Objective: Low tidal volume ventilation (LTVV) is one of the strategies to prevent ventilator-induced lung injuries. This study aimed to investigate the use of LTVV among endotracheally intubated patients who received mechanical ventilation (MV) in emergency departments (EDs). Methods: We conducted a retrospective, standardized chart review of all adult patients who received MV in 6 EDs between July 2020 and June 2021. The data of a total of 766 patients who had an initial application of MV in the ED were analyzed. The primary outcome was exhaled tidal volume. Logistic regression analyses were conducted to develop a multivariate model identifying the factors associated with conventional tidal volume ventilation (CTVV), defined as the exhaled tidal volume of >8 mL/kg predicted body weight. Results: Of the 766 patients, 483 patients (62.8%) were male. Respiratory failure (37.8%) was the most common indication for MV. In the initial ventilator setting, pressure control ventilation was preferred to volume control ventilation (80.4% vs. 19.0%). LTVV was used in 418 patients (54.6%). In the multivariate logistic regression analysis, the factors associated with the CTVV were female sex (adjusted odds ratio [OR], 2.62; 95% confidence interval [CI], 1.03-6.69), height (adjusted OR, 0.92; 95% CI, 0.89-0.94), and respiratory rate (adjusted OR, 0.93; 95% CI, 0.87-0.99). Conclusion About half of the adult patients undergoing MV received LTVV in the ED. The female sex, height, and respiratory rate were associated with CTVV. The use of predicted body weight based on sex could increase the usage of LTVV.

Robots are being used to assist the recovery of walking ability for patients with neurologic disorders. This study aimed to evaluate the feasibility and functional improvement of training with robot-assisted gait training (RAGT) using the Morning Walk®, an end-effector type robot using footplates and saddle seat support. A total of 189 individuals (65.1% men, 34.9% women; mean age, 53.2 years; age range: 5–87 years) with brain lesions, spinal cord injuries, Parkinson's disease, peripheral neuropathies, and pediatric patients were involved in this retrospectively registered clinical trial. Each participant performed 30 minutes of RAGT, five times a week, for a total of 24 sessions. Failure was defined as an inability to complete all 24 sessions, and the reasons for discontinuation were analyzed. Parameters of Medical Research Council scales and Functional Ambulation Categories were analyzed before and after RAGT training. Among the 189 patients, 22 (11.6%) failed to complete the RAGT. The reasons included decreased cooperation, musculoskeletal pain, saddle seat discomfort, excessive body-weight support, joint spasticity or restricted joint motion, urinary incontinence from an indwelling urinary catheter, and fatigue. Comparison between the pre- and post-training motor and ambulatory functions showed significant improvement. The result of the study indicates that the Morning Walk® is feasible and safe and useful for functional improvement in patients with various neurologic disordersTRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003627

Robots are being used to assist the recovery of walking ability for patients with neurologic disorders. This study aimed to evaluate the feasibility and functional improvement of training with robot-assisted gait training (RAGT) using the Morning Walk®, an end-effector type robot using footplates and saddle seat support. A total of 189 individuals (65.1% men, 34.9% women; mean age, 53.2 years; age range: 5–87 years) with brain lesions, spinal cord injuries, Parkinson's disease, peripheral neuropathies, and pediatric patients were involved in this retrospectively registered clinical trial. Each participant performed 30 minutes of RAGT, five times a week, for a total of 24 sessions. Failure was defined as an inability to complete all 24 sessions, and the reasons for discontinuation were analyzed. Parameters of Medical Research Council scales and Functional Ambulation Categories were analyzed before and after RAGT training. Among the 189 patients, 22 (11.6%) failed to complete the RAGT. The reasons included decreased cooperation, musculoskeletal pain, saddle seat discomfort, excessive body-weight support, joint spasticity or restricted joint motion, urinary incontinence from an indwelling urinary catheter, and fatigue. Comparison between the pre- and post-training motor and ambulatory functions showed significant improvement. The result of the study indicates that the Morning Walk® is feasible and safe and useful for functional improvement in patients with various neurologic disordersTRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003627
Brain ; Fatigue ; Female ; Gait ; Humans ; Information Services ; Joints ; Male ; Muscle Spasticity ; Musculoskeletal Pain ; Nervous System Diseases ; Parkinson Disease ; Peripheral Nervous System Diseases ; Retrospective Studies ; Spinal Cord Injuries ; Urinary Catheters ; Urinary Incontinence ; Walking ; Weights and Measures

