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Prescribing Pattern and Safety Analysis of Nonsteroidal Anti-inflammatory Drug and Gastro- Protective Agent following Reimbursement Guidelines Relaxation (요양급여심사기준 완화에 따른 비스테로이드성 항염제 및 위장관 보호제 처방 변화 및 안정성 분석)

  • Han, Mi Hye;Noh, Eunsun;Nam, Jin Hyun;Lee, Sang Won;Lee, Eui-Kyung
    • Korean Journal of Clinical Pharmacy
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    • v.27 no.4
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    • pp.250-257
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    • 2017
  • Objective: The prevalence rate of osteoarthritis in Koreans aged 50 years or older is 14.3%, and the total amount of medical costs is more than KRW 1 trillion. Recently, the reimbursement guidelines for osteoarthritis treatment have changed. Methods: In this study, we sought to describe prescription patterns of nonsteroidal anti-inflammatory drugs (NSAIDs) and gastro-protective agent (GPA) and analyze the clinical and economic impacts of the new policy using the national health insurance claims data. The incidence of upper gastrointestinal adverse event by policy change was identified through the odds ratio, and changes in medicine and medical costs related to osteoarthritis through mean and median. Results: There were 204,552 patients before the reimbursement guidelines relaxation and 239,710 after it, a 17.2% rise. The prescription ratio was 3.3% for the patients prescribed with COX-2 selective NSAIDs alone and 1.3% for those with both COX-2 selective NSAIDs and GPA combination before the reimbursement guidelines relaxation. The reimbursement guidelines relaxation significantly increased their ratios to 6.9% and 2.8%, respectively. Gastrointestinal adverse events significantly reduced by 1.21%p after reimbursement guidelines relaxation. The average medicine cost per person increased significantly to KRW 140,291 from KRW 137,323 after the reimbursement guidelines relaxation, while the average medical cost per person slightly decreased from KRW 311,605 to KRW 310,755 after the relaxation, showing no meaningful difference. Conclusion: The reimbursement guidelines relaxation may influence on decreasing the upper gastrointestinal adverse event, increasing the medicine costs and maintaining the medical costs for osteoarthritis.

Clinical Efficacy of Radiation-Sterilized Allografts for Sellar Reconstruction after Transsphenoidal Surgery

  • Kim, Se-Jin;Jeon, Chi-Man;Kong, Doo-Sik;Park, Kwan;Kim, Jong-Hyun
    • Journal of Korean Neurosurgical Society
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    • v.50 no.6
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    • pp.503-506
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    • 2011
  • Objective : The aim of this study was to assess the safety and efficacy of radiation-sterilized allografts of iliac bone and fascia lata from cadaver specimens to repair skull base defects after transsphenoidal surgery. Methods : Between May 2009 and January 2010, 31 consecutive patients underwent endonasal transsphenoidal surgery and all patients received sellar reconstruction using allografts following tumor removal. The allografts were obtained from the local tissue bank and harvested from cadaver donors. The specimens used in our approach were tensor fascia lata and the flat area of iliac bone. For preparation, allografts were treated with gamma irradiation after routine screening by culture, and then stored at $-70^{\circ}C$. Results : The mean follow-up period after surgery was 12.6 months (range, 7.4-16 months). Overall, postoperative cerebrospinal fluid (CSF) leaks occurred in three patients (9.7%) and postoperative meningitis in one patient (3.2%). There was no definitive evidence of wound infection at the routine postoperative follow-up examination or during re-do surgery in three patients. Postoperative meningitis in one patient was improved with the use of antibiotics and prolonged CSF diversion. Conclusion : We suggest that allograft materials can be a feasible alternative to autologous tissue grafts for sellar reconstruction following transsphenoidal surgery under selected circumstances such as no or little intraoperative CSF leaks.

