This study was performed to evaluate the effectiveness of the 2-step needle insertion technique to reduce pain during local anesthesia in children. Local anesthesia was performed bilaterally using conventional technique and a 2-step technique, and to compare the degree of pain using the 2-step with that using the conventional technique during local anesthesia using a pain scale.
The pain scores were significantly different between the conventional technique and the 2-step insertion technique at 5.82 ± 2.14 and 2.57 ± 2.09, respectively (p < 0.001). The subjective degree of pain based on gender, age, and Frankl’s behavior rating scale was significantly lower in the 2-step insertion technique (p < 0.001). Subjective pain levels in the area of maxilla and mandible, anterior and posterior parts were lower in the group treated using the 2-step insertion technique (p < 0.001).
The 2-step insertion technique is a simple and effective way to reduce pain during local anesthesia not only in children with a positive attitude to dental treatment, but also in children with negative attitudes, and is thought to be more effective if combined with application of topical anesthesia or distraction.

Background: The coronavirus disease-2019 (COVID-19) pandemic has led to restrictions on daily living including social distancing. These restrictions had an impact on the individual's healthy lifestyle and health status. We investigated the associated factors with changes of metabolic abnormalities among general population in COVID-19. Methods: The participants were 43,639 people who received health check-ups twice in 2019 and 2021 during COVID-19 pandemic, at 16 health promotion centers. Metabolic abnormalities were identified according to the third report of the cholesterol education program criteria. Multiple logistic regression analysis was performed to confirm the factors related to changes of metabolic abnormalities during COVID-19. Results: Metabolic syndrome and metabolic abnormalities increased overall during the COVID-19 pandemic. This increase was mostly appeared in males. The occurrence of metabolic syndrome during COVID-19 was associated with 50s and older age (odds ratio [OR], 1.130; 95% confidence interval [CI], 1.019-1.254), attempt to quit smoking (OR, 1.467; 95% CI, 1.171-1.839), start smoking (OR, 1.251; 95% CI, 1.110-1.412), decrease in aerobic exercise (OR, 1.328; 95% CI, 1.162-1.517), and increase in strength exercise (OR, 0.704; 95% CI, 0.592-0.838). Conclusions The metabolic syndrome is closely related to smoking experience and lack of exercise during COVID-19.

Background: Tibial tuberosity transposition (TTT) causes caudalization of the patellar ligament insertion in canine medial patellar luxation, which can lead to increases in patellofemoral contact pressure. Objectives: The purpose of this study is to confirm the effect of patellofemoral contact mechanics after craniolateral and caudolateral transposition of tibial tuberosity in normal canine hindlimbs. Methods: Craniolateral and caudolateral transposition of tibial tuberosity was performed in 5 specimens, respectively. The pressure was measured in the specimen before TTT, and then in the same specimen after TTT. In this process, data was obtained in 10 specimens. The measurement results were output as visualization data through the manufacturer's software and numerical data through spreadsheet. Based on these 2 data and the anatomical structure of the patellofemoral joint (PFJ) surface, whole measurement area was analysed by dividing into medial, lateral and central area. Results: In craniolateralization of tibial tuberosity, total, medial, central contact pressure was decreased and lateral contact pressure was not statistically changed lateral contact pressure than normal PFJ. In caudolateralization of tibial tuberosity, total, lateral contact pressure was increased and medial contact pressure was not statistically changed than normal PFJ. Although not statistically significant changed, central contact pressure in caudolateralization of tibial tuberosity was increased in all 5 specimens. Conclusions These results imply that traditional TTT, prone to caudal shift of patellar tendon, can increase retropatellar pressure may lead to various complications and diseases of the stifle joint.

Persistent bone marrow aplasia after intensive chemotherapy is uncommon, but is one of the fatal complications in patients with acute myeloid leukemia (AML). Although allogeneic hematopoietic stem cell transplantation (HSCT) is considered to be contraindicated for patients who have hematologic diseases with serious infections, such as bacterial septicemia or invasive fungal diseases, combined with prolonged neutropenia due to frequent morbidity and mortality, such risks can be overcome by non-myeloablative conditioning and best supportive care. Here, we report an AML patient with persistent marrow aplasia after induction therapy, treated successfully with reduced-intensity allogeneic HSCT despite severe bacterial and fungal infections.
Anemia, Aplastic ; Bone Marrow* ; Drug Therapy* ; Hematologic Diseases ; Hematopoietic Stem Cell Transplantation ; Humans ; Leukemia, Myeloid, Acute* ; Mortality ; Neutropenia ; Sepsis ; Stem Cell Transplantation* ; Stem Cells*

BACKGROUND: The role of Smad4 in carcinogenesis is important, because of its function as a central mediator of TGF-beta signaling. In the present study we analyzed the expressions of Smad4 mRNA and protein in human gastric cancer cell lines and tissues and we also analyzed their clinicopathological significance. METHODS: We used semi-quantitative RT-PCR for Smad4 mRNA expression in 13 cases of fresh gastric cancer tissues and two gastric cancer cell lines (MKN-28, SNU-1). We also used immunohistochemistry for Smad4 protein expression in 88 cases of formalin fixed gastric cancers tissues. RESULTS: The mRNA level of Smad4 was higher in MKN-28 cell line (intestinal type) than in the SNU-1 cell line (diffuse type). Fresh frozen gastric cancer tissues showed that the intestinal type of gastric cancer had higher Smad4 mRNA expressions than the diffuse type of gastric cancer (p<0.05). Immunohistochemical staining for Smad4 revealed that cytoplasmic and nuclear expressions of Smad4 were significantly correlated with histologic types of gastric cancer (p<0.05). That is, the intestinal type of gastric cancer showed more cytoplasmic and nuclear smad4 expressions than did the diffuse type of gastric cancer. Reduced cytoplasmic expressions and positive nuclear expressions of Smad4 were more prominent in the advanced gastric cancer than in the early gastric cancer. CONCLUSION: Taken together, we suggest that loss of Smad4 expression might be associated with the intestinal type of gastric cancer. Also reduced cytoplasmic Smad4 expressions and increased nuclear Smad4 expressions may be associated with the advanced stage of gastric cancer.
Adenocarcinoma* ; Carcinogenesis ; Cell Line ; Cytoplasm ; Formaldehyde ; Humans ; Immunohistochemistry ; RNA, Messenger ; Smad4 Protein ; Stomach Neoplasms ; Transforming Growth Factor beta

Purpose: This study investigated hand-washing practice among community-dwelling older adults during the coronavirus disease 2019 (COVID-19) pandemic and aimed to identify the impact of COVID-19-related concerns and depression on hand-washing practice. Methods: This was a secondary analysis of data extracted from the 2020 Community Health Survey. The primary data were collected through self-reporting from August 10 to September 8, 2020 in a cross-sectional study. The subjects consisted of 1,350 adults aged 65 or older living in J Province who participated in the 2020 Community Health Survey. Results: The factors affecting hand-washing practice among older adults were male gender (β = –.18, p < .001), age (β = –.07, p = .001), no education (β = –.20, p < .001) and elementary, middle, and high school graduation (β = –.15, p < .001) compared to a college or higher education, poor health perception (β = –.13, p < .001), COVID-19-related concerns (β = .08, p = .005), and depression (β = –.07, p = .001). To summarize, the factors negatively affecting hand-washing practice included male gender, lower education level, poor health perception, and depression, while the factors positively associated with hand-washing practice included COVID-19-related concerns. Conclusion These findings show the importance of considering these multifaceted determinants when designing targeted interventions and educational programs aimed at promoting hand-washing among older adults. Additionally, based on the relationship between hand-washing practice and COVID-19-related concerns and depression, interventions that can alleviate mental problems along with providing proper education are required.

OBJECTIVES: The purpose of this study is to find the cephalometric variables which are significantly correlated with the apnea-hypopnea index (AHI) in suspected Korean obstructive sleep apnea (OSA) patients. METHODS: We examined lateral cephalogram and attended-full night laboratory polysomnography of the 40 participants who complained of OSA symptoms. The correlation analysis was conducted to find the cephalometric variables which are significantly correlated with the AHI. RESULTS: The correlation analysis showed that the higher AHI was associated with the longer distance between hyoid and mandibular plane (p = 0.023), the longer distance between C3 and hyoid (p = 0.014), the longer tongue length (p = 0.003), the larger inferior tongue area (p = 0.008), the larger anterior displacement of the hyoid bone (p = 0.024), the longer distance between posterior nasal spine and the tip of the soft palate (p = 0.021), and the larger cross-sectional area of soft palate (p = 0.001) of cephalogram in erect position. The higher AHI was correlated with the longer distance between hyoid and mandibular plane (p = 0.008), the longer tongue length (p = 0.037), the larger inferior tongue area (p = 0.013), the thicker uvula (p = 0.004), the longer distance between retrognathion and hyoid (p = 0.025), and larger cross-sectional area of soft palate (p = 0.001) of cephalogram in supine position. CONCLUSIONS: The present preliminary results showed the candidate measurements of cephalogram which are significantly correlated with the AHI in suspected OSA.
Apnea* ; Cephalometry ; Humans ; Hyoid Bone ; Palate, Soft ; Polysomnography ; Sleep Apnea, Obstructive* ; Spine ; Supine Position ; Tongue ; Uvula

Kaposi's sarcoma (KS) is a multicentric human immunodeficiency virus-associated neoplasm characterized by multiple vascular nodules in the skin, mucous membranes, and viscera. Gastrointestinal acquired immunodeficiency syndrome (AIDS)-related KS is the most common visceral involvement reported in disseminated disease. Here, we present the findings of a rare case of KS involving multiple organs with abdominal pain and active bleeding in the colon. Multiple intraluminal lesions were found in the terminal ileum, sigmoid colon, and rectum by ileocolonoscopy, and in the jejunum and ileum by fluoroscopy. Abdominopelvic CT revealed multiple enhanced flat lesions in the ileum and enlarged lymph nodes. The diagnosis was confirmed by histopathology, and antiretroviral therapy was initiated as the treatment of choice for KS. Owing to the increasing number of AIDS patients, it is essential for radiologists and clinicians to be aware of the imaging characteristics of KS to protect physicians from indiscriminate exposure to AIDS.

Liver injury is a common consequence of blunt abdominopelvic trauma. Contrast-enhanced CT allows for the rapid detection and evaluation of liver injury. The treatment strategy for blunt liver injury has shifted from surgical to nonoperative management, which has been widely complemented by interventional management to treat both liver injury and its complications. In this article, we review the major imaging features of liver injury and the role of interventional management for the treatment of liver injury.

Liver injury is a common consequence of blunt abdominopelvic trauma. Contrast-enhanced CT allows for the rapid detection and evaluation of liver injury. The treatment strategy for blunt liver injury has shifted from surgical to nonoperative management, which has been widely complemented by interventional management to treat both liver injury and its complications. In this article, we review the major imaging features of liver injury and the role of interventional management for the treatment of liver injury.