1
|
Kang DW, Park SK, Yu YL, Lee Y, Lee DH, Kang S. Effectiveness of next-generation sequencing for patients with advanced non-small-cell lung cancer: a population-based registry study. ESMO Open 2024; 9:102200. [PMID: 38194884 PMCID: PMC10820286 DOI: 10.1016/j.esmoop.2023.102200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/25/2023] [Accepted: 11/17/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Despite the growing use of next-generation sequencing (NGS) in the management of advanced non-small-cell lung cancer (NSCLC), there is little evidence that its use leads to improved clinical outcomes. This study aimed to compare the effectiveness of NGS with that of single-gene testing (SGT) alone in patients with advanced NSCLC. MATERIALS AND METHODS This was a retrospective cohort study conducted on patients diagnosed with advanced lung adenocarcinoma between 2017 and 2018 from a nationwide, population-based database. We identified patients who had SGT exclusively (SGT group) or underwent upfront NGS or NGS following SGT as an initial evaluation (NGS group). Patients were followed up until death or the end of the study (31 December 2019). The adjusted hazard ratio (aHR) for death was estimated using the Cox proportional hazards model. The factors affecting the adoption of NGS were identified. RESULTS Of 8566 patients diagnosed with advanced lung adenocarcinoma, 402 and 6932 patients were assigned to the NGS and SGT groups, respectively. More NGS was carried out in younger patients, those with higher incomes, and those living in urban areas. After balancing these confounders through matching, no difference was observed in the median overall survival and risk of death between the NGS and SGT groups [18.5 versus 19.7 months, log-rank P = 0.783; aHR 0.98, 95% confidence interval (CI) 0.84-1.14, respectively]. Only in a subgroup for whom epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) inhibitors were not indicated, NGS was associated with better survival outcomes (14.1 versus 9.0 months, log-rank P = 0.006; aHR 0.82, 95% CI 0.69-0.97). CONCLUSIONS In the real world, NGS for all-comers in patients with advanced NSCLC did not increase survival outcomes. When health care resources to support equal access to NGS are limited, upfront SGT followed by NGS may be a more efficient strategy.
Collapse
Affiliation(s)
- D-W Kang
- School of Pharmacy, Sungkyunkwan University, Suwon
| | - S-K Park
- College of Pharmacy, The Catholic University of Korea, Bucheon
| | - Y L Yu
- Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang
| | - Y Lee
- Department of Internal Medicine, National Cancer Center, Goyang
| | - D H Lee
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul
| | - S Kang
- Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang; Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
| |
Collapse
|
2
|
Bae JH, Ryu JC, Ha SH, Kim BJ, Kang DW, Kwon SU, Kim JS, Chang JY. Association of Left Vertebral Artery Hypoplasia with Posterior Circulation Stroke and the Functional Outcome of Patients with Atrial Fibrillation-Related Cardioembolic Stroke. AJNR Am J Neuroradiol 2023; 44:65-69. [PMID: 36521964 PMCID: PMC9835927 DOI: 10.3174/ajnr.a7738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE A cardiogenic embolus could reach the posterior circulation through the right vertebral artery because of a relatively larger diameter in cases of left vertebral artery hypoplasia. Hence, we investigated whether left vertebral artery hypoplasia is associated with cardiac embolisms with atrial fibrillation in the posterior circulation and its functional outcomes. MATERIALS AND METHODS In this monocentric retrospective study, patients with acute cardioembolic stroke with atrial fibrillation were enrolled and underwent CT or neck MRA, which visualized the aortic arch and subclavian arteries. The laterality and size of vertebral artery hypoplasia were recorded. Posterior circulation stroke, basilar artery occlusion, and the functional outcomes after 3 months were investigated. RESULTS This study included 407 patients; the patients with left vertebral artery hypoplasia experienced a higher rate of posterior circulation stroke (19 versus 73; 42.2% versus 20.2%; P = .001) and basilar artery occlusion (5 versus 10; 11.1% versus 2.8%; P = .005) than the patients without left vertebral artery hypoplasia. Multivariate analysis revealed that left vertebral artery hypoplasia showed an association with lower odds of achieving a good functional outcome 3 months after the stroke (OR = 0.4; 95% CI, 0.2-0.9; P = .027). CONCLUSIONS Patients with cardioembolic stroke and left vertebral artery hypoplasia had posterior circulation stroke, basilar artery occlusion, and poor functional outcomes after 3 months.
Collapse
Affiliation(s)
- J-H Bae
- From the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - J-C Ryu
- From the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - S H Ha
- From the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - B J Kim
- From the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - D-W Kang
- From the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - S U Kwon
- From the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - J-S Kim
- Department of Neurology (J.-S.K.), Gangneung Asan Hospital, Gangneung, Korea
| | - J Y Chang
- From the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| |
Collapse
|
3
|
Normann AJ, Kang DW, Christopher CN, Norris MK, Dieli-Conwright CM. Improved Sleep Quality Is Associated with Reduced Insulin Resistance in Cancer Survivors Undertaking Circuit, Interval-Based Exercise. Cancer Epidemiol Biomarkers Prev 2022; 31:1509-1510. [PMID: 35775225 DOI: 10.1158/1055-9965.epi-22-0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Cancer patients often experience poor sleep quality, typically induced by cancer-related treatments, a sedentary lifestyle, and psychological distress, leading to an increased risk of metabolic dysregulation such as obesity and insulin resistance. In this novel 16-week pilot study, we examined the effect of a circuit-based aerobic and resistance exercise intervention on self-reported sleep quality in breast, prostate, and colorectal cancer survivors and explored the association between changes in sleep quality and insulin resistance. METHODS Survivors of breast, prostate or colorectal cancers who were sedentary, overweight or obese (BMI>25.0 kg/m2) were randomized to exercise (n=60) or usual care (n=30). The 16-week intervention included supervised moderate-vigorous aerobic (65-85% of VO2max) and resistance (65-85% of 1-repetition maximum) exercise performed in a circuit, interval fashion three times per week. Patient-reported sleep quality and insulin resistance were assessed at baseline and post-intervention using Pittsburgh Sleep Quality Index (PSQI) and Homeostasis Model of Assessment (HOMA-IR), respectively. Mean changes in PSQI score that are negative demonstrate improvements in sleep. Between-group differences were determined using repeated-measures analysis of variance. Associations between changes in PSQI and insulin resistance were computed using Pearson correlations. RESULTS Participants were 63.2±10.8 years old, obese (87%), female (55%), and completed chemotherapy + radiation therapy (75%). Adherence to the intervention was 92% and the retention rate was 100%. Post-intervention, the PSQI global score improved significantly in the exercise group when compared to usual care (mean between-group difference, -2.7; 95% CI, -4.2 to -0.6). Change in PSQI was inversely associated with change in HOMA-IR (r=-0.91; p<0.01) among the exercise group. CONCLUSIONS A circuit, interval-based aerobic and resistance exercise intervention improved patient-reported sleep quality in breast, prostate, and colorectal cancer survivors. Additionally, this exercise-induced improvement in sleep-quality may result in reduced insulin resistance.
Collapse
|
4
|
Lee NJ, Chung MS, Jung SC, Kim HS, Choi CG, Kim SJ, Lee DH, Suh DC, Kwon SU, Kang DW, Kim JS. Comparison of High-Resolution MR Imaging and Digital Subtraction Angiography for the Characterization and Diagnosis of Intracranial Artery Disease. AJNR Am J Neuroradiol 2016; 37:2245-2250. [PMID: 27659192 DOI: 10.3174/ajnr.a4950] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/22/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE High-resolution MR imaging has recently been introduced as a promising diagnostic modality in intracranial artery disease. Our aim was to compare high-resolution MR imaging with digital subtraction angiography for the characterization and diagnosis of various intracranial artery diseases. MATERIALS AND METHODS Thirty-seven patients who had undergone both high-resolution MR imaging and DSA for intracranial artery disease were enrolled in our study (August 2011 to April 2014). The time interval between the high-resolution MR imaging and DSA was within 1 month. The degree of stenosis and the minimal luminal diameter were independently measured by 2 observers in both DSA and high-resolution MR imaging, and the results were compared. Two observers independently diagnosed intracranial artery diseases on DSA and high-resolution MR imaging. The time interval between the diagnoses on DSA and high-resolution MR imaging was 2 weeks. Interobserver diagnostic agreement for each technique and intermodality diagnostic agreement for each observer were acquired. RESULTS High-resolution MR imaging showed moderate-to-excellent agreement (interclass correlation coefficient = 0.892-0.949; κ = 0.548-0.614) and significant correlations (R = 0.766-892) with DSA on the degree of stenosis and minimal luminal diameter. The interobserver diagnostic agreement was good for DSA (κ = 0.643) and excellent for high-resolution MR imaging (κ = 0.818). The intermodality diagnostic agreement was good (κ = 0.704) for observer 1 and moderate (κ = 0.579) for observer 2, respectively. CONCLUSIONS High-resolution MR imaging may be an imaging method comparable with DSA for the characterization and diagnosis of various intracranial artery diseases.
