Garcinia Cambogia-Induced Refractory Status Epilepticus

Garcinia cambogia (G.cambogia) is a herbal dietary supplement for managing obesity. Several adverse effects of G.cambogia have been reported including serotonin syndrome and mania. We report a patient with refractory status epilepticus after taking G.cambogia. A 24-year-old woman was admitted with continuing seizures. Based on electroencephalography and neuroimaging findings, she was diagnosed as refractory status epilepticus attributed to G.cambogia-related encephalopathy. After cessation of the G.cambogia with administrating antiepileptic drugs, she fully recovered without seizure recurrence and neurological sequelae.

Autonomic Dysfunction in Sleep Disorders: From Neurobiological Basis to Potential Therapeutic Approaches

Sleep disorder has been portrayed as merely a common dissatisfaction with sleep quality and quantity. However, sleep disorder is actually a medical condition characterized by inconsistent sleep patterns that interfere with emotional dynamics, cognitive functioning, and even physical performance. This is consistent with sleep abnormalities being more common in patients with autonomic dysfunction than in the general population. The autonomic nervous system coordinates various visceral functions ranging from respiration to neuroendocrine secretion in order to maintain homeostasis of the body. Because the cell population and efferent signals involved in autonomic regulation are spatially adjacent to those that regulate the sleep-wake system, sleep architecture and autonomic coordination exert effects on each other, suggesting the presence of a bidirectional relationship in addition to shared pathology.The primary goal of this review is to highlight the bidirectional and shared relationship between sleep and autonomic regulation. It also introduces the effects of autonomic dysfunction on insomnia, breathing disorders, central disorders of hypersomnolence, parasomnias, and movement disorders. This information will assist clinicians in determining how neuromodulation can have the greatest therapeutic effects in patients with sleep disorders.

Heart-Rate-Based Machine-Learning Algorithms for Screening Orthostatic Hypotension

Background@#and Purpose: Many elderly patients are unable to actively stand up by themselves and have contraindications to performing the head-up tilt test (HUTT). We aimed to develop screening algorithms for diagnosing orthostatic hypotension (OH) before performing the HUTT. @*Methods@#This study recruited 663 patients with orthostatic intolerance (78 with and 585 without OH, as confirmed by the HUTT) and compared their clinical characteristics. Univariate and multivariate analyses were performed to investigate potential predictors of an OH diagnosis. Machine-learning algorithms were applied to determine whether the accuracy of OH prediction could be used for screening OH without performing the HUTT. @*Results@#Differences between expiration and inspiration (E-I differences), expiration:inspiration ratios (E:I ratios), and Valsalva ratios were smaller in patients with OH than in those without OH. The univariate analysis showed that increased age and baseline systolic blood pressure (BP) as well as decreased E-I difference, E:I ratio, and Valsalva ratio were correlated with OH. In the multivariate analysis, increased baseline systolic BP and decreased Valsalva ratio were found to be independent predictors of OH. Using those variables as input features, the classification accuracies of the support vector machine, k-nearest neighbors, and random forest methods were 84.4%, 84.4%, and 90.6%, respectively. @*Conclusions@#We have identified clinical parameters that are strongly associated with OH. Machine-learning analysis using those parameters was highly accurate in differentiating OH from non-OH patients. These parameters could be useful screening factors for OH in patients who are unable to perform the HUTT.

Chlorfenapyr Intoxication Manifested by Extensive Leukoencephalomyelopathy

No abstract available.

A Case of Circadian Rhythm Sleep-Wake Disorder in Partial Blindness

Although it is well known that sleep disturbances can be developed in complete blindness, normally entrained circadian rhythm was observed in the majority of patients with partial blindness. Here, we describe a case with circadian rhythm sleep-wake disorder in partial loss of light perception. A 58-year-old man presented with difficulty in sleep initiation and excessive daytime sleepiness after retinal surgery. The electroretinography revealed partial impairment of light perception in the right side and preserved light perception in the left side. He was diagnosed as circadian rhythm sleep-wake disorder due to impaired light perception. While taking 2 mg of melatonin regularly at 9 every night, his sleep cycle and difficulty in sleep initiation were gradually improved and became fully normalized after 2 weeks. Circadian rhythm sleep-wake disorder could be developed even in partial blindness. Melatonin supplements could effectively improve the circadian rhythm sleep-wake disorder in partial blindness, like as in complete blindness.

Wolff-Parkinson-White Syndrome in a Patient with Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like Episodes Syndrome Mimicking Juvenile Myoclonic Epilepsy

No abstract available.

Concurrent Validity of the Seven-Item BBS-3P with Other Clinical Measures of Balance in a Sample of Stroke Patients

PURPOSE: The aim of this study was to investigate if the 7–item Berg balance scale (BBS) 3–point, which is a short form of the BBS (SFBBS), has compatible psychometric properties in comparison with the original BBS, and also to study the concurrent validity using a 10-meter walk test (10mWT) and a timed up and go test (TUG), which are widely used with SFBBS in clinical settings. METHODS: A total of 255 patients who had experienced stroke participated in this cross-sectional study. We used results obtained from 188 patients who completed both 10mWT and TUG. The three levels in the center of the BBS were collapsed to a single level (i.e.,0-2-4) to form the SFBBS. The concurrent validity was assessed by computing the Spearman coefficients for correlation among outcome measures and in between each outcome measure and the SFBBS. As there were four outcomes, the corrected p-value for significant correlation was 0.013 (0.05/4). RESULTS: Spearman coefficients for correlations and evaluation instruments for concurrent validity revealed significantly high validity for both of SFBBS and BBS (r=0.944). 10mWT and TUG were −0.749 and −0.770 respectively, which are in the high margin and are statistically significant (p>0.000). CONCLUSION: SFBBS has sound psychometric properties for evaluating patients with stroke. Thus, we recommend the use of SFBBS in both clinical and research settings.

Lithium Intoxication Induced by Angiotensin II Receptor Blocker/Thiazide Combination Agent

No abstract available.

Extracellular HMGB1 Released after Zinc-treatment Induces Neuronal Death in Primary Cortical Cultures / 대한해부학회지

As a nonhistone DNA-binding protein, high mobility group box 1 (HMGB1) is released in large amounts into the extracellular space immediately after ischemic insult and plays a role in the release of proinflammatory cytokines. Here, we the examined cytokine-like or signaling molecule-like function of extracellular HMGB1 in primary cortical cultures. We found that a large amount of HMGB1 was released following zinc-induced neuronal cell death in primary cortical cultures and that this extracellular HMGB1 might aggravate neuronal damage. The conditioned media collected from zinc-treated primary cortical cultures decreased neuronal cell survival to 69.6+/-1.4% of control values when added to fresh primary cortical cultures. In contrast, treatment with HMGB1-depleted conditioned media produced by cultures treated with an HMGB1 siRNA-expression vector suppressed the induction of neuronal death. A mutant HMGB1 siRNA-expression vector did not suppress the induction of neuronal death, demonstrating a role of HMGB1 in neuronal death. Moreover, HMGB1-depletion in media conditioned by cotreatment with anti-HMGB1 antibody or with anti-RAGE antibody, a potential receptor for HMGB1, recovered neuronal cell survival to 81.0+/-4.0% and 79.0+/-4.0%, respectively, when added to fresh primary cortical cultures. These results indicate that extracellular HMGB1 released after zinc treatment induces neuronal death, which might aggravate zinc toxicity.

A Case of Primary Cutaneous Plasmacytoma

A 66-year-old female patient had a firm, non-tender, dome shaped mass on the scalp. The lesion had enlarged slowly for 2 years, and measured about 4 × 6 cm. The histologic finding of the skin biopsy specimen demonstrated an infiltration of immature plasma cells in the dermis, which express monoclonal cytoplasmic lambda light chain by immunohistochemical stainings, and staging work-up after the biopsy revealed no evidence of disease in other foci. The mass on the scalp was treated successfully by radiation therapy, with the diagnosis of primary cutaneous plasmacytoma.

Detection of antibodies to human melanoma cell in vitiligo by western blot analysis

Vitiligo is a disease in which melanocytes are selectively destroyed. The disease is thought to be an autoimmune process being there are antibodies to pigment cells in the sera of patients and animals with vitiligo. In the present study, sera from vitiligo patients were examined for reactivity with the human melanoma cell line, SK-Mel-28, by Western blot analysis of solubilized membrane antigens of these cells to identify the pigment cell antigens defined by antibodies in the patients with vitiligo. Antibody reactivity to human melanoma cells (SK-Mel-28) was investigated in 14 patients with vitiligo, and 16 with normal control individuals. Antibodies to the 116-113, 60, 40 KD antigens were associated with vitiligo being present in 79%, 86%, and 43% respectively of the patients with vitiligo, but in only 6%, 38% and 6% of the normal controls. In contrast, antibodies to the 160-155, 78 and 64 KD antigens were equally common in vitiligo and in normal individuals. The results suggest that autoreactivity to pigment cells occurs more commonly in patients with vitiligo than in the normal control and high autoreactivity to pigment cells in the vitiligo sera might be an impertinent epiphemenon to destroyed pigment cell.

Epidermal Grafting after Removal of Recipient Epidermis by CO2 Laser Ablation in Vitiligo / 대한피부과학회지

BACKGROUND: Epidermal grafting using cryotherapy for recipient sites is in widespread use. However the peripheral hypopigmented haloes that occur around the recipient sites require prolon gation of the treatment period. OBJECTIVE: We used a CO2 laser to remove the epidermis of the recipient sites for betteri results. METHODS: We treated lie localized vitiligo patients with CO2 laser to remove t.he epidermis and grafted suction blister rooves. We observed repigmentation and complications 1 month later. RESULTS & CONCLUSIONS : The superiority of this method is demonstrated by the fact 1) all prodedures can be completed on the day of operation 2) the incidence of hypertrophic scar and peripheral hypopigmented halos can be observed.The problems of this method are 1) uneven repigmentation of recipient. sites 2) hyperpigrnentation of recipient sites