Background: and PurposeThe impact of fluid-attenuated inversion recovery hyperintense vessels (FHVs) on outcomes in patients ineligible for recanalization therapy with large-vessel occlusion (LVO) is unclear. We investigated the impact of FHVs determined using the FHV– Alberta Stroke Program Early CT Score (ASPECTS) on clinical outcomes in patients with LVO stroke of mild-to-moderate severity ineligible for recanalization therapy. Methods: Sixty-eight consecutive patients with M1-middle cerebral artery occlusion who underwent magnetic resonance imaging within 24 hours of symptom onset and were ineligible for recanalization were included. Patients were dichotomized into a severe-FHV group (FHV-ASPECTS ≤4; n=33) and a mild-FHV group (FHV-ASPECTS >4; n=35), and multiple logistic regression analysis was used to examine the relationships of FHV scores with early neurological deterioration (END) and an unfavorable 3-month outcome (modified Rankin Scale score ≥3). Results: Mean age was 66.2±13.5 years (mean±SD), and 30 (44%) were female. The severe-FHV group had a larger infarct volume (median, 5.5 mL vs. 3 mL) and more frequently exhibited the susceptibility vessel sign (30% vs. 3%) than the mild-FHV group. Ipsilateral old nonlacunar infarct was more frequent in the mild-FHV group than in the severe-FHV group (37% vs. 15%). The severe-FHV group had a fivefold higher risk of END (odds ratio [OR] 5.02, 95% confidence interval [CI] 1.36–18.45) and unfavorable outcome (OR 5.97, 95% CI 1.18–33.31, p=0.03) compared with the mild-FHV group. Conclusions Greater FHV extent was associated with higher risk of END and unfavorable outcome in patients with LVO stroke of mild-to-moderate severity.

Background: and PurposeThe impact of fluid-attenuated inversion recovery hyperintense vessels (FHVs) on outcomes in patients ineligible for recanalization therapy with large-vessel occlusion (LVO) is unclear. We investigated the impact of FHVs determined using the FHV– Alberta Stroke Program Early CT Score (ASPECTS) on clinical outcomes in patients with LVO stroke of mild-to-moderate severity ineligible for recanalization therapy. Methods: Sixty-eight consecutive patients with M1-middle cerebral artery occlusion who underwent magnetic resonance imaging within 24 hours of symptom onset and were ineligible for recanalization were included. Patients were dichotomized into a severe-FHV group (FHV-ASPECTS ≤4; n=33) and a mild-FHV group (FHV-ASPECTS >4; n=35), and multiple logistic regression analysis was used to examine the relationships of FHV scores with early neurological deterioration (END) and an unfavorable 3-month outcome (modified Rankin Scale score ≥3). Results: Mean age was 66.2±13.5 years (mean±SD), and 30 (44%) were female. The severe-FHV group had a larger infarct volume (median, 5.5 mL vs. 3 mL) and more frequently exhibited the susceptibility vessel sign (30% vs. 3%) than the mild-FHV group. Ipsilateral old nonlacunar infarct was more frequent in the mild-FHV group than in the severe-FHV group (37% vs. 15%). The severe-FHV group had a fivefold higher risk of END (odds ratio [OR] 5.02, 95% confidence interval [CI] 1.36–18.45) and unfavorable outcome (OR 5.97, 95% CI 1.18–33.31, p=0.03) compared with the mild-FHV group. Conclusions Greater FHV extent was associated with higher risk of END and unfavorable outcome in patients with LVO stroke of mild-to-moderate severity.

