Feasibility of Establishing a Stroke Care System through the Acute Stroke Hotline in Busan Metropolitan Area

Background@#The importance of establishing a regional stroke safety net for the treatment of acute stroke is increasingly emphasized. In this study, we analyzed effectiveness of transferring the suspected acute ischemic stroke (AIS) patients through the 1899-0215 hotline system from 119 ambulances and nearby hospitals. @*Methods@#From July 2015 to July 2022, we analyzed data from 632 suspected acute stroke patients through the hotline. Furthermore, we investigated the proportion of patients in the target population who were eligible for reperfusion therapy and compared cases transferred by 119 emergency services (EMS) with those transferred from nearby hospitals. @*Results@#Six hundred thirty-two suspected acute stroke patients were transferred to our stroke center through the 1899-0215 hotline system. The accuracy of diagnosing acute stroke among transferred patients is 81.0% for 119 EMS and 80.5% for cases transferred from nearby hospitals. Of the 200 patients transferred from hospitals, they were transferred from 47 nearby hospitals with an average transfer distance of 38.2 km and an average transfer time of 65 minutes. Among 291 patients diagnosed with AIS, The onset-to-door time was significantly shorter (p<0.01) for patients transferred by 119 EMS. The proportion of patients who received reperfusion therapy was significantly higher (p<0.01) for those transferred by 119 EMS. @*Conclusions@#The hotline service will become a useful tool for establishing a regional stroke network in the Busan area, and its effectiveness will be particularly useful for 119 EMS. Measures are needed in the Busan metropolitan region to ensure the speediness of transferring acute stroke patients between hospitals.

Anatomical study of the adductor canal: three-dimensional micro-computed tomography, histological, and immunofluorescence findings relevant to neural blockade / 대한마취과학회지

Background@#A precise anatomical understanding of the adductor canal (AC) and its neural components is essential for discerning the action mechanism of the AC block. We therefore aimed to clarify the detailed anatomy of the AC using micro-computed tomography (micro-CT), histological evaluation, and immunofluorescence (IF) assays. @*Methods@#Gross dissections of 39 thighs provided morphometric data relevant to injection landmarks. Serial sectional images of the AC were defined using micro-CT and ultrasonography. The fascial and neural structures of the AC proper were histologically evaluated using Masson’s trichrome and Verhoeff-Van Gieson staining, and double IF staining using choline acetyltransferase (ChAT) and neurofilament 200 antibodies. @*Results@#The posteromedial branch insertion of the nerve to vastus medialis (NVM) into the lateral border of the AC proper was lower (14.5 ± 2.4 cm [mean ± SD] above the base of the patella) than the origin of the proximal AC. The AC consists of a thin subsartorial fascia in the proximal region and a thick aponeurosis-like vastoadductor membrane in the distal region. In the proximal AC, the posteromedial branch of the NVM (pmNVM) consistently contained both sensory and motor fibers, and more ChAT-positive fibers were observed than in the saphenous nerve (27.5 ± 11.2 / 104 vs. 4.2 ± 2.6 / 104 [counts/µm2], P < 0.001). @*Conclusions@#Anatomical differences in fascial structures between the proximal and distal AC and a mixed neural component of the neighboring pmNVM have been visualized using micro-CT images, histological evaluation, and IF assays.

Self-reported Non-celiac Gluten Sensitivity in the Korean Population: Demographic and Clinical Characteristics

Background/Aims@#Non-celiac gluten sensitivity is characterized by intestinal and extra intestinal symptoms associated with the consumption of gluten-containing food. Since biomarkers for non-celiac gluten sensitivity are lacking, its prevalence is estimated based on self-reported symptoms. However, no data exist on self-reported non-celiac gluten sensitivity in the Korean population. Thus, we aim to investigate the prevalence of self-reported non-celiac gluten sensitivity in the Korean population and to determine its demographic and clinical characteristics. @*Methods@#This study surveyed Korean participants aged 18-80 years who visited gastroenterology outpatient clinics at 9 tertiary hospitals in South Korea from January 2016 to February 2017. They were questioned regarding symptoms related to gluten ingestion: degree of discomfort (visual analog scale score), frequency, time of symptom onset, and duration. Abdominal discomfort caused by 11 differentkinds of gluten-containing Korean food items was investigated. @*Results@#More non-celiac gluten sensitivity self-reporters were identified among those with irritable bowel syndrome (33.6%) than among controls (5.8%). Major gastrointestinal symptoms included bloating (75.0%), abdominal discomfort (71.3%), and belching (45.0%).Common extra-intestinal symptoms included fatigue (20.0%) and headache (13.7%). More than half of those who self-reported nonceliac gluten sensitivity (66.3%) developed symptoms within 1 hour of food ingestion, and symptoms were localized in the upper abdomen (37.5%) and entire abdomen (30.0%). @*Conclusion@#Our findings suggest that if there are gluten-related symptoms in irritable bowel syndrome, the possibility of accompanying non-celiacgluten sensitivity should be considered.

