Ischemic preconditioning (IP), short pre-treatment sublethal ischemia, induces a state of protection against subsequent prolonged ischemia-reperfusion. The purpose of this study was to investigate the expression of HO-1, HSP70, and iNOS proteins in the liver subjected to the courses of reperfusion after repetitive cycles of remote IP in the rat. Using thirty five week-old rats, the remote preconditioning was undertaken by vascular clamp occlusion of blood flow to one hindlimb, with 3 and 10 cycles of 5 minutes occlusion followed by 5 minutes reperfusion. The liver was removed 0, 3, 6, 24, and 72 hours of reperfusion after remote IP and assayed by immunohistochemical staining and Western blotting analyses for anti-HO-1, anti-HSP70, and anti-iNOS antibodies. The expression of HO-1 in rat liver increased at 72 hours of reperfusion groups after 3 and 10 cycles of remote IP, compared with normal control groups. The expression of HSP70 in rat liver increased at 6 hours of reperfusion groups after 3 cycles of remote IP, compared with normal control groups. The expression of HSP70 in rat liver increased at 0 hour of reperfusion groups after 10 cycles of remote IP, compared with normal control groups and decreased at 24 and 72 hours of reperfusion groups. The expression of iNOS in rat liver increased at 24 hours of reperfusion groups, but decreased at 72 hours of reperfusion groups after 3 and 10 cycles of remote IP, compared with normal control groups. In summary, these results showed that at early phase of reperfusion after remote IP, HSP70 expression was increased in rat liver. However, at 72 hrs of reperfusion after remote IP, HO-1 expression was increased and iNOS expression was decreased in rat liver.
Animals ; Blotting, Western ; Hindlimb ; Ischemia ; Ischemic Preconditioning ; Liver ; Proteins ; Rats ; Reperfusion

As the interest in health is increasing and the population enjoyed the leisure sports is steadily increasing, the stress fracture, fracture or variant of metatarsal bone of foot has been shown frequently. The mistaken estimation about the length and rank of metatarsal bones during the osteotomy of the metatarsal bones of foot can be complicated. It is essential to have detailed knowledges about the anatomical structure of surgical region. This study aimed to investigate the metatarsal bones of foot and to develop a regression equation that can predict the length of metatarsal bones during the osteotomy. The subject of this study is fifty four feet (30M/224F). We measured the whole length and the article length of metatarsal bone. Also, we measured the whole width and the article width in the head, body, base of the metatarsal bone. The data was analyzed using SPSS win 13.0. The regression equation models of length of the metatarsal bones were developed by multiple regression analysis. The regression equation predicted first metatarsal length was second metatarsal articular length x0.770+7.780, second metatarsal length was third metatarsal length x0.976+6.050, third metatarsal length was fourth metatarsal length x1.000+0.922, fourth metatarsal length was third metatarsal length x0.917+4.167, fifth metatarsal length was fourth metatarsal length x0.901+7.972. The results of this study would be useful to clarify the characteristics of the metatarsal bone of the foot, to develop a regression equation for prediction of the length of the metatarsal bone.
Foot ; Fractures, Stress ; Head ; Leisure Activities ; Metatarsal Bones ; Osteotomy ; Sports

Operating Room nurses are required to have special skills and knowledge to do their job. However, because there is no systematic education program, which considers special circumstances in the OR, novice nurses have a great deal of difficulty adapting themselves to the work environment. The purpose of this study is to develope a multimedia education program, which provides the systematic learning environment, so novice nurses can adapt to the OR environment more effectively. This study has been implemented according to Computer Assisted Instruction Design Model(Il-Joo Na and In-Sung Jung, 1990), which goes through the following steps; 1). Education program analysis 2). Development, evaluation 3). CompletionLearning goals, objectives, motive strategy, and analysis of the education program are analyzed by the concepts based on basic education materials for novice surgery nurses of 6 Medical Centers in Seoul and 'Development of the job training program for newly employed nurses in operating rooms. 'written by Ji-Young Yoon(2000). We divided 9 areas of the contents in surgery education; 1. Basic orientation 2. OR nurses' roles and responsibilities 3. Asceptic technique 4. Disinfection and sterilization 5. OR safety 6. OR nursing care 7. Surgical positioning 8. OR Material management 9. Anesthetic care. We selected asceptic technique, which is the most fundamental concept in OR nursing care. The program screens consist of cover screen, screen for guide, mini menu screen, and test screen. We distributed questionnaires to fifteen experts and investigated their opinions to analyze learning contents and effects of the Courseware. The education program was modified based on respones provided by experts. This study offers an educational program, which allows the individuals to choose the areas they want to learn. The program is easy to use, which encourages the individuals to search for additional information more than one area.
Computer-Assisted Instruction ; Disinfection ; Education* ; Learning ; Multimedia* ; Nursing Care ; Operating Rooms* ; Surveys and Questionnaires ; Seoul ; Sterilization

