Lesion activity assessment of early caries using dye-enhanced quantitative light-induced fluorescence.

We aimed to determine whether dye-enhanced quantitative light-induced fluorescence (DEQLF), wherein porous structure of caries lesions is stained with a fluorescent dye, could quantitatively distinguish between active and inactive caries. A total of 126 bovine specimens were prepared to artificially simulate caries activity. Active caries were demineralized with 1% carbopol solution for 3 (A3), 5 (A5), and 10 days (A10). For inactive caries, half specimens in each group were remineralized with 2% NaF and reallocated into three groups (I3, I5, and I10, respectively). Wet specimens were dried with compressed air for 10 s and then dyed with 100-µM sodium fluorescein for 10 s. Fluorescence images of speicmens were captured with a QLF-digital 2 + Biluminator. Fluorescence intensity (ΔG) was measured in fluorescence images of dyed specimens. ΔG between active and inactive groups was compared using independent t-test, and ΔG among active groups (or inactive groups) were compared using ANOVA (α = 0.05). ΔG in the active groups was 33.7-59.0 higher than that in the inactive groups (P < 0.001). Except between I3 and I5, there was significant differences in ΔG according to the demineralization period (P < 0.001). DEQLF might be used to evaluate early caries activity, and longitudinally monitor changes in lesion activity.

Noninvasive detection of microleakage in all-ceramic crowns using quantitative light-induced fluorescence technology.

The early noninvasive detection of crown microleakage is very important for tooth maintenance and preservation. A crown margin in a subgingival position combined with the obscuring effect of a ceramic crown make it difficult to diagnose microleakage using traditional methods such as visual-tactile examinations and radiography. The aim of this study was to determine the effectiveness of quantitative light-induced fluorescence (QLF) technology for diagnosing microleakage in an all-ceramic crown noninvasively. In this study the red fluorescence glow was detected through a crown wall using the Qraycam QLF device (AIOBIO, Seoul, Republic of Korea). No abnormalities were detected by a visual examination, whereas the Qraycam device revealed both strong red fluorescence and fluorescence loss in suspicious lesions, which were confirmed after crown removal. It was possible to determine that the carious lesions inside the crown were related to bacteria-induced microleakage. After performing caries removal and crown reattachment, the red fluorescence glow was no longer detected. QLF examinations made it easy to identify the presence of microleakage in an all-ceramic crown noninvasively based on red fluorescence. These findings indicate that QLF technology can be effectively applied to provide objective evidence for detecting microleakage and diagnosing carious lesions inside an all-ceramic crown noninvasively.

Evaluation of tooth wear by estimating enamel thickness with quantitative light-induced fluorescence technology.

BACKGROUND: Various techniques have been suggested to quantitatively assess tooth wear; most have limited clinical application. The first aim of this in vitro study was to estimate the residual enamel thickness of teeth with various degrees of occlusal wear using quantitative light-induced fluorescence (QLF). The second aim was to identify relationships between the fluorescence parameters of QLF and the conventional tooth wear index (TWI) system. METHODS: Sixty-nine extracted permanent premolars and molars with initial stages of tooth wear (TWI score 1a-2: enamel wear to dentin exposure) were used. Two blinded and trained examiners participated in evaluation procedures. Occlusal QLF-digital (QLF-D) images were acquired for selecting area of interest (AOI) and calculating fluorescence for occlusal tooth wear (ΔFwear) of the AOI by the first examiner. Each specimen was cross-sectioned in the buccal-lingual direction. Enamel thickness from images obtained by stereomicroscopy and TWI of each sample was determined by the second examiner. Spearman correlation was used to determine the relationship of ΔFwear with enamel thickness and TWI. ΔFwear values were compared between histological scores with the Mann-Whitney U test. RESULTS: Seventy-six AOIs were analyzed. As enamel thickness decreased, ΔFwear values significantly increased and strongly correlated with enamel thickness (Spearman rho = -0.825, P < 0.001). There were significant differences in ΔFwear values among TWI scores (P < 0.001); ΔFwear strongly correlated with TWI (Spearman rho = 0.753, P < 0.001). CONCLUSIONS: ΔFwear values, which denote fluorescence difference by using QLF, showed a strong correlation with residual enamel thickness and tooth wear severity.