Robots are being used to assist the recovery of walking ability for patients with neurologic disorders. This study aimed to evaluate the feasibility and functional improvement of training with robot-assisted gait training (RAGT) using the Morning Walk®, an end-effector type robot using footplates and saddle seat support. A total of 189 individuals (65.1% men, 34.9% women; mean age, 53.2 years; age range: 5–87 years) with brain lesions, spinal cord injuries, Parkinson's disease, peripheral neuropathies, and pediatric patients were involved in this retrospectively registered clinical trial. Each participant performed 30 minutes of RAGT, five times a week, for a total of 24 sessions. Failure was defined as an inability to complete all 24 sessions, and the reasons for discontinuation were analyzed. Parameters of Medical Research Council scales and Functional Ambulation Categories were analyzed before and after RAGT training. Among the 189 patients, 22 (11.6%) failed to complete the RAGT. The reasons included decreased cooperation, musculoskeletal pain, saddle seat discomfort, excessive body-weight support, joint spasticity or restricted joint motion, urinary incontinence from an indwelling urinary catheter, and fatigue. Comparison between the pre- and post-training motor and ambulatory functions showed significant improvement. The result of the study indicates that the Morning Walk® is feasible and safe and useful for functional improvement in patients with various neurologic disordersTRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003627

BACKGROUND: Enhancement and maintenance of the stemness of mesenchymal stem cells (MSCs) is one of the most important factors contributing to the successful in vivo therapeutic application of these cells. In this regard, three-dimensional (3D) spheroid formation has been developed as reliable method for increasing the pluripotency of MSCs. Moreover, using a new protocol, we have previously shown that dental tissues of extracted wisdom teeth can be effectively cryopreserved for subsequent use as a source of autologous stem cells. The main purpose of this study is to analyze the stemness and in vitro osteogenic differentiation potential of 3D spheroid dental MSCs compared with conventional monolayer cultured MSCs. METHODS: In this study, MSC-characterized stem cells were isolated and cultured from long-term cryopreserved dental follicles (hDFSCs), and then 2D hDFSCs were cultured under 3D spheroid-forming conditions using a newly designed microchip dish. The spheroids (3D hDFSCs) thus produced were investigated and characterized with respect to stemness, MSC marker expression, apoptosis, cell cycle analysis, extracellular matrix (ECM) production, and osteogenic and adipogenic differentiation properties. RESULTS: In terms of MSC and senescence markers, spheroid cells showed no difference when compared with 2D hDFSCs; however, 3D hDFSCs were observed to have a higher proportion of cell cycle arrest and a larger number of apoptotic cells. Moreover, spheroids showed substantially increased levels of pluripotency marker (early transcription factors) and ECM protein expression. Compared with 2D hDFSCs, there was also a notable enhancement in the osteogenic induction potential of spheroids, although no differences were observed with respect to in vitro adipogenesis. CONCLUSION: To the best of our knowledge, this is the first study to demonstrate the application of a spheroid culture system for dental follicle-derived stem cells using a microchip dish. Although further studies are needed, including in vivo transplantation, the results obtained in this study indicate that spheroid hDFSCs derived from cryopreserved dental follicle tissues could be used as a valuable source of autologous stem cells for bone tissue regeneration.
Adipogenesis ; Aging ; Apoptosis ; Bone and Bones ; Cell Cycle ; Cell Cycle Checkpoints ; Dental Sac ; Extracellular Matrix ; Humans ; In Vitro Techniques ; Mesenchymal Stromal Cells ; Methods ; Molar, Third ; Osteogenesis ; Regeneration ; Stem Cells

