Cancer-Specific Sequences in the Diagnosis and Treatment of NUT Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#NUT carcinoma (NC) is a solid tumor caused by the rearrangement of NUTM1 that usually develops in midline structures, such as the thorax. No standard treatment has been established despite high lethality. Thus, we investigated whether targeting the junction region of NUTM1 fusion breakpoints could serve as a potential treatment option for NC. @*Materials and Methods@#We designed and evaluated a series of small interfering RNAs (siRNAs) targeting the junction region of BRD4-NUTM1 fusion (B4N), the most common form of NUTM1 fusion. Droplet digital polymerase chain reaction using the blood of patients was also tested to evaluate the treatment responses by the junction sequence of the B4N fusion transcripts. @*Results@#As expected, the majority of NC fusion types were B4N (12 of 18, 67%). B4N fusion-specific siRNA treatment on NC cells showed specific inhibitory effects on the B4N fusion transcript and fusion protein without affecting the endogenous expression of the parent genes, resulting in decreased relative cell growth and attenuation of tumor size. In addition, the fusion transcript levels in platelet-rich-plasma samples of the NC patients with systemic metastasis showed a negative correlation with therapeutic effect, suggesting its potential as a measure of treatment responsiveness. @*Conclusion@#This study suggests that tumor-specific sequences could be used to treat patients with fusion genes as part of precision medicine for a rare but deadly disease.

Interlaboratory Comparison Study (Ring Test) of Next-Generation Sequencing–Based NTRK Fusion Detection in South Korea / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Tropomyosin receptor kinase (TRK) inhibitors are approved for the treatment of neurotrophic receptor tyrosine kinase (NTRK) fusion-positive tumors. The detection of NTRK fusion using a validated method is required before therapeutic application. An interlaboratory comparison study of next-generation sequencing (NGS)–based NTRK gene fusion detection with validated clinical samples was conducted at six major hospitals in South Korea. @*Materials and Methods@#A total of 18 samples, including a positive standard reference and eight positive and nine negative clinical samples, were validated using the VENTANA pan-TRK (EPR17341) and TruSight Oncology 500 assays. These samples were then tested using four different NGS panels currently being used at the six participating institutions. @*Results@#NTRK fusions were not detected in any of the nine negative clinical samples, demonstrating 100% specificity in all six participating institutions. All assays showed 100% analytical sensitivity to identify the NTRK fusion status in formalin-fixed paraffin-embedded (FFPE) samples, although with variable clinical sensitivity. False-negative results were due to low tumor purity, poor RNA quality, and DNA-based sequencing panel. The RNA-based targeted NGS assay showed an overall high success rate of identifying NTRK fusion status in FFPE samples. @*Conclusion@#This study is the first to test the proficiency of NGS-based NTRK detection in South Korea with the largest participating institutions. RNA-based NGS assays to detect NTRK fusions can accurately characterize fusion transcripts if sufficient RNA of adequate quality is available. The comparative performance data will support the implementation of targeted NGS-based sequencing assays for NTRK fusion detection in routine diagnostics.

The Comparative Analysis of Mental Health Literacy in General Population:The Analysis of National Mental Health Literacy and Attitude Survey in 2021 / 정신신체의학

Objectives@#: The purpose of this study is to analyze Mental health literacy in General population. @*Methods@#: We analyze the National Mental Health Literacy and Attitude Survey Data in 2021. We investigate 2016 general population and evaluate sociodemographic characteristics, Mental health literacy and stigma. We utilize 4 Case vignette which consist of Major Depressive Disorder, Schizophrenia, Alcohol Use Disorder and Suicidal Ideation. @*Results@#: Schizophrenia (27.6%) have the lower disease recognition compare to Major Depressive Disorder (43.8%) and Alcohol Use Disorder (61.7%) (p<0.001). The stigma of Alcohol use disorder (52.8%) is highest and the stigma of Schizophrenia (47.2%) is the second highest (p<0.001). @*Conclusions@#: The education and overcoming the stigma in Mental health is needed in Schizophrenia and Alcohol Use Disorder.

