Clinical Evaluation of Conditioned Media of Human Umbilical Cord Blood Mesenchymal Stem Cells for Improvement of Symptoms of Sensitive Skin: Prospective, Single Blinded, Split-face Study

Background@#The exact definition of sensitive skin is not established yet. Since its high prevalence and significant influence on quality of life, it has become an important topic of research. Among various ingredients, conditioned media from umbilical cord blood-derived mesenchymal stem cells (UCB-MSC-CM) can be a promising source for the treatment of sensitive skin. @*Objective@#We evaluated the efficacy and safety of UCB-MSC-CM on patients with sensitive skin. @*Methods@#We designed a randomized, single blinded, prospective, split-face comparison study and enrolled thirty patients. All patients underwent nonablative fractional laser over the entire face before UCB-MSC-CM or normal saline was applied. Each facial area was randomly assigned to undergo treatment with either UCB-MSC-CM or normal saline. We performed three sessions at two-week intervals, and final results were assessed on six weeks after the last session. As an outcome measure, we evaluated a five-point global assessment scale, transepidermal water loss (TEWL), erythema index (EI) and Sensitive Scale-10. Twenty seven subjects were included in final analysis. @*Results@#The treated side exhibited greater improvement compared to the untreated side based on a five-point global assessment scale. TEWL, EI of the treated side were significantly lower than those of the untreated side throughout study period. Sensitive Scale-10 was significantly improved after treatment. @*Conclusion@#The application of UCB-MSC-CM resulted in improved skin barrier function and reduced inflammatory responsiveness, which could provide beneficial effect on sensitive skin.

Dabigatran Toxicity Secondary to Acute Kidney Injury

Dabigatran is the first oral direct thrombin inhibitor approved by the US Food and Drug Administration (FDA) for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Because dabigatran is excreted mainly by the kidneys, serum levels of dabigatran can be elevated to a supratherapeutic range in patients with renal failure, predisposing to emergent bleeding. We describe the case of a 66-year-old man taking dabigatran 150 mg twice daily for atrial fibrillation and cerebral infarction who presented with hematochezia and disseminated intravascular coagulation. Laboratory evaluation showed a hemoglobin level of 6.3 g/dL, platelets of 138,000/mm3, activated partial thromboplastin time (aPTT) of 10?s, and an international normalized ratio (INR) of 8.17. Colonoscopy showed a bleeding anal fissure. Hemostasis was provided by hemoclips and packed red blood cells and fresh frozen plasma were transfused. Since then, there was no further hematochezia, however, bleeding including oral mucosal bleeding, hematuria, and intravenous site bleeding persisted. At presentation, his serum creatinine was 4.96 mg/dL (baseline creatinine, 0.9 mg/dL). Dabigatran toxicity secondary to acute kidney injury was presumed. Because acute kidney injury of unknown cause was progressing after admission, he was treated with hemodialysis. Fresh frozen plasma transfusion was provided with hemodialysis. At 15 days from admission, there was no further bleeding, and laboratory values, including hemoglobin, partial thromboplastin time, and prothrombin time were normalized. He was discharged without bleeding. After 2 months, he undergoes dialysis three times per week and no recurrence of bleeding has been observed.

Heart Rate Variability during Propofol-Remifentanil TCI Induction in Diabetic Patients / 대한마취과학회지

BACKGROUND: The aim of this study was to compare heart rate variability (HRV) changes between diabetics and non-diabetics throughout induction with maintaining BIS 40-60 by propofol-remifentanil target controlled infusion. METHODS: Non-diabetic patients (n = 12) and non-insulin dependent diabetes mellitus (NIDDM) patients (n=12) were recruited. Anesthesia was induced by target controlled infusion of propofol and remifentanil. Target effect-site concentration of propofol was adjusted to maintain bispectral index (BIS) 40-60, and target effect-site concentration of remifentanil was adjusted to maintain blood pressure (BP) within 20% of baseline value. The HRV was recorded at resting, after glycopyrrolate injection, during BIS 40-60, and after intubation. Log-transformed power spectrum (ms2) of TP (total power, < or = 0.4 Hz), LF (low frequency, 0.04-0.15 Hz), HF (high frequency, 0.15-0.4 Hz), LFnorm (normalized LF, LF/[LF + HF]), HFnorm (normalized HF, HF/[LF + HF]), and LF/HF ratio were compared. RESULTS: Initial LnTP, LnLF, and LnHF was significantly lower in diabetics (P < 0.05). During BIS 40-60, LnTP, LnLF, and LnHF in non-diabetics decreased significantly (P < 0.05). Immediately after intubation, LnLF, LnHF in non-diabetics, and LnHF in diabetics decreased significantly (P < 0.05). LF/HF ratio showed no significant change throughout induction. Systolic, diastolic BP, mean arterial pressure, and heart rate have no significant differences between the groups. CONCLUSIONS: This study suggests that hemodynamic variables and balance of autonomic nervous system measured by HRV can not be altered during induction, by adjusting effect site concentration of propofol and remifentanil in accordance with BIS and BP in diabetic patients.

