Speckle noise reduction for ultrasound images by using speckle reducing anisotropic diffusion and Bayes threshold.

Ultrasound imaging has been used for diagnosing lesions in the human body. In the process of acquiring ultrasound images, speckle noise may occur, affecting image quality and auto-lesion classification. Despite the efforts to resolve this, conventional algorithms exhibit poor speckle noise removal and edge preservation performance. Accordingly, in this study, a novel algorithm is proposed based on speckle reducing anisotropic diffusion (SRAD) and a Bayes threshold in the wavelet domain. In this algorithm, SRAD is employed as a preprocessing filter, and the Bayes threshold is used to remove the residual noise in the resulting image. Compared to the conventional filtering techniques, experimental results showed that the proposed algorithm exhibited superior performance in terms of peak signal-to-noise ratio (average = 28.61 dB) and structural similarity (average = 0.778).

Diagnostic value of magnetic resonance cholangiopancreatography to detect bile duct stones in acute biliary pancreatitis.

OBJECTIVES: This study aims to evaluate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in detecting common bile duct (CBD) stones in acute biliary pancreatitis (ABP). METHODS: The medical records of patients presenting with ABP from January 2008 to July 2013 were reviewed to assess the value of MRCP in detecting CBD stones in ABP. Endoscopic retrograde cholangiopancreatography (ERCP) was used as the reference standard to assess the diagnostic yield of MRCP in detecting choledocholithiasis. When ERCP was unavailable, intraoperative cholangiography or clinical follow-up was used as the reference standard. RESULTS: Seventy-eight patients who underwent MRCP were diagnosed with ABP, and thirty of the 78 patients (38%) were confirmed to have CBD stones per the study protocol. The sensitivity of MRCP in detecting CBD stones in ABP was 93.3% compared to 66.7% for abdominal CT (P < 0.008). The overall accuracy of MRCP in detecting choledocholithiasis was 85.9% compared to 74.0% for abdominal CT (P < 0.041). The area under the receiver operating characteristic curve (AUC) of MRCP in detecting CBD stones was 0.882, which was more accurate than the AUC of 0.727 for abdominal CT (P = 0.039). In 38 patients who underwent ERCP, the sensitivity and negative predictive value of MRCP in detecting CBD stones were both 100% regardless of the dilatation of the bile duct (≥7 mm versus < 7 mm). CONCLUSION: MRCP is an effective, noninvasive modality to detect CBD stones in ABP and can help identify patients who require ERCP.

Effects of dynamic neural mobilization on cerebral cortical activity in patients with stroke.

[Purpose] The current study aimed to identify the effects of dynamic neural mobilization on cerebral cortical activity in patients with stroke, and to present efficient intervention methods for stroke management. [Subjects and Methods] A total of 20 hemiplegic patients diagnosed with stroke over the past 6 months were sampled, and randomly divided into groups I (n=10) and II (n=10). Groups I and II underwent neural mobilization and dynamic neural mobilization, respectively, on the paralyzed arm. Both interventions were administered for 30 min, once a day, for 4 days a week, over a course of 4 weeks. ß-waves and µ-rhythms in the C3 and C4 areas of the cerebral cortex were measured using electroencephalography, both before and after the intervention. [Results] After the intervention, both groups showed significant changes in the ß-waves and µ-rhythms in the C3 area alone. Further, significant inter-group differences in the ß-waves and µ-rhythms were only present in the C3 area. [Conclusion] Dynamic neural mobilization is an efficient intervention because it increases ß-waves and µ-rhythms in the cerebral cortex. Therefore, the effects of continuous intervention programs involving dynamic neural mobilization in patients with stroke should be investigated in the future.

Effect of scapular stabilization exercise on neck alignment and muscle activity in patients with forward head posture.

[Purpose] The purpose of this study was to investigate the effects of scapula movement on neck alignment and the muscles in patients with forward head posture, who has the structural changes around the neck caused from the forward head posture, when scapular stabilization exercise is applied. [Subjects and Methods] A sample of 30 patients with forward head posture were recruited and participated in an intervention for 30 minutes a day, three times per week for 4 weeks. Fifteen patients were assigned to the scapular stabilization exercise group and the remaining 15 were assigned to the neck stabilization exercise group. Before the intervention, the craniovertebral angle (CVA), cranial rotation angle (CRA), and muscle activity of the muscles around the neck were measured. Four weeks later, these 3 factors were re-measured and analyzed. [Results] Within-group changes in CVA and CRA were observed in both groups and were statistically significant. Only the CVA group had a statistically significant between-group differences. Within-group changes in muscular activity were significant differences in all groups. Between groups, the lower back trapezius and serratus anterior showed statistically significant differences. [Conclusion] Scapular stabilization brought about improvement in posture through activation of the neck muscles, the lower trapezius, and the serratus anterior. Therefore, the intervention has a positive effect on neck alignment by reducing the compensatory movements of the muscles involved in forward head posture. Structural changes are observed.

Effects on muscle activities according to the type of bodyblade exercise in quadruped position.

[Purpose] Most studies on bodyblade exercise have examined changes in muscle activities in the trunk and shoulders according to the hand position or direction while in a standing position. The present study compared and examined the changes in muscle activities around the shoulders and trunk according to different bodyblade lifting methods during stabilization exercise in a quadruped position. [Subjects and Methods] The present study was conducted on 20 healthy males. The following exercise four types were performed with the bodyblade held by flexing the dominant arm at 180° in a quadruped position. The muscle activity and the ratio of muscle activity were measured. [Results] The SA and IO, EO muscles showed significant differences. Moreover, the SA/UT activity ratio showed significant differences according to the type of exercise. The Tukey's post hoc test results were as follows: for the SA muscle, exercise types 4, 2 were more effective than types 1, 3: and for the IO muscle, types 1, 2 were more effective than types 3, 4. [Conclusion] The present study showed that type 2 scapular stabilization exercise (crossed leg lifting with the hand raised above the head on a vertical plane) showed selective and positive effects on trunk muscle strengthening and stabilization. In future, additional studies are required to design effective exercise programs for pain management and improvement of muscle activities in patients with complaints of shoulder pain due to scapular winging.

Effect of lumbar stabilization exercise on disc herniation index, sacral angle, and functional improvement in patients with lumbar disc herniation.

[Purpose] This study aimed to examine the effects of pelvic movements on the back function of patients with lumbar disc herniation when lumbar stabilization exercise was applied to the patients, suggest an intervention method that can be used in future clinical therapies. [Subjects and Methods] Thirty patients with lumbar disc herniation underwent the intervention 30 minutes per day, three times per week for 4 weeks. Of them, 15 patients were assigned to the balance center stabilization resistance exercise group (experimental group I) and the other 15 were assigned to the three-dimensional stabilization exercise group (experimental group II). Before the intervention, disc herniation index was measured using magnetic resonance imaging, sacral angle was measured using X-ray, and back function was measured using the KODI. Four weeks later, these three factors were re-measured and analyzed. [Results] There was a significant pre- versus post-intervention difference in disc herniation index, sacral angle, and KODI in experimental group I and a significant difference in disc herniation index and KODI in experimental group II, and each group of disc herniation index and sacral angle had a significant difference. In experimental group I, each disc herniation index and sacral angle had a negative correlation. [Conclusion] The lumbar stabilization exercise, which controls balance using pelvic movements, improves mobility and stability of the sacroiliac joint; therefore, it increases pelvic and back movements. These kinds of movements not only improved proprioception sense, they also had positive effects on lumbar disc function recovery.

Analysis of Aggregation Delay for Multisource Sensor Data with On-Off Traffic Pattern in Wireless Body Area Networks.

Data aggregation plays an important role to improve the transmission efficiency in wireless body area networks (WBANs); however, it inherently induces additional aggregation delay. Therefore, the effect of packet aggregation on WBAN applications, which are vulnerable to delay, must be analyzed rigorously. In this paper, we analyze the packet aggregation delay for multisource sensor data with an on-off traffic pattern in WBANs. Considering two operational parameters of the aggregation threshold and aggregation timer, we calculate the probability that a packet aggregation occurs during a unit time and then derive the average aggregation delay in closed-form. The analysis results show that the aggregation delay increases as the aggregation timer or aggregation threshold increases, but is bounded below a certain level according to the number of active sensors and their on-off traffic attribute. This implies that the data aggregation technique can maximize the transmission efficiency while satisfying a given delay requirement in the WBAN system.

On the degrees of freedom of interference alignment for multicell MIMO interfering broadcast channels.

The interference alignment (IA) is a promising technique to efficiently mitigate interference and to enhance capacity of a wireless network. This paper proposes an interference alignment scheme for a cellular network with L cells and K users under a multiple-input multiple-output (MIMO) Gaussian interfering broadcast channel (IFBC) scenario. The proposed IA scheme aligns intercell interferences (ICI) into a small dimensional subspace through a cooperative receive beamforming and cancels both the ICI and interuser interferences (IUI) simultaneously through a transmit beamforming. We characterize the feasibility condition for the proposed IA to achieve a total number of degrees of freedom (DoF) of LK in terms of the numbers of transmit antennas and receive antennas. Then we derive the maximum number of DoF achieved by the proposed IA by finding an optimal dimension of ICI alignment subspace for a given antenna configuration. The numerical results show that the proposed IA scheme has a better DoF performance than the conventional schemes.

Safety and efficacy of tailored antiplatelet therapy using prasugrel or ticagrelor based on clopidogrel responsiveness in endovascular treatment for intracranial aneurysms: a meta-analysis.

BACKGROUND: Clopidogrel (CPG)-based dual antiplatelet therapy (DAPT) in combination with aspirin has been widely used before endovascular procedures for intracranial aneurysms to prevent procedural thromboembolic complication (TEC). However, the main drawback of CPG is the high proportion of hyporesponders. This study sought to investigate the usefulness of tailored DAPT using novel P2Y12 inhibitors (prasugrel or ticagrelor, (PSG/TCG)) guided by a platelet reactivity test (PRT), compared with CPG-based conventional DAPT. METHOD: Data were extracted from PubMed, Embase, and Cochrane Central Register of Controlled Trials by two independent reviewers. A random effects model was used to investigate the procedural TEC and hemorrhagic complications (HEC) of the tailored DAPT and conventional therapy by risk ratios (RR) and 95% confidence intervals (95% CI). Additionally, we performed subgroup analyses to directly compare prasugrel/ticagrelor with CPG. RESULTS: Six studies comprising 2557 patients were included in the analysis. Compared with conventional non-tailored therapy, PRT-guided tailored DAPT with PSG/TCG was associated with a lower risk of TEC (RR 0.40, 95% CI 0.22 to 0.74, P=0.004) without increasing HEC rates. The subgroup analysis showed that the switch to PSG/TCG in CPG hyporesponders was related to a lower incidence of TEC (RR 0.46, 95% CI 0.23 to 0.95, P=0.03) without a difference in HEC, compared with maintenance of CPG in CPG responders. CONCLUSION: Evidence from this analysis supports PRT-guided tailored DAPT (using PSG/TCG) as a better choice for preparation towards endovascular procedures to treat aneurysms. Furthermore, it suggests that PSG/TCG is not limited to the role of a substitute for CPG but may be a first-line agent for DAPT.

Novel pyrimidines as acid pump antagonists (APAs).

A series of pyrimidine derivatives as acid pump antagonists (APAs) was synthesized and the inhibitory activities against H(+)/K(+) ATPase isolated from hog gastric mucosa were determined. After elaborating on substituents at C2 and C4 position of the pyrimidine scaffold, we have observed that the compound 7h is a potent APA with H(+)/K(+) ATPase, IC(50) = 52 nM.

Spatial epidemic dynamics of the COVID-19 outbreak in China.

BACKGROUND: On 31 December 2019 an outbreak of COVID-19 in Wuhan, China, was reported. The outbreak spread rapidly to other Chinese cities and multiple countries. This study described the spatio-temporal pattern and measured the spatial association of the early stages of the COVID-19 epidemic in mainland China from 16 January-06 February 2020. METHODS: This study explored the spatial epidemic dynamics of COVID-19 in mainland China. Moran's I spatial statistic with various definitions of neighbours was used to conduct a test to determine whether a spatial association of the COVID-19 infections existed. RESULTS: The spatial spread of the COVID-19 pandemic in China was observed. The results showed that most of the models, except medical-care-based connection models, indicated a significant spatial association of COVID-19 infections from around 22 January 2020. CONCLUSIONS: Spatial analysis is of great help in understanding the spread of infectious diseases, and spatial association was the key to the spatial spread during the early stages of the COVID-19 pandemic in mainland China.

Space-Time Relationship between Short-Term Exposure to Fine and Coarse Particles and Mortality in a Nationwide Analysis of Korea: A Bayesian Hierarchical Spatio-Temporal Model.

