• Title/Summary/Keyword: sequential treatment

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Multimodal Therapy for Patients with Acute Ischemic Stroke : Outcomes and Related Prognostic Factors

  • Jeong, Seung-Young;Park, Seung-Soo;Koh, Eun-Jeong;Eun, Jong-Pil;Choi, Ha-Young
    • Journal of Korean Neurosurgical Society
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    • v.45 no.6
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    • pp.360-368
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    • 2009
  • Objective : The objectives of this study were to analyze the recanalization rates and outcomes of multimodal therapy that consisted of sequential intravenous (IV)/intra-arterial (IA) thrombolysis, mechanical thrombolysis including mechanical clot disruption using microcatheters and microwires, balloon angioplasty, and stenting for acute ischemic stroke, and to evaluate the prognostic factors related to the outcome. Methods : Fifty patients who were admitted to the hospital within 8 hours from ischemic symptom onset were retrospectively analyzed. Initial IV thrombolysis and subsequent cerebral angiography were performed in all patients. If successful recanalization was not achieved by IV thrombolysis, additional IA thrombolysis with mechanical thrombolysis, including balloon angioplasty and stenting, were performed. The outcomes were assessed by the National Institute of Health Stroke Scale (NIHSS) change and modified Rankin scale (mRS) and prognostic factors were analyzed. Results : Successful recanalization was achieved in 42 (84%) of 50 patients, which consisted of 8 patients after IV thrombolysis, 19 patients after IA thrombolysis with mechanical clot disruption, and 15 patients after balloon angioplasty or stenting. Symptomatic hemorrhage occurred in 4 (8%) patients. Good outcomes were achieved in 76% and 70% of patients upon discharge, and 93% and 84% of patients after 3 months according to the NIHSS change and mRS. The initial clinical status, recanalization achievement, and presence of symptomatic hemorrhage were statistically related to the outcomes. Conclusion : Multimodal therapy may be an effective and safe treatment modality for acute ischemic stroke. Balloon angioplasty and stenting is effective for acute thrombolysis, and produce higher recanalization rates with better outcomes.

Effects of Presowing Seed Treatments on Improvement of Seed Germination and Seedling Emergence of Onion (양파의 발아 및 입묘 향상을 위한 종자처리의 효과)

  • 강진호;정은호;김만배;박정민
    • Korean Journal of Plant Resources
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    • v.17 no.3
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    • pp.219-226
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    • 2004
  • Transplantings of onion (Allium cepa L.) seedlings are required for higher germinability and uniformity. This study was done to determine effects of various seed treatments (seed cleaning, priming, GA$_3$, prechilling, drying, and light quality during seed drying) on germination and seedling emergence. Nongwoodaego and Changnyungdaego were used as cultivars for checking seed germination, and two cultivars and Cheonjuguhyeonghwang were investigated with seedling production rate. Seed cleaning using water prior to the other treatments greatly increased germination rate. Priming with 200mM Ca(NO$_3$)$_2$ solution somewhat alleviated the germination rate while GA$_3$ did not. Prechilling had the highest rate among the treatments. Seed drying after prechilling enhanced the rate compared to non drying, and during drying the prechilled seeds red light illumination showed the greatest rate in comparison with dark, blue, and far-red ones. Seedling production rate was enhanced in sequential treatments of seed cleaning, prechilling for 3 to 5 days, and red light treatment during 6 hour seed drying.

Sequential treatment from mandibulectomy to reconstruction on mandibular oral cancer - Case review I: mandibular ramus and angle lesion of primary intraosseous squamous cell carcinoma

  • Lee, Won-Bum;Hwang, Dae-Seok;Kim, Uk-Kyu
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.47 no.2
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    • pp.120-127
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    • 2021
  • Primary intraosseous squamous cell carcinoma (PIOSCC) is very rare type of squamous cell carcinoma (SCC) that occurs within the jaw and arises from remnants of odontogenic epithelium with no connection to the oral mucosa. This study reports two cases of PIOSCC of the mandible. Reported in this article are two cases of PIOSCC of the mandible that were treated with resection and reconstruction using a fibular free flap. The first case was a 36-year-old male patient who complained of right mandibular pain. Computed tomography (CT) and panoramic radiograph revealed a large radiolucency in the mandibular ramus area. At first, an odontogenic keratocyst was tentatively diagnosed, and an excision procedure was carried out at another clinic. A final biopsy after cyst enucleation revealed well-differentiated SCC, so we proceeded with segmental mandibulectomy and reconstruction using a fibular free flap. The second case was a 48-year-old male patient with left mandibular pain. CT and panoramic radiograph revealed irregular radiolucency in the mandibular angle area near tooth #38. At first, osteomyelitis was tentatively diagnosed, and a curettage was carried out. A later biopsy revealed well-differentiated SCC, so segmental mandibulectomy and reconstruction with a fibular free flap were secondarily performed. Our two cases have had no recurrence. The facial appearance of both patients is satisfactory, and the neo-mandibular body created using a fibular bone transfer displays adequate bony volume.

