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Pre-anesthetic evaluation is an important aspect of perioperative patient management. However, anesthesiologists often encounter challenges during anesthesia due toconditions that are not detected during pre-anesthetic evaluations.Case: Case 1 involved a 74-year-old female patient scheduled for cranioplasty and meningioma excision. Severe pancytopenia was detected during anesthesia. Cranioplasty was onlyperformed, the surgery was terminated, and drug-induced pancytopenia was diagnosed andtreated. The pre-anesthetic test results were normal, except for anemia. Case 2 involved a71-year-old male patient who discovered large ecchymosis during general anesthesia preparation in the operating room for choledochal cyst surgery. Surgery was canceled to evaluatethe bleeding tendency, and acquired coagulation factor VIII deficiency was diagnosed andtreated. The pre-anesthetic tests were normal, except for prolongation of the activated partial thromboplastin time.Conclusions: Abrupt hematologic and hemostatic changes may occur during anesthesiaeven though pre-anesthetic evaluation findings are normal.
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Herpes zoster (HZ) is one of the most common cutaneous adverse reactionsassociated with the coronavirus disease 2019 (COVID-19) vaccine and has been widely reported. This study aimed to evaluate HZ following COVID-19 vaccination from the viewpointof pain management.Methods: A retrospective study was conducted on 42 patients with HZ who visited the painclinic between August 2021 and October 2021. Medical records were reviewed to comparepain severity, treatment methods, treatment duration, and incidence rate of postherpeticneuralgia (PHN) in patients who received COVID-19 vaccination within 6 weeks prior to developing symptoms compared with other patients with HZ.Results: Fourteen patients developed HZ within 6 weeks after vaccination and were significantly younger than the other HZ groups. There were no significant differences in the frequency of prodromal pain, location of pain, pain severity, treatment methods, treatmentduration, or incidence of PHN compared with the other HZ groups.Conclusions: COVID-19 vaccination-related HZ showed clinical features similar to those ofthe other HZ.
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Background/Aims@#Among several methods used to prevent endoscopic submucosal dissection (ESD) bleeding, the recently developed hemostatic powder (HP) has few technical limitations and is relatively easy-to-use. This study aimed to analyze the hemostatic effects and mechanisms of two HPs using a porcine upper gastrointestinal hemorrhage model. @*Methods@#We evaluated HPs (Endospray and epidermal growth factor [EGF]-endospray) for adhesion, waterproofing ability, permeability, and absorption in vitro. ESD was performed to induce bleeding ulcers in the porcine stomachs. In a total of three pigs, three bleeding ulcers per animal were generated. Hemostasis and rebleeding were evaluated endoscopically. After 72 hours, the animals were sacrificed, and histologically analyzed. @*Results@#The water absorption of HPs was over 20 times the initial value within 30 minutes. The gelated HPs completely blocked water penetration into the applied site within 5 minutes and strongly adhered to the Petri-dish surface for up to 6 hours. The initial hemostasis rates within 5 minutes were 33.3%, 100.0%, and 66.7%, and the rebleeding rates at 6 to 72 hours after HP application were 33.3%, 16.7%, and 33.3% (control, Endospray, and EGF-endospray groups, respectively). Histological analysis revealed the thickness of the regenerated mucosa (522.1, 514.5, and 680.3 µm) and the submucosal layer (1,510.3, 2,848.2, and 3,062.3 µm) and the number of newly formed blood vessels (15.3, 17.9, and 20.5) in the control, Endospray, and EGFendospray groups, respectively. @*Conclusions@#The endoscopic HPs demonstrated the ability to elicit effective initial hemostasis and the histological ulcer-healing effect of EGF in an animal model of hemorrhagic gastric ulcers.
