Background: and Purpose We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion. Methods: Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization. Results: Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032). Conclusions The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.

Background: and Purpose We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion. Methods: Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization. Results: Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032). Conclusions The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.

Background: This is the first clinical study conducted among Asian women using breast implants manufactured by an Asian company. Four-year data regarding the safety and efficacy of BellaGel breast implants have already been published, and we now report 6-year data. Methods: This study was designed to take place over 10 years. It included 103 patients who underwent breast reconstruction or augmentation using BellaGel breast implants. The rates of implant rupture and capsular contracture were measured and analyzed to evaluate the effectiveness of the breast implant. Results: At patients’ 6-year postoperative visits, the implant rupture and capsular contracture rates were 1.15% and 2.30%, respectively. The implant rupture rate was 3.77% among reconstruction cases and 0% among augmentation cases. The capsular contracture rate was 5.66% among reconstruction cases and 0.83% among augmentation cases. Conclusions The 6-year data from this planned 10-year study suggest that the BellaGel cohesive silicone gel-filled breast implant is an effective and safe medical device that can be used in breast reconstruction and augmentation.

OBJECTIVES: This study examined the association between executive functions and time perspectives in patients with adult attention-deficit/hyperactivity disorder (ADHD). The executive function including self-management to time, self-organization/problem solving, self-restraint or inhibition, self-motivation, and self-regulation of emotion was analyzed. In addition, the time perspective, including past-negative, past-positive, present-hedonistic, present-fatalistic, future-negative, and future-positive, were investigated. The correlations between the executive functions and time perspectives were analyzed in an adult ADHD patient group. METHODS: Thirty-six participants were divided into 17 in the ADHD group and 19 in the Control group. The participants conduct psychological tests including Barkley Deficits in Executive Functioning Scale (BDEFS), ADHD Self-Report Scale, and the Swedish Zimbardo Time Perspective Inventory to confirm their executive functions, attention, and time perspectives. The participants were recruited at Samsung Medical Center from April 2017 to November 2018. The collected data was analyzed using a t-test and Pearson correlation analysis. RESULTS: The adult ADHD patients group showed significantly higher scores in the BDEFS and ADHD Self-Report Scale than the control group. In time perspective scores, the adult ADHD patients group was higher in the past-negative, present-hedonistic, present-fatalistic time perspectives than the control group. In addition, the adult ADHD patients group was lower in future-positive than the control group. In the adult ADHD patients group, the future-positive time perspectives were negatively correlated with the executive functions. CONCLUSION: These results suggest that the negative time perspective is related to the executive function deficits in an adult ADHD group, particularly in the self-management of time, self-organization/problem solving, and self-motivation.
Adult ; Executive Function ; Humans ; Psychological Tests ; Self Care ; Self-Control

Complete removal is most important in treating the malignant tumor from the auricle, but the cosmetic and reconstructive plan after removal should also be considered because auricular appearance contributes enormously to the facial aesthetics. Mohs micrographic surgery (MMS), which is commonly used in dermatology, is considered as minimal marginal surgery that offers superior cure rates in the treatment of facial skin cancer. Therefore, MMS could provide a minimally invasive way to manage the malignant tumor of the auricle. This article reports that basosquamous cell carcinoma arising in the auricle was treated with wide resection combined with MMS. Conclusively, we could accomplish the surgical purpose of both completely removing the tumor and maintaining the auricular aesthetic shape by additionally introducing MMS in the treatment.
Dermatology ; Esthetics ; Mohs Surgery* ; Skin Neoplasms

BACKGROUND AND OBJECTIVES: The cause of idiopathic sudden sensorineural hearing loss (ISSNHL) is still unclear, but recently, chronic inflammation and thrombosis have received attention. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are some of the markers that show the state of inflammation and ischemia, which are measured routinely in the complete blood cell count (CBC) test. The aim of this study were to investigate the relevance of NLR and PLR with ISSNHL. SUBJECTS AND METHOD: Enrolled in our retrospective analysis were 103 patients diagnosed with ISSNHL. Blood samples were taken from the patients and hearing assessments were performed. NLR and PLR were calculated using the CBC results. Then the patients were divided into 4 groups using Sigel's criteria according to their response to the treatment, which were again classified two groups, the “recovered” and “unrecovered” group. RESULTS: NLR, PLR, and neutrophil values of the unrecovered group were significantly higher than the recovered group (p=0.002, p=0.009, and p=0.038, respectively). On the other hand, lymphocyte values were significantly higher in the recovered group (p=0.007). After adjustment in a multivariate logistic regression analysis, NLR was associated with the recovery of ISSNHL (Odds ratio=1.290, p=0.042). In addition, NLR and PLR values were also significantly different between the groups classified by the Sigel's criteria (p=0.009 and p=0.029, respectively). CONCLUSION: PLR values may be useful in predicting hearing recovery after treatment in patients with ISSNH. It is also expected to be a potential marker for predicting the prognosis and determining further treatment options.
Biomarkers ; Blood Cell Count ; Hand ; Hearing ; Hearing Loss, Sensorineural* ; Humans ; Inflammation ; Ischemia ; Logistic Models ; Lymphocytes ; Methods ; Neutrophils ; Prognosis* ; Retrospective Studies ; Thrombosis