Comparative Study to the Tribological Characteristics of Graphite Nano Lubricants after Thermal Degradation (그라파이트 나노윤활유의 열화 후 윤활 특성 비교 연구)

  • Lee, Jae-Keun;Lee, Chang-Gun;Hwang, Yu-Jin;Choi, Young-Min;Park, Min-Chan;Choi, Cheol;Oh, Je-Myung
    • Tribology and Lubricants
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    • v.24 no.4
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    • pp.190-195
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    • 2008
  • Many researchers have tried to improve the tribological characteristics of lubricant by adding various nano particles in the base lubricant. But the reliability evaluation of the lubricants are rarely performed in its real operation condition. In this study, the physical property and the tribological characteristics of the graphite nano lubricant were evaluated and compared with raw lubricant after thermal degrading. In order to evaluate the tirbological characteristics, the disk-on-disk tribotester was adopted to measure the friction coefficient of the graphite nano lubricants. Also the temperature variations of friction surfaces were measured by the thermocouple installed on the fixed plate in the test chamber of the tribotester. The kinematic viscosity was measured using a capillary viscometer on the temperatures of 40, 60 and $80^{\circ}C$. The results showed that the graphite nano lubricant had lower friction coefficient and less wear on the friction surfaces than raw lubricant. After thermally degrading, the friction coefficients of graphite nano lubricant increased, but the friction coefficients after thermal degradation were still maintained lower than those of raw lubricant.

Effects of Extranasal Molding after Primary Cleft Lip Nasal Repair: Photogrammetric Analysis (구순열비교정술 후 외비주형술(Extranasal molding): 비주길이의 사진계측학적 분석)

  • Han, Ki Hwan;Paik, Dae Hyang;Son, Hyung Bin;Kim, Jun Hyung;Son, Dae Gu
    • Archives of Plastic Surgery
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    • v.33 no.5
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    • pp.563-569
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    • 2006
  • Purpose: In the correction of cleft lip, there have been various methods to minimize recurrence of the nasal deformity after primary nasal surgery. After cheiloplasty and primary nasal surgery, we tried to elongate the columella of the cleft side, to stretch the vestibular lining of cleft side, and to elevate the alar cartilage of the cleft side with a molding prong. Methods: We had fifteen cleft lip patients; 12 unilateral cases(6.3-8.2 months), and 3 bilateral cases(3 - 7.5 months). Immediately after primary repair of the cleft lip, the toboggan shaped molding prong was located to deep inside of vestibular web of the cleft side. It was persistently suspended by a silicone tube which was connected to the prong and the frontal scalp. The results were analyzed with $Photoshop^{(R)}$ photogrammetrically for 6 - 48 months with on average of 20.6 months. We measured the proportion index of columellar length-interalar distance for three times(preoperation, immediate postoperation, and postoperation) on the nasal base views. Results: In unilateral, the index had a significant increase statistically between preoperation(10.73) and immediate postoperation(23.96). It is supposed that columellar length was reconstructed to 105.80% of normal side. But, it was decreased to maintain 87.7% of normal side in postoperation(20.54). The results were similar in bilateral. The linear scars by suture penetrating nose skin were not discernable. Conclusion: In summary, placement of the molding prong could elongate the reconstructed columella with some relapse postoperatively.

Correlation between Magnetic Resonance Image Signal Changes and Electromyographic Findings after Sciatic Nerve Transection in the Rat (백서의 좌골신경 절단 후 비복근의 자기공명영상 신호강도 변화와 근전도 소견의 관계)

  • Lee, Joo Hwan;Lee, Jang Chul;Kim, Dong Won;Park, Ki Young;Lee, Sung Moon
    • Journal of Korean Neurosurgical Society
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    • v.29 no.1
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    • pp.101-107
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    • 2000
  • Objectives : The evaluation of peripheral nerve injuries has traditionally relied on a clinical history, physical examination, and electrodiagnostic studies. The purpose of the present study was to examine serial magnetic resonance image(MRI) changes following acute muscle denervation under experimental conditions and to identify potential advantages and disadvantages of this use of MRI. Methods : An experimental transection of right sciatic nerve on Spargue-Dawley rats was performed. MRI was performed with T1-weighted spin-echo and STIR sequences. The imaging findings were compared with EMG in order to determine its sensitivity relative to this standard procedure. A simultaneous histopathological study provided information about the morphological basis of the imaging findings. Signal intensities were expressed as a ratio of abnormal to normal. Results : The signal intensity ratio of muscles with the STIR sequence was increased significantly at 2 weeks after sciatic nerve transection(p<0.05), although definite signal change was seen as early as 4 days postdenervation in one. EMG revealed significant denervation potential from 3 days after nerve transection. Diffuse cell atrophy was revealed hostologically at 2 weeks after transection, which was at the same time of significant signal change in MRI. Conclusion : MRI signal changes in denervated muscles secondary to nerve injury correlate with the degree of muscle atrophy on histologic examination. In addition to EMG, MRI can document the course of muscle atrophy and mesenchymal abnormalities in denervation. These results indicate that MRI can play a complementary role in the evaluation of patients with denervation.

