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ABSTRACT: Abstract Bipolar RF is capable of delivering higher energy fluencies direct to the dermis through a needle electrode. This produces heat when the tissue electrical resistance converts the electric current to thermal energy in the tissue. A 38-year-old man visited our clinic for reduction of submental fat deposit, but otherwise in overall good health. After deciding to perform phosphatidylcholine (PPC) injections subcutaneously, we concerned about edema and swelling of injection site lasted several weeks. We wanted to shorten the period of edema and swelling, we decided to add bipolar radiofrequency (RF) treatment. After 1 week of PPC injection combined with RF treatment, overall volume of jowl was decreased and edema and swelling on the PPC injected site markedly subsided. This reduction of fat deposit lasts longer than 1 year. Follow-up for 1 year demonstrated that the cosmetic results were well-maintained.
Journal of Dermatological Treatment 04/2013; · 1.23 Impact Factor
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ABSTRACT: BACKGROUND: When rescuers perform cardiopulmonary resuscitation (CPR) from a standing position, the height at which chest compressions are carried out is raised. OBJECTIVE: To determine whether chest compressions delivered on a bed adjusted to rescuer's knee height are as effective as those delivered on the floor. MATERIALS AND METHODS: A total of 20 fourth-year medical students participated in the study. The students performed chest compressions for 2 min each on a manikin lying on the floor (test 1) and on a manikin lying on a bed (test 2). The average compression rate (ACR) and the average compression depth (ACD) were compared between the two tests. RESULTS: The ACR was not significantly different between tests 1 and 2 (120.1 to 132.9 vs 115.7 to 131.2 numbers/min, 95% CI, p=0.324). The ACD was also not significantly different between tests 1 and 2 (51.2 to 56.6 vs 49.4 to 55.7 mm, 95% CI, p=0.058). CONCLUSIONS: The results suggest that there may be no significant differences in compression rate and depth between CPR performed on manikins placed on the floor and those placed at a rescuer's knee height.
Emergency Medicine Journal 04/2013; · 1.44 Impact Factor
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ABSTRACT: OBJECTIVE: Rescuers should attempt effective chest compressions on cardiac arrest victims regardless of their skill level. We assessed the effect of the guidance and feedback provided by emergency medical dispatchers to untrained lay rescuers on the quality of telephone-assisted, compression-only cardiopulmonary resuscitation (CPR). METHODS: Untrained lay volunteers were randomised to receive (i) only initial instructions (Group A, n=22), (ii) instructions to count the number of compressions to receive the rates' feedback (Group B, n=21), or (iii) instructions to perform compressions according to an audible metronome tick (GroupC, n=19). CPR quality was evaluated by reviewing the videos and manikin reports. RESULTS: Chest compression depths and average compression rates did not differ among the groups. The proportion of subjects who performed compressions at appropriate rates was highest in Group C, and the proportion of subjects who performed compressions at slow rates was highest in Group A. Thirty-one participants had 91 cases of hands-off events. Group B had the longest hands-off time, and the highest incidence and number of hands-off events. CONCLUSIONS: Dispatcher assistance beyond initial guidance is necessary for performance of telephone-assisted compression-only CPR by untrained laypersons. The instruction to count numbers out loud resulted in an increased frequency of appropriate compression rates, but led to more-frequent interruptions. Therefore, the directions provided during telephone-assisted CPR should take into account whether the layperson has received CPR training.
Resuscitation 02/2013; · 3.60 Impact Factor
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ABSTRACT: Microneedles provide a minimally invasive means to transport molecules into the skin. A number of specific strategies have been employed to use microneedles for transdermal delivery.
The purpose of this study was to investigate the safety of two new digital microneedle devices (Digital Hand® and Digital Pro®; Bomtech Electronics Co., Ltd., Seoul, Korea) for the perforation of skin in skin-hairless-1 mice. This device replaces conventional needles and is designed specifically for intradermal delivery.
