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Endovascular Stroke Therapy Focused on Stent Retriever Thrombectomy and Direct Clot Aspiration : Historical Review and Modern Application

  • Kang, Dong-Hun;Park, Jaechan
    • Journal of Korean Neurosurgical Society
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    • v.60 no.3
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    • pp.335-347
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    • 2017
  • Intravenous recombinant tissue plasminogen activator had been the only approved treatment for acute ischemic stroke since its approval in 1995. However, the restrictive time window, numerous contraindications, and its low recanalization rate were all limitations of this modality. Under those circumstances, endovascular stroke therapy went through a great evolution during the past two decades of intravenous thrombolysis. The results of the 2013 randomized trials for endovascular stroke therapy were neutral, although they were limited by insufficient imaging screening at enrollment, early-generation devices with less efficacy, and treatment delays. Huge progress was made in 2015, as there were five randomized clinical trials which all demonstrated the safety and efficacy of endovascular stroke treatment. Despite differences in detail patient enrollment criteria, all 5 trials employed key factors for good functional recovery; (1) screening with non-invasive imaging to identify the proximal occlusion and exclude a large infarct core, (2) using highly effective modern thrombectomy devices mainly with stent retriever, and (3) establishment of a fast workflow to achieve effective reperfusion. The results of those trials indicate that modern thrombectomy devices can allow for faster and more effective reperfusion, which can lead to improved clinical outcomes compared to intravenous thrombolysis alone. These advances in mechanical thrombectomy are promising in the global fight against ischemic stroke-related disability and mortality. Two current mainstreams among such mechanical thrombectomy techniques, "stent retriever thrombectomy" and "direct clot aspiration", are the topic of this review. Stent retriever thrombectomy using Solitaire and Trevo retriever will be firstly discussed. And, the commonalities and the differences between two major clot aspiration thrombectomy techniques; a direct aspiration first pass technique (ADAPT) and forced arterial suction thrombectomy (FAST), will be additionally explained. Finally, details regarding the combination of direct clot aspiration and stent retriever thrombectomy, the switching strategy and the Solumbra technique, will be described.

Geotechnical engineering behavior of biopolymer-treated soft marine soil

  • Kwon, Yeong-Man;Chang, Ilhan;Lee, Minhyeong;Cho, Gye-Chun
    • Geomechanics and Engineering
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    • v.17 no.5
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    • pp.453-464
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    • 2019
  • Soft marine soil has high fine-grained soil content and in-situ water content. Thus, it has low shear strength and bearing capacity and is susceptible to a large settlement, which leads to difficulties with coastal infrastructure construction. Therefore, strength improvement and settlement control are essential considerations for construction on soft marine soil deposits. Biopolymers show their potential for improving soil stability, which can reduce the environmental drawbacks of conventional soil treatment. This study used two biopolymers, an anionic xanthan gum biopolymer and a cationic ${\varepsilon}-polylysine$ biopolymer, as representatives to enhance the geotechnical engineering properties of soft marine soil. Effects of the biopolymers on marine soil were analyzed through a series of experiments considering the Atterberg limits, shear strength at a constant water content, compressive strength in a dry condition, laboratory consolidation, and sedimentation. Xanthan gum treatment affects the Atterberg limits, shear strength, and compressive strength by interparticle bonding and the formation of a viscous hydrogel. However, xanthan gum delays the consolidation procedure and increases the compressibility of soils. While ${\varepsilon}-polylysine$ treatment does not affect compressive strength, it shows potential for coagulating soil particles in a suspension state. ${\varepsilon}-Polylysine$ forms bridges between soil particles, showing an increase in settling velocity and final sediment density. The results of this study show various potential applications of biopolymers. Xanthan gum biopolymer was identified as a soil strengthening material, while ${\varepsilon}-polylysine$ biopolymer can be applied as a soil-coagulating material.

The Analysis of Conservative Treatment in Midshaft Fractures of Clavicle (쇄골 간부 골절의 보존적 치료 분석)

  • Cha, Seung-Do;Chung, Soo-Tai;Kim, Yong-Hoon;Park, Sang-Jun
    • Clinics in Shoulder and Elbow
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    • v.13 no.1
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    • pp.27-33
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    • 2010
  • Purpose: Most clavicular fractures can be healed by conservative treatment, although there are many factors that influence healing. The aim of the present study was to analyze factors that influence (i) bone union of midshaft fractures of the clavicle treated conservatively and (ii) bone functioning, after union. The long-term goal was to determine which treatments are adequate. Materials and Methods: We evaluated factors that have an effect on bone union and bone function after union. We evaluated age, fracture site, comminution, displacement, shortening and other factors. Among 523 clavicular midshaft fractures that presented between January 2004 and Jun 2009 at our Department of Orthopaedic Surgery, we identified 270 who had conservative treatment and 173 patients who had surgical treatment. Results: The period required for bone union increased with the degree of displacement. For the group below 12 years of age, and the group without comminution, it took half the time to achieve bone union compared with the other groups. Displacement mostly occurred within 2 weeks after conservative treatment. Conclusion: In patients with a comminuted clavicular midshaft fracture, we might, because of expected delays in bone union, delay the start of rehabilitation until patients are more than 13 years old. Because the degree of displacement may be increased within 2 weeks during conservative treatment, we can think about surgical treatments.

Cervico-facial Infection Due to Dental Origin: A Retrospective Clinical Study (치성 원인에 의한 경안면 감염에 대한 후향적 연구)

  • Ryu, Kyung-Sun;Lee, Hyun-Kyung;Kim, Do-Young;Kim, Moo-Gun;Jung, Tae-Young;Park, Sang-Jun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.35 no.4
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    • pp.236-242
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    • 2013
  • Purpose: The objective of this retrospective study is to evaluate the factors affecting the spread of odontogenic infection. Furthermore, this study was performed to apply to future treatments. Methods: A total of 65 patients, who had received treatment for odontogenic infections from 2010 to 2012 for 3 years, were enrolled in this study. The causes of infection, presence of systemic disease, and complications, durations of treatment, treatment methods, and inflammation levels were compared with the data. Results: Patients over 70 years with systemic disease required immediate drainage, systemic antibiotic therapy and hospitalization. We can determine the direction of the early diagnosis and treatment through blood tests (white blood cells, neutrophil, C-reactive protein [CRP]) and computed tomography. Patients over 70 years with systemic disease had the highest percentage. In addition, these patients showed high levels of inflammation index, such as CRP average of 24.8 and needed for a long-term treatment period and a wide range of surgical incision & drainage several times. Systemic diseases, particularly diabetes mellitus and hypertension, accelerate the spread of infection and had a negative effect that delays healing. Eventually, five of the 65 patients showed serious systemic complications. Conclusion: When evaluating cervico-facial infected patients due to odontogenic infection, the most important thing is deciding the appropriate diagnosis and degree of disease. Considering the patient's systemic status and age, we need to decide the treatment plan. Especially, those patients over 70 years with systemic disease should be treated with rapid surgical approach, and the use of a wide range of antibiotics and intensive care. If proper treatment principle does not apply, severe life-threatening complications will result, such as necrotizing fascitis, acute airway obstruction, mediastinitis, and others.