Hypertensive Brainstem Encephalopathy Combined with Acute Ischemic Stroke

Posterior reversible encephalopathy syndrome is a clinicoradiological syndrome characterized by a unique reversible pattern on imaging and total regression of clinical symptoms and signs. Hypertensive brainstem encephalopathy (HBE), a brainstem variant of posterior reversible encephalopathy syndrome, is rare. In addition, a concomitant occurrence of acute ischemic stroke and HBE is even more rare. We here report three patients with HBE accompanied by acute cerebral infarction detected by brain magnetic resonance imaging and the importance of initial blood pressure control.

Reversible Dementia With Rapid Recovery to Normal Cognition: A Case Report

We report the case of a 54-year-old female who was diagnosed with clinical dementia and recovered to normal cognition in only 11 days through appropriate intervention. The patient was on a complicated regimen of psychiatric medications for underlying depression and panic disorder. The patient noted increased deterioration in executive function gradual memory impairment starting in early 2020.As a result of the neuroimaging, prominent neurodegeneration and in vivo brain pathology were not observed. During outpatient clinic follow-up, severe obstructive sleep apnea (OSA) was confirmed. Based on the diagnostic results, a clinical impression was made for reversible dementia due to psychiatric drugs and OSA. During hospitalization for 10 days, the patient’s regimen of psychiatric medications with anticholinergic effects was changed, and long-acting benzodiazepines were reduced. The patient also underwent continuous positive airway pressure titration to ameliorate OSA. The patient reported subjective cognitive improvement and a comprehensive neuropsychiatric test performed at discharge later showed a normal range in all cognitive domains, and the patient's activity of daily living evaluated at the outpatient clinic after discharge had recovered.

Dieckol isolated from Eisenia bicyclis extract suppresses RANKL-induced osteoclastogenesis in murine RAW 264.7 cells

Objective: To demonstrate the effect of dieckol from Eisenia bicyclis on osteoclastogenesis using RAW 264.7 cells. Methods: Murine macrophage RAW 264.7 cells were subjected to dieckol treatment, followed by treatment with receptor activator of nuclear factor kappa-B ligand (RANKL) to induce osteoclastogenesis. Tartrate-resistant acid phosphatase (TRAP) activity was examined using a TRAP activity kit. Western blotting analysis was conducted to examine the level of osteoclast- related factors, including TRAP and calcitonin receptor (CTR), transcriptional factors, including c-Fos, c-Jun, and nuclear factor of activated T cells cytoplasmic 1 (NFATc1), nuclear factor kappa-B (NF-κB), extracellular signal-regulated kinase (ERK), and c-Jun N-terminal kinase (JNK). Immunofluorescence staining was conducted to examine the expression of c-Fos, c-Jun, and NFATc1. Results: Among the four phlorotannin compounds present in Eisenia bicyclis, dieckol significantly hindered osteoclast differentiation and expression of RANKL-induced TRAP and CTR. In addition, dieckol downregulated the expression levels of c-Fos, c-Jun, NFATc1, ERK, and JNK, and suppressed NF-κB signaling. Conclusions: Dieckol can suppress RANKL-induced osteoclastogenesis. Therefore, it has therapeutic potential in treating osteoclastogenesis- associated diseases.

