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Most preconditioning techniques before fat grafting require external manipulation. Since nutrition is the main factor maintaining the balance of lipogenesis and lipolysis, we hypothesized that fasting before undergoing autologous fat grafting may increase lipolysis and reduce adipocyte size, thereby improving the fat graft survival rate. C57BL/6 mice were divided into 24 h starved or fed groups. Adipose tissue lipolysis, adipogenesis, and angiogenesis-related gene expression, in fat from both groups, were analyzed. The volume and weight of the grafted fat at 4–8 weeks postoperatively were measured using micro-computed tomography. Immunohistochemistry staining and mRNA expression analysis were also performed to evaluate the effect of fasting on fat graft survival. Fasting decreased adipocyte size by inducing adipose tissue lipolysis. Adipogenesis-related genes were remarkably downregulated while lipolysis-related genes and angiogenesis inducer genes were significantly upregulated in the starved adipose tissue. The mice grafted with the fat from the 24 h starved group had approximately 20% larger volumes and considerably heavier weights than those from the fed group. Increased viable adipocytes and vessels, and reduced macrophages in the fat grafts obtained from the 24 h starved group were also observed. Fasting for 24 h before harvesting fat increased the retention volume of fat graft by increasing angiogenesis via VEGF induction. Therefore, fasting would be a novel and reliable preconditioning strategy to improve graft survival in autologous fat grafting. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Cough is the most common respiratory symptom that can have various causes. It is a major clinical problem that can reduce a patient’s quality of life. Thus, clinical guidelines for the treatment of cough were established in 2014 by the cough guideline committee under the Korean Academy of Tuberculosis and Respiratory Diseases. From October 2018 to July 2020, cough guidelines were revised by members of the committee based on the first guidelines. The purpose of these guidelines is to help clinicians efficiently diagnose and treat patients with cough. This article highlights the recommendations and summary of the revised Korean cough guidelines. It includes a revised algorithm for the evaluation of acute, subacute, and chronic cough. For a chronic cough, upper airway cough syndrome (UACS), cough variant asthma (CVA), and gastroesophageal reflux disease (GERD) should be considered in differential diagnoses. If UACS is suspected, first-generation antihistamines and nasal decongestants can be used empirically. In cases with CVA, inhaled corticosteroids are recommended to improve cough. In patients with suspected chronic cough due to symptomatic GERD, proton pump inhibitors are recommended. Chronic bronchitis, bronchiectasis, bronchiolitis, lung cancer, aspiration, intake of angiotensin-converting enzyme inhibitor, intake of dipeptidyl peptidase-4 inhibitor, habitual cough, psychogenic cough, interstitial lung disease, environmental and occupational factors, tuberculosis, obstructive sleep apnea, peritoneal dialysis, and unexplained cough can also be considered as causes of a chronic cough. Chronic cough due to laryngeal dysfunction syndrome has been newly added to the guidelines.

Background Fibroma of tendon sheath (FTS) is an uncommon mass that arises from the tendon sheath of extremities, particularly in children. The tumor typically affects adults between ages 20 and 50 years with a predominance in males. To date, growth hormone (GH) treatment is safe for children without risk factors and is accepted worldwide as a treatment for Turner syndrome. Case description This article reports the case of a nine-year-old female patient with Turner syndrome and FTS during GH treatment. She had been treated with daily subcutaneous GH to improve growth failure with a mean dose of 0.28 mg/kg/week and the level of insulin-like growth factor 1 (IGF-1) was within the normal range. During the follow-up period, she complained about the mass on her hand and diagnosed as FTS. Conclusion This report illustrates the clinical impact of Turner syndrome and GH treatments on the occurrence of this tumor through literature reviews. Further studies are needed to highlight the association between FTS and GH treatment, especially in Turner syndrome. Though it is not yet confirmed, it may be worth considering FTS as a possible diagnosis in patients undergoing GH treatment.

Background Some patients who need surgery refuse a blood transfusion because of their religious beliefs or concerns about blood-borne infections. In recent years, bloodless surgery has been performed successfully in many procedures, and is therefore of increasing interest in orthognathic surgery.Methods Ten Jehovah’s Witnesses who visited our bloodless surgery center for orthognathic surgery participated in this study. To maintain hemoglobin (Hb) levels above 10 g/dL before surgery, recombinant erythropoietin (rEPO) was subcutaneously administered and iron supplements were intravenously administered. During surgery, acute normovolemic hemodilution (ANH) and induced hypotensive anesthesia were used. To elevate the Hb levels to >10 g/dL after surgery, a similar method to the preoperative approach was used.Results The 10 patients comprised three men and seven women. Their average Hb level at the first visit was 11.1 g/dL. With treatment according to our protocol, the average preoperative Hb level rose to 12.01 g/dL, and the average Hb level on postoperative day 1 was 10.01 g/dL. No patients needed a blood transfusion, and all patients were discharged without any complications.Conclusions This study presents a way to manage patients who refuse blood transfusions while undergoing orthognathic surgery. rEPO and iron supplementation were used to maintain Hb levels above 10 g/dL. During surgery, blood loss was minimized by a meticulous procedure and induced hypotensive anesthesia, and intravascular volume was maintained by ANH. Our practical approach to orthognathic surgery for Jehovah’s Witnesses can be applied to the management of all patients who refuse blood transfusions.

Fungal biological control of soybean cyst nematodes (SCN) is an important component of integrated pest management for soybean. However, very few fungal biological control agents are available in the market. In this study, we have screened fungi previously isolated from SCN cysts over 3 years from a long-term crop rotation field experiment for their ability to antagonize SCN using (i) parasitism, (ii) egg hatch inhibition, and (iii) J2 mortality. We evaluated egg parasitism using an in-vitro egg parasitism bioassays and scored parasitism using the egg parasitic index (EPI) and fluorescent microscopy. The ability of these fungi to produce metabolites causing egg hatch inhibition and J2 mortality was assessed in bioassays using filter-sterilized culture filtrates. We identified 10 high-performing isolates each for egg parasitism and toxicity toward SCN eggs and J2s and repeated the tests after storage for 1 year of cryopreservation at −80°C to validate the durability of biocontrol potential of the chosen 20 isolates. Although the parasitic ability changed slightly for the majority of strains after cryopreservation, they still scored 5/10 on EPI scales. There were no differences in the ability of fungi to produce antinemic metabolites after cryopreservation. [Formula: see text] Copyright © 2020 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .

OBJECTIVEA thorough investigation of the long-term outcomes and chronological changes of multimodal treatments for petroclival meningiomas is required to establish optimal management strategies. The authors retrospectively reviewed the long-term clinical outcomes of patients with petroclival meningioma according to various treatments, including various surgical approaches, and they suggest treatment strategies based on 30 years of experience at a single institution.METHODSNinety-two patients with petroclival meningiomas were treated surgically at the authors’ institution from 1986 to 2015. Patient demographics, overall survival, local tumor control rates, and functional outcomes according to multimodal treatments, as well as chronological change in management strategies, were evaluated. The mean clinical and radiological follow-up periods were 121 months (range 1–368 months) and 105 months (range 1–348 months), respectively.RESULTSA posterior transpetrosal approach was most frequently selected and was followed in 44 patients (48%); a simple retrosigmoid approach, undertaken in 30 patients, was the second most common. The initial extent of resection and following adjuvant treatment modality were classified into 3 subgroups: gross-total resection (GTR) only in 13 patients; non-GTR treatment followed by adjuvant radiosurgery or radiation therapy (non-GTR+RS/RT) in 56 patients; and non-GTR without adjuvant treatment (non-GTR only) in 23 patients. The overall progression-free survival rate was 85.8% at 5 years and 81.2% at 10 years. Progression or recurrence rates according to each subgroup were 7.7%, 12.5%, and 30.4%, respectively.CONCLUSIONSThe authors’ preferred multimodal treatment strategy, that of planned incomplete resection and subsequent adjuvant radiosurgery, is a feasible option for the management of patients with large petroclival meningiomas, considering both local tumor control and postoperative quality of life.

Objective: HL301 is a combination product of seven medicinal plants that has been proven effective in acute bronchitis by two phase II studies. In the present study, its efficacy and safety compare...

In Korea, 4 big layer companies that possess one grandparent and 3 parent stocks are in charge of 100% of the layer chicken industry. In this study, we investigated the antimicrobial resistance of commensal 578 E. coli isolated from 20 flocks of 4-layer breeder farms (A, B, C, and D), moreover, compared the characteristics of their resistance and virulence genes. Isolates from farms B and D showed significantly higher resistance to the β-lactam antimicrobials (amoxicillin, ampicillin, and 1st-, 2nd-, and 3rd-generation cephalosporins). However, resistance to ciprofloxacin, nalidixic acid, and tetracycline was significantly higher in the isolates from farm A (P < 0.05). Interestingly, the isolates from farm C showed significantly lower resistance to most antimicrobials tested in this study. The isolates from farms B, C, and D showed the high multiple resistance to the 3 antimicrobial classes. Furthermore, the isolates from farm A showed the highest multiple resistance against the 5 classes. Among the 412 β-lactam-resistant isolates, 123 (29.9%) carried blaTEM-1, but the distribution was significantly different among the farms from 17.5% to 51.4% (P < 0.05). Similarly, the most prevalent tetracycline resistance gene in the isolates from farms B, C, and D was tetA (50.0–77.0%); however, the isolates from farm A showed the highest prevalence in tetB (70.6%). The distribution of quinolone (qnrB, qnrD, and qnrS) and sulfonamide (su12)-resistant genes were also significantly different among the farms but that of chloramphenicol (catA1)- and aminoglycoside (aac [3]-II, and aac [6′]-Ib)-resistant genes possessed no significant difference among the farms. Moreover, the isolates from farm C showed significantly higher prevalence in virulence genes (iroN, ompT, hlyF, and iss) than the other 3 farms (P < 0.05). Furthermore, the phenotypic and genotypic characteristics of E. coli isolates were significantly different among the farms, and improved management protocols are required to control of horizontal and vertical transmission of avian disease, including the dissemination of resistant bacteria in breeder flocks.

