Effects of Tegoprazan Versus Esomeprazole on Nighttime Heartburn and Sleep Quality in Gastroesophageal Reflux Disease: A Multicenter Double-blind Randomized Controlled Trial

Background/Aims@#Patients with gastroesophageal reflux disease (GERD) frequently experience nighttime heartburn and sleep disturbance. Tegoprazan is a new potassium-competitive acid blocker that can rapidly block acid secretion. This study aims to evaluate the efficacy of tegoprazan compared with esomeprazole in relieving nighttime heartburn and sleep disturbances. @*Methods@#Patients with erosive esophagitis, nighttime heartburn, and sleep disturbances were randomized to receive tegoprazan 50 mg or esomeprazole 40 mg for 2 weeks. The primary endpoint was time to first nighttime heartburn-free interval. The percentage of nighttime heartburn-free days was also compared between the 2 groups. @*Results@#A total of 46 patients were enrolled in this study. Time to the first nighttime heartburn-free interval was shorter with tegoprazan than with esomeprazole but the difference was not statistically significant (1.5 days vs 3 days, P = 0.151). The percentage of nighttime heartburn-free days was higher in the tegoprazan group but the difference was insignificant (57.8% vs 43.1%, P = 0.107). Adverse events occurred in 2 patients. They were mild in severity. @*Conclusions@#Tegoprazan may induce faster relief of nighttime heartburn symptoms and may improve sleep disorders associated with nighttime heartburn. Further large-scale studies are required to validate our findings.

Two Indices Affecting the Directions of the Sylvian Fissure Dissection in Middle Cerebral Artery Bifurcation Aneurysms

OBJECTIVE: This study proposes more objective methods for deciding the appropriate direction of the sylvian fissure dissection during surgical clipping in middle cerebral artery (MCA) bifurcation aneurysms. METHODS: We reviewed data of 36 consecutive patients with MCA bifurcation aneurysms. We measured 2 indices preoperatively on 3-dimensional computed tomography angiography (3D-CTA). Analysis of the calculated data allowed us to select the appropriate direction of sylvian fissure dissection for ease of proximal control of M1. Statistically, Mann-Whitney test was used. RESULTS: We classified subjects into 2 groups based on the technical level of M1 exposure during surgical clipping. When it was difficult to expose M1, subjects were assigned to Group I, and Group II were subjects in whom M1 exposure was easy. The mean difference between the distances extending from the limbus sphenoidale (LS) line to the internal carotid artery bifurcation and extending from the LS line to the MCA bifurcation was 1.00 +/- 0.42 mm in group I and 4.39 +/- 2.14 mm in group II. The mean M1 angle was 9.36 +/- 3.73degrees in the group I and 34.05 +/- 16.71degrees in the group II (M1 slope gap p < 0.05, M1 angle p < 0.05). CONCLUSION: We have found an objective method for preoperatively verifying ease of exposure of M1 artery during surgical clipping. Therefore, we suggest use of the preoperative M1 slope gap and M1 angle as indicators in 3D-CTA selecting the direction of sylvian fissure dissection for easy proximal control of M1.

Two Indices Affecting the Directions of the Sylvian Fissure Dissection in Middle Cerebral Artery Bifurcation Aneurysms

