Safety and Effectiveness of Empagliflozin in Korean Patients with Type 2 Diabetes Mellitus: Results from a Nationwide Post-Marketing Surveillance

Background@#To evaluate the safety and effectiveness of empagliflozin in routine clinical settings, we collected and assessed the clinical profiles of Korean patients with type 2 diabetes mellitus. @*Methods@#This was a post-marketing surveillance study of empagliflozin 10 and 25 mg. Information on adverse events and adverse drug reactions (ADRs) was collected as safety data sets. Available effectiveness outcomes, including glycosylated hemoglobin (HbA1c) level, fasting plasma glucose, body weight, and blood pressure, were assessed. @*Results@#The incidence rate of ADRs was 5.14% in the safety dataset (n=3,231). Pollakiuria, pruritis genital, and weight loss were the most common ADRs. ADRs of special interest accounted for only 1.18%, and there were no serious events that led to mortality or hospitalization. In the effectiveness data set (n=2,567), empagliflozin significantly reduced the mean HbA1c level and body weight during the study period by –0.68%±1.39% and –1.91±3.37 kg (both P<0.0001), respectively. In addition, shorter disease duration, absence of dyslipidemia, and higher baseline HbA1c levels were identified as the clinical features characteristic of a “responder” to empagliflozin therapy. @*Conclusion@#Empagliflozin is a safe and potent glucose-lowering drug in routine use among Korean patients with type 2 diabetes mellitus. It is expected to have better glycemic efficacy in Korean patients with poorly controlled type 2 diabetes mellitus.

Out-of-hospital cardiac arrest: incidence, patient characteristics, outcomes, and trends over time between 2012 and 2018 in an urban city

Objective@#This study aimed to determine the incidence, characteristics, and outcomes of out-of-hospital cardiac arrests (OHCA) and to investigate the trends for the same in Changwon city, South Korea between 2012 and 2018. @*Methods@#We analyzed a list of adult cardiac arrest cases occurring between 2012 and 2018 from the OHCA surveillance registry and the Changwon Fire Department’s emergency medical services database. The trends in the incidence and resuscitation-related characteristics were assessed using nonparametric tests for trends across ordered groups. The predictors of the primary outcome were investigated using multivariable logistic regression. The primary outcome was a good neurological outcome at hospital discharge. @*Results@#A total of 2,951 OHCAs were attended by the emergency medical services and of these, 2,834 were included in this study. Overall, the proportion of patients discharged with a good neurologic outcome was 4.7% (133/2,834). Both OHCA survival and good neurologic outcomes improved significantly over time, from 4.9% and 2.1%, respectively, in 2012 to 10.3% and 7.4% in 2018 (P<0.001). The Utstein comparator (bystander-witnessed arrests presenting with initial shockable rhythm) increased over the study period (P-for-trend<0.001). Age, response time, scene time, in-hospital cardiopulmonary resuscitation (CPR) time, witness presence, cardiac origin, and shockable rhythm were associated with good neurologic outcomes. @*Conclusion@#With the gradual increase in the proportion of patients with witnessed cardiac arrests, bystander CPR, and initial shockable rhythm, the rate of survival and a good neurologic outcome at discharge also increased annually.

Midterm Outcomes of Intramedullary Fixation of Intertrochanteric Femoral Fractures Using Compression Hip Nails: Radiologic and Clinical Results

Background@#Various implants are used to treat intertrochanteric fractures. However, the optimal implant to stabilize intertrochanteric femoral fractures is still a matter of debate. The purpose of the present study was to evaluate the midterm outcomes of patients treated using compression hip nails (CHNs). @*Methods@#Between March 2013 and April 2018, 164 patients with intertrochanteric femoral fractures who were treated with internal fixation using CHNs were enrolled in this study. The mean age of the patients was 79.6 years. We retrospectively collected and estimated information such as reduction state, implant position, operation time, blood loss, hospital stay, time to achieve union, clinical scores (Harris hip score [HHS] and EuroQol five-dimensional [EQ-5D]), intraoperative complications (such as lag jamming and drill bit breakage), failure of fixation, avascular necrosis, and surgical site infection. @*Results@#The mean follow-up period was 39.69 months. Eight percent of the patients required an open reduction. The mean operation time was 131 minutes, the mean blood loss was 221.19 mL, the mean hospital stay was 20.66 days, and the average time to union was 18 weeks. Intraoperative complications included 8 cases of breakage of the drill bit while making distal holes. The failure rate was 3.7% and revision surgery was performed in 6 cases (for cut-out in 5 and pull-out of the lag screw in 1). Asymptomatic venous thromboembolism occurred in 2 cases and hematoma requiring intervention occurred in 1 case. There were no other complications such as avascular necrosis, infection, and lateral irritation. At the 2-year follow-up, the averages of HHS and EQ-5D were 71.54 and 0.68, respectively. @*Conclusions@#Among the implants used to treat intertrochanteric femoral fractures, CHNs had a surgical failure of 3.7% and showed good radiologic and clinical results.

Therapeutic Effect of HDAC5 Binding and Cell Penetrating Peptide for the Treatment of Inflammatory Bowel Disease

BACKGROUND@#Inflammatory bowel disease (IBD) is an incurable disease that negatively influences the quality of life of patients. Current and emerging therapies target proinflammatory cytokines and/or receptors to downregulate proinflammatory responses, but insufficient remission requires other therapeutic agents. Herein, we report that the synthetic antiinflammatory peptide 15 (SAP15) is capable of cell penetration and anti-inflammatory activity in human macrophages. @*METHODS@#SAP15 was labeled with fluorescence and administered to human leukemia monocytic cells (THP-1) cells for cell penetration analysis. Using biolayer interferometry analysis, the binding affinity of SAP15 with histone deacetylase 5 (HDAC5) was measured. SAP15-treated THP-1 cells were analyzed by protein phosphorylation assay, flow cytometry, and enzyme-linked immunosorbent assay (ELISA). In addition, in vivo analysis of the therapeutic effect on IBD was observed in a dextran sulfate sodium (DSS)-induced model. Samples from SAP15-treated mice were analyzed at both the macroscopic and microscopic levels using ELISA, myeloperoxidase (MPO) assays, and histological evaluations. @*RESULTS@#SAP15 was internalized within the cytosol and nucleus of THP-1 cells and bound to the HDAC5 protein. SAP15-treated macrophages were assessed for protein phosphorylation and showed inhibited phosphorylation of HDAC5 and other immune-related proteins, which led to increased M2-like macrophage markers and decreased M1-like macrophage markers and tumor necrosis factor-a and interleukin-6 cytokine levels. The SAP15 treatment on IBD model showed significant recovery of colon length. Further histological analysis of colon demonstrated the therapeutic effect of SAP15 on mucosal layer. Moreover, proinflammatory cytokine levels and MPO activity from the plasma show that SAP15 is effective in reduced proinflammatory responses. @*CONCLUSION@#These findings suggest that SAP15 is a novel peptide with a novel cell-penetrating peptide with antiinflammatory property that can be used as a therapeutic agent for IBD and other inflammatory diseases.

Position Statement: Atypical Femoral Fracture from the Korean Society for Bone and Mineral Research in 2023

As the aging population increases, the number of patients with osteoporosis is gradually rising. Osteoporosis is a metabolic bone disease characterized by low bone mass and the microarchitectural deterioration of bone tissue, resulting in reduced bone strength and an increased risk of low-energy or fragility fractures. Thus, the use of anti-resorptive agents, such as bisphosphonates (BPs), to prevent osteoporotic fractures is growing annually. BPs are effective in reducing hip and other fractures. However, the longer a patient takes BPs, the higher the risk of an atypical femoral fracture (AFF). The exact mechanism by which long-term BP use affects the development of AFFs has not yet been clarified. However, several theories have been suggested to explain the pathogenesis of AFFs, such as suppressed bone remodeling, impaired bone healing, altered bone quality, and femoral morphology. The management of AFFs requires both medical and surgical approaches. BPs therapy should be discontinued immediately, and calcium and vitamin D levels should be evaluated and supplemented if insufficient. Teriparatide can be used for AFFs. Intramedullary nailing is the primary treatment for complete AFFs, and prophylactic femoral nailing is recommended if signs of an impending fracture are detected.

Pediatric out-of-hospital cardiac arrest: incidence and outcomes in an urban city

Objective@#The aim of this study was to examine the incidence and outcomes of pediatric out-of-hospital cardiac arrests (OHCA) in Changwon city, South Korea. @*Methods@#From the Out-of-Hospital Cardiac Arrest Surveillance registry and the Changwon Fire Department’s Emergency Medical Services data, we obtained a list of 119 assessed pediatric OHCAs occurred between January 2012 and December 2018. We analyzed basic demographic variables, the location of cardiac arrest, witnessed status, bystander cardiopulmonary resuscitation (CPR), time variables for CPR, dispatcher-assisted CPR, initial cardiac rhythm, automated defibrillator use, and clinical outcomes at hospital discharge. @*Results@#A total of 2,954 OHCAs occurred during the study period, of which 72 were pediatric OHCAs. The rate of witnessed cardiac arrest was 30.6% (22/72), and bystander CPR was performed in 29 patients (40.3%). The rate of cardiac arrest occurring in public places was 16.7% (12/72). The rate of shockable rhythm in the initial electrocardiogram rhythm was 8.3% (6/72). Twelve patients (16.7%) survived to admission. The proportion of survivors discharged was 4.3% (3/70), and the rate of discharge with a good prognosis was 2.8% (2/70). @*Conclusion@#The incidence rate of pediatric OHCA was low in Changwon city. The survival rate was also low. Thus, studies with larger sample sizes and continuous monitoring in the community are needed.

The Utility of Peripheral Vitrectomy Featuring Scleral Indentation during Scleral Fixation of Intraocular Lenses

Purpose@#We evaluated the utility of peripheral vitrectomy featuring scleral indentation; we compared a group who underwent peripheral vitrectomy to a control group for whom vitrectomy was combined with scleral fixation of intraocular lenses (IOLs) in patients exhibiting IOL dislocations. @*Methods@#From January 2018 to December 2020, 20 eyes of patients evidencing IOL dislocations that underwent total vitrectomy, IOL removal, and IOL scleral fixation were evaluated; peripheral vitrectomy with scleral indentation was performed in 10 patients. All operations were performed by the same surgeon. We excluded patients with follow-up periods less than 6 months, those with a history of retinal and/or glaucoma surgery, and patients with retinal abnormalities or glaucoma that might significantly compromise visual acuity. The postoperative best-corrected visual acuity, intraocular pressure, astigmatism changes, and complications were retrieved from the medical records. @*Results@#Six months after surgery, the best corrected visual acuity was 0.95 (the Snellen measure) in the group who underwent peripheral vitrectomy featuring scleral indentation, and 0.60 in the control group (p = 0.029). The total astigmatism values were 0.48 diopter in the former and 2.80 diopter in the latter group; the difference was significant (p < 0.001). @*Conclusions@#In patients with IOL dislocations who underwent vitrectomy combined with IOL scleral fixation, improvements in visual acuity were further enhanced when peripheral vitrectomy was combined with scleral indentation. Complete removal of the peripheral vitreous may stabilize IOL positioning by the remnant vitreous.

Change of In-Shoe Plantar Pressure According to Types of Shoes (Flat Shoes, Running Shoes, and High Heels)

Background@#The type of footwear is one of several factors that affect foot pressure. Despite its usefulness in identifying pathology and preventing and treating foot-related diseases, the type of shoes has been investigated and compared in only a few studies. This study aimed to investigate differences in plantar pressure, induced by flat, running, and high-heeled shoes in healthy, young women. @*Methods@#A total of 27 healthy women (27 feet) with a mean age of 21.5 ± 2.03 years were included in this study. Based on demographic data, radiologic measurements, clinical scores, temporal gait parameters, and kinematic parameters of gait, we confirmed the participants had normal feet. Then, pedobarographic data were measured by dividing each foot into seven regions to compare the three types of shoes. Peak plantar pressure and pressure-time integral were calculated using the Pedar-X system. The one-way analysis of variance and the Kruskal-Wallis test with Mann Whitney U-test were used for statistical analyses. @*Results@#Regarding the 7 regions of the foot, flat shoes resulted in a significantly higher pressure than running shoes in the hallux and lesser toes and the highest pressure in the metatarsal head (MTH) 3–5 and the hindfoot. In contrast, in the MTH 1 and MTH 2 regions, the high-heeled shoes had the highest measured pressure, followed by the flat shoes. Lastly, there was no high pressure in running shoes in any region except for the midfoot compared to the other shoes. @*Conclusions@#It can be inferred from our findings that flat and high-heeled shoes can generate a considerable burden on specific parts of the foot, which will aid in choosing appropriate shoes. Also, wearing running shoes places less burden on the overall foot.

Palatopharyngeal Muscle Suspension Suture Technique for Obstructive Sleep Apnea / 대한이비인후과학회지

Various treatment modalities for obstructive sleep apnea (OSA) patients were introduced including continuous positive airway pressure (CPAP), lifestyle modification, and surgery. Numerous factors such as compliance, treatment failure, and preference should be considered when deciding the treatment. In general, patients for whom CPAP or other conservative treatment modalities failed become candidates for surgical treatments. Uvulopalatopharyngoplasty is one of the most generally performed surgeries, of which success rate is relatively low. Recently, numerous techniques that can correct lateral pharyngeal obstruction for OSA patients were introduced. However, some of them are technically difficult and aggressive. In this article, we introduce a novel surgical method for OSA called palatopharyngeal muscle suspension suture technique.

The Prognosis of Glyphosate herbicide intoxicated patients according to their salt types

Purpose@#Glyphosate herbicide (GH) is a widely used herbicide and has been associated with significant mortality as poisoned cases increases. One of the reasons for high toxicity is thought to be toxic effect of its ingredient with glyphosate. This study was designed to determine differences in the clinical course with the salt-type contained in GH. @*Methods@#This was a retrospective study conducted at a single hospital between January 2013 and December 2017. We enrolled GH-poisoned patients visited the emergency department. According to salt-type, patients were divided into 4 groups: isopropylamine (IPA), ammonium (Am), potassium (Po), and mixed salts (Mi) groups. The demographics, laboratory variables, complications, and their mortality were analyzed to determine clinical differences associated with each salt-type. Addtionally, we subdivided patients into survivor and non-survivor groups for investigating predictive factors for the mortality. @*Results@#Total of 348 GH-poisoned patients were divided as follows: IPA 248, Am 41, Po 10, and Mi 49 patients. There was no difference in demographic or underlying disease history, but systolic blood pressure (SBP) was low in Po group. The ratio of intentional ingestion was higher in Po and Mi groups. Metabolic acidosis and relatively high lactate level were presented in Po group.As the primary outcome, the mortality rates were as follows: IPA, 26 (10.5%); Am, 2 (4.9%); Po, 1 (10%); and Mi, 1 (2%). There was no statistically significant difference in the mortality and the incidence of complications. Additionally, age, low SBP, low pH, corrected QT (QTc) prolongation, and respiratory failure requiring mechanical ventilation were analyzed as independent predictors for mortality in a regression analysis. @*Conclusion@#There was no statistical difference in their complications and the mortality across the GH-salt groups in this study.

A Study on Complementary Policy to Enhance the Effectiveness of National Dementia Policy in Terms of Medical Services / 신경정신의학

Objectives@#South Korea has established four national dementia plans (NDPs). However, there have been few policy studies focusing on health services to improve the effectiveness of the NDPs. This study aimed to develop measures to raise the efficacy of medical care in NDP. @*Methods@#We classified the implementation policies of the 3rd NDP and the national dementia initiative according to the key objectives of the dementia policy of the Organisation for Economic Co-operation and Development. After investigating the progress, complementary policies were developed by reviewing the existing policy literature and exemplary cases in developed countries. @*Results@#The Community Dementia Reassurance Center should provide integrated services. To promote early screening, private medical services should be engaged. To provide post-diagnostic support, we propose a “Dementia Intensive Support Team” in hospitals. To care for severe cases of behavioral and psychological symptoms of dementia (BPSD), an “Intensive Care Unit for BPSD” is needed. It would be more effective for the various functions of the “Dementia Reassurance Hospital” to be implemented by various private medical institutions, rather than for all the functions to be implemented only by public long-term care hospitals. @*Conclusion@#Rather than carrying out all projects in the public domain, active use of private resources will increase the effectiveness and efficiency of the NDP.

