OBJECTIVES: The prevalence of constipation is high after stroke. Multiple factors such as long-term bed-ridden status, comorbidity, medical illnesses are combined in this condition. However, the change of bowel movement during the early stage of stroke remains uncertain. METHODS: Patients with first stroke who admitted in a single institute from 2008 to 2009 were reviewed retrospectively and 36 patients were enrolled. As a control group, 47 consecutive orthopedic patients needing bed rest without surgery in the same period were enrolled. Data of stroke associated factors, frequency of BM (bowel movement) during 5 weeks, use of gastrointestinal medications, and outcomes were collected from the medical records. RESULTS: The cumulative incidence of decreased (<3/week) and severely decreased BM (<1/week) were 80.6% and 69.4% in stroke patients and 53.2% and 14.9% in control group (P<0.05). The cumulative incidence of increased BM (>3/day) was 38.9% in stroke and 14.9% in control group. In acute stroke, 58% of patient showed severely decreased BM in first week, and the proportion was rapidly decreased below 15% from second week. However, laxative use increased with hospital days. The occurrence of severely decreased BM in stroke patients was associated with National Institutes of Health Stroke Scale (NIHSS; P=0.004). Severely decreased BM was not associated with poor outcomes including death, morbidity, and stroke recurrence. CONCLUSION: Decreased BM is common in acute stroke. The occurrence of severely decreased BM is associated with NIHSS. However, the severe manifestation occurred mainly in the first week, and considered to be well controlled by laxatives.
Bed Rest ; Comorbidity ; Constipation* ; Humans ; Incidence ; Laxatives ; Medical Records ; National Institutes of Health (U.S.) ; Orthopedics ; Prevalence ; Recurrence ; Retrospective Studies ; Stroke*

The use of computers, especially for virtual reality (VR), to understand, assess, and treat various mental health problems has been developed for the last decade, including application for phobia, post-traumatic stress disorder, attention deficits, and schizophrenia. However, the number of VR tools addressing obsessive-compulsive disorder (OCD) is still lacking due to the heterogeneous symptoms of OCD and poor understanding of the relationship between VR and OCD. This article reviews the empirical literatures for VR tools in the future, which involve applications for both clinical work and experimental research in this area, including examining symptoms using VR according to OCD patients' individual symptoms, extending OCD research in the VR setting to also study behavioral and physiological correlations of the symptoms, and expanding the use of VR for OCD to cognitive-behavioral intervention.
Mental Health ; Obsessive-Compulsive Disorder ; Phobic Disorders ; Schizophrenia ; Stress Disorders, Post-Traumatic

OBJECTIVE: The identifying schizotypal trait in obsessive-compulsive disorder (OCD) patients is important to predict clinical course, since those patients are hardly overcome through conventional intervention methods. This paper presents the trial of classification method of obsessive-compulsive disorder with schizotypal trait using Frontal Lobe Function Test (FLFT). METHODS: 110 OCD patients are divided into two groups:27 pure OCD patients, and 83 non-pure OCD patients. After training artificial neural network (ANN) using frontal-lobe function test data of train data (schizophrenia, pure OCD, and normal group), we classify test data (non-pure OCD patients) into one of the three groups. RESULTS: Among the total 83 test data (non-pure OCD patients), 44 patients were classified as schizophrenia, 32 patients as normal, and 7 patients as pure OCD. With respect to the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) data of those classified patients, ordering score in compulsion was significantly different between three groups. Moreover, cluster A socre (Schizoid, Schizotypal) of Personality Diagnostic Questionnaire (PDQ) data showed significant difference between them. CONCLUSION: The results presented that those OCD patients who are classified as schizophrenia using generated model with machine learning technique is tend to have compulsive symptom of arrangement and schizotypal personality disorder.
Machine Learning ; Classification* ; Frontal Lobe* ; Humans ; Obsessive-Compulsive Disorder* ; Surveys and Questionnaires ; Schizophrenia ; Schizotypal Personality Disorder

