BACKGROUND AND OBJECTIVES: Although the necessity of hearing aids as one of the rehabilitation methods is increasing, many hearing impaired persons are avoiding the use of behind-the-ear (BTE) hearing aids and prefer the complete-in-the-canal (CIC) hearing aids. CIC hearing aids have cosmetic and acoustic advantages but have problems of acoustic feedback and discomfort in wearing. Changes in the external auditory canal (EAC) by mandibular movements are a primary factor for the acoustic feedback and discomfort. The purpose of this research is to study the pattern of changes in the EAC by mandibular movement using the Korean population as subjects and to get basic data concerning the manufacture of impressions and shells for CIC hearing aids. MATERIALS AND METHODS: Subjects were 19 men with a fit external ear diameter to make CIC hearing aid. Impressions were made by taking 5 different conditions of jaw into consideration : fully opened state, 1/2 opened state, biting state, chewing state and resting state. Impressions were scanned at intervals of O.1mm using a 3D Laser digitizing system. We measured anterior to posterior (AP) width and superior to inferior (SI) height of each impression at the first bend, interbend and the 2nd bend of 5 conditions. RESULTS: Compared with the resting state, statistically significant changes in the AP width of the ear canal were observed at the interbend in the following order : fully opened jaw, 1/2 opened jaw (p <0.05), at 1st bend: 1/2 opened jaw (p<0.05). The 2nd bend biting state showed maximal AP width of the ear canal (p<0.05). The SI height of ear canal revealed statistically insignificant changes. CONCLUSION: We recommend making of ear impressions in the chewing state and shells to be supported at the interbend of the ear canal. The SI dimension of a shell tip should be more ground than AP dimension.
Acoustics ; Ear Canal* ; Ear* ; Ear, External ; Hearing Aids ; Humans ; Jaw ; Male ; Mandible ; Mastication ; Persons With Hearing Impairments ; Rehabilitation

BACKGROUND: The purpose of this study is to identify the differences of risk factors and stroke mechanism between early and late recurrence in patients with long-term antiplatelet therapy for stroke prevention. METHODS: We enrolled 114 consecutive patients with recurrent infarction who had been taking antiplatelet agents regularly since previous noncardioembolic cerebral infarction. Total 81 patients (49 men and 32 women) were met to the inclusion criteria through standardized evaluation. Subjects were classified into two groups depending on the time-to-recurrence after antiplatelet therapy: early antiplatelet failure (within 2 years, n=41, hereafter as "EAF") and later antiplatelet failure (after 2 years, n=40, hereafter as "LAF"). We investigated the differences of clinical factors between two groups using univariate and multivariate analysis. RESULTS: Family history of stroke (29.3% in EAF vs. 10% in LAF, p=0.029) was more frequent in EAF group. Low HDL-cholesterol and High total cholesterol/HDL-cholesterol ratio were associated with the LAF group (p=0.042, 0.005 respectively). Multivariate analysis showed that family history of stroke (OR=5.283, 95%CI 1.178-23.699, p=0.030) and previous infarction classified as large artery atherosclerosis (OR=8.497, 95%CI 1.444-50.015, p=0.018) were significant predictors for EAF whereas total cholesterol/HDL-cholesterol ratio (OR=2.002, 95%CI 1.183-3.389, p=0.010) was for LAF. CONCLUSIONS: This study suggests that family history of stroke and cerebral infarction due to large artery atherosclerosis are more responsible for the early recurrence while dyslipidemic condition is more related to the late recurrence during long-term antiplatelet therapy in patients with previous cerebral infarction.
Arteries ; Atherosclerosis ; Cerebral Infarction ; Humans ; Infarction ; Male ; Multivariate Analysis ; Platelet Aggregation Inhibitors ; Recurrence ; Risk Factors ; Stroke ; Treatment Failure

