OBJECTIVE: To report successful cases of extubation from invasive mechanical ventilation at our institution using pulmonary rehabilitation consisting of noninvasive ventilation (NIV) in neuromuscular patients with experience of reintubation. METHODS: Patients who experienced extubation failure via the conventional weaning strategy but afterwards had extubation success via NIV were studied retrospectively. Continuous end-tidal CO₂ (ETCO₂) and pulse oxyhemoglobin saturation (SpO₂) monitoring were performed. Extubation success was defined as a state not requiring invasive mechanical ventilation via endotracheal tube or tracheotomy during a period of at least 5 days. RESULTS: A total of 18 patients with ventilatory failure who initially experienced extubation failure were finally placed under part-time NIV after extubation. No patient had any serious or long-term adverse effect from NIV, and all patients left the hospital alive. CONCLUSION: NIV may promote successful weaning in neuromuscular patients with experience of reintubation.
Humans ; Neuromuscular Diseases* ; Noninvasive Ventilation* ; Oxyhemoglobins ; Rehabilitation ; Respiration, Artificial ; Retrospective Studies ; Tracheotomy ; Weaning*

BACKGROUND AND PURPOSE: Periodic limb movements (PLM) during sleep (PLMS) are associated with cortical and cardiovascular activation. Changes in cerebral hemodynamics caused by cortical activity can be measured using near-infrared spectroscopy (NIRS). We investigated oscillatory components of cerebral hemodynamics during PLM and different sleep stages in restless legs syndrome (RLS) patients with PLMS. METHODS: Four female RLS patients with PLMS, and four age- and sex-matched normal controls were included. PLM and sleep stages were scored using polysomnography, while the spontaneous cerebral hemodynamics was measured by NIRS. The phase and amplitude of the cerebral oxyhemoglobin concentration [HbO] and the deoxyhemoglobin concentration [Hb] low-frequency oscillations (LFOs) were evaluated during each sleep stage [waking, light sleep (LS; stages N1 and N2), slow-wave sleep (stage N3), and rapid eye movement (REM) sleep]. In RLS patients with PLMS, the cerebral hemodynamics during LS was divided into LS with and without PLM. RESULTS: The cerebral hemodynamics activity varied among the different sleep stages. There were changes in phase differences between [HbO] and [Hb] LFOs during the different sleep stages in the normal controls but not in the RLS patients with PLMS. The [HbO] and [Hb] LFO amplitudes were higher in the patient group than in controls during both LS with PLM and REM sleep. CONCLUSIONS: The present study has demonstrated the presence of cerebral hemodynamics disturbances in RLS patients with PLMS, which may contribute to an increased risk of cerebrovascular events.
Extremities* ; Female ; Hemodynamics* ; Humans ; Oxyhemoglobins ; Polysomnography ; Restless Legs Syndrome* ; Sleep Stages ; Sleep, REM ; Spectroscopy, Near-Infrared*

We present the case of a 28-year-old pregnant woman with subarachnoid hemorrhage who was initially unable to undergo a CT scan and exhibited interestingly high signal intensities only on T2-weighted MRI without any signal change on fluid attenuated inversion recovery and gradient-echo imaging. These findings could be explained by a combination of factors that increase the signal intensity with elevations in the concentrations of protein and oxyhemoglobin due to massive bleeding and with the decreased fluid void signal inferred by the presence of hydrocephalus.
Adult ; Female ; Hemorrhage ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging* ; Oxyhemoglobins ; Pregnant Women ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed

OBJECTIVES: Several studies suggest that nocturia may be related to obstructive sleep apnea syndrome (OSAS). The mechanism by which OSAS develops nocturia has not been determined. The present study aimed to determine the prevalence of nocturia among adults with OSAS and to identify factors that may be predictive in this regard. METHODS: Retrospective review of clinical and polysomnographic data obtained from patients evaluated at the sleep clinics of the St. Paul's Hospital between 2009 and 2012. The urinary symptoms were assessed on the basis of the International Prostate Symptom Score (IPSS). Pathologic nocturia was defined as two or more urination events per night. OSAS was defined as apnea-hypopnea index (AHI) > or =5. A multivariate analysis using logistic regression was performed to examine the relationship between polysomnographic variables and the presence of pathologic nocturia, while controlling for confounding factor. RESULTS: A total of 161 men >18 years of age (mean age 46.7+/-14.1), who had been referred to a sleep laboratory, were included in the present study. Among these, 27 patients with primary snoring and 134 patients with obstructive sleep apnea were confirmed by polysomnography. Nocturia was found in 53 patients with OSAS (39.6%) and 8 patients with primary snoring (29.6%). The AHI was higher in patients with nocturia than in those without nocturia (p=0.001). OSAS patients with nocturia had higher arousal index (p=0.044), and lower nadir oxyhemoglobin saturation (p=0.001). Multiple regression analysis showed that age (beta=0.227, p=0.003), and AHI (beta=0.258, p=0.001) were associated with nocturia, and that the presence of pathologic nocturia was predicted by age (OR 1.04 ; p=0.004) and AHI (OR 1.02 ; p=0.001). CONCLUSION: Nocturia is common among patients with OSAS. The strongest predictors of nocturia are age and AHI in patients with OSAS.
Adult ; Arousal ; Humans ; Logistic Models ; Male ; Multivariate Analysis ; Nocturia* ; Oxyhemoglobins ; Polysomnography ; Prevalence* ; Prostate ; Retrospective Studies ; Sleep Apnea, Obstructive* ; Snoring ; Urination

Acute pulmonary thromboembolism (PTE) is a major medical problem in many hospitalized patients with medical and surgical conditions, and venous thromboembolism is responsible for up to 15% of all in-hospital deaths. However, PTE complicating acute intoxication has been reported only rarely, and prophylaxis for venous thromboembolism is not routinely incorporated into the management of acute poisoning in emergency departments or general wards. We describe here a case of pulmonary thromboembolism that developed within 48 h of acute benzodiazepine overdose. A 47-year-old female patient was brought to the emergency department by ambulance. She had been found unconscious, and empty packages of medications prescribed by her psychiatrist and an empty bottle of liquor were found. The estimated drugs and amounts were alprazolam 22.5 mg, diazepam 150 mg, flunitrazepam 7.5 mg, fluoxetine 150 mg, and propranolol 600 mg. Approximately 40 hours after initial presentation, she complained of dyspnea and pulse oxymetry indicated 84%. Her arterial pH was 7.41, pCO2 41.6 mmHg, pO2 46.8 mmHg, and oxyhemoglobin saturation was 83.4%. The serum D-dimer concentration was 2.78 mcg/dL, and computed tomography of the chest showed acute PTE in the right upper lobar and segmental pulmonary arteries and both lower segmental pulmonary arteries. When caring for patients with sedative drug overdose, a high level of suspicion of PTE is required, and appropriate diagnostic and therapeutic measures might be undertaken when PTE is suspected. In addition, appropriate prophylaxis for venous thrombosis should be considered.
Alprazolam ; Ambulances ; Benzodiazepines* ; Diazepam ; Drug Overdose ; Dyspnea ; Emergency Service, Hospital ; Female ; Flunitrazepam ; Fluoxetine ; Humans ; Hydrogen-Ion Concentration ; Middle Aged ; Oxyhemoglobins ; Patients' Rooms ; Poisoning ; Propranolol ; Psychiatry ; Pulmonary Artery ; Pulmonary Embolism* ; Thorax ; Venous Thromboembolism ; Venous Thrombosis

It remains unclear whether language tasks in one's first (L1) or second (L2) language can cause stress responses and whether frontal, autonomic and behavioral responses to stressful tasks are correlated. In this study, we studied 22 Chinese subjects whose L2 was English and measured the cerebral blood oxygenation in their frontal lobe by using functional near-infrared spectroscopy (fNIRS) as participants engaged in a mental arithmetic task (MAT) and verbal fluency tasks (VFTs) in L1 (Chinese) and L2 (English). To examine the activated cortical areas, we estimated the channel location based on Montreal Neurological Institute (MNI) standard brain space by using a probabilistic estimation method. We evaluated heart rate (HR) changes to analyze autonomic nervous system (ANS) functioning. We found that the MAT and VFTs induced greater increases in HR than did the control (Ctrl) task. Furthermore, subjects developed greater increases in HR in the MAT and VFTL2 than they did in the VFTL1. Compared with the Ctrl task, the MAT and both VFTL1 and VFTL2 produced robust and widespread bilateral activation of the frontal cortex. Interestingly, partial correlation analysis indicated that the activity in the left inferior frontal gyrus (LIFG) [Brodmann's area (BA) 47] was consistently correlated with the increases in HR across the three tasks (MAT, VFTL2, and VFTL1), after controlling for the performance data. The present results suggested that a VFT in L2 may be more stressful than in L1. The LIFG may affect the activation of the sympathetic system induced by stressful tasks, including MATs and VFTs.
Adult ; Autonomic Nervous System ; physiology ; Brain Mapping ; methods ; Female ; Functional Laterality ; Heart Rate ; physiology ; Humans ; Language ; Male ; Oxyhemoglobins ; metabolism ; Prefrontal Cortex ; metabolism ; physiology ; Psychomotor Performance ; physiology ; Spectroscopy, Near-Infrared ; methods ; Stress, Psychological