Squamous Cell Carcinoma in the Lacrimal Sac of Young Patient Who Had Conjunctival Squamous Papilloma

Purpose@#To report a squamous cell carcinoma in the lacrimal sac of a young patient.Case summary: A 30-year-old female patient who had a history of conjunctival squamous papilloma resected at 15 years of age complained of pain and a mass around the right lacrimal sac that had occurred 1 week prior. Antibiotic treatment for 10 days under suspicion of dacryocystitis did not relieve her symptoms. After being diagnosed with lacrimal sac obstruction after dacryocystography, a 1.7 × 1.7 cm round mass was found on orbit non-contrast computed tomography. Endonasal dacryocystorhinostomy and excisional biopsy were performed. Histopathological examination revealed the initial invasive squamous cell carcinoma. An additional resected tissue biopsy was performed later. The mass diagnosed as carcinoma was completely resected and it was confirmed that there were no malignant cells around the resected area. @*Conclusions@#Squamous cell carcinoma of the lacrimal sac is rare and is known to be less common in young patients. It is believed that this case should not exclude the possibility of malignant tumors of the lacrimal sac regardless of age. Given that squamous cell carcinoma of the lacrimal sac is associated with a high-risk of human papillomavirus, this disease should be considered if there is a history of papilloma.

The Association of Childhood Maltreatment with Adulthood Mental Disorders and Suicidality in Korea: a Nationwide Community Study

Background@#Although childhood maltreatment is a known risk factor for adulthood mental health, the impact of different types of childhood maltreatment on mental disorders is not yet clear. This study explored the association of each type of childhood maltreatment with adulthood mental disorders and suicidality in South Korea. @*Methods@#A total of 5,102 individuals from the general populations over the age of 18 responded to the Korean version of the Composite International Diagnostic Interview and questions about childhood maltreatment (emotional neglect, psychological abuse, physical abuse, and sexual abuse). To evaluate the odds ratio for mental disorders and suicidality associated with each type of childhood maltreatment, we used logistic regression analysis. @*Results@#About 17.0% of the respondents reported having experienced a type of maltreatment in childhood. According to the type, 9.4% reported physical abuse, 9.3% reported emotional neglect, 7.9% reported psychological abuse, and 3.8% reported sexual abuse. Exposure to each type of childhood maltreatment was associated with most types of mental disorders after adjusting for sociodemographic factors. Each type of childhood maltreatment victim was associated with suicidality (suicidal ideations, suicide plans, and suicide attempts).Dose-response patterns for suicide attempts were observed in all types of victims. Moreover, the respondents who experienced frequent childhood emotional neglect were 14 times more likely to have attempted suicide. @*Conclusion@#Childhood maltreatment was associated with mental health in adulthood.The findings show the need for early detection and intervention of victims of childhood maltreatment to minimize its negative impact on adult mental health.

Squamous Cell Carcinoma in the Lacrimal Sac of Young Patient Who Had Conjunctival Squamous Papilloma

Purpose@#To report a squamous cell carcinoma in the lacrimal sac of a young patient.Case summary: A 30-year-old female patient who had a history of conjunctival squamous papilloma resected at 15 years of age complained of pain and a mass around the right lacrimal sac that had occurred 1 week prior. Antibiotic treatment for 10 days under suspicion of dacryocystitis did not relieve her symptoms. After being diagnosed with lacrimal sac obstruction after dacryocystography, a 1.7 × 1.7 cm round mass was found on orbit non-contrast computed tomography. Endonasal dacryocystorhinostomy and excisional biopsy were performed. Histopathological examination revealed the initial invasive squamous cell carcinoma. An additional resected tissue biopsy was performed later. The mass diagnosed as carcinoma was completely resected and it was confirmed that there were no malignant cells around the resected area. @*Conclusions@#Squamous cell carcinoma of the lacrimal sac is rare and is known to be less common in young patients. It is believed that this case should not exclude the possibility of malignant tumors of the lacrimal sac regardless of age. Given that squamous cell carcinoma of the lacrimal sac is associated with a high-risk of human papillomavirus, this disease should be considered if there is a history of papilloma.

