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Ruptured Saccular Aneurysm Arising from Fenestrated Proximal Anterior Cerebral Artery : Case Report and Literature Review

  • Kwon, Woo-Keun;Park, Kyung-Jae;Park, Dong-Hyuk;Kang, Shin-Hyuk
    • Journal of Korean Neurosurgical Society
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    • v.53 no.5
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    • pp.293-296
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    • 2013
  • The aneurysm arising from fenestrated proximal anterior cerebral artery (ACA) is considered to be unique. The authors report a case of a 59-year-old woman who presented with a subarachnoid hemorrhage (SAH) secondary to a ruptured aneurysm originating from the fenestrated A1 segment of right ACA. The patient had another unruptured aneurysm which was located at the right middle cerebral artery bifurcation. She was successfully treated with surgical clipping for both aneurysms. From the previously existing literatures, we found 18 more cases (1983-2011) of aneurysms associated with fenestrated A1 segment. All cases represented saccular type of aneurysms, and 79% of the patients had SAH. There were three subtypes of the fenestrated A1 aneurysms depending on the anatomical location, relative to the fenestrated segment. The most common type was the aneurysms located on the proximal end of fenestrated artery (82%). Azygos ACA and hypoplastic A1 were frequently accompanied by the aneurysm (33% and 31%, respectively), and multiple aneurysms were shown in three cases (16%). Considering that fenestrated A1 segment is likely to develop an aneurysm, which has high risk of rupture, early management may benefit patients with aneurysms accompanied by fenestrated proximal ACA.

DIAGNOSTIC ABILITY OF THE PERIAPICAL RADIOGRAPHS AND DIGITAL IMAGE IN THE DETECTION OF THE ARTIFICIAL PROXIMAL CARIES (인공적 인접면 치아우식증의 구내방사선사진과 디지털 영상의 진단능 평가)

  • Heo Min-Suk;You Dong-Soo
    • Journal of Korean Academy of Oral and Maxillofacial Radiology
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    • v.24 no.2
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    • pp.439-450
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    • 1994
  • Recently, the digital image was introduced into radiological image. The digital image has the power of contrast enhancement, histogram control, and other digitally enhancement. At the point of the resolution, periapical radiograph is superior to the digital image, but enhanced digital procedure improves the diagnostic ability of the digital image. The purpose of this study was to evaluate the diagnostic ability of artificial proximal caries in conventional radiographs, digital radiographs and enhanced digital radiographs (histogram specification). ROC (Receiver Operating Characteristic) analysis and paired t-test were used for the evaluation of detectability, and following results were acquired: 1. The mean ROC area of conventional radiographs was 0.9274. 2. The mean ROC area of unenhanced digital image was 0.9168. 3. The mean ROC area of enhanced digital image was 0.9339. 4. The diagnostic ability of three imaging methods was not significant difference(p>0.05). So, the digital images had similar diagnostic ability of artificial proximal caries to conventional radiographs. If properly enhanced digital image, it may be superior to conventional radiographs.

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Effects of Dopamine on Intracellular pH in Opossum Kidney Cells

  • Kang, Kyung-Woo;Kim, Yung-Kyu
    • The Korean Journal of Physiology and Pharmacology
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    • v.7 no.3
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    • pp.187-191
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    • 2003
  • $Na^+/H^+$ exchanger (NHE) has a critical role in regulation of intracellular pH (pHi) in the renal proximal tubular cells. It has recently been shown that dopamine inhibits NHE in the renal proximal tubules. Nevertheless, there is a dearth of information on the effects of long-term (chronic) dopamine treatment on NHE activities. This study was performed to elucidate the pHi regulatory mechanisms during the chronic dopamine treatments in renal proximal tubular OK cells. The resting pHi was greatly decreased by chronic dopamine treatments. The initial rate and the amplitude of intracellular acidification by isosmotical $Na^+$ removal from the bath medium in chronically dopamine-treated cells were much smaller than those in control. Although it seemed to be attenuated in $Na^+$-dependent pH regulation system, $Na^+$-dependent pHi recovery by NHE after intracelluar acid loading in the dopamine-treated groups was not significantly different from the control. The result is interpreted to be due to the balance between the stimulation effects of lower pHi on the NHE activity and counterbalance by dopamine. Our data strongly suggested that chronic dopamine treatment increased intrinsic intracellular buffer capacity, since higher buffer capacity was induced by lower resting pHi and this effect could attenuate pHi changes under extracellular $Na^+$-free conditions in chronically dopamine-treated cells. Our study also demonstrated that intracellular acidification induced by chronic dopamine treatments was not mediated by changes in NHE activity.

