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Jong Kwon Park,1 Won Beom Jung,1 Jung-Hee Yoon2 1Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea; 2Department of Radiology, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of KoreaCorrespondence: Jong Kwon Park Email jparkvk@gmail.comPurpose: Abdominal arteries differ from the arteries located at the extremities in histological composition and clinical features. This study investigated the distributional pattern of atherosclerosis in arteries of the abdomen and lower extremities and its association with clinical and hematologic factors.Patients and Methods: This retrospective study included 227 patients with atherosclerosis who underwent computed tomography angiography (CTA) of the abdomen and lower extremities. The distributional pattern of atherosclerosis was categorized into type 1 (suprainguinal elastic), type 2 (infrainguinal muscular), and type 3 (both arterial involvement). Chi-square tests, Mann–Whitney U-tests, and logistic regression analysis were used to investigate the data.Results: Of the 227 patients, 132 (58%) had type 1 and 95 (42%) had type 3 atherosclerosis. None had type 2. Older age, heavier smoking, and higher levels of HbA1c and homocysteine were the significant risk factors for type 3 atherosclerosis (odds ratio: 1.076, 1.023, 1.426, and 1.130, respectively). Patients with type 3 showed significantly lower right and left ankle and toe brachial indices compared to type 1 (P: 0.029, 0.023, 0.003, and < 0.001, respectively).Conclusion: In arteries of the abdomen and lower extremities, atherosclerosis may occur initially at suprainguinal elastic arteries. In addition, the significant risk factors for type 3 atherosclerosis may contribute to the development of atherosclerosis at infrainguinal muscular arteries and deteriorate the peripheral arterial circulation. Therefore, if atherosclerotic lesions are found at the suprainguinal elastic arteries on CTA, to prevent atherosclerosis at infrainguinal muscular arteries and subsequent peripheral arterial ischemic disease, cessation of smoking and control of blood glucose and homocysteine may be recommended, especially in elderly patients.Keywords: atherosclerosis, elastic arteries, muscular arteries, risk factors

Percutaneous radiofrequency ablation (RFA) is one of the curative treatments for hepatocellular carcinoma (HCC), but local tumor progression (LTP) has been a main limitation of RFA. This study aims to evaluate the LTP of percutaneous no-touch RFA (NtRFA) for HCC ≤ 5 cm and compare with conventional RFA (intratumoral puncture) through a systematic review and meta-analysis.MEDLINE, EMBASE, and Cochrane Library were searched for studies on percutaneous NtRFA for HCC ≤ 5 cm. The pooled proportions of the overall and cumulative incidence rates at 1, 2, and 3 years for LTP after NtRFA were assessed using a random-effects model. For studies comparing NtRFA with conventional RFA, relative risks (RR) and hazard ratios (HR) were meta-analytically pooled with LTP as the outcome.Twelve studies with 900 patients were included. The pooled overall rate of LTP after NtRFA was 6% (95% CI, 4-8%). The pooled 1-, 2-, and 3-year cumulative incidence rates of LTP were 3% (95% CI, 2-5%), 5% (95% CI, 3- 9%), and 8% (95% CI, 6-11%), respectively. Compared to conventional RFA, the pooled RR and HR of LTP were 0.26 (95% CI, 0.16-0.41) and 0.28 (95% CI, 0.11-0.70), respectively (both p0.01). Subgroup analysis including only randomized controlled studies also showed better local tumor control of NtRFA with HR of 0.13 (95% CI, 0.14-0.42).Percutaneous NtRFA is an effective treatment for HCC ≤ 5 cm with an overall LTP rate of 6% and provides lower LTP compared with conventional RFA.• The pooled 1-, 2-, and 3-year cumulative incidence rates of local tumor progression after no-touch radiofrequency ablation for HCC ≤ 5 cm were 3% (95% CI, 2-5%), 5% (95% CI, 3-9%), and 8% (95% CI, 6-11%). • No-touch radiofrequency ablation had significantly lower rates of local tumor progression compared to conventional radiofrequency ablation (hazard ratio, 0.28; 95% CI, 0.11-0.70; relative risk, 0.26; 95% CI, 0.16-0.41; p0.01, respectively).

