• Title/Summary/Keyword: Evidence-Based Medicine

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Clinical Evaluation of TightRope Cranial Cruciate Ligament Technique for Treatment of Cranial Cruciate Ligament Deficiency in Dogs (전방 십자인대 결손을 보이는 개에서 TightRope을 이용한 치료방법 평가)

  • Yoon, Hun-Young;Kim, Kyung-Hee;Jeong, Soon-Wuk
    • Journal of Veterinary Clinics
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    • v.29 no.6
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    • pp.455-459
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    • 2012
  • Nine dogs presented to the Veterinary Medical Teaching Hospital of Konkuk University and Woosung Animal Hospital with a history of pelvic limb lameness. On physical examination, 9 dogs all showed a consistent weight bearing lameness and mild muscle atrophy. There was cranial drawer sign with pain in 9 dogs. Mediolateral radiographic projection revealed cranial subluxation of the tibial tuberosity in a tibial compression view. The right and left stifle joints were affected in 7 dogs and 2 dogs respectively. TightRope cranial cruciate ligament (CCL) technique for treatment of CCL deficiency was performed. Polyester and nylon were used to stabilize the stifle in 3 dogs and 6 dogs respectively. Suture sizes were 0.8 mm (n = 2), 0.9 mm (n = 4), 1.1 mm (n = 2), and $1.1mm{\times}2$ strands (n = 1) in diameter. Mean (${\pm}SD$) surgical duration was $48.3{\pm}8.5$ minutes (range 35 to 60 minutes). Preoperative and postoperative mean (${\pm}SD$) cranial drawer signs were $8.6{\pm}1.6$ mm (rage 7 to 12 mm) and $1.2{\pm}1.0$ mm (rage 0 to 3 mm) respectively. Immediate postoperative radiographs of the affected limb revealed no evidence of cranial subluxation of the tibial tuberosity in a tibial compression view of 9 dogs. Normal limb function was regained in 8 dogs within 8 weeks postoperatively. A consistent weight bearing lameness resolved in all dogs after TightRope CCL technique, but reoccurred in one dog (case No. 6) 2 weeks after surgery. Cranial subluxation of the tibial tuberosity was identified in a tibial compression test. During the second surgery, breakage of surgical button was identified and a tibial wedge osteotomy was performed. Based on surgical time, complication, stifle stability, and functional recovery, the present study indicated that TightRope CCL technique is effective treatment for the dogs with CCL deficiency.

Analysis of the Case with Serial Killer Young Cheol Yoo (유영철 연쇄살인사건 분석)

  • Lee, Jin-Dong;Lee, Sang-Han
    • Journal of forensic and investigative science
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    • v.2 no.1
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    • pp.32-51
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    • 2007
  • Serial violent crimes have occurred more frequently. Additional attention is paid to relevant areas in which discussions has also increased. This study analyzed Young-cheol Yoo, serial killer case. Two of Yoo's crimes were studied for modus operandi. The cases selected were the premeditated break-in homicide of upper-class elderly people and the impulsive homicide of the Hwanghak-Dong street vendor. Crime motives, targets, times, places, means and methods were analyzed. Profiling techniques in Young-cheol Yoo cases were evaluated and the problems discovered during investigation were discussed. The followings are the findings of the analysis of the serial killer Yoo cases. Yoo exhibited a hatred toward the rich, the elderly, and women as well as a fear of diseases and death. Yoo's crime targets were the elderly residing in wealthy houses, street vendors and prostitutes. The numbers of victims were: 3 men and 5 women victims in 4 homicide cases involving the elderly residents in wealthy houses; one man in 1 street vendor homicide case 11 women in 11 prostitute homicide cases, so total 20 persons were murdered in 16 cases. The time of the crimes were between 10 am and noon in the homicide cases of the elderly and very late at night or early in the morning in the prostitute homicide cases. Means and methods facilitated include the use of a knife as a threat and a hammer made by Yoo to strike the head and face of victims. In the homicide cases involving the elderly, he attempted to disguise the crime scene as a burglary or committed arson to destroy the evidence; in the prostitute homicide cases, bodies were mutilated and buried in secret. 1) Generally each serial killer case has different characteristics, motives, and purposes; while some serial killer cases involve similar methods, others use different methods. Unlike other crimes, serial killers' characteristics and tastes are very different, so it is difficult to explain serial killings based on a specific model. It is important to accurately capture modus operandi of each serial killing and for detectives to familiarize themselves with them. The process of tracing and use of imagination which follows a serial killer's psychology and thought must be used to find out what kind of thoughts pushed the killer to commit the crime. In order to investigate and research difficult subjects such as serial killing, various methods, skills, and relevant knowledge should be studied, and institutional endeavors should go hand in hand with individual efforts.

