Purpose: The coronavirus disease 2019 (COVID-19) pandemic disrupted the emergency medical care system worldwide. We analyzed the changes in the management of intracerebral hemorrhage (ICH) and compared the pre-COVID-19 and COVID-19 eras. Materials and Methods: From March to October of the COVID-19 era (2020), 83 consecutive patients with ICH were admitted to four comprehensive stroke centers. We retrospectively reviewed the data of patients and compared the treatment workflow metrics, treatment modalities, and clinical outcomes with the patients admitted during the same period of pre-COVID-19 era (2017–2019). Results: Three hundred thirty-eight patients (83 in COVID-19 era and 255 in pre-COVID-19 era) were included in this study. Symptom onset/detection-to-door time [COVID-19; 56.0 min (34.0–106.0), pre-COVID-19; 40.0 min (27.0–98.0), p=0.016] and median door to-intensive treatment time differed between the two groups [COVID-19; 349.0 min (177.0–560.0), pre-COVID-19; 184.0 min (134.0–271.0), p<0.001]. Hematoma expansion was detected more significantly in the COVID-19 era (39.8% vs. 22.1%, p=0.002). At 3-month follow-up, clinical outcomes of patients were worse in the COVID-19 era (Good modified Rankin Scale; 33.7% in COVID-19, 46.7% in pre-COVID-19, p=0.039). Conclusion During the COVID-19 era, delays in management of ICH was associated with hematoma expansion and worse outcomes.

Objective: Within the last 2 years, coronavirus disease 2019 has spread rapidly across several continents, with 100 million confirmed infected patients. Physical barrier enclosure, also called “aerosol-box,” is a solution for the shortage of protective devices and spaces. In this study, we examined the safety of the novel barrier enclosure. Methods: We simulated droplets by nebulizing 1% glycerol+99% ethanol solution. Two experienced physicians performed intubation under two conditions, such as the isolator condition (applying isolator without negative condition) and the negative pressure condition (applying isolator with the negative condition). We compared two conditions with two control groups, including negative control (room air) and positive control (synthetizing droplet air). During the procedure, particles were counted for 30 seconds, and this was repeated 10 times. At each condition, depending on the result of the normality test (Shapiro-Wilk test), an independent t-test was used when normality was satisfied, and a Mann-Whitney U-test was used when normality was not satisfied. Results: The total number of particles in the positive control was 308,788 (175,936-461,124). The total number of particles for both conditions was significantly less than the positive control. Total number of particles in the isolator condition was 30,952 (27,592-33,244, P=0.001) and that in the negative pressure condition was 27,890 (27,165-29,786, P=0.001). Conclusion The novel barrier significantly reduces synthetizing droplets exposure during intubation. Application of negative pressure through the isolator results in an additional decrease in particle exposure. Studies involving a larger population of operators and prolonged procedures are required.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic disrupted the emergency medical care system worldwide. We analyzed the changes in the management of intracerebral hemorrhage (ICH) and compared the pre-COVID-19 and COVID-19 eras. Materials and Methods: From March to October of the COVID-19 era (2020), 83 consecutive patients with ICH were admitted to four comprehensive stroke centers. We retrospectively reviewed the data of patients and compared the treatment workflow metrics, treatment modalities, and clinical outcomes with the patients admitted during the same period of pre-COVID-19 era (2017–2019). Results: Three hundred thirty-eight patients (83 in COVID-19 era and 255 in pre-COVID-19 era) were included in this study. Symptom onset/detection-to-door time [COVID-19; 56.0 min (34.0–106.0), pre-COVID-19; 40.0 min (27.0–98.0), p=0.016] and median door to-intensive treatment time differed between the two groups [COVID-19; 349.0 min (177.0–560.0), pre-COVID-19; 184.0 min (134.0–271.0), p<0.001]. Hematoma expansion was detected more significantly in the COVID-19 era (39.8% vs. 22.1%, p=0.002). At 3-month follow-up, clinical outcomes of patients were worse in the COVID-19 era (Good modified Rankin Scale; 33.7% in COVID-19, 46.7% in pre-COVID-19, p=0.039). Conclusion During the COVID-19 era, delays in management of ICH was associated with hematoma expansion and worse outcomes.

