OBJECTIVE: To describe factors associated with the severity of post-stroke dysphagia. METHODS: We reviewed retrospectively medical records of patients having dysphagia following stroke in Seoul National University hospital from April 2002 through Dec 2009. A total of 578 patients (male and female, 331 and 247) were included. The following parameters were recorded and analyzed: patient's sex, age, type of stroke, onset of dysphagia, location of lesion and the American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale (ASHA NOMS). Using Binary logistic regression and multiple regression analysis, the relationship between dysphagia severity and other factors were analyzed. RESULTS: Their average duration between onset of stroke and the date of videofluoroscopic swallowing study (VFSS) was 32.3 +/- 18.4 days. Patients with hemorrhagic stroke (172 patients, ASHA 4.06 +/- 1.98) showed poorer swallowing function than those with ischemic stroke (406 patients, ASHA 4.49 +/- 2.02, p=0.013). Binary logistic regression analysis showed that patients who had longer duration from onset to the first study, hemorrhagic stroke, bilateral lesion and older age were at higher risk for dysphagia requiring non-oral supplements (p=0.031, 0.039, 0.042, and 0.043, respectively). Multiple regression analysis revealed that longer duration from onset to study, older age and hemorrhagic stroke were associated with the lower ASHA NOMS (p=0.006, 0.009 and 0.021, respectively). Bilateral lesion, sex, history of previous stroke and involvement of the brainstem, however, were not significant factors. CONCLUSION: Hemorrhagic stroke, longer duration from stroke onset to the initial evaluation, and older age were identified as associated factors with the poorer swallowing function after stroke. Further prospective studies will be required to evaluate the prognostic value of these characteristics.
American Speech-Language-Hearing Association ; Brain Stem ; Deglutition ; Deglutition Disorders ; Female ; Humans ; Logistic Models ; Medical Records ; Regression Analysis ; Retrospective Studies ; Stroke

BACKGROUND: It is well documented that BIS reflects the level of sedation but conflicting results exist about whether BIS can reflect the depth of anesthesia. We intended to identify this issue by investigating the correlation between the pre-incision bispectral index (BIS) values and the hemodynamic responses to skin incision during sevoflurane-N2O anesthesia in children. METHODS: In total, 117 ASA physical status I or II pediatric patients, aged 6 mo-12 yr, were enrolled. After induction and intubation with thiopental, rocuronium, sevoflurane and N2O, patients were randomly allocated to one of the four end-tidal sevoflurane concentrations (ETsevo); 2.0, 2.5, 3.0, and 3.5 %; with 60% N2O. The ETsevo was maintained constant for more than 15 min before and 5 min after skin incision. BIS, heart rate (HR), and systolic arterial pressure (SAP) before and after skin incision were recorded. RESULTS: Although there were no correlation between pre-incision BIS and change in BIS, SAP, and HR (Pearson's coefficient -0.120, -0.102, and -0.080, respectively), there were correlations between changes of BIS and changes in SAP and HR (Pearson's coefficient 0.318 and 0.309, respectively, P < 0.05). CONCLUSIONS: There was a correlation between the change of BIS, but not BISpre, and change in hemodynamic variables with skin incision during sevoflurane anesthesia in children.
Anesthesia* ; Arterial Pressure ; Child* ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Skin* ; Thiopental

Systemic amyloidosis after gastric cancer surgery is a very rare phenomenon. Less than ten such cases have been reported in the international literature. Although systemic amyloidosis has been reported to be associated with lymphoma, multiple myeloma, and renal cell carcinoma, its association with gastric cancer remains unclear. We report a case of a 64-year-old male who developed systemic amyloidosis 24 months after a Billroth-I gastrectomy for gastric cancer, and provide a brief review of the literature.
Amyloidosis* ; Carcinoma, Renal Cell ; Gastrectomy ; Humans ; Lymphoma ; Male ; Middle Aged ; Multiple Myeloma ; Stomach Neoplasms*

