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Colonic interposition is the main procedure used in esophageal reconstruction. We report a rare case of simultaneous treatment of an anastomotic site stricture and a neoplasm in the interpositioned colon. A 69-year-old female visited our outpatient clinic with symptoms of progressive dysphagia for 1 year. At the age of 30 years, the patient underwent esophagectomy with retrosternal colonic interposition because of severe esophageal burns after chemical ingestion. Upper gastrointestinal endoscopy revealed stricture at the anastomosis site and a 10-mm flat elevated high-grade dysplasia in the interpositioned colon. First, through-the-scope balloon dilatation was performed for strictures. However, stenosis was observed during the second upper gastrointestinal endoscopy session.Therefore, a second session of through-the-scope balloon dilatation was performed, and simultaneously, endoscopic submucosal dissection was also successfully performed. After 2 months of follow-up, stenosis persisted; consequently, balloon dilatation was performed. No recurrence of neoplasm was confirmed endoscopically. Through-the-scope balloon dilatation of the stricture site and simultaneous endoscopic submucosal dissection of the neoplasm in the interpositioned colon were successfully performed.
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Recent several reports have demonstrated that periodontitis is prevalent and adversely affects the survival in patients with chronic kidney disease (CKD) or end-stage kidney disease. However, its impact on transplant outcomes remains uncertain. Methods: This retrospective cohort study included 136 and 167 patients, respectively, who underwent living donor kidney transplantation (KT) at Seoul National University Hospital from July 2012 to August 2016 and Korea University Hospital from April 2008 to October 2018. We divided patients into three groups according to stages of periodontitis based on a new classification system. Results: Patients with severe periodontitis were older, had a higher prevalence of diabetes, a higher body mass index and C-reactive protein level, a lower cardiac output, and were more likely to be smokers, indicating its association with chronic systemic inflammation. After KT, stage IV periodontitis was independently associated with a lower incidence of acute T cell-mediated rejection, suggesting the possible effect of periodontitis on immune function. However, 1-year and 3-year estimated glomerular filtration rates were not different. Among the KT recipients followed up more than 3 years, new-onset cardiovascular disease occurred in nine patients, and coronary artery disease occurred more frequently in patients with stage IV periodontitis. However, diabetes was the independent predictor of new-onset coronary artery disease in multivariate logistic regression analysis. Conclusion: Our findings showed that periodontitis might be an important player in determining posttransplant outcomes in recipients. Further interventional trials to test whether treating periodontitis could modify transplant outcome are needed.
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Objectives@#With the rapid changes in society, there are more arguments for redefining dental education system. This study aimed to review and analyze the problems in the current dental education system in Korea and then propose an integrated education system based on those findings. @*Methods@#A narrative review of the problems confronting the dental education system in Korea was carried out. Accordingly, full-text screening and specialists’ discussions were extracted from the review. The purpose of the review was to summarize the strengths and weaknesses of Korean dental education systems to offer perspectives on an integrated education system in accordance with the specialists’ opinions. @*Results@#The results revealed that the problems of the current dental education system were identified in clinical education, basic science, and humanities and social sciences. Dental schools should provide clinical education so that dental students can be exposed to the clinical environment at an early stage and perform patient-based clinical practice. It is also imperative to encourage participation in research programs to train dental scientists, as well as to reflect on courses that can adapt to changes brought about by new technologies. It is recommended that education opportunities for integrated humanities and social sciences be provided. @*Conclusions@#It will be critical in the future for dental schools to embrace a flexible education system from various perspectives. It is vital that dental schools play a role in developing students’ critical thinking, problem-solving, and decision-making skills. Finally, as part of an integrated education system, an improvement program should be devised.
