The purpose of this study is to introduce the method of palate repair that combines minimal hard palate dissection and radical retropositiong of levator musculature, which was presented by Sommerlad. As this method presents, additional use of the operating microscope enables atraumatic and radical dissection, and it might provide more improved speech function to the patients. A total of 17 patients with cleft palate underwent Sommerlad's method from December 2003 to August 2004. The mean follow-up period was 4.5 months. The use of a microscope provided high quality variable magnification and good illumination at the operating field. Repair was carried out through incisions at the margins of cleft with mucoperiosteal flap elevation. Muscles were rearranged and repaired properly. It was unable to evaluate the improvement of speech because the patients were too young to learn meaningful speech. Average operating time including anesthetic induction time, V-tube insertion and recovery from anesthesia was 2 hours 45 minutes which was not quite different from conventional method's operating time. Oronasal fistula developed in 2 patients of them. One of them was healed spontaneously. As meticulous and radical muscle dissection was possible with Sommerlad's method, we could minimize the trauma to the muscular and neurovascluar structure. In addition, we expect better faculty of speech as a result of this method although longer follow-up time was unavailable.
In clinical neurology various different electrophysiological tests are widely used to demonstrate the unsuspected malfunctioning in the nervous system and to monitor over time the clinical status of patients. In addition clinical neurologists and neurosurgeons take advantage of the intraoperative monitorings to increase the quality of neurosurgical operations in the posterior fossa, in the spinal cord, or in visual pathways. In the field of movement disorders, elecrophysiolgical tests provide neurologists with making accurate differential diagnoses with useful therapeutic stratergies as well as with investigating the pathophysiological machanisms. By using the electromyographic tests it could be possible for us to evaluate the types of blephalospasm, the extent of hemifacial spasm, the level of myoclonus, and the prime muscles of torticollis etc. Sometimes the myographic guidance may be critical for choosing the exact injecting site of botulinum toxin. These several decades various electroencephalographic and evoked potential tests has been utilized in the electrophysiological laboratories to understand the basic pathophysiology of myoclonus, spasticity and other central motor dysfunctions. It could be one of the breakthroughs in the area of behavorial neurology that the brain function can be mapped by the spontaneous or evoked electrical activities of nervous system since the movement related potentials (MRPs) had been studies for several decades. Various reflex tests such as masseter reflex, blink reflex, click evoked vestibulocollic reflex, facial reflex, stretch reflex, flexor reflex, H-reflex, H-reflex recovery curve, vestibular inhibition of H-reflex, reciprocal inhibition, recurrent or Renshaw reflex, Ib inhibition, cutaneous reflex have been also used to understand normal or abnormal physiology in movement disorders. Polysomnography, posturography and gait studies are also applied in clinical neurology in association with with movement disorders which are useful in deciding the treatment regimen.
Kim, Sook Za;Song, Woong Ju;Jeon, Young Mi;Levy, Harvey L.
Journal of The Korean Society of Inherited Metabolic disease
/
v.13
no.1
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pp.48-53
/
2013
Tyrosinemia I (fumarylacetoacetate hydrolase deficiency) is an autosomal recessive inborn error of tyrosine metabolism that produces liver failure in infancy or a more chronic course of liver disease with cirrhosis, often complicated by hepatocellular carcinoma in childhood or early adolescence. We studied a 37-year-old woman with tyrosinemia I whose severe liver disease in infancy and rickets during childhood were resolved with dietary therapy. From 14 years of age, she resumed unrestricted diet with the continued presence of the biochemical features of tyrosinemia, yet maintained normal liver function. In adult years, she accumulated only a small amount of succinylacetone. Despite this evolution to a mild biochemical and clinical phenotype, she eventually developed hepatocellular carcinoma. Her fumarylacetoacetate hydrolase genotype consists of a splice mutation, IVS6-1G>T, and a novel missense mutation, p.Q279R. Studies of resected liver revealed the absence of hydrolytic activity and immunological expression of fumarylacetoacetate hydrolase in tumour. In the non-tumoral areas, however, 53% of normal hydrolytic activity and immunologically present fumarylacetoacetate hydrolase were found. This case demonstrates the high risk of liver cancer in tyrosinemia I even in a seemingly favorable biological environment. In this study of tyrosinemia I, Case 2 with negative succinylacetone accumulation and the recovery of acute liver failure was compared with Case 1. Diet restriction and NTBC treatment are crucial to prevent hepatocellular carcinoma until liver transplant can take place and cure the condition. Further studies are needed to examine cases where liver cancer did not result despite clinical symptoms/signs of tyrosinemia type I.
