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Treatment-emergent central sleep apnea has been referred to as ‘complex sleep apnea’, where apparently obstructive respiratory events convert to central apneas with application of positive airway pressure. Potential contributing factors may include increased propensity for arousals and positive airway pressure-induced reductions in CO2 which amplifies unstable ventilatory control. Here we demonstrate the dramatic beneficial effects of zolpidem and enhanced expiratory rebreathing space on complex sleep apnea, which helps to elude the mechanism of complex sleep apnea.

Background The incidence of food allergies has increased dramatically during the last decade. Recently, probiotics have been studied for the prevention and treatment of allergic disease. Objective We examined whether Bifidobacterium longum KACC 91563 and Enterococcus faecalis KACC 91532 have the capacity to suppress food allergies. Methods B longum KACC 91563 and E faecalis KACC 91532 were administered to BALB/c wild-type mice, in which food allergy was induced by using ovalbumin and alum. Food allergy symptoms and various immune responses were assessed. Results B longum KACC 91563, but not E faecalis KACC 91532, alleviated food allergy symptoms. Extracellular vesicles of B longum KACC 91563 bound specifically to mast cells and induced apoptosis without affecting T-cell immune responses. Furthermore, injection of family 5 extracellular solute-binding protein, a main component of extracellular vesicles, into mice markedly reduced the occurrence of diarrhea in a mouse food allergy model. Conclusion B longum KACC 91563 induces apoptosis of mast cells specifically and alleviates food allergy symptoms. Accordingly, B longum KACC 91563 and family 5 extracellular solute-binding protein exhibit potential as therapeutic approaches for food allergies.

Pandemics in poultry caused by the highly pathogenic avian influenza (HPAI) A virus occur too frequently globally, and there is growing concern about the HPAI A virus due to the possibility of a pandemic among humans. Thus, it is important to develop a vaccine against HPAI suitable for both humans and animals. Various approaches are underway to develop such vaccines. In particular, an edible vaccine would be a convenient way to vaccinate poultry because of the behaviour of the animals. However, an edible vaccine is still not available. In this study, we developed a strategy of effective vaccination of mice by the oral administration of transgenic Arabidopsis plants (HA-TG) expressing haemagglutinin (HA) in the endoplasmic reticulum (ER). Expression of HA in the ER resulted in its high-level accumulation, N-glycosylation, protection from proteolytic degradation and long-term stability. Oral administration of HA-TG with saponin elicited high levels of HA-specific systemic IgG and mucosal IgA responses in mice, which resulted in protection against a lethal influenza virus infection with attenuated inflammatory symptoms. Based on these results, we propose that oral administration of freeze-dried leaf powders from transgenic plants expressing HA in the ER together with saponin is an attractive strategy for vaccination against influenza A virus.

Weight loss has been reported to reduce the severity of obstructive sleep apnea (OSA), particularly in the obese population. However, prospective studies with polysomnography (PSG) for the precise evaluation of OSA are lacking especially in Asian countries. We evaluated the effects of surgical weight loss for treating OSA using PSG data obtained before and after surgery. We performed a prospective study analyzing the clinical and PSG data obtained from our cohort of bariatric surgical candidates with moderate to severe OSA, as confirmed by preoperative PSG. The patients underwent follow-up PSG at least 12 months after bariatric surgery (laparoscopic Roux-en-Y gastric bypass). Of the 47 patients (70.1 %) with moderate to severe OSA among 67 patients who underwent preoperative PSG, 10 patients underwent postoperative PSG. The mean apnea-hypopnea index (AHI) of these 10 patients significantly reduced from 51.0 ± 34.2 to 9.3 ± 12.9 events/h, while their mean body mass index (BMI) loss was from 39.9 ± 8.3 to 26.9 ± 4.4 kg/m2. Although the severity of OSA improved considerably, OSA resolution was achieved in only five patients (50 %). When compared to the patients who achieved OSA resolution, the patients with residual OSA showed a tendency to have lower minimum arterial oxygen saturation (SaO2) levels and higher supine AHI values in preoperative PSG. Surgical weight loss resulted in the significant improvement of OSA associated with obesity. However, OSA remained in a considerable proportion of patients even after substantial weight loss. We recommend that postoperative PSG be considered for the evaluation of residual OSA, especially in patients with low minimum SaO2 levels and high supine AHI in preoperative PSG.

