• Title/Summary/Keyword: Clinical practice

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Removable implant-supported partial denture using milled bar with Locator® attachments in a cleft lip & palate patient: A clinical report (구순구개열 환자에서 Locator® 유지장치가 장착된 milled titanium bar를 이용한 가철성 임플란트 피개 국소의치의 보철수복증례)

  • Yang, Sang-Hyun;Kim, Kyoung-A;Kim, Ja-Yeong;Seo, Jae-Min
    • The Journal of Korean Academy of Prosthodontics
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    • v.53 no.3
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    • pp.207-214
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    • 2015
  • Due to the limitations of conventional removable partial denture prostheses to treat a cleft lip & palate patient who shows scar tissue on upper lip, excessive absorption of the maxillary residual alveolar ridge, and class III malocclusion with narrow palate and undergrowth of the maxilla, 4 implants were placed on the maxillary edentulous region and a maxillary removable implant-supported partial denture was planned using a CAD/CAM milled titanium bar. Unlike metal or gold casting technique which has shrinkage after the molding, CAD/CAM milled titanium bar is highly-precise, economical and lightweight. In practice, however, it is very hard to obtain accurate friction-fit from the milled bar and reduction in retention can occur due to repetitive insertion and removal of the denture. Various auxiliary retention systems (e.g. $ERA^{(R)}$, $CEKA^{(R)}$, magnetics, $Locator^{(R)}$ attachment), in order to deal with these problems, can be used to obtain additional retention, cost-effectiveness and ease of replacement. Out of diverse auxiliary attachments, $Locator^{(R)}$ has characteristics that are dual retentive, minimal in vertical height and convenient of attachment replacement. Drill and tapping method is simple and the replacement of the metal female part of $Locator^{(R)}$ attachment is convenient. In this case, the $Locator^{(R)}$ attachment is connected to the milled titanium bar fabricated by CAD/CAM, using the drill and tapping technique. Afterward, screw holes were formed and 3 $Locator^{(R)}$ attachments were secured with 20 Ncm holding force for additional retention. Following this procedure, satisfactory results were obtained in terms of aesthetic facial form, masticatory function and denture retention, and I hereby report this case.

Correlation of Exercise-Induced Bronchoconstriction to $PC_{20}$ and Maximal Airway Narrowing on the Dose-Response Curve to Methacholine (운동유발성 기관지수축의 정도와 Methacholine 유발시험의 민감도 및 최대기도협착과의 관련성)

  • Lim, Hyung-Suk;Yoon, Kyung-Ae;Koh, Young-Yull
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.2
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    • pp.165-174
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    • 1995
  • Background: Exercise is one of the most common precipitants of acute asthma encountered in clinical practice. The development of airflow limitation that occurs several minutes after vigorous exercise, i. g. exercise-induced bronchoconstriction(EIB), has been shown to be closely correlated with the nonspecific bronchial hyperresponsiveness, which is the hallmark of bronchial asthma. All previous reports that assessed the correlation of EIB to nonspecific bronchial hyperresponsiveness have focused on airway sensitivity($PC_{20}$) to inhaled bronchoconstrictor such as methacholine or histamine. However, maximal airway narrowing(MAN), reflecting the extent to which the airways can narrow, when being exposed to high dose of inhaled stimuli, has not been studied in relation to the degree of EIB. Methods: Fifty-six children with mild asthma(41 boys and 15 girls), aged 6 to 15 years(mean${\pm}$SD, $9.9{\pm}2.5$ years) completed this study. Subjects attended the laboratory on two consecutive days. Each subject performed the high-dose methacholine inhalation test at 4 p.m. on the first day. The dose-response curves were characterized by their position($PC_{20}$) and MAN, which was defined as maximal response plateau(MRP: when two or three data points of the highest concentrations fell within a 5% response range) or the last of the data points(when a plateau could not be measured). On the next day, exercise challenge, free running outdoors for ten minutes, was performed at 9 a.m.. $FEV_1$ was measured at graduated intervals, 3 to 10 minutes apart, until 60 minutes after exercise. Response(the maximal ${\triangle}FEV_1$ from the pre-exercise value) was classified arbitrarily into three groups; no response((-) EIB: ${\triangle}FEV_1$<10%), equivocal response ($({\pm})$EIB:10%<${\triangle}FEV_1$<20%) and definite response($({\pm})$EIB:${\triangle}FEV_1$>20%). Results: 1) When geometric mean $PC_{20}$ of the three groups were compared, $PC_{20}$ of (+) EIB group was significantly lower than that of (-)EIB group. 2) There was a close correlation between $PC_{20}$ and the severity of EIB in the whole group(r=-0.568, p<0.01). 3) Of the total 56 subjects, MRP could be measured in 36 subjects, and the MRP of these subjects correlated fairly with the severity of EIB(r=0.355, p<0.05) 4) The MAN of (+) EIB group was significantly higher than that of (-)EIB group(p<0.01). 5) The MAN correlated well with the severity of EIB in the whole group(r=0.546, p<0.01). Conclusion: The degree of MAN as well as bronchial sensitivity($PC_{20}$) to methacholine is correlated well with the severity of EIB. The results suggest that the two main components of airway hyperresponsiveness may be equally important determinants of exercise reactivity, although the mechanism may be different from each other. The present study also provides further evidence that EIB is a manifestation of the increased airway reactivity characteristic of bronchial asthma.

