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Abstract Objective To evaluate clinical and radiological outcomes including hindfoot alignment after plate vs intramedullary nailing (IMN) for distal tibia fracture and to define radiologic parameters that influence changes in hindfoot alignment. Methods Among 92 patients with distal tibia metaphyseal fractures treated from 2002 to 2015, 39 cases of intramedullary nailing and 53 cases of standard plate osteosynthesis were performed. Union rate and complication rate were compared in both groups. Radiographic measurements including hindfoot angulation, moment arm, calcaneal pitch angle, and Meary angle were evaluated at a minimum of 1‐year follow‐up. Hindfoot alignment changes after surgery were compared between both groups using student t‐test. Correlation and regression were analyzed between fracture alignment parameters and hindfoot alignment. Results All patients ultimately healed, with an average union period of 26 weeks in both groups. The AOFAS and VAS scores were not significantly different between the two groups. Complications were similar between the two groups. Hindfoot alignment angle, calcaneal pitch, and Meary angle showed no significant differences between the groups. The hindfoot moment arm increased with valgus in the IMN group. A low correlation was detected between angulation at the fracture site in the coronal view and hindfoot alignment (angulation and moment arm) changes (R = 0.38). A significantly high correlation was noted only between transverse rotation and hindfoot alignment changes (R = 0.79). Conclusions Rotation in the transverse plane notably influenced changes in hindfoot alignment. And this suggests that patients with distal tibia fracture should be closely monitored for hindfoot alignment changes caused by intraoperative transverse rotation regardless of the fixation method.

Abstract Background Alcohol consumption is a major risk factor for esophageal cancer; however, a high incidence of esophageal cancer is observed particularly among Eastern Asians, although they consume relatively less alcohol, presumably due to the high frequency of aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphisms. Nevertheless, the association between ALDH2 polymorphisms and esophageal cancer remains under debate. In the present study, we evaluated the association between ALDH2 rs671 polymorphisms and the risk of esophageal cancer in the South Korean population. Methods This study included 783 hospital based-cases and 8732 population-based controls. Information on smoking history and alcohol consumption was obtained from the medical records or interview questionnaires. Age-adjusted logistic regression analysis was performed to assess the association between ALDH2 rs671 polymorphisms and esophageal cancer. Results Odds ratios (ORs) for esophageal cancer in men with GA and AA genotypes were 2.75 (95% confidence interval [CI]: 2.34–3.23) and 0.08 (95% CI: 0.00–0.35), respectively; whereas, in women, these ratios were 2.99 (95% CI: 1.43–6.34) and 6.18 (95% CI: 1.40–19.62), respectively, taking subjects with the ALDH2 GG genotype as a reference. In men, the association between ALDH2 polymorphisms and esophageal cancer was modified by alcohol consumption. Conclusion In Eastern Asians, ALDH2 rs671 polymorphisms are associated with esophageal cancer, which may be linked to acetaldehyde accumulation.

Mucosa-associated lymphoid tissue (MALT) lymphoma predominantly involves the gastrointestinal tract, with the stomach being the most commonly affected site. Colonic involvement is quite rare. Hence, the etiology, clinical characteristics, treatment, and outcome of colonic MALT lymphoma are not well established. This paper reports a case of MALT lymphoma of the transverse colon, presenting as a subepithelial tumor in a 50-year-old woman. The patient received 3,060 cGy in 17 fractions with external beam radiation therapy for three weeks. At 2 months after radiation therapy, a colonoscopy examination revealed complete resolution and a scar change of the lesion. The follow-up at 24 months revealed no evidence of tumor recurrence after radiation therapy.

This study aimed to investigate the relationship between diabetic foot ulcer and depression based on treatment methods employed, as evaluated according to Medicare claims data provided by the Health Insurance Review and Assessment Service (HIRA). Data on diabetic foot patients from January 2011 to December 2016 were collected from the HIRA using codes for diabetic foot and depression disorder. The incidence of depression was analyzed based on patients’ demographic variables, and comorbidities were assessed using the Charlson comorbidity index (CCI). The participants were divided into two groups based on the treatment method used: a limb-saving group and an amputation group. The 1-, 3-, and 5-year incidence rates of depression were 10.1%, 20.4%, and 29.5%, respectively, in the limb-saving group and 4.5%, 8.2%, and 11.5%, respectively, in the amputation group. Female sex, the CCI, and the use of limb-saving treatment methods were significant risk factors. It is plausible that depression in diabetic foot patients may be associated with frequent recurrence and chronicity rather than a single intense event. Our findings highlight the need for clinicians to consider the treatment period as a contributor to patient mood disorders when selecting the appropriate course of action in patients.

