Search

Osteoporosis is a well-known risk factor of screw loosening. Classically, dual-energy x-ray absorptiometry (DEXA) scan is an easy and cost-effective method of detecting bone mineral density (BMD). However, T-score on DEXA scan can be overestimated in patients with degenerative changes of the spine. Our objective was to identify correlation between Hounsfield unit (HU) measured by 3-dimensional computed tomography (3D-CT) and screw loosening.A total of 113 patients treated with lumbosacral spinal fusion were reviewed and categorized into a screw loosening group and a normal group to compare their average values of preoperative CT HU. Screw loosening was defined as radiolucent area around screw that was thicker than 1 mm with a "double halo sign".There were statistically significant differences in patient age and steroid use between screw loosening and non-loosening groups. There was no significant difference in BMD or T-score between the 2 groups. However, HU values measured in axial, coronal, and sagittal images were significantly different between the 2 groups. In the receiver operating characteristic for HU values measured in CT images, the greatest area under the curve was 0.774 and that was in case of Hounsfield unit measured by axial CT images from L1 to L4.Preoperative CT HU is associated with screw loosening. It can be a better predictor of screw loosening than DEXA scan. The best predictor of screw loosening in this study is the average value of HU from L1 to L4 in axial cut.

The hypoglossal canal (HC) is an unusual location of the posterior fossa dural arteriovenous fistula (AVF), which usually occurs in the transverse or sigmoid sinus. Herein, we report a case of HC dural AVF successfully treated with transvenous coil embolization using detachable coils in a 68-year-old woman who presented with headache and left pulsatile tinnitus for 2 months. Brain magnetic resonance imaging (MRI) and cerebral angiography revealed left HC dural AVF. The pulsatile bruit disappeared immediately after the procedure. Follow-up MRI showed complete disappearance of the fistula. Precise localization of the fistula through careful consideration of the anatomy and transvenous coil embolization using a detachable coil can facilitate the treatment for HC dural AVF.

Findings on the association between statin therapy and Parkinson's disease (PD) occurrence have been inconsistent. This study aimed to identify the association between statin use and PD in participants with a history of hyperlipidemia or blood cholesterol200 in a Korean population to exclude nonstatin users owing to normal lipid values.We conducted a nested case-control analysis using the Korean National Health Insurance Service-National Sample Cohort assessed between 2002 and 2015. We identified 3026 PD cases. A total of 12,104 controls were then individually matched by age, sex, income, and region of residence at a ratio of 1:4. Potential confounders comprised basic demographic factors, lifestyle factors, various medical conditions and comorbidities. A conditional/unconditional logistic regression method was applied.Compared with statin use for6 months, adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for 6-12 months of statin use and ≥12 months of statin use were 1.03 (0.92-1.15) and 1.61 (1.35-1.93) after adjustment for confounders, respectively (P = 0.664 and P 0.001). In analyses according to statin solubility, only the association between lipophilic statin use for ≥12 months and PD maintained statistical significance, with an aOR of 1.64 (95% CI = 1.34-2.01, P 0.001). These relations were consistent in subgroup analyses by covariates.Statin use for more than 12 months was associated with a higher probability of PD in the Korean population with hyperlipidemia. This probability was significant for lipophilic statins but not hydrophilic statins.

Background Acute hydrocephalus may decrease cerebral perfusion by increasing intracranial pressure. Computed tomography perfusion (CTP) has become a significant adjunct in evaluating regional and global cerebral blood flow (CBF). Purpose To investigate the changes in cerebral perfusion parameters and maximum contrast enhancement (MCE) in patients with hydrocephalus with ventriculoperitoneal shunt (VPS). Material and Methods We performed brain CTP in 45 patients, including those with subarachnoid hemorrhage (SAH)-induced hydrocephalus with VPS (n = 14, G1), hydrocephalus (not related to SAH) with VPS (n = 11, G2), SAH-induced hydrocephalus without VPS (n = 10, G3), and hydrocephalus (not related to SAH) without VPS (n = 10, G4). We measured the cerebral perfusion in the frontal white matter (FWM), centrum semiovale, basal ganglia (BG), and eight cortical lesions of interest and compared the differences in CTP parameters among the groups. Results Between the four groups, cerebral blood volume and MCE in the left FWM and CBF in the right FWM increased significantly in G1 and G2 who underwent VP shunt compared to G3 and G4, whereas perfusion significantly reduced in G3 and G4 who did not undergo VP shunt compared to G1 and G2. MCE in the left BG significantly increased in G2 and decreased in G3 and G4. SAH-induced hydrocephalus showed a lower perfusion than hydrocephalus (not related to SAH) in FWM. Conclusions Perfusion changes in patients with hydrocephalus after VP shunt were seen in the FWM and BG, which appears to be the result of the hydrocephalus reducing brain perfusion in the deep part of the brain. We concluded that SAH slows brain perfusion recovery.

ObjectivesThe relationship between smoking and subjective cognitive decline (SCD), which is defined as the subjective perception of cognitive decline, is not well known. This study aimed to investigate the relationship of various types of smoking, including E-cigarette smoking and the use of E-liquid, with the incidence of SCD among Korean adults.MethodsWe evaluated the 2018 Korean Community Health Survey data collected from community-dwelling people in Korea. A total of 104,453 non-smokers, 38,607 past smokers, and 26,776 current smokers with eligible data were included in the study. SCD was assessed using the Behavioral Risk Factor Surveillance System. The past or current smoking pack-years throughout each participant's entire life were calculated. Multiple regression analyses were carried out to estimate the adjusted odds ratios (ORs) as measures of the association between each type of smoking and SCD after adjustment for potential confounders.ResultsCompared to no exposure, passive smoking was associated with higher odds of SCD. Compared to non-smokers, past smokers had a higher OR for SCD; however, current smokers did not. There were no significant associations between passive smoking and SCD in the non-smoker and past smoker groups, but there was a significant relationship between them in the current smoker group. While the cumulative dose of smoking was correlated with an increased OR of SCD in each group of current smokers and past smokers, E-cigarette smoking and the use of E-liquid were not associated with higher ORs in the current smoker group.ConclusionOur findings support that passive smoking and past smoking are significantly associated with SCD and that more cumulative exposure to smoking is correlated with a higher OR of SCD.

