Background/Aims: We aimed to compare the effectiveness and safety of Janus kinase inhibitors (JAKi) vs. biologic disease- modifying antirheumatic drugs (bDMARD) in Korean patients with rheumatoid arthritis (RA) who had an inadequate response to conventional synthetic DMARDs. Methods: A quasi-experimental, multi-center, prospective, non-randomized study was conducted to compare response rates between JAKi and bDMARDs in patients with RA naïve to targeted therapy. An interim analysis was performed to estimate the proportion of patients achieving low disease activity (LDA) based on disease activity score (DAS)–28– erythroid sedimentation rate (ESR) (DAS28-ESR) at 24 weeks after treatment initiation and to evaluate the development of adverse events (AEs). Results: Among 506 patients enrolled from 17 institutions between April 2020 and August 2022, 346 (196 JAKi group and 150 bDMARD group) were included in the analysis. After 24 weeks of treatment, 49.0% of JAKi users and 48.7% of bDMARD users achieved LDA (p = 0.954). DAS28-ESR remission rates were also comparable between JAKi and bDMARD users (30.1% and 31.3%, respectively; p = 0.806). The frequency of AEs reported in the JAKi group was numerically higher than that in the bDMARDs group, but the frequencies of serious and severe AEs were comparable between the groups. Conclusions Our interim findings reveal JAKi have comparable effectiveness and safety to bDMARDs at 24 weeks after treatment initiation.

Persistent hiccups are rare complications following epidural steroid injections. Although the underlying etiology is not clearly understood, corticosteroids are the drug group referenced most frequently in the literature as being associated with hiccups. A 54-year-old man occurred a persistent hiccup after cervical root block due to cervical radiculopathy. A stellate ganglion block was performed, but the hiccup continued. After that, the hiccup did not stop, so metoclopramide 10 mg was prescribed. After taking the drug the next day, hiccups started to decrease in frequency, the hiccup was completely stopped from the second day of taking the drug, the hiccup was completely stopped. He reported that he had not experienced recurrent hiccups. This report highlights the importance of evaluating the cause of hiccups and determining the treatment strategy accordingly.

Persistent hiccups are rare complications following epidural steroid injections. Although the underlying etiology is not clearly understood, corticosteroids are the drug group referenced most frequently in the literature as being associated with hiccups. A 54-year-old man occurred a persistent hiccup after cervical root block due to cervical radiculopathy. A stellate ganglion block was performed, but the hiccup continued. After that, the hiccup did not stop, so metoclopramide 10 mg was prescribed. After taking the drug the next day, hiccups started to decrease in frequency, the hiccup was completely stopped from the second day of taking the drug, the hiccup was completely stopped. He reported that he had not experienced recurrent hiccups. This report highlights the importance of evaluating the cause of hiccups and determining the treatment strategy accordingly.

Anticoagulants ; Atrial Fibrillation ; Female ; Heart Valve Diseases ; Hemorrhage ; Humans ; Kidney Failure, Chronic ; Male ; Multivariate Analysis ; Myocardial Infarction ; Platelet Aggregation Inhibitors ; Prospective Studies ; Smoke ; Smoking ; Stroke ; Warfarin

BACKGROUND: Platelet-rich plasma (PRP) has been advocated as a way to introduce increased concentrations of growth factors and other bioactive molecules to injured tissues in an attempt to optimize the local healing environment. Many methods for PRP preparation have been introduced. Despite variations in the volume of whole blood taken and the efficacy of the platelet concentration, the main objective of PRP preparation is to obtain sufficient platelet concentration in the finally processed autologous plasma. We have been making our own internal primitive PRP preparation, which is safe and aseptic, using simple tubes and a centrifugal separator at the outpatient department base. METHODS: Twenty cc of whole blood was collected and 10 cc of blood was added to each of two bottles, followed by addition of 1.5 cc adenosine-citrate-dextrose-acid solution to each bottle. Then, centrifugal separation was performed at 4,000 RPM for 15 minutes. Then, the buffy coat layer was aspirated using a 10 cc syringe equipped with a spinal needle. Platelet activation was initiated by addition of CaCl2 and botropase. RESULTS: We were successful in attaining PRP, which was three folds and six folds concentrated compared with the initial platelet count of whole blood. CONCLUSIONS: Our protocol is economical and only requires a few simple procedures for preparation of PRP. We expect the protocol to be applied to clinical trials without significant cost of time and money.
Blood Platelets ; Humans ; Intercellular Signaling Peptides and Proteins ; Needles ; Outpatients ; Plasma ; Platelet Activation ; Platelet Count ; Platelet-Rich Plasma* ; Syringes

