It already has been known that various ions were participated in phototransduction mechanism of the vertebrate photoreceptor during the visual adaptation. The vitreous humor(VH)contains certain amount of Na+, K+ and Ca++ as well. However, the roles of these ions are unknown except functioning of metabolic process. Our preliminary electroretinogram(ERG) experiments suggested that the permeability of these ions has light dependent activity during the light illumination. We have supported this suggestion more tangibly by trying out various experiments with bullfrog eyes as a reference of visual adaptation. The results are summarized as follows: 1)According to our atomic absorption spectroscopic measurements, the concentration of Na+, K+ and Ca++ in light adapted VH was higher than that of dark adapted VH. This result indicated that the light-dependention transport systems which affect the ionic movements might be in internal limiting membrane(ILM). 2)The amplitude of ERG b-wave was reduced by concentration decrement of Na+ and concentration increment of K+ respectively. On the other hand, the elimination of Ca++ within ringer solution resulted in b-wave amplitude increment. 3)Treatment of Na+ hannel blockers(TTX, STX)and K+ channel blockers(Ba++, Cd++, Cs+, 4-AP and TEA)in the vitreous humor side induced the increment and the decrement of b-wave response respectively. Taken together, these results suggest that the light dependent Na+ K+ channels exist in the ILM of vertebrate retina which participates visual adaptation.
Absorption ; Hand ; Ions ; Light Signal Transduction ; Lighting ; Membranes* ; Metabolism ; Permeability ; Photoreceptor Cells, Vertebrate ; Rana catesbeiana ; Retina ; Vertebrates* ; Vitreous Body

Locked-in Syndrome is a severe pontine stroke causing quadriplegia, lower cranial nerve paralysis, and mutism with preservation of only vertical gaze and upper eyelid movement in a conscious patient. We present a case of a Locked-in Syndrome patient who received communication training with augmentative and alternative communication equipment by using eye blinks. After 3 weeks of training, the patient was able to make an attempt to interact with other people, and associate a new word by Korean alphabet selection. Augmentative and alternative communication equipment which uses eye blinks might be considered to be beneficial in improving the communication skills of locked-in syndrome patients.
Communication Aids for Disabled ; Cranial Nerves ; Eye ; Eyelids ; Humans ; Mutism ; Paralysis ; Quadriplegia ; Stroke

OBJECTIVE: To investigate the effect of treadmill aerobic exercise for eight weeks on cardiopulmonary fitness and functional mobility in stroke patients METHOD: Twenty one stroke patients who could walk independently and had MMSE score of 24 or higher were included. We used maximal exercise test by means of modified Harbor protocol before and after eight weeks' treadmill aerobic exercise. We monitored patients' status with EKG, heart rate, blood pressure and Borg rating of perceived exertion, and measured maximal O2 consumption, maximal heart rate, blood pressure, minute ventilation, rate pressure product and respiratory exchange ratio during maximal exercise test. We also assessed functional mobility by Fugl-Meyer assessment of lower extremity, Berg balance scale, five times sit to stand test, timed up & go test, dynamic gait index scale, activities-specific balance confidence scale and Korean-modified Barthel index before and after 8 weeks' training. RESULTS: Twenty one patients completed treadmill aerobic exercise training. After eight weeks' treadmill aerobic exercise, the cardiopulmonary fitness, measured by maximal O2 consumption, maximal heart rate, minute ventilation, systolic blood pressure, functional mobility measured by Fugl-Meyer assessment of lower extremity, Berg balance scale, five times sit to stand test, timed up & go test, dynamic gait index scale, activities-specific balance confidence scale and Korean-modified Barthel index showed statistically significant improvement (p<0.05). CONCLUSION: Eight weeks' treadmill aerobic exercise improved the cardiopulmonary fitness and functional mobility in ambulatory stroke patients.
Blood Pressure ; Electrocardiography ; Exercise ; Exercise Test ; Gait ; Heart Rate ; Humans ; Lower Extremity ; Stroke ; Ventilation

PURPOSE: To reassess the usefulness of criteria for lymph node size in predicting metastatic lymph node ofgastric adenocarcinoma and to determine appropriate size criteria. MATERIALS AND METHODS: We reviewed the pathology of 1669 lymph nodes from 105 gastric adenocarcinoma patients and measured their long and short axis diameters. To determine the degree of lymph node shrinkage during fixation for pathologic examination, we measured the size of 105 lymph nodes both in the fresh state and on pathology slides after fixation and obtained their correlation equation ; this was used to determine the fresh-state size of the 1669 nodes. We analysed the distribution of metastatic and nonmetastatic lymph nodes according to their long and short axis and plotted a sensitivity-specificity curve to determine the appropriate size criteria for metastatic lymph nodes. RESULTS: There were 535 metastatic lymph nodes and their mean diameter was 8.2+/-4.9mm on the long axis and 5.7+/-3.8mm on the short axis. The mean diameter of nonmetastatic lymph nodes was 4.9+/-2.8mm, 3.0+/-1.7mm on the long and short axis, respectively. There difference in size between metastatic and nonmetastatic lymph nodes was not statistically significant. The (P>0.05) distribution curve of metastatic and nonmetastatic lymph nodesoverlapped over wide range of lymph node size. We determined appropriate size criteria at the point where sensitivity and specificity curves crossed, but the form of the curves was such that this was difficult. CONCLUSION: Appropriate size criteria on lymph node metastasis were 6.2mm for #1-6 lymph node group and 8.1mm for #7-12 lymph node group on long axis diameter and 4.0mm, 5.3mm on short axis diameter. But, even with this size criteria the expected accuracy was low(67-70%). This results showed limitation of size criteria to diagnose metastatic lymph node.
Adenocarcinoma ; Axis, Cervical Vertebra ; Humans ; Lymph Nodes* ; Neoplasm Metastasis* ; Pathology ; Sensitivity and Specificity

