ObjectiveTo observe the effect of transcutaneous electric nerve stimulation (TENS) and physical therapy on shoulder pain after stroke. Methods60 patients of shoulder pain after stroke were randomly divided into treatment group (30 cases) and control group(30 cases). The patients in the treatment group were treated with TENS and physical therapy. The cases in the control group were treated with TENS only. All patients were evaluated with visual analogous score of pain (VAS) and Fugl-Meyer measure (FM) before and after treatment. ResultsThe scores of VAS and FM improved more significantly in treatment group than in control group(P<0.01).ConclusionTranscutaneous electric nerve stimulation combined with physical therapy showed more effective on shoulder pain after stroke.

Behcet's disease was originally described as a triple symptom complex of oral aphthous ulceration, genital ulceration, and hypopyon iritis. It is now known to have a wide systemic manifestations. Among them, the central nervous system involvement should be diagnosed earlier because of it's lethal potential. Recently the authors experienced a case of Behcet's disease with CNS involvement. A 51-year-old female patient was admitted due to deterioration of mentality and generalized ache since 2 years prior to admission. The findings on physical examination were compatible with Behcet's disease, but without cerebrospinal pleocytosis. The manifestations were improved with medications of prednisolone, chlorambucil, colchicines, but relapsed relapsed 2 months later during subsequent tapering of prednisolone and chlorambucil. The patient is now on medication again. A case of Behcet's disease with CNS manifestations is reported with review of literature.
Behcet Syndrome ; Central Nervous System ; Chlorambucil ; Female ; Humans ; Iritis ; Leukocytosis ; Middle Aged ; Physical Examination ; Prednisolone ; Stomatitis, Aphthous ; Ulcer

Objective To analyze the ultrasonic features of thyroid microcarcinoma (TMC) and the causes of misdiagnosis. Methods The ultrasonic features including shape, margin, echogenecity, microcalcification, vascularity and lymphadenopathy were analyzed retrospectively in 26 pathologically-proven TMC patients. Results In 26 cases, 11 cases were diagnosed correctly before operation (11/26, 42.31%), 12 cases were misdiagnosed (12/26, 46.15%) as adenoma or benign nodule, and 3 cases were missed diagnosed (3/26, 11.54%). Among the 23 cases detected on ultrasound, 21 cases were solid and hypoechoic (21/23, 91.30%);19 cases were ill-defined (19/23, 82.61%);12 cases were taller than wide in shape (12/23, 52.17%); 14 cases had microcalcification (14/23, 60.87%); 7 cases showed central or peripheral blood flow signals (7/23,30.43%) with arterial resistance index>0.70 in 3 lesions and<0.70 in 4 lesions. Conclusions Several ultrasonographic features are helpful in identiifcation of TMC, including hypo/iso-echogenecity, ill-deifned margin, taller-than-wide shape, microcalciifcation, arterial signals with high resistance index, and abnormal lymphadenopathy. Moreover, for cases with multiple lesions, to the potential co-existence of benign and malignant lesions should be considered.

In practice of forensic medicine, potential disease can be associated with fatal asphyxia in restraint position. Research has demonstrated that nitric oxide (NO) and nitric oxide synthase (NOS) are plentifully distributed in skeletal muscle, contributing to the regulation of contractile and relaxation. In the current study, respiratory functions, indices of diaphragmatic biomechanical functions ex vivo, as well as NO levels in serum, the expressions of diaphragmatic inducible NOS (iNOS) mRNA, and the effects of L-NNA on contractility of the diaphragm were observed in sepsis induced by cecal ligation and puncture (CLP) under the condition of restraint position. The results showed that in the CLP12-18h rats, respiratory dysfunctions; indices of diaphragmatic biomechanical functions (Pt, +dT/dt(max), -dT/dt(max), CT, Po, force over the full range of the force-frequency relationship and fatigue resistance) declined progressively; the NO level in serum, and iNOS mRNA expression in the diaphragm increased progressively; force increased significantly at all stimulation frequencies after L-NNA pre-incubation. Restraint position 1 h in CLP12 h rats resulted in severe respiratory dysfunctions after relative stable respiratory functions, almost all the indices of diaphragmatic biomechanical functions declined further, whereas little change took place in NO level in serum and diaphragmatic iNOS mRNA expression; and the effects of L-NNA were lack of statistical significance compared with those of CLP12 h, but differed from CLP18 h group. These results suggest that restraint position and sepsis act together in a synergistic manner to aggravate the great reduction of diaphragmatic contractility via, at least in part, the negative modulation of NO, which may contribute to the pathogenesis of positional asphyxia.
Animals ; Asphyxia ; Diaphragm/physiology* ; Muscle Contraction ; Muscle, Skeletal ; Nitric Oxide/metabolism* ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type II ; Rats ; Respiration Disorders ; Restraint, Physical ; Sepsis

Objective To investigate a shorter and safer route for contralateral C_7 nerve root transfer. Methods Eight male patients were treated from Dec2005 to Nov.2006Their range of age was from 22 to 43 years with an average of 30 yearsFive cases had total brachial plexus avulsion.The operative delay was from 2 to 6 months(mean:4 months).The sealenus anterior muscle was transected before a prespinaJ & ret- ropharyngeal tunnel was madeThe contralateral C_7 nerve root was used to repair the upper trunk or the infra- clavicular lateral cord and posterior cord of injured side via this routeusing direct anastomosis or nerve graft- ing.Results The length of the harvested contralateral C_7 nerve root was(4.67?0.52em in the early 5 casesThe nerve graft was6.25?0.35)em long for repairing supraclavicular brachial plexus and(8.56?0.45cm long for repairing infraclavicular brachial plexusThe length of the harvested contralateral C_7 nerve root averaged 6.85cm in the other 3 cases2 of which had direct anastomosis to the residual nerve C_5 and C_6 nerve roots and the other used nerve graft of 3 cm in lengthTransient contralateral sensory symptoms were re- ported in most patientsAt 3 months followups6 patients had tingling sensation on the contralateral fingers with percussion on the injured cervical areaIpsilateral SSEP could be recorded by stimulating at 2 cm above sternoclavicular joint on the injured sideAt 7 months follow ups of 5 patientsCMAP could be recorded in bi- cepsdeltoids and infraspinatus or triceps with stimulation at Erb's pointHoweverno clinical movements was noticedAt 12 months follow ups of 3 patientswe could observe early motor and sensory function recovery of those patients to different extent.Conclusion Transection of anterior scalenus muscle shortens the length of the transfer route and allows more efficient neurotizationThe procedure is convenient and safeprovided certain precautions being usedThe principal of contralateral C_7 nerve transfer are reconstruct the anterior divi- sions of upper trunkposterior divisions of upper trunk and suprascapular nerve when repairing the supraclavic- ula brachial plexusReconstruct the lateral cord and posterior cord when repairing the infraclavicula brachial plexusPostsurgical fasting for 4 days included foods and liquids will benefit of healing of anastomosed nerves and regenerationaud avoid complications.

OBJECTIVEConcentration of extracellular calcium ([Ca(2+)](o)) in the central nervous system decreases substantially in different conditions. It results in facilitating neuronal excitability. The goal of this study is to examine the mechanisms of enhanced neuronal excitation in low [Ca(2+)](o) in order to provide new clues to treat the hyperexcitability diseases in clinic.

METHODSWhole-cell patch-clamp technique and neuron culture were used in the study.

RESULTSThe firing threshold of cultured hippocampal neurons decreased markedly in low [Ca(2+)](o) saline. Unexpectedly, apamine and isoprenaline, antagonists of medium afterhyperpolarization (mAHP) and slow AHP (sAHP) respectively, had no statistic significant effect on excitability of neurons. TTX at a low concentration was sufficient to inhibit I(NaP), which blocked the increase of firing frequency in low [Ca(2+)](o). It also reduced the number of spikes in normal [Ca(2+)](o).

CONCLUSIONThese results suggest that in cultured hippocampal neurons, modulation of spiking threshold but not AHP may cause the increased excitability in low [Ca(2+)](o).

Action Potentials ; drug effects ; Animals ; Apamin ; pharmacology ; Calcium ; pharmacology ; Cells, Cultured ; Dose-Response Relationship, Drug ; Electric Stimulation ; Embryo, Mammalian ; Hippocampus ; cytology ; Neurons ; drug effects ; Patch-Clamp Techniques ; Rats ; Sodium Channel Blockers ; pharmacology ; Tetrodotoxin ; pharmacology

To examine AZT resistance of HIV-1 isolates from AZT treated or untreated Korean, several biological characteristics such as syncytium formation, HIV-1 reverse transcriptase activity and the p24 antigen production in MT-2 cells infected with 4 HRT_1 isolates were determined. As controls, we tested HIV-1 HTLV-IIIB and pre-drug isolate as AZT susceptible strains, in addition to HIV-1 RTMC/MT-2 and post-drug isolate as AZT resistant strains. When the inoculum size of HIV-1 was 300 TCID50well and 100 TCID50/well, the AZT susceptibility of AZT untreated HIV-1 isolates 8806 and 9571 were similar to that of HIV-1 HTLV-IIIB and AZT-susceptible HIV-1 strains. When we evaluated AZT resistance of isolates HRs-1 8812 and 9113 treated with AZT for 36 months by observation of syncytium formation, HIV-1 8812 showed resistance simillar to that of HIV-1 RTMC/MT-2 strain forming syncytium up to AZT 1microgram/ml, and HIV-1 9113 showed resistance identical with that of AZT-resistant HIV-1 strain which formed syncytium up to AZT 10 microgram/ml. Especially, when we evaluated AZT resistance by HIV-1 reverse transcriptase activty and the p24 antigen production, HIV-1 isolates 8812 and 9113 showed much higher resistance (>10 - 200 fold) compared with HN-1 RTMC/MT-2 and AZT-resistant HIV-1 strain.
Giant Cells ; HIV-1* ; Korea* ; Population Characteristics ; RNA-Directed DNA Polymerase ; Zidovudine*

