Manejo da sede: perspectiva do paciente cirúrgico queimado / Thirst management: perspective of burnt surgical patient

Objetivo: explorar a percepção de um paciente cirúrgico queimado em relação à sede e seu manejo no período pré-operatório e pós-operatório imediato. Relato de caso: trata-se de um estudo com abordagem qualitativa, exploratória, do tipo estudo de caso. Os critérios de inclusão foram: paciente estar internado no centro de tratamento de queimados, ser submetido a procedimento cirúrgico ou balneoterapia, ter experenciado a sede no período pré-operatório ou pós-operatório e ter recebido o manejo da sede. Para a coleta de dados utilizou-se entrevista semiestruturada, gravada e transcrita. Paciente do sexo feminino, de 32 anos, admitida com queimaduras de segundo grau em extensão de tórax, membros superiores e pescoço por tentativa de autoextermínio com álcool. Passou por seis procedimentos e esteve internada por 15 dias até o momento da coleta. Experienciou o desconforto sede durante o jejum pré-operatório e pós-operatório, considerado intenso e muito estressante durante sua internação. Conclusão: a partir da identificação do desconforto sede, utilizou-se como estratégia o picolé de gelo, que fez diferença em seu tratamento. O modelo de manejo da sede é pioneiro no cuidado ao paciente queimado e apresenta benefícios para minorar a sede.

Objective: explore thirst perception of a burnt surgical patient and its management in the preoperative and immediate postoperative period. Case report: study with a qualitative and exploratory approach, named as case study. Inclusion criteria were: inpatient at burnt treatment unit, undergone surgical procedure or balneotherapy, experienced thirst in the preoperative or postoperative period and received thirst management. For data collection, semi-structured interviews were performed, recorded and transcribed. Female patient, 32 years old, admitted with second degree burns in extension of thorax, upper limbs and neck due to attempted self-extermination with alcohol. Underwent six procedures and was hospitalized for 15 days until the data collection. Experienced thirst discomfort during preoperative and postoperative fasting, which was considered intense and very stressful during his hospitalization. Conclusion: since the identification of thirst discomfort, the ice popsicle was used as a strategy, which made difference in her treatment. The thirst management model is pioneer in care of burnt patients and has benefits to alleviate thirst.

Cold chain time- and temperature-controlled transport of vaccines: a simulated experimental study

Different cooling strategies between sets for 30 seconds does not have beneficial effect on resistance exercise with blood flow restriction / Diferentes estratégias de resfriamento entre séries por 30 segundos não têm efeito benéfico no treinamento resistido com restrição de fluxo sanguíneo

ABSTRACT The ice application (cooling) has become popular during physical activities to improve performance. This study aimed to test whether different cooling places could increase the number of repetitions (volume) during resistance training with blood flow restriction (BFR). Ten women volunteered for this study. The sample characterization is presented in mean and standard deviation: age: 28.5 ± 8.6 years; height: 164.6 ± 8.3 cm; total body mass: 61.5 ± 7.1 maximal dynamic strength test (1RM): 236.5 ± 54.8 kg; 30% 1RM: 71.6 ± 16.5; SBP: 124.7 ± 7.7 mm Hg; 1.3 x SBP: 161.8 ± 10.4 mm Hg. The subjects performed five sessions of resistance exercise with BFR. Three sets were held in each session, with the intensity of 30% of 1RM until muscle failure; and 30-second rest period between sets. The cooling sites were: hands, neck, and tunnel temperature. One session without cooling was done and considered as a control group. There was neither difference in the total number of repetitions of repetitions among interventions, nor a significant difference among interventions for RPE (P = 0.49). Therefore, we do not recommend cooling to maintain a high number of repetitions during strength training with BFR.

