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Secondary intention healing offers an alternative when surgical options are infeasible. This study analyzed the effect of micronized acellular dermal matrices (mADMs; CGderm Matrix®, CG Bio, Seoul, Republic of Korea) on secondary intention healing in patients with complex soft-tissue defects and assessed mADMs’ efficacy in promoting secondary healing and improving clinical outcomes in these challenging cases. This retrospective study included 26 patients treated with sheet-type reprocessed mADMs between August 2022 and December 2022 at Soonchunhyang University Cheonan Hospital. Patients with full-thickness skin defects classified as complex wounds were included. Data on demographics, wound characteristics, and treatment outcomes were collected and analyzed. Wound area was measured using ImageJ software, and statistical analyses were conducted using SPSS. The application of mADMs resulted in a median wound area reduction of 81.35%, demonstrating its significant efficacy in wound healing. Most patients presented with compromised vascular supply, significant tissue loss, or infections that precluded conventional surgical interventions. No significant correlations were observed between patient variables and wound-healing outcomes, indicating the complex nature of wound healing. mADMs effectively promote secondary intention healing by providing a supportive extracellular matrix scaffold that enhances epithelialization and angiogenesis. Their rapid absorption, ease of handling, and ability to improve wound tensile strength make them particularly suitable for complex wounds.

Anode‐free lithium metal batteries (AFLMBs) show promise as a means of further enhancing the energy density of current lithium‐ion batteries, as they do not require conventional graphite anodes. The anode‐free configuration, however, suffers from inferior chemical stability of the solid electrolyte interphase (SEI) layer and experiences inhomogeneous lithium deposition during charge/discharge processes, resulting in rapid capacity fading. To address these issues, a carbonized polydopamine (CPD) coating is applied to the copper current collector. The CPD‐coated copper current collector promotes highly efficient and reversible lithium plating and stripping processes, resulting in a densely packed lithium deposition that significantly improves cycling stability. The anode‐free full cell, consisting of CPD‐coated copper current collector and a LiFePO4 cathode, demonstrates significantly improved electrochemical performance, with a capacity retention of more than 63% after 100 cycles at a current rate of 0.3C. The stability of the SEI layer and the presence of lithiophilic sites are verified through a range of techniques, including optical microscopy, Raman spectroscopy, X‐ray photoelectron spectroscopy, chronoamperometry, and electrochemical impedance spectroscopy. Based on these collective findings, it can be inferred that the use of CPD coating provides a simple way to enhance the electrochemical performance of AFLMBs.

Abstract Locoregional recurrent thyroid cancer is commonly treated with re-do operation. This study aimed to investigate the feasibility of using robotic system for re-do operation in locoregional recurrent thyroid cancer. Sixty-five patients who underwent re-do robotic operation using trans-axillary approach for locoregional recurrent thyroid cancer from October 2007 to April 2021 at Yonsei University Hospital were analyzed. Completion total thyroidectomy (CTT) was performed in 26 cases, CTT and modified radical neck node dissection (mRND) in 16, and mRND in 23. Most of the re-do robotic operations were performed at site of previous incision. All patients were diagnosed with papillary thyroid carcinoma (PTC). CTT with central compartment neck dissection (CCND) took 117.6 ± 26.3 min, CTT with mRND 255.6 ± 38.6 min, and mRND, 211.7 ± 52.9 min. Transient hypocalcemia occurred in 17 (26.2%) patients and permanent hypocalcemia occurred in 3 (4.6%). There was one case of recurrent laryngeal nerve(RLN) injury. One patient was diagnosed with structural recurrence after re-do robotic operation. Median follow-up duration was 50.7 ± 37.1 months. Re-do robotic operation can be an alternative for patients who are diagnosed with locoregional recurrent thyroid cancer after thyroidectomy, with no increase in morbidity, similar oncologic outcomes, and superior cosmetic satisfaction.