Remote ischemic preconditioning (IP), brief tolerating cycles of ischemia and reperfusion in remote non-vital organs, can reduce ischemic injury of the heart. IP induces cardiac protection by down-regulating iNOS or up-regulating eNOS. In addition, Akt has been known to protect myocardium against ischemia-reperfusion injury. This study was undertaken to observe the expression of iNOS, eNOS, Akt and phospho-Akt (p-Akt) in the rat myocardium after IP. Thirty-five weeks-old male Sprague-Dawley rats were divided into control and IP groups. The IP group was further subdivided into 3 groups based on the number of cycles of IP. For IP, left commom iliac artery was occluded 3, 6 and 10 cycles for 5 min of ischemia alternating with 5 min of reperfusion. The rat were sacrificed at 0, 3, 6, 24 and 72 hours of IP and the heart was removed. The expression of iNOS, eNOS, Akt and p-Akt in the rat myocardium was examined by immunohistochemical staining and Western blot analysis. The expression of iNOS was increased by IP and was higher in 10IP groups than 3IP and 6IP group. The expression of eNOS was increased or decreased by IP and was showed no difference with increasing episode of IP. The expression of Akt was decreased by IP at 24 and 72 hours after reperfusion, and showed no differences with increasing episode of IP. The expression of p-Akt was increased by IP and showed no difference with increasing episode of IP. These results suggest that hind limb ischemic preconditioning provides cardiac protection through up-regulation of eNOS and phosphorylation of Akt, however excessive episodes of remote preconditioning may induce the myocardial ischemic injury through overexpression of iNOS.
Animals ; Blotting, Western ; Extremities ; Heart ; Humans ; Iliac Artery ; Ischemia ; Ischemic Preconditioning ; Male ; Myocardium ; Phosphorylation ; Rats ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; Up-Regulation

Akt, heat shock protein (HSP72)72, and HSP90 induced by ischemic preconditioning protect cells from the ischemic injury. The purpose of this study was to examine the alterations of the level of phospho-Akt, HSP72, and HSP90 in the rat tibialis anterior and soleus muscles after cyclic episodes of ischemic preconditioning. Sprague-Dawley rats aged 35 weeks were divided into control and ischemic preconditioning (IP) groups. The IP group was divided into 3 subgroups based on cycles of IP. Left common iliac artery was occluded 3, 6, and 10 times for 5 minutes, followed by 5 minutes reperfusion. The experimental animals were sacrificed at 0, 3, 6, 24, and 72 hours after reperfusion, and left tibialis anterior and soleus muscles were removed. The expression of phospho-Akt, HSP72, and HSP90 were examined with immunohistochemical methods and Western blot analysis. The results were as follows; 1. In the 3 and 6 times of IP groups, the expression of phospho-Akt (p-Akt) was increased at 0 and 3 hours after reperfusion, compared with control group. The expression of p-Akt in the 10 times of IP group was lower than that in 3 and 6 times of IP groups. At 72 hours after reperfusion, the expression of p-Akt showed no difference among the IP groups. The expression of p-Akt was higher in Soleus than that in Tibialis anterior. 2. The expression of HSP72 in 3 times of IP group increased at 0 and 3 hours after reperfusion, compared with 6 and 10 times of IP groups. The expression of HSP72 in the 10 times of IP group was lower than that in 3 and 6 times of IP groups. At 72 hours after reperfusion, the expression of HSP72 showed no difference among the IP groups. The expression of HSP72 was higher in Soleus than that in Tibialis anterior. 3. In the 3 and 6 times of IP groups, the expression of HSP90 increased at 0 and 3 hours after reperfusion, compared with control group. The expression of HSP90 in the 10 times of IP group was lower than that in 3 and 6 times of IP groups. At 24 hours after reperfusion, the expression of HSP90 showed no difference with increasing episode of IP. The expression level of HSP90 was higher in Soleus than that in Tibialis anterior. These findings suggest that ischemic preconditioning increases the expression of p-Akt, HSP72 and HSP90 at early phase after reperfusion in the rat tibialis anterior and soleus muscles. However, increased cycles of ischemic preconditioning may not induce the expression of them.
Animals ; Blotting, Western ; Heat-Shock Proteins ; Iliac Artery ; Ischemic Preconditioning* ; Muscles* ; Phosphorylation* ; Rats* ; Rats, Sprague-Dawley ; Reperfusion

