Click sound can evoke myogenic potentials in active sternocleidomastoid(SCM) muscle. These are due to activity of vestibular afferent rather than cochlear, which produce very short latency inhibition of ipsilateral motor unit activity. We investigated the click-evoked vestibulocollic reflexes in neck muscles to find out the significance and relationship of latency and amplitude of myogenic potentials between two different methods of muscles activation. EMGs were recorded from surface electrode evoked by sound stimuli(95dB SPL, 5/sec repetitive rate, 512 times) over SCM muscles on each side. Myogenic potentials have two biphasic responses which were termed P1, N1, P2, N2 based on the polarity of their components. The subjects were 24 normal volunteers. EMG recordings were obtained from 12 subjects(Group 1) who keeped head 10 cm above ground in supine position to activate their neck flexors to the degree required through the averaging runs(bilateral SCM muscles activation method). EMGs from another 12 subjects(Group 2) were recorded by rotating head to the opposite side to activate SCM muscle throughout the procedure(unilateral SCM muscle activation method). The latencies and amplitudes of myogenic potentials in the SCM muscle after stimulation were analysed and compared between the two methods. The latencies(msec) of P1 and N1 were 11.2+/-2.4, 21.7+/-1.1 respectively in Group 1 and 13.3+/-2.4, 23.0+/-1.1 respectively in Group 2. The amplitude(uV) of P1-N1 were 38.78.1 in Group 1 and 33.28.1 in Group 2. There were no significant differences in latencies and amplitudes of P1 and N1 between the groups(p<0.05). Unilateral muscle activation is easier and comfortable than the bilateral muscle activation and there were no significant difference in latency and amplitude of P1. The myogenic potential of unilateral vestibular function loss disappeared in a patient who was labyrinthectomized but there was normal response of potential in a patient who is profound sensory neural hearing loss. Click evoked myogenic potentials is a simple method of examining vestibulocollic reflex. Click evoked myogenic potential is related to vestibular status.
Electrodes ; Head ; Healthy Volunteers ; Hearing Loss ; Humans ; Muscles ; Neck ; Neck Muscles ; Reflex* ; Supine Position

BACKGROUND: The anterior spinal artery infarction constitutes a classical syndrome of vascular myelopathy. The causes of the anterior spinal artery syndrome are various, but most episode probably occur as the result of atherosclerosis or dissection of the aorta and its branches. However, few cases reported developed with spinal structural abnormalities. CASE: A 65-year-old man presented with sudden paraparesis. There was no evidence of hypertension, diabetes and smoking. Motor weakness was more prominent on the left side and progressed. Loss of pain and temperature senses were shown at the level of 71 with preservation of touch, joint perception and vibration senses. The DTR's of legs were depressed and extensor toe signs were presented. A C-spine MRI showed high signal intensity on 72 weighted image and low signal on 71 weighted image(C6-71) with cervical spinal stenosis at the C4-C7 spinal level and mild cervical disc protrusion (C6-C7, C7-T1). After three months later, follow up cervical MRI showed somewhat decreased size of high signal intensity on 72 weighted image and more prominent low signal on 71 image. DISCUSSION: In our case, we could not find any usual cause of anterior spinal artery infarction. However only cervical spinal stenosis associated with mild cervical disc protrusion was present. In stenotic cervical canal, the anterior spinal artery can be more vulnerable to extrinsic compression and the infarction may early develop with insignificant trigger event, such as disc protrusion. We concluded that the ischemic change of anterior two thirds of cervical spinal cord might develop due to the compression of the anterior spinal artery by cervical stenosis and mild cervical intervertebral disc protrusion.
Aged ; Anterior Spinal Artery Syndrome* ; Aorta ; Arteries ; Atherosclerosis ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Hypertension ; Infarction ; Intervertebral Disc ; Joints ; Leg ; Magnetic Resonance Imaging ; Paraparesis ; Smoke ; Smoking ; Spinal Cord ; Spinal Cord Diseases ; Spinal Stenosis* ; Toes ; Vibration

