Endovascular Thrombectomy for Acute Ischemic Stroke : Current Concept in Management

Endovascular thrombectomy (EVT) has been established as the standard of care in the treatment of acute ischemic stroke (AIS) based on landmark randomized controlled trials. Nevertheless, while the strict eligibility of EVT for AIS patients restrict the wide application of EVT, a considerable population still undergoes off-label EVT. Besides, it is important to acknowledge that recanalization is not achieved in approximately 20% of procedures, and more than 50% of patients who undergo EVT still do not experience a favorable outcome. This article reviews the brief history of EVT trials and recent progressions in the treatment of AIS, with focusing on the expanding eligibility criteria, new target for EVT, and the evolution of EVT techniques.

Geometric influence of anterior cerebral artery rotation on the formation of anterior communicating artery aneurysm

Objective@#Several particular morphological factors that contribute to the hemodynamics of the anterior communicating artery (ACoA) have been documented, but no study has investigated the role of the degree of anterior cerebral artery (ACA) rotation on the presence of ACoA aneurysms (ACoAAs). @*Methods@#A retrospective study of an institutional aneurysm database was performed; patients with ruptured or nonruptured ACoAAs were selected. Two sex- and age-matched control groups were identified: control Group A (nonaneurysms) and control Group B (middle cerebral artery aneurysms). Measurements of ACA rotation degree were obtained by using a three-dimensional imaging tool. @*Results@#From 2015 to 2020, 315 patients were identified: 105 in the ACoAA group, 105 in control Group A, and 105 in control Group B. The average age at the time of presentation was 64 years, and 52.4% were female. The ACA rotation degree of the ACoAA group was significantly higher than that of control Group A (p <0.01). The A1 ratio and the A1A2 ratio of the ACoAA group were greater than those of control Group A (p <0.01 and p <0.01, respectively). The ACA rotation degree correlated insignificantly with aneurysm size in ACoAA patients (p=0.78). The ACA rotation degree in the ACoAA group was also insignificantly different from that in control B (p=0.11). @*Conclusions@#The degree of ACA rotation was greater in the ACoAA group than in the nonaneurysm group, and it may serve as an imaging marker for ACoAA.

Trapping and A4-A4 end-to-side anastomosis for the treatment of a ruptured A3 fusiform aneurysm: Potential risk of in-situ bypass

The treatment of complicated anterior cerebral artery aneurysms remains challenging. Here, the authors describe a case of ruptured complicated A3 aneurysm, which was treated with trapping and in-situ bypass. A 47-year-old man presented to the emergency department with severe headache and vomiting. Computed tomography illustrated acute intracerebral hemorrhage in the right frontal lobe. Digital subtraction angiography (DSA) confirmed a ruptured fusiform A3 aneurysm with lobulation and a daughter sac. Trapping of the ruptured fusiform A3 aneurysm and distal end-toside A4 anastomosis was performed. DSA on postoperative day 7 showed mild vasospasm to the afferent artery. However, 2 months later, DSA demonstrated that the antegrade flow through the anastomosis site had recovered. Thus, surgeons should be aware of the possibility of postsurgical vasospasm of anastomosed arteries, especially in cases of ruptured aneurysms.

Response of Leptomeningeal Dissemination of Anaplastic Glioma to Temozolomide: Experience of Two Cases

The incidence of leptomeningeal dissemination (LMD) of anaplastic glioma has been increasing. LMD can be observed at the time of initial presentation or the time of recurrence. As a result of both rarity and unusual presentation, a standard therapy has not yet been suggested. In contrast to leptomeningeal carcinomatosis for systemic solid cancers, a relatively prolonged survival is observed in some patients with LMD of anaplastic gliomas. Treatment modalities include whole craniospinal irradiation, intra-cerebrospinal fluid (CSF) chemotherapy, and systemic chemotherapy. In some cases, response to temozolomide (TMZ), with or without combined radiation has been reported. Here, we report two cases of LMD of an anaplastic glioma. In one case LMD presented at the time of diagnosis, and in the other at the time of recurrence after radiation. CSF cytology was positive in both cases, and persisted in spite of intrathecal methotrexate chemotherapy. Later, TMZ was prescribed for progressing brain parenchymal lesions, and both radiological and cytological responses were obtained after oral TMZ treatment.