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Treatment Strategies for Depression during Pregnancy and Lactation (임신과 수유기 우울증의 치료 전략)

  • Lee, Soyoung Irene;Jung, Han-Yong
    • Korean Journal of Biological Psychiatry
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    • v.14 no.2
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    • pp.91-98
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    • 2007
  • Objectives : Considering the impact of depressive illness on physical and mental health of both mother and fetus, specification of a treatment algorithm for depressive disorder during pregnancy is legitimated. This article provides a systemic review of treatments for depressive disorder during pregnancy and lactation. Methods : According to the search strategy of the Clinical Research Center for Depression of Korean Health 21 R & D Project, PubMed and EMBASE were searched using terms with regard to the treatment of depressive disorders during pregnancy and lactation. Reference lists of related reviews and studies were searched. In addition, relevant practice guidelines were searched using the PubMed. All identified clinical literatures were reviewed and summarized in a narrative manner. Results : Pharmacotherapy during pregnancy and lactation requires a comprehensive assessment of the risks and benefits of treatment for both mother and fetus or neonate. Recently, there is growing evidence that the use of tricyclic and selective serotonin reuptake inhibitors during pregnancy and lactation does not result in increased risks of teratogenicity. Treatment strategies are described according to the point of time of pregnancy or lactation. FDA categories for antidepressants during pregnancy and lactation are described. In addition, issues regarding to the electroconvulsive therapy and psychosocial treatment are discussed. Conclusion : The treatment option for depressive disorders during pregnancy and lactation depends on the severity of depressive illnesses of the individual patient. For mild to moderate depression, the non-pharmacological treatment should be considered first. For moderate to severe depression, pharmacotherapy should be administered in addition to the psychosocial treatment. ECT is recommended for depressive disorder of severe intensity. As the research knowledge is limited, the recommendations should based on the best judgement of psychiatrists.

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Metabolic Changes on Occipital Cortex during Visual Stimulation with Functional MR Imaging and H MR Spectroscopy (기능적 자기공명영상법과 양성자 가지공명분광법을 이용한 시각자극에 의한 후두염 피질의 대사물질 변화)

  • Kim, Tae;Suh, Tae-Suk;Choe, Bo-Young;Kim, Sung-Eun;Lee, Heung-Kyu;Shinn, Kyung-Sub
    • Investigative Magnetic Resonance Imaging
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    • v.3 no.1
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    • pp.47-52
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    • 1999
  • Purpose : The purpose of this study was aimed to evaluate the BOLD(blood oxygen level dependent) contrast fMRI(functional MR imaging) in the occipital lobe and to compare with the metabolic changes based on H MRS (MR spectroscopy) and MRSI (MR spectroscopic imaging) before and after visual stimulation Materials and Methods : Healthy human volunteers (eight males and two females with 24-30 year age) participated in this study. All of the BOLD fMRI were acquired on a 1.5T MR with EPI during supervised visual stimulation in the occipital lobe. The red flicker with 8Hz was used for visual stimulation. After imaging acquisition, the MR images were transferred into unix workstation and processed with acquired from the same location based on the activation map. MRSI (magnetic resonance spectroscopic imaging) was also acquired to analyze the lactate changes before and after stimulation. Results : The activation maps were successfully produced by BOLD effect due to visual stimulation. NAA (N-acetyle aspartate)/Cr (creatine) ratio varied only from $1.79{\pm}0.28{\;}to{\;}1.88{\pm}0.20$ in activation area before and after stimulation. However, the signal intensity of lactate was elevated $9.48{\pm}4.38$ times higher than before activation. Lactate metabolite images were consistent with the activation maps. Conclusion : The BOLD contrast fMRI is enough sensitive to detect the activated area in human brain during the visual stimulation. Lactate metabolite map presents the evidence of lactate elevation on the same area of activation.