The Effect of a Proximal and Distal Tibiofibular Joint Manipulation on Dorsiflexion and Balance in Individuals with a History of Lateral Ankle Sprain

  • Chae, Yun-Won;Park, Ji-Won;Nam, Ki-Seok
    • The Journal of Korean Physical Therapy
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    • v.29 no.2
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    • pp.95-100
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    • 2017
  • Purpose: This study aimed to evaluate the changes in dorsiflexion and balance following proximal and distal tibiofibular joint manipulation in individuals with a history of lateral ankle sprain (LAS). Methods: Fifteen participants with a history of unilateral LAS, exhibiting a restriction in ankle dorsiflexion were included in this study. LAS ankle received a manipulation to the proximal and distal tibiofibular joint, while the opposite control ankle received no manipulation intervention. The outcome measures included ankle dorsiflexion and balance. Ankle dorsiflexion was measured using weight-bearing lunge test. Static and dynamic balances were measured using the overall, anterioposterior, and mediolateral balance index via the biodex balance system. Measurements were obtained prior to and following manipulation. Results: This study showed that ankle dorsiflexion and dynamic balance were improved following the manipulation compared to those prior to the manipulation (p<0.05). There was no significant change in static balance (p>0.05). Conclusion: The joint manipulation technique applied to the ankle of those with a history of LAS appears to improve ankle dorsiflexion and dynamic balance. This suggest that a manipulation to the proximal and distal tibiofibular joint could be provided as preliminary data regarding the prophylactic effects of recurrent LAS.

Hemiarthroplasty for Fractures or Fracture-Dislocations of the Proximal Humerus (상완골 근위부 골절 또는 골절 및 탈구에서의 상완골 두 치환술)

  • Kim Young Kyu;Eom Gi Serk
    • Clinics in Shoulder and Elbow
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    • v.3 no.1
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    • pp.20-25
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    • 2000
  • Purpose : To evaluate functional results and study factors influencing results after humeral hemiarthroplasty for comminuted fractures of the proximal humerus. Materials and Methods: We reviewed 12 patients with average follow-up period of 23 months(12 to 42). The proximal humeral fractures consisted of one anatomical neck fracture, five three-part and six four-part fractures or fracture-dislocations. Constant score and Compito et al' evaluation system were used for clinical assessment. Statistical analysis was done with the Wilcoxon test. Results: Six cases of anatomical neck, three-part fractures or fracture-dislocations showed 61 points on the average Constant score and three unsatisfactory results on the Compito et al' evaluation; Six of four-part fractures or fracture-dislocations showed 51 points and three unsatisfactory results. There were 59(two unsatisfactory) for five non-associated dislocation and 53(four unsatistactory) for seven associated dislocation; 66(one unsatisfactory) for three under 60 years and 41(five unsatisfactory) for nine over 60 years; 67(two unsatisfactory) for seven tuberosity union and 41(four unsatisfactory) for five tuberosity non-union or resorption; 58(four unsatisfactory) for ten early operation within two weeks and 43(all unsatisfactory) for two delayed operation; and 18(unsatisfactory) for one case of a accompanied rotator cuff tear. Conclusion: We concluded that tuberosity union was important factor influencing the results. Also, we thought that age, timing of operation and accompanied rotator cuff tear could be influenced to results.

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14N Mines Pulsed-ENDOR of Proximal Histidine and Heme of Aquometmyoglobin and Fluormetmyoglobin

  • Lee, Hong-In
    • Bulletin of the Korean Chemical Society
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    • v.23 no.12
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    • pp.1769-1772
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    • 2002
  • Previous $^{19}F\;and\;^{1,2}H$ electron-nuclear double resonance (ENDOR) study of fluorometmyoglobin (MbF) in frozen-solution state provided sensitive tools sensing subtle structural changes of the heme that are not obtainable from X-ray. [Fann et al., J. Am. Chem. Soc. 1995, 117, 6019] Because of the intrinsic inhomogeneouse EPR line broadening effect of MbF in frozen-solution state, detection of the intrinsic inhomogeneouse EPR line broadening effect of MbF in frozen-solution state, detection of the electronic and geometrical changes of the heme ring itself and the proximal histidine by using $^{14}N$ CW ENDOR was interfered. In the present study, hyperfine-sensitive $^{14}N$ Mims ENDOR technique of pulsed-EPR was employed to probe the changes. With two different $\tau$ values of 128 and 196 ns, $^{14}N$ ENDOR signals of the heme and proximal histidine were completely resolved at $g'_{II}(=g_e=2)$. This study present that X-band $^{14}N$ Mims ENDOR sequence can sensitively detect the small changes of the spin densities and p orbital populations of the proximal and the heme nitrogens, caused by ligand and pH variation of the distal site.

