Objective: This study aimed to illustrate the techniques of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) using double cages and compare surgical outcomes with those using a single cage. Methods: We retrospectively analyzed 62 patients who underwent single-level UBE-TLIF using 3-dimensional (3D)-printed titanium cages (29 with a single cage and 33 with double cages). Radiological parameters, including Bridwell fusion and subsidence grading, were assessed via x-ray and computed tomography at 6 months and 1 year. Clinical outcomes were measured using the visual analogue scale (VAS) for lower back and leg pain, as well as the Oswestry Disability Index (ODI). Results: At the 6-month follow-up, the overall fusion rate (grades I + II) was significantly higher in the double-cage group (86.2% vs. 100%, p=0.04); however, no significant difference was noted at the 1-year follow-up (89.6% vs. 100%). The double-cage group showed lower cage subsidence rates at both follow-ups (3% vs. 31%, p=0.01; 12.1% vs. 38%, p=0.03). The double-cage group exhibited significantly greater improvements in leg pain (VAS: 7.6 to 1.7 vs. 7.2 to 1.4, p=0.03) and ODI (28.6 to 10.8 vs. 28.3 to 9.4, p=0.01) at 1 year. Conclusion UBE-TLIF with 3D-printed titanium cages achieved a favorable fusion rate at the 1-year follow-up, regardless of whether single or double cages were used. However, double cages accelerated fusion at the 6-month follow-up and significantly reduced cage subsidence at both the 6-month and 1-year follow-ups. These benefits contributed to improved VAS scores for leg pain and ODI at the final follow-up.

Objective: Fluoroscopy-guided percutaneous pedicle screw fixation (FGPSF) and its further development, robot-assisted percutaneous pedicle screw fixation (RAPSF), are minimally invasive spinal surgery (MISS) techniques. FGPSF is a standard technique at our hospital, and RAPSF incorporating artificial intelligence has been performed at our hospital since October 2021. This study compared these 2 techniques and analyzed their differences, accuracy, and clinical outcomes based on our experiences. Methods: This study conducted a detailed analysis of screw accuracy and the clinical outcomes of 2 MISS techniques, FGPSF, and RAPSF. Screw accuracy was evaluated using the Gertzbein and Robbins scale, categorizing placements into grades A–E, with grades A and B considered clinically acceptable. Accuracy was assessed using postoperative computed tomography images for FGPSF and intraoperative O-arm scan images for RAPSF. Clinical outcomes were compared by examining parameters, such as hospitalization duration, C-reactive protein (CRP) normalization period, estimated blood loss (EBL), and preoperative/postoperative visual analogue scale (VAS) scores. Screw-related complications were reviewed. Independent image evaluations by nonparticipating spine specialists ensured objective and reliable assessments. Results: Both FGPSF and RAPSF demonstrated high rates of clinically acceptable screw placement, with minimal breaches that required no repositioning. The clinically acceptable rates of FGPSF and RAPSF were similar (99.17% and 99.19%, respectively). Both groups also demonstrated similar clinical outcomes. The CRP normalization period, EBL, and ΔVAS (preoperative—postoperative) scores revealed no statistically significant differences between FGPSF and RAPSF. Neither group experienced screw-related complications; however, the RAPSF group exhibited a statistically significant shorter hospital stay than the FGPSF group. Conclusion This study compared the accuracy and clinical outcomes of FGPSF and RAPSF. Both methods demonstrated no significant differences in accuracy or clinical outcomes. Spine surgeons selected between the 2 methods based on individual patient needs, and additional research is required to fully understand the practical advantages of each technique in the clinical field.

Objective: This study compared the clinical and radiological outcomes of uniportal endoscopic and biportal endoscopic transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative disease during the early learning stage of the technique. Methods: We retrospectively analyzed patients who underwent uniportal endoscopic TLIF (n=15) and biportal endoscopic TLIF (n=19) between January and October 2021 during the first year of adoption of these techniques. Radiological parameters, including Bridewell fusion and subsidence grading, were evaluated by x-ray and computed tomography (CT) at 3-month, 6-month, and 1-year follow-up visits. Clinical outcomes were evaluated using the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Results: Uniportal endoscopic TLIF showed significantly higher frequencies of intraoperative endplate injuries (uniportal [20%] vs. biportal [0%], p=0.01) and 1-year cage subsidence (uniportal [60%] vs. biportal [26.3%], p=0.04) than biportal endoscopic TLIF. The 1-year fusion rates did not differ significantly between the 2 surgical groups (uniportal [93.3%] vs. biportal [89.5%], p=0.37). Neural complications such as postoperative dysesthesia and dural tears occurred in uniportal endoscopic TLIF. There were no significant differences in the VAS for back and leg pain or ODI. Conclusion Complete endplate preparation under endoscopic guidance improved interbody fusion, and this procedure may be feasible in the early learning stage, regardless of the type of endoscope. Both endoscopic TLIF techniques achieved good clinical outcomes and fusion rates. However, unskilled use of the cage guide device caused endplate breakage and neural injury during uniportal endoscopic cage insertion. Uniportal endoscopic TLIF may require more experience for appropriate cage insertion.

