Outcome of intraoperative injection of collagen in arthroscopic repair of full-thickness rotator cuff tear: a retrospective cohort study.

BACKGROUND: Rotator cuff (RC) pathologies are considered the most common cause of shoulder disability and pain. Arthroscopic repair of RC tears has proven to be an effective operation. Nonhealing and retear remain significant clinical problems and a challenge to surgeons. In addition, the essential biological augment to enhance RC tendon-bone healing is still under research. The purpose of the study was to assess the safety and efficacy of injection of atelocollagen and acellular dermal matrix (ADM) allograft in arthroscopic repair of full-thickness RC tears. METHODS: From January 2018 to March 2020, a total of 129 patients with full-thickness RC tear were treated by arthroscopic repair only (group 1, n = 36, with a mean age = 63.2 years), arthroscopic repair together with atelocollagen 1-mL injection (group 2, n = 44, with a mean age = 63 years), or RC tears together with ADM allograft 1-mL injection (group 3, n = 49, with a mean age = 64.6 years). They were prospectively studied. This study included patients with a repairable full-thickness tear of the supraspinatus tendon size <5 cm. We excluded patients with isolated tears of the subscapularis tendon, those with a previous shoulder surgery, and those who had any type of injection for less than 6 weeks. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, Constant Shoulder score, visual analog scale pain score, and range of motion were evaluated preoperatively, at 3, 6, and 12 months of the postoperative period and the final follow-up. In addition, magnetic resonance imaging was performed at 2 months and 12 months postoperatively. RESULTS: The mean follow-up period was 20 months. All groups showed improvement in functional and pain score at the final follow-up; however, there is no superior outcome among the 3 groups (P > .05). After 2 months, the nonhealing rate was 11% (4 of 36) for group 1, 4% (2 of 44) for group 2, and 2% (1 of 49) for group 3 (P > .05). The retear rates after 12 months was 19.4% (7 of 36) for group 1, 13.6% (6 of 44) for group 2, and 20.4% (10 of 49) for group 3 (P > .05). Adverse events were not detected in any groups. CONCLUSION: Our study did not show superior clinical or radiologic outcomes of atelocollagen and ADM allograft injections in arthroscopic RC repair over 12 months of follow-up in comparison to the control group. However, adverse events related to atelocollagen and ADM allograft injection were not observed.

Synthesis of Monodisperse Bi-Compartmentalized Amphiphilic Janus Microparticles for Tailored Assembly at the Oil-Water Interface.

Janus particles endowed with controlled anisotropies represent promising building blocks and assembly materials because of their asymmetric functionalities. Herein, we show that using the seeded monomer swelling and polymerization technique allows us to obtain bi-compartmentalized Janus microparticles that are generated depending on the phase miscibility of the poly (alkyl acrylate) chains against the polystyrene seed, thus minimizing the interfacial free energy. When tetradecyl acrylate is used, complete compartmentalization into two distinct bulbs can be achieved, while tuning the relative dimension ratio of compartmented bulb against the whole particle. Finally, we have demonstrated that selectively patching the silica nanoparticles onto one of the bulb surfaces gives amphiphilicity to the particles that can assemble at the oil-water interface with a designated level of adhesion, thus leading to development of a highly stable Pickering emulsion system.

Age-dependent association between cigarette smoking on white matter hyperintensities.

Previous reports have shown that cigarette smoking is associated with white matter hyperintensities (WMHs). However, it remains unclear whether this is true for all ages. We investigated the association between cigarette smoking, WMHs, and age. We retrospectively reviewed charts from 595 patients, who presented as outpatients from January 2007 to March 2010. Grading of periventricular WMHs (PVWMHs) and the scores of deep WMHs (DWMHs) was determined based on criteria established by the Rotterdam Scan Study. We compared the degree of WMHs between smokers and non-smokers, and those younger than the age of 65 years versus those above. In younger age group, smokers had higher grades of PVWMHs and more microbleeds than non-smokers. In the older age group, total burden of DWMHs was much greater in smokers than nonsmokers. Multivariate regression analysis showed that cigarette smoking was an independent risk factor for PVWMHs in the younger age group and for DWMHs in the older age group. The location of WMHs in association with smoking seems to differ among age groups. Age should be considered when interpreting the effects of smoking on the brain.