Dieckol isolated from Eisenia bicyclis extract suppresses RANKL-induced osteoclastogenesis in murine RAW 264.7 cells

Objective: To demonstrate the effect of dieckol from Eisenia bicyclis on osteoclastogenesis using RAW 264.7 cells. Methods: Murine macrophage RAW 264.7 cells were subjected to dieckol treatment, followed by treatment with receptor activator of nuclear factor kappa-B ligand (RANKL) to induce osteoclastogenesis. Tartrate-resistant acid phosphatase (TRAP) activity was examined using a TRAP activity kit. Western blotting analysis was conducted to examine the level of osteoclast- related factors, including TRAP and calcitonin receptor (CTR), transcriptional factors, including c-Fos, c-Jun, and nuclear factor of activated T cells cytoplasmic 1 (NFATc1), nuclear factor kappa-B (NF-κB), extracellular signal-regulated kinase (ERK), and c-Jun N-terminal kinase (JNK). Immunofluorescence staining was conducted to examine the expression of c-Fos, c-Jun, and NFATc1. Results: Among the four phlorotannin compounds present in Eisenia bicyclis, dieckol significantly hindered osteoclast differentiation and expression of RANKL-induced TRAP and CTR. In addition, dieckol downregulated the expression levels of c-Fos, c-Jun, NFATc1, ERK, and JNK, and suppressed NF-κB signaling. Conclusions: Dieckol can suppress RANKL-induced osteoclastogenesis. Therefore, it has therapeutic potential in treating osteoclastogenesis- associated diseases.

Tolosa-Hunt Syndrome Presenting as Cluster-Like Headache

A 48-year-old man came with a left-sided headache that was compatible with diagnostic criteria of cluster headache. Left oculomotor nerve palsy developed 2 weeks after headache onset. Magnetic resonance imaging showed wall thickening and enhancement by contrast material in the lateral aspect of the left cavernous sinus, consistent with a possible inflammatory lesion. The patient reported the almost complete remission of the pain and diplopia after steroid therapy. We speculate that Tolosa-Hunt syndrome should be included as a cause of cluster-like headaches.

Anti-senescence and anti-wrinkle activities of 3-bromo-4,5-dihydroxybenzaldehyde from Polysiphonia morrowii Harvey in human dermal fibroblasts

Objective:To investigate the anti-senescence effect of 3-bromo-4,5-dihydroxybenzaldehyde (BDB) from Polysiphonia morrowii Harvey in human dermal fibroblasts (HDF). Methods:HDF were subjected to treatment of BDB and then treated with hydrogen peroxide (H2O2) to induce premature senescence. Senescence-associated β-galactosidase (SA-β-gal) activity in HDF was determined using the SA-β-gal staining method. Intracellular reactive oxygen species (ROS) production was measured using the 2',7'-dichlorodihydrofluorescein diacetate assay. Western blotting assay was performed to assess the level of antioxidant enzyme glutathione peroxidase 1 (GPX1). In addition, intracellular collagen and collagenase contents were analyzed using the respective ELISA kits. Elastase activity in HDF supernatants was measured from p-nitroaniline release and normalized using total protein content. Results:Treatment of HDF with H2O2 increased the activity of SA-β-gal, but BDB pre-treatment resulted in the reduction of SA-β-gal activity. Moreover, BDB significantly reduced H2O2-induced intracellular ROS production. BDB also markedly increased the level of GPX1, which was inhibited by 400 μM of H2O2. Furthermore, in in vitro study, BDB significantly increased intracellular collagen content and decreased matrix metalloproteinase-1 and elastase activities in HDF. Conclusions:Our results demonstrate that BDB shows anti-senescence and anti-wrinkle activities in vitro.

The usefulness of transanal tube for reducing anastomotic leak in mid rectal cancer: compared to diverting stoma

Purpose@#Diverting stoma (DS) and transanal tube (TAT) are the 2 main procedures for reducing anastomotic leak (AL) in rectal cancer surgery. However, few studies have compared the protective effect of the 2 modalities against AL. @*Methods@#Total of 165 patients with mid rectal cancer, who underwent curative resection from 2012 to 2017, were included.Clinical characteristics and outcomes were compared. Risk factors for AL were identified using multivariate analysis. @*Results@#The DS group had lower tumor location, higher rates of neoadjuvant concurrent chemoradiotherapy, and longer operative time than the TAT group. However, the level of the anastomosis did not show statistically significant differences (DS: 4.6 cm vs. TAT: 4.9 cm, P = 0.061). AL occurred in 14 of the 165 patients (8.5%), with 10 (10.2%) in the DS group and 4 (6.0%) in the TAT group (P = 0.405). On multivariate analysis, only low body mass index (BMI) and smoking were significantly related to AL. Neither the protection method nor neoadjuvant chemoradiotherapy demonstrated statistical differences in AL. Seven of 10 patients in the DS group who experienced AL were treated conservatively, while all 4 in the TAT group underwent reoperation. @*Conclusion@#TAT seems to have comparable protective effect against AL to DS. However, in AL, DS appeared to be more effective in preventing reoperation. Therefore, DS is recommended in patients with low BMI or smoking, and with an expected higher probability of morbidity or mortality in case of reoperation. In other cases, TAT may be considered as an alternative to DS.

Acute Motor Axonal Neuropathy Accompanied with Delayed Facial Diplegia / 대한신경근육질환학회지

Facial nerve palsy is one of major accompanying features in Guillain-Barré syndrome (GBS). In most of the cases, facial weakness develops simultaneously with other symptoms such as motor weakness, sensory change and other cranial neuropathies. However, facial palsy also occurs after the nadir of neurological deficits or even after the beginning of limb weakness improvement, called delayed facial palsy (DFP). DFP has been reported in Miller Fisher syndrome, but it rarely found from the acute motor axonal neuropathy subtype of GBS. Recently, we experienced a patient who diagnosed acute motor axonal neuropathy accompanying with delayed facial diplegia.

Protective Effect of Brassica napus L. Hydrosols against Inflammation Response in RAW 264.7 Cells / 中国结合医学杂志

OBJECTIVE@#To demonstrate the anti-inflammatory activity of Brassica napus L. hydrosols (BNH) in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells.@*METHODS@#Composition analysis of BNH was conducted via gas chromatography-mass spectrometry after BNH were extracted. The nitric oxide (NO) production was measured using the Griess assay. Prostaglandin E@*RESULTS@#Compared with LPS-stimulated cells, BNH markedly decreased the generation of NO and PGE@*CONCLUSION@#The anti-inflammatory activities of BNH were mediated via blockage of the NF-κB signaling pathways in LPS-stimulated RAW 264.7 cells.

Public Perception on Coinsurance Rate of the National Health Insurance in Korea / 보건행정학회지

Background@#Although Korean government have been adopting several policies to expand coverage of National Health Insurance (NHI) program, the coverage rate is still below average across Organization for Economic Cooperation and Development countries.This study was to identify public perception on appropriateness of coinsurance rate and factors associated with coinsurance rate in National Health Insurance. @*Methods@#For this cross-sectional study, 507 participants over aged 20 years were recruited from telephone surveys. Respondents experienced at least one and more visiting medical facilities due to medical problems in last 12 months. Demographic factors, socioeconomic positions, and experiences on medical utilization were measured in order to identify factors associated with perception appropriateness of coinsurance rate. @*Results@#The 49.9% (n=209) of the public responded that the coinsurance rate of NHI program was appropriate. There were no differences in positive perception according to socio-demographic factors and experiences on medical utilization except for gender, residential area, and felt expensive when using medical services. People who felt burden of medical expenditure were more likely to perceive coinsurance rate inappropriate (odds ratio, 2.33; 95% confidence interval, 1.52–3.58) @*Conclusion@#In spite of the relatively low coverage rate of NHI, this study identified that 49.9% of the public perceived the current coinsurance rate was adequate. However, people who felt the burden of medical expenditure were still had a negative perception of the coinsurance rate needed to decrease the coinsurance rate.

Public Perception on Coinsurance Rate of the National Health Insurance in Korea / 보건행정학회지