Hwangryunagyotang is supposed to have significant effects on some sorts of cardiovascular diseases like atherosclerosis. For this study. ACAT inhibitor was put in LDLR -/- mice to derive free cholesterol from it. This was to examine the effectiveness of Hwangryunnagyotang on its protecting and recovering function with endothelial cells damaged by free cholesterol through experimental. The results reported below. Hwangryunagyotang suppressed the crystallization of reactive oxygen species in macrophages and the numbers of free cholesterol crystal plate structured and reduced fragmentation of nucleus in ECV 304 cell strain by ACAT inhibitor significantly. Hwangryunagyotang also suppressed the necrosis of tissue in LDLR -/- mice' (treated with ACAT inhibitor) inflammatory portion which is adjacent to aortic root, proximal aorta and carotid artery by immunohistochemistry and fluorescence microscopy. On the whole, Hwangryunagyotang suppressed the necrosis of endothelial cells and especially it's effcet for the necrosis of para-myocardial tissues by free cholesterol. With this result, I suggest Hwangryunagyotang might have protective and recovery effects on atherosclerosis, so we need to carry on this study henceforth clinically and experimentally as well.
Objective : We aimed to analyze the effectiveness of external neurolysis on the common peroneal nerve (CPN) in patients with posture-induced compressive peroneal neuropathy (PICPNe). Further, we aimed to examine the utility of magnetic resonance imaging (MRI) in assessing the severity of denervation status and predicting the postoperative prognosis. Methods : We included 13 patients (eight males and five females) with foot drop who underwent CPN decompression between 2018 and 2020. We designed a grading system for assessing the postoperative functional outcome. Additionally, we performed MRI to evaluate the denervation status of the affected musculature and its effect on postoperative recovery. Results : The median time to surgery was 3 months. The median preoperative ankle dorsiflexion and eversion grades were both 3, while the average functional grade was 1. Posterior crural intermuscular septum was the most common cause of nerve compression, followed by deep tendinous fascia and anterior crural intermuscular septum. There was a significant postoperative improvement in the median postoperative ankle dorsiflexion and eversion grades and average postoperative functional (4, 5, and 2.38, respectively). Preoperative ankle eversion was significantly correlated with denervation status. Additionally, the devernation status on MRI was positively correlated with the outcome favorability. However, denervation atrophy led to a less favorable outcome. Conclusion : Among patients with intractable PICPNe despite conservative management, surgical intervention could clinically improve motor function and functional ability. Additionally, MRI examination of the affected muscle could help diagnose CPNe and assess the postoperative prognosis.
Samuel Schick;Alex Dombrowsky;Jamal Egbaria;Kyle D. Paul;Eugene Brabston;Amit Momaya;Brent Ponce
Clinics in Shoulder and Elbow
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v.26
no.3
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pp.267-275
/
2023
Background: Physical therapy (PT) plays an important role in the recovery of function following anatomic total shoulder arthroplasty (aTSA). While several PT protocols have been published for these patients, there is no standardized protocol for aTSA rehabilitation. This lack of standardization may lead to confusion between patients and physicians, possibly resulting in suboptimal outcomes. This study examines how PT protocols provided by academic orthopedic surgery programs vary regarding therapeutic goals and activities following aTSA. Methods: PT protocols for aTSA available online from the Accreditation Council for Graduate Medical Education accredited orthopedic surgery programs were included for review. Each protocol was analyzed to evaluate it for differences in recommendation of length of immobilization, range of motion (ROM) goals, start time for and progression of therapeutic exercises, and timing for return to functional activity. Results: Of 175 accredited programs, 25 (14.2%) had protocols publicly available, programs (92%) recommended sling immobilization outside of therapy for an average of 4.4±2.0 weeks. Most protocols gave recommendations on starting active forward flexion (24 protocols, range 1-7 weeks), external rotation (22 protocols, range 1-7 weeks), and internal rotation (18 protocols, range 4-7 weeks). Full passive ROM was recommended at 10.8±5.7 weeks, and active ROM was 13.3±3.9 weeks, on average. ROM goals were inconsistent among protocols, with significant variations in recommended ROM and resistance exercise start times. Only 13 protocols (52%) gave recommendations on resuming recreational activities (mean, 17.4±4.4 weeks). Conclusions: Publicly available PT protocols for aTSA rehabilitation are highly variable. Level of evidence: IV.
