Gastric insufflation and surgical view according to mask ventilation method for laparoscopic cholecystectomy: a randomized controlled study.

BACKGROUND: Proper mask ventilation is important to prevent air inflow into the stomach during induction of general anesthesia, and it is difficult to send airflow only through the trachea without gastric inflation. Changes in gastric insufflation according to mask ventilation during anesthesia induction were compared. METHODS: In this prospective, randomized, single-blind study, 230 patients were analyzed to a facemask-ventilated group (Ventilation group) or no-ventilation group (Apnea group) during anesthesia induction. After loss of consciousness, pressure-controlled ventilation at an inspiratory pressure of 15 cmH2O was performed for two minutes with a two-handed mask-hold technique for Ventilation group. For Apnea group, only the facemask was fitted to the face for one minute with no ventilation. Next, endotracheal intubation was performed. The gastric cross-sectional area (CSA, cm2) was measured using ultrasound before and after induction. After pneumoperitoneum with carbon dioxide, gastric insufflation of the surgical view was graded by the surgeon for each group. RESULTS: Increase of postinduction antral CSA on ultrasound were not significantly different between Ventilation group and Apnea group (0.04 ± 0.3 and 0.02 ± 0.28, p-value = 0.225). Additionally, there were no significant differences between the two groups in surgical grade according to surgeon's judgement. CONCLUSIONS: Pressure-controlled ventilation at an inspiratory pressure of 15 cmH2O for two minutes did not increase gastric antral CSA and insufflation of stomach by laparoscopic view. TRIAL REGISTRATION: http://cris.nih.go.kr (KCT0003620) on 13/3/2019.

Modified Cardiovascular Sequential Organ Failure Assessment Score in Sepsis: External Validation in Intensive Care Unit Patients.

BACKGROUND: There is a need to update the cardiovascular (CV) Sequential Organ Failure Assessment (SOFA) score to reflect the current practice in sepsis. We previously proposed the modified CV SOFA score from data on blood pressure, norepinephrine equivalent dose, and lactate as gathered from emergency departments. In this study, we externally validated the modified CV SOFA score in multicenter intensive care unit (ICU) patients. METHODS: A multicenter retrospective observational study was conducted on ICU patients at six hospitals in Korea. We included adult patients with sepsis who were admitted to ICUs. We compared the prognostic performance of the modified CV/total SOFA score and the original CV/total SOFA score in predicting 28-day mortality. Discrimination and calibration were evaluated using the area under the receiver operating characteristic curve (AUROC) and the calibration curve, respectively. RESULTS: We analyzed 1,015 ICU patients with sepsis. In overall patients, the 28-day mortality rate was 31.2%. The predictive validity of the modified CV SOFA (AUROC, 0.712; 95% confidence interval [CI], 0.677-0.746; P < 0.001) was significantly higher than that of the original CV SOFA (AUROC, 0.644; 95% CI, 0.611-0.677). The predictive validity of modified total SOFA score for 28-day mortality was significantly higher than that of the original total SOFA (AUROC, 0.747 vs. 0.730; 95% CI, 0.715-0.779; P = 0.002). The calibration curve of the original CV SOFA for 28-day mortality showed poor calibration. In contrast, the calibration curve of the modified CV SOFA for 28-day mortality showed good calibration. CONCLUSION: In patients with sepsis in the ICU, the modified SOFA score performed better than the original SOFA score in predicting 28-day mortality.

Feasibility of Assessing Maxillary and Mandibular Bone Mineral Density for Dental Implantation by Using Multidetector Computed Tomography.

PURPOSE: The purpose of this study was to evaluate the feasibility of measuring bone mineral density (BMD) of the maxillary and mandibular bones for dental implantation by using multidetector computed tomography (MDCT). MATERIALS AND METHODS: We performed MDCT in 141 patients (78 women and 63 men) at the lumbar vertebrae and at the maxillary and mandibular bones, with a view to dental implantation, from July 2015 to June 2017. Quantitative CT (QCT) using MDCT was performed to obtain Hounsfield unit (HU) values for the maxillary and mandibular bones and to obtain T scores for the lumbar vertebrae. We statistically analyzed the relationships among HU values, and the correlations of QCT values with T scores and of T scores with HU values. RESULTS: There were statistically significant correlations among all these parameters. CONCLUSIONS: QCT using MDCT of the maxillary and mandibular bones seems to be a feasible method for measuring BMD before dental implantation.

