Recent Trends in the Withdrawal of Life-Sustaining Treatment in Patients with Acute Cerebrovascular Disease : 2017–2021

Objective@#: The Act on Life-Sustaining Treatment (LST) decisions for end-of-life patients has been effective since February 2018. An increasing number of patients and their families want to withhold or withdraw from LST when medical futility is expected. This study aimed to investigate the status of the Act on LST decisions for patients with acute cerebrovascular disease at a single hospital. @*Methods@#: Between January 2017 and December 2021, 227 patients with acute cerebrovascular diseases, including hemorrhagic stroke (n=184) and ischemic stroke (n=43), died at the hospital. The study period was divided into the periods before and after the Act. @*Results@#: The duration of hospitalization decreased after the Act was implemented compared to before (15.9±16.1 vs. 11.2±18.6 days, p=0.127). The rate of obtaining consent for the LST plan tended to increase after the Act (139/183 [76.0%] vs. 27/44 [61.4%], p=0.077). Notably, none of the patients made an LST decision independently. Ventilator withdrawal was more frequently performed after the Act than before (52/183 [28.4%] vs. 0/44 [0%], p<0.001). Conversely, the rate of organ donation decreased after the Act was implemented (5/183 [2.7%] vs. 6/44 [13.6%], p=0.008). Refusal to undergo surgery was more common after the Act was implemented than before (87/149 [58.4%] vs. 15/41 [36.6%], p=0.021) among the 190 patients who required surgery. @*Conclusion@#: After the Act on LST decisions was implemented, the rate of LST withdrawal increased in patients with acute cerebrovascular disease. However, the decision to withdraw LST was made by the patient’s family rather than the patient themselves. After the execution of the Act, we also observed an increased rate of refusal to undergo surgery and a decreased rate of organ donation. The Act on LST decisions may reduce unnecessary treatments that prolong end-of-life processes without a curative effect. However, the widespread application of this law may also reduce beneficial treatments and contribute to a decline in organ donation.

Epigenetic Regulation of the Expression of T Cell Stimulatory and Inhibitory Factors by Histone H3 Lysine Modification Enzymes and Its Prognostic Roles in Glioblastoma

Background@#This study aimed to identify the specific T cell co-stimulatory and co-inhibitory factors that play prognostic roles in patients with glioblastoma. Additionally, the unique histone H3 modification enzymes that regulate the expression levels of these specific costimulatory and co-inhibitory factors were investigated. @*Methods@#The medical records of 84 patients newly diagnosed with glioblastoma at our institution from January 2006 to December 2020 were retrospectively reviewed.Immunohistochemical (IHC) staining for T cell co-stimulatory factors (CD27, CD28, CD137, OX40, and ICOS), T cell co-inhibitory factors (CTLA4, PD1, PD-L1, TIM3, and CD200R), and histone H3 lysine modification enzymes (MLL4, RIZ, EZH1, NSD2, KDM5c, JMJD1a, UTX, and JMJD5) was performed on archived paraffin-embedded tissues obtained by biopsy or resection. Quantitative real time-polymerase chain reaction (qRT-PCR) was performed for specific factors, which demonstrated causal relationships, in order to validate the findings of the IHC examinations. @*Results@#The mean follow-up duration was 27.5 months (range, 4.1–43.5 months). During this period, 76 patients (90.5%) died, and the mean OS was 19.4 months (95% confidence interval, 16.3–20.9 months). Linear positive correlations were observed between the expression levels of CD28 and JMJD1a (R2 linear = 0.982) and those of CD137 and UTX (R2 linear = 1.528). Alternatively, significant negative correlations were observed between the expression levels of CTLA4 and RIZ (R2 linear = −1.746) and those of PD-L1 and EZH1 (R2 linear = −2.118); relationships were confirmed by qRT-PCR. In the multivariate analysis, increased expression levels of CD28 (P = 0.042), and CD137 (P = 0.009), and decreased expression levels of CTLA4 (P = 0.003), PD-L1 (P = 0.020), and EZH1 (P = 0.040) were significantly associated with longer survival. @*Conclusion@#These findings suggest that the expression of certain T cell co-stimulatory factors, such as CD28 and CD 137, and co-inhibitory factors, such as CTLA4 and PD-L1 are associated with prognosis of glioblastoma patients.

