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Successful Motor Evoked Potential Monitoring in Cervical Myelopathy : Related Factors and the Effect of Increased Stimulation Intensity

  • Shim, Hyok Ki;Lee, Jae Meen;Kim, Dong Hwan;Nam, Kyoung Hyup;Choi, Byung Kwan;Han, In Ho
    • Journal of Korean Neurosurgical Society
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    • v.64 no.1
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    • pp.78-87
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    • 2021
  • Objective : Intraoperative neurophysiological monitoring (IONM) has been widely used during spine surgery to reduce or prevent neurologic deficits, however, its application to the surgical management for cervical myelopathy remains controversial. This study aimed to assess the success rate of IONM in patients with cervical myelopathy and to investigate the factors associated with successful baseline monitoring and the effect of increasing the stimulation intensity by focusing on motor evoked potentials (MEPs). Methods : The data of 88 patients who underwent surgery for cervical myelopathy with IONM between January 2016 and June 2018 were retrospectively reviewed. The success rate of baseline MEP monitoring at the initial stimulation of 400 V was investigated. In unmonitorable cases, the stimulation intensity was increased to 999 V, and the success rate final MEP monitoring was reinvestigated. In addition, factors related to the success rate of baseline MEP monitoring were investigated using independent t-test, Wilcoxon rank-sum test, chi-squared test, and Fisher's exact probability test for statistical analysis. The factors included age, sex, body mass index, diabetes mellitus, smoking history, symptom duration, Torg-Pavlov ratio, space available for the cord (SAC), cord compression ratio (CCR), intramedullary increased signal intensity (SI) on magnetic resonance imaging, SI length, SI ratio, the Medical Research Council (MRC) grade, the preoperative modified Nurick grade and Japanese Orthopedic Association (JOA) score. Results : The overall success rate for reliable MEP response was 52.3% after increasing the stimulation intensity. No complications were observed to be associated with increased intensity. The factors related to the success rate of final MEP monitoring were found to be SAC (p<0.001), CCR (p<0.001), MRC grade (p<0.001), preoperative modified Nurick grade (p<0.001), and JOA score (p<0.001). The cut-off score for successful MEP monitoring was 5.67 mm for SAC, 47.33% for the CCR, 3 points for MRC grade, 2 points for the modified Nurick grade, and 12 points for the JOA score. Conclusion : Increasing the stimulation intensity could significantly improve the success rate of baseline MEP monitoring for unmonitorable cases at the initial stimulation in cervical myelopathy. In particular, the SAC, CCR, MRC grade, preoperative Nurick grade and JOA score may be considered as the more important related factors associated with the success rate of MEP monitoring. Therefore, the degree of preoperative neurological functional deficits and the presence of spinal cord compression on imaging could be used as new detailed criteria for the application of IONM in patients with cervical myelopathy.

Influencing the Factors on Obesity in Upper-Grade Elementary School Children (초등학교 고학년 아동의 비만 영향 요인)

  • Jang, Ji Hye;Kwon, Myung Soon
    • Journal of Korean Public Health Nursing
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    • v.31 no.1
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    • pp.162-177
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    • 2017
  • Purpose: The purpose of this study was to investigate the degree of obesity and dietary self-efficacy scale and to identify factors that affect obesity in upper-grade elementary school students. Methods: A total of 458 fifth to sixth grade elementary school students in Seoul and Chuncheon city, and rural areas of Gangwon Province, were included in this study. The data was analyzed by descriptive statistics, ${\chi}^2$-test, t-test, ANOVA, and logistic regression. Results: The results revealed significant differences in the obesity region, perceived body image, experience of weight loss, family member of mother's age, mother's job and father's job between 'not obesity group' and 'obesity group'. The logistic regression analysis revealed that obesity was related with gender, region, and perceived body image. Conclusion: Gender, region, and perceived body image showed a relationship with obesity in upper-grade elementary school students. Thus, to develop obesity management program for upper grade elementary school students, we should be considered the gender, region, and perceived body image should be considered.