Amorphous Fluoropolymer Membrane for Gas Separation Applications.

Amorphous fluoropolymers have been studied in the past few decades and received extensive attention due to their unique and useful properties. One of the remarkable properties of amorphous fluoropolymers is high fractional free volume (FFV), and they tend to retain large amounts of solvent inside their polymer chains. In this study, amorphous flouoropolymer membranes were employed to examine the influences of the residual solvent and drying condition on the thermal properties, gas permeation behavior, and structure change by the polymer chains. Thermal properties of the produced membranes were characterized by differential scanning calorimetry (DSC) and a thermogravimetric analysis (TGA) to verify the effects of residual solvent. The residual solvent content and the glass transition temperature (Tg) of amorphous fluoropolymer membranes prepared with both solvents decrease with increasing drying temperature. The effect of the thermal treatment method on the d-spacing between the polymer chains of the prepared membranes was investigated using X-ray diffraction (XRD). The d-spacing decreased with drying below the Tg whereas it drastically increased near the Tg because of chain relaxation. From these phenomena, the helium permeability of the membranes treated at 120 °C radically increased. However, the oxygen and nitrogen permeability decreased with decreasing residual solvent content. The glass transition range shifted to higher temperature, from 75 °C to 133 °C, depending on the reduced amount of residual solvent.

Comparative Study on Osseointegration of Implants After Flap and Flapless Surgery in the Mandible of Dogs.

PURPOSE: The objective of this study was to compare the implant stability and osseointegration of implants using a flap or flapless technique. MATERIAL AND METHODS: Mandibular premolars and molars were extracted from both sides in 6 dogs. After 8 weeks, 4 fixtures were implanted using either a flap or flapless technique. Implant stability quotient was measured on insertion and at 2, 4, and 8 weeks later. The animals were killed while the tissues were histologically analyzed. RESULTS: Implant stability increased for 8 weeks, and no statistically significant differences were observed between the surgical protocols. Bone-implant contact showed 60.27% ± 30.99% for flapless surgery and 59.73% ± 17.12% for flap surgery. And the results of new bone formation area from total area showed 56.07% ± 27.78% for flapless surgery and 57.00% ± 14.66% for flap surgery. There were no statistically significant differences. CONCLUSION: This study showed no significant difference in implant stability as well as osseointegration regardless of flap or flapless technique.

Incidence and Management of Fractured Dental Implants: Case Reports.

The fracture of dental implants is a rare occurrence in clinical settings. Possible causes of implant fracture include design or production flaws, overloaded occlusion force, implant location, metal fatigue, and bone resorption around the implant. This study reports on the successful removal and reimplantation of fractured implants.

Comparison of pressure-controlled ventilation with volume-controlled ventilation during one-lung ventilation: a systematic review and meta-analysis.

BACKGROUND: Not only arterial hypoxemia but acute lung injury also has become the major concerns of one-lung ventilation (OLV). The use of pressure-controlled ventilation (PCV) for OLV offers the potential advantages of lower airway pressure and intrapulmonary shunt, which result in a reduced risk of barotrauma and improved oxygenation, respectively. METHODS: We searched Medline, Embase, the Cochrane central register of controlled trials and KoreaMedto find publications comparing the effects of PCV with those of volume-controlled ventilation (VCV) during intraoperative OLV in adults. A meta-analysis of randomized controlled trials was performed using the Cochrane Review Methods. RESULTS: Six studies (259 participants) were included. The PaO2/FiO2 ratio in PCV was higher than in VCV [weighted mean difference (WMD) = 11.04 mmHg, 95 % confidence interval (CI) = 0.30 to 21.77, P = 0.04, I(2) = 3 %] and peak inspiratory pressure was significantly lower in PCV (WMD = -4.91 cm H2O, 95 % CI = -7.30 to -2.53, P < 0.0001, I (2) = 91 %). No differences in PaCO2, tidal volume, heart rate and blood pressure were observed. There were also no differences incompliance, plateau and mean airway pressure. CONCLUSIONS: Our meta-analysis provided the evidence of improved oxygenation in PCV. However, it is difficult to draw any definitive conclusions due to the fact that the duration of ventilation in the studies reviewed was insufficient to reveal clinically relevant benefits or disadvantages of PCV. Significantly lower peak inspiratory pressure is the advantage of PCV.

Morphology of pedestrian roads and thermal responses during summer, in the urban area of Bucheon city, Korea.

