Fulminant hepatic failure (FHF) is often accompanied by a myriad of neurologic complications, which are associated with high morbidity and mortality. Although appropriate neuromonitoring is recommended for early diagnosis and to minimize secondary brain injury, individuals with FHF usually have a high chance of coagulopathy, which limits the ability to use invasive neuromonitoring. Jugular bulb venous oxygen saturation (JvO₂) monitoring is well known as a surrogate direct measures of global brain oxygen use. We report the case of a patient with increased intracranial pressure due to FHF, in which JvO₂ was used for appropriate brain oxygen monitoring.
Brain Edema ; Brain Injuries ; Brain* ; Early Diagnosis ; Hepatic Encephalopathy ; Humans ; Intracranial Pressure ; Jugular Veins ; Liver Failure, Acute* ; Mortality ; Oxygen Consumption ; Oxygen*

Purpose: This study aimed to examine whether first-time mothers’ grit, spousal support, and age can make significant differences in latent means of child-rearing passion, postpartum depression, and happiness. Methods: Data were collected from April 2 to July 16, 2019. Two hundred sixteen first-time mothers of infants and toddlers aged 0–2 years participated in a self-reported questionnaire study in which scales of nurturing passion, postpartum depression, happiness, grit, and spousal support were included. The collected data were analyzed with IBM SPSS ver. 18.0 (IBM Co., Armonk, NY, USA) for descriptive statistics and Pearson correlation analyses. In addition, Mplus (ver. 7.0) was used for the Multiple Indicators Multiple Causes (MIMIC) model approach. Results: The MIMIC model yielded an appropriate fit to the data (χ2=103.74, degrees of freedom=53, comparative fit index=0.96, root mean square error of approximation=0.07, standardized root mean square residual=0.05). The paths from grit and spousal support all had significantly positive beta coefficients (p<0.05) to child-rearing passion (β=0.3 and β=0.26, respectively) and happiness (β=0.22 and β=0.39, respectively), while the corresponding paths to postpartum depression were all negatively significant (β= -0.24 for both). These results suggest that unlike chronological maturity (i.e., age), grittier individuals with stronger spousal support display greater passion for child-rearing, as well as greater happiness. In a similar vein, they suffered less from postpartum depression. Conclusion These results imply that grit can be employed to enhance first-time mothers’ child-rearing passion and happiness as it can also concurrently offset the effects of a negative labor and child-birth experience on first-time mothers’ mental health, e.g., in terms of reducing postpartum depression.

Purpose: This study aimed to examine whether first-time mothers’ grit, spousal support, and age can make significant differences in latent means of child-rearing passion, postpartum depression, and happiness. Methods: Data were collected from April 2 to July 16, 2019. Two hundred sixteen first-time mothers of infants and toddlers aged 0–2 years participated in a self-reported questionnaire study in which scales of nurturing passion, postpartum depression, happiness, grit, and spousal support were included. The collected data were analyzed with IBM SPSS ver. 18.0 (IBM Co., Armonk, NY, USA) for descriptive statistics and Pearson correlation analyses. In addition, Mplus (ver. 7.0) was used for the Multiple Indicators Multiple Causes (MIMIC) model approach. Results: The MIMIC model yielded an appropriate fit to the data (χ2=103.74, degrees of freedom=53, comparative fit index=0.96, root mean square error of approximation=0.07, standardized root mean square residual=0.05). The paths from grit and spousal support all had significantly positive beta coefficients (p<0.05) to child-rearing passion (β=0.3 and β=0.26, respectively) and happiness (β=0.22 and β=0.39, respectively), while the corresponding paths to postpartum depression were all negatively significant (β= -0.24 for both). These results suggest that unlike chronological maturity (i.e., age), grittier individuals with stronger spousal support display greater passion for child-rearing, as well as greater happiness. In a similar vein, they suffered less from postpartum depression. Conclusion These results imply that grit can be employed to enhance first-time mothers’ child-rearing passion and happiness as it can also concurrently offset the effects of a negative labor and child-birth experience on first-time mothers’ mental health, e.g., in terms of reducing postpartum depression.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is classically characterized by symmetric vasogenic edema in the parietooccipital areas, but may occur at other sites with varying imaging appearances. CASE REPORT: A 55-year old female with chronic kidney disease (CKD) was admitted to the emergency room, presenting with nausea, vomiting and seizure. The initial blood pressure was 145/90 mmHg. Fluid attenuated inversion recovery demonstrated diffuse vasogenic edema in the bilateral cortical and subcortical white matters involving the frontal lobes. Perfusion magnetic resonance imaging (MRP) showed no hyper- or hypoperfusion at blood pressure levels of 140/50 mmHg. A follow-up magnetic resonance imaging at 3 weeks later demonstrated complete resolution of previous lesions. CONCLUSIONS: Earlier reports have demonstrated that PRES can occur in cases of atypical distributions, and features of imaging findings and normotensive settings. It is important to note that PRES is a dynamic process. As a result, we suggest that MRP must be considered in the appropriate temporal framework, to avoid misinterpretation of the other diseases, especially in CKD patients.
Blood Pressure ; Edema ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Frontal Lobe ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Nausea ; Perfusion Imaging ; Perfusion ; Posterior Leukoencephalopathy Syndrome ; Renal Insufficiency, Chronic ; Seizures ; Vomiting ; White Matter

