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The suprachiasmatic nucleus (SCN) in the anterior hypothalamus is the major circadian pace-maker in humans. Melatonin is a key hormone secreted by the pineal gland in response to dark-ness. Light-induced stimuli are transmitted along the retinohypothalamic tract to the SCN. Acti-vation of the SCN inhibits the production of melatonin by the pineal gland through a complex neural pathway passing through the superior cervical ganglion. Accordingly, when light is una-vailable, the pineal gland secretes melatonin. The circadian rhythm modulates sleep-wake cycles as well as many physiological functions of the endocrine system, including core body tempera-ture, pulse rate, oxygen consumption, hormone levels, metabolism, and gastrointestinal function. In neurodegenerative disorders, the sleep-wake cycle is disrupted and circadian regulation is al-tered, which accelerates disease progression, further disrupting circadian regulation and setting up a vicious cycle. Melatonin plays a critical role in the regulation of circadian rhythms and is a multifunctional pleiotropic agent with broad neuroprotective effects in neurodegenerative disor-ders, viral or autoimmune diseases, and cancer. In this review, I discuss the neuroprotective functions of melatonin in circadian regulation and its roles in promoting anti-inflammatory activ-ity, enhancing immune system functions, and preventing alterations in glucose metabolism and mitochondrial dysfunction in neurodegenerative disorders and autoimmune central nervous sys-tem diseases.

Background and objective: Kirengeshoma koreana Nakai is an endemic and endangered species in South Korea. We conducted in vitro propagation and regeneration of K. koreana from stem cuttings to investigate the effects of nine different basal culture media and five different carbohydrate sources on its growth.Methods: Apical segments (at least 1 cm long) collected randomly from a six-week-old K. koreana plantlet grown in vitro were used as explants. In the first experiment, the explants were transferred into square vessels containing 50 mL of nine different basal culture media supplemented with 30 g⋅L-1 sucrose and 3 g⋅L-1 Phytagel. In the second experiment, the explants were transferred into square vessels containing 50 mL half-strength SH medium supplemented with five different carbohydrate sources at 30 g⋅L-1. Each medium was solidified with 3 g⋅L-1 Phytagel. All experiments contained 4 cultures, and the experiments were repeated four times to enhance reproducibility. Data on stem length, shoot fresh weight, leaf width, leaf length, root count, and root length were collected at the end of 8 weeks of culture.Results: ANOVA showed that the basal culture medium had a significant effect on K. koreana growth (p < .001). The half-strength SH medium was the best condition for stem length, shoot fresh weight, leaf width and root length (3.76 ± 0.12 cm, 0.60 ± 0.06 g, 1.19 ± 0.05 cm, and 2.83 ± 0.13 cm, respectively). However, the highest percentage increase in root count (13.00 ± 0.90) was found to occur with half-strength WPM. The effect of different carbohydrate sources on K. koreana growth was significantly different (p < .001), with the exception of stem length and leaf width (p = .26 and p = .09, respectively). Maltose was the best condition for shoot fresh weight (0.90 ± 0.09 g). Although there was no significant difference, sucrose was found to be best for leaf width, leaf length and root length (1.34 ± 0.07 cm, 2.34 ± 0.10 cm, and 3.86 ± 0.19 cm, respectively).Conclusion: This in vitro propagation and regeneration system for K. koreana shows promise in terms of scalability and could help greatly with germplasm conservation and restoration efforts for the species.

Background and objective: As the COVID-19 pandemic gripped the entire world and people found themselves spending more time at home, many households began gardening, and purchased various ornamental plants. Many cultivars of Hibiscus syriacus are grown for their showy flowers, or used as landscape shrubs. H. syriacus is generally known for its high rate of asexual reproduction. However, it is known that the effectiveness of propagation by cuttings can have big differences depending on internal and external factors. This study was conducted to determine the effects of optimal rooting bed soil composition and auxin on the rooting of H. syriacus cuttings.Methods: Cuttings used in this study were from 17 cultivars. As types of bed soil for propagation by cutting, gardening bed soil, sand, mixed soil 1, and mixed soil 2 were used, and the plant growth regulators of IBA and NAA were applied at 500, 1000, and 1500 mg⋅L-1 concentrations.Results: The rooting rate and number of roots were highest with the combination of perlite and vermiculite. On the other hand, the gardening bed soil showed an extremely low rooting percentage. The root growth was improved in most cultivars when treated by plant growth regulator. The highest rooting rate was verified at IBA 500 mg⋅L-1 treatment while the number of roots and root length showed good result in IBA 1500 mg⋅L-1 treatment.Conclusion: In many cultivars, it was observed that the rooting rate and number of roots differed depending on the bed soil. The most suitable bed soil for the cuttings was a mixture of peat moss and vermiculite, and it was possible to increase the efficiency through treatment with a growth regulator, and the efficiency of IBA was better than that of NAA. However, it is necessary to identify which detailed growth regulator treatment is suitable for the root development of each cultivar, because plant growth regulator was less effective and even problematic in some cultivars.