OBJECTIVE: To investigate the relationship among the G(-634)C polymorphism in interleukin-6 (IL-6) gene, change in production of IL-6 by whole blood cells (WBCs), and bone mineral density (BMD) after hormone replacement therapy (HRT) in postmenopausal Korean women. METHODS: The IL-6 G(-634)C polymorphism was analyzed by restriction fragment length polymorphsim (REFLP) in 194 postmenopausal Korean women receiving sequential HRT for 1 year. IL-6 and soluble IL-6 receptor (sIL-6r) produced by WBCs cultured with lipopolysaccharide for 2 days, and serum CrossLaps (CTX) and osteocalcin were measured using enzyme-linked immunosorbent assay (ELISA) and immunoassay respectively. BMD at the lumbar spine and proximal femur was determined by dual energy X-ray absorptiometry. RESULTS: The annual percent changes of BMD were not associated with IL-6 genotypes, and the distribution of IL-6 genotypes were not different between HRT-responders and HRT-nonresponders (women who lose more than 3% of bone mass per year). After HRT of 6 months, an increase in IL-6 production by WBCs, without change in sIL-6r production was noted. There were no differences in the 6 month changes of bone turnover markers and IL-6 production by WBCs after HRT across IL-6 genotypes. Change in IL-6 production by WBCs after HRT of 6 month did not correlated with changes of bone turnover markers, but correlated negatively with annual change of BMD at trochanter after HRT. CONCLUSION: The IL-6 G(-634)C polymorphism did not associate with change in BMD after HRT in postmenopausal Korean women, and did not affect change in the production of IL-6 and sIL-6r by WBCs.
Absorptiometry, Photon ; Blood Cells ; Bone Density* ; Enzyme-Linked Immunosorbent Assay ; Female ; Femur ; Genotype ; Hormone Replacement Therapy* ; Humans ; Immunoassay ; Interleukin-6* ; Osteocalcin ; Receptors, Interleukin-6 ; Spine

Objective To analyze the risk factors of hospital acquired pneumonia (HAP) caused by nonfermentative bacteria in ICU.Methods Using binary logistic regression analysis,we reviewed the related risk factors of hospital acquired pneumonia caused by nonfermentative bacteria from January,2002 to May,2006 in ICU of our hospital.Results Univariate regression ana- lysis identified 22 variables associated with HAP,including age,diabetes mellitus,malignant tumor,chronic obstructive pul- monary disease (COPD),smoking,Glasgow Coma Scale (GCS) score,Acute Physiology and Chronic Healthy EvaluationⅡ(APACHEⅡ) score.Multivariate regression analysis confirmed 6 high risk factors:aspiration,COPD,use of antacids,seda- tive agents,mechanical ventilation and tracheal intubation or tracheostomy.Conclusions Aspiration,COPD,use of antacids, sedative agents,mechanical ventilation,tracheal intubation or tracheostomy are high risk factors associated with HAP.

PURPOSE: This study was done to identify the process of change, decisional balance and self-efficacy corresponding to stage of exercise behavior based on the Transtheoretical model in patients with chronic arthritis. METHOD: The participants were 151 patients with chronic arthritis using an out-patient pain clinic and hospital in C city. The collected data were analyzed using ANOVA, Sheffe test and discriminant analysis with SPSS/WIN. RESULTS: The patients were distributed as follows for each stage of exercise behavior 21.8% in the precontemplation stage, 26.5% in the contemplation stage, 25.2% in the preparation stage, 7.3% in the action stage, and 19.2% in the maintenance stage. Significant effects for stage of change were found for nine of the 10 processes of change and Pros, Cons, self-efficacy. Scores on these variables were found to increase across the stage of exercise behaviors from precontemplation to maintenance. Discriminant analysis revealed that self-efficacy and stimulus control, and reinforcement management were the major correlates of the stage of exercise behaviors. CONCLUSION: The findings of this study give useful information for exercise intervention, by using strategies of exercise for chronic arthritis patients in different stages of exercise behavior.
Arthritis* ; Humans ; Outpatients ; Pain Clinics