For fully edentulous patients, implant-supported overdenture can be considered to enhance chewing efficiency and denture stability. Implant planning software can be used to fabricate a surgical guide for a more precise consideration of anatomic factors and prediction of the shape of definitive prosthesis. Though there are many possible attachments for implant overdenture, milled bar can be useful due to its splinting effect of implants and rigid support of overdenture. This report presents a case of implant-supported milled bar overdenture after guided implant surgery performed with two surgical guide that was fabricated before and after bone reduction.

Objective: It is difficult to predict medical outcomes for acute pyelonephritis (APN) in women. A delay in diagnosis and treatment results in rapid progression to circulatory collapse, multiple organ failure, and death. We investigated the value of procalcitonin (PCT) and neutrophil-to-lymphocyte ratio (NLR) in APN patients hospitalized through the emergency room. Methods: We retrospectively evaluated women with APN presenting in the emergency room from January 2014 to May 2018. Inflammatory biomarkers, including PCT and NLR, were measured, and the severity of pyelonephritis was assessed using the Surviving Sepsis Campaign definitions (Sepsis-3). Multivariable logistic regression analysis was used to evaluate the risk factors associated with septic shock and the prediction for septic shock was compared using a receiver operating characteristic (ROC) curve. Results: A total of 357 female patients with APN were included. The median level of PCT and NLR was higher in the septic shock group compared with other groups. Multivariate logistic regression analysis showed that age and PCT were risk factors for septic shock. When the ROC curve of septic shock was compared, PCT showed a higher area under the curve than NLR (NLR 0.65 vs. PCT 0.80). Conclusion The initial NLR in the emergency room showed significant differences depending on the severity as classified by Sepsis-3 definitions. However, NLR was not found to be associated with septic shock in female patients with APN.

Objective: It is difficult to predict medical outcomes for acute pyelonephritis (APN) in women. A delay in diagnosis and treatment results in rapid progression to circulatory collapse, multiple organ failure, and death. We investigated the value of procalcitonin (PCT) and neutrophil-to-lymphocyte ratio (NLR) in APN patients hospitalized through the emergency room. Methods: We retrospectively evaluated women with APN presenting in the emergency room from January 2014 to May 2018. Inflammatory biomarkers, including PCT and NLR, were measured, and the severity of pyelonephritis was assessed using the Surviving Sepsis Campaign definitions (Sepsis-3). Multivariable logistic regression analysis was used to evaluate the risk factors associated with septic shock and the prediction for septic shock was compared using a receiver operating characteristic (ROC) curve. Results: A total of 357 female patients with APN were included. The median level of PCT and NLR was higher in the septic shock group compared with other groups. Multivariate logistic regression analysis showed that age and PCT were risk factors for septic shock. When the ROC curve of septic shock was compared, PCT showed a higher area under the curve than NLR (NLR 0.65 vs. PCT 0.80). Conclusion The initial NLR in the emergency room showed significant differences depending on the severity as classified by Sepsis-3 definitions. However, NLR was not found to be associated with septic shock in female patients with APN.

Objective: Serious bacterial infection (SBI) is a common disease among infants, and it is associated with high morbidity and mortality. Making the diagnosis of SBI is challenging and measurement of various biomarkers is useful. This study examined the utility of lactate at an emergency department for diagnosing SBI patients. Methods: This was a retrospective, observational study of febrile infants less than 90 days old presenting to the emergency department of a tertiary hospital between September 2014 and August 2017. The demographic and laboratory data was collected through a chart review. Results: Laboratory tests such as the white blood cell count, C-reactive protein (CRP), procalcitonin, and lactate showed significant differences on the Student-T test and the Mann Whitney-U test. Multivariabe logistic regression test was done using the variables with significant differences. CRP (P=0.037; odds ratio, 1.01), procalcitonin (P=0.011; odds ratio, 1.02) and lactate (P=0.001; odds ratio, 2.38) shows significant correlation. Conclusion For febrile infants at the emergency department, the measurement of lactate is expected to be a useful tool to diagnose serious bacterial infection.

Objective: Tsutsugamushi disease is a febrile illness caused by tick bites. Delay in making the diagnosis and treatment cause an increase of the frequency of complications and mortality. The aim of this study was to determine quick sequential organ failure assessment (qSOFA) to predict the clinical outcome of scrub typhus patients in emergency departments. Methods: This was a retrospective, observational study of patients with tsutsugamushi disease and who presented to the emergency department of an urban hospital and a rural tertiary hospital between January 2013 and December 2018. The demographic and laboratory data was collected through a chart review. Statistical analysis was performed by dividing the patients into the general ward admission group (general ward) and the intensive care unit admission group (ICU). Results: Age, Acute Physiology and Chronic Health Evaluation II (APACHE) II score and laboratory tests such as pH, leukocyte count, C-reactive protein, and procalcitonin also showed significant differences between the general ward and ICU groups on the univariable logistic regression analysis, but only the qSOFA score among the variables showed a significant difference on the multivariate logistic regression analysis (P=0.014). Conclusion The qSOFA score will be a prompt and useful tool for predicting the prognosis of patients with tsutsugamushi disease in the emergency department.