The Association of Childhood Maltreatment with Adulthood Mental Disorders and Suicidality in Korea: a Nationwide Community Study

Background@#Although childhood maltreatment is a known risk factor for adulthood mental health, the impact of different types of childhood maltreatment on mental disorders is not yet clear. This study explored the association of each type of childhood maltreatment with adulthood mental disorders and suicidality in South Korea. @*Methods@#A total of 5,102 individuals from the general populations over the age of 18 responded to the Korean version of the Composite International Diagnostic Interview and questions about childhood maltreatment (emotional neglect, psychological abuse, physical abuse, and sexual abuse). To evaluate the odds ratio for mental disorders and suicidality associated with each type of childhood maltreatment, we used logistic regression analysis. @*Results@#About 17.0% of the respondents reported having experienced a type of maltreatment in childhood. According to the type, 9.4% reported physical abuse, 9.3% reported emotional neglect, 7.9% reported psychological abuse, and 3.8% reported sexual abuse. Exposure to each type of childhood maltreatment was associated with most types of mental disorders after adjusting for sociodemographic factors. Each type of childhood maltreatment victim was associated with suicidality (suicidal ideations, suicide plans, and suicide attempts).Dose-response patterns for suicide attempts were observed in all types of victims. Moreover, the respondents who experienced frequent childhood emotional neglect were 14 times more likely to have attempted suicide. @*Conclusion@#Childhood maltreatment was associated with mental health in adulthood.The findings show the need for early detection and intervention of victims of childhood maltreatment to minimize its negative impact on adult mental health.

The impact of COVID-19 on the injury pattern for maxillofacial fracture in Daegu city, South Korea / 대한악안면성형재건외과학회지

Background@#This study aimed to analyze the impact of COVID-19 on oral and maxillofacial fracture in Daegu by comparing the demographic data in 2019 and 2020, retrospectively. We collected data from all patients having trauma who visited the emergency room for oral and maxillofacial fractures. @*Methods@#This retrospective study was based on chart review of patients who visited the emergency department of Kyungpook National University Hospital in Daegu, South Korea from January 1, 2019, to December 31, 2020. We conducted a comparative study for patients who presented with maxillofacial fractures with occlusal instability during pre-COVID-19 era (2019) and COVID-19 era (2000) with demographics and pattern of injuries. @*Results@#After the outbreak of COVID-19, the number of monthly oral and maxillofacial fractures, especially sportsrelated oral and maxillofacial fractures, decreased significantly. Also, the number of alcohol-related fractures increased significantly. In addition, as the number of monthly confirmed cases of COVID-19 increases, the incidence of fracture among these cases tends to decrease. @*Conclusions@#The COVID-19 pandemic has changed the daily life in Korea. Identifying the characteristics of patients having trauma can provide a good lead to understand this long-lasting infectious disease and prepare for future outbreaks.

Risk Factors Affecting the Early Complications of Femoral Head Fractures

Purpose@#This study analyzed the prognostic factors in patients with femoral head fractures by comparing two groups with and without complications. @*Materials and Methods@#A retrospective study was performed on femoral head fracture patients who visited two different level-1 trauma centers from January 1, 2014 to June 30, 2018. Thirty-three patients with a follow-up period of more than one year were included. Early complications were defined as fair or poor in the Thompson–Epstein clinical evaluation criteria and grades 3 or 4 in the Kellgren– Lawrence classification within one year after the fracture. The patients were divided into two groups, with and without early complications. Statistical analysis was performed for the nominal variables with a Fisher’s exact test and continuous variables using a Mann–Whitney U test. @*Results@#Nine patients (27.3%) had early complications, and there were no significant differences according to age, sex, treatment method, combined fractures, Pipkin classification, and AO/OTA classification between the two groups. @*Conclusion@#The prognosis in femoral head fractures is difficult to predict. Therefore, the validation of existing classifications or a new classification is necessary.

