Magnesium Sulfate and Cerebral Oxygen Saturation in Mild Traumatic Brain Injury: A Randomized, Double-Blind, Controlled Trial.

Perioperative cerebral hypoperfusion/ischemia is considered to play a pivotal role in the development of secondary traumatic brain injury (TBI). This prospective randomized, double-blind, controlled study investigated whether magnesium sulfate (MgSO4) infusion was associated with neuroprotection in maintaining regional cerebral oxygen saturation (rSO2) values in patients with mild TBI undergoing general anesthesia. Immediately after intubation, we randomly assigned patients with TBI to receive either intravenous MgSO4 (30 mg/kg for 10 min, followed by a continuous infusion of 15 mg/kg/h) or a placebo (saline) during surgery. We also implemented an intervention protocol for a sudden desaturation exceeding 20% of the initial baseline rSO2. The intraoperative rSO2 values were similar with respect to the median (left. 67% vs. 66%, respectively; p = 0.654), lowest, and highest rSO2 in both groups. The incidence (left 31.2% vs. 24.3%; p = 0.521) and duration (left 2.6% vs. 3.5%; p = 0.638) of cerebral desaturations (the relative decline in rSO2 < 80% of the baseline value) were also similar for both groups. Although the patients suffered serious traumatic injuries, all critical desaturation events were restored (100%) following stringent adherence to the intervention protocol. Intraoperative remifentanil consumption, postoperative pain intensity, and fentanyl consumption at 6 h were lower in the MgSO4 group (p = 0.024, 0.017, and 0.041, respectively) compared to the control group, whereas the satisfaction score was higher in the MgSO4 group (p = 0.007). The rSO2 did not respond to intraoperative MgSO4 in mild TBI. Nevertheless, MgSO4 helped the postoperative pain intensity, reduce the amount of intraoperative and postoperative analgesics administered, and heighten the satisfaction score.

Dual-Frequency Ultrasound as a New Treatment Modality for Refractory Rosacea: A Retrospective Study.

BACKGROUND: Dual-frequency ultrasound (DFU) has emerged as a new treatment modality for improving inflammatory skin disorders. Although there have been few pilot studies, there are a limited number of studies that investigated efficacy of DFU on refractory rosacea. OBJECTIVE: This study investigated the effect of DFU on patients with refractory rosacea. MATERIALS AND METHODS: The authors retrospectively analyzed medical records of 42 patients with refractory rosacea (erythematotelangiectatic rosacea [ETR], n = 26; papulopustular rosacea [PPR], n = 14, mixed, n = 2). The patients were treated with DFU twice per week for the 1st week, and then once per week thereafter. Efficacy was assessed using erythema index (EI), transepithelial water loss (TEWL), and patient self-assessment (PSA). RESULTS: Treatment with DFU resulted in significant decrease in EI, TEWL, and PSA. No significant difference was noted between ETR and PPR. CONCLUSION: Application of DFU in patients with refractory rosacea resulted in improvement in persistent erythema, barrier dysfunction, and patient-reported symptoms. Dual-frequency ultrasound may be an additional treatment option for rosacea that is resistant to other treatments.

Clinical Efficacy of Diphenylcyclopropenone Immunotherapy as Monotherapy for Multiple Viral Warts.

BACKGROUND: Diphenylcyclopropenone (DPCP) immunotherapy for viral warts has been used for many years, but no studies have analyzed the treatment effects of DPCP alone, without the use of conventional therapy before immunotherapy. OBJECTIVES: We evaluated clinical efficacy of DPCP monotherapy compared to cryotherapy and pulsed dye laser (PDL) therapy. We also assessed the impact of initial sensitization on clinical response. METHODS: We retrospectively analyzed the medical records of 250 patients with multiple viral warts between January 2008 and December 2015. RESULTS: The DPCP-only group (n = 43) showed a lower clinical response (75.6%) than the cryotherapy-only group (n = 171, 89.8%, P < .01) and PDL-only group (n = 36, 90.3%, P < .01). The positive clinical response was 76.3% (119/156) in the successful sensitization group (n = 21) and 74.4% in the failed sensitization group ( P = .870). CONCLUSIONS: DPCP monotherapy has a lower clinical response than conventional therapy. Initial sensitization to DPCP does not predict a failed response with continued immunotherapy for viral warts.

