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Endoscopic endonasal surgery (EES) is widely employed for interventions in skull base. Despite advancements in surgical techniques, cerebrospinal fluid (CSF) leakage remains a significant concern. The introduction of nasoseptal flap (NSF) dramatically reduced the CSF leakage rates, yet reconstruction techniques continue to vary among institutions and lack standardization. Recently, injectable hydroxyapatite (HA), traditionally used in open skull base reconstruction, has been adapted for use in EES. This study compares the effectiveness of HA and NSF reconstruction with the standard multilayer NSF reconstruction alone. We searched for eligible studies in PubMed, Embase, and Cochrane Library. CSF leakage rates and reconstruction-associated complication rates were thoroughly evaluated. We initially reviewed 3650 records, narrowing down to 13 articles for full-text examination. Of these, 3 retrospective cohort studies met our inclusion criteria, comparing outcomes of HA combined with NSF to NSF alone. The HA plus NSF group tended to exhibit lower rates of CSF leakage compared to the NSF alone group. Similarly, the rate of reconstruction-associated complication was also lower in the HA plus NSF group than in the control group. Skull base reconstruction using HA and NSF can be an effective way to minimize CSF leakage without major complications.

PurposeAs per the 2016 World Health Organization (WHO) guidelines on the classification of central nervous system tumors, solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs) constitute a single disease entity, known as SFT/HPC. This study provides a clinical analysis of these tumors and describes the treatment outcomes of SFT/HPCs.MethodsThis retrospective study included 76 patients with histopathologically proven SFT/HPC. Reclassification according to the 2016 WHO guideline was done for patients who were diagnosed with SFT or HPC based on the 2007 WHO classification. Recurrence-free survival (RFS) and overall survival (OS) were evaluated for all patients and subgroups.ResultsThe median follow-up period was 77.9 months. The median RFS and OS were 126.5 and 136.8 months, respectively. The 1-, 5-, 10-, and 15-year RFS rates were 93%, 72%, 40%, and 40%, respectively. The 1-, 5-, 10- and 15-year OS rates were 97%, 89%, 54%, and 35%, respectively. In multivariable analyses, stereotactic radiosurgery (SRS; p = 0.009, hazard ratio [HR] 6.986), female sex (p = 0.023, HR 1.76), and age over 45 (p = 0.037, HR 2.74) were associated with shorter RFS. Patients who underwent SRS as initial treatment had a shorter OS than that of patients who underwent primary resection (p < 0.001, HR 12.86).ConclusionsHigh-grade tumors tended to have worse OS and occur extracranial metastases earlier than low-grade tumors. The median RFS was not different between grade II and III tumors. Male sex, younger age, and GTR were associated with a better RFS. A history of SRS before tumor resection was associated with a shorter RFS and OS.

Objective The aim of this study was to identify work stress associated with the development of suicidal ideation with a focus on gender and age differences among Korean employees. Methods The data of 95 356 healthy employees aged >18 years who had undergone at least two comprehensive health examinations at Kangbuk Samsung Hospital Health Screening Center, South Korea, were analyzed. Risk of suicidal ideation was assessed using a self-reported questionnaire examining suicidal ideation during the past year. Work stress was measured using the Korean Occupational Stress Scale-Short Form. A Cox proportional hazards model was used to examine relationship between work stress and suicidal ideation. Considering gender and age differences in the association between work stress and suicidal ideation, the data were stratified by gender and age groups. Results During 289 706 person-years of follow-up, suicide ideation was identified in 3 460 participants. For male workers, high job demands and lack of reward were associated with the risk of suicidal ideation in young adults and midlife decade group. Job insecurity was associated with the risk of suicidal ideation in midlife decade and middle-aged and older adulthood. Organizational injustice was associated with the risk of suicidal ideation in middle-aged and older adulthood. Discomfort in an organizational climate was associated with the development of suicidal ideation in all age groups. For female workers, organizational injustice and discomfort in an organizational climate were associated with the risk of suicidal ideation in early adulthood. Conclusion The results suggested that certain work stressors are risk factors of suicidal ideation. Gender and age differences in components of work stress associated with suicidal ideation were also observed.

