Neonatal hypernatremia often occurs in poorly breastfeeding infants, and rehydration without complications is the primary treatment. However, the etiologies and management for neonates who present with hypernatremia immediately after birth are not well reported. In this case report, we describe a neonate with hypernatremia and hyperosmolality, born to a mother with oligohydramnios of unknown etiology. Meticulous fluid therapies considering the time to physiologic diuresis were successfully performed, and the underlying cause was determined to be an uncontrolled maternal central diabetes insipidus.

The prevalence of unruptured intracranial aneurysm varies between 3.6% and 6%.Aneurysms in the posterior circulation, inaccessible by normothermic surgical clipping and giant aneurysms require direct surgical clipping under hypothermic circulatory arrest for cerebral protection.The authors describe a case of giant basilar aneurysm clipping requiring deep hypothermic total circulatory arrest under total intravenous anesthesia.The patient was a 43-year-old female with a giant aneurysm at the tip of the basilar artery.Total intravenous anesthesia with propofol (average effect site concentration 4 mcg/ml) and remifentanil (average effect site concentration 3 ng/ml) and deep hypothermic total circulatory arrest were performed.Neurophysiologic function was monitored by electroencephalography, and somatosensory and motor evoked potentials. Cardiac and coagulation profiles showed no significant changes. The aneurysm was successfully clipped but the patient expired. Further collations of clinical experiences should enable the identification of an optimal means of anesthetic management during complex cerebrovascular surgery.
Adult ; Anesthesia, Intravenous ; Aneurysm ; Circulatory Arrest, Deep Hypothermia Induced ; Electroencephalography ; Evoked Potentials, Motor ; Female ; Humans ; Intracranial Aneurysm ; Piperidines ; Prevalence ; Propofol ; Surgical Instruments

Purpose: Most of the currently used concepts and measurements of social support have been relevant for general population. The main purpose of this study is to conduct the concept analysis of perceived social support(PSS) of family caregivers for people with dementia. Methods: This study adopted the Walker and Avant concept analysis methodology. Results: Findings from this concept analysis suggested four defining attributes of PSS of family caregivers for people with dementia: 1) PSS is help or assistance that family caregivers perceive as available when needed; 2) PSS is offered through socio-ecological structure; 3) PSS has a specific function to meet the needs of family caregivers; and 4) PSS includes quality aspects where family caregivers choose, use, or evaluate it. Borrowing from the socio-ecological model, this study proposed the structural aspects of PSS. This study also identified functional aspects of PSS, such as emotional support, informational support, appraisal support, and practical support. Finally, this study assessed quality aspects of PSS, such as satisfaction, timeliness, usefulness, accessibility, and coordination. Conclusion Focusing on family caregivers for people with dementia, we proposed a new model of PSS. The present study helped refine and clarify the concept of PSS of family caregivers for people with dementia. The results of this study may also contribute to promoting the development of more effective instruments for the concept.

Purpose: Repeated transcranial direct current stimulation (tDCS) is expected to have the potential to improve cognitive function in patients with mild cognitive impairment (MCI). We aimed to evaluate the efficacy and safety of at-home tDCS for elderly patients with MCI. Materials and Methods: Patients aged 60–80 years, who maintained normal daily living but reported objective memory impairments, were enrolled. Active or sham stimulations were applied to the dorsal frontal cortex (left: anode; right: cathode) at home for 2 weeks. Changes in cognitive function were assessed using visual recognition tasks and the Mini-Mental State Exam (MMSE), and safety and efficacy were assessed using self-reports and a remote monitoring application. Results: Of the 19 participants enrolled, 12 participants were included in the efficacy analysis. Response times and MMSE scores significantly improved after active stimulation compared to the sham stimulation; however, there were no significant differences in the proportion of correct responses. The mean compliance of the efficacy group was 97.5%±4.1%. Three participants experienced burns, but no permanent sequelae remained. Conclusion This preliminary result suggests that home-based tDCS may be a promising treatment option for MCI patients; however, it requires more attention and technological development to address safety concerns.

