The association between the neutrophil-to-lymphocyte ratio and bacteremia in elderly patients admitted to the emergency department

Objective@#Bacteremia is a common cause of increased morbidity and mortality in elderly patients, but early diagnosis and identification are complex. The neutrophil-to-lymphocyte count ratio (NLR) is suggested as a useful indicator for diagnosing bloodstream infections. This study evaluated whether the NLR at admission is associated with bloodstream infections in older patients admitted to the emergency department. @*Methods@#A retrospective, multicenter analysis was performed on patients admitted to the emergency department from November 2016 to February 2017. We included patients aged 65 years and older who visited the emergency department with medical problems. Baseline NLR values were measured upon admission to the emergency department. The primary outcome was a positive blood culture. @*Results@#A total of 1,815 patients were included in this study. The median age was 77.25±7.38 years, and bacteremia was identified in 290 older patients (15.9%). The NLR was significantly higher in the bacteremia group (15.95±22.03) than in the non-bacteremia group (8.76±8.74, P<0.001). In the multivariate logistic regression analysis, the NLR was associated with bacteremia after adjusting for confounding factors as continuous variables (odds ratio [OR], 1.033; 95% confidence interval [CI], 1.009-1.057) and categorical variables (NLR ≥10; OR, 2.018; 95% CI, 1.246-3.268). The area under the curve of the NLR was determined to be 0.667 (95% CI, 0.639-0.694). @*Conclusion@#These results indicate that the NLR at admission to the emergency department is associated with bloodstream infections. Early suspicion of bacteremia, by determining the initial NLR value, will help treat bacteremia in elderly patients.

External validation of the STONE score and the modified STONE score for the patients with suspicious urinary stone in the emergency department

Objective@#We aimed to investigate diagnostic accuracy of the STONE score and the modified STONE score by external validation in a large-scale cohort. @*Methods@#We retrospectively reviewed the medical records of patients with suspected urinary stones who underwent computed tomography in the emergency center of a single tertiary hospital from 2014 to 2015. We compared and analyzed our cohort and two original studies with each other. Patients were categorized into three risk groups (low, moderate, and high) according to both scoring systems. The prevalence of urinary stones and alternative diagnoses was evaluated in each group. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with our data for each score performance. @*Results@#Eight hundred fifty-six patients out of a total of 1,013 were diagnosed with urinary stones. The prevalence of urinary stones in the high-risk group of the STONE and the modified STONE scores were 91.1% and 91.2%, respectively. The areas under the receiver operating characteristic curve of both scores were 0.71 and 0.73, respectively. The optimal cutoff value for predicting urinary stones using the STONE score was 9, with 87.9% sensitivity, 45.9% specificity, 89.8% PPV, and 40.9% NPV. In the case of the modified STONE score, the optimal cutoff value was 10, which was the same as that of the original study with 85.9% sensitivity, 54.8% specificity, 91.2% PPV, and 41.6% NPV. @*Conclusion@#The STONE and the modified STONE scores showed good diagnostic accuracy in high-risk groups of patients with suspected urinary stones. These scoring systems would be helpful to physicians in their diagnoses and in reducing radiation exposure.

A study on the proper catheter position in minimally invasive surgery using stereotactic aspiration plus urokinase for intracerebral hemorrhage

Objective@#The surgical method for treating spontaneous intracranial hemorrhage (ICH) is not well established despite ICH’s high prevalence and poor prognosis. Minimally invasive surgery has recently received attention; however, literature on this method is scarce. In particular, the appropriate location of the catheter in the hematoma has not been described. We examined whether the catheter position affects the hematoma reduction in a hematoma ＞50 cc. @*Methods@#We investigated the prognoses of 36 patients with ICH who underwent stereotactic aspiration and hematoma drainage using urokinase from January 2010 to December 2018 and the hematoma reduction rates according to the tube position. Two methods evaluated the position of the catheter. In the first method, the hematoma was an imaginary sphere. The center point was set as the operation target. We evaluated the catheter position by determining whether it was in the deep part or the outer part of the half point from that location to the hematoma margin. In the second method, we evaluated whether the catheter was located 1 cm inside the hematoma margin. @*Results@#In both the first and second evaluations, there were no differences in age, midline shift, intraventricular hemorrhage status, hematoma volume on admission, Glasgow Coma Scale score on admission, time to operation after symptom onset, and systolic blood pressure. The rates of decrease in bleeding and the prognoses were also not significantly different. @*Conclusions@#If the catheter is in the hematoma, the rate of hematoma reduction at any position is similar.

