Search

Malignant cerebral infarction has a high risk of fatal brain edema and increased intracranial pressure with cerebral herniation causing death. One of the major causes of death is a rebound cerebral edema during rewarming phase. A 66-year-old male patient presented with the right hemiplegia and global aphasia due to malignant cerebral infarction in the whole territory of middle cerebral artery with the occlusion of the proximal internal carotid artery. Being refused decompressive hemicraniectomy, he received the therapeutic hypothermia for 6 days. After rewarming for 6 hours, mentality was suddenly decreased and dilated left pupil. Follow-up CT revealed that midline shifting was more aggravated. We decided on repeated hypothermia for rebound cerebral edema and successfully controlled. We report our experience with repeated hypothermia for rebound cerebral edema following therapeutic hypothermia in malignant cerebral infarction. [ABSTRACT FROM AUTHOR]

Purpose: This study was to identify symptoms and provided services of home-based cancer patients in J province. Methods: 1,350 data poins for 167 home-based cancer patients were analyzed retrospectively. 13 symptoms and 39 service items were measured by tools for home-based cancer patients suggested by the Ministry for Health, Welfare and Family Affairs. Results: The mean number of provided services was 7.4± 9.1. The most common symptoms were fatigue, anorexia, and pain. Patients whose duration after diagnosis was over 6 years, who had metastasis, or who underwent terminal care had more symptoms. Patient education, emotional and spiritual support, and basic assessment and services were provided most often. Frequency of provided services in patients whose duration after diagnosis was over 6 years or who had metastasis was higher. Services such as symptom and pain control, or death of the patient/the bereaved were provided with more support with patients who underwent terminal care. Conclusion: There were some differences in provided services according to medical characteristics. Patients experienced diverse symptoms, but services regarding these symptoms seemed to be insufficient. For more effective services, cooperation between organizations for home-based cancer patients is needed to form a better management model based on the merit of each facility or patient characteristics. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to evaluate the effect of serum sodium level on seizure features of benign convulsions with mild gastroenteritis. Methods : We assessed 31 patients with benign convulsions with gastroenteritis at Soonchunhyang University Cheonan Hospital, from March 2010 to December 2012. The patients data including sex, age on visit, semiology, frequency and duration of seizure, laboratory findings, seizure onset after gastroenteritis, EEG findings and brain MRI findings were retrospectively reviewed. Results : Thirteen boys and 18 girls were involved in the study. Their mean age was 19.7±12.7 months. Twenty two patients (71.0%) visited hospital from November to March in terms of monthly distribution. The seizure types were generalized tonic clonic seizures (61.3 %), generalized tonic (29.0%), atonic (6.5%) and partial seizures (3.2%). The duration of seizures was mostly within 5 minutes. The onset of seizures from gastroenteritis was 1 to 3 days. Stool rotavirus antigen test were positive in 3 of 20 patients. Electroencephalography was performed in 22 patients, in which only four patients showed generalized delta activities without sharp wave/spike discharge. Brain MRI was performed in 16 patients and only one patient had small venous malformation in the right frontal lobe. Seven out of 31 patients had mild hyponatremia. There were no significant differences in the semiology, frequency and duration of seizures between the group with mild hyponatremia and normal group. Conclusion: The study showed that mild hyponatremia did not affect seizure features of benign convulsions with mild gastroenteritis. However, further studies are needed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the effects of aroma hand massage on Sleep, depression and quality of life in the institutionalized elderly women. Methods: This study was a nonequivalent control group pretestposttest design. The data was collected from June 23 to August 10 of 2009. Fifty - Six elderly women were divided into two groups, 27 institutionalized elderly women for the experimental group and 29 institutionalized elderly women for the control group. As for experimental treatment, the experimental group went through aroma hand massage with blended oil-a mixture of Lavender, Bergamot, Chamomile Roman in the ratio of 1 : 1 : 1, which was diluted 2.0% with jojoba carrier oil 20 mL-on each hand for 5 minutes, three times a week during two weeks. Control group went non-treatment. Results: The aroma hand massage experimental group showed more significant differences in the charge of sleep score (t=3.83, p=.00) and depression (t=-3.54, p=.00). Conclusion: Aroma hand massage had a positive effect on sleep and depression in Institutionalized elderly women. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify congruence between self-perception and objective status of obesity according to %Fat, and to investigate health promotion lifestyle in college women. Methods: The participants were a convenience sample of 392 college women who were eligible and agreed to participate in this study. Respondents were asked questions using a health promotion lifestyle profile and were evaluated for their body composition using InBody 3.0. The data were analyzed with SPSS 14.0 program, which was used for Chi square, ANOVA, and post-hoc comparison with Scheffe. Results: The major findings were as follows; 1) Overall, 41.8% of participants misclassified their perceived status of weight by %Fat standards and kappa was 0.329. 2) Two percent were underweight by BMI but overweight by %Fat and 39.0% normal weight by BMI but overweight by %Fat. 3) There were significant differences in health promotion lifestyle according to self-perception of body weight but there was no difference in health promotion lifestyle according to %Fat standards. Conclusion: These findings suggest the necessity for development and application of tailored health promotion program based on self-perception of body weight and %Fat in order to reform incorrect body image and health behavior in college women. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to find out whether Er:YAG laser can aid in debonding ceramic brackets, and to see what kind of method will be the most appropriate for debonding. Methods: One hundred and ninety teeth, monocrystalline brackets (MISO™, HT, Ansan-Si, Korea), polycrystalline brackets (Transcend™ series 6000, 3M Untek, Monrovia, CA, USA) and the KEY Laser3 (KavoDental, Biberach, Germany) were used. Experimental groups were classified according to the type of ceramic brackets, and the amount of laser energy (0, 140, 300, 450, 600 mJ). After applying laser on the bracket at two points at 1 pulse each, the shear bond strength was measured. The effect of heat caused by laser was measured at the enamel beneath the bracket and pulp chamber. After measuring the shear bond strength, adhesive residue was evaluated and enamel surface was investigated using SEM. Results: All ceramic bracket groups showed a significant decrease in shear bond strength as the laser energy increased. The greatest average temperature change was 3.78°C on the enamel beneath the bracket and 0.9°C on the pulp chamber. Through SEM, crater shape holes caused by the laser was seen on the enamel and adhesive surfaces. Conclusions: If laser is applied on ceramic brackets for debonding, 300 - 450 mJ of laser energy will be safe and efficient for monocrystalline brackets (MISO™), and about 450 mJ for polycrystalline brackets (TranscendTM series 6000). [ABSTRACT FROM AUTHOR]

