The efficacy of high frequency oscillation superimposed on conventional mechanical ventilation (combined ventilation) was evaluated in 11 patients requiring respiratory care. These patients were comatose and in an apneic state. The conventional ventilator was initially set at a tidal volume of 10ml/kg at a rate of 10/min.(control) and half of the tidal volume was delivered throughout superimposing high frequency oscillations. While changing high frequency rates(5,10 and 15 Hz) at an interval of 15 minutes(experimental groups 1,2 and 3), blood pressure, pulse rate, peak and mean airway pressure, and expiratory volume were measured and arterial blood gas analysis was performed. There were no significant differences in cardiovascular and blood gas parameters between each group and the control. But PaCO2 and PaO2 rose and airway pressures(peak and mean airway pressure) were reduced as the high frequency rates increased, especially in the group with the largest samplitude oscillations. These results suggest that combined ventilation can achieve an adequate gas exchange and low airway pressure without cardiovascular embarrassment in respiratory support. This should help to provide an alternative mode for the management of patients with respiratory failure requiring mechanical ventilation.
Blood Gas Analysis ; Blood Pressure ; Coma ; Heart Rate ; High-Frequency Ventilation ; Humans ; Respiration, Artificial* ; Respiratory Insufficiency ; Tidal Volume ; Ventilation* ; Ventilators, Mechanical

OBJECTIVE: To investigate the anatomical correlates of the neuropsychological deficits in patients with the cerebellar stroke. METHODS: We screened patients who were admitted to the National Rehabilitation Center with the cerebellar stroke between October 2012 and November 2016. The patients with the cerebellar stroke who underwent neuropsychological testing for which the Seoul Neuropsychological Screening Battery (SNSB) or the SNSB-II were enrolled. The neuropsychological function capacities were compared in accordance with the stroke type (hemorrhagic vs. ischemic) and the location (right/left anterior, right/left posterior intermediate, right/left posterior lateral lobe, and vermis). Mean z-scores were computed to compare the patient performances with the population averages. RESULTS: Twenty-six patients (15 with ischemic stroke and 11 with hemorrhagic stroke) with a mean age of 54.8±16.6 years were assessed 8.8±9.2 months after the stroke. Differences in the neuropsychological functioning according to the stroke type were not observed. All of the numerical subtests of the stroke patients showed significantly poorer performances compared with the population averages (mean z-score < 0), and some of the subtests revealed abnormal performances in attention-, visuospatial function-, memory-, and frontal/executive function-related tasks (mean z-score <−1). The patients with the presence of a lesion in the right posterior intermediate lobe of the cerebellum showed a poorer performance in the subtests evaluating the executive function including the Korean-version Stroop Test (p=0.04), the Digit Symbol Coding Test (p=0.01), and the Korean-version Trail Making Test (p=0.02) compared with the patients without that lesion. CONCLUSION: The present study confirms that the cerebellar stroke affects the neuropsychological functioning which is associated with the anatomical site of stroke.
Cerebellum ; Clinical Coding ; Cognition ; Executive Function ; Humans ; Mass Screening ; Neuropsychological Tests ; Rehabilitation Centers ; Seoul ; Stroke* ; Stroop Test ; Trail Making Test