No abstract available.
Neurofibroma*

BACKGROUND: Various techniques for lengthening short columellae have been used for bilateral cleft nose repair. However, previous methods have not yielded satisfactory results. We performed a full-thickness skin graft to lengthen short columellae during secondary cleft nose repair in adult patients. METHODS: Ten bilateral cleft lip and nose patients underwent secondary cheiloplasty with open rhinoplasty between July 2008 and August 2014. The patients underwent a full-thickness skin graft on the medial crura to elongate the columella. The average age of the patients at the time of surgery was 22.2 years. Nasal profiles were evaluated before and after the operation using the photogrammetric method. RESULTS: The nasal profiles were improved in all patients, and all skin grafts were well taken, with the exception of one patient. Columellar height, nostril height, and columella-lip angle increased, and nasal width decreased significantly. The ratios of columellar height to nasal height, columellar height to nasal width, and nasal height to nasal width increased to a statistically significant extent. CONCLUSIONS: Columella lengthening with a full-thickness skin graft is a simple and effective method for the repair of severely short columellae in bilateral cleft nose patients. We had satisfactory outcomes, with good color matching and aesthetically pleasing contours.
Adult ; Cleft Lip* ; Humans ; Nose* ; Rhinoplasty ; Skin Transplantation ; Skin* ; Transplants*

No abstract available.
Methicillin-Resistant Staphylococcus aureus*

BACKGROUND: Orthognathic surgery is required in 25% to 35% of patients with a cleft lip and palate, for whom functional recovery and aesthetic improvement after surgery are important. The aim of this study was to examine maxillary and mandibular changes, along with concomitant soft tissue changes, in cleft patients who underwent LeFort I osteotomy and sagittal split ramus osteotomy (two-jaw surgery). METHODS: Twenty-eight cleft patients who underwent two-jaw surgery between August 2008 and November 2013 were included. Cephalometric analysis was conducted before and after surgery. Preoperative and postoperative measurements of the bone and soft tissue were compared. RESULTS: The mean horizontal advancement of the maxilla (point A) was 6.12 mm, while that of the mandible (point B) was -5.19 mm. The mean point A-nasion-point B angle was -4.1degrees before surgery, and increased to 2.5degrees after surgery. The mean nasolabial angle was 72.7degrees before surgery, and increased to 88.7degrees after surgery. The mean minimal distance between Rickett's E-line and the upper lip was 6.52 mm before surgery and 1.81 mm after surgery. The ratio of soft tissue change to bone change was 0.55 between point A and point A' and 0.93 between point B and point B'. CONCLUSIONS: Patients with cleft lip and palate who underwent two-jaw surgery showed optimal soft tissue changes. The position of the soft tissue (point A') was shifted by a distance equal to 55% of the change in the maxillary bone. Therefore, bone surgery without soft tissue correction can achieve good aesthetic results.
Cleft Lip ; Humans ; Lip ; Mandible ; Maxilla ; Orthognathic Surgery ; Osteotomy ; Osteotomy, Le Fort ; Osteotomy, Sagittal Split Ramus ; Palate

BACKGROUND: Frontal sinus fractures, particularly anterior sinus fractures, are relatively common facial fractures. Many agree on the general principles of frontal fracture management; however, the optimal methods of reduction are still controversial. In this article, we suggest a simple reduction method using a subbrow incision as a treatment for isolated anterior sinus fractures. METHODS: Between March 2011 and March 2014, 13 patients with isolated frontal sinus fractures were treated by open reduction and internal fixation through a subbrow incision. The subbrow incision line was designed to be precisely at the lower margin of the brow in order to obtain an inconspicuous scar. A periosteal incision was made at 3 mm above the superior orbital rim. The fracture site of the frontal bone was reduced, and bone fixation was performed using an absorbable plate and screws. RESULTS: Contour deformities were completely restored in all patients, and all patients were satisfied with the results. Scars were barely visible in the long-term follow-up. No complications related to the procedure, such as infection, uncontrolled sinus bleeding, hematoma, paresthesia, mucocele, or posterior wall and brain injury were observed. CONCLUSIONS: The subbrow approach allowed for an accurate reduction and internal fixation of the fractures in the anterior table of the frontal sinus by providing a direct visualization of the fracture. Considering the surgical success of the reduction and the rigid fixation, patient satisfaction, and aesthetic problems, this transcutaneous approach through a subbrow incision is concluded to be superior to the other reduction techniques used in the case of an anterior table frontal sinus fracture.
Brain Injuries ; Cicatrix ; Congenital Abnormalities ; Follow-Up Studies ; Fracture Fixation, Internal ; Frontal Bone ; Frontal Sinus* ; Hematoma ; Hemorrhage ; Humans ; Mucocele ; Orbit ; Paresthesia ; Patient Satisfaction ; Surgical Procedures, Minimally Invasive