A case of acute kidney injury caused by dapsone-induced methemoglobinemia in a patient with chronic kidney disease

Methemoglobinemia (MetHb), which is characterized by an increased methemoglobin level, is a rare but potentially fatal disorder caused by congenital enzyme deficiencies or exposure to oxidizing agents, including dapsone. Elevation in the methemoglobin level impairs the oxygen-carrying capacity of hemoglobin, produces functional anemia, and induces tissue hypoxia. Such hypoxia results in microcirculation injury and hypoperfusion in the tissue and organs, including the kidney, and is a risk factor for acute kidney injury (AKI). This paper reports a case of AKI caused by dapsone-induced MetHb in a patient with chronic kidney disease, in which the patient ingested approximately 1,500 mg of dapsone in a suicide attempt, which was treated with aggressive management, including methylene blue, ascorbic acid, and transfusion.

Effect on sinus cycle length and atrioventricular node function after high‑power short‑duration versus conventional radiofrequency catheter ablation in paroxysmal atrial fibrillation

Background@#The efficacy and safety of high-power, short-duration (HPSD) radiofrequency catheter ablation for atrial fibrillation (AF) have been demonstrated in several studies. We aimed to evaluate and compare the effects of the conventional method and the HPSD method for AF ablation on the sinus and AV node function in patients with paroxysmal AF. @*Methods@#The medical records of patients with paroxysmal AF who underwent pulmonary vein isolation (PVI) were retrieved from a prospectively collected AF ablation registry at a large-sized tertiary center. The HPSD group (n = 41) was distinguished from the conventional ablation group (n = 198) in terms of the power (50 W vs. 20–40 W) and dura‑ tion (6–10 s vs. 20–30 s) of radiofrequency energy delivery during PVI. Peri-procedural changes in cardiac autonomy were assessed in terms of the changes in sinus cycle length (SCL), block cycle length (BCL), and effective refractory period (ERP) of the atrioventricular node (AVN). @*Results@#The SCL, BCL, and ERP of the AVN at baseline and post-ablation were not significantly different between the conventional ablation group and the HPSD group. Shortening of the SCL, BCL, and ERP of the AVN was observed immediately after AF ablation in both groups. One-year recurrence of AF/atrial flutter (35.1% vs. 20.3%; P = 0.011) and atrial flutter (13.8% vs. 4.7%; P = 0.015) were higher in the HPSD group than in the conventional ablation group. @*Conclusion@#Both the HPSD and the conventional ablation method resulted in post-ablation vagal modification as evidenced by the shortening of SCL, BCL, and ERP of the AVN. One-year recurrence of atrial flutter and AF/atrial flutter was higher in patients who underwent the HPSD method.

Comparison between GlideRite® rigid stylet and Parker Flex-It™ stylet to facilitate GlideScope intubation in simulated difficult intubation: a randomized controlled study

The GlideScope® videolaryngoscope (GVL) is widely used in patients with difficult airways and provides a good glottic view. However, the acute angle of the blade can make insertion and advancement of an endotracheal tube (ETT) more difficult than direct laryngoscopy, and the use of a stylet is recommended. This randomized controlled trial compared Parker Flex-It™ stylet (PFS) with GlideRite® rigid stylet (GRS) to facilitate intubation with the GVL in simulated difficult intubations. Methods: Fifty-four patients were randomly allocated to undergo GVL intubation using either GRS (GRS group) or PFS (PFS group). The total intubation time (TIT), 100-mm visual analog scale (VAS) for ease of intubation, success rate at the first attempt, use of laryngeal manipulation, tube advancement rate by assistant, and complications were recorded. Results: There was no significant difference between the GRS and PFS groups regarding TIT (50.3 ± 12.0 s in the GRS group and 57.8 ± 18.8 s in the PFS group, P = 0.108). However, intubation was more difficult in the PFS group than in the GRS group according to VAS score (P = 0.011). Cases in which the ETT was advanced from the stylet by an assistant, were more frequent in the GRS group than in the PFS group (P = 0.002). The overall incidence of possible complications was not significantly different. Conclusions: In patients with a simulated difficult airway, there was no difference in TIT using either the PFS or GRS. However, endotracheal intubation with PFS is more difficult to perform than GRS.

