PURPOSE: To assess clinical and angiographic outcomes after endovascular treatment (EVT) in ischemic stroke patients according to anesthesia types (general anesthesia vs. conscious sedation). MATERIALS AND METHODS: A systematic literature review through an online data base between January 1990 and September 2017 was performed. A fixed effect model was used in cases of <50% heterogeneity. The primary outcomes were good clinical outcome at the 3-month follow-up and successful recanalization. A meta-regression analysis was done to estimate primary outcomes of log odds ratio (OR) on onset-to-puncture time (OTP) differences. Publication bias was determined using Begg’s funnel plot and additional the Trim and Fill method. RESULTS: Sixteen articles including 2,662 patients (general anesthesia, n=1,275; conscious sedation, n=1,387) were included. General anesthesia significantly decreased good outcomes than conscious sedation (OR, 0.564; 95% confidence interval [CI], 0.354–0.899). However, outcomes did not differ significantly in randomized controlled trials (RCTs; OR, 1.101; 95% CI, 0.395–3.071). Anesthesia type was not associated with successful recanalization (OR, 0.985; 95% CI, 0.787–1.233). General anesthesia increased the risk of mortality (OR, 1.532; 95% CI, 1.187–1.976) and pneumonia (OR, 1.613; 95% CI, 1.172–2.221), but not symptomatic intracranial hemorrhage (OR, 1.125; 95% CI, 0.767–1.652). The meta-regression analysis showed no linear relationship between OTP differences and log OR of good outcome (coefficient, 0.0004; P=0.95) or successful recanalization (coefficient, 0.0005; P=0.94), respectively. CONCLUSION: General anesthesia seemed to be associated with adverse clinical outcome after EVT. However, its efficacy was not demonstrated in RCTs. Successful recanalization did not differ according to anesthesia type. Studies using individual patient data based on further RCTs are necessary to elucidate anesthesia effect on procedural and clinical outcomes.
Anesthesia ; Anesthesia, General ; Conscious Sedation ; Follow-Up Studies ; Humans ; Intracranial Hemorrhages ; Methods ; Mortality ; Odds Ratio ; Pneumonia ; Population Characteristics ; Publication Bias ; Stroke

Natural language processing (NLP) is a computerized approach to analyzing text that explores how computers can be used to understand and manipulate natural language text or speech to do useful things. In healthcare field, these NLP techniques are applied in a variety of applications, ranging from evaluating the adequacy of treatment, assessing the presence of the acute illness, and the other clinical decision support. After converting text into computer-readable data through the text preprocessing process, an NLP can extract valuable information using the rule-based algorithm, machine learning, and neural network. We can use NLP to distinguish subtypes of stroke or accurately extract critical clinical information such as severity of stroke and prognosis of patients, etc. If these NLP methods are actively utilized in the future, they will be able to make the most of the electronic health records to enable optimal medical judgment.

Natural language processing (NLP) is a computerized approach to analyzing text that explores how computers can be used to understand and manipulate natural language text or speech to do useful things. In healthcare field, these NLP techniques are applied in a variety of applications, ranging from evaluating the adequacy of treatment, assessing the presence of the acute illness, and the other clinical decision support. After converting text into computer-readable data through the text preprocessing process, an NLP can extract valuable information using the rule-based algorithm, machine learning, and neural network. We can use NLP to distinguish subtypes of stroke or accurately extract critical clinical information such as severity of stroke and prognosis of patients, etc. If these NLP methods are actively utilized in the future, they will be able to make the most of the electronic health records to enable optimal medical judgment.

