A Clinical Observation of Delayed Neurologic Deterioration Following Carbon Monoxide Poisoning

Some patients with anoxic exposure develop new neurologic deficits after periods of delay when they recover from the initial anoxia. This Delayed Neurologic Deterioration(DND) is most commonly seen following carbon monoxidelf'O) poisoning. This study was done to further describe the clinical features of this interesting but rare entity. We reviewed the records and brain scans of 37 patients who were admitted to Seoul National University Hospital because of DND following CO poisoning during the period January 1980 to December 1986. On reviewing the data, we were able to see certain patterns. Age may be important in the development of DND. Most patients were in their 40's to 60's. Patients with severe CO poisoning may be at higher risk of developing DND. However many patients with DND had brief periods of unconsciousness during acute poisoning. The lucid interval was usually 1-4 weeks. Long lucid interval may predict good prognosis. Global encephalopathy was the most common. Post-CO Parkinsonism was diagnosed in 5. Parkinsonism was part of global encephalopathy. They improved with L-dopa better than with anticholinergics. Low density in the globus pallidus may not be associated with Parkinsonism. Diffuse brain atrophy was the most common radiological finding

Does Objective Structured Clinical Examinations Score Reflect the Clinical Reasoning Ability of Medical Students?

Abstract:BackgroundClinical reasoning ability is an important factor in a physician's competence and thus should be taught and tested in medical schools. Medical schools generally use objective structured clinical examinations (OSCE) to measure the clinical competency of medical students. However, it is unknown whether OSCE can also evaluate clinical reasoning ability. In this study, the authors investigated whether OSCE scores reflected students' clinical reasoning abilities.MethodsSixty-five fourth-year medical students participated in this study. Medical students completed the OSCE with 4 cases using standardized patients. For assessment of clinical reasoning, students were asked to list differential diagnoses and the findings that were compatible or not compatible with each diagnosis. The OSCE score (score of patient encounter), diagnostic accuracy score, clinical reasoning score, clinical knowledge score and grade point average (GPA) were obtained for each student, and correlation analysis was performed.ResultsClinical reasoning score was significantly correlated with diagnostic accuracy and GPA (correlation coefficient = 0.258 and 0.380; P = 0.038 and 0.002, respectively) but not with OSCE score or clinical knowledge score (correlation coefficient = 0.137 and 0.242; P = 0.276 and 0.052, respectively). Total OSCE score was not significantly correlated with clinical knowledge test score, clinical reasoning score, diagnostic accuracy score or GPA.ConclusionsOSCE score from patient encounters did not reflect the clinical reasoning abilities of the medical students in this study. The evaluation of medical students' clinical reasoning abilities through OSCE should be strengthened

QUANTIFICATION OF THE DYNAMIC GLENOHUMERAL STABILITY PROVIDED BY THE ROTATOR CUFF MUSCLES IN THE LATE COCKING PHASE OF THROWING

The purpose of this study was to investigate quantitatively the dynamic glenohumeral stability provided by the rotator cuff muscles in the late-cocking phase of throwing. Using ten cadaveric shoulders, a new biomechanical parameter (dynamic stability index) was calculated considering compressive and shear forces to the glenoid provided by each cuff muscle. The rotator cuff muscles provided the joint with significant dynamic stability in the late cocking. However, the dynamic stability provided by the cuff muscles with the arm in coronal plane significantly decreased when compared with that in the scapular plane. Rehabilitation of the throwing athletes should emphasize strengthening of the external and internal rotators. Moving the arm into the coronal plane in the late cocking phase should be avoided by a specific strengthening program to prevent further anatomic damage to the static stabilizers

Suppression of STAT3 and HIF-1 Alpha Mediates Anti-Angiogenic Activity of Betulinic Acid in Hypoxic PC-3 Prostate Cancer Cells

Background: Signal transducer and activator of transcription 3 (STAT3) is a transcription factor that regulates various cellular processes such as cell survival, angiogenesis and proliferation. In the present study, we examined that betulinic acid (BA), a triterpene from the bark of white birch, had the inhibitory effects on hypoxia-mediated activation of STAT3 in androgen independent human prostate cancer PC-3 cells. Methodology/Principal Findings: BA inhibited the protein expression and the transcriptional activities of hypoxia-inducible factor-1a (HIF-1a) under hypoxic condition. Consistently, BA blocked hypoxia-induced phosphorylation, DNA binding activity and nuclear accumulation of STAT3. In addition, BA significantly reduced cellular and secreted levels of vascular endothelial growth factor (VEGF), a critical angiogenic factor and a target gene of STAT3 induced under hypoxia. Furthermore, BA prevented in vitro capillary tube formation in human umbilical vein endothelial cells (HUVECs) maintained in conditioned medium of hypoxic PC-3 cells, implying anti-angiogenic activity of BA under hypoxic condition. Of note, chromatin immunoprecipitation (ChiP) assay revealed that BA inhibited binding of HIF-1a and STAT3 to VEGF promoter. Furthermore, silencing STAT3 using siRNA transfection effectively enhanced the reduced VEGF production induced by BA treatment under hypoxia. Conclusions/Significance: Taken together, our results suggest that BA has anti-angiogenic activity by disturbing th

Fully integrated lab-on-a-disc for simultaneous analysis of biochemistry and immunoassay from whole blood

We report a fully integrated device that can perform both multiple biochemical analysis and sandwich type immunoassay simultaneously on a disc. The whole blood is applied directly to the disposable "lab-on-a-disc" containing different kinds of freeze-dried reagents for the blood chemistry analysis as well as reagents required for the immunoassay. The concentrations of different kinds of analytes are reported within 22 min by simply inserting a disc to a portable device. Using the innovative laser irradiated ferrowax microvalves together with the centrifugal microfluidics, the total process of plasma separation, metering, mixing, incubation, washing, and detection is fully automated. The analyzer is equipped with an optical detection module to measure absorbances at 10 different wavelengths to accommodate the various kinds of reaction protocols. Compared to the conventional blood analysis done in clinical laboratories, it is advantageous for point-of-care applications because it requires a smaller amount of blood (350 mu L vs. 3 mL), takes less time (22 min vs. several days), does not require specially trained operators or expensive instruments to run biochemical analysis and immunoassay separately.close554