Familial hemiplegic migraine with prolonged coma and cerebellar atrophy: CACNA1A T666M mutation in a Korean family.

We report the first Korean patient with familial hemiplegic migraine type 1, with clinical and multimodal imaging findings. A 43-yr-old man was admitted for right hemianopia and aphasia, followed by coma. MRI showed only cerebellar atrophy. CT angiography showed mild vasodilation of intracranial blood vessels and increased vascularity in the left hemisphere and perfusion-weighted imaging showed elevated cerebral blood flow. Gene analysis of the patient and his mother led to the identification of a heterozygous point mutation (1997C→T, T666M) in exon 16 of the CACNA1A gene. Familial hemiplegic migraine should be considered in patients with episodic neurological dysfunction with cerebellar atrophy.

Narrow band imaging versus white light for detecting sessile serrated lesion: A prospective randomized multicenter study.

Objectives: Colonoscopy is the gold standard diagnostic test used to detect early colorectal lesions and prevent colorectal carcinoma. Narrow band imaging (NBI) is an imaging technique that provides improved image resolution of the mucosa during endoscopy. Whether NBI improves the detection of sessile serrated lesion (SSL) is controversial-our aim was to assess this during routine colonoscopy. Methods: We conducted a multicenter, prospective, randomized, controlled trial. Patients underwent colonoscopy for screening, surveillance, or symptoms. They were randomized to either high-definition white light (HD-WL) or NBI in a 1:1 ratio. The primary outcome was SSL detection rate. Secondary outcomes were adenoma detection rate (ADR) and polyp detection rate (PDR). Results: A total of 400 patients were randomized to NBI (N = 200) or HD-WL (N = 200). The total colonoscopy time was slightly longer in the NBI group compared to HD-WL (median time 14 vs. 12 min, p = 0.033). There were no statistically significant differences in SSL detection rate (7.5% NBI vs. 8.0% HD-WL; p = 0.852), ADR (41.0% NBI vs. 37.5% HD-WL; p = 0.531), or PDR (61.0% NBI vs. 54.0% HD-WL; p = 0.157) between the two groups. No significant predictors of SSL detection were found on univariable or multivariable analysis. Increasing age and increased withdrawal time were an independent predictors of polyp detection and increasing age was also an independent predictor of adenoma detection on multivariable analysis. Conclusion: In the hands of experienced colonoscopists, NBI does not improve SSL detection compared to HD-WL. Withdrawal time and patient age remain important factors for polyp and adenoma detection.

Self-Patterned Stretchable Electrode Based on Silver Nanowire Bundle Mesh Developed by Liquid Bridge Evaporation.

A new strategy is required to realize a low-cost stretchable electrode while realizing high stretchability, conductivity, and manufacturability. In this study, we fabricated a self-patterned stretchable electrode using a simple and scalable process. The stretchable electrode is composed of a bridged square-shaped (BSS) AgNW bundle mesh developed by liquid bridge evaporation and a stretchable polymer matrix patterned with a microcavity array. Owing to the BSS structure and microcavity array, which effectively concentrate the applied strain on the deformable square region of the BSS structure under tensile stretching, the stretchable electrode exhibits high stretchability with a low ΔR/R0 of 10.3 at a strain of 40%. Furthermore, by exploiting the self-patterning ability-attributable to the difference in the ability to form liquid bridges according to the distance between microstructures-we successfully demonstrated a stretchable AgNW bundle mesh with complex patterns without using additional patterning processes. In particular, stretchable electrodes were fabricated by spray coating and bar coating, which are widely used in industry for low-cost mass production. We believe that this study significantly contributes to the commercialization of stretchable electronics while achieving high performance and complex patterns, such as stretchable displays and electronic skin.

