Polymorphism of Nitric Oxide Synthase 1 Affects the Clinical Phenotypes of Ischemic Stroke in Korean Population

OBJECTIVE: To investigate whether four single nucleotide polymorphisms (SNPs) rs2293054 [Ile734Ile], rs1047735 [His902His], rs2293044 [Val1353Val], rs2682826 (3'UTR) of nitric oxide synthase 1 (NOS1) are associated with the development and clinical phenotypes of ischemic stroke. METHODS: We enrolled 120 ischemic stroke patients and 314 control subjects. Ischemic stroke patients were divided into subgroups according to the scores of the National Institutes of Health Stroke Survey (NIHSS, <6 and ≥6) and Modified Barthel Index (MBI, <60 and ≥60). SNPStats, SNPAnalyzer, and HelixTree programs were used to calculate odds ratios (ORs), 95% confidence intervals (CIs), and p-values. Multiple logistic regression models were performed to analyze genetic data. RESULTS: No SNPs of the NOS1 gene were found to be associated with ischemic stroke. However, in an analysis of clinical phenotypes, we found that rs2293054 was associated with the NIHSS scores of ischemic stroke patients in codominant (p=0.019), dominant (p=0.007), overdominant (p=0.033), and log-additive (p=0.0048) models. Also, rs2682826 revealed a significant association in the recessive model (p=0.034). In allele frequency analysis, we also found that the T alleles of rs2293054 were associated with lower NIHSS scores (p=0.007). Respectively, rs2293054 had a significant association in the MBI scores of ischemic stroke in codominant (p=0.038), dominant (p=0.031), overdominant (p=0.045), and log-additive (p=0.04) models. CONCLUSION: These results suggest that NOS1 may be related to the clinical phenotypes of ischemic stroke in Korean population.

Transcriptional mutagenesis by 8-oxodG in alpha-synuclein aggregation and the pathogenesis of Parkinson's disease

Parkinson's disease (PD) is an age-related progressive neurodegenerative disease associated with selective loss of dopaminergic neurons. The characteristic hallmark of the disease is intracytoplasmic proteinacious inclusion bodies called Lewy bodies, primarily consisting of a presynaptic protein alpha-synuclein. Oxidative stress-mediated damage to macromolecules have been shown to occur frequently in PD. Oxidative damage to DNA in the form of oxidized guanine (8-oxodG) accumulates in both the mitochondrial and nuclear DNA of dopaminergic neurons of the substantia nigra in PD. 8-oxodG-mediated transcriptional mutagenesis has been shown to have the potential to alter phenotype of cells through production of mutant pool of proteins. This review comprehensively summarizes the role of oxidative stress-mediated damage incurred during neurodegeneration, and highlights the scope of transcriptional mutagenesis event in leading to alpha-synuclein aggregation as seen in PD.

Considerations for Possibility of Anti-convulsants in Prehospital Stage

PURPOSE: The aim of this study was to evaluate the reliability of the chief complaint addressing seizure in 119 run-sheets and to estimate the frequency of recommended administration of prehospital anti-convulsants. METHODS: A retrospective medical review of the period from 1 January, 2007 to 1 December, 2012 at one university hospital was conducted. Patients who were transported by 119 ambulance and whose chief complaint addressing seizure were enrolled. Medical records were independently reviewed by two emergency physicians. The reliability was analyzed according to the level of prehospital providers. prehospital providers. The operational definition of prehospital status epilepticus was cases with prolonged (lasting five minutes or more) or repetitive generalized convulsive seizures and seizure witnessed by 119 providers or persistent seizure at the time of arrival at the hospital. RESULTS: Among 239 medical records, 188(78.7%) cases with seizure were identified. The reliability was increased when level I emergency medical technicians were staffed(90.6% vs 74.3%). Psychiatric disorders(4.6%) and hyperventilation syndrome(3.8%) were frequently confused with seizure. Prehospital anti-convulsants were recommended in 15 cases(6.3%). CONCLUSION: Chief complaints addressing seizure by 119 prehospital providers were reliable. Not only rarity of prehospital status epilepticus but also other medical and legal barriers should be considered in regard to the possibility of prehospital anti-convulsant administration.