Increasing Prevalence of the Sensitization to Cat/Dog Allergens in Korea.

BACKGROUND: Recently, the number of domestic pets has increased. As a consequence, sensitization to animal allergens, such as cat or dog allergens, has become a problem. OBJECTIVE: We studied the annual trends of sensitization to cats or dogs, and the characteristics of the patients. METHODS: We retrospectively analyzed the medical records of 7,469 patients who visited a dermatology clinic and underwent an allergic profile test, from January 2011 to December 2015. Specific immunoglobulin E (IgE) levels to cat or dog antibody greater than 3.50 IU/ml were regarded as positive results. RESULTS: In all, 274 patients showed significant increase in levels of specific IgE antibody to dog, and 307 revealed increase in levels of of specific IgE antibody to cat. The prevalence of these specific IgEs increased from 2011 to 2015. Independent risks for sensitization to cat allergens were sensitization to dog, but not to house dust, Dermatophagoides pteronyssinus, and D. farinae. Independent risks for sensitization to dog allergens were sensitization to cat, but not to house dust, D. pteronyssinus, and D. farinae. Total IgE level was not related to specific IgE level against either cats or dogs. CONCLUSION: In conclusion, the prevalence of sensitization to cat or dog has increased. Sensitization to cat or dog is related to each other, but is irrelevant to the total IgE level.

Congenital Non-Neural Granular Cell Tumor Mimicking Nevus Lipomatosus Superficialis.

A 4-month-old infant presented with asymptomatic soft nodules on his right forearm, which had developed since birth. On the suspicion of nevus lipomatosus superficialis (NLS), biopsy was performed. Histopathologic findings showed monomorphic polygonal cells with abundant granular cytoplasm. Immunohistochemical stains for CD68 and vimentin were strongly positive, but were negative for S-100 protein. Based on the pathologic findings, the patient was diagnosed as non-neural granular cell tumor (NN-GCT). GCT can be divided into conventional and non-neural GCT by immunoreactivity for S-100 protein. NN-GCT is typically manifested as a well-circumscribed, papulo-nodular dermal mass, and is known to occur in a younger group than does in conventional GCT, but is rare among children. To our knowledge, there have been no case reports of NN-GCT which appeared at birth and presented as grouped nodules. Therefore, we report this interesting case of congenital NN-GCT clinically mimicking NLS.

The histopathological differentiation between palmar psoriasis and hand eczema: A retrospective review of 96 cases.

BACKGROUND: The histopathologic differences among palmar psoriasis (PP), hand eczema (HE), and hyperkeratotic hand dermatitis (HHD) have been poorly described. OBJECTIVES: We sought to distinguish among PP, HE, and HHD on a histopathologic basis. METHODS: We retrospectively analyzed the histology of hematoxylin-eosin-stained sections obtained from 96 patients diagnosed with PP, HE, or HHD. RESULTS: The patients were divided into 4 subgroups: PP (n = 16, group A), HE without atopic or nummular dermatitis (n = 41, group B), HE with atopic or nummular dermatitis (n = 14, group C), and HHD (n = 25, group D). Loss of the granular layer (group A 62.5%, group B 24.4%, group C 0%) was more consistent with a diagnosis of PP (P = .047) than HE (P = .002). Psoriasiform epidermal hyperplasia (group B 36.6%, group C 35.7%, group D 72.0%) favored a diagnosis of HHD (P = .01) over HE (P = .043). LIMITATIONS: Limitations of this study include its retrospective nature and small sample size. CONCLUSION: Our study demonstrated that a significant difference exists in the thickness of the granular layer between PP and HE, which might be helpful in differentiating between these 2 conditions. There was no difference between PP and HHD.

Anteroposterior translation of the glenohumeral joint in various pathologies: differences between shoulder MRI in the adducted neutral rotation and abducted externally rotated positions.