Sleep-related head jerk (SRHJ) is conceived as a physiological motor phenomenon, which is mostly seen during rapid eye movement (REM) sleep. It should be distinguished from movements during REM sleep, mainly REM sleep behavior disorder (RBD). A 25-year-old male complained of daytime sleepiness with snoring and dream enactment behavior (DEB). Video polysomnography (PSG) excluded RBD and obstructive sleep apnea; frequent SRHJs during REM sleep with or without respiratory effort-related arousals, and SRHJs followed by one episode of DEB was observed. On PSG with continuous positive airway pressure titration, SRHJ with arousal events still remained but DEB symptom was resolved. REM without atonia unrelated to head jerks was not observed on all PSG data. Excessive SRHJs with arousal related to a sleep disturbance could indicate an SRHJ disorder, which might be a novel sleep-related movement disorder. In addition, clinicians should be careful in diagnosing young patients with RBD.

Acne vulgaris is a common skin disease caused by multifactorial reasons involving excessive sebum secretion and inflammation by Cutibacterium acnes (C. acnes). Various conventional therapies are available for the treatment of acne vulgaris; however, topical photodynamic therapy (PDT) has attracted much attention because of its great potential for sebum-reducing, anti-inflammatory, and antimicrobial activities. Although 5-aminolevulinic acid (ALA) has been broadly used as a photosensitizer for topical PDT, it has several limitations such as long incubation time, pain, and post-inflammatory hyperpigmentation. Here, we report a biocompatible nanoformulation consisting of methylene blue and salicylic acid (MBSD), as a potent PDT and acne therapeutics, enclosed within oleic acid. Photoactivated MBSD showed antimicrobial activity against C. acnes along with long-term stability. When 24 patients with acne were treated with MBSD and light irradiation 5 times at 1-week intervals, MBSD-based PDT exhibited a remarkable reduction in acne lesions and sebum production. In addition, the therapeutic procedure was painless and safe, without any adverse events. Therefore, MBSD is a promising topical PDT agent for biocompatible, safe, and effective acne treatment.

Gaucher disease (GD) is an autosomal recessive disorder characterized by excessive accumulation of glucosylceramide in multiple organs. This study was performed to determine the detection rate of GD in a selected patient population with unexplained splenomegaly in Korea.This was a multicenter, observational study conducted at 18 sites in Korea between December 2016 and February 2020. Adult patients with unexplained splenomegaly were enrolled and tested for β-glucosidase enzyme activity on dried blood spots (DBS) and in peripheral blood leukocytes. Mutation analysis was performed if the test was positive or indeterminate for the enzyme assay. The primary endpoint was the percentage of patients with GD in patients with unexplained splenomegaly.A total of 352 patients were enrolled in this study (male patients, 199; mean age, 48.42 yr). Amongst them, 14.77% of patients had concomitant hepatomegaly. The most common sign related to GD was splenomegaly (100%), followed by thrombocytopenia (44.32%) and, anemia (40.91%). The β-glucosidase activity assay on DBS and peripheral leukocytes showed abnormal results in sixteen and six patients, respectively. Eight patients were tested for the mutation, seven of whom were negative and one patient showed a positive mutation analysis result. One female patient who presented with splenomegaly and thrombocytopenia was diagnosed with type 1 GD. The detection rate of GD was 0.2841% (exact 95% CI, 0.0072‒1.5726).The detection rate of GD in probable high-risk patients in Korea was lower than expected. However, the role of hemato-oncologists is still important in the diagnosis of GD.

