU/mL, P < 0.001 in women)] and HOMA index [(1.24 ± 0.86 vs 1.43 ± 1.24, P < 0.001 in men), (1.02 ± 0.76 vs 1.13 ± 0.87, P = 0.033 in women)] compared to control group. The HOMA index revealed a positive correlation with body mass index (BMI) (r = 0.378, P < 0.001), waist circumference (r =0.356, P < 0.001), percent body fat (r = 0.296, P < 0.001), systolic blood pressure (r = 0.202, P < 0.001), total cholesterol (r = 0.134, P < 0.001), triglycerides (r = 0.292, P < 0.001), cystatin C (r = 0.069, P < 0.001) and uric acid (r = 0.142, P < 0.001). The QUICKI index revealed a negative correlation with BMI (r = -0.254, P < 0.001), waist circumference (r = 0-0.243, P < 0.001), percent body fat (r = -0.217, P < 0.001), systolic blood pressure (r = -0.132, P < 0.001), total cholesterol (r = -0.106, P < 0.001), triglycerides (r = -0.205, P < 0.001), cystatin C (r = -0.044, P < 0.001) and uric acid (r = -0.096, P < 0.001). For subjects identified with IR, the odds ratio of an accompanying diagnosis of chronic hepatitis B was 1.534 (95% CI: 1.158-2.031, HOMA index criteria) or 1.566 (95% CI: 1.124-2.182, QUICKI criteria) after adjustment for age, gender, BMI, and amount of alcohol consumption. CONCLUSION: Our study demonstrates that CVHB is associated with IR. CVHB may need to be monitored for occurrence of IR and diabetes mellitus.

Serum amylase has recently been shown to be associated with ghrelin and adiponectin as well as obesity. We investigated the relationship between total amylase and metabolic syndrome in adults.4495 adults were enrolled. All subjects denied any medical history or status of a disorder that could influence their serum amylase. Anthropometry, metabolic risk factors and total amylase concentration were measured. Each participant was categorized into one of 4 subgroups according to their total amylase concentration. Multiple logistic regression analysis was used to assess the independent association between amylase concentration and metabolic syndrome. Receiver-operating characteristics (ROC) curves analyses were used for comparison of the diagnostic value of amylase and other biomarkers for metabolic syndrome.The prevalence of metabolic syndrome by the National Cholesterol Education Program criteria was 13.4%, 15.3%, 19.3%, and 24.2% of those in the fourth, third, second, and lowest quartile of amylase concentration (P for trend0.001). After adjusting for age, sex, and body mass index, the odds ratios of the lower quartiles were significantly higher compared to the fourth quartile for the presence of metabolic syndrome. In ROC curve analysis, amylase was similar to uric acid as a significant diagnostic indicator for metabolic syndrome, but it had lower diagnostic value than alanine aminotransferase, γ-glutamyltransferase or C-reactive protein.Lower amylase concentration is associated with an increased prevalence of metabolic syndrome. Amylase may contribute to identifying metabolic syndrome, although further research is needed to understand the mechanism behind these associations.

To perform a multicenter survey to determine how many parents understood the optimal time for surgical correction of cryptorchidism in children.We enrolled 377 parents of patients who had recently undergone surgical correction of cryptorchidism. These parents were divided into 3 groups according to their indicated preference of the optimal patient age for surgical correction: group 1 (1 year old, 39 parents, 10.3%), group 2 (1-2 years old, 169 parents, 44.8%), and group 3 (3 years, 169 parents, 44.8%).The mean age of the children who underwent orchiopexy was 4.9 ± 5.2 years. The interval from diagnosis to surgical correction of cryptorchidism was 17.1 ± 29.8, 15.4 ± 14.4, and 29.0 ± 24.4 months in groups 1, 2, and 3, respectively (P.001). The mean age of the parents was significantly associated with the perception of the optimal time for surgical correction of cryptorchidism (P = .021 and P = .002). The number of highly educated parents was lowest in group 3 (P.001). The number of parents with2 children was 69.2% in group 1, 71.0% in group 2, and 84.0% in group 3 (P = .009). In group 3, the parents often delayed surgery because of the patient being too young (49.1%) and the parents' expectations of spontaneous descent (48.5%).Parents younger in age, with higher education levels and with fewer children, preferred early orchiopexy. Active intervention by a physician and public education for parents might be necessary to encourage earlier treatment of cryptorchidism.