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Patients suffering from rare human diseases often go through a painful journey for finding a definite molecular diagnosis prerequisite of appropriate cures. With a novel variant isolated from a single patient, determination of its pathogenicity to end such “diagnostic odyssey” requires multi-step processes involving experts in diverse areas of interest, including clinicians, bioinformaticians and research scientists. Recent efforts in building large-scale genomic databases and in silico prediction platforms have facilitated identification of potentially pathogenic variants causative of rare human diseases of a Mendelian basis. However, the functional significance of individual variants remains elusive in many cases, thus requiring incorporation of versatile and rapid model organism (MO)-based platforms for functional analyses. In this review, the current scope of rare disease research is briefly discussed. In addition, an overview of invertebrate MOs for their key features relevant to rare neurological diseases is provided, with the characteristics of two representative invertebrate MOs, Drosophila melanogaster and Caenorhabditis elegans , as well as the challenges against them. Finally, recently developed research networks integrating these MOs in collaborative research are portraited with an array of bioinformatical analyses embedded. A comprehensive survey of MO-based research activities provided in this review will help us to design a wellstructured analysis of candidate genes or potentially pathogenic variants for their roles in rare neurological diseases in future.
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Purpose@#To assess the refractive changes and stability after cataract surgery with insertion of three different intraocular lenses in axial myopes. @*Methods@#A retrospective analysis was performed with 44 eyes of normal axial length (22.0 mm < axial length ≤ 24.5 mm) and 49 eyes of long axial length (24.5 mm < axial length) in patients who underwent phacoemulsification and posterior chamber lens insertion. Automated keratometry examination and refraction were performed using an autorefractor keratometer; A-scan ultrasound was used to calculate target refraction. One-piece intraocular lenses (IOLs) and three-piece IOLs were inserted. At 2 and 12 months postoperatively, refraction differences relative to the target refraction (calculated using the SRK-T formula) were analyzed. The refractive changes between 2 and 12 months postoperatively were compared according to the IOL. @*Results@#Myopic shift from the target refraction was observed with eyes of long axial length, compared with eyes of normal axial length, at 2 and 12 months postoperatively (p = 0.003, p = 0.013). For refractive stability according to IOL, there was no significant difference in eyes with normal axial length; in eyes with long axial length, three-piece IOLs showed significant refractive stability (p < 0.05). @*Conclusions@#In eyes with long axial length, there was a significant difference in postoperative refractive stability according to the inserted IOL; three-piece IOLs showed significant refractive stability compared with one-piece IOLs.
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Purpose@#To evaluate the changes in corneal astigmatism before and after epiblepharon correction surgery with a Scheimpflug camera. @*Methods@#From April, 2019, to June, 2020, 48 eyes of 24 patients underwent epiblepharon correction surgery. The patients were divided into two subgroups by age and their best corrected visual acuity (BCVA) and corneal anterior and posterior astigmatism were compared before and after correction surgery. @*Results@#There was no difference in BCVA after the correction surgery. To assess the changes in the keratometric value and astigmatism after epiblepharon surgery, a Scheimpflug camera was used. The anterior flat and mean keratometry changed from 42.10 ± 1.46 to 42.43 ± 1.10 D (p = 0.035) and from 42.97 ± 1.26 to 43.21 ± 1.15 D (p = 0.012), respectively, while the posterior corneal astigmatism changed from 0.44 ± 0.31 to 0.35 ± 0.17 D (p = 0.047). There were no significant changes in steep keratometry (p = 0.191) or anterior corneal astigmatism (p = 0.126). @*Conclusions@#There were significant changes after epiblepharon correction surgery in anterior keratometry reading and posterior corneal astigmatism.
