Orexin’s role in human cognition has recently been emphasized and emerging evidences indicate its close relationship with Alzheimer’s disease (AD). This review aimed to demonstrate recent research on the relationship between orexin and AD. Orexin’s role in stress regulation and memory is discussed, with significant findings related to sexual disparities in stress response, with potential clinical implications pertaining to AD pathology. There are controversies regarding the orexin levels in AD patients, but the role of orexin in the trajectory of AD is still emphasized in recent literatures. Orexin is also accentuated in the context of tau pathology, and orexin as a potential therapeutic target for AD is frequently discussed. Future directions with regard to the relationship between orexin and AD are suggested: 1) consideration for AD trajectory in the measurement of orexin levels, 2) the need for objective measure such as polysomnography and actigraphy, 3) the need for close observation of cognitive profiles of orexin-deficient narcolepsy patients, 4) the need for validation studies by neuroimaging 5) the need for taking account sexual disparities in orexinergic activiation, and 6) consideration for orexin’s role as a stress regulator. The aforementioned new perspectives could help unravel the relationship between orexin and AD.

BACKGROUND:Acute vestibular neuronitis is the disease of which the etiology and pathophysiology are largely unknown . But the viral infection and ischemia of the labyrinth and the vestibular nerve are considered as general etiology. This study was performed to support the viral infection rather than the ischemic theory. MATERIALS & METHODS:We studied seventy years old female patient who showed painful vesicles on left auricle and vertigo with spontaneous nystagmus to the right side. We performed physical examination, serologic test, ENG test, pure tone audiogram, brain magnetic resonance imaging and polymerase chain reaction. RESULTS:We found small vesicles and vascular injection in left EAC, herpes zoster IgG positive, spontaneous right beating in electronystagmograpy, 54% left canal paresis in Caloric test , decreasing left side Tc in velocity step rotatory test, decresed gain, deviation to left in symmetry and phase lead in sinusoidal harmonic acceleration test, normal range hearing in pure tone audiogram, microangiopathy on cortex in brain MRI and negative PCR. CONCLUSION:This case supports viral infection etiology rather than ischemia in vestibular neuritis. But more studies to find the etiology of vestibular neuronitis are required.
Acceleration ; Brain ; Caloric Tests ; Ear, Inner ; Female ; Hearing ; Herpes Zoster ; Herpes Zoster Oticus ; Humans ; Immunoglobulin G ; Ischemia ; Magnetic Resonance Imaging ; Paresis ; Physical Examination ; Polymerase Chain Reaction ; Reference Values ; Serologic Tests ; Vertigo ; Vestibular Nerve ; Vestibular Neuronitis

Rectovagianl fistula(RVF) is a congenital or acquired communication between the two epithelial-lined surface of the rectum and the vagina. We present our experience with 62 patients with RVF. There were various etiologies and repair methods of rectovaginal fistula. The purpose of this study was to retospectively review the clinical course of the patients we treated and to evaluate the efficacy of various treatment options. The mean age was 40.5 yr, The type of RVF was classified to one of two(simple and complex), according to their location, size and etiology. RVF was developed most commonly after radiotherapy due to cervical cancer(n=17), then after pelvic surgery due to malignancy(n=16), obstetric trauma after episiotomy at delivery(n=7), congenital malformation(n=4), inflammatory bowel disease(n=1), Bechet's disease(n=1), infections such as perianal fistula or abscess(n=2), direct invasion of carcinoma(n=3), after chemotherapy(n=1), and idiopathic(n=6). Three cases of them associated with rectovesicovaginal fistula. Surgical therapeutic option was divided to local repair, abdominal approach and tissue transposition by the type of RVF. Most simple RVFs were repaired with local approach through the vagina or rectum. Most complex RVFs were repaired through abdominal approach or tissue transposition. With an average follow up of 20 months, the treatment results were as follows: completely healed(n=36, 58.1%), persistent symptom(n=6, 9.7%), recurrence after repair(n=5, 8.1%), loss of search or death(n=15, 24.1%). Therefore we assist that the management of RVF depends on size, location, and cause. anal sphincter function and overall health status of the patient. Careful preoperative assessment of the fistula, surrounding tissues, and anal sphincter and exclusion of associated disease are essential. With through evaluation, thoughtful consideration of treatment options, and meticulous operative technique, patient can be assured of an optimal outcome.
Anal Canal ; Episiotomy ; Female ; Fistula ; Follow-Up Studies ; Humans ; Radiotherapy ; Rectovaginal Fistula* ; Rectum ; Recurrence ; Vagina

