Recent studies for the diabetic polyneuropathy have quantified as well as compared the clinical and the electrophysiological findings. Thirty-one diabetic patients were examined with a conventional nerve conduction study, a late response, a somatosensory evoked potential (SEP), a sympathetic skin response (SSR), a R-R interval, and a needle electromyography (EMG) after the clinical examination. The purposes of this study were to evaluate the correlation of clinical features and electrophysiological findings and to provide reliable criteria for the diagnosis of diabetic polyneuropathy. Diabetic polyneuropathy was diagnosed when a nerve conduction study revealed abnormal findings in two or more peripheral nerves. The following parameters were highly correlated with a diabetic polyneuropathy; ankle jerks (Spearman's r=0.92), H reflexes (Spearman's r=0.92), F waves by the tibial nerve stimulation (Spearman's r=0.88), F waves by the peroneal nerve stimulations (Spearman's r=0.84), and amplitudes of a sensory nerve action potential (SNAP) in the sural nerve (Spearman's r=0.79), SEPs by the tibial nerve stimulation (Spearman's r=0.79). Motor nerve conduction of the upper limbs, R-R interval ratios, and blood pressure changes had no significant correlations with a diabetic polyneuropathy. We concluded that these clinical and electrophysiological findings with significantly high correlation values would be good parameters for the diagnosis of diabetic polyneuropathy.
Action Potentials ; Ankle ; Blood Pressure ; Diabetic Neuropathies* ; Diagnosis ; Electromyography ; Evoked Potentials, Somatosensory ; H-Reflex ; Humans ; Needles ; Neural Conduction ; Peripheral Nerves ; Peroneal Nerve ; Polyneuropathies ; Skin ; Sural Nerve ; Tibial Nerve ; Upper Extremity

Objectives: The present paper aimed to examine whether an aging workforce is associated with an increase in work-related fatal injuries and to explore the underlying reasons for this potential increase.Material and methodsAged workers were defined as those who were at least 55 years old. Work-related fatalities were assessed in aged and young workers who were registered with the workers' compensation system in 2021 in the Republic of Korea. Total waged workers, based on raw data from the Local Area Labor Force Survey in 2021, were used as the denominator to estimate the work-related fatality rates. Results: Most work-related fatalities in the aged workers occurred among individuals working in the “construction sector” (58.9%), those with “elementary occupations (unskilled workers)” (46.1%), and those with the employment status of “daily worker” (60.8%). The estimated incidence (0.973/10,000) of work-related fatalities among aged workers was about four times higher than that (0.239/10,000) among younger workers. “Falling,” “collision,” “struck by an object,” and “trip and slip” were more frequent types of work-related fatalities among aged workers relative to young workers. The category of “buildings, structures, and surfaces” was a more frequent cause of work-related fatalities among aged workers than among young workers. Conclusions Aged workers had a higher incidence of work-related fatalities than young workers. Frequent engagement in precarious employment and jobs, coupled with the greater physical vulnerability of aged workers, were likely causes of their higher level of work-related fatal injuries.

Methemoglobinemia is rare. It is classified into two types: congenital methemoglobinemia and acquired methemoglobinemia. Methemoglobin is incapable of binding oxygen, leading to complications such as cyanosis, dyspnea, headache, and heart failure. In the present case, a 35-year-old man with congenital methemoglobinemia underwent general anesthesia for thyroidectomy. The patient was diagnosed with hemoglobin M at 7 years of age. Ventilation was performed with FiO2 1.0. Arterial blood gas analysis showed that the pH was 7.4, PaO 2 439 mmHg, PaCO2 40.5 mmHg, oxyhemoglobin level of 83.2%, and methemoglobin level of 15.5%. The patient had a stable course, although cyanosis was observed during surgery.

Spinal cord injury often leads to central neuropathic pain syndromes, such as allodynic and hyperalgesic behaviors. Electrophysiologically, spinal dorsal horn neurons show enhanced activity to non-noxious and noxious stimuli as well as increased spontaneous activity following spinal cord injury, which often called hyperexcitability or central sensitization. Under hyperexcitable states, spinal neurons lose their ability of discrimination and encoding somatosensory information followed by abnormal somatosensory recognition to non-noxious and noxious stimuli. In the present review, we summarize a variety of pathophysiological mechanisms of neuronal hyperexcitability for treating or preventing central neuropathic pain syndrome following spinal cord injury.
Animals ; Central Nervous System Sensitization ; Discrimination (Psychology) ; Neuralgia ; Neurons ; Posterior Horn Cells ; Rats ; Spinal Cord ; Spinal Cord Injuries

Methemoglobinemia is rare. It is classified into two types: congenital methemoglobinemia and acquired methemoglobinemia. Methemoglobin is incapable of binding oxygen, leading to complications such as cyanosis, dyspnea, headache, and heart failure. In the present case, a 35-year-old man with congenital methemoglobinemia underwent general anesthesia for thyroidectomy. The patient was diagnosed with hemoglobin M at 7 years of age. Ventilation was performed with FiO2 1.0. Arterial blood gas analysis showed that the pH was 7.4, PaO 2 439 mmHg, PaCO2 40.5 mmHg, oxyhemoglobin level of 83.2%, and methemoglobin level of 15.5%. The patient had a stable course, although cyanosis was observed during surgery.

