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Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a neuroinflammatory disease mediated by autoantibodies against the NMDAR, typically presenting with psychiatric symptoms, cognitive dysfunction, and motor dysfunction. These neuropsychiatric symptoms may be mimicked by drug abuse, and the development of anti-NMDAR encephalitis may be triggered by certain substance use. Here we report a case of anti-NMDAR encephalitis who developed neuropsychiatric symptoms after illicit substance use, the first report in Korea.
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Background@#Liver fibrosis is an early stage of liver cirrhosis. As a reversible lesion before cirrhosis, liver failure, and liver cancer, it has been a target for drug discovery. Many antifibrotic candidates have shown promising results in experimental animal models; however, due to adverse clinical reactions, most antifibrotic agents are still preclinical. Therefore, rodent models have been used to examine the histopathological differences between the control and treatment groups to evaluate the efficacy of anti-fibrotic agents in non-clinical research. In addition, with improvements in digital image analysis incorporating artificial intelligence (AI), a few researchers have developed an automated quantification of fibrosis. However, the performance of multiple deep learning algorithms for the optimal quantification of hepatic fibrosis has not been evaluated. Here, we investigated three different localization algorithms, mask R-CNN, DeepLabV3+, and SSD, to detect hepatic fibrosis. @*Results@#5750 images with 7503 annotations were trained using the three algorithms, and the model performance was evaluated in large-scale images and compared to the training images. The results showed that the precision values were comparable among the algorithms. However, there was a gap in the recall, leading to a difference in model accuracy. The mask R-CNN outperformed the recall value (0.93) and showed the closest prediction results to the annotation for detecting hepatic fibrosis among the algorithms. DeepLabV3+ also showed good performance; however, it had limitations in the misprediction of hepatic fibrosis as inflammatory cells and connective tissue. The trained SSD showed the lowest performance and was limited in predicting hepatic fibrosis compared to the other algorithms because of its low recall value (0.75). @*Conclusions@#We suggest it would be a more useful tool to apply segmentation algorithms in implementing AI algorithms to predict hepatic fibrosis in non-clinical studies.
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Objective@#Dysphagia is a common symptom of stroke and affects 23–50% of such patients. In addition, bulbar involvement, which causes dysphagia, is the primary initial symptom in approximately 25–30% of amyotrophic lateral sclerosis (ALS) patients. The purpose of this study was to compare patterns of swallowing difficulties in stroke and ALS patients. @*Methods@#We retrospectively recruited 84 ALS patients with dysphagia and 294 stroke patients with dysphagia between January 2017 and December 2019. Swallowing processes were reviewed by videofluoroscopic swallowing studies (VFSSs). The presence of oral residues and oral transit times (OTTs) were measured in the oral phase, and the presence of penetration and aspiration and residues in valleculae or pyriform sinuses were evaluated. Statistical analysis was performed using SPSS 25.0 and comparisons using the Chi-square test. @*Results@#ALS patients more frequently had delayed OTTs and oral residues than stroke patients, and stroke patients more frequently experienced aspiration and had delayed thin liquid pharyngeal transit times (PTTs). However, no significant intergroup difference was observed for the presence of penetration, residues in valleculae or pyriform sinuses, or thick liquid PTTs. @*Conclusion@#The study shows that ALS patients exhibit slower food processing in the oral cavity and more significant bulbar muscle weakness than stroke patients. On the other hand, stroke patients had greater thin liquid aspiration rates than ALS patients. These findings should be considered when choosing treatments for ALS and stroke.
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Spinal dural arteriovenous fistula (SDAVF) is known for its ambiguous and various clinical presentations. Among these presentations, congestive myelopathy is one of the most common, yet it is challenging to correctly diagnose SDAVF at initial presentation. Several diseases present as myelopathy, including demyelinating diseases. Herein, we present two cases of congestive myelopathy due to SDAVF presenting to the emergency room (ER) with progressive quadriparesis. Even though the patients had a proper magnetic resonance imaging (MRI) examination from the initial presentation, there was a delay in making a final diagnosis. Both patients’ clinical presentation and MRI mimicked central nervous system (CNS) demyelinating disease initially, and a more thorough examination revealed SDAVF. Such a delay in diagnosis can result in more neurological deterioration and may result in more sequelae. Hence, SDAVF should always be considered as a differential diagnosis when examining patients with myelopathy.
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Guillain-Barre syndrome (GBS) is acute inflammatory demyelinating polyradiculoneuropathy, which is often related to post-infectious etiology. However, GBS has also been reported to be caused by non-infectious factors such as trauma. This report describes a rare case of post-traumatic GBS with dramatic response to immunoglobulin therapy. And here, we also discussed about the importance of differential diagnosis with critical illness polyneuropathy.
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Background@#Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive motor neuron degeneration with phenotypic heterogeneity, including age at onset. Juvenile ALS (JALS) includes ALS patients aged less than 25 years who typically show slow progression. This study aimed to identify the characteristics of juvenile ALS from Korean ALS cohorts. @*Methods@#We retrospectively investigated the clinical characteristics of JALS patients, who met the revised El Escorial-Airlie House criteria, in the Korean motor neuron disease cohort om January 2002 to November 2018. To evaluate the genetic background ofin JALS, we screened the SOD1 mutation in all JALS patients using PCR. @*Results@#Among the seven JALS patients, the mean age was 22.1 years (± 2.19 years) and 4 patients were male. Most patients were diagnosed within less than 12 months, but in one patient, it took 96 months to make the initial diagnosis. On assessing the cognitive function, none of the patients had dementia. The progression rate of JALS during follow-up was usually low (median [IQR], 0.31 [0.11-0.52]), except in patients with SOD1 mutation (3.40) and CLEC4C mutation (1.12). One patient revealed a family history of ALS with SOD1 mutation, but we also detected the SOD1 mutation among sporadic JALS patients. @*Conclusions@#Although JALS patients with genetic mutations (SOD1-p.Asn87Ser and CLEC4C-p.Lys210*) showed faster progression than other JALS patients, one patient with SOD1 mutation (p.Gly17Ala) showed slow progression. Familial ALS was rare; however, it might be caused by low or incomplete penetrance of the genes or by small number of JALS patients. To investigate the other genetic causes of JALS without the SOD1 mutation, a further study including detailed genetic analysis is needed.
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Background@#Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive motor neuron degeneration with phenotypic heterogeneity, including age at onset. Juvenile ALS (JALS) includes ALS patients aged less than 25 years who typically show slow progression. This study aimed to identify the characteristics of juvenile ALS from Korean ALS cohorts. @*Methods@#We retrospectively investigated the clinical characteristics of JALS patients, who met the revised El Escorial-Airlie House criteria, in the Korean motor neuron disease cohort om January 2002 to November 2018. To evaluate the genetic background ofin JALS, we screened the SOD1 mutation in all JALS patients using PCR. @*Results@#Among the seven JALS patients, the mean age was 22.1 years (± 2.19 years) and 4 patients were male. Most patients were diagnosed within less than 12 months, but in one patient, it took 96 months to make the initial diagnosis. On assessing the cognitive function, none of the patients had dementia. The progression rate of JALS during follow-up was usually low (median [IQR], 0.31 [0.11-0.52]), except in patients with SOD1 mutation (3.40) and CLEC4C mutation (1.12). One patient revealed a family history of ALS with SOD1 mutation, but we also detected the SOD1 mutation among sporadic JALS patients. @*Conclusions@#Although JALS patients with genetic mutations (SOD1-p.Asn87Ser and CLEC4C-p.Lys210*) showed faster progression than other JALS patients, one patient with SOD1 mutation (p.Gly17Ala) showed slow progression. Familial ALS was rare; however, it might be caused by low or incomplete penetrance of the genes or by small number of JALS patients. To investigate the other genetic causes of JALS without the SOD1 mutation, a further study including detailed genetic analysis is needed.
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Alzheimer's disease (AD), the most common form of dementia, has emerged as a major global public health challenge. However, the complexity of AD in its biological, genetic, and clinical aspects has hindered the development of effective therapeutic agents. Research plans that integrate new drug discoveries are urgently needed, including those based on novel and reliable biomarkers that reflect not only clinical phenotype, but also genetic and neuroimaging information. Therapeutic strategies such as stratification (i.e., subgrouping of patients having similar clinical characteristics or genetic background) and personalized medicine could be set as new directions for developing effective drugs for AD. In this review, we describe a therapeutic strategy that is based on immune-inflammation modulation for a subgroup of AD and related dementias, arguing that the use of stratification and personalized medicine is a promising way to achieve targeted medicine. The Korean AD Research Platform Initiative based on Immune-Inflammatory biomarkers (K-ARPI) has recently launched a strategy to develop novel biomarkers to identify a subpopulation of patients with AD and to develop new drug candidates for delaying the progression of AD by modulating toxic immune inflammatory response. Sphingosine kinase 1 (SphK1) and its metabolites, triggering receptor expressed on myeloid cells-2 (TREM2) related signals, and actin motility related proteins including Nck-associated protein 1 (Nap1) were selected as promising targets to modulate neuroinflammation. Their roles in stratification and personalized medicine will be discussed.
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Humanos , Actinas , Doença de Alzheimer , Biomarcadores , Demência , Inflamação , Neuroimagem , Fenótipo , Fosfotransferases , Medicina de Precisão , Saúde Pública , EsfingosinaRESUMO
No abstract available.
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Inalação , Óxido Nitroso , Embolia Pulmonar , Degeneração Combinada SubagudaRESUMO
BACKGROUND: For the correction of small ptotic breasts, augmentation mastopexy provides a better shape than other techniques, but its periareolar or vertical scar is a limiting factor. Subglandular augmentation tends to increase ptosis. Submuscular augmentation may result in a "Waterfall" deformity (double contour deformity). This report uses examples of two patients to illustrate concepts for improving breast augmentation of ptotic breasts. METHODS: Two patients initially underwent insertion of breast implants for ptotic breasts, using full height type of implants inserted by the type III dual plane technique. Both patients had wanted breasts that were not excessively large, but which had an improved shape and minimal scars. At nearly the same time after the initial surgery (postoperative day 3 and 7), each patient exhibited a unilateral double contour breast deformity. The initial implants were changed to shorter height implants to shift volume to the lower pole. RESULTS: Changing the implants resulted in improved breast shape by enhancing the leverage effect. The double contour deformities observed after using the taller implants were improved by changing to shorter implants. CONCLUSIONS: For rotating the nipple areolar complex upward during correction of small ptotic breasts with implants, the type III dual plane technique is an effective way to produce a larger volume pocket in the lower pole of the breast. More leverage effect can be obtained by using a shorter height and greater projection type of shaped implant instead of a full height implant.
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Feminino , Humanos , Implante Mamário , Implantes de Mama , Mama , Cicatriz , Anormalidades Congênitas , Mamoplastia , Mamilos , Complicações Pós-OperatóriasRESUMO
BACKGROUND: Synmastia is serious condition but rare. Synmastia is a technical complication caused by over dissection of the medial pocket over the sternum. In sunken chest, the medial portion of Pectoralis muscle tends to be elevated easily from the sternocostal area. So it should be more careful to prevent from overdissection in breast augmentation of sunken chest. METHODS: An idea was obtained from buttock augmentation with implant. For buttock augmentation, implants are placed intramuscularly for the protection of sciatic nerve and for the prevention of implant displacement. Muscle splitting concept for intramuscular placing of implant in sunken chest adds tissue to sunken area and provide guarding barrier to reduce detaching tendency at the parasternal area. RESULTS: As I had the concept of intramuscular placement at the medial side for the breast augmentation in case of sunken chest, I experienced steady medial breast contour in 5 cases of sunken chest. CONCLUSIONS: Muscle splitting as coronal plane of medial portion of pectoral muscle make muscular pouch at the medial corner of subpectoral pocket which is effective for the prevention of medial displacement of implant in breast augmentation of sunken chest by guarding effect of irregularly arranged muscle fibers which resist against the detaching force of pectoral muscle from the sternocostal origin.
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Mama , Nádegas , Músculos , Músculos Peitorais , Nervo Isquiático , Esterno , TóraxRESUMO
The Natrelle(TM) 410 (Allergan Inc., Irvine, CA, USA) shaped, form-stable silicone gel implant was introduced in Europe in 1993. Its "form stability" relates to increased cohesiveness or stiffness of the gel filler, allowing the implant to maintain its shape in the upright position. The anatomical form-stable implant is helpful for reducing ripples and provides more natural looking due to less upper pole fullness, so it has some benefits for the thin patients. And it provides more expansion to the lower pole, it has also benefits for the ptotic breasts or constricted breasts. I have experienced 69 cases with anatomical form-stable implants (52 Polytech Replicon(R) (POLYTECH Health & Aesthetics, Dieburg, Germany) implants, 85 Natrelle(TM) 410 implants) from February to December of 2012. The most common used implants are MF295 g of Natrelle(TM) 410 and high profile 315 g of Polytech Replicon(R). I did reoperations for 2 breasts of 2 patients. One was due to hematoma and the other was due to displacement. Both cases are my early experiences of shaped implants. There is no other complication yet. I need longer follow-up period for the appropriate evaluation. In my early experiences, the results of anatomical form-stable implants seem to make less fullness of upper pole, less ripples, more tightness, and similar recovery periods in contrast with the results of round textured implants.
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Feminino , Humanos , Mama , Implantes de Mama , Deslocamento Psicológico , Estética , Europa (Continente) , Seguimentos , Hematoma , Mamoplastia , Modelos Anatômicos , Géis de SiliconeRESUMO
No abstract available.