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Immune responses of hepatitis B vaccination among very low birth weight infant (극소 저출생체중아의 영아기 B형 간염 항체 생성률 조사)

  • Kim, Young-Deuk;Han, Myung-Ki;Kim, Ai-Rhan E.;Kim, Ki-Soo;Pi, Soo-Young
    • Clinical and Experimental Pediatrics
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    • v.49 no.8
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    • pp.857-863
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    • 2006
  • Purpose : To evaluate the immunogenicity of hepatitis B vaccine among very low birth weight infants(VLBWI) who were vaccinated at 0, 1, 6 months of chronological age and to determine the factors associated with antibody formations. Methods : A total of 243 VLBWI admitted to Seoul and Gangneung Asan Medical Center neonatal intensive care units from 1997 to 2004 were included. Of 243, 13 infants were born to HBs Ag positive mother. All infants were given DNA recombinant vaccine at 0, 1, and 6 months of chronological age. Infants born to HBs Ag positive mothers received hepatitis B immunoglobulin at birth and a total of 4 doses of vaccinations. An antibody level over 10 mIU/mL, tested at 3-4 months after last vaccination, was regarded as a positive seroconversion. Results : The seroconversion rates were 84.4 percent and 84.5 percent for VLBWI and extremely low birth weight infants(ELBWI), respectively. Of 28 seronegative infants who were given revaccinations, 60.7 percent seroconverted, resulting in 95.3 percent, 97.5 percent seroconversion rates for VLBWI and ELBWI, respectively. 76.9 percent of infants born to HBsAg positive mothers seroconverted and none became hepatitis B carriers. Factors such as gestational age, sex, various neonatal illness, and kinds of vaccinations did not influence the formation of the hepatits B antibody, however, the higher the weight at time of first vacciation yielded better seroconversion rate. Conclusion : Revaccination of seronegative VLBWI after 3 doses of hepatitis B vaccinaton is very effective. Therefore, testing the immune status after the hepatitis B vaccination, a practice not routinely done, is highly recommended.

A comparative study of educators vs, non-educators designed to improve dental radiographic quality control - Focusing on theories of dental radiographic and practical training and clinical practice education - (치과방사선 질관리 향상을 위한 교육자 대비 비교육자 비교연구 - 치과방사선학 이론 및 실습교육과 임상실습교육을 중심으로 -)

  • Kim, Seung-Hee;Hong, Su-Min;Lee, Kwang-Ok
    • Journal of the Korean Society of Radiology
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    • v.6 no.5
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    • pp.421-426
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    • 2012
  • The purpose of this study was to investigate the knowledge of dental hygiene students of the quality assurance of dental radiation such quality assurance and related educational experiences in an effort to accelerate the preparation of a curriculum for systematic quality-assurance. The subjects in this study were 453 dental hygiene students who participated in dental radiography courses. Varied statistical analyses such as frequency analyses, reliability, chi-square, and independent samples t-tests were conducted on the data collected, using SPSS 12.0. Scheffe test was also used after one-way ANOVA as post-hoc tests. Results showed that (a) the students' acknowledge level of Radiographic Quality Assurance was $7.71{\pm}1.7$ out of 12 on average. The more theory and practical classes students took, the higher points they got (p<0.001); (b) Most of the students experienced 1-3 lessons out of 13 in practical training and 26.3% of students did not take any practical lesson. ;(c)Students who did not take any practical training got 7.20 points out of 13, students who took 1-3 lessons got 7.84 points out of 13, students who took 4-5 lessons got 7.87 points out of 13, and students who took more than 6 lessons got 8.14 points out of 13 on average. The more practical classes they took the higher acknowledge level they were. Therefore it needs to provide adequate practical lessons to them.