Objective: Biportal endoscopic surgery was developed to treat degenerative pathologies that cause myelopathy. Thoracic disc herniation accelerates myelopathy at the level of thoracic stenosis caused by ossification of the ligamentum flavum (OLF). This study describes a feasible surgical technique for the biportal endoscopic posterior approach for removing the thoracic OLF and herniated disc that cause thoracic myelopathy. Methods: Bilateral laminar thinning was performed while preserving the midline and contralateral bony structures. The thoracic OLF was thinned and cut at the bony drilled edge using a diamond drill. The OLF was elevated and removed using an en bloc technique after epidural dissection. The herniated disc was removed through the space created after medial facetectomy. All the procedures were performed without neural injury. Results: Postoperatively, the neurological symptoms of thoracic myelopathy improved, as did the upper back and chest wall pain. Conclusion We successfully treated double-crushing lesions of the thoracic herniated disc and OLF using biportal endoscopy. In biportal endoscopic surgery, drills and instruments can be smoothly used in the narrow spinal canal of the upper thoracic vertebrae. The biportal endoscopic posterior thoracic approach may be an attractive surgical option for treating thoracic myelopathy caused by combined degenerative pathologies.

OBJECTIVES: To suggest direction for improving policies by understanding current management of narcotics or psychotropic drugs and analyzing their distributions and usage. METHOD: We conducted a comparison analysis between health insurance claims and the amount supplied to health care institutions for narcotics or psychotropic drugs through health insurance claims data and drug distribution supply data from 2010 to 2012 collected from Korea Pharmaceutical Information Service Center (KPIS). Furthermore, we carried out literature investigation and online search to comprehend the current management of narcotics drugs in Korea. RESULTS: The amount supplied to medical institutions for all drugs in 2012 was 19.4 trillion won, which increased from 19.5 trillion in 2011 by 0.54%. For narcotic drugs, the amount supplied was 318.4 billion won in 2011 and increased to 335.1 billion won by 5.3% in 2012, which exceeded the rate of increase for the amount supplied for all drugs. The proportion of amount claimed in the total amount supplied to medical institutions for all drugs was 60.5% in 2012, whereas the proportion of amount claimed for narcotic drugs was 55.6%, which showed that narcotic drugs were used relatively less within health insurance. Furthermore, management of the current domestic distribution supply data focuses on manufacturing and medical institution supply stages. CONCLUSION: Hereafter, the management of narcotics or psychotropic drugs needs to be improved by reinforcing active monitoring in optimal prescription and usage in patients by collecting and analyzing information on drug usage of patients.
Delivery of Health Care ; Humans ; Information Services ; Insurance, Health ; Korea ; Narcotics* ; Prescriptions ; Psychotropic Drugs

PURPOSE: Skin allergies through type 1 and 4 hypersensitivity reactions are the most frequent manifestations of drug allergies. We had previously experienced a case of a nurse with cefotiam-induced contact urticaria syndrome. To aid in preventing the progression of drug-induced allergic disease in nurses, we conducted a survey of tertiary hospital nurses who were likely to have been exposed professionally to antibiotics. METHODS: All 539 staff nurses at a tertiary hospital were asked to respond to a questionnaire regarding antibiotic exposure. Of the 457 nurses (84.8%) who responded, 427 (79.2%) received a physical examination of the hands and 318 (59.0%) received skin prick tests with the beta-lactam antibiotics cefotiam, cefoperazone, ceftizoxime, flomoxef, piperacillin and penicillin G. RESULTS: A positive response to at least one of the antibiotics occurred in 8 (2.6%) of the 311 subjects included in the analysis and stages 1 and 2 contact urticaria syndrome were observed in 38 (8.9%) and 3 (0.7%) of 427 nurses, respectively. The frequencies of a positive antibiotic skin test (6.9 versus 1.3%, chi-square=7.15, P=0.018), stage 1 contact urticaria syndrome (14.4 versus 7.4%, chi-square=4.33, P=0.038) and drug allergy (15.3 versus 3.6%, chi-square=18.28, P=0.000) were higher in subjects with a positive skin allergy history than in those without. Allergic rhinitis (P=0.02, OR=3.86, CI=1.23-12.06), night cough (P=0.04, OR=3.12, CI=1.03-9.41) and food allergy (P=0.00, OR=9.90, CI=3.38-29.98) were significant risk factors for drug allergy. CONCLUSIONS: Antibiotic sensitization and drug allergy occurred more frequently in nurses with a positive skin allergy history. Atopy may be an important risk factor for drug allergy.
Anti-Bacterial Agents ; Cefoperazone ; Cefotiam ; Ceftizoxime ; Cephalosporins ; Cough ; Drug Hypersensitivity ; Food Hypersensitivity ; Hand ; Hypersensitivity ; Penicillin G ; Physical Examination ; Piperacillin ; Rhinitis ; Rhinitis, Allergic, Perennial ; Risk Factors ; Skin ; Skin Tests ; Tertiary Care Centers ; Urticaria ; Surveys and Questionnaires