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Occurrence of Wilting Disease(Fusarium spp) according to Crop Rotation and Continuous Cropping of Sesame(Sesamun indicum) (참깨연작(連作) 및 윤작재배(輪作栽培)에 따른 시들음병(病)(Fusarium spp)의 발생상황(發生狀況))

  • Paik, Su-Bong;Do, Eun-Su;Yang, Jang-Seock;Han, Man-Jong
    • The Korean Journal of Mycology
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    • v.16 no.4
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    • pp.220-225
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    • 1988
  • This study was carried out to investigate the effect on the system of crop rotation of sesame(Sesamum indicum L). The results of infected plant percentage and yield of sesame wilting disease, fluctuation of density of Fusarium oxysporum and Actinomycetes, and their pathogenicity test on Fusarium spp isolated from sesame cultural soil were investigated. Density of F. oxysporum was the highest in a sesame continuous cropping soil but that of Actinomycetes was the lowest in that soil. And that of F. oxysporum and Actinomycetes according to investigation date was the highest at June. 30 and July. 30, respectively. Their pathogenicity of F. oxysporum and F. solani isolated from sesame cultural soil to sesame, peanut and green gram were recognized to all isolates except one isolate among F. oxysporum 8 isolates and one isolate to sesame, 2 isolates to peanut and all isolates to green gram among F. solani 4 isolates. F. oxysporum density and infected plant of wilting disease were increased as a result of replanted cultivation of sesame, and yield of that was prominantly reduced. Relation between density of F. oxysporum in cultural soil and infected plant percentage showed positive correlation and yield index highly negative. There was little difference between sesame-upland rice and sesame-peanut in the system of crop rotation.

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Studies on the Zanthoxylum piperitum $D_E$ $C_{ANDOLIE}$ - 1. Pungent principles and Essential oil composition - (천초(川椒)에 관(關)한 연구(硏究) - 1. 신미성분(辛味成分)과 정유성분(精油成分) -)

  • Jung, Hyun-Sook
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.16 no.2
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    • pp.123-127
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    • 1987
  • The Pungent principles and Essential oil compositions of Zanthoxylum piperitum $D_E$ $C_{ANDOLIE}$(peel, barb) were analysed by HPLC and GC, respectively. Total Pungent principle contents of peels were about as 12 times as those of barks. The Sanshool I, Sanshool IV, Sanshool III and Sanshoo V were the major Pungent principles in the peels and barks. Besides, several Unknown Pungent principles were discovered in the peels and barks, too. Total Essential oil contents of peels were higher than those of barks at the ratio of 1.8 % to 0.5%. The Cineol+Limonene(37.7%) were the main Essential oil compositions in the peels, while ${\alpha}-Terpineol(16.5%)$ and Pinene(15.5%) were the major portion in the barks. The Essential oil of peels and barks were composed Pinen, Myrcene, Cineol+Limonene, Linalool, Isopulegol, Terpinen-4-ol, ${\alpha}-Terpineol$ and Piperitone. Besides, seven Unknown compositions were discovered, too.

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The current status and control measures of BSE in the worldwide (국내, 외 광우병의 발생 현황과 대응 방안)