Background@#Although Korean government have been adopting several policies to expand coverage of National Health Insurance (NHI) program, the coverage rate is still below average across Organization for Economic Cooperation and Development countries.This study was to identify public perception on appropriateness of coinsurance rate and factors associated with coinsurance rate in National Health Insurance. @*Methods@#For this cross-sectional study, 507 participants over aged 20 years were recruited from telephone surveys. Respondents experienced at least one and more visiting medical facilities due to medical problems in last 12 months. Demographic factors, socioeconomic positions, and experiences on medical utilization were measured in order to identify factors associated with perception appropriateness of coinsurance rate. @*Results@#The 49.9% (n=209) of the public responded that the coinsurance rate of NHI program was appropriate. There were no differences in positive perception according to socio-demographic factors and experiences on medical utilization except for gender, residential area, and felt expensive when using medical services. People who felt burden of medical expenditure were more likely to perceive coinsurance rate inappropriate (odds ratio, 2.33; 95% confidence interval, 1.52–3.58) @*Conclusion@#In spite of the relatively low coverage rate of NHI, this study identified that 49.9% of the public perceived the current coinsurance rate was adequate. However, people who felt the burden of medical expenditure were still had a negative perception of the coinsurance rate needed to decrease the coinsurance rate.

The trend of prevalence of pain in Korea from 2005 to 2016

Background@#Korean society is afflicted with rapid aging. Aging is a risk factor for pain, and pain can reduce patients’ quality of life. Thus, adequate management and monitoring of changing trends accompanying the demographic shift are highly valuable. However, this study was conducted because no studies have investigated the recent changes in the prevalence of pain. @*Methods@#The extent of the prevalence of pain was determined by questions related to quality of life based on the data derived from the Korea National Health and Nutrition Survey (KNHNS) from 2005 to 2016. The annual frequencies of the pain group and severe pain group were calculated using the survey questionnaire. Multiple logistic regression analysis was performed to determine possible differences in prevalence by year. @*Results@#The prevalence of pain in all populations was 30.6% in 2005 and 18.9% in 2016. The average prevalence from 2005 to 2016 was 21.9%. A declining trend occurred over time with an odds ratio of 0.929 per year (95% CI: 0.921-0.938).The prevalence of severe pain was 2.35% in 2005 and 1.88% in 2016. Likewise, a decrease was observed over time, with an odds ratio of 0.920 per year at 95% CI 0.901-0.939. The decline in age-/sex-stratified analysis also showed a statistically significant trend in all groups. @*Conclusions@#The prevalence of pain in Korean society, based on the KNHNS, has declined since 2005. Such a trend was observed in all ages and sexs, and was most significant in the elderly.

Iatrogenic Development of Cerebrospinal Fluid Leakage in Diagnosing Spontaneous Intracranial Hypotension / 가정의학회지

A 34-year-old woman came to the emergency room complaining of a severe orthostatic headache. Results of a cerebrospinal fluid tap and brain computed tomography were normal. Based on her history and symptoms, she was found to have spontaneous intracranial hypotension. She was hospitalized and her symptoms improved with conservative treatment. On the next day, her headache suddenly worsened. Cisternography was performed to confirm the diagnosis and determine the spinal level of her cerebrospinal fluid leak. It revealed multiple cerebrospinal fluid leaks in the lumbar and upper thoracic regions. It was strongly believed that she had an iatrogenic cerebrospinal fluid leak in the lumbar region. An epidural blood patch was performed level by level on the lumbar and upper thoracic regions. Her symptoms resolved after the epidural blood patch and she was later discharged without any complications. In this case, an iatrogenic cerebrospinal fluid leak was caused by a dural puncture made while diagnosing spontaneous intracranial hypotension, which is always a risk and hampers the patient's progress. Therefore, in cases of spontaneous intracranial hypotension, an effort to minimize dural punctures is needed and a non-invasive test such as magnetic resonance imaging should be considered first.

Comparison between cerebral state index and bispectral index during desflurane anesthesia / 대한마취과학회지

BACKGROUND: Cerebral state index (CSI) is an anesthesia depth monitor alternative to bispectral index (BIS). Published comparative studies have used propofol or sevoflurane. However, studies using desflurane have not been reported yet. Different volatile anesthetics have different electroencephalography signatures. The performance of CSI may be different in desflurane anesthesia. Therefore, the objective of this study was to compare CSI and BIS during desflurane anesthesia. METHODS: Thirty-three patients were recruited. Desflurane and remifentanil were used to maintain general anesthesia. BIS and CSI were recorded simultaneously every minute. End-tidal concentration of desflurane was maintained at 4% from the beginning of surgery for 5 minutes. Pairwise data of CSI and BIS were obtained five times at one-minute intervals. This process was repeated in the order of 6%, 8%, and 10%. RESULTS: BIS and CSI were negatively correlated with the end-tidal concentration of desflurane with a similar degree of correlation (correlation coefficient BIS: –0.847, CSI: –0.844). The relationship between CSI and BIS had a good linearity with a slope close to 1 (R2 = 0.905, slope = 1.01). For the relationship between CSI and BIS at each end-tidal concentration of desflurane, CSI and BIS showed good linearity in 4% and 10% (R2 = 0.559, 0.540). However, the linearity and slope were decreased in 6% and 8% (R2 = 0.163, 0.014). CONCLUSIONS: CSI showed an equivalent degree of overall performance compared to BIS in desflurane anesthesia. Accounting for previous literature, CSI can be used as a good substitute for BIS regardless of the kind of anesthetics used.

