BACKGROUND: Psychogenic non epileptic seizures (PNES) are characterized by repeated seizures that are typically caused by stress and psychologic problems such as anxiety and depression. This contrasts with epileptic seizures (ES), which are transient and caused by irregular excitement of nerve cells. PNES can be found in patients with ES, but due to their differing etiologies, it is important to determine the psychologic characteristics that differentiate PNES from ES. METHODS: This study identified psychopathologic and personality traits in 137 patients with PNES (n=7, 49.3% female) or ES (n=0, 35.7% female) using MMPI. The diagnosis was based on a medical history of seizures and the clinical examination in patients who visited the epilepsy clinic. Statistical analyses for comparing MMPI differences between the two groups were conducted using the t-test, chi-square test, and analysis of covariance. RESULTS: We analyzed the frequency of individuals who exhibited a T score of ≥5 on the MMPI, and the results indicated that there were significantly more patients in the PNES group than in the ES group who had elevated scores on the hypochondriasis (Hs) scale and hysteria (Hy) scale. The mean scores of Hs, Hy, paranoia scale and schizophrenia scale were significantly higher in the PNES group than in the ES group. CONCLUSIONS: These results suggest that patients with PNES have greater psychologic problems than ES patients. Differences in MMPI profile patterns between patients with PNES and ES may be helpful in tailoring appropriate therapeutic interventions for the two groups.
Anxiety ; Depression ; Diagnosis ; Epilepsy* ; Humans ; Hypochondriasis ; Hysteria ; MMPI* ; Neurons ; Paranoid Disorders ; Schizophrenia ; Seizures*

Purpose: To evaluate the effect of adalimumab in pediatric uveitis and subsequent changes in anterior chamber inflammation following the inactivation of uveitis. Methods: In this retrospective study, patients with noninfectious uveitis younger than 18 years of age who were treated with adalimumab for more than 12 months were included. The rate of complete suppression and the relapse in anterior chamber inflammation following the initiation of adalimumab therapy were evaluated using anterior chamber cell score and laser flare photometry (LFP) values, if available. Changes in visual acuity and the sparing effect of topical steroid agents were also evaluated. Results: Among 22 eyes of 12 pediatric uveitis patients enrolled, 13 eyes were associated with juvenile idiopathic arthritis and nine eyes had idiopathic uveitis. The mean ± standard deviation age was 10.2 ± 3.6 years. Types of uveitis included ante-rior uveitis (n = 17) and panuveitis (n = 5). Quiescence was observed in 14 eyes (63.6%) at 3 months and in 21 eyes (95.5%) at 12 months after initiation, respectively. After achieving inactive uveitis, uveitis relapsed in two eyes at 6 months, even with adalimumab treatment. In 11 eyes, anterior chamber showed 0.5+ cell scores during the rest of the follow-up period and one of those eyes met the criteria for the relapse based on LFP values. The dosage of topical steroids decreased significantly at 3, 9, and 12 months after the initiation of therapy (p ≤ 0.05). Visual acuity did not show improvement. There were no severe adverse effects of anti-tumor necrosis factor-α treatment reported. Conclusions In this study, adalimumab achieved a quiescent state in most eyes with pediatric noninfectious uveitis for 12 months with a relapse rate of 9.5%. LFP values together with the anterior chamber cell score can be utilized to monitor the improvement or relapse in anterior chamber inflammation in pediatric noninfectious uveitis.

Objectives: Circadian misalignment may increase the risk of obesity and related obstructive sleep apnea (OSA). Considerable young adults have social jetlag (SJL), which is defined as the time discrepancy between workdays and free days. We aim to evaluate the relationship between SJL and sleep and respiratory disturbance in patients with untreated OSA patients. Methods: A total of 180 OSA patients under the age of 50 [mean 38.3±8.0 y, 93.3% male, mean apnea-hypopnea index (AHI) 38.2±27.4 /h] were recruited from the university affiliated sleep clinic and fulfilled sleep-related questionnaires including Munich Chronotype Questionnaire (MCTQ). SJL was defined as the difference in sleep midpoints between work and free days. Patients were divided into three groups with SJL less than 1 hour, 1–2 hours, and 2 hours or more and the clinical and sleep data of each group were compared. Results: 51.6% (n=93) suffered from significant SJL (≥1 h). Patients with ≥2h of SJL (16.6%, n=30) had the largest neck circumference (NC). AHI and sleep parameters were not significantly different among groups except lowest oxygen saturation (LoS) was the lowest in the group of ≥2 h. SJL was positively correlated with body mass index and NC and negatively correlated with LoS after adjusting for age and sex. Conclusions About a half of young adults with OSA have significant SJL more than 1 h. This study suggests that SJL is associated with being overweight, while it seems not increase the severity of OSA nor deteriorate sleep quality in young adults.

Objectives: Circadian misalignment may increase the risk of obesity and related obstructive sleep apnea (OSA). Considerable young adults have social jetlag (SJL), which is defined as the time discrepancy between workdays and free days. We aim to evaluate the relationship between SJL and sleep and respiratory disturbance in patients with untreated OSA patients. Methods: A total of 180 OSA patients under the age of 50 [mean 38.3±8.0 y, 93.3% male, mean apnea-hypopnea index (AHI) 38.2±27.4 /h] were recruited from the university affiliated sleep clinic and fulfilled sleep-related questionnaires including Munich Chronotype Questionnaire (MCTQ). SJL was defined as the difference in sleep midpoints between work and free days. Patients were divided into three groups with SJL less than 1 hour, 1–2 hours, and 2 hours or more and the clinical and sleep data of each group were compared. Results: 51.6% (n=93) suffered from significant SJL (≥1 h). Patients with ≥2h of SJL (16.6%, n=30) had the largest neck circumference (NC). AHI and sleep parameters were not significantly different among groups except lowest oxygen saturation (LoS) was the lowest in the group of ≥2 h. SJL was positively correlated with body mass index and NC and negatively correlated with LoS after adjusting for age and sex. Conclusions About a half of young adults with OSA have significant SJL more than 1 h. This study suggests that SJL is associated with being overweight, while it seems not increase the severity of OSA nor deteriorate sleep quality in young adults.