OBJECTIVE: To investigate the anatomical correlates of the neuropsychological deficits in patients with the cerebellar stroke. METHODS: We screened patients who were admitted to the National Rehabilitation Center with the cerebellar stroke between October 2012 and November 2016. The patients with the cerebellar stroke who underwent neuropsychological testing for which the Seoul Neuropsychological Screening Battery (SNSB) or the SNSB-II were enrolled. The neuropsychological function capacities were compared in accordance with the stroke type (hemorrhagic vs. ischemic) and the location (right/left anterior, right/left posterior intermediate, right/left posterior lateral lobe, and vermis). Mean z-scores were computed to compare the patient performances with the population averages. RESULTS: Twenty-six patients (15 with ischemic stroke and 11 with hemorrhagic stroke) with a mean age of 54.8±16.6 years were assessed 8.8±9.2 months after the stroke. Differences in the neuropsychological functioning according to the stroke type were not observed. All of the numerical subtests of the stroke patients showed significantly poorer performances compared with the population averages (mean z-score < 0), and some of the subtests revealed abnormal performances in attention-, visuospatial function-, memory-, and frontal/executive function-related tasks (mean z-score <−1). The patients with the presence of a lesion in the right posterior intermediate lobe of the cerebellum showed a poorer performance in the subtests evaluating the executive function including the Korean-version Stroop Test (p=0.04), the Digit Symbol Coding Test (p=0.01), and the Korean-version Trail Making Test (p=0.02) compared with the patients without that lesion. CONCLUSION: The present study confirms that the cerebellar stroke affects the neuropsychological functioning which is associated with the anatomical site of stroke.
Cerebellum ; Clinical Coding ; Cognition ; Executive Function ; Humans ; Mass Screening ; Neuropsychological Tests ; Rehabilitation Centers ; Seoul ; Stroke* ; Stroop Test ; Trail Making Test

BACKGROUND: The purpose of this study is to examine the effect of the spiritual well-being on social nicotine dependence, alcohol consumption, use of internet and gambling among medical students (n=271). METHODS: A cross-sectional survey was conducted on 271 medical students using self-administered questionnaires including the spiritual well-being scale, KTSND score, the alcohol use disorder identification test, the internet addiction test, and the Canadian problem gambling index (Korean Version). RESULTS: There were significant negative relationships between spiritual well being and addictive behaviors such as social nicotine dependence (r=-0.160, P<0.05), alcohol consumption (r=-0.357, P<0.001), internet overuse (r=-0.156, P<0.01). High social nicotine dependence was related with high alcohol consumption (r=0.317, P<0.01), as well as internet overuse with gambling (r=0.165, P<0.01). Spiritual well being on was significantly related to alcohol consumption (beta=-0.244, P<0.01) and use of internet (beta=-0.136, P<0.01). This suggests the higher spiritual well being score the student has, the lower possibility of alcohol or internet overuse he or she tends to have. On the other hand, the impact of spiritual well being on social nicotine dependence or gambling were not significant. CONCLUSIONS: The milestone of the current study is to provide the importance of better understanding of spiritual background of an individual, and to address the necessity of its holistic approach. Moreover, new spiritual counseling model and its healing program should be developed and validated before application.
Alcohol Drinking* ; Behavior, Addictive ; Counseling ; Cross-Sectional Studies ; Gambling* ; Hand ; Humans ; Internet* ; Nicotine* ; Students, Medical* ; Tobacco Use Disorder*

This study was aimed to elucidate the endothelium-dependent vascular effects of halothane and sevoflurane on rabbit aortic rings at two conventional concentrations(high induction and low maintenance concentration in human). Isometric tenslon was recorded in isolated aortic rings. Preparations of rabbit thoracic aorta were suspended in Krebs' buffer and aerated with 95% O2 and 5% CO2. One set of the rings had intact endothelium and the other set of the rings had endothelium mechanically denuded. In the first experiments, the rings were precontracted with norepinephrine(NE) of 10-7 M. After tension was stabilized in 10~15 minutes following NE, halothane(1, 2%) or sevoflurane(2, 4%) was bubbled with O2/CO2 gas mixture at increasing concentrations. In the second experiment, O2/CO2 gas mixture only(control rings), halothane 2% or sevoflurane 4 % with O2/CO2, gas mixture was bubbled for 10(-7) minutes prior to and during contraction with NE of 10M. After tension was stabilized following NE, acetylcholine(10(-8)-10(-6) M) was added cumulatively. In the third experiment, the procedure was as same as the second experiment except for that acetylcholine(10(-8)-10(-6) M) was substitued for nitroglycerin (10(-9)-10(-6) M) . The present study demonstated that both of halothane and sevoflurane at high concentration caused a vasoconstriction to 110.7+/-4.2% and 122.4+/-8.4% in vascular rings with intact endothelium, and 106.1+/-1.9% and 118.3+/-3.5% in vascular rings with denuded endothelium, respectively, compared to each control value of 100%. Furthermore, halothane and sevoflurane attenuated the acetylcholine induced relaxing response in NE-precontracted vascular rings with intact endothelium, but did not affect any change of tension in vascular rings with denuded endothelium. Halothane and sevoflurane did not attenuate the nitroglycerin induced relaxing response in NE-precontracted vascular rings with both intact and denuded endothelium. In conclusion, halothane and sevoflurane at high concentration has vasoconstrictory effects on vascular smooth muscles in rabbit aortic rings regardless of presence of endothelium and also attenuated the endothelium-dependent relaxation.
Acetylcholine ; Aorta, Thoracic ; Endothelium* ; Halothane* ; Muscle, Smooth, Vascular ; Nitroglycerin ; Norepinephrine ; Relaxation ; Vasoconstriction

