Multiple Antiplatelet Therapy in Ischemic Stroke Already on Antiplatelet Agents Based on the Linked Big Data for Stroke

Background@#Optimal antiplatelet strategy for patients with ischemic stroke who were already on single antiplatelet therapy (SAPT) remains to be elucidated. This study aimed to evaluate the effect of different antiplatelet regimens on vascular and safety outcomes at 1 year after non-cardioembolic stroke in patients previously on SAPT. @*Methods@#We identified 9,284 patients with acute non-cardioembolic ischemic stroke that occurred on SAPT using linked data. Patients were categorized into three groups according to antiplatelet strategy at discharge: 1) SAPT; 2) dual antiplatelet therapy (DAPT); and 3) triple antiplatelet therapy (TAPT). One-year outcomes included recurrent ischemic stroke, composite outcomes (recurrent ischemic stroke, myocardial infarction, intracerebral hemorrhage, and death), and major bleeding. @*Results@#Of 9,284 patients, 5,565 (59.9%) maintained SAPT, 3,638 (39.2%) were treated with DAPT, and 81 (0.9%) were treated with TAPT. Multiple antiplatelet therapy did not reduce the risks of 1-year recurrent stroke (DAPT, hazard ratio [HR], 1.08, 95% confidence interval [CI], 0.92–1.27, P = 0.339; TAPT, HR, 0.71, 95% CI, 0.27–1.91, P = 0.500) and 1-year composite outcome (DAPT, HR, 1.09, 95% CI, 0.68–1.97, P = 0.592; TAPT, HR, 1.46, 95% CI, 0.68–1.97, P = 0.592). However, the TAPT groups showed an increased risk of major bleeding complications (DAPT, HR, 1.23, 95% CI, 0.89–1.71, P = 0.208; TAPT, HR, 4.65, 95% CI, 2.01–10.74, P < 0.001). @*Conclusion@#Additional use of antiplatelet agents in patients with non-cardioembolic ischemic stroke who were already on SAPT did not reduce the 1-year incidence of vascular outcomes, although it increased the risk of bleeding complications.

Added Predictive Values of Proton Density Magnetic Resonance Imaging on Posterior Communicating Artery Aneurysms and Surrounding Soft Tissues with Simple Classification

Objective@#: Deciphering the anatomy of posterior communicating artery (PCoA) aneurysms in relation to surrounding structures is essential to determine adjuvant surgical procedures. However, it is difficult to predict surgical structures through preoperative imaging studies. We aimed to present anatomical structures using preoperative high-resolution three-dimensional proton densityweighted turbo spin-echo magnetic resonance (PDMR) imaging with simple classification. @*Methods@#: From January 2020 to April 2022, 30 patients underwent PDMR before microsurgical clipping for unruptured PCoA aneurysms in a single tertiary institute. We retrospectively reviewed the radiographic images and operative data of these patients. The structural relationship described by PDMR and intraoperative findings were compared. Subsequently, we classified aneurysms into two groups and analyzed the rate of adjuvant surgical procedures and contact with the surrounding structures. @*Results@#: Correlations between preoperative PDMR predictions and actual intraoperative findings for PCoA aneurysm contact to the oculomotor nerve, temporal uncus, and anterior petroclinoid fold (APCF) reported a diagnostic accuracy of 0.90, 0.87, and 0.90, respectively. In 12 patients (40.0%), an aneurysm dome was located on the plane of the oculomotor triangle and was classified as the infratentorial type. Compared to the supratentorial type PCoA aneurysm, adjuvant procedures were required more frequently (66.7% vs. 22.2%, p=0.024) for infratentorial type PCoA aneurysm clipping. @*Conclusion@#: Preoperative PCoA aneurysm categorization using PDMR can be helpful for predicting surgical complexity and planning of microsurgical clipping.

