BACKGROUND: Despite progress in intubation techniques, dental trauma is one of the most common complications of general anesthesia. As the flange of the Macintosh blade appears responsible for most dental injuries, we modified the ordinary Macintosh blade by partially removing its flange and evaluated the effectiveness of the modified blade in terms of reducing potential of dental injuries. METHODS: Four hundred and eighty-three patients scheduled for elective surgery requiring general anesthesia with endotracheal tube placement were included in this prospective study. Laryngoscopy was performed twice, once using an ordinary Macintosh No. 3 blade and once using the modified Macintosh blade. The modification consisted of reducing the height of the flange by partial removal, as described by Callander et al. When optimum visibility of the glottis was obtained, the distance between the flange of the blade and the upper incisor was measured. We compared blade-tooth distances and laryngoscopic views for the two blades. RESULTS: The modified blade with low-height flange provided more distance than the ordinary type of blade (P<0.01). The incidence of direct contact between the blade and the upper tooth was 20.3% when the ordinary blade was used, and nearly 80% of these did not involve direct contact when using the modified blade. In addition, the modified blade provided a greater field of view than the ordinary blade (P<0.01). CONCLUSIONS: The modified Macintosh blade used in this study proved to be a useful device, which could reduce dental injuries and provide a better laryngoscopic view during laryngoscopy.
Anesthesia, General ; Glottis ; Humans ; Incidence ; Incisor ; Intubation ; Intubation, Intratracheal ; Laryngoscopes* ; Laryngoscopy ; Prospective Studies ; Tooth

BACKGROUND: There is a well recognized interlaboratory variation in the results using the polymerase chain reaction(PCR) to detect the IS6110 sequence. The clinical utility of a commercially developed PCR test(Amplicor) in bronchial washings for detecting pulmonary tuberculosis in smear negative patients was evaluated. The sensitivity and specificity of Amplicor was compared with that of an in-house PCR test used for detecting the IS6110 sequence of Mycobacterium tuberculosis(M.tbc) in the bronchial washing fluid. METHODS: 66 patients whose sputum smear for M.tbc were negative or who could not produce any sputum were recruited from January 1999 to July 1999. They all had a bronchoscopy performed to determine if there were signs of hemoptysis, patients who could not cough up sputum, lung lesion that exclude pulmonary tuberculosis. Pulmonary tuberculosis was diagnosed on the basis of a positive culture or a response to anti-tuberculosis therapy. RESULTS: 19 patients with tuberculosis were identified and samples from 16 patients were later confirmed by culture. Bronchial washing for Amplicor PCR revealed a sensitivity, specificity, positive and negative predictive values of 94.7%, 97.9%, 94.7%, 97.9%, respectively. Using IS6110 based PCR, the sensitivity, specificity, positive and negative predictive values were of 73.7%, 87.2%, 70%, 89.1% respectively. CONCLUSION: Bronchial washing for Amplicor PCR proved to be more useful than IS6110 based PCR in rapidly diagnosing smear negative pulmonary pulmoary tuberculosis in patients where tuberculosis was likely to be differential and rapid diagnosis was essential for optimal treatment.
Bronchoscopy ; Cough ; Diagnosis* ; Hemoptysis ; Humans ; Lung ; Mycobacterium ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary*

Neurofibromatosis type 1 is the most common tumor predisposition syndrome inherited in an autosomal dominant (100% penetrance) fashion with a wide variety of expressivity. From the perspective of plastic surgery, the most significant clinical symptoms, including disfiguration, peripheral neurologic symptoms, and skeletal abnormalities, are caused by various tumors originating from the affected nerves. Surgical removal is the standard of care for these tumors. However, the outcome is frequently unsatisfactory, facilitating the search for additional therapeutic adjuvants. Current trials of molecularly targeted therapies are promising.Abbreviations: CALMs, café-au-lait macules; CNs, cutaneous neurofibromas; FDG, 18F-fluoro-deoxy-glucose; MAPK, mitogen-activated protein kinase; MPNSTs, malignant peripheral nerve sheath tumors; MRI, magnetic resonance imaging; NF1, neurofibromatosis type 1; NIH, National Institutes of Health; PET, positron emission tomography; PN, plexiform neurofibromas; TME, tumor microenvironment

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.