We used two newly developed digital microneedle devices to perforate the skin of skin-hairless-1 mice. We conducted a comparative study of the two digital microneedle devices and DTS® (Disk type-microneedle Therapy System; DTS lab., Seoul, Korea). To evaluate skin stability, we performed visual and dermatoscopic inspections, measurements of transepidermal water loss, and biopsies.
The two novel digital microneedle devices did not induce significant abnormalities of the skin on visual or dermatoscopic inspection, regardless of needle size (0.25~2.0 mm). No significant histopathological changes, such as inflammatory cell infiltration, desquamation of the stratum corneum, or disruption of the basal layer, were observed. The digital microneedle devices and microneedle therapy system produced similar results on measures of skin stability.
These two novel digital microneedle devices are safe transdermal drug delivery systems.
Annals of Dermatology 02/2013; 25(1):46-53. · 0.53 Impact Factor
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ABSTRACT: Background Keloid scars derive from abnormal fibrous wound healing when the mechanisms controlling tissue repair and regeneration malfunction. Previous studies have reported a reduction in hyaluronic acid among fibroblasts cultured from keloid tissue compared with the levels in normal skin. Here, we evaluated the efficacy and safety of subdermal minimal surgery using hyaluronic acid as a novel treatment in keloid scars. Objective To evaluate the clinical efficacy and safety of subdermal minimal surgery technology in the treatment of keloids. Materials and methods Ten Korean patients (Fitzpatrick skin type II-IV) with keloids on the upper arms were enrolled in this study. All patients underwent three sessions of subdermal minimal surgery at three-week intervals. Scar assessments were performed at baseline, before each treatment session, and three months after the final treatment, with three different assessment methods. Specifically, in addition to the Vancouver Scar Scale (VSS), two independent physicians performed global assessment evaluations regarding the final cosmetic results. As a final form of assessment, participant satisfaction was assessed using a four-point scale. Results All volunteers completed three treatment sessions, and nine of 10 patients were satisfied with the procedure. The average VSS score decreased three months after the final treatment, and global assessment showed clinical improvement of the scars. No adverse events occurred, except transient spot bleeding at entry points and slight post-procedure edema, which resolved within 48 hours. Conclusion Subdermal minimal surgery technology may help to improve keloids on the upper arm without noticeable adverse effects.
International journal of dermatology 12/2012; 51(12):1502-7. · 1.18 Impact Factor
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Resuscitation 10/2012; · 3.60 Impact Factor
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ABSTRACT: Background Different types of laser have recently been reported as effective tools of treatment in striae distensae. Although fractional photothermolysis is effective for striae distensae, post-inflammatory hyperpigmentation is a major concern and common complication. There are no reports of the effects of using an intradermal radiofrequency (RF) device in striae distensae. Autologous platelet-rich plasma (PRP) is an effective treatment known for its wound-healing effects. Methods Nineteen Asian female patients with striae distensae were enrolled in this study. Three sessions of intradermal RF (1134-kHz frequency, 12-W power, 26-G electrode size) combined with autologous PRP were performed in each patient at intervals of four weeks. Patients were evaluated subjectively by the investigators and by themselves. Results Evaluation of clinical results at four weeks after treatment showed that only one (5.3%) of the 19 patients achieved excellent improvement, whereas seven (36.8%) demonstrated marked improvement, six (31.6%) showed moderate improvement, and five (26.3%) showed mild improvement. None of the patients showed worsening of striae distensae. A total of 63.2% of patients reported they were "satisfied" or "very satisfied" with the degree of overall improvement. Conclusions Intradermal RF combined with autologous PRP appears to be an effective treatment for striae distensae.
International journal of dermatology 10/2012; 51(10):1253-8. · 1.18 Impact Factor
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ABSTRACT: Allergic contact dermatitis (ACD) is a manifestation of a cell-mediated immune response, but its mechanism remains unknown. Recently, we investigated whether ACD involves various neuropeptides. Substance P (SP) is a neuropeptide that is known to act as a neurokinin receptor when the immune response is initiated. Calcitonin gene-related peptide (CGRP) is a distinct typical neuropeptide and, with SP, induces the immune response. Neuropeptides in neurogenic inflammation are regulated by the inactivation of receptors and enzymes that can cause neuropeptide degradation (e.g. angiotensin-converting enzyme [ACE]), but no enzyme that can degrade SP and CGRP has yet been reported.
