Purpose: We evaluated risk factors associated with reoperation following exposed hydroxyapatite orbital implant placement. Methods: We retrospectively analyzed 34 patients (34 eyes) diagnosed with exposed hydroxyapatite orbital implants at our institution between 2008 and 2022; all patients had a minimum follow-up of 12 months. All patients initially received conservative management. However, if symptoms, such as pain, discharge, or progressive exposure persisted, surgery was undertaken. We analyzed several variables, including age, sex, diabetic status, preoperative diagnosis, surgical approach, implant type and size, and exposed implant surface area. Regression analysis was performed to identify variables associated with reoperation. Results: Of the 34 patients (34 eyes), 17 (50.0%) were managed conservatively, whereas 17 (50.0%) required surgical intervention. Regression analysis revealed a significant association between the size of the exposed area and the need for reoperation (p = 0.018); however, other factors did not significantly impact reoperation rates. Receiver operating characteristic curve analysis identified a threshold of 4.5 mm for exposed area size, with an area under the curve of 0.934, sensitivity of 0.882, and specificity of 0.824. Patients categorized into small and large groups based on the 4.5 mm threshold revealed a statistically significant difference in reoperation rates (p < 0.001). Conclusions Our study demonstrates that the size of the exposed area is the single most significant predictor of revision surgery in patients with exposed hydroxyapatite orbital implants. Notably, an exposed area > 4.5 mm was associated with a significantly increased risk of reoperation.

Purpose: We evaluated risk factors associated with reoperation following exposed hydroxyapatite orbital implant placement. Methods: We retrospectively analyzed 34 patients (34 eyes) diagnosed with exposed hydroxyapatite orbital implants at our institution between 2008 and 2022; all patients had a minimum follow-up of 12 months. All patients initially received conservative management. However, if symptoms, such as pain, discharge, or progressive exposure persisted, surgery was undertaken. We analyzed several variables, including age, sex, diabetic status, preoperative diagnosis, surgical approach, implant type and size, and exposed implant surface area. Regression analysis was performed to identify variables associated with reoperation. Results: Of the 34 patients (34 eyes), 17 (50.0%) were managed conservatively, whereas 17 (50.0%) required surgical intervention. Regression analysis revealed a significant association between the size of the exposed area and the need for reoperation (p = 0.018); however, other factors did not significantly impact reoperation rates. Receiver operating characteristic curve analysis identified a threshold of 4.5 mm for exposed area size, with an area under the curve of 0.934, sensitivity of 0.882, and specificity of 0.824. Patients categorized into small and large groups based on the 4.5 mm threshold revealed a statistically significant difference in reoperation rates (p < 0.001). Conclusions Our study demonstrates that the size of the exposed area is the single most significant predictor of revision surgery in patients with exposed hydroxyapatite orbital implants. Notably, an exposed area > 4.5 mm was associated with a significantly increased risk of reoperation.

Purpose: We evaluated risk factors associated with reoperation following exposed hydroxyapatite orbital implant placement. Methods: We retrospectively analyzed 34 patients (34 eyes) diagnosed with exposed hydroxyapatite orbital implants at our institution between 2008 and 2022; all patients had a minimum follow-up of 12 months. All patients initially received conservative management. However, if symptoms, such as pain, discharge, or progressive exposure persisted, surgery was undertaken. We analyzed several variables, including age, sex, diabetic status, preoperative diagnosis, surgical approach, implant type and size, and exposed implant surface area. Regression analysis was performed to identify variables associated with reoperation. Results: Of the 34 patients (34 eyes), 17 (50.0%) were managed conservatively, whereas 17 (50.0%) required surgical intervention. Regression analysis revealed a significant association between the size of the exposed area and the need for reoperation (p = 0.018); however, other factors did not significantly impact reoperation rates. Receiver operating characteristic curve analysis identified a threshold of 4.5 mm for exposed area size, with an area under the curve of 0.934, sensitivity of 0.882, and specificity of 0.824. Patients categorized into small and large groups based on the 4.5 mm threshold revealed a statistically significant difference in reoperation rates (p < 0.001). Conclusions Our study demonstrates that the size of the exposed area is the single most significant predictor of revision surgery in patients with exposed hydroxyapatite orbital implants. Notably, an exposed area > 4.5 mm was associated with a significantly increased risk of reoperation.

Purpose: We evaluated risk factors associated with reoperation following exposed hydroxyapatite orbital implant placement. Methods: We retrospectively analyzed 34 patients (34 eyes) diagnosed with exposed hydroxyapatite orbital implants at our institution between 2008 and 2022; all patients had a minimum follow-up of 12 months. All patients initially received conservative management. However, if symptoms, such as pain, discharge, or progressive exposure persisted, surgery was undertaken. We analyzed several variables, including age, sex, diabetic status, preoperative diagnosis, surgical approach, implant type and size, and exposed implant surface area. Regression analysis was performed to identify variables associated with reoperation. Results: Of the 34 patients (34 eyes), 17 (50.0%) were managed conservatively, whereas 17 (50.0%) required surgical intervention. Regression analysis revealed a significant association between the size of the exposed area and the need for reoperation (p = 0.018); however, other factors did not significantly impact reoperation rates. Receiver operating characteristic curve analysis identified a threshold of 4.5 mm for exposed area size, with an area under the curve of 0.934, sensitivity of 0.882, and specificity of 0.824. Patients categorized into small and large groups based on the 4.5 mm threshold revealed a statistically significant difference in reoperation rates (p < 0.001). Conclusions Our study demonstrates that the size of the exposed area is the single most significant predictor of revision surgery in patients with exposed hydroxyapatite orbital implants. Notably, an exposed area > 4.5 mm was associated with a significantly increased risk of reoperation.

BACKGROUND: Coronary artery bypass graft(CABG) in patients with advanced left ventricular dysfunction has often been regarded as having high mortality rate, despite the great improvement in operative result of CABG. With recent advances in surgical technique and myocardial protection, surgical revascularization improved the symptom and long-term survival of these high risk patients more than the medical conservative treatment. MATERIAL AND METHOD: Clinical data of 31(4.1%) patients with preoperative ejection fraction less than 30% among 864 CABGs performed between January 1995 and March 1999 were retrospectively analyzed and pre- and postoperative changes of the ejection fraction on echocardiography were analyzed. There were 26 men and 5 women. The mean age was 60.7 years(range 41 to 72 years). History of myocardial infarction(30 cases, 98%) was the most common preoperative risk factor. There were seven irreversible myocardial infarction on thallium scan. Most patients had triple vessel diseases(26 cases, 84%) and first degree of Rentrop classification(16 cases, 52%) on coronary angiography. The mean number of distal anastomosis during CABG was per patient was 4.9+/-0.8 sites in each patient. In addition to long saphenous veins, the internal mammary artery was used in 20 patients. Total bypass time was 244.7+/-3.7 minutes(range, 117 to 567 minutes), and mean aortic cross-clamp time was 77.9+/-1.6 minutes(range, 30 to 178 minutes). There were five other reparative procedures such as two left ventricular aneurysmectomy, two mitral repair, and one aortic valve replacement. There were twelve postoperative complications such as three cardiac arrhythmia, two bleeding(re-operation), one delayed sternal closure, eleven usage of intra-aortic balloon counterpulsation for low cardiac output. Two patients died, postoperative mortality was 6.5%. Twenty-nine patients were relieved of chest pain and left ventricular ejection fraction after operation was significantly higher(38.5+/-11.6%, P<0.001) as compared with preoperative left ventricular ejection fraction(25.3+/-2.3%). The follow up period of out patient was 25.3 months. CONCLUSION: In patients with coronary artery disease and advanced left ventricular dysfunction, coronary artery bypass grafting can be performed relatively safely with improvement in left ventricular function, but it will be necessary to study long term results.
Aortic Valve ; Arrhythmias, Cardiac ; Cardiac Output, Low ; Chest Pain ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Counterpulsation ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Male ; Mammary Arteries ; Mortality ; Myocardial Infarction ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Saphenous Vein ; Stroke Volume ; Thallium ; Ventricular Dysfunction, Left* ; Ventricular Function, Left

OBJECTIVE: Brain computed tomography (CT) is commonly performed to diagnose acute altered mental status (AMS), a critically important symptom in many serious diseases. However, negative CT results are common, which result in unnecessary CT use. Therefore, this study aimed to determine the clinical factors associated with positive CT findings. METHODS: Patients with acute AMS selected from an emergency department-based registry were retrospectively evaluated. Patients with non-traumatic and noncommunicable diseases on initial presentation and with Glasgow Comal Scale scores of < 15 were included in the study. RESULTS: Among the 367 brain CT results of patients with AMS during the study period, 146 (39.8%) were positive. In a multivariate analysis, the presence of focal neurologic deficit (odds ratio [OR], 132.6; 95% confidence interval [CI], 37.8 to 464.6), C-reactive protein level < 2 mg/dL (OR, 3.9; 95% CI, 1.4 to 10.6), and Glasgow Comal Scale score < 9 (OR, 2.4; 95% CI, 1.2 to 4.8) were significantly associated with positive brain CT results. CONCLUSION: The presence of focal neurologic deficit, initial Glasgow Comal Scale score of < 9, and initial C-reactive protein levels of < 2 mg/dL can facilitate the selection of brain CT to diagnose patients with acute AMS in the emergency department.
Brain* ; C-Reactive Protein ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Multivariate Analysis ; Neurologic Manifestations ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; Unconsciousness

BACKGROUND/AIMS: To evaluate and select microRNAs relevant to acute myeloid leukemia (AML) pathogenesis, we analyzed differential microRNA expression by quantitative small RNA next-generation sequencing using duplicate marrow samples from individual AML patients. METHODS: For this study, we obtained paired marrow samples at two different time points (initial diagnosis and first complete remission status) in patients with AML. Bone marrow microRNAs were profiled by next-generation small RNA sequencing. Quantification of microRNA expression was performed by counting aligned reads to microRNA genes. RESULTS: Among 38 samples (32 paired samples from 16 AML patients and 6 normal marrow controls), 27 were eligible for sequencing. Small RNA sequencing showed that 12 microRNAs were selectively expressed at higher levels in AML patients than in normal controls. Among these 12 microRNAs, mir-181, mir-221, and mir-3154 were more highly expressed at initial AML diagnosis as compared to first complete remission. Significant correlations were found between higher expression levels of mir-221, mir-146, and mir-155 and higher marrow blast counts. CONCLUSIONS: Our results demonstrate that mir-221 and mir-181 are selectively enriched in AML marrow and reflect disease activity. mir-3154 is a novel microRNA that is relevant to AML but needs further validation.
Bone Marrow ; Diagnosis ; Humans ; Leukemia, Myeloid, Acute* ; MicroRNAs* ; RNA* ; Sequence Analysis, RNA*

Objectives: This study was conducted to explore recent trends in the prevalence of pediatric elevated blood pressure and hypertension (HTN) in Korea and the United States, applying the new HTN reference values for adolescents. Methods: This study analyzed 17 339 (8755 Korean and 8584 American) adolescents aged 10 to 17 who participated in the Korea National Health and Nutrition Examination Survey and the National Health and Nutrition Examination Survey, respectively, between 2005 and 2016. HTN was defined using percentile-based reference values for non-overweight adolescents from 7 nations, and obesity was defined by body mass index (BMI) based on country-specific growth charts. All analyses were stratified by sex and year-over-year changes were evaluated by calculating the p for trend. Results: Systolic blood pressure showed a statistically meaningful upward trend in Korean boys and girls, while diastolic blood pressure did not show any significant changes. Both systolic and diastolic blood pressure levels declined among United States boys and girls. The prevalence of elevated blood pressure and HTN remained similar in Korean adolescents, but declined in both sexes among United States adolescents. BMI increased in both sexes among Korean adolescents, although the overweight and obesity rates stayed the same. No significant trends were found in any obesity indices among United States adolescents. The prevalence of elevated blood pressure and HTN by obesity level was higher among Korean adolescents than among their United States peers in both sexes, and the gap became higher at more severe levels of obesity. Conclusions Despite the strong correlation between obesity and HTN, recent trends in the prevalence of HTN and obesity among Korean and United States adolescents were strikingly different. Follow-up studies are necessary to determine why the prevalence of HTN was more than twice as high among Korean adolescents than among their United States counterparts.