Electroencephalographic Changes Induced by a Neurofeedback Training : A Preliminary Study in Primary Insomniac Patients / 수면정신생리

OBJECTIVES: Insomnia is one of the most prevalent sleep disorders. Recent studies suggest that cognitive and physical arousal play an important role in the generation of primary insomnia. Studies have also shown that information processing disorders due to cortical hyperactivity might interfere with normal sleep onset and sleep continuity. Therefore, focusing on central nervous system arousal and normalizing the information process have become current topics of interest. It has been well known that neurofeedback can reduce the brain hyperarousal by modulating patients' brain waves during a sequence of behavior therapy. The purpose of this study was to investigate effects of neurofeedback therapy on electroencephalography (EEG) characteristics in patients with primary insomnia. METHODS: Thirteen subjects who met the criteria for an insomnia diagnosis and 14 control subjects who were matched on sex and age were included. Neurofeedback and sham treatments were performed in a random order for 30 minutes, respectively. EEG spectral power analyses were performed to quantify effects of the neurofeedback therapy on brain wave forms. RESULTS: In patients with primary insomnia, relative spectral theta and sigma power during a therapeutic neurofeedback session were significantly lower than during a sham session (13.9 ± 2.6 vs. 12.2 ± 3.8 and 3.6 ± 0.9 vs. 3.2 ± 1.0 in %, respectively; p < 0.05). There were no statistically significant changes in other EEG spectral bands. CONCLUSION: For the first time in Korea, EEG spectral power in the theta band was found to increase when a neurofeedback session was applied to patients with insomnia. This outcome might provide some insight into new interventions for improving sleep onset. However, the treatment response of insomniacs was not precisely evaluated due to limitations of the current pilot study, which requires follow-up studies with larger samples in the future.

<b>Study on the Constitutional Distributions of Disease Types and Symptoms by </b><b><i>Shisho </i></b><b>Constitution in Outpatients at the </b><b>Center for Kampo Medicine, Keio University </b> / 日本東洋医学雑誌

<b>Objectives </b>: The purpose of this study is to know the <i>shisho </i>constitutional distribution of outpatients at the Center for Kampo Medicine, Keio University School of Medicine (the Keio Kampo Center, herein) and to find out if there are differences in the type of diseases and symptoms according to <i>shisho </i>constitution.<br><b>Methods </b>: We collected data from 366 outpatients at the Keio Kampo Center. All did a SSCQ-P (<i>shisho </i>Constitution Questionnaire for Patients) to obtain a <i>shisho </i>constitution diagnosis. We then classified their shisho constitutions and surveyed disease and symptom prevalence according to same.<br><b>Results </b>: 1 : Among the 366 outpatients, distribution rates for Taiyojin, Syoyojin, Taiinjin, and Syoinjin were 0.8%, 27.3%, 28.7%, and 43.2% respectively. 2 : And the prevalence of V. Mental and behavioral disorders, XI. Diseases of the digestive system, XV. Pregnancy, childbirth and the puerperium, and Feeling of coldness (under XVIII. Symptoms, signs and abnormal clinical and laboratory findings, NEC) items for Shoinjin were significantly higher than those for the other constitutions. (p < 0.05)<br><b>Conclusions </b>: The distribution rate for shisho in 366 outpatients at the Keio Kampo Center was different from that in Korea, with the rate for shoinjin in these outpatients at the Center especially, being significantly higher than that for Koreans. There were also significant differences in the prevalence of some diseases and symptoms in shoinjin group.

Novel CFTR Mutations in a Korean Infant with Cystic Fibrosis and Pancreatic Insufficiency

Cystic fibrosis (CF) is an autosomal recessive disease that is very rare in Asians: only a few cases have been reported in Korea. We treated a female infant with CF who had steatorrhea and failure to thrive. Her sweat chloride concentration was 102.0 mM/L. Genetic analysis identified two novel mutations including a splice site mutation (c.1766+2T>C) and a frameshift mutation (c.3908dupA; Asn1303LysfsX6). Pancreatic enzyme replacement and fat-soluble vitamin supplementation enabled the patient to get a catch-up growth. This is the first report of a Korean patient with CF demonstrating pancreatic insufficiency. CF should therefore be considered in the differential diagnosis of infants with steatorrhea and failure to thrive.