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Association between Physical Activity and Postoperative Complications after Esophagectomy for Cancer: A Prospective Observational Study

  • Tatematsu, Noriatsu;Park, Moonhwa;Tanaka, Eiji;Sakai, Yoshiharu;Tsuboyama, Tadao
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.1
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    • pp.47-51
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    • 2013
  • Background: Postoperative complications after esophagectomy can lead to considerable patient discomfort and prolonged length of hospital stay. Lack of physical activity can be one of the independent risk factors for postoperative complications because physical activity is closely related to physical function. The objective of this study was to determine whether physical activity among esophageal cancer patients decreases their risk of postoperative complications after esophagectomy. Materials and Methods: We investigated 51 consecutive patients with newly diagnosed resectable esophageal cancer who were scheduled to receive esophagectomy between January 2009 and November 2011. Demographic, clinicopathologic, and treatment information were recorded and physical function was measured. The last 7-days short version of the International Physical Activity Questionnaire was used to assess physical activity before the operation. Stepwise multiple logistic regression analysis was used to determine whether preoperative physical activity is related to the risk of postoperative complications. Results: Male gender [OR 18.6, (95%CIs: 1.2-284.4); P=0.035], 3-field lymph node dissection (OR 9.6, [95%CIs: 1.4-66.6]; P=0.022), low-level physical activity (OR 28.3, [95%CIs: 3.5-227.7]; P=0.002), and preoperative comorbidities [OR 5.9, (95%CIs: 1.1-31.5); P=0.037] were found to be independently associated with postoperative complications. Conclusions: The present study shows that low-level physical activity, preoperative comorbidities, and 3-field lymph node dissection are independent and significant risk factors for postoperative complications after esophagectomy. Although further study is required, maintaining high-level physical activity preoperatively may decrease the risk of postoperative complications.

The Influence of Water Storage on Mechanical Properties of Adhesive Resin (수중 보관이 접착용 레진의 물리적 성질에 미치는 영향)

  • Kim, Won-Chan;Lee, Kwang-won;Lee, Jeong;Yu, Mi-Kyoung;Kim, Jeong-Hee
    • Journal of Dental Rehabilitation and Applied Science
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    • v.22 no.2
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    • pp.193-202
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    • 2006
  • Objective To evaluate the influence of water storage on the mechanical properties of dental adhesives over 1 and 3 months. Materials and Methods Adhesive resin sheets were prepared by pouring either All-bond 2(AB), Clearfil SE Bond(SE) into a mold measuring $15{\times}15{\times}0.9mm$. After solvent in primer evaporation, the adhesives were light-cured and removed from the mold and divided in two pieces, trimmed to hourglass shape that were used to determine the micro-tensile strength(MTS). Another hourglass shaped metal mold measuring $2.0{\times}1.5mm$ in cross-section area was made to determine the Young's modulus(E). Adhesive specimens for Young's modulus(E) were prepared in the same method. Specimens were stored at $37^{\circ}C$ in distilled water and tested after 1 and 3 months. The data were analyzed by one-way ANOVA and Tukey's test. Results Water storage significantly decreased the micro-tensile strength(MTS) of AB and SE specimens after 1 and 3 months(P<0.05). The Young's modulus(E) were also decreased after water storage for 1 and 3 months, but statistically not significant in each group of AB and SE group respectively. Conclusions Long-term exposure of adhesive resin to water can cause reduction of mechanical properties. It may compromise resin/dentin bonds and affect longevity of restorations.

Treatment of Nonsyndromic Craniosynostosis Using Multi-Split Osteotomy and Rigid Fixation with Absorbable Plates

