PURPOSE: The bedside lung ultrasound in emergency (BLUE) protocol is an excellent diagnostic tool for acute respiratory failures requiring admission to the intensive care unit. We incorporated cardiac ultrasound in the BLUE algorithm because cardiac origin is also necessary to examine in an emergency setting. We studied the usefulness of the emergency department (ED)-BLUE protocol for patients complaining of dyspnea in an emergency department. METHODS: At first, we assessed lung sliding, artifacts (Alines and B-lines), alveolar consolidation and pleural effusion on stage I and II evaluation. Then, we checked heart to detect 3Es (Effusion, Equality, and Ejection fractions). We divided all the possible conditions into 10 categories. We compared it with final diagnosis and examined the agreements using kappa statistics. We compared the physician's level of confidence for the first impression. The 10 categories were: 1) normal or inconclusive, 2) pulmonary embolism, 3) airway disease (chronic obstructive pulmonary disease or asthma), 4) pneumothorax, 5) large pleural effusion, 6) alveolar consolidation, 7) acute pulmonary edema due to systolic congestive heart failure, 8) acute respiratory distress syndrome, 9) chronic interstitial lung disease with exacerbation, and 10) pericardial effusion with/without tamponade. RESULTS: This prospective study was performed for 172 patients over 18-years-of-age with dyspnea during a 25-month period. Kappa value between the diagnosis after ED-BLUE and final diagnosis was 0.812(p<0.001). The mean of physician's full term for LOC for the first impression before and after ED-BLUE was 3.09+/-0.83 and 4.36+/-0.70 (paired t-test, p<0.001). CONCLUSION: ED-BLUE protocol could help the emergency physician make an accurate diagnosis in patients with dyspnea in the emergent setting.
Artifacts ; Dyspnea ; Emergencies ; Heart ; Heart Failure ; Humans ; Intensive Care Units ; Lung ; Lung Diseases, Interstitial ; Lung Diseases, Obstructive ; Pericardial Effusion ; Pleural Effusion ; Pneumothorax ; Prospective Studies ; Pulmonary Edema ; Pulmonary Embolism ; Respiratory Distress Syndrome, Adult

BACKGROUND: The prognosis of paraquat intoxication patients is poor and this makes the prediction of mortality important in administering aggressive treatment and admission. This article investigates the usefulness of simplified acute physiology score II (SAPS II), as a predictor of the mortality in paraquat intoxication. METHODS: We retrospectively reviewed 65 patients who were admitted in one hospital between January in 2005 and December in 2010. We calculated their SAPS II, serum paraquat level, and severity index of paraquat poisoning (SIPP) at the time of intensive care unit (ICU) admission. We investigated the relationship between each systems and the mortality. RESULTS: Overall mortality was 73.8%: 48 out of 65 patients died. Non-survived group (n = 48) had a higher SAPS II score (30.44 +/- 15.99) than survived group (n = 17 [15.7 +/- 6.26], p < 0.001). Serum paraquat level and SIPP were significantly higher in non-survived group than in survived group (p < 0.05, in all comparisons). By using the area under receiver operating characteristic curves (AUC), the SAPS II system yielded equal discriminative power (AUC = 0.82) with serum paraquat level (AUC = 0.896) and SIPP (AUC = 0.865). Hosmer-Lemeshow goodness-of-fit test C indicated SAPS II score validated well in paraquat intoxication group (p = 0.33). CONCLUSIONS: Serum paraquat level is the best way for prediction of mortality in patients with acute paraquat intoxication. If checking serum paraquat level is impossible or delayed, SAPS II score can be an alternative tool for evaluating the prognosis in paraquat intoxication.
Humans ; Intensive Care Units ; Paraquat ; Prognosis ; Research Design ; Retrospective Studies ; ROC Curve

The current study aimed to compare the pH, solubility value, and ion release capability of premixed mineral trioxide aggregates (MTAs) versus conventional pulp capping materials before and after setting. The following materials were used: resin-modified calcium silicate cement (TheraCal LC®, TLC), resin-modified calcium hydroxide cement (Ultra-BlendTM plus, UBP), and 2 kinds of premixed MTA (Endocem MTA® premixed regular 〔EMPR〕 and Well-RootTM PT 〔WRP〕). The specimens of each material were prepared before and after setting and were immersed in distilled water. The materials’ pH and solubility value were assessed. Next, three kinds of ion (calcium, sulfide, and strontium) released by pulp capping materials were evaluated via inductively coupled plasma atomic emission spectrometry. In the after-setting group, the pH of TLC and UBP decreased. However, the pH of the premixed MTAs increased with time. TLC released a higher concentration of strontium ion compared with the other materials. Meanwhile, EMPR released a significantly high concentration of sulfide ion (p < 0.05). In the after-setting group, the 2 kinds of premixed MTAs released a significantly higher concentration of calcium ion compared with the other materials (p < 0.05). In the after-setting group, EMPR had a significantly low solubility value (p < 0.05). The Kruskal-Wallis test, followed by the Mann-Whitney U test with Bonferroni correction, was used in statistical analysis. In conclusion, resin-modified calcium silicate cement, modified calcium hydroxide cement, and the 2 kinds of premixed MTAs had an alkaline pH and low solubility value and they released various concentrations of ions after setting.