Assessment of tooth wear based on autofluorescence properties measured using the QLF technology in vitro.

BACKGROUND: The difference in autofluorescence between enamel and dentine layer has prompted recommendations to use the quantitative light-induced fluorescence (QLF) method for quantifying tooth wear (TW). This study investigated the potential of QLF for distinguishing the severity of occlusal TW based on differences in the autofluorescence intensity. METHODS: In total, 106 extracted permanent molars and premolars having suspected wear without pulp exposure were used. The severity of wear was determined by visually examining all teeth using the tooth wear index (TWI) of Smith and Knight. QLF images were captured and converted into 8-bit grayscale images. The difference in the fluorescence intensity (ΔG) was calculated by comparing mean grayscale levels between sound and worn areas. Finally, histological examination was conducted by stereomicroscope to confirm the presence of dentine exposure. RESULTS: 100 teeth were included in the final analysis without six teeth having enamel cracks around worn area. The ΔG values increased with the severity of TW as quantified using conventional TWI codes, and differed significantly between the sound and enamel- and dentine-wear teeth (P < 0.001). The histology indicated that enamel remained on 57 teeth, while 43 teeth had dentine-exposed wear and showed significant differences in ΔG compared with enamel-remained teeth. CONCLUSIONS: The fluorescence intensity differed significantly depending on the presence of dentine exposure. ΔG could be used to distinguish between sound and enamel- and dentine-wear teeth with a significant correlation. These findings indicate that QLF could be useful for determining the severity of TW of occlusal surfaces noninvasively.

Comparison of fluorescence parameters between three generations of QLF devices for detecting enamel caries in vitro and on smooth surfaces.

BACKGROUND: This study compared two fluorescence parameters (fluorescence loss [ΔF] and red fluorescence gain [ΔR]) among three generations of quantitative light-induced fluorescence (QLF) systems with the aim of determining the validities of these parameters in the three devices for differentiating the severity of enamel caries. METHODS: Forty-one extracted human premolars and molars with suspected enamel caries were selected. Fluorescence images of all teeth were obtained using first-, second-, and third-generation QLF systems (Inspektor Pro, QLF-D, and Qraycam, respectively). Fluorescence parameters were then calculated using proprietary software. All of the specimens were also categorized histologically using polarized-light microscopy (PLM) based on histological levels related to the lesion depth into sound enamel (S), caries limited to the outer half of the enamel (E1), and caries involving the inner half of the enamel (E2). The Mann-Whitney test with Bonferroni correction was used to compare fluorescence parameters among the three generations of systems. The sensitivity, specificity, and area under the receiver operating characteristics curve (AUC) at two thresholds (S/E1 for detecting enamel caries lesions and E1/E2 for differentiating the caries severity) were calculated for evaluating the validities of the fluorescence parameters obtained using all three generations of QLF devices. RESULTS: ΔF did not differ significantly between the devices at any histological level. In addition, ΔF showed large AUCs at the thresholds of S/E1 and E1/E2 (0.97-0.98 and 0.89-0.90, respectively). On the other hand, ΔR was significantly higher for the third-generation device than for the first- and second-generation devices for E2 lesions (P < 0.001). At the S/E1 threshold, ΔR values of the first- and third-generation devices showed larger AUCs (0.96-0.97) compared with that of the second-generation device (0.91), whereas at the E1/E2 threshold the AUC was the largest for the third-generation device (0.87). CONCLUSIONS: The ΔF fluorescence parameter did not differ between the three generations of QLF devices, and showed high validity values. In terms of ΔR, the devices of all generations also showed good diagnostic performance for quantifying and detecting enamel caries lesions, but the third-generation QLF system produced superior results.

Integrins αvß5 and αvß6 Mediate IL-4-induced Collective Migration in Human Airway Epithelial Cells.

A positive link between persistent cellular motion and a defective tight junction barrier allows increased antigenic penetration and contact between ligand-receptor pairs, leading to exacerbated allergic airway inflammation and remodeling. Given that collective cell migration involves cell-cell and cell-extracellular matrix adhesions, and given that IL-4 induces epithelial barrier dysfunction and decreases cell-extracellular matrix adhesions, we hypothesized that IL-4 may induce collective migration in the well-differentiated primary human nasal epithelial cells (HNECs). Well-differentiated HNECs were treated with IL-4, and the effects of IL-4 on cell migration were investigated using genetic and pharmacological approaches, live-cell imaging, a vertex model, and immunostaining. IL-4 disrupted the expression and localization of the tight junction proteins zonula occludens 1 and occludin, and it induced the cleavage and asymmetric distribution of E-cadherin in the HNEC layers. It also induced collective epithelial migration and cell shape changes driven by actin cytoskeleton reorganization. In addition, the effect of IL-4 on collective HNEC migration was reversed by pharmacologic and genetic inhibition of the αv-integrin-activating enzyme furin, and function-blocking antibodies for αvß5 or αvß6. In IL-4-stimulated cells, both anti-αvß5 and anti-αvß6 inhibited the phosphorylation of focal adhesion kinase. Furthermore, both ß5- and ß6-integrins were enriched in basal cells in the injured airway epithelium with allergic rhinitis. These findings suggest that αvß5 and αvß6 serve as critical mechanoreceptors in IL-4-induced collective HNEC migration through the focal adhesion kinase signaling pathway. These results have implications for targeting treatment of exacerbation of respiratory allergic diseases.

Caries detection and quantification around stained pits and fissures in occlusal tooth surfaces with fluorescence.

Occlusal discoloration due to staining frequently occurs on the pits and fissures of teeth. Noncariogenic discoloration (non-CD) refers to the attachment of staining chromogens to sound surfaces, whereas cariogenic discoloration (CD) represents the discoloration of porous structures due to bacterial metabolites and mineral loss from the enamel surface. This study evaluated whether it is possible to distinguish between non-CD and CD on stained occlusal surfaces with fluorescence assessed by the quantitative light-induced fluorescence (QLF) technology. Sixty-two extracted human permanent teeth with suspected discolorations on the pit and fissure were examined. The maximum values of fluorescence loss (ΔFmax) and red fluorescence gain (ΔRmax) were calculated using QLF images. Using histology as the gold standard, it was found that 12 teeth were sound (non-CD), while 50 teeth had enamel and dentine caries (CD). The validity tests at the enamel histological caries level, ΔRmax (ρ = 0.80) were strongly correlated with the histology (P < 0.001). At the optimum threshold (105.0) of ΔRmax, it showed high levels of sensitivity and specificity (0.96 and 0.83, respectively). Therefore, QLF can be used to distinguish non-CD from CD on occlusal surfaces using red fluorescence values with high validity.

Quantitative light-induced fluorescence technology for quantitative evaluation of tooth wear.

Various technologies used to objectively determine enamel thickness or dentin exposure have been suggested. However, most methods have clinical limitations. This study was conducted to confirm the potential of quantitative light-induced fluorescence (QLF) using autofluorescence intensity of occlusal surfaces of worn teeth according to enamel grinding depth in vitro. Sixteen permanent premolars were used. Each tooth was gradationally ground down at the occlusal surface in the apical direction. QLF-digital and swept-source optical coherence tomography images were acquired at each grinding depth (in steps of 100 µm). All QLF images were converted to 8-bit grayscale images to calculate the fluorescence intensity. The maximum brightness (MB) values of the same sound regions in grayscale images before (MBbaseline) and phased values after (MBworn) the grinding process were calculated. Finally, 13 samples were evaluated. MBworn increased over the grinding depth range with a strong correlation (r=0.994, P<0.001). In conclusion, the fluorescence intensity of the teeth and grinding depth was strongly correlated in the QLF images. Therefore, QLF technology may be a useful noninvasive tool used to monitor the progression of tooth wear and to conveniently estimate enamel thickness.

Clinical usefulness of ankle brachial index and brachial-ankle pulse wave velocity in patients with ischemic stroke.

Ankle brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) are widely used noninvasive modalities to evaluate atherosclerosis. Recently, evidence has increased supporting the use of ABI and baPWV as markers of cerebrovascular disease. This study sought to examine the relationship between ABI and baPWV with ischemic stroke. This study also aimed to determine which pathogenic mechanism, large artery disease (LAD) or small vessel disease (SVD), is related to ABI or baPWV. Retrospectively, 121 patients with ischemic stroke and 38 subjects with no obvious ischemic stroke history were recruited. First, ABI and baPWV were compared between the groups. Then, within the stroke group, the relevance of ABI and baPWV with regard to SVD and LAD, which were classified by brain magnetic resonance image (MRI) and magnetic resonance angiography (MRA) or computed tomography angiography (CTA) findings, was assessed. The baPWV was higher in the stroke group than non-stroke group (1,944.18±416.6 cm/s vs. 1,749.76±669.6 cm/s, P<0.01). Regarding LAD, we found that mean ABI value was lower in the group with extracranial large artery stenosis (P<0.01), and there was an inverse linear correlation between ABI and the grade of extracranial large artery stenosis (P<0.01). For SVD, there was a significant correlation between SVD and baPWV (2,057.6±456.57 cm/s in the SVD (+) group vs. 1,491±271.62 cm/s in the SVD (-) group; P<0.01). However, the grade of abnormalities detected in SVD did not correlate linearly with baPWV. These findings show that baPWV is a reliable surrogate marker of ischemic stroke. Furthermore, baPWV and ABI can be used to indicate the presence of small vessel disease and large arterial disease, respectively.

Plaque autofluorescence as potential diagnostic targets for oral malodor.

The aim of this study was to determine whether the degree of tongue and interdental plaque can be used to assess oral malodor by quantifying their fluorescence as detected using quantitative light-induced fluorescence (QLF) technology. Ninety-nine subjects who complained of oral malodor were included. The level of oral malodor was quantified using the organoleptic score (OLS) and the concentration of volatile sulfur compounds (VSCs). The fluorescence properties of tongue and interdental plaque were quantified as scores calculated by multiplying the intensity and area of fluorescence in QLF-digital images, and the combined plaque fluorescence (CPF) score was obtained by summing the scores for the two regions. The associations of the scores with malodor levels and the diagnostic accuracy of the CPF score were analyzed. The two plaque fluorescence scores and their combined score differed significantly with the level of oral malodor (p<0.001). The CPF score was moderately correlated with OLS (r=0.64) and VSC levels (r=0.54), and its area under the receiver operating characteristic curve was 0.77 for identifying subjects with definite oral malodor (OLS≥2). In conclusion, plaque fluorescence from tongue and interdental sites as detected using QLF technology can be used to assess the level of oral malodor.

Leptin, pre-existing vascular disease, and increased arteriovenous fistula maturation failure in dialysis patients.

BACKGROUND: The adipocytokine leptin is an independent cardiovascular risk factor and exerts proatherogenic effect. Pre-existing vascular disease is an important cause of arteriovenous fistula (AVF) maturation failure. We explored the association between serum leptin, pre-existing vascular disease, and AVF maturation failure in incident hemodialysis patients. METHODS: Vein samples from 62 patients were collected at the time of AVF creation. Pre-existing vascular disease was evaluated with histologic changes and immunohistochemical characteristics of cellular phenotypes in intima. AVF maturation failure was defined as an AVF that could not be used successfully by the third month after its creation. RESULTS: The prevalence of body mass index ≥30 kg/m2 was 17%, and AVF maturation failure occurred in 28 (45%) patients. Patients within the highest leptin tertile showed significantly higher maturation failure rate, independent of age, gender, diabetes, and body mass index. On histologic examination, significant differences in intimal hyperplasia (13.3 ± 4.5 vs 18.2 ± 5.2 vs 30.3 ± 14.3 µm) and medial thickening (76.8 ± 23.7 vs 103.9 ± 33.6 vs 109.3 ± 36.5 µm) were observed across leptin tertiles. Similarly, medial fibrosis was most severe in the highest tertile. According to the immunohistochemical staining, most intimal cells were α-smooth muscle actin-positive, vimentin-positive, desmin-negative myofibroblasts. However, in the lowest tertile, desmin-positive contractile smooth muscle cells were also frequently observed, suggesting relatively slow phenotypic changes in this group. Furthermore, as leptin tertiles increased, the expression of leptin receptor in the luminal border of intima was significantly decreased. CONCLUSIONS: Obesity-related higher fistula maturation failure rate may be partly mediated by higher leptin level-associated pre-existing vascular diseases in end-stage renal disease patients. Decreased expression of leptin receptor may be related to this association.

Clinical assessment of oral malodor using autofluorescence of tongue coating.

OBJECTIVES: The aim of this study was to evaluate whether a new method using quantitative light-induced fluorescence-digital (QLF-D) was appropriate for the diagnosis of oral malodor by quantifying the fluorescence of tongue coating. METHODS: This study examined 103 healthy subjects who have an oral malodor as a main complaint. The levels of oral malodor were measured by organoleptic scores (OLS) and volatile sulfur compound (VSC) levels. The fluorescent tongue coating images captured by QLF-D were quantified as the integrated fluorescence score (IF score) by multiplying the intensity and area of fluorescence. The correlations between the fluorescence parameters and OLS as well as VSC levels and the diagnostic accuracy of the IF score were evaluated. RESULTS: The IF score of tongue coating showed a significant positive correlation with the OLS (r=0.54, p<0.01) and the VSC levels (r=0.49, p<0.01). This score was significantly differed with the level of oral malodor (p<0.001), and its AUC was 0.72 in identifying the patient with definite oral malodor (≥OLS 2). CONCLUSIONS: A new method quantifying tongue coating fluorescence detected by QLF-D can be used to diagnose oral malodor and assess its severity in the clinical practice.

Effects of dietary Forsythia suspensa on feed utilization, rumen fermentation, and immune response of Korean native goats (Capra hircus) / Efectos de la adición dietaria de Forsythia suspensa sobre utilización del alimento, fermentación ruminal y respuesta inmune en cabras nativas coreanas (Capra hircus) / Efeitos na dieta pela utilização de Forsythia suspensa nos alimentos, fermentação ruminal e resposta imune em caprinos nativos coreanos (Capra hircus)

Background: plant extracts of Forsythia suspensa, which contain pinoresinol, have been proposed as an alternative to antibiotics due to their antioxidant, anti-inflammatory, and microflora modulating effects. Objective: to evaluate the effects of dietary F. suspensa on feed utilization, rumen fermentation, blood parameters and immune response of Korean native goats (Capra hircus). Methods: a total of nine Korean native goats were assigned to one of three dietary treatments: 1) a basal diet without F. suspensa, 2) a basal diet added with 0.25% F. suspensa, or 3) a basal diet added with 0.50% F. suspensa. A change-over design was used in three consecutive periods to give 9 replicates per treatment. Each period lasted 18 days, including 15 days of adaptation to feed and environmental conditions and three days of total collection of feces and urine. Rumen fluid and blood samples were also collected. Nutrient digestibility, nitrogen retention, ruminal content, and blood metabolites—including immunoglobulins—were measured. Results: F. suspensa supplementation had no effect on nutrient digestibility, whole body nitrogen retention rate, ruminal pH, acetate, propionate, isobutyrate, butyrate, isovalerate, or valerate content (p>0.05). However, F. suspensa supplementation decreased total volatile fatty acids (VFA) concentration compared with the control diet, regardless of F. suspensa concentrations (p<0.05). Goats fed a diet containing 0.25% F. suspensa had greater alkaline phosphatase (ALP) concentration than those fed a control or a diet with 0.50% F. suspensa (p<0.05). Feeding different concentrations of dietary F. suspensa did not influence plasma IgA and IgM levels (p>0.05), although goats receiving both 0.25% and 0.50% F. suspensa diets had greater plasma IgG than those fed the control diet (p<0.05). Conclusion: supplementation of 0.25% F. suspensa significantly decreased total VFA concentrations and increased plasma IgG in Korean native goats, compared with those fed the control diet.