Aim To determine the relationship between knowledge, attitude and the practice of hand hygiene by nursing and midwifery students in Cambodia. Background Hand hygiene is the most cost-effective means to prevent hospital-acquired infections. Techniques of hand hygiene are simple; however, many researchers have found hand hygiene knowledge, attitude and practice to be poor in many healthcare settings worldwide, especially in developing countries. Cambodia is a developing country in Southeast Asia and data regarding hand hygiene are limited. Methods A cross-sectional descriptive study was conducted to assess the level of knowledge, attitude and practice of hand hygiene. Students in nursing and midwifery programmes were the target population (n = 300). Survey data were collected from January to May 2017. Descriptive statistics, t-tests and correlation coefficients were calculated to assess relationships between student knowledge, attitude and hand hygiene practice. Result The level of knowledge, attitude and practice of hand hygiene in nursing and midwifery students was moderate. A majority of students had received hand hygiene training. There was no significant difference between nursing and midwifery students in knowledge, attitude and practice of hand hygiene. However, a Pearson correlation of attitude and practice had a weak positive relationship. Conclusion Both nursing and midwifery students demonstrated moderate levels of knowledge, attitudes and practice of hand hygiene. Implication for nursing and health policy This study identified a need for hand hygiene training. Developing training programmes to improve attitudes about hand hygiene is strongly recommended. Effective training may contribute to change behaviours of hand hygiene (attitude), improve practice and ultimately reduce hospital-acquired infections.

Only a few studies have reported nontraumatic intracerebral hemorrhage in young patients notwithstanding its fatal and devastating characteristics. This study investigated the clinical characteristics and outcome of nontraumatic intracerebral hemorrhage in young patients in comparison to those of the elderly. A retrospective review of consecutive patients admitted at the department of neurosurgery of two tertiary care medical centers presenting with first-ever nontraumatic intracerebral hemorrhage was performed. We identified and compared the demographics, etiologies, risk factors, and laboratory, radiological, and clinical findings between elderly and young patients. Additionally, logistic regression analyses of independent prognostic factors associated with 1-month mortality and favorable functional outcome were performed. Altogether, 247 patients including 69 young patients and 178 elderly patients were enrolled. On multivariate analysis, young patients exhibited significantly more often an infratentorial hematoma location, excessive alcohol consumption, and high body mass index (BMI), but less frequent systemic hypertension. There was no statistical difference between the two groups in 1-month mortality (17.46% and 18.01% for young and elderly patients, respectively), but the favorable functional outcome based on modified Rankin scale score of 0 or 1 was significantly different between the two groups (favorable outcome in 51.79% and 29.93% of patients, respectively). Predictors of 1-month mortality was the presence of herniation in the young group, and lower Glasgow Coma Scale score, renal or heart disease, and leukocytosis (WBC > 10,000) in the elderly group. Lower National Institutes Health Stroke Scale score was associated with favorable functional outcome in both groups. Nontraumatic intracerebral hemorrhage in younger patients appears to be associated with excessive alcohol consumption and high BMI. Younger patients had similar short-term mortality but more favorable functional outcome than the elderly.

There are no recommended guidelines for monitoring parameters during venoarterial extracorporeal membrane oxygenation (V-A ECMO). We evaluated whether regional cerebral oxygen saturation (rScO2) could be a monitoring parameter for mortality during V-A ECMO. We retrospectively searched our database for adult patients who underwent V-A ECMO between April 2015 and October 2016 and identified 21 patients with rScO2 data. Their baseline and clinical characteristics during the first 7 days (vital signs, arterial blood gas results, ECMO variables, rScO2, Swan-Ganz catheter parameters, transthoracic echocardiography parameters, and outcomes) were collected and evaluated for associations with 28 day mortality. The survivor group (12 patients, 57.1%) had higher rScO2 values and lower lactate levels, compared with the nonsurvivor group (nine cases, 42.9%) during the first 7 days. The areas under the receiver operating characteristics curves were 0.87 for right rScO2 (p < 0.001) and 0.86 for left rScO2 (p < 0.001). The optimal cutoff values for right and left rScO2 were 58% (sensitivity: 78.7%, specificity: 83.3%) and 57% (sensitivity: 80.0%, specificity: 70.8%), respectively. Kaplan-Meier analysis revealed that the risks of 28 day mortality were higher among patients with a right rScO2 of