Effect of Konjac Glucomannan (KGM) on the Reconstitution of the Dermal Environment against UVB-Induced Condition.

Skin layers serve as a barrier against unexpected critical changes in the body due to environmental factors. Excessive ultraviolet (UV) B exposure increases the levels of age-related factors, leading to senescent cells and damaged skin tissues. Widely used as a dietary supplement, konjac (Amorphophallus konjac) glucomannan (KGM) has shown skin regeneration potential in patch or sheet form with anti-inflammatory or immunosuppressive effects. However, the ability of KGM to reconstitute senescent/damaged skin following UV radiation has not been explored. Here, we demonstrate that KGM alleviates skin damage by increasing the proportion of young cell populations in UVB-exposed senescent human epidermal primary melanocytes. Young cell numbers increased depending on KGM dosage, but the senescent cells were not removed. Real-time quantitative polymerase chain reaction (RT-qPCR) and Western blot analysis showed that mRNA and protein levels of age- and pigmentation-related factors decreased in a manner dependent on the rate at which new cells were generated. Moreover, an analysis of mRNA and protein levels indicated that KGM facilitated youth by increasing cell proliferation in UVB-damaged human fibroblasts. Thus, KGM is a highly effective natural agent for maintaining skin homeostasis by promoting the reconstitution of the dermal environment against UVB-induced acute senescence or skin damage.

Rotator cuff tear with joint stiffness: a review of current treatment and rehabilitation.

Repair of the rotator cuff tear is a joint-tightening procedure that can worsen joint stiffness. This paradoxical phenomenon complicates treatment of rotator cuff tear with joint stiffness. As a result, there is controversy about how and when to treat joint stiffness. As many treatments have been published, this review discusses the latest findings on treatment of rotator cuff tear with joint stiffness.

Proteomic Classification and Identification of Proteins Related to Tissue Healing of Platelet-Rich Plasma.

BACKGROUND: Platelet-rich plasma (PRP) is a plasma component of autologous blood containing a high concentration of platelets. PRP is used to promote healing of damaged tissues. However, there are not many studies on the composition and expression patterns of active proteins in PRP. The purpose of this study was to identify unknown factors that contribute to tissue healing by proteomic analysis of proteins in PRP. METHODS: Three men in their 30s with no basal disease participated in this study. All identified proteins were classified for tissue healing-related functions on the basis of the gene ontology analysis of adhesion molecule with Ig-like domain 2 (AmiGO2). PRP was prepared by using the ACP kit and GPS III kit. RESULTS: We identified a total of 125 proteins related to wound healing, along with three proteins for angiogenesis involved in wound healing, two proteins for fibroblast migration, four proteins for collagen biosynthesis process, two proteins for glycosaminoglycan biosynthesis process, and 13 proteins for glycosaminoglycan binding. So, in addition to the growth factors that have been already known to be involved in tissue healing, 25 new proteins were identified. CONCLUSIONS: We identified the unknown proteins associated with tissue healing in PRP. Our findings may serve as a foundation for the establishment of basic medical evidence for PRP applications.

17-Allylamino-17-demethoxygeldanamycin down-regulates hyaluronic acid-induced glioma invasion by blocking matrix metalloproteinase-9 secretion.

