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OBJECTIVES@#Opioids are prescribed to treat moderate to severe pain. We investigated recent trends in opioid (morphine, oxycodone, fentanyl, and hydromorphone) prescriptions using data from the Korean National Health Insurance Service-National Sample Cohort between 2002 and 2015. @*METHODS@#The morphine milligram equivalent (MME) was calculated to standardize the relative potency of opioids. The number (cases) or amount (MME) of annual opioid prescriptions per 10,000 registrants was computed to analyze trends in opioid prescriptions after age standardization. Joinpoint regression analysis was conducted to calculate the annual percentage change and average annual percentage change (AAPC). @*RESULTS@#The number (cases) of prescriptions per 10,000 registrants increased from 0.07 in 2002 to 41.23 in 2015 (AAPC, 76.0%; 95% confidence interval [CI], 61.6 to 91.7). The MME per 10,000 registrants increased from 15.06 in 2002 to 40,727.80 in 2015 (AAPC, 103.0%; 95% CI, 78.2 to 131.3). The highest AAPC of prescriptions and MME per 10,000 registrants were observed in the elderly (60-69 years) and in patients treated at general hospitals. Fentanyl prescriptions increased most rapidly among the 4 opioids. @*CONCLUSIONS@#Consumption of opioids greatly increased in Korea over the 14-year study period.
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Background@#Non-invasive painless signaling therapy (NPST) is an electro-cutaneous treatment that converts endogenous pain information into synthetic non-pain information. This study explored whether pain improvement by NPST in failed back surgery syndrome (FBSS) patients is related to cerebral modulation. @*Methods@#Electroencephalography (EEG) analysis was performed in 11 patients with FBSS. Subjects received daily NPST for 5 days. Before the first treatment, patients completed the Brief Pain Inventory (BPI) and Beck Depression Inventory and underwent baseline EEG. After the final treatment, they responded again to the BPI, reported the percent pain improvement (PPI), and then underwent post-treatment EEG. If the PPI grade was zero, they were assigned to the ineffective group, while all others were assigned to the effective group. We used standardized low-resolution brain electromagnetic tomography (sLORETA) to explore the EEG current-source distribution (CSD) associated with pain improvement by NPST. @*Results@#The 11 participants had a median age of 67.0 years, and 63.6% were female. The sLORETA images revealed a beta-2 CSD increment in 12 voxels of the right anterior cingulate gyrus (ACG) and the right medial frontal area. The point of maximal CSD changes was in the right ACG. The alpha band CSD increased in 2 voxels of the left transverse gyrus. @*Conclusions@#Pain improvement by NPST in FBSS patients was associated with increased cerebral activity, mainly in the right ACG. The change in afferent information induced by NPST seems to be associated with cerebral pain perception.
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Background/Aims@#Nonalcoholic fatty liver disease (NAFLD) is closely related to gut-microbiome. There is a paucity of research on which strains of gut microbiota affect the progression of NAFLD. This study explored the NAFLD-associated microbiome in humans and the role of Lactobacillus in the progression of NAFLD in mice. @*Methods@#The gut microbiome was analyzed via next-generation sequencing in healthy people (n=37) and NAFLD patients with elevated liver enzymes (n=57). Six-week-old male C57BL/6J mice were separated into six groups (n=10 per group; normal, Western, and four Western diet + strains [109 colony-forming units/g for 8 weeks; L. acidophilus, L. fermentum, L. paracasei, and L. plantarum]). Liver/body weight ratio, liver pathology, serum analysis, and metagenomics in the mice were examined. @*Results@#Compared to healthy subjects (1.6±4.3), NAFLD patients showed an elevated Firmicutes/Bacteroidetes ratio (25.0±29.0) and a reduced composition of Akkermansia and L. murinus (P<0.05). In the animal experiment, L. acidophilus group was associated with a significant reduction in liver/body weight ratio (5.5±0.4) compared to the Western group (6.2±0.6) (P<0.05). L. acidophilus (41.0±8.6), L. fermentum (44.3±12.6), and L. plantarum (39.0±7.6) groups showed decreased cholesterol levels compared to the Western group (85.7±8.6) (P<0.05). In comparison of steatosis, L. acidophilus (1.9±0.6), L. plantarum (2.4±0.7), and L. paracasei (2.0±0.9) groups showed significant improvement of steatosis compared to the Western group (2.6±0.5) (P<0.05). @*Conclusions@#Ingestion of Lactobacillus, such as L. acidophilus, L. fermentum, and L. plantarum, ameliorates the progression of nonalcoholic steatosis by lowering cholesterol. The use of Lactobacillus can be considered as a useful strategy for the treatment of NAFLD.
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Objective@#To retrospectively review the characteristics of preschool children with speech and language disorders to determine their clinical features and compares the average degrees of language delay based on hospital visit purposes, language developmental delay causes, and maternal language. @*Methods@#One thousand one hundred two children (832 males, 270 females) with the chief complaint of language or speech problems who underwent language assessment for the first time were included. Their medical records, including demographic data, language environments, and family history of language problems and other developmental problems, were collected. Furthermore, the results of language and developmental assessments and hearing tests were collected. @*Results@#Among the children enrolled in this study, 24% had parental problems and 9% were nurtured by their grandparents. The average degree of language delay did not differ regarding purposes of hospital visits. The average degree of language delay was greatest in children with autism spectrum disorders and least in children with mixed receptive–expressive language disorders. In children with mothers who do not speak Korean as their native language, social quotients in the social maturity scale were less than 70. @*Conclusion@#Language environment is an essential factor that may cause speech and language disorders. Moreover, maternal language seems to affect the social quotient of the social maturity scale.
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Background@#Non-invasive painless signaling therapy (NPST) is an electro-cutaneous treatment that converts endogenous pain information into synthetic non-pain information. This study explored whether pain improvement by NPST in failed back surgery syndrome (FBSS) patients is related to cerebral modulation. @*Methods@#Electroencephalography (EEG) analysis was performed in 11 patients with FBSS. Subjects received daily NPST for 5 days. Before the first treatment, patients completed the Brief Pain Inventory (BPI) and Beck Depression Inventory and underwent baseline EEG. After the final treatment, they responded again to the BPI, reported the percent pain improvement (PPI), and then underwent post-treatment EEG. If the PPI grade was zero, they were assigned to the ineffective group, while all others were assigned to the effective group. We used standardized low-resolution brain electromagnetic tomography (sLORETA) to explore the EEG current-source distribution (CSD) associated with pain improvement by NPST. @*Results@#The 11 participants had a median age of 67.0 years, and 63.6% were female. The sLORETA images revealed a beta-2 CSD increment in 12 voxels of the right anterior cingulate gyrus (ACG) and the right medial frontal area. The point of maximal CSD changes was in the right ACG. The alpha band CSD increased in 2 voxels of the left transverse gyrus. @*Conclusions@#Pain improvement by NPST in FBSS patients was associated with increased cerebral activity, mainly in the right ACG. The change in afferent information induced by NPST seems to be associated with cerebral pain perception.
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Background@#To compare the muscle strength of patients with a hip fracture according to the presence of sarcopenia after surgery and the correlation of measured values between a Biodex and surface electromyography (sEMG) in postoperative measurement of muscle strength. @*Methods@#Seventy-one patients who underwent hip fracture surgery were included in this study. Muscle mass was measured using dual energy X-ray absorptiometry and the grip strength was evaluated using a dynamometer. The diagnosis of sarcopenia followed the Asian Working Group for Sarcopenia criteria. We evaluated the Biodex to assess muscle strength according to the presence of sarcopenia and at the same time measured the sEMG to evaluate the correlation of muscle strength between Biodex and sEMG. @*Results@#We assigned 34 patients with sarcopenia and 37 without sarcopenia to 2 groups. In the comparison of muscle strength using Biodex and sEMG between the 2 groups, it was confirmed that muscle strength of sarcopenia group was decreased compared with that of the non-sarcopenia group, although there was no statistical significance between the groups. However, Biodex and sEMG showed very close correlation with muscle strength in all variables. @*Conclusions@#We suggest that using sEMG for the evaluation of muscle strength after hip fracture surgery may be an excellent tool alternative to isokinetic testing machines such as the Biodex.
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Background@#Free-flap reconstruction for recurrent head and neck cancer may be challenging depending on the previous treatments, those are, chemotherapy, radiotherapy, and surgery, including neck dissection or free tissue transfer. Specifically, the previous treatment could compromise the neck vessels, thereby making free-flap reconstruction more difficult. This study aimed to investigate the correlation between previous treatments and vascular compromise of the free flap. @*Methods@#In this retrospective study, 124 free-flap reconstructions in 116 patients for recurrent head and neck cancer between 1993 and 2017 were investigated. The demographic characteristics, previous treatments, flap choices, infections, recipient vessels, and vascular crises were evaluated. @*Results@#Of the 124 reconstruction cases, 10 had vascular crises. There were six revisions, totaling six flap failures. The success rate of free-flap reconstruction for recurrent cancer was 95.2%, which significantly differed from that for primary cancer (98.8%, p= 0.006). Moreover, in the recurrent cancer group, no correlation was found between previous treatments and vascular crises (p> 0.05). Increased rates of contralateral or uncommon anastomoses were found following neck dissection (p< 0.05). @*Conclusion@#Previous neck dissection or radiotherapy could lead to scarring and tissue damage, which could in turn make microvascular reconstruction more challenging; however, the effect was not definite in this study. Approximately 60% of patients with previous neck dissection had compromised ipsilateral recipient vessels, which resulted in contralateral or uncommon anastomoses. In this study, free-flap reconstruction seems to be quite safe and preferable in patients with recurrent head and neck cancer based on the overall survival rate.
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A 60-year-old woman with a history of diabetes mellitus and chronic renal failure was admitted tothe hospital with severe pain in the upper lip, which began 4 days prior to admission, accompaniedby a bullous lesion and suspected cellulitis in the upper lip. Immediately after admission, asthe patient´s general condition worsened, tests revealed a non-ST elevated myocardial infarction,septic embolism of the lung, as well as septic shock. Her upper lip suddenly presented a gangrenousand necrotic change, which the tissue and blood culture confirmed to be a Klebsiella pneumoniaeinfection. After a quick response, the patient’s general condition improved. Subsequently,serial debridement was performed to effectively clear away the purulent discharge. While undergeneral anesthesia, the process confirmed full-layer necrosis of the upper lip including the orbicularisoris muscle. Almost half of the entire upper lip sustained a full-layer skin and soft tissue defect,with scar contracture. Six months later, to correct the drooling and lip sealing following thedefects, a scar release and an Abbe flap coverage were performed considering both functionaland aesthetic aspects. The follow-up revealed a favorable corrective result of the upper lip drooling,and the patient was satisfied from a functional perspective.
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Oral mucosal melanoma is a very rare type of malignant melanoma, the characteristics of whichdiffer from those of cutaneous melanoma. Primary amelanotic melanoma of the mandibular gingiva,which can invade the mandibular bone, is very rare worldwide. Here, we report a case in whichwe performed a reconstruction of the mandible and gingiva using the fibula osteocutaneous freeflap procedure to treat a patient diagnosed with a primary amelanotic melanoma of the mandibulargingiva. The procedure was successful, and no recurrence was observed 10 months after surgery.Oral mucosal melanoma has a much poorer prognosis and a lower 5-year survival rate thancutaneous melanoma. However, recently, immunomodulatory therapies for mutations in melanocyticlesions have been used effectively to treat the increasing number of patients developing thistype of melanoma, thus improving the prognosis of patients with oral mucosal melanoma.
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STAEMENT OF PROBLEM: In Korea, the preliminary impression trays for dental and edentulous maxillae are manufactured on the base of the statistical value of Westerners. There had been less study on the dental and edentulous arches of Koreans. PURPOSE: The purpose of this study was to evaluate an average dental cast, preliminary impression trays, three-dimensional relation of dental and edentulous maxilla of Koreans. MATERIAL AND METHODS: The subjects for this study were 173 dental casts of maxilla (dental: 52, edentulous: 146) with ages 18~60 years old. Each of the master casts was measured 69 measuring points on the dental cast of maxilla, and 46 measuring points on the edentulous cast of maxilla with three-dimensional digital measuring machine. Each measuring points were analysed and were overlapped, that three dimensional dental graphic manufactured by CAD/CAM system. RESULTS: 1. A standard of distribution to alveolar bone were width between left and right buccal border lines of the standard 3/4 line. The mean value of dental and edentulous casts were 67.27mm, 63.49mm, respectively. 2. Morphological classification of dental casts were divided into three groups of V-shape, O-shape, U-shape, that proportion of distribution were 17%, 16%, 67%, respectively. Dimensional classification of the dental casts were divided into five groups of less than 63mm, 63 up to 65mm, 65 up to 67mm, 67 up to 69mm, more than 69mm, respectively. 3. Morphological classification of edentulous casts were divided into three groups of V-shape, O-shape, U-shape, that proportion of distribution were 18%, 17%, 65%, respectively. Dimensional classification of the edentulous casts were divided into five groups of less than 57mm, 57 up to 61mm, 61 up to 65mm, 65 up to 69mm, more than 69mm, respectively. 4. Mean dental and edentulous cast of maxilla were overlapped, the proportion of bone resorption to alveolar bone is higher than that of palatal bone, its difference were higher anterior 2/4 area than posterior 3/4 area. CONCLUSION: It obtains information of preliminary impression trays for dental and edentulous maxilla of Koreans.