The depressor anguli oris (DAO) muscle is a thin, superficial muscle located below the corner of the mouth. It is the target for botulinum neurotoxin (BoNT) injection therapy, aimed at treating drooping mouth corners. Hyperactivity of the DAO muscle can lead to a sad, tired, or angry appearance in some patients. However, it is difficult to inject BoNT into the DAO muscle because its medial border overlaps with the depressor labii inferioris and its lateral border is adjacent to the risorius, zygomaticus major, and platysma muscles. Moreover, a lack of knowledge of the anatomy of the DAO muscle and the properties of BoNT can lead to side effects, such as asymmetrical smiles. Anatomical-based injection sites were provided for the DAO muscle, and the proper injection technique was reviewed. We proposed optimal injection sites based on the external anatomical landmarks of the face. The aim of these guidelines is to standardize the procedure and maximize the effects of BoNT injections while minimizing adverse events, all by reducing the dose unit and injection points.

The mentalis muscle is a paired muscle originating from the alveolar bone of the mandible. This muscle is the main target muscle for botulinum neurotoxin (BoNT) injection therapy, which aims to treat cobblestone chin caused by mentalis hyperactivity. However, a lack of knowledge on the anatomy of the mentalis muscle and the properties of BoNT can lead to side effects, such as mouth closure insufficiency and smile asymmetry due to ptosis of the lower lip after BoNT injection procedures. Therefore, we have reviewed the anatomical properties associated with BoNT injection into the mentalis muscle.An up-to-date understanding of the localization of the BoNT injection point according to mandibular anatomy leads to better injection localization into the mentalis muscle. Optimal injection sites have been provided for the mentalis muscle and a proper injection technique has been described. We have suggested optimal injection sites based on the external anatomical landmarks of the mandible. The aim of these guidelines is to maximize the effects of BoNT therapy by minimizing the deleterious effects, which can be very useful in clinical settings.

Background: and Purpose The rate of donepezil discontinuation and the underlying reasons for discontinuation in Asian patients with Alzheimer’s disease (AD) are currently unknown. We aimed to determine the treatment discontinuation rates in AD patients who had newly been prescribed donepezil in routine clinical practice in Asia. Methods: This 1-year observational study involved 38 institutions in seven Asian countries, and it evaluated 398 participants aged 50–90 years with a diagnosis of probable AD and on newly prescribed donepezil monotherapy. The primary endpoint was the rate of donepezil discontinuation over 1 year. Secondary endpoints included the reason for discontinuation,treatment duration, changes in cognitive function over the 1-year study period, and compliance as assessed using a clinician rating scale (CRS) and visual analog scale (VAS). Results: Donepezil was discontinued in 83 (20.9%) patients, most commonly due to an adverse event (43.4%). The mean treatment duration was 103.67 days in patients who discontinued. Among patients whose cognitive function was assessed at baseline and 1 year, there were no significant changes in scores on the Mini-Mental State Examination, Montreal Cognitive Assessment, and Trail-Making Test–Black and White scores, whereas the Clinical Dementia Rating score increased significantly (p<0.001). Treatment compliance at 1 year was 96.8% (306/316) on the CRS and 92.6±14.1% (mean±standard deviation) on the VAS. Conclusions In patients on newly prescribed donepezil, the primary reason for discontinuation was an adverse event. Cognitive assessments revealed no significant worsening at 1 year, indicating that continuous donepezil treatment contributes to the maintenance of cognitive function.