This paper presents a wide-band multi-level switched mode class-E/F23 Power Amplifier (PA) with a reconfigurable power stage core transistor and a load with reconfigurable reactance compensation part. An Automatic Calibration Scheme (ACS) is proposed to perform the core and load reconfiguration based on a proposed algorithm. The PA is formed by a class-D driver amplifier, the switched mode cascaded reconfigurable power stage, the reconfigurable class-E/F23 load, the ACS and its algorithm, and the matching network at the end of the load before the antenna. The proposed PA is implemented using a 130 nm CMOS technology. The wideband PA operates in the frequency range from 470 MHz to 690 MHz for a TV White Space (TVWS) application with 220 MHz bandwidth. Even though reaching a high maximum Power Added Efficiency (PAEmax) for the design with low output powers is challenging a PAEmax of 32% for a 10 dBm output power level from a low supply voltage of 2.2 V. The proposed ACS provides an output power with a flatness around 0.6 dB which shows 57% improvement in compare with the structure without the ACS. The PA achieved a selectable multi-level output power from 10 dBm to 14 dBm over the 220 MHz bandwidth.

Fibroma of tendon sheath (FTS) is an uncommon mass that arises from the tendon sheath of extremities. The tumor typically affects adults between ages 20 and 50 years with a predominance in males. To date, growth hormone (GH) treatment is safe for children with Turner syndrome without risk factors and is accepted worldwide. This article reports the case of a nine-year-old female patient with Turner syndrome and FTS during GH treatment. She had been treated with daily subcutaneous GH to improve growth failure with a mean dose of 0.28 mg/kg/week and the level of insulin-like growth factor-1 was within the normal range. During the follow-up period, she complained about a mass in her hand, subsequently diagnosed as FTS. This report illustrates the clinical impact of Turner syndrome and GH treatments on the occurrence of this tumor through literature reviews. Further studies are needed to highlight the association between FTS and GH treatment, especially in Turner syndrome.

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

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

Background/Aims There is insufficient quality data to recommend the use of herbs for the treatment of acute bronchitis. Small number of randomized trials of plant extracts for this purpose were determined to be low quality and there are concerns for the safety. HL301 is a combined product of seven medicinal plants. In the present study, we tried to evaluate the efficacy and safety of HL301 for the treatment of acute bronchitis with a randomized, double-blind, placebo-controlled, multicenter trial design. Methods A total of 166 patients with acute bronchitis were randomized to receive placebo or HL301 (600 mg/day) for 7 days. The primary endpoint was change in bronchitis severity score (BSS) from baseline visit (visit 2) to the end of treatment (visit 3). Other efficacy variables were the change of each component of the BSS (cough, sputum, dyspnea, chest pain, and crackle) with treatment, response rate, improvement rate, satisfaction rate and number of rescue medications taken. Results Changes in the BSS from visit 2 to visit 3 were higher in the HL301 group than in the placebo group both in the full analysis set (4.57 ± 1.82 vs. 3.15 ± 3.08, p < 0.01) and in the per protocol set (4.62 ± 1.81 vs. 3.30 ± 3.03, p < 0.01). Four BSS components (cough, sputum, dyspnea, and chest pain) improved more with HL301 treatment than with placebo treatment. Participants treated with HL301 showed higher response, improvement, and satisfaction rates and less use of rescue medication than the placebo group. Conclusions HL301 (600 mg/day) was effective and safe for symptomatic treatment of acute bronchitis.

Brain cancer: A clearer view of glioblastoma An improved strategy for cultivating patient-derived tumors in mice gives researchers a faster, more accurate means for testing glioblastoma treatments. Such ‘xenograft’ models are powerful tools for characterizing a patient’s cancer, but current cultivation techniques are too slow or fail to capture key features of this deadly disease. Researchers led by Jeong Hun Kim and Sun Ha Paek at Seoul National University Hospital in South Korea have demonstrated that glioblastoma cells injected into the mouse eye produce growths that mirror key characteristics of the original tumor. The tissue environment of the retina is physiologically similar to that of the brain, and cancer cells injected into the eye form glioblastoma-like tumors twice as quickly as the same cells injected into the skull. This means clinical researchers can assess drug response and accordingly adjust patient care more quickly.

Lymphadenopathy after coronavirus disease 2019 (COVID-19) vaccination is a common side effect that usually resolves within several days to weeks, and only observation is recommended. However, for prolonged lymphadenopathy, other possibilities, including malignancy or other lymphoproliferative diseases, may be considered. Herein, we report the case of a 66-year-old woman who experienced prolonged ipsilateral supraclavicular lymph node enlargement after the second dose of the ChAdOx1 (Oxford-AstraZeneca) COVID-19 vaccine, which was eventually diagnosed as extrapulmonary tuberculosis.

