• 제목/요약/키워드: Brain shift

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Surgical Management of Massive Cerebral Infarction

  • Huh, Jun-Suk;Shin, Hyung-Shik;Shin, Jun-Jae;Kim, Tae-Hong;Hwang, Yong-Soon;Park, Sang-Keun
    • Journal of Korean Neurosurgical Society
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    • 제42권4호
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    • pp.331-336
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    • 2007
  • Objective : The aim of this study was to analyze the treatment results and prognostic factors in patients with massive cerebral infarction who underwent decompressive craniectomy. Methods : From January 2000 to December 2005, we performed decompressive craniectomy in 24 patients with massive cerebral infarction. We retrospectively reviewed the medical records, radiological findings, initial clinical assessment using the Glasgow Coma Scale, serial computerized tomography (CT) with measurement of midline and septum pellucidum shift, and cerebral infarction territories. Patients were evaluated based on the following factors : the pre- and post-operative midline shifting on CT scan, infarction area or its dominancy, consciousness level, pupillary light reflex and Glasgow Outcome Scale. Results : All 24 patients (11 men, 13 women; mean age, 63 years; right middle cerebral artery (MCA) territory, 17 patients; left MCA territory, 7 patients) were treated with large decompressive craniectomy and duroplasty. The average time interval between the onset of symptoms and surgical decompression was 2.5 days. The mean Glasgow Coma Scale was 12.4 on admission and 8.3 preoperatively. Of the 24 surgically treated patients, the good outcome group (Group 2 : GOS 4-5) comprised 9 cases and the poor outcome group (Group1 : GOS 1-3) comprised 15 cases. Conclusion : We consider decompressive craniectomy for large hemispheric infarction as a life-saving procedure. Good preoperative GCS, late clinical deterioration, small size of the infarction area, absence of anisocoria, and preoperative midline shift less than 11mm were considered to be positive predictors of good outcome. Careful patient selection based on the above-mentioned factors and early operation may improve the functional outcome of surgical management for large hemispheric infarction.

점구분 분광술 여기 방식과 나선형 판독경사를 이용한 삼차원 화학적 변위 영상법의 개발 (Three-dimensional Chemical Shift Imaging with PRESS Excitation and Spiral Readouts)

  • 김동현
    • Investigative Magnetic Resonance Imaging
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    • 제12권1호
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    • pp.27-32
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    • 2008
  • 목적: 점구분-분광술을 이용한 여기법과 나선형 판독경사를 이용하여 삼차원 화학적변위영상을 개발하고자 하였다. 대상 및 방법: 상수 밀도를 갖는 나선형 판독경사를 디자인하는 분석식을 이용하여 스캐너에서 실시간으로 각종 지표들을 바꿀수 있도록 개발하였다 ($32{\times}32$ 행렬, $24{\times}24\;cm$ FOV). 생체내 뇌 데이터를 수집하였고 그리딩 알고리즘을 이용하여 분광학 영상을 재구성하였다. 결과: 본 연구에서 개발한 영상 기법을 이용하면, 점구분 분광술의 이점인 뇌 표면의 지방의 신호를 제거하면서 나선형 패턴이 갖는 장점들을 이용할 수 있다. 나선형 샘플링은 영상을 얻는데 걸리는 시간과 영상의 해상도를 자유로이 조절할 수 있는 유연성을 가지고 있다. 삼차원 고해상도 점구분-분광술 영상을 $5760\;cm^3$의 공간에서 얻는데 걸리는 총 시간이 12.5 분이었다. 결론: 점구분 분광술과 나선형 샘플링을 결합하여 삼차원 화학적 변위 영상을 얻는 새로운 방법을 개발하였다. 이를 통해 넓은 공간을 확보하며 동시에 지방 신호를 제거하는 기법을 사용할수 있게 되었다.

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Effect of black chokeberry on skeletal muscle damage and neuronal cell death

  • Kim, Jisu;Lee, Kang Pa;Beak, Suji;Kang, Hye Ra;Kim, Yong Kyun;Lim, Kiwon
    • 운동영양학회지
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    • 제23권4호
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    • pp.26-31
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    • 2019
  • [Purpose] Numerous epidemiological studies have shown that it is possible to prescribe exercise for neurodegenerative disease, such as Alzheimer's disease and Parkinson's disease. However, despite the availability of diverse scientific knowledge, the effects of exercise in this regard are still unclear. Therefore, this study attempted to investigate a substance, such as black chokeberry (Aronia melanocapa L.) that could improve the ability of the treatment and enhance the benefits of exercising in neurodegenerative diseases. [Methods] The cell viability was tested with 2,3-bis[2-methyloxy-4-nitro-5-sulfophenyl]-2H-tetrazolim-5-carboxanilide and the cells were stained with ethidium homodimer-1 solution. The mRNA expression levels were evaluated by microarray. The active compounds of black chokeberry ethanolic extract (BCE) were analyzed by gas chromatography. The chemical shift analysis in the brain was performed using magnetic resonance spectroscopy. [Results] BCE treatment decreased hydrogen peroxide-induced L6 cell death and beta amyloid induced primary neuronal cell death. Furthermore, BCE treatment significantly reduced the mRNA levels of the inflammatory factors, such as IL-1α, Cxcl13, IL36rn, Itgb2, Epha2, Slamf8, Itgb6, Kdm6b, Acvr1, Cd6, Adora3, Cd27, Gata3, Tnfrsf25, Cd40lg, Clec10a, and Slc11a1, in the primary neuronal cells. Next, we identified 16 active compounds from BCE, including D-mannitol. In vivo, BCE (administered orally at a dosage of 50 mg/kg) significantly regulated chemical shift in the brain. [Conclusion] Our findings suggest that BCE can serve as a candidate for neurodegenerative disease therapy owing to its cyto-protective and anti-inflammatory effects. Therefore, BCE treatment is expected to prevent damage to the muscles and neurons of the athletes who continue high intensity exercise. In future studies, it would be necessary to elucidate the effects of combined BCE intake and exercise.

