BACKGROUND: After multiple trauma, blood coagulation activity is enhanced and fibrinolytic activity is suppressed by overproduction of plasminogen activator inhibitor-1 (PAI-1). Intermittent sequential pneumatic compression (ISPC) is an effective method to prevent deep vein thrombosis. Its action is explained by the mechanical effect on blood flow, as well as by the enhancement of fibrinolysis by the reduction of PAI-1. The aim of this study was to determine the effects of ISPC on coagulation and fibrinolysis after multiple trauma. METHODS: Thirty-nine trauma patients were either treated with ISPC (ISPC group, 20 patients) or without ISPC (control group, 19 patients). We measured the plasma levels of the thrombin antithrombin III complex (TAT), the plasmin alpha 2 plasmin inhibitor complex (PIC), the tissue plasminogen activator (t-PA), and the plasminogen activator inhibitor-1 (PAI-1) on admission and at 1, 2, 3, 6, 12, and 24 hours after admission. RESULTS: The TAT was higher than normal in both groups, with no significant difference between the two groups throughout the study period. The PIC level of ISPC group was significantly higher than that of the control group. In the ISPC group, the PIC level increased gradually, reaching a peak at 3 hours and decreasing thereafter. In the control group, the PIC level increased to a peak level at 2 hours. The TAT/PIC ratio dropped in the first two hours and increased at 3 hours, dropping again thereafter. In the ISPC group, the ratio dropped gradually without an intermittent fluctuation. At 3 and 6 hours, the control group showed a significantly greater ratio compared to the ISPC group. PAI-1 was higher than normal in bothgroups, with a significantly lower level in the ISPC group from 2 hours to 24 hours. For the t-PA level, no difference was noted between the two groups, with the peak level occurring at 1 hour. The PAI-1/t-PA ratio was significantly greater in the control group from 2 hours to 12 hours than in the ISPC group, but the difference was not significant at 24 hours. CONCLUSIONS: In multiple trauma patients, ISPC does not seem to affect coagulation, but enhances fibrinolysis through suppressed PAI-1 production. This effect of ISPC may be maintained for 12 hours.
alpha-2-Antiplasmin ; Antithrombin III ; Blood Coagulation ; Fibrinolysin ; Fibrinolysis* ; Humans ; Multiple Trauma* ; Plasma ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Thrombin ; Tissue Plasminogen Activator ; Venous Thrombosis

PURPOSE: This study was performed to evaluate the accuracy of two different methods of performing the tongue blade test (TBT) on patients with mandible fractures. METHODS: A prospective randomized trial was performed over 28 months, and the accuracy of TBT for the diagnosis of patients with mandibular fractures was evaluated using the radiographic confirmative diagnosis as the gold standard. A consecutive sample of 126 patients (36 mandibular fractures) were enrolled to this study. Method A is addressed the patient's ability to grasp a tongue blade between his teeth and hold the blade against a twistling motion, and Method B is to addressed the patient's ability to grasp a tongue blade between his teeth and then to hold the tongue blade against the examiner's mild effort to remove it. We compared the accuracy of the two methods. RESULTS: The sensitivity of method A was 95.0% (19/20), and that of method B was 93.8% (15/16). The specificities of the two methods were 68.8% and 64.4%, respectively. No statistically significant difference was found between the two methods (p>0.05). CONCLUSIONS: Based on this study, we conclude that we can choose either of the two method and that both methods of TBT are highly effective screening tests for diagnosing mandibular fractures.
Diagnosis ; Hand Strength ; Humans ; Mandible ; Mandibular Fractures* ; Mass Screening ; Prospective Studies ; Tongue* ; Tooth

