Publications by authors named "Jae Hong Park"

303 Publications

Lifestyle Changes that Impact Personal Quality of Life in the COVID-19 Pandemic in South Korea.

Psychiatry Investig 2021 Jul 22;18(7):701-707. Epub 2021 Jul 22.

Department of Psychiatry, Dong-A University Hospital, Busan, Republic of Korea.

Objective: We investigated which factors in psychological changes positively or negatively affect the quality of life to suggest desirable directions in the period of the COVID-19 pandemic.

Methods: Online survey was conducted with 1,011 adults more than 19 years old in Busan, South Korea. Quality of life was measured using the World Health Organization Quality of Life-BREF. Questions regarding the psychological changes were about COVID-19-related concerns, distress in complying with quarantine guidelines, and interest in seeking something to do alone.

Results: Quality of life was perceived to be below average (mean±SD, 2.86±0.53). The more economic worries there were, the lower the quality of life in psychological, social relationships and environmental domains. The more distress one experienced when maintaining their personal hygiene, the higher the quality of life related to their physical health. Likewise, the more difficult it was to maintain social distances, the higher the quality of life associated with psychological and social relationships. The more interested someone was in how to spend time alone, the higher the quality of life in all domains significantly.

Conclusion: We can minimize the negative impacts of COVID-19 by maintaining economic stability, maintaining prosocial behaviors related to personal hygiene and making good use of personal time.
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http://dx.doi.org/10.30773/pi.2021.0043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328828PMC
July 2021

The Prevalence of Depression, Anxiety and Associated Factors among the General Public during COVID-19 Pandemic: a Cross-sectional Study in Korea.

J Korean Med Sci 2021 Jul 26;36(29):e214. Epub 2021 Jul 26.

Department of Psychiatry, Dong-A University Hospital, Busan, Korea.

Background: Since its first case confirmed on January 20, 2020, Korea has been through three waves of the COVID-19 pandemic. Fears of the fourth wave persist as new cases continue to emerge. In such unpredictable times, the mental well-being of people is of crucial importance. This study examined the levels of depression and anxiety and their predictors among the Korean general public in Busan, Korea, during the COVID-19 pandemic.

Methods: We conducted a cross-sectional study via a self-reported questionnaire administered to 2,288 adult residents (aged 19-60 years) of Busan, Korea. Participants' depression and anxiety were assessed using the Korean version of the Patient Health Questionnaire-4 (PHQ-4), which consists of PHQ-2 and Generalized Anxiety Disorder-2 (GAD-2), with the cutoff score of 3.

Results: The mean age of the participants was 39.71 years. COVID-19 had several psychosocial impacts on people. It was revealed that 80.3% had restrictions in outside activities, 47.3% reported financial difficulties, and 53.6% had a fear of death or fatal outcome when infected with COVID-19. We performed logistic regression analysis to identify the factors associated with depression and anxiety. A total of 30.7% participants were classified as at risk of depression based on cutoff score of 3 on PHQ-2. Logistic regression analysis revealed that changes in sleep pattern due to COVID-19 were most strongly associated with depression, followed by restrictions in outside activities due to social distancing and increased family conflicts due to COVID-19. Also, 22.6% participants were classified as at risk of anxiety based on a cutoff score of 3 on GAD-2. Analysis revealed that changes in sleep pattern due to COVID-19 were most strongly associated with anxiety, followed by spending a lot of time searching for COVID-19-related information and having a fear of death or fatal outcome when infected with COVID-19.

Conclusion: The results are alarming; 30.7% had a PHQ-2 score of 3 or higher, indicating depression, and 22.6% had a GAD-2 score of 3 or higher, indicating anxiety. Changes in sleep pattern had the strongest association with both depression and anxiety. Our results can be used to formulate mental health policies tailored to the context of the city. Our findings suggest the high prevalence of depression and anxiety in the society during the COVID-19 pandemic, which places growing importance on early intervention for mental health problems during these times.
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http://dx.doi.org/10.3346/jkms.2021.36.e214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313395PMC
July 2021

Effects of dietary lysozyme supplementation on growth performance, nutrient digestibility, intestinal microbiota, and blood profiles of weanling pigs challenged with .

J Anim Sci Technol 2021 May 31;63(3):501-509. Epub 2021 May 31.

Department of Animal Resource and Science, Dankook University, Cheonan 31116, Korea.

The aim of this was evaluate the efficacy of lysozyme on growth performance, nutrient digestibility, excreta microflora population, and blood profiles of weanling pigs under () challenge. A total of 30 piglets weaned at 25 days, 7.46 kg body weight, were assigned to three dietary treatments, composed of five replications, two piglets per replication, for 7 days. The dietary treatment groups were negative control (NC; without antibiotics and lysozyme), positive control (PC; NC + antibiotics), lysozyme (NC + 0.1% lysozyme). All piglets were challenged orally with 6 ml suspension, containing K88 (2 × 10 CFU/mL). Dietary supplementation with lysozyme and PC resulted in no significant differences in average daily gain and gain to feed efficiency. Weanling pigs fed with challenge with lysozyme and PC treatments had significantly enhanced nutrient retentions of dry matter and energy ( < 0.05); however, there was a tendency to increase nitrogen digestibility. Furthermore, dietary inclusion of lysozyme and antibiotics treatment groups had a beneficial effect on excreta, ileal, and cecal of the fecal microbial population as decreased ( < 0.05) counts, without effects on counts. A significant effect were observed on a white blood cells, epinephrine and cortisol concentrations were reduced in piglets fed diets containing challenge with lysozyme and antibiotics supplementation comparison with the NC group. Therefore, the present data indicate that lysozyme in diet could ameliorate the experimental stress response induced by in piglets by decreasing intestinal , white blood cells and stress hormones and improving nutrient digestibility.
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http://dx.doi.org/10.5187/jast.2021.e54DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204002PMC
May 2021

Clinical and Neuroimaging Features in Charcot-Marie-Tooth Patients with Mutations.

Life (Basel) 2021 May 28;11(6). Epub 2021 May 28.

Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

Charcot-Marie-Tooth disease (CMT) is the most common inherited peripheral neuropathy. Mutations in the gene cause dominant intermediate CMT type F (CMTDIF). The aim of this study is to investigate phenotypic heterogeneities and characteristics of CMT patients with mutations. We enrolled 1143 Korean CMT families and excluded 344 families with a duplication. We further analyzed the 799 remaining families to find their mutations using whole-exome sequencing (WES). We identified two mutations (p.Gly77Arg and p.Lys89Glu) in three families, among which a heterozygous p.Gly77Arg mutation was novel. In addition, a significant uncertain variant (p.Thr177Asn) was observed in one family. The frequency of the mutation in the Korean population is 0.38% in duplication-negative families. All three families showed mutation. Electrophysiological findings regarding the p.Lys89Glu mutation showed that the motor nerve conduction velocity (MNCV) of the median nerve was markedly reduced, indicating demyelinating neuropathy, and sural nerve biopsy revealed severe loss of myelinated axons with onion bulb formation. Lower extremity Magnetic Resonance Imaging (MRI) demonstrated relatively more severe intramuscular fat infiltrations in demyelinating type (p.Lys89Glu mutation) patients compared to intermediate type (p.Gly77Arg mutation) patients. The anterolateral and superficial posterior compartment muscles of the distal calf were preferentially affected in demyelinating type patients. Therefore, it seems that the investigated mutations do cause not only the known intermediate type but also demyelinating-type neuropathy. We first presented three Korean families with mutations and found phenotypic heterogeneities of both intermediate and demyelinating neuropathy. We suggest that those findings are useful for the differential diagnosis of CMT patients with unknown variants.
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http://dx.doi.org/10.3390/life11060494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227704PMC
May 2021

Leriche Syndrome Misdiagnosed as Complex Regional Pain Syndrome in a Patient with Neuropathic Pain Caused by a Chip Fracture: A Case Report.

Medicina (Kaunas) 2021 May 12;57(5). Epub 2021 May 12.

Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital of Inje University, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Korea.

Introduction: Leriche syndrome is an aortoiliac occlusive disease caused by atherosclerotic occlusion. We report a case of Leriche syndrome with a fracture that was suspected as complex regional pain syndrome (CRPS), as the post-traumatic pain gradually worsened in the form of excruciating neuropathic pain.

Case Report: A 52-year-old woman with a history of hypertension was referred to the Department of Pain Medicine from a local orthopedic clinic because of suspected CRPS for excruciating neuropathic pain for one month. She complained of gait dysfunction and severe pain in the right foot following an incident of trauma with the right first toe. The average pain intensity assessed using the visual analog scale (VAS) was 90 (0: no pain, 100: the worst pain imaginable), and the neuropathic pain was evident as a score of 6/10 on Douleur neuropathique 4. Allodynia, hyperalgesia, blue discoloration of the skin, asymmetric temperature change (1.38 °C), and edematous soft tissue changes were observed. Ultrasonography showed a chip fracture in the first distal phalanx of the right first toe. The diagnosis was most probably CRPS type I according to the Budapest research criteria for CRPS. However, multiple pain management techniques were insufficient in controlling the symptoms. A month and a half later, an ankle-brachial index score of less than 0.4 suggested severe peripheral artery disease. Computed tomography angiography showed total occlusion between the infrarenal abdominal aorta and the bilateral common iliac arteries. Therefore, she underwent aortic-bifemoral bypass surgery with a diagnosis of Leriche syndrome. Three months after the surgery, the average pain intensity was graded as 10 on the VAS (0-100), the color of the skin of the right first toe improved and no gait dysfunction was observed.

Conclusion: A chip fracture in a region with insufficient blood flow could manifest as excruciating neuropathic pain in Leriche syndrome.
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http://dx.doi.org/10.3390/medicina57050486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150991PMC
May 2021

Constructing an adult orofacial premotor atlas in Allen mouse CCF.

Elife 2021 Apr 27;10. Epub 2021 Apr 27.

Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, United States.

Premotor circuits in the brainstem project to pools of orofacial motoneurons to execute essential motor action such as licking, chewing, breathing, and in rodent, whisking. Previous transsynaptic tracing studies only mapped orofacial premotor circuits in neonatal mice, but the adult circuits remain unknown as a consequence of technical difficulties. Here, we developed a three-step monosynaptic transsynaptic tracing strategy to identify premotor neurons controlling vibrissa, tongue protrusion, and jaw-closing muscles in the adult mouse. We registered these different groups of premotor neurons onto the Allen mouse brain common coordinate framework (CCF) and consequently generated a combined 3D orofacial premotor atlas, revealing unique spatial organizations of distinct premotor circuits. We further uncovered premotor neurons that simultaneously innervate multiple motor nuclei and, consequently, are likely to coordinate different muscles involved in the same orofacial motor actions. Our method for tracing adult premotor circuits and registering to Allen CCF is generally applicable and should facilitate the investigations of motor controls of diverse behaviors.
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http://dx.doi.org/10.7554/eLife.67291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137149PMC
April 2021

Genetic and clinical spectrums in Korean Charcot-Marie-Tooth disease patients with myelin protein zero mutations.

Mol Genet Genomic Med 2021 Jun 6;9(6):e1678. Epub 2021 Apr 6.

Department of Biological Sciences, Kongju National University, Gongju, Korea.

Background: Charcot-Marie-Tooth disease (CMT) is the most common disorder of inherited peripheral neuropathies characterized by distal muscle weakness and sensory loss. CMT is usually classified into three types, demyelinating, axonal, and intermediate neuropathies. Mutations in myelin protein zero (MPZ) gene which encodes a transmembrane protein of the Schwann cells as a major component of peripheral myelin have been reported to cause various type of CMT.

Methods: This study screened MPZ mutations in Korean CMT patients (1,121 families) by whole exome sequencing and targeted sequencing.

Results: We identified 22 pathogenic or likely pathogenic MPZ mutations in 36 families as the underlying cause of the CMT1B, CMTDID, or CMT2I subtypes. Among them, five mutations were novel. The frequency of CMT patients with the MPZ mutations was similar or slightly lower compared to other ethnic groups.

Conclusions: We showed that the median onset ages and clinical phenotypes varied by subtypes: the most severe in the CMT1B group, and the mildest in the CMT2I group. This study also observed a clear correlation that earlier onsets cause more severe symptoms. We believe that this study will provide useful reference data for genetic and clinical information on CMT patients with MPZ mutations in Korea.
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http://dx.doi.org/10.1002/mgg3.1678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8222852PMC
June 2021

The principles of presenting statistical results: Table.

Korean J Anesthesiol 2021 04 24;74(2):115-119. Epub 2021 Mar 24.

Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.