Role of Neurosurgeons in the Treatment of Acute Ischemic Stroke in the Emergency Room

Objective@#: With the recent increase in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), the role of neurosurgeons in AIS treatment has become increasingly important. This study aimed to assess the outcomes of patients with AIS treated by neurosurgeons and neurologists in the emergency room (ER) of a tertiary hospital in South Korea. @*Methods@#: From January 2020 to June 2021, 536 patients with AIS within 24 hours of symptom onset were admitted to our hospital via the ER. Based on the type of doctors who provided initial care for AIS in the ER, patients were divided into two groups : (a) neurosurgeon group (n=119, 22.2%) and (b) neurologist group (n=417, 77.8%). @*Results@#: Intravenous tissue plasminogen activator (tPA) was administered in 82 (15.3%) of 536 patients (n=17 [14.3%] in the neurosurgeon group and n=65 [15.6%] in the neurologist group). The door-to-tPA time was not significantly different between both groups (median, 53 minutes; interquartile range [IQR], 45–58 vs. median, 54 minutes; IQR, 46–74; p=0.372). MT was performed in 69 patients (12.9%) (n=25, 36.2% in the neurosurgeon group and n=44, 63.8% in the neurologist group). The neurosurgeon group achieved a shorter door-to-puncture time than the neurologist group (median, 115 minutes; IQR, 107–151 vs. median, 162 minutes; IQR, 117–189; p=0.049). Good clinical outcomes (3-month modified Rankin Scale 0–2) did not differ significantly between the two groups (96/119 [80.7%] vs. 322/417 [77.2%], p=0.454). @*Conclusion@#: The neurosurgeon group showed similar door-to-treatment time and clinical outcomes to the neurologist group in patients with AIS in the ER. This study suggests that neurosurgeons have comparable abilities to care for patients with AIS in the ER.

Overexpression of Dock180 and Elmo1 in Melanoma is Associated with Cell Survival and Migration

Background@#Melanoma is one of the most aggressive and metastatic skin cancers. Although overexpression of Dock180 and Elmo1 has been identified in various cancers, including glioma, ovarian cancer, and breast cancer, their expression and functions in melanoma remain unknown. @*Objective@#This study aims to confirm the expression of Dock180 and Elmo1, their underlying mechanisms, and roles in melanoma. @*Methods@#Both immunohistochemical staining and Western blotting were used to confirm expression of Dock180 and Elmo1 in human melanoma. To identify roles of Dock180 and Elmo1 in cell survival, apoptosis and migration, downregulation of Dock180 or Elmo1 in melanoma cells with small interfering RNA (siRNA) was performed. @*Results@#We identified overexpression of Dock180 and Elmo1 in human melanoma compared to normal skin ex vivo. Inhibition of Dock180 or Elmo1 following siRNA in melanoma cells reduced cell viability and increased apoptosis as supported by increased proportion of cells with Annexin V-PE (+) staining and sub-G0/G1 peak in cell cycle analysis. Moreover, inhibition of Dock180 or Elmo1 regulated apoptosis-related proteins, showing downregulation of Bcl-2, caspase-3, and PARP and upregulation of Bax, PUMA, cleaved caspase-3, and cleaved PARP. Furthermore, knockdown of Dock180 and Elmo1 in melanoma cells reduced cell migration and changed cellular signaling pathways including ERK and AKT. Vemurafenib decreased cell viability in concentration-dependent manner, while transfection with Dock180- or Elmo1-specific siRNA in melanoma cells significantly reduced cell viability. @*Conclusion@#Our results suggest that both Dock180 and Elmo1 may be associated with cancer progression, and can be potential targets for treatment of melanoma.

