Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Background and Objectives: Fungus ball is the most common type of fungal sinusitis commonly associated with good prognosis. However, postoperative results depending on the extent of the lesion has not been investigated. This study aimed to identify differences in postoperative results depending on the location and extent of the fungus ball.Subjects and Method Medical records of 165 patients who underwent endoscopic sinus surgery and who were diagnosed with fungus balls by biopsy from 2010 to 2019 were retrospectively reviewed. Patients were classified into four grades according to the location and extent of the fungus ball based on their endoscopic and CT findings. Poor outcome is defined as any pathologic signs such as nasal secretion, granulation, and polyps or narrowing of the natural ostium observed postoperatively according to Kennedy’s criteria, whereas good outcome is defined as absence of pathologic signs. Results: A total of 23 patients were Grade 1, 38 Grade 2, 67 Grade 3, and 37 Grade 4. Grades 1 and 2 were mostly asymptomatic. However, as the location of the fungus ball became closer to the natural ostium, patients complained postnasal drip and purulent discharge. Grades 3 and 4, who have much severe and more extensive lesions than those of Grades 1 and 2, had poor outcome (p=0.007) and took longer time to completely recover (p<0.001). Conclusion Wound healing was delayed and poor when the fungus ball was located closer to the natural ostium of the maxillary sinus. Therefore, preoperative consultation using endoscopic and CT findings could be useful for predicting their postoperative results.

Background and Objectives: The conjunctivodacryocystorhinostomy (CDCR) is rarely performed in epiphora, which is caused by complete proximal bicanalicular obstruction. The purpose of this study is to analyze the characteristics, clinical results and complications of patients who underwent CDCR.Subjects and Method We enrolled 12 patients who underwent CDCR due to proximal canalicular obstruction from 2006 to 2019. We retrospectively analyzed the causes of epiphora, trauma history, the cause of revision operation and the clinical outcome. Results: A total of 12 patients (7 males and 5 females) underwent CDCR (mean age 46 years). The causes of trauma were such as laceration (n=7, 58%) and iatrogenic (n=1, 8%), idiopathic obstruction (n=4, 33%). After the initial surgery, 5 patients (41%) were categorized in good outcome and the Jones tube was located well in 6 (50%) patients. Revision surgery was performed in 6 (50%) cases, with 4 cases having good outcome. The success rate of CDCR, including revision surgery, was increased to 83%. Most common cause of revision surgery was tube migration. In addition, the subjective outcome in patients with traumatic causes were worse but it had no statistical significance compared to that of patients with idiopathic and iatrogenic causes (p=0.07). Conclusion About a half of the patients had good recovery rate after the initial operation. The outcome increased to 83% after revision operation. The success rate of CDCR for traumatic patients was worse than for those with idiopathic and iatrogenic causes. It seems that accompanied eyelid damage in traumatic patients may have affected the result of success rate.

PURPOSE: The aim of this study was to evaluate the feasibility of monitoring external branch of the superior laryngeal nerve (EBSLN) during robotic thyroid surgery. METHODS: A total of 10 patients undergoing bilateral axillo-breast approach (BABA) robotic thyroid surgery were enrolled. The nerve integrity monitor (NIM Response 2.0 System) was used for EBSLN monitoring. We performed voice assessments preoperatively and at 1 and 3 months postoperatively using Voice Handicap Index-10 (VHI-10), maximal phonation time (MPT), phonation efficient index (PEI), and laryngeal electromyography (EMG). RESULTS: A total of 19 EBSLNs were at risk and 14 EBSLNs (73.7%) were identified using neuromonitoring. VHI-10 showed a change of voice over time (0.1 vs. 3.6 vs. 1.3); however, this was not statistically significant. VHI-10 scores normalized at 3 months postoperatively compared to the preoperative scores. MPT (a) (16.0 vs. 15.6 vs. 15.4), and MPT (e) (20.1 vs. 15.4 vs. 18.5) showed no significant differences preoperatively compared to the values obtained 1 and 3 months postoperatively. There was a significant change of PEI over time (4.8 vs. 1.1 vs. 4.6) (P = 0.036); however, the values normalized at 3 months postoperatively. Laryngeal EMG results showed 4 cases (21.2%) of neuropathy of EBSLNs at 1 month postoperatively, and electrodiagnostic studies revealed nearly complete recovery of the function of EBSLNs in 4 patients at 3 months postoperatively CONCLUSION: It is suggested that neuromonitoring of EBSLNs during BABA robotic thyroid surgery is feasible and might be helpful to preserve voice quality.
Electromyography ; Humans ; Intraoperative Neurophysiological Monitoring ; Laryngeal Nerves* ; Phonation ; Prospective Studies* ; Thyroid Gland* ; Thyroidectomy ; Voice ; Voice Quality