Comparative Viral Metagenomics of Environmental Samples from Korea

The introduction of metagenomics into the field of virology has facilitated the exploration of viral communities in various natural habitats. Understanding the viral ecology of a variety of sample types throughout the biosphere is important per se, but it also has potential applications in clinical and diagnostic virology. However, the procedures used by viral metagenomics may produce technical errors, such as amplification bias, while public viral databases are very limited, which may hamper the determination of the viral diversity in samples. This review considers the current state of viral metagenomics, based on examples from Korean viral metagenomic studies-i.e., rice paddy soil, fermented foods, human gut, seawater, and the near-surface atmosphere. Viral metagenomics has become widespread due to various methodological developments, and much attention has been focused on studies that consider the intrinsic role of viruses that interact with their hosts.

Recent Methodological Approaches to Human Microbiome

Human body is one of the most complex and diverse microbial ecosystem in which various microbes are living together with their hosts. Starting with Louis Pasteur's postulation that human health is dependent on gut-resident microbiota, microbes in the gastrointestinal tract have been studied using culture-based techniques. Cultivation has the great advantage that isolates can be recovered and used to further studies for their ability to utilize different substrates and other physiological properties. However, cultivation method is very labor-intensive and can not reveal representative microbial diversity of human intestinal tract. Only small fraction of the microbes residing in human intestine can be cultured and majority of intestinal microbes (approximately 60~70% of intestinal microbes) can not be come into view with currently available cultivation techniques. To avoid reliance on cultivation, many culture-independent molecular methods have been developed to analysis environmental microbes and our understanding of complex microbial communities has been greatly increased by molecular methods in recent decades. These culture-independent methods are mainly based on the use of microbial DNA sequences. Among prokaryotic DNAs targeted by molecular analysis, approximately 1.5 kb long 16S ribosomal DNA gene that encodes part of the small subunit (SSU) of ribosome is often used for analysis of microbial diversity. Molecular techniques introduced in microbial ecology have made it possible to study the composition of intestinal flora in a culture-independent way based on the detection of SSU rDNA.

Clinical Characteristics of the Patients Who Died Despite of Low APACHE II Score after Intensive Care / 대한마취과학회지

BACKGROUND: The acute physiology and chronic health evaluation (APACHE) II score is considered to be a precise predictor of mortality and a useful basic research tool. A lower APACHE II score means a better prognosis of patients, which means that these relatively low risk patients are more likely to benefit from the improved patient management than the higher predicted mortality admissions. Therefore, these patients are obvious targets for intensive care and for decreasing the level of intensive care unit (ICU) mortality. METHODS: This study reviewed the medical records of 729 patients, whose APACHE II scores on the ICU admission day were 10 or less, from June 1, 2001 to May 31, 2002 in University Hospital. The data of the patient's age, gender, disease category, first admission or readmission, APACHE II score, length of stay at the ICU and the hospital were reviewed. RESULTS: The average mortality rate of the patients who had an APACHE II score of 10 or less was 4.1%. The mortality of the cancer patients (8%) was significantly higher than the other disease groups. The mortality of the readmitted patients was significantly higher than the mortality of the patients who were admitted to the ICU for the first time. CONCLUSIONS: Among the patients in the ICU with a low APACHE II score, the mortality of cancer patients was high. The mortality of the readmitted patients was significantly higher than in those on the first admission.

Prognosis of Patients Admitted to ICU after Cardiopulmonary Resuscitation in Emergency Room / 대한마취과학회지

BACKGROUND: The prognosis of patients admitted to intensive care unit (ICU) after cardiopulmonary resuscitation (CPR) is poor. Although the number of these patients is increasing as a consequence of emergency medical service improvements, we had no information conceiving the survival rates of patients admitted to ICU after CPR in Korea. The aim of this study was to determine the outcome of these patients. METHODS: We retrospectively evaluated all patients admitted to an ICU after CPR at an emergency room of a teaching hospital during the 24 month period from July, 2002 to July, 2004. The demographic and clinical information of each patient were recorded. These included primary diagnosis, total resuscitation time, APACHE II score (acute physiology and chronic health evaluation II score) at admission to ICU, ICU days, and hospital days. We analyzed all variables in the database and compared the data of patients who died in hospital with that of those who were discharged. RESULTS: Thirty-seven patients were admitted to the ICU after CPR in the emergency room, and 14 were discharged alive. APACHE II scores were significantly lower and Glasgow coma scales were significantly higher in survivors. CONCLUSIONS: 38% of patients who admitted to ICU after CPR in the emergency room were discharged from hospital alive. We evaluated that the severity scores of patients who receive CPR before ICU admission are important predictors of survival.

A Simple and Accurate Method for Determining Antioxidative Activity

Antioxidative activity is an important factor in inhibiting oxidative stress. The usual methods for determining antioxidative activity are time-consuming and cumbersome. They are also indirect processes that use biological material such as brain or liver microsome. This study therefore proposed a new method. Redoxpotential was determined using galvanic cell with or without the addition of various antioxidants or herbal extracts in zinc sulfate solution. The result was compared with the results from the TBA method and the peroxide value from sodium thiosulfate titration. All methods showed significant and dose-dependent enhancement of antioxidative activity by adding ascorbic acid, quercetin, ginseng, or gingko biloba extract. The result of redox potential using galvanic cell showed the smallest standard deviation and took the shortest time among the three methods. Therefore, the antioxidative potential of chemical substances and herbal extracts can be determined simply, directly and accurately in a short period of time using galvanic cell.

The Clinical Characteristics of Child and Adolescent with Attention Deficit or Hyperactivity / 신경정신의학

OBJECTIVES: This study is to understand basic clinical characteristics, behavior symptoms, psychopathology, intelligence and neuropsychiatric functions of ADHD. METHODS: This study examined 1,432 outpatients with attention deficit or hyperactivity under 19 who had visited Yeung Nam University Psychiatric Center from July 01, 1998 to June 20, 2001 with K-ABC, K-WISC (or K-WAIS), K-PIC, ADDESHV, ACTeRS, CAP, SNAP, CPT and WCST RESULTS: 41.2% of the whole outpatients who visited clinics were diagnosed as having ADHD. 37.5% of the patients with ADHD had ADHD-I;59.8% had ADHD-C;and 2.7% had ADHD-HI. The proportion of males to females was 5.6 to 1. Females were a little younger and had generally lower functional standards including intellectual level than males (p<.001). The psychopathology through K-PIC showed that 23.8% of the subjects had psychopathologies related to language development and 18.5-26.5% of the subjects had other psychopathologies related to performance development, anxiety, delinquency, psychosis, autism. In behavioral symptom checklist, general difference was confirmed (p<.001), and ADHD subtype was differentiated by behavioral symptom checklist, especially ADDES-HV and ACTeRS (p<.05). In intellectual level, children with ADHD showed significantly lower IQ than normal children (p<.001). It raised questions that there can be problems not only in the course of testing IQs of children with ADHD but in development and display their intellectual abilities. And children with ADHD showed significantly poorer attention and performance abilities than normal children (p<.05). CONCLUSION: With above results, this study could confirm that ADHD-C had the largest percentage among subtypes of ADHD. And though the proportion of female patients was low, their functional standards were generally lower than male patients. Besides co-existent psychiatric diseases can be ignored in diagnosing ADHD. Though specific differences among subtypes have not been discovered, children with ADHD showed significantly lower functional standards such as IQ, attention, and performance abilities than normal children.

Application of Stop-Signal Task for Evaluation of Children with Attention Deficit Hyperactivity Disorder / 신경정신의학

OBJECTICES AND METHODS: The purpose of this study was to examine availabilities of stop-signal task as a screening test for ADHD and as a research tool. Stop-signal task was applied to 40 ADHD patients and 18 normal children. Followings are the results of this study. RESULTS: There were significant differences between ADHD group and control group in ZRFT, mean delay x block and primary-RT of stop-signal task performance(p<0.05). There was no significant difference in results of continuous performance test. SSRT of stop-signal task had significant correlation with hit reaction time of continuous performance test, and primary-RT and primary-SD with attentiveness and hit reaction time of continuous performance test. There was no significant correlation between scores of ADDES-HV and stop-signal task performance. In change of primary-SD according to intelligence, primary-SD decreased as intelligence increased but made plateau after IQ 110, and in change of SSRT according to age, SSRT decreased as intelligence increased but made plateau after 10 year-old. In discriminant ability, mean delay x block and primary-RT showed highest discriminant ability (each 75%). In addition P-inhibit showed 63.89%, SSRT showed 58%, ZRFT showed 67%, and primary-SD showed 58% in discriminant ability. There was no significant difference in stop-signal task performance between ADHD with hyperactivity and ADHD without hyperactivity. CONCLUSION: In this point of view, stop-signal task was proved to be a useful research tool for attention deficit hyperactivity disorder as well as useful screening test tool.

