ABSTRACT
Objective@#Cardiac tamponade with hemodynamic collapse requires immediate treatment, and ultrasound-guided pericardiocentesis is the treatment of choice. Although an essential skill for emergency physicians, there is a lack of training. We created a phantom that could practice ultrasound-guided pericardiocentesis using readily available materials. The pros and cons of the materials used were then compared. @*Methods@#Cardiac tamponade phantoms were made from gelatin, and included a heart, liver, and rib cage. We conducted a model-specific satisfaction questionnaire targeting 15 emergency physicians. The questionnaire was designed to be answered on a Likert 5-point scale. @*Results@#Creating the gelatin model took 6 hours. At room temperature, the gelatin model was able to retain its shape for 3 days. Fifteen physicians participated in the questionnaire, comprising five subjects having actual pericardiocentesis experience. In the questionnaire, our model achieved high satisfaction with all questions. @*Conclusion@#In our study, the pericardiocentesis phantom made from gelatin could maintain its shape for a long time, there was better recognition of the needle tip, and the model was more similar to the actual cardiac tamponade situation. Considering these positive characteristics, we recommend the phantom as a model for pericardiocentesis training.
ABSTRACT
Objective@#The characteristics and prognosis of out-of-hospital cardiac arrest (OHCA) patients can vary due to a variety of factors, including the time of the day. We tried to identify the characteristics and prognosis of OHCA in a Korean metro city based on the time of the day. @*Methods@#This citywide retrospective observational study was conducted from January 1, 2015, to November 31, 2020, in Daegu, Korea on patients over 18 years of age who were suspected of having a medical etiology of OHCA. We evaluated the characteristics and outcomes of OHCA, according to the time of day, divided into dawn (00:00-05:59), morning (06:00-11:59), afternoon (12:00-17:59), and night (18:00-23:59). The outcome variables were survival to hospital discharge and favorable neurological outcomes. @*Results@#The median age of the total of 4,783 OHCA patients in the study was 72.0 years of which 3,096 (64.7%) were males. The number of patients who survived was 317 (7.8%) and 301 (6.3%) were discharged with favorable neurological outcomes. There were 672 (14.0%) patients admitted at dawn, 1,607 (33.6%) in the morning, 1,379 (28.8%) in the afternoon, and 1,125 (23.5%) at night. After adjusting for the possible confounding variables, compared with the morning group, the survival to hospital discharge was low in the afternoon and the night (adjusted odds ratio [aOR], 0.69; 95% confidence interval [CI], 0.48-0.98 and aOR, 0.48; 95% CI, 0.32-0.74). In addition, favorable neurological outcomes were also low in the afternoon and the night compared with the morning (aOR, 0.59; 95% CI, 0.40-0.85 and aOR, 0.62; 95% CI, 0.41-0.93). @*Conclusion@#Diurnal differences in OHCA outcomes were observed. Identification of the diurnal OHCA characteristics will be necessary to devise an appropriate regional emergency medical services strategy.
ABSTRACT
In mammalian species, females are born with a number of oocytes exceeding what they release via ovulation. In humans, an average girl is born with over a thousand times more oocytes than she will ovulate in her lifetime. The reason for having such an excessive number of oocytes in a neonatal female ovary is currently unknown. However, it is well established that the oocyte number decreases throughout the entire lifetime until the ovary loses them all. In this review, data published in the past 80 years were used to assess the current knowledge regarding the changing number of oocytes in humans and mice, as well as the reported factors that contribute to the decline of oocyte numbers. Briefly, a collective estimation indicates that an average girl is born with approximately 600,000 oocytes, which is 2,000 times more than the number of oocytes that she will ovulate in her lifetime. The oocyte number begins to decrease immediately after birth and is reduced to half of the initial number by puberty and almost zero by age 50 years. Multiple factors that are either intrinsic or extrinsic to the ovary contribute to the decline of the oocyte number. The inflammation caused by the ovulatory luteinizing hormone surge is discussed as a potential contributing factor to the decline of the oocyte pool during the reproductive lifespan.