The purpose of this study was to elucidate the effect of urban morphology representing sky view factor (SVF) on urban microclimate and on human thermal responses. The physical environments and the changes in body temperatures as well as psychological responses were investigated in summer in Bucheon, Korea. The dry bulb temperature ranged from 31.5 °C at SVF 0.082 site to 35.7 °C at SVF 0.922 site. Most of the environmental elements were statistically correlated to the SVF: the dry bulb temperature R (2) = 0.602, UVB R (2) = 0.556 and the illumination level R (2) = 0.609. The mean skin temperature increased up to 36.0 °C at the SVF 0.940 site and decreased to 33.9 °C at the SVF 0.082 site. The mean skin temperature was statistically correlated to the SVF (p = 0.005). However, the core body temperature was not correlated to SVF because of time delay effect to the previously exposed thermal environment. In the investigation of thermal acceptability, only 5 % of subjects were dissatisfied with the road that was covered with plentiful trees; in contrast, approximately 50 % of subjects were dissatisfied with the road with poor solar obstacles in the summer. The thermal stress was affected by the urban morphology, and the plentiful urban greening improved thermal comfort.

Histomorphometric Analysis of Contaminated Autogenous Tooth Graft Materials After Various Sterilization.

PURPOSE: The purpose of this study was to evaluate histomorphometrically contaminated autogenous tooth graft materials, which were resterilized. MATERIALS AND METHODS: The intentional defects (diameter: 8 mm, depth: 4 mm) were formed around implant fixture on the iliac crest of 6 mongrel dogs. Autogenous tooth graft materials were made by extracted premolars. After the contamination of the tooth materials, graft procedure was performed; no contaminated group (control group), contaminated groups (nonsterilization group [group 1], ethylene oxide [EO] gas group [group 2], and autoclave group [group 3]). The bone-to-implant contact (BIC) and the new bone formation rate (NBFR) were evaluated after sacrifice. RESULTS: The BIC and NBFR of groups 1 and 3 were significantly lower than the control group after 4 weeks. The BIC and NBRF of group 3 were significantly lower than the control group after 8 weeks. However, the BIC and NBRF of group 2 was not significantly different comparing with the control group after 4 and 8 weeks. CONCLUSION: Sterilization using EO gas may be more favorable than high-pressure sterilization in cases the reuse of contaminated autogenous tooth graft materials.

Early Bone Formation at a Femur Defect Using CGF and PRF Grafts in Adult Dogs: A Comparative Study.

PURPOSE: The purpose of this study was to compare the predictability of new bone formation using an autologous concentrated growth factor (CGF) graft alone and platelet graft alone. MATERIALS AND METHODS: Four bony defects of 8 mm were formed, and 3.7- × 10-mm implants were placed in the right femur. The platelet-rich fibrin (PRF), CGF, and synthetic bone were grafted to the bone defect area. Enzyme linked immunosorbent assay quantitative analysis and microscopic analysis of the fibrinogen structure were performed. RESULTS: At 4 weeks, the comparisons of each experimental group showed a significant difference between the CGF group and the synthetic bone graft group. When comparing the CGF and allograft material groups, the allograft group showed significantly more new bone formation. In the case of vascular endothelial growth factor, CGF had 1.5 times more than PRF. CGF showed a fibrinogen structure with a constant diameter. CONCLUSION: When applied to a clinical case, CGF is predicted to show better results than PRF.

The usefulness of a classification and regression tree algorithm for detecting perioperative transfusion-related pulmonary complications.

BACKGROUND: Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are leading causes of transfusion-related mortality. An electronic medical record-based screening classification and regression tree (CART) algorithm was previously developed for predicting transfusion-related pulmonary complications. In the Republic of Korea, TRALI is not sufficiently recognized and an accurate TRALI incidence has not been reported. Therefore, we carried out this study to assess the incidence of TRALI and to determine whether the CART algorithm can be applied to our hospital data. STUDY DESIGN AND METHODS: A retrospective analysis of all patients who received any type of transfusion during anesthesia was performed. After the patients were diagnosed by the relevant diagnostic criteria, they were reclassified by the CART algorithm. The validity of the algorithm was evaluated with sensitivity, specificity, likelihood ratios, and misclassification rate. RESULTS: Among 1948 patients who had received 11,269 units of transfusion, 26 TRALI and 20 TACO cases were identified. The incidence of TRALI among the transfused patients was 1.33% and per unit of transfused blood product was 0.23%. The sensitivity and specificity of the TRALI algorithm were estimated to be 73.1% (95% confidence interval [CI], 53.9%-86.3%) and 57.0% (95% CI, 52.5%-61.4%). For TACO, the sensitivity and specificity were 90.0% (95% CI, 69.9%-97.2%) and 56.0% (95% CI, 51.6%-60.4%), respectively. CONCLUSIONS: Low specificity of the CART algorithm adopted previously indicated its limited diagnostic value in the Republic of Korea. A new algorithm is needed to facilitate the detection of transfusion-related complications.

