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Objective Infection is one of most devastating complications in ventriculoperitoneal (VP) shunt surgery. Preoperative hair removal has traditionally been performed to reduce infectious complications. We performed VP shunt surgeries and evaluated the prevalence of infection in patients who were shaved and those who were unshaven. Methods A retrospective analysis was conducted of 82 patients with hydrocephalus of various pathologies who underwent VP shunt surgery, with or without having the head shaved, between March 2010 and March 2017. For patients in the non-shaved group (n=36), absorbable suture materials were used for wound closure, and Nylon sutures or staples were used in the shaved group (n=46). We evaluated the infection outcomes of patients in the two groups. Results There was no difference in the average age of patients in the two groups. In the non-shaved group, there were no infections, while two patients in the shaved group required revision because of shunt infection. Conclusion Non-shaved shunt surgery may be safe and effective, with no increase of infection rate. We recommend that shunt procedures could be performed without shaving the hair, which may increase patients' satisfaction without increasing infection risk.

Hernandez, DJ, Healy, S, Giacomini, ML, and Kwon, YS. Effect of rest interval duration on the volume completed during a high-intensity bench press exercise. J Strength Cond Res XX(X): 000-000, 2020-Between-set rest intervals (RIs) are one of the most important variables in resistance training; however, no known research has investigated the effects of RIs greater than 5 minutes during high-intensity strength training. The purpose of this research was to examine the effects of 3 different RIs on repetition sustainability and training volume (sets × reps × resistance) during a high-intensity bench press exercise. Fifteen resistance-trained male subjects (mean ± SD, age = 25.5 ± 4.5 years, and bench press 1 repetition maximum [1RM] ratio [1RM/body mass] = 1.39 ± 0.1) completed 3 experimental sessions, during which 4 sets of the bench press were performed with 85% of 1RM load. Subjects performed the bench press using 3 different RIs in a random counterbalanced design. Data were analyzed using both a one- and two-way analysis of variance with repeated measures. As sets progressed, repetitions were significantly different (p < 0.05) between all RIs, and only the 8-minute RI (p < 0.05) allowed for the complete sustainability of repetitions over 4 consecutive sets. Subjects attained the greatest training volume (p < 0.05) using an 8-minute RI between sets compared with a 2- or 5-minute RI. Similarly, a significantly greater training volume was achieved using the 5-minute RI compared with the 2-minute RI. Resistance-trained men, with the goal of greater volume during strength training, would benefit from longer RIs, specifically using an 8-minute RI between 4 consecutive sets of a bench press exercise.

Alicea, SK, Parrott, AD, Manos, TM, and Kwon, YS. Comparison of the affective responses to continuous training and high-intensity interval training protocols: application of the dual-mode model. J Strength Cond Res XX(X): 000-000, 2020-High-intensity interval training (HIIT) is time-efficient and has physiological benefits similar to or greater than that of continuous training (CT); however, there are mixed results regarding how HIIT protocols influence affect. The purpose of this study was to compare acute affective responses between HIIT and CT protocols over time using the Dual-Mode Model (DMM) as a theoretical framework. Subjects included 12 healthy women (aged 19-28 years) who completed a HIIT protocol consisting of a 2-minute work interval (100% V[Combining Dot Above]O2max) followed by a 2-minute rest interval (∼55% V[Combining Dot Above]O2max), and a CT protocol set at the workrate corresponding to their respiratory compensation point (RCP; ∼80% V[Combining Dot Above]O2max). Protocols were matched for average intensity, total duration, and energy expenditure. After blood pressure, anthropometrics, body composition, and V[Combining Dot Above]O2max measurements were taken, responses were recorded for affect (Feeling Scale [FS]), arousal (Felt Arousal Scale [FAS]), and rate of perceived exertion (RPE) before each protocol, during the last 10 seconds of every 2 minutes during the protocol, and at time points 2, 5, and 10 minutes after the protocol. Heart rate was also monitored continuously, and exercise enjoyment was measured before and after exercise. A repeated-measures analysis of variance revealed no significant differences in affect between CT (M = 2.5, SD = 2.1) and HIIT (M = 2.6, SD = 2.1) protocols over the duration of the exercise. There were no significant differences in mean RPE between CT (M = 12.9, SD = 2.7) and HIIT (M = 13.0, SD = 1.9) protocols (t = 0.333, p = 0.745) or in enjoyment between CT (M = 2.3, SD = 1.1) and HIIT (M = 2.0, SD = 0.9) protocols (t = -0.288, p = 0.492). In addition, based on visual inspection, the general patterning of the mean FS and FAS values between HIIT and CT was similar within the circumplex model, supporting the DMM. In conclusion, a HIIT protocol at V[Combining Dot Above]O2max and 1:1 exercise:rest interval did not result in a different affect response, perceived exertion, or enjoyment level when compared with a CT protocol at RCP.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic disrupted the emergency medical care system worldwide. We analyzed the changes in the management of intracerebral hemorrhage (ICH) and compared the pre-COVID-19 and COVID-19 eras. MATERIALS AND METHODS: From March to October of the COVID-19 era (2020), 83 consecutive patients with ICH were admitted to four comprehensive stroke centers. We retrospectively reviewed the data of patients and compared the treatment workflow metrics, treatment modalities, and clinical outcomes with the patients admitted during the same period of pre-COVID-19 era (2017-2019). RESULTS: Three hundred thirty-eight patients (83 in COVID-19 era and 255 in pre-COVID-19 era) were included in this study. Symptom onset/detection-to-door time [COVID-19; 56.0 min (34.0-106.0), pre-COVID-19; 40.0 min (27.0-98.0), p=0.016] and median door to-intensive treatment time differed between the two groups [COVID-19; 349.0 min (177.0-560.0), pre-COVID-19; 184.0 min (134.0-271.0), p

Objective: To evaluate the clinicopathological characteristics of grade group 1 (GG1) prostate cancer in Korean populations.Methods: We retrospectively analyzed 492 consecutive radical prostatectomy specimens from our institution, which included those from 322 men with clinical GG1 and 170 with clinical GG2 tumors between years 2009 and 2018. The incidence of Gleason score (GS) upgrading, extraprostatic extension (EPE), and seminal vesicle invasion (SVI) were evaluated in patients with clinical GG1. In pathological GG1 cases, the distribution of adverse pathological features including EPE, lymphovascular invasion (LVI), perineural invasion (PNI), and biochemical recurrence (BCR) was analyzed.Results: Altogether, 78 (24.2%) out of 322 men in the clinical GG1 group demonstrated upgrading of GS, including 19 men with pathological Gleason score 4 + 3 = 7 and 6 with ≥ pathological Gleason score 4 + 4 = 8 cases. EPE was found in 37 (11.5%) and 22 (8.9%) men in clinical GG1 and pathological GG1 group, respectively. The incidence of LVI and PNI in the pathological GG1 cases was 2.8% (n = 7) and 28.6% (n = 71), respectively. BCR was observed in 4 men in pathological GG1 T2 (n = 226) and 2 men in GG1 T3 (n = 22) group. When we compared the pathological features between pathological GG1 T3 vs. GG2 T2, there was no statistical differences in the incidence of LVI and PNI between the two groups.Conclusions: Contrary to the current concept that GG1 is almost always clinically insignificant, it seems that GG1 still possess its respectable position as a group of cancer with aggressiveness. These findings should be kept in mind when deciding on treatment options for prostate cancer patients in the Asian populations.

