Purpose: This study compared the subjective and objective sleep quality between subjects with and without thoracic hyper-kyphosis. Methods: Forty participants were divided into a hyper-kyphosis (n = 17) and normal group (n = 17) by thoracic spinal angle measurement. The subjective sleep quality was measured using PSQI, a self-report, and objective sleep quality was measured using an actigraphy that measures time according to sleep patterns. Results: The PSQI scores of subjects with thoracic hyper-kyphosis were significantly higher than those with normal thoracic curvature (p = 0.013). The total sleep time and real sleep time were less in subjects with hyper-kyphosis than in normal subjects (p = 0.006;p = 0.029). The light sleep time was less in subjects with excessive spondylolisthesis than in normal subjects (p = 0.010). Light sleep time was less in those with hyper-kyphosis, but deep sleep time was similar to the subjects with a normal thoracic curvature (p = 0.003;p = 0.140). Conclusion Subjects with thoracic hyper-kyphosis had a decrease in subjective sleep quality, such as sleep discomfort, and objective sleep quality, such as a decrease in sleep time compared to normal subjects.

The VSD in TOF is usually large and unrestrictive with an equal to or greater than that of the aortic annulus. Typically shunting through the VSD is bidirectional or right-to-left component. Restrictive VSD in TOF caused by ingrowing fibrotic tissue is very rare. We report a case of restrictive VSD and LVOTO in TOF caused by ingrowing fibrotic tissue with the review of literature.
Constriction, Pathologic* ; Fibrosis ; Heart Septal Defects, Ventricular* ; Tetralogy of Fallot*

PURPOSE: We conducted the immunoassay of pertussis according to ages, in order to evaluate protective immunity against pertussis in Korean populations. METHODS: Healthy subjects were enrolled at four university hospitals in Korea. The subjects were grouped as seven age groups (every 10 years). Antibodies against pertussis toxin (PT) in sera were measured by enzyme linked immunosorbent assay (ELISA) kits. Geometric mean concentrations (GMC) of antibodies and the ratios of the subjects with seroprotective antibody levels were determined. The subjects with antibody titers > or =24.0 EU/mL were considered to seroprotective as the manufacturer's protocol. RESULTS: Total 1,605 subjects (age: 2 months-65 years) participated in this study, and their GMC was 56.16+/-50.54 EU/mL. Among seven age groups, age group <11 year showed the highest GMC (64.78+/-53.24 EU/mL) (P<0.001). In the analysis of the ratios of the subjects with seroprotective antibody titers, 68.2% of the subjects were proven to seroprotective, and age group <11 year also showed the highest ratio (76.5%) (P<0.001). CONCLUSIONS: We found that adolescences or adults (age group > or =11 year) showed lower levels of antibody against pertussis and lower ratio of the subjects with seroprotective antibody titers than children (age group <11 year).
Adult ; Antibodies ; Child ; Enzyme-Linked Immunosorbent Assay ; Hospitals, University ; Humans ; Immunization ; Immunoassay ; Korea ; Pertussis Toxin ; Whooping Cough

Placenta increta is a kind of placental adhesion which can cause severe postpartum hemorrhage and life-threatening condition. It might necessitate a hysterectomy, but conservative management can be considerable for preserving reproductive potential when possible. A 34-years-old woman in her 41st week of pregnancy had normal full term spontaneous delivery. Retained placenta after removal by placenta forceps resulted in mild bleeding. Placenta increta was clinically diagnosed on computerized tomography. Remnant placenta in situ was nearly disappeared 2 months later after five-time intramuscular injection of 50 mg methotrexate and three-times curettage was done for conservative management.
Curettage ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Injections, Intramuscular ; Methotrexate ; Placenta ; Placenta Accreta ; Placenta, Retained ; Postpartum Hemorrhage ; Pregnancy ; Surgical Instruments

PURPOSE: There has been no attempt to establish an objective implant surgical evaluation protocol to assess residents' surgical competence and improve their surgical outcomes. The present study presents a newly developed assessment and rating system and simulation model that can assist the teaching staffs to evaluate the surgical events and surgical skills of residents objectively. METHODS: Articles published in peer-reviewed English journals were selected using several scientific databases and subsequently reviewed regarding surgical competence and assessment tools. Particularly, medical journals reporting rating and evaluation protocols for various types of medical surgeries were thoroughly analyzed. Based on these studies, an implant surgical technique assessment and rating system (iSTAR) has been developed. Also, a specialized dental typodont was developed for the valid and reliable assessment of surgery. RESULTS: The iSTAR consists of two parts including surgical information and task-specific checklists. Specialized simulation model was subsequently produced and can be used in combination with iSTAR. CONCLUSIONS: The assessment and rating system provided may serve as a reference guide for teaching staffs to evaluate the residents' implant surgical techniques.
Checklist ; Dental Implantation ; Educational Measurement ; Mental Competency ; Oral Surgical Procedures

PURPOSE: The objective of this study was to elucidate the role of collagen membranes (CMs) when used in conjunction with bovine hydroxyapatite particles incorporated with collagen matrix (BHC) for lateral onlay grafts in dogs. METHODS: The first, second, and third premolars in the right maxilla of mongrel dogs (n=5) were extracted. After 2 months of healing, two BHC blocks (4 mmx4 mmx5 mm) were placed on the buccal ridge, one with and one without the coverage by a CM. The animals were sacrificed after 8 weeks for histometric analysis. RESULTS: The collagen network of the membranes remained and served as a barrier. The quantity and quality of bone regeneration were all significantly greater in the membrane group than in the no-membrane group (P<0.05). CONCLUSIONS: The use of barrier membranes in lateral onlay grafts leads to superior new bone formation and bone quality compared with bone graft alone.
Alveolar Ridge Augmentation ; Animals ; Bicuspid ; Bone Regeneration ; Bone Substitutes ; Collagen ; Dogs ; Durapatite ; Guided Tissue Regeneration ; Inlays ; Maxilla ; Membranes ; Osteogenesis ; Transplants

PURPOSE: Calcium phosphate (CaP)-coated implants promote osseointegration and survival rate. The aim of this study was to (1) analyze the dissolution behavior of the residual CaP particles of removed implants and (2) evaluate bone apposition of CaP-coated machined surface implants at the early healing phase. METHODS: Mandibular premolars were extracted from five dogs. After eight weeks, the implants were placed according to drilling protocols: a nonmobile implant (NI) group and rotational implant (RI) group. For CaP dissolution behavior analysis, 8 implants were removed after 0, 1, 2, and 4 weeks. The surface morphology and deposition of the coatings were observed. For bone apposition analysis, block sections were obtained after 1-, 2-, and 4-week healing periods and the specimens were analyzed. RESULTS: Calcium and phosphorus were detected in the implants that were removed immediately after insertion, and the other implants were composed mainly of titanium. There were no notable differences between the NI and RI groups in terms of the healing process. The bone-to-implant contact and bone density in the RI group showed a remarkable increase after 2 weeks of healing. CONCLUSIONS: It can be speculated that the CaP coating dissolves early in the healing phase and chemically induces early bone formation regardless of the primary stability.
Animals ; Bicuspid ; Bone Density ; Calcium* ; Dental Implantation ; Dogs ; Osseointegration ; Osteogenesis ; Phosphorus ; Survival Rate ; Titanium

Giardia intestinalis infections arise primarily from contaminated food or water. Zoonotic transmission is possible, and at least 7 major assemblages including 2 assemblages recovered from humans have been identified. The determination of the genotype of G. intestinalis is useful not only for assessing the correlation of clinical symptoms and genotypes, but also for finding the infection route and its causative agent in epidemiological studies. In this study, methods to identify the genotypes more specifically than the known 2 genotypes recovered from humans have been developed using the intergenic spacer (IGS) region of rDNA. The IGS region contains varying sequences and is thus suitable for comparing isolates once they are classified as the same strain. Genomic DNA was extracted from cysts isolated from the feces of 5 Chinese, 2 Laotians and 2 Koreans infected with G. intestinalis and the trophozoites of WB, K1, and GS strains cultured in the laboratory, respectively. The rDNA containing the IGS region was amplified by PCR and cloned. The nucleotide sequence of the 3' end of IGS region was determined and examined by multiple alignment and phylogenetic analysis. Based on the nucleotide sequence of the IGS region, 13 G. intestinalis isolates were classified to assemblages A and B, and assemblage A was subdivided into A1 and A2. Then, the primers specific to each assemblage were designed, and PCR was performed using those primers. It detected as little as 10 pg of DNA, and the PCR amplified products with the specific length to each assemblage (A1, 176 bp; A2, 261 bp; B, 319 bp) were found. The PCR specific to 3 assemblages of G. intestinalis did not react with other bacteria or protozoans, and it did not react with G. intestinalis isolates obtained from dogs and rats. It was thus confirmed that by applying this PCR method amplifying the IGS region, the detection of G. intestinalis and its genotyping can be determined simultaneously.
Sequence Analysis, DNA ; Sensitivity and Specificity ; Polymerase Chain Reaction/*methods ; Phylogeny ; Mice ; Humans ; Giardiasis/parasitology/veterinary ; Giardia lamblia/*classification/genetics/*isolation & purification ; Genotype ; Dogs ; Dog Diseases/parasitology ; DNA, Ribosomal Spacer/*analysis ; DNA, Protozoan/*analysis/isolation & purification ; Base Sequence ; Animals

A 3 month old female baby, who had been diagnosed with right atrial isomerism associated with total anomalous pulmonary venous return (TAPVR), a functional single ventricle and major aortopulmonary collateral arteries (MAPCA), underwent left MAPCA unifocalization and left Blalock-Taussig shunt (3.5 mm) at 3 months of age. The postoperative course was complicated by pulmonary venous congestion, and the drainage site of the TAPVR was found to be stenotic on echocardiography. We performed sutureless repair of the TAPVR along with unifocalization of the right MAPCA. She was put on an extracorporeal membrane oxygenator for 8 days after the 2nd operation, and she was able to come off the oxygenator with the placement of a central shunt (3 mm). She developed tracheal stenosis, which was presumably due to longstanding endotracheal intubation, and she then underwent tracheostomy. She was discharged to home on day 104 after the 1st operation, and she has been followed up for 2 months in a good clinical condition.
Arteries ; Drainage ; Echocardiography ; Extracorporeal Membrane Oxygenation ; Female ; Heterotaxy Syndrome* ; Humans ; Hyperemia ; Infant ; Intubation, Intratracheal ; Oxygen ; Oxygenators ; Oxygenators, Membrane ; Scimitar Syndrome ; Tracheal Stenosis ; Tracheostomy

PURPOSE: The aim of this study was to investigate the clinicopathologic features of and the prognosis for colorectal cancers (CRCs) with microsatellite instabilities (MSIs). METHODS: Between 2006 and 2009, genotyping was performed on 245 patients with stage II/III CRCs to establish the MSI status. The clinicopathologic differences and the prognostic value of MSI were analyzed. The median follow-up period was 38 months (range, 7-68 months). RESULTS: Of the total 245 patients, 20 (8.2%) had MSI-high (H) and 225 (91.8%) had MSI-low (L) or stable (S) CRCs. Adjuvant chemotherapies were performed on 101 stage II (87.8%) and 107 stage III patients (82.3%). Patients with MSI-H CRCs more frequently had a family history of colon cancer (10% vs. 2.7%, P = 0.003), more frequently had a cancer located at the proximal colon (90.0% vs. 19.1%, P < 0.0001), and more often showed a mucinous phenotype or poor differentiation (35.0% vs. 7.1%, P = 0.001). Despite less frequent lymph node metastasis (25% vs. 55.6%, P = 0.01), the number of retrieved lymph nodes was higher (26.3 +/- 13.1 vs. 20.7 +/- 1.2, P = 0.04) in the MSI-H group. The overall survival and the disease-free survival (DFS) did not differ with respect to MSI status. However, in the stage II subgroup, the DFS for patients with MSI-H CRCs was significantly worse (72.2% vs. 90.7%, P = 0.03). The multivariate analysis performed on this subgroup revealed that MSI-H was an independent poor prognostic factor (adjusted hazard ratio, 4.0; 95% confidence interval, 1.0-15.6, P = 0.046). CONCLUSION: MSI-H CRCs had distinct clinicopathologic features, and MSI-H was an independent poor prognostic factor in stage II CRCs. Considering the majority of stage II patients were administrated adjuvant chemotherapy, the efficacy of adjuvant chemotherapy for treating MSI CRCs might be different from that for treating MSI-L/S tumors.
Chemotherapy, Adjuvant ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymph Nodes ; Microsatellite Instability* ; Microsatellite Repeats* ; Mucins ; Multivariate Analysis ; Neoplasm Metastasis ; Phenotype ; Prognosis