BACKGROUND: Olfactory dysfunction is common in patients with Parkinsons disease (PD) and may precede the development of parkinsonian motor symptoms. Cardiac sympathetic denervation, which can be visualized by a cardiac (123)I-metaiodobenzylguanidine (MIBG) scan, is common in patients with PD. In this study, we evaluated olfactory functions in patients with IPD and MSA, and investigated an association between olfaction and cardiac 123I-MIBG uptake in these patients. METHODS: We prospectively enrolled 26 patients with PD, 19 patients with MSA, and 18 healthy controls. Olfactory function was evaluated with a 12-Item Cross-Cultural Smell Identification Test (CC-SIT) and Butanol threshold. 123I-MIBG (111 mBq) was injected intravenously into each subject, and cardiac uptake was imaged 3 hours later. The regions of interest were the whole heart and the mediastinum of the front image, and the ratio of 123I-MIBG uptake in the heart to that in the mediastinum (H/M ratio) was calculated. The clinical stages of parkinsonism were assessed according to the classification of Hoehn and Yahr (H&Y) and the Unified PD Rating Scale (UPDRS). RESULTS: The mean CC-SIT score in patients with PD was 4.4+/-2.2, which was significantly lower than that in patients with MSA (6.7+/-2.0) or in controls (7.3+/-2.6). There was a significant positive correlation between cardiac 123I-MIBG uptake and the CC-SIT score in patients with PD (r=0.56, p=0.003). Neither the CC-SIT score nor cardiac 123I-MIBG uptake were significantly correlated with the disease duration, the H&Y stage or motor UPDRS score. In the patients with MSA, the CC-SIT and cardiac 123I-MIBG uptake did not show a significant correlation with age (r=0.01 and r=0.11, each p>0.05), and they were not significantly correlated with each other (r=0.01, p>0.05). CONCLUSIONS: Our data suggest that the functional loss of the olfactory and cardiac sympathetic systems is closely coupled in PD.
3-Iodobenzylguanidine ; Classification ; Heart ; Humans ; Mediastinum ; Multiple System Atrophy* ; Olfaction Disorders ; Parkinson Disease* ; Parkinsonian Disorders ; Prospective Studies ; Smell ; Sympathectomy

Apraxia of eyelid closure is an uncommon condition characterized by difficulties in voluntary eye closing with preserved normal blinking. Meige's syndrome is a disorder of adults, and is characterized by prolonged symmetric dystonic contraction of the orofacial muscles and blepharospasm. We report a case of apraxia of eyelid closure on the right eye with Meige's syndrome on the left eye complicating a left middle cerebral artery territory infarction.
Adult ; Apraxias* ; Blepharospasm ; Blinking ; Eyelids* ; Humans ; Infarction ; Infarction, Middle Cerebral Artery* ; Middle Cerebral Artery ; Muscles

BACKGROUND: The role of several cardiogenic risk factors, including patent foramen ovale, in patients with cryptogenic stroke has been extensively studied. However, little attention has been paid to the role of non-cardioembolic causes of cryptogenic stroke. We therefore sought to identify the characteristics of cryptogenic stroke. METHODS: We studied 832 patients with acute infarction in the middle cerebral arterial territory. We divided the patients into four subtypes: 402 with large artery atherosclerosis (LAA), 133 with cardioembolism, 182 with small arterial occlusion (SAO), and 115 with cryptogenic stroke. We compared risk factors and lesion patterns observed by diffusion-weighted imaging (DWI) between patients with cryptogenic stroke and those with stroke of other subtypes. RESULTS: Both risk factors and DWI lesion patterns differed between the cryptogenic and cardioembolic groups (P<0.05). Risk factors for cryptogenic stroke were similar to those for the LAA and SAO groups. Similarly, DWI lesion patterns for cryptogenic stroke were similar to LAA patients. Large cortical infarcts on DWI were more common in the cardioembolic group than in the LAA or cryptogenic groups (P<0.001). In contrast, deep, non-lacunar (OR 5.02; 95% CI 2.68~9.40; P<0.001) and superficial perforator infarcts (OR 2.23; 95% CI 1.08~4.59; P=0.029) were independently associated with the cryptogenic group. CONCLUSIONS: Our results indicate that non-cardioembolic causes, such as macro- and microangiopathy, are important mechanisms in the pathogenesis of cryptogenic stroke.
Arteries ; Atherosclerosis ; Foramen Ovale, Patent ; Humans ; Infarction ; Magnetic Resonance Imaging ; Risk Factors ; Stroke*