The Dyeing Properties and Antibacterial Activity of Fabrics Dyed with Camomile Extract (캐모마일 추출액 염색직물의 염색성 및 항균성)

  • Park Young-Hee
    • Journal of the Korean Society of Clothing and Textiles
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    • v.29 no.8 s.145
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    • pp.1188-1195
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    • 2005
  • The effects on the dyeing properties and antibacterial activity of fabrics dyed with camomile extract were analyzed. As the results obtained, the surface color of all the dyed fabric was tinged with the yellow of the bright color tone. In the test results of durability, the durability to sunlight of the dyed fabric of both cotton and silk showed from 2nd grade to 3rd grade. The durability to laundry of the dyed fabric of both cotton and silk showed relatively higher grade of 4th-5th. The durability to synthetic sweat of all the fabrics except fer the dyed fabric mordanted with $CuSO_4{\cdot}5H_2O$ showed the relatively good result of 3rd- 5th grade. The durability to friction and dry cleaning of all the dyed fabrics showed the excellent result of 4th-5th grade. In the test results of antibiosis, the dyed fabric of cotton showed the decrease rate of $50\%$ to Staphylococcus aureus and the decrease rate of $70\%$ to Klebsiella pneumoniae. The dyed fabric of silk showed the significant effect with Microscopic growth to the mold bacillus Aspergillus niger.

A Study on the Relationship between Self-Esteem and Meaning of Life in Higher Grade Elementary School Students (초등학교 고학년 학생의 자아존중감과 삶의 의미)

  • Kang, Kyung-Ah;Kim, Shin-Jeong;Song, Mi-Kyung
    • Research in Community and Public Health Nursing
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    • v.20 no.3
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    • pp.269-276
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    • 2009
  • Purpose: The purpose of this study was to identify the relationship between self-esteem and meaning of life in higher grade elementary school students. Methods: Four hundred eighty four elementary school students in their $4{\sim}6th$-grade at S, G and C City were recruited by convenient sampling. Data were collected from August to October, 2008 using a self-reported questionnaire. The collected data were analyzed by the SPSS/WIN 12.0 program with mean, standard deviation, t-test, ANOVA, Duncan's test, and Pearson's correlation. Results: The average score of meaning of life was $3.07{\pm}0.38$ and that of self-esteem was $3.43{\pm}0.62$. There were significant differences in self-esteem according to variables region and religion, and in meaning of life scores according to variables region, grade, sex and religion. There was a significant positive correlation between self-esteem and meaning of life. Conclusion: Self-esteem and meaning of life should be considered as important factors for healthy development in the elementary school period. Self-esteem should be considered as a main content in developing programs for finding meaning of life for higher grade elementary school students.

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Human Telomerase Gene and High-Risk Human Papillomavirus Infection are Related to Cervical Intraepithelial Neoplasia

  • Zhao, Xu-Ye;Cui, Yongm;Jiang, Shu-Fang;Liu, Ke-Jun;Han, Hai-Qiong;Liu, Xiao-Su;Li, Yali
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.2
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    • pp.693-697
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    • 2015
  • Our aims were to evaluate the clinical performance of human telomerase RNA gene component (hTERC gene) amplification assay with high-risk human papillomavirus (HR-HPV) DNA test of Hybrid Capture 2 DNA test (HC2), for the detection of high grade cervical precancerous lesions and cancer (CIN 2+). In addition, the association shown between hTERC gene amplification and HPV DNA test positive in women with and without cervical neoplasia was assessed. There were 92 women who underwent cytology, HR-HPV DNA test, hTERC gene amplification test, colposcopy and biopsy. We compared the clinical performance of hTERC gene test along with HR-HPV DNA test of women with colposcopy and routine screening. The samples were histology-confirmed high-grade cervical intraepithelial neoplasia (CIN 2) or worse (CIN2+) as the positive criterion. The test of hTERC gene showed the hTERC gene amplification positivity increased with the severity of histological abnormality and cytological abnormality. The test of hTERC gene showed higher specificity than HR-HPV DNA test for high-grade lesions (84.4% versus 50%) and also higher positive predictive value (90.4% versus 76.5%). Our results predicted that hTERC gene amplification demonstrated more specific performance for predicting the risk of progression and offer a strong potential as a tool for triage in cervical cancer screening, with the limited sensitive as HR-HPV DNA test.