Self-induced hypoxia has been reported particularly in adolescents, and it can result in neurological injury. Here, we present a case of electroencephalogram (EEG) abnormalities induced by habitual neck compression differentiated from epileptic seizures by Tc-99m HMPAO SPECT. A 19-year-old male was admitted for evaluation of recurrent generalized tonic-clonic seizures. No interictal EEG abnormality was detected; however, abnormal slow delta waves were found immediately after habitual right neck compression. To differentiate EEG abnormalities due to a hemodynamic deficit induced by habitual neck compression from an epileptic seizure, Tc-99m HMPAO SPECT was performed immediately after right carotid artery compression. Abnormal delta waves were triggered, and cerebral hypoperfusion in the right internal carotid artery territory was detected on Tc-99m HMPAO SPECT. The slow delta wave detected on the EEG resulted from the cerebral hypoperfusion because of the habitual neck compression.

CD137 is a member of the tumor necrosis factor/nerve growth factor receptor superfamily. Interaction of CD137 with its ligand (CD137L) affects the apoptosis, proliferation and differentiation of immune cells. Interestingly, the CD137 receptor/ligand system involves the bi-directional transduction of signals. The expression of CD137 and its ligand is not restricted to immune organs, but can also be detected in a wide variety of tissues such as the brain, kidney, lung and heart. However, its role in brain is largely unknown. This study was performed to determine the role of CD137L reverse signaling in the apoptosis of neural stem cells. We identified the expression of CD137 and its ligand in C17.2 neural stem cells derived from mouse embryonic cerebellum. We found that the activation of CD137L reverse signaling by CD137 resulted in a decrease in cell adhesion to the fibronectin-coated culture basement, thus causing detachment-induced cell death. Furthermore, we showed that the cell death induced by CD137 was completely ameliorated by integrin activators and caspase inhibitors. Therefore we suggest that CD137L reverse signaling exerts a pro-apoptotic effect by suppressing integrin-mediated survival signals in neural stem cells.

STUDY OBJECTIVES: To determine whether short sleep duration alone or combined with obstructive sleep apnea (OSA) is associated with regional body fat including abdominal visceral fat area (VFA) among Korean adults. DESIGN: Cross-sectional study. SETTING: Ansan, South Korea. PARTICIPANTS: There were 838 community participants age 40-69 y from the Korean Genome and Epidemiology Study. MEASUREMENTS AND RESULTS: Subjective habitual sleep duration and OSA were defined based on a structured sleep questionnaire and a home portable sleep study, respectively. Abdominal VFA and hepatic fat components were assessed by computed tomography. Adjusted mean VFA and hepatic fat were highest in the shortest sleep duration group (< 5 h) and decreased linearly with increasing sleep duration. Individuals with OSA (apnea-hypopnea index ≥ 5) had a higher body mass index, waist circumference, percent body fat, VFA, and hepatic fat than those without OSA after adjusting for age and sex. The adjusted odds ratio (OR) for visceral obesity (VFA ≥ 100 cm2) was 2.05 (95% confidence interval [CI], 1.09-3.86) in individuals sleeping less than 5 h compared with those sleeping longer than 7 h, and 1.57 (95% CI, 1.08-2.26) in individuals with OSA compared with those without OSA, after adjusting for all confounding factors including body mass index. A combination of short sleep duration (< 5 h) and OSA substantially increased the OR for visceral obesity (OR, 4.40, 95% CI, 1.80-10.77) compared with those who slept longer (≥ 7 h) without OSA. CONCLUSION: Short sleep duration and OSA are independently associated with visceral obesity in adults. The association is particularly strong in short sleepers with OSA.

The present study utilized a population-based sample investigating the following aims: (1) compare the longitudinal course of insomnia in middle-aged and older adults and (2) examine age-related differences on subjective complaint and objective performance in middle-aged and older adults based on the course of insomnia.1657 middle-aged adults (48.16% male, mean age=55.35±4.03years) and 405 older adults (48.40% male, mean age=70.13±3.88years) from the Korean Genome and Epidemiology Study (KoGES) were classified into 4 groups - no insomnia (NI), single episode insomnia (SEI), remitted persistent insomnia (PI-R), and ongoing persistent insomnia (PI-O) based on their course of insomnia over 5 time points spaced two years apart. Their performance on the psychomotor vigilance task (PVT) and subjective daytime sleepiness were compared across different insomnia groups, and the results were compared between middle-aged adults and older adults.Analysis of covariance indicated that subjective daytime sleepiness was significantly different across the insomnia groups in middle-aged adults based on insomnia group (P=.0001), but, did not affect objective vigilance performance. In contrast, older adults displayed significantly different PVT response time, but not daytime sleepiness, based on insomnia group (P=0.03).Insomnia impacts psychomotor performance and subjective sleepiness differently, based on age group. There may be underlying processes associated with the aging that amplifies the impact of insomnia on vigilance performance, yet lessens perceived sleepiness in older adults.