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Objective@#Subdural hematoma (SDH) primarily occurs in elderly patients. While most patients have good prognosis, some do not. Hematoma recurrence is one of the factors influencing prognosis. Moreover, some characteristic radiological factors may increase the recurrence rate. The aim of this study was to investigate whether the presence of trauma influenced radiological characteristics and hematoma recurrence in SDH patients treated with burr hole trephination. @*Methods@#From January 2012 to December 2014, we selected 83 patients diagnosed with unilateral SDH using computed tomography and/or magnetic resonance imaging. We divided the patients into 2 groups based on the presence of trauma. We compared the 2 groups with multiple parameters, such as patient factors, radiological characteristics, and recurrence rate. @*Results@#Patients who had a prolonged international normalized ratio (INR) were significantly more common in the non-traumatic SDH group (22.2%:55.2%, p=0.002). There was no statistical difference in radiological parameters between the 2 groups. The recurrence rate was marginally higher in the non-traumatic SDH group (14.8%:17.2%, p=0.502), but this difference was not statistically significant. @*Conclusion@#There were no statistically significant differences in the radiological findings, including brain atrophy, hematoma density, thickness of hematoma, and degree of midline shifting between the 2 groups. The associated trauma history may not influence recurrence. Anticoagulants medication influence INR prolongation, and commonly shown in nontraumatic group, but not statistically. INR prolongation was statistically more common in non-traumatic SDH patients than in traumatic SDH patients. INR prolongation is only a different characteristic between 2 groups.
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Purpose@#Paeonia Radix Alba is a traditional herbal medicine used to treat the liver and the spleen. Many studies have reported that Paeonia Radix Alba extract (PR) affects liver injury, but there has been no study on liver injuries induced by thioacetamide (TAA). Therefore, we aimed at evaluating the effect of PR on a TAA-induced acute liver injury (ALI) model. @*Methods@#The antioxidant activity of PR was assayed by the content of total polyphenol, total flavonoid, 1,1-diphenyl-2′-picrylhydrazyl (DPPH), and 2,2'-azino-bis (3-ethylbenzo-thiazoline-6-sulfonicacid) (ABTS) radical scavenging activities in vitro test. ALI was induced via-intraperitoneal injection of TAA (200 mg/kg body weight) for three consecutive days. Also, silymarin (100 mg/ kg body weight) and PR (100 or 200 mg/kg body weight) were administered at 1 hours 30 minutes prior to TAA treatment. The levels of ammonia, glutamic oxaloacetic transaminase (GOT), and glutamic pyruvic transaminase (GPT) were analyzed using an assay kit. The expressions of antioxidant proteins including Nrf2, Keap1, HO-1, SOD, catalase, and GPx-1/2 and oxidative stressrelated proteins including NOX2, p47 phox , and p22 phox were evaluated by the western blot analysis. @*Results@#PR showed excellent antioxidant activity in vitro. TAA administration increased the levels of ammonia, GOT, and GPT in the ALI control group compared to the normal group, whereas it was significantly reduced by PR pretreatment. Moreover, NADPH oxidase protein expressions were upregulated after TAA treatment, while the elevated expressions were inhibited by PR pretreatment. The expressions of antioxidant protein were downregulated in the ALI control group, whereas Nrf2 activation in the PR group was accompanied by increased levels of antioxidant enzymes. @*Conclusion@#PR administration increased the antioxidant enzymes via activation of the Keap1/Nrf2 pathway and inhibited the protein levels of NADPH oxidase factors. Taken together, these results showed that PR treatment may be considered to ameliorate acute liver injury induced by TAA.
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Background@#Interscalene brachial plexus block (ISBPB) is commonly used with general anesthesia for postoperative pain management in shoulder surgery. This study investigated the incidence of hypothermia and changes in the body temperature in patients undergoing arthroscopic shoulder surgery under ISBPB with propofol sedation. @*Methods@#This retrospective study enrolled 220 patients who underwent arthroscopic shoulder surgery. Patients were divided into general anesthesia (n = 34) and ISBPB with propofol sedation (n = 186) groups, and medical records were retrospectively compared. In addition, patients from the ISBPB group were further divided according to age (elderly, [≥ 65 years]; n = 98 vs. young, [< 65 years]; n = 88), and the incidence of hypothermia and changes in the body temperature were compared. @*Results@#Twenty-seven patients (12.3%) experienced perioperative hypothermia (range; 35.3–35.9℃). The incidence of perioperative hypothermia was 29.4% and 9.1% in the general anesthesia and ISBPB groups, respectively, and there was a significant difference between the two groups (P = 0.002). The incidence of perioperative hypothermia according to age in the ISBPB group was 9.2% and 9.1% in the elderly and young groups, respectively, and there was no significant difference between the two groups (P = 0.983). @*Conclusions@#The incidence of perioperative hypothermia during arthroscopic shoulder surgery under ISBPB with propofol sedation is lower than that under general anesthesia. Furthermore, when using ISBPB with propofol sedation, the incidence of perioperative hypothermia in elderly patients is similar to that in younger patients.