PurposeThe anti-tumor effect of the beta-adrenergic receptor antagonist propranolol in breast cancer is well known; however, its activity in glioblastoma is not well-evaluated. The Notch-Hes pathway is known to regulate cell differentiation, proliferation, and apoptosis. We investigated the effect of propranolol to human glioblastoma cell lines, and the role of Notch and Hes signaling in this process.MethodsWe performed immunohistochemical staining on 31 surgically resected primary human glioblastoma tissues. We also used glioblastoma cell lines of U87-MG, LN229, and neuroblastoma cell line of SH-SY5Y in this study. The effect of propranolol and isoproterenol on cell proliferation was evaluated using the MTT assay (absorbance 570nm). The impact of propranolol on gene expression (Notch and Hes) was evaluated using real-time (RT) PCR, whereas protein levels of Notch1 and Hes1 were measured using western blotting (WB), simultaneously. Small interfering RNA (siRNA) was used to suppress the Notch gene to investigate its role in the proliferation of glioblastoma.ResultsPropranolol and isoproterenol caused a dose-dependent decrease in cell proliferation (MTT assay). RT-PCR showed an increase in Notch1 and Hes1 expression by propranolol, whereas WB demonstrated increase in Notch1 protein, but a decrease in Hes1 by propranolol. The proliferation of U87-MG and LN229 was not significantly suppressed after transfection with Notch siRNA.ConclusionThese results demonstrated that propranolol suppressed the proliferation of glioblastoma cell lines and neuroblastoma cell line, and Hes1 was more closely involved than Notch1 was in glioblastoma proliferation.

Objective : We reported the differentially methylated genes in patients with subarachnoid hemorrhage (SAH) using bioinformatics analyses to explore the biological characteristics of the development of delayed cerebral ischemia (DCI).Methods : DNA methylation profiles obtained from 40 SAH patients from an epigenome-wide association study were analyzed. Functional enrichment analysis, protein-protein interaction (PPI) network, and module analyses were carried out.Results : A total of 13 patients (32.5%) experienced DCI during the follow-up. In total, we categorized the genes into the two groups of hypermethylation (n=910) and hypomethylation (n=870). The hypermethylated genes referred to biological processes of organic cyclic compound biosynthesis, nucleobase-containing compound biosynthesis, heterocycle biosynthesis, aromatic compound biosynthesis and cellular nitrogen compound biosynthesis. The hypomethylated genes referred to biological processes of carbohydrate metabolism, the regulation of cell size, and the detection of a stimulus, and molecular functions of amylase activity, and hydrolase activity. Based on PPI network and module analysis, three hypermethylation modules were mainly associated with antigen-processing, Golgi-to-ER retrograde transport, and G alpha (i) signaling events, and two hypomethylation modules were associated with post-translational protein phosphorylation and the regulation of natural killer cell chemotaxis. VHL, KIF3A, KIFAP3, RACGAP1, and OPRM1 were identified as hub genes for hypermethylation, and ALB and IL5 as hub genes for hypomethylation.Conclusion : This study provided novel insights into DCI pathogenesis following SAH. Differently methylated hub genes can be useful biomarkers for the accurate DCI diagnosis.

Although stereotactic or neuronavigation-guided hematoma drainage for spontaneous intracerebral hemorrhage (ICH) is widely used, its clinical efficacy and factors for predictive results remain to be fully elucidated. This study sought to determine the efficacy of hematoma evacuation for spontaneous ICH, in addition to the factors affecting it. We retrospectively reviewed patients who underwent stereotactic or neuronavigation-guided catheter insertion for spontaneous ICH at our institute between April 2010 and December 2019. We identified and compared the clinical and radiographic factors between groups according to the hematoma evacuation rate of 70%. Logistic regression analyses were performed to identify factors affecting hematoma evacuation. We investigated whether the hematoma evacuation rate was associated with patient survival. A total of 95 patients who underwent stereotactic or neuronavigation-guided catheter insertion and hematoma drainage for spontaneous ICH were included. A multivariate analysis indicated that a hematoma volume of 30–60 cm3 (odds ratio [OR] = 8.064, 95% confidence interval [CI] = 2.285–28.468, P = 0.001), blend sign (OR = 6.790, 95% CI = 1.239–37.210, P = 0.027), diabetes (OR = 0.188, 95% CI = 0.041–0.870, P = 0.032), and leukocytosis (OR = 3.061, 95% CI = 1.094–8.563, P = 0.033) were significantly associated with a higher hematoma evacuation. The mean hematoma evacuation rate in patients with 1-month mortality was lower than that in survivors (P = 0.051). Our study revealed that a hematoma volume of 30–60 cm3, the presence of a blend sign and leukocytosis, and the absence of diabetes are independent predictors that affect more than 70% of hematoma evacuations.

Prolonged carriage of carbapenemase-producing Enterobacteriaceae (CPE) constitutes a substantial epidemiologic threat. This study aimed to evaluate whether the types of carbapenemase and organism can affect the duration of carriage and to evaluate the clinical factors associated with prolonged carriage. We retrospectively reviewed data for patients admitted between May 2013 and August 2018 who were identified as CPE carriers. A total of 702 patients were identified, the major types of carbapenemase and organism were Oxacillinase (OXA)-48-like (n = 480, 68.4%) and Klebsiella pneumoniae (K. pneumoniae) (n = 584, 83.2%). The analyses of time to spontaneous decolonization using the Kaplan&ndash, Meier method showed that OXA-48-like and K. pneumoniae were significantly associated with prolonged carriage (log rank, p = 0.001 and p &lt, 0.001). In multivariable logistic analysis to assess the risk factors for CPE prolonged carriage in the 188 patients with available follow-up culture data for 3 months, K. pneumoniae (adjusted odds ratio [aOR] 6.58, 95% confidence interval [CI], 1.05&ndash, 41.27, p = 0.044), CPE positive clinical specimen (aOR 11.14, 95% CI, 4.73&ndash, 26.25, p &lt, 0.001), and concurrent Clostridioides difficile infection (CDI) (aOR 3.98, 95% CI 1.29&ndash, 12.26, p = 0.016) were predictive of prolonged carriage. Our results suggest that CP-K. pneumoniae may have higher probability of prolonged carriage, while the effect of OXA-48-like CPE is inconclusive. Furthermore, patients with CP-K. pneumoniae who had positive clinical specimen or concurrent CDI can cause a vicious circle in prolonged carriage.

