Influence of electrocautery-induced electromagnetic interference on quantitative electroencephalographic monitoring of hypnosis during general anesthesia: comparison between the ADMS® and the BIS VISTATM / 대한마취과학회지

BACKGROUND: Hypnosis monitors analyze small-amplitude electrical signals transmitted from the brain that could be exposed to the electromagnetic field that occurs around the body during electrocautery (ECT). We investigated the influence of ECT on hypnosis monitoring during anesthesia. METHODS: We simultaneously monitored BIS and uCON during 50 gynecologic oncology surgeries. During the episodes of ECT, we compared the absolute difference (a-Diff) between the baseline index and the most deviated index after ECT over either 30–60 s (ECT30–60) or more than 60 s (ECT > 60) between the monitors. We also investigated the bias and the limits of agreement between the monitors. RESULTS: Between the two monitors, the a-Diff of ECT30–60 was 1.4 ± 1.1 for the BIS, which was significantly greater than 0.6 ± 0.9 for the uCON (P = 0.003), and the a-Diff of ECT > 60 was 16.5 ± 8.2 for the BIS, which was also significantly greater than 1.4 ± 1.3 for uCON (P 60 was significantly greater than that during ECT30–60 (P 60 (P = 0.056). The estimated bias between the monitors was 6.3 ± 9.8 and 95% limits agreement was –12.3 to 25.0. CONCLUSIONS: Prolonged ECT intervention might lead to spurious estimations of quantitative EEG indexes. Therefore, hypnosis should be clinically assessed in combination with scrutinized judgment of relevant clinical symptoms and signs for hypnosis.

Gender Differences in the Formal Thought Disorder in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: Formal thought disorder has been regarded as an essential symptom in the diagnostic criteria for schizophrenia. The aim of our study was to present gender differences in the formal thought disorder among patients with schizophrenia. METHODS: We tested for potential gender differences in the formal thought disorder among 167 inpatients with schizophrenia (86 men and 81 women). The Scale for the Assessment of Thought, Language and Communication (TLC scale), Clinical Language Disorder Rating Scale (CLANG), Brief Psychiatric Rating Scale, Young Mania Rating Scale, and Calgary Depression Scale for Schizophrenia were used for evaluation of thought disorder, language disorder, overall symptoms, manic symptoms, and depressive symptoms, respectively. Using the analysis of covariance for continuous variables and logistic regression analysis for discrete variables, gender differences in the formal thought disorder were evaluated. RESULTS: After adjusting for the effects of marital status and religious affiliation, men showed a significantly higher score on the perseveration (TLC scale ; F=7.538, p=0.007), blocking (TLC scale ; F=8.956, p=0.003), stilted speech (TLC scale ; F=6.921, p=0.009), lack of details (CLANG ; F=7.375, p=0.007), dysfluency (CLANG ; F=21.250, p<0.0001), and dysarthria (CLANG ; F=31.198, p<0.0001) items than women. CONCLUSION: Our study has a virtue of exploring gender differences in the formal thought disorder in patients with schizophrenia. Based on our findings, further study might enlighten regarding neural correlates (namely, cerebral asymmetry/lateralization) for gender-differed patterns of the formal thought disorder in patients with schizophrenia.

On Textual and Contextual Position of The Ophthalmological Treatise of Bodhisattva Nagarjuna / 의사학

