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Objective: This study aimed to investigate prescription patterns in patients with insomnia who still met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria despite having already been taking hypnotics, and to determine which drug(s) and what combination therapies were preferred. Methods: Sixty-three patients were enrolled in this study. Patients were selected from participants registered at six university hospitals for a prospective study to evaluate the efficacy of melatonin (Circadin).Results: The prescribed hypnotics were clonazepam (n=33), trazodone (n=23), zolpidem (n=22), quetiapine (n=14), mirtazapine (n=12), lorazepam (n=10), alprazolam (n=7), triazolam (n=5), doxepin (n=5), diazepam (n=3), etizolam (n=2), and flunitrazepam (n=1). There were five types of monotherapies (benzodiazepine, zolpidem, trazodone, mirtazapine, and doxepin) and 18 types of combination therapies. The total number of hypnotics used ranged from one to six. The frequency of benzodiazepine use was quite high, at 51/63. Conclusion: This study showed that insomnia can be treated in a wide variety of ways. In particular, 63% of the insomnia treatments in this study used combination therapy. This means that the gap between evidence-based pharmacotherapy and pharmacotherapy used in clinical practice is substantial. This also means that insomnia is still not fully understood and is a heterogeneous condition. In the future, more studies are needed to deepen our understanding of the pathophysiology of insomnia.

Background The validation of adult-based US risk stratification systems (RSSs) in the discrimination of malignant thyroid nodules in a pediatric population remains lacking. Purpose To estimate and compare the diagnostic performance of pediatric US RSSs based on five adult-based RSSs in the discrimination of malignant thyroid nodules in a pediatric sample. Materials and methods Pediatric patients (age ≤18 years) with histopathologically confirmed US-detected thyroid nodules at a tertiary referral hospital between January 2000 and April 2020 were analyzed retrospectively. The diagnostic performance of US-based fine-needle aspiration biopsy (FNAB) criteria in thyroid cancer detection was estimated. The following sensitivity analyses were performed

BACKGROUND Bronchiolitis obliterans syndrome (BOS) is a life-threatening respiratory complication of allogeneic hematopoietic stem cell transplantation (HSCT). Although pulmonary function testing is crucial for monitoring BOS, little information exists on the association of these test results with outcomes in children with BOS. OBJECTIVES The purpose of this study was to determine the correlation between changes in lung function after BOS diagnosis and long-term outcomes. METHODS A total of 428 children underwent allogeneic HSCT from January 2006 to December 2017 at Asan Medical Center. Twenty-three (5.4%) were diagnosed with BOS after allogeneic HSCT, and their clinical data were reviewed. Twenty-one subjects underwent regular pulmonary function testing for 24 months after BOS diagnosis. RESULTS Among the 21 children with BOS, 8 died, 5 underwent lung transplantation (TPL), and 15 required oxygen (O2 ) therapy. The FEV1 % predicted (pred), FVC% pred, and FEF25%-75% pred were 37.8 ± 12.7% (mean ± SD), 62.2 ± 16.2%, and 16.4 ± 9.6%, respectively, at the time of BOS diagnosis. Changes in the FEV1 % pred were greater in the death and lung TPL groups (-24.8 ± 22.3%) than in the survival without lung TPL group (5.7 ± 21.8%) and greater in the O2 therapy (-19.4 ± 23.4%) group than in the group without O2 therapy (14.2 ± 20.0%) during the first 3 months after BOS diagnosis. CONCLUSION The change in FEV1 during the first 3 months after BOS diagnosis correlated with outcomes including survival, lung TPL, and O2 therapy. These results suggest that more active intervention in the first 3 months after BOS diagnosis may be needed to improve prognosis.

Background and Aims The diagnostic performance of diffusion-weighted imaging magnetic resonance enterography [DWI-MRE] has not been clearly established in a paediatric population. We systematically evaluated the diagnostic performance of DWI-MRE for the detection of bowel inflammation in paediatric patients with suspected or known inflammatory bowel disease [IBD]. Methods MEDLINE/PubMed, EMBASE, Web of science and the Cochrane library were searched for articles investigating the diagnostic performance of DWI-MRE for the detection of bowel inflammation in paediatric patients with suspected or known IBD up to December 31, 2020. Pooled sensitivity and specificity were calculated using a bivariate random-effects model. Pooled inter-reader agreement for the interpretation of DWI-MRE was also calculated. This study was registered as PROSPERO CRD42021228754. Results Nine studies covering 400 paediatric patients were included. The pooled sensitivity and specificity of DWI-MRE for the detection of bowel inflammation were 0.93 (95% confidence interval [CI], 0.88–0.96) and 0.96 [95% CI, 0.87–0.99], respectively. Substantial heterogeneity was noted in both sensitivity [I2 = 66%; p Conclusions DWI-MRE, especially when used with spasmolytics, is accurate for the detection of bowel inflammation in paediatric patients with suspected or known IBD. Quantitative measurement of ADC is not practical for this purpose.