Favorable Outcome in Elderly Asian Patients with Metastatic Renal Cell Carcinoma Treated with Everolimus: The Osaka Urologic Oncology Group

  • Inamoto, Teruo;Azuma, Haruhito;Nonomura, Norio;Nakatani, Tatsuya;Matsuda, Tadashi;Nozawa, Masahiro;Ueda, Takeshi;Kinoshita, Hidefumi;Nishimura, Kazuo;Kanayama, Hiro-Omi;Miki, Tsuneharu;Tomita, Yoshihiko;Yoshioka, Toshiaki;Tsujihata, Masao;Uemura, Hirotsugu
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.4
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    • pp.1811-1815
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    • 2014
  • Background: In clinical trials with no upper age limit, the proportion of older patients is usually small, probably reflecting the more conservative approach adopted by clinicians when treating the elderly. An exploratory analysis of elderly patients in the RECORD-1 Trial showed that patients ${\geq}$ 65 y.o. had superior median PFS than overall RECORD-1 population (5.4 months and 4.9 months, respectively). We investigated the efficacy, relative benefit and safety of Everolimus (EVE) as sequential therapy after failure of VEGFr-TKI therapy for older patients with metastatic renal cell cancer (mRCC), in daily practice. Materials and Methods: 172 consecutive IRB approved patients with mRCC (median age 65, M:F 135/37, 78% clear cell) who received salvage EVE at 39 tertiary institutions between October 2009 and August 2011 were included in this analysis. Some 31% had progressed on sunitinib, 22% on sorafenib, 1% on axitinib, 41% on sequential therapy, and 5% had received other therapy. Patients with brain metastases were not included and 95% of the patients had a ECOG (Eastern Cooperative Oncology Group) performance status (PS) of 0 or 1. Previous radiotherapy was an exclusion criterion, but prior chemotherapy was permitted. Adequate organ function and hematologic parameters were mandatory. EVE administration was approved by the institutional review board at each participating institution and signed informed consent was obtained from all patients. Results: Median time of the whole cohort to last follow-up was 3.5 months (range 0.4-15.2 months). Forty four percent were continuing to take EVE at last followup. There were 86 (50%) patients ${\geq}$ 65 y.o. and 86 (50%) <65 y.o. The percentage of patients who showed PR/SD was higher in the older group than in the younger one (5.9%/61.2% vs 1.2%/46.5%, respectively). Median survival of older patients was also significantly longer (3.5 +/- 0.31 vs 3.1 +/- 0.34, hazard ratio=0.45, CI; 0.255-0.802). Analysis using Cox regression model adjusted for gender, PS, number of metastases, site of metastases, histology, smoking history and age detected an association between age and PFS (p=0.011). The frequency of adverse events in elderly patients treated with EVE was no greater than that in younger patients, although such toxicity may have had a greater impact on their quality of life. Conclusions: Older patients should not generally be excluded from accepted therapies (mTOR inhibitors after failure of VEGFr-TKI therapy) for mRCC.

A Study on the Impact of General Characteristics on Achievement Motivation in Dental Hygiene Students (치위생과 학생들의 일반적인 특성이 성취동기에 미치는 영향 연구)

  • Youn, Hye-Jeong;Lim, Sun-A;Kim, Soo-kyung
    • Journal of dental hygiene science
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    • v.11 no.5
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    • pp.389-395
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    • 2011
  • The purpose of this study was to examine dental hygiene students' achievement motivation and factors affecting dental hygiene students' achievement motivation by the general characteristics of subjects in this study. The subjects in this study were 450 who were selected by convenience sampling from three different three-year-course colleges. After a survey was conducted, the answer sheets from 421 respondents were analyzed. The collected data were analyzed, which made use of t-test, ANOVA and Kruscal-Wallis test. The findings of the study were as follows. 1. The dental hygiene students investigated got 3.34 in achievement motivation. They got the highest score of 3.78 in the item 'I perform what I have to do with a sense of responsibility.' and they got the lowest score of 2.67 in the item 'I like to do something risky.' 2. Concerning links between their general characteristics and achievement motivation, the students whose academic year was higher(p<0.001) and who had more clinical practice experiences (p<0.01) were better motivated than their counterparts. As to connections between achievement motivation and expected post-graduation length of service, those who replied that they planned to find another job after getting married were better motivated(p<0.05). Regarding relationship between achievement motivation and a will to work abroad, the students who had a stronger will to work abroad were better motivated. 3. As a result of checking the influence of their general characteristics on achievement motivation, stronger motivation was found among the students whose academic year was higher(p<0.01), who intended to work until marriage(p<0.01) and who didn't plan to keep working after marriage(p<0.05) when the other variables were controlled. Therefore dental hygiene students should be taught to look at things positively when they enter college, and they should also be educated to become progressive to keep working for their lifetime instead of just getting a temporary job after graduation.

Evaluation of Attenuation Rate Error on Skin Dosimeter using Monte Carlo Simulation in Photon and Electron Beam Therapy (광자선 및 전자선 치료에서 피부선량계의 측정과 시뮬레이션을 이용한 감약률 오차 평가)

  • Han, Moo-Jae;Yang, Seung-Woo;Heo, Seung-Uk;Bae, Sang-Il;Moon, Young-Min;Park, Sung-Kwang;Kim, Jin-Young
    • Journal of the Korean Society of Radiology
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    • v.14 no.6
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    • pp.841-848
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    • 2020
  • In the field of radiation therapy using photon beams and electron beams, since each patient has a different sensitivity to radiation, skin side effects may occur even at the same dose. Therefore, if there is a risk of excessive dose to the skin, a dosimeter is attached to verify whether the correct dose is being investigated. However, since the skin dosimeter checks the attachment site visually by measuring a point dose, it is difficult to confirm an accurate dose distribution. As a result, the measurement and simulation errors of the material HgI2 in the 6 MV photon beam were 3.73% and 5.24%, respectively, at the minimum thickness of 25 ㎛, and the material PbI2 was 4.73% and 5.65%, respectively. On the other hand, as a result of the 6 MeV electron beam, the measurement and simulation errors of the material HgI2 were 1.35% and 1.12%, respectively, at a minimum thickness of 25 ㎛, and the material PbI2 showed relatively low attenuation error, 1.67% and 1.20%, respectively. Therefore, it was evaluated that the thickness of the photon beam within 25 ㎛ and the electron beam within 100 ㎛ is suitable to have a reduction rate error within 5%. This study presents a new research direction for a flexible dosimeter attached to the human body that is required in clinical practice and the construction conditions of a future skin dosimeter.

Low-intensity Oral Anticoagulation Versus High-intensity Oral Anticoagulation in Patients with Mechanical Bileaflet Prosthetic Heart Valves (이엽성 기게 심장판막 환자에 대한 낮은 강도의 항응고제 요법의 결과에 대한 임상분석)

  • Jeong, Seong-Cheol;Kim, Mi-Jung;Song, Chang-Min;Kim, Woo-Shik;Shin, Yong-Chul;Kim, Byung-Yul
    • Journal of Chest Surgery
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    • v.41 no.4
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    • pp.430-438
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    • 2008
  • Background: All the patients with mechanical valves require warfarin therapy in order to prevent them from developing thromboembolic complications. According to the ACC/AHA practice guidelines, after AVR with bileaflet mechanical prostheses in patients with no risk factors, warfarin is indicated to achieve an INR of 2.0 to 3.0. After MVR with any mechanical valve, warfarin is indicated to achieve an INR of 2.5 to 3.5. But in our clinical experience, bleeding complications (epistaxis, hematuria, uterine bleeding, intracerebral hemorrhage etc.) frequently developed in patients who maintained their INR within this value. So, we retrospectively reviewed the patients with bileaflet mechanical heart valve prosthesis and we determined the optimal anticoagulation value. Material and Method: From January 1984 to February 2007, 311 patients have been followed up at a national medical center. We classified the AVR patients (n=60) into three groups as follows: an INR from 1.5 to 2.0 in Group I, an INR from 2.0 to 2.5 in Group II and an INR from 2.5 to 3.0 in Group III. We classified the MVR (n=171) and DVR (n=80) patients into four groups as follows: an INR from 1.5 to 2.0 in Group I, an INR from 2.0 to 2.5 in Group II, an INR from 2.5 to 3.0 in Group III and an INR from 3.0 to 3.5 in Group III. We compared the groups for their thromboembolic and bleeding complications by means of the Kaplan Meier method. Result: In the AVR patients, 2 thromboembolic complications and 4 bleeding complications occurred and the log rank test failed to identify any statistical significance between the groups for thethromboembolic complication rate, but groups I and II had lower bleeding complication rates than did group III. Thirteen thromboembolic complication and 15 bleeding complication occurred in the MVR and DVR patients, and the log rank test also failed to identify statistical significance between the groups for the thromboembolic complication rate, but groups I and II had lower bleeding complication rates that did groups III and IV. Conclusion: The thromboembolic complication rate was not statistically different between groups I and II and groups III and IV, but the bleeding complication rates of groups I and II were lower than those of groups III and IV. So this outcome encouraged us to continue using our low intensive anticoagulation regime, that is, an INR of 1.5 to 2.5.

