BACKGROUND: Mechanisms of secondary injury (post-ischemic injury) in the central nervous system have cently reported in a vast of amount of experiments. Among many factors which give rise to post-ischemic neuronal damage, glial deterioration probably mediated by calcium paradox, could be another of the aggravating deleterious factars to the already ischemic neurophil. METHODS: Here we have designed experiment to investigate calcium paradox in astroglial cell line, humsn asttocytoma U1242MG. Intracellular calcium alterations in experimental cells were monitored by using calcium indicating dye fura-2 and epifluorescent photometry system. RESULTS: Intracellular free calcium changes during reperfusion phase after exposure to low calcium led to a prampt increase in intracellular calcium level after 10 and 30 minutes. The way of calcium entry during the reperfusion phase was mediated by the revase mode of Na+/Ca(2+) exchanger. Cells that had a reduction of reperfusate calcium to 10 uM increased cell viability. Also we observed an inverse relationship between major enzymatic activity in the astrocytoma cells (i.e., glutamine synthetase activity) and the duration of reperfusion in the the same protocols. CONCLUSIONS: A relatively small amount of intracellular calcium increase by the reverse mode of Na+/Ca(2+) exchanger during the reperfusion period is related to a limitation of enzyme activity and viability 24 hours later.
Anesthesia* ; Astrocytoma ; Brain ; Calcium ; Capnography* ; Cell Line ; Cell Survival ; Central Nervous System ; Fura-2 ; Glutamate-Ammonia Ligase ; Ions ; Neuroglia ; Neurons ; Photometry ; Reperfusion

A 3rd degree burn on the heel including the Achilles tendon is vulnerable and requires active treatment to improve the functional outcomes. Previously, there have been a few treatments on severe burns, such as amputation, debridement or simple skin graft. The cooperative technique of an anterior lateral thigh flap with Achilles tendon reconstruction can be an innovative procedure that preserves the major arteries. The authors review a case and report the clinical outcome.
Achilles Tendon* ; Amputation ; Arteries ; Burns* ; Debridement ; Free Tissue Flaps* ; Heel* ; Reconstructive Surgical Procedures ; Skin ; Surgical Flaps ; Thigh* ; Transplants

Background: More comprehensive healthcare services should be provided to patients with complex chronic diseases to better manage their complex care needs. This study examined the effectiveness of comprehensive primary care in patients with complex chronic diseases. Methods: We obtained 2002–2019 data from the National Health Insurance Sample Cohort Database. Participants were individuals aged ≥ 30 years with at least two of the following diseases: hypertension, diabetes mellitus, and hyperlipidemia. Doctors’ offices were classified into specialized, functional, and gray-zone based on patient composition and major diagnostic categories. The Cox proportional hazard model was used to examine the association between office type and hospital admission due to all-causes, severe cardiovascular or cerebrovascular diseases (CVDs), hypertension, diabetes mellitus, or hyperlipidemia. Results: The mean patient age was 60.3 years; 55.8% were females. Among the 24,906 patients, 12.8%, 38.3%, and 49.0% visited specialized, functional, and gray-zone offices, respectively. Patients visiting functional offices had a lower risk of all-cause admission (hazard ratio [HR], 0.935; 95% confidence interval [CI], 0.895–0.976) and CVD-related admission (HR, 0.908; 95% CI, 0.844–0.977) than those visiting specialized offices.However, the admission risks for hypertension, diabetes mellitus, and hyperlipidemia were not significantly different among office types. Conclusion This study provides evidence of the effectiveness of primary care in functional doctors’ offices for patients with complex chronic diseases beyond a single chronic disease and suggests the need for policies to strengthen functional offices providing comprehensive care.

OBJECTIVE: To examine the effect of cold spray (Ethyl chloride) on reducing pain during needle electromyography (EMG). METHOD: Seventy-six adults, who had experienced needle electromyographic examination, were studied. They were randomly assigned to either experimental or control group. In experimental group, cold spray was applied to needling point of examining muscles before each needle examination. In control group, needle examination was performed without pre-treatment. The intensity of pain was assessed by the Visual analogue scale (VAS) and Verbal rating scale (VRS). Denial to re-examination was evaluated after EMG study. RESULTS: The VAS, VRS and denial to re-examination were significantly lower in experimental group (p<0.05). CONCLUSION: The application of cold spray before needle examination decreased the intensity of pain and denial to re-examination.
Adult ; Denial (Psychology) ; Electromyography* ; Humans ; Muscles ; Needles*