PURPOSE: The lessor saphenous vein is an anatomical index in various surgical methods involving an approach to the popliteal fossa. However, occasionally, there have been some cases where the surgical process was difficult because the lessor saphenous vein was not found in the popliteal fossa during the operation process. The aim of this study is to determine the frequency of the anatomical variation of lessor saphenous vein not found in the popliteal fossa with a review of the literature. MATERIALS AND METHODS: This study was conducted on 83 cases of selective neurectomy for hypertrophic calf performed in our clinic from March 1997 to June 2013. There were 42 patients, with a mean age of 32.8 years old. We confirmed the existence of the lessor saphenous vein in the popliteal fossa during the operation process. RESULTS: Among 83 cases during this study period, the lesser saphenous vein was not found in four cases. In one patient, no lesser saphenous vein was found on either side of the popliteal fossa, and in two patients, no lesser saphenous vein was found on the left side of the popliteal fossa. As a result, the frequency of variation was found to be 4.8%. CONCLUSION: Due to the anatomical variation of the lessor saphenous vein, it may not be found in the midline of the popliteal fossa. Based on the literature review, several possibilities for failure to observe the lesser saphenous vein could be suggested. If surgeons are well aware of these possibilities, the steadier operation could be performed.
Anatomic Variation ; Humans ; Methods ; Popliteal Vein ; Saphenous Vein*

Congenital laryngeal cleft is a rare anomaly, which can cause serious problems of airway and repeated aspiration pneumonia. It is due m failure of fusion of the posterior cricoid cartilage lamina. Dysphagia with aspiration of food is commonly seen w1h resultant bouts of pneumonia. Detection of an unsuspected minor cleft may be difficult, but the pediatrician should suspect the possibility of deft from the clinical features. This paper includes. a detailed case report of one patient with congenital laryngeal cleft and the review of literatures.
Cricoid Cartilage ; Deglutition Disorders ; Humans ; Pneumonia ; Pneumonia, Aspiration

BACKGROUND/AIMS: Obesity is a worldwide concern, but its influence on critical care outcomes is not well understood. We tested the hypothesis that abnormal body mass index (BMI) would be an independent predictor of higher mortality rates in intensive care unit (ICU). METHODS: We retrospectively reviewed patients who had admitted to the ICU from January 2007 to December 2007. Admission BMI was analyzed as both a three categorical (underweight, < 18.5 kg/m2; normal weight, 18.5 to 24.9 kg/m2; overweight and obese, > or = 25 kg/m2) and continuous variables among all patients with an ICU lenth of stay > or = 4 days. The primary outcome was ICU mortality. RESULTS: The multivariate analysis on ICU mortality selected Mortality Prediction Model-Admission (MPM at time zero) (hazard ratio [HR], 1.024; p = 0.001; 95% confidence interval [CI], 1.010 to 1.037), failed extubation (HR, 5.092; p = 0.0001; 95% CI, 2.742 to 9.456) as significant risk factors. When controlling these variables, none of the BMI group and BMI as a continuous variable had an independent association with ICU mortality. CONCLUSIONS: BMI did not have a significant influence on ICU mortality. The ICU mortality was influenced more strongly by severity of illness and failed extubation rather than BMI.
Adult ; Aged ; *Body Mass Index ; Critical Care/*statistics & numerical data ; Critical Illness/*mortality ; Female ; Humans ; Intensive Care Units/statistics & numerical data ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Multivariate Analysis ; Obesity/*mortality ; Prognosis ; Proportional Hazards Models ; Respiration, Artificial/statistics & numerical data ; Severity of Illness Index ; Thinness/mortality

OBJECTIVES: Virtual reality has been increasingly used in the psychiatric field. Presence, the sense of "being there," is an essential concept in terms of the effectiveness of the virtual reality. The present study aimed to investigate the characteristics of the presence-related brain regions in patients with schizophrenia. METHODS: Using fMRI, brain activities were measured while performing the virtual reality tasks in fifteen healthy normal subjects and fifteen patients with schizophrenia. The tasks consisted of listening to some stories and inferring the content of the previous events. Ambiguous information was given for the experimental task, whereas clear information was given for the control task. Correlations between the image contrast values and the presence scores were analyzed. RESULTS: The presence-related brain regions in healthy controls were identified in the two discrete region groups that could be referred to as the cognitive neural correlates and the perceptual neural correlates. The former included the anterior cingulate, the left inferior temporal gyrus, the right lingual gyrus, and the right cuneus, whereas the latter consisted of the right posterior cingulate, the left lingual gyrus and the right fusiform gyrus. Compared with healthy controls, regional correlation patterns were different in patients with schizophrenia, including that the posterior cingulate had significant correlations. CONCLUSION: These results suggest that patients with schizophrenia utilize perceptual apparatus for the presence more than the cognitive aspect. A peculiar pattern of the presence in schizophrenia may be related to increased correlations between the posterior cingulate and other brain regions.
Brain ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Schizophrenia