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Objectives@#With the rapid changes in society, there are more arguments for redefining dental education system. This study aimed to review and analyze the problems in the current dental education system in Korea and then propose an integrated education system based on those findings. @*Methods@#A narrative review of the problems confronting the dental education system in Korea was carried out. Accordingly, full-text screening and specialists’ discussions were extracted from the review. The purpose of the review was to summarize the strengths and weaknesses of Korean dental education systems to offer perspectives on an integrated education system in accordance with the specialists’ opinions. @*Results@#The results revealed that the problems of the current dental education system were identified in clinical education, basic science, and humanities and social sciences. Dental schools should provide clinical education so that dental students can be exposed to the clinical environment at an early stage and perform patient-based clinical practice. It is also imperative to encourage participation in research programs to train dental scientists, as well as to reflect on courses that can adapt to changes brought about by new technologies. It is recommended that education opportunities for integrated humanities and social sciences be provided. @*Conclusions@#It will be critical in the future for dental schools to embrace a flexible education system from various perspectives. It is vital that dental schools play a role in developing students’ critical thinking, problem-solving, and decision-making skills. Finally, as part of an integrated education system, an improvement program should be devised.
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This study describes the epidemiological characteristics of coronavirus disease 2019 (COVID-19) based on reported cases from long-term care facilities. As of April 20th, 2020, 3 long-term care facilities in a metropolitan area of South Korea had reported cases of COVID-19. These facilities’ employees were presumed to be the sources of infection. There were 2 nursing hospitals that did not report any additional cases. One nursing home had a total of 25 cases, with an attack rate of 51.4% (95% CI 35.6–67.0), and a fatality rate of 38.9% (95% CI 20.3–61.4) among residents. The results from this study suggest that early detection and maintenance of infection control minimizes the risk of rapid transmission.
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No abstract available.
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Purpose@#Coronavirus Disease 2019 (COVID-19), an emerging infectious disease introduced in South Korea in 2020. Medically inclined college students are more susceptible to be infected by the virus. The purpose of this study was to investigate factors influencing preventive behavior against COVID-19 among medically inclined college students. @*Methods@#This is a cross-sectional study using a questionnaire survey. Data were collected from 400 medically inclined college students from four colleges of medice. Independent t-test, one-way ANOVA, Pearson correlation coefficients and multiple regression analysis were conducted to analysis the data. @*Results@#The study subjects had high knowledge and optimism related to COVID-19. Preventive behavior against COVID-19 was affected mostly by attitude (β=.32, p<.001). Such behavior was also high in relation to knowledge (β=.17, p<.001), and nursing students (β=.15, p=.002). @*Conclusion@#Infection prevention education for medically inclined college students mainly focuses on knowledge transfer. Infection preventive education programs aimed at improving COVID-19 optimistic attitudes and knowledge are helpful for these students to maintain appropriate preventive practices. The confirmation of the importance of optimistic attitudes and risk perception toward infectious diseases through this study can provide insight into infection prevention education programs to improve practice to wards new epidemic prevention behaviors.
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Objective: To determine the anti-neuroinflammatory activity of Moringa oleifera leaf extract (MLE) under lipopolysaccharide stimulation of mouse murine microglia BV2 cells in vitro. Methods: The cytotoxicity effect of MLE was investigated by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl-tetrazolium bromide assay. The inflammatory response of BV-2 cells were induced with lipopolysaccharide. The generation of nitric oxide levels was determined by using Griess assay and the level of pro-inflammatory cytokines (IL-1β, IL-6 and TNF-α) was evaluated by ELISA kit. The expression of iNOS, COX-2 as well as IκB-α was carried out by immunoblot analysis. Results: MLE reduced the nitric oxide production in concentration-dependent manner, and maintained the viability of BV-2 microglial cells which indicated absence of toxicity. In addition, MLE repressed the activation of nuclear factor kappa B by arresting the deterioration of IκB-α, consequently resulted in suppression of cytokines expression such as COX-2 and iNOS. Conclusions: MLE inhibitory activities are associated with the inhibition of nuclear factor kappa B transcriptional activity in BV2 microglial cells. Thus MLE may offer a substantial treatment for neuroinflammatory diseases.
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In the original publication of this article, there was a typo error in Figure 1A.