Initial risk factors associated with in-hospital mortality after surgery in adult patients admitted to emergency department with gastrointestinal perforation

Objective@#Gastrointestinal perforation (GIP) is a life-threatening disease with a high mortality rate. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are recognized markers of inflammation associated with poor outcomes in a range of clinical situations. The study aimed to identify the independent risk factors with in-hospital mortality and examine the association of initial NLR and PLR with mortality in adult patients with GIP undergoing surgery. @*Methods@#This was a multi-center retrospective observational study. This study reviewed the electronic medical records of adult patients with GIP admitted to three academic hospitals between January 2009 and December 2018, who underwent surgery. The demographic and clinical data of the GIP patients were obtained. A multivariate logistic regression model was used to evaluate the risk factors associated with in-hospital mortality and to determine the association between the initial NLR and PLR and in-hospital mortality. The primary outcome was all-cause in-hospital mortality. @*Results@#Among the 9,279 patients, 879 adult patients with GIP underwent surgery. Seventy-eight patients (8.9%) died and 801 (91.1%) survived. Multivariate logistic regression analysis revealed female, underlying chronic renal failure, Creactive protein≥100 mg/L, and albumin<3.5 g/dL to be factors associated with in-hospital mortality (adjusted odds ratio [95% confidence interval], 2.73 [1.07-6.97], 4.20 [1.83-9.68], 8.43 [2.29-31.03], and 5.36 [2.29-12.59], respectively). @*Conclusion@#In adult patients with GIP receiving surgery, female, underlying chronic renal failure, initial high C-reactive protein, and low albumin might be independent risk factors associated with in-hospital mortality. The initial NLR and PLR were not found to be associated with mortality.

Use of the National Early Warning Score for predicting in-hospital mortality in older adults admitted to the emergency department

Objective@#The National Early Warning Score (NEWS), based on the patients’ vital signs, detects clinical deterioration in critically ill patients and is used to reduce the incidence of in-hospital cardiac arrest. However, although mortality prediction based on vital signs may be difficult in older patients, the effectiveness of the NEWS has not yet been evaluated in this population. This study aimed to test the hypothesis that an elevated NEWS at admission increases the mortality risk in older patients admitted to the emergency department (ED). @*Methods@#We conducted a single-center retrospective study, including patients admitted to the ED between November 2016 and February 2017. We included patients aged >65 years who were admitted to the ED for any medical problem. The NEWS was calculated at the time of ED admission. The primary outcome was in-hospital mortality. @*Results@#In total, 3,169 patients were included in this study. Median age was 75 years (interquartile range [IQR], 70 to 80 years), and 1,557 (49.1%) patients were male. The in-hospital mortality rate was 5.1% (161 patients). Median NEWS was higher in non-survivors than in survivors (5 [IQR, 3–8] vs. 1 [IQR, 0–3], P65 years.