PURPOSE: This study was designed to examine the effect of aroma massage therapy on lower extremity edema of terminal cancer patients. METHODS: A total of thirty-six terminal cancer patients with lower extremity edema were divided into two groups: the aroma massage group received massage with blending oil which was applied from toes to 10 cm above the knee of the subject for 15 to 20 minutes in each turn, while the control group received sham aroma massage (applied with carrier oil only). The circumferences of the fore-foot, ankle and calf were measured before massage and 30 minutes, 2 hours, and 12 hours after massage. The blood pressure, pulse and body temperature were also measured to find the change of subject's physiologic conditions. RESULTS: There were no significant differences in blood pressure, heart rate, body temperature and lower extremity circumferences between two groups. However, edema at each site was slightly improved in the treatment group after the aroma massage therapy, compared to baseline data (P<0.05). In addition, the reduction of lower extremity circumference was maximal at 2 hours in foot, 30 min in right ankle and 12 hours in right calf after aroma massage therapy (P<0.05). CONCLUSION: Our results suggest that aroma massage therapy is not effective on the lower extremity edema of terminal cancer patients.
Animals ; Ankle ; Aromatherapy ; Blood Pressure ; Body Temperature ; Edema ; Foot ; Heart Rate ; Hospices ; Humans ; Knee ; Lower Extremity ; Massage ; Salicylamides ; Toes

Given that household food security issues have become the concern of the Korean society, this study aimed to develop food security measures for the Korean population. Based on the literature reviews on previously developed food security measures, the 18-item US household food security survey module (US HFSSM) was adapted. The developed food security measures was assessed by qualitative validity method. It was evaluated and modified by face validity by expert focus groups belong to university, public health center, and government agencies and by cognitive interview by 40 subjects with low household income who live in an urban community and are participants in welfare programs of local districts. Then, it was reviewed and revised by the National Institute of the Korean Language and the advisory committee for nutrition survey of Korean National Health and Nutrition Examination Survey (KNHANES). The results showed that the developed questionnaire items were well adapted by expert focus groups and general subjects, showing the feasibility of measuring food security with the developed measures although there were discrepancies in some expressions of questionnaire items between experts focus groups and general subjects. The study to assess reliability and quantitative validity of the developed food security measures should be further needed to examine its application for KNHANES.
Advisory Committees ; Family Characteristics ; Focus Groups ; Food Supply ; Government Agencies ; Nutrition Surveys ; Public Health ; Surveys and Questionnaires

BACKGROUDN: The ratio of mitral inflow (E) and annular velocity (E') to stroke volume (E/E'/SV) has been used as an index of diastolic elastance (Ed). However, its change during exercise has not been evaluated. We hypothesized that Ed values obtained during exercise would be abnormal in patients with apical hypertrophic cardiomyopathy (ApHCM). METHODS: Ed was measured at rest and during graded supine bicycle exercise (25 Watts, 3 minute increments) in 15 patients with ApHCM (12 male; mean age, 57 years) and in 15 age- and gender-matched control subjects. RESULTS: Ed was not significantly different at rest and during 25 W of exercise. However, Ed was significantly higher at 50 W of exercise in patients with ApHCM compared to control subjects (0.21+/-0.05 vs. 0.15+/-0.04 cm/s, p=0.0059). There was significant positive correlation between the magnitude of change in proBNP levels during exercise and the change of Ed from rest to 50 W of exercise (r2=0.69, p<0.0001). CONCLUSION: Noninvasively-determined Ed was similar at rest and during mild exercise between patients with ApHCM and control subjects. However, Ed was significantly higher during moderate exercise in ApHCM patients, suggesting a dynamic change in LV stiffness during exercise in these patients.
Cardiomyopathy, Hypertrophic* ; Humans ; Male ; Stroke Volume

BACKGROUDN: The ratio of mitral inflow (E) and annular velocity (E') to stroke volume (E/E'/SV) has been used as an index of diastolic elastance (Ed). However, its change during exercise has not been evaluated. We hypothesized that Ed values obtained during exercise would be abnormal in patients with apical hypertrophic cardiomyopathy (ApHCM). METHODS: Ed was measured at rest and during graded supine bicycle exercise (25 Watts, 3 minute increments) in 15 patients with ApHCM (12 male; mean age, 57 years) and in 15 age- and gender-matched control subjects. RESULTS: Ed was not significantly different at rest and during 25 W of exercise. However, Ed was significantly higher at 50 W of exercise in patients with ApHCM compared to control subjects (0.21+/-0.05 vs. 0.15+/-0.04 cm/s, p=0.0059). There was significant positive correlation between the magnitude of change in proBNP levels during exercise and the change of Ed from rest to 50 W of exercise (r2=0.69, p<0.0001). CONCLUSION: Noninvasively-determined Ed was similar at rest and during mild exercise between patients with ApHCM and control subjects. However, Ed was significantly higher during moderate exercise in ApHCM patients, suggesting a dynamic change in LV stiffness during exercise in these patients.
Cardiomyopathy, Hypertrophic* ; Humans ; Male ; Stroke Volume

