• Annals of Clinical Neurophysiology
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• 제3권2호
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• pp.156-159
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• 2001

Miller Fisher syndrome(MFS) has been the focus of conflicting opinions regarding the peripheral versus the central nature of the site of major neural injury. We present our electrophysiological findings in one case of MFS to help clarify the pattern of peripheral nerve injury in this syndrome. A 45-year-old man visited our hospital due to sudden diplopia. Initial examination revealed internuclear opthalmoplegia. The next day, his symptoms rapidly aggravated to complete external ophthalmoplegia, ataxia, and areflexia with hand and foot numbness. Serial electrophysiological studies were performed. The results of brainstem evoked potential(BAEP) and blink reflex were normal in the serial studies. Motor and sensory nerve conduction study(NCS) were normal findings in second hospital day, but ulnar sensory nerve shows no sensory nerve action potential(SNAP) and sural sensory conduction velocity was delayed in 7th hospital day. Our patient's clinical presentation began to improve on 15th hospital day, and his electrophysiologic study showed improvement on 29th hospital day. We believe that all the manifestations of MFS can be explained by the involvement of peripheral nerves without brainstem or cerebellar lesion with the serial electrophysiological studies.

• Archives of Plastic Surgery
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• 제49권3호
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• pp.440-443
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• 2022

Spinal accessory nerve (SAN) palsy is typically a result of posterior triangle surgery and can present with partial or complete paralysis of the trapezius muscle and severe shoulder dysfunction. We share an atypical case of a patient who presented with SAN palsy following an injury sustained playing competitive volleyball. A 19-year-old right hand dominant competitive volleyball player presented with right shoulder weakness, dyskinesia, and pain. She injured the right shoulder during a volleyball game 2 years prior when diving routinely for a ball. On physical examination she had weakness of shoulder shrug and a pronounced shift of the scapula when abducting or forward flexing her shoulder greater than 90 degrees. Manual stabilization of the scapula eliminated this shift, so we performed scapulopexy to stabilize the inferior angle of the scapula. At 6 months postoperative, she had full active range of motion of the shoulder. SAN palsy can occur following what would seem to be a routine volleyball maneuver. This could be due to a combination of muscle hypertrophy from intensive volleyball training and stretch sustained while diving for a ball. Despite delayed presentation and complete atrophy of the trapezius, a satisfactory outcome was achieved with scapulopexy.

• 한국임상수의학회지
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• 제39권6호
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• pp.373-377
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• 2022

Hypercoagulability is the most common coagulopathy seen in dogs with neoplasia, whereas a hypocoagulable state is relatively rare. A 16-year-old spayed female miniature Schnauzer presented with bilateral epistaxis, bilateral hindlimb swelling, and lameness. Previously, the dog was diagnosed with intermediate grade solid carcinoma after mastectomy, and then showed generalized ecchymoses on the abdomen and bilateral hindlimbs on presentation. Laboratory tests revealed a hypocoagulable state, including thrombocytopenia, hypofibrinogenemia, and delayed prothrombin and activated partial thromboplastin time. Thromboelastography demonstrated a prolonged K time with a decreased alpha angle and low maximal amplitude, reflecting a decrease in clot strength. The hypocoagulable state of disseminated intravascular coagulopathy was speculated based on the presence of an underlying tumor, clinical symptoms, and laboratory results of the hypocoagulable state. This case shows the incidence of hemostatic dysfunction as a paraneoplastic syndrome in a dog with mammary gland carcinoma.

• 대한정형외과학회지
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• 제54권6호
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• pp.557-561
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• 2019

대부분의 저에너지 외상에 의한 골반환 골절은 합병증 없이 보존적 치료만으로 호전이 되어 혈관손상 등의 합병증에 대한 초기평가를 간과하기 쉽다. 본 증례보고에서는 평소 aspirin을 복용하던 81세 여자환자가 낙상으로 비전위성 치골지 골절이 발생하면서 corona mortis가 손상되어 나타난 대량출혈을 보고하는 바이다. 고령의 골반환 골절 환자에서는 골절의 전위 여부와 관계없이 혈관 손상이 지연되어 발생할 수도 있기 때문에 면밀한 이학적 검사 및 감시가 필요하다.