Analysis of the Proportion of Patients Who Were Admitted to the Emergency Department of the Tertiary Care Hospital for Primary Care

BACKGROUND: The medical service delivery system in Korea works inefficiently and patients tend to visit tertiary hospitals by means of the emergency department (ED). Overcrowding of the ED threatens the health and life of emergency patients as a result of the inability to effectively distribute emergency medical resources in the community. To solve this problem, improvement in the medical delivery system and dispersion of patients by strengthening primary care may be helpful. In order to make policy decisions for this, it is necessary to estimate the scale of patients who can be distributed to primary care.METHODS: From January 1 to December 31, 2016, we analyzed the National Emergency Department Information System (NEDIS) data of patients who visited a tertiary ED to examine the proportion of patients eligible for primary medical care. The inclusion and exclusion criteria for primary care were made through the consensus of three physicians.RESULTS: A total of 65,061 NEDIS records were analyzed. Among them, by inclusion criteria, 29,818 cases were Korean Triage and Acuity Scale level 4 and 5, and 11,791 patients visited the ED during the day. After considering the exclusion criteria, there were 6,468 cases who may be suitable for primary medical care.CONCLUSION: Of the patients who visited the ED of tertiary hospitals, approximately 10% of them may be suitable for primary care. There should be a discussion and social consensus to reduce overcrowding in EDs and deliver better medical services.

Management of the paralyzed face using temporalis tendon transfer via intraoral and transcutaneous approach / 대한악안면성형재건외과학회지

Temporalis tendon transfer is a technique for dynamic facial reanimation. Since its inception, nearly 80 years ago, it has undergone a wealth of innovation to produce the modern operation. Temporalis tendon transfer is a relatively minimally invasive technique for the dynamic reanimation of the paralyzed face. This technique can produce significant and appropriate movement of the lateral oral commissure, more closely mimicking the normal side. The aim of this article is to review the technique of temporalis tendon transfer involving transferring of the coronoid process of the mandible with the insertion of the temporalis tendon via intra-oral and transcutaneous approach.

Results of Endovascular Coil Embolization Treatment for Small (≤ 5 mm) Unruptured Intracranial Aneurysms

OBJECTIVE: Researchers and clinicians have been unable to fully elucidate the natural course of and proper treatment for unruptured intracranial aneurysms (UIAs) smaller than or equal to 5 mm, particularly with regard to whether close observation or surgery is more appropriate. In this retrospective study, we evaluated the safety and efficacy of endovascular coil embolization of small (≤ 5 mm) asymptomatic UIAs by analyzing outcomes and complications associated with the procedure. MATERIALS AND METHODS: We analyzed data from 150 patients with small asymptomatic UIAs (≤ 5 mm) treated with coil embolization between January 2011 and December 2015. Three-dimensional angiography was used to measure aneurysm size. We evaluated procedure-related morbidity and mortality, immediate post-operative angiographic results, brain computed thomography follow-up results on post-operative day one, and clinical progress. RESULTS: UIAs occurred primarily in the anterior circulation area (142 cases, 94.67%), though eight patients exhibited UIAs of the posterior circulation. Following coil embolization, aneurysms with complete occlusion were observed in 137 cases (91.3%). Partial occlusion occurred in five cases (3.33%), while the procedure had failed in eight cases (5.33%). Procedure-related morbidity and mortality were five cases (3.33%) and zero cases, respectively. CONCLUSION: The endovascular treatment of small asymptomatic UIAs is associated with good short-term outcomes without permanent neurologic complications as well as low overall complication and morbidity rates. Thus, the procedure should be considered for patients with smaller asymptomatic UIAs.