탈륨-201 SPECT에서 뇌농양 집적 (Brain Abscess Uptake at TI-201 Brain SPECT)

  • 이원형;한은지;유이령;정용안;손형선;김성훈;정수교;최영진
    • Nuclear Medicine and Molecular Imaging
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    • 제41권4호
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    • pp.339-341
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    • 2007
  • A 22-year-old woman with a history of acute lymphoblastic leukemia was hospitalized for headache and vomiting. CT scan showed a well-defined, ring like enhancing mass in the left frontal lobe with surrounding edema and midline shift. Magnetic resonance imaging demonstrated a round homogeneous mass with a ring of enhancement in the left frontal lobe. Tl-201 brain SPECT showed increased focal uptake coinciding with the CT and MRI abnormality. Aspiration of the lesion performed through a burr hole yielded many neutrophils, a few lymphocytes and histiocytes with some strands of filamentous microorganism-like material. Modified AFB stained negative for norcardia. Gram stain showed a few white blood cells and no microorganism. Antibiotics were started and produced a good clinical response. After one month, CT scan showed markedly reduction in size and extent was observed.

Mothers' experience of caring for home-quarantined children after close contact with COVID-19 in Korea: an exploratory qualitative study

  • Lee, Hyeyeon;Kim, Mihui;Kim, Ocksim;Kim, Sue;Choi, Seongmi
    • 여성건강간호학회지
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    • 제27권3호
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    • pp.220-229
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    • 2021
  • Purpose: The world saw a shift into a new society consequent to the coronavirus disease 2019 (COVID-19), which made home quarantine mandatory for a person in close contact with those who tested positive. For children, however, home quarantine was not limited only to themselves but parents, especially mothers were involved and required to quarantine. This qualitative study aims to explore and understand mothers' experience and their related psychosocial issues while caring for their school-aged children in Korea, who had to home quarantine after coming in close contact with COVID-19 positive individuals. Methods: Data were collected from October 2020 to January 2021 via in-depth, semi-structured interviews with nine mothers of children who had to home quarantine. Interviews were conducted face-to-face in an independent space near the participant's home or workplace (n=5) or via online platforms or telephone (n=4). The data were analyzed using thematic analysis through several iterative team meetings. Results: Thematic analysis revealed the following four themes: "Unable to be relieved due to uncertain situations surrounding me," "Blame and hurt toward me, others, and one another," "Pulling myself together for my children in my broken daily life," and "Changes in the meaning of life amid COVID-19." Conclusion: The narratives show that mothers experienced psychosocial difficulties while caring for their children during home quarantine. It is necessary to reduce the social stigma toward individuals in home quarantine and establish policies to ensure work-family compatibility for such mothers.

치료저항성 우울증의 연구에서 패러다임의 전환 (Paradigm Shift in the Study of Treatment Resistant Depression)

  • 김용구
    • 생물정신의학
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    • 제23권2호
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    • pp.37-40
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    • 2016
  • Treatment-resistant depression (TRD) is a major public health problem. It is estimated that about 30% of patients with major depressive disorder do not show substantial clinical improvement to somatic or psychosocial treatment. Most of studies for TRD have focused on the subjects already known as TRD. Patients with unipolar depressive episodes that do not respond satisfactorily to numerous sequential treatment regimens were included in the TRD studies. Such post hoc experimental design can be regarded only as consequences of having TRD, rather than as causal risk factors for it. Although informative, data derived from such studies often do not allow a distinction to be made between cause and effect. So, we should shift paradigm toward examining the risk for developing TRD in untreated depressed patients. To deal with this problem, untreated depressed patients should be enrolled in the study to identify biological markers for treatment resistance. The peripheral or central biological markers should be explored before starting treatment. Subsequent systematic administration of treatments with appropriate monitoring in the subjects can determine the risk for developing treatment resistance in untreated individuals. Such information could give a cue to improve the initial diagnosis and provide more effective treatment for TRD.

