Objectives: This study aimed to determine whether collagen triple helix repeat containing-1 (CTHRC1), which is involved in vascular remodeling and bone formation, can stimulate odontogenic differentiation and angiogenesis when administered to human dental pulp stem cells (hDPSCs). Materials and Methods: The viability of hDPSCs upon exposure to CTHRC1 was assessed with the WST-1 assay. CTHRC1 doses of 5, 10, and 20 µg/mL were administered to hDPSCs.Reverse-transcription polymerase reaction was used to detect dentin sialophosphoprotein, dentin matrix protein 1, vascular endothelial growth factor, and fibroblast growth factor 2. The formation of mineralization nodules was evaluated using Alizarin red. A scratch wound assay was conducted to evaluate the effect of CTHRC1 on cell migration. Data were analyzed using 1-way analysis of variance followed by the Tukey post hoc test. The threshold for statistical significance was set at p < 0.05. Results: CTHRC1 doses of 5, 10, and 20 µg/mL had no significant effect on the viability of hDPSCs. Mineralized nodules were formed and odontogenic markers were upregulated, indicating that CTHRC1 promoted odontogenic differentiation. Scratch wound assays demonstrated that CTHRC1 significantly enhanced the migration of hDPSCs. Conclusions CTHRC1 promoted odontogenic differentiation and mineralization in hDPSCs.

This project developed a neural network based on nursing diagnoses among 98 nursing diagnoses Korea Nurses Association recommended when related factors and clinical signs are entered. This nursing diagnosis system consists of five sub-systems: data-input system from which a nurse can obtain knowledge from experts; data-base system in which nurses can manage statistical data; inference support system which provides learning effect; inference system which increases inference ability of nurses using existing data and nursing diagnoses data; and result-retrieve system in which nurses can look at the outcomes of nursing process. This nursing diagnosis system provides a interface which enables maintenance and revision easier as well as to induce a diagnosis through the communication between the nurse and the patient. In addition, this system makes nurses determine the nursing diagnoses in a more accurate manner by linking the learning effect of the system whit intra-neural network algorithm. This nursing diagnosis system will assist nurses to provide foster and more accurate way to implement nursing diagnosis.
Diagnosis ; Humans ; Information Systems* ; Korea ; Learning ; Nursing Diagnosis* ; Nursing Process* ; Nursing*

In recent years, reports of diabetes mellitus (DM) cases that do not fit the traditional classification system have increased in prevalence. While insulin deficiency appears as type 1 DM (T1DM), the new type also has the clinical features of type 2 DM (T2DM); as such, this new type of DM is called ketosis-prone diabetes (KPD) and is correlated with findings of severe hyperglycemia and ketoacidosis. To provide a clear, clinical classification of DM, new classification systems are being studied. Among these, the Aβ system demonstrates the highest sensitivity and specificity in predicting clinical features and prognosis. We report 2 cases of KPD in Korean pediatric patients. The first patient was referred while in a state of diabetic ketoacidosis (DKA) and was considered to have T1DM. However, their blood glucose was well-controlled even with small doses of insulin, and the treatment was able to be changed to metformin therapy. The second patient seemed to be a typical case of T2DM because of his obesity and strong family history. However, blood glucose was not well-controlled with a regular diet, and ketosis occurred. After performing a glucagon stimulation test, both patients showed different clinical features that were finally diagnosed as type A-β+ KPD. The rapid and accurate diagnosis of KPD can reduce the duration of inappropriate insulin use and improve patients' quality of life. Further, the treatment of KPD children should be individualized according to each patient's lifestyle to preventing recurrent DKA.
Adolescent ; Blood Glucose ; Child ; Classification ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diabetic Ketoacidosis ; Diagnosis ; Diet ; Glucagon ; Humans ; Hyperglycemia ; Insulin ; Ketosis ; Life Style ; Metformin ; Obesity ; Prevalence ; Prognosis ; Quality of Life ; Sensitivity and Specificity

A pseudoaneurysm is a contained arterial disruption in the intimal and medial layers of an arterial wall. It may originate from a perforation caused by traumatic or iatrogenic injury or the dehiscence of a surgical anastomosis. Because of its insidious onset and delayed presentation, orthopaedic surgeons should be aware of the possibility of such a lesion after an initial trauma. We report on a case of a delayed huge pseudoaneurysm of the popliteal artery that occurred 11 months after conservative treatment of a supracondylar fracture of the femur in order to keep in mind the possibility of the delayed presentation of vascular injury after a distal femur fracture.
Anastomosis, Surgical ; Aneurysm, False* ; Femoral Fractures ; Femur* ; Popliteal Artery* ; Vascular System Injuries

Significantly decreased perfusion pressure is common in vascular territories irrigating neuronal tissue in patients with AVMs. There is evidence that "adaptive autoregulatory displacement" occurs in these patients which maintains cerebral blood flow above ischemic levels. Chronic arteriolar vasodilatation does not usually lead to vasomotor paralysis because most patients maintain a constant cerebral blood flow in spite of increased systemic arterial pressure. AVM hemodynamics appears to play an important role in the etiology of spontaneous intracerebral hemorrhage. Large AVM with high-flow and severe arterial hypotension are least likely to hemorrhage. In patients with AVMassociated aneurysm, the etiology of these dual lesions is likely multifactorial, with hemodynamic stresses having a dominant influence.
Aneurysm ; Arterial Pressure ; Cerebral Hemorrhage ; Hemodynamics* ; Hemorrhage ; Humans ; Hypotension ; Neurons ; Paralysis ; Perfusion ; Vasodilation

When a tear occurs in one of the major cervicocerebral arteries and allows blood to enter the wall of the artery and split its layers, the result is either stenosis or aneurysmal dilatation of the vessel. Vertebral artery dissection (VAD) is an infrequent occurrence but is a leading cause of stroke in young and otherwise healthy patients. This article discusses recent developments in understanding of the epidemiology and pathogenesis of VAD and the various clinical manifestations, methods of diagnosis, and approaches to treatment.
Aneurysm ; Arteries ; Constriction, Pathologic ; Dilatation ; Glycosaminoglycans ; Humans ; Natural History ; Stroke ; Vertebral Artery ; Vertebral Artery Dissection

Cerebral aneurysms are common lesions. In most populations, the incidence of subarachnoid hemorrhage (SAH) is 10 per 100,000 personyears. The case fatality rate of SAH is about 50 percent in population-based studies, with a trend toward gradual improvement. Associated conditions include autosomal dominant polycystic kidney disease, fibromuscular dysplasia, Marfan's syndrome, Ehlers-Danlos syndrome, and arteriovenous malformations of the brain. The risk factors for the rupture of cerebral aneurysms include increasing size, specific site, smoking, and hypertension. Cerebral aneurysms can be divided into two different categories: saccular (atherosclerotic) and dissecting (nonatherosclerotic). The most common histologic finding in saccular aneurysms is a decrease in the tunica media, the middle muscular layer of the artery, causing structural defects. These defects combined with hemodynamic factors, lead to aneurysmal outpouchings at arterial branch points in the subarachnoid space at the base of the brain. Dissecting aneurysms are characterized by widespread disruption of the internal elastic lamina that leads to mural thrombus formation and causes ischemic or hemorrhagic symptoms. Ultimately, therapeutic strategies should be based on the epidemiology, natural history, and pathogenesis of the cerebral aneurysms.
Aneurysm ; Aneurysm, Dissecting ; Arteries ; Arteriovenous Malformations ; Brain ; Ehlers-Danlos Syndrome ; Fibromuscular Dysplasia ; Hemodynamics ; Hypertension ; Incidence ; Intracranial Aneurysm ; Marfan Syndrome ; Natural History ; Polycystic Kidney, Autosomal Dominant ; Risk Factors ; Rupture ; Smoke ; Smoking ; Subarachnoid Hemorrhage ; Subarachnoid Space ; Thrombosis ; Tunica Media

OBJECTIVE: The intracranial pathologies after head trauma should be usually progressed. It is clearly visualized in the non-invasive brain CT. The invasive monitor such as intracranial pressure (ICP) monitoring may be accompanied with the complications. This study aims whether the patients with severe head injury could be managed with serial CT scans. METHODS: The medical records of 113 patients with severe head injury in the prospectively enrolled trauma bank were retrospectively analyzed. After the emergency care, all the patients were admitted to the intensive care unit for the aggressive medical managements. Repeat brain CT scans were routinely taken at 6 hours and 48 hours after the trauma. ICP monitoring was restrictively applied for the uncertain intracranial pressure based on the CT. The surgical intervention and the mortality rate were analyzed. RESULTS: Immediate surgical intervention after the initial CT scan was done in 47 patients. Among the initially non-surgical patients, 59 patients were managed with the serial CT scans and 7 with the ICP monitoring. Surgical interventions underwent eventually for 10 patients in the initially non-surgical patients; 1 in the ICP monitoring and 9 in the serial CT. The mortality rate was 23.7% in the serial brain CT and 28.6% in the ICP monitoring. There was no statistical difference between two groups in the aspect of mortality (p=0.33). CONCLUSION: Serial CT scans in time could be a good way to monitor the intracranial progression in the severe head injury and reduce the implantation of an invasive ICP probe.
Brain* ; Craniocerebral Trauma* ; Emergency Medical Services ; Humans ; Intensive Care Units ; Intracranial Pressure* ; Medical Records ; Mortality ; Pathology ; Prospective Studies ; Retrospective Studies ; Tomography, X-Ray Computed*

The thoracic spine is rigidly stabilized by the ribs, anterior and posterior longitudinal ligaments, and a sagittal orientation of the facet joints that resists axial rotation and horizontal translation. Thus, a significant force is required to cause a fracture and dislocation in the thoracic spine. A 32-year-old man was involved in a motor-vehicle accident and presented with complete paraplegia and spondyloptosis on the 8th thoracic vertebral segment. He also suffered with hypoxia and hypovolemic shock. Posterior reduction and fixation with pedicle screw was achieved with the anatomic alignment and rigid stability. This posterior technique for thoracic spondyloptosis is believed to be sufficient to make good alignment and solid fixation.
Adult ; Anoxia ; Dislocations ; Humans ; Longitudinal Ligaments ; Paraplegia ; Ribs ; Shock ; Spine ; Zygapophyseal Joint

Objective: To understand the anatomic characteristics of the aortic arch (AA) and its major branches to build a foundation toward performing endovascular surgery safely. Methods: A total of 25 formalin fixed Korean adult cadavers were used. The authors investigated : anatomical variations of the AA and its major branches; curvature of the AA; distance from the mid-vertebrae line to the origin of the major branches; distances from the origin of the major branches of AA to the origin of its distal branches; and the angle of the three major branches, the brachiocephalic trunk (BCT), the left common carotid artery (LCCA) and the left subclavian artery (LSCA) arising from AA. Results: The three major branches directly originated from AA in 21 (84%) of the cadavers. In two (8%) of remaining four cadavers, orifice of LCCA was slightly above the stem of BCT. In remaining two (8%) cadavers, the left vertebral artery (LVA) was directly originated from AA. Average angle of AA curvature to the coronal plane was 62.2 degrees. BCT originated 0.92 mm on the right of the mid-vertebrae line. LCCA and LSCA originated from 12.3 mm and 22.8 mm on the left of the mid-vertebrae line. Mean distance from the origin of the BCT to the origin of the RCCA was 32.5 mm. Mean distance from the origin of the LSCA to the origin of the LVA was 33.8 mm. Average angles at which the major branches arise from the AA were 65.3, 46.9 and 63.8 degrees. Conclusion: This study may provides a basic anatomical information to catheterize AA and its branches for safely performing endovascular surgery.
Adult ; Aorta ; Aorta, Thoracic ; Atherectomy ; Brachiocephalic Trunk ; Cadaver ; Carotid Artery, Common ; Catheters ; Formaldehyde ; Humans ; Subclavian Artery ; Vertebral Artery