BACKGROUND: Viral screening assays performed for blood donors are required to have high sensitivity because false negative results can lead to transfusion-transmitted infections. To minimize the number of false negative cases, a systematic quality assurance program is required to verify donor screening tests. METHODS: The current status of quality assurance (QA) for blood donor screening tests in Korea and other countries was reviewed. A quality assurance program using the national standards of the Korea Food and Drug Administration (KFDA) was done as a pilot study to evaluate both the need for such a program and the feasibility of such a program. RESULTS: Singapore had a national quality assurance programs for the anti-HIVdonor screening tests. In the United Kingdom, all laboratories use the NIBSC working standards as QA materials for the donors screening. Ninety-five % (84/80) of blood centers replied that they would participate in a national quality assessment program and 92% (84/77) of the blood centers also felt that an independent organization should be designated to operate the program. Quality control materials with a weak reactivity should be included in a quality assessment program for donor screening. CONCLUSION: We propose 2 models for a National Quality Assurance Program (NQAP). In the first model, an independent national reference laboratory (NRL) needs to be established that operates the national quality assurance program. The second model involves the integration of the national quality assurance program for donor screening into the External Quality Assurance Survey run by the Korean Association of Clinical Assurance for Clinical Laboratory (KAQACL) using the national standards.
Blood Donors ; Donor Selection ; Great Britain ; Humans ; Korea ; Mass Screening ; Pilot Projects ; Quality Control ; Singapore ; Tissue Donors ; United States Food and Drug Administration

While acute anemia is regarded as a precipitating factor of ischemic stroke, there have been few reports on the evolution of infarction in the acute period of ischemic stroke by anemia. We describe a 71-year-old man with acute multiple territory infarction who had progressive neurologic deficits of paraparesis and dysarthria. This case suggests that sustained severe anemia due to intractable intestinal bleeding is an important cause of aggravation of ischemic stroke.
Anemia ; Dysarthria ; Hemorrhage ; Infarction ; Neurologic Manifestations ; Paraparesis ; Precipitating Factors ; Stroke

PURPOSE: Paraquat (1,1-dimethyl-4,4'-bipyridylium chloride) is widely a used non- selective herbicide. In spite of efforts to improve the outcome in patients poisoned with paraquat, the mortality rates still remains high. The purpose of this study is to identify initial stat laboratory parameters which can affect the survival rate of these patients. METHODS: A retrospective analysis by chart review was done on 67 patients who had ingested paraquat and who had presented to the Emergency Medical Center of Chonnam University Hospital from June 1997 to July 2001. RESULTS: The results were as follows: 1) Survivors were significantly younger than the nonsurvivors (38 years vs 44 years, p=0.03). The volume of paraquat ingested by survivors was significantly smaller than that ingested by the deceased (1 mouthful vs 3 mouthfuls, p<0.001). 2) The WBC count and the levels of serum AST, BUN and serum creatinine in the deceased were significantly higher than those in the survivors. The levels of serum potassium and bicarbonate, arterial pH, and base excess in survivors were significantly higher than those in the deceased. 3) A multivariate analysis revealed that serum creatinine, serum potassium, and arterial base excess were associated with the fatality rate. CONCLUSION: Initial stat laboratory parameters including arterial blood gas analysis, renal function test, and serum electrolytes could be used to predict the outcome of patients poisoned with paraquat. However, the development of readily applicable and reliable indices predicting outcome is desired for the future.
Blood Gas Analysis ; Creatinine ; Electrolytes ; Emergencies ; Humans ; Hydrogen-Ion Concentration ; Jeollanam-do ; Mortality ; Mouth ; Multivariate Analysis ; Paraquat* ; Potassium ; Retrospective Studies ; Survival Rate* ; Survivors