OBJECTIVE: This study examined the association between the wave form in quantitative electroencephalography (QEEG) and the cognitive and behavioral characteristics measured by the Korean version of Wechsler Intelligence Scale for Children 4th edition (K-WISC-IV), Korean version of the attention deficit/hyperactivity disorder Rating Scale (K-ARS), and Korean version of Child Behavior Checklist (K-CBCL) in children diagnosed with ADHD. METHOD: A retrospective cross-sectional study was performed on children aged 8 to 13 years, who were diagnosed with ADHD at Samsung Medical Center from November 2011 to March 2017. A total of 57 ADHD children were selected by a medical chart review. Their QEEG findings and psychological test results, including K-WISC-IV, K-CBCL, and K-ARS (n=42), were collected. The QEEG was analyzed by the ranges of Hz: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), and beta (12–25 Hz) and transformed to the z-scored relative power. The collected data were analyzed using Pearson and Partial correlation analysis. RESULTS: The Letter-Number Sequencing scores of K-WISC was positively correlated with fronto-central alpha. The hyperactivity/impulsivity scores of K-ARS were positively correlated with the theta/beta ratio. Among the items of K-CBCL, social immaturity was positively correlated with delta and theta, and negatively correlated with alpha. Social competence was negatively correlated delta and theta, and positively correlated with alpha. CONCLUSION: These results suggest that the resting state QEEG results of children with ADHD may reflect their cognitive and behavioral characteristics, especially in working memory/executive function, hyperactivity/impulsivity, and sociality.
Checklist ; Child ; Child Behavior ; Cross-Sectional Studies* ; Electroencephalography* ; Humans ; Intelligence ; Methods ; Psychological Tests ; Retrospective Studies* ; Social Skills

OBJECTIVES: Attention deficit hyperactivity disorder (ADHD) is a disease of high heritability. Parents of children with ADHD have high parenting stress and low parenting efficacy. In this study, we assessed parents' characteristics including inattention, hyperactivity, impulsivity, executive function, anxiety/depression severity level, child's ADHD symptom severity, and parents' emotional distress level. The relationships between severity of ADHD symptoms in children, cognitive and emotional characteristics in parents, as well as parenting stress and parenting efficacy were evaluated. METHODS: 96 parents participated in the study. Each parent assessed their child's ADHD symptom severity, their own ADHD symptom severity, as well as executive function, depression, anxiety, parenting stress and parenting efficacy. Collected data was analyzed using multiple regression analysis. RESULTS: The mean ADHD Rating Scale score of 53 children was 22.91 (±9.63). Of these, 26 (49.0%) were taking medication. Eight (8.3%) of the 96 parents had psychiatric illnesses and 12 (12.5%) had the possibility of ADHD. Mothers showed significantly higher levels of parenting stress (p < 0.001), depression (p=0.006), and parenting efficacy (p < 0.001) compared with fathers. The children's ADHD symptoms, severity, and parental depression were related to high parenting stress. The ADHD symptoms of parents were associated with high parenting stress (p=0.032). Parental executive function was significantly associated with low parenting efficacy (p=0.015). CONCLUSION: Children's ADHD symptoms severity, parental depression and ADHD symptom severity were significantly associated with high parenting stress. Parental executive function was significantly associated with low parenting efficacy. In addition to treating the children with ADHD, evaluation and treatment of parents' symptoms is needed in order to reduce parenting stress and provide a stable parenting environment.
Anxiety ; Attention Deficit Disorder with Hyperactivity* ; Child ; Depression ; Executive Function* ; Fathers ; Humans ; Impulsive Behavior ; Mothers ; Parenting ; Parents*

OBJECTIVE: When managing patients with acute meningitis in an emergency department (ED), early diagnosis of the type of infection (bacterial or viral) considerably affects the clinical course and treatment because of the high mortality and morbidity associated with bacterial meningitis (BM). The serum delta neutrophil index (DNI), a new inflammatory marker, reflects the fraction of circulating immature granulocytes and is elevated in cases of bacterial infection. The objective of this study was to evaluate whether serum DNI can be used to differentiate between BM and viral meningitis (VM) in the ED. METHODS: This retrospective, observational study included 104 consecutive patients (aged >18 years) diagnosed with acute meningitis from January 2012 to November 2014 in a regional emergency center. White blood cell and neutrophil counts, C-reactive protein level, and DNI were evaluated regarding their usefulness for differentiating BM and VM. RESULTS: Serum DNI was not significantly higher in the BM group (n=12) than in the VM group (n=92) (0 [interquartile range, 0% to 2.73%] vs. 0 [interquartile range, 0 to 0%], P=0.057). However, the white blood cell count and C-reactive protein level were statistically higher in the BM group (P=0.034 and P=0.026, respectively). Serum DNI was not found to be a statistically useful differential diagnostic parameter (area under the curve, 0.628; 95% confidence interval, 0.438 to 0.818). CONCLUSION: Currently, there is no evidence that the serum DNI aids in differentiating acute BM from acute VM in the ED.
Bacterial Infections ; Biomarkers ; C-Reactive Protein ; Early Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Granulocytes ; Humans ; Leukocyte Count ; Leukocytes ; Meningitis ; Meningitis, Bacterial ; Meningitis, Viral* ; Mortality ; Neutrophils* ; Observational Study ; Retrospective Studies

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disease. The main causes of death in ADPKD are cardiovascular disease as well as infections and neurological reasons. ADPKD is causing vasculopathy including aortic root dilation, cerebral artery aneurysm, coronary aneurysm, and aortic dissection. In this case report, we describe a 37-year-old female ADPKD patient with non-ST elevation MI (NSTEMI) caused by coronary artery focal spasm.
Adult ; Aneurysm ; Cardiovascular Diseases ; Cause of Death ; Cerebral Arteries ; Coronary Aneurysm ; Coronary Vessels* ; Female ; Humans ; Myocardial Infarction* ; Polycystic Kidney, Autosomal Dominant* ; Spasm*