Epilepsy or the occurrence of spontaneous recurrent epileptiform discharges (SREDs, seizures) is one of the most common neurological disorders. Shift in the balance of brain between excitatory and inhibitory functions due to different types of structural or functional alterations may cause epileptiform discharges. N-Methyl-D-aspartate (NMDA) receptor dysfunctions have been implicated in modulating seizure activities. Seizures and epilepsy are clearly dependent on elevated intracellular calcium concentration ([C
Purpose: Dandy-Walker syndrome is a rare congenital brain malformation that occurs one in every 25,000-35,000 live births, mostly in females. It is characterized by cystic enlargement of the fourth ventricle, agenesis or hypogenesis of the cerebellar vermis and enlargement of the posterior fossa. In this report, the authors aimed to address a rare case of a 14-months-old female Dandy-Walker syndrome patient that is presented with submucous cleft palate. Methods: A 14-months-old female patient admitted to our outpatient clinic, via the department of pediatrics, with the complaints of nasal regurgitation, choking and breathing difficulties. She was diagnosed as Dandy-Walker syndrome by magnetic resonance imaging evaluation, at another hospital and underwent a shunt operation for the hydrocephalus continuing treatments. On physical examination, she had structural abnormality of bifid uvula, and palpable notch in the posterior surface of the hard palate. Her submucous cleft palate was corrected, which used a double opposing Z-plasty under general anesthesia. Results: In a follow-up period of 2 months, no complications, such as wound dehiscence, necrosis and infection occurred, which shows satisfactory results. She consulted with pediatric neurologists and physical therapists for further evaluation and management of the abnormalities in the central nervous system. Conclusion: Dandy-Walker syndrome patient with a cleft palate is a very rare case to find, which only a few cases are reported around the world. Authors would like to share this case of Dandy-Walker syndrome patient, with submucous cleft palate, who underwent a double opposing Z-plasty that shows satisfactory results.
Objectives: Despite the growing concern regarding the adverse effects related to problematic smartphone use (PSU), little is known about underlying morphologic changes in the brain. The brainstem is a deep brain structure that consists of several important nuclei associated with emotions, sensations, and motor functions. In this study, we sought to examine the difference in the volume of brainstem substructures among adolescents with and without PSU. Methods: A total of 87 Korean adolescents participated in this study. The PSU group (n=20, age=16.2±1.1, female:male=12:8) was designated if participants reported a total Smartphone Addiction Proneness Scale (SAPS) score of ≥42, whereas the remaining participants were assigned to the control group (n=67, age=15.3±1.7, female:male=19:48). High-resolution T1 magnetic resonance imaging was performed, and the volume of each of the four brainstem substructures [midbrain, pons, medulla, and superior cerebellar peduncle (SCP)] was measured. Analysis of covariance was conducted to reveal group differences after adjusting for effects of age, gender, whole brainstem volume, depressive symptoms, and impulsivity. Results: The PSU group showed a significantly smaller volume of the SCP than the control group (F=8.273, p=0.005). The volume of the SCP and the SAPS score were negatively correlated (Pearson's r=-0.218, p=0.047). Conclusion: The present study is the first to reveal an altered volume of the brainstem substructure among adolescents with PSU. This finding suggests that the altered white matter structure in the brainstem could be one of the neurobiological mechanisms underlying behavioral changes in PSU.
Objectives A growing body of evidence has suggested that morphologic changes in cerebellum may be implicated with pathophysiology of major depressive disorder (MDD). The aim of this study is to investigate a difference in the volume and cortical thickness of the specific region of cerebellum between patients with MDD and healthy controls (HC). Methods A total of 127 patients with MDD and 105 HC participated in this study and underwent T1-weighted structural magnetic resonance imaging. We analyzed volume and cortical thickness of each twelve cerebellum regions divided by left and right and the volume and cortical thickness of the whole cerebellum from T1-weigted image of participants. One-way analysis of covariance was used to investigate the volume and cortical thickness difference of total and specific regions between two groups adjusting for age, gender, medication, and total intracranial cavity volume. Results We found that the patients with MDD had significantly greater volume in the left cerebellum lobule III region [false discovery rate (FDR)-corrected p = 0.034] compared to HC. Also, our findings indicate that cortical thickness of left lobule VIIB (FDR-corrected p = 0.032) and lobule VIIIB (FDR-corrected p = 0.032) are significantly thinner in the patients with MDD compared with the HC. No significant volume and cortical thickness differences were observed in other sub-regions of the cerebellum. The volumes and cortical thickness of whole cerebellum between patients with MDD and HC did not differ significantly. Conclusions We observed the region-specific volume and cortical thickness difference in cerebellum between the patients with MDD and HC. The results of our study implicate that the information about structural alterations in cerebellum with further replicative studies might provide a stepping stone toward a specific marker to diagnose MDD.