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Background@#The direct entry of the camera under the epiglottis may provide a better view of the glottis than the indirect lifting of the epiglottis by placing the Macintosh blade tip on the vallecula when using the video laryngoscope. This study aimed to compare the efficiency of two different methods of lifting the epiglottis during the visualization of glottis using video laryngoscopy in the same patient. @*Methods@#This prospective study enrolled 60 patients who underwent general anesthesia with tracheal intubation. In each patient, glottic views were obtained by directly (group DE) and indirectly lifting the epiglottis (group IE). These two methods were compared using the modified Cormack and Lehane grade and the percentage of glottis opening (POGO) score as assessment parameters. @*Results@#Modified Cormack and Lehane grade showed a significant difference between the groups DE and IE (P = 0.004). The difference in the POGO score between the groups DE and IE was also statistically significant (87.5% and 64.4%, respectively; P < 0.001). @*Conclusions@#Our results, therefore, revealed that the method of directly lifting epiglottis was better at exposing glottis than the method of indirectly lifting epiglottis using a video laryngoscope.
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Background@#The direct entry of the camera under the epiglottis may provide a better view of the glottis than the indirect lifting of the epiglottis by placing the Macintosh blade tip on the vallecula when using the video laryngoscope. This study aimed to compare the efficiency of two different methods of lifting the epiglottis during the visualization of glottis using video laryngoscopy in the same patient. @*Methods@#This prospective study enrolled 60 patients who underwent general anesthesia with tracheal intubation. In each patient, glottic views were obtained by directly (group DE) and indirectly lifting the epiglottis (group IE). These two methods were compared using the modified Cormack and Lehane grade and the percentage of glottis opening (POGO) score as assessment parameters. @*Results@#Modified Cormack and Lehane grade showed a significant difference between the groups DE and IE (P = 0.004). The difference in the POGO score between the groups DE and IE was also statistically significant (87.5% and 64.4%, respectively; P < 0.001). @*Conclusions@#Our results, therefore, revealed that the method of directly lifting epiglottis was better at exposing glottis than the method of indirectly lifting epiglottis using a video laryngoscope.
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Purpose@#The purpose of this study is to explore nursing care worker's experience of care services for infected patients in long-term care hospital. @*Methods@#For this study, the researcher used the convenience sampling method to recruit 9 nursing care workers in long-term care hospitals. Data were collected through in-depth interview with them. The data collected were analyzed using the thematic analysis method. @*Results@#24 codes were extracted, and through the process of organizing the meanings, 8 sub-themes and 4 themes were deduced. The themes deduced were ‘Diversely coexisting psychological responses’, ‘Caring for an infected patient at a given position’, ‘Obstacles to implementation of principled infection control guidelines’, ‘Needs for customized education of caregiver for infected patients’. @*Conclusion@#This study would be deemed significant in that it has provided for some basic data to the education of the nursing care workers and the development of an intervention program.
