Sleep is essential to brain function and mental health. Insomnia and obstructive sleep apnea (OSA) are the two most common sleep disorders, and are major public health concerns. Proton magnetic resonance spectroscopy (1H-MRS) is a non-invasive method of quantifying neurometabolite concentrations. Therefore, 1H-MRS studies on individuals with sleep disorders may enhance our understanding of the pathophysiology of these disorders. In this article, we reviewed 1H-MRS studies in insomnia and OSA that reported changes in neurometabolite concentrations. Previous studies have consistently reported insomnia-related reductions in γ-aminobutyric acid (GABA) levels in the frontal and occipital regions, which suggest that changes in GABA are important to the etiology of insomnia. These results may support the hyperarousal theory that insomnia is associated with increased cognitive and physiological arousal. In addition, the severity of insomnia was associated with low glutamate and glutamine levels. Previous studies of OSA have consistently reported reduced N-acetylaspartate (NAA) levels in the frontal, parietooccipital, and temporal regions. In addition, OSA was associated with increased myo-inositol levels. These results may provide evidence that intermittent hypoxia induced by OSA may result in neuronal damage in the brain, which can be related to neurocognitive dysfunction in patients with OSA. The current review summarizes findings related to neurochemical changes in insomnia and OSA. Future well-designed studies using 1H-MRS have the potential to enhance our understanding of the pathophysiology of sleep disorders including insomnia and OSA.

Suicide is a leading cause of death worldwide, especially among adolescents and young adults. Considering this fact, it is imperative that we understand the neural mechanisms underlying suicidal thoughts and behaviors in youth from a neurodevelopmental perspective. In this review, we focused on the magnetic resonance imaging studies that examined the neural correlates of suicidal ideations (SI) or attempts (SA) in youth. We reviewed twenty-three cross-sectional studies reporting the structural and functional alterations in association with SI or SA among adolescents and young adults with various mental disorders. The previous literature suggests that the dorsolateral prefrontal cortex, anterior cingulate cortex, and ventral frontolimbic circuit, may play an important role in the pathophysiology of suicidal behavior in youth through altered top-down control over emotion and impulsivity. Future studies with a longitudinal design and using multimodal imaging techniques may be of help to identify novel therapeutic targets specific for youth with suicidal thoughts and behaviors.

Sleep is essential to brain function and mental health. Insomnia and obstructive sleep apnea (OSA) are the two most common sleep disorders, and are major public health concerns. Proton magnetic resonance spectroscopy (1H-MRS) is a non-invasive method of quantifying neurometabolite concentrations. Therefore, 1H-MRS studies on individuals with sleep disorders may enhance our understanding of the pathophysiology of these disorders. In this article, we reviewed 1H-MRS studies in insomnia and OSA that reported changes in neurometabolite concentrations. Previous studies have consistently reported insomnia-related reductions in γ-aminobutyric acid (GABA) levels in the frontal and occipital regions, which suggest that changes in GABA are important to the etiology of insomnia. These results may support the hyperarousal theory that insomnia is associated with increased cognitive and physiological arousal. In addition, the severity of insomnia was associated with low glutamate and glutamine levels. Previous studies of OSA have consistently reported reduced N-acetylaspartate (NAA) levels in the frontal, parietooccipital, and temporal regions. In addition, OSA was associated with increased myo-inositol levels. These results may provide evidence that intermittent hypoxia induced by OSA may result in neuronal damage in the brain, which can be related to neurocognitive dysfunction in patients with OSA. The current review summarizes findings related to neurochemical changes in insomnia and OSA. Future well-designed studies using 1H-MRS have the potential to enhance our understanding of the pathophysiology of sleep disorders including insomnia and OSA.

Background: Liver transplantation (LT) may be associated with massive blood loss and the need for allogeneic blood transfusion. Intraoperative blood salvage autotransfusion (IBSA) can reduce the need for allogeneic blood transfusion. This study aimed to investigate the effectiveness of blood salvage in LT. Methods: Among 355 adult patients who underwent elective living-donor LT between January 1, 2019, and December 31, 2022, 59 recipients without advanced hepatocellular carcinoma received IBSA using Cell Saver (CS group). Based on sex, age, model for end-stage liver disease (MELD) score, preoperative laboratory results, and other factors, 118 of the 296 recipients who did not undergo IBSA were matched using propensity score (non-CS group). The primary outcome was the amount of intraoperative allogenic red blood cell (RBC) transfusion. Comparisons were made between the two groups regarding the amount of other blood components transfused and postoperative laboratory findings. Results: The transfused allogeneic RBC for the CS group was significantly lower than that of the non-CS group (1,506.0 vs. 1,957.5 ml, P = 0.026). No significant differences in the transfused total fresh frozen plasma, platelets, cryoprecipitate, and estimated blood loss were observed between the two groups. The postoperative allogeneic RBC transfusion was significantly lower in the CS group than in the non-CS group (1,500.0 vs. 2,100.0 ml, P = 0.039). No significant differences in postoperative laboratory findings were observed at postoperative day 1 and discharge. Conclusions Using IBSA during LT can effectively reduce the need for perioperative allogeneic blood transfusions without causing subsequent coagulopathy.

This study examined the influence of the apical sizes on the sealing ability of a root canal filling. Thirty-six single rooted teeth with a single canal were divided into 3 groups (n = 12) and instrumented with either the Profile(R) or LightSpeed(R) system to achieve three different apical sizes (master apical file [MAF] of #25, #40, or #60). The teeth were filled with gutta percha using a modified continuous wave technique. The level of microleakage was determined by immersing ten teeth from each group into India ink for 1 week followed by clearing with nitric acid, ethyl-alcohol, and methylsalicylate. The microleakage was measured using vernier calipers. The data was analyzed statistically using Kruskal-Wallis one-way ANOVA and a Student-Newman-Keuls Method. Two teeth from each group were sectioned horizontally at 1, 2, 3 and 4 mm from the apex in order to observe a cross section. The apical size was significantly (p < .05) influenced the level of microleakage. In the Student-Newman-Deuls Method, MAF sizes of #25 and #40; and MAF sizes of #25 and #60, respectively showed a statistically significant difference. There was no significant difference between #40 and #60. In most cross sections, oval-shaped canals were observed, and the irregularity of the internal surface increased with decreasing apical size. There was also an increase in the area of recess, which is the area where the canal space is not filled with either gutta-percha or sealer. When the root canals are filled using a modified continuous wave technique, canal filling with more consistent and predictable outcome may be expected as the apical preparation size is increased.
Carbon ; Dental Pulp Cavity ; Gutta-Percha ; India ; Ink ; Nitric Acid ; Salicylates ; Tooth

Paraformaldehyde has been used in the past as a pulpotomy agent. However, it has a severe cytotoxic effect and may cause alveolar bone necrosis. Depulpin, a devitalizing agent containing 49% paraformaldehyde, is no longer used frequently due to its severe side effects. In the two cases described in the present study, Depulpin was used as a devitalizing agent during root canal treatment. It caused a gradual loss of sensibility in adjacent teeth, gingival necrosis, and osteomyelitis. This case report demonstrates the serious side effects of using a paraformaldehyde-containing paste as a devitalizing agent for pulp, particularly mandibular bone necrosis.
Dental Pulp Cavity ; Necrosis* ; Osteomyelitis ; Pulpotomy ; Tooth

PURPOSE: This study aimed to identify the influence of nurses' resilience and anger expression styles on their nursing work performance in emergency departments. METHODS: The study included 107 nurses from 5 hospitals in Seoul and Gyeonggi-do who consented to participate. Data ware collected from March to April 2016. Multiple regression analysis was used to identify factors influencing nurses' performance. RESULTS: Nurses' performance was higher when resilience was high and anger expression was low. The result of the multiple regression indicated that present working years in the emergency room, work satisfaction, anger expression, anger control, and resilience predicted 39.4%(F=7.27, p < .001) of the nursing performance of hospital nurses in emergency departments. The most powerful predictor was resilience (β=.45, p < .001), followed by anger-out (β=−.25, p=.006). CONCLUSION: This study showed that the most influential variables of work performance in emergency nurses ware resilience and anger expression. To enhance the nursing performance of hospital nurses in emergency departments, it is necessary to develop and implement mentorship programs that enhance resilience and educational programs that help them manage their anger.
Anger ; Emergencies ; Emergency Service, Hospital ; Gyeonggi-do ; Humans ; Job Satisfaction ; Mentors ; Nursing ; Seoul ; Work Performance

PURPOSE: This study aimed to identify the influence of nurses' resilience and anger expression styles on their nursing work performance in emergency departments. METHODS: The study included 107 nurses from 5 hospitals in Seoul and Gyeonggi-do who consented to participate. Data ware collected from March to April 2016. Multiple regression analysis was used to identify factors influencing nurses' performance. RESULTS: Nurses' performance was higher when resilience was high and anger expression was low. The result of the multiple regression indicated that present working years in the emergency room, work satisfaction, anger expression, anger control, and resilience predicted 39.4%(F=7.27, p < .001) of the nursing performance of hospital nurses in emergency departments. The most powerful predictor was resilience (β=.45, p < .001), followed by anger-out (β=−.25, p=.006). CONCLUSION This study showed that the most influential variables of work performance in emergency nurses ware resilience and anger expression. To enhance the nursing performance of hospital nurses in emergency departments, it is necessary to develop and implement mentorship programs that enhance resilience and educational programs that help them manage their anger.