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BACKGROUND: The abnormal barrier function in atopic dermatitis(AD) is caused by a reduction in the amounts of ceramides in the intercellular lipids in the stratum corneum(SC). Replenishing the SC via the topical application of ceramides and pseudoceramides leads to effective recovery of the barrier function of skin. OBJECTIVES: An open clinical crossover evaluation was conducted to investigate the effects in AD of a multi-lamellar emulsion(MLE) that contained pseudoceramide(PC-9s). METHODS: The study group included 30 AD patiendaverage age: 4.4 yr, range: 1-8 yr), who applied MLE or a commercial moisturizing cream(CMC, 5% urea) alternately for four weeks each. We divided the subjects into two subgroups and started with different treatments in each subgroup. Treatment efficacy was evaluated using the average subjective satisfaction scores for each symptom and the global clinical response. In addition, the SCORAD(Scoring AD) index was adopted to evaluate the severity of AD as objectively as possible. The patients were evaluated using this index every other week. RESULTS: Although the SCORAD improved in both subgroups, the patients had better results (p<0.05) when applying MLE(31-35% decrease) than CMC(13% increase to 14% decrease). The subjective satisfaction scores of the symptoms and signs of patients, including itching, erythema, and dry skin, were higher in the MLE group than in the CMC group, and the global response to treatment was also better in the MLE group. During the follow-up period, AD improved in all patients. MLE was more effective than CMC in our patients. CONCLUSIONS: The topical application of a multi-lamellar emulsion containing pseudoceramide is an effective regimen for improving symptoms of AD.
Ceramides ; Cross-Over Studies* ; Dermatitis, Atopic* ; Erythema ; Follow-Up Studies ; Humans ; Pruritus ; Skin ; Treatment Outcome

BACKGROUND: Advanced chronic obstructive pulmonary disease is characterized by progressive pulmonary hypertension leading to right heart dysfunction, which plays a important role in clinical evaluation but remains difficult and challenging to quantify. The noninvasive doppler echocardiographic value referred to as the Tei index has been suggested as a simple, reproducible and reliable parameter of the right ventricular function. The purpose of this was to assess the right ventricular function in patients with chronic obstructive pulmonary disease using the Tei index and to evaluate its relationship with the pulmonary functional status. METHODS: The study population comprised of 26 patients with chronic obstructive pulmonary disease and 10 normal control subjects. The Tei index was obtained by dividing the sum of the isovolumetric contraction and the relaxation tines by the ejection time using a pulsed-wave doppler. It was compared with the other available Doppler echocardiographic parameters of systolic or diastolic and with the pulmonary function of the patients. RESULTS: The Tei indices of the patients with COPD were significantly higher than those of normal subjects (0.45±0.17 vs. 0.27±0.03, p<0.01). The isovolumetric contraction time/ejection time(0.32±0.08 vs. 0.25±0.05, p<0.05), the isovolumetric relaxation time/ejection time(0.29±0.16 vs. 0.15±0.08, p<0.05) and the preejection period/ejection time (0.46±0.10 vs. 0.38±0.06, p<0.05) were prolonged and the ejection time (255.2±32.6 vs. 314.2±16.5 msec, p<0.05) was significantly shortened in patients with COPD compared to normal subjects. The tei indices were inversely correlated with the FEV1(r=-0.46, p=<0.05) and were prolonged significantly in patients with a severe obstructive ventilatory dysfunction(less than 35% of predicted FEV1) compared to those with a mild and moderate ventilatory dysfunction. The tei indices showed an inverse correlation with the ejection time (r=-0.469), the isovolumetric contraction time/ejection time(r=0.453), the isovolumetric relaxation time/ejection time(r=0.896) and the preejection period/ejection time(r=0.480). CONCLUSION: The tei index appeared to be a useful noninvasive means of evaluating the right ventricular function. It revealed a significant correlation with the pulmonary function in patients with COPD.
Echocardiography* ; Heart ; Humans ; Hypertension, Pulmonary ; Pulmonary Disease, Chronic Obstructive* ; Relaxation ; Ventricular Function, Right*