OBJECTIVE: To evaluate the usefulness of the mental component summary (MCS) from the short form 36-item health survey (SF-36) as a screening test for depression in patients with chronic musculoskeletal pain and identify the optimal cut-off value that predicts a positive depression score measured by the center for epidemiological study depression survey (CES-D). METHOD: This study was designed as a questionnaire survey. 502 patients who visited our outpatient clinics due to chronic musculoskeletal pain were evaluated. They completed the SF-36 and the CES-D. The correlation between the MCS score from the SF-36 and the CES-D was identified, and also the cut-off value of the MCS score was determined with ROC curves used the CES-D as the standard measure for depression. The MCS scores were compared according to age, sex, duration of diseases, diagnosis, and the presence of depression. RESULTS: The mean overall score of CES-D and the MCS score were 17.5+/-10.2, 52.2+/-16.4 respectively. The MCS scores negatively correlated with the CES-D (gamma=-0.879, p<0.01). There were no significant differences of the MCS scores in each group according to age, sex, duration of diseases, and diagnosis (p>0.05). However, patients with depression had significantly lower MCS scores than patients without depression (p<0.05). The cut-off value was 42.4 with 88.1% of sensitivity and 92.6% of specificity. CONCLUSION: The MCS scores would be useful screening test for depression with cut-off value of 42.4 that predicts the closest result of the CES-D.
Ambulatory Care Facilities ; Chronic Pain ; Depression* ; Diagnosis ; Epidemiologic Studies ; Health Surveys* ; Humans ; Mass Screening* ; Musculoskeletal Pain* ; Surveys and Questionnaires ; ROC Curve ; Sensitivity and Specificity

We report here a case of maternal 3-methylcrotonyl-coenzyme A carboxylase (3-MCC) deficiency in a Korean woman. Her 2 infants had elevated 3-hydroxyisovalerylcarnitine (C5-OH) on a neonatal screening test by liquid chromatography-tandem mass spectrometry (LC-MS/MS), but normal results were found on urine organic acid analysis. The patient was subjected to serial testing and we confirmed a maternal 3-MCC deficiency by blood spot and breast milk spot test by LC-MS/MS, serum amino acid analysis, urine organic acid and molecular genetic analysis that found c.838G>T (p.Asp280Tyr) homozygous mutation within exon 9 of the MCCB gene. Especially, we confirmed marked higher levels of C5-OH on breast milk spot by LC-MS/MS, in the case of maternal 3-MCC deficiency vs. controls.
Breast* ; Exons ; Female ; Humans ; Infant ; Infant, Newborn ; Mass Spectrometry ; Milk, Human* ; Molecular Biology ; Neonatal Screening

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating conditions, which is usually monophasic. Recurrent ADEM and multiphasic disseminated encephalomyelitis (MDEM) is much less characterized entity, and its differentiation from multiple sclerosis (MS) poses a diagnostic challenge. We report a case of multiphasic disseminated encephalomyelitis (MDEM). The patient had two episodes of paraparesis and other neurologic symptoms, which were separated by 2 months. The patient presented with fever, headache, mental change, lower extremity weakness, voiding difficulty as well as focal neurologic deficits, which showed good response on steroid and acyclovir. Brain MRI revealed variable sized, multifocal, subcortical white matter lesions with gray matter involvement, and spine MRI revealed high signal intensity from C3 to T9 spinal cord. The CSF study showed elevated protein count and negative oligoclonal band.
Acyclovir ; Brain ; Encephalomyelitis ; Encephalomyelitis, Acute Disseminated ; Fever ; Headache ; Humans ; Lower Extremity ; Multiple Sclerosis ; Neurologic Manifestations ; Paraparesis ; Simplexvirus ; Spinal Cord ; Spine

Background: Health-adjusted life expectancy (HALE) is an indicator of the average lifespan in good health. Through this study, we aimed to identify regional disparities in the gap between HALE and life expectancy, considering the trends that have changed over time in Korea. Methods: We employed a group-based multi-trajectory modeling approach to capture trends in the gap between HALE and life expectancy at the regional level from 2008 to 2019. HALE was calculated using incidence-based “years lived with disability.” This methodology was also employed in the Korean National Burden of Disease Study. Results: Based on five different information criteria, the most fitted number of trajectory groups was seven, with at least 11 regions in each group. Among the seven groups, one had an exceptionally large gap between HALE and life expectancy compared to that of the others.This group was assigned to 17 regions, of which six were metropolitan cities. Conclusion Based on the results of this study, we identified regions in which health levels have deteriorated over time, particularly within specific areas of metropolitan cities. These findings can be used to design comprehensive policy interventions for community health promotion and urban regeneration projects in the future.

Atretic cephalocele is a rare congenital cranial anomaly. We have experienced 3 cases of atretic cephalocele at the Department of Neurosurgery, Kyungpook University Hospital between 1990 and 1993. Clinical features, operative considerations, and outcome are discussed.
Encephalocele* ; Gyeongsangbuk-do ; Neurosurgery

Pathologic splenic rupture is an uncommon finding associated with a long list of pathologic conditions, including infectious diseases, hematologic diseases, metabolic disorders, drug therapy, primary and secondary benign or malignant splenic tumors, acute or chronic pancreatitis, collagen disorders pregnancy, and others. In this report, we present a case study of a pathologic splenic rupture caused by metastasis from a previously undiagnosed gastric carcinoma.
Collagen ; Communicable Diseases ; Drug Therapy ; Hematologic Diseases ; Neoplasm Metastasis ; Pancreatitis, Chronic ; Pregnancy ; Splenic Rupture*