The Benefits of Navien™ Intracranial Support Catheter for Endovascular Treatment

OBJECTIVE: Endovascular treatment is one of the most important treatments along with open craniotomy for cerebrovascular surgery. The successful treatment of endovascular disease relies on appropriate instruments and the surgeon's skill. Endovascular treatment needs to provide safe and stable access to the catheter cavity. Additionally, it is important to maintain a round shape without changing to an oval shape. The catheter for endovascular treatment has to be flexible and accommodate at least 0.027 inches of inner diameter. The 6-Fr Navien™ Intracranial Support Catheter (formerly the ReFlex Intracranial Catheter; Covidien Vascular Therapies, Mansfield, MA, USA) provides 0.072 inches of inner diameter. MATERIALS AND METHODS: We reviewed 61 cases for 56 cases of endovascular treatment with a Navien catheter. A triaxial system was used for all procedures with femoral arterial access. The Navien catheter was placed in the petrous segment of the internal carotid artery or third segment of the vertebral artery. The patients had various shapes of intracranial arteries, including tortuous vessels. RESULTS: The Navien catheter was used for 61 cases of endovascular treatment. We had 59 cases of coil embolization at unruptured and ruptured aneurysms and two cases of stent insertion into the middle cerebral artery. All the cases were successful without any catheter-related complications. CONCLUSION: The Navien catheter is a recently developed catheter that has several strengths compared with previously developed catheters. It provides a more stable environment for endovascular treatment. It provides a cavity sufficient for endovascular treatment devices. Additionally, it is sufficiently flexible to approach tortuous vessels.

Effects of Oral Streptokinase-Streptodornase on Remnant Chronic Subdural Hematomas / 대한신경손상학회지

OBJECTIVE: In most cases, the postoperative course of a chronic subdural hematoma (CSDH) is good, but CSDHs sometimes remain after the inserted catheter is removed, and the outcomes of such remnant hematomas are unclear. As oral streptokinase-streptodornase (OSS) has anti-inflammatory and hematologic effects, we assessed the effects of OSS on remnant CSDHs through a retrospective analysis of clinical data. METHODS: This study included 101 patients with traumatic CSDH who had remnant CSDH after burr-hole trephination with the closed drainage system between October 2009 and December 2012. We assessed the clinical outcomes, remnant CSDH volume, and recurrence rate from computed tomography scans in order to evaluate the effects of OSS. RESULTS: No significant differences were found in the changes in remnant hematoma volume between the OSS-treated and non-treated groups (p=0.531). The reoperation rate because of was 5.4% (2 patients) in the OSS-treated group and 6.3% (4 patients) in the non-treated group. The number of patients requiring reoperation did not differ between the groups (p=0.658). CONCLUSION: OSS treatment was not associated with a significant reduction in the remnant CSDH volume or recurrence rate after burr-hole drainage. Thus, there seems to be no basis for using OSS in CSDH patients.

Identification of a New Selective Chemical Inhibitor of Mutant Isocitrate Dehydrogenase-1

BACKGROUND: Recent genome-wide sequencing studies have identified unexpected genetic alterations in cancer. In particular, missense mutations in isocitrate dehydrogenase-1 (IDH1) at arginine 132, mostly substituted into histidine (IDH1-R132H) were observed to frequently occur in glioma patients. METHODS: We have purified recombinant IDH1 and IDH1-R132H proteins and monitored their catalytic activities. In parallel experiments, we have attempted to find new selective IDH1-R132H chemical inhibitor(s) from a fragment-based chemical library. RESULTS: We have found that IDH1, but not IDH1-R132H, can catalyze the conversion of isocitrate into alpha-ketoglutarate (alpha-KG). In addition, we have observed that IDH1-R132H was more efficient than IDH1 in converting alpha-KG into (R)-2-hydroxyglutarate (R-2HG). Moreover, we have identified a new hit molecule, e.g., 2-(3-trifluoromethylphenyl)isothioazol-3(2H)-one as a new selective IDH1-R132H inhibitor. CONCLUSIONS: We have observed an underlying biochemical mechanism explaining how a heterozygous IDH1 mutation contributes to the generation of R-2HG and increases cellular histone H3 trimethylation levels. We have also identified a novel selective IDH1-R132H chemical hit molecule, e.g., 2-(3-trifluoromethylphenyl)isothioazol-3(2H)-one, which could be used for a future lead development against IDH1-R132H.

