Presurgical maxillary orthodontics during neonatal period has been advocated to facilitate cleft lip and/or palate cases through correcting widened alveolar bone and twisting or bending protruded premaxilla. This may improve post-orthodontic surgical lip repair procedure. Premaxilla cannot be moved into the correct position by a passive acrylic appliance alone. Therefore active acrylic appliance may be necessary and force vector, amount and stability of appliance are mandatory. Because neonatal infant still doesn't have a fully grown face, there may be some limitations to apply proper active force to the patient. The authors devised a new active stabilized extraoral appliance which provided stable extraoral force in the cleft lip and/or palate patients. We applied our new device to 2 infants with unilateral and bilateral cleft lip and palate. Stability of extraoral part has been increased by elastic rubber band, and the intraoral part is firmly connected to extraoral part. By using this device, the gap has decreased from 11.5mm to 6.5mm between right and left alveolar ridge in 1-month infant with unilateral case after 7 weeks. In 2-month infant with bilateral cleft, the length between premaxilla and alveolar ridge decreased from 6.5mm to 2.0mm after 4 weeks. We think our intraoral active stabilized orthodontic appliance could be widly used in cleft patients to put their maxillary segments to desirable position. This procedure makes the cleft lip surgery easier, with less tension.
Alveolar Process ; Cleft Lip* ; Cleft Palate ; Humans ; Infant ; Lip ; Orthodontic Appliances ; Orthodontics ; Palate* ; Rubber

Mycobacterium abscessus belongs to a group of rapidly growing mycobacteria (RGM) that cause a broad spectrum of infections in humans. In addition, the association of M. abscessus with the cause of community- and hospital-acquired infections has been recently reported. In fact, M. abscessus is known to be the most drug-resistant mycobacterium and naturally resistant to first-line anti-tuberculous drugs, resulting in the limited therapeutic options and a high failure rate of treatment response. Three closely related species; M. abscessus (sensu stricto), M. bolletii, and M. massiliense are currently identified however, consensus on the naming of M. abscessus-related species has not been made to date. We herein discuss the advanced understanding of the virulence potentials and pathophysiological features of M. abscessus to establish novel therapeutic strategies for M. abscessus infection.
Consensus ; Humans ; Mycobacterium

PURPOSE: The rapid recognition of cardiac arrest is an important factor for survival in cardiac arrest patients, and gasping is a primary barrier to the recognition of a cardiac arrest. This study examined differences in capability of recognizing a cardiac arrest and gasping among lay people, hospital nurses, and medical dispatchers. METHODS: From January to July 2016, 193 participants (65 lay people 62 hospital nurses, and 66 medical dispatchers) watched video clips of a collapsed virtual patient with unresponsiveness, gasping or seizure and answered a questionnaire asking whether the patient was in cardiac arrest or not. The results of the questionnaire were analyzed and compared among the groups. RESULTS: The total score of the questionnaire on the determination of cardiac arrest among lay people, nurses, and medical dispatchers were significant (3.09±1.43 vs. 4.15±1.22 vs. 4.45±1.29 points, p < 0.01). In the questions regarding cardiac arrest with gasping, the correct answer rate was highest in the dispatchers, followed in order by nurses and lay people (82.5% vs. 54.8% vs. 29.7%, p < 0.001). CONCLUSION: In this study, lay people had the lowest recognition capability of a cardiac arrest and gasping among the groups. In addition, gasping is a meaningful barrier to cardiac arrest recognition for both lay people and healthcare providers.
Cardiopulmonary Resuscitation ; Health Personnel ; Heart Arrest* ; Humans ; Respiration ; Seizures

PURPOSE: Hand fractures can be treated conservatively in many cases, but rotation malalignment is one of the important indications for surgical treatment because of dysfunction. We performed open reduction and internal fixation in these malalignment fractures and report clinical and radiological results. METHODS: This study included 28 patients (18 male, 10 female) who had metacarpal and phalangeal fractures with rotational malalignment of finger on initial examination. Patients with combined injuries including open soft tissue damage or multiple fractures were excluded. Mean age was 36.1 years and average follow-up period was 14.6 months. Perioperative extent of rotation and correction during the follow-up, union on the radiographs, Range of motion, disability of the arm, shoulder and hand (DASH) score, and pinch power at the last follow-up were evaluated. RESULTS: Average corrected angulation of rotation was 11.9° and no patient showed scissoring appearance of fingers at the last follow-up. All patients showed solid bony union on the radiographs during the follow-up. The average of total active motion of the injured fingers were average 254°, average DASH score was 3.2 and average pinch power was 3.0 kg at the last follow-up. CONCLUSION: Clinical and radiologically satisfactory results were obtained in all patients. Care should be taken not to overlook the rotational misalignment after fracture of the hand, and surgical treatment should be considered to ensure correct reduction and fixation.
Arm ; Finger Phalanges ; Fingers ; Follow-Up Studies ; Fractures, Multiple ; Hand ; Humans ; Male ; Metacarpal Bones ; Range of Motion, Articular ; Shoulder

