Conservative Approach for Traumatic Anterior Crown–Root Fractured Teeth by Orthodontic Extrusion using Customized Mini-Tube Appliance: A Clinical Review

A complicated crown–root fracture is a fracture involving enamel, dentin, cementum, and pulp. Because crown fracture generally extends below the gingival margin, several options may be indicated to expose the margins before permanent restoration. Among them, orthodontic extrusion is the most non-invasive treatment option. In this case report, a case of traumatic crown–root fracture of the maxillary incisor was managed by root canal treatment with fiber-reinforced ceramic post-placement followed by orthodontic extrusion using a customized mini-tube appliance technique. Then, the porcelain fused zirconia crown was restored. Traumatized orthodontic extruded teeth have shown a reliable prognosis without inflammatory signs nor complications after a 15-month follow-up

Spinal intramedullary cavernous angioma patient in a pain clinic - A case report -

Background Spinal intramedullary cavernous angioma is a rare form of spinal cord tumor that is associated with myelopathy and significant morbidity and surgical treatment is almost always required. Case We report a case of spinal intramedullary cavernous angioma in a pain clinic with initial symptoms of unilateral interdigital space sensory change. Morton’s neuroma and piriformis syndrome were clinically suspected, however, symptoms acutely aggravated, and paraplegia developed following the patient’s COVID-19 vaccination. Vaccine-associated side effects were ruled out and spinal intramedullary cavernous angioma was confirmed through magnetic resonance image. The patient underwent surgery for complete mass excision. Conclusions Recent reports of COVID-19 vaccine-associated side effects have raised sensitive concerns to both health care providers and the public, that in some cases when the symptoms coincide with vaccination history, it may delay time-sensitive diagnosis and treatment and spend unnecessary costs

Educational value of spinal injection therapy videos in Korean YouTube for back pain patients

Background YouTube, the largest online video platform, has become increasingly popular as a source of health information to patients. The aim of the study was to assess whether Korean patients were well informed about spinal injection from YouTube. Methods Search for the keyword “cheog-chu ju-sa” in Korean language was done, and the quality of the 51 videos with the highest number of views was evaluated independently by two pain management doctors. Results The averages of global quality scores evaluated by the two doctors were 3.0 and 3.5 and modified DISCERN (mDISCERN) scores were 2.8 and 3.0, respectively. The Kappa statistic between the two doctors’ scores was 0.285 and 0.417. Conclusions The percentage of low-quality videos with a global quality score of 2 or less is 18–36%, which indicated that these videos might provide inaccurate or misleading medical information to the patient. Pain clinic doctors should be wary of medically misleading information available on online platforms, such as YouTube, and strive to create and distribute professional quality educational materials

The question of preoperative anxiety and depression in older patients and family protectors

Background Higher levels of anxiety increase the risks of surgery, including morbidity and mortality. The objectives of this study were to measure anxiety and depression during the preoperative period and to identify the degree of knowledge and concerns of older patients and their family protectors regarding anesthesia, and the causes of these concerns. Methods We administered a questionnaire to older patients scheduled to undergo surgery and their family protectors one day prior to the surgery. The questionnaire included tools for quantifying anxiety and depression (Anxiety-Visual Analogue Scale, the Amsterdam Preoperative Anxiety and Information Scale, State-Trait Anxiety Inventory Korean YZ Form, and Short Form Geriatric Depression Scale). We also asked about the concrete causes of anxiety using pre-created forms. Results There were 140 older patients and family protectors who participated in the study. The majority of older patients (n = 114, 81.4%) undergoing surgery and their family protectors (n = 114, 81.4%) indicated that they were anxious. Most of the older patients and their family protectors responded that they had insufficient knowledge about anesthesia, and they were mostly worried about failure to awaken following surgery, and postoperative pain. Older patients with higher anxiety scores showed higher depression scores. There were significant differences in depression scores depending on the presence of cohabitating family members. Conclusions It is important to remember that older patients with higher depression scores have higher anxiety during the preoperative period

Additional effect of magnesium sulfate and vitamin C in laparoscopic gynecologic surgery for postoperative pain management: a double-blind randomized controlled trial

Background This clinical trial was conducted to determine whether combined use of magnesium sulfate and vitamin C more significantly reduced postoperative fentanyl consumption and pain than magnesium sulfate or vitamin C alone. Methods The prospective, double-blinded, randomized controlled study enrolled 132 patients scheduled for laparoscopic gynecologic surgery. The patients were randomly allocated to one of the four groups (n = 33 for each group; Group M [magnesium sulfate 40 mg/kg], Group V [vitamin C 50 mg/kg], Group MV [magnesium sulfate 40 mg/kg and vitamin C 50 mg/kg] and Group C [isotonic saline 40 ml]). Cumulative postoperative fentanyl consumption (primary endpoint measure), postoperative pain score by numeric rating scale, and postoperative nausea and vomiting were recorded at 1, 6, 24, and 48 h after discharge from the postanesthesia care unit. Results Cumulative postoperative fentanyl consumption was significantly less in Groups M, V, and MV than in Group C at all time points. Group MV showed significantly less cumulative postoperative fentanyl consumption than Group M at postoperative 24 h (mean ± standard deviation, 156.6 ± 67.5 vs. 235.6 ± 94.6 µg, P = 0.001), as well as significantly less consumption than Groups M and V at postoperative 48 h (190.8 ± 74.6 vs. 301.0 ± 114.8 or 284.1 ± 128.6 µg, P < 0.001, P = 0.003, respectively). Conclusions Combined use of magnesium sulfate and vitamin C provides an additional benefit in postoperative pain management after laparoscopic gynecologic surgery in comparison to single administration of magnesium sulfate or vitamin C

