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Evidence of Cortical Reorganization in a Monoparetic Patient with Cerebral Palsy Detected by Combined Functional MRI and TMS

  • Kwon, Yong-Hyun;Jang, Sung-Ho;Lee, Mi-Young;Byun, Woo-Mok;Cho, Yoon-Woo;Ahn, Sang-Ho
    • Journal of Yeungnam Medical Science
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    • v.22 no.1
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    • pp.96-103
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    • 2005
  • The motor recovery mechanism of a 21-year-old male monoparetic patient with cerebral palsy, who had complained of a mild weakness on his right hand since infancy, was examined using functional Magnetic Resonance Imaging (fMRI) and Transcranial Magnetic Stimulation (TMS). The patient showed mild motor impairment on the right hand. MRI located the main lesion on the left precentral knob of the brain. fMRI was performed on this patient as well as 8 control subjects using the Blood Oxygen Level Dependent technique at 1.5 T with a standard head coil. The motor activation task consisted of finger flexionextension exercises at 1 Hz cycles. TMS was carried out using a round coil. The anterior portion of the coil was applied tangentially to the scalp at a 1.0 cm separation. Magnetic stimulation was carried out with the maximal output. The Motor Evoked Potentials (MEPs) from both Abductor Pollicis Brevis muscles (APB) were obtained simultaneously. fMRI revealed that the unaffected (right) primary sensori-motor cortex (SM1), which was centered on precentral knob, was activated by the hand movements of the control subjects as well as by the unaffected (left) hand movements of the patient. However, the affected(right) hand movements of the patient activated the medial portion of the injured precentral knob of the left SM1. The optimal scalp site for the affected (right) APB was located at 1 cm medial to that of the unaffected (left) APB. When the optimal scalp site was stimulated, the MEP characteristics from the affected (right) APB showed a delayed latency, lower amplitude, and a distorted figure compared with that of the unaffected (left) APB. Therefore, the motor function of the affected (right) hand was shown to be reorganized in the medial portion of the injured precentral knob.

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Suitability Assessment of Domestic Natural Waters as a Culture Medium for Daphnia magna (Daphnia magna의 배양배지로서 국내 자연수의 적절성 평가)

  • Yeom, Dong-Hyuk;Jeon, Chan-Sig
    • Korean Journal of Ecology and Environment
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    • v.45 no.3
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    • pp.271-277
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    • 2012
  • The present study was conducted to assess the suitability of domestic natural waters as a Daphnia magna culture medium. In order to assess survival rate and reproductive output, young female daphnids (parent animals), aged less than 24 hours at the start of the test and produced in the Elendt M4 medium, were exposed to Elendt M4 medium, de-chlorinated tap water, and natural mineral water for 21 days. D. magna cultured in Elendt M4 medium (reference medium) and natural mineral water met the criteria of OECD No. 211, Daphnia magna Reproduction Test Guidelines in terms of percent adult survival, first day of reproduction, and average young production. However, the mortalities of adult daphnids observed in de-chlorinated tap water were more than 20% in two reproduction tests for 21 days. Mortality was observed on exposure days 13, 15, and 18 in de-chlorinated water. The use of D. magna is recommended in water of hardness >80 mg $CaCO_3\;L^{-1}$. However, the hardness of de-chlorinated tap water used in the present study was 50~53 mg $CaCO_3\;L^{-1}$. Therefore, it is judged that the delayed mortalities observed in de-chlorinated tap water were caused by a rapid decreased in hardness when the medium was changed from Elendt M4 to de-chlorinated tap water. When D. magna is cultured using domestic natural waters (underground water, surface water, and de-chlorinated water), the quality-control (QC) data should be maintained through a standardization for health assessment method, toxicity test method using reference chemical, test intervals of reference toxicant toxicity test, and data treatment and interpretation. In the long term, national research programs are needed for the development of test species which are representative of domestic aquatic environmental conditions among indigenous daphnids.