Purpose: Acute nicotine poisoning by liquid nicotine in electronic cigarettes is becoming an increasing problem worldwide. The current systematic review aimed to determine the harm of acute nicotine poisoning by reviewing published case reports. Methods: An online literature search with PubMed, Embase, Cochrane Library, and KoreaMed database was performed to identify relevant studies addressing acute nicotine poisoning with electronic cigarettes. Two investigators searched the case reports written in English or Korean. Results: Twenty-six cases were included in this study. The routes of intoxication included ingestion in 18 cases, intravenous injection in three cases, subcutaneous injection in two cases, and ocular exposure in two cases. Ten cases had a cardiac arrest, and seven of them died. Seven out of 12 cases with intentional poisoning had a cardiac arrest. Nine children under 18 years were reported, and three of them had a cardiac arrest. Sixteen cases without a cardiac arrest recovered well, except for one case with sudden sensorineural hearing loss. Conclusion The authors reviewed the risks of electronic cigarette liquid in terms of acute poisoning through a systematic review.The nicotine solution of an e-cigarette can be life-threatening in cases of acute poisoning. Therefore, active emergency treatment with early recognition is necessary. In addition, various management methods and regulations for preventing acute nicotine poisoning, such as restriction of distribution and nicotine concentration, should be considered.

Purpose: Acute nicotine poisoning by liquid nicotine in electronic cigarettes is becoming an increasing problem worldwide. The current systematic review aimed to determine the harm of acute nicotine poisoning by reviewing published case reports. Methods: An online literature search with PubMed, Embase, Cochrane Library, and KoreaMed database was performed to identify relevant studies addressing acute nicotine poisoning with electronic cigarettes. Two investigators searched the case reports written in English or Korean. Results: Twenty-six cases were included in this study. The routes of intoxication included ingestion in 18 cases, intravenous injection in three cases, subcutaneous injection in two cases, and ocular exposure in two cases. Ten cases had a cardiac arrest, and seven of them died. Seven out of 12 cases with intentional poisoning had a cardiac arrest. Nine children under 18 years were reported, and three of them had a cardiac arrest. Sixteen cases without a cardiac arrest recovered well, except for one case with sudden sensorineural hearing loss. Conclusion The authors reviewed the risks of electronic cigarette liquid in terms of acute poisoning through a systematic review.The nicotine solution of an e-cigarette can be life-threatening in cases of acute poisoning. Therefore, active emergency treatment with early recognition is necessary. In addition, various management methods and regulations for preventing acute nicotine poisoning, such as restriction of distribution and nicotine concentration, should be considered.

PURPOSE: This study investigated the association between hypoalbuminemia and 28-day mortality in patients with severe sepsis and septic shock. METHODS: A prospective observational study, including consecutive patients with severe sepsis and septic shock, was performed from July 2008 to June 2011. Patient demographic data, comorbidities, blood test results (including albumin concentration), and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared between 28-day survivors and non-survivors. Patients were divided into normal albumin (> or =3.3 mg/dl) and hypoalbuminemia (<3.3 mg/dl) groups. The Cox proportional hazards regression analysis was conducted to identify the predictors of 28-day mortality. Analysis of the area under the receiver operating characteristic curve was performed to compare the prognostic performance of albumin concentrations versus APACHE II scores. RESULTS: During the study period, a total of 493 patients were included and 140(28.4%) died. The albumin concentrations of non-survivors were significantly lower than those of survivors (3.3+/-0.6 mg/dl vs. 2.8+/-0.6 mg/dl, respectively) and the hypoalbuminemia group had a higher mortality rate than the normal albumin group (41.2% vs. 10.3%, respectively, p<0.01). In Cox analysis, hypoalbuminemia was associated with a 3.8-fold increased risk of death during the 28-day follow-up period (hazard ratio, 3.83; 95% CI, 2.22-6.59). The AUC of albumin concentration was 0.73(95% CI, 0.69-0.78), which was comparable with that of APACHE II score (0.77; 95% CI, 0.73-0.81). CONCLUSION: Hypoalbuminemia is an independent predictor of 28-day mortality in patients with severe sepsis and septic shock.
APACHE ; Area Under Curve ; Comorbidity ; Follow-Up Studies ; Hematologic Tests ; Humans ; Hypoalbuminemia* ; Mortality ; Prospective Studies ; ROC Curve ; Sepsis* ; Shock, Septic* ; Survivors