To examine regional abnormalities in the brains of patients with obsessive-compulsive disorder (OCD), we assessed the gray matter (GM) density using voxel-based morphometry (VBM). We compared magnetic resonance images (MRIs) acquired from 71 OCD patients and 71 age- and gender-matched normal controls and examined the relationship between GM density and various clinical variables in OCD patients. We also investigated whether GM density differs among the subtypes of OCD compared to healthy controls. We detected significant reduction of GM in the inferior frontal gyrus, the medial frontal gyrus, the insula, the cingulate gyrus, and the superior temporal gyrus of OCD patients. A significant increase in GM density was observed in the postcentral gyrus, the thalamus, and the putamen. Some of these regions, including the insular and postcentral gyrus, were also associated with the severity of obsessive- compulsive symptoms. These findings indicate that the frontal-subcortical circuitry is dysfunctional in OCD, and suggest that the parietal cortex may play a role in the pathophysiology of this disease.
Adolescent ; Adult ; Brain/*pathology ; Child ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Obsessive-Compulsive Disorder/*pathology ; Parietal Lobe/pathology ; Sex Characteristics

BACKGROUND: Atypical hemolytic uremic syndrome (aHUS) involves dysregulation of the complement system, but whether this also occurs in thrombotic thrombocytopenic purpura (TTP) remains unclear. Although these conditions are difficult to differentiate clinically, TTP can be distinguished by low (<10%) ADAMTS13 activity. The aim was to identify the differences in complement activation products between TTP and aHUS and investigate ADAMTS13 activity as a prognostic factor in aHUS. METHODS: We analyzed patients with thrombotic microangiopathy diagnosed as TTP (N=48) or aHUS (N=50), selected from a Korean registry (N=551). Complement activation products in the plasma samples collected from the patients prior to treatment and in 40 healthy controls were measured by ELISA. RESULTS: The levels of generalized (C3a), alternate (factor Bb), and terminal (C5a and C5b-9) markers were significantly higher (all P<0.01) in the patients than in the healthy controls. Only the factor Bb levels significantly differed (P=0.008) between the two disease groups. In aHUS patients, high normal ADAMTS13 activity (≥77%) was associated with improved treatment response (OR, 6.769; 95% CI, 1.605–28.542; P=0.005), remission (OR, 6.000; 95% CI, 1.693–21.262; P=0.004), exacerbation (OR, 0.242; 95% CI, 0.064–0.916; P=0.031), and disease-associated mortality rates (OR, 0.155; 95% CI, 0.029–0.813; P=0.017). CONCLUSION: These data suggest that complement biomarkers, except factor Bb, are similarly activated in TTP and aHUS patients, and ADAMTS13 activity can predict the treatment response and outcome in aHUS patients.
Atypical Hemolytic Uremic Syndrome ; Biomarkers ; Complement Activation ; Complement System Proteins ; Enzyme-Linked Immunosorbent Assay ; Humans ; Mortality ; Plasma ; Purpura, Thrombotic Thrombocytopenic ; Thrombotic Microangiopathies

The consequences of coronavirus disease 2019 (COVID-19) are particularly severe in older adults with a disproportionate number of severe and fatal outcomes. Therefore, this integrative review aimed to provide a comprehensive overview of the clinical characteristics, management approaches, and prognosis of older patients diagnosed with COVID-19. Common clinical presentations in older patients include fever, cough, and dyspnea. Additionally, preexisting comorbidities, especially diabetes and pulmonary and cardiovascular diseases, were frequently observed and associated with adverse outcomes. Management strategies varied, however, early diagnosis, vigilant monitoring, and multidisciplinary care were identified as key factors for enhancing patient outcomes. Nonetheless, the prognosis remains guarded for older patients, with increased rates of hospitalization, mechanical ventilation, and mortality. However, timely therapeutic interventions, especially antiviral and supportive treatments, have demonstrated some efficacy in mitigating the severe consequences in this age group. In conclusion, while older adults remain highly susceptible to severe outcomes from COVID-19, early intervention, rigorous monitoring, and comprehensive care can play a pivotal role in improving their clinical outcomes.