This study aims to develop a generative adversarial networks (GAN)-based image translation model for synthesizing lumbar spine Computed Tomography (CT) to Magnetic Resonance (MR) images, focusing on sagittal images, and to evaluate its performance. A cycle-consistent GAN was used to translate lumbar spine CT slices into synthetic T2-weighted MR images. The model was trained on a dataset of 100 cases with co-registered CT and MR images in the sagittal plane from patients with degenerative disease. A qualitative analysis was performed with 30 cases, using a similarity score to evaluate anatomical features by neurosurgeons. Quantitative metrics, including mean absolute error (MAE), peak signal-to-noise ratio (PSNR), and structural similarity index (SSIM), were also computed. The GAN model successfully generated synthetic T2-weighted MR images that visually resembled real MR images. In qualitative evaluation, the similarity score for anatomical features (e.g., disc signal, paraspinal muscles, facet joints) averaged over 80%. The disc signal showed the highest similarity at 88.11% ± 4.47%. In the quantitative assessment of sagittal images, the results were: MAE = 43.32 ± 10.29, PSNR = 12.80 ± 1.55, and SSIM = 0.28 ± 0.07. This approach could be valuable in clinical settings where MR image is unavailable, potentially reducing healthcare costs.

Galla rhois is a commonly used traditional medicine for the treatment of pathogenic bacteria in Korea as well as in other parts of Asia. Methyl gallate (MG), a major component of Galla Rhois, exhibits strong antibacterial activity, but its mechanism of action against Salmonella spp. is unclear. In the present study, we investigated the antibacterial actions of MG against Salmonella. The antibacterial activity determined by broth dilution method indicated that the antibacterial activity of MG against Salmonella strains ranged from 3.9 to 125 µg/ml. In vitro bacterial viability test indicated that MG significantly decreased the viability of Salmonella over 40% when combined with ATPase inhibitors. The time-kill curves showed that a combined MG and ATPase inhibitors (DCCD and NaN3) treatment reduced the bacterial counts dramatically after 24 h. Oral administration of MG showed a strong anti-bacterial activity against WS-5 infected BALB/c mice. In contrast to the untreated Salmonella infected control animals, MG treated groups showed no clinical symptoms of the disease, such as lethargy and liver damage. It was observed that MG treatment significantly increased the survival of animals from Salmonella infection, while in untreated groups all animal succumbed to disease by the sixth day post infection. Thus, the present study demonstrates the therapeutic ability of MG against Salmonella infections.

PurposePrimary central nervous system lymphoma (PCNSL) involving the hypothalamic–pituitary axis (H–P axis) is a rare intracranial neoplasm. We aimed to determine the unique characteristics and treatment outcomes of patients with PCNSL at the H–P axis and review the literature.MethodsWe retrospectively reviewed the electronic medical records of patients with PCNSL in our institute from 2000 to 2017. We analyzed patient characteristics, clinicopathologic features, imaging results, and treatment outcomes. Furthermore, we searched the PubMed database and gathered more cases from published studies to analyze patient treatment outcomes.ResultsA total of 488 patients were diagnosed with central nervous system lymphoma at our institute. Seven (1.4%) patients had H–P axis involvement, five had diffuse large B-cell lymphoma, and two had mucosa-associated lymphoid tissue lymphoma. All patients had anterior pituitary lobe dysfunction, and two had posterior lobe dysfunction. The median progression-free survival (PFS) for seven patients was 29.0 (range: 0.9–48.1) months, and the 3-year survival rate was 42.9%. Pooled analysis included 45 patients. The median PFS for these patients was 7.0 months (0.9–52.0), and the 2-year survival rate was 20%. Univariate and multivariate analyses revealed that the patients with visual field defects had better prognosis (p = 0.0153 and 0.043, respectively).ConclusionPCNSL at the H–P axis is associated with a higher rate of pituitary dysfunction than other parasellar pathologies. PCNSL at the H–P axis has a worse treatment outcome than PCNSL at other sites. However, visual field defect is related to a favorable prognosis in these patients.

PurposeThe aim of this study was to identify gender- and age-specific occupational stress associated with depressive symptoms among Korean employees.MethodsData of 73,014 employees aged 18 and above who had undergone comprehensive health examinations at Kangbuk Samsung Hospital Health Screening Center, South Korea, in January 2012 and who were followed up until December 2017 were collected, and 63,959 (participation rate: 87.59%, men: 50,413, women: 13,546) were finally analyzed. A Cox proportional hazards model was used to estimate the hazard ratios and 95% confidence intervals of the relationship between occupational stress and depressive symptoms. In light of gender and age differences in the association between occupational stress and depressive symptoms, interaction and stratification by gender and age groups were tested.ResultsDuring 238,630 person-years of follow-up, case-level depressive symptoms developed in 4227 participants (an incident rate of 1.8%). There were gender differences in the relationship between job stress and incident depressive symptoms. For men, high job demand, job insecurity, lack of reward, and discomfort in their organizational climate were associated with incident depressive symptoms in all age groups. Insufficient job control was associated with the development of depressive symptoms only in midlife and organizational injustice only in early adulthood. For women, the results for high job demand, organizational injustice, and discomfort in an organizational climate were associated with the onset of depressive symptoms from early adulthood to the midlife decade.ConclusionThe results suggest gender and age differences in the relationship between occupational stress and incident depressive symptoms.