Study Objectives The pathomechanism of restless legs syndrome (RLS) is related to brain iron deficiency and iron therapy is effective for RLS, however, the effect of iron therapy on human brain iron state has never been studied with magnetic resonance imaging. This study aimed to investigate the change of brain iron concentrations in patients with RLS after intravenous iron therapy using quantitative susceptibility mapping (QSM). Methods We enrolled 31 RLS patients and 20 healthy controls. All participants underwent initial baseline (t0) assessment using brain magnetic resonance imaging, serum iron status, and sleep questionnaires including international RLS Study Group rating scale (IRLS). RLS patients underwent follow-up tests at 6 and 24 weeks (t1 and t2) after receiving 1000 mg ferric carboxymaltose. Iron content of region-of-interest on QSM images was measured for 13 neural substrates using the fixed-shaped method. Results RLS symptoms evaluated using IRLS were significantly improved after iron treatment (t0: 29.7±6.5, t1: 19.5±8.5, t2: 21.3±10.1; p Conclusions Intravenous iron treatment results in changes in brain iron content which correlate to reductions in RLS severity. This suggests a connection between symptom improvement and the associated specific brain regions constituting the sensorimotor network.

Study Objectives We conducted a prospective study to quantify motor activity during sleep measured by actigraphy before and after 3 months of treatment with clonazepam in patients with video-polysomnography (vPSG) confirmed isolated rapid eye movement (REM) sleep behavior disorder (iRBD). Methods The motor activity amount (MAA) and the motor activity block (MAB) during sleep were obtained from actigraphy. Then, we compared quantitative actigraphic measures with the results of the REM sleep behavior disorder questionnaire for the previous 3-month period (RBDQ-3M) and of the Clinical Global Impression-Improvement scale (CGI-I), and analyzed correlations between baseline vPSG measures and actigraphic measures. Results Twenty-three iRBD patients were included in the study. After medication treatment, large activity MAA dropped in 39% of patients, and the number of MABs decreased in 30% of patients when applying 50% reduction criteria. 52% of patients showed more than 50% improvement in either one. On the other hand, 43% of patients answered “much or very much improved” on the CGI-I, and RBDQ-3M was reduced by more than half in 35% of patients. However, there was no significant association between the subjective and objective measures. Phasic submental muscle activity during REM sleep was highly correlated with small activity MAA (Spearman’s rho = 0.78, p < .001) while proximal and axial movements during REM sleep correlated with large activity MAA (rho = 0.47, p = .030 for proximal movements, rho = 0.47, p = .032 for axial movements). Conclusions Our findings imply that quantifying motor activity during sleep using actigraphy can objectively assess therapeutic response in drug trials in patients with iRBD.

OBJECTIVE: This study investigated demographic, sleep related symptoms and mental health status as predictors of clinically significant treatment responses to cognitive behavioral therapy in adults who have good adherence for the cognitive behavioral therapy for insomnia (CBT-I) program in primary insomnia. METHODS: A total of 42 adults with primary insomnia disorder were treated with CBT-I at a university hospital from June 2020 to January 2021. Demographic variables were surveyed and sleep-related symptoms were measured using self-reported questionnaires before and after the intervention, comprising a 6-week interval. The treatment responder group was defined as patients with an Insomnia Severity Index change score >7 compared to baseline. Logistic regression and paired t-test examined whether these factors predicted treatment outcomes for CBT-I. RESULTS: Demographic variables did not predict treatment outcomes. Higher levels of anxiety were associated with a higher likelihood of treatment response (odds ratio [OR] = 1.234; confidence interval [CI]: 1.008–1.511). More severe insomnia at baseline was associated with a greater likelihood of treatment response (OR = 1.450; CI: 1.121–1.875). The lesser the dysfunctional beliefs and attitudes about sleep, the more effective the treatment response (OR = 0.943; CI: 0.904–0.984). Unlike the group of treatment responders, daytime function, depressive mood, and anxiety status did not improve in the group of treatment non-responders after CBT-I intervention. CONCLUSIONS: Patients with severe insomnia and anxiety at baseline should be treated more aggressively with CBT-I. During treatment, patients’ mental health problems and daytime activities should be continuously monitored, in order to help improve these problems which might strengthen the effectiveness of CBT-I.

Background: Alcohol consumption has been considered as a modifiable risk factor for dementia development and alcohol-related brain damage may further impair cognitive abilities in dementia patients. This study aimed to find out the differences in cognitive function according to current alcohol drinking in patients with self-perceived memory decline, including subjective cognitive decline (SCD), mild cognitive impairment (MCI) and early Alzheimer-type dementia (ATD).Methods: From May 2018 to December 2019, retrospective chart review was performed in patients who visited CHA Bundang Medical Center for cognitive decline. A two-way analysis of variance with interaction test were used to analyze the impact of alcohol consumption on cognitive function between groups.Results: A total of 147 patients was classified into three groups of SCD (n=30), MCI (n=53), and ATD (n=64), and each group was divided into two subgroups of alcohol users and alcohol non-users, according to the current status of alcohol consumption. Between SCD, MCI and ATD groups, scores of clock drawing test and Go/No-go test were significantly lower in current alcohol users of ATD groups compared to the SCD and MCI groups (p

Knowledge of the topographic thickness of the skin and soft tissues is necessary when performing a high-intensity focused ultrasound (HIFU) procedure. Thermal tissue injury to the superficial musculoaponeurotic system (SMAS) or deeper can injure the facial nerve and its branches.To demonstrate the topographic thickness of the lower facial skin, superficial fat, and SMAS.The ultrasound data of 200 healthy patients who underwent lower facial rejuvenation were retrospectively reviewed.The mean age was 41.1 ± 13.7 years (range, 19-76 years). The jowl had thinner skin, thicker superficial fat, and deeper superficial and deep margins of the SMAS than the preauricle or lower cheek. The thickness of the superficial fat decreased with age, especially on the preauricle, lower cheek, and jowl. Women had thicker superficial fat than men on the preauricle and lower cheek. The superficial and deep margins of the SMAS were located more superficially in old and male patients with a slim facial figure than in young and female patients with a chubby facial figure.The present findings provide anatomical information regarding the superficial fat and SMAS, which is useful in determining the focal penetration depth of HIFU treatment for lower face rejuvenation.

Objective Mild cognitive impairment (MCI) was found in 30 - 50% of the isolated REM sleep behavior disorder (iRBD) patients. Furthermore, it is known that patients with Parkinson’s Disease have attention network defects. Given that iRBD is known to be the prodromal disease of α -synucleinopathies, our aim was to investigate whether there are attention network dysfunctions in iRBD patients following the presence of MCI. Methods 14 healthy controls, 48 iRBD patients, 24 with MCI and 24 without MCI, were included in this study. Attention network task (ANT) was used to assess alerting, orienting, and executive control networks. Event-related potentials (ERPs) and behavioral performances were recorded during the ANT. Parietal N1 and P3 components were analyzed to find effects of the three attention networks. Results IRBD patients without MCI showed neuropsychological, behavioral, and ERP results similar to those of healthy controls. On the other hand, iRBD patients with MCI showed a general decline in cognitive domains with no alerting effect (controls, p = 0.043; iRBD-noMCI, p = 0.014; iRBD-MCI, p = 0.130) while preserving orienting and executive control effect. Furthermore, iRBD patients with MCI had impairments in executive function and verbal memory domains, compared to iRBD patients without MCI. Conclusions Our findings indicate that when cognition is reduced to MCI levels in iRBD patients, the attention network, especially the alerting component, is impaired. The attention network and cognition, on the other hand, can be preserved in iRBD patients due to the compensatory mechanism.

In space exploration, instruments measuring magnetic fields require magnetic cleanliness because it helps to distinguish the magnetic field generated by the spacecraft from the ambient field. A spacecraft has its own DC and AC magnetic fields generated by the current flow and residual moments of the spacecraft instruments. Therefore, analysis and testing are required in the development phase. The Korea Pathfinder Lunar Orbiter (KPLO) carries the KPLO Magnetometer (KMAG) instrument to observe magnetic fields on the lunar surface and the space environment around the Moon. To verify the magnetic cleanliness of the KPLO, we analyzed the magnetic field generated by it. We used the positional information and the magnetic dipole moments of twenty-five instruments, with which the KPLO is equipped. The analysis method was a Python program using magpylib. Finally, the worst-case analysis results showed that the spacecraft field around the magnetometer is less than 700 nT, which is the KMAG magnetic cleanliness requirement.

