The aim of this study was to compare the length between the mesio-buccal and mesio-lingual canal of the mandibular molars before and after early coronal flaring at the different measuring time using several electronic apex locators. Fifty mandibular molars with complete apical formation and patent foramens were selected. After establishing the initial working length of the buccal and lingual canal of the mesial root using a surgical microscope (Carl Zeiss Co. Germany) at 25X with #15 K-file tip just visible at the foramen, radiographs were taken for the working length. After measuring the length of mesio-buccal and mesio-lingual canal (control group), the electronic lengths were measured at different times using several electronic apex locators (experimental groups; I-Root ZX, II-Bingo, III-Propex, IV-Diagnostic). After early coronal flaring using the K3 file, the additional electronic lengths were measured using the same manner. The results were as follows: One canal has a correct working length for the mesial root of the mandibular molar, it can be used effectively for measuring the electronic working length of another canal when the files are superimposed or encountered at the apex. In addition, the accuracy of the electronic apex locators was increased as the measurement was accomplished after the early coronal flaring of the root canal and the measuring time was repeated.
Dental Pulp Cavity* ; Molar*

Purpose: We devised omental free-shaped flap reinforcement on anastomosis and dissected area (OFFROAD) following reconstruction after gastrectomy. This study aimed to evaluate its safety and early clinical outcomes. Methods: One hundred fifty-six patients who underwent totally laparoscopic distal gastrectomy with delta anastomosis from July 2016 to April 2018 were divided into the OFFROAD group (80 patients) and non-OFFROAD group (76 patients). Differences in short-term operative outcomes and surgical complications were compared between the groups. All patients’ inflammatory marker levels were measured to monitor flap necrotic change and inflammatory reactions. The clinical features of both groups in terms of anastomotic leakage were transcribed. Results: Pain score in postoperative day1 was significantly lower in OFFROAD group. The serum WBC count on POD 1 was significantly lower in OG than in NOG. The mean duration of OFFROAD was shorter than five minutes. There were no statistical differences in short-term outcomes and surgical complications between two groups. Anastomotic leakage occurred in three patients in each group and there was no statistical difference in incidence. However, clinical features were notable when anastomotic leakage occurs. Unlike all three patients of non-OFFROAD group manifested every features of peritonitis, each patient of OFFROAD group just manifested only one of the three. Conclusion This study showed the safety and feasibility of OFFROAD procedure. It might mitigate septic complications when there is an anastomotic leakage. Additional large-scale study is needed to assess the versatile usefulness of OFFROAD aside from its role as a physical barrier.

BACKGROUND: We retrospectively reviewed the outcomes of patients who had been treated with meloxicam for the extra-abdominal desmoid tumors and evaluated the correlation between clinical outcome and clinic pathological variables. METHODS: Twenty patients treated with meloxicam were followed up every 3 to 6 months. Meloxicam administration was planned at 15 mg/day orally for 6 months. RESULTS: Of the 20 patients evaluated, according to Response Evaluation Criteria in Solid Tumors criteria, there were five patients with partial response (25.0%), eight with stable disease (40.0%), and seven with tumor progression (35.0%). The cumulative probability of dropping out from our nonsurgical strategy using meloxicam was 35.0% at 1 year and 35.0% at 5 years. CONCLUSIONS: The present study suggests that conservative treatment would be a primary treatment option for this perplexing disease even though we were not able to determine that the use of a cyclooxygenase-2 inhibitor would have an additional influence on the natural course of a desmoid tumor.
Cyclooxygenase 2 ; Fibromatosis, Aggressive* ; Humans ; Response Evaluation Criteria in Solid Tumors ; Retrospective Studies

OBJECTIVE: To prospectively evaluate the diagnostic performance of computer-aided diagnosis (CAD) for detection of thyroid cancers via ultrasonography (US). MATERIALS AND METHODS: This study included 50 consecutive patients with 117 thyroid nodules on US during the period between June 2016 and July 2016. A radiologist performed US examinations using real-time CAD integrated into a US scanner. We compared the diagnostic performance of radiologist, the CAD system, and the CAD-assisted radiologist for the detection of thyroid cancers. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the CAD system were 80.0, 88.1, 83.3, 85.5, and 84.6%, respectively, and were not significantly different from those of the radiologist (p > 0.05). The CAD-assisted radiologist showed improved diagnostic sensitivity compared with the radiologist alone (92.0% vs. 84.0%, p = 0.037), while the specificity and PPV were reduced (85.1% vs. 95.5%, p = 0.005 and 82.1% vs. 93.3%, p = 0.008). The radiologist assisted by the CAD system exhibited better diagnostic sensitivity and NPV than the CAD system alone (92.0% vs. 80.0%, p = 0.009 and 93.4% vs. 88.9%, p = 0.013), while the specificities and PPVs were not significantly different (88.1% vs. 85.1%, p = 0.151 and 83.3% vs. 82.1%, p = 0.613, respectively). CONCLUSION: The CAD system may be an adjunct to radiological intervention in the diagnosis of thyroid cancer.
Artificial Intelligence ; Diagnosis* ; Humans ; Prospective Studies ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Ultrasonography*