Abstract NFκB signaling has a pivotal role in regulation of development, innate immunity, and inflammation. Ikk2 is one of the two critical kinases that regulate the NFκB signaling pathway. While the role of Ikk2 in immunity, inflammation and oncogenesis has received attention, an understanding of the role of Ikk2 in vertebrate development has been compounded by the embryonic lethality seen in mice lacking Ikk2. We find that despite abnormal angiogenesis in IKK2 zygotic mutants of zebrafish, the maternal activity of Ikk2 supports embryogenesis and maturation of fertile animals and allows to study the role of IKK2 in development. Maternal-zygotic ikk2 mutants represent the first vertebrates globally devoid of maternal and zygotic Ikk2 activity. They are defective in cell proliferation as evidenced by abnormal cytokinesis, nuclear enlargement and syncytialisation of a significant portion of blastoderm. We further document that reduced phosphorylation of Aurora A by Ikk2 could underlie the basis of these defects in cell division.

The purpose of this study is to evaluate the utility of QR (quick response) codes in explaining the proper method for orthotic use after orthopedic surgery. A questionnaire survey was adopted to evaluate patient satisfaction with education and training in orthotic applications after orthopedic surgery. The study periods were 1 April to 30 April 2017, and 1 October to 31 October 2017. The oral training involving the conventional orthoses was conducted in April, and the videos with the orthosis on the QR code were captured in October. The QR code containing the data was distributed and the education was conducted. A total of 68 patients (QR-code group: 33) participated in the questionnaire survey. After the QR code application, the number of retraining cases increased from 62.9 to 93.9% (p-value < 0.01). The mean scores of the four items measuring the comprehension increased from 10.97 to 14.39. The satisfaction level rose from 7.14 to 9.30, and the performance increased from 7.14 to 9.52 (p-value < 0.01). The QR code is expected to be a valuable method for explaining the orthotic application after orthopedic surgery, and especially when repeated explanations are needed for elderly patients.

Sensory tricks are clinical maneuvers that may partially relieve dystonic contractions. Any clinical maneuver that modulates afferent sensory and efferent motor pathways could be used as a sensory trick in patients with cervical dystonia. Although various sensory tricks have been described to reduce cervical dystonia, little is known about the exact mechanisms by which they operate. We report a case of cervical dystonia that was alleviated through the use of a visual-sensory trick. Our findings suggest that visual stimulation might be an effective sensory trick in cervical dystonia by compensating for a defective sensory system, or because visual pathways might be also affected by sensory interactions in cervical dystonia. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether machine learning (ML)-based center of pressure (COP) analysis for gait assessment, when used in conjunction with clinical information, offers additive benefits in predicting functional outcomes in patients with acute ischemic stroke., Design: A prospective, single-center cohort study., Setting: A tertiary hospital setting., Participants: A total of 185 patients with acute ischemic stroke, capable of walking 10 m with or without a gait aid by day 7 postadmission. From these patients, 10,804 pairs of consecutive footfalls were included for analysis., Interventions: Not applicable., Main Outcome Measures: The dependent variable was a 3-month poor functional outcome, defined as modified Rankin scale score ≥2. For independent variables, 65 clinical variables including demographics, anthropometrics, comorbidities, laboratory data, questionnaires, and drug history were included. Gait function was evaluated using a pressure-sensitive mat. Time-series COP data were parameterized into spatial and temporal variables and analyzed with logistic regression and 2 ML models (light gradient-boosting machine and multilayer perceptron [MLP]). We derived GAIT-AI output scores from the best-performing model analyzed COP data and constructed multivariable logistic regression models using clinical variables and the GAIT scores., Results: Among the included patients, 70 (37.8%) experienced unfavorable outcomes. The MLP model demonstrated the highest predictive performance with an area under the receiver operating characteristic curve (AUROC) of 0.799. Multivariable logistic regression identified age, initial National Institutes of Health Stroke Scale, and initial Fall Efficacy Scale-International as associated factors with unfavorable outcomes. The combined multivariable logistic regression incorporating COP-derived output scores improved the AUROC to 0.812., Conclusions: Gait function, assessed through COP analysis, serves as a significant predictor of functional outcome in patients with acute ischemic stroke. ML-based COP analysis, when combined with clinical data, enhances the prediction of poor functional outcomes., (Copyright © 2024 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