Assessment of early nutritional state in critical patients with intoxication and the effect of nutritional status on prognosis (중독 중환자에서의 초기 영양상태평가와 예후와의 관계)

  • Ko, Dong-wan;Choi, Sangcheon;Min, Young-gi;Lee, Hyuk jin;Park, Eun Jung
    • Journal of The Korean Society of Clinical Toxicology
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    • v.19 no.2
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    • pp.93-99
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    • 2021
  • Purpose: Nutritional status and support in critically ill patients are important factors in determining patient recovery and prognosis. The aim of this study was to analyze the early nutritional status and the methods of nutritional support in critically ill patients with acute poisoning and to evaluate the effect of nutritional status on prognosis. Methods: A retrospective study was conducted in tertiary care teaching hospital from January 2018 to December 2020. in an emergency department of university hospital, 220 patients who were stayed more than 2 days of poisoning in intensive care unit were enrolled. Results: 155 (70.5%) of patients with acute poisoning had low-risk in nutritional risk screening (NRS). Patients with malignancy had higher NRS (low risk 5.2%, moderate risk 18.5%, high risk 13.2%, p=0.024). Patients of 91.4% supplied nutrition via oral route or enteral route. Parenteral route for starting method of nutritional support were higher in patients with acute poisoning of herbicide or pesticide (medicine 3.2%, herbicide 13.8%, pesticide 22.2%, p=0.000). In multivariate logistic regression analysis, herbicide or pesticide intoxication, higher risk in NRS and sequential organ failure assessment over 4.5 were affecting factor on poor recovery at discharge. Conclusion: NRS in patients intoxicated with herbicide or pesticide were higher than that in patients intoxicated with medicine intoxication. Enteral nutrition in patients intoxicated with herbicide or pesticide was less common. Initial NRS was correlated with recovery at discharge in patient with intoxication. It is expected to be helpful in finding patients with high-risk nutritional status in acute poisoning patients and establishing a treatment plan that can actively implement nutritional support.

Optimization, Purification, and Characterization of Haloalkaline Serine Protease from a Haloalkaliphilic Archaeon Natrialba hulunbeirensis Strain WNHS14

  • Ahmed, Rania S;Embaby, Amira M;Hassan, Mostafa;Soliman, Nadia A;Abdel-Fattah, Yasser R
    • Microbiology and Biotechnology Letters
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    • v.49 no.2
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    • pp.181-191
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    • 2021
  • The present study addresses isolation, optimization, partial purification, and characterization of a haloalkaline serine protease from a newly isolated haloarchaeal strain isolated from Wadi El Natrun in Egypt. We expected that a two-step sequential statistical approach (one variable at a time, followed by response surface methodology) might maximize the production of the haloalkaline serine protease. The enzyme was partially purified using Hiprep 16/60 sephacryl S-100 HR gel filtration column. Molecular identification revealed the newly isolated haloarchaeon to be Natrialba hulunbeirensis strain WNHS14. Among several tested physicochemical determinants, casamino acids, KCl, and NaCl showed the most significant effects on enzyme production as determined from results of the One-Variable-At-A-time (OVAT) study. The BoxBehnken design localized the optimal levels of the three key determinants; casamino acids, KCl, and NaCl to be 0.5% (w/v), 0.02% (w/v), and 15% (w/v), respectively, obtaining 62.9 U/ml as the maximal amount of protease produced after treatment at 40℃, and pH 9 for 9 days with 6-fold enhancement in yield. The enzyme was partially purified after size exclusion chromatography with specific activity, purification fold, and yield of 1282.63 U/mg, 8.9, and 23%, respectively. The enzyme showed its maximal activity at pH, temperature, and NaCl concentration optima of 10, 75℃, and 2 M, respectively. Phenylmethylsulfonyl fluoride (PMSF, 5 mM) completely inhibited enzyme activity.

Immediate effect of Nd:YAG laser monotherapy on subgingival periodontal pathogens: a pilot clinical study