BACKGROUND: Use of GlideScope® laryngoscopes and lightwands for tracheal intubation does not require much force. Theoretically, less stimulation can reduce hemodynamic changes during intubation. We investigated the hemodynamic response to tracheal intubation using different laryngoscope types during remifentanil infusion. METHODS: Sixty American Society of Anesthesiologists class I-II patients were compared in terms of tracheal intubation time, hemodynamic changes, and postoperative pharyngeal complications when using a GlideScope®, lightwand, or Macintosh laryngoscope. Propofol and rocuronium were injected and remifentanil was infused for three minutes. Blood pressure and heart rate were measured before and 1, 3, and 5 minutes after tracheal intubation. Patients were assessed for postoperative oral and tracheal bleeding as well as hoarseness, dysphagia, and sore throat. RESULTS: Intubation time was prolonged in the GlideScope® group. All three groups showed a significant decrease in systolic and diastolic blood pressure 1, 3, and 5 minutesafter tracheal intubation. Heart rates increased significantly in all three groups immediately after intubation as well as 1 minute later in the GlideScope® group. However, there were no differences in blood pressure, heart rate, or the occurrence of hoarseness, dysphagia, and sore throat among the three groups. CONCLUSIONS: No differences in hemodynamic change were found among the three different techniques.
Blood Pressure ; Deglutition Disorders ; Heart Rate ; Hemodynamics* ; Hemorrhage ; Hoarseness ; Humans ; Intubation* ; Laryngoscopes* ; Pharyngitis ; Propofol

BACKGROUND: Use of GlideScope® laryngoscopes and lightwands for tracheal intubation does not require much force. Theoretically, less stimulation can reduce hemodynamic changes during intubation. We investigated the hemodynamic response to tracheal intubation using different laryngoscope types during remifentanil infusion. METHODS: Sixty American Society of Anesthesiologists class I-II patients were compared in terms of tracheal intubation time, hemodynamic changes, and postoperative pharyngeal complications when using a GlideScope®, lightwand, or Macintosh laryngoscope. Propofol and rocuronium were injected and remifentanil was infused for three minutes. Blood pressure and heart rate were measured before and 1, 3, and 5 minutes after tracheal intubation. Patients were assessed for postoperative oral and tracheal bleeding as well as hoarseness, dysphagia, and sore throat. RESULTS: Intubation time was prolonged in the GlideScope® group. All three groups showed a significant decrease in systolic and diastolic blood pressure 1, 3, and 5 minutesafter tracheal intubation. Heart rates increased significantly in all three groups immediately after intubation as well as 1 minute later in the GlideScope® group. However, there were no differences in blood pressure, heart rate, or the occurrence of hoarseness, dysphagia, and sore throat among the three groups. CONCLUSIONS: No differences in hemodynamic change were found among the three different techniques.
Blood Pressure ; Deglutition Disorders ; Heart Rate ; Hemodynamics* ; Hemorrhage ; Hoarseness ; Humans ; Intubation* ; Laryngoscopes* ; Pharyngitis ; Propofol