PURPOSE: The present study was performed to determine the translation of the glenohumeral joint in patients with and without shoulder lesions by comparing the magnetic resonance images obtained in the conventional adducted neutral rotation position with those obtained in the abducted externally rotated position. METHODS: Two hundred and eighty-five consecutive shoulders without rotator cuff tears that had been subjected to magnetic resonance imaging (MRI) without arthrography in the abducted externally rotated position were reviewed retrospectively. Among them, 50 shoulders without pathology were selected at random to be compared with three shoulder pathology groups, comprising shoulders with superior labrum, anterior-to-posterior (SLAP) lesions without range of motion (ROM) limitation (group I, 47 shoulders), with massive rotator cuff tears without ROM limitation (group II, 20 shoulders), and with full-thickness subscapularis tendon tears without ROM limitation (group III, 20 shoulders). Glenohumeral translation in the anterior-to-posterior direction relative to the glenoid face was evaluated using a method based on the glenohumeral contact point (CP) and humeral head centre (HHC) in the adducted neutral rotation and abducted externally rotated views, which were measured by three orthopaedic surgeons. For each shoulder, the differences in translation for the glenohumeral CP and HHC between the adducted neutral rotation and abducted externally rotated views were calculated as relative posterior translation in millimetres. RESULTS: The differences in ΔCP and ΔHHC between group I and the normal control group were not statistically significant. The differences in ΔCP (P = 0.001) and ΔHHC (P = 0.001) between group II and the normal control group were statistically significant. Additionally, the differences in ΔCP and ΔHHC between group III and the normal control group were not statistically significant. CONCLUSIONS: The MRI in abducted externally rotated view in patients with SLAP lesions or full-thickness subscapularis tendon tears diagnosed by conventional MRI alone showed no significant glenohumeral posterior translation relative to the adducted neutral rotation view in the present study. However, the abducted externally rotated view in patients with massive rotator cuff tears showed significant glenohumeral anterior translation relative to the adducted neutral rotation view.

Comparisons of retear patterns for 3 arthroscopic rotator cuff repair methods.

BACKGROUND: Only a few studies have reported an unusual retear pattern after arthroscopic rotator cuff repair based on the repair method. PURPOSE: To compare the retear pattern of the arthroscopic single-row technique (SRT), conventional suture-bridge technique (SBT), and knotless suture-bridge technique (K-SBT) for rotator cuff tears. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This study evaluated 65 shoulders with retears revealed on magnetic resonance imaging at least 6 months after arthroscopic repair for a full-thickness rotator cuff tear. A retear was revealed in 21, 22, and 22 shoulders after the SRT, SBT, and K-SBT, respectively. Retears were classified as type 1 (unhealed tendons), type 2 (medially ruptured tendons with a healed footprint), or type 3 (unable to classify). Retear patterns were classified as full- or partial-thickness lesions; partial-thickness retears were further classified as articular- or bursal-side lesions. RESULTS: A type 1 retear was observed in 71.4%, 40.9%, and 54.5% and a type 2 retear in 23.8%, 59.0%, and 40.9% of patients in the SRT, SBT, and K-SBT groups, respectively. No significant differences were observed among the 3 groups together (P = .195); however, a significant difference was observed between the SRT and SBT groups alone (P = .049). No significant differences were observed for either type 1 (P = .121) or type 2 (including both full- and partial-thickness) retears (P = .064) among the 3 groups together. When respective pairs of groups were compared, a significant difference was noted in both type 1 (P = .044) and type 2 retears (P = .019) between the SRT and SBT groups alone. No significant differences were observed in type 1 (P = .281) or type 2 full-thickness retears (P = .117) among the 3 groups together. When pairs of groups were compared, a significant difference in type 2 full-thickness retears was detected between the SRT and SBT groups alone (P = .037). CONCLUSION: The SBT has a different retear pattern than that of the SRT. However, the K-SBT retear pattern was not different from that of the SRT.

Repair integrity and functional outcome after arthroscopic conversion to a full-thickness rotator cuff tear: articular- versus bursal-side partial tears.