BACKGROUND: Aerobic exercise can effectively reduce visceral fat. However, few studies have examined the effect of daily physical activity on obesity and cardiopulmonary function in the subjects with diabetes. We examined the effect of moderate intensity of walking in obese diabetes patients by monitoring of daily activity and measuring the change in abdominal fat area, muscle are and maximal muscle strength. METHODS: We randomly assigned 27 obese women with type 2 diabetes to an aerobic exercise group (AG, n = 13) and control group (CG, n = 14). The AG performed moderate intensity walking for 60 minutes per exercise, 5 times per week, and for 12 weeks. The activity energy expenditure was monitored by a multi-record accelerometer. The CG maintained routine daily activities. At the time of the initiation of the study and after 12 weeks of exercise, the aerobic exercise capacity was assessed using oxygen consumption rate at anaerobic threshold (VO2-AT). The abdominal fat area and the quadriceps muscle area were measured by computed tomography, and the maximum muscle strength of the upper and lower limbs was measured by a chest press and a leg press, respectively. RESULTS: The mean age of the study subjects was 56.6 +/- 8.0 years, the mean duration of diabetes was 6.3 +/- 6.0 years, and the body weight index (BMI) was 27.3 +/- 2.7 kg/m2. The BMI of the AG was significantly decreased (P = 0.003). In the AG, the visceral fat area and subcutaneous fat area were also significantly decreased (P = 0.018 and P < 0.001, respectively) but not in CG. VO2-AT of the AG was significantly improved, while that of the CG did not change (P = 0.009 and P = 0.115, respectively). The quadriceps muscle mass and the maximal muscle strength of the AG did not change, however, the CG showed a significant decrease. Duration of moderate intensity exercise was correlated with the decrease in total abdominal fat area (r = -0.484; P = 0.011) and that of high intensity exercise was correlated with improvement of cardiopulmonary function (r = 0.414; P = 0.032). CONCLUSION: Daily moderate intensity aerobic exercise is effective at reducing abdominal fat mass, while high intensity exercise improves cardiopulmonary function.
Abdominal Fat ; Anaerobic Threshold ; Body Weight ; Diabetes Mellitus, Type 2 ; Energy Metabolism ; Exercise ; Female ; Humans ; Intra-Abdominal Fat ; Leg ; Lower Extremity ; Motor Activity ; Muscle Strength ; Muscles ; Obesity ; Oxygen Consumption ; Quadriceps Muscle ; Subcutaneous Fat ; Thigh ; Thorax ; Walking

BACKGROUND: Aerobic exercise can effectively reduce visceral fat. However, few studies have examined the effect of daily physical activity on obesity and cardiopulmonary function in the subjects with diabetes. We examined the effect of moderate intensity of walking in obese diabetes patients by monitoring of daily activity and measuring the change in abdominal fat area, muscle are and maximal muscle strength. METHODS: We randomly assigned 27 obese women with type 2 diabetes to an aerobic exercise group (AG, n = 13) and control group (CG, n = 14). The AG performed moderate intensity walking for 60 minutes per exercise, 5 times per week, and for 12 weeks. The activity energy expenditure was monitored by a multi-record accelerometer. The CG maintained routine daily activities. At the time of the initiation of the study and after 12 weeks of exercise, the aerobic exercise capacity was assessed using oxygen consumption rate at anaerobic threshold (VO2-AT). The abdominal fat area and the quadriceps muscle area were measured by computed tomography, and the maximum muscle strength of the upper and lower limbs was measured by a chest press and a leg press, respectively. RESULTS: The mean age of the study subjects was 56.6 +/- 8.0 years, the mean duration of diabetes was 6.3 +/- 6.0 years, and the body weight index (BMI) was 27.3 +/- 2.7 kg/m2. The BMI of the AG was significantly decreased (P = 0.003). In the AG, the visceral fat area and subcutaneous fat area were also significantly decreased (P = 0.018 and P < 0.001, respectively) but not in CG. VO2-AT of the AG was significantly improved, while that of the CG did not change (P = 0.009 and P = 0.115, respectively). The quadriceps muscle mass and the maximal muscle strength of the AG did not change, however, the CG showed a significant decrease. Duration of moderate intensity exercise was correlated with the decrease in total abdominal fat area (r = -0.484; P = 0.011) and that of high intensity exercise was correlated with improvement of cardiopulmonary function (r = 0.414; P = 0.032). CONCLUSION: Daily moderate intensity aerobic exercise is effective at reducing abdominal fat mass, while high intensity exercise improves cardiopulmonary function.
Abdominal Fat ; Anaerobic Threshold ; Body Weight ; Diabetes Mellitus, Type 2 ; Energy Metabolism ; Exercise ; Female ; Humans ; Intra-Abdominal Fat ; Leg ; Lower Extremity ; Motor Activity ; Muscle Strength ; Muscles ; Obesity ; Oxygen Consumption ; Quadriceps Muscle ; Subcutaneous Fat ; Thigh ; Thorax ; Walking