PURPOSE: Postoperative pain for robotic thyroid surgeries including bilateral axillo-breast approach (BABA) has not been well studied. In this study, we have developed a self-reporting application (SRA) for iPad and prospectively collected pain scores from open thyroidectomy (OT) and BABA robotic thyroidectomy (RT) patients. METHODS: Female patients who underwent total thyroidectomy for papillary thyroid carcinoma were included. Patients recorded pain scores for throat, anterior neck, posterior neck, chest, and back on postoperative days 1, 2, and 3. Once discharged, on postoperative day 14, a survey was also conducted on satisfaction of SRA and cosmesis. RESULTS: A total of 54 patients were enrolled (27 BABA RT and 27 OT). There were no significant differences between the 2 groups in clinicopathological characteristics and postoperative complication rates. Postoperative pain scores at days 1, 2, 3, and 14 were not significantly different between the groups for throat, anterior neck, posterior neck, or back. Postoperative analgesic requirements were similar between the 2 groups. Wound satisfaction scores were significantly higher in the BABA RT group (BABA RT 7.4 vs. OT 5.7; P = 0.016). Satisfaction scores for the usefulness of SRA were above 7.2 for all four questionnaire items on the 10-point scale. CONCLUSION: Postoperative pain for BABA RT is equivalent to OT but offers greater cosmetic satisfaction for patients. A mobile device application such as SRA may facilitate proper assessment and management of pain in postoperative patients.
Female ; Humans ; Neck ; Pain, Postoperative* ; Pharynx ; Postoperative Complications ; Prospective Studies ; Thorax ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy* ; Wounds and Injuries

PURPOSE: Predicting life expectancy of terminally ill cancer patients is very important. In many studies, ferritin is detected at higher levels in the sera of cancer patients, and higher ferritin level correlates with aggressiveness of disease and poor outcomes of patients. This study evaluated a prognostic role of serum ferritin levels in terminally ill cancer patients. METHODS: This study enrolled 65 terminally ill cancer patients from March through June 2012. We assessed routine laboratory findings including serum ferritin levels as well as demographic and clinical characteristics of the patients. To examine the association between serum ferritin levels and patient's characteristics, we used Spearman's correlation analysis, Wilcoxon's rank sum test or Kruskal-Wallis test, as appropriately. For multivariate analysis, Cox's proportional hazard regression model was used to evaluate significance of serum ferritin levels as a prognostic factor. RESULTS: A negative correlation between serum ferritin levels and survival time was found. After adjusting for sex, age, performance status, creatinine levels and white blood cell counts, serum ferritin levels were significantly associated with survival time. CONCLUSION: Even at the very end of life of terminal cancer patients, serum ferritin levels were an independent prognostic factor for survival.
Creatinine ; Ferritins* ; Humans ; Leukocyte Count ; Life Expectancy ; Multivariate Analysis ; Prognosis ; Terminally Ill*

OBJECTIVES: This study aims to investigate associated factors including the physician and the employer of successful return to work (RTW) in occupationally injured workers. METHODS: This study is based on the first panel study of workers' compensation insurance (PSWCI), published in June 2014. The PSWCI is a sample survey of occupationally injured workers who completed medical care in 2012 (89,921 people). A total of 2000 subjects were sampled based on sex, age, nine metropolitan-based regions, disability ratings, duration of rehabilitation, and whether vocational rehabilitation service was used. We divided the study population into two groups: return to work (RTW) group (job retention, reemployment, unpaid family worker, and self-employment), and non-RTW group (joblessness and economical inactivity). The odds ratios (ORs) and 95 % confidence intervals (CI) related to differences in basic characteristics, part of physician and employer-related factors between those who succeeded to RTW and those who did not were measured using multivariable logistic regression model. RESULTS: The success of RTW is 70.6 % (n = 1412) among participants. The ORs (95 % CI) of the participants belonging to RTW who received periodic recovery assessment from the medical care institution and the physician are 1.51 (1.07-2.13). The ORs (95 % CI) are 1.68 (1.05-2.69) for the RTW group who received work ability assessment and referral for vocational return. When the employer maintains the relationship with the occupationally injured worker, the worker has 1.39 times higher odds (95 % CI: 1.41-2.26) of the RTW group compared to the non-RTW group. CONCLUSIONS: The physician and the employer have a significant impact on the RTW.
Accidents, Occupational ; Humans ; Insurance* ; Korea* ; Logistic Models ; Occupations ; Odds Ratio ; Referral and Consultation ; Rehabilitation ; Rehabilitation, Vocational ; Return to Work* ; Workers' Compensation*