An Overview of Seabed Storage Methods for Pipelines and Other Oil and Gas Equipment

  • Fatah, M.C.;Mills, A.;Darwin, A.;Selman, C.
    • Corrosion Science and Technology
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    • v.16 no.2
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    • pp.76-84
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    • 2017
  • In the construction of subsea oil and gas developments, it is increasingly common that subsea oil and gas equipment will be installed in subsea well before final hookup and production. Installation of wellheads, subsea hardware, pipelines, and surface facilities (platforms, FPSO, FLNG, connected terminals, or gas plants) are increasingly driven by independent cost and vessel availability schedules; this gives rise to requirements that the subsea facilities must be stored in the seabed for a specific time. In addition, schedule delays, particularly in the installation or startup of the connected platform, FPSO, FLNG, or onshore plant may cause unexpected extensions of the intended storage period. Currently, there are two methods commonly used for storage subsea facilities in the seabed: dry parking and wet parking. Each method has its own risks, challenges, and implications for the facility life and its integrity. The corrosion management and preservation method selection is a crucial factor to be considered in choosing the appropriate storage method and achieving a successful seabed storage. An overview of those factors is presented, along with a discussion on the internal corrosion threats and assessments.

Senotherapeutics: emerging strategy for healthy aging and age-related disease

  • Kim, Eok-Cheon;Kim, Jae-Ryong
    • BMB Reports
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    • v.52 no.1
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    • pp.47-55
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    • 2019
  • Cellular senescence (CS) is one of hallmarks of aging and accumulation of senescent cells (SCs) with age contributes to tissue or organismal aging, as well as the pathophysiologies of diverse age-related diseases (ARDs). Genetic ablation of SCs in tissues lengthened health span and reduced the risk of age-related pathologies in a mouse model, suggesting a direct link between SCs, longevity, and ARDs. Therefore, senotherapeutics, medicines targeting SCs, might be an emerging strategy for the extension of health span, and prevention or treatment of ARDs. Senotherapeutics are classified as senolytics which kills SCs selectively; senomorphics which modulate functions and morphology of SCs to those of young cells, or delays the progression of young cells to SCs in tissues; and immune-system mediators of the clearance of SCs. Some senolytics and senomorphics have been proven to markedly prevent or treat ARDs in animal models. This review will present the current status of the development of senotherapeutics, in relation to aging itself and ARDs. Finally, future directions and opportunities for senotherapeutics use will discussed. This knowledge will provide information that can be used to develop novel senotherapeutics for health span and ARDs.

Bone mineral Density of lumbar Spine in Children With Spastic Quadriplegia and Spastic Diplegia (경직성 사지마비와 양하지마비 아동의 요추부 골밀도)

  • Song, Ju-Young;Kim, Jin-Sang
    • Physical Therapy Korea
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    • v.8 no.1
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    • pp.51-58
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    • 2001
  • In children with cerebral palsy, bone density is decreased by disturbance of bone remodelling due to lack of normal weight bearing and muscle contraction through physical activity. Loss of bone density cause fracture, delays treatment with immobilization, and leads to functional limitation. The purpose of this study was to investigate bone mineral density of lumbar spine in children with spastic quadriplegia and diplegia. Six spastic quadriplegia and 14 spastic diplegia were evaluated in this study. QDR 4500 X-ray densitometer was used to measure bone density at lumbar spine (L1~L4). Children with cerebral palsy showed lower bone density than that of normal children. Bone density in children with spastic quadriplegia and diplegia was $-1.812{\pm}.962$, $-1.519{\pm}.935$, respectively. However, there was no significant differences in bone density between children with spastic quadriplegia and diplegia. There was no significant difference in bone density relation to motor development level, height, and weight. Further study is needed to find the appropriate interventions for preventing loss of bone density in children with cerebral palsy.

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Factors Delaying Hospital Arrival Time after Stroke (뇌졸중 환자들의 지연도착시간에 관한 요인들)