The effect of arterial tortuosity on intracranial atherosclerosis (ICAS) is not well understood. This study aimed to evaluate the effect of global intracranial arterial tortuosity on intracranial atherosclerotic burden in patients with ischemic stroke. We included patients with acute ischemic stroke who underwent magnetic resonance angiography (MRA) and classified them into three groups according to the ICAS burden. Global tortuosity index (GTI) was defined as the standardized mean curvature of the entire intracranial arteries, measured by in-house vessel analysis software. Of the 516 patients included, 274 patients had no ICAS, 140 patients had a low ICAS burden, and 102 patients had a high ICAS burden. GTI increased with higher ICAS burden. After adjustment for age, sex, vascular risk factors, and standardized mean arterial area, GTI was independently associated with ICAS burden (adjusted odds ratio [adjusted OR] 1.33; 95% confidence interval [CI] 1.09-1.62). The degree of association increased when the arterial tortuosity was analyzed limited to the basal arteries (adjusted OR 1.48; 95% CI 1.22-1.81). We demonstrated that GTI is associated with ICAS burden in patients with ischemic stroke, suggesting a role for global arterial tortuosity in ICAS., (© 2024. The Author(s).)

Background: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by transient constriction of cerebral arteries, leading to severe headache and potential complications. The association between RCVS and Guillain-Barre syndrome (GBS) is rare and poorly understood and warrants further investigation., Methods: A detailed case of RCVS in a patient with GBS was presented, followed by a comprehensive literature review. PubMed, Embase, and Google Scholar were searched for relevant cases and studies., Results: The case involved a 62-year-old woman with GBS who developed RCVS. The literature review identified three additional reported cases. RCVS in GBS primarily affected middle-aged women and presented with a variety of neurological symptoms. Neuroimaging showed reversible vasoconstriction in the cerebral arteries, along with other complications such as posterior reversible encephalopathy syndrome, subarachnoid hemorrhage, and infarcts. While the treatment for GBS consisted mainly of intravenous immunoglobulin, specific treatments for RCVS remain unclear., Conclusions: The coexistence of RCVS and GBS is a rare occurrence. RCVS in GBS may result from the disruption of cerebral vascular tone regulation, possibly influenced by GBS-related dysautonomia and consequent high blood pressure. Recognizing RCVS in GBS patients is critical for appropriate management., (© 2023. Fondazione Società Italiana di Neurologia.)

The study by Chen et al. of a 56-year-old man diagnosed with acute hemorrhagic encephalomyelitis (AHEM) had a significant impact on us. The authors provided a comprehensive account of their diagnostic journey and emphasized the need to differentiate myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) from AHEM. However, recent research suggests that AHEM may not be an isolated entity, but rather a phenotype within MOGAD. The patient's clinical presentation included MRI brain lesions characteristic of MOGAD in addition to hemorrhagic abnormalities. These findings raise the possibility that AHEM in this case represents a MOGAD phenotype. In conclusion, it is important to recognize the potential association between AHEM and MOGAD, especially when distinct MOGAD brain MRI patterns are present, as in this case.

Competing Interests: The authors have no potential conflicts of interest to disclose.