Considerations for Possibility of Anti-convulsants in Prehospital Stage

PURPOSE: The aim of this study was to evaluate the reliability of the chief complaint addressing seizure in 119 run-sheets and to estimate the frequency of recommended administration of prehospital anti-convulsants. METHODS: A retrospective medical review of the period from 1 January, 2007 to 1 December, 2012 at one university hospital was conducted. Patients who were transported by 119 ambulance and whose chief complaint addressing seizure were enrolled. Medical records were independently reviewed by two emergency physicians. The reliability was analyzed according to the level of prehospital providers. prehospital providers. The operational definition of prehospital status epilepticus was cases with prolonged (lasting five minutes or more) or repetitive generalized convulsive seizures and seizure witnessed by 119 providers or persistent seizure at the time of arrival at the hospital. RESULTS: Among 239 medical records, 188(78.7%) cases with seizure were identified. The reliability was increased when level I emergency medical technicians were staffed(90.6% vs 74.3%). Psychiatric disorders(4.6%) and hyperventilation syndrome(3.8%) were frequently confused with seizure. Prehospital anti-convulsants were recommended in 15 cases(6.3%). CONCLUSION: Chief complaints addressing seizure by 119 prehospital providers were reliable. Not only rarity of prehospital status epilepticus but also other medical and legal barriers should be considered in regard to the possibility of prehospital anti-convulsant administration.

Three Cases with Manic Symptoms and Cognitive Dysfunction after Wild Plant Ingestion

Distinguishing wild plants in spring from ingestible plants is difficult. Differentiation of budding plants from other plants is particularly difficult. Many people want to find edible plants for health during the spring season. Scopolia japonica can cause symptoms of mania. The author experienced three cases of poisoning by Scopolia japonica. We reported on the cases with literature reviews.

Four Cases of Phytolacca Esculenta Van Houtte Intoxication due to Misidentification as a Ginseng

Poisoning by Phytolacca esculenta commonly occurs by misidentification as other edible plants. The root of Phytolacca esculenta is similar to other roots, such as kudzu, balloon flower, codonopsis lanceolata, and ginseng. The author experienced four cases of Phytolacca esculenta intoxication due to misidentification as a ginseng. We report on these cases with a review of the literature.

Botulinum Toxin Type A for Facial Wrinkles and Benign Masseter Hypertrophy in Korean Patients / 대한피부과학회지

BACKGROUND: The utilization of botulinum toxin has rapidly expanded into various aesthetic applications. Achieving success with the aesthetic use of neurotoxins depends on several factors, including an understanding of the anatomy, the methods of dilution and the injection technique. Any guidelines representing a consensus for aesthetic treatments using botulinum toxin type A (BTA) have not been published in Korea. OBJECTIVE: We wanted to provide consensus recommendations on the treatment of facial wrinkles and benign masseter hypertrophy using BTA in Korean patients. METHODS: A panel of experienced Korean dermatologists was convened to develop a clinical consensus. The clinical consensus was comprised of the recommendations of the panel and the guidelines on general issues, such as the reconstitution and handling of the BTA, the procedural considerations, the dosing and injection-site standardizations, and the prevention and treatment of unwanted effects. Specific recommendations were provided according to the area of treatment, including glabellar lines, horizontal forehead lines, lateral periorbital wrinkles and benign masseter hypertrophy. RESULTS: The recommended final concentration of BTA was 50 units/ml (5 units/0.1 ml) after reconstitution with physiologic saline. For glabellar lines, the members recommend three injection points (a total of 8 units). For forehead wrinkles, the members recommend nine injections in two rows into the frontalis with 1 unit/point. For crow's feet, the members recommend three injections per side (7 units/side) at the lateral part of the orbicularis oculi. For benign masseter hypertrophy, three injections per side (24~30 units/side) were recommended. CONCLUSION: These consensus recommendations will provide a framework for Korean dermatologists who wish to perform safe and efficacious injection of BTA for facial rejuvenation.

Celastrol inhibits production of nitric oxideandproinflammatory cytokines through MAPK signal transduction and NF-kappaB in LPS-stimulated BV-2 microglial cells

Excessive production of nitric oxide (NO) and proinflammatory cytokines from activated microglia play an important role in human neurodegenerative disorders. Here, we investigated whether celastrol, which has been used as a potent anti-inflammatory and anti-oxidative agent in Chinese medicine, attenuates excessive production of NO and proinflammatory cytokines such as TNF-alpha and IL-1beta in LPS-stimulated BV-2 cells, a mouse microglial cell line. We report here that the LPS-elicited excessive production of NO, TNF-alpha, and IL-1beta in BV-2 cells was largely inhibited in the presence of celastrol, and the attenuation of inducible iNOS and these cytokines resulted from the reduced expression of mRNAs of iNOS and these cytokines, respectively. The molecular mechanisms that underlie celastrol-mediated attenuation were the inhibition of LPS-induced phosphorylation of MAPK/ERK1/2 and the DNA binding activity of NF-kappaB in BV-2 cells. The results indicate that celastrol effectively attenuated NO and proinflammatory cytokine production via the inhibition of ERK1/2 phosphorylation and NF-kappaB activation in LPS-activated microglia. Thus, celastrol may be an effective therapeutic candidate for use in the treatment of neurodegenerative human brain disorders.

The Effect and Appropriateness of CPR Training in Elementary School Children

PURPOSE: We undertook this study to evaluate the effects and the appropriateness of CPR training for elementary school children. METHODS: The Kangwon National University developed a "Human Body Explorer Program", where local fifth and sixth grade students would learn about the human body. The 72 students who participated in this program were used in this study. The subjects were evaluated by comparing CPR data collected from nurses working at Kangwon National University Hospital. The education sessions consisted of a 30 minute video tape and slides; then, under the supervision of their teacher, the subjects were asked to practice what they had seen. Ten criteria were used to evaluate the subject's CPR proficiency. The CPR skill sessions used Laerdal's HeartSim(R) 4000, and the data stored from the HeartSim(R) 4000 were collected for further analysis. A statistical analysis was done using the SPSS statistical software package. A pvalue< 0.05 was considered to statistically significant. RESULTS: A total of 72 subjects were evaluated. Their average age was 13.2+/-0.5 years. The subjects had very little experience with CPR education(0.17) prior to this study. The data gathered were compared to the evaluation table and yielded an average score of 20.53. The criteria used in the study had the following results: The assessing responsiveness(2.0/2.0), activating the EMS (calling for help) (1.99/2.0), checking for breathing(3.47/4.0), and compression to ventilation ratio of 15:2(1.6/2.0) showed to be at the 80 percentile. However the follow criteria showed a less than 80 percentile: opening the airway(1.54/2.0), mouth-to-mouth breathing(2.04/4.0), checking the carotid pulse(2.0/4.0), chest compression(1.88/4.0), chest compression velocity(1.02/4.0), and reassessment(1.44/2.0). The data from the manikin was extrapolated, and upon examination, we found the following: Correct ventilation was 25+/-31%, insufficient ventilation was 67+/-38% and excessive ventilation was 3+/-10%. Correct chest compression was 9+/-23% and insufficient compression was 91+/-23%, and excessive compression was absent. We compared these scores to the score from nurses of Kangwon University Hospital and found that elementary school children scored higher in all variables except in rate of chest compression. The scores were statistically significant (p<0.05) in total score, check for breathing, and reassessment. The skills evaluation showed that the adults scored higher than the elementary school children. All variables were significant (p<0.05). CONCLUSION: We found that elementary school children were superior to adult counterparts in understanding the CPR scheme. An expansion of CPR training to elementary school children is needed.

Microglia, major player in the brain inflammation: their roles in the pathogenesis of Parkinson's disease

Inflammation, a self-defensive reaction against various pathogenic stimuli, may become harmful self-damaging process. Increasing evidence has linked chronic inflammation to a number of neurodegenerative disorders including Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis. In the central nervous system, microglia, the resident innate immune cells play major role in the inflammatory process. Although they form the first line of defense for the neural parenchyma, uncontrolled activation of microglia may directly toxic to neurons by releasing various substances such as inflammatory cytokines (IL-1beta, TNF-alpha, IL-6), NO, PGE

A Study of the Investigative Method of Cause of Death for Making out a Death Certificate