  • Nam, Su Bong;Nam, Kyeong Wook;Lee, Jae Woo;Song, Kyeong Ho;Bae, Yong Chan
    • Archives of Craniofacial Surgery
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    • v.17 no.4
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    • pp.211-217
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    • 2016
  • Background: Nonsyndromic craniosynostosis is a relatively common craniofacial anomaly and various techniques were introduced to achieve its operative goals. Authors found that by using smaller bone fragments than that used in conventional cranioplasty, sufficiently rigid bone union and effective regeneration capacity could be achieved with better postoperative outcome, only if their stable fixation was ensured. Methods: Through bicoronal incisional approach, involved synostotic cranial bone together with its surrounding areas were removed. The resected bone flap was split into as many pieces as possible. The extent of this 'multi-split osteotomy' depends on the degree of dysmorphology, expectative volume increment after surgery and probable dead space caused by bony gap between bone segments. Rigid interosseous fixation was performed with variable types of absorbable plate and screw. In all cases, the pre-operational three-dimensional computed tomography (3D CT) was checked and brain CT was taken immediately after the surgery. Also about 12 months after the operation, 3D CT was checked again to see postoperative morphology improvement, bone union, regeneration and intracranial volume change. Results: The bony gaps seen in the immediate postoperative brain CT were all improved as seen in the 3D CT after 12 months from the surgery. No small bone fragment resorption was observed. Brain volume increase was found to be made gradually, leaving no case of remaining epidural dead space. Conclusion: We conclude that it is meaningful in presenting a new possibility to be applied to not only nonsyndromic craniosynostosis but also other reconstructive cranial vault surgeries.

Loosening torque of Universal Abutment screws after cyclic loading: influence of tightening technique and screw coating

  • Bacchi, Atais;Regalin, Alexandre;Bhering, Claudia Lopes Brilhante;Alessandretti, Rodrigo;Spazzin, Aloisio Oro
    • The Journal of Advanced Prosthodontics
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    • v.7 no.5
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    • pp.375-379
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    • 2015
  • PURPOSE. The purpose of this study was to evaluate the influence of tightening technique and the screw coating on the loosening torque of screws used for Universal Abutment fixation after cyclic loading. MATERIALS AND METHODS. Forty implants (Titamax Ti Cortical, HE, Neodent) (n=10) were submerged in acrylic resin and four tightening techniques for Universal Abutment fixation were evaluated: A - torque with 32 Ncm (control); B - torque with 32 Ncm holding the torque meter for 20 seconds; C - torque with 32 Ncm and retorque after 10 minutes; D - torque (32 Ncm) holding the torque meter for 20 seconds and retorque after 10 minutes as initially. Samples were divided into subgroups according to the screw used: conventional titanium screw or diamond like carbon-coated (DLC) screw. Metallic crowns were fabricated for each abutment. Samples were submitted to cyclic loading at $10^6$ cycles and 130 N of force. Data were analyzed by two-way ANOVA and Tukey's test (5%). RESULTS. The tightening technique did not show significant influence on the loosening torque of screws (P=.509). Conventional titanium screws showed significant higher loosening torque values than DLC (P=.000). CONCLUSION. The use of conventional titanium screw is more important than the tightening techniques employed in this study to provide long-term stability to Universal Abutment screws.

Impact of Intravenous Omega-3-Enriched Lipid Emulsion on Liver Enzyme and Triglyceride Serum Levels of Children Undergoing Gastrointestinal Surgery

  • Hanindita, Meta Herdiana;Widjaja, Nur Aisiyah;Irawan, Roedi;Hidayat, Boerhan;Hariastawa, IGB Adria
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.23 no.1
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    • pp.98-104
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    • 2020
  • Purpose: To investigate the impact of omega-3-enriched lipid emulsion (LE) on liver enzyme (aspartate transaminase [AST] and alanine aminotransferase [ALT]) and triglyceride (TG) levels of children undergoing gastrointestinal surgery. Methods: This experimental randomized controlled group pretest-posttest design study included 14 children who underwent gastrointestinal surgery due to duodenal atresia, jejunal atresia, esophageal atresia, and need for parenteral nutrition for a minimum of 3 days at RSUD Dr. Soetomo Surabaya between August 2018 and January 2019. These children were divided into two groups, those who received standard intravenous LE (medium-chain triglyceride [MCT]/long-chain triglyceride [LCT]) and those who received intravenous omega-3-enriched LE. Differences in AST, ALT, and TG levels were measured before surgery and 3 days after the administration of parenteral nutrition. Results: Liver enzyme and TG levels in each group did not differ significantly before versus 3 days after surgery. However, TG levels were significantly lower in the omega-3-enriched intravenous LE group (p=0.041) at 3 days after surgery, and statistically significant difference in changes in TG levels was noted at 3 days after surgery between MCT/LCT intravenous LE group and the omega-3-enriched intravenous LE group (p=0.008). Conclusion: The intravenous omega-3-enriched LE had a better TG-lowering effect than the MCT/LCT intravenous LE in children undergoing gastrointestinal surgery.