In South Korea, rural areas have been recognized for their potential as sustainable spaces for the future, but they are currently facing major problems. Unplanned construction of facilities such as factories, livestock facilities, and solar panels near residential areas is destroying the rural environment and deteriorating the quality of life of residents. Detection and monitoring of rural facilities are necessary to prevent disorderly development in rural areas and to manage rural space in a planned manner. In this study, satellite imagery data was utilized to obtain information on rural areas, which is useful for observing large areas and monitoring time series changes compared to field surveys. In this study, KOMPSAT ortho-mosaic optical imagery from 2019 and 2020 were utilized to construct AI training datasets for rural hazardous facilities segmentation for Seosan, Anseong, Naju, and Geochang areas. The dataset can be used in image segmentation models to classify rural facilities and can be used to monitor potentially hazardous facilities in rural areas. It is expected to contribute to solving rural problems by serving as the basis for rural planning.

Air pollution is a serious problem in the world, and it is necessary to monitor air pollution emission sources in other neighboring countries to respond to the problem of air pollution spreading across borders. In this study, we utilized domestic and international optical images from KOMPSAT-3/3A satellites to build an AI training dataset for classifying industrial parks and quarries, which are representative sources of air pollution emissions. The data can be used to identify the distribution of air pollution emission sources located at home and abroad along with various state-of-the-art models in the image segmentation field, and is expected to contribute to the preservation of Korea’s air environment as a basis for establishing air-related policies.