OBJECTIVE: The aim of this study was to compare titanium and cobalt alloy clip induced artifacts in 16- and 64-row multislice computed tomography angiograms. METHODS: A total of 40 intracranial aneurysms in 37 patients treated using titanium or cobalt-alloy clips were enrolled in this study. Computed tomography angiography (CTA) was performed using a 16-row (12 aneurysms; cobalt-alloy clips in 8 and titanium clips in 4) or 64-row (28 aneurysms; cobalt-alloy clips in 14 and titanium clips in 14) multislice CT machine after surgical clipping. Clip-induced artifacts were divided into white and black components, and artifact sizes were quantified by measuring the areas of these components. RESULTS: The titanium clips (634.9 +/- 308.44 mm2) produced smaller artifacts than cobalt alloy clips (2,797.4 +/- 3,121.98 mm2) by CTA (p=0.006), but the mean size of titanium clip induced artifacts was smaller for 64-row (544.0 +/- 68.77 mm2) than for 16-row (953.3 +/- 279.95 mm2) multislice CTA (p=0.026). On the other hand, cobalt alloy clip related artifacts were similarly sized (64-row, 2,191.5 +/- 2,072.86 mm2 versus 16-row, 3,857.6 +/- 4,386.56 mm2, p=0.246). CONCLUSION: Titanium clips produce smaller artifacts than cobalt-alloy clips and 64-row multislice CTA reduced titanium clip-induced artifacts as compared with 16-row multislice CTA. However, cobalt-alloy clip artifacts were huge and were not reduced by the higher row CTA unit.
Alloys ; Aneurysm ; Angiography ; Artifacts ; Cobalt ; Hand ; Humans ; Intracranial Aneurysm ; Multidetector Computed Tomography ; Surgical Instruments ; Titanium

OBJECTIVE: The aim of this study was to compare titanium and cobalt alloy clip induced artifacts in 16- and 64-row multislice computed tomography angiograms. METHODS: A total of 40 intracranial aneurysms in 37 patients treated using titanium or cobalt-alloy clips were enrolled in this study. Computed tomography angiography (CTA) was performed using a 16-row (12 aneurysms; cobalt-alloy clips in 8 and titanium clips in 4) or 64-row (28 aneurysms; cobalt-alloy clips in 14 and titanium clips in 14) multislice CT machine after surgical clipping. Clip-induced artifacts were divided into white and black components, and artifact sizes were quantified by measuring the areas of these components. RESULTS: The titanium clips (634.9 +/- 308.44 mm2) produced smaller artifacts than cobalt alloy clips (2,797.4 +/- 3,121.98 mm2) by CTA (p=0.006), but the mean size of titanium clip induced artifacts was smaller for 64-row (544.0 +/- 68.77 mm2) than for 16-row (953.3 +/- 279.95 mm2) multislice CTA (p=0.026). On the other hand, cobalt alloy clip related artifacts were similarly sized (64-row, 2,191.5 +/- 2,072.86 mm2 versus 16-row, 3,857.6 +/- 4,386.56 mm2, p=0.246). CONCLUSION: Titanium clips produce smaller artifacts than cobalt-alloy clips and 64-row multislice CTA reduced titanium clip-induced artifacts as compared with 16-row multislice CTA. However, cobalt-alloy clip artifacts were huge and were not reduced by the higher row CTA unit.
Alloys ; Aneurysm ; Angiography ; Artifacts ; Cobalt ; Hand ; Humans ; Intracranial Aneurysm ; Multidetector Computed Tomography ; Surgical Instruments ; Titanium

No abstract available.
Magnetic Resonance Imaging* ; Subacute Combined Degeneration*

Leprosy is an infectious disease caused by Mycobacterium leprae and characterized by dermal and peripheral nerve lesions. The facial nerve is also frequently involved in leprosy. There are a few electrophysiologic studies on the facial nerve involvement in leprosy patients, but there is no electrophysiologic study on the facial nerve involvement in cured leprosy patitents. So we performed facial nerve conduction study and Blink reflex study in 19 cured leprosy patients who have been managed with Dapsone for a long time. Facial motor latencies were prolonged in 11 patients(57.9%).: 10 of 15 patients in lepromatous type; 1 of 4 patients in tuberculoid type. Prolonged latencies were shown in temporal branch, zygomatic branch, buccal branch, and mandibular branch in 9(47.4%), 6(31.6%), 5(26.3%), and 3(15.8%), respectively. Blink reflex study suggests combined facial nerve and trigeminal nerve lesion in 2 patients.
Blinking ; Communicable Diseases ; Dapsone ; Facial Nerve* ; Humans ; Leprosy* ; Mycobacterium leprae ; Peripheral Nerves ; Trigeminal Nerve