Dear Editor, Prosopometamorphopsia (PM) is the visual distortion of face perception, which is generally accompanied by other types of visual illusions. It is mainly associated with the fusiform face area and the adjacent occipital face area. There are rare reports of PM in patients with stroke, epilepsy, tumor, and migraine, and also in patients with eye disease.1 Cases involving epilepsy have only been reported as ictal manifestations.2 Herein we describe a man with variable manifestations of postictal PM without other visual illusions after focal status epilepticus in occipital lobe epilepsy. A 45-year-old man presented with a 1-week history of visual disturbances. He experienced intermittent flashes of light with blurring of vision in the left visual field. He had a history of generalized tonic-clonic convulsions in 2004. At that time he was diagnosed with cavernous hemangioma in the right occipital area. He responded favorably to valproate, experiencing no symptoms while receiving this treatment for 10 years. However, he had stopped taking valproate on his own 2 years previously. Neurologic examination was normal except for left homonymous hemianopsia. Contrast-enhanced MRI of the brain including T1-weighted, T2 weighted, fluid-attenuated inversion recovery, and gradient-echo sequences showed unchanged cavernous hemangioma from that in the previous study, but was otherwise normal. Electroencephalogram (EEG) revealed repeated periodic rhythmic fast activities confined to the right occipital area that were suggestive of focal status epilepticus (Supplementary Fig. 1 in the online-only Data Supplement). Intravenous valproate was administered as a loading dose of 20 mg/kg, followed by 450 mg of oral valproate twice daily. His visual symptoms disappeared over the next 2 days. However, on day 3 he started visualizing distortion of people's faces, describing that they looked like a two-dimensional plane. The distortion was mainly in the right half of the face, and the right eye and the chin appeared wavy with a blurred image of the nose. His visual impairment was specific to face perception only. The patient's drawing of his doctor's face depicted PM over the entire face, which it being more severe in the right half (Fig. 1A). Follow-up EEG showed well-developed and symmetric posterior alpha activity without focal slowing. Accordingly, postictal PM was strongly suspected. On day 4 his symptom partially improved, with another drawing of his doctor's face now showing PM restricted to the right half of the face (Fig. 1B). The patient was discharged on day 5, at which time his symptom had not completely resolved. At the 1 week follow-up the patient reported that he no longer saw distorted faces of people, and a third drawing depicted his doctor's face normally (Fig. 1C). Fig. 1 Patient's drawing of his doctor's face. A: A drawing made on day 3 depicts bilateral prosopometamorphopsia (PM) that is more severe in the right half of the face. B: A drawing made on day 4 depicts unilateral PM restricted to the right half of the face. ... Until now, PM has been reported as an ictal manifestation. Our patient developed postictal visual illusion restricted to the face only, which has not been reported in cases of epilepsy. Although the exact mechanism of PM remains unclear, the fusiform face area and occipital face area are considered to play a major role.3 It is hypothesized that the occipital face area of each hemisphere recognizes the contralateral side of the face, and that facial information from both hemispheres is transmitted to the fusiform face area in the right hemisphere. It is interesting that postictal cerebral dysfunction of right occipital area in our case initially led to bilateral PM, which was subsequently changed into a unilateral pattern. This is strongly suggestive that PM can present with variable phenotypes based on the pattern of involvement of the right occipital lesion, and also supports the above hypothesis that facial information from both hemisphere is transmitted to the right occipital area.

Background and Purpose Sleep need differs between individuals, and so the same duration of sleep will lead to sleep insufficiency in some individuals but not others. The aim of this study was to determine the separate and combined associations of both sleep duration and unmet sleep need with excessive daytime sleepiness (EDS) in Korean adults. Methods The participants comprised 2,769 Korean adults aged 19 years or older. They completed questionnaires about their sleep habits over the previous month. The question regarding sleep need was "How much sleep do you need to be at your best during the day?" Unmet sleep need was calculated as sleep need minus habitual sleep duration. Participants with a score of >10 on the Epworth Sleepiness Scale were considered to have EDS. Results The overall prevalence of EDS was 11.9%. Approximately one-third of the participants (31.9%) reported not getting at least 7 hours of sleep. An unmet sleep need of >0 hours was present in 30.2% of the participants. An adjusted multivariate logistic regression analysis revealed a significant excess risk of EDS in the groups with unmet sleep needs of ≥2 hours [odds ratio (OR), 1.80; 95% confidence interval (CI), 1.27–2.54] and 0.01–2 hours (OR, 1.42; 95% CI, 1.02–1.98). However, habitual sleep duration was not significantly related to EDS. Conclusions EDS was found to be associated with unmet sleep need but not with habitual sleep duration when both factors were examined together. We suggest that individual unmet sleep need is more important than habitual sleep duration in terms of the relation to EDS.

