Exploratory Structural Equation Modeling Analysis of the Social Network Site Use Motives Scale

Objective@#Social Network Site Use Motives Scale (SUMS) was developed under the assumption that it consists of six factors, but only four factors were extracted as a result of Exploratory Factor Analysis. The goal of the present study was to investigate whether SUMS consists of four or six factors using Confirmatory Factor Analysis (CFA) and Exploratory Structural Equation Modeling (ESEM) approach. @*Methods@#A Korean college student sample (n=600; mean age, 21 years; 58% female) filled out the SUMS and the Social Network Site Addiction Proneness Scale. CFA and ESEM were used to assess the factor structure of the SUMS. @*Results@#Results indicated that a four-factor solution to the SUMS had inadequate fit in the sample examined using both CFA and ESEM and a six-factor solution to the SUMS had insufficient fit using CFA, whereas fit was optimal using ESEM for the six-factor model. In addition, the scale showed adequate convergent validity and reliability. @*Conclusion@#These findings support the six-factor model of SNS use motives and suggest that ESEM is a more appropriate method than CFA for examining the factor structure of the SUMS. The results displayed the usefulness of the ESEM framework in the investigation of use motives.

Psychometric Properties of the Mental Health Continuum-Short Form (MHC-SF): A Study With Individuals With Schizophrenia Living in the Community

Objective@#The Mental Health Continuum-Short Form (MHC-SF) is widely used to measure positive mental health. This study is the first to examine the psychometric properties of the MHC-SF in persons with schizophrenia living in the community. @*Methods@#Two hundred thirty-one individuals with schizophrenia living in the community in South Korea filled out the MHC-SF. Confirmatory factor analysis (CFA), bifactor CFA, exploratory structural equation modeling (ESEM), and bifactor ESEM were undertaken to examine the factor structure of the MHC-SF. @*Results@#Results showed that a three-factor bifactor ESEM model yielded better fit than the other alternative models. Indices of internal consistency reliability were acceptable. @*Conclusion@#The results suggest that bifactor ESEM is an appropriate analysis for examining the factor structure of the MHC-SF in individuals with schizophrenia. The findings support the use of the overall MHC-SF scale rather than the use of the subscales in people with schizophrenia.

Intraoperative Neurophysiologic Testing of the Perigastric Vagus Nerve Branches to Evaluate Viability and Signals along Nerve Pathways during Gastrectomy

PURPOSE: The perigastric vagus nerve may play an important role in preserving function after gastrectomy, and intraoperative neurophysiologic tests might represent a feasible method of evaluating the vagus nerve. The purpose of this study is to assess the feasibility of neurophysiologic evaluations of the function and viability of perigastric vagus nerve branches during gastrectomy. MATERIALS AND METHODS: Thirteen patients (1 open total gastrectomy, 1 laparoscopic total gastrectomy, and 11 laparoscopic distal gastrectomy) were prospectively enrolled. The hepatic and celiac branches of the vagus nerve were exposed, and grabbing type stimulation electrodes were applied as follows: 10–30 mA intensity, 4 trains, 1,000 µs/train, and 5× frequency. Visible myocontractile movement and electrical signals were monitored via needle probes before and after gastrectomy. Gastrointestinal symptoms were evaluated preoperatively and postoperatively at 3 weeks and 3 months, respectively. RESULTS: Responses were observed after stimulating the celiac branch in 10, 9, 10, and 6 patients in the antrum, pylorus, duodenum, and proximal jejunum, respectively. Ten patients responded to hepatic branch stimulation at the duodenum. After vagus-preserving distal gastrectomy, 2 patients lost responses to the celiac branch at the duodenum and jejunum (1 each), and 1 patient lost response to the hepatic branch at the duodenum. Significant procedure-related complications and meaningful postoperative diarrhea were not observed. CONCLUSIONS: Intraoperative neurophysiologic testing seems to be a feasible methodology for monitoring the perigastric vagus nerves. Innervation of the duodenum via the celiac branch and postoperative preservation of the function of the vagus nerves were confirmed in most patients. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0000823