Collapse
Affiliation(s)
- N J Lee
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - M S Chung
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - S C Jung
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - H S Kim
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - C-G Choi
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - S J Kim
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - D H Lee
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - D C Suh
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - S U Kwon
- Department of Neurology (S.U.K., D.-W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - D-W Kang
- Department of Neurology (S.U.K., D.-W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - J S Kim
- Department of Neurology (S.U.K., D.-W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
5
|
Kwon JH, Kang DW, Cheon MG, Kim J. First Report of Alternaria Leaf Spot Caused by Alternaria sp. on Highbush Blueberry (Vaccinium corymbosum) in South Korea. Plant Dis 2014; 98:1434. [PMID: 30703952 DOI: 10.1094/pdis-04-14-0344-pdn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In South Korea, the culture, production, and consumption of blueberry (Vaccinium corymbosum) have increased rapidly over the past 10 years. In June and July 2012, blueberry plants with leaf spots (~10% of disease incidence) were sampled from a blueberry orchard in Jinju, South Korea. Leaf symptoms included small (1 to 5 mm in diameter) brown spots that were circular to irregular in shape. The spots expanded and fused into irregularly shaped, large lesions with distinct dark, brownish-red borders. The leaves with severe infection dropped early. A fungus was recovered consistently from sections of surface-disinfested (1% NaOCl) symptomatic leaf tissue after transfer onto water agar and sub-culture on PDA at 25°C. Fungal colonies were dark olive and produced loose, aerial hyphae on the culture surfaces. Conidia, which had 3 to 6 transverse septa, 1 to 2 longitudinal septa, and sometimes also a few oblique septa, were pale brown to golden brown, ellipsoid to ovoid, obclavate to obpyriform, and 16 to 42 × 7 to 16 μm (n = 50). Conidiophores were pale to mid-brown, solitary or fasciculate, and 28 to 116 × 3 to 5 μm (n = 50). The species was placed in the Alternaria alternata group (1). To confirm the identity of the fungus, the complete internal transcribed spacer (ITS) rDNA region of a representative isolate, AAVC-01, was amplified using ITS1 and ITS4 primers (2). The DNA products were cloned into the pGEM-T Easy vector (Promega, Madison, WI) and the resulting pOR13 plasmid was sequenced using universal primers. The resulting 570-bp sequence was deposited in GenBank (Accession No. KJ636460). Comparison of ITS rDNA sequences with other Alternaria spp. using ClustalX showed ≥99% similarity with the sequences of A. alternata causing blight on Jatropha curcas (JQ660842) from Mexico and Cajannus cajan (JQ074093) from India, citrus black rot (AF404664) from South Africa, and other Alternaria species, including A. tenuissima (WAC13639) (3), A. lini (Y17071), and A. longipes (AF267137). Two base substitutions, C to T at positions 345 and 426, were found in the 570-bp amplicon. Phylogenetic analysis revealed that the present Alternaria sp. infecting blueberry grouped separately from A. tenuissima and A. alternata reported from other hosts. A representative isolate of the pathogen was used to inoculate V. corymbosum Northland leaves for pathogenicity testing. A conidial suspension (2 × 104 conidia/ml) from a single spore culture and 0.025% Tween was spot inoculated onto 30 leaves, ranging from recently emerged to oldest, of 2-year-old V. corymbosum Northland plants. Ten leaves were treated with sterilized distilled water and 0.025% Tween as a control. The plants were kept in a moist chamber with >90% relative humidity at 25°C for 48 h and then moved to a greenhouse. After 15 days, leaf spot symptoms similar to those observed in the field developed on the inoculated leaves, whereas the control plants remained asymptomatic. The causal fungus was re-isolated from the lesions of the inoculated plants to fulfill Koch's postulates. To our knowledge, this is the first report of Alternaria sp. on V. corymbosum in South Korea. References: (1) E. G. Simmons. Page 1797 in: Alternaria: An Identification Manual. CBS Fungal Biodiversity Centre, Utrecht, The Netherlands, 2007. (2) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990. (3) M. P. You et al. Plant Dis. 98:423, 2014.
Collapse
Affiliation(s)
- J-H Kwon
- Gyeongsangnam-do Agricultural Research and Extension Services, Jinju 660-360, South Korea
| | - D-W Kang
- Gyeongsangnam-do Agricultural Research and Extension Services, Jinju 660-360, South Korea
| | - M-G Cheon
- Gyeongsangnam-do Agricultural Research and Extension Services, Jinju 660-360, South Korea
| | - J Kim
- Institute of Agriculture and Life Sciences, Gyeongsang National University, Jinju 660-701, South Korea. This work was supported by the Rural Development Administration fund PJ009192
| |
Collapse
|
6
|
Kwon JH, Kang DW, Lee SD, Kim J. First Report of Sclerotium Rot Caused by Sclerotium rolfsii on Yacón in South Korea. Plant Dis 2014; 98:1443. [PMID: 30703993 DOI: 10.1094/pdis-06-14-0616-pdn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Yacón, or ground apple (Smallanthus sonchifolius), is a perennial plant grown in the northern and central Andes from Colombia to northern Argentina for its crisp, sweet, and tuberous roots. In 2012, yacóns cultivated in the research field of the Gyeongsangnam-do Agriculture and Extension Services, Jinju, South Korea, suddenly died. The characteristic symptoms consisted of rotting, wilting, and blighting. Initial symptoms included water-soaked lesions on lower stem tissue near the soil line. Infected plants gradually withered, and white mycelial mats and sclerotia appeared on the surface of roots and stems at the soil line. The sclerotia were collected and disinfested by immersion in 1% sodium hypochlorite solution for 30 s and in sterilized distilled water for 1 min. Then, the sclerotia were placed on potato dextrose agar (PDA) and incubated at 30°C. Numerous globoid sclerotia were formed on PDA after 18 days of growth. The sclerotia (1 to 3 mm in diameter) were white at first and then gradually turned dark brown. Aerial mycelia usually formed many narrow hyphal strands 4 to 9 μm wide. The white mycelium formed a typical clamp connection after 5 days of growth. To fulfill Koch's postulates, 50-day-old healthy seedlings were transplanted individually into pots (10 × 10 × 9 cm) containing autoclaved soil. After 7 days, five seedlings were inoculated with colonized agar discs (6 mm in diameter) directly on the base of the plant, and five yacón seedlings were inoculated similarly with PDA discs as the control treatment. The inoculated and non-inoculated plants were incubated in a humid growth chamber at 28°C for 24 h and then maintained in a greenhouse. Eight days after inoculation, the yacón seedlings inoculated with the fungus died, whereas those treated with PDA discs were symptomless. The fungus was re-isolated from the artificially inoculated plants. To confirm the identity of the causal fungus, the complete internal transcribed spacer (ITS) rDNA region of the fungus was amplified using the primers ITS1 (5'-TCCGTAGGTGAACCTGCGG-3') and ITS4 (5'-TCCTCCGCTTATTGATATGC-3') (2), and the PCR amplicons were cloned into the pGEM-T Easy vector. The resulting plasmid (pOR119) was sequenced in both directions with the primers M13F and M13R. The resulting 684 bp of ITS rDNA sequence was deposited in GenBank (Accession No. KJ944395). A DNA analysis revealed that it was 100% identical to Sclerotium rolfsii (HM355751). Cultures of S. rolfsii have been deposited with the Korean Agricultural Culture Collection (KACC 47750), National Academy of Agricultural Science, Suwon, South Korea. On the basis of symptoms, fungal colonies, the ITS sequence, and pathogenicity to the host, this fungus was identified as S. rolfsii Saccardo (1). This is the first report of sclerotium rot on yacón caused by S. rolfsii in South Korea. References: (1) J. E. M. Mordue. CMI Descriptions of Pathogenic Fungi and Bacteria, No. 410, 1974. (2) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds. Academic Press, San Diego, 1990.
Collapse
Affiliation(s)
- J-H Kwon
- Gyeongsangnam-do Agricultural Research and Extension, Jinju 660-360, South Korea
| | - D-W Kang
- Gyeongsangnam-do Agricultural Research and Extension, Jinju 660-360, South Korea
| | - S-D Lee
- Gyeongsangnam-do Agricultural Research and Extension, Jinju 660-360, South Korea
| | - J Kim
- Institute of Agriculture and Life Sciences, Gyeongsang National University, Jinju 660-701, South Korea. This work was supported by the Rural Development Administration fund PJ009192
| |
Collapse
|
7
|
Kwon JH, Kang DW, Kim J. Sclerotium rolfsii Causes White Rot on Taro in Korea. Plant Dis 2013; 97:1000. [PMID: 30722580 DOI: 10.1094/pdis-01-13-0093-pdn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Taro (Colocasia esculenta L.) is grown throughout the world primarily for its tubers, which become edible after cooking. Taro stems are often used in a traditional soup in South Korea. In September 2012, a suspected white rot of taro occurred in a farmer's fields in Jinju, South Korea. Infected plants gradually withered, a white mycelial mat appeared, and numerous sclerotia developed on the surface of petioles near the soil line. The heavily infected petioles rotted and the entire plant eventually died. The freshly isolated pathogenic fungus was grown on potato dextrose agar (PDA) and examined microscopically. Aerial mycelia usually formed many narrow hyphal strands 4 to 8 μm wide. The white mycelia formed a typical clamp connection structure after 6 days growth at 25°C. The sclerotia were white at first, gradually turned dark brown, and were 1 to 3 mm in diameter. Small globoid sclerotia formed abundantly on PDA after 18 days of growth. Ten 2-month-old potted taro plants were inoculated with S. rolfsii-colonized agar discs directly at the base of each plant and kept at 25°C in a greenhouse to test pathogenicity. Three taro plants were inoculated similarly with uncolonized agar discs as controls. Eight days after inoculation, blight symptoms were observed, and S. rolfsii was reisolated from the artificially inoculated plants. The control taro plants remained healthy. We amplified and sequenced an internal transcribed spacer (ITS) rDNA region of the isolate using the ITS1 (5'-TCCGTAGGTGAACCTGCGG-3') and ITS4 (5'-TCCTCCGCTTATTGATATGC-3') primers to confirm the identity of the fungus (2). The resulting 684-bp sequence was deposited in GenBank (Accession No. KC491876). A comparison with other sequences available in the GenBank database revealed that the ITS sequence shared 100% similarity with Sclerotium rolfsii sequences (HQ420816 and JN017199). Based on the symptoms, mycological characteristics, ITS sequence analysis, and host plant pathogenicity, this fungus was identified as S. rolfsii Saccardo (1). To our knowledge, this is the first report of white rot in taro caused by S. rolfsii in Korea. References: (1) J. E. Mordue. CMI Descriptions of Pathogenic Fungi and Bacteria. No. 410, 1974. (2) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, New York, 1990.
Collapse
Affiliation(s)
- J-H Kwon
- Gyeongsangnam-do Agricultural Research and Extension Services, Jinju 660-360, Korea
| | - D-W Kang
- Gyeongsangnam-do Agricultural Research and Extension Services, Jinju 660-360, Korea
| | - J Kim
- Institute of Agriculture and Life Sciences, Gyeongsang National University, Jinju 660-701, Korea. This work was supported by the Rural Development Administration fund PJ009192
| |
Collapse
|
8
|
Kim YJ, Lee DH, Kwon JY, Kang DW, Suh DC, Kim JS, Kwon SU. High resolution MRI difference between moyamoya disease and intracranial atherosclerosis. Eur J Neurol 2013; 20:1311-8. [PMID: 23789981 DOI: 10.1111/ene.12202] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/30/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Along with intracranial atherosclerotic disease (ICAD), moyamoya disease (MMD) is the most common cause of middle cerebral artery (MCA) occlusion in Asians. Although they have differing vascular wall pathologies, conventional angiographic evaluation methods cannot easily differentiate MMD from ICAD in certain situations, such as in young patients with atherosclerotic risk factors. High resolution magnetic resonance imaging (HR-MRI) findings for the diseased segments of MCAs in MMD and symptomatic ICAD were compared to further elucidate differences in arterial wall changes. METHODS Angiographically confirmed patients, 12 MMD and 20 ICAD, who suffered a stroke due to MCA occlusion were recruited and underwent HR-MRI. The size of the outer diameter and other stenotic vessel wall characteristics revealed by HR-MRI, including enhancement, eccentricity and other lesion patterns, were analyzed by two independent reviewers in a blind fashion. RESULTS MMD patients were younger than ICAD patients (32.92 ± 11.08 years vs. 51.85 ± 11.97 years; mean ± SD) and displayed a smaller outer diameter in the stenotic portion (1.61 ± 0.43 mm for MMD vs. 3.03 ± 0.53 mm for ICAD, P < 0.0001). Eccentric lesions (three of 12 in MMD vs. 19 of 20 in ICAD, P < 0.0001) and focal enhancements in diseased areas (two of seven in MMD vs. 13 of 17 in ICAD, P = 0.061) were less common in MMD cases. CONCLUSIONS Our HR-MRI findings show that MMD is associated with smaller, concentric occlusive lesions which are rarely enhanced compared with symptomatic ICAD, consistent with the results of previous pathological reports. HR-MRI may therefore have utility in differentiating MMD from ICAD.