Previous studies have shown an association between mortality and ambient air pollution in South Korea. However, these studies may have been subject to bias, as they lacked adjustment for spatio-temporal structures. This paper addresses this research gap by examining the association between air pollution and cause-specific mortality in South Korea between 2012 and 2015 using a two-stage Bayesian spatio-temporal model. We used 2012-2014 mortality and air pollution data for parameter estimation (i.e., model fitting) and 2015 data for model validation. Our results suggest that the relative risks of total, cardiovascular, and respiratory mortality were 1.028, 1.047, and 1.045, respectively, with every 10-µg/m3 increase in monthly PM2.5 (fine particulate matter) exposure. These findings warrant protection of populations who experience elevated ambient air pollution exposure to mitigate mortality burden in South Korea.

Efficacy of Endobiliary Radiofrequency Ablation using a Novel Endoluminal Radiofrequency Ablation Catheter in a Swine Model.

Purpose: Endobiliary radiofrequency ablation (RFA) is a new endoscopic ablative technique. However, the ideal power setting for RFA has not yet been clarified. Therefore, we intended to evaluate the effects of endobiliary RFA according to time variations using novel RFA. Materials and methods: Nine female pigs were divided into three groups according to ablation time (60, 90, and 120 seconds) with the same setting (10 watts, 80 °C). All pigs underwent endoscopic retrograde cholangiography (ERC) and endobiliary RFA in the common bile duct. Gross and histologic examinations were performed after 24 hours. Results: The ERC and application of the endobiliary RFA were 100% successful, and the post-RFA cholangiogram did not show contrast leakage. The median depth of microscopic ablation was significantly different among the three groups (60 vs. 90 vs. 120 seconds = 1.90 (1.17-2.23) vs. 2.44 (2.31-2.60) vs. 2.52 (2.47-2.64) mm, p = 0.018). There was also a linear relationship between ablation time and microscopic ablation depth (r2 = 0.552, p = 0.002). However, no significant differences in macroscopic or microscopic ablation length were observed. In addition, there were focal ablation injuries in adjacent liver tissue in five of the nine pigs (2/3 in 60, 1/3 in 90, and 2/3 in 120 seconds). Conclusion: Endobiliary RFA using a novel RFA catheter resulted in controlled ablation with a linear relationship between microscopic ablation depth and ablation time in a swine model. Clinical studies are needed to validate the safe energy condition of endobiliary RFA in malignant biliary obstruction.

PAR-5359, a well-balanced PPARalpha/gamma dual agonist, exhibits equivalent antidiabetic and hypolipidemic activities in vitro and in vivo.

Peroxisome proliferator-activated receptor (PPAR) alpha and gamma are key regulators of lipid homeostasis and insulin resistance. In this study, we characterize the pharmacological profiles of PAR-5359, a dual agonist of PPARalpha and gamma with well-balanced activities. In transient transactivation assay, PAR-5359 (3-(4-(2[4-(4chloro-phenyl)-3,6-dihydro-2H-pyridin-1-yl]-ethoxy)-phenyl)-(2S)-ethoxy-propionic acid) significantly activated human and mouse PPARalpha and gamma without activating PPARdelta. In functional assays using human mesenchymal stem cells and human hepatoma HepG2 cells, PAR-5359 significantly induced adipocyte differentiation and human ApoA1 secretion, which coincided with its transactivation potencies against the corresponding human receptor subtypes. Interestingly, PAR-5359 showed equivalent potencies against the mouse receptor subtypes (alpha and gamma; 2.84 microM and 3.02 microM, respectively), which suggests the possibility that PAR-5359 could simultaneously activates each subtype of receptors subtype in under physiological conditions. In an insulin-resistant ob/ob mouse model, PAR-5359 significantly reduced plasma insulin levels, improved insulin sensitivity (HOMA-IR), and completely normalized plasma glucose levels. In a severe diabetic db/db mouse model, PAR-5359 dose-dependently reduced the plasma levels of glucose (ED(30) = 0.07 mg/kg). Furthermore, it lowered plasma levels of non HDL- (ED(30) = 0.13 mg/kg) and total cholesterol (ED(30) = 0.03 mg/kg) in high cholesterol diet-fed rats for 4 days treatment. These results suggest that PAR-5359 has the balanced activities for PPARalpha and PPARgamma in vivo as well as in vitro. And its balanced activities may render PAR-5359 as a pharmacological tool in elucidating the complex roles of PPARalpha/gamma dual agonists.

Anti-inflammatory effects of 8-hydroxy-2'-deoxyguanosine on lipopolysaccharide-induced inflammation via Rac suppression in Balb/c mice.