3D finite element simulation of human proximal femoral fracture under quasi-static load

  • Hambli, Ridha
    • Advances in biomechanics and applications
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    • v.1 no.1
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    • pp.1-14
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    • 2014
  • In this paper, a simple and accurate finite element model coupled to quasi-brittle damage law able to describe the multiple cracks initiation and their progressive propagation is developed in order to predict the complete force-displacement curve and the fracture pattern of human proximal femur under quasi-static load. The motivation of this work was to propose a simple and practical FE model with a good compromise between complexity and accuracy of the simulation considering a limited number of model parameters that can predict proximal femur fracture more accurately and physically than the fracture criteria based models. Different damage laws for cortical and trabecular bone are proposed based on experimental results to describe the inelastic damage accumulation under the excessive load. When the damage parameter reaches its critical value inside an element of the mesh, its stiffness matrix is set to zero leading to the redistribution of the stress state in the vicinity of the fractured zone (crack initiation). Once a crack is initiated, the propagation direction is simulated by the propagation of the broken elements of the mesh. To illustrate the potential of the proposed approach, the left femur of a male (age 61) previously investigated by Keyak and Falkinstein, 2003 (Model B: male, age 61) was simulated till complete fracture under one-legged stance quasi-static load. The proposed finite element model leads to more realistic and precise results concerning the shape of the force-displacement curve (yielding and fracturing) and the profile of the fractured edge.

The Clinical Effects of Complex Korean Medicine Treatment in Patient with Avulsion Fracture of the Proximal 5th Metatarsal (제5 중족골 근위부 견열골절 환자의 복합 한의치료 효과)

  • An, Sung-Hu;Jeong, Yeong-Jin;Yeom, Seung-Ryong;Kwon, Young-Dal
    • Journal of Korean Medicine Rehabilitation
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    • v.31 no.2
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    • pp.109-114
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    • 2021
  • The purpose of this study is to report the effect in treating a patient with a case of avulsion fracture of the proximal 5th metatarsal with a combination of Korean medicine therapy. We treated the patient with acupuncture, pharmacopuncture, moxibustion, cupping, and herbal medicine The numeric rating scale, X-ray were applied as outcome measures. After complex Korean medicine treatment, this patient's avulsion fracture of the proximal 5th metatarsal was improved and pain was reduced. This result shows that Korean medical therapy may be an effective option for avulsion fracture of the proximal 5th metatarsal.

A Study on Load Distribution of Gaming Server Using Proximal Policy Optimization (Proximal Policy Optimization을 이용한 게임서버의 부하분산에 관한 연구)

  • Park, Jung-min;Kim, Hye-young;Cho, Sung Hyun
    • Journal of Korea Game Society
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    • v.19 no.3
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    • pp.5-14
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    • 2019
  • The gaming server is based on a distributed server. In order to distribute workloads of gaming servers, distributed gaming servers apply some algorithms which divide each of gaming server's workload into balanced workload among the gaming servers and as a result, efficiently manage response time and fusibility of server requested by the clients. In this paper, we propose a load balancing agent using PPO(Proximal Policy Optimization) which is one of the methods from a greedy algorithm and Policy Gradient which is from Reinforcement Learning. The proposed load balancing agent is compared with the previous researches based on the simulation.

Correction of the Proximal Intertarsal Instability in a Dog

  • Jung, Yunsoo;Lee, Ho-hyun;Yun, Sungho;Kwon, Young-sam
    • Journal of Veterinary Clinics
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    • v.36 no.3
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    • pp.166-168
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    • 2019
  • A 22-month-old female mongrel dog weighing 4.8 kg was referred with chief complaint of bite wounds and lameness. The patient showed non-weight bearing lameness on left hindlimb and lateral instability of intertarsal joint. On radiograph, proximal intertarsal luxation between calcaneus and fourth tarsal bone was diagnosed. To imitate the long collateral and calcaneoquartal ligament, bone tunnels were drilled in the distal calcaneus and proximal fifth metatarsal bone. The figure-eight suture was placed with 0.5 mm cerclage wire through the predrilled holes. At 2 weeks after surgery, the lameness of hindlimb was still present. However, the patient had weight bearing lameness for 4 weeks after operation and was able to walk and run without lameness at 5 weeks after surgery. This case report explains the successful correction of intertarsal luxation with a single figure of eight wire suture in case of luxation to the intertarsal joint.