General medical journals such as the Korean Journal of Anesthesiology (KJA) receive numerous manuscripts every year. However, reviewers have noticed that the tables presented in various manuscripts have great diversity in their appearance, resulting in difficulties in the review and publication process. It might be due to the lack of clear written instructions regarding reporting of statistical results for authors. Therefore, the present article aims to briefly outline reporting methods for several table types, which are commonly used to present statistical results. We hope this article will serve as a guideline for reviewers as well as for authors, who wish to submit a manuscript to the KJA.
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http://dx.doi.org/10.4097/kja.20582DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024217PMC
April 2021

Effect of human acellular dermal matrix (Megaderm™) on infra-auricular depressed deformities, Frey's syndrome, and first bite syndrome following parotidectomy: a multi-center prospective study.

Gland Surg 2021 Feb;10(2):670-677

Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.

Background: Parotidectomy is the primary treatment for parotid gland tumors. However, complications may include a prominent facial scar or infra-auricular depressed deformity, Frey's syndrome, first bite syndrome, or other facial pain, numbness, and paralysis. Acellular dermal matrix (ADM) has been widely used to prevent these complications in parotid surgery, but there have been no prospective, multi-center trials documenting its efficacy. This study evaluates the effectiveness of ADM implantation in preventing infra-auricular depressed deformity, Frey's syndrome and first bite syndrome after parotidectomy.

Methods: We analyzed 51 cases of standard parotidectomy and 58 cases of parotidectomy with implantation of Megaderm™ ADM through prospective multicenter trial. Acute complications including infection, seroma, hematoma, skin necrosis, and acute parotid area pain were evaluated 1 week postoperatively. Clinician grading of Frey's syndrome and blinded clinician evaluation of infra-auricular depressed deformities were conducted at 3, 6, and 12 months. Patients evaluated subjective satisfaction with neck appearance, Frey's syndrome quality, and acute parotid area pain at 3, 6, and 12 months.

Results: There was a higher incidence of seroma in the Megaderm™ group than in the control group at week 1. The incidence and total clinician-evaluated Frey's syndrome scores were significantly lower in the Megaderm™ group than in the control group at 3, 6, and 12 months. Both the objective and subjective evaluations of the facial contour showed a better outcome in the Megaderm™ group compared to the control group at 3, 6, and 12 months. There were no significant differences between the groups in the patient-reported Frey's syndrome quality scores at 3, 6, and 12 months, but the Megaderm™ group reported significantly less acute pain than the control group.

Conclusions: ADM implantation can effectively reduce the occurrence of Frey's syndrome, infra-auricular depressed deformity, and first bite syndrome after parotidectomy. ADM may be especially advantageous in complex parotidectomy cases when significant complications are expected.
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http://dx.doi.org/10.21037/gs-20-703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944068PMC
February 2021

Aerosol and droplet generation from orbital repair: Surgical risk in the pandemic era.

Am J Otolaryngol 2021 Jul-Aug;42(4):102970. Epub 2021 Feb 27.

Indiana University Department of Otolaryngology - Head and Neck Surgery, USA.

Introduction: The highly contagious COVID-19 has resulted in millions of deaths worldwide. Physicians performing orbital procedures may be at increased risk of occupational exposure to the virus due to exposure to secretions. The goal of this study is to measure the droplet and aerosol production during repair of the inferior orbital rim and trial a smoke-evacuating electrocautery handpiece as a mitigation device.

Material And Methods: The inferior rim of 6 cadaveric orbits was approached transconjunctivally using either standard or smoke-evacuator electrocautery and plated using a high-speed drill. Following fluorescein inoculation, droplet generation was measured by counting under ultraviolet-A (UV-A) light against a blue background. Aerosol generation from 0.300-10.000 μm was measured using an optical particle sizer. Droplet and aerosol generation was compared against retraction of the orbital soft tissue as a negative control.

Results: No droplets were observed following the orbital approach using electrocautery. Visible droplets were observed after plating with a high-speed drill for 3 of 6 orbits. Total aerosol generation was significantly higher than negative control following the use of standard electrocautery. Use of smoke-evacuator electrocautery was associated with significantly lower aerosol generation in 2 of 3 size groups and in total. There was no significant increase in total aerosols associated with high-speed drilling.

Discussion And Conclusions: Droplet generation for orbital repair was present only following plating with high-speed drill. Aerosol generation during standard electrocautery was significantly reduced using a smoke-evacuating electrocautery handpiece. Aerosols were not significantly increased by high-speed drilling.
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http://dx.doi.org/10.1016/j.amjoto.2021.102970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912556PMC
June 2021

Cotton Ball Self-Retraction Technique: A Novel Surgical Method Used During Microflap Dissection.

Laryngoscope 2021 09 5;131(9):E2553-E2557. Epub 2021 Mar 5.

Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Soonchunhyang University, Cheonan, South Korea.

Objectives/hypothesis: Microsurgical removal with a microflap technique via direct laryngoscopy is considered the primary treatment option for vocal cysts. However, the microflap technique is technically difficult and challenging. Therefore, we developed the "cotton ball self-retraction" technique to aid in vocal cyst surgery and reduce the cyst rupture incidence. This study aimed to evaluate the efficacy of this technique in microflap dissection for vocal cysts by comparing its treatment outcomes with those of the conventional technique as well as investigate the rate of recurrence using a retrospective chart review.

Study Design: A retrospective review.

Methods: We reviewed the medical records of 169 patients who underwent surgery with the microflap technique for vocal cysts from December 2006 to December 2017. The patients were divided into two groups: 78 patients underwent laryngomicrosurgery using the conventional microflap technique (group A), whereas the remaining 91 patients underwent surgery with the microflap technique with cotton ball self-retraction (group B). The voice outcomes and operative data of the two groups were retrospectively reviewed and compared.

Results: The cyst ruptured intraoperatively in 42 of 78 (53.8%) patients in group A and 17 of 91 (18.6%) patients in group B. Recurrence during the follow-up period was detected in 9 of 78 (11.5%) patients in group A and 2 of 91 (2.19%) patients in group B. The degrees of improvement in assessed voice parameters were not significantly different between the groups.

Conclusion: The cotton ball technique allows accurate and effective dissection during microflap surgery for intracordal cysts.

Level Of Evidence: 3 Laryngoscope, 131:E2553-E2557, 2021.
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http://dx.doi.org/10.1002/lary.29500DOI Listing
September 2021

Aerosol generation during cadaveric simulation of otologic surgery and live cochlear implantation.

Laryngoscope Investig Otolaryngol 2021 Feb 16;6(1):129-136. Epub 2020 Dec 16.

Department of Otolaryngology - Head & Neck Surgery Indiana University School of Medicine Indianapolis Indiana USA.

Objective: The risk of SARS-CoV-2 transmission to healthcare workers through airborne aerosolization during otologic surgery has not been characterized. The objective of this study was to describe and quantify the aerosol generation during common otologic procedures in both cadaveric surgical simulation and live patient surgery.

Methods: The number concentrations of generated aerosols in the particle size range of 0.30 to 10.0 μm were quantified using an optical particle sizer during both a cadaveric simulation of routine otologic procedures as well as cochlear implant surgery on live patients in the operating room.

Results: In the cadaveric simulation, temporalis fascia graft harvest using cold techniques (without electrocautery) (n = 4) did not generate aerosols above baseline concentrations. Tympanoplasty (n = 3) and mastoidectomy (n = 3) both produced statistically significant increases in concentrations of aerosols ( < 0.05), predominantly submicron particles (< 1.0 μm). High-speed, powered drilling of the temporal bone during mastoidectomy with a Multi Flute cutting burr resulted in higher peak concentrations and greater number of spikes in aerosols than with a diamond burr. In the operating room, spikes in aerosols occurred during both cochlear implant surgeries.

Conclusion: In the cadaveric simulation, temporalis fascia graft harvest without electrocautery did not generate aerosol levels above baseline, while significant aerosol levels were generated during mastoidectomy and to a much less degree during tympanoplasty. Aerosol spikes were appreciated during cochlear implantation surgery in live patients.

Level Of Evidence: 2.
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http://dx.doi.org/10.1002/lio2.506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883621PMC
February 2021

Aerosol generation during routine rhinologic surgeries and in-office procedures.

Laryngoscope Investig Otolaryngol 2021 Feb 14;6(1):49-57. Epub 2021 Jan 14.

Department of Otolaryngology - Head & Neck Surgery Indiana University Indianapolis Indiana USA.

Objective: Cadaveric simulations have shown endonasal drilling and cautery generate aerosols, which is a significant concern for otolaryngologists during the COVID-19 era. This study quantifies aerosol generation during routine rhinologic surgeries and in-office procedures in live patients.

Methods: Aerosols ranging from 0.30 to 10.0 μm were measured in real-time using an optical particle sizer during surgeries and in-office procedures. Various mask conditions were tested during rigid nasal endoscopy (RNE) and postoperative debridement (POD).

Results: Higher aerosol concentrations (AC) ranging from 2.69 to 10.0 μm were measured during RNE ( = 9) with no mask vs two mask conditions ( = .002 and = .017). Mean AC (0.30-10.0 μm) were significantly higher during POD (n = 9) for no mask vs a mask covering the patient's mouth condition (mean difference = 0.16 ± 0.03 particles/cm, 95% CI 0.10-0.22,  < .001). There were no discernible spikes in aerosol levels during endoscopic septoplasty (n = 3). Aerosol spikes were measured in two of three functional endoscopic sinus surgeries (FESS) with microdebrider. Using suction mitigation, there were no discernible spikes during powered drilling in two anterior skull base surgeries (ASBS).

Conclusion: Use of a surgical mask over the patient's mouth during in-office procedures or a mask with a slit for an endoscope during RNE significantly diminished aerosol generation. However, whether this reduction in aerosol generation is sufficient to prevent transmission of communicable diseases via aerosols was beyond the scope of this study. There were several spikes in aerosols during FESS and ASBS, though none were associated with endonasal drilling with the use of suction mitigation.

Level Of Evidence: 4.
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http://dx.doi.org/10.1002/lio2.520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883622PMC
February 2021

Aerosol Generation During Myringotomy With Tympanostomy Tube Insertion: Implications for Otolaryngology in the COVID-19 Era.

Otolaryngol Head Neck Surg 2021 Feb 9:194599821989626. Epub 2021 Feb 9.

Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.

The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission to health care workers during myringotomy and tympanostomy tube (MT) insertion is unknown. To determine the need for enhanced precautions to prevent potential spread via aerosolized particles, we used an optical particle sizer to measure aerosol generation intraoperatively during a case series of MT insertion. We also discuss our institutional experience with safe pandemic-era perioperative practices. There was no measured increase in aerosol particle number during the procedure at a distance of 30 cm from the external auditory canal. These initial data are reassuring regarding the risk of SARS-CoV-2 transmission to the operating room team due to aerosol generation, but further study is necessary before making definitive recommendations.
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http://dx.doi.org/10.1177/0194599821989626DOI Listing
February 2021

Impaired prenatal motor axon development necessitates early therapeutic intervention in severe SMA.

Sci Transl Med 2021 01;13(578)

Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.

Gene replacement and pre-mRNA splicing modifier therapies represent breakthrough gene targeting treatments for the neuromuscular disease spinal muscular atrophy (SMA), but mechanisms underlying variable efficacy of treatment are incompletely understood. Our examination of severe infantile onset human SMA tissues obtained at expedited autopsy revealed persistence of developmentally immature motor neuron axons, many of which are actively degenerating. We identified similar features in a mouse model of severe SMA, in which impaired radial growth and Schwann cell ensheathment of motor axons began during embryogenesis and resulted in reduced acquisition of myelinated axons that impeded motor axon function neonatally. Axons that failed to ensheath degenerated rapidly postnatally, specifically releasing neurofilament light chain protein into the blood. Genetic restoration of survival motor neuron protein (SMN) expression in mouse motor neurons, but not in Schwann cells or muscle, improved SMA motor axon development and maintenance. Treatment with small-molecule splice modifiers beginning immediately after birth in mice increased radial growth of the already myelinated axons, but in utero treatment was required to restore axonal growth and associated maturation, prevent subsequent neonatal axon degeneration, and enhance motor axon function. Together, these data reveal a cellular basis for the fulminant neonatal worsening of patients with infantile onset SMA and identify a temporal window for more effective treatment. These findings suggest that minimizing treatment delay is critical to achieve optimal therapeutic efficacy.
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http://dx.doi.org/10.1126/scitranslmed.abb6871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208236PMC
January 2021

The Relationship between the Timing of Sugammadex Administration and the Upper Airway Obstruction during Awakening from Anesthesia: A Retrospective Study.

Medicina (Kaunas) 2021 Jan 21;57(2). Epub 2021 Jan 21.

Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital of Inje University, 875 Haeun-daero, Haeundae-gu, Busan KS012, Korea.

: The harmonization of recovery of consciousness and muscular function is important in emergence from anesthesia. Even if muscular function is recovered, tracheal extubation without adequate recovery of consciousness may increase the risk of respiratory complications. In particular, upper airway obstruction is one of the common respiratory complications and can sometimes be fatal. However, the association between the timing of sugammadex administration and the upper airway obstruction that can occur during awakening from anesthesia has rarely been studied. : The medical records of 456 patients who had surgery under general endotracheal anesthesia (GETA) at the Haeundae Paik Hospital between October 2017 and July 2018 and who received intravenous sugammadex to reverse rocuronium-induced neuromuscular blockade were analyzed. The correlations between bispectral index (BIS) and minimum alveolar concentration (MAC) at the time of sugammadex administration, the incidence of complications, and the time to tracheal extubation were analyzed to investigate how different timings of sugammadex administration affected upper airway obstruction after tracheal extubation. : The effect of BIS and the duration from anesthetic discontinuation to sugammadex administration on upper airway obstruction was not statistically significant. However, the odds ratio of complication rates with MAC < 0.3 compared with MAC ≥ 0.3 was 0.40 (95% confidence interval 0.20 to 0.81, = 0.011), showing a statistically significant increase in risk with MAC ≥ 0.3 for upper airway obstruction.
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http://dx.doi.org/10.3390/medicina57020088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909768PMC
January 2021

Severe Atrophy of the Ipsilateral Psoas Muscle Associated with Hip Osteoarthritis and Spinal Stenosis-A Case Report.

Medicina (Kaunas) 2021 Jan 15;57(1). Epub 2021 Jan 15.

Department of Anesthesia & Pain Medicine, Inje University Haeundae Paik Hospital, Busan 612-896, Korea.

Pathology of the lumbar spine and hip joint can commonly coexist in the elderly. Anterior and lateral leg pain as symptoms of hip osteoarthritis and spinal stenosis can closely resemble each other, with only subtle differences in both history and physical examinations. It is not easy to identify the origin of this kind of hip pain. The possibility of hip osteoarthritis should not be underestimated, as this could lead to an incorrect diagnosis and inappropriate spinal surgery. We report the case of a 54-year-old female with chronic right anterior and lateral leg pain who did not respond to repeated spinal blocks based on lumbar MRI, but in whom hip osteoarthritis was considered since severe atrophy of the ipsilateral psoas muscle was identified. We suggest that severe psoas muscle atrophy can be a clinical clue to identify hip osteoarthritis and is related to lower extremity pain, even if there is a coexisting lumbar spine pathology.
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http://dx.doi.org/10.3390/medicina57010073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830484PMC
January 2021

Evaluation of Contrast Flow Patterns with Cervical Interlaminar Epidural Injection: Comparison of Midline and Paramedian Approaches.

Medicina (Kaunas) 2020 Dec 24;57(1). Epub 2020 Dec 24.

Department of Anesthesia & Pain Medicine, Inje University Haeundae Paik Hospital, Busan 612-896, Korea.

The purpose of this study was to compare and to analyze contrast spread patterns between the paramedian and midline approaches to cervical interlaminar epidural injection (CIEI). We retrospectively enrolled 84 CIEI cases that had been performed for unilateral cervical spinal pain from April 2019 to April 2020. After 3 mL of contrast had been injected into the epidural space, fluoroscopic images were obtained. The CIEI was divided into a midline (Group M, = 42) and a paramedian (Group P, = 42) approach by anteroposterior imaging. The P Group was classified into a more medial (Group Pm, = 26) and a more lateral (Group Pl, = 16) group. Using ImageJ on an anteroposterior image, we assessed the grayscale brightness ratio of the ipsilateral or contralateral side of the vertebral body as well as the intervertebral disc space one level just above the needle location. We identified the dispersion of contrast into the ventral epidural space. : The grayscale brightness ratio was significantly higher in Group P than in Group M ( < 0.001). The incidence of ventral epidural spread in Group M was 57.1% versus 88.1% in Group P, which was significantly different ( = 0.001). The fluoroscopic CIEI finding in the paramedian approach predominantly showed an excellent delivery of the injectate to the ipsilateral side in comparison to the contralateral side. This showed a greater advantage in delivery toward ventral epidural space as compared to the midline approach.
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http://dx.doi.org/10.3390/medicina57010008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823639PMC
December 2020

Development of a size-selective sampler combined with an adenosine triphosphate bioluminescence assay for the rapid measurement of bioaerosols.

Environ Res 2021 03 10;194:110615. Epub 2020 Dec 10.

School of Health Sciences, Purdue University, West Lafayette, IN, 47906, USA. Electronic address:

In this study, a size-selective bioaerosol sampler was built and combined with adenosine triphosphate (ATP) bioluminescence assay for measuring the bioaerosol concentration more rapidly and easily. The ATP bioaerosol sampler consisted of a respirable cyclone, an impactor to collect bioaerosols onto the head of a swab used for ATP bioluminescence assay, a swab holder, and a sampling pump. The collection efficiency of the impactor was tested using aerosolized sodium chloride particles and then the particle diameter corresponding to the collection efficiency of 50% (cut-off diameter) was evaluated. The experimental cut-off diameter was 0.44 μm. The correlations between ATP bioluminescence (relative light unit; RLU) from commercially available swabs (UltraSnap and SuperSnap, Hygiena, LLC, U.S.A.) and colony forming unit (CFU) were examined using Escherichia coli (E. coli) suspension and then the conversion equations from RLU to CFU were obtained. From the correlation results, the R values of UltraSnap and SuperSnap were 0.53 and 0.81, respectively. The conversion equations were the linear function and the slopes of UltraSnap and SuperSnap were 633.6 and 277.78, respectively. In the lab and field tests, the ATP bioaerosol sampler and a conventional Andersen impactor were tested and the results were compared. In the lab tests, concentrations of aerosolized E. coli collected using the sampler were highly correlated to those from the Anderson impactor (R = 0.85). In the field tests, the concentrations measured using the ATP bioaerosol sampler were higher than those from the Andersen impactor due to the limitations of the colony counting method. These findings confirm the feasibility of developing a sampler for rapid measurement of bioaerosol concentrations, offering a compact device for measuring exposure to bioaerosols, and an easy-to-use methodological concept for efficient air quality management.
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http://dx.doi.org/10.1016/j.envres.2020.110615DOI Listing
March 2021

Creation of Curved Nanostructures Using Soft-Materials-Derived Lithography.

Nanomaterials (Basel) 2020 Dec 3;10(12). Epub 2020 Dec 3.

National NanoFab Center, 291 Daehak-ro, Yuseong-gu, Deajeon 34141, Korea.