The potent antioxidant and anti-hypertension activities have evidenced gastric enzymatic hydrolysates from flounder fish and their derived peptides. However, peptide composition and functional effect in various enzymatic hydrolysates differ by enzyme types, hydrolyzed times temperatures, etc. Therefore, we determined potential anti-hypertensive effect of hydrolysates produced from flounder fish using commercial enzymes such as Protamex, Flavourzyme, and Kojizyme which are common food grade proteases and characterized on its derived peptides. In this study, Protamex-mediated hydrolysate showed a more potent anti-hypertension effect than other commercial enzymes. Protamex-mediated hydrolysate was fractionated into three ranges of molecular weight (above 10 kDa (FPH-I), 5-10 kDa (FPH-II), and below 5 kDa (FPH-III)). The FPH-III exhibited the strongest anti-hypertensive effect, and it was revealed that three active peptides, valine-phenylalanine-serine-glycinetryptophan-alanine-alanine (VFSGWAA), leucine-histidine-phenylalanine (LHF) and tryptophan-proline-tryptophan (WPW) were contained. The activities were confirmed via angiotensin-converting enzyme (ACE) inhibition and molecular docking simulation. Among the three peptides, LHF and WPW have a molecular structure stability against the gastrointestinal digestion. LHF showed a significant anti-hypertension effect at 9 h after oral administration in spontaneously hypertensive rats (SHRs). Therefore, we suggest that Protamex-mediated hydrolysate would be an excellent anti-hypertensive agent due to the existence of stabilized functional peptides, including LHF and WPW.

Metformin is a well-established drug for the treatment of type 2 diabetes mellitus. The incidence of metformin-induced lactic acidosis is low, but the estimated mortality rate is approximately 50% in cases with lactic acidosis in combination with metformin therapy. Lactic acidosis occurs most often in patients with compromised cardiac, pulmonary, hepatic, and/or renal function. Acute kidney injury is a relatively frequent problem in cirrhosis patients. Hepatorenal syndrome is a diagnosis of exclusion, making its diagnosis difficult in the clinical field. We report a case of metformin-induced lactic acidosis with acute kidney injury that was misdiagnosed as hepatorenal syndrome in a cirrhosis patient.
Acidosis ; Acidosis, Lactic ; Acute Kidney Injury ; Diabetes Mellitus, Type 2 ; Fibrosis ; Hepatorenal Syndrome ; Humans ; Incidence ; Liver Cirrhosis ; Metformin

Metformin is a well-established drug for the treatment of type 2 diabetes mellitus. The incidence of metformin-induced lactic acidosis is low, but the estimated mortality rate is approximately 50% in cases with lactic acidosis in combination with metformin therapy. Lactic acidosis occurs most often in patients with compromised cardiac, pulmonary, hepatic, and/or renal function. Acute kidney injury is a relatively frequent problem in cirrhosis patients. Hepatorenal syndrome is a diagnosis of exclusion, making its diagnosis difficult in the clinical field. We report a case of metformin-induced lactic acidosis with acute kidney injury that was misdiagnosed as hepatorenal syndrome in a cirrhosis patient.
Acidosis ; Acidosis, Lactic ; Acute Kidney Injury ; Diabetes Mellitus, Type 2 ; Fibrosis ; Hepatorenal Syndrome ; Humans ; Incidence ; Liver Cirrhosis ; Metformin