To clarify CT findings that predict outcome of conservative treatment in patients with non-strangulated adhesive small bowel obstruction (SBO). Unenhanced and contrast-enhanced abdominopelvic CT studies in 189 patients with adhesive SBO who had initial conservative treatment were reviewed. The CT findings included transition zone, beak signs, maximum bowel diameter, bowel diameter ratio, decreased bowel wall enhancement, increased unenhanced bowel wall attenuation, anterior parietal adhesion, bowel wall thickening, closed-loop obstruction, small bowel feces sign, whirl sign, mesenteric haziness, mesenteric, peritoneal fluid, and submucosal edema. These findings were statistically compared according to the success or failure of treatment. Conservative treatment succeeded in 144 patients (76.2%) and failed in 45 patients (23.8%). At multivariate analysis, the lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid were independent findings predicting failure of conservative treatment, with odds ratios of 5.23, 5.5, 13.55, and 4.89, respectively. The presence of all significant findings showed a high specificity of 97.2% with positive likelihood ratio of 8.8. If CT scans showed none of the three significant findings, the negative predictive value was 97.6% and negative likelihood ratio was 0.08. The lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid are independent CT findings predicting the failure of conservative treatment in patients with non-strangulated adhesive SBO. The combination of all CT findings suggests the need for surgery; absence of two or all CT findings should suggest an attempt for conservative treatment. • To minimize delayed operation, it is important to identify non-strangulated adhesive small bowel obstruction patients in whom initial conservative treatment is likely to fail. • The lack of small bowel feces sign, the presence of mesenteric haziness, and a moderate amount of mesenteric fluid are independent factors predicting the failure of conservative treatment in patients with non-strangulated adhesive small bowel obstruction. • The combination of all three CT findings suggests the need for surgery; absence of two or all three CT findings should suggest an attempt for conservative treatment.

To evaluate the intraobserver and interobserver reliability of gallbladder polyp measurements using transabdominal US and the factors that affect reliability. From November 2017 to February 2018, two radiologists measured the maximum diameter of 91 gallbladder polyps using transabdominal US. Intraobserver and interobserver agreement were determined using 95% Bland-Altman limits of agreement and intraclass correlation coefficients (ICCs). The effects of image settings, polyp location, and polyp size were evaluated by comparing ICCs using z tests. The intraobserver agreement rates were 0.960 (95% confidence interval [CI], 0.939–0.973) for observer 1 and 0.962 (95% CI, 0.943–0.975) for observer 2. The ICCs between the two observers were 0.963 (95% CI, 0.926–0.979) for the first measurement and 0.973 (95% CI, 0.950–0.984) for the second measurement. The 95% limits of agreement on repeated measurements were 22.3–25.2% of the mean, and those between the two observers were 25.5–34.2% of the mean. ICCs for large polyps (≥ 5 mm) were significantly higher than those for small polyps (

Cinnamomum cassia has been widely used as a natural product to treat diseases in Asia due to its diverse pharmacological functions including anti-inflammatory, anti-oxidant, anti-microbial, anti-diabetic, and anti-tumor effects. Despite its ethnomedicinal benefits, little information regarding its toxicity is currently available. The aim of this study was to evaluate its potential long-term toxicity and genotoxicity in compliance with test guidelines of the Organization for Economic Cooperation and Development. A 13-week repeat-dose oral toxicity study revealed that body weights of rats were normal after receiving cinnamon extract at up to 2000 mg/kg. High-dose intake of cinnamon extract (2000 mg/kg) showed potential nephrotoxicity and hepatotoxicity to both males and females as evidenced by obvious increases of kidney/liver weight along with a small but statistically elevation of total cholesterol level. Overall findings from genetic toxicity testing battery including Ames test, in vitro mammalian cell micronucleus assay, and in vivo bone marrow micronucleus assay indicated that cinnamon extract was not mutagenic or clastogenic. In conclusion, cinnamon extract may possess potential nephrotoxicity and hepatotoxicity at dose higher than its recommended daily safe dose. Further study is needed to clarify the mechanism involved in its induction of liver and kidney injury.

Artemisia capillaris (AC) has been used as an alternative therapy in obesity, atopic dermatitis, and liver diseases through several biological activity including anti-steatotic, antioxidant, and anti-inflammatory activities. Despite its ethnomedicinal benefits, no sufficient background information is available about the long-term safety and genotoxicity of the AC extract. Therefore, the present study was carried out to investigate the 13-week subchronic toxicity and genotoxicity of the AC extract according to the test guidelines published by the Organization for Economic Cooperation and Development. In the 13-week toxicity study using doses of 25, 74, 222, 667, and 2000 mg/kg body weight, oral administration of the AC extract in male and female rats did not result in any significant adverse effects in food/water consumption, body weight, mortality, hematology, serum biochemistry, organ weight and histopathology. Accordingly, the no-observed-adverse-effect level in rats of both genders was established for the AC extract at 2000 mg/kg/day, the highest dose level tested. In addition, the AC extract was not genotoxic in a battery of tests including Ames test, in vitro chromosome aberration assay and in vivo micronucleus assay. In conclusion, we demonstrated that the AC extract is considered as a safe traditional medicine for human consumption.

