The teaching of geriatric dentistry in South Korean dental schools.

OBJECTIVE: The purpose of this study was to investigate the curriculum of geriatric dentistry for undergraduates in Korean dental schools. BACKGROUND: For development purposes, it was necessary to compare geriatric dentistry education programmes in South Korea to programmes in the United States and Europe. METHODS: The most recent curriculum and related information on geriatric dentistry at the undergraduate level in all 11 dental schools in South Korea were collected by both official letter and e-mail. A symposium for gathering expert opinions to improve geriatric dentistry education in South Korea was also held. The collected data were analysed, and the expert opinions at the symposium were summarised. RESULTS: Six of 11 schools had a didactic course as compulsory and three schools as elective. The course was usually conducted as a form of integrated lectures, and the level of standardisation of lecture content was very low. There were no topics for older people who cannot access dental clinics due to functional frailty or disability. No dental school-affiliated hospitals had an independent department for geriatric dentistry. No schools provided clinical teaching for geriatric dentistry. There were no outreach programmes for geriatric dentistry. CONCLUSIONS: The educational curriculum for geriatric dentistry in South Korea was insufficient to cope with social and demographic changes. Curriculum content should include clinical practice education and needs to be focused on frail and dependent older adult patients. An essential educational curriculum and core competency for geriatric dentistry should be prepared.

Factors affecting incorrect interpretation of abdominal computed tomography in non-traumatic patients by novice emergency physicians.

OBJECTIVE: Accurate interpretation of computed tomography (CT) scans is critical for patient care in the emergency department. We aimed to identify factors associated with an incorrect interpretation of abdominal CT by novice emergency residents and to analyze the characteristics of incorrectly interpreted scans. METHODS: This retrospective analysis of a prospective observational cohort was conducted at three urban emergency departments. Discrepancies between the interpretations by postgraduate year-1 (PGY-1) emergency residents and the final radiologists' reports were assessed by independent adjudicators. Potential factors associated with incorrect interpretation included patient age, sex, time of interpretation, and organ category. Adjusted odds ratios (aORs) for incorrect interpretation were calculated using multivariable logistic regression analysis. RESULTS: Among 1,628 eligible cases, 270 (16.6%) were incorrect. The urinary system was the most correctly interpreted organ system (95.8%, 365/381), while the biliary tract was the most incorrectly interpreted (28.4%, 48/169). Normal CT images showed high false-positive rates of incorrect interpretation (28.2%, 96/340). Organ category was found to be a major determinant of incorrect interpretation. Using the urinary system as a reference, the aOR for incorrect interpretation of biliary tract disease was 9.20 (95% confidence interval, 5.0-16.90) and the aOR for incorrectly interpreting normal CT images was 8.47 (95% confidence interval, 4.85-14.78). CONCLUSION: Biliary tract disease is a major factor associated with incorrect preliminary interpretations of abdominal CT scans by PGY-1 emergency residents. PGY-1 residents also showed high false-positive interpretation rates for normal CT images. Emergency residents' training should focus on these two areas to improve abdominal CT interpretation accuracy.

Calibration of radiochromic EBT3 film using laser-accelerated protons.

We present a proof of principle for onsite calibration of a radiochromic film (EBT3) using CR-39 as an absolute proton-counting detector and laser-accelerated protons as a calibration source. A special detector assembly composed of aluminum range filters, an EBT3 film, and a CR-39 detector is used to expose the EBT3 film with protons in an energy range of 3.65 MeV-5.85 MeV. In our design, the proton beam is divided into small beamlets and their projection images are taken on the EBT3 film and the CR-39 detector by maintaining a certain distance between the two detectors. Owing to the geometrical factor of the configuration and scattering inside the EBT3, the areal number density of protons was kept below the saturation level of the CR-39 detector. We also present a method to relate the number of protons detected on the CR-39 in a narrow energy range to protons with a broad energy spectrum that contribute to the dose deposited in the EBT3 film. The energy spectrum of protons emitted along the target normal direction is simultaneously measured using another CR-39 detector installed in a Thomson parabola spectrometer. The calibration curves for the EBT3 film were obtained in the optical density range of 0.01-0.25 for low dose values of 0.1 Gy-3.0 Gy. Our results are in good agreement with the calibrations of the EBT3 film that are traditionally carried out using conventional accelerators. The method presented here can be further extended for onsite calibration of radiochromic films of other types and for a higher range of dose values.

Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia: A retrospective cohort study according to the Sepsis-3 definitions.

