Search

Background: Chylothorax after congenital heart surgery is not an uncommon com-plication, and it is associated with significant morbidity. However, consensus treatment guidelines are lacking. To improve the treatment outcomes of patients with postoperative chylothorax, we implemented a standardized management protocol at Severance Hospi-tal in September 2014.Methods: A retrospective review of patients treated at a single center was done. All cor-rective and palliative operations for congenital heart disease performed at our institution between January 2008 and April 2018 were reviewed. The incidence and treatment out-comes of postoperative chylothorax were analyzed.Results: The incidence of chylothorax was 1.9%. Sixty-one percent of the patients could be managed with a low-fat diet, while 28% of the patients required complete restriction of enteral feeding. Thoracic duct embolization was performed in 2 patients and chest tube drainage decreased immediately after the procedure. No patient required thoracic duct ligation or pleurodesis. After implementation of the institutional management protocol, the number of chest tube drainage days decreased (median, 24 vs. 14 days; p=0.45).Conclusion: Implementing a strategy to reduce postoperative chylothorax resulted in an acceptable incidence of postoperative chylothorax. Instituting a clinical practice proto-col helped to curtail the treatment duration and to decrease the requirement for surgical treatment. Image-guided embolization of the thoracic duct is an effective treatment for postoperative chylothorax.

Cerebral air embolism combined with cardiomyopathy secondary to pulmonary barotrauma is rare. Here, we report an unusual case of cerebral air embolism combined with transient cardiomyopathy secondary to large bulla rupture during a pulmonary function test after lung cancer surgery. The patient experienced loss of consciousness. Computed tomography and magnetic resonance imaging suggested a cerebral air embolism. Electrocardiography showed ST-segment elevation and abnormally high plasma levels of cardiac enzymes. Echocardiography and coronary angiography suggested cardiomyopathy. The patient was discharged with no sequelae.

We report a case of acute type I aortic dissection in which an emergency graft replacement of the ascending aorta and innominate artery was performed. We performed false lumen thrombosis through hybrid thoracic endovascular aortic repair to seal the primary entry tear, followed by false lumen obliteration at the level of the descending thoracic aorta, abdominal aorta, and right common iliac artery. Over a period of 4.5 years, we used Amplatzer vascular plugs and coils based on our computed tomography angiography follow-up protocol.

BackgroundResveratrol (RSV) is a polyphenolic phytoalexin that has many effects on metabolic diseases such as diabetes and obesity. Given the importance of brown adipose tissue (BAT) for energy expenditure, we investigated the effects of RSV on brown adipocytes.MethodsFor the in vitro study, interscapular BAT was isolated from 7-week-old male Sprague Dawley rats. For the in vivo study, 7-week-old male Otsuka Long Evans Tokushima Fatty (OLETF) rats were divided into four groups and treated for 27 weeks with: standard diet (SD); SD+RSV (10 mg/kg body weight, daily); high fat diet (HFD); HFD+RSV. RSV was provided via oral gavage once daily during the in vivo experiments.ResultsRSV treatment of primary cultured brown preadipocytes promoted mitochondrial activity, along with over-expression of estrogen receptor α (ER-α). In OLETF rats, both HFD and RSV treatment increased the weight of BAT and the differentiation of BAT. However, only RSV increased the mitochondrial activity and ER-α expression of BAT in the HFD-fed group. Finally, RSV improved the insulin sensitivity of OLETF rats by increasing the mitochondrial activity of BAT, despite having no effects on white adipocytes and muscles in either diet group.ConclusionRSV could improve insulin resistance, which might be associated with mitochondrial activity of brown adipocyte. Further studies evaluating the activity of RSV for both the differentiation and mitochondrial activity of BAT could be helpful in investigating the effects of RSV on metabolic parameters.