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OBJECTIVES: To identify diagnostically meaningful differences between Warthin's tumor and malignant masses in the parotid gland by dynamic susceptibility contrast (DSC) MR imaging. METHODS: Eleven malignant parotid tumors and 9 Warthin's tumors were included. MR imaging was performed on all patients. Signal intensity time curves of tumors were obtained by DSC MR imaging and dynamic susceptibility contrast percentages (DSC%) were calculated. RESULTS: No significant difference was observed between malignant tumors and Warthin's tumors (P = 0.437), although DSC% values tended to be higher for Warthin's tumors. CONCLUSIONS: Warthin's tumor tended to have higher DSC% values than malignant parotid tumors, but this difference was not significantly different.
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Humans , Magnetic Resonance Imaging , Parotid Gland , PerfusionABSTRACT
PURPOSE: Sonic hedgehog (Shh) signaling pathway is known to play a crucial role in carcinogenesis in various malignancies, including lung cancer regarding tumorigenesis, angiogenesis, and cellular differentiation. The aim of this study was to investigate the value of components of Shh pathway as a prognostic marker in extensive stage small cell lung cancer (ES-SCLC) patients. MATERIALS AND METHODS: We retrospectively analyzed data of 36 patients who were diagnosed with ES-SCLC between 2008 and 2012 at a single center. We performed immuo-histochemistry for glioma-associated oncogene homolog zinc finger protein 1 (Gli1), patched, Shh, and Ptch-mediated repression of smoothened (Smo) proteins using formalin-fixed, paraffin-embedded tissue derived from primary tumors. We then conducted survival analysis to evaluate the prognostic impact of these markers. RESULTS: All 36 patients received platinum-based doublet chemotherapy. The median progression free survival and median overall survival were 6.9 months [95% confidence interval (CI), 6.5–7.3] and 11.7 months (95% CI, 9.1–14.3), respectively. The overall response rate was 84%. Of the 36 tissue specimens examined, over-expression of Gli1, Patched, Shh, and Smo was found in 12 (33.3%), five (13.9%), five (13.9%), and six (16.7%) cases, respectively. We found that high expression of Shh was associated with worse progression free survival (6.3 vs. 7.6 months, p=0.005) and overall survival (9.2 vs. 12.0 months, p=0.039) by both univariate and multivariate analyses, whereas other markers were not related to patient prognosis. CONCLUSION: A high proportion of small cell lung cancer tumors express proteins related to Shh pathway, and over-expression of Shh is correlated with poor prognosis.
Subject(s)
Humans , Carcinogenesis , Disease-Free Survival , Drug Therapy , Hedgehog Proteins , Hedgehogs , Lung Neoplasms , Multivariate Analysis , Oncogenes , Prognosis , Repression, Psychology , Retrospective Studies , Small Cell Lung Carcinoma , Zinc FingersABSTRACT
PURPOSE: Direct application of atmospheric-pressure plasma jets (APPJs) has been established as an effective method of microbial decontamination. This study aimed to investigate the bactericidal effect of direct application of an APPJ using helium gas (He-APPJ) on Porphyromonas gingivalis biofilms on sandblasted and acid-etched (SLA) titanium discs. METHODS: On the SLA discs covered by P. gingivalis biofilms, an APPJ with helium (He) as a discharge gas was applied at 3 different time intervals (0, 3, and 5 minutes). To evaluate the effect of the plasma itself, the He gas–only group was used as the control group. The bactericidal effect of the He-APPJ was determined by the number of colony-forming units. Bacterial viability was observed by confocal laser scanning microscopy (CLSM), and bacterial morphology was examined by scanning electron microscopy (SEM). RESULTS: As the plasma treatment time increased, the amount of P. gingivalis decreased, and the difference was statistically significant. In the SEM images, compared to the control group, the bacterial biofilm structure on SLA discs treated by the He-APPJ for more than 3 minutes was destroyed. In addition, the CLSM images showed consistent results. Even in sites distant from the area of direct He-APPJ exposure, decontamination effects were observed in both SEM and CLSM images. CONCLUSIONS: He-APPJ application was effective in removing P. gingivalis biofilm on SLA titanium discs in an in vitro experiment.
