The symptom of crocodile tears refers to an abnormal gusto-lacrimal reflex whereby any stimulus causing parotid secretion also induces lacrimation. It is a sequelae lesion of facial nerve, usually after the facial paralysis. The authors found the symptom of crocodile tears in one case after facial paralysis due to herpes zoster oticus and two cases after Bell's palsy.
Alligators and Crocodiles* ; Bell Palsy ; Facial Nerve ; Facial Paralysis* ; Herpes Zoster Oticus ; Reflex ; Tears*

Hypertension is the leading factor of cardiovascular mortality and morbidity. Although antihypertensive medical treatment is the cornerstone of blood pressure control, lifestyle modification, including optimal diet therapy, such as dietary approaches to stop hypertension (DASH), cannot be overemphasized.Current Concepts: Due to the mismatch between sodium intake and excretion process being the key mechanisms according to physiologic principles, low sodium and high potassium intakes are the critical components of DASH. If the patient has a sensitive elevation of blood pressure following increased sodium intake, a low sodium diet could be essential for optimal blood pressure control. Salt sensitivity is increased by the activated reninangiotensin system, sympathetic nervous activity, sodium channels disorder, and endothelial dysfunction and frequently observed in the elderly and patients with obesity and chronic kidney disease. Increased potassium intake could attenuate sodium absorption by affecting the intracellular chloride and WNK4 activity, especially in patients with salt sensitivity or high salt intake.Discussion and Conclusion: For low sodium and high potassium intakes, the Na/K diet ratio could be a good target for intervention, and this approach is a critical component of DASH.

PURPOSE: We proposed a multi-physiological signals based real-time intelligent triggering system(MITS) for Cardiac MRI. Induced noise of the system was analyzed. MATERIALS AND METHODS: MITS makes cardiac MR imaging sequence synchronize to the cardiac motion using ECG, respiratory signal and second order derivative of SPO2 signal. Abnormal peaks due to arrhythmia or subject's motion are rejected using the average R-R intervals and R-peak values. Induced eddy currents by gradients switching in cardiac MR imaging are analyzed. The induced eddy currents were removed by hardware and software filters. RESULTS: Cardiac MR images that synchronized to the cardiac and respiratory motion are acquired using MITS successfully without artifacts caused by induced eddy currents of gradient switching or subject's motion or arrhythmia. We showed that the second order derivative of the SPO2 signal can be used as a complement to the ECG signals. CONCLUSION: The proposed system performs cardiac and respiratory gating with multi-physiological signals in real time. During the cardiac gating, induced noise caused by eddy currents is removed. False triggers due to subject's motion or arrhythmia are rejected. The cardiac MR imaging with free breathing is obtained using MITS.
Arrhythmias, Cardiac ; Artifacts ; Complement System Proteins ; Electrocardiography ; Magnetic Resonance Imaging* ; Noise ; Respiration

PURPOSE: A new compressed sensing technique by iterative truncation of small transformed coefficients (ITSC) is proposed for fast cardiac CINE MRI. MATERIALS AND METHODS: The proposed reconstruction is composed of two processes: truncation of the small transformed coefficients in the r-f domain, and restoration of the measured data in the k-t domain. The two processes are sequentially applied iteratively until the reconstructed images converge, with the assumption that the cardiac CINE images are inherently sparse in the r-f domain. A novel sampling strategy to reduce the normalized mean square error of the reconstructed images is proposed. RESULTS: The technique shows the least normalized mean square error among the four methods under comparison (zero filling, view sharing, k-t FOCUSS, and ITSC). Application of ITSC for multi-slice cardiac CINE imaging was tested with the number of slices of 2 to 8 in a single breath-hold, to demonstrate the clinical usefulness of the technique. CONCLUSIONS: Reconstructed images with the compression factors of 3-4 appear very close to the images without compression. Furthermore the proposed algorithm is computationally efficient and is stable without using matrix inversion during the reconstruction.
Magnetic Resonance Imaging, Cine*

