Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea

Background@#Coronavirus disease 2019 (COVID-19) is a global public health crisis that has had a significant impact on emergency medical services (EMS). Several studies have reported an increase in the incidence of out-of-hospital cardiac arrest (OHCA) and a decreased survival due to COVID-19, which has been limited to a short period or has been reported in some regions. This study aimed to investigate the effect of COVID-19 on OHCA patients using a nationwide database. @*Methods@#We included adult OHCA patients treated by EMS providers from January 19, 2019 to January 20, 2021. The years before and after the first confirmed case in Korea were set as the non-COVID-19 and COVID-19 periods, respectively. The main exposure of interest was the COVID-19 period, and the primary outcome was prehospital return of spontaneous circulation (ROSC). Other OHCA variables were compared before and after the COVID-19 pandemic and analyzed. We performed a multivariable logistic regression analysis to understand the independent effect of the COVID-19 period on prehospital ROSC. @*Results@#The final analysis included 51,921 eligible patients, including 25,355 (48.8%) during the non-COVID-19 period and 26,566 (51.2%) during the COVID-19 period. Prehospital ROSC deteriorated during the COVID-19 period (10.2% vs. 11.1%, P = 0.001). In the main analysis, the adjusted odds ratios (AORs) for prehospital ROSC showed no significant differences between the COVID-19 and non-COVID-19 periods (AOR [95% confidence interval], 1.02 [0.96–1.09]). @*Conclusion@#This study found that the proportion of prehospital ROSC was lower during the COVID-19 period than during the non-COVID-19 period; however, there was no statistical significance when adjusting for potential confounders. Continuous efforts are needed to restore the broken chain of survival in the prehospital phase and increase the survival rate of OHCA patients.

The Impact of the COVID-19 Outbreak on Emergency Medical Service:An Analysis of Patient Transportations and Time Intervals

Background@#This study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on the Emergency Medical Service (EMS) system in South Korea. The study focused on the differences in EMS time intervals following the COVID-19 outbreak, particularly for patients with fever. @*Methods@#A retrospective analysis of EMS patient transportation data from 2017 to 2022 was conducted using the national EMS database. @*Results@#Starting from the year 2020, coinciding with the COVID-19 outbreak, all EMS time intervals experienced an increase. For the years 2017 to 2022, the mean response time interval values were 8.6, 8.6, 8.6, 10.2, 12.8, and 11.4 minutes, and the mean scene time interval values were 7.1, 7.2, 7.4, 9.0, 9.8, and 10.9 minutes. The mean transport time interval (TTI) values were 12.1, 12.3, 12.4, 14.2, 16.9, and 16.2 minutes, and the mean turnaround time interval values were 27.6, 27.9, 28.7, 35.2, 42.0, and 43.1 minutes. Fever (≥ 37.5°C) patients experienced more pronounced prolongations in EMS time intervals compared to non-fever patients and had a higher probability of being non-transported. The mean differences in TTI between fever and non-fever patients were 0.8, 0.8, 0.8, 4.3, 4.8, and 3.2 minutes, respectively, from 2017 to 2022. Furthermore, the odds ratios for fever patients being transported to the emergency department were 2.7, 2.9, 2.8, 1.1, 0.8, and 0.7, respectively, from 2017 to 2022. @*Conclusion@#The study findings highlight the significant impact of the COVID-19 outbreak on the EMS system and emphasize the importance of ongoing monitoring to evaluate the burden on the EMS system.

Reduction of Isolated Zygomatic Arch Fractures with Gillies Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of facial bone fracture is increasing. The zygomatic bone, due to its anatomical prominence, is the second most common site of all facial bone fractures. In this study, we present the clinical experiences of zygomatic arch fracture in a tertiary hospital and introduce the Gillies approach for reduction and its outcome results. SUBJECTS AND METHOD: We collected data from retrospective chart reviews of patients who underwent surgeries from 2010 to 2017 for zygomatic arch fractures at Chungbuk National University Hospital. Data were analyzed according to age, gender, cause of trauma, location of trauma, and clinical symptoms including trismus. All surgery was performed under general anesthesia and via the use of Gillies approach. The result of surgery was evaluated by postoperative facial computed tomography. RESULTS: Sixteen patients underwent surgery for zygomatic arch fracture. The patients had the average age of 41.3 years, a male predominance of 15:1 and physical assault as the most common cause of trauma. The time lag between injury and surgical reduction was 5.5 days. The surgical outcomes were assessed “good” in 14 cases and “moderate” in one case. Patients who had trismus preoperatively were resolved of it in all cases after operation. Postoperative complications were absent. CONCLUSION: The Gillies approach proved to be a relatively easy, safe, and reliable method, and its surgical outcomes was satisfactory in our experiences.