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This study examined the effects of response-facilitating factors(Food-related Knowledge, Response-Efficacy, and Self-Efficacy) and response-inhibiting factors(Severity, Vulnerability, and Consumer Stress) on the consumer’ behavior intention based on protection motivation theory, which explains the behavioral change to protect oneself. This study was conducted to reduce the customers’ concerns regarding food safety accidents and introduce ways to make them more interested in food safety. A sample of 225 adults over 19 years of age was collected in February 2018 through a self-administered questionnaire. The results of the cognitive mediation process of protective motivation theory showed that the consumers’ knowledge and self-efficacy which are response-facilitating factors, positively influence the behavioral intention. Severity and consumer stress were response-inhibiting factors. On the other hand, response-efficacy, which is a response-facilitating factor, and vulnerability, which is a response-inhibiting factor, did not influence the behavioral intention. Therefore, severity and consumer stress are response-inhibiting factors. The results were analyzed as a result of a behavioral change to protect oneself from food safety accidents. The applicability of the theory of protection motivation on the topic of food safety was also confirmed.
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This study was undertaken to provide basic data for revitalizing the school meal support centers and improvingschool meals, by analyzing the purchase conditions and satisfaction of food according to an adoptionof a school meal service support center. Comparing the purchasing efficiency, convenience to purchase, andhigher overall satisfaction was achieved when a school meal service support center was adopted by the localgovernment, as compared to non-adopted school meal service support centers. Therefore, it is considered thatthe adaption of a school meal service support center is urgently required by non-adoption local governments.Moreover, the stability of food material supplies was also higher in the adopted rather than the non-adoptedcenters. Satisfaction with the quality of food ingredients was also found to be significantly higher in theadopted centers. These results indicate that if the local government adopts and introduces the school mealsupport center, inconsistencies observed in the return and exchange processes experienced by the non-adoptedcenters can be resolved, and food quality satisfaction can be improved. We, therefore, propose the necessityto implement a system for determining reasonable pricing by establishing systematic cooperation amongschools, manufacturing entities (suppliers), and the School Meal Service Support Center.
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Purpose@#The purpose of this study was to compare the axial displacement of the hexagonal and conical abutment in internal conical connection implant after screw tightening and cyclic loading. @*Materials and Methods@#Internal conical connection implants were divided into two groups (n = 10): group HEX, hexagonal abutment; and group CON, conical 2-piece abutments. The axial displacement and removal torque values were measured after 30 Ncm torque tightening and 250N loading test of 100,000 cycles. The Student t test with 5% significance level was used to evaluate the data. @*Results@#HEX group demonstrated significantly higher axial displacement values after 30 Ncm tightening in comparison to the CON group (P < 0.05). No significant difference was found in axial displacement after cyclic loading (P = 0.052). Removal torque loss before and after the cyclic loading both revealed no significant difference between groups (P = 0.057 and P = 0.138). Removal torque value decreased after cyclic loading in both groups (P < 0.05). @*Conclusion@#Overall, both abutment with or without hexagon index presented similar biomechanical performance except HEX group demonstrated significantly more axial displacement after applying tightening torque.
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Background@#Proteinuria is a significant risk factor for progression of IgA nephropathy (IgAN) and has a positive correlation with severity of foot process effacement (FPE). We evaluated the relationship of FPE with proteinuria and histologic characteristics, including the Oxford classification. @*Methods@#Patients who underwent renal biopsy and were diagnosed with IgAN at a single center were retrospectively reviewed. Patients aged less than 18 years and those with the possibility of secondary causes were excluded from the study. Subsequently, we evaluated the association between degree of proteinuria, severity of FPE, and histologic characteristics, including the Oxford classification and other immunofluorescence stains. @*Results@#A total of 805 cases of renal biopsy was performed at our institution, and 327 patients were diagnosed with IgAN. Among them, 82 patients were excluded. Severity of FPE had an impact on the degree of proteinuria. Notably, the group with diffuse FPE had more than about 1.3 g/day of urine protein compared to those with rare FPE. Among the histologic characteristics, M1 score and immune deposition of IgG affected severity of FPE (hazard ratios [95% confidence interval], 1.90 [1.10 to 3.26], and 3.77 [1.66 to 8.54], respectively). @*Conclusion@#Severity of FPE had an impact on the degree of proteinuria and may be associated with the pathogenesis of IgAN.
