Objective: High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry. Methods: We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months. Results: Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours. Conclusion The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.

BACKGROUND: The safety and clinical effectiveness data of peramivir in the real clinical field are limited. A prospective observational study was conducted based on the post-marketing surveillance data to evaluate the post-marketing safety and effectiveness of peramivir in Korean adults with seasonal influenza. METHODS: Among adults aged 20 years or older who were diagnosed with influenza A or B, patients who started peramivir within 48 hours from the initial symptoms of influenza were enrolled. All adverse events (AEs) that occurred within 7 days after administration of peramivir were checked. For the evaluation of effectiveness, changes in the severity of influenza symptoms and daily living performance were examined before and 7 days after the administration of peramivir. The date on which influenza related symptoms disappeared was checked. RESULTS: A total of 3,024 patients were enrolled for safety evaluation and 2,939 patients were for effectiveness evaluation. In the safety evaluation, 42 AEs were observed in 35 (1.16%) patients. The most common AE was fever. AEs were mostly rated as mild in severity. Serious AEs were observed in 10 patients and two of them died. However, both deaths were considered to be less relevant to peramivir. In the effectiveness evaluation, the severity of influenza symptoms decreased by 10.68 ± 4.01 points and daily living performance was improved 5.59 ± 2.16 points. Influenza related symptoms disappeared on average 3.02 ± 2.39 days after peramivir administration. CONCLUSION: Peramivir showed a tolerable safety profile and acceptable effectiveness in Korean adult patients with seasonal influenza.
Adult* ; Fever ; Humans ; Influenza, Human* ; Observational Study* ; Prospective Studies* ; Seasons ; Treatment Outcome

PURPOSE: Therapeutic hypothermia (TH) has become a standard strategy for reducing brain damage in the postresuscitation period. The aim of this study is to investigate the outcomes and current performance of TH with out-of-hospital cardiac arrest (OHCA) survivors through the Korean hypothermia network (KORHN) registry. METHODS: We used the KORHN registry, a web-based, multicenter registry that includes 24 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TH from 2007 to 2012 were included. The primary outcomes were neurologic outcome at hospital discharge and in-hospital mortality. The secondary outcomes were TH performance and adverse events during TH. RESULTS: A total of 930 patients were included; of these, 556 (59.8%) patients survived to discharge and 249 (26.8%) were discharged with good neurologic outcomes. The median time from return of spontaneous circulation (ROSC) to the start of TH was 101 (interquartile range (IQR): 46-200) minutes. The induction, maintenance, and rewarming durations were 150 (IQR: 80-267) minutes, 1440 (IQR: 1290-1440) minutes, and 708 (IQR: 420-900) minutes, respectively. The time from the ROSC to coronary angiography was 1,045 (IQR: 121-12,051) hours. Hyperglycemia (46.3%) was the most frequent adverse event. CONCLUSION: Over one quarter of OHCA survivors (26.8%) were discharged with good neurologic outcome. TH performance was managed appropriately in terms of the factors related to the timing of TH, which were the start time for cooling and the rewarming duration.
Adult ; Brain ; Coma ; Coronary Angiography ; Hospital Mortality ; Humans ; Hyperglycemia ; Hypothermia* ; Hypothermia, Induced ; Korea ; Out-of-Hospital Cardiac Arrest* ; Registries ; Republic of Korea ; Rewarming ; Survivors

Reports of extradural spinal meningioma are rare, and differentiation from a metastatic lesion is important. We treated a case of thoracic extradural meningioma with surgical excision and obtained a favorable outcome without recurrence during one-year follow-up. Thus, we report on a case with review of the literature.
Follow-Up Studies ; Meningioma* ; Recurrence ; Spine*

Xylitol is a sugar alcohol with a variety of functions including bactericidal and anticariogenic effects. However, the cellular mechanisms underlying the role of xylitol in bone metabolism are not yet clarified. In our present study, we exploited the physiological role of xylitol on osteoclast differentiation in a co-culture system of osteoblastic and RAW 264.7 cells. Xylitol treatment of these co-cultures reduced the number of tartrate-resistant acid phosphatase (TRAP)-positive multinucleated cells induced by 10 nM 1alpha,25(OH)2D3 in a dose-dependent manner. A cell viability test revealed no marked cellular damage by up to 100 mM of xylitol. Exposure of osteoblastic cells to xylitol decreased RANKL, but not OPG, mRNA expression in the presence of 10(-8) M 1alpha,25(OH)2D3 in a dose-dependent manner. Furthermore, bone resorption activity, assessed on bone slices in the co-culture system, was found to be dramatically decreased with increasing xylitol concentrations. RANKL and OPG proteins were assayed by ELISA and the soluble RANKL (sRANKL) concentration was decreased with an increased xylitol concentration. In contrast, OPG was unaltered by any xylitol concentration in this assay. These results indicate that xylitol inhibits 1alpha,25(OH)2D3-induced osteoclastogenesis by reducing the sRANKL/OPG expression ratio in osteoblastic cells.
Acid Phosphatase ; Bone Resorption ; Cell Survival ; Coculture Techniques ; Enzyme-Linked Immunosorbent Assay ; Isoenzymes ; Osteoblasts ; Osteoclasts ; Proteins ; RNA, Messenger ; Vitamins ; Xylitol

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.
Aged ; Angiography ; Choroid ; Ethnic Groups ; Eye ; Female ; Fluorescein ; Humans ; Hypertension ; Incidence ; Korea ; Macular Degeneration ; Male ; Membranes ; Photography ; Retinaldehyde ; Smoke ; Smoking ; Specialization

The purpose of this project was to study the effect of calcium sulfate on early bony consolidation in distraction osteogenesis in the dog model. Eight canine dogs were used for this study. The lateral surface of the mandibular body was exposed in the subperiosteal plane and the vertical osteotomy on the mandibular body was carried out. An external distraction device was applied to the mandibular body. Mandibular distraction was started 5 days after the osteotomy at a rate of 1mm per day for a total of 10mm distraction in the control group 1 and in the calcium sulfate group 1, and at a rate 2mm per day for a total of 10mm distraction in the control group 2 and in the calcium sulfate group 2. After completion of distraction, the gel type calcium sulfate was implanted into the distracted zone in the calcium sulfate groups. External distraction device was left in place for 6 weeks to allow for bony consolidation. Serial radiographs were carried out every week. One dog of each group, a total of four dogs, were sacrificed at the time of 3 weeks and another four dogs at 6 weeks after distraction. Address Correspondence : Byung Chae Cho, M.D., Department of Plastic and Reconstructive Surgery, College of Medicine, Kyungpook National University, 50, Samduk-Dong 2Ga, Chung-Gu, Taegu 700-421, Korea, Tel: 053) 420-5681/Fax: 053)425-3879/E-mail: bccho@knu.ac.kr New bone was generated in the distracted zone in the control group 1 and in the calcium sulfate groups. However, new bone was not developed in the control group 2. In the calcium sulfate group 1, osteogenesis was seen and abundant active osteoblasts formed woven bone in the edges and center of the distracted zone by 3 weeks after calcium sulfate implantation. By 6 weeks after calcium sulfate implantation, much active woven bone had been formed in most of the area of the distracted zone with a narrow fibrous interzone. In the calcium sulfate group 2, new bone formation was developed in one half of the distracted zone at 6 weeks after implantation. New bone formation was lesser than the calcim sulfate group 2 at 6 weeks after implantation. In conclusion, calcium sulfate is effective for easily bony consolidation in distraction osteogenesis.
Animals ; Calcium Sulfate* ; Dogs ; Osteoblasts ; Osteogenesis ; Osteogenesis, Distraction* ; Osteotomy

The purpose of this study is to investigate the effect of artificial dermis(Terudermis(R)) on cartilage induction from perichondrium. A total of 24 rabbits were used and divided into control(n = 12) and experimental groups(n = 12). Each group was divided into 2 weeks(n = 6) and 4 weeks subgroups(n = 6). The dorsal skin of the rabbit ear was incised in reverse L-shape and the perichondrium was exposed. The silicone membrane from the Terudermis(R) , 1 x 1 cm sized,was removed. The Terudermis(R) was grafted on the exposed perichondrium in the experimental group. However, Terudermis(R) was not grafted in the control group. At 2 and 4 weeks after the surgery, the specimen was obtained and studied by histologic study. The results are as follows: 1. In control group at 2 weeks after surgery, the appearance of perichondrocytes and chondrocytes were not different from those of normal tissue. 2. In control group at 4 weeks after surgery, the extent of chondroblast differentiation and cartilage regeneration was insignificant compared to experimental group. 3. In experimental group at 2 weeks after surgery, we examined the active differentiation process of chondroblast beneath the perichondrium. The mean thickness of the neocartilage layer was 0.11+/-0.04 mm. 4. In experimental group at 4 weeks after surgery, there was an active regenerated new cartilage layer eneath the perichondrium, but the neocartilage layer was immature. The mean thickness of neocartilage layer was 0.33+/-0.10 mm. In conclusion, this study suggested that the grafted Terudermis(R) has an effect on chondrogenetic induction by activating the perichondrium.
Cartilage ; Chondrocytes ; Chondrogenesis* ; Dermis* ; Ear ; Membranes ; Rabbits ; Regeneration ; Silicones ; Skin ; Transplants

The purpose of this study was to evaluate the influence of different types of PLGA scaffolds on the formation of human auricular and septal cartilages. The scaffolds were formed in tubular shape from 110,000 g/mol PLGA (poly lactic glycolic acid) and 220,000 g/mol one. Elastic cartilage was taken from the ear of a patient aged under 20 years old and hyaline cartilage from the nasal septum. The chondrocytes cells were then isolated by Klausburn method. After second passages, the chondrocytes were seeded on the PLGA scaffolds followed by in vitro culture for one week. The cells-PLGA scaffold complex was implanted at the back of nude mouses for 8 weeks. The tissue engineered cartilages were separated from nude mouse and examined histologically after staining with the Hematoxylin Eosin and Verhoeff. The formation of extracellular matrix and the porosity of the scaffolds were examined by scanning electron microscopy. The pores were well formed and uniformly distributed in both 110,000 g/mol and 220,000 g/mol PLGA scaffolds. The extracellular matrix was formed better in 110,000 g/mol PLGA compared to 220,000 g/mol one. And hyaline cartilage was proliferated better in vitro culture than elastic cartilage. After 8 weeks in vivo culture, cartilage was well formed with 110,000 g/mol PLGA, however lumen was collapsed. In contrast with 220,000 g/mol PLGA scaffold, neocartilage was formed in minimal amount while the architecture of scaffold was well preserved. Elastic cartilage seems to be better than hyaline one in terms of neocartilage formation. From the analysis after Verhoeff staining the cartilages, the neocartilage from elastic cartilage was proved to be elastic cartilage. In summary, there was no significant difference between elastic cartilage and hyaline cartilage in their morphologies, proliferation rates and the degree of cartilage formation since they were tissue engineered, however marked difference was found in neocartilage formation and preservation of scaffold architecture between 110,000 g/mol PLGA scaffold and 220,000 one. From the present findings, it is concluded that the influence of scaffold materials is significantly higher than that of different types of cells on the formation of new tissues.
Animals ; Cartilage* ; Chondrocytes* ; Ear ; Elastic Cartilage ; Eosine Yellowish-(YS) ; Extracellular Matrix ; Hematoxylin ; Humans* ; Hyalin* ; Hyaline Cartilage ; Mice ; Mice, Nude ; Microscopy, Electron, Scanning ; Nasal Septum ; Porosity ; Young Adult

Sixteen dogs were used to study the effect of bone morphogenic protein(BMP-4), betaig-h3 and chitosan during the early bony consolidation stage in the distracted zones of mandibles. The lateral surface of the mandibular body was exposed in the subperiosteal plane and vertical osteotomy was carried out on the mandibular body. An external distraction device was applied to the mandibular body about 1 cm apart from the osteotomy line. Mandibular distraction was started 5 days after the mandibular osteotomy at a rate of 2 mm per day for a total of 10 mm distraction for 5 days. The experimental group was divided into 4 groups: control group, BMP-4 group, betaig-h3 group and chitosan group depending on the injected material into the distracted area. Four dogs were allocated to each group. On the day of completion of distraction, 0.5 ml of BMP-4, 0.5 ml of betaig-h3, 0.5 ml of 5% chitosan solution was injected respectively into the distracted area of each group with the same amount of tripolyphosphate in dual syringe for solidification of the injected solution. In the control group, 1 ml of tripolyphosphate was injected into the distracted area. After injection of the study materials, the distraction device was left in place for 4 or 7 weeks to allow bony consolidation. Radiographs were taken weekly. Two dogs in each group, a total of eight dogs, were sacrified in 4 weeks, and another eight dogs in 7 weeks after completion of distraction. Bone specimens of the distracted mandibles were taken for histologic examination. The mineral density of the distracted bone was measured during the radiological procedures and analysed by the computer. In the radiographs of the distracted areas of the mandibles, the control group has shown a mostly radiolucent zone but the other groups have shown the radiodense zones with various width of central radiolucent zones. The central radiolucent zone became narrower in time and vertical thickness of the radiodense zone was about twice thicker in 7 weeks than that of 4 weeks after finishing bone distraction. BMP-4 group showed the thickest radiodense zone and the chitosan group shows the thinnest radiodense zone. The mineral density of bone was highest in the BMP-4 group and lowest in the control group. In the histological findings of the distracted areas of mandibles, the control group showed whole fibrous tissue but the other groups showed new woven bones with central narrow fibrous interzone. The degree of new bone formation was most remarkable in the BMP-4 group and was least remarkable in the chitosan group. In conclusion, there was an active formation of a new bone in the distracted area of the mandible by injection of BMP-4, betaig-h3 and chitosan. The new bone formation was most remarkable in the BMP-4 group followed by betaig-h3, chitosan and control group. These findings suggest that BMP-4 is clinically worth using for early bony consolidation in the distraction osteogenesis.
Animals ; Chitosan* ; Dogs ; Humans* ; Mandible* ; Mandibular Osteotomy ; Osteogenesis ; Osteogenesis, Distraction* ; Osteotomy ; Syringes