Encapsulated Unresolved Subdural Hematoma Mimicking Acute Epidural Hematoma: A Case Report / 대한신경손상학회지

Encapsulated acute subdural hematoma (ASDH) has been uncommonly reported. To our knowledge, a few cases of lentiform ASDH have been reported. The mechanism of encapsulated ASDH has been studied but not completely clarified. Encapsulated lentiform ASDH on a computed tomography (CT) scan mimics acute epidural hematoma (AEDH). Misinterpretation of biconvex-shaped ASDH on CT scan as AEDH often occurs and is usually identified by neurosurgical intervention. We report a case of an 85-year-old man presenting with a 2-day history of mental deterioration and right-sided weakness. CT scan revealed a biconvex-shaped hyperdense mass mixed with various densities of blood along the left temporoparietal cerebral convexity, which was misinterpreted as AEDH preoperatively. Emergency craniectomy was performed, but no AEDH was found beneath the skull. In the subdural space, encapsulated ASDH was located. En block resection of encapsulated ASDH was done. Emergency craniectomy confirmed that the preoperatively diagnosed AEDH was an encapsulated ASDH postoperatively. Radiologic studies of AEDH-like SDH allow us to establish an easy differential diagnosis between AEDH and ASDH by distinct features. More histological studies will provide us information on the mechanism underlying encapsulated ASDH.

A Comprehensive Combination Method for Cooling Induction After Cardiac Arrest: A Clinical Feasibility Study

PURPOSE: To evaluate the cooling efficacy and safety of a comprehensive combination method for cooling induction in post-cardiac arrest patients. METHODS: Adult out-of-hospital cardiac arrest (OHCA) patients cooled using combination methods in a tertiary teaching hospital from January 2009 to June 2011were enrolled in the study. Patients were placed into one of two groups: 1) a typical combination (combination I) group, in which cold saline infusion, ice bags,and endovascular cooling were applied, and 2) acomprehensive combination (combination II) group, in which cold saline infusion, ice bags, endovascular cooling, skin exposure, and fanning with ice-water massage were applied. The time from cardiac arrest, return of spontaneous circulation (ROSC), and cooling start to 34degrees C, as well asadverse events during cooling, were recorded. RESULTS: Forty-two out of 125(34%) of OHCA patients with ROSC were cooled usingcombination methods. There were no differences in baseline characteristics between the two combination groups. The time [median (IQR)] from arrest, ROSC, and cooling to 34degrees C of the combination II group were significantly shorter than those of the combination I group [215 min(range 156~270 min) vs. 320 min (range 263-385) for median IQR, p=.002; 189 min (range 135-220 min) vs. 288 min (range 227-358 min) for ROSC, p=.002; 150min (range 120-180 min) vs. 210 min (range 180-260 min) for cooling to 34degrees C, p=.030, respectively]. There were no statistical differences in adverse events during and after cooling induction between the two groups. CONCLUSION: A comprehensive combination cooling method is feasible and capable of reducing the induction time for endovascular cooling in post-cardiac arrest patients.

A Comprehensive Combination Method for Cooling Induction After Cardiac Arrest: A Clinical Feasibility Study

PURPOSE: To evaluate the cooling efficacy and safety of a comprehensive combination method for cooling induction in post-cardiac arrest patients. METHODS: Adult out-of-hospital cardiac arrest (OHCA) patients cooled using combination methods in a tertiary teaching hospital from January 2009 to June 2011were enrolled in the study. Patients were placed into one of two groups: 1) a typical combination (combination I) group, in which cold saline infusion, ice bags,and endovascular cooling were applied, and 2) acomprehensive combination (combination II) group, in which cold saline infusion, ice bags, endovascular cooling, skin exposure, and fanning with ice-water massage were applied. The time from cardiac arrest, return of spontaneous circulation (ROSC), and cooling start to 34degrees C, as well asadverse events during cooling, were recorded. RESULTS: Forty-two out of 125(34%) of OHCA patients with ROSC were cooled usingcombination methods. There were no differences in baseline characteristics between the two combination groups. The time [median (IQR)] from arrest, ROSC, and cooling to 34degrees C of the combination II group were significantly shorter than those of the combination I group [215 min(range 156~270 min) vs. 320 min (range 263-385) for median IQR, p=.002; 189 min (range 135-220 min) vs. 288 min (range 227-358 min) for ROSC, p=.002; 150min (range 120-180 min) vs. 210 min (range 180-260 min) for cooling to 34degrees C, p=.030, respectively]. There were no statistical differences in adverse events during and after cooling induction between the two groups. CONCLUSION: A comprehensive combination cooling method is feasible and capable of reducing the induction time for endovascular cooling in post-cardiac arrest patients.