Background: G protein-coupled receptor 40 (GPR40) is a key molecule in diabetes and fatty liver, but its role in endothelial dysfunction remains unclear. Our objective in this study was to determine whether GPR40 agonists protect endothelial cells against palmitatemediated oxidative stress. Methods: Human umbilical vein endothelial cells (HUVECs) were used to investigate effects of various GPR40 agonists on vascular endothelium. Results: In HUVECs, AM1638, a GPR40-full agonist, enhanced nuclear factor erythroid 2–related factor 2 (NRF2) translocation to the nucleus and heme oxygenase-1 (HO-1) expression, which blocked palmitate-induced superoxide production. Those antioxidant effects were not detected after treatment with LY2922470 or TAK875, GPR40-partial agonists, suggesting that GPR40 regulates reactive oxygen species (ROS) removal in a ligand-dependent manner. We also found that palmitate-induced CCAAT/enhancer‐binding protein homologous protein expression; X-box binding protein-1 splicing, nuclear condensation, and fragmentation; and caspase-3 cleavage were all blocked in an NRF2-dependent manner after AM1638 treatment. Both LY2922470 and TAK875 also improved cell viability independent of the NRF2/ROS pathway by reducing palmitate-mediated endoplasmic reticulum stress and nuclear damage. GPR40 agonists thus have beneficial effects against palmitate in HUVECs. In particular, AM1638 reduced palmitate-induced superoxide production and cytotoxicity in an NRF2/HO-1 dependent manner. Conclusion GPR40 could be developed as a good therapeutic target to prevent or treat cardiovascular diseases such as atherosclerosis.

BACKGROUND: Thromboelastography (TEG) provides comprehensive information on the whole blood clot formation phases, whereas thrombin generation assay (TGA) reveals the endogenous thrombin levels in plasma. We investigated the potential significance of TEG and TGA parameters for prediction of clinical bleeding in hematologic patients on the basis of the patient's platelet levels. METHODS: TEG and TGA were performed in 126 patients with thrombocytopenia or hematologic malignancies. The bleeding tendencies were stratified on the basis of the World Health Organization bleeding grade. RESULTS: Maximum amplitude (MA) and clot formation in TEG and endogenous thrombin potential (ETP) in TGA showed significant associations with high bleeding grades (P=0.001 and P=0.011, respectively). In patients with platelet counts ≤10×10⁹/L, low MA values were strongly associated with a high bleeding risk. For bleeding prediction, the area under the curve (AUC) of MA (0.857) and ETP (0.809) in patients with severe thrombocytopenia tended to be higher than that of platelets (0.740) in all patients. Patients with platelet counts ≤10×10⁹/L displayed the highest AUC of the combined MA and ETP (0.929). CONCLUSIONS: Both TEG and TGA were considered to be good predictors of clinical bleeding in patients with severe thrombocytopenia. Combination of the ETP and MA values resulted in a more sensitive bleeding risk prediction in those with severe thrombocytopenia.
Area Under Curve ; Blood Platelets ; Hematologic Neoplasms* ; Hemorrhage* ; Humans ; Plasma ; Platelet Count ; Thrombelastography* ; Thrombin* ; Thrombocytopenia* ; World Health Organization

Purpose: To investigate the clinical features of non-affected fellow eyes in patients with unilateral facial port-wine stain (PWS) and ipsilateral secondary glaucoma. Methods: We performed a retrospective analysis of the medical records of 35 patients with unilateral facial PWS glaucoma and those of controls (35 subjects without both facial PWS and glaucoma) between September 1996 and May 2020. We noted patients’ age at the glaucoma diagnosis (for unilateral facial PWS glaucoma patients) or at the initial examination (for controls), cup-to-disc ratio (CDR), and intraocular pressure (IOP). We compared the clinical features between the glaucoma-free eyes in patients with unilateral facial PWS glaucoma and the controls. Results: The mean age at the glaucoma diagnosis for unilateral facial PWS glaucoma patients was 0.56 ± 0.99 years (range, 0.08-4). The mean IOP of the glaucoma-free eyes was 16.68 ± 5.73 mmHg (range, 9-22.9), and the mean CDR was 0.37 ± 0.14 (range, 0.15-0.80) at glaucoma diagnosis. The mean IOP of the glaucoma-free eyes was 14.14 ± 6.29 mmHg (range, 8.1-26.7), and the mean CDR was 0.37 ± 0.12 (range, 0.26-0.82) at final examination. When comparing glaucoma-free eyes of the unilateral facial PWS glaucoma patients with the control group (mean age, 11.2 ± 7.4 years), the mean CDR was significantly greater (0.37 ± 0.12 vs. 0.30 ± 0.08; p = 0.014) but there was no significant difference in the mean IOP (14.14 ± 6.29 mmHg vs. 14.57 ± 2.49 mmHg; p = 0.712). Conclusions The glaucoma-free eyes of unilateral facial PWS glaucoma patients showed greater CDR compared to the non-facial PWS and non-glaucoma controls. Additional longitudinal studies are needed to investigate the clinical course of those eyes, whether the risk of developing glaucoma is increased.