Background: Triolein emulsion embolization into the carotid artery depicts reversible increased vascular permeability that can promote the effect of chemotherapy or can reduce the amount of chemotherapeutic drugs for equivalent effectiveness. Purpose: To establish the minimum dosage of 0.5% triolein for studying vascular permeability changes in a triolein emulsion model. Material and Methods: Sixty-six cats were divided into six groups based on the amount of emulsified triolein (0.5%) infused into the carotid artery: group 1 ( n=12, 6 ml/kg), group 2 ( n=12, 4.5 ml/kg), group 3 ( n=12, 3 ml/kg), group 4 ( n=10, 1.5 ml/kg), group 5 ( n=10, 1 ml/kg), and group 6 ( n=10, 3 ml/kg of saline (control group)). T1-weighted, T2-weighted, and post-contrast T1-weighted MRI was performed 2 h after the infusion of the triolein emulsion. Contrast enhancement ratios (CERs) were obtained with pre- and post-contrast T1-weighted images in the ipsilateral and contralateral hemispheres. Signal intensity ratios (SIRs) of the ipsilateral and contralateral hemispheres were evaluated on T2-weighted images. After removal of the brain tissues, edema ratios in the ipsilateral and contralateral hemispheres were obtained from wet versus dry brain weights. Data were statistically evaluated by analysis of variance, followed by the Tukey honestly significant difference test to compare the difference in the mean CER of the ipsilateral and contralateral hemispheres, mean SIR on T2-weighted image, and mean edema ratio between each group when overall significance was attained. Results: In the ipsilateral hemispheres, the difference in the CER between the control group and groups 1 ( P=0.004), 2 ( P=0.043), and 3 ( P=0.008) were statistically significant. The difference in the CERs between the triolein emulsion groups was not statistically significant ( P>0.05). The T2-weighted SIRs were significantly different between the control group and groups 1 ( P=0.027) and 2 ( P=0.004). However, the edema ratios of all doses in the triolein emulsion groups showed no significant differences compared with the control group. Conclusion: The minimum dosage of 0.5% triolein emulsion to achieve increased vascular permeability in the hemisphere in cat brains appears to be 3 ml/kg. This minimum dosage of triolein emulsion can be useful for acquiring basic data in further studies of vascular permeability changes in a triolein emulsion model.

After determining the normal ranges of serum high-density lipoprotein cholesterol levels, correlates of HDL-cholesterol were analysed in a sample of 1, 283 males and 2, 123 females aged 40 years and older in an agricultural area of Shibata City, Niigata Prefecture. The distribution of serum HDL-cholesterol was nearly a log-scale normal distribution curve. The median and the lower and upper normal limits were calculated theoretically and the median values were :40-49 age group, 51.9 mg/100 ml for males and 52.5 mg/100 ml for females ; 50-59 age group, 52.5 and 51.4; 60-69 age group, 51.4 and 49.4; over 70 age group, 49.4 and 47.9. There was almost no difference in HDL-cholesterol levels between both sexes. This was explained as possibly due to alcohol intake raising HDL-cholesterol levels in males. There was a positive association of HDL-cholesterol levels with reported amount of alcohol intake in males. Inverse relationships were found between serum HDL-cholesterol levels and obesity in any age group for both sexes. An inverse correlation between percent energy contribution by carbohydrate and HDL-cholesterol was observed in males. Caloric intake was positively correlated to HDL-cholesterol in females.

Background To test the hypothesis that triolein emulsion will increase vascular permeability of skeletal muscle. Methods Triolein emulsion was infused into the superficial femoral artery in rabbits (triolein group, n = 12). As a control, saline was infused (saline group, n = 18). Pre- and post-contrast T1-weighted MR images were obtained two hours after infusion. The MR images were qualitatively and quantitatively evaluated by assessing the contrast enhancement of the ipsilateral muscles. Histologic examination was performed in all rabbits. Results The ipsilateral muscles of the rabbits in the triolein group showed contrast enhancement, as opposed to in the ipsilateral muscles of the rabbits in the saline group. The contrast enhancement of the lesions was statistically significant (p < 0.001). Histologic findings showed that most examination areas of the triolein and saline groups had a normal appearance. Conclusion Rabbit thigh muscle revealed significantly increased vascular permeability with triolein emulsion; this was clearly demonstrated on the postcontrast MR images.

