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Background: Stroke unit care is recommended as a standard care for acute stroke. We sought to determine whether morbidity and mortality of patients who admitted for acute ischemic stroke have been improved after implementation of stroke unit care in a regional public hospital. Methods: Seoul Medical Center is a regional public hospital in Seoul, the capital of Korea. Stroke unit has been established at June, 2011. Information of all consecutive stroke patients admitted to our hospital including functional outcome has been collected prospectively from April, 2008 as a part of a nationwide multicenter stroke registry. We compared outcomes of pre and post commencement of stroke unit, obtained from April, 2008 to December, 2010 and from January 2012 to November 2017, respectively. Primary outcome was a good functional outcome defined as a modified Rankin scale score of 2 or less at 3 months. A secondary outcome was death at 3 months. Results: Of all acute ischemic stroke, 366 and 1540 patients were identified as pre and post commencement of stroke unit. There were no significant differences in mean age (69.5±13.1 years versus 69.2±12.2 years; p =.684), sex distribution (male, 59.8% versus 59.4%, p =.906) and mean National Institutes of Health Stroke Scale score at admission (5.7±5.4 versus 5.6±5.9, p =.759) between two epochs. Good functional outcome was increased from 46.4% to 53.6% ( p =.015) while mortality at 3 months dropped from 11.7 % to 5.4% ( p Conclusions: Our study shows the improvement of outcomes in patients with acute ischemic stroke after commencement of stroke unit care. Stroke unit care service needs to be expanded in other regional public hospitals in Korea.

The Addenbrooke's Cognitive Examination (ACE) is a valid dementia-screening test that is a simple and effective instrument. We aimed to assess the diagnostic accuracy of the Korean version of the ACE (K-ACE) in a Korean population. A total of 115 subjects (50 with Alzheimer's dementia [AD], 26 with mild cognitive impairment [MCI], and 39 controls) who visited the Neurology Outpatient Clinic of Seoul Medical Center were included. The ACE was translated and modified to create the K-ACE. The sensitivity, specificity, area under the curve, reliability, and Verbal-Language/Orientation-Memory ratio were evaluated. The receiver-operating characteristic (ROC) curve was used to determine the optimal cutoff score in screening for dementia. The ROC curves showed the superiority of the K-ACE over the Korean Mini-Mental Status Examination in the diagnosis of AD and MCI. The optimal cutoff of the K-ACE for the identification of AD was 68/69, which had a sensitivity of 90% and a specificity of 84%. The K-ACE is a short, reliable, and valid neuropsychological test battery used to screen for dementia in the Korean elderly.

Huntington's disease is caused by CAG trinucleotide expansions in the gene encoding huntingtin. N- terminal fragments of huntingtin with polyglutamine produce aggregates in the endosome-lysosomal system, where proteolytic fragments of huntingtin is generated. Heat shock protein 70 (HSP70) prevents the formation of protein aggregates, but the effect of HSP70 on the huntingtin in the endosome-lysosomal system is unknown. This study was to determine whether HSP70 alters the distribution of huntingtin in endosome-lysosomal system. HSP70 expressing stable cells (NIH/3T3 or cerebral hybrid cell line A1) were generated, and mutant [(CAG)(100)] huntingtin was transiently overexpressed. Analysis of subcellular distribution by immunocytochemistry or proteolysis cleavage by Western blotting was performed. 18 CAG repeat wild type [WT; (CAG)(18)] huntingtin was used as a control. Cells with huntingtin showed patterns of endosome-lysosomal accumulation, from a "dispersed vacuole (DV)" type into a coalescent "perinuclear vacuole (PV)" type over time. In WT huntingtin, HSP70 increased the cells with the PV types that enhanced the proteolytic cleavage of huntingtin. However, HSP70 reduced cells of the DV and PV types expressing mutant huntingtin, that result in less proteolysis than that of control. In addition, intranuclear inclusions were formed only in mutant cells, which was not affected by HSP70. These results suggest that HSP70 alters the distribution of huntingtin in the endosome- lysosomal system, and that this contributes to huntingtin proteolysis.