Epidemiology of Second Non-breast Primary Cancers among Survivors of Breast Cancer: A Korean Population–Based Study by the SMARTSHIP Group / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This study aimed to evaluate the incidence and prognosis of second non-breast primary cancer (SNBPC) among Korean survivors of breast cancer. @*Materials and Methods@#Data from the Korean National Health Insurance Service were searched to identify women who received curative surgery for initial breast cancer (IBC) between 2003 and 2008 (n=64,340). Among them, patients with the following characteristics were excluded: other cancer diagnosis before IBC (n=10,866), radiotherapy before IBC (n=349), absence of data on sex or age (n=371), or male (n=248). Accordingly, data of 52,506 women until December 2017 were analyzed. SNBPC was defined as a newly diagnosed SNBPC that occurred 5 years or more after IBC diagnosis. @*Results@#The median follow-up time of all patients was 12.13 years. SNBPC was developed in 3,084 (5.87%) women after a median of 7.61 years following IBC diagnosis. The 10-year incidence of SNBPC was 5.78% (95% confidence interval [CI], 5.56 to 6.00). Higher SNBPC incidence was found in survivors with the following factors: old age at IBC diagnosis, low household income, and receiving combined chemotherapy with endocrine therapy, whereas receiving radiotherapy was related to a lower incidence of SNBPC (hazard ratio, 0.89; p < 0.01). Among the patients with SNBPC, the 5-year survival rate was 62.28% (95% CI, 65.53 to 69.02). @*Conclusion@#Approximately 5% of breast cancer survivors developed SNBPC within 10 years after IBC diagnosis. The risk of SNBPC was associated with patient’s age at IBC diagnosis, income level, and a receipt of systemic treatments.

A Multi-Center Educational Research Regarding Breastfeeding for Pediatrics Residents in Korea

Purpose@#Pediatricians have a significant responsibility to educate mothers about the importance of breastfeeding. However, there have been minimal efforts in the courses of resident training in Korea. The purpose of this study is to evaluate the change in knowledge and attitude before and after a 4-week breastfeeding educational intervention among multicenter residents. @*Methods@#Prospective interventional educational research was designed for residents at eight training hospitals in Korea. Institutional reviews were obtained in each hospital. The education curriculum consisted of 14 courses regarding breastfeeding theory and practice. These materials were used to teach pediatric residents for 4 weeks. Knowledge-based tests were administered before the course, and re-tests were administered after the course using different test items of similar levels. Test scores and survey responses were compared before and after the intervention. @*Results@#A total of 73 residents (1st year 20, 2nd year 23, 3rd year 16, and 4th year residents 14) from eight training hospitals completed the intervention. Their average age was 30.3±2.9 years, 17 (23.3%) were male, 22 (30.1%) were married, and eight had more than one child of their own. The mean pre-test score was 61.8±13.4 and the mean post-test score was 78.3±7.5 (P<0.001). The inter-grade difference in the score was significant in the pre-test (P=0.005), but not significant in the post-test (P=0.155). There were more responses of obtaining confidence after the intervention (P<0.001). @*Conclusion@#In our study, pediatric residents showed improvement in their knowledge and confidence level after 4 weeks of the breastfeeding curriculum. This will provide a basis for future policymaking in the training of pediatric residents regarding breastfeeding in Korea.

Clinical Manifestations and Maternal and Perinatal Outcomes in Pregnancy Following Laboratory-Confirmed SARS-CoV-2 Infection in South Korea

Purpose@#To determine the clinical manifestations and maternal and perinatal outcomes in pregnant women with coronavirus disease 2019 (COVID-19). @*Methods@#We conducted a retrospective observational study of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to National Health Insurance Service (NHIS) Ilsan Hospital between August 2020 and October 2021. The maternal and perinatal outcomes were investigated. @*Results@#Among 184 pregnant women infected with SARS-CoV-2, 79 women delivered. Of the women who delivered, with 36 women giving birth during the quarantine period. At delivery, 45 women were positive for SARS-CoV-2 by polymerase chain reaction (PCR), whereas 34 women were negative. The most common clinical manifestations were cough (65.2%), fever (38.0%), and myalgia (33.2%). Regarding perinatal outcomes, none of the babies had an Apgar score <7 at 5 minutes, and none were intubated following the delivery. The preterm birth rate and small-for-gestational-age (SGA) rate were 15.2% and 16.5%, respectively. All babies who was delivered at NHIS Ilsan Hospital were negative for SARS-CoV-2 infection by PCR, which was evaluated using amniotic fluid, cord blood, neonatal nasopharyngeal and oropharyngeal swabs in the 1st and 2nd days following delivery, although 45 women were positive for SARS-CoV-2 infection by PCR at the time of delivery. @*Conclusion@#Most pregnant women with COVID-19 in South Korea were unlikely to manifest symptoms or present with a severe disease progression. The observed preterm birth rate and SGA rate were higher in women with COVID-19 than in those without COVID-19. However, there was no evidence of vertical transmission, and all babies were negative for SARS-CoV-2 infection during pregnancy.

