Post-stroke cognitive impairment on the Mini-Mental State Examination primarily relates to left middle cerebral artery infarcts.

BACKGROUND: Post-stroke cognitive impairment can occur after damage to various brain regions, and cognitive deficits depend on infarct location. The Mini-Mental State Examination (MMSE) is still widely used to assess post-stroke cognition, but it has been criticized for capturing only certain cognitive deficits. Along these lines, it might be hypothesized that cognitive deficits as measured with the MMSE primarily involve certain infarct locations. AIMS: This comprehensive lesion-symptom mapping study aimed to determine which acute infarct locations are associated with post-stroke cognitive impairment on the MMSE. METHODS: We examined associations between impairment on the MMSE (<5th percentile; normative data) and infarct location in 1198 patients (age 67 ± 12 years, 43% female) with acute ischemic stroke using voxel-based lesion-symptom mapping. As a frame of reference, infarct patterns associated with impairments in individual cognitive domains were determined, based on a more detailed neuropsychological assessment. RESULTS: Impairment on the MMSE was present in 420 patients (35%). Large voxel clusters in the left middle cerebral artery territory and thalamus were significantly (p < 0.01) associated with cognitive impairment on the MMSE, with highest odds ratios (>15) in the thalamus and superior temporal gyrus. In comparison, domain-specific impairments were related to various infarct patterns across both hemispheres including the left medial temporal lobe (verbal memory) and right parietal lobe (visuospatial functioning). CONCLUSIONS: Our findings indicate that post-stroke cognitive impairment on the MMSE primarily relates to infarct locations in the left middle cerebral artery territory. The MMSE is apparently less sensitive to cognitive deficits that specifically relate to other locations.

Mechanistic impacts of long-term gamma irradiation on physicochemical, structural, and mechanical stabilities of radiation-responsive geopolymer pastes.

The mechanistic effects of long-term γ irradiation on the mineralogical, microstructural, structural, physical, and chemical properties of 40 wt% blast furnace slag + 60 wt% fly ash geopolymer pastes have been examined. Ambient curing for 28 days during normal equilibration was followed by exposure to 60Co irradiation (1574, 4822, 10,214 kGy). The material characteristics are controlled largely through the competing mechanisms of beneficial equilibration at initial lower dosages, which enhances gelation and crosslinking, and detrimental equilibration at subsequent higher dosages, which causes structural and microstructural destabilisation. Irradiation for 2 months (1574 kGy) increases the compressive strength ~45% (~57 to ~83 MPa) through conversion of less-crosslinked (Q0/Q1/Q1') to more-crosslinked (Q2/Q3/Q4) silicate species. The transition between these regimes occurs after ~5 months of irradiation (~4000 kGy). Beyond this, the rates of beneficial equilibration and detrimental equilibration equalise upon completion of normal geopolymerisation. Additional geopolymerisation from γ irradiation is controlled by the rate-limiting release of Si4+ from the unreacted aluminosilicates and silicates and their rapid incorporation in the geopolymer network. The aqueous leaching of the geopolymer pastes is not affected significantly by γ irradiation. These data reveal the potential for these materials as intermediate-level wasteforms that can outperform Portland cement-based materials.

Tobacco etch virus (TEV) protease with multiple mutations to improve solubility and reduce self-cleavage exhibits enhanced enzymatic activity.

Tobacco etch virus (TEV) protease is a 27-kDa catalytic domain of the polyprotein nuclear inclusion a (NIa) in TEV, which recognizes the specific amino acid sequence ENLYFQG/S and cleaves between Q and G/S. Despite its substrate specificity, its use is limited by its autoinactivation through self-cleavage and poor solubility during purification. It was previously reported that T17S/N68D/I77V mutations improve the solubility and yield of TEV protease and S219 mutations provide protection against self-cleavage. In this study, we isolated TEV proteases with S219N and S219V mutations in the background of T17S, N68D, and I77V without the inclusion body, and measured their enzyme kinetics. The kcat of two isolated S219N and S219V mutants in the background of T17S, N68D, and I77V mutations was highly increased compared to that of the control, and S219N was twofold faster than S219V without Km change. This result indicates that combination of these mutations can further enhance TEV activity.

Contrast-Induced Acute Kidney Injury in Radiologic Management of Acute Ischemic Stroke in the Emergency Setting.

