Purpose: Patients undergoing breast surgery may experience chronic postoperative pain in the breasts, upper extremities, and axillary regions, and no established methods for preventing this pain are available at present. This study aimed to investigate whether coaptation of the transected intercostal nerve can prevent the development of neuropathic and chronic breast pain after mastectomy in implant-based breast reconstruction. Methods: A prospective, double-blind, randomized controlled trial was conducted by dividing patients who underwent implant-based breast reconstruction after mastectomy into a control group without nerve coaptation and an experimental group with nerve coaptation.Patient clinical information was collected, and a survey using the pain and quality of life scale was conducted at 6 and 12 months after surgery. Results: Fifteen patients completed the study, including seven in the control group and eight in the experimental group. The two groups showed no significant differences in terms of clinical factors. The experimental group exhibited lower Short-Form McGill Pain Questionnaire scores than the control group at 6 and 12 months postoperatively, with a statistically significant difference at 6 months. Numerical Rating Scale and Present Pain Intensity scores for both groups were in the “no to mild” range throughout the study period, with no statistically significant differences between the groups. Although the difference in the BREAST-Q™ results did not reach statistical significance, the experimental group showed an improvement in the quality of life. Conclusion Intercostal nerve coaptation after mastectomy in implant-based breast reconstruction may facilitate initial nerve recovery. Although trial results are needed to fully determine the clinical impact, our findings support the ongoing scientific and clinical efforts to use this technique.

Purpose: Patients undergoing breast surgery may experience chronic postoperative pain in the breasts, upper extremities, and axillary regions, and no established methods for preventing this pain are available at present. This study aimed to investigate whether coaptation of the transected intercostal nerve can prevent the development of neuropathic and chronic breast pain after mastectomy in implant-based breast reconstruction. Methods: A prospective, double-blind, randomized controlled trial was conducted by dividing patients who underwent implant-based breast reconstruction after mastectomy into a control group without nerve coaptation and an experimental group with nerve coaptation.Patient clinical information was collected, and a survey using the pain and quality of life scale was conducted at 6 and 12 months after surgery. Results: Fifteen patients completed the study, including seven in the control group and eight in the experimental group. The two groups showed no significant differences in terms of clinical factors. The experimental group exhibited lower Short-Form McGill Pain Questionnaire scores than the control group at 6 and 12 months postoperatively, with a statistically significant difference at 6 months. Numerical Rating Scale and Present Pain Intensity scores for both groups were in the “no to mild” range throughout the study period, with no statistically significant differences between the groups. Although the difference in the BREAST-Q™ results did not reach statistical significance, the experimental group showed an improvement in the quality of life. Conclusion Intercostal nerve coaptation after mastectomy in implant-based breast reconstruction may facilitate initial nerve recovery. Although trial results are needed to fully determine the clinical impact, our findings support the ongoing scientific and clinical efforts to use this technique.

Purpose: Patients undergoing breast surgery may experience chronic postoperative pain in the breasts, upper extremities, and axillary regions, and no established methods for preventing this pain are available at present. This study aimed to investigate whether coaptation of the transected intercostal nerve can prevent the development of neuropathic and chronic breast pain after mastectomy in implant-based breast reconstruction. Methods: A prospective, double-blind, randomized controlled trial was conducted by dividing patients who underwent implant-based breast reconstruction after mastectomy into a control group without nerve coaptation and an experimental group with nerve coaptation.Patient clinical information was collected, and a survey using the pain and quality of life scale was conducted at 6 and 12 months after surgery. Results: Fifteen patients completed the study, including seven in the control group and eight in the experimental group. The two groups showed no significant differences in terms of clinical factors. The experimental group exhibited lower Short-Form McGill Pain Questionnaire scores than the control group at 6 and 12 months postoperatively, with a statistically significant difference at 6 months. Numerical Rating Scale and Present Pain Intensity scores for both groups were in the “no to mild” range throughout the study period, with no statistically significant differences between the groups. Although the difference in the BREAST-Q™ results did not reach statistical significance, the experimental group showed an improvement in the quality of life. Conclusion Intercostal nerve coaptation after mastectomy in implant-based breast reconstruction may facilitate initial nerve recovery. Although trial results are needed to fully determine the clinical impact, our findings support the ongoing scientific and clinical efforts to use this technique.