Shear bond strength of veneer ceramic and colored zirconia by using aqueous metal chloride solutions (염화수화물용액 침지법으로 제작한 유색 지르코니아와 전장도재의 전단결합강도)

  • Yun, Kwi-Dug;Ryu, Su-Kyoung;Vang, Mong-Sook;Yang, Hong-So;Kim, Hyun-Seung;Park, Sang-Won
    • The Journal of Korean Academy of Prosthodontics
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    • v.48 no.2
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    • pp.151-157
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    • 2010
  • Purpose: The purposes of this study was to evaluates shear bond strength between zirconia core and veneer-ceramic in order to examine the clinical practice of colored zirconia block fabricated by infiltration method into the metal chloride solution. Material and methods: CNU block and $Everest{(R)}$ ZS blank were used. VITA In-$Ceram{(R)}$2000 YZ Coloring liquid (LL1) and 3 aqueous metal chloride solutions containing chromium and molybdenum ingredients were used. 40 zirconia specimens were prepared into cuboid shape ($5{\times}5{\times}10 mm$). All specimens were divided into 5 groups by infiltrating into the coloring liquids. After that, porcelain was build up into the shape of $5{\times}5{\times}4mm^3$, followed by sintering. The maximum loading and shear bond strength was measured. Failure patterns and failure sites were examined. Results: 1. There were no statistical differences in shear bond strength between zirconia blocks (P > .05). 2. There were no statistically significant differences in shear bond strength between non-colored and colored zirconia blocks, while shear bond strength of non-colored zirconia blocks is higher than that of colored specimen (P > .05). 3. In the comparison with shear bond strength among colored zirconia blocks, there were no statistical differences according to kinds of coloring liquid (P > .05). 4. Mixed failure patterns were mainly observed in the failure between zirconia and veneering ceramic. The veneering ceramic failure of all specimens was observed in either interface of zirconia or veneering ceramic. Conclusion: Shear bond strength between colored zirconia and veneering ceramic shows lower tendency than non-colored zirconia, but there was clinically allowable value.

AN EPIDEMIOLOGIC STUDY ON THE PEDIATRIC PATIENTS IN DEPARTMENT-OF PEDIATRIC DENTISTRY, CHOSUN UNIVERSITY DENTAL HOSPITAL FOR LAST 10 YEARS(1990-1999) (최근 10년간 조선대학교 치과병원 소아치과에 내원한 신환에 관한 역학적 연구(1990-1999))

  • Ryu, Hyun-Seop;Kim, Hyo-Suck;Lee, Chang-Seop;Lee, Sang-Ho
    • Journal of the korean academy of Pediatric Dentistry
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    • v.28 no.3
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    • pp.345-354
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    • 2001
  • The purpose of this study was to make public oral health plan more effective and the improvement of the hospital management system for better clinical dental practice. Distribution and trends were examined in all patients who had been examined and diagnosed at Department of Pedodontics, Dental Hospital, Chosun University over 10 year-period from 1990 to 1999 Results were as follows, 1. The number of patients per year was increasing trend after 1996 and higher visiting rate in male(55.9%) than in female(44.1%). 2. Age distribution had shown $3\sim4$ year-old cup being the largest (23.4%) and each percentage of $5\sim6,\;7\sim8,\;0\sim2,\;9\sim10,\;11\sim12,\;13\sim14,\;above\sim15$ year-old group was 19.9%, 17.7%, 14.6%, 12.6%, 8.0%, 3.3%. 0.5%. 3. Geographic distribution showed a majority of patients in Kwang-Ju (83.0%). Group in the suburbs of Kwang-Ju(Jang-Sung group) was 5.4%. 4. Dental caries showed the highest percentage(40.5%) in chief complaints and percentage of oral exam, orthodontic problem, oral pain, trauma, supernumerary teeth, swelling was 13.9% 12.6%, 8.8%, 7.4%, 5.5%, 4.9%. 5. In all patients with traumatic problem, crown fracture showed the highest percentage(41.4%) and percentage of subluxation was 19.4%. 6. Majority(78.7%) of patients were not refered, and percentage of patients refered from local clinic was 20.5%. 7. Patients who had periodic check-up comprised 19.6%, and percentage of after 3, 6, 9, 12, 18, 24month was 36.7%, 22.2%, 13.5%, 11.3%, 5.4%, 11.0%.

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