Background: Subarachnoid hemorrhage is a potentially devastating cerebrovascular attack with a high proportion of poor outcomes and mortality. Recent studies have reported decreased mortality with the improvement in devices and techniques for treating ruptured aneurysms and neurocritical care. This study investigated the relationship between hospital volume and shortand long-term mortality in patients treated with subarachnoid hemorrhage. Methods: We selected subarachnoid hemorrhage patients treated with clipping and coiling from March–May 2013 to June–August 2014 using data from Acute Stroke Registry, and the selected subarachnoid hemorrhage (SAH) patients were tracked in connection with data of Health Insurance Review and Assessment Service to evaluate the short-term and long-term mortality. Results: A total of 625 subarachnoid hemorrhage patients were admitted to high-volume hospitals (n = 355, 57%) and low-volume hospitals (n = 270, 43%) for six months. The mortality of SAH patients treated with clipping and coiling was 12.3%, 20.2%, 21.4%, and 24.3% at 14 days, three months, one year, and five years, respectively. The short-term and long-term mortality in high-volume hospitals was significantly lower than that in low-volume hospitals. On Cox regression analysis of death in patients with severe clinical status, lowvolume hospitals had significantly higher mortality than high-volume hospitals during shortterm follow-up. On Cox regression analysis in the mild clinical status group, there was no statistical difference between high-volume hospitals and low-volume hospitals. Conclusion In subarachnoid hemorrhage patients treated with clipping and coiling, lowvolume hospitals had higher short-term mortality than high-volume hospitals. These results from a nationwide database imply that acute SAH should be treated by a skilled neurosurgeon with adequate facilities in a high-volume hospital.

Background: Subarachnoid hemorrhage is a potentially devastating cerebrovascular attack with a high proportion of poor outcomes and mortality. Recent studies have reported decreased mortality with the improvement in devices and techniques for treating ruptured aneurysms and neurocritical care. This study investigated the relationship between hospital volume and shortand long-term mortality in patients treated with subarachnoid hemorrhage. Methods: We selected subarachnoid hemorrhage patients treated with clipping and coiling from March–May 2013 to June–August 2014 using data from Acute Stroke Registry, and the selected subarachnoid hemorrhage (SAH) patients were tracked in connection with data of Health Insurance Review and Assessment Service to evaluate the short-term and long-term mortality. Results: A total of 625 subarachnoid hemorrhage patients were admitted to high-volume hospitals (n = 355, 57%) and low-volume hospitals (n = 270, 43%) for six months. The mortality of SAH patients treated with clipping and coiling was 12.3%, 20.2%, 21.4%, and 24.3% at 14 days, three months, one year, and five years, respectively. The short-term and long-term mortality in high-volume hospitals was significantly lower than that in low-volume hospitals. On Cox regression analysis of death in patients with severe clinical status, lowvolume hospitals had significantly higher mortality than high-volume hospitals during shortterm follow-up. On Cox regression analysis in the mild clinical status group, there was no statistical difference between high-volume hospitals and low-volume hospitals. Conclusion In subarachnoid hemorrhage patients treated with clipping and coiling, lowvolume hospitals had higher short-term mortality than high-volume hospitals. These results from a nationwide database imply that acute SAH should be treated by a skilled neurosurgeon with adequate facilities in a high-volume hospital.

OBJECTIVES: This in vitro study investigated whether short-term application of calcium hydroxide in the root canal system for 1 and 4 wk affects the fracture strength of human permanent teeth. MATERIALS AND METHODS: Thirty two mature human single rooted mandibular premolars in similar size and dentin thickness without decay or restorations were hand and rotary instrumented and 16 teeth vertically packed with calcium hydroxide paste and sealed coronally with caviton to imitate the endodontic procedure and the other 16 teeth was left empty as a control group. The apicies of all the samples were sealed with resin, submerged in normal saline and put in a storage box at 37degrees C to mimic the oral environment. After 1 and 4 wk, 8 samples out of 16 samples from each group were removed from the storage box and fracture strength test was performed. The maximum load required to fracture the samples was recorded and data were analysed statistically by the two way ANOVA test at 5% significance level. RESULTS: The mean fracture strengths of two groups after 1 wk and 4 wk were similar. The intracanal placement of calcium hydroxide weakened the fracture strength of teeth by 8.2% after 4 wk: an average of 39.23 MPa for no treatment group and 36.01 MPa for CH group. However there was no statistically significant difference between experimental groups and between time intervals. CONCLUSIONS: These results suggest that short term calcium hydroxide application is available during endodontic treatment.
Bicuspid ; Calcium ; Calcium Hydroxide ; Calcium Sulfate ; Dental Cements ; Dental Pulp Cavity ; Dentin ; Hand ; Humans ; Hydrazines ; Hydroxides ; Root Canal Filling Materials ; Tooth ; Vinyl Compounds ; Zinc Oxide