BACKGROUND: The evaluation of behavioral and psychological symptoms (BPSD) is important for the diagnosis and management of Alzheimer's disease (AD). Previous studies have reported the prevalence and severity of BPSD changes. However, these studies have mainly focused on the AD patients with mild to moderate severity. Our study investigated the BPSD in AD patients with more advanced stages and looked at the prevalence and severity of BPSD with the progression of disease. METHODS: One hundred thirty six patients with probable AD received the Korean version of the neuropsychiatric inventory along with the expanded version of the Korean Clinical Dementia Rating Scale (CDR) and the Korean version of the Mini-Mental State Examination (K-MMSE). RESULTS: The mean K-MMSE, CDR and NPI scores were 10.1 (SD=7.1), 2.0 (SD=1.5) and 32.7 (SD=26.2), respectively. CDR and K-MMSE scores did not correlate with the total NPI score but did correlate with some of the subscale NPI scores. Apathy had the highest relationship to CDR (r=0.39, p<0.01). Aberrant motor was most correlated with the total score of NPI (r=0.65, p<0.01). The mean number of positive NPI items was 4.3, which ranged from 2.1 (CDR 5 group) to 5.4 (CDR 2 group). The most frequent symptom was apathy and the least was euphoria. The severity of BPSD increased as the dementia severity increased to CDR 2 except apathy. Night-time behavior and anxiety were frequent in the early stages whereas apathy and aberrant motor were frequent symptoms in later stages. CONCLUSIONS: These observations suggest that BPSD is relatively independent of cognitive functions. The prevalence and severity of BPSD with the exclusion of apathy, increased as the dementia severity increased from CDR 0.5 to CDR 2 and then declined declined except apathy.
Alzheimer Disease* ; Anxiety ; Apathy ; Dementia ; Diagnosis ; Euphoria ; Humans ; Prevalence

BACKGROUND: This study was conducted to determine the effect of the distributional relationship between dental roots and the mandibular bone on single mandibular bone fractures, which are common craniofacial fractures. METHODS: This was a retrospective, single-center study in Seoul, Korea. Patients with single mandibular fractures in the symphysis, parasymphysis, body, and angle area, with tooth structure involvement were included. The control group included patients with simple, bone-level lacerations without fractures. In total, 94 patients (72 males and 22 females) were included in the treatment group, and 125 (71 males and 54 females) were included in the control group. The height of the mandibular bone and the dental root were measured with panoramic radiography. The central incisor represented the symphysis area, the canine represented the parasymphysis area, the first molar represented the body area, and the second molar represented the angle area. RESULTS: In the treatment group, symphysis fractures occurred in 16 patients (17%), parasymphysis fractures in 36 patients (38%), body fractures in 17 patients (18%), and angle fractures in 25 patients (27%). The ratios of the dental roots to the total height of the mandibular bone in the treatment group were 30.35%, 39.75%, 39.53%, and 36.27% for symphysis, parasymphysis, body, and angle areas, respectively, whereas in the control group, they were 27.73%, 39.70%, 36.76%, and 35.48%. The ratios of the treatment group were significantly higher than those of the control group. CONCLUSION: The results show that the higher ratio of the dental root to the height of the mandibular bone increases the fracture risk.
Fractures, Bone* ; Humans ; Incisor ; Korea ; Lacerations ; Male ; Mandible ; Mandibular Fractures ; Molar ; Radiography, Panoramic ; Retrospective Studies ; Seoul ; Tooth ; Tooth Root

BACKGROUND: Temporal hollowing is inevitable after decompressive craniectomy. This complication affects self-perception and quality of life, and various techniques and materials have therefore been used to restore patients’ confidence. Autologous fat grafting in postoperative scar tissue has been considered challenging because of the hostile tissue environment. However, in this study, we demonstrate that autologous fat grafting can be a simple and safe treatment of choice, even for postoperative depressed temporal scar tissue. METHODS: Autologous fat grafting was performed in 13 patients from 2011 to 2016. Fat was harvested according to Coleman’s strategy, using a tumescent technique. Patient-reported outcomes were collected preoperatively and at 1-month and 1-year follow-ups. Photographs were taken at each visit. RESULTS: The thighs were the donor site in all cases for the first procedure. The median final volume of harvested fat was 29.4 mL (interquartile range [IQR], 24.0–32.8 mL). The median final volume of fat transferred into the temporal area was 4.9 mL on the right side (IQR, 2.5–7.1 mL) and 4.6 mL on the left side (IQR, 3.7–5.9 mL). There were no major complications. The patient-reported outcomes showed significantly improved self-perceptions at 1 month and at 1 year. CONCLUSIONS: Despite concerns about the survival of grafted fat in scar tissue, we advise autologous fat grafting for patients with temporal hollowing resulting from a previous craniectomy.
Adipose Tissue ; Cicatrix ; Decompressive Craniectomy ; Follow-Up Studies ; Humans ; Lipectomy ; Quality of Life ; Self Concept ; Thigh ; Tissue Donors ; Transplantation ; Transplantation, Autologous ; Transplants