Background Delayed post-ischemic leukoencephalopathy (DPIL) is a rare complication after mechanical thrombectomy, with no well-established clinical characteristics and pathomechanism. We explored the characteristics and possible mechanisms in three patients with DPIL. Case Report Based on the clinical manifestations and laboratory findings including magnetic resonance imaging, magnetic resonance spectroscopy, electroencephalography, and lumbar puncture, DPIL was diagnosed in three patients. We administered antiplatelet agents and conservative treatment. Cardioembolism, successful recanalization using a balloon guiding catheter, and fluctuating or gradually worsening neurological symptoms in delayed phase between 13 and 70 days were common features of DPIL. Diffusion-weighted imaging and fluid-attenuated inversion recovery showed high-signal intensity in the affected subcortical white matter. Laboratory findings provided no evidence of an epileptic disorder, inflammatory demyelination, or tumorous conditions. Conclusion This report shows the characteristics and neuroradiologic images of DPIL. Among the various hypotheses, regional hypoxic-ischemic leukoencephalopathy and delayed reperfusion injury might be the pathomechanism underlying DPIL.

The coronavirus disease 2019 (COVID-19) pandemic has reduced the ability to prevent or control chronic disease due to the concerns about safety in accessing health care. Inflammatory bowel disease (IBD) is a chronic condition requiring long- term sustained treatment, which is difficult in the current panedemic situation. The Korean Association for the Study of Intestinal Diseases (KASID) has developed an expert consensus statement on the clinical practice management of adult inflammatory bowel disease during the COVID-19 pandemic. This expert consensus statement is based on guidelines and clinical reports from several countries around the world. It provides recommendations to deal with the risk of COVID-19 and medication use in IBD patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and emphasizes the importance of right treatment approach to avoid worsening of the disease condition in IBD patients.

Paracrine interactions are imperative for the maintenance of adipose tissue intercellular homeostasis, and intracellular organelle dysfunction results in local and systemic alterations in metabolic homeostasis. It is currently accepted that mitochondrial proteotoxic stress activates the mitochondrial unfolded protein response (UPRmt) in vitro and in vivo. The induction of mitochondrial chaperones and proteases during the UPRmt is a key cell-autonomous mechanism of mitochondrial quality control. The UPRmt also affects systemic metabolism through the secretion of cell non-autonomous peptides and cytokines (hereafter, metabokines). Mitochondrial function in adipose tissue plays a pivotal role in whole-body metabolism and human diseases. Despite continuing interest in the role of the UPRmt and quality control pathways of mitochondria in energy metabolism, studies on the roles of the UPRmt and metabokines in white adipose tissue are relatively sparse. Here, we describe the role of the UPRmt in adipose tissue, including adipocytes and resident macrophages, and the interactive roles of cell non-autonomous metabokines, particularly growth differentiation factor 15, in local adipose cellular homeostasis and systemic energy metabolism.

Purpose This study aimed to investigate the effects of exposure to endocrine disruptors, burnout, and social support from peers on premenstrual syndrome (PMS) in nurses. Methods This descriptive correlational study was conducted among 122 nurses under the age of 49 working at a university hospital. The participants answered self-report questionnaires. The data were analyzed using the t-test, analysis of variance, Pearson or Spearman correlation coefficients, and hierarchical multiple regression in SPSS version 23.0. Results The mean age of the nurses was 28.9 years. Of these nurses, 49.2% were working in a general ward, 24.6% in the intensive care unit, 14.8% in the emergency room, and 11.4% in an outpatient department. The explanatory power of the model was 38.3%, and it was statistically significant (F=11.74, p≤.001). Exposure to endocrine disruptors (β=0.32, p

Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular neoplasm that often develops a coagulopathy known as Kasabach­Merritt phenomenon (KMP). Visceral involvement denotes a poor prognosis. We report a case of visceral KHE with KMP successfully treated with corticosteroids and vincristine. The infant had been born vaginally at 34 weeks 6 days’ gestation, weighing 2,360 g. He was admitted for the management of respiratory failure. Blood tests showed anemia and thrombocytopenia 1 hour after delivery. Additional blood tests revealed a prothrombin time of 12.1 seconds, activated partial thromboplastin time of 60.6 seconds, fibrinogen levels of 72.4 mg/dL, and D­dimer levels >3,200 ng/mL. Despite supportive measures and daily transfusions, the clinical condition and coagulopathy gradually worsened. Renal ultrasonography performed to find the origin of the coagulopathy revealed an echogenic mass measuring >3 cm in the abdominal cavity. A magnetic resonance imaging scan showed an ill­marginated, infiltrative mass like lesion in the right anteromedial and posteromedial perirenal space that was hypointense with mild enhancement on T1­ and T2­weighted images. Large vascular tumors adherent to other visceral organs were noted during exploratory laparotomy but could not be resected. Treatment with methylprednisolone was ineffective. Vincristine was administered weekly from the 17th hospital day, and the coagulation profile showed gradual improvement after its initiation. Intravenous methylprednisolone was switched to oral prednisolone on the 57th hospital day. He was discharged on the 73rd hospital day and continued vincristine treatment every 2 weeks and oral prednisolone administration as an outpatient treatment for 8 weeks. He remained symptom­free at the 39­month follow­up.

Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus, is threatening global health worldwide with unprecedented contagiousness and severity. The best strategy to overcome COVID-19 is a vaccine. Various vaccines are currently being developed, and mass vaccination is in progress. Despite the very encouraging clinical trial results of these vaccines, there is insufficient information on the safety and efficacy of vaccines for inflammatory bowel disease (IBD) patients facing various issues. After reviewing current evidence and international guidelines, the Korean Association for the Study of Intestinal Diseases (KASID) developed an expert consensus statement on COVID-19 vaccination issues for Korean IBD patients. This expert consensus statement emphasizes that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination be strongly recommended for IBD patients, and it is safe for IBD patients receiving immunomodulatory therapy.

Soy isoflavones have been reported to possess many physiological activities such as antioxidant activity and inhibition of cancer cell proliferation. This study investigated the photoprotective effects of soybean extract in human fibroblast cell line and hairless mice model. Human fibroblast was treated with soybean extract before and after ultraviolet B (UVB; 290-302 nm) irradiation. In the soybean extract treated group, the cells showed better resistance to ultraviolet (UV) than control group. The amount of type I collagen recovered from the soybean treated group was higher than the vehicle group exposed to UV-induced damage. Moreover, increased expression of metalloproteinases-1 as a result of UV irradiation was suppressed by the soybean extract. Female mice were orally administered soybean extract and irradiated with UVB light for 8 weeks. The effects of the soybean extract on the skin appearance, collagen deposition and epidermal thickness in the UV-damaged mouse skin were analyzed using histopathological methods. In soybean extract treated group, the skin had a better morphology than that of the control group. Furthermore, the amount of type I collagen was increased and overexpression of MMP-1 was reduced in the soybean extract group compared to vehicle group. Additionally, up-regulation of pro-inflammatory cytokines induced by UV irradiation was suppressed by dietary soybean extract treatment. It appears that soybean extract had a photoprotective effect, including anti-aging and anti-inflammatory effect, from UV-induced damage in not only human fibroblast, but also hairless mice. We confirmed that these effects were possibly due to promotion of collagen synthesis and inhibition of MMP-1 expression.

Background A receptor tyrosine kinase for ephrin ligands, EPHB2, is expressed in normal colorectal tissues and colorectal cancers (CRCs). The aim of this study was to investigate EPHB2 expression over CRC progression and determine its prognostic significance in CRC. Methods To measure EPHB2 mRNA and protein expression, real-time polymerase chain reaction and immunohistochemistry were performed in 32 fresh-frozen and 567 formalin-fixed paraffin-embedded CRC samples, respectively. We further investigated clinicopathological features and overall and recurrence-free survival according to EPHB2 protein expression. Results The EPHB2 level was upregulated in CRC samples compared to non-cancerous tissue in most samples and showed a strong positive correlation with AXIN2. Notably, CD44 had a positive association with both mRNA and protein levels of EPHB2. Immunohistochemical analysis revealed no difference in EPHB2 expression between adenoma and carcinoma areas. Although EPHB2 expression was slightly lower in invasive fronts compared to surface area (p < .05), there was no difference between superficial and metastatic areas. EPHB2 positivity was associated with lymphatic (p < .001) and venous (p = .001) invasion, TNM stage (p < .001), and microsatellite instability (p = .036). Kaplan–Meier analysis demonstrated that CRC patients with EPHB2 positivity showed better clinical outcomes in both overall (p = .049) and recurrence-free survival (p = .015). However, multivariate analysis failed to show that EPHB2 is an independent prognostic marker in CRCs (hazard ratio, 0.692; p = .692). Conclusions Our results suggest that EPHB2 is overexpressed in a subset of CRCs and is a significant prognostic marker.