Objective To determine whether modified constraint-induced movement therapy (mCIMT) with continuous restraint is feasible and effective in improving the use of the paretic arm in the real world among infants and toddlers with unilateral cerebral palsy (CP). Design Single-blind randomized controlled trial. Setting Tertiary hospital. Participants Children aged 7 to 36 months with unilateral CP (N = 24; 16 boys, 8 girls). Intervention The experimental group received 2-hour clinic-based mCIMT sessions (5 days per week for 3 weeks), and a continuous restraint was applied. Main Outcome Measures Standardized assessments were conducted. Peabody Developmental Motor Scales-2 (PDMS-2), Gross Motor Function Measure-66, Pediatric Motor Activity Log (PMAL), and Pediatric Evaluation of Disability Inventory were measured pre- and postintervention. Children who agreed to participate in the accelerometer study additionally wore accelerometers on both their wrists for 3 days before and after the intervention. Results The mCIMT group exhibited greater improvement in PMAL-how often (p = 0.048; ηp2 = 0.173), PMAL-how well (p = 0.008; ηp2 = 0.289), and PDMS-2 visual motor integration (p = 0.014; ηp2 = 0.256) posttreatment than the control group. The percentage of time in moderate-to-vigorous physical activity (z = –2.24; p = 0.03) and vector magnitude average counts (z = –2.52; p = 0.01) significantly increased in children in who wore accelerometers (N = 8) after the 3-week mCIMT protocol. Conclusion mCIMT with continuous restraint applied to infants and toddlers with unilateral CP appeared to have a positive effect on paretic hand use in the real world. Clinical Trial Registration Number NCT03418519

Medial femoral torsion (MFT) is a common pathologic gait in cerebral palsy (CP) children that can be corrected by femoral derotational osteotomy (FDO). It is not clearly known as to how much various gait parameters change after FDO. The aim of this study was to quantify changes in gait parameters after FDO. The study group included 19 young CP patients (28 limbs, age

The prostatic hyperplasia in benign prostatic hyperplasia (BPH) leads to obstructive micturition symptoms. Previous studies showed that pontine micturition center (PMC), ventrolateral periaqueductal gray (vlPAG), and medial preopticnucleus (MPA) regions in the brain have been known to regulate the urinary bladder function. The present study shows the influences of Panax ginseng on nerve growth factor (NGF) expressions in PMC, vlPAG, and MPA regions in the brain. Wistar rats were used for the present study. The rats split into four groups; 4 groups (n=6) in control group, BPH-induced group, BPH-induced and P. ginseng-treated group, and BPH-induced and finasteride-treated group. BPH in rats was induced by testosterone and the animals were evaluated for NGF expression in PMC, vlPAG, and MPA regions in the brain. The NGF expression was identified using immunohistochemistry (IHC). The NGF expression by IHC showed spots with dark brown color. In our results, NGF expressions in PMC, vlPAG, and MPA regions in the brainstem of the BPH-induced group showed increase than the control animal. These increased NGF expressions in three regions were decreased using treatment with P. ginseng (200mg/kg). These results suggest that P. ginseng has therapeutic effects on the symptoms of BPH and is associated with the regulation of NGF expression in the brain. In conclusion, the administration of P. ginseng helps nerve growth factor activation.

Treatment of acute triangular fibrocartilage complex (TFCC) tear using arthroscopic suture repair has been used as a general treatment method, but it is difficult to obtain perfect results in all cases. We evaluated clinical and radiologic outcomes of the acute TFCC tear with distal radioulnar joint instability using the arthroscopic suture repair with pronator quadratus (PQ) advancement. Altogether, 80 patients (48 male, 32 female; mean ± SD age, 37.3 ± 11.5 years; mean ± SD follow-up, 23.7 ± 11.4 months) were enrolled in the study. Follow-up was at least 12 months (range, 12-38 months). Patients were divided into group 1 with arthroscopic suture repair alone (34 patients; 17 male, 17 female; mean ± SD age, 35.2 ± 10.8 years; mean ± SD follow-up, 28.1 ± 15.1 months) and group 2 with additional PQ advancement (46 patients; 29 male, 17 female; mean ± SD age, 38.9 ± 11.9 years; mean ± SD follow-up, 18.4 ± 6.2 months), and clinical and radiological assessment was performed. We also compared the ulnar translation of the injured wrist with that of the uninjured wrist using the Push Pull gauge.There was no difference in the range of motion and the grip strength between the 2 groups. However, the disabilities of the arm, shoulder, and hand score (P = 0.042) at 6-month follow-up and disabilities of the arm, shoulder, and hand score (P = 0.015) and patient-rated wrist evaluation score (P = 0.012) at 12-month follow-up were improved in group 2, and patients' satisfaction (P = 0.032) was also higher in group 2. The ulnar translation rate was also improved in group 2 at 6-month follow-up (P = 0.015) and 12-month follow-up (P = 0.045).Arthroscopic suture repair with PQ advancement provided more clinical improvement and proper stability; therefore, it will be an acceptable effective treatment option for acute TFCC tear with distal radioulnar joint instability.

Background Bisphosphonates are widely used as bone stabilizers, which can cause major side effects including bisphosphonate-related osteonecrosis of the jaw (BRONJ) that occurs more frequently in the mandible. Consequently, there is a need for a detailed investigation of BRONJ of the maxilla and, in particular, of involvement of the maxillary sinus. Objective Our aim was to evaluate the characteristic radiologic and clinical manifestations in patients with maxillary sinusitis and a history of long-term bisphosphonate use. Methods Between January 2015 and July 2018, 55 patients with symptoms consistent with chronic rhinosinusitis who underwent a paranasal sinus computed tomography (CT) and had a history of >12 months of bisphosphonate therapy were included in the analysis. Results Radiologically and clinically evident chronic rhinosinusitis was noted in 24 of the 55 patients, of whom more than half (14/24, 58.3%) had BRONJ. The CT studies demonstrated that the maxillary sinus was involved in all 24 patients, characterized by unilateral involvement (70.8%) and bony remodeling in the posterior maxillary region (90.5%). The evidence of osteitis on CT and/or single-photon emission CT was observed in the majority of cases (19/21, 90.5%) and 12 patients (50.0%) had oroantral fistula. However, there were no differences in the clinical appearance of the diseases with respect to the radiologic aspects. Conclusions Besides its well-known effects on the mandible, long-term bisphosphonate use can also affect the maxillary sinus, with typical clinical and radiological manifestations.