OBJECTIVE: The aim of this meta-analysis was to investigate the effects of ankle foot orthosis on adult post-stroke hemiplegic patients' walking ability and pattern. METHOD: We searched for the case controlled clinical trials about the effects of ankle foot orthosis (AFO) for walking ability and pattern using quantitative gait analysis in adult post-stroke patients, which published between January 1950 and July 2012 in PubMed, and searching engine of Journal of Korean Academy of Rehabilitation Medicine. The mean standardized difference (MSD) and a 95% confidence interval (CI) were estimated for gait ability and pattern using fixed effect models. RESULTS: Sixteen of the 56 articles were included in this analysis. The selected studies involved a total of 274 patients. The walking speed, cadence, the portion of double limb supporting, stride length on affected side, the portion of swing period on unaffected side, and symmetry of swing period were improved by AFO. The oxygen cost was decreased by AFO. The AFO did improve ankle dorsiflexion at initial contact, maximal ankle dorsiflexion at swing phase, but the ankle plantar flexion at push-off did not. CONCLUSION: The ankle foot orthosis has some evidence to improve the walking ability and gait pattern in post-stroke hemiplegic patients.
Adult ; Animals ; Ankle ; Case-Control Studies ; Extremities ; Foot ; Foot Orthoses ; Gait ; Gait Disorders, Neurologic ; Hemiplegia ; Humans ; Orthotic Devices ; Oxygen ; Stroke ; Walking

BACKGROUND: Arterial hypoxemia has been noted in patients with liver cirrhosis because of bronchial vessel dilatation. Cabenes et al. reported that bronchial hyperresponsiveness to the metacholine inhalation was observed in patients of left side heart failure, he suggested that one of the mechanism was bronchial vessel dilatation. We hypothesized that patients of liver cirrhosis might have bronchial hyperresponsiveness to metacholine inhalation due to portal hypertension. We evaluate the relationship between bronchial responsiveness and severity of liver cirrhosirs, severity of portal hypertension. METHODS: In the 22 patients of the liver cirrhosis with clinical portal hypertension metacholine provocation test was done and determined PC20 FEV1. We classified lifter cirrhosis according to Pugh- Child classification Esophagogastroscopies were performed for the evaluation of the relationship between bronchial hyperresponsiveness and severity of esophageal varix. RESULTS: In the 22 cases of the liver cirrhosis with clinical portal hypertension. The causes of liver cirrhosis, alcoholic hepatitis was 9 cases. hepatitis B virus was 12 cases, hepatitis C virus was 1 case. and 151 cases (68.18%) of total 22 cases were positive in metacholine provocation test. In positive cases There was no significant relationship between PC20FEV1 and severity of liver cirrhosis which were classified by Pugh-Child classification or severity of esophageal varix(p<0.05). CONCLUSION: we observed that bronchial responsiveness to metacholine increased in the patients of liver cirrhosis and there was no significant relationship between the severity of liver cirrhosis and the severity of esophageal varix.
Anoxia ; Child ; Classification ; Dilatation ; Esophageal and Gastric Varices ; Fibrosis ; Heart Failure ; Hepacivirus ; Hepatitis ; Hepatitis B virus ; Humans ; Hypertension, Portal ; Inhalation ; Liver Cirrhosis* ; Liver Cirrhosis, Alcoholic ; Liver*

Background: This retrospective study investigated the incidence rate of accidental foreign body aspiration and ingestion according to patient sex, age, and dental department. This study aimed to verify whether the incidence rate is higher in geriatric than in younger patients and whether it is different among dental departments. Methods: Accidental foreign body aspiration and ingestion cases were collected from electronic health records and the safety report system of Yonsei University Dental Hospital from January 2011 to December 2017. The collected data included patients’ age, sex, medical conditions, treatment procedures, and foreign objects that were accidentally aspirated or ingested. The incidence rate was calculated as the number of accidental foreign body aspirations and ingestions relative to the total number of patient visits. Differences depending on the patients’ sex, age, and dental department were statistically identified. Results: There were 2 aspiration and 37 ingestion cases during the 7-year analysis period. The male to female incidence ratio was 2.8:1. The incidence rate increased with age and increased rapidly among those aged 80 years or older. Seven of the 37 patients with accidental foreign body ingestion had intellectual disability, Lou Gehrig’s disease, dystonia, or oral and maxillofacial cancer. The incidence rate was highest in the Predoctoral Student Clinic and the Department of Prosthodontics. The most frequently swallowed objects were fixed dental prostheses and dental implant components. Conclusion The incidence rate of accidental foreign body aspiration and ingestion differed according to patient sex, age, and dental department. Dental practitioners must identify high-risk patients and apply various methods to prevent accidental foreign body aspiration and ingestion in dental clinics. Inexperienced practitioners should be particularly careful.