Purpose: This study aimed to evaluate the effects of exercise program on chronic low back pain, daily living disability and depression in chronic low back pain patients treated with epidural injections. Methods: The design of this study was a nonequivalent control group pretest-posttest experiment. The sample was recruited among low back pain patients treated with epidural injections from an orthopedic specialty hospital. Participants were randomly assigned to a treatment group (n=25) or a comparison group (n=27). The treatment was a six week exercise program for low back pain. Data were collected from September to November 2011, and were analyzed using descriptive statistics, x2-test, one-tailed t-test for independent samples, and Mann-Whitney U test using the SPSS/WIN 12.0 program. Results: Patients in the treatment group reported statistically significantly lower levels of back pain on flexion and extension, less daily living disability, and less depression than those in the comparison group. Conclusion: The back pain relief exercise program could be an effective adjunct nursing intervention for low back pain patients treated with epidural injections. [ABSTRACT FROM AUTHOR]

Purpose: Purposes of this study were to develop a reliable and valid checklist to assess and manage post-stroke dysphagia and to identify its utilization. Methods: The first step was to develop checklist through systematic literatures reviews, to test the content validity from 11 clinical experts, and to test the construct validity and the internal consistency from 97 patients with post-stroke dysphagia. The second step was to identify clinical use of the check- list from the same 97 patients. Results: A total of 18 items compromised the assessment checklist and 64 items for intervention checklist. Internal consistencies of assessment checklist and intervention checklist were .84 and .98, respectively. In both checklists, level of utilization of general appearance was the highest, while that of early signs of aspiration was the lowest. The utilization levels of two checklists were significantly higher among patients who were less than 60 years old, and had liquid diet, facial paralysis, and previous history of aspiration pneumonia. Conclusion: We found that the checklists were reliable and valid. Further study is needed to develop specific strategies to improve nurses' use of assessment and intervention checklists for post-stroke dysphagia. [ABSTRACT FROM AUTHOR]

Background: The problem with current dental hygienist education is that it operates as an education system based on the national examination rather than on a practical basis; thus, graduates have difficulties in practice after obtaining their license. This study aimed to propose a job-oriented curriculum by analyzing the links between the task analysis of Korean dental hygienists and dental hygiene learning goals.Methods: This study performed a relationship analysis based on a second job analysis study of dental hygienists conducted by the Korea Health Personnel Licensing Examination Institute and the learning goals of the Korean Dental Hygiene Faculty Association.Results: Based on the links between the task and learning goals of the dental hygienist, they were classified into six types: 1) tasks listed in the license exam and learning goal, 2) tasks not listed in the license exam but listed in learning goals, 3) tasks not listed in learning goals, 4) learning goals not related to tasks, 5) learning goals listed in a few tasks, and 6) tasks related to several learning goals. The results showed that most of them correspond to the 5th classification, followed by the 3rd and 4th categories, which are mostly basic science learning goals. Tasks without learning goals are not included in the curriculum; thus, the curriculum needs to be supplemented. The overlapping learning goals of several subjects for one job skill must be reduced in job-oriented education.Conclusion: We suggest that the dental hygiene curriculum be developed based on task analysis and reflected in the national dental hygienist exam. The clinical practice performance of dental hygienists will take further leap forward through task-oriented education.

Background: Smoking in adolescence leads to an intensified addiction to nicotine when physical and mental growth has not yet been completed. With the advent of e-cigarettes, the rate of e-cigarette use among Korean adolescents has been steadily increasing. To date, studies on e-cigarettes and oral health, especially on the relationship between smoking styles and oral health in adolescents, are limited. Therefore, this study aimed to identify the risk factors for oral health problems caused by the repeated use of conventional cigarettes and e-cigarettes.Methods: This explanatory research study compared the adolescents’ experiences of periodontal disease symptoms according to smoking type through a secondary analysis of the original data from the 15th Adolescent Health Behavior Survey (2019). Cross-analysis was performed to compare the smoking patterns according to the adolescents’ general characteristics. Finally, a binary logistic regression analysis was performed to determine how smoking characteristics affect the adolescents’ experience of periodontal disease symptoms.Results: In terms of patients’ general characteristics, significant differences were observed in sex, school level, grades, household economic status, type of residence, and father’s education level between adolescents who smoked conventional cigarettes alone and those who smoked both conventional cigarettes and e-cigarettes (p＜0.05). After checking the factors affecting the smoking pattern and the experience of periodontal disease symptoms in adolescents, it was found that the duplicate smoking group was more likely to experience periodontal disease symptoms (odds ratio, 1.20) than the group that smoked conventional cigarettes alone (p＜0.05).Conclusion: Duplicate smokers experienced more symptoms of periodontal disease than those who smoked cigarettes alone. Based on the findings of this study, smoking cessation counseling according to the smoking type and differentiated education for oral health promotion should be provided.