This study aimed to explore the association between restless legs syndrome and irritable bowel syndrome in an epidemiological cohort. We included 3365 adults, of whom 1602 were female (age 52.5 ± 7.5 years), who had participated in the Korean Genome and Epidemiology Study (2005-2006). The diagnosis of restless legs syndrome was based on the criteria proposed by the International Restless Legs Syndrome Study Group, and irritable bowel syndrome was defined according to the Rome II criteria. The prevalence of each condition was determined and their association was tested by logistic regression analysis. Age, sex, haemoglobin concentration, renal insufficiency, use of medications and depressive mood were all adjusted for. The prevalence of restless legs syndrome and irritable bowel syndrome was 4.5 and 11.1%, respectively. Irritable bowel syndrome was more prevalent in the group with restless legs syndrome (24.0 versus 10.5%, P0.001). Subjects with restless legs syndrome were older (54.2 ± 8.4 versus 52.4 ± 7.4, P = 0.006) and more depressive (26.7 versus 12.5%, P0.001), and were predominantly female (57.3 versus 47.2%, P = 0.015), had more frequent insomnia symptoms (44.0 versus 28.2%, P0.001), had lower haemoglobin concentration (13.7 ± 1.5 versus 14.1 ± 1.6 g dL(-1) P = 0.004) and higher highly sensitive C-reactive protein (1.8 ± 5.1 versus 1.4 ± 2.9 mg dL(-1), P = 0.08). The adjusted odds ratio of restless legs syndrome in relation to irritable bowel syndrome was 2.59 (1.74-3.85, P0.001). Irritable bowel syndrome appeared to be associated with restless legs syndrome independently from other major risk factors for restless legs syndrome. Searching for the mechanisms underlying this association is indicated.

Objectives/Hypothesis: The aim of this study was to demonstrate postoperative changes in sleep quality in children with obstructive sleep apnea (OSA), using both conventional sleep staging and electrocardiogram-based cardiopulmonary coupling (CPC) analysis. The hypothesis is that being electroencephalography (EEG)-independent, CPC may detect changes in sleep quality that traditional sleep architecture analysis cannot. Study Design: Retrospective outcome research. Methods: We included 37 children (aged 6.89 ± 2.76 years, 28 male) with OSA who underwent adenotonsillectomy, and analyzed standard polysomnography and CPC parameters from a full-night study before and after adenotonsillectomy. High-frequency coupling (HFC) and low-frequency coupling (LFC) were used as indices of stable and unstable sleep, respectively. Results: Adenotonsillectomy led to a significant change in CPC parameters (HFC, 50.3 ± 16.1% to 56.1 ± 14.7%, P = .03; LFC, 35.1 ± 14.5% to 27.3 ± 13.0%, P = .003), which was paralleled by improvements in the apnea-hypopnea (12.7 ± 13.7 to 1.0 ± 0.8, P < .001) and arousal index (20.8 ± 11.5 to 9.9 ± 3.9, P < .001). Polysomnographic sleep stage parameters other than the arousal index did not reflect postoperative resolution of OSA. Conclusions: In pediatric OSA, postoperative improvement of sleep quality is more readily discernible by CPC analysis than EEG-based sleep staging. The CPC analysis may have potential advantages in the assessment of sleep quality in pediatric populations.

We have recently found that thyroid transcription factor-1 (TTF-1), a homeodomain-containing transcription factor, is postnatally expressed in discrete areas of the hypothalamus and closely involved in neuroendocrine functions. We now report that transcription of cyclooxygenase-2 (COX-2), the rate limiting enzyme in prostaglandin biosynthesis, was inhibited by TTF-1. Double immunohistochemistry demonstrated that TTF-1 was expressed in the astrocytes and endothelial cells of blood vessel in the hypothalamus. Promoter assays and electrophoretic mobility shift assays showed that TTF-1 inhibited COX-2 transcription by binding to specific binding domains in the COX-2 promoter. Furthermore, blocking TTF-1 synthesis by intracerebroventricular injection of an antisense oligomer induced an increase of COX-2 synthesis in non-neuronal cells of the rat hypothalamus, and resulted in animals' hyperthermia. These results suggest that TTF-1 is physiologically involved in the control of thermogenesis by regulating COX-2 transcription in the brain.