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Objective@#This study aims to identify significant factors such as sweat that can be used as important predictors of acute coronary syndrome (ACS) in patients visiting the emergency department (ED) complaining of chest pain. @*Methods@#This observational, retrospective, registry-based study conducted from May 2020 to November 2020 evaluated patients who visited the ED due to chest pain. Parameters associated with ACS were investigated, and the clinical characteristics and symptoms were analyzed. @*Results@#A total of 230 patients visited the ED with chest pain. Of these, 94 (40.9%) were diagnosed with ACS. Univariate regression analysis showed that facial sweating (odds ratio [OR], 2.624; 95% confidence interval [CI], 1.241-5.549; P=0.012) and drench sweating (OR, 3.346; 95% CI, 1.602-6.991; P=0.001) were associated with ACS. Hence, we classified these patients as the actual sweating group. However, the sweaty feeling self-reported by patients with no visible sweat did not correlate with ACS. Multivariate logistic regression analysis showed that age (OR, 1.043; 95% CI, 1.016-1.071; P=0.002), quantum of smoking (OR, 1.023; 95% CI, 1.005-1.041; P=0.010), diastolic blood pressure (OR, 1.028; 95% CI, 1.004-1.049; P=0.009), squeezing chest pain (OR, 2.128; 95% CI, 1.000-4.531; P=0.050), and actual sweating (OR, 2.300; 95% CI, 1.209-4.374; P=0.011) were significantly associated with ACS. @*Conclusion@#Age, the quantum of smoking, diastolic blood pressure, squeezing chest pain, and actual sweating are useful predictors for ACS diagnosis. Unlike actual sweating, patient-reported sweating is not significantly related to the diagnosis of ACS. The results of this study will be beneficial in predicting ACS to ensure early and emergency medical care in the pre-hospital setting.
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In vitro studies are essential to predict the clinical performance of ceramic widely used as restorative materials. Traditional experiments such as fracture toughness and flexural strength have been used to evaluate the properties of brittle ceramics. However, these experiments have a limitation that the load conditions, failure patterns, and load values at which failure occurs are not similar to human occlusal force ranges or clinical failures. On the other hand, the edge chipping test (ECT), which was recently introduced to study chipping fracture of ceramics, has similar failure patterns to clinical trials. In addition, the failure loads from ECT were similar to human occlusal force. ECT can be usefully used in the study of ceramic properties. In this literature review, a more clinically meaningful experimental study of ceramics by examining the meaning and limitations of traditional ceramic failure tests and comparing them with ECT.
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Background@#Acute ischemic stroke is a time-sensitive disease. Emergency medical service (EMS) prehospital notification of potential patients with stroke could play an important role in improving the in-hospital medical response and timely treatment of patients with acute ischemic stroke. We analyzed the effects of FASTroke, a mobile app that EMS can use to notify hospitals of patients with suspected acute ischemic stroke at the prehospital stage. @*Methods@#We conducted a retrospective observational study of patients diagnosed with acute ischemic stroke at 5 major hospitals in metropolitan Daegu City, Korea, from February 2020 to January 2021. The clinical conditions and time required for managing patients were compared according to whether the EMS employed FASTroke app and further compared the factors by dividing the patients into subgroups according to the preregistration received by the hospitals when using FASTroke app. @*Results@#Of the 563 patients diagnosed with acute ischemic stroke, FASTroke was activated for 200; of these, 93 were preregistered. The FASTroke prenotification showed faster door-tocomputed-tomography times (19 minutes vs. 25 minutes, P < 0.001), faster door-to-intravenousthrombolysis times (37 minutes vs. 48 minutes, P < 0.001), and faster door-to-endovascularthrombectomy times (82 minutes vs. 119 minutes, P < 0.001). The time was further shortened when the preregistration was conducted simultaneously by the receiving hospital. @*Conclusion@#The FASTroke app is an easy and useful tool for prenotification as a regional stroke care system in the metropolitan area, leading to reduced transport and acute ischemic stroke management time and more reperfusion treatment. The effect was more significant when the preregistration was performed jointly.
ABSTRACT
Loss of posterior bite support might cause unstable occlusal relationship and when the mandible slides forward in the centric or habitual occlusion, excessive load is applied to the anterior region followed by causing the occlusal plane to collapse or leading to a decrease in occlusal vertical dimension. In addition, disorder of temporomandibular joint function may occur. The inter-dental arch discrepancy causes a mismatch in the vertical and horizontal overlap of the anterior and posterior regions. The deep bite in the anterior region and the scissor bite in the posterior region cause unstable occlusal contact and insufficient occlusal contact area. This report was to rehabilitate a patient with above-mentioned complex problems. Physiologic adaptation to increased vertical dimension and new occlusal plane were evaluated using provisional prostheses, and definitive prostheses was fabricated using cross-mounting technique. Stable occlusion, harmonious teeth overlap and adequate occlusal plane were established, so functionally and aesthetically satisfactory results are obtained.