Background: and Purpose Patients with dementia are particularly vulnerable to coronavirus disease 2019 (COVID-19) because they tend to be older and often have concomitant diseases. Previous studies have investigated the impact of dementia on COVID-19 outcomes, but the evidence is not robust for Asian populations. We aimed to determine the relationship between dementia and COVID-19 outcomes using data from a large-scale nationwide public database. Methods: Data on patients with COVID-19 who were released from quarantine between January 1, 2020 and April 30, 2020, published by the Korea Disease Control and Prevention Agency, were divided into two groups based on the dementia status. Propensity-score matching was used to adjust for multiple confounders between the dementia and no-dementia groups. Binary, ordinal logistic regression and multivariate Cox proportional-hazards models were used to compare mortality, quarantine duration, and clinical deterioration according to the dementia status in the two groups. Results: Males and older individuals (age ≥60 years) constituted 41.5% and 32.9%, respectively, of the 5,299 patients. The prevalence of dementia was 4.2%, and 4.5% of the participants died during hospitalization. In multivariate analysis, dementia was significantly associated with increased mortality (odds ratio [OR]=2.80, 95% confidence interval [CI]=1.60–4.60), longer duration of quarantine (hazard ratio=1.69, 95% CI=1.16–2.45), and larger shift to a worse clinical severity (common OR=1.74, 95% CI=1.18–2.61). Conclusions After adjusting for important clinical predictors, dementia was associated with increased in-hospital mortality, duration of quarantine, and clinical deterioration during hospitalization in COVID-19 patients.

BACKGROUND AND PURPOSE: The vertebral artery (VA) is important for the development of the transverse foramen (TF). Most studies of these structures have focused on anatomical anomalies. Therefore, we investigated quantitatively the association between the relative sizes of the TF and VA. METHODS: We recruited a consecutive series of subjects who underwent CT angiography to estimate the relative sizes of the VA and TF in axial source images. Two neurologists independently reviewed the axial CT images of 208 patients who had no history of transient ischemic attack or stroke. Averaged areas of the VA and TF were defined by the sum of the areas at each level from C3 to C6, divided by 4. Correlation analyses were adjusted for age, sex, and vascular risk factors. RESULTS: The mean age of the subjects was 53 years. The interobserver and intraobserver reliabilities of TF size were good. There was a linear relationship between the sizes of the VA and TF on each side (right side: r2=0.58, p<0.001; left side: r2=0.62, p<0.001). The area of the VA was significantly associated with that of the TF after adjusting for vascular risk factors. CONCLUSIONS: The size of the VA is strongly and linearly correlated with the size of the TF. These findings suggest that measurement of the TF and VA with CT angiography is a reliable method for evaluating VA diseases, and may provide new insight into the differentiation between VA hypoplasia and atherosclerosis of the VA.
Angiography ; Atherosclerosis ; Humans ; Ischemic Attack, Transient ; Stroke ; Vertebral Artery

BACKGROUND: Early escharectomy has been shown to improve survival rates and treatment outcomes in major burn patients. However, its mechanism, especially in human immune systems, has not been fully elucidated. This observational study, focusing on cytokines, was conducted to assess changes in the levels of tumor necrosis factor alpha (TNF alpha) and interleukin-10 (IL-10) in major burn patients that underwent early tissue excision. METHODS: Seventeen ASA physical status II or III adults major burn patients, admitted to general surgery for burn wound care, were initially recruited. When early escharectomy was scheduled, a series of blood samples was obtained four times at 72 and 24 hours preop and at 24 and 72 hours postop. Changing levels of TNF alpha and IL-10 were measured by quantitative sandwich immnuoassay. RESULTS: Subjects suffered from 70% TBSA burns. Both cytokines demonstrated a significant tendency to increase in the blood during the study period. Although they temporarily decreased 24 hours after surgery, this effect did not last. CONCLUSIONS: Burn injury certainly increases cytokine response. Early escharectomy appears to decrease the pro and anti-inflammatory cytokines only temporarily. It did not seem to have any long term effect in the human immune system in major burn patients, probably due to the complex nature of the injury.
Adult ; Burns* ; Cytokines* ; Humans ; Immune System ; Interleukin-10 ; Observational Study ; Survival Rate ; Tumor Necrosis Factor-alpha ; Wounds and Injuries