Intraoperative direct puncture and embolization (IOPE) using a glue material for spinal cord arteriovenous fistula: a case report

Introduction

Spinal arteriovenous fistula (AVF) is treated by embolization or surgery. However, transarterial embolization or surgery is difficult in rare cases when the fistula site is very complicated to access especially as in fistular nidus supplied by posterior and anterior spinal artery. We present the case which was treated with intraoperative direct puncture and embolization (IOPE) using glue material, since the usual transarterial or transvenous neurointerventional approach was difficult to embolize the AVF.

Methods

A 36-year-old woman presented with progressive leg weakness and pain after a 20-year history of lower back pain. She had pelvic and spinal AVF combined with arteriovenous malformation (AVM). Despite prior treatment of the pelvic lesion with radiotherapy and coil embolization, the spinal lesion persisted and caused repeated subarachnoid hemorrhages. A spinal angiogram revealed a tortuous and long feeder of the AVF which had growing venous sac, as well as AVM. Two embolization trials failed because of the long tortuosity and associated anterior spinal artery. Four months later, drastic leg weakness and pain occurred, and IOPE was performed using a glue material.

Results

The subsequent recovery of the patient was rapid. One month later, the use of a strong opioid could be discontinued, and the patient could walk with aid. A follow-up spinal angiogram revealed that the venous sac of the AVF had disappeared.

Conclusion

In spinal AVF which is not feasible to access by usual intervention approach and to dissect surgically, IOPE with glue material can be considered for the treatment.

     

The role of quercetin on the survival of neuron-like PC12 cells and the expression of α-synuclein

Both genetic and environmental factors are important in the pathogenesis of Parkinson's disease. As α-synuclein is a major constituent of Lewy bodies, a pathologic hallmark of Parkinson's disease, genetic aspects of α-synuclein is widely studied. However, the influence of dietary factors such as quercetin on α-synuclein was rarely studied. Herein we aimed to study the neuroprotective role of quercetin against various toxins affecting apoptosis, autophagy and aggresome, and the role of quercetin on α-synuclein expression. PC12 cells were pre-treated with quercetin(100, 500, 1,000 μM) and then together with various drugs such as 1-methyl-4-phenylpyridinium(MPP+; a free radical generator), 6-hydroxydopamine(6-OHDA; a free radical generator), ammonium chloride(an autophagy inhibitor), and nocodazole(an aggresome inhibitor). Cell viability was determined using a 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltertazolium bromide(MTT) assay. Apoptosis was detected by annexin V-fluorescein isothiocyanate and propidium iodide through the use of fluorescence activated cell sorter. α-Synuclein expression was detected by western blot assay and immunohistochemistry. The role of α-synuclein was further studied by knocking out α-synuclein using RNA interference. Cell viability increased at lower concentrations(100 and 500 μM) of quercetin but decreased at higher concentration(1,000 μM). Quercetin exerted neuroprotective effect against MPP+, ammonium chloride and nocodazole at 100 μM. MPP+ induced apoptosis was decreased by 100 μM quercetin. Quercetin treatment increased α-synuclein expression. However, knocking out α-synuclein exerted no significant effect on cell survival. In conclusion, quercetin is neuroprotective against toxic agents via affecting various mechanisms such as apoptosis, autophagy and aggresome. Because α-synuclein expression is increased by quercetin, the role of quercetin as an environmental factor in Parkinson's disease pathogenesis needs further investigation.     

Stigma of Mental Illnesses as Perceived by North Korean Defectors Living in South Korea

Objective

This study aims to provide the information of the stigmas of mental illness such as psychosis, alcoholism, attempt suicide, and depression among North Korean defectors.

Methods

We examined stigma for the mental illnesses of 639 North Korean defectors aged 19 to 65 years who live in the Settlement Support Center for North Korean Refugees. The stigmas of mental illnesses were assessed using the Perceived Devaluation-Discrimination Scale We directly compared the stigma level between North Korean defectors and the general population of South Korea.

Results

North Korean defectors had higher perceived stigmas of psychosis and alcoholism and lower perceived stigmas of depression than South Koreans. Perceived stigma associated with attempted suicide was similar for North Korean defectors and South Koreans. Only marital status in sociodemographic variables had associations with higher perceived stigma of psychosis, alcoholism, and depression in the North Korean defectors. North Korean defectors, who spent more than one year in transit country, had associations with lower perceived stigma of psychosis and alcoholism. North Korean defectors, who had the experience of compulsory repatriation to North Korea or North Korean family in South Korea, had an association with higher perceived stigma of depression.

Conclusion

North Korean defectors had higher perceived stigmas of psychosis and alcoholism and lower perceived stigmas of depression than South Koreans. Further studies are needed to document serial changes in stigmas for mental illnesses associated with the receipt of education at the Settlement Support Center for North Korean defectors.     

Atypical pathogens in adult patients admitted with community-acquired pneumonia in Korea

This study examined the prevalence of atypical pathogens causing community-acquired pneumonia (CAP) in Korea. We collected sera and clinical data for a period of 1 year for the adult patients consecutively admitted to Chunchon Sacred Heart Hospital with CAP. The diagnosis was made using serologic methods to detect antibodies for Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella spp., Chlamydia psittaci, and Coxiella burnetii. Among 81 recruited patients, C. pneumoniae (n = 10, 12.3%) was the leading cause of illness, followed by M. pneumoniae (n = 7, 8.6%). One case of C. burnetii pneumonia was detected, but there were no cases of Legionella spp. or C. psittaci. Three cases of C. pneumoniae pneumonia were co-infected with either M. pneumoniae or C. burnetii. There was no significant difference between atypical pneumonia and non-diagnosed pneumonia in terms of clinical manifestations. In conclusion, of the atypical pathogens causing CAP, C. pneumoniae and M. pneumoniae appear to be the important etiologic pathogens in Korea.     

Maximum force and the center of pressure trajectory length according to foot angles during stair walking

[Purpose] Walking with the feet turned inward or outward often causes issues for the people with these walking patterns. The purpose of this study was to examine the influence of in-toeing and out-toeing on maximum force and the center of pressure (COP) trajectory length during stair walking. [Subjects and Methods] The subjects were 30 female university students without orthopedic diseases of the foot. The foot angle was divided into three types: in-toeing, normal, and out-toeing. A plantar pressure measurement instrument was used, and the maximum force was obtained by dividing the foot into six regions covering the anterior medial-lateral, middle medial-lateral, and posterior medial-lateral regions. The COP trajectory length was statistically calculated by measuring the medial-lateral, anterior-posterior, and total travel distances. [Results] During stair climbing, the maximum force was significantly different in the anterior lateral region. During stair descending, the maximum force was significantly different in the anterior lateral, middle medial, middle lateral, posterior medial, and posterior lateral regions. The COP trajectory length showed a statistically significant difference in the medio-lateral travel distance. [Conclusion] Walking with abnormal foot angles causes deformed foot structures and can result in musculoskeletal disabilities in the long term. Therefore, therapeutic intervention is required to maintain normal foot angles.Key words: Foot angle, Stair walking, Maximum force