Objective The LiquoGuard® system is a new ventricular-type monitoring device that facilitates intracranial pressure (ICP)-controlled or volume-controlled drainage of cerebrospinal fluid (CSF). The purpose of this study is to report the authors' experience with the LiquoGuard® ICP monitoring system, as well as the clinical safety, usefulness, and limitations of this device in the management of patients with traumatic brain injury (TBI). Methods Intraventricular ICP monitoring was performed on 10 patients with TBI using the LiquoGuard® monitoring system. ICP measurements, volume of drained CSF, and clinical outcomes were analyzed and discussed. Results ICP monitoring was performed on 10 patients for a mean duration of 6.9 days. With a mean 82,718 records per patient, the mean initial ICP was 16.4 mm Hg and the average ICP across the total duration of monitoring was 15.5 mm Hg. The mean volume of drained CSF was 29.2 cc/day, with no CSF drained in 4 patients. Seven of 10 patients showed 1 or 2 episodes of abnormal ICP measurements. No patient exhibited complications associated with ICP monitoring. Conclusion The LiquoGuard® system is a versatile tool in the management of TBI patients. Its use is both reliable and feasible for ICP monitoring and therapeutic drainage of CSF. However, episodes of abnormal ICP measurements were frequently observed in patients with slit ventricles, and further study may be needed to overcome this issue.

Neurilemmomas, also known as schwannomas, are benign, slow-growing tumors that arise from Schwann cells of nerve roots. They can occur anywhere in the body, but those arising in the head and neck account for 25% to 45% of the cases [1]. Primary neurilemmomas of the thyroid gland are very rare. Only 20 cases of primary thyroid neurilemmoma have been documented in the English literature [2]. They were usually asymptomatic, and only two cases were found in children [3,4]. Here we report this rare tumor in a 14-year-old girl, which was clinically mistaken for a malignant thyroid nodule.

Arteriovenous graft for hemodialysis vascular access is a widely used technique with many advantages. However, it has crucial complications with graft thrombosis and infection. We recently experienced an unusual case of arteriovenous graft complication involving graft thrombosis related to fistula formation between the graft and the natural vein with infection. We diagnosed this condition using Doppler ultrasound and computed tomography angiography. Successful surgical treatment including partial graft excision and creation of a secondary arteriovenous fistula using an inadvertently dilated cephalic vein was performed. The dialysis unit staff should keep this condition in mind and try to prevent this complication.

Background: The elderly have been reported to show anatomical and physiologic changes in the upper airway, which might affect the supraglottic airway (SGA) performance in geriatric populations. This study aimed to evaluate the clinical efficacy of the classic laryngeal mask airway (LMA-C) in the elderly compared with young adult patients. Methods: Fifty patients aged 65.85 years (elderly group) and 50 patients aged 20.40 years (young group) who were scheduled for surgery using the LMA-C for general anesthesia were enrolled in this prospective, non-randomized, comparative study. Manipulations required during insertion, success rate, insertion time, oropharyngeal leak pressure, gastric insufflation, and intraoperative inadequate ventilation with the LMA-C were assessed. Fiberoptic evaluation was used to determine the position of the LMA-C. Results: In the elderly group, the insertion success rate on the first attempt was significantly lower than that in the young group (84 vs. 96%, P = 0.02). The insertion time in the elderly group was significantly longer than that in the young group (28.5 ± 19.6 vs. 22.2 ± 6.4 seconds, P = 0.001). However, there was no difference in oropharyngeal leak pressure or fiberoptic grade between the two groups after proper placement of the LMA-C. During the surgery, inadequate ventilation events occurred more frequently in the elderly group than in the young group (31.3 vs. 4.0%, P < 0.001). Conclusions: The clinical efficacy of the LMA-C in elderly patients was inferior to that in young adult patients. Therefore, further studies are required to determine the type of SGA that can provide excellent clinical efficacy in the geriatric population.

We previously reported that cold application to the palms between sets of high-intensity bench press exercise produces an ergogenic effect in men. In this study, we hypothesized that palm cooling (PC) or heating during rest intervals between high-intensity weight training sets will increase total repetitions and exercise volume load (kilograms) in resistance trained female subjects in a thermoneutral (TN) environment. Eight female subjects (mean ± SD, age = 25 ± 6 years, height = 160 ± 6 cm, body mass = 56 ± 7 kg, 1-repetition maximum [1RM] = 52 ± 6 kg, weight training experience = 6 ± 2 years) completed 4 sets of 85% 1RM bench press exercise to failure, with 3-minute rest intervals. Exercise trials were performed in a counterbalanced order on 3 days, separated by at least 3 days in TN, Palm heating (PH), and PC conditions. Heating and cooling were applied by placing both hands in a hand cooling device with the hand plate set to 45° C for heating and 10° C for cooling. Data were analyzed using a 2-factor repeated-measures analysis of variance and Tukey's post hoc tests. Palm cooling repetitions were significantly higher than TN repetitions during the second set, and PH repetitions were significantly higher than those of TN during the fourth set. Total exercise volume load (kilograms) for both PC (1,387 ± 358) and PH (1,349 ± 267) were significantly higher than TN (1,187 ± 262). In women, both heating and cooling of the palms between sets of resistance exercise increased the total exercise volume load performed. This ergogenic response to a peripheral sensory input is consistent with the central governor theory of muscular fatigue.

Double-tiered subchondral support (DSS) procedures with optimal distal dorsal cortical distance (DDD) have been reported to be effective in treating distal radius fractures, but there have been no studies of osteoporotic distal radius fractures in elderly patients. In this study, we demonstrated the efficacy of the DSS procedure with optimal DDD using a variable-angle volar locking-plate system for the treatment of osteoporotic distal radius fractures in elderly patients.One hundred and twenty-two patients (mean age, 73.3 years; age range, 65-88 years) with distal radius fracture were treated using a variable-angle volar locking-plate system with DSS. Patients were divided into DSS and non-DSS groups based on postoperative and 12-month follow-up radiographs, and radiological and clinical assessment was performed. Finally, we divided all 122 patients into two groups based on volar tilt of 6° on 12-month follow-up radiographs, and postoperative DDD values were compared.Volar tilt decreased (p=0.02), and ulnar variance increased (p=0.01) more in the non-DSS group. The non-DSS group showed a significant correlation between postoperative DDD value and change in DDD value (p=0.00). The mean postoperative DDDs in the group with final volar tilt6° and in the group with final volar tilt≥6° were 6.4mm (SD±1.7mm) and 4.6mm (SD±1.4mm) respectively (p=0.02). At 4-month follow-up, pronation (p=0.05) and supination (p=0.04) were improved, and at 12-month follow-up, supination (p=0.05) was improved in the DSS group.The use of the DSS procedure and reduction of DDD to 4.6mm or less using a variable-angle volar locking-plate system was effective in maintaining anatomical reduction for the treatment of osteoporotic distal radius fractures in elderly patients.III Therapeutic study.

Spindle cell ductal carcinoma in situ (DCIS) is a recently recognized subtype of DCIS, which is associated with a very rare and unique morphology. Although the histologic features have been relatively well described in a few reports, the cytologic features have not. Even though the distinction of this lesion from usual DCIS is not crucial clinically, it should be noted that this lesion might simulate the features of metaplastic carcinoma on fine needle aspiration cytology. Here, we report a case of spindle cell DCIS in a 45-year-old female, with the detailed cytologic features, both on conventional and liquid-based preparations, along with some useful immunohistochemical staining markers for the differential diagnosis.

Cadmium (Cd) is the most potent nephrotoxic heavy metal and may affect bone; it also has a long biological half-life in the human body. This study was designed to assess the effect of environmental low-level Cd exposure on kidney function and bone in the general population. The subjects of this cross-sectional study were 1907 healthy Korean adults who had not been exposed to Cd occupationally. We analyzed the concentrations of Cd in the urine, markers of renal tubule damage, such as β2-microglobulin (β2-MG) and N-acetyl-β-D-glucosaminidase (NAG) activity in the urine, calculated the estimated glomerular filtration rate (eGFR) using serum creatinine, and measured bone mineral density (BMD). Also, we analyzed malondialdehyde (MDA) levels in the urine. The geometric mean concentration of Cd in urine was higher in women (1.36 μg/g creatinine) than in men (0.82 μg/g creatinine). Urinary Cd was significantly positively correlated with urinary β2-MG and NAG activity, whereas it was negatively correlated with eGFR and BMD. The risk of renal tubule damage was significantly associated with urine Cd level, and the association remained significant after controlling for various confounding variables. However, no association was observed between urinary Cd level and glomerular dysfunction or bone damage. The concentration of MDA was increased with urinary Cd level in a dose-dependent manner. These findings suggest that low-level environmental Cd exposure may cause microscopic damage to renal tubules through oxidative stress but might not impair kidney glomeruli or bones.

Rationale Epithelial-myoepithelial carcinoma is an extremely rare, malignant neoplasm that occurs most frequently in the major salivary glands and accounts for approximately 1% of all salivary gland neoplasms. Few reports have described the presence of epithelial-myoepithelial carcinoma in the sinonasal region; hence, the treatment guideline and prognosis remain unclear. Patient concerns We reported a case of a 75-year-old woman with complaint of nasal obstruction and frequent epistaxis for 3 years. During the nasal endoscopic examination, a mass in the left nasal cavity originating from the left nasal septum that caused bleeding on touch was observed. Diagnoses A diagnosis of epithelial-myoepithelial carcinoma was made based on the features of histopathology and immunohistochemistry of the surgical specimens. The patient was treated by surgical removal of the septal mass using the endonasal endoscopic approach. Outcomes In the serial follow-up paranasal sinus imaging and endoscopic inspection, evidence of recurrence was absent for 18 months after surgery. Lessons This report highlights a case of epithelial-myoepithelial carcinoma originating from a minor salivary gland in the nasal septum, one of the most unusual locations. Diagnosis of epithelial-myoepithelial carcinoma should be made based on the findings of immunohistochemistry of the operative specimen. Clinicians should consider complete surgical resection as the effective treatment of choice.

Backgroud The goal of this study was to evaluate the clinical and radiological outcomes of arthroscopic partial repair with medialization of the attachment site of the rotator cuff tendon and to identify prognostic factors affecting rotator cuff healing in patients with irreparable large to massive posterosuperior rotator cuff tears. Methods Between July 2012 and March 2016, 42 patients with irreparable large to massive posterosuperior rotator cuff tears underwent an arthroscopic partial repair with medialization of the attachment site of the rotator cuff tendon. All patients had a minimum of 2-year follow-up (mean, 35.4 ± 7.3 months). Clinical evaluation was performed using the visual analog scale, the University of California, Los Angeles shoulder rating scale, Constant score, and active range of motion. Radiological evaluation was performed using magnetic resonance imaging and simple radiography. Results Clinical outcomes at the final follow-up improved significantly compared with the preoperative values (all p < 0.001). The failure rate was 23.8% (10/42); however, clinical outcomes significantly improved regardless of cuff healing (all p < 0.001). The mean acromiohumeral distance was 6.5 ± 1.7 mm (range, 3.2–9.7 mm) before surgery and 6.3 ± 1.6 mm (range, 2.8–9.5 mm) at the final follow-up. Preoperative acromiohumeral distance was associated with failure of cuff healing in the univariate analysis (p = 0.043) and multivariate analysis (p = 0.048). A receiver operating characteristic curve was used to determine the predictive cutoff value for the smallest preoperative acromiohumeral distance for successful healing, which was calculated as 5.3 mm. Conclusions Despite healing failure, arthroscopic partial repair with medialization can be a possible treatment option for irreparable large to massive posterosuperior rotator cuff tears because of the improvement in clinical outcome. The shorter preoperative acromiohumeral distance was the single most important factor negatively affecting cuff healing, and the likelihood of success of healing might be improved if a repair is performed when the preoperative acromiohumeral distance is < 5.3 mm.

Immunoglobulin G4 (IgG4)-related hypertrophic pachymeningitis, defined as focally or diffusely thickened dura mater and lymphoplasmacytic infiltration with increased IgG4 bearing plasma cells, is a rare disease. Moreover, cases involving bone are even rarer. In this report, the authors describe a case of IgG4-related hypertrophic pachymeningitis involving the skull in a 65-year-old man presenting with generalized tonic seizures. There is a 2.4 cm diameter extra-axial mass at the vertex of the left frontal convexity and thickened dura mater with contrast enhancement on magnetic resonance (MR) imaging. In addition, the skull adjacent to the mass was focally enhanced. He underwent surgical resection of the enhanced mass and skull. Histopathological findings revealed chronic inflammation with fibrosis, and idiopathic hypertrophic intracranial pachymeningitis was considered. However, eight months after surgery, partial seizures developed and brain MR imaging revealed a recurrence adjacent to the previous mass. We decided to perform additional immunohistochemical staining of the previous specimen, instead of a re-excision. Immunohistochemical staining showed markedly increased IgG4 (+) plasma cells. Consequently, IgG4-related hypertrophic meningitis was confirmed. Since then, steroids and immunosuppressant medications were started. Follow-up MR imaging at 3 months after medication initiation demonstrated complete remission. In conclusion, IgG4-related hypertrophic pachymeningitis should be considered in the differential diagnosis of hypertrophic cranial pachymeningitis.