Implant Stability Measurements in the Long-Term Follow-up of Dentis Implants: A Retrospective Study With Periotest.

PURPOSE: The purpose of this study was to evaluate retrospectively the stability of Dentis implant with the Periotest. METHODS: In total, 36 patients and 88 implants were investigated. Periotest was used to measure implant stability, and a periapical view was taken immediately after surgery and again immediately after, 3 months after, 6 months and 5 years after prosthesis placement. Bone loss on the periapical view, bone quality according to tactile sensation, and area of implant installation were assessed. RESULTS: The mean Periotest value (PTV) immediately after surgery was -1.02, and the mean bone loss rate (bone loss/fixture length × 100) at 6 months after prosthesis placement was 8.42%. PTV was higher with more bone loss (types III, IV vs types I, II bone). The lowest mean PTV was in the lower molar area (-1.48), followed by the lower anterior (-1.41), upper molar (0.11), and upper anterior area (5). One implant failed and survival rates were 98.9%. CONCLUSION: Implant stability was lower in cases with more bone loss and poor bone quality and in the maxilla versus the mandible.

Evaluation of bone formation after grafting with deproteinized bovine bone and mineralized allogenic bone.

PURPOSE: The purpose of this study was to evaluate the ability of new bone formation of deproteinized bovine bone (Bio-Oss) and mineralized allogenic bone (Tutoplast). MATERIALS AND METHODS: Sixty rats were divided into control and experimental groups (groups 1 and 2): control group, unfilled control; group 1, Bio-Oss; group 2, Tutoplast, respectively. The animals were killed after 6 and 12 weeks, and newly formed bone was analyzed histomorphometrically. RESULTS: In the control group, some new bone formed in the rim of the defect area. In the group 1, newly formed bone was thinner than the adjacent normal bone, and Bio-Oss particles were observed. In the group 2, showed a pattern of gradual fusion with adjacent bone, as well as particles in some areas, similar to the Bio-Oss-treated group. In the 12-week groups, the amount of new bone formation was significantly higher in the experimental groups than in the control group, and it was significantly higher in group 2 than in group 1. CONCLUSION: Although Tutoplast and Bio-Oss graft materials seem to be useful for bone grafts, Tutoplast showed more active new bone formation than Bio-Oss.

Kinematic effect of Nintendo Wii(TM) sports program exercise on obstacle gait in elderly women with falling risk.

[Purpose] This study evaluated the changes in balance ability and obstacle gait after lumbar stabilization exercise and Nintendo Wii(TM) Sports in elderly at risk for falls. [Subjects and Methods] Twenty-four elderly women with at risk for falls were randomly divided into the control, lumbar stabilization exercise, and Nintendo Wii Sports groups. Static balance was measured by the Berg Balance Scale and functional reach test, dynamic balance by the timed up-and-go test, and obstacle negotiation function by crossing velocity and maximum vertical heel clearance. [Results] Both the lumbar stabilization exercise and Nintendo Wii Sports groups showed significant improvements in obstacle negotiation function after the exercise compared to the control group. Berg Balance Scale and functional reach test scores were greater in the lumbar stabilization exercise group, while the timed up-and-go test time was significantly better in the Nintendo Wii Sports groups. [Conclusion] Lumbar stabilization exercises and Nintendo Wii Sports improve falling related balance and obstacle negotiation function in elderly women at risk for falls.

Displaced implants into maxillary sinus: report of cases.

Although the number of implant placement in the edentulous maxillary region is increasing, there are often some cases in which implants accidentally get displaced into maxillary sinus because of low bone quality, insufficient bone height, bone resorption after surgery, and improper treatment plan. Implants displaced into the maxillary sinus can cause some complications, including mucosal thickening and sinusitis; however, there are also many cases causing no symptoms at all. Treatment procedures for implants displaced into maxillary sinus are observation, removal of implants through intraoral approach, and removal through nasal cavity using endoscope. But treatment may vary according to the presence of sinusitis, ostium obstruction, and oroantral fistula. In this study, 4 patients with present illness of implants displaced into maxillary sinus were selected, and appropriate evaluation and treatment for these cases were studied.