Introduction Several studies suggest that sleep and circadian rhythm disruptions, and physical activity changes may serve as risk factors for the occurrence of Parkinson’s disease and its prodromal features. Obstructive sleep apnea (OSA) is commonly found in patients with RBD. The comorbid OSA is associated with non-motor symptoms, including daytime sleepiness, cogntive decline and autonomic nervous system dysfunction. Therefore, we investigated whether circadian rest-activity patterns and RBD-related symptoms will be improved after positive airway pressure (PAP) therapy in patients who had iRBD with comorbid OSA. Methods Seven patients were diagnosed as iRBD with OSA (AHI ≥ 10) confirmed by video-polysomnography. The patients wore actigraphy devices for 14 consecutive days befor and after PAP therapy for 3 months. The mean motor activity amount (MAA) and the motor activity block (MAB) during sleep were obtained from actigraphic data. Non-parametric circadian rhythm activity including inter-daily stability(IS), intra-daily variability, least 5 average, most 10 average and relative amplitude were anlayzed. In addition, we obtainted the REM sleep behavior disorder questionnaire for the previous 3-month period (RBDQ-3M) and of the Clinical Global Impression-Improvement scale (CGI-I). Results Four of 7 patients had good compliance of PAP usage (average usage > 4hr during sleep), and three patients had poor compliance of PAP usage. In good compliance group, score of RBD-3M decreased ( p=0.029) and value of IS were increased (p=0.029 ) significantly. Also, 3 of 4 patients answered “Very much improved or much improved” in a questionnaire of CGI. In poor comliance group, there was no any significant change in all values. In addition, only one patient answered “ much imrpoved” and two patients answered “minimally improved” in CGI. Conclusion The PAP treatment of OSA in iRBD can be role as a lifestyle modifier that improves circadian rest-activity patterns and, it may be of value as a disease-modifying effect of behavioral or lifestyle changes that have been reported to be associated with decreased risk of neurodegenerative disorder. We will continue enroll the data and will investigate not only improvement of circadian rhythm, but also decreasing of motor activities during sleep after PAP therapy. Support (if any)

Brainstem encephalitis (BE) associated with Mycoplasma pneumoniae in adults is rare, and the diagnosis is challenging. We describe an uncommon case of BE in an immunocompetent patient. A 43-year-old, otherwise healthy woman visited our emergency department with high fever and a sore throat, and 3 days later she returned with an altered drowsy mental status. Magnetic resonance imaging displayed diffuse swelling in bilateral cerebral regions involving the bilateral pons. The sera tested positive for the immunoglobulin (Ig) M antibody against M. Pneumoniae as detected by an enzyme immunoassay (EIA), and on hospital day 10, the level of IgM index against M. pneumoniae further increased from 1.5 to 2.1. We changed the antibiotic regimen from vancomycin and ceftriaxone to clarithromycin based on detection of M. pneumoniae, and we added intravenous immunoglobulin. After one month, the patient fully recovered from the neurological deficits. A follow-up brain magnetic resonance imaging was performed, which showed completely resolved lesions. Particle agglutination assay (PA) and EIA are both largely used to diagnose M. pneumoniae. Compared to the PA test, the EIA test could be a reliable tool because it separately measures IgM and IgG antibodies. We diagnosed BE associated with M. pneumoniae through EIA with an increasing level of IgM in the acute and subacute paired sera. Early treatment with macrolide antibiotics resulted in a good outcome.

Objectives: Cognitive behavioral therapy for insomnia (CBT-I) is the first line treatment for insomnia. However, many patients remain with sleep disturbances even after undergoing CBT-I, and those with short sleep durations have shown fewer gains. Acceptance and commitment therapy (ACT) is one of the third wave of behavioral therapies, and it is useful in helping patients get flexibility of mind. Therefore, we incorporated its components into CBT-I, came up with an advanced CBT-I program that involves cognitive behavior therapy based on ACT, and examined its efficacy in comparison to that of CBT-I. Methods: Patients with chronic primary insomnia were recruited at the memory center of CHA University Hospital from June to August 2020. To examine the efficacy of advanced CBT-I compared to that of CBT-I, the patients (n=16) were assigned to two groups (CBT-I: n=6; advanced CBT-I: n=10). The patients in each group were treated for 4 weeks (8 sessions). The quality of sleep, severity of insomnia, sleepiness, depression, anxiety, acceptance, efforts to sleep, and dysfunctional beliefs concerning sleep were assessed with self-report questionnaires. Results: The severity of insomnia, quality of sleep, depression, anxiety, acceptance, efforts to sleep, and dysfunctional beliefs concerning sleep improved after both CBT-I and advanced CBT-I treatment. Conclusions: This study examined the efficacy of advanced CBT-I in improving the severity of insomnia, sleep quality, and other symptoms related to sleep. The results suggest that components of ACT were useful for insomnia.

