PURPOSE: The CD5 molecules of mice (Ly-1) and humans (T1) are pan-T cell antigens and are also found on a minor subpopulation of B cells. Cl)5+ B cells constitute a large fraction of the B cells early in development and in neonate. There are many reports about the production and mRNA expression of CD5+ B cells and in this study CD5 mRNA expression by peripheral blood mononuclear cell (PBMC) was examined in neonate and compared with those in normal children and childrens of acute febrile diseases. METHODS: Ten normal neonate(mean age, 1.2 days), ten children of acute febrile disease (mean age, 8.5 months) and ten nomal children (mean age 9 months) were studied. One mililiter of venous blood was drawn and immunophenotypes were determined using FACS (fluorescent activated cell sortor) with FITC-conjugated anti-CD5 and PE-conjugated anti-CD 19. PBMC was separated and CD5 mRNA expression was examined in these groups. RESULTS: 1) From the analysis using FACS, there was no significant difference for the CD5+ 1' cell fractions in white blood cells among neonates(78.52+13.98 %), acute febrile infectious disease controls (l0.86 + 5.56 %) and normal controls (73.53 + 4.62 %) (p>0.05). 2) The fractions of CD5+ H cell in B cells were markedly high in neonate (65.18+ 13.67 %) as compared to that in children of acute febrile disease controls (27.14+5.96 %) and normal controls (20.04+5.92 %) (p<0.001). 3) CD5 mRNA expression was detected only in neonate and not in children of acute febrile disease controls or normal controls. CONCLUSIONS: Neonate has a large fraction of CD5+ B cells in total H cells as compared to that of children of acute febrile diseases or normal controls. PHMC of neonate normally expressed CD5 mRNA but that of acute febrile group or normal control group did not. Further study about the roles and meanings of CD5 mRNA expression may be needed.
Animals ; Antigens, CD5 ; B-Lymphocytes ; Child ; Communicable Diseases ; Humans ; Infant, Newborn* ; Leukocytes ; Mice ; RNA, Messenger*

Humans ; Kidney Failure, Chronic ; epidemiology ; physiopathology ; therapy ; Singapore ; epidemiology

STUDY DESIGN: A retrospective study. OBJECTIVES: This study examined the cervical range of motion (ROM) of cervical spondylotic myelopathy patients, before and after open door laminoplasty. SUMMARY OF LITERATURE REVIEW: Majority of the cases regarding the change of cervical range of motion after cervical laminoplasty showed decreased range of motion, and the results were diverse. MATERIALS AND METHODS: Of the 487 patients, who underwent open door laminoplasty at our hospital from March 1997 to March 2008, 98 had been followed for at least 2 years and had cervical flexion-extension lateral x-rays. In all patients, open door laminoplasty involved at least three segments: three, four, and five segments in 11, 52, and 35 patients, respectively. In previous cases, fixation involved sutures using suture anchors. The lordosis or kyphosis between C2 and C7 was analyzed using cervical flexion-extension lateral radiographs before and 2 years after the operation. RESULTS: The average patient age was 62.7 (range 32-82) years; 65 patients were male and 33 were female. From preoperatively to postoperatively, the average kyphosis of cervical flexion decreased from 10.7degrees to 7.8degrees, average lordosis decreased from 21.2degrees to 14.2degrees, and cervical ROM decreased from 31.9degrees to 22.0degrees, respectively (mean 9.9degrees, 31.0%). CONCLUSIONS: We could observe decreased cervical range of motion after cervical laminoplasty for cervical spondylotic myelopathic patients. Thus, the treatment to prevent the postoperative decrease of cervical range of motion and further study to find a new treatment are thought to be essential.
Animals ; Female ; Humans ; Kyphosis ; Lordosis ; Male ; Range of Motion, Articular ; Retrospective Studies ; Spinal Cord Diseases ; Spine ; Suture Anchors ; Sutures