PURPOSE: Hypoxia can impair the therapeutic efficacy of radiotherapy (RT). Therefore, a new strategy is necessary for enhancing the response to RT. In this study, we investigated whether the combination of nanoparticles and RT is effective in eliminating the radioresistance of hypoxic tumors. MATERIALS AND METHODS: Gold nanoparticles (GNPs) consisting of a silica core with a gold shell were used. CT26 colon cancer mouse model was developed to study whether the combination of RT and GNPs reduced hypoxia-induced radioresistance. Hypoxia inducible factor-1α (HIF-1α) was used as a hypoxia marker. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining were conducted to evaluate cell death. RESULTS: Hypoxic tumor cells had an impaired response to RT. GNPs combined with RT enhanced anti-tumor effect in hypoxic tumor compared with RT alone. The combination of GNPs and RT decreased tumor cell viability compare to RT alone in vitro. Under hypoxia, tumors treated with GNPs + RT showed a higher response than that shown by tumors treated with RT alone. When a reactive oxygen species (ROS) scavenger was added, the enhanced antitumor effect of GNPs + RT was diminished. CONCLUSION: In the present study, hypoxic tumors treated with GNPs + RT showed favorable responses, which might be attributable to the ROS production induced by GNPs + RT. Taken together, GNPs combined with RT seems to be potential modality for enhancing the response to RT in hypoxic tumors.
Animals ; Anoxia ; Cell Death ; Cell Survival ; Colonic Neoplasms ; DNA Nucleotidylexotransferase ; In Vitro Techniques ; Mice ; Nanoparticles* ; Radiotherapy* ; Reactive Oxygen Species ; Silicon Dioxide

The half-dried leaves of Stewartia. pseudocamellia were extracted with hot water (SPE) and partitioned with n-hexane (SPEH), dichloromethane (SPED), and ethyl acetate (SPEE) successively. SPE and SPEE showed significant inhibitory effects against melanogenesis and tyrosinase activities. By bioassay-guided isolation, ten phenolic compounds were isolated by column chromatography from SPEE. The whitening effect of the isolated compounds from SPEE were tested for the inhibitory activities against melanogenesis using B16 melanoma cells, in vitro inhibition of tyrosinase, and L-3,4-dihydorxy-indole-2-carboxylic acid (L-DOPA) auto-oxidation assay. A cytotoxic activity assay was done to examine the cellular toxicity in Raw 264.7 macrophage cells. Of the compounds isolated, gallic acid and quercetin revealed significant inhibitory activities against melanogenesis compared to arbutin. In particular, quercetin exhibited similar inhibitory activities against tyrosinase and L-DOPA oxidation without cytotoxicity. These results suggested that SPE could be used as a potential source of natural skin-whitening material in cosmetics as well as in food products.
Arbutin ; Chromatography ; Gallic Acid ; Levodopa ; Macrophages ; Melanoma, Experimental ; Methylene Chloride ; Monophenol Monooxygenase ; Phenol* ; Quercetin ; Water

PURPOSE: To describe the early experience of analyzing variations and time trends in bladder volume of the rectal cancer patients who received bladder ultrasound scan. MATERIALS AND METHODS: We identified 20 consecutive rectal cancer patients who received whole pelvic radiotherapy (RT) and bladder ultrasound scan between February and April 2012. Before simulation and during the entire course of treatment, patients were scanned with portable automated ultrasonic bladder scanner, 5 times consecutively, and the median value was reported. Then a radiation oncologist contoured the bladder inner wall shown on simulation computed tomography (CT) and calculated its volume. RESULTS: Before simulation, the median bladder volume measured using simulation CT and bladder ultrasound scan was 427 mL (range, 74 to 1,172 mL) and 417 mL (range, 147 to 1,245 mL), respectively. There was strong linear correlation (R = 0.93, p < 0.001) between the two results. During the course of treatment, there were wide variations in the bladder volume and every time, measurements were below the baseline with statistical significance (12/16). At 6 weeks after RT, the median volume was reduced by 59.3% to 175 mL. Compared to the baseline, bladder volume was reduced by 38% or 161 mL on average every week for 6 weeks. CONCLUSION: To our knowledge, this study is the first to prove that there are bladder volume variations and a reduction in bladder volume in rectal cancer patients. Moreover, our results will serve as the basis for implementation of bladder training to patients receiving RT with full bladder.
Humans ; Observer Variation ; Rectal Neoplasms ; Ultrasonics ; Urinary Bladder

PURPOSE: We investigated the effect of location changes in the inferior border of the belly board (BB) aperture by adding a bladder compression device (BCD). MATERIALS AND METHODS: We respectively reviewed data from 10 rectal cancer patients with a median age 64 years (range, 45~75) and who underwent computed tomography (CT) simulation with the use of BB to receive pelvic radiotherapy between May and September 2010. A CT simulation was again performed with the addition of BCD since small bowel (SB) within the irradiated volume limited boost irradiation of 5.4 Gy using the cone down technique after 45 Gy. The addition of BCD made the inferior border of BB move from symphysis pubis to the lumbosacral junction (LSJ). RESULTS: Following the addition of BCD, the irradiated volumes of SB and the abdominopelvic cavity (APC) significantly decreased (174.3+/-89.5 mL vs. 373.3+/-145.0 mL, p=0.001, 1282.6+/-218.7 mL vs. 1571.9+/-158 mL, p<0.001, respectively). Bladder volume within the treated volume increased with BCD (222.9+/-117.9 mL vs. 153.7+/-95.5 mL, p<0.001). The ratio of irradiated bladder volume to APC volume with BCD (33.5+/-14.7%) increased considerably compared to patients without a BCD (27.5+/-13.1%) (p<0.001), and the ratio of irradiated SB to APC volume decreased significantly with BCD (13.9+/-7.6% vs. 24.2+/-10.2%, p<0.001). The ratios of the irradiated SB volumeand irradiated bladder volume to APC volume negatively correlated (p=0.001). CONCLUSION: This study demonstrated that the addition of BCD, which made the inferior border of BB move up to the LSJ, increased the ratio of the bladder to APC volume and as a result, decreased the irradiated volume of SB.
Humans ; Rectal Neoplasms ; Urinary Bladder