BACKGROUND: A few studies have compared high-grade partial-thickness articular- and bursal-side rotator cuff tears postoperatively. PURPOSE: To compare the clinical and radiological outcomes of high-grade partial-thickness rotator cuff tears treated with arthroscopic conversion to full-thickness tears, followed by repair. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Forty-three consecutive shoulders with high-grade partial-thickness rotator cuff tears (20 articular- and 23 bursal-side lesions) treated with arthroscopic conversion to full-thickness tears, followed by repair using the suture-bridge technique, were evaluated. The final functional evaluation was conducted at a mean of 35.53 months (range, 24-54 months). Radiological outcomes were evaluated at a minimum of 1 year postoperatively. The following outcome measures were used in this study: the American Shoulder and Elbow Surgeons (ASES) score, the University of California, Los Angeles (UCLA) Shoulder Rating Scale, the Constant score, and range of motion. RESULTS: At the final follow-up, the mean ASES, UCLA, and Constant scores improved significantly to 91.80, 32.70, and 75.85, respectively, in the articular-side group (all P < .001). The mean ASES, UCLA, and Constant scores improved significantly to 90.80, 32.52, and 83.00, respectively, in the bursal-side group (all P < .001). The UCLA and ASES scores did not differ significantly between the 2 groups (P = .821 and .869, respectively), while the Constant scores did (P = .048). The retear rate was 0% in the articular-side group and 9.5% in the bursal-side group; this difference was not significant (P = .204). CONCLUSION: The arthroscopic repair of partial-thickness bursal-side tears resulted in comparable or superior postoperative functional outcomes compared with that of articular-side tears. However, the postoperative retear rate did not differ significantly between the 2 groups.

Clinical outcomes after arthroscopic trans-tendon suture-bridge technique in partial-thickness articular-side rotator cuff tear.

PURPOSE: We evaluated the functional and radiological outcomes of arthroscopic trans-tendon suture-bridge repair for partial-thickness articular-side rotator cuff tears. METHODS: From December 2008 to May 2010, 32 consecutive patients with partial-thickness articular-side rotator cuff tears prospectively underwent arthroscopic trans-tendon suture-bridge repair. We included patients with articular-side partial-thickness supraspinatus tears involving more than half the normal thickness. Patients underwent ultrasonography or magnetic resonance imaging postoperatively. The functional outcomes of patients were evaluated at a minimum 1 year postoperatively. The mean age and follow-up period for the patients were 51.8 ± 13.7 years and 17.4 ± 4.2 months, respectively. Five outcome measures were used before surgery and at the final follow-up: a visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA), the Constant-Murley score and range of motion (ROM). RESULTS: The radiological follow-up rate was 87.5%, and the follow-up rate for clinical evaluation was 96.9%. Mean UCLA, ASES and Constant-Murley scores improved from 19.1 ± 5.4, 45.2 ± 16.0 and 58.0 ± 19.6 preoperatively to 35.7 ± 8.5, 79.0 ± 15.8 and 78.1 ± 12.9 at final follow-up, respectively (all p ≤ 0.001). Mean VAS score and ROM (forward flexion) improved from 6.1 ± 1.9 and 140 ± 36.6 preoperatively to 2.6 ± 1.9 and 163 ± 25.2 at the final follow-up, respectively (p ≤ 0.001). Additionally, the postoperative radiological examination showed cuff integrity without retear in all patients. CONCLUSIONS: Arthroscopic trans-tendon suture-bridge repair for partial-thickness articular-side rotator cuff tears resulted in significant improvement in function compared with that before the operation.

Changes in tendon length with increasing rotator cuff tear size.

PURPOSE: To investigate the change in tendon length with increasing size of rotator cuff tears in patients receiving arthroscopic rotator cuff repair. METHODS: This is a prospective evaluation of 100 consecutive patients who met the inclusion criterion of a U-shaped or crescent-shaped full-thickness tear and who were treated by arthroscopic rotator cuff (supraspinatus and/or infraspinatus) repair from 2009 to 2010. The anterior-to-posterior dimension of the cuff tear was estimated under arthroscopic guidance, and the medial-to-lateral dimension was estimated on pre-operative MRI. The tendon length, from its distal end to the musculotendinous junction, was estimated under arthroscopic observation after arthroscopic rotator cuff repair. The relationships between tendon length and the anterior-to-posterior and medial-to-lateral dimensions of the cuff tear were analyzed. RESULTS: The average tendon length in patients with full-thickness tears was 17.0 mm. The tendon length decreased significantly with an increase in cuff tear size, for both the anterior-to-posterior (r = -0.328, P = 0.001) and medial-to-lateral dimensions (r = -0.681, P < 0.001). When the full-thickness tears were grouped according to the lengths of the anterior-to-posterior and medial-to-lateral dimensions, tendon length differed significantly among the groups (P = 0.008 and P < 0.001, respectively). CONCLUSIONS: In full-thickness tears, the rotator cuff tendon length decreased with increases in the anterior-to-posterior and medial-to-lateral dimensions of the tear size, with a higher correlation between tendon length and the medial-to-lateral dimension. During arthroscopic rotator cuff repair, passing a suture too medially for complete footprint coverage using a strong fixation technique can lead to excess tension and medial cuff tears. LEVEL OF EVIDENCE: II.