Collapse
Affiliation(s)
- Y J Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | | | | | | | | | | |
Collapse
|
9
|
Yoon Y, Lee DH, Kang DW, Kwon SU, Suh DC, Bang OY, Kim JS. Stroke recurrence patterns are predicted by the subtypes and mechanisms of the past, non-cardiogenic stroke. Eur J Neurol 2013; 20:928-34. [PMID: 23398300 DOI: 10.1111/ene.12101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 12/12/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The association between past stroke subtypes and recurrent stroke subtypes in non-cardiogenic stroke remains unknown. METHODS Patients with ischaemic stroke who had a past history of large-artery disease (LAD) or small-artery disease (SAD) subtypes were assessed. LAD was subdivided into intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS). LAD stroke mechanisms were categorized as artery-to-artery embolism, in situ thrombotic occlusion and local branch occlusion, while SAD was subdivided into lacunar infarction (LI) and branch atheromatous disease (BAD) on the basis of magnetic resonance imaging findings. The relationship between past and current strokes was analyzed. RESULTS Among the 202 patients enrolled, the LAD group (n = 111) had 64 and 47 patients with ICAS and ECAS, and the SAD group (n = 91) had 63 and 28 patients with LI and BAD, respectively, at the time of past stroke. Patients with LAD developed LAD-associated strokes most often (n = 99, 89.2%), and patients with SAD developed SAD most often (n = 69, 75.8%; P < 0.001). Patients with ICAS were more likely to develop ICAS later (n = 46, 79.3%), whereas those with ECAS developed ECAS more often (n = 31, 75.6%; P < 0.001). Patients with ICAS presenting with artery-to-artery embolism more often developed artery-to-artery embolism later (n = 26, 72.2%), whereas those with local branch occlusion developed recurrent local branch occlusion most often (n = 10, 66.7%, P = 0.005). In the SAD group, patients with BAD developed LAD more frequently than the LI group (n = 11, 39.3% vs. n = 9, 14.3%, P = 0.022). CONCLUSIONS The subtypes and mechanisms of recurrent stroke are significantly influenced by those of the past stroke.
Collapse
Affiliation(s)
- Y Yoon
- Department of Neurology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
10
|
Kang DW, Oh DA, Fu GY, Anderson JM, Zepeda ML. Porcine model to evaluate local tissue tolerability associated with subcutaneous delivery of protein. J Pharmacol Toxicol Methods 2013; 67:140-7. [PMID: 23376811 DOI: 10.1016/j.vascn.2013.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 12/20/2012] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The conversion from intravenous (IV) to subcutaneous (SC) delivery of biotherapeutics has increased in recent years. Some of the reasons for this shift in route of delivery are due to patient convenience, reduced adverse systemic effects, lack of a need for vascular access, and reduced cost of patient care, which ultimately lead to improved patient quality of life. One caveat to SC delivery is the limited volumes that can be administered at a single site and the associated local tolerability. To characterize factors that affect subcutaneous delivery of large volumes of therapeutic proteins, a porcine model was developed. Model endpoints included measurement of interstitial pressure, assessment of local skin visco-elasticity, and the qualitative assessment of local infusion sites. METHODS Immunoglobulin G (IgG) was subcutaneously infused into the abdominal region of Yucatan miniature swine. Changes in interstitial pressure were measured, using an in-line pressure transducer, during and after infusions. Additionally, pre- and post-infusion changes in local skin visco-elasticity were measured using a Cutometer®. Lastly, infusion sites were assessed for post-infusion local skin reactions such as erythema and swelling. Similar assessments were made following SC IgG delivery with the permeation enhancer recombinant human hyaluronidase PH20 (rHuPH20). RESULTS Subcutaneous infusions of IgG, in the presence of rHuPH20, significantly reduced average interstitial pressures by 55% during the infusion period and by 67% during the post-infusion period, compared to the control. Infusions in the presence of rHuPH20 also maintained better local skin elasticity as seen by a 42% increase in local skin pliability compared to the control. Finally, infusions with rHuPH20 resulted in an 80% reduction in swelling area compared to the control. DISCUSSION A large animal model was developed that incorporates both quantitative and qualitative assessment methods to aid in understanding SC delivery of proteins.
Collapse
Affiliation(s)
- D W Kang
- Halozyme Therapeutics Inc., San Diego, CA 92121, United States.
| | | | | | | | | |
Collapse
|
11
|
Merino JG, Latour LL, Tso A, Lee KY, Kang DW, Davis LA, Lazar RM, Horvath KA, Corso PJ, Warach S. Blood-brain barrier disruption after cardiac surgery. AJNR Am J Neuroradiol 2012; 34:518-23. [PMID: 22918429 DOI: 10.3174/ajnr.a3251] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CNS complications are often seen after heart surgery, and postsurgical disruption of the BBB may play an etiologic role. The objective of this study was to determine the prevalence of MR imaging-detected BBB disruption (HARM) and DWI lesions after cardiac surgery. MATERIALS AND METHODS All patients had an MRI after cardiac surgery. For half the patients (group 1), we administered gadolinium 24 hours after surgery and obtained high-resolution DWI and FLAIR images 24-48 hours later. We administered gadolinium to the other half (group 2) at the time of the postoperative scan, 2-4 days after surgery. Two stroke neurologists evaluated the images. RESULTS Of the 19 patients we studied, none had clinical evidence of a stroke or delirium at the time of the gadolinium administration or the scan, but 9 patients (47%) had HARM (67% in group 1; 30% in group 2; P = .18) and 14 patients (74%) had DWI lesions (70% in group 1; 78% in group 2; P = 1.0). Not all patients with DWI lesions had HARM, and not all patients with HARM had DWI lesions (P = .56). CONCLUSIONS Almost half the patients undergoing cardiac surgery have evidence of HARM, and three-quarters have acute lesions on DWI after surgery. BBB disruption is more prevalent in the first 24 hours after surgery. These findings suggest that MR imaging can be used as an imaging biomarker to assess therapies that may protect the BBB in patients undergoing heart surgery.
Collapse
Affiliation(s)
- J G Merino
- Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Kang DW, Hwang WC, Park MH, Ko GH, Ha WS, Kim KS, Lee YC, Choi KY, Min DS. Rebamipide abolishes Helicobacter pylori CagA-induced phospholipase D1 expression via inhibition of NFκB and suppresses invasion of gastric cancer cells. Oncogene 2012; 32:3531-42. [PMID: 22890316 DOI: 10.1038/onc.2012.358] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 06/08/2012] [Accepted: 06/30/2012] [Indexed: 12/21/2022]
Abstract
Infection with cagA-positive Helicobacter pylori is a risk factor for the development of severe gastritis and gastric cancer (GC). CagA protein is injected into gastric epithelial cells and deregulates a variety of cellular signaling molecules. Phospholipase D (PLD) is elevated in many different types of human cancers and has been implicated as a critical factor in inflammation and carcinogenesis. In this study, we show that infection with cagA-positive H. pylori in GC cells significantly induces PLD1 expression via CagA-dependent activation of nuclear factor κB (NFκB). Interestingly, the level of PLD1 protein and IκBα phosphorylation is aberrantly upregulated in H. pylori-infected human GC tissues. Infection with cagA-positive H. pylori and expression of CagA enhanced the binding of NFκB to the PLD1 promoter, and two functional NFκB-binding sites were identified within the PLD1 promoter. Rebamipide, a mucosal-protective antiulcer agent, abolished H. pylori cagA-induced PLD1 expression via inhibition of binding of NFκB to the PLD1 promoter, and also inhibited PLD activity. Moreover, rebamipide suppressed H. pylori-induced matrix metalloproteinase-9, interleukin-8 and activation-induced cytidine deaminase expression as well as invasion of GC cells through downregulation of PLD1. Our data suggest that H. pylori cagA targets PLD1 for invasion of GC cells, and rebamipide might contribute to the antitumorigenic effect of GC cells via inhibition of the H. pylori cagA-NFκB-PLD1 signaling pathway.
Collapse
Affiliation(s)
- D W Kang
- Department of Molecular Biology, College of Natural Science, Pusan National University, Busan, Republic of Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Yoo SH, Kwon SU, Jo MW, Kang DW, Kim JS. Age- and weight-adjusted warfarin initiation nomogram for ischaemic stroke patients. Eur J Neurol 2012; 19:1547-53. [PMID: 22672718 DOI: 10.1111/j.1468-1331.2012.03772.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 04/24/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Specific guidelines for initial dosing of warfarin in ischaemic stroke patients have not been developed. Therefore, we have developed an age- and weight-adjusted warfarin initiation nomogram (AW-WIN) for ischaemic stroke patients and then evaluated the efficacy and safety of AW-WIN compared with physician-determined warfarin dosing (PDWD). METHODS The age- and weight-adjusted warfarin initiation nomogram was administered to 104 acute ischaemic stroke patients between January 2008 and February 2009. A historical control group (PDWD) of 96 patients was selected from comparable patients who were discharged with warfarin during the previous year. Time-to-therapeutic international normalized ratios (INRs) and the incidence of excessive anticoagulation were compared in the AW-WIN and PDWD groups. RESULTS The general characteristics, risk factors, and stroke mechanism of the AW-WIN and PDWD groups did not differ significantly. The mean time to INR ≥ 2.0 was significantly shorter in the AW-WIN than in the PDWD group (4.9 ± 0.7 vs. 6.2 ± 0.8 days, P = 0.0008). After adjustment for potential confounding variables, the AW-WIN group reached target INR faster than the PDWD group (hazard ratio, 1.76; 95% confidence interval, 1.26-2.45; P = 0.001). The time-to-therapeutic INR ≥1.7 was shorter (P = 0.0002), the proportion of patients with therapeutic INR (2-3) at 5 days was higher (P = 0.002), and the rate of excessive anticoagulation of ≥3.5 INR during hospitalization was lower (P = 0.024) in the AW-WIN than in the PDWD group. CONCLUSIONS AW-WIN reduces the time to target INR and the risk of excessive anticoagulation. AW-WIN may be an efficient and safe method of anticoagulation during the acute phase of ischaemic stroke.