Human mesenchymal stem cells (MSCs) have been used in cell-based therapy to promote revascularization after peripheral or myocardial ischemia. High levels of reactive oxygen species (ROS) are involved in the senescence and apoptosis of MSCs, causing defective neovascularization. Here, we examined the effect of the natural antioxidant lycopene on oxidative stress-induced apoptosis in MSCs. Although H2O2 (200 muM) increased intracellular ROS levels in human MSCs, lycopene (10 muM) pretreatment suppressed H2O2-induced ROS generation and increased survival. H2O2-induced ROS increased the levels of phosphorylated p38 mitogen activated protein kinase (MAPK), Jun-N-terminal kinase (JNK), ataxia telangiectasia mutated (ATM), and p53, which were inhibited by lycopene pretreatment. Furthermore, lycopene pretreatment decreased the expression of cleaved poly (ADP ribose) polymerase-1 (PARP-1) and caspase-3 and increased the expression of B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X protein (Bax), which were induced by H2O2 treatment. Moreover, lycopene significantly increased manganese superoxide dismutase (MnSOD) expression and decreased cellular ROS levels via the PI3K-Akt pathway. Our findings show that lycopene pretreatment prevents ischemic injury by suppressing apoptosis-associated signal pathway and enhancing anti-oxidant protein, suggesting that lycopene could be developed as a beneficial broad-spectrum agent for the successful MSC transplantation in ischemic diseases.
Aging ; Apoptosis* ; Ataxia Telangiectasia ; bcl-2-Associated X Protein ; Caspase 3 ; Humans* ; Lymphoma, B-Cell ; Mesenchymal Stromal Cells* ; Myocardial Ischemia ; Oxidative Stress ; Phosphotransferases ; Protein Kinases ; Reactive Oxygen Species ; Signal Transduction ; Superoxide Dismutase

BACKGROUND: Effective chest compression may improve the return of spontaneous circulation and neurologic outcome in arrest victims. For fear of rescuer's fatigue, guidelines for cardiopulmonary resuscitation (CPR) recommended that chest compression (CC) should be switched every 2 minutes, but there is little evidence. We investigated whether health personnel could provide consistent quality of CC for 2 minutes. METHODS: We recruited prospectively health personnel working on one university hospital. On the day assigned randomly, CPR performance data was collected with use of CPR recording technology. Quality of CPR was calculated every 30 seconds interval. To identify the quality decay, we used repeated measure analysis of variance with SPSS 17.0 for analysis. RESULTS: We analyzed 8,485 CCs performed by 41 subjects. Total number of CC decayed between 90 to 120 seconds (51.6 +/- 3.3 to 50.8 +/- 3.5, p = 0.020) within recommended range. The ratio of correct depth CC decayed between 90 to 120 seconds, falling from 83.4 +/- 24.9% to 68.3 +/- 38.4% (p = 0.002). The ratio of low depth CC increased significantly over time (10.2 +/- 20.7% to 31.3 +/- 38.5%, p < 0.001). CONCLUSIONS: Health personnel may provide adequate number of CC for 2 minutes. But, the number of correct depth CC may decay between 90 to 120 seconds. Also the number of low depth CC may increase over time.
Cardiopulmonary Resuscitation ; Fatigue ; Health Personnel ; Humans ; Manikins ; Prospective Studies ; Quality of Health Care ; Thorax

PURPOSE: The 2005 guidelines for cardiopulmonary resuscitation (CPR) caution that effective compression is essential (Class I) and chest compression (CC) by rescuers should be switched every 2 minutes to avoid rescuer's fatigue. It is controversial how long effective CC by a single individual can be provided. There are few reports about CPR quality, especially when rescuers perform CC for more than 10 minutes. The mean CPR period was about 30 minutes in Korea. We investigated the quality of CC and rescuer's fatigue after about 30 minutes. METHODS: From April 2009 to July 2009, health care providers (HCPs) were recruited into this study. The study simulated 2 person, in-hospital CPR. On the test day, which had been randomly assigned, each participant performed 7 CCs for about 30 minutes. The period of each CC was 2 minutes, and the period of each circulation check was 5 seconds. Participants' heart rates (HR) and visual analogue scale (VAS) scores for fatigue were obtained before and after each CC. Data for each 2 minutes CC was obtained with the use of Resusci Anne(R) with the Laerdal(R) PC skill reporting system. We used one-way repeated measures ANOVA for comparison of quality and fatigue of each CC and multiple linear regression for finding the predictors for correct CC. SPSS 17.0 was used for analysis. RESULTS: Among a total of 30 HCPs, data from 27 were analyzed. All participants were certified as a BLS provider and some were certified as BLS instructors. The rate of effective compression was 83.8+/-24.3%. Despite 2 min CC tasks were repeated alternatively for about 30 minutes, there were no differences in the number of correct CCs, depth and velocity of compression, and the number of incorrect CCs. CONCLUSION: During in-hospital CPR, HCPs may provide effective chest compressions on shifts with minimal effect of fatigue, even if they provide CC for 30 minutes.
Cardiopulmonary Resuscitation ; Fatigue ; Health Personnel ; Heart Rate ; Humans ; Korea ; Linear Models ; Manikins ; Thorax

