• Title/Summary/Keyword: number of lesions

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A Study of Psychometric Function Curve for Korean Standard Monosyllabic Word Lists for Preschoolers (KS-MWL-P) (한국표준 학령전기용 단음절어표 (Korean Standard Monosyllabic Word Lists for Preschoolers, KS-MWL-P)의 심리음향기능곡선 연구)

  • Shin, Hyun-Wook;Kim, Jin-Sook
    • The Journal of the Acoustical Society of Korea
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    • v.28 no.6
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    • pp.534-541
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    • 2009
  • Word recognition test (WRT) for the children can be useful for diagnosing the degree of communication disability, prescribing hearing instruments, planning aural rehabilitation and speech therapy, and determination of site of lesions. The Korean standard monosyllabic word lists for preschoolers (KS-MWL-P) were developed considering the criteria given by the literatures. However, the authors of KS-MWL-P suggested more children should be included to verify homogeneity of the lists using psychometric function curve since only 8 children participated in the developing process. The purpose of this study was to explore the homogeneity of KS-MWL-P for supplementing the limitations of the lists employing psychometric analysis. To 23 preschoolers who have normal-hearing, 100 monosyllabic KS-MWL-P words were examined with the pictures. Psychometric function curve with linear slopes of 20% and 80%'s correct rates through accounting recognition scores of each monosyllabic word at variable intensities from -10 to 40 dBHL was obtained and analyzed. As a result, s-shaped psychometric function curve was presented with increasing correct rate depending on intensity and showed no statistical significant differences among each word and list. The congruous graph shapes among lists also indicated good homogeneity and the list 1,2,3,4's average slopes were 4.48, 3.86, 4.65, 4.50. It was verified that the homogeneity was suitable because the analysis of variance showed no statistical significance among lists (p>0.05). However, KS-MWL-P's order of slope according to the order of the number of items, $1{\sim}10$, $1{\sim}20$, $1{\sim}25$ showed no difference with the p-value of 0.93, 0.59, 0.91, 0.70 for the lists 1,2,3, and 4, respectively. Although KS-MWL-P was assumed that the lower-numbered items were easy for testing younger ages, this study's results could not agree with the author's conclusion. Considering this matter, rearranging of the number of items should be performed according to the analysis of slope suggested by this study for testing younger children with easier items. Other than this, in conclusion, KS-MWL-P was proved to be useful for clinical and rehabilitative evaluating and training tools for preschoolers.

Hybrid Off-pump Coronary Artery Bypass Combined with Percutaneous Coronary Intervention: Indications and Early Results (심폐바이패스 없이 시행하는 관상동맥우회술과 경피적 관상동맥중재술의 병합요법 : 적응증 및 조기성적)

  • Hwang Ho Young;Kim Jin Hyun;Cho Kwang Ree;Kim Ki-Bong
    • Journal of Chest Surgery
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    • v.38 no.11 s.256
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    • pp.733-738
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    • 2005
  • Background: The possibility of incomplete revascularization and development of flow competition after revascularization of the borderline lesion made the hybrid strategy as an option for complete revascularization. Material and Method: From January f998 to July 2004, 25 $(3.2\%)$ patients underwent hybrid revascularization among 782 total OPCAB procedures. Clinical results and angiographic patencies were evalulated. Percutaneous coronary intervention (PCI) was peformed before CABG in 8 patients and after CABG in 47 patients. Result: The causes of PCIs before CABG were to achieve complete revascularization with minimally invasive surgery (n=7) and emergent PCI for culprit lesion (n=1). The indications of PCIs after CABG were high possibility of flow competition in the borderline lesion of right coronary artery territory (n=8), diffuse atheromatous lesion preventing anastomosis of graft (n=5), severe calcified ascending aorta with no more arterial grafi available (n=3), and intramyocardial coronary lesion (n=1). Mean number of distal anastomoses was $2.3\pm1.0$. Mean number of lesions treated by PCI was $1.2\pm0.4$. There was no operative or procedure-related mortality. PCI-related complication was periprocedural myocardial infarction in one patient, and complications related to CABG were transient atrial fibrillation (n=5), perioperative myocardial infarction (n=1), and transient renal dysfunction (n=1). Early postoperative coronary angiography $(1.8{pm}1.6days)$ revealed $100\%$ patency rate of grafts (57/57). The stenosis occurred in one patient performed PCI before CABG, which was successfully treated with re-ballooning. During midterm follow-up (mean; $25{\pm}26$ months), 1 patient died of congestive heart failure. All survivors (n=24) accomplished follow-up coronary angiographics, which showed .all grafts (56/57) were patent except one string sign. In-stent restenosis was developed in 2 patients who received bare metal stents. Conclusion: In selected patients, complete revascularization was achieved with low risk by taking the hybrid strategy.

