PURPOSE: Early assessment of injury severity is important in management of major trauma patients. In general, hypotensive major trauma patients show more severe outcomes from injuries compared with normotensive major trauma patients. In this study, we analyzed the clinical features of severe trauma patients with initial hypotension and attempted to determine the prognostic factors of mortality in these patients. METHODS: A retrospective study was conducted within our hospital. Review of trauma registry data identified 679 major trauma patients (Injury severity score, ISS>15). From January 2011 to December 2013, all major trauma patients with initial systolic blood pressure lower than 90 mmHg were included (N=77). The patients were divided into two groups - those who survived and those who expired - and the differences in initial and final values were compared between the two groups. RESULTS: Out of a total of 77 patients, 55 patients survived and 22 patients died. The data showed almost no difference in heart rate between the two groups. The expired group showed low Glasgow Coma Scale (GCS) score, systolic blood pressure, revised trauma score, initial pH, and follow-up pH, as well as higher age, ISS, initial lactate, prothrombin time (PT), international normalized ration (INR), and follow-up lactate, compared with the survived group. In multivariate logistic analysis, age (p=0.034, OR 1.071), GCS (p=0.006, OR 0.61), initial base excess (p=0.042, OR 0.57), and follow-up base excess (p=0.041, OR 0.799) were independently associated with mortality. CONCLUSION: The patient's age, initial GCS, initial base excess and follow-up values of base excess were good prognostic factors for mortality in the expired major trauma patients with initial hypotension.
Blood Pressure ; Emergency Service, Hospital* ; Follow-Up Studies ; Glasgow Coma Scale ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypotension* ; Lactic Acid ; Mortality* ; Multiple Trauma ; Prothrombin Time ; Retrospective Studies

We have successfully applied the nested PCR to detect Cylindrocarpon destructans, a major pathogen causing root rot disease from ginseng seedlings in our former study. The PCR assay, in this study, was used to detect the pathogen from soils. The nested PCR using internal transcribed spacer (ITS) 1, 4 primer set and Dest 1, 4 primer set maintained the specificity in soils containing various microorganisms. For a soil DNA extraction method targeting chlamydospores, when several cell wall disrupting methods were tested, the combination of lyophilization and grinding with glass beads, which broke almost all the chlamydospores, was the strongest. The DNA extraction method which was completed based on the above was simple and time-saving because of exclusion of unnecessary stages, and efficient to apply in soils. As three ginseng fields whose histories were known were analyzed, the PCR assay resulted as our expectation derived from the field information. The direct PCR method will be utilized as a reliable and rapid tool for detecting and monitoring C. destructans in ginseng fields.
Cell Wall ; DNA ; Freeze Drying ; Glass ; Panax ; Polymerase Chain Reaction ; Seedlings ; Sensitivity and Specificity ; Soil

Background: Disseminating public knowledge on malignant melanoma through YouTube is an important way to bridge the gap between physicians and patients. However, videos recorded on this topic in Korea are yet to be evaluated. Objective: We aimed to evaluate the quality of YouTube videos on malignant melanoma recorded in Korea. We also investigated whether there was a difference in the quality of videos made by medical professionals (subdivided into dermatologists and non-dermatologists) and non-medical personnel. Methods: We included all videos recorded in Korean by searching YouTube using the keywords “melanoma” or “malignant melanoma”. The search was performed on March 22, 2021. The inclusion criterion was videos in Korean language that contained medical information about malignant melanoma. The characteristics and content information were collected for each video. Video quality (DISCERN, Global Quality Scale [GQS], Journal of the American Medical Association [JAMA] benchmark criteria) was analyzed. Results: Eighty-five videos met the inclusion criterion for the analysis. Fifty-six (66%) and 29 videos (34%) were made by medical and non-medical personnel, respectively. The videos made by medical professionals significantly contained more of the following information than those made by non-medical personnel: clinical information (p＜ 0.001), symptoms and signs (p=0.001), risk factors (p＜0.05), diagnosis (p＜0.001). Videos made by medical professionals, videos with a length of more than 5 minutes, or videos with more than 10,000 views had significantly higher quality scores (DISCERN, GQS, JAMA). Conclusion Considering that YouTube is being used as a portal for medical information, the participation of medical professionals is essential for providing more accurate information.

The purpose of this retrospective study was to describe cases of feline intermediate- to high-grade alimentary lymphoma regarding signalment, clinical presentation, laboratory findings, response to therapy (modified 25-week University of Wisconsin–Madison [UW-25] vs. COP [cyclophosphamide, vincristine, prednisone]), toxicosis, and outcomes and to identify prognostic factors. Sixteen cats were treated with chemotherapy protocols. Response rates and survival did not differ statistically between the two protocols. The progression-free interval (PFI) and median survival time (MST) in cats achieving a response to therapy were longer than in those with no response [NR] (complete remission [CR] vs. partial remission [PR] vs. NR; PFI, 124 vs. 49 vs. 12 days, p < 0.001; MST, 361 vs. 118 vs. 16 days, p < 0.001). Clinical stage was another prognostic factor for PFI and MST. The PFI and MST in cats in stage I were longer than in those in other stages (PFI, 107 days vs. 30 days; MST, 193 days vs. 54 days). Hematologic and gastrointestinal toxicosis was mostly low grade. In comparing the modified UW-25 protocol with the COP protocol, there was not much difference in the number of neutropenic episodes and grade levels.

