PURPOSE: Laparoscopic cholecystectomy (LC) is now a standard operation for benign gallbladder (GB) disease. However, previous upper abdominal surgery (UAS) has been regarded as a relative contraindication for LC. The purpose of this study was to examine the effects of history of upper abdominal surgery including gastrectomy on the operative and postoperative results of LC. METHODS: A total of 769 patients underwent LC between March 2008 and December 2015, and the surgical outcomes of 45 patients who had a history of UAS were retrospectively compared with those who did not. Twenty of 45 patients with a history of UAS received gastrectomy, and the remaining 25 received non-gastrectomy UAS. The degree of adhesion and clinical outcomes were further compared between these two groups. RESULTS: The patients with a history of UAS required placement of a greater number of trocars, longer operation time, longer duration of drainage insertion, and higher open conversion rate (4.4%) compared to patients with no history of UAS. However, there were no significant differences in postoperative hospital stay or complication rate between the two groups. In the UAS group, 93.3% of patients required adhesiolysis. There were no significant differences in clinical findings or perioperative outcomes between gastrectomy group and non-gastrectomy group. CONCLUSION: A history of UAS including gastrectomy increases the technical difficulty of LC as well as open conversion rate. However, LC can be a feasible and safe approach when performed with adequate methods.
Cholecystectomy, Laparoscopic* ; Drainage ; Gallbladder ; Gastrectomy* ; Humans ; Length of Stay ; Retrospective Studies ; Surgical Instruments

PURPOSE: Patients with brain damage suffer from limitations in performing the activities of daily living (ADL) because of their motor function and visual perception impairment. The aim of this study was to help improve the motor function and visual perception ability of patients with brain damage by providing them with virtual reality-based contents. The usability results of the patients and specialists group were also evaluated. METHODS: The ADL contents consisted of living room, kitchen, veranda, and convenience store, similar to a real home environment, and these were organized by a rehabilitation specialist (e.g., neurologist, physiotherapist, and occupational therapist). The contents consisted of tasks, such as turning on the living room lights, organizing the drawers, organizing the kitchen, watering the plants on the veranda, and buying products at convenience stores. To evaluate the usability of the virtual reality-based visual cognitive rehabilitation service, general elderly subjects (n=11), stroke patients (n=7), stroke patients with visual impairment (n=4), and rehabilitation specialists (n=11) were selected. The questionnaires were distributed to the subjects who were using the service, and the subjective satisfaction of individual users was obtained as data. The data were analyzed using SPSS 21.0 software. The general characteristics of the users and the evaluation scores of the experts were analyzed using descriptive statistics. RESULTS: The usability test result of this study showed that the mean value of the questionnaire related to content understanding and difficulty was high, between 4–5 points. CONCLUSION: The virtual reality rehabilitation service of this study is an efficient service that can improve the function, interest, and motivation of stroke patients.
Activities of Daily Living ; Aged ; Brain ; Cognitive Therapy ; Humans ; Motivation ; Physical Therapists ; Rehabilitation ; Specialization ; Stroke ; Vision Disorders ; Visual Perception ; Water

To date, researchers have developed various animal models of Alzheimer’s disease (AD) to investigate its mechanisms and to identify potential therapeutic treatments. A widely recognized model that mimics the pathology of human sporadic AD involves intracerebroventricular (ICV) injection with streptozotocin (STZ). However, ICV injections are an invasive approach, which creates limitations in generalizing the results. In this study, we produced a rodent model of AD using STZ (3 mg/kg) injection via the cisterna magna (CM) once every week for 4 weeks, and analyzed at 4 weeks and 16 weeks after final injection. In the CM-STZ rodent model of AD, we observed increase in extracellular amyloid-beta (Aβ) deposition and decrease and abnormal morphology of post-synaptic protein, PSD95 in 16 weeks STZ-injected group. The model developed using our less-invasive method induced features of AD-like pathology, including significantly increased extracellular amyloid-beta deposition, and decreased synaptic protein in the hippocampus. These findings supporting the success of this alternative approach, and thus, we suggest this is a promising, less invasive model for use in future AD research.