Patients with brain metastases the usefulness of contrast-enhanced FLAIR images after delay (뇌전이 환자의 조영 증강 후 지연 FLAIR 영상의 유용성)

  • Byun, Jae-Hu;Park, Myung-Hwan;Lee, Jin-Wan
    • Korean Journal of Digital Imaging in Medicine
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    • v.16 no.1
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    • pp.13-19
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    • 2014
  • Purpose: FLAIR image is beneficial for the diagnosis of various bran diseases including ischemic CVS, brain tumors and infections. However the border between the legion of brain metastasis and surrounding edema may not be clear. Therefore, this study aims to investigate the practical benefits of delayed imaging by comparing the image from a patient with brain metastasis before a contrast enhancement and the image 10 minutes after a contrast enhancement. Materials and methods: Of the 92 people who underwent MRI brain metastases in suspected patients 13 people in three patients there is no video to target the 37 people confirmed cases, and motion artifacts brain metastases in our hospital June-December 2013, 18 people measurement position except for the three incorrect patient (male: 11 people, female: 7 people, average age: 60 years) in the target, test equipment, 3.0T MR System (ACHIEVA Release, Philips, I was 8ChannelSENSE Head Coil use Best, and the Netherlands). TR 11000 ms, TE 125 ms, TI2800 ms, Slice Thickness 5 mm, gap 5 mm, is a Slice number 21, the parameters of the 3D FFE, T2 FLAIR variable that was used to test, TR 8.1 ms, TE 3.7 ms, Slice number 240 I set to. The experiment was conducted by acquiring the FLAIR prior to contrast enhancement (heretofore referred to as Pre FLAIR), and acquiring the 3D FFE CE five minutes after the contrast enhancement, and recomposing the images in an axial plane of S/T 3mm, G 0mm (heretofore referred to as MPR TRA CE). Using the FLAIR 10 minutes after the contrast enhancement (heretofore referred to as Post FLAIR) and Pi-View, a retrospective study was conducted. Using MRIcro on the image of a patient confirmed for his diagnosis, the images before and after the contrast media, as well as the CNR and SNR of the MPR TRA CE images of the lesion and the site absent of lesion were compared and analyzed using a one-way analysis of variance. Results: CNR for Pre FLAIR and Post FLAIR were 34.35 and 60.13, respectively, with MPR TRA CE at 23.77 showing no significant difference (p<0.050). Post-experiment analysis shows a difference between Pre FLAIR and Post FLAIR in terms of CNR (p<0.050), but no difference in CNR between Post FLAIR and MPR TRA CE (p>0.050), indicating that the contrast media had an effect only on Pre FLAIR and Post FLAIR. The SNR for the normal site Pre FLAIR was 106.43, and for the lesion site 140.79. Post FLAIR for the normal site was 107.79, and for the lesion site 167.91. MPR TRA CE for the normal site was 140.23 and for the lesion site 183.19, showing significant difference (p<0.050), and post-experiment analysis shows that there was a difference in SNR only on the lesion sites for Pre FLAIR and Post FLAIR (p<0.050). There was no difference in SNR between the normal site and lesion site for Post FLAIR and MPR TRA CE, indicating no effect from the contrast media (p>0.050). Conclusions: This experiment shows that Post FLAIR has a higher contrast than Pre FLAIR, and a higher SNR for lesions, It was not not statistically significant and MPR TRA CE but CNR came out high. Inspection of post-contrast which is used in a high magnetic field is frequently used images of 3D T1 but, since the signal of the contrast medium and the blood flow is included, this method can be diagnostic accuracy is reduced, it is believed that when used in combination with Post FLAIR, and that can provide video information added to the diagnosis of brain metastases.