AIMS Urinary cystatin C has been suggested as a useful biomarker for diagnosis of acute kidney injury (AKI). Multiple myeloma is often complicated by AKI. Therefore, we investigated whether the urinary cystatin C was available for diagnosis of AKI in multiple myeloma. MATERIALS AND METHODS This study included 39 patients with monoclonal gammopathy of undetermined significance (MGUS) or multiple myeloma. We reviewed the medical records retrospectively and investigated whether urinary γ-globulin and myeloma progression had effects on urinary cystatin C excretion. RESULTS Spearman's correlation analysis showed that serum β2-microglobulin and serum cystatin C had a significant positive correlation with the urinary cystatin C excretion (r = 0.513, p = 0.001, r = 0.659, p < 0.001) and FEcystatinC (r = 0.585, p = 0.002, r = 0.711, p < 0.001). The GFRcr also had a significant negative correlation with the urinary cystatin C excretion (r = -0.582, p < 0.001) and FEcystatinC (r = -0.474, p = 0.002). In addition, the urinary γ-globulin had a significant positive correlation with the urinary cystatin C excretion (r = 0.678, p < 0.001) and FEcystatinC (r = 0.731, p < 0.001). Urinary γ-globulin was the most significant factor to influence urinary cystatin C excretion in multiple regression test. CONCLUSION These results indicate that urinary γ-globulin and myeloma progression can increase the fractional and total excretion of urinary cystatin C. Therefore, it is believed that the urinary cystatin C can be affected by urinary γ-globulin and myeloma progression in the diagnosis of AKI in multiple myeloma. In addition, urinary γ-globulin is believed to be the most significant factor to influence on urinary cystatin C.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. Tyrosine kinase inhibitors (TKIs), such as imatinibmesylate, have been used for the adjuvant treatment of KIT-positive GISTs. Several pathologic changes after imatinib treatment of metastatic GIST including tumor necrosis, myxohyaline or sclerohyalinestroma, proliferative index decline, a varying degree of hemorrhage, edema, and cystic change have been reported in previous studies. More specifically, cystic changes after imatinib treatment were mainly induced by necrosis, hemorrhage, and degeneration. Until now, there have been no reports of cystic changes due to a dilated bile duct entrapped by a totally regressed tumor. We report a case of a 61-year-old man who was diagnosed with high-risk GIST of the stomach complicated by hepatic metastasis and who had such a unique pathologic changes with imatinib treatment.

The widespread belief that local cooling impairs short-term, strenuous exercise performance is controversial. Eighteen original investigations involving cooling before and intermittent cooling during short-term, intensive exercise are summarized in this review. Previous literature examining short-term intensive exercise and local cooling primarily has been limited to the effects on muscle performance immediately or within minutes following cold application. Most previous cooling studies used equal and longer than 10 minutes of pre-cooling, and found that cooling reduced strength, performance and endurance. Because short duration, high intensity exercise requires adequate warm-up to prepare for optimal performance, prolonged pre-cooling is not an effective method to prepare for this type of exercise. The literature related to the effect of acute local cooling immediately before short duration, high intensity isotonic exercise such as weight lifting is limited. However, local intermittent cooling during short-term, high intense exercise may provide possible beneficial effects; first, by pain reduction, caused by an "irritation effect" from hand thermal receptors which block pain sensation, or second, by a cooling effect, whereby stimulation of hand thermal receptors or a slight lowering of blood temperature might alter central fatigue.

124I has a complex decay scheme with high gamma energy and low positron abundance. In this study, comparative performance measurements of 124I were performed in terms of spatial resolution, sensitivity, and image quality. All measurements were performed using both 2D and 3D PET in both brain mode and whole body mode. The transverse and axial spatial resolutions at 1 cm were 5.56 and 6.07 mm for 124I, and were 4.58 and 4.77 mm and for 18F, respectively. Sensitivities were 0.5 kcps/MBq (2D) and 3.4 kcps/MBq (3D) for 124I, and 1.8 kcps/MBq (2D) and 9.8 kcps/MBq (3D) for 18F. The %contrast of 3D was higher than that of 2D in 124I. For 124I PET imaging, 3D acquisition with brain mode was highest achievable imaging acquisition mode with finer spatial resolution and higher contrast. This result will be useful for 124I PET imaging.

Multiloculated hydrocephalus (MLH) is a condition in which patients have multiple, separate abnormal cerebrospinal fluid collections with no communication between them. Despite technical advancements in pediatric neurosurgery, neurological outcomes are poor in these patients and the approach to this pathology remains problematic especially given individual anatomic complexity and cerebrospinal fluid (CSF) hydrodynamics. A uniform surgical strategy has not yet been developed. Current treatment options for MLH are microsurgical fenestration of separate compartments by open craniotomy or endoscopy, shunt surgery in which multiple catheters are placed in the compartments, and combinations of these modalities. Craniotomy for fenestration allows better visualization of the compartments and membranes, and it can offer easy fenestration or excision of membranes and wide communication of cystic compartments. Hemostasis is more easily achieved. However, because of profound loss of CSF during surgery, open craniotomy is associated with an increased chance of subdural hygroma and/or hematoma collection and shunt malfunction. Endoscopy has advantages such as minimal invasiveness, avoidance of brain retraction, less blood loss, faster operation time, and shorter hospital stay. Disadvantages are also similar to those of open craniotomy. Intraoperative bleeding can usually be easily managed by irrigation or coagulation. However, handling of significant intraoperative bleeding is not as easy. Currently, endoscopic fenestration tends to be performed more often as initial treatment and open craniotomy may be useful in patients requiring repeated endoscopic procedures.

Because Asian populations have different lifestyles, such as squatting and sitting on the floor, from those of Western populations, it is possible that the clinical results and survival rate of unicompartmental knee arthroplasty (UKA) for Asian patients may be different. This study described outcomes of mobile bearing medial UKA for Korean patients.A total of the 164 knees treated with mobile bearing UKAs in 147 patients (14 males and 133 females) were reviewed. The mean follow-up period was 12.1years (range 10.1-14).The clinical outcomes, such as the Hospital for Special Surgery Knee score, the Oxford Knee Score and the Knee Society rating system, showed statistically significant improvement from pre-operative to final follow-up (P0.05). A total of 26 UKAs (15.8%) required revision; the most common reason was bearing dislocation. The 95% confidence interval of survival rate at 12years was 84.1%, with revision for any reason as the end point.Minimally invasive mobile bearing UKA in Asian patients who required high degrees of knee flexion showed rapid recovery and good clinical outcome. However, they also showed relatively high rates of bearing dislocation and aseptic loosening. Therefore, mobile bearing UKA should only be performed in patients whose lifestyle involves high flexions after carefully considering these risks and benefits.

