• The Korean Journal of Pain
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• 제24권4호
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• pp.216-220
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• 2011

Background: Transforaminal epidural steroid injection is one of the effective treatments in managing radicular pain. There have been some prospective studies on the depth to the epidural space with the transforaminal approach. However, there have been no studies about the depth in Asians, especially Koreans. This study was carried out in order to evaluate the depth to the epidural space and the oblique angle and factors that influence the depth to the epidural space during lumbar transforaminal epidural injection. Methods: A total of 248 patients undergoing fluoroscopically guided transforaminal epidural steroid injections were evaluated. At the L3-4, L4-5, L5-S1, and S1 levels, we measured the oblique angle and depth to the epidural space. Results: Needle depth was positively associated with body mass index (correlation coefficient 0.52, P = 0.004). The median depths (in centimeters) to the epidural space were 6.13 cm, 6.42 cm, and 7.13 cm for 50-60 kg, 60-70 kg, and 70-80 kg groups, respectively, at L5-S1. Age and height were not significantly associated with the needle depth. Conclusions: There is a positive association between the BMI (and weight) and transforaminal epidural depth but not with age, sex, and height.

• Journal of Microbiology and Biotechnology
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• 제21권7호
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• pp.719-727
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• 2011

Botulism is a neuroparalytic disease caused by Clostridium botulinum, which produces seven (A-G) antigenically diverse neurotoxins (BoNTs). BoNTs are the most poisonous substances known to humans, with a median lethal dose ($LD_{50}$) of approximately 1 ng/kg of body weight. Owing to their extreme potency and lethality, they have the potential to be used as a bioterrorism agent. The mouse bioassay is the gold standard for the detection of botulinum neurotoxins; however, it requires at least 3-4 days for completion. Attempts have been made to develop an ELISA-based detection system, which is potentially an easier and more rapid method of botulinum neurotoxin detection. The present study was designed using a synthetic gene approach. The synthetic gene encoding the catalytic domain of BoNT serotype B from amino acids 1-450 was constructed with PCR overlapping primers (BoNT/B LC), cloned in a pQE30 UA vector, and expressed in an E. coli M15 host system. Recombinant protein production was optimized at 0.5 mM IPTG final concentration, 4 h post induction, resulting in a maximum yield of recombinant proteins. The immunogenic nature of the recombinant BoNT/B LC protein was evaluated by ELISA. Antibodies were raised in BALB/c mice using various adjuvants. A significant rise in antibody titer (p<0.05) was observed in the Alum group, followed by the Titermax Classic group, Freund's adjuvant, and the Titermax Gold group. These developed high-titer antibodies may prove useful for the detection of botulinum neurotoxins in food and clinical samples.

• Journal of Chest Surgery
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• 제54권5호
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• pp.348-355
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• 2021

Background: Congenital diaphragmatic hernia (CDH) is a rare disease often requiring mechanical ventilation after birth. In severe cases, extracorporeal membrane oxygenation (ECMO) may be needed. This study analyzed the outcomes of patients with CDH treated with ECMO and investigated factors related to in-hospital mortality. Methods: Among 254 newborns diagnosed with CDH between 2008 and 2020, 51 patients needed ECMO support. At Asan Medical Center, a multidisciplinary team approach has been applied for managing newborns with CDH since 2018. Outcomes were compared between hospital survivors and nonsurvivors. Results: ECMO was established at a median of 17 hours after birth. The mean birth weight was 3.1±0.5 kg. Twenty-three patients (23/51, 45.1%) were weaned from ECMO, and 16 patients (16/51, 31.4%) survived to discharge. The ECMO mode was veno-venous in 24 patients (47.1%) and veno-arterial in 27 patients (52.9%). Most cannulations (50/51, 98%) were accomplished through a transverse cervical incision. No significant between-group differences in baseline characteristics and prenatal indices were observed. The oxygenation index (1 hour before: 90.0 vs. 51.0, p=0.005) and blood lactate level (peak: 7.9 vs. 5.2 mmol/L, p=0.023) before ECMO were higher in nonsurvivors. Major bleeding during ECMO more frequently occurred in nonsurvivors (57.1% vs. 12.5%, p=0.007). In the multivariate analysis, the oxygenation index measured at 1 hour before ECMO initiation was identified as a significant risk factor for in-hospital mortality (odds ratio, 1.02; 95% confidence interval, 1.01-1.04; p=0.05). Conclusion: The survival of neonates after ECMO for CDH is suboptimal. Timely application of ECMO is crucial for better survival outcomes.

