BACKGROUND: Total intravenous anesthesia with propofol can cause respiratory depression and apnea especially during induction of anesthesia. To study the possibility of reversal of respiratory depression during anesthesia with propofol, pretreated with nabuphine or not, the respiratory effects of doxapram to spontaneously ventilating patients were investigated. METHODS: Patients were divided into 4 groups - saline-propofol-saline group (SPS), saline-propofol- doxapram group (SPD), nalbuphine-propofol-saline group (NPS), and nalbuphine-propofol-doxapram group (NPD). After saline or nalbuphine pretreatment, anesthesia was induced with propofol and then doxapram or saline was intravenously injected. Apneic time interval, blood pressure, heart rate, respiratory rate, minute ventilation, end tidal CO2 partial pressure and oxygen saturation were measured in every minutes during induction of anesthesia. Percent changes of each values were compared. RESULTS: There is no differences in apneic time intervals in each groups. The percent change of first minute ventilation in SPD group after doxapram injection unchanged significantly compared with those depressions of SPS, NPS and NPD group (p<0.05). Respiratory rates increased in SPD and SPS groups after laryngeal mask insertion. There is no differences in minute ventilation, respiratory rate and end-tidal CO2 concentration between nalbuphine pretreated groups regardless of doxapram injection. CONCLUSIONS: Doxapram has effect in increasing minute ventilation after propofol induction within first few minutes, but it cannot reverse respiratory depression during propofol induction pretreated with nalbuphine.
Anesthesia ; Anesthesia, Intravenous* ; Apnea ; Blood Pressure ; Depression ; Doxapram* ; Heart Rate ; Humans ; Laryngeal Masks ; Nalbuphine* ; Oxygen ; Partial Pressure ; Propofol* ; Respiratory Insufficiency ; Respiratory Rate ; Ventilation

Recently a new generation of crown and bridge veneering resins containing submicron glass fillers was introduced. These ultrasmall particle hybrid composite materials distinguish themselves, compared with conventional microfill crown and bridge resins, through improved mechanical properties. It is claimed that these composites are suitable for metal free crowns and even bridges using fiber reinforcement. The purpose of this study was to evaluate the effect of thermal cycling on the tensile strength of the following veneering composites: Artglass(Heraeus Kulzer Co., Wehrheim, Germany), Estenia(Kuraray Co., Japan), Sculpture(Jeneric Pentron Co., Wallingford, U.S.A.), and Targis(Ivoclar Co., Schaan Liechenstein). According to manufacturer' s instructions, rectangular tensile test specimens measuring 1.5 x 2.0 x 4.5 mm were made using a teflon mold. Whole specimens were divided into two groups. One group was dried in a desiccator at 25C for 10 days, and another group was subjected to thermal cycling(10,000 x) in water(5/55 10. All test specimens were placed in a universal testing machine and loaded until fracture with a crosshead speed of 0.5mm/min. Weibull analysis and Tukey s test were used to analyze the data. The fracture surfaces of specimens were observed in SEM and the aliphatic C=C absorbance peak of Estenia and Targis resin was analyzed using Fourier transform infrared(FTIR) spectroscopy. Within the limitations imposed in this study, the following conclusions can be drawn 1. Both in drying condition and, thermal cycling condition, the highest tensile strength was observed in Estenia testing group(p<0.05). 2. The strength data were fit to single-mode Weibull distribution, and the Weibull modulus of all veneering composite resin specimens increased after thermal cycling treatment. 3. After thermal cycling test, the highest tensile strength was observed in the Estenia group, and the lowest value was observed in the Targis group. The tensile strength values showed the significant differences between each group(p<0.05). 4. The aliphatic C = C absorbance peak of Estenia and Targis resin was decreased after light curing, and there was no distinct change after thermal cycling.
Composite Resins* ; Crowns* ; Fourier Analysis ; Fungi ; Glass ; Polytetrafluoroethylene ; Silicone Elastomers ; Spectroscopy, Fourier Transform Infrared ; Spectrum Analysis ; Tensile Strength*