Purpose The purpose of this study is to describe the rate of cytomegalovirus (CMV) virolactia, and the prevalence of breast milk (BM)-transmitted postnatal CMV infection among premature infants after freeze-thawing (FT) and Holder pasteurization (HP) of breast milk. Methods This is a single-center, retrospective study of 312 infants born at less than 32 weeks of gestation, or with a birth weight less than 1,500 g from January 2013 to June 2017. All infants were screened for CMV-specific immunoglobulin (Ig) G and IgM at birth. Initial CMV specific polymerase chain reaction (PCR) and CMV culture were performed on mothers’ BM and babies’ urine within the first 21 days of life. FT and HP of BM was used to prevent the transmission of CMV. For the surveillance of postnatal CMV infection, CMV culture and CMV specific PCR of urine from babies were repeated one to two months after the initial screening. Screening for viremia and viruria was performed if postnatal CMV infection was suspected. Results Among 178 BM samples obtained from mothers of CMV-IgG-seropositive infants, 80 (44.9%) were CMV PCR positive. CMV deoxyribonucleic acid (DNA) was detected in five of the 22 BM samples (22.7%) obtained from the mothers of CMV-IgG seronegative infants. When CMV DNA load in BM was measured before and after HP, various results were shown. Sixty-three infants out of 232 (27.2%) were evaluated for postnatal CMV infection and four infants out of 63 (6.3%) were infected. Conclusion Interventions to prevent BM-transmitted CMV infection can reduce the chance of postnatal CMV infection, but not completely eliminate it.

Backgrounds/Aims: Percutaneous endoscopic gastrostomy (PEG) is a widely used method for long-term tube feeding. This study aimed to investigate the clinical characteristics and outcomes of patients who utilized long-term feeding tube via PEG. Methods: The medical records of 137 patients who underwent PEG tube insertion at Ewha Womans University Mokdong Hospital between January 2002 and December 2013 were reviewed. Results: PEG was indicated most frequently for cerebrovascular accidents (66 patients, 48.2%), followed by head and neck cancer (20 patients, 14.6%), and Parkinson’s disease (10 patients, 7.3%). The tubes were endoscopically inserted in 133 patients (97.1%); 4 patients (2.9%) underwent radiologic intervention. The tubes of 90 patients (65.7%) were exchanged at least once during the follow- up period. At the first exchange, 71 patients (78.9%) had their tubes exchanged by endoscopy, 24 patients (16.7%) by manually, and 4 patients (4.4%) by radiologic intervention. Of the 61 patients (44.5%) who had their tubes exchanged twice, 44 patients (72.1%) changed their tubes by endoscopic exchange, 13 patients (21.3%) by manually, and 4 patients (4.4%) via radiologic intervention. The mean time interval between the initial insertion and the first exchange was 9.83±6.19 months, and that between the initial insertion and the second exchange was 10.7±6.25 months. Of all the 137 patients, acute complications at initial insertion occurred in only 18 patients (13.1%), with insertion site infection (9 patients, 6.6%) being the most common acute complication. Conclusions: PEG appears to be a safe procedure for providing long-term tube feeding. Our results may help to develop strategies for further management of subjects receiving feeding tubes via PEG.

Background/Aims: Appropriate sedation during endoscopy can significantly reduce the discomfort experienced by a patient when the procedure is performed; however, it is associated with several potential risks. Very few reports describe sedation-related adverse events occurring during endoscopy. Our study evaluated the current status of sedation-related adverse events during a diagnostic upper endoscopy. Materials and Methods: We reviewed medical records of 5,564 cases of diagnostic upper endoscopy performed using midazolam for sedation at the Ewha Womans University, Mokdong Hospital, between January 2015 and March 2016. Results: Among the 5,564 cases, sedation-related adverse events were reported in 56 cases (1.0%). Among these 56 patients, 30 patients (53.6.%) were men and 26 patients (46.4%) were women. Mean age of the patients was 63.7±15.4 years. The most common adverse event reported was hypoxia, which was observed in 37 patients (0.7%). Other adverse events included sedation failure (18 patients, 0.3%) and delayed discharge from the recovery room due to delayed recovery of consciousness (one patient, 0.02%). Among patients presenting with hypoxia, 35 patients recovered after administration of intravenous flumazenil and oxygen via nasal prongs. Administration of oxygen alone helped recovery in 2 patients. All patients recovered uneventfully with no mortalities registered. Conclusions: Our study showed that the use of sedative midazolam is relatively safe during an upper endoscopy. The rate of occurrence of adverse events was very low, and no fatal adverse events were observed. However, close observation and continuous monitoring is an essential component of safe sedation during endoscopy.