• Translational and Clinical Pharmacology
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• 제25권3호
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• pp.147-152
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• 2017

This study focused on the role of cytochrome P450 2D6 (CYP2D6) genotypes to predict phenotypes in the metabolism of dextromethorphan. CYP2D6 genotypes and metabolic ratios (MRs) of dextromethorphan were determined in 201 Koreans. Unsupervised clustering algorithms, hierarchical and k-means clustering analysis, and color visualizations of CYP2D6 activity were performed on a subset of 130 subjects. A total of 23 different genotypes were identified, five of which were observed in one subject. Phenotype classifications were based on the means, medians, and standard deviations of the log MR values for each genotype. Color visualization was used to display the mean and median of each genotype as different color intensities. Cutoff values were determined using receiver operating characteristic curves from the k-means analysis, and the data were validated in the remaining subset of 71 subjects. Using the two highest silhouette values, the selected numbers of clusters were three (the best) and four. The findings from the two clustering algorithms were similar to those of other studies, classifying $^*5/^*5$ as a lowest activity group and genotypes containing duplicated alleles (i.e., $CYP2D6^*1/^*2N$) as a highest activity group. The validation of the k-means clustering results with data from the 71 subjects revealed relatively high concordance rates: 92.8% and 73.9% in three and four clusters, respectively. Additionally, color visualization allowed for rapid interpretation of results. Although the clustering approach to predict CYP2D6 phenotype from CYP2D6 genotype is not fully complete, it provides general information about the genotype to phenotype relationship, including rare genotypes with only one subject.

• Geomechanics and Engineering
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• 제17권1호
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• pp.81-95
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• 2019

Due to the importance of soil reinforcement using geotextiles in geotechnical engineering, study and investigation into long-term performance, design life and survivability of geotextiles, especially due to installation damage are necessary and will affect their economy. During installation, spreading and compaction of backfill materials, geotextiles may encounter severe stresses which can be higher than they will experience in-service. This paper aims to investigate the installation damage of geotextiles, in order to obtain a good approach to the estimation of the material's strength reduction factor. A series of full-scale tests were conducted to simulate the installation process. The study includes four deliberately poorly-graded backfill materials, two kinds of subgrades with different CBR values, three nonwoven needle-punched geotextiles of classes 1, 2 and 3 (according to AASHTO M288-08) and two different relative densities for the backfill materials. Also, to determine how well or how poorly the geotextiles tolerated the imposed construction stresses, grab tensile tests and visual inspections were carried out on geotextile specimens (before and after installation). Visual inspections of the geotextiles revealed sedimentation of fine-grained particles in all specimens and local stretching of geotextiles by larger soil particles which exerted some damage. A regression model is proposed to reliably predict the installation damage reduction factor. The results, obtained by grab tensile tests and via the proposed models, indicated that the strength reduction factor due to installation damage was reduced as the median grain size and relative density of the backfill decreases, stress transferred to the geotextiles' level decreases and as the as-received grab tensile strength of geotextile and the subgrades' CBR value increase.

• Journal of Korean Neurosurgical Society
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• 제64권4호
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• pp.619-630
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• 2021

Objective : The skull base reconstruction step, which prevents cerebrospinal fluid (CSF) leakage, is one of the most challenging steps in endoscopic skull base surgery (ESS). The purpose of this study was to assess the outcomes and complications of a reconstruction technique for immediate CSF leakage repair using multiple onlay grafts following ESS. Methods : A total of 230 consecutive patients who underwent skull base reconstruction using multiple onlay grafts with fibrin sealant patch (FSP), hydroxyapatite cement (HAC), and pedicled nasoseptal flap (PNF) for high-flow CSF leakage following ESS at three institutions were enrolled. We retrospectively reviewed the medical and radiological records to analyze the preoperative features and postoperative results. Results : The diagnoses included craniopharyngioma (46.8%), meningioma (34.0%), pituitary adenoma (5.3%), chordoma (1.6%), Rathke's cleft cyst (1.1%) and others (n=21, 11.2%). The trans-planum/tuberculum approach (94.3%) was the most commonly adapted surgical method, followed by the trans-sellar and transclival approaches. The third ventricle was opened in 78 patients (41.5%). Lumbar CSF drainage was not performed postoperatively in any of the patients. Postoperative CSF leakage occurred in four patients (1.7%) due to technical mistakes and were repaired with the same technique. However, postoperative meningitis occurred in 13.5% (n=31) of the patients, but no microorganisms were identified. The median latency to the diagnosis of meningitis was 8 days (range, 2-38). CSF leakage was the unique risk factor for postoperative meningitis (p<0.001). Conclusion : The use of multiple onlay grafts with FSP, HAC, and PNF is a reliable reconstruction technique that provides immediate and complete CSF leakage repair and mucosal grafting on the skull base without the need to harvest autologous tissue or perform postoperative CSF diversion. However, postoperative meningitis should be monitored carefully.

• Journal of Preventive Medicine and Public Health
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• 제54권2호
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• pp.119-128
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• 2021

Objectives: Ongoing, proactive, planned, and patient-centered diabetes education is the cornerstone of care for all persons with diabetes. Thus, the aim of this study was to explore the information needs of type 2 diabetes mellitus patients receiving insulin treatment in North-East Ethiopia. Methods: The study was conducted from July 2019 to January 2020 using a qualitative enquiry (phenomenological approach) with purposive sampling. Face-to-face in-depth interviews were used to collect data until reaching theoretical saturation. The participants were type 2 diabetes patients receiving insulin treatment. They were identified from the diabetes patients' registration book at the diabetes clinic and interviewed at their appointment time, and were selected to include wide variations in terms of socio-demographic characteristics. Twenty-four participants (11 men and 13 women), with a median age of 57 years, were interviewed. The data were organized using QDA Miner Lite version 2.0.7 and analyzed thematically using narrative strategies. Results: Most participants had not heard of diabetes before their diagnosis. They had limited knowledge of diabetes, but ascribed different connotations for it in the local language (Amharic). The needs reflections of patients were categorized into diabetes education and participants' recommendations. Diabetes education was totally absent at hospitals, and patients received education primarily from the Ethiopian Diabetes Association and broadcast and digital media. Thus, the major concern of patients was the availability of diabetes education programs at health institutions. Conclusions: Patients' main concern was the absence of routine diabetes education, which necessitates urgent action to implement diabetes education programs, especially at health institutions.

• Journal of Chest Surgery
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• 제54권6호
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• pp.466-472
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• 2021

Background: Major intraoperative hemorrhage reportedly predicts unfavorable survival outcomes following surgical resection for esophageal carcinoma (EC). However, the factors predicting the amount of blood lost during thoracoscopic esophagectomy have yet to be sufficiently studied. We sought to identify risk factors for excessive blood loss during video-assisted thoracoscopic surgery (VATS) for EC. Methods: Using simple and multiple linear regression models, we performed retrospective analyses of the associations between clinicopathological/surgical factors and estimated hemorrhagic volume in 168 consecutive patients who underwent VATS-type esophagectomy for EC. Results: The median blood loss amount was 225 mL (interquartile range, 126-380 mL). Abdominal laparotomy (p<0.001), thoracic duct resection (p=0.014), and division of the azygos arch (p<0.001) were significantly related to high volumes of blood loss. Body mass index and operative duration, as continuous variables, were also correlated positively with blood loss volume in simple linear regression. The multiple linear regression analysis identified prolonged operative duration (p<0.001), open laparotomy approach (p=0.003), azygos arch division (p=0.005), and high body mass index (p=0.014) as independent predictors of higher hemorrhage amounts during VATS esophagectomy. Conclusion: As well as body mass index, operation-related factors such as operative duration, open laparotomy, and division of the azygos arch were independently predictive of estimated blood loss during VATS esophagectomy for EC. Laparoscopic abdominal procedures and azygos arch preservation might be minimally invasive options that would potentially reduce intraoperative hemorrhage, although oncological radicality remains an important consideration.