BACKGROUND AND OBJECTIVES: Vestibular evoked myogenic potential (VEMP) is muscle reflex caused by surface electrodes following repeated high-intensity auditory stimulation. The current study attempted to determine whether VEMP can be consistently evoked from the sternocleidomastoid muscle (SCM) by the 100 dB air-conducted and 50 dB bone-conducted 500 Hz-tone burst. SUBJECTS AND METHOD: Air-conducted and bone-conducted VEMPs in response to 500 Hz-tone burst were recorded from the SCM of 13 normal volunteers. Subjects were seated on their chairs and made to hold their heads turned up as far as possible towards the side, contralateral to the stimulated ear voluntarily. Two different sound durations (rise/fall time=2 msec, plateau time=2 msec[2/2] and rise/fall time=5 msec, plateau time=5 msec[5/5]) were presented through a insertphone or bone vibrators. Latencies and amplitudes of p13 and n23 responses were measured. RESULTS: All normal volunteers showed p13-n23 responses to 50 dB bone-conducted tone burst as well as to 100 dB air-conducted tone burst. The values of latency of p13 and n23 were the most reliable at 5/5 air-conducted in evaluation by coefficiency of variance. Mean p13 and N23 latencies by airconducted tone burst were significantly longer than those of bone-conducted. Mean p13-n23 amplitudes by air-conducted tone burst were significantly larger than those by bone-conducted at 2/2 sound duration. CONCLUSION: VEMP could be consis-tently evoked by the 100 dB air-conducted and 50 dB bone-conducted 500 Hz-tone burst, especially at 5/5 air-conducted.
Acoustic Stimulation ; Ear ; Electrodes ; Head ; Healthy Volunteers ; Reflex ; Vestibular Evoked Myogenic Potentials*

PURPOSE: To investigate and document a disaster medical response during the collapse of the Gyeongju Mauna Ocean Resort gymnasium, which occurred on February 17, 2014. METHODS: The official records of each institution were verified to select the study population. All the medical records and emergency medical service records were reviewed by an emergency physician. Personal or telephonic interviews were conducted without a separate questionnaire if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. RESULTS: One hundred fifty-five accident victims, who were treated at 12 hospitals mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of the collapse was disseminated in 4 minutes, it took at lease 69 minutes for a dispatch of 4 disaster medical assistance teams to take action; 4.5% of patients were treated on-site, 56.7% were transferred to 2 nearest hospitals, and 42.6% were transferred to hospitals with poor preparation to handle disaster victims. CONCLUSION: In the collapse of the Gyeongju Mauna Ocean Resort gymnasium, the initial triage and distribution of patients were inefficient, with delayed arrival of medical assistance teams. These problems had also been noted in prior mass casualty incidents. Government agencies are implementing improvements, and this study could aid the implementation process.
Disaster Victims ; Disasters* ; Emergencies ; Emergency Medical Services ; Government Agencies ; Gyeongsangbuk-do ; Health Resorts* ; Humans ; Mass Casualty Incidents ; Medical Assistance ; Medical Records ; Social Networking ; Triage ; Wounds and Injuries

OBJECTIVE: To investigate and document the disaster medical response during the Gyeongju Mauna Ocean Resort gymnasium collapse on February 17, 2014. METHODS: Official records of each institution were verified to select the study population. All the medical records and emergency medical service run sheets were reviewed by an emergency physician. Personal or telephonic interviews were conducted, without a separate questionnaire, if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. RESULTS: One hundred fifty-five accident victims treated at 12 hospitals, mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of collapse was disseminated in 4 minutes, dispatch of 4 disaster medical assistance teams took at least 69 minutes to take the decision of dispatch. Four point five percent were treated at the accident site, 56.7% were transferred to 2 hospitals that were nearest to the collapse site, and 42.6% were transferred to hospitals that were poorly prepared to handle disaster victims. CONCLUSION: In the Gyeongju Mauna Ocean Resort gymnasium collapse, the initial triage and distribution of patients was inefficient and medical assistance arrived late. These problems had also been noted in prior mass casualty incidents.
Disaster Victims ; Disasters* ; Emergencies ; Emergency Medical Services ; Gyeongsangbuk-do ; Health Resorts* ; Humans ; Mass Casualty Incidents ; Medical Assistance ; Medical Records ; Social Networking ; Triage ; Wounds and Injuries

BACKGROUND: Dendritic cell (DC)-based vaccines are currently being evaluated as a novel strategy for tumor vaccination and immunotherapy. However, inducing long-term regression in established tumor-implanted mice is difficult. Here, we show that deoxypohophyllotoxin (DPT) induces maturation and activation of bone marrow-derived DCs via Toll-like receptor (TLR) 4 activation of MAPK and NF-kappaB. METHODS: The phenotypic and functional maturation of DPT-treated DCs was assessed by flow cytometric analysis and cytokine production, respectively. DPT-treated DCs was also used for mixed leukocyte reaction to evaluate T cell-priming capacity and for tumor regression against melanoma. RESULTS: DPT promoted the activation of CD8+ T cells and the Th1 immune response by inducing IL-12 production in DCs. In a B16F10 melanoma-implanted mouse model, we demonstrated that DPT-treated DCs (DPT-DCs) enhance immune priming and regression of an established tumor in vivo. Furthermore, migration of DPT-DCs to the draining lymph nodes was induced via CCR7 upregulation. Mice that received DPT-DCs displayed enhanced antitumor therapeutic efficacy, which was associated with increased IFN-gamma production and induction of cytotoxic T lymphocyte activity. CONCLUSION: These findings strongly suggest that the adjuvant effect of DPT in DC vaccination is associated with the polarization of T effector cells toward a Th1 phenotype and provides a potential therapeutic antitumor immunity.
Animals ; Dendritic Cells ; Immunotherapy ; Interleukin-12 ; Lymph Nodes ; Lymphocyte Culture Test, Mixed ; Lymphocytes ; Mice ; Phenotype ; Podophyllotoxin ; T-Lymphocytes ; Toll-Like Receptors ; Up-Regulation ; Vaccination ; Vaccines

PURPOSE: Anthracycline and taxanes are effective agents in advanced breast cancer and prolong survival times. Some patients achieve prolongation of life with capecitabine, gemcitabine, or vinorelbine, even after failure of both anthracycline and taxanes. We analyzed the efficacy and toxicity of gemcitabine and vinorelbine combination chemotherapy in anthracycline- and taxane-pretreated advanced breast cancer. MATERIALS AND METHODS: The medical records of anthracycline- and taxane-pretreated metastatic breast cancer patients who received gemcitabine and vinorelbine combination chemotherapy at the Seoul National University Hospital were reviewed. Gemcitabine (1,000 mg/m2) and vinorelbine (25 mg/m2) were administered intravenously on days 1 and 8 every 3 weeks. RESULTS: Between 2000 and 2006, 57 patients were eligible (median age, 45 years), and the median number of previous chemotherapy regimens was 3 (range, 1~5). The overall response rate was 30% (95% CI, 18.1~41.9), and the disease control rate was 46% (PR, 30%; SD, 16%). The median duration of follow-up was 33.4 months, the median time-to-progression (TTP) was 3.9 months, and the median overall survival was 10.8 months. None of thepatients with patients with anthracycline and taxane primary resistance showed a response and the median TTP for these patients was significantly shorter than that of other patients (1.9 vs. 4.4 months; p=0.018). Although the efficacy was unsatisfactory in patients with both anthracycline and taxane primary resistance, gemcitabine and vinorelbine combination chemotherapy showed comparable efficacy in anthracycline- and/or taxane-sensitive patients and the patients with secondary resistance, even after failure of second-line therapy. Grade 3/4 hematologic toxicities included neutropenia (18.1%) and febrile neutropenia (0.3%), and non-hematologic toxicities were tolerable. CONCLUSION: Gemcitabine and vinorelbine combination chemotherapy in anthracycline- and taxane-pretreated advanced breast cancer was effective and tolerable.
Breast ; Breast Neoplasms ; Bridged Compounds ; Deoxycytidine ; Drug Therapy, Combination ; Fluorouracil ; Follow-Up Studies ; Humans ; Life Support Care ; Medical Records ; Neutropenia ; Taxoids ; Thymine Nucleotides ; Vinblastine ; Capecitabine