OBJECT: Nicotine dependence is the most common substance abuse disorder. One of the characteristics of nicotine dependence is craving. Regional activation of the brain induced by craving for nicotine was evaluated by using functional magnetic resonance imaging to investigate neuroanatomical site of smoking craving. METHOD: A smoker who satisfied DSM-IV criteria for nicotine dependence and a non smoker was studied. MRI data were acquired on a 1.5T Magnetom Vision Plus with a head volume coil. Two sets of visual stimuli were presented to subjects in a random manner. One was the film scenes of inducing smoking craving and the other was neutral stimuli not related to smoking. There were two fMRI sessions before and after smoking or sham smoking. Data were analyzed using SPM99. RESULTS: fMRI showed significant activated area in anterior cingulate and medial frontal lobes in the smoker during smoking craving. Right dorsolateral prefrontal cortex and parietal lobes were activated in the control during visual stimulation before smoking. After smoking, there was no brain activation during visual stimulation in both of smoker and non smoker. CONCLUSION: Metabolic activity of the anterior cingulate and medial frontal lobes increased during craving for smoking. This result suggests that fMRI may be a valuable tool in the identification of neurobiological process of craving.
Brain ; Diagnostic and Statistical Manual of Mental Disorders ; Frontal Lobe ; Head ; Magnetic Resonance Imaging* ; Nicotine ; Parietal Lobe ; Photic Stimulation ; Prefrontal Cortex ; Smoke* ; Smoking* ; Substance-Related Disorders ; Tobacco Use Disorder

Brain magnetic resonance imaging (MRI) is a key tool for diagnosing neurodegenerative diseases such as Alzheimer’s disease (AD). However, MRI analysis by visual interpretation and reading can be time-consuming and requires specialized expertise. Brain MRI-based artificial intelligence (AI) software has been developed to aid clinicians in diagnosing and managing neurodegenerative disorders, including AD. This study demonstrates the clinical application of the AI software for volumetric analysis of brain MRI scans in patients within the AD spectrum. In the current case series, four patients with memory impairment visited the memory clinic of Yeouido St. Mary’s Hospital. They underwent a series of assessments, including automated analysis of AI-based software for brain MRI volumetric measurements. The information provided by the software was highly accurate, consistent, and was especially valuable for the early diagnosis and monitoring of disease progression. The results imply that this technology potentially aids in the early detection and management of AD, making it a valuable tool for clinicians in the diagnosis of neurodegenerative diseases.

Melatonin is a hormone with neuroregulatory, antioxidant and anti-inflammatory properties. Its benevolent effects on Alzheimer’s disease (AD) has been replicated in both animal models and clinical studies. Melatonin was effective in deterring the toxic effects of amyloid beta (Aβ) and reducing tau phosphorylation. Conflicting results exist for the clinical effectiveness of melatonin administration in AD patients. The positive effects of melatonin in AD have mainly been viewed from its role in sleep and circadian rhythm. Several limitations exist in the previous research on the relationship between melatonin and AD. Future research should focus on sharpening methodology, and adopting more expanded, multi-faceted approach, with consideration for melatonin’s antioxidant and anti-inflam-matory properties.

We evaluated the postoperative results of cubital tunnel release with modified Eaton's method of anterior transposition of ulnar nerve using fasciodermal sling. This study included 12 patients. According to Dellon's classification, patients were categorized 3 groups as mild(n=2), moderate(n=6), and severe(n=4). Through the longitudinal incision on the medial aspect of the elbow, ulnar nerve was released both proximally and distally. And then, ulnar nerve was wrapped with fasciodermal sling about 3 4 cm in size, which was elevated from the fascia of the common origin of the flexor and pronator muscles. Postoperative results were assessed by modified Kleinman and Bishop's rating system. There were excellent in 4 patients(33%), good in 7 patients(58%) and fair in 1 patient(9%). No patient complained of tingling sensation of the ring and/or small finger. Although all patients showed some improvement of key- pinch, grip-power and static 2-point discrimination, those were not statistically significant. Finally, this procedure has advantages as simple operative technique, short postoperative immobilization, and brief rehabilitation period.
Classification ; Cubital Tunnel Syndrome* ; Discrimination (Psychology) ; Elbow ; Fascia ; Fingers ; Humans ; Immobilization ; Muscles ; Rehabilitation ; Sensation ; Ulnar Nerve*

