Chonbuk National University Hospital Research Articles

Effects of sling-based manual therapy on cervicothoracic junction in patients with neck pain and forward head posture: A randomized clinical trial

ObjectiveThe purpose of this study was to investigate the effect of 4 weeks of sling-based manual therapy on the cervicothoracic junction (CTJ) area in patients with neck pain and forward head posture. DesignSingle-blind randomized controlled trial. SettingOutpatient, Chonbuk National University hospital, Republic of Korea. SubjectsA total of 22 participants with neck pain (Numeric Pain Rating Scale >3) and forward head posture (craniovertebral angle <51) were randomly assigned to a CTJ group or a control group (n = 11 each). InterventionIn the control group, joint mobilization and motor control training was applied for the upper cervical spine (C0–C1). The CTJ group applied the same intervention to the upper cervical spine and cervicothoracic junction (C7-T3). Main measuresNumeric pain rating scale and neck disability index, craniovertebral angle, active range of motion, and muscle activity were evaluated before and after 4 weeks of intervention. ResultThe CTJ group participants showed significant improvement in the craniovertebral angle and cervical extension range after the intervention than the control group (P = 0.025, P = 0.001). While both groups presented significant differences after the intervention regarding Numeric pain rating scale, neck disability index, and muscle activity (sternocleidomastoid and anterior scalene muscle), there were no statistically significant differences between the groups (P > 0.05). ConclusionOur results suggest that the CTJ and the upper cervical region in patients with neck pain and forward head posture represent an area which if approached by manual therapy, improves cervical mobility and posture.

Analysis of Cell Fraction of 99mTc-HMPAO Radiolabeled Leukocytes.

99mTc-HMPAO radiolabeled autologous leukocyte scintigraphy is routinely used clinically for infection imaging. Leukocytes are mostly separated via sedimentation. It is unknown whether leukocytes are clearly separated by sedimentation or selectively labeled. Therefore, in this study, the blood cell numbers were investigated after leukocyte radiolabeling to identify the cells strongly radiolabeled by 99mTc-HMPAO. This study was performed with leftover blood samples of the patients who underwent 99mTc-HMPAO scintigraphy at Chonbuk National University Hospital (2018-2019). The blood of 22 patients was drawn for 99mTc-HMPAO scintigraphy. WBCs were separated via conventional sedimentation at our clinic and radiolabeled. The concentration of cell components was determined using an automatic hematology analyzer. The cells in the final sample injectate sample were separated using Histopaque and counted with a dose calibrator. The average numbers of RBCs, WBCs, and PLTs in the final injection sample were 79 ± 33, 23.26 ± 11.95, and 229.5 ± 206.57 x 103/μL, respectively. The PLT number was almost 10-fold the number of WBCs. The number of RBCs was nearly 3-fold higher than WBCs [RBC/WBC ratio = 4.67 ± 3.58, and PLT/WBC ratio = 10.65 ± 12.46]. Following Histopaque separation, the activity of each layer showed 99mTc-HMPAO labeling of WBC > RBC > PLT in order. The total activity/cell numbers of WBCs, RBCs and PLTs were 0.016 ± 0.010, 0.005 ± 0.005 and 0.003 ± 0.002, respectively (p > 0.05). Although the numbers of RBCs and PLTs were highly increased after sedimentation, their individual cellular activity was lower than that of WBCs. 99mTc-HMPAO was more selective to WBCs than RBCs or PLTs. In conclusion, a higher number of WBCs were radiolabeled compared with RBCs and PLTs.

The Associations between Liver Enzymes and Cardiovascular Risk Factors in Adults with Mild Dyslipidemia.

Hypertension and dyslipidemia often occur as comorbidities, with both being strong risk factors for developing cardiovascular diseases (CVD). Abnormal liver function test could reflect a potential CVD risk even in patients with mild dyslipidemia. The aim of this study was to assess the compounding relationship between liver enzymes and cardiovascular risk factors in subjects with mild dyslipidemia. The present analysis was performed among 438 participants who had enrolled in at least one of the nine clinical studies done at the Chonbuk National University Hospital between 2009 and 2019. Significant linear increasing trends were observed in blood pressure level and other cardiovascular risk factors across quartiles of serum γ-glutamyltransferase (GGT) or alanine aminotransferase (ALT), with the increment in hypertension prevalence occurring across the quartiles of GGT and ALT. On multivariate logistic regression analyses, the odds ratios for hypertension, adjusted for smoking, drinking and obesity, in the highest quartiles of GGT, ALT, aspartate aminotransferase, and alkaline phosphatase were 3.688, 1.617, 1.372, and 1.166, respectively. Our study indicates that GGT is a superior marker for predicting CVD risk among liver enzymes. Routine screening of plasma GGT levels in patients with mild dyslipidemia will allow for early detection of CVD.

Abstract TP203: Factors Associated With Temporal Window Failure in Transcranial Doppler Sonography

Background and purpose: Temporal window failure (TWF) is found in 8-20% of subjects. Although it has been reported that, it is more common for the elderly and females, there are not enough studies on this topic. This study aimed to identify new factors affecting TWF. Methods: This study analyzed 376 patients who underwent both transcranial Doppler sonography (TCD) and cerebral angiographic imaging among patients visited the neurology department of Chonbuk National University Hospital from January to December 2018. They were divided into two groups depending on the presence of TWF. Afterward, demographics and cardiovascular factors, degree of stenosis from proximal intracranial artery (ICA) to the middle cerebral artery (MCA), and MCA diameter and skull features were examined. Results: The mean age of the patients was 68.4±12.1 years old and 241 of them (64.1%) were male. The study subjects were composed of 314 TWF negative patients (83.5%) and 62 TWF positive patients (16.5%). The stenosis from the proximal ICA to the 2/3 segment of the MCA proximal was not different between the two groups. Factors affecting TWF were analyzed using multivariate logistic regression analysis and the results showed that age (odds ratio [OR], 1.05; p =0.019), female (OR, 4.64; p =0.002), temporal bone thickness (OR, 6.03; p &lt;0.001), temporal bone density (OR, 0.996; p =0.002), and soft tissue thickness (OR, 1.31; p =0.004) significantly affected TWF. Conclusions: We confirmed that the soft tissue thickness of the temporal area was a new associated factor of TWF in addition to the previously reported age, sex, temporal bone thickness, and temporal bone density. The results implied that measuring the soft tissue thickness of the temporal area for patients with suspected TWF would be useful to clinically identify the measurement error due to a technical problem.

A Comparative Analysis of Clinical Screening Test and Language Specific Test in Language Delay Children.

The aim of this study was to investigate the usefulness of a clinical screening test [the Korean Infant and Child Developmental Test (KICDT)] compared to language specific tests: the sequenced language scale for infant (SELSI) and the Preschool Receptive-Expressive language Scale (PRES) in children with delayed language development. A retrospective chart review was conducted on 615 children who visited the Department of Pediatrics at Chonbuk National University Hospital from January 2013 to December 2016. All patients were evaluated with KICDT as a clinical screening test and SELSI or PRES as a language specific test. Language Developmental Quotients (LDQs) from the KICDT were compared with the Receptive Language Quotient (RLQ) and expressive language quotient (ELQ) from the SELSI or PRES. The sensitivity, specificity and predictive values of LDQ of KICDT were calculated by comparing with SELSI/PRES. Language DQs from the KICDT were significantly correlated with the RLQ (r=0.706), ELQ (r=0.768), and total language quotient (TLQ) (r=0.766) from the SELSI/PRES (p<0.05). In cross tabulation, the patients belonging to the retardation groups in both KICDT and SELSI/PRES were 417 (67.8%). Otherwise, patients belonging to the normal group in KICDT but not in SELSI/PRES were 151 (24.6%). Sensitivity and specificity of LDQ of KICDT relative to SELSI/PRES were 72.3% and 92.2% respectively (p<0.05). Our data suggests that clinical screening tests alone, not cumbersome language specific tests, can determine language developmental delays in children.

Analgosedation during flexible fiberoptic bronchoscopy: comparing the clinical effectiveness and safety of remifentanil versus midazolam/propofol

BackgroundThere are limited data regarding the efficacy and safety of remifentanil sedation for diagnostic bronchoscopy. The aim of this study was to evaluate the clinical efficacy and safety of remifentanil by comparing it with those of conventional drugs, midazolam and propofol.MethodsA retrospective study of 186 patients who underwent diagnostic bronchoscopy at Chonbuk National University Hospital was performed. Patients were classified into the remifentanil group and midazolam/propofol group according to the drugs used during bronchoscopy.ResultsOf the 186 patients, 111 patients received remifentanil and 75 received midazolam/propofol during the bronchoscopy. The proportion of patients who required bronchoscopy for endobronchial inspection alone was significantly higher in the midazolam/propofol group than in the remifentanil group (93.3% vs. 73.0%; p < 0.001). In contrast, the proportion of patients who required more invasive procedures, such as bronchoscopic biopsy, bronchoalveolar lavage, or transbronchial lung biopsy, was significantly higher in the remifentanil group than in the midazolam/propofol group (27.0% vs. 6.7%; p < 0.001). The recovery time was significantly shorter in the remifentanil group than in the midazolam/propofol group (mean 6.4 min vs. 11.6 min, p < 0.001). There were no significant differences between the groups with regard to safety events including desaturation, hypotension, and arrhythmia.ConclusionsDespite the higher proportion of patients who underwent more invasive procedures in the remifentanil group than in the midazolam/propofol group, there was no significant difference in safety events between the groups. Those in the remifentanil group also demonstrated a faster recovery time than those in the midazolam/propofol group.

Relationship between asymptomatic rotavirus infection and jaundice in neonates: a retrospective study

BackgroundRotavirus (RV) infection in neonates can be mild or even asymptomatic. In RV infection, jaundice is often reported, but the relationship between jaundice and RV infection has not been studied. This study aimed to determine the importance of asymptomatic RV screening in neonates with jaundice.MethodsNeonates from the neonatal intensive care unit (NICU) of Chonbuk National University Hospital, those transferred from local obstetrics and gynecology hospitals and outpatient clinics were selected from 2014 to 2017. The study included only infants aged between 3 and 28 days. Jaundice was defined according to gestational age and birth age, in accordance with the American Academy of Pediatrics guidelines criteria. RV infection was confirmed by a stool test, and RV screening and laboratory tests were performed at admission.ResultsAmong 596 patients, 166 patients had jaundice. RV infection was observed in 70 (42%) jaundice patients. There were 36 (22%) jaundice patients with asymptomatic RV infection. Patients with onset of jaundice 3–7 days after birth had a high incidence of RV infection. When the RV test was positive, the risk of jaundice was significantly high [odds ratio (OR) 1.89; 95% confidence interval (CI), 1.20–2.98; p = 0.006].ConclusionsInfants with the onset of jaundice > 3 days after birth were likely to have RV infection. Therefore, we suggest that screening tests for RV infection be included as part of the evaluation of jaundiced infants presenting to NICU.

Comparative study of antiretroviral drug regimens and drug-drug interactions between younger and older HIV-infected patients at a tertiary care teaching hospital in South Korea.

BackgroundWith the advent of combination antiretroviral therapy (ART), people living with HIV have lived to older age. So they have experienced age-related illnesses and have taken non-antiretroviral (ARV) medications to manage these illnesses. The aims of this study were to investigate the use patterns of ARV agents in HIV-positive patients by age and to evaluate potential or contraindicated drug–drug interactions (DDIs) between ARV and non-ARV.MethodsThis study was retrospectively conducted with HIV-infected patients receiving ART medications between October 2011 and September 2017 at Chonbuk National University Hospital in South Korea. Data were collected by reviewing patients’ electronic medical charts.ResultsAmong 207 patients diagnosed with HIV infection, 183 (86.9% males; 104 aged <50 years and 79 aged ≥50 years) were selected based on inclusion criteria. In 2017, the most frequently prescribed ART regimen was nucleoside reverse transcriptase inhibitors (NRTIs)/integrase strand transfer inhibitors (INSTIs; total, 66.3%; <50 years, 36.3%; ≥50 years, 30.0%) followed by NRTIs/protease inhibitors (PIs; total, 23.8%; <50 years, 15.0%; ≥50 years, 8.8%). In 2017, the most frequently prescribed NRTI combination was abacavir/lamivudine (total, 34.4%; <50 years, 20.6%; ≥50 years, 13.8%) followed by tenofovir alafenamide/emtricitabine (FTC; total, 31.3%; <50 years, 16.3%; ≥50 years, 15.0%) and tenofovir disoproxil fumarate/FTC (total, 28.1%; <50 years, 16.9%; ≥50 years, 11.3%). In 2017, elvitegravir (EVG)/cobicistat (COBI; total, 57.1%; <50 years, 30.4%; ≥50 years, 26.8%) was most frequently prescribed followed by dolutegravir (total, 32.1%; <50 years, 19.6%; ≥50 years, 12.5%). Potential or contraindicated DDIs between boosted PIs with ritonavir or EVG/COBI and coprescribed drugs occurred most frequently.ConclusionCurrently, NRTIs/INSTIs is the most frequently prescribed ARV combination. Abacavir/lamivudine, tenofovir alafenamide/FTC, and tenofovir disoproxil fumarate/FTC are the most used NRTIs, and EVG/COBI followed by dolutegravir is the most prescribed INSTIs. Potential or contraindicated DDIs occur mainly between boosted PIs or EVG/COBI and non-ARV medications.

Factors Influencing Delirium in Neurological Intensive Care Unit Patient

Purpose: The aims of this study were to describe the incidence rate of delirium and to identify factors influencing delirium in neurological intensive care unit patients. Methods: The participants were 193 critically ill patients with neurological disorder from Chonbuk national university hospital in Jeonju. Data were collected between April 1 and November 25, 2017 using four structured questionnaires: Confusion Assessment Method for the Intensive Care Unit, Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II, and Karnofsky Performance Scale. Data were analyzed using descriptive statistics, independent t-test, x² test, Mann-Whitney U test, and logistic regression using the SPSS/WIN 24.0 program. Results: The incidence rate of delirium was 11.9%. Delirium was related with age, length of stay in intensive care unit, Glasgow Coma Scale score, Acute Physiology and Chronic Health Evaluation II score, Karnofsky Performance Scale score, use of physical restraint, antihypertensive drugs, and anticonvulsants. Logistic regression analysis showed that age, length of stay in intensive care unit, use of physical restraint, and anticonvulsants were factors influencing delirium in neurological intensive care unit patients. Conclusion: Delirium was related to demographic, clinical, medication-related, and environmental factors in patients in neurological intensive care units. Therefore, nurses should consider the patient`s age, length of stay intensive care unit, use of physical restraint, and anticonvulsants in assessing delirium in neurological intensive care unit patients. Delirium prevention programs considering these factors may be effective for such patients.

A New Efficient Trocar to Insert the Wound Drainage Tube: Jackson-Pratt Drainage Tube.

Introduction: A trocar is used to pierce the muscle and skin to insert the wound drainage tube into the operating field to drain excess blood and fluid just after the operation.1 However, the handle of the trocar always becomes slippery, making it difficult for the operator to control it. Sometimes, the lack of control of a trocar may lead the trocar tip to protrude forward in an unwanted direction and penetrate into another organ of the patient. Sometimes, the operator could hurt his hand while pulling the trocar out by the sharp edge of trocar tip. In this video clip, we would like to introduce a brand new trocar that can be used to insert the wound drainage tube.Materials and Methods: The new trocar has two quadrangle grips (SUNGWON MEDICAL CO., LTD., Korea Patent; 10-1540199). One of the grips has an embossing surface to prevent the trocar from rotating unnecessarily when the operator pushes the trocar to penetrate the muscle and skin. The upper side of the grip has a sunken surface that helps the operator to direct the trocar tip using tactile sensation in the absence of visibility. The other grip has a smooth surface near the trocar tip to prevent it from slipping when the operator picks, by hand, the trocar that has emerged out of the skin. We measured the roughness and friction of the hand grip of the trocars by using Optical 3D Surface Measurement System and scanning of electron microscope. In addition, we assessed the questionnaires answered by surgeons on three domains, including the unwanted turn of the trocar tip, the unwanted sliding of the trocar grip, and the directivity of the trocar tip. The three domains were calculated by the amount of degree that a surgeon felt ranging across a continuum from 0 to an extreme amount of 10 subscales.Results: This trocar is routinely used for all open procedures. The roughness and friction of the brand new trocar had higher roughness and friction than the old trocar (roughness: 0.4365 ± 0.2664 and 1.9988 ± 0.72783 Ra, p < 0.05; friction: 3.059 ± 0.286 and 3.486 ± 0.428 N, p < 0.05). The questionnaire was attempted by 32 surgeons. The score of the unwanted turn of the previous trocar tip was higher than that of the brand new trocar (6.46 ± 3.09 vs 0.65 ± 1.03, p < 0.001). The score of the unwanted sliding of trocar grip of the previous trocar was higher than that of the new trocar (7.46 ± 1.98 vs 1.50 ± 1.90, p < 0.001). The score of the directivity of the trocar tip of the new trocar was higher than that of the old trocar (8.93 ± 1.47 vs 3.09 ± 2.30, p < 0.001).Conclusion: Trocar insertion using the new trocar that has quadrangle grips with sanding surface is an efficient and feasible technique for patients and surgeons.Acknowledgments: The authors thank the members of the medical device clinical trial center of Chonbuk National University Hospital for helpful discussions. This research was also supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant No.: HI15C1529). However, the Ministry of Health & Welfare, Republic of Korea, had no role in design or conduct of the study, including collection, management, analysis, or interpretation of the data in addition to preparation, review, or approval of the article.J.K.P. has patent of this trocar and the patent was transferred to SUNGWON MEDICAL device company. The other authors have nothing to disclose. SUNGWON MEDICAL device company had no role in design or conduct of the study, including collection, management, analysis, or interpretation of the data in addition to preparation, review, or approval of the article.Runtime of video: 3 mins

Sinonasal Hemangioma: Diagnosis, Treatment, and Follow-Up of 37 Patients at a Single Center

Hemangioma is a common benign vascular lesion of the head and neck region. It rarely involves the mucous membranes of the nasal cavity and paranasal sinuses. It should be added to the differential diagnosis of nasal cavity masses when the presenting symptoms are epistaxis or nasal obstruction. A retrospective chart review was conducted of a histologic diagnosis of lobular capillary hemangioma or cavernous hemangioma of the sinonasal mucous membranes treated at the Chonbuk National University Hospital from January 1995 through December 2015. There were 1,479 patients diagnosed with hemangiomas in the total body area. Medical records were reviewed to gather data on clinical symptoms, demographic characteristics, site of tumor, imaging and histologic features, and treatment. A review of the literature on previously diagnosed cases of sinonasal hemangioma was performed. Three hundred patients had hemangiomas in the head and neck region and only 37 patients (12.5%) had hemangiomas of the sinonasal mucous membranes. The most common complaint was nasal obstruction (59.5%), followed by epistaxis (51.4%). There were 18 male (48.6%) and 19 female (51.4%) patients. The predominant subsites were the nasal septum (40.5%), followed by the inferior turbinate (29.7%), the maxillary sinus (8.1%), and the uncinate process (8.1%). Lobular capillary hemangioma (24of 37) was more common than cavernous hemangioma (13 of 37). There was a meaningful correlation between the histologic type and tumor site of the hemangioma. Sinonasal hemangiomas are relatively uncommon. Clinicians should be aware of the clinical, radiologic, and histologic features of sinonasal hemangiomas to avoid a misdiagnosis of a malignant tumor, angiofibroma, or other benign mass.

Effects of clarithromycin treatment in scrub typhus in children: comparison with chloramphenicol and azithromycin.

PurposeChloramphenicol and tetracycline are not recommended for treating scrub typhus in pediatric patients because of potential side effects, such as aplastic anemia or tooth discoloration. While clarithromycin has recently been used in adults, few reports have been published on its effects in pediatric patients. We report the clinical profiles of pediatric scrub typhus and the effects of clarithromycin on scrub typhus in children.MethodsWe retrospectively analyzed medical records of 56 children with scrub typhus who were admitted between 2004 and 2013 to Chonbuk National University Hospital, Jeonju, Korea. Cases were divided into 3 groups based on thetreatment drug (chloramphenicol, azithromycin, and clarithromycin). We compared their clinical manifestations and laboratory findings.ResultsAll patients exhibited fever and rash. Other common clinical manifestations were eschars (66%), lymphadenopathy (48%), upper respiratory symptoms (42%), abdominal pain (32%), and hepatosplenomegaly (14%). Elevated levels of C-reactive protein, erythrocyte sedimentation rates, aspartate transaminase, and alanine transaminase were detected in 95%, 96%, 84%, and 77% of patients, respectively. Additionally, decreased platelet and white blood cell levels were observed in 43% and 36% of patients, respectively. There were no statistical differences between the treatment groups in mean age (P=0.114) or sex (P=0.507). However, time to defervescence after the treatments differed significantly, being the shortest in the clarithromycin group (P=0.019). All patients recovered without complications related to the disease or drugs.ConclusionClarithromycin was as effective as chloramphenicol and azithromycin in pediatric scrub typhus patients and may be used as a first-line treatment drug.

Drug Use Evaluation of Tigecycline

Tigecycline is a wide-spectrum intravenous glycylcycline and is generally active against most gram-positive and gram-negative bacteria, including anaerobes, atypical bacteria and many species of multidrug-resistant bacteria. This agent presents a predictable pharmacokinetic profile and minimal drug interaction. It is generally well tolerated, with nausea being the most common adverse event. However, currently FDA warned about increased risk for death in patients who received tigecycline for serious infections. Therefore, this study was performed to evaluate the use of tigecycline and its efficacy. We retrospectively analyzed medical records of patients who received tigecycline at Chonbuk National University Hospital, from January 1, 2013 to December 31, 2014. As a result, the justification of appropriate use showed a rate of 69 cases (86.2%). Tigecycline was properly used according to the criteria in 51-80 cases (81.2-100%), while culture and sensitivity were infrequently performed before the initial dose. The mean duration of administration was 18±15 days. Complications in tigecycline use were usually GI problems including nausea (12 cases), vomiting (6 cases) and diarrhea (2 cases); the treatment efficacy response rate was 57.5%. This study showed that tigecycline was being used for appropriate reasons, but not being well mon- itored. Inappropriate use of tigecycline can lead to cause multidrug-resistant bacteria and unexpect- ed side effects. So, a cautious attitude is required in its use.

Population pharmacokinetics of aripiprazole in healthy Korean subjects.

Aripiprazole is widely used to treat schizophrenia and bipolar disorder. This study aimed to develop a combined population pharmacokinetic model for aripiprazole in healthy Korean subjects and to identify the significant covariates in the pharmacokinetic variability of aripiprazole. Aripiprazole plasma concentrations and demographic data were collected retrospectively from previous bioequivalence studies that were conducted in Chonbuk National University Hospital. Informed consent was obtained from subjects for cytochrome P450 (CYP) genotyping. The population pharmacokinetic parameters of aripiprazole were estimated using nonlinear mixed-effect modeling with first-order conditional estimation with interaction method. The effects of age, sex, weight, height, and CYP genotype were assessed as covariates. A total of 1,508 samples from 88 subjects in three bioequivalence studies were collected. The two-compartment model was adopted, and the final population model showed that the CYP2D6 genotype polymorphism, height and weight significantly affect aripiprazole disposition. The bootstrap and visual predictive check results were evaluated, showing that the accuracy of the pharmacokinetic model was acceptable. A population pharmacokinetic model of aripiprazole was developed for Korean subjects. CYP2D6 genotype polymorphism, weight, and height were included as significant factors affecting aripiprazole disposition. The population pharmacokinetic parameters of aripiprazole estimated in the present study may be useful for individualizing clinical dosages and for studying the concentration-effect relationship of the drug.

Direct Immunofluorescence in Clinically Diagnosed Oral Lichen Planus

Purpose: Oral lichen planus (OLP) is relatively common mucosal disease in clinical dentistry. OLP is intractable and regarded having malignant potential. Until now, there is some debate on how far OLP can be malignant, and which characteristics can be a risk factor for malignant transformation. Clinician need to know some differences between OLP and lesions similar to OLP to manage properly and suppose prognosis correctly. Therefore, the aim of this study was to divide clinical OLP into two groups and to compare the results of direct immunofluorescence (DIF) between two groups. Methods: This study was conducted on outpatients who visited at the department of Oral Medicine in Chonbuk National University Hospital from January 2007 to November 2015. Patients with DIF result were retrospectively reviewed. The selected patients were classified ‘clinical typical of OLP’ (CTO) or ‘clinical compatible with OLP’ (CCW) by modified World Health Organization diagnostic criteria of OLP and oral lichenoid lesion. Results: DIF were classified by deposition intensity or pattern of anti-human antibody and fibrinogen. The classification of fluorescence pattern in each specimen was graded as positive, possibly positive or negative. Conclusions: Both CTO and CCW had positive and possibly positive pattern. Prevalence of positive pattern was 68.8% in CTO and 52.6% in CCW and that of possibly positive pattern was 9.4% in CTO and 5.3% in CCW. Prevalence of negative was 21.8% in CTO and 42.1% in CCW.

Management of Colonic Diverticulitis Tailored to Location and Severity: Comparison of the Right and the Left Colon.

PurposeThis study assessed optimal management of colonic diverticulitis as functions of disease location and severity and factors associated with complicated diverticulitis.MethodsThis retrospective review analyzed 202 patients diagnosed between 2007 and 2014 at Chonbuk National University Hospital, South Korea, with colonic diverticulitis by using abdominopelvic computed tomography. Diverticulitis location was determined, and disease severity was categorized using the modified Hinchey classification.ResultsPatients included 108 males (53.5%) and 94 females (46.5%); of these, 167 patients (82.7%) were diagnosed with right-sided and 35 (17.3%) with left-sided colonic diverticulitis. Of the 167 patients with right-sided colonic diverticulitis, 12 (7.2%) had complicated and 155 (92.8%) had uncomplicated diverticulitis; of these, 157 patients (94.0%) were successfully managed conservatively. Of the 35 patients with left-sided colonic diverticulitis, 23 (65.7%) had complicated and 12 (34.3%) had uncomplicated diverticulitis; of these, 23 patients (65.7%) were managed surgically. Among patients with right-sided diverticulitis, those with complicated disease were significantly older (54.3 ± 12.7 years vs. 42.5 ± 13.4 years, P = 0.004) and more likely to be smokers (66.7% vs. 32.9%, P = 0.027) than those with uncomplicated disease. However, among patients with left-sided diverticulitis, those with complicated disease had significantly lower body mass index (BMI; 21.9 ± 4.7 kg/m2 vs. 25.8 ± 4.3 kg/m2, P = 0.021) than those with uncomplicated disease.ConclusionConservative management may be effective in patients with right-sided diverticulitis and patients with uncomplicated left-sided colonic diverticulitis. Surgical management may be required for patients with complicated left-sided diverticulitis. Factors associated with complicated diverticulitis include older age, smoking and lower BMI.

The Clinical Outcome of Endoscopic Endonasal Silicone Tube Intubation According to Nasolacrimal Duct Resistance

Purpose: To evaluate the clinical result of silicone tube intubation through Hasner’s valve according to nasolacrimal duct resistance under intranasal endoscopic guidance in partial acquired nasolacrimal duct obstruction patients. Methods: The present study enrolled a total of 50 eyes from 31 patients diagnosed with partial acquired nasolacrimal duct obstruction in the Department of Ophthalmology, Chonbuk National University Hospital from 2012 January to 2012 December. Silicone tube intubation was done through the Hasner’s valve and confirmed by intranasal endoscopy and the nasolacrimal duct resistance was measured. Success was defined as the disappearance of epiphora, and failure was defined as the maintenance of epiphora after silicone tube intubation. Results: There were 8 male patients and 23 female patients, ages between 32 to 80 and the average age was 61.4 years old. 3 eyes of 3 patients (6%) had no resistance, 26 eyes of 17 patients (52%) had mild resistance, 17 eyes of 15 patients (34%) had moderate resistance and 4 eyes of 3 patients (8%) had severe resistance. The success was 44 eyes (88%) and the failure was 6 eyes (12%). In the no resistance and mild resistance groups the success rates were both 100%, while an 82% of success rate in the moderate resistance group and 25% success rate in the severe resistance group were observed. The success rates showed clear distinction between severe, moderate and mild resistance patients. Conclusions: Ensuring the passage of a silicone tube through Hasner’s valve increases the success rate in the functional aspect; however, the resistance of the nasolacrimal duct can highly influence the success rate. Therefore, if a patient has severe nasolacrimal duct resistance, dacryocystorhinostomy should be considered earlier. J Korean Ophthalmol Soc 2016;57(1):1-5

THE INFLUENCE OF TOTAL OR SUB-TOTAL GASTRECTOMY ON GLUCOSE CONTROL IN DIABETIC AND NON-DIABETIC PATIENTS.

Although bariatric surgery including gastrectomy has recently emerged as a useful treatment for type 2 DM with obesity, it is not clear whether gastrectomy itself can have beneficial effects on glucose metabolism. Therefore, in this study, we investigated changes in blood glucose in patients with and without diabetes who underwent gastrectomy. From Jan 2010 to May 2014, 77 patients with diabetes and 77 patients without diabetes who underwent gastrectomy at Chonbuk National University Hospital, South Korea, were included. We compared fasting plasma glucose levels and HbA1c value before and after gastric surgery. After gastrectomy, 59 patients (38.3%) showed reduced fasting plasma glucose levels at the 1 year point, and 80 patients (51.9%) exhibited reduced fasting plasma glucose at 3 years, irrespective of their diabetes status. Among 77 patients with diabetes, decreased fasting plasma glucose was observed in 22 (28.6%) and 46 patients (59.7%) 1 and 3 years after gastrectomy, respectively. In patients who exhibited reduced fasting plasma glucose after gastrectomy, the degree of reduced glucose was as follows: 56.4±48.5 vs 23.2±16.1 mg/dL after 1 year, 58.3±52.3 vs 18.4±13.7 mg/dL after 3 years, in DM and non-DM patient respectively. Although there was a significant drop in mean fasting glucose after gastrectomy, not all patients experienced a drop in fasting glucose. Gastrectomy did not show a consistent association with glucose reduction in patients with and without diabetes, and in about half of the patients, fasting plasma glucose levels increased after gastrectomy. Therefore, bariatric surgery including gastrectomy needs to be performed with care in diabetes, and glucose monitoring including oral glucose tolerance tests should be done for assessing or prediction of the glucose state after gastric surgery in non-DM patients.

Levels of common salivary protein 1 in healthy subjects and periodontal patients.

PurposeHuman saliva, as a vital part of the immune defense system, contains a number of distinct proteins and peptides. Recently human common salivary protein 1 (CSP1) has been identified as an abundant salivary protein and may play a role in promoting the binding of cariogenic bacteria to salivary pellicles. However, nothing else is known regarding the role of CSP1 in periodontology. The aim of this study was to quantify and compare CSP1 levels between healthy subjects and periodontal patients.MethodsThis controlled clinical study was conducted in periodontally healthy individuals and patients with chronic periodontitis Chonbuk National University Hospital, with Institutional Review Board approval. Whole saliva samples were collected from 36 healthy subjects and 33 chronic periodontitis patients and analyzed. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immune blotting were conducted to ensure that anti-CSP1 monoclonal antibody (mAb) binds to CSP1 in human saliva. A sandwich enzyme-linked immunosorbent assay (ELISA) system was house-fabricated using mAb-hCSP1#14 and mAb-hCSP1#4 as a capture and a detector mAb, respectively. The CSP1 concentrations in saliva from 36 healthy subjects and 33 periodontal patients were quantified using the CSP1 sandwich ELISA system, and the results were analyzed using the Student’s t-test.ResultsImmunoblot analysis using mAb-hCSP1 as a probe confirmed that CSP1 in human saliva existed as a single band with a molecular weight of approximately 27-kDa. The quantification of CSP1 concentrations by CSP1 ELISA showed that the median values (25th to 75th percentiles) of periodontal patients and healthy subjects were 9,474 ng/mL (range, 8,434–10,139 ng/mL) and 8,598 ng/mL (range, 7,421–9,877 ng/mL), respectively. The Student’s t-test indicated the presence of a statistically significant difference between the 2 groups (P=0.024).ConclusionsThe presence of a significant difference in CSP1 levels between healthy subjects and periodontal patients suggests that CSP1 may be a potential biomarker for the detection or screening of periodontitis patients.

Predictive factors for early response to methimazole in children and adolescents with Graves disease: a single-institute study between 1993 and 2013.

PurposeWe aimed to investigate the predictive factors for early response to methimazole (MMI) in pediatric patients with Graves disease (GD).MethodsOur study included 44 pediatric patients who were diagnosed with GD between January 1, 1993, and December 31, 2013, and were available for follow-up, achieving a normalization of thyroid functions (TFs) at the Chonbuk National University Hospital Pediatric Department. We retrospectively analyzed TFs such as tri-iodothyronine (T3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), and thyroid antibody levels at diagnosis. We also examined their family history of thyroid disease, symptoms at presentation, and normalization time for TF after treatment. We divided our clinical series of patients into the following 4 age groups: <7 years old, 7–12 years old, 13–15 years old, and 16–18 years old.ResultsAt diagnosis, the time of normalization of T3 was significantly shorter in the higher antimicrosomal antibody (AMA) group compared with the lower AMA group (2.53 months vs. 6.18 months) (P<0.05). However, the time of normalization of T3/fT4/TSH had no significant correlations with other variables such as age, sex, a family history of thyroid diseases, thyroglobulin, thyroid-stimulating immunoglobulin, or antithyroglobulin antibody (ATA).ConclusionHigher serological titers of AMA at diagnosis may have prognostic value in the response to initial MMI treatment in pediatric hyperthyroid GD patients.