The Effects of Propofol and Thiopental Continuous Infusion on Serum Potassium Disturbances in Neurosurgical Patients

OBJECTIVE: The potassium disturbance associated with thiopental continuous infusion in neurosurgical patients is well known. However, the effect of propofol continuous infusion on serum potassium levels has not been investigated extensively. METHODS: We reviewed the medical records of 60 consecutive patients who received coma therapy or deep sedation for intracranial pressure control using either thiopental or propofol between January 2010 and January 2012. RESULTS: The overall incidence of hypokalemia (K5.0 mmol/L, 32.4% vs. 4.3%, p=0.010) and the peak potassium concentration (4.8 mmol/L vs. 4.2 mmol/L, p=0.037) after the cessation of therapy were higher in thiopental group. On multivariate analysis, thiopental [8.82 (1.00-77.81); p=0.049] and duration of continuous infusion [1.02 (1.00-1.04); p=0.016] were associated with rebound hyperkalemia once therapy was discontinued. CONCLUSION: Propofol was less frequently associated with moderate to severe hypokalemia after induction and rebound hyperkalemia following the cessation of continuous infusion than thiopental.

Comparison of Treatment Methods in Lumbar Spinal Stenosis for Geriatric Patient: Nerve Block Versus Radiofrequency Neurotomy Versus Spinal Surgery

OBJECTIVE: The incidence of spinal treatment, including nerve block, radiofrequency neurotomy, instrumented fusions, is increasing, and progressively involves patients of age 65 and older. Treatment of the geriatric patients is often a difficult challenge for the spine surgeon. General health, sociofamilial and mental condition of the patients as well as the treatment techniques and postoperative management are to be accurately evaluated and planned. We tried to compare three treatment methods of spinal stenosis for geriatric patient in single institution. METHODS: The cases of treatment methods in spinal stenosis over than 65 years old were analyzed. The numbers of patients were 371 underwent nerve block, radiofrequency neurotomy, instrumented fusions from January 2009 to December 2012 (nerve block: 253, radiofrequency neurotomy: 56, instrumented fusions: 62). The authors reviewed medical records, operative findings and postoperative clinical results, retrospectively. Simple X-ray were evaluated and clinical outcome was measured by Odom's criteria at 1 month after procedures. RESULTS: We were observed excellent and good results in 162 (64%) patients with nerve block, 40 (71%) patient with radIofrequency neurotomy, 46 (74%) patient with spinal surgery. Poor results were 20 (8%) patients in nerve block, 2 (3%) patients in radiofrequency neurotomy, 3 (5%) patient in spinal surgery. CONCLUSION: We reviewed literatures and analyzed three treatment methods of spinal stenosis for geriatric patients. Although the long term outcome of surgical treatment was most favorable, radiofrequency neurotomy and nerve block can be considered for the secondary management of elderly lumbar spinals stenosis patients.

Propofol Infusion Associated Metabolic Acidosis in Patients Undergoing Neurosurgical Anesthesia: A Retrospective Study

OBJECTIVE: Propofol and volatile anesthesia have been associated with metabolic acidosis induced by increased lactate. This study was designed to evaluate changes in pH, base excess (BE), and lactate in response to different anesthetic agents and to characterize propofol infusion-associated lactic acidosis. METHODS: The medical records of patients undergoing neurosurgical anesthesia between January 2005 and September 2012 were examined. Patients were divided into 2 groups : those who received propofol (total intravenous anesthesia, TIVA) and those who received sevoflurane (balanced inhalation anesthesia, BIA) anesthesia. Propensity analysis was performed (1 : 1 match, n=47), and the characteristics of the patients who developed severe acidosis were recorded. RESULTS: In the matched TIVA and BIA groups, the incidence of metabolic acidosis (11% vs. 13%, p=1) and base excess (p>0.05) were similar. All patients in the TIVA group who developed severe acidosis did so within 4 hours of the initiation of propofol infusion, and these patients improved when propofol was discontinued. CONCLUSIONS: The incidence of metabolic acidosis was similar during neurosurgical anesthesia with propofol or sevoflurane. In addition, severe acidosis associated with propofol infusion appears to be reversible when propofol is discontinued.

Unintended Complication of Intracranial Subdural Hematoma after Percutaneous Epidural Neuroplasty

Percutaneous epidural neuroplasty (PEN) is a known interventional technique for the management of spinal pain. As with any procedures, PEN is associated with complications ranging from mild to more serious ones. We present a case of intracranial subdural hematoma after PEN requiring surgical evacuation. We review the relevant literature and discuss possible complications of PEN and patholophysiology of intracranial subdural hematoma after PEN.

Sevoflurane versus propofol for interventional neuroradiology: a comparison of the maintenance and recovery profiles at comparable depths of anesthesia / 대한마취과학회지

BACKGROUND: Sevoflurane and propofol are used widely for interventional neuroradiology (INR). Using the bispectral index (BIS), we compared the clinical properties of sevoflurane and propofol anesthesia in patients undergoing INR at comparable depths of anesthesia. METHODS: The patients were allocated randomly into two groups. The sevoflurane group received propofol (1.5 mg/kg), alfentanil (5 microg/kg), and rocuronium (0.6 mg/kg) for induction, and the propofol group was induced with a target effect-site concentration of propofol (4 microg/ml), alfentanil (5 microg/kg), and rocuronium (0.6 mg/kg). After intubation, anesthesia was maintained with sevoflurane or propofol with 67% nitrous oxide in 33% oxygen. Sevoflurane and propofol concentrations were titrated to maintain the BIS at 50-60. Phenylephrine or opioid was used to maintain the mean arterial pressure within 20% of the baseline values. The amounts of phenylephrine or alfentanil used, the number of patients showing movement during the procedure, and the recovery times were recorded. RESULTS: Compared to the propofol group, the sevoflurane group showed faster recovery in spontaneous ventilation, eye opening, extubation, and orientation (4 vs. 7 min, 7 vs. 9 min, 8 vs. 10 min, 10 vs. 14 min, respectively; P < 0.01). In the propofol group, significantly greater amounts phenylephrine were used (P < 0.05), and more patients moved during the procedure (P < 0.05). CONCLUSIONS: The use of sevoflurane in maintaining anesthesia during INR was associated with faster recovery, less patient movement during the procedure, and a more stable hemodynamic response when compared to propofol.

The relationship between perioperative nausea and vomiting and serum serotonin concentrations in patients undergoing cesarean section under epidural anesthesia / 대한마취과학회지

BACKGROUND: Serotonin-also known as 5-hydroxytryptamine or 5-HT-can induce nausea and vomiting (NV) by peripheral mechanisms via the activation of 5-HT3 receptors. In this study, we observed perioperative NV, including intraoperative NV, and changes in serum 5-HT concentrations. We evaluated the relationship between perioperative NV and serum 5-HT levels in patients undergoing cesarean section under epidural anesthesia, and carried out a pilot study to determine if further studies on a larger scale were justified. METHODS: Twenty-eight patients who were scheduled for cesarean section under epidural anesthesia were included in the study. Patients were assigned to 2 groups according to the occurrence of NV after induction, i.e., an NV-positive or an NV-negative group. Serum 5-HT concentrations were measured before induction, at the time that NV occurred (in the case of the NV-positive group) or 5 min after the umbilical cord clamping (in the case of the NV-negative group) during surgery, and at 2 h postoperatively. RESULTS: NV occurred in 10 of the 28 patients. No significant differences in serum 5-HT concentrations were found within or between the two groups. CONCLUSIONS: This study suggests that there is no correlation between serum 5-HT concentration and the occurrence of perioperative NV in patients undergoing cesarean section under epidural anesthesia, and the findings do not seem to support further investigations regarding a possible relationship between serum 5-HT concentration and perioperative NV.

Traumatic Delayed Subdural Hematoma Accompanied Acute Cerebral Infarction during Anticoagulant Therapy in an Old Patient / 대한신경손상학회지

Oral anticoagulant therapy is generally being used in patient with a high thromboembolic risk such as cerebrovascular or cardiovascular accident, in spite of increased bleeding tendencies and most of them are old-age patients. A stroke frequently leads to a fall, which in turn causes a minor trauma, and it is often reported that anticoagulant therapy for treatment of stroke may aggravate traumatic brain injury. The authors report a case that required surgical treatments for subacute subdural hematoma which was found during antiplatelets and anticoagulant therapy for acute ischemic stroke. The hematoma had not been found at the time of head injury accompanied by a cerebral infarction.

Traumatic Delayed Subdural Hematoma Accompanied Acute Cerebral Infarction during Anticoagulant Therapy in an Old Patient / 대한신경손상학회지

Oral anticoagulant therapy is generally being used in patient with a high thromboembolic risk such as cerebrovascular or cardiovascular accident, in spite of increased bleeding tendencies and most of them are old-age patients. A stroke frequently leads to a fall, which in turn causes a minor trauma, and it is often reported that anticoagulant therapy for treatment of stroke may aggravate traumatic brain injury. The authors report a case that required surgical treatments for subacute subdural hematoma which was found during antiplatelets and anticoagulant therapy for acute ischemic stroke. The hematoma had not been found at the time of head injury accompanied by a cerebral infarction.

Disseminated Tuberculosis of Central Nervous System : Spinal Intramedullary and Intracranial Tuberculomas

As a cause of spinal cord compression, intramedullary spinal tuberculoma with central nervous system (CNS) involvement is rare. Aurthors report a 66-year-old female presented with multiple CNS tuberculomas including spinal intramedullary tuberculoma manifesting paraparesis and urinary dysfunction. We review the clinical menifestation and experiences of previous reported literature.

Predictability of passive leg raising test on anesthesia-induced hypotension in patients undergoing cardiac surgery

BACKGROUND: Hypotension often occurs after induction of general anesthesia. Although preload status has been considered as an important factor for the occurrence of this hypotension, there have been inconsistent results on this topic. The dynamic preload parameters have not been studied as a predictor of hypotension, and therefore we hypothesized that the passive leg raising (PLR) test, a dynamic preload parameter, could predict anesthesia-induced hypotension and conducted a prospective clinical study. METHODS: In 40 patients undergoing elective cardiac surgery, mean arterial pressure (MAP), stroke volume variation, stroke volume (SV) and cardiac index (CI) were measured using arterial line and FloTrac(TM)/Vigileo(TM) system before, during and after PLR test, respectively. Occurrence of anesthesia-induced hypotension was recorded. The ability of PLR test to predict hypotension was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS: The incidence of hypotension was 90%, which includes 12.5% of refractory hypotension. Changes in MAP and CI induced by PLR test predicted hypotension (area under ROC curves: 0.722 and 0.788, respectively). Changes in SV and CI induced by PLR test predicted refractory hypotension (area under ROC curves: 0.863 and 0.789, respectively). CONCLUSIONS: Our results suggest that PLR test can predict hypotension and refractory hypotension occurring after induction of anesthesia in patients undergoing cardiac surgery.

The neuroprotective effect of combining sevoflurane and remote ischemic preconditioning in forebrain ischemia model

BACKGROUND: The aim of this study was to investigate the combining effects of sevoflurane and remote ischemic preconditioning (RIPC) on cell death of pyramidal neurons in the CA1 hippocampus induced by transient global cerebral ischemia in rats. METHODS: Twenty rats were assigned to one of two groups; sevoflurane group and combination of sevoflurane and RIPC group. RIPC was performed by occluding the bilateral femoral arteries for 10 min 3 times in an interval of 10 min. Ischemia was induced by a bilateral common carotid artery occlusion plus hemorrhagic hypotension (26-30 mmHg) and was maintained for 8 min. Histologic outcomes were measured at 7 days after ischemia in CA1 pyramidal cells of the rat hippocampus. RESULTS: The combination group contained significantly more viable cells in the hippocampal CA1 area than sevoflurane group (71% vs. 46%, P = 0.03). The mean percentage of apoptotic cells was significantly reduced in the combination group compared to sevoflurane group (11% vs. 41%, P = 0.014). CONCLUSIONS: A combination of sevoflurane and RIPC can offer additional neuroprotective effects after transient global cerebral ischemia in rats.

Long Term Clinical Outcomes of Malignant Meningiomas

OBJECTIVE: Malignant meningiomas are rare and have worse prognosis than benign meningiomas. We report our experience of a malignant meningioma and review relevant literature in an attempt to investigate the clinical features, treatment, and prognosis of these tumors. METHODS: Fifteen patients underwent surgical treatment for intracranial malignant meningiomas between year 1990 and 2012 in our institution. Anaplastic meningiomas were diagnosed in thirteen cases and papillary meningiomas in two. Fourteen patients (93.3%) received radiotherapy after surgical resection. All patients were followed regularly including clinical-neurological follow-up as well as magnetic resonance imaging. Progression was determined radiographically when there was more than 10% of mass volume increase or when there were onset or worsening of neurological symptoms not attributable to other causes. RESULTS: Six patients were male and nine were women, and their mean age was 56.9 years (range 36-78). The median follow-up was 54 months (range 3-246). According to our study result, the 5-year progression free survival rate of malignant meningiomas was 53.6%. There were 2 cases (13.3%) of postoperative complications. Recurrences were confirmed in 4 patients (26.7%) during follow-up, the median recurrence time was 35 months (range 12-61), and further procedures were performed. Two of the recurred patients were treated with radiosurgery after secondary tumor resection, and other two patients were treated with radiosurgery alone. There was no more recurred disease patients in the follow-up period after then. CONCLUSION: We report the outcomes of the aggressive surgery with radiation of malignant meningiomas. Although the data is limited, we found that radiosurgery treatment had favorable tumor control on recurred patients from our experience.

Decorin and TGF-beta Expression after Partial Myotomy of the Extraocular Muscle in Rat

PURPOSE: To report the expression of decorin and TGF-beta in partial myotomy of the extraocular muscle in rats. METHODS: Partial myotomy of the superior rectus muscle was performed on the right eye of 10 Sprague-Dawley rats followed by exposure of the left superior rectus muscle and a simple suture of the conjunctiva. The bilateral superior rectus muscle was obtained from all rats at 2 weeks postoperatively. The tissues were observed under light microscopy with hematoxylin-eosin, Masson's trichrome staining and immunohistochemistry. RESULTS: Histological examinations of the surgical area at 2 weeks after postoperatively showed irregularly concentrated fibrosis on light microscopy with hematoxylin-eosin and Masson's trichrome staining of the experimental eyes. Immnohistochemistry showed that expression of decorin was in the same location as TGF-beta in the experimental group. CONCLUSIONS: The expression of decorin was found in the healing process after partial myotomy of the extraocular muscle in rats. Immunohistochemistry showed that expression of decorin was in the same location as with TGF-beta.

Sugammadex versus neostigmine reversal of moderate rocuronium-induced neuromuscular blockade in Korean patients / 대한마취과학회지

BACKGROUND: Rapid and complete reversal of neuromuscular blockade (NMB) is desirable at the end of surgery. Sugammadex reverses rocuronium-induced NMB by encapsulation. It is well tolerated in Caucasian patients, providing rapid reversal of moderate (reappearance of T2) rocuronium-induced NMB. We investigated the efficacy and safety of sugammadex versus neostigmine in Korean patients. METHODS: This randomized, safety assessor-blinded trial (NCT01050543) included Korean patients undergoing general anesthesia. Rocuronium 0.6 mg/kg was given prior to intubation with maintenance doses of 0.1-0.2 mg/kg as required. Patients received sugammadex 2.0 mg/kg or neostigmine 50 microg/kg with glycopyrrolate 10 microg/kg to reverse the NMB at the reappearance of T2, after the last rocuronium dose. The primary efficacy endpoint was the time from sugammadex or neostigmine administration to recovery of the train-of-four (TOF) ratio to 0.9. The safety of these medications was also assessed. RESULTS: Of 128 randomized patients, 118 had evaluable data (n = 59 in each group). The geometric mean (95% confidence interval) time to recovery of the TOF ratio to 0.9 was 1.8 (1.6, 2.0) minutes in the sugammadex group and 14.8 (12.4, 17.6) minutes in the neostigmine group (P < 0.0001). Sugammadex was generally well tolerated, with no evidence of residual or recurrence of NMB; four patients in the neostigmine group reported adverse events possibly indicative of inadequate NMB reversal. CONCLUSIONS: Sugammadex was well tolerated and provided rapid reversal of moderate rocuronium-induced NMB in Korean patients, with a recovery time 8.1 times faster than neostigmine. These results are consistent with those reported for Caucasian patients.