OBJECTIVE: The aim of this study is to investigate abnormal findings of social brain network in Korean children with autism spectrum disorder (ASD) compared with typically developing children (TDC). METHODS: Functional magnetic resonance imaging (fMRI) was performed to examine brain activations during the processing of emotional faces (happy, fearful, and neutral) in 17 children with ASD, 24 TDC. RESULTS: When emotional face stimuli were given to children with ASD, various areas of the social brain relevant to social cognition showed reduced activation. Specifically, ASD children exhibited less activation in the right amygdala (AMY), right superior temporal sulcus (STS) and right inferior frontal gyrus (IFG) than TDC group when fearful faces were shown. Activation of left insular cortex and right IFG in response to happy faces was less in the ASD group. Similar findings were also found in left superior insular gyrus and right insula in case of neutral stimulation. CONCLUSION: These findings suggest that children with ASD have different processing of social and emotional experience at the neural level. In other words, the deficit of social cognition in ASD could be explained by the deterioration of the capacity for visual analysis of emotional faces, the subsequent inner imitation through mirror neuron system (MNS), and the ability to transmit it to the limbic system and to process the transmitted emotion.
Amygdala ; Brain* ; Autism Spectrum Disorder* ; Child* ; Cognition ; Humans ; Limbic System ; Magnetic Resonance Imaging* ; Mirror Neurons

Fluorouracil is well known as a standard chemotherapeutic drug in breast cancer and other cancers that is converted to flurodeoxyuridine monophosphate (FdUMP) and leads to the inhibition of thymidylate synthase (TS) in tumor tissue. The role of this enzyme is the catalysis of the methylation from deoxyuridine monophosphate (dUMP) to deozythymidine monophosphate (dUMP), which is a very important process for DNA synthesis in tumor tissues. Increased level of TS protein correlates inversely with sensitivity and response to 5 FU in human cancer cell lines. Authurs evaluated the TS expression level using the immunohistochmical staining and analysed their relationship with other prognostic factors and clinical outcome of breast cancer patients. The results were as follows; 1) TS level was not related histopathologic stage, involvement of axillary lymph nodes, estrogen receptor, progesterone receptor, recurrent type, primary tmor and recurrent tumors, disease free survival rate. 2) TS level was associated with e-erbB2 overexpression. 3) c-erbB2 overexpression was related with recurrence rate. 4) TS level appeared to be related with recurrence rate. So w conclude the TS level can be used as an independant prognostic predictor on breast cancer patients.
Breast Neoplasms* ; Breast* ; Catalysis ; Cell Line ; Deoxyuridine ; Disease-Free Survival ; DNA ; Estrogens ; Fluorouracil ; Humans ; Lymph Nodes ; Methylation ; Receptors, Progesterone ; Recurrence ; Thymidylate Synthase*

BACKGROUND: Hypervolemic hemodilution (HHD) seems to be a good alternative to acute normovolemic hemodilution to reduce transfusion requirements because it requires less time and effort. In a prospective study in healthy donors, we studied the effects of HHD on blood loss and mononuclear cell counts of aspirated bone marrow which were transplanted. METHODS: After induction of anesthesia and positioning to prone, donors of the HHD group (n = 25) were administered 7.5 ml/kg of pentastarch and the same amount of Hartmann's solution prior to aspiration, but those of the control group (n = 25) were administered only 2 ml/kg/h of Hartmann's solution. Bone marrow was aspirated at the iliac spine and blood loss was replaced with pentastarch and Hartmann's solution for both groups. Hemoglobins and hematocrits were counted after induction, after hemodilution and the end of aspiration. Hemoglobins and mononuclear cell counts of aspirated bone marrow were also counted. RESULTS: HHD decreased hemoglobin from 13.2 +/- 1.1 g/dl to 10.7 +/- 1.0 g/dl significantly (P < 0.01). Even though hemoglobins of both groups at the end of aspiration were not different (9.3 +/- 2.3 g/dl at control vs 9.5 +/- 1.1 g/dl at HHD), calculated blood loss based on body weight through aspirated bone marrow was less in the HHD group (18.0 +/- 1.8% at control vs 16.3 2.0% at HHD, P < 0.05). There was no difference in counted mononuclear cell counts between the two groups (1.8 +/- 0.7 x 10(7)/ml at control vs 1.8 +/- 0.7 x 10(7)/ml at HHD). CONCLUSIONS: During bone marrow harvesting in healthy donors, HHD reduced blood loss through aspirated bone marrow, but does not affect transplanted bone marrow mononuclear cell counts.
Anesthesia ; Body Weight ; Bone Marrow* ; Cell Count* ; Hematocrit ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Prospective Studies ; Spine ; Tissue Donors