Effect of Cerebral Motor Cortex Stimulation in Amyotrophic Lateral Sclerosis Model: A Preliminary Controlled Study

OBJECTIVE: To observe the effect of the depolarizing stimulation in amyotrophic lateral sclerosis (ALS) mouse model on the survival and behavioral performance. METHOD: Transgenic male mouse model of ALS at the age of 9~11 weeks were divided into sham control group (n=10) and stimulation group (n=9). Electrode was implanted in the motor cortex in left hemisphere. Movement thresholds (MT) were regularly checked. Half threshold of MT, unipolar, and continuous electrical stimulation (frequency, 50 Hz; pulse duration, 220micron s) was delivered through implanted electrode. Behavioral tests including Rota-rod and Paw-grip endurance were checked every day. RESULTS: Induction of symptom was delayed in 8 days in stimulation than sham control group. However, there was no significant difference in survival in both groups. Behavioral tests showed that stimulation group is significantly better than sham group in Rota-rod (11~15 weeks) and in grip endurance (11~14, 16 weeks). MT was always between 1.0 volt and 3.2 volt in sham group, however, MT was between 0.8 volt and 2.8 volt in stimulation group. MT was jumped up around the time of death in both groups. CONCLUSION: Electrical stimulation is considered to be one of possible trial methods in ALS model. However, parameters of the stimulation in the experiment should be modified for better results.

Cerebral Aneurysm Arising from the Azygous Anterior Cerebral Artery : Case Report / 대한뇌혈관외과학회지

The azygous anterior cerebral artery (ACA) is a rare type of ACA anomaly. In the conventional angiography, cognition of its realm is difficult without considerable reading. Clinically, misreading its nature causes confusion during the surgical approach to its associated cerebral aneurysm. We report this rare clinical experience with an angiographic and surgical review.

Clinical Relevance of Pain Patterns in Osteoporotic Vertebral Compression Fractures

Few studies have been conducted to explain the pain patterns resulting from osteoporotic vertebral compression fractures (OVCF). We analyzed pain patterns to elucidate the pain mechanism and to provide initial guide for the management of OVCFs. Sixty-four patients underwent percutaneous vertebroplasty (N=55) or kyphoplasty (N=9). Three pain patterns were formulized to classify pains due to OVCFs: midline paravertebral (Type A), diffuse paravertebral (Type B), and remote lumbosacral pains (Type C). The degree of compression was measured using scale of deformity index, kyphosis rate, and kyphosis angle. Numerical rating scores were serially measured to determine the postoperative outcomes. As vertebral body height (VBH) decreased, paravertebral pain became more enlarged and extended anteriorly (p<0.05). Type A and B patterns significantly showed the reverse relationship with deformity index (p<0.05), yet Type C pattern was not affected by deformity index. Postoperative pain severity was significantly improved (p<0.05), and patients with a limited pain distribution showed a more favorable outcome (p<0.05). The improvement was closely related with the restoration of VBH, but not with kyphosis rate or angle. Thus, pain pattern study is useful not only as a guide in decision making for the management of patients with OVCF, but also in predicting the treatment outcome.

