No abstract available.
Animals ; Medulla Oblongata* ; Putrescine* ; Rats*

A 60 year-old right-handed man developed a sudden inability to find his way home from work. Neurologic examina-tions revealed no focal neurological deficit. Neuropsychological tests showed a memory deficit especially in the visu-ospatial domain along with visuospatial and frontal-executive dysfunction. A brain MRI revealed a small but discrete lesion in the right thalamus. The majority of the lesion was confined to the dorsomedial nucleus. These results suggest that a small unilateral thalamic infarction affecting the anterior area may be sufficient to produce "strategic-infarct dementia" without focal neurological deficit.
Brain ; Dementia ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Mediodorsal Thalamic Nucleus ; Memory ; Memory Disorders ; Middle Aged ; Neuropsychological Tests ; Thalamus

A 60 year-old right-handed man developed a sudden inability to find his way home from work. Neurologic examina-tions revealed no focal neurological deficit. Neuropsychological tests showed a memory deficit especially in the visu-ospatial domain along with visuospatial and frontal-executive dysfunction. A brain MRI revealed a small but discrete lesion in the right thalamus. The majority of the lesion was confined to the dorsomedial nucleus. These results suggest that a small unilateral thalamic infarction affecting the anterior area may be sufficient to produce "strategic-infarct dementia" without focal neurological deficit.
Brain ; Dementia ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Mediodorsal Thalamic Nucleus ; Memory ; Memory Disorders ; Middle Aged ; Neuropsychological Tests ; Thalamus

Although malignant melanoma usually occurs after the diagnosis of vitiligo-like depigmentation, the latter is rarely followed by the former. We herein report on such a case in which recognition of the vitiligo-like depigmentation preceded diagnosing the metastatic melanoma by several months. A 56-year-old woman had first developed vitiligo-like depigmentation on the forehead, eyelids, neck and back 18 months previously and thereafter she detected a hard mass in the left axilla 2 months previously. Based on the histologic findings, the axillary mass was diagnosed as metastatic melanoma. To evaluate the primary tumor focus, thorough examinations that included PET-CT, bone scan and sigmoidoscopy were performed, but we couldn`t find any the original primary tumor. Our case suggests that the vitiligo-like depigmentation could be a sign that heralds metastatic melanoma.
Axilla ; Eyelids ; Female ; Forehead ; Humans ; Melanoma ; Middle Aged ; Neck ; Sigmoidoscopy

No abstract available.
Head* ; Humans ; Leukoencephalopathy, Progressive Multifocal* ; Lymphoma, T-Cell* ; Neck*

More than 95% of ectopic pregnancies involve the fallopian tubes. Other sites of ectopic implantation are less frequent, and a pregnancy in the myometrium is extremely rare. Few cases are reported in the literature which satisfy the criteria required for the diagnosis of intramural ectopic pregnancy, and unequivocal diagnosis without extirpation of the ruptured uterus is difficult. Most of ruptured cases have been treated with surgical modality including hysterectomy, and for more conservative management early detection is important. MRI is a useful, noninvasive and confirmative imaging modality for the detection of intramural pregnancy. Chemotherapy with methotrexate is an effective treatment that allows preservation of reproductive potential in selected case. We described a case of unruptured intramural pregnancy diagnosed with MRI and successfully treated with methotrexate. Theoretical and possible pathophysiologic derangements of this rare pregnancy- related disorder are also reviewed.
Animals ; Diagnosis ; Drug Therapy* ; Fallopian Tubes ; Female ; Hysterectomy ; Magnetic Resonance Imaging ; Methotrexate ; Mice ; Myometrium ; Pregnancy* ; Pregnancy, Ectopic ; Uterus

OBJECTIVE: Lumbar discectomy is an effective treatment for lumbar disc herniation (LDH); however, up to 2–18% of patients with LDH have experienced recurrent disc herniation. The purpose of this study was to evaluate the efficacy of a novel annular closure device (ACD) for preventing LDH recurrence and re-operation compared with that of conventional lumbar discectomy (CLD).METHODS: In this prospective randomized controlled trial, we compared CLD with discectomy utilizing the Barricaid® (Intrinsic Therapeutics, Inc., Woburn, MA, USA) ACD. Primary radiologic outcomes included disc height, percentage of preoperative disc height maintained, and re-herniation rates. Additional clinical outcomes included visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI) scores, and 12-item short-form health survey (SF-12) quality of life scores. Outcomes were measured at preoperation and at 1 week, 1, 3, 6, 12, and 24 months postoperation.RESULTS: Sixty patients (30 CLD, 30 ACD) were enrolled in this study. At 24-month follow-up, the disc height in the ACD group was significantly greater than that in the CLD group (11.4±1.5 vs. 10.2±1.2 mm, p=0.006). Re-herniation occurred in one patient in the ACD group versus six patients in the CLD group (χ²=4.04, p=0.044). Back and leg VAS scores, ODI scores, and SF-12 scores improved significantly in both groups compared with preoperative scores in the first 7 days following surgery and remained at significantly improved levels at a 24-month follow-up. However, no statistical difference was found between the two groups.CONCLUSION: Lumbar discectomy with the Barricaid® (Intrinsic Therapeutics, Inc.) ACD is more effective at maintaining disc height and preventing re-herniation compared with conventional discectomy. Our results suggest that adoption of ACD in lumbar discectomy can help improve the treatment outcome.
Diskectomy ; Follow-Up Studies ; Health Surveys ; Humans ; Intervertebral Disc Displacement ; Leg ; Prospective Studies ; Quality of Life ; Recurrence ; Treatment Outcome ; Visual Analog Scale

STUDY DESIGN: In-vitro biomechanical investigation. PURPOSE: To evaluate the biomechanical effects of the degeneration of the biodegradable cervical plates developed for anterior cervical discectomy and fusion (ACDF) on fusion and adjacent levels. OVERVIEW OF LITERATURE: Biodegradable implants have been recently introduced for cervical spine surgery. However, their effectiveness and safety remains unclear. METHODS: A linear three-dimensional finite element (FE) model of the lower cervical spine, comprising the C4–C6 vertebrae was developed using computed tomography images of a 46-year-old woman. The model was validated by comparison with previous reports. Four models of ACDF were analyzed and compared: (1) a titanium plate and bone block (Tita), (2) strong biodegradable plate and bone block (PLA-4G) that represents the early state of the biodegradable plate with full strength, (3) weak biodegradable plate and bone block (PLA-1G) that represents the late state of the biodegradable plate with decreased strength, and (4) stand-alone bone block (Bloc). FE analysis was performed to investigate the relative motion and intervertebral disc stress at the surgical (C5–C6 segment) and adjacent (C4–C5 segment) levels. RESULTS: The Tita and PLA-4G models were superior to the other models in terms of higher segment stiffness, smaller relative motion, and lower bone stress at the surgical level. However, the maximal von Mises stress at the intervertebral disc at the adjacent level was significantly higher in the Tita and PLA-4G models than in the other models. The relative motion at the adjacent level was significantly lower in the PLA-1G and Bloc models than in the other models. CONCLUSIONS: The use of biodegradable plates will enhance spinal fusion in the initial stronger period and prevent adjacent segment degeneration in the later, weaker period.
Absorbable Implants ; Diskectomy ; Female ; Finite Element Analysis ; Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Middle Aged ; Spinal Fusion ; Spine ; Titanium

PURPOSE: This review aimed to evaluate the effectiveness of telemonitoring (TM) in the management of children and adolescents with asthma. METHODS: We searched Ovid-MEDLINE, Ovid-EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and 5 domestic databases to identify randomized controlled trials (RCTs) published through December 2017. Two reviewers independently selected relevant studies, assessed methodological quality and extracted data. We performed a meta-analysis of TM versus usual care and summarized the intervention characteristics of included studies. RESULTS: Of the 3,095 articles identified, 8 RCTs (9 articles) were included in this review. The type of TM intervention of included studies was varying across studies (transmitted data, transmission frequency, data review, etc.). The pooled asthma control score was not significantly different between TM and usual care (standardized mean difference 0.04, 95% confidence interval (CI) −0.20~0.28). Another pooled analysis demonstrated no statistically significant difference in asthma exacerbation between TM and usual care (odds ratio 0.95, 95% CI 0.43~2.09). Overall, the pooled results from these studies revealed that TM did not lead to clinically significant improvements in health outcomes, but some studies in our analysis suggested that TM increased patient medication adherence and intervention adherence. CONCLUSION: The current evidence base does not demonstrate any differences between TM intervention and usual care, but TM intervention might be considered a promising strategy for the delivery of self-management support for children and adolescents with asthma. Further well-designed studies are needed to assess the effects on clinical outcomes.
Adolescent* ; Asthma* ; Child* ; Humans ; Medication Adherence ; Nursing ; Self Care ; Telemedicine

Background: and Purpose This study aimed to determine the ability of deep learning using convolutional neural networks (CNNs) to diagnose transient global amnesia (TGA) based on electroencephalography (EEG) data, and to differentiate between patients with recurrent TGA events and those with a single TGA event. Methods: We retrospectively enrolled newly diagnosed patients with TGA and healthy controls. All patients with TGA and the healthy controls underwent EEG. The EEG signals were converted into images using time-frequency analysis with short-time Fourier transforms. We employed two CNN models (AlexNet and VGG19) to classify the patients with TGA and the healthy controls, and for further classification of patients with recurrent TGA events and those with a single TGA event. Results: We enrolled 171 patients with TGA and 68 healthy controls. The accuracy and area under the curve (AUC) of the AlexNet and VGG19 models in classifying patients with TGA and healthy controls were 70.4% and 71.8%, and 0.718 and 0.743, respectively. In addition, the accuracy and AUC of the AlexNet and VGG19 models in classifying patients with recurrent TGA events and those with a single TGA event were 71.1% and 88.4%, and 0.773 and 0.873, respectively. Conclusions We have successfully demonstrated the feasibility of deep learning in diagnosing TGA based on EEG data, and used two different CNN models to distinguish between patients with recurrent TGA events and those with a single TGA event.