Background: Although the dopaminergic system is interconnected with the hypothalamic-pituitary-thyroid axis, few studies have explained the causal relationship between thyroid disease and Parkinson’s disease (PD). Objective: The goal of this study was to investigate the association between thyroid diseases and PD in Korean residents. Methods: The Korean National Health Insurance Service-National Sample Cohort, which includes individuals aged ≥40 years, was assessed from 2002 to 2015. A total of 5,586 PD patients were matched by age, sex, income, and the region of residence with 22,344 control participants at a ratio of 1:4. In the PD and control groups, previous histories of levothyroxine treatment, goiter, hypothyroidism, thyroiditis, and hyperthyroidism were investigated. Results: The rates of levothyroxine treatment for more than 3 months, hypothyroidism, and hyperthyroidism were higher in the PD group than the control group (3.2%, 3.8%, and 2.8% vs. 2.5%, 2.9%, and 1.9%, respectively, p

Objective Notch receptors are heterodimeric transmembrane proteins that regulate cell fate, such as differentiation, proliferation, and apoptosis. Dysregulated Notch pathway signaling has been observed in glioblastomas, as well as in other human malignancies. Nerve growth factor (NGF) is essential for cell growth and differentiation in the nervous system. Recent reports suggest that NGF stimulates glioblastoma proliferation. However, the relationship between NGF and Notch1 in glioblastomas remains unknown. Therefore, we investigated expression of Notch1 in a glioblastoma cell line (U87-MG), and examined the relationship between NGF and Notch1 signaling. Methods We evaluated expression of Notch1 in human glioblastomas and normal brain tissues by immunohistochemical staining. The effect of NGF on glioblastoma cell line (U87-MG) was evaluated by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. To evaluate the relationship between NGF and Notch1 signaling, Notch1 and Hes1 expression were evaluated by reverse transcription polymerase chain reaction (RT-PCR) and Western blot analysis, respectively. To confirm the effects of NGF on Notch1 signaling, Notch1 and Hes1 small interfering RNAs (siRNAs) were used. Results In immunohistochemistry, Notch1 expression was higher in glioblastoma than in normal brain tissue. MTT assay showed that NGF stimulates U87-MG cells in a dose-dependent manner. RT-PCR and Western blot analysis demonstrated that Notch1 and Hes1 expression were increased by NGF in a dose-dependent manner. After transfection with Notch1 and Hes1 siRNAs, there was no significant difference between controls and 100 nM NGF-β, which means that U87-MG cell proliferation was suppressed by Notch1 and Hes1 siRNAs. Conclusion These results indicate that NGF stimulates glioblastoma cell proliferation via Notch1 signaling through Hes 1.

To investigate the relationship between the K-line tilt and classical cervical parameters such as the C2–C7 sagittal vertical axis (SVA), cervical lordosis, and the T1 slope in cervical sagittal alignment. We assessed whether the K-line tilt can be used as an excellent cervical parameter. We reviewed 50 patients aged 60–89 years who visited the spine center outpatient clinic from May 2017 to September 2017 through cervical spine lateral radiography and checked the cervical spine parameters. All targeted patients were randomized without any prejudice. Radiographic measurements included the K-line tilt, C2–C7 lordosis, the C2–C7 SVA, the T1 slope, and T1 slope minus C2–C7 lordosis (T1S-CL). Pearson correlation coefficients were calculated between the K-line tilt and each cervical parameter. Of the 50 patients, 33 were men. The mean age of the patients was 70.84 ± 7.52 years. The mean K-line tilt was 11.28 ± 8.31°. The K-line tilt was correlated with the C2–C7 SVA (r = 0.813, P = 0.000) and T1S-CL (r = 0.315, P = 0.026). This study showed that the K-line tilt is also a useful parameter like the C2–C7 SVA and T1S-CL in cervical sagittal alignment. These slides can be retrieved under Electronic Supplementary Material.

Contrast-induced encephalopathy after cerebral angiography is a rare complication and until now, only few cases have been reported. This paper reports on contras-induced encephalopathy mimicking meningoencephalitis after cerebral angiography by using iodixanol, an iso-osmolar non-ionic contrast agent. A 58-year-old woman underwent cerebral angiography for the evaluation of multiple intracranial aneurysms. A few hours later, she had persistent headache, vomiting, fever, and seizures. Brain computed tomography (CT) showed sulcal obliteration of right cerebral hemisphere and cerebrospinal fluid profile was unremarkable. The next day, she developed left side hemiparesis, sensory loss, and left-sided neglect with drowsy mentality. Brain magnetic resonance imaging (MRI) showed cerebral swelling with leptomeningeal enhancement in the right parieto-occipital lobe without sign of ischemia or hemorrhage. The patient was managed with intravenous dexamethasone, mannitol and anticonvulsant. There was a progressive neurological improvement with complete resolution of the symptoms at day 6. This observation highlights that contrast-induced encephalopathy can be caused by an iso-osmolar non-ionic contrast agent. This rare entity should be suspected if neurologic deterioration after cerebral angiography is not explained by other frequent causes such as acute infarction or hemorrhage.