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PROSPECTIVE CLINICAL EVALUATION OF THREE DIFFERENT BONDING SYSTEMS IN CLASS V RESIN RESTORATIONS WITH OR WITHOUT MECHANICAL RETENTION (접착제와 와동형성의 차이에 따른 5급 복합레진 수복의 전향적 임상연구)

  • Lee Kyung-Wook;Choung Sae-Joon;Han Young-Chul;Son Ho-Hyun;Um Chung-Moon;Oh Myoung-Hwan;Cho Byeong-Hoon
    • Restorative Dentistry and Endodontics
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    • v.31 no.4
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    • pp.300-311
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    • 2006
  • The purpose of this study is to evaluate prospectively the effect of different bonding systems and retention grooves on the clinical performance of resin restorations in non-carious cervical lesions (NCCLs). Thirty-nine healthy adults who had at least 2 NCCLs in their premolar areas were included in this study. One hundred and fifty teeth were equally assigned to six groups: (A) Scotchbond Multi-Purpose (SBMP, 3M ESPE, St. Paul, MN, USA, 4th generation bonding system) without retention grooves; (B) SBMP with retention grooves; (C) BC Plus (Vericom Co., Anyang, Gyeonggido, Korea, 5th generation bonding system) without retention grooves; (D) BC Plus with retention grooves; (E) Adper Prompt (3M ESPE, Seefeld, Germany, 6th generation bonding system) without retention grooves; (F) Adper Prompt with retention grooves. All cavities were filled with a hybrid composite resin. Denfil (Vericom Co., Anyang, Gyeonggido, Korea) by one operator. Restorations were evaluated at baseline and at 6-month recall, according to the modified USPHS (United States Public Health Service) criteria. Additionally, clinical photographs were taken and epoxy resin replicas were made for SEM evaluation. At 6-month recall, there were some differences in the number of alpha ratings among the experimental groups. But, despite the differences in the number of alpha ratings, there was no significant difference among the 3 adhesive systems (p < 0.05). There was also no significant difference between the groups with or without mechanical retention (p < 0.05). Follow-ups for longer periods than 6 months are needed to verify the clinical performance of different bonding systems and retention grooves.

STUDIES ON AVIAN VISCERAL LYMPHOMATOSIS I. THE INCREASED INCIDENSE AMONG CHICKEN FLOCKS AND PATHOLOGIC PICTURES (장기형임파종증(臟器型淋巴腫症)에 관(關)한 연구(硏究) 1. 계군(鷄群)에서의 임파종증(淋巴腫症)의 발생(發生) 및 병리학적소견(病理學的所見))

  • Kim, Uh Ho;Lim, Chang Hyeong
    • Korean Journal of Veterinary Research
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    • v.4 no.1
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    • pp.35-42
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    • 1964
  • 1). An nanlysis was made of 3,500 postmortem diagnoses for the three years 1961 through 1963 to determine whether there was any actual incidence of avian visceral lymphomntosis in the field. Chickens autopsied, which showed gross alterations were 7.6 percent or 266 cases. The diminished incidence of the disease in second and third years seemed due to decreased total numbers of chicken flocks year by year for the reason of difficult feed supply. 2). Because chickens autopsied in this study were not clearly known of their breeds and lines, no distinct data on the incidence in various breeds were made. Some exact breeds were in too small numbers to have any statistical significance. Inconceivably, no other types of avian leukosis than visceral lymphomatosis had been observed in any appreciable number in this analysis. 3). Pathologic analysis for affected organs was made grossly and microscopically. In the gross pictures, liver, spleen, kidney, ovary, and in some case, intestine principally showed lesions, but its manifestation was variable in different organs. In such organs, livers were affected more frequently, and spleens followed next. The organs were classified and arranged according to the gross alterations, and among their distribution one-half of livers were in diffuse variety; one-fourths in nodular; about one-sevenths in mixed; and granular variety followed next. In the spleen samples, two-thirds were in diffuse variety; one-fourths in nodular; and follicular only in three cases. Ovaries almost showed follicular lesions, the diffused were less than one-fifths of total specimens. Kidneys were occurred almost in diffuse variety. And intestine showed only nodular tomors. Microscopically, 42 cases of visceral lymphomatosis composed of 24 livers, 10 spleens, 3 kidneys, 3 intestines and 2 ovaries were examined. The tumor cells were lymphoid cells showing various component in size, shape and stainability. Mitotic figures were usually present. The proportion of the component cells were various in all cases and there were variations in the distribution of the tumor cells. The types of distribution were classified according to the standard proposed by Horiuchi as nodular, infiltrative and diffuse proliferation. In cases of visceral lymphomatosis of the livers and the spleens the types of infiltrative, nodular and diffuse proliferation could be classified. In the cases of the kidneys the types of diffuse and nodular proliferation were observed. In the cases of the intestines and the ovaries the types of infiltrative and diffuse proliferation were observed respectively.

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Clinical Study of Pulmonary Tuberculosis for Admitted Patients at National Masan Tuberculosis Hospital (국립마산결핵병원에 입원한 환자에 대한 폐결핵의 임상적 동태에 관한 연구)

  • Park, Seung-Kyu;Choi, In-Hwan;Kim, Chul-Min;Kim, Cheon-Tae;Song, Sun-Dae
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.2
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    • pp.241-250
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    • 1997
  • Objective : Although the prevalence of pulmonary tuberculosis has decreased progressively after the national control program for tuberculosis began, nowadays the number of MDRTB is increasing seriously. MDRTB tends to be poor responsive to current antituberculosis regimens. It is mainly due to poor compliance, high rate of side reaction of secondary drugs, and limitation in number of available drugs. The purpose of present study is to evaluate the clinical features of pulmonary tuberculosis patients admitted in one national tuberculosis hospital and to expose the problems pertaining to current remedies, to increase the treatment efficacy for pulmonary tuberculosis including MDRTB in the end. Method : Retrospective analysis of 336 pulmonary tuberculosis patients admitted in National Masan Tuberculosis Hospital was done. Contents of analysis were patients profile, the first diagnosed time and medical institutes, family history, residence, previous treatment history, chief complaints at the time of admission, lesion site on chest X -ray film, combined deseases, side reaction to antibuberculosis drugs, used drugs before admission and the results of drug sensitivity test. Results : The ratio between male and female was 4 : 1. Age showed relatively even distribution from 3rd to 6 th decades. 64.6% of the patients was diagnosed at public health center. Weight loss was the most common complaint at admission. Bilateral lesions on chest X-ray films were 59.8%. 130patients had combined desease, of which DM was the most common(37.7%). 95patients had family history, of which parents were the most common(41.7%). According to the time of first diagnosis, 31 patients were diagnosed before 1980, and after then the number of patients was increased by degrees. Residence overwhelmed in pusan and gyung-nam province. 258 patients got previous treatment history, of which 112 patients(43.4%) had more than 3 times and only 133 patients(51.6%)got regular medication. 97 patients used more than other 3 drugs in addition to INH, EMB, RFP and PZA before admission. 154 patients were informed with the results of drug sensitivity test. of which 77 patients had resistance to more than 5 drugs. Gastrointestinal problem was the most common in side reaction to drugs. Conclusion : In the case of weight loss of unknown cause, tuberculosis should be suspected. In first treatment, sufficient and satisfactory explanation for tuberculosis is necessary and treatment period should not be stict to 6 month-short term therapy. In retreatment, new drugs should not be added to used drugs even though drug sensitivity results show sensitivity to some of them. Proper time for surgical intervention should not be delayed.

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Studies on Neck Blast Infection of Rice Plant (벼 이삭목도열병(病)의 감염(感染)에 관(關)한 연구(硏究))

  • Kim, Hong Gi;Park, Jong Seong
    • Korean Journal of Agricultural Science
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    • v.12 no.2
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    • pp.206-241
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    • 1985
  • Attempts to search infection period, infection speed in the tissue of neck blast of rice plant, location of inoculum source and effects of several conditions about the leaf sheath of rice plants for neck blast incidence have been made. 1. The most infectious period for neck blast incidence was the booting stage just before heading date, and most of necks have been infected during the booting stage and on heading date. But $Indica{\times}Japonica$ hybrid varieties had shown always high possibility for infection after booting stage. 2. Incubation period for neck blast of rice plants under natural conditions had rather a long period ranging from 10 to 22 days. Under artificial inoculation condition incubation period in the young panicle was shorter than in the old panicle. Panicles that emerged from the sheath of flag leaf had long incubation period, with a low infection rate and they also shown slow infection speed in the tissue. 3. Considering the incubation period of neck blast of rice plant, we assumed that the most effective application periods of chemicals are 5-10 days for immediate effective chemicals and 10-15 days for slow effective chemicals before heading. 4. Infiltration of conidia into the leaf sheath of rice plant carried out by saturation effect with water through the suture of the upper three leaves. The number of conidia observed in the leaf sheath during the booting stage were higher than those in the leaf sheath during other stages. Ligule had protected to infiltrate of conidia into the leaf sheath. 5. When conidia were infiltrated into the leaf sheath, the highest number of attached conidia was observed on the panicle base and panicle axis with hairs and degenerated panicle, which seemed to promote the infection of neck blast. 6. The lowest spore concentration for neck blast incidence was variable with rice varietal groups. $Indica{\times}Japonica$ hybrid varieties were infected easily compared to the Japonica type varieties, especially. The number of spores for neck blast incidence in $Indica{\times}Japonica$ hybrid varieties was less than 100 and disease index was higher also in $Indica{\times}Japonica$ hybrid than in Japonica type varieties. 7. Nitrogen content and silicate content were related with blast incidence in necks of rice plants in the different growing stage changed during growing period. Nitrogen content increased from booting stage to heading date and then decreased gradually as time passes. Silicate content increased from booting stage after heading with time. Change of these content promoted to increase neck blast infection. 8. Conidia moved to rice plant by ascending and desending dispersal and then attached on the rice plant. Conidia transfered horizontally was found very negligible. So we presumed that infection rate of neck blast was very low after emergence of panicle base from the leaf sheath. Also ascending air current by temperature difference between upper and lower side of rice plant seemed to increase the liberation of spores. 9. Conidial number of the blast fungus collected just before and after heading date was closely related with neck blast incidence. Lesions on three leaves from the top were closely related with neck blast incidence, because they had high potential for conidia formation of rice blast fungus and they were direct inoculum sources for neck blast. 10. The condition inside the leaf sheath was very favorable for the incidence of neck blast and the neck blast incidence in the leaf sheath increased as the level of fertilizer applied increased. Therefore, the infection rate of neck blast on the all panicle parts such as panicle base, panicle branches, spikelets, nodes, and internodes inside the leaf sheath didn't show differences due to varietal resistance or fertilizers applied. 11. Except for others among dominant species of fungi in the leaf sheath, only Gerlachia oryzae appeared to promote incidence of neck blast. It was assumed that days for heading of varieties were related with neck blast incidence.

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Choledochal Cyst in Korea - A Survey by the Korean Association of Pediatric Surgeons - (담관낭종 -대한소아외과학회회원 대상 전국조사-)

  • Choi, Kum-Ja;Kim, D.Y.;Kim, S.Y.;Kim, S.C.;Kim, S.K.;Kim, W.K.;Kim, I.K.;Kim, J.E.;Kim, J.C.;Kim, H.Y.;Kim, H.J.;Park, K.W.;Park, W.H.;Park, J.Y.;Paek, H.K.;Seo, J.M.;Song, Y.T.;Oh, S.M.;Yoo, S.Y.;Lee, D.S.;Lee, M.D.;Lee, S.K.;Lee, S.C.;Park, Y.S.;Lee, T.H.;Chung, S.Y.
    • Advances in pediatric surgery
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    • v.9 no.1
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    • pp.45-51
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    • 2003
  • A nationwide survey on choledochal cyst was undertaken among 39 members of the Korean Association of Pediatric Surgeons. The members were required to complete a questionnaire and the case registration form for each patient during the five year period of 1997 to 2001. Three hundred and forty eight patients were registered from 32 institutions. The average number of patients per surgeon was one to two every year. The male to female ratio was 1:3.4. The age of patients on diagnosis was $49.0{\pm}44.4$ months. The geographic distribution was 34.8% in Seoul and Kyoungki-do, 33.3% in Kyoungsang-do, 17.9% in Cholla-do, and 8.5% in Choongchung-do, in order of frequency. The three common clinical presentations were abdominal pain (63.8%), vomiting (35.3%), and jaundice (29.1%). Only seven patients (2%) presented with classic triad, and 25 patients were diagnosed by antenatal ultrasonographic examination. According to the Todani Classification, 238 patients (7l.3%) were type 1, 3 (0.9%) type 11, and 93 (27.8%) type IV. At the time of the operation, three important associated conditions were choledocholithiasis in 45 patients (15.1%), liver fibrosis (Grade 1-4) in 35, and previous operative procedure for biliary diseases in 10. Associated anomalies were observed in 13 patients (3.8%). Three hundred thirty nine (98.8%) of 343 lesions were treated by Cyst excision and Roux-Y hepaticoiejunostomy. One hundred seventy-six patients had an anomalous arrangement of the pancreatobiliary ductal system (APBD): APBD was not in 92 patients, biliary duct joined to the pancreatic duct in 51, and pancreatic duct joined to the biliary duct in 26. There were 8.5% early, and 7.7% late phase operative complications. The major complications were bleeding, anastomotic leakage, and acute pancreatitis. The combination of acute abdomen and choledochal cyst may suggest spontaneous rupture. Because of the development of late intrahepatic bile duct stones, long term follow up after cyst excision and hepaticojejunostomy is required. The optimal time of surgical intervention should also be considered in the situation of routine use of antenatal ultrasonographic examination. This is the first review of the choledochal cyst in Korea and provides baseline data for future comparisons.

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Clinical Characteristics of Endobronchial Tuberculosis that Develops in Patients over 70 Years of Age (70세 이상의 고령에서 발생한 기관지 결핵의 임상적 특징)

  • Kim, Hwi Jong;Kim, Hyeon Sik;Ma, Jeong Eun;Lee, Seung Jun;Ham, Hyoun Seok;Cho, Yu Ji;Jeong, Yi Yeong;Jeon, Kyoung-Nyeo;Kim, Ho Cheol;Lee, Jong Deok;Hwang, Young Sil
    • Tuberculosis and Respiratory Diseases
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    • v.63 no.5
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    • pp.412-416
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    • 2007
  • Background: The possibility of developing pulmonary tuberculosis usually increases with increasing age. Therefore, the incidence of endobronchial tuberculosis in older people may increase. We evaluated the clinical characteristics in patients with endobronchial tuberculosis above the age of 70 years. Methods: We enrolled 74 patients (12 males and 62 females; mean age $64.6{\pm}16.2 $years) that were diagnosed with endobronchial tuberculosis from March 2003 to July 2006 at Gyeongsang University Hospital. We retrospectively evaluated the clinical characteristics of endobronchial tuberculosis for patients 70 years or older (older group) and for patients below the age of 70 years (younger group). Results: The number of patients in the older group was 41 (55%). Cough was the most common symptom in the two groups of patients and dyspnea on exertion was more common in the older group of patients than in the younger group of patients (31.7% vs. 12.1%). The actively caesating type of disease was more common in the younger group of patients than in the older group of patients (66.7% vs. 39%). The edematous type of disease was more common in the older group of patients than in the younger group of patients (53.7% vs. 27.2%) (p<0.05). Tracheal and main bronchial involvement of lesions were more common for the younger group of patients than for the older group of patients (30.3% vs. 9.7%) (p<0.05). Conclusion: Endobronchial tuberculosis was commonly observed in patients older than 70 years and this group of patients had some clinical characteristics that were different from the younger group of patients.

