Neural Substrates of Aphasia in Acute Left Hemispheric Stroke Using VoxelBased Lesion-symptom Brain Mapping

It is unclear how these brain lesions fit into the language processing in acute stroke. In this study, we aimed to investigate the neuroanatomical lesion related to language processing in acute stage of stroke patients using voxel-based lesion-symptom mapping (VLSM). 73 acute first-ever post-stroke patients were enrolled in this retrospective study, who had undertaken brain magnetic resonance imaging (MRI) and Korean version of the Western Aphasia Test within 1 month from onset. Each voxel was compared with aphasia quotient and subtest scores as dependent variables using VLSM. The aphasia group showed significantly much more involvement of extra-nuclear area, insula, inferior frontal gyrus and superior temporal gyrus compared to non-aphasia group. The deficit of spontaneous speech domain was associated with the inferior parietal lobule, inferior and middle frontal gyrus and insula.The insular cortex, inferior parietal lobule, inferior frontal gyrus, middle frontal gyrus and superior temporal gyrus were related to deficit of comprehension. The inferior parietal lobule, insula, precentral gyrus, inferior frontal gyrus were related to the deficit of repetition. The deficit of naming was related to inferior parietal lobule, insula and inferior frontal gyrus. In conclusion, VLSM from early MRI imaging study after stroke may be useful to understand the language process network and establish early rehabilitation strategies after stroke.

Characteristics and Risk Factors of Aspiration in Lateral Medullary Infarction / 대한연하장애학회지

Objective@#To evaluate the characteristics of dysphagia and identify the risk factors of bolus aspiration in patients presenting with pure lateral medullary infarction (LMI). @*Methods@#Between January 2014 and January 2019, 51 post-stroke patients with LMI who underwent a videofluoroscopic swallowing study (VFSS) were enrolled retrospectively, and their medical records and brain magnetic resonance imaging results were reviewed. The VFSS results were evaluated to analyze the swallowing function using the penetration-aspiration scale, functional dysphagia scale, and imaging analysis software. @*Results@#Bolus aspiration was detected in 21 patients (41.2%). The common abnormal VFSS findings were residue in valleculae (74.5%), delayed triggering of pharyngeal swallow (72.5%), residue in pyriform sinuses (62.7%), delayed pharyngeal transit time (56.9%), reduced laryngeal elevation (51.0%), and coating of the pharyngeal wall (49.0%). The incidence of aspiration was significantly higher in the typical lesions (including the diagonal band-shaped lesions) and the large type lesions extending ventrally or dorsally, as compared to other lesion types (P＜0.05). Logistic regression analyses revealed that the residue in pyriform sinuses is a significant independent risk factor of aspiration in the puree trial, and prolonged pharyngeal delay time (PDT) and residue in valleculae are significant risk factors in the thin liquid trial (P＜0.05). @*Conclusion@#Considering all clinical factors, lesion locations, and swallowing processes, results of the current study indicate that residue in pyriform sinuses is an independent risk factor of aspiration in the swallowing puree technique, whereas prolonged PDT and residue in valleculae are independent risk factors of aspiration in the swallowing liquid technique.

Effect of immune-enhancing enteral nutrition formula enriched with plant-derived n-3 fatty acids on natural killer cell activity in rehabilitation patients

BACKGROUND/OBJECTIVES: Enteral nutrition formulas with immune-enhancing nutrients, such as n-3 fatty acids, may manage patients' nutritional status and pathophysiological processes. The aim of our study was to investigate natural killer (NK) cell activity alterations and related cytokine changes resulting from feeding with soybean oil-containing enteral nutrition formula (control group) and plant-derived n-3 fatty acid-enriched enteral nutrition formula. SUBJECTS/METHODS: Subjects participated for 14 consecutive days and consumed enteral formula containing canola and flaxseed oil (n3EN, test group) in nonsurgical patients hospitalized for rehabilitation. Blood samples were collected on the first day and 14 days after the consumption of each formula daily, and anthropometric parameters were collected. Hematology and biochemical values were analyzed, and NK cell activities and serum cytokine concentration were measured. A total of sixty subjects were included in the analysis, excluding dropouts. RESULTS: No significant differences were found in biochemical parameters. The n3EN group's NK cell activities at effector:tumor cell ratios of 10:1, 5:1, 2.5:1 and 0.625:1 were significantly higher than those of the control group after two weeks (P < 0.05). However, there were no statistically significant differences in serum cytokine interleukin (IL)-12, interferon-γ, IL-1β, IL-6 and tumor necrosis factor-α values between the two groups. CONCLUSIONS: In conclusion, this study elucidates the beneficial effects of plant-derived n-3 fatty acid supplementation in enteral formula on NK cell activity.