PURPOSE: We address investigative or analytical methods to report death in drawing up a death certificate. METHOD: This study was based on the death certificates completed at the emergency department, Kangwon University hospital, from September 2003 to August 2005. The data were collected through notices about drawing up death certificates and included the death certificate and the medical records in the emergency department. RESULTS: The research subjects were 29,059 patients who came to the emergency room during the period of study. Death certificates or medical certificates of death were issued to 793 of these. As to the place of death, 537 (72.5%) deaths occurred at home, 1 (0.1%) in medical institutions, 12 (1.6%) in public institutions, 48 (6.5%) patients was dead on arrival, 2 (0.3%) at industrial factories, 20 (2.7%) on road, 120 (16.2%) at other places and 1 (0.13%) was not defined. As to the types of death, death from disease was the highest (445, 60.1%), and death from external causes was next (168, 22.7%), followed by death from other or unknown causes (128, 17.3%). For death from external causes, traffic accident was 24 (14.1%), poisoning was 13 (7.6%), accidental fall was 18 (10.6%), accidental drowning was 27, 15.9%), suicide was (64, 37.6%), murder was 1 (0.6%), and other was 23 (13.5%). The study on the cause of death, 92 (16.4%) of 562 patients was found to have been helped in diagnosing the cause of death. However, in the case of death from external causes, except for death from disease, 109 patients were surveyed, the study helped to identify the cause of death in only 46 (42.2%). Likewise, in 14 (60.7%) of 23 patients the study helped to identify the cause of death as sudden death. CONCLUSION: Simple X-rays and laboratory examinations were used to determine the cause of death when drawing up a death certificate, and these helped more in identifying the causes of death from external causes than in identifying the causes of death from diseases. Especially, these worked much better for sudden death.

A Study on the Minimal Phototoxic Dose (MPD) / 대한피부과학회지

In order to measure the MPD with 8-methoxypsoralen, we selected 49 Korean healthy male vlunteers without phototoxic or photosensitive dermatoses. They were divided to 3 groups (Immediate; group 1, 1 hour; group 2, 2 hours', group 3) according to the waiting time, intervals of application of photosensitizer a,nd UVA:irradiation. The reaults were summarized as follows: 1. MPDs of group 1 had no clinical significance. 2, MPDs of group 2 were more than those of group '3 independently of application methods of photosensitizer. 3. In the cases of topical application of 8-MOP, MPDs of group 3 according to reading interval (24 hours, 48 hours and 72 hours after UVA irradiation) were 3.4+/-2.9 J/cm2, 1.9+/-l.5 J/cm' and l. 7+1, 2/cm, respectively. 4 In the cases of oral administration of 8-MOP, MPDs of group 3 according to reading; interval as topical application of 8-MOP were 7.1+/-2.3 J/cm, 4.4+/-1.1 J/ cm2 and 4.2+/-l.2 J/cm2, respectively. 5 MPL)s accarding to the skin types as follows; (waiting time; 2 hours, read- ing interval; 48 hours) a. In the case of topical application of 8-MOP, MPDs of the skin type ]II, 1V and V were 0.9+/-0.5 J/cm2, 1.8+/-1.1 J/cm2 and 3.0+/-l.3 J/cm2 respectively. b. In the case of oral administration of 8-MOP, MPDs of skin type g, W and were 3.5+/-1.1 J/cm2, 4.7+/-1.3 J/cm2 and 6.9+/-l.8 J/cm2, respectively.

A Case of Pityriasis Lichenoides et Varioliformis Acuta Treated with Photochemotherapy / 대한피부과학회지

A lg year-old female patient with pityriasis lichenoides et varioliforrnis acuta (PLEVA) was been treated with PUVA, At first, she was treated with tetracycline for 8 weeks with improvement somewhat. But 2 months later, her skin lesions aggravated slowly. So, we tried to treated her with PUVA and then she was cleared completely. The initial dose of UVA was 5 J/cm The UVA dosage increased by 10g of the previous exposure and increased to the maximum dose, 15 J/cm The patient exposed to UVA R times per week. 12 times after the PUVA therapy, the skin lesions begin to improve and completely improved at 21 times of Pl.JVA therapy. She was followed up every week and there was no side effect except hyperpigrnentation till 24 months. The total dose during treatment is 210 J/cm.