• The Journal of Advanced Prosthodontics
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• 제13권6호
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• pp.351-360
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• 2021

PURPOSE. The aim of this study was to evaluate the efficiency of occlusal and interproximal adjustments of single implant crowns (SIC), comparing a digital cast-free approach (CF) and a protocol using 3D printed casts (PC). MATERIALS AND METHODS. A titanium implant was inserted at position of lower right first molar in a typodont. The implant position was scanned using an intraoral scanner and SICs were fabricated accordingly. Ten crowns (CF; n = 10) were subject to a digital cast-free workflow without any labside occlusal and interproximal modifications. Ten other identical crowns (PC) were adjusted to 3D printed casts before delivery. All crowns were then adapted to the testing model, simulating chair-side adjustments during clinical placement. Adjustment time, quantity of adjustments, and contact relationship were assessed. Data were analyzed using SPSS software (P < .05). RESULTS. Median and interquartile range (IQR) of clinical adjustment time was 02:44 (IQR 00:45) minutes in group CF and 01:46 (IQR 00:21) minutes in group PC. Laboratory and clinical adjustment time in group PC was 04:25 (IQR 00:59) minutes in total. Mean and standard deviation (±SD) of root mean squared error (RMSE) of quantity of clinical adjustments was 45 ± 7 ㎛ in group CF and 34 ± 6 ㎛ in group PC. RMSE of total adjustments was 61 ± 11 ㎛ in group PC. Quality of occlusal contacts was better in group CF. CONCLUSION. Time effort for clinical adjustments was higher in the cast-free protocol, whereas quantity of modifications was lower, and the occlusal contact relationship was found more favourable.

• Archives of Plastic Surgery
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• 제50권1호
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• pp.30-36
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• 2023

Background Most children with facial lacerations require sedation for primary sutures. However, sedation guidelines for invasive treatment are lacking. This study evaluated the current status of the sedation methods used for pediatric facial laceration repair in Korea. Methods We surveyed one resident in each included plastic surgery training hospital using face-to-face interviews or e-mail correspondence. The health care center types (secondary or tertiary hospitals), sedation drug types, usage, and dosage, procedure sequence, monitoring methods, drug effects, adverse events, and operator and guardian satisfaction were investigated. Results We included 45/67 hospitals (67%) that used a single drug, ketamine in 31 hospitals and chloral hydrate in 14 hospitals. All health care center used similar sedatives. The most used drug administered was 5 mg/kg intramuscular ketamine (10 hospitals; 32%). The most common chloral hydrate administration approach was oral 50 mg/kg (seven hospitals; 50%). Twenty-two hospitals (71%) using ketamine followed this sequence: administration of sedatives, local anesthesia, primary repair, and imaging work-up. The most common sequence used for chloral hydrate (eight hospitals; 57%) was local anesthesia, administration of sedatives, imaging work-up, and primary repair. All hospitals that used ketamine and seven (50%) of those using chloral hydrate monitored oxygen saturation. Median operator satisfaction differed significantly between ketamine and chloral hydrate (4.0 [interquartile range, 4.0-4.0] vs. 3.0 [interquartile range, 3.0-4.0]; p <0.001). Conclusion The hospitals used various procedural sedation methods for children with facial lacerations. Guidelines that consider the patient's condition and drug characteristics are needed for safe and effective sedation.