No abstract available.

Since the patient’s airway is shared between an anesthesiologist and a surgeon, airway management during upper airway surgery can be challenging. Beyond the conventional method of general anesthesia, high-flow nasal oxygenation (HFNO) has recently been used as a key technique for tubeless anesthesia. HFNO provides humidified, heated oxygen up to 70 L/min, which promises improved oxygenation and ventilation, allowing for prolonged apneic oxygenation. In previous physiological and clinical studies, HFNO has been demonstrated that tubeless anesthesia safely provide an uninterrupted surgical field during laryngeal surgeries. Although tubeless anesthesia remains uncommon, it can be a good alternative to conventional anesthesia if an anesthesiologist and a surgeon select appropriate patients together with sufficient experience. A safe strategy for tubeless anesthesia, along with appropriate backup plans, including endotracheal intubation and high-frequency jet ventilation, should be considered for upper airway surgery.

Objective: This study investigated the prevalence and comorbidities of attention deficit hyperactivity disorder (ADHD) among adults and children/adolescents in Korea. Methods: This study used data from the Korea Health Insurance Review and Assessment Service collected from 2008 to 2018. Study participants comprised patients with at least one diagnosis of ADHD (International Statistical Classification of Diseases and Related Health Provisions, 10th revision code F90.0). Prevalence rates and psychiatric comorbidities were also analyzed. Results: We identified 878,996 patients diagnosed with ADHD between 2008 and 2018. The overall prevalence rate of diagnosed ADHD increased steeply from 127.1/100,000 in 2008 to 192.9/100,000 in 2018; it increased 1.47 times in children/adolescents (≤ 18 years) and 10.1 times in adults (＞ 18 years) during this period. Among adult and children/adolescent ADHD patients, 61.84% (95% confidence interval [95% CI] 61.74−61.93) and 78.72% (95% CI 78.53− 78.91) had at least one psychiatric comorbidity, respectively. Conclusion Our results showed that the prevalence rate of diagnosed ADHD has increased in Korea; however, it is lower than the global average. Further studies are required to identify and treat vulnerable populations appropriately.

Heterotopia refers to the finding of normal tissue in foreign sites, entirely separate from the main organ. Heterotopic gastric mucosa has been observed throughout the alimentary tract, everywhere from the oral cavity to the rectum. However, occurrences in the umbilicus are an extremely rare and peculiar phenomena. We report the case of heterotopic gastric mucosa in the umbilicus.
Gastric Mucosa ; Mouth ; Rectum ; Umbilicus

BACKGROUND: Xanthelasma palpebrarum is the most common type of xanthoma. Due to its delicate location near the eye, treatment of xanthelasma palpebrarum is rather difficult. The treatment includes surgical excision, local treatment with chemicals, and various laser therapies. OBJECTIVE: This study was designed to review the various therapeutic modalities and to evaluate the efficacy and safety of bichloroacetic acid (BCA) for the treatment of xanthelasma palpebrarum. METHODS: Nine patients, with a total of 19 xanthelasma lesions, were treated with BCA. The efficacy and safety were assessed over a follow-up period of 6 to 24 months (average, 16 months). RESULTS: All lesions were grossly removed completely with a single treatment and the treatment was well-tolerated by patients. Erythema and oozing were observed in six patients but improved after two weeks' dressing. Xanthelasma palpebrarum recurred in three patients, but the mean size of the recurred lesions was smaller in comparison to the primary lesion. CONCLUSION: BCA is an effective and safe therapeutic modality for xanthelasma palpebrarum. Advantages include simplicity, cost-effectiveness, speed, safety and efficacy.
Bandages ; Dichloroacetic Acid* ; Erythema ; Follow-Up Studies ; Humans ; Laser Therapy ; Xanthomatosis

Dermatofibrosarcoma protuberance is a relatively rare malignant soft tissue tumor which is locally invasive and looks like a protruded hardened plaque composed of multiple nodules. It seldom occurs on the scalp and the occurrence rate is less than 5%. Nowadays there is a tendency to choose Mohs surgery as a primary treatment instead of a wide excision, because Mohs surgery can reduce cases of recurrence. We report a case of multiple dermatofibrosarcoma protuberans on the scalp of a 32-year-old man. We planned a delayed operation using tissue expanders. We inserted two skin expanders and successfully expanded scalp tissue more than 150% after 7 months. Mohs surgery was performed with a 4 cm distance from borderline of lesions and then the large scalp skin defect was covered by the expanded skin which had been prepared by tissue expanders. It has been 9 months since the operation was performed and there have been no signs of recurrence.
Adult ; Dermatofibrosarcoma* ; Humans ; Mohs Surgery* ; Recurrence ; Scalp* ; Skin ; Tissue Expansion Devices ; Tissue Expansion*

Objectives : Recently, several attempts have been made to use repeated transcranial magnetic stimulation (rTMS) with various stimulation frequencies as a novel treatment for patients with obsessive-compulsive disorder (OCD). However, findings about the efficacy of rTMS in treating OCD have been inconsistent. In the present study, we evaluated the clinical effect and safety of low frequency rTMS on the right dorsolateral prefrontal cortex in the treatment of refractory OCD. METHODS : Twenty-four patients with treatment-refractory OCD received a daily treatment of 20 minutes low frequency rTMS (1 Hz) to the right dorsolateral prefrontal cortex with power of 100% of motor threshold, for 15 days. Clinical status was evaluated using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Anxiety Scale (HAMA), and Clinical Global Impression (CGI) at baseline, at the end of the rTMS treatment (3 weeks), and 4 weeks after finishing the rTMS treatment course. RESULTS : After 3 weeks treatment with low frequency rTMS, Y-BOCS, HAMA and CGI-S scores were significantly decreased. CONCLUSION : The present study found that low-frequency rTMS on the right prefrontal cortex for 3 weeks showed significant therapeutic effects in patients with OCD. Further controlled trials are indicated to assess the efficacy of rTMS in the treatment of OCD.
Anxiety ; Humans ; Obsessive-Compulsive Disorder ; Prefrontal Cortex ; Transcranial Magnetic Stimulation

OBJECTIVE: Gene expression microarrays become a widely used tool in biomedicine. With growing needs of microarray data sharing, there are efforts for the development of microarray standards. MAGE-OM(Microarray Gene Expression Object Model) is a data exchange model and MAGE-ML is an XML-based data exchange format. Most database, however, do not have a suitable structure for MAGE-ML storage and maximum use of the data. Therefore, we have created relational database implementing MAGE-OM for the storage of MAGE-ML with importing and exporting capabilities. METHODS: A relational schema is derived from MAGE-OM with simple object-relational mapping strategy to reduce complexity of MAGE-OM. Data transfer between database and MAGE-ML document is performed via MAGE-OM using the MAGE Software Toolkit(MAGEstk). RESULTS: Our database accepts microarray data as MAGE-ML files through web-based interface, classifying into two types of submission, array or experiment. MAGE-ML import-export function is flexible to accommodate changing data model by separating model definition and implementation layers. CONCLUSION: Standard-based implementation of gene expression database enhances the collection and the structured storage of large-scale gene expression data from heterogeneous data sources.
Information Storage and Retrieval ; Gene Expression* ; Information Dissemination

BACKGROUND: It is known that bupivacaine induce cell death in several immortalized cells. However, there is no report concerning bupivacaine-induced cell death in the primary cultured cardiomyocytes. We compared the direct cytotoxicity of local anesthetics in cardiomyocytes. Furthermore, the mechanisms of cell death were evaluated. METHODS: The myocardial cells of rat pups were cultured 3 days after seeding. The methyltetrazolium (MTT) assay was employed to quantify differences in cellular viability. To confirm apoptosis, Hoechst-propidium iodide staining, DNA fragmentation by electrophoresis and western blot analysis were performed. And to examine the mechanisms of cell death, intracellular calcium and expression levels of mitogen-activated protein kinases (MAPKs) family members were evaluated. RESULTS: Among the local anesthetics under 1 mM concentration for 18 h, only bupivacaine significantly decreased the MTT activity (P < 0.001). Bupivacaine induced cell death in a dose-responsive and time dependent manner. Cell death showed apoptotic characteristics, such as DNA fragmentation, chromatin condensation, decrease of precursor caspase-3 protein level, increased cleaved PARP, and cytochrome C release into the cytoplasm. Bupivacaine phosphorylated three major MAPKs, i.e. extracellular signal-regulated kinases (ERKs), p38 kinase and c-Jun N-terminal kinases (JNKs) stress-activated protein kinases. Administration of ERK inhibitor increase cell death, whereas inhibitors of p38 kinase and JNK decreased cell death (P < 0.05). In addition, the intracellular calcium level was approximately 4 times higher after the bupivacaine treatment (P < 0.001), which was inhibited by calcium chelators (P < 0.001). Calcium chelators inhibited expression of MAPKs. CONCLUSIONS: In bupivacaine-induced apoptosis in cardiomyocytes, intracellular calcium increase and MAPKs family plays important roles.
Anesthetics, Local ; Animals ; Apoptosis* ; Blotting, Western ; Bupivacaine ; Calcium ; Caspase 3 ; Cell Death ; Chelating Agents ; Chromatin ; Cytochromes c ; Cytoplasm ; DNA Fragmentation ; Electrophoresis ; Extracellular Signal-Regulated MAP Kinases ; Humans ; Mitogen-Activated Protein Kinases ; Myocytes, Cardiac* ; p38 Mitogen-Activated Protein Kinases* ; Phosphotransferases ; Protein Kinases ; Rats