PURPOSE: Skin allergies through type 1 and 4 hypersensitivity reactions are the most frequent manifestations of drug allergies. We had previously experienced a case of a nurse with cefotiam-induced contact urticaria syndrome. To aid in preventing the progression of drug-induced allergic disease in nurses, we conducted a survey of tertiary hospital nurses who were likely to have been exposed professionally to antibiotics. METHODS: All 539 staff nurses at a tertiary hospital were asked to respond to a questionnaire regarding antibiotic exposure. Of the 457 nurses (84.8%) who responded, 427 (79.2%) received a physical examination of the hands and 318 (59.0%) received skin prick tests with the beta-lactam antibiotics cefotiam, cefoperazone, ceftizoxime, flomoxef, piperacillin and penicillin G. RESULTS: A positive response to at least one of the antibiotics occurred in 8 (2.6%) of the 311 subjects included in the analysis and stages 1 and 2 contact urticaria syndrome were observed in 38 (8.9%) and 3 (0.7%) of 427 nurses, respectively. The frequencies of a positive antibiotic skin test (6.9 versus 1.3%, chi-square=7.15, P=0.018), stage 1 contact urticaria syndrome (14.4 versus 7.4%, chi-square=4.33, P=0.038) and drug allergy (15.3 versus 3.6%, chi-square=18.28, P=0.000) were higher in subjects with a positive skin allergy history than in those without. Allergic rhinitis (P=0.02, OR=3.86, CI=1.23-12.06), night cough (P=0.04, OR=3.12, CI=1.03-9.41) and food allergy (P=0.00, OR=9.90, CI=3.38-29.98) were significant risk factors for drug allergy. CONCLUSIONS: Antibiotic sensitization and drug allergy occurred more frequently in nurses with a positive skin allergy history. Atopy may be an important risk factor for drug allergy.
Anti-Bacterial Agents ; Cefoperazone ; Cefotiam ; Ceftizoxime ; Cephalosporins ; Cough ; Drug Hypersensitivity ; Food Hypersensitivity ; Hand ; Hypersensitivity ; Penicillin G ; Physical Examination ; Piperacillin ; Rhinitis ; Rhinitis, Allergic, Perennial ; Risk Factors ; Skin ; Skin Tests ; Tertiary Care Centers ; Urticaria ; Surveys and Questionnaires

TGF-beta1 is well known to induce Ig germ-line alpha (GLalpha) transcription and subsequent IgA isotype class switching recombination (CSR). Homeodomain protein TG-interacting factor (TGIF) and E3-ubiquitin ligases TGIF interacting ubiquitin ligase 1 (Tiul1) are implicated in the negative regulation of TGF-beta signaling. In the present study, we investigated the roles of Tiul1 and TGIF in TGFbeta1-induced IgA CSR. We found that over-expression of Tiul1 decreased TGFbeta1-induced GLalpha promoter activity and strengthened the inhibitory effect of Smad7 on the promoter activity. Likewise, overexpression of TGIF also diminished GLalpha promoter activity and further strengthened the inhibitory effect of Tiul1, suggesting that Tiul1 and TGIF can down-regulate TGFbeta1-induced GLalpha expression. In parallel, overexpression of Tiul1 decreased the expression of endogenous IgA CSR-predicitive transcripts (GLT(alpha), PST(alpha), and CT(alpha)) and TGFbeta1-induced IgA secretion, but not GLT(gamma3) and IgG3 secretion. Here, over-expressed TGIF further strengthened the inhibitory effect of Tiul1. These results suggest that Tiul1 and TGIF act as negatively regulators in TGFbeta1-induced IgA isotype expression.
Down-Regulation ; Immunoglobulin A ; Immunoglobulin Class Switching ; Immunoglobulin G ; Ligases ; Recombination, Genetic ; Transforming Growth Factor beta ; Transforming Growth Factor beta1 ; Ubiquitin