Changes in Heart Rate Variability in Elderly Hypertensive Patients during Combined Spinal-Epidural Anesthesia / 대한마취과학회지

BACKGROUND: We evaluated the changes in heart rate variability (HRV) in elderly patients with or without hypertension before and after combined spinal-epidural anesthesia (CSE). METHODS: Elderly hypertensive (group H, n = 28) and non-hypertensive patients (group C, n = 32) were recruited. We analyzed the spectral components of HRV, total power ( or = T6 [H]) according to fixed analgesia level. RESULTS: Before CSE, group H showed significantly lower LnLF than that of group C (P < 0.05). Fifteen and 10 min after CSE, decrease of SBP and increase of HR in group HH were significantly greater compared with group CL and lesser with group CH, respectively. LnTP, LnLF and LnHF in both control groups (CL and CH) were significantly decreased 15-20 min after CSE compared with pre-CSE values. LnLF and LnHF in group HH were significantly lower than those in group HL 10-15 min after CSE. But there were no significant changes of LFnorm, HFnorm and LF/HF in all four groups. CONCLUSIONS: The group H showed significantly lower LnLF than that of group C before CSE. In group HH, LnLF and LnHF were significantly lower than those in group HL 10-15 min after CSE, but the balance of the autonomic nervous system was not changed significantly.

Validity and Reliability of Self-Report in Cancer Screening

BACKGROUND: The study was aimed to examine the validity and the reliability of self-report of gastric cancer screening (endoscopy or upper GI), mammography, and Pap smear. METHODS: The study subjects for validity included those who had undergone 276 endoscopies or UGIs, 127 mammograms, and 125 Pap smears performed at a health promotion center of P and I university hospital during January 1, 1999 to June 30, 1999 and January 1, 2002 to June 30, 2002. The study subjects for reliability included those who had undergone 86 endoscopies or UGIs, 31 mammograms, and 33 Pap smears who went through two surveys. The data was collected by mail or telephone interview. We calculated the sensitivity of self-reports by comparing the self-report and the laboratory results as a gold standard, and the agreement between repeateds reportings. RESULTS: The sensitivities based on the test year were 49.3% for gastric cancer screening, 56.7% for mammography, and 53.6% Pap smear, and the sensitivities on the test month were 39.1%, 45.7%, and 46.4%, respectively. The agreement between the two self-reporting on the test year were 59.6% for gastric cancer screening, 67.7% for mammography, and 63.6% Pap smear, and the agreement on the test month were 82.3% for gastric cancer screening, 74.2% for mammography, and 72.7% for Pap smear. CONCLUSION: Self-report alone may not provide accurate or reliable data on the cancer screening compliance. It is recommended to utilize other objective data for cancer screening. And it would be helpful to utilize a memo-book as a reminder to screen for cancer in order to enhance the validity and the reliability of self-report.

Screening for High Risk Population of Dementia and Development of the Preventive Program Using Web / 간호학회지

PURPOSE: This study was to develop a screening model for identifying a high risk group of dementia and to develop and evaluate the web-based prevention program. METHOD: It was conducted in 5 phases. 1) Data were collected from dementia patients and non-dementia patients in a community. 2) A screening model of the high risk population was constructed. 3) The validity test was performed and the model was confirmed. 4) Four weeks-prevention program was developed. 5) The program was administered, and evaluated the effects. RESULT: The model consisted of age, illiteracy, history of stroke and hypercholesterolemia. The program was designed with 12 sessions, group health education using web-based individual instruction program, and 12 sessions of low-intensity physical exercise program. After the completion, their self-efficacy, and health behaviors in experimental group were significantly improved over those in the control group. The perceived barrier in the treatment group is significantly decreased. CONCLUSION: The screening model developed is very simple and can be utilized in diverse community settings. And the web based prevention program will encourage individual learning and timely feedback, therefore it can facilitate their active participation and promote health management behaviors at home.

The Validity of a Questionnaire on Juvenile Smoking Status through Urine Nicotine Detection

BACKGROUND: In comparison to the decreasing smoking rate of adults, the smoking rate in adolescents and women is still increasing worldwide including Korea. Previous studies on the smoking rate of adolescents were done by questionnaires allowing bias in their response because of smoking ban among adolescents in Korea. In order to know the actual smoking rate of Korean adolescents, we performed an objective study using urine nicotine detection. METHODS: From April to July 2002, 306 boy's high school students and 325 girl's high school students in Seoul were included for this study. We obtained self-reported questionnaire from them and assessed urine nicotine level by NicCheck I Test Strip to check their actual smoking status. RESULTS: The current smoking rate of male students by self-reported questionnaire was 14.9%, 20.4%, 22.5%, respectively and that by detection of urine nicotine was 26.6%, 38.0%, 29.6%, respectively, in the 1st, 2nd and 3rd grade. The current smoking rate of female students by self-reported questionnaire was 22.6%, 23.9%, respectively and that by detection of urine nicotine was 46.6%, 35.4%, respectively in the 2nd and 3rd grade. The Kappa index of the questionnaire results was 0.27, 0.46, 0.75, respectively in the 1st, 2nd and 3rd grade male students and 0.33, 0.44, respectively in the 2nd and 3rd grade female students respectively. CONCLUSION: The smoking rate of students by detection of urine nicotine was higher than that of the self-reported questionnaire results. The validity of the questionnaire results was more accurate in males than females, and higher grade than lower grade. The self-reported questionnaire was an insufficient tool for evaluation of adolescents' smoking status, especially in female students and lower grade students.

The Correlation of Lean Body Mass with Muscle Function in Duchenne Muscular Dystrophy

OBJECTIVE: To evaluate the relationship between the lean body mass and muscle function in patients with Duchenne muscular dystrophy (DMD). METHOD: The subjects were thirty two DMD patients and an age-matched twelve healthy control volunteers. The DMD patients were divided into two groups; ambulatory and non-ambulatory groups. The body composition with dual energy X-ray absorptiometry (DEXA), body mass index (BMI) and functional state of all subjects were measured. RESULTS: There was no significant difference in BMI among all groups. The non-ambulatory DMD group was siginificantly higher in total body fat (%) compared with other two groups (p<0.05). The mean lean body mass (%) for upper extremities did not show the significant difference; however, for lower extremities, there was a significantly lower in DMD groups (p<0.05). These findings were corresponded with low muscle functional state for lower extremities in DMD groups. CONCLUSION: There was a significant correlation between muscle function and the percentage of mean lean body mass. The assessment of lean body mass by DEXA provides more accurate and reliable information about the muscle function in DMD.

The Effect of Vertebral Endplate Area and Shape in the Patients with Lumbar Herniated Intervertebral Disc

OBJECTIVE: To determine whether the area and the shape of the vertebral body endplate in the magnetic resonance image (MRI) findings were risk factors for the development of symptomatic herniated lumbar intervertebral disc. METHOD: Sixty patients of low back pain with the age below 60 were enrolled. They didn't have spondylolisthesis or the history of spine surgery. MRI films of these patients were reviewed. Anteroposterior and transverse diameter of endplates, height of vertebral body and intervertebral discs were measured. The relation of these data and intervertebral disc herniation, body weight, height, body mass index (BMI) were statistically studied. RESULTS: Patients' weight, BMI, the vertebral body area and the shape of the endplate were related to disc herniations. Furthermore, the larger and circular vertebral body was observed in the patients with disc herniation. In the patients with lower back pain, men were diagnosed disc herniations of the MRI finding more than women. CONCLUSION: In anatomical aspect, the area and the shape of the vertebral body at the endplate level were important factors contributing to the development of disc herniations at L4-L5 and L5-S1.