Hyaluronic acid (HA) has been implicated in cell adhesion, motility, and tumor progression in gliomas. We previously reported that HA stimulates secretion of matrix metalloproteinase-9 (MMP-9) and induces glioma invasion. However, the molecular mechanism of HA action and therapeutic strategies for blocking HA-induced MMP-9 secretion remain unknown. Here, we report that the Hsp90 inhibitor 17-allylamino-17-demethoxygeldanamycin (17-AAG) blocks MMP-9 secretion and that HA-induced nuclear factor-kappaB (NF-kappaB) activation is mediated by IkappaB kinase, which phosphorylates the NF-kappaB inhibitor IkappaBalpha and promotes its degradation. In addition, using an RNA interference approach, we show that the focal adhesion kinase plays a critical role in mediating HA-induced NF-kappaB activation, which resulted in increased MMP-9 expression and secretion, cell migration, and invasion. Importantly, we show that 17-AAG acts by blocking focal adhesion kinase activation, thereby inhibiting IkappaB kinase-dependent IkappaBalpha phosphorylation/degradation, NF-kappaB activation, and MMP-9 expression. This leads to suppression of HA-induced cell migration and invasion. Based on our data, we propose that 17-AAG is a candidate drug for treatment of highly invasive gliomas resulting from HA-induced, NF-kappaB-mediated MMP-9 secretion.

Monodisperse polystyrene-silica core-shell particles and silica hollow spheres prepared by the Stöber method.

Monodisperse polystyrene (PS) bead particles (diameter approximately 750 nm) have been synthesized with an initiator, 2,2'-azobis(2-methylpropionamidine) dihydrochloride (AIBA), using a surfactant-free emulsion polymerization. The PS particles charged positively by the cationic initiator exhibit uniform size with a narrow size distribution. The Stöber method was adopted to coat silica on the surface of the PS particles. The silica coatings were performed on different conditions; pH (10.0-12.5), tetraethylorthosilicate (TEOS) concentration (10-40 mM), and reaction time (1-5 h). The reaction rates are too low at low pH (10.0) so that no or little silica is coated on the PS bead particles. At high pH condition (approximately 12.5) relatively rough silica shell and heterogeneous nucleation of silica colloids were observed due to high reaction rate of TEOS hydrolysis and condensation reaction. Smooth surface with uniform thickness of silica shells were obtained at a pH value around 11. Also, the thickness of silica coated on the PS spheres increases with increase of TEOS concentration and reaction time. Silica hollow spheres were also obtained by calcination of the PS-silica core-shell particles.

A study on the synthesis of polystyrene-silica nanocomposite particles by soap-free emulsion polymerization using cationic initiator in company with colloidal silica sol solution.

Nano-sized polystyrene (PS)-silica nanocomposite particles have been prepared by soap-free emulsion polymerization using a cationic initiator, 2,2'-azobis(isobutyramidine) hydrochloride (AIBA) with a colloidal silica (Ludox SM30, 7 nm diameter). The cationic initiator leads to the formation of the PS-silica nanocomposite particles by electrostatic interaction with negatively charged silica particles. Morphology, particle size distribution, reactivity and silica content of the particles were monitored on different reaction conditions such as pH, the addition time of silica sol and the amount of the silica sol. It is found that the nucleation of styrene monomer depends on the pH of water medium, the addition time of silica, the presence of silica in polymerization system. The reaction whose styrene monomer didn't react in water medium with pH 10 was progressed in the presence of silica sol to give nanocomposite particles. In the condition of constant pH 10 in the polymerization system, the increase of the amount of silica gave little influence to the changes in the particle size and particle size distribution of nanocomposite particles. The changes in the pH of medium gave much influence on the particle size and particle size distribution due to the changes in ionic interaction of silica and initiator. The silica content absorbed on the nanocomposite particles decreases with decreasing the pH values in the polymerization media.

Prospective Clinical Research of the Efficacy of Platelet-rich Plasma in the Outpatient-based Treatment of Rotator Cuff Tendinopathy.