PURPOSE: To determine the effect of changing practice guidelines designed to avoid hyperoxia or hypoxia in very low birth weight or very preterm infants. METHODS: We analyzed a database of <1,500 g birth weight or <32 weeks of gestation infants who were born and admitted to the neonatal intensive care unit of Chungnam National University Hospital from January 2007 to July 2010. First, we defined the relationship between arterial partial pressure of oxygen (PaO2) and pulse oxygen saturation (SpO2). When we evaluated 96 pairs of PaO2 and SpO2 measurements, oxygen saturation was 90-94% at a PaO2 of 43-79 mmHg on the oxyhemoglobin dissociation curve, according to pulse oximetry. Based on this observation, a change in practice was instituted in August 2008 with the objective of avoiding hypoxia and hyperoxia in preterm infants with targeting a SpO2 90-94% (period II). Before the change in practice, high alarms for SpO2 were set at 100% and low alarms at 95% (period I). RESULTS: Sixty-eight infants the met enrollment criteria and 38 (56%) were born during period II, after the change in SpO2 targets. Demographic characteristics, except gender, were similar between the infants born in both periods. After correcting for the effect of confounding factors, the rates for mortality, severe retinopathy of prematurity, and IVH attended to be lower than those for infants in period II. No difference in the rate of patent ductus arteriosus needed to treat was observed. CONCLUSION: A change in the practice guidelines aimed at avoiding low oxygen saturation and hyperoxia did not increase neonatal complication rates and showed promising results, suggesting decreased mortality and improvements in short term morbidity. It is still unclear what range of oxygen saturation is appropriate for very preterm infants but the more careful saturation targeting guideline should be considered to prevent hypoxemic events and hyperoxia.
Anoxia ; Birth Weight ; Blood Gas Analysis ; Dissociative Disorders ; Ductus Arteriosus, Patent ; Humans ; Hyperoxia ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Oximetry ; Oxygen ; Oxyhemoglobins ; Partial Pressure ; Pregnancy ; Retinopathy of Prematurity

Aluminum phosphide is commonly used as a rodenticidal agent in agricultural workplaces. However, reported cases of aluminum phosphide poisoning in Korea are rare. Upon contact with moisture in the air, aluminum phosphide releases highly toxic phosphine gas (PH3). PH3 is readily absorbed through lung epithelium and into the bloodstream. Phosphine may cause denaturing of oxyhemoglobin and enzymes important to respiration and metabolism, and also may effect cellular membranes. There are numerous complications associated with acute aluminum phosphide poisoning including gastrointestinal, respiratory, and cardiac toxicities. We report the case of a 46-year-old man who suffered from respiratory and cardiac toxicities after unintentional aluminum phosphide exposure. More intensive education for prevention is recommended.
Aluminum ; Aluminum Compounds ; Epithelium ; Humans ; Korea ; Lung ; Membranes ; Middle Aged ; Oxyhemoglobins ; Phosphines ; Respiration

With the widespread clinical application of neoadjuvant chemotherapy, it has become an essential part of combination therapy for patients with breast cancer. However, a rapid, accurate, and effective approach for assessing the therapeutic efficacy of neoadjuvant chemotherapy is unavailable. Routine physical examinations cannot provide effective clinical evaluation. Although imaging techniques play an important role in evaluating the therapeutic effect of neoadjuvant chemotherapy, this is limited because it only detects morphologic changes. Blood oxygen detection for breast diseases is an emerging diagnostic technique that has distinctive merit in assessing the efficacy of chemotherapy. Biologic markers are becoming more important in assessing the effect of neoadjuvant chemotherapy for patients with breast cancer. This review summarizes the principles and the current applied practice of these approaches to evaluate the effect of neoadjuvant chemotherapy for patients with breast cancer.
Biomarkers, Tumor ; metabolism ; Breast Neoplasms ; diagnosis ; drug therapy ; metabolism ; Chemotherapy, Adjuvant ; Evaluation Studies as Topic ; Female ; Humans ; Magnetic Resonance Imaging ; Mammography ; instrumentation ; Molybdenum ; Neoadjuvant Therapy ; Oxyhemoglobins ; metabolism ; Positron-Emission Tomography ; Ultrasonography, Mammary

The paper first analyses the principles of measurement of the two-wave oximeter and their limitations in technology. We propose to filter off motion interference from pulse oximeter signal using an algorithm based on the Beer-Lambert law that requires a three-wave probe (660 nm, 850 nm, and 940 nm). Based on the new algorithm, this paper describes the design principle of the circuitry and the software flowchart. Also, we study the calibration method of the pulse oximeter sensor and discuss the results in this paper.
Calibration ; standards ; Equipment Design ; Humans ; Oximetry ; instrumentation ; Oxygen ; metabolism ; Oxyhemoglobins ; analysis