Sixty healthy adult patients undergoing general anesthesia for elective surgery were randomly allocated to three group(n = 20), and their EMG response(twitch height) of the adductor digiti mini muscle(hypothena) to TOF stimulation of ulnar nerve by Datex relaxograph was monitored. The patients were received a bolus injection of vecuronium(0.1mg/kg) alone in group I, vecuronium(0.1 mg/kg) after 25-50% recovery from SCh(l mg/kg) in group II, and the mixed injection of SCh(1 mg/kg) and vecuronium(O.I mg/kg) in group III. The onset time(mean SEM) of effect of vecuronium(0.1 mg/kg) in group II(2.2+/-0.4 min) and group III(1.7+/-0.2 min) significantly was shorten when compared with a bolus injection of vecuronium alone in group(4.4+/-0,4 min)(p<0.05). The duration(mean+/-SEM) of vecuronium(0.1 mg/kg), however, had no significant differences among three group. It was 33+/-2 min in group I, 39+/-3 min in group II, and 34+/-2 min in group III. The potency of twitch height depression of vecuronium(0.1 mg/kg) was increased significantly following preinjection of SCh(1 mg/kg) and at the mixed injection of SCh and vecuronium The intensity of fasciculation induced by SCh was not affected at the mixed injection of vecuronium in group III. The peak increases in arterial pressare and heart rate on the endotracheal intubation were attenuated significantly at the mixed injection of SCh (1 mg/kg) and vecuronium(0.1 mg/kg) when compared with its effect of SCh (1 mg/kg) in group II(p<0.05).
Adult ; Anesthesia, General ; Depression ; Fasciculation ; Heart Rate ; Humans ; Intubation, Intratracheal ; Neuromuscular Blockade* ; Succinylcholine* ; Ulnar Nerve ; Vecuronium Bromide*

OBJECTIVES: Aims were to evaluate foot deformity in patients with rheumatoid arthritis for its types, prevalence, and relation with duration of the disease. METHODS: Inspection, measuring of hallux valgus and calcaneal angle and footprint were done on 256 feet of 128 patients with rheumatoid arthritis. Transverse (metatarsal) arch and longitudinal arch were evaluated by foot printings. RESULTS: 1) The most common type of foot deformities was hallux valgus in 175 of 256 feet(68.4%). Depressed transverse arches were in 169(66.0%), toe deformities including claw toe, hammer toe, curl toe and mallet toe in 125(48.9%), calcaneal valgus in 87(34.0%), callus in 67(26.2%), pes planus in 37(14.5%), and bunion in 25 (9.8%) of 256 feet. 2) Foot involvements as the initial manifestation were seen in 41 (32.0%) of 128 patients with rheumatoid arthritis. A duration of rheumatoid arthritis over 10 years were seen in 37 of 128 patients. In this patients mean number of involved toes per foot was 2.78 which was not statistically significant increase compared to that of all patients, 2.23 (p-value>0.05). Even with absence of foot symptoms in 28 of 128 patient with rheumatoid arthritis, toe deformities were seen in 1.55 toes per foot. And prevalence of hallux valgus, pes planus, depressed transverse arch and calcaneal valgus were 58.9%, 10.7%, 51.8% and 39.3% respectively. CONCLUSIONS: Foot deformities in patients with rheumatoid arthritis were usually inevitable complication. Even in the patients who had no foot symptom, there were foot deformities. So, we think that physicians should pay attention to the foot in all rheumatoid arthritis.
Arthritis, Rheumatoid* ; Bony Callus ; Congenital Abnormalities ; Flatfoot ; Foot Deformities ; Foot* ; Hallux Valgus ; Hammer Toe Syndrome ; Humans ; Prevalence ; Toes