Impact of the Coronavirus Disease Pandemic on Patients with Head Injuries in South Korea

Objective@#: The coronavirus disease 2019 (COVID-19) pandemic is affecting the characteristics of patients with head injuries. This study aimed to evaluate the effect of the COVID-19 pandemic on patients with head injuries at a regional emergency medical center in South Korea. @*Methods@#: From April 2019 to November 2020, 350 patients with head injuries were admitted to our hospital. The study period was divided into the pre-COVID-19 (n=169) and COVID-19 (n=181) eras (10 months each). Patients with severe head injuries requiring surgery (n=74) were categorized into those who underwent surgery (n=41) and those who refused surgery (n=33). @*Results@#: Head injuries in pediatric patients (<3 years) were more frequent in the COVID-19 era than in the pre-COVID-19 era (8.8% vs. 3.6%, p=0.048). More patients refused surgery in the COVID-19 era than in the pre-COVID-19 era (57.9% vs. 30.6%, p=0.021). Refusal of surgery was associated with old age (67.7±14.5 vs. 52.4±19.1, p<0.001), marital status (married, 84.8% vs. 61.0%, p=0.037), unemployment (42.4% vs. 68.3%, p=0.034), COVID-19 era (66.7% vs. 39.0%, p=0.021), and lower Glasgow coma scale scores (6.12±3.08 vs. 10.6±3.80, p<0.001). Multivariable logistic regression analysis revealed that refusal of surgery was independently associated with old age (adjusted odds ratio [OR], 1.084; 95% confidence interval [CI], 1.030–1.140; p=0.002), COVID-19 era (adjusted OR, 6.869; 95% CI, 1.624–29.054; p=0.009), and lower Glasgow coma scale scores (adjusted OR, 0.694; 95% CI, 0.568–0.848; p<0.001). @*Conclusion@#: We observed an increased prevalence of head injuries in pediatric patients (<3 years) during the COVID-19 pandemic. Additionally, among patients with severe head injuries requiring surgery, more patients refused to undergo surgery during the COVID-19 pandemic.

Comparative Analysis of the Patients with Spontaneous Thalamic Hemorrhage with Concurrent Intraventricular Hemorrhage and Those without Intraventricular Hemorrhage

Background@#This study aimed to compare the characteristics of patients with spontaneous thalamic hemorrhage (STH) accompanied by intraventricular hemorrhage (IVH) with those of patients without IVH. @*Methods@#The medical records of consecutive patients with STH admitted to our institute between January 2000 and December 2018 were reviewed retrospectively. The laboratory and radiological results, mortality, and functional recovery were compared between the STH patients with IVH and those without IVH. @*Results@#Among 2,389 patients with spontaneous intracerebral hemorrhage, 233 (9.8%) patients were included in this study. Concurrent IVH was detected in 159 (68.2%) patients with STH, and more frequently in those with body mass index ≥ 25, Glasgow Coma Scale score of 3–8, underlying disease, family history of stoke, posterior/medial/global location of hematoma, ventriculomegaly, large volume of hemorrhage, and midline shift ≥ 5 mm. The 3-month mortality was 25.8% and 8.1% (P = 0.039), the rate of good functional recovery at 6 months was 52.2% and 31.0% (P = 0.040), and incidence of delayed normal pressure hydrocephalus (NPH) at 12 months was 10.8% and 24.5% (P = 0.062) in the STH patients with IVH and those without IVH, respectively. At 12 months, delayed NPH developed in 28 of 47 (59.6%) patients who received external ventricular drainage (EVD)-based treatment, 5 of 45 (11.1%) patients who underwent endoscopic evacuation-based treatment, and 8 of 45 (17.8%) patients who underwent other surgeries. @*Conclusion@#Concurrent IVH is strongly associated with mortality in patients with STH. Delayed NPH may develop more frequently in STH patients with IVH who were treated with EVD.

