Venous leg ulcers, the most common form of leg ulcers, are relevant to the pathogenicity of pericapillary fibrin cuff. Sarcoidosis, a multiorgan granulomatous disease, causes fibrin deposition in tissues. We report a case of a 50-year-old man with venous leg ulcers coexisting with sarcoidosis. On the basis of the histologic findings, we propose the hypothesis that sarcoidosis patients are prone to the development of venous leg ulcers.
Capillaries ; Fibrin ; Humans ; Leg Ulcer* ; Leg* ; Middle Aged ; Sarcoidosis* ; Virulence

The temporal lobe is essential in saving declarative memory and plays an important role along with the cerebral neocortex in creating and maintaining long-term memory. Damage to the temporal lobe is expected to result in cognitive impairment or dementia, which has characteristic symptoms such as cognitive and behavioral dysfunction and decreasing self-reliance in activities of daily living. We report on a patient, who suffered from dementia due to meningovascular syphilis affecting the medial temporal lobe, and on the outcome of cognitive rehabilitation.
Activities of Daily Living ; Dementia ; Humans ; Memory ; Memory, Long-Term ; Neocortex ; Syphilis ; Temporal Lobe

The temporal lobe is essential in saving declarative memory and plays an important role along with the cerebral neocortex in creating and maintaining long-term memory. Damage to the temporal lobe is expected to result in cognitive impairment or dementia, which has characteristic symptoms such as cognitive and behavioral dysfunction and decreasing self-reliance in activities of daily living. We report on a patient, who suffered from dementia due to meningovascular syphilis affecting the medial temporal lobe, and on the outcome of cognitive rehabilitation.
Activities of Daily Living ; Dementia ; Humans ; Memory ; Memory, Long-Term ; Neocortex ; Syphilis ; Temporal Lobe

PURPOSE: We compared and analyzed central corneal thickness (CCT) measurements according to the corneal thickness obtained with noncontact specular microscopy (NCSM) and ultrasound pachymetry (USP). METHODS: CCT was measured in the order of NCSM and USP by a single optometrist in 120 eyes of 120 healthy subjects. The measurements were compared between the devices and the measurement agreements and correlations between the devices were analyzed. To determine if the measurements differed depending on the thickness of the cornea, the patients were divided into three tertile groups from the thinnest patient by CCT measurement using USP, and then the differences in CCT measured by the two devices were analyzed. RESULTS: The CCT measurements using NCSM and USP were 548.25 ± 4.64 µm and 533.09 ± 35.96 µm, respectively. NCSM measurements were found to be thicker, showing statistically significant differences between the measurements (p < 0.001). The two examinations showed a high degree of correlation (r = 0.878; p < 0.01). In the three groups, the differences in CCT measurements between NCSM and USP were 12.93 ± 21.88 µm, 16.85 ± 15.89 µm, and 15.70 ± 20.46 µm, respectively, but the differences between the three groups were not statistically significant (p = 0.655). CONCLUSIONS: Our results show that although the differences in CCT measurements using NCSM and USP were consistent regardless of the corneal thickness, the CCT measurements by NCSM and USP were highly correlated.
Cornea ; Corneal Pachymetry ; Healthy Volunteers ; Humans ; Microscopy ; Ultrasonography

OBJECTIVE: To explore plastic changes in the red nucleus (RN) of stroke patients with severe corticospinal tract (CST) injury as a compensatory mechanism for recovery of hand function. METHODS: The moderate group (MG) comprised 5 patients with synergistic hand grasp movement combined with limited extension, and the severe group (SG) included 5 patients with synergistic hand grasp movement alone. The control group (CG) included 5 healthy subjects. Motor assessment was measured by Motricity Index (MI). Diffusion tensor imaging was analyzed using fractional anisotropy (FA) and radial diffusivity (RD) in the individual regions of interest (ROIs)—bilateral internal capsule and anterior pons for CST injury and bilateral RN for rubrospinal tract (RST) injury. RESULTS: The SG showed a significantly lower MI score than the MG mainly due to differences in hand subscores. Significantly reduced FA was observed in both MG and SG compared with CG, while SG showed increased MD and RD in the affected ROIs of CST, and increased FA on the unaffected side compared with CG. However, in the RN ROI, a significantly increased FA and decreased RD on the unaffected side similar to the affected side were found only in the SG. The relative index of FA was lower and RD in SG was higher than in CG in RST. CONCLUSION: The diffusion metrics of RST showed changes in patients with severe CST injury, suggesting that RST may play a role in the recovery of hand function in patients with severe CST injury.
Anisotropy ; Diffusion Tensor Imaging ; Diffusion* ; Extrapyramidal Tracts ; Hand ; Hand Strength ; Healthy Volunteers ; Humans ; Internal Capsule ; Neuronal Plasticity ; Paraplegia ; Plastics ; Pons ; Pyramidal Tracts* ; Recovery of Function ; Red Nucleus* ; Stroke* ; Upper Extremity