Analysis of Awareness, Knowledge, and Behavior about Food Hygiene·Safety Among the elderly / 대한지역사회영양학회지

Objectives@#This study was conducted to investigate the awareness, knowledge, and behavior about food hygiene·safety among the elderly, and to provide basic data on this for their healthy dietary life. @*Methods@#The study was conducted through a survey using a self-administered questionnaire on 473 elderly people over 60 years old living in Seoul and Gyeonggido. The questionnaire was designed to examine general characteristics, meal preparation status, the relation between awareness, knowledge, food hygiene behavior, and safety. @*Results@#Among the particpants, 44.2% of the total people surveyed were elderly married couples, and 14.0% were single-person households. For men, most of the meals were prepared by the spouse (74.1%), and among women, 93.8% prepared their meals themselves (P < 0.001). 61.3% of the total subjects answered that they were very interested in food hygiene and safety. Men (32.4%) thought it was more difficult to collect food hygiene·safety information compared to women (14.0%, P < 0.001). The knowledge score about food hygiene·safety was 0.60 (P < 0.05) and the behavior score was 3.70 (P < 0.001). The correlation coefficient between knowledge and behavior according to food hygiene·safety was 0.371 (P < 0.001). @*Conclusions@#The food hygiene·safety behavior of the elderly was associated with knowledge (P < 0.001). Therefore, food hygiene·safety education is necessary to ensure information availability and promote the health of the elderly.

Analysis of Awareness, Knowledge, and Behavior about Food Hygiene·Safety Among the elderly / 대한지역사회영양학회지

Objectives@#This study was conducted to investigate the awareness, knowledge, and behavior about food hygiene·safety among the elderly, and to provide basic data on this for their healthy dietary life. @*Methods@#The study was conducted through a survey using a self-administered questionnaire on 473 elderly people over 60 years old living in Seoul and Gyeonggido. The questionnaire was designed to examine general characteristics, meal preparation status, the relation between awareness, knowledge, food hygiene behavior, and safety. @*Results@#Among the particpants, 44.2% of the total people surveyed were elderly married couples, and 14.0% were single-person households. For men, most of the meals were prepared by the spouse (74.1%), and among women, 93.8% prepared their meals themselves (P < 0.001). 61.3% of the total subjects answered that they were very interested in food hygiene and safety. Men (32.4%) thought it was more difficult to collect food hygiene·safety information compared to women (14.0%, P < 0.001). The knowledge score about food hygiene·safety was 0.60 (P < 0.05) and the behavior score was 3.70 (P < 0.001). The correlation coefficient between knowledge and behavior according to food hygiene·safety was 0.371 (P < 0.001). @*Conclusions@#The food hygiene·safety behavior of the elderly was associated with knowledge (P < 0.001). Therefore, food hygiene·safety education is necessary to ensure information availability and promote the health of the elderly.

TM4SF4 and LRRK2 Are Potential Therapeutic Targets in Lung and Breast Cancers through Outlier Analysis / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#To find biomarkers for disease, there have been constant attempts to investigate the genes that differ from those in the disease groups. However, the values that lie outside the overall pattern of a distribution, the outliers, are frequently excluded in traditional analytical methods as they are considered to be ‘some sort of problem.’ Such outliers may have a biologic role in the disease group. Thus, this study explored new biomarker using outlier analysis, and verified the suitability of therapeutic potential of two genes (TM4SF4 and LRRK2). @*Materials and Methods@#Modified Tukey’s fences outlier analysis was carried out to identify new biomarkers using the public gene expression datasets. And we verified the presence of the selected biomarkers in other clinical samples via customized gene expression panels and tissue microarrays. Moreover, a siRNA-based knockdown test was performed to evaluate the impact of the biomarkers on oncogenic phenotypes. @*Results@#TM4SF4 in lung cancer and LRRK2 in breast cancer were chosen as candidates among the genes derived from the analysis. TM4SF4 and LRRK2 were overexpressed in the small number of samples with lung cancer (4.20%) and breast cancer (2.42%), respectively. Knockdown of TM4SF4 and LRRK2 suppressed the growth of lung and breast cancer cell lines. The LRRK2 overexpressing cell lines were more sensitive to LRRK2-IN-1 than the LRRK2 under-expressing cell lines @*Conclusion@#Our modified outlier-based analysis method has proved to rescue biomarkers previously missed or unnoticed by traditional analysis showing TM4SF4 and LRRK2 are novel target candidates for lung and breast cancer, respectively.