[Effects of frozen gauze with normal saline and ice on thirst and oral condition of laparoscopic cholecystectomy patients: pilot study].

PURPOSE: The purpose of this study was to examine the effects of using gauze frozen with normal saline or ice on thirst-relief and oral condition of laparoscopic cholecystectomy patients. METHODS: A quasi-experimental nonequivalent control group, pretest-posttest design was used. Participants (n=53) received either gauze frozen with normal saline (n=17), ice (n=18) or wet gauze (n=18) for thirst-relief. The subjective thirst level and oral condition of the participants were assessed before the intervention, 15 min after the first intervention and 15 min after the second intervention. RESULTS: After oral care was provided twice, there were significant differences in thirst level among the groups. When oral care was provided twice, the oral condition of tongue, saliva, mucosal membrane, and gingiva was improved in patients receiving gauze frozen with normal saline or ice. CONCLUSION: Gauze frozen with normal saline and ice can be effective for oral care in reducing the thirst level and improving the condition of the oral cavity.

Purification and characterization of a thermostable xylanase from the brown-rot fungus Laetiporus sulphureus.

A thermostable extracellular xylanase was purified and characterized from brown-rot basidiomycete Laetiporus sulphureus, cultivated on biologically pretreated Pinus densiflora biomass. After three consecutive purification steps using DEAE, Mono Q, and Superdex 75 columns, the xylanase specific activity was found to be 72.4 U/mg, nine fold higher than that of the crude culture solution, purity was 96%, and the molecular mass determined to be 69.3 kDa. The optimal pH and temperature for xylanase activity were 3.0 and 80 degrees C, respectively. Although activity of xylanase was highest at 80 degrees C, it showed highest thermostability at 60 degrees C, retaining approximately 97% of its relative activity following incubation for 4 h. In the presence of 5 mM solution of CaCl2, the relative xylanase activity increased by 35.9%; however, it decreased significantly in the presence of 10 mM solution of Cu2+. Among the xylan-based substrates tested, purified L. sulphureus xylanase showed the highest activity on beechwood xylan. Thin-layer chromatography (TLC) experiments revealed that purified L. sulphureus xylanase is an endoxylanase that hydrolyzes xylotriose, xylotetraose, and xylopentaose but not xylobiose.

Biological pretreatment of softwood Pinus densiflora by three white rot fungi.

The effects of biological pretreatment on the Japanese red pine Pinus densiflora, was evaluated after exposure to three white rot fungi Ceriporia lacerata, Stereum hirsutum, and Polyporus brumalis. Change in chemical composition, structural modification, and their susceptibility to enzymatic saccharification in the degraded wood were analyzed. Of the three white rot fungi tested, S. hirsutum selectively degraded the lignin of this sortwood rather than the holocellulose component. After eight weeks of pretreatment with S. hirsutum, total weight loss was 10.7%, while lignin loss was the highest at 14.52% among the tested samples. However, holocellulose loss was lower at 7.81% compared to those of C. lacerata and P. brumalis. Extracelluar enzymes from S. hirsutum showed higher activity of ligninase and lower activity of cellulase than those from other white rot fungi. Thus, total weight loss and changes in chemical composition of the Japanese red pine was well correlated with the enzyme activities related with lignin- and cellulose degradation in these fungi. Based on the data obtained from analysis of physical characterization of degraded wood by X-ray Diffractometry (XRD) and pore size distribution, S. hirsutum was considered as an effective potential fungus for biological pretreatment. In particular, the increase of available pore size of over 120 nm in pretreated wood powder with S. hirsutum made enzymes accessible for further enzymatic saccharification. When Japanese red pine chips treated with S. hirsutum were enzymatically saccharified using commercial enzymes (Cellulclast 1.5 L and Novozyme 188), sugar yield was greatly increased (21.01%) compared to non-pretreated control samples, indicating that white rot fungus S. hirsutum provides an effective process in increasing sugar yield from woody biomass.