The Patient Recognition, Acceptability and Evaluation of Feasibility for Day Surgery (종합병원 일부 입원환자의 당일수술에 대한 태도와 당일수술 적용 가능성 평가)

  • Beak, Young-Ran;Lee, Kyeong-Soo;Kim, Seok-Beom;Kang, Pock-Soo;Kang, Young-Ah
    • Journal of Preventive Medicine and Public Health
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    • v.33 no.3
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    • pp.334-342
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    • 2000
  • Objectives . This study was conducted in order to investigate the degree of recognition, acceptability, and altitude towards day surgery of patients who were hospitalized with diseases that were candidates for day surgery; in order to analyze the average length of stay for treatment of the ailments; and to analyze the percentage of patients who could be discharged on the same day after the surgery ,using the post-anesthesia discharge scoring system. Methods : Data was collected between February 1 and March 31, 1999 from 353 patients who received surgery for cataract, adenoid hypertrophy, inguinal hernia, strabismus, ptosis, cholelithiasis, hemorrhoid, or anal fistula, at a general hospital in Daegu city. The patients were interviewed and surveyed by a post-anesthesia discharge scoring system(PADS) in order to collect data on patient condition such as vital signs, activity and mental status, pain, nausea and vomiting, surgical bleeding, intake and output after the surgery. Results : Among the 353 patients, 52.7% were after of the day surgery and 52.7% were interested in day surgery. Of the respondents, 43.1% said 'my ailment was not serious and the surgery was simple' and 30.4% said 'according to my condition rest at home was desirable' as the reasons for wanting day surgery Alternatively, 56.5% of those declining day surgery said the 'uncertainty of staying home' was the reason. The greatest concern in discharging within 24 hours after surgery was a post-op emergency situation. On the other hand, the shortened hospitalization was the largest advantage of day surgery with 39.1% responding this way, followed by the savings in hospitalization costs (25.8%) and emotional stability (13.7%). The majority of those surveyed (47.6%) believed that discharge should be determined within 1-2 days after the surgery. The average hospital stay was 3.1 days for dischargeable ailments. Pain (45.6%), nausea and vomiting (10.5%), and headache (7.9%) were the common symptoms following surgery. The percentage of patients who were able to be discharged within 24 hours after surgery revealed 95.2% were dischargeable after approximately 3 hours, 99.2% dischargeable after 12 hours, and 100% dischargeable after 24 hours. Conclusions : According to the PADS score, the cataract extract and strabismus correction patients were eligible for day surgery and the further evaluation concerning the reason for delayed recovery of the other diseases is needed.

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Emergency Coronary Artery Bypass Operation for Card iogen ic Shock (심인성 쇼크에 대한 응급 관상동맥 우회술)

  • 김응중;이원용
    • Journal of Chest Surgery
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    • v.30 no.10
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    • pp.966-972
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    • 1997
  • Between June 1994 to August 1996, 13 patients underwent emergency coronary artery bypass operations. There were 3 males and 10 females and ages ranged from 56 to 80 years with the mean of 65.5 years. The indications for emergency operations were cardiogenic shock in 12 cases and intractable polymorphic VT(ve'ntricular tachycardia) in 1 case. The causes of cardiogenic shock were acute evolving infarction in 6 cases, PTCA failure in 4 cases, acute myocardial infarction in 1 case, and post-AMI VSR(ventricular septal rupture) in 1 case. Pive out of 13 patients could go to operating room within 2 hours. However, the operations were delayed from 3 to 10 hours in 8 patients due to non-medical causes. In 12 patients, 37 distal anastomoses were constructed with only 3 LITA's(left internal thoracic arteries) and 34 saphenous veins. In a patient with post-AMI VSR, VSR repair was added. In a patient with intractable VT and critical sten sis limited to left main coronary artery, left main coronary angioplasty was performed. Pive patients died after operation with the operative mortality of 38.5%. Three patients died in the operating room due to LV pump failure, one patient died due to intractable ventricular tachycardia on postoperative second day, and one patient died on postoperative 7th day due to multi-organ failure with complications of mediastinal bleeding, low cardiac output syndrome, ARF, and lower extremity ischemia due to IABP. In 8 survived patients, 3 major complications (mediastinitis, PMI, UGI bleeding) developed but eventually recovered. We think that the aggressive approach to critically ill patients will salvage some of such patients and the most important factor for patient salvage is early surgical intervention before irreversible damage occurs.