BACKGROUND: The purpose of this study is to compare the clinical outcomes of the control group and platelet-rich plasma (PRP) group among the patients who failed to respond to conservative treatment as outpatient-based therapy for rotator cuff tendinopathy, and to compare the clinical results of leukocyte-poor (LP) PRP and leukocyte-rich (LR) PRP. METHODS: Inclusion criteria are (1) over 18-year-old, (2) patients with rotator cuff tendinopathy, no rotator cuff tear by radiologic diagnosis (ultrasonography or magnetic resonance imaging) within the last 3 months, and (3) not effective to conservative treatment for more than 1 month. Of the final 60 subjects, 33 patients in the exercise treatment group and 27 patients in the PRP injection group (LP-PRP, 13; LR-PRP, 14) were included. Clinical evaluation was carried out by assessing the outcomes of treatment using the Numeric Rating Scale pain score, the American Shoulder and Elbow Society (ASES) score, and the Constant score at baseline and at 3 and 6 months after the procedure. RESULTS: There was a statistically significant difference in ΔASES3months (ASES3months-ASESfirst) score between the control and PRP groups (p=0.006). However, there was no statistical significance between LP-PRP and LR-PRP groups (p>0.05). CONCLUSIONS: This study showed that PRP injection was more effective than exercise therapy for the first 3 months. However, there was no difference between the LP-PRP group and the LR-PRP group. Regardless of the type of PRP, clinical application of PRP injection in patients with rotator cuff tendinopathy seems to be effective in early treatment.

Intense-pulsed-UV-converted perhydropolysilazane gate dielectrics for organic field-effect transistors and logic gates.

We fabricated a high-quality perhydropolysilazane (PHPS)-derived SiO2 film by intense pulsed UV irradiation and applied it as a gate dielectric layer in high-performance organic field-effect transistors (OFETs) and complementary inverters. The conversion process of PHPS to SiO2 was optimized by varying the number of intense pulses and applied voltage. The chemical structure and gate dielectric properties of the PHPS-derived SiO2 films were systematically investigated via Fourier transform infrared spectroscopy and leakage current measurements, respectively. The resulting PHPS-derived SiO2 gate dielectric layer showed a dielectric constant of 3.8 at 1 MHz and a leakage current density of 9.7 × 10-12 A cm-2 at 4.0 MV cm-1. The PHPS-derived SiO2 film was utilized as a gate dielectric for fabricating benchmark p- and n-channel OFETs based on pentacene and N,N'-dioctyl-3,4,9,10-perylenedicarboximide (PTCDI-C8), respectively. The resulting OFETs exhibited good electrical properties, such as carrier mobilities of 0.16 (±0.01) cm2 V-1 s-1 (for the pentacene OFET) and 0.02 (±0.01) cm2 V-1 s-1 (for the PTCDI-C8 OFET) and an on-off current ratio larger than 105. The fabrication of the PHPS-derived SiO2 gate dielectric layer by a simple solution process and intense pulsed UV irradiation at room temperature serves as a novel approach for the realization of large-area flexible electronics in the flexible device industry of the future.

Use of a life-size three-dimensional-printed spine model for pedicle screw instrumentation training.

BACKGROUND: Training beginners of the pedicle screw instrumentation technique in the operating room is limited because of issues related to patient safety and surgical efficiency. Three-dimensional (3D) printing enables training or simulation surgery on a real-size replica of deformed spine, which is difficult to perform in the usual cadaver or surrogate plastic models. The purpose of this study was to evaluate the educational effect of using a real-size 3D-printed spine model for training beginners of the free-hand pedicle screw instrumentation technique. We asked whether the use of a 3D spine model can improve (1) screw instrumentation accuracy and (2) length of procedure. METHODS: Twenty life-size 3D-printed lumbar spine models were made from 10 volunteers (two models for each volunteer). Two novice surgeons who had no experience of free-hand pedicle screw instrumentation technique were instructed by an experienced surgeon, and each surgeon inserted 10 pedicle screws for each lumbar spine model. Computed tomography scans of the spine models were obtained to evaluate screw instrumentation accuracy. The length of time in completing the procedure was recorded. The results of the latter 10 spine models were compared with those of the former 10 models to evaluate learning effect. RESULTS: A total of 37/200 screws (18.5%) perforated the pedicle cortex with a mean of 1.7 mm (range, 1.2-3.3 mm). However, the latter half of the models had significantly less violation than the former half (10/100 vs. 27/100, p < 0.001). The mean length of time to complete 10 pedicle screw instrumentations in a spine model was 42.8 ± 5.3 min for the former 10 spine models and 35.6 ± 2.9 min for the latter 10 spine models. The latter 10 spine models had significantly less time than the former 10 models (p < 0.001). CONCLUSION: A life-size 3D-printed spine model can be an excellent tool for training beginners of the free-hand pedicle screw instrumentation.