Background Context. Cervical laminoplasty often gives rise to cervical sagittal imbalance attributable to injury of posterior structures including laminae, articular facets, muscles, and ligaments. Purpose. To determine the effect of age on sagittal cervical alignment after cervical laminoplasty procedure so as to identify the group with the greatest degree of variation. Study Setting. Single-center retrospective chart review in a tertiary referral hospital. Outcome Measures. The sagittal vertical axis (SVA) (C2-7), T1 slope, and cervical lordosis. Methods. We included patients who underwent cervical laminoplasty between 2014 and 2018 and divided 60 consecutive patients into two groups using the cut-off age of 65 years. The Paired t -test and Mann-Whitney U test were used to compare changes between preoperative radiographic cervical sagittal parameters and those 1 year after surgery. Results. Mean patient ages in the older and younger groups were 71 years and 52 years, respectively. The difference of C2-7 SVA was greater in the older group. Conclusion. Postoperative cervical balance can be worse when laminoplasty is performed in elderly patients.

Posttraumatic hydrocephalus (PTH) is common in patients undergoing decompressive craniectomy (DC) for traumatic brain injury (TBI), but the incidence, mechanisms, and risk factors have not been fully elucidated. This study aimed to determine the incidence of and the factors associated with PTH. We retrospectively reviewed patients who underwent DC for TBI at our institute between January 2014 and December 2018. We identified and compared the demographic, clinical, and radiological data, and 12-month functional outcome (as assessed by the Glasgow Outcome Scale [GOS]) between patients who developed PTH and those who did not. Logistic regression analyses were performed to identify risk factors for PTH. Additionally, the influence of PTH on unfavorable functional outcome was analyzed. PTH developed in 18 (18.95%) of the 95 patients who survived at 1 month after DC. A multivariate analysis indicated that postoperative intraventricular hemorrhage (odds ratio [OR] 4.493, P = 0.020), postoperative subdural hygroma (OR 4.074, P = 0.021), and postoperative hypothermia treatment (OR 9.705, P = 0.010) were significantly associated with PTH. The 12-month functional outcome significantly differed between the patients who developed PTH and those who did not (P = 0.049). Patients who developed PTH had significantly poorer 12-month functional outcomes than those who did not (P = 0.049). Another multivariate analysis indicated that subdural hemorrhage (OR 6.814, P = 0.031) and the presence of at least one dilated pupil before DC (OR 8.202, P = 0.000) were significantly associated with unfavorable functional outcomes (GOS grades 1–3). Although the influence of PTH (OR 5.122, P = 0.056) was not statistically significant in the multivariate analysis, it had a great impact on unfavorable functional outcomes. PTH considerably affects functional outcomes at 12 months after DC for TBI. Furthermore, postoperative imaging findings such as intraventricular hemorrhage and subdural hygroma can predict the development of PTH; therefore, careful observation is required during the follow-up period.

We sought to investigate the relationship between cervical cord compression and factors related to whole-spine sagittal balance.This retrospective single-center study included patients who visited our clinic for the evaluation of lumbar pathology including trauma and degeneration. Patients aged 60-89 years who underwent whole-spine sagittal T2 scout magnetic resonance imaging and whole-spine radiograph between 2014 and 2018 were included in our study. We consecutively enrolled 100 patients for our study without any prejudice. We collected data on patient characteristics, diagnosis, cervical cord compression index (CCI), sagittal vertical axis (C7-S1, C2-7), and other parameters related to sagittal balance such as pelvic incidence minus lumbar lordosis. Pearson correlation coefficients were calculated to compare CCI with each whole-spine sagittal balance parameter.Of the 100 patients, 44 were men. The mean age was 74.21 years. On the basis of Pearson correlation coefficients, CCI showed the strongest positive linear correlation with C7-S1 sagittal vertical axis (r = 0.688; P 0.01), followed by the C2-7 sagittal vertical axis (r = 0.563; P0.01).Cervical cord compression is more likely to develop in patients with sagittal imbalance. It is important to use whole-spine radiograph and whole-spine T2 scout magnetic resonance imaging to analyze CCI in these patients.

BACKGROUND The majority of earlier studies of the parameters of sagittal balance did not consider the influence of spinal muscles on spinal sagittal alignment. OBJECTIVE To analyze the relationship between the paraspinal muscle (quantity and quality) and sagittal alignment in elderly patients. METHODS We reviewed 50 full-spine lateral standing radiographs and lumbar magnetic resonance images of elderly patients at a single center. The radiographic parameters examined were thoracic kyphosis, lumbar lordosis (LL), sagittal vertical axis, pelvic tilt, sacral slope, and pelvic incidence (PI). The lumbar muscularity (LM; quantity) and fatty degeneration ratio (FD; quality) in the paraspinal muscle were measured at the L3 level on magnetic resonance images. The relationships between the parameters, LM, and FD were analyzed with the Pearson correlation coefficient and multiple linear regression. RESULTS Pearson analysis demonstrated that the FD had significant correlations with age (r = 0.393), thoracic kyphosis (r = -0.559), pelvic tilt (r = 0.430), sagittal vertical axis (r = 0.488), and PI - LL (r = 0.479, P < .05), and a close negative correlation was found between the FD and LL (r = -0.505, P < .01). The LM had significant correlations with the LL (r = 0.342) and PI - LL (r = -0.283, P < .05). Regression models that controlled for confounding factors such as body mass index confirmed the correlations between the above parameters and FD (P < .05). CONCLUSION The quality of the paraspinal muscle could be one of the various factors that influence sagittal balance. ABBREVIATIONS BMI, body mass indexCSA, cross-sectional areaFD, fatty degeneration ratioLL, lumbar lordosisLM, lumbar muscularityPI, pelvic incidencePT, pelvic tiltSC, subcutaneous fatSS, sacral slopeSVA, sagittal vertical axisTK, thoracic kyphosisVB, vertebral body.