Background: and Purpose The rate of donepezil discontinuation and the underlying reasons for discontinuation in Asian patients with Alzheimer’s disease (AD) are currently unknown. We aimed to determine the treatment discontinuation rates in AD patients who had newly been prescribed donepezil in routine clinical practice in Asia. Methods: This 1-year observational study involved 38 institutions in seven Asian countries, and it evaluated 398 participants aged 50–90 years with a diagnosis of probable AD and on newly prescribed donepezil monotherapy. The primary endpoint was the rate of donepezil discontinuation over 1 year. Secondary endpoints included the reason for discontinuation,treatment duration, changes in cognitive function over the 1-year study period, and compliance as assessed using a clinician rating scale (CRS) and visual analog scale (VAS). Results: Donepezil was discontinued in 83 (20.9%) patients, most commonly due to an adverse event (43.4%). The mean treatment duration was 103.67 days in patients who discontinued. Among patients whose cognitive function was assessed at baseline and 1 year, there were no significant changes in scores on the Mini-Mental State Examination, Montreal Cognitive Assessment, and Trail-Making Test–Black and White scores, whereas the Clinical Dementia Rating score increased significantly (p<0.001). Treatment compliance at 1 year was 96.8% (306/316) on the CRS and 92.6±14.1% (mean±standard deviation) on the VAS. Conclusions In patients on newly prescribed donepezil, the primary reason for discontinuation was an adverse event. Cognitive assessments revealed no significant worsening at 1 year, indicating that continuous donepezil treatment contributes to the maintenance of cognitive function.

The dog frontal sinus may represent an alternative model dental implant research; its topographical resemblance to the maxillary sinus renders it a potentially favorable experimental environment. The aim of this study was thus to elucidate the anatomical configuration of the canine frontal sinus and histological characteristics, and to determine whether it could be a new canine experimental model for dental implant research. Twenty-four sides of canine frontal bones were harvested. The distance from the nasion to the emerging point of the lateral aspect of the canine frontal sinus was measured with the aid of Lucion software. The thicknesses of the canine frontal sinus wall were measured, and the two specimens stained with hematoxylin and eosin. The mean distance from the nasion to the emerging point of the lateral aspect of the canine frontal sinus was 16.0 mm. The mean thicknesses of the canine frontal bone at 3, 6, 9, 12, and 15 mm lateral to the midsagittal plane were 2.3, 2.7, 3.2, 3.8, and 3.7 mm, respectively. The canine frontal sinus was lined with pseudostratified ciliated columnar epithelium. These data suggest that the canine frontal sinus is a suitable alternative to the canine maxillary sinus as a model for studying various sinus augmentation protocols.
Animals ; Dental Implants ; Dogs ; Eosine Yellowish-(YS) ; Epithelium ; Frontal Bone ; Frontal Sinus* ; Hematoxylin ; Maxillary Sinus ; Models, Theoretical*

Hypernatremia is a rare cause of rhabdomyolysis. Here, we report a case of hypernatremia-induced rhabdomyolysis in a patient with meningioma involving the pituitary gland. A 61-year-old male was admitted for decreased mentality and poor oral intake. He had undergone an operation for meningioma 10 years prior. At admission, he appeared lethargic and severely dehydrated with an initial sodium level of 178 mEq/L. Hypernatremia remained persistent despite massive hydration and the serum creatine phosphokinase level was 18,047 U/L after 3 days. Bone scintigraphy also showed findings consistent with rhabdomyolysis. Brain magnetic resonance imaging revealed extensive masses involving the pituitary gland and an intranasal biopsy confirmed meningioma. Polyuria, and low anti-diuretic hormone levels supported the diagnosis of central diabetes insipidus-induced hypernatremia. Desmopressin was administered intranasally and the patient's serum sodium and muscle enzyme levels were normalized.
Biopsy ; Brain ; Creatine Kinase ; Deamino Arginine Vasopressin ; Diabetes Insipidus ; Diagnosis ; Humans ; Hypernatremia ; Magnetic Resonance Imaging ; Male ; Meningioma* ; Middle Aged ; Pituitary Gland* ; Polyuria ; Radionuclide Imaging ; Rhabdomyolysis* ; Sodium