Desiccant and water evaporation based cooling system is recently suggested as an alternative to refrigeration systems using typical vapor compression cycle for the purpose of energy saving and greenhouse gas reduction. The system receives the heat for the regeneration of the rotor from district heating, which is waste heat from a CHP plant or an incineration plant. KDHC (Korea District Heating Corporation) installed 4 systems at 4 individual houses in Su-Won, Korea and conducted field tests from Aug. 2010 to Sep. 2010. In this study, indoor conditions have been measured when the system is off as well as in operation. Also indoor conditions have been characterized according to outdoor conditions and users’ operation. Referring the ASHRAE standard, the cooling system in operation has been checked whether it could make indoor conditions comfortable or not. By analyzing the monitored variables, performance characteristics of the system were figured out. Major characteristics such as cooling capacity, heat & electricity consumption, and the COP of the system have been compared with those from the previous laboratory experiment.

We report a case of severe obstructive sleep apnea (OSA) in a patient with symptomatic daytime cardiac bradyarrhythmia. Continuous positive airway pressure therapy prevented atrioventricular blocks that emerged after cardiac pacing for sick sinus syndrome. OSA could be associated with daytime bradyarrhythmia.

An association between zolpidem administration and sleep-related eating disorder (SRED) has been suggested. The authors observed zolpidem-induced SRED in restless legs syndrome (RLS). With the review of previous reports, we identified a common occurrence of RLS in zolpidem-induced SRED.

Thyroid transcription factor 1 (TTF-1) is required for morphogenesis of the fetal diencephalon. Previous reports showed that mice carrying a TTF-1 null mutation lacked normal development of the pituitary gland. In this study, a role for TTF-1 in the regulation of growth hormone and prolactin transcription was identified. In-situ hybridization analysis demonstrated TTF-1 mRNA in the growth hormone-producing cells and prolactin-producing cells of the rat anterior pituitary gland. In the GH3 pituitary cell line, we identified TTF-1 as a factor functionally regulating growth hormone and prolactin transcription. TTF-1 activated prolactin transcription, but inhibited growth hormone transcription. Inhibition and activation of growth hormone and prolactin transcription, respectively, by TTF-1 disappeared upon deletion of the TTF-1 binding motifs within the promoters of these genes. These data suggest that TTF-1 plays a regulatory role in the transcription of growth hormone and prolactin genes and may regulate transdifferentiation of cells expressing these two hormones.

TTF-1 is a member of the NKx family of homeodomain genes, and is required for morphogenesis and fetal diencephalon development. Our previous studies have shown that TTF-1 expression is maintained in some regions of the postnatal rat brain and transactivates the gene expression of several neuropeptides. In this study, a potential role for TTF-1 in the regulation of feeding behavior was identified. Immunohistochemical analysis showed that TTF-1 is present in several hypothalamic nuclei of the adult rat brain involved in the control of feeding behavior. Food deprivation for two days markedly increased the hypothalamic levels of TTF-1 mRNA and protein. Intracerebroventricular administration of an antisense TTF-1 oligodeoxynucleotide significantly decreased TTF-1 protein abundance in the hypothalamus. This TTF-1 decrease was followed by a significant decrease in neuropeptide Y mRNA content and an increase in proopiomelanocortin mRNA content, and in turn resulted in a decrease of the animal's food intake and body weight. These results suggest a novel role for TTF-1 in the regulation of feeding behavior in the rat hypothalamus.

The aims of this analysis were to: (1) determine the value of ictal SPECT in the localization of neocortical epileptogenic foci, (2) evaluate the relationships between the results of ictal SPECT and other potential affecting factors, and (3) compare traditional visual analysis and the subtraction method. We retrospectively analyzed 81 consecutive patients with neocortical epilepsy who underwent epilepsy surgery and achieved a favourable surgical outcome, including 36 patients with normal MRI. Side-by-side visual analysis and subtraction images were classified as correctly localizing,correctly lateralizing, or non-localizing/non-lateralizing images according to the resected lobe. Side-by-side visual analysis and subtraction SPECT correctly localized the epileptogenic lobe in 58.9% and 63.0% of patients, respectively. The two methods were complementary and the diagnostic sensitivity of ictal SPECT using the two methods was 79.0%. Ictal SPECT using the visual method correctly localized the epileptogenic lobe more frequently in patients with a localizing pattern of ictal scalp EEG at the time of radioligand injection. When using subtraction images, an injection delay of less than 20 s after seizure onset was significantly correlated with correct localization. The subtraction method was superior to the visual method for localizing frontal lobe epilepsy (FLE) and parietal lobe epilepsy (PLE), and in patients with non-localizing/non-lateralizing EEG at onset. Ictal SPECT analyses using visual and subtraction methods are useful and complementary for the localization of the epileptogenic foci of neocortical epilepsy. Early radioligand injection and ictal EEG patterns are related to ictal SPECT localization. The subtraction method may be more useful in some epileptic syndromes.

Object. The aim of this study was to investigate changes in electroencephalography (EEG) patterns obtained from added or repositioned electrodes after those initially implanted had failed to indicate the true local ictal onset zone. The authors focused on the following matters: rationale for adding or repositioning electrodes, topographic and frequency characteristics of ictal onset before and after adding or repositioning electrodes, the effect of the procedures, and the relationship between changes in intracranial EEG onset patterns and surgical outcomes. Methods. Of 183 patients with intracranial recordings, 18 experienced repositioning of existing or implanting of additional electrodes 7 or 10 days later. All patients underwent resection and were followed up for more than 1 year. In particular, the relationship between surgical outcome and distribution/frequency of intracranial seizure onset was analyzed. Results of noninvasive presurgical evaluations in patients who had undergone single and double invasive studies were also evaluated. By adding or repositioning electrodes, a new ictal onset zone was revealed in 13 patients. In another four, the second evaluation led to a change in defining the resection margin. Ictal onset in the partially sampled area, simultaneous or independent onset in two separate areas, and onset in the distal end of the electrode strip or grid were common reasons for failing to localize the ictal onset zone during the initial evaluation. Seven of 11 patients who were ultimately found to have a focal ictal onset zone on the second evaluation became seizure free after the operation. Only one of six patients with a regional ictal onset zone identified on the second evaluation became seizure free. There was no relationship between the frequency of the ictal rhythm and surgical outcome. Note, however, that surgical outcome was more favorable in patients who had undergone a single invasive study than in those who had undergone double invasive studies. The patients who needed a second evaluation had less localizing information and less concordant results on presurgical evaluations. When comparing nonlesional cases, surgical outcomes were not significantly different among patients with a single invasive study and those with double invasive studies. No additional morbidity or death occurred during the second study. Conclusions. The addition or reposition of intracranial electrodes with a short-term interval should be considered in selected patients. Spatial restriction of the ictal onset rhythm identified on repeated evaluation is the most important predictor of a good surgical outcome.

Objective: To determine the ictal focus and the role of seizure characteristics, fluorodeoxyglucose (FDG) PET, and subtraction ictal SPECT in patients diagnosed as having nonlesional lateral temporal lobe epilepsy by long-term scalp video-EEG monitoring. Methods: The authors studied 33 consecutive patients with nonlesional neocortical epilepsy who had a scalp ictal onset zone localized in the temporal lobe and good surgical outcome after focal neocortical resection. All patients were evaluated using intracranial recordings prior to resection. Semiology, FDG-PET, and ictal–interictal subtraction SPECT were used to verify the diagnostic role of these methods in the localization of epileptic foci. Results: The ictal onset zones, confirmed by intracranial study, were the lateral temporal (22 patients), parietal (5), frontal (3), temporoparietal (2), and occipital (1) areas. FDG-PET analyzed by statistical parametric mapping correctly localized the epileptogenic lobe in 18 of 33 patients and subtraction ictal SPECT correctly localized it in 13 of 25 patients. However, in patients with extratemporal ictal onset zones, FDG-PET and ictal SPECT in combination correctly localized the epileptogenic lobe in only 3 of 11 cases. Conclusions: An extratemporal ictal onset zone was encountered in patients with nonlesional lateral temporal lobe seizures based on scalp video-EEG monitoring. FDG-PET and subtraction SPECT had localizing value in no more than half of patients.

OBJECTIVE: A chemo-sensitizing effect of levetiracetam (LEV) has been suggested because LEV inhibits O-6-methylguanine-DNA methyltransferase (MGMT). However, the survival benefit of LEV has not been clinically documented. This study was performed to assess the survival benefit of LEV as a chemo-sensitizer of temozolomide for glioblastoma patients compared to other anti-epileptic drugs (AEDs). METHODS: A total of 46 consecutive patients with primary supratentorial glioblastoma who were treated with concomitant chemoradiotherapy and adjuvant temozolomide therapy with LEV were prospectively enrolled. Forty-four consecutive patients with the same condition who had not taken LEV during identical chemoradiotherapy were selected as the control group. Gender, age, extent of lesion, the Karnofsky performance scale (KPS) score, extent of removal, and methylation status of the MGMT promoter were not significantly different between the LEV group and the control group. RESULTS: The median progression-free and overall survival (PFS and OS, respectively) of the LEV group (10.8 months [95% CI, 8.3-13.3] and 25.7 months [95% CI, 21.0-30.4], respectively) were significantly longer than those of the control group (6.6 months [95% CI, 5.2-8.0] and 16.8 [95% CI, 12.2-21.4], respectively) (p = 0.017 and 0.035, respectively). Significant prognostic factors for OS of all 90 patients were the preoperative KPS score (p = 0.027; HR = 0.360), methylation status of the MGMT promoter (p = 0.002; HR = 0.203), and LEV (p = 0.004; HR = 0.244) in multivariate analysis. CONCLUSIONS: LEV may provide a survival benefit in glioblastoma patients who receive temozolomide-based chemotherapy compared with other AEDs. A prospective randomized study may be indicated.

