Supplementary Table 9, column 'Edoxaban', row 'eGFR category', '95 mL/min' (page 15). The cell should be coloured green instead of yellow. It should also read "60 mg"instead of "60 mg (use with caution in 'supranormal' renal function)."In the above-indicated cell, a footnote has also been added to state: "Edoxaban should be used in patients with high creatinine clearance only after a careful evaluation of the individual thromboembolic and bleeding risk."Supplementary Table 9, column 'Edoxaban', row 'Dose reduction in selected patients' (page 16). The cell should read "Edoxaban 60 mg reduced to 30 mg once daily if any of the following: creatinine clearance 15-50 mL/min, body weight <60 kg, concomitant use of dronedarone, erythromycin, ciclosporine or ketokonazole"instead of "Edoxaban 60 mg reduced to 30 mg once daily, and edoxaban 30 mg reduced to 15mg once daily, if any of the following: creatinine clearance of 30-50 mL/min, body weight <60 kg, concomitant us of verapamil or quinidine or dronedarone."

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2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).

Principles and Practice of Sleep Medicine

Since the introduction of the first edition of International Classification of Sleep Disorders: Diagnostic and Coding Manual(ICSD-1)in 1990,national and international meetings were held to openly discuss the ongoing developments of sleep disorders and a new International Classification of Sleep Disorders: Diagnostic and Coding Manual(ICSD-2)was published in 2005.Compared with ICSD-1,the classification of ICSD-2 was developed in a manner compatible with new International Classification of Diseases(ICD-9 and ICD-10)and formed a coordinated system of International Classification of Diseases.The updated version was characterized by the significant improvements of its logicality and clinical practicability,and was more consistent with the International Classification of Disease.The contents of ICSD-2 were introduced in this article.

Brief introduction to second edition of International Classification of Sleep Disorders:Diagnostic and Coding Manual

OX40 (CD134) and its binding partner, OX40L (CD252), are members of the TNFR/TNF superfamily and are expressed on activated CD4 and CD8 T cells as well as a number of other lymphoid and non-lymphoid cells. Costimulatory signals from OX40 to a conventional T cell promote division and survival, augmenting the clonal expansion of effector and memory populations as they are being generated to antigen. OX40 additionally suppresses the differentiation and activity of Treg, further amplifying this process. OX40 and OX40L also regulate cytokine production from T cells, antigen-presenting cells, NK cells, and NKT cells, and modulate cytokine receptor signaling. In line with these important modulatory functions, OX40/OX40L interactions have been found to play a central role in the development of multiple inflammatory and autoimmune diseases, making them attractive candidates for intervention in the clinic. Conversely, stimulating OX40 has shown it to be a candidate for therapeutic immunization strategies for cancer and infectious disease. This review provides a broad overview of the biology of OX40, and the intracellular signals from OX40, that impact many aspects of immune function, and have promoted OX40 as one of the most prominent costimulatory molecules known to control T cells.

The Significance of OX40 and OX40L to T cell Biology and Immune Disease

Second-generation chimeric antigen receptors (CARs) retarget and reprogramme T cells to augment their antitumour efficacy. The combined activating and co-stimulatory domains incorporated in these CARs critically determine the function, differentiation, metabolism and persistence of engineered T cells. CD19-targeted CARs that incorporate CD28 or 4-1BB signalling domains are the best known to date. Both have shown remarkable complete remission rates in patients with refractory B cell malignancies. Recent data indicate that CD28-based CARs direct a brisk proliferative response and boost effector functions, whereas 4-1BB-based CARs induce a more progressive T cell accumulation that may compensate for less immediate potency. These distinct kinetic features can be exploited to further develop CAR-based T cell therapies for a variety of cancers. A new field of immunopharmacology is emerging.

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The pharmacology of second-generation chimeric antigen receptors

STUDY OBJECTIVES
Chronic intermittent hypoxia due to obstructive sleep apnea (OSA) causes oxidative stress, which may contribute to the pathophysiology of Parkinson's disease (PD). However, the bidirectional relationship between PD and OSA has not been satisfactorily established. The objective of this study was to try to estimate whether there is a bidirectional relationship between PD and OSA through a retrospective cohort study on South Korean population.


METHODS
This study used data from the Korean National Health Information Database of the National Health Insurance Service, which contains data from 3.5 million individuals evenly distributed. In Study 1, patients with OSA were matched in a 1:2 ratio with non-OSA controls. In Study 2, patients with PD were matched in a 1:2 ratio with non-PD controls. A stratified Cox proportional hazard model was used to calculate hazard ratios (HR).


RESULTS
In Study 1, which included 6,396 OSA patients and 12,792 non-OSA controls, the incidence of PD per 10,000 person-years (PY) was 11.59 in the OSA group and 8.46 in the non-OSA group. The OSA group demonstrated a 1.54-fold higher incidence of PD than the non-OSA group (95% confidence interval, 1.14-2.07, P<0.05). In Study 2, which included 3,427 PD patients and 6,854 non-PD controls, the incidence of OSA per 10,000 PY was 14.97 in the PD group and 7.72 in the non-PD group. The PD group demonstrated a 1.92-fold higher incidence for OSA than the non-PD group (95% CI =1.32-2.78, P<0.05).


CONCLUSIONS
This study supports a possible bidirectional relationship between PD and OSA.

Bidirectional association between Parkinson's disease and obstructive sleep apnea: a cohort study.