Does 3-O-Methyldopa(3-OMD) Inhibit the Binding of Levodopa to Plasma Protein / 대한정신약물학회지

OBJECTIVE: We determined the influence of 3-OMD in the protein binding of levodopa to estimate the effect of 3-OMD on the penetration of levodopa into brain. METHOD: P-glycoprotein in the brain may serve to limit drug penetration into the brain. Because it is not available as an experimental substance, but has similar binding properties with alpha 1 acid glycoprotein(AGP), we used AGP in this study. Additionally, we used blood plasma to see the affinity of plasma binding of levodopa. The final concentration of chemicals used in this study were 125, 250, 500, 1000, 2000, 4000 microgram/l for levodopa and 0, 1250, 5000, 10,000 microgram/l for 3-OMD, 1 mg/l for AGP. The free fraction of levodopa in blood plasma and AGP were separated by ultrafiltration method and determined by beta-counter, respectively. RESULTS: We found that levodopa did not bind with AGP, but only 22-24% from 125 microgram/l to 4000 microgram/l of it bound with blood plasma. The addition of 3-OMD to the blood plasma did not significantly change the binding of levodopa. CONCLUSIONS: We can conclude that 3-OMD does not influence the penetration of levodopa into brain. These small amount of the binding does not expect to influence to other drugs on the binding with plasma.

MR Imaging of Pineal Cysts

PURPOSE: To evaluate the incidence and characteristic findings of pineal cyst incidentally detected on magnetic resonance(MR) imaging. MATERIALS AND METHODS: Brain MR images obtained in 2432 patients were retrospectively reviewed to determine the incidence and MR findings of pineal cysts, which were evaluated according to their size, shape, location, signal intensity, interval change, contrast enhancement and mass effect on adjacent structures. RESULTS: Cysts were encountered in 107(4.4 %) of 2432 patients evaluated. Their size ranged from 1 x 1 x 1 to 15 x 8 x 9(mean, 5.97 x 3.87 x 4.82)mm. All were spherical(n=53) or oval(n=54) in shape. Their margin was smooth and they were homogeneous in nature. On T1-weighted images, the cysts were seen to be hyperintense(n=57) or isointense(n=50) to cerebrospinal fluid, but less so than brain parenchyma. T2-weighted images showed them to be isointense(n=51) or hyperintense(n=56) to cerebrospinal fluid. The cysts were centrally located in 65 cases and eccentrically in 42. Compression of the superior colliculi of the tectum was demonstrated in 17 cases(15.9 %). No patients presented clinical symptoms or signs related to either pineal or tectal lesions. Peripheral enhancement around the cyst after Gd-DTPA injection was demonstrated in 51 cases ( 1 00 %). Follow-up examinations in 19 cases demonstrated no interval change. CONCLUSION: The incidence of pineal cysts was 4.4%. The MR characteristics of simple pineal cysts include: (1) an oval or spherical shape, (2) a smooth outer margin and homogeneous nature, (3) isosignal or slightly high signal intensity to cerebrospinal fluid on whole pulse sequences, (4) ring enhancement after contrast injection,(5) an absence of interval change, as seen during follow up MR study. These MR appearances of pineal cysts might be helpful for differentiating them from pineal tumors.

The Study of Reliability and Validity of Attention Deficit Disorder Evaluation Scale-School Version(ADDES-SV) / 영남의대학술지

The purpose of this study was to examine the reliability and validity of attention deficit disorder evaluation scale-school version(ADDES-SV). Between October 1996 and November 1996, ADDES-SV was administered to 263 elementary school students in the second grade and between Jun 1996 and October 1996, 28 attention deficit hyperactivity disorder patients. In the reliability test, the test-retest reliability coefficient was significantly high and that of inattention was 0.88, that of impulsivity was 0.80, that of hyperactivity was 0.83 and total score was 0.83. In the reliability test by internal consistancy, the Cronbach alpha coefficient was significantly high and that of inattention was 0.98, that of impulsivity was 0.87, that of hyperactivity was 0.87(p<0.05). The half-sprit reliability coefficient by first-second half method showed high correlation and that of inattention was part 1: 0.96, part 2: 0.96 impulsivity was part 1: 0.95, part 2: 0.93, hyperactivity was part 1: 0.92, part 2: 0.94(p<0.05). Inter-rater reliability by pearson correlation coefficient was significantly high and that of inattention was 0.92, that of impulsivity was 0.87, that of hyperactivity was 0.89 and total score was 0.89. The concurrent validity between ADDES-SV and CAP scale was 0.85 in attention deficit hyperactivity disorder patient group and 0.79 in normal control group(p<0.05). In discriminant validity test between attention deficit hyperactivity disorder patient group and normal control group, the patient group showed higher score(p<0.05). The total discriminant capacity of the patient group in ADDES-SV was 94.6%. In this point of view, ADDES-SV scale showed high reliability and validity in applying to Korean subjects and was proved to be the useful screening test tool for attention deficit hyperactivity disorder research.

Human monocyte-derived a putative factor which enhances neutrophil viability and superoxide production / 대한면역학회지

No abstract available.