OBJECTIVE: Mycoplasmas have been implicated in many diseases including cervicitis, urethritis, salpingitis, endometritis... and functioning as cofactors catalyzing the HIV disease state. The oncogenic potentiality of mycoplasma was only recently realized when they were shown causing chromosomal changes and in vitro cell transformations through gradual progressive chromsomal loss and translocation. Few study has been reported the prevalence of mycoplasma infection in human cancers and suggested that there was a connection between these organisms and human cancers. The objective of this study was to determine the relationship between Ureaplasma urealyticum infection and cervical cancer. METHODS: The detection frequency of Ureaplasma urealyticum in 52 invasive cervical cancer tissues and 17 normal cervical tissues was studied using PCR. RESULTS: U. urealyticum DNA was detected in 8 out of 52(15.4%) invasive cervical cancer tissues and 1 out of 17(5.9%) normal cervical tissues. No statistic significance was observed between the detection frequency of Ureaplasma urealyticum and clinicopathologic parameters. The prevalence of Ureaplasma urealyticum in invasive cervical tissues was 15.4% and this rate was higher than 5.9% in normal cervical tissues but there was no statistic significance. CONCLUSIONS: With respect to clinicopathologic parameters of cervical cancer, there was no significant relation between U. urealyticum infection and cervical cancer. There is, however, few study and case on cervical cancer internally and externally. It is considered that more studies on the subject with much cases should be made.
Carcinogenesis ; DNA ; Endometritis ; Female ; HIV ; Humans ; Mycoplasma ; Mycoplasma Infections ; Polymerase Chain Reaction ; Prevalence ; Salpingitis ; Ureaplasma urealyticum* ; Ureaplasma* ; Urethritis ; Uterine Cervical Neoplasms* ; Uterine Cervicitis

OBJECTIVE: The human MAGE 3 gene encodes tumor specific antigens that are recognized by autologue cytotoxic T lymphocytes (CTL). The MAGE 3 gene is expressed not only in melanoma but in the other malignant tumors as well. There is, however, little information on the expression of the gene in uterine cervical carcinomas. The author thus studied the expression of the MAGE 3 gene products in uterine cervical carcinoma and discuss the possibility of specific immunologic diagnosis using MAGE 3 gene products. METHODS: The expression of MAGE 3 gene product in 17 normal tissues of the cervix, 32 cervical intraepithelial neoplasia (8 CIN I, 10 CIN II, 14 CIS), and 43 invasive cervical carcinomas was studied by immunohistochemistry using anti-MAGE 3 mAb 57B in paraffin sections RESULTS: No expression of MAGE 3 gene product was detected in normal cervical tissues and in cervical intraepithelial neoplasias. The expression of MAGE 3 gene product was detected in 30.2% (13/43) of invasive cervical carcinomas. The MAGE 3 gene product was stained as a cytoplasmic protein in cancer cells. No statistically significant differences were observed between MAGE 3 gene product expression status and clinicopathologic parameters. CONCLUSIONS: The MAGE 3 gene products was expressed in invasive cervical carcinoma tissues.
Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Cytoplasm ; Female ; Humans ; Immunohistochemistry ; Immunologic Tests ; Melanoma ; Paraffin ; T-Lymphocytes, Cytotoxic

OBJECTIVE: The purpose of this study was to review the clinicopathologic features, recurrent rate, survival rate and controversable issues in the treatment of the ovarian malignant germ cell tumors. PATIENTS AND METHODS: From August, 1991 to November, 1998 thirty-one patients with malignant germ cell tumors of the ovary treated in the department of obstetrics and gynecology, Kosin University Medical college, were eligible and assessable. Demographic characteristics, symptoms, signs, stage, tumor grade, mode of therapy and results of follow up were reviewed retrospectively. RESULTS: The patients with malignant germ cell tumor constituted 6.37% of all ovarian malignancies during this period. Histologic subtypes were 8 dysgerminoma(25.8%), 7 endodermal sinus tumor(22.6%), 10 immature teratoma(32.3%), 3 mixed germ cell tumor(9.7%), 3 choriocarcinoma(9.7%). The age of the patients ranged from 10 to 40 years (mean +/-S.D.; 24.26 +/- 7.51). The most common symptom was abdominal pain(38.7%). Most had stageI(18 cases, 58.0%) or stageIII(5 cases, 16.2%) diseases. All patients underwent surgery as the initial treatment, and nine patients received more than one operation. Postoperative adjuvant chemotherapeutic regimens were VAC, VBP, EP, BEP, EMA, and EMA CO. The mean follow up duration was 26.0(+/- S.D.; +/- 20.3) months. The 2-year and 5-year survival rate were 91.97%(+/- S.E.; +/- 0.05) and 86.86%(+/- S.E.; +/- 0.07).
Endoderm ; Female ; Follow-Up Studies ; Germ Cells* ; Gynecology ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Obstetrics ; Ovary ; Retrospective Studies ; Survival Rate