Protocol for the Systematic Fixation, Circuit-Based Sampling, and Qualitative and Quantitative Neuropathological Analysis of Human Brain Tissue.

Human brain tissue has long been a critical resource for neuroanatomy and neuropathology, but with the advent of advanced imaging and molecular sequencing techniques, it has become possible to use human brain tissue to study, in great detail, the structural, molecular, and even functional underpinnings of human brain disease. In the century following the first description of Alzheimer's disease (AD), numerous technological advances applied to human tissue have enabled novel diagnostic approaches using diverse physical and molecular biomarkers, and many drug therapies have been tested in clinical trials (Schachter and Davis, Dialogues Clin Neurosci 2:91-100, 2000). The methods for brain procurement and tissue stabilization have remained somewhat consistently focused on formalin fixation and freezing. Although these methods have enabled research protocols of multiple modalities, new, more advanced technologies demand improved methodologies for the procurement, characterization, stabilization, and preparation of both normal and diseased human brain tissues. Here, we describe our current protocols for the procurement and characterization of fixed brain tissue, to enable systematic and precisely targeted diagnoses, and describe the novel, quantitative molecular, and neuroanatomical studies that broadly expand the use of formalin-fixed, paraffin-embedded (FFPE) tissue that will further our understanding of the mechanisms underlying human neuropathologies.

The Management of Foreign Body Sensation in the Throat after Stroke by Trigger Point Injection on Posterior Belly of Digastric Muscles / 고신대학교의과대학학술지

Foreign body (FB) sensation in the throat is often a common symptom encountered in clinical practice. FB sensation in throat has numerous causes mainly caused by reflex diseases such as laryngopharyngeal reflux. Its treatment has been focused on organic problems or hysteria while musculoskeletal problem has been neglected. We hereby report a patient with dysphagia and complaint of FB sensation in the throat after nasogastric tube removal. It was relieved by trigger point injection on the posterior belly of digastric muscles.

The Management of Foreign Body Sensation in the Throat after Stroke by Trigger Point Injection on Posterior Belly of Digastric Muscles / 고신대학교의과대학학술지

Foreign body (FB) sensation in the throat is often a common symptom encountered in clinical practice. FB sensation in throat has numerous causes mainly caused by reflex diseases such as laryngopharyngeal reflux. Its treatment has been focused on organic problems or hysteria while musculoskeletal problem has been neglected. We hereby report a patient with dysphagia and complaint of FB sensation in the throat after nasogastric tube removal. It was relieved by trigger point injection on the posterior belly of digastric muscles.

A Case of “Sinking Skin Flap Syndrome” in Vegetative State Patient / 대한신경손상학회지

Sinking skin flap syndrome is defined by a series of neurological symptoms with skin depression at the site of cranial defect. We experienced neurological improvement in a patient with markedly sunken craniectomy site after ventriculoperitoneal shunt (V-P shunt) clamping operation. A 17-year old female patient was in vegetative state and spastic quadriplegia after traumatic brain injury. She was suffered from frequent vomiting. To evaluate central nervous system problem we checked brain computed tomography which showed that right frontotemporoparietal craniectomy area was markedly sunken and midline was shifting to the left. After V-P shunt clamping operation, craniectomy site was elevated and midline shifting was improved. Vomiting was disappeared. Coma Recovery Scale-revised (CRS-R) score was improved from 3 to 6.

Neuropathological and transcriptomic characteristics of the aged brain.

As more people live longer, age-related neurodegenerative diseases are an increasingly important societal health issue. Treatments targeting specific pathologies such as amyloid beta in Alzheimer's disease (AD) have not led to effective treatments, and there is increasing evidence of a disconnect between traditional pathology and cognitive abilities with advancing age, indicative of individual variation in resilience to pathology. Here, we generated a comprehensive neuropathological, molecular, and transcriptomic characterization of hippocampus and two regions cortex in 107 aged donors (median = 90) from the Adult Changes in Thought (ACT) study as a freely-available resource (http://aging.brain-map.org/). We confirm established associations between AD pathology and dementia, albeit with increased, presumably aging-related variability, and identify sets of co-expressed genes correlated with pathological tau and inflammation markers. Finally, we demonstrate a relationship between dementia and RNA quality, and find common gene signatures, highlighting the importance of properly controlling for RNA quality when studying dementia.