OBJECTIVE: This study proposes more objective methods for deciding the appropriate direction of the sylvian fissure dissection during surgical clipping in middle cerebral artery (MCA) bifurcation aneurysms. METHODS: We reviewed data of 36 consecutive patients with MCA bifurcation aneurysms. We measured 2 indices preoperatively on 3-dimensional computed tomography angiography (3D-CTA). Analysis of the calculated data allowed us to select the appropriate direction of sylvian fissure dissection for ease of proximal control of M1. Statistically, Mann-Whitney test was used. RESULTS: We classified subjects into 2 groups based on the technical level of M1 exposure during surgical clipping. When it was difficult to expose M1, subjects were assigned to Group I, and Group II were subjects in whom M1 exposure was easy. The mean difference between the distances extending from the limbus sphenoidale (LS) line to the internal carotid artery bifurcation and extending from the LS line to the MCA bifurcation was 1.00 +/- 0.42 mm in group I and 4.39 +/- 2.14 mm in group II. The mean M1 angle was 9.36 +/- 3.73degrees in the group I and 34.05 +/- 16.71degrees in the group II (M1 slope gap p < 0.05, M1 angle p < 0.05). CONCLUSION: We have found an objective method for preoperatively verifying ease of exposure of M1 artery during surgical clipping. Therefore, we suggest use of the preoperative M1 slope gap and M1 angle as indicators in 3D-CTA selecting the direction of sylvian fissure dissection for easy proximal control of M1.

The Comparisons of Surgical Outcomes and Clinical Characteristics between the Far Lateral Lumbar Disc Herniations and the Paramedian Lumbar Disc Herniations

OBJECTIVE: The purpose of this study is to analyze clinical characteristics and surgical outcomes of the far lateral and the paramedian disc herniations. METHODS: The 88 patients who underwent an operation for lumbar disc herniations were reviewed. Visual analogue scale of leg and back pain, occurrence of sensory dysesthesia and motor deficit before and after operations were used to compare the far lateral with the paramedian disc herniations. RESULTS: Statistically, the far lateral herniations had more severe radicular leg pain and showed more frequent occurrence of sensory dysesthesia than paramedian herniations before operation (p0.05). CONCLUSION: Preoperatively, the far lateral herniations had more severe radicular leg pain and frequent occurrence of sensory dysesthesia. Postoperatively, the sensory dysesthesia was less improved and back pain was more severe in the far lateral herniations.

Fulminant Meningitis after Radiotherapy for Clival Chordoma

The best treatment for clival chordoma is obtained with total surgical excision, sometimes combined with adjuvant radiotherapy. A cerebrospinal fluid (CSF) fistula is a fatal complication that may occur following extended transsphenoidal surgery (TSS) and adjuvant radiotherapy. We report a case of fulminant meningitis without a CSF fistula in a 57-year-old woman who underwent TSS and multiple radiotherapies for a clival chordoma. She presented to our emergency room with copious epistaxis and odor inside her nasal cavity and had an unexpected fatal outcome. She was diagnosed with meningitis based on CSF culture and blood culture. While treating clival chordomas with adjuvant radiotherapy, clinicians should be aware of the possibility of fulminant meningitis.

Protective Effects of Fenofibrate Against the Inflammatory Cytokines in Lipopolysaccharide-Induced Mice Brain Tissues

BACKGROUND: Increasing evidence suggests that the entry of proinflammatory factors into the brain induces the activation of microglia, astrocytes, and oligodendrocytes and then produces the more proinflammatory cytokines and reactive oxygen species that can ultimately lead to neuronal death. This has clinical implications and provides a link between periperal inflammation and neuroinflammation. Peroxisome proliferator-activated receptors (PPARs), a member of the nuclear hormone receptor superfamily, has been implicated in the regulation of immunity and inflammation in rodents and humans. The objective of this study was to investigate whether the increased expression of PPAR with fenofibrate treatment was altered in the immune system of mice brain tissue after Lipopolysaccharide (LPS) was injected intraperitoneally. METHODS: PPARs expression was investigated in the brain tissues of BalB/c mice (n=6) under four situationssterile saline injection (control), LPS injection to generate periperal inflammation, LPS injection (5 mg/kg) with pretreated fenofibrate, and fenofibrate injection (100 mg/kg). RESULTS: Fenofibrate has protective effects against the increase of LPS-induced proinflammatory cytokines including interleukin (IL)-1beta, IL-6, and tumer necrosis factor-alpha in serum and brain tissue, measured using the enzyme linked immunosorbent assay, reverse transcriptase-polymerase chain reaction, and Western blot analysis. Also fenofibrate pretreatment markedly suppressed the reduction of PPARs mRNA and protein level by LPS injection. Moreover, the increased activation of PPARs abrogated the reduction of ABCD3, ACOX1, and catalase expression leading to an increase in the antioxidative capacity in brain tissue blocking the production of lipid peroxidation after LPS administration. CONCLUSION: The antiinflammatory and antioxidative properties of fenofibrate may be useful in ameliorating the progression of neuronal diseases.