BACKGROUND AND PURPOSE: The use of invasive cerebral angiography with CTA for active treatment of patients with suspected ischemic strokes has been increasing recently. This study aimed to identify the incidence of postcontrast acute kidney injury using baseline renal function when CTA and cerebral angiography were performed sequentially. MATERIALS AND METHODS: This retrospective observational study evaluated adults (18 years of age or older) with ischemic stroke who underwent CTA and cerebral angiography sequentially between 2010 and 2018. The incidence of postcontrast acute kidney injury was determined using the baseline estimated glomerular filtration rate. The value of the baseline estimated glomerular filtration rate at which the occurrence of postcontrast acute kidney injury increased was also determined. RESULTS: Postcontrast acute kidney injury occurred in 57/601 (9.5%) patients. Those with a baseline estimated glomerular filtration rate of <30 mL/min/1.73 m2 showed a higher incidence of acute kidney injury. Age, chronic kidney disease, medication (nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, ß blockers, statins, and insulin) use following contrast media exposure, and serum albumin affected the incidence of postcontrast acute kidney injury. The incidence of postcontrast acute kidney injury increased when the baseline estimated glomerular filtration rate was <43 mL/min/1.73 m2. CONCLUSIONS: Patients with low baseline renal function had the highest incidence of postcontrast acute kidney injury after CTA and cerebral angiography, but no fatal adverse effects were documented. Thus, patients suspected of having a stroke should be actively managed with respect to neurovascular function.

Functional Outcomes of Fragility Fracture Integrated Rehabilitation Management in Sarcopenic Patients after Hip Fracture Surgery and Predictors of Independent Ambulation.

OBJECTIVES: To compare the changes in the functional level of patients with versus without sarcopenia who received by fragility fracture integrated rehabilitation management (FIRM) after hip fracture (HF) surgery over a 6-month follow-up period and to identify variables influencing independent ambulation (IA) at 6 months after HF. DESIGN: Prospective observational study. SETTING: Three in-hospital rehabilitation setting. PARTICIPANTS: Patients older than 65 years of age (N=80) categorized by the presence of sarcopenia. INTERVENTION: The FIRM program during the-2 week hospital stay after surgery. MEASUREMENTS: Main outcomes for ambulatory function (Koval score, Functional Ambulatory Category) and other secondary outcomes were measured at rehabilitation admission, at discharge, at 3 months and 6 months after surgery. Other secondary outcomes were measured. The possibility of IA at 6 months after surgery were also investigated. RESULTS: Sarcopenia and non-sarcopenia patients did not differ significantly in terms of changes in ambulation or other functions over a 6-month follow-up (p < 0.001 or p = 0.001). The two groups did not differ significantly in terms of final functional status (6 months). The IA ratios of the two groups did not significantly differ at 6 months after surgery (sarcopenia [54.3%] and non-sarcopenia [64.5%]). IA before fracture (p = 0.039) and age (≥80 years) (p = 0.03) were independent predictors and sarcopenia was not a predictor for the possibility of IA at 6-months after surgery. CONCLUSIONS: The FIRM program was effective for promoting functional recovery in older patients with fragility HF, either with or without sarcopenia. The present findings provide evidence of the pressing need for integrated rehabilitation management in fragility fracture care to improve functional recovery in patients with sarcopenia.

A multicenter, randomized, open-label comparative study of prabotulinumtoxinA with two different dosages and diverse proportional injection styles for the reduction of gastrocnemius muscle hypertrophy in Asian women.

A botulinum toxin (BTX) injection can be a simple and safe alternative to calf reduction surgery or liposuction without interrupting daily life. However, its optimum dosage and clinical response are not yet well known. A total of 40 patients with bilateral gastrocnemius muscle hypertrophy were enrolled in this study. All volunteers were randomly categorized into four groups and then administered different amounts of BTX (160 U and 200 U) on the medial and lateral aspects of their calves. All subjects showed clinical improvement with a reduction in the gastrocnemius muscle size after BTX injection. However, our results showed that the decrease in leg circumference was not dose dependent. No side effects of the injections, such as weakness of the legs, deformity, or abnormal sensation, were observed. There were also no cases of swelling, edema, hematoma, or infection. BTX at both dosages can be safely and effectively applied for calf muscle contouring without disturbing gait during walking or running.

Perirenal fat stranding on CT: is there an association with bladder outlet obstruction?

