Background: There is a need to update the cardiovascular (CV) Sequential Organ Failure Assessment (SOFA) score to reflect the current practice in sepsis. We previously proposed the modified CV SOFA score from data on blood pressure, norepinephrine equivalent dose, and lactate as gathered from emergency departments. In this study, we externally validated the modified CV SOFA score in multicenter intensive care unit (ICU) patients. Methods: A multicenter retrospective observational study was conducted on ICU patients at six hospitals in Korea. We included adult patients with sepsis who were admitted to ICUs. We compared the prognostic performance of the modified CV/total SOFA score and the original CV/total SOFA score in predicting 28-day mortality. Discrimination and calibration were evaluated using the area under the receiver operating characteristic curve (AUROC) and the calibration curve, respectively. Results: We analyzed 1,015 ICU patients with sepsis. In overall patients, the 28-day mortality rate was 31.2%. The predictive validity of the modified CV SOFA (AUROC, 0.712; 95% confidence interval [CI], 0.677–0.746; P < 0.001) was significantly higher than that of the original CV SOFA (AUROC, 0.644; 95% CI, 0.611–0.677). The predictive validity of modified total SOFA score for 28-day mortality was significantly higher than that of the original total SOFA (AUROC, 0.747 vs. 0.730; 95% CI, 0.715–0.779; P = 0.002). The calibration curve of the original CV SOFA for 28-day mortality showed poor calibration. In contrast, the calibration curve of the modified CV SOFA for 28-day mortality showed good calibration. Conclusion In patients with sepsis in the ICU, the modified SOFA score performed better than the original SOFA score in predicting 28-day mortality.

PURPOSE: The purpose of this study was to investigate the clinical efficacy of an optimized prolate ablation procedure for correcting residual refractive errors following laser surgery. METHODS: We analyzed 24 eyes of 15 patients who underwent an optimized prolate ablation procedure for the correction of residual refractive errors following laser in situ keratomileusis, laser-assisted subepithelial keratectomy, or photorefractive keratectomy surgeries. Preoperative ophthalmic examinations were performed, and uncorrected distance visual acuity, corrected distance visual acuity, manifest refraction values (sphere, cylinder, and spherical equivalent), point spread function, modulation transfer function, corneal asphericity (Q value), ocular aberrations, and corneal haze measurements were obtained postoperatively at 1, 3, and 6 months. RESULTS: Uncorrected distance visual acuity improved and refractive errors decreased significantly at 1, 3, and 6 months postoperatively. Total coma aberration increased at 3 and 6 months postoperatively, while changes in all other aberrations were not statistically significant. Similarly, no significant changes in point spread function were detected, but modulation transfer function increased significantly at the postoperative time points measured. CONCLUSIONS: The optimized prolate ablation procedure was effective in terms of improving visual acuity and objective visual performance for the correction of persistent refractive errors following laser surgery.
Coma ; Humans ; Keratectomy, Subepithelial, Laser-Assisted ; Keratomileusis, Laser In Situ ; Laser Therapy* ; Phosmet* ; Photorefractive Keratectomy ; Refractive Errors* ; Refractive Surgical Procedures ; Treatment Outcome ; Visual Acuity

PURPOSE: Correlations between maximum flexion and functional outcomes in total knee arthroplasty (TKA) patients are reportedly weak. We investigated whether there are differences between passive maximum flexion in nonweight bearing and other types of maximum flexion and whether the type of maximum flexion correlates with functional outcomes. MATERIALS AND METHODS: A total of 210 patients (359 knees) underwent preoperative evaluation and postoperative follow-up evaluations (6, 12, and 24 months) for the assessment of clinical outcomes including maximum knee flexion. Maximum flexion was measured under five conditions: passive nonweight bearing, passive weight bearing, active nonweight bearing, and active weight bearing with or without arm support. Data were analyzed for relationships between passive maximum flexion in nonweight bearing by Pearson correlation analyses, and a variance comparison between measurement techniques via paired t test. RESULTS: We observed substantial differences between passive maximum flexion in nonweight bearing and the other four maximum flexion types. At all time points, passive maximum flexion in nonweight bearing correlated poorly with active maximum flexion in weight bearing with or without arm support. Active maximum flexion in weight bearing better correlated with functional outcomes than the other maximum flexion types. CONCLUSIONS: Our study suggests active maximum flexion in weight bearing should be reported together with passive maximum flexion in nonweight bearing in research on the knee motion arc after TKA.
Arm ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Humans ; Knee ; Weight-Bearing

Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases that degrade the extracellular matrix and other extracellular proteins. Upregulation of MMPs activity is known to be required for the inflammatory cell infiltration after spinal cord injury (SCI) and most likely contributes to early blood spinal barrier disruption and inflammation, thereby leading to the impairment of functional recovery. Here, we examined the effect of ethanol extract of Bupleurum falcatum (BF) on functional recovery by inhibiting MMP-2 and -9 activation and inflammation after SCI. Rats received a moderate, weight-drop contusion injury to spinal cord were administered orally with BF at a dose of 100 mg/kg for 14 d and functional recovery was measured by Basso-Beattie-Bresnahan locomotor open field behavioral rating test, inclined plane test and foot print analysis. To examine the neuroprotective effect of BF, TUNEL staining and counting were also performed. In addition, the expression and/or activation of MMP-2, MMP-9 and inflammatory mediators such as TNF-alpha, IL-1beta, COX-2, and iNOS were examined by RT-PCR and gelatin zymography using spinal cord tissue from 1 d after injury. Our data showed that BF significantly inhibited the expression and activation of both MMP-2 and MMP-9 after SCI. The mRNA expressions of TNF-alpha, IL-1beta, COX-2, and iNOS were also significantly attenuated by BF. Furthermore, BF reduced apoptotic cell death at 1 d after injury, thereby significantly reduced lesion volume and improved functional recovery. Taken together, these results suggest that BF can be used as a potential therapeutic agent for treating acute spinal injury.
Animals ; Blood-Brain Barrier ; Bupleurum ; Cell Death ; Contusions ; Endopeptidases ; Ethanol ; Extracellular Matrix ; Foot ; Gelatin ; In Situ Nick-End Labeling ; Inflammation ; Matrix Metalloproteinases ; Neuroprotective Agents ; Proteins ; Rats ; RNA, Messenger ; Spinal Cord ; Spinal Cord Injuries ; Spinal Injuries ; Tumor Necrosis Factor-alpha ; Up-Regulation

PURPOSE: This study was performed to compare the characteristics and perceptions of medical school students and professional graduate medical school students. METHODS: Study subjects were 131 medical students from a national university and 113 applicants of a professional graduate medical school. We developed a self-reported questionnaire asking about socio-demographic characteristics; the level of satisfaction of educational environment; perception of missions of medical education and career plan and student activities during school. RESULTS: Students from the professional graduate medical school were significantly different from medical students in socio-demographic characteristics. They also showed higher satisfaction with their education, were more supportive of student union activities and were more anxious about economic and health problems than medical students. However, there was no difference between the two groups regarding perception of missions of medical education and career plan after graduation. CONCLUSION: Based on the above results, it is necessary to consider the characteristics and perceptions of professional graduate medical students when developing educational policies for these older students. The limitation of this study includes a restricted sample, and generalization of results should be done carefully. Thus, more extensive, wide-ranging studies would be useful.
Education ; Education, Medical ; Generalization (Psychology) ; Humans ; Missions and Missionaries ; Schools, Medical* ; Students, Medical ; Surveys and Questionnaires

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas filled cysts in the intestinal wall. The diagnosis of PCI is usually made by colonoscopy, histology, or radiologic findings. We report a case of PCI in a 35-year-old man. The patient initially complained of watery diarrhea and abdominal bloating for 2 weeks. Simple abdominal X-ray demonstrated numerous, small, round, air densities on the right upper abdomen along the ascending and proximal transverse colon. Colonoscopy revealed numerous, 5-20 mm sized, sessile polypoid, balloon-like distended, protruding subepithelial masses covered with normal colonic mucosa from cecum to proximal transverse colon. We performed a CT colonoscopy and confirmed PCI with multiple air-filled cystic masses along the colonic wall from cecum to proximal transverse colon. The patient was treated with antibiotics and oxygen inhalation for 2 weeks. Follow-up CT colonoscopy revealed marked regression in the number and size of the air-filled cystic masses. Herein, we report the first case of the PCI in Korea diagnosed by CT colonoscopy. Follow-up evaluation with CT colonoscopy was performed after the treatment of the PCI. CT colonoscopy is a useful non-invasive diagnostic tool for the diagnosis of pneumatosis cystoides intestinalis.
Adult ; Colonic Diseases/pathology/radiography ; *Colonography, Computed Tomographic ; Humans ; Intestinal Mucosa/pathology ; Male ; Pneumatosis Cystoides Intestinalis/*pathology/radiography

Unilateral brachial plexus injury is a rare complication of thoracoscopic sympathectomy, which is generally considered to be a simple and safe procedure. We report on a 20-year-old female patient who developed persistent pain and weakness of the left arm after thoracoscopic sympathectomy for hyperhidrosis. An electromyographic study revealed evidence of denervation at the C5-C7 level, and a nerve conduction study on the left brachial plexus showed decreased amplitude of the compound muscle action potential of the left musculocutaneous and axillary nerves. The above findings are compatible with left brachial plexopathy, with predominant involvement of the lateral and posterior cord. We suggest that this complication was caused by stretch and/or compression of the left brachial plexus when the arm was hyperabuducted upwards during the operation. Careful attention to positioning by the surgeon and anesthesiologist is needed to prevent this debilitating injury.
Action Potentials ; Arm ; Brachial Plexus Neuropathies ; Brachial Plexus* ; Denervation ; Female ; Humans ; Hyperhidrosis ; Neural Conduction ; Sympathectomy* ; Young Adult