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Alzheimer’s disease (AD) is a progressive and most frequently diagnosed neurodegenerative disorder. However, there is still no drug preventing the progress of this disorder. β-Amyrin, an ingredient of the surface wax of tomato fruit and dandelion coffee, is previously reported to ameliorate memory impairment induced by cholinergic dysfunction. Therefore, we tested whether β-amyrin can prevent AD-like pathology. β-Amyrin blocked amyloid β (Aβ)-induced long-term potentiation (LTP) impairment in the hippocampal slices. Moreover, β-amyrin improved Aβ-induced suppression of phosphatidylinositol-3-kinase (PI3K)/Akt signaling.LY294002, a PI3K inhibitor, blocked the effect of β-amyrin on Aβ-induced LTP impairment. In in vivo experiments, we observed that β-amyrin ameliorated object recognition memory deficit in Aβ-injected AD mice model. Moreover, neurogenesis impairments induced by Aβ was improved by β-amyrin treatment. Taken together, β-amyrin might be a good candidate of treatment or supplement for AD patients.
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Background@#Endoscopic procedures of the esophagus are more complicated than those of other regions of the gastrointestinal tract. They have a relatively long procedure time and high risk of complications, such as perforation and bleeding. Perforations that occur during the procedure can accompany pneumoperitoneum and pneumomediastinum through leakage of insufflation air and cause severe ventilatory impairment.Case: A 58-year-old male patient underwent enucleation of leiomyoma in the esophagus using endoscopy under general anesthesia. Ventilatory impairment occurred 15 min after commencement of the procedure. Subsequently, subcutaneous emphysema and severe abdominal distension were observed. We suggested the possibility of microperforation during the procedure to the endoscopist, and he performed endoscopic clipping around the excision site of leiomyoma. @*Conclusions@#Providing anesthetic care by anesthesiologists during endoscopic procedures is considered necessary for patient safety. Complications of endoscopic procedures can be detected and managed early without sequelae during anesthetic care.
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Background@#Oocyte retrieval is the most important procedure in in vitro fertilization (IVF). Various anesthetic methods are used to control a patient’s anxiety and pain during IVF; however, there are no recommended anesthetic methods at present. In this study, we retrospectively investigated chemical pregnancy rates according to the anesthetic method used for oocyte retrieval. @*Methods@#We reviewed records of patients who underwent oocyte retrieval between January 1, 2012 and December 31, 2017. Patients were divided into the spinal anesthesia (SA) and monitored anesthesia care (MAC) groups. The primary outcome was chemical pregnancy rate after IVF. @*Results@#The study included 95 patients. SA was administered in 77 (81%) and MAC in 18 (19%). The overall chemical pregnancy rate was 32.6% (31/95). According to the anesthetic method, the pregnancy rate was 32.5% (25/77) in the SA group and 33.3% (6/18) in the MAC group. There was no statistical difference in the pregnancy rate between the groups (P = 0.575). The procedural time was significantly shorter in the SA group than in the MAC group (P < 0.001). @*Conclusions@#Chemical pregnancy rates were not significantly different between the SA and MAC groups. However, the procedure duration was shorter in the SA group than in the MAC group.
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Herpes zoster ophthalmicus (HZO) is an infectious disease that results from the reactivation of latent varicella zoster virus in the ophthalmic branch of the trigeminal ganglia. HZO manifests with herpes zoster-like symptoms such as rash with or without signs of ocular involvement. Cavernous sinus thrombosis (CST) is a life-threatening condition accompanied by signs and symptoms involving the eyes and the cranial nerves. Case: We report a case of septic cavernous sinus thrombosis (caused by Streptococcus constellatus ssp. constellatus) which was masked by the simultaneous occurrence of HZO in this patient, resulting in delayed diagnosis. Conclusions: CST may be obscured by HZO, prompt diagnosis and treatment is necessary when such case arrive.