While it is reasonably well known that certain dental procedures increase the temperature of the tooth's surface, of greater interest is their potential damaging effect on the pulp and tooth-supporting tissues. Previous studies have investigated the responses of the pulp, periodontal ligament, and alveolar bone to thermal irritation and the temperature at which thermal damage is initiated. There are also many in vitro studies that have measured the temperature increase of the pulp and tooth-supporting tissues during restorative and endodontic procedures. This review article provides an overview of studies measuring temperature increases in tooth structures during several restorative and endodontic procedures, and proposes clinical guidelines for reducing potential thermal hazards to the pulp and supporting tissues.
Periodontal Ligament ; Root Canal Obturation ; Tooth ; Tooth Preparation ; Ultrasonics

The effects of unripe apple mask pack made from unripe apple extracts on the skin status of middle-aged women for 4 weeks were investigated. The subjects were divided into three groups: placebo mask pack as the control (PM, n = 8), apple mask pack (AM, n = 16), and apple mask pack + apple intake (AAM, n = 12). The study included a survey questionnaire, and evaluations of nutrients intakes and of skin status. Skin status was measured by Aramo-TS. After 4 weeks, facial moisture, elasticity, evenness, and wrinkle level were improved in AM and AAM. The facial moisture level (AM: +3.13 +/- 2.73, AAM: +2.25 +/- 2.93) and elasticity level (AM: +5.81 +/- 8.27, AAM: +5.50 +/- 6.13) of AM (p < 0.001) and AAM (p < 0.05) were increased. The facial evenness level (AM: -5.25 +/- 8.13, AAM: -9.17 +/- 4.26) and wrinkle level (AM: -10.88 +/- 11.74, AAM: -17.83 +/- 12.22) were significantly decreased. AAM was more effective in improving skin elasticity, evenness, and wrinkle. The skin status of PM was not changed. While the macronutrient intakes of all the subjects were not different before and after the study, the daily intakes of some vitamins (vitamins B6, C, and E and folic acid) during the study were significantly increased in AAM. These findings suggested that regular use of apple mask pack was effective in improving overall skin status. Furthermore, the consumption of apples with mask pack application was much better in improving skin status.
Elasticity ; Female ; Humans ; Malus ; Masks ; Surveys and Questionnaires ; Skin ; Vitamins

Purpose: Exercise is a representative noninvasive treatment that can be applied to various diseases. We studied the effect of resistance exercise on motor function and spatial learning ability in Parkinson disease (PD) mice. Methods: The rotarod test and beam walking test were conducted to evaluate the effect of resistance exercise on motor function, and the Morris water maze test was conducted to examine the effect of resistance exercise on spatial learning ability. The effect of resistance exercise on brain-derived neurotrophic factor (BDNF) and tropomyosin receptor kinase B (TrkB) expression and 5’-adenosine monophosphate-activated protein kinase (AMPK) phosphorylation was investigated by Western blot analysis. New cell generation was confirmed by immunohistochemistry for 5-bromo-2’-deoxyuridine. Results: Resistance exercise improved coordination, balance, and spatial learning ability in PD mice. Resistance exercise enhanced new cell production, BDNF and TrkB expression, and AMPK phosphorylation in PD mice. The effect of such resistance exercise was similar to that of levodopa application. Conclusions In PD-induced mice, resistance exercise enhanced AMPK phosphorylation to increase BDNF expression and new neuron generation, thereby improving spatial learning ability. Resistance exercise is believed to help improve symptoms of PD.

Purpose: When splitting a liver for adult and pediatric graft recipients, the retained left medial section (S4) will undergo ischemic necrosis and the right trisection graft becomes an extended right liver (ERL) graft. We investigated the fates of the retained S4 and its prognostic impact in adult split liver transplantation (SLT) using an ERL graft. Methods: This was a retrospective analysis of 25 adult SLT recipients who received split ERL grafts. Results: The mean model for end-stage liver disease (MELD) score was 27.3 ± 10.9 and graft-recipient weight ratio (GRWR) was 1.98 ± 0.44. The mean donor age was 26.5 ± 7.7 years. The split ERL graft weight was 1,181.5 ± 252.8 g, which resulted in a mean GRWR of 1.98 ± 0.44. Computed tomography of the retained S4 parenchyma revealed small ischemic necrosis in 16 patients (64.0%) and large ischemic necrosis in the remaining 9 patients (36.0%). No S4-associated biliary complications were developed. The mean GRWR was 1.87 ± 0.43 in the 9 patients with large ischemic necrosis and 2.10 ± 0.44 in the 15 cases with small ischemic necrosis (P = 0.283). The retained S4 parenchyma showed gradual atrophy on follow-up imaging studies. The amount of S4 ischemic necrosis was not associated with graft (P = 0.592) or patient (P = 0.243) survival. A MELD score of >30 and pretransplant ventilator support were associated with inferior outcomes. Conclusion The amount of S4 ischemic necrosis is not a prognostic factor in adult SLT recipients, probably due to a sufficiently large GRWR.

BACKGROUND: Hepatocellular carcinoma (HCC) recurrence and development of de novo malignancy (DNM) after liver transplantation (LT) are the major causes of late recipient death.METHODS: We analyzed the incidence of extrahepatic DNM following living donor LT according to the status of pretransplant hepatic malignancy. We selected 2,076 adult patients who underwent primary LDLT during 7 years from January 2010 to December 2016.RESULTS: The pretransplant hepatic malignancy group (n = 1,012) showed 45 cases (4.4%) of the following extrahepatic DNMs: posttransplant lymphoproliferative disease (PTLD) in 10; lung cancer in 10; stomach cancer in 6; colorectal cancer in 5; urinary bladder cancer in 3; and other cancers in 11. The pretransplant no hepatic malignancy group (n = 1,064) showed 25 cases (2.3%) of the following extrahepatic DNMs: colorectal cancer in 3; stomach cancer in 3; leukemia in 3; lung cancer in 3; PTLD in 2; prostate cancer in 2; and other cancers in 9. Incidences of extrahepatic DNM in the pretransplant hepatic malignancy and no hepatic malignancy groups were as follows: 1.1% and 0.5% at 1 year, 3.2% and 2.0% at 3 years, 4.6% and 2.5% at 5 years, and 5.4% and 2.8% at 8 years, respectively (P = 0.006). Their overall patient survival rates were as follows: 97.3% and 97.2% at 1 year, 91.6% and 95.9% at 3 years, 89.8% and 95.4% at 5 years, and 89.2% and 95.4% at 8 years, respectively (P < 0.001). Pretransplant hepatic malignancy was the only significant risk factor for posttransplant extrahepatic DNM.CONCLUSION: Our results suggest that patients who had pretransplant hepatic malignancy be followed up more strictly because they have a potential risk of primary hepatic malignancy recurrence as well as a higher risk of extrahepatic DNM than patients without pretransplant hepatic malignancy.

BACKGROUND: Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. This study established an individualized HBV prophylaxis protocol, through optimization of hepatitis B immunoglobulin (HBIG) administration, with application of simulative half-life (SHL). METHODS: This study involved five parts: Part 1 developed the SHL estimation method with 20 patients; Parts 2 and 3 assessed the SHL variability and developed a simulation model to apply SHL in 100 patients; Part 4 validated the simulation model in 114 patients, and Part 5 was a cross-sectional study on the current status of HBIG infusion intervals in 660 patients. RESULTS: In Part 1, infusion of 10,000 IU HBIG induced add-on rise hepatitis B surface antibody (anti-HBs) titer of 5,252.5 ± 873.7 IU/L, which was 4.4% lower than actual measurement. Mean SHL of 20.0 ± 3.7 days was 2.2% longer than actual measurement. In Part 2, the medians of the intra- and inter-individual coefficient of variation in SHL were 13.5% and 18.5%, respectively. Pretransplant HBV DNA load and posttransplant antiviral therapy did not affect SHL. In Part 3, a simulation model was developed to determine the interval of HBIG infusion, by using SHL. In Part 4, all 114 patients were successfully managed with regular HBIG infusion intervals of ≥ 8 weeks, and the interval was prolonged to ≥ 12 weeks in 89.4%, with a target trough anti-HBs titer ≥ 200 IU/L. In Part 5, 47.4% of our patients received HBIG excessively, at a target trough titer of 500 IU/L. CONCLUSION: SHL estimation using only clinically available parameters seems to be reliably accurate when compared with actual measurements. We believe that SHL estimation is helpful to establish a personalized HBV prophylaxis protocol for optimizing HBIG administration.
Cross-Sectional Studies ; DNA ; Half-Life ; Hepatitis B virus ; Hepatitis B ; Hepatitis ; Humans ; Immunoglobulins ; Liver Transplantation ; Methods ; Recurrence

Purpose: When splitting a liver for adult and pediatric graft recipients, the retained left medial section (S4) will undergo ischemic necrosis and the right trisection graft becomes an extended right liver (ERL) graft. We investigated the fates of the retained S4 and its prognostic impact in adult split liver transplantation (SLT) using an ERL graft. Methods: This was a retrospective analysis of 25 adult SLT recipients who received split ERL grafts. Results: The mean model for end-stage liver disease (MELD) score was 27.3 ± 10.9 and graft-recipient weight ratio (GRWR) was 1.98 ± 0.44. The mean donor age was 26.5 ± 7.7 years. The split ERL graft weight was 1,181.5 ± 252.8 g, which resulted in a mean GRWR of 1.98 ± 0.44. Computed tomography of the retained S4 parenchyma revealed small ischemic necrosis in 16 patients (64.0%) and large ischemic necrosis in the remaining 9 patients (36.0%). No S4-associated biliary complications were developed. The mean GRWR was 1.87 ± 0.43 in the 9 patients with large ischemic necrosis and 2.10 ± 0.44 in the 15 cases with small ischemic necrosis (P = 0.283). The retained S4 parenchyma showed gradual atrophy on follow-up imaging studies. The amount of S4 ischemic necrosis was not associated with graft (P = 0.592) or patient (P = 0.243) survival. A MELD score of >30 and pretransplant ventilator support were associated with inferior outcomes. Conclusion The amount of S4 ischemic necrosis is not a prognostic factor in adult SLT recipients, probably due to a sufficiently large GRWR.

BACKGROUND: Hepatocellular carcinoma (HCC) recurrence and development of de novo malignancy (DNM) after liver transplantation (LT) are the major causes of late recipient death. METHODS: We analyzed the incidence of extrahepatic DNM following living donor LT according to the status of pretransplant hepatic malignancy. We selected 2,076 adult patients who underwent primary LDLT during 7 years from January 2010 to December 2016. RESULTS: The pretransplant hepatic malignancy group (n = 1,012) showed 45 cases (4.4%) of the following extrahepatic DNMs: posttransplant lymphoproliferative disease (PTLD) in 10; lung cancer in 10; stomach cancer in 6; colorectal cancer in 5; urinary bladder cancer in 3; and other cancers in 11. The pretransplant no hepatic malignancy group (n = 1,064) showed 25 cases (2.3%) of the following extrahepatic DNMs: colorectal cancer in 3; stomach cancer in 3; leukemia in 3; lung cancer in 3; PTLD in 2; prostate cancer in 2; and other cancers in 9. Incidences of extrahepatic DNM in the pretransplant hepatic malignancy and no hepatic malignancy groups were as follows: 1.1% and 0.5% at 1 year, 3.2% and 2.0% at 3 years, 4.6% and 2.5% at 5 years, and 5.4% and 2.8% at 8 years, respectively (P = 0.006). Their overall patient survival rates were as follows: 97.3% and 97.2% at 1 year, 91.6% and 95.9% at 3 years, 89.8% and 95.4% at 5 years, and 89.2% and 95.4% at 8 years, respectively (P < 0.001). Pretransplant hepatic malignancy was the only significant risk factor for posttransplant extrahepatic DNM. CONCLUSION Our results suggest that patients who had pretransplant hepatic malignancy be followed up more strictly because they have a potential risk of primary hepatic malignancy recurrence as well as a higher risk of extrahepatic DNM than patients without pretransplant hepatic malignancy.