Coronary artery aneurysms are uncommon, are usually associated with atherosclerosis, and rarely involve all three major coronary arteries. The present report describes a rare case of a young female patient presenting with acute myocardial infarction (AMI). Coronary angiography revealed multiple severe aneurysmal and stenotic changes. Based on clinical feature and angiographic findings, it was strongly suspected that the patient had polyarteritis nodosa (PAN) complicated by AMI. The patient was treated with standard cardiac medications and immunosuppressive agents and has remained stable without further complications during a follow-up period of 6 months.
Extracorporeal membrane oxygenation (ECMO) is a useful treatment for refractory out-of-hospital cardiac arrest (OHCA). However, little is known about the predictors of survival and neurologic outcome after ECMO. We analyzed our institution's experience with ECMO for refractory OHCA and evaluated the predictors of survival and neurologic outcome after ECMO.This was a retrospective review of the medical records of 23 patients who were treated with ECMO due to OHCA that was unresponsive to conventional cardiopulmonary resuscitation, between January 2009 and January 2014.Our ECMO team was activated within 10 min for refractory OHCA, and the 30-day survival rate was 43.5 %. In a multivariate analysis that evaluated independent factors contributing to mortality, urine output ≤ 0.5 mL · kg(-1) · h(-1) (defined as oliguria) during the 24 h after ECMO was statistically significant (OR, 32.271; 95 % CI, 1.379-755.282; p = 0.031). Just after ECMO implantation, 6 of the 9 patients (66.7 %) who had normal findings on brain computed tomography (CT) survived with a cerebral performance category (CPC) of grade 1. However, only 3 of the 11 patients (27 %) who had evidence of hypoxic brain damage on initial brain CT survived (their CPC grade was 4).Based on our findings, the survival rate can be improved by rapid implantation of ECMO, and oliguria seen during the first 24 h after ECMO may be an independent predictor of mortality. Furthermore, findings on brain CT just after ECMO and subsequent images may represent an important predictor for neurologic outcome after ECMO.
This study aimed to identify the determinant factors for clinical outcomes and survival rates of patients with cardiac arrest (CA) concurrent with acute myocardial infarction (AMI) who underwent extracorporeal cardiopulmonary resuscitation (ECPR) using extracorporeal membrane oxygenation (ECMO).We retrospectively evaluated 37 patients admitted to our emergency department between January 2006 and August 2012 for AMI-induced CA treated with ECPR during ongoing continuous chest compressions.Mean patient age was 61.4 ± 11.3 years, and 27 patients (73%) were men. Mean CPR time was 50.8 ± 35.4 min. Door-to-ECMO and door-to-balloon times were 84.4 ± 55.3 and 98.4 ± 56.8 min, respectively. Mean ECMO time was 106.4 ± 84.7 h; nine (24%) patients died within 24 h after ECMO initiation. Twelve (32%) patients were weaned off ECMO, seven (19%) of whom survived >30 days after ECMO removal; all except one had Cerebral Performance Category Grade 1. Of the patients who survived, 5 of them were able to be discharged. In multivariate analysis, statistical significance was only observed in door-to-ECMO time ≤60 min (OR, 6.0; 95% CI, 1,177-852.025; p = 0.033).We conclude that ECMO insertion within 60 min of the arrival of patients with AMI and CA at the ED appears to be a good option for maintaining myocardial and systemic perfusion, thereby increasing the survival rate of these patients.
Exercise enhances memory function by increasing neurogenesis in the hippocampus, and circadian rhythms modulate synaptic plasticity in the hippocampus. The circadian rhythm-dependent effects of treadmill exercise on memory function in relation with neurogenesis were investigated using mice.The step-down avoidance test was used to evaluate short-term memory, the 8-arm maze test was used to test spatial learning ability, and 5-bromo-2'-deoxyuridine immunofluorescence was used to assess neurogenesis. Western blotting was also performed to assess levels of synaptic plasticity-associated proteins, such as brain-derived neurotrophic factor, tyrosine kinase receptor B, phosphorylated cAMP response element-binding protein, early growth response protein 1, postsynaptic density protein 95, and growth-associated protein 43. The mice in the treadmill exercise at zeitgeber 1 group started exercising 1 hour after sunrise, the mice in the treadmill exercise at zeitgeber 6 group started exercising 6 hours after sunrise, and the mice in the treadmill exercise at zeitgeber 13 group started exercising 1 hour after sunset. The mice in the exercise groups were forced to run on a motorized treadmill for 30 minutes once a day for 7 weeks.Treadmill exercise improved short-term memory and spatial learning ability, and increased hippocampal neurogenesis and the expression of synaptic plasticity-associated proteins. These effects of treadmill exercise were stronger in mice that exercised during the day or in the evening than in mice that exercised at dawn.Treadmill exercise improved memory function by increasing neurogenesis and the expression of synaptic plasticity-associated proteins. These results suggest that the memory-enhancing effect of treadmill exercise may depend on circadian rhythm changes.
본 연구의 목적은 재외동포 한국학교와 한글학교 학생들의 사회적 지지가 자기효능 감에 어떠한 영향을 미치는지를 알아보는 것이다. 이를 위해 L한글학교와 T한국학교의 3학년 학생 80여명의 자료를 활용하여 중다회귀분석 및 남녀 집단별 차이를 분석하였 다. 연구의 결과 첫째, 학생들이 지각한 교사 지지가 자기효능감에 영향을 주는 것으로 나타났다. 특히 교사가 학생들을 이해하고 공감하며 잘 가르치기 위해 노력하는 것이 학생의 자신감에 영향을 주는 것을 보여 주었다. 둘째, 또래 지지는 효능감 전체에는 통계적으로 유의미한 영향을 보이지 않았다. 셋째, 학생들의 사회적 지지와 자기효능 감 하위 요인 중 자신감의 차이가 성별에서 통계적으로 유의미한 것으로 나타났다. 재 외동포 한국학교와 한글학교 수업에서 학생 개인이 지각한 사회적 지지와 자기 효능감 의 관계가 유의미한 것이 검증되었다. 재외동포 한국학교와 한글학교가 전세계적으로 1700개가 넘고, 한국어와 한국사회의 이해, 역사 및 문화 수업이 활발하게 이루어지고 있는 만큼 수업의 효과와 관련된 구체적 연구들이 더욱 필요하다.
Lateral calcaneocuboid ligament injury and bifurcate ligament injuries are one of the most difficult injuries to diagnose. Frequently, this injuries are confused as lateral ankle ligament injuries. Underdiagnosed, these injuries can develop to chronic instability.
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