The purpose of this retrospective study was to describe cases of feline intermediate- to high-grade alimentary lymphoma regarding signalment, clinical presentation, laboratory findings, response to therapy (modified 25-week University of Wisconsin–Madison [UW-25] vs. COP [cyclophosphamide, vincristine, prednisone]), toxicosis, and outcomes and to identify prognostic factors. Sixteen cats were treated with chemotherapy protocols. Response rates and survival did not differ statistically between the two protocols. The progression-free interval (PFI) and median survival time (MST) in cats achieving a response to therapy were longer than in those with no response [NR] (complete remission [CR] vs. partial remission [PR] vs. NR; PFI, 124 vs. 49 vs. 12 days, p < 0.001; MST, 361 vs. 118 vs. 16 days, p < 0.001). Clinical stage was another prognostic factor for PFI and MST. The PFI and MST in cats in stage I were longer than in those in other stages (PFI, 107 days vs. 30 days; MST, 193 days vs. 54 days). Hematologic and gastrointestinal toxicosis was mostly low grade. In comparing the modified UW-25 protocol with the COP protocol, there was not much difference in the number of neutropenic episodes and grade levels.

PURPOSE: Bone is the most common site of metastasis from breast cancer. An abnormal bone scan finding, however, is not specific in differentiation of bone metastasis from traumatic or inflammatory bone diseases. The purpose of this study was to identify clinical findings that could help evaluate the etiology of solitary costal hot spots on a bone scan. METHODS: The study included 32 patients (all women, mean age 51+/-1 years) showing solitary costal hot spots on postoperative bone scans performed between January 1998 and December 2002. In order to classify the etiology of solitary costal hot spots as non-malignant or malignant, all available clinical, scintigraphic, laboratory and other radiographic examinations were taken into consideration. RESULTS: The mean follow-up period was 42.5 months. Among 32 hot spots, 7 (21.8%) were metastatic, and the remaining 25 (78.2%) non-malignant. The mean period of first detection after operation was 17.0+/-16.3 months in the metastatic and 26.0+/-21.3 months in the non-malignant groups. The metastatic group was significantly associated with advanced breast cancer. In the localization of rib lesion, 20 (62.5%) of the solitary costal hot spots were in the anterior arc, 5 (15.6%) in the lateral arc and 7 (21.9%) in the posterior arc. In the group with a location at the anterior arc, 16 (80%) were non-malignant, whereas 4 (20%) were malignant. In those localized at the anterior arc, 12 (60%) were on ipsilateral and 8 (28%) were on contralateral. The difference between the hot spots in the ipsilateral and contralateral locations was not significant. The carcinoembryonic antigen (CEA) and CA15-3 were elevated: in 5 (51%) and 3 (43%) patients with metastatic spots, and in 4 (16%) and 1 (4%) patient with non-malignant lesions, which were significantly different. CONCLUSION: It was found that an advanced state of primary breast cancer and the increase of tumor markers (CEA and CA15-3) were the significant factors for the direction of the nature of solitary costal hot spots on postoperative bone scans in patients with breast cancer.
Bone Diseases ; Breast Neoplasms* ; Breast* ; Carcinoembryonic Antigen ; Female ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Ribs ; Biomarkers, Tumor

BACKGROUND: Postburn sternomental contractures cause various changes in mouth, oral cavity, pharynx, larynx and related structures. Although there are many methods to predict difficult intubation, the modified Mallampati test (mMT) and the El-Ganzouri multivariate risk index (EGRI) are popular tests. The authors wanted to compare modified Onah class with these 2 tests and also explored the possibility that Onah class could be an adequate independent predictor for difficult intubation. METHODS: One hundred and nine patients, aged 18 to 60 years of age, scheduled for elective surgery for reconstruction of postburn sternomental contractures were divided according to the modified Onah class. We made assessments prior to general anesthesia with respect to mouth opening, thyromental distance, mMT, neck movement, ability to prognath, body weight, and history of difficult tracheal intubation. The accuracy, specificity, positive and negative predictive values were calculated from the data of the 3 tests, and as the 3 tests were compared with patient's laryngoscopic view grade according to Cormack and Lehane criteria by using the Chi-square test. RESULTS: The incidence of Cormack and Lehane grade III, IV was 39.4%. Onah class showed significantly higher accuracy, specificity, and positive predictive value than mMT and EGRI. There were significant correlations between modified Onah class 2b, 3 and the Cormack and Lehane grade III, IV. CONCLUSIONS: Application of modified Onah class for preoperative prediction of the degree of difficulty with laryngeal visualization can reduce the frequency of both an unanticipated failure to visualize laryngeal structures as well as potential unnecessary interventions related to over-prediction of airway difficulty in patients with postburn sternomental contractures.
Aged ; Anesthesia, General ; Body Weight ; Contracture ; Humans ; Incidence ; Intubation ; Larynx ; Mouth ; Neck ; Organometallic Compounds ; Pharynx ; Sensitivity and Specificity

BACKGROUND: Asthma can be described as the hypersensitivity of the airway to various stimuli. Injury to tracheal epithelial cells could be the reason for tracheal hypersensitivity in asthma or upper respiratory infection. This study is based on the hypothesis that the dysfunction of the airway in asthma is caused by epithelial cell injury. METHODS: After isolating guinea-pig tracheal preparations, in order to examine the role of airway epithelium in response to smooth muscle, we measured the contractile responses to acetylcholine, carbachol, and histamine on the isolated epithelium-denuded or epithelium-intact guinea-pig tracheal preparations. When tracheal tones were stabilized, each contractile agent was added cumulatively to the organ baths to obtain concentration-response curves, and ED50 and ED95 were calculated. RESULTS: In both groups, tracheal tones increased in response to contractile agents, in concentration- dependent manners. In comparing both groups, the contractility of denuded trachea was increased by 10 7 and 10 6 M in acetylcholine, and by 10 6 M in histamine significantly. In denuded trachea, ED50 and ED95 increased significantly in response to both acetylcholine and histamine. However, they did not increase in carbachol. CONCLUSIONS: The removal of the epithelium increased the contractile responses to acetylcholine and histamine.
Acetylcholine ; Asthma ; Baths ; Carbachol ; Epithelial Cells ; Epithelium ; Histamine ; Hypersensitivity ; Muscle, Smooth* ; Trachea

Breast reconstruction using TRAM flap after mastectomy has been widely adopted and regarded as a gold standard method. In patients with the abdominal midline scar, insufficient blood circulation to regions contralateral to the pedicle disables inclusion of them in the TRAM flap design. So modifications including Double- pedicled TRAM, Super-charged, Turbo-charged, Bipedicled free TRAM et al. have been attempted to resolve the problem of circulatory interruption by midline scar. The authors designed a new bipedicled free TRAM flap to avoid limitations like epigastric buldging, significant abdominal weakness and complexity of flap insetting. The two donor arteries(right and left deep inferior epigastric arteries) are anastomosed to the proximal and distal ends of divided internal mammary arteries using the reverse flow. Vein anastomoses were performed in the same manner through the divided venae comitantes. Two patients having infraumbilical midline scar underwent breast reconstruction using author`s new flap. Flaps survived without fat necrosis or partial flap loss in both patients and their results in aesthetic aspects were very satisfactory. Compared to previous method for breast reconstruction of patients having infraumbilical midline scar, author's new method is useful and effective in terms of the aesthetic and technical aspect.
Blood Circulation ; Breast* ; Cicatrix* ; Fat Necrosis ; Female ; Humans ; Mammaplasty* ; Mammary Arteries ; Mastectomy ; Tissue Donors ; Veins

PURPOSE: With this study, we evaluated the operative and neuropsychological outcomes after epilepsy surgery in children. METHODS: We studied the surgical outcomes and the possibly related factors retrospectively by reviewing the medical records of 28 patients who underwent epilepsy surgery before the age of 15 years along with the battery of neuropsychological tests. RESULTS: The mean age of seizure onset was 84.8 months, and the mean period at the surgery after the onset of seizure was 62.4 months. Among 28 patients, 15 had complex partial seizures(CPS) only, 11 CPS with secondary generalization, and two simple partial seizures in addition to CPS. The types of the surgery included anterior temporal lobectomy with amygdalo-hippocampectomy(9 patients), extra-temporal or lateral temporal resection with temporal lobectomy(16 patients), and extra-temporal resection(3 patients). Evaluating their surgical outcomes, 21 patients belonged to Engel class I, five to class II, and each one to class III and IV respectively. There was no significant difference in full scale intelligence quotient(IQ) and verbal IQ after the epilepsy surgery. However, the performance IQ was higher in the older age group after the operation(P=0.011). When the patients were divided into two prognostic groups, the Engel classification after the surgery was the only significant influencing factor(P=0.037). CONCLUSION: The intelligence quotient and memory did not deteriorate after the epilepsy surgery. The overall neuropsychological outcomes improved in about half of the patients. And it was significantly influenced by the seizure outcomes after the surgery.
Anterior Temporal Lobectomy ; Child ; Classification ; Epilepsies, Partial ; Epilepsy* ; Generalization (Psychology) ; Humans ; Intelligence ; Medical Records ; Memory ; Neuropsychological Tests ; Retrospective Studies ; Seizures