Improved Diagnostic Accuracy of Alzheimer's Disease by Combining Regional Cortical Thickness and Default Mode Network Functional Connectivity: Validated in the Alzheimer's Disease Neuroimaging Initiative Set

OBJECTIVE: To identify potential imaging biomarkers of Alzheimer's disease by combining brain cortical thickness (CThk) and functional connectivity and to validate this model's diagnostic accuracy in a validation set. MATERIALS AND METHODS: Data from 98 subjects was retrospectively reviewed, including a study set (n = 63) and a validation set from the Alzheimer's Disease Neuroimaging Initiative (n = 35). From each subject, data for CThk and functional connectivity of the default mode network was extracted from structural T1-weighted and resting-state functional magnetic resonance imaging. Cortical regions with significant differences between patients and healthy controls in the correlation of CThk and functional connectivity were identified in the study set. The diagnostic accuracy of functional connectivity measures combined with CThk in the identified regions was evaluated against that in the medial temporal lobes using the validation set and application of a support vector machine. RESULTS: Group-wise differences in the correlation of CThk and default mode network functional connectivity were identified in the superior temporal (p < 0.001) and supramarginal gyrus (p = 0.007) of the left cerebral hemisphere. Default mode network functional connectivity combined with the CThk of those two regions were more accurate than that combined with the CThk of both medial temporal lobes (91.7% vs. 75%). CONCLUSION: Combining functional information with CThk of the superior temporal and supramarginal gyri in the left cerebral hemisphere improves diagnostic accuracy, making it a potential imaging biomarker for Alzheimer's disease.

Acute Fascial Space Abscess upon Dental Implantation to Patients with Diabetes Mellitus

As popularity of dental implantation is increasing, the number of cases associated with complications also increase. Evaluation on diabetes mellitus is often neglected due to the disease's irrelevance to implantability. However, patients with diabetes mellitus are susceptible to infection due to impaired bactericidal ability of neutrophils, cellular immunity and activity of complements. Due to this established connection between diabetes mellitus and infection, a couple of cases were selected to present patients with diabetes mellitus with glycemic incontrollability, suffering from post-implantation dentigerous inter-fascial space abscess.

Impact of Delirium on Clinical Outcomes in Intensive Care Unit Patients: An Observational Study in a Korean General Hospital / 신경정신의학

OBJECTIVES: The purpose of this study is to evaluate the impact of delirium on clinical outcomes in intensive care unit (ICU) patients in a Korean general hospital. METHODS: All patients admitted to ICU from March 1, 2013 to October 31, 2013 were assessed by Confusion Assessment Method adapted for use in the ICU for delirium daily, and consistently comatose patients were excluded for analysis. Differences in clinical outcomes (mortality, length of hospital stay, length of ICU stay) were analyzed between delirious patients and non-delirious patients. Subsequently, the impact of delirium on clinical outcomes was analyzed with adjusting for covariates including surgery, age, emergent admission, presence of surgery, and severity of illness. RESULTS: The analysis included 129 delirious patients and 469 non-delirious patients. As primary outcome, mortality, length of stay (hospital day, ICU-stay) were significantly high in the delirious group. The association remained the same after adjusting for the covariates. CONCLUSION: The results correspond with those of previous research studies conducted in foreign ICU. Based on this observation that delirium also has an impact on clinical outcomes in Korean ICU, integrative and in-depth investigation on ICU delirium will be needed.

Levodopa-induced Thrombocytopenia

Drug-induced thrombocytopenia can be caused by various medications and should be suspected in any patients with newly developed thrombocytopenia. We report a patient with severe thrombocytopenia induced by L-dopa. This is the first case report on L-dopa-induced thrombocytopenia in Korea.

A Case of Isolated Cerebellar Nodulus Infarction with Periodic Alternating Nystagmus and Unilateral Vestibulopathy

We report a patient with an isolated cerebellar nodulus infarction who presented with periodic alternating nystagmus (PAN), perverted head-shaking nystagmus (pHSN), and loss of tilt suppression of the vestibulo-ocular reflex (VOR). Several days after the initial symptoms resolved, the patient also presented with purely vestibular syndrome with vertigo, spontaneous horizontal nystagmus without the usual signs of cerebellar dysfunction. The chain of those symptoms were ascribed to ischemia of the cerebellar nodulus.