  • McCawley, Thomas K.;McCawley, Mark N.;Rams, Thomas E.
    • Journal of Periodontal and Implant Science
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    • v.52 no.1
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    • pp.77-87
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    • 2022
  • Purpose: This pilot study assessed the immediate in vivo effect of high peak pulse power neodymium-doped yttrium aluminum garnet (Nd:YAG) laser monotherapy on selected red/orange complex periodontal pathogens in deep human periodontal pockets. Methods: Twelve adults with severe periodontitis were treated with the Laser-Assisted New Attachment Procedure (LANAP®) surgical protocol, wherein a free-running, digitally pulsed, Nd:YAG dental laser was used as the initial therapeutic step before mechanical root debridement. Using a flexible optical fiber in a handpiece, Nd:YAG laser energy, at a density of 196 J/cm2 and a high peak pulse power of 1,333 W/pulse, was directed parallel to untreated tooth root surfaces in sequential coronal-apical passes to clinical periodontal probing depths, for a total applied energy dose of approximately 8-12 joules per millimeter of periodontal probing depth at each periodontal site. Subgingival biofilm specimens were collected from each patient before and immediately after Nd:YAG laser monotherapy from periodontal pockets exhibiting ≥6 mm probing depths and bleeding on probing. Selected red/orange complex periodontal pathogens (Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia/nigrescens, Fusobacterium nucleatum, Parvimonas micra, and Campylobacter species) were quantified in the subgingival samples using established anaerobic culture techniques. Results: All immediate post-treatment subgingival biofilm specimens continued to yield microbial growth after Nd:YAG laser monotherapy. The mean levels of total cultivable red/orange complex periodontal pathogens per patient significantly decreased from 12.0% pretreatment to 4.9% (a 59.2% decrease) immediately after Nd:YAG laser monotherapy, with 3 (25%) patients rendered culture-negative for all evaluated red/orange complex periodontal pathogens. Conclusions: High peak pulse power Nd:YAG laser monotherapy, used as the initial step in the LANAP® surgical protocol on mature subgingival biofilms, immediately induced significant reductions of nearly 60% in the mean total cultivable red/orange complex periodontal pathogen proportions per patient prior to mechanical root instrumentation and the rest of the LANAP® surgical protocol.

Surgical Management and Long-Term Results of Rathke's Cleft Cyst

  • Seung-Ho, Seo;Kihwan, Hwang;So Young, Ji;Jung Ho, Han;Chae-Yong, Kim
    • Journal of Korean Neurosurgical Society
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    • v.66 no.1
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    • pp.82-89
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    • 2023
  • Objective : Rathke's cleft cysts (RCCs) are nonneoplastic cysts. Most of them are asymptomatic and stable; when symptomatic, RCCs are surgically fenestrated and drained. However, the outcomes remain unclear. The authors evaluated the outcomes of RCC decompression. Methods : Between 2004 and 2019, 32 RCCs were decompressed in a single tertiary institution. The clinical characteristics, intraoperative findings, postoperative complications, and endocrinological and surgical outcomes were retrospectively reviewed. Patients who underwent sequential imaging at least twice and at least 12 months after surgery were included in the analysis. Results : Patients' mean age was 40.8±14.9 years, and 62.5% were women. The mean follow-up duration was 62.3±48.6 months. In 21 patients (65.6%), no residual cysts were identified on postoperative magnetic resonance imaging. Of the 18 patients with preoperative visual field defects, 17 (94.4%) experienced postoperative visual improvement. Postoperative complications included endocrinological deterioration in 11 patients (34.4%), permanent diabetes insipidus in 11 (34.4%), infection in four (12.5%), intrasellar hemorrhage in three (9.4%), and cerebrospinal fluid leak in two (6.3%). Follow-up images revealed cyst recurrence in nine patients (28.1%), an average of 20.4 months after surgery; in three patients, the cysts were symptomatic, and resection was repeated. Multivariable analysis revealed that postoperative endocrinological deterioration was the only independent factor associated with cyst recurrence (p=0.028; hazard ratio, 6.800). Conclusion : Our findings showed that although only cyst fenestration for decompression was performed to preserve pituitary function, more pituitary dysfunction occurred than expected. Besides, the postoperative hormonal deterioration itself acted as a risk factor for cyst recurrence. In conclusion, surgery for RCC should be more careful.

Sequential anti-inflammatory and osteogenic effects of a dual drug delivery scaffold loaded with parthenolide and naringin in periodontitis