Comparison of one-jaw and two-jaw orthognathic surgery in patients with skeletal Class III malocclusion using data from 10 multi-centers in Korea: Part I. Demographic and skeletodental characteristics / 대한치과교정학회지

Objective@#To investigate demographic and skeletodental characteristics of one-jaw (1J-OGS) and two-jaw orthognathic surgery (2J-OGS) in patients with skeletal Class III malocclusion. @*Methods@#750 skeletal Class III patients who underwent OGS at 10 university hospitals in Korea between 2015 and 2019 were investigated; after dividing them into the 1J-OGS (n = 186) and 2J-OGS groups (n = 564), demographic and skeletodental characteristics were statistically analyzed. @*Results@#2J-OGS was more frequently performed than 1J-OGS (75.2 vs. 24.8%), despite regional differences (capital area vs. provinces, 86.6 vs. 30.7%, p 0.05). The most prevalent skeletal patterns in both groups were hyper-divergent pattern (50.0 and 54.4%, respectively) and left-side chin point deviation (both 49.5%).Maxillary spacing (odds ratio [OR], 3.645; p < 0.001) increased the probability of 2J-OGS, while maxillary crowding (OR, 0.672; p < 0.05) and normo-divergent pattern (OR, 0.615; p < 0.05) decreased the probability of 2J-OGS. @*Conclusions@#In both groups, males outnumbered females, and their mean operation age was older. The most frequent ALD was crowding in the 1J-OGS group, and spacing in the 2J-OGS group, while skeletal characteristics were not significantly different between the two groups.

Part II. What drives Korean adults to seek orthodontic treatment: Factors contributing to orthodontic treatment decisions / 대한치과교정학회지

Objective@#This study aimed to identify the perceptions of orthodontic treatment among Korean adults and determine the factors that drive them to seek orthodontic treatment. @*Methods@#A total of 2,321 adults aged 19–64 years were surveyed using an internet research system from a specialized research company. The participants were divided into the following groups based on their experience of and willingness to undergo orthodontic treatment: experience, acceptance, and non-acceptance groups. The characteristics of the participants were compared using analysis of variance with post-hoc analysis.Multinomial logistic regression analysis was performed in all three models with the non-acceptance group as a reference. @*Results@#In terms of demographic characteristics, age, gender, marital status, and education had significant influences on orthodontic treatment decisions in adults in the experience and acceptance groups (p < 0.001). When all the factors were analyzed, age, marital status, past dental treatment experience, regular oral examinations, demand for orthodontic treatment, optimal treatment period, health insurance coverage, information on orthodontic treatments, perceptions regarding orthodontic treatment, and psychosocial impact of dental esthetics significantly influenced orthodontic treatment decisions in adults in the experience and acceptance groups (p < 0.001). @*Conclusions@#These findings suggest that various factors influence orthodontic treatment decisions in adults. Individuals who seek orthodontic treatment were found to undergo more regular dental treatment and oral examination than those who did not. They also had a better perception of orthodontic treatment and more negative values for the psychosocial impact of dental esthetics.

Esophageal Thermal Injury after Catheter Ablation for Atrial Fibrillation with High-Power (50 Watts) Radiofrequency Energy

Background and Objectives@#Data regarding the safety of atrial fibrillation (AF) ablation using high-power (50 W) radiofrequency (RF) energy in Asian populations are limited. This study was conducted to evaluate the incidence and pattern of esophageal injury after highpower AF ablation in an Asian cohort. @*Methods@#We searched the prospective AF ablation registry to identify patients who underwent AF ablation with 50 W RF energy using the smart touch surround flow catheter (Biosense Webster, Diamond Bar, CA, USA). Visitag™ (Biosense Webster) was used for lesion annotation with predefined settings of catheter stability (3 mm for 5 seconds) and minimum contact force (50% of time >5 g). All patients underwent upper gastrointestinal endoscopy at 1 or 3 days after the ablation. @*Results@#A total of 159 patients (mean age: 63±9 years, male: 69%, paroxysmal AF: 45.3%, persistent AF: 27.7%, long-standing persistent AF: 27.0%) were analyzed. Initially, 26 patients underwent pulmonary vein isolation with 50 W for 5 seconds at each point. The remaining 133 patients underwent prolonged RF duration (anterior 10 seconds and posterior 6 seconds). The incidence rates of esophageal erythema/erosion and superficial ulceration were 1.3% for each type of the lesion. Food stasis, a suggestive finding of gastroparesis, was observed in 25 (15.7%) patients. There were no cases of cardiac tamponade, stroke, or death. @*Conclusions@#In Asian patients, AF ablations using 50 W resulted in very low rates of mild esophageal complications.

