PURPOSE: To analyze innervated myotendinous cylinders (IMCs) in the extraocular muscles (EOMs) of normal subjects and strabismic patients. METHODS: The rectus muscles of 37 subjects were analyzed. Distal myotendinous specimens were obtained from 3 normal subjects, 20 patients with acquired strabismus, 11 with infantile strabismus, and from 3 with congenital nystagmus, and were studied by using light microscopy. Some specimens (6 rectus muscles) were also examined by transmission electron microscopy. RESULTS: IMCs were found in the distal myotendinous regions of EOMs. The IMCs of patients with acquired strabismus showed no significant morphological alterations. However, significant IMCs alterations were observed at the distal myotendinous junction of patients with congenital strabismus and congenital nystagmus. CONCLUSIONS: This study supports the notion that IMCs in human EOMs function mainly as proprioceptors, along with effector properties, and a disturbance of ocular proprioceptors plays an important role in the pathogenesis of oculomotor disorder. We suggest that a proprioceptive feedback system should be stimulated and calibrated early in life for the development of binocular vision.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Microscopy, Electron, Transmission ; Middle Aged ; Oculomotor Muscles/*innervation/physiopathology/ultrastructure ; Proprioception/physiology ; Strabismus/*pathology/physiopathology ; Young Adult

Purpose: : This study aimed to identify the effects of a multifaceted pediatric delirium education program for pediatric intensive care unit (PICU) nurses on their delirium knowledge, confidence in delirium nursing, and delirium evaluation accuracy. Methods: : This study used a one-group pretest-posttest design. The participants were 50 nurses in two units of the PICU at S General Hospital in Seoul. All participants took a 1-hour lecture with case-based practice for the first two weeks, and received feedback as they applied the program to clinical practice over the next two weeks. Test measures were completed before and after the four week intervention period for all participants. The delirium evaluation accuracy was measured using the Korean version of the Cornell Assessment of Pediatric Delirium. Data were analyzed using the chi-square and paired t-tests. Results: : After the Pediatric Delirium Education Program, nurses’ delirium knowledge (x2 =11.65, p =.001), confidence in delirium nursing (t=9.71, p＜.001), and delirium evaluation accuracy (t=6.07, p＜.001) improved significantly. Conclusions : Pediatric delirium education programs for PICU nurses were effective. For active application of the program in clinical practice in the future, various cases of childhood delirium and specific strategies for each subject must be developed. To achieve this, long-term intervention and research for multiple organizations are required.

OBJECTIVE: To evaluate the colonic motility and nutrients intake in children with spastic cerebral palsy (CP) and to compare the results with those of normal children. METHOD: Thirty-eight children with spastic CP were participated in this study. They took the radioopaque markers for 3 successive days. Then, abdominal X-ray was taken on the fourth day. Total and segmental colon transits were estimated by the simplified assessment of a single-film technique by Metcalf et al. The amounts of nutrients intake for 3 days were recorded and nutritional factors were analyzed by ESHA Food Processor. Then, daily intakes of the nutrients were compared with Recommended Dietary Allowance of the Korean Nutrition Society. RESULTS: Total and segmental colon transit time were more than 2 times delayed in children with spastic CP as compared with those of normal controls. Total colon transit time was significantly prolonged in quadriplegic and non-ambulatory children (p<0.05). On the evaluation of daily nutrients intake, most of nutritional factors were inadequate in children with spastic CP. CONCLUSION: The children with spastic CP had the problems in colonic motility and nutritional intake. Also, delayed colon transit time was significantly related with poor mobility. Therefore, early intervention for these problems will be required in spastic CP, especially quadriplegic and non-ambulatory children.
Cerebral Palsy* ; Child* ; Colon* ; Early Intervention (Education) ; Humans ; Muscle Spasticity* ; Recommended Dietary Allowances

The case of a 33-day-old boy with Pierre Robin syndrome using a Cook(R) airway exchange catheter in laryngeal mask airway-guided fiberoptic intubation is presented. After induction with sevoflurane, classical reusable laryngeal mask airway (LMA) #1 was inserted and ultrathin fiberoptic bronchoscope (FOB) was passed through. A Cook(R) airway exchange catheter (1.6 mm ID, 2.7 mm OD) was passed through the LMA under the guidance of the FOB but failed to enter the trachea despite many trials. Then, an endotracheal tube (3.0 mm ID) was mounted on the FOB and railroaded over the FOB. After successful intubation, the Cook(R) airway exchange catheter was placed in the midtrachea through the lumen of the endotracheal tube. Even though the tracheal tube was accidentally displaced out of the trachea during LMA removal, the endotracheal tube could be easily railroaded over the airway exchange catheter.
Bronchoscopes ; Catheters ; Humans ; Infant, Newborn ; Intubation ; Laryngeal Masks ; Methyl Ethers ; Pierre Robin Syndrome ; Railroads ; Songbirds ; Trachea