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Post-Infarction Ventricular Septal Rupture : 10 Years of Experience (급성 심근경색증 후 심실중격 결손: 10년 경험)

  • Jung, Yo-Chun;Cho, Kwang-Ree;Kim, Ki-Bong
    • Journal of Chest Surgery
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    • v.40 no.5 s.274
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    • pp.351-355
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    • 2007
  • Background: Postinfarction ventricular septal rupture is associated with mortality as high as $85\sim90%$, if it is treated medically. This report documents our experience with postinfarction ventricular septal rupture that was treated surgically, Material and Method: We retrospectively reviewed the medical records of 11 patients who were operated on due to postinfarction ventricular septal rupture between August 1996 and August 2006. There were 4 men and 7 women, with a mean age of $70{\pm}11$ years (age range: $50\sim84$ years). The location of the rupture was anterior in 7 cases and posterior in 4 cases. The interval between the onset of acute myocardial infarction and the occurrence of the ventricular septal rupture was $2.0{\pm}1.3$ days (range: $1\sim5$ days). Operation was performed at an average of $2.4{\pm}2.7$ days (range: $0\sim8$ days) after the diagnosis of septal rupture. Preoperative intraaortic balloon pump therapy was performed in 10 patients. Result: The infarct exclusion technique was used in all cases. Coronary artery bypass grafting was done in 8 cases, with the mean number of distal anastomosis being $1.0{\pm}0.8$. There was one operative death. In 2 patients, reoperation was performed due to a residual septal defect. The postoperative morbidities were transient atrial fibrillation (n=7), paroxysmal supraventricular tachycardia (n=1), low cardiac output syndrome (n=3), bleeding reoperation (n=2), delayed sternal closure (n=2), acute renal failure (n=2), pneumonia (n=1), intraaortic balloon pump-related thromboembolism (n=1), and transient delirium (n=2). Nine patients have been followed up for a mean of $38{\pm}40$ months except for one follow-up loss. There have been 3 late deaths. At the latest follow-up, all 6 survivors were in a good functional class. Conclusion: We demonstrated satisfactory operative and midterm results with our strategy of preoperative intraaortic balloon pump therapy, early repair of septal rupture by infarct exclusion and combined coronary revascularization.

Effect of Barley Green Manure on Rice Growth and Yield According to Tillage Date in Spring (녹비보리의 환원시기가 후작물 벼 생육 및 수량에 미치는 영향)

  • Kim, Min-Tae;Ku, Ja-Hwan;Jeon, Weon-Tai;Seong, Ki-Yeong;Park, Chang-Young;Ryu, Jin-Hee;Cho, Hyeoun-Suk;Oh, In-Seok;Lee, Yong-Hwan;Lee, Jong-Ki;Park, Man;Kang, Ui-Gum
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.56 no.2
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    • pp.119-123
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    • 2011
  • To use barley as a green manure crop, this study has been conducted in Suwon, Gyeonggi-do to establish the barley green manure (BGM)-rice cropping system with emphasis on soil incorporation date and BGM density. The nitrogen (N) contents of rye and barley, grass green manure crops, were 1.4~2.4% at early growth stage and decreased rapidly to 0.6~1.0% at late growth stage. The biomass of barley was 449 kg/l0a at heading stage (HS) and increased to 421 kg/10a at 10 days after heading stage (DAH), 473 kg/10a at 20 DAH. C/N ratio of BGM was the lowest 26.3 at HS. The N contents of BGM was in the range of 0.9~1.5%, the highest at HS and gradually decreased, and the output of N were 4.3-6.3 kg/10a. The total amount of nitrogen, phosphorous and potassium of BGM showed the highest level at 10 DAH. Culm length of rice was relatively longer as the BGM application time was delayed. The application of BGM into soil increased plant height of rice by 7.2~7.7 em as compared to the plants treated with commercial fertilizer at recommended rate. but panicle length of rice showed a similar tendency in both the soil-applied of BGM and commercial fertilizer. N contents of unhulled rice was the highest at HS of BGM and followed by 10 DAH of BGM and 20 DAH of BGM. This trend could also be seen in rice straw. The yield of rice in the soil-applied of BGM was 10~15% lower than in the soil-applied of commercial fertilizer. Based on this study, application of BGM made it possible to save 30~50% of application amount of nitrogen fertilizer for following crops.