Medical knowledge in India began to be introduced to China in earliest from the Later Han Dynasty period to the times of Wei-Qin and South & North Dynasties. This is proved by many Buddhist medical books appeared in those days. Of the contents of Indian medicine, the theory of four major elements affected Chinese medicine more than did the theory of body fluids. Based on the theory of four major elements that was began to be introduced in Fu shuo fu yi jing, an attempt to establish a new medical system was made in Zhou hou bai yifang written by Tao Hong-jing and Sun Si-miao who tried to develop etiology further but could not achieve any great outcomes. Unlike the foregoing situation, Indian medicine aroused a large echo in China in the field of ophthalmology with ophthalmological knowledge mentioned in Susrutasamhita and 'Jin-zhen-shu'(cataract couching) introduced as a surgical treatment of cataract. The Susrutasamhita which is one of the three major texts of Indian medicine contains additional information on surgical operations not introduced in the Carakasamhita. The technique of cataract surgery was particularly popular in the Tang and Song dynasty periods in China under the name Long shu pu sa yan lun(The Ophthalmological Treatise of Bodhisattva Nagarjuna) or Long shu lun and was even designated as a subject to educate medical officers. While the original text of Long shu pu sa yan lun was not handed down, the first testimony that show the trace of the introduction of this text into China was the Tian zhu jing lun yan mentioned in Wai tai mi yao(Arcane Essential from the Imperial Library) written by Wang Tao. Long shang dao ren who was mentioned as the compiler of the book is assumed to be Long shu. Although Tian zhu jing lun yan introduced anatomical knowledge about the eyeball that could have not been in the traditional Chinese medicine, this book has only limited quantity of information in this regard. Thereafter, Tai ping sheng hui fang(Holy Prescriptions for Universal Relief) compiled by a national agency at the beginning of the Song Dynasty period introduced Long shu pu sa yan lun without clear indication of the reference. Contemporary with this book, many ophthalmological books such as Mi chuan yan ke long mu lun(Longmu's Ophthalmology Secretly Handed Down) were published. As Chinese culture was spreading out into surrounding countries, medical knowledge was also introduced to Korean peninsula and Japan. The ophthalmological knowledge contained in Long shu pu sa yan lun was also reflected and some parts of it were introduced in I shin bo in Japan. Based on the policy decision of King Sejong, the fourth king of Joseon Dynasty, large scaled promoting projects of medical knowledge was established. It is notable that the Ui bang ryu chwi compiled as a result of the synthesis of the medical treatises available at that time initiated by King Sejong contained a considerable part of Long shu pu sa yan lun in reedited form that had already passed into oblivion in China. The intellectuals in Joseon Dynasty who participated in the compilation of Ui bang ryu chwi not only indicated that Long shu pu sa yan lun was a medical text published in the times of Wei-Qin and South & North Dynasties in China but also clearly indicated the textual reference and left the original text for later generation without modifying the contents. According to the Ui bang ryu chwi, the Long shu pu sa yan lun indicated that the core causes of eye diseases were heat, winds, and three body fluids(tridosa) and contained the analyses of symptoms, related treatments, and several analyses of wrong treatments. In addition, Long shu pu sa yan lun explained diverse eye diseases through more than 30 medical treatments. In particular, this book accurately described golden needle acupuncture for treatment of a Nei-zhang understood to be cataract. Therefore, this book is a significant textual record in the history of ophthalmological medicine in East Asia. Along with the golden needle acupuncture which is a method of removing the crystalline lens in which white turbidity occurred by stabbing the eyeball with a needle, traces of Indian medicine that had been already lost in China were clearly indicated in Long shu pu sa yan lun kept in the Ui bang ryu chwi. In particular, the book indicates that the eyes were directly correlated with the brain and that to treat the internal disorder, treating the brain that lost stability due to heat and bodily wind was indispensable; these are the traces of Indian influence. This textual source demonstrates a case of knowledge exchange in field of medicine with concrete cases of the encounter and clash between the standpoints of understanding human body.

Sex-Related Differences of EEG Coherences between Patients with Schizophrenia and Healthy Controls

OBJECTIVES: Alteration of epigenetic effects of testosterone during early development was suggested as an ancillary mechanism for the genesis of schizophrenia. EEG coherence was thought to be a marker for cerebral laterality of which important determinant was testosterone during early development. We studied sex-related differences of EEG coherences between patients with schizophrenia and controls to examine the sex effects in the genesis of schizophrenia. METHODS: EEG was recorded in 35 patients with schizophrenia and 46 healthy controls in the eyes closed resting state. Pair-wise EEG coherences were calculated over delta, theta, alpha, beta and gamma frequency bands. To examine the differences of EEG coherence according to sex in each group, ANCOVA was performed using Statistical Analysis system (SAS, Ver 9.3) and R (Ver 2.15.2). RESULTS: Healthy control males showed more increased right intrahemispheric coherences than healthy control females in delta, theta, alpha and beta frequency bands. In patients with schizophrenia, this male dominant pattern in right intrahemispheric coherences was attenuated especially in alpha and beta bands. Healthy control females showed more increased interhemispheric coherences than healthy control males in delta, theta, beta and gamma frequency bands. In patients with schizophrenia, these female dominant patterns in interhemispheric coherences were attenuated especially in delta, theta, and beta bands, which were commonly observed in frontal to central areas. CONCLUSION: Sex differences in resting EEG coherences were attenuated in schizophrenia patients. These results imply that sex-related aberrant cerebral lateralization might exist in patients with schizophrenia, which are partly due to sex hormones via epigenetic mechanisms.