Antecedentes: los extractos de la planta Forsythia suspensa contienen pinoresinol. Dicha planta se ha propuesto como una alternativa a los antibióticos debido a su contenido de antioxidantes, antiinflamatorios y sus efectos moduladores de la microflora. Objetivo: evaluar los efectos dietarios de F. suspensa sobre la utilización del alimento, fermentación ruminal, parámetros sanguíneos y respuesta inmune en cabras nativas coreanas (Capra hircus). Métodos: un total de nueve cabras nativas coreanas fueron asignadas a 1 de 3 tratamientos: (1) una dieta basal sin F. suspensa, (2) una dieta basal con 0,25%, o (3) 0,50% de F. suspensa dietaría en un diseño change-over por tres periodos consecutivos con nueve réplicas por tratamiento. Cada periodo se prolongó por 18 días, incluyendo 15 días de adaptación al alimento y a las condiciones ambientales, y tres días de colección total de heces y orina. Tambien se colectó fluido ruminal y muestras sanguineas. Se midió la digestibilidad de nutrientes, nitrógeno retenido, contenido ruminal y metabolitos sanguíneos —incluyendo inmunoglobulinas—. Resultados: la suplementación con F. suspensa no tuvo efecto sobre la digestibilidad de los nutrientes, la tasa de retención de N, pH ruminal, ni sobre los contenidos de acetato, propionato, isobutirato, butirato, isovalerato o valerato (p>0,05). Sin embargo, la suplementación con F. suspensa disminuyo la concentración total de ácidos grasos volátiles (VFA) en comparacion con la dieta control, sin tener en cuenta las concentraciones de F. suspensa (p<0,05). Las cabras alimentadas con la dieta de 0,25% de F. suspensa tuvieron mayor concentración de fosfatasa alcalina (ALP) que cuando fueron alimentadas con la dieta control o con la de 0,50% de F. suspensa (p<0,05). Aunque la alimentación con diferentes concentraciones de F. suspensa no influyo en los niveles de IgA y IgM en plasma (p>0,05), las cabras que recibieron 0,25 y 0,50% de F. suspensa tuvieron mayor concentración de IgG en plasma que aquellas alimentadas con la dieta control (p<0,05). Conclusiones: la suplementación de 0,25% de F. suspensa disminuyo significativamente la concentración total de VFA e incrementó la IgG en el plasma de las cabras nativas coreanas, en comparación con aquellas que consumieron la dieta control.

Antecedentes: a Forsythiae suspensa é uma planta e seu extrato contém pinoresinol. Tem sido proposta como uma alternativa aos antibióticos existentes, devido ao seu teor de antioxidantes, anti-inflamatórias e efeitos moduladores da microflora, com base em estudos feitos in vivo e in vitro. Objetivo: avaliar os efeitos na dieta da inclusão de F. suspensa no aproveitamento alimentar, fermentação ruminal, parâmetros sanguíneos e resposta imune em caprinos coreanos nativos (Capra hircus). Métodos: um total de nove cabras coreanas nativas foram assignadas a um de três tratamentos na dieta: (1) uma dieta basal sem F. suspensa, (2) uma dieta basal com 0,25% de F. suspensa, ou (3) com 0,50% de F. suspensa na dieta. Se fez um desenho change-over por três períodos consecutivos com nove repetições por tratamento. Cada período de pesquisa consistiu de 18 dias, incluindo 15 dias de adaptação às condições alimentares e ambientais, e três dias de coleta total de fezes e urina. Também foram coletadas amostras de líquido ruminal e sangue. Mediou-se a digestibilidade dos nutrientes, o nitrogênio (N) retido, o conteúdo ruminal, e os parâmetros sanguíneos —incluindo imunoglobulinas—. Resultados: a suplementação com F. suspensa não teve nenhum efeito sobre a digestibilidade dos nutrientes, a taxa de retenção de N, o pH do rúmen, nem sobre os conteúdos de: acetato, propionato, isobutirato, butirato, isovalerato e valerato (p>0,05). No entanto, a suplementação de F. suspensa diminuiu a concentração total de ácidos gordurosos voláteis (AGV) em comparação com a dieta controle, independentemente das concentrações de F. suspensa (p<0,05). As cabras alimentadas com 0,25% F. suspensa na dieta tiveram maiores quantidades da enzima fosfatasse alcalina (ALP) do que quando elas foram alimentadas com a dieta controle ou com 0,50% de F. suspensa (p<0,05). Ainda que a alimentação com diferentes níveis de F. suspensa não influenciou os níveis de IgA e IgM no plasma (p>0,05), as cabras que receberam na dieta 0,25 e 0,50% de F. suspensa tiveram uma maior concentração de IgG no plasma comparadas as cabras alimentadas com a dieta controle (p<0,05). Conclusões: a suplementação com 0,25% e 50% diminuiu significativamente a concentração de AGV e incrementou a concentração em plasma de IgG em cabras nativas coreanas comparadas com aquelas que consumiram a dieta controle.