Part II. What drives Korean adults to seek orthodontic treatment: Factors contributing to orthodontic treatment decisions / 대한치과교정학회지

Objective@#This study aimed to identify the perceptions of orthodontic treatment among Korean adults and determine the factors that drive them to seek orthodontic treatment. @*Methods@#A total of 2,321 adults aged 19–64 years were surveyed using an internet research system from a specialized research company. The participants were divided into the following groups based on their experience of and willingness to undergo orthodontic treatment: experience, acceptance, and non-acceptance groups. The characteristics of the participants were compared using analysis of variance with post-hoc analysis.Multinomial logistic regression analysis was performed in all three models with the non-acceptance group as a reference. @*Results@#In terms of demographic characteristics, age, gender, marital status, and education had significant influences on orthodontic treatment decisions in adults in the experience and acceptance groups (p < 0.001). When all the factors were analyzed, age, marital status, past dental treatment experience, regular oral examinations, demand for orthodontic treatment, optimal treatment period, health insurance coverage, information on orthodontic treatments, perceptions regarding orthodontic treatment, and psychosocial impact of dental esthetics significantly influenced orthodontic treatment decisions in adults in the experience and acceptance groups (p < 0.001). @*Conclusions@#These findings suggest that various factors influence orthodontic treatment decisions in adults. Individuals who seek orthodontic treatment were found to undergo more regular dental treatment and oral examination than those who did not. They also had a better perception of orthodontic treatment and more negative values for the psychosocial impact of dental esthetics.

Esophageal Thermal Injury after Catheter Ablation for Atrial Fibrillation with High-Power (50 Watts) Radiofrequency Energy

Background and Objectives@#Data regarding the safety of atrial fibrillation (AF) ablation using high-power (50 W) radiofrequency (RF) energy in Asian populations are limited. This study was conducted to evaluate the incidence and pattern of esophageal injury after highpower AF ablation in an Asian cohort. @*Methods@#We searched the prospective AF ablation registry to identify patients who underwent AF ablation with 50 W RF energy using the smart touch surround flow catheter (Biosense Webster, Diamond Bar, CA, USA). Visitag™ (Biosense Webster) was used for lesion annotation with predefined settings of catheter stability (3 mm for 5 seconds) and minimum contact force (50% of time >5 g). All patients underwent upper gastrointestinal endoscopy at 1 or 3 days after the ablation. @*Results@#A total of 159 patients (mean age: 63±9 years, male: 69%, paroxysmal AF: 45.3%, persistent AF: 27.7%, long-standing persistent AF: 27.0%) were analyzed. Initially, 26 patients underwent pulmonary vein isolation with 50 W for 5 seconds at each point. The remaining 133 patients underwent prolonged RF duration (anterior 10 seconds and posterior 6 seconds). The incidence rates of esophageal erythema/erosion and superficial ulceration were 1.3% for each type of the lesion. Food stasis, a suggestive finding of gastroparesis, was observed in 25 (15.7%) patients. There were no cases of cardiac tamponade, stroke, or death. @*Conclusions@#In Asian patients, AF ablations using 50 W resulted in very low rates of mild esophageal complications.

Effect of two-week continuous epidural administration of 2% lidocaine on mechanical allodynia induced by spinal nerve ligation in rats

Background@#Lidocaine is an effective against certain types of neuropathic pain. This study aimed to investigate whether timing of initiating continuous epidural infusion of lidocaine affected the glial activation and development of neuropathic pain induced by L5/6 spinal nerve ligation (SNL) in rats. @*Methods@#Following L5/6 SNL, rats were epidurally infused 2% lidocaine (drug infusion initiated on days 1, and 7 post SNL model establishment) or saline (saline infusion initiated on day 1 post SNL model establishment) continuously for 14 days. Mechanical allodynia of the hind paw to von Frey filament stimuli was determined prior to surgery, postoperative day 3, and once weekly after SNL model establishment. At 7 days after the infusion of saline or lidocaine ended, spinal activation of proinflammatory cytokines and astrocytes was evaluated immunohistochemically, using antibodies to interleukin-6 (IL-6) and glial fibrillary acidic protein (GFAP). @*Results@#Continuous epidural administration of 2% lidocaine for 14 days increased the mechanical withdrawal threshold regardless of the difference in timing of initiating lidocaine administration. Epidurally infusing 2% lidocaine inhibited nerve ligation-induced IL-6 and GFAP activation. In the 2% lidocaine infusion group, rats maintained the increased mechanical withdrawal threshold even at 7 days after the discontinuation of 2% lidocaine infusion. @*Conclusions@#Continuous epidural administration of 2% lidocaine inhibited the development of SNL-induced mechanical allodynia and suppressed IL-6 and GFAP activation regardless of the difference in timing of initiating lidocaine administration.

Clinical outcomes after pulmonary vein isolation using an automated tagging module in patients with paroxysmal atrial fibrillation

Background@#An automated tagging module (VISITAG™; Biosense Webster, Irvine, CA) allows objective demonstration of energy delivery. However, the effect of VISITAG™ on clinical outcomes remains unclear. This study evaluated (1) clinical outcome after AF ablation using VISITAG™ and (2) the prevalence of gaps in the ablation line. @*Methods@#This retrospective analysis included 157 consecutive patients (mean age, 56.7 years; 73.2% men) with paroxysmal atrial fibrillation who underwent successful PVI between 2013 and 2016. Outcomes after the index procedure were compared between those using the VISITAG™ module (VISITAG group, n = 62) and those not using it (control group, n = 95). The primary outcome was recurrence of AF or atrial tachycardia after a blanking period of 3 months. @*Results@#The VISITAG group showed significantly shorter overall procedure time (172.2 ± 37.6 min vs. 286.9 ± 66.7 min, P  15 s,  60% force over time, > 6 g contact force) showed higher recurrence-free survival rate compared with those with gaps (borderline statistical significance, 91.7% vs. 66.0%, P = 0.094). @*Conclusion@#Use of the VISITAG™ module significantly reduced procedure, ablation, and fluoroscopic times with a similar AF/AT recurrence rate compared with the conventional ablation. Clinical implications of minimizing gaps along the ablation line should be evaluated further in the future prospective studies.

Biomarkers and Associated Immune Mechanisms for Early Detection and Therapeutic Management of Sepsis

Sepsis is conceptually defined as life-threatening organ dysfunction that is caused by a dysregulated host response to infection. Although there has been significant advancement in recent decades in defining and understanding sepsis pathology, clinical management of sepsis is challenging due to difficulties in diagnosis, a lack of reliable prognostic biomarkers, and treatment options that are largely limited to antibiotic therapy and fundamental supportive measures. The lack of reliable diagnostic and prognostic tests makes it difficult to triage patients who are in need of more urgent care. Furthermore, while the acute inpatient treatment of sepsis warrants ongoing attention and investigation, efforts must also be directed toward longer term survival and outcomes. Sepsis survivors experience incomplete recovery, with long-term health impairments that may require both cognitive and physical treatment and rehabilitation. This review summarizes recent advances in sepsis prognosis research and discusses progress made in elucidating the underlying causes of prolonged health deficits experienced by patients surviving the early phases of sepsis.

Part I. What drives Korean adults to seek orthodontic treatment: Reliability and validity of a measurement instrument for the perception of orthodontic treatment / 대한치과교정학회지

Objective@#To develop a standardized instrument to measure the level of cognition for orthodontic treatment in adults, and verify its reliability and validity for assessing perceptions of orthodontic treatment in adults. @*Methods@#A total of 406 adults aged 19–64 years were surveyed by an internet research system. A tool was developed through the instrument development and verification stages. The data were analyzed by correlation analysis, exploratory factor analysis, confirmatory factor analysis, and Cronbach’s α test. @*Results@#The instrument consisted of 11 items covering four factors related to orthodontic treatment. Three items were related to general perception, four described the perception of the treatment for adults, two related to the treatment effects, and two related to the retention of orthodontic treatment. In the reliability test, Cronbach’s α was 0.845 for the 11 items. In assessments for individual components, Cronbach’s α was 0.764 for the general perception of orthodontic treatment, 0.705 for the perception of this treatment for adults, 0.707 for the effects of the treatment, and 0.701 for the retention of orthodontic treatment.Finally, a measurement instrument for the perception of orthodontic treatment in adults was designed to assess the 11 items on a four-point Likert scale. @*Conclusions@#This study developed a standard measurement instrument for assessing the perception of orthodontic treatment in adults. The proposed instrument will enable additional studies on the influence of an adult’s perception of orthodontic treatment on the decision to undergo treatment.

Onychopapilloma Presenting as Erythronychia and Leukonychia: Dermoscopic Features of Two Cases in Korea

No abstract available.

Terra Firma-Forme Dermatosis Developed after Thyroidectomy: Clinical and Dermoscopic Features

No abstract available.

Pigmented Onychomatricoma Showing a Longitudinal Melanonychia: A Case Report and Brief Review of Literature

No abstract available.

Intraoperative airway obstruction caused by dissection of the internal wall of a reinforced endotracheal tube: A case report

Endotracheal intubation is the gold standard for airway management in general anesthesia. However, airway patency is not guaranteed by keeping the endotracheal tube (ETT) in place. Sometimes, the ETT itself may become a cause of airway obstruction; there are some reports on airway obstruction related to reinforced tube malfunction. We report a rare case with an obstruction of reinforced endotracheal tubes caused by dissection of the internal wall. Recognition of the possibility of airway obstruction due to a rare cause and monitoring patients vigilantly during anesthesia is very important for patient safety.

Intraoperative airway obstruction caused by dissection of the internal wall of a reinforced endotracheal tube: A case report

Endotracheal intubation is the gold standard for airway management in general anesthesia. However, airway patency is not guaranteed by keeping the endotracheal tube (ETT) in place. Sometimes, the ETT itself may become a cause of airway obstruction; there are some reports on airway obstruction related to reinforced tube malfunction. We report a rare case with an obstruction of reinforced endotracheal tubes caused by dissection of the internal wall. Recognition of the possibility of airway obstruction due to a rare cause and monitoring patients vigilantly during anesthesia is very important for patient safety.

Effect of Harderian adenectomy on the statistical analyses of mouse brain imaging using positron emission tomography

Positron emission tomography (PET) using 2-deoxy-2-[18F] fluoro-D-glucose (FDG) as a radioactive tracer is a useful technique for in vivo brain imaging. However, the anatomical and physiological features of the Harderian gland limit the use of FDG-PET imaging in the mouse brain. The gland shows strong FDG uptake, which in turn results in distorted PET images of the frontal brain region. The purpose of this study was to determine if a simple surgical procedure to remove the Harderian gland prior to PET imaging of mouse brains could reduce or eliminate FDG uptake. Measurement of FDG uptake in unilaterally adenectomized mice showed that the radioactive signal emitted from the intact Harderian gland distorts frontal brain region images. Spatial parametric measurement analysis demonstrated that the presence of the Harderian gland could prevent accurate assessment of brain PET imaging. Bilateral Harderian adenectomy efficiently eliminated unwanted radioactive signal spillover into the frontal brain region beginning on postoperative Day 10. Harderian adenectomy did not cause any post-operative complications during the experimental period. These findings demonstrate the benefits of performing a Harderian adenectomy prior to PET imaging of mouse brains.

Deep Vein Thrombosis Due to Hematoma as a Rare Complication after Femoral Arterial Catheterization / 영남의대학술지

Hematoma is quite a common complication of femoral arterial catheterization. However, to the best of our knowledge, there have been no previous studies regarding deep vein thrombosis (DVT) caused by compression of a vein due to a hematoma. We report a case of a hematoma developing after femoral arterial catheterization and causing extensive symptomatic DVT. A 59-year-old male was seen in our Emergency Department with right lower leg swelling 15 days after coronary stent implantation performed using right femoral artery access. Computed tomographic (CT) scanning revealed a large hematoma (45 mm in its longest diameter) compressing the common femoral vein and with DVT from the right external iliac vein to the popliteal vein. Due to the extensive DVT involvement, we decided to release the compressed common femoral vein by surgical evacuation of the large hematoma. However, even following evacuation of the hematoma, as the DVT did not resolve soon, further mechanical thrombectomy and catheter-directed thrombolysis were performed. Angiography then showed nearly resolved DVT, and the leg swelling was improved. The patient was discharged with the anticoagulation medication, warfarin.

A Case of Acute Recurrent Pancreatitis Caused by Proximal Migration of a Prophylactic Pancreatic Stent / 대한내과학회지

Acute pancreatitis is one of the most common complications of endoscopic retrograde cholangiopancreatography (ERCP). Prophylactic pancreatic stents are effective for reducing the risk for post-ERCP pancreatitis in high-risk patients. However, an unretrieved pancreatic stent, as a result of proximal migration, can cause pancreatitis. We experienced a case of recurrent acute pancreatitis associated with a pancreatic ductal leak and stricture due to proximal migration of a prophylactic stent in a patient with suspected acute gallstone pancreatitis. We endoscopically retrieved the proximally migrated stent and inserted a new pancreatic stent. Follow-up pancreatic imaging showed that the pancreatitis and pancreatic ductal leak/stricture had resolved.