Recently, invasive infections with the human pathogen Streptococcus dysgalactiae subspeciesequisimilis (SDSE) have increased around the globe. Typing of the emm gene of SDSE, which encodes a virulence factor (M protein), has provided important information. Here, we report two cases of invasive SDSE infection that presented with endocarditis and bacteremia, and their emm gene types.
Bacteremia ; Endocarditis ; Humans ; Streptococcus* ; Virulence

Recently, invasive infections with the human pathogen Streptococcus dysgalactiae subspeciesequisimilis (SDSE) have increased around the globe. Typing of the emm gene of SDSE, which encodes a virulence factor (M protein), has provided important information. Here, we report two cases of invasive SDSE infection that presented with endocarditis and bacteremia, and their emm gene types.
Bacteremia ; Endocarditis ; Humans ; Streptococcus* ; Virulence

BACKGROUND/AIMS: To compare the frequency of metabolic syndrome (MetS) and magnitude of insulin resistance, measured by the homeostatic model assessment of insulin resistance (HOMA-IR), between South Korean women with rheumatoid arthritis (RA) and healthy subjects, and to evaluate risk factors for MetS and increased HOMA-IR in patients with RA. METHODS: In a cross-sectional setting, 84 female patients with RA and 109 age-matched healthy female subjects were consecutively recruited at a university-affiliated rheumatology center in South Korea. MetS was defined according to the Third Report of the National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP III) 2004 criteria. RESULTS: The frequency of MetS did not differ significantly between patients with RA (19%) and healthy subjects (15.6%, p = 0.566), although patients with RA had a higher HOMA-IR compared with healthy subjects (p < 0.001). Patients with RA met the NCEP-ATP III 2004 criteria for high blood pressure more often than healthy subjects (44% vs. 19.3%, p < 0.001), and low high density lipoprotein cholesterol was more prevalent in healthy subjects (33%) than in patients with RA (14.3%, p = 0.004). Although no obvious risk factors for the presence of MetS were identified in patients with RA, higher serum C-reactive protein and disease activity score assessed using the 28-joint count for swelling and tenderness-erythrocyte sedimentation rate significantly contributed to a higher HOMA-IR. CONCLUSIONS: Despite their increased insulin resistance, South Korean women with RA did not have a significantly higher frequency of MetS compared with that in healthy subjects.
Adult ; Aged ; Arthritis, Rheumatoid/diagnosis/*epidemiology ; Biological Markers/blood ; Case-Control Studies ; Chi-Square Distribution ; Cross-Sectional Studies ; Female ; Humans ; Insulin Resistance ; Linear Models ; Logistic Models ; Metabolic Syndrome X/blood/diagnosis/*epidemiology ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Prevalence ; Republic of Korea/epidemiology ; Risk Assessment ; Risk Factors ; Sex Factors ; Young Adult

Sihler's staining allows visualization of the nerve distribution within soft tissues without extensive dissection and does not require slide preparation, unlike traditional approaches. This technique can be applied to the mucosa, muscle, and organs that contain myelinated nerve fibers. In particular, Sihler's technique may be considered the best tool for observing nerve distribution within skeletal muscles. The intramuscular distribution pattern of nerves is difficult to observe through manual manipulation due to the gradual tapering of nerves toward the terminal end of muscles, so it should be accompanied by histological studies to establish the finer branches therein. This method provides useful information not only for anatomists but also for physiologists and clinicians. Advanced knowledge of the nerve distribution patterns will be useful for developing guidelines for clinicians who perform operations such as muscle resection, tendon transplantation, and botulinum toxin injection. Furthermore, it is a useful technique to develop neurosurgical techniques and perform electrophysiological experiments. In this review, Sihler's staining technique is described in detail, covering its history, staining protocol, advantages, disadvantages, and possible applications. The application of this technique for determining the arterial distribution pattern is also described additionally in this study.
Anatomists ; Arteries ; Botulinum Toxins ; Humans ; Mucous Membrane ; Muscle, Skeletal ; Muscles ; Nerve Fibers, Myelinated ; Tendons ; Transplants