BACKGROUND Despite the great benefits of mobile health applications (mHAs) in managing non-communicable diseases (NCDs) internationally, studies have documented general challenges to broad adoption of mHAs among middle to older age groups. By focusing on broad adoption, these studies have been limited in their evaluation of patients who can benefit the most from the functionalities provided by mHAs. OBJECTIVE This study aims to evaluate the knowledge, self-confidence, perceived benefits, and barriers of using mHAs depending on experience with mHAs among the middle-aged and older adults. Furthermore, we aim to identify the factors associated with the actual use of mHAs. METHODS We conducted a cross-sectional survey at a single tertiary hospital in Seoul, Korea, between May 1 and May 31, 2018. Of the 625 patients who were contacted, 323 participants were granted full inclusion to the study. We compared demographics, knowledge, self-confidence, and perceived benefits and barriers by experience with using mHAs, then performed logistic regression to identify the factors associated with mHA use. RESULTS Among the participants, 64.1% (N = 207) had experience using mHAs. Those in the experienced group were more likely to have more than college education (55.1% vs. 27.5%, P < 0.001) and to report a higher monthly income (≥ $7,000, 22.7% vs. 18.1%, P = 0.05) than their less-experienced counterparts. Although the experienced group was more likely to have higher self-confidence in using mHAs, about half of the study participants, including people with experience using mHAs, did not have appropriate knowledge of mobile technology. With adjusted logistic model, higher educated (adjusted PR (aPR) = 1.53, 95% CI, 1.26–1.80), higher perceived benefits of mHAs (aPR = 1.43, 95% CI, 1.04–1.83), and higher self-confidence using mHAs (aPR = 1.41, 95% CI, 1.12–1.70) were significant factors associated with mHA use. CONCLUSIONS The use of mHAs among middle-aged and older adults is becoming more common globally; nevertheless, there are still people unable to use mHAs properly because of lack of experience and knowledge. Strategies are needed to encourage the reliable usage of mHAs among those who may need it the most by improving self-confidence and better articulating benefits.

To evaluate the intraobserver and interobserver reliability of gallbladder polyp measurements using transabdominal US and the factors that affect reliability.From November 2017 to February 2018, two radiologists measured the maximum diameter of 91 gallbladder polyps using transabdominal US. Intraobserver and interobserver agreement were determined using 95% Bland-Altman limits of agreement and intraclass correlation coefficients (ICCs). The effects of image settings, polyp location, and polyp size were evaluated by comparing ICCs using z tests.The intraobserver agreement rates were 0.960 (95% confidence interval [CI], 0.939-0.973) for observer 1 and 0.962 (95% CI, 0.943-0.975) for observer 2. The ICCs between the two observers were 0.963 (95% CI, 0.926-0.979) for the first measurement and 0.973 (95% CI, 0.950-0.984) for the second measurement. The 95% limits of agreement on repeated measurements were 22.3-25.2% of the mean, and those between the two observers were 25.5-34.2% of the mean. ICCs for large polyps (≥ 5 mm) were significantly higher than those for small polyps ( 5 mm). There were no significant differences in the ICCs between image settings and polyp location.Polyp size measurements using transabdominal US are highly repeatable and reproducible. Polyp size significantly affects the reliability of measurement. Diameter changes of approximately less than 25% may fall within the measurement error; this should be considered while interpreting the change in size during follow-up US, especially for small polyps.• Gallbladder polyp size measurement using transabdominal US is highly repeatable and reproducible. • Diameter changes of approximately less than 25% should be interpreted carefully, especially in small polyps.

Retroperitoneal fibrosis (RPF) is an uncommon fibrotic reaction in the retroperitoneum. There is an idiopathic form and a secondary form associated with IgG4-related disease, drugs (methysergide, pergolide, bromocriptine, ergotamine, methyldopa, hydralazine), infections (tuberculosis, histoplasmosis, actinomycosis), malignancies (carcinoid tumor, Hodgkin’s and non-Hodgkin’s lymphomas, sarcomas, carcinomas of the colon, prostate, breast, and stomach), prior surgeries, and radiation therapy. The idiopathic form accounts for more than two-thirds of cases and it was thought to result from a local inflammatory response to antigens in the atherosclerotic plaques in the abdominal aorta, combined with auto-immunologic factors. Thus, the fibroinflammatory tissue usually encases the infrarenal portion of the abdominal aorta, inferior vena cava, and ureters (1-3). Here, we report two rare cases of idiopathic RPF involving only a unilateral renal pelvis and sinus; thus mimicking renal pelvic cancer.