Rumex acetosa is a folk medicine for gastritis and gastric ulcers. In our previous study, the ethanol extract of R. acetosa inhibited gastric ulcers and protected gastric tissue in mice induced with HCl/ethanol from gastric ulcers. Moreover, we isolated six anthraquinone compounds from this plant and evaluated their antiHelicobacter pylori activity. Therefore, this study was conducted to identify further the related antioxidant and anti-inflammatory activities and the bioactive constituents. Five fractions of n-hexane, methylene chloride, ethyl acetate, n-butanol, and aqueous fractions were obtained from the total ethanolic extract from whole parts of R. acetosa that had exhibited antioxidant and anti-inflammatory activities. The ethyl acetate fraction contained the highest total phenol and flavonoid contents among the five fractions and exhibited the most potent antioxidant effect on 2,2-diphenyl-1-picrylhydrazyl radical scavenging assay. Among the six compounds, emodin showed the most potent antioxidant activity. Next, we induced inflammation in the LPS-induced RAW 264.7 cell line. The methylene chloride fraction showed the strongest reducing nitric oxide production activity among the fractions. In addition, the methylene chloride fraction suppressed the phosphorylation of ERK and JNK, and the expression of cyclooxygenase-2 in a dose-dependent manner. These physiological activities of the fraction and the compounds could be involved in the anti-gastric ulcer activity of R. acetosa

Medial meniscal root tears have been repaired using various methods. Arthroscopic all-inside repair using a suture anchor is one of the popular methods. However, insertion of the suture anchor into the proper position at the posterior root of the medial meniscus is technically difficult. Some methods have been reported to facilitate suture anchor insertion through a high posteromedial portal, a posterior trans-septal portal, or a medial quadriceptal portal. Nevertheless, many surgeons still have difficulty during anchor insertion. We introduce a technical tip for easy suture anchor insertion using a 25° curved guide and a soft suture anchor through a routine posteromedial portal.
Menisci, Tibial ; Surgeons ; Suture Anchors* ; Sutures* ; Tears

BACKGROUND/AIMS: Despite improvements in surgical techniques and postoperative patient care, bile leakage can occur after hepatobiliary surgery and may lead to serious complications. The aim of this retrospective study was to evaluate the efficacy of endoscopic treatment of bile leakage after hepatobiliary surgery. METHODS: The medical records of 20 patients who underwent endoscopic retrograde cholangiopancreatography because of bile leakage after hepatobiliary surgery from August 2009 to September 2014 were reviewed retrospectively. Endoscopic treatment included insertion of an endoscopic retrograde biliary drainage stent after endoscopic sphincterotomy. RESULTS: Most cases of bile leakage presented as percutaneous bile drainage through a Jackson-Pratt bag (75%), followed by abdominal pain (20%). The sites of bile leaks were the cystic duct stump in 10 patients, intrahepatic ducts in five, liver beds in three, common hepatic duct in one, and common bile duct in one. Of the three cases of bile leakage combined with bile duct stricture, one patient had severe bile duct obstruction, and the others had mild strictures. Five cases of bile leakage also exhibited common bile duct stones. Concerning endoscopic modalities, endoscopic therapy for bile leakage was successful in 19 patients (95%). One patient experienced endoscopic failure because of an operation-induced bile duct deformity. One patient developed guidewire-induced microperforation during cannulation, which recovered with conservative treatment. One patient developed recurrent bile leakage, which required additional biliary stenting with sphincterotomy. CONCLUSIONS: The endoscopic approach should be considered a first-line modality for the diagnosis and treatment of bile leakage after hepatobiliary surgery.
Abdominal Pain ; Bile Ducts ; Bile* ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Cholestasis ; Common Bile Duct ; Congenital Abnormalities ; Constriction, Pathologic ; Cystic Duct ; Diagnosis ; Drainage ; Hepatic Duct, Common ; Humans ; Liver ; Medical Records ; Patient Care ; Retrospective Studies ; Sphincterotomy, Endoscopic ; Stents

PURPOSE: The purpose of this study is to compare the effectiveness of the GlideRite with the conventional-malleable-stylet (CMS) in endotracheal intubation (ETI) using the Macintosh-laryngoscope. METHODS: This study is a randomized crossover simulation study. Participants performed ETI using both the GlideRite and the CMS in the normal airway and in a tongue edema (simulated difficult airway resulting in lower percentage of glottis opening [POGO]) model. RESULTS: In both the normal and the tongue edema models, all 36 participants performed ETI successfully using the two stylets on the first attempt. In the normal airway model, there was no difference in time required for ETI (T(ETI)) or ease of handling between the two stylets. In the tongue edema model, the T(ETI) increased as POGO score decreased with the CMS (POGO score showing negative correlation with T(ETI) for the CMS, Spearman's rho=-0.518, p=0.001) but not for the GlideRite (rho=-0.208, p=0.224). The T(ETI) was shorter with the GlideRite than the CMS, but without statistical significance (15.1 vs. 18.8 seconds, p=0.385). Ease of handling was superior with the GlideRite compared to the CMS (p=0.006). CONCLUSION: Performance of the GlideRite and the CMS was not different in the normal airway model. However, in the simulated difficult airway model with a low POGO score, the GlideRite performed better than the CMS for direct laryngoscopic intubation.
Edema ; Glottis ; Intubation ; Intubation, Intratracheal* ; Tongue

