Background: and Purpose: This study aimed to evaluate the brain magnetic resonance imaging (MRI) of patients with acute transient global amnesia (TGA) using volumetric analysis to verify whether the brains of TGA patients have pre-existing structural abnormalities. Methods: We evaluated the brain MRI data from 87 TGA patients and 20 age- and sexmatched control subjects. We included brain MRIs obtained from TGA patients within 72 hours of symptom onset to verify the pre-existence of structural change. For voxel-based morphometric analyses, statistical parametric mapping was employed to analyze the structural differences between patients with TGA and control subjects. Results: TGA patients exhibited significant volume reductions in the bilateral ventral anterior cingulate cortices (corrected p<0.05). Conclusions TGA patients might have pre-existing structural changes in bilateral ventral anterior cingulate cortices prior to TGA attacks.

Background: and Purpose Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS; 2–5) who achieved mTICI 2b versus those who achieved mTICI 2c/3 after MT. Methods: This study utilized data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combined databases from 32 thrombectomy-capable stroke centers between 2013 and 2023. The study included only patients with low ASPECTS who achieved mTICI 2b, 2c, or 3 after MT for internal carotid artery or middle cerebral artery (M1) stroke. Results: Of the 10,229 patients who underwent MT, 234 met the inclusion criteria. Of those, 98 (41.9%) achieved mTICI 2b, and 136 (58.1%) achieved mTICI 2c/3. There were no significant differences in baseline characteristics between the two groups. The 90-day favorable outcome (modified Rankin Scale score: 0–3) was significantly better in the mTICI 2c/3 group than in the mTICI 2b group (adjusted odds ratio 2.35; 95% confidence interval [CI] 1.18–4.81; P=0.02). Binomial logistic regression revealed that achieving mTICI 2c/3 was significantly associated with higher odds of a favorable 90-day outcome (odds ratio 2.14; 95% CI 1.07–4.41; P=0.04). Conclusion In patients with low ASPECTS, achieving an mTICI 2c/3 score after MT is associated with a more favorable 90-day outcome. These findings suggest that mTICI 2c/3 is a better target for MT than mTICI 2b in patients with low ASPECTS.

Purpose: Muscle relaxation following electrical automatic massage (EAM) has been found to reduce fatigue, depression, stress, anxiety, and pain in individuals with various conditions. However, the effects of EAM have not been extensively explored in patients with Alzheimer’s disease (AD). Materials and Methods: Here, we conducted a randomized controlled study to evaluate the effects of EAM on the cognitive and non-cognitive functions of patients with AD spectrum disorders. Results: We found that EAM attenuated changes in attention-associated cognitive scores and subjective sleep quality relative to those in controls. Conclusion While further studies in a clinical setting are needed to support our findings, these encouraging results suggest that EAM may be an alternative therapy for the management of associated symptoms in AD (ClinicalTrials.gov ID: NCT03507192, 24/04/2018).

Purpose: Muscle relaxation following electrical automatic massage (EAM) has been found to reduce fatigue, depression, stress, anxiety, and pain in individuals with various conditions. However, the effects of EAM have not been extensively explored in patients with Alzheimer’s disease (AD). Materials and Methods: Here, we conducted a randomized controlled study to evaluate the effects of EAM on the cognitive and non-cognitive functions of patients with AD spectrum disorders. Results: We found that EAM attenuated changes in attention-associated cognitive scores and subjective sleep quality relative to those in controls. Conclusion While further studies in a clinical setting are needed to support our findings, these encouraging results suggest that EAM may be an alternative therapy for the management of associated symptoms in AD (ClinicalTrials.gov ID: NCT03507192, 24/04/2018).

Objective: Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists’ attitude toward polypharmacy has been under debate. Methods: We developed an original questionnaire about Psychiatrists’ attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide. Results: The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p<0.001), whereas the culture in India and Nepal were associated with low scores (β=-0.15, p=0.01, and β=-0.17, p=0.006, respectively). Conclusion Policy on polypharmacy may influence psychiatrists’ decision-making. Thus, policies considering rational polypharmacy should be established.

PURPOSE: Alpha-amanitin induces potent oxidative stress and apoptosis, and may play a significant role in the pathogenesis of hepatotoxicity. This study examined the mechanisms of α-amanitin-induced apoptosis in vitro, and whether green tea extract (GTE) offers protection against hepatic damage caused by α-amanitin (AMA) induced apoptosis in vivo. METHODS: The effects of GTE and SIL on the cell viability of cultured murine hepatocytes induced by AMA were evaluated using an MTT assay. Apoptosis was assessed by an analysis of DNA fragmentation and caspase-3. In the in vivo protocol, mice were divided into the following four groups: control group (0.9% saline injection), AMA group (α-amanitin 0.6 mg/kg), AMA+SIL group (α-amanitin and silibinin 50 mg/kg), and AMA+GTE group (α-amanitin and green tea extract 25 mg/kg). After 48 hours of treatment, the hepatic aminotransferase and the extent of hepatonecrosis of each subject was evaluated. RESULTS: In the hepatocytes exposed to AMA and the tested antidotes, the cell viability was significantly lower than the AMA only group. An analysis of DNA fragmentation showed distinctive cleavage of hepatocyte nuclear DNA in the cells exposed to AMA. In addition, the AMA and GTE or SIL groups showed more relief of the cleavage of the nuclear DNA ladder. Similarly, values of caspase-3 in the AMA+GTE and AMA+SIL groups were significantly lower than in the AMA group. The serum AST and ALT levels were significantly higher in the AMA group than in the control and significantly lower in the AMA+GTE group. In addition, AMA+GTE induced a significant decrease in hepatonecrosis compared to the controls when a histologic grading scale was used. CONCLUSION GTE is effective against AMA-induced hepatotoxicity with its apoptosis regulatory properties under in vitro and in vivo conditions.

BACKGROUND AND OBJECTIVES: Negative Pressure Wound Therapy (NPWT) has been used in many surgery to treat complicated wound and impaired wound healing by delivering negative pressure at the wound site through a patented dressing, which helps draw wound edges together, remove infectious materials, and actively promote granulation at the cellular level. Recently application of NPWT has been increased to treat deep neck infection. We aimed to retrieve indications and guidelines to treat deep neck infection from our cases and after reviewing articles. SUBJECTS AND METHOD: From our experience with 9 cases presented as deep neck abscess in which the application of a Vacuum-assisted closure device was used instead of common drainage tubes after surgical evacuation and journal review, indications and guidelines to apply NPWT as one of the tools to treat deep neck infection were retrieved. RESULTS: Indication and Guideline of NPWT. 1) For simple abscess involving single space excepting the mediastinum, intravenous administration of broad-spectrum antibiotics, needle aspiration or simple surgical drainage is recommended. 2) In the case of failure of previous treatments, NPWT will be necessary for immunocompromised hosts such as diabetic patients for whom more than two spaces are involved, the mediastinal involvement, compromised airway or disseminated intravascular coagulation. In severe cases involving the chest, video-assisted thoracoscopic surgery or mediastinoscopy could be used. 3) For patients with improving signs such as decreasing pus, increasing granulation formation, negative culture results from sponge, and normalized C-reactive protein, we can stop NPWT and convert to the regular wound care. CONCLUSION: Indication and Guideline of NPWT could be applied to treat deep neck infection.
Abscess ; Administration, Intravenous ; Anti-Bacterial Agents ; Bandages ; C-Reactive Protein ; Disseminated Intravascular Coagulation ; Drainage ; Humans ; Immunocompromised Host ; Mediastinoscopy ; Mediastinum ; Neck* ; Needles ; Negative-Pressure Wound Therapy* ; Porifera ; Suppuration ; Thoracic Surgery, Video-Assisted ; Thorax ; Wound Healing ; Wounds and Injuries