BACKGROUND: Bronchial hbyperresponsiveness (BHR) is a key feature of asthma, and may precede the development of asthma. Genetically determined and acquired factors may contribute to development of BHR. OBJECTIVE: To evaluate expression of bronchial responsiveness to methacholine according to age, sex, smoking habit, and atopy in general population without bronchial asthma, a cross sectional study was performed. METHOD: A total of 1,190 general population who composed of 408 subjects with age less than 19 years (young age group), 621 subjects with age from 20 to 40 years (middle age group), and 161 subjects with age more than 41 years (old age group) were enrolled. Evaluations were made by a questionnaire, serum IgE level and skin prick test to common inhalant allergens, and methacholine bronchial provocation test (MBPT). Bronchial responsiveness were evaluated by positive rate of MBPT (PC,p-methacholine 4 25mg/ml), and slope of dose- response curve (slope, %fall of FEV, / log[last concentration of methacholine, mg/ml]). RESULT: Positive rate of MBPT was 11.0%, and slope (mean+SE) was 10.6+0.2 %/mg/ml. Postive rate of MBPT was more prevalent in the young age group than in middle and old age groups (19.6% vs. 6.6% vs. 6.2%, p<0.05), and slope was higher in young age group than in other groups (14.4+0.4 vs. 8.6+0.3 vs. 8.9+0.5 %/mg/ml, p<0.05). No significant differences in positive rate of MBPT and slope were noted according to sex in young and old age groups. However, in the middle age group, slope was higher in females than in males (9.5+0.4 vs. 7.9+ 0.3 %/mg/ml, p<0.05). No significant differences of slope was observed according to smoking habit in males of middle age group, but in males of old age group, the slope was higher in subjects with smoking habit than those without it (9.6+0.8 vs. 6.5+0.9 %/mg/ml, p<0.05). Significant relationship was observed between geometric value of serum IgE level and slope(r=0. 152, p=0.009). The postive rate of MBPT and slope were significantly higher in subjects with positive skin rea,ctivity to common inhalant allergens than those without it (14.3% vs. 8.6%, p ( 0.05; 11.8+0.4 vs. 9.8+0.3 %/mg/ml, p<0.05). The difference of bronchial responsiveness according to skin reactivity was observed in young and middle age groups, but not in old age group. CONCLUSION: Bronchial responsiveness to methacholine is significantly higher in children than in adults, in middle-aged females than in middle-aged males. Atopy and smoking may have a dif ferent role to determine the bronchial responsiveness depending upon age and sex.
Adult ; Allergens ; Asthma* ; Bronchial Provocation Tests ; Child ; Female ; Humans ; Immunoglobulin E ; Male ; Methacholine Chloride* ; Middle Aged ; Skin ; Smoke ; Smoking ; Surveys and Questionnaires

This experiment was performed to define the paricipation of a discrete hypothalamic neural structure in the genesis of pulmonary edema and the effect of alpha adrenergic blockade. Fifty adult cats weighing 2.5 to 4.0 Kg, were used in this study. The components of the pathophysiological systemic changes, lung weight, and histopathological changes of lung and hypothalamus were studied in groups of animals when intracranial pressure(ICP) was raised to 200 mmH2O of 300 mmH2O for 2 hours by intraventricular infusion with normal saline. The animals were divided into 5 groups : The normal control group was comprised in 10 normal cats. Control and phentolamine treated animal groups which had an elevated ICP of up 200 mmH2O consisted of 10 cats each. Control and phentolamine treated animal groups which had an elevated ICP of up to 300 mmH2O consisted of 10 cats each. The results obtained were as follows : 1) In the animal groups of elevated ICP to 200 mmH2O or 300 mmH2O, there were hemodynamic systemic changes which were neurogenically mediated and caused an immediate elevation in blood pressure of 30 mmHg to 60 mmHg. The hemodynamic data of the animals that had an elevated ICP of up to 300 mmH2O were significantly more deviated from normal control values than the 200 mmH2O ICP groups. The hemodynamic responses of the phentolamine treated animal with elevated ICP of up to 200 and 300 mmH2O were less deviated from normal control values. 2) The lung weights of the animals with an elevated ICP of up to 200 and 300 mmH2O were significantly heavier than the normal control value(p<0.05) and the lung weights of the animals with an elevated ICP of 300 mmH2O were significantly heavier than those with an ICP of 200 mmH2O(p<0.01). The lung weights of the phentolamine treated animal groups were significantly lighter than the control group but showed little increase in the lung weight when compared to the normal value. 3) By controlling the elevated ICP above 200 mmH2O in the experimental animals we have confirmed gross and microscopic appearances of hemorrhagic pulmonary edema. Histopathological changes of the phentolamine treated animals were significantly less sever than in the control groups. 4) By elevating ICP above 200 mmH2O in the experimental animals, we have confirmed discrete bilateral hemorrhagic spots of the anterior hypothalamus, preoptic region induced by increased intracranial pressure. Histopathological changes of the phentolamine treated animals with the elevated ICP were significantly less severe than of the control groups. 5) This experimental model may define the specific particification of the hypothalamus in the pathophysiological pathogenesis of neurogenic pulmonary edema. These results suggest that the lungs are directly affected by the intense sympathetic discharge evoked by release phenomenon from the sympathoinhibitory influence of the hypothalamus, and pulmonary edema was effectively eliminated by alpha adrenergic blockade.
Adult ; Animals ; Blood Pressure ; Cats* ; Edema* ; Hemodynamics ; Humans ; Hypothalamus ; Hypothalamus, Anterior ; Infusions, Intraventricular ; Intracranial Pressure ; Lung* ; Models, Theoretical ; Phentolamine* ; Pulmonary Edema ; Reference Values ; Weights and Measures