Purpose We aimed to evaluate the clinical characteristics of microsatellite instability in early gastric cancer. Materials and Methods The microsatellite instability status of resected early gastric tumors was evaluated using two mononucleotide repeat markers (BAT25 and BAT26) and three dinucleotide repeat markers (D5S346, D2S123, and D17S250). Tumors with instability in two or more markers were defined as microsatellite instability-high (MSI-H) and others were classified as microsatellite stable (MSS). Results Overall, 1,156 tumors were included in the analysis, with 85 (7.4%) classified as MSI-H compared with MSS tumors. For MSI-H tumors, there was a significant correlation with the female sex, older age, tumor location in the lower gastric body, intestinal histology, lymphovascular invasion (LVI), and submucosal invasion (P

Objective To establish a preoperative evaluation procedure by measuring the volume of dead space using MRI in patients with ischial pressure injuries. Methods Patients with spinal cord injury and ischial pressure injuries who underwent treatment between August 2016 and November 2019 were included in the study. Preoperative MRI scan was conducted on all patients. The volume estimation and three-dimensional (3D) reconstruction were performed based on MRI data using a 3D Slicer. Based on the resulting volume, a muscle flap that could fit the dead space was selected. Surgery was performed with the selected muscle flap, and a fasciocutaneous flap was added, if necessary. Results A total of eight patients with ischial pressure injuries were included in the study. The mean patient age was 59.0 ± 11.0 years. The mean body mass index was 26.62 ± 3.89 kg/m2. The mean volume of dead space was 104.75 ± 81.05 cm3. The gracilis muscle was the most selected muscle flap and was used in four patients. In five of eight cases, a fasciocutaneous flap was used as well. The mean follow-up period was 16 months, and by that point, none of the patients evinced complications that required surgery. Conclusions To the authors' knowledge, this is the first report on volumetric evaluation of dead space in ischial pressure injuries. The authors believe that the 3D reconstruction process would enable adequate dead space obliteration in ischial pressure injuries. The authors propose that preoperative MRI scans in patients with ischial pressure injury should become an essential part of the process.

OBJECTIVE The authors aimed to investigate the dosimetric parameter and the minimally required dose associated with long-term control of sellar and parasellar tumors after Gamma Knife surgery (GKS) in children. METHODS A retrospective analysis was performed on pediatric patients younger than 19 years of age who were diagnosed with sellar and parasellar tumors and received GKS at the authors’ institution from 1998 to 2019. Cox proportional hazards regression analyses were used to investigate the dosimetric parameters associated with treatment outcome. The Kaplan-Meier method was used to analyze tumor control rates after GKS. RESULTS Overall, 37 patients with 40 sellar and parasellar tumors, including 22 craniopharyngiomas and 12 pituitary adenomas, had a mean follow-up of 85.8 months. The gross target volume was 0.05 cm3 to 15.28 cm3, and the mean marginal dose was 15.8 Gy (range 9.6–30.0 Gy). Ten patients experienced treatment failure at a mean of 28.0 ± 26.7 months. The actuarial 5- and 10-year tumor control rates were 79.0% and 69.8%, respectively. D98% was an independent predictive factor of tumor control (HR 0.846 [95% CI 0.749–0.956], p = 0.007), with a cutoff value of 11.5 Gy for the entire cohort and 10 Gy for the craniopharyngioma group. Visual deterioration occurred in 2 patients with the maximum point dose of 10.1 Gy and 10.6 Gy to the optic apparatus. CONCLUSIONS In pediatric patients, D98% was a reliable index of the minimum required dose for long-term control of sellar and parasellar tumors after GKS. The optimal D98% value for each tumor diagnosis needs to be elucidated in the future.

BACKGROUND Downturned oral commissures develop gradually with aging. Tools have been developed to evaluate the marionette line or the lower face. However, there is no validated and reproducible tool to evaluate the progress after oral commissure treatment in clinical practice. OBJECTIVE The authors aimed to develop a scoring system to evaluate therapeutic interventions for downturned oral commissures and to verify its reliability, reproducibility, and clinical significance. METHODS AND MATERIALS In the Scale Development Group, the Delphi method was used to establish a 5-graded scoring system to evaluate oral commissure position. The scoring system was applied to 50 participants. The authors recorded and compared the intrarater agreement, interrater agreement, and significance of the grade-dependent scale. RESULTS Delphi analysis of the scoring system verified the grade description adequacy. Intrarater agreement showed almost perfect agreement, and the intraclass correlation coefficient of the interrater agreement had a significantly higher agreement rate. The differences between the clinical grades were significant. CONCLUSION The Hugel Downturned Oral Commissure Scale is precise, reproducible, and reflective of the clinical differences for downturned oral commissure. Its novelty lies in the use of specific angles and ratio. This scale has clinical trial potential owing to its standardized and quantitative assessment.