Curcumin, a natural polyphenolic flavonoid extracted from the rhizome of Curcuma longa L., was shown to possess superior potency to resensitize methicillin-resistant Staphylococcus aureus (MRSA) to antibiotics. Previous studies have shown the synergistic activity of curcumin with β-lactam and quinolone antibiotics. Further, to understand the anti-MRSA mechanism of curcumin, we investigated the potentiated effect of curcumin by its interaction in diverse conditions. The mechanism of anti-MRSA action of curcumin was analyzed by the viability assay in the presence of detergents, ATPase inhibitors and peptidoglycan (PGN) from S. aureus, and the PBP2a protein level was analyzed by western blotting. The morphological changes in the curcumin-treated MRSA strains were investigated by transmission electron microscopy (TEM). We analyzed increased susceptibility to MRSA isolates in the presence of curcumin. The optical densities at 600 nm (OD600) of the suspensions treated with the combinations of curcumin with triton X-100 and Tris were reduced to 63% and 59%, respectively, compared to curcumin without treatment. N,N'-dicyclohexylcarbodiimide (DCCD) and sodium azide (NaN3) were reduced to 94% and 55%, respectively. When peptidoglycan (PGN) from S. aureus was combined with curcumin, PGN (0–125 μg/mL) gradually blocked the antibacterial activity of curcumin (125 μg/mL); however, at a concentration of 125 µg/mL PGN, it did not completely block curcumin. Curcumin has a significant effect on the protein level of PBP2a. The TEM images of MRSA showed damage of the cell wall, disruption of the cytoplasmic contents, broken cell membrane and cell lysis after the treatment of curcumin. These data indicate a remarkable antibacterial effect of curcumin, with membrane permeability enhancers and ATPase inhibitors, and curcumin did not directly bind to PGN on the cell wall. Further, the antimicrobial action of curcumin involved in the PBP2a-mediated resistance mechanism was investigated.

Childhood trauma is a well-established risk factor for adult psychopathology, yet the underlying neuropsychiatric mechanisms remain unclear. Therefore, this study examined whether resilience mediates the relationship between childhood trauma and depressive and anxiety symptoms, and whether this pathway is moderated by harm avoidance (HA). A total of 218 Korean adults (aged 19-50 years; 79 men and 139 women) completed validated measures of childhood trauma (Childhood Trauma Questionnaire (CTQ)-Short Form), harm avoidance (Temperament and Character Inventory-Harm Avoidance subscale), resilience (Brief Resilience Scale), depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder-7). Mediation and moderated mediation models were tested using structural equation modeling, and indirect effects were estimated via bootstrapping with 5000 resamples. Childhood trauma was associated with lower resilience, an effect moderated by HA. Resilience was strongly inversely associated with depression and anxiety. Indirect effects of trauma through resilience were significant for both outcomes, with stronger effects at higher HA. The associations between childhood trauma and both depression and anxiety were mediated by resilience, and this indirect pathway was amplified by HA. These findings suggest a neuropsychiatric mechanism whereby early-life stress and temperament jointly shape effective neural vulnerability, leading to depression- and anxiety-associated outcomes.

Background/Objectives: Stressors occurring across the life course are considered to have a cumulative impact on health, but there is no instrument for assessing lifetime stressor exposure in Korea. Therefore, we validated the Stress and Adversity Inventory (Adult STRAIN) in Korean. Methods: We translated the Adult STRAIN into Korean and examined its concurrent, predictive, and comparative predictive validity in 218 Korean adults (79 men, 139 women; Mage = 29.5; 19–50 years old) recruited from a psychiatric setting. We assessed concurrent validity using Pearson’s correlations, predictive validity using multiple regression models, and comparative predictive validity using multivariate logistic regression to identify participants with lifetime psychiatric diagnoses. Results: The Korean STRAIN exhibited sufficient usability and acceptability; good concurrent validity with other measures of early adversity, life events, and perceived stress (rs = 0.48–0.61); and strong predictive validity in relation to anxiety and depressive symptoms (β = 0.08–0.47; ΔR2 = 0.11–0.21). Each domain of Korean-style stress, based on the timing, type, life domain, and sociopsychological characteristics of stress exposure, showed a different distribution of lifetime psychiatric diagnosis probabilities (odds ratios = 1.20–4.85). Finally, the test–retest reliability for total lifetime stressor count and severity over four weeks was high. Conclusions: The Korean STRAIN is a practical, valid, and reliable instrument for researchers and clinicians to efficiently assess lifetime stressor exposure.