Collapse
Affiliation(s)
- S-H Yoo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
14
|
Abstract
In September and October 2010, leaf spots were observed on Korean raspberry (Rubus crataegifolius Bunge) plants in farmers' fields in Hapcheon, Gyeongnam Province, South Korea. Disease incidence ranged from 50 to 80% among fields. Circular- to irregular-shaped spots surrounded by yellow halos occurred frequently on the leaves of Korean raspberry plants. Brown spots became dark with wavy borders and ranged from 20 to 300 mm in diameter. Infected leaves became chlorotic, blighted, and eventually died. Fungal hyphae covered the lesions with abundant conidia and conidiophores. Fresh leaf specimens were collected from infected plants and the putative causal pathogen was isolated onto potato dextrose agar (PDA). A total of 30 isolates of the fungus were collected from diseased plants collected in the field. Fungal colonies were gray to brown on PDA. Colonies formed conidia, 38 to 210 × 8 to 20 μm, which were solitary or catenary, obclavate to cylindrical, smooth, straight or curved, and subhyaline to pale brown or brown. Conidiophores, 98 to 840 × 4 to 12 μm, were slightly or conspicuously swollen at apex, single, simple, straight or slightly flexuous, pale to midbrown, smooth, septate, thick, monotretic, and determinate or in tufts. Morphological characteristics of the fungal specimens were similar to descriptions of Corynespora cassiicola (1). A representative isolate of the pathogen was used to inoculate leaves of Korean raspberry plants for pathogenicity testing. Five leaves of a 3-month-old potted plant were sprayed with a suspension of conidia in water. Conidia were harvested from PDA cultures and adjusted to 2 × 104 conidia/ml with a hemocytometer. Five leaves sprayed with sterile distilled water served as controls. Inoculated plants were placed in a humid chamber with 100% relative humidity at 30°C for 24 h and then moved to a greenhouse. Symptoms similar to those observed in the farmers' fields developed on the inoculated leaves within 12 days, whereas the controls remained asymptomatic. The causal fungus was reisolated from the lesions of inoculated plants to satisfy Koch's postulates. To confirm the identity of the fungus, the complete internal transcribed spacer (ITS) rDNA region was amplified and sequenced (3). Amplification of the ITS region generated a 559-bp sequence (GenBank Accession No. JQ340026) with 100% similarity to sequences of C. cassiicola in GenBank (Accession No. GU138988) causing leaf spot on cassava (2). Based on the symptoms, morphological characteristics, pathogenicity, and molecular identification, this fungus was identified as C. cassiicola (1). To our knowledge, this is the first report of leaf spot caused by C. cassiicola on Korean raspberry. The recent occurrence of leaf spot on Korean raspberry suggests that C. cassiicola is spreading widely and posing a serious threat to these plants in Korea. References: (1) M. B. Ellis et al. No. 303 in: CMI Descriptions of Pathogenic Fungi and Bacteria. Surrey, Kew, UK, 1971. (2) X.-B. Liu et al. Plant Dis. 94:916, 2010. (3) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds. Academic Press, Inc., New York, 1990.
Collapse
Affiliation(s)
- J-H Kwon
- Gyeongsangnam-do Agricultural Research and Extension Services, Jinju 660-360, Korea
| | - D-W Kang
- Gyeongsangnam-do Agricultural Research and Extension Services, Jinju 660-360, Korea
| | - Y-S Kwak
- Institute of Agriculture and Life Sciences, Gyeongsang National University, Jinju 660-701, Korea. This work was supported by the Rural Development Administration fund PJ007345
| | - J Kim
- Institute of Agriculture and Life Sciences, Gyeongsang National University, Jinju 660-701, Korea. This work was supported by the Rural Development Administration fund PJ007345
| |
Collapse
|
15
|
Choi-Kwon S, Han K, Choi S, Suh M, Kim YJ, Song H, Cho KH, Nah HW, Kwon SU, Kang DW, Kim JS. Poststroke depression and emotional incontinence: factors related to acute and subacute stages. Neurology 2012; 78:1130-7. [PMID: 22459674 DOI: 10.1212/wnl.0b013e31824f8090] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To investigate the characteristics and prevalence of poststroke depression (PSD) and poststroke emotional incontinence (PSEI) and the factors related to these conditions at admission and 3 months after stroke. METHODS We evaluated 508 consecutive patients with acute ischemic stroke for PSD and PSEI at admission and 3 months later. PSD was evaluated using the Beck Depression Inventory, and PSEI was evaluated using Kim's criteria. Blood samples were collected and genotyped for the promoter region of the serotonin transporter protein (5-HTTLPR) and the number of tandem repeats within intron 2 (STin2 VNTR). Perceived social support (the ENRICHD Social Support Inventory) was also measured. RESULTS PSD and PSEI were present in 13.7% and 9.4% of patients, respectively, at admission and in 17.7% and 11.7%, respectively, at 3 months after stroke. Multivariate analyses showed that PSD at admission was associated with the NIH Stroke Scale score at admission (p < 0.001), whereas PSD at 3 months was associated with the presence of microbleeds (p < 0.01) and perceived low social support (p < 0.001). In contrast, only lesion location (p = 0.022) was associated with PSEI at admission, whereas modified Rankin Scale score (p = 0.019), STin2 VNTR (p = 0.040), and low social support (p = 0.042) were related to PSEI 3 months after stroke. CONCLUSIONS Diverse factors such as neurologic dysfunction, lesion location, microbleeds, genetic traits, and social support are differently related to acute and subacute emotional disturbances. Strategies to prevent or manage these problems should consider these differences.
Collapse
Affiliation(s)
- S Choi-Kwon
- College of Nursing, Seoul National University, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Garcia-Peña EI, Parameswaran P, Kang DW, Canul-Chan M, Krajmalnik-Brown R. Anaerobic digestion and co-digestion processes of vegetable and fruit residues: process and microbial ecology. Bioresour Technol 2011; 102:9447-9455. [PMID: 21865034 DOI: 10.1016/j.biortech.2011.07.068] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 07/18/2011] [Accepted: 07/20/2011] [Indexed: 05/31/2023]
Abstract
This study evaluated the feasibility of methane production from fruit and vegetable waste (FVW) obtained from the central food distribution market in Mexico City using an anaerobic digestion (AD) process. Batch systems showed that pH control and nitrogen addition had significant effects on biogas production, methane yield, and volatile solids (VS) removal from the FVW (0.42 m(biogas)(3)/kg VS, 50%, and 80%, respectively). Co-digestion of the FVW with meat residues (MR) enhanced the process performance and was also evaluated in a 30 L AD system. When the system reached stable operation, its methane yield was 0.25 (m(3)/kg TS), and the removal of the organic matter measured as the total chemical demand (tCOD) was 65%. The microbial population (general Bacteria and Archaea) in the 30 L system was also determined and characterized and was closely correlated with its potential function in the AD system.
Collapse
Affiliation(s)
- E I Garcia-Peña
- Bioprocesses Department, Unidad Profesional Interdisciplinaria de Biotecnología, IPN P.O. Box 07340, Mexico City, Mexico.
| | | | | | | | | |
Collapse
|
17
|
Yoo SB, Ryu V, Park EY, Kim BT, Kang DW, Lee JH, Jahng JW. The arcuate NPY, POMC, and CART expressions responding to food deprivation are exaggerated in young female rats that experienced neonatal maternal separation. Neuropeptides 2011; 45:343-9. [PMID: 21821286 DOI: 10.1016/j.npep.2011.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 06/08/2011] [Accepted: 07/13/2011] [Indexed: 11/23/2022]
Abstract
This study was conducted to examine the effect of neonatal maternal separation on the hypothalamic feeding peptides expression in young female offspring. Sprague-Dawley pups were separated from dam for 3h daily during PND 1-14 (MS), or left undisturbed except routine cage cleaning (NH). Weanling female pups were housed in group and the arcuate mRNA levels of neuropeptide Y (NPY), proopiomelanocortin (POMC), and cocaine-amphetamine regulated transcript (CART) were examined at two months of age with or without food deprivation. The basal arcuate expression levels of these peptides did not differ between NH and MS group. However, a 48 h of food deprivation significantly increased NPY mRNA level, and decreased POMC and CART, in the arcuate nucleus of MS females, but not in NH females. Fasting-induced elevation of the plasma corticosterone tended to be greater in MS group than in NH, but the basal levels did not differ between the groups. Plasma leptin levels were decreased in MS females compared with NH, and food deprivation significantly suppressed the leptin levels both in NH and MS groups. Results suggest that MS experience may increase stress vulnerability in female rats and exaggerate the feeding peptides expression in the arcuate nucleus responding to metabolic stress food deprivation.
Collapse
Affiliation(s)
- S B Yoo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Republic of Korea
| | | | | | | | | | | | | |
Collapse
|
18
|
Chun JK, Jeon BY, Kang DW, Kim DS. Bacille Calmette Guérin (BCG) can induce Kawasaki disease-like features in programmed death-1 (PD-1) gene knockout mice. Clin Exp Rheumatol 2011; 29:743-750. [PMID: 21906434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 03/24/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Various genetic variants of inhibitory immune signals have been suspected as feasible causes of Kawasaki disease (KD). We investigated the associative role of programmed death-1 (PD-1) gene in the pathogenesis of KD by injecting bacilli Calmette Guérin (BCG) to PD-1 gene knockout (PD-1KO) mice. METHODS In order to induce KD-like clinical manifestations in young PD-1KO mice, intradermal injection of the bacilli Calmette Guérin (BCG) was performed twice on the abdominal skin with a 4-week interval. For defining the role of BCG, heat shock protein (HSP) 65 was challenged. In addition, Staphylococcus aureus was adopted as a microorganism that does not contain HSP65 structure. One month after the second injection, heart, liver, and kidneys were removed and examined. RESULTS PD-1KO mice showed KD-like features including prolonged fever for more than 5 days, erythematous swelling on soles, tail skin desquamation, and gallbladder (GB) hydrops. Inflammatory cell aggregation and intimal proliferation in at least more than one coronary artery was found in all PD-1KO mice whereas scanty coronary lesion was found in wild type (WT) mice. When the PD-1KO mice were injected twice with HSP65, coronary arterial lesions similar to those seen after BCG injection were observed. Inflammatory reactions in other organs including hepatic arteries, renal arteries, and biliary arteries were also observed in PD-1KO mice. CONCLUSIONS Our data suggest that PD-1 gene may be one of the genetic predispositions of KD and antigens containing HSP65 structure could be a triggering factor of KD by our animal model of KD.
Collapse
Affiliation(s)
- J-K Chun
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | | | | | | |
Collapse
|
19
|
Yu KH, Hong KS, Lee BC, Oh MS, Cho YJ, Koo JS, Park JM, Bae HJ, Han MK, Ju YS, Kang DW, Appelros P, Norrving B, Terent A. Comparison of 90-day case-fatality after ischemic stroke between two different stroke outcome registries using propensity score matching analysis. Acta Neurol Scand 2011; 123:325-31. [PMID: 21426306 DOI: 10.1111/j.1600-0404.2010.01406.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND It has not been clarified whether the disparity in ischemic stroke outcome between populations is caused by ethnic and geographic differences or by variations in case mix. Propensity score matching (PSM) analysis can overcome some analytical problems but is rarely used in stroke outcome research. This study was to compare the ischemic stroke case-fatality between two PSM cohorts of Sweden and Korea. METHODS Prognostic variables related to baseline characteristics and stroke care were included in our PSM model. Then, we selected 7675 Swedish and 1220 Korean patients with ischemic stroke from each stroke registers and performed one-to-one matching based on propensity scores of each patient. RESULTS After PSM, all measured variables were well balanced in 1163 matched subjects, and the 90-day case-fatality was identical 6.2% (HR 0.997, 95%CI 0.905-1.099) in Sweden and Korea. CONCLUSIONS No difference is found in the 90-day case-fatality in propensity score-matched Swedish and Korean patients with ischemic stroke.
Collapse
Affiliation(s)
- K-H Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Song HS, Kang CK, Kim JS, Park CA, Kim YB, Lee DH, Kang DW, Kwon SU, Cho ZH. Assessment of pial branches using 7-tesla MRI in cerebral arterial disease. Cerebrovasc Dis 2010; 29:410. [PMID: 20185908 DOI: 10.1159/000288056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- H-S Song
- Department of Neurology, College of Medicine, Kyung Hee University, Seoul, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Hong KS, Kang DW, Bae HJ, Kim YK, Han MK, Park JM, Rha JH, Lee YS, Koo JS, Cho YJ, Kwon SU, Kim SE, Park SH. Effect of cilnidipine vs losartan on cerebral blood flow in hypertensive patients with a history of ischemic stroke: a randomized controlled trial. Acta Neurol Scand 2010; 121:51-7. [PMID: 19925528 DOI: 10.1111/j.1600-0404.2009.01299.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to compare the effects of antihypertensive agents on cerebral blood flow (CBF) in hypertensive patients with previous ischemic stroke. MATERIALS AND METHODS In this double-blind, multi-center, non-inferiority trial, 196 patients were randomized to cilnidipine 10-20 mg or losartan 50-100 mg once daily for 4 weeks. Baseline and follow-up CBF as measured by single photon emission computed tomography were obtained in 167. The primary endpoint was the global CBF change. The secondary endpoints were the CBF change in the hemisphere ipsilateral to the index stroke, non-impairment of global CBF and blood pressure (BP) reduction. RESULTS Global CBF increased significantly in the cilnidipine arm (9.0 +/- 29.6%, P = 0.0071) and the losartan arm (11.4 +/- 31.4%, P = 0.0012), and these changes were not different between the two groups (P = 0.607). However, the estimated difference in percentage global CBF change between the two groups was -2.43% (97.5% CI, -13.06% to 8.21%), which crossed the predetermined non-inferiority margin of -8.6%. Ipsilesional hemispheric CBF change, non-impairment of global CBF and BP reduction were similar in the two groups. CONCLUSIONS This trial failed to prove the non-inferiority of cilnidipine to losartan regarding global CBF change. Both the treatments, however, increase the global CBF despite BP lowering.
Collapse
Affiliation(s)
- K-S Hong
- Department of Neurology, Clinical Research Center, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
BACKGROUND It is unknown whether the development of cerebral microbleeds (MBs), small areas of signal loss on T2*-weighted gradient-echo imaging (GRE), follows a slow or a rapid process. We hypothesized that MBs may develop rapidly after certain critical events, such as strokes, and investigated the frequency, location, and factors associated with the formation of new MBs after acute ischemic stroke. METHODS We retrospectively examined 237 consecutive acute ischemic stroke patients who underwent MRI within 24 hours and follow-up MRI during the week after symptom onset. We defined new MBs as MBs that newly appeared on follow-up GRE outside the infarcted area. We examined the association of new MBs with demographics, risk factors, laboratory data, baseline MBs, and small vessel disease (SVD; leukoaraiosis and lacunar infarctions). RESULTS Seventy-five patients (31.6%) had baseline MBs, and 30 (12.7%) developed new MBs. Multiple logistic regression analysis indicated that the presence of baseline MBs (odds ratio [OR] 5.72, 95% confidence interval [CI] 2.12-15.42, p = 0.001) and severe SVD (OR 2.94, 95% CI 1.12-7.77, p = 0.03) independently predicted the development of new MBs. Of the 56 new MBs, 29 (51.8%) appeared in the lobar location, 17 (30.4%) appeared in the deep location, and 10 (17.9%) appeared in the infratentorial location. CONCLUSIONS This study suggests that new microbleeds (MBs) can develop rapidly after acute ischemic stroke. Baseline MBs and severe small vessel disease are predictors for the development of new MBs. Further studies will be needed to investigate the clinical implications and mechanisms of these findings.
Collapse
Affiliation(s)
- S-B Jeon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | | | | | | | | | | |
Collapse
|
23
|
Kim JS, Cho KH, Kang DW, Kwon SU, Suh DC. Basilar artery atherosclerotic disease is related to subacute lesion volume increase in pontine base infarction. Acta Neurol Scand 2009; 120:88-93. [PMID: 19630153 DOI: 10.1111/j.1600-0404.2008.01124.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although basilar artery atherosclerotic disease (BAD) is frequent in patients with pontine base infarction, it remains unknown whether BAD is related to the lesion size or clinical outcome. METHODS We studied 56 patients with unilateral pontine base infarction who underwent (i) diffusion-weighted MRI within 48 h after stroke onset and (ii) follow-up MRI and MR angiography in the subacute stage. Neurologic progression was defined as increased National Institutes of Health Stroke Scale score by > or = 2 during admission. Clinical outcome was dichotomized as good and poor (> or = 3) according to the modified Rankin Scale at 1 month after stroke onset. RESULTS Twenty-two patients (39%) had BAD and 15 patients (27%) had neurologic progression. Follow-up MRI performed at median 3.5 +/- 1.1 days after the initial MRI showed the lesion volume significantly increased (P < 0.001). The BAD was not significantly related to demographic characteristics, risk factors, initial and follow-up lesion volume, neurologic progression and clinical outcome, but was closely related to the subacute increase in lesion volume (P = 0.004 for 20% increase, P = 0.029 for 50% increase). CONCLUSIONS BAD is related to subacute increase in lesion volume, but not to ultimate poor clinical outcome in patients with pontine base infarction.
Collapse
Affiliation(s)
- J S Kim
- Stroke Center and Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea.
| | | | | | | | | |
Collapse
|
24
|
Cho AH, Suh DC, Kim GE, Kim JS, Lee DH, Kwon SU, Park SM, Kang DW. MRI evidence of reperfusion injury associated with neurological deficits after carotid revascularization procedures. Eur J Neurol 2009; 16:1066-9. [PMID: 19486141 DOI: 10.1111/j.1468-1331.2009.02650.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Some patients develop major neurological complications after carotid revascularization procedures, despite the lack of new infarcts or classical hyperperfusion syndrome. METHODS In four patients who developed major neurological deficits after carotid revascularization procedures, but without evidence of new ischemic infarcts or hyperperfusion, we performed post-procedural MRI [diffusion-weighted image (DWI), perfusion-weighted image (PWI), pre-and post-contrast fluid-attenuated inversion recovery (FLAIR) image] immediately after and 1 day after the procedure. RESULTS Post-gadolinium FLAIR images on 1 day after the procedures showed prominent leptomeningeal enhancements in the revascularized hemispheres. These radiological findings disappeared on follow-up FLAIR images accompanied by the clinical improvement over the following several days after the procedures. CONCLUSION Reperfusion syndrome may be associated with transient severe neurological deficits after carotid revascularization in patients without new ischemic events or classical hyperperfusion syndrome.
Collapse
Affiliation(s)
- A-H Cho
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Hong KS, Kang DW, Koo JS, Yu KH, Han MK, Cho YJ, Park JM, Bae HJ, Lee BC. Impact of neurological and medical complications on 3-month outcomes in acute ischaemic stroke. Eur J Neurol 2009; 15:1324-31. [PMID: 19049549 DOI: 10.1111/j.1468-1331.2008.02310.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the impact of neurological and medical complications on 3-month outcomes in acute ischaemic stroke patients. METHODS We prospectively investigated complications for all the consecutive acute ischaemic stroke patients admitted within 7 days from onset in four university hospitals during a 1-year period. Baseline data and 3-month outcomes were collected. Poor outcome was defined as a modified Rankin Scale score 3-6. RESULTS A total of 1 254 patients were recruited: 264 (21.1%) and 303 (24.2%) patients experienced one or more neurological and medical complications, respectively. The most common complications were ischaemic stroke progression (17.1%) and pneumonia (12.0%). Of 1 233 patients with available 3-month outcomes, 34.9% had a poor outcome. Multivariate analysis revealed that neurological (odds ratio, 95% confidence interval; 5.47, 3.63-8.24) and medical (3.47, 2.30-5.23) complications were independent predictors of the poor outcome. For the individual complications, ischaemic stroke progression (7.48, 4.73-11.84), symptomatic hemorrhagic transformation (3.57, 1.33-9.54), pneumonia (4.44, 2.20-8.99), extracranial bleeding (4.45, 1.88-10.53), and urinary tract infection (2.72, 1.32-5.60) were independently associated with the poor outcome. CONCLUSION Outcome after ischaemic stroke is adversely influenced by complications, especially ischaemic stroke progression, symptomatic hemorrhagic transformation, pneumonia, extracranial bleeding, and urinary tract infection. Interventions to prevent those complications might improve ischaemic stroke outcome.
Collapse
Affiliation(s)
- K-S Hong
- Department of Neurology, Clinical Research Center, Ilsan Paik Hospital, Inje University, Goyang, Korea.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Cho KH, Kang DW, Kwon SU, Kim JS. Location of single subcortical infarction due to middle cerebral artery atherosclerosis: proximal versus distal arterial stenosis. J Neurol Neurosurg Psychiatry 2009; 80:48-52. [PMID: 18931013 DOI: 10.1136/jnnp.2007.143354] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Atherosclerotic middle cerebral artery (MCA) disease may produce subcortical infarction either in the upper part (corona radiata, CR) or in the lower area (internal capsule, IC) of the pyramidal tract. The study aimed to see whether the location of MCA stenosis (proximal vs distal) determines the location of subcortical infarction. METHODS 62 consecutive patients who developed an acute (<72 h) infarction either on the CR or IC confirmed by diffusion-weighted MRI due to corresponding focal MCA M1 stenosis assessed by MR angiography were studied. The distance between the MCA origin and the centre of stenotic portion (S) and that between the MCA origin and its bifurcation site (M) were measured. Based on the S/M ratio, stenotic lesions were divided into "proximal' and "distal'. The relationship between the location of arterial stenosis and the location of infarcts was analysed. RESULTS Thirteen of 31 patients (41.9%) with proximal M1 stenosis had IC lesions, while 26 (83.9%) of 31 patients with distal stenosis had CR lesions (p = 0.025). The S/M ratio in patients with the CR infarcts (mean (SD) 0.65 (0.21) was significantly greater than in those with the IC infarcts (0.48 (0.23)) (p = 0.007). In addition, the National Institutes of Health Stroke Scale score at admission was higher in patients with proximal M1 stenosis than in those with distal stenosis (6 vs 3.5; p = 0.04). CONCLUSIONS The results suggest that perforating arteries arising from the distal M1 segment are related to infarcts involving the upper part of pyramidal tract, while those from proximal segment are related to lower lesions.
Collapse
Affiliation(s)
- K-H Cho
- Department of Neurology, Keimyung University School of Medicine, Dogsan Medical Center, Dagu, Korea
| | | | | | | |
Collapse
|
27
|
Kang JH, Yoon YS, Kang DW, Chung SS, Chang JW. Gamma knife radiosurgery for medically refractory idiopathic trigeminal neuralgia. Acta Neurochir Suppl 2008; 101:35-8. [PMID: 18642631 DOI: 10.1007/978-3-211-78205-7_6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Gamma knife radiosurgery (GKS) has been generally considered as a viable therapeutic option for the management of medically refractory idiopathic trigeminal neuralgia (TN). We reviewed our experience with GKS in patients with TN. Between Feb 1996 and May 2006, 77 patients with medical refractory idiopathic TN were treated using GKS. Thirty-six patients who had undergone other previous procedures, previous GKS, or had brain stem lesion, atypical symptoms, were excluded from this study. Pain improvement was achieved in 38 of the patients with TN (pain response rate 92.7%). Twenty-three patients were pain free and 15 had reduced pain. There were no serious complications. We think that GKS is an effective treatment option for patients with medical refractory idiopathic TN.
Collapse
Affiliation(s)
- J H Kang
- Department of Neurosurgery, Brain Korea 21 Project for Medical Science & Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
28
|
Choi-Kwon S, Choi J, Kwon SU, Kang DW, Kim JS. Fluoxetine improves the quality of life in patients with poststroke emotional disturbances. Cerebrovasc Dis 2008; 26:266-71. [PMID: 18648199 DOI: 10.1159/000147454] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 03/17/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fluoxetine may improve the poststroke emotional disturbances. The purpose of the present study was to evaluate the efficacy of fluoxetine on quality of life (QOL) over time in stroke patients with emotional disturbances. METHODS We studied 152 consecutive stroke patients (mean age, 58 years) who had either poststroke depression (PSD), emotional incontinence (PSEI) or anger proneness (PSAP) at an average of 14 months (range = 3-28) after the onset of stroke. The Korean version of SF-36 was used to assess the QOL. The presence of PSD, PSEI and PSAP was also determined with a standardized questionnaire. The subjects were given either 20 mg/day of fluoxetine (n = 76) or placebo (n = 76) for 3 months. Follow-up evaluations were done at 3, 6 and 12 months after the beginning of the treatment. RESULTS The score in the mental health domain was significantly higher in the fluoxetine group than in the placebo group at the 3-, 6- and 12-month follow-ups. The scores in the general health (p < 0.05) and social functioning (p < 0.05) domains were also significantly higher in the fluoxetine than in the placebo group at 12 months of follow up even if there was no definitive improvement in PSD, PSEI and PSAP at this time. CONCLUSIONS Fluoxetine is effective in improving QOL, particularly so in the mental health subdomain. Our results suggest that fluoxetine may be used to improve the QOL of stroke patients with emotional disturbances.
Collapse
Affiliation(s)
- S Choi-Kwon
- College of Nursing, Seoul National University, Seoul, Korea
| | | | | | | | | |
Collapse
|
29
|
Choi CG, Lee DH, Lee JH, Pyun HW, Kang DW, Kwon SU, Kim JK, Kim SJ, Suh DC. Detection of intracranial atherosclerotic steno-occlusive disease with 3D time-of-flight magnetic resonance angiography with sensitivity encoding at 3T. AJNR Am J Neuroradiol 2007; 28:439-46. [PMID: 17353309 PMCID: PMC7977826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND AND PURPOSE The spatial resolution of 3D time-of-flight MR angiography (TOF-MRA) can be improved within a reasonable examination time by combining 3T and sensitivity encoding technique. We evaluated the diagnostic performance of high-resolution 3D TOF-MRA at 3T in patients with suspected atherosclerotic steno-occlusive disease of the intracranial arteries. MATERIALS AND METHODS We assessed 160 arteries in 39 patients: 68 distal internal carotid arteries, 68 middle cerebral arteries, and 24 vertebrobasilar arteries. The measured voxel size of 3D TOF-MRA was 0.28 x 0.56 x 1.2 mm(3). Steno-occlusive disease was assessed independently by 2 observers using conventional angiography as the reference standard. RESULTS According to observers 1 and 2, respectively, 3D TOF-MRA at 3T had a sensitivity of 78%/85% (21/27, 23/27), a specificity of 95%/95% (126/133, 127/133), a positive predictive value of 75%/79% (21/28, 23/29), and a negative predictive value of 95%/97% (126/132, 127/131), using a 50%-99% threshold of diameter stenosis. For detection of complete occlusion, according to observers 1 and 2, respectively, 3D TOF-MRA at 3T had a sensitivity of 100% (13/13), a specificity of 99% (145/147), a positive predictive value of 87% (13/15), and a negative predictive value of 100% (145/145). Interobserver agreement of 3D TOF-MRA was excellent (kappa = 0.81). CONCLUSION High-resolution 3D TOF-MRA with sensitivity encoding at 3T can be used as a reliable diagnostic tool for the detection of clinically significant steno-occlusive disease of major intracranial arteries.
Collapse
Affiliation(s)
- C G Choi
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Oh SH, Nakano M, Bando E, Keisuke N, Shigemoto S, Jeong JH, Kang DW. Relationship between occlusal tooth contact patterns and tightness of proximal tooth contact. J Oral Rehabil 2006; 33:749-53. [PMID: 16938103 DOI: 10.1111/j.1365-2842.2006.01635.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to investigate the relationship between occlusal tooth contact patterns and the tightness of proximal tooth contact (TPTC) during clenching. Twenty young adult volunteers with healthy dentition participated in the study. TPTC between the left second premolar (P2) and the first molar (M1) was measured during clenching at the 50% maximum voluntary contraction level in the intercuspal position (ICP). A silicone impression material was used to make an interocclusal record at the ICP in each subject, and interocclusal records were analysed using an image-processing system. Subjects were classified according to the presence or absence of each type (A, B or C) of occlusal contact. Statistical analysis was performed using the Mann-Whitney U-test. The results of this study exhibited a relationship between B-type contact and the TPTC of maxillary teeth. The experimental group with a lack of B-type contact on maxillary P2 and/or M1 showed a statistically greater TPTC than the group with B-type contact on both of these teeth (P < 0.01). These results suggest that occlusal tooth contact patterns have an influence on TPTC during clenching.
Collapse
Affiliation(s)
- S-H Oh
- Department of Prosthodontics, College of Dentistry, Chosun University, Gwangju, Republic of Korea.
| | | | | | | | | | | | | |
Collapse
|
31
|
Sin HS, Huh JW, Kim DS, Kang DW, Min DS, Kim TH, Ha HS, Kim HH, Lee SY, Kim HS. Transcriptional control of the HERV-H LTR element of the GSDML gene in human tissues and cancer cells. Arch Virol 2006; 151:1985-94. [PMID: 16625320 DOI: 10.1007/s00705-006-0764-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Accepted: 03/10/2006] [Indexed: 01/25/2023]
Abstract
Long terminal repeats (LTRs) of human endogenous retroviruses (HERVs) have been reported to serve as alternative promoters in functional genes. The GSDML (gasdermin-like protein) gene located on human chromosome 17q21 has been found to be an oncogenomic recombination hotspot. Here, we identified the LTR element of HERV-H with reverse orientation as an alternative promoter of the GSDML gene and analyzed its expression pattern in human tissues and cancer cells. A reporter gene assay of the promoter activity of the LTR on the GSDML gene in human cancer cell lines (HCT-116 and HeLa) and a kidney cell line (Cos7) of African green monkey indicated that the LTR promoter with reverse orientation had stronger promoter activity than forward one. The transcripts of this LTR-derived promoter were widely distributed in various human tissues and cancer cells, whereas the transcripts of the cellular promoter were found only in stomach tissues and some cancer cells (HCT116, MCF7, U937, C-33A, and PC3). These findings suggest that the LTR element on the GSDML gene was integrated into the hominoid lineage and acquired the role of transcriptional regulation of human tissues and cancer cells.
Collapse
Affiliation(s)
- H-S Sin
- Division of Biological Sciences, College of Natural Sciences, Pusan National University, Busan, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
BACKGROUND Based on previous observations of a high rate of ischemic lesion recurrence on diffusion-weighted imaging (DWI) within 1 week after an acute ischemic stroke, the authors hypothesized that silent new ischemic lesions are common between 1 week and 90 days after index stroke and that early lesion recurrence may be associated with late lesion recurrence. METHODS The authors studied 80 acute ischemic stroke patients who had initial MRI performed within 48 hours, and follow-up scans at 5 days and at 30 or 90 days after onset. Early lesion recurrences were defined as new ischemic lesions on 5-day DWI, and late lesion recurrences were defined as those on 30- or 90-day DWI or fluid attenuation inversion recovery image. Early lesion recurrence occurring outside the initial perfusion deficit was termed distant lesion recurrence. RESULTS Late lesion recurrence occurred in 26%, more frequently observed on 30-day MRI than 90-day MRI (p = 0.016). Early lesion recurrence (OR 4.0; 95% CI 1.3 to 11.7) and distant early lesion recurrence (OR 6.9; 95% CI 1.5 to 32.2) were independently associated with late lesion recurrence by multiple logistic regression analyses. CONCLUSIONS There may be a continued risk for recurrent ischemic lesions in the weeks following the clinically symptomatic stroke. Future studies are needed to investigate whether MRI-defined ischemic lesion recurrences predict subsequent clinical recurrence and thus may be a potential surrogate endpoint in stroke secondary prevention trials.
Collapse
Affiliation(s)
- D W Kang
- Stroke Branch, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1063, USA
| | | | | | | | | |
Collapse
|
33
|
Abstract
OBJECTIVE To report diffusion-weighted imaging (DWI) findings and postulate the pathogenic mechanism of Wernicke's encephalopathy (WE). PATIENT A 47-year-old-woman presented with altered consciousness, ophthalmoplegia, and ataxia. DWI revealed the abnormal signal changes in periaqueductal gray matter, mamillary bodies and bilateral medial thalami. Apparent diffusion coefficient (ADC) map revealed the high signal intensity lesions in bilateral medial thalami, suggestive of vasogenic edema. The abnormal signal intensity lesions disappeared on follow-up imaging with clinical improvement. CONCLUSIONS Vasogenic edema plays an important role in the pathogenesis of WE and can be reversed by proper management. DWI findings in the early stage of WE may provide useful information about the prognosis.
Collapse
Affiliation(s)
- K S Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi-do, South Korea.
| | | | | | | | | |
Collapse
|
34
|
Affiliation(s)
- K Chu
- Department of Neurology and Clinical Research Institute, Seoul National University Hospital, Neuroscience Research Institute, SNUMRC, Seoul, Korea
| | | | | | | |
Collapse
|
35
|
Kang DW, Kim DE, Yoon BW, Seo JW, Roh JK. Delayed diagnosis: recurrent cerebral infarction associated with Churg-Strauss syndrome. Cerebrovasc Dis 2002; 12:280-1. [PMID: 11641597 DOI: 10.1159/000047717] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- D W Kang
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
36
|
Abstract
Diffusion-weighted MR (DWI) can detect changes in water diffusion associated with cellular dysfunction, which enables the differentiation of cytotoxic edema from vasogenic edema. In this study on DWI findings in central pontine (CPM) and extrapontine myelinolysis (EPM), DWI showed high signal intensities in the bilateral pons, midbrain, and genu of the corpus callosum. The corresponding apparent diffusion coefficient values were rather low. This suggests that cytotoxic edema does in fact exist in CPM and EPM and that DWI can be useful in the rapid diagnosis and prediction of the various types of edema occurring in active demyelinating diseases.
Collapse
Affiliation(s)
- K Chu
- Department of Neurology, Seoul National University Hospital, Neuroscience Research Institute, SNUMRC, South Korea
| | | | | | | |
Collapse
|
37
|
Uehara T, Bléry M, Kang DW, Chen CC, Ho LH, Gartland GL, Liu FT, Vivier E, Cooper MD, Kubagawa H. Inhibition of IgE-mediated mast cell activation by the paired Ig-like receptor PIR-B. J Clin Invest 2001; 108:1041-50. [PMID: 11581305 PMCID: PMC200947 DOI: 10.1172/jci12195] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The potential of the paired Ig-like receptors of activating (PIR-A) and inhibitory (PIR-B) types for modifying an IgE antibody-mediated allergic response was evaluated in mouse bone marrow-derived mast cells. Although mast cells produced both PIR-A and PIR-B, PIR-B was found to be preferentially expressed on the cell surface, where it was constitutively tyrosine phosphorylated and associated with intracellular SHP-1 protein tyrosine phosphatase. PIR-B coligation with the IgE receptor (FcepsilonRI) inhibited IgE-mediated mast cell activation and release of serotonin. Surprisingly, the inhibitory activity of PIR-B was unimpaired in SHP-1-deficient mast cells. A third functional tyrosine-based inhibitory motif, one that fails to bind the SHP-1, SHP-2, and SHIP phosphatases, was identified in parallel studies of FcepsilonRI-bearing rat basophilic leukemia (RBL) cells transfected with constructs having mutations in the PIR-B cytoplasmic region. These results define the preferential expression of the PIR-B molecules on mast cells and an inhibitory potential that can be mediated via a SHP-1-independent pathway.
Collapse
Affiliation(s)
- T Uehara
- Division of Developmental and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-3300, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
BACKGROUND Cerebral venous thrombosis (CVT) is a cause of stroke with obscure pathophysiologic properties that differ from arterial stroke. Its main mechanisms of pathophysiology are the breakdown of the blood-brain barrier and the coexistence of cytotoxic and vasogenic edema. However, conventional magnetic resonance imaging (MRI) cannot differentiate between vasogenic and cytotoxic edema. OBJECTIVES To describe the diffusion-weighted imaging (DWI) findings and characterize the clinical applications of DWI in CVT. SETTING A tertiary referral center, neurology department. DESIGN AND METHODS From November 1998 to March 2001, 14 patients (5 men, 9 women; mean age, 43 +/- 10 years) with CVT underwent DWI, conventional MRI, MR venography, or conventional cerebral angiography. Abnormal findings on DWI and conventional MRI indicated the necessity of MR venography and conventional angiography to confirm the diagnosis of CVT. Apparent diffusion coefficient (ADC) values were measured in all of the abnormal lesions with visual inspection of DWI and T2-weighted echo planar imaging. RESULTS Findings on DWI were grouped according to 3 patterns: (1) Heterogeneous signal intensity (SI) (10 patients) showed mixed bright high SI and low SI and the corresponding ADC values were inversely correlated to the DWI SI. The areas of prominent low SI on DWI were reversed with adequate treatment on follow-up MRI in 1 patient. (2) Multifocal high SI (3 patients) was similar to that observed in acute arterial stroke. The corresponding ADC values were decreased and DWI was performed in the acute stages. (3) Intravascular clot with high SI was found with (1 patient, also in heterogeneous SI group) or without (1 patient) parenchymal lesions. In 1 patient, DWI demonstrated T2-negative and fluid attenuated inversion recovery-negative lesions without correlative symptoms. CONCLUSIONS These data suggest that DWI with ADC maps can be used to discriminate between types of edema for tissue viability and to provide information about stages and diagnostic clues in CVT.
Collapse
Affiliation(s)
- K Chu
- Department of Neurology and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | | | | | | |
Collapse
|
39
|
Abstract
BACKGROUND In human and experimental models, diffusion-weighted magnetic resonance imaging (DWI) findings in status epilepticus (SE) have been reported to show that apparent diffusion coefficients are reduced during the initial phase and normalized or increased in the later phase of prolonged SE. This effect is caused by cytotoxic edema induced by excitotoxicity. In humans, only focal DWI abnormalities have been reported in partial SE. OBJECTIVES To report and discuss the DWI findings suggesting diffuse neuronal injury in a patient with nonconvulsive SE. DESIGN AND METHODS A 56-year-old man was admitted because of changing levels of consciousness over 3 days. On admission he was comatose. He had nystagmoid eye movement, forced eye blinking, and oroalimentary automatism. The results of a search for possible infectious and metabolic etiologies were negative, and electroencephalographic findings showed continuous, semirhythmic, bifrontal sharp waves of 2 Hz. Phenytoin and midazolam hydrochloride were infused to alleviate the seizure activities. He underwent DWI initially (3 days after the onset of seizure) and at the 5-month follow-up. SETTING The neurology department of a tertiary referral center. RESULTS During SE, DWI findings showed marked, diffuse gyriform cortical hyperintensity throughout the brain. The apparent diffusion coefficient decreased in the corresponding areas, especially in the occipital lobes. Findings from T2-weighted magnetic resonance imaging showed the intense cortical hyperintensity with gyral swelling and no involvement of brainstem, basal ganglia, thalamus, and white matter. The follow-up DWI findings showed marked atrophy and hypointensity in the corresponding regions. The apparent diffusion coefficient increased in the corresponding regions. CONCLUSIONS Diffusion-weighted imaging in our patient indicated that the magnetic resonance imaging abnormalities of the affected cortex were due to cytotoxic edema caused by neuronal excitotoxicity during prolonged SE. Diffusion-weighted imaging can be used in the localization of seizure focus for predicting the prognosis of the affected tissue and for researching the basic pathophysiology of SE.
Collapse
Affiliation(s)
- K Chu
- Department of Neurology, Seoul National University Hospital, Clinical Research Institute, Neuroscience Research Institute, Seoul National University Medical Research Institute, 28, Yongon-dong, Seoul 110-744, South Korea
| | | | | | | | | |
Collapse
|
40
|
Abstract
PURPOSE This study was undertaken to determine what patients with epilepsy need to know about their condition, and to discern what differences exist between patients' perceptions of this need and the medical profession's perception of what patients should know. METHODS Seventy-five consecutive patients with epilepsy and 56 medical personnel (residents and nurses) who were working in either Neurology or Neurosurgery Units were studied using a structured questionnaire consisting of 3 subsets with a total of 27 questions. RESULTS Using a Likert scale, epilepsy patients gave high priority to their need for more information about "how epilepsy is diagnosed," "the structure of the brain" (p < 0.05, p < 0.01, respectively), and "the diet that might prevent the attack" (p < 0.05) than did medical personnel. Our study also revealed that men were more concerned with questions regarding smoking and drinking than were women (p < 0.05, respectively), whereas married patients gave higher scores in the category of employment (p < 0.01) and contraception/pregnancy (p < 0.05) than did unmarried patients. The patients with one or more seizures per month rated higher scores on questions concerning the first aid at the time of attack and dosage of antiepileptic drugs (AEDs; p < 0.05, respectively) than did the patients with fewer than one seizure per month. The patients taking poly-AED treatment gave higher scores on six items related to AED therapy than did those receiving monotherapy. No significant differences were found with regard to the length of time patients had the condition, nor to educational level or current employment status. CONCLUSIONS An educational program for epilepsy patients should be developed on the basis of understanding that there are differences in perspectives among patients with different sociocultural contexts as well as between patients and medical personnel.
Collapse
Affiliation(s)
- S Choi-Kwon
- College of Nursing, Seoul National University, 28, Yongon-Dong, Chongno-Gu, Seoul 110-799, Korea.
| | | | | | | | | |
Collapse
|
41
|
Abstract
Androgen was reported to cause cerebral venous thrombosis (CVT) during replacement therapy for aplastic anemia. Oxymetholone, a synthetic androgen analogue, has been widely used in the treatment of aplastic anemia. A 40-year-old woman with aplastic anemia visited our hospital because of severe headache, nausea, vomiting, blurred vision and diplopia for a period of 1 month. She had taken oxymetholone for 2 years. Neurological examination revealed bilateral papilledema and bilateral sixth nerve palsies. Brain magnetic resonance imaging (MRI), performed at the time of admission, demonstrated left-sided tentorial SDH, and focal cerebral thrombosis of the left superficial sylvian vein and sigmoid sinus. MR venography revealed multiple irregularities in the superior sagittal sinus and left transverse sinus. CVT with tentorial subdural hematoma (SDH) caused by oxymetholone was strongly suggested. Oxymetholone was immediately discontinued, and her symptoms and signs disappeared. Because of the thrombocytopenia, anticoagulation was not started. She was discharged and visited the outpatient clinic without neurological symptoms for 6 months. This report supports the cautions given about the risk of CVT with oxymetholone supplementation in aplastic anemia. To the best of our knowledge, this is the first report of CVT associated with tentorial SDH that was probably caused by oxymetholone.