Dual-Task Training Effect on Cognitive and Body Function, β-amyloid Levels in Alzheimer’s Dementia Patients: A Randomized Controlled Trial

Purpose@#Dementia is a disease in which cognitive function declines, leading to deterioration of body functions and activities of daily living. The purpose of this study is to explore the effects of dual-task training, including cognitive tasks, on cognitive and body function and β-amyloid levels in Alzheimer’s dementia patients. @*Methods@#34 inpatients diagnosed with Alzheimer’s dementia at a nursing hospital located in South Korea. The patients were randomly divided into a dual-task group (n=16) and a single-task group (n=18). Each group was trained for 30 minutes three times a week for eight weeks. The MMSE-K was used to measure the patients’ cognitive function. To assess the patients’ static balance ability, their LOS was measured using BioRescue. while dynamic balance was measured using the BBS. The 10MWT were conducted to evaluate the patients’ walking ability. Blood analysis was performed to measure levels of β-amyloid. @*Results@#Both groups exhibited statistically significant improvements in gait function after the training (p<0.05). The dual-task group exhibited statistically significant differences in cognitive function, static and dynamic balance function, and β-amyloid levels after training (p<0.05). A significant difference was observed between the two groups (p<0.05). @*Conclusion@#Dual-task training were found to be effective in improving cognitive and bodily functioning and reducing β-amyloid levels in Alzheimer’s dementia patients. Thus, this may be suggested as an effective exercise method for the treatment and early prevention of Alzheimer’s dementia.

A split-face study of moisturizer containing Centella asiatica extract after ablative fractional carbon dioxide laser resurfacing

Background@#Ablative fractional CO2 laser treatment is popular for improving atrophic acne scars; however, complications after laser treatment are unavoidable. The purpose of this study was to investigate the efficacy and safety of a moisturizer containing Centella asiatica extract when applied after ablative fractional CO2 laser resurfacing. @*Methods@#A split-face study was conducted between September 2020 and December 2020 on 34 patients (16 females and 18 males) who were treated with ablative fractional CO2 laser resurfacing. After laser treatment, C. asiatica extract was applied to the right side of the face and purified water was applied to the left side. We compared the right and left sides of the face at various time points after laser treatment using an automatic skin analysis device to investigate the degree of moisture and post-inflammatory hyperpigmentation. @*Results@#No significant difference in the degree of moisture was found between the two sides of the face immediately after laser treatment (P=0.059), but there was a significant difference at 1 and 4 hours after post-laser treatment care (P<0.001). Regarding post-inflammatory hyperpigmentation, there was no significant difference between the two sides of the face before laser treatment (P=0.184), but a significant difference was found at 6 weeks after laser treatment (P<0.001). @*Conclusions@#Our results show that applying C. asiatica extract is a novel post-laser treatment modality that can provide satisfactory results without complications after ablative fractional CO2 laser resurfacing.

A split-face study evaluating the efficacy of a topical antioxidant cream containing tocotrienol after 1064-nm picosecond Nd:YAG laser treatment for environment-induced skin pigmentation

Background@#This study aimed to evaluate the efficacy and safety of a topical antioxidant cream containing tocotrienol after 1064-nm picosecond neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment for environment-induced skin pigmentation. @*Methods@#A split-face study was conducted between December 2020 and March 2021 in 26 patients (25 women and one man) who were treated with a 1064-nm picosecond Nd:YAG laser. On the right side of the face, an antioxidant cream containing tocotrienol was applied after picosecond laser treatment, and on the left side, only picosecond laser treatment was performed. We compared the right and left sides of the face at 4 weeks after laser treatment using an automatic skin analysis device to investigate skin pigmentation. The melasma severity scores of the two sides were evaluated before and 4 weeks after picosecond laser treatment. @*Results@#The skin pigmentation score showed a significant difference between pretreatment and 4 weeks after picosecond laser treatment on both sides of the face (P0.05). @*Conclusions@#Our results show that, for the treatment of environment-induced skin pigmentation, the application of a tocotrienol-containing antioxidant cream after 1064-nm picosecond laser treatment can provide good results without any complications.