Obstructive jaundice produced by periportal tuberculous adenitis in the absence of pulmonary tuberculosis is quite rare. We are reporting the case of a 58-year-old woman who presented with constitutional symptoms and biochemical evidence of biliary tract obstruction. By abdominal sonogram and CT scan, a mass around the head of pancreas and periportal area was detected. The ERCP showed fistula connected proximal common bile duct to lymph node. The patient underwent laparotomy and recognized tuberculous adenitis of periportal lymph node which caused biliary tract obstruction with fistula.
Biliary Tract* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Female ; Fistula ; Head ; Humans ; Jaundice, Obstructive ; Laparotomy ; Lymph Nodes ; Lymphadenitis* ; Middle Aged ; Pancreas ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary ; Yemen*

BACKGROUND: Our goal was to investigate the effects of low intensity resistance training on body fat, muscle mass and strength, cardiovascular fitness, and insulin sensitivity in type 2 diabetes. METHODS: Twenty-eight overweight women with type 2 diabetes were randomly assigned to a resistance training group (RG, n = 13) or a control group (CG, n = 15). RG performed resistance training using elastic bands, of which strength was equal to 40 to 50% of one repetition maximum (1RM), for three days per week. Each exercise consisted of three sets for 60 minutes. We assessed abdominal fat using computed tomography, muscle mass using dual-energy X-ray absorptiometry, and muscle strength using Keiser's chest and leg press. Insulin sensitivity was measured using the insulin tolerance test, and aerobic capacity was expressed as oxygen uptake at the anaerobic threshold (AT-VO2) before and after the 12-week exercise program. RESULTS: The age of participants was 56.4 +/- 7.1 years, duration of diabetes was 5.9 +/- 5.5 years, and BMI was 27.4 +/- 2.5 kg/m2, without significant differences between two groups. During intervention, a greater increase in muscle mass and greater decreases in both total fat mass and abdominal fat were observed in RG compared to those of CG (P = 0.015, P = 0.011, P = 0.010, respectively). Increase in 1RM of upper and lower extremities was observed in the RG (P = 0.004, P = 0.040, respectively), without changes in AT-VO2 and insulin resistance in either group. CONCLUSION: In conclusion, the low intensity resistance training was effective in increasing muscle mass and strength and reducing total fat mass without change of insulin sensitivity in type 2 diabetic patients.
Abdominal Fat ; Absorptiometry, Photon ; Adipose Tissue ; Anaerobic Threshold ; Diabetes Mellitus, Type 2 ; Female ; Humans ; Insulin ; Insulin Resistance ; Leg ; Lower Extremity ; Muscle Strength ; Muscles ; Overweight ; Oxygen ; Resistance Training ; Thorax