RESUMO A aplicação do gelo (resfriamento) tem sido uma estratégia popular durante as atividades físicas para aumentar o desempenho. O objetivo deste estudo foi testar se diferentes locais de resfriamento podem aumentar o número de repetições (volume) durante o treinamento resistido com restrição do fluxo sanguíneo (RFS). Dez mulheres se voluntariaram para este estudo. A caracterização da amostra é apresentada em média e desvio padrão: idade: 28,5 ± 8,6 anos; estatura: 164,6 ± 8,3 cm; massa corporal total: 61,5 ± 7,1; teste de força muscular dinâmica (1RM): 236,5 ± 54,8kg; 30% 1RM: 71,6 ± 16,5; PAS: 124,7 ± 7,7 mm Hg; 1,3 x PAS: 161,8 ± 10,4 mmHg, participaram do estudo. Os sujeitos realizaram cinco sessões de exercício resistido com RFS. Três séries foram realizadas em cada sessão, com a intensidade de 30% de 1RM até falha muscular e 30 segundos de descanso entre as séries. Os locais de resfriamento foram: mãos, pescoço e temperatura do túnel. Uma sessão sem resfriamento foi realizada e considerada como grupo controle. Não houve diferença no número total de repetições entre as intervenções, nem diferença entre as intervenções para percepção subjetiva de esforço (P = 0,49). Portanto, nós não recomendamos o resfriamento para manter um alto número de repetições durante o treinamento de força com restrição do fluxo sanguíneo.

Intracorporeal renal hypothermia with ice slush for robot-assisted partial nephrectomy in a highly complex renal mass

ABSTRACT

Cold Urticaria: Clinical Features and Natural Course in a Tropical Country

PURPOSE: To review the clinical features and natural courses of cold urticaria (ColdU) in a tropical country. METHODS: A retrospective chart review was performed of patients who visited Siriraj Urticaria Clinic, Siriraj Hospital, Bangkok, Thailand, and were diagnosed with ColdU between 2007 and 2018. Data on provocation and threshold tests, clinical courses, and laboratory work-up were analyzed and compared with data reported by studies in temperate countries. RESULTS: Of 1,063 chronic urticaria patients, 27 (2.5%) were diagnosed with ColdU, with a mean age of symptom onset of 34.8 years. Half of the patients had a history of atopy, and 1 (3.7%) had a history of anaphylaxis. All patients were positive to 1 of 3 provocation tests: an ice cube test; TempTest 4.0; or a tray filled with ice, salt and water. Thirteen patients underwent the ice cube test, and all had positive results. TempTest was performed on 15 patients, 8 of whom had positive results, with a mean critical temperature threshold (CTT) of 21.0°C. All of the 7 patients who had a negative TempTest result later produced positive results to the immersion of their hand and forearm in a tray filled with ice, salt, and water. All patients were treated with H1-antihistamines, the vast majority (96.3%) being non-sedating H1-antihistamines. Some (14.8%) needed to be administered oral corticosteroids, ciclosporin, or omalizumab. Six patients (22.2%) were in remission. A Kaplan-Meier survival curve demonstrated 5-year and 10-year remission rates of 13.8% and 42.6%, respectively. CONCLUSIONS: The rate of anaphylaxis in patients with ColdU in a tropical country was lower than those reported by other studies conducted intemperate climates. On the other hand, the number of female patients, mean age at symptom onset, atopy rate, rate of concomitant chronic spontaneous urticaria and mean CTT were higher.

Effects of Reduced Plantar Cutaneous Sensation on Static Postural the Kinematic Strategy Control in Individuals with or without Chronic Ankle Instability / 대한스포츠의학회지

PURPOSE: To investigate the alteration of lower extremity movement during maintaining balance test with their eyes closed in chronic ankle instability (CAI) patients compared to healthy group with and without plantar cutaneous sensation. METHODS: Ten healthy volunteers (age, 23.40±2.22 years; height, 165.42±6.67 cm; weight, 60.93±13.42 kg) and 10 CAI patients (age, 23.90±2.56 years; height, 166.89±10.50 cm; weight, 67.43±12.96 kg), were recruited. Subjects immersed both feet in an ice water for 10 minutes and performed three trials of a single-leg stance balance test with their eyes closed while standing on a force plate for 10 seconds. RESULTS: CAI group showed increased knee flexion, reduced knee external rotation, and hip internal rotation compared to the healthy group from single-limb stance with eyes closed after diminished plantar cutaneous sensation. However, there was no significant interaction between group and time. CONCLUSION: These findings indicate that the postural kinematic analyses revealed that individuals with CAI used different strategy of controlling their lower extremities, which alters transverse plane motion of hip and knee compared to the healthy group in order to compensate for their ankle deficits after freezing the plantar cutaneous.

Comparison of the Impact of an Optimized Ice Cooling Vest and a Paraffin Cooling Vest on Physiological and Perceptual Strain

BACKGROUND: Ice cooling vests can cause tissue damage and have no flexibility. Therefore, these two undesirable properties of ice cooling vest were optimized, and the present study was aimed to compare the impact of the optimized ice cooling vest and a commercial paraffin cooling vest on physiological and perceptual strain under controlled conditions. METHODS: For optimizing, hydrogel was used to increase the flexibility and a layer of the ethylene vinyl acetate foam was placed into the inside layer of packs to prevent tissue damage. Then, 15 men with an optimized ice cooling vest, with a commercial paraffin cooling vest, and without a cooling vest performed tests including exercise on a treadmill (speed of 2.8 km/hr and slope of %0) under hot (40℃) and dry (40 %) condition for 60 min. The physiological strain index and skin temperature were measured every 5 and 15 minutes, respectively. The heat strain score index and perceptual strain index were also assessed every 15 minutes. RESULTS: The mean values of the physiological and perceptual indices differed significantly between exercise with and without cooling vests (P 0.05). CONCLUSIONS: The optimized ice cooling vest was as effective as the commercial paraffin cooling vest to control the thermal strain. However, ice has a greater latent heat and less production cost.

A case of anhidrotic ectodermal dysplasia presenting with pyrexia, atopic eczema, and food allergy

Anhidrotic ectodermal dysplasia (AED) is a rare hereditary disorder with a triad of sparse hair, dental hypoplasia, and anhidrosis. Here we report a case of AED with food allergy and atopic eczema. The patient was a 11-month-old boy admitted to our hospital with pyrexia for 2 weeks. He presented with a history of dry skin, eczema, and food allergy to egg. On clinical examination, his body temperature was 38.8°C, with dry skin and eczema almost all over the body, sparse eyebrows, and scalp hair. Laboratory investigations and physical examination did not show any evidence of infection. Radioallergosorbent test was positive to egg yolk, egg white, ovomucoid, milk, house dust, and house dust mite. As the child did not sweat despite the high fever, we performed the sweat test which revealed a total lack of sweat glands. Genetic examination revealed a mutation of the EDA gene and he was diagnosed as AED. His pyrexia improved upon cooling with ice and fan. His mother had lost 8 teeth and her sweat test demonstrated low sweating, suggestive of her being a carrier of AED. Atopy and immune deficiencies have been shown to have a higher prevalence in patients with AED. Disruption of the skin barrier in patients with AED make them more prone to allergic diseases such as atopic eczema, bronchial asthma, allergic rhinitis and food allergy. Careful assessment of the familial history is essential to differentiate AED when examining patients with pyrexia of unknown origin and comorbid allergic diseases.

Análise microbiológica do gelo produzido e comercializado na cidade de Maceió, AL

As doenças de origem alimentar são reconhecidas pela Organização Mundial de Saúde como um grave problema de saúde pública. Como qualquer outro alimento, o gelo é uma fonte de transmissão de sérias doenças infecciosas. Com o presente estudo pretendeu-se avaliar a qualidade rnicrobiológica do gelo em cubos e escamas produzidos e comercializados na cidade de Maceió/AL. Participaram deste estudo nove fábricas localizadas em diversos bairros. De cada fábrica foi coletada uma amostra do gelo em cubo e do de escamas. Foram realizadas duas visitas, uma no mês de fevereiro e outra em julho de 2018, totalizando 36 amostras. Foram pesquisadas as bactérias do grupo coliformes a 35°C e Escherichia coli. Todas as amostras apresentaram contaminação pelos rnicro-organismos pesquisados, determinando, portanto, que estavam improprias para consumo humano segundo os parâmetros da legislação em vigor. Faz-se necessário uma fiscalização mais rigorosa dos órgãos competentes, para que o consumidor não adquira um produto que possa causar problemas a sua saúde.

Food-borne diseases are recognized by the World Health Organization as a serious public health problem. Like any other food, ice is a source of transmission of serious infectious diseases. With the present study was to assess the microbiological quality of ice cubes and scales produced and sold in the city of Maceió/AL. Participated in this study nine factories located in various districts. Each plant was collected a sample of ice cube and scales. Two visits, one in February and one in July 2018, a total of 36 samples. Were the bacteria coliform group to 35°c and Escherichia coli. 100% of the samples showed contamination by micro-organisms surveyed, determining that they were improper for human consumption according to the parameters of the legislation in force. A more rigorous inspection of the competent bodies is necessary, so that the consumer does not buy a product that can cause problems to his health.

Integrated clinical experience with concurrent problem-based learning is associated with improved clinical reasoning among physical therapy students in the United States / 보건의료교육평가

Clinical reasoning (CR) is a key learning domain for physical therapy educators and a core skill for entry-level practitioners. Integrated clinical experience (ICE) and problem-based learning (PBL) have each been reported to improve interpersonal and social domains, while promoting knowledge acquisition and CR. Unfortunately, studies monitoring CR during ICE with concurrent PBL in physical therapy education are sparse. We hypothesized that ICE with concurrent PBL would be associated with improved self-reported CR in third-year student physical therapists (PTs) in the United States. The Self-Assessment of Clinical Reflection and Reasoning (SACRR) survey was administered to 42 student PTs at the beginning and end of their third and final year of didactic training. Between the pretest and posttest analyses, the participants completed faculty-led ICE and PBL coursework for 16 weeks. The overall SACRR score and 26 individual item scores were examined. The Wilcoxon rank-sum test and paired t-test were used, with statistical significance accepted at P < 0.05. Significant improvements were observed in the overall SACRR score (P < 0.001), including 6 of the 26 survey items centered around decision-making based on experience and evidence, as well as self-reflection and reasoning. ICE with PBL was associated with improved self-assessed CR and reflection in third-year student PTs in the United States. Monitoring the impact of curricular design on CR may improve educators' ability to enhance cognitive and psychomotor skills, which underscores the importance of increasing the explicit use of theoretical frameworks and teaching techniques for coping with uncertainty as a way of enhancing entry-level training.

Excellent treatment outcomes in children younger than 18 months with stage 4 MYCN nonamplified neuroblastoma / 소아과

PURPOSE: Although the prognosis is generally good in patients with intermediate-risk neuroblastoma, no consensus has been reached on the ideal treatment regimen. This study analyzed treatment outcomes and toxicities in patients younger than 18 months with stage 4 MYCN nonamplified neuroblastoma. METHODS: We retrospectively analyzed 20 patients younger than 18 months newly diagnosed with stage 4 MYCN nonamplified neuroblastoma between January 2009 and December 2015. Patients received 9 cycles of chemotherapy and surgery, with or without local radiotherapy, followed by 12 cycles of differentiation therapy with 13-cis-retinoic acid. Chemotherapy consisted of alternating cycles of cisplatin, etoposide, doxorubicin, and cyclophosphamide (CEDC) and ifosfamide, carboplatin, and etoposide (ICE) regimens. RESULTS: The most common primary tumor site was the abdomen (85%), and the most common metastatic sites were the lymph nodes (65%), followed by the bones (60%), liver (55%), skin (45%), and bone marrow (25%). At the end of induction therapy, 14 patients (70%) achieved complete response, with 1 achieving very good partial response, 4 achieving partial response, and 1 showing mixed response. Nine patients (45%) received local radiotherapy. At a median follow-up of 47 months (range, 17–91 months), none of these patients experienced relapse, progression, or secondary malignancy, or died. Three years after chemotherapy completion, none of the patients had experienced grade ≥3 late adverse effects. CONCLUSION: Patients younger than 18 months with stage 4 MYCN nonamplified neuroblastoma showed excellent outcomes, without significant late adverse effects, when treated with alternating cycles of CEDC and ICE, followed by surgery and differentiation therapy.