BACKGROUND: A forceps-biopsy is performed to acquire tissue from patients with an endobronchial carcinoma using a flexible bronchoscope. Recently, a cryo-biopsy has also been used to acquire tissue samples. Cryo-biopsy is the diagnostic application of extreme cold for the local destruction of abnormal living tissue. This technique is safe, with no radiation danger, no risk of electrical accidents, and a little risk of bleeding. This study compared a forceps-biopsy with a cryo-biopsy using a flexible bronchoscope, and examined the chemosensitivity and level of VEGF (vascular endothelial growth factor) in the specimens obtained from the cryo-biopsy. METHODS: We present a prospective study of 30 consecutive patients who underwent a forceps-biopsy between January 2007 and October 2007 with a mean age of 62.1 years and a male:female ratio of 5 : 1. A flexible bronchoscope was inserted to the area of the abnormal lesions, and a cryo-probe was then applied through the working channel of the flexible bronchoscope. A temperature of approximately -80 was delivered to the tumor site for 8 seconds. The cryo-biopsy was performed after destroying the tumor mass. RESULTS: The mean size of the tissue from the forceps-biopsy and cryo-biopsy were 2.0+/-1.2 mm and 6.0+/-3.0 mm. A chemosensitivity test was performed on 5 specimens obtained using cryo-biopsy and the level of VEGF was examined in 2 specimens obtained from a cryo-biopsy. There were no side effects in either group. CONCLUSION: Cryo-biopsy using a flexible bronchoscope is a safe and effective technique for acquiring tissue samples.
Bronchoscopes ; Bronchoscopy ; Extreme Cold ; Hemorrhage ; Humans ; Prospective Studies ; Vascular Endothelial Growth Factor A

OBJECTIVES: Bone densitometry is a current method for evaluating skeletal status, assessing osteoporosis, and determining fracture risk. DEXA has rapidly become a dominent method for evaluating skeletal status. But the comparison of patient data among different DEXA scanners is complicated because the instruments show differences in scanner design, bone mineral calibration, and analysis algorithms. The purpose of this study is making standardization of DEXA and comparability among different DEXA system. METHODS: Posteroanterior lumbar spine (L2-IA) measurements of healthy 83 racially homogenous Korean women, age 38-66 years (mean +/- 516, range of BMD 0.624-1.574g/cm) were obtained on a Lunar DPX-L, a Hologic QDR-2000, and a Norland XR-36. All sujects had no spinal deformities, ostophytes, fracture and scoliosis on thoracolumbar spinal X-ray. We performed the measurement of BMD in each subjects with different three scanners at the same time. RESULTS: The results of cross-calibration spinal BMD (L2-4, g/cm2) in patient study (r2=0.972-0.974); Lunar DPX-L=(1.149 X Hologic)+0.008=(1.022 X Norland)+0.137, Hologic QDR-2000=(0.847 X Lunar)+0.019= (0.876 X Norland)+0.124, and Norland XR-36=(0.954 X Lunar)-0.107=1.110 X Hologic)-0.113. The average absolute difference in patients` spinal BMD values (L2-L4) between Lunar and Hologic was 0.146g/cm2 (14%); it was 0.156g/cm2 (15%) between Lunar and Norland and 0.010g/cm2 (1%) between Hologic and Norland. CONCLUSIONS: The formula of this cross-calibration shows good correlation. We conclude that it is possible to compare the different spinal BMD values obtained on the different DEXA scanners.
Absorptiometry, Photon* ; Bone Density ; Calibration ; Congenital Abnormalities ; Densitometry ; Female ; Humans ; Osteoporosis ; Scoliosis ; Spine