ABSTRACT
Additive manufacturing (AM) for dental materials can produce more complex forms than conventional manufacturing methods.Compared to milling processing, AM consumes less equipment and materials, making sustainability an advantage. AM can be categorized into 7 types. Polymers made by vat polymerization are the most suitable material for AM due to superior mechanical properties and internal fit compared to conventional self-polymerizing methods. However, polymers are mainly used as provisional restoration due to their relatively low mechanical strength. Metal AM uses powder bed fusion methods and has higher fracture toughness and density than castings, but has higher residual stress, which requires research on post-processing methods to remove them. AM for ceramic use vat polymerization of materials mixed with ceramic powder and resin polymer. The ceramic materials for AM needs complex post-processing such as debinding of polymer and sintering. The low mechanical strength and volumetric accuracy of the products made by AM must be improved to be commercialized. AM requires more research to find the most suitable fabrication process conditions, as the mechanical properties and surface of any material will vary depending on the processing condition.
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Clinical applications of translucent zirconia as well as traditional zirconia (3 mol% yttria stabilized tetragonal zirconia polycrystal, 3Y-TZP) are increasing. For this reason, studies on factors affecting the optical properties of dental zirconia have been continuously reported. The optical effect of dental zirconia may vary depending on the yttria content, the thickness of the prosthesis, the sintering process, polishing, glazing and cementation in laboratory and clinical procedures. Increasing the yttria concentration can reduce the masking effect. Translucency decreases as the thickness of the restoration increases, but the required thickness may vary depending on the properties of the zirconia block. The high-speed sintering method can shorten the manufacturing time, but in some cases, the translucency of the prosthesis may decrease. In addition, the optical properties can be affected by the surface roughness of zirconia and the polishing process. The use of an appropriate colored cement can help with the masking effect of zirconia and can be useful for color matching for more esthetic results.
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Background/Aims@#Multi-drug resistant pathogens are increasing among healthcare-associated infections. It is well known that copper and copper alloys have antimicrobial activity. We evaluated the activity of copper against bacteria in a hospital setting in Korea. @*Methods@#This study was conducted in a laboratory and medical intensive care unit (ICU). Methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus faecium (VRE) were inoculated onto copper, copper alloy and stainless steel plates. After 24 hours of incubation, colony-forming units (CFU) were counted in the laboratory. Two similar rooms were chosen in the ICU; one room had copper-containing surface, and the other room contained items with a stainless steel surfaces. Items were sampled weekly for 8 weeks when the rooms were not crowded and when the rooms were busier with healthcare workers or visitors. @*Results@#In vitro time-kill curves showed copper or, a copper alloy yielded a significant reduction in MRSA and VRE CFUs over 15 minutes. Upon exposure to stainless steel plates, CFUs were slowly reduced for 24 hours. In vivo, MRSA CFUs were lower in rooms with copper-containing surfaces compared with controls, both after cleaning and after patients had received visitors (p < 0.05). Analysis of VRE revealed similar results, but VRE CFUs from copper-containing surfaces of drug carts in the ICU did not decrease significantly. @*Conclusions@#Copper has antimicrobial activity and appears to reduce the number of multi-drug resistant microorganisms in a hospital environment. This finding suggests the potential of the use of copper fittings, instruments and surfaces in hospital.
ABSTRACT
There are very few reports of the restoration of tooth loss using dental implants in patients with diffuse sclerosing osteomyelitis (DSO). Because the patients with DSO have unfavorable bone quality for osseointegration of dental implants, additional considerations such as surgical trauma, infection control, and an extended healing period are essential when placing dental implants. The purpose of this study is to report on the success of osseointegration of a dental implant in the patient with DSO.
ABSTRACT
Implant prostheses and removable partial dentures are mainly used as treatment methods for partial edentulous patients who have lost a number of teeth. The implant-assisted removable partial denture (IARPD) is strategically selected. The defect in maxillofacial structure due to osteomyelitis, a type of facial bone infection, causes dysfunction such as mastication, swallowing, and pronunciation, as well as social and psychological effects, so a removable restoration is required to restore the supporting tissue. Design of abutment and partial dentures is an essential factor in the success of treatment. In this case, IARPD, which has superior retention and stability compared to traditional removable partial dentures, can have a good prognosis. In a partial edentulous patient with bone defects due to osteomyelitis treatment, the stability of the denture was secured with IARPD restoration. Moreover, maintenance problem that may occur in the future was minimized by providing an appropriate denture design and occlusal scheme through several provisional restorations. This case can be expected to have a favorable prognosis in the long term.