BACKGROUND: The limitation of activities of daily living (ADL) is a critical problem in dementia patients in addition to cognitive dysfunction. In spite of many previous studies about the relationship between cognitive dysfunction, ADL and the nature of functional changes, there have not been any clear explanations about the liaisons between them due to various results from the diversity of objects and methods. The purpose of this study is to evaluate the relationship between ADL and clinical features in patients with Alzheimer's disease. METHODS: One hundred thirty-four patients with Alzheimer's disease were enrolled to participate in the study. The physical activity of daily living (P-ADL) and the Korean instrumental activity of daily living (K-IADL) were evaluated in the patients. In addition, all subjects were tested by a Korean version of the expanded clinical dementia rating scale (CDR), and a Korean version of the mini-mental state examination (K-MMSE) and a Korean version of the neuropsychiatric inventory (NPI). RESULTS: ADL was significantly correlated with cognitive functioning (r>-0.75, p<0.01). NPI was not significantly correlated with P-ADL and KIADL. The ability to use the telephone was the most highly correlated with CDR and K-MMSE (r>0.72, p<0.01). The ability to use the telephone was the most predictable item in K-IADL and bathing was the most predictable item in PADL. The deterioration of K-IADL showed rapid progression in the degree of CDR 2 and P-ADL showed rapid progression in the degree of CDR 4, respectively. CONCLUSIONS: The ADL decline induced by dementia may progress and have a close correlation with clinical manifestations of dementia including cognitive dysfunction, behavioral symptoms and psychological symptoms.
Activities of Daily Living ; Alzheimer Disease* ; Baths ; Behavioral Symptoms ; Dementia ; Humans ; Motor Activity ; Telephone

Objective: This study aimed to explore the mediating effects of cancer-related dysfunctional beliefs regarding sleep and intolerance of uncertainty on the effect of depression, insomnia, and anxiety on fear of progression (FoP). Methods: We retrospectively reviewed medical records of patients with cancer who visited the Sleep Clinic for cancer patients in Asan Medical Center for the first time between December 2021 and March 2022. Data collected included age, sex, types of cancer, staging, current treatment modalities, and history of surgical procedures. In addition, psychological symptoms were rated using the Insomnia Severity Scale (ISI), Patient Health Questionnaire–9 items (PHQ-9), State subcategory of the State and Trait of Anxiety Inventory (STAI-S), Short form of Fear of Progression Questionnaire, Cancer-related Dysfunctional Beliefs about Sleep scale (C-DBS), single item of pain and fatigue, Connor Davidson Resilience Scale 2-item (CD-RISC2), and Intolerance of Uncertainty–12 (IUS-12). The predictive variables for FoP were determined by linear regression analysis. Results: The FoP was significantly correlated with age (r=-0.289), ISI (r=0.178), PHQ-9 (r=0.703), STAI-S (r=0.377), fatigue (r=0.452), CD-RISC2 (r=-0.270), IUS-12 (r=0.585), and C-DBS (r=0.427, all p<0.01). A mediation analysis showed that intolerance of uncertainty and dysfunctional beliefs about sleep mediated the relationship of FoP with insomnia, depression, or anxiety. Conclusion Psychological support for intolerance of uncertainty and cancer-related dysfunctional beliefs about sleep in patients with cancer may be beneficial to reduce their FoP.

Objective: The discrepancy between desired time in bed and desired total sleep time (DBST index) is correlated with the severity of insomnia among the general population. This study aimed to explore whether the change in DBST index is associated with changes in insomnia severity. Methods: The study was conducted as a single source tracking online survey among the general population. The first survey (T1) was completed by all 399 participants, and the second survey (T2) was completed by 233 participants 5–6 weeks after the T1 survey with a simple instruction of reducing the DBST index. Participants’ age, sex, marital status, past psychiatric history, and sleep patterns were collected. In addition to the DBST index, the Glasgow Sleep Effort Scale (GSES), Dysfunctional Beliefs about Sleep-2 items (DBS-2), and Insomnia Severity Index (ISI) were rated. Results: The change in the ISI (T1–T2) was significantly correlated with the changes in the GSES (r=0.24, p<0.001), DBS-2 (r=0.22, p<0.001), and DBST index (r=0.15, p=0.020). The change in insomnia severity was expected with change in the GSES (β=0.23, p<0.001), DBS-2 (β=0.20, p=0.002), and DBST index (β=0.13, p=0.037). Mediation analysis showed that change in DBST index directly influenced change in insomnia severity and change in GSES or DBS-2 did not mediate the relationship. Conclusion Changing the DBST index can be a simple way to reduce insomnia severity among the general population.

BACKGROUND: The effect of genistein on different types of cells has been investigated. However, its effect on the nervous system is still unclear. The aim of the present work is to explore the effect of genistein on rat neuroblastoma B35 cells. METHODS: The effect of genistein on the proliferation of B35 cells, its cytotoxicity, the cell-cycle distribution, the ultra-structural changes and the induction of apoptosis were determined using MTT assay, LDH assay, Flow-cytometric analysis, transmission electron microscopy and Hoechst staining, respectively. Furthermore, Real-time quantitative RT-PCR and Western blotting were used to examine the transcriptional and post-translational alterations of the G2/M cell-cycle arrest marker cyclin-dependent kinase inhibitor p21(waf1/cip1) and the apoptosis-related genes after genistein treatment. RESULTS: Genistein significantly inhibits cell survival, slightly elevates the release of lactate dehydrogenase and induced apoptosis in B35 cells. Genistein increased the number of cells at S-phase and induced cells to accumulate at the G2/M phase. These G2/M arrested cells are associated with a marked up-regulation of p21(waf1/cip1) at both the mRNA and protein levels. We observed that genistein up-regulates pro-apoptotic Bax with concurrent down-regulation of the anti-apoptotic Bcl-2 protein. CONCLUSION: These observations suggest that the anticancer effect of genistein on B35 neuroblastoma cells is mediated through multiple cellular pathways including G2/M cell-cycle arrest and the induction of apoptosis.
Animals ; Apoptosis* ; Blotting, Western ; Cell Cycle Checkpoints* ; Cell Cycle* ; Cell Survival ; Down-Regulation ; Genistein* ; L-Lactate Dehydrogenase ; Microscopy, Electron, Transmission ; Nervous System ; Neuroblastoma* ; Phosphotransferases ; Rats* ; RNA, Messenger ; Up-Regulation

Drinking excessive alcohol has been recognized as a risk factor for hypertension. However, the mechanism by which alcohol intake causes hypertension still remains elusive. We tested the hypothesis that ethanol itself acts as a stress factor on vasculature and indirectly modulates vascular contractility. After end of exposure to 1, 2.5 and 5% ethanol for 45 min, rat aortic strips were subjected to contractile responses, immunoblot for Hsp70 and the measurement of levels of myosin light chain phosphorylation. Exposure to 5% ethanol not only augmented contractions to KCl or phenylephrine, but also increased expression of Hsp70 and the levels of myosin light chain phosphorylation. There were no significant differences in contractions produced by 1 micromol/L phorbol 12,13-dibutyrate, a protein kinase C activator, whether the tissues were exposed to 5% ethanol or not. This is the first report to show that even short exposure to ethanol has a delayed effect to increase vascular smooth muscle contractility through a modulation of thick filament regulation. It may be a mechanism by which ingestion of alcohol induces hypertension.
Animals ; Drinking ; Eating ; Ethanol* ; Hypertension ; Muscle, Smooth, Vascular ; Myosin Light Chains ; Phenylephrine ; Phorbol 12,13-Dibutyrate ; Phosphorylation ; Protein Kinase C ; Rats ; Risk Factors