Tracheal intubation without the use of muscle relaxant in severe burn patients using propofol and varying doses of remifentanil / 대한마취과학회지

BACKGROUND: Severe burn patients often have a difficult airway. Tracheal intubation can be conducted safely in patients in a stable hemodynamic condition using a propofol in conjunction with remifentanil without employing muscle relaxant. However, no studies have been conducted to date to evaluate intubation of severe burn patients. Therefore, this study was conducted to evaluate the condition of tracheal intubation with propofol and varying doses of remifentanil without muscle relaxants in severe burn patients. METHODS: Eighty severe burn patients were divided into four groups at random. Anesthesia was intravenously induced by continuous infusion of propofol (4 microgram/ml of effect site concentration)and slowly injected remifentanil. Groups 1, 2, 3, and 4 received 1, 1.5, 2, and 2.5 microgram/kg of remifentanil, respectively. Ninety seconds after the administration of remifentanil, tracheal intubation was attempted. We used a scoring system in which jaw relaxation, the state when laryngoscopy was inserted, vocal cord opening, cough, limb movement, and difficulty with laryngoscopy were divided into or = 3 (not acceptable). In addition, the hemodynamic changes were measured at baseline, before intubation, and 1, 2, 3, 4, and 5 min after intubation. RESULTS: Clinically acceptable intubating conditions were observed in 35%, 40%, 55%, and 70% of the patients in groups 1-4, respectively. The mean arterial pressure and heart rate decreased immediately before intubation in all groups. One patient was treated for bradycardia however, no patients manifested hypotension. CONCLUSIONS: Propofol and slowly injected remifentanil (2.5 microgram/kg) without muscle relaxant can provide clinically acceptable intubating conditions and stable hemodynamic conditions in major burn patients. However, further studies should be conducted to evaluate the effects of increased doses of remifentanil.

Evaluation of Plasma Homocysteine Assay by ADVIA Centaur Analyzer / 대한진단검사의학회지

BACKGROUND: Hyperhomocysteinemia is a risk factor for the cardiovascular diseases that can be usually reversed with vitamin supplements. Quantitative analysis of homocysteine helps to identify patients who might get benefits from the intervention therapy. Recently, as the automated homocysteine assay (ADVIA Centaur, Bayer, USA) by direct chemiluminesence method has been developed, we evaluated the performance of the ADVIA Centaur immunoassay analyzer for homocysteine. METHODS: The total plasma homocysteine concentrations were measured by ADVIA Centaur and by HPLC (HP1100 series with FLD, Hewlett Packard Co., Germany). To test the linearity, a dilution series was prepared. Between-run and total precision of the ADVIA Centaur assay were evaluated with Bio-Rad Homocysteine Controls for 10 days. The correlation was evaluated using 100 plasma samples from patients. NCCLS guidelines (EP5-A, EP6-P, and EP9-T) were followed to evaluate the ADVIA Centaur homocysteine assay. RESULTS: In the precision study, within-run and total run coefficients of variation (CV) of ADVIA Centaur assay were below 5%. The linearity was maintained well (R2=0.9978). The comparison study indicated a good correlation between the HPLC and ADVIA Centaur assay, and its correlation coefficient (R) was 0.9690. CONCLUSIONS: Since the ADVIA Centaur homocysteine immunoassay showed an excellent correlation with the HPLC method and is more convenient, automatic, and rapid than the HPLC method, it should be potentially beneficial in the clinical laboratories.

Transfer of Metallic Debris from the Metal Surface of an Acetabular Cup to Artificial Femoral Heads by Scraping: Comparison Between Alumina and Cobalt-chrome Heads / 대한정형외과연구학회지

PURPOSE: The purpose of the current in vitro study was to evaluate the transfer of metal to both alumina and cobalt-chrome (Co-Cr) heads that were scraped by a titanium alloy surface under different load conditions. MATERIALS AND METHODS: Alumina and Co-Cr heads were scraped by an acetabular metal shell under various loads using a creep tester. Microstructural changes in the scraped area were visualized with a scanning electron microscope and chemical element changes were assessed using an energy dispersive X-ray spectrometry. Changes in the roughness of the scraped surface were evaluated by a three-dimensional surface profiling system. RESULTS: Metal transfer to alumina and Co-Cr heads began to be detectable at a 10~15 kg load, which could be exerted by one-handed force. At loads of 30, 50 kg, fissures occurred on the head surfaces in addition to metal transfer. CONCLUSION: This study reveals that metallic debris was transferred from the titanium alloy acetabular shell to both alumina and Co-Cr heads by minor scraping. When the contact force increased, scratching of the head surface occurred in addition to the transfer of metal. The results of this study suggest that the greatest possible effort should be made to protect femoral heads, regardless of material, from contact with metallic surfaces during total hip arthroplasty.