The anatomical description and the relationship between the root apex and the inferior wall of sinus are critical in diagnoses and surgeries of the sinus pathoses, and in dental implantation. So, identification of the proximity between the root apex and the inferior wall of sinus and the clarification of cortical thickness of inferior wall of sinus are indicated the topography of spreading dental infection into the maxillary sinus. Therefore, anatomical knowledge of the topography between the root apex and the inferior wall maxillary sinus are important in the diagnosis and treatment planning of the dental implantation, endodontic procedures, and orthodontic treatment. The purposes of this study were to clarify the morphological and clinical characteristics of the maxillary sinus, especially the inferior wall of sinus in Korean, and to identify the relationship between the inferior wall of maxillary sinus and the roots of maxillary teeth. 24 sides of maxillae of the hemi -sectioned Korean heads were used in this study. All specimens were taken DentaScan reformatted cross -sectional images were taken for the radiographic evaluation of the maxillary teeth and inferior wall of maxillary sinus. All specimens were decalcificated and thenp were sectioned coronally. On the sectioned specimen, 21 metric items were measured using the image analyzing system. The results were as follows: 1. The distance between the each root apex and the inferior wall of maxillary sinus were measured. In the 2nd molar area the distance from the root apex to the inferior wall of sinus was the shortest and the longest in the 1st premolar area. 2. The thickness of the cortical plate of the inferior wall of maxillary sinus was thinnest in the 1st premolar area, whereas, the thickest in the 2nd premolar area. 3. The vertical relationship between the inferior wall and the roots of the maxillary molars was classified into 5 types. Type I (the inferior wall of sinus was located above the level connecting the buccal and lingual root apices) was predominant (54.5% in the 1st molar area, 52.4% in the 2nd molar area). 4. The horizontal relationship between the inferior wall of sinus and root apex were classified into 3 types. Type 2 (the alveolar recess of the inferior wall of sinus was located between the buccal and lingual roots) was predominant (80% in the 1st and 2nd molar area). Taken all together, this study demonstrated various anatomical characteristics and relationships between the maxillary sinus and their surrounding structures. Recognition of these findings may have an impact on the clinical management of patients.
Asian Continental Ancestry Group ; Bicuspid ; Dental Implantation ; Dental Implants ; Diagnosis ; Head ; Humans ; Maxilla ; Maxillary Sinus* ; Molar ; Tooth