OBJECTIVE: The aim of this study is to determine prognostic factor affecting the mode of delivery in women with one previous low transverse cesarean section by comparing success group with failure group in Vaginal birth after cesarean (VBAC). METHODS: In this retrospective study, 79 patients with one previous low transverse cesarean section who attempted vaginal birth at Jeon-Ju Jesus Presbyterian hospital from January 1, 1997 to December 31, 2007. Information was collected and analyzed to see if there is significant difference between success group and failure group in VBAC. and the significance was set at P<0.05. RESULTS: The VBAC success rate turned out to 88.6%. There was one case of uterine rupture which was associated with hypoxic -ischemic encephalopathy in neonate. But, there was no case of the fetal death or mother death. There were significant difference between two groups in gestational age, expected fetal body weight, cervical dilation, Bishop score, thickness of lower uterine segment. CONCLUSION: The prognostic factors on success of VBAC can be aid in deciding the mode of delivery after cesarean section. Patient being chosen under strict indication, can enhance the VBAC trial and success rate.
Cesarean Section ; Female ; Fetal Death ; Fetal Weight ; Gestational Age ; Humans ; Infant, Newborn ; Lipids ; Mothers ; Parturition ; Pregnancy ; Protestantism ; Quaternary Ammonium Compounds ; Retrospective Studies ; Uterine Rupture ; Vaginal Birth after Cesarean

STUDY DESIGN: A retrospective radiological assessment was conducted. OBJECTIVES: An attempt to analyze the degenerative change of an intervertebral disc for adjacent segment degeneration in lumbar degenerative diseases. LITERATURE REVIEW SUMMARY: A review of the literature failed to uncover any documented study examining the quantitative analysis of the degenerative change of the intervertebral disc for adjacent segment degeneration. METHODS: This study was based on 45 patients, treated operatively or conservatively at this hospital, between April 1995 and July 2004. 39 and 6 cases of operative and conservative treatments, respectively, were performed. In the 39 operative treatments, there were 34 cases of fusion and 5 of discectomy. Dynamic X-ray and MRI were performed at the initial evaluation, and again more than 2 years later. In the 34 fusion cases, the upper and lower adjacent segments of the fused level were studied, and in the 11 non-fusion cases (conservative treatment or discectomy), the L3-4, L4-5 and L5-S1 level were studied. The instability of the dynamic X-ray and Thompson grade changes of the disc on MRI were also evaluated. Statistical analysis was carried out using the Wilcoxon signed rank test. RESULTS: Adjacent segment degeneration was found in 10 of the 34 cases (29.4%) on plain X-ray. The average Thompson grades of the 33 upper segment cases were 2.6 and 3.4 preoperatively and postoperatively (P=0.000), and for the 24 of the lower segment cases were 2.9and 3.2 (P=0.033), respectively. No statistical increase in the Thompson grade was found in the non-fusion group. CONCLUSIONS: The adjacent discs of the fusion group showed statistically meaningful degeneration on MRI, but this was not correlated with adjacent segment degeneration on plain X-ray. Various anatomical and functional factors must be considered in the evaluation of adjacent segment disease.
Diskectomy ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Fusion*

STUDY DESIGN: A retrospective radiological assessment was conducted. OBJECTIVES: An attempt to analyze the degenerative change of an intervertebral disc for adjacent segment degeneration in lumbar degenerative diseases. LITERATURE REVIEW SUMMARY: A review of the literature failed to uncover any documented study examining the quantitative analysis of the degenerative change of the intervertebral disc for adjacent segment degeneration. METHODS: This study was based on 45 patients, treated operatively or conservatively at this hospital, between April 1995 and July 2004. 39 and 6 cases of operative and conservative treatments, respectively, were performed. In the 39 operative treatments, there were 34 cases of fusion and 5 of discectomy. Dynamic X-ray and MRI were performed at the initial evaluation, and again more than 2 years later. In the 34 fusion cases, the upper and lower adjacent segments of the fused level were studied, and in the 11 non-fusion cases (conservative treatment or discectomy), the L3-4, L4-5 and L5-S1 level were studied. The instability of the dynamic X-ray and Thompson grade changes of the disc on MRI were also evaluated. Statistical analysis was carried out using the Wilcoxon signed rank test. RESULTS: Adjacent segment degeneration was found in 10 of the 34 cases (29.4%) on plain X-ray. The average Thompson grades of the 33 upper segment cases were 2.6 and 3.4 preoperatively and postoperatively (P=0.000), and for the 24 of the lower segment cases were 2.9and 3.2 (P=0.033), respectively. No statistical increase in the Thompson grade was found in the non-fusion group. CONCLUSIONS: The adjacent discs of the fusion group showed statistically meaningful degeneration on MRI, but this was not correlated with adjacent segment degeneration on plain X-ray. Various anatomical and functional factors must be considered in the evaluation of adjacent segment disease.
Diskectomy ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Fusion*

BACKGROUND: Carotid endarterectomy is a very high risk operation, combined with high incidence of stroke and myocardial infarction. We experienced 36 cases of carotid endarterectomies during the last two years. We reviewed these cases with anesthetic management and neurologic monitoring. METHODS: All of the operations were performed under general anesthesia. 33 cases were monitored by EEG and SEP. We maintained cerebral perfusion during cross-clamping and shunt by normothermia, normocarbia and mild hypertension. RESULTS: 33% of the patients had severe coronary artery stenosis and 41% had severe contralateral carotid artery stenosis preoperatively. During the operation, 10 patients showed transient EEG changes without SEP change or neurologic sequele. The major postoperative complication was myocarial infarction in one patient. There were 3 cases of postoperative cerebral infarction in radiologic findings. One case occurred after myocardial infarction and the other two cases showed no clinical evidence of neurologic deficit. CONCLUSIONS: In anesthetic management of carotid endarterectomy patients, maintaining cerebral perfusion, preventing perioperative myocardial infarction are important and monitoring neurologic function with EEG and SEP should be considered to prevent neurologic deficits.
Anesthesia, General ; Carotid Stenosis ; Cerebral Infarction ; Coronary Stenosis ; Electroencephalography* ; Endarterectomy, Carotid* ; Humans ; Hypertension ; Incidence ; Infarction ; Myocardial Infarction ; Neurologic Manifestations ; Perfusion ; Postoperative Complications ; Stroke

The Truncus arteriosus is a congenital malformation in which only one great artery arises from the base of the heart and gives origin to the systemic, pulmonary and coronary arteries proximal to the aortic arch. Pulmonary blood flow is governed by the size of the pulmonary arteries and the pulmonary vascular resistance. In infancy, pulmonary blood flow is usually excessive because pulmonary vascular resistance is not greatly increased. Thus, despite an obligatory admixture of systemic and pulmonary venous blood in the common trunk, only minimal cyanosis is present. Rarely pulmonary blood blood flow is restricted by hypoplastic or stenotic pulmonary arteries arising from the truncus. The prognosis in persistent truncus arteriosus is very poor. the median age of survival of the 94 patients with the disease reported up to 1962 was only five weeks. The longest survival reported is the case of the man described by Carr et al who lived to the age of 36 years and 2 months. We report the case of a man with persistent truncus arteriosus who lives to the age of 29 years.
Aorta, Thoracic ; Arteries ; Coronary Vessels ; Cyanosis ; Heart ; Humans ; Prognosis ; Pulmonary Artery ; Truncus Arteriosus ; Truncus Arteriosus, Persistent* ; Vascular Resistance