Motor conduction slowing in diabetic distal symmetrical polyneuropathy (DSP) generally exceeds that in distal axonal polyneuropathy. Additional mechanisms secondary to axonal injury may contribute to motor conduction slowing; however, its clinical and pathophysiological significance has rarely been discussed. The purpose of this study was to evaluate the clinical and pathophysiological significance of conduction slowing in DSP. We analyzed motor conduction in 50 patients with symptomatic painful DSP and 25 patients with asymptomatic painless DSP. Motor conduction data from 40 patients with amyotrophic lateral sclerosis (ALS) were used as controls for pure axonal conduction slowing. Compound muscle action potential amplitude (CMAP), distal motor latency (DL), and conduction velocity (CV) values were converted to a percentage of the upper or lower limits of normal and then presented in square root transformation (SQRT) form. Plots of SQRT-DL and SQRT-CV against SQRT-CMAP were analyzed. Regression analysis showed that DL and CV are amplitude-dependent in both painless DSP and ALS. Changes of DL and CV in painful DSP were not amplitude-dependent except for DL in the lower extremities. Our data support the hypothesis that the mechanism of slowing is similar in both painless DSP and ALS, and that it results from the loss of large, fast-conducting fibres. Lack of amplitude-dependency in conduction slowing in painful DSP may reflect combined axonal and demyelinating changes.

Objective Electroacupuncture (EA) is a traditional medicine in patients with post-stroke rehabilitation. Brain-derived neurotrophic factor (BDNF) is a potent growth factor involved in recovery following cerebral injury. The aim of the present study was to investigate whether EA increases BDNF levels and facilitates functional recovery. Methods Occlusion of the middle cerebral artery was performed in rats (N=12) followed by reperfusion. EA was applied at the GV20 (Baihui) acupoint. Motor and sensory functions were monitored on the Garcia scale for 2 weeks. Expressions of BDNF and receptor tyrosine kinase B (trkB) were determined by immunoblotting and immunohistochemistry. Results Improvement of Garcia scores, particularly in motor performance, were noted in the group with EA stimulation (pConclusion These results indicate that EA at GV20 improves motor recovery and stimulates BDNF/trkB expression in rats with cerebral ischaemia.

Recent studies have documented that testosterone relaxes several smooth muscles by modulating K(+) channel activities. Smooth muscles of seminal vesicles play a fundamental role in ejaculation, which might involve testosterone. This study was aimed to assess the role of testosterone in seminal vesicular motility by studying its effects on contractile agents and on the ion channels of single vesicular myocytes in a rabbit model. The contractile responses of circular smooth muscle strips of rabbit seminal vesicles to norepinephrine (10 microM), a high concentration of KCl (70 mM), and testosterone (10 microM) were observed. Single vesicular myocytes of rabbit were isolated using proteolytic enzymes including collagenase and papain. Inside-out, attached, and whole-cell configurations were examined using the patch clamp technique. The applications of 10 microM norepinephrine or 70 mM KCl induced tonic contractions, and 10 microM testosterone (pharmacological concentration) evoked dose-dependent relaxations of these precontracted strips. Various K(+) channel blockers, such as tetraethylammonium (TEA; 10 mM), iberiotoxin (0.1 microM), 4-aminopyridine (4-AP, 10 microM), or glibenclamide (10 microM) rarely affected these relaxations. Single channel data (of inside-out and attached configurations) of BK channel activity were also hardly affected by testosterone (10 microM). On the other hand, however, testosterone reduced L-type Ca(2+) currents significantly, and found to induce acute relaxation of seminal vesicular smooth muscle and this was mediated, at least in part, by Ca(2+) current inhibition in rabbit.

The smaller flip chip electronic packages are likely to have the higher current densities through their bumps, and this caused a failure due to electromigration at the eutectic SnPb solder bumps. In this study, we have analyzed the edge displacement with time and the relative Pb contents along the line as a result of the electromigration of eutectic SnPb using "edge drift" structures. It was of interest that an incubation stage for the edge drift was observed in the eutectic SnPb electromigration, i.e. there was a time duration before an edge began to move. The time duration for the incubation stage, and the drift velocity decreased in the smaller line length. It was observed that Pb became depleted at the cathode end while a pile-up of Pb was formed near the cathode end after the end of the incubation stage.

Background: The Korean version of Mini-Mental Status Examination (K-MMSE) and the Korean version of Addenbrooke Cognitive Examination (K-ACE) have been validated as quick neuropsychological tests for screening dementia in various clinical settings. Medial temporal atrophy (MTA) is an early pathological characteristic of Alzheimer's disease (AD). We aimed to assess the diagnostic validity of the fusion of the neuropsychological test and visual rating scale (VRS) of MTA in AD. Materials and Methods: A total of fifty subjects (25 AD, 25 controls) were included. The neuropsychological tests used were the K-MMSE and the K-ACE. T1 axial imaging visual rating scale (VRS) was applied for assessing the grade of MTA. We calculated the fusion score with the difference of neuropsychological test and VRS of MTA. The receiver operating characteristics (ROC) curve was used to determine optimal cut-off score, sensitivity and specificity of the fusion scores in screening AD. Results: No significant differences in age, gender and education were found between AD and control group. The values of K-MMSE, K-ACE, CDR, VRS and cognitive function test minus VRS were significantly lower in the AD group than control group. The AUC (Area under the curve), sensitivity and specificity for K-MMSE minus VRS were 0.857, 84% and 80% and for K-ACE minus VRS were 0.884, 80% and 88%, respectively. Those for K-MMSE only were 0.842, 76% and 72% and for K-ACE only were 0.868, 80% and 88%, respectively. Conclusions: The fusion of the neuropsychological test and VRS suggested clinical usefulness in their easy and superiority over neuropsychological test only. However, this study failed to find any difference. This may be because of small numbers in the study or because there is no true difference.

Light scattering and photon correlation spectroscopy were used to study nucleation in a fluid that is initially exposed to uniform and time-independent shear, S. The shear is abruptly turned off, and subsequently we measure the time dependence of the mean droplet size R(t) and the droplet number density N(t). It is found that N(t) depends critically on the value of S that was present prior to its being switched off. Existing theorize of nucleation, lacking a control parameter such as S, cannot be utilised to explain these observations, except when the shear is relatively weak

Light scattering was used to study nucleation in a quenched binary mixture exposed to a uniform shear. Shear deforms and ruptures droplets once they have grown to sufficient size. In the resulting steady state, the droplets are monodisperse in size. A plot or the cloud point line exhibits two segments or different slopes with a crossover near the temperature corresponding to the Becker-Doring limit. An energy-based argument explains a number or our observations

e15681 Background: To evaluate survival time and its prognostic factors contributing to survival of advanced unresected cholangiocarcinoma. Methods: We reviewed the experience of 330 patients with histologically proven unresected advanced intrahepatic and hilar cholangiocarcinoma and evaluated their survival time and significant prognostic factors. They did not receive any surgery, chemotherapy and radiotherapy and they underwent only palliative nonsurgical biliary drainage if it was needed to relieve biliary obstructive symptom. Results: Survival time of overall cholangiocarcinoma (median±SD) was 3.9±7.8 months; 3±5.3 months for intrahepatic cholangiocarcinoma, 5.9±10.1 months for hilar cholangiocarcinoma. By Kaplan-Meier survival analysis, intrahepatic cholangiocarcinoma patients survived significantly shorter than hilar cholangiocarcinoma patients. By multivariate analysis for intrahepatic cholangiocarcinoma, distant metastasis was independently associated with shorter survival time. Multivariate analysis for hilar cholangiocarcinoma showed initial CEA > 30 ng/dl were independent predictors of shorter survival. Conclusions: Patients with unresectable cholangiocarcinoma who do not undergo surgery, chemotherapy and/or radiotherapy have a dismal prognosis. We hope that the outcome of our study would help clinicians better predict the prognosis of cholangiocarcinoma patients not receiving such aggressive treatments. These data would be used as the comparable data for control groups of future studies to assess the outcome of newly designed or developed treatment method. No significant financial relationships to disclose.

21044 Background: Several studies have addressed the incidence of brain metastasis in HER-2/neu-overexpressing metastatic breast cancer. However, the relevance of HER-2/neu overexpression as a risk factor for brain metastases in breast cancer has not yet been clearly defined. The aim of this study is to analyze the risk of brain metastasis in HER-2/neu-positive early breast cancer patients in comparison with HER-2/neu-negative patients. Methods: We used tissue microarray to examine HER- 2/neu overexpression by immunohistochemistry (IHC) in 773 consecutive patients diagnosed with breast carcinoma who underwent surgery between January 1993 and December 1998. Patients were considered HER-2/neu-positive if they were 3+ on IHC testing. A total of 194 (25.1%) patients with HER-2/neu-overexpressing newly diagnosed breast cancer were identified in our study. The medical records and pathologic data of all 773 patients were reviewed retrospectively. Results: During a median follow-up period of 8.1 years, brain metastasis were identified in 7.2% (14 patients) with 194 HER-2/neu-overexpressing breast cancer compared with 2.6% (15 patients) in 597 HER-2/neu-negative patients (hazard ratio 2.924 [1.385–6.175], P=0.005). More HER-2/neu-overexpressing patients developed distant metastasis (33.5% vs. 18.8%, P=0.0001). The 8-year overall survival was 76.1% for HER-2/neu-negative patients versus 56.4% for HER-2/neu-positive patients (P No significant financial relationships to disclose.