Background/Aims: Little is known about the practical clinical application of neuromodulators and psychiatric treatments in patients with functional gastrointestinal disorders (FGIDs). We investigate the knowledge, attitudes, and practices of Korean clinicians regarding the use of neuromodulators and psychiatric treatments for FGIDs. Methods: This prospective, online, cross-sectional study was conducted between May and August 2022. A questionnaire regarding the knowledge, attitude, and practice of neuromodulators and psychiatric treatments for FGIDs was developed and administered to primary care clinicians and gastroenterologists in university hospitals in Korea. Results: Overall, 451 clinicians from primary (n = 179, 39.7%), secondary (n = 113, 25.1%), and tertiary (n = 159, 35.3%) hospitals participated in the survey. Most of them considered that neuromodulators (98.7%) and psychiatric treatment (86.5%) were required for patients with FGIDs. However, approximately one-third of them did not prescribe neuromodulators, mainly due to unfamiliarity with the drugs, and only one-quarter considered psychiatric referral. Compared to gastroenterologists at university hospitals, primary care clinicians’ prescriptions had a lower rate (87.2% vs 64.2%, P < 0.001) and shorter duration of neuromodulator. The psychiatric referral rate was lower for primary care clinicians than for gastroenterologists at university hospitals (19.0% vs 34.2%, P < 0.001). Conclusions Knowledge, attitude, and practice levels regarding neuromodulators and psychiatric treatment among clinicians are inhomogeneous, and a knowledge gap exists between primary care clinicians and gastroenterologists at university hospitals. Encouraging ongoing education for Korean clinicians regarding the appropriate use of neuromodulators and psychiatric treatments in patients with FGIDs is suggested.

Background/Aims: Little is known about the practical clinical application of neuromodulators and psychiatric treatments in patients with functional gastrointestinal disorders (FGIDs). We investigate the knowledge, attitudes, and practices of Korean clinicians regarding the use of neuromodulators and psychiatric treatments for FGIDs. Methods: This prospective, online, cross-sectional study was conducted between May and August 2022. A questionnaire regarding the knowledge, attitude, and practice of neuromodulators and psychiatric treatments for FGIDs was developed and administered to primary care clinicians and gastroenterologists in university hospitals in Korea. Results: Overall, 451 clinicians from primary (n = 179, 39.7%), secondary (n = 113, 25.1%), and tertiary (n = 159, 35.3%) hospitals participated in the survey. Most of them considered that neuromodulators (98.7%) and psychiatric treatment (86.5%) were required for patients with FGIDs. However, approximately one-third of them did not prescribe neuromodulators, mainly due to unfamiliarity with the drugs, and only one-quarter considered psychiatric referral. Compared to gastroenterologists at university hospitals, primary care clinicians’ prescriptions had a lower rate (87.2% vs 64.2%, P < 0.001) and shorter duration of neuromodulator. The psychiatric referral rate was lower for primary care clinicians than for gastroenterologists at university hospitals (19.0% vs 34.2%, P < 0.001). Conclusions Knowledge, attitude, and practice levels regarding neuromodulators and psychiatric treatment among clinicians are inhomogeneous, and a knowledge gap exists between primary care clinicians and gastroenterologists at university hospitals. Encouraging ongoing education for Korean clinicians regarding the appropriate use of neuromodulators and psychiatric treatments in patients with FGIDs is suggested.

Background/Aims: Little is known about the practical clinical application of neuromodulators and psychiatric treatments in patients with functional gastrointestinal disorders (FGIDs). We investigate the knowledge, attitudes, and practices of Korean clinicians regarding the use of neuromodulators and psychiatric treatments for FGIDs. Methods: This prospective, online, cross-sectional study was conducted between May and August 2022. A questionnaire regarding the knowledge, attitude, and practice of neuromodulators and psychiatric treatments for FGIDs was developed and administered to primary care clinicians and gastroenterologists in university hospitals in Korea. Results: Overall, 451 clinicians from primary (n = 179, 39.7%), secondary (n = 113, 25.1%), and tertiary (n = 159, 35.3%) hospitals participated in the survey. Most of them considered that neuromodulators (98.7%) and psychiatric treatment (86.5%) were required for patients with FGIDs. However, approximately one-third of them did not prescribe neuromodulators, mainly due to unfamiliarity with the drugs, and only one-quarter considered psychiatric referral. Compared to gastroenterologists at university hospitals, primary care clinicians’ prescriptions had a lower rate (87.2% vs 64.2%, P < 0.001) and shorter duration of neuromodulator. The psychiatric referral rate was lower for primary care clinicians than for gastroenterologists at university hospitals (19.0% vs 34.2%, P < 0.001). Conclusions Knowledge, attitude, and practice levels regarding neuromodulators and psychiatric treatment among clinicians are inhomogeneous, and a knowledge gap exists between primary care clinicians and gastroenterologists at university hospitals. Encouraging ongoing education for Korean clinicians regarding the appropriate use of neuromodulators and psychiatric treatments in patients with FGIDs is suggested.

Background: In this study, we used an ex-vivo model to investigate the recovery pattern of both the train-of-four (TOF) ratio and first twitch tension of TOF (T1), and determined their relationship during recovery from rocuronium-induced neuromuscular blockade at various concentrations of sugammadex. Methods: Tissue specimens of the phrenic nerve-hemidiaphragm were obtained from 60 adult Sprague-Dawley rats. Each specimen was immersed in an organ bath filled with Krebs buffer solution and stimulated with the TOF pattern using indirect supramaximal stimulation at 20-second intervals. After a 30-minute stabilization period, rocuronium loading and booster doses were serially administered at 10-minute intervals in each sample until > 95% depression of T1 was confirmed. Specimens were randomly allocated to either the control group (washout) or to one of five sugammadex concentration groups (0.75, 1, 2, 4, or 8 times equimolar doses of rocuronium to produce >95% T1 depressions; SGX0.75, SGX1, SGX2, SGX4, and SGX8, respectively). Recovery from neuromuscular blockade was monitored using T1 and the TOF ratio simultaneously until the recovery of T1 to > 95% and the TOF ratio to > 0.9. Results: Statistically significant intergroup differences were observed between the recovery patterns of T1 and the TOF ratio (TOFR, p<0.050), except between SGX2 and SGX4 groups. TOFR/T1 values were maintained at nearly 1 in the control, SGX0.75, and SGX1 groups; however, they were exponentially decayed in the SGX2, SGX4, and SGX8 groups. Conclusions Recovery of the TOF ratio may be influenced by the sugammadex dose, and a TOF ratio of 1.0 may be achieved before full T1 recovery if administration of sugammadex exceeds that of rocuronium.

BACKGROUND: Several types of receptors are found at neuromuscular presynaptic membranes. Presynaptic inhibitory A1 and facilitatory A2A receptors mediate different modulatory functions on acetylcholine release. This study investigated whether adenosine A1 receptor agonist contributes to the first twitch tension (T1) of train-of-four (TOF) stimulation depression and TOF fade during rocuronium-induced neuromuscular blockade, and sugammadex-induced recovery. METHODS: Phrenic nerve-diaphragm tissues were obtained from 30 adult Sprague-Dawley rats. Each tissue specimen was randomly allocated to either control group or 2-chloroadenosine (CADO, 10 μM) group. One hour of reaction time was allowed before initiating main experimental data collection. Loading and boost doses of rocuronium were sequentially administered until > 95% depression of the T1 was achieved. After confirming that there was no T1 twitch tension response, 15 min of resting time was allowed, after which sugammadex was administered. Recovery profiles (T1, TOF ratio [TOFR], and recovery index) were collected for 1 h and compared between groups. RESULTS: There were statistically significant differences on amount of rocuronium (actually used during experiment), TOFR changes during concentration-response of rocuronium (P = 0.04), and recovery profiles (P < 0.01) of CADO group comparing with the control group. However, at the initial phase of this experiment, dose-response of rocuronium in each group demonstrated no statistically significant differences (P = 0.12). CONCLUSIONS: The adenosine A1 receptor agonist (CADO) influenced the TOFR and the recovery profile. After activating adenosine receptor, sugammadex-induced recovery from rocuronium-induced neuromuscular block was delayed.
2-Chloroadenosine ; Acetylcholine ; Adenosine* ; Adult ; Data Collection ; Depression ; Humans ; Membranes ; Neuromuscular Blockade* ; Neuromuscular Junction ; Neuromuscular Nondepolarizing Agents ; Rats, Sprague-Dawley ; Reaction Time ; Receptor, Adenosine A1 ; Receptors, Purinergic P1*

We evaluated the conditions required for sutures tied to a post for tibial fixation during anterior cruciate ligament (ACL) reconstruction. Harvested porcine tendon was used as a graft material and nonabsorbable suture was used for sutures. Samples were tested for ultimate tensile load and elongation according to thread numbers, knot numbers, suture techniques and stitch numbers. As thread numbers were increased, ultimate tensile load was increased and elongation was decreased. However, more than 4 strands of threads provided the sufficient ultimate tensile load more than 454 N of normal ACL for daily activities. As knot numbers were increased, ultimate tensile load was increased, but elongation was decreased. In terms of failure mode, unraveling occurred 100% in 3 and 4 knots, 81.2% in 5 knots, 54.5% in 6 knots, and 0% in 7 knots. Suture techniques and stitch numbers didn't significantly affect the ultimate tensile load and the elongation. For sutures tied to a post for tibial fixation in ACL reconstruction, more than 4 threads, more than 7 knots, and more than 4 stitches provide adequate ultimate tensile load and elongation.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction* ; Knee ; Suture Techniques* ; Sutures* ; Tendons* ; Transplants

BACKGROUND: To determine if tibial positioning affects the external rotation of the tibia in a dial test for posterolateral rotatory instability combined with posterior cruciate ligament (PCL) injuries. METHODS: Between April 2007 and October 2007, 16 patients with a PCL tear and posterolateral rotatory instability were diagnosed using a dial test. The thigh-foot angle was measured at both 30degrees and 90degrees of knee flexion with an external rotation stress applied to the tibia in 2 different positions (reduction and posterior subluxation). The measurements were performed twice by 2 orthopedic surgeons. RESULTS: In posterior subluxation, the mean side-to-side difference in the thigh-foot angle was 11.56 +/- 3.01degrees at 30degrees of knee flexion and 11.88 +/- 4.03degrees at 90degrees of knee flexion. In the sequential dial test performed with the tibia reduced, the mean side-to-side difference was 15.94 +/- 4.17degrees (p < 0.05) at 30degrees of knee flexion and 16.88 +/- 4.42degrees (p = 0.001) at 90degrees of knee flexion. The mean tibial external rotation was 5.31 +/- 2.86degrees and 6.87 +/- 3.59degrees higher in the reduced position than in the posterior subluxation at both 30degrees and 90degrees of knee flexion. CONCLUSIONS: In the dial test, reducing the tibia with an anterior force increases the ability of an examiner to detect posterolateral rotary instability of the knee combined with PCL injuries.
Adolescent ; Adult ; Biomechanics ; Female ; Humans ; Joint Instability/*diagnosis/physiopathology ; Knee Joint/*physiopathology ; Male ; Middle Aged ; *Physical Examination ; Posterior Cruciate Ligament/*injuries/physiopathology ; Range of Motion, Articular ; Tibia/*physiopathology ; Young Adult

PURPOSE: To compare the clinical efficacy after an arthroscopic ACL double-bundle reconstruction with and without functional knee brace. MATERIALS AND METHODS: Between July 2004 and May 2006, fifty patients who underwent an ACL double-bundle reconstruction with and without a functional knee brace for more than a 1-year follow-up were evaluated. The patients were treated with brace (Group 1, 22 cases) or without (Group 2, 28 cases) a brace after surgrey. Stability was assessed by maximal manual testing with a KT-1000 arthrometer, anterior stress radiographs using the Telos device and a lateral pivot shift test. The clinical results were assessed by the OAK (Orthopadische Arbeitsgruppe Knie) score, IKDC (International Knee Documentation Committee) score, mid thigh circumference and the range of motion. RESULTS: More than one year after surgery, average of OAK score, IKDC score, lateral pivot shift test of the stability results and maximal manual testing with the KT-1000 arthrometer, stress radiographs with the Telos device, mid thigh circumference difference, range of motion of the clinical results were similar in both groups. CONCLUSION: An ACL double-bundle reconstruction produces similar stability and clinical results regardlness of whether or not a functional knee brace is used.
Braces ; Follow-Up Studies ; Humans ; Knee ; Range of Motion, Articular ; Thigh

Perioperative cerebral infarction is uncommon and its mechanism is often uncertain. This is a report of an unusual case of acute cerebral infarction following general anesthesia. The patient was a 83-year-old female admitted for total hip replacement arthroplasty (THRA). There were no previous cerebro- and cardio-vascular symptoms and history. During introduced general anesthesia with sevoflurane, there was a persistent low systolic BP of 80-100 mmHg (preoperative BP was 140/85 mmHg). On emerging from anesthesia, confusion and dense right hemiparesis were observed. Emergency CT brain scan showed early cerebral infarction in the middle cerebral artery (MCA) territory. Even though prompt supportive neurosurgical intensive care was initiated, the patient died at postoperative 4 days.
Aged, 80 and over ; Anesthesia ; Anesthesia, General ; Arthroplasty* ; Arthroplasty, Replacement, Hip* ; Brain ; Cerebral Infarction* ; Emergencies ; Female ; Humans ; Critical Care ; Middle Cerebral Artery ; Paresis

We report here on a case of a patient who developed paraplegia after thoracic epidural block that was done for the management of postherpetic neuralgia, and the patient was later diagnosed with spine metastasis from prostate cancer. This patient developed paraplegia of both lower extremities 2 weeks after the epidural block. We took X-ray and performed MRI of the thoracic spine for the differential diagnosis of paraplegia associated with herpes zoster, complications of epidural block or other diseases. The diagnosis of the paraplegia was spinal cord compression at T8, and this was caused by metastatic tumor that originated from prostate cancer. When we encounter paraplegia after epidural block, we should also consider other diseases as well as the complications of epidural block like direct neural damage, abscess and hematoma. Especially when there is the possibility of cancer, early detection, an accurate diagnosis and timely treatment can provide the best chance to ameliorate further medical consequences and optimize the quality of life.
Abscess ; Diagnosis ; Diagnosis, Differential ; Hematoma ; Herpes Zoster ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Neuralgia, Postherpetic ; Paraplegia ; Prostate ; Prostatic Neoplasms ; Quality of Life ; Spinal Cord Compression ; Spine