New Diagnostic Criteria and Treatment for Dementia with Lewy Bodies

Dementia with Lewy bodies (DLB) is the second most common cause of neurodegenerative dementia. The Dementia with Lewy Bodies Consortium has revised DLB consensus diagnostic criteria. We reviewed recent (fourth) clinical diagnosis criteria and treatment options. The revised DLB clinical criteria included clinical features and updated diagnostic biomarkers. Compared with third criteria, they removed suggestive features and reassigned rapid eye movement sleep behavior disorder (RBD) in core clini-cal features with fluctuating cognition, recurrent visual hallucination, and parkinsonism. They classified biomarkers into two groups, indicative and supportive biomarkers, according to diagnostic specificity and evidence quality. Indicative biomarkers in-cluded reduced dopamine transporter uptake in basal ganglia demonstrated by single-photon emission CT or positron emission tomography, low uptake 123 Iodine- metaiodobenzylguanidine myocardial scintigraphy, and RBD in polysomnography. In treatment of DLB, cholinesterase inhibitor can improve cognitive function and activities of daily living. Neuroleptics should use with caution due to sensitivity in DLB.

Frequency of Depressive Disorders According to Cognitive Continuum in the Elderly Living in the Community

Objective@#We investigated the frequency of depressive disorders in the elderly with normal cognition (NC), mild cognitive impairment (MCI) and dementia patients living in the community to find out the association between cognitive disorders and depressive disorders in the community dwelling elderly. @*Methods@#6,262 baseline study subjects from November 2010 through October 2012 were enrolled based on the Korean longitudinal study on cognitive aging and dementia which is the first nationwide multi-center population based prospective cohort study in Korea. Diagnosis of MCI, dementia, major depressive disorder (MDD), minor depressive disorder (mDD) and subsyndromal depression (SSD) was made by psychiatrists with expertise in dementia based on the appropriate diagnostic criteria. @*Results@#4,303 NC, 1,737 MCI, 222 dementia were enrolled. The frequency of MDD, mDD, SSD were highest in dementia and lowest in NC and showed significant difference among three groups. The odds ratio also increased significantly in MCI and dementia compared with NC showing highest odds ratio in dementia. @*Conclusion@#Our findings propose that MCI and dementia in the community dwelling elderly were significantly associated with various types of depressive disorders showing highest association tendency in dementia.

Leak Sign on Dynamic-SusceptibilityContrast Magnetic Resonance Imaging in Acute Intracerebral Hemorrhage

Purpose@#A CT angiography spot sign (CTA-spot) is a significant predictor of the early expansion of an intracerebral hemorrhage (ICH-Ex). Dynamic-susceptibility-contrast magnetic resonance imaging (DSC-MRI) can track the real-time leaking of contrast agents. It may be able to indicate active bleeding, like a CTA-spot. @*Materials and Methods@#From September 2014 to February 2017, we did noncontrast CT, CTA, and DSC-MRI examinations of seven patients with acute ICH. We investigated the time from symptom onset to the first contrast-enhanced imaging.We evaluated the time course of the contrast leak within the ICH at the source image of the DSC-MRI and the volume change of ICH between non-contrast CT and DSCMRI. We compared the number of slices showing CTA-spots and DSC-MRI leaks. @*Results@#The CTA-spot and DSC-MRI leak-sign were present in four patients, and two patients among those showed ICH-Ex. The time from the symptom onset to CTA or DSC-MRI was shorter for those with a DSC-MRI leak or CTA-spot than for three patients without either (70-130 minutes vs. 135-270 minutes). The leak-sign began earlier, lasted longer, and spread to more slices in the patients with ICH-Ex than in those without ICH-Ex. The number of slices of the DSC-MRI leak and the number of the CTA-spot were well correlated. @*Conclusion@#DSC-MRI can demonstrate the leakage of GBCA within hyperacute ICH, showing the good contrast between hematoma and contrast. The DSC-MRI leakage sign could be related to the hematoma expansion in patients with ICH.