Intramuscular Hematoma Following Radial Extracorporeal Shockwave Therapy for Chronic Neurogenic Heterotopic Ossification: A Case Report

Extracorporeal shockwave therapy (ESWT) has been reported to be a safe and effective method for decreasing pain and relieving range of motion (ROM) limitations caused by neurogenic heterotopic ossification (NHO), though there has been no report that it might cause hematoma if applied to NHO. We hereby report a case of massive hematoma after ESWT, specifically the radial shockwave therapy (RSWT) device at both hips in a 49-year-old female patient with NHO. She had developed NHO after extensive subarachnoid hemorrhage. We had applied RSWT according to the previous report. The pain and the ROM limitations were gradually improved. Six weeks later, she reported pain and ROM limitations on the right hip. From a medial aspect, swelling and bruising of the right thigh could be seen. Magnetic resonance imaging and ultrasonography suggested a large hematoma between right hip adductor muscles. The symptoms disappeared after conservative treatment for one month, and subsequent follow-up imaging studies demonstrated resolution of the hematoma.

Compensatory Technique Using Therapeutic Band for Dysphagia / 대한연하장애학회지

A 63-year-old man visited outpatient clinic complaining of dysphagia due to left jugular foramen meningioma. The patient underwent conventional dysphagia rehabilitation programs but functional improvement was not enough. A videofluoroscopic swallowing study (VFSS) revealed decreased laryngeal elevation and a lot of residue in pyriform sinus and vallecula. We noticed that enhancing laryngeal elevation like mendelshon maneuver promotes functional compensation, so we developed a therapeutic band for promoting laryngeal elevation. In follow-up VFSS, swallowing function was improved on the band. Persistent dysphagia due to decreased laryngeal elevation is very common and this case showed the possibility of improvement of symptom using therapeutic band we devleoped with conventional dysphagia rehabilitation programs.

An Analysis between Pre- and Post-exercise of the Respiratory and Metabolic State for the Acute and Subacute Stroke Patients

To evaluate oxygenation and metabolic state of the non-brainstem stroke patients after the moderate intensity exercise using arterial blood gas analysis (ABGA). Fifty-two stroke patients were recruited. All the subjects were to follow the instructions for the exercise, not suffered cardiopulmonary diseases before, and not diagnosed with brainstem disorders. They were ordered to maintain 70% heart rate of maximal heart rate during exercise and checked blood pressure, pulse rate, respiratory rate (RR), and ABGA before and after the exercise, respectively. O² saturation, PaO², PaCO², O² content, HCO³⁻, pH, and anion gap were compared between the exercise, and those data changes were performed correlation analysis into age and the time after stroke onset. The data comparison was also done into the subgroup of the severity of stroke using National Institutes of Health Stroke Scale (NIHSS). The statistically significant results were observed in the change of O² saturation, PaO², PaCO², O² content, HCO3⁻, pH, and anion gap after the exercise. The decrease of HCO³⁻ and increase of RR were proportional to age, however the data showed no correlation with the NIHSS. These results suggest relatively preserved respiratory compensation mechanism and homeostatic effect to maintain metabolic balance among the non-brainstem stroke patients.

Ultrasonographic Measurement of Thickness of the Thyrohyoid Muscle: A Pilot Study

OBJECTIVE: To evaluate the normal thickness of the thyrohyoid muscle, which is one of the key muscles related to swallowing, by ultrasonography. METHODS: The thickness of the left and right thyrohyoid muscles was measured in normal male and female adults ranging in age from 20 to 79 years by ultrasonography. The groups were classified according to age as follows: subjects ranging in age from 20 to 39 years were classified into group A, subjects ranging in age from 40 to 59 years were classified into group B, and subjects ranging in age from 60 to 79 years were classified into group C. The measurement level was the line that joins the upper tip of the superior thyroid notch and the oblique line of the thyroid cartilage. Also, a correlation with the thyrohyoid muscle was investigated by collecting information regarding height, weight, body mass index (BMI), age, and gender of subjects in the healthy group. RESULTS: The number of subjects in each group was as follows: group A (n=82), group B (n=62), and group C (n=60). Also, the thicknesses of the left and right muscles were 2.72±0.65 mm and 2.87±0.76 mm in group A, 2.83±0.61 mm and 2.93±0.67 mm in group B, and 2.59±054 mm and 2.73±0.55 mm in group C, respectively. Thyrohyoid muscle had a correlation with height, weight, and BMI. The thickness of the left and right thyrohyoid muscles was greater in male subjects than in female subjects and the right side muscle was thicker than the left side muscle. CONCLUSION: The average thickness of the left and right thyrohyoid muscles was 3.20±0.54 mm in male subjects and 2.34±0.37 mm in female subjects. The thickness of the thyrohyoid muscle was positively correlated with height, weight, and BMI, and the thyrohyoid muscle was thicker in male subjects than in female subjects and the right side muscle was thicker than the left side muscle.