Anatomical variations of vertebral artery and C2 isthmus in atlanto-axial fusion: Consecutive surgical 100 cases.

VA anomalies in extra- and intraosseous regions of the craniovertebral junction (CVJ) is considered very carefully during the posterior screw fixation for the atlantoaxial instability (AAI). This study aims to compare the incidence and variations of VA anomalies, isthmus and pedicle size of C2 in 100 patients with AAI due to congenital skeletal anomaly (CSA) and acquired disease by using three-dimensional CT angiograms (3D CTA) before surgery. The CSA group contained 48 patients and the acquired disease group consisted of 52. In the CSA group, Os odontoideum was the major cause with 43 patients. The causes of acquired disease were RA in 16 patients and OA in 36 patients. Five patients had the anomalous VA in only CSA group; fenestration 2 patients and persistent first intersegmental (PFIS) artery 3 patients. Between CSA and acquired disease groups, no significant differences were found in the isthmus height, internal height, and pedicle width of C2 except the right internal height that is bigger in CSA group. The high-riding VA (isthmus height <4 mm or internal height <2 mm) had no significant difference between CSA group (27.1%) and acquired disease group (34.6%). However, in acquired disease group, patients with rheumatoid arthritis had smaller left internal height (4.21 ±â€¯1.63 vs. 5.51 ±â€¯1.83 mm) and pedicle width (4.11 ±â€¯1.05 vs. 5.05 ±â€¯1.66 mm) of C2 than those of patients with degenerative osteoarthritis. Therefore, in the case of atlantoaxial fusion, we should contemplate VA anomaly and the high-riding VA, especially in patients with CSA and RA.

Targeted and non-targeted metabolite identification of MAM-2201 in human, mouse, and rat hepatocytes.

MAM-2201 is a fluorinated naphthoylindole synthetic cannabinoid with potent psychoactive properties that has been detected as an active ingredient in herbal incense blends. To gain a greater understanding of MAM-2201 metabolism and to compare its metabolic fate in humans with those in animals, the metabolism of MAM-2201 in human, mouse, and rat hepatocytes was investigated using liquid chromatography-high-resolution mass spectrometry combined with targeted and non-targeted metabolite profiling approaches. Nineteen phase I metabolites (M1-M19) reported previously in human liver microsomes and 13 novel metabolites were identified in human, mouse, and rat hepatocytes: 1 phase I metabolite (M20) and 12 phase II metabolites including 6 glucuronides (G1-G6), 1 sulfate (S1), and 5 glutathione (GSH) conjugates (GS1-GS5) of MAM-2201 metabolites. G3 was human-specific, but M20, G1, G2, and 5 GSH conjugates were rat-specific, indicating species-related differences in MAM-2201 metabolism. The findings in the present study can be useful for the experimental design and assessment of metabolism-mediated toxic risk of MAM-2201.

Leukocyte-Poor Platelet-Rich Plasma-Derived Growth Factors Enhance Human Fibroblast Proliferation In Vitro.