Background: The relationship between solitary life and multimorbidity among older people in Korea is not clear.We aimed to examine the association between solitary life and the prevalence of multimorbidity among Korean older people. Methods: We analyzed the data from the Korea National Health and Nutrition Examination Survey Ⅶ(2016-2018) using multivariable logistic regression analysis. The study included 4,244 individuals aged ≥60 years. Results: Multimorbidity was reported in 31.0% of the participants. The rate of multimorbidity was significantly higher in older people living alone compared to those living with their families. After adjusting for confounding variables such as age, sex, smoking status, alcohol consumption, body mass index (BMI), educational level, and personal income, older people living alone were significantly associated with higher risks of having multimorbidity compared to those living with their families (odds ratio, 1.24; 95% confidence interval, 1.04-1.48). Conclusions Since there is a risk of multimorbidity in older people living alone, it is necessary to examine whether multimorbidity exists in older people living alone.

Oxidative stress brings about apoptosis through various mechanisms. In particular, oxidative stress in neuronal cells can causes a variety of brain diseases. This study was conducted to investigate the effect of Bidens tripartita on oxidative stress in neuronal cells. B. tripartita has traditionally been used in Russia as a medicine for diseases such as rhinitis, angina and colitis. Over-production of glutamate induces oxidative stress. When the oxidative stress occurs in the cells, reactive oxygen species (ROS) and Ca 2+ increase. In addition, the abrupt decline of mitochondrial membrane potential and the decrease of glutathione related enzymes such as glutathione reductase (GR) and glutathione peroxidase (GPx) are also observed. The samples used in the experiment showed cytoprotective effect in the MTT assay. It also lowered the ROS and Ca 2+ level, and increased degree of mitochondrial membrane potential, GR and GPx. As a result, B. tripartita had a positive effect against oxidative stress. Thus, it is expected to have potential for treatment and prevention of degenerative brain diseases such as Alzheimer’s disease.

Purpose: To evaluate the association between long-term glycated hemoglobin A (HbA1c) variability and treatment outcomes ofanti-vascular endothelial growth factor (VEGF) injection in diabetic macular edema patients. Methods: The medical records of 49 eyes (38 patients) that received anti-VEGF injection for diabetic macular edema were reviewedretrospectively. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) before injection and at onemonth and six months after injection were analyzed. HbA1c variability (HbA1c coefficient of variation [CV]) was calculated usingthe HbA1c results from the year prior to (before) and the year after injection and compared with clinical results. Results: In the group with a low mean HbA1c level before injection, the group with lower HbA1c CV showed greater reduction inmacular edema one month after injection (low HbA1c CV, 122.4 ± 123.2 μm versus high HbA1c CV, 5.2 ± 37.0 μm, p= 0.027).In the group with high mean HbA1c, there was no significant difference between HbA1c variability and clinical features. In a multivariateanalysis, the factor related to the reduction of macular edema was initial CMT (one month adjusted hazard ratio (aHR)0.5, p< 0.001; six months aHR 0.3, p= 0.023). The factor associated with visual gain was initial visual acuity (LogMAR) (onemonth aHR 0.4, p< 0.001; six months aHR 0.4, p< 0.001). The association between mean HbA1c or HbA1c variability and clinicaloutcome was not significant. Conclusions Unlike initial CMT or BCVA, mean HbA1c and HbA1c variability were not significantly associated with clinical outcomesof anti-VEGF injection in diabetic macular edema patients.