To evaluate the outcome of staging chest CT and to identify clinicoradiological factors predictive of lung metastasis in patients with hepatoblastoma based on the 2017 PRE-Treatment EXTent of tumor (PRETEXT) system. This bi-center study retrospectively identified patients diagnosed with hepatoblastoma between January 1998 and September 2019 in two tertiary hospitals. The primary outcome was the proportion of the patients who had lung metastasis at staging chest CT. The diagnostic accuracy of staging chest CT was calculated based on the 2017 PRETEXT criteria. The secondary outcome was the identification of factors predictive of lung metastasis using multivariable logistic regression. In total, 123 patients (median age, 1 year; interquartile range, 0–4 years; 59 female) were included. Among those, 28% (35/123; 95% confidence interval [CI], 21–37%) had lung metastasis at staging chest CT. The overall accuracy of staging chest CT was 96.8%. The proportion of lung metastasis in patients with stage I, II, III, and IV was 0%, 24% (12 of 49; 95% CI, 14–38%), 23% (9 of 40; 95% CI, 12–38%), and 56% (14 of 25; 95% CI, 37–73%), respectively. Multifocality (adjusted odds ratio, 6.7; 95% CI, 2.7–17.5; p < .001) and male sex (adjusted odds ratio, 3.1; 95% CI, 1.2–8.6; p = .02) were associated with the presence of lung metastasis. Twenty-eight percent of the patients with hepatoblastoma had lung metastasis at staging chest CT. Multifocality and male sex were predictive factors for lung metastasis on staging chest CT. • The proportion of lung metastasis in patients with hepatoblastoma was 28%. • The overall accuracy of staging chest CT was 97% based on the 2017 PRETEXT system. • Hepatic tumor multifocality and male sex were predictors of lung metastasis.

To identify predictors of failed enema reduction in children with intussusception. PubMed and EMBASE were searched for all studies published over a 20-year time frame, prior to March 25, 2020. Original articles that reported predictors of failed enema reduction were included. The pooled odds ratio (OR) for successful enema reduction according to various features was calculated. The combined estimates were meta-analytically pooled by random-effects modeling. The risk of bias was assessed using the National Institute of Health Quality Assessment Tool. This review was registered to the PROSPERO (CRD42020190178). A total of 38 studies, comprising 40,133 cases, were included. The shorter duration of symptoms (< 24 h; combined OR, 3.812; 95% CI, 2.150–6.759) and abdominal pain (combined OR, 2.098; 95% CI, 1.405–3.133) were associated with the success (all p < 0.001). Age < 1 year (combined OR, 0.385; 95% CI, 0.166–0.893; p = 0.026), fever (combined OR, 0.519; 95% CI, 0.371–0.725; p < 0.001), rectal bleeding (combined OR, 0.252; 95% CI, 0.165–0.387; p < 0.001), and vomiting (combined OR, 0.497; 95% CI, 0.372–0.664; p < 0.001) were associated with the failed reduction. The ascites (combined OR, 0.127; 95% CI, 0.044–0.368; p = 0.001), left-sided intussusception (combined OR, 0.121; 95% CI, 0.058–0.252; p < 0.001), and trapped fluid (combined OR, 0.179; 95% CI, 0.061–0.525; p = 0.017) on US were associated with the failed reduction. Successful predictors for intussusception reduction have been summarized. This evidence can help identify patients who are more likely to fail non-operative reduction and could be potential surgical candidates. • A shorter duration of symptoms and presence of abdominal pain were associated with increased probability of success. • Age (less than 1 year), presence of fever, rectal bleeding, vomiting, and presence of ascites, left-sided intussusception, or trapped fluid on ultrasonography were associated with decreased probability of success. • This study suggests that various clinical and ultrasonography predictors would help identify patients who are more likely to fail nonoperative reduction and identify potential preoperative candidates.

To evaluate the diagnostic performance of adult-based “American College of Radiology- Thyroid Imaging Reporting And Data System” (ACR-TIRADS) and “American Thyroid Association” (ATA) in the pediatric population. MEDLINE/PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched for articles investigating the diagnostic performance of each stratification system (ACR-TIRADS or ATA) and evaluated them according to three aspects: (a) the risk of malignancy in each category; (b) diagnostic performance using the classic indicators (sensitivity, specificity); and (c) diagnostic performance regarding fine needle aspiration/biopsy recommendation. In addition to pathologic diagnosis, we allowed imaging follow-up as the reference standard for benign nodules. Eight articles (1036 thyroid nodules) were included. For ACR-TIRADS, the pooled risk of malignancy in category was as follows: category 5 (59.3%); 4 (20.7%); 3 (11.0%); 2 (6.0%), and 1 (5.5%). For nodules of high suspicion of malignancy (category 4 or 5), the pooled sensitivity and specificity were 0.84 and 0.64. For ATA, the pooled risk of malignancy was as follows: category 5 (55.4%); 4 (34.2%); 3 (12.2%); and 2 (7.5%). For nodules of high suspicion of malignancy (category 4 or 5), the pooled sensitivity and specificity were 0.90 and 0.50. For category 5 nodules, the pooled specificity was significantly higher in ACR-TIRADS (p = 0.02). For ACR-TIRADS, the missed malignancy rate was 21.7% and the unnecessary biopsy rate was 62.7%. Information was not sufficient for this calculation with ATA. The diagnostic performance of ACR-TIRADS and ATA in the pediatric population was somewhat modest. Large studies are mandatory for further validation and future amendments. • The pooled sensitivity and specificity for highly suspicious nodules (category 4 or 5) for ACR-TIRADS were 0.84 and 0.64, and for ATA were 0.90 and 0.50, respectively. • When applying ACR-TIRADS for children, the pooled missed malignancy rate (21.7%) and unnecessary biopsy rates (62.7%) are still reasonably high. Insufficient information was available to perform these calculations for the ATA system. • Current risk stratification systems, especially ACR-TIRADS, require modification by focusing more on increasing the sensitivity and decreasing the missed malignancy rate. Lowering size cut-off for biopsy would be a reasonable option.

Background and Aims Evidence is limited regarding clinical course and magnetic resonance imaging [MRI] features of perianal fistula [PAF] in Korean children with Crohn’s disease [CD]. We investigated MRI features of PAF and associations with long-term outcomes. Methods We retrospectively analysed 243 patients with pelvic MRI for diagnosis of CD. Incidence of clinically evident PAF at diagnosis was determined, as were the proportions of patients with clinical failure [failure to achieve fistula healing within 1 year] and recurrence [new/recurrent PAF after fistula healing within 1 year]. Associations between outcomes and MRI features, specified in modified Van Assche index and MAGNIFI-CD, were evaluated. Associations between later development of clinically evident PAF and subclinical PAF detected on MRI at diagnosis were evaluated. Results Among 243 included patients, 108 [44.4%] and 76 [31.3%] had clinically evident and subclinical PAF at diagnosis, respectively; 66.4% of the patients with clinically evident PAF achieved fistula healing within 1 year, and 32.7% of those patients developed recurrence. Fistula length and dominant features of the tracts were associated with clinical failure, and fistula length was associated with recurrence. Clinically evident PAF developed in 17.0% of the patients without clinically evident PAF at diagnosis. We did not find statistically significant association between subclinical PAF and later development of clinically evident PAF [adjusted hazard ratio, 2.438; p = 0.15]. Conclusions A considerable proportion of Korean paediatric CD patients had clinically evident and subclinical PAF. Fistula length and dominant feature of the tract on MRI are useful predictors of outcomes.

Purpose: The aim of this study was to validate the postnatal urinary tract dilation (UTD) classification system by correlating it with the need for surgical intervention.Methods: Young infants who underwent ultrasound (US) examinations for prenatal hydronephrosis were retrospectively identified. The kidney units (KUs; right, left, or bilateral) were graded from UTD P0 (very low risk) to P3 (high risk) based on seven US criteria from the UTD system. Surgery-free survival curves were constructed using the Kaplan-Meier method. Univariable and multivariable Cox proportional-hazards regression analysis clustered by patients was performed. Interobserver agreement was analyzed using the weighted kappa coefficient.Results: In total, 504 KUs from 336 patients (mean age, 18.3±15.9 days; range, 1 to 94 days; males, n=276) were included, with a median follow-up of 24.2 months. Fifty-eight KUs underwent surgical intervention. Significant differences were observed among the Kaplan-Meier curves stratified into UTD groups (P

To evaluate the diagnostic performance of 2021 K-TIRADS biopsy criteria for detecting malignant thyroid nodules in a pediatric population, making comparisons with 2016 K-TIRADS.This retrospective study included pediatric patients with histopathologically confirmed diagnoses. The diagnostic performance of 2021 K-TIRADS was compared with that of 2016 K-TIRADS. Simulation studies were performed by changing biopsy cut-off sizes for K-TIRADS 5 to 1.0 cm (K-TIRADSTwo hundred seventy-seven thyroid nodules (54.9% malignant) from 221 pediatric patients were analyzed. All simulated 2021 K-TIRADS showed higher accuracy than 2016 K-TIRADS. Compared with 2021 K-TIRADSIn pediatric patients, 2021 K-TIRADS showed superior diagnostic accuracy to 2016 K-TIRADS, especially with a biopsy cut-off of 0.5 cm for K-TIRADS 5 and 1.0-1.5 cm for K-TIRADS 4.• All simulated 2021 K-TIRADS showed higher accuracy than 2016 K-TIRADS. • 2021 K-TIRADS with cut-off size for K-TIRADS 5 of 0.5 cm showed lower specificity but higher sensitivity and accuracy than that of 1.0 cm. • Compared with 2016 K-TIRADS, 2021 K-TIRADS (biopsy cut-offs, 0.5 cm for K-TIRADS 5; 1.0-1.5 cm for K-TIRADS 4) showed higher sensitivity while maintaining specificity in small nodules, and higher specificity while maintaining sensitivity in large nodules.

To evaluate associations between postnatal imaging features and outcome of left-sided congenital diaphragmatic hernia, as defined by overall survival and a requirement for extracorporeal membrane oxygenation (ECMO).Newborns diagnosed prenatally with left-sided congenital diaphragmatic hernia between January 2013 and September 2021 were studied retrospectively. The esophageal deviation index was newly defined as the largest diameter from the midline to deviated gastric tube divided by the largest transverse diameter of the thoracic cavity on the radiograph. Regression analyses were performed to identify postnatal imaging features associated with overall survival and a requirement for ECMO. The predictive power (ie, area under the curve [AUC] of a time-dependent receiver operating characteristic curve) of prenatal, postnatal, and intraoperative findings for predicting survival were calculated.Ninety-seven patients (54 males; mean gestational age, 38.3 ± 1.9 weeks; mean birth weight, 2956.5 ± 540.0 g) were analyzed. The esophageal deviation index (adjusted hazard ratio [HR], moderate [≥0.19 to0.24], 6.427 [P = .029]; severe [≥0.24], 33.007 [P .001]) and right pneumothorax (adjusted HR, 8.763; P = .002) were associated with overall survival and with a requirement for ECMO. Liver herniation on postnatal ultrasound also was associated with overall survival (P .001) and need for ECMO (P = .001). In addition, the AUC for prediction of 1-year survival from postnatal ultrasound was comparable with that of prenatally or intraoperatively detected liver herniation (0.93; 95% CI, 0.88-0.97).The esophageal deviation index, right pneumothorax, and liver herniation observed by postnatal imaging have prognostic value in patients with left-sided congenital diaphragmatic hernia.

Purpose: This study evaluated the accuracy of attenuation imaging (ATI) for the assessment of hepatic steatosis in pediatric patients, in comparison with the FibroScan vibration-controlled transient elastography controlled attenuation parameter (CAP).Methods: Consecutive pediatric patients referred for evaluation of obesity who underwent both ATI and FibroScan between February 2020 and September 2021 were included. The correlation between attenuation coefficient (AC) and CAP values was assessed using the Spearman test. The AC cutoff value for discriminating hepatic steatosis corresponding to a CAP value of 241 dB/m was calculated. Multivariable linear regression analysis was performed to estimate the strength of the association between AC and CAP. The diagnostic accuracy of AC cutoffs was estimated using the imperfect gold-standard methodology based on a two-level Bayesian latent class model.Results: Seventy patients (median age, 12.5 years; interquartile range, 11.0 to 14.0 years; male:female, 58:12) were included. AC and CAP showed a moderate-to-good correlation (ρ =0.646, P

Context Pituitary stalk thickening (PST) is often identified on magnetic resonance imaging (MRI), either incidentally or during diagnostic workup of hypopituitarism. However, the neoplastic etiology and natural course of PST are not fully understood, although this knowledge is required to establish diagnostic and surveillance strategies. Objective This work aimed to investigate the neoplastic etiology and natural course of PST. Methods MEDLINE/PubMed and EMBASE databases were searched up to February 2021 to identify original research investigating the etiologies of PST. The proportion of neoplastic etiology in patients with PST was meta-analytically pooled. Supplementary analysis exploring factors suggesting neoplasm was also performed. For initially indeterminate cases without confirmed diagnosis, the proportion of patients showing progression of PST during follow-up was evaluated. Results Eighteen studies covering 1368 patients with PST were included. The pooled proportion of neoplasm was 45.2% (95% CI, 33.3%-57.8%), with substantial heterogeneity across studies (I2 = 93%). The most common neoplasm was germ cell tumor (14.0% of study population), followed by Langerhans cell histiocytosis (10.2%) and metastasis (4.7%). The studies on pediatric populations and those with more than 50% of patients having at least one pituitary hormone deficiency tended to show a higher proportion of neoplasm. The pituitary stalk was thicker in neoplasms, but the difference was not significant (pooled mean difference, 2.08 mm; P = .08). In initially indeterminate cases, 18.5% (95% CI, 7.6%-38.3%) showed progression of PST during follow-up. Conclusion PST was commonly confirmed to be neoplastic, especially in pediatric populations. As isolated PST frequently progresses, follow-up imaging is essential in initially indeterminate cases.

OBJECTIVES To compare the feasibility and clinical applicability of ElastQ imaging (Philips Healthcare, Best, the Netherlands) with that of SuperSonic shear imaging (SSI; SuperSonic Imagine, Aix-en-Provence, France) using an elastographic phantom and a pilot study of patients. METHODS Two-dimensional shear wave elastography measurement was performed by ElastQ imaging and SSI by 2 radiologists. An elastographic phantom with 5 target elasticities at 2 acquisition depths was used. The coefficients of variation and intraclass correlation coefficients (ICCs) were evaluated for repeatability and interobserver agreement, respectively. The mean elasticities of the systems at each target were compared. The proportions of measurements that were out of the range of expected values and measurement errors were calculated to determine accuracy. Liver stiffness (LS) was measured by both systems in 27 children and young adult patients with various liver diseases. RESULTS Both systems provided high repeatability in elasticity measurements of phantom targets (coefficients of variation, 0.69%-15.82%), and there was excellent interobserver agreement (ICC, 0.992). Most (90%) mean elasticities of targets were significantly different between the techniques (P ≤ .002) and acquisition depths (P ≤ .004). ElastQ imaging had significantly lower proportions of out-of-range measurements and measurement errors (P ≤ .003) than SSI. In patients with liver disease, LS measurements of the systems were strongly correlated (ρ = 0.955; P

Accurate risk stratification according to the extent of Langerhans cell histiocytosis (LCH) determined on whole-body evaluation is important for determining the treatment plans and prognosis in patients with LCH. This study aimed to compare the lesion detectability and the accuracy of risk stratification of skeletal survey, bone scan, and whole-body magnetic resonance imaging (WB-MRI) in patients with LCH. Patients with newly-diagnosed LCH who underwent all three imaging modalities were retrospectively included (n = 46). The sensitivity and mean number of false-positives per patient for LCH lesions, and the accuracy of risk stratification of each modality were assessed. WB-MRI had significantly higher sensitivity (99.0%; 95% confidence interval, 93.2–99.9%) than skeletal survey (56.6%; p 0.017). WB-MRI tended to have higher accuracy for the risk stratification than skeletal survey and bone scan (concordance rate of 0.98, 0.91, and 0.83, respectively), although the differences were not significant (overall p-value 0.066). In conclusion, WB-MRI had higher detectability for LCH lesions than skeletal survey and bone scan, while the three whole-body imaging modalities had comparable accuracy in the initial risk stratification of LCH.

Background Respiratory artifacts impair image quality of magnetic resonance imaging (MRI) in children who cannot hold breath during MRI examination. Purpose To compare the quality of free-breathing contrast-enhanced 3D T1-weighted (T1W) images of the upper abdomen in children using Cartesian acquisition (Cartesian eTHRIVE), stack-of-stars acquisition with spectral fat suppression (3D VANE eTHRIVE), and stack-of-stars acquisition with fat suppression using modified Dixon (3D VANE mDixon). Material and Methods Pediatric patients (aged Results In 41 patients, 3D VANE eTHRIVE showed the highest scores for all image quality parameters ( P ≤ 0.001). 3D VANE eTHRIVE also showed higher scores for respiratory ( P ≤ 0.001) and radial artefacts than 3D VANE mDixon ( P = 0.001). There were no significant differences in coefficients of variation of signal intensity of the liver and spleen between 3D VANE eTHRIVE and 3D VANE mDixon. Acquisition time was longer for 3D VANE eTHRIVE (81.26 ± 16 s) than for Cartesian eTHRIVE (7.87 ± 0.95 s) and 3D VANE mDixon (76.66 ± 12.4 s, P Conclusion The application of stack-of-stars acquisition to 3D T1W abdominal MRI resulted in better image quality than Cartesian acquisition in free-breathing children. In stack-of-stars acquisition, spectral fat suppression resulted in better image quality and fewer artifacts than mDixon.

We aimed to assess the diagnostic performance of transient elastography for evaluating liver fibrosis in children and adolescents.A computerized search of Medline and Embase up to December 31, 2017, was performed to identify studies. Studies evaluating the diagnostic performance of transient elastography for the severity of liver fibrosis in children and adolescents were selected. Pooled sensitivity and specificity were calculated using hierarchic logistic regression modeling. Multiple subgroup analysis was performed.In this meta-analysis that included 11 original articles involving 723 patients, transient elastography showed a summary sensitivity of 95% (95% CI, 74-99%) and a specificity of 90% (95% CI, 81-95%) for the diagnosis of significant liver fibrosis (stage ≥ F2) in children. The hierarchic summary ROC AUC was 0.96 (95% CI, 0.94-0.98). Multiple subgroup analysis for the diagnosis of significant hepatic fibrosis showed clinically acceptable ranges of sensitivity and specificity across all subgroups. In additional subgroup analysis, the diagnostic accuracies of transient elastography according to the Metavir system were also within a clinically acceptable range, measured up to a sensitivity of 86% and specificity of 86% for diagnosing Metavir stage F4 fibrosis.Transient elastography showed highly accurate diagnostic performance for the diagnosis of liver fibrosis in children.

OBJECTIVES To assess the diagnostic performance of ultrasound (US) elastography in evaluating portal hypertension in children and compare the liver and spleen stiffness values between the portal hypertension and control groups. METHODS Studies in the MEDLINE and Embase databases were selected that investigated the diagnostic performance of US elastography in children with portal hypertension up to December 21, 2017. Pooled sensitivity and specificity data were assessed by hierarchical logistic regression modeling. RESULTS Eleven studies were included in the systematic review, and a meta-analysis could be conducted in 7 of these publications to evaluate the diagnostic performance of US elastography. The summary sensitivity and specificity of this method for liver stiffness were 90% (95% confidence interval [CI], 83%-94%) and 79% (95% CI, 73%-84%), respectively, and the area under the hierarchical summary receiver operating characteristic curve was 0.92 (95% CI, 0.90-0.94). A subgroup analysis of 5 transient elastographic studies revealed similar diagnostic performance (sensitivity, 90%; specificity, 78%). In 10 of the 11 studies that investigated liver stiffness and 2 of the 3 studies that also measured spleen stiffness, patients in the portal hypertension group had a significantly higher stiffness value than the control group (P

To evaluate signal changes in the hippocampus of epileptic seizure rat models, based on quantified creatine chemical exchange saturation transfer (CrCEST) signals. CEST data and 1H magnetic resonance spectroscopy (1H MRS) data were obtained for the two imaging groups: control (CTRL) and epileptic seizure-induced (ES; via kainic acid [KA] injection) groups. CrCEST signals in the hippocampal regions were quantitatively evaluated; correlations between CrCEST signals and phosphocreatine (PCr) and total creatine (tCr; PCr + Cr) concentrations, derived from the analysis of 1H MRS data, were investigated as a function of time changes (before KA injection, 3 and 5 h after KA injection). Measured CrCEST signals were exhibited significant differences between before and after KA injection in the ES group. At each time point, CrCEST signals showed significant correlations with PCr concentration (all |r| > 0.59; all P 0.05). CrCEST can adequately detect changes in the concentration of Cr as a result of energy metabolism, and may serve as a potentially useful tool for diagnosis and assessment of prognosis in epilepsy.

BC 1750년경의 함무라비법전, BC 1400년경의 히타이트법전, 모세율법의 헤브라이법전 등 고대법(古代法)에서는 일반적으로 피해자의 실손해액의 몇 배를 배상하게 하는 배수적 손해보상을 규정해왔다. 근대법에 있어서 징벌적 손해배상은 영국의 보통법에 의하여 발전되었다. 영국에서는 1275년 최초의 배 수적 손해배상을 결정한 법률을 제정하였다. 1763년 징벌적 손해배상이 보통법에 명시적으로 수용된 두 개의 판례(Huckle v. Money 사건, Wilkes v. Wood 사건)가 나왔고, 1766년에도 이를 인정하는 판례(Benson v. Frederich 사건)가 있었다. 이후 1964년 Rookes v. Barnard 사건 판결을 계기로 오늘과 같은 제도로 확립되었다. 현재 징벌적 손해배상은 영국·미국·캐나다 등 영미법을 근간으로 하는 국가에서 주로 행해지고 있다. 민·형사책임의 분화를 가장 큰 성과로 여기는 대륙법계 국가에서는 특수한 제도의 징벌적 손해배상제도의 도입을 반대해오고 있었다. 그러나 징벌적 손해배상제도는 고의성·악의성을 가진 불법행위자들을 징벌하고 억제하여, 사회질서를 유지하게 하는 순기능이 부각되면서, 제도의 도입은 피할 수 없는 시대적 흐름이 되었다. 최근에는 대륙법계 국가들에서도 개별법(식품안전, 소비자 권익보호 등)에 한해서 징벌적 손해배상제도의 성격을 띄는 배수적 손해보상제도 혹은 징벌적 손해배상을 인정하고 있는 추세를 보인다. 그러나 영미계의 특수한 제도인 징벌적 손해배상제도는 한국의 법체계를 고려하지 않은 제도이므로, 징벌적 손해배상제도의 법적 성질은 쟁점거리가 되고 있다. 현행 손해배상제도의 결점을 비롯한 많은 이유들로 우리는 징벌적 손해배상제도의 필요성을 충분히 느끼고 있다. 그러나 한국에 맞는 법체계를 정립하기 위해서 우리는 징벌적 손해배상에 대한 많은 분석과 연구로 합리적인 제도의 구축을 실현해야한다. 본문에서는 영국, 미국, 중국의 제도 경험을 고찰한 후, 해외의 경험적 사례를 통한, 구체적 한국으로의 점진적인 제도 도입에 관해 살펴본다.

To evaluate the diagnostic performance of reduced-dose CT for suspected appendicitis. A systematic search of the MEDLINE and EMBASE databases was carried out through to 10 January 2017. Studies evaluating the diagnostic performance of reduced-dose CT for suspected appendicitis in paediatric and adult patients were selected. Pooled summary estimates of sensitivity and specificity were calculated using hierarchical logistic regression modelling. Meta-regression was performed. Fourteen original articles with a total of 3,262 patients were included. For all studies using reduced-dose CT, the summary sensitivity was 96 % (95 % CI 93–98) with a summary specificity of 94 % (95 % CI 92–95). For the 11 studies providing a head-to-head comparison between reduced-dose CT and standard-dose CT, reduced-dose CT demonstrated a comparable summary sensitivity of 96 % (95 % CI 91–98) and specificity of 94 % (95 % CI 93–96) without any significant differences (p=.41). In meta-regression, there were no significant factors affecting the heterogeneity. The median effective radiation dose of the reduced-dose CT was 1.8 mSv (1.46–4.16 mSv), which was a 78 % reduction in effective radiation dose compared to the standard-dose CT. Reduced-dose CT shows excellent diagnostic performance for suspected appendicitis. • Reduced-dose CT shows excellent diagnostic performance for evaluating suspected appendicitis. • Reduced-dose CT has a comparable diagnostic performance to standard-dose CT. • Median effective radiation dose of reduced-dose CT was 1.8 mSv (1.46–4.16). • Reduced-dose CT achieved a 78 % dose reduction compared to standard-dose CT.

Objective Previous studies have reported that both preference for spicy food and drinking behavior are associated with the activity of the opioid system in the central nervous system. The relationship between the preference for spicy food and the risk of alcohol dependence by comparing spicy food preference in alcohol-dependent patients vs. healthy controls was investigated. Also the association between the preference for spicy food and OPRM1 A118G was studied. Methods A total of 150 Korean male patients with alcohol dependence and 100 normal male control subjects were included in this study. Preference for spicy food was measured using the Food Preference Scale (FPS). DNA analysis was conducted to detect the A118G polymorphism. Results The mean FPS score was significantly higher in the alcohol-dependent patients (61.2±24.2) than in the normal control subjects (53.0±22.0). FPS scores differed significantly between alcohol-dependent patients and normal control subjects who had the G allele in OPRM1 A118G, but not between the two groups with the AA genotype. Conclusion A strong preference for spicy food can be assumed to be a risk factor for alcohol dependence, particularly in those carrying the G allele in OPRM1 A118G.

To assess the diagnostic performance of shear-wave elastography for determining the severity of liver fibrosis in children and adolescents. An electronic literature search of PubMed and EMBASE was conducted. Bivariate modelling and hierarchical summary receiver-operating-characteristic modelling were performed to evaluate the diagnostic performance of shear-wave elastography. Meta-regression and subgroup analyses according to the modality of shear-wave imaging and the degree of liver fibrosis were also performed. Twelve eligible studies with 550 patients were included. Shear-wave elastography showed a summary sensitivity of 81 % (95 % CI: 71–88) and a specificity of 91 % (95 % CI: 83–96) for the prediction of significant liver fibrosis. The number of measurements of shear-wave elastography performed was a significant factor influencing study heterogeneity. Subgroup analysis revealed shear-wave elastography to have an excellent diagnostic performance according to each degree of liver fibrosis. Supersonic shear imaging (SSI) had a higher sensitivity (p

A relationship between alcohol dependence (AD) and calcium/calmodulin-dependent protein kinase IV (CAMKIV) has been reported in a whole genome study of Korean AD patients. The purpose of the present study is to compare the frequency of CAMKIV genotypes and alleles between AD and control subjects in Korea.The present study includes 281 AD patients and 139 control subjects. Seven single nucleotide polymorphism of CAMKIV gene known to show significant separation ratio in Asians were searched in SNP database and previous studies related to CAMKIV gene. Polymerase chain reaction and restriction fragment length polymorphism techniques were used to analyze genotype of CAMKIV gene SNPs.Major TT genotype and T allele frequencies of rs 25917 in AD patients were significantly higher than those of control subjects (genotype frequency, p=0.002; allele frequency, p=0.001). Major CC genotype and C allele frequencies of rs 117590959 in AD patients were also significantly higher than those of control subjects (genotype frequency, p0.001; allele frequency, p=0.001). Major genotypes of rs25917 (p=0.002, odd ratio: 3.13, 95% CI: 1.54-6.38) and rs11790959 (p=0.002, odd ratio: 3.22, 95% CI: 1.52-6.81) showed significantly higher odds ratios associated with AD than minor genotypes in logistic regression.These results suggest that CAMKIV might be a candidate AD gene. Further research is needed to determine the precise relationship between CAMKIV and AD and the function of each SNP.