BACKGROUND: Information concerning the cardiopulmonary effects of pneumoperitoneum in children is lacking. METHODS: Twenty eight patients were assigned to receive diagnostic laparoscopy (n = 12) or laparoscopic surgery (n = 16). Before insufflation of CO2, tidal volume was set at 10 ml/kg and respiratory rate was adjusted to achieve an end-tidal CO2 (P(ET)CO2) of 30-35 mmHg. Abdominal pressure was maintained at 10-15 mmHg by a CO2 insufflator. We measured the changes of systolic arterial pressure (SAP), heart rate (HR), P(ET)CO2 and peak airway pressure (PAP) at 5 min before (control value) and after CO2 insufflation and 5 min after CO2 deflation. RESULTS: SAP and PAP were increased significantly after pnemoperitoneum compared with the control both in diagnostic laparoscopy and laparoscopic surgery (P < 0.05). P(ET)CO2 was increased significantly after pneumoperitoneum and after CO2 deflation in laparoscopic surgery compared with the control and also with diagnostic laparoscopy (P < 0.05). Driving pressure (the difference between peak airway pressure and abdominal pressure) was increased significantly after pneumoperitoneum in laparoscopic surgery compared with diagnostic laparoscopy (P < 0.05). CONCLUSIONS: SAP, PAP and P(ET)CO2 increases during diagnostic laparoscopy and laparoscopic surgery, but this effect appears to be of smaller magnitude in diagnostic laparoscopy compared to laparoscopic surgery. We found that these changes had no clinically deleterious effects in healthy children.
Arterial Pressure ; Child ; Heart Rate ; Humans ; Insufflation ; Laparoscopy ; Pneumoperitoneum ; Respiratory Rate ; Tidal Volume

PURPOSE: The optimal interval at which to repeat prostate-specific antigen (PSA) measurement is controversial. We evaluated the probability of the serum PSA value increasing above specific cutoff values (4.0 ng/ml, 3.0 ng/ml, and 2.5 ng/ml) on annual follow-up visits in men with a lower baseline PSA than each cutoff value. MATERIALS AND METHODS: Between 2002 and 2006, a total of 14,459 men aged 40 to 79 years who underwent serum PSA determinations at least twice during health examinations at 11 medical centers were enrolled in this study. To reduce probable bias, we excluded men with pyuria, those with a baseline or follow-up PSA level of 10.0 ng/ml or more, and those with a history of medication with 5 alpha-reductase inhibitors. Serum PSA underwent logarithmic conversion to work out the normal distribution. The cumulative rate of freedom from increase in PSA above 4.0 ng/ml, 3.0 ng/ml, and 2.5 ng/ml was estimated with the Kaplan-Meier method according to baseline PSA range and age. The significance level was 1%. RESULTS: The rate of increase in PSA was lower in men who had a baseline PSA value in the low range and whose age was in the 40s or 50s. However, the cumulative rate of freedom from increase in PSA decreased as the PSA cutoff value was lowered. The optimal screening interval for men in their 40s and 50s whose baseline serum PSA level was 1.0 ng/ml or lower was 3 years when the significance level for PSA rising above 4.0 ng/ml was 1%. It was 2 years and 1 year, respectively, when the cutoff value was lowered to 3.0 ng/ml or 2.5 ng/ml. An annual PSA screening interval was recommended in men older than their 60s. CONCLUSIONS: The PSA test interval should be individualized according to baseline PSA, age, and PSA cutoff value.
Aged ; Bias (Epidemiology) ; Cholestenone 5 alpha-Reductase ; Follow-Up Studies ; Freedom ; Humans ; Male ; Mass Screening ; Prostate-Specific Antigen ; Pyuria

A 67-year-old male presented with a subarachnoid hemorrhage and was found to have a basilar artery (BA) tip aneurysm, which was incorporated to both posterior cerebral arteries (PCAs). First, he was treated with the single stent, which was deployed from P1 segment of the right PCA to BA, and coil embolization was done. Follow-up angiogram at 18 months revealed coil compaction of the aneurysm. Therefore, we accomplished the Y-configured dual stent assisted coil embolization. Follow-up angiogram at 30 months revealed no recanalization of aneurysm and patent blood flow of both PCAs. In conclusion, staged Y-shaped stents assisted coil embolization is an alternative treatment option in a wide-neck basilar tip aneurysm decreasing the extent of coil compaction of aneurysm and preserving an incorporated vessel.
Aged ; Aneurysm* ; Basilar Artery ; Embolization, Therapeutic* ; Follow-Up Studies ; Humans ; Male ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery ; Stents* ; Subarachnoid Hemorrhage