Association Between Short-Term PASI90 Achievement and Drug Survival of Biologics in Patients with Psoriasis

Background@#With accumulating evidence that achieving a 90% improvement in the Psoriasis Area and Severity Index score (PASI90) has better correlation with improved healthrelated quality of life as compared to PASI75 achievement, there has been demand for establishing new treatment goals for psoriasis. @*Objective@#We investigated whether the short-term PASI90 achievement would predict longer drug survival as compared to PASI75 achievement. @*Methods@#This single-center retrospective cohort study reviewed 180 treatment series in 128 patients with plaque psoriasis, who were treated with tumor necrosis factor-alpha inhibitors (n=12), ustekinumab (n=88), secukinumab (n=23), guselkumab (n=45), and ixekizumab (n=12). The first effectiveness assessment, usually performed within 12 to 20 weeks, was considered a short-term treatment response to biologics. @*Results@#After adjustment for covariates, time-dependent Cox proportional hazards regression analysis showed that moderate responders (short-term achievement of ≥PASI75 but

Differences in Clinical Responses to Ustekinumab Treatment among Body Regions: Results from a Real-World Prospective, Observational, and Multi-Center Study in Korea

Background@#In psoriasis treatment, not all body regions improve simultaneously after clinical interventions. @*Objective@#This study was aimed at evaluating clinical responses across body regions, which may differentially influence patient treatment plans. @*Methods@#This prospective, observational, and multi-center study was conducted in Koreans who adhered to ustekinumab treatment based on criteria per local label and reimbursement guidelines. A total of 581 were included in this analysis. @*Results@#The mean (±standard deviation) psoriasis area severity index (PASI) score at baseline, age, disease duration, and body surface area (%) were 18.9±9.69, 44.2±13.29 years, 11.3±9.65 years, and 27.8±17.83, respectively. Across the head and neck, upper extremities, trunk, and lower extremities, the correlation between the PASI sub-scores for the upper and lower extremities was the highest (r=0.680). The mean PASI sub-score for the lower extremities was the highest at baseline. PASI90 and PASI100 scores were the highest for the head and neck region, indicating the highest response rates, while those for the lower extremities were consistently low at all visits. @*Conclusion@#We found differences in regional ustekinumab responses, with the lower extremities being the most difficult to treat. These findings should be considered in psoriasis treatment.

The Effect of Formula-based Nutritional Treatment on Colitis in a Murine Model

Background@#Exclusive enteral nutrition (EEN) induces remission in pediatric Crohn's disease (CD). The exact mechanism of EEN therapy in CD is unknown, but alteration of the intestinal microflora after EEN is thought to affect mucosal healing. To determine the link between EEN therapy and therapeutic efficacy in CD, we established a murine model of dextran sulfate sodium (DSS)-induced colitis and applied EEN therapy. @*Methods@#Eight-week-old C57BL/6 mice were administered DSS for 4 days to induce colitis, and either normal chow (NC) or EEN was administered for the following 4 days. The mice were grouped according to the feeding pattern after DSS administration: DSS/NC and DSS/ EEN groups. The clinical course was confirmed via daily observation of the weight and stool. Fecal samples were collected and 16sRNA sequencing was used. The mice were sacrificed to confirm colonic histopathology. @*Results@#Weight reduction and increase in disease activity were observed as the day progressed for 4 days after DSS administration. There was significant weight recovery and improvement in disease activity in the EEN group compared to that in the NC group. Verrucomicrobia and Proteobacteria abundances tended to increase and Bacteroidetes abundance decreased in the EEN group. In the EEN group, significant changes in the β-diversity of the microbiota were observed. In the analysis of microbiome species, abundances of Akkermansia muciniphila, Clostridium cocleatum, mucin-degrading bacteria, Flintibacter butyricus, and Parabacteroides goldsteinii, which are beneficial microbiota, were significantly increased in the EEN group compared to those in the NC group. More abundant mucins were confirmed in the colonic histopathology of the EEN group. These microbial and histopathological differences suggested that EEN might improve colitis symptoms in a murine colitis model by promoting mucin recycling and subsequently inducing the healing effect of the gut barrier. @*Conclusion@#EEN showed clinical efficacy in a murine model of colitis. Based on the increase in mucin-degrading bacteria and the pathological increase in mucin production after EEN administration, it can be observed that mucin plays an important role in the therapeutic effect of EEN.