OBJECTIVE: To determine the association between perirenal fat stranding (PFS) on CT and bladder outlet obstruction (BOO). METHODS: CT scans from 122 patients who had undergone urodynamic study for lower urinary tract symptoms (LUTS) were registered after exclusion of patients with renal or retroperitoneal disease. Images were independently reviewed by two radiologists and compared with those of 244 age- and sex-matched control patients without LUTS. The PFS severity was scored on a four-point scale, and the interobserver agreement was assessed with kappa statistics. The severity score and incidence was compared between the groups, and the association with baseline characteristics was analyzed. For the LUTS group, an association between PFS severity and urodynamic and laboratory data was evaluated. RESULTS: PFS was more frequent and more severe in the LUTS group than in the control group (p-value < 0.001); its presence was significantly associated with male gender and older age (p-value < 0.001). PFS was predominantly bilateral in both groups (80.1-93.2%). In the LUTS group, PFS severity scores were significantly correlated with the maximum flow rate, maximum detrusor pressure and estimated glomerular filtration rate (p-value < 0.001). Interobserver agreements were excellent for PFS presence (κ = 0.883) and severity (κ = 0.816). CONCLUSION: Severe PFS was observed in older, male patients with LUTS. PFS severity was associated with the degree of BOO and impaired renal function. ADVANCES IN KNOWLEDGE: Recognition of PFS on the CT scan may warrant further evaluation of BOO and appropriate management to prevent renal impairment.

Efficacy of light-emitting diode photomodulation in reducing erythema after fractional carbon dioxide laser resurfacing: a pilot study.

BACKGROUND: The most common side effects of fractional carbon dioxide (CO2 ) laser resurfacing are erythema and edema of the treated skin. Light-emitting diode (LED) devices have been shown to stimulate fibroblast activity and hasten wound healing. The current study was designed to evaluate the efficacy of such LED devices in treating post-laser therapy erythema. OBJECTIVES: To evaluate the clinical efficacy of LED photomodulation in reducing erythema resulting from ablative fractional CO2 laser resurfacing. MATERIALS AND METHODS: Randomly selected facial halves of 10 Korean subjects (Fitzpatrick skin type III-IV) were treated using a 635-nm wavelength LED array immediately after full-face fractional laser skin resurfacing. Each participant was subsequently treated with LED daily for the following 7 days. Clinical photographs, subjective physician assessment, and chromometer erythema index were used to track the results, with clinical improvement assessed using a 5-point grading scale. RESULTS: The postlaser erythema resolved faster on the experimental side than the control side, with improvements noted according to physician assessment and chromometer erythema index. Statistically significant improvements between the two sides were first noted on day 4. CONCLUSION: Treatment using a 635-nm-wavelength LED array decreases the intensity and duration of post-fractional CO2 laser treatment erythema.

Efficacy and safety of a novel botulinum toxin type A product for the treatment of moderate to severe glabellar lines: a randomized, double-blind, active-controlled multicenter study.

BACKGROUND: A new botulinum toxin type A (NBoNT) produced from the same strain of Clostridium botulinum as onabotulinumtoxinA (OBoNT) is widely used in Asia. OBJECTIVES: To compare the efficacy and safety of NBoNT and OBoNT for moderate to severe glabellar wrinkles. METHODS: A double-blind, randomized, active-controlled, phase III study was performed. Three hundred fourteen patients were randomized at a 1:1 ratio to receive 20 U of toxin. The primary end point was the responder rate according to investigator live assessment at maximum frown at week 4. Secondary end points were responder rates according to investigator live assessment with frowning and at rest at weeks 8, 12, and 16, with additional photographic assessment by a panel of blinded raters 4 weeks after injection. Subjective satisfaction scores were also evaluated. RESULTS: Four weeks after treatment, responder rates for maximum frown were 93.7% (133/142) in the NBoNT group and 94.5% (138/146) in the OBoNT group. For secondary end points, there was no significant difference between the two groups for any variable at any time point. Noninferiority of NBoNT was confirmed. There were no serious adverse effects with either toxin. CONCLUSION: NBoNT is equally as effective as OBoNT for the treatment of glabellar frown lines. Both toxins were well tolerated.

Facial skin barrier function recovery after microneedle transdermal delivery treatment.

BACKGROUND: Microneedle treatment is currently used in the cosmetic industry for several skin conditions. Despite their extensive use, there is lack of sufficient data on the safety of microneedles. OBJECTIVE: To investigate the degree of acute skin damage and the time required for facial skin barrier function to recover using different microneedle lengths and numbers of applications. MATERIALS AND METHODS: Each side of a volunteer's face was randomly treated with one of the following treatments: five applications of 0.15-mm microneedles, five applications of 0.25-mm microneedles, 10 applications of 0.15-mm microneedles, or 10 applications of 0.25-mm microneedles. Transepidermal water loss, stratum corneum hydration, and skin erythema were measured at baseline, immediately after treatment, 4 hours after treatment, and 8 hours after treatment and at 24-hour intervals for 3 days. RESULTS: Prompt recovery of barrier function (within 72 hours) was observed after microneedle treatment. CONCLUSION: Microneedle treatment is simple and inexpensive, and the skin barrier disruption it causes resolves quickly. Therefore, it can serve as an effective physical method of enhancing transdermal delivery of medications for the treatment of many cosmetic and dermatological conditions.