Purpose: To compare the interobserver and intraobserver reliability of mean apparent diffusion coefficient (ADC) values using contrast-enhanced (CE) T1 weighted image (WI) and T2WI as structural images between manual and semiautomatic segmentation methods. Materials and Methods: Between January 2011 and May 2013, 28 patients who underwent brain MR with diffusion weighted image (DWI) and were pathologically confirmed as having glioblastoma participated in our study. The ADC values were measured twice in manual and semiautomatic segmentation methods using CE-T1WI and T2WI as structural images to obtain interobserver and intraobserver reliability. Moreover, intraobserver reliabilities of the different segmentation methods were assessed after subgrouping of the patients based on the MR findings. Results: Interobserver and intraobserver reliabilities were high in both manual and semiautomatic segmentation methods on CE-T1WI-based evaluation, while interobserver reliability on T2WI-based evaluation was not high enough to be used in a clinical context. The intraobserver reliability was particularly lower with the T2WI-based semiautomatic segmentation method in the subgroups with involved
목적 : 자기공명영상을 이용한 치매연구에서 삼차원 T1강조 뇌 구조 영상으로 뇌기능을 분석할 경우 복셀 기반 형태분석 방법이 이용 된다. 그러나 일반적으로 The Montreal Neurological Institute (MNI) 152 라는 젊은 서양성인 뇌로 만들어진 표준판에 정규화되고 이는 분석오차가 생길 수 있어 한국 노인 및 치매환자의 뇌를 분석할 경우 부정확한 결과를 초래한다. 따라서, 본 연구의 목적은 뇌 분석을 최적화 하기 위해 한국 노인 및 치매 환자의 뇌 구조 영상의 표준판을 개발하는데 있다. 대상 및 방법 : 검사장비는 3테슬러를 이용하였으며 8채널 SENSE (sensitivity encoding) 머리코일을 이용하였다. 펄스열은 삼차원 T1 강조 터보 경사자장 타입으로 뇌의 해부학 영상을 획득하였다. 신경심리 검사 점수결과에 따라 정상 노인 43명, 경도인지장애 환자 44명, 알츠하이머성 치매 환자 36명 의 세 그룹으로 나누었다. 일반 선형 모델 방정식을 사용하여 나이와 성별 및 질환간의 차이에 의한 인자를 고려 하였으며, 평가된 인자는 쌍일치 접근 방법으로 한국 노인과 치매 환자의 뇌 표준판을 만들었다. 두 표준판의 Talairach 기준 점에 따른 평균거리와 뇌실의 거리를 계산하였다. 또한 뇌 전체 영역에서 회백질과 백질을 확률이 50% 이상인 복셀 개수를 세어 회백질과 백질의 영역을 계산하였다. 결과 : 최종 뇌 표준판은 MNI152뇌 표준판과 비교했을 경우 공간 분해능이 높았고, 평균거리와 뇌실의 크기에서 차이가 있었다. 회백질 및 백질의 영역은 본 연구에서 개발한 뇌 표준판의 회백질과 백질 모두에서 더 적었고, 백질보다 회백질에서 더 많은 차이가 있었다. 결론 : 본 연구에서 개발한 한국 뇌 표준판은 앞으로 한국 노인과 치매환자의 질환을 분석하는 연구에 유용할 것으로 생각된다.