BACKGROUND: Temporal hollowing is inevitable after decompressive craniectomy. This complication affects self-perception and quality of life, and various techniques and materials have therefore been used to restore patients’ confidence. Autologous fat grafting in postoperative scar tissue has been considered challenging because of the hostile tissue environment. However, in this study, we demonstrate that autologous fat grafting can be a simple and safe treatment of choice, even for postoperative depressed temporal scar tissue. METHODS: Autologous fat grafting was performed in 13 patients from 2011 to 2016. Fat was harvested according to Coleman’s strategy, using a tumescent technique. Patient-reported outcomes were collected preoperatively and at 1-month and 1-year follow-ups. Photographs were taken at each visit. RESULTS: The thighs were the donor site in all cases for the first procedure. The median final volume of harvested fat was 29.4 mL (interquartile range [IQR], 24.0–32.8 mL). The median final volume of fat transferred into the temporal area was 4.9 mL on the right side (IQR, 2.5–7.1 mL) and 4.6 mL on the left side (IQR, 3.7–5.9 mL). There were no major complications. The patient-reported outcomes showed significantly improved self-perceptions at 1 month and at 1 year. CONCLUSIONS: Despite concerns about the survival of grafted fat in scar tissue, we advise autologous fat grafting for patients with temporal hollowing resulting from a previous craniectomy.
Adipose Tissue ; Cicatrix ; Decompressive Craniectomy ; Follow-Up Studies ; Humans ; Lipectomy ; Quality of Life ; Self Concept ; Thigh ; Tissue Donors ; Transplantation ; Transplantation, Autologous ; Transplants

OBJECTIVES: Osteoporosis is a disease of bones that is thought to result from an imbalance between bone resorption and bone formation. Although osteoporosis itself has no symptoms, osteoporosis caused by osteoclasts leads to an increased risk of fracture. Here we examined the effects of cornus officinalis on receptor activator of nuclear factor-kappaB ligand (RANKL)-mediated osteoclast differentiation. METHODS: We evaluated the effects of cornus officinalis on RANKL-induced osteoclast differentiation from bone marrow-derived macrophages (BMMs) and performed a cytotoxicity assay, reverse transcriptase-polymerase chain reaction (RT-PCR), and Western blot analysis. RESULTS: Cornus officinalis significantly inhibits RANKL-mediated osteoclast differentiation in a dose-dependent manner, but without cytotoxicity against BMMs. The mRNA expression of tartrate-resistant acid phosphatase (TRAP), osteoclast-associated receptor (OSCAR), c-Fos, and nuclear factor of activated T cells cytoplasmic 1 (NFATc1) in BMMs treated with RANKL was considerably inhibited by cornus officinalis treatment. Also, cornus officinalis inhibits the protein expression of c-Fos and NFATc1. Cornus officinalis greatly inhibits RANKL-induced phosphorylation of p38 and c-JUN N-terminal kinase (JNK). Also, cornus officinalis significantly suppresses RANKL-induced degradation of I-kappaB. CONCLUSIONS: Taken together, our results suggest that cornus officinalis may be a useful the treatment of osteoporosis.
Acid Phosphatase ; Blotting, Western ; Bone Resorption ; Cornus ; Cytoplasm ; Isoenzymes ; JNK Mitogen-Activated Protein Kinases ; Macrophages ; Osteoclasts ; Osteogenesis ; Osteoporosis ; Phosphorylation ; RANK Ligand ; Receptor Activator of Nuclear Factor-kappa B ; RNA, Messenger ; T-Lymphocytes

BACKGROUND/AIMS: Cancer is known to be a disease by many factors. However, specific results of reprogramming by pluripotency-related transcription factors remain to be scarcely reported. Here, we verified potential effects of pluripotent-related genes in hepatocellular carcinoma cancer cells. METHODS: To better understand reprogramming of cancer cells in different genetic backgrounds, we used four liver cancer cell lines representing different states of p53 (HepG2, Hep3B, Huh7 and PLC). Retroviral-mediated introduction of reprogramming related genes (KLF4, Oct4, Sox2, and Myc) was used to induce the expression of proteins related to a pluripotent status in liver cancer cells. RESULTS: Hep3B cells (null p53) exhibited a higher efficiency of reprogramming in comparison to the other liver cancer cell lines. The reprogrammed Hep3B cells acquired similar characteristics to pluripotent stem cells. However, loss of stemness in Hep3B-iPCs was detected during continual passage. CONCLUSIONS: We demonstrated that reprogramming was achieved in tumor cells through retroviral induction of genes associated with reprogramming. Interestingly, the reprogrammed pluripotent cancer cells (iPCs) were very different from original cancer cells in terms of colony shape and expressed markers. The induction of pluripotency of liver cancer cells correlated with the status of p53, suggesting that different expression level of p53 in cancer cells may affect their reprogramming.
Carcinoma, Hepatocellular ; Cell Line ; Genetic Background ; Induced Pluripotent Stem Cells* ; Liver Neoplasms* ; Pluripotent Stem Cells ; Transcription Factors ; Zidovudine