Noninvasive Qureshi Grading Scheme Predicts 90-Day mRS in Patients with Acute Ischemic Stroke.

BACKGROUND: The Qureshi grading scheme is an effective classification system for evaluating the severity of acute arterial occlusion. However, this scheme is of limited utility because it is based on invasive angiography. In this study, we assessed whether a relationship between a noninvasive Qureshi score, based on magnetic resonance angiography (MRA) or computed tomography angiography (CTA), and 90-day functional outcome could be observed in patients with acute ischemic stroke. METHODS: A stroke neurologist evaluated all patients with acute ischemic stroke who presented to the emergency room within 12 hour of symptom onset. Two neurologists independently assessed the noninvasive Qureshi score from initial MRA or CTA. We assessed the relationship between the noninvasive Qureshi grading scheme and clinical outcome on day 90. RESULTS: Of a total 125 patients, 75 underwent MRA and 50 underwent CTA. Interobserver reliability showed good agreement (κ = .62). The noninvasive Qureshi score for MRA or CTA and that for CTA alone were directly associated with a good 90-day functional outcome (odds ratio, .672; P = .016 and odds ratio, .511; P = .042). CONCLUSIONS: The noninvasive Qureshi scheme using MRA or CTA provides meaningful information about long-term functional outcomes in patients with acute ischemic stroke.

A randomized controlled trial of comparison on time and rate of cecal and termianl Ileal intubation according to adult-colonoscope length: intermediate versus long.

For a complete colonoscopic examination, a high intubation rate and a short intubation time have been demanded to colonoscopists, if possible. The aim of the present study was to compare these examination parameters, intubation time and rate, according to the length of colonoscope. A total of 507 healthy Korean subjects were randomly assigned into two groups: intermediate length adult-colonoscope (n=254) and long length adult-colonoscope (n=253). There were significant differences in cecal intubation time and in terminal ileal intubation rate according to the length of the colonoscope. Time-to-cecal intubation was shorter for the intermediate-scope group than for the long-scope group (234.2 ± 115.0 sec vs 280.7 ± 135.0 sec, P < 0.001). However, the success rate of terminal ileal intubation was higher in the long-scope group than in the intermediate-scope group (95.3% vs 84.3%, P < 0.001). There were no significant differences in other colonoscopic parameters between the two groups. The intermediate length adult-colonoscope decreased the time to reach the cecum, whereas the long-scope showed a success rate of terminal ileal intubation. These findings suggest that it is reasonable to prepare and use these two types of colonoscope appropriate to the needs of the patient and examination, instead of employing only one type of colonoscope.

Use of tissue expansion to allow reconstruction of the back after wide resection of a diffuse neurofibroma.

Diffuse neurofibroma presents as a diffuse overgrowth of subcutaneous tissue, and usually involves the face, scalp, neck, or chest, but rarely occurs in the back. The management of large soft tissue defects after wide resection of a diffuse neurofibroma is a major surgical challenge. We report the case of a diffuse neurofibroma of the back that required reconstruction after wide resection of the tumour using an expanded myocutaneous advancement flap and a tissue expander. Tissue expansion is essentially a simple technique for expanding available normal skin, and it provides optimally matched skin in terms of colour, texture, hair-bearing qualities, and sensation.

Can subcortical infarction cause apraxia of eyelid opening?

Apraxia of eyelid opening is the inability to voluntarily open the eyes in the absence of motor dysfunction or blepharospasm. It has been described mostly in association with extrapyramidal diseases and only rarely in cortical lesions. We report a right-handed woman with a right subcortical lesion due to borderzone infarction showing eyelid opening apraxia.