OBJECTIVE: The purpose of this study is to assess morphologically the changes of macrophages during various developmental periods of the corpus luteum in the rat ovary. METHODS: The female rats (Sprague-Dawley strain) at age 8 weeks, ovulatory period; 6 days of gestation, early pregnancy period; 19 days of gestation, late pregnancy period; and postpartum 5 days, postpartum period were used. Removed ovaries were dissected and used for TdT-mediated dUTP biotin nick end labelling (TUNEL), macrophages immunohistochemistry, and Transmission Electron Microscopy (TEM). RESULTS: Macrophages were observed in all the developmental periods. The number of apoptotic bodies and macrophages was highest at the ovulatory period, and decreased at postpartum period, early pregnancy period and late pregnancy period in order. The immunoreactivity of macrophages was high at ovulatory period, moderate at late pregnacy and postpartum period, and low at early pregnancy period. In TEM observations, two types of macrophages were observed. One was non-phagocytic macrophage which has slender cell body and long cytoplasmic processes and contained no apoptotic bodies, and the other was phagocytic macrophage which contained apoptotic bodies, phagocytic vacuoles and many lipid droplets and located near the capillaries. CONCLUSION: In the rat corpus luteum, the number and the degree of immunoreactivity of macrophages changed according to the functional developmental periods of the corpus luteum. The functions of the macrophages were suggested as the elimination of apoptotic bodies at the ovulatory and postpartum periods, and luteotropic action at the early and late pregnancy periods. Ultrastructurally, two types of macrophages, phagocytic and non-phagocytic, were confirmed.
Animals ; Apoptosis ; Biotin ; Capillaries ; Corpus Luteum* ; Cytoplasm ; Female ; Humans ; Immunohistochemistry ; Macrophages* ; Microscopy, Electron, Transmission* ; Ovary ; Postpartum Period ; Pregnancy ; Rats* ; Vacuoles

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) is an important cause of various gastrointestinal diseases. H. pylori eradication is essential for the cure and prevention of associated diseases. Nowdays, proton pump inhibitor (PPI)-based triple therapy is the standard eradication regimen. The aims of this study were to compare the H. pylori eradication rate of different PPI-based triple therapies and to find out the factors influencing the eradication rate. METHODS: From May 2002 through Febraury 2004, H. pylori infected patients were treated with the eradication regimen based on one of the four PPIs (omeprazole, rabeprazole, esomeprazole and lansoprazole) for 1 or 2 weeks. After two weeks, drug compliance, adverse effects, and smoking history during the eradication therapy were obtained. The follow-up H. pylori test was performed 4 weeks after the completion of therapy. The data were analyzed by Chi-square test and multiple logistic regression analysis. RESULTS: Overall eradication rate was 83.5%. There was no significant difference in eradication rate among four PPIs (p=0.379). Odds ratio (OR) for omeprazole and rabeprazole was 1.15 (95% CI 0.50-2.68); for omeprazole and esomeprazole, OR 1.63 (95% CI 0.68-3.89); and for omeprazole and lansoprazole, OR 1.13 (95% CI 0.50-2.56). Smoking habit, site of ulcer, and the duration of therapy affected the eradication rate significantly. CONCLUSIONS: The efficacy of four different PPIs for H. pylori eradication is similar to each other. Smoking, site of ulcer, and the duration of treatment have significant effects on eradication rates.
Adult ; Anti-Infective Agents/*therapeutic use ; Anti-Ulcer Agents/*therapeutic use ; Comparative Study ; Drug Therapy, Combination ; English Abstract ; Female ; Helicobacter Infections/*drug therapy/microbiology ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Proton Pumps/*antagonists & inhibitors

In rare cases, early gastric cancer resembles the endoscopic features of a submucosal tumor (SMT). A correct histological diagnosis is difficult with repeated biopsy specimens because they are covered with normal mucosa. Some features known to suggest malignant SMT include a size greater than 3 to 5 cm, a rapid growth rate, echoheterogeneity and irregular margins on endoscopic ultrasonography (EUS). Various techniques including US-guided biopsy, partial removal by an endoscopic snare excision, as well as EUS with a fine needle aspiration were used to enhance the diagnostic accuracy. We recently experienced a case of early gastric cancer, presenting as a submucosal tumor-like lesion, which was confirmed by endoscopic mucosal resection. We report this case with a review of the relevant literature.
Adenocarcinoma* ; Biopsy ; Biopsy, Fine-Needle ; Diagnosis ; Endosonography ; Mucous Membrane ; SNARE Proteins ; Stomach Neoplasms