Dual-Task Training Effect on Cognitive and Body Function, β-amyloid Levels in Alzheimer’s Dementia Patients: A Randomized Controlled Trial

Purpose@#Dementia is a disease in which cognitive function declines, leading to deterioration of body functions and activities of daily living. The purpose of this study is to explore the effects of dual-task training, including cognitive tasks, on cognitive and body function and β-amyloid levels in Alzheimer’s dementia patients. @*Methods@#34 inpatients diagnosed with Alzheimer’s dementia at a nursing hospital located in South Korea. The patients were randomly divided into a dual-task group (n=16) and a single-task group (n=18). Each group was trained for 30 minutes three times a week for eight weeks. The MMSE-K was used to measure the patients’ cognitive function. To assess the patients’ static balance ability, their LOS was measured using BioRescue. while dynamic balance was measured using the BBS. The 10MWT were conducted to evaluate the patients’ walking ability. Blood analysis was performed to measure levels of β-amyloid. @*Results@#Both groups exhibited statistically significant improvements in gait function after the training (p<0.05). The dual-task group exhibited statistically significant differences in cognitive function, static and dynamic balance function, and β-amyloid levels after training (p<0.05). A significant difference was observed between the two groups (p<0.05). @*Conclusion@#Dual-task training were found to be effective in improving cognitive and bodily functioning and reducing β-amyloid levels in Alzheimer’s dementia patients. Thus, this may be suggested as an effective exercise method for the treatment and early prevention of Alzheimer’s dementia.

A split-face study of moisturizer containing Centella asiatica extract after ablative fractional carbon dioxide laser resurfacing

Background@#Ablative fractional CO2 laser treatment is popular for improving atrophic acne scars; however, complications after laser treatment are unavoidable. The purpose of this study was to investigate the efficacy and safety of a moisturizer containing Centella asiatica extract when applied after ablative fractional CO2 laser resurfacing. @*Methods@#A split-face study was conducted between September 2020 and December 2020 on 34 patients (16 females and 18 males) who were treated with ablative fractional CO2 laser resurfacing. After laser treatment, C. asiatica extract was applied to the right side of the face and purified water was applied to the left side. We compared the right and left sides of the face at various time points after laser treatment using an automatic skin analysis device to investigate the degree of moisture and post-inflammatory hyperpigmentation. @*Results@#No significant difference in the degree of moisture was found between the two sides of the face immediately after laser treatment (P=0.059), but there was a significant difference at 1 and 4 hours after post-laser treatment care (P<0.001). Regarding post-inflammatory hyperpigmentation, there was no significant difference between the two sides of the face before laser treatment (P=0.184), but a significant difference was found at 6 weeks after laser treatment (P<0.001). @*Conclusions@#Our results show that applying C. asiatica extract is a novel post-laser treatment modality that can provide satisfactory results without complications after ablative fractional CO2 laser resurfacing.

A split-face study evaluating the efficacy of a topical antioxidant cream containing tocotrienol after 1064-nm picosecond Nd:YAG laser treatment for environment-induced skin pigmentation

Background@#This study aimed to evaluate the efficacy and safety of a topical antioxidant cream containing tocotrienol after 1064-nm picosecond neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment for environment-induced skin pigmentation. @*Methods@#A split-face study was conducted between December 2020 and March 2021 in 26 patients (25 women and one man) who were treated with a 1064-nm picosecond Nd:YAG laser. On the right side of the face, an antioxidant cream containing tocotrienol was applied after picosecond laser treatment, and on the left side, only picosecond laser treatment was performed. We compared the right and left sides of the face at 4 weeks after laser treatment using an automatic skin analysis device to investigate skin pigmentation. The melasma severity scores of the two sides were evaluated before and 4 weeks after picosecond laser treatment. @*Results@#The skin pigmentation score showed a significant difference between pretreatment and 4 weeks after picosecond laser treatment on both sides of the face (P0.05). @*Conclusions@#Our results show that, for the treatment of environment-induced skin pigmentation, the application of a tocotrienol-containing antioxidant cream after 1064-nm picosecond laser treatment can provide good results without any complications.

