PURPOSE: We studied this study to see the effect of hearing music on response to pain during needling. We hypothesized that music would reduce pain in newborns. METHODS: Twenty term and near-term newborns were enrolled for the study. They were admitted to neonatal intensive care unit of Hanyang University Guri Hospital from May 1, 2011 to September 30, 2011. We evaluated pain response to needling, such as arterial puncture or heel prick, by using Neonatal Infant Pain Scale (NIPS; facial expression, crying, breathing patterns, arms, legs, state of arousal) and duration of crying through video recording. We started video recording when the newborns were stable with 0 score of NIPS, and continued for 3 minutes after needling. Each newborn took video-recordings in 2 separate periods. One was done with hearing music (Music group) and the other without music (Control group). Two observers reviewed the videotapes and gave final scores in agreement. T-test was done for comparisons of pain scale and duration of crying between music and control groups. RESULTS: Mean age and hospital days at test of the subjects were 6+/-5 days of life (1-16 days of life) and 3+/-2 days, respectively. Twenty-one of 40 needlings (52.5%) for blood sample were from radial arterial puncture and 19 (47.5%) from heel prick. The music group had lower NIPS score than the controls (5.6+/-1.1 vs 6.5+/-0.7, P=0.006). Among the NIPS parameters, the music group had lower scores in crying and arm (crying, 1.6+/-0.5 vs 1.9+/-0.3, P=0.028; arm, 0.3+/-0.5 vs 0.7+/-0.5, P=0.01) parameters. The remaining parameters such as facial expression, leg, breathing patterns and state of arousal, and duration of crying were not significantly different in 2 groups. CONCLUSION: c reduced pain response to needling in newborns. Music could be one of modalities to relieve pain during routine medical procedures in newborns.
Arm ; Arousal ; Crying ; Facial Expression ; Hearing* ; Heel ; Humans ; Infant ; Infant, Newborn* ; Intensive Care, Neonatal ; Korea ; Leg ; Music* ; Punctures ; Respiration ; Video Recording ; Videotape Recording

We describe 2 cases in which radiographic evidence of thromboembolic events was obtained during germ cell tumor diagnosis. There was no evidence of coagulation factor abnormalities or contributory procedures or drugs in either patient. We used anticoagulation therapy for thrombolysis in one patient, but in the other, the thromboembolism resolved spontaneously.
Blood Coagulation Factors ; Child ; Germ Cells ; Humans ; Neoplasms, Germ Cell and Embryonal ; Thromboembolism

PURPOSE: To evaluate the incidence and degree of bile duct dilatation after partial gastrectomy due togastric cancer and to determine any differences between gastroduodenostomy (Billoth I) and gastrojejunostomy(Billoth II). MATERIALS AND METHODS: We retrospectively analyzed the follow up abdominal CT findings in 113patients who had undergone partial gastrectomy without truncal vagotomy or cholecystectomy. In all cases,preoperative abdminal CT findings showed no evidence of bile duct dilatation. Among 113 patients, 41 underwentBilloth I surgery, and 72 underwent Billoth II. No case showed clinical or radiological evidence of obstructivecauses of bile duct dilatation. Among these patients, we decided the criteria for dilatation when this was noted.The grade was either mild (3 -4 mm), moderate (5 -8mm), or severe (over 9mm), as measured at the centralintra-hepatic duct. Extra-hepatic duct dilatation was graded as mild (6 -8mm), moderate (9 -12mm) or severe (over13 mm). We analyzed serum bilrirubin and alkaline phosphatase levels. RESULTS: When the central intrahepatic ductwas measured, 78 of 113 patients(69 %) showed bile duct dilata-tion; 24 of 41 cases(58.5 %) were in the billoth Igroup and 54 of 72 (75 %) were the in Billoth II group. After measurement of the extra hepatic duct, 22 of41cases(53.6%) in the Billoth I group and 54 of 72 (75 %) in the Billoth II group were found to be dilated. Theresults showed a slightly increased incidence of bile duct dilatation in the Billoth, II group but this was notstatistically significant(p>0.05). In the laboratory, total, direct, and indirect bilirubin, as well as alkalinephosphatase levels, were measured. Higher levels were found in Billoth II than in Billoth I but all findings werewithin normal limits. CONCLUSION: Mild dilatation of the bile duct after partial gastrectomy was a not uncommonfinding, and there was no significant difference of incidence or degree of dilatation according to the procedureperformed. If a patient has no clinical symptoms, it appears that clinical it appears that clinical evaluationdoes not require fur-ther study.
Alkaline Phosphatase ; Bile Ducts* ; Bile* ; Bilirubin ; Cholecystectomy ; Dilatation* ; Follow-Up Studies ; Gastrectomy* ; Hepatic Duct, Common ; Humans ; Incidence ; Retrospective Studies ; Stomach Neoplasms* ; Stomach* ; Tomography, X-Ray Computed ; Vagotomy, Truncal

Background: Regimens for the treatment of multidrug-resistant tuberculosis (MDR-TB) have been changed from injectable-containing regimens to all-oral regimens. The economic effectiveness of new all-oral regimens compared with conventional injectable-containing regimens was scarcely evaluated. This study was conducted to compare the cost-effectiveness between all-oral longer-course regimens (the oral regimen group) and conventional injectablecontaining regimens (the control group) to treat newly diagnosed MDR-TB patients. Methods: A health economic analysis over lifetime horizon (20 years) from the perspective of the healthcare system in Korea was conducted. We developed a combined simulation model of a decision tree model (initial two years) and two Markov models (remaining 18 years, sixmonth cycle length) to calculate the incremental cost-effectiveness ratio (ICER) between the two groups. The transition probabilities and cost in each cycle were assumed based on the published data and the analysis of health big data that combined country-level claims data and TB registry in 2013–2018. Results: The oral regimen group was assumed to spend 20,778 USD more and lived 1.093 years or 1.056 quality-adjusted life year (QALY) longer than the control group. The ICER of the base case was calculated to be 19,007 USD/life year gained and 19,674 USD/QALY. The results of sensitivity analyses showed that base case results were very robust and stable, and the oral regimen was cost-effective with a 100% probability for a willingness to pay more than 21,250 USD/QALY. Conclusion This study confirmed that the new all-oral longer regimens for the treatment of MDR-TB were cost-effective in replacing conventional injectable-containing regimens.