Objective: High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry. Methods: We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months. Results: Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours. Conclusion The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.

OBJECTIVE: The purpose of this study was to test the hypothesis that an increase in the neutrophil-to-lymphocyte ratio (NLR) increases the risk of in-hospital density in patients aged 65 and older, who are hospitalized in intensive care through the emergency rooms. METHODS: A retrospective medical record study was conducted on elderly patients who were admitted to intensive care units via the emergency room. The exclusion criteria were data loss, intensive care unit reentry, cerebrovascular accidents, hematologic disease, and trauma cases. RESULTS: The study included 526 patients; the mean age was 79, and 261 (49.6%) were male. The in-hospital mortality was 18.4% (97 patients). The initial NLR was higher in the non-survivor group than the survivor group, but the difference was not statistically significant (9.82±11.02 vs. 11.48±6.11, P=0.080). In multivariate logistic analysis, the initial NLR had no statistical significance, and the odd ratio was increased from one day later. Comparing the receiver operating characteristic curve of the NLR and Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scores, the NLR showed an increase in the area of under curve (AUC) value over time as well as the highest AUC with the SAPS II scores. CONCLUSION In elderly adults, early NLR was found to have weak power to predict in-hospital mortality. Over time, the NLR values more than two days after intensive care unit admission may be useful in predicting the in-hospital mortality for older patients. This may be due to the delay in the immune response and the complex medical history.

PURPOSE: There is increasing interest in intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) in critically ill patients. This study investigated the effects and outcomes of elevated IAP in a trauma intensive care unit (ICU) population. METHODS: Eleven consecutive critically ill patients admitted to the trauma ICU at Pusan National University Hospital Regional Trauma Center were included in this study. IAP was measured every 8–12 hours (intermittently) for 72 hours. IAP was registered as mean and maximal values per day throughout the study period. IAH was defined as IAP ≥12 mmHg. Abdominal compartment syndrome was defined as IAP ≥20 mmHg plus ≥1 new organ failure. The main outcome measure was in-hospital mortality. RESULTS: According to maximal and mean IAP values, 10 (90.9%) of the patients developed IAH during the study period. The Sequential Organ Failure Assessment (SOFA) score was significantly higher in patients with IAP ≥20 mmHg than in those with IAP <20 mmHg (16 vs. 5, p=0.049). The hospital mortality rate was 27.3%. Patients with a maximum IAP ≥20 mmHg exhibited significantly higher hospital mortality rates (p=0.006). Non-survivors had higher maximum and mean IAP values. CONCLUSIONS Our results suggest that an elevated IAP may be associated with a poor prognosis in critically ill trauma patients.

Leprosy is a chronic infectious and granulomatous disease caused by Mycobacterium leprae. It is treated with a multidrug therapy (MDT), which is consisted of dapsone, rifampicin, and clofazimine. However, there were relapsed leprosy associated with various predisposing factors; persisting organism, multiple involved skin lesions and nerves, HIV infection, monotherapy, inadequate and irregular therapy. Early or late relapses were observed in leprosy. Early onset relapses may occur due to insufficient treatment, and late relapses are probably with persistent bacilli and drug resistant organisms. Herein, we report on an interesting case of a 78-year-old man presented with relapsed leprosy associated with ulcerative skin lesions. The patient was diagnosed with lepromatous leprosy about 40 years ago, and he was treated with dapsone monotherapy and MDT. Our case is thought to have occurred due to persistent bacilli related to irregular therapy.

In the present study, we investigated whether tussilagone, a natural product derived from Tussilago farfara, significantly affects the production and gene expression of airway MUC5AC mucin. Confluent NCI-H292 cells were pretreated with tussilagone for 30 min and then stimulated with EGF (epidermal growth factor) or PMA (phorbol 12-myristate 13-acetate) for 24 h or the indicated periods. The MUC5AC mucin gene expression was measured by RT-PCR. Production of MUC5AC mucin protein was measured by ELISA. To elucidate the action mechanism of tussilagone, effect of tussilagone on PMA-induced NF-κB signaling pathway was investigated by western blot analysis. Tussilagone significantly inhibited the production of MUC5AC mucin protein and down-regulated the expression of MUC5AC mucin gene, induced by EGF or PMA. Tussilagone inhibited PMA-induced activation (phosphorylation) of inhibitory kappa B kinase (IKK), and thus phosphorylation and degradation of inhibitory kappa Ba (IκBα). Tussilagone inhibited PMA-induced phosphorylation and nuclear translocation of nuclear factor kappa B (NF-κB) p65. This, in turn, led to the down-regulation of MUC5AC protein production in NCI-H292 cells. These results suggest that tussilagone can regulate the production and gene expression of mucin by acting on airway epithelial cells through regulation of NF-κB signaling pathway.
Blotting, Western ; Down-Regulation ; Enzyme-Linked Immunosorbent Assay ; Epidermal Growth Factor ; Epithelial Cells* ; Epithelium ; Gene Expression* ; Mucins* ; NF-kappa B ; Phosphorylation ; Phosphotransferases ; Tussilago