Osteogenic ability according to the decalcified modality of auto-tooth bone grafts in peri-implant defects in dogs.

PURPOSE: The purpose of this study was to evaluate the bone generation capacity of the autotransplantation material with clinical and histological analyses after controlled acid treatment conditions. MATERIAL AND METHODS: Bony defects were formed in the femur. Then, autotransplantation material was grafted after hydroxyapatite-coated implant placement. Experimental groups were classified according to the acid treatment method: 2% H2SO4 (group 1), 2% HCl (group 2), 2% HNO3 (group 3), or 2% ethylenediaminetetraacetic acid (EDTA) (group 4). RESULTS: The new bone formation area and bone-implant contact (BIC) of the autotransplantation materials were measured after 8 weeks. The new bone formation area in experimental groups 2, 3, and 4 were greater than that in the control group (no graft) and in experimental group 1 at 8 weeks, and the BIC of experimental group 4 was greater than that in the control group and in experimental group 1; these differences showed statistical significance (P < 0.05). CONCLUSION: Auto-tooth bone treated with EDTA resulted in more effective bone formation in dogs' femurs than bone treated with other solutions.

Analysis of Core Stability Exercise Effect on the Physical and Psychological Function of Elderly Women Vulnerable to Falls during Obstacle Negotiation.

[Purpose] The aim of the present study was to investigate the effects of core stability exercise (CSE) on the physical and psychological functions of elderly women while negotiating general obstacles. [Subjects and Methods] After allocating 10 elderly women each to the core stability training group and the control group, we carried out Performance-Oriented Mobility Assessment (POMA) and measured crossing velocity (CV), maximum vertical heel clearance (MVHC), and knee flexion angle for assessing physical performances. We evaluated depression and fear of falling for assessing psychological functions. [Results] Relative to the control group, the core stability training group showed statistically significant overall changes after the training session: an increase in POMA scores, faster CV, lower MVHC, and a decrease in knee flexion angle. Furthermore, depression and fear of falling decreased significantly. [Conclusion] CSE can have a positive effect on the improvement of physical and psychological performances of older women who are vulnerable to falls as they negotiate everyday obstacles.

Enhanced attachment of human osteoblasts on NH3-treated poly(L-lactic acid) membranes for guided bone regeneration.

Barrier membranes for guided bone regeneration (GBR) were prepared by a solvent casting method using solutions of poly(L-lactic acid) (PLLA) and chitosan. PLLA and PLLA/chitosan membranes were treated with ammonia gas plasma. PLLA/chitosan membranes were successfully fabricated, and the surface of the PLLA/chitosan membrane was clearly modified by NH3 plasma treatment according to attenuated total reflectance (ATR-FTIR), X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM) analyses. Additionally, water contact angle testing indicated that the hydrophilicity of these membranes was significantly increased. MG-63 cells were cultured on each type of membrane, and cell viability was examined using an MTT assay. After one week of culturing, MG-63 cells were more abundant on PLLA/chitosan membranes than on PLLA membranes. The cell viability of PLLA/chitosan membranes with plasma treatment was significantly higher than that of PLLA membranes. These results suggest that this plasma-treated membrane is suitable for GBR and is a promising source of bioactive membrane material for bone regeneration.

Consideration of various bone quality evaluation methods.

PURPOSE: Bone quality at the implant site has a significant effect on the success and prognosis of implants. The purpose of this article was to evaluate several methods used in evaluating bone quality and discuss the advantages and disadvantages. METHODS: The search was made using PubMed database about quantitative computed tomography (QCT), and quantitative cone-beam computerized tomography (QCBCT), dual energy x-ray absorptiometry (DXA) scans, the resistance force against the hands of the surgeon, assessment of the effect of the torque of the drill, the initial fixed value of the implant, and fractal analysis according to the Lekholm and Zarb, and Misch classifications as the standard. RESULTS: The method for measuring the resistance force and torque during implant placement and the method used to determine the implant's initial implant fixed value were easy and simple. QCBCT was reported to involve less radiation and to be more objective than QCT. DXA and fractal analysis have limits when used to classify bone quality as type II or type III. CONCLUSION: Among the methods used to evaluate bone quality in implants, a method using computed tomography, measured in Hounsfield units, was found to be the most predictive.