BACKGROUND: Anesthesia induction with desflurane is troublesome because of the frequent sympathetic hyperactivity during desflurane administration. We thought that a low concentration of desflurane combined with a target-controlled infusion (TCI) of remifentanil would eliminate the desflurane-related complications and provide hemodynamic stability during desflurane induction. An up-and-down study was planned to find the target effect-site concentration of remifentanil to block the hemodynamic response to endotracheal intubation, the highest level of stimulus, during anesthesia induction with administering desflurane at 1 MAC. METHODS: Remifentanil TCI was initiated before desflurane administration. When the preset target was achieved, spontaneous inhalation of desflurane 1 MAC was performed until the patients became unconscious. Laryngoscopic tracheal intubation was facilitated with rocuronium injection. The starting concentration of remifentanil and the test space were 5 and 1 ng/ml, respectively. The criteria for up-and-down was a 20% increase of the mean arterial pressure or heart rate after intubation. The median effective concentration (EC50) of remifentanil was calculated from 6 independent pairs. The complications related with remifentanil and desflurane were assessed during the study. RESULTS: We studied 20 patients using 2-5 ng/ml of the effect-site concentrations of remifentanil. The EC50 of remifentanil was 3.7 ng/ml. Loss of consciousness was achieved at 125 +/- 22 s after desflurane inhalation and this was irrespective of the combined remifentanil concentrations. Any remifentanil-related complication was not observed. Transient cough was seen in one patient who received 2 ng/ml of remifentanil. CONCLUSIONS: We demonstrated that uncomplicated induction with desflurane was possible by the use of target-controlled remifentanil. The EC50 of remifentanil to block the hemodynamic response to tracheal intubation was 3.7 ng/ml during inhalational induction with 1 MAC desflurane.
Androstanols ; Anesthesia ; Arterial Pressure ; Cough ; Heart Rate ; Hemodynamics ; Humans ; Inhalation ; Intubation ; Intubation, Intratracheal ; Isoflurane ; Isoxazoles ; Piperidines ; Unconscious (Psychology) ; Unconsciousness

Functional bladder disorders including overactive bladder and interstitial cystitis may induce problems in many other parts of our body such as brain and gut. In fact, diagnosis is often less accurate owing to their complex symptoms. To have correct diagnosis of these diseases, we need to understand the pathophysiology behind overlapped clinical presentation. First, we focused on reviewing literatures that have reported the link between bladder and brain, as the patients with bladder disorders frequently accompanied mood disorders such as depression and anxiety. Second, we reviewed literatures that have described the relationship between bladder and gut. There exist many evidences of patients who suffered from both bladder and intestinal diseases, such as irritable bowel syndrome and inflammatory bowel disease, at the same time. Furthermore, the interaction between brain and gut, well-known as brain-gut axis, might be a key factor that could change the activity of bladder and vice versa. For example, the affective disorders could alter the activity of efferent nerves or autonomic nervous system that modulate the gut itself and its microbiota, which might cause the destruction of homeostasis in bladder eventually. In this way, the communication between bladder and brain-gut axis might affect permeability, inflammation, as well as infectious etiology and dysbiosis in bladder diseases. In this review, we aimed to find an innovative insight of the pathophysiology in the functional bladder disorders, and we could provide a new understanding of the overlapped clinical presentation by elucidating the pathophysiology of functional bladder disorders.