Background: Diffusion-weighted image (DWI) might be useful to predict the prognosis of acute hypoxic encephalopathy. The aim of our study was to test whether the early change and extent of DWI abnormalities can be an indicator of the clinical outcome of hypoxic encephalopathy. Methods: Forty-four patients who were diagnosed as hypoxic encephalopathy due to the cardiorespiratory arrest were retrospectively identified. Clinical variables were determined, and the DWI abnormalities were counted by four areas: cortex, subcortical white matter, cerebellum and deep grey matter, and were divided into three groups by the extent of lesions. Prognosis was classified as 'poor' (Glasgow coma scale (GSC) at 30 days after arrest

Wilson’s disease shows considerably various symptoms that sometimes timely diagnosis is delayed when patient shows vague clinical presentation. We present a female patient whose initial symptom was hypersomnia and severe fatigue. She was initially diagnosed as depression. Because initial hepatic function test was unremarkable, it was not easy to come to think about relationship between hepatic function and hypersomnia. Her final diagnosis was Wilson’s disease. This case suggested that hypersomnia otherwise unexplained could be the presenting symptom of Wilson’s disease.

Reduction effect of greenhouse gas emissions from district cooling system by using waste heat from a cogeneration plant has received specific attention from the perspective of national energy and environmental policy, and was studied in this work. For each cooling system of a residential and commercial building, greenhouse gas emissions was estimated and compared to quantify reduction effect on emissions where the heat source of heat-powered cooling system was replaced with a cogeneration waste heat. In addition, to address the problem that the values of waste heat and CEF vary depending on variables such as national or geographical conditions, a general-purpose criterion to measure the utility of substituting a district cooling for a conventional system was suggested.

We report a 38-year-old woman with bilateral tonic (Adie's) pupils who was diagnosed as having Vogt-Koyanagi-Harada syndrome. The tonic pupils persisted after other clinical features of this syndrome had disappeared.

Background Inflammation plays a role in the response to metabolic stress in type 2 diabetes. However, the effects of rosiglitazone on inflammation of skeletal muscle have not been fully examined in type 2 diabetes. Methods We investigated the effects of the insulin-sensitizing anti-diabetic agent, rosiglitazone, on the progression of skeletal muscle inflammation in Otsuka Long-Evans Tokushima Fatty (OLETF) type 2 diabetic rats. We examined the expression of serologic markers (serum glucose, insulin and free fatty acid) and inflammatory cytokines (tumor-necrosis factor-α, interleukin [IL]-1β and IL-6) in OLETF rats from early to advanced diabetic stage (from 28 to 40 weeks of age). Results Serum glucose and insulin concentrations were significantly decreased in rosiglitazone-treated OLETF rats compared to untreated OLETF rats. Rosiglitazone treatment significantly decreased the concentrations of serum inflammatory cytokines from 28 to 40 weeks of age. The mRNA expression of various cytokines in skeletal muscle was reduced in rosiglitazone-treated OLETF rats compared with untreated OLETF rats. Furthermore, rosiglitazone treatment resulted in the downregulation of ERK1/2 phosphorylation and NF-κB expression in the skeletal muscle of OLETF rats. Conclusion These results suggest that rosiglitazone may improve insulin sensitivity with its anti-inflammatory effects on skeletal muscle.

Background and Purpose Endothelial impairment is a linking mechanism between obstructive sleep apnea (OSA) and cardiovascular diseases. Profiles of endothelial microparticles (EMPs) and endothelial progenitor cells (EPCs) reflect the degree of endothelial impairment. The aims of this study were to measure the levels of EMPs and progenitor cells in OSA, determine the correlations between these factors and OSA severity and the degree of atherosclerosis, and document any changes in these factors after therapy. Methods Subjects with (n=82) and without (n=22) OSA were recruited prospectively. We measured the number of colony-forming units (CFU) in cell culture as the endothelial progenitor cell index, and the number of EMPs using flow cytometry with CD31 [platelet endothelial cell adhesion molecule (PECAM)], CD42 (platelet glycoprotein), annexin V, and CD62E (E-selectin) antibodies at baseline and after 4-6 weeks of continuous positive airway pressure (CPAP) therapy. Carotid intima-media thickness (IMT) was regarded as a marker of atherosclerosis. Results The levels of PECAM+CD42- (p