Human Papillomavirus Testing with Hybrid Capture II and DNA Chip

  • Im Jee-Aee;Shim Moon-Jung;Ryang Yong-Suk;Lee Duk-Chul
    • Biomedical Science Letters
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    • v.11 no.1
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    • pp.51-56
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    • 2005
  • The detection of high-risk human papilloma virus (HPV) allows us to predict the presence and future development of cervical intraepitheliallesion. In this study, we compared Hybrid Capture II and DNA chip methods for detection of HPV in cervical swab samples. And we evaluated the clinical efficacy and diagnostic performance of HPV DNA chip and Hybrid Capture II for detecting HPV in cervical neoplastic lesions. Seventy four patients were classified into three groups according to their histologic diagnosis: Group I (nonspecific chronic cervicitis), Group II (low-grade squamous intraepithelial lesion (SIL); koilocytosis, and mild dysplasia), and Group III (high-grade SIL;, moderate, severe dysplasia and in situ carcinoma). Cytologic diagnosis were based on the Bethesda System. Hybrid Capture II and DNA chip methods were performed to detect HPV. In 41 of the 74 cervical samples $(55.4\%)$, HPV DNAs were detected by Hybrid Capture II. In Group III, HPV-positive cases were detected in 15 $(20.3\%)$ of 74 patients by Hybrid Capture II. 25 patients with ASCUS cytology were histopathologically examined: 9 cases $(36\%)$ were Group II. In 18 patients with low-grade SIL cytology, 13 cases $(72.2\%)$ were Group II and 3 cases $(16.7\%)$ were Group III. 12 cases $(92.3\%)$ were Group ill of 13 patients with high-grade SIL cytology. The sensitivity of each test was $82\%$ in Hybrid Capture II and $53.9\%$ in DNA chip test. And the specificity was $74.3\%,\;85.7\%$ in Hybrid Capture II and DNA chip. In conclusion, Hybrid Capture II test is more sensitive than DNA chip in detecting women with cervical neoplastic lesions. Especially, in diagnosing of ASCUS, Hybrid Capture II test is more sensitive. Therefore, Hybrid Capture II test for cancer-associated HPV DNA is a viable option in the management of women with ASCUS.

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Reconstruction of Posterior Cruciate Ligament and Posterolateral Structure with Allo-Achilles Tendon (동종 아킬레스 건을 이용한 후방 십자 인대 및 후 외방 구조물 재건술)

  • Oh, In-Suk;Lee, Dong-Joo;Cho, Kyu-Jung;Kim, Myung-Ku
    • Journal of the Korean Arthroscopy Society
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    • v.9 no.2
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    • pp.162-166
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    • 2005
  • Purpose: The purpose of this study were to evaluate the results of arthroscopic PCL reconstruction and posterolateral structure reconstruction. Materials and Methods: We performed 10 cases of arthrocopic PCL and posterolateral structure reconstruction using allo-achilles tendon. The average follow-up period was 25 months. We performed KT-2000 testing and posterior drawer test for posterior instability and tibial external rotation test for posterolateral rotatory instability, and measure Tegner and Lysholm score preoperatively and compared these with the results of a final evaluation in each cases. Results: The Preoperative average KT-2000 tests was 7.1 mm, posterior drawer test was Grade III and tibial external rotation test was positive at both 30 and 90 degrees of knee flexion in all cases. Preoperative average Lysholm score was 65.9 and Tegner score was 3.1. At the final evaluation, an average KT-2000 test was 2.2 mm, posteior drawer test, Grade 0 was 2 cases, Grade 1.4 cases, Grade II, 3 cases, Grade III, 1 cases. The tibial external rotation test at both 30 and 90 degrees of knee flexion was positive in 1 cases and positive at only 90 degrees in 2 cases. Lysholm score was 87.6 and Tegner score was 5.7. The objective and subjective score of final evaluation is increased in compare with preoperative one. Conclusion: Arthrocopic PCL and posterolateral structure reconstruction using allo-achilles tendon is one of the good surgical treatment method in patients having posterior and posterolateral rotatory instability.

