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Purpose: To investigate the clinical features and treatment outcomes of patients with choroidal tuberculoma. Methods: In this retrospective, observational case series, the medical records of five patients with choroidal tuberculoma who were followed up at a university hospital for at least 6 months were analyzed. Results: Of five patients, one was male and four were female. The overall mean age was 38.0 ± 9.4 years (mean follow-up: 41.2 ± 33.8 months). Tuberculin skin test was performed in three patients, and it was positive in two of them. Interferon-gamma assay was performed in two patients and was positive in all two. Three patients had systemic tuberculosis involving the lung or other organs. Five patients were treated with antitubercular therapy for a period of 9.6 ± 8.6 months. Systemic corticosteroid treatment was performed in 3 patients, with a period of 3.5 ± 0.7 months. One patient with a recurrent vascularized tuberculoma was successfully treated with single intravitreal bevacizumab injection. Conclusion: Choroidal tuberculoma can develop without evidence of systemic tuberculosis and can recur despite antitubercular treatment. High index of suspicion is important in early detection, and management of choroidal tuberculoma. In cases of suspected choroidal tuberculoma, positive results on immunological tests would be sufficient to initiate antitubercular therapy even if radiological evidence of systemic tuberculosis is not found. Antitubercular therapy combined with systemic corticosteroids provided favorable results. Intravitreal injection of anti-vascular endothelial growth factor may be considered for highly vascularized choroidal tuberculoma. [ABSTRACT FROM AUTHOR]

DNA double-strand break (DSB) induction is one of the phenotypes of cellular damage from radiation exposure and is commonly quantified by γ-H2AX assay with the number of excess fluorescent foci per cell as the main component. However, the number of foci alone may not fully characterize the state of DNA damage following exposures to different radiation qualities. This study investigated the feasibility of utilizing the focus size distribution and dephosphorylation rate of γ-H2AX to identify the type of causative radiation and dose. Human lung epithelial cells and mouse vascular endothelial cells were used to observe the expression changes of γ-H2AX foci due to alpha particle and X-ray exposures. Results showed that the average number of excess foci per cell linearly increased with the dose. The focus size distribution showed a consistent pattern depending on the causative radiation type. Three criteria for the identification of causative radiation type were derived from experimental focus size distributions and were validated in blind testing with correct identification of 27 out of 32 samples. The dose could be estimated based on the proportionality constant specific to the identified radiation type with a difference of less than 15% from the actual value. The different dephosphorylation rates of γ-H2AX produced from alpha particle and X-ray exposures were effectively utilized to determine the individual dose contributions of alpha particles and X-rays under mixed beam exposure. Individual doses were estimated to have differences of less than ~ 12% from actual values. [ABSTRACT FROM AUTHOR]

Although not as common as hip or knee arthroplasty, shoulder arthroplasty is becoming a more common procedure. Reverse total shoulder arthroplasty (RTSA) is known to be an effective surgical procedure for massive irreparable rotator cuff tears, comminuted proximal humerus fractures, and revision shoulder arthroplasty. The utilization of RTSA has been increasing, and although complications following reverse arthroplasty have been reported, there are few reports in the literature that focus on the imaging features of RTSA. Herein, we demonstrate the biomechanics of RTSA, prosthesis components, indications, and imaging features of the normal postoperative appearance and various complications after RTSA. Familiarization with the normal and abnormal imaging appearances after RTSA can be helpful for appropriate management of patients. [ABSTRACT FROM AUTHOR]

Anxiety, depression, and insomnia are highly prevalent among migraineurs and are associated with negative health consequences. Anxiety and depression, however, unlike insomnia, are usually underdiagnosed, due to less self-reporting of these two conditions. The aim of the present study was to evaluate the risk of anxiety and depression in migraineurs with self-reported insomnia, using a general population-based sample. We used data from a nationwide population-based survey on headache and sleep, the Korean Headache-Sleep Study. Of all 2,695 participants, 143 (5.3%), 268 (10.0%), 116 (4.3%), and 290 (10.8%) were classified as having migraine, anxiety, depression, and self-reported insomnia, respectively. The risk of anxiety (odds ratio [OR] = 7.0, 95% confidence interval [CI] = 3.0–16.7) and depression (OR = 3.3, 95% CI = 1.3–8.5) was significantly increased in migraineurs with self-reported insomnia. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for anxiety in migraineurs with self-reported insomnia were 46.5%, 89.0%, 64.5%, and 79.5%, respectively. For depression, the sensitivity, specificity, PPV, and NPV were 41.7%, 82.4%, 32.3%, and 87.5%, respectively. Self-reported insomnia is likely to be comorbid with anxiety and depression in migraineurs and could thus be a useful predictor of anxiety and depression in migraine. [ABSTRACT FROM AUTHOR]

Background: Meningitis is an inflammatory process involving meninges. It is difficult to diagnose because of the absence of a diagnostic biomarker. We first report here the possibility of cerebrospinal fluid (CSF) vitamin D-binding protein (VDBP) as a new biomarker for the diagnosis of meningitis.Methods: This prospective study enrolled a total of 102 subjects (58 patients with non-neurologic disease, 17 patients with meningitis, and 27 patients with other neurologic diseases) from 2017 to 2018. CSF and blood samples were collected in pairs. Total 25(OH)D in CSF and serum and VDBP levels in serum were measured. GC genotyping was also performed to determine polymorphisms of rs4588 and rs7041. CSF total 25(OH)D and VDBP levels were compared with serum total 25(OH)D and VDBP levels according to disease (meningitis vs. non-meningitis). Receiver operating characteristic (ROC) analysis for the diagnosis of meningitis using CSF VDBP level was performed.Results: Mean CSF VDBP and serum VDBP levels of all patients were 1.48 ± 1.32 and 181.28 ± 56.90 μg/mL, respectively. CSF VDBP level in the meningitis disease group (3.20 ± 1.49 μg/mL) was significantly (P < 0.001) higher than that in other disease groups. According to ROC curve analysis, the appropriate cut-off value for CSF VDBP was 1.96 μg/mL, showing sensitivity of 82.4% and specificity of 85.9%. AUC of CSF VDBP was 0.879 (95% CI: 0.789-0.962).Conclusions: CSF VDBP level showed very good diagnostic performance. It could be used as a potential biomarker for the diagnosis of meningitis. [ABSTRACT FROM AUTHOR]

Background: The purpose of this nationwide age- and sex-matched longitudinal follow-up study was to investigate the risk of developing ischemic stroke in ankylosing spondylitis (AS).Methods: The data in this study, spanning from January 1, 2010 to December 31, 2014, was obtained from a database maintained by the Korean National Health Insurance Service. A total of 12,988 patients with a diagnosis of AS were enrolled. The control group consisted of 64,940 age-sex-stratified matching subjects without AS. The 6year ischemic stroke incidence rate for each group was calculated using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to estimate the hazard ratio of ischemic stroke.Results: During the follow-up period, 73 patients (0.56%) in the AS group and 250 patients (0.38%) in the control group developed ischemic stroke (p = 0.0041). The hazard ratio of ischemic stroke in the AS group was 1.46 (95% confidence interval [95% CI], 1.13-1.90) after adjusting for age and sex. The adjusted hazard ratio of ischemic stroke in the AS group was 1.35 (95% CI, 1.04-1.75) after controlling for demographics and comorbid medical disorders. According to subgroup analysis, in female and diabetes and non-hypertension and dyslipidemia subgroups, ischemic stroke incidence rates were significantly higher in AS patients than those in control group.Conclusion: Our nationwide longitudinal study suggests an increased risk of ischemic stroke in AS patients. [ABSTRACT FROM AUTHOR]

The authors regret to state that an incorrect image was uploaded in Fig. 2. Please see a newly updated Fig. 2. All statements including Figure Legends are correct. [ABSTRACT FROM AUTHOR]

Based on biomechanical theory, lamina cribrosa (LC) displacement, the key component of progressive glaucomatous change, is presumed to be dependent on intraocular pressure (IOP) as well as tissue stiffness of LC. In the performance of the Valsalva maneuver, both IOP and cerebrospinal fluid pressure can increase. The present study investigated the age-dependent variation of LC displacement during the standardized Valsalva maneuver in healthy subjects. Sixty-three (63) eyes (age range: 20–76 years) were prospectively underwent IOP measurement and Cirrus HD-OCT optic disc scans before and during the standardized Valsalva maneuver. During the standardized Valsalva maneuver, the IOP significantly increased from 13.2 ± 2.9 mmHg to 18.6 ± 5.2 mmHg (P < 0.001). The maximal LC depth significantly decreased in the younger age groups (age: 20 s to 40 s) but not in the older age groups (age: over 50). The BMO distance did not change significantly. Younger age (P = 0.009), a smaller increase of IOP during the Valsalva maneuver (P = 0.002), and greater baseline maximal LC depth (P = 0.013) were associated with more anterior displacement of the LC during the standardized Valsalva maneuver. Taken together, age as well as translaminar pressure dynamics seems to play a crucial role in LC biomechanics. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare clinical outcomes and perform gait analysis during walking to identify differences in kinematic and kinetic parameters between two alignment methods in robotic-assisted total knee arthroplasty (TKA).Methods: Sixty patients were randomly assigned to undergo robotic-assisted TKA using either mechanical (30 patients) or kinematic (30 patients) alignment method. Clinical outcomes including varus and valgus laxities, range of motion (ROM), Hospital for Specific Surgery (HSS), Knee Society Score (KSS), and Western Ontario and McMaster Universities (WOMAC) scores and radiological outcomes were evaluated. Gait analysis of 3D spatiotemporal, kinetic, and kinematic parameters during walking was then performed for 10 age and gender matched patients of each group to determine differences between the two alignment methods.Results: The median follow-up duration of the mechanical method group was 8.7 (range 8.1-9.4) years and that of the kinematic method group was 8.4 (range 8.0-9.1) years. Clinical outcomes between the two groups showed no significant difference in HSS, WOMAC, ROM, KS pain, or function score at the last follow-up. No significant difference in varus and valgus laxity assessment, mechanical alignment of the lower limb, or perioperative complications was shown between the two groups. In gait analysis, no significant difference in kinematic or kinetic parameters was found except for varus angle (p < 0.05) and mediolateral ground reaction force (p < 0.05).Conclusions: Results of this study show that mechanical and kinematic knee alignment methods provide comparable clinical and radiological outcomes after robotic total knee arthroplasty with an average follow-up of 8 years. There were no functional difference during walking between the two alignment methods either.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Patients with cervical myelopathy may experience symptoms of radiculopathy, and it is not easy to determine whether these symptoms are caused by the myelopathy itself or by a radiculopathy accompanied by root compression. Therefore, we aimed to investigate the prevalence of radiculopathy combined with cervical myelopathy and to evaluate the characteristics of cervical myelopathy with or without radiculopathy. We enrolled 127 patients with cervical myelopathy in this retrospective study and reviewed their medical records and magnetic resonance imaging findings. They were divided into two groups according to the presence of cervical radiculopathy, and their age, sex, involved spinal segment, cord signal change, surgical method, clinical status were compared, and postsurgical recovery was compared using four clinical questionnaires. The incidence and level of radiculopathy combined with myelopathy were investigated. Combined cervical radiculopathy and myelopathy was diagnosed in 66 patients (51.9%, group 1), whereas 61 patients did not have radiculopathy (group 2). There was no difference in sex, age, cord signal change, preoperative Japanese Orthopedic Association score, neck disability index, and neck visual analogue scale (VAS) between the two groups, but group 1 showed higher preoperative arm VAS score ( p = 0.001). Postoperative arm and neck VAS scores were significantly improved in group 1 ( p = 0.001 and 0.009). Half of the patients had combined cervical myelopathy and radiculopathy. A high preoperative arm VAS score was a characteristic of radiculopathy combined with myelopathy. [ABSTRACT FROM AUTHOR]

The RAS association domain family 1A (RASSF1A) gene is silenced by DNA methylation in over 50% of all solid tumors of different histological types. However, the biochemical function of the RASSF1A protein is unknown. We show that RASSF1A colocalizes with microtubules in interphase and decorates spindles and centrosomes during mitosis. RASSF1A has a strong cytoprotective activity against the microtubule-destabilizing drug nocodazole, and against cold-treatment in vivo. Conversely, loss of RASSF1 in RASSF1-/- mouse embryonic fibroblasts renders the cells more sensitive to nocodazole-induced depolymerization of microtubules. The domain required for both microtubule association and stabilization was mapped to a 169 amino-acid fragment that contains the RAS association domain. Overexpression of RASSF1A induces mitotic arrest at metaphase with aberrant mitotic cells reminiscent of such produced by the microtubule-stabilizing drug paclitaxel (taxol), including monopolar spindles, or complete lack of a mitotic spindle. Altered microtubule stability in cells lacking RASSF1A is likely to affect spindle assembly and chromosome attachment, processes that need to be carefully controlled to protect cells from genomic instability and transformation. In addition, knowledge of the microtubule-targeting function of RASSF1 may aid in the development of new anticancer drugs.Oncogene (2003) 22, 8125-8136. doi:10.1038/sj.onc.1206984 [ABSTRACT FROM AUTHOR]

Pneumonia is related to oral health of the elderly and intensive care unit patients. However, studies on the relationship between overall oral health and pneumonia in the general population have been limited. The purpose of this study was to investigate the association between oral health and pneumonia using a nationwide population-based Korean cohort database. Data from 122,251 participants who underwent health screening and oral examinations in 2004 or 2005 were analyzed. Cox proportional hazard regression analysis was performed to evaluate the association between oral health and pneumonia. The risk of pneumonia increased significantly in groups with a higher number of dental caries and missing teeth, with respective adjusted hazard ratios (HRs) and 95% confidence interval (CI) of 1.265 (1.086–1.473; p = 0.0025) and 1.218 (1.113–1.332; p < 0.0001), and decreased significantly in frequent tooth brushing and regular professional dental cleaning groups, with respective adjusted HRs and 95% CI of 0.853 (0.786–0.926; p = 0.0001) and 0.920 (0.855–0.990; p = 0.0255). In addition, regardless of age and comorbidities, oral health status and oral hygiene behaviors were associated with pneumonia. The results indicate that improved oral health may reduce the risk of pneumonia in the general population. [ABSTRACT FROM AUTHOR]

Background and Aims: Liver cirrhosis is a substantial health burden in the USA, but population-based data regarding the trend and medical expenditure are limited and outdated. We investigated the trends of inpatient admissions, costs, and inpatient mortality from 2005 to 2015 among cirrhotic patients.Methods: A retrospective analysis was conducted using the National Inpatient Sample database. We adjusted the costs to 2015 US dollars using a 3% inflation rate. National estimates of admissions were determined using discharge weights.Results: We identified 1,627,348 admissions in cirrhotic patients between 2005 and 2015. From 2005 to 2015, the number of weighted admissions in cirrhotic patients almost doubled (from 505,032 to 961,650) and the total annual hospitalization cost in this population increased three times (from 5.8 to 16.3 billion US dollars). Notably, admission rates varied by liver disease etiology, decreasing from 2005 to 2015 among patients with hepatitis C virus (HCV)-related cirrhosis while increasing (almost tripled) among patients with nonalcoholic fatty liver disease (NAFLD)-related cirrhosis. The annual inpatient mortality rate per 1000 admissions overall decreased from 63.8 to 58.2 between 2005 and 2015 except for NAFLD (27.2 to 35.8) (P < 0.001).Conclusions: Rates and costs of admissions in cirrhotic patients have increased substantially between 2005 and 2015 in the USA, but varied by liver disease etiology, with decreasing rate for HCV-associated cirrhosis and for HBV-associated cirrhosis but increasing for NAFLD-associated cirrhosis. Inpatient mortality also increased by one-third for NAFLD, while it decreased for other diseases. Cost also varied by etiology and lower for HCV-associated cirrhosis. [ABSTRACT FROM AUTHOR]

The authors wish to acknowledge a confusion in alignment definition in the published paper. [ABSTRACT FROM AUTHOR]

Background: Bleeding is one of the unavoidable complications of total knee arthroplasty (TKA). Tranexamic acid (TXA) in last decade has emerged as an effective and safe way to decrease postoperative bleeding and transfusion rates. Although there is little doubt on the efficacy of the drug, the debate on ideal mode is more recent. We undertook this study to find out the most effective and yet safest way of TXA administration. Materials and Methods: A single institution - two hospital-based, double-blinded, prospective, randomized control trial was conducted from January 2015 to December 2015. One hundred and fifty patients were randomly divided in one of the three groups using computer-generated tables - intravenous (IV), intraarticular and combined. Evident loss through drain, total loss based on gross method and hemoglobin balance method, hidden blood losses, hemoglobin, and hematocrit drop, all possible complications related to TXA were evaluated and compared among groups. The analysis of variance and Tukey's post hoc were used for continuous outcome variables and Chi-square test for binary outcome variables. Results: Evident loss in combined group was 574.25 ± 209.8 ml, significantly less than IV (685.4 ± 289.9 ml) and intraarticular group (724.3 ± 246.8 ml). Total loss was similarly least for combined group (930.1 ± 262.2 ml) compared to IV (1208.3 ± 368.8 ml) and intraarticular group (1198.1 ± 356.8 ml). There were no transfusions in combined group compared to five in IV and four in intraarticular group. Combined group also had least hidden losses after surgery. No patients in any group developed symptomatic deep venous thrombosis. Conclusion: Combined administration of drug is most effective way to decrease postoperative bleeding and requirement of transfusion in unilateral TKA without increasing any risk of complications. [ABSTRACT FROM AUTHOR]

Low-grade waste heat recovery technologies reduce the environmental impact of fossil fuels and improve overall efficiency. This paper presents the economic assessment of greenhouse gas (GHG) reduction through waste heat recovery using organic Rankine cycle (ORC). The ORC engine is one of the mature low temperature heat engines. The low boiling temperature of organic working fluid enables ORC to recover low-temperature waste heat. The recovered waste heat is utilized to produce electricity and hot water. The GHG emissions for equivalent power and hot water from three fossil fuels-coal, natural gas, and diesel oil-are estimated using the fuel analysis approach and corresponding emission factors. The relative decrease in GHG emission is calculated using fossil fuels as the base case. The total cost of the ORC system is used to analyze the GHG reduction cost for each of the considered fossil fuels. A sensitivity analysis is also conducted to investigate the effect of the key parameter of the ORC system on the cost of GHG reduction. Throughout the 20-year life cycle of the ORC plant, the GHG reduction cost for R245fa is 0.02 $/kg to 0.04 $/kg and that for pentane is 0.04 $/kg to 0.05 $/kg. The working fluid, evaporation pressure, and pinch point temperature difference considerably affect the GHG emission. [ABSTRACT FROM AUTHOR]

Abstract  This paper examines ship-speed performance based on acomputational method. The computations are carried out under identical model conditions, i.e., resistance and self-propulsion tests, to predict the speed-power relationship. The self-propulsion point is obtained from the self-propulsive computational results of two propeller rotative speeds. The speed-power relationship in full scale is obtained through analyzing the computational results in model scale according to the model-ship performance analysis method of ITTC’78. The object ship is a VLCC. The limiting streamlines and the distribution of the pressure coefficient on the hull, the wake characteristics on the propeller plane, and the wave characteristics around a model ship are also investigated. After completing the computations, a series of model tests are conducted to evaluate the accuracy of the predictions by comparing the computational results with the experimental results. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to demonstrate the feasibility, safety, and success of percutaneous paracoccygeal catheter drainage of deep pelvic abscesses using a combination of sonography and fluoroscopic guidance. Methods: From April 2005 to December 2006, under sonography and fluoroscopic guidance, sixteen patients with deep pelvic abscess underwent percutaneous paracoccygeal drainage. The causes of pelvic abscesses were post-operative complications. The patient was in prone position; the puncture site was first evaluated with sonography. After local anesthesia, a thin needle (22 G) was positioned along the lateral margin of the coccyx to avoid an eventual injury of sciatic nerve or vessels into the deep pelvic abscess under sonography guidance. Small dose of contrast was injected under fluoroscopy to verify the needle. With Seldinger technique catheters were placed for drainage. Catheter drainage was maintained for 9-40 days. Patients underwent clinical follow-up and subsequent imaging as necessary. Results: Neither significant complications nor technical failures were observed. A complete resolution of the abscess was achieved in 14 patients, and significant resolution of abscess was also observed in the other 2 patients. Conclusions: Sonography and fluoroscopic guided percutaneous paracoccygeal drainage is safe, feasible and efficient approach in the treatment of deep pelvic abscess. [ABSTRACT FROM AUTHOR]

Sesquiterpene cyclase, the first committed step enzyme from the general isoprenoid building block farnesyl pyrophosphate (FPP) for the synthesis of phytoalexin capsidiol, was isolated from the UV-C treated leaves of Capsicum annuum. This sesquiterpene cyclase, termed as CASC2 showing 77% amino acid identity with the previously cloned sesquiterpene cyclase CASC1, was composed of 560 amino acids with a calculated molecular mass of 64,907. The mRNA expression pattern of CASC2 was very similar to that of CASC1 during the time course of UV-C irradiated leaves of pepper on RNA blot analysis by using each specific probe. The heterologous expression in Escherichia coli using the CASC2 full length failed; however the chimeric construct of CASC2 in which the amino terminal 164 amino acid substituted by the equivalent portion of either CASC1 or tobacco sesquiterpene cyclase was capable of expressing the functional sesquiterpene cyclase activities. The radio-labeled enzymatic products catalyzed by the partially purified chimeric CASC2 were comigrated with authentic radiolabeled sesquiterpene on thin layer chromatography. [ABSTRACT FROM AUTHOR]