Background and objective A cough-specific quality-of-life questionnaire is recommended to assess the impact of cough; however, a simple instrument to quantify cough is required for everyday clinical practice. This study was aimed to develop a short patient-completed questionnaire (COugh Assessment Test, COAT). Methods The COAT was developed and validated by comparison with the Korean version of Leicester Cough Questionnaire (K-LCQ) and cough numeric rating scale (NRS, 0-10, 11-point scale) for chronic cough patients. Results Item selection identified five items regarding cough frequency, daily activity, sleep disturbance, fatigue and cough hypersensitivity (0-4 scaling of items, 0-20 score range) through reliability test cohort (n = 78). Test-retest reliability was strong (intra-class correlation coefficient = 0.88). The final COAT was compared with K-LCQ and cough NRS in a validation cohort (n = 323). In Rasch analysis, COAT fitted well to a unidimensional model. Pearson correlations of COAT versus K-LCQ (i) before treatment, (ii) after treatment; COAT versus cough NRS (iii) before treatment, (iv) after treatment; (v) delta-COAT versus delta-cough NRS, (vi) delta-COAT versus delta-K-LCQ were (i) -0.71, (ii) -0.81, (iii) 0.69, (iv) 0.82, (v) -0.66 and (vi) 0.72, respectively. Conclusion The COAT is a useful, simple questionnaire for assessing and monitoring cough.

To evaluate the combined effects of a decompressive craniectomy and prolonged selective brain hypothermia on large hemispheric infarction in a rat model.Permanent middle cerebral artery infarction using an endovascular occlusion technique was created in rats assigned to 4 groups. Normothermia was maintained without a craniectomy in group A (n = 20) as the control, prolonged (44 hours), selective brain hypothermic treatment was performed on group B (n = 20), a craniectomy was performed on group C (n = 18), and prolonged, selective brain hypothermic treatment using a cooling coil implanted in the craniectomy site was combined with a craniectomy for group D (n = 18).Group B and C exhibited a significantly reduced infarct volume when compared with the control. Furthermore, group D showed a significantly reduced infarct volume when compared with group C, plus a significantly improved neurologic score. These results for group D were associated with an increased neuronal cell count and reduced hyperactive microglia and hypertrophic astrocytes in the cortical penumbra (P0.01). Moreover, a greater preservation of normal-appearing axonal bundles and the blood-brain barrier was observed in the core infarct region at the caudoputamen.A decompressive craniectomy reduced the infarct volume and improved the neurologic outcomes in a rat model of middle cerebral artery infarction. Furthermore, when combined with prolonged selective brain hypothermia, significant additional benefits were observed for the neurologic outcomes, infarct volume, and degree of neuroinflammation.

On September 27, 2012, an explosion from hydrofluoric acid occurred in Gumi city of Gyeongbuk province, Republic of Korea, exposing livestock animals nearby to Hydrofluoric acid (HF). This study aimed at evaluating the HF exposure among cattle raised near the accident site by determining the fluoride ion (F(−1)) levels and other biochemical parameters in the animals’ urine and serum. The study groups included 90 cattle raised on farms near the accident site and, as controls, 21 cattle raised on a farm more than 100 km away from the accident site. Urine and blood serum samples were taken from 10% to 20% of the cattle on each farm that were present 17 days after the accident. The F(−1) concentrations in the samples were analysed by the fluoride-ion-selective electrode method or a biochemistry analyser. The mean F(−1) levels in the cattle serum samples (expressed as mg/L) were 0.23 (100 m), 0.15 (500 m), 0.23 (800 m), 0.11 (900 m), 0.07 (1.2 km), 0.16 (1.5 km), and 0.10 in the control group. The mean F(−1) levels in the cattle urine samples (expressed as F(−1) mg/g creatinine) were 27.8 (100 m), 24.4 (500 m), 11.1 (800 m), 16.3 (900 m), 3.02 (1.2 km), 9.16 (1.5 km), and 3.58 in the control group. The mean ± SD concentrations of calcium ions in serum (expressed as mg/dL) were 9.72 ± 0.41 (100 m), 9.54 ± 0.57 (500 m), 8.31 ± 0.44 (800 m), 9.06 ± 0.40 (900 m), 8.36 ± 0.89 (1.2 km), 9.13 ± 0.98 (1.5 km), and 10.48 ± 1.43 in the control group. The serum and urine F(−1) levels in cattle exposed to HF decreased with the distance from the accident site, suggesting that the relative F(−1) levels in urine after normalization through concentration of urinary creatinine could be a more reliable biomarker for HF exposure in cattle than the urine F(−1) level alone.

Purpose Ossiculoplasty outcome parameter staging (OOPS) and middle ear risk index (MERI) are the most commonly used indices for predicting prognosis of patients with chronic otitis media (COM). This study aimed to verify the efficiency of OOPS and MERI scores in predicting outcomes of patients with COM who underwent tympanoplasty. Methods We retrospectively reviewed the data of patients who underwent tympanoplasty (n = 526). OOPS, and MERI scores were collected. Hearing data were measured 1 day preoperatively, and 3 and 12 months postoperatively. Operation success was defined according to the Korean Society of Otology guidelines. Results For calculation of success, the ROC values of MERI were 0.551 at 12 months. ROC values of OOPS were 0.637 at 12 months. There were no significant differences in hearing variables among the three groups according to MERI. There were significantly favorable outcomes in hearing variables in the low-risk group in OOPS. The mean OOPS score was greater in patients with success than those with non-success. Otorrhea, ossicle status, and status of mucosa as variables in both indices were associated with success. The type of mastoidectomy as a variable in OOPS alone was associated with success. Absence of hypertension, presence of ossiculoplasty, and use of incus as ossiculoplasty material were associated with poor success rate. Conclusion Compared with MERI, the OOPS index was more closely associated with the hearing outcomes, which may be due to the extent of inflammation in the OOPS index.

본 연구에서는 추출용매와 저장 기간에 따라 마늘의 주요 성분이 추출액 중으로 용출 또는 마늘 내에 잔류하는 정도를 확인하고자 에탄올이 0, 25, 50, 70 및 100% 혼합된 용매를 마늘 무게 대비 동량으로 가하여 8°C에서 35일간 저장하면서 7일 간격으로 시료를 취하여 추출물과 남은 잔사마늘에서 황화합물의 변화를 분석하였다. Alliin의 함량은 저장 기간이 경과할수록 마늘 추출물에서는 증가하였으며 잔사마늘에서는 감소하였다. Allicin 함량은 alliin의 함량 변화와 동일한 경향이었으며, 물 추출물에서 저장 28일에 27.53mg/L로 가장 높은 함량이었다. S-Allyl-cysteine 함량은 추출물에서는 저장 기간이 경과할수록 증가하는 경향이었는데 저장 35일에는 100% 주정 추출물에서 32.1 mg/L로 가장 높은 함량이었다. 추출물 중의 diallyl disulfide(DADS) 함량은 저장 기간이 경과할수록 증가하여 저장 35일에 100% 주정 추출물에 84.5 mg/L로 가장 높았고 잔사마늘보다는 추출물에서 함량이 더 높았다. Diallyl trisulfide 역시 DADS와 유사한 경향으로 추출물에서 저장 기간에 따라 함량이 증가하였는데 저장 35일에 100% 주정 추출물은 988.9 mg/L로 물 추출물보다 약 80배 더 높은 함량이었다. 35일간 저장된 마늘 추출물의 항산화 활성을 측정한 결과 ABTS 라디칼 소거 활성은 75% 주정 추출물에서 가장 높았고 β-carotene linoleic acid를 이용한 항산화 활성은 1,250 mg/L 농도에서 100% 물 추출물이 7.25%로 활성이 가장 낮았으나, 75% 주정 추출물에서 39.40%로 가장 높았다.

Opuntia species have been used for centuries as food resources and in traditional folk medicine for their nutritional properties and their benefit in chronic diseases, particularly diabetes, obesity, cardiovascular diseases, and cancer. The aim of this study was to evaluate the antioxidant activities and anti-inflammatory effects of 75% ethanol extracts from Opuntia ficus-indica fruits (OFFE) and Opuntia humifusa fruits (OHFE). The total polyphenol and total flavonoid contents of OFFE were 17.07±0.08 and 8.65±0.08 mgQE/g, respectively, whereas those of OHFE were 9.41±0.14 and 2.03±0.08 mgQE/g, respectively. The antioxidant activities of OFFE and OHFE were determined based on various radical scavenging activities using 1,1-diphenyl-2-dipicrylhydrazyl (DPPH) and 2,2'-azino-bis(3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) radical scavenging assays. The DPPH and ABTS radical scavenging activities of OFFE were significantly higher than those of OHFE. In addition, the release of nitric oxide (NO) and reactive oxygen species (ROS) were ameliorated by pretreatment with OFFE and OHFE in a dose-dependent manner. OFFE also suppressed the secretion of pro-inflammatory cytokines, including interleukin-1β (IL-1β) and interleukin-6(IL-6) but not tumor necrosis factor-α (TNF-α) from lipopolysaccharide (LPS)-stimulated RAW 264.7 cells, but the OHFE did not decrease cytokine expression. These results suggest that OFFE exhibits strong antioxidant activity and anti-inflammatory effects and can be developed as a potential therapeutic candidate for diseases involving oxidative stress and inflammation.

OBJECTIVEThe authors investigated the incidence, clinical course, and predisposing factors associated with delayed facial palsy (DFP) following microvascular decompression (MVD).METHODSThe authors reviewed the records of 310 patients (311 cases) who were followed after MVD for hemifacial spasm (HFS). Of these patients, 45 (14.5%) developed DFP after MVD. The clinical characteristics and predisposing factors of the patients with HFS were investigated to identify prognostic factors that predicted the development of DFP after MVD. Log-rank tests were used to compare times to symptom disappearance, and a logistic regression analysis was performed to compare clinical characteristics between patients who developed DFP and those who did not.RESULTSHFS was completely resolved immediately after MVD in 158 cases (50.8%), and HFS eventually disappeared in 289 (92.9%) of the cases. Of the 45 patients with DFP, 17 were men and 28 were women. DFP occurred between postoperative Days 1 and 44 (mean 9.67 days). Finally, 44 patients (97.8%) completely recovered. The average time to recovery was 3.9 months (range 1–24 months). Patients who had experienced an immediate disappearance of HFS experienced a significantly higher occurrence of DFP than those who did not (odds ratio 0.383, 95% confidence interval 0.183–0.802; p = 0.011). In addition, preoperative botulinum neurotoxin injections negatively influenced the occurrence of DFP (p = 0.016).CONCLUSIONSIn this study, the incidence rate of DFP was slightly higher than previously reported values. Moreover, DFP can occur even when spasms disappear immediately after MVD, but the patients with DFP can fully recover within weeks.