The purpose of study was to analyze correlations between bony torsions measured by Staheli's rotation profile, computed tomography (CT) torsional study, and gait analysis in patients with cerebral palsy (CP).The study group comprised of 26 children with CP (spastic diplegia, Gross Motor Function Classification System (GMFCS) 1-2, mean age 12.6 years) with torsional deformities. All subjects were assessed by examining: 1) rotational profile [internal rotation (IR) and external rotation (ER)], 2) CT torsional profile [femoral anteversion (FAV) and tibial torsion (TT)], and 3) gait analysis [mean hip rotation (HR) and mean knee rotation (KR)]. Statistical analysis was performed using the Pearson correlation test.In the femur, there was good correlation between FAV and Staheli's rotational profile of IR and ER (Pearson correlation coefficient (PC=0.69, 0.52, p0.05)). ER correlated very strongly with mean HR during gait (PC=0.8, p0.05). There was, however, poor correlation between HR and IR (p0.05), and between HR and FAV (p0.05). In the tibia, mean KR correlated well with thigh-foot angle (TFA) (PC=0.72) and CT tibia torsion (TT) (PC=0.62). TT also correlated with TFA (PC=0.62).Gait analysis and Staheli's rotational profile reflect both static and dynamic factors of gait abnormalities. However, CT study reflect static factor primarily. Dynamic factors tend to influence the measurements of the femoral torsion only due to large rotational arc of hip joint. In surgical planning, it must be considered that HR sometimes does not correlate with CT anteversion angle. Similarly, it must also be considered that KR correlates well with TFA and CT TT angle.

Some cerebral cavernous malformations (CCMs) may be associated with vascular malformations that occur on the capillary-venous side of the cerebral circulation. The association between CCMs and dural arteriovenous shunts (DAVSs) is not well known. The purpose of this study is to investigate the relationship between CCMs and DAVSs. We retrospectively analyzed 179 patients diagnosed as intracranial DAVSs and performed with digital subtraction angiography (DSA). The DSA images were investigated for the location, cortical venous reflux (CVR), multiplicity, and treatment method/result of DAVS. MR images were investigated for the location, number, and size of CCMs and correlated with the DSA images. Six of the 179 patients with DAVSs presented with coexistent CCMs (3.4 %; M/F = 3:3; mean age, 38 ± 22 years). Five of the six DAVS patients with CCMs were associated with CVR (83 %). The total number of CCMs associated with DAVS was 20. Multiple CCMs (range, 2–7) were seen in four (66 %) of six patients. Eighteen (90 %) of the 20 CCMs were located on the ipsilateral hemisphere of the CVR (n = 10) or adjacent to the deep venous reflux (n = 8). Five de novo CCMs were detected in two patients. All de novo CCMs were located on the ipsilateral hemisphere of the DAVS with CVR or juxtapositioned to abnormally dilated deep vein. CCMs may develop in association to DAVSs. The relationship between CCMs and DAVSs suggests the venous pathogenic origin of CCMs and the role of venous hypertension in the de novo development of CCMs.

OBJECTIVE Percutaneous vertebroplasty (PVP) is an effective treatment modality for management of osteoporotic compression fracture. However physicians sometimes have problems of high pressure in cement delivery and cement leakage when using Jamshidi® needle (JN). Bone void filler (BVF) has larger lumen which may possibly diminish these problems. This study aims to compare the radiologic and clinical outcome of JN and BVF for PVP. METHODS One hundred twenty-eight patients were treated with PVP for osteoporotic vertebral compression fracture (VCF) where 46 patients underwent PVP with JN needle and 82 patients with BVF. Radiologic outcome such as kyphotic angle and vertebral body height (VBH) and clinical outcome such as visual analog scale (VAS) scores were measured after treatment in both groups. RESULTS In JN PVP group, mean of 3.26 cc of polymethylmethacrylate (PMMA) were injected and 4.07 cc in BVF PVP group (p

Delayed cranioplasty after decompressive craniectomy was performed using various reconstruction materials and methods. Bone graft infection is a major concern with cranioplasty. This study identified factors that are related to bone graft infection after cranioplasty.A total of 140 patients underwent reconstructive cranioplasty after decompressive craniectomy between 2000 and 2009. The sample population included 102 male patients and 39 female patients aged 6 years to 76 years, with a mean age of 47.5 years. Autografts were used for cranioplasty when available. Polymethylmethacrylate or customized linear high-density polyethylene was considered when autografts were unavailable. Bone graft infection was defined as the removal of the infected bone graft, and the related factors were evaluated retrospectively.Bone graft infection occurred in 11 patients (7.86%). Bone graft infection after cranioplasty was significantly related to the number of operations (p = 0.002), operation time (p = 0.031), and diabetes (p = 0.004). An increased number of operations increased the infection rate from 4.3% to 33%. Infection rates increased rapidly after three times. The infection rate was less than 10% when cranioplasty was completed within 199 minutes. An infection rate greater than 20% was observed when cranioplasty required more than 200 minutes. Other factors, such as graft material, fixation devices, age, sex, the cause of the operation, the interval between craniectomy and cranioplasty, and underlying nondiabetic diseases, did not significantly alter the infection rate.Short surgical times (200 minutes) and a lower number of previous operations (less than three times) may decrease the risk of bone flap infection. Careful attention is required when performing cranioplasty, particularly in patients with diabetes.Prognostic/therapeutic study, level IV.

To evaluate initial radiologic findings of symptomatic intracranial vertebrobasilar dissections (VBDs) as well as the results at follow-up imaging of dissections that are conservatively managed.The respective institutional review boards approved this retrospective study and waived the need for informed consent. The initial radiologic findings of 210 patients with 230 symptomatic intracranial VBDs were retrospectively evaluated (48 ruptured, 182 unruptured). Those patients had undergone conventional angiography as well as magnetic resonance imaging and/or computed tomographic angiography, so that angiographic shapes and pathognomonic findings (eg, intramural hematoma, intimal flap) could be reviewed. The primary angiographic shapes of the symptomatic intracranial VBDs were subdivided into three groups: (a) dilatation without stenosis, (b) pearl-and-string, and (c) stenosis without dilatation. Furthermore, the radiologic evolution of conservatively managed symptomatic intracranial VBDs was evaluated. The respective frequencies of the radiologic findings at initial and follow-up imaging studies were compared by using χ2 tests.Primary shape differed significantly between ruptured and unruptured symptomatic intracranial VBDs. Most ruptured dissections presented with one of two main structures: dilatation without stenosis or pearl-and-string appearance. The primary shape of unruptured dissections was evenly distributed among the three types of findings. Intramural hematomas were most frequently found in the stenosis-without-dilatation group (42 of 60 [70%]), followed by the pearl-and-string group (27 of 90 [30%]). Intimal flap was most frequently found in the pearl-and-string group (21 of 90 [23%]), followed by the stenosis-without-dilatation group (eight of 60 [13%]). Follow-up results significantly differed by initial VBD shapes: Seventy-four percent (25 of 34) of the dilatation-without-stenosis group showed no change, whereas improvement was observed in 91% (39 of 43) of the stenosis-without-dilatation group (P.05). Intracranial VBDs with intramural hematoma showed improvement in 63% (34 of 54) of cases, progression occurred in 20% (11 of 54), and only 17% (nine of 54) exhibited no change (P.05).Primary angiographic shapes of symptomatic intracranial VBDs differed between ruptured and unruptured lesions. The stenosis-without-dilatation lesions most frequently exhibited radiologic improvement at follow-up imaging, followed by pearl-and-string and dilatation-without-stenosis lesions.