Annual Report on External Quality Assessment in Clinical Chemistry in Korea (2003) / 임상검사와정도관리

Ten trials of external quality assessment for Clinical Chemistry in general chemistry and blood gas were performed in 2003. All the control materials were sent in specifically-made boxes at the same time. The response rates were 90.3% in general chemistry and 91.8% in blood gas. The items included sodium, potassium, chloride, BUN, glucose, calcium, phosphorus, uric acid, creatinine, bilirubin, total protein, albumin, total cholesterol, triglyceride, AST, ALT, ALP, LD and GGT in general chemistry and pH, pCO2 and pO2 in blood gas. Compared with the previous year (2002), the methods of analysis are not changed much and the coefficient of variation and VIS scores of general chemistry items are decreased.

Trace Metal Analysis Using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) / 대한진단검사의학회지

BACKGROUND: The exposure of human beings to toxic trace metals continues to be an important public health issue and concern. This study was conducted to assess the exposure to trace metals in the general Korean population by inductively coupled plasma-mass spectrometry (ICP-MS). METHODS: Blood and urine samples were obtained from 175 healthy subjects including those who visited the health promotion center or healthy volunteers. Specimens were collected in special containers and we applied simple sample processing to minimize contamination. We used ICP-MS (Fisons Instrument, Cheshire, UK) to analyze simultaneously the concentration of metals including lead, cadmium, aluminum, cobalt, copper, zinc and selenium. The effects of age, sex and smoking on the trace metal concentrations were also investigated. RESULTS: Distribution of trace metal levels in the general healthy population skewed toward lower values, which reflected low levels of exposure in the general healthy population. The concentrations of some trace metals were significantly affected by age, sex or smoking status. CONCLUSIONS: We performed a simultaneous multielement analysis of biological samples by ICPMS, a reliable and sensitive technique, to build a database of trace metal values in the general population. The results in this study can provide background data for future epidemiological and clinical studies associated with trace metal exposure in the Korean population.

Selective Bronchial Suction Catheter after Resection Surgery of Lung: Case report / 대한흉부외과학회지

We applied our technique of selective bronchial suctioning (SBS) for the treatment of atelectasis after resection surgery of lung in four patients with refractory atelectasis who were treated successfully. We considered that SBS using hydro-catheter insertion under local anesthesia above fourth tracheal ring is the effective technique for the treatment of refractory atelectasis when conventional respiratory therapy is not effective and a bronchoscopist is not available.

Annual Report on External Quality Assessment in Clinical Chemistry in Korea (2002) / 임상검사와정도관리

Ten trials of external quality assessment for Clinical Chemistry in general chemistry and blood gas were performed in 2002. All the control materials were sent in specially-made boxes at the same time. The response rates were 81.2% in general chemistry and 85.7% in blood gas. The items included sodium, potassium, chloride, BUN, glucose, calcium, phosphorus, uric acid, creatinine, bilirubin, total protein, albumin, total cholesterol, triglyceride, AST, ALT, ALP, LD and GGT in general chemistry and pH, pCO2 and pO2 in blood gas. Compared with the previous year(2001), the methods of analysis are not changed much and the coefficient of variation and VIS scores of general chemistry items show no significant change.

Mutation Analysis of Wilson Disease Gene: Arg778Leu Mutation in Korean Children / 대한소아소화기영양학회지

BACKGROUND: Wilson disease (WD) is an autosomal recessive disorder of copper transport and characterized by degenerative changes in the brain, liver dysfunction, and Kayser-Fleischer rings due to toxic accumulation of copper. Since the identification of Wilson disease gene (ATP7B), more than 80 mutations have been detected among the different ethnic groups. METHODS: Twenty three children with Wilson disease were included in this study. They were all diagnosed by low serum ceruloplasmin and increased 24 hour urinary copper excretion with characteristic clinical findings. We analysed WD gene mutation by assessing the nucleotide sequence of exon 7, 8, 9 and 10 including intron-exon boundaries of ATP7B gene from genomic DNA. RESULTS: Arg778Leu mutation was identified in 16 WD patients; three were homozygous and 13 were heterozygous for this mutation. Of the 46 alleles, 19 alleles had a Arg778Leu mutation (19/46=41%). Homozygote patients had neurologic forms of WD. Arg778Leu mutation was not found among 50 normal healthy persons. CONCLUSION: Arg778Leu mutation is a common mutation in Korean WD gene. Arg778Leu mutation screening might be used as a useful supplementary diagnostic test in some patients to confirm Wilson disease in Korea.

