Targeted temperature management in a patient with suspected hypoxic-ischemic brain injury after successful resuscitation from cardiac arrest: a case report / 고신대학교의과대학학술지

Hypoxic-ischemic brain injury (HIBI) after cardiac arrest (CA) is a leading cause of mortality and long-term neurological disorders in survivors. Targeted temperature management (TTM) has been rigorously studied as a way to improve results compared to a normal body temperature for preventing secondary damage after HIBI. We report a case of successful TTM in a patient who was suspected to have HIBI after resuscitation from cardiovascular collapse due to respiratory failure during elective surgery under brachial plexus block with dexmedetomidine and remifentanil infusion. A 27-year-old male patient developed CA due to apnea during orthopedic surgery. TTM was performed in the surgical intensive care unit for 72 hours after resuscitation, and the patient recovered successfully. TTM application immediately after resuscitation from CA in patients with suspected HIBI may be an appropriate treatment.

The anti-nociceptive effect of BPC-157 on the incisional pain model in rats

Background@#The pentadecapeptide BPC-157 has been shown to have anti-inflammatory and wound healing effects on multiple target tissues and organs. Peptides have potent anti-inflammatory effects on periodontal tissues in rats with periodontitis. Few studies have investigated the effect of BPC-157 on pain after dental procedures or oral surgeries. The purpose of the present study was to investigate the antinociceptive effects of BPC-157 on postoperative incisional pain in rats. @*Methods@#Sprague–Dawley rats were randomly divided into five groups: control (saline with the same volume), BPC10 (10 μg/kg of BPC-157), BPC20 (20 μg/kg of BPC-157), BPC40 (40 μg/kg of BPC-157), and morphine (5 mg/kg of morphine). A 1-cm longitudinal incision was made through the skin, fascia, and muscle of the plantar aspect of the hind paw in isoflurane-anesthetised rats. Withdrawal responses were measured using von Frey filaments at 0, 2, 6 h and 4, 7 d after incision. The formalin test was also performed to differentiate its anti-nociceptive effect from an inflammatory reaction or central sensitization. Pain behavior was quantified periodically in phases 1 and 2 by counting the number of flinches in the ipsilateral paw after injection with 30 μL of 5% formalin. @*Results@#The threshold of mechanical allodynia was significantly increased in the BPC10, BPC20, BPC40 and morphine groups compared with that in the control group at 2 h. These increasing thresholds then returned to the levels of the control group. The BPC-157 group showed a much higher threshold at 4 days after incision than the control group. The thresholds of the BPC groups, except the morphine group, were normalized 7 days after incision. The flinching numbers of the BPC10, BPC20, BPC40 and morphine groups were significantly decreased in phase 1, but there was no decrease in the BPC-157 groups except the morphine group in phase 2. @*Conclusions@#BPC-157 was effective only for a short period after incision. It was also effective during phase 1 but not during phase 2, as determined by the formalin test. BPC-157 might have a short antinociceptive effect, even though it has anti-inflammatory and wound healing effects.

Concealed congenital long QT syndrome during velopharyngeal dysfunction correction: a case report

The congenital long QT syndrome (LQTS) is an inherited cardiac disorder characterized by increased QT intervals and a tendency to experience ventricular tachycardia, which can cause fainting, heart failure, or sudden death. A 4-year-old female patient undergoing velopharyngeal correction surgery under general anesthesia suddenly developed Torsades de pointes. Although the patient spontaneously resolved to sinus rhythm without treatment, subsequent QT prolongation persisted. Here, we report a case of concealed LQTS with a literature review.

Change in fibrinogen levels and severe postoperative bleeding in cardiac surgery

Thromboelastography or rotational thromboelastometry, is being increasingly utilized in cardiac surgery of late. However, it is an indirect test and is not available in all centers. Low fibrinogen levels before and after cardiopulmonary bypass (CPB) have been described to be associated with postoperative bleeding in cardiac surgery. This study explored the usefulness of reduction ratio of the fibrinogen levels before CPB (preCPB) and after CPB (postCPB) in predicting postoperative hemorrhage. A retrospective, observational study of adult patients who underwent cardiac surgery with CPB between February 2014 and January 2016 was conducted, which included a total of 264 patients. The fibrinogen levels were measured twice, preCPB and postCPB, and the fibrinogen reduction ratio was acquired [(preCPB − postCPB)/preCPB]. Postoperative blood loss, which was defined as the blood collected from the chest drain for 12 hours following arrival at the intensive care unit, was considered severe if it was more than 1,000 mL. A multivariate analysis showed that fibrinogen reduction ratio, sex, and postCPB platelet count were significantly associated with severe postoperative bleeding. However, the pre- and postCPB fibrinogen levels were not significantly associated with severe bleeding. Furthermore, a fibrinogen reduction ratio of > 41.3% was independently associated with postoperative severe bleeding, with an odds ratio of 3.472 (1.483–8.162). These results suggest that the reduction ratio of pre- and postCPB fibrinogen levels may be utilized in predicting postoperative bleeding.

Development and Validation of a Virtual Reality-Based Training Program for Promoting Subjective Well-Being

Objective@#Enhancing subjective well-being is an effective way to improve mental health. This study aimed to validate a virtual reality-based interactive feedback program as an intervention tool for promoting subjective well-being. @*Methods@#Thirty-six males participated in this program, consisting of three tasks constructed based on the theories of positive psychology: ‘Experience-based problem recognition task’, ‘Future self-based success story expression task’, and ‘Strength expression task’. Participants rated visual analog scores associated with each of the tasks’ contents. The concurrent validity of task scores was evaluated by correlations with the psychological scale scores. @*Results@#The total task score was positively correlated with scores of Mental Health Continuum-Short Form (MHC-SF) emotional well-being and psychological well-being, Rosenberg’s Self-Esteem Scale, Dispositional Hope Scale agency dimension and pathways dimension, and Life Orientation Test Revised, but not with MHC-SF social well-being scores. After controlling for the effects of the other task scores, the task scores had linear relationships with certain psychological assessments. @*Conclusion@#Since the task scores are closely related to indicators of well-being, self-esteem, hope, and optimism, the program contents are well associated with certain aspects of subjective well-being and thus may be available for training that improves subjective well-being through interactive feedback.

Development and Validation of a Virtual Reality-Based Training Program for Promoting Subjective Well-Being

Objective@#Enhancing subjective well-being is an effective way to improve mental health. This study aimed to validate a virtual reality-based interactive feedback program as an intervention tool for promoting subjective well-being. @*Methods@#Thirty-six males participated in this program, consisting of three tasks constructed based on the theories of positive psychology: ‘Experience-based problem recognition task’, ‘Future self-based success story expression task’, and ‘Strength expression task’. Participants rated visual analog scores associated with each of the tasks’ contents. The concurrent validity of task scores was evaluated by correlations with the psychological scale scores. @*Results@#The total task score was positively correlated with scores of Mental Health Continuum-Short Form (MHC-SF) emotional well-being and psychological well-being, Rosenberg’s Self-Esteem Scale, Dispositional Hope Scale agency dimension and pathways dimension, and Life Orientation Test Revised, but not with MHC-SF social well-being scores. After controlling for the effects of the other task scores, the task scores had linear relationships with certain psychological assessments. @*Conclusion@#Since the task scores are closely related to indicators of well-being, self-esteem, hope, and optimism, the program contents are well associated with certain aspects of subjective well-being and thus may be available for training that improves subjective well-being through interactive feedback.

Genetic diversity of bovine Mycobacterium avium subsp. paratuberculosis discriminated by IS1311 PCR-REA, MIRU-VNTR, and MLSSR genotyping

The aim of this study was to describe the genetic diversity of Mycobacterium avium subsp. paratuberculosis (MAP) obtained from individual cows in Korea. Twelve MAP-positive fecal DNA samples and 19 MAP isolates were obtained from 10 cattle herds located in 5 provinces in Korea. In addition, 5 MAP isolates obtained from the Czech Republic and Slovakia and 3 isolates from Australia were genotyped for comparison with the domestic isolates. The most prevalent strains in Korea were of the “bison-type” genotype (23 of 31 fecal DNA/isolates) and were distributed nationwide. The remaining MAP isolates (8) and all of the foreign isolates were identified as “cattle-type”. The bison-type strains which were discriminated only as INMV 68 in variable-number tandem repeats of mycobacterial interspersed repetitive units (MIRU-VNTR) typing. Multilocus short sequence repeat (MLSSR) typing differentiated the bison-type strains into 3 different subtypes. The cattle-type strains were divided into 3 subtypes by MIRU-VNTR and 8 subtypes by MLSSR. The allelic diversities in the MIRU-VNTR and MLSSR results were calculated as 0.567 and 0.866, respectively. These results suggest that MIRU-VNTR typing cannot provide a sufficient description of the epidemiological situation of MAP. Therefore, an alternative method, such as MLSSR, is needed for typing of MAP strains to elucidate the molecular epidemiology of MAP infections. Overall, this study is the first epidemiological survey report in Korea using both MIRU-VNTR and MLSSR typing methods, and it has provided basic data necessary to elucidate the characteristics of MAP infections in Korea.

Gene Expression Profiles of Th1-type Chemokines in Whole Blood of Mycobacterium avium subsp. paratuberculosis-Infected Cattle

Johne's disease (JD) is a chronic, debilitating disease of ruminants including cows, and is caused by Mycobacterium avium subsp. paratuberculosis (MAP). MAP is not only important in animal husbandry, but also in public health as it is associated with the onset of Crohn's disease, a chronic inflammatory bowel disease in humans. JD, like other mycobacterial diseases including tuberculosis, is classified into different stages based on the progression of infection. In addition, development of diagnostic assays that can distinguish between subclinical and clinical stages of JD is essential to control mycobacterial infection by providing an effective treatment. For the development of novel diagnostic methods of JD, it is important to investigate and understand the mRNA expression of the various immune markers in individuals at each stage of infection. In this study, we measured the levels of Th1-type chemokines, CXCR3, CCL4, CCL5, CXCL9, CXCL10, and CXCL11 in MAP-infected bovine blood by interferon (IFN)-γ release assay (IGRA) using IFN-γ as an alternative biomarker. The association of mRNA expression patterns of these chemokines with the MAP infection stages was analyzed and IFN-γ, CCL5, and CXCL10 were found to be significantly upregulated compared to IFN-γ, the biomarker used in IGRA. Our results further indicate that IFN-γ levels significantly increased in individuals with MAP-specific antibody, and CCL5 and CXCL10 levels significantly increased in those with MAP DNA. In particular, CCL5 was significantly upregulated in individuals, in which both MAP-specific antibody and MAP DNA were detected, but the expression of CXCL10 was specifically elevated in MAP DNA-detected individuals without MAP-specific antibody.

The Relationship between Low Intrinsic Motivation and Basic Psychological Need in Internet Gaming Disorder

Due to the increasing use of the internet, various social problems have been emerging, and one of them is internet gaming disorder (IGD). The purpose of this study was to investigate whether low internal motivation was present in IGD and basic psychological needs affected internal motivation. Twenty-one individuals with IGD and 21 healthy controls performed a ‘motivation task’ in which the avatar in virtual reality asked whether they would accept an activity in two conditions stimulating intrinsic or extrinsic motivation. The task performance was compared between the two groups, and was correlated with the Basic Psychological Needs Scale scores. Patients had a significantly lower acceptance rate of the proposal in the intrinsic motivation condition than controls, and this intrinsic motivated tendency was correlated with the satisfaction in their basic psychological needs. As with other substance use disorders, IGD was associated with a lower level of internal motivation, which was related to the dissatisfaction of basic psychological needs such as autonomy, competence, and relationship.

Effects of Triamcinolone-soaked Packing for Endonasal Revision in Patients with Failed Endoscopic Dacryocystorhinostomy

PURPOSE: To evaluate the efficacy of endonasal revision using triamcinolone-soaked nasal packing in patients exhibiting recurrence of epiphora after endoscopic dacryocystorhinostomy. CASE SUMMARY: Four patients (4 eyes) who presented with the chief complaint of recurrence of epiphora after endoscopic dacryocystorhinostomy underwent endonasal revision under local anesthesia. On nasal endoscopy, granulation tissue and membranous tissue around the osseous foramen was removed during endonasal revision. According to the operator's judgement, the osseous foramen was additionally expanded. Following insertion of a silicone tube, triamcinolone-soaked nasal packing was used for intra-nasal packing. The silicone tube was removed after follow-up of more than 12 weeks. Immediately after removing the silicone tube, there was free passage of saline on lacrimal syringing as well as complete resolution of epiphora. At over 6 months of follow-up after tube removal, there was no recurrence of epiphora in any of the 4 patients. CONCLUSIONS: Triamcinolone-soaked nasal packing may be considered in patients with failed endoscopic dacryocystorhinostomy.

Radiologic and Clinical Courses of Degenerative Lumbar Scoliosis (10°–25°) after a Short-Segment Fusion

STUDY DESIGN: Retrospective study. PURPOSE: We report the surgical outcomes of small degenerative lumbar scoliosis (DLS) patients treated by a short-segment fusion and followed for a minimum of 5 years. OVERVIEW OF LITERATURE: Several surgical options are available for the treatment of DLS, such as decompression only, decompression plus a short-segment fusion, or decompression with a long segment fusion. Few studies have evaluated the results of a short-segment fusion in patients with DLS over time. METHODS: Seventy small DLS patients (Cobb's angle, 10°–25°) with a minimum follow-up of 5 years were treated with a short-segment fusion between March 2004 and February 2010. The mean patient age was 71 (male:female=16:54), with a follow-up of 6.5 years (range, 5.0–11.6). The Cobb's angle, 1 and 2 segment coronal upper intervertebral angle, 1 and 2 segment sagittal upper intervertebral angle, the lumbar lordosis angle, and the C7 plumb lines (coronal and sagittal) were evaluated using simple radiographs, and visual analog scale (VAS), back pain was assessed preoperatively, immediately after surgery, and at 3, 6, and 12 months and 3 and 5 years after surgery. To identify factors influencing the radiologic progression, age, number of fusion segments, vertebral levels of fusion, body mass index, lowest instrumented vertebra (L5 or S1), bone mineral density (>–2.5, ≤–2.5), and the presence of an interbody fusion were analyzed. RESULTS: The Cobb's angle and 1 segment coronal upper intervertebral angle showed more progression during follow up, particularly at 6 and 12 months after surgery. Clinical outcomes and radiological results were found to be significantly associated (p=0.041). No statistically significant association was found between other factors affecting radiologic progression from postoperative 6 months to 1 year. CONCLUSIONS: Radiologic variables (the Cobb's angle and coronal upper intervertebral angle–1) should be carefully considered and clinical caution exercised from 6 to 12 months after short-segment fusion in small DLS (10°–25°).

Hemodynamic Analysis in Patients Who Underwent Lumbar Spine Fusion Surgery without Blood Transfusion / 대한정형외과학회잡지

PURPOSE: Lumbar fusion surgery was performed on transfusion-free patients and hemodynamic changes were analyzed. MATERIALS AND METHODS: A total of 36 transfusion-free patients who had undergone lumbar fusion surgery using recombinant human erythropoietin (rHuEPO) before surgery from April 2007 to March 2014 were included in the study. Hemoglobin and hematocrit levels were measured before surgery, immediately after surgery, 12 hours after surgery, on day 1, day 2, day 3, and day 7. Changes in levels were investigated and the factors affecting the changes in hemoglobin levels were analyzed. RESULTS: Changes in hemoglobin and hematocrit were -18.11% before surgery and -22.92% on day 7, respectively, and they tended to recover from day 2 after surgery. Depending on the patient's age, gender, body mass index, blood loss, and surgery method (presence of lumbar interbody fusion), the changes in hemoglobin level did not show statistically significant differences; however, significant differences were observed in the surgical time and extent of the operation. CONCLUSION: Transfusion alternatives during lumbar spinal fusion are deemed safe methods, leading to good, postoperative hemodynamic outcomes. However, the surgical time and extent of the operation must be determined before surgery.

Factors Affecting the Expansion of Chondrocytes Harvested from Rabbit Auricle and Nasal Septum / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In tissue engineering of the cartilage, cellular expansion is an essential step for creating useful amounts of tissue required. Many variables such as media composition, growth factors and cell seeding density have been utilized to stimulate the ability of cellular proliferation and to reduce the number of expansion in monolayer. The object of this study was to evaluate the effects of human serum (HS) and rabbit serum (RS) on cellular proliferation of auricular and nasal septal chondrocytes of the rabbit. SUBJECTS AND METHOD: Auricular and nasal septal chondrocytes of the New Zealand White Rabbit were expanded in monolayer in medium supplemented with 2% RS, 5% RS, 10% RS, or 10% HS with or without adding of growth factors. The effect of the supplements on the cellular proliferation was compared. RESULTS: The proliferation yield of chondrocytes grown in RS was comparable to that with HS. Both serums results in increased proliferation; however, the amount of cellular proliferation was not correlated with the concentration of the serum. The proliferation rate of nasal septal chondrocytes was higher than that of auricular chondrocytes. CONCLUSION: Both HS and RS resulted in the increased proliferation of rabbit auricular and nasal septal chondrocytes. The results show that the determination of appropriate types and concentrations of serum is required for cell expansion in constructing tissue-engineered cartilage.

The Relationship of Minor Trauma with the Surgical Outcome in Patients with Cervical Myelopathy

STUDY DESIGN: Retrospective study. OBJECTIVES: To determine the influence of trauma on the neurologic course in patients who have undergone surgery for cervical myelopathy. SUMMARY OF LITERATURE REVIEW: The postsurgical outcomes were worse from trauma in patients who had a cervical ossification of the posterior longitudinal ligament (OPLL) or cervical canal stenosis, in comparison with patients who did not. MATERIALS AND METHODS: The study was conducted on 70 patients who had undergone surgery due to cervical myelopathy from January 2004 to December 2013 and had at least 1 year of follow-up. Depending on trauma history, the patients were divided into two groups, and their radiological (simple radiographic, computed tomographic, and magnetic resonance imaging) and clinical (Japanese Orthopaedic Association [JOA] score, motor power of upper extremities) results were compared retrospectively. RESULTS: Among 70 patients in total, 18 patients were in the trauma group and 52 were in the non-trauma group, and all cases in the trauma group had a history of minor trauma (11 cases of drivers traffic accidents, 4 cases of slipping and falling, 2 cases of minor pedestrian accidents, and 1 case of falling). Radiologically narrower diameter of the spinal canal showed statistically significant difference between two groups (p=0.042). The JOA scores before and after surgery and the recovery rate did not have a clinically meaningful difference with trauma. However, the degree of motor improvement was significantly higher for the trauma group within 1 week after surgery (p=0.040). CONCLUSIONS: Minor trauma itself may adversely affect the patients' clinical courses.

Comparison of Computed Tomography Coronary Angiography and Exercise ECG Test for Diagnostic Accuracy in Real-World Practice / 대한내과학회지

BACKGROUND/AIMS: The exercise ECG test (XECG) and computed tomography coronary angiography (CTCA) have been used widely in initial evaluations of coronary artery disease (CAD) in real-world practice. In this study, we compared the diagnostic power of CTCA and XECG, based on conventional coronary angiography (CCA). METHODS: We enrolled 589 consecutive patients retrospectively who had been examined with both XECG and CTCA for the evaluation of CAD in outpatient clinics. Significant stenosis was defined as more than 50% diameter stenosis. Triage to CCA and/or revascularization treatment (RT) by the results of XECG and CTCA and the diagnostic accuracy of both exams, based on CCA, were investigated. RESULTS: In the 589 patients, 107 (19%) were triaged to CCA for further evaluation; in 77 (12.8%) significant stenosis was detected on CCA. Also, 65 (11%) patients underwent RT. In the CTCA results, 120 patients had significant stenosis. Of them, 58 (48%) and 75 (62%) patients were triaged to RT and CCA, respectively. Based on the XECG, 115 positive patients were triaged to RT and CCA (23 [20%]/41 [35%]). Among 107 patients with CCA, the sensitivity, specificity, positive predictive value, and negative predictive value for significant stenosis on CCA of CTCA were 89.9%, 74.0%, 90.6%, and 71.4%, respectively, and those of XECG were 50.0, 67.9, 78.0, and 37.3, respectively. The kappa value of CCA and CTCA was 0.62 (p < 0.001) and that of CCA and XECG was 0.145 (p = 0.113). CONCLUSIONS: In real-world practice, CCA was decided on more frequently, based on CTCA. CTCA showed better diagnostic accuracy than XECG.

Postoperative Outcomes of Patients with Severe Aortic Regurgitation and Decreased Left Ventricular Ejection Fraction

BACKGROUND AND OBJECTIVES: The postoperative outcomes of patients with severe aortic regurgitation (AR) and a low ejection fraction (EF) were elucidated. SUBJECTS AND METHODS: The study group consisted of 201 consecutive patients that underwent corrective surgery for isolated AR. The clinical data of patients with a preoperative EF or =50% (n=142, group II) were compared. The clinical follow-up duration was 3.2+/-2.4 years. RESULTS: There was no operative mortality for patients in both groups. Group I patients showed significant improvement of the EF after surgery, from 41+/-6% to 53+/-12% (p<0.001) and the EF (53+/-12 vs 56+/-1%, p=0.09) at follow-up was not significantly different between patients in the two groups. The 5-year survival rate was 70.5+/-8.9% for group I patients and 88.0+/-3.5% for group II patients (p=0.06). The cumulative incidence of congestive heart failure at 5 years was significantly higher in group I patients (32.1+/-9.7% vs 8.5+/-3.1%, p=0.003). Independent determinants of development of congestive heart failure in group I patients were age [hazards ratio (HR)=1.1, 95% confidence interval (CI)=1.02-1.16, p=0.01] and EF (HR=0.82, 95% CI=0.69-0.97, p=0.02). The best cut-off value of the preoperative EF in predicting the development of congestive heart failure was 41.5%, with a sensitivity and specificity of 90.9% and 68.9%, respectively. CONCLUSION: A relatively high 5-year survival rate without operative mortality is anticipated in patients with reduced a preoperative left ventricular ejection fraction (LVEF) and the incidence of congestive heart failure was higher when compared to patients with a normal preoperative LVEF, which could be predicted by the level of the preoperative LVEF.

A Case of Water Intoxication and Grand Mal Seizure due to Oxytocin / 대한산부인과학회잡지

A 17-year-old primigravida, who had an elective abortion in the second trimester of pregnancy in a local clinic, was transferred to our hospital in state of status epilepticus. During the last 2-hr period immediately prior to admission the patient had an unknown number of generalized convulsions together with intermittent episodes of vomiting. Despite the administration of anticonvulsants and sedatives her condition was one of wild agitated response to stimuli, alternating with deep coma. After a tentative diagnosis of dilutional hyponatremia, she was given hypertonic saline solutions in addition to anticonvulsant therapy. Fourteen hours after her seizure, the patient was awake, alert, and cheerful but totally amnescent about the previous period. This case of severe water intoxication associated with an infusion of oxytocin reported here may serve as a reminder of the potential hazards of a widely used procedure, and of the precautions which must be observed.