Objective Therapeutic hypothermia (TH) and decompressive craniectomy are neuroprotective interventions following severe brain swelling. The precise benefits, risks, and clinical outcomes in brain swelling after TH are still being investigated. We aimed to investigate the effects of TH in severe brain injury after decompressive craniectomy. Methods We reviewed the cases of 24 patients who underwent decompressive craniectomy with intracranial pressure (ICP) monitor insertion in one medical center between January 2012 and May 2016. All patients had an ICP greater than 15 mmHg and a Glasgow Coma Scale score of less than 7 at the time of intervention. TH was induced in half of the patients (n=12) directly after surgery; the remaining 12 patients remained normothermic. The ICP, vital signs, complications, and functional outcomes were reviewed and compared between the patient groups. Results The mean ICP in the TH group was significantly lower than in the normothermia group. Complications during the 3 days after surgery were not different between the groups, with the exception of hypokalemia in the TH group. Mortality in the intensive care unit (ICU) was higher in the normothermia group, but the functional outcomes 3 months after surgery were not different between the TH and normothermia groups. Conclusion TH after decompressive craniectomy was effective for lowering ICP in patients with severe brain swelling. TH also reduced mortality in the ICU, but it had no benefit in functional outcomes.

Objective Cerebral venous thrombosis (CVT) is a rare condition for which few clinical reviews have been conducted in Korea. Our aim was to investigate, risk factors, clinical presentations/courses, and outcomes of 22 patients treated for CVT at two centers. Materials and methods A retrospective analysis was conducted, selecting 22 patients diagnosed with and treated for CVT at two patient care centers over a 10-year period (January 1, 2004 to August 31, 2015). Patient data, pathogenetic concerns (laboratory findings), risk factors, locations, symptoms, treatments, and clinical outcomes were reviewed. Results Mean patient age at diagnosis was 54.41 ± 16.19. Patients most often presented with headache (40%), followed by seizure (27%) and altered mental status (18%). Focal motor deficits (5%), visual symptoms (5%), and dysarthria (5%) were less common. Important predisposing factors in CVT included prothrombotic conditions (35%), infections (14%), hyperthyroidism (18%), trauma (14%), and malignancy (4%). By location, 9 patients (40%) experienced thrombosis of superior sagittal sinus predominantly, with involvement of transverse sinus in 20 (90%), sigmoid sinus in 12 (40%), and the deep venous system in 5 (23%). Treatment generally consisted of anticoagulants (63%) or antiplatelet (23%) drugs, but surgical decompression was considered if warranted (14%). Medical therapy in CVT yields good functional outcomes. Conclusion Mean age of patients with CVT in our study exceeded that reported in Europe or in America and had difference in risk factors. Functional outcomes are good with use of antithrombotic medication, whether or not hemorrhagic infarction is evident.

Holmes' tremor is a rare but severely disabling movement disorder characterized by a combination of resting, action, and intention tremor. Because Holmes' tremor is usually resistant to pharmacotherapy, surgical treatment is required for symptom control in most cases. We report the case of a 56-year-old man who was diagnosed with Holmes' tremor and treated with stimulation of the ventralis intermedius nucleus of the thalamus and posterior subthalamic area. Deep brain stimulation alleviated the patient's tremor over a 3-year follow-up period.

Various dichroic dyes were synthesized and applied to two different host materials for the study of optimized molecular structures of guest–host system for the coatable polarizer using liquid crystalline polymers. The host material containing planar and linear mesogens had an advantage in exhibiting high orientation orders, but easily formed disclinations due to causing the strong intermolecular attraction between the guest and host molecules. The balance of intermolecular attraction and repulsion between the guest and host molecules is important to simultaneously achieve high orientations and uniform alignments without disclinations. The highest dichroic ratio of coatable polarizers was obtained when the π-conjugation lengths of guest and host molecules have an appropriate ratio. Also, the guest molecules with a long π-conjugation length improved the orientation of host molecules.

Guest–host coatable polarizers were manufactured by liquid crystalline polymers and dichroic azo dyes. The highest dichroic ratio of the polarizers was observed within the permissible limit of guest concentration, because any increase in the guest concentrations beyond the permissible limit decreased the alignment ability of the host. The orientational behavior of dye molecules in guest–host systems tend to be more sensitive to intermolecular steric hindrance as compared to that in PVA-based polarizing films. Also, the polarity difference between guest and host molecules had a great effect on the alignment of the guest–host system. Long conjugation, abundant π-electrons for transfer and the charge distribution without deviation from the long axis are required for a highly anisotropic transition dipole moment.

Organic dyes with low electrical conductivity have recently been suggested as replacements for Cr/CrOx and carbon black in developing black matrices with low dielectric constants for liquid crystal displays (LCDs). Two perylene diimide dyes with broad absorption spectra were synthesized, and dye-type, hybrid-type and carbon black-type black matrices were fabricated using one of the dyes. Donating groups were substituted on the bay positions of the dyes by C–N coupling to enhance their solubility in propylene glycol methyl ether acetate, one of the most widely used industrial solvents in the LCD manufacturing processes. The thermal and spectral properties of the dyes were studied by thermogravimetric analysis and UV–Visible spectroscopy. Furthermore, the thermal, optical and dielectric properties of the black matrices were examined by color spectroscopy, optical density measurement and impedance analysis. The hybrid-type black matrix showed promising results with a low dielectric constant, low transmittance spectrum and high thermal stability.