PURPOSE: This study investigated the association between hypoalbuminemia and 28-day mortality in patients with severe sepsis and septic shock. METHODS: A prospective observational study, including consecutive patients with severe sepsis and septic shock, was performed from July 2008 to June 2011. Patient demographic data, comorbidities, blood test results (including albumin concentration), and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared between 28-day survivors and non-survivors. Patients were divided into normal albumin (> or =3.3 mg/dl) and hypoalbuminemia (<3.3 mg/dl) groups. The Cox proportional hazards regression analysis was conducted to identify the predictors of 28-day mortality. Analysis of the area under the receiver operating characteristic curve was performed to compare the prognostic performance of albumin concentrations versus APACHE II scores. RESULTS: During the study period, a total of 493 patients were included and 140(28.4%) died. The albumin concentrations of non-survivors were significantly lower than those of survivors (3.3+/-0.6 mg/dl vs. 2.8+/-0.6 mg/dl, respectively) and the hypoalbuminemia group had a higher mortality rate than the normal albumin group (41.2% vs. 10.3%, respectively, p<0.01). In Cox analysis, hypoalbuminemia was associated with a 3.8-fold increased risk of death during the 28-day follow-up period (hazard ratio, 3.83; 95% CI, 2.22-6.59). The AUC of albumin concentration was 0.73(95% CI, 0.69-0.78), which was comparable with that of APACHE II score (0.77; 95% CI, 0.73-0.81). CONCLUSION: Hypoalbuminemia is an independent predictor of 28-day mortality in patients with severe sepsis and septic shock.
APACHE ; Area Under Curve ; Comorbidity ; Follow-Up Studies ; Hematologic Tests ; Humans ; Hypoalbuminemia* ; Mortality ; Prospective Studies ; ROC Curve ; Sepsis* ; Shock, Septic* ; Survivors

Barbiturate has been used for the therapy of increased intracranial pressure (ICP) patients. However, it has some serious side effects such as rebound response or convulsion. According to recent reports, propofol can be used for coma therapy and the therapeutic result has been satisfactory. We used propofol instead of barbiturate in coma therapy and experienced a case of rebound response. On admission day, a 20-year-old female patient received an endovascular embolization for an arteriovenous malformation (AVM) in the left occipital lobe. The next day, she went into a coma and the brain CT showed a massive intracerebral hematoma at the AVM site. The patient was transferred to the operating room for decompressive surgery. At the end of the surgery, the brain edema did not subside. The patient was infused with propofol (4 mg/kg/h) after the surgery for propofol coma therapy. During the 6 day propofol therapy, ICP was effectively controlled under 20 mmHg. After completion of the propofol coma therapy, the patient was revived enough to verbally obey. 16 hours later, ICP increased to more than 30 mmHg and the patient was reinfused with propofol. We experienced a rebound response in propofol coma therapy similar to that in barbiturate coma therapy.
Arteriovenous Malformations ; Brain ; Brain Edema ; Coma* ; Female ; Hematoma ; Humans ; Intracranial Pressure ; Occipital Lobe ; Operating Rooms ; Propofol* ; Seizures ; Young Adult

BACKGROUND: This study was conducted to observe the prevalence of vitamin D deficiency during pregnancy and the effects of maternal 25-hydroxy-vitamin D (25-[OH]D) levels on fetal bone growth. METHODS: Five hundred twenty-three Korean pregnant women were randomly recruited and serum 25-(OH)D level was measured. During pregnancy, fetal ultrasonography and serum 25-(OH)D measurements were carried out 3 times in 275 of 523 pregnant women. Fetal biparietal and occipitofrontal diameter, head and abdominal circumference, and femur and humerus length were measured through fetal ultrasonography. RESULTS: The prevalence of vitamin D deficiency (25-[OH]D<20 ng/mL) based on the 1st serum measurement of 25-(OH)D was 88.9%. There was no association between maternal serum 25-(OH)D level and fetal bone growth. In 275 pregnant women who completed study design, the mean value of 25-(OH)D was 12.97+/-5.93, 19.12+/-9.82, and 19.60+/-9.98 ng/mL at 12 to 14, 20 to 22, and 32 to 34 weeks of pregnancy, respectively and there was an association between the difference of serum 25-(OH)D level between 12 to 14 and 20 to 22 weeks and growth velocity of fetal biparietal diameter between 20 to 22 and 32 to 34 weeks of pregnancy. CONCLUSIONS: This study shows a high prevalence of vitamin D deficiency in Korean pregnant women and the change of serum 25-(OH)D levels is related with the growth of fetal biparietal diameter, however other parameters are not associated with serum 25-(OH)D levels.
Bone Development* ; Female ; Femur ; Fetal Development ; Head ; Humans ; Humerus ; Pregnancy* ; Pregnant Women ; Prevalence ; Ultrasonography ; Ultrasonography, Prenatal ; Vitamin D ; Vitamin D Deficiency