Transforming growth factor-beta (TGF-beta) and its receptors have been suggested to play key roles in the pathogenesis of asthma. The aim of this study was to evaluate the effects of genetic variations in the TGF-beta receptor type III (TGFBR3) on asthma and on its related phenotypes in the general population. A cohort of 2,118 subjects aged from 10 to 18 years responded to a questionnaire concerning asthma symptoms and risk factors. Methacholine airway hyperresponsiveness (AHR), skin test responses to common aeroallergens, and serum total IgE levels were evaluated in the cohort. A total of 19 SNPs for TGFBR3 were found using direct re-sequencing in 24 healthy adults. Of these, informative SNPs [+44T>C (S15F) and +2753G>A at 3'UTR] were selected and scored using the high throughput single base extension method. Atopy was identified in subjects with 44T>C allele [P = 0.04, OR (95% CI) = 0.79 (0.62-0.99)] and in subjects with Ht1 (CG) more frequently than in subjects with other haplotypes [P = 0.04, OR (95% CI) = 1.27 (1.01-1.59)]. The A allele in 2753G>A was more common in subjects with non-atopic asthma [OR (95% CI) = 1.76 (1.01-3.05)]. A significant association was found between non-atopic asthma and 44T_2753A [OR (95% CI) = 2.16 (1.22-3.82)]. Genetic variations in TGFBR3 appear to be associated with a genetic predisposition to development of asthma and to phenotypes of asthma. Also, the minor allele 2753G and the haplotype TA in the TGFBR3 gene were associated with a pathogenesis of non-atopic asthma.
Adolescent ; Adult ; Asian Continental Ancestry Group/*genetics ; Asthma/ethnology/*genetics/immunology ; Case-Control Studies ; Child ; Cohort Studies ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; *Genetic Variation/physiology ; Genetics, Population ; Genome-Wide Association Study ; Genotype ; Humans ; Immunoglobulin E/immunology ; Linkage Disequilibrium ; Male ; Proteoglycans/*genetics ; Receptors, Transforming Growth Factor beta/*genetics

OBJECTIVE: To evaluate the association of ultrasonographic (US) findings of medial meniscus protrusion (MMP) with clinical and plain radiographic assessment in knee osteoarthritis (OA). METHOD: One hundred and twenty six knees of 63 patients were studied. The degree of protrusion for each knee of patients was measured during standing by US. Radiographs were examined in order to determine whether the participants had radiographic osteoarthritis, graded using the Kellgren-Lawrence (K-L) grade. Clinical assessment was performed by recording a visual analogue scale (VAS). Correlation was obtained between the difference of VAS and MMP in the same patient. Assessment of pain, stiffness, and disability were performed by comparison of K-WOMAC index and MMP in a patient. RESULTS: Mean protrusion (mean+/-S.D.) for knees with each K-L I, II, III, and IV grade were 0.27+/-0.52 cm, 0.38+/-0.60 cm, 0.55+/-0.76 cm, and 0.75+/-0.08 cm, respectively. The difference was significant (p<0.05). Significant correlation was observed between MMP and VAS in K-L grades II (p=0.002, r=0.500) and III (p=0.002, r=0.684), also between DeltaMMP and DeltaVAS (p=0.000, r=0.558). With the K-WOMAC index, MMP were correlated with pain and stiffness (p<0.01), but not with disability score. CONCLUSION: The degree of MMP measured by US is associated with K-L grade in knee OA patients. The degree of MMP can be a reliable indicator, like K-L grade, for radiological severity of knee OA. MMP has been correlated with VAS and with subscore of pain and stiffness, but not disability in the K-WOMAC index.
Humans ; Knee ; Menisci, Tibial ; Osteoarthritis ; Osteoarthritis, Knee

Primary lung cancer is unusual in children; the squamous cell variant is extremely rare. Lung cancer is classified by histologic types into small-cell lung cancer, non-small cell lung caner, carcinoid, mucoepidermoid carcinoma, and adenoid cystic carcinoma. Furthermore, non-small cell lung cancer is subclassified into adenocarcinoma, large-cell carcinoma, and squamous cell carcinoma. The incidence of lung cancer is influenced by smoking, especially in squamous cell carcinoma, and large cell carcinoma. The present treatments for these tumors are chemotherapy, radiation therapy, and surgical resection depending on their histologic types or stages, but yield very poor survival rates. In this article, we report a case of basaloid squamous cell lung carcinoma in an 11-year-old boy who had symptoms of both leg weakness and back pain radiating to both legs. We confirmed the primary lung carcinoma cells by percutaneous transthoracic needle biopsy. The metastatic carcinoma cells were identified at the bone marrow and lumbar spine. We treated with a combination chemotherapy and radiation therapy. However, he expired 4 months after the onset of disease.
Adenocarcinoma ; Back Pain ; Biopsy, Needle ; Bone Marrow ; Carcinoid Tumor ; Carcinoma, Adenoid Cystic ; Carcinoma, Large Cell ; Carcinoma, Mucoepidermoid ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Child* ; Drug Therapy ; Drug Therapy, Combination ; Humans ; Incidence ; Leg ; Lung Neoplasms ; Lung* ; Male* ; Smoke ; Smoking ; Spine ; Survival Rate