Quadriplegia as a position-related complication after parotidectomy: the need for cooperation between anesthesiologists and surgeons when positioning patients: A case report

During surgery, the patient is positioned optimally according to the type of operation. Careful attention is required because damage associated with patient positioning may occur during the course of the surgery. Here, we present a case of hyperextension neck injury observed following parotidectomy. A 68-year-old man who was diagnosed with a parotid tumor underwent an elective right partial superficial parotidectomy. After surgery, the patient was not able to move his upper and lower extremities and experienced voiding difficulty. Cervical magnetic resonance imaging showed spinal cord injury at the C3-4 and C5-6 levels. High-dose steroid treatment was started, and emergency laminoplasty C4-5 to C5-6 was performed. Following laminoplasty, motor function was almost fully recovered, but proprioception was weak, and voiding difficulty remained a problem. The patient received rehabilitation treatment in the hospital for about 3 months, demonstrating improvement. He was discharged and continued treatment in the outpatient department.

Quadriplegia as a position-related complication after parotidectomy: the need for cooperation between anesthesiologists and surgeons when positioning patients: A case report

During surgery, the patient is positioned optimally according to the type of operation. Careful attention is required because damage associated with patient positioning may occur during the course of the surgery. Here, we present a case of hyperextension neck injury observed following parotidectomy. A 68-year-old man who was diagnosed with a parotid tumor underwent an elective right partial superficial parotidectomy. After surgery, the patient was not able to move his upper and lower extremities and experienced voiding difficulty. Cervical magnetic resonance imaging showed spinal cord injury at the C3-4 and C5-6 levels. High-dose steroid treatment was started, and emergency laminoplasty C4-5 to C5-6 was performed. Following laminoplasty, motor function was almost fully recovered, but proprioception was weak, and voiding difficulty remained a problem. The patient received rehabilitation treatment in the hospital for about 3 months, demonstrating improvement. He was discharged and continued treatment in the outpatient department.

High levels of carcinoembryonic antigen and smoking might be markers of colorectal adenoma in Korean males aged 40-49 years / 영남의대학술지

BACKGROUND: Prevalence of adenoma in males aged 40-49 years in Korea was higher than expected. The aim of this study was to investigate the prevalence and risk factors of colorectal adenoma in males aged 40-49 years. METHODS: Total 1,902 asymptomatic subjects with a mean age of 47.9±6.7 years, who underwent a screening colonoscopy in a health promotion center of Myongji Hospital from 2010 to 2013 were enrolled in this study. We conducted a case-control study to determine the risk factors for adenoma. The subjects were classified into two groups (adenoma vs. controls). To validate the diagnostic value of carcinoembryonic antigen (CEA) for adenoma, area under the receiver operating characteristic curve (AUROC) was calculated. RESULTS: At least one colorectal adenoma was identified in 385 subjects (20.2%). Among these 385 subjects, 372 subjects were found to have a non-advanced adenoma, 13 subjects had an invasive adenoma. One subject had cancer. Male sex, age, smoking, metabolic syndrome, and elevated CEA level were significantly associated with a colorectal adenoma in univariate analysis. However, metabolic syndrome was not significant in multivariate analysis. In the male group, the AUROC of CEA for colorectal adenoma was 0.600 (0.543 to 0.656) in non-smokers under 50 years of age, and 0.615 (0.540 to 0.690) in smokers under 50 years of age. CONCLUSION: Male sex, smoking, and high levels of CEA seem to be associated with colorectal adenoma. High levels of CEA and smoking may be diagnostic markers for any colorectal adenoma in Korean males aged 40-49 years.