BACKGROUND: Leukocyte-poor platelet-rich plasma (LP-PRP) from peripheral blood is currently used as a concentrated source of growth factors to stimulate repair at sites of soft tissue injury. Fibroblasts are primary mediators of wound healing. Thus, we aimed to assess the positive effect of LP-PRP on human fibroblast proliferation in vitro. METHODS: LP-PRP was prepared from 49 donors. The fibroblasts were seeded, and at 24 hours after seeding, 1 × 107/10 µL LP-PRP was added once to each well. The cells were harvested 10 times during study period at our planned points, and we examined cell proliferation using the water-soluble tetrazolium salt-1 assay. We collected the supernatants and measured the amount of growth factors such as platelet-derived growth factor (PDGF)-AB/BB, insulin-like growth factor-1 (IGF-1), transforming growth factor-ß1 (TGF-ß1), and vascular endothelial growth factor (VEGF), which are known to be involved in wound healing processes, by multiplex assay. RESULTS: Human fibroblasts treated with LP-PRP showed a significant increase in proliferation when compared to untreated controls (p < 0.001 at days 4, 6, and 8). Multiplex cytokine assays revealed various secretion patterns. PDGF-AB/BB appeared at early time points and peaked before fibroblast proliferation. IGF-1 and TGF-ß1 secretion gradually increased and peaked on days 4 and 6 post-treatment. The early VEGF concentration was lower than the concentration of other growth factors but increased along with cell proliferation. CONCLUSIONS: Platelets in LP-PRP release growth factors such as PDGF, IGF-1, TGF-ß1 and VEGF, and these growth factors have a promoting effect for human fibroblast proliferation, one of the important mediators of wound healing. These results suggest that growth factors derived from LP-PRP enhance the proliferation of human fibroblast.

Rapid analysis of drugs of abuse and their metabolites in human urine using dilute and shoot liquid chromatography-tandem mass spectrometry.

Liquid chromatography-tandem mass spectrometric method for analysis of 113 abuse drugs and their metabolites in human urine was developed and validated. A simple sample clean-up procedure using the "dilute and shoot" approach, followed by reversed phase separation, provided a fast and reliable method for routine analysis. Drugs were separated in a Capcell Pak MG-III C18 column using a gradient elution of 1 mM ammonium formate with 0.1% formic acid in water and acetonitrile. The total time for analysis was 32 min. The multiple reaction monitoring mode using two transitions (e.g., quantifier and qualifier) was optimized for both identification and determination. The calibration curves for each analyte were linear over the concentration ranges of 1-100, 5-100, or 10-100 ng/mL using 400 µL of human urine sample with the coefficient of determination above 0.9921. The coefficient of variation and accuracy for the intra- and inter-assays of the tested drugs at three QC levels were 1.1-14.6 and 86.7-106.8%, respectively. The present method was successfully applied to the analysis of forensic urine samples obtained from 17 drug abusers. This method is useful for the rapid and accurate determination of multiple drug abuse with a small amount of urine in forensic and clinical toxicology.

Neurosyphilis Mimicking Creutzfeldt-Jakob Disease.

BACKGROUND: As rapidly progressive dementia (RPD), general paresis and Creutzfeldt-Jakob disease (CJD) may have overlapping clinical presentation due to a wide variety of clinical manifestations. CASE REPORT: A 57-year-old man presented with rapid progressive cognitive decline, behavioral change, ataxic gait, tremor and pyramidal signs for 3 months. In addition to these multiple systemic involvements, positive result for the cerebrospinal fluid (CSF) 14-3-3 protein tentatively diagnosed him as probable CJD. However, due to increased serum rapid plasma reagin, venereal disease research laboratory, and fluorescent treponemal antibody-absorption reactivity in CSF, the final diagnosis was changed to general paresis. CONCLUSIONS: A patient with RPD needs to be carefully considered for differential diagnosis, among a long list of diseases. It is important to rule out CJD, which is the most frequent in RPD and is a fatal disease with no cure. Diagnostic criteria or marker of CJD, such as 14-3-3 protein, may be inconclusive, and a typical pattern in diffusion-weighted imaging is important to rule out other reversible diseases.