Objective: To compare short- and long-term dentoalveolar, skeletal, and rotational changes evaluated by Björk’s structural method of superimposition between children with Class II malocclusion treated by functional appliances and untreated matched controls. Methods: Seventy-nine prepubertal or pubertal children (mean age, 11.57 ± 1.40 years) with Class II malocclusion were included. Thirty-four children were treated using an activator with a high-pull headgear (Z-activator), while 28 were treated using an activator without a headgear (E-activator). Seventeen untreated children were included as controls. Lateral cephalograms were obtained before treatment (T1), after functional appliance treatment (T2), and after retention in the postpubertal phase (T3). Changes from T1 to T2 and T1 to T3 were compared between the treated groups and control group using multiple linear regression analysis. Results: Relative to the findings in the control group at T2, the sagittal jaw relationship (subspinalenasion- pogonion, p < 0.001), maxillary prognathism (sella-nasion-subspinale, p < 0.05), and condylar growth (p < 0.001) exhibited significant improvements in the Z- and E-activator groups, which also showed a significantly increased maxillary incisor retraction (p < 0.001) and decreased overjet (p < 0.001). Only the E-activator group exhibited significant backward rotation of the maxilla at T2 (p < 0.01). The improvements in the sagittal jaw relationship (p < 0.01) and dental relationship (p < 0.001) remained significant at T3. Condylar growth and jaw rotations were not significant at T3. Conclusions Functional appliance treatment in children with Class II malocclusion can significantly improve the sagittal jaw relationship and dental relationships in the long term.

Pancreatic acinar cell carcinoma (ACC) is a rare neoplasm accounting less than 1% of malignant pancreatic tumors. A 47-year-old male patient visited the emergency room with epigastric pain. Computed tomography or magnetic resonance imaging revealed a 4.7-cm heterogeneously enhanced solid and cystic mass with internal necrosis located in the head of the pancreas. Radiological diagnosis was borderline malignancy such as neuroendocrine tumor or solid pseudopapillary neoplasm. Two months later, the necrotic mass in the pancreas head had grown up to 11 cm, compressing the duodenum, superior mesenteric vein, and proximal transverse colon. Pylorus preserving pancreatoduodenectomy with segmental resection of transverse colon was performed. Histopathological examination revealed that the tumor was pancreatic ACC. The patient recovered without any complication and was doing well without recurrence for 12 months after surgery.

OBJECTIVE: The Ubiquitous Spaced Retrieval-based Memory Advancement and Rehabilitation Training (USMART) program was developed by transforming the spaced retrieval-based memory training which consisted of 24 face-to-face sessions into a self-administered program with an iPAD app. The objective of this study was to evaluate the feasibility and efficacy of USMART in elderly subjects with mild cognitive impairment (MCI). METHODS: Feasibility was evaluated by checking the satisfaction of the participants with a 5-point Likert scale. The efficacy of the program on cognitive functions was evaluated by the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery before and after USMART. RESULTS: Among the 10 participants, 7 completed both pre- and post-USMART assessments. The overall satisfaction score was 8.0+/-1.0 out of 10. The mean Word List Memory Test (WLMT) scores significantly increased after USMART training after adjusting for age, educational levels, baseline Mini-Mental Status Examination scores, and the number of training sessions (pre-USMART, 16.0+/-4.1; post-USMART, 17.9+/-4.5; p=0.014, RM-ANOVA). The magnitude of the improvements in the WLMT scores significantly correlated with the number of training sessions during 4 weeks (r=0.793; p=0.033). CONCLUSION: USMART was effective in improving memory and was well tolerated by most participants with MCI, suggesting that it may be a convenient and cost-effective alternative for the cognitive rehabilitation of elderly subjects with cognitive impairments. Further studies with large numbers of participants are necessary to examine the relationship between the number of training sessions and the improvements in memory function.
Aged ; Alzheimer Disease ; Cognitive Therapy ; Computer User Training ; Dementia ; Education* ; Humans ; Learning ; Memory* ; Mild Cognitive Impairment ; Rehabilitation*

Hemophagocytic lymphohistiocytosis (HLH), associated with acute myelocytic leukemia (AML), is a very rare disease. We here report a case of HLH occurring after induction chemotherapy for AML. AML-associated HLH can be triggered by AML itself, by chemotherapeutic agents, or by infectious complications. Our patient developed a high-grade fever of unknown cause, bilateral pulmonary infiltrates, and shock after successful treatment of AML with induction chemotherapy, and had high serum ferritin, hypertriglyceridemia, hypofibrinogenemia, hemophagocytic histiocytes in bone marrow, low natural killer cell activity, and elevated soluble interleukin-2 receptor levels. A diagnosis of HLH was made. Dexamethasone, cyclosporine, and etoposide were given and allogeneic hematopoietic stem cell transplantation was performed. Careful suspicion of HLH may be warranted if a patient experiences fever of unknown etiology, high ferritin levels, and liver dysfunction during AML treatment.
Bone Marrow ; Cyclosporine ; Dexamethasone ; Diagnosis ; Etoposide ; Ferritins ; Fever ; Hematopoietic Stem Cell Transplantation ; Histiocytes ; Humans ; Hypertriglyceridemia ; Induction Chemotherapy* ; Interleukin-2 ; Killer Cells, Natural ; Leukemia, Myeloid, Acute* ; Liver Diseases ; Lymphohistiocytosis, Hemophagocytic* ; Rare Diseases ; Shock

BACKGROUND: Postoperative nausea and vomiting (PONV) frequently occurs following bimaxillary orthognathic surgeries. Compared to opioids, Nefopam is associated with lower incidences of PONV, and does not induce gastrointestinal tract injury, coagulopathy, nephrotoxicity, or fracture healing dysfunction, which are common side effects of Nonsteroidal anti-inflammatory drugs. We compared nefopam- and fentanyl-induced incidence of PONV in patients with access to patient-controlled analgesia (PCA) following bimaxillary orthognathic surgeries. METHODS: Patients undergoing bimaxillary orthognathic surgeries were randomly divided into nefopam and fentanyl groups. Nefopam 120 mg or fentanyl 700 µg was mixed with normal saline to a final volume of 120 mL. Patients were given access to nefopam or fentanyl via PCA. Postoperative pain intensity and PONV were measured at 30 minutes and 1 hour after surgery in the recovery room and at 8, 24, 48, and 72 hours after surgery in the ward. The frequency of bolus delivery was compared at each time point. RESULTS: Eighty-nine patients were enrolled in this study, with 48 in the nefopam (N) group and 41 in the fentanyl (F) group. PONV occurred in 13 patients (27.7%) in the N group and 7 patients (17.1%) in the F group at 8 hours post-surgery (P = 0.568), and there were no significant differences between the two groups at any of the time points. VAS scores were 4.4 ± 2.0 and 3.7 ± 1.9 in the N and F groups, respectively, at 8 hours after surgery (P = 0.122), and cumulative bolus delivery was 10.7 ± 13.7 and 8.6 ± 8.5, respectively (P = 0.408). There were no significant differences in pain or bolus delivery at any of the remaining time points. CONCLUSION: Patients who underwent bimaxillary orthognathic surgery and were given nefopam via PCA did not experience a lower rate of PONV compared to those that received fentanyl via PCA. Furthermore, nefopam and fentanyl did not provide significantly different postoperative pain control.
Analgesia, Patient-Controlled ; Analgesics, Opioid ; Fentanyl ; Fracture Healing ; Gastrointestinal Tract ; Humans ; Incidence ; Nefopam ; Orthognathic Surgery ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Prospective Studies ; Recovery Room

Saphenous mononeuropathy is an uncommon neuropathy in clinical condition, which may incur from various surgical procedures, direct trauma, or entrapment, and most frequently involves at the adductor canal, or Hunter's canal. A 17-year old female, who was majoring in ballet, visited our rehabilitation clinic for numbness in the medial aspect of the left lower leg for the previous 9 months, without weakness. The electrodiagnostic study revealed only a delayed small potential in the left saphenous nerve. MRI examination showed soft tissue swelling in the medial side of the left knee. Accordingly, we diagnosed the patient with saphenous mononeuropathy around the knee, without lumbar plexopathy or femoral neuropathy. We report a case of saphenous mononeuropathy which developed after repetitive compression on the medial side of the knee without any other iatrogenic injury, and include a review of the relevant literature.
Female ; Femoral Neuropathy ; Humans ; Hypesthesia ; Knee ; Leg ; Mononeuropathies

Chronic kidney disease (CKD)-mineral and bone disorder (CKD-MBD) is a common complication of CKD, often accompanied by extra-skeletal calcification in adult patients. As increased vascular calcification is predicted to increase cardiovascular mortality and morbidity, the revised Kidney Disease: Improving Global Outcomes guidelines recommend avoiding calcium-containing phosphate chelators. However, extra-skeletal calcification is less commonly noticed in pediatric patients. Here, we report our experience of such a complication in pediatric patients receiving maintenance peritoneal dialysis. Extra-skeletal calcification was noticed at the corneas, pelvic cavity, and soft tissues of the lower leg in 4 out of 32 patients on maintenance peritoneal dialysis. These patients experienced the aggravation of extra-skeletal calcifications during peritoneal dialysis, and 2 of them underwent excisional operations. It is required to monitor extra-skeletal calcifications in children on kidney replacement therapy.

Objectives: This study aimed to propose an efficient mental health service plan to be implemented during epidemics by identifying the mental health characteristics of people who have returned from countries with large-scale coronavirus disease-2019 (COVID-19) outbreaks. Methods: We analyzed the mental health evaluation scale data submitted by 504 quarantined people who had returned from countries hit by the COVID-19 pandemic from January to April 2020 through a government support project. Results: The average age of the study group was 35.6±8.72 years, and males accounted for 67.1% and females 32.9% of the total subjects. The screening score for post-traumatic stress disorder was met by 12.1% of the subjects. Moderate to high level of depression and anxiety symptoms were seen in 10.7% and 7.0%, respectively. Also, 2.2% of the group complained of clinical level somatization symptoms, and 1.4% were evaluated as being at a high risk of suicide. The average scores and the proportion of subjects at high risk on all scales were significantly higher in female than in male. In a comparison by age, the average score of post-traumatic stress symptoms was significantly higher in subjects in their 20s than those in their 50s, and the proportion of the subjects at high risk for post-traumatic stress symptoms also showed a significant variation between age groups. However, there were no significant differences by age with respect to depression, anxiety, somatic symptoms, and suicidal tendencies. Conclusion During an epidemic, the mental health problems of people may increase, and the risk appears to be higher in female and young adults. Therefore, in addition to strong protection policies, a customized support system for each target group is required.

Objective: Advanced cervical cancer is still difficult to treat and in the case of recurrent cancer, it is desirable to utilize personalized treatment rather than uniform treatment because the type of recurrence is different for each individual. Therefore, this study aimed to establish a patient-derived organoid (PDO) platform to determine the effects of chemotherapy, radiation therapy, and targeted therapy in cervical cancer. Methods: We established organoids from 4 patients with various types of cervical cancer. The histopathological and gene profiles of these organoid models were compared to determine their characteristics and the maintenance of the patient phenotype. Each type of organoid was also subjected to anticancer drug screening and radiation therapy to evaluate its sensitivity. Results: We established PDOs to recapitulate the main elements of the original patient tumors, including the DNA copy number and mutational profile. We selected 7 drugs that showed growth inhibition in cervical cancer organoids out of 171 using an Food and Drug Administration -approved drug library. Moreover, adenocarcinoma and large-cell neuroendocrine carcinoma showed resistance to radiation therapy. whereas squamous cell carcinoma and villoglandular carcinoma showed a significant response to radiotherapy. Conclusion Our results showed that patient-derived cervical cancer organoids can be used as a platform for drug and radiation sensitivity testing. These findings suggest that patient-derived cervical cancer organoids could be used as a personalized medicine platform and may provide the best treatment options for patients with various subtypes of cervical cancer.