ABSTRACT: The 2016 Surviving Sepsis Campaign guidelines suggest guiding resuscitation to normalize lactate levels in patients with sepsis-associated hyperlactatemia as a marker of tissue hypoperfusion. This study evaluated the prognostic value of lactate levels and lactate clearance for 30-day mortality in patients with sepsis and septic shock diagnosed in the emergency department.We performed a retrospective cohort study of sepsis patients with initial lactate levels of ≥2 mmol/L. All patients met the Sepsis-3 definitions. The prognostic value of 6-hour lactate levels, 6-hour lactate clearance, 6-hour lactate metrics (≥2 mmol/L), and lactate clearance metrics (<10%, <20%, and <30%) was evaluated. We compared the sensitivity and specificity between metrics.Of the 363 sepsis and septic shock patients, 148 died (30-day mortality: 40.8%). Nonsurvivors had significantly higher 6-hour lactate levels and lower 6-hour lactate clearance than those of survivors. Six-hour lactate levels and 6-hour lactate clearance were associated with 30-day mortality after adjusting for potential confounders (odds ratio, 1.191 [95% confidence interval (CI), 1.097-1.294] and 0.989 [0.983-0.995], respectively). Six-hour lactate levels had better prognostic value than 6-hour lactate clearance (area under the curve, 0.720 [95% CI, 0.670-0.765] vs 0.656 [0.605-0.705]; P = .02). Six-hour lactate levels of ≥3.5 mmol/L and 6-hour lactate clearance of <24.4% were the optimal cut-off value in predicting the 30-day mortality. The prognostic value of 6-hour lactate metrics and 6-hour lactate clearance metrics did not differ. Six-hour lactate levels (≥2 mmol/L) had the highest sensitivity (89.2%).Six-hour lactate levels proved to be more accurate in predicting 30-day mortality than 6-hour lactate clearance and initial lactate levels.

Vasoactive-Inotropic Score as an Early Predictor of Mortality in Adult Patients with Sepsis.

Vasoactive and inotropic medications are essential for sepsis management; however, the association between the maximum Vasoactive-Inotropic score (VISmax) and clinical outcomes is unknown in adult patients with sepsis. We investigated the VISmax as a predictor for mortality among such patients in the emergency department (ED) and compared its prognostic value with that of the sequential organ failure assessment (SOFA) score. This single-center retrospective study included 910 patients diagnosed with sepsis between January 2016 and March 2020. We calculated the VISmax using the highest doses of vasopressors and inotropes administered during the first 6 h on ED admission and categorized it as 0-5, 6-15, 16-30, 31-45, and >45 points. The primary outcome was 30-day mortality. VISmax for 30-day mortality was significantly higher in non-survivors than in survivors. The mortality rates in the five VISmax groups were 17.2%, 20.8%, 33.3%, 54.6%, and 70.0%, respectively. The optimal cut-off value of VISmax to predict 30-day mortality was 31. VISmax had better prognostic value than the cardiovascular component of the SOFA score and initial lactate levels. VISmax was comparable to the APACHE II score in predicting 30-day mortality. Multivariable analysis showed that VISmax 16-30, 31-45, and >45 were independent risk factors for 30-day mortality. VISmax in ED could help clinicians to identify sepsis patients with poor prognosis.

Strategies to prevent COVID-19 transmission in the emergency department of a regional base hospital in Korea: From index patient until pandemic declaration.

OBJECTIVE: This study aimed to describe the timely strategies used to prevent the spread of the emerging coronavirus disease 2019 (COVID-19) and present the activities performed in a regional base hospital in South Korea, from the identification of the index patient until the pandemic declaration. METHODS: This is a descriptive study detailing the step-by-step guidelines implemented to manage COVID-19 in a regional tertiary base hospital from January to March 2020. We described our three-phase response to the COVID-19 outbreak as per the national and global quarantine procedures applied during each critical event and highlighted the activities implemented from the perspective of public health crisis preparedness involving emerging infectious diseases. RESULTS: During the COVID-19 outbreak in Korea, we improved and implemented a rapid and flexible screening system for visiting patients using patient history and radiological testing and created a separate isolation zone for patients under investigation. This active identification-isolation strategy has been effectively applied in the COVID-19 outbreak. CONCLUSIONS: The step-by-step enforced strategies to prevent the spread of COVID-19, though not perfect, adequately reduced the risk of transmission of the highly contagious infectious disease in the hospital while maintaining the emergency medical system.

Highly efficient double plasma mirror producing ultrahigh-contrast multi-petawatt laser pulses.

We present a highly efficient double plasma mirror (DPM) that provides ultrahigh-contrast multi-petawatt (PW) laser pulses with a temporal contrast ratio reaching 1017 up to 160 ps and 1012 up to 2 ps before the main pulse. The high reflectivity of 70%, along with the high-contrast enhancement factor of 700,000, was achieved from the DPM installed after the final stage of a 4 PW Ti:sapphire laser. The 4 PW laser was equipped with cross-polarized wave generation and optical parametric chirped-pulse amplification stages for initial high-contrast operation. The DPM operation was undertaken with conditions that did not modify the spatiotemporal profiles of incident multi-PW laser pulses. This highly efficient DPM with the high-contrast enhancement promises the utilization of multiple PMs as a practical rear end for upcoming tens of petawatt lasers to achieve ultrahigh temporal contrast.