PURPOSE: Invariant natural killer T (iNKT) cells play a critical role in the pathogenesis of asthma. We previously reported the association between circulating Th2-like iNKT cells and lung function in asthma patients and the suppressive effect of Toll-like receptor 5 ligand flagellin B (FlaB) on asthmatic in a mouse model. Thus, we investigated whether FlaB modulates the function of circulating iNKT cells in asthmatic patients. METHODS: Peripheral blood mononuclear cells (PBMCs) were treated with FlaB, and the secreted and intracellular cytokines of iNKT cells were evaluated by using ELISA and flow cytometry, respectively, following stimulation with alpha-galactosylceramide. Foxp3+ iNKT cells were also measured. To determine the effect of FlaB-treated dendritic cells (DCs) on iNKT cells, we co-cultured CD14+ monocyte-derived DCs and T cells from patients with house dust mite-sensitive asthma and analyzed intracellular cytokines in iNKT cells. RESULTS: A reduction of IL-4 and IL-17 production by iNKT cells in PBMCs after FlaB treatment was alleviated following blocking of IL-10 signaling. A decrease in the frequencies of IL-4+ and IL-17+ iNKT cells by FlaB-treated DCs was reversed after blocking of IL-10 signaling. Simultaneously, an increase in Foxp3+ iNKT cells induced by FlaB treatment disappeared after blocking of IL-10. CONCLUSIONS: FlaB may inhibit Th2- and Th17-like iNKT cells and induce Foxp3+ iNKT cells by DCs via an IL-10-dependent mechanism in asthmatic patients. In patients with a specific asthma phenotype associated with iNKT cells, FlaB may be an effective immunomodulator for iNKT cell-targeted immunotherapy.
Animals ; Asthma* ; Cytokines ; Dendritic Cells* ; Dust ; Enzyme-Linked Immunosorbent Assay ; Flagellin* ; Flow Cytometry ; Humans ; Immunotherapy ; Interleukin-10 ; Interleukin-17 ; Interleukin-4 ; Lung ; Mice ; Natural Killer T-Cells* ; Phenotype ; T-Lymphocytes ; Toll-Like Receptor 5

OBJECTIVE: To compare the effectiveness of the GlideRite stylet with the conventional malleable stylet (CMS) in endotracheal intubation (ETI) by the Macintosh laryngoscope. METHODS: This study is a randomized, crossover, simulation study. Participants performed ETI using both the GlideRite stylet and the CMS in a normal airway model and a tongue edema model (simulated difficult airway resulting in lower percentage of glottic opening [POGO]). RESULTS: In both the normal and tongue edema models, all 36 participants successfully performed ETI with the two stylets on the first attempt. In the normal airway model, there was no difference in time required for ETI (TETI) or in ease of handling between the two stylets. In the tongue edema model, the TETI using the CMS increased as the POGO score decreased (POGO score was negatively correlated with TETI for the CMS, Spearman’s rho=-0.518, P=0.001); this difference was not seen with the GlideRite (rho=-0.208, P=0.224). The TETI was shorter with the GlideRite than with the CMS, however, this difference was not statistically significant (15.1 vs. 18.8 seconds, P=0.385). Ease of handling was superior with the GlideRite compared with the CMS (P=0.006). CONCLUSION: Performance of the GlideRite and the CMS were not different in the normal airway model. However, in the simulated difficult airway model with a low POGO score, the GlideRite performed better than the CMS for direct laryngoscopic intubation.
Edema ; Intubation ; Intubation, Intratracheal* ; Laryngoscopes* ; Manikins* ; Tongue

PURPOSE: We performed this study to investigate whether there is difference in the effect of intravenous (IV) thrombolysis according to the presence of diffusion-weighted imaging- fluid-attenuated inversion recovery (DWI-FLAIR) mismatch among acute ischemic stroke patients who visited the emergency department (ED) within 3 hours from the onset of symptom. METHODS: Among ED patients presenting with an acute ischemic stroke between January 2011 and May 2013, those who underwent MRI and received IV thrombolytic therapy were included in this retrospective study. Patients were divided into DWI-FLAIR mismatch and match groups and compared for their initial NIHSS (National Institutes of Health Stroke Scale), NIHSS 24-hour after the thrombolytic therapy, NIHSS on discharge, early neurologic improvement (ENI), and major neurologic improvement (MNI). RESULTS: During study period, 50 patients were finally included among 213 acute ischemic stroke patients. DWI-FLAIR mismatch group showed significantly more reduction in NIHSS 24-hour after the thrombolytic therapy and NIHSS on discharge than the match group (5.5 vs. 1.2, p<0.001, 6.0 vs. 2.3, p<0.01, respectively). Moreover, ENI and MNI occurred significantly more in DWI-FLAIR mismatch group than match group (27/36 vs. 2/14, p<0.001, 12/36 vs. 0/14, p=0.012, respectively). CONCLUSION: Among acute ischemic stroke patients who visited ED within 3 hours from the onset of symptom, those patients who had DWI-FLAIR mismatch on MRI showed significantly better response to IV thrombolytic therapy than DWI-FLAIR match group in terms of neurologic outcome.
Academies and Institutes ; Brain Infarction ; Emergency Service, Hospital ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Stroke* ; Thrombolytic Therapy*