Influence of Head-Neck Rotation on Elbow Flexor and Extensor Muscle Activity and Strength in Normal Adults

Purpose@#This study examined the effects of the directions of neck rotation position on the muscle activity and strength of the elbow flexor and extensor muscle. @*Methods@#Forty-one healthy adults participated in this study. The subjects were asked to their elbow 90° flexion in three different neck rotations (neutral, ipsilateral, and contralateral) in the sitting position. The muscle activities of the biceps and triceps brachii muscle were measured using surface electromyography. And the muscle strength of the elbow flexor was measured using dynamometer. One way repeated measures ANOVA was used to compare the muscle activity and strength of the elbow flexor and extensor depending on the different neck turning directions. @*Results@#There were significant differences between contralateral neck rotation and ipsilateral neck rotation, contralateral neck rotation and neutral position. But, there was no significant difference in the triceps brachii muscle activity in comparison with the neck rotation. There were significant differences between contralateral neck rotation and ipsilateral neck rotation, contralateral neck rotation and neutral position. @*Conclusion@#To summarize this study, the elbow flexor and extensor muscle activity and strength was highest in the contralateral neck rotation position. In other words, it was possible to confirm the effect of Asymmetrical Tonic Neck Reflex in healthy adults whose primitive reflexes were inhibition, and head and neck positions should be considered during clinical evaluation and treatment.

The Association Between Lung Function and Type 2 Diabetes in Koreans

ObjectivesThis study was performed to test the association between lung function and type 2 diabetes mellitus (T2DM) in Korean patients.MethodsData from the 6th Korea National Health and Nutrition Examination Survey (2013 to 2015) was used in this study. There were 3,466 individuals aged between 40 and 80 years, with T2DM, who had a smoking and alcohol status listed, and blood analysis (including blood pressure), were included in this study. Lung function, measured by spirometer ventilatory dysfunction was categorized into 3 patterns: normal, restrictive ventilatory dysfunction, and obstructive ventilatory dysfunction (OVD).ResultsBased on multivariate logistic regression analysis, individuals with restrictive ventilatory dysfunction had an increased odds ratio (OR 1.615, 95% CI 1.137–2.294) for T2DM compared with individuals with normal ventilatory function, whereas OVD had no increase in the odds ratio (OR 1.169, 95 % CI 0.857–1.594). Model 1, which adjusted for age and gender, showed that the probability of having restrictive disorder was 1.559 times (95% CI 1.617–2.082) higher for prediabetes patients, and 2.320 times (95% CI 1.611–3.343) higher for T2DM patients, compared to normal individuals. For Model 4, which was fully adjusted for variables, the probability of having a restrictive disorder was 1.837 times higher for T2DM patients (95% CI 1.260–2.679).ConclusionRestrictive ventilatory dysfunction, but not OVD, was associated independently with T2DM.

Association between Secondhand Smoke Exposure and Depressive Symptoms among Korean Adults

Objectives@#The aim of this study is to investigate the association between secondhand smoke (SHS) exposure and depressive symptoms among Korean adults. This study also explored the mediating role of self-rated health (SRH) and perceived usual stress (PUS) in the association between depressive symptoms, suicidal ideation and SHS exposure. @*Methods@#Data from the Korea National Health and Nutrition Examination Surveys (KNHANES) in 2014 and 2016 was analyzed for 10539 participants aged 19 years or older. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated in the logistic regression analysis with adjustment for the potential confounding factors. We also adopted the mediation analysis method by Hayes and Preacher. @*Results@#After adjusting for the potential confounding factors, SHS at home and at public places were associated with depressive symptoms and suicidal ideation among non-smokers. After adjusting for the potential confounding factors, SHS at home and at public places was associated with depressive symptoms and suicidal ideation among non-smokers. Meanwhile SHS at workplaces was associated with depressive symptoms among former smokers and with suicidal ideation among current smokers. There was an additive effect of SHS on depressive symptoms only among non-smokers. SRH mediated the association between SHS and depressive symptoms and suicidal ideation among non-smokers. We did not observe any significant mediating effect of SRH nor PUS on the association between SHS and depressive symptoms among former and current smokers. @*Conclusions@#SHS may be associated with depressive symptoms and suicidal ideation in Korean adults. Our study elucidated how SHS interacted with depressive symptoms among non-smokers through the mediation by SRH.