In the present study, we investigated the effects of pioglitazone (PGZ) in the hippocampal CA1 region of low- or high-fat diet (LFD or HFD) fed gerbils after transient forebrain ischemia. After 8 weeks of LFD or HFD feeding, PGZ (30 mg/kg) was intraperitoneally administered to the gerbils, following which ischemia was induced by occlusion of the bilateral common carotid arteries for 5 min. Administration of PGZ significantly reduced the ischemia-induced hyperactivity 1 day after ischemia/reperfusion in both LFD- and HFD-fed gerbils. At 4 days after ischemia/reperfusion, the neurons were significantly reduced and microglial activation was observed in the hippocampal CA1 region in LFD- and HFD-fed gerbils. The microglial activation was more prominent in the HFD-fed gerbils compared to the LFD-fed gerbils. Administration of PGZ ameliorated ischemia-induced neuronal death and microglial activation in the hippocampal CA1 region 4 days after ischemia/reperfusion in the LFD-fed gerbils, but not in the HFD-gerbils. At 6 h after ischemia/reperfusion, tumor necrosis factor-α (TNF-α) and interlukin-1β (IL-1β) levels were significantly increased in the hippocampal homogenates of LFD-fed group compared to control group, and HFD feeding further increased TNF-α and IL-1β levels. PGZ treatment significantly ameliorated the increase of TNF-α and IL-1β levels in LFD-fed gerbils, not in the HFD-fed gerbils. At 12 h after ischemia/reperfusion, superoxide dismutase (SOD) and malondialdehyde (MDA) levels in hippocampal homogenates were significantly increased in the LFD-fed group compared to the control group, and HFD feeding significantly showed relatively reduction in SOD activity and increase in MDA level. PGZ administration significantly reduced the increase in MDA levels 12 h after ischemia/reperfusion in the LFD-fed gerbils, but not in the HFD-fed gerbils. These results suggest that PGZ ameliorates the neuronal damage induced by ischemia by maintaining the TNF-α, IL-1β, SOD and MDA levels in LFD-fed gerbils. In addition, HFD feeding affects the modulation of these parameters in the hippocampus after transient forebrain ischemia.

Objective Endovascular treatment of wide-necked intracranial aneurysms is a challenge and the durability and the safety of these treated aneurysms remain unknown. The aim of this study was to evaluate the clinical and long-term angiographic results of wide-necked intracranial aneurysms treated with coil embolization. Methods Between January 2002 and December 2012, 53 wide-necked aneurysms treated with coil embolization were selected. Forty were female, and 13 were male. Twenty eight (52.8%) were ruptured aneurysms, and 25 (47.2%) were unruptured aneurysms. The patents' medical and radiological records were reviewed retrospectively. Results Of the 53 aneurysms, coiling alone was employed in 45 (84.9%) and stent-assisted coiling was done in 8 (15.1%). The initial angiographic results revealed Raymond class 1 (complete occlusion) in 30 (56.6%) cases, Raymond class 2 (residual neck) in 18 (34.0%) cases, and Raymond class 3 (residual sac) in 5 (9.4%) cases. The mean angiographic follow-up period was 37.9 months (12-120 months). At the last angiographies, Raymond class 1 was seen in 26 (49.1%) cases, Raymond class 2 in 16 (30.2%), and Raymond class 3 in 11 (20.8%). Angiographic recurrence occurred in 22 (41.5%) patients, with minor recurrence in 7 (13.2%) cases and major recurrence in 15 (28.3%). Retreatment was performed in 8 cases (15.1%). A suboptimal result on the initial angiography was a significant predictor of recurrence in this study (p=0.03). Conclusion The predictor of recurrence in wide-necked aneurysms is a suboptimal result on the initial angiography. Long-term angiographic follow-up is recommended in wide-necked aneurysms.

STUDY DESIGN Retrospective analysis. OBJECTIVE The main objectives of this study were to analyze and compare cervical sagittal parameters, including the T1 slope, in a population of 45 patients with degenerative cervical spondylolisthesis (DCS) and to compare these patients with a control group of asymptomatic population. SUMMARY OF BACKGROUND DATA Sagittal balance in the cervical spine is as important as the pelvic incidence and is related to the concept of T1 slope. Compared with degenerative lumbar spondylolisthesis, there are few studies evaluating DCS, and characteristic changes of the cervical sagittal parameters (including T1 slope) in patients with DCS are not well studied. METHODS We identified 45 patients with DCS (5.8%) from a database of 767 patients, using cervical radiograph in a standing position. All had radiograph and computed tomographic scan at the same time. Cervical sagittal parameters were analyzed on computed tomographic scan in a standardized supine position. The following cervical sagittal parameters were measured: T1 slope, neck tilt, thoracic inlet angle, and cervical lordosis (C2-C7 angle). The DCS group was compared with a control group of 45 asymptomatic age- and sex-matched adults to the DCS group, who were studied in a recently published study. RESULTS Of our initial group of 767 patients, 45 with anterolisthesis (5.8%) were included for this study. The T1 slope was significantly greater for DCS (26.06° ± 7.3°) compared with the control group (22.32° ± 7.0°). No significant difference of the neck tilt, thoracic inlet angle, and C2-C7 angle was seen between the DSC group and the control group. Therefore, the T1 slope of the DSC group was significantly greater than that of the control group (P < 0.005). CONCLUSION The DCS group was characterized by a greater T1 slope than the control group; therefore, we suggest that a high T1 slope may be a predisposing factor in developing DCS. LEVEL OF EVIDENCE 3.

