A Preliminary Comparison of Efficacy of Intravaginal Misoprostol with Intravenous Sulprostone for Termination of Second-Trimester Pregnancy / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to compare the efficacy of intravaginal misoprostol and that of intravenous sulprostone for termination of second-trimester pregnancy. METHODS: Fouty-six patients were randomly assigned to misoprostol and sulprostone group, and the misoprostol group was further divided into two groups according to gestational age. In the misoprostol group, the patients at or before 20 weeks of gestation received 400 microgram of intravaginal misoprostol every 4 hours until labor pain was established, 200 microgram every 6 hours after 20 weeks of gestation. In the sulprostone group, intravenous sulprostone was infused at the speed of 100 microgram/hr regardless of gestational age. RESULTS: At or before 20 weeks of gestation, the mean time from induction to completion of termination was shorter, and the success rate within 24 hours was higher in the misoprostol group than in the sulprostone group (9.0 vs. 20.2 hours; 86% vs 50%). After 20 weeks, the mean induction time was longer at misoprostol group than sulprostol group but, there was no significant difference in success rate within 24 hours (14.7 vs. 7.1 hours; 83% vs. 86%). There was no significant difference in the prevalence of complication between two groups. CONCLUSION: Misoprostol is superior to sulprostone for termination of pregnancy at or before 20 weeks of gestation, but both have almost equal effectiveness after 20 weeks of gestation. Considering less cost and complication, the efficacy of misoprostol should be further investigated for termination of second-trimester pregnancy.

Cauda Equina Syndrome by Disc Prolapse after Caesarian Section Delivery / 대한주산의학회잡지

Cauda equina syndrome develops as rapidly progressive neurologic deficit of lower extremities and urogenital system often resulting in serious outcome such as complete irreversible paraparesis, therefore prompt diagnosis and decompression is mandatory. However, if it occurs after childbirth, it may be overlooked being regarded as symptoms related to pregnancy and delivery. We experienced a cauda equina syndrome by prolased disc in a 32-year-old woman just after Caesarian section who was managed with prompt decompressive surgery and achieved favorable result. Because of the importance of early detect and prompt decompression for cauda equina syndrome and possible occurrence at perinatal period, we report this case reviewing the literature especially concerning about changes of spine and disc during pregnancy and after delivery.

Kinesin Superfamily KIF5 Proteins Bind to betaIII Spectrin

The kinesin proteins (KIFs) make up a large superfamily of molecular motors that transport cargo such as vesicles, protein complexes, and organelles. KIF5 is a heterotetrameric motor that conveys vesicles and plays an important role in neuronal function. Here, we used the yeast two-hybrid system to identify the neuronal protein (s) that interacts with the tail region of KIF5 and found a specific interaction with betaIII spectrin. The amino acid residues between 1394 and 1774 of betaIII spectrin were required for the interaction with KIF5C. betaIII spectrin also bound to the tail region of neuronal KIF5A and ubiquitous KIF5B but not to other kinesin family members in the yeast two-hybrid assay. In addition, these proteins showed specific interactions, confirmed by GST pull-down assay and co-immunoprecipitation. betaIII spectrin interacted with GST-KIF5 fusion proteins, but not with GST alone. An antibody to betaIII spectrin specifically co-immunoprecipitated KIF5s associated with betaIII spectrin from mouse brain extracts. These results suggest that KIF5 motor proteins transport vesicles or organelles that are coated with betaIII spectrin.

Molecular Motor Proteins of the Kinesin Superfamily Proteins (KIFs): Structure, Cargo and Disease

Intracellular organelle transport is essential for morphogenesis and functioning of the cell. Kinesins and kinesin-related proteins make up a large superfamily of molecular motors that transport cargoes such as vesicles, organelles (e.g. mitochondria, peroxisomes, lysosomes), protein complexes (e.g. elements of the cytoskeleton, virus particles), and mRNAs in a microtubule- and ATP-dependent manner in neuronal and non-neuronal cells. Until now, more than 45 kinesin superfamily proteins (KIFs) have been identified in the mouse and human genomes. Elucidating the transport pathways mediated by kinesins, the identities of the cargoes moved, and the nature of the proteins that link kinesin motors to cargoes are areas of intense investigation. This review focuses on the structure, the binding partners of kinesins and kinesin-based human diseases.

An Investigation to the Diagnostic Validity of MMSE-K and the Psychopathology in a Group of Urban Patients with Dementia of Alzheimer Type / 신경정신의학

OBJECTIVES: The purpose of present study was to determine the validity of MMSE-K and its items in a group of urban patients with dementia of Alzheimer type and investigate the frequency of psychiatric symptoms and the correlation between the severity of cognitive impairment and that of psychopathology in them. METHODS: The subjects were 107 residents, aged over 55, of an urban community, who participated voluntarily in a free medical service for dementic patients. At first, MMSE-K were administered to all the participients to screen for the cognitive impairment. They were diagnosed mainly by the criteria of DSM-IV for dementia of Alzheimer type. Other diagnostic procedures were performed at that time and these included: a history taking for the past and present medical and psychiatric illnesses of the subject and its family members, physical and neurological examinations, clinical evaluations using several psychiatric symptom rating scales such as BPRS, HDRS, HARS and Overt Aggression Scale, Hachinski's Ishcemic Scale, evaluations for sleep disturbances and behavioral problems in daily living. The majority, of total 72 subjects who were evaluated as having cognitive dysfunctions, were the patients with dementia of Alzheimer type: 52 dementia of Alzheimer type, 12 vascular dementia, one mixed type of the two, and 7 others. We determined the validity of MMSE-K and its items in 52 subjects with dementia of Alzheimer type except the two, who could not respond well to the instructions of MMSE-K due to severe cognitive impairments, and 34 non-dementic subjects with only mild psychiatric symptoms. In 42 subjects with dementia of Alzheimer type who completed all the clinical rating scales with confidence, we investigated the frequency of psychiatric symptoms and the correlation between the severity of cognitive impairment and psychopathology. RESULTS: 1) The percent of false positive in diagnosing dementia of Alzheimer type using MMSE-K was 8.0%, and the sensitivity of MMSE-K was 82% in our 107 urban subjects. 2) There were statistically significant differences in the the mean scores of all items except the item, judgement, between the patients with dementia of Alzheimer type and non-dementic subjects(p<0.05). The two items, orientation for time and place, and the item, copy two pentagons, had the sensitivity and specificity over 70%. 3) The frequencies of behavioral and psychiatric symptoms in 42 patients with dementia of Alzheimer type were as follows: verbal aggression(50.0%), depression(46.2%), insomnia(30.8%), ...... , hallucination(21.2%) and delusion(15.4%). 4) The more cognitive dysfunctions had the patient with dementia of Alzheimer type, the more higher scores in the thinking disturbance subscale of BPRS they showed(p<0.01). CONCLUSION: MMSE-K was proved to be a valid instrument to evaluate the cognitive impairments in patients with dementia of Alzheimer type, but the item, judgement, newly admitted to MMSE-K instead of a language item in MMSE, was proved to be lack of power to discriminate the dementic patient from non-dementic subjects. Our subjects with dementia of Alzheimer type had revealed several behavioral and psychiatric symptoms other than cognitive dysfunctions, and those included depression, anxiety, insommnia, aggression, delusion and hallucination which needed intensive pharmacological interventions.