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Effect of Electromagnetic Navigated Ventriculoperitoneal Shunt Placement on Failure Rates

  • Jung, Nayoung;Kim, Dongwon
    • Journal of Korean Neurosurgical Society
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    • v.53 no.3
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    • pp.150-154
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    • 2013
  • Objective : To evaluate the effect of electromagnetic (EM) navigation system on ventriculoperitoneal (VP) shunt failure rate through comparing the result of standard shunt placement. Methods : All patients undergoing VP shunt from October 2007 to September 2010 were included in this retrospective study. The first group received shunt surgery using EM navigation. The second group had catheters inserted using manual method with anatomical landmark. The relationship between proximal catheter position and shunt revision rate was evaluated using postoperative computed tomography by a 3-point scale. 1) Grade I; optimal position free-floating in cerebrospinal fluid, 2) Grade II; touching choroid or ventricular wall, 3) Grade III; tip within parenchyma. Results : A total of 72 patients were participated, 27 with EM navigated shunts and 45 with standard shunts. Grade I was found in 25 patients from group 1 and 32 patients from group 2. Only 2 patients without use of navigation belonged to grade III. Proximal obstruction took place 7% in grade I, 15% in grade II and 100% in grade III. Shunt revision occurred in 11% of group 1 and 31% of group 2. Compared in terms of proximal catheter position, there was growing trend of revision rate according to increase of grade on each group. Although infection rate was similar between both groups, the result had no statistical meaning (p=0.905, chi-square test). Conclusion : The use of EM navigation in routine shunt surgery can eliminate poor shunt placement resulting in a dramatic reduction in failure rates.

The Effects of Development and Application of Environment Education Program by Using Places around School on the Environment-Friendly Attitudes (학교 주변 장소를 활용한 환경교육 프로그램의 개발과 적용이 환경친화적 태도에 미치는 효과)

  • Lee, Yong-Seob
    • Hwankyungkyoyuk
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    • v.20 no.4
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    • pp.166-179
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    • 2007
  • The purpose of this study is to find a concrete plan by examining effect of environmental education program on Environment-friendly Attitudes in sixth grade elementary school and to testify the educational values of environmental education program. The study was carried out by 32 students, which was experimental group and by 32 students, control group, in the sixth grade of Y elementary school located in yangjung, Busan city. Both group was found out the same quality group through the pre-test. Environmental class using environmental education program was applied to experimental group and traditional lecture class was applied to control group. After executing post-test to each group, comparative analysis was conducted by t-test using a SPSS 12.0 program. The result of post-test showed that experimental group taken environmental class using environmental education program was more statistically meaningful than control group taken traditional lecture class in the cognitive, emotional, behavioral area. As a result, in sixth grade elementary school environmental class using a environmental education program was more effective in knowledge-acquirement about the overall environ mental programs, and in fostering Environment-friendly Attitudes and behaviors than traditional lecture class. The teacher must develop efficient environment education program in such side.

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The Effect of Career Search Programs on Career Search Efficacy, Career Search Behavior and Career Decision Making in Nursing Students (진로탐색 프로그램이 간호대학생의 진로탐색효능감과 진로탐색행동 및 진로결정수준에 미치는 효과)

  • Moon, Inn Oh;Kim, Hee Sun
    • The Journal of Korean Academic Society of Nursing Education
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    • v.18 no.3
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    • pp.393-402
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    • 2012
  • Purpose: This study was conducted to test the effect of a Career Search Program on career search efficacy, career search behavior, and career decision making for nursing students. Methods: A non-equivalent pre-post test of a quasi-experimental design was used. Fifty first grade nursing students participated in the study with 22 in the experimental group and 28 in the control group. We used a Career Search Program which was held 6 times over 6 weeks, 90 minutes per session. Descriptive statistics, ${\chi}^2$-test, and independent t-test were used for statistical analysis with SPSS 19.0. Results: There were significant increases in career search efficacy (t=2.07, p=.044) and career search behavior(t=2.65, p=.011) in the experimental group compared to the control group. However, career decision making was not significantly changed (t=0.96, p=.342). Conclusion: These results suggest that a Career grade Search Program has an effect on increasing career search efficacy and career search behavior in first grade nursing students. In addition, more programs to impact career decision making should be developed for nursing college students.