Objective: Early identification of COVID-19 in patients is important to prevent significant worsening of the disease. This study was undertaken to verify whether MEWS (Modified Early Warning Score), NEWS(National Early Warning Score), ROX index, and CURB-65, which are early diagnostic tools for severe respiratory diseases, could be applied to patients visiting the emergency room for COVID-19. Methods: This retrospective observational study included patients who visited an emergency medical center from September 1 to October 31, 2020, and from January 1 to February 28, 2021. Based on the vital signs and blood tests during the emergency room visit, severity evaluation tools and early diagnostic tools for severe cases were used and compared according to their area under the curve (AUC) values. The primary outcome was in-hospital mortality, while the secondary outcomes were intensive care unit admission rate and the need for mechanical ventilation based on these four tools (MEWS, NEWS, ROX index, and CURB-65). Results: A total of 667 patients were analyzed. No significant difference was determined between the non-survivor group and survivor group in the MEWS values (P=0.13), but statistically significant differences were observed for NEWS (5 vs. 1, P<0.05), CURB-65 (2 vs. 1, P<0.05), and ROX index (16.61 vs. 23.1, P<0.01). The AUC value of NEWS for death prediction indicated a good predictive power at 0.80, while that of MEWS showed a low predictive power at 0.57, which was statistically significant. Moreover, the AUC values of CURB-65 and ROX index did not differ significantly from values obtained for NEWS. Conclusion As early diagnostic tools for predicting death in COVID-19 patients, NEWS, ROX index, and CURB-65 showed excellent discrimination ability, whereas MEWS showed statistically and significantly lower discrimination ability.

Till date, researchers have been developing animal models of Alzheimer’s disease (AD) in various species to understand the pathological characterization and molecular mechanistic pathways associated with this condition in humans to identify potential therapeutic treatments. A widely recognized AD model that mimics the pathology of human AD involves the intracerebroventricular (ICV) injection with streptozotocin (STZ).However, ICV injection as an invasive approach has several limitations related to complicated surgical procedures. Therefore, in the present study, we created a customized stereotaxic frame using the XperCT-guided system for injecting STZ in cynomolgus monkeys, aiming to establish an AD model. The anatomical structures surrounding the cisterna magna (CM) were confirmed using CT/MRI fusion images of monkey brain with XperCT, the c-arm cone beam computed tomography. XperCT was used to determine the appropriate direction in which the needle tip should be inserted within the CM region. Cerebrospinal fluid (CSF) was collected to confirm the accurate target site when STZ was injected into the CM.Cynomolgus monkeys were administered STZ dissolved in artificial CSF once every week for 4 weeks via intracisterna magna (ICM) injection using XperCT-guided stereotactic system. The molecular mechanisms underlying the progression of STZ-induced AD pathology were analyzed two weeks after the final injection. The monkeys subjected to XperCT-based STZ injection via the ICM route showed features of AD pathology, including markedly enhanced neuronal loss, synaptic impairment, and tau phosphorylation in the hippocampus. These findings suggest a new approach for the construction of neurodegenerative disease models and development of therapeutic strategies.

Ischemic stroke results from arterial occlusion and can cause irreversible brain injury. A non-human primate (NHP) model of ischemic stroke was previously developed to investigate its pathophysiology and for efficacy testing of therapeutic candidates; however, fine motor impairment remains to be well-characterized. We evaluated hand motor function in a cynomolgus monkey model of ischemic stroke. Endovascular transient middle cerebral artery occlusion (MCAO) with an angiographic microcatheter induced cerebral infarction. In vivo magnetic resonance imaging mapped and measured the ischemia-induced infarct lesion. In vivo diffusion tensor imaging (DTI) of the stroke lesion to assess the neuroplastic changes and fiber tractography demonstrated three-dimensional patterns in the corticospinal tract 12 weeks after MCAO. The hand dexterity task (HDT) was used to evaluate fine motor movement of upper extremity digits. The HDT was modified for a home cage-based training system, instead of conventional chair restraint training. The lesion was localized in the middle cerebral artery territory, including the sensorimotor cortex. Maximum infarct volume was exhibited over the first week after MCAO, which progressively inhibited ischemic core expansion, manifested by enhanced functional recovery of the affected hand over 12 weeks after MCAO. The total performance time decreased with increasing success rate for both hands on the HDT. Compensatory strategies and retrieval failure improved in the chronic phase after stroke. Our findings demonstrate the recovery of fine motor skill after stroke, and outline the behavioral characteristics and features of functional disorder of NHP stroke model, providing a basis for assessing hand motor function after stroke.

Mitochondria continuously fuse and divide to maintain homeostasis. An impairment in the balance between the fusion and fission processes can trigger mitochondrial dysfunction. Accumulating evidence suggests that mitochondrial dysfunction is related to neurodegenerative diseases such as Parkinson's disease (PD), with excessive mitochondrial fission in dopaminergic neurons being one of the pathological mechanisms of PD. Here, we investigated the balance between mitochondrial fusion and fission in the substantia nigra of a non-human primate model of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced PD. We found that MPTP induced shorter and abnormally distributed mitochondria. This phenomenon was accompanied by the activation of dynamin-related protein 1 (Drp1), a mitochondrial fission protein, through increased phosphorylation at S616. Thereafter, we assessed for activation of the components of the cyclin-dependent kinase 5 (CDK5) and extracellular signal-regulated kinase (ERK) signaling cascades, which are known regulators of Drp1(S616) phosphorylation. MPTP induced an increase in p25 and p35, which are required for CDK5 activation. Together, these findings suggest that the phosphorylation of Drp1(S616) by CDK5 is involved in mitochondrial fission in the substantia nigra of a non-human primate model of MPTP-induced PD.
1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine ; Cyclin-Dependent Kinase 5 ; Cyclin-Dependent Kinases ; Dopaminergic Neurons ; Homeostasis ; Mitochondria ; Mitochondrial Dynamics ; Neurodegenerative Diseases ; Parkinson Disease ; Phosphorylation ; Phosphotransferases ; Primates ; Substantia Nigra

The function of microglia/macrophages after ischemic stroke is poorly understood. This study examines the role of microglia/macrophages in the focal infarct area after transient middle cerebral artery occlusion (MCAO) in rhesus monkeys. We measured infarct volume and neurological function by magnetic resonance imaging (MRI) and non-human primate stroke scale (NHPSS), respectively, to assess temporal changes following MCAO. Activated phagocytic microglia/macrophages were examined by immunohistochemistry in post-mortem brains (n=6 MCAO, n=2 controls) at 3 and 24 hours (acute stage), 2 and 4 weeks (subacute stage), and 4, and 20 months (chronic stage) following MCAO. We found that the infarct volume progressively decreased between 1 and 4 weeks following MCAO, in parallel with the neurological recovery. Greater presence of cluster of differentiation 68 (CD68)-expressing microglia/macrophages was detected in the infarct lesion in the subacute and chronic stage, compared to the acute stage. Surprisingly, 98~99% of transforming growth factor beta (TGFβ) was found colocalized with CD68-expressing cells. CD68-expressing microglia/macrophages, rather than CD206⁺ cells, may exert anti-inflammatory effects by secreting TGFβ after the subacute stage of ischemic stroke. CD68⁺ microglia/macrophages can therefore be used as a potential therapeutic target.
Brain ; Haplorhini ; Immunohistochemistry ; Infarction, Middle Cerebral Artery ; Inflammation ; Macaca mulatta ; Magnetic Resonance Imaging ; Microglia ; Middle Cerebral Artery ; Primates ; Stroke ; Transforming Growth Factor beta