Home Improvement in HIV Primary Care: Investigating the Patient-Centered Medical Home Model for People Living with HIV/AIDS.

This article details the processes and findings of a 3-year demonstration project implementing population health management and the Patient-Centered Medical Home (PCMH) model in 3 community health centers in Alameda County, California. The article provides a first look at the PCMH Continuum, a tool for aiding staff in conceptualizing and implementing complex organizational change. Findings of the project evaluation also are shared, comprising a road map for other organizations looking to implement population health management, panel management, and PCMH. The article reflects on lessons learned and best practices from the demonstration project.

The Effects of the VFSS Timing After Nasogastric Tube Removal on Swallowing Function of the Patients With Dysphagia

OBJECTIVE: To evaluate the effects of the videofluoroscopic swallowing study (VFSS) timing after the nasogastric tube (NGT) removal on swallowing function of the patients with dysphagia. METHODS: This study was conducted on 40 NGT-fed patients with dysphagia. To assess the patients' swallowing function, VFSS was performed twice using a 5-mL 35% diluted barium solution. For the initial examination, VFSS was performed immediately after the NGT removal (VFSS 1). For the second examination, VFSS was performed five hours after the NGT removal (VFSS 2). We used the functional dysphagia scale (FDS) to assess swallowing function. In the FDS, a significant difference in the four items in the oral phase, seven items in the pharyngeal phase, and total scores were assessed (p<0.05). We also used modified penetration-aspiration scale (mPAS) to compare the two examinations (p<0.05). RESULTS: A paired t-test was performed to confirm the statistical significance of the two examinations (p<0.05). The overall swallowing function was assessed as better in VFSS 2 than in VFSS 1. In the FDS, significant differences in the residue in valleculae (p=0.002), the residue in pyriform sinuses (p=0.001), the coating of pharyngeal wall after swallow (p=0.001), and the total scores (p<0.001) were found between the two examinations. Also, in the mPAS that assessed the degree of penetration-aspiration, a significant difference was found between the two examinations (p<0.001). CONCLUSION: The results of this study confirmed that the timing of the VFSS after the NGT removal affects the swallowing function. Thus, to accurately assess the swallowing function, VFSS must be performed in NGT-fed patients after they have rested for a certain period following the removal of their NGT.

The need for high-quality training and surgical standards for adult male circumcision in China / 中华男科学杂志

Although HIV is a significant problem in Africa, HIV infection rates are rising rapidly in other regions such as Asia and South America. International health organizations have recognized the need to develop effective strategies to check the worldwide transmission of HIV. Studies have demonstrated the significant reduction of HIV, HPV, HSV-2 and other STD infection rates with male circumcision (MC). Although numerous MC techniques are available, there are no standardized protocols and surgical training programs. Studies have shown that the standardization of MC techniques coupled with training programs can significantly reduce complication rates. High complication rates have been a primary obstacle to the implementation of MC services. We recommend the establishment of surgical standards and training protocols prior to the promotion of MC services in China.

Alcohol coverage in California newspapers: frequency, prominence, and framing.

The purpose of this study was to investigate the nature and extent of alcohol coverage in California newspapers by examining the frequency, positioning, and framing of alcohol-related articles. A content analysis assessed the frequency and nature of alcohol references in news content drawn from a random sample of nine California newspaper issues from September 1997 to June 1998. The study findings indicate that alcohol is mentioned at least once a day in daily newspapers with more frequent mention in smaller newspapers. Alcohol is most often discussed in relation to trauma or in the context of promoting alcohol consumption. Articles on trauma and driving while intoxicated receive more prominence than other stories mentioning alcohol. Despite the relative frequency of alcohol content in trauma news, these stories are rarely framed with any sort of health context. Public health advocates should work toward increasing the frequency and improving the framing of alcohol in newspaper coverage.

Independent evaluation of the California Tobacco Control Program: relationships between program exposure and outcomes, 1996-1998.

OBJECTIVES: This study sought to determine the effects of the California Tobacco Control Program on tobacco-related attitudes and behaviors. METHODS: In 1996 and 1998, a telephone survey was conducted among adults in randomly selected households in 18 California counties. Tenth-grade youths in 84 randomly selected high schools completed a written survey. In analyses conducted at the county level, differences in outcomes were regressed on an index of program exposure. RESULTS: Among adults, program exposure was associated with decreased smoking prevalence rates, increased no-smoking policies in homes, and decreased violations of workplace no-smoking policies. Among youths, there was no effect of program exposure on outcomes. CONCLUSIONS: These results suggest that the California Tobacco Control Program may have reduced adult smoking prevalence rates and exposure to environmental tobacco smoke.