No abstract available.
Finasteride* ; Risk Factors ; Venous Thrombosis*

OBJECTIVE: This study is to compare the effects of green tea polyphenol (GTP) pre-treatment with those of GTP post-treatment on cisplatin (CP)-induced nephrotoxicity in rat. METHODS: Male Sprague-Dawley rats were randomly divided into six groups. Animals in the control group received 0.9% saline (intraperitoneal); animals in the GTP group received 0.9% saline and GTP (0.2% GTP as their sole source of drinking water); the CP group received only CP (7 mg/kg, intraperitoneal); the CP+preGTP group received GTP from two days before CP to four days after CP and the CP+postGTP group received GTP for four days after CP. CP-induced renal toxicity was evaluated by plasma creatinine and blood urea nitrogen (BUN) concentrations; kidney tissue gamma-glutamyl transpeptidase (GGT) and alkaline phosphatase (AP) activities and histopathological examinations. RESULTS: High serume creatinine and BUN concentrations were observed in CP treated rats. The GGT and AP activites were lower in kidney of CP treated rats compared to control rats. In addition, treatment with CP resulted in development of a marked tubular necrosis, and tubular dilation in kidney of rats. Pretreatment with GTP resulted in markedly reduced elevation of serum creatinine and BUN amounts and changes of GGT and AP activity in kidney induced by CP. CP-induced histopathological changes, including tubular necrosis and dilation, were ameliorated in GTP pre-treated rats, compared to CP alone or GTP post-treated rats. CONCLUSION: These results demonstrate that GTP might have some protective effect against CP-induced nephrotoxicity in rat, and GTP pre-treatment was more effective than GTP post-treatment on reduction of CP-induced renal dysfunction.
Alkaline Phosphatase ; Animals ; Blood Urea Nitrogen ; Cisplatin ; Creatinine ; Drinking ; gamma-Glutamyltransferase ; Guanosine Triphosphate ; Humans ; Kidney ; Male ; Necrosis ; Plasma ; Rats* ; Rats, Sprague-Dawley ; Tea*

PURPOSE: The expressions of Cytokeratin7 (CK7) and CK20 have been studied by a lot of cancer researchers, and these 2 protein markers are often used to find the primary foci of metastatic cancers. There have been numerous studies on vimentin, p53 and Ki-67 as prognostic factors for different cancers. However, it seems that there are a few investigations on the expression of CK7 and CK20 in papillary carcinoma of the thyroid. This study aimed to investigate the expressions of CK7, CK20, vimentin, p53 and Ki-67 in papillary thyroid carcinoma, and we wanted to determine whether the expressions of vimentin, p53, and Ki-67 are related to such prognostic factors as age, the tumor size, nodal metastasis or perithyroidal tissue invasion. METHODS: Paraffin slices of 44 papillary thyroid carcinomas from 44 patients were used for immunohistochemistry with using monoclonal antibody against CK7, CK20, vimentin, p53 and Ki-67. The expressions of CK7, CK20 and vimentin were determined simply by the staining competence, and more than 5% positive cells out of 1,000 cells in a highpowered microscopic view was considered as positive for the p53 and Ki-67 expressions. The expressions of vimentin, p53 and Ki-67 were investigated for their correlation with age, perithyroidal tissue invasion, the size of the tumor and metastasis to the cervical lymph nodes. RESULTS: Total of 44 patients (7 men and 37 women) were examined. The average size of tumor was 1.3 cm, and 28 (63.6%) out of 44 patients had perithyroidal tissue invasion. 29 (65.9%) patients had cervical lymph node metastases. The expression of CK7 was observed in all 44 (100%) patients, but only three (6.8%) among them had the expression of CK20. The expression of vimentin was shown in 43 (97.7%) patients. The expressions of p53 and Ki-67 were seen in 33 (75%) patients and 12 (27.7%) patients, respectively. The expressions of vimentin, p53 and Ki-67 were not significantly related with age (P=1.0, 0.084), perithyroidal tissue invasion (P=1.0, 0.798), the size of the tumor (P=0.234, 0.313) and cervical lymph node metastases (P=0.582, 0.948). CONCLUSION: As expected, papillary thyroid carcinoma showed a CK7(+)/CK20(-) pattern. Further research is needed to find the meaning of the expression of vimentin because it was meaningless analyzing the relationship between the prognostic factors due to fact that 97.7% of the patients had the expression of vimentin. There was no statistically significant relation between the expressions of p53 and Ki-67 and age, the size of thyroid tumor, perithyroidal tissue invasionand cervical lymph node metastasis.
Carcinoma, Papillary ; Humans ; Immunohistochemistry ; Lymph Nodes ; Male ; Mental Competency ; Neoplasm Metastasis ; Paraffin ; Thyroid Gland* ; Thyroid Neoplasms* ; Vimentin*