Objective Head injury is the main cause of death and severe disability in bicycle-related injuries. The purpose of this study was to compare the demographic characteristics and injury mechanisms of bicycle-related head injuries according to the severity and outcome and determine the main risk factors and common types of accompanying injuries. Methods A total of 205 patients who were admitted to the neurosurgery department of our hospital for bicycle-related head injuries between 2007 and 2016 were analyzed. We categorized the patients into two groups according to severity and outcome of head injury, and then identified the differences in age, sex, and cause of injury between the two groups. Results Collisions with a motor vehicle increased the risk of severe head injury (p=0.011), resulted in poor outcomes (Glasgow Outcome Scale [GOS] ≤3; p=0.022), and caused more accompanying chest/abdominal (p

Among the distal anterior inferior cerebellar artery (AICA) aneurysms, a unique aneurysm at the meatal loop inside the internal auditory meatus is extremely rare. The authors report a case of surgically treated total intrameatal AICA aneurysm. A 62-year-old female patient presenting with sudden bursting headache and neck pain was transferred to our department. Computed tomography and digital subtraction angiography showed subarachnoid hemorrhage at the basal, prepontine cistern and an aneurysm of the distal anterior inferior cerebellar artery inside the internal auditory meatus. Surgery was performed by retrosigmoid craniotomy with unroofing of the internal auditory meatus. The aneurysm was identified between the seventh and eighth cranial nerve in the meatus and was removed from the canal and clipped with a small straight Sugita clip. After operation the patient experienced transient facial paresis and tinnitus but improved during follow up.

Summary Purpose The study aimed to develop a mind-body therapeutic program and evaluate its effects on mitigating uncertainty, anxiety, and implantation rate of second-trial in vitro fertilization (IVF) women. Methods This study employed a nonequivalent control group nonsynchronized design. The conceptual framework and program content were developed from a preliminary survey of eight infertile women and the extensive review of the literature. Program focuses on three uncertainty-induced anxieties in infertile women: cognitive, emotional, and biological responses. To evaluate the effect of the intervention, the infertile women with unknown cause preparing for a second IVF treatment were sampled at convenience (26 experimental and 24 control). Results The experimental group in the study showed greater decrease in uncertainty and anxiety in premeasurements and postmeasurements than the control group did. However, no statistically significant differences in the implantation rate between groups were observed. Conclusion This study is meaningful as the first intervention program for alleviating uncertainty and anxiety provided during the IVF treatment process. The positive effects of the mind-body therapeutic program in alleviating both uncertainty and anxiety have direct meaning for clinical applications.

Four novel yellow quinophthalone dyes were designed and synthesized in order to examine the influence of aggregation behavior on the optical and thermal properties of liquid crystal display color filters. These synthesized dyes showed different absorption spectra and thermogravimetric behavior according to their characteristic structures. When the synthesized dyes were dissolved in industrial solvent-binder composites and spin-coated onto a glass substrate, re-aggregation or migration of the dye molecules were shown in the field emission scanning electron microscopy images after the baking processes. The degree of aggregation depended on the structures of the dyes and affected various properties of the color filters. The transmittances of the color filters decreased as the aggregation of the dye molecules increased. The contrast ratios of the color filters also reduced with aggregation after the baking process. The color difference values of the color filters increased remarkably with more aggregation as the baking process was repeated.

Three new organic sensitizers with phenothiazine chromophores were synthesized and used in dye-sensitized solar cells. N-substituents were added to the phenothiazine to suppress dye aggregation and an ethylthiol was added as an additional donor function. The effects of these substituents on the performance of the dyes were investigated by assessing the photophysical, electrochemical, and photovoltaic properties. The introduction of an N-methoxyphenyl unit improved the open-circuit voltage; the addition of the ethylthiol unit decreased the amount of dye adsorbed on the TiO 2 . A very high open-circuit voltage of 818.5 mV was achieved by the phenothiazine with added N-methoxyphenyl and ethylthiol groups. However, the best overall conversion efficiency was achieved by a cell fabricated with a phenothiazine devoid of the ethylthiol group (an overall conversion efficiency = 6.02%, short-circuit current = 10.20 mA/cm 2 , open-circuit voltage = 781.7 mV, fill factor = 75.50% under AM 1.5G conditions) due to the high open-circuit voltage and greater dye adsorption.

ObjectiveTo examine the safety and efficacy of mechanical thrombectomy using a retrievable stent for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms.MethodsBetween June 2011 and June 2015, 631 consecutive patients with ruptured intracranial aneurysms underwent coil embolization at 6 hospitals. Among 53 patients who had thromboembolic complications, 15 patients harboring 15 aneurysms underwent rescue mechanical thrombectomy with a retrievable stent for the treatment of thromboembolic occlusion during the coiling of ruptured aneurysms. The patients' clinical and radiologic outcomes were retrospectively reviewed.ResultsOf the 15 aneurysms, coiling alone was used for 13 (86.7%), and stent-assisted coiling was performed for 2 (13.3%). Thromboembolic occlusion most frequently occurred distal to the aneurysm (n=10, 66.7%), followed by proximal to the aneurysm (n=3, 20%), and at the coil−parent vessel interface (n=2, 13.3%). All patients underwent mechanical thrombectomy with a retrievable stent, including 5 patients who were initially treated with an IA tirofiban infusion. Complete recanalization (Thrombolysis in Cerebral Infarction (TICI) 3) was obtained in 13 (86.7%) and partial recanalization (TICI 2b) in 2 (13.3%). Two patients who had received IA tirofiban before mechanical thrombectomy had hemorrhagic complications. At 6 months after discharge, 9 patients had a modified Rankin Scale (mRS) score of 1, 3 patients were mRS 2, 1 patient was mRS 3, 1 patient was mRS 4, and 1 patient was mRS 6.ConclusionsRescue mechanical thrombectomy using a retrievable stent can be a useful treatment for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms.