Established antiepileptic drugs (AEDs) decrease membrane excitability by interacting with neurotransmitter receptors or ion channels. AEDs developed prior to 1980 appear to act on sodium channels, gamma-amino butyric acid type A (GABA(A)) receptors or calcium channels. Benzodiazepines and barbiturates enhance GABA(A) receptormediated inhibition. Barbiturates increase the duration of chloride channel opening and at higher doses, they block voltage-dependent calcium channels presynaptically, decreasing excitatory amino acid (EAAs) transmission. Benzodiazepines also interact with the GABA(A) receptor complex and increase the frequency of chloride channel opening. Phenytoin, carbamazepine and possibly sodium valproate decrease high frequency repetitive firing of action potentials by enhancing sodium channel inactivation. At higher doses, PHT may block sodium channels presynaptically and decrease EAAs release. In addition to the action on sodium channel, CBZ interacts with adenosine receptor and decrease C-AMP, and block reuptake of norepinephrine. VPA shows diverse mechanisms including sodium channel blocking. It increases synaptosomal GABA by increasing production and decreasing break-down and interacts with T-type calcium channels preventing thalamocortical interaction necessary for absence. Ethosuximide and sodium valproate reduce a low threshold (T-type) calcium channel current. The mechanisms of action of newly developed AEDs are not fully established. Felbamate is broad-spectrum, and probably has multiple actions on sodium channels, interaction with GABA(A) receptors, and interaction with NM.D.A receptors. Gabapentin binds to a high affinity site on neuronal membranes in a restricted regional distribution of the CNS. This binding site may be related to a possible active transport process of gabapentin into neurons. However this has not proven and the mechanism of action of gabapentin remains uncertain. It is structurally related to GABA and its action of antiepileptic activity is suspected due to change of neuronal amino acids (interfere glutamate synthesis, block GABA uptake, and enhance GABA release). Lamotrigine, initially developed as an antifolate drug, decreases sustained high frequency repetitive firing of voltage-dependent sodium action potentials that may result in a preferential decreased release of presynaptic glutamate. It may also interact with GABA receptors but its primary antiepileptic action is on the sodium channel similar to the PHT and CBZ. Because of such a diverse mechanism of action, LTG is one of the wide spectrum AEDs. Oxcarbazepine's mechanism of action is not known ; however, its similarity in structure and clinical efficacy to that of carbamazepine suggests that its mechanism of action may involve inhibition of sustained high frequency repetitive firing of voltage-dependent sodium action potentials. Vigabatrin is a "designer" drug as is developed rationally, and it reversibly inhibits GABA transaminase, the enzyme that degrades GABA, thereby producing greater available pools of presynaptic GABA for release in central synapses. Increased activity of GABA at postsynaptic receptors may underlie the clinical efficacy of VGB. Tiagabine is a potent blocker of GABA re-uptake by glia and neuron.
4-Aminobutyrate Transaminase ; Action Potentials ; Amino Acids ; Anticonvulsants* ; Barbiturates ; Benzodiazepines ; Binding Sites ; Biological Transport, Active ; Butyric Acid ; Calcium Channels ; Calcium Channels, T-Type ; Carbamazepine ; Chloride Channels ; Ethosuximide ; Excitatory Amino Acids ; Fires ; gamma-Aminobutyric Acid ; Glutamic Acid ; Ion Channels ; Membranes ; Neuroglia ; Neurons ; Neurotransmitter Agents ; Norepinephrine ; Phenytoin ; Receptors, GABA ; Receptors, GABA-A ; Receptors, Neurotransmitter ; Receptors, Purinergic P1 ; Sodium ; Sodium Channels ; Synapses ; Valproic Acid ; Vigabatrin

We performed surgery for correction of abnormal head turn in 10 patients with congenital nystagmus. For 3 patients with a head turn of 30 degrees, a 40% augmented modified kestenbaum operation was performed. For 4 patients with a head turn of 45 degrees, a 40% augmented modified kestenbaum operation combined with a 3 - 4 mm recession of conjunctival and subconjunctival tissues was performed. Finally, for 3 patients with a head turn of 60 degrees, a 60% augmented modified kestenbaum procedure combined with a 3 - 4 mm recession of conjunctival and subconjunctival tissues was performed. At the final follow-up visit(averaging 5.9 months), 7 patients showed complete corrections of previous head turn and 3 patients showed a small residual head turn of less than 10 degrees to the same side of the preoperative head turn. The average amount of correction we obtained from the surgery described above were 26.7, 42.5 and 56.7 degrees for the patients who had had a preoperative head turn of 30, 45 and 60 degrees respectively. Among the 10 patients, 4 showed no change in corrected visual acuity, but 6 showed increased corrected visual acuity by over 1 Snellen line. From the above results, we concluded that if recession procedure of the conjunctival and subconjunctival tissues was combined with augmented modified Kestenbaum procedure, its effect for correction of abnormal head turn in a patient with congenital nystagmus could be enhanced.
Follow-Up Studies ; Head* ; Humans ; Nystagmus, Congenital* ; Visual Acuity

Prolonged disorders of consciousness comprise a spectrum of impaired consciousness where arousal is preserved with impaired awareness, which last more than 4 weeks. Vegetative state is a prototype of the prolonged disorders of consciousness. A patient in the vegetative state has no signs of awareness. The minimally conscious state is characterized by inconsistent but reproducible signs of awareness and is regarded as a transitional state of recovery of consciousness. Differentiating patients in minimally conscious state from those in vegetative state is still challenging. Utilizing standardized neurobehavioral assessment tools could improve diagnostic accuracy. Recent advances in neuroimaging and electrophysiologic tools may aid the diagnosis and prognostication. Treatment for recovery of consciousness is still limited. More research on the diagnosis and treatment of prolonged disorders of consciousness is needed not only for improved care of patients with prolonged disorders of consciousness but also a greater understanding of human consciousness.

Purpose: Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and metabolic syndrome. This study evaluated the significance of markers such as the triglyceride-to-highdensity lipoprotein cholesterol (TG/HDL-C) ratio and TG-glucose (TyG) indices in a group of patients with NAFLD. Methods: We retrospectively analyzed the data of patients aged 5–18 years diagnosed with NAFLD between January 2014 and January 2021. Results: Among the 151 patients with NAFLD, 79.5% were found to be obese, and the mean TG/HDL-C ratio (3.78±2.54 vs. 3.13±2.24) and TyG index (4.69±0.28 vs. 4.56±0.30) were slightly higher in patients with obesity compared to those without obesity. Patients with severe hepatic steatosis had a significantly higher mean TG/HDL-C ratio (4.11±2.16 vs. 3.11±2.30, p=0.035) than those with mild to moderate steatosis. Severe hepatic steatosis grade was defined as an area under the receiver operating characteristic curve of the TG/HDL-C ratio of 0.760 (95% confidence interval, 0.544–0.875), with an optimal cutoff value of 3.37. Conclusion A high TG/HDL-C ratio is associated with severe hepatic steatosis and diabetes mellitus in children with NAFLD. Measurement of this ratio can help clinicians in identifying patients and targeting them for treatment and follow-up.

Purpose: Infantile hypertrophic pyloric stenosis (IHPS) is a common gastrointestinal disease in neonates and hypochloremia metabolic alkalosis is a typical laboratory finding in affected patients. This study aimed to analyze the clinical characteristics of infants with IHPS and evaluate the association of clinical and laboratory parameters with ultrasonographic findings. Methods: Infants diagnosed with IHPS between January 2017 and July 2022 were retrospectively evaluated. Results: A total of 67 patients were included in the study. The mean age at diagnosis was 40.5±19.59 days, and the mean symptom duration was 11.97±9.91 days. The mean pyloric muscle thickness and pyloric canal length were 4.87±1.05 mm and 19.6±3.46 mm, respectively. Hyponatremia and metabolic alkalosis were observed in five (7.5%) and 36 (53.7%) patients, respectively. Serum sodium (p=0.011), potassium (p=0.023), and chloride levels (p=0.015) were significantly lower in patients with high bicarbonate levels (≥30 mmol/L). Furthermore, pyloric canal length was significantly higher in patients with high bicarbonate levels (p=0.015). To assess metabolic alkalosis in IHPS patients, the area under the receiver operating characteristic curve of pyloric canal length was 0.910 and the optimal cutoff value of the pyloric canal length was 23.5 mm. Conclusion We found a close association between laboratory and ultrasonographic findings of IHPS. Clinicians should give special consideration to patients with pyloric lengths exceeding 23.5 mm and appropriate fluid rehydration should be given to these patients.

PURPOSE: The purpose of this study is to identify visiting nurses' occupational satisfaction and their stress who are working at district health centers in Chungnam province. METHODS: The subjects of the study were 109 visiting nurses of 16 district health centers in Chungnam province. The data were collected by self report questionnaires from March 1 to 31, 2010. The data were analyzed by Cronbach's alpha, t-test, ANOVA (Sheffe's test), and correlation coefficient using the SPSS program. RESULTS: The results of this study were as follows. The occupational stress level of the subjects was 46.7 and the level of subjects' occupational satisfaction was 2.46. There was a significant negative correlation between occupational satisfaction and occupational stress (r=-.627). CONCLUSION: The occupational stress level of the subjects, and stress levels of 'work environment,' 'job insecurity' and 'organizational structure' were higher than those of the Korean women workers' standard. The level of subjects' occupational satisfaction was lower than that of the nurse practitioners. There was a significant correlation among occupational stress and 'burden of workload' and 'visiting nurse career'. The study showed that occupational stress was correlated with occupational satisfaction. The results suggest that further follow-up study on visiting nurse is necessary to relieve their occupational stress and increase occupational satisfaction.
Community Health Nursing ; Female ; Humans ; Nurse Practitioners ; Surveys and Questionnaires ; Self Report

PURPOSE: This study was done to examine the effects of foot massage as a nursing intervention on preoperative anxiety, depression and sleep satisfaction in patients with breast surgery. METHOD: Research design was a nonequivalent control group non-synchronized design. Forty-one patients were assigned to the control group (21) and the experimental group (20). The patients answered a questionnaire containing measures of anxiety, depression and sleep satisfaction before and after the intervention. The collected data were analyzed by means of descriptive statistics, Cronbach's alpha, Chi-square test, and t-test using the SPSS WIN 11.0 program. RESULT: Anxiety and depression for the experimental group were significantly lower than those for the control group(t=2.556, p=0.008, t=2.932, p=0.006). Sleep pattern of the experimental group was significantly higher than that of the control group (t=2.313, p=0.013). CONCLUSION: Judging from these results, it is suggested that foot massage might have beneficial effects on reducing preoperative anxiety, depression, and increasing sleep satisfaction.
Anxiety* ; Breast* ; Depression* ; Foot* ; Humans ; Massage* ; Nursing ; Preoperative Care ; Surveys and Questionnaires ; Research Design

This study was undertaken to elucidate the status of Metagonimus species infection and to demonstrate the first and the second intermediate hosts of the fluke at the several localities along the Gum river, Chungchung-nam Do, Korea from March 1979 to October 1980. The results are summarized as follows: Total 790 stool specimens of inhabitants from 6 localities along Gum river were examined by the combination of cellophane thick smear technique and formalin-ether concentration technique. The positive rate of intestinal helminths was 80.3 percent, and the egg positive rate of Metagonimus sp. was 21 percent from a total of 790 specimens examined. In the age bracket of 20-49, the positive rates of Metagonimus sp. were 31.1-36.5 percent, and the males (26.8 percent) were infected three times higher than females (8.9 percent). By the area of the river, Gumsan which is located upper stream showed the highest positive rate (40.5 percent) of the fluke, whereas the rates decreased gradually toward upper part of river (Muju) or the descending lower area of the river. The most lower area of river (Gangkyeong and Nonsan), no positive Metagonimus infection case was found. The infection rate of Clonorchis sinensis in 790 was 37.3 percent, and the status of mixed infection of Metagonimus with C. sinensis was found 127 cases (76 percent) out of 166 cases with Metagonimus infection. The result of measurement of ova from 166 cases of Metagonimus infection, large ova were found in 41.1 percent, small size ova in 31.9 percent and the mixed type in 27.1 percent, respectively. The adult worms were recovered from the 6 cases after treatment with niclosamide, and the measurements of the worms showed similar morphological characteristics of the Metagonimus yokogawai. Twenty-two species in 5 families of fresh water fish were caught. Out of 22 species of fish, 18 species were found infected with metacercaria of Metagonimus. In order to observe the distribution of metacercariae in the body and the rate of infection of the individual host, a total of 94 Pseudogobio esocinus were examined. Total 84 (89.4 percent) out of 94 fish were infected with the metacercariae and the rates of distribution of the metacercaria were observed in the following order: on scale; 93.4 percent, in gill; 3.2 percent, head part; 2.9 percent, but a few metacercaria was found in muscle and visceral organs. The development of the metacercariae which were isolated from the scale of Pseudogobio esocinus were experimentally traced in the albino rat host from one day to 30 days after infection. At the 6th day, several eggs were visible in the uterine tubule of the some worms, on the 10th day, worms became 326.0 x 208.0 micrometer in size, however the bodies of worms grew no more until the 30th day after infection. The oral sucker was larger in size than the ventral sucker during early stage of the worms, but the 7th day after infection, it reversed. The ventral sucker situated on the ventral right side of the body. Right side of testis laid somewhat toward, and uterus and vetellaria extended to the posterior margin of the right testis. Snails(Koreanomelania nodifila var. ovulum) were collected in the river, Buri-Myeon, Gumsan-Gun, and found the natural emerging ophthalmo-pleurophocercus cercaria. From the above result, the prevalence of Metagonimus species infection showed relatively higher rates from the inhabitants along the middle to upper localities of the river. Even though no sweetfish was caught in the surveyed areas, Gum river basin is the one of the new endemic foci of metagonimiasis in Korea.
parasitology-helminth-trematoda ; Metagonimus spp. ; metagonimiasis-epidemiology ; taxonomy ; Ascaris lumbricoides ; Trichuris trichiura ; hookworm ; Trichostrongylus orientalis ; Clonorchis sinensis ; Taenia sp. ; Pseudogobio esocinus ; Acheilognathus intermedia ; Carassius carassius ; Hemibarbus labeo ; Hemibarbus longirostris ; Paracheilognathus rhombea ; Parapelecus jouyi ; Pseudopungtungia nigra ; Pungtungia herzi ; Sarcocheilichthys wakiyae ; Zacco playtpus ; Zacco temmincki ; Gobiobotia brevibarba ; Gobiobotia macrocephalus ; Siniperca kawamebari ; Siniperca scherzeri ; Liobagrus andersonii ; Pelteobargrus fluvidraco ; Pseudobagrus emarginatus ; Pseudobagrus sp. ; Mogurnda obscura ; Parasilurus asotus

PURPOSE: The purposes of the study were to examine the knowledge and practice about Middle East Respiratory Syndrome (MERS) isolation precaution, and to explore influencing factors of the isolation practice among hospital nurses. METHODS: A total of 182 nurses were recruited from four general hospitals where MERS patients had been treated. The knowledge and practice of MERS isolation precaution were measured by the scales developed based on the CDC guidelines. The collected data were analyzed by SPSS/WIN 22 with descriptive statistics, T-test, One-way ANOVA, Pearson correlation coefficients, and hierachical multiple regression analysis. RESULTS: The nurses were 30 years old in average, and half of them had less than 5 years of clinical experience. and knowledge on droplet precautions (β=.171, p=.019) were the significant predictors, explaining 19.6% of variance in the MERS isolation guideline practice. Clinical experience (β=.225, p=.002), working at infection unit (β=−.203, p=.011). CONCLUSION: The knowledge on droplet precaution and general knowledge on MERS were the important modifiable factor to improve the MERS isolation guideline practice among hospital nurses, even after adjusting clinical experience and demographic variables. It is necessary to develop an efficient education program on specific guidelines for prevention and management of infection by improving the knowledge on infectious disease such as MERS as well as droplet precaution which are modifiable factors.
Centers for Disease Control and Prevention (U.S.) ; Communicable Diseases ; Coronavirus Infections ; Education ; Hospitals, General ; Humans ; Middle East ; Weights and Measures