α-Synuclein and tau deposition in the central nervous system is responsible for various parkinsonian syndromes, including Parkinson’s disease, multiple system atrophy, dementia with Lewy bodies, progressive supranuclear palsy and corticobasal degeneration. Emerging evidence has suggested that pathologic α-synuclein and tau are transmitted from cell to cell and further accelerate the aggregation of pathologic proteins in neighboring cells. Furthermore, extracellular pathologic proteins have also been reported to provoke inflammatory responses that lead to neurodegeneration. Therefore, immunotherapies targeting extracellular α-synuclein and tau have been proposed as potential disease-modifying strategies. In this review, we summarize completed phase I trials and ongoing phase II trials of immunotherapies against α-synuclein and tau and further discuss concerns and hurdles to overcome in the future.

Mycobacterium mucogenicum, a mucoid, nonpigmented rapidly-growing mycobacteria has been recently characterized and rarely seen in human infection. M. mucogenicum does produce clinical disease, mainly posttraumatic wounds and catheter-related sepsis. We report a case of M. mucogenicum bacteremia identified by high performance liquid chromatography in a patient with pneumonia and chronic obstructive pulmonary disease.
Bacteremia* ; Chromatography, Liquid ; Humans ; Mycobacterium* ; Pneumonia* ; Pulmonary Disease, Chronic Obstructive* ; Sepsis ; Wounds and Injuries

BACKGROUND: The intradermal test for the screening of Clonorchis sinensis is difficult to interpret because the sensitivity and persistence rates of reactions after treatment are not well known. METHODS: Stool egg examinations and intradermal tests for C. sinensis and Paragonimus westermani were performed for 1,207 persons who lived in endemic areas of C. sinensis infestation, and epidemiologic data were also surveyed. RESULTS: The infestation rate of C. sinensis was 12% (male 14%, female 9%). It was higher in Southeastern area of Gyungsang Namdo Province and Ulsan (22%) than in Busan (10%), whereas much higher in Gangseo/Buk/Sasang (28%) than in other areas of Busan. The performance of C. sinensis intradermal test was as belows; sensitivity 45%, specificity 80.8%, positive predictive value 24%, negative predictive value 92%, and diagnostic efficiency 77%. Positive C. sinensis intradermal reaction persisted for longer than 40 years after treatment of C. sinensis infestation in at least 30% of patients. C. sinensis intradermal reaction turned to be positive within 4 months after intake of raw fish in more than half the patients. CONCLUSION: The infestation rate of C. sinensis was still very high in inhabitants around Nakdong River, an endemic area. We think that C. sinensis intradermal test is inadequate to diagnose current clonorchiasis.
Busan ; Clonorchiasis ; Clonorchis sinensis* ; Diagnosis* ; Female ; Humans ; Intradermal Tests* ; Mass Screening ; Ovum ; Paragonimus westermani ; Rivers ; Sensitivity and Specificity ; Ulsan

Objective: To assess the feasibility of quantitatively assessing pancreatic steatosis using magnetic resonance imaging (MRI) and its correlation with obesity and metabolic risk factors in pediatric patients. Materials and Methods: Pediatric patients (≤ 18 years) who underwent liver fat quantification MRI between January 2016 and June 2019 were retrospectively included and divided into the obesity and control groups. Pancreatic proton density fat fraction (P-PDFF) was measured as the average value for three circular regions of interest (ROIs) drawn in the pancreatic head, body, and tail. Age, weight, laboratory results, and mean liver MRI values including liver PDFF (L-PDFF), stiffness on MR elastography, and T2* values were assessed for their correlation with P-PDFF using linear regression analysis. The associations between P-PDFF and metabolic risk factors, including obesity, hypertension, diabetes mellitus (DM), and dyslipidemia, were assessed using logistic regression analysis. Results: A total of 172 patients (male:female = 125:47; mean ± standard deviation [SD], 13.2 ± 3.1 years) were included. The mean P-PDFF was significantly higher in the obesity group than in the control group (mean ± SD, 4.2 ± 2.5% vs. 3.4 ± 2.4%; p = 0.037). L-PDFF and liver stiffness values showed no significant correlation with P-PDFF (p = 0.235 and p = 0.567, respectively). P-PDFF was significantly associated with obesity (odds ratio 1.146, 95% confidence interval 1.006–1.307, p = 0.041), but there was no significant association with hypertension, DM, and dyslipidemia. Conclusion MRI can be used to quantitatively measure pancreatic steatosis in children. P-PDFF is significantly associated with obesity in pediatric patients.