Purpose: Several studies have been conducted on the relationship between green tea intake and metabolic syndrome. However, compared to the studies carried out internationally, there is inadequate research on the relationship between domestic green tea consumption and metabolic syndrome. Therefore, in this study, the general characteristics of Koreans according to their green tea intake and its association with metabolic syndrome were examined. Methods: A total of 44,611 subjects were included in the study, and analysis was carried out using data from the Korean Genome and Epidemiology Study (KoGES) for Korean adults aged 40 or older. Green tea consumption was estimated using 106 verified food frequency questionnaires (FFQ). Metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) parameters. After adjusting for confounding variables by performing a Cox regression analysis, the association between green tea consumption and metabolic syndrome was confirmed through the hazard ratio (HR) and 95% confidence interval (CI). Results: The average incidence of metabolic syndrome was 18.7% (20.8% in men and 17.8% in women). Compared to those who drank almost no green tea, in subject groups consuming more than one cup of green tea a day, the metabolic syndrome incidence was significantly reduced by 15% (HR, 0.85; 95% CI, 0.74–0.96; p trend = 0.0200) among men and by 19% (HR, 0.81; 95% CI, 0.73–0.90; p trend < 0.0001) among women. In addition, the biomarkers related to metabolic syndrome also tended to decrease overall in these groups. Conclusion This study concluded that as the intake of green tea increased, the incidence of metabolic syndrome and related indicators decreased. Therefore, green tea intake is believed to have a positive effect on the prevention and management of the metabolic syndrome.

Background: The need for regulatory science development to evaluate advanced regulatory products is gradually increasing without hindering the technological development. Creating a research environment and fostering experts through the establishment of regulatory agency-led policies are essential for the development of regulatory science. Method: This is a comparative study of the United States, Japan, Singapore, and Korea. The literature and websites of each regulatory agency were reviewed, and the focus was on advantages and comparing advantages based on definition, development trends, and expert training projects. Results: The United States is striving to develop regulatory science in response to changes in the new pharmaceutical industry through the regulatory science report, and to foster expert both inside and outside the Food and Drug Administration (FDA). Japan is promoting regulatory science centered on regulatory science centers, and is focusing on researching work-related regulatory science within the Pharmaceuticals and Medical Devices Agency (PMDA) and improving employees’ ability to make regulatory decisions. Singapore was aiming to improve Southeast Asia’s regulatory capabilities under the leadership of Centre of Regulatory Excellence (CoRE) within Duke-NUS University. In 2021, Korea is in its early stages, starting to run a university's degree program related to regulatory science this year. Conclusion Regulatory science should be developed with the aim of improving the regulatory ability of the Ministry of Food and Drug Safety with Korea’s independent concept of regulatory science.

BACKGROUND AND OBJECTIVES: In this study, we tried to study the criteria and characteristics of patients with noise-induced hearing loss by analyzing the pure tone audiogram such as "C5 dip" or "4 kHz notch". SUBJECTS AND METHOD: Out of 553 patients who complained of tinnitus and hearing loss, medical examination by interview, physical examination, hearing test, brain MRI and survey of tinnitus were performed from January 2010 to December 2012, targeting 81 patients who underwent pure tone hearing test. We analyzed the clinical characteristics of 81 patients with the exception of systemic disease or a history of otologic disease, conductive hearing loss, and vestibular schwannomas. Patients consisted of 70 men and 11 women (34 persons on both sides, 31 persons on right side, and 16 persons on left side), with an average of 48.1+/-12.9 years. 4 kHz notch-type sensorineural hearing loss was compared with contralateral hearing. RESULTS: The audiogram of 4 kHz notch was analyzed, and the results were as follows; 0.5 kHz (11.2+/-9.9 dB HL), 1 kHz (13.2+/-9.9 dB HL), 2 kHz (19.4+/-15.4 dB HL), 3 kHz (38.1+/-18.7 dB HL), 4 kHz (49.3+/-16.2 dB HL), 8 kHz (27.2+/-16.2 dB HL). Among all frequencies of 4 kHz notch audiogram, there was no significant hearing loss in 0.5 kHz and 1 kHz, but significant hearing loss was noted in higher frequencies (paired t-test, p>0.05). The contralateral ear showed a ski-slope hearing loss in about half of the patients. CONCLUSION: Remarkable points of the 4 kHz notch audiogram analysis, known as a typical characteristic of noise-induced hearing loss, were as follows; First, there was hearing loss of about 50 dB HL at 4 kHz. Second, the hearing threshold was improved to about 30 dB HL at 8 kHz. Third, the 4 kHz-notch audiogram showed a significant hearing loss in a high-pitched tone of over 2 kHz, but otherwise there were no significant hearing loss observed in 0.5 kHz and 1 kHz. Fourth, even if there were no symptoms, contralateral ear can still show the ski-slope type of hearing loss.
Brain ; Ear ; Ear Diseases ; Female ; Hearing Loss* ; Hearing Loss, Conductive ; Hearing Loss, Noise-Induced ; Hearing Loss, Sensorineural ; Hearing Tests ; Hearing* ; Humans ; Magnetic Resonance Imaging ; Male ; Neuroma, Acoustic ; Noise* ; Physical Examination ; Tinnitus