We report here a case of an inflammatory myofibroblastic tumor in the retroperitoneum, which mimicked a germ cell tumor of the undescended testis. A 75-year-old healthy man presented with a palpable abdominal mass. On the computed tomography image, there was large, well-defined soft tissue mass in the left side of the retroperitoneum, and there was no visible left testis or seminal vesicle. After contrast enhancement, the mass appeared to be relatively homogeneous, considering its large size. With ultrasonography, it appeared as a well-defined, hypoechoic mass with intratumoral vascularity. This solid mass was surgically diagnosed as an inflammatory myofibroblastic tumor.

Objective: To evaluate the association between Non-alcoholic fatty liver disease (NAFLD) with renal stone disease detected on computed tomography (CT). Method: A total 1812 patients who underwent abdomen-pelvis CT in July 2015 were included in this study. The inclusion criteria for NAFLD were as follows: (i) lower average Hounsfield unit (HU) of hepatic right lobe, left medial and lateral segment when compared with that of spleen, (ii) patients who having urolithiasis in kidneys, ureters and urinary bladder, and (iii) patients underwent abdomen-pelvis CT including noncontrast image. The statistical significance of the association between NAFLD and renal stone disease was assessed using Chi Square Test. The Odds ratios and 95% CI were calculated to assess the propensity of renal stones disease for NAFLD by using Logistic Regression analysis. Results: The frequency of renal stone disease in patients with NAFLD was higher approximately 19% than those who having renal stone disease without NAFLD. In addition, the presence of NAFLD was linked with renal stone disease showing that detection rate of renal stone disease in patients with NAFLD was markedly high (odds ratio: 5, 95% CI, 3–8.2) (p

To define the risk factors and adverse effects associated with repeated canalith repositioning procedures (CRPs).A case series featuring chart review.An academic university hospital.We retrospectively reviewed 1900 patients (average age, 54.9 years; range, 11-88 years) diagnosed with benign paroxysmal positional vertigo (BPPV). All underwent repeated CRPs. We recorded clinical features including age, gender, BPPV cause (idiopathic or secondary), symptom duration, the canal involved, the number of sessions of CRP, recurrence, follow-up duration, and complications. We compared these factors using Pearson's chi-squared test and multiple linear regression analysis with dummy variables.BPPV was diagnosed based on the results of the head roll and Dix-Hallpike tests.The overall BPPV resolution rate for patients treated with repeated CRPs was 96.4%. The risk factors for the need for multiple CRPs in BPPV were the duration of vertigo before treatment (β = 0.326, p 0.001), the type of canal involved (β = 0.130, p 0.001), and age (β = 0.040, p = 0.040). The explanatory power of the regression model attained 46.0% (F = 172.510, p 0.001). The failure rate of repeated CRPs was 3.6% and complications included canal conversion (3.1%), nausea (46.4%), vomiting (4.9%), head heaviness (50.8%), imbalance (31.9%), and hypotension or palpitations (8.6%). However, almost all patients recovered.The risk factors associated with the need for Multiple CRPs were as follows: longer duration of vertigo before treatment, bilateral or multiple canal involved, and age50 years.

To evaluate the added value of the morphologic features of lymph nodes (LNs) on diffusion-weighted images (DWI), an interval reading was performed for the T2-weighted images (T2WI) and the combined image set (T2WI and DWI) using extracted imaging characteristics from 54 metastatic and 172 benign LNs in 44 patients with primary rectal cancer. The specificity and accuracy increased after adding DWI to T2WI for both readers (specificity: from 59% to 73% and from 41% to 68% for readers 1 and 2, respectively; accuracy: from 58% to 68% and from 44% to 64% for readers 1 and 2, respectively, P