A Case of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy with Cardiac Arrest in the Emergency Department

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a heart muscle disorder characterized by patch replacement of right ventricular myocardium by adipose and fibrous tissue and by electrical instability of the right ventricular myocardium. ARVD/C is rare in South Korea but is an important cause of cardiac arrest in young patients. The clinical manifestations of ARVD/C vary from sudden cardiac death of previously asymptomatic patients to chronic symptoms in patients with recurrent palpitations and/or right or biventricular failure. Diagnosis is based on several major and minor criteria involving structural, histologic, eletrocardiographic, arrhythmic, and genetic factors. Therapy is directed to prevent and/or treat malignant vetricular tachyarrhythmias with medications, implantable cadioverter defibrillator, radiofrequency ablation, and surgery in selected cases. We experienced a case of ARVD/C with ventricular fibrilltion in the emergency department. The electrocardiography of postresuscitation showed QRS prolongation and inversion of T waves in the right precordial leads. Echocardiography revealed a dilated right atrium and right ventricle, and right ventricular dysfunction. Multislice computed tomography and cardiac magnetic resonance imaging showed multifocal fat infiltration involving right ventricular myocardium, right ventricular trabeulae, and the right ventricular side of the ventricular septum with dilatation of the right ventricle and right ventricular outflow tract and abundant epicardial fat. An implantable cardioverter defibrillator was implanted, and the patient was transferred to another hospital.

A Projection-based Intensity Correction Method of Phased-Array Coil Images

PURPOSE: To develop a novel approach to calculate the sensitivity profiles of the phased array coil for use in non-uniform intensity correction. MATERIALS AND METHODS: The proposed intensity correction method estimates the sensitivity profile of the coil to extract intensity variations that represent the scanned image. The sensitivity profile is estimated by fitting a non-linear curve to various angles of projections through the imaged object in order to eliminate the high-frequency image content. Filtered back projection is then used to compute the estimates of the sensitivity profile of each coil. The method was applied both to phantom and brain images from 8-channel phased-array coil and 4-channel phased-array coil, respectively. RESULTS: Intensity-corrected images from the proposed method have more uniform intensity than those from the commonly used `sum-of-squares' approach. By using the proposed correction method, the intensity variation was reduced to 6.1% from 13.1%, acquired from the `sum-of-squares'. CONCLUSION: The proposed method is more effective at correcting the intensity non-uniformity of the phased-array surface-coil images than the conventional`sum-of-squares' method.

A Projection-based Intensity Correction Method of Phased-Array Coil Images

PURPOSE: To develop a novel approach to calculate the sensitivity profiles of the phased array coil for use in non-uniform intensity correction. MATERIALS AND METHODS: The proposed intensity correction method estimates the sensitivity profile of the coil to extract intensity variations that represent the scanned image. The sensitivity profile is estimated by fitting a non-linear curve to various angles of projections through the imaged object in order to eliminate the high-frequency image content. Filtered back projection is then used to compute the estimates of the sensitivity profile of each coil. The method was applied both to phantom and brain images from 8-channel phased-array coil and 4-channel phased-array coil, respectively. RESULTS: Intensity-corrected images from the proposed method have more uniform intensity than those from the commonly used `sum-of-squares' approach. By using the proposed correction method, the intensity variation was reduced to 6.1% from 13.1%, acquired from the `sum-of-squares'. CONCLUSION: The proposed method is more effective at correcting the intensity non-uniformity of the phased-array surface-coil images than the conventional`sum-of-squares' method.