Association between Secondhand Smoke Exposure and Depressive Symptoms among Korean Adults

Objectives@#The aim of this study is to investigate the association between secondhand smoke (SHS) exposure and depressive symptoms among Korean adults. This study also explored the mediating role of self-rated health (SRH) and perceived usual stress (PUS) in the association between depressive symptoms, suicidal ideation and SHS exposure. @*Methods@#Data from the Korea National Health and Nutrition Examination Surveys (KNHANES) in 2014 and 2016 was analyzed for 10539 participants aged 19 years or older. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated in the logistic regression analysis with adjustment for the potential confounding factors. We also adopted the mediation analysis method by Hayes and Preacher. @*Results@#After adjusting for the potential confounding factors, SHS at home and at public places were associated with depressive symptoms and suicidal ideation among non-smokers. After adjusting for the potential confounding factors, SHS at home and at public places was associated with depressive symptoms and suicidal ideation among non-smokers. Meanwhile SHS at workplaces was associated with depressive symptoms among former smokers and with suicidal ideation among current smokers. There was an additive effect of SHS on depressive symptoms only among non-smokers. SRH mediated the association between SHS and depressive symptoms and suicidal ideation among non-smokers. We did not observe any significant mediating effect of SRH nor PUS on the association between SHS and depressive symptoms among former and current smokers. @*Conclusions@#SHS may be associated with depressive symptoms and suicidal ideation in Korean adults. Our study elucidated how SHS interacted with depressive symptoms among non-smokers through the mediation by SRH.

Influence of Head-Neck Rotation on Elbow Flexor and Extensor Muscle Activity and Strength in Normal Adults

Purpose@#This study examined the effects of the directions of neck rotation position on the muscle activity and strength of the elbow flexor and extensor muscle. @*Methods@#Forty-one healthy adults participated in this study. The subjects were asked to their elbow 90° flexion in three different neck rotations (neutral, ipsilateral, and contralateral) in the sitting position. The muscle activities of the biceps and triceps brachii muscle were measured using surface electromyography. And the muscle strength of the elbow flexor was measured using dynamometer. One way repeated measures ANOVA was used to compare the muscle activity and strength of the elbow flexor and extensor depending on the different neck turning directions. @*Results@#There were significant differences between contralateral neck rotation and ipsilateral neck rotation, contralateral neck rotation and neutral position. But, there was no significant difference in the triceps brachii muscle activity in comparison with the neck rotation. There were significant differences between contralateral neck rotation and ipsilateral neck rotation, contralateral neck rotation and neutral position. @*Conclusion@#To summarize this study, the elbow flexor and extensor muscle activity and strength was highest in the contralateral neck rotation position. In other words, it was possible to confirm the effect of Asymmetrical Tonic Neck Reflex in healthy adults whose primitive reflexes were inhibition, and head and neck positions should be considered during clinical evaluation and treatment.

A Meta-analysis for Evaluating Efficacy of Neuroendoscopic Surgery versus Craniotomy for Supratentorial Hypertensive Intracerebral Hemorrhage