We investigated changes in the expression of SP and CGRP, as representative of typical neuropeptides, in ACD skin in mouse and human and the effect of ACE expression on the degradation of these neuropeptides using reverse transcription polymerase chain reaction and immunoblot assay. We also examined the relationship between ACD and neuropeptides in skin tissue from human ACD subjects and mice with induced ACD by analyzing cytokine expression and the results of hematoxylin and eosin staining and immunofluorescence assay.
Expression of SP, CGRP, and ACE was higher in skin tissues from animals with acute ACD than in normal animal skin. However, CGRP expression in human skin with acute ACD was lower than in normal skin, unlike expression of SP and ACE, both of which were higher in ACD human skin than in normal human skin.
We found different patterns of neuropeptide expression in human versus mouse skin. These neuropeptide activities were influenced by an increase in neuropeptide degrading enzymes. Our findings show that when SP is produced, expression of CGRP is suppressed in human skin with ACD. The reduction of CGRP expression in patients with acute ACD is caused by mast cells activated by SP.
International journal of dermatology 08/2012; 51(8):939-46. · 1.18 Impact Factor
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ABSTRACT: Resuscitation on a medical bed is difficult because of the need to match the height of the bed to the height of the rescuer, which is impossible on a fixed-height medical bed. This study investigated the effect of using a step stool on chest compressions performed on a manikin in a fixed-height medical bed.
This prospective, observational study was performed using simulated resuscitation manikins and a fixed-height (78 cm) medical bed. Chest compression-ventilation of more than five cycles was performed with and without a 20-cm-high step stool. A total of 74 medical students participated in this study. The quality of the chest compressions was examined using the Laerdal PC Skill Reporting System. The angle between the arm of the rescuer and the bed was measured. In addition, whether the heels of the rescuer reached the ground during the compressions was assessed using lateral-view pictures.
Use of the step stool improved the quality of the chest compressions with regard to depth, proper compressions, insufficient compressions and incorrect hand position (P < 0.05). The angle between the rescuer's arm and bed during the chest compressions was closer to vertical with the use of the step stool than without it (average angle, 83.84 ± 4.16° and 73.41 ± 9.16°, respectively; P < 0.001).
In-hospital resuscitation was conducted on a fixed-height medical bed by rescuers of different heights. The use of a step stool may improve the quality and effectiveness of chest compressions, particularly for short rescuers.
Emergency medicine Australasia: EMA 08/2012; 24(4):369-73. · 0.98 Impact Factor
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ABSTRACT: The purpose of this study is to compare the cardiopulmonary resuscitation (CPR) team dynamics and performance between a conventional simulation training group and a script-based training group.
This was a prospective randomised controlled trial of educational intervention for CPR team training. Fourteen teams, each consisting of five members, were recruited. The conventional group (C) received training using a didactic lecture and simulation with debriefing, while the script group (S) received training using a resuscitation script. The team activity was evaluated with checklists both before and after 1 week of training. The videotaped simulated resuscitation events were compared in terms of team dynamics and performance aspects.
Both groups showed significantly higher leadership scores after training (C: 58.2 ± 9.2 vs. 67.2 ± 9.5, p=0.007; S: 57.9 ± 8.1 vs. 65.4 ± 12.1, p=0.034). However, there were no significant improvements in performance scores in either group after training. There were no differences in the score improvement after training between the two groups in dynamics (C: 9.1 ± 12.6 vs. S: 7.4 ± 13.7, p=0.715), performance (C: 5.5 ± 11.4 vs. S: 4.7 ± 9.6, p=0.838) and total scores (C: 14.6 ± 20.1 vs. S: 12.2 ± 19.5, p=0.726).
Script-based CPR team training resulted in comparable improvements in team dynamics scores compared with conventional simulation training. Resuscitation scripts may be used as an adjunct for CPR team training.
Emergency Medicine Journal 08/2011; 28(8):690-4. · 1.44 Impact Factor
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Archives of neurology 08/2011; 68(8):1076. · 6.31 Impact Factor
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ABSTRACT: Activating transcription factor 3, a member of the activating transcription factor/cyclic adenosine monophosphate response element-binding family of transcription factors, is an adaptive response gene that plays an oncogenic role in the development of various cancers. To our knowledge, few information are available on the possible role of activating transcription factor 3 in skin cancer. In this study, we investigated the expression of activating transcription factor 3 in basal cell carcinomas (n = 5), actinic keratoses (n = 7), squamous cell carcinomas (n = 19), and Bowen disease (n = 14) by immunohistochemistry. In results, activating transcription factor 3 was significantly expressed in squamous cell carcinomas (15/19), suggesting that it is involved in the pathogenesis of squamous cell carcinomas but not in basal cell carcinomas (0/5). In addition, higher expression of activating transcription factor 3 was observed in squamous cell carcinomas that were metastatic (P < .01) or arose in organ transplant recipients (P < .05). Therefore, activating transcription factor 3 appears to play an oncogenic role in the development of squamous cell carcinomas and may be related to the biologic behavior of them.
Human pathology 02/2011; 42(7):954-9. · 3.03 Impact Factor
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ABSTRACT: Household transmission of the pandemic H1N1 2009 virus infection (pH1N1) frequently occurred in children and adolescents within several days after development of index cases. However, antiviral therapy for index cases did not seem to prevent household transmission of pH1N1.
American journal of infection control 12/2010; 38(10):e43-5. · 3.01 Impact Factor
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ABSTRACT: S100B is a biomarker that reflects injury to the central nervous system. As the spine is an integral part of the spinal cord, a study was undertaken to investigate whether serum S100B levels are associated with acute spinal fracture without head injury.
The study population consisted of 32 consecutive patients aged > or = 18 years in whom the emergency physicians suspected spinal fractures. All the patients underwent CT scans to establish the diagnosis of spinal fracture. MRI was then performed on all the patients to determine the presence of spinal cord injury.
Serum S100B levels were higher in the spinal fracture group than in the non-spinal fracture group, and 19 of the 20 patients in the spinal fracture group (95%) had an S100B level >0.12 microg/l, whereas all 12 of the non-spinal fracture group had an S100B level < or = 0.12 microg/l. The S100B level in patients with epidural encroachment of the spinal cord was significantly higher (0.22-4.58 microg/l; mean 2.45 microg/l; 95% CI 0.95 to 3.94) than in those without epidural encroachment (0.114-2.87 microg/l; mean 0.80 microg/l; 95% CI 0.24 to 1.37) (p=0.037). Plain radiography revealed no definite abnormal findings in half of the patients with spinal fracture.
Serum S100B levels are raised in all patients with acute spinal fracture without head injury. Spinal fracture may therefore be one of the extracerebral sources of S100B. Serum S100B levels may be an effective tool for excluding subtle spinal fractures with no clear radiographic findings.
Emergency Medicine Journal 03/2010; 27(3):209-12. · 1.44 Impact Factor
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ABSTRACT: Early diagnosis of active pulmonary tuberculosis (PTB) is critical for TB control, and difficult in patients with smear-negative sputum.
We wanted to evaluate the usefulness of clinical findings, high-resolution computed tomography (HRCT), interferon-gamma-releasing assay (IGRA) and polymerase chain reaction (PCR) of sputum in the diagnosis of smear-negative PTB. Methods: From June 2006 to September 2008, 178 patients with suspected PTB on the basis of clinical and radiological findings visited our institute. After excluding smear-positive cases (n = 77) and cases with an inconclusive diagnosis (n = 17), we studied 84 patients. Their clinical records, HRCT, sputum TB-PCR assay and IGRA results were retrospectively evaluated. A QuantiFeron-TB Gold (QFT-G; Cellestis Ltd., Carnegie, Vic., Australia) assay was used for the IGRA.
Active PTB was diagnosed in 40 (48%) of 84 patients; lack of sputum and young age were significantly associated with an increased risk of PTB. The sensitivities of sputum PCR assay, IGRA, and HRCT were 43.2, 84.4 and 80.0%, respectively, and the specificities were 97.7, 82.9 and 70.5%, respectively. Among the 38 patients suspected of having PTB based on HRCT, 24 patients showed positive results on the IGRA, and 23 of these were diagnosed with active PTB. Among the 35 patients suggested not to have TB based on HRCT, 25 showed negative results on the IGRA, and 23 (92%) of these were diagnosed as not to have TB.
The combined results of HRCT and the IGRA could help decision-making for early initiation of treatment in smear-negative patients.
Respiration 01/2010; 79(6):454-60. · 2.26 Impact Factor
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ABSTRACT: Background: The purpose of this paper is to investigate for the epidemiologic and clinical characteristics of patients with diagnosed novel influenza A (H1N1) and to evaluate the usefulness of clinical diagnosis. Methods: Out of 696 patients who visited the community sentinel hospital for novel influenza from 27 Aug 2009 to 10 Sep 2009, 557 patients had performed the conventional RT-PCR test. Of these patients, 540 patients were enrolled to our study excluding 17 patients who had performed the test for their own request without clinical suspicion. Results: The 79 patients (14.6%) were finally diagnosed as novel influenza by conventional RT-PCR, with median age 19. Main clinical symptoms were febrile sense, cough, rhinorrhea, and sore throat. The odd ratios of the symptoms with fever, febrile sense and myalgia, acute febrile respiratory disease, influenza-likely illness, the age with 10 to 19, and students were statistically significantly higher in finally diagnosed patients group. The sensitivity, specificity, and positive and negative predictive values of rapid antigen test for influenza were 29.4%, 99.3%, 90.9%, and 85.7%, respectively. In the acute febrile respiratory disease and influenza-likely illness, the sensitivity, specificity, and positive and negative predictive value were 77.2%, 38.3%, 17.7%, and 90.7%, and 69.6%, 46.6%, 18.3%, and 89.9%, respectively. Conclusion: In the community sentinel hospital, the patients with novel influenza A (H1N1) present the clinical manifestations similar to the common seasonal influenza. Primary health care providers might have a lot of difficulties in differentiation and treatment necessitating consideration of a variety of diagnostic methods.
Korean Journal of Family Medicine 01/2010; 31(2):115.
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European journal of emergency medicine: official journal of the European Society for Emergency Medicine 09/2009; 16(4):228-30. · 0.73 Impact Factor
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ABSTRACT: Cutaneous aspergillosis is very rare and occurs predominantly in transplant patients. Here, we report a 55-year-old female who underwent steroid treatment for 1 month and developed secondary cutaneous aspergillosis from pulmonary aspergillosis due to Aspergillus fumigatus.
Diagnostic microbiology and infectious disease 09/2009; 66(1):104-7. · 2.45 Impact Factor
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International journal of dermatology 08/2009; 49(7):845-7. · 1.18 Impact Factor
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ABSTRACT: Omental infarction is a rare disease entity that can cause acute or subacute abdominal pain. In the past, it was thought that omental infarction mainly occurred on the right side because it was detected when surgery was performed on patients who complained of abdominal pain on the right side.
We present this case to demonstrate that omental infarction can occur at any site, including the epigastric area and the lower abdomen, and even on the left side where the greater omentum is located.
Four patients with omental infarction presented to the Emergency Department with various clinical symptoms. All of them were diagnosed by computed tomography scan. Omental infarction occurred on the right side in 2 patients, at the epigastric area in 1 patient, and on the left side in 1 patient. Three were improved with supportive care. Laparoscopy was performed in 1 patient because his abdominal pain persisted despite conservative treatment.
Omental infarction should be included in the differential diagnosis list of acute abdominal pain because it can occur at any site. In addition, because this disease runs a self-limited course, conservative care is recommended. Thus, unnecessary operations can be avoided in cases where omental infarction is diagnosed by imaging studies.
Journal of Emergency Medicine 01/2009; 42(2):149-54. · 1.31 Impact Factor