Predictors of Default from Treatment for Tuberculosis: a Single Center Case-Control Study in Korea

Default from tuberculosis (TB) treatment could exacerbate the disease and result in the emergence of drug resistance. This study identified the risk factors for default from TB treatment in Korea. This single-center case-control study analyzed 46 default cases and 100 controls. Default was defined as interrupting treatment for 2 or more consecutive months. The reasons for default were mainly incorrect perception or information about TB (41.3%) and experience of adverse events due to TB drugs (41.3%). In univariate analysis, low income (< 2,000 US dollars/month, 88.1% vs. 68.4%, P = 0.015), absence of TB stigma (4.3% vs. 61.3%, P < 0.001), treatment by a non-pulmonologist (74.1% vs. 25.9%, P < 0.001), history of previous treatment (37.0% vs. 19.0%, P = 0.019), former defaulter (15.2% vs. 2.0%, P = 0.005), and combined extrapulmonary TB (54.3% vs. 34.0%, P = 0.020) were significant risk factors for default. In multivariate analysis, the absence of TB stigma (adjusted odd ratio [aOR]: 46.299, 95% confidence interval [CI]: 8.078-265.365, P < 0.001), treatment by a non-pulmonologist (aOR: 14.567, 95% CI: 3.260-65.089, P < 0.001), former defaulters (aOR: 33.226, 95% CI: 2.658-415.309, P = 0.007), and low income (aOR: 5.246, 95% CI: 1.249-22.029, P = 0.024) were independent predictors of default from TB treatment. In conclusion, patients with absence of disease stigma, treated by a non-pulmonologist, who were former defaulters, and with low income should be carefully monitored during TB treatment in Korea to avoid treatment default.

An Alternative Surgical Technique for Repair of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

BACKGROUND: For the surgical management of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), there have been various techniques that reduce the tension and kinking of the coronary artery during reimplantation to the aorta. The aim of this study is to describe the results of our modified technique of coronary reimplantation for the treatment of ALCAPA. METHODS: Between October 2003 and February 2011, seven patients underwent coronary reimplantation with the modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta). The median follow-up duration was 52 months (range, 4 to 72 months). Clinical outcomes and serial echocardiographic data were reviewed. RESULTS: There was no mortality. One patient had a small amount of cerebral hemorrhage postoperatively and improved without any sequelae. Another patient had left diaphragm palsy and underwent diaphragm plication. Follow-up echocardiogram showed that all patients had normal ventricular function without chamber enlargement. CONCLUSION: Our modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta) demonstrated successful clinical outcomes. We conclude that this surgical technique can be a potential alternative for the treatment of ALCAPA.

Totally Thoracoscopic Ablation for Treatment of Atrial Fibrillation after Atrial Septal Defect Device Closure

Atrial septal defect (ASD) is one of the most common congenital heart defects in adults. Surgical repair is the most common treatment approach, but device closure has recently become widely performed in accordance with the trend toward less invasive surgical approaches. Although surgery is recommended when ASD is accompanied by atrial fibrillation, this study reports a case in which a complete cure was achieved by closure of a device and totally thoracoscopic ablation.

Thoracoscopic Removal of Ectopic Mediastinal Parathyroid Adenoma

Ectopic mediastinal parathyroid adenomas or hyperplasias account for up to 25% of primary hyperparathyroidism cases. Most abnormal parathyroid glands are found in the superior mediastinum within the thymus and can be removed through a cervical incision; however, a few of these glands are not accessible using standard cervical surgical approaches. Surgical resection has traditionally been performed via median sternotomy or thoracotomy. However, recent advancement in video-assisted thoracic surgery techniques has decreased the need for sternotomy or thoracotomy to remove these ectopic parathyroid glands. Here, we report a successful case of video-assisted thoracoscopic removal of a mediastinal parathyroid adenoma.

Anti-N-Methyl-D-Aspartate Receptor Encephalitis in Korea: Clinical Features, Treatment, and Outcome

BACKGROUND AND PURPOSE: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common type of autoimmune synaptic encephalitis and it often responds to treatment. We analyzed the clinical characteristics of anti-NMDAR encephalitis in Korea. METHODS: Serum and/or cerebrospinal fluid (CSF) of adult patients (aged > or =18 years) with encephalitis of undetermined cause were screened for anti-NMDAR antibodies using a cell-based indirect immunofluorescence assay. The patients came from 41 university hospitals. RESULTS: Of the 721 patients screened, 40 were identified with anti-NMDAR antibodies and clinical details of 32 patients were obtained (median age, 41.5 years; 15 females). Twenty-two patients (68.8%) presented with psychiatric symptoms, 16 (50%) with seizures, 13 (40.6%) with movement disorders, 15 (46.9%) with dysautonomia, 11 (34.4%) with memory disturbance, and 11 (34.4%) with speech disturbance. Magnetic resonance imaging, electroencephalography, and CSF examinations yielded nonspecific findings. Tumor information was only available for 22 patients: 5 patients had tumors, and 2 of these patients had ovarian teratomas. Twenty-two patients received immunotherapy and/or surgery, and therapeutic responses were analyzed in 21 patients, of which 14 (66.7%) achieved favorable functional outcomes (score on the modified Rankin Scale of 0-2). CONCLUSIONS: This study investigated the clinical characteristics of adult anti-NMDAR encephalitis in Korea. Currently, elderly patients who do not have tumors are commonly diagnosed with this condition. Understanding the detailed clinical characteristics of this disease will improve the early detection of anti-NMDAR encephalitis in patients both young and old.

Marginal and internal fitness of three-unit zirconia cores fabricated using several CAD/CAM systems / 대한치과보철학회지

PURPOSE: This study was aimed to compare the margin and internal fitness of 3-unit zirconia bridge cores fabricated by several CAD/CAM systems using replica technique. MATERIALS AND METHODS: Three unit-bridge models in which upper canine and upper second premolar were used as abutments and upper first premolar was missed, were fabricated. Fourty models were classified into 4 groups (Cerasys(R) (Group C), Dentaim(R) (Group D), KaVo Everest(R) (Group K), Lava(TM)(Group L)), and zirconia cores were fabricated by each company. Sixteen points were measured on each abutment by replica technique. Statistical analysis was accomplished with two way ANOVA and Dunnett T3 (alpha=.05). RESULTS: In most systems, there was a larger gap on inter margin than outer margin. In the Group K, overall fitness was excellent, but the incisal gap was very large. In the Group C, marginal gap was significantly larger than Group K, but overall internal gap was uniform (P<.05). The axial gap was under 100 microm in all system. The difference between internal and external gap was small on Group L and C. However, internal gap was significantly larger than external gap in Group D (P<.05). The fitness of canine was better than second premolar among abutments (P<.05). CONCLUSION: The marginal and internal gap was within the clinically allowed range in all of the three systems. There was a larger gap on second premolar than canine on internal and marginal surface. In most systems, there was a larger gap on occlusal surface than axial surface.

An assessment of statistical errors of articles in the Journal of Korean Academy of Prosthodontics: Comparison between Korean version and English version / 대한치과보철학회지

STATEMENT OF PROBLEM: The aim of dental research is to advance scientific knowledge and leads to improvement in the treatment and prevention of dental disease. Utilizing an effective research design and adequate statistical methods are essential procedures ensuring that the results of researches are based on evidences. A research should utilize proper statistical methods without statistical errors; Otherwise, it could adversely affect clinical practice and future research. PURPOSE: This study was made to investigate the statistical methods used in the Journal of Korean Academy of Prosthodontics (JKAP) and then to assess them for the statistical errors. MATERIAL AND METHODS: Among the total of 399 articles in the JKAP published from 2000 to 2006, 292 articles using statistics were reviewed. The validity of the statistical methods used in them were assessed using a checklist based on the guideline for statistical reporting in the uniform requirements for manuscripts submitted to biomedical journals by International Committee of Medical Journal Editors. The checklist consisted of three categories of statistical errors: 1) Unspecified computer statistical packages, 2) Inadequate description of statistical methods, 3) Misuse of statistical terms. Then, the results were compared between the Korean version and the English version in the JKAP. RESULTS: Among the 212 articles using statistics in the Korean version, 115 articles (54%) and among the 80 articles using statistics in the English version, 47 articles (59%) were shown to have unspecified computer statistical packages without statistically significant difference (P = .66). Likewise, 101 articles (48%) in the Korean version and 25 articles (31%) in the English version were shown to have the inadequate description of statistical methods without statistically significant difference (P = .09). However, 114 articles (54%) in the Korean version and 19 articles (24%) in the English version were shown to have the misuse of statistical terms with statistically significant difference (P = .01). CONCLUSION: Some of the articles in the JKAP had inadequate statistical validity, given the statistical errors identified in this assessment. Hence, dental researchers should be more careful when it comes to describing and applying statistical methods.

Manual Liquid-Based Cytology (Liqui-PREPtrade mark) in Breast Fine Needle Aspiration Cytology: Comparison with the Conventional Smears / 대한세포병리학회지

Fine needle aspiration (FNA) cytology of the breast is a useful method for diagnosing breast lesions. Yet making the definite diagnosis with performing FNA is limited by some problems, such as the low cellularity, the poor preservation and the obscuring background. Recent studies have found that liquid-based cytology solves such problems, but it is an expensive method and it is limited by the loss of the background information. The purpose of this study is to compare the Liqui-PREP(TM), a new manual liquid-based method of cytology, and the conventional smears for analyzing breast FNA cytology materials. A total of 31 randomized FNA specimens of breast were studied. In each case, both the conventional smears and the Liqui-PREP(TM) method were performed, and the smears were evaluated for cellularity, cellular preservation, the background, the cytologic features and the architectural arrangement. The cellularity and architectural arrangement were equal for both preparations. The Liqui-PREP(TM) specimens showed better cellular preservation, loss of the obscuring background, no overlapping of cells and a smaller area to screen compared with the conventional smears. Moreover, it has the potential advantages of being able to use the remaining specimens for immunohistochemical study and ploidy analysis, and it can reduce the costs for preparation compared with the other liquid-based methods of cytology. But some background information is lost in the Liqui-PREP(TM) specimens, the same as the other liquid-based methods of cytology. In conclusion, the Liqui-PREP(TM) and conventional smears showed good correlation, but they have their respective advantages and disadvantages. These results suggest that Liqui-PREP(TM) can contribute to making the accurate diagnosis with performing breast FNA cytology when it is used along with other methods.

Predictive Factors of Epstein-Barr Virus Association in Gastric Adenocarcinoma

BACKGROUND: It is important to detect Epstein-Barr virus (EBV) in the setting of gastric cancer so that early viral targeted therapy and prevention can be undertaken. The aim of this study was to investigate the predictive clinicopathologic factors for EBV-related gastric cancer. METHODS: The archival tumor tissues from 335 patients with gastric cancer were examined using tissue microarray. The detection of EBV was performed using EBV mRNA in situ hybridization (EBV-ISH), and the results were compared against clinicopathologic factors. RESULTS: EBV-related gastric cancers were identified in 21 of 335 investigated cases (6.27%). The anatomical predisposition of EBV-related cancers to manifest in the upper stomach was statistically significant (p<0.001). EBV-related cancers were almost always (20/21) accompanied by lymphoid stroma. No differences in age, sex, histologic differentiation, or T or N stage were noted between EBV-positive and EBV-negative gastric carcinomas. CONCLUSIONS: The association of EBV with gastric adenocarcinomas could be predicted when tumors with lymphoid stroma occurred in the upper stomach.

Primary Neuroendocrine Carcinoma of the Urethra / 대한비뇨기과학회지

Primary neuroendocrine carcinomas are uncommon highly malignant tumors of the genitourinary tract, and they have a poor prognosis. We report here on a case of a primary neuroendocrine carcinoma of the urethra that developed after radical cystectomy and ileal conduit diversion for treating transitional cell carcinoma of the urinary bladder.

The Eyebrow Approach to Anterior Communicating Artery Aneurysms / 대한뇌혈관외과학회지

OBJECTIVE: This study reviewed the clinical outcomes of patients with anterior communicating artery (AComA) aneurysms that were treated surgically using an eyebrow approach. The indications and limitations of this approach for the treatment of AComA aneurysms are also suggested. METHODS: Between October 1999 and June 2006, 121 procedures were performed on 115 patients with 146 cerebral aneurysms via a superior orbital rim craniotomy through an eyebrow incision. Of them, 51 patients with AComA aneurysms were reviewed retrospectively according to the patient's age and gender, the Hunt-Hess grade upon admission, the Fisher grade of the subarachnoid hemorrhage, the size of the aneurysm, the direction of the aneurysmal sac, the outcome at 3-month follow-up period, complications and the intraoperative problems. RESULTS: Overall, excellent and good outcomes were achieved in 47 patients (92.1%) and one patient died (2.0%). Clinically, there were 7 patients with a poor grade (Hunt-Hess grade 4); 3 showed a good outcome, 2 fair, 1 poor and 1 died. Premature rupture of the aneurysm during surgery occurred in 5 patients. One procedure was converted to the pterional approach due to severe brain swelling. Postoperative subdural fluid collection was noted in 9 patients, of whom 2 patients required temporary drainage and 1 patient needed a permanent subdural fluid diversion. Vasospasm and a subsequent infarction were observed in 4 patients. Hydrocephalus that required a ventriculoperitoneal shunt was found in only 2 patients. CONCLUSIONS: The favorable indications for eyebrow surgery include good grade patients with a ruptured or unruptured AComA aneurysm, and patients with small and medium sized aneurysms. Furthermore, the poor grade or high Fisher grade patients with or without multiple concomitant aneurysms can also be treated with eyebrow surgery.

Shear bond strengths of composite resin to porcelains among porcelain repair systems / 대한치과보철학회지

PURPOSE: This in vitro study evaluated shear bond strengths of surface treatment porcelains with four porcelain repair systems simulating intraoral bonding of composite resin to feldspathic porcelain or pressable porcelain. MATERIAL AND METHODS: Eighty Porcelain disks were prepared. Group A: forty disk specimens were fabricated with Feldspathic Porcelain(Omega(R)900, Vident, Menlo Park, CA, USA). Group B: forty disk specimens were fabricated with Pressable Porcelain(IPS Empress 2 ingot, Ivoclar-Vivadent, Schaan, Liechtenstein, Germany). Each groups was divided into 4 subgroups and composite resin cylinders were bonded to specimen with one of the following four systems: Clearfil Porcelain Bond(L. Morita, Tustin, CA, USA), Ulradent Porcelain Etch.(Ultradent, Salt Lake City, UT, USA), Porcelain Liner-M(Sun Medical Co., Kyoto, Japan), Cimara Kit(Voco, Germany). After surface conditioning with one of the four porcelain repair systems, substrate surfaces of the specimen were examined microscopically(SEM). Shear bond strengths of specimens for each subgroup were determined with a universal testing machine (5mm/min crosshead speed) after storing them in distilled water at 37+/-1 degrees C for 24 hours. Stress at failure was measured in MPa, and mode of failure was recorded. Differences among four repair systems were analyzed with two way ANOVA and Duncan test at the 95% significance level. RESULTS: In the scanning electron photomicrograph of the treated porcelain surface, hydrofluoric acid etched group appeared the highest roughness. The shear bond strength of the phosphoric acid etched group was not significantly(p>0.05) different between feldspathic porcelain and pressable porcelain. But in no treatment and roughened with a bur group, the shear bond strength of the feldspathic porcelain was significantly higher than that of the pressable porcelain. In hydrofluoric acid etched group, the shear bond strength of the pressable porcelain was significantly higher(p0.05). However in the other groups, there were significant differences in shear bond strengths between feldspathic porcelain and pressable porcelain(p<0.05).

Diffuse Ganglioneuromatosis of Appendix associated with Von Recklinghausen;s Disease

Gastrointestinal ganglioneuromatosis is a rare neoplastic condition that can occur in association with von Recklinghausen's disease with multiple endocrine neoplasia type II B. The main locations are the ileum, colon, and appendix. We report a case of diffuse ganglioneuromatosis of the appendix associated with a mesenteric and ileocecal plexiform neurofibroma in von Recklinghausen's disease.

Two Cases of Strongyloidiasis Diagnosed by Colonoscopic Biopsy

Strongyloides stercoralis is an intestinal nematode that is able to infect the host tissue and persist for many years through autoinfection, and it causes life-threatening hyperinfection in immunocompromised hosts. We report here on two cases of strongyloidiasis that were diagnosed by colonoscopic biopsy. One case was a 73-year-old woman who was hospitalized with complaints of melena. She was being treated with corticosteroid due to her asthma and rheumatoid arthritis. The other case was a 63-year-old man who suffered with abdominal discomfort and severe loss of body weight (18 kg) for 2 months. In both cases, colonoscopic examination revealed polyps and petechiae at the entire colon. Microscopically, a small illdefined granuloma with a longitudinally sectioned parasite was seen on the colonoscopic biopsy. Endoscopic examination was done after suspecting parasitic infestation. The gastric and duodenal mucosa showed numerous cross sections of adult worms, eggs and larvae that were developing in crypts. Even if such a patient is in an asymptomatic state, this illness must be treated due to the potential for fatal autoinfection.

Leydig Cell Tumor in Cryptorchid Testis / 대한비뇨기과학회지

Leydig cell tumors are rare, constituting only 1-3% of all testicular tumors; but they are still the focus of interest due to the difficulties in determining their exact nature and subsequent type of treatment. Generally, there appears to be no association with cryptorchidism, but there have been reports of Leydig cell tumors in cryptorchid testes. Herein, a case of a Leydig cell tumor in cryptorchidism is reported.

Treatment of Meningitis Caused by Vancomycin-Resistant Enterococcus with Synercid

Vancomycin-resistant enterococci(VRE) are rare cause of meningitis, occurring in immunocompromised patients, severely ill, hospitalized patient, and patients who have undergone neurosurgical procedures. Resistance to vancomycin has increased in frequency during the past few years. Limited therapeutic options are available for VRE infections and the optimum therapy has not been established. We report a case of VRE meningitis that was successfully treated with administration of quinupristindalfopristin (Synercid) by both intravenous and intraventricular routes. A brief review of the literature is provided, which indicates that optimal management with Synercid should include daily intraventricular doses of at least 2 mg and intravenous 0.5 mg/kg every 8 hours. We also review the previously reported cases of VRE meningitis.

Effects of various surface treatments for titanium on surface micro roughness, static wettability, fibronectin adsorption / 대한치과보철학회지

Purpose: This study aims to get the fundamental data which is necessary to the development direction of implant surface treatment hereafter, based on the understanding the surface structure and properties of titanium which is suitable for the absorption of initial tissue fluid by researching effects of additional surface treatments for sandblasted with large grit and acid-etched(SLA) titanium on surface micro-roughness, static wettability, fibronectin adsorption. Materials and Method: In the Control groups, the commercial pure titanium disks which is 10mm in diameter and 2mm in thickness were treated with HCI after sandblasting with 50micrometer Al2O3. The experiment groups were made an experiment each by being treated with 1) 22.5% nitric acid according to SLA+ASTM F86 protocol, 2) SLA+30% peroxide, 3) SLA+NaOH, 4) SLA+Oxalic acid, and 5) SLA+600degree C heating. In each group, the value of Ra and RMS which are the gauges of surface roughness was measured, surface wettability was measured by analyzing with Sessile drop method, and fibronectin adsorption was measured with immunological assay. The significance of each group was verified by (SPSS, ver.10.0 SPSS Inc.) Kruskal-Wallis Test.(alpha=0.05) And the correlation significance between Surface micro-roughness and surface wettability, surface roughness and fibronectin adsorption, and surface wettability and fibronectin adsorption was tested by Spearman's correlation analysis. Result: All measure groups showed the significant differences in surface micro-roughness, surface wettability, and fibronectin adsorption.(p0.05) Conclusion: Surface micro-roughness and surface wettability rarely affected the absorption of initial tissue fluid on the surface of titanium.