Manganese and Iron Interaction: a Mechanism of Manganese-Induced Parkinsonism

  • Zheng, Wei
    • Proceedings of the Korea Environmental Mutagen Society Conference
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    • 2003.10a
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    • pp.34-63
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    • 2003
  • Occupational and environmental exposure to manganese continue to represent a realistic public health problem in both developed and developing countries. Increased utility of MMT as a replacement for lead in gasoline creates a new source of environmental exposure to manganese. It is, therefore, imperative that further attention be directed at molecular neurotoxicology of manganese. A Need for a more complete understanding of manganese functions both in health and disease, and for a better defined role of manganese in iron metabolism is well substantiated. The in-depth studies in this area should provide novel information on the potential public health risk associated with manganese exposure. It will also explore novel mechanism(s) of manganese-induced neurotoxicity from the angle of Mn-Fe interaction at both systemic and cellular levels. More importantly, the result of these studies will offer clues to the etiology of IPD and its associated abnormal iron and energy metabolism. To achieve these goals, however, a number of outstanding questions remain to be resolved. First, one must understand what species of manganese in the biological matrices plays critical role in the induction of neurotoxicity, Mn(II) or Mn(III)? In our own studies with aconitase, Cpx-I, and Cpx-II, manganese was added to the buffers as the divalent salt, i.e., $MnCl_2$. While it is quite reasonable to suggest that the effect on aconitase and/or Cpx-I activites was associated with the divalent species of manganese, the experimental design does not preclude the possibility that a manganese species of higher oxidation state, such as Mn(III), is required for the induction of these effects. The ionic radius of Mn(III) is 65 ppm, which is similar to the ionic size to Fe(III) (65 ppm at the high spin state) in aconitase (Nieboer and Fletcher, 1996; Sneed et al., 1953). Thus it is plausible that the higher oxidation state of manganese optimally fits into the geometric space of aconitase, serving as the active species in this enzymatic reaction. In the current literature, most of the studies on manganese toxicity have used Mn(II) as $MnCl_2$ rather than Mn(III). The obvious advantage of Mn(II) is its good water solubility, which allows effortless preparation in either in vivo or in vitro investigation, whereas almost all of the Mn(III) salt products on the comparison between two valent manganese species nearly infeasible. Thus a more intimate collaboration with physiochemists to develop a better way to study Mn(III) species in biological matrices is pressingly needed. Second, In spite of the special affinity of manganese for mitochondria and its similar chemical properties to iron, there is a sound reason to postulate that manganese may act as an iron surrogate in certain iron-requiring enzymes. It is, therefore, imperative to design the physiochemical studies to determine whether manganese can indeed exchange with iron in proteins, and to understand how manganese interacts with tertiary structure of proteins. The studies on binding properties (such as affinity constant, dissociation parameter, etc.) of manganese and iron to key enzymes associated with iron and energy regulation would add additional information to our knowledge of Mn-Fe neurotoxicity. Third, manganese exposure, either in vivo or in vitro, promotes cellular overload of iron. It is still unclear, however, how exactly manganese interacts with cellular iron regulatory processes and what is the mechanism underlying this cellular iron overload. As discussed above, the binding of IRP-I to TfR mRNA leads to the expression of TfR, thereby increasing cellular iron uptake. The sequence encoding TfR mRNA, in particular IRE fragments, has been well-documented in literature. It is therefore possible to use molecular technique to elaborate whether manganese cytotoxicity influences the mRNA expression of iron regulatory proteins and how manganese exposure alters the binding activity of IPRs to TfR mRNA. Finally, the current manganese investigation has largely focused on the issues ranging from disposition/toxicity study to the characterization of clinical symptoms. Much less has been done regarding the risk assessment of environmenta/occupational exposure. One of the unsolved, pressing puzzles is the lack of reliable biomarker(s) for manganese-induced neurologic lesions in long-term, low-level exposure situation. Lack of such a diagnostic means renders it impossible to assess the human health risk and long-term social impact associated with potentially elevated manganese in environment. The biochemical interaction between manganese and iron, particularly the ensuing subtle changes of certain relevant proteins, provides the opportunity to identify and develop such a specific biomarker for manganese-induced neuronal damage. By learning the molecular mechanism of cytotoxicity, one will be able to find a better way for prediction and treatment of manganese-initiated neurodegenerative diseases.

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