Non-thrombotic pulmonary embolism (NTPE) is a rare but potentially fatal complication of filler injections. It can result not only from direct intravascular injection but also from the migration of fillers into veins due to local pressure. Here, we report the autopsy findings of two deaths resulting from NTPE following vaginal filler injections. The first case involved a 38-year-old woman who lost consciousness 20-40 minutes after receiving an injection of 15 mL of hyaluronic acid (HA) filler. A large amount of filler was observed in the vagina with gross embolization of the paravaginal vessels. Microscopic examination revealed HA embolism in the lungs. Despite treatment, the patient died 10 days after the procedure. The second case involved a 35-year-old woman who experienced desaturation and cardiac arrest 4 minutes after receiving a collagen filler and a hybrid filler consisting of HA and polylactic acid. An autopsy revealed NTPE and systemic embolism of the collagen filler. She died 1 month after treatment in the intensive care unit. The vagina poses a significant risk for filler injections owing to its rich venous plexus. Doctors should be fully aware of this risk, and a complete autopsy should be performed in such cases.

Secondary dyslipidemia, characterized by elevated blood cholesterol and triglycerides, arises from various underlying conditions. The identification and appropriate handling of these causes is crucial for effective treatment. Major contributors include unhealthy diets, diseases impacting lipid metabolism, and medication side effects. Prioritizing the correction of secondary causes before initiating conventional lipid-lowering therapies is essential. Subsequent lipid profiles guide the selection of appropriate guideline-based lipid-lowering interventions.

Objectives: This study investigated the relationship between exposure to endocrine-disrupting chemicals (EDCs), specifically phthalates, bisphenol A, bisphenol F, and bisphenol S, and the severity of attention-deficit/hyperactivity disorder (ADHD) symptoms using neuropsychological tests in children diagnosed with ADHD. Methods: This study included 67 medication-naïve children with ADHD aged 6–16 years. The urinary concentrations of EDCs were measured, and ADHD symptom severity was evaluated using neuropsychological tests and clinical symptom scale measurements. The Jonckheere–Terpstra test, Pearson and Spearman correlation analyses, linear regression models, and multiple regression models were used to examine the relationship between EDC exposure and ADHD symptoms. Results: A significant correlation was observed between urinary phthalate metabolite concentrations and commission error T-scores in the visual Advanced Test of Attention test. No significant associations were found with other neuropsychological indicators or bisphenol levels. Conclusion Phthalate exposure affects impulsivity in children with ADHD, which is consistent with the results of previous studies that used parental surveys. However, bisphenols are not clearly associated with ADHD symptoms, which is consistent with the results of previous studies.

Cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) is a neurodegenerative disorder caused by a biallelic expansion of pentanucleotide repeats in the RFC1 gene. Previous studies have reported up to 22% of patients with late-onset ataxia harbor this pathogenic repeat expansion. Despite its relatively high prevalence, CANVAS is often underdiagnosed because the disease is not well recognized and genetic testing is not performed in clinical practice. Here, we present a patient with characteristic clinical features, confirmed by genetic testing.

Background: Despite the critical importance of sleep medicine within neurology, notable gaps in education and clinical practice persist among neurologists. This study aims to explore the extent of involvement and the challenges faced by Korean neurologists in sleep medicine, focusing on awareness of polysomnography training program, the operation of sleep study facilities, and educational exposure. Methods: An online survey collected responses from 233 neurologists, focusing on their demographics, knowledge of and involvement in sleep medicine, operation of sleep study facilities, and participation in residency training. Results: The findings indicated that 84.9% of neurologists were aware of polysomnography training program, primarily through professional societies. Nonetheless, 15.1% reported unfamiliarity with these initiatives, with 72.7% of this subgroup expressing interest in sleep medicine yet lacking access to information. In terms of clinical practice, 74 neurologists operated sleep study facilities, with 63% intending to expand. Key operational challenges included staff management, maintaining patient volumes, and inadequate institutional support. Among respondents from teaching hospitals, only 36 out of 114 reported active resident involvement in sleep study interpretations, predominantly hindered by excessive workloads and insufficient staffing. Conclusions A significant number of neurologists have an interest in sleep medicine; however, substantial challenges impede effective education and clinical practice. These results underscore the need for improved educational resources and institutional support to enhance the growth and effectiveness of sleep medicine practices among neurologists.

Purpose: We present a case of anterior displacement of the lens-iris diaphragm associated with Vogt–Koyanagi–Harada (VKH) disease.Case summary: A 35-year-old woman presented with decreased vision in her right eye. Examination revealed corrected visual acuity of 0.6 in the right eye and 1.0 in the left eye. Intraocular pressure (IOP) was 14 and 16 mmHg in the right and left eye, respectively. Spherical equivalent (SE) was -17.25 D in the right eye and -9.75 D in the left eye. Slit lamp examination and three-dimensional anterior segment photography revealed anterior displacement of the lens-iris diaphragm in both eyes. Two days later, the left eye developed similar symptoms with an SE of -15.5 D. Fundus examination revealed serous retinal detachment and fluorescein fundus photography demonstrated focal leakage leading to the diagnosis of atypical VKH disease. The patient was treated with oral corticosteroids and her symptoms resolved after 3 weeks. The Final SE was -10.25 D in the right eye and -9.75 D in the left eye. Conclusions We suggest there is an association between atypical VKH and anterior lens-iris diaphragm displacement in the absence of elevated IOP; early myopic shift may be associated with this presentation. Therefore, patients with isolated lens-iris diaphragm displacement, particularly those without a history of medications should be monitored for the possibility of developing VKH disease.

Purpose: We investigated the relationship between metabolic syndrome and open-angle glaucoma (OAG) in postmenopausal women using data from the Korea National Health and Nutrition Examination Survey (KNHANES). Methods: A multiple logistic regression analysis was conducted on postmenopausal women from KNHANES from 2010 to 2012, divided into open angle glaucoma and non-glaucoma groups. The analysis adjusted for age, intraocular pressure, education level, income level, physical activity, smoking, and alcohol consumption. Results: The odds ratio (OR) for OAG was 1.801 (95% confidence interval [CI] 1.071-3.030) in the presence of metabolic syndrome. Among the components of metabolic syndrome, hypertriglyceridemia had an OR of 1.779 (95% CI 1.148-2.758). When hypertriglyceridemia was accompanied by hyperglycemia, the OR was 2.032 (95% CI 1.154-3.578). The OR was 1.839 (95% CI 1.209-2.797) when hypertriglyceridemia was accompanied by hypertension. For the combination of hypertriglyceridemia, hyperglycemia, and hypertension, the OR was 1.962 (95% CI 1.102-3.493). When hypertriglyceridemia, hyperglycemia, and waist circumference over 80 cm were present, the OR was 1.863 (95% CI 1.003-3.458). Lastly, the combination of hypertriglyceridemia, hyperglycemia, and low HDL cholesterol resulted in an OR of 1.976 (95% CI 1.096-3.562). Conclusions In postmenopausal women, the presence of metabolic syndrome was associated with OAG, but the number of metabolic syndrome components was not related. Among the components of metabolic syndrome, only elevated triglycerides were associated with OAG.

Purpose: To evaluate the short-term efficacy and safety of latanoprostene bunod 0.024% in patients with primary open-angle glaucoma. Methods: A retrospective study was conducted from September 2022 to September 2023, involving 29 eyes from patients diagnosed with primary open-angle glaucoma. The study analyzed the intraocular pressure (IOP)-lowering effects of latanoprostene bunod 0.024% at 1 and 3 months after administration. Additionally, adverse events reported by patients at each visit were documented. Results: The mean age of patients at the start of treatment was 64.46 years. The baseline IOP was 17.46 ± 4.03 mmHg, which significantly decreased to 15.07 ± 4.23 mmHg (p = 0.002) at 1 month (29 eyes) and 14.93 ± 3.86 mmHg (p = 0.002) at 3 months (28 eyes) after latanoprostene bunod administration. After 1 month, 9 patients reported adverse events, including conjunctival hyperemia (1 eye, 3.5%), itching (2 eyes, 6.9%), foreign body sensation (2 eyes, 6.9%), stinging (2 eyes, 6.9%), ocular pain (2 eyes, 6.9%), and deepening of the upper eyelid sulcus (1 eye, 3.5%). The patient who experienced deepening of the upper eyelid sulcus discontinued treatment. After 3 months, 2 eyes with itching discontinued treatment due to conjunctival allergy. Conclusions Latanoprostene bunod 0.024% demonstrated short-term efficacy in reducing IOP and a manageable safety profile in patients with primary open-angle glaucoma.

Purpose: To compare the macular and peripapillary vascular parameters between the primary angle closure suspect (PACS) eyes and normal control eyes using optical coherence tomography angiography (OCTA). Methods: In this retrospective study, 42 PACS subjects and 38 normal individuals are included. Vessel density (VD) and perfusion density (PD) of the macular area and peripapillary area, and fovea avascular zone parameter were analyzed using OCTA and compared between two groups after adjustment for the axial length. Results: There were no statistically significant differences in sex ratio, age, refractive errors and intraocular pressures between both groups. In the peripapillary area, inferior VD and PD in the outer zone were significantly lower in the PACS eyes, while the retinal nerve fiber layer thicknesses were similar between groups (p = 0.032, 0.026). In the macular superficial capillary plexus, inferior VD and PD in the inner zone, inferior VD and PD, nasal VD and PD in the outer zone were significantly lower in the PACS eyes, whereas ganglion cell inner plexiform layer thickness were similar between both groups (all p < 0.005). Conclusions The VDs and PDs of retinal capillaries in PACS eyes, which have no glaucomatous changes in the retinal nerve fiber layer and optic nerve disc, were significantly lower compared to normal eyes.

This case report investigates the effects of semi-occluded vocal tract exercises (SOVTEs) on voice improvement in elderly female patients with presbyphonia. Elderly female patients with presbyphonia commonly present with symptoms such as hoarseness, decreased vocal intensity, and phonatory difficulties. These symptoms are often associated with age-related vocal fold atrophy, leading to compensatory muscle tension and inefficient phonation, which necessitate targeted therapeutic interventions. In this study, two elderly female patients, aged 73 years and 71 years, participated in a voice therapy program centered on SOVTEs designed to promote vocal fold vibration efficiency and reduce compensatory tension. Case 1 underwent five therapy sessions, while Case 2 completed sixteen sessions. Pre- and post-treatment voice assessments revealed notable improvements in vocal quality, suggesting that SOVTEs may be an effective therapeutic approach for managing presbyphonia in elderly women.