OBJECTIVE: To evaluate the effect of stretching therapy of neurogenic bladder in spinal cord injured patients. METHOD: Twelve spinal cord injured patients who had neurogeic bladder manifested with urinary incontinence resistant to oral and intravesical anticholinergic instillation treatment were selected. Oxybutynin solution was instillated via foley catheter and the catheter was clamped until incontinence occur. This was performed twice a day for 7 days. The urodynamic studies were compared before and after therapy. Total volume of daily incontinence and total volume of daily fluid intake were also monitored. RESULTS: After stretching therapy, median maximal bladder capacity increased from 190.08 to 457.17 ml (p<0.01), mean bladder compliance increased from 8.46 to 18.85 ml/cmH2O (p<0.01), mean reflex volume increased from 148.75 to 252.17 ml (p<0.05), mean maximal detrusor pressure decreased from 52.17 to 28.29 cmH2O (p<0.01), mean clinical maximal capacity increased from 277.50 to 537.50 ml (p<0.01), and mean daily incontinent volume decreased from 508.33 ml to 20.83 ml (p<0.01). No significant correlation was found between the duration since onset of injury and the urodynamic finding. CONCLUSION: This study proved that stretching therapy of bladder was an effective method in spinal cord injured patients who had neurogenic bladder with uncontrolled incontinence with conventional therapy.
Administration, Intravesical ; Catheters ; Compliance ; Humans ; Reflex ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urinary Incontinence ; Urodynamics

Neural stem cells (NSCs) have been suggested as a groundbreaking solution for stroke patients because they have the potential for self-renewal and differentiation into neurons. The differentiation of NSCs into neurons is integral for increasing the therapeutic efficiency of NSCs during inflammation. Apoptosis signal-regulating kinase 1 (ASK1) is preferentially activated by oxidative stress and inflammation, which is the fundamental pathology of brain damage in stroke. ASK1 may be involved in the early inflammation response after stroke and may be related to the differentiation of NSCs because of the relationship between ASK1 and the p38 mitogen-activated protein kinase pathway. Therefore, we investigated whether ASK1 is linked to the differentiation of NSCs under the context of inflammation. On the basis of the results of a microarray analysis, we performed the following experiments: western blot analysis to confirm ASK1, DCX, MAP2, phospho-p38 expression; fluorescence-activated cell sorting assay to estimate cell death; and immunocytochemistry to visualize and confirm the differentiation of cells in brain tissue. Neurosphere size and cell survival were highly maintained in ASK1-suppressed, lipopolysaccharide (LPS)-treated brains compared with only LPS-treated brains. The number of positive cells for MAP2, a neuronal marker, was lower in the ASK1-suppressed group than in the control group. According to our microarray data, phospho-p38 expression was inversely linked to ASK1 suppression, and our immunohistochemistry data showed that slight upregulation of ASK1 by LPS promoted the differentiation of endogenous, neuronal stem cells into neurons, but highly increased ASK1 levels after cerebral ischemic damage led to high levels of cell death. We conclude that ASK1 is regulated in response to the early inflammation phase and regulates the differentiation of NSCs after inflammatory-inducing events, such as ischemic stroke.
Animals ; Cell Death ; Infarction, Middle Cerebral Artery/*metabolism ; Lipopolysaccharides/pharmacology ; MAP Kinase Kinase Kinase 5/genetics/*metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Microtubule-Associated Proteins/genetics/metabolism ; Neural Stem Cells/cytology/drug effects/*metabolism ; *Neurogenesis ; Neuropeptides/genetics/metabolism ; p38 Mitogen-Activated Protein Kinases/genetics/metabolism

We present a 53-year-old woman with a large chest wall mass in the interpectoral space, which was eventually confirmed as a lipogranuloma resulting from hydrogel implant rupture. Ultrasonography (US) showed reduced implant volume with surrounding peri-implant fluid collection, suggesting the possibility of implant rupture. A heterogeneously hypoechoic mass was found between the pectoralis major and minor muscles adjacent to the ruptured implant. On magnetic resonance imaging (MRI), there was a large mass in the left interpectoral space of the upper inner chest wall. The mass showed slightly high signal intensity (SI) on pre-contrast T1-weighted image (WI) with mixed iso and high SI on T2-WI. The signal of the mass was suppressed using the water suppression technique but not with the fat suppression technique on T2-WI. The mass showed diffuse enhancement upon contrast enhancement. The enhancing kinetics showed persistent enhancement pattern. US-guided core needle biopsy revealed a lipogranuloma and removal confirmed a ruptured PIP hydrogel implant.
Biopsy, Large-Core Needle ; Breast ; Female ; Humans ; Hydrogel* ; Kinetics ; Magnetic Resonance Imaging ; Middle Aged ; Muscles ; Rupture* ; Thoracic Wall* ; Thorax* ; Ultrasonography ; Water