BACKGROUND: Traditional carotid artery stenting (CAS) consists of predilatation, optional deployment of embolic protection devices, stenting, and poststent angioplasty. Each step carries a risk of thromboembolism. OBJECTIVE: To design a new and simplified procedural protocol, suboptimal balloon angioplasty without routine poststenting balloon dilatation, and to describe the efficacy this protocol in terms of procedural risks and angiographic and clinical outcomes. METHODS: Over a period of 6 years, 161 carotid artery stenoses in 156 consecutive patients were treated by CAS with embolic protection devices. Among them, 110 lesions in 107 patients (68.3%) were treated by our simplified method (symptomatic, > 50% stenosis; asymptomatic, > 70% stenosis). Overall, 98 lesions (88.3%) had severe stenosis (> 70%). RESULTS: The mean stenosis was reduced from 77% to 10% after CAS. A persistent neurological deficit developed in 2 patients from thromboembolism. Hemodynamic insufficiency developed in 14 lesions during CAS (12.7%). The ipsilateral stroke and mortality rate was 4.5% within 1 month after CAS (asymptomatic, 3.6%; symptomatic, 4.8%). Over a mean of 19 months of follow-up, additive angioplasty was performed in 2 patients as a result of progressive restenosis (≥ 50%). A comparison of the balloon sizes of the prestent angioplasty for group 1 (balloon, ≤ 4 mm) and group 2 (balloon, ≥ 5 mm) showed no difference in restenosis between the groups at 15 months of follow-up after CAS. CONCLUSION: Our CAS technique with suboptimal prestenting angioplasty without routine use of poststenting dilatation is safe, simple, and efficient with acceptable risks.

Computed radiography (CR) images will require large storage facilities and long transmission times for picture archiving and communications system (PACS) implementation. The American College of Radiology and National Equipment Manufacturers Association (ACR/NEMA) group is planning to adopt a JPEG2000 compression algorithm in the Digital Imaging and Communications in Medicine (DICOM) standard for better utilization of medical images. The purpose of this study was to evaluate and compare the results of JPEG and JPEG2000 compressions in medical images. We applied various compression ratios of JPEG and JPEG2000 to chest, abdomen, and hand images obtained using the AGFA CR (Computed Radiography) system (AGFAMD-4.0, BELGIUM) and the FUJI CR system (FCR 9000C, JAPAN). A quantitative evaluation was carried out using the PSNR (peak signal to noise ratio), which is a commonly used measure for the evaluation of reconstructed images and measures how the reconstructed images differ from the original images. In the JPEG and JPEG2000 comparison for compression ratios up to 60:1, the PSNR value showed less than 30 dB in accordance with CR modalities and image regions in JPEG compression whereas JPEG2000 showed more than 30 dB in the same compression ratios for both AGFA and FUJI CR images. As the compression ratios were increased to 200:1, use of the JPEG2000 algorithm showed over 30 dB of the PSNR value in accordance with CR modalities and image regions. In general, when the PSNR value gets greater than or equal to 30 dB, the quality of the processed image is acceptable. Nevertheless, the PSNR value cannot absolutely stand for the quality in terms of perceptibility. The artifact of blockiness is found to be visible not only for the AGFA CR image at 40:1 but also for the FUJI CR image at 40:1 and 60:1 in JPEG compression while no significant artifact were observed in the JPEG2000 compressed image up to 200:1. In conclusion, JPEG2000 appeared to be a more effective method of compression than JPEG in medical imaging applications based on the PSNR value, ROC studies may be needed to establish whether these applications are suitable for real clinical situations requiring diagnostic accuracy.

The incidence of complications associated with cerebrovascular diseases in patients who receive hemodialysis for a long-term period is higher than that of other complications. It is known that mortality due to cerebral hemorrhage is two times higher compared to non-dialysis patients. Anti-coagulants used for hemodialysis are essential. Accordingly, in cases in which the cerebral hemorrhage occurred, the selection of anti-coagulants for the prevention of further bleeding poses a great challenge to physicians. The change of hematoma and patient prognosis has a direct relationship. Many ongoing studies are conducted to examine the causative factors causing the increased hematoma and their related prognostic factors. In the current study, we examined the effect of nafamostat mesylate (a serine protease inhibitor) on the change of hematoma compared to heparin in hemodialysis patients.The current study was conducted in 17 hemodialysis patients who developed a cerebral hemorrhage. These patients were assigned to two groups based on the type of anti-coagulants that they used (i.e., nafamostat mesylate and heparin). Then, the factors affecting the change of hematoma following the onset of cerebral hemorrhage were examined. The prognosis of hematoma was assessed based on brain CT scans, which were performed two weeks after the onset of cerebral hemorrhage in four groups. Following this, groups 1 (the decreased hematoma) and 2 (the decreased delay) were merged to group A (resolving group), and groups 3 (the increased hematoma) and 4 (the death following the aggravation) were merged to group B (the expansion group) for further analysis.There were no significant differences in baseline characteristics between the nafamostat group and the heparin group. A comparison between the resolving group and the expansion group also showed that there were no significant differences in baseline characteristics. In the anti-coagulants and the change of hematoma, however, there were significant differences between the two groups (p = 0.024). A comparison of the change of hematoma between the four groups was also made. This showed that platelet counts and BUN level were significant factors (Platelet; p = 0.042, BUN; p = 0.043 ANOVA with resolving group).Nafamostat mesylate has a similar profile of anti-coagulative activity to heparin. It is assumed, however, that nafamostat has an affirmative effect on the recovery of damaged sites following the onset of cerebral hemorrhage. It is an anti-coagulant that can be safely used for hemodialysis following the onset of cerebral hemorrhage.

Intracranial arterial stenosis usually occurs due to atherosclerosis and is considered the most common cause of stroke worldwide. Although the effectiveness of bypass surgery for ischemic stroke is controversial, the superficial temporal artery to the middle cerebral artery bypass for ischemic stroke is a common procedure. In our report, a 50-year-old man presented with sudden-onset left side weakness and dysarthria. An angiogram showed significant stenosis in the junction of the right cavernous-supraclinoid internal carotid artery and right pericallosal artery. Symptoms altered between improvement and deterioration. Magnetic resonance imaging showed a repeated progression of anterior cerebral artery (ACA) infarction despite maximal medical therapy. We performed a STA-ACA bypass with contralateral STA interposition. Postoperative course was uneventful with no further progression of symptoms. Thus, bypass surgery may be considered in patients with symptomatic stenosis or occlusion of the ACA, especially when patients present progressive symptoms despite maximal medical therapy.