Journal of the Korean Society of Industry Convergence
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v.27
no.4_2
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pp.833-840
/
2024
According to recent data from the Korea Meteorological Administration(KMA), the frequency of typhoons around the Korea Peninsula is almost unchanged, but the intensity is on the rise due to climate change. A typhoon that has become so powerful can cause partial or complete damage to the traffic signal structures, limiting the operation of the vehicle and causing traffic congestion. If the traffic signal structure fails to function properly due to the influence of the typhoon, not only the v ehicle operation will be disrupted, but also direct damage to the traffic signal structure will occur. In addition, if the social overhead cost of traffic congestion is included, the recovery cost caused by the typhoon will increase to an extent that it is difficult to estimate. Therefore, in this study, a wind tunnel experiment was performed by producing a wind tunnel model of an existing fixed traffic signal structure and a traffic signal structure in which signs and traffic lights are hinged. Also, The fixed and hinge structures were modeled as 3D finite elements, and wind-resistant analysis was performed by wind speed, and, wind-resistant safety of traffic signal structures were analyzed and examined through wind-resistant analyses. From the comparative analysis of the results of experiment and FE analysis, it was known that the stress reduction rate of the hinge connection structure was at least 30% compared to that of the fixed connection structure from the results of the wind tunnel experiment and FE analysis. And As a result of finite element analysis for the maximum design wind speed of 50m/s, it was found that the maximum stress generated in the existing structure exceeded all the yield stress, but the maximum stress of the hinge connection structure was within the yield stress. Finally The hinge connection structure showed a relatively large stress reduction rate as the wind speed increased and the length of the lateral beam was shorter at the same wind speed.
Objectives : The aim of present study was to investigate recovery effects of gypsum, which has been used clinically in diabetes therapy. Methods : We established three groups, normal, control, and gypsum, and assigned 6 rats to each group. The normal group was not treated by any process and fed normal saline. The control & gypsum groups were administered streptozotocin(STZ) to induce diabetes. Gypsum extract was orally administered to the gypsum group for 10 days. After 8 weeks, the rats were sacrificed and their body weight, 24hrs urinary protein excretion, glucose, albumin, BUN, creatinine, total-cholesterol, LDL-cholesterol, triglyceride in blood, level of glycation end-product (AGE) and transforming growth factor ($TGF-{\beta}1$) in serum were measured. Morphological profiles and morphometric studies of the kidney cortex. renal transforming growth factor ($TGF-{\beta}1$) expression, macrophage/monocyte antigen (ED-1), and type IV collagen expression were studied. Results : The following results were obtained. The protein amount in urine per 24hrs of the gypsum-treated group as compared to the control was significantly reduced. The BUN and creatinine level in serum of the gypsum-treated group as compared to the control was significantly inhibited. The construction change in the kidneys of the gypsum-treated group as compared to the control was significantly inhibited. The factor of the gypsum-treated group as compared to the control was significantly inhibited. which induced the structural change in the kidneys. Conclusions : The above results suggest that gypsum partially improved kidney function.
This paper presents a study of the microstructure and mechanical properties of commercial high-hardness armor (HHA) steels tempered at different temperatures. Although the as-received specimens of all the steels exhibit a tempered martensite structure with lath type morphology, the A steel, which has the smallest carbon content, had the lowest hardness due to reduced solid solution hardening and larger lath thickness, irrespective of tempering conditions. As the tempering temperature increases, the hardness of the steels steadily decreases because dislocation density decreases and the lath thickness of martensite increases due to recovery and over-aging effects. When the variations in hardness plotted as a function of tempering temperature are compared with the hardness of the as-received specimens, it seems that the B steel, which has the highest yield and tensile strengths, is fabricated by quenching, while the other steels are fabricated by quenching and tempering. On the other hand, the impact properties of the steels are affected by specimen orientation and test temperature as well as microstructure. Based on these results, the effect of tempering on the microstructure and mechanical properties of commercial high-hardness armor steels is discussed.
We have investigated the two types of voltage-dependent outward potassium (K) currents, i.e. delayed rectifier K current ($I_{K(V)}$) and 'A-like' transient outward K current ($I_{to}$) with patch-clamp technique in single smooth muscle cells (SMCs) isolated from rabbit basilar artery, and investigated the characteristics of them. The time-courses of activation were well fitted by exponential function raised to second power ($n^2$) in $I_{K(V)}$ and fourth power ($n^4$) in $I_{to}$. The activation, inactivation and recovery time courses of $I_{to}$ were much faster than that of $I_{K(V)}$. The steady-state activation and inactivation of $I_{K(V)}$ was at the more hyperpolarized range than that of $I_{to}$ contrary to the reports in other vascular SMCs. Tetraethylammonium chloride (TEA; 10 mM) markedly inhibited $I_{K(V)}$ but little affected $I_{to}$. 4-Aminopyridine (4-AP) had similar inhibitory potency on both currents. While a low concentration of $Cd^{2+}$ (0.5 mM) shifted the current- voltage relationship of $I_{to}$ to the positive direction without change of maximum conductance, $Cd^{2+}$ did not cause any appreciable change for $I_{K(V)}$.
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