OBJECTIVES: The family caregivers of patients with dementia experience high caregiver burden. This study aims to investigate the prevalence of depression in family caregivers of dementia patients and to reveal whether or not the depression is affected by caregiver burden.METHODS: Multi-stage cluster sampling was adopted in this study. Interviews were conducted face-to-face with 18-year-old and older people living in the community from June to November 2016. Korean version of Composite International Diagnostic Interview(K-CIDI) was applied to assess the prevalence of one-year MDD of the subjects. It also examined whether caregivers in the survey lived with the dementia patients, whether they were caregiving the dementia patients themselves, and which relationship they had.RESULTS: Cross-analysis was conducted on the relationships in MDD and caregiver burden according to demographic factors, with a total of 5,102 respondents in the study. Prevalence of one-year MDD was 8.2% for sons and daughters and 50% for spouses with dementia. Among the families who had caregiver burden with dementia, prevalence of one-year MDD was 12.9%. Elderly and small numbers of family were also significantly associated with the prevalence of one-year MDD.CONCLUSION: The prevalence of one-year MDD of the family caregivers of patients with dementia was higher than without that of patients according to family relation and caregiver burden. Caregivers who were elderly and had two or fewer family members had more caregiver burden and higher prevalence of one-year MDD.
Adolescent ; Aged ; Caregivers ; Dementia ; Demography ; Depression ; Depressive Disorder, Major ; Family Relations ; Humans ; Korea ; Nuclear Family ; Prevalence ; Spouses ; Surveys and Questionnaires

Chronic kidney disease (CKD) is associated with increased risk of cardiovascular (CV) events, and the disease burden is rising rapidly. An important contributor to CV events and CKD progression is high blood pressure (BP). The main mechanisms of hypertension in early and advanced CKD are renin-angiotensin system activation and volume overload, respectively. Sodium retention is well known as a factor for high BP in CKD. However, a BP increase in response to total body sodium or volume overload can be limited by neurohormonal modulation. Recent clinical trial data favoring intensive BP lowering in CKD imply that the balance between volume and neurohormonal control could be revisited with respect to the safety and efficacy of strict volume control when using antihypertensive medications. In hemodialysis patients, the role of more liberal use of antihypertensive medications with the concept of functional dry weight for intensive BP control must be studied.

This study shows a case of neoadjuvant chemotherapy application for the management of a 34-year-old male patient diagnosed with invasive intraductal papillary mucinous neoplasm (IPMN), for which curative margin-negative resection initially seemed challenging. Five cycles of the FOLFIRINOX regimen (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) were administered preoperatively, resulting in a significant reduction of the intraductal mass size and deformity of the main vessels. The patient subsequently underwent a successful robotic pylorus-preserving pancreatoduodenectomy. Postoperatively, the patient received adjuvant chemotherapy with FOLFIRINOX, and after 5 months, showed no signs of tumor recurrence or specific complications. These findings suggest that neoadjuvant therapy can be a potentially effective strategy even in advanced invasive IPMN. Further research is necessary to establish guidelines for its application.

Purpose: Netarsudil is a Rho kinase inhibitor and the first new class of clinically useful ocular hypotensive agents. In this study, we conducted a systematic literature review and meta-analysis to summarize and synthesize the available evidence on the efficacy and safety of fixed-dose combination (FDC) therapy with netarsudil/latanoprost in patients with glaucoma. Methods: We identified relevant studies in PubMed, Ovid Medline, Embase, and Cochrane Central until April 2021. The quality of the studies and the level of evidence were assessed using the Risk of Bias tool. Efficacy was measured as the mean difference in reducing intraocular pressure (IOP), and safety was assessed by the risk of conjunctival hyperemia (CH) due to FDC therapy, netarsudil monotherapy, or latanoprost monotherapy. Results: Four studies met the predefined eligibility criteria and were included in the meta-analysis. The mean difference in the reduction in IOP after 2 weeks and 4 to 6 weeks of drug administration was -2.41 mmHg (95% confidence interval [CI], -2.95 to -1.87) and -1.77 mmHg (95% CI, -2.31 to -1.87), respectively, in patients receiving FDC therapy versus those receiving latanoprost monotherapy. On the other hand, latanoprost monotherapy had a greater effect in reducing IOP than netarsudil monotherapy after 4 to 6 weeks of administration (mean difference, 0.95 mmHg; 95% CI, 0.43 to 1.47). The risk of CH was significantly higher with both FDC therapy and netarsudil monotherapy compared to latanoprost monotherapy in week 12, where the relative ratio was 3.01 (95% CI, 1.95 to 4.66) and 2.33 (95% CI, 1.54 to 3.54), each. Conclusions Netarsudil/latanoprost FDC therapy has a significantly greater effect on reducing IOP than latanoprost alone. The symptoms of CH were mostly mild, and only a few glaucoma patients discontinued the medication owing to CH in earlier clinical trials. Therefore, it would be beneficial to consider the administration of netarsudil/latanoprost FDC therapy in patients with glaucoma.

PURPOSE: To report brain metastasis of hepatocellular carcinoma presenting as homonymous hemianopia. CASE SUMMARY: A 51-year-old female with a history of hepatectomy and diagnosis of hepatocellular carcinoma (HCC) 19 months earlier was referred to our neuro-ophthalmology clinic for evaluation due to headache and decreased visual acuity over the past several months. Best visual acuity was 20/20, and the results of all other aspects of our examination were normal except Humphrey automatic perimetry, which showed complete left homonymous hemianopia. Brain magnetic resonance imaging showed a large mass in the right occipital lobe. Craniotomy and removal of tumor were performed. HCC was confirmed by histopathologic examination. CONCLUSIONS: Metastasis of hepatocellular carcinoma to the occipital lobe is extremely rare but can present as homonymous hemianopia. Therefore, clinicians should be aware of this when examining a patient with a history of HCC.
Brain ; Brain Neoplasms ; Carcinoma, Hepatocellular* ; Craniotomy ; Diagnosis ; Female ; Headache ; Hemianopsia* ; Hepatectomy ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis* ; Occipital Lobe* ; Visual Acuity ; Visual Field Tests

PURPOSE: Bronchiolitis obliterans (BO) is an uncommon disease of the respiratory bronchioles and alveolar ducts that results in fibrosis and obliteration of the small airways. The causes of BO are diverse, but postinfectious BO is usually seen in children, especially after viral or Mycoplasma pneumoniae (M. pneumoniae) pneumonia. The aim of this study was to evaluate functional abnormalities such as bronchial hyperresponsiveness in the patients with High Resolution Computed Tomography (HRCT) findings suggestive of BO after M. pneumoniae pneumonia. METHODS: The diagnosis of M. pneumoniae pneumonia was made by a fourfold or higher rise in the antibody titers between acute and convalescent phase or a single very high titers (> or =1: 640) among children with clinical pneumonia. HRCT was checked in those with intermittent or chronic respiratory symptoms between one and two years after M. pneumoniae pneumonia. Eighteen patients with HRCT findings suggestive of BO (Group 1) and 24 patients with normal HRCT findings (Group 2) underwent methacholine bronchial challenge and skin prick testing. RESULTS: Mean FEV1 (% predicted) value of Group 1 (92.0%) was significantly lower than that of the Group 2. (101.1%) (P=0.048) The geometric mean of methacholine PC20 in Group 1 (8.5 mg/ mL) was significantly lower than that of the Group 2, (25.7 mg/mL) (P=0.008) with a higher frequency of bronchial hyperresponsiveness (PC20< 8 mg/mL) in Group 1 (38.8%) than in Group 2. (8.3%) (P=0.017) Prevalence of atopy was not different between Group 1 and Group 2, and mean FEV1 (% predicted) value and methacholine PC20 showed no significant difference according to the presence of atopy in either group. CONCLUSION: HRCT findings suggestive of BO after M. pneumoniae pneumonia were associated with functional abnormalities such as lower spirometric values and enhanced bronchial hyperresponsiveness.
Bronchioles ; Bronchiolitis Obliterans* ; Bronchiolitis* ; Child ; Diagnosis ; Fibrosis ; Humans ; Hypersensitivity, Immediate ; Methacholine Chloride ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia* ; Pneumonia, Mycoplasma* ; Prevalence ; Skin