Neurofilament light chains (NfLs) are promising biomarkers of neuroaxonal damage in stroke patients. We investigated the correlations between NfL levels and infarct volume, initial stroke severity, and functional outcomes at discharge in patients with acute ischemic stroke. We prospectively included 15 patients with first-ever acute ischemic stroke and 8 age- and sex-matched healthy controls without other neurological disorders. Serum NfL levels were measured using the single-molecule array (Simoa) technique twice within 24 hours of admission (NfL1D) and on the seventh hospital day (NfL7D) in patients with stroke and once in healthy controls. We assessed the infarct volume on diffusion-weighted magnetic resonance imaging using the free software ITK-SNAP. Serum NfL1D levels in stroke patients were significantly higher (28.4 pg/mL; interquartile range [IQR], 43.0) than in healthy controls (14.5 pg/mL; IQR, 3.2; P = .005). Temporal pattern analyses demonstrated that NfL7D levels were increased (114.0 pg/mL; IQR, 109.6) compared to NfL1D levels in all stroke patients (P = .001). There was a strong correlation between NfL7D levels and infarct volume (R = 0.67, P = .007). The difference between NfL1D and NfL7D (NfLdiff levels) was strongly correlated with the infarct volume (R = 0.63; P = .013). However, there was no statistically significant correlation between NfL levels and the initial stroke severity or functional outcomes at discharge. NfL levels in the subacute stage of stroke and the NfL difference between admission and 7th day of hospital were correlated with infarct volume in patients with acute ischemic stroke., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Competing Interests: None

Competing Interests: None

Competing Interests: None

Background: We aimed to determine whether estimated glomerular filtration rate (eGFR) is an independent predictor of clinical outcomes in patients with acute ischemic stroke not treated with reperfusion therapy., Methods: A total of 1420 patients with acute ischemic stroke from a hospital-based stroke registry were included in this study. Patients managed with intravenous thrombolysis or endovascular reperfusion therapy were excluded. The included patients were categorized into five groups according to eGFR, as follows: ≥90, 60-89, 45-59, 30-44, and <30 mL/min/1.73 m 2 . The effects of eGFR on functional outcome at discharge, in-hospital mortality, neurologic deterioration, and hemorrhagic transformation were evaluated using logistic regression analyses., Results: In univariable logistic regression analysis, reduced eGFR was associated with poor functional outcome at discharge ( p < 0.001) and in-hospital mortality ( p = 0.001), but not with neurologic deterioration and hemorrhagic transformation. However, no significant associations were observed between eGFR and any clinical outcomes in multivariable analysis after adjusting for clinical and laboratory variables., Conclusions: Reduced eGFR was associated with poor functional outcomes at discharge and in-hospital mortality but was not an independent predictor of short-term clinical outcomes in patients with acute ischemic stroke who did not undergo reperfusion therapy.

Objectives: While the prevalence of active cancer patients experiencing acute stroke is increasing, the effects of active cancer on reperfusion therapy outcomes are inconclusive. Thus, we aimed to compare the safety and outcomes of reperfusion therapy in acute stroke patients with and without active cancer., Materials and Methods: A comprehensive literature search was conducted for studies comparing the effects of intravenous thrombolysis (IVT) or endovascular treatment (EVT) in ischemic stroke patients with and without active cancer. The literature was screened using both a manual and machine learning algorithm approach. The outcomes evaluated were symptomatic intracerebral hemorrhage (sICH), all-type intracerebral hemorrhage (aICH), successful recanalization, favorable outcomes (modified Rankin Scale, 0-2), and mortality. We calculated the pooled odds ratio (OR) and 95% confidence interval (CI) using the random-effects model from the included studies., Results: Seven studies were analyzed in this meta-analysis. IVT (n = 1012) was associated with an increased risk of sICH (OR, 9.80; 95% CI, 3.19-30.13) in the active cancer group. However, no significant differences in aICH, favorable outcomes, and mortality were found between groups. Although sICH and successful recanalization in the EVT group (n = 2496) were similar, we observed fewer favorable outcomes (OR, 0.55; 95% CI, 0.33-0.93) and a high prevalence of mortality (OR, 2.91; 95% CI, 1.89-4.47) in the active cancer group., Conclusions: Reperfusion therapy may benefit selected patients with acute ischemic stroke with active cancer, considering the comparable clinical outcomes of IVT and procedure-related outcomes of EVT. These results should be cautiously interpreted and confirmed in future well-designed large-scale studies., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background and Purpose: To evaluate the outcome events and bleeding complications of the European Society of Cardiology (ESC) guideline-matched oral anticoagulant therapy for patients with acute ischemic stroke and atrial fibrillation (AF)., Methods: Patients with acute ischemic stroke and AF from a nationwide multicenter registry (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts [K-ATTENTION]) between January 2013 and December 2015 were included in the study. Patients were divided into the ESC guideline-matched and the non-matched groups. The primary outcome was recurrence of any stroke during the 90-day follow-up period. Secondary outcomes were major adverse cerebrovascular and cardiovascular events, ischemic stroke, intracranial hemorrhage, acute coronary syndrome, allcause mortality, and major hemorrhage. Propensity score matching and logistic regression analyses were performed to assess the effect of the treatments administered., Results: Among 2,321 eligible patients, 1,126 patients were 1:1 matched to the ESC guidelinematched and the non-matched groups. As compared with the non-matched group, the ESC guideline-matched group had a lower risk of any recurrent stroke (1.4% vs. 3.4%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.18 to 0.95). The risk of recurrent ischemic stroke was lower in the ESC guideline-matched group than in the non-matched group (0.9% vs. 2.7%; OR, 0.32; 95% CI, 0.11 to 0.88). There was no significant difference in the other secondary outcomes between the two groups., Conclusions: ESC guideline-matched oral anticoagulant therapy was associated with reduced risks of any stroke and ischemic stroke as compared with the non-matched therapy.

Competing Interests: None

The present study aimed to investigate the predictive value of free fatty acid (FFA) in embolic stroke of undetermined source (ESUS) according to the presence of potential embolic sources (PES) after extensive etiologic evaluation.This was a retrospective observational study based on a single-center registry from January 2011 to July 2017. Stroke subtypes were determined through laboratory findings, brain, and angiographic imaging, carotid ultrasonography, transthoracic echocardiography, and 24-hour Holter monitoring. If ESUS was suspected, transesophageal echocardiography was additionally performed. Patients were classified into ESUS with PES and ESUS without PES. PES included mitral annular calcification, mitral valve prolapse, patent foramen ovale, atrial septal aneurysm, spontaneous echo contrast, ventricular aneurysm, and high-risk plaques of aortic arch, or carotid bulb. We compared clinical and laboratory findings between the two groups.Of a total of 110 ESUS patients, 61 patients (55.5%) had no PES. Patients with ESUS without PES had higher levels of serum FFA, systolic blood pressure, diastolic blood pressure (DBP), and left atrial (LA) enlargement compared with those of ESUS with PES. Multivariable analysis demonstrated that the FFA level, DBP, and LA volume index were associated with ESUS without PES [odds ratio (OR) 1.038, 95% confidence interval (CI) 1.019-1.058 for FFA/10 μEq/L, OR 1.414, 95% CI 1.037-1.928 for DBP/10 mm Hg, and OR 1.073, 95% CI 1.009-1.141 for LA volume index].Higher levels of FFA, DBP, and LA volume index are associated with ESUS without PES, highlighting the need to identify the role of these markers in ESUS through further large-scale, multi-center and prospective studies.

Objective and Background: Post-dural puncture headache is the most common significant adverse event following lumbar puncture. In this study, we investigated the possible systemic factors associated with risk for post-dural puncture headache (PDPH)., Methods: We performed a retrospective cohort study in 969 patients who underwent diagnostic lumbar puncture following a standardized protocol. We compared the clinical and laboratory profiles of the post-dural puncture headache group and non-headache group. We also identified independent factors associated with the incidence of post-dural puncture headache., Results: A total of 48 patients (5%) reported headache; 12 of these patients (25%) received a therapeutic epidural blood patch and the remaining 36 patients improved with conservative treatment. After adjusting for other variables that could be related to PDPH, we found that the development of post lumbar puncture headache was independently associated with age (OR: 0.97, 95% CI: 0.95-0.99, P = .001) and serum glucose levels (OR: 0.98, 95% CI: 0.97-0.99, P = .008).When the patients were classified by age, serum glucose levels were persistently lower in patients with PDPH vs those patients without PDPH in all age groups, with more clearly significant differences observed in the elderly (age <30 years, 103.4 mg/dL vs 106.3 mg/dL, P = .716; >60 years, 111.8 mg/dL vs 137.3 mg/dL, P = .023)., Conclusions: Low glucose levels were inversely associated with risk for post-dural puncture headache. Patients with low serum glucose should be carefully monitored for headache after lumbar puncture., (© 2020 American Headache Society.)

Competing Interests: The authors have no potential conflicts of interest to disclose.

