Factors Affecting the Onset of Hyperactive Delirium in Terminally Ill Cancer Patients in Hospice Care / 생물치료정신의학

Objectives@#：Hyperactive delirium is a state of acute mental confusion including aggressive and impulsive behavior and it is burdensome for the family and caregivers of terminal cancer patients. Therefore, predicting the symptoms of hyperactive delirium can provide benefits to care terminal cancer patients. In this study, several risk factors were evaluated during hospitalization for predicting delirious symptom in terminal cancer patients. @*Methods@#：Patients who died of cancer in a palliative care unit from January 2011 to September 2012 were investigated by retrospective chart review. Clinical and laboratory data were collected to identify the factors associated with hyperactive delirium. Univariate and multivariate analysis by logistic regression were applied. Additional survival analysis was conducted to measure the onset of delirium symptoms after pneumonia. @*Results@#：During hospitalization, 49 of 201 patients showed the symptoms of hyperactive delirium (24.4%). Developing a delirious symptom was associated with male (OR=3.36, p=0.002), bone metastasis (OR=3.70, p=0.002), pneumonia during hospitalization (OR=3.17, p=0.02) and depressive mood (OR=2.53, p80.011). In additional survival analysis, half of patients developed symptoms of delirium within 3 days after pneumonia. @*Conclusion@#：Our results suggest that male, bone metastasis, depressive mood, and pneumonia are risk factors that can affect hyperactive delirium in terminally ill cancer patients. In addition, many patients with pneumonia abruptly developed the symptoms of hyperactive delirium within 3 days. Our finding may provide clues for predicting hyperactive delirium, and it can be helpful to manage delirium symptoms.

Aucubin Promotes Differentiation of Neural Precursor Cells into GABAergic Neurons

Aucubin is a small compound naturally found in traditional medicinal herbs with primarily anti-inflammatory and protective effects. In the nervous system, aucubin is reported to be neuroprotective by enhancing neuronal survival and inhibiting apoptotic cell death in cultures and disease models. Our previous data, however, suggest that aucubin facilitates neurite elongation in cultured hippocampal neurons and axonal regrowth in regenerating sciatic nerves. Here, we investigated whether aucubin facilitates the differentiation of neural precursor cells (NPCs) into specific types of neurons. In NPCs cultured primarily from the rat embryonic hippocampus, aucubin significantly elevated the number of GAD65/67 immunoreactive cells and the expression of GAD65/67 proteins was upregulated dramatically by more than three-fold at relatively low concentrations of aucubin (0.01 µM to 10 µM). The expression of both NeuN and vGluT1 of NPCs, the markers for neurons and glutamatergic cells, respectively, and the number of vGluT1 immunoreactive cells also increased with higher concentrations of aucubin (1 µM and 10 µM), but the ratio of the increases was largely lower than GAD expression and GAD immunoreactive cells. The GABAergic differentiation of pax6-expressing late NPCs into GABA-producing cells was further supported in cortical NPCs primarily cultured from transgenic mouse brains, which express recombinant GFP under the control of pax6 promoter. The results suggest that aucubin can be developed as a therapeutic candidate for neurodegenerative disorders caused by the loss of inhibitory GABAergic neurons.

Disseminated neonatal herpes simplex virus infection with necrotizing encephalitis: an autopsy case

An autopsy case of disseminated HSV type 2 infection occurring in a neonate at 32 weeks' gestation, delivered by cesarean section after premature rupture of membrane of 7 days duration, is presented. Herpes simplex virus type 2 was isolated from the vesicular skin lesion. The mother and patient had specific antibody to type 2 herpes simplex virus. Patient's parents had denied any herpetic orolabial or genital lesion during or before this pregnancy. Cultures from the cervical and vaginal swabs of the mother were negative for HSV. Postmortem examination showed hepatic necrosis, skin vesicle, devastating necrotizing inflammation of the brain, chorioretinitis and interstitial pneumonitis.