Jin-Sun Jun1 &ast;, Jun-Sang Sunwoo2 &ast;, Jung-Ick Byun,3 Jung-Won Shin,4 Tae-Joon Kim,5 Carlos H Schenck,6 Ki-Young Jung7 1Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea; 2Department of Neurology, Kangbuk Samsung Hospital, Seoul, Republic of Korea; 3Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; 4Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; 5Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea; 6Minnesota Regional Sleep Disorders Center, and Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA; 7Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea&ast;These authors contributed equally to this workCorrespondence: Ki-Young Jung, Department of Neurology, Seoul National University Hospital, Neuroscience Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea, Tel +82-2-2072-4988, Fax +82-2-3672-7553, Email jungky@snu.ac.krObjective: To identify emotional and environmental factors that aggravate dream enactment behaviors (DEBs) in isolated rapid eye movement (REM) sleep behavior disorder (iRBD).Methods: In this cross-sectional study, a total of 96 polysomnography-confirmed iRBD patients (mean age, 68.5 years; men, 68%) and their caregivers completed questionnaires regarding potential aggravating factors related to DEBs, including emotion/feelings (stress, anger, anxiety, depressive mood, fatigue, pain), food (alcohol, caffeine, overeating in the evening, fasting/hunger), activities and sleep patterns (strenuous exercise, sex before bed, conflict/fighting, sleep deprivation, oversleeping, sleeping away from home, watching TV before bed), weather/environmental factors (cloudy or rainy weather, heat, cold, noise) and medication (skipping medication, taking hypnotics).Results: The patients reported that stress (61%) was the most aggravating factor for DEBs, followed by anxiety (56%), anger (51%), fatigue (49%), and watching TV before bed (46%). Similarly, the caregivers reported that these factors were most relevant to the aggravation of DEBs in the patients, although some factors were ranked differently. In the subgroup analyses, aggravating factors for DEBs did not differ by RBD symptom severity. Interestingly, the proportion of patients experiencing DEB aggravation by stress, anxiety and depressive mood was significantly higher in women than in men. Furthermore, depressed patients reported that stress and cloudy or rainy weather made DEBs worse than nondepressed patients.Conclusion: Our results suggest that DEBs in iRBD patients may be mainly aggravated by emotional factors. These negative effects appeared to be more prominent in female and depressed patients.Keywords: REM sleep behavior disorder, dream enactment behavior, precipitating factors

Background Recently, pulsed dye laser (PDL) combined with triamcinolone intralesional injection (TAILI) has been introduced for surgical scar prevention. However, little is known about this procedure's effectiveness in preventing hypertrophic scar following surgical scar removal. Objectives This study aimed to evaluate the outcome of early intervention using PDL combined with TAILI after surgical removal of hypertrophic cesarean section (CS) scars. Methods The medical records of 35 patients who underwent early intervention using PDL and TAILI after removal of hypertrophic CS scars were retrospectively reviewed. The scars' average Vancouver Scar Scale (VSS) scores before scar removal and three months after the final treatment were compared. Results The patients received 4.23 treatments on average and were followed up for a mean period of 7.74 months. The mean final VSS was 3.11 ± 1.52 and was significantly lower than that of the previous VSS (9.29 ± 1.74, P = 0.000). VSS of the previous CS scar, and the presence or absence of keloid formation in other areas, were associated with treatment outcome (P = 0.003 and 0.008, respectively). Conclusions Early intervention using PDL combined with TAILI could prevent the recurrence or progression of hypertrophic CS scarring after surgical scar removal.

Background Topical calcineurin inhibitors have been used to treat vitiligo, either alone or in combination with phototherapy; however, the long-term safety of these agents remains controversial. Objective To investigate the risk of lymphoma and skin cancer in vitiligo patients who received topical calcineurin inhibitors or phototherapy. Methods A multicenter retrospective cohort study of 25,694 vitiligo patients who received topical calcineurin inhibitors or phototherapy for 6 weeks or more between 2001 and 2019 was performed. Cumulative doses of topical calcineurin inhibitors and total phototherapy sessions were determined. Outcomes were the development of lymphoma or skin cancer after enrollment, confirmed through chart review and pathology reports. Results During 95,203 person-years, 13 cases of lymphoma, 22 of actinic keratosis, 15 of nonmelanoma skin cancer, and 5 of melanoma were observed. The risk of lymphoma and skin cancer was not significantly increased by topical calcineurin inhibitor dose or phototherapy sessions. The interaction between the topical calcineurin inhibitors and phototherapy was not associated with an increased risk of skin cancer. Limitations Retrospective study, individual follow-up duration less than 4 years, and no adjustment for comorbidities and medication history. Not generalizable to other races. Conclusion The long-term risk of skin cancer or lymphoma was not associated with the use of topical calcineurin inhibitors, phototherapy, and both treatments in combination in patients with vitiligo.