Development and Effects of Combined Exercise and an Exercise Habit Formation Program for Undergraduate Nursing Students / 기본간호학회지

Purpose@#This study was conducted to develop and test the effects of a combined exercise and exercise habit formation program for undergraduate nursing students. @*Methods@#A non-equivalent control group pre-post test design was used. The participants were 44 students (experimental group: 23, control group: 21) who had not done regular exercise for over 3 months before this study. The program was developed based on theory of planned behavior and the habit formation model. The program consisted of 24 sessions for 8 weeks and included combined exercise (aerobic exercise 30 minutes, resistance exercise 20 minutes, and flexibility exercise 10 minutes), exercise intention promotion strategy and exercise habit formation strategy (30 minutes, weekly). Data collection was done before, and immediately after the program: September 4 to October 29. Data were analyzed using t-test, paired t-test, x2 test, Mann-Whitney U test, and Wilcoxon signed rank-sum test with SPSS/ WIN 21.0 program. @*Results@#Exercise intention, exercise habit strength, exercise behavior, and physical fitness (cardiopulmonary endurance, muscle strength, and muscle endurance) were significantly better and stress and fatigue were significantly lower in the experimental group compared to the control group. @*Conclusion@#The study findings indicate that the combined exercise and exercise habit formation program for undergraduate nursing students was effective and can be recommended as an intervention for improving healthy lifestyle of undergraduate nursing students.

Clinical Usefulness of Contrast-Enhanced Computed Tomography in Patients with Non-Obstructive Acute Pyleonephritis / 고신대학교의과대학학술지

Objectives@#The aim of this study is to investigate the clinical utility of contrast-enhanced computed tomography (CECT) in patient with non-obstrcutive acute pyelonephritis (APN). @*Methods@#From 2007 to 2013, 537 APN patients who underwent a CE-CT scan within 24 hours after hospital admission were enrolled. We divided these patients into greater (50% or greater involvment, n = 143) and lesser (less than 50% involvement, n = 394) groups based on renal parenchymal involvement in CE-CT examination. We compared clinical characteristics between two groups and analyzed the clinical value of CE-CT scan as a reliable marker for predicting clinical severity and disease course in patient with non-obstructive APN. @*Results@#The mean estimated glomerular filtration rate was 70.6 ± 25.5 mL/min/1.73m2. Compared with patients in lesser group, the patients in greater group had lower serum albumin levels (3.5 ± 0.5 vs 3.8 ± 0.6, P < 0.01) and longer hosptal stay (10.1 ± 4.7 vs 8.8 ± 4.5, P < 0.05). In addition, acute kidney injury (AKI) (23.1% vs 11.4%, P < 0.005) and bacteremia (36.4% vs 26.8%, P = 0.02) were frequently developed in greater group, respectively. The overall incidence of AKI was 14.8% based on RIFLE criteria. In a multivariate logistic regression analysis for predciting AKI, age, presence of diabetes mellitus and the presence of renal parenchymal involvement of greater than 50% in CE-CT were significant predictors of AKI. @*Conclusions@#The CE-CT scan could be useful to predict the clinical severity and course in non-obstructive APN patients with preserved renal function.

Clinical significance of abnormal chest radiographic findings for acute kidney injury in patients with scrub typhus

Background@#Abnormal chest radiographs are frequently encountered in patients with scrub typhus. This study aimed to investigate whether chest radiography on admission is significant as a predictive factor for acute kidney injury (AKI) in patients with scrub typhus. @*Methods@#From 2010 to 2016, 467 patients were diagnosed with scrub typhus in our hospital. We divided the patients into two groups: normal chest radiograph (NCR) and abnormal chest radiograph (AbNCR), based on chest radiography findings. The incidence, clinical characteristics, and severity of AKI were compared between AKI and non- AKI groups according to the RIFLE classification. @*Results@#Of the 467 patients, 96 (20.6%) constituted the AbNCR group. Compared with NCR patients, AbNCR patients were older (71 ± 11 vs. 62 ± 13 years, P < 0.001) and had higher total leukocyte counts (9.43 × 103/mL vs. 6.98 × 103/mL, P < 0.001). The AbNCR group had significantly longer duration of hospital stay (8.9 ± 5.5 vs. 6.3 ± 2.8 days, P < 0.001) and higher incidence of AKI (46.9% vs. 15.1%, P < 0.001). The common abnormal chest radiographic findings were pulmonary abnormalities, such as pulmonary congestion and pleural effusion. The overall AKI incidence was 21.6%, of which 12.4%, 7.9%, and 1.3% cases were classified as risk, injury, and failure, respectively. In a multivariable logistic regression analysis for association with AKI, old age, presence of chronic kidney disease or hypertension, leukocytosis, hypoalbuminemia, and chest radiographic abnormalities on admission were significant predictors of AKI. @*Conclusion@#Chest radiographic abnormalities on admission were independently associated with AKI in patients with scrub typhus.

Primary Effusion Lymphoma in a Non-Human Immunodeficiency Virus Patient: A Case Report

Primary effusion lymphoma is a large cell non-Hodgkin lymphoma exclusively presenting with effusions in body cavities in absence of solid tumor masses. It is typically associated with human herpesvirus 8 infection in immunocompromised patients with human immunodeficiency virus (HIV) infection. We report herein a case of primary effusion lymphoma in a HIV-negative patient.

Prevalence of Mutations in Discoidin Domain-Containing Receptor Tyrosine Kinase 2 (DDR2) in Squamous Cell Lung Cancers in Korean Patients / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The discoidin domain-containing receptor tyrosine kinase 2 (DDR2) is known to contain mutations in a small subset of patients with squamous cell carcinomas (SCC) of the lung. Studying the DDR2 mutations in patients with SCC of the lung would advance our understanding and guide the development of therapeutic strategies against lung cancer. MATERIALS AND METHODS: We selected 100 samples through a preliminary genetic screen, including specimens from biopsies and surgical resection, and confirmed SCC by histologic examination. DDR2 mutations on exons 6, 15, 16, and 18 were analyzed by Sanger sequencing of formalin-fixed, paraffin-embedded tissue samples. The functional effects of novel DDR2 mutants were confirmed by in vitro assays. RESULTS: We identified novel somatic mutations of DDR2 in two of the 100 SCC samples studied. One mutation was c.1745T>A (p.V582E) and the other was c.1784T>C (p.L595P), and both were on exon 15. Both patients were smokers and EGFR/KRAS/ALK-triple negative. The expression of the mutant DDR2 induced activation of DDR2 by the collagen ligand and caused enhanced cell growth and tumor progression. Moreover, dasatinib, a DDR2 inhibitor, showed potential efficacy against DDR2 L595P mutant–bearing cells. CONCLUSION: Our results suggest that a mutation in DDR2 occurs naturally with a frequency of about 2% in Korean lung SCC patients. In addition, we showed that each of the novel DDR2 mutations were located in a kinase domain and induced an increase in cell proliferation rate.

SEC31A-ALK Fusion Gene in Lung Adenocarcinoma / Journal of the Korean Cancer Association, 대한암학회지

Anaplastic lymphoma kinase (ALK) fusion is a common mechanism underlying pathogenesis of non-small cell lung carcinoma (NSCLC) where these rearrangements represent important diagnostic and therapeutic targets. In this study, we found a new ALK fusion gene, SEC31A-ALK, in lung carcinoma from a 53-year-old Korean man. The conjoined region in the fusion transcript was generated by the fusion of SEC31A exon 21 and ALK exon 20 by genomic rearrangement, which contributed to generation of an intact, in-frame open reading frame. SEC31A-ALK encodes a predicted fusion protein of 1,438 amino acids comprising the WD40 domain of SEC31A at the N-terminus and ALK kinase domain at the C-terminus. Fluorescence in situ hybridization studies suggested that SEC31A-ALK was generated by an unbalanced genomic rearrangement associated with loss of the 3'-end of SEC31A. This is the first report of SEC31A-ALK fusion transcript in clinical NSCLC, which could be a novel diagnostic and therapeutic target for patients with NSCLC.

Effect of Epidural Electrical Stimulation and Repetitive Transcranial Magnetic Stimulation in Rats With Diffuse Traumatic Brain Injury

OBJECTIVE: To evaluate the effects of epidural electrical stimulation (EES) and repetitive transcranial magnetic stimulation (rTMS) on motor recovery and brain activity in a rat model of diffuse traumatic brain injury (TBI) compared to the control group. METHODS: Thirty rats weighing 270-285 g with diffuse TBI with 45 kg/cm2 using a weight-drop model were assigned to one of three groups: the EES group (ES) (anodal electrical stimulation at 50 Hz), the rTMS group (MS) (magnetic stimulation at 10 Hz, 3-second stimulation with 6-second intervals, 4,000 total stimulations per day), and the sham-treated control group (sham) (no stimulation). They were pre-trained to perform a single-pellet reaching task (SPRT) and a rotarod test (RRT) for 14 days. Diffuse TBI was then induced and an electrode was implanted over the dominant motor cortex. The changes in SPRT success rate, RRT performance time rate and the expression of c-Fos after two weeks of EES or rTMS were tracked. RESULTS: SPRT improved significantly from day 8 to day 12 in the ES group and from day 4 to day 14 in the MS group (p<0.05) compared to the sham group. RRT improved significantly from day 6 to day 11 in ES and from day 4 to day 9 in MS compared to the sham group. The ES and MS groups showed increased expression of c-Fos in the cerebral cortex compared to the sham group. CONCLUSION: ES or MS in a rat model of diffuse TBI can be used to enhance motor recovery and brain activity.

Two Successfully Treated Cases of Pulmonary Fibrosis Due to Paraquat Poisoning

Paraquat poisoning can cause severe multiple organ failure involving the kidneys, liver, lungs, adrenals, and central nervous system. The toxic effect of paraquat on the lung manifests as pulmonary edema, hypoxia, respiratory failure, and pulmonary fibrosis. However, optimal guidelines for treatment of lung fibrosis following paraquat ingestion are not available. We experienced two cases, a 45-year-old Korean male and a 66-year-old Korean male, who visited the emergency center because of paraquat poisoning. They initially received methylprednisolone pulse therapy and cyclophosphamide. Then they experienced pulmonary fibrosis approximately 10 days after admission during renal recovery. Although steroid pulse therapy with cyclophosphamide was reported to reduce mortality due to paraquat poisoning, the side effects of cyclophosphamide treatment were concerning in our patients, who had already received cyclophosphamide. Therefore, we decided to repeat steroid pulse therapy without cyclophosphamide. Fortunately, pulmonary fibrosis in these two patients resolved after repeated steroid pulse therapy. Thus, steroid pulse therapy alone could benefit patients with lung fibrosis, who have already received steroid and cyclophosphamide treatment. Herein, we report on two cases of pulmonary fibrosis due to paraquat poisoning that were treated successfully with repeated steroid pulse therapy.

Balloon Dilatation for an Esophageal Stricture by Long-Term Use of a Nasogastric Tube: A Case Report

In the present report, we describe a case of long-term follow-up esophageal stricture occurring in a patient with nasogastric tube use. A 63-year-old man who had experienced dislocation of the 6th and 7th cervical vertebrae as the result of an external injury received treatment at another hospital and was admitted to the rehabilitation department of our hospital. After he exhibited normal swallowing in a videofluoroscopic swallowing test, the nasogastric tube was removed and oral feeding with a dysphagia diet was initiated. However, during oral feeding, the patient complained of swallowing difficulties in his lower throat. An esophagogastroduodenoscopy was performed to examine the lesions below the pharynx and a 2-mm stricture was observed. A balloon dilatation was performed for a total of 9 times to extend the stricture. After the procedure, the patient was able to easily swallow a normal diet through the esophagus and the vomiting symptoms disappeared. An esophagography showed that the diameter of the esophageal stricture was 11 mm.

Antidepressant-Like Effects of Lycii Radicis Cortex and Betaine in the Forced Swimming Test in Rats

The purpose of the present study was to examine the effect of Lycii Radicis Cortex (LRC) and betaine (BT) on immobility and neurochemical change in the forced swimming test (FST) in the rat. LRC, BT or fluoxentine was administered intraperitoneally to Sprague-Dawley rats three times (1, 5 and 23.5 h) before the FST. To investigate antidepressant-like effect, serotonin (5-HT) and norepinephrine (NE) were examined in the hippocampus and hypothalamus of rats. LRC (100 mg/kg) and BT (30, 100 mg/kg) significantly decreased the immobility time in the FST. LRC (100 mg/kg) significantly increased both 5-HT and NE levels in the hypothalamus of rats exposed to FST. BT (100 mg/kg) significantly increased 5-HT levels in the hypothalamus and hippocampus of rats. Taken together, these results demonstrated that improvement in the behavioral changes after LRC and BT administration may be mediated by elevation of 5-HT level in the hypothalamus and hippocampus, indicating a possible antidepressant-like activity. The present results suggest that the efficacy of LRC and BT in an animal model of depression may provide anti-depressant effects in human, which remains to be determined.