This study was carried out to manifest risk factors related grain dust induced asthma, especially allergic and immunologic factors. Six grain workers first diagnosed as grain dust induced asthma by specific antigen bronchial asthma challenge test (cases) and 37 grain workers showed negative finding (controls) in the same firm were selected. Questionnaire survey for respiratory symptoms, interview, physical examination, PFT, methacholine bronchial hyperresponsiveness, specific challenge tests and skin prick test for four grains (grain, corn, rye and seed dust) were conducted. To evaluate the role of specific antibodies to grain dust, we detected serum specific IgE and IgG antibodies by ELISA in 43 employees. The results were summarized as follows : 1. Compared with the group having no respiratory symptoms, odds ratio of grain dust induced asthma with respiratory symptoms was 3.04 (95% CI 0.32-28.80). 2. Compared with the group having no ventilatory impairment, odds ratio of grain dust induced asthma with ventilatory impairment was 0.54 (95% CI 0.06-5.21). 3. Compared with the group showed negative skin test for general respirable antigen, odds ratio of grain dust induced asthma with atopy was 8.02 (95% CI 0.42-153.25). 4. Compared with the group showed negative finding on specific allergic skin test, odds ratio of grain dust induced asthma with positive finding was 5.88 (95% CI 0.63-55.38). 5. In immunologic test, compared with the group not increased total IgE(<160 IU/ml), odds ratio of grain dust induced asthma with increased group (> or = 160 IU/ml) was 4.78 (95% CI 0.50-44.57). 6. Compared with the group showed negative finding on specific IgE antibody, odds ratio of grain dust induced asthma with positive finding was 2.63 (95% CI 0.43-16.16). 7. Compared with the group showed normal finding on nonspecific (methacholine) bronchial hyperresponsiveness, odds ratio of grain dust induced asthma with positive finding was 76.82(95% CI 3.37 - 1566.34). Statistically significant odds ratio were fecund for specific skin test with grain, total IgE and nonspecific (methacholine) bronchial hyperreponsiveness.
Antibodies ; Asthma ; Asthma, Occupational* ; Cereals* ; Dust ; Enzyme-Linked Immunosorbent Assay ; Immunoglobulin E ; Immunoglobulin G ; Immunologic Factors ; Immunologic Tests ; Methacholine Chloride ; Odds Ratio ; Physical Examination ; Questionnaires ; Risk Factors* ; Secale cereale ; Skin ; Skin Tests ; Zea mays

This study was carried out to manifest risk factors related grain dust induced asthma, especially allergic and immunologic factors. Six grain workers first diagnosed as grain dust induced asthma by specific antigen bronchial asthma challenge test (cases) and 37 grain workers showed negative finding (controls) in the same firm were selected. Questionnaire survey for respiratory symptoms, interview, physical examination, PFT, methacholine bronchial hyperresponsiveness, specific challenge tests and skin prick test for four grains (grain, corn, rye and seed dust) were conducted. To evaluate the role of specific antibodies to grain dust, we detected serum specific IgE and IgG antibodies by ELISA in 43 employees. The results were summarized as follows : 1. Compared with the group having no respiratory symptoms, odds ratio of grain dust induced asthma with respiratory symptoms was 3.04 (95% CI 0.32-28.80). 2. Compared with the group having no ventilatory impairment, odds ratio of grain dust induced asthma with ventilatory impairment was 0.54 (95% CI 0.06-5.21). 3. Compared with the group showed negative skin test for general respirable antigen, odds ratio of grain dust induced asthma with atopy was 8.02 (95% CI 0.42-153.25). 4. Compared with the group showed negative finding on specific allergic skin test, odds ratio of grain dust induced asthma with positive finding was 5.88 (95% CI 0.63-55.38). 5. In immunologic test, compared with the group not increased total IgE(<160 IU/ml), odds ratio of grain dust induced asthma with increased group (> or = 160 IU/ml) was 4.78 (95% CI 0.50-44.57). 6. Compared with the group showed negative finding on specific IgE antibody, odds ratio of grain dust induced asthma with positive finding was 2.63 (95% CI 0.43-16.16). 7. Compared with the group showed normal finding on nonspecific (methacholine) bronchial hyperresponsiveness, odds ratio of grain dust induced asthma with positive finding was 76.82(95% CI 3.37 - 1566.34). Statistically significant odds ratio were fecund for specific skin test with grain, total IgE and nonspecific (methacholine) bronchial hyperreponsiveness.
Antibodies ; Asthma ; Asthma, Occupational* ; Cereals* ; Dust ; Enzyme-Linked Immunosorbent Assay ; Immunoglobulin E ; Immunoglobulin G ; Immunologic Factors ; Immunologic Tests ; Methacholine Chloride ; Odds Ratio ; Physical Examination ; Questionnaires ; Risk Factors* ; Secale cereale ; Skin ; Skin Tests ; Zea mays

The objectives of this study were to investigate the prevalence and risk factors of occupationally related carpal tunnel syndrome (CTS) among workers employed in services and manufacturing industries analysing the sensitivity and specificity of clinical symptoms and signs. Three surveys were made for this study. The first survey was done for 1,447 workers employed by 25 companies. The jobs of the employees were repetitive works at VDT and assembly lines. Therefore, employees could be divided to two groups, doing repetitive works and non repetitive works. The second survey was made for 189 workers who were randomly selected from 517 workers complained some symptoms at their hands and wrists. We examined their symptoms and carried out neurological examinations for CTS (Tinel's sign, Phalen's sign, pin prick test, carpal compressive test, toniquet compression test). The third survey was made for nerve conduction study (NCS) for 57 workers who had shown positive signs for CTS. The main results of this study were as follows: 1. From the first survey, we have found that there were significant statistical differences in getting uncomfortable neuromuscular symptoms by sex, job type, total working hours during a week, duration of current work, and kinds of work. Odds ratio in male vs female, repetitive vs non repetitive, service vs manufacturing companies, total working hours during a week, and duration of current work were 1.867(95% CI=1.467-2.377), 1.680 (95% CI=1.121-2.279), 1.663(95% CI=1.213-2.279), 1.016(95% CI=1.006-1.027) and 1.283 (95% CI=1.097-1.501) respectively. 2. From the second survey, we have found that 46 peoples (25.0%) were positive for one or more than one signs in neurological examinations of NIOSH criteria. Positive findings from neurological examinations were high among workers of low level of education (p-value=0.008), manufacturing jobs (p-value=0.00), long hours a week (p-value=0.028), and long duration of current work (p-value=0.00). 3. From the third survey, we diagnosed 35 peoples (61.4%) had CTS by NCS. They had abnormally delayed latent period or velocity in median nerve conduction velocity.
Carpal Tunnel Syndrome* ; Education ; Female ; Hand ; Humans ; Male ; Median Nerve ; National Institute for Occupational Safety and Health (U.S.) ; Neural Conduction ; Neurologic Examination ; Occupations ; Odds Ratio ; Prevalence ; Risk Factors ; Sensitivity and Specificity ; Wrist

The industrial use of MMMF(man-made mineral fibers), has been increasing, particularly since the banning of most asbestos products. Fibrous minerals can cause health abnormalities currently associated with occupational exposure to glass fiber. This study was conducted to evaluate health risks of glass fiber manufactory workers within the country. we examined questionaries, physical examination including auscultation, chest x-ray, pulmonary function test for 488 male workers, to go through their dermal itching symptoms and respiratory evaluation. we had the results as follows. 1. In 45% of the workers itching had been expressed at their entrance. At that time we was investigating, 18.5% had itching, and most of them complained it when they fall asleep and night. The frequent itching site is waist and groin, upper and lower extremity in order, and it had been expressed mainly during summer and winter. 2. As the results of ventilatory functions test, 6.0% were obstructive type, 1.0% were restrictive type. so, glass fiber exposures should be controlled or elimination by protective devices in the workplace. 3. The means of FVC, FFV1, FFV1% were in normal range. As the comparison of ventilatory functions by age groups, MMF was decreased significantly for the group, 50 years old and more than other groups. And the comparison by the serving periods at glass fiber producing factory, MMF was decreased for the workers had worked for 11-15 years. Therefore, MMF be more sensitive index in the evaluation of ventilatory impairments caused by glass fiber workers.
Asbestos ; Auscultation ; Glass* ; Groin ; Humans ; Korea* ; Lower Extremity ; Male ; Middle Aged ; Minerals ; Occupational Exposure ; Physical Examination ; Protective Devices ; Pruritus ; Reference Values ; Respiratory Function Tests ; Thorax

Excessive pathological attrition over the entire dentition can cause decreased masticatory function, and pathological problems of the temporomandibular joint and the muscular nervous system. In this case, 71 year-old male patient with severe attrition and fracture across the entire tooth was treated by full mouth rehabilitation for regaining space of restoration. In order to determine the appropriate vertical dimension of the patient’s occlusion, facial appearance, aesthetics, restoration space were evaluated, and provisional restoration of the raised vertical dimension was made. After 4 months of evaluation, the entire restoration of monolithic zirconia crown using CAD-CAM was completed. Through the above process, satisfactory aesthetic and functional results were obtained.

Methods: Multimodality IONM data, including somatosensory-evoked potentials (SSEP) and motor-evoked potentials (MEP), were reviewed in 64 patients who underwent three-column spinal surgery from 2011 to 2015. Surgical procedures included posterior vertebral column resection, pedicle subtraction osteotomy, total en bloc spondylectomy, piecemeal spondylectomy, and corpectomy with laminectomy (n=27) in three cervical, 34 thoracic, and 31 lumbar procedures. Results: Significant IONM signal changes occurred in 11 of 64 (17.1%) patients. SSEP and MEP were changed in 11 patients. Postoperative neurologic deterioration occurred in 54.5% (6 of 11) of the patients, and two of them were permanent. There was no postoperative neurologic deterioration in patients without significant signal change. Suspected causes of IONM data changes are as follows: adhesion/tethering, translation, contusion, and perfusion. Conclusions Based on the results of this study, to enhance neurologic safety in three-column spinal surgery, surgeons should pay attention to protect the spinal cord from mechanical insult, especially when the spinal column was totally destabilized during surgery, and not to compromise perfusion to the spinal cord in close cooperation with a neurologist and anesthesiologist.

No abstract available.

Development of a competence-based curriculum is important. This study aimed to develop competence assessment tools in emergency medicine and use it to assess competence of Cameroonian healthcare professionals. This was a cross-sectional, descriptive study. Through literature review, expert survey, and discrimination tests, we developed a self-survey questionnaire and a scenario-based competence assessment tool for assessing clinical knowledge and self-confidence to perform clinical practices or procedures. The self-survey consisted of 23 domains and 94 questionnaires on a 5-point Likert scale. Objective scenario-based competence assessment tool was used to validate the self-survey results for five life-threatening diseases presenting frequently in emergency rooms of Cameroon. Response rate of the self-survey was 82.6%. In this first half of competence assessment, knowledge of infectious disease had the highest score (4.6 ± 0.4) followed by obstetrics and gynecology (4.2 ± 0.6) and hematology and oncology (4.2 ± 0.5); in contrast, respondents rated the lowest score in the domains of disaster, abuse and assault, and psychiatric and behavior disorder (all of mean 2.8). In the scenario-based test, knowledge of multiple trauma had the highest score (4.3 ± 1.2) followed by anaphylaxis (3.4 ± 1.4), diabetic ketoacidosis (3.3 ± 1.0), ST-elevation myocardial infarction (2.5 ± 1.4), and septic shock (2.2 ± 1.1). Mean difference between the self-survey and scenario-based test was statistically insignificant (mean, −0.02; 95% confidence interval, −0.41 to 0.36), and agreement rate was 58.3%. Both evaluation tools showed a moderate correlation, and the study population had relatively low competence for specific aspects of emergency medicine and clinical procedures and skills.
Anaphylaxis ; Cameroon* ; Communicable Diseases ; Curriculum ; Delivery of Health Care* ; Developing Countries ; Diabetic Ketoacidosis ; Disasters ; Discrimination (Psychology) ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Gynecology ; Hematology ; Mental Competency* ; Multiple Trauma ; Myocardial Infarction ; Obstetrics ; Professional Competence ; Shock, Septic ; Surveys and Questionnaires