Background Several biological markers have been identified as risk factors for cardiovascular disease and are associated with increased risk of metabolic syndrome. We thus compared biomarkers and their association with metabolic syndrome. Methods We measured the white blood cell count, high-sensitivity C-reactive protein, homeostasis model assessment of insulin resistance (HOMA-IR), homocysteine, cystatin C, γ-glutamyl transferase (GGT), alanine aminotransferase (ALT) and uric acid levels in 4624 adults without a medical history of cardiovascular disease. Metabolic syndrome was defined using criteria from the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) and the International Diabetes Federation (IDF). Results The HOMA-IR and GGT were most strongly correlated with metabolic syndrome. The area under the receiver operating characteristic curve was highest for the HOMA-IR (0.773, 95% CI: 0.755–0.791 [men]; 0.792, 95% CI: 0.775–0.808 [women]) and the GGT (0.687, 95% CI: 0.667–0.706 [men]; 0.721, 95% CI: 0.703–0.739 [women]) in AHA/NHLBI criteria. The best cut-off value of HOMA-IR and GGT for identifying metabolic syndrome was (1.22, 30 IU/l [men], 1.28, 15 IU/l [women]). Conclusion HOMA-IR and GGT are most strongly associated with metabolic syndrome, suggesting that theses biomarkers may contribute to identifying metabolic syndrome more than other factors.

Objectives: To determine chronological characteristics of vestibular recovery after vestibular neuritis (VN) by using various clinical parameters. Study Design: Prospective clinical study. Methods: Twenty of 22 consecutive patients with acute VN underwent serial follow-ups of static (spontaneous nystagmus, subjective visual vertical, and ocular torsion) and dynamic (head-shaking nystagmus [HSN], vibration-induced nystagmus [VIN], head thrust test, and caloric test) vestibular imbalances for 1 year after symptom onset. Results: Static vestibular imbalances improved more rapidly than dynamic imbalances. Among the dynamic imbalances, a trend of higher recovery rate was found in head thrust sign, HSN, and VIN than in caloric asymmetry. HSN tended to be more sensitive in detecting vestibular asymmetry than VIN and head thrust sign. Some patients showed direction reversal of HSN (n = 5, 25.0%) or VIN (n = 5, 25.0%) during follow-up. Direction of VIN changed according to the stimulation sites in four (20.0%) patients. Conclusions: In view of more rapid resolution of static vestibular imbalance after VN, evaluation of the dynamic vestibular imbalances may provide more useful information for underlying vestibulopathy, especially in the compensated phase. The different temporal profiles ofdynamic vestibular recovery may reflect different chronological characteristics of vestibular compensation according to stimulus frequency. Direction reversal of HSN and VIN during follow-up suggests that lateralization of VNbased on the direction of these nystagmus should be considered in the context of disease phase.

Drug resistance is a major concern during nucleoside/ nucleotide analogues therapy in patients with chronic hepatitis B virus (HBV) infections. The aim of this study was to measure the risk of lamivudine resistance provided for each predictive factor in patients with chronic HBV infections.A total of 183 patients were analyzed among 315 patients with chronic HBV infections enrolled in a tertiary referral hospital between January 2001 and December 2003 on this retrospective cohort study. AST/ALT, HBeAg/anti-HBe, serum HBV DNA levels were tested for every 3 or 6 months. HBV DNA level was tested using Cobas Amplicor HBV Monitor test. Viral breakthrough was defined as HBV DNAor = 5 log10 copies/mL on two consecutive visits in patients who, on treatment, achieved HBV DNA5 log10 copies/mL. The risk of viral breakthrough was measured using Cox proportional hazards model for variables: age, sex, BMI (kg/m(2)), baseline ALT, HBeAg positivity, baseline HBV DNA level, serum HBV DNA level at 6 month of lamivudine therapy.The cumulative rates of viral breakthrough were 9.6%, 39.0%, 55.8% at 12, 24, 36 months, respectively. Serum HBV DNA level of 6 month of lamivudine therapy and presence of HBeAg were independent predictors for viral breakthrough. The relative risk was 1.43 (95% C.I. 1.09-1.89, P=0.010) for serum HBV DNA level at 6 months of lamivudine therapy and 1.77 (95% C.I. 1.06-2.95, P=0.029) for presence of HBeAg.Serum HBV DNA level at 6 months of therapy and HBeAg positivity were predictors of early lamivudine resistance in patients with chronic HBV infections. An alternate therapy should be considered when serum viral load is high at 6 months of lamivudine therapy.

To determine the adaptive capability of saccadic eye movements, and its association with enduring saccadic dysmetria in cerebellar and lateral medullary infarction (LMI), we investigated saccadic accuracy and adaptation in 15 patients with cerebellar or lateral medullary infarction, compared with those of 7 patients with diffuse cerebellar atrophy and 11 normal subjects. Saccade adaptation was elicited by a 37.5% backward target step during the primary saccade in both horizontal directions. Horizontal preadaptive saccadic gains were decreased in patients with cerebellar infarction, and contralesionally in patients with LMI. In contrast, adaptive saccadic gain change was reduced in patients with diffuse cerebellar atrophy and cerebellar infarction. Saccadic hypometria and reduced saccadic adaptability were dissociated in the majority of the patients with cerebellar infarctions; seven of the eight patients with cerebellar infarction showed saccadic hypometria and only three of them showed reduced saccadic adaptation, uni- or bilaterally in two with bilateral infarctions and ipsilesionally in one with unilateral infarction. The most commonly affected structure on MRI was the cerebellar hemisphere in the patients either with saccadic hypometria or with reduced saccadic adaptation. All patients with unilateral LMI exhibited normal saccadic gain adaptation in both directions, including those patients with enduring saccadic ipsipulsion. Our results suggest that the cerebellar hemispheres as well as the dorsal vermis and fastigial nucleus may be involved in the control of saccadic accuracy and adaptation. Reduced saccadic adaptation and persisting dysmetria are not tightly linked to each other in the cerebellar or lateral medullary lesions.

Previous studies have demonstrated that male hypogonadism is associated with a low level of vitamin D. However, no reports have investigated the effects of vitamin D on testosterone levels in Korean men. Our aim was to investigate whether testosterone levels are associated with serum vitamin D levels and whether seasonal variation exists. This cross-sectional study analyzed serum 25-hydroxyvitamin D [25(OH)D], total testosterone (TT), and free testosterone (FT) in 652 Korean men over 40 years of age who had undergone a comprehensive medical examination. The average age of the subjects was 56.7 ± 7.9 years, and the mean serum 25(OH)D, TT and FT levels were 21.23 ± 7.9 ng ml−1 , 4.70 ± 1.6 ng ml−1 , and 8.12 ± 3.3 pg ml−1 , respectively. In the multiple linear regression model, 25(OH)D showed positive association with TT (β =0.137, P< 0.001) and FT (β =0.103, P= 0.008). 25(OH)D and FT showed similar seasonal or monthly variation after adjustment for age. A vitamin D deficiency [25(OH)D < 20 ng ml−1 ] was associated with an increased risk of deficiencies of TT (

The authors investigated whether fatty acid emulsion affects the blood-brain barrier (BBB), whether disrupted BBB is reversible, and whether the fatty acid emulsion technique may be a model for BBB research.The fat emulsion was made with 0.05 mL of oleic acid or linoleic acid and 20 mL of normal saline. The internal carotid artery in 14 cats was infused with oleic acid emulsion (group 1) and with linoleic acid emulsion in 12 cats (group 2). Gd-enhanced T1-weighted (Gd-T1WI), diffusion-weighted (DWI), and additional apparent diffusion coefficient (ADC) map magnetic resonance imaging (MRI) was obtained at 1 hour, 1 and 4 days, and 1 week after infusion. MRI findings were evaluated qualitatively. Quantitatively, the signal intensity ratio (SIR) of the lesion to the contralateral hemisphere was measured on Gd-T1WIs. The SIRs were statistically analyzed using the student t test. The brain tissue was removed immediately for light and electron microscopy examination if the lesion showed no contrast enhancement and was isointense on DWIs and the ADC maps.The lesions appeared at 1 hour in both groups as contrast enhancement on Gd-T1WIs, as isointensity or mild hyperintensity on DWIs, and as isointensity on the ADC maps. On day 1, these MRI findings were decreased in group 1 and were not seen in group 2. At 1 hour, the SIRs of group 1 were significantly higher than those of group 2 (P = 0.016). On day 1, the SIRs of both groups approximated 1.0. Light microscopy findings revealed minor necrosis and demyelination in one cat from group 1 and in 3 cats from group 2. Electron microscopy examinations showed minimal findings in the cortical lesions in groups 1 and 2.Infusion of unsaturated fatty acid emulsion into the carotid artery of cats revealed vasogenic edema of the brain and reversible changes as depicted on MRI. This unsaturated fat emulsion technique may be used as a model for research on BBB disruption.

To investigate the differences in corneal endothelial cell morphology between diabetic patients who were divided by the degree of the severity of diabetic retinopathy and normal patients after phacoemulsification with intraocular lens (IOL) implantation.Department of Ophthalmology, College of Medicine, Pusan National University, Pusan, Korea.Before and 6 months after phacoemulsification, specular microscopy was used to evaluate the number and morphology of endothelial cells in patients with diabetic retinopathy. The patients were divided into 3 groups: group I (n=30 eyes), without diabetes; group II (n=30 eyes), diabetes with severe nonproliferative diabetic retinopathy; group III (n=30 eyes), diabetes with high-risk proliferative diabetic retinopathy (PDR).Postoperative corneal endothelial cell density and hexagonality were significantly decreased and the coefficient of variation in cell size increased in all groups, in contrast to the preoperative state (P.05). During the postoperative 6 months, the percentage of hexagonal cells showed a tendency to decrease progressively, and this was a significant difference between the 3 groups (P.05). However, the patterns of change in endothelial cell density and the coefficient of variation in cell size were not different between the groups (P.05). At the postoperative 6 months, the corneal endothelial cell density and the coefficient of variation in cell size of high-risk PDR patients were statistically changed compared with normal persons (P.05). However, the percentage of hexagonal cell was not significantly difference between diabetic retinopathy patients and normal patients (P.05).Corneal endothelial cell density significantly decreased and the coefficient of variation in cell size significantly increased for high-risk PDR patients undergoing phacoemulsification, in contrast to normal persons at the postoperative 6 months.

BACKGROUND AND PURPOSE: In fat embolism, free fatty acid is more toxic than neutral fat in terms of tissue damage. We evaluated the hyperacute embolic effects of triolein and oleic acid in cat brains by using MR imaging and electron microscopy. METHODS: T2-weighted imaging, diffusion-weighted imaging, and contrast-enhanced T1-weighted imaging were performed in cat brains after the injection of triolein (group 1, n = 8) or oleic acid (group 2, n = 10) into the internal carotid artery. MR images were quantitatively assessed by comparing the signal intensity ratios of the lesions with their counterparts on T2-weighted images, apparent diffusion coefficient (ADC) maps, and contrast-enhanced T1-weighted images. Electron microscopic findings in group 1 were compared with those in group 2. RESULTS: Qualitatively, MR images revealed two types of lesions. Type 1 lesions were hyperintense on diffusion-weighted images and hypointense on ADC maps. Type 2 lesions were isointense or mildly hyperintense on diffusion-weighted images and isointense on ADC maps. Quantitatively, the signal intensity ratios of type 1 lesions in group 2 specimens were significantly higher on T2-weighted images (P = .013)/(P = .027) and lower on ADC maps compared with those of group 1. Electron microscopy of type 1 lesions in both groups revealed more prominent widening of the perivascular space and swelling of the neural cells in group 2, in contrast to notable endothelial defects in group 1. CONCLUSION: MR and electron microscopic data on cerebral fat embolism induced by either triolein or oleic acid revealed characteristics suggestive of both vasogenic and cytotoxic edema in the hyperacute stage. Tissue damage appeared more severe in the oleic acid group than in the triolein group.