Background As there is increased concern over the radiation exposure particularly in adolescents and young adults, computed tomography (CT) dose reduction is needed in the diagnosis of acute appendicitis. Purpose To evaluate the optimal strength of sinogram affirmed iterative reconstruction (SAFIRE) to obtain the best image quality on a 30-mAs applied low-dose CT (LDCT30mAs) and to compare the diagnostic performances of the LDCT30mAs with different SAFIRE strengths with that of the 100-mAs applied LDCT (LDCT100mAs) for the diagnosis of acute appendicitis. Material and Methods A total of 102 consecutive patients (47 men, 55 women; mean age, 41.2 years; range, 15–82 years) with right lower quadrant pain underwent abdominal-pelvic CT, consisting of arterial phase LDCT100mAs and portal venous phase LDCT30mAs under a fixed 120 kV. LDCT30mAs images were reconstructed separately with five strength levels (S1–S5). Two blinded radiologists recorded scores for the subjective image quality of the LDCT30mAs dataset (S0–S5) and confidence scores for the diagnosis of acute appendicitis on each dataset and LDCT100mAs. CT image noise was measured for each set. Results The study population consisted of 58 patients with confirmed appendicitis and 44 without appendicitis. There was no significant difference in diagnostic performance between LDCT100mAs and LDCT30mAs with any strength for both readers (AUC for reader 1, LDCT30mAs with S0–S5 = 0.97, LDCT100mAs = 0.93, P = 0.0936; for reader 2, LDCT30mAs with S0–S5 = 0.96, LDCT100mAs = 0.97, P = 0.128). The measured noise decreased as the strength increased from S0 to S5 (mean, 20.8 > 17.7 > 15.6 > 13.5 > 11.5 > 9.5, P S4 > S5, P Conclusion Although measured noise declined as SAFIRE strength increased, S3 seems optimal for the best subjective image quality on LDCT30mAs. The diagnostic performance of LDCT30mAs with any strength is comparable to that of LDCT100mAs for the diagnosis of acute appendicitis.

Purpose To investigate gray-scale and color Doppler sonographic (US) features of complex fibroadenoma (FA), according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. Methods From 2010 through 2013, 586 women with FAs were seen; 101 (17%) of those lesions were diagnosed as complex FAs on percutaneous needle biopsy or surgery. Among the patients with complex FAs, 67 who had US examination results available were included in this study. In addition, the results from 98 women who had simple FAs were included as controls. US features were retrospectively analyzed by two breast radiologists in consensus for shape, margin, echogenicity, posterior acoustic pattern, boundary, orientation, and associated findings. They also reassessed the BI-RADS category for FAs. Color Doppler US examination results were classified according to the amount of vascularity as absent, moderate, or marked. Results Complex FA were larger than simple FAs were (14.5 cm versus 12.1 cm, p > 0.05). On univariate analysis, a round to irregular shape, an uncircumscribed margin, the presence of associated findings, and BI-RADS categorization as 4a and 4b were more frequently revealed in complex than in simple FAs (p < 0.05). Multivariate analysis revealed that the tumor margin was a predictive factor for complex FA (odds ratio: 6.08; 95% confidence interval: 1.14–32.49, p < 0.05). On color Doppler US, the complex FAs had higher degrees of vascularity than simple FA (p < 0.05). Conclusions Complex FAs, in comparison with simple FAs, tend to have more aggressive features and to be in higher BI-RADS categories on US examination. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 43:556–562, 2015

Therapeutic cancer vaccines promote immune responses by delivering tumour-specific antigens. Recently, we developed iron oxide (Fe3O4)–zinc oxide (ZnO) core-shell nanoparticles (CSNPs) as carriers for antigen delivery into dendritic cells (DCs), and the CSNPs were injected subcutaneously into C57BL/6 mice to examine the systemic toxicity, tissue distribution and excretion of the CSNPs. The doses injected were 0, 4, 20 and 200 mg kg–1 weekly for 4 weeks. No significant changes were observed after the CSNPs administration with respect to mortality, clinical observations, body weight, food intake, water consumption, urinalysis, haematology, serum biochemistry,and organ weights. A dose-dependent increase in granulomatous inflammation was observed at the injection site of the CSNP-treated animals, but no other histopathological lesions in other organs could be attributed to the CSNPs. The Zn concentration, which is an indicator for CSNPs, was not significantly higher in the sampled tissues, urine, or faeces after the CSNP injection. In contrast, the Zn concentration at the subcutaneous skin of the site injected with the CSNPs increased in a dose-dependent manner, along with a macroscopic deposition of the CSNPs. The CSNP residue at the injection site resulted in a foreign body response with the appearance of macrophage infiltration, but otherwise did not show any systemic distribution or toxicity at up to 200 mg kg–1 during this study. In conclusion, CSNPs could be used as good antigen carriers for DC-based immunotherapy, although further study is needed to completely clear the residue of the CSNPs at the injection site. Copyright © 2015 John Wiley & Sons, Ltd.

Meningiomas arising outside the intracranial compartment are known as extradural meningiomas. Extradural meningiomas are rare conditions, accounting for less than 2% of all meningiomas. Primary intraosseous meningioma is used to describe a subset of extradural meningiomas arising from bone. A 46-year-old woman presented with left exophthalmos. Computed tomography and magnetic resonance images revealed an expansile bony lesion in the orbital lateral wall of the left sphenoid bone. The patient underwent craniotomy for excision of the bony lesion. Pathologic examination revealed an intraosseous meningioma.

Ecklonia cava (EC) is known to have antioxidant, anti-inflammatory, antidiabetic, and anticancer properties. Despite its wide use and beneficial properties, comprehensive toxicological information regarding EC extract is currently limited. Therefore, the purpose of this study was to investigate acute toxicity, subchronic toxicity, and genotoxicity of enzymatic EC extract according to test guidelines published by Organization for Economic Cooperation and Development. The acute oral LD50 values of this EC extract administered to rats and dogs were estimated to be more than 3000 mg/kg BW. In an oral 13-week toxicity study, changes in body weights of rats exposed to the EC extract up to 3000 mg/kg BW were found to be normal. In addition, repeated doses of EC extract failed to influence any systematic parameters of treatment-related toxic symptoms such as food/water consumption, mortality, urinalysis, hematology, serum biochemistry, organ weight, or histopathology. These results indicated that the no-observed-adverse-effect level for the EC extract was 3000 mg/kg/day for male and female rats. Data obtained from Ames test, chromosome aberration assay, and micronucleus assay indicated that EC extract was not mutagenic or clastogenic. Taken together, these results support the safety of enzymatic EC extract as a potential therapeutic for human consumption against various diseases.

Koji products have been considered as an effective fermented food consumed in East Asia with many health benefits. Particularly, rice koji with Aspergillus terreus (RAT) has been reported to be able to prevent hyperlipidemia and hepatic steatosis through regulating cholesterol synthesis. Despite its biological activities, there is a lack of comprehensive information to give an assurance of its safety. Therefore, the objective of this study was to perform a series of toxicological studies (repeated dose oral toxicity and genotoxicity) according to test guidelines published by the Organization for Economic Cooperation and Development. Along with acute toxicity study using rats and beagle dogs, a 13-week toxicity study revealed no clear RAT-related toxic changes, including body weight, mortality, hematology, serum biochemistry, organ weight, and histopathology after oral administration at doses of 500, 1000, and 2000 mg/kg BW. The no-observed-adverse-effect level of RAT was considered to be more than 2000 mg/kg BW/day in rats of both genders. In addition, potential genotoxicity was evaluated using a standard battery of tests (Ames test, chromosome aberration assay, and micronucleus assay) which revealed that RAT showed no genotoxicity. Accordingly, these results suggest that RAT is a safe and non-toxic functional food for human consumption at proper dose.

Objective The aim of the study was to compare the diagnostic performance of model-based iterative reconstruction (MBIR), adaptive statistical iterative reconstruction (ASIR), and filtered back projection (FBP) on submillisievert low-dose computed tomography (LDCT) for detecting hepatic metastases. Methods Thirty-eight patients having hepatic metastases underwent abdomen CT. Computed tomography protocol consisted of routine standard-dose portal venous phase scan (120 kVp) and 90-second delayed low-dose scan (80 kVp). The LDCT images were reconstructed with FBP, ASIR, and MBIR, respectively. Two readers recorded the number of hepatic metastases on each image set. Results A total of 105 metastatic lesions were analyzed. For reader 1, sensitivity for detecting metastases was stationary between FBP (49%) and ASIR (52%, P = 0.0697); however, sensitivity increased in MBIR (66%, P = 0.0035). For reader 2, it was stationary for all the following sets: FBP (65%), ASIR (68%), and MBIR (67%, P > 0.05). Conclusions The MBIR and ASIR showed a limited sensitivity for detecting hepatic metastases in submillisievert LDCT.

Background Because further treatment plans depends on lymph node (LN) status after neoadjuvant chemoradiation therapy (CRT), the accurate characterization of LN is important. Purpose To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) for LN characterization after CRT and to compare the performance with that of LN size. Material and Methods Fifty-three patients (36 men, 17 women; mean age, 58 years; age range, 34–79 years) who underwent CRT and subsequent surgery were included. All patients underwent 1.5-T magnetic resonance imaging (MRI). Each regional LN on post-CRT MRI was identified in consensus by two radiologists after reviewing the pre-CRT MRI. The ADC value and size in each LN was measured. To compare the mean ADC values and sizes of the metastatic and non-metastatic LNs after CRT, the t-test was used. To calculate the performance, a ROC curve analysis was performed. The histopathological examinations served as the reference standard. Results A total of 115 LNs (29 metastatic and 86 non-metastatic) were matched and analyzed. The mean ADC of the metastatic LNs was significantly higher than that of the non-metastatic LNs (1.36 ± 0.27 × 10–3mm2/s; 1.13 ± 0.23 × 10–3mm2/s, P Conclusion The performance of ADC for LN characterization after CRT was comparable to that of LN size.