BACKGROUND AND OBJECTIVES: The purpose of the study was to evaluate the changes in electrical stimulation levels, i.e. threshold (T) levels, comfortable (C) levels, dynamic range (DR), and electrode impedance values (EIVs) during the first year in cochlear implant users. SUBJECTS AND METHOD: The maps of 49 cochlear implant users (at least 1 year mapping), using the Nucleus device, were examined at the time of initial connection, and at 6 and 12 months post-initial stimulation. T levels, C levels, DR and EIVs were analyzed according to three frequency levels. RESULTS: During the first 6 months of implant use, C levels and DR increased significantly whereas T levels were stable. EIVs of current carrying electrodes decreased significantly from the connection to the 12-month visit. The changes of electrical stimulation levels did not differ among three frequency levels during the entire follow-up. CONCLUSION: During the first 6 months of implant use, C levels and DR increased significantly. Thus, an appropriate mapping in the first 6 month is critical to setup hearing capacity in implant users. The mapping should be performed under the best communication environment between the audiologist and the patient, and it makes correct setting of T levels from the initial connection period.
Auditory Threshold ; Cochlear Implants ; Electric Impedance ; Electric Stimulation ; Electrodes ; Hearing ; Humans ; Lifting ; Longitudinal Studies

Skin cancers usually occur on the face and so successive cutaneous reconstruction after surgery is very important for the patients' quality of life. Cutaneous reconstruction is especially difficult when the defects after surgery involve the nasolabial fold. The nasolabial folds run from each side of the nose to the corners of the mouth, separating the cheeks from the upper lip. This area has complex contours, unique skin color and texture and the limited availability of mobile adjacent skin. We reconstructed such a defect after Mohs micrographic surgery for basal cell carcinoma of the nasolabial fold area, and we used a subcutaneous island pedicle flap and periosteal suspension suture. Herein we report on the details with the pictures, and we discuss the cosmetic effect and limitations of this method.
Carcinoma, Basal Cell ; Cheek ; Cosmetics ; Lip ; Mohs Surgery ; Mouth ; Nasolabial Fold ; Nose ; Quality of Life ; Skin ; Skin Neoplasms ; Sutures

Coronary stenting for long complex lesion is effective but associated with complication. We compared the results of stenting between with multiple conventional stenting group (group A) and with single long stenting group (group B). Fifty patients were prospectively and randomly enrolled: 25 patients for each group. Each group showed no significant differences of clinical characteristics. One patient died of heart failure in each group, not associated with the procedure itself. One patients had cerebrovascular accident in each group. Five patients had major bleeding (2, group A; 3, group B). Angiographic success rate was 100% in each group and procedural success rate was 96% and 100% in group A and B, respectively. Angiographic and clinical restenosis rate at 6 months follow-up were 60%, 36% in group A and 65%, 44% in group B, respectively (p=S). Multivariate analysis showed that several factors affected the angiographic restenosis rate as follows; a) male gender (M:F=76.9%:25.0%, P<0.001), b) AMI (AMI:stable angina pectoris=72.7%:66.7%, P<0.001), c) lesion length d) residual stenosis. In conclusion, there were no statistical differences of restenosis and complication rate between the two groups. Our data support single long stenting is acceptable and economically more favorable for long diffuse lesion, compared to multiple conventional stenting.
Constriction, Pathologic ; Coronary Stenosis* ; Coronary Vessels* ; Follow-Up Studies ; Heart Failure ; Hemorrhage ; Humans ; Male ; Multivariate Analysis ; Prospective Studies ; Stents* ; Stroke