Histologic tumor grading requires assessments on a continuum of morphologic alterations for which objective measuring tools may not be as easily developed as for laboratory tests. As a consequence, some subjectivity cannot be avoided, and issues such as inter-observer variability and lack of reproducibility are frequently identified as limits to the prognostic and predictive values of grading[1-5]. Various methods have been suggested to resolve these issues, employing not only conventional semi-quantitative sche mes but also relatively new approaches such as entropy- based texture analysis and fractal dimension analysis[6-12]. Although the specific criteria used for tumor grading vary by type of cancer, the strategy behind histologic grading is based primarily on the degree of tumor differentiation or the extent to which a tumor resembles the normal tissue counterpart. In this study, we hypothesized that the amount of histologic disorderliness in the arrangement of tumor cells may be quantified by adopting the concept of entropy, and that the quantified measurements would correlate with degree of differentiation. Here, by modifying the statistical thermodynamic definition of entropy that is often taken to be a measure of disorderliness in a physical system, we develop a novel mathematical formula to compute the relative degree of histologic disorderliness of tumor cells. We then apply the formula to colorectal adenocarcinomas with varying degrees of differentiation and determine whether disorderliness is a useful feature for grading cancer.

The aim of this study is to assess the relationship between the venous angioarchitectural features and the clinical course of intracranial dural arteriovenous shunt (DAVS) with cortical venous reflux (CVR). With institutional review board approval, 41 patients (M:F = 24:17; median age, 52 years (range, 1–72 years), median follow-up; 1.5 years; partial treatment, n = 36) with persistent CVR were included. We evaluated the initial presentation and the incidence of annual morbidity (hemorrhage or new/worsened nonhemorrhagic neurological deficit (NHND)) according to the venous angiographic patterns—isolated venous sinus, occlusion of the draining sinus, direct pial venous drainage, pseudophlebitic pattern, venous ectasia, brisk venous drainage, and length of pial vein reflux—on digital subtraction angiography. Cox regression was performed to identify independent factors for clinical course. During 111.9 patient-years of follow-up, the overall annual morbidity rate was 11.6 % (mortality; n = 3, rate; 2.6 %/year). Hemorrhage occurred in five patients (12.2 %, rate; 4.5 %/year) and new/worsened NHND occurred in eight patients (19.5 %, rate; 7.2 %/year). Patients with isolated venous sinus, direct pial venous drainage, and pseudophlebitic pattern were associated with initial aggressive presentation. Venous ectasia was associated with initial hemorrhagic presentation. Brisk venous drainage was associated with initial benign presentation. Patients with isolated venous sinus showed a poor clinical course with a higher annual incidence of hemorrhage or new/worsened NHND (91.2 %/year vs 9.2 %/year; hazard ratio, 6.681; p = 0.027). Venous angioarchitectural features may be predictive of the clinical course of DAVSs. DAVS patients with isolated venous sinus may be especially at high risk for future aggressive clinical course.

Objective Cerebral hyperperfusion syndrome (CHS) is a serious complication after carotid endarterectomy (CEA). However, the prevalence of CHS has decreased as techniques have improved. This study evaluates the role of strict blood pressure (BP) control for the prevention of CHS. Methods All 18 patients who received CEA from February 2009 through November 2012 were retrospectively reviewed. All patients were routinely managed in an intensive care unit by a same protocol. The cerebral perfusion state was evaluated on the basis of the regional cerebral blood flow (rCBF) study by perfusion computed tomography (pCT) and mean velocity by transcranial doppler (TCD). BP was strictly controlled (100% increase in the rCBF by pCT or in the mean velocity by TCD compared with preoperative values) or CHS was detected, BP was maintained below 120/80 mm Hg. Results TCD and pCT data on the patients were analyzed. Ipsilateral rCBF was significantly increased after CEA in the pCT (p=0.049). Post-CEA hyperperfusion was observed in 3 patients (18.7%) in the pCT and 2 patients (12.5%) in the TCD study. No patients developed clinical CHS for one month after CEA. Furthermore, no patients developed additional neurological deficits related to postoperative cerebrovascular complications. Conclusion Intensive care with strict BP control (

Introduction: Distal anterior cerebral artery (DACA) aneurysms are less common and surgical morbidity has been reported relatively high due to intraoperative rupture and narrow surgical field. Endovascular treatment can be alternative to surgery. This study investigated the efficacy and safety of endovascular coiling for ruptured DACA aneurysms comparing with microsurgical clipping. Patients and Methods: Between January 1999 and March 2012, consecutive 94 patients with ruptured DACA aneurysm were treated by surgical clipping (n=52, 55.3%) and endovascular coiling (n=42, 44.7%) in five institutions including only 2 cases of recurrence (2.1%, 1 in clip and 1 in coil). The clinical outcomes of patients and procedure-related complications (intraprocedural rupture and any infarction) were evaluated and compared between two groups. Results: There were 38 males and 56 females (mean age; 55.1 years). Initial Hunt-Hess grade was GII in 25 patients (37.2%), GIII in 36 patients (38.3%), GIV in 12 patients (12.8%), and GV in 11 patients (11.7%), which was significantly higher in coil group (2.77 in clip vs 3.26 in coil, p=0.016). Initial CT scanning showed ruptured DACA aneurysm with ICH (n=35; 37.2%) and hydrocephalus (n=25; 26.6%). Maximal diameter of aneurysm was less than 5mm in 36 (38.3%), 5~10mm in 53 (56.4%), and 10mm and more than in 5 (5.3%). Technical success rate was 100% and complete occlusion or neck remnant of aneurysm was achieved in 87 [92.6%, 49 (96.1%) in clip vs 38 (90.5%) in coil, p=0.404] and incomplete in 6 (6.4%). At discharge, favorable outcome (modified GOS; good and fair) was obtained in 70 [77.8%, 44 (84.6%) in clip vs 26 (68.4%) in coil, p=0.078]. Intraprocedural rupture occurred only in clipping group [6 cases (11.5%), p=0.031]. Any procedure-related infarction occurred in 7 [7.4%, 6 (11.5%) in clip vs 1 (2.4%) in coil, p=0.126]. Intraprocedural thrombus was detected in 5 cases of coil group and most of them were restored by thrombolytic therapy. There was one case of acute rebleeding in coiling group and this patient died. Conclusions: Endovascular coiling was comparable treatment with clipping for ruptured DACA aneurysms.

We observed the acute effects of Qigong training on the levels of human endogenous opioid peptides, such as beta-endorphin, and other stress hormones [adrenocorticotrophic hormone (ACTH), cortisol, and dehydroepiandrosterone-sulfate (DHEA-S)] in a group of ChunDoSunBup Qigong trainees. At pre (-10 min), mid (40 min) and post (70 min) time of training, blood was taken for the determination of plasma level of hormones. The level of beta-endorphin was significantly increased during the mid-time of training while the level of ACTH declined at the mid- and post- time of training. Cortisol and DHEA-S were not significantly changed during training. This result suggests that Qigong training, as a stress coping method, affects and plays a role in hormonal regulation related to the maintenance of homeostasis in man.