Background Clear cell sarcoma (CCS) of soft tissue is a rare soft tissue sarcoma with melanocytic differentiation and shares morphologic, immunohistochemical, ultrastructural, and molecular features with malignant melanoma (MM). Because the prognosis of CCS is much different from MM, it is important to distinguish each other by selective method. CCS is well-recognized as having the t(12;22)(q13;q12) translocation, on the other hand MM is not. Therefore, detecting Ewing sarcoma region 1 (ESWR1) gene rearrangement can serve as a crucial diagnostic determinant. Methods Biopsy was taken from a 52-year-old man who reported a 3-year history of a gradually enlarging nodule on the sole of his left foot. Routine and special stains for melanocytic markers and fluorescence in situ hybridization (FISH) evaluation using dual color break-apart rearrangement probes specific for ESWR1 was performed for formalin-fixed tissue. Results Neoplastic cells expressed diffuse but strong positivity for HMB45 and S100 but not for Melan-A. Dual color, break-apart interphase FISH revealed EWS(22q12) gene rearrangements in CCS tumor cells. Conclusion Fluorescence in situ hybridization evaluation using ESWR1 gene probe for CCS sharing clinical and histopathological characteristics with MM is a valuable tool to distinguish each other.

We present two cases of adrenocortical oncocytomas that were well-delineated on multi-detector computed tomography and magnetic resonance imaging. The images showed a well-enhanced large mass with multiple stippled calcifications in a 10-yr-old girl who was consulted due to precocious puberty. A well-enhanced solid mass with necrotic components was incidentally noticed in a 54-yr-old man. These lesions were resected and diagnosed as adrenocortical oncocytomas through immunohistochemical studies and electron microscopy. Adrenocortical oncocytomas are rare disease entities, therefore, we report these interesting, rare adrenocortical oncocytomas here with radiologic findings, and discuss differential diagnosis. Graphical Abstract

Ethnopharmacology relevance Dendropanax morbifera Leveille (DM) has been used in traditional medicines for infectious and skin diseases, and dysmenorrhea. It exhibits a diverse therapeutic potential including anti-cancer, anti-thrombotic, anti-diabetic, anti-oxidant, and anti-inflammatory activities. Aim of the study Despite promising health benefits of DM, knowledge of its potential adverse effects is very limited. The current study focused on the investigation of subchronic toxicity and genotoxicity of extract obtained from DM according to the test guidelines published by the Organization for Economic Cooperation and Development. Materials and methods We conducted a toxicological evaluation of DM extracts using 14-day repeated-dose toxicity study and 13-week repeated-dose toxicity study in Sprague-Dawley rats administered orally at doses of 500, 1000, or 2000 mg/kg/day. The clastogenicity of DM extract was also evaluated by in vitro chromosome aberration assay and in vivo micronucleus assay. Results Assessment of subchronic toxicity of DM extract by oral administration in rats revealed unremarkable treatment-related findings with respect to food/water consumption, body weight, mortality, urinalysis, hematology, serum biochemistry, necropsy, organ weight and histopathology at doses of 500, 1000, and 2000 mg/kg. Accordingly, the level of no-observed-adverse-effect for DM extract in 13-week subchronic toxicity study was considered to be 2000 mg/kg/day in rats. The data observed from in vitro chromosome aberration assay and in vivo micronucleus assay exclude any clastogenicity of DM extract. Conclusion The results suggest that the oral consumption of DM extract has no adverse effects in humans and represents a safe traditional medicine.

Regardless of advancement in imaging techniques, the recognition of vegetative foreign bodies in the abdomen remains a difficult task. Simple radiography and computed tomography will ignore radiolucent foreign bodies. Here, we report the case of a 34-year-old man with a penetrating injury to the abdomen caused by a radiolucent wooden foreign body that was not initially detected. However, imaging can be specific and reliably diagnostic when performed in the appropriate clinical setting. Multidetector computed tomography is frequently underused but has proven useful for the assessment of retained wooden foreign bodies in the abdomen.