The epiopathogenesis of craniosynostosis remains obscure. According to the studies involved, the conditions observed at birth are very different. In case that a deformity is obvious or the risk of brain compression is possible, strip craniectomy, frontal bone advancement and cranial vault remodeling methods are used. These direct reshaping or remodeling methods are time consuming and require greater use of physical resources and still are not uniformly successful in making skull shape to normal. Distraction of the cranial bone has been studied to solve this problem. This study subsequently included 30 white rabbits aged about 25 weeks. The rabbits were divided in three groups. In group I, a 0.25mm distraction was done every other day after 3 day latency period. In group II, there was a 7 day latency period with the same rate of distraction as in group I. There was a 3 day latency period with a 0.5mm distraction every other day in group III. The contralateral side underwent a sham operation as a control group. During distraction and after consolidation periods, histologic and ultrastructural studies were carried out. And a serial radiologic study was done. As a result, group I and group II showed successful distraction osteogenesis, and we demonstrated the biological and mechanical factor associated with distraction osteogenesis. In group I, despite the short latency period, there was successful bone regeneration. Group III, it also showed successful ossification. During the distraction period, there was a remarkable increase of TGF-beta1 in both groups, especially in periosteum osteoid and newly developed connective tissue. In conclusion, we have demonstrated a useful model of distraction osteogenesis in rabbit skulls, and attempted to evaluate associated biological and mechanical factors.
Bone Regeneration ; Brain ; Congenital Abnormalities ; Connective Tissue ; Craniosynostoses ; Frontal Bone ; Latency Period (Psychology) ; Osteogenesis, Distraction ; Parturition ; Periosteum ; Rabbits ; Skull* ; Transforming Growth Factor beta1

Secondary peptic ulceration and gastritis have been known to be associated with stress, exogenous agents, drugs or infection. Salicylate (aspirin) ingestion has been known to be associated with increased incidence of gastric ulcer and more frequently as the cause of hemorrhagic gastric erosions and gastritis. Some medications such as tetracyclines and iron preparations have been associated with ulceration of the gastrointestinal tract. Chemotherapeutic agents including cytoxan and methotrexate also have been implicated in the development of mucosal and gastrointestinal ulcers. We have experienced two cases of hemorrhagic gastric ulcers due to creosote ingestion in a 13 month and a 45 year old boys. Creosote is a main component of one of the popular digestives, Jungrohwan in Japan and Korea.
Creosote* ; Cyclophosphamide ; Eating ; Gastritis ; Gastrointestinal Tract ; Humans ; Incidence ; Iron ; Japan ; Korea ; Methotrexate ; Middle Aged ; Peptic Ulcer ; Stomach Ulcer* ; Tetracyclines ; Ulcer

Acrodermatitis enteropethica (AE) is a rare autosomal recessive disorder of zinc absorption leading to chronic diarrhea and characteristic skin lesion. The term is also applied to any acquired zinc deficiency state resulting in the same clinical pictures. We experienced one case of AE in 1 month old male infant who had bacterial enterocolitis. The skin around mouth, anus, eyes, ears, hands and legs became reddish, vesicular and eczematoid. Serum zinc level was decreased to 51.4 microgram/dL (N=70~150). Endoscopic finding revealed pale gastric mucosa and villous atrophy of small intestine. Biopsy finding of small intestine showed no villi due to mucosal atrophy. On 13 day of admission jaundice with DIC were noted and AST & ALT were elevated to 110 & 36.8 IU/L, respectively. Diarrhea was improved but jaundice and liver function were not recovered until discharge from hospital. After discharge when the patient was 4 months of age serum bilirubin and AST/ALT had not been normalized. CMV shell vial culture of urine and CMV Ig G antibody were positive. So intravenous ganciclovir injection of 7.5 mg/kg, two times a day for 2 weeks and then 10 mg/kg/day for 3 months was done from 4 to 6 months of age. No virus was found in the urine and AST & ALT were normalized at 2 months after stopping ganciclovir treatment.
Absorption ; Acrodermatitis* ; Anal Canal ; Atrophy ; Bilirubin ; Biopsy ; Dacarbazine ; Diarrhea ; Ear ; Enterocolitis ; Ganciclovir ; Gastric Mucosa ; Hand ; Hepatitis* ; Humans ; Infant ; Infant, Newborn ; Intestine, Small ; Jaundice ; Leg ; Liver ; Male ; Mouth ; Skin ; Zinc

Duodenal web is an uncommon lesion that infrequently cause partial or complete intestinal obstruction. If the duonenal web is incomplete and only partially obstructs the duodenal lumen, the onset of symptoms may be delayed for years, and obstructive symptoms will be only minimal and intermittent. Congenital duodenal obstruction is occasionally associated with intestinal malrotation. We experienced a case of duodenal web associated with intestinal malrotation in a 9-year-old girl who had been suffered from intermittent projectile vomiting since birth without failure to thrive. The diagnosis was made by UGI series & abdominal CT. Patient remained asymptomatic after operation.
Child ; Diagnosis ; Duodenal Obstruction ; Failure to Thrive ; Female ; Humans ; Intestinal Obstruction ; Parturition ; Tomography, X-Ray Computed ; Vomiting