BACKGROUND: The aim of the study was to establish a new syphilis test algorithm using Architect Syphilis TP (Abbott Japan, Japan: AST), a fully automated treponemal antibody test, as a screening test in a university hospital laboratory. We evaluated performance characteristics of AST in various patient groups. METHODS: A total of 1,357 serum samples obtained from patients at a university hospital from June to August, 2008 were categorized into checkup, preoperative, other diseases, diagnosis (clinically suspected of syphilis), and follow up groups. We compared the results of AST with those of RPR (N=1,276) or Treponema pallidum hemagglutination assay (TPHA, N=81). Samples with discrepant results between RPR or TPHA and AST were retested by fluorescent treponemal antibody absorption test (FTA-ABS) and all patients' clinical records were thoroughly reviewed. RESULTS: The positive rate of AST was significantly higher than that of RPR in preoperative and other diseases groups and was the same as that of RPR in diagnosis group. There were no significant differences in check up and follow up groups. The results of AST showed 97.4% (1,243/1,276) and 97.5% (79/81) concordance rates with those of RPR and TPHA, respectively. Among 26 RPR-AST discrepant and FTA-ABS confirmed cases, there were 20 RPR false-negatives, 4 RPR false-positives, 1 AST false-negative, and 1 AST false-positive. CONCLUSIONS: Based on the results and literature review, we established a new syphilis test algorithm using AST as a screening test, which would be helpful for detection of more syphilis patients including latent infections.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Algorithms ; Autoanalysis ; Child ; Child, Preschool ; False Positive Reactions ; Female ; Fluorescent Treponemal Antibody-Absorption Test/methods ; Hemagglutination Tests/methods ; Humans ; Male ; Middle Aged ; Reagent Kits, Diagnostic ; Sensitivity and Specificity ; Syphilis/*diagnosis ; Syphilis Serodiagnosis/*methods

BACKGROUND: The number of patients suffering from acute myocardial infarction is on the increase in Korea due to the westernization of life style. Recent improvement of therapeutic stratigies have shown early mortality benefits in acute myocardial infarction. But we don't have data how many patients died and what's the cause of death in these patients. This study aimed to find out the mortality rate, cause of death and it's relevant prognostic factors of myocardial infarction (MI) patients who admitted alive, and to construct a database which will be used to develop a risk stratification strategy for the implementation of new preventive therapeutic modalities, such as implantable cardioverter-defibrillator (ICD). METHODS: Seven hundred and forty two MI patients admitted to our hospital from March, 1999 to August, 2002 were included in this study. The risk factors and survivals were evaluated by medical record searching and telephone survey in these patients. RESULTS: The average age was 64 years-old and 67% was male. During the mean follow up 20.7+/-15.4 months, total 105 cardiac death (14.2%) was occurred and cumulative mortality rate at 1 year and 2 year was 5.69% and 10.80%, respectively. Of the total 129 death, in-hospital death was 68 (cardiac death 48, non-cardiac death 20) and out of hospital death was 60 (cardiac death 57, non-cardiac death 4). When it comes to cause of death, most common cause of cardiac death was malignant arrhythmia. The proportion of malignant arrhythmia in cardiac death was 81.3% and 72% of in-hospital and out of hospital death, respectively. Multivariate analysis showed that old age, low LV ejection fraction and no percutaneous coronary intervention (PCI) treatment were independent risk factors for cardiac mortality. CONCLUSIONS: Myocardial infarction shows still high mortality rate despite the recent development of therapeutic strategy. As post-MI patients with low LVEF or no PCI shows high mortality, the early reperfusion therapy should be encouraged. Additionally, because malignant arrhythmia was one of the most in cause of cardiac death, ICD therapy to prevent sudden cardiac death should be considered in an active manner.
Arrhythmias, Cardiac ; Cause of Death* ; Death ; Death, Sudden, Cardiac ; Defibrillators, Implantable ; Follow-Up Studies ; Humans ; Korea ; Life Style ; Male ; Medical Records ; Middle Aged ; Mortality* ; Multivariate Analysis ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Reperfusion ; Risk Factors ; Telephone