Introduction: Thromboelastography (TEG) provides an overall assessment of the platelet-coagulation protein cascade interaction. The information generated from the TEG is rapidly obtained and made useful to guide replacement therapy. The purpose of this study was to evaluate the efficacy of the TEG as its guided blood replacement therapy and pharmacological therapy during liver transplantation. METHODS: This study was carried out in 13 consecutive patients who were subjected to TEG-guided replacement therapy during liver transplantation. A prepared mixture of blood products used for continuous replacement therapy was a fluid composed of red blood cells(2 units), fresh frozen plasma (2 units), and normal saline(500 ml). The pharmacological therapy was performed by comparing TEG of untreated blood and blood treated with antifibrinolytic and heparin neutralizing agent. Based on the findings of TEG, platelet concentrates were given. The TEG samples were obtained at various intervals. Additional TEG tracing was obtained as needed to see the effect of therapeutic intervention. RESULTS: In all patients the reaction time was kept in an acceptable range in the preanhepatic stage by administration of the mixture of blood products. Heparin-induced anticoagulation was observed in 3 cases in the anhepatic stage and in 11 cases upon reperfusion. Fibrinolysis was seen in all but one patients: 8% in the preanhepatic stage, 41% in the anhepatic stage, 69% at reperfusion, and 2% in the postanhepatic stage. Early and aggressive treatment with epsilon-aminocaproic acid effectively inhibited fibrinolysis without complications. Ten patients needed platelet transfusion in the postanhepatic stage with significant improvement in the TEG. CONCLUSIONS: The results of this study suggest that TEG monitoring and TEG-guided replacement and pharmacological therapy are clinically effective in maintaining blood coagulability.
Aminocaproic Acid ; Blood Platelets ; Fibrinolysis ; Heparin ; Humans ; Liver Transplantation* ; Liver* ; Plasma ; Platelet Transfusion ; Reaction Time ; Reperfusion ; Thrombelastography ; Transplantation

This paper explains some of the difficulties doctors face when taking up a career in research. It describes the efforts by the government and the Ministry of Health (MOH) to nurture the Clinician Scientist Programme. The nature of research and the mindset of clinicians who are passionate about research are explored and the reasons which drive some of them to pursue a research career. It discusses the need to have structured training for research and how continuing research education is necessary for the researcher. The paper discusses the goals for research and how we can achieve better research outcomes and the importance of good mentorship. It suggests ways to engage more doctors in research in the restructured hospitals by overcoming some of the problems they encounter. Finally, it relates the Biomedical Science initiative of the government through the National Research Foundation and the various programmes in Translational Clinical Research available for clinicians who are keen on a research career.
Career Choice ; Goals ; Humans ; Physicians ; Research Personnel ; supply & distribution ; Singapore ; Translational Medical Research ; education ; manpower

OBJECTIVE: Cross-sectional survey was performed to evaluate prevalence of allergic rhinitis and its causative allergens in people in rural area of Cheju Isl~and. Subject and METHOD: A total of 1,236 people with 1,055 children and 181 adults in rural area of Cheju Island were enrolled in this study. In children, 544 were males and 511 were females, and their mean age was 12.3(ranging from 7 to 16) years. In adults, 78 were males and 103 were females, and their mean age was 50.1 (ratging from 18 to 87) years. Evaluations included a questionnaire survey, and skin prick test with extracts of Japanese cedar (Cryptomera japonica, J cedar) pollen and citrus red mite (Panonychus citri, CRM) as well as eleven common inhalant allergens. RESULTS: Prevalence of chronic nasal symptoms was 40.6% (429/1,055) in children, and 45.8 % (83/181) in adults. Prevalence of allergic rhinitis based on positive nasal symptoms on the questionnaire and positive skin response to one or more of the 13 inhalant allergens were 15.4 % (159/1.035) in children, and 19.3% (35/181) in adults. Of 1,035 children, skin-test response was positive in 37.6%, and common sensitizing allergens in order of decreasing frequency were Dermatophagoides pteronpssinus (DP) (26.6%), D. farinae (DF)(22.6%), CRM(14.2%), cockroach(11.3%) and J cedar(9.7%). Of 181 adults, skin-test response was positive in 25.9%, and t,he most common sensitizing allergen was CRM(16.5%), followed by cockroach(11.0%), DP(9. 9%), DF(9.4%), and J cedar(6.6%). Of 159 children with allergic rhinitis, the common sensitizing allergens in order of deereasing frequency were DP(79.2%), DF(67.3%), CRM(35.8%), J cedar(32.7%), and cockroach(27.0%). Of 35 adults with allergic rhinitis, the most common sensitizing allergen was CRM(68.6%), followed by DP(40%), DF(34.3%), cockroach(34.3%), and J cedar(28.9%). CONCLUSION: Allergic rhinitis is a very common disease with a prevalence of 15.4% in children and 19.3% in adults in rural area of Cheju island, and common sensitizing allergens include house dust mite, citrus red mite, cockroach, and Japanese cedar pollen.
Adult ; Allergens* ; Child ; Citrus ; Cockroaches ; Cross-Sectional Studies ; Cryptomeria ; Female ; Humans ; Jeju-do* ; Male ; Mites ; Pollen ; Prevalence* ; Pyroglyphidae ; Rhinitis* ; Skin ; Surveys and Questionnaires