Purpose To evaluate in pediatric patients the diagnostic performance of magnetic resonance imaging (MRI) for suspected appendicitis and its negative appendectomy rate. Materials and Methods The study involved diagnostic accuracy studies that used MRI for pediatric patients with suspected appendicitis. Various field strengths and sequences were used in each included study. The diagnostic accuracy of MRI in pediatric patients with suspected appendicitis and negative appendectomy rate were assessed. A search of MEDLINE and EMBASE databases was performed until January 10, 2017. Two reviewers assessed the methodological quality of the articles using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Pooled sensitivity and specificity for appendicitis diagnosis were calculated using hierarchical logistic regression modeling. Meta-regression was performed to explore factors affecting study heterogeneity. The pooled negative appendectomy rate was analyzed. Results Thirteen original articles with 1946 patients were included. The summary sensitivity and specificity were 97% (95% confidence interval [CI], 95–98%) and 97% (95% CI, 93–98%), respectively; the area under the hierarchical summary receiver operating characteristic (HSROC) curve was 0.98 (95% CI, 0.97–0.99). In meta-regression, use of diffusion-weighted imaging (P

The aim of the study was to correlate liver stiffness (LS) and hepatic venous-pressure gradient (HVPG) and to evaluate the diagnostic performance of shear-wave elastography (SWE) for predicting clinically significant portal hypertension in children with suspected liver diseases, in consideration of the reliability criteria.We identified 33 SWEs from 32 children who underwent HVPG measurement within 2 weeks between June 2012 and October 2015. The correlation between LS and HVPG was assessed. The diagnostic performance for predicting clinically significant portal hypertension (HVPG ≥ 10 mmHg) was assessed using the receiver-operating characteristic curve. Reliable measurement was evaluated based on the coefficient of variation (CV).LS was significantly correlated with HVPG (r = 0.742, P 0.001). The area under the receiver-operating characteristic curve for predicting clinically significant portal hypertension was 0.914, and the best cutoff value of 18.4 kPa showed sensitivity of 87.5% and specificity of 84.0%. LS measurements having CV ≤ 0.2 were significantly correlated with HVPG (r = 0.774, P .001), whereas those having CV 0.2 did not show a significant correlation with HVPG (r = 0.598, P = 0.089).SWE had excellent diagnostic performance for predicting clinically significant portal hypertension in children with suspected liver diseases. LS measurements having CV ≤ 0.2 may possibly be used as a reliability criterion in SWE measurement.

Objectives To evaluate the diagnostic performance of sonographic features of biliary atresia in patients with infantile cholestasis. Methods The Ovid-MEDLINE and EMBASE databases were searched for studies of the diagnostic performance of sonographic features of biliary atresia in patients with infantile cholestasis. A meta-analysis was performed to evaluate the diagnostic performance of the triangular cord sign and other sonographic features in patients with biliary atresia. Results Seventeen eligible studies with 1444 patients were included. The triangular cord sign had high accuracy for diagnosing biliary atresia: the meta-analytic summary sensitivity and specificity were 85% (95% confidence interval, 77%–90%) and 97% (95% confidence interval, 94%–99%), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.97. Meta-regression analysis revealed that the cutoff thickness of the triangular cord sign (3 or 4 mm) was a significant factor affecting study heterogeneity (P

Sacrococcygeal teratomas are the most common solid tumor in newborn infants. The diagnosis is not difficult in many cases; however, there should be additional information on imaging studies in order to manage those infants properly. Details include histology, morphologic classification, complications such as rupture, bleeding, and mass effects on the adjacent structures. Although imaging features cannot accurately predict the histologic subtypes of the tumors, thorough evaluation of the imaging features can help distinguish malignant tumors from benign tumors. In this article, pathogenesis, histological characteristics, clinical considerations, and morphologic characteristics will be discussed.

To evaluate the distribution of chloromas using whole body magnetic resonance (MR) imaging in pediatric patients with acute myeloid leukemia (AML) and to assess the clinical role of whole body MR imaging in management of pediatric patients with AML.We retrospectively searched pediatric patients (18 years old) who were diagnosed with AML and underwent whole body MR imaging during their illness between January 2006 and December 2014. The presence of chloromas was defined as when it was proven pathologically or showed typical imaging features. Nonchloroma lesions that were incidentally detected and were not previously seen on other imaging studies were defined as clinically occult nonchloroma lesions.Sixty-nine whole body MR scans of 40 patients with AML were included. The musculoskeletal system (42.9%) was the most commonly affected by chloromas. A total of 77 chloromas were identified in 11 (27.5%) of 40 patients. Nine (81.8%) of these 11 patients had 2 or more chloromas. There were 39 (50.6%) unexpected chloromas, which were incidentally detected, in 7 patients. Whole body MR scanning provided additional information regarding 21 clinically occult nonchloroma lesions in this patient population.Chloromas tended to show multiplicity and be present without symptoms. The most common site of involvement was the musculoskeletal system. Whole body MR imaging provided additional information that affected the clinical management of children with AML.