Effects of Repetitive High Frequency Motor Cortex Transcranial Magnetic Stimulation and Cortical Disinhibition in Diabetic Patients with Neuropathic Pain: A Case Control Study

OBJECTIVE: To investigate the cortical disinhibition in diabetic patients with neuropathic pain and without pain. In addition, we assessed the cortical disinhibition and pain relief after repetitive transcranial magnetic stimulation (rTMS).METHOD: We recruited diabetic patients with neuropathic pain (n = 15) and without pain (n = 15). We compared the TMS parameters such as motor evoked potential (MEP) amplitude, cortical silent period (CSP), intracortical inhibition (ICI %) and intracortical facilitation (ICF %) between two groups. Moreover, we evaluated the changes of pain and TMS parameters after five consecutive high frequency (10 Hz) rTMS sessions in diabetic patients with neuropathic pain. The neuropathic pain intensity (visual analog scale) and TMS parameters were assessed on pre-rTMS, post-rTMS 1day, and post-rTMS 5 day.RESULTS: The comparison of the CSP, ICI % revealed significant differences between two groups (p<0.01). After rTMS sessions, the decrease in pain intensity across the three time points revealed a pattern of significant differences (p<0.01). The change of CSP and ICI % across the three test points revealed a pattern of significant differences (p<0.01). The ICI % revealed immediate increase after first rTMS application and significant increase after five rTMS application (p<0.01) in diabetic patients with neuropathic pain. The MEP amplitude and ICF % did not reveal any significant changes.CONCLUSION: Our findings demonstrate that cortical inhibition was decreased in diabetic patients with neuropathic pain compared with patients without pain. Furthermore, we also identified that five daily rTMS sessions restored the defective intracortical inhibition which related to improvement of neuropathic pain in diabetic patients.

Visual Evoked Potential Using Head-Mounted Display Versus Cathode Ray Tube: A Pilot Study

OBJECTIVE: To present a new stimulation method based on the use of a head-mounted display (HMD) during pattern reversal visual evoked potential (PR-VEP) testing and to compare variables of HMD to those of conventional cathode ray tube (CRT). METHODS: Twenty-three normal subjects without visual problems were recruited. PR-VEPs were generated using CRT or HMD stimuli. VEP outcome measures included latencies (N75, P100, and N145) and peak-to-peak amplitudes (N75-P100 and P100-N145). Subjective discomfort associated with HMD was determined using a self-administered questionnaire. RESULTS: PR-VEPs generated by HMD stimuli showed typical triphasic waveforms, the components of which were found to be correlated with those obtained using conventional CRT stimuli. Self-administered discomfort questionnaires revealed that HMD was more comfortable in some aspects. It allowed subjects to concentrate better than CRT. CONCLUSION: The described HMD stimulation can be used as an alternative to the standard CRT stimulation for PR-VEPs. PR-VEP testing using HMD has potential applications in clinical practice and visual system research because HMD can be used on a wider range of subjects compared to CRT.

Ultrasound-Guided Myofascial Trigger Point Injection Into Brachialis Muscle for Rotator Cuff Disease Patients With Upper Arm Pain: A Pilot Study

OBJECTIVE: To assess the efficacy of trigger point injection into brachialis muscle for rotator cuff disease patients with upper arm pain. METHODS: A prospective, randomized, and single-blinded clinical pilot trial was performed at university rehabilitation hospital. Twenty-one patients clinically diagnosed with rotator cuff disease suspected of having brachialis myofascial pain syndrome (MPS) were randomly allocated into two groups. Effect of ultrasound (US)-guided trigger point injection (n=11) and oral non-steroidal anti-inflammatory drug (NSAID) (n=10) was compared by visual analog scale (VAS). RESULTS: US-guided trigger point injection of brachialis muscle resulted in excellent outcome compared to the oral NSAID group. Mean VAS scores decreased significantly after 2 weeks of treatment compared to the baseline in both groups (7.3 vs. 4.5 in the injection group and 7.4 vs. 5.9 in the oral group). The decrease of the VAS score caused by injection (capital DE, CyrillicVAS=-2.8) was significantly larger than caused by oral NSAID (capital DE, CyrillicVAS=-1.5) (p<0.05). CONCLUSION: In patients with rotator cuff disease, US-guided trigger point injection of the brachialis muscle is safe and effective for both diagnosis and treatment when the cause of pain is suspected to be originated from the muscle.

Clinical Features and Associated Abnormalities in Children and Adolescents With Corpus Callosal Anomalies

Callosal anomalies are frequently associated with other central nervous system (CNS) and/or somatic anomalies. We retrospectively analyzed the clinical features of corpus callosal agenesis/hypoplasia accompanying other CNS and/or somatic anomalies. We reviewed the imaging and clinical information of patients who underwent brain magnetic resonance imaging in our hospital, between 2005 and 2012. Callosal anomalies were isolated in 13 patients, accompanied by other CNS anomalies in 10 patients, associated with only non-CNS somatic anomalies in four patients, and with both CNS and non-CNS abnormalities in four patients. Out of 31 patients, four developed normally, without impairments in motor or cognitive functions. Five of nine patients with cerebral palsy were accompanied by other CNS and/or somatic anomalies, and showed worse Gross Motor Function Classification System scores, compared with the other four patients with isolated callosal anomaly. In addition, patients with other CNS anomalies also had a higher seizure risk.