Jaw relations and the recording methods have been controversial aspects of dentistry. The purpose of this study was to quantify the relative muscle activity of the masseter and temporal muscles in relation to different intermaxillary relations recorded by intra-oral tracer during maximal clenching and to decide the optimal mandibular position. Ten volunteers with healthy TMJ were studied. Intra-oral tracer was assembled and bite block was fabricated in the articulator. Intra-oral tracer was placed in the mouth, and four mandibular positions were recorded. EMG activity was recorded on a BIO-PAK system (Bio-Research Associates, Inc. USA.) in masseter and temporal muscle and compared in each mandibular positions. The results were as follows: 1. In comparison with maximum intercuspation, the chewing position was the most similar followed by tapping position, myocentric position and posterior border position. However the differences were not statistically significant. 2. In comparison of bilateral symmetry of masseter muscle, tapping position was the most symmetrical followed by chewing position and maximum intercuspation. Myocentric position and posterior border position were not symmetrical. (P<.05). 3. In comparison of bilateral symmetry of anterior temporal muscle, chewing position was the most symmetrical followed by posterior border position, maximum intercuspation, myocentric position and tapping position. However the differences were not statistically significant. 4. In comparison of proportionality of anterior temporal muscle to masseter muscle activity on left side, posterior border position was the greatest followed by myocentric position, tapping position, chewing position and maximum intercuspation. And the proportionality of posterior border position was greater than that of maximum intercuspation. (P<.05). 5. In comparison of proportionality of anterior temporal muscle to masseter muscle activity on right side, myocentric position was the greatest followed by posterior border position, tapping position, maximum intercuspation and chewing position. However the differences were not statistically significant.
Dental Articulators ; Dentistry ; Jaw ; Masseter Muscle ; Mastication ; Mouth ; Temporal Muscle ; Temporomandibular Joint ; Volunteers

BACKGROUND: Decreased heart rate variability(HRV) has been shown to be an independent predictor of poor outcome after acute myocardial infarction, Spectral analysis of HRV has recently been shown to be a reliable noninvasive test for quantiative assessment of cardiovascular autonomic regulatory response. We estimated the reproducibility and circadian rhythm of HRV parameters in patients with acute myocardial infarction. METHODS: Three consecutive 24-hour ambulatory electrocardiographic recordings were made in 24 patients with acute myocardial infarction, with 10~14 days after the acute attack, and analyzed for HRV parameters of both frequency and time domains. Parameters of frequency domain include low frequency(LF) and high frequency(HF) components. Parameters of time domain include sdRR, SDANN, SD, pNN50, rMSSD, HRV index. RESULTS: Mean total, low frequency and high frequency amplitude spectral densities were 33msec, 19msec and 11msec, respectively. Mean values of sdRR, SDANN, SD, rMSSD, pNN50 and HRV index were 103msec, 90msec, 47msec, 28msec, 7% and 32, respectively. Coefficients of variation(CV) of total amplitude spectral density, and low and high frequency components were 7%, 9% and 12%, respectively. CV of most HRV parameters of time domain were also around 10% except rMSSD and pNN50. Heart rate increased in the morning to be sustained during the day time and decreased in the night. Heart rate variability of high frequency component decreased in the early morning to be sustained during day time with increase in the night. CONCLUSIONS: We conclude that in the predischarge period of acute myocardial infarction, HRV parameters of frequency and time domains are reproducible and there are some morning fall of cardiac vagal activity.
Circadian Rhythm ; Electrocardiography ; Heart Rate* ; Heart* ; Humans ; Myocardial Infarction*

To evaluate the radiographic characteristics of osteochondritis dissecans (OCD) and useful parameter for predicting mechanical stability, we retrospectively analysed 26 plain radiographic examinations and seven MR imagings in 28 cases of OCD in 24 patients. Typical radiologic findings were osteochondral defect with sclerotic rim of variable thickeness and osteochondral fragment. Sites of osteochondral defect were medial (35.9%) or lateral (32%) femoral chondyle and medial (7.1%) or lateral (25%) side of talar dome. Sclerotic rim was seen in 24 cases (85%) and osteochondral fragments including nine loose bodies were seen in 21 cases (75%). The size of osteochondral defect with unstable fragment (average 2.05cm) and loose body (2.04cm) in the knee joint were similar to, but statistically larger than that with stable fragment (1.35cm). All osteochondral defects were well visualized on MR images. Abnormalities of articular cartilage and effusion in the interface between the parent bone and fragment were seem in five cases of which there were confirmed three unstable cases arthroscopically. We conclude that size of defect may be a good parameter for predicting mechanical stability and MRI may be useful in the diagnosis of OCD and determining the methods of treatment.
Cartilage, Articular ; Diagnosis ; Humans ; Knee Joint ; Magnetic Resonance Imaging ; Osteochondritis Dissecans* ; Osteochondritis* ; Parents ; Retrospective Studies

PURPOSE: To assess the spinal canal and neural foraminal stenosis associated with spondylolisthesis on MR imaging. MATERIALS AND METHODS: We retrospectively analysed MR findings of 63 cases of spondylolisthesis(degenerative type:23 cases, isthmic type:40 cases) regarding the type and grade of spondylolisthesis, prensence or absence of associated spinal canal stenosis, and the severity of associated neural foraminal stenosis. RESULTS: Central canal stenosis were more frequent in degenerative type(91%) than isthmic type(33%), and more frequent in grade II spondylolisthesis of degenerative type(100%) and isthmic type(89%) than in grade spondylolisthesis of degenerative type(45%) and isthmic type(20%). There was positive correlation between the severity of neural foraminal stenosis and the grade of spondylolisthesis, whereas there was no significant difference between degenerative and isthmic types. CONCLUSION: Degenerative spondylolisthesis were frequently associated with central canal stenosis more than isthmic type. When the grade of spondylolisthesis was higher, it was more frequently associated with central canal stenosis and severe neural foraminal stenosis.
Constriction, Pathologic* ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Canal ; Spondylolisthesis*

Objective: Fatigue is a common, debilitating nonmotor symptom of Parkinson’s disease (PD), but its mechanism is poorly understood. We aimed to determine whether electroencephalography (EEG) could objectively measure fatigue and to explore the pathophysiology of fatigue in PD. Methods: We studied 32 de novo PD patients who underwent EEG. We compared brain activity between 19 PD patients without fatigue and 13 PD patients with fatigue via EEG power spectra and graphs, including the global efficiency, characteristic path length, clustering coefficient, small-worldness, local efficiency, degree centrality, closeness centrality, and betweenness centrality. Results: No significant differences in absolute or relative power were detected between PD patients without or with fatigue (all p > 0.02, Bonferroni-corrected). According to our network analysis, brain network efficiency differed by frequency band. Generally, the brain network in the frontal area for theta and delta bands showed greater efficiency, and in the temporal area, the alpha1 band was less efficient in PD patients without fatigue (p < 0.0001, p = 0.0011, and p = 0.0007, respectively, Bonferroni-corrected). Conclusion Our study suggests that PD patients with fatigue have less efficient networks in the frontal area than PD patients without fatigue. These findings may explain why fatigue is common in PD, a frontostriatal disorder. Increased efficiency in the temporal area in PD patients with fatigue is assumed to be compensatory. Brain network analysis using graph theory is more valuable than power spectrum analysis in revealing the brain mechanism related to fatigue.

OBJECTIVE: The authors evaluated the accuracies and ease of use of several commonly used microanastomosis training models (synthetic tube, chicken wing, and living rat model). METHODS: A survey was conducted among neurosurgeons and neurosurgery residents at a workshop held in 2009 at the authors' institute. Questions addressed model accuracy (similarity to real vessels and actual procedures) and practicality (availability of materials and ease of application in daily practice). Answers to each question were rated using a 5-point scale. Participants were also asked what types of training methods they would chose to improve their skills and to introduce the topic to other neurosurgeons or neurosurgery residents. RESULTS: Of the 24 participants, 20 (83.3%) responded to the survey. The living rat model was favored for model accuracy (p < 0.001; synthetic tube -0.95 +/- 0.686, chicken wing, 0.15 +/- 0.587, and rat, 1.75 +/- 0.444) and the chicken wing model for practicality (p < 0.001; synthetic tube -1.55 +/- 0.605, chicken wing, 1.80 +/- 0.523, and rat, 1.30 +/- 0.923). All (100%) chose the living rat model for improving their skills, and for introducing the subject to other neurosurgeons or neurosurgery residents, the chicken wing and living rat models were selected by 18 (90%) and 20 (100%), respectively. CONCLUSION: Of 3 methods examined, the chicken wing model was found to be the most practical, but the living rat model was found to represent reality the best. We recommend the chicken wing model to train surgeons who have mastered basic techniques, and the living rat model for experienced surgeons to maintain skill levels.
Animals ; Cerebral Revascularization ; Chickens ; Microsurgery ; Neurosurgery ; Rats ; Wings, Animal

Objective: The COVID-19 is overwhelming health care systems globally. Hospital isolation may generate considerable psychological stress. However, there has been scarce evidence on psychological interventions for these patients due to maintain staff safety. We investigated the feasibility and effectiveness of telephone based interventions for psychological problems in hospital isolated patients with COVID-19. Methods: Psychiatrists visited the ward where the patients were hospitalized and interventions were given by using a ward telephone for 30 minutes. All patients were approached to receive a two-week psychological intervention program and/or pharmacotherapy whenever needed. Psychological problems were assessed at baseline, one, and two weeks. For the assessment of anxiety and depressive symptoms, the Hospital Anxiety and Depression Scale was administered to patients once a week. Insomnia severity index and Beck Depression Inventory 9 item were checked weekly to assess insomnia and suicide idea. Results: Of 33 enrolled, clinically meaningful psychological symptoms were found in 6 (18%) patients for anxiety; 13 (39%) for depression; 10 (30%) for insomnia; and 3 (9%) for suicidal ideation. In 9 patients (27%), psychotropic medications were prescribed to manage anxiety, agitation, depressed mood, insomnia, impulsivity, and suicide idea.Compared to baseline, significant improvements were found in anxiety, depression, and suicidal ideation at one week.There were no statistical differences between the values evaluated at baseline and at two weeks. Conclusion Our report at least indicates potential usefulness of telephone based interventions in hospital isolated patients with COVID-19, and will hopefully form the basis for future randomized clinical trials.

PURPOSE: This research was an empirical study designed to identify precursors and interaction effects related to nurses' patient identification behavior. A multilevel analysis methodology was used. METHODS: A self-report survey was administered to registered nurses (RNs) of a university hospital in South Korea. Of the questionnaires, 1114 were analyzed. RESULTS: The individual-level factors that had a significantly positive association with patient identification behavior were person-organization value congruence, organizational commitment, occupational commitment, tenure at the hospital, and tenure at the unit. Significantly negative group-level precursors of patient identification behavior were burnout climate and the number of RNs. Two interaction effects of the person-organization value congruence climate were identified. The first was a group-level moderating effect in which the negative relationship between the number of RNs and patient identification behavior was weaker when the nursing unit's value congruence climate was high. The second was a cross-level moderating effect in which the positive relationship between tenure at the unit and patient identification behavior was weaker when value congruence climate was high. CONCLUSION: This study simultaneously tested both individual-level and group-level factors that potentially influence patient identification behavior and identified the moderating role of person-organization value congruence climate. Implications of these results are discussed.
Adult ; Attitude of Health Personnel ; Female ; Humans ; Interprofessional Relations ; Male ; Middle Aged ; Nursing Staff, Hospital/organization & administration/*psychology ; Organizational Culture ; *Patient Identification Systems ; Questionnaires ; Workplace