The fashion of vascular anastomosis, end-to-end or end-to-side (E-to-S), are depended upon surgeon's preference or surgical situations. In E-to-S anastomosis two different methods of arteriotomy are applicable but it has been suggested the type, either elliptical or slit arteriotomy, play a different role in the flow hemodynamics. We thought that the difference is more considerable in microvascular surgery. This study examines the effects of elliptical versus slit arteriotomy on morphologic vessel patency. Twenty male Sprague-Dawley rats were divided into two groups of ten rats each. Both carotid arteries were selected as a experimental model. During the procedures the rat brain was tolerable to ischemia and all animals were survived after operations. The morphologic analysis of anastomosis site was through resin-casting method with scanning electromicroscopic examination. The results showed notable difference between two groups in three-dimensional morphology at two-month of operation. This difference may affect the flow hemodynamics and long-term vessel patency. In microvascular anastomosis, the mortpologic difference of the elliptical arteriotomy is worse than slit arteriotomy which compromises the vessel circumference.
Animals ; Brain ; Carotid Arteries ; Hemodynamics ; Humans ; Ischemia ; Male ; Models, Theoretical ; Rats ; Rats, Sprague-Dawley

Background and Objectives: Recurrence rates after radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients are not low especially in non-paroxysmal AF. The diameter of left atrium (LA) has been widely used to predict the recurrence after RFCA for decades. However, LA diameter represents structural remodeling of LA and does not reflect electrical remodeling. We aimed to determine the predictive value of electrical remodeling of LA which is represented by the amount of low voltage zone (LVZ). Methods: We performed a retrospective cohort analysis of AF patients who underwent de novo RFCA in a single-center. Results: A total of 3,120 AF patients with de novo RFCA were analyzed. Among these patients, 537 patients underwent an electroanatomic mapping with bipolar voltage measurement of LA.The diameter of LA and flow velocity of LA appendage (LAA) differed significantly according to quartile group of LVZ area and percentage: patients with high LVZ had large LA diameter and low LAA flow velocity (p<0.001). Freedom from late recurrence (LR) was significantly lower in patients with high LVZ area and percentage (p<0.001). The diameter and surface area of LA had area under curve (AUC) of 0.592 and 0.593, respectively (p=0.002 for both). The predictive value of LVZ area (AUC, 0.676) and percentage (AUC, 0.671) were both superior compared with LA diameter (p=0.011 and 0.027 for each comparison). Conclusions In conclusion, LVZ can predict freedom from LR after RFCA in AF patients. Predictive value was higher in parameters reflecting electrical rather than structural remodeling of LA.

PURPOSE: The aim of this study was to evaluate the efficiency of community visiting health service units using DEA and to compare the results with those of traditional evaluation methods. METHODS: Data were collected using 2008 annual reports of 10 districts in one city. Input variables were number of staff and operational budget per year and output variables were number of managed household per nurse, rate of controlled hypertension, and diabetes mellitus. EMS Window version 3.1 was used to measure efficiency score and bootstrapping Chi-square test was applied to identify differences between efficient and non-efficient unit by organizational factors. RESULTS: The average efficiency score of 10 community visiting health services was about 66%. Only two of the units operated program efficiently. The career of the staff was one among other factors associated with efficiency. The evaluation results from the traditional method and DEA were totally different. CONCLUSION: These results indicate that, evaluation methods have very important and significant effects on the evaluation results of community visiting health service units. The DEA method is recommend as an alterative method for evaluating community visiting health service.
Budgets ; Community Health Nursing ; Diabetes Mellitus ; Family Characteristics ; Health Services ; Hypertension

Primary dissociated neuronal cultures are widely used research tools to investigate of pathological mechanisms and to treat various central and peripheral nervous system problems including trauma and degenerative neuronal diseases. We introduced a protocol that utilizes hippocampal and cortical neurons from embryonic day 17 or 18 mice. We applied appropriate markers (GAP-43 and synaptophysin) to investigate whether neurite outgrowth and synaptogenesis can be distinguished at a particular period of time. GAP-43 was found along the neural processes in a typical granular pattern, and its expression increased proportionally as neurites lengthened during the early in vitro period. Unlike GAP-43, granular immunoreactive patterns of synaptophysin along the neurites were clearly found from day 2 in vitro with relatively high immunoreactive levels. Expression of synaptic markers from cortical neurons reached peak level earlier than that of hippocampal neurons, although neurite outgrowths of hippocampal neurons were faster than those of cortical neurons. The amount of peak synaptic markers expressed was also higher in cortical neurons than that in hippocampal neurons. These results strongly suggest the usefulness of primary cultured neurons from mice embryos for synaptic function and plasticity studies, because of their clear and typical patterns of morphology that establish synapses. Results from this study also suggest the proper amount of time in vitro according to neuronal types (cortical or hippocampal) when utilized in experiments related with synaptogenesis or synaptic activities.
Animals ; Embryonic Structures ; GAP-43 Protein ; Mice ; Neurites ; Neurons ; Peripheral Nervous System ; Plastics ; Synapses ; Synaptophysin

PURPOSE: Cost-benefit analysis is one of the most commonly used economic evaluation methods, which helps to inform the economic value of a program to decision makers. However, the selection of a correct benefit estimation method remains critical for accurate cost-benefit analysis. This paper compared benefit estimations among three different benefit estimation models. METHODS: Data from community-based chronic hypertension management programs in a city in South Korea were used. Three different benefit estimation methods were compared. The first was a standard deterministic estimation model; second, a repeated-measures deterministic estimation model; and third, a transitional probability estimation model. RESULTS: The estimated net benefit of the three different methods were $1,273.01, $-3,749.42, and $-5,122.55 respectively. CONCLUSION: The transitional probability estimation model showed the most correct and realistic benefit estimation, as it traced possible paths of changing status between time points and it accounted for both positive and negative benefits.
Adult ; Aged ; Blood Pressure ; Chronic Disease ; Cost-Benefit Analysis/*methods ; Databases, Factual ; Female ; Humans ; Hypertension/economics/*therapy ; Male ; Middle Aged ; *Models, Statistical ; Program Evaluation

Ovarian serous tumors of low malignant potential (borderline serous tumors) are intermediate in their clinical behavior between benign serous cystadenoma and malignant neoplasm, and are associated with 10 year survival rates in excess of 90%. Borderline ovarian serous tumors are characterized by absence of stromal invasion but presence of some characteristics of malignancy. Borderline ovarian tumors occur predominantly in premenopausal women, and associated with a very good prognosis. The principal treatment of borderline malignancy is surgical resection of the primary tumor. But approximatley 20% of patients with ovarian tumors of low malignant potential present with Stage III or IV disease at the time of diagnosis. The benefit of postsurgical therapy in this group of patients has not been well established. We report two cases of advanced ovarian serous borderline tumor, one of which was treated with 3 cycles of cisplatin-taxol chemotherpy.
Cystadenoma, Serous ; Diagnosis ; Female ; Humans ; Prognosis ; Survival Rate

Supine exercise test was done with bicycle ergometer and echocardiography in 28 patients with chronic aortic regurgitation. Ejection fraction was measured before and immediately after exercise from echocardiography, wall stress and radius/thickness ratio was calculated from echocardiography and systolic blood pressure. 1. There was no difference in left ventricular end systolic and diastolic dimension, ejection fraction at rest, radius/thickness ratio, wall stress between NYHA functional class I, II, III. But work capacity was greater in NYHA class I than in class II, III(39712+/-10778 watt-sec, 23766+/-14280 watt-sec, 11968+/-6052 watt-sec respectively). Ejection fraction after exercise was significantly increased in class I(66.3+/-8.9% at rast vs 71.3+/-10.7% after exercise). 2. Ejection fraction was increased more than 5% in 12 patients(group I) and increased less than 5% or decreased in 16 patients(group II). There was no difference in basal E.F., Ded, Des and postexercise heart rate-blod pressure product between group I and II. But between group I and II, there was significant difference in diastolic redius/thickness ratio(2.55+/-0.30 vs 3.00+/-0.51), mean radius/thickness ratio(1.86+/-0.23 vs 2.18+/-0.30), systolic wall stress(192.3+/-38.6mmHg vs 240.2+/-57.7mmHg), mean wall stress(265.8mmHg vs 334.8+/-68.7mmHg) and work capacity(33848+/-12682 watt-sec vs 19210+/-12342 watt-sce). 3. Work capacity was more than 23800 watt-sec in 16 patients(group A), and less than 23800 watt-sec in 12 patients(group B). There was no difference in ejection fraction at rest, radius/thickness ratio, wall stress, and left ventricular dimension. But ejection fraction after exercise was significantly different between group A and B(68.6+/-14.6% vs 55.8+/-14.2%). 4. In nine patients with end systolic dimension greater than 50 mm ejection fraction was decreased or increased less than 5% in 7 patients. So mean ejection fraction was significantly decreased after exercise(56.8+/-7.5% at rest, 51.0+/-16.3% after exercise).
Aortic Valve Insufficiency* ; Blood Pressure ; Echocardiography* ; Exercise Test ; Heart ; Humans

Objectives: In this prospective randomized controlled trial, we measured the primary and secondary stability of two surface-treated implants placed in the posterior maxilla, applied 3-month loading protocols, and compared and analyzed the short-term outcomes of the implants. Patients and Methods: From June 2018 to June 2019, patients with a residual bone height of 4 mm in the posterior maxilla were enrolled and randomly divided into two groups to place SA implants (Osstem Implants, Korea) in Group A and NH implants (Hiossen, USA) in Group B. Finally, 14 implants placed in 13 patients in Group A and 17 implants placed in 14 patients in Group B were analyzed. The measured primary and secondary stability of each implant was represented by implant stability quotient (ISQ), and treatment outcomes were evaluated. Results: Group A consisted of patients with an average age of 62.2 years (range, 48-80 years), and Group B consisted of patients with an average age of 58.1 years (range, 35-82 years). Primary stability was 73.86±6.40 and 71.24±5.32 in Groups A and B, respectively (P=0.222). Secondary stability was 79.07±5.21 in Group A and 78.29±4.74 in Group B (P=0.667). A steep increase in ISQ during the healing period was observed in Group B, though it was not significant (P=0.265). The mean follow-up period was 378.5±164.6 days in Group A and 385.3±167.9 days in Group B. All implants in each group met the success criteria, and the success rate was 100%. Conclusion Two surface-treated implants placed in the posterior maxilla with greater than 4 mm alveolar bone height exhibited successful one-year treatment outcomes if a primary stability of 65 or higher ISQ was obtained and a 3-month early loading protocol was applied.

Objectives: In this prospective randomized controlled trial, we measured the primary and secondary stability of two surface-treated implants placed in the posterior maxilla, applied 3-month loading protocols, and compared and analyzed the short-term outcomes of the implants. Patients and Methods: From June 2018 to June 2019, patients with a residual bone height of 4 mm in the posterior maxilla were enrolled and randomly divided into two groups to place SA implants (Osstem Implants, Korea) in Group A and NH implants (Hiossen, USA) in Group B. Finally, 14 implants placed in 13 patients in Group A and 17 implants placed in 14 patients in Group B were analyzed. The measured primary and secondary stability of each implant was represented by implant stability quotient (ISQ), and treatment outcomes were evaluated. Results: Group A consisted of patients with an average age of 62.2 years (range, 48-80 years), and Group B consisted of patients with an average age of 58.1 years (range, 35-82 years). Primary stability was 73.86±6.40 and 71.24±5.32 in Groups A and B, respectively (P=0.222). Secondary stability was 79.07±5.21 in Group A and 78.29±4.74 in Group B (P=0.667). A steep increase in ISQ during the healing period was observed in Group B, though it was not significant (P=0.265). The mean follow-up period was 378.5±164.6 days in Group A and 385.3±167.9 days in Group B. All implants in each group met the success criteria, and the success rate was 100%. Conclusion Two surface-treated implants placed in the posterior maxilla with greater than 4 mm alveolar bone height exhibited successful one-year treatment outcomes if a primary stability of 65 or higher ISQ was obtained and a 3-month early loading protocol was applied.

Objectives: Ultra-wide implants may be used as a replacement if existing implants fail. This study was conducted to evaluate the factors influencing the prognosis and failure of ultra-wide implants. Patients and Methods: This study evaluated whether sex, age, site, diameter, length, additional surgery, implant stability (primary and secondary), and reason for ultra-wide implant placement affect the 5-year survival and success rates and marginal bone loss (MBL) of ultra-wide implants. Seventy-eight ultra-wide implants that were placed in 71 patients (39 males and 32 females) from 2008 to 2010 were studied. One-way ANOVA analysis was conducted to evaluate the statistical significance of MBL according to the patient’s sex, implant site, and diameter. Independent sample t-tests were used to determine the statistical significance of MBL analysis which was used to determine the significance of the 5-year success and survival rates related to the variables. One-way ANOVA was conducted to evaluate the statistical significance of sex, implantation site, diameter, and MBL. Independent sample t-tests were used to evaluate the correlation between implantability and MBL for implantation reasons, while additional surgery, length, and Kaplan–Meier analysis were used to evaluate 5-year survival and success rates. Results: The mean age of patients was 54.2 years with a survival rate of 92.3% and a success rate of 83.3% over a mean 97.8-month period of observation. MBL averaged 0.2 mm after one year of prosthetic function loading and 0.54 mm at the time of final observation. Success rates correlated with primary stability (P=0.045), survival rates correlated with secondary stability (P=0.036), and MBL did not correlate with any variables. Conclusion Ultra-wide implants can be used to achieve secure initial fixation in the maxillary and mandibular molar regions with poor bone quality or for alternative purposes in cases of previous implant failure.