Exploration of the injured brachial plexus is very hard due to the close approximation with other vital structures and the anatomic complexity. It is essential to identify the exact level and type of traumatic brachial plexus injury (BPI) to decide the appropriate surgical approach for the injury and to infer the postoperative prognosis. However, it can be difficult to image the brachial plexus because of the anatomic properties. The purpose of this study is to analyze the diagnostic value of MRI according to various planes of the level and the type of the traumatic BPI. In sixty patients with traumatic BPI, whose diagnosis was confirmed by clinicopathological and surgical findings, the preoperative MRI films were reread retrospectively. Brachial plexus injuries were divided into two groups of preganglionic BPI and postganglionic BPI, and then postganglionic BPI was divided into 3 subgroups of Zone I, Zone II and Zone III by major adjacent structures such as scalenus anterior muscle and pectoralis minor muscle. The accuracy of MRI was investigated with the confirmed diagnosis on axial, sagittal and coronal planes. In preganglionic BPI, the accuracy of MRI was 96% on axial plane and it was statistically significant compared to sagittal and coronal planes. In postganglionic BPI, the accuracy of MRI was 100% on sagittal plane and 86% on coronal plane in Zone I, but it was not significant statistically. In Zone II and III the accuracy of MRI were 89% and 80% on sagittal plane, and 61% and 60% on coronal plane, but it was not significant statistically. In conclusion, the MRI can provide useful guidance to diagnose preganglionic and postganglionic BPI. Axial imaging is considered better for preganglionic lesion and sagittal imaging for postganglionic BPI, but it demands further study on larger number of subjects with traumatic RPI.
Brachial Plexus* ; Diagnosis ; Humans ; Magnetic Resonance Imaging* ; Prognosis ; Retrospective Studies

Parkinson’s disease (PD) is the second most prevalent neurodegenerative disorder and is characterized by progressive dopaminergic and nondopaminergic neuronal loss and the presence of Lewy bodies, which are primarily composed of aggregated α-synuclein. Despite advancements in symptomatic therapies, such as dopamine replacement and deep brain stimulation, no disease-modifying therapies (DMTs) have been identified to slow or arrest neurodegeneration in patients with PD. Challenges in DMT development include disease heterogeneity, the absence of reliable biomarkers, and the multifaceted pathophysiology of PD, encompassing neuroinflammation, mitochondrial dysfunction, lysosomal impairment, and oxidative stress. Drug repositioning and repurposing strategies using existing drugs for new therapeutic applications offer promising approaches to accelerate the development of DMTs for PD. These strategies minimize time, cost, and risk by using compounds with established safety profiles. Prominent candidates include glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, ambroxol, calcium channel blockers, statins, iron-chelating agents, c-Abl inhibitors, and memantine. Although preclinical and early clinical studies have demonstrated encouraging results, numerous phase III trials have yielded unfavorable outcomes, elucidating the complexity of PD pathophysiology and the need for innovative trial designs. This review evaluates the potential of prioritized repurposed drugs for PD, focusing on their mechanisms, preclinical evidence, and clinical trial outcomes, and highlights the ongoing challenges and opportunities in this field.

Parkinson’s disease (PD) is the second most prevalent neurodegenerative disorder and is characterized by progressive dopaminergic and nondopaminergic neuronal loss and the presence of Lewy bodies, which are primarily composed of aggregated α-synuclein. Despite advancements in symptomatic therapies, such as dopamine replacement and deep brain stimulation, no disease-modifying therapies (DMTs) have been identified to slow or arrest neurodegeneration in patients with PD. Challenges in DMT development include disease heterogeneity, the absence of reliable biomarkers, and the multifaceted pathophysiology of PD, encompassing neuroinflammation, mitochondrial dysfunction, lysosomal impairment, and oxidative stress. Drug repositioning and repurposing strategies using existing drugs for new therapeutic applications offer promising approaches to accelerate the development of DMTs for PD. These strategies minimize time, cost, and risk by using compounds with established safety profiles. Prominent candidates include glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, ambroxol, calcium channel blockers, statins, iron-chelating agents, c-Abl inhibitors, and memantine. Although preclinical and early clinical studies have demonstrated encouraging results, numerous phase III trials have yielded unfavorable outcomes, elucidating the complexity of PD pathophysiology and the need for innovative trial designs. This review evaluates the potential of prioritized repurposed drugs for PD, focusing on their mechanisms, preclinical evidence, and clinical trial outcomes, and highlights the ongoing challenges and opportunities in this field.