연구목적 최근의 신경영상 연구들은 주요 우울장애의 기전을 인지 회로와 감정 회로 연결의 기능장애 즉, 후외방 전두피질과 전전두엽을 번연계로 연결하는 전측대상피질의 연결성 장애에 초점을 맞추고 있다. 소아청소년 주요 우울장애에서 확산텐서영상(diffusion tensor image, DTI)을 사용한 종전의 연구들은 양측 구상회속, 양측 하측 전두후두속, 좌측 전측대상피질, 좌측 상종속 등에서 신경연결의 감소를 보고하였다. 이 연구에서 우리는 정신과적 투약력이 없는 초발 주요 우울장애 청소년에서의 신경 연결성을 DTI를 이용하여 정상 대조군과 비교하였다. 방 법 고려대학교 구로병원을 내원한 청소년 환아들 중 정신과적 투약력이 없으며 주요 우울장애를 처음으로 진단받은 환아들(n=26, 남성 10명, 여성 16명) 및 대조군(n=27, 남성 5명, 여성 22명)을 모집하였다. 정신과적 면담, 지능지수, 해밀턴 우울척도를 포함한 심리검사, 확산강조영상을 포함한 MRI 검사가 항우울제 투약 전에 시행되었다. Fractional anisotropy(FA), radial diffusivity, mean diffusivity, axial diffusivity가 DTI를 사용하여 계산되었다. 통계적 분석을 위해 FMRIB Software Library-Tract Based Spatial Statistic가 사용되었다. 결 과 전체 뇌의 분석에서는 유의한 구조적 변화를 관찰할 수 없었다. 그러나 관심영역을 지정하여 시행한 분석을 하였을 때, 환아군에서 대조군에 비해 우측 상종속 부위에 유의미한 FA값의 감소를 보인 3개의 다발이 관찰되었다. 결 론 주요 우울장애를 진단받은 청소년 환아군에서 대조군에 비해 DTI에 기반하여 우측의 상종속에 연결성 감소를 보였다. 따라서 DTI를 통한 구조적 연결성은 정신과적 투약력이 없는 초발 주요 우울장애 청소년에서도 생체 표지자로 사용될 수 있을 것이라 생각된다.
본 연구는 기분 장애(mood disorder) 환자들과 정상 대조군간의 대뇌 피질 두께를 측정 하여 구조적 이상을 비교하였다. 2020년 9월부터 2022년 8월까지 경상남도 양산 P 병원 정신건강의학과에서 기분 장애 진단을 받은 44명과 이상 병변이 없는 정상인 59명을 대상으로 후향적 연구를 시행하였다. 자기공명영상(MRI) 검사 후 획득한 3D-T1 MPRAGE 영상을 이용하였고, FreeSurfer 소프트웨어를 사용하여 대뇌 피질 두께를 측정하였다. 통계분석은 독립표본 t-검정을 이용하여 두 그룹간 평균의 차이를 측정하고, cohen's d 검정을 통해 두 그룹간 평균 차이의 크기를 평가하였다. 또한, 측정된 평균 피질 두께와 환자의 양성·음성증상(Positive and Negative Syndrome Scale, PANSS)간의 상관관계를 분석하였다. 기분장애 환자는 정상대조군에 비해 양측 상전두이랑(both superior frontal), 주둥이 중전두이랑(both rostral middle frontal), 꼬리 중전두이랑(both caudal middle frontal), 하전두이랑 주름 세곳(both pars opercularis, pars orbitals, pars triangularis), 상측두이랑(both superior temporal), 하측두이랑(both inferior temporal), 외측안와전두피질(both lateral orbito frontal), 내측안와전두피질(both medial orbito frontal), 방추형이랑(both fusiform), 후대상피질(both posterior cingulate), 대상이랑의 협부(both isthmus cingulate), 상두정수리소엽(both superior parietal), 하두정엽(both inferior parietal), 변연상이랑(both supramarginal), 좌측 후중심이랑(left post central), 우측 상부측두고랑(right bank of the superior temporal sulcus), 중측두이랑(right middle temporal), 전대상피질(right rostral anterior cingulate), 뇌섬엽(right insula)의 두께가 유의미하게 감소하였다(p<0.05). 그 중 평균 차이의 크기(cohen's d)가 큰 영역은 좌측 fusiform (d=0.82), pars opercularis (d=0.94), superior frontal (d=0.88), 우측 lateral orbito frontal (d=0.85), pars orbitalis (d=0.89) 로 나타났다. 또한, PANSS와 양측 대뇌 피질의 평균 두께는 약한 음의 상관관계(left hemisphere r=-0.234, right hemisphere r=-0.230)를 나타내었다. 이러한 연구의 결과는 정상인과 비교하여 기분장애 환자의 피질 두께 감소영역을 확인하였고 질환의 증상 정도와 피질 두께 변화의 관련성을 확인하는 데 도움이 될 것으로 기대된다.
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70