Orthostatic headache after suboccipital craniectomy has been rarely reported. A 32-year-old man underwent emergent suboccipital craniectomy due to acute bilateral cerebellar infarctions with massive brain edema. Although his neurological deterioration halted after the craniectomy, he still suffered from a severe disabling orthostatic headache. We performed two epidural blood patches at the levels of the lumbar and thoracic spine. He improved considerably a few days after the repetitive epidural blood patches. Epidural blood patches may be a useful treatment modality for post-craniectomy postural headaches.
Adult ; Blood Patch, Epidural* ; Brain Edema ; Headache* ; Humans ; Infarction ; Spine

The authors report jerky seesaw nystagmus, extorsional downbeating in the right eye and intorsional upbeating in the left eye, in a patient with right internuclear ophthalmoplegia (INO). This pattern of nystagmus may occur by disrupting pathways from contralateral posterior and anterior semicircular canals by a lesion in the medial longitudinal fasciculus. Depending on damage to the pathways from contralateral vertical canals, various patterns of dissociated torsional-vertical nystagmus may accompany INO.
Humans ; Ocular Motility Disorders* ; Semicircular Canals

CDK2 and CDK4 known promoter of cell cycling catalyze phosphorylation of RB protein. Enzyme specificity between two CDKs that work at a different cell cycle phase is not clearly understood. In order to define kinase properties of CDK2 and CDK4 in complex with cycline A or cycline D1 in relation to their respective role in cell cycling regulation, we examined enzymatic properties of both CDK4/cycline D1 and CDK2/cycline A in vitro. Association constant, Km for ATP in CDK4/cyclin D1 was found as 418 micrometer, a value unusually high whereas CDK2/cyclin A was 23 micrometer, a value close to most of other regulatory protein kinases. Turnover value for both CDK4/cyclin D1 and CDK2/cyclin A were estimated as 3.4 and 3.9 min(-1)respectively. Kinetic efficiency estimation indicates far over one order magnitude less efficiency for CDK4/cyclin D1 than the value of CDK2/cycline A (9.3 pM(-1)min(-1)and 170 pM(-1)min(-1)respectively). In addition, inhibition of cellular CDK4 caused increase of cellular levels of ATP, even though inhibition of CDK2 did not change it noticeably. These data suggest cellular CDK4/cyclin D1 activity is tightly associated with cellular ATP concentration. Also, analysis of phosphorylated serine/threonine sites on RB catalyzed by CDK4/cyclin D1 and CDK2/cyclin A showed significant differences in their preference of phosphorylation sites in RB C-terminal domain. Since RB is known to regulate various cellular proteins by binding and this binding is controlled by its phosphorylation, these data shown here clearly indicate significant difference in their biochemical properties between CDK4/cyclin D1 and CDK2/cyclin A affecting regulation of cellular RB function.
Adenosine Triphosphate/metabolism ; Amino Acid Sequence ; Baculoviridae/genetics ; CDC2-CDC28 Kinases/genetics/isolation&purification/*metabolism ; Cyclin A/genetics/isolation&purification/*metabolism ; Cyclin D1/genetics/isolation&purification/*metabolism ; Cyclin-Dependent Kinases/antagonists&inhibitors/genetics/isolation&purification/*metabolism ; Human ; Kinetics ; Molecular Sequence Data ; Phosphorylation ; Protein Conformation ; Protein p16/metabolism ; Recombinant Proteins/genetics/isolation&purification/metabolism

Post-stroke atrial fibrillation has been frequently reported especially in the patients with right insular infarct as an evidence of cerebrogenic mechanism affecting on cardiac rhythm. However, conversion to normal sinus rhythm after stroke in patients who had atrial fibrillation has not been reported. A 88-year-old men who had untreated atrial fibrillation was admitted to hospital due to left middle cerebral artery territory infarction. During admission, second ischemic attack occurred in right middle cerebral artery territory. At that time, his atrial fibrillation converted spontaneously to normal sinus rhythm. Restored sinus rhythm sustained until he died due to sepsis. This case is evidence supporting a theory that brain is associated with control of cardiac rhythm. If no risk factor is revealed by intensive investigation in patients with acute cerebral infarctions that cardioembolism is strongly suspected as a cause, physicians should concern transformation of atrial fibrillation to normal sinus rhythm after stroke.
Atrial Fibrillation ; Autonomic Nervous System ; Brain ; Cerebral Infarction ; Humans ; Infarction ; Male ; Middle Cerebral Artery ; Risk Factors ; Sepsis ; Stroke

No abstract available.
Anesthesia, Spinal* ; Arachnoid* ; Headache* ; Humans ; Incidental Findings*

No abstract available.
Anesthesia, Spinal* ; Arachnoid* ; Headache* ; Humans ; Incidental Findings*