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コラム：招聘レポー

Epileptic nystagmus: A case report and systematic review

AbstractPurposeWe aimed to define the characteristics of epileptic nystagmus and correlate those with other clinical findings in a large number of patients.MethodsWe report a patient with epileptic nystagmus and additionally reviewed the reported clinical features of 36 more patients through a systematic literature search. We analyzed the characteristics of epileptic nystagmus and attempted correlations of those with alertness of the patients and epileptic foci on EEG.ResultsAll 33 patients with unilateral horizontal nystagmus showed nystagmus beating away from the side of ictal discharges. Epileptic nystagmus was preceded by gaze deviation in 21 patients, with contraversive in 19 and ipsiversive in 2. Seizures associated with epileptic nystagmus were mostly focal (25/29, 86.2%) with or without loss of awareness. Ictal discharges originated from the occipital (n=16), parietal (n=9), temporo-occipital (n=6), frontal (n=4), and temporal (n=3) areas, and two patients had multiple epileptic foci. Seizures were usually symptomatic (24/37, 64.9%). The presence of preceding gaze deviation and midline crossing of the nystagmus did not correlate with the ictal onset zone or alertness of the patients. Recording of epileptic nystagmus was available only in 6 patients, and the epileptic nystagmus could be localized to the saccadic areas in two and to the smooth pursuit areas in another two. Two patients showed the features of epileptic nystagmus from both areas.ConclusionEven though the localizing value of epileptic nystagmus seems limited in previous reports, the fast phase of epileptic nystagmus was almost always directed away from the epileptic focus that mostly arose from the posterior part of the cerebral hemisphere

Thyroid function in obese Korean children and adolescents: Korea National Health and Nutrition Examination Survey 2013–2015

Purpose In recent years, there has been an increasing focus on thyroid function in pediatric obese patients, but no nationwide study evaluating the relationship between thyroid function and obesity has yet been conducted in Korea. We aimed to evaluate thyroid dysfunction in obese Korean children. Methods We analyzed the associations between obesity and thyroid hormone levels among 975 Korean boys and girls aged 10–18 years and who participated in the Korean National Health and Nutrition Examination Survey VI (2013–2015). Results Average serum thyrotropin (TSH) and serum free thyroxine (fT4) levels in the nonobese group were 2.7±0.1 μIU/mL and 1.3±0.0 ng/dL, respectively, and those in the overweight group were 3.1±0.2 μIU/mL and 1.2±0.0 ng/dL. Serum TSH level was significantly higher in the abdominal obesity group than in the normal group (P=0.023). fT4 level was significantly lower in both the overweight and abdominal obesity groups than in the normal group (P<0.001, P=0.014). Serum TSH level was associated positively with abdominal obesity and levels of high-density lipoprotein cholesterol and triglyceride. Serum fT4 level was negatively correlated with abdominal obesity (P=0.014). Conclusions Korean children with abdominal obesity showed increased TSH and decreased fT4 levels compared to normal children

Considerations of Blood Properties, Outlet Boundary Conditions and Energy Loss Approaches in Computational Fluid Dynamics Modeling

Despite recent development of computational fluid dynamics (CFD) research, analysis of computational fluid dynamics of cerebral vessels has several limitations. Although blood is a non-Newtonian fluid, velocity and pressure fields were computed under the assumptions of incompressible, laminar, steady-state flows and Newtonian fluid dynamics. The pulsatile nature of blood flow is not properly applied in inlet and outlet boundaries. Therefore, we present these technical limitations and discuss the possible solution by comparing the theoretical and computational studies

Loss of Human Leukocyte Antigen Class I Expression Is Associated with Poor Prognosis in Patients with Advanced Breast Cancer

Background Human leukocyte antigen class I (HLA-I) molecules play important roles in regulating immune responses. Loss or reduction of HLA-I expression has been shown to be associated with prognosis in several cancers. Regulatory T-cells (Tregs) also play critical functions in immune response regulation. Evaluation of HLA-I expression status by the EMR8-5 antibody and its clinical impact in breast cancer have not been well studied, and its relationship with Tregs remains unclear. Methods We evaluated HLA-I expression and Treg infiltration by immunohistochemistry in 465 surgically resected breast cancer samples. We examined the correlation between HLA-I expression and Treg infiltration and clinicopathologic characteristics and survival analyses were performed. Results Total loss of HLA-I expression was found in 84 breast cancer samples (18.1%). Univariate survival analysis revealed that loss of HLA-I expression was significantly associated with worse disease-specific survival (DSS) (p = .029). HLA-I was not an independent prognostic factor in the entire patient group, but it was an adverse independent prognostic factor for DSS in patients with advanced disease (stage II–IV) (p = .031). Treg numbers were significantly higher in the intratumoral stroma of HLA-I–positive tumors than in HLA-I–negative tumors (median 6.3 cells/high power field vs 2.1 cells/high power field, p < .001). However, Tregs were not an independent prognostic factor in our cohort. Conclusions Our findings suggest that the loss of HLA-I expression is associated with poor prognosis in breast cancer patients, highlighting the role of HLA-I alterations in immune evasion mechanisms of breast cancer. HLA-I could be a promising marker that enables the application of more effective and precise immunotherapies for patients with advanced breast cancer

The effect of overweight on the luteinizing hormone level after gonadorelin stimulation test in girls with idiopathic central precocious puberty

Purpose We investigated the effect of overweight on luteinizing hormone (LH) levels after a gonadorelin stimulation test in Korean girls with idiopathic central precocious puberty (CPP). Methods Medical records of 234 girls diagnosed with idiopathic CPP were reviewed retrospectively. CPP was diagnosed when the peak LH levels after gonadorelin stimulation was >5.0 U/L. The enrolled girls had a peak LH level >5.0 U/L after a gonadorelin stimulation test. Selected girls were classified as normoweight (body mass index [BMI] below the 85th percentile with respect to age) and overweight (BMI greater than the 85th percentile with respect to age). Results The peak LH (8.95±2.85 U/L vs. 11.97±8.42 U/L, P<0.01) and peak follicle-stimulating hormone (9.60±2.91 U/L vs. 11.17±7.77 U/L, P=0.04) after gonadorelin stimulation were lower in overweight girls with idiopathic CPP than in normoweight girls with idiopathic CPP. Being overweight was negatively associated with peak LH levels after gonadorelin stimulation test (odds ratio, 0.89; 95 % confidence interval, 0.81–0.98, P=0.02). Conclusions In girls with idiopathic CPP, being overweight led to a lower LH peak after gonadorelin stimulation. Further research is needed to better understand the role of overweight on gonadotropin secretion in precocious puberty