BACKGROUND: This study was designed to evaluate the hemodynamic effects of vecuronium, pancuronium and rocuronium in patients with coronary artery disease (CABG) or valvular heart disease (VHD). METHODS: With IRB approval, 121 patients (61 patients with CABG and 60 patients with VHD) were randomly divided into a vecuronium, pancuronium and rocuronium group, respectively. Midazolam and fentanyl were administered and then 3 times of ED95 of a muscle relaxant (vecuronium, 0.12 mg/kg; pancuronium, 0.12 mg/kg; or rocuronium, 0.9 mg/kg) was injected. Additional dose of fentanyl was given and the patient was intubated. Hemodynamic variables were measured before the induction of anesthesia, just prior and 1 min after the administration of the muscle relaxant, just before intubation, 5 and 10 min after intubation. RESULTS: The number of patients enrolled in the CABG-vecuronium, CABG-pancuronium, CABG- rocuronium, VHD-vecuronium, VHD-pancuronium, and VHD-rocuronium was 20, 20, 21, 19, 20, and 21 respectively. Each of 10, 4, 4, 5, 1, and 1, respectively, were treated for hypotension or bradycardia during the induction of anesthesia. The heart rate (HR) changed significantly only in the CABG- vecuronium group compared with the control value. All three muscle relaxants decreased mean systemic artery pressure (MAP) significantly in both CABG and VHD patients. The decrease in HR and MAP were significantly greater in CABG-vecuronium and VHD-vecuronium than in CABG-pancuronium and VHD-pancuronium, respectively. The decrease in HR was also greater in VHD-vecuronium than in VHD-rocuronium. Cardiac index (CI) decreased in CABG-vecuronium and all VHD patients. The decrease in CI was greater in CABG-vecuronium than in CABG-pancuronium but it was not significantly different among the three muscle relaxants in VHD patients. CONCLUSIONS: While pancuronium and rocuronium exerted minimal hemodynamic effects, vecuronium reduced HR and MAP more significantly than pancuronium in both CABG and VHD patients, and CI also decreased more significantly with vecuronium in CABG patients.
Anesthesia* ; Arteries ; Bradycardia ; Coronary Artery Disease* ; Coronary Vessels* ; Ethics Committees, Research ; Fentanyl ; Heart Rate ; Heart Valve Diseases* ; Hemodynamics* ; Humans ; Hypotension ; Intubation ; Midazolam ; Pancuronium* ; Vecuronium Bromide*

BACKGROUND: The decreased estimated glomerular filtration rate (eGFR) levels at admission in patients with stroke have been associated with more severe clinical deficits and with worse outcomes; however, the relationship between eGFR levels and volumetric measurement of cerebral infarct size on neuroimaging has not been studied, to our knowledge. METHODS: Consecutive patients who presented within 48h of ischemic stroke and underwent brain diffusion-weighted imaging (DWI) over a 55-month period were studied. Patients with ischemic stroke of large artery atherosclerosis (LAA), small vessel occlusion (SVO), or cardioembolism (CE) etiologies were included. Those who were treated with thrombolysis and disabled before index stroke were excluded. Infarction volumes were log transformed to approximate normality. Chronic kidney disease (CKD) was defined as an eGFR < 60 mL/min per 1.73 m2. Subjects were categorized into two groups: CKD or no CKD. The relationship between CKD and DWI infarct volumes was examined using an analysis of covariance. RESULTS: Of the included 405 patients (mean age, 68 years; female, 60.2%; LAA, 60.0%; SVO, 16.5%; CE, 23.5%), 108 patients had CKD. Infarct volumes (mL, median [interquartile range]) were not significantly different between stroke patients with CKD and those without CKD in any stroke subtype (LAA, 0.77 [0.01-2.97] vs. 0.96 [0.01-5.22]; SVO, 0.18 [0.02-0.21] vs. 0.27 [0.01-0.52]; CE, 8.91 [0.04-28.54] vs. 5.22 [0.05-42.39]). Adjustment for possible confounders did not change the associations. CONCLUSIONS: Renal impairment is not associated with cerebral infarct volume among acute ischemic stroke patients.
Arteries ; Atherosclerosis ; Brain ; Female ; Glomerular Filtration Rate ; Humans ; Infarction ; Neuroimaging ; Renal Insufficiency, Chronic ; Stroke*