Recently, we observed that 8-hydroxyguanosine triphosphate and 8-hydroxy-2'-deoxyguanosine (oh(8)dG) inactivate Rac and consequently down-regulate the Rac-linked NADPH oxidase, iNOS, and Cox2. Based on these observations, we tested whether oh(8)dG has anti-inflammatory activity in vivo in lipopolysaccharide (LPS)-treated mice. LPS (1 mg/kg, ip)-treated mice exhibit marked inflammatory responses, including increases in proinflammatory cytokines (TNF-alpha, IL-6, IL-18, and IL-12p70) in serum and infiltration of neutrophils, increased translocation of NF-kappaB p50 from the cytosol to the nucleus, and phosphorylation of c-Jun in lung tissues. Mice were pretreated with oh(8)dG (up to 60 mg/kg, ip) 4 h before LPS injection, and this pretreatment dose-dependently inhibited the inflammatory responses; the inhibitions observed with 60 mg/kg oh(8)dG were statistically significant. At the same time, oh(8)dG pretreatment inactivated Rac in lung tissues. Oh(8)dG pretreatment (50 mg/kg, ip) also significantly protected against LPS-induced septic death. Furthermore, oh(8)dG was more effective than acetyl salicylic acid in inhibiting these inflammatory responses. 8-Hydroxyguanosine also had some effect but was much weaker than oh(8)dG. The effects of normal nucleosides (dG, G, and A) were negligible or not significant. These results support an anti-inflammatory activity for oh(8)dG, which could be ascribed to its Rac-inactivating action.

Mechanical Thrombectomy with Solitaire Stent Retrieval for Acute Cardioembolic Stroke.

OBJECTIVE: Few studies have reported the outcome of mechanical thrombectomy with Solitaire stent retrival (MTSR) in subtypes of acute ischemic stroke. The purpose of this study was to evaluate the efficacy and result of MTSR in acute cardioembolic stroke. METHODS: Twenty consecutive patients with acute cardioembolic stroke were treated by MTSR. The angiographic outcome was assessed by thrombolysis in cerebral infarction (TICI) grade. TICI grade 2a, 2b, or 3 with a measurable thrombus that was retrieved was considered as a success when MTSR was performed in the site of primary vessel occlusion, and TICI grade 2b or 3 was considered as a success when final result was reported. Clinical and radiological results were compared between two groups divided on the basis of final results of MTSR. Persistent thrombus compression sign on angiogram was defined as a stenotic, tapered arterial lumen whenever temporary stenting was performed. The clinical outcomes were assessed by the modified Rankin Scale (mRS) at 3 months. RESULTS: The failure rate of MTSR was 20% (4/20) and other modalities, such as permanent stenting, were needed. Final successful recanalization (TICI grade 2b or 3) was 80% when other treatments were included. The rate of good outcome (mRS≤2) was 35% at the 3-month follow-up. Failure of MTSR was significantly correlated with persistent thrombus compression sign (p=0.001). CONCLUSION: Some cases of cardioembolic stroke are resistant to MTSR and may need other treatment modalities. Careful interpretation of angiogram may be helpful to the decision.

Wettability and spontaneous penetration of a water drop into hydrophobic pores.

The penetration of a water drop into hydrophobic pores reflects its instability on a porous surface. To understand the mechanism of penetration and to predict the behavior of such a drop, an investigation was conducted through experimental study combined theoretical analysis. Water drops with volumes from 0.5 to 15µL were examined on Polydimethylsiloxane (PDMS) substrates containing pores of 800µm and less in diameter. Results showed a critical condition at which a drop starts to penetrate into a certain sized pore. The critical condition presents a parabolic relationship between the volume of a water drop and the size of a hydrophobic pore. This behavior was due to a net force resulting from Laplace pressure, and capillary pressure. This force was found to be affected by the porosity, wetting angle, and there after the critical condition. The finding of this research will be beneficial for future design of structured surfaces.

The Effect of Preoperative Antiplatelet Therapy on Hemorrhagic Complications after Decompressive Craniectomy in Patients with Traumatic Brain Injury.