To evaluate the magnetic resonance imaging and electron microscopic findings of the hyperacute stage of cerebral fat embolism in cats and the time needed for the development of vasogenic edema.Magnetic resonance imaging was performed at 30 minutes (group 1, n = 9) and at 30 minutes and 1, 2, 4, and 6 hours after embolization with triolein (group 2, n = 10). As a control for group 2, the same acquisition was obtained after embolization with polyvinyl alcohol particles (group 3, n = 5). Magnetic resonance images were analyzed qualitatively and quantitatively. Electron microscopic examination was done in all cats.In group 1, the lesions were iso- or slightly hyperintense on T2-weighted (T2W) and diffusion-weighted (DWIs) images, hypointense on the apparent diffusion coefficient (ADC) map image, and markedly enhanced on the gadolinium-enhanced T1-weighted images (Gd-T1WIs). In group 2 at 30 minutes, the lesions were similar to those in group 1. Thereafter, the lesions became more hyperintense on T2WIs and DWIs and more hypointense on the ADC map image. The lesions were enhanced on Gd-T1WIs at all acquisition times. In group 3, the lesions showed mild hyperintensity on T2WIs at 6 hours but hypointensity on the ADC map image from 30 minutes, with a tendency toward a greater decrease over time. The lesions were not enhanced on Gd-T1WIs at any time point. Electron microscopic findings revealed discontinuity of the capillary endothelial wall, perivascular and interstitial edema, and swelling of glial and neuronal cells in groups 1 and 2. Cellular swelling and interstitial edema were more prominent in group 2. In group 3, interstitial edema was seen; however, discontinuity of the endothelial wall was absent.The lesions were hyperintense on T2WIs and DWIs, hypointense on the ADC map image, and enhanced on Gd-T1WIs. On electron microscopy, the lesions showed cytotoxic and vasogenic edema with disruption of the blood-brain barrier. Vasogenic edema seems to develop within 30 minutes in cerebral fat embolism in cats.

To determine its roles in the diagnosis and the systemic evaluation of metastatic brain tumours, whole-body positron emission tomography (PET) using [18F]FDG was performed in 20 consecutive patients.All patients were thought to be suffering or needing to be differentiated from metastatic brain tumours. Nine patients had multiple brain lesions; six were older and showed a rim-enhancing lesion with surrounding oedema; seven had homogeneously enhancing periventricular lesion(s) on computed tomography (CT) and/or magnetic resonance (MR) imaging, thought to be central nervous system lymphomas. Two patients had skull mass(es) and two patients had a solid mass suspected to be, respectively, a haemorrhagic metastasis and a metastatic malignant melanoma. All of them received whole-body [18F]FDG PET and conventional systemic work-up for metastasis in order to compare the results of the two methods.Metastatic brain tumours were diagnosed on whole-body [18F]FDG PET in eleven patients who had extracranial and intracranial hypermetabolic lesions. In nine of these, a conventional work-up also detected primary lesions which on whole-body [18F]FDG PET were seen to be hypermetabolic foci. Systemic lymph node metastases were detected by whole-body [18F]FDG PET only in two patients and histological diagnosis was possible by biopsy of lymph nodes rather than of brain lesions. In the remaining nine patients who had only intracranial hypermetabolic foci, histological diagnosis was made by craniotomy or stereotactic biopsy. It was confirmed that seven of nine patients were suffering from a primary brain tumour and two from metastatic carcinoma. None of the nine showed evidence of systemic cancer on conventional work-up. Histological diagnoses of the primary brain tumours were four cases of primary central nervous system lymphoma and one each of multifocal glioblastoma, Ewing's sarcoma, and cavernous angioma. Patients felt no discomfort during the whole-body [18F]FDG PET procedure and there were no complications. The false negative rate in [18F]FDG PET and in conventional work-up was 15.4% and 30.7% respectively. There were no false positives on either [18F]FDG PET or conventional work-up.It is suggested that whole-body [18F]FDG PET is a safe, reliable, and convenient method for the diagnosis and systemic evaluation of patients thought to be suffering or needing to be differentiated from a metastatic brain tumour.

Young-Jin Tak, Yun-Jin Kim, Sang-Yeoup Lee, Jeong-Gyu Lee, Dong-Wook Jung Yu-Hyeon Yi, Young-Hye Cho, Eun-Jung Choi, Byung-Mann Cho Department of Family Medicine, Pusan National University Hospital (1) ; Family Medicine Clinic, Pusan National University Yangsan Hospital ; Medical Education Unit, Pusan National University School of Medicine; and Department of Preventive Medicine, Pusan National University Hospital

The funding acknowledgment in this article was omitted as published. (J Prev Med Public Health 2012;45(2):70-77) Additional acknowledgment is as follows: ACKNOWLEDGEMENTS "This work was supported by a 2-Year Research Grant of Pusan National University"