A 59-year-old woman was scheduled to undergo a robot-assisted distal gastrectomy under general anesthesia. During the operation, the vital signs were maintained in normal range. After 7 hours of surgery, the pulse oxymeter graph became flat and the end tidal CO2 concentration suddenly decreased. Palpation of the carotid artery revealed no heart beat but the EKG continued to show sinus rhythm. Pulseless electrical activity (PEA) was diagnosed. An advanced cardiopulmonary life support protocol for PEA was immediately initiated, which included chest compressions and doses of IV cardiovascular drugs. However, in spite of continuous CPR, the heart wasn't recovered from the arrest. We experienced cardiac arrest for pulseless electrical activity during robot-assisted distal gastrectomy.
Anesthesia, General ; Cardiopulmonary Resuscitation ; Cardiovascular Agents ; Carotid Arteries ; Electrocardiography ; Female ; Gastrectomy ; Heart ; Heart Arrest ; Humans ; Hypovolemia ; Middle Aged ; Palpation ; Peas ; Reference Values ; Thorax ; Vital Signs

OBJECTIVES: Dentists and dental hygienists undergo high levels of stress due to various factors and the burnout of health-care personnel is very important in the context of personal and social problems. Therefore, empirical research reflecting the social, cultural, and special circumstances of the medical environment is necessary. Here, we explore the causes and outcomes of burnout in dentists and dental hygienists and present ways to prevent burnout. METHODS: A cross-sectional research design was used to measure burnout of 141 dentists and 61 dental hygienists. A structured questionnaire containing the Maslach Burnout Inventory (MBI) was administered from May to June, 2018. Data were analyzed using SPSS 25.0, descriptive statistics, t-test, Mann-Whitney test, Kruskall-Wallis test, and multiple regression analysis. RESULTS: Each participant's MBI was measured in three aspects (emotional exhaustion, depersonalization, and personal accomplishment). The MBI scores of dentists with regards to their emotional exhaustion, depersonalization, and personal accomplishment were 24.8%, 34%, and 48.2%, respectively. Alternatively the scores of dental hygienists were 45.9%, 44.3% and 52.5%, respectively, for the same parameters. While the factors affecting the burnout of dentists and dental hygienists were different, it had a negative impact on the professional performance of both. CONCLUSIONS: According to the results of this study, Korean dentists and dental hygienists experience high levels of work-related burnouts. This can have adverse impacts on their personal health and that of their patients. Therefore, stress management is necessary in dentists and dental hygienists.
Dental Hygienists ; Dentists ; Depersonalization ; Empirical Research ; Humans ; Research Design ; Social Problems

Purpose: This study was conducted to develop a convolutional neural network (CNN) algorithm that can diagnose cervical foraminal stenosis using oblique radiographs and evaluate its accuracy. Materials and Methods: A total of 997 patients who underwent cervical MRI and cervical oblique radiographs within a 3-month interval were included. Oblique radiographs were labeled as “foraminal stenosis” or “no foraminal stenosis” according to whether foraminal stenosis was present in the C2–T1 levels based on MRI evaluation as ground truth. The CNN model involved data augmentation, image preprocessing, and transfer learning using DenseNet161. Visualization of the location of the CNN model was performed using gradient-weight class activation mapping (Grad-CAM). Results: The area under the curve (AUC) of the receiver operating characteristic curve based on DenseNet161 was 0.889 (95% confidence interval, 0.851–0.927). The F1 score, accuracy, precision, and recall were 88.5%, 84.6%, 88.1%, and 88.5%, respectively.The accuracy of the proposed CNN model was significantly higher than that of two orthopedic surgeons (64.0%, p<0.001; 58.0%, p<0.001). Grad-CAM analysis demonstrated that the CNN model most frequently focused on the foramen location for the determination of foraminal stenosis, although disc space was also frequently taken into consideration. Conclusion A CNN algorithm that can detect neural foraminal stenosis in cervical oblique radiographs was developed. The AUC, F1 score, and accuracy were 0.889, 88.5%, and 84.6%, respectively. With the current CNN model, cervical oblique radiography could be a more effective screening tool for neural foraminal stenosis.

Amyotrophic lateral sclerosis (ALS), also referred to as Lou Gehrig's disease, is a degenerative disorder of motor neuron system of the spinal cord and the cortical neuron. Patients with ALS present a unique challenge to the anesthesiologist. Respiratory muscle weakness, for instance, can result in trouble with proper breathing after general anesthesia. We report a case of spinal anesthesia for discectomy in a patient with ALS.
Amyotrophic Lateral Sclerosis ; Anesthesia, General ; Anesthesia, Spinal ; Diskectomy ; Humans ; Motor Neurons ; Neurons ; Respiration ; Respiratory Muscles ; Spinal Cord

BACKGROUND: Control of postoperative pain is an important aspect of postoperative patient management. Among the methods of postoperative pain control, patient-controlled analgesia (PCA) has been the most commonly used. This study tested the convenience and safety of a PCA method in which the dose adjusted according to time. METHODS: This study included 100 patients who had previously undergone orthognathic surgery, discectomy, or total hip arthroplasty, and wished to control their postoperative pain through PCA. In the test group (n = 50), the rate of infusion was changed over time, while in the control group (n = 50), drugs were administered at a fixed rate. Patients' pain scores on the visual analogue scale, number of rescue analgesic infusions, side effects, and patients' satisfaction with analgesia were compared between the two groups. RESULTS: The patients and controls were matched for age, gender, height, weight, and body mass index. No significant difference in the mount of drug administered was found between the test and control groups at 0-24 h after the operation; however, a significant difference was observed at 24-48 h after the operation between the two groups. No difference was found in the postoperative pain score, number of side effects, and patient satisfaction between the two groups. CONCLUSIONS: Patient-controlled anesthesia administered at changing rates of infusion has similar numbers of side effects as infusion performed at a fixed rate; however, the former allows for efficient and safe management of postoperative pain even in small doses.
Analgesia ; Analgesia, Patient-Controlled ; Anesthesia ; Arthroplasty, Replacement, Hip ; Body Mass Index ; Diskectomy ; Humans ; Infusion Pumps ; Methods ; Morphine ; Orthognathic Surgery ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction