Background: Hemispheric asymmetry studies of working memory are mainly carried out in western countries. Data on Chinese is limited in this area of research. On the other hand, working memory assessment can be limited by the temporal resolution of the imaging modality as well as the design of the cognitive paradigm. These methodological limitations infl uence result interpretation hence hinder cross study comparison. Hemispheric study of memory using a pure working memory paradigm on native Chinese speakers, using a hemodynamic technique with high temporal resolution is thus mandatory. Objective: We aimed to investigate the feasibility of the functional transcranial Doppler sonography (fTCD) and 2-back task with alphabets in assessing the hemispheric lateralization of memory in healthy right-handed Chinese. Methods: Thirteen healthy right-handed Chinese subjects (7 males and 6 females, 19-22 years old) were included. Bilateral monitoring of the cerebral blood fl ow velocity (CFBV) changes in their left and right middle cerebral arteries (MCAs) was performed using fTCD during their performance of a 2-back working memory task with alphabets. Differences of CBFV change between left and right MCAs were analyzed, and the laterality index (LI) was determined. Results: Left lateralization was found in all subjects, with females performed better than males (p < 0.05). No difference in age, response time and LI between the male and female subjects could be observed (p > 0.05). A weak correlation was found between performance accuracy/response time and LI (r2 = 0.12). Conclusion: To the best of our knowledge, this is the fi rst report on the use of fTCD in memory function assessment in Chinese. The consistency of our results with previous studies demonstrates the feasibility as well as the potential application of the 2-back task with alphabets and f

PURPOSE: Goggles are frequently worn in the sport of swimming and are designed to form a seal around the periorbital tissue orbit. The resultant pressure on the eye may have the potential to affect intraocular pressure and blood flow of the optic nerve head. This study evaluates the influence of wearing swimming goggles on intraocular pressure (IOP) and blood flow of the ocular nerve head (ONH) in normal subjects. MATERIALS AND METHODS: Thirty healthy participants took part in this study. The IOP of each participant was measured using a Goldmann tonometer. Measurements were taken immediately before putting on swimming goggles, at 5, 10, 30, and 60 minutes after putting on swimming goggles, and then immediately after taking off the goggles. Blood flow of the ONH was measured using the Heidelberg retinal flowmeter. RESULTS: The average IOP before, during and after wearing the swimming goggles were 11.88 +/- 2.82mmHg, 14.20 +/- 2.81 mmHg and 11.78 +/- 2.89mmHg, respectively. The IOP increased immediately after putting on the goggles (p < 0.05) and then returned to normal values immediately after removal (p > 0.05). Blood flow of the ONH was 336.60 +/- 89.07 Arbitrary Units (AU) before and 319.18 +/- 96.02 AU after the goggles were worn (p < 0.05). CONCLUSION: A small but significant IOP elevation was observed immediately after the swimming goggles were put on. This elevated IOP was maintained while the goggles were kept on, and then returned to normal levels as soon as they were taken off. Blood flow of the ONH did not change significantly throughout the experiment. These facts should be considered for safety concerns, especially in advanced glaucoma patients.
Adult ; Eye Protective Devices/*adverse effects ; Female ; Humans ; *Intraocular Pressure ; Male ; Optic Disk/*blood supply ; Regional Blood Flow ; *Swimming ; Time Factors