The objective of this in vitro study was to evaluate the efficacy of a Ca(OH)2 removal before and after early coronal flaring using different types of instruments. 100 plastic blocks with 30degrees artificial curved canals were used in this study and randomly divided into a control group and 4 experimental groups(GG, OS, GT, PT Group) 20 teeth each. The canals were instrumented, and Ca(OH)2 was temporary filled into the each canal. Irrigation was performed with Max-i-Probe 25-, 30-gauge probes before and after recapitulation. The results of this study were as follows: 1. There were no significant difference among the groups in size of irrigating needle(p<0.05). 2. There was a significant difference between before and after recapitulation regardless size of irrigating needle(p<0.05). 3. Before recapitulation, there was a significant difference between 25- and 30-gauge needle in all groups(p<0.05). 4. After recapitulation, there was a significant difference between 25- and 30-gauge needle in the control group(p<0.05). But there were no significant difference among the experimental groups. It is concluded that the effectiveness of canal irrigation was decided to the depth of irrigating needle into the canal. The effect of canal irrigation tend to facilitate by the early coronal flaring. The recapitulation was the most effective during canal irrigation regardless the size of irrigating needle. Therefore, the recapitulation is a mandatory way to facilitate the effectiveness of canal irrigation during canal enlargement.
Needles ; Plastics ; Tooth

We present a case of a young male with a five year history of a hair-loss patch presenting linear distribution on the scalp. A biopsy specimen revealed a lymphocytic panniculitis and fat degeneration with mucin deposit. Focal hydropic degeneration of basal cells was also evident. Direct immuno-fluorescence revealed peribulbar granular deposits of IgM, IgA and C3. Antinuclear antibody was negative. Clinical appearance was unusual but histological examination revealed linear lupus erythematosus profundus. To our knowledge, only one other case of linear lupus erythematosus profundus on the scalp has been reported in English written literature until now.
Alopecia* ; Antibodies, Antinuclear ; Biopsy ; Humans ; Immunoglobulin A ; Immunoglobulin M ; Male ; Mucins ; Panniculitis ; Panniculitis, Lupus Erythematosus* ; Scalp*

PURPOSE: This study was designed to establish standard guidelines to meet the growing health care needs of adolescents by direct assessment of pediatricians' current practices, attitude and obstacles to the primary care of adolescents. MEHTODS: A questionnaire consisting of 9 questions, including personal characteristics of respondents, current health care practice of adolescents, attitude, obstacles to providing adolescent care, interest in further training, roles of Korean Pediatric Society for adolescent medicine, etc., was completed by 214 pediatricians. RESULTS: Among the respondents, 87.4% were in the 4th or 5th decade of age, and 88.8% of respondents were working for private clicins. More than 60% of respondents were managing patients without age limits. Most of the respondents were interested in adolescent medicine. However, approximately one half of all respondents answered that they could not currently provide satisfactory care to their adolescent patients. Obstacles to providing adolescent care include : their image as "baby doctors", lack of knowledge and skills in adolescent medicine, lack of separate hours for adolescents and concern that parents would object to certain types of care. Among respondents who wanted to further training, many were interested in Continuing Medical Education(CME) course, lecture series, introducing reading lists and publishing textbooks, while others expressed their interest in a newsletter and mini-fellowship. Respondents expected the Korean Pediatric Society to play a role in activating the adolescent medicine as a field for pediatric practice through educating adolescents, pediatricians and advertising via mass media. CONCLUSION: Future policy decisions and medical education must respond to these realities in pediatric practice.
Adolescent Medicine ; Adolescent* ; Surveys and Questionnaires ; Delivery of Health Care* ; Education, Medical ; Humans ; Mass Media ; Parents ; Periodicals as Topic ; Primary Health Care

PURPOSE: Occult papillary thyroid carcinomas (OPC) are defined as tumors measuring < or =15 mm in size. They are believed to be a less aggressive subset of papillary cancers, which behave more like benign lesions, and are often treated more conservatively. However, some groups have reported a high incidence of metastases from papillary microcarcinomas and favor an aggressive surgical resection followed by radioiodine therapy. We review our experience in an attempt to characterize the biology and optimal treatment for OPCs. METHODS: From October 2001 to March 2006, among impalpable thyroid nodules detected incidentally during screening exams, 214 patients underwent surgery for occult papillary thyroid cancer (OPC) at Kangnam Cha University hospital. The data from these patients were analyzed retrospectively. The mean follow up period was 19.9+/-11.7 (max : 53, min : 1) months. RESULTS: The mean age of these patients was 41.4 year, and 188 (87.7%) were female. 41% of the patients underwent a total or neartotal thyroidectomy, 42% had a central lymph node dissection and 41% had radioiodine ablation therapy after surgery. Of the 214 patients, 40 (18.7%) had lymph node metastases. The LN metastases were associated with the tumor size (P=0.0007), extracapsular invasion (P=0.0268) and multifocality (P=0.0024), but there was no association with age and gender. The incidence of the LN metastases (20%) and extracapsular invasion (59.1%) were higher in the tumors between 0.5~1.0 cm in size. With a follow-up up to 53 months, 3 patients had a local recurrence (0.014%) but no patients currently has active disease. No patients with OPC died died during this period. CONCLUSION: In OPC patients, a progressively increasing frequency of signs of tumor aggressiveness with increasing tumor size was observed but a small size itself could not guarantee a low risk or low recurrence rate. The prevalence of LN metastases and extracapsular invasion were higher in tumors > 0.5 cm in size. Therefore, we prefer near-total or total thyroidectomy with central lymph node dissection. Early detection and treatment of OPC might be warranted by the routine use of thyroid USG and USG-guided FNA.
Biology ; Female ; Follow-Up Studies ; Humans ; Incidence ; Lymph Node Excision ; Lymph Nodes ; Mass Screening ; Neoplasm Metastasis ; Prevalence ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Thyroidectomy

Objectives: The FOURIER trial reported that inhibition of PCSK9 with evolocumab on a background of statin therapy lowered low-density lipoprotein (LDL) cholesterol levels to a median of 30 mg per deciliter (0.78 mmol per liter) and reduced the risk of cardiovascular events. Here, we report data from a single center focusing on the effect of a PCSK9 inhibitor antibody on hyperlipidemia. Methods: We enrolled 29 hypercholesterolemia patients who had LDL cholesterol levels ≥ 70 mg per deciliter or nonHDL cholesterol ≥ 100 mg per deciliter and were divided into two groups (placebo n = 14, evolocumab n = 15), and participated in a 72 - 96 week, randomized, double-blind, placebo-controlled trial with statin therapy. Patients were randomly assigned to receive evolocumab (140 mg every 2 weeks or 420 mg monthly) or matched placebo via subcutaneous injection. Lipid changes during follow-up were analyzed. Results: The median LDL cholesterol level at baseline was 88 mg per deciliter, and the average LDL cholesterol level was 101.8 ± 20.0 mg per deciliter. At 4 weeks, the median LDL cholesterol level was 39 mg per deciliter, and the average LDL cholesterol level was 34.8 ± 51.8 mg per deciliter. Compared to placebo group, the LDL cholesterol levels were significantly reduced after treatment (P < 0.001), as well as total cholesterol, ApoB, and ApoB / ApoA1 levels. During follow-up, no discomfort was reported at local injection sites, and no cases of abnormal liver function were observed. Conclusions Evolocumab significantly reduced LDL cholesterol levels and was well tolerated.

Objectives: The FOURIER trial reported that inhibition of PCSK9 with evolocumab on a background of statin therapy lowered low-density lipoprotein (LDL) cholesterol levels to a median of 30 mg per deciliter (0.78 mmol per liter) and reduced the risk of cardiovascular events. Here, we report data from a single center focusing on the effect of a PCSK9 inhibitor antibody on hyperlipidemia. Methods: We enrolled 29 hypercholesterolemia patients who had LDL cholesterol levels ≥ 70 mg per deciliter or nonHDL cholesterol ≥ 100 mg per deciliter and were divided into two groups (placebo n = 14, evolocumab n = 15), and participated in a 72 - 96 week, randomized, double-blind, placebo-controlled trial with statin therapy. Patients were randomly assigned to receive evolocumab (140 mg every 2 weeks or 420 mg monthly) or matched placebo via subcutaneous injection. Lipid changes during follow-up were analyzed. Results: The median LDL cholesterol level at baseline was 88 mg per deciliter, and the average LDL cholesterol level was 101.8 ± 20.0 mg per deciliter. At 4 weeks, the median LDL cholesterol level was 39 mg per deciliter, and the average LDL cholesterol level was 34.8 ± 51.8 mg per deciliter. Compared to placebo group, the LDL cholesterol levels were significantly reduced after treatment (P < 0.001), as well as total cholesterol, ApoB, and ApoB / ApoA1 levels. During follow-up, no discomfort was reported at local injection sites, and no cases of abnormal liver function were observed. Conclusions Evolocumab significantly reduced LDL cholesterol levels and was well tolerated.