A histologic study of bone formation according to different cryoprotectants during cryopreservation of bone

PURPOSE: Several cryoprotectants are in use to help the survival of cells during cryopreservation of bone in maxillofacial region. Among them, Me2SO(dimethyl sulfoxide), EG(ethylene glycol), sucrose were used for experimentally created defects with accompanying cryopreserved bone graft in the rabbit model. The aim of this study is to analyze the effect of above mentioned agents on bone formation using histologic and histomorphometrical methods, thus to provide experimental support for clinical application of these agents. MATERIALS AND METHODS: Nine rabbits were used as experimental animals. Surgical defects were created on the distal femoral heads and mesial tibial heads of each animal using trephine drill(5mm diameter and 5mm length). The harvested bones were cryopreserved in -80 degrees C refrigerator for one week. The defects were filled with cryopreserved bone with cryoprotectants as experimental groups and cryopreserved bone without cryoprotectant as control. Then, the animals were sacrificed at 1, 2, and 3 weeks after surgery. With Goldner's modified Masson trichrome staining and semiautomatic image analysis system, we observed the change of the cells and bone formation. RESULTS: After bone graft, bone formation and active remodeling process were examined in all experimental groups and the control. But the intensity of such activities of the control were somewhat weaker than that of the experiments. Especially Me2SO+ sucrose group was the best in bone formation and bone remodeling. Me2SO group was more than that of EG group in bone fomation. Sucrose seems to be helpful in survival of the bone cell. Histologic findings showed superior bony quantity and quality in experimental groups than that in control. CONCLUSIONS: The data from this study provides the basis for future studies for evaluating the effect of cryoprotectants in the cryopreservation of bone and clinical study for predictable use of these agents.

Functional MRI Study on Perceiving Orthographic Structure and Simplified Semantic Pictures

The different perceiving patterns of each picture, alphabetic words and Chinese characters, were widely investigated psychophysically. The more precise localisation can be done in terms of brain activity using functional image technique such as PET and fMRI recently. Until now, there was no fMRI study to make direct comparison between perception of single Chinese character and simplified pictures (pictograph). We have made direct comparison of these two components using modern magnetic resonance techniques. We cannot confirm the right hemispheric dominance for perception of single Chinese character and pictographs. These two kinds of perceiving pattern can be underlying different mechanism.

MANDIBULAR CONTOURING SURGERY BY MULTIPLE STEP SURGICAL CORRECTION WITH ANGLE-SPLITTING OSTECTOMY

The mandibular contour determines the shape of the lower part of the face and thus influences the appearance of the face. A patient with a large, squarish, or broad face who desires a small, round, or slender face can undergo mandibular contouring surgery to reduce the width of the lower face. The successful correction of a prominent mandibular angle by conventional angle ostectomy has been reported. But, in the majority of patients with a widened facial appearance, both the mandibular angle and part of the mandibular body anterior to it are protuberant laterally, so both must be resected. The purpose of this study is to introduce a new method of performing mandibular contouring surgery, more effectively and easily, and to reduce postoperative complication and evaluate its results. We treated 6 patients who has prominent mandibular angle using multiple step osteotomy with angle-splitting ostectomy. The advantages of this new method are as following. (1) easily performable (2) effective mandibular contouring surgery by reducing the width of lower face (3) producing a natural relief of the mandibular angle (4) low risk of soft tissue damage and complications (5) shortening of the operation time. etc.

The effects of resorbable plate in the healing process of mandibular fracture of the rabbits

A Preliminary Results of Acoustic Noise Effect due to Gradient Pulsing in Functional MRI

PURPOSE: In functional MRI(fMRI), the acoustic noise effects of gradient pulsing are analyzed with two different combinations of readout and phase-encoding gradients for sagittal-view images. MATERIALS AND METHODS: Series of sagittal-view EPI images for fMRI obtained from five healthy volunteers. In order to show the effect of gradient pulsing noise, this study was duplicated for the Y readout / Z phase-encoding gradients and the Z readout / Y phase-encoding gradients. The first 7 images were obtained with visual stimulation. This sequential paradigm without and with visual stimulation was repeated 4 times, and was followed by the last 7 images being obtained without visual stimulation. In order to compare the visual cortex activation according to the combination of readout and phase-encoding gradients, the number of activated pixels and the average intensities of the activated pixels were analyzed, where the total activation is defined by multiplying the number of activated pixels by the average intensities of the activated pixels. RESULTS: The experimental results show that the combination of Z readout and Y phase-encoding gradients produce larger visual cortex activation than the combination of Y readout and Z phase-encoding gradients when a sagittal-view fMRI is performed. CONCLUSION: This experiment result represents that visual cortex response can be affected by acoustic noise. Therefore, the combination of the Z readout and Y phase encoding gradients is efficient for sagittal view fMRI because it has less acoustic noise.

Analysis of fMRI Signal Using Independent Component Analysis

The fMRI signals are composed of many various signals. It is very difficult to find the accurate parameter for the model of fMRI signal containing only neural activity, though we may estimating the signal patterns by the modeling of several signal components. Besides the nose by the physiologic motion, the motion of object and noise of MR instruments make it more difficult to analyze signals of fMRI. Therefore, it is not easy to select an accurate reference data that can accurately reflect neural activity, and the method of an analysis of various signal patterns containing the information of neural activity is an issue of the post-processing methods for fMRI. In the present study, fMRI data was analyzed with the Independent Component Analysis(ICA) method that doesn't need a priori-knowledge or reference data. ICA can be more effective over the analytic method using cross-correlation analysis and can separate the signal patterns of the signals with delayed response or motion related components. The Principal Component Analysis (PCA) threshold, wavelet spatial filtering and analysis of a part of whole images can be used for the reduction of the freedom of data before ICA analysis, and these preceding analyses may be useful for a more effective analysis. As a result, ICA method will be effective for the analysis of signal patterns in fMRI and the pre-filtering may be necessary for the reduction of the degree of freedom of the data.

Magnetic resonance imaging of abdominal disease

Magnetic Resonance Imaging(MRI) with 2.0 Tesla superconductive magnet developed by Korea Advanced Institute ofScience was performed in 25 patients with various abdominal diseases and compared with x-ray CT. MRI was obtainedwith spin echo technique using a variety of pulse sequence and various slice orientation including axial, sgittaland coronal section in order to evaluate the diagnostic value, limitation and to determine the optimal pulsesequency in various abdominal diseases. MRI demonstrated the capability of detecting the lesions shown on CT inall cases and also detected one case of diffuse hepatocellular carcinoma which was not seen on CT. MRI showedcapability of differentiation of various liver mass including hepatocellular carcinoma, hemangnioma and simplecyst. MRI showed better anatomical resolution of tumor in retroperitoneum and pelvis, however CT delineatedalimentary tract disease better than MRI did.

KAIS Resistive NMR-CT and Its Clinical Application

This paper contains the results of cl inical studies with 0.1 and 0.15 Tesla KAIS NMR Tomograph which was developed by Korea Advanced 1 nstitute of 5cience. A variety of imaging modes such as saturation recovery(SR), spin echo(SE), and inversion recovery(SR) as well as echo and repetition times were applied. Clinical imagings were performed on 22 patients with dlseases of brain (15 cases), cervical spine(2 cases}, chest (2 cases), pancreas (2 cases), and kidney (1 case). In SR imaglng, we have obtained images strongly dependent on the hydrogen nuclei density. SE with long echo time and IR are effective for T2 and T1 dependent images, respectively. Results of clinical NMR imaging are presented and compared with X-CT and the other radiological examinations. Obtained results appear promising and with further examinations along with parameter adjustment, it is expected that the NMR imaging will not only substitute many conventional diagnostic methods such as X.ray CT but also be useful for the early detection of tumor and other lesions not obtainable with other modalities.