OBJECTIVE: Hypertensive intracerebral hemorrhage is a potentially life-threatening neurological deficit with the highest morbidity and mortality. In recent years, neuroendoscopy has been used to treat intracerebral hemorrhages (ICHs). However, the choice of neuroendoscopic surgery or craniotomy for patients with ICHs is controversial. The objective of this meta-analysis was to assess the efficacy of neuroendoscopic surgery compared to craniotomy in patients with supratentorial hypertensive ICH.MATERIALS AND METHODS: A systematic electronic search was performed using online electronic databases such as Pubmed, Embase, and Cochrane library updated on December 2017. The meta-analysis was performed by only including studies designed as randomized controlled trials.RESULTS: Three randomized controlled trials met our inclusion criteria. Pooled analysis of death showed that neuroendoscopic surgery decreased the rate of death compared to craniotomy (RR=0.58, 95% CI: 0.26–1.29; P=0.18). Pooled results of complications showed that neuroendoscopic surgery tended to have fewer complications than craniotomy had (RR=0.37, 95% CI: 0.28–0.49; P < 0.0001).CONCLUSION: Although the presenting analyses suggest that neuroendoscopic surgery should have fewer complications than craniotomy dose, it had no superior advantage in morbidity rate definitely. Therefore, it may be necessary for the neurosurgeons to select best optimal patients for individual treatment.

A prospective, comparative evaluation of axillary hair removal with an 808-nm diode laser at different fluences

BACKGROUND: Diode lasers are the gold standard for removing unwanted hair. Lowering the energy should result in less pain and could theoretically affect therapeutic efficacy. This study evaluated the efficacy of an 808-nm diode laser at different fluences for permanent axillary hair removal in Korean women. METHODS: Twenty-four Korean women were divided into two groups. Each patient received laser treatment at both axillae, which were divided into upper and lower parts. Each part received different fluence from an HR808 prototype diode at 1-month intervals: 8, 10, 12, and 14 J/cm². Hair count and thickness were recorded at each follow-up visit and at a 3-month follow-up after the final laser treatment by photography and using a folliscope. At the final visit, pain and patient satisfaction were surveyed. Three plastic surgeons assessed the results on photographs. RESULTS: The mean hair follicle density reduction was 62.18%, 65.28%, 73.08%, and 78.29% on the right upper side, right lower side, left upper side, and left lower side, respectively. The mean hair follicle thickness reduction was 45%, 48%, 54%, and 59% on the right upper side, right lower side, left upper side, and left lower side, respectively. In the plastic surgeons' assessment, the left upper and lower sides scored 2.71. The right upper and lower sides scored 2.38 and 2.04, respectively. CONCLUSIONS: High-fluence (14 J/cm²) treatment with an HR 808 prototype diode laser efficiently removed unwanted hair. No significant difference in comfort was reported compared to the low-fluence mode (8–10 J/cm²).

Modified Arachnoid Plasty Reduces Chronic Subdural Hematoma after Unruptured Aneurysm Clipping : Technical Note

OBJECTIVE: Chronic subdural hematoma (CSDH) is a rare complication of unruptured intracranial aneurysm (UIA) clipping surgery. To prevent postoperative CSDH by reducing subdural fluid collection, we applied the modified arachnoid plasty (MAP) during the UIA clipping surgery to seal the dissected arachnoid plane. METHODS: This retrospective study included 286 patients enrolled from July 2012 to May 2015. We performed arachnoid plasty in all patients, with MAP used after June 17, 2014. Patients were divided into two groups (non-MAP vs. MAP), and by using uni- and multivariate analyses, baseline characteristics, and relationships with postoperative CSDH between the two groups were analyzed. The degree of preoperative brain atrophy was estimated using the bicaudate ratio (BCR) index. RESULTS: Ten patients (3.5%) among 286 patients had postoperative CSDH after clipping. Nine (3.1%) were in the non-MAP group, and one (0.9%) was in the MAP group. The higher BCR index showed statistical significance with occurrence of postoperative CSDH in both uni- (p=0.018) and multivariate (p=0.012; odds ratio [OR], 8.547; 95% confidence interval [CI], 1.616–45.455) analyses. MAP was associated with a lower risk of postoperative CSDH (p=0.022; OR, 0.068; 95% CI, 0.007–0.683). CONCLUSION: This study shows that the degree of preoperative brain atrophy is associated with an increased occurrence of CSDH after clipping and that MAP could help reduce the risk of postoperative CSDH after unruptured aneurysm clipping via a lateral supraorbital approach.