Resistance Exercise Improves Spatial Learning Ability Through Phosphorylation of 5’-Adenosine Monophosphate-Activated Protein Kinase in Parkinson Disease Mice / 대한배뇨장애요실금학회지

Purpose@#Exercise is a representative noninvasive treatment that can be applied to various diseases. We studied the effect of resistance exercise on motor function and spatial learning ability in Parkinson disease (PD) mice. @*Methods@#The rotarod test and beam walking test were conducted to evaluate the effect of resistance exercise on motor function, and the Morris water maze test was conducted to examine the effect of resistance exercise on spatial learning ability. The effect of resistance exercise on brain-derived neurotrophic factor (BDNF) and tropomyosin receptor kinase B (TrkB) expression and 5’-adenosine monophosphate-activated protein kinase (AMPK) phosphorylation was investigated by Western blot analysis. New cell generation was confirmed by immunohistochemistry for 5-bromo-2’-deoxyuridine. @*Results@#Resistance exercise improved coordination, balance, and spatial learning ability in PD mice. Resistance exercise enhanced new cell production, BDNF and TrkB expression, and AMPK phosphorylation in PD mice. The effect of such resistance exercise was similar to that of levodopa application. @*Conclusions@#In PD-induced mice, resistance exercise enhanced AMPK phosphorylation to increase BDNF expression and new neuron generation, thereby improving spatial learning ability. Resistance exercise is believed to help improve symptoms of PD.

A Study of Clinical Characteristics in Korean Patients with Chronic Actinic Dermatitis / 대한피부과학회지

Background@#Chronic actinic dermatitis is a rare, acquired, persistent eczematous eruption of photo-distributed areas.There are limited data available on the clinical characteristics of Korean patients diagnosed with chronic actinic dermatitis. @*Objective@#To evaluate the clinical features and prognosis of chronic actinic dermatitis patients in Korea. @*Methods@#Sixty-two Korean patients diagnosed with chronic actinic dermatitis through clinical findings, phototesting, and skin biopsy from six hospitals were included in this study, and their clinical characteristics were evaluated. @*Results@#Among the 62 patients, 51 were men, and the mean age at diagnosis was 60.3±12.8 years. Phototesting was performed for 27 patients, with results available for 18 patients. Patch tests were performed for only 4.8% of the patients. Skin pathology tests were performed for 47 patients and showed the following: spongiosis, acanthosis, actinic elastosis, and pseudo-lymphomatous change. Twelve patients were clinically diagnosed without using diagnostic tools such as phototesting, patch testing, and skin biopsy. The most commonly used systemic treatments were antihistamine, cyclosporine, steroid, and azathioprine. Although avoiding ultraviolet irradiation and outdoor activities are critical, only 22.6% of patients used sunscreen. @*Conclusion@#Although phototesting is highly recommended for diagnosing chronic actinic dermatitis, phototesting was performed for less than half of the patients to diagnose chronic actinic dermatitis. Patch tests and photopatch tests are also recommended to disclose a causative agent.

A Study of Clinical Characteristics in Korean Patients with Chronic Actinic Dermatitis / 대한피부과학회지

Background@#Chronic actinic dermatitis is a rare, acquired, persistent eczematous eruption of photo-distributed areas.There are limited data available on the clinical characteristics of Korean patients diagnosed with chronic actinic dermatitis. @*Objective@#To evaluate the clinical features and prognosis of chronic actinic dermatitis patients in Korea. @*Methods@#Sixty-two Korean patients diagnosed with chronic actinic dermatitis through clinical findings, phototesting, and skin biopsy from six hospitals were included in this study, and their clinical characteristics were evaluated. @*Results@#Among the 62 patients, 51 were men, and the mean age at diagnosis was 60.3±12.8 years. Phototesting was performed for 27 patients, with results available for 18 patients. Patch tests were performed for only 4.8% of the patients. Skin pathology tests were performed for 47 patients and showed the following: spongiosis, acanthosis, actinic elastosis, and pseudo-lymphomatous change. Twelve patients were clinically diagnosed without using diagnostic tools such as phototesting, patch testing, and skin biopsy. The most commonly used systemic treatments were antihistamine, cyclosporine, steroid, and azathioprine. Although avoiding ultraviolet irradiation and outdoor activities are critical, only 22.6% of patients used sunscreen. @*Conclusion@#Although phototesting is highly recommended for diagnosing chronic actinic dermatitis, phototesting was performed for less than half of the patients to diagnose chronic actinic dermatitis. Patch tests and photopatch tests are also recommended to disclose a causative agent.

Eccrine Syringofibroadenoma Associated with Bowen's Disease: A Case Report and Review of the Literature

Imbalance of Gut Streptococcus, Clostridium, and Akkermansia Determines the Natural Course of Atopic Dermatitis in Infant

PURPOSE: The roles of gut microbiota on the natural course of atopic dermatitis (AD) are not yet fully understood. We investigated whether the composition and function of gut microbiota and short-chain fatty acids (SCFAs) at 6 months of age could affect the natural course of AD up to 24 months in early childhood.METHODS: Fecal samples from 132 infants were analyzed using pyrosequencing, including 84 healthy controls, 22 transient AD and 26 persistent AD subjects from the Cohort for Childhood Origin of Asthma and Allergic Diseases (COCOA) birth cohort. The functional profile of the gut microbiome was analyzed by whole-metagenome sequencing. SCFAs were measured using gas chromatography-mass spectrometry.RESULTS: Low levels of Streptococcus and high amounts of Akkermansia were evident in transient AD cases, and low Clostridium, Akkermansia and high Streptococcus were found in children with persistent AD. The relative abundance of Streptococcus positively correlated with scoring of AD (SCORAD) score, whereas that of Clostridium negatively correlated with SCORAD score. The persistent AD group showed decreased gut microbial functional genes related to oxidative phosphorylation compared with healthy controls. Butyrate and valerate levels were lower in transient AD infants compared with healthy and persistent AD infants.CONCLUSIONS: Compositions, functions and metabolites of the early gut microbiome are related to natural courses of AD in infants.

Clinical Factors for the Differential Diagnosis of Verruca Plana on the Head and Neck: A Study of Biopsy-proven Cases / 대한피부과학회지

Background@#Both verruca plana (VP) and seborrheic keratosis (SK) cause a major cosmetic concern. However, it is difficult to discriminate VP from SK presenting multiple tiny papules, especially those located on the face and neck. As VP and SK have different treatment strategies and prognoses, differentiation between them is important.Objective The objective of this study was to elucidate the clinical differential characteristics between VP and VP-like SK on the face and neck. @*Methods@#We retrospectively investigated patients who underwent skin biopsy for differentiating between VP and VP-like SK. Multivariable logistic regression analysis was conducted to identify factors associated with the differential diagnosis. @*Results@#Among 80 identified cases, 48.7% (n=39) was VP, and 51.3% (n=41) was VP-like SK. In the multivariable logistic regression analysis, larger than 3-mm, skin-like or pink lesion color, and confluent distribution were more likely to indicate VP than VP-like SK. @*Conclusion@#Our study proposed useful clinical differential characteristics between VP and VP-like SK on the face and neck in a large number of biopsy-proven cases. Still, there are exceptions. Therefore, in such confusing cases, skin biopsy to attain exact diagnosis is recommended.

Impact of the Dedicated Neurointensivists on the Outcome in Patients with Ischemic Stroke Based on the Linked Big Data for Stroke in Korea

Background@#Neurocritical care by dedicated neurointensivists may improve outcomes of critically ill patients with severe brain injury. In this study, we aimed to validate whether neurointensive care could improve the outcome in patients with critically ill acute ischemic stroke using the linked big dataset on stroke in Korea. @*Methods@#We included 1,405 acute ischemic stroke patients with mechanical ventilator support in the intensive care unit after an index stroke. Patients were retrieved from linking the Clinical Research Center for Stroke Registry and the Health Insurance Review and Assessment Service data from the period between January 2007 and December 2014. The outcomes were mortality at discharge and at 3 months after an index stroke. The main outcomes were compared between the centers with and without dedicated neurointensivists. @*Results@#Among the included patients, 303 (21.6%) were admitted to the centers with dedicated neurointensivists. The patients treated by dedicated neurointensivists had significantly lower in-hospital mortality (18.3% vs. 26.8%, P = 0.002) as well as lower mortality at 3-month (38.0% vs. 49.1%, P < 0.001) than those who were treated without neurointensivists. After adjusting for confounders, a treatment without neurointensivists was independently associated with higher in-hospital mortality (odds ratio [OR], 1.59; 95% confidence intervals [CIs], 1.13–2.25; P = 0.008) and 3-month mortality (OR, 1.48; 95% CIs, 1.12–1.95; P = 0.005). @*Conclusion@#Treatment by dedicated neurointensivists is associated with lower in-hospital and 3-month mortality using the linked big datasets for stroke in Korea. This finding stresses the importance of neurointensivists in treating patients with severe ischemic stroke.

Pervasive Misclassification and Misconception of Study Designs in Asian Dermatology Journals Listed in Science Citation Index-Expanded

Background@#Misclassification of study designs of journals can hinder the readers from assessing the strengths and weaknesses of the study and evaluating the applicability of the study in the real-world setting. However, it seems that it is common for authors to neglect to classify the study design. @*Objective@#We aimed to evaluate the accuracy of the classification of study designs and examine the common errors. @*Methods@#This descriptive study analyzed four Asian dermatology journals listed in the science citation index expanded from January 2018 to December 2018. We investigated discrepancies between author-reported and actual study designs.Design Algorithm for Medical Literature on Intervention (DAMI) was used to determine the actual study design. @*Results@#Of the 177 papers analyzed, only 72 articles (40.7%) revealed their study design and among them, 23 articles (32.0%) showed discrepancies between the author-reported and the actual study designs. Case-control studies were the most commonly misclassified study designs by authors. @*Conclusion@#There were considerable differences between the author-reported study design and the actual study design in Asian dermatology journals. Proper classification of study designs by the authors is essential to strengthen evidencebased medicine.

Evaluation of Prognostic Factors for the Parotid Cancer Treated With Surgery and Postoperative Radiotherapy

Objectives@#. To investigate the prognostic factors and treatment outcomes of primary parotid carcinoma treated with surgery and postoperative radiotherapy (PORT). @*Methods@#. We reviewed retrospectively 57 patients with primary parotid carcinoma who were treated with surgery and PORT between 2005 and 2014. Superficial parotidectomy was performed in 19 patients, total parotidectomy in 10 patients, and total parotidectomy with lymph node dissection in 28 patients PORT on the tumor bed was performed in 41 patients, while PORT on tumor bed and ipsilateral cervical lymph nodes was performed in 16 patients. @*Results@#. With a median follow-up of 66 months, the 5-year overall survival, disease-free survival, locoregional control, and distant control rates were 77.0%, 60.2%, 77.6%, and 72.8%, respectively. The 5-year overall survival by stage was 100%, 100%, 80.0%, and 46.4% in stage I, II, III, and IV, respectively. Recurrences at primary lesions were found in seven patients, while at cervical nodes in six patients. Distant recurrences were developed in 12 patients. No patient with the low and intermediate histologic grade developed distant failure. As prognostic factors, the histologic grade for overall survival (P=0.005), pathological T-stage (P=0.009) and differentiation grade (P=0.009) for disease-free survival, pathological T-stage for locoregional control (P=0.007), and lympho-vascular invasion (P=0.023) for distant recurrence were significant on multivariate analysis. @*Conclusion@#. This study revealed that differentiation grade, histologic grade, pathological T-stage, and lympho-vascular invasion were significant independent prognostic factors on clinical outcomes.

Imipramine Ameliorates Depressive Symptoms by Blocking Differential Alteration of Dendritic Spine Structure in Amygdala and Prefrontal Cortex of Chronic Stress-Induced Mice

Previous studies have shown disrupted synaptic plasticity and neural activity in depression. Such alteration is strongly associated with disrupted synaptic structures. Chronic stress has been known to induce changes in dendritic structure in the basolateral amygdala (BLA) and medial prefrontal cortex (mPFC), but antidepressant effect on structure of these brain areas has been unclear. Here, the effects of imipramine on dendritic spine density and morphology in BLA and mPFC subregions of stressed mice were examined. Chronic restraint stress caused depressive-like behaviors such as enhanced social avoidance and despair level coincident with differential changes in dendritic spine structure. Chronic stress enhanced dendritic spine density in the lateral nucleus of BLA with no significant change in the basal nucleus of BLA, and altered the proportion of stubby or mushroom spines in both subregions. Conversely, in the apical and basal mPFC, chronic stress caused a significant reduction in spine density. The proportion of stubby or mushroom spines in these subregions overall reduced while the proportion of thin spines increased after repeated stress. Interestingly, most of these structural alterations by chronic stress were reversed by imipramine. In addition, structural changes caused by stress and blocking the changes by imipramine were corelated well with altered activation and expression of synaptic plasticity-promoting molecules such as phospho-CREB, phospho-CAMKII, and PSD-95. Collectively, our data suggest that imipramine modulates stress-induced changes in synaptic structure and synaptic plasticity-promoting molecules in a coordinated manner although structural and molecular alterations induced by stress are distinct in the BLA and mPFC.

A fiberoptic orotracheal intubation successfully performed using a modified Guedel airway in a sedated emergency patient - A case report -

Background@#An airway assessment is usually best performed before an elective operation. But in an emergency operation, proper airway assessment can often be difficult. Fiberoptic intubation is a powerful and safe technique to deal with airway difficulty, but it requires a lot of training to be able to perform correctly. There are various specialized oral airways for fiberoptic intubation, but none of them have perfect functionality.CaseA 75-year-old male (body weight 71.6 kg, height 159.3 cm, body mass index 28.22 kg/m2) was diagnosed with acute appendicitis, and it was decided to do a laparoscopic appendectomy. After the induction of general anesthesia, it was impossible to insert the direct laryngoscope deep enough for vocal cord visualization without damaging the teeth because of limited mouth opening. We successfully performed fiberoptic intubation with a newly modified Guedel airway via a longitudinal channel on the convex side and a distal opened lingual end. @*Conclusions@#Our modified Guedel airway can be useful in assisting fiberoptic intubation in unexpectedly difficult airway situations.

Smoking Exposure and Placental Vascular Compromise: A Nationwide Population-Based Study in South Korea

PURPOSE: This study aims to investigate the effects of smoking on the development of placenta-associated syndromes, including preeclampsia, abruptio placentae, and placenta previa, which share the common pathophysiology of vascular compromise of the placenta. METHODS: A total of 966,629 pregnancies identified from the Korean National Insurance Claims Database and the National Health Information Database were analyzed from 2010 to 2014. The adjusted odds ratio and attributable risk of smoking for the development of placenta-associated syndromes, such as preeclampsia, placenta previa, and abruptio placentae, were analyzed. Maternal age, alcohol consumption, exercise habit, and economic status were controlled as confounding variables. A binary logistic regression model was used, and simple and multiple logistic regression analyses were performed. RESULTS: Among 966,629 pregnancies, 11.86% of women were ever smokers. Ever smokers had a higher risk of developing placenta previa (adjusted odds ratio, 1.23; 95% confidence interval [CI], 1.18–1.29; adjusted attributable risk, 18.70%). The adjusted odds ratio of developing placenta-associated syndromes in ever smokers compared to nonsmokers over the age of 35 years with a low economic status was 1.32 (95% CI, 1.18–1.47), with an adjusted attributable risk of 23.95%. CONCLUSION: The risk of developing placenta-associated syndromes, such as preeclampsia, placenta previa, and abruptio placentae, is high in ever smokers. Pregnant ever smokers who are >35 years and belong to the lower one-third of the economic division require special care to prevent the development of placenta-associated syndromes.