Purpose: To report a case of accidental swallowing of nasal packing gauze during silicone tube intubation under local anesthesia.Case summary: A 58-year-old male patient underwent silicone tube intubation for partial nasolacrimal duct obstruction on the right side. In preparing for surgery, six cottonoids soaked were packed in righ nasal cavity, to facilitate anesthesia and prevent bleeding. Strings detectable by X-ray were attached at the cottonoids and cut 5 cm from the nostrils. After surgical hand scrubbing, the strings were not present. One cottonoid was found in the nasal cavity, but five cottonoids could not be detected by endonasal endoscopic exploration. The patient said he swallowed “something like sputum”. He did not notice any discomfort and the surgery was performed as scheduled. Abdominal X-ray performed immediately after surgery showed the presence of the five strings in the stomach. The strings were not seen on X-ray conducted 4 days later. The patient defecated normal stools three times and did not notice any discomfort over the course of 4 days. Conclusions Surgeons need to be aware of the possibility of accidental swallowing of nasal packing gauze during nasolacrimal duct surgery. Use of gauze detectable by X-ray is helpful to determine its location.

OBJECTIVE: Early progressive infarction (EPI) is frequently observed and related to poor functional outcome in patients with middle cerebral artery (MCA) infarction caused by MCA occlusion. We evaluated the perfusion parameters of magnetic resonance imaging (MRI) as a predictor of EPI. METHODS: We retrospectively analyzed patients with acute MCA territory infarction caused by MCA occlusion. EPI was defined as a National Institutes of Health Stroke Scale increment ≥2 points during 24 hours despite receiving standard treatment. Regional parameter ratios, such as cerebral blood flow and volume (rCBV) ratio (ipsilateral value/contralateral value) on perfusion MRI were analyzed to investigate the association with EPI. RESULTS: Sixty-four patients were enrolled in total. EPI was present in 18 (28%) subjects and all EPI occurred within 3 days after hospitalization. Diabetes mellitus, rCBV ratio and regional time to peak (rTTP) ratio showed statically significant differences in both groups. Multi-variate analysis indicated that history of diabetes mellitus [odds ratio (OR), 6.13; 95% confidence interval (CI), 1.55-24.24] and a low rCBV ratio (rCBV, <0.85; OR, 6.57; 95% CI, 1.4-30.27) was significantly correlated with EPI. CONCLUSION: The incidence of EPI is considerable in patients with acute MCA territory infarction caused by MCA occlusion. We suggest that rCBV ratio is a useful neuro-imaging parameter to predict EPI.
Cerebrovascular Circulation ; Diabetes Mellitus ; Hospitalization ; Humans ; Incidence ; Infarction* ; Infarction, Middle Cerebral Artery* ; Magnetic Resonance Imaging* ; Middle Cerebral Artery* ; National Institutes of Health (U.S.) ; Perfusion ; Retrospective Studies ; Stroke

Background: Little is known regarding the functional outcome and quality of life of neuro-ICU survivors. In Korea, the neuro-ICU concept was introduced relatively late and data about long term outcome and predictors concerning functional outcome is scarce. The main objective of this study was to analyze functional outcome and mortality, and to determine prognostic predictors for the outcome in patients admitted to Korean neuro-ICUs. Methods: Consecutive adult (≥ 15-years-of-age) patients admitted to a neuro-ICU due to various causes including ischemic or hemorrhagic stroke, and other neurological or neurosurgical problems such as traumatic brain injury, seizure, or drug intoxication during an 18-month period from July 2008 through December 2009 were included. Demographic and clinical variables were compared between groups stratifi ed based on 6-month modifi ed Rankin scale score. Results: Of 555 patients, there were signifi cant differences in age (P=0.013), sex (P=0.02), hospital stay (P<0.01), neuro-ICU stay (P<0.01), admission diagnosis (P=0.001), intubation (P<0.01), mechanical ventilation (P<0.01), tracheostomy (P<0.01), comorbid conditions such as atrial fi brillation (P<0.01), cardiac complication (P<0.01) and pulmonary complication (P<0.01), a high Therapeutic Intervention Scoring System (TISS-28) score (P<0.01), and a high Acute Physiology and chronic health evaluation (APACHE) II score (P<0.01) between favorable and unfavorable outcome groups. The overall mortality rate was 15.0% (n=83). In multivariable logistic regression analysis, age, sex, high TISS-28, high APACHE II score, intubation, and cardiac complication were independent predictors of unfavorable outcome. Conclusion: The identifi ed predictors for functional outcomes in Korean neuro-ICU patients will be an important aid in diagnosing and treating neuro-ICU patients.