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The sustained growth of digital healthcare in the field of neurology relies on portable and cost-effective brain monitoring tools that can accurately monitor brain function in real time. Functional near-infrared spectroscopy (fNIRS) is one such tool that has become popular among researchers and clinicians as a practical alternative to functional magnetic resonance imaging, and as a complementary tool to modalities such as electroencephalography. This review covers the contribution of fNIRS to the personalized goals of digital healthcare in neurology by identifying two major trends that drive current fNIRS research. The first major trend is multimodal monitoring using fNIRS, which allows clinicians to access more data that will help them to understand the interconnection between the cerebral hemodynamics and other physiological phenomena in patients. This allows clinicians to make an overall assessment of physical health to obtain a more-detailed and individualized diagnosis. The second major trend is that fNIRS research is being conducted with naturalistic experimental paradigms that involve multisensory stimulation in familiar settings. Cerebral monitoring of multisensory stimulation during dynamic activities or within virtual reality helps to understand the complex brain activities that occur in everyday life. Finally, the scope of future fNIRS studies is discussed to facilitate more-accurate assessments of brain activation and the wider clinical acceptance of fNIRS as a medical device for digital healthcare.
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Purpose@#Transient tachypnea of the newborn (TTN) is the most prevalent respiratory disease worldwide. Many neonates with TTN generally demonstrate spontaneous improvement. However, only few patients present with severe complications. This study aimed to investigate the differences in clinical features to identify neonates at risk for further complications. @*Methods@#Between January 2015 and December 2020, 267 neonates who developed dyspnea within 6 h of birth were delivered at a gestational age of at least 37 weeks. The experimental group (group E) included 44 neonates who required invasive mechanical ventilation, whereas the control group (group C) included 223 neonates who required only observation or non-invasive respiratory support. We analyzed the differences in clinical and perinatal factors between the two groups. @*Results@#Gestational age and pH on arterial blood gas analysis at admission were significantly lower in group E (p90 breaths/min), and pneumothorax, were more frequently observed in group E (p90 breaths/min), and need for respiratory assistance (fraction of inspired oxygen concentration ≥0.25) are predictive factors for increased risk of progression to a more severe disease course in neonates with TTN. Additional studies are needed to identify definitive factors that can differentiate TTN that improves spontaneously from TTN that requires intensive care.
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Background and Objectives@#Aortic valve replacement (AVR) is considered a class I indication for symptomatic severe aortic stenosis (AS). However, there is little evidence regarding the potential benefits of early AVR in symptomatic patients diagnosed with normal-flow, low-gradient (NFLG) severe AS. @*Methods@#Two-hundred eighty-one patients diagnosed with symptomatic NFLG severe AS (stroke volume index ≥35 mL/m 2 , mean transaortic pressure gradient <40 mmHg, peak transaortic velocity <4 m/s, and aortic valve area <1.0 cm 2 ) between January 2010 and December 2020 were included in this retrospective study. After performing 1:1 propensity score matching, 121 patients aged 75.1±9.8 years (including 63 women) who underwent early AVR within 3 months after index echocardiography, were compared with 121 patients who received conservative care. The primary outcome was a composite of all-cause death and heart failure (HF) hospitalization. @*Results@#During a median follow-up of 21.9 months, 48 primary outcomes (18 in the early AVR group and 30 in the conservative care group) occurred. The early AVR group demonstrated a significantly lower incidence of primary outcomes (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.29–0.93; p=0.028); specifically, there was no significant difference in all-cause death (HR, 0.51; 95% CI, 0.23–1.16; p=0.110), although the early AVR group showed a significantly lower incidence of hospitalization for HF (HR, 0.43; 95% CI, 0.19–0.95, p=0.037). Subgroup analyses supported the main findings. @*Conclusions@#An early AVR strategy may be beneficial in reducing the risk of a composite outcome of death or hospitalization for HF in symptomatic patients with NFLG severe AS.Future randomized studies are required to validate and confirm our findings.
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Purpose@#In Lisfranc joint injury, the traditional treatment has been open reduction and internal fixation with a transarticular screw. Despite this, additional complications, such as damage to the articular surface and breakage of the screw, have been reported. Therefore, this study compared the clinical and radiological outcomes of dorsal bridge plating with those of transarticular screws and combination treatment in Lisfranc joint injury. @*Materials and Methods@#Among the 43 patients who underwent surgical treatment due to Lisfranc joint injury from June 2015 to March 2021, 40 cases followed for more than six months after surgery were analyzed, excluding three patients: one lost to follow-up, one had to amputate, and one expired. The radiological parameters were measured using the Wilppula classification in the last follow-up. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score. @*Results@#The AOFAS midfoot score, according to the surgical method, was significantly higher in the dorsal bridge plating (p=0.003). The radiological outcomes showed significantly better anatomical reduction when dorsal bridge plating was used (p=0.040). According to the Wilppula classification, the AOFAS midfoot score improved as the quality of anatomical reduction improved (p=0.018). Finally, the AOFAS midfoot score decreased as the number of column fixations increased (p=0.002). There were two complications: screw breakage in dorsal bridge plating and superficial skin necrosis in the combination treatment. Skin defects caused by necrosis improved after negative pressure wound therapy and split-thickness skin graft. @*Conclusion@#In treating Lisfranc joint injuries, open reduction and internal fixation by dorsal bridge plating can be an appropriate treatment option. Nevertheless, studies, such as long-term follow-up research, on complications, such as osteoarthritis, will be needed.
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Objective@#Depression in Parkinson’s disease (PD) affects the quality of life of patients. Postural instability and gait disturbance are associated with the severity and prognosis of PD. We investigated the association of depression with axial involvement in early-stage PD patients. @*Methods@#This study involved 95 PD patients unexposed to antiparkinsonian drugs. After a baseline assessment for depression, the subjects were divided into a depressed PD group and a nondepressed PD group. Analyses were conducted to identify an association of depression at baseline with the following outcome variables: the progression to Hoehn and Yahr scale (H-Y) stage 3, the occurrence of freezing of gait (FOG), levodopa-induced dyskinesia, and wearing-off. The follow-up period was 53.40 ± 16.79 months from baseline. @*Results@#Kaplan–Meier survival curves for H-Y stage 3 and FOG showed more prominent progression to H-Y stage 3 and occurrences of FOG in the depressed PD group than in the nondepressed PD group (log-rank p = 0.025 and 0.003, respectively). Depression in drug-naïve, early-stage PD patients showed a significant association with the progression to H-Y stage 3 (hazard ratio = 2.55; 95% confidence interval = 1.32–4.93; p = 0.005), as analyzed by Cox regression analyses. In contrast, the occurrence of levodopa-induced dyskinesia and wearing-off did not differ between the two groups (log-rank p = 0.903 and 0.351, respectively). @*Conclusion@#Depression in drug-naïve, early-stage PD patients is associated with an earlier occurrence of postural instability. This suggests shared nondopaminergic pathogenic mechanisms and potentially enables the prediction of early development of postural instability.
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Objective@#Associations between various metabolic conditions and Parkinson’s disease (PD) have been previously identified in epidemiological studies. We aimed to investigate the causal effect of lipid levels, type 2 diabetes mellitus (T2DM), and body mass index (BMI) on PD in a Korean population via Mendelian randomization (MR). @*Methods@#Two-sample MR analyses were performed with inverse-variance weighted (IVW), weighted median, and MR-Egger regression approaches. We identified genetic variants associated with lipid concentrations, T2DM, and BMI in publicly available summary statistics, which were either collected from genome-wide association studies (GWASs) or from meta-analyses of GWAS that targeted only Korean individuals or East Asian individuals, including Korean individuals. The outcome dataset was a GWAS on PD performed in a Korean population. @*Results@#From previous GWASs and meta-analyses, we selected single nucleotide polymorphisms as the instrumental variables. Variants associated with serum levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides, as well as with T2DM and BMI, were selected (n = 11, 19, 17, 89, and 9, respectively). There were no statistically significant causal associations observed between the five exposures and PD using either the IVW, weighted median, or MR-Egger methods (p-values of the IVW method: 0.332, 0.610, 0.634, 0.275, and 0.860, respectively). @*Conclusion@#This study does not support a clinically relevant causal effect of lipid levels, T2DM, and BMI on PD risk in a Korean population.
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The development of medical and device treatment of heart failure (HF) has improved the survival and quality of life in HF patients. However, not all HF patients respond well to these up-to-date HF treatments. We have termed these non-responders as advanced HF patients. The definition, diagnosis, and treatment of advanced HF are discussed in this review article.Current Concepts: After current guideline-directed treatments, advanced HF patients can experience aggravation and decompensation, usually resulting in hospitalization for the symptoms and volume control. Recurrent decompensation or hospitalization can cause a vicious cycle between the heart and other vital organs, such as the kidney and liver. Current and up-to-date guidelines recommend treatments, including heart transplant, left ventricular assist device (LVAD), and hospice care, for advanced HF. Given the limitation of heart transplant donors, LVAD can be used as a bridge to transplant, in addition to destination therapy. Updated LVAD system can reduce pump-related thrombosis, stroke, and bleeding.Discussion and Conclusion: Current guidelines suggest early recognition of advanced HF and referral to advanced HF specialists. Despite advances in the treatments of advanced HF, unmet needs for further improving clinical outcomes and quality of life exist.
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BACKGROUND/OBJECTIVES@#Benign prostatic hyperplasia (BPH) is the most common prostate disease and one of the most common chronic diseases caused by aging in men. On the other hand, there has been no research on BPH using Abeliophyllum distichum Nakai (A.distichum). Therefore, this study investigated the effects of A. distichum on BPH.MATERIALS/METHODS: A. distichum leaves were extracted with distilled water, 70% ethanol, and 95% hexane as solvents. Subsequently, the inhibitory effects of each A. distichum extract on androgen receptor (AR) signaling were evaluated in vitro. The testosterone-induced BPH model was then used to confirm the efficacy of A. distichum leaves in 70% ethanol extract (ADLE). @*RESULTS@#ADLE had the strongest inhibitory effect on AR signaling. A comparison of the activity of ADLE by harvest time showed that the leaves of A. distichum harvested in autumn had a superior inhibitory effect on AR signaling to those harvested at other times. In the BPH rat model, the administration of ADLE reduced the prostate size and prostate epithelial cell thickness significantly and inhibited AR signaling. Subsequently, the administration of ADLE also reduced the expression of growth factors, thereby inactivating the PI3K/AKT pathway. @*CONCLUSIONS@#An analysis of the efficacy of ADLE to relieve BPH showed that the ethanol extract grown in autumn exhibited the highest inhibitory ability of the androgen-signaling related factors in vitro. ADLE also inhibited the expression of growth factors by inhibiting the expression of the androgen-signaling related factors in vivo. Overall, ADLE is proposed as a functional food that is effective in preventing BPH.
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Objectives@#The aim of this study was to develop policy tasks and approaches for the integration of oral health care systems in South and North Korea on the basis of a literature research, and to verify their validity through a Delphi survey of an expert panel. @*Methods@#Twelve policy tasks and 11 approaches for South-North Korea integration were developed by a comparative model of oral health care systems. Two rounds of Delphi surveys were conducted via e-mail on May 20 and June 16, 2020, targeting 10 experts with experience in inter-Korean oral health care exchange and cooperation or related research. The mean, coefficient of variation (CV), and content validity ration (CVR) were calculated for each item. The validity of each item was judged based on the CVR. @*Results@#The five policy tasks that meet the consensus of experts are: the integration of dental college education, the integration of activity qualifications and supply/demand for general dentists, the integration of education and training for auxiliary dental personnel, the integration of activity qualifications and supply/demand for auxiliary dental personnel, and the integration of oral health care financing. The nine approaches of the consensus of experts are: sharing the philosophy, values, and strategies, guaranteeing geographic access for residents, standardized oral health care delivery, an integrated performance management system, an integrated computerized information system, an integrated governance structure, the installation and operation of an integrated organization, the re-education and re-qualification of active oral health care personnel, and integrated goals for oral health outcomes. @*Conclusions@#The expert panel showed a relatively high degree of agreement with policy tasks and approaches for the integration of the South-North Korea oral health care systems. It is necessary to develop more realistic contents based on more reliable North Korean data in the future.
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Background@#Colorectal cancer is one of the most common cancers worldwide. Colorectal cancer that has recurred and metastasized to other organs also has a very poor prognosis. According to recent studies, the long interspersed element-1 (LINE-1) retrotransposon open reading frame (ORF) is located in the intron of the c-Met proto-oncogene, which is involved in cancer progression and metastasis, and regulates its expression. However, no study has compared the expression patterns of LINE-1 ORF1 and c-Met, which are closely related to cancer progression and metastasis, and their correlation in primary and recurrent cancers. @*Methods@#In the present study, we compared the expression patterns of LINE-1 ORF1 and c-Met in both primary and recurrent colorectal cancer tissues from 10 patients. Expression patterns and correlations between LINE-1 ORF1 and c-Met proto-oncogene proteins were analyzed by immunofluorescence staining using both LINE-1 ORF1 and c-Met antibodies. @*Results@#The expression patterns of LINE-1 ORF1 and c-Met showed significant individual differences, and the expression of both proteins was correlated in all colorectal cancer patients. However, the expression levels of LINE-1 ORF1 and c-Met were not significantly different between primary and recurrent colorectal cancers. @*Conclusions@#The protein expression levels of LINE-1 ORF1 and c-Met were correlated, but did not change significantly in cases of recurrent colorectal cancer in the same patient.
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Purpose@#This study sought to compare clinical outcomes between transcatheter aortic valve replacement (TAVR) and sutureless aortic valve replacement (SU-AVR). @*Materials and Methods@#In total, 320 patients with symptomatic severe aortic stenosis who underwent TAVR (n=254) or SU-AVR (n=66) at Severance Cardiovascular Hospital between July 2011 and September 2019 were included for analysis. Propensity score matching and inverse probability weighted adjustment were performed to adjust for confounding baseline characteristics. Outcomes defined by the Valve Academic Research Consortium-2 in 62 patients pairs were compared. @*Results@#Device success (79.0% vs. 79.0%, p>0.999) and 30-day mortality (4.8% vs. 0.0%, p=0.244) did not differ between the TAVR and SU-AVR groups. The TAVR group developed more frequent mild or moderate paravalvular leakage (59.7% vs. 8.1%, p<0.001), whereas SU-AVR was associated with higher rates of major or life-threatening bleeding (9.7% vs. 22.6%, p=0.040), acute kidney injury (8.1% vs. 21.0%, p=0.041), and new-onset atrial fibrillation (4.8% vs. 32.3%. p<0.001) at 30 days, along with longer stays in the intensive care unit (ICU) (1.9±1.6 days vs. 5.9±9.2 days, p=0.009) and hospital (7.1±7.9 days vs. 13.1±8.8 days, p<0.001). The TAVR group showed a trend towards a higher 1-year all-cause mortality, compared with the SU-AVR group (7.0% vs 1.7%, p=0.149). Cardiovascular mortality, however, did not differ significantly (1.6% vs 1.7%, p=0.960). @*Conclusion@#TAVR achieved a similar 1-year survival rate free from cardiovascular mortality as SU-AVR and was associated with a lower incidence of complications, except for paravalvular leakage, and shorter stays in the ICU and hospital.
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Results from cardiovascular outcome trials (CVOT) with 5 different sodium-glucose cotransporter 2 inhibitors (SGLT2i; empagliflozin, canagliflozin, dapagliflozin, ertugliflozin, sotagliflozin), initially developed for their glucose-lowering effect by blocking tubular glucose reabsorption in kidney, have been shown to decrease the risk of heart failure hospitalization (HFH) across a range of patients with and without atherosclerotic cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). Following these CVOT results, SGLT2i (dapagliflozin, empagliflozin, sotagliflozin) also were reported to reduce HFH and cardiovascular death in patients with heart failure with reduced ejection fraction (HFrEF), regardless of existence or absence of T2DM. Ongoing studies have been conducted to evaluate the clinical benefit of SGLT2i (empagliflozin, dapagliflozin) in patients with heart failure with preserved ejection fraction (HFpEF). Although SGLT2i brought us to the entrance of a new era for prevention of HF incidence and worsening of HF, the search for pivotal mechanism of SGLT2i to improve our pharmacological armamentarium should continue in order to protect every HF patient from fatal progression of HF disease. In this review, we summarized the updated clinical evidences on SGLT2i (rather than basic and translational evidence) for reduction of HF risk in T2DM patients and favorable clinical outcomes in both HFrEF and HFpEF patients.
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Purpose@#This study sought to compare clinical outcomes between transcatheter aortic valve replacement (TAVR) and sutureless aortic valve replacement (SU-AVR). @*Materials and Methods@#In total, 320 patients with symptomatic severe aortic stenosis who underwent TAVR (n=254) or SU-AVR (n=66) at Severance Cardiovascular Hospital between July 2011 and September 2019 were included for analysis. Propensity score matching and inverse probability weighted adjustment were performed to adjust for confounding baseline characteristics. Outcomes defined by the Valve Academic Research Consortium-2 in 62 patients pairs were compared. @*Results@#Device success (79.0% vs. 79.0%, p>0.999) and 30-day mortality (4.8% vs. 0.0%, p=0.244) did not differ between the TAVR and SU-AVR groups. The TAVR group developed more frequent mild or moderate paravalvular leakage (59.7% vs. 8.1%, p<0.001), whereas SU-AVR was associated with higher rates of major or life-threatening bleeding (9.7% vs. 22.6%, p=0.040), acute kidney injury (8.1% vs. 21.0%, p=0.041), and new-onset atrial fibrillation (4.8% vs. 32.3%. p<0.001) at 30 days, along with longer stays in the intensive care unit (ICU) (1.9±1.6 days vs. 5.9±9.2 days, p=0.009) and hospital (7.1±7.9 days vs. 13.1±8.8 days, p<0.001). The TAVR group showed a trend towards a higher 1-year all-cause mortality, compared with the SU-AVR group (7.0% vs 1.7%, p=0.149). Cardiovascular mortality, however, did not differ significantly (1.6% vs 1.7%, p=0.960). @*Conclusion@#TAVR achieved a similar 1-year survival rate free from cardiovascular mortality as SU-AVR and was associated with a lower incidence of complications, except for paravalvular leakage, and shorter stays in the ICU and hospital.
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Results from cardiovascular outcome trials (CVOT) with 5 different sodium-glucose cotransporter 2 inhibitors (SGLT2i; empagliflozin, canagliflozin, dapagliflozin, ertugliflozin, sotagliflozin), initially developed for their glucose-lowering effect by blocking tubular glucose reabsorption in kidney, have been shown to decrease the risk of heart failure hospitalization (HFH) across a range of patients with and without atherosclerotic cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). Following these CVOT results, SGLT2i (dapagliflozin, empagliflozin, sotagliflozin) also were reported to reduce HFH and cardiovascular death in patients with heart failure with reduced ejection fraction (HFrEF), regardless of existence or absence of T2DM. Ongoing studies have been conducted to evaluate the clinical benefit of SGLT2i (empagliflozin, dapagliflozin) in patients with heart failure with preserved ejection fraction (HFpEF). Although SGLT2i brought us to the entrance of a new era for prevention of HF incidence and worsening of HF, the search for pivotal mechanism of SGLT2i to improve our pharmacological armamentarium should continue in order to protect every HF patient from fatal progression of HF disease. In this review, we summarized the updated clinical evidences on SGLT2i (rather than basic and translational evidence) for reduction of HF risk in T2DM patients and favorable clinical outcomes in both HFrEF and HFpEF patients.
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Purpose@#We report a case of iatrogenic Horner’s syndrome developing after robot-assisted transaxillary total thyroidectomy.Case summary: A 31-year-old female with right-eye ptosis was referred to our clinic. Three weeks prior, she had undergone robot-assisted total thyroidectomy via the right transaxillary approach to treat right-side thyroid cancer. On ocular examination, the palpebral fissure widths were 5.0 mm in the right lid and 8.0 mm in the left lid, the marginal reflex distances 1, 1.0 mm in the right lid and 4.0 mm in the left lid, and the levator muscle function of both eyes normal. In a dark room, the pupil diameter was 2.5 mm in the right eye and 4.0 mm in the left eye. She did not complain of facial anhidrosis. Thirty minutes after instillation of 0.5% (w/v) apraclonidine into the right eye, the right palpebral fissure width increased from 5.0 to 8.0 mm, and the pupil size from 2.5 to 4.0 mm in the dark. @*Conclusions@#Horner’s syndrome can develop after robot-assisted transaxillary total thyroidectomy; patients should be counselled in this regard.
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Purpose@#We evaluated a new color vision test, thus the ColorDx Cone contrast test HD ([CCT-HD]; Konan Medical, Inc., Irvine, CA, USA) in normal and color vision-deficient (CVD) eyes of Koreans. @*Methods@#The CCT-HD was performed on 66 healthy Koreans (125 normal eyes) and 25 patients (50 eyes) with congenital CVD. The results from normal eyes were compared and analyzed in terms of binocular agreement, patient ages, and spherical equivalents. The CCT-HD results on CVD eyes were compared and analyzed. @*Results@#We found no significant difference in any of the long (L), medium (M), or short wavelength (S) cone cell sensitivity (L-CCT, M-CCT, S-CCT) scores for normal eyes; also, there was no significant effect of age and no significant correlation between the spherical equivalent and the CCT score. In normal eyes, all scores were >75 (normal ≥75). The average protan L-CCT score was significantly reduced (13.0 ± 13.2; p < 0.001) as was the average deutan M-CCT score (31.7 ± 16.6; p < 0.001). The CCT-HD L-CCT and M-CCT exhibited 100% sensitivity and specificity in terms of diagnosing protans and deutans respectively. @*Conclusions@#CCT-HD allows classification and quantitative evaluation of protans and deutans, and is thus useful when examining color vision status.
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Purpose@#The aim of this study is to evaluate the feasibility and safety of intracorporeal anastomosis in laparoscopic colectomy for benign and malignant tumor diseases in actual clinical settings. @*Methods@#From January 2016 to June 2021, a total of 114 cases were selected for laparoscopic colectomy for benign or malignant tumor diseases. Seventeen cases that underwent simultaneous combined laparoscopic procedures were excluded from the study. The remaining patients were separated into 48 cases in the intracorporeal group and 49 cases in the extracorporeal group. Medical records were reviewed retrospec tively. @*Results@#Patients in the intracorporeal group were older than those in the extracorporeal group (62.6 years vs. 54.9 years, p = 0.001). Body mass index, American Society of Anestheologists physical status classifica tion, comorbidity, smoking, and laparotomy history did not differ significantly between groups. Surgeries for malignancy were performed in 35 (72.9%) and 32 cases (65.3%) in the respective intracorporeal and extracorporeal groups. Right hemicolectomy was performed in 39 (81.3%) and 45 cases (91.8%) in the intracorporeal and extracorporeal groups, respectively, and postoperative hospital stays were 9.8 and 8.9 days (p = 0.081). Operation time (216.9 minutes vs. 203.5 minutes, p = 0.212) and intraoperative blood loss (72.7 mL vs. 75.7 mL, p = 0.700) were not significantly different. Anastomotic leakage was observed in one case in each group. @*Conclusion@#In laparoscopic colectomy, intracorporeal anastomosis could be considered as a safe and feasible technique for benign and malignant tumor diseases.
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Purpose@#Pulmonary underdevelopment is one of the pulmonary causes of neonatal mortality, which is categorized into pulmonary agenesis, pulmonary aplasia, and pulmonary hypoplasia. Congenital diaphragmatic hernia is a well-known cause of pulmonary hypoplasia; however, further studies are needed for other etiologies. Patients with pulmonary underdevelopment show varying degrees of clinical severity. Most patients with pulmonary underdevelopment have respiratory distress at birth, while a few have only mild symptoms. Our study investigated the natural course and prognosis of pulmonary underdevelopment by analyzing multiple cases from a single tertiary medical center. @*Methods@#A retrospective review was conducted on patients diagnosed with pulmonary hypoplasia and agenesis from January 2000 to August 2019. Cases were extracted from the clinical database of Seoul National University Children’s Hospital by searching for keywords related to pulmonary underdevelopment. @*Results@#A total of 28 patients were identified. Four patients had pulmonary agenesis, and all were idiopathic. Twenty-four patients had evidence of pulmonary hypoplasia with diverse causes. The median age at diagnosis was 11.5 days (range, 1–240 days) and the mean gestational age was 35 weeks 2 days± 3 weeks 6 days. Twenty patients received ventilator care and 11 had various degrees of pulmonary hypertension. The long-term survival rate was 50%. The median age of death among pulmonary hypoplasia patients were 11 days (range, 1–730 days). All patients without ventilator care survived. The incidence of ventilator care, pneumothorax, and pulmonary hypertension were significantly higher among patients who died. @*Conclusion@#The prognosis of pulmonary underdevelopment depends on the severity of respiratory distress and pulmonary hypertension in earlier life. Patients with severe distress appear to have severe degree of pulmonary hypoplasia. Patients without ventilator support in the neonatal period survived without significant morbidities.
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Objective@#To investigate the efficacy of levodopa/carbidopa/entacapone (LCE) at bedtime for treating sleep disturbance in patients with Parkinson’s disease (PD) with motor fluctuations. @*Methods@#Participants included 128 PD patients with motor fluctuations. All patients were assessed for motor, nonmotor, and sleep-specific symptoms using the United Parkinson’s Disease Rating Scale (UPDRS), the Korean version of the Nonmotor Symptom Scale, the Parkinson’s Disease Sleep Scale (PDSS), the Epworth Sleepiness Scale, and the Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire (RBDSQ). We compared the baseline characteristics of patients with sleep disturbance (PDSS score < 120) and those without sleep disturbance (PDSS score ≥ 120). Thirty-nine patients with sleep disturbance who agreed to take LCE at bedtime completed 3-month follow-ups. We analyzed changes in the scores of motor, nonmotor, and sleep symptom scales over the 3 months. @*Results@#PD patients with sleep disturbance were at more advanced disease stages and had more severe motor, nonmotor, and sleep symptoms than those without sleep disturbance. Patients who took LCE at night showed improvements in motor (UPDRS part III, p = 0.007) and sleep symptoms (total PDSS, p < 0.001). Sleep features that benefitted from LCE included not only nocturnal motor components but also insomnia (PDSS items 2 and 3, p = 0.005 and p < 0.001) and rapid eye movement behavior disorder (PDSS item 6, p = 0.002; and RBDSQ, p < 0.001). @*Conclusion@#The use of LCE at bedtime may be a useful treatment for sleep disturbance in advanced PD patients with motor fluctuations.
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Background@#This study aims to investigate the frequency of distal femoral and popliteal arterial calcification and to evaluate the intraoperative and postoperative effects of arterial calcification in patients undergoing total knee arthroplasty using a tourniquet. @*Methods@#The records of 5,438 patients who had undergone primary total knee arthroplasty between January 2003 and January 2017 were retrospectively reviewed. We examined the preoperative radiographs of the knee from all patients for calcifications of the femoral and popliteal arteries. Vascular calcification was identified on preoperative radiographs in 223 cases. Intraoperative and postoperative complications were investigated among these patients. Postoperative complications were analyzed from the time of surgery to the last follow-up (minimum 1-year follow-up). @*Results@#Vascular calcification of the arteries around the knee was found in 223 cases (4.1%). The mean patient age was 70.6 years in the non-calcification group and 73.8 years in the calcification group (p > 0.05). The calcification group was classified into medial, intimal, or mixed subgroups according to the morphology of calcification on preoperative radiographs. The medial type included 46 cases (20.6%); intimal type, 161 cases (72.2%); and mixed type, 16 cases (2.7%). There was no statistically significant difference in demographic and surgical data among the three groups. There were intraoperative complications in two cases in the medial type group, both of which involved tourniquet failure. There was also a postoperative complication in one case in the medial type group, which involved wound dehiscence at 2 weeks postoperatively. No other postoperative complications were identified during 1-year follow-up. @*Conclusions@#Despite the presence of calcifications in the arteries around the knee, total knee arthroplasty (using a tourniquet) can be performed without serious complications.