BACKGROUND AND OBJECTIVES: Local immune response, one of the pathogenesis of middle ear effusion (MEE) is associated with the development and persistence of effusion in the middle ear cavity and inflammatory mediators play a major role in the production of MEE. The purpose of this study was to determine the effects of TNF-alpha antagonist and oxatomide on the outcome of immune mediated otitis media with effusion (OME) in rats. MATERIALS AND METHOD: Otitis media was induced by injecting KLH (Keyhole lympet hemocyanin) transtympanically 7 days after systemic immunization. Phosphate-buffered saline solution was used as control. Other groups were pretreated with TNF-alpha antagonist (soluble TNF receptor type I, sTNF RI) or oxatomide respectively before transtympanic injection of KLH. Seventy-two hours after the transtympanic injection, temporal bones in each group were examined histopathologically and vascular permeability of the middle ear mucosa was measured by the Evans blue vital dye technique. RESULTS: In the KLH, sTNF RI and oxatomide groups, MEE was developed in 83%, 0%, 66% of the ears, respectively. The oxatomide group and sTNF RI group showed significant decrease in inflammation, mucosal thickening and vascular permeability as compared with KLH group and those parameters of sTNF RI group showed lower values than those of oxatomide group. CONCLUSION: Transtympanic administration of sTNF RI and oxatomide appears to suppress the development of immune mediated OME. In terms of inhibiting MEE, sTNF RI was more effective than oxatomide. This study suggests that TNF-alpha antagonist and oxatomide may have a adjunctive role in the treatment and prevention of otitis media with effusion.
Animals ; Capillary Permeability ; Ear ; Ear, Middle ; Evans Blue ; Hemocyanin ; Immunization ; Inflammation ; Leukotriene Antagonists ; Mucous Membrane ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; Rats ; Receptors, Tumor Necrosis Factor ; Sodium Chloride ; Temporal Bone ; Tumor Necrosis Factor-alpha*

Japanese encephalitis has been the leading cause of epidemic viral encephalitis in Korea. In 2010, 26 patients with Japanese encephalitis were documented in Korea. Patients older than 50 years accounted for 54% of this cohort, and none of the patients was younger than 10 years. The number of documented cases of Japanese encephalitis increased markedly in 2010 compared to the annual reported cases during the previous 10 years.
Asian Continental Ancestry Group ; Cohort Studies ; Encephalitis, Japanese ; Encephalitis, Viral ; Humans ; Korea

BACKGROUND: There is very limited data present on smoking cessation rates in outpatient departments of pulmonology. In this study, we aimed to investigate the effectiveness of a brief smoking cessation intervention program in an outpatient department of pulmonology and identify predictors of smoking cessation failure. METHODS: After a brief recommendation of smoking cessation from pulmonologists, smokers willing to quit smoking were given individual counseling and supplement drugs. Fifty smokers were included in this study and baseline characteristics, smoking history and success rate were reviewed at 3 months. RESULTS: The mean age of the patients was 58.3+/-14.6 years and the total group of patients included 3 women. The rate of smoking cessation success was 74% at 3 months, and there were no differences in age, spirometric indexes and associated diseases between the smoking cessation success and failure group. The rate of supplement drug usage was not different in both groups either. However, body weight, mean number of cigarette usage per day and nicotine dependence scores in the failure group were significantly higher than in the success group. In multivariate analysis, body weight and mean number of cigarette usage per day were significant. Two smokers with a depressive disorder failed the smoking cessation. CONCLUSION: A smoking cessation intervention program in the outpatient department of pulmonology showed a favorable success rate. More intensive interventions are needed to unfavorable groups which include the obese and heavy smokers.
Body Weight ; Counseling ; Depressive Disorder ; Female ; Humans ; Multivariate Analysis ; Outpatients ; Pulmonary Medicine ; Smoke ; Smoking ; Smoking Cessation ; Tobacco Products ; Tobacco Use Disorder