The purpose of this study was to evaluate the effect of the reaction between investment material and zirconia on the strength of zirconia in the application of heat-pressing method. Sixty specimens were cut (24 mm×4 mm×0.5 mm) into plates from Zirtooth ™ Multi O-9814 block (∅98×14T, HASS, Gangwondo, Korea) and sintered at 1450℃. Specimens were divided into 6 subgroups according to the depending on the investement material; (a) UN group (Control), (b) PH group (Prime vest HS), (c) CP group (Calibra-press), (d) BV group (BC-Vest), (e) MH group (Microstar-HS), (f) F1 group (Formula 1). Five investment materials were buried according to the procedure recommended by the manufacturer and left at room temperature for 30 minutes. The investment mold was dried and maintained at an elevated temperature of 850℃ for 50 minutes. Then, Amber Lisi-POZ LT (HASS) was placed in a thermoformed electric furnace (Programat EP3000/G2, Ivoclar Vivadent, Schaan, Liechtenstein) together with the mold, heated to 915℃ at an elevation temperature of 45℃/min, and moored for 15 minutes. The specimens were loaded to fracture in a universal testing machine and the fracture surface was examined by a field-emission scanning electron microscopy (FE-SEM). The surface of the zirconia specimen with the investment material was analyzed by energy dispersive X-ray spectroscopy (EDS). The 3-point flexural strength test showed the highest value (1265.5 MPa) in the UN group and the lowest value (756.1 MPa) in the F1 group. As a result of EDS analysis, the largest amount of Si was detected in the F1 group, and the most interfacial changes occurred as a result of FE-SEM analysis. It was concluded that when the zirconia is buried with the investment material and the heat press molding is performed, the state of the interface is changed due to the investment material at the bonding interface while the strength is lowered.

The purpose of this study was to investigate the effect of glazing treatment of multi-colored zirconia disc and lithium disilicate block on the optical properties. From an Ultra Translucent Multi-Layered (UTML) disc containing 50% cubic crystal and a lithium disilicate-based Amber Mill Direct (AMD) block, the 1.2 mm thick specimens of the upper layer (T), the center (M), and the lower layer (B) were prepared. Three types of paste glaze of InSync Glaze Paste, IPS E.max Ceram Glaze Paste, and Amber Ceram G7 Glaze Paste were applied and fired to a uniform thickness on the surface of the specimen. CIE L * , a * , b * values were measured using a spectrophotometer and contrast and translucency were calculated. The bonding interface with the glaze layer was observed using HR FE-SEM. In the glazed groups, L * value increased, but a * value and b * value decreased. The translucency value measured in the untreated group was statically higher in the AMD groups than in UTML groups (P<0.05).The translucency did not show a significant difference before and after glazing treatment in the UTML group (P>0.05), but significantly decreased compared to the untreated group after glazing treatment in the AMD group (P<0.05). The contrast ratios generally increased after glaze treatment compared to the untreated group. Since the glaze treatment can affect the optical properties of ceramic restorations, the choice of glaze should be considered important for the desired color by the dental technician.

The purpose of this study was to evaluate the effect of the reaction between investment material and zirconia on the strength of zirconia in the application of heat-pressing method. Sixty specimens were cut (24 mm×4 mm×0.5 mm) into plates from Zirtooth ™ Multi O-9814 block (∅98×14T, HASS, Gangwondo, Korea) and sintered at 1450℃. Specimens were divided into 6 subgroups according to the depending on the investement material; (a) UN group (Control), (b) PH group (Prime vest HS), (c) CP group (Calibra-press), (d) BV group (BC-Vest), (e) MH group (Microstar-HS), (f) F1 group (Formula 1). Five investment materials were buried according to the procedure recommended by the manufacturer and left at room temperature for 30 minutes. The investment mold was dried and maintained at an elevated temperature of 850℃ for 50 minutes. Then, Amber Lisi-POZ LT (HASS) was placed in a thermoformed electric furnace (Programat EP3000/G2, Ivoclar Vivadent, Schaan, Liechtenstein) together with the mold, heated to 915℃ at an elevation temperature of 45℃/min, and moored for 15 minutes. The specimens were loaded to fracture in a universal testing machine and the fracture surface was examined by a field-emission scanning electron microscopy (FE-SEM). The surface of the zirconia specimen with the investment material was analyzed by energy dispersive X-ray spectroscopy (EDS). The 3-point flexural strength test showed the highest value (1265.5 MPa) in the UN group and the lowest value (756.1 MPa) in the F1 group. As a result of EDS analysis, the largest amount of Si was detected in the F1 group, and the most interfacial changes occurred as a result of FE-SEM analysis. It was concluded that when the zirconia is buried with the investment material and the heat press molding is performed, the state of the interface is changed due to the investment material at the bonding interface while the strength is lowered.