The Characteristics of Supramammillary Cells Projecting to the Hippocampus in Stress Response in the Rat

The hypothalamus-pituitary-adrenocortex (HPA) axis is the central mediator of the stress response. The supramammillary (SuM) region is relatively unique among the hypothalamic structures in that it sends a large, direct projection to the hippocampal formation. It has been shown that mild stress could activate the SuM cells that project to the hippocampus. However, the role of these cell populations in modulating the stress response is not known. The present study examined the effect of stress on different populations of SuM cells that project to the hippocampus by injecting the fluorescent retrograde tracer, fluorogold (FG), into the hippocampus and utilizing the immunohistochemistry of choline acetyltransferase (ChAT), corticotrophin releasing factor (CRF), serotonin (5-HT), glutamate decarboxylase (GAD), tyrosine hydroxylase (TH) and NADPH-d reactivity. Immobilization (IMO) stress (2 hr) produced an increase in the expression of ChAT-immunoreactivity, and tended to increase in CRF, 5-HT, GAD, TH-immunoreactivity and nitric oxide (NO)-reactivity in the SuM cells. Fifty-three percent of 5-HT, 31% of ChAT and 56% of CRF cells were double stained with retrograde cells from the hippocampus. By contrast, a few retrogradely labeled cells projecting to the hippocampus were immunoreactive for dopamine, gamma-aminobutyric acid (GABA) and NO. These results suggest that the SuM region contains distinct cell populations that differentially respond to stress. In addition, the findings suggest that serotonergic, cholinergic and corticotropin releasing cells projecting to the hippocampus within the SuM nucleus may play an important role in modulating stress-related behaviors.

Anti-doping education and dietary supplementation practice in Korean elite university athletes

This study was conducted to investigate relationships and gender differences in dietary supplement (DS) and oriental supplement (OS) prevalence as well as anti-doping awareness during training and the game period. Korea National Sport University athletes (343 male and 136 female) participated in this study and completed DS and OS practice and anti-doping awareness questionnaires. Forty-six percent of athletes used DS during the training period, and there was significantly higher DS use in females (53%) compared to males (43%) (P < 0.05). Twenty-eight percent of athletes used OS, and there was significantly higher OS use in females (35%) than males (26%) (P < 0.05) during the training period. The primary reason of DS use was to supply energy both in males (36%) and females (28%). The main reason for male athletes' OS use was to supply energy (41%). Meanwhile, the reasons for female athletes' OS use were to supply energy (23%), to maintain health (19%), and to improve recovery ability (20%), which showed a significant gender difference (P < 0.05). Athletes rated their perceived degree of satisfaction, perceived importance, and beliefs in efficacy of DS and OS use all over 50% during the training period, and no gender differences were detected. In a comparison between athletes educated about anti-doping (at least more than one time) and non-received athletes, DS and OS use during the training period was 2.30 (1.47-3.60) and 1.71 (1.03-2.82), respectively. DS and OS use immediately before the game period was 2.38 (1.50-3.80) and 3.99 (1.20-13.28), respectively. Elite athletes' anti-doping education was highly related to increased DS use during the training period and immediately before the game. Although elite athletes use various DS and OS during the training period and before the game period, doping education for elite athletes is related with DS and OS use during the training period and before the game.

Meigs' syndrome with elevated serum CA125 level / 대한산부인과학회지

Meigs' syndrome is characterized by the pleural effusion and ascites in patient with solid benign ovarian tumors and the resolution of the effusion after resection of the tumor. Elevated serum CA125 levels in postmenopausal women with solid adnexal masses, ascites and pleural effusion are highly suggestive for malignant ovary tumor. We present a case of Meigs' syndrome with elevated serum CA125.

Incidence of Patent Foramen Ovale in Ischemic Stroke Patients: A Transcranial Doppler Study

BACKGROUND: Patent foramen ovale (PFO) is increasingly being recognized in stroke patients. The capability of transcranial Doppler (TCD) to detect a PFO has been established. We studied the frequency of PFO in patients with ischemic stroke. METHODS: Eighty-nine patients with ischemic stroke (62 men, mean age: 56.5) consecutively underwent a contrast-enhanced TCD with monitoring of the bilateral middle cerebral arteries (MCA). The contrast solution, which consisted of 8 ml of normal saline, 1 ml of air, and 0.2 ml of patient's blood, was injected twice during normal breathing and the Valsalva maneuver. High intensity transient signals (HITS) were counted for 30 seconds after the injection. RESULTS: Patent foramen ovale was detected in 19 patients (21%). The mean age was similar in those with (55 years) and those without (57 years) PFO. Patent foramen ovale was more frequent among men (26%) than women (11%). There were no differences in the frequency of PFO among stroke subtypes (large artery atherosclerosis, 18%; small artery occlusion, 27%; cardioembolic, 27%; undetermined cause, 11%). CONCLUSIONS: Patent foramen ovale is common in patients with ischemic stroke of all subtypes.