Spontaneous Resolution of a Large Chronic Subdural Hematoma Which Required Surgical Decompression

  • Lee, Gun Seok;Park, Young Seok;Min, Kyung Soo;Lee, Mou Seop
    • Journal of Korean Neurosurgical Society
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    • 제58권3호
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    • pp.301-303
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    • 2015
  • We report on a case of an 87-year-old woman who showed spontaneous resolution of a large chronic subdural hematoma which required surgical decompression. She had suffered from confused mentality and right side weakness of motor grade II for 10 days. The initial brain CT scan showed a 22 mm thick low density lesion located in the left fronto-temporo-parietal region with midline shift (12 mm) which required emergency decompression. However, because she and her family did not want surgery, she was followed up in the outpatient clinic. Five months later, follow up brain CT showed that the CSDH had disappeared and the patient became neurologically normal. The reasons for spontaneous resolution of CSDH remain unclear. We discuss the possible relation between mechanisms of physio-pathogenesis and spontaneous resolution of a large chronic subdural hematoma (CSH) in an elderly patient.

Infrequent Hemorrhagic Complications Following Surgical Drainage of Chronic Subdural Hematomas

  • Rusconi, Angelo;Sangiorgi, Simone;Bifone, Lidia;Balbi, Sergio
    • Journal of Korean Neurosurgical Society
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    • 제57권5호
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    • pp.379-385
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    • 2015
  • Chronic subdural hematomas mainly occur amongst elderly people and usually develop after minor head injuries. In younger patients, subdural collections may be related to hypertension, coagulopathies, vascular abnormalities, and substance abuse. Different techniques can be used for the surgical treatment of symptomatic chronic subdural hematomas : single or double burr-hole evacuation, with or without subdural drainage, twist-drill craniostomies and classical craniotomies. Failure of the brain to re-expand, pneumocephalus, incomplete evacuation, and recurrence of the fluid collection are common complications following these procedures. Acute subdural hematomas may also occur. Rarely reported hemorrhagic complications include subarachnoid, intracerebral, intraventricular, and remote cerebellar hemorrhages. The causes of such uncommon complications are difficult to explain and remain poorly understood. Overdrainage and intracranial hypotension, rapid brain decompression and shift of the intracranial contents, cerebrospinal fluid loss, vascular dysregulation and impairment of venous outflow are the main mechanisms discussed in the literature. In this article we report three cases of different post-operative intracranial bleeding and review the related literature.

Ethanol-induced Activiationof Transcription Factor NF-$\kappa$B and AP-1 in C6 Glial Cells

  • Park, Jae -Won;Shim, Young-Sup
    • Preventive Nutrition and Food Science
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    • 제4권3호
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    • pp.209-214
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    • 1999
  • In this study, the effectof ethanol and acetaldehyde on DNA binding activities of NF-$textsc{k}$B and AP-1 were evaluated in C6 rat glial cells. Both NF-$textsc{k}$B and AP-1 are important transcription factors for the expression of various cytokines in glial cells. Our data showed that neither ethanol nor acetaldehyde induced conspicuous cell death of C6 cells at clinically realistic concentrations. When the DNA binding activities of nuclear NF-$textsc{k}$B and AP-1 were estimated using electrophoretic mobility shift assay (EMSA), ethanol(0.3%) or acetaldehyde(1mM) induced transient activation of these transcription factors, which attained peak levels at 4~8 hours and declined to basal levels at 12 hours after treatement . The supershift analysis showed that the increased activities of NF-$textsc{k}$B in ethanol/acetaldehyde-treated C6 cells were due to the preferential induction of p65/p50 heterodimer complex. The DNA binding activities of these transcriptional factors decreased below basal levels when cells were cultured with either ethanol or acetaldehyde for 24 hours, and showed the inhibitory effect of chronic ehtanol /acetaldehyde treatment on the activities of these transsriptional factors. Our data indicate that either ethanol or acetaldehyde can induce functional changes of glial cells throught bi-directional modulation of NF-$textsc{k}$B and AP-1 DNA binding activities.

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Emerging paradigms in cancer cell plasticity

  • Hyunbin D. Huh;Hyun Woo Park
    • BMB Reports
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    • 제57권6호
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    • pp.273-280
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    • 2024
  • Cancer cells metastasize to distant organs by altering their characteristics within the tumor microenvironment (TME) to effectively overcome challenges during the multistep tumorigenesis. Plasticity endows cancer cell with the capacity to shift between different morphological states to invade, disseminate, and seed metastasis. The epithelial-to-mesenchymal transition (EMT) is a theory derived from tissue biopsy, which explains the acquisition of EMT transcription factors (TFs) that convey mesenchymal features during cancer migration and invasion. On the other hand, adherent-to-suspension transition (AST) is an emerging theory derived from liquid biopsy, which describes the acquisition of hematopoietic features by AST-TFs that reprograms anchorage dependency during the dissemination of circulating tumor cells (CTCs). The induction and plasticity of EMT and AST dynamically reprogram cell-cell interaction and cell-matrix interaction during cancer dissemination and colonization. Here, we review the mechanisms governing cellular plasticity of AST and EMT during the metastatic cascade and discuss therapeutic challenges posed by these two morphological adaptations to provide insights for establishing new therapeutic interventions.