BACKGROUND: The aim of this study was to examine the safety and efficacy of sedation and analgesia using remifentanil during percutaneous endoscopic lumbar discectomy (PELD). METHODS: Eighty ASA patients with physical status 1 or 2 who underwent a PELD were enrolled in this study. They were randomized to receive one of two treatments: a fentanyl bolus of 0.7microgram/kg 5 min before the procedure and of 0.7microgram/kg during the procedure (n = 40, group F), or a remifentanil titration at an infusion rate of 0.1-0.3microgram/kg/min available throughout the procedure according to the appeal of pain, level of sedation and side-effects (n = 40, group R). The observer's assessment of alertness/sedation (OAA/S) scale, blood pressure, heart rate, respiratory rate, SpO2, and end tidal CO2 were assessed and measured during and/or after the procedures. The visual analogue scale of pain (VAS), and the patient and endoscopist satisfaction scale were assessed after the procedures. RESULTS: There were no significant differences between the two groups in terms of the recovery characteristics, incidence of complications and satisfaction score of patients. In 92.5% of the cases among the remifentanil group, the spine surgeon made uniform judgements that remifentanil worked better than the usually used fentanyl procedure, whereas in 7.5% of the cases the effects were indifferent. The VAS score of the R group was significantly lower than that of the F group. CONCLUSIONS: We concluded that sedation and analgesia with remifentanil is very useful for painful local procedures such as PELDs.
Analgesia ; Blood Pressure ; Diskectomy* ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Respiratory Rate ; Spine

This study aimed to evaluate the long-term outcomes of teeth treated with reattachment technique in children and adolescents. Twenty seven permanent anterior teeth from 21 patients treated with fragment reattachment were evaluated. Clinical photos and medical records were used to assess treatment outcomes. Effect of pulp treatment and the ratio of fragment on success rate were statistically analyzed. Detachment of fragment was observed in 17 teeth, and their duration of retention was 21.41 ± 23.39 months. Repeated trauma was found to be the most frequent causes of failure. Pulp treatment before reattachment did not affect the success rate (p > 0.05). The mean ratio of fragment was 0.482 ± 0.147, and the success rate was affected by the ratio of fragment (p = 0.018). The median retention time of the teeth was 72 months if the ratio was under 0.5, and 8 months for that of the others. A significant correlation was found between the ratio of fragment and retention time (p = 0.003). Reattachment can be a predictable treatment option for crown fracture in anterior teeth in children and adolescents when a fracture involves less than 50% of the clinical crown.

A 12-year-old girl with nephrotic syndrome was admitted to Kosin University Gospel Hospital because of progressive generalized edema and weight gain for the last one month. From the eighth day of admission, she developed headache and generalized tonic seizures. Magnetic resonance imaging (MRI) of the brain showed multiple T2-high signal intensity lesions in the bilateral posterior parieto-occipital cortex and subcortical white matter. The convulsions responded to anticonvulsant and antihypertensive drugs but recurred again until she developed massive diuresis and became normotensive. Follow-up brain MRI 5 days later showed complete resolution of the previous abnormal lesions. The cause of Posterior Reversible Encephalopathy Syndrome (PRES) in our case remains unclear. Blood pressure has been only moderately elevated when the patient became symptomatic. Here, we report a case of minimal change nephrotic syndrome complicated by PRES with a literature review.
Antihypertensive Agents ; Blood Pressure ; Brain ; Child ; Diuresis ; Edema ; Follow-Up Studies ; Headache ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Seizures ; Weight Gain

BACKGROUND: Many nursing university students were stressed during clinical practice. The purpose of this study was to identify the difference between stress of clinical practice and mental health according to behavioral styles in nursing university students.METHODS: The participants of this study were 233 junior and senior nursing students who had experienced clinical practice. Data were collected by self-report questionnaires in online from November 2017 to March 2018. Collected data were analyzed with SPSS/WIN 25.0 using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients.RESULTS: The most frequent DISC behavior style of the subjects was conscientiousness (43.8%), follewed by steadiness (19.7%), influence (18.9%), and dominance (17.6%). The participants'scores for stress of clinical practice and mental health were 3.35±0.55 and 1.13±0.65. The stress of clinical practice of the subjects was different according to DISC behavior styles(F=2.86, p=.038). The results show that the higher the score of stress of clinical practice was the higher the score of mental health(r=.51, p < .001).CONCLUSION: This study found that the difference of DISC behavioral styles can be attributed to stress of clinical practice. Therefore, nursing intervention program considering with the subjects'DISC behavior styles needs to be developed to reduce their stress of clinical practice.
Humans ; Mental Health ; Nursing ; Students, Nursing

Objectives: In this functional magnetic resonance imaging study, we aimed to investigate the differences in brain activation between individuals with autism spectrum disorder (ASD) and typically developing (TD) individuals during perspective taking. We also examined the association between brain activation and empathic and interoceptive abilities. Methods: During scanning, participants from the ASD (n=17) and TD (n=22) groups were shown pain stimuli and asked to rate the level of the observed pain from both self- and other-perspectives. Empathic abilities, including perspective taking, were measured using an empathic questionnaire, and three dimensions of interoception were assessed: interoceptive accuracy, interoceptive sensibility, and interoceptive trait prediction errors. Results: During self-perspective taking, the ASD group exhibited greater activation in the left precuneus than the TD group. During other-perspective taking, relative hyperactivation extended to areas including the right precuneus, right superior frontal gyrus, left caudate nucleus, and left amygdala. Brain activation levels in the right superior frontal gyrus while taking other-perspective were negatively correlated with interoceptive accuracy, and those in the left caudate were negatively correlated with perspective taking ability in the ASD group. Conclusion Individuals with ASD show atypical brain activation during perspective taking. Notably, their brain regions associated with stress reactions and escape responses are overactivated when taking other-perspective. This overactivity is related to poor interoceptive accuracy, suggesting that individuals with ASD may experience difficulties with the self-other distinction or atypical embodiment when considering another person’s perspective.

Terson syndrome is a vitreous hemorrhage associated with subarachnoid hemorrhage. This can be caused by spontaneous, aneurysmal rupture or traumatic subarachnoid hemorrhage, but never has been reported as a consequence of hemorrhage due to thrombolysis and thrombectomy treatments of acute ischemic stroke patient. A 48-year-old man presented with left sided weakness was diagnosed as cerebral infarction on right middle cerebral artery territory due to complete occlusion of right distal internal carotid, middle cerebral, and anterior cerebral artery. He underwent thrombolysis and mechanical thrombectomy, and subarachnoid hemorrhage developed. Later, visual disturbance on right eye occurred so he was consulted to ophthalmology. Vitreous hemorrhage was found and surgery was recommended after two weeks of observation. After pars planar vitrectomy, visual acuity improved, along with functional ability. Therefore, possibilities of Terson syndrome in patients with subarachnoid hemorrhage have to be kept in mind to improve not only visual acuity but also rehabilitation outcome.
Aneurysm ; Anterior Cerebral Artery ; Cerebral Infarction ; Hemorrhage ; Humans ; Middle Aged ; Middle Cerebral Artery ; Ophthalmology ; Rupture ; Stroke* ; Subarachnoid Hemorrhage* ; Subarachnoid Hemorrhage, Traumatic ; Thrombectomy* ; Treatment Outcome ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage

Complicated malaria is mainly caused by Plasmodium falciparum, but, increasingly, Plasmodium vivax is also being reported as a cause. Since the reemergence of indigenous vivax malaria in 1993, cases of severe malaria have been steadily reported in Korea. Herein, we report a case of vivax malaria complicated by adult respiratory distress syndrome (ARDS) that was successfully managed with extracorporeal membrane oxygenation (ECMO). A 59-year-old man presented at our hospital with fever and abdominal pain, which had persisted for 10 days. On admission, the patient had impaired consciousness, shock, hypoxia and haziness in both lungs, jaundice, thrombocytopenia and disseminated intravascular coagulation, metabolic acidosis, and acute kidney injury. A peripheral blood smear and a rapid diagnostic test verified P. vivax mono-infection. Ten hours after admission, hypoxia became more severe, despite providing maximal ventilatory support. The administration of antimalarial agents, ECMO, and continuous venovenous hemofiltration resulted in an improvement of his vital signs and laboratory findings. He was discharged from the hospital 7 weeks later, without any sequelae.
Acute Kidney Injury ; Anoxia ; Antimalarials/*administration & dosage ; Extracorporeal Membrane Oxygenation ; Humans ; Lung/radiography ; Malaria, Vivax/*complications/diagnosis/radiography/therapy ; Male ; Middle Aged ; Multiple Organ Failure ; Plasmodium vivax/*isolation & purification ; Republic of Korea ; Respiratory Distress Syndrome, Adult/*complications/radiography/therapy ; Treatment Outcome

The object of this study was to evaluate the seasonality of gout in Korea. We retrospectively examined data from 330 patients seen at nine rheumatology clinics, treated with urate lowering therapy (ULT) more than one year after stopping prophylactic medication. Demographic data, clinical and laboratory features, and seasonality of gout onset and flares were collected. Season was classified in three-month intervals. The mean age was 52.2 yr and mean disease duration was 26.8 months. The male to female count was 318:12. The onset of acute gouty attacks was obtained in 256 patients. Gout developed most commonly in summer season (36.7%) (P<0.001) and in June (15.6%, P=0.002). During ULT, there were 147 (male 97.3%) gout flares. Although there was no statistically significant difference, gout flares were more common in summer (30.6%). Aggravating factors were identified in 57 flares: alcohol (72.0%) was most common. In the patients who attained target serum uric acid (<6 mg/dL) at the end of prophylaxis, gout flares were high in fall (35.8%) and September (17.0%). In Korea, the summer is most common season of gout onset and there is a tendency for gout flares to increase during ULT in summer/fall season.
Alcohol Drinking ; Arthritis, Gouty/drug therapy/*epidemiology ; Blood Pressure ; Body Mass Index ; Comorbidity ; Female ; Gout Suppressants/therapeutic use ; Humans ; Lipids/blood ; Male ; Middle Aged ; Proteinuria ; Republic of Korea/epidemiology ; Retrospective Studies ; *Seasons ; *Symptom Flare Up ; Uric Acid/blood