• Clinical and Experimental Pediatrics
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• 제57권3호
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• pp.140-148
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• 2014

Purpose: Lowe syndrome is a rare, X-linked recessive disorder caused by mutations in the OCRL gene. It involves multiple anatomic systems, particularly the eyes, central nervous system, and kidneys, and leads to profound growth failure and global developmental delay. This study evaluated the clinical and genetic characteristics of Korean patients with Lowe syndrome. Methods: The clinical findings and results of genetic studies were reviewed for 12 male patients diagnosed with Lowe syndrome at a single medical institution. Results: The mean age of the patients at presentation was 2.2 months (range, 0-4 months), although the diagnosis was delayed by a mean of 2.8 years (range, 0-9.7 years). The mean follow-up period was 9.0 years (range, 0.6-16.7 years). Nine mutations in OCRL were identified in 11 patients (92%), with three novel mutations. The main presentation was congenital cataract in both eyes necessitating early cataract removal in the 11 patients with impaired visual acuity. Profound short stature and developmental delay were observed in all patients, and seizures occurred in 50% of the patients. All patients suffered from proximal renal tubular dysfunction, and one patient developed chronic renal failure. Other manifestations included pathologic fracture (50%), cutaneous cysts (42%), and cryptorchidism (42%). However, there was no bleeding tendency, and none of the patients died during the study period. Conclusion: This study describes the clinical and genetic characteristics of Korean patients with Lowe syndrome. The observations are helpful for understanding the natural courses of Lowe syndrome and for appropriate genetic counseling.

• 한국과학교육학회지
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• 제18권3호
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• pp.273-282
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• 1998

학습 초기에 과학적 개념과 상충되는 오개념을 이용하여 인지 갈등을 일으킴으로써 개념 변화를 꾀하는 갈등유발집단과 과학적 개념과 어느정도 일치하는 부분과학개념을 이용하여 과학적 개념과 연결시켜줌으로써 개념 변화를 꾀하는 비갈등집단의 개념 형성 정도 및 지속효과를 비교하였다. 초등학교 5 6 학년을 대상으로 일상 생활에서 쉽게 접할 수 있는 열전도, 열평형, 작용 반작용, 자유낙하, 무게보존 등에 관한 기초적인 5가지 개념을 이용하였다. 갈등유발집단에게는 오개념을 가지고 답하리라 예상되는 문항을 제시하였으며, 비갈등집단에게는 과학적개념과 어느 정도 일치하는 부분과학개념을 가지고 답하리라 예상되는 문항을 제시하였다. 그 다음, 시범 실험을 실시하여 갈등유발집단은 오개념을 드러내어 갈등이 일어나게 하였으며, 비갈등집단은 부분과학개념을 이끌어내어 갈등이 일어나지 않고 과학적 개념과 연결시킬 수 있게 하였다. 두 집단 모두 설명식의 간단한 처치를 동일하게 실시하였으며 처치 직후와 일주후, 한달후에 사후 검사를 실시하여 개념의 형성 정도 및 지속 효과를 비교하였다. 기초적인 5가지 개념에 대해 갈등과 비갈등의 효과를 비교해 본 결과 열평형 개념과 작용 반작용 개념에서 갈등유발집단에 더 효과적인 결과를 얻었다. 그리고 학업성적을 통한 상위 수준과 하위 수준의 학생들을 비교하였을 때 상위 수준의 학생들은 열전도와 열평형 개념에서 갈등을 일으킨 다음 갈등을 해소해 주는 방법이 더 효과적이었으며, 하위 수준의 학생들은 갈등의 방법이나 비갈등의 방법이나 개념의 형성 정도나 지속 효과면에서 차이가 나타나지 않았다. 전체적으로 초등학생들에게서는 두 방법간에 뚜렷한 경향성은 나타나지 않았으나, 개념과 학습자의 특성에 따라 다양한 결과가 나타났다. 따라서 학습할 개념의 특성, 학생의 선개념 상태, 학습에서의 성공 경험에 따라 적절한 방법을 사용하여야 한다고 본다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권6호
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• pp.3593-3601
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• 2013