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

Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal outcome caused by sudden discontinuation or dose reduction of dopaminergic agents. We report an extremely rare case of NMS after deep brain stimulation (DBS) surgery in a cerebral palsy (CP) patient without the withdrawal of dopaminergic agents. A 19-year-old girl with CP was admitted for DBS due to medically refractory dystonia and rigidity. Dopaminergic agents were not stopped preoperatively. DBS was performed uneventfully under monitored anesthesia. Dopaminergic medication was continued during the postoperative period. She manifested spasticity and muscle rigidity, and was high fever resistant to anti-pyretic drugs at 2 h postoperative. At postoperative 20 h, she suffered cardiac arrest and expired, despite vigorous cardiopulmonary resuscitation. NMS should be considered for hyperthermia and severe spasticity in CP patients after DBS surgery, irrespective of continued dopaminergic medication.

Recently, piezoresistive-type (PRT) pressure sensors have been gaining attention in variety of applications due to their simplicity, low cost, miniature size and ruggedness. The electrical behavior of a pressure sensor is highly dependent on the temperature gradient which seriously degrades its reliability and reduces measurement accuracy. In this paper, polynomial-based adaptive digital temperature compensation is presented for automotive piezoresistive pressure sensor applications. The non-linear temperature dependency of a pressure sensor is accurately compensated for by incorporating opposite characteristics of the pressure sensor as a function of temperature. The compensation polynomial is fully implemented in a digital system and a scaling technique is introduced to enhance its accuracy. The resource sharing technique is adopted for minimizing controller area and power consumption. The negative temperature coefficient (NTC) instead of proportional to absolute temperature (PTAT) or complementary to absolute temperature (CTAT) is used as the temperature-sensing element since it offers the best temperature characteristics for grade 0 ambient temperature operating range according to the automotive electronics council (AEC) test qualification ACE-Q100. The shared structure approach uses an existing analog signal conditioning path, composed of a programmable gain amplifier (PGA) and an analog-to-digital converter (ADC). For improving the accuracy over wide range of temperature, a high-resolution sigma-delta ADC is integrated. The measured temperature compensation accuracy is within ±0.068% with full scale when temperature varies from −40 °C to 150 °C according to ACE-Q100. It takes 37 µs to compute the temperature compensation with a clock frequency of 10 MHz. The proposed technique is integrated in an automotive pressure sensor signal conditioning chip using a 180 nm complementary metal–oxide–semiconductor (CMOS) process.

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that arises from a complex interaction of environmental and genetic factors. Despite numerous pharmacological and behavioral interventions, approximately 10% of patients remain refractory. High-frequency deep brain stimulation (HF-DBS) has shown promising results for treatment-refractory OCD. We report the follow-up result of up to 6 years of 4 treatment-refractory OCD patients treated by HF-DBS. Targets of stimulation were the anterior limb of the internal capsule (ALIC) in two cases, and the nucleus accumbens (NAc) in the remaining cohort. The clinical profiles were quantified by the Yale-Brown obsessive-compulsive scale (Y-BOCS). Highly significant reductions in Y-BOCS scores were obtained from all patients during the follow-up period. A greater that 90% reduction in Y-BOCS, observed in the most successful case, was achieved with NAc HF-DBS. Y-BOCS scores in the other patients consistently achieved over 50% reductions in OCD symptoms. FDG-PET imaging indicated post-surgical reductions in metabolism, in not only targeted limbic networks, but also other frontal cortical and subcortical regions, suggesting that large-scale network modulation and inhibitions are associated with functional recovery in OCD. This study demonstrates that HF-DBS targeted to the ALIC and NAc is a safe and effective method for ameliorating intractable, treatment-refractory OCD symptoms. The NAc appeared to be the superior target for symptom reduction, and local inhibition of NAc activity and reduced frontal metabolism are key therapeutic indications.