ABSTRACT
Congenital tooth agenesis is the most common developmental dental anomaly, of which oligodontia is defined as the absence of six or more permanent teeth, except the third molars. Tooth agenesis causes malocclusion, alveolar atrophy, aesthetic and psychosocial problems. This clinical report describes a multidisciplinary treatment for a patient diagnosed as oligodontia, who exhibited absence of 14 permanent teeth, atrophy of maxillary alveolar bone, and mandibular protrusion. Restoration space was secured and tooth axis was improved by the extraction of deciduous teeth and orthodontic treatment. However, edge-to-edge bite of posterior teeth and arch dimension discrepancy due to atrophic maxilla was remained. To restore the aesthetics and functionality, implant retained prosthesis was planned. Considering minimal bone grafts, location and number of dental implants and prostheses design were determined. Through the gradual adjustment of provisional restoration, the appropriate centric and eccentric occlusion was reflected into a definitive prosthesis. Currently, stable functional results were attained, however, regular follow up and maintenance care over lifetimes should be performed.
ABSTRACT
Purpose@#The aim of this study is to compare the hardness according to the conditions of metal alloys. Moreover, the correlation between the cast crown hardness before and after wear testing and the degree of wear for each dental alloy was assessed. @*Materials and Methods@#Cast crowns of three metal alloys (Co-Cr, gold, and Ni-Cr alloys) opposing smooth-surface monolithic zirconia were used. The Vickers microhardness of the ingot (which did not undergo wear testing) and the cast crown before and after wear testing were measured for each alloy. Two-way ANOVA and Scheffé tests were used to compare the measured hardness values. Moreover, the Pearson correlation coefficient was used to evaluate the relationship between the surface hardness and the wear of the cast crown (α=.05). @*Results@#There was no significant difference in the hardness before and after wear testing for the gold alloy (P >.05); however, the hardness of the worn surface of the cast crown increased compared to that of the cast crown before the wear tests of Ni-Cr and Co-Cr alloys (P .05). @*Conclusion@#There was a significant difference in hardness between dental alloys under the same conditions. No correlation existed between the surface hardness of the cast crown before and after wear testing and the wear of the cast crown.
ABSTRACT
Objective@#In somatic symptom disorder (SSD), cognitive dysfunction is related to perceptive distortion that excessively amplifies bodily sensations. The association between high body mass index (BMI) and cognitive dysfunction could be attributed to underlying systemic inflammation. We aimed to evaluate whether patients with SSD and high BMI exhibit increased somatic symptom severity and whether this is mediated by cognitive dysfunction. @*Methods@#This retrospective, cross-sectional study was conducted on 54 patients with SSD (20 males/34 females, mean age ± standard deviation: 40.65 ± 13.23 years). Participants’ BMI, laboratory data including complete blood count and lipid profile, results from the Korean Wechsler Adult Intelligence Scale-IV, and scores of the Korean-Symptom Checklist 95-Somatization (SCL95-SOM) were analyzed. We performed a path analysis to evaluate BMI as a predictor of somatic symptoms. @*Results@#In a path analysis, the SCL95-SOM score was directly influenced by working memory (b = −0.326, p = 0.032), which was significantly influenced by BMI (b = −0.338, p = 0.009), although there was no direct effect of BMI on the SCL95-SOM score. The path analytic model showed a close fit to the data with the following values: χ2 (df) = 0.918 (1), p = 0.338, root mean square error of approximation = 0.000 (＜ 0.001), and comparative fit index = 1.00. @*Conclusion@#Patients with SSD and high BMI may exhibit increased somatic symptom severity, and this is mediated by working memory dysfunction. Weight management may help improve symptoms in patients with SSD and high BMI.
ABSTRACT
Objective@#Early defibrillation is crucial for the survival of patients with out-of-hospital cardiac arrest. This study aimed to examine the trends and associated factors regarding public awareness and willingness to use automated external defibrillators (AEDs) through citywide surveys. @*Methods@#Three-round surveys were conducted in February 2012 (n=1,000), December 2016 (n=1,141), and December 2018 (n=1,001) among citizens in Daegu, South Korea, who were aged ≥19 years. The subjects were selected through a three-stage quota sampling. Awareness and willingness to use an AED were assessed in the three groups. The primary outcome was willingness to use AEDs. @*Results@#Of 3,142 respondents, 3,069 were eligible for analysis. The proportion of respondents who knew how to use AEDs increased from 4.7% in 2012 to 20.8% in 2018. Of the respondents in 2012, 2016, and 2018, 39.7%, 50.0%, and 43.2%, respectively, were willing to use an AED. Factors associated with willingness to use AEDs were male sex (adjusted odds ratio [AOR], 1.39; 95% confidence interval [CI], 1.10–1.75), cardiopulmonary resuscitation training experience in the previous 2 years (AOR, 1.80; 95% CI, 1.43–2.28), recognition of the Good Samaritan law (AOR, 1.45; 95% CI, 1.13–1.86), and awareness of how to use an AED (AOR, 4.40; 95% CI, 3.26–5.93). @*Conclusion@#To increase willingness to use AEDs, education in AED use and the Good Samaritan law, along with re-education to maintain knowledge of AED use, should be considered.