  • Song Yung Sun;Lee Su Young
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.16 no.5
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    • pp.1075-1078
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    • 2002
  • Objective: The management for the stroke should ,given as soon as possible to be effect. But Patients with stroke symptoms commonly delay many hours before seeking medical attention. We evaluated the factors which are related to the time of hospital arrival after acute stroke. Method: Data were obtained from 317 patients admitted to our hospital within 72 hours of stroke onset. We assessed demographic variables, stoke subtype. referral routes. history of previous stroke, level of consciousness, distance from the place where stroke occurred to hospital, and the time interval between onset of stroke and arrival at the hospital. Results: Mean patient age was 65.99±9.57 years. The mean time interval between onset of stroke and hospital arrival was 17.26±18.69 hours and 128 (40.38%) patients arrived within 6 hours. The patients whoes stoke subtype was infarction, who arrived our hospital by way of other hospital, who had no suffered from previous stroke and who showed no impairement of consciousness was arrived at the hospital late(p<0.05). Conclusion: The majority of patients arrive at the hospital after prolonged delays for multiple reasons, and patients with milder symptoms, for whom treatment might be more effective, were less likely to arrive in time for therapy. Our study suggest that effective education about stroke to the patients and public would be highly necessary.

DNA Replication is not Required in Re-establishment of HMRE Silencer Function at the HSP82 Yeast Heat Shock Locus

  • Lee, See-Woo;Gross, David S.
    • Journal of Microbiology
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    • v.34 no.1
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    • pp.30-36
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    • 1996
  • We have exmained the re-establishment of HIMRE mediated silencing function on the transcriptional activity of yeast heast shock gene HSP82. To test whether the onset of SIR repression can occur in growing cells in the rpesence of a potent inhibitor of DNA replication, HMRa/HSP82 strains with SIR4- and SIR4S$^{+}$ genetic backgrounds were arrested in S phase by incubation of a culture in 200 mM hydroxyurea for 120 min. It was clear that following a 20 minute heat shock, silencing of the HMRa/HSP82 allele in cells pretreated with hydroxyurea does occur in a SIR4-dependen fashion, even though the kinetics of repression appears to be substantially delayed. We also have tested whether re- establishement of silencing at the HMR/hsp82 locus can occur in G1-arrested cells. Cell cycle arrest at G1 phase was achieved by treatment of early log a cell cultures with .alpha.-factor mating pheromone, which induces G1 arrest. The result suggests that passage through S phase (and therefore DNA replication) is nor required for re-establishing silencer-mediated repression at the HMNRa/HSP82 locus. Finally, to test whether de nono protein synthesis is required for re-establishment of silencer-mediated repression, cells were pretreated with cycloheximide (500 /.mu.g/ml) 120 min. It was apparent that inhibiting protein synthesis delays, but does not prevent, re-establishment of silencer-mediated repression. Altogether, these results indicate that re-establishment of silencer-mediated repression is not dependent on the DNA replication and has no requirement for protein synthesis.s.

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Long Term Outcomes after Pediatric Liver Transplantation

  • Yazigi, Nada A.
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.16 no.4
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    • pp.207-218
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    • 2013
  • Long term outcomes after liver transplantation are major determinants of quality of life and of the value of this heroic treatment. As short term outcomes are excellent, our community is turning to take a harder look at long term outcomes. The purpose of this paper is to review these outcomes, and highlight proposed treatments, as well as pressing topics needing to be studied. A systemic review of the English literature was carried in PubMed, covering all papers addressing long term outcomes in pediatric liver transplant from 2000-2013. Late outcomes after pediatric liver transplant affect the liver graft in the form of chronic liver dysfunction. The causes include rejection particularly humoral rejection, but also de novo autoimmune hepatitis, and recurrent disease. The metabolic syndrome is a major factor in long term cardiovascular complication risk. Secondary infections, kidney dysfunction and malignancy remain a reality of those patients. There is growing evidence of late cognitive and executive function delays affecting daily life productivity as well as likely adherence. Finally, despite a good health status, quality of life measures are comparable to those of children with chronic diseases. Long term outcomes are the new frontier in pediatric liver transplantation. Much is needed to improve graft survival, but also to avoid systemic morbidities from long term immunosuppression. Quality of life is a new inclusive measure that will require interventions and innovative approaches respectful not only on the patients but also of their social circle.