No abstract available.

OBJECTIVE: To evaluate the efficacy of low dose gonadotropin releasing hormone agonist(GnRH-a) therapy combined with high dose human menopausal gonadotrpin(hMG) following estrogen & progesteron therapy for poor responders. METHODS: From May 1997 to Feb 1999, 36 patients who were defined as poor responders on previous consecutive two and more superovulation cycles were randomly allocated to lowdose GnRH-a short protocol with high dose hMG protocol pretreated with estrogen & progesterone(E/P therapy)(n=16)(study group) and the clomiphene citrate with hMG(n=20)(control group). All patients were planned to undergone in-vitro- fertilization(IVF) and embryo transfer(ET) after controlled ovarian hyperstimulation(COH). RESULTS: Two groups were similar with respect to clinical features and basal FSH and E2 levels. The mean level of E2 on day 5, 304.3+/-148.ng/ml in study group was significantly higher than that in control group, 182+/-34.9ng/ml. The mean levels of E2 on hCG day was also significantly higher in study group than control group(1324+/-320ng/ml, vs 414+/-168ng/ml). The mean day of hCG day in study group, 12.3+/-0.3 was shorter than that in control group, 13.8+/-0.4. The concellation rates of cycles were significantly lower in study group than control group(13.2% vs 84.2%). But clinical pregnancy rates did not showed the significant difference between two groups. CONCLUSION: The study suggested that a lowdose GnRH-a short protocol with high dose hMG pretreated with estrogen & progesterone can improve the ovarian response in poor responder group.
Clomiphene ; Embryonic Structures ; Estrogens ; Gonadotropin-Releasing Hormone* ; Humans ; Pregnancy Rate ; Progesterone ; Superovulation

The safety and feasibility of simple coil embolization and stent deployment for the treatment of posterior inferior cerebellar artery (PICA) aneurysms, as well as their radiologic and clinical results, have not been adequately understood. Especially, if dissecting aneurysm of proximal PICA is associated with small caliber PICA and stenosis of ipsilateral vertebral artery orifice (VAO), endovascular coiling with saving of PICA is not always easy. This 64-year-old man presented with subarachnoid hemorrhage due to a ruptured dissecting aneurysm of left proximal PICA. The aneurysm was irregularly fusiform in nature with a shallow PICA orifice (1.4 mm) and narrow caliber (0.9–1.5 mm). Moreover, the ipsilateral VAO showed severe stenosis (1.8 mm). We performed bifemoral puncture and chose additional route from right vertebral artery to left vertebrobasilar junction for retrograde approach and deployment of LVIS Jr. intraluminal support at proximal PICA. And then, the antegrade approach and coiling of aneurysm was done. Despite of transient thrombus of PICA, the aneurysm was successfully secured with preservation of whole PICA course. For preservation of narrow PICA with ipsilateral VAO stenosis, the contralateral approach and deployment of LVIS Jr. intraluminal support may be considered.
Aneurysm ; Aneurysm, Dissecting ; Arteries ; Constriction, Pathologic ; Embolization, Therapeutic ; Humans ; Middle Aged ; Pica ; Punctures ; Stents ; Subarachnoid Hemorrhage ; Thrombosis ; Vertebral Artery

The aim of this study was to determine if a 457 nm blue laser could effectively polymerize dental composite resins. After light curing 6 dental composite resins using a laser or a LED light-curing unit at 530 mW/cm2 and 900 mW/cm2, respectively, degree of conversion and microhardness were evaluated. Degree of conversion of specimens by the laser and LED was similar (on top surface 54.4–67.7% and 55.2–67.1%, respectively; on bottom surface 35.1–53.8% and 45.4–53.1%, respectively). Microhardness was also similar (on top surface 28.5–83.6 Hv and 19.1–82.4 Hv, respectively; on bottom surface 22.5–65.4 Hv and 16.8–74.4 Hv, respectively), although, in some cases, laser-treated specimens showed slightly lower microhardness than the LED-treated on bottom surface. The present study shows that the 457 nm laser can polymerize dental composite resins to the same level as LED achieved.
Composite Resins ; Polymerization ; Polymers

Objective: : The Solitaire Platinum 4×40 mm stent retriever contains radiopaque markers with a long length. We evaluated the effect of Solitaire Platinum 4×40 mm stent retriever in Solumbra technique thrombectomy, and compared it with shorter Solitaire stent retrievers. Methods: : A total of 70 patients who underwent Solumbra technique thrombectomy with equal diameter (4 mm) and different length (40 vs. 20 mm) Solitaire stent retrievers were divided into two groups : the Solitaire Platinum 4×40 mm stent (4×40) group and the Solitaire FR 4×20 mm stent or Solitaire Platinum 4×20 mm stent (4×20) group. The clinical outcomes, Thrombolysis in Cerebral Infarction score, the first pass reperfusion status, and complications were evaluated and compared between the two groups. Multivariate analysis was performed to evaluate the predictive factors for reperfusion and complete reperfusion from the first pass. Results: : Higher first-pass reperfusion and complete reperfusion were achieved in the 4×40 group (68.0% and 48.0%) than in the 4×20 group (46.7% and 33.3%; p=0.004 and 0.007, respectively). In multivariate analysis, radiopaque device and longer stent retriever were correlated with first-pass reperfusion (p=0.014 and 0.008, respectively) and first-pass complete reperfusion (p=0.022 and 0.012, respectively). Conclusion : Our study demonstrated the usefulness of the Solitaire Platinum 4×40 mm stent retriever, which led to higher firstpass reperfusion and complete reperfusion rates than the Solitaire FR 4×20 mm stent or the Solitaire Platinum 4×20 mm stent, especially in Solumbra technique thrombectomy.

Objective: : The low-profile Neuroform Atlas stent can be deployed directly without an exchange maneuver by navigating into the Gateway balloon. This retrospective study assessed the safety and efficacy of Neuroform Atlas stenting as a rescue treatment after failure of mechanical thrombetomy (MT) for large artery occlusion. Methods: : Between June 2018 and December 2019, a total of 31 patients underwent Neuroform Atlas stenting with prior Gateway balloon angioplasty after failure of conventional MT caused by residual intracranial atherosclerotic stenosis (ICAS). Primary outcomes were successful recanalization and patency of the vessel 24 hours after intervention. Secondary outcomes were vessel patency after 14 days and 3-month modified Rankin Scale. Peri-procedural complications, intracerebral hemorrhage (ICH), and 3-month mortality were reviewed. Results: : With a 100% of successful recanalization, median value of stenosis was reduced from 79.0% to 23.5%. Twenty-eight patients (90.3%) showed tolerable vessel patency after 14 days. New infarctions occurred in three patients (9.7%) over a period of 14 days; two patient (6.5%) underwent stent occlusion at 24 hours, and the other patient (3.2%) with delayed stent occlusion had a non-symptomatic dot infarct. There were no peri-procedural complications. Two patients (6.5%) developed an ICH immediately after the procedure with one of them is symptomatic. Conclusion : Neuroform Atlas stenting seems to be an effective and safe rescue treatment modality for failed MT with residual ICAS, by its high successful recanalization rate with tolerable patency, and low peri-procedural complication rate. Further multicenter and randomized controlled trials are needed to confirm our findings.

The purpose of the present study was to assess the temperature change and compressive property of bulk-fill composites (BFCs) by the light curing. Seven resin-based composites (RBCs), including five BFCs, were chosen to evaluate their maximum temperature rise and exothermic heat during and after light curing and compressive strength (CS) and modulus (CM) for 4-mm thick state. Light attenuation coefficients (ACs) showed reasonably high correlation with filler content (vol% and wt%).Except one resin product, AC values of BFCs were lower than those of RBCs tested. All the tested specimens showed temperature rise (9.8-23.6℃) and exothermic heat (4.2-18.3℃) for 4-mm thick case. CS and CM values of the tested specimens ranged approximately 69 to 116 MPa and 1.3 to 2.8 GPa, respectively. The difference of temperature changes and compressive properties (CS and CM) between BFCs and RBCs was not consistent and had no statistically consistent significance.

Purpose: The least constrained prosthesis is generally recommended in primary total knee arthroplasty (TKA). Nevertheless, a varus/valgus constrained (VVC) prosthesis should be implanted when a semi-constrained prosthesis is not good for adequate stability, especially in the coronal plane. In domestic situations, however, the VVC prosthesis could not always be prepared for every primary TKA case. Therefore, it is sometimes impractical to use a VVC prosthesis for unsual unstable situations. This study provides information for preparing VVC prostheses in the preoperative planning of primary TKA through an analysis of primary VVC TKA cases. Materials and Methods: This study reviewed 1,797 primary TKAs, performed between May 2003 and February 2016. The reasons for requiring VVC prosthesis and the preoperative conditions in 29 TKAs that underwent primary TKA with a VVC prosthesis were analyzed retrospectively. Results: In primary TKA, 29 cases (1.6%) in 27 patients (6 male and 21 female) used VVC prosthesis. Two patients underwent a VVC prosthesis on both knees. The mean age of the patients was 63.4 years old (34–79 years). The mean flexion contracture was 16.2° (-20°–90°), and the mean angle of great flexion was 111.7° (35°–145°). The situations requiring a VVC prosthesis were severe valgus deformity in 10 knees, knee stiffness requiring extensive soft tissue release in 10 knees, previously injured collateral ligaments in five knees, and distal femoral bone defect due to avascular necrosis in four knees. The mean tibiofemoral angle was 25.7° (21°–43°) in 10 cases with a valgus deformity. The mean flexion contracture was 37.5° (20°–90°), and the mean range of motion was 48.5° (10°–70°) in 10 cases with knee stiffness. Conclusion The preparation of VVC prosthesis is recommended, even for primary TKA in cases of severe valgus deformity (tibiofemoral angle>20°), stiff knee (the range of motion: less than 70° with more than 20° flexion contracture), and the cases with a previous collateral ligament injury. This information will help in the preparation of adequate TKA prostheses for unusual unstable situations.

Purpose: In medical education, peer assessment is considered to be an effective learning strategy. Although several studies have examined agreement between peer and faculty assessments regarding basic life support (BLS), few studies have done so for advanced resuscitation skills (ARS) such as intubation and defibrillation. Therefore, this study aimed to determine the degree of agreement between medical students’ and faculty assessments of ARS examinations. Methods: This retrospective explorative study was conducted during the emergency medicine (EM) clinical clerkship of fourth-year medical students from April to July 2020. A faculty assessor (FA) and a peer assessor (PA) assessed each examinee’s resuscitation skills (including BLS, intubation, and defibrillation) using a checklist that consisted of 20 binary items (performed or not performed) and 1 global proficiency rating using a 5-point Likert scale. The prior examinee assessed the next examinee after feedback and training as a PA. All 54 students participated in peer assessment. The assessments of 44 FA/PA pairs were analyzed using the intraclass correlation coefficient (ICC) and Gwet’s first-order agreement coefficient. Results: The PA scores were higher than the FA scores (mean±standard deviation, 20.2±2.5 [FA] vs. 22.3±2.4 [PA]; P<0.001). The agreement was poor to moderate for the overall checklist (ICC, 0.55; 95% confidence interval [CI], 0.31 to 0.73; P<0.01), BLS (ICC, 0.19; 95% CI, -0.11 to 0.46; P<0.10), intubation (ICC, 0.51; 95% CI, 0.26 to 0.70; P<0.01), and defibrillation (ICC, 0.49; 95% CI, 0.23 to 0.68; P<0.01). Conclusion Senior medical students showed unreliable agreement in ARS assessments compared to faculty assessments. If a peer assessment is planned in skills education, comprehensive preparation and sufficient assessor training should be provided in advance.

The purpose of the present study was to assess the temperature change and compressive property of bulk-fill composites (BFCs) by the light curing. Seven resin-based composites (RBCs), including five BFCs, were chosen to evaluate their maximum temperature rise and exothermic heat during and after light curing and compressive strength (CS) and modulus (CM) for 4-mm thick state. Light attenuation coefficients (ACs) showed reasonably high correlation with filler content (vol% and wt%).Except one resin product, AC values of BFCs were lower than those of RBCs tested. All the tested specimens showed temperature rise (9.8-23.6℃) and exothermic heat (4.2-18.3℃) for 4-mm thick case. CS and CM values of the tested specimens ranged approximately 69 to 116 MPa and 1.3 to 2.8 GPa, respectively. The difference of temperature changes and compressive properties (CS and CM) between BFCs and RBCs was not consistent and had no statistically consistent significance.