Usefulness of Pain Distribution Pattern Assessment in Decision-Making for the Patients with Lumbar Zygapophyseal and Sacroiliac Joint Arthropathy

There are currently no initial guides for the diagnosis of somatic referred pain of lumbar zygapophyseal joint (LZJ) or sacroiliac joint (SIJ). We developed a classification system of LZJ and SIJ pain, the "pain distribution pattern template (PDPT)" depending on the pain distribution patterns from a pool of 200 patients whose spinal pain source was confirmed. We prospectively applied the PDPT to determine its contribution to clinical decision-making for 419 patients whose pain was presumed to arise from the LZJs (259 patients) or SIJs (160 patients). Forty-nine percent (128/259) of LZJ and 46% (74/160) of SIJ arthopathies diagnosed by PDPT were confirmed by nerve blocks. Diagnostic reliabilities were significantly higher in Type A and C patterns in LZJ and Type C in SIJ arthropathies, 64%, 80%, and 68.4%, respectively. For both LZJ and SIJ arthropathies, favorable outcome after radiofrequency (RF) neurotomies was similar to the rate of positive responses to diagnostic blocks in Type A to Type D, whereas the outcome was unpredictable in those with undetermined type (Type E). Considering the paucity of currently available diagnostic methods for LZJ and SIJ arthropathies, PDPT is useful in clinical decision- making as well as in predicting the treatment outcome.

Investigation of the Growth Rate Change in Recombinant BCG which was cloned Mycobacterium tuberculosis Adenylate Kinase Mutation Gene or Human Muscle-type Adenylate Kinase Synthetic Gene / 결핵및호흡기질환

BACKGROUND: Normal cell proliferation and viability is strongly depends on the availability of metabolic energy and the maintenance of the appropriate adenylate-nucleotide pools. Hypothetically, changes in adenylate kinase (AK) expression could therefore be associated with adaptation to altered growth characteristics or inversely altered growth characteristics of proliferating cells could drive the changes in the metabolic profile. This study investigated whether the expression of either AK1 or a Mycobacterium tuberculosis adenylate kinase mutant which has the same catalytic activity of AK1 could affect the growth rate of slow-growing BCG. METHOD: Recombinant BCGs, which were cloned the human muscle-type adenylate kinase synthetic gene (AK1) and adenylate kinase mutation gene (AKmtDM) of Mycobacterium tuberculosis into the Mycobacterium/E.coli expression vectors, were constructed. Recombinant BCGs and wild-type BCG were cultured in 7H9 media and the optical density at 600nm was measured at intervals of 2-3 days. RESULT: There wasn't the growth rate change induced by AK1 or AKmtDM expression in recombinant BCGs. CONCLUSION: The expression of AK1 or Mycobacterium tuberculosis adenylate kinase mutant in BCG does not affect the growth rate of BCG.

Selective Neurotomy of Sacral Lateral Branches for Pain of Sacroiliac Joint Dysfunction

OBJECTIVE: The sacroiliac joint complex is often related with functionally incapacitating pain in old aged people. The purpose of this study is to delineate the investigation strategies and to determine the long-term effect of radiofrequency (RF) neurotomies for pain arising from sacroiliac joint dysfunction(SIJD) METHODS: Sixteen patients were diagnosed as having chronic pain from SIJD by comparative controlled blocks on L5 dorsal rami, sacroiliac joints and deep interosseous ligaments. After confirming the positive response (more than 50% of pain relief), sensory stimulation was applied to detect the `pathological' branches. Subsequently, RF neurotomies were performed on the selected nerve branches. Surgical outcome was graded as successful, moderate improvement, and failure after a 6month follow-up period. RESULTS: Stimulation intensity was 0.45V to elicit pain response in the L5 dorsal rami and lateral sacral branches. The number of RF-lesioned nerve branches was 6per patient. The average number of lesions for each branch was 1.3. Most commonly selected branches were L5 dorsal ramus (88%) and S2-upper division (88%). Ten patients (63%) reported a successful outcome according to the outcome criteria after 6months of follow-up, and five patients (31%) reported complete relief (100%). Five patients (31%) showed moderate improvements. One patient reported failure. CONCLUSION: RF neurotomy of lateral sacral branches is an excellent treatment modality for the pain due to SIJD, provided that comparative controlled block shows a positive response.