PURPOSE: We examined the respiratory morbidities in late-preterm infants compared to those of the early-preterm infants and term infants throughout the first year of life. METHODS: Data were retrospectively collected for 87 late-preterm, 72 early-preterm, and 608 term infants who were admitted to NICU and the nursery of Busan St. Mary's Medical Center from Jan 2007 to Oct 2009. RESULTS: There were significant differences in the proportions of the out-born infants, twin pregnancy, small for gestational age, and Caesarean section in the three groups (P<0.05). Late-preterm and early-preterm infants had longer duration of hospitalization, larger proportions of respiratory distress syndrome, mechanical ventilation at birth, oxygen therapy after 48 hours of birth, oxygen dependency at 28 days, and continuous positive airway pressure support at 28 days compared to term infants during the neonatal period (P=0.000). Late-preterm infants and early-preterm infants were re-admitted more often than term infants during the first year of life (P=0.000). Also Late-preterm and early-preterm infants had increased chance of respiratory tract illness than term infants (P=0.001). CONCLUSION: In this study, we demonstrated that there are higher chances of respiratory morbidities in the late-preterm infants than the term infants either during the neonatal period or throughout the first year of life, although early-preterm infants showed greatest respiratory morbidities.
Cesarean Section ; Continuous Positive Airway Pressure ; Dependency (Psychology) ; Female ; Gestational Age ; Hospitalization ; Humans ; Infant ; Nurseries ; Oxygen ; Parturition ; Pregnancy ; Pregnancy, Twin ; Respiration, Artificial ; Respiratory System ; Retrospective Studies

BACKGROUND: Damage to teeth has long been associated with endotracheal intubation. But, no rules designed to predict dental injuries have been formulated. In this prospective study, we undertook to identify relationships between anatomic airway measurements used customarily in bedside practice, and blade-tooth distance during laryngoscopy, to assess the usefulness of these anatomic measurements as predictors of dental injury. METHODS: Four hundred and eighty-three patients scheduled for elective surgery requiring general anesthesia with endotracheal tube placement were included. During a preoperative visit, a number of measurements and assessments of features that might predict difficult intubation were performed. When optimum visibility of the glottis was obtained during laryngoscopy, the distance between the flange of the blade and the upper incisor was measured. We determined which of the individual airway characteristics correlated with the blade-tooth distance and best predicted the potential of dental injury. RESULTS: The blade-tooth distance was found to correlate with the individual scales of the Mallampati classification (Spearman's correlation coefficient, r = - 0.356, P < 0.01), mandibular protrusion (r = - 0.390, P < 0.01), head and neck movement (r = - 0.276, P < 0.01), interincisor gap (r = - 0.648, P < 0.01), and the condition of the upper teeth (r = - 0.313, P < 0.01). The frequency of direct blade-tooth contact significantly increased as the scales of these five anatomic measurements increased (P < 0.01). CONCLUSIONS: This study shows for the first time that some airway measurements are correlated with blade-tooth distance, and that they can be considered as useful predictors of dental injury during laryngoscopy.
Anesthesia, General ; Classification ; Glottis ; Head ; Humans ; Incisor ; Intubation ; Intubation, Intratracheal ; Laryngoscopy* ; Neck ; Prospective Studies ; Tooth ; Weights and Measures

BACKGROUND: Central venous pressure (CVP) monitoring provides a useful estimate of the volume status of the systemic circulation. Both increase in the intrathoracic pressure by applying positive-end expiratory pressure (PEEP) and various patient positioning may commonly mislead the interpretation of CVP. We investigated the effect of body posture and different PEEPs on CVP in anesthetized patients. METHODS: Ninety-one patients (ASA I or II) scheduled for elective surgery with supine (50 patients), lateral decubitus (27 patients), or prone position (14 patients) were included. After induction of general anesthesia, CVP, mean arterial pressure (MAP), heart rate (HR), end-tidal CO2 (EtCO2) and peak inspiratory pressure (PIP) were measured under different PEEP conditions of 0, 5, 10, and 15 cmH2O in each body posture. RESULTS: CVP and PIP increased gradually by the increment of PEEP in patients with all positions. The magnitude of changes of CVP and PIP was significantly greater than other PEEP conditions when PEEP was 15 cmH2O, especially in prone position (P < 0.05). There were no differences in MAP, HR and EtCO2 during the increase of PEEP in all positions. CONCLUSIONS: These results suggest that PEEP as much as 15 cmH2O may alter reliability of CVP in estimating adequate circulatory volumes, especially in prone position.
Anesthesia, General ; Arterial Pressure ; Central Venous Pressure ; Heart Rate ; Humans ; Patient Positioning ; Positive-Pressure Respiration ; Posture ; Prone Position