STUDY OBJECTIVES: Restless legs syndrome (RLS) is known to be a risk factor for cardiovascular disease. However, there are no electrophysiological biomarkers to assess this risk. This study aimed to evaluate heart rate variability (HRV) and cardiovascular reflexes in the supine and standing positions during wakefulness in patients with RLS. METHODS: Fourteen drug-naïve patients with RLS (12 women and 2 men, mean age, 42.14 ± 7.81 years) and 10 healthy control patients underwent tests for blood pressure, heart rate when in the supine and standing positions, and deep breathing and handgrip tests in controlled laboratory conditions. Data on 5-minute R-R intervals at each position were collected and analyzed for HRV. RESULTS: Expected cardiovascular reflexes were within the normal range and were similar between the 2 groups. In HRV analysis, the normalized unit of the low-frequency component and the low-frequency/high-frequency ratio during standing were lower in patients with RLS than in the control patients. The low-frequency/high-frequency ratio responses during the change from the supine to the standing position were significantly reduced in patients with RLS (mean ± standard deviation, 2.94 ± 3.11; control patients: 7.51 ± 5.58; P = .042.) On Spearman rank correlation, questionnaires related to sleep problems were associated with the parameters of HRV. CONCLUSIONS: Patients with RLS showed reduced sympatho-vagal responses during the change from the supine to the upright position during wakefulness, and RLS-related sleep disturbance was a contributing factor for autonomic nervous system dysfunction. This case-control study showed a difference in HRV response to position change in a considerably small group of patients with RLS. The relevance of this finding is uncertain, but it may be worthy of further investigation in longitudinal studies on RLS and cardiovascular disease. CITATION: Shin J-W, Sunwoo J-S, Byun J-I, et al. Reduced sympatho-vagal responses to orthostatic stress in drug-naïve idiopathic restless legs syndrome. J Clin Sleep Med. 2021;17(5):957–963.

Objective/Background We performed bioinformatic analysis of proteomic data to identify the biomarkers of restless legs syndrome (RLS) and provide insights into the putative pathomechanisms, including iron deficiency, inflammation, and hypoxic pathways. Patients/methods Patients with drug-naive idiopathic RLS were recruited at a university hospital from June 2017 to February 2018. Serum samples from patients with RLS (n = 7) and healthy sex- and age-matched controls (n = 6) were evaluated by proteomic analysis. For differentially expressed proteins (DEPs) in patients with RLS, compared to those in controls, the expression profiles and protein–protein interaction (PPI) network were characterized between dysregulated proteins and extracted proteins involved in iron deficiency, hypoxia, and inflammation responses using the String database (http://string-DB.org). The PPI network was visualized by Cytoscape ver. 3. 7. 1. Statistical analyses of the validation Western blot assays were performed using a Student's t-test. Results Interactome network analysis revealed a relationship among the eight proteins, their associated genes, and 150, 47, and 11 proteins related to iron deficiency, inflammation, and hypoxic pathways, respectively. All DEPs were well associated with inflammation, and complement 3, complement C4A, alpha-2 HS glycoprotein, and alpha-2 macroglobulin precursor were found to be in hub positions of networks involved in PPIs including iron deficiency, hypoxia pathway, and inflammation. C3 and C4A were verified using western blotting. Conclusions We identified key molecules that represent the selected cellular pathways as protein biomarkers by PPI network analysis. Changes in inflammation can mediate or affect the pathomechanism of RLS and can thus act as systemic biomarkers.

White matter (WM) tract-specific changes may precede gray matter loss in isolated rapid eye movement sleep behavior disorder (iRBD). We aimed to evaluate tract-specific WM changes using tract-specific statistical analysis (TSSA) and their correlation with clinical variables in iRBD patients.This was a cross-sectional single-center study of 50 polysomnography-confirmed iRBD patients and 20 age- and sex-matched controls. We used TSSA to identify tract-specific fractional anisotropy (FA) and mean diffusivity (MD) in fourteen major fiber tracts and analyzed between-group differences in these values. Correlations between FA or MD values and clinical variables, including RBD symptom severity, depression and cognition, were evaluated.Patients with iRBD showed lower FA in the right anterior thalamic radiation (ATR) and higher MD in the bilateral ATR and right inferior fronto-occipital fasciculus (IF-OF) than controls after adjusting for age, sex, and years of education. MD values in the IF-OF positively correlated with scores on the Korean version of the Rapid Eye Movement Sleep Behavior Disorder Questionnaire-Hong Kong (RBDQ-KR, p = 0.042) and the Korean version of the geriatric depression scale (GDS-K, p = 0.002) in iRBD patients. Only GDS-K scores independently correlated with IF-OF MD values after adjusting for RBDQ-KR scores (adjusted p = 0.026).This study suggests WM microstructural disruption in the bilateral ATR and right IF-OF in patients with iRBD and that alterations in the IF-OF may contribute to depressive symptoms.