Parkinson’s disease (PD) is the second most prevalent neurodegenerative disorder and is characterized by progressive dopaminergic and nondopaminergic neuronal loss and the presence of Lewy bodies, which are primarily composed of aggregated α-synuclein. Despite advancements in symptomatic therapies, such as dopamine replacement and deep brain stimulation, no disease-modifying therapies (DMTs) have been identified to slow or arrest neurodegeneration in patients with PD. Challenges in DMT development include disease heterogeneity, the absence of reliable biomarkers, and the multifaceted pathophysiology of PD, encompassing neuroinflammation, mitochondrial dysfunction, lysosomal impairment, and oxidative stress. Drug repositioning and repurposing strategies using existing drugs for new therapeutic applications offer promising approaches to accelerate the development of DMTs for PD. These strategies minimize time, cost, and risk by using compounds with established safety profiles. Prominent candidates include glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, ambroxol, calcium channel blockers, statins, iron-chelating agents, c-Abl inhibitors, and memantine. Although preclinical and early clinical studies have demonstrated encouraging results, numerous phase III trials have yielded unfavorable outcomes, elucidating the complexity of PD pathophysiology and the need for innovative trial designs. This review evaluates the potential of prioritized repurposed drugs for PD, focusing on their mechanisms, preclinical evidence, and clinical trial outcomes, and highlights the ongoing challenges and opportunities in this field.

Cavernous hemangiomas rarely involve the female genital tract. It is difficult to identify vascular malformations when these lesions are concealed in the vagina or deep vulva area. We present a rare case of vaginal cavernous hemangioma in a 30-year-old primiparous woman with an early severe postpartum hemorrhage (PPH) and delayed continuous bleeding from the episiotomy site. She was treated successfully with transarterial embolization of the left vaginal artery. To our knowledge, this is the first reported case of PPH caused by rupture of a vaginal hemangioma during vaginal delivery in English literature.
Adult ; Arteries ; Episiotomy ; Female ; Hemangioma ; Hemangioma, Cavernous* ; Hemorrhage ; Humans ; Postpartum Hemorrhage* ; Postpartum Period* ; Rupture ; Vagina ; Vascular Malformations ; Vulva

Objective: The present study aimed to explore how the patterns of interaction between stress and positive resources differ according to the severity of depression and which resources play the most important role among the various positive resources. Methods: The study included 1,806 people who had visited a health screening center for a mental health check-up to evaluate the levels of perceived stress, positive resources, and depressive symptoms. The participants were divided into a depressive group (n=1,642, mean age 50.60, female 68%) and a non-depressive group (n=164, mean age 48.42, female 66.6%). We conducted hierarchical regression analyses and simple slope analyses to examine the interaction between perceived stress and positive resources. Results: The interaction between perceived stress and optimism was significantly associated with depression in non-depressive groups. In depressive groups, the interactions between five types of positive resources (optimism, purpose in life, self-control, social support and care) and perceived stress were all significantly related to depression. Conclusion Interventions that promote optimism can be helpful for preventing inevitable stress from leading to depression. A deficiency in positive resources may be a factor in aggravating depression in stressful situations for people reporting moderate to severe depressive symptoms.

Objectives: ：Although subclinical depression symptoms are associated with suicidal idea, most research have focused on clinical depression such as major depressive disorder or dysthymia. The aim of this study is to investigate network structure of depressive symptom and to reveal which symptoms are associated with suicidal ideation. Methods: ：We used part of data from the seventh Korea National Health and Nutrition Examination Survey. Participants were between 19 and 65 years of age (N=8,741). Network analysis with Isingfit model is used to reveal network structure of depressive symptoms and most central symptom and edges assessed by patient health questionnaire (PHQ-9). Results: ：The most two central symptoms were psychomotor activity and suicidal ideation. The strongest edge was psychomotor activity-suicidal ideation. Suicidal ideation also has strong association with depressive mood and worthlessness. Conclusions ：These results suggest that psychomotor activity and suicidal ideation can serve as treatment target for subclinical depression and psychomotor activity, worthlessness and depressed mood may be important factor for early intervention of suicidal ideation.

BACKGROUND: Spinal cord ischemic injury occurring after surgical repair of thoracoabdominal aortic disease leaves a devastating complication. The purpose of this study was to evaluate the effects of anesthetic preconditioning on neurologic outcome and Bcl-2 family protein gene expression in transient spinal ischemia. METHODS: In first experiment rats were divided by 4 groups and anesthetized with intraperitoneal propofol, enflurane, sevoflurane, or isoflurane. In second experiment, all rats were anesthetized with intraperitoneal propofol and enflurane, sevoflurane, isoflurane were given during 30 minutes and 14 minutes of spinal ischemia was induced 30 minutes later. Spinal ischemia was produced by both induced hypotension and thoracic aortic cross clamping. Neurologic scores were assessed 1, 3, 24, 48 hours after transient spinal ischemia. After 48 hours, rats were killed under anesthesia and spinal cords were removed for the assay of Bcl-2 family protein mRNA expression. RESULTS: The neurologic injury of S and I group were significantly lesser than P group. 30 minutes of anesthetic preconditioning with enflurane, sevoflurane, and isoflurane showed significantly better neurologic outcome compared to propofol, enflurane, sevoflurane, or isoflurane anesthetized rats. Bcl-2 family protein mRNA expression of I group and IP group were lesser than the other groups. CONCLUSIONS: Anesthetic preconditioning with volatile anesthetics for 30 minutes could reduce ischemic injury during transient spinal ischemia. The degree of neurologic injury may not be related to the expression of pro-apoptotic protein Bax. Isoflurane may have different influence on apoptosis after spinal ischemia compared to enflurane or sevoflurane.
Anesthesia ; Anesthetics ; Anesthetics, Inhalation ; Animals ; Aortic Diseases ; Apoptosis ; Constriction ; Enflurane ; Gene Expression ; Humans ; Hypotension ; Ischemia* ; Isoflurane ; Propofol ; Rats* ; RNA, Messenger* ; Spinal Cord ; Spinal Cord Ischemia