Acute normovolemic hemodilution is widely used to conserve blood and to minimize the need for homologous blood transfusion during operation. To evaluate the effects of aeute isovolemic hemodilution on hemodynamics and oxygen transport, pulmonary artery catheter and radial artery catheter were introduced in 8 patients in whom maxillofacial or Wertheim's operation were performed. Blood(estimated from allowable blood loss) was withdrawn from radial artery, and simultaneously replaced by intravenous administration of 5% plasmanate and Hartmann solution. Acute isovolemic hemodilution decreased the hematocrit level from 33.2+/-3.7% to 29.6+/-2.9%. Cardiac output increased significantly, which was associated with decreased systemic vaacular resistance. Oxygen transport and oxygen consumption increased despite a decrease in oxygen carrying capacity. Heart rate, mean arterial perssure, mean pulmonary arterial pressure, central venous pressure, and pulmonary capillary wedge pressure did not change significantly during hemodilution. The results indicate that blood perfusion and oxygenation to tissue were well maintained in the hemodilution of the magnitude used in this study. Therfore it could be concluded that acute isovolemic hemodilution is a safe and relatively simple method of conserving blood and minimizing homologous blood transfusion.
Administration, Intravenous ; Arterial Pressure ; Blood Transfusion ; Cardiac Output ; Catheters ; Central Venous Pressure ; Natural Resources ; Heart Rate ; Hematocrit ; Hemodilution* ; Hemodynamics ; Humans ; Oxygen ; Oxygen Consumption ; Perfusion ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Radial Artery

Acute normovolemic hemodilution is widely used to conserve blood and to minimize the need for homologous blood transfusion during operation. To evaluate the effects of aeute isovolemic hemodilution on hemodynamics and oxygen transport, pulmonary artery catheter and radial artery catheter were introduced in 8 patients in whom maxillofacial or Wertheim's operation were performed. Blood(estimated from allowable blood loss) was withdrawn from radial artery, and simultaneously replaced by intravenous administration of 5% plasmanate and Hartmann solution. Acute isovolemic hemodilution decreased the hematocrit level from 33.2+/-3.7% to 29.6+/-2.9%. Cardiac output increased significantly, which was associated with decreased systemic vaacular resistance. Oxygen transport and oxygen consumption increased despite a decrease in oxygen carrying capacity. Heart rate, mean arterial perssure, mean pulmonary arterial pressure, central venous pressure, and pulmonary capillary wedge pressure did not change significantly during hemodilution. The results indicate that blood perfusion and oxygenation to tissue were well maintained in the hemodilution of the magnitude used in this study. Therfore it could be concluded that acute isovolemic hemodilution is a safe and relatively simple method of conserving blood and minimizing homologous blood transfusion.
Administration, Intravenous ; Arterial Pressure ; Blood Transfusion ; Cardiac Output ; Catheters ; Central Venous Pressure ; Natural Resources ; Heart Rate ; Hematocrit ; Hemodilution* ; Hemodynamics ; Humans ; Oxygen ; Oxygen Consumption ; Perfusion ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Radial Artery

Alzheimer's disease (AD) without cure remains as a serious health issue in the modern society. The major neuropathological alterations in AD are characterized by chronic neuroinflammation and neuronal loss due to neurofibrillary tangles (NFTs) of abnormally hyperphosphorylated tau, plaques of β-amyloid (Aβ) and various metabolic dysfunctions. Due to the multifaceted nature of AD pathology and our limited understanding on its etiology, AD is difficult to be treated with currently available pharmaceuticals. This unmet need, however, could be met with stem cell technology that can be engineered to replace neuronal loss in AD patients. Although stem cell therapy for AD is only in its development stages, it has vast potential uses ranging from replacement therapy to disease modelling and drug development. Current progress with stem cells in animal model studies offers promising results for the new prospective treatment for AD. This review will discuss the characteristics of AD, current progress in stem cell therapy and remaining challenges and promises in its development.
Alzheimer Disease* ; Humans ; Models, Animal ; Neurofibrillary Tangles ; Neurogenesis ; Neurons ; Pathology ; Prospective Studies* ; Stem Cells* ; Transplantation