No data exist on the usefulness of the delta neutrophil index (DNI) to discriminate pulmonary tuberculosis (PTB) from community-acquired pneumonia (CAP). We performed a retrospective cohort study involving patients with PTB (n = 62) and CAP (n = 215), and compared their initial DNI levels. The median DNI values were 0% (interquartile ranges [IQR] 0–0.2%) and 1.6% (IQR 0.7–2.9%) in PTB and CAP, respectively, which was significantly lower in PTB patients (P P 1.0%) may be useful to rule out the possibility of PTB due to its high NPV.

Objective We sought to analyze the long-term outcome of Gamma Knife radiosurgery (GKS) for symptomatic brainstem cavernous malformation (s-BSCM). Methods Forty-five patients (14 males, 31 females) were treated with GKS for s-BSCM from January 1998 to December 2011. All patients were followed up for >5 years, and their clinical data were analyzed retrospectively. All patients had a history of symptomatic bleeding once or more before GKS. These hemorrhages caused neurologic deficits including cranial nerve deficits, hemiparesis, hemisensory deficits, spasticity, or chorea. The mean target volume of s-BSCM was 1.82 cm3, and the median prescribed marginal dose of radiation was 13 Gy. The mean clinical and imaging follow-up period was 9.31 years (range 5.1–19.4 years). Results The 45 patients had 69 hemorrhagic events before GKS. During the follow-up period after GKS, 35 patients had no hemorrhagic event, 6 patients had 1 episode of symptomatic hemorrhage, and 4 patients had 2 episodes. The calculated annual hemorrhage rate was 40.06% at pre-GKS, 3.3% at 2 years after GKS, 1.48% at 5 years after GKS, and 4.64% at >5 years after GKS. In this study of 45 patients, symptomatic radiation-induced complications developed in only 1 patient (2.2%). No patients had died at the last follow-up. Conclusions GKS for s-BSCM is a safe and effective alternative to surgical resection for reducing the rate of recurrent hemorrhage. Because the annual hemorrhage rate increases >5 years after GKS, clinicians should monitor patients closely to determine their subsequent treatment.

We present our experience on the hypofractionated Gamma Knife radiosurgery (FGKS) for large skull base meningioma as an initial treatment. We retrospectively reviewed 23 patients with large skull base meningioma ≥10 cm3 who underwent FGKS as the initial treatment option. The mean volume of tumors prior to radiosurgery was 21.2±15.63 cm3 (range, 10.09~71.42). The median total margin dose and marginal dose per fraction were 18 Gy (range, 15~20) and 6 Gy (range, 5~6), respectively. Patients underwent three or four fractionations in consecutive days with the same Leksell® frame. The mean follow-up duration was 38 months (range, 17~78). There was no mortality. At the last follow-up, the tumor volume was stationary in 15 patients (65.2%) and had decreased in 8 patients (34.8%). Six patients who had cranial neuropathy at the time of FGKS showed improvement at the last clinical follow-up. Following FGKS, 4 patients (17%) had new cranial neuropathy. The trigeminal neuropathy was the most common and all were transient. The mean Karnofsky Performance Status score at pre-FGKS and the last clinical follow-up was 97.0±10.4 points (median, 100) and 98.6±6.9 (median, 100) points, respectively. FGKS has showed satisfactory tumor control with functional preservation for large skull base meningiomas. Further prospective studies of large cohorts with long term follow-up are required to clarify the efficacy in the tumor control and functional outcome as well as radiation toxicity., Graphical Abstract

Portulaca oleracea L., a species of Portulacaceae, is ubiquitous. It is a well-known traditional Chinese medicine for removing heat, counteracting toxicity, cooling blood, and maintaining hemostasia; it is also used as antidysentery agent. This study investigated the anti-oxidative and anti-inflammatory activities of water and ethanol extracts from P. oleracea. The total polyphenol content (21.08±0.03 mg GAE/g) and total flavonoid content (5.45±0.76 mg QE/g) of the ethanolic extracts were higher than those of the water extracts. The antioxidative activities were determined by evaluating the 1,1-diphenyl-2-picrylhydrazyl (DPPH) and the 2,2’-azinobis(3-ethylbenzothiazoline-6-sulphonic acid) (ABTS) radical scavenging activity and by the ferric reducing antioxidant potential (FRAP) assay. The ABTS radical scavenging activity of the water extract (75.53%) was higher in those of the water extract (67.03%) at concentration of 1,000 μg/mL. The DPPH radical scavenging activity and FRAP of the ethanol extract were higher than those of the water extract. We also investigated the anti-inflammatory activity of the P. oleracea extracts in LPS-stimulated Raw 264.7 cells. The production levels of nitric oxide (NO) and reactive oxygen species (ROS) significantly decreased with an increasing concentration of the extract. The expression levels of pro-inflammatory cytokines (tumor necrosis faction (TNF)-α, interleukin (IL)-1β, and IL-6) were significantly lower in the ethanol extract than in the LPS alone treatment group. Based on these results, ethanolic extract from P. oleracea could be an effective antioxidant and anti-inflammatory agent.