Reversible splenium lesion of the corpus callosum in hemorrhagic fever with renal failure syndrome.

This is the first case of virus-associated encephalitis/encephalopathy in which the pathogen was Hantaan virus. A 53-yr-old man presented fever, renal failure and a hemorrhagic tendency and he was diagnosed with hemorrhagic fever with renal failure syndrome (HFRS). In the course of his illness, mild neurologic symptoms such as dizziness and confusion developed and magnetic resonance images revealed a reversible lesion in the splenium of the corpus callosum. This case suggests that HFRS patients with neurologic symptoms like dizziness and mental slowing should be considered to have structural brain lesions and to require brain imaging studies.

Use of the descending branch of lateral circumflex femoral artery as a recipient pedicle for coverage of a knee defect with free flap: anatomical and clinical study.

BACKGROUND: With recent advances in free tissue transfer, soft tissue defects involving the knee can be covered perfectly utilizing various free flaps. Yet the success of this operation depends on a secure nontraumatic recipient pedicle around the knee area. The purpose of this study is to introduce the descending branch (DB) of the lateral circumflex femoral artery (LCFA) as a new recipient pedicle for knee defect coverage. METHODS: Through autopsies of eight cadavers and a total of 11 extremities involving the area 10- and 15-cm above the upper margin of the patella, the number and sizes of the artery and vein of the descending branch of the lateral circumflex femoral artery were investigated. In a clinical setting, two cases of soft tissue defects in the area of the knee were reconstructed utilizing the DB of the LCFA with an anterolateral thigh perforator (ALTP) free flap on the ipsilateral side. RESULTS: Anatomical: The descending branches of the lateral circumflex femoral vessels measuring 10- and 15-cm above the lateral aspect of the patella numbered 1 artery and about 1.5 veins. The diameters of these vessels ranged from 1.0 to 2.0 mm (1.4 +/- 0.4 mm) for the artery at 10-cm site and 1.0 to 3.0 mm (1.9 +/- 0.5 mm) at the 15-cm site and 0.8 to 2.0 mm (1.2 +/- 0.4 mm) for the vein at the 10-cm site and 1.0 to 3.0 mm (1.9 +/- 0.5 mm) at the 15-cm site. Under clinical conditions, the two case flaps survived well without major complications. The clinical follow-up period was from 12 to 14 months (mean: 13 months). CONCLUSIONS: The advantage in using this recipient pedicle lies not only in its superficial aspect but also in the protection offered by the surrounding muscle. Thus the defect could be reconstructed efficiently without stress upon the surgeon; if the ALTP flap of the ipsilateral side was used, the defect could be reconstructed efficiently within the same surgical field.

Comparision of remifentanil and remifentanil/midazolam for outpatient anesthesia in prolotherapy.

BACKGROUND: Prolotherapy is a therapeutic procedure used for chronic musculoskeletal and arthritic pain. It involves injecting an irritant solution to pain sites and causes patient discomfort, which can lead to treatment discontinuation. Remifentanil is an ultra short-acting micro-opiate receptor agonist that permits a rapid transition from intense analgesia to a minimal residual effect. Here, we evaluated the effect of remifentanil as a preparative medication for ambulatory prolotherapy. METHODS: Eighty patients taking prolotherapy were assigned into three groups for pre-therapeutic injections: remifentanil 0.1 microgram/kg/min alone (Group R), remifentanil 0.05 microgram/kg/min with midazolam 2 mg (Group M), and normal saline (Group C). Pain and sedation scores, blood pressure, pulse oxygen saturation, heart rate, satisfaction score, and time to discharge were measured. RESULTS: Pain scores in groups M and R were lower than group C during and after prolotherapy. The sedation score of group M was higher than groups R and C. Nine patients in group R experienced dizziness during prolotherapy. In group M, 8 patients experienced dizziness and 2 patients experienced nausea. There was no difference in time to discharge among all groups. Satisfaction scores in group M (7.3 +/- 0.8) and group R (7.0 +/- 0.8) were higher than that of group C (5.3 +/- 0.6). CONCLUSIONS: Remifentanil and remifentanil/midazolam effectively reduce the pain produced by prolotherapy.