Collapse
Affiliation(s)
- K Chu
- Department of Neurology, Clinical Research Institute, Seoul National University Hospital, Neuroscience Research Institute, SNUMRC, 28, Yongon-Dong, Chongro-Gu, Seoul 110-744, South Korea
| | | | | | | |
Collapse
|
42
|
Kang DW, Chu K, Cho JY, Koo JS, Yoon BW, Roh JK, Song IC, Chang KH. Diffusion weighted magnetic resonance imaging in Neuro-Behçet's disease. J Neurol Neurosurg Psychiatry 2001; 70:412-3. [PMID: 11181878 PMCID: PMC1737267 DOI: 10.1136/jnnp.70.3.412] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
43
|
Yoon BW, Bae HJ, Kang DW, Lee SH, Hong KS, Kim KB, Park BJ, Roh JK. Intracranial cerebral artery disease as a risk factor for central nervous system complications of coronary artery bypass graft surgery. Stroke 2001; 32:94-9. [PMID: 11136921 DOI: 10.1161/01.str.32.1.94] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Although extracranial carotid artery disease (ECAD) is accepted as a risk factor for central nervous system (CNS) complications after coronary artery bypass graft (CABG) surgery, it remains to be clarified whether intracranial cerebral artery disease (ICAD) may also increase the risk. We conducted a prospective study to elucidate the relation between ICAD and CNS complications after CABG surgery. METHODS We prospectively studied 201 patients undergoing nonemergency isolated CABG surgery during a 39-month period (from March 1995 to June 1998). Each patient was evaluated before surgery with neurological examination, transcranial Doppler, and carotid duplex ultrasonography. Magnetic resonance angiography was used to determine the presence and severity of ECAD and ICAD in patients with abnormal findings on clinical examination, carotid duplex ultrasonography, or transcranial Doppler. Patients were followed after surgery and evaluated for the development of CNS complications. Association between CNS complications and their potential predictors was analyzed. RESULTS One hundred nine patients (54.2%) were found to have ECAD and/or ICAD. ECAD alone was found in 48 patients (23.9%), ICAD alone in 33 (16.4%), and both ECAD and ICAD in 28 (13.9%). Fifty-one patients (25.4%) had single or multiple CNS complications: 23 (11.4%) had delirium; 18 (9.0%) had hypoxic-metabolic encephalopathy; 7 (3.5%) had stroke; and 7 (3. 5%) had seizure. In multivariate analysis, ICAD was found to have an independent association with the development of CNS complications (prevalence OR, 2.28; 95% CI, 1.04 to 5.01) after controlling for covariates including age, occurrence of intraoperative events, and reoperation. The joint effect of ECAD and ICAD was also statistically significant and stronger than ICAD alone (prevalence OR, 3.87; 95% CI, 1.80 to 6.52). CONCLUSIONS Our results suggest that ICAD may be an independent risk factor for CNS complications after CABG surgery. These results support pre-CABG evaluation of the intracranial arteries for the risk assessment of CABG surgery, at least in black and Asian patients, in whom there may be a higher prevalence of intracranial arterial stenosis.
Collapse
Affiliation(s)
- B W Yoon
- Department of Neurology, Seoul National University, Korea
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
Riluzole is a neuroprotective agent the efficacy of which was proven in amyotrophic lateral sclerosis in human and in animal models of cerebral ischemia. However, the dosage used in animal experiments was much higher than that in human. We investigated the efficacy of low dose riluzole, which was similar to the dose used in human trials, in animal model of global ischemia. Global ischemia was induced in male Mongolian gerbils for 5min under monitoring of rectal temperature. Riluzole (0.8 mg/kg) were injected intraperitoneally 30min before ischemia. Seven days after ischemia, animals were decapitated and surviving nerve cells in hippocampal CA1 area were quantified. The number of surviving cells was compared between in riluzole-treated and control groups and the former showed statistically significant better survivals than the latter (P<0.001).
Collapse
Affiliation(s)
- H J Bae
- Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
We report two patients displaying hyperintensities on diffusion-weighted imaging (DWI) in the area of Wallerian degeneration (WD) at 12 days after stroke. High signal intensities were more conspicuous on DWI than on T2-weighted images. Both patients showed decreased diffusion anisotropy resulting in elevated apparent diffusion coefficient in the area of WD. These patients illustrate that DWI may be useful in the detection of the early stage of WD.
Collapse
Affiliation(s)
- D W Kang
- Department of Neurology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, 110-744, Seoul, South Korea
| | | | | | | | | | | |
Collapse
|
46
|
Kang DW, Lee SH, Bae HJ, Han MH, Yoon BW, Roh JK. Acute bilateral cerebellar infarcts in the territory of posterior inferior cerebellar artery. Neurology 2000; 55:582-4. [PMID: 10953199 DOI: 10.1212/wnl.55.4.582] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors report 12 patients with acute bilateral cerebellar infarcts in posterior inferior cerebellar artery (PICA) territory. They found three topographic patterns: A) bilateral medial PICA in six patients; B) unilateral whole + contralateral medial PICA in four; and C) bilateral small multiple in two. Nine patients in Groups A and B had unilateral PICA or vertebral artery disease, and both patients in Group C had bilateral vertebral artery disease. These findings support that unilateral supply to both medial PICA territories may be the most relevant pathogenesis of this syndrome.
Collapse
Affiliation(s)
- D W Kang
- Department of Neurology, Seoul National University Hospital, Korea
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
Sjögren's syndrome (SS) is a systemic lymphoproliferative, autoimmune disease, which is characterized by dryness of the eyes, mouth, and other mucous membranes. The nervous system may be affected in up to 20% of the cases of primary or secondary SS. We present a case of a 54-year-old woman with trochlear nerve palsy complicating Sjögren's syndrome secondary to rheumatoid arthritis. We suggest that all patients with multiple cranial neuropathies, especially when associated with rheumatoid arthritis, should be carefully examined for the possible presence of secondary SS.
Collapse
Affiliation(s)
- K Chu
- Department of Neurology, Seoul National University Hospital, Neuroscience Research Institute, SNUMRC, 28 Yongon-dong, Chongno-gu, 110-744, Seoul, South Korea
| | | | | | | |
Collapse
|
48
|
Kang DW, Roh JK, Lee YS, Song IC, Yoon BW, Chang KH. Neuronal metabolic changes in the cortical region after subcortical infarction: a proton MR spectroscopy study. J Neurol Neurosurg Psychiatry 2000; 69:222-7. [PMID: 10896697 PMCID: PMC1737068 DOI: 10.1136/jnnp.69.2.222] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate whether proton magnetic resonance spectroscopy ((1)H MRS) can detect neuronal metabolic changes in the cortical region in patients with cortical dysfunction after subcortical infarction. METHODS Fifteen patients with subcortical large (diameter>/=20 mm) infarcts were studied; nine patients with cortical dysfunction (group A), and six without (group B). Seven patients with lacunar infarction served as controls. Infarct volume was measured on T2 weighted images with an image analyser. (1)H MRS data were obtained in three regions; high signal intensity area on T2 weighted image, overlying cortex with a normal T2 MRI appearance, and contralateral homologous cortical region. RESULTS Infarct volume was not different between groups A and B. N-acetylaspartate (NAA)/creatine+phosphocreatine (Cr) ratios in the cortical region overlying subcortical infarcts in group A were significantly lower than those in group B and the control group (p=0.002). The NAA/Cr ratios in the overlying cortex were significantly lower than those in the contralateral normal cortex in group A on the initial (p=0. 015) and follow up (p=0.028) (1)H MRS, but these differences were not found in group B and the control group. CONCLUSIONS The results support the idea that the cerebral cortex is a responsible location for cortical dysfunction after subcortical infarctions. (1)H MRS can be used as a sensitive method for the detection of a neuronal metabolic damage, which is not demonstrated by conventional MRI.
Collapse
Affiliation(s)
- D W Kang
- Department of Neurology, College of Medicine, Seoul National University, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
| | | | | | | | | | | |
Collapse
|
49
|
Abstract
BACKGROUND AND PURPOSE Diffusion-weighted imaging (DWI) is superior to conventional MRI in identification of small new ischemic lesions and discrimination of recent infarcts from old ones. Thus, this technique is useful in the detection of acute multiple brain infarcts (AMBI). We sought to determine the frequency and the topographical and etiologic patterns of AMBI detected on DWI. METHODS We studied 329 consecutive ischemic stroke patients who underwent DWI and MRI/MR angiography within 4 days of stroke onset. AMBI was defined as noncontiguous high signal intensities on DWI in >1 vascular territory. Stroke mechanism was determined according to the criteria of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). RESULTS We detected AMBI in 95 patients (28.9%). AMBI in anterior circulation was found in 62 cases: in 1 hemisphere in 42 (group A) and in bilateral hemispheres in 20 (group B). Twenty-two patients had AMBI in the posterior circulation (group C) and 11 in both anterior and posterior circulations (group D). The most frequent cause of stroke was large-artery atherosclerosis in groups A (33/42), B (9/20), and C (15/22) (P=0.02) and cardioembolism in group D (6/11) (P=0.02). Elevated fibrinogen or hematocrit was significantly associated with group B (P=0.01). In 9 patients in groups B and D, anatomic variations of anterior or posterior cerebral arteries or patent posterior communicating artery contributed to AMBI. CONCLUSIONS Different topographical patterns of AMBI are associated with different vascular pathologies and stroke mechanisms. Hemorheologic abnormality or vascular anatomic variations may be contributing factors in the pathogenesis of AMBI in bilateral cerebral hemispheres or in both anterior and posterior circulations.
Collapse
Affiliation(s)
- J K Roh
- Departments of Neurology and Radiology, Seoul National University College of Medicine, Korea.
| | | | | | | | | |
Collapse
|
50
|
Kim BG, Lee SK, Kim JY, Kang DW, Lee W, Song H, Lee DS. Interpretation of Wada memory test for lateralization of seizure focus by use of (99m)technetium-HMPAO SPECT. Epilepsia 2000; 41:65-70. [PMID: 10643926 DOI: 10.1111/j.1528-1157.2000.tb01507.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Although the intracarotid amobarbital procedure (IAP) or Wada test is useful in lateralizing seizure focus in patients with temporal lobe epilepsy (TLE), the results of the IAP memory test are frequently nonlateralizing. An insufficient suppression of the medial temporal region contralateral to the seizure focus may contribute to the failure of lateralization. We tried to correlate IAP memory results with the functional changes in the contralateral medial temporal region as measured by single photon emission computed tomography (SPECT) during IAP. METHODS We performed a (99m)technetium-(Tc) hexamethylene-propylene-amine-oxime (HMPAO) brain SPECT in 19 medial TLE patients during a contralateral IAP (sodium amobarbital injected contralateral to the seizure focus). Regional cerebral blood flow (rCBF) was measured in the contralateral medial temporal region. The amount of decrease in the rCBF was calculated by subtracting the previous measurement from the one obtained with the interictal SPECT. RESULTS Ten (53%) patients passed and nine (47%) failed the contralateral IAP. The mean percentage decrease in rCBF was 5.3+/-5.3%. There was a significant negative correlation between a decrease in the rCBF and the IAP memory-retention score by Spearman correlation (p = -0.53: p<0.021). Patients with smaller decreases in rCBF (<5%) more frequently passed the contralateral IAP memory test than did those with larger decreases (80 vs. 22%; p<0.023). CONCLUSIONS We suggest that an insufficient suppression of the contralateral medial temporal function is partly responsible for nonlateralizing IAP memory tests. An IAP-SPECT may be useful in interpreting IAP memory tests for the lateralization of seizure focus in TLE patients.
Collapse
Affiliation(s)
- B G Kim
- Department of Neurology, College of Medicine, Seoul National University, Korea
| | | | | | | | | | | | | |
Collapse
|