In this study, curved nanostructures, which are difficult to obtain, were created on an Si substrate through the bonding, swelling, and breaking processes of the polymer and silicone substrate. This method can be utilized to obtain convex nanostructures over large areas. The method is simpler than typical semiconductor processing with photolithography or compared to wet- or vacuum-based dry etching processes. The polymer bonding, swelling (or no swelling), and breaking processes that are performed in this process were theoretically analyzed through a numerical analysis of permeability and modeling. Through this process, we designed a convex nanostructure that can be produced experimentally in an accurate manner.
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http://dx.doi.org/10.3390/nano10122414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761667PMC
December 2020

Aerosol and droplet generation from mandible and midface fixation: Surgical risk in the pandemic era.

Am J Otolaryngol 2021 Jan - Feb;42(1):102829. Epub 2020 Nov 5.

Indiana University Department of Otolaryngology - Head & Neck Surgery, 1130 W Michigan St, FH 400, Indianapolis, IN 46202, USA.

Purpose: The COVID-19 pandemic has led to concerns over transmission risk from healthcare procedures, especially when operating in the head and neck such as during surgical repair of facial fractures. This study aims to quantify aerosol and droplet generation from mandibular and midface open fixation and measure mitigation of airborne particles by a smoke evacuating electrocautery hand piece.

Materials And Methods: The soft tissue of the bilateral mandible and midface of two fresh frozen cadaveric specimens was infiltrated using a 0.1% fluorescein solution. Surgical fixation via oral vestibular approach was performed on each of these sites. Droplet splatter on the surgeon's chest, facemask, and up to 198.12 cm (6.5 ft) away from each surgical site was measured against a blue background under ultraviolet-A (UV-A) light. Aerosol generation was measured using an optical particle sizer.

Results: No visible droplet contamination was observed for any trials of mandible or midface fixation. Total aerosolized particle counts from 0.300-10.000 μm were increased compared to baseline following each use of standard electrocautery (n = 4, p < 0.001) but not with use of a suction evacuating electrocautery hand piece (n = 4, p = 0.103). Total particle counts were also increased during use of the powered drill (n = 8, p < 0.001).

Conclusions: Risk from visible droplets during mandible and midface fixation is low. However, significant increases in aerosolized particles were measured after electrocautery use and during powered drilling. Aerosol dispersion is significantly decreased with the use of a smoke evacuating electrocautery hand piece.
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http://dx.doi.org/10.1016/j.amjoto.2020.102829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832379PMC
December 2020

The Effect of Black Pepper () Extract Supplementation on Growth Performance, Nutrient Digestibility, Fecal Microbial, Fecal Gas Emission, and Meat Quality of Finishing Pigs.

Animals (Basel) 2020 Oct 25;10(11). Epub 2020 Oct 25.

Department of Animal Resource and Science, Dankook University, No. 29 Anseodong, Cheonan 330-714, Choongnam, Korea.

The study was conducted to assess the effect of black pepper extract (BPE) supplementation on the growth performance, nutrient digestibility, fecal microbial, fecal gas emission, and meat quality of finishing pigs. A total of 180 crossbred [(Landrace × Yorkshire) × Duroc] finishing pigs with average initial body weight (BW) of 53.7 ± 1.42 kg were used in 10-week trial and allotted to 6 dietary treatments (6 replications pens/treatment with 5 pigs per pen). The dietary treatments were: CON (basal diet), TRT1-CON + 0.025% BPE, TRT2-CON + 0.05% BPE, TRT3-CON + 0.1% BPE, TRT4-CON + 0.2% BPE, TRT5-CON + 0.4% BPE. Linear increase in body weight gain (BWG) ( = 0.038, 0.006) and average daily gain (ADG) were observed ( = 0.035, 0.007,and 0.006 respectively), during the overall trial in pigs fed increasing levels of BPE in supplemented diet compared to control. The dietary supplementation of BPE showed a linear increase ( = 0.007) in gain-to-feed ratio (G:F) at week 10. However, there were no significant results observed on average daily feed intake (ADFI) during the overall experiment. The total tract digestibility of dry matter (DM) was linearly improved ( = 0.053) with graded levels of BPE. In addition, BPE diet supplementation had linearly increased fecal counts ( = 0.048) and decreased counts ( = 0.031) in pigs at week 10. Furthermore, NH3, methyl mercaptans, and acetic acid was linearly decreased ( = 0.023, 0.056, 0.054) in pigs fed graded level of BPE supplementation. The inclusion of BPE in pigs' diet had linearly increased ( = 0.015) backfat thickness at week 10. Thus, we concluded that BPE supplementation had positively enhanced the growth performance, nutrient digestibility, fecal microbial, fecal gas emission, and meat quality of finishing pigs.
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http://dx.doi.org/10.3390/ani10111965DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693949PMC
October 2020

The effect of protease on growth performance, nutrient digestibility, and expression of growth-related genes and amino acid transporters in broilers.

J Anim Sci Technol 2020 Sep 30;62(5):614-627. Epub 2020 Sep 30.

Department of Animal Resource and Science, Dankook University, Cheonan 31116, Korea.

During the course of this trial, our team assessed the influence of protease upon the growth performance, the nutrient digestibility, and the expression of growth-related genes and amino acid transporters within the liver, muscle, and small intestines of broilers. During the first step, our team allocated 600 broilers into four dietary treatments for a period of 35 days in order to measure the growth performance and nutrient digestibility of the broilers selected. The separate treatments contained 10 replicates (15 birds per replicate). The treatments were composed of: 1) CON, basal diet; 2) T1, basal diet + 0.03% protease; 3) T2, basal diet + 0.06% protease; and 4) T3, basal diet + 0.09% protease. Next, the broiler chick sample tissue was harvested from the CON and T3 groups in order to conduct gene expression analysis following the feeding trials the broilers underwent. Our team discovered that the broilers fed protease diets possessed increased body weight and an average daily gain, but conversely, had lower feed conversion ratios when their dietary protease levels increased from 0% to 0.09% ( < 0.05). Additionally, significant linear improvements were identified among the nutrient digestibility of dry matter, crude protein, energy, and amino acids within broilers supplied with protease diets when contrasted and compared with broilers supplied with the basal diet ( < 0.05). In addition, the gene expression of the genes , and in the liver, and the genes and in the breast muscles, was significantly increased after broilers were fed with a protease diet as compared to broilers that subsisted on a basal diet ( < 0.05). Protease supplementation also raised the expression levels within these amino acid transporters: , and , located in the small intestine, when compared to the basal diet ( < 0.05). Our results suggest that protease supplementation in their diet improved the growth performance of broilers via an increase in the expression growth-related genes within broiler liver and muscle tissue. In addition, protease supplementation enhanced broiler digestibility via the upregulation of amino acid transporter expression within the small intestine.
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http://dx.doi.org/10.5187/jast.2020.62.5.614DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553844PMC
September 2020

Influences of dietary flavonoid (quercetin) supplementation on growth performance and immune response of growing pigs challenged with lipopolysaccharide.

J Anim Sci Technol 2020 Sep 30;62(5):605-613. Epub 2020 Sep 30.

Department of Animal Resource and Science, Dankook University, Cheonan 31116, Korea.

This study was conducted to evaluate the effects of dietary supplementation of plant flavonoid (quercetin) on immune parameters, growth performance, and nutrient digestibility in growing pigs challenged with lipopolysaccharide (LPS). A total of 40 crossbred ([Landrace × Yorkshire] × Duroc) growing pigs; initial body weight (BW) of 26.95 ± 1.26 kg were used in a six-week experimental trial. Pigs were randomly allocated into one of four treatment groups in a 2 × 2 factorial arrangement with the following factors; without LPS challenge and with LPS challenge (day 21) supplemented with or without 0.1% flavonoid according to BW (2 replicate pens per treatment with 2 gilts and 3 barrows per pen). The single- dose LPS (100 ug / kg BW) injection showed trends tended to be increased in interleukin-6 (IL-6) after 2 h and 6 h of challenge compared with unchallenged pigs. However, other measured immune indices (white blood cell, immunoglobulin G, lymphocyte, and tumor necrosis factor), growth performance, and nutrient digestibility were not significantly different between challenged and non-challenged animals. The supplementation of flavonoid significantly increased ( < 0.05) average daily gain (ADG) during day 0-21, tended to increase dry matter and nitrogen digestibility, significantly reduced IL-6, increased Ig-G and WBC concentrations and increased lymphocytes percentage regardless of LPS challenge.
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http://dx.doi.org/10.5187/jast.2020.62.5.605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553839PMC
September 2020

Cholecystectomy is Feasible in Children with Small-Sized or Large Numbers of Gallstones and in Those with Persistent Symptoms Despite Medical Treatment.

Pediatr Gastroenterol Hepatol Nutr 2020 Sep 27;23(5):430-438. Epub 2020 Aug 27.

Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea.

Purpose: We investigated the clinical features and factors affecting the choice of treatment modality and the course of pediatric gallstone (GS) disease.

Methods: We retrospectively analyzed the medical records of 65 patients diagnosed with GS using imaging studies between January 2009 and December 2017 were included.

Results: This study included 65 patients (33 boys and 32 girls; mean age, 8.5±5.3 years; range, 0.2-18 years) who primarily presented with abdominal pain (34%), jaundice (18%), and vomiting (8%). Idiopathic GS occurred in 36 patients (55.4%). The risk factors for GS included antibiotic use, obesity, hemolytic disease, and chemotherapy in 8 (12.3%), 7 (10.8%), 6 (9.2%), and 4 patients (6.2%), respectively. We observed multiple stones (including sandy stones) in 31 patients (47.7%), a single stone in 17 (26.2%), and several stones in 17 (26.2%). GS with a diameter of <5 mm occurred in 45 patients (69.2%). Comorbidities included hepatitis, choledocholithiasis, cholecystitis, and acute pancreatitis in 20 (30.8%), 11 (16.9%), 11 (16.9%), and 4 patients (6.2%), respectively. Ursodeoxycholic acid (UDCA) was administered to 54 patients (83.1%), leading to stone dissolution in 22 patients (33.8%) within 6 months. Cholecystectomy was performed in 18 patients (27.7%) (mean age, 11.9±5.1 years). Most patients treated surgically had multiple stones (83%) and stones measuring <5 mm in size (89%), and 66.7% of patients had cholesterol stones.

Conclusion: Cholecystectomy is feasible in patients with small-sized or large numbers of GS and those with persistent abdominal pain and/or jaundice. UDCA administration with close follow-up is recommended in patients with uncomplicated GS.
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http://dx.doi.org/10.5223/pghn.2020.23.5.430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481062PMC
September 2020

Quantification of bisphenols in Korean urine using online solid-phase extraction-high-performance liquid chromatography-tandem mass spectrometry.

Environ Toxicol Pharmacol 2020 Nov 14;80:103491. Epub 2020 Sep 14.

Food Safety Risk Assessment Division, National Institute of Food and Drug Safety Evaluation, Chungcheongbuk-do, 363-700, Republic of Korea. Electronic address:

Bisphenol A (BPA), an endocrine-disrupting chemical, has been used as a basic raw material for the production of polycarbonate plastics. As concern over the toxic effects of BPA grows, it is gradually being replaced in many consumer products with compounds such as bisphenol F (BPF) and bisphenol S (BPS). In this study, online solid-phase extraction-high-performance liquid chromatography-tandem mass spectrometry was used to analyze the urinary concentrations of BPA, BPF, and BPS in 2487 Korean urine samples collected between 2017 and 2018. The detection rates and geometric mean (GM) concentrations were as follows: BPA (82.1 %; 0.65 μg/L), BPF (11.1 %; not calculated), and BPS (63.6 %; 0.20 μg/L), respectively. The mean daily intake based on urinary BPA concentrations was 0.013 μg/kg bw/day (95th percentile, 0.089 μg/kg bw/day), which is lower than the tolerable daily intake. This is the first study observing urinary BPA, BPF, and BPS concentrations based on a nationally representative Korean population and could contribute to the evaluation of bisphenol analogue exposure levels in risk assessments.
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http://dx.doi.org/10.1016/j.etap.2020.103491DOI Listing
November 2020

Externally Monitored Versus Conventional Buried Flaps in Laryngopharyngeal Reconstruction.

Clin Exp Otorhinolaryngol 2020 Sep 10. Epub 2020 Sep 10.

Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea.

Objectives: To compare the surgical outcomes of externally monitored and conventional buried flaps with the goal of determining the usefulness of external monitoring of buried flaps.

Methods: In this case-control study with propensity score matching, 30 patients were evenly divided into externally monitored buried flap and conventional buried flap groups. The total operative time for free flap reconstruction, the flap survival rate, the length of hospital stay, the initial time of a reliable visual assessment, complications, the final diet achieved, and the duration until diet initiation were compared between the groups.

Results: The mean operative time for reconstruction was 115 minutes (interquartile range, 85-150 minutes) and 142 minutes (interquartile range, 95-180 minutes) in the externally monitored and conventional groups, respectively (P= 0.245). The median length of hospital stay was 24 days (interquartile range, 18-30 days) and 27 days (interquartile range, 20-41 days) in the externally monitored and conventional groups, respectively (P=0.298). The median duration until diet initiation was 15 days (interquartile range, 15-21 days) and 18 days (interquartile range, 15-34 days) in the externally monitored and conventional groups, respectively (P=0.466). The final diet, initial time of a reliable visual assessment, and complications were comparable between the groups, but the external skin paddle provided an excellent visual assessment immediately postoperatively in all cases.

Conclusion: The outcomes were comparable between the groups, indicating that externalization of the cutaneous component of a buried flap may be a straightforward and useful technique for monitoring a buried anterolateral thigh free flap in laryngopharyngeal reconstructions. The salvage and false-positive rates of compromised flaps should be compared in large subject groups in future studies to prove that the use of an external skin paddle improves flap monitoring.
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http://dx.doi.org/10.21053/ceo.2020.00234DOI Listing
September 2020

Thermally assisted nanotransfer printing with sub-20-nm resolution and 8-inch wafer scalability.

Sci Adv 2020 Jul 29;6(31):eabb6462. Epub 2020 Jul 29.

Department of Materials Science and Engineering, Pukyoung National University (PKNU), 45 Yongso-ro, Nam-gu, Busan 48513, Republic of Korea.

Nanotransfer printing (nTP) has attracted considerable attention due to its good pattern resolution, process simplicity, and cost-effectiveness. However, the development of a large-area nTP process has been hampered by critical reliability issues related to the uniform replication and regular transfer printing of functional nanomaterials. Here, we present a very practical thermally assisted nanotransfer printing (T-nTP) process that can easily produce well-ordered nanostructures on an 8-inch wafer via the use of a heat-rolling press system that provides both uniform pressure and heat. We also demonstrate various complex pattern geometries, such as wave, square, nut, zigzag, and elliptical nanostructures, on diverse substrates via T-nTP. Furthermore, we demonstrate how to obtain a high-density crossbar metal-insulator-metal memristive array using a combined method of T-nTP and directed self-assembly. We expect that the state-of-the-art T-nTP process presented here combined with other emerging patterning techniques will be especially useful for the large-area nanofabrication of various devices.
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http://dx.doi.org/10.1126/sciadv.abb6462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439568PMC
July 2020

Effect of depth of anesthesia on the phase lag entropy in patients undergoing general anesthesia by propofol: A STROBE-compliant study.

Medicine (Baltimore) 2020 Jul;99(30):e21303

Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan.

The PLEM100 (Inbody Co., Ltd., Seoul, Korea) is a device for measuring phase lag entropy (PLE), a recently developed index for the quantification of consciousness during sedation and general anesthesia. In the present study, we assessed changes in PLE along with the level of consciousness during the induction of general anesthesia using propofol. PLE was compared with the bispectral index (BIS), which is currently the most commonly used index of consciousness.After obtaining Institutional Review Board approval and written informed consent, we enrolled 15 patients (8 men, 7 women; mean age: 37 ± 9 years; mean height: 168 ± 8 cm; mean weight; 68 ± 11 kg) undergoing nasal bone reduction. PLE and BIS sensors were attached simultaneously, and general anesthesia was induced via target-controlled infusion (TCI) of propofol. PLE and BIS scores were recorded when the calculated effect site concentration shown on the TCI pump was equal to the target concentrations of 1.5, 2.0, 2.5, 2.8, 3.0, 3.2, 3.4, and 3.5 μg/mL (and at each 0.1 μg/mL increase, thereafter). Observer's Assessment of Alertness/Sedation (OAA/S) scores were also recorded until unconsciousness was achieved. Throughout the anesthesia period, all pairs of PLE and BIS data were collected using data acquisition software.The partial correlation coefficients between OAA/S scores and PLE, and between OAA/S scores and BIS were 0.778 (P < .001) and 0.846 (P < .001), respectively. Throughout the period of anesthesia, PLE and BIS exhibited a significant positive correlation. The partial correlation coefficient prior to the loss of consciousness was 0.838 (P < .001), and 0.669 (P < .001) following the loss of consciousness. Intra-class correlation between the 2 indices was 0.889 (P < .001) and 0.791 (P < .001) prior and following the loss of consciousness, respectively.PLE exhibited a strong and predictable correlation with both BIS and OAA/S scores. These results suggest that PLE is reliable for assessing the level of consciousness during sedation and general anesthesia.
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http://dx.doi.org/10.1097/MD.0000000000021303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387050PMC
July 2020

Mitigation of Aerosols Generated During Rhinologic Surgery: A Pandemic-Era Cadaveric Simulation.

Otolaryngol Head Neck Surg 2021 02 11;164(2):433-442. Epub 2020 Aug 11.

Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA.

Objective: After significant restrictions initially due to the COVID-19 pandemic, otolaryngologists have begun resuming normal clinical practice. However, the risk of SARS-CoV-2 transmission to health care workers through aerosolization and airborne transmission during rhinologic surgery remains incompletely characterized. The objective of this study was to quantify the number concentrations of aerosols generated during rhinologic surgery with and without interventions involving 3 passive suction devices.

Study Design: Cadaver simulation.

Setting: Dedicated surgical laboratory.

Subjects And Methods: In a simulation of rhinologic procedures with and without different passive suction interventions, the concentrations of generated aerosols in the particle size range of 0.30 to 10.0 µm were quantified with an optical particle sizer.

Results: Functional endoscopic sinus surgery with and without microdebrider, high-speed powered drilling, use of an ultrasonic aspirator, and electrocautery all produced statistically significant increases in concentrations of aerosols of various sizes ( < .05). Powered drilling, ultrasonic aspirator, and electrocautery generated the highest concentration of aerosols, predominantly submicroparticles <1 µm. All interventions with a suction device were effective in reducing aerosols, though the surgical smoke evacuation system was the most effective passive suction method in 2 of the 5 surgical conditions with statistical significance ( < .05).

Conclusion: Significant aerosol concentrations were produced in the range of 0.30 to 10.0 µm during all rhinologic procedures in this cadaver simulation. Rhinologic surgery with a passive suction device results in significant mitigation of generated aerosols.
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http://dx.doi.org/10.1177/0194599820951169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424621PMC
February 2021
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