  • Rui Chen;Mengting Wang;Qiaoling Qi;Yanli Tang;Zhenzhao Guo;Shuai Wu;Qiyan Li
    • Journal of Periodontal and Implant Science
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    • v.53 no.1
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    • pp.20-37
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    • 2023
  • Purpose: Our pilot study showed that a 3-dimensional dual drug delivery scaffold (DDDS) loaded with Chinese herbs significantly increased the regenerated bone volume fraction. This study aimed to confirm the synergistic anti-inflammatory and osteogenic preclinical effects of this system. Methods: The targets and pathways of parthenolide and naringin were predicted. Three cell models were used to assess the anti-inflammatory effects of parthenolide and the osteogenic effects of naringin. First, the distance between the cementoenamel junction and alveolar bone crest (CEJ-ABC) and the bone mineral density (BMD) of surgical defects were measured in a rat model of periodontitis with periodontal fenestration defects. Additionally, the mRNA expression levels of matrix metallopeptidase 9 (MMP9) and alkaline phosphatase (ALP) were measured. Furthermore, the number of inflammatory cells and osteoclasts, as well as the protein expression levels of tumor necrosis factor-alpha (TNF-α) and levels of ALP were determined. Results: Target prediction suggested prostaglandin peroxidase synthase (PTGS2) as a potential target of parthenolide, while cytochrome P450 family 19 subfamily A1 (CYP19A1) and taste 2 receptor member 31 (TAS2R31) were potential targets of naringin. Parthenolide mainly targeted inflammation-related pathways, while naringin participated in steroid hormone synthesis and taste transduction. In vitro experiments revealed significant antiinflammatory effects of parthenolide on RAW264.7 cells, and significant osteogenic effects of naringin on bone marrow mesenchymal stem cells and MC3T3-E1 cells. DDDS loaded with parthenolide and naringin decreased the CEJ-ABC distance and increased BMD and ALP levels in a time-dependent manner. Inflammation was significantly alleviated after 14 days of DDDS treatment. Additionally, after 56 days, the DDDS group exhibited the highest BMD and ALP levels. Conclusions: DDDS loaded with parthenolide and naringin in a rat model achieved significant synergistic anti-inflammatory and osteogenic effects, providing powerful preclinical evidence.

Combined bi-borehole technology for grouting and blocking of flowing water in karst conduits: Numerical investigation and engineering application

  • Pan, Dongdong;Zhang, Yichi;Xu, Zhenhao;Li, Haiyan;Li, Zhaofeng
    • Geomechanics and Engineering
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    • v.29 no.4
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    • pp.391-405
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    • 2022
  • A newly proposed grouting simulation method, the sequential diffusion solidification method was introduced into the numerical simulation of combined bi-borehole grouting. The traditional, critical and difficult numerical problem for the temporal and spatial variation simulation of the slurry is solved. Thus, numerical simulation of grouting and blocking of flowing water in karst conduits is realized and the mechanism understanding of the combined bi-borehole technology is promoted. The sensitivity analysis of the influence factors of combined bi-borehole grouting was investigated. Through orthogonal experiment, the influences of proximal and distal slurry properties, the initial flow velocity of the conduit and the proximal and distal slurry injection rate on the blocking efficiency are compared. The velocity variation, pressure variation and slurry deposition phenomenon were monitored, and the flow field characteristics and slurry outflow behavior were analyzed. The interaction mechanism between the proximal and distal slurries in the combined bi-borehole grouting is revealed. The results show that, under the orthogonal experiment conditions, the slurry injection rate has the greatest impact on blocking. With a constant slurry injection rate, the blocking efficiency can be increased by more than 30% when using slurry with weak time-dependent viscosity behavior in the distal borehole and slurry with strong time-dependent viscosity behavior in the proximal borehole respectively. According to the results of numerical simulation, the grouting scheme of "intercept the flow from the proximal borehole by quick-setting slurry, and grout cement slurry from the distal borehole" is put forward and successfully applied to the water inflow treatment project of China Resources Cement (Pingnan) Limestone Mine.

The Association Between Childhood Interpersonal Trauma and Psychiatric Symptom Complexity, and the Mediating Impact of Dissociation (아동기 대인관계 외상, 정신 증상의 복잡성 및 해리의 매개 효과)

  • Kim, Yaeseul;Kim, Seok Hyeon;Kim, Daeho;Kim, Eun Kyoung;Kim, Jiyeong;Choi, Nayeon
    • Anxiety and mood
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    • v.18 no.2
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    • pp.72-79
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    • 2022
  • Objective : Any traumatic event can be a risk factor, for subsequent mental disorder. However, childhood trauma, especially in interpersonal nature, is associated with later development of complex symptom patterns. This study examined the role of dissociation as a mediator between childhood trauma and symptom complexity. Methods : A pooled data of 369 psychiatric outpatients at a university-affiliated hospital was analyzed for descriptive statistics, group differences, and bivariate correlation analysis to verify a structural model. The questionnaires included the Symptom Checklist-90-Revised, the Trauma History Screen, the Dissociative Experiences Scale-Taxon, the Beck Depression Inventory, the Beck Anxiety Inventory, and the Abbreviated PTSD checklist. Results : When other trauma variables were controlled, childhood interpersonal trauma had significant correlation with symptom complexity (r=0.155, p=0.003). Among the paths analyzed, that of childhood interpersonal trauma and dissociation showed the greatest impact on symptom complexity (b=9.34, t=5.75, p<0.001). Based on the significance of the indirect impact, the results suggest a complete mediation impact of dissociation on symptom complexity. Conclusion : This study validated that childhood interpersonal trauma impacts symptom complexity, through the sequential mediating impact of dissociation. Thus, clinicians should understand childhood interpersonal trauma, dissociation, and symptom patterns in a complex and interacting mode, and develop effective pertinent treatment strategies.