Floridoside [α-D-galactopyranosyl-(1-2)-L-glycerol] from marine red algae Laurencia undulata (L. undulata) has received considerable attention as a bioactive compound especially for its beneficial effects on human health. This study aimed to evaluate the effect of floridoside in the process of osteogenic differentiation in murine bone marrow mesenchymal (D1) cells and elucidate the mechanism underlying the effect. Under the osteogenic differentiation condition in D1 cells, floridoside showed up-regulation of the sequential markers such as alkaline phosphate (ALP), type I collagen, osteocalcin/osteopontin and mineralisation in the progression. In addition, mRNA levels of Runx-2 and Osterix with floridoside showed remarkable increase at days 14 and 21 compared to the control cells with only ODM media. Thus, our results suggest that floridoside can promote osteogenic differentiation via controlling the sequential markers at the early and late stages of osteogenic differentiation in D1 cells, and it may be a potential therapeutic agent for bone formation.

The long-term clinical outcome of pediatric intracranial epepdymoma is poor with a high rate of recurrence. One of the main reasons for this poor outcome is the tumor’s inherent resistance to chemotherapy. Signal transducer and activator of transcription 3 (STAT3) is overactive in many human cancers, and inhibition of STAT3 signaling is an emerging area of interest in oncology. In this study, the possibility of STAT3 inhibition as a treatment was investigated in pediatric intracranial ependymoma tissues and cell lines. STAT3 activation status was checked in ependymoma tissues. The responses to conventional chemotherapeutic agents and a STAT3 inhibitor WP1066 in primarily cultured ependymoma cells were measured by cell viability assay. Apoptosis assays were conducted to reveal the cytotoxic mechanism of applied agents. Knockdown of STAT3 was tried to confirm the effects of STAT3 inhibition in ependymoma cells. High levels of phospho-STAT3 (p-STAT3) expression were observed in ependymoma tissue, especially in the anaplastic histology group. There was no cytotoxic effect of cisplatin, ifosfamide, and etoposide. Both brain tumor-initiating cells (BTICs) and bulk tumor cells (BCs) showed considerably decreased viability after WP1066 treatment. However, BTICs had fewer responses than BCs. No additive or synergistic effect was observed for combination therapy of WP1066 and cisplatin. WP1066 effectively abrogated p-STAT3 expression. An increased apoptosis and decreased Survivin expression were observed after WP1066 treatment. Knockdown of STAT3 also decreased cell survival, supporting the critical role of STAT3 in sustaining ependymoma cells. In this study, we observed a cytotoxic effect of STAT3 inhibitor on ependymoma BTICs and BCs. There is urgent need to develop new therapeutic agents for pediatric ependymoma. STAT3 inhibitors may be a new group of drugs for clinical application.

Image co-registration is used in frameless gamma knife radiosurgery (GKSRS) to assign a stereotactic coordinate system and verify patient setup before irradiation. The accuracy of co-registration with cone beam computed tomography (CBCT) images of a Gamma Knife IconTM (GK Icon) was assessed, and the effects of the region of co-registration (ROC) were studied. CBCT-to-CBCT co-registration is used for patient setup verification, and its accuracy was examined by co-registering CBCT images taken at various configurations with a reference CBCT series. The accuracy of stereotactic coordinate assignment was investigated by co-registering stereotactic CT images with CBCT images taken at various configurations. An anthropomorphic phantom was used, and the coordinates of fifteen landmarks inside the phantom were measured. The co-registration accuracy between stereotactic magnetic resonance (MR) and CBCT images was evaluated using images from forty-one patients. The positions of the anterior and posterior commissures were measured in both a fiducial marker-based system and a co-registered system. To assess the effects of MR image distortions, co-registration was performed with four different ranges, and the accuracy of the results was compared. Co-registration between CBCT images gave a mean three-dimensional deviation of 0.2 ± 0.1 mm. The co-registration of stereotactic CT images with CBCT images produced a mean deviation of 0.5 ± 0.2 mm. The co-registration of MR images with CBCT images resulted in the smallest three-dimensional difference (0.8 ± 0.3 mm) when a co-registration region covering the skull base area was applied. The image co-registration errors in frameless GKSRS were similar to the imaging errors of frame-based GKSRS. The lower portion of the patient's head, including the base of the skull, is recommended for the ROC.

This paper presents a low power Gaussian Frequency-Shift Keying (GFSK) transceiver (TRX) with high efficiency power management unit and integrated Single-Pole Double-Throw switch for Bluetooth low energy application. Receiver (RX) is implemented with the RF front-end with an inductor-less low-noise transconductance amplifier and 25% duty-cycle current-driven passive mixers, and low-IF baseband analog with a complex Band Pass Filter(BPF). A transmitter (TX) employs an analog phase-locked loop (PLL) with one-point GFSK modulation and class-D digital Power Amplifier (PA) to reduce current consumption. In the analog PLL, low power Voltage Controlled Oscillator (VCO) is designed and the automatic bandwidth calibration is proposed to optimize bandwidth, settling time, and phase noise by adjusting the charge pump current, VCO gain, and resistor and capacitor values of the loop filter. The Analog Digital Converter (ADC) adopts straightforward architecture to reduce current consumption. The DC-DC buck converter operates by automatically selecting an optimum mode among triple modes, Pulse Width Modulation (PWM), Pulse Frequency Modulation (PFM), and retention, depending on load current. The TRX is implemented using 1P6M 55-nm Complementary Metal−Oxide−Semiconductor (CMOS) technology and the die area is 1.79 mm2. TRX consumes 5 mW on RX and 6 mW on the TX when PA is 0-dBm. Measured sensitivity of RX is −95 dBm at 2.44 GHz. Efficiency of the DC-DC buck converter is over 89% when the load current is higher than 2.5 mA in the PWM mode. Quiescent current consumption is 400 nA from a supply voltage of 3 V in the retention mode.

PURPOSE:Stereotactic radiosurgery (SRS) is widely used for brain metastases but has been relatively contraindicated for large lesions (>3 cm). In the present study, we analyzed the efficacy and toxicity of hypofractionated Gamma Knife radiosurgery to treat metastatic brain tumors for which surgical resection were not considered as the primary treatment option. METHODS AND MATERIALS:Thirty-six patients, forty cases were treated with Gamma Knife-based fractionated SRS for three to four consecutive days with the same Leksell frame on their heads. The mean gross tumor volume was 18.3 cm³, and the median dose was 8 Gy at 50% isodose line with 3 fractions for three consecutive days (range, 5 to 11 Gy and 2 to 4 fractions for 2 to 4 consecutive days). Survival rates and prognostic factors were analyzed. RESULTS:The overall survival rate at one and two years was 66.7 and 33.1%, respectively. The median survival time was 16.2 months, and the local control rate was 90%. RTOG toxicity grade 1 was observed in 3 (8.3%) patients, grade 2 in 1 (2.7%) patient and grade 3 in 1 (2.7%) patient respectively. Radiation necrosis was developed in 1 (2.7%) patient. KPS scores and control of primary disease resulted in significant differences in survival. CONCLUSIONS:Our findings suggest that consecutive hypofractionated Gamma Knife SRS could be applied to large metastatic brain tumors with effective tumor control and low toxicity rates.

We retrospectively analyzed our experience with time-staged gamma knife stereotactic radiosurgery (GKS) in treating large arteriovenous malformation(AVM)s;≥ 10 cm3).Forty-five patients who underwent time-staged GKS (2-stage, n = 37;3-stage,n = 8) between March 1998 and December 2011 were included. The mean volume treated was 20.42±6.29 cm3 (range, 10.20-38.50 cm3). Obliteration rates of AVMs and the associated complications after GKS were evaluated.Mean AVM volume (and median marginal dose) at each GKS session in the 37 patients who underwent 2-stage GKS was 19.67±6.08 cm3 (13 Gy) at session 1 and 6.97±6.92 cm3 (17 Gy) at session 2. The median interval period was 39 months. After follow-up period of 37 months, the complete obliteration rate was 64.9%. The mean AVM volume (and median marginal dose) at each GKS session in the 8 patients who underwent 3-stage GKS was 23.90±6.50 cm3 (12.25 Gy), 19.43±7.46 cm3 (13.5 Gy), 7.48±6.86 cm3 (15.5 Gy) at session 1, 2, and 3, respectively. The median interval duration between each GKS session was 37.5 and 38 months, respectively. After a median follow-up period of 47.5 months, 5 patients (62.5%) achieved complete obliteration. Postradiosurgical hemorrhage developed in 5 patients (11.1%) including one case of major bleeding and 4 cases of minor bleeding. No patient suffered from clinically symptomatic radiation necrosis following radiation.Time-staged GKS could be an effective and safe treatment option in the management of large AVMs.