Selective sebaceous gland electrothermolysis as a treatment for acne: a prospective pilot study.

Although many therapeutic options exist for acne, relapse often occurs after treatment is stopped. Some preliminary evidence suggests that selective electrothermolysis of the sebaceous glands may represent a novel therapeutic intervention. This trial was conducted to evaluate the efficacy and tolerability of selective sebaceous gland electrothermolysis for the treatment of facial acne. Twelve patients with facial acne were enrolled, all of whom underwent three sessions of therapy. During each session, a 1.5-mm long needle with 0.45-mm of base insulation was inserted into pores of acne lesions. Upon insertion, a high-frequency electrical current was applied for 0.25-0.50 seconds, for a total output of 40 W. Each treatment session took approximately 30-60 minutes. Subject response to therapy was evaluated at one month and 12 months after the final treatment. All the enrolled subjects completed the study and all reported satisfaction with treatment results. In all cases, a reduction in inflammatory and noninflammatory lesion counts was observed after three sessions of selective electrothermolysis, although a few small papules and comedones persisted in several areas of untreated facial skin. Mean lesion reduction at one month after the final treatment was 98.14% for inflammatory lesions and 83.09% for noninflammatory lesions. Clinical success was achieved in the majority of patients (seven of 12 patients) at one month after the second treatment and in all patients at one month after the final treatment. All patients reported transient post-treatment erythema, which faded after a few days. Clinically evident relapse occurred in two of 12 patients (16.7%) one year after the final treatment session. Selective sebaceous gland electrothermolysis can be a safe and effective method of achieving consistent remission in acne.

Comparison between swallowing-related and limb muscle involvement in dermatomyositis patients.

OBJECTIVE: To determine the relationship between the movement of the hyolaryngeal complex and the motor power of limb muscles and the differences in the hyolaryngeal movement according to the creatine kinase (CK) levels in dermatomyositis patients. METHOD: We retrospectively selected 13 patients who had undergone a videofluoroscopic swallowing study (VFSS) for swallowing difficulty from patients diagnosed with dermatomyositis. The maximal anterior and superior displacements of the hyoid and larynx and the cricopharyngeal opening were acquired by frame-by-frame analysis using the VFSS. We investigated the motor power of the bilateral shoulder abductor, elbow flexor, hip flexor, and knee extensor muscles to determine the limb muscle involvement and used the American Speech-Language-Hearing Association (ASHA) National Outcomes Measurement System (NOMS) swallowing level (ASHA level) to assess dysphagia severity. Spearman's correlation test was used to identify the relationship between the kinematic data of the laryngeal structures, ASHA levels, and the total motor scores in dermatomyositis patients. RESULTS: There was no significant correlation between the kinematic data of the laryngeal structures, ASHA levels, and total motor scores. Only the anterior movements of the hyoid and larynx had a significant relationship to the upper oesophageal sphincter opening. CONCLUSION: Dysphagia evaluation should be considered separately in dermatomyositis patients irrespective of limb involvement or dysphagia severity because the swallowing-related muscle involvement had no relationship to the limb muscle involvement or the severity of dysphagia in dermatomyositis. It is hoped that our results can be used to evaluate the therapeutic effects of dysphagia management in dermatomyositis patients.

Expression of metastasis-associated molecules in non-small cell lung cancer and their prognostic significance.

Molecules associated with tumor invasion and metastasis have been actively investigated, but their prognostic significance has been variously reported by investigators. We evaluated the expression of matrix metalloproteinase (MMP)-1, MMP-2, MMP-3, MMP-9, MMP-10, tissue inhibitor of MMPs (TIMP)-1, TIMP-2, ß-catenin, E-cadherin and cyclooxygenase-2 (COX-2) in 43 cases of non-small cell lung cancer (NSCLC). Immunohistochemistry of each marker was performed on tissue microarray paraffin blocks, and the results were determined by a semi-quantitative method using an intensity score (0-3) and percentage score (0-3). The expression scores of each marker were correlated with TNM stage and patient survival data. The expression of MMP-3 and COX-2 was significantly increased in higher stage tumors (P<0.001 and P=0.046, respectively), while a correlation with patient survival length was observed for MMP-1 and COX-2 (P=0.034 and 0.019, respectively). All stage I or II cases with increased MMP-1 expression succumbed to NSCLC within 34.1 months. Cases with low expression of both MMP-1 and COX-2 had a significantly longer survival time than cases with high expression of either of the two markers (P=0.002). These results suggest that MMP-1 and COX-2 are plausible candidate survival markers for NSCLC.