Background: Streptozotocin-induced diabetic animals are characterized by hyperphagia due to deficiencies of insulin and leptin. Forkhead box-containing protein of the O subfamily-1 (FoxO1) regulates energy homeostasis by regulating energy expenditure and food intake as well as mediating insulin and leptin signals in the hypothalamus. To identify the mediator of diabetic hyperphagia, we examined the effects of insulin or leptin on hypothalamic FoxO1 expression in a diabetic animal model. Methods: Diabetes was induced in mice (C57BL/6) by intraperitoneal administration of streptozotocin (200 mg/kg). Stainless steel cannula w as implanted into the lateral ventricle of the brain in each mouse. After three weeks, the mice were administered saline, insulin or leptin via intracerebroventricular (ICV) route. The medial hypothalamus was isolated to evaluate the mRNA expressions of FoxO1 and neuropeptides. Results: Streptozotocin-induced diabetic mice exhibited significant elevations of blood glucose and food intake and significantly low levels of serum insulin and leptin . The levels of hypothalamic FoxO1 mRNA were significantly increased in diabetic mice. The hypothalamic expression of neuropeptide Y (NPY) mRNA was increased, but the expression of preproopiomelanocortin (POMC) mRNA was decreased in diabetic mice. ICV administration of insulin or leptin attenuated the upregula tion of hypothalamic FoxO1 mRNA, and resulted in downregulation of NP Y mRNA and upregulation of POMC mRNA in diabetic mice. Conclusion: We observed that the expression of hypothalamic FoxO1 mRNA was increased in streptozotocin-induced diabetic mice, and that it was significantly attenuated by central administration of insulin or leptin. These results suggest that hypothalamic FoxO1 is the direct mediator of diabetic hyperphagia. (Korean Diabetes J 33:375-381, 2009)

Background and Purpose: This stu dy a ime d to d et e rmin e whethe r there are c lin ic oel ec tri c a l diffe re n c e s be twe en a nt er io r la te ral te mp oral lo be e pi le psy (ALTLE) a nd p os te rio r la te ra l te mp o ra l lo be e p ile p s y (P LTLE), ta k in g me di a l temp or a l lo be e pi le psy (MTLE) a s a re fe re nce. M et h ods: We a n a lyze d the his to ric a l in fo r ma tio n , ic ta l s emio lo g ie s , a n d ic ta l EEGs o f temp o ra l lo be ep ilep s y p a tien ts with a d o c ume n te d fa vo ra ble s ur g ic a l o u tc o me (En g e l c la s s I o r II) a t fo llo w-up a fte r mo re tha n o n e ye a r . LTLE wa s d e fin ed whe n a d is c r ete le s io n o n MRI o r a n ic ta l o n s e t zo n e in in va s ive s tud y wa s lo c a te d o uts id e the c o lla te ra l s u lc u s . LTLE wa s fu rther d ivide d in to ALTLE a n d P LTL E by re fe rence to the lin e a cross the c ereb ra l p e d un c le . To ta l 107 s eizu re s o f 13 ALTLE, 8 P LTLE a n d 21 MTLE pa tie n ts wer e re vie wed . R esul t s: In itia l hyp o mo to r s ymp to m wa s fre que n tly o bs er ved in P LTLE (P

Our objective was to investigate if weekend catch-up sleep is independently related to a decrease in the risk for hypertension in Korean adults.The subjects included 2782 Korean adults ages 19 years and older. Data on demographic variables, sleep duration (weekday and weekend), and hypertension were obtained using questionnaires. Logistic regression analyses were performed to test the association between hypertension and sleep duration (weekday and weekend catch-up sleep duration); we also adjusted for possible covariates.After adjustment for confounding variables, we found that individuals who slept less than 6 hours a night had an increased odds ratio (OR) for hypertension (OR, 1.73; 95% confidence interval [CI], 1.13-2.64) compared to individuals who slept 7 to8 hours a night. Furthermore, one hour of weekend catch-up sleep was significantly associated with decreased risk for hypertension (OR, 0.83; 95% CI, 0.72-0.95). There were significant differences for groups with and without subjective sleep insufficiency in the association between weekend catch-up sleep duration and the prevalence of hypertension; in addition, the effect of an extra hour of weekend catch-up sleep per night on hypertension was stronger in those subjects who experienced subjective sleep insufficiency (OR, 0.61; 95% CI, 0.46-0.82).Sleeping more on the weekend to compensate for weekday sleep deficit could lower the risk for hypertension in Korean adults, especially in Korean adults who have the subjective symptom of sleep insufficiency.