Ebstein anomaly is a rare congenital heart malformation typically involving the tricuspid valve and the right ventricle that has a wide range of anatomical and pathophysiological presentations. Various surgical repair techniques for Ebstein anomaly have been report-ed because of its near-infinite anatomical variability. Cone repair for Ebstein anomaly can achieve nearly anatomical reconstruction of the tricuspid valve with promising outcomes. In this article, the surgical techniques for cone repair in adult patients with Ebstein anom-aly are described in detail, and clinical experiences and technically challenging cases are presented.

Background: Owing to the increase in the aging population, the health problems of the elderly have become important social problems. Social support has a positive effect on improving the quality of life and prolonging the life of elderly people. It is one of the major factors that affects the oral health status of elderly people. The purpose of this study was to examine the relationship between oral health status and social support in elderly people using representative data.Methods: In this study, data from a community health survey in 2015 involving 63,929 elderly people aged over 65 years were analyzed. T-test and ANOVA analyses were performed to compare the general characteristics of and perception about social support. Additionally, a linear regression analysis was performed to confirm the relationship between perceptions about social support and subjective oral health status.Results: We found that sex, age, household income, education level, the presence of a spouse, existence of an unmet dental need, and regular oral check-up had a significant effect on subjective oral health status (p＜0.05). In addition, when controlled for all factors, social support has a significant impact on subjective oral health status.Conclusion: The findings indicate that social support is associated with the subjective oral health status of Korean elderly. This suggests that community-level or government investment is required to improve the oral health of the elderly. In particular, policy interventions such as the establishment of facilities that promote social networks, especially facilities based on friendship networks, are needed.

Our review aimed to summarize and evaluate evidence on the effectiveness of bee venom acupuncture (BVA) in the treatment of shoulder pain. Randomized controlled trials (RCTs) evaluating the effectiveness of BVA on shoulder pain were searched up to October 2019 in 11 electronic databases (Medline, Embase, CENTRAL, CiNii, CNKI, VIP, Wanfang, Kmbase, NDSL, RISS, OASIS). The methodological quality of the included RCTs were evaluated using Cochrane Risk of Bias tool and a meta-analysis was performed. Seven studies were included in the review, and four studies were included in the meta-analysis. Comparing BVA plus conventional therapy (CT) with saline injection plus CT, it showed an effect in favor of BVA plus CT in visual analog scale (VAS) and pain rating scale (PRS) (p = 0.02, p = 0.009, respectively). Comparing BVA plus physiotherapy (PT) with saline injection plus PT, it showed that there was no significant difference in VAS and verbal rating scale (VRS) between the two groups. This systematic review and meta-analysis suggest that BVA could be beneficial as an adjuvant treatment for shoulder pain.

Purpose Fluorodeoxyglucose (FDG) uptake of bone marrow (BM) and adipose tissue is known to reflect systemic inflammatory response to cancer cell. The objective of this study was to evaluate the prognostic value of F-18 FDG uptake of BM and determine characteristics of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) on PET/CT images in malignant melanoma. Materials and Methods We retrospectively reviewed 33 patients histopathologically diagnosed with malignant melanoma via FDG PET/CT staging. BM-to-liver uptake ratio (BLR), volume of VAT and SAT, CT Hounsfield unit (HU), and mean of standardized uptake value (SUVmean) of VAT and SAT on PET/CT were measured and prognostic values of these parameters for prediction of disease progression-free survival (DPFS) were evaluated. Results Patients with stage III–IV melanoma had higher CT HU and SUVmean for SAT and VAT but lower volume of VAT compared with patients at stage I–II (p < 0.05). Survival analysis, patients with high CT HU of VAT and SAT, high SUVmean of VAT and SAT, and high BLR showed worse DPFS (all p < 0.05), indicating significant association. However, volume of SAT or VAT failed to show significant association with DPFS (p > 0.05). Conclusion CT HU, SUVmean of SAT and VAT, and BLR provide prognostic information for DPFS in malignant melanoma.

Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.

Background: Chemical meningitis results from foreign materials causing inflammation to the meninges covering the brain and spinal cord. Cerebrospinal fluid (CSF) study of chemical meningitis mimics bacterial meningitis. Case Report: We report three cases of chemical meningitis after spinal or epidural anesthesia with mepivacaine or bupivacaine. They experienced mental change or seizure. The results of CSF study revealed increased polymorphonuclear cell count and protein level and decreased glucose concentration. Gram staining and bacterial culture of CSF were all negative. We started empirical antibiotics and corticosteroids immediately and the patients were rapidly improved. Concclusion: The chemical meningitis should be differentiated in bacterial meningitis because bacterial meningitis is life-threatening and requires immediate antibiotic therapy. Chemical meningitis dramatically responds to steroid. The results of CSF study improved shortly after steroid administration.

Anthracnose crown rot (ACR), caused by Colletotrichum fructicola, is a serious disease of strawberry in Korea. The primary inoculums of ACR were symptomless strawberry plants, plant debris, and other host plants. To effectively control anthracnose in symptomless transplanted strawberries, it is necessary to use diseasefree plants, detect the disease early, and apply a fungicide. Therefore, in 2010 and 2011, we evaluated the efficacy of pre-plant fungicide dips by using strawberry transplants infected by C. fructicola for the control of anthracnose. Dipping plants in prochloraz-Mn for 10 min before planting was most effective for controlling anthracnose in symptomless strawberry plants and resulted in more than 76% control efficacy. Azoxystrobin showed a control efficacy of over 40%, but plants treated with pyraclostrobin, mancozeb and iminoctadine tris showed high disease severity. The control efficacy of the dip treatment with prochloraz-Mn did not differ with temperature and time. Treatment with prochloraz-Mn for more than an hour caused growth suppression in strawberry plants. Therefore, the development of anthracnose can be effectively reduced by dipping strawberry plants for 10 min in prochloraz-Mn before planting.

Background: Cerebral artery dissection comprises a large portion of stroke etiology among young stroke patients. Dissection of the main arterial trunk, such as carotid or vertebral artery, is not rare. However, dissection of peripheral arteries such as the superior cerebellar artery (SCA) is extremely rare. Case Report: A 28 year old man presented with vertigo and gait disturbance. He had posterior neck pain after vomiting and subsequently felt a spinning sensation on the day prior to admission. Neurologic examination on admission showed left beating gaze evoked nystagmus in the left gaze. Left arm ataxia and truncal ataxia were also observed. Diffusion-weighted imaging showed diffusion restriction of the left SCA territory. Cerebral angiography showed fusiform dilatation of the left SCA, suggestive of arterial dissection. Conclusion: We describe a rare case of cerebellar infarction caused by SCA dissection after severe vomiting in a healthy young man.

A scanning electron microscopic study was performed to observe the surface ultrastructures of the third-stage larvae of Gnathostoma hispidum. The early third-stage larvae (EL3) were collected from the viscera of Chinese loaches by the artificial digestion method. The advanced third-stage larvae (ADL3) were recovered from mice experimentally infected with EL3. Both larval worms were fixed with 2.5% glutaraldehyde, dehydrated in graded alcohol, dryed in critical point dryer, and coated with gold. The specimens were observed with a SEM (DS-130C). On the head bulb of both larval stage, the mouth had a pair of lateral lips of equal size and of half moon shape. Each lip had a couple of labial papillae and a small amphid located between the two papillae. The hooklets on the head bulb had single-pointed tips and curved posteriorly. The cuticular spines of EL3 were larger and more densely distributed in the anterior area (about 1.8 micron in length) and gradually decreased in size and number posteriorly. The cuticular spines in the anterior area of ADL3 were sharp-pointed and about 4.5 micron in length, and those in the middle area were about 1.75 micron. The velvety cuticular folds and dot-like cuticular spines were distributed in the posterior area. A cervical papilla was located between the 7th and 8th transverse striations. A dome-like body papilla was located at the posterior 1/4 of body. An ellipsoidal excretory pore was located between the 17th and 18th striations. From the above results, it is suggested that the characteristic SEM findings obtained from this study may be helpful on the species identification of larval Gnathostoma.