Background: It is not well known whether prestroke antiplatelet agents (PAs) are associated with the subtypes of ischemic stroke., Methods: We screened patients in a hospital-based stroke registry. Patients who were admitted with a diagnosis of first-time ischemic stroke within 5 days of symptom onset were included. Ischemic stroke subtypes were classified in accordance with the Trial of ORG 10172 in Acute Stroke Treatment classification based on stroke mechanism: large-artery atherosclerosis (LA), cardioembolism (CE), small vessel occlusion (SVO), other determined (OC) or undetermined causes (UC). Multinomial logistic regression analyses were performed to evaluate the effect of PA on stroke subtypes before and after propensity score matching., Results: Among 3,025 patients, 748 (24.7%) were taking antiplatelet agents prior to stroke. After propensity score matching, 1,190 patients were ultimately included. The PA group was associated with strokes caused by SVO rather than LA in multinomial logistic regression of an unmatched dataset. However, multivariable analysis after propensity score matching demonstrated that PA use was associated with a higher probability of SVO and CE (OR 2.05, p < 0.001 and OR 1.62, p = 0.05, respectively) compared with LA., Conclusions: PAs were associated with specific index stroke subtypes., (© 2016 S. Karger AG, Basel.)

Objective: To investigate whether prestroke antiplatelet agent (PA) use was associated with initial stroke severity., Methods: This was a retrospective, case-control study based on data from a prospectively collected hospital-based stroke registry (Korea University Stroke Registry). A total of 3,025 patients who were admitted with a diagnosis of first-ever ischemic stroke within 5 days of symptom onset were included. Stroke severity was measured with the NIH Stroke Scale (NIHSS). NIHSS score ≤4 at admission was categorized as mild stroke. Patients from the PA group were matched with those from the non-PA group using estimated propensity scores at a 1:1 ratio. Stepwise multivariable logistic regression analyses were performed on patients in the matched datasets with initial mild stroke., Results: Patients' mean age was 66.3 ± 13.0 years, and 1,850 were men (61.5%). A total of 748 patients had been taking antiplatelet agents prior to stroke onset; 644 patients (86.1%) were taking a single antiplatelet agent. Among these agents, aspirin (83.7%) was the most common. A total of 102 patients (13.6%) were taking 2 antiplatelet agents. Multivariable analysis after propensity score matching demonstrated that PA use was associated with initial mild stroke (odds ratio 1.344; 95% confidence interval 1.014-1.782)., Conclusions: PA use was associated with decreased first-ever stroke severity, suggesting that it has a beneficial effect., Classification of Evidence: This study provides Class II evidence that prestroke use of antiplatelet agents reduces stroke severity in patients with first-ever acute ischemic stroke., (© 2015 American Academy of Neurology.)

Purpose: To identify power motion-mode Doppler (PMD) patterns and assess their diagnostic value for the diagnosis of middle cerebral artery (MCA) stenosis., Methods: Retrospective analyses of PMD data were performed for the identification of specific patterns related to MCA stenosis. The interrater reliability and the validity of these patterns were studied, using magnetic resonance angiography and conventional transcranial Doppler sonography as gold standards., Results: Three PMD patterns were identified: the so-called black-hole, the white-hole, and the diastolic-band patterns in 58 among 178 MCAs. The mean flow velocity was significantly higher in arterial segments with the black-hole patterns and lower in segments with the diastolic-band pattern compared with the segments with normal patterns. The interrater reliability was good for each pattern. The black-hole pattern or its combination with the white-hole pattern showed the highest validity., Conclusion: Despite some limitations, the black-hole PMD pattern or its combination with the white-hole pattern appeared as a reliable and valid marker for the diagnosis of MCA stenosis., (© 2014 Wiley Periodicals, Inc.)