Analysis of Microsatellite Instability in Ovarian Epithelial Cancer

BACKGROUND: The aim of this study was to clarify the incidence and role of microsatellite instability (MSI) in sporadic ovarian epithelial cancers (OEC). We investigated the MSI status and mismatch repair (MMR) protein expression in OEC. METHODS: MSI was examined by fluorescence- based polymerase chain reaction using five NCI panel markers (BAT25, BAT26, D2S123, D5S346 and D17S250) in 46 cases of OEC. Immunohistochemistry (IHC) for hMLH1 and hMSH2 was performed. RESULTS: Seven cases (15.2%) exhibited high-frequency MSI (MSIH), one exhibited low-frequency MSI (MSI-L), and the remaining 38 demonstrated microsatellite stability (MSS). MSI-H in OEC was not associated with histologic grade, FIGO stage, tumor size, mitoses or histologic type. Loss of expression of either hMLH1 or hMSH2 was observed in 4 of the 7 (59.3%) MSI-H cases, whereas 4 of the 39 (10.3%) MSI-L or MSS tumors revealed loss of expression of MMR proteins. The sensitivity and specificity of immunohistochemistry for hMLH1 and hMSH2 were 57.1% and 89.7%. CONCLUSIONS: Our data suggest that a genetic defect in the MMR system might play a role in the carcinogenesis of a minor subset of sporadic OEC however, immunohistochemical testing for hMLH1 and hMSH2 cannot accurately determine microsatellite instability status in OEC.

The Utilization of Environment-Friendly Agricultural Products of College Students in the Seoul and Incheon Areas / 대한지역사회영양학회지

The purpose of study was to investigate the utilization of environment-friendly agricultural products of the college students attending nutrition education. The subjects were 387 college students (male 53.2%, female 46.8%) at universities in the Seoul and Incheon areas. A cross-sectional study was conducted by a self-administered questionnaire. The percentage of subjects who purchased environment-friendly agricultural products was 37.2%. The most purchased environment-friendly agricultural products were vegetables. The main reason for preferring the environment-friendly agricultural products was good for health (53.7%). Also, the main motive of purchasing the environment-friendly agricultural products was for health (87.5%). For the quality of the environment-friendly agricultural products, they answered 'safety' (4.19), 'freshness' (4.03) and 'nutrition' (3.90), respectively. For college students' right choices of environment-friendly agricultural products, information and consumer education on these products are necessary.

A Case of Stickler Syndrome with Large Eyeballs

Stickler syndrome is an autosomal dominant disorder of connective tissue with a wide range of expressivity and incomplete penetrance which is called hereditary progressive arthro-ophthalmopathy. Affected neohates may present with the Pierre-Robin syndrome, progressive myopia, retinal detachment, flat face, hypertelorism, progressive arthritis. Early recognition of the syndrome is important, not only for genetic counselling but also to offer a more precise prognosis and proper treatment of many serious disorders that may occur in affected children. We experienced a case of Stickler syndrome with large eyeballs in a 3-day-old female baby who showed Pierre-Robin anomaly, flat face, hypertelorism, epicanthal folds, long philtrum, micrognathia, deft palate, high congenital myopia, chorioretinal degeneration, thin habitus and hyperextensible joints.

A Case of Spontaneouse Hemothorax Associated with a Posterior Mediastinal Endodermal Sinus Tumor in a Female Patient

Primary endodermal sinus tumor (yolk sac tumor) of the mediastinum is rare. Most patients are young and male, and the great majority of tumors are found in the anterior mediastinum, and spontaneous hemothorax is a rare presentation of intrathoracic tumors. We report a case of spontaneous hemothorax associated with a posterior mediastinal endoderml sinus tumor occuring in a female patient. Brief review and related literatures were also presented.

A Case of Spondylothoracic Dysplasia with Congenital Heart Disease

We experienced a case of spondylothoracic dysplasia in a 1 day old male who has short neck with limitation of movement, asymmetric thorax, marked scoliosis and a systolic heart murmur. He was born with normal weight and full term. The history of his family and mother is not specific. On x-ray, multiple hemivertebrae in thorax, spina bifida and maldevelopmental thoacic cavity were detected. On echocardiogram, he had small ASD and PDA.

A Case of Intestinal Abnormal Rotation by Mesenteric Lymphangioma

Mesenteric lymphangioma was first recognized when an autopsy case was recorded in 1507 by Benevieni. It has been known clinically rare disease and probably a congenital developmental abnormality due to failure of drainage of peripheral primary lymphatic spaces. We experienced a case of abnormal rotation in intestine by mesenteric lymphangioma in a 8 years old male who showed vomiting and abdominal pain. A brief review of related literatures is also presented.