60 years of age. A total of 588,147 participants were randomly selected for senior cohort using 10% simple random sampling. We identified senile (> 65 years old) patients who underwent hip fracture surgery from January 2005 to December 2014 and those who developed pneumonia during hospitalization from the NHIS-Senior cohort. The index date of hip fracture occurrence was defined as the date of admission to the acute care hospital. The last date of follow-up was defined as the date of death or 31 December 2015, whichever came first. A multivariable-adjusted Cox proportional hazards model was used to investigate the effects of pneumonia on all-cause mortality.RESULTS: During the enrollment period, a total of 14,736 patients, who were older than 65 years, underwent hip fracture surgeries. Among them, 1,629 patients (11.05%) developed pneumonia during the hospitalization. The pneumonia incidence was 16.39% (601/3,666) in men patients and 9.29% (1,028/10,042) in women patients. Compared to 13,107 non-pneumonia patients, adjusted relative risk (aRR) of death in pneumonia patients was 2.69 (95% confidence interval [CI], 2.14–3.38; P < 0.001) within postoperative 30-day, 3.40 (95% CI, 3.01–3.83; P < 0.001) within postoperative 90-day, 2.86 (95% CI, 2.61–3.15; P < 0.001) within postoperative 180-day and 2.31 (95% CI, 2.14–2.50; P < 0.001) within postoperative 1-year. According to patient's age, the aRR of death in pneumonia patients was 5.75 (95% CI, 2.89–11.43) in adults aged < 70 years, 5.14 (95% CI, 4.08–6.46) in those aged 70–79 years, 3.29 (95% CI, 2.81–3.86) in those aged 80–89 years and 2.02 (95% CI, 1.52–2.69) in those aged ≥ 90 years. The aRR was 3.63 (95% CI, 3.01–4.38) in men pneumonia patients, and 3.27 (95% CI, 2.80–3.83) in women pneumonia patients.CONCLUSION: The prevalence of pneumonia in elderly hip fracture patients was 11.05%. Men had higher incidence (16.39%) than women (9.29%). Compared to non-pneumonia patients, the pneumonia patients had higher 30-day to 1-year mortalities with aRR of 2.31 to 3.40. They had increased mortality in all age groups older than 65 years with aRR of 1.52 to 4.08. Both genders of pneumonia patients had higher risk of mortality (aRR, 3.63 in men and 3.27 in women) compared to non-pneumonia patients.]]>
Adult ; Aged ; Cohort Studies ; Female ; Follow-Up Studies ; Hip ; Hospitalization ; Humans ; Incidence ; Korea ; Male ; Mortality ; National Health Programs ; Pneumonia ; Prevalence ; Proportional Hazards Models

BACKGROUND: The purposes of this study were 1) to investigate the incidence of pneumonia during hospitalization in elderly hip fracture patients, 2) to evaluate the effect of pneumonia on 30 day to 1 year mortality and 3) to analyze the impact of age and gender on the mortality rate in the pneumonia patients using a nationwide cohort of Korea. METHODS: The Korean National Health Insurance Service (NHIS) database included approximately 5.5 million Korean enrollees > 60 years of age. A total of 588,147 participants were randomly selected for senior cohort using 10% simple random sampling. We identified senile (> 65 years old) patients who underwent hip fracture surgery from January 2005 to December 2014 and those who developed pneumonia during hospitalization from the NHIS-Senior cohort. The index date of hip fracture occurrence was defined as the date of admission to the acute care hospital. The last date of follow-up was defined as the date of death or 31 December 2015, whichever came first. A multivariable-adjusted Cox proportional hazards model was used to investigate the effects of pneumonia on all-cause mortality. RESULTS: During the enrollment period, a total of 14,736 patients, who were older than 65 years, underwent hip fracture surgeries. Among them, 1,629 patients (11.05%) developed pneumonia during the hospitalization. The pneumonia incidence was 16.39% (601/3,666) in men patients and 9.29% (1,028/10,042) in women patients. Compared to 13,107 non-pneumonia patients, adjusted relative risk (aRR) of death in pneumonia patients was 2.69 (95% confidence interval [CI], 2.14–3.38; P < 0.001) within postoperative 30-day, 3.40 (95% CI, 3.01–3.83; P < 0.001) within postoperative 90-day, 2.86 (95% CI, 2.61–3.15; P < 0.001) within postoperative 180-day and 2.31 (95% CI, 2.14–2.50; P < 0.001) within postoperative 1-year. According to patient's age, the aRR of death in pneumonia patients was 5.75 (95% CI, 2.89–11.43) in adults aged < 70 years, 5.14 (95% CI, 4.08–6.46) in those aged 70–79 years, 3.29 (95% CI, 2.81–3.86) in those aged 80–89 years and 2.02 (95% CI, 1.52–2.69) in those aged ≥ 90 years. The aRR was 3.63 (95% CI, 3.01–4.38) in men pneumonia patients, and 3.27 (95% CI, 2.80–3.83) in women pneumonia patients. CONCLUSION The prevalence of pneumonia in elderly hip fracture patients was 11.05%. Men had higher incidence (16.39%) than women (9.29%). Compared to non-pneumonia patients, the pneumonia patients had higher 30-day to 1-year mortalities with aRR of 2.31 to 3.40. They had increased mortality in all age groups older than 65 years with aRR of 1.52 to 4.08. Both genders of pneumonia patients had higher risk of mortality (aRR, 3.63 in men and 3.27 in women) compared to non-pneumonia patients.

Most epidermal growth factor receptor (EGFR) gene mutations are detected in lung adenocarcinomas. In contrast, these mutations have rarely been reported in small cell lung cancer (SCLC). We herein report two cases of EGFR-mutant SCLC transformed from and combined with lung adenocarcinoma. In one case, SCLC appeared to be transformed from EGFR mutant 19-del adenocarcinoma when the patient became resistant to gefitinib. The other patient had combined EGFR-mutant 19-del SCLC and adenocarcinoma at the initial diagnosis, which was resistant to gefitinib at multiple sites. Further comparative molecular analyses of these histologically distinct tumors would provide useful information regarding the role of EGFR mutation in the pathogenesis of SCLC. In conclusion, despite the presence of the same EGFR mutation, gefitinib was not effective in treatment of SCLC. Therefore, confirmation of SCLC cell morphology may become an important means of predicting resistance to EGFR tyrosine kinase inhibitors in addition to common secondary genetic alterations.
Adenocarcinoma* ; Diagnosis ; Drug Resistance ; Humans ; Lung* ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor* ; Small Cell Lung Carcinoma*

PURPOSE: To evaluate the risk factors of sliding after internal fixation with sliding compression hip screw in stable intertrochanteric fracture of the femur. MATERIALS AND METHODS: From March 2000 to April 2003, 61 stable intertrochanteric fractures (Kyle-Gustilo type II) were treated operatively with sliding compression hip screws. The patients were 40 females and 21 males with an average age of 74 (range, 54~99). We measured vertical and horizontal shortening in regard to age, sex, bone mineral density, neck-shaft angle, cancellous bone defect, and the existence of lessor trochanter fracture on postoperative 6 months. RESULTS: The average vertical shortening was 4.1 mm (0~22 mm) and the average horizontal shortening was 7.3 mm (0~30 mm). Age, sex, bone density and neck-shaft angle were not significantly related with vertical and horizontal shortening (p>0.05). Vertical shortening was significantly greater in the group with cancellous bone defect and in the group without lesser trochanter fracture (p<0.05). CONCLUSION: Proper management for fracture site and fixation was needed to make it stable because the stable intertrochanteric fracture with cancellous bone defect and intact lesser trochanter could be induced into unexpected sliding.
Bone Density ; Female ; Femur* ; Hip ; Hip Fractures ; Humans ; Male ; Risk Factors

The vast majority of epidermal growth factor receptor (EGFR) gene mutations are detected in lung adenocarcinoma. EGFR mutations are the strongest predictor of response to EGFR tyrosine kinase inhibitor (TKI) treatment in patient with advanced non-small cell lung cancer. Of these, exon 19 deletions and exon 21 L858R point mutations account for more than 80% of mutations detected in tumor with EGFR mutations, which called classical EGFR mutations, and double mutations mainly composed of classical and uncommon EGFR mutations are reported to be present in 13% of total EGFR mutations. But there has been no report to date of patient with double mutation of TKI sensitive uncommon EGFR mutations (G719C and L861Q). We experienced a case of patient with lung adenocarcinoma with double mutation of G719C and L861Q, the first case on our literature review, and showing partial response to TKI treatment.
Adenocarcinoma* ; Carcinoma, Non-Small-Cell Lung ; Exons ; Humans ; Lung Neoplasms ; Lung* ; Point Mutation ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor

PURPOSE: Multiple skin leiomyoma and uterine myoma bearing autosomal dominant traits are benign smooth muscle tumors which originate in skin or female uterus. Skin leiomyoma occurs after gene mutation originating from arrector pili muscle of hair follicle where its clinical manifestations vary significantly from person to person. Our department hereby reports the histological findings and genetic evaluations of this very rare disease. METHODS: A 57-year-old woman presented in our institute with multiple tumors in the left and central parts of her back that started to appear since 19 years ago. The patient was diagnosed as having uterine myoma 15 years ago and underwent hysterectomy. Biopsy has been done on the specimen, and genomic DNA was separated from Fumarate hydratase gene for it to go through PCR amplification. The results of PCR amplification were aligned by sequencer. RESULTS: According to the results of biopsy, tumor cells were spindle-shaped and were aligned in a bundle where there was no dysplasia or mitosis. Moreover, these cells had abundant eosinophilic cytoplasm with elongated nucleus, and benign leiomyoma that showed positive reactions to SMA stain were found. In genetic examination, mutations such as heterozygous single nucleotide substitutions were found in alignments of amplified DNA. CONCLUSION: Multiple skin leiomyoma and uterine myoma are relatively uncommon diseases that are transmitted through autosomally dominant traits from genetic mutations. When a patient's chief complaint lies upon skin-colored or brown masses that occur in multiples appearing in the trunk or extremities with characteristic clinical symptoms and histological findings, and when the patient's family history is acknowledged such as skin or uterine leiomyoma or renal tumor, necessary genetic examination on multiple skin leiomyoma and uterine myoma could be done, and thereby precise diagnosis could also be made.
Biopsy ; Cytoplasm ; Diagnosis ; DNA ; Eosinophils ; Extremities ; Female ; Fumarate Hydratase* ; Hair Follicle ; Humans ; Hysterectomy ; Leiomyoma* ; Middle Aged ; Mitosis ; Polymerase Chain Reaction ; Rare Diseases ; Skin ; Smooth Muscle Tumor ; Uterus

PURPOSE: We investigated relationship between displacement and morphologic changes of medial meniscus and articular cartilage loss on magnetic resonance (MR) Images in early osteoarthritis of the knee. MATERIALS AND METHODS: Ninety-three cases with symptomatic knee and early osteoarthritis on the plain radiographs underwent MR imaging of the knee. We measured displacement, tear, and morphological changes of medial meniscus according to the amount of articular cartilage loss on coronal and sagittal MR images. RESULTS: The mean medial meniscal displacement was greater in cartilage loss group(4.3+/-2.8 mm) than control group(2.2+/-1.9 mm). The mean anterior meniscal displacement was greater in cartilage loss group (3.6+/-2.3 mm) than control group(1.9+/-1.2 mm). But meniscal displacement was not correlated with articular cartilage loss (p>0.05). The morphological changes of medial meniscus were 53.4%(31/58) in cartilage loss group and 11.4% (4/35) in control group (p<0.05). CONCLUSION: In early osteoarthritis of the knee, displacement and morphological changes of medial menisci had correlation with articular cartilage loss in MRI study.
Cartilage ; Cartilage, Articular ; Knee* ; Magnetic Resonance Imaging ; Menisci, Tibial* ; Osteoarthritis*

PURPOSE: Skin hyperpigmentation in end stage renal disease patients is known to be attributed to the accumulation of middle molecular weight (MMW) substances such as urochromic pigments and carotenoids. Therefore, there is a possibility that hyperpigmentation may be improved by high-flux hemodialysis (HF-HD) and online hemodiafiltration (HDF). This prospective study was undertaken to investigate the quantitative changes in skin color in HD patients according to dialysis modality. METHODS: Eighty-two stable ESRD patients undergoing HD were enrolled and divided into three groups according to their dialysis modality. Melanin index and erythema index of forearm and abdomen (nonsun exposed area), and forehead (sun exposed area) were measured by narrow-band reflectance spectrophotometer at baseline and after 12 months. RESULTS: There were no significant differences in the baseline values of melanin and erythema indices among the three groups. But the changes in forehead melanin index were significantly lower in HDF patients (-1.0+/-2.4%) compared to the LF-HD group (0.3+/-1.6%) (p<0.05), and forehead erythema index was significantly decreased in patients treated by HDF (-1.6+/-2.5%) relative to the lowflux hemodialysis group (-0.1+/-2.5%) (p<0.05). CONCLUSION: The changes in skin color of sun exposed area were reduced by HDF, suggesting that enhanced removal of MMW substances by convective therapy may be of advantage to skin hyperpigmentation in ESRD patients.
Abdomen ; Carotenoids ; Dialysis ; Erythema ; Forearm ; Forehead ; Hemodiafiltration ; Humans ; Hyperpigmentation ; Imidazoles ; Kidney Failure, Chronic ; Melanins ; Molecular Weight ; Nitro Compounds ; Prospective Studies ; Renal Dialysis ; Skin ; Solar System