Subject(s)
Bacterial Load , Biofilms , Decontamination , Helium , In Vitro Techniques , Methods , Microbial Viability , Microscopy, Confocal , Microscopy, Electron, Scanning , Plasma Gases , Plasma , Porphyromonas gingivalis , Porphyromonas , Stem Cells , TitaniumABSTRACT
PURPOSE@#The purpose of this study was to evaluate the clinical and magnetic resonance imaging (MRI) findings of soft tissue metastases distinct from benign soft tissue lesions.@*MATERIALS AND METHODS@#We retrospectively analyzed the MRI findings of soft tissue lesions found incidentally in patients with primary carcinoma and those without primary carcinoma from 2002–2015. To evaluate the features of soft tissue metastases distinct from benign soft tissue lesions, patients with benign soft tissue lesions were randomly selected and statistically analyzed for the distinctive features of the two groups.@*RESULTS@#A total of 47 patients (mean age 46.2 years) and 36 controls (mean age 46.2 years) were enrolled. Thirty six of the 47 patients were diagnosed with soft tissue metastasis, most commonly as the primary cancer (31%). The most common site of soft tissue metastasis was the lower extremities (36%) followed by the upper extremities (31%). Soft tissue metastasis was statistically significantly different from benign soft tissue lesions according to patient age, lesion size, margin, presence of degenerative changes in lesions, and presence of edema around the mass.@*CONCLUSION@#If the incident soft tissue lesion shows malignant features on MRI in patients with primary carcinoma or in patients over 40 years of age, the radiologist should consider the possibility of metastatic cancer.
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PURPOSE: Oral lichen planus (OLP) is a chronic oral mucosal disease that has been recognized as an immune condition. The purpose of this study was to evaluate factors affecting the clinical outcomes of topical corticosteroid application on OLP lesions using dexamethasone gargle and ointment. METHODS: The charts of patients who were clinically diagnosed with OLP and treated with dexamethasone from July 2003 to August 2017 at the Section of Dentistry of Seoul National University Bundang Hospital were thoroughly evaluated to identify subjects who were suitable for this retrospective study. For each patient, age at the index date, gender, medical history, and dental records related to OLP lesions and dexamethasone treatment were reviewed. RESULTS: In total, 113 of the 225 patients were included in the present study. Among them, 79 patients were female (69.9%) and 34 were male (30.1%), with a mean age of 57.6 years. The average duration of dexamethasone treatment was 4.7 months and the mean follow-up period was 2.24 years. Improvements were observed within 1 year after dexamethasone treatment in most cases, and 17.7% of patients had a new OLP lesion after treatment. New OLP lesions were more frequently gingival than mucosal, although mucosal OLP lesions were more common than gingival OLP lesions in all age groups. In age- and gender-adjusted multivariate logistic regression, a history of malignant disease was found to be a significant factor affecting the formation of new lesions. Gingival OLP lesions and intermittent use of dexamethasone showed near-significant associations. In Kaplan-Meier failure analysis, history of malignancy, menopausal status, age, and the site of the OLP lesion were significant factors affecting clinical outcomes. CONCLUSIONS: The treatment outcomes of OLP were significantly influenced by age, history of malignancy, menopausal status, and the site of the OLP lesion, but not by factors related to dexamethasone treatment.
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Female , Humans , Male , Dental Records , Dentistry , Dexamethasone , Follow-Up Studies , Lichen Planus, Oral , Logistic Models , Retrospective Studies , Seoul , Survival AnalysisABSTRACT
Male breast cancer is a rare disease, accounting for about 1% of all breast cancers. Little is known about the etiology of male breast cancer, especially developed in young man. Genetic and hormonal factors have been reported to be involved in its pathogenesis. But, less is known regarding the role of anthropometric or other endocrine risk factors. It's extremely rare for breast cancer to occur in young male patient because male breast cancer generally occur in old patients. A 29-year-old male was diagnosed with breast cancer in our institution who was with diabetes and obesity. There was no specific risk of genetic or hormonal factors for his breast cancer.
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Adult , Humans , Male , Breast Neoplasms , Breast Neoplasms, Male , Breast , Obesity , Rare Diseases , Risk FactorsABSTRACT
PURPOSE: Recurrent headaches are common among Korean students, causing absences from school or learning impediments. However, most school nurses are unable to provide appropriate diagnosis and treatment as they lack accurate information about the clinical aspects or treatment of headaches. The aim of this study was to investigate school nurses's clinical knowledge, assessment, and management of headache and educational needs in headache management. METHODS: This was a cross-sectional study targeting 250 school nurses who participated in the training lecture hosted by and were working at elementary, middle, and high schools. Surveys with insufficient data were excluded. RESULTS: Participants were 237 school nurses; 122 elementary school nurses, 62 middle school nurses, and 53 high school nurses, with an average age of 42.4±8.8 years. In all, 58.2% of the school nurses responded that they had received headache education, 68.8% responded that they knew the classifications of a headache, and 38.4% responded that they knew a headache assessment method. Only, 29% had a protocol for headache treatment. The educational needs (0-7 points) of school nurses to manage students with headaches were 5.8 for headache knowledge education, 5.5 for acute pharmacotherapy, 5.0 for preventive pharmacotherapy, 6.0 for lifestyle modification, and 6.0 for complementary remedy. CONCLUSION: School nurses had high educational needs for headache management but, they had insufficient knowledge of headaches and had not a protocol for the headache management in most cases. It suggests that headache knowledge education should be performed and the standardized headache management guideline should be developed to improve the performance of school nurses.
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Humans , Classification , Cross-Sectional Studies , Diagnosis , Disease Management , Drug Therapy , Education , Headache , Learning , Life Style , Methods , School NursingABSTRACT
PURPOSE: Recurrent headaches are common among Korean students, causing absences from school or learning impediments. However, most school nurses are unable to provide appropriate diagnosis and treatment as they lack accurate information about the clinical aspects or treatment of headaches. The aim of this study was to investigate school nurses's clinical knowledge, assessment, and management of headache and educational needs in headache management. METHODS: This was a cross-sectional study targeting 250 school nurses who participated in the training lecture hosted by and were working at elementary, middle, and high schools. Surveys with insufficient data were excluded. RESULTS: Participants were 237 school nurses; 122 elementary school nurses, 62 middle school nurses, and 53 high school nurses, with an average age of 42.4±8.8 years. In all, 58.2% of the school nurses responded that they had received headache education, 68.8% responded that they knew the classifications of a headache, and 38.4% responded that they knew a headache assessment method. Only, 29% had a protocol for headache treatment. The educational needs (0-7 points) of school nurses to manage students with headaches were 5.8 for headache knowledge education, 5.5 for acute pharmacotherapy, 5.0 for preventive pharmacotherapy, 6.0 for lifestyle modification, and 6.0 for complementary remedy. CONCLUSION: School nurses had high educational needs for headache management but, they had insufficient knowledge of headaches and had not a protocol for the headache management in most cases. It suggests that headache knowledge education should be performed and the standardized headache management guideline should be developed to improve the performance of school nurses.
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Humans , Classification , Cross-Sectional Studies , Diagnosis , Disease Management , Drug Therapy , Education , Headache , Learning , Life Style , Methods , School NursingABSTRACT
PURPOSE: A novel index, the periodontal inflamed surface area (PISA), represents the sum of the periodontal pocket depth of bleeding on probing (BOP)-positive sites. In the present study, we evaluated correlations between PISA and periodontal classifications, and examined PISA as an index integrating the discrete conventional periodontal indexes. METHODS: This study was a cross-sectional subgroup analysis of data from a prospective cohort study investigating the association between chronic periodontitis and the clinical features of ankylosing spondylitis. Data from 84 patients without systemic diseases (the control group in the previous study) were analyzed in the present study. RESULTS: PISA values were positively correlated with conventional periodontal classifications (Spearman correlation coefficient=0.52; P<0.01) and with periodontal indexes, such as BOP and the plaque index (PI) (r=0.94; P<0.01 and r=0.60; P<0.01, respectively; Pearson correlation test). Porphyromonas gingivalis (P. gingivalis) expression and the presence of serum P. gingivalis antibodies were significant factors affecting PISA values in a simple linear regression analysis, together with periodontal classification, PI, bleeding index, and smoking, but not in the multivariate analysis. In the multivariate linear regression analysis, PISA values were positively correlated with the quantity of current smoking, PI, and severity of periodontal disease. CONCLUSIONS: PISA integrates multiple periodontal indexes, such as probing pocket depth, BOP, and PI into a numerical variable. PISA is advantageous for quantifying periodontal inflammation and plaque accumulation.