Although patients with cirrhosis are known to be in a state of “rebalance” in that pro- and anticoagulant factors increase the risk for both bleeding and thrombosis, the prevalence of portal vein thrombosis (PVT) in patients with cirrhosis can be up to 26%. Therefore, physicians should consider anticoagulation for the prevention and management of PVT in patients with cirrhosis who are at high risk of PVT. Vitamin K antagonist or low molecular weight heparin is suggested as the standard treatment for PVT in cirrhosis. With the advent of new direct-acting oral anticoagulants (DOACs), there is a paradigm shift of switching to DOACs for the treatment of PVT in patients with cirrhosis. However, the safety and efficacy of DOACs in the treatment of PVT was not well-known in patients with cirrhosis. Therefore, this review focused on the current knowledge about the efficacy, safety concerns, and hepatic metabolism of DOACs in patients with cirrhosis and PVT.

Although patients with cirrhosis are known to be in a state of “rebalance” in that pro- and anticoagulant factors increase the risk for both bleeding and thrombosis, the prevalence of portal vein thrombosis (PVT) in patients with cirrhosis can be up to 26%. Therefore, physicians should consider anticoagulation for the prevention and management of PVT in patients with cirrhosis who are at high risk of PVT. Vitamin K antagonist or low molecular weight heparin is suggested as the standard treatment for PVT in cirrhosis. With the advent of new direct-acting oral anticoagulants (DOACs), there is a paradigm shift of switching to DOACs for the treatment of PVT in patients with cirrhosis. However, the safety and efficacy of DOACs in the treatment of PVT was not well-known in patients with cirrhosis. Therefore, this review focused on the current knowledge about the efficacy, safety concerns, and hepatic metabolism of DOACs in patients with cirrhosis and PVT.

Intestinal microorganisms interact with various immune cells and are involved in gut homeostasis and immune regulation. Although many studies have discussed the roles of the microorganisms themselves, interest in the effector function of their metabolites is increasing. The metabolic processes of these molecules provide important clues to the existence and function of gut microbes. The interrelationship between metabolites and T lymphocytes in particular plays a significant role in adaptive immune functions. Our current review focuses on 3 groups of metabolites: short-chain fatty acids, bile acids metabolites, and polyamines. We collated the findings of several studies on the transformation and production of these metabolites by gut microbes and explained their immunological roles. Specifically, we summarized the reports on changes in mucosal immune homeostasis represented by the Tregs and Th17 cells balance. The relationship between specific metabolites and diseases was also analyzed through latest studies. Thus, this review highlights microbial metabolites as the hidden treasure having potential diagnostic markers and therapeutic targets through a comprehensive understanding of the gut-immune interaction.

PURPOSE: To analyze the cause and treatment method of humerus nonunions which were initially treated by operation. The causes of nonunion were analyzed according to the initial treatment method. We report upon treatment options. MATERIALS AND METHODS: We reviewed 15 cases of humerus nonunion, which were initially treated surgically (7 cases of dynamic compression plate, 4 of Ender nail, 3 of interlocking intramedullary nail, 1 of K-wire) from January 1992 to January 2001. RESULTS: The causes of nonunion were determined to be as follows ; inadequate internal fixation or technical failure (9 cases), postoperatively applied improper external immobilization (5 cases), inadequate choice of implant (1 case). We treated the nonunion as follows; dynamic compression plate and bone graft in 11 cases, intramedullary nailing with small plate augumentation and bone graft in two, maintenance of initial nail with small plate augumentation and bone graft in two. All cases had bone union at an average of 15.9 weeks without complications, such as osteomyelitis, radial nerve palsy, or joint stiffness. CONCLUSION: Plate fixation is considered to be superior to intramedullary fixation in the treatment of nonunion. However, cases that received interlocking intramedullary nailing can be treated easily with small plate augumentation and bone graft without initial nail removal.
Fracture Fixation, Intramedullary ; Humerus* ; Immobilization ; Joints ; Osteomyelitis ; Paralysis ; Radial Nerve ; Transplants