• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.437-448
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• 2018

Objective: Acute ischemic stroke (AIS) requires time-dependent reperfusion therapy, and early recognition of AIS is important to patient outcomes. This study was conducted to identify the clinical features and risk factors of AIS patients that are missed during the early stages of diagnosis. Methods: We retrospectively reviewed AIS patients admitted to a hospital through the emergency department. AIS patients were defined as ischemic stroke patients who visited the emergency department within 6 hours of symptom onset. Patients were classified into two groups: an activation group (A group), in which patients were identified as AIS and the stroke team was activated, and a non-activation group (NA group), for whom the stroke team was not activated. Results: The stroke team was activated for 213 of a total of 262 AIS patients (81.3%), while it was not activated for the remaining 49 (18.7%). The NA group was found to be younger, have lower initial National Institutes of Health Stroke Scale scores, lower incidence of previous hypertension, and a greater incidence of cerebellum and cardio-embolic infarcts than the A group. The chief complaints in the A group were traditional stroke symptoms, side weakness (61.0%), and speech disturbance (17.8%), whereas the NA group had non-traditional symptoms, dizziness (32.7%), and decreased levels of consciousness (22.4%). Independent factors associated with missed stroke team activation were nystagmus, nausea/vomiting, dizziness, gait disturbance, and general weakness. Conclusion: A high index of AIS suspicion is required to identify such patients with these findings. Education on focused neurological examinations and the development of clinical decision tools that could differentiate non-stroke and stroke are needed.

• The Plant Pathology Journal
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• v.33 no.2
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• pp.163-169
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• 2017

$SIMAPKKK{\alpha}$, a tomato (Solanum lycopersicum) mitogen-activated protein kinase kinase kinase, is a positive regulator of Pto-mediated effector-triggered immunity, which elicits programmed cell death (PCD) in plants. In this study, we examined whether putative phosphorylation sites in the conserved activation segment of the $SIMAPKKK{\alpha}$ kinase domain are critical for eliciting PCD. Three amino acids, $threonine^{353}$, $serine^{360}$ ($Ser^{360}$), or $serine^{364}$ ($Ser^{364}$), in the conserved activation segment of $SIMAPKKK{\alpha}$ kinase domain were substituted to alanine (T353A, S360A, or S364A), and these variants were transiently expressed in tomato and Nicotiana benthamiana plants. Two alanine substitutions, S360A and S364A, completely abolished $SIMAPKKK{\alpha}$ PCD-eliciting activity in both plants, while T353A substitution did not affect its PCD-eliciting activity. $SIMAPKKK{\alpha}$ wild type and variant proteins accumulated to similar levels in plant leaves. However, $SIMAPKKK{\alpha}$ protein with the largest size was missed when either S360A or S364A substitutions were expressed, whereas proteins with the smaller masses were more accumulated than those of full-length of $SIMAPKKK{\alpha}$ and T353A. These results suggest that phosphorylation of $SIMAPKKK{\alpha}$ at $Ser^{360}$ and $Ser^{364}$ is critical for PCD elicitation in plants.

• Journal of Society of Occupational Therapy for the Aged and Dementia
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• v.12 no.2
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• pp.87-95
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• 2018

Objective : Vibration stimulators are easier to obtain in clinical settings than other treatment tools, and it is advantageous that the arm activation training can be performed passively. Despite the following advantages, recent studies on vibration sense have not been activated yet. The purpose of this study was to investigate the effect of vibration sensation on the hands of the affected upper limb on unilateral reduction of stroke patients. Method : Patients with unilateral neglect due to stroke were enrolled in this study for about 3 weeks from October 19, 2018 to November 7, The research design used ABA design among the single-subject experimental research design, and a total of 18 circuits (4 baseline, 6 intervention, 3 baseline regression) were performed once a day on weekdays Respectively. MMES-K was used to select the subjects. Line bisection test (LBT), Albert's test and Star Cancellation Test (SCT) were used as unilateral neglect test. For the analysis, the baseline and intervention period measurements were visually analyzed using graphs and mean values were used. Result : All three evaluations showed that the number of errors missed during the training period was lower than the baseline period, and this decrease remained after training. The error was reduced by an average of $2{\pm}1.2$ omissions and an average omissions of $0.6{\pm}0.5$ omitting an average of $4.5{\pm}1$ omissions in the line break test. As a result of the Albert test, the average error decreased by $22.5{\pm}1.9$ omissions and $8{\pm}7.3$ omissions and $0.3{\pm}0.5$ omissions, respectively. In the star clearance test, the average error decreased from $26{\pm}4.6$ to $21.8{\pm}1.7$ and $20{\pm}0$, respectively. Conclusion : In this study, vibrotactile stimulation therapy showed a continuous effect on improving unilateral neglect. Based on these findings, further research should be conducted in order to improve objectivity in future studies. Further research on various arbitration methods that maximize the effect of intervention will be needed.