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Objective: This study aimed to analyse surgical outcomes of paediatric patients with congenital cholesteatoma according to age. Method: This was a retrospective study reviewing the records of 186 children (136 boys and 50 girls) from August 1993 to January 2016. Patients were divided into three age groups (equal to or less than 3 years, over 3 and less than 7 years, and 7 to 15 years). Results: There were significant differences in chief complaints, location of cholesteatoma in the middle ear, computed tomography findings, operation methods, ossicular erosion and type of cholesteatoma sac among the three groups. In addition, older age, open type cholesteatoma, ossicular erosion and mastoid invasion of cholesteatoma increased the recurrence rate after surgery. However, despite higher pre-operative air–bone gap in older children, hearing can be improved enough after proper surgery with ossicular reconstruction. Conclusion: Delayed detection of paediatric cholesteatoma can lead to extensive disease and the need for an aggressive operation, which can result in worse hearing outcomes and an increased recurrence risk. [ABSTRACT FROM AUTHOR]

The conversion of a depleted gas reservoir into underground storage is currently considered to substitute liquefied liquefied natural gas tanks. This study investigates the validity of the operation scenario of the storage with a compositional simulation model and analyzes potential compositional changes of the gas for the purpose of predicting and managing the gas quality in the future. According to the simulation results, the overall operation conforms to the design concepts and operation scenario, confirming the validity of the pre-storage operation scenario. Moreover, the compositional variation of gas in the reservoir was closely examined, clarifying the changes in each component. [ABSTRACT FROM AUTHOR]

A new bimetallic oxycarbide was synthesized and characterized by XRD, TEM, EDS, XPS and adsorption–desorption of probe molecules. All the molybdenum was reduced and 35% of tungsten was present as WO x . The number of metallic sites, Lewis and Brönsted acid sites were estimated. A turnover rate of 0.1 s−1 was measured at 300 °C for the first order n-heptane isomerization. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the relationship between serum levels of the glycoxylation productNε-(carboxymethyl)lysine (CML) and development of chronic diabetic complications and degree of diabetic control in children and adolescents with type 1 diabetes.The serum levels of CML were measured in 87 patients with uncomplicated type 1 diabetes mellitus (12.7 ± 4.6 years of age) and in seven patients with background retinopathy, microalbuminuria or neuropathy (18.2 ± 5.2 years of age) and compared with those in 64 normal control subjects (12.6 ± 5.2 years of age). The mean durations of diabetes in uncomplicated and complicated patients were 5.0 ± 3.4 years (0.1–14 years), and 8.6 ± 5.0 years (3.1–18 years), respectively. The serum levels of CML were measured by enzyme-linked immunosorbent assay using a monoclonal anti-CML antibody (6D12).The serum levels of CML were significantly higher in the patient group than those in the control group; 0.85 ± 0.37 (0.37–1.93) U/ml vs. 0.56 ± 0.23 (0.15–1.05) U/ml (p < 0.001) and significantly higher in the patient group with chronic complications than those in patient group without chronic complications; 1.06 ± 0.39 (0.72–1.78) U/ml vs. 0.83 ± 0.36 (0.37–1.93) U/ml (p < 0.05). Weak, but statistically significant relationship between CML levels and haemoglobin A1c levels at the measurement of CML was observed (r = 0.29, p < 0.05).Our data are suggesting that higher serum levels of CML are involved in the development of chronic diabetic complications, and serum levels of CML reflect the degree of diabetic control for a long duration in type 1 diabetic children and adolescents. [ABSTRACT FROM AUTHOR]

An abstract of the article "First Confirmed Report of Powdery Mildew Caused by Podosphaera xanthii on Farfugium japonicum in Korea" by S.E. Cho, M.J. Park and C.H. Shin is presented.

