BACKGROUND: Cyclosporine has a narrow therapeutic window and many serious side effects. The new oral microemulsion cyclosporine is known to have better absorption profile than non-microemulsion cyclosporine. The purpose of this study was to confirm above finding in stable renal transplant patients and also to compare correlation between AUC0-4 and C0, C2. METHODS: We checked the absorption profile of microemulsion cyclosporine group (N=15, ME group) and non-microeulsion cyclosporine group (N=15, NE group). All Patients had received renal transplantation at least 12 months before. Blood sampling for cyclosporine level was drawn before and at 1, 2, 3 hour after the cyclosporine morning dose (respectively C0, C1, C2 and C3). AUC0-4 was calculated with the formula: 256+C1+0.9xC2+1.4xC3. Age, sex, body weight, serum creatinine and cyclosporine dose were not different between ME group and NE group, but duration after transplantation was significantly higher in NE group (4.7+/-0.8 versus 3.0+/-1.9 year, p<0.05). RESULTS: AUC0-4 in ME group was significantly higher than NE group (2, 816+/-721 versus 2, 055+/-658 ng.h/mL, p<0.05). AUC0-4/dose, Cmax and Cmax/ dose were significantly higher in ME group. But these statistical differences were not consistent in both sexes. The difference of absorption profile between ME and NE group existed only in the female sex. In ME group, C1 correlated best with AUC0-4 (C0: r=0.493, C1: r=0.911, C2: r=0.906, C3: r= 0.789) and in NE group, C2 was the best (C0: r= 0.064, C1: r=0.958, C2: r=0.980, C3: r=0.912). CONCLUSION: Microemulsion cyclosporine is more bioavailable than non-microemulsion cyclosporine in stable renal transplant patients. C2 is better single time point marker for therapeutic drug monitoring in stable renal transplant patients than C0.
Absorption* ; Area Under Curve ; Body Weight ; Creatinine ; Cyclosporine* ; Drug Monitoring* ; Female ; Humans ; Kidney Transplantation ; Transplantation*

Stroke is a leading cause of adult disability and the second-leading cause of death in Korea. It is also the third-leading cause of death in the United States, leading to a serious demand for new interventions to improve the quality of life in stroke survivors. To this end, direct cortical stimulation using an epidural electrode has been reported with promising results in animal and human studies, showing the potential for enhancing the recovery in chronic stroke patients. For optimal results, doctors must be able to modify the stimulation pattern as frequently as needed over a period of time for a given patient. However, severe aftereffects caused by stroke limit patients' activities, making regular doctor visits for treatment difficult. This study aims to develop a prototype of a telemedicine system to enhance stroke recovery by using a ZigBee-based wireless neuro-stimulator. The ZigBee is a stable platform for many low-power wireless applications. To allow stroke patients to remotely obtain neuro-stimulation treatments from their doctors, we connected the ZigBee to the internet. The system also allows doctors to personalize treatment based on the history of the stimulation parameters. The system developed here can also be beneficial as a common platform for a wide range of brain diseases and clinical care for which electric stimulation is used.
Adult ; Animals ; Brain Diseases ; Cause of Death ; Electric Stimulation ; Electrodes ; Humans ; Internet ; Korea ; Quality of Life ; Stroke ; Survivors ; Telemedicine ; United States

Objective: The bedside on-site ultrasound examination is a very useful diagnostic test for medically ill elderly emergency patients. However, it is not known whether it is being sufficiently used in the real world scenario. We investigated this aspect in patients with chest pain in two emergency departments in the Seoul metropolitan area. Methods: Elderly patients with chest pain who visited the two emergency departments from January 2019 to December 2019 were recruited using the ‘cardiogenic pain’ code, which is the third step classification of the Korean Triage and Acuity Scale, and their medical records were reviewed to confirm whether an emergency physician-performed ultrasound prescription code was entered. Results: Of the 744 elderly patients with chest pain, 66 were given bedside on-site ultrasound examinations. The rate of examination was 8.8%. Among the emergency departments, the local emergency departments accounted for 33 out of 389 patients (8.5%), and the regional emergency department accounted for 33 out of 355 (9.3%). Conclusion These results raise the need to check the extent of bedside on-site ultrasound examinations that are conducted in the initial care of medically ill emergency elderly patients nationwide.

Completion thyroidectomy is defined as surgical removal of the remnant thyroid tissue after resection of the thyroid gland. The frequency of completion thyroidectomy varies among researchers, but is estimated to be about 5-45%. Completion thyroidectomy may cause complications due to the presence of inflammation, adhesions, swelling, and scars at the surgical site due to the initial surgery. There is still controversy over the indications and timing of completion thyroidectomy. In this review, we would like to summarize the changes in indications for completion thyroidectomy and review the literature on its necessity.

Objective: The bedside on-site ultrasound examination is a very useful diagnostic test for medically ill elderly emergency patients. However, it is not known whether it is being sufficiently used in the real world scenario. We investigated this aspect in patients with chest pain in two emergency departments in the Seoul metropolitan area. Methods: Elderly patients with chest pain who visited the two emergency departments from January 2019 to December 2019 were recruited using the ‘cardiogenic pain’ code, which is the third step classification of the Korean Triage and Acuity Scale, and their medical records were reviewed to confirm whether an emergency physician-performed ultrasound prescription code was entered. Results: Of the 744 elderly patients with chest pain, 66 were given bedside on-site ultrasound examinations. The rate of examination was 8.8%. Among the emergency departments, the local emergency departments accounted for 33 out of 389 patients (8.5%), and the regional emergency department accounted for 33 out of 355 (9.3%). Conclusion These results raise the need to check the extent of bedside on-site ultrasound examinations that are conducted in the initial care of medically ill emergency elderly patients nationwide.

Background and Objectives: Papillary thyroid carcinoma (PTC) with lateral neck lymph node metastasis is known as a major risk factor for tumor recurrence after surgical treatment. The aim of this study is to identify risk factors for loco-regional recurrence in patients with PTC with lateral neck lymph node metastasis, which has a high risk of recurrence.Subjects and Method This study involved 319 patients who underwent total thyroidectomy, central lymph node (LN) and lateral LN dissection due to PTC. The patients’ demographics and pathological factors, including lymph node metastasis were retrospectively reviewed. Univariate, multivariate and C-index with variable selection analyses were performed to identify factors associated with recurrence-free survival (RFS). Results: A mean follow-up of 101 months, 35 (10.9%) patients had a loco-regional recurrence. In multivariate analysis according to loco-regional recurrence, patients with a primary tumor of more than 4 cm, multifocality, vascular invasion, and bilateral lateral cervical metastasis were associated with worse RFS. In the variable selection analysis, lateral lymph node metastasis ratio was also statistically significant. Conclusion PTC with lateral neck lymph node metastasis included tumors larger than 4 cm. Multifocality, vascular invasion, high lateral lymph node metastasis ratio and bilateral neck lymph node metastasis are predictive factors of loco-regional recurrence, and these risk factors should be carefully followed-up after surgery.