BACKGROUND: Spinal cord ischemic injury occurring after surgical repair of thoracoabdominal aortic disease leaves a devastating complication. The purpose of this study was to evaluate the effects of anesthetic preconditioning on neurologic outcome and Bcl-2 family protein gene expression in transient spinal ischemia. METHODS: In first experiment rats were divided by 4 groups and anesthetized with intraperitoneal propofol, enflurane, sevoflurane, or isoflurane. In second experiment, all rats were anesthetized with intraperitoneal propofol and enflurane, sevoflurane, isoflurane were given during 30 minutes and 14 minutes of spinal ischemia was induced 30 minutes later. Spinal ischemia was produced by both induced hypotension and thoracic aortic cross clamping. Neurologic scores were assessed 1, 3, 24, 48 hours after transient spinal ischemia. After 48 hours, rats were killed under anesthesia and spinal cords were removed for the assay of Bcl-2 family protein mRNA expression. RESULTS: The neurologic injury of S and I group were significantly lesser than P group. 30 minutes of anesthetic preconditioning with enflurane, sevoflurane, and isoflurane showed significantly better neurologic outcome compared to propofol, enflurane, sevoflurane, or isoflurane anesthetized rats. Bcl-2 family protein mRNA expression of I group and IP group were lesser than the other groups. CONCLUSIONS: Anesthetic preconditioning with volatile anesthetics for 30 minutes could reduce ischemic injury during transient spinal ischemia. The degree of neurologic injury may not be related to the expression of pro-apoptotic protein Bax. Isoflurane may have different influence on apoptosis after spinal ischemia compared to enflurane or sevoflurane.
Anesthesia ; Anesthetics ; Anesthetics, Inhalation ; Animals ; Aortic Diseases ; Apoptosis ; Constriction ; Enflurane ; Gene Expression ; Humans ; Hypotension ; Ischemia* ; Isoflurane ; Propofol ; Rats* ; RNA, Messenger* ; Spinal Cord ; Spinal Cord Ischemia

PURPOSE: In chronic renal failure (CRF), extracellular fluid (ECF) volume is maintained close to normal, often until end-stage renal disease is imminent. This remarkable feat is accomplished by an increase in fractional excretion of sodium (FENa) in inverse proportion to the decline in glomerular filtration rate (GFR). Many researchers have carried out to try to indentify in animal study but human study was not done in Korea. METHODS: The study is an investigation of the changes of plamsa and urine electrolytes and FENa and fractional excretion of potassium (FEK) in 19 patients (13 men and 6 women) with chronic renal failure. Ages of 19 patients were average 54.6 year-old (range, 29-74 years). Underlying renal disease of the CRF was 42.1% in diabetic nephropathy, 31.6% in chronic glomerulonephritis, 10.5% in hydronephrosis with ureter reflux, and 5.3% in IgA nephropathy. RESULTS: In CRF, plasma Na+ is decreased significantly from normal control 141 +/- 2.1 mEq/L to 139.9 +/- 3.2 mEq/L and GFR from 75.9 +/- 42.9 mL/min to 9.7 +/- 6.3 mL/min, but plasma K+ is increased significantly from 4.2 +/- 0.4 mEq/L to 4.7 +/- 0.8 mEq/L. In CRF however, urine Na+ is decreased significantly from normal control 175.4 +/- 68.5 mEq/L to 89.9 +/- 31.6 mEq/L and osmolality from 610.6 +/- 210.9 mOsm/kg to 397.7 +/- 119.1 mOsm/kg, but urine K+ is decreased tendency from control 32.1 +/- 22.7 mEq/L to 24.3 +/- 14.8 mEq/L. FENa, FEK, and transtubular potassium gradient (TTKG) on CRF were 3.4 +/- 5.4%, 15.4 +/- 20.8% 7.1 +/- 6.9% each and 0.6 +/- 0.6%, 2.2 +/- 2.3% 3.2 +/- 2.8% on normal persons. The difference between CRF and normal control in FENa, FEK, TTKG and osmolar clearance were statistically significant. CONCLUSION: These results suggest that renal tubular cells of CRF were responsible for the decreased Na+ and K+ reabsorption and enhance K+ secretion.
Animals ; Diabetic Nephropathies ; Electrolytes ; Extracellular Fluid ; Glomerular Filtration Rate ; Glomerulonephritis ; Glomerulonephritis, IGA ; Humans ; Hydronephrosis ; Kidney Failure, Chronic* ; Korea ; Male ; Osmolar Concentration ; Plasma ; Potassium ; Sodium ; Ureter