Background Aurora kinase A (AURKA), or STK15/BTAK, is a member of the serine/threonine kinase family and plays important roles in mitosis and chromosome stability. This study investigated the clinical significance of AURKA expression in colorectal cancer patients in Korea. Methods AURKA protein expression was evaluated by immunohistochemistry in 151 patients with colorectal adenocarcinoma using tissue microarray blocks. We analyzed the relationship between clinicopathological characteristics and AURKA expression. In addition, the prognostic significance of various clinicopathological data for progression-free survival (PFS) was assessed. Also we evaluated copy number variations by array comparative genomic hybridization and AURKA gene amplification using fluorescence in situ hybridization in colorectal carcinoma tissues. Results AURKA gene amplification was found more frequently in the 20q13.2–13.33 gain-positive group than the group with no significant gain on the AURKA-containing locus. AURKA protein expression was detected in 45% of the cases (68/151). Positive staining for AURKA was observed more often in male patients (p = .035) and distally located tumors (p = .021). PFS was shorter in patients with AURKA expression compared to those with low-level AURKA expression (p < .001). Univariate analysis revealed that AURKA expression (p = .001), age (p = .034), lymphatic invasion (p = .001), perineural invasion (p = .002), and TNM stage (p = .013) significantly affected PFS. In a multivariate analysis of PFS, a Cox proportional hazard model confirmed that AURKA expression was an independent and significant prognostic factor in colorectal adenocarcinoma (hazard ratio, 3.944; p < .001). Conclusions AURKA could serve as an independent factor to predict a poor prognosis in Korean colorectal adenocarcinoma patients.

Early diagnosis and management of cerebral edema in acute liver failure is important to reduce neurological complication and mortality. Ammonia-induced astrocyte swelling and increased blood brain barrier permeability via transmembrane dysfunction are major mechanisms of cerebral edema in acute liver failure. Conventional therapy can be used to lower intracranial pressure. In addition, various treatment options are available to reduce serum ammonia level. Herein, we described the pathophysiology, monitoring, and management of cerebral edema in acute liver failure.

Primary thyroid cancers including papillary, follicular, poorly differentiated, and anaplastic carcinomas show substantial differences in biological and clinical behaviors. Even in the same pathological type, there is wide variability in the clinical course of disease progression. The molecular carcinogenesis of thyroid cancer has advanced tremendously in the last decade. However, specific inhibition of oncogenic pathways did not provide a significant survival benefit in advanced progressive thyroid cancer that is resistant to radioactive iodine therapy. Accumulating evidence clearly shows that cellular energy metabolism, which is controlled by oncogenes and other tumor-related factors, is a critical factor determining the clinical phenotypes of cancer. However, the role and nature of energy metabolism in thyroid cancer remain unclear. In this article, we discuss the role of cellular energy metabolism, particularly mitochondrial energy metabolism, in thyroid cancer. Determining the molecular nature of metabolic remodeling in thyroid cancer may provide new biomarkers and therapeutic targets that may be useful in the management of refractory thyroid cancers.

Background: Acute aortic dissection typically manifests severe abrupt chest or back pain which can be accompanied by various neurologic symptoms. However, in case without typical pain, the accurate diagnosis is very difficult. Case Report: A 77-year old female patient presented with symptoms of right cerebral hypoperfusion such as altered mental status, left sided hemiplegia and hypesthesia, tonic-clonic movement and right sided gaze deviation. Initial brain CT angiography revealed a dissection of ascending aorta and intramural hematoma compressing the origin of common carotid artery. Perfusion brain CT showed the prolonged time to peak and mean transit time for right cerebral hemisphere. Emergent replacement of ascending aorta and hemiarch was done without complication. Conclusion: Cerebral hemispheric hypoperfusion could be initial manifestations of the aortic dissection. Aortic dissection should be discriminated in a patient with neurologic deficit accompanied by atypical systemic symptoms.