Study on the Plasma Homocysteine and Serum Vitamin B12, Folate Levels in Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Cardiovascular disease is the most frequent cause of death in rheumatoid arthritis(RA) patients and hyperhomocysteinemia is an independent risk factor for cardiovascular disease. We evaluated the status of homocysteine, vitamin B12 and folate in RA patients and the influence of the drugs used in RA on homocysteine and vitamin levels. METHODS: Fifty-six RA patients and 22 controls were studied. Plasma total homocysteine was measured by HPLC method and serum folate and vitamin B12 were measured by chemiluminescence immunoassay. In RA patients, age, sex, disease duration, medications and laboratory findings were analyzed. RESULTS: Serum vitamin B12 level was significantly lower in RA patients compared to controls(p=0.033). No significant difference in serum folate level was found between RA patients and controls but plasma total homocysteine level was significantly higher in RA patients. There was no difference in plasma total homocysteine level between patients taking MTX with folate and controls, but plasma total homocysteine level was significantly higher in patients not taking MTX compared with controls(p=0.028). In RA patients taking only hydroxychloroquine(HCQ) as a DMARD, there was significantly lower serum folate level(p=0.033) and higher plasma total homocysteine level(p=0.043) compared with controls. There was a significant negative correlation between plasma total homocysteine level and serum folate level in RA patients(r=-0.319, p=0.017). CONCLUSION: Plasma total homocysteine level was increased in RA patients but not in patients taking MTX and folate. These findings suggested that folate supplementation may be effective to prevent hyperhomocysteinemia in RA patients.

Clinical Study on Fiberoptic Awake Intubation and Self Pronation in Cervical Spine Disease Patients / 대한마취과학회지

In cervical spine disease patients, the authors performed awake intubation with a flexible fiberscope under local anesthetic preparation to avoid insult to the cervical spine during intubation, and had patients self pronate for positioning to prevent possible complications durings the turning from cart to operating table. We performed this method in 25patients(age15-68 years,19male female6). For oral anesthesia we used 15-20cc of 4% lidocaine in a divided dose. We injected 2 cc of 2% lidocaine for each superior laryngeal nerve block and injected 4-6 cc of 2 to 4% lidocaine through the cricothyroid membrane for transtracheal nerve block with a 22-gauge intravenous catheter. It took 5-10 minutes in 23 patients and over 10 minutes in 2 patients for local anesthetic preparation. It took less than 1 minute in 15 patients, 1-4 minutes in 6 patients and more than 4 minutes in 4 patients for fiberoptic awake intubation. We observed vocal cord movement in 6 patients and blood clot in the trachea in 7 patients. Seventeen patients did pronate without help, 5 patients needed some help and 3 patients needed full support. Among the 3 patients who needed full support, 2 patients were in a halo traction state and one was in deep sedation. Ten patients complained of pain or discomfort during intubation. This complaint may be related which the time taken for intubation and inadequate local anesthesia. There were no complications related to positioning. We concluded that fiberoptic awake intubation and self pronation for positioning is a safe and useful method for anesthetic mnagement in cervical spine disease patients.

Differential application of rate and delta check on selected clinical chemistry tests

Through the present delta value check used in quality control programs is a powerful tool for detecting random errors in clinical chemistry analysis, it has some problems, such as missed true errors and delays in reporting time, because it also has the potential of showing erroneous positive results. Recently, new calculation methods for delta check with delta difference, delta percent change, rate difference, and rate percent change have been suggested by Lacher and Connelly (Clin Chem 34:1966-1970, 1988). Based on this new delta check method, we made the new criteria of which calculation method is applied to the clinical chemistry tests, i.e., the differential application of rate and delta check, and selectively applied the new method to 17 chemistry tests in order to solve the above problems. The applied criteria were the time dependence of the test item and the coefficient of variation of the absolute delta difference. Calcium, inorganic phosphorus, total protein, albumin, sodium, potassium, and chloride were classified as delta difference calculation method group; glucose and cholesterol as delta percent change group; creatinine, total and direct bilirubin as rate difference group; and urea nitrogen, uric acid, ALP, ALT, and AST as rate percent change group. With the previous criteria by Whitehurst et al. (Clin Chem 221:87-92) for 5045 specimens, the check-out rate was 47.8% (2,411 out of 5,045), and the positive predictive value was 0.41% (10 out of 2,411). For the new criteria, the check-out rate was 12.7% (621 out of 5,045), and the positive predictive value was 1.8% (nine out of 621).(ABSTRACT TRUNCATED AT 250 WORDS)