Evaluation of Community Land Model version 3.5-Dynamic Global Vegetation Model over Deciduous Forest in Gwangneung, Korea (광릉 활엽수림에서 Community Land Model 3.5-Dynamic Global Vegetation Model의 평가)

  • Lim, Hee-Jeong;Lee, Young-Hee;Kwon, Hyo-Jung
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.12 no.2
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    • pp.95-106
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    • 2010
  • The performance of Community Land Model version 3.5 - Dynamic Global Vegetation Model (CLM-DGVM) was evaluated through a comparison with the observation over temperate deciduous forest in Gwangneung, Korea. Influence of plant phenology, composition of plant functional type, and climate variability on carbon exchanges was also examined through sensitivity test. To get equilibrium carbon storage, the model was run for 400 years driven by the observed atmospheric data at the deciduous forest of the year 2006. We run the model for 2006 with the equilibrium carbon storage at Gwangneung forest and compared the model output with the observation. A comparison of leaf area index (LAI) between the model and observation indicated that the simulated phenology poorly represented the timing of budburst, leaf-fall, and evolution of LAI. Senescence of the phenology was delayed about four weeks and the simulated maximum LAI (of 5.8 $m^2$ $m^{-2}$) was greater than the observed value (of 4.5 $m^2$ $m^{-2}$). The overestimated LAI contributed to overestimation of both gross primary productivity (GPP) and ecosystem respiration $(R_e)$ through increased photosynthesis and foliar autotropic respiration $(R_a)$, respectively. Despite the discrepancy between the simulated and observed LAI, the simulated tree carbon storage amounts were comparable with the reported values at the site. Change in plant phenology from the simulated to the observed reduced more than six weeks of the plant growth period, resulting in the decreased amount of GPP and $R_e$. These values, however, were still higher (~10% of GPP and 40% of $R_e$) than the observed values. The effect of change in plant functional type composition (from dominant temperate deciduous forest to the coexistence of temperate deciduous and needle leaf forests) on the estimated amount of GPP and $R_e$ was marginal. The influence of climate variability on carbon storage amounts was not significant. The simulated inter-annual variation of GPP and $R_e$ from 1994 to 2003 depended on annual mean air temperature and total radiation but not on precipitation. Other deficiencies of CLM3.5-DGVM have been discussed.

Coronary Artery Bypass Grafting in Elderly Patients Older Than 75 Years (75세 이상 고령환자의 관상동맥우회로술)