ABSTRACT
Background/Aims@#Multi-drug resistant pathogens are increasing among healthcare-associated infections. It is well known that copper and copper alloys have antimicrobial activity. We evaluated the activity of copper against bacteria in a hospital setting in Korea. @*Methods@#This study was conducted in a laboratory and medical intensive care unit (ICU). Methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus faecium (VRE) were inoculated onto copper, copper alloy and stainless steel plates. After 24 hours of incubation, colony-forming units (CFU) were counted in the laboratory. Two similar rooms were chosen in the ICU; one room had copper-containing surface, and the other room contained items with a stainless steel surfaces. Items were sampled weekly for 8 weeks when the rooms were not crowded and when the rooms were busier with healthcare workers or visitors. @*Results@#In vitro time-kill curves showed copper or, a copper alloy yielded a significant reduction in MRSA and VRE CFUs over 15 minutes. Upon exposure to stainless steel plates, CFUs were slowly reduced for 24 hours. In vivo, MRSA CFUs were lower in rooms with copper-containing surfaces compared with controls, both after cleaning and after patients had received visitors (p < 0.05). Analysis of VRE revealed similar results, but VRE CFUs from copper-containing surfaces of drug carts in the ICU did not decrease significantly. @*Conclusions@#Copper has antimicrobial activity and appears to reduce the number of multi-drug resistant microorganisms in a hospital environment. This finding suggests the potential of the use of copper fittings, instruments and surfaces in hospital.
ABSTRACT
There are very few reports of the restoration of tooth loss using dental implants in patients with diffuse sclerosing osteomyelitis (DSO). Because the patients with DSO have unfavorable bone quality for osseointegration of dental implants, additional considerations such as surgical trauma, infection control, and an extended healing period are essential when placing dental implants. The purpose of this study is to report on the success of osseointegration of a dental implant in the patient with DSO.
ABSTRACT
Implant prostheses and removable partial dentures are mainly used as treatment methods for partial edentulous patients who have lost a number of teeth. The implant-assisted removable partial denture (IARPD) is strategically selected. The defect in maxillofacial structure due to osteomyelitis, a type of facial bone infection, causes dysfunction such as mastication, swallowing, and pronunciation, as well as social and psychological effects, so a removable restoration is required to restore the supporting tissue. Design of abutment and partial dentures is an essential factor in the success of treatment. In this case, IARPD, which has superior retention and stability compared to traditional removable partial dentures, can have a good prognosis. In a partial edentulous patient with bone defects due to osteomyelitis treatment, the stability of the denture was secured with IARPD restoration. Moreover, maintenance problem that may occur in the future was minimized by providing an appropriate denture design and occlusal scheme through several provisional restorations. This case can be expected to have a favorable prognosis in the long term.
ABSTRACT
Congenital tooth agenesis is the most common developmental dental anomaly, of which oligodontia is defined as the absence of six or more permanent teeth, except the third molars. Tooth agenesis causes malocclusion, alveolar atrophy, aesthetic and psychosocial problems. This clinical report describes a multidisciplinary treatment for a patient diagnosed as oligodontia, who exhibited absence of 14 permanent teeth, atrophy of maxillary alveolar bone, and mandibular protrusion. Restoration space was secured and tooth axis was improved by the extraction of deciduous teeth and orthodontic treatment. However, edge-to-edge bite of posterior teeth and arch dimension discrepancy due to atrophic maxilla was remained. To restore the aesthetics and functionality, implant retained prosthesis was planned. Considering minimal bone grafts, location and number of dental implants and prostheses design were determined. Through the gradual adjustment of provisional restoration, the appropriate centric and eccentric occlusion was reflected into a definitive prosthesis. Currently, stable functional results were attained, however, regular follow up and maintenance care over lifetimes should be performed.