Wingspan Stenting for Symptomatic Severe In-Stent Stenosis of a Closed-Cell Stent after Stent-Assisted Coiling of a Ruptured Intracranial Aneurysm

We report the 3-year follow-up result of Wingspan intracranial stenting for symptomatic severe in-stent stenosis after stent-assisted coiling (SAC) for a ruptured left distal internal carotid artery (ICA) aneurysm. A middle-aged male patient visited our hospital for in-stent stenosis of a stent that was placed to treat a ruptured ICA aneurysm. Routine follow-up cerebral angiography, 1 year after SAC, showed in-stent stenosis around the distal markers of the inserted stent at the left M1 proximal segment. Six months later, he developed right dysesthesia. We performed intracranial stenting with Wingspan stent for the in-stent stenosis. Follow-up digital subtraction angiography performed 1 year after the Wingspan stenting showed good patency of the ICA and middle cerebral artery flow without evidence of restenosis. At 3-year follow-up, magnetic resonance angiography showed sufficient middle cerebral artery flow although the stenting segment could not be visualized clearly. Wingspan stenting might be a feasible option in patients with iatrogenic intracranial stenosis resulting from in-stent stenosis who experience the progression of intracranial stenosis with manifestation of neurological symptoms despite dual anti-platelet therapy.

Molecular Epidemiology of Viral Conjunctivitis in the Southern Region of South Korea, 2012–2016

Epidemic keratoconjunctivitis (EKC) and acute hemorrhagic conjunctivitis (AHC) are common diseases caused by human adenoviruses (HAdV) and enteroviruses, respectively, in South Korea. However, there are limited studies on the molecular epidemiology of viral conjunctivitis in South Korea. The main objective of this study was to characterize the genotypes of adenoviruses and enteroviruses causing viral conjunctivitis in the southwest region of South Korea. We collected conjunctival swabs from 492 patients with suspected cases of viral conjunctivitis from 6 ophthalmic hospitals in Gwangju Metropolitan City, in South Korea, between 2012 and 2016. Of the 492 samples tested, HAdVs and enteroviruses were detected in 249 samples (50.6%) and 19 samples (3.9%), respectively. The genotype analysis detected HAdV-8 in 183 samples (73.5%), HAdV-37 in 14 samples (5.6%), and HAdV-3, and HAdV-4 in 9 samples (3.6%) each. We detected coxsackievirus A24 (CVA24) and coxsackievirus B1 (CVB1) in 8 samples (42.0%) and 4 samples (21.0%), respectively. We also reported for the first time HAdV-56-infected cases of EKC in South Korea. Furthermore, we found three cases of coinfection with HAdV and enterovirus genotypes in our samples. HAdV-8 and CVA24, the main causes of EKC and AHC, respectively, worldwide, were also found to be the predominant genotypes in our study.

Anterior Cervical Discectomy and Fusion Alters Whole-Spine Sagittal Alignment

PURPOSE: Anterior cervical discectomy and fusion (ACDF) has become a common spine procedure, however, there have been no previous studies on whole spine alignment changes after cervical fusion. Our purpose in this study was to determine whole spine sagittal alignment and pelvic alignment changes after ACDF. MATERIALS AND METHODS: Forty-eight patients who had undergone ACDF from January 2011 to December 2012 were enrolled in this study. Cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis (SVA), and pelvic parameters were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores and Neck Disability Index (NDI) values. RESULTS: Forty-eight patients were grouped according to operative method (cage only, cage & plate), operative level (upper level: C3/4 & C4/5; lower level: C5/6 & C6/7), and cervical lordosis (high lordosis, low lordosis). All patients experienced significant improvements in VAS scores and NDI values after surgery. Among the radiologic parameters, pelvic tilt increased and sacral slope decreased at 12 months postoperatively. Only the high cervical lordosis group showed significantly-decreased cervical lordosis and a shortened SVA postoperatively. Correlation tests revealed that cervical lordosis was significantly correlated with SVA and that SVA was significantly correlated with pelvic tilt and sacral slope. CONCLUSION: ACDF affects whole spine sagittal alignment, especially in patients with high cervical lordosis. In these patients, alteration of cervical lordosis to a normal angle shortened the SVA and resulted in reciprocal changes in pelvic tilt and sacral slope.