To investigate whether the apparent diffusion coefficient (ADC) could be used to discriminate metastatic from non-metastatic lymph nodes (LNs) in patients with primary rectal cancer.This study investigated 34 patients (male: 12, female: 22, mean: 62.7, range: 37-82) who underwent 1.5-T MRI with diffusion-weighted imaging (DWI) and subsequent surgical resection. A blinded radiologist measured the ADC value in each regional LN after referring to the T2-weighted images and DWI. The t-test was used to compare the mean ADC values of the metastatic and non-metastatic LNs. A ROC analysis was performed to calculate the diagnostic performance and obtain the optimal cut-off. The histopathological results were used as the reference standard.114 LNs (46 metastatic and 68 non-metastatic) were matched and analyzed. The mean ADC of the metastatic LNs was significantly lower than that of the non-metastatic LNs (0.9 ± 0.15 × 10(-3) mm(2)/s; 1.1 ± 0.22 × 10(-3) mm(2)/s, P0.0001). The area under the ROC curve was 0.734 (95% confidence interval, 0.644-0.812). When an ADC value of 1.0 × 10(-3) mm(2)/s was used as the cut-off, a maximum accuracy of 72% was calculated (sensitivity, 78%; specificity, 67%).Although ADC could be used to discriminate metastatic from non-metastatic LNs, the diagnostic accuracy is approximately 70%.

Aim Most studies about the structures of the human skin have been on the general histologic features of the skin. The purpose of this study was to understand the relationship between the microrelief (MR) pattern and histologic structure of the human skin, and to find the usefulness of the three-dimensional reconstruction (3DR) technique of pathological skin tissue. Materials, Subjects, and Methods Human skin specimens were obtained from the medial forearm, abdomen, and volar aspects of the finger tips of cadavers. Two-dimensional surface-viewed images of the skin showing MR patterns were obtained using dry dermoscopy. Histologic structures of the skin were evaluated by 3D images obtained using the 3DR technique. Results MR was deeper and wider in the abdomen than in the medial side of the forearm. In the medial side of the forearm, 10.27 rete ridges were distributed in a plateau, on average. In the abdomen, about 14.37 rete ridges were distributed in a plateau. From 3DR technique, MR pattern thought to be a superordinate concept to rete ridges. Conclusion The 3DR technique was useful and may allow a better understanding of the pathogenetic changes in the skin surface in aging skin.

Primary malignancies presenting with multiple distant metastases include lung cancer, gastrointestinal malignancy, breast cancer, and prostatic cancer. Multiple distant metastases from follicular thyroid carcinoma (FTC) are uncommon. Cystic formation in FTC is an atypical finding in ultrasonography. The cystic formation of a thyroid nodule is usually considered a benign sonographic finding. We report the case of a 78-year-old man who presented with multiple distant metastases from an FTC with a predominantly cystic formation.

We present a case of a 71-year-old man with prostate cancer who had no prior underlying liver disease. During metastatic evaluation, a solid mass in the liver was identified by computed tomography and ultrasound. Gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging demonstrated a well-defined, peripheral enhancing hepatic mass containing small cystic component. This lesion was diagnosed as hepatic neuroendocrine tumor. Primary neuroendocrine tumors of the liver are extremely rare. This case is interesting because of the rarity of this neoplasm and the unique radiologic findings despite its small size. Reviews of previously reported cases in the literature are also presented.

Ileoileal intussusceptions caused by inflammatory fibroid polyps are uncommon. Inflammatory fibroid polyps (Vanek’s tumor) are rare benign lesions that originate in the submucosa of the gastrointestinal tract. Here, we report the case of a 54-year-old woman who was admitted with an acute onset of abdominal pain and signs of intestinal obstruction. The ileal segment was resected, and single-layer end-to-end anastomosis was performed. A submucosal polypoid mass measuring approximately 4.5 × 4.0 cm was found. The histopathological analysis revealed an ulcerated mucosal lesion with variable cellularity that was formed by spindle cells with slight mitosis and abundant inflammatory infiltrate that was mainly composed of eosinophils. Immunohistochemistry confirmed the diagnosis of ileal inflammatory fibroid polyps. Cross-sectional imaging (multidetector computed tomography) plays a significant role in diagnosing this condition and guiding its management.

Purpose To compare the lesion conspicuity and diagnostic performance of three imaging data sets (T2WI, combined T2WI and DWI [combined DWI], contrast-enhanced (CE)-T1WI) in assessing perianal fistulas. Methods Two radiologists with 7 and 15 years of experience assessed 28 fistulas from 24 patients in each image set. Results The lesion conspicuity was improved for only one reader after reading the combined DWI (P = 0.0039) and CE-T1WI (P = 0.0215). The accuracy was stationary for fistula type (reader 1, all 93%; reader 2, all 89%) or for direction of internal opening (96% for all sets; 92% for CE-T1WI). Conclusion Although combined DWI and CE-T1WI might improve fistula conspicuity, they showed comparable diagnostic performance to T2WI.