Background Although deep neural networks have shown promising results in the diagnosis of skin cancer, a prospective evaluation in a real-world setting could confirm these results. This study aimed to evaluate whether an algorithm (http://b2019.modelderm.com) improves the accuracy of nondermatologists in diagnosing skin neoplasms. Methods A total of 285 cases (random series) with skin neoplasms suspected of malignancy by either physicians or patients were recruited in two tertiary care centers located in South Korea. An artificial intelligence (AI) group (144 cases, mean [SD] age, 57.0 [17.7] years; 62 [43.1%] men) was diagnosed via routine examination with photographic review and assistance by the algorithm, whereas the control group (141 cases, mean [SD] age, 61.0 [15.3] years; 52 [36.9%] men) was diagnosed only via routine examination with a photographic review. The accuracy of the nondermatologists before and after the interventions was compared. Results Among the AI group, the accuracy of the first impression (Top-1 accuracy; 58.3%) after the assistance of AI was higher than that before the assistance (46.5%, P = .008). The number of differential diagnoses of the participants increased from 1.9 ± 0.5 to 2.2 ± 0.6 after the assistance (P < .001). In the control group, the difference in the Top-1 accuracy between before and after reviewing photographs was not significant (before, 46.1%; after, 51.8%; P = .19), and the number of differential diagnoses did not significantly increase (before, 2.0 ± 0.4; after, 2.1 ± 0.5; P = .57). Conclusions In real-world settings, AI augmented the diagnostic accuracy of trainee doctors. The limitation of this study is that the algorithm was tested only for Asians recruited from a single region. Additional international randomized controlled trials involving various ethnicities are required.

생태주의 담론은 근대 이후 산업화로 인하여 가속화된 자연의 파괴에 대해 경각심을 일으키며 자연에 대한 인간의 지배를 정당화하는 인간중심주의가 생태학적 위기의 근저에 놓여있음을 보여주었다. 환경과 생태에 대한 입장들이 인식시킨 새로운 이해는 일상의 삶 속에서의 인식과 실천을 변화시켰고 다양한 문화콘텐츠에서도 중요한 주제의식으로 등장해 왔다. 그러나 인간에 의해 인공물로서 만들어지는 예술은 생태와 생태성에 대한 인식을 내재화 하고 생태학적 변화를 추구하는 실천적 활동으로 제시되더라도 인공물로서의 특성을 가질 수밖에 없는 한, 자연과의 연결성 회복이라는 주제에 적합한지에 대한 의문과 긴장을 부담으로 안게 된다. 이 논문은 예술과 과학사이의 접점에서 실험되고 있는 미디어아트에서의 생태주의적 시도들을 중심으로 하여 생태 미학의 가능성을 논하고자 한다. 이를 위하여 우선 20세기 말 등장한 ‘환경주의 미학’이 보여주는 새로운 이해가 무엇이며 한계는 무엇인지가 다루어질 것이다. 환경 미학으로부터 생태 미학으로의 전환을 논하기 위하여 생태주의 일반이 수용하는 관점이 무엇인지를 논하고 이를 바탕으로 미디어아트에서의 생태성을 다루는 작품들이 생태주의 관점에서 어떻게 평가될 수 있을지를 논하려 한다.

Jumping stump syndrome is considered to be a peripherally induced movement disorder due to damage to peripheral nerves leading to dystonia or myoclonus. Anti-leucine-rich glioma-inactivated 1 antibody (anti-LGI 1 Ab) encephalitis is clinically characterized with progressive cognitive dysfunction and seizure including facial brachial dystonic seizure. We report a case of a woman with a history of intractable involuntary movement on amputated forearm diagnosed as anti-LGI 1 Ab encephalitis, mimicking symptoms of jumping stump syndrome.