Soft-tissue expansion is a new surgical technique of providing donor tissue in modern reconstructive surgery. This technique provides a quantity of tissue of similar color, texture, and hair-bearing qualities for reconstruction of adjacent defects. It is known that the expanded skin shows several constant histologic changes including the increase in collagen fibers and vascularity within dermis, and thinning of subcutaneous tissue and dermis. In this study, the author observed serial histologic changes of rabbit skin induced by progressive tissue expansion up to excessive expansion of 6 times. The results are as follows: 1. Changes in the thickness of the epidermis was minimal until 3 times of expansion, but slight thinning was observed at excessive expansion state. 2. The thickness of the dermis was progressively decreased, and collagen fibers in the dermis was rapidly increased in early phase of expansion. 3. The vascularity in the dermis was also progressively increased. 4. The skin appendages showed no structural changes even in excessive expansion. 5. The panniculus carnosus showed no atrophic changes and the thickness was maintained in excessive expansion.
Collagen ; Dermis ; Epidermis ; Humans ; Skin* ; Subcutaneous Tissue ; Tissue Donors ; Tissue Expansion*

PURPOSE: This study compared the effectiveness and ease of operation of two different training methods, response sequence based training (RBST) and chest compression first training (CCFT), for cardiopulmonary resuscitation (CPR). METHODS: Eighty-five railroad workers were divided into two groups: those who applied the usual CPR training method (response sequence based training, 44 people) and those who applied our CPR training method (chest compression first training, 41 people). The objective skill performances were evaluated by using a mannequin (JAMY-IV RECO, Kyotokagaku, Japan). RESULTS: There was no statistical difference in CPR performance and artificial ventilation success rate between the RSBT group and the CCFT group. However, the artificial compression success rate and compression depth of the CCFT group compared to the RSBT group was statistically higher (p=0.006, 0.001). In addition, the wrong-hand-position rate of the RSBT group compared to the CCFT group was statistically higher (p=0.000). Furthermore, instructor satisfaction with practical training operations in the CCFT group compared to the RSBT group was statistically higher (p=0.001) and instructors reported that students were focused and easily capable of performing the CCFT training method. CONCLUSION: The chest compression first training method is easy to perform and not too complex to operate, making it effective in student performance and instruction. More effective CPR training is expected based on this method.
Cardiopulmonary Resuscitation* ; Education ; Humans ; Manikins ; Methods* ; Railroads ; Teaching ; Thorax ; Ventilation

BACKGROUND: The diagnosis of dementia is dependent on the decline of cognitive and functional ability. To measure the functional ability, a Korean version of Instrumental Activities of Daily Living (K-IADL) was developed and validated. However, the characteristics of the instrument were not fully evaluated. The study was conducted for the purpose of investigating which of the variables were associated with the K-IADL scores. METHODS: The study group from Namwon, Korea, consisting of 235 participants aged 65 years and over, was given the K-IADL to evaluate the functional ability of the participants. The independent variables included sociodemographic data (age, sex, education), vascular factors (blood pressure [BP], history of hypertension and type 2 diabetes mellitus, smoking, alcohol intake, and heart rate), and anthropometric measurements (height and arm length). RESULTS: Age, female gender, low educational attainment, high systolic BP, shorter height and arm length were significantly associated with higher K-IADL scores in univariate analyses. Among the results, age, education, systolic BP, and arm length showed independent associations with the K-IADL in multivariate analysis. CONCLUSIONS: The K-IADL was not influenced by gender in adjusted regression analyses, however education and arm length affected the functional scores, which could suggest a possibility of functional reserve. Also, it was suggested that vascular risk factors could be associated with functional ability.
Activities of Daily Living* ; Aged* ; Arm ; Blood Pressure ; Dementia ; Diabetes Mellitus, Type 2 ; Diagnosis ; Education ; Female ; Heart ; Humans ; Hypertension ; Jeollabuk-do ; Korea ; Multivariate Analysis ; Regression Analysis ; Risk Factors ; Smoke ; Smoking

PURPOSE: Addressing a patient's chief complaint is the first and key element of treating patients. This study determined the effectiveness of emergency medical technician and residents of an emergency department in addressing a patient's chief complaints. If emergency and hospital personnel misunderstand the chief symptoms of patients it could result in erroneous transport and treatment, thus losing precious time in finding the proper treatment. METHODS: A retrospective chart review study was performed in 1137 patients (at least 18 years of age), who visited one university hospital, for a period of 3 months. Patients who were did not undergo trauma, addiction, and cardiac arrest were included. RESULTS: A total of 150 cases (13.2%) did not match the chief symptoms reported by 119 emergency medical personnel and emergency medicine residents. Systemic symptoms, nervous system symptoms, and psychiatric symptoms were the main categories inconsistently assessed. The rank and certification of emergency medical technicians did not make a difference, but older patients (59 years of age or older) were statistically different. The assessment fo chief symptoms by an emergency medical resident tended to be more accurate than assessment of emergency medical technicians in the final diagnosis. CONCLUSION: Systemic symptoms, nervous symptoms, and psychiatric symptoms, were chief complaines easily misreported for older patients. This likely reflects a difficulty in the evaluation of obscure symptoms in older patients. It will require specific additional training programs to improve the response to these chief complaints.
Certification ; Emergencies ; Emergency Medical Technicians ; Emergency Medicine ; Heart Arrest ; Humans ; Nervous System ; Personnel, Hospital ; Retrospective Studies

BACKGROUND: The present study was aimed at defining the topological characteristics of the carotid intima-media thickness (IMT) in hypertensives, and to delineate whether the characteristics were different from those of non-hypertensive vascular risk factors. METHODS: B-mode carotid ultrasonography was performed in 33 participants who were devoid of stroke, ischemic heart disease, and carotid plaques. Longitudinal carotid images were obtained at 6 angular sites, 0 degree indexed adjacent to the external carotid artery (ECA) side from axial image crossing both internal carotid artery (ICA) and ECA, and then 45 degrees, 90 degrees, 180 degrees, 225 degrees, and 270 degrees. From the level of the flow divider, with an interval of 5 mm, up to 15 mm proximally, all the carotid IMT was measured. The IMT was then analyzed according to the levels and angles and compared according to either of hypertension or non-hypertension vascular risk factors. RESULTS: The carotid IMT showed asymmetric distributions in both the hypertension and non-hypertension risk groups. The IMT difference according to hypertension was observed better in the right carotid artery than the left. The right carotid IMT in the hypertension group showed significantly higher values at the most levels, and especially at 0 degree and 180 degrees of angular sites. CONCLUSIONS: It is important to understand the different topological characteristics of the carotid IMT according to the presence of hypertension, for a better reproducibility and predictability of the ultrasonic carotid IMT measurement.
Carotid Arteries ; Carotid Artery, External ; Carotid Artery, Internal ; Carotid Intima-Media Thickness* ; Hypertension ; Myocardial Ischemia ; Risk Factors ; Stroke ; Ultrasonics ; Ultrasonography

This study assesses the fertilization and blastocyst-forming rate in mice cumulus-oocyte complexes (COCs) after the exposure of human ovarian endometriotic fluid. Endometriotic fluid was obtained from a single patient by aspiration at the time of a laparoscopic cystectomy and serially diluted. COCs were obtained from 46-week-old female BDF1 mice. After exposure to ovarian endometriotic fluid for five minutes, the COCs were washed three times and the oocytes were then fertilized by mice sperm. The fertilization and blastocyst formation rate and the proportion of hatching/hatched blastocyst in the four treatment groups were not inferior to those in non-exposure group.
Animals ; Blastocyst ; Cystectomy ; Embryonic Development* ; Female ; Fertilization ; Fertilization in Vitro ; Humans ; Mice* ; Oocytes* ; Pregnancy ; Spermatozoa

To date, there have been many clinical trials to examine carotid endarterectomy (CEA) for its clinical usefulness, and-in comparison with the results of CEA-carotid artery stenting (CAS) for its clinical impact. The paper summarizes the guideline for extracranial carotid arterial disease, providing the classification of recommendation and level of evidence. Extracranial carotid artery is unique in its geometry, hemodynamics, and hemorheologic characteristics. Invasive or non-invasive imaging methods for the extracranial carotid arterial disease should be used appropriately for decision making.
Arteries ; Carotid Arteries ; Carotid Artery Diseases ; Decision Making ; Embolic Protection Devices ; Endarterectomy ; Endarterectomy, Carotid ; Hemodynamics ; Stents

Objectives: The aim of this study was to analyze the relationship between objective social isolation (SI) and unmet medical needs (UMN) in adults aged 19 and older. Methods: A cross-sectional analysis was conducted of 208 619 adults aged 19 and older, excluding missing data, using the 2019 Korea Community Health Survey. To analyze the association between objective SI and UMN, the chi-square test and logistic regression analysis were performed. Results: The prevalence of UMN was 1.14 times higher (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.06 to 1.23) among those with SI than among those without SI, and the OR for groups with 5 SI types was 2.77 (95% CI, 1.86 to 4.12) compared to those with no SI types. In addition, a stratified analysis by age group showed that the association between SI and UMN existed even in groups under 64 years old. However, among those aged 65 and older, SI was associated with an OR of 1.53 (95% CI, 1.37 to 1.71) for UMN compared to non-SI. As the number of SI types increased, the prevalence of UMN also increased, indicating a strong association between SI and UMN in older adults. Conclusions This study found that individuals with SI experienced UMN due to fear and anxiety about interpersonal relationships. Therefore, based on the results of this cross-sectional study, it is necessary to investigate the causal relationship between SI and UMN through future longitudinal data.

Blepharospasm is a focal dystonia that consists of repetitive involuntary spasmodic contractions of the orbicularis oculi muscle. A 27-year-old man was admitted with ptosis and involuntary blinking in both eyes. He was diagnosed as having schizophrenia when he was 15 years old and medicated with chlorpromazine for 12 years. After excluding all the possible etiopathological causes of the blepharospam, the offending drug was discontinued and changed to an atypical antipsychotic, clozapine. Clozapine was increased up to 75 mg in the 7th day of admission, and the symptoms were slowly ameliorated.
Adolescent ; Adult ; Blepharospasm* ; Blinking ; Chlorpromazine ; Clozapine ; Dystonic Disorders ; Humans ; Schizophrenia

BACKGROUND: The cerebellum and its neural circuitry have been assumed to play a major role in the pathophysiology of essential tremor (ET). In this study, we sought to find associations between ET and cerebellar dysfunction. METHODS: We performed tandem gait test in 41 ET patients and 44 age-matched controls. Investigators assessed tandem gait by counting the number of missteps during ten-step tandem walk and each subject repeated the trial three times. RESULTS: ET patients had a higher average and total numbers of missteps during tandem gait tests than control subjects (p<0.05). Sex-adjusted odds ratio of the association between tandem gait abnormality and ET was 3.40 (95% confidence intervals 1.06-10.85). According to age stratification, aged ET patients (age > or =70 years) showed significantly higher prevalence of tandem gait abnormality than young ones. Interaction terms determined by a likelihood ratio test was also statistically significant (p<0.05). CONCLUSIONS: Dysfunction of cerebellar neural circuitry may be associated with the pathophysiological mechanism of ET. In addition, aging may be an important factor modifying the association.
Aging ; Cerebellar Diseases* ; Cerebellum ; Essential Tremor* ; Gait ; Humans ; Odds Ratio ; Prevalence ; Research Personnel