BACKGROUND:GPi (Internal globus pallidus) DBS (deep brain stimulation) is recognized as a safe, reliable, reversible and adjustable treatment in patients with medically refractory dystonia. OBJECTIVES:This report describes the long-term clinical outcome of 36 patients implanted with GPi DBS at the Neurosurgery Department of Seoul National University Hospital. METHODS:Nine patients with a known genetic cause, 12 patients with acquired dystonia, and 15 patients with isolated dystonia without a known genetic cause were included. When categorized by phenomenology, 29 patients had generalized, 5 patients had segmental, and 2 patients had multifocal dystonia. Patients were assessed preoperatively and at defined follow-up examinations postoperatively, using the Burke-Fahn-Marsden dystonia rating scale (BFMDRS) for movement and functional disability assessment. The mean follow-up duration was 47 months (range, 12-84). RESULTS:The mean movement scores significantly decreased from 44.88 points preoperatively to 26.45 points at 60-month follow up (N = 19, P = 0.006). The mean disability score was also decreased over time, from 11.54 points preoperatively to 8.26 points at 60-month follow up, despite no statistical significance (N = 19, P = 0.073). When analyzed the movement and disability improvement rates at 12-month follow up point, no significant difference was noted according to etiology, disease duration, age at surgery, age of onset, and phenomenology. However, the patients with DYT-1 dystonia and isolated dystonia without a known genetic cause showed marked improvement. CONCLUSIONS:GPi DBS is a safe and efficient therapeutic method for treatment of dystonia patients to improve both movement and disability. However, this study has some limitations caused by the retrospective design with small sample size in a single-center.

Awakening during deep brain stimulation (DBS) surgery may be stressful to patients. The aim of the current study was to evaluate the effect on MER signals and their applicability to subthalmic nucleus (STN) DBS surgery for patients with Parkinson's disease (PD) under sedation with propofol and fentanyl. Sixteen consecutive patients with PD underwent STN-DBS surgery with propofol and fentanyl. Their MER signals were achieved during the surgery. To identify the microelectrodes positions, the preoperative MRI and postoperative CT were used. Clinical profiles were also collected at the baseline and at 6 months after surgery. All the signals were slightly attenuated and contained only bursting patterns, compared with our previous report. All electrodes were mostly located in the middle one third part of the STN on both sides of the brain in the fused images. Six months later, the patients were improved significantly in the medication-off state and they met with less dyskinesia and less off-duration. Our study revealed that the sedation with propofol and fentanyl was applicable to STN-DBS surgery. There were no significant problems in precise positioning of bilateral electrodes. The surgery also improved significantly clinical outcomes in 6-month follow-up.

Organizing pneumonia by paragonimiasis and coexistent aspergilloma as a pulmonary nodule is a rare case of lung disease. Its radiographic or CT feature has not been described before in the radiologic literature. We present organizing pneumonia by paragonimiasis and coexistent aspergilloma manifested as a pulmonary irregular nodule on CT.

Store-operated Ca(2+) entry (SOCE) channels are the main pathway of Ca(2+) entry in non-excitable cells such as neural progenitor cells (NPCs). However, the role of SOCE channels has not been defined in the neuronal differentiation from NPCs. Here, we show that canonical transient receptor potential channel (TRPC) as SOCE channel influences the induction of the neuronal differentiation of A2B5(+) NPCs isolated from postnatal-12-day rat cerebrums. The amplitudes of SOCE were significantly higher in neural cells differentiated from proliferating A2B5(+) NPCs and applications of SOCE blockers, 2-aminoethoxy-diphenylborane (2-APB), and ruthenium red (RR), inhibited their rise of SOCE. Among TRPC subtypes (TRPC1-7), marked expression of TRPC5 and TRPC6 with turned-off TRPC1 expression was observed in neuronal cells differentiated from proliferating A2B5(+) NPCs. TRPC5 small interfering RNA (siRNA) blocked the neuronal differentiation from A2B5(+) NPCs and reduced the rise of SOCE. In contrast, TRPC6 siRNA had no significant effect on the neuronal differentiation from A2B5(+) NPCs. These results indicate that calcium regulation by TRPC5 would play a key role as a switch between proliferation and neuronal differentiation from NPCs.