Price of PRICE (Protection, Rest, Ice, Compression, and Elevation) redefined: a case of entrapment neuropathy in an individual with hemophilia

No abstract available.

Evidence-based Treatment of Acute Lateral Ankle Sprain / 대한족부족관절학회지

Acute lateral ankle sprain, which is the most common musculoskeletal injury, can be treated effectively with appropriate evidence-based initial care using PRICE (protection, rest, ice, compression, and elevation) and functional rehabilitation. Many systemic reviews reporting a high-level of evidence supporting the clinical usefulness and necessity of primary surgical repair for acute lateral ankle sprain have been insufficient. Regardless of the severity of ligament complex injuries, the surgical treatment for acute lateral ankle sprain without concomitant pathologies is not recommended and should be considered only in young professional athletes with complete ligament rupture (grade III) and severe instability.

Efficacy of Gaze Photographs in Diagnosing Ocular Myasthenia Gravis

BACKGROUND AND PURPOSE: The various tests that are routinely used to diagnose generalized myasthenia gravis, such as the edrophonium test, serum anti-acetylcholine-receptor antibodies (AChR-Ab), and repetitive nerve stimulation (RNS) tests, have lower diagnostic sensitivity in ocular myasthenia gravis (OMG). Diagnosing OMG becomes even more difficult when the clinical symptoms are subtle. There is no gold-standard diagnostic test available for OMG patients, and so this study compared the diagnostic sensitivity of gaze photographs with conventional tests in OMG. METHODS: Records of gaze photographs were available for 25 of 31 consecutive patients diagnosed with OMG. Each patient underwent a neuro-ophthalmologic examination, serum AChR-Ab, RNS, edrophonium test, ice tests, and the acquisition of gaze photographs. The margin reflex distance 1 (MRD1) was measured on each of the gaze photographs, with MRD1 < 2 mm or an interlid MRD1 difference of ≥2 mm on any of the gaze photographs defined as a positive sign of OMG. The diagnostic sensitivities of the tests were assessed. RESULTS: The mean age at onset was 38.5 years (range, 2–76 years), and 13 patients (52%) were men. The diagnostic sensitivities of the RNS test, AChR-Ab test, gaze photographs, and ice test were 56%, 64%, 80%, and 73%, respectively. CONCLUSIONS: The diagnostic sensitivity was higher for gaze photographs than for the other tests applied to OMG patients.

O uso do picolé mentolado no manejo da sede do paciente idoso no pósoperatório imediato: ensaio clínico randomizado / The use of mentholated popsicle to manage the elderly patient´s thirst in the immediate postoperative period: randomized clinical trial

Os mecanismos fisiológicos de detecção e controle da sede no paciente cirúrgico idoso ocorrem de forma diferenciada do que em adultos e crianças o que justifica o investimento na condução de estudos sobre estratégias que podem proporcionar alívio deste sintoma com o uso de temperatura fria e volume pequeno. O objetivo do estudo foi comparar a intensidade e o desconforto da sede de pacientes idosos que degustaram o picolé mentolado com a sede de pacientes idosos que receberam o cuidado usual, no pós-operatório imediato. Trata-se de ensaio clínico randomizado em paralelo com dois grupos, realizado em sala de recuperação pós-anestésica de hospital público de ensino no sul do Brasil. A amostra foi composta de 50 pacientes idosos em pós-operatório imediato, os quais foram alocados em dois grupos, sendo 25 no grupo controle e 25 no grupo experimental, sem perda de seguimento. Os critérios de inclusão foram: pacientes com idade >= 60 anos; estar em jejum; verbalizar sede e ter sido aprovado na avaliação do Protocolo de Segurança no Manejo da Sede. Os pacientes com restrições à ingesta ou deglutição, bem como os que autorreferiram alergia à menta, foram excluídos. Os pacientes alocados no grupo controle receberam o cuidado usual de rotina da instituição, onde o estudo foi conduzido, que consiste na manutenção do jejum. Já os pacientes alocados no grupo experimental receberam um picolé mentolado de 20 ml. Os desfechos primários de interesse foram a intensidade e o desconforto da sede, sendo que ambos foram avaliados inicialmente (T0) e novamente (T1) após 20 minutos da intervenção ou cuidado usual. A intensidade da sede foi mensurada por meio da Escala Numérica (zero significa nenhuma sede e 10 a maior sede já vivenciada pelo paciente), e o desconforto da sede pela Escala de Desconforto da Sede Perioperatória (pontuação de zero a 14 pontos, sendo zero a ausência de desconforto e 14 corresponde ao desconforto mais intenso relacionado à sede). A mediana da intensidade e do desconforto da sede inicial (T0) foi de 6,0 para os participantes alocados no grupo experimental, e 5,0 para a intensidade e 6,0 para o desconforto da sede para os participantes alocados no grupo controle. Para a comparação das mudanças nos escores da Escala Numérica e da Escala de Desconforto da Sede Perioperatória entre o grupo experimental e o grupo controle (valor final menos valor inicial), o teste de Mann-Whitney foi empregado para diferenças de medianas. Os resultados do ensaio clínico randomizado demonstraram que houve diminuição estatisticamente significante na intensidade (p<0,001) e no desconforto da sede (p<0,001) dos pacientes cirúrgicos idosos, após vinte minutos da degustação do picolé mentolado quando comparados à intensidade e desconforto da sede dos pacientes que receberam o cuidado usual, no pósoperatório imediato. Considerando a escassez de evidências sobre estratégias para manejo da sede do paciente cirúrgico idoso, o picolé mentolado é uma estratégia inovadora e segura, podendo se tornar método de escolha para uso na prática clínica

Physiological mechanisms of detection and control of thirst in the elderly surgical patient occur differently than in adults and children, which justifies the investment in conducting studies on strategies that can provide relief of this symptom with use of cold temperature and small volume. The aim of the study was to compare thirst intensity and discomfort of elderly patients who savoured mentholated popsicle with thirst of elderly patients who received the usual care in the immediate postoperative period. This is a randomized controlled clinical trial in parallel with two groups, conducted in a post anesthesia care unit of a public teaching hospital in southern Brazil. The sample consisted of 50 elderly patients in the immediate postoperative period, who were allocated in two groups, 25 in the control and 25 in the experimental group, without follow-up losses. Inclusion criteria were: patients aged >= 60 years; being fasting; verbalize thirst and having been approved in the assessment of Safety Protocol of Thirst Management. Patients with restrictions to ingestion or swallowing, as well as those who self-referred peppermint allergy, were excluded. Patients assigned to the control group received usual routine care of the institution where the study was conducted, which consists in maintenance of fasting. Patients assigned to the experimental group received a 20 ml mentholated popsicle. Primary outcomes of interest were thirst intensity and discomfort, both of which were assessed initially (T0) and again (T1) after 20 minutes of the intervention or usual care. Thirst intensity was measured using a Numerical Scale (zero means no thirst and 10 the greatest thirst ever experienced by patient), and thirst discomfort by Perioperative Thirst Discomfort Scale (score of zero to 14 points, being zero the absence of discomfort and 14 corresponds to the most intense discomfort related to thirst). Median of initial thirst intensity and discomfort (T0) was 6.0 for the participants assigned to the experimental group, 5.0 for thirst intensity and 6.0 for thirst discomfort for the participants assigned to the control group. Mann-Whitney test was used evaluating differences in medians, comparing changes in Numerical Scale and in Perioperative Thirst Discomfort Scale between the experimental group and the control group (final value minus initial value). Results of the randomized clinical trial demonstrated that there was a statistically significant decrease in thirst intensity (p <0.001) and discomfort (p <0.001) of elderly surgical patients, after twenty minutes of tasting the mentholated popsicle when compared to thirst intensity and discomfort of the patients who received the usual care, in the immediate postoperative period. Considering the shortage of evidence on strategies for thirst management of elderly surgical patient, mentholated popsicle is an innovative and safe strategy, and may become a method of choice for use in clinical practice

Treatment of post-traumatic hematoma and fibrosis using hyaluronidase injection

Patients complaining of swelling and hematoma caused by contusion of the face can be easily seen in the emergency room. Most of the treatments were conservative treatments such as ice bag application, mild compression dressing, and massage. During the follow-up, fibrosis progression due to hematoma was frequently observed in the contusion site. When hematoma or fibrosis is confirmed, hyaluronidase (H-lase) 1,500 IU and 2 mL of normal saline were mixed and subcutaneously injected in crisscross manner. To evaluate the improvement of hematoma before and after hyaluronidase injection, three plastic surgeons evaluated using the Vancouver scar scale and compared preoperative and postoperative images. Hematoma and fibrosis after facial trauma improved after hyaluronidase injection for early treatment.

Prevalence and Density of Digenetic Trematode Metacercariae in Clams and Oysters from Western Coastal Regions of the Republic of Korea

A survey was performed to know the recent infection status of digenetic trematode metacercariae in clams and oysters from 4 sites in western coastal regions of the Republic of Korea (=Korea). Four species of clams (Mactra veneriformis, Ruditapes philippinarum, Cyclina sinensis, and Saxidomus purpuratus) were collected from Taean-gun, Chungcheongnam-do (Province), Buan-gun (County) and Gochang-gun, Jeollabuk-do, and oysters, Crassostrea gigas, from Shinan-gun, Jeollanam-do were transferred to our laboratory on ice and examined by the artificial digestion method. The metacercariae of Himasthla alincia were detected in 3 species of clams, M. veneriformis, R. philippinarum, and C. sinensis from the 3 surveyed areas. The positive rate and the mean density per clam infected were 98.9% (30.8 metacercariae) in M. veneriformis, 60.0% (5.0) in R. philippinarum, and 96.0% (28.4) in C. sinensis. The positive rate (mean density) of Acanthoparyphium tyosenense metacercariae in M. veneriformis was 50.0% (2.1) from Taean-gun and 70.0% (2.8) from Gochang-gun. The metacercariae of Parvatrema spp. were detected in M. veneriformis and R. philippinarum from Taean-gun and Gochang-gun; the positive rate (mean density) was 63.3% (4,123) and 50.0% (19) in M. veneriformis, and 6.7% (126) and 100% (238) in R. philippinarum from the 2 regions, respectively. The metacercariae of Gymnophalloides seoi were detected in all 30 oysters from Shinan-gun, and their average density per oyster was 646. From the above results, it has been confirmed that more than 3 species of metacercariae are prevalent in clams from the western coastal regions, and G. seoi metacercariae are still prevalent in oysters from Shinan-gun, Jeollanam-do, Korea

Electrochemical Characteristics of Nanotubular Ti-25Nb-xZr Ternary Alloys for Dental Implant Materials