Dear Editor, A 44-year-old man with hypertension and diabetes presented with an acute headache and left hemiparesis. He reported recent inadequate control of blood pressure and diabetes. At the time of admission, his blood pressure was 240/130 mmHg, but fever and myalgia were absent. Immediate computed tomography (CT) revealed a right frontotemporal lobe intracerebral hemorrhage (ICH), and some areas of ICH appeared to be associated with other lesions (Fig. 1). Immediate surgery was performed because of rapidly deteriorating consciousness. After insertion of a catheter to the nearest ICH site, white purulent discharge was observed and irrigation was performed. Blood tests revealed unremarkable findings, with the exception of a slightly increased C-reactive protein level (0.12 mg/L). Staphylococcus saprophyticus was detected on culture, and vancomycin was given for 21 days. Postoperative CT confirmed that the fluid level disappeared and problems caused by the mass as a spaceoccupying lesion had nearly resolved (Fig. 2). The patient became more alert, and the left hemiparesis gradually improved. Brain abscess typically presents with various neurological symptoms and is associated with high mortality [1]. It sometimes occurs in association with ICH, but may occur due to hematogenous spread from distal foci [2]. In a case of brain abscess, prompt diagnosis, timely surgical treatment, and antibiotic therapy are important for improving prognosis. In this patient, a brain abscess developed with ICH. It was thought that the abscess was caused by hematogenous spread from an unknown site and that uncontrolled diabetes contributed to abscess generation or exacerbation. Moreover, it is possible that the abscess was overlooked on initial brain imaging because of hemorrhage into the abscess cavity. Treatment for the abscess might have been delayed, but fortunately, the fluid level in the abscess cavity raised the suspicion of an abscess. This case demonstrates that an abscess can be overlooked when ICH invades the abscess cavity, although an abscess should be suspected in the presence of a fluid level and differences in density of the brain parenchyma around the ICH.

Asymptomatic Brain Abscess with Intracerebral Hemorrhage

Copyright 2016 by The Korean Society of Clinical Neurophysiology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Address for correspondence; Hyun Goo Kang Department of Neurology, Chosun University School of Medicine, 365 Philmun-daero, Dong-gu, Gwangju 61453, Korea Tel: +82-62-220-3182 Fax: +82-62-232-7587 E-mail: naroo12@Chosun.ac.kr There are no potential conflicts of interest to disclose. This study was supported by research fund from Chosun University Hospital, 2016. Brief Communication

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Unilateral Optic Neuritis after Acute Hepatitis A

Toxoplasma encephalitis is an opportunistic infection that may occur in immunocompromised or advanced HIV (Human Immunodeficiency Virus) patients and lead to serious complications in the CNS. We report a 44-year-old man with toxoplasma encephalitis combined with HIV infection. He was admitted with headache and neck stiffness. Brain computed tomography showed normal findings. Tuberculous meningitis was suspected from CSF and serum tests. However, his symptoms continued to progress, and toxoplasma encephalitis was diagnosed based on brain magnetic resonance imaging and serum tests. J Korean Neurol Assoc 36(3):185-188, 2018

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Toxoplasma Encephalitis in a Patient with Human Immunodeficiency Virus Infection

사제로 보존적인 치료만을 하였으며 복통 증상을 호소한 적은 없 었다. 내원 3일 전 급성 복통이 있었으나 특별한 치료 없이 지내던 중 내원 당일 오전부터 의식이 저하되어 응급실로 왔다. 신체 진찰에 서 복부는 부드러우며 팽만하여 있었고, 장음은 감소되어 있었다. 글래스고우 혼수척도 8점이었으며 활력징후는 혈압 60/40 mmHg, 맥박 128회/분, 호흡수 24회/분, 체온 36°C였다. 중심정맥압은 0 cmH2O였으며 혈청검사에서 혈색소는 10.2 g/dL, 백혈구는 2,900/mm, 혈소판은 99,000/mm 크레아티닌 2.5 mg/dL, 빌리루 빈 5 mg/dL였고, 젖산 농도(lactic acid)는 131.7 mg/dL로 증가되어 있었다. 동맥혈가스분석은 pH 7.17, 동맥혈산소분압 80.0 mmHg, 동맥혈탄산가스분압 36 mmHg, 중탄산이온 13.6 mEq/L였다. 동맥혈산소분압 대 흡입산소농도 비는 290 mmHg였다. 도파민을 15 mcg/kg/min을 한 시간 이상 주어도 평균동맥압은 60 mmHg 이상으로 오르지 않았다. Sequential organ failure assessment 점수 17점으로 심한 패혈증을 보이고 있었다. 심장초음파에서는 심근병 증(cardiomyopathy) 소견을 보였으며, 단순흉부촬영에서 이상 소 견은 관찰되지 않았으나(Fig. A), 복부 컴퓨터단층촬영(abdominal computed tomography)에서는 대장 전반에 걸친 확장 및 대변막힘 (fecal impaction), 소변정체(urinary retention)를 보였고, 기계적 장폐쇄는 보이지 않았다(Fig. B, C).

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Hyun Goo Kang

Papers

Bidirectional association between Parkinson's disease and obstructive sleep apnea: a cohort study.

Asymptomatic Brain Abscess with Intracerebral Hemorrhage

Unilateral Optic Neuritis after Acute Hepatitis A

Toxoplasma Encephalitis in a Patient with Human Immunodeficiency Virus Infection

Acute Intestinal Pseudo-Obstruction in a Patient with MELAS Syndrome