Background: For a number of reasons from cultural compatibility, to accessibility, to cost, traditional healers are a major source of health care in developing countries. In Malaysia, it's been estimated that upwards of 80% of the population consult traditional healers even if simultaneously seeking treatment from the Western medical system. Partially as a result of the widespread practice of visiting traditional healers, cancer diagnosis and treatment in Malaysia is often delayed or interrupted resulting in late presentation, advanced stage diagnosis, and a higher mortality rate than in Western countries. However, there is very little research on the role of traditional healers in cancer treatment in Malaysia. Materials and Methods: This qualitative study was designed to identify the roles traditional healers play in cancer diagnosis and treatment, with an eye to alleviating the cancer burden through educational responses with four publics in mind-policy makers, Western medical personnel, traditional healers, and the general public. In-depth interviews were conducted with 14 Malay traditional healers, 13 cancer survivors who had seen both traditional healers and Western doctors, and 12 cancer medical specialists. Results: Analysis of the data from these 39 participants revealed four roles traditional healers play in cancer treatment-medicinal healer, emotional comforter, spiritual guide, and palliative caregiver. Conclusions: Three roles (emotional, spiritual, palliative) can be seen as complementary to the allopathic system. Emotional and spiritual roles may augment the effectiveness of biomedical treatment. Cancer awareness and education programs need to position traditional healers as complementary, rather than an alternative to Western medical treatment; Validating the roles Traditional Healers can play in cancer treatment in MY through health promotion and education will contribute to alleviating the nation's cancer burden.

• Archives of Plastic Surgery
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• 제43권6호
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• pp.512-517
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• 2016

Background Studies of the ear-molding technique have emphasized the importance of initiating molding early to achieve the best results. In the present study, we describe the immediate effects and long-term outcomes of this technique, focusing on children who were older than the ideal age of treatment initiation. Methods Patients who visited our institution from July 2014 to November 2015 were included. Medical charts were reviewed to collect data on demographics, the duration of treatment, the types of deformities, and the manner of recognition of the deformity and referral to our institution. Parents were surveyed to assess the degree of improvement, the level of procedural discomfort at the end of treatment, any changes in the shape of the molded auricle, and overall satisfaction 12 months after their last follow-up visits. Results A review of 28 ears in 18 patients was conducted, including the following types of deformities: constricted ear (64.2%), Stahl ear (21.4%), prominent ear (7.1%), and cryptotia (7.1%). The average score for the degree of improvement, rated on a 5-point scale (1, very poor; 5, excellent), was 3.5 at the end of treatment, with a score of 2.6 for procedural discomfort (1, very mild; 5, very severe). After 12 months, the shapes of all ears were well maintained. The average overall satisfaction score was 3.6 (1, very dissatisfied; 5, very satisfied). Conclusions We had reasonable outcomes in older patients. After 1 year of follow-up, these outcomes were well maintained. Patients past the ideal age at presentation can still be candidates for the molding technique.

• 한국지능정보시스템학회:학술대회논문집
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• 한국지능정보시스템학회 2001년도 The Pacific Aisan Confrence On Intelligent Systems 2001
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• pp.59-64
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• 2001

The robot soccer simulation game is a dynamic multi-agent environment. In this paper we suggest a new reinforcement learning approach to each agent's dynamic positioning in such dynamic environment. Reinforcement learning is the machine learning in which an agent learns from indirect, delayed reward an optimal policy to chose sequences of actions that produce the greatest cumulative reward. Therefore the reinforcement learning is different from supervised learning in the sense that there is no presentation of input pairs as training examples. Furthermore, model-free reinforcement learning algorithms like Q-learning do not require defining or learning any models of the surrounding environment. Nevertheless it can learn the optimal policy if the agent can visit every state- action pair infinitely. However, the biggest problem of monolithic reinforcement learning is that its straightforward applications do not successfully scale up to more complex environments due to the intractable large space of states. In order to address this problem. we suggest Adaptive Mediation-based Modular Q-Learning (AMMQL)as an improvement of the existing Modular Q-Learning (MQL). While simple modular Q-learning combines the results from each learning module in a fixed way, AMMQL combines them in a more flexible way by assigning different weight to each module according to its contribution to rewards. Therefore in addition to resolving the problem of large state effectively, AMMQL can show higher adaptability to environmental changes than pure MQL. This paper introduces the concept of AMMQL and presents details of its application into dynamic positioning of robot soccer agents.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제1권1호
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• pp.120-124
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• 1998

미숙아에서 유문협착증은 매우 드문 질환으로 증상이 비전형적이고 한번의 복부 초음파 검사로 진단이 어렵다. 저자들은 구토와 수유 곤란이 발생한 미숙아에서 계속적인 복부 초음파 검사와 위장관 조영술로 유문협착증으로 진단하였고 수술 후 증세 호전되어 퇴원한 2례를 보고하는 바이다.