Decompressive hemicraniectomy followed by subsequent therapeutic hypothermia can reduce mortality in patients with malignant cerebral infarction without significantly increasing risk. We report three cases of malignant cerebral infarction treated with hemicraniectomy followed by hypothermia. Case 1 received elective decompressive surgery and hypothermia. Case 2 developed subsequent cerebral infarction with uncal herniation. Therefore, emergent decompressive surgery and hypothermia was performed in this case. Despite surgery and hyperosmolar therapy, case 3 received hypothermia treatment for refractory increased intracranial pressure. All patients survived with a score of 4 or 5 on the modified Rankin scale. Therefore, we suggest that application of hypothermia after hemicraniectomy is safe and feasible. Several possible modifications can be made to improve the management strategy in order to increase the benefits of hypothermia treatment.

Background: Tuberculosis (TB) remains an important cause of morbidity and mortality throughout the world. The surge of TB has been accompanied by an increase in multi-drug-resistant tuberculosis (MDR-TB). In this study, we developed a denaturing HPLC (DHPLC) method for detecting rpoB gene mutation as a rifampin resistance based on sequence., Methods: In this study, we used 99 mycobacterial isolates grown in Ogawa media. At first, we used a PCR method that can amplify the 235 bp and 136 bp rpoB DNAs of Mycobacterium tuberculosis complex (MTB) and Non-tuberculous mycobacteria (NTM). And then, PCR-restriction fragment length polymorphism (RFLP) of rpoB DNA (342 bp), which comprises the Rif(T) region, was used for the differential identification of Mycobacteria. Finally, we detected these amplicons by DHPLC, compared to PCR-RFLP results, and performed sequencing., Results: Among 99 mycobacterial isolates, 80 (81%) were MTB and 19 (19%) were NTM. NTM were identified to 7 different species by DHPLC and PCR-RFLP. rpoB mutation was detected in 9 (11%) of the MTB specimens. These results were confirmed by using sequencing., Conclusions: DHPLC provided a rapid, simple, and automatable performance for detection of rifampin resistant Mycobacterium tuberculosis complex and would be helpful as a supplemental method in high-throughput clinical laboratories.

The present study has been designed as a basic study on laboratory diagnosis of giardiasis and to demonstrate a more effective method for the detection of Giardia lamblia cyst with the inherent advantages of minimizing both the number of stool examinations required and the interval of stool collections for estimating the real state of prevalence in the shortest time possible. There were 3 subject groups of 75 children each currently residing in an orphanage in Gunsan city, Jeonbuk province from which stool specimens were collected every day, every other day, and every 3 days. The procedure is as follows: Resuspend the fixed sample after fixation with SAF solution. Centrifuge the sediment for 1 min. at 2,000 rpm after straining through gauze into a tube. Divide the sediment into 3 parts and use them for direct fecal smear, formalin-ether concentration (MGL) and zinc sulfate (ZnSO(4)) floatation techniques. The results are summarized as follows: Overall infection rate after 10 trials showed a 60 percent positive indication. The positive rate among children under 4 years old was significantly higher than the rate in children over 4 years old. No significant difference in rate by sex was observed. The results of examinations by direct fecal smear and MGL techniques appeared more accurate than that obtained by ZnSO(4) floatation method as indicated by a higher positive rate. Of all three methods concerned, combinations of two demonstrated a higher positive rate than that shown by any one alone. In three consecutive examinations under varying conditions such as different days, the cyst detection rate by MGL technique indicated 83 percent. In 5 examinations under the same varying conditions, the indicated rate was 94 percent. The interval of stool collection proved to be insignificant for the cyst detection rate. In conclusion, both MGL method and modified fecal direct smear can provide a good cyst detection rate of G. lamblia provided that more than 3 consecutive examinations of stool under varying conditions are carried out.