No abstract available.
Cesarean Section* ; Female ; Myotonic Dystrophy* ; Pregnancy

Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-year-old female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.
Aged ; Airway Obstruction ; Analgesics, Opioid ; Asthma ; Diagnosis, Differential ; Female ; Femur Neck ; Fentanyl* ; Humans ; Intensive Care Units ; Lung Diseases, Obstructive ; Muscle Rigidity ; Oxygen ; Periprosthetic Fractures ; Physical Examination ; Thoracic Wall* ; Thorax* ; Ventilation

Fractures of the lateral process of the talus (LPT) are considered rare, accounting for less than 1% of all ankle injuries in the general population. These fractures are nearly 15 times more likely to occur in snowboarders. Recently, the number of population who started enjoying cable-wakeboard is increasing and this sport may cause fracture of the LPT by axial loading occur on the LPT while boarding or trick. We report on a case of involving LPT fracture during cable-wakeboard trick with successful screw osteosynthesis.
Ankle Injuries ; Skiing ; Sports ; Talus

Transcriptional regulation of a gene is not always correlated with genetic information inherited from parents because the transcription of specific genes is often governed by the modification of chromatin structure. The study of transcriptional regulation by modifying chromatin structure is well-known as "epigenetics". Several methods involved in the modification of chromatin structure have been developed in the mammalian species during evolution. Among those methods, methylations of specific DNA region or histone are often used to control specific gene transcription. Therefore, understanding the activity of proteins involved in DNA or histone methylation is an initial step to control the transcriptional activity of a specific gene. Polycomb group (PcG) proteins were known to be repressors of transcription of a specific gene by creating and maintaining methylation or ubiquitination of the specific region of histone. Dependent on the target histone, the activity of PcG proteins effects on the development of specific lineage cells or the activity of specific cell types. In this review, the function, expression and activity of PcG proteins related with the development or activation of T cells are discussed.
Chromatin ; DNA ; Epigenomics ; Genes, vif ; Histone Code ; Histones ; Humans ; Methylation ; Parents ; Polycomb-Group Proteins ; Proteins ; T-Lymphocytes ; Ubiquitin ; Ubiquitination

Severe asthma represents 3–10% of all cases of asthma, but accounts for > 60% of total asthma-related medical costs. Uncontrolled asthma symptoms and frequent asthma exacerbations associated with severe asthma have profound adverse effects on patients' quality of life. The concepts of difficult-to-treat asthma and severe asthma are different; severe asthma represents one kind of difficult-to-treat asthma. Misdiagnosis, nonadherence, and comorbidities may also be causes of difficult-to-treat asthma. This review discusses important principles in the treatment of difficult-to-treat asthma and severe asthma.
Asthma* ; Comorbidity ; Diagnostic Errors ; Quality of Life

OBJECTIVE: To demonstrate that human visual illusion can contribute to sub-endocardial dark rim artifact in contrast-enhanced myocardial perfusion magnetic resonance images.MATERIALS AND METHODS: Numerical phantoms were generated to simulate the first-passage of contrast agent in the heart, and rendered in conventional gray scale as well as in color scale with reduced luminance variation. Cardiac perfusion images were acquired from two healthy volunteers, and were displayed by the same gray and color scales used in the numerical study. Before and after k-space windowing, the left ventricle (LV)-myocardium boarders were analyzed visually and quantitatively through intensity profiles perpendicular the boarders.RESULTS: k-space windowing yielded monotonically decreasing signal intensity near the LV-myocardium boarder in the phantom images, as confirmed by negative finite difference values near the board ranging −1.07 to −0.14. However, the dark band still appears, which is perceived by visual illusion. Dark rim is perceived in the in-vivo images after k-space windowing that removed the quantitative signal dip, suggesting that the perceived dark rim is a visual illusion. The perceived dark rim is stronger at peak LV enhancement than the peak myocardial enhancement, due to the larger intensity difference between LV and myocardium. In both numerical phantom and in-vivo images, the illusory dark band is not visible in the color map due to reduced luminance variation.CONCLUSION: Visual illusion is another potential cause of dark rim artifact in contrast-enhanced myocardial perfusion MRI as demonstrated by illusory rim perceived in the absence of quantitative intensity undershoot.

Magnetic resonance angiography (MRA) plays an important role in accurate diagnosis and appropriate treatment planning for patients with arterial disease. Contrastenhanced (CE) MRA is fast and robust, offering hemodynamic information of arterial flow, but involves the risk of a side effect called nephrogenic systemic fibrosis. Various non-contrast-enhanced (NCE) MRA techniques have been developed by utilizing the fact that arterial blood is moving fast compared to background tissues.NCE MRA is completely free of any safety issues, but has different drawbacks for various approaches. This review article describes basic principles of CE and NCE MRA techniques with a focus on how to generate angiographic image contrast from a pulse sequence perspective. Advantages, pitfalls, and key applications are also discussed for each MRA method.

PURPOSE: To develop a two-dimensional (2D) image-based respiratory motion correction technique for free-breathing coronary magnetic resonance angiography (MRA). MATERIALS AND METHODS: The proposed respiratory navigator obtained aliased a 2D sagittal image from under-sampled k-space data and utilized motion correlation between the aliased images. The proposed navigator was incorporated into the conventional coronary MRA sequence including the diaphragm navigator and tested in three healthy subjects. RESULTS: The delineation of major coronary arteries was significantly improved using the proposed 2D motion correction (S/I and A/P) compared to one-dimensional (S/I) correction using the conventional diaphragm navigator. CONCLUSION: The 2D image-based respiratory navigator was proposed for free-breathing coronary angiography and showed the potential for improving respiratory motion correction compared to the conventional 1D correction.
Coronary Angiography ; Coronary Vessels ; Diaphragm ; Healthy Volunteers ; Magnetic Resonance Angiography

Limited data are available about incomplete stent expansion (SE) on platelet deposition (PD). We examined PD following different SE using an extracorporeal porcine arteriovenous shunt model to which a perfusion chamber with four parallel silastic tubes were connected. Blood flow was set at a 20 and 100 mL/min in 1.8 and 3.1 mm diameter tubes, respectively. P154 stents were deployed completely (Group A, n=15) or incompletely (Group B, n=15) in 1.8 mm (n=13) and 3.1 mm (n=17) tubes. 51Cr-labelled platelet autologous blood was injected 1 hr before the perfusion. After 15 min-perfusion, the testing tubes were assessed for radioactivity counts. In-stent cross sectional area was measured by intravascular ultrasound. There was a significant difference in PD between group A and B regardless of channel size (118+/-18.4 vs 261.4+/-52.1 pits x 10(6)/cm2, p<0.05). With adjusted shear rate and similar stenosis, PD was similar in both tubes. In smaller 1.8 mm tubes, a stenosis as subtle as 10% was associated with a significant PD difference (226.1+/-20 vs 112.9+/-20.5 plts x 10(6)/cm2, p<0.005). This model enabled a repetitive, simultaneous comparison of PD following different SE states. It seems that the quality of SE remains crucial in smaller channels.
Animal ; Arteriovenous Shunt, Surgical ; Extracorporeal Circulation ; Male ; Models, Animal ; Perfusion ; Platelet Activation* ; Stents/adverse effects* ; Swine ; Thrombosis/etiology*