PURPOSE: To develop a robot-arm type image-guided surgery system for percuatneous screw fixation of the sacro-iliac joint and to evaluate its accuracy. MATERIALS AND METHODS: We have developed an image-guided surgery system using a three-dimensional digitizer (Microscribe 3-D G2, Immersion, USA) and a personal computer. The registration error and target localization error at fiducial registration were measured 30 times for each using a phantom made with plastic pelvic bone model (Sawbones, USA). Sixteen 6.5 mm cannulated screws were inserted into four plastic bone models, and the accuracy was evaluated. RESULTS: The target localization error was 1.46+/-0.47 mm while the registration error was 0.73+/-0.23 mm. All of the 16 screws were inserted well across the sacro-iliac joint, and there was neither cortical breach nor collision between screws or washers. CONCLUSION: The accuracy of the developed system was similar to that of optical tracker-based navigation systems, and its helpfulness and usefulness was proven with simulation surgery using plastic bone models.
Immersion ; Joints* ; Microcomputers ; Pelvic Bones ; Plastics ; Surgery, Computer-Assisted*

BACKGROUND/AIMS: Diagnostic or thepapeutic endoscopic retrograde cholangiopancreatography (ERCP) is the mainstream for the pancreaticobiliary disease. However, the ERCP related complications are serious and sometimes fatal to the patients. We have reviewed our experiences of the operative management for the ERCP injury. METHODS: Medical records of 13 patients who underwent laparotomic surgical intervention for various ERCP injuries from March 1996 to August 2002 at Department of Surgery, the Catholic University of Korea were reviewed. RESULTS: The age range of the patients was from 28 to 85 years. There were 5 females and 8 males. 6 patients showed the duodenal perforations and 4 patients suffered from bleedings around the ampulla of Vater. One of the 4 bleeding patients had huge expanding submucosal hematomas throughout the entire duodenum. We found massive retroperitoneal extraluminal air density in one patient but we could not find any leakage of the contrast media during the upper gastrointestinal series, however, this patient complained aggravated peritoneal irritation sign, so we explored the abdomen. Most of the patients had free abdominal or retroperitoneal air shadows (n=7) on plain chest or abdominal X-ray. We diagnosed the uncontrolled bleeding from the sphincterotomy site using the gastroduodenal fiberscopes in 3 patients. On the computed tomogaphic images, one patient showed a huge duodenal hematoma, another one had a retroperitoneal fluid collection and another one revealed a retroperitoneal air shadow. One patient showed aggravated pancreatitis on the serial CT scan and finally the patient developed a hemorrhagic necrotizing pancreatitis, then we explored the abdomen and tried peripancreatic drainage but we lost the patient in 19 postoperative day due to sepsis. The other 12 patients survived by the various surgical procedures. For the 6 patients, we performed duodenotomic sphincteroplasty, tube duodenostomy and biliary drainage with T-tube. One patient survived with Whipple's procedure, one patient improved by the pyloric exclusion and one patient cured with the duodenal diverticulization. Other procedures were primary repair of the duodenum, transduodenal sphincteroplasty and just cholecystectomy and T-tube choledochostomy. CONCLUSION: There was tendency to uneventful improvement of patients by the early detection and urgent laparotomic surgical intervention of the ERCP complication.
Abdomen ; Ampulla of Vater ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholecystectomy ; Choledochostomy ; Contrast Media ; Drainage ; Duodenostomy ; Duodenum ; Female ; Hematoma ; Hemorrhage ; Humans ; Korea ; Male ; Medical Records ; Pancreatitis ; Sepsis ; Sphincterotomy, Transhepatic ; Thorax ; Tomography, X-Ray Computed

We investigated the association between breastfeeding and cognitive development in infants during their first 3 years. The present study was a part of the Mothers' and Children's Environmental Health (MOCEH) study, which was a multi-center birth cohort project in Korea that began in 2006. A total of 697 infants were tested at age 12, 24, and 36 months using the Korean version of the Bayley Scales of Infant Development II (K-BSID-II). The use and duration of breastfeeding and formula feeding were measured. The relationship between breastfeeding and the mental development index (MDI) score was analyzed by multiple linear regression analysis. The results indicated a positive correlation between breastfeeding duration and MDI score. After adjusting for covariates, infants who were breastfed for ≥ 9 months had significantly better cognitive development than those who had not been breastfed. These results suggest that the longer duration of breastfeeding improves cognitive development in infants.
Adult ; *Breast Feeding ; Child Development/*physiology ; Child, Preschool ; Cognition/*physiology ; Demography ; Female ; Follow-Up Studies ; Humans ; Infant ; Interviews as Topic ; Linear Models ; Male ; Mothers/psychology ; Multivariate Analysis ; Program Evaluation ; Prospective Studies ; Republic of Korea

Protein S deficiency is one of the several risk factors for thrombophilia and can cause blood clotting disorders such as deep vein thrombosis and pulmonary embolism. A 54-year-old man was admitted with the complaint of dyspnea and was diagnosed with pulmonary embolism. The patient had very low level of free protein S, total protein S antigen, and protein S activity (type I protein S deficiency). In history taking, we found that his mother, 78 year old, had a history of same disease 10 years ago, and confirmed the pronounced low level of protein S. The patient's son also had very low level of protein S, however there had not been any history of pulmonary embolism yet. This case study suggests that asymptomatic persons with a family history of protein S deficiency and pulmonary embolism should be checked regularly for early detection of the disease, as protein S deficiency can be suspected.
Blood Coagulation ; Dyspnea ; Humans ; Middle Aged ; Mothers ; Protein S ; Protein S Deficiency* ; Pulmonary Embolism* ; Risk Factors ; Thrombophilia ; Venous Thrombosis

Background: The most important aspect of a retrospective cohort study is the operational definition (OP) of the disease. We developed a detailed OP for the detection of sodiumglucose cotransporter-2 inhibitors (SGLT2i) related to diabetic ketoacidosis (DKA). The OP was systemically verified and analyzed. Methods: All patients prescribed SGLT2i at four university hospitals were enrolled in this experiment. A DKA diagnostic algorithm was created and distributed to each hospital;subsequently, the number of SGLT2i-related DKAs was confirmed. Then, the algorithm functionality was verified through manual chart reviews by an endocrinologist using the same OP. Results: A total of 8,958 patients were initially prescribed SGLT2i. According to the algorithm, 0.18% (16/8,958) were confirmed to have SGLT2i-related DKA. However, based on manual chart reviews of these 16 cases, there was only one case of SGLT2i-related DKA (positive predictive value = 6.3%). Even after repeatedly narrowing the diagnosis range of the algorithm, the effect of a positive predictive value was insignificant (6.3–10.0%, P > 0.999). Conclusion Owing to the nature of electronic medical record data, we could not create an algorithm that clearly differentiates SGLT2i-related DKA despite repeated attempts. In all retrospective studies, a portion of the samples should be randomly selected to confirm the accuracy of the OP through chart review. In retrospective cohort studies in which chart review is not possible, it will be difficult to guarantee the reliability of the results.

To elucidate the role of nitric oxide synthase (NOS) in the pathogenesis of experimental autoimmune encephalomyelitis (EAE), we analyzed the expression of constitutive neuronal NOS (nNOS), endothelial NOS (eNOS), and inducible NOS (iNOS) in the spinal cords of rats with EAE. We further examined the structural interaction between apoptotic cells and spinal cord cells including neurons and astrocytes, which are potent cell types of nitric oxide (NO) production in the brain. Western blot analysis showed that three forms of NOS significantly increased in the spinal cords of rats at the peak stage of EAE, while small amounts of these enzymes were identified in the spinal cords of rats without EAE. Immunohistochemical study showed that the expression of either nNOS or eNOS increased in the brain cells including neurons and astrocytes during the peak and recovery stages of EAE, while the expression of iNOS was found mainly in the inflammatory macrophages in the perivascular EAE lesions. Double labeling showed that apoptotic cells had intimate contacts with either neurons or astrocytes, which are major cell types to express nNOS and eNOS constitutively. Our results suggest that the three NOS may play an important role in the recovery of EAE.
Animals ; Apoptosis ; Encephalomyelitis, Autoimmune, Experimental/*enzymology ; Endothelium, Vascular/enzymology ; Immunohistochemistry ; In Situ Nick-End Labeling ; Male ; Nitric Oxide Synthase/*metabolism ; Nitric Oxide Synthase Type I ; Nitric Oxide Synthase Type II ; Nitric Oxide Synthase Type III ; Rats ; Rats, Inbred Lew ; Spinal Cord/*enzymology/pathology

Background: Paxlovid is an oral antiviral drug that received emergency use authorization in South Korea for the treatment of patients with mild-to-moderate coronavirus disease 2019 (COVID-19) on January 14, 2022. Since the onset of the severe acute respiratory syndrome coronavirus 2 pandemic, the virus has continued to evolve. The emergence of new variants has raised concerns about possible reductions in the effectiveness of vaccines and drugs. The effectiveness of Paxlovid in patients infected with the omicron variant and subvariants has not yet been determined. This study assessed the effectiveness of Paxlovid at reducing the risk of severe/critical illness or death and death in patients with mild-to-moderate COVID-19 caused by omicron subvariant BA.5. Methods: In this nationwide retrospective cohort study, data on 8,902,726 patients were collected from four sources (the Drug Utilization Review database, COVID-19 Patient Information Management System, confirmed patient information, and basic epidemiological investigation data) between July 1 and November 30, 2022. Multivariable logistic regression analysis was conducted, with adjustment for age, sex, severe acute respiratory syndrome coronavirus 2 immunity (vaccination), and comorbidities. Results: A total of 1,936,925 patients with COVID-19 were included in the analysis, including 420,996 patients treated with Paxlovid, and 1,515,959 patients not treated with Paxlovid. Paxlovid treatment in patients aged ≥ 60 years of age was associated with significantly reduced risk of severe/critical illness or death (46.0%), and death rate (32.5%), and its effectiveness was high, regardless of vaccination status. Conclusion Paxlovid is effective at reducing the risk of death due to COVID-19 in patients with omicron BA.5 infection, especially in older patients, regardless of vaccination status. This suggests that older patients with COVID-19-related symptoms should be administered Paxlovid, regardless of their vaccination status, to reduce severity and risk of death.

PURPOSE: To elucidate the impact of surgical varicocele repair on the pregnancy rate through new meta-analyses of randomized clinical trials that compared surgical varicocele repair and observation. MATERIALS AND METHODS: The PubMed and Embase online databases were searched for studies released before December 2012. References were manually reviewed, and two researchers independently extracted the data. To assess the quality of the studies, the Cochrane risk of bias as a quality assessment tool for randomized controlled trials was applied. RESULTS: Seven randomized clinical trials were included in our meta-analyses, all of which compared pregnancy outcomes between surgical varicocele repair and control. There were differences in enrollment criteria among the studies. Four studies included patients with clinical varicocele, but three studies enrolled patients with subclinical varicocele. Meanwhile, four trials enrolled patients with impaired semen quality only, but the other three trials did not. In a meta-analysis of all seven trials, a forest plot using the random-effects model showed an odds ratio (OR) of 1.90 (95% confidence interval [CI], 0.77 to 4.66; p=0.1621). However, for subanalysis of three studies that included patients with clinical varicocele and abnormal semen parameters, the fixed-effects pooled OR was significant (OR, 4.15; 95% CI, 2.31 to 7.45; p<0.001), favoring varicocelectomy. CONCLUSIONS: Varicocelectomy for male subfertility is proven effective in men with clinical varicocele and impaired semen quality. Therefore, surgical repair should be offered as the first-line treatment of clinical varicocele in subfertile men.
Bias (Epidemiology) ; Female ; Humans ; Infertility ; Infertility, Male ; Male ; Odds Ratio ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Semen ; Semen Analysis ; Treatment Outcome ; Varicocele

The present study was conducted to determine the antibiotic susceptibilities of local Mycoplasma hyopneumoniae (Mhp) and Mycoplasma hyorhinis (Mhr) filed isolates. Minimum inhibitory concentrations (MICs) of Mhp and Mhr field isolates (twelve each) obtained from enzootic pneumonia-like lung lesions during 2009-2011 from Korea were determined using the broth microdilution method. Tylvalosin showed the highest activity against Mhp and Mhr field isolates, with MIC90 values of 0.06 µg/mL and 0.12 µg/mL, respectively. Therefore, Korean Mhp and Mhr isolates are highly susceptible to tylvalosin.
In Vitro Techniques* ; Korea* ; Lung ; Methods ; Microbial Sensitivity Tests ; Mycoplasma hyopneumoniae* ; Mycoplasma hyorhinis* ; Mycoplasma*

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease caused by the degeneration of motor neurons. Mutations in Cu/Zn superoxide dismutase (SOD1), including G93A, were reportedly linked to familial ALS. SOD1 is a key antioxidant enzyme, and is also one of the major targets for oxidative damage in the brains of patients suffering from Alzheimer's disease (AD). Several lines of evidence suggest that intracellular amyloid beta (Abeta) is associated with the pathogenesis of AD. In this report we demonstrate that intracellular Abeta directly interacts with SOD1, and that this interaction decreases the enzymatic activity of the enzyme. We observed Abeta-SOD1 aggregates in the perinuclear region of H4 cells, and mapped the SOD1 binding region to Abeta amino acids 26-42. Interestingly, intracellular Abeta binds to the SOD1 G93A mutant with greater affinity than to wild-type SOD1. This resulted in considerably less mutant enzymatic activity. Our study implicates a potential role for Abeta in the development of ALS by interacting with the SOD1 G93A mutant.
Amino Acid Sequence ; Amyloid beta-Protein/chemistry/*metabolism ; Amyotrophic Lateral Sclerosis/*enzymology ; Apoptosis ; Cell Line ; Cell Line, Tumor ; Humans ; Molecular Sequence Data ; Point Mutation ; Protein Binding ; Protein Interaction Domains and Motifs ; Superoxide Dismutase/genetics/*metabolism