Purpose: It has been reported that restless legs syndrome (RLS) might be associated with multiple psychosomatic symptoms. We aimed to identify which psychosomatic symptom is the most related in RLS patients compared to healthy controls. We also attempted to determine the relation between psychosomatic comorbidity and RLS severity regardless of sleep-related symptoms., Methods: One hundred two newly diagnosed patients with RLS and 37 healthy control subjects participated in the present study. The RLS patients were categorized as mild and severe based on the International RLS Study Group rating scale. Data on demographics were collected. All participants completed the Pittsburgh Sleep Quality Index, Athens Insomnia Scale, and Epworth Sleepiness Scale as sleep-related questionnaires. All participants completed the Symptom Checklist-90-Revision (SCL-90-R)., Results: RLS patients were found to have pervasive comorbid psychosomatic symptoms. Somatization was found to be the most significant contributing factor (OR 1.145, 95 % CI 1.061-1.234, p < 0.001) for psychosomatic comorbidity in RLS. Severe RLS patients were found to have poorer sleep quality than mild RLS patients. Furthermore, severe RLS patients had higher scores for most psychosomatic symptom domains in SCL-90-R. Anxiety was found to be the most independent contributing factor for psychosomatic comorbidity according to RLS severity (OR 1.145, 95 % CI 1.043-1.257, p = 0.005)., Conclusions: Our study demonstrates that comorbid psychosomatic distress is considerable in patients with RLS. Furthermore, most psychosomatic comorbidity is increased with the RLS severity in association with poorer sleep quality.

To mutagenize rice genomes, a two-element system is utilized. This system comprises an immobile Ac element driven by the CaMV 35S promoter, and a gene trap Ds carrying a partial intron with alternative splice acceptors fused to the GUS coding region. Rapid, large-scale generation of a Ds transposant population was achieved using a plant regeneration procedure involving the tissue culture of seed-derived calli carrying Ac and Ds elements. During tissue cultures, Ds mobility accompanies changes in methylation patterns of a terminal region of Ds, where over 70% of plants contained independent Ds insertions. In the transposon population, around 12% of plants expressed GUS at the early seedling stage. A flanking-sequence-tag (FST) database has been established by cloning over 19,968 Ds insertion sites and the Ds map shows relatively uniform distribution across the rice chromosomes.

Background: Although long-term predictors of mortality and vascular events after ischemic stroke are well defined, the age-dependent differences in predicting outcomes are unknown, particularly for lipid parameters., Methods: We assessed recurrent stroke and other vascular events in patients with first-ever ischemic strokes who were registered in a prospectively collected hospital-based stroke registry. Patients were classified into a middle-age group (40-64 years old) and an old-age group (65 years and older)., Results: A total of 551 patients comprising 235 middle-age and 316 old-age subjects were investigated. At the mean follow-up of 26.4 months, 49 (8.9%) patients had experienced recurrent stroke. Outcome events in the middle-age group (3.8%) were less frequent than in the old-age group (12.7%). The effects of vascular risk factors were different across age groups. In particular, the hazard ratio direction for triglycerides was significantly different between age groups for recurrent stroke or composite outcomes., Conclusions: Incidence and predictors of stroke and other vascular events following ischemic stroke are age-dependent. Differential effects of triglycerides on long-term outcomes following ischemic stroke were found to be hazardous at middle age but turned out to be non-significant at old age., (Copyright © 2012 S. Karger AG, Basel.)

Background: Well before the H1N1 influenza, health care organizations worldwide prepared for a pandemic of unpredictable impact. Planners anticipated the possibility of a pandemic involving high mortality, high health care demands, rates of absenteeism rising up to 20-30% among health care workers, rationing of health care, and extraordinary psychological stress., Method: The intervention we describe emerged from the recognition that an expected influenza pandemic indicated a need to build resilience to maintain the health of individuals within the organization and to protect the capacity of the organization to respond to extraordinary demands. Training sessions were one component of a multifaceted approach to reducing stress through effective preparation and served as an evidence based platform for our hospital's response to the H1N1 pandemic., Results: The training was delivered to more than 1250 hospital staff representing more than 22 departments within the hospital. The proportion of participants who felt better able to cope after the session (76%) was significantly higher than the proportion who felt prepared to deal confidently with the pandemic before the session (35%). Ten key themes emerged from our qualitative analysis of written comments, including family-work balance, antiviral prophylaxis, and mistrust or fear towards health care workers., Conclusions: Drawing on what we learned from the impact of SARS on our hospital, we had the opportunity to improve our organization's preparedness for the pandemic. Our results suggest that an evidence-based approach to interventions that target known mediators of distress and meet standards of continuing professional development is not only possible and relevant, but readily supportable by senior hospital administration., (Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.)