Reshaping tumor immune microenvironment by Epstein-Barr virus activation in the stroma of colorectal cancer

Summary: The formation of tumor immune microenvironment (TIM) is complicated and poorly understood. Little is known about the effect of a viral infection potentially inducing an additional immune response in the TIM. Here, we identify Epstein-Barr virus (EBV) expression in the TIM in colorectal cancer (CRC) tissue through EBV-encoded RNA in-situ hybridization and RNA sequencing data and investigate the effects of EBV on TIM composition and clinical outcomes. EBV was detected in tumor-infiltrating lymphocytes, but not in cancer cells. EBV positivity was associated with older age, male sex, and SMAD4 mutations. EBV-positive tumors were characterized by enrichment in chemokine/cytokine signaling pathways and altered immune cell composition, including plasma and CD4 T cells, as well as cancer cells intrinsically enriched pathways related to immune tolerance, leading to poor prognosis. In conclusion, we identified EBV expression in TIM and suggested its association with poor prognosis by altering the TIM in CRC

Vocal cord paralysis following general anesthesia with endotracheal intubation: a clinical review on 43 cases

Background Vocal cord paralysis (VCP) is one of the most stressful experiences for patients undergoing general anesthesia. Moreover, it is a risk factor for aspiration pneumonia and may increase morbidity and mortality. We examined several clinical features of the condition by reviewing the medical records of patients who experienced VCP following general anesthesia. Methods We reviewed the medical records of 321 patients who consulted an otolaryngologist owing to hoarseness, sore throat, throat discomfort, or dysphagia after general anesthesia. Among these, we included in the present study 43 patients who were diagnosed with VCP by laryngoscopy, who did not have symptoms of suspected VCP before surgery, who had no past history of VCP, and for whom endotracheal intubation was not continued after surgery. Results The mean age of patients with VCP was 51.3 years. With respect to surgical site, the most common was upper limb surgery, performed in 12 cases (9 cases were performed in sitting posture. With respect to surgical duration, only 11 cases lasted less than 3 h, whereas 32 cases required a surgical duration longer than 3 h. The most common symptom of VCP was hoarseness. Nine of the patients with VCP recovered spontaneously, but VCP persisted in 13 cases until the final follow-up examination. Conclusions We hope that this study might call attention to the occurrence of VCP following general anesthesia. Moreover, it is necessary to further evaluate the reasons for the higher incidence of VCP in upper limb surgery performed in sitting posture

Longitudinal change in arterial stiffness after delivery in women with preeclampsia and normotension: a prospective cohort study

Background Preeclampsia is associated with increased arterial stiffness during pregnancy. However, data on the longitudinal change in arterial stiffness after delivery in women with preeclampsia are lacking. In this pilot study, we aimed to examine the longitudinal change in arterial stiffness using the cardio-ankle vascular index after delivery in women with preeclamptic and normotensive pregnancies. Methods We enrolled pregnant women with preeclampsia (n = 37) and normotension (n = 36) who gave birth at Seoul National University Bundang Hospital between March 2013 and May 2016, and followed-up at day 1, 6 months, and 12 months after delivery. The longitudinal change in the cardio-ankle vascular index and other variables (blood pressure, lipid profiles, serum creatinine, and liver enzymes) were compared between the two groups using the mixed-effects model, and interactions among the main predictors were examined. Results The longitudinal change in the cardio-ankle vascular index did not significantly differ between the two groups (β = 0.11, 95% CI: − 0.31–0.54, p = 0.60). Predictors of the longitudinal change in the cardio-ankle vascular index included age, time since delivery, body mass index, and diabetes mellitus. Women with preeclampsia showed significantly elevated blood pressure, lipid profiles, serum creatinine, and liver enzymes compared to women with normotension over the course of 1 year of follow-up. Conclusions Preeclampsia is associated with unfavorable blood pressure and metabolic indices after delivery. However, we found no difference in the longitudinal change in arterial stiffness between women with preeclampsia and normotension over the course of 1 year after delivery. Trial registration Retrospectively registered at ClinicalTrials.gov on October 29, 2019 ( NCT04142268 ).This study was supported by a grant from the Seoul National University Bundang Hospital Research Fund (02–2013-077). The funding institution had no role in the design, conduct, analysis, and interpretation of the findings, or in the decision to publish