OBJECTIVE: Traditionally, it is generally recommended that antiplatelet agent should be discontinued before surgery. However, decompressive craniectomy (DC) in patients with traumatic brain injury (TBI) is performed emergently in most cases. Therefore, DC cannot be delayed to the time when the effect of antiplatelet agent on bleeding tendency dissipates. In this study, we evaluated the effect of preinjury antiplatelet therapy on hemorrhagic complications after emergent DC in patients with TBI. METHODS: We retrospectively investigated patients with TBI who underwent emergent DC between 2006 and 2015. The patients were separated into two groups according to the use of preinjury antiplatelet agent: group 1 (patients taking antiplatelet agent) and group 2 (patients not taking antiplatelet agent). The rate of hemorrhagic complications (postoperative epidural or subdural hemorrhage, newly developed, or progression of preexisting contusion or intracerebral hemorrhage within the field of DC) and the rate of reoperation within 7 days after DC were compared between two groups. RESULTS: During the study period, DC was performed in 90 patients. Of them, 19 patients were taking antiplatelet agent before TBI. The rate of hemorrhagic complications was 52.6% (10/19) in group 1 and 46.5% (33/71) in group 2 (p=0.633). The rate of reoperation was 36.8% (7/19) in group 1 and 36.6% (26/71) in group 2 (p=0.986). No statistical difference was found between two groups. CONCLUSION: Preinjury antiplatelet therapy did not influence the rate of hemorrhagic complications and reoperation after DC. Emergent DC in patients with TBI should not be delayed because of preinjury antiplatelet therapy.

The cell cycle regulator 14-3-3σ opposes and reverses cancer metabolic reprogramming.

Extensive reprogramming of cellular energy metabolism is a hallmark of cancer. Despite its importance, the molecular mechanism controlling this tumour metabolic shift remains not fully understood. Here we show that 14-3-3σ regulates cancer metabolic reprogramming and protects cells from tumorigenic transformation. 14-3-3σ opposes tumour-promoting metabolic programmes by enhancing c-Myc poly-ubiquitination and subsequent degradation. 14-3-3σ demonstrates the suppressive impact on cancer glycolysis, glutaminolysis, mitochondrial biogenesis and other major metabolic processes of tumours. Importantly, 14-3-3σ expression levels predict overall and recurrence-free survival rates, tumour glucose uptake and metabolic gene expression in breast cancer patients. Thus, these results highlight that 14-3-3σ is an important regulator of tumour metabolism, and loss of 14-3-3σ expression is critical for cancer metabolic reprogramming. We anticipate that pharmacologically elevating the function of 14-3-3σ in tumours could be a promising direction for targeted anticancer metabolism therapy development in future.

Postoperative epidural hematoma covering the galeal flap in pediatric patients with moyamoya disease: clinical manifestation, risk factors, and outcomes.

OBJECT: Postoperative epidural hematoma (EDH), a blood collection between the inserted galeal flap and the overlying skull flap (epigaleal flap hematoma), is a frustrating complication of the surgical treatment of moyamoya disease (MMD) in pediatric patients. The symptoms of postoperative EDH are often similar to those of postoperative cerebral ischemia, and may cause confusion during clinical decision making. The authors designed this study to evaluate the incidence, clinical presentation, risk factors, and treatment outcomes of postoperative EDH in pediatric patients with MMD. METHODS: A retrospective review of 148 pediatric patients with 250 craniotomies who underwent indirect bypass revascularization surgery between January 2002 and December 2006 was performed. This group consisted of 60 male and 88 female patients, and the mean age at surgery was 7.5 years (range 1-18 years). RESULTS: Of the 250 craniotomies, postoperative EDH was detected in 32 cases. In 12 cases of EDH, surgical treatment was necessary (4.8% of 250 craniotomies). During the same period, 743 non-MMD craniotomy operations were performed. In 6 of these 743 operations, patients developed postoperative EDH that required surgical treatment, significantly less than the percentage of EDH requiring postoperative treatment in patients with MMD (0.8%, p < 0.001). The average interval between craniotomy surgery and the detection of EDH was 1.8 days (range 0-5 days) in patients with MMD and 0.5 days (range 0-2 days; p = 0.018) in the non-MMD craniotomy group. Postoperative EDH was observed in significantly fewer cases (17 of 191) when a subcutaneous drain (SCD) was inserted over the bone flap than in cases in which an SCD was not inserted (14 of 55; p = 0.001). The mean international normalized ratio of prothrombin time in the immediate postoperative blood test was 1.27 ± 0.17 in the EDH group and 1.20 ± 0.11 in the non-EDH group (values are expressed as the mean ± SD; p = 0.008). Central galeal flap tenting suture and immediate postoperative platelet count were not related to the incidence of postoperative EDH following pediatric MMD surgery. CONCLUSIONS: Postoperative EDH is more likely to be found following craniotomy in patients with MMD than in those without MMD, and may occur in a delayed fashion. Insertion of an SCD and immediate correction of an abnormal value for international normalized ratio of prothrombin time can decrease the incidence of postoperative EDH following surgery for pediatric MMD.