PURPOSE: The purpose of this study was to investigate the electrochemical characteristics of nanotubular Ti-25Nb-xZr ternary alloys for dental implant materials. MATERIALS AND METHODS: Ti-25Nb-xZr alloys with different Zr contents (0, 3, 7, and 15 wt.%) were manufactured using commercially pure titanium (CP-Ti), niobium (Nb), and zirconium (Zr) (99.95 wt.% purity). The alloys were prepared by arc melting in argon (Ar) atmosphere. The Ti-25Nb-xZr alloys were homogenized in Ar atmosphere at 1,000℃ for 12 hours followed by quenching into ice water. The microstructure of the Ti-25Nb-xZr alloys was examined by a field emission scanning electron microscope. The phases in the alloys were identified by an X-ray diffractometer. The chemical composition of the nanotube-formed surfaces was determined by energy-dispersive X-ray spectroscopy. Selforganized TiO₂ was prepared by electrochemical oxidation of the samples in a 1.0 M H₃PO₄+0.8 wt.% NaF electrolyte. The anodization potential was 30 V and time was 1 hour by DC supplier. Surface wettability was evaluated for both the metallographically polished and nanotube-formed surfaces using a contact-angle goniometer. The corrosion properties of the specimens were investigated using a 0.9 wt.% aqueous solution of NaCl at 36℃±5℃ using a potentiodynamic polarization test. RESULT: Needle-like structure of Ti-25Nb-xZr alloys was transform to equiaxed structure as Zr content increased. Nanotube formed on Ti-25Nb-xZr alloys show two sizes of nanotube structure. The diameters of the large tubes decreased and small tubes increased as Zr content increased. The lower contact angles for nanotube formed Ti-25NbxZr alloys surfaces showed compare to non-nanotube formed surface. The corrosion resistance of alloy increased as Zr content increased, and nanotube formed surface showed longer the passive regions compared to non-treatment surface. CONCLUSION: It is confirmed that corrosion resistance of alloy increased as Zr content increased, and nanotube formed surface has longer passive region compared to without treatment surface.

Zoonotic Trematode Metacercariae in Fish from Yangon, Myanmar and Their Adults Recovered from Experimental Animals

A survey was performed to investigate the infection status of zoonotic trematode (ZT) metacercariae in fish from a local market in Yangon City, Myanmar. A total of 264 fish (12 species) were collected through 4 times from December 2013 to June 2015. All collected fish were transferred to our laboratory on ice and examined by the artificial digestion method. More than 7 species of ZT metacercariae, i.e., Haplorchis taichui, H. pumilio, H. yokogawai, Centrocestus spp., Stellantchasmus falcatus, Pygidiopsis cambodiensis, and Procerovum sp. were detected. Metacercariae of H. taichui were collected in 58 (42.3%) out of 137 fish (5 species), and their average density was 42.9 per fish infected. Metacercariae of H. pumilio were detected in 96 (49.0%) out of 196 fish (9 species), and their average density was 23.6 per fish infected. H. yokogawai metacercariae were found in 40 (50.0%) out of 80 fish (5 species), and Centrocestus spp. metacercariae in 91 (50.8%) out of 179 fish (8 species), and their densities were 306 and 25.8 per fish infected, respectively. Metacercariae of S. falcatus and P. cambodiensis were detected only in mullets, Chelon macrolepis. A total of 280 Procerovum sp. metacercariae were found in 6 out of 12 climbing perch, Anabas testudineus. Morphological characteristics of adult flukes recovered from experimental animals were described. It has been first confirmed that fish from Yangon, Myanmar are commonly infected with various species of ZT metacercariae.

A Case of Cold Urticaria Mistaken as Congestion Status during Breast Reconstruction with Deep Inferior Epigastric Perforator Free Flap Coverage

We present the first reported case of cold urticaria, which was mistaken as congestion status, in a patient undergoing breast reconstruction with deep inferior epigastric perforator (DIEP) flap coverage. A 53-year-old woman underwent an immediate bilateral breast reconstruction with DIEP flap coverage. The harvested DIEP flap was wrapped with wet gauze and kept above an ice pack to minimize ischemic damage before flap in-setting to the mastectomy site. After the transfer of the harvested DIEP flap, she had suddenly developed an erythematous and edematous lesion, specifically on the flap. The room temperature was raised and a single dose of steroid and antihistamine was given intravenously. At the first instance, flap congestion was suspected; however, as the rash gradually spread throughout the body, we could deduce that it was cold urticaria. The erythematous rash and whirl resolved soon after receiving medication. Patients with known cold urticaria undergoing surgical procedures require several precautions (e.g., antihistamine, relatively warm operation room) to lessen the risk of severe reaction. Especially in patients with DIEP free flap, the lack of preoperative treatment could result in a pinkish flap due to urticaria, which could be mistaken by the surgeon as a congested flap.