The anatomical description and the relationship between the root apex and the inferior wall of sinus are critical in diagnoses and surgeries of the sinus pathoses, and in dental implantation. So, identification of the proximity between the root apex and the inferior wall of sinus and the clarification of cortical thickness of inferior wall of sinus are indicated the topography of spreading dental infection into the maxillary sinus. Therefore, anatomical knowledge of the topography between the root apex and the inferior wall maxillary sinus are important in the diagnosis and treatment planning of the dental implantation, endodontic procedures, and orthodontic treatment. The purposes of this study were 1) to clarify the morphological and clinical characteristics of the maxillary sinus, especially the inferior wall of sinus in Korean, 2) to identify the relationship between the inferior wall of maxillary sinus and the roots of maxillary teeth, and 3) to evaluate the degree of accuracy of DentaScan reformatted images of the maxillary sinus. 33 sides of maxillae of the hemi -sectioned Korean heads were used in this study. All specimens were taken periapical radiographs, computed tomography and DentaScan reformatted cross -sectional images were taken for the radiographic evaluation of the maxillary teeth and inferior wall of maxillary sinus. From the CT images, 3 -dimentional reconstructive images of maxillary sinuses were made using the V -works TM 3.0 program. All specimens were decalcificated and then were sectioned coronally. On the sectioned specimen, 21 metric items were measured using the image analyzing system. The results were as follows: 1. In 6 categories of maxillary sinus according to their lateral aspects and shapes of the inferior walls, flat (54.5%) and round (21.2%) inferior wall of maxillary sinus were prominent. In 58.4%, the anterior limit of maxillary sinus was located in the 1st premolar area and the posterior limit was in the 3rd molar and maxillary tuberosity area (93.9%). The lowest level of the maxillary sinus was in the 1st molar and 2nd molar area. 2. From the 3 -dimentional reconstructive images of maxillary sinus, the maximum anteroposterior length of sinus was 39.3 +/-4.2 mm, the maximum height was 37.1 +/-5.6 mm, and the maximum width was 32.6 +/-6.5 mm. And the average volume of sinus was 15.1 +/-6.2 ml. All measurements were larger in male than female. Taken all together, this study demonstrated various anatomical characteristics and relationships between the maxillary sinus and their surrounding structures. Recognition of these findings may have an impact on the clinical management of patients.
Asian Continental Ancestry Group ; Bicuspid ; Dental Implantation ; Dental Implants ; Diagnosis ; Female ; Head ; Humans ; Male ; Maxilla ; Maxillary Sinus* ; Molar ; Tooth

BACKGROUND: Although dual energy X-ray absorptiometry (DXA) is known to standard equipment for bone mineral density (BMD) measurements. Different results of BMD measurement using a number of different types of devices are difficult to use clinical practice. The purpose of this study was to evaluate discrepancy and standardizations of DXA devices from three manufactures using a European Spine Phantom (ESP). METHODS: We calculated the accuracy and precision of 36 DXA devices from three manufacturers (10 Hologic, 16 Lunar, and 10 Osteosys) using a ESP (semi-anthropomorphic). The ESP was measured 5 times on each equipment without repositioning. Accuracy was assessed by comparing BMD (g/cm2) values measured on each device with the actual value of the phantom. Precision was assessed by the coefficient of variation (CVsd). RESULTS: Lunar devices were, on average, 22%, 8.3%, and 5% overestimation for low (L1) BMD values, medium (L2), and high (L3) BMD values. Hologic devices were, on average, 6% overestimation for L1 BMD, and 5% and 6.2% underestimation for L2 and L3 BMD values. Osteosys devices was, on average, 12.7% (0.063 g/cm2), 6.3% (0.062 g/cm2), and 5% (0.075 g/cm2) underestimation for L1, L2, and L3, respectively. The mean CVsd for L1-L3 BMD were 0.01%, 0.78%, and 2.46% for Lunar, Hologic, and Osteosys devices respectively. CONCLUSIONS: The BMD comparison in this study demonstrates that BMD result of three different devices are significant different between three devices. Differences of BMD between three devices are necessary to BMD standardization.
Absorptiometry, Photon ; Bone Density ; Densitometry* ; Lumbar Vertebrae ; Spine*

OBJECTIVE: To test the feasibility of newly developed 3- dimensional virtual reality (VR) program for assessing the post-stroke cognitive dysfunction. METHOD: Thirty five post-stroke patients and twenty normal healthy subjects were recruited in this study, and post-stroke patients were classified into three groups according to the severity of cognitive dysfunction. We developed three dimensional virtual reality program to assess the cognitive function with virtual subway environment from taking a subway to arriving at one's destination. The total score, number of success and cue were obtained during completing virtual tasks. We investigated the test-retest reliability, and the parameters of the 3-dimensional VR program were compared with Korean Mini-mental status examination. RESULTS: All parameters of the VR program were significantly correlated with MMSE score (p<0.01), and showed the significant difference between patient subgroups and control group (p<0.05). The test-retest reliability of the VR program was significantly high (p<0.01). CONCLUSION: Three dimensional virtual reality program may be helpful to assess the cognitive function in patients with stroke.
Cues ; Humans ; Railroads ; Stroke