Phytochemical Constituents from the Aerial Part of Ducrosia ismaelis Asch

Phytochemical investigation of the aerial components of Ducrosia ismaelis Asch. led to the isolation of six known compounds, psoralen (1), isopsoralen (2), cnidioside A (3), (-)-syringaresinol-O-beta-D-glucopyranoside (4), (E)-plicatin B (5), trilinolein (6). The chemical structures of these compounds were elucidated from spectroscopic data and by comparison of these data with previously published results. The antioxidant, anti-osteoporotic and cardiovascular related activities of the isolated compounds were assessed using oxygen radical absorbance capacity (ORAC), reducing capacity, tartrate-resistant acid phosphatase (TRAP), and soluble epoxide hydrolase (sEH) inhibitory activity assays. Compounds (3-5) showed potent peroxyl radical-scavenging capacities with ORAC values of 11.06 +/- 0.39, 7.98 +/- 0.10, and 13.99 +/- 0.06 Trolox equivalent (TE) at concentrations of 10 microM, respectively. Only compounds 4 and 5 was able to significantly reduce Cu2+ ions, with a reduction value of 9.06 +/- 0.32 and 4.61 +/- 0.00 microM Trolox Equivalent (TE) at a concentration of 10 microM. Compound 5 at 10 microM exhibited a potent inhibitory effect on osteoclastic TRAP activity with a TRAP value of 86.05 +/- 6.55% of the control. Compounds 1, 3 and 5 potently inhibited sEH activity with IC50 values of 41.6 4.9, 16.0 1.1, and 49.0 5.7 microM, respectively.

Isolation and Structure Determination of an Imidazo-pyrimidine, 5-Chlorocavernicolin, Maleimide oximes and Nucleosides from a Marine Sponge Extract

In a continuation of our studies to discover bioactive secondary metabolites from marine sources, we further investigated samples from a tryptamine and phenyl-alkane producing sponge, which resulted in the isolation of four uncommon small molecules and five nucleosides. Their structures were determined to be 7,8-dihydroimidazo[1,5-c]pyrimidin-5(6H)-one (1), 5-chlorocavernicolin (2), maleimide-5-oxime (3), 3-methylmaleimide-5-oxime (4), uridine (5), 2'-deoxyuridine (6), thymidine (7), adenine (8), and adenosine (9) by spectroscopic analyses. The isolated compounds were evaluated for inhibitory activity against soluble epoxide hydrolase (sEH) as well as the Wnt/beta-catenine signaling pathway.

Solitary Fibrous Tumor of Central Nervous System: A Case Report

Solitary fibrous tumor (SFT) is a rare neoplasm of mesenchymal origin, especially in the central nervous system (CNS). Reported herein is a case of SFT of CNS in a 63-year-old female patient who had confused mentality, without other neurological deficit. The brain MRI showed an ovoid mass in the right frontal lobe. The tumor was surgically removed grossly and totally, and the pathologic diagnosis was SFT. At 55 months after the surgery, the tumor recurred at the primary site and at an adjacent area. A second operation was thus done, and the tumor was again surgically removed grossly and totally. The pathologic diagnosis was the same as the previous, but the Ki-67 index was elevated. Ten months later, two small recurring tumors in the right frontal skull base were found in the follow-up MRI. It was decided that radiation therapy be done, and MRI was done again 3 months later. In the follow-up MRI, the size of the recurring mass was found to have decreased, and the patient did not manifest any significant symptom. Follow-up will again be done 18 months after the second surgery.

Atypical Noncontiguous Multiple Spinal Tuberculosis: A Case Report

OBJECTIVE: Spinal tuberculosis-associated symptoms are not so unique as to immediately indicate the proper diagnosis in most cases. Distinguishing spinal tuberculosis (Pott's disease) from pyogenic spondylitis is often difficult, and lesions metastatic from systemic malignancy are the other major entity from which spinal tuberculosis must be distinguished. CLINICAL PRESENTATION: A 27-year-old male patient presented with a history of back pain after a minor trauma 1 month ago. Computed tomography and magnetic resonance imaging of the thoracic spine showed multiple osteolytic bone lesions at the bodies of T9, T10 and T11 vertebrae and the spinous processes of T12 and L1. Other noncontiguous osteolytic lesions were noted at S2 body and right sacro-iliac joint. INTERVENTION: To confirm the pathologic diagnosis, the patient underwent an open biopsy for the T12 and L1 spinous process lesions and a percutaneous transpedicular biopsy on T9, T10, T11 lesions. Frozen biopsy was reported as compatible with chronic granulomatous caseating necrosis without malignant cells. The final diagnosis was an atypical presentation of multiple spinal tuberculosis. The patient received an appropriate enteral anti-tuberculosis therapy and recovered without any complications. Follow-up MRI taken after a year of medical treatment revealed marked resolution of the lesions. CONCLUSION: Current research indicates the incidence of multi-level noncontiguous, remote vertebral tuberculosis is 1.1% to 16%. Because tuberculous spondylitis could represent variant and atypical pattern, the disease should be considered in differential diagnosis along with other diseases such as metastatic neoplasm, pyogenic spondylitis, especially when the radiologic studies are revealing multiple spinal lesions.

The Influence of the Vertical Location of VDT Screen on the Ocular Dryness

The fatigue of eye is much caused by eye dryness during VDT work. We performed this study to find out whether eye dryness is reduced wit the computer screen which is placed lower than primary gaze during VDT work. Forty people without eye disease were selected. One VDT screen was placed 5degreesabove the primary gaze(5degreesup screen) and the other 25degreesbelow the primary gaze(25degreesdown screen). We measured the frequency of blinking and vertical palpebral fissure height, at rest and while they enjoyed an interesting computer game for 20 minutes. Tear film break-up time(BUT) was also measured at rest, during and immediately after computer game. At rest, the average frequency of blinking was 22.35+/-6.28/min and BUT was 10.20+/-2.63 seconds. During VDT work with 5degreesup screen, the measurements were significantly decreased to 7.48+/-3.43/min and 5.38+/-1.43/min, respectively. These, however, were improved with 25degreesdown screen showing 10.05+/-4.59/min and 7.00+/-1.55 second(p>0.01). The average vertical palpebral fissure height was 6.49+/-1.07mm at rest, and 9.49+/-1.26mm with 5degreesup screen. With 25degreesdown screen, this was 7.69+/-1.01mm and narrower than the measurement with 5degreesup screen(p>0.01). This study reveals that the visual fatigue from the ocular dryness will be improved with the computer screen placed 25degreeslower than primary gaze and laid adeqately back like in reading position.

Dissociated Vertical Deviation after Correction of Infantile Esotropia

Dissociated vrtical deviation(DVD) is frequently associated with infantile esotropia. It is hard to find DVD before surgery for esodeviation, and usually found after surgery. We studied the occurrence of DVD in 176 patients who had had horizontal rectus muscle surgery for the correction of infantile esotropia and followed up for 6 months or more. DVD was seen in 78 patients(44.3%), preoperatively in 27 patients(34.6%) and postoperatively in 51 patients(65.4%). Among 51 patients with DVD after surgery, DVD occurred in 24.0% of patients with preoperative angle of esodeviation less than 50 PD and in 44.6% of patients with preoperative angle of esodeviation more than 51 PD(P0.05). Inferior oblique overaction(IOOA) was accompanied with DVD in 71.8% and occurred without DVD in 28.6%. This study revealed postoperative DVD developed more in large angle esotropia such as deviation angle greater than 51 PD, and IOOA was frequently accompanied. The result suggests that in large angle infantile esotropia with mild IOOA and DVD or fundus extorsion we may need the preventive correction of DVD and IOOA.

Success Rate of Silicone Tube Intubation

It has been Known that silicone intubation may be an effective procedure for total or partial obstruction in infants of age one year or less, and the older the patient, the lower the success rate. We had performed silicone intubation on 40 eyes of 39 patients from january 1995 to May 1996, and they were divided into 3 groups according to age: group 1, 6 months to 6 years: group 2,6 to 16.: group 3, one 16 years. The success rate was 92.4% in groups 1 and 2, respectively: 83.3% ingroup 3. The success rate in patients with partial obstruction in group 3 was 100% In view of the results of the present study, silicone intubation may be in primary procedure for partial obstruction of lacrimal drainage system.