The Investigation of the Pain after the Orthotic Treatment in Adolescent Idiopathic Scoliosis

OBJECTIVE: The purpose of this study was to investigate the pain after the orthotic management in adolescent idiopathic scoliosis patients. METHOD: We retrospectively reviewed the medical records and radiographs of all patients with idiopathic scoliosis seen in our institution from March, 1997 to February, 2002. Inclusion criteria in this study included a diagnosis of adolescent idopathic scoliosis, with no history of back pain before brace prescription, with Cobb's angle 15-degree or more. All subjects were educated to do scoliosis correction exercise, educated for correct posture, and to wear the orthosis over 22 hours per day, even during sleeping. RESULTS: Forty-nine subjects were reviewed, treated with the orthosis. We found that pain regions occurring after institution of modified Boston orthosis were chest wall (contacting with pad), lower back, neck and pelvis orderly. We also found that aggravation of Cobb's angle in patients with pain more than without pain, but any disease was not found in the former. CONCLUSION: There were no serious conditions with the patients who had the pain after institution of the modified Boston orthosis, but the pain was often associated with curve progression in adolescent idiopathic scoliosis patients.

Clinical Profile of Duchenne Muscular Dystrophy

OBJECTIVE: To evaluate clinical features in general and possible complications in Duchenne muscular dystrophy (DMD) which could be used for comprehensive rehabilitation management. METHOD: One hundred and seventy-two patients with DMD were followed over 3 year period to provide clinical profile causing impairment and disability. We measured height, weight and manual muscle testing (MMT) when the patients visited the hospital. And we could measure pulmonary function, electrocardiogram (EKG), and intelligence quotient (IQ) test in cooporative patients. RESULTS: The median height and weight of DMD boys were normally distributed before age 12, but during the second decade height was markedly reduced, and weight was no longer normally distributed. The MMT measurement showed loss of strength in a fairly linear fashion according to increasing age, and extensor of lower extremities were weaker than flexors showing typical contractures of legs. There was a direct relationship between pulmonary function and MMT scores of upper extremities. There was a high occurrence (40%) of abnormal EKG, but none of the patients had a history of cardiovascular complication. DMD children suffered wide spectrum of psychological disturbance such as somatic complaints, attention and emotional problems in addition to expected psychological problems due to chronic disease and its progression, and 50.9% of them were below average on the IQ test. CONCLUSION: These data on DMD subjects provide clinicians with useful information regarding the prevalence and severity of measurable impairment at different stages of the disease.

Laparoscopic Inguinal Herniorraphy with an Extracorporea Suturing Needle

This report describes an innovative and effective application of the extracorporeal suturing needle (ESN) to perform a laparoscopic inguinal herniorraphy. Between 1/1/96 and 12/31/96, we treated 23 patients with inguinal hernia using this suturing needle uniquely designed by Nahm-gun Oh. This new technique and device allow sutures to be made in the tissues near the floor of the internal inguinal canal without exposing the area while the movement of the ESN is observed with a laparoscopic camera. In 16 patients, the internal inguinal ring was ligated and fixed medially to the fascial root of the inferior epigastric vessels and to laterally the internal oblique muscle, using the ESN. In 5 patients with large inguinal hernias, the sutures were placed to force the inguinal canal with intraperitoneal onlay mesh fixation to the fascia, using the ESN, causing a narrowing of the internal inguinal canal. In 2 patients with inguinal hernias, the peritoneum of the internal inguinal ring was closed and laterally fixed to the internal oblique muscle by using the ESN. The ESN has been used successfully in 96% of the patients with inguinal hernias. One patient had a recurrence of the hernia. No permanent complications were seen in the patients involved in this study. Some transient postoperative complications included groin pain (21%), urinary retention (13%), and abdominal wall hematoma (9%). In four patients (17%), contralateral inguinal hernias were discovered during their operations and were corrected using the same procedures. We conclude that the extracorporeal suturing needle was safely and effectively used in laparoscopic inguinal herniorrhaphies and should be considered for use in laparoscopic herniorrhaphies and other laparoscopic surgeries.