OBJECTIVES: To determine the diagnostic performance of transrectal ultrasound in virgin patients with polycystic ovary syndrome (PCOS) by receiver operating characteristic (ROC) curve analysis, compared with conventional transvaginal ultrasound assessment. METHODS: Ultrasound examinations were performed in 963 Korean women, with transvaginal transducers in 677 women and transrectal transducers in 286 women at Ewha Womans University Mokdong Hospital. Transvaginal ultrasound examinations were performed in 494 normal control women and 183 PCOS patients according to National Institutes of Health (NIH) PCOS diagnostic criteria. In virgin patients, transrectal ultrasound examinations were performed in 141 normal control women and 145 PCOS patients. ROC curves were calculated for ovarian volume and follicle number. RESULTS: By transvaginal ultrasound examination, the ovarian volume showed an area under the ROC curve (AURC) of 0.838. An ovarian volume decision threshold > 7 cm3 had a sensitivity of 73.0% and a specificity of 84.2% for the diagnosis of PCOS. The follicle number showed an AURC of 0.886. A follicle number decision threshold > or = 9 had a sensitivity of 78.6% and a specificity of 87.2% for the diagnosis of PCOS. By transrectal ultrasound examination, the ovarian volume and the follicle number showed AURCs of 0.815 as same thresholds with a sensitivity of 67.2% and 66.4%, respectively and a specificity of 86.8% each. Ovarian volume and follicle number by transvaginal and transrectal ultrasound assessment had a high diagnostic power for PCOS screening. CONCLUSION: Transrectal ultrasound assessment is as effective as conventional transvaginal ultrasound for the detection of PCOS in virgin patients.
Diagnosis ; Female ; Humans ; Mass Screening ; National Institutes of Health (U.S.) ; Polycystic Ovary Syndrome* ; ROC Curve ; Sensitivity and Specificity ; Transducers ; Ultrasonography*

Conventional angiography still remains the procedure of choice in evaluation of cerebral aneurysm. However, MRI and MR angiography can play different roles in vizualizing cerebral aneurysm. A 43-year-old male was evaluated for recurrent seizure attacks. The brain MRI showed non-enhancing iso-signal mass on T1WI, signal voiding mass with stalk-like structure on coronal T2WI in the right temporal region. MRA also revealed dark round signal. However, the conventional cerebral angiography failed to visualize it. Finally, the mass was confirmed as a huge aneurysm filled with intraluminal thrombus on operation. It should seem that contrast media could not fill the aneurysmal sac because of intraluminal thrombus in conventional angiography. But aneurysmal sac seemed to be visible on MRA as paramagnetic artifact of thrombus. So, it can be assumed that MRA is superior to the conventional angiography in some cases of cerebral aneurysm, especially when it is associated with intraluminal thrombus.
Adult ; Aneurysm ; Angiography* ; Artifacts ; Brain ; Cerebral Angiography ; Contrast Media ; Humans ; Intracranial Aneurysm* ; Magnetic Resonance Imaging ; Male ; Seizures ; Thrombosis

BACKGROUND: Although nucleotides -like Adenosine Triphosphate (ATP) and its derivatives Adenosine, were known to induce growth inhibition and apoptosis in diverse cell lines, little is known about their effects on trophoblast. OBJECTIVE: To elucidate the effects of extracellular ATP and adenosine on trophoblast cell growth and to delineate if apoptosis is involved in this mechanism. MATERIALS AND METHODS: We used TL cell line, derived from human term placenta. The cells were cultured for 24, 48, and 72 hours after being treated with ATP and adenosine, each. Also, cell growth according to different concentrations of ATP and adenosine was evaluated. To test whether apoptosis was induced by each nucleotide, DNA fragmentation and nuclear condensation by Hoechst 33258 stain and P53 protein expression were evaluated. RESULTS: Cell growth was inhibited by ATP and adenosine in time and dose-dependent manner. Furthermore, the growth inhibitory effect of adenosine was stronger than ATP, whereas signs of DNA fragmentation and nuclear condensation were observed in ATP treated cells, but not in adenosine treated ones. CONCLUSION: Our results shows that ATP and adenosine exert inhibitory effect on growth in TL cell line. These findings suggest that pathological production of ATP or its metabolites, adenosine, may lead to a pathologic status such as preeclampsia or intrauterine growth restriction.
Adenosine Triphosphate* ; Adenosine* ; Apoptosis* ; Bisbenzimidazole ; Cell Line* ; DNA Fragmentation ; Humans* ; Nucleotides ; Placenta ; Pre-Eclampsia ; Trophoblasts