Purpose The aim of this study is to prepare medical staff in order to prevent medical malpractice litigation through analysis of litigation cases related to the department of surgery in Korea. Methods A total of 94 litigation cases related to the department of surgery, where a certain amount of payment was ordered to the defendant between 2005 through 2010, were analyzed. We examined time of occurrence, amount claimed and awarded in damages, plaintiff claims, and court opinion. Results An average of 3.2 years was spent from the date of the incident occurring to the end of the litigation procedures. The average amount awarded in judgments for damages was 59,708,983 ± 67,307,264 (range, 1,700,000-365,201,482) Korean won. Cases were found involving the following opinion of the court: violation of duty of care (49 cases), violation of informed consent (7 cases), violation of duty of care and informed consent (5 cases), and settlement, reconciliation, and others (32 cases). By analyzing defendants' negligence in court opinions, diagnosis (30.8%) was the most common, followed by post-operation management (27.7%). Conclusion Physicians have to conduct treatment and surgery based on exact diagnosis and be careful to observe patients' conditions and symptoms after surgery. It is essential to identify the current status and characteristics of medical litigation for reducing further litigation and improving patient safety. In order to create a safe medical environment, national efforts should be made not only by individuals but also at the national level.

Background: Gamma knife radiosurgery (GKRS) has recently been used as a treatment modality for dural arteriovenous fistula (DAVF). Objective: To retrospectively analyze the outcomes of GKRS for DAVF at a single institute. Methods: Between 1998 and 2016, a total of 20 patients underwent GKRS for DAVF. After excluding 4 patients with > 12 months of follow-up, 16 patients were enrolled in this study. Twelve patients had undergone embolization prior to GKRS. The most common location was the cavernous sinus (CS). The median clinical and radiological follow-up durations were 87.5 (range 24–186) months and 44.5 (range 14–174) months. Results: Ten (62.5%) of the 16 DAVFs were obliterated; 8 were confirmed on angiography. Five cases resulted in small, residual DAVFs, and one case remained unchanged. The obliteration rate of GKRS for CS DAVF was significantly higher than that for non-CS DAVF (100 vs. 40%; p = 0.034). Fifteen out of 16 patients (94%) had a favorable outcome, and the remaining patient had an unfavorable outcome. Hemorrhage after GKRS occurred in only 1 patient, who presented with seizure. Conclusions: GKRS is a safe and effective treatment modality for DAVF in combination with a traditional treatment option such as endovascular embolization or microsurgery.

Intracranial ependymomas are rare tumors in adults. Although recent advancements from demographic, clinical, and biological studies provide new perspectives on this rare tumor, they are not yet widely applied in clinical practice. Currently, most ependymoma patients are treated in the same way: via surgical resection with adjuvant radiation therapy. However, it is reasonable to apply more aggressive treatment for high-risk patients. From this point of view, we performed a study to investigate risk grouping for disease progression of intracranial ependymomas in adults. A total of 53 patients were included in this study. Data were extracted for patient and tumor characteristics, extent of resection, progression-free survival (PFS), and overall survival. Prognostic variables from univariate and multivariate survival analyses were included in a recursive partitioning analysis for the hierarchical risk grouping of the estimated PFS. Three risk groups were defined based on the clinical prognostic factors. Survival analysis showed significant differences in mean PFS between the different groups: 160.5±22.1months in the complete resection group, 100.4±36.8months in the incomplete-resection and intraventricular-location group, and 23.5±6.9months in the incomplete-resection and extraventricular-location group (p0.001). The risk of disease progression in adult intracranial ependymoma patients could be stratified by degree of resection and tumor location. In clinical practice, this result could provide useful information, such as when "second-look" surgery should be performed or whether small tumors invading the fourth ventricle floor should be resected at the expense of neurological deficit.

Glioblastoma multiforme (GBM) is the most common and aggressive form of brain tumors. GBMs, like other tumors, rely relatively less on mitochondrial oxidative phosphorylation (OXPHOS) and utilize more aerobic glycolysis, and this metabolic shift becomes augmented under hypoxia. In the present study, we investigated the physiological significance of altered glucose metabolism and hypoxic adaptation in the GBM cell line U251 and two newly established primary GBMs (GBM28 and GBM37). We found that these three GBMs exhibited differential growth rates under hypoxia compared to those under normoxia. Under normoxia, the basal expressions of HIF1α and the glycolysis-associated genes, PDK1, PDK3, and GLUT1, were relatively low in U251 and GBM28, while their basal expressions were high in GBM37. Under hypoxia, the expressions of these genes were enhanced further in all three GBMs. Treatment with dichloroacetate (DCA), an inhibitor of pyruvate dehydrogenase kinase (PDK), induced cell death in GBM28 and GBM37 maintained under normoxia, whereas DCA effects disappeared under hypoxia, suggesting that hypoxic adaptation dominated DCA effects in these GBMs. In contrast, the inhibition of HIF1α with chrysin suppressed the expression of PDK1, PDK3, and GLUT1 and markedly promoted cell death of all GBMs under both normoxia and hypoxia. Interestingly, however, GBMs treated with chrysin under hypoxia still sustained higher viability than those under normoxia, and chrysin and DCA co-treatment was unable to eliminate this hypoxia-dependent resistance. Together, these results suggest that hypoxic adaptation is critical for maintaining viability of GBMs, and targeting hypoxic adaptation can be an important treatment option for GBMs.

Garlic (Allium sativum L.) and traditional herb has several functional properties and strong biological activities, making it useful as a functional food material. We investigated the antioxidant and anti-inflammatory activity of mixed compounds from red garlic and supplementary materials, including ginger (Zingiber officinale Roscoe), doraji (Platycodon grandiflorum), quince (Chaenomeles sinensis), citrus peel (Citri Pericarpium), and mint (Mentha arvensis). The extracts were prepared with water (W) and ethanol (E) at 70℃ (W-70, E-70) and 95℃ (W-95, E-95) for 3 h. The total content of phenolic compounds was the highest in E-70 (608.60 mg/100 g). Alliin, one of the active ingredients in red garlic, was contained at 1.18-1.29 mg/g and 0.81-0.85 mg/g in water and ethanol extract, respectively. Another active ingredient of red garlic, S-allyl-cysteine (SAC) had higher content in the water extract than in the ethanol extracts. DPPH radical scavenging activity was higher in E-70 (15.96-73.65%) at 313-5,000 μg/mL. ABTS radical scavenging activity was also higher in E-70 (5.71-77.19%) than in the others. The ROS production rate showed the same tendency as the NO production, with more efficacy in E-95. The expression level of iNOS and IL-1β was decreased in the E-95 significantly at the concentration of 1,000 μg/mL compared to the lipopolysaccharide (LPS) treated group. Based on the above results, the antioxidative and anti-inflammatory activities of the extracts of red garlic and supplementary materials were expressed by different useful substances. The contents of these useful substances were different according to the extraction solvent and temperature.

Purpose Homeobox (HOX) genes are essential developmental regulators that should normally be in the silenced state in an adult brain. The aberrant expression of HOX genes has been associated with the prognosis of many cancer types, including glioblastoma (GBM). This study examined the identity and role of HOX genes affecting GBM prognosis and treatment resistance. Materials and methods The full series of HOX genes of five pairs of initial and recurrent human GBM samples were screened by microarray analysis to determine the most plausible candidate responsible for GBM prognosis. Another 20 newly diagnosed GBM samples were used for prognostic validation. In vitro experiments were performed to confirm the role of HOX in treatment resistance. Mediators involved in HOX gene regulation were searched using differentially expressed gene analysis, gene set enrichment tests, and network analysis. Results The underexpression of HOXA11 was identified as a consistent signature for a poor prognosis among the HOX genes. The overall survival of the GBM patients indicated a significantly favorable prognosis in patients with high HOXA11 expression (31±15.3 months) compared to the prognoses in thosewith low HOXA11 expression (18±7.3 months, p=0.03). When HOXA11 was suppressed in the GBM cell lines, the anticancer effect of radiotherapy and/or temozolomide declined. In addition, five candidate mediators (TGFBR2, CRIM1, TXNIP, DPYSL2, and CRMP1) that may confer an oncologic effect after HOXA11 suppression were identified. Conclusion The treatment resistance induced by the underexpression of HOXA11 can contribute to a poor prognosis in GBM. Further investigation will be needed to confirm the value of HOXA11 as a potential target for overcoming the treatment resistance by developing chemo- or radiosensitizers.

The efficacy and safety of Chinese herbs for symptomatic treatment of bronchitis is not well established. We evaluated the efficacy and safety of a combination product of seven herbs (HL301) for the treatment of acute bronchitis (AB) and acute exacerbation of chronic bronchitis (AECB) using a randomized, double-blind, placebo-controlled, multicenter trial design.A total of 160 patients with AB or with AECB were randomized to receive placebo or one of three doses of HL301 (0.6 g/day, 1.2 g/day, or 1.8 g/day) for a total of 7 days. The primary study endpoint was the change in bronchitis severity score (BSS) from the baseline visit (visit 2) to the end of treatment visit (visit 3). Other efficacy variables were percentage BSS systemic sign efficacy after treatment and change in individual BSS parameters after treatment.Changes in BSS from visit 2 to visit 3 in the three treatment groups (4.63 ± 2.24, 4.08 ± 1.63, and 4.15 ± 1.74 in the HL301 0.6 g/day, 1.2 g/day, and 1.8 g/day groups, respectively) were higher than that of the placebo group (2.88 ± 2.57) in the per protocol set (PPS) (P .05), and it was also valid in the full analysis set (FAS). The number of participants whose symptoms (measured by BSS) improved at least 30% after treatment was higher in all three treatment groups compared to the placebo group in both the FAS and the PPS (P .05, for all).Three different doses of HL301 (0.6 g/day, 1.2 g/day, and 1.8 g/day) were effective in decreasing the BSS index compared to placebo. HL301 may be effective for symptomatic treatment of both AB and AECB.Essential components of HL301 have not been delineated in the study and patients with AB and AECB were indiscriminately enrolled in the present study. Respective evaluation of the efficacy of HL301 for AB and AECB will be necessary in the future.