  • Yoo Dong Gon;Kim Chong Wook;Park Chong Bin;Choo Suk Jung;Lee Jae Won;Song Meong Gun;Song Hyun
    • Journal of Chest Surgery
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    • v.38 no.2 s.247
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    • pp.123-131
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    • 2005
  • Background: The number of elderly patients undergoing coronary artery bypass grafting (CABG) is increasing. Elderly patients are at increased risk for a variety of perioperative complications and mortality. We identified determinants of operative complications and mortality in elderly patients undergoing CABG. Material and Method: Between January 1995 and July 2003, 91 patients older than 75 years underwent isolated CABG at Asan Medical Center. There were 67 men and 24 women with mean age of $77.0\pm2.4$ years. Thirty clinical or hemodynamic variables hypothesized as predictors of operative mortality were evaluated. Result: CABG was performed under emergency conditions in 5 patients. The internal thoracic artery was used in 85 patients and 10 patients received both internal thoracic arteries. The mean number of distal anastomosis was 3.7 per patient. Operative mortality was $3.3\%$. Twenty-two patients had at least one major postoperative complication. Low cardiac output syndrome was the most common complication, followed by reoperation for bleeding, pulmonary dysfunction, perioperative myocardial infarction, stroke, acute renal failure, ventricular arrhythmia, upper gastrointestinal bleeding, infection, and delayed sternal closure. None were the predictors of mortality. Renal failure, peripheral vascular disease, emergency operation, recent myocardial infarction, congestive heart failure, New York Heart Association (HYHA) class III or IV, Canadian Cardiovascular Society (CCS) angina scale III or IV, and low left ventricle ejection fraction below $40\%$ were univariate predictors of overall complications. Actuarial probability of survival was $94.9\%,\;89.8\%,\;and\;83.5\%$ at postoperative 1, 3 and 5 years respectively. During the follow-up period $93.3\%$ of patients were in NYHA class I, or II and $91.1\%$ were free from angina. Conclusion: Although operative complication is increased, CABG can be performed with an acceptable operative mortality and excellent late results in patients older than 75 years.

Coronary Artery Bypass Graft in Patient with Advanced Left Ventricular Dysfunction (중등도 이상의 좌심실 기능 부전 환자에서의 관상동 우회술의 임상 분석)

  • 정종필;김승우;신제균
    • Journal of Chest Surgery
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    • v.34 no.12
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    • pp.901-908
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    • 2001
  • Background : Coronary artery bypass graft(CABG) in patients with advanced left ventricular dysfunction has often been regarded as having high mortality rate, despite the great improvement in operative result of CABG. With recent advances in surgical technique and myocardial protection, surgical revascularization improved the symptom and long-term survival of these high risk patients more than the medical conservative treatment. Material and Methold : Clinical data of 31(4.1%) patients with preoperative ejection fraction less than 30% among 864 CABGs performed between January 1995 and March 1999 were retrospectively analyzed and pre- and postoperative changes of the ejection fraction on echocardiography were analyzed. There were 26 men and 5 women. The mean age was 60.7 years(range 41 to 72 years). History of myocardial infarction(30 cases, 98%) was the most common preoperative risk factor. There were seven irreversible myocardial infarction on thallium scan. Most patients had triple vessel diseases(26 cases, 84%) and first degree of Rentrop classification(16 cases, 52%) on coronary angiography. The mean number of distal anastomosis during CABG was per patient was 4.9${\pm}$0.8 sites in each patient. In addition to long saphenous veins, the internal mammary artery was used in 20 patients. Total bypass time was 244.7${\pm}$3.7 minutes(range, 117 to 567 minutes), and mean aortic cross-clamp time was 77.9 ${\pm}$ 1.6 minutes(range, 30 to 178 minutes). There were five other reparative procedures such as two left ventricular aneurysrmectomy, two mitral repair, and one aortic valve replacement. There were twelve postoperative complications such as three cardiac arrhythmia, two bleeding(re-operation), one delayed sternal closure, eleven usage of intra-aortic balloon counterpulsation for low cardiac output. Two patients died, postoperative mortality was 6.5% . Twenty-nine patients were relieved of chest pain and left ventricular ejection fraction after operation was significantly higher(38.5${\pm}$11.6%, p 0.001) as compared with preoperative left ventricular ejection fraction(25.3${\pm}$2.3%). The follow up period of out patient was 25. 3 months. Conclusion: In patients with coronary artery disease and advanced left ventricular dysfunction, coronary artery bypass grafting can be performed relatively safely with improvement in left ventricular function, but it will be necessary to study long term results.

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