Electrostatic shock acceleration of ions in near-critical-density plasma driven by a femtosecond petawatt laser.

With the recent advances in ultrahigh intensity lasers, exotic astrophysical phenomena can be investigated in laboratory environments. Collisionless shock in a plasma, prevalent in astrophysical events, is produced when a strong electric or electromagnetic force induces a shock structure in a time scale shorter than the collision time of charged particles. A near-critical-density (NCD) plasma, generated with an intense femtosecond laser, can be utilized to excite a collisionless shock due to its efficient and rapid energy absorption. We present electrostatic shock acceleration (ESA) in experiments performed with a high-density helium gas jet, containing a small fraction of hydrogen, irradiated with a 30 fs, petawatt laser. The onset of ESA exhibited a strong dependence on plasma density, consistent with the result of particle-in-cell simulations on relativistic plasma dynamics. The mass-dependent ESA in the NCD plasma, confirmed by the preferential reflection of only protons with two times the shock velocity, opens a new possibility of selective acceleration of ions by electrostatic shock.

Prevalence of co-morbidities and evaluation of their monitoring in Korean patients with rheumatoid arthritis: comparison with the results of an international, cross-sectional study (COMORA).

AIM: We designed this study to evaluate the prevalence of comorbidities, their monitoring states and association with treatment medication in Korean rheumatoid arthritis (RA) patients compared with patients from other countries. METHODS: We analyzed 1050 RA patients from 11 Korean centers and compared them with 3520 patients from 16 other countries using an international, cross-sectional study evaluating comorbidities of RA (COMORA) database. RESULTS: Annual evaluations of cardiovascular (CV) risk were less frequently performed in Korea (P = 0.0011). The prevalence of CV-associated morbidity was similar between Korean and international RA patients, although the proportions of current smokers, patients with a family history of CV disease, patients with hyperlipidemia, and patients with Framingham score > 20% were significantly lower in Korea (P < 0.0001 for all), and the antiplatelet agents were more optimally used in Korea (P = 0.0004). Prostate cancer screening was less frequently performed compared to other countries (P < 0.0001). Less than 10% of Korean RA patients were given influenza and pneumococcal vaccinations according to current recommendations. CONCLUSIONS: There are differences in the prevalence of comorbidities and monitoring states of the risk factors between patients in Korea and in other countries. The prevalence of CV morbidity was similar between the two groups although the prevalence of CV risk factors was significantly low in Korea, suggesting that rheumatologists in Korea need to pay more attention to yearly CV risk monitoring, in addition to the screening of malignancy and vaccination of RA patients against infectious diseases.

Stability of unilateral sagittal split ramus osteotomy for correction of facial asymmetry: long-term case series and literature review.

Bilateral sagittal split ramus osteotomy is considered a standard technique in mandibular orthognathic surgeries to reduce unexpected bilateral stress in the temporomandibular joints. Unilateral sagittal split ramus osteotomy (USSO) was recently introduced to correct facial asymmetry caused by asymmetric mandibular prognathism and has shown favorable outcomes. If unilateral surgery could guarantee long-term postoperative stability as well as favorable results, operation time and the incidence of postoperative complications could be reduced compared to those in bilateral surgery. This report highlights three consecutive cases with long-term follow-up in which USSO was used to correct asymmetric mandibular prognathism. Long-term postoperative changes in the condylar contour and ramus and condylar head length were analyzed using routine radiography and computed tomography. In addition, prior USSO studies were reviewed to outline clear criteria for applying this technique. In conclusion, patients showing functional-type asymmetry with predicted unilateral mandibular movement of less than 7 mm can be considered suitable candidates for USSO-based correction of asymmetric mandibular prognathism with or without maxillary arch surgeries.

A retrospective analysis of 20 surgically corrected bimaxillary protrusion patients.

This paper presents a retrospective review and analysis of 20 bimaxillary protrusion patients who visited the authors' hospital between 1986 and 1998 following surgical correction. The lateral cephalometric radiographs of each patient were taken preoperatively (T0), within 1 week after surgery (T1), and at least 1 postoperative year later (T2). Hard and soft tissue analysis was performed on each cephalometric radiograph. The matched pair t test was employed for T0-T1, T1-T2, and T0-T2 periods. The sample consisted of 20 Korean adult patients with bimaxillary protrusion (18 women and 2 men), aged 21 to 33 years. The first premolars were removed in 18 of the 20 cases. The Wunderer method was selected in 18 of the 20 maxillary cases, and the anterior subapical osteotomy was selected in all mandibular cases. Augmentation genioplasty was combined in 3 cases, and reduction glossoplasty was combined in 2 cases. Orthodontic treatment was accompanied in 8 cases. The statistical analysis of all the variables revealed that, except for overbites, there were significant differences between T1-T2 and between T0-T2 periods (P < .01). This suggests that most of the bimaxillary patients want instant esthetic facial results and that their soft tissue profiles were improved significantly. However, the postoperative course should be cautiously observed.