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Humans , Antibodies , Chronic Periodontitis , Classification , Cohort Studies , Dental Plaque , Hemorrhage , Inflammation , Linear Models , Multivariate Analysis , Periodontal Diseases , Periodontal Index , Periodontal Pocket , Porphyromonas gingivalis , Prospective Studies , Smoke , Smoking , Spondylitis, AnkylosingABSTRACT
PURPOSE: Ultrasound-guided fine needle aspiration (US-FNA) in thyroid nodules is presently most commonly used to identify whether these nodules are benign or malignant. However, atypical or follicular lesions of undetermined significance (AUS/FLUS), as categorized in the Bethesda System for reporting the results of FNA, cannot be classified as benign or malignant. Therefore, several clinical factors should be considered to assess the risk of malignancy in patients with AUS/FLUS. The purpose of the present study was to determine which clinical factor increased the risk of malignancy in patients with AUS/FLUS. METHODS: A retrospective study was done on 129 patients with fine needle aspiration categorized as AUS/FLUS from January 2011 through April 2015. Univariate and multivariate analyses were performed to assess the independent effect of risk factors such as age, sex, size of nodule, atypical descriptors, and ultrasonography criteria for malignancy. RESULTS: We identified that the presence of spiculated margin (odds ratio [OR], 5.655; 95% confidence interval [CI], 2.114-15.131; P = 0.001), nuclear grooving (OR, 3.697; 95% CI, 1.409-9.701; P = 0.008), irregular nuclei (OR, 3.903; 95% CI, 1.442-10.560; P = 0.001) were shown to be significantly related to malignancy on univariate and multivariate analyses. CONCLUSION: We recommend that surgical resection of thyroid nodules be considered in patients with AUS/FLUS showing the histologic findings such as nuclear grooving, irregular nuclei along with spiculated margin of ultrasonographic finding.
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Humans , Biopsy, Fine-Needle , Multivariate Analysis , Retrospective Studies , Risk Factors , Subject Headings , Thyroid Gland , Thyroid Nodule , UltrasonographyABSTRACT
We report the eventually successful treatment of a huge bone defect and peri-implantitis following reconstruction of a previously failed intra-mobile cylinder implant system (IMZ) implant site using distraction osteogenesis (DO). In the anterior mandible, two IMZ implants failed and surgical debridement was performed in accordance to the patient's needs. Thereafter, mobility and suppuration were decreased and the patient visited the dental clinic on a regular basis for oral health maintenance. However, the inflammation did not resolve, and the bone destruction around the implants progressed for 4 years. Finally, the implants failed and a severe bone defect remained after implant removal. To reconstruct the bone defects, we attempted bone graft procedures. Titanium mesh was unsuccessfully used to obtain bone volume regeneration. However, DO subsequently was used to obtain sufficient bone volume for implant placement. The new implants were then installed, followed by prosthetic procedures. In conclusion, progression of peri-implantitis could not be arrested despite surgical intervention and repeated maintenance care for 3 years. Reconstruction of the peri-implantitis site was complicated due to its horizontal and vertical bone defects. Lesions caused by implant failure require an aggressive regenerative strategy, such as DO. DO was successful in reconstruction of a peri-implantitis site that was complicated due to horizontal and vertical bone defects.