  • Yoo, Han-Sang
    • 한국환경농학회:학술대회논문집
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    • 2009.07a
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    • pp.273-282
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    • 2009
  • The transmissible spongiform encephalopathies (TSEs) disease group are fatal neurodegenerative disorders affecting a wide range of hosts. The group includes kuru and Creutzfeldt-Jakob disease (CJD) in humans, scrapie in sheep and goats and Bovine spongiform encephalopathy (BSE) in cattle. The exact nature of the infectious agent involved in the transmission of these diseases remains controversial. However, a central event in their pathogenesis is the accumulation in infected tissues of an abnormal form of a host-encoded protein, the prion protein (PrP). Whereas the normal cellular protein is fully sensitive to protease ($PrP^{sen}$), the disease-associated prion protein ($PrP^d$) is only partly degraded ($PrP^{res}$), its amino-terminal end being removed. BSE was first reported in the mid-80s in the UK. Ten years later, a new form of human prion disease, variant CJD (vCJD) developed in the wake of the BSE epidemic, and there is now strong scientific evidence that vCJD was initiated by the exposure of humans to BSE-infected tissues, thus indicating a zoonotic disease. However, the ban on the feeding of animal-derived proteins to ruminants, and the apparent lack of vertical transmission of BSE, have led to a decline in the incidence of the disease within cattle herd and therefore, an assumed decreased risk for human contacting vCJD. The origin of the original case(s) of BSE still remains an enigma even though three hypotheses have been raised. Hypotheses are i) sheep- or goat-derived scrapie-infected tissues included in meat and bone meal fed to cattle, ii) a previously undetected sporadic or genetic bovine TSE contaminating cattle feed or iii) originating from a human TSE through animal feed contaminated with human remains. A host cellular membrane protein ($PrP^C$), which is abundant in central nervous system tissue, appear to be conformationally altered in the diseased host into a prion protein ($PrP^{Sc}$). This $PrP^{Sc}$ is detergent insoluble and partially protease-resistant ($PrP^{res}$). The term $PrP^{res}$ is normally used to describe the protein detected after protease treatment, in techniques such as Western immunoblotting, and enzyme-linked immunosorbant assay using fresh/frozen tissue. Immunohistochemistry may performed with formalin-fixed tissues. Also, clinical signs of the BSE are one of the major diagnostic indicators. Recently, atypical forms (known as H- and L-type) of BSE have appeared in several European countries, Japan, Canada and the United States. An unusual case was also reported in a miniature zebu. The atypical BSE fall into two groups based on the relative molecular mass (Mm) of the unglycosylated $PrP^{res}$ band relative to that of classical BSE, one of the higher Mm (H-type) and the other lower (L-type). Both types have been detected worldwide as rare cases in older animals, at a low prevalence consistent with the possibility of sporadic forms of prion diseases in cattle. This raises the unwelcome possibility that vCJD could increase in the human population. Now, active surveillance program against BSE is going on in Korea. In regional veterinary service lab, ELISA is applied to screen the BSE in slaughter and confirmatory tests by Western immunoblotting and immunohistochemisty are carried out if there are positive or suspect in the screening test. Also, the ruminant feed ban is rigorously enforced. Removal of specified risk materials such as brain and spinal cord from cattle is mandatory process at slaughter to prevent the infected material from entering the human food chain.

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The snacking pattern, diet, lifestyle and menu preferences of elementary school students in Gyeonggi area, considering the most frequently eaten snacks (자주 섭취하는 간식의 종류에 따른 경기지역 초등학교 고학년생의 간식섭취실태, 식생활과 생활습관 및 음식 기호도)

  • Park, Hyejin;Kang, Hyunjoo;Lee, Eun-Sook;Lee, Hongmie
    • Journal of Nutrition and Health
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    • v.54 no.5
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    • pp.547-559
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    • 2021
  • Purpose: This study compares the snacking pattern, diet, lifestyle, and food preference of children by evaluating the most frequently eaten snacks. Methods: The survey enrolled 435 students from three elementary schools in Gyeonggi. Based on the most frequently eaten snacks, the subjects were divided into 3 groups: fruits and milk/dairy products for natural snacks (NS, n = 114); noodles, snack foods and fast foods for meal-like snacks (MS, n = 74); cookies, beverages and bread as sweet snacks (SS, n = 247). Results: Compared to the MS group, preferences of the NS group were significantly higher for jabgokbap (cooked rice with multi-grains, p < 0.05) and saengchae (seasoned raw vegetables, p < 0.01), and significantly lower for gogitwigim (deep-fried meat, p < 0.05). Taste preference of the NS group was considered to be more desirable; the taste preference of more subjects was 'sweet taste' in the SS group, 'spicy taste' in the MS group, 'salty taste' in the MS and SS groups, and 'sour taste' and 'bland taste' in the NS group than the other groups. Compared to the MS and SS groups, the NS group was determined to exercise more frequently; exercising for more than 30 minutes/day was determined to be 76.3% in the NS group and 58.1% and 57.9% in the other groups (p < 0.01). Moreover, a higher proportion of subjects in the MS group tended to answer 'not hungry' as the reason for leaving school meals, as compared to other groups (p = 0.055), thereby suggesting that inappropriate snacking habits interfere with regular meals. Conclusion: This study provides evidence that healthy snacking habits, which include natural snacks such as milk/dairy products and fruits, are important for children during the elementary school years, since these habits are associated with healthier diet, lifestyle, and food and taste preferences. These results provide basic information for developing nutritional education materials for elementary school children.

Radiation Therapy and Chemotherapy after Breast Conserving Surgery for Invasive Breast Cancer: An Intermediate Result (침윤성 유방암에서 유방보존수술 후 방사선치료 및 항암화학 병용치료의 성적 및 위험인자 분석)

  • Lee, Seok-Ho;Choi, Jin-Ho;Lee, Young-Don;Park, Heoung-Kyu;Kim, Hyun-Young;Park, Se-Hoon;Lee, Kyu-Chan
    • Radiation Oncology Journal
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    • v.25 no.1
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    • pp.16-25
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    • 2007
  • [ $\underline{Purpose}$ ]: Breast conserving surgery (BCS) followed by chemotherapy (CTx.) and radiation therapy (RT) is widely performed for the treatment of early breast cancer. This retrospective study was undertaken to evaluate our interim results in terms of failure patterns, survival and relative risk factors. $\underline{Materials\;and\;Methods}$: From January 1999 through December 2003, 129 patients diagnosed with invasive breast cancer and treated with BCS followed by RT were subject to retrospective review. The median age of the patients was 45 years (age distribution, $27{\sim}76$ years). The proportions of patients according to their tumor, nodes, and metastases (TNM) stage were 65 (50.4%) in stage I, 41 (31.7%) in stage IIa, 13 (10.1%) in stage IIb, 9 (7.0%) in stage III, and 1 patient (0.8%) in stage IIIc. For 32 patients (24.8%), axillary node metastasis was found after dissection. BCS consisted of quadrantectomy in 115 patients (89.1%) and lumpectomy in 14 patients (10.6%). Axillary node dissection at axillary level I and II was performed for 120 patients (93%). For 7 patients (5.4%), only sentinel node dissection was performed with BCS. For 2 patients (1.6%) axillary dissection of any type was not performed. Postoperative RT was given with 6 MV X-rays. A tumor dose of 50.4 Gy was delivered to the entire breast area using a tangential field with a wedge compensator. An aditional dose of $9{\sim}16\;Gy$ was given to the primary tumor bed areas with electron beams. In 30 patients (23.3%), RT was delivered to the supraclavicular node. Most patients had adjuvant CTx. with $4{\sim}6$ cycles of CMF (cyclophosphamide, methotrexate, 5-fluorouracil) regimens. The median follow-up period was 50 months (range: $17{\sim}93$ months). $\underline{Results}$: The actuarial 5 year survival rate (5Y-OSR) was 96.9%, and the 5 year disease free survival rate (5Y-DFSR) was 93.7%. Local recurrences were noted in 2 patients (true: 2, regional node: 1) as the first sign of recurrence at a mean time of 29.3 months after surgery. Five patients developed distant metastases as the first sign of recurrence at $6{\sim}33$ months (mean 21 months). Sites of distant metastatic sites were bone in 3 patients, liver in 1 patient and systemic lesions in 1 patient. Among the patients with distant metastatic sites, two patients died at 17 and 25 months during the follow-up period. According to stage, the 5Y-OSR was 95.5%, 100%, 84.6%, and 100% for stage I, IIa, IIb, and III respectively. The 5Y-DFSR was 96.8%, 92.7%, 76.9%, and 100% for stage I, IIa, IIb, and III respectively. Stage was the only risk factor for local recurrence based on univariate analysis. Ten stage III patients included in this analysis had a primary tumor size of less than 3 cm and had more than 4 axillary lymph node metastases. The 10 stage III patients received not only breast RT but also received posterior axillary boost RT to the supraclavicular node. During the median 53.3 months follow-up period, no any local or distant failure was found. Complications were asymptomatic radiation pneumonitis in 10 patients, symptomatic pneumonitis in 1 patient and lymphedema in 8 patients. $\underline{Conclusion}$: Although our follow up period is short, we had excellent local control and survival results and reaffirmed that BCS followed by RT and CTx. appears to be an adequate treatment method. These results also provide evidence that distant failure occurs earlier and more frequent as compared with local failure. Further studies and a longer follow-up period are needed to assess the effectiveness of BCS followed by RT for the patients with less than a 3 cm primary tumor and more than 4 axillary node metastases.