OBJECTIVE: To investigate the effects of high frequency (10 Hz) repetitive transcranial magnetic stimulation (rTMS) on visuospatial motor learning, stimulated on the premotor cortex in basal ganglia hemorrhage patients. METHOD: Nine patients were randomized to receive real and sham rTMS. We subdivided into two groups according to the integrity of the corticospinal tract measured by diffusion tensor tractography. The implicit visuospatial learning paradigm composed of numbers 1 to 4, in which 12 sequential numbers (2-3-1-4-3-2-4-1-3-4-2-1) were incorporated randomly. We obtained the mean fraction anisotrophy (FA) and apparent diffusion coefficient (ADC) values from the corticospinal tract and subdividing into two groups by calculating the relative value (laterality %). RESULTS: rTMS on the premotor cortex was effective only in simple motor learning but not in visuospatial learning in group analysis. The primary motor cortex excitability after the premotor cortex stimulation has been changed significantly. Subdividing into two groups according to the integrity of the corticospinal tract using the ADC value, the low ADC value group showed significant reduction of the visuospatial response time. CONCLUSION: High frequency rTMS on the premotor cortex was effective in simple motor learning and also in the group who maintained more integrity of the corticospinal tract in basal ganglia hemorrhage.
Basal Ganglia Hemorrhage ; Diffusion ; Hemorrhage ; Humans ; Learning ; Motor Cortex ; Pyramidal Tracts ; Salicylamides ; Stroke ; Transcranial Magnetic Stimulation

Disruption of the cytoskeletal network and axonal membranes characterizes diffuse axonal injury (DAI) after traumatic brain injury. Histologic abnormalities seen in DAI hypothetically decrease the diffusion along axons and increase the diffusion in directions perpendicular to them. We tested this hypothesis by measuring the diffusion characteristics of traumatized brain tissue with use of diffusion tensor imaging (DTI). Two patients with traumatic brain injuries and five control subjects were studied with DTI. Mechanisms of change in fractional anisotropy maps of DTI were explored using an eigenvalue analysis of the diffusion tensor. Axial diffusivity (λ1) were decreased and radial diffusivity ((λ2+λ3)/2) were increased in both caudal middle frontal gyri, pars orbitalis gyri, fusiform gyri, parahippocampal gyri (patient 1), caudal middle frontal gyri, precentral gyri, middle temporal gyri (patient 2). Both axial and radial diffusivity were increased in most of the frontal lobe gyri. We applied new analytic methods for DAI in traumatic brain injury.

BACKGROUND: We analyzed whether thyroid stimulating hormone receptor (TSH-R) is expressed in a skeletal muscle cell line and if TSH has influence on the differentiation of muscle cells or on the determination of muscle fiber types. METHODS: TSH-R gene expression was detected with nested real-time polymerase chain reaction (RT-PCR) in C2C12, a mouse skeletal muscle cell line. The effect of TSH on myotube differentiation was assessed by microscopic examination of myotube formation and through the measurement of expression of muscle differentiation markers, i.e., myogenin and myoD, and muscle type-specific genes, i.e., MyHC1, MyHC2a, and MyHC2b, with quantitative RT-PCR before and after incubation of C2C12 myotube with TSH. RESULTS: TSH-R was expressed in the mouse skeletal muscle cell line. However, treatment with TSH had little effect on the differentiation of muscle cells, although the expression of the muscle differention marker myogenin was significantly increased after TSH treatment. Treatment of TSH did not affect the expression of muscle type-specific genes. CONCLUSION: TSH-R is expressed in a mouse skeletal muscle cell line, but the role of TSH receptor signaling in skeletal muscle needs further investigation.
Animals ; Antigens, Differentiation ; Cell Line ; Gene Expression ; Mice ; Muscle Cells ; Muscle Fibers, Skeletal ; Muscle, Skeletal ; Muscles ; Myogenin ; Real-Time Polymerase Chain Reaction ; Receptors, Thyrotropin ; Thyroid Gland ; Thyrotropin

OBJECTIVE: To assess the risk factors for delirium in patients admitted to a rehabilitation unit for acute or subacute neurological or musculoskeletal disorders. METHODS: We reviewed the medical records of 537 patients admitted to a rehabilitation unit and selected 398 patients in the acute or subacute stage of various neurological or musculoskeletal disorders. Among them, patients who had suffered from delirium were categorized into the delirium group (n=65), and the other patients were categorized into the non-delirium group (n=333). As potential risk factors for delirium, the patients' diagnosis, underlying disease, demographic data, hospital stay duration, surgery, and laboratory findings were reviewed, and the differences between the two groups with respect to independent risk factors were analyzed. RESULTS: The average age in the delirium group was higher; the hospital stay and pre-transfer periods were longer. A large proportion of the patients were admitted for musculoskeletal disorders, and many patients had diabetes mellitus, dementia, and depression as underlying diseases. Laboratory tests revealed increases in the white blood cells (WBC), glucose, blood urea nitrogen (BUN), total bilirubin, aspartate transaminase (AST), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels in the delirium group, while the hemoglobin, calcium, phosphorus, protein, albumin, and potassium levels were decreased. Depression, musculoskeletal disorders, traumatic brain injury, elevated WBC, BUN, AST, and CRP levels, and decreased potassium and phosphorus levels were identified as independent risk factors for delirium. CONCLUSION: Risk factors treatable before delirium onset were identified in rehabilitation patients in acute and subacute stages of various disorders. Early diagnosis and prevention of these risk factors could decrease delirium occurrence and increase rehabilitation effectiveness.
Aspartate Aminotransferases ; Bilirubin ; Blood Glucose ; Blood Sedimentation ; Brain Injuries ; C-Reactive Protein ; Calcium ; Delirium* ; Dementia ; Depression ; Diabetes Mellitus ; Diagnosis ; Early Diagnosis ; Humans ; Length of Stay ; Leukocytes ; Medical Records ; Nitrogen ; Phosphorus ; Potassium ; Rehabilitation* ; Risk Factors* ; Urea

OBJECTIVE: To delineate whether cortical plasticity induced by continuous theta burst stimulation (cTBS) differed according to catechol-O-methyltransferase (COMT) gene polymorphism in healthy older adults. METHODS: Eighteen healthy older volunteers (mean age 73.78+/-5.04; 12 females and 6 males) were recruited. Volunteers randomly assigned in either a sham-first or real cTBS first group participated in two separate TMS visits with at least a 2-day wash-out period. Genotyping was carried out at baseline by a separate researcher who was blinded. cTBS was delivered in a hot spot over M1 at an active motor threshold of 80%. Motor evoked potentials (MEPs) were obtained at 120% of the resting motor threshold before and after sham/cTBS. RESULTS: The relative MEP to baseline was significantly decreased 0 and 10 minutes post-stimulation and increased 40 minutes post-stimulation, as compared with the sham condition. Immediately after cTBS, the Val/Val group had a significantly reduced relative MEP value, as compared with the MET carrier group. CONCLUSION: In healthy older persons, cTBS-induced motor plasticity was reduced in the COMT Val/Val group as compared with the 158Met carrier group.
Adult ; Aged* ; Catechol O-Methyltransferase ; Evoked Potentials, Motor ; Female ; Humans ; Motor Cortex ; Neuronal Plasticity ; Plastics* ; Polymorphism, Genetic ; Transcranial Magnetic Stimulation ; Volunteers