BACKGROUND AND PURPOSE: The National Institutes of Health Stroke Scale (NIHSS) score is known to be effective in predicting the likelihood of recovery after stroke. However, the baseline NIHSS score predicts long-term outcomes rather crudely because early changes in stroke scores may influence the stroke outcomes. Therefore, a precise prognostic algorithm or a cutoff point for predicting long-term outcomes based on data from serial NIHSS scores is needed. METHODS: We serially assessed 437 patients with acute symptomatic ischemic stroke within the middle cerebral artery territory who presented with nonlacunar stroke and were followed-up for at least 6 months after symptom onset. The NIHSS score was serially checked at 0, 1, 3, 7, and 14 days after admission. In all patients, the Barthel index (BI) and the modified Rankin Scale (mRS) score were checked, with a poor outcome defined as any of the following endpoints: death, modified mRS score of >3, or BI of <60. RESULTS: A marked neurological improvement or worsening (i.e., a change in the NIHSS score of at least 4) was seen in 13.5% or 5.5% of the patients, respectively, during the first 7 days after admission. About 25% of the 437 patients had poor long-term outcomes. Analysis of receiver operating characteristic curves showed that the NIHSS score at day 7 after admission was better for predicting poor long-term outcomes than was the baseline score (P=0.003). In addition, we analyzed the cutoff point of the 7th-day NIHSS score for predicting a poor outcome at 6 months after symptom onset. An NIHSS score of at least 6 at day 7 after admission predicted poor long-term outcomes with a sensitivity of 84% [95% confidence interval (CI), 76-90%], a specificity of 92% (95% CI, 88-94%), and positive and negative predictive values of 77% and 95%, respectively. A logistic regression analysis revealed that age, diffusion-weighted imaging lesion volume, stroke history, and 7th-day NIHSS score were independently associated with poor outcome. However, no score used in addition to the 7th-day NIHSS score improved the prediction of a poor outcome. CONCLUSIONS: An NIHSS score of at least 6 on day 7 after admission accurately forecasts a poor long-term outcome after stroke. Our data may be helpful in predicting the long-term prognosis as well as in making decisions regarding novel therapeutic applications in subacute-stroke trials.
Humans ; Logistic Models ; Middle Cerebral Artery* ; National Institutes of Health (U.S.) ; Prognosis ; ROC Curve ; Sensitivity and Specificity ; Stroke Volume ; Stroke*

Hepatitis E is a self-limited and enterically transmitted acute viral hepatitis that occurs from epidemic outbreaks of developing countries and sporadic hepatitis in non-endemic areas. In endemic areas, hepatitis E virus (HEV) is one of the most common causes of acute hepatitis and hepatic failure in pregnancy. Its mortality rate has been reported up to 20%. In non-endemic areas, HEV infection without any travel history is very rare. In Korea, only one case of simple hepatitis E without any travel history to endemic areas was reported. Recently, we experienced a case of acute hepatitis. The patient who had a travel history to India, showed watery diarrhea and high fever. Transaminase level and total bilirubin were increased, and prothrombin time was prolonged. It was positive for IgM anti-HEV and IgG anti-HEV, and showed no evidence of other viral infections or drug ingestion history. In spite of absence of useful test such as seroconversion of IgM anti-HEV and HEV RNA PCR, we diagnosed the case as an acute hepatitis E from his symptom, travel history and initial serologic marker. We report this as a case of hepatitis E infected from endemic areas.
Acute Disease ; Adult ; English Abstract ; Female ; Hepatitis E/*diagnosis ; Humans ; India ; Travel

BACKGROUND: Conventional biomarkers cannot always establish the cause of pleural effusions; thus, alternative tests permitting rapid and accurate diagnosis are required. The primary aim of this study is to assess the ability of pentraxin-3 (PTX3) in order to diagnose the cause of pleural effusion and compare its efficacy to that of other previously identified biomarkers. METHODS: We studied 118 patients with pleural effusion, classified as transudates and exudates including malignant, tuberculous, and parapneumonic effusions (MPE, TPE, and PPE). The levels of PTX3, C-reactive protein (CRP), procalcitonin (PCT) and lactate in the pleural fluid were assessed. RESULTS: The levels of pleural fluid PTX3 were significantly higher in patients with PPE than in those with MPE or TPE. PTX3 yielded the most favorable discriminating ability to predict PPE from MPE or TPE by providing the following: area under the curve, 0.74 (95% confidence interval, 0.63-0.84), sensitivity, 62.07%; and specificity, 81.08% with a cut-off point of 25.00 ng/mL. CONCLUSION: Our data suggests that PTX3 may allow improved differentiation of PPE from MPE or TPE compared to the previously identified biomarkers CRP and PCT.
Biomarkers ; C-Reactive Protein ; Diagnosis ; Diagnosis, Differential* ; Exudates and Transudates ; Humans ; Lactic Acid ; Pleural Effusion*

Recently, increasing evidence suggests that neuroinflammation may be a critical factor in the development of Parkinson’s disease (PD) in addition to the ratio of acetylcholine/dopamine because dopaminergic neurons are particularly vulnerable to inflammatory attack. In this study, we investigated whether botulinum neurotoxin A (BoNT-A) was effective for the treatment of PD through its anti-neuroinflammatory effects and the modulation of acetylcholine and dopamine release. We found that BoNT-A ameliorated MPTP and 6-OHDA-induced PD progression, reduced acetylcholine release, levels of IL-1β, IL-6 and TNF-α as well as GFAP expression, but enhanced dopamine release and tyrosine hydroxylase expression. These results indicated that BoNT-A had beneficial effects on MPTP or 6-OHDA-induced PD-like behavior impairments via its anti-neuroinflammation properties, recovering dopamine, and reducing acetylcholine release.