Quercus glauca Thunb. (syn. Cyclobalanopsis glauca (Thunb.) Oerst.), known as ring-cupped oak or Japanese blue oak, is a dominant tree species commonly found in evergreen forests in East Asia (2). In May 2012, hundreds of Q. glauca were found heavily affected by a powdery mildew in several locations of Jeju Islands, Korea. Symptoms on overwintered leaves appeared as circular to irregular blackish violet to dark brown felt-like growths with numerous chasmothecia on abaxial leaf surfaces. New infections on current-year leaves started in early summer and were characterized by typical white patches with abundant sporulation on abaxial leaf surfaces. In early autumn, with formation of special aerial hyphae and without further sporulation, the patches turned light brown to brown. Formation of chasmothecia was noticed from late autumn. The adaxial leaf surface was free of powdery mildew growths and exhibited yellowing and discoloration. Voucher specimens were deposited in the Korea University Herbarium (KUS). Special aerial hyphae were falcate to curved, aseptate, at first hyaline, later deep brown to purplish brown, thick-walled, and 80 to 140 × 6 to 15 μm. Conidiophores were 175 to 245 × 10 to 12 μm, and produced 2 to 4 immature conidia in chains with a sinuate outline. Foot-cells of conidiophores were cylindrical and 80 to 120 μm long. Conidia were lemon- to barrel-shaped, 26 to 35 × 17 to 24 μm with a length/width ratio of 1.2 to 1.6, and devoid of fibrosin bodies. Primary conidia were apically conical and basally subtruncate. Germ tubes produced in the lateral to perihilar position of conidia were long and slender (3 μm wide). Chasmothecia were scattered or gregarious, partly embedded with special aerial hyphae, dark brown, spherical, 55 to 70 μm in diameter, and contained a single ascus. Chasmothecial peridia consisted of two layers. Exoperidia (outer layer) were composed of dark brown, polygonal cells 10 to 20 μm wide. Endoperidia (inner layer) consisted of hyaline, polygonal cells 10 to 15 μm wide. Appendages were basally attached, mycelioid, rare or few, and pale brown to rusty brown. Asci were short stalked, 55 to 72 × 35 to 46 μm, had a terminal oculus 10 to 20 μm wide, and contained 8 ascospores. Ascospores were oblong-elliptical, 22 to 27 × 10 to 12.5 μm, subhyaline, and contained 1 or 2 oil drops. The specific measurements and characteristics (especially falcate aerial hyphae) were consistent with those of Cystotheca wrightii Berk. & M.A. Curtis (1). Fungal DNA was extracted by the Chelex method. The internal transcribed spacer (ITS) region of rDNA of KUS-F27309 was amplified with primers ITS5/P3 and sequenced directly (4). The resulting 589-bp sequence was deposited in GenBank (Accession No. KF735066). A BLAST search in GenBank showed that the Korean isolate had 100% homology with C. wrightii on Q. glauca from Japan (AB000932). Powdery mildews of Q. glauca associated with C. wrightii have been known in Japan, Taiwan, and China (1,3), but not in Korea. Finding of C. wrightii on Q. glauca could pose a potential threat to other evergreen oak species in southern part of Korea. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No. 11, CBS, Utrecht, Netherlands, 2012. (2) X. Y. Chen et al. Acta Bot. Sin. 39:149, 1997. (3) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, retrieved 21 October, 2013. (4) S. Takamatsu et al. Mycol. Res. 113:117, 2009.

Hibiscus mutabilis L., known as cotton rose, is a deciduous shrub native to China. Horticultural varieties of the species are widely planted throughout the world (4). In September 2012, typical powdery mildew symptoms on the cotton rose were observed in a public garden of Jeju City, Korea. Powdery mildew colonies were circular to irregular white patches on both sides of the leaves and also on young stems and sepals. As the disease progressed, white mycelial growth covered the entire shoot portion, causing leaf distortion. In the middle of November, numerous chasmothecia were formed on the lesions. Voucher specimens (n = 4) were deposited in the Korea University Herbarium (KUS). Hyphal appressoria were only swollen part of hyphae or occasionally nipple-shaped. Conidiophores were 140 to 275 × 10 to 11.5 μm and produced 2 to 8 immature conidia in chains with a crenate outline. Foot-cells of conidiophores were straight, 30 to 65 μm long, and cylindric. Conidia were hyaline, ellipsoid-ovoid, and measured 27 to 42 × 17.5 to 21 μm with a length/width ratio of 1.5 to 2.4, and had distinct fibrosin bodies. Chasmothecia were amphigenous, cauligenous, 85 to 110 μm in diameter, and contained one ascus each. Peridium cells of chasmothecia were irregularly polygonal, large, and 15 to 38 μm wide. Appendages were mycelioid, 1- to 6-septate, brown at the base, and becoming paler. Asci were sessile, oval to broadly fusiform, with terminal oculus of 15 to 20 μm wide. Ascospores numbered eight per ascus were ellipsoidal, 19 to 25 × 14 to 16 μm. The morphological characteristics were consistent with previous records of P. xanthii (Castagne) U. Braun & Shishkoff (1). To confirm the identification, the complete internal transcribed spacer (ITS) region of rDNA from isolate KUS-F27134 was amplified with the primers ITS5 and P3 and sequenced (3). The resulting sequence of 477 bp was deposited in GenBank (Accession No. KC460208). The Korean isolate showed >99% similarity with dozens of sequences of P. xanthii ex cucurbitaceous hosts (e.g., JQ912061, JQ409565, HM070403, etc.) as well as Podosphaera sp. ex H. mutabilis from Japan (AB040308). Pathogenicity was confirmed through inoculation tests by gently pressing diseased leaves onto young leaves of three asymptomatic, potted 2-year-old seedlings. Three non-inoculated seedlings were used as controls. Plants were maintained in a greenhouse at 24 to 30°C. Inoculated leaves developed symptoms after 7 days, whereas the control plants remained symptomless. The fungus present on the inoculated leaves was morphologically identical to that observed on the original diseased leaves, fulfilling Koch's postulates. Powdery mildew infections of H. mutabilis associated with P. xanthii (including P. fuliginea in broad sense) have been known in China, Japan, and Taiwan (1,2). To our knowledge, this is the first report of powdery mildew caused by P. xanthii on H. mutabilis in Korea. Since Jeju, the southmost island of Korea, is the only habitat of cotton rose in Korea and is the northmost natural habitat in Asia, powdery mildew is a new threat to the health of wild populations of cotton rose. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No.11. CBS, Utrecht, 2012. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, retrieved January 18, 2013. (3) S. Takamatsu et al. Mycol. Res. 113:117, 2009. (4) D. A. Wise. J. Hered. 64:285, 1973.

Melia azedarach L., called chinaberry, is native to Southeast Asia and Australia. The trees are commonly planted as ornamentals in the southern part of Korea. In October 2010, a leaf spot disease was observed on trees for the first time in Wando, Korea. Further surveys conducted from 2010 to 2012 showed that the disease occurs on trees in Jeju, Seogwipo, and Tongyeong cities as well as Wando county with nearly 100% incidence. Leaf spots were circular to semicircular, later becoming angular, small, pale brown in the center with a dark brown margin, and later becoming milky white. Leaf spots sometimes coalesced to blight the entire leaf and were capable of rapidly defoliating whole trees in late September. Fruiting was amphigenous, but mostly hypogenous. Stromata were substomatal, globular, dark brown, and 25 to 70 μm in diameter. Conidiophores were densely fasciculate, pale olivaceous to pale brown, substraight to mildly curved, not geniculate, 10 to 30 μm long, 2.5 to 4.5 μm wide, and aseptate or uniseptate. Conidia were pale olivaceous, generally darker than conidiophores, cylindric to obclavate, substraight in shorter ones, curved to mildly sinuous in longer ones, obconically truncate at the base, obtuse at the apex, 2- to 14-septate, 16 to 120 × 3 to 5 μm, guttulate, and had inconspicuous hila. Morphological characteristics of the fungus were consistent with the previous descriptions of Pseudocercospora subsessilis (Syd. & P. Syd.) Deighton (2). Voucher specimens (n = 6) were deposited in the Korea University Herbarium (KUS). An isolate from KUS-F25395 was deposited in the Korean Agricultural Culture Collection (KACC45688). The complete internal transcribed spacer (ITS) region of rDNA was amplified with the primers ITS1/ITS4 (3) and sequenced. The resulting sequence of 517 bp was deposited in GenBank (Accession No. JX993904). A BLAST search in GenBank revealed that the sequence shows >99% similarity (1 bp substitution) with a sequence of P. subsessilis ex M. azedarach from Cuba (GU269815). For pathogenicity tests, hyphal suspensions were prepared by grinding 3-week-old colonies grown on potato dextrose agar with distilled water using a mortar and pestle. Five 3-year-old chinaberry trees were inoculated with hyphal suspensions using a fine haired paint brush. Three healthy trees of the same age, serving as controls, were sprayed with sterile water. The plants were covered with plastic bags to maintain 100% relative humidity for 24 h and then transferred to a greenhouse. Typical symptoms of necrotic spots that appeared on the inoculated leaves 10 days after inoculation were identical to the ones observed in the field. P. subsessilis was reisolated from symptomatic leaf tissues, confirming Koch's postulates. No symptoms were observed on control plants. The disease has been reported in several Asian countries as well as in Cuba and the United States (1). To our knowledge, this is the first report of leaf spot on chinaberry caused by P. subsessilis in Korea. The observed high incidence and severity suggest that this disease can be a limiting factor in utilizing this tree species as ornamentals in public areas. References: (1) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, Retrieved October 22, 2012. (2) Y. L. Guo and W. H. Hsieh. The genus Pseudocercospora in China. International Academic Publishers, Beijing, China, 1995. (3) T. J. White et al. PCR Protocols. Academic Press, San Diego, CA, 1990.

Background: Growth retardation is a common problem for children with chronic kidney disease. Although renal transplantation (RTx) resolves endocrine metabolic and uremic disturbances, growth continues to be suboptimal. This study aims to describe changes in height from diagnosis to final adult height (FAH) in Korean renal allograft recipients and determine factors associated with posttransplantation growth., Methods: We retrospectively reviewed 63 renal allograft recipients who underwent RTx at <15 years of age with regular follow-up for >3 years afterwards. Pre- and post-RTx growth was analyzed by height Z scores (Ht&#95;Z) at RTx, 2 and 5 years follow-up, and at FAH., Results: Ht&#95;Z decreased from diagnosis to dialysis by -0.8 (P = .009) and from dialysis to RTx by -0.46 (P < .001). The mean baseline Ht&#95;Z at RTx was -1.62 ± 1.36. The change in Ht&#95;Z at 2 and 5 years after transplantation was 0.68 ± 0.88 and 0.48 ± 0.86, respectively. Both variables were negatively correlated with baseline age at RTx. Mean FAH was -1.22 ± 1.11 and was positively correlated with baseline height at RTx. Height at start of dialysis and dialysis duration were significant determinants of baseline height at RTx (P < .001)., Conclusions: Although there is significant posttransplant catch-up growth among younger recipients and among those with greater baseline height deficit, catch-up growth is not sustained and greater FAH is attained in those who are taller at RTx. Achieving greater height before dialysis and decreasing dialysis duration leads to maximal height at RTx as well as greater FAH., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Epidural steroid injections are commonly used to treat lumbosacral radicular and discogenic pain. When used in this manner, these agents can cause minor, transient systemic side effects and rarely result in any serious complications. Because adverse reactions are uncommon and transient, epidural injections are considered a safe therapeutic intervention. We describe the first case of persistent hiccups as a consequence of a thoracic epidural steroid injection in a patient with thoracic discogenic pain.

A symptomatic popliteal cyst after total knee arthroplasty (TKA) is rare, occurring most frequently as a result of intra-articular knee pathology. We present a case of a large dissecting popliteal cyst 7 years after TKA with symptoms of severe calf pain and functional disability. The symptomatic cyst was excised completely in a first-stage operation, and the severely worn TKA was corrected by a second-stage surgical procedure. The patient in this report was pain free and had satisfactory range of knee motion 5 years after the index revision TKA, without recurrence of effusion or popliteal cyst formation.

Objective: The purpose of this study was to determine the method of treatment and outcome of women with cervical adenocarcinoma in situ (AIS)., Methods: Following institutional review board approval, all women diagnosed with cervical AIS from 1987 to 1999 were identified. Data were retrospectively collected by record review and correspondence with medical providers., Results: Of 132 women treated with cone biopsy for AIS, 95 (72%) were managed conservatively after cold knife cone or loop electrical excisional procedure alone; 37 (28%) eventually underwent hysterectomy. The median age of diagnosis was 29 years (range, 17-47) in the conservative management group and 40 years (range, 25-72) in the hysterectomy group (P < 0.0001). Seventy-four percent were nulliparous in the conservative group compared with 27% in the hysterectomy group (P < 0.0001). Of the 95 conservatively managed patients, 92 obtained negative margins; three were followed despite positive or unevaluable margins. During a median follow-up of 30 months, 9 women required evaluation for follow-up abnormalities after cone biopsy with negative margins. None had pathologic evidence of recurrent AIS. Twenty-three infants were delivered. Hysterectomy was generally performed for undesired fertility or persistently positive cone margins. One woman required hysterectomy for recurrent AIS. Thirteen (62%) of twenty-one hysterectomy specimens had residual AIS following cone biopsy with positive or unevaluable margins; 1 (6%) of 16 had residual AIS following cone biopsy with negative margins (P < 0.0001). No patient developed invasive adenocarcinoma., Conclusions: Younger women with cervical AIS may be effectively treated with cone biopsy alone if negative margins can be achieved., (Copyright 2000 Academic Press.)

Shoulder pain is a common musculoskeletal ailment. The process of determining the etiology of shoulder pain can be difficult. The differential diagnoses include: both intracapsular and extracapsular lesions; and neurologic, vascular, postural, and visceral causes. We present an unusual case of shoulder pain accompanied by loss of shoulder range of motion (ROM), initially thought to be caused by an intrinsic shoulder disorder. However, it ultimately was determined that a cervical radicular disorder caused both the impaired ROM and the patient's shoulder pain.

Citrullinemia is an autosomal recessive disease due to the mutations in the argininosuccinate synthetase (ASS) gene. Mutation analysis was performed on three Korean patients with citrullinemia. All of the three patients had the splicing mutation previously reported as IVS6-2A>G mutation. Two had Gly324Ser mutation and the other patient had a 67-bp insertion mutation in exon 15. The IVS6-2A>G mutation was reported to be found frequently in Japanese patients with citrullinemia, but Caucasian patients showed the extreme mutational heterogeneity. Although a limited number of Korean patients were studied, the IVS6-2A>G mutation appears to be one of the most frequent mutant alleles in Korean patients with citrullinemia. The Gly324Ser mutation identified in two patients also suggests the possible high frequency of this mutation in Korean patients as well.

Objective: Bone grafting plays an important role in reconstructing infected tibial nonunions. The effects of antibiotic-impregnated bone grafting in infection elimination and bone incorporation was reported in this retrospective study., Methods: Ninety-six patients treated for infected tibial nonunions were evaluated. These patients were managed with local antibiotic bead therapy and staged antibiotic-impregnated autogenous cancellous bone graft or pure autogenous cancellous bone graft. Patients were randomized to antibiotic-impregnated bone grafting or bone grafting-only groups on the basis of whether the admission date was odd or even. Patients were divided into two groups (antibiotic-impregnated bone grafting group and pure cancellous bone grafting group), according to the procedure used in preparing the bone grafts. The antibiotic-impregnated bone grafting group included 37 men and 9 women whose average age was 36 years (range, 17 to 72 years). The average follow-up period was 4.8 years. By using the Cierny-Mader staging classification of chronic osteomyelitis, 32 of 46 patients (70%) were stage 4A, and 14 of 36 patients (30%) were stage 4B. The pure cancellous bone grafting group included 39 men and 11 women whose average age was 37 years (range, 18 to 72 years). The average follow-up period was 4.5 years (range, 4 to 6 years). Thirty-nine of 50 patients (78%) were stage 4A, and 11 of 50 patients (22%) were stage 4B. The bone defects in both groups ranged from 2 to 4 cm., Results: Wound healing and bony union were achieved in the antibiotic-impregnated bone grafting group. Only two patients had recurrent infections. The infection arrest rate was 95.6%. However, 9 of 50 patients in the pure cancellous bone grafting group had recurrent infections. The infection arrest rate was 82%. The antibiotic-impregnated bone grafting group had significantly superior results (95.6% vs. 82% chi2 test, p < 0.05) in infection elimination than the pure cancellous bone grafting group., Conclusion: After 4 to 6 years of follow-up, our results suggest that the use of impregnating antibiotics have no adverse effects on autogenic cancellous bone graft incorporation and could help to eliminate infection effectively.

Even a small intracranial germinoma (GE) frequently provokes pituitary hypofunction. We evaluated the relationships between preoperative hormonal status and hormonal outcome and between size of suprasellar mass and hormonal outcome in 22 children with intracranial pure GE to determine whether or not these can reflect the degree of hypothalamo-pituitary axis destruction. Preoperative hormonal status was graded from I to IV according to the serum prolactin level (s-PRL) and thyroid function (TF). The hormonal outcome was estimated by the type and the number of hormonal replacement medications taken on the basis of the triple load test and endocrinological examinations at the time of the last follow-up (median period: 43 months). Fifteen of the 22 patients had suprasellar lesions. All 13 patients who had diabetes insipidus (DI) at presentation needed desmopressin acetate (DDAVP) during the follow-up period. The correlation between increment of preoperative grade and the increment in the number of hormones to be replaced was statistically significant (P<0.05). This preoperative grading was a more reliable predictor than the size of suprasellar tumor. In conclusion, preoperative grading by s-PRL and TF test is useful for the prediction of posttreatment hormonal replacement in children with intracranial pure GE.

Between January of 1991 and December of 1993, 36 patients who had tibia fractures complicated by small infected tibia defects were treated at the authors' service. The group included 30 men and 6 women whose average age was 36.5 years (range, 18-72 years). The average follow-up period was 3.7 years. By using the Cierney-Mader staging classification of chronic osteomyelitis, 26 of 36 patients (72%) were stage 4A and 10 of 36 patients (28%) were stage 4B. Ten patients required muscle transfer. All patients were treated with a two-stage protocol. In the first stage, antibiotic-impregnated polymethylmethacrylate bead chains were used to obliterate the debrided osseous defect. In the second stage, the beads were removed, and the defects were reconstructed with antibiotic-impregnated autogenic cancellous bone graft. The time between the first and second stage was 2 to 8 weeks for patients without muscle transfer and 8 to 12 weeks for the patients with muscle transfer. The bone defects ranged from 2 to 4 cm. Wound healing and bony union were achieved in all patients. Only two patients had recurrent infections. The infection arrest rate was 94.4%. Minor pin tract infection of the external skeletal fixation was seen in two patients. Two patients developed skin rashes secondary to antibiotic therapy. Radiographs at an average follow-up of 3.7 years showed good consolidation and hypertrophy of grafted bones in all patients. After 3 to 5 years of follow-up, our results suggest that the use of impregnating antibiotics have no adverse effects on autogenic cancellous bone graft incorporation and may help to eliminate infection. This treatment protocol provided rapid recovery from osteomyelitis. The use of antibiotic-impregnated autogenic bone graft seems to be an effective and safe method for the management of small infected tibial defects.