A Comparative Analysis of Chronic Subdural Hematoma in Two Age Groups of Younger and Older than 75 Years / 대한신경손상학회지

OBJECTIVE: Chronic subdural hematoma (cSDH) is one of the most common types of intracranial hemorrhage. As the number of elderly people is increasing, the incidence of cSDH is growing. Therefore, we analyzed clinical manifestation of the cSDH. METHODS: The authors retrospectively reviewed the data of the 169 patients of cSDH who were 65 years or older and undergone burr-hole trephination and closed drainage in our hospital between January 2008 and December 2012. Patients were divided into two subgroups; group A: young than 75 years, group B: 75 years or older. We analyzed the differences of clinical aspects and surgical results in both groups. RESULTS: Proportion of male patients in group A (83.8%) was higher than in group B (58.4%) with statistical significance (p=0.003). Alteration of consciousness as an initial symptom was significantly more frequent in group A (17.5%) than in group B (4.4%)(p=0.006). Postoperatively, 164 of 169 patients (97%) were free from symptom within three days in both groups. Pneumonia followed the surgery in three patients (one in group A and two in group B). CONCLUSION: There were no difference in the rate of complications between group A and B. Therefore, burr-hole trephination and external drainage is safe and effective management in both groups.

Korean Anxiety Sensitivity Index-3: Its Factor Structure, Reliability, and Validity in Non-Clinical Samples

OBJECTIVE: The aim here is to examine the factorial structure, internal consistency, and concurrent validity of the Korean version of the Anxiety Sensitivity Index-3 (K-ASI-3) in student samples in Korea. Also, we investigated the cross-cultural differences in the Social Concerns factor. METHODS: K-ASI-3 was administered to non clinical samples in Korea. Internal consistency, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were undertaken to examine the factorial structure and reliability of the K-ASI-3. RESULTS: Results from CFA comparing our data to factor solutions commonly reported as representative of European-American samples indicated an adequate fit. The K-ASI-3 showed good performance on the indices of internal consistency and concurrent validity. In addition, using regression analyses, we found the Social Concerns factor is most strongly related to life satisfaction and worry. However, we found no evidence that Korean college students express more Social Concerns than their European Caucasian counterparts. CONCLUSION: The authors demonstrate that the K-ASI-3 has highly internally consistent and psychometrically sound items, and that it reliably measures three lower-order domains assessing Physical, Social, and Cognitive Concerns.

Evaluation of the Neurological Safety of Epidural Milnacipran in Rats

BACKGROUND: Milnacipran is a balanced serotonin norepinephrine reuptake inhibitor with minimal side effects and broad safety margin. It acts primarily on the descending inhibitory pain pathway in brain and spinal cord. In many animal studies, intrathecal administration of milnacipran is effective in neuropathic pain management. However, there is no study for the neurological safety of milnacipran when it is administered neuraxially. This study examined the neurotoxicity of epidural milnacipran by observing behavioral and sensory-motor changes with histopathological examinations of spinal cords in rats. METHODS: Sixty rats were divided into 3 groups, with each group receiving epidural administration of either 0.3 ml (3 mg) of milnacipran (group M, n = 20), 0.3 ml of 40% alcohol (group A, n = 20), or 0.3 ml of normal saline (group S, n = 20). RESULTS: There were no abnormal changes in the behavioral, sensory-motor, or histopathological findings in all rats of groups M and S over a 3-week observation period, whereas all rats in group A had abnormal changes. CONCLUSIONS: Based on these findings, the direct epidural administration of milnacipran in rats did not present any evidence of neurotoxicity in behavioral, sensory-motor and histopathological evaluations.