PURPOSE: The dose of drug and the size of instrument are determined based on children's weight. We aimed to validate the finger counting method (FCM) for weight estimation in Korean children using the Monte Carlo simulation. METHODS: We estimated the weight of Korean children aged 1 to 9 years by the FCM. These measurements were compared with the weight extracted by the Monte Carlo simulation applied to the “2007 Korean Children and Adolescents Growth Standard”. Pearson correlation coefficients (r) were measured to assess the correlation between the weight extracted by the simulation and that estimated by FCM. Bland-Altman analyses were performed to assess the agreement between the weight extracted by the simulation and that estimated by FCM and 2 other well-known pediatric weight estimation formulas (the Advanced Pediatric Life Support and Luscombe formulas). RESULTS: Data regarding 9,000 children's weight selected by age and gender was randomly extracted using the simulation. We found a positive correlation between the weight estimated by the FCM and the weight extracted (in boys, r = 0.896, P < 0.001; in girls, r = 0.899, P < 0.001). The FCM tended to underestimate weight in the children aged 7 years or old. CONCLUSION: This article suggests the usefulness of FCM in weight estimation, particularly in children younger than 7 years. With appreciation of the limitation in older children, the FCM could be applied to emergency practice.
Adolescent ; Body Weight ; Child ; Emergencies ; Emergency Service, Hospital ; Female ; Fingers* ; Humans ; Methods* ; Monte Carlo Method ; Resuscitation

PURPOSE: Sudden cardiac arrest (SCA) accounts for approximately 15% of all-cause mortality in the US and 50% of all cardiovascular mortalities in developed countries; 10% of cases have an underlying structural cardiac abnormality. An echocardiography has widely been used to evaluate cardiac abnormality, but it needs to be performed by emergency physicians available in the emergency department immediately after death, rather than by cardiologists. We aimed to determine whether post-mortem echocardiography (PME) performed in the emergency department may reveal such abnormalities. METHODS: We evaluated the reliability and validity of PME performed by emergency physicians in the emergency department. Measurement by a cardiologist was used as reference. RESULTS: Two emergency physicians performed PME on 3 out of the 4 included patients who died after unsuccessful cardiopulmonary resuscitation. PME was started within 10 minutes of death, and it took 10 minutes to complete. Parasternal views in either supine or left decubitus position were most helpful. The adequacy of the image was rated good to fair, and that of measurements was acceptable to borderline. Regarding the chamber size and left ventricular wall thickness, intraclass correlation coefficients for reliability and validity were 0.97 (n=15) and 0.95 (n=35), respectively (p<0.001). Evaluation of presence/absence of left ventricular wall thinning, valve calcification, and pericardial effusion was incomplete (3/7-5/7), precluding further analysis. CONCLUSION: Emergency physicians could perform reliable and valid PME to assess the chamber size and left ventricular wall thickness. A large prospective study with collaboration between emergency physicians and cardiologists would reveal the feasibility and usefulness of PME in diagnosing structural causes of sudden cardiac arrest.
Cardiopulmonary Resuscitation ; Cooperative Behavior ; Death, Sudden, Cardiac* ; Developed Countries ; Echocardiography* ; Emergencies* ; Emergency Service, Hospital* ; Heart Arrest ; Humans ; Mortality ; Pericardial Effusion ; Prospective Studies ; Reproducibility of Results

PURPOSE: In an effort to determine the characteristics of foreign suicides who visit an emergency center, this study analyzed suicidal attempt between natives and foreigners. METHODS: We conducted a retrospective analysis of 1,218 Korean and 149 foreign suicidal attempters who visited a regional emergency center from January 1, 2009 to December 31, 2013. We compared two groups according to age, sex, selected suicidal methods, past psychiatric history, medical examination and treatment acceptance, elapsed time to visit an emergency center after suicidal attempt, emergency center residence time, and hospitalization period. RESULTS: No difference in medical exam acceptance and tetanus vaccination was observed between the two groups. However, we found a difference in hospitalization acceptance. The prevalence rate of psychiatric disorders was lower in foreign suicides, and the refusal rate of psychiatric treatment was higher in foreign patients. CONCLUSION: In foreign suicides, social support including finance is required for easy access to health care service. In addition, more active interdisciplinary cooperation with the department of psychiatry and close observation is needed.
Disulfiram ; Emergencies* ; Emigrants and Immigrants* ; Health Services Accessibility ; Hospitalization ; Humans ; Population Groups* ; Prevalence ; Retrospective Studies ; Suicide ; Tetanus ; Vaccination

Considerable evidence has been published since the 2020 Korean Cardiopulmonary Resuscitation Guidelines were reported. The International Liaison Committee on Resuscitation (ILCOR) also publishes the Consensus on CPR and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) summary annually. This review provides expert opinions by reviewing the recent evidence on CPR and ILCOR treatment recommendations. The authors reviewed the CoSTR summary published by ILCOR in 2021 and 2022. PICO (population, intervention, comparator, outcome) questions for each topic were reviewed using a systemic or scoping review methodology. Two experts were appointed for each question and reviewed the topic independently. Topics suggested by the reviewers for revision or additional description of the guidelines were discussed at a consensus conference. Forty-three questions were reviewed, including 15 on basic life support, seven on advanced life support, two on pediatric life support, 11 on neonatal life support, six on education and teams, one on first aid, and one related to coronavirus disease 2019 (COVID-19). Finally, the current Korean CPR Guideline was maintained for 28 questions, and expert opinions were suggested for 15 questions.