• Journal of Yeungnam Medical Science
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• v.24 no.2
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• pp.262-274
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• 2007

Purpose : Bone morphogenetic proteins (BMPs) play an important role in the formation of cartilage and bone, as well as regulating the growth of chondroblasts and osteoblasts. In this study, we investigated whether recombinant human BMP adenoviruses are available for ex vivo gene therapy, using human fibroblasts and human bone marrow stromal cells in an animal spinal fusion model. Materials and Methods : Human fibroblasts and human bone marrow stromal cells were transduced with recombinant BMP-2 adenovirus (AdBMP-2) or recombinant BMP-7 adenovirus (AdBMP-7), referred to as AdBMP-7/BMSC, AdBMP-2/BMSC, AdBMP-7/HuFb, and AdBMP-2/HuFb. We showed that each cell secreted active BMPs by alkaline phosphatase staining. Since AdBMP-2 or AdBMP-7 tranducing cells were injected into the paravertebral muscle of athymic nude mice, at 4 weeks and 7 weeks, we confirmed that new bone formation occurred by induction of spinal fusion on radiographs and histochemical staining. Results : In the region where the AdBMP-7/BMSC was injected, new bone formation was observed in all cases and spinal fusion was induced in two of these. AdBMP-2/BMSC induced bone formation and spinal fusion occurred among one of five. However, in the region where AdBMP/HuFb was injected, neither bone formation nor spinal fusion was observed. Conclusion : The osteoinductivity of AdBMP-7 was superior to that of AdBMP-2. In addition, the human bone marrow stromal cells were more efficient than the human fibroblasts for bone formation and spinal fusion. Therefore, the results of this study suggest that AdBMP-7/BMSC would be the most useful approach to ex vivo gene therapy for an animal spinal fusion model.

• Journal of Yeungnam Medical Science
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• v.24 no.1
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• pp.1-10
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• 2007

The chronic fatigue immune dysfunction syndrome (abbreviated CFIDS or CFS) is a disorder characterized by debilitating fatigue(over 6 months.), along with cognitive, musculoskeletal, and sleep abnormalities. The etiology of this illness is unlikely to be a single agent. Findings to date suggest that physiological and psychological factors work together to predispose and perpetuate the illness. Diagnosis is made difficult by the nonspecific clinical findings and no available diagnostic testing. With no known cause or cure for the chronic fatigue and immune dysfunction syndrome, treatment is based on relieving symptoms and improving the quality of life of affected patients. There is emerging evidence that chronic fatigue syndrome may be familial. In the future, studies will examine the extent to which genetic and environmental factors play a role in the development of chronic fatigue syndrome. Most patients with CFS have psychiatric problems such as a generalized anxiety disorder, or major or minor depression, therefore, these mental health disorders may be correlated with the pathophysiology of the CFS. The treatment for CFS must be individualized, due to the heterogeneity of the CFS population. Also the treatment of CFS is built on a foundation of patient-physician relationship, respect and advocacy.

• Journal of Yeungnam Medical Science
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• v.24 no.2
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• pp.243-251
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• 2007

Purpose : This study was conducted to assess the surgical outcomes of limbal lensectomy with or without anterior vitrectomy for the management of lens subluxation. Materials and Methods : The medical records of 20 consecutive patients (33 eyes) with lens subluxation who had undergone limbal lensectomy with or without anterior vitrectomy from February 1999 to January 2004 were retrospectively reviewed. Results : All the patients, except one high axial myopic patient, were implanted with scleral sutured posterior chamber intraocular lens. We evaluated the preoperative, postoperative visual acuity and postoperative complications and compared the results in group I (limbal lensectomy with anterior vitrectomy, 27 eyes) to those in group II (limbal lensectomy without anterior vitrectomy, 6 eyes). The preoperative best-corrected visual acuity was 0.21 and postoperative best-corrected visual acuity was improved by 2 lines or more in all 27 eyes in group I, and in 5 eyes in group II (p>0.05). The most frequent postoperative complication was intraocular lens dislocation in four eyes (14.8%) in group I alone. No retinal detachment occurred in either group, even in patients with high myopia. Conclusion : Limbal lensectomy without anterior vitrectomy improved visual acuity similarly to limbal lensectomy with anterior vitrectomy without significant increase of postoperative complications. This results of this study suggest that anterior vitrectomy is not necessarily required for the management of lens subluxation.

• Journal of Yeungnam Medical Science
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• v.24 no.2
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• pp.197-205
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• 2007

Background : The occurrence of atrial fibrillation after ablation of atrial flutter is clinically important. We investigated variables predicting this evolution in ablated patients without a previous atrial fibrillation history. Materials and Methods : Thirty-six patients (Male=28) who were diagnosed as atrial flutter without previous atrial fibrillation history were enrolled in this study. Group 1 (n=11) was defined as those who developed atrial fibrillation after atrial flutter ablation during 1 year follow-up. Group 2 (n=25) was defined as those who has not occurred atrial fibrillation during same follow-up term. Echocardiogram was performed to all patients. We measured left atrial size, left ventricle end diastolic and systolic dimension, ejection fraction and left atrial volume index before and after ablation of atrial flutter. The differences of each variables were compared and analyzed between two groups. Results : The preablation left ventricular ejection fraction (preLVEF) and postablation left ventricular ejection fraction (postLVEF) are $54{\pm}14%$, $56{\pm}13%$ in group 1 and $47{\pm}16%$, $52{\pm}13%$ in group 2. The differences between each two groups are statistically insignificant ($2.2{\pm}1.5$ in group 1 vs $5.4{\pm}9.8$ in group 2, p=0.53). The preablation left atrial size (preLA) and postablation left atrial size (postLA) are $40{\pm}4mm$, $41{\pm}4mm$ in group1 and $44{\pm}8mm$, $41{\pm}4mm$ in group 2. The atrial sizes of both groups were increased but, the differences of left atrial size between two groups before and after flutter ablation were statistically insignificant ($0.6{\pm}0.9mm$ in group 1 vs $-3.8{\pm}7.4mm$ in group 2, p=0.149). The left atrial volume index before flutter ablation was significantly reduced in group 1 than group 2 ($32{\pm}10mm^3/m^2$, $35{\pm}10mm^3/m^2$ in group 1 and $32{\pm}10mm^3/m^2$, $29{\pm}8mm^3/m^2$ in group 2, p<0.05). Conclusion : The difference between left atrial volume index before and after atrial flutter ablation is the robust predictor of occurrence of atrial fibrillation after atrial flutter ablation without previous atrial fibrillation.

• Journal of Yeungnam Medical Science
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• v.24 no.2
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• pp.154-161
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• 2007

Background : This study was undertaken to evaluate the effectiveness of the Bonfils intubation fibrescope for cases of difficult tracheal intubation. Materials and Methods : For patients with an ASA physical status 1 or 2 betwen the ages of 20-90, direct laryngoscopy was performed and the layngoscopic view graded according to the Cormack and Lehane classification. Forty patients with Cormack and Lehane grade 3 or 4 were intubated using the Bonfils intubation fibrescope. During intubation, the success rates for tracheal intubation, overall time to intubation, number of attempts and adverse effects were recorded. The Thyromental and sternomental distances were recorded after the orotracheal intubation. Results : The success rates were significantly higher in Cormack and Lehane grade 3 (96.9%) patients compared to grade 4 (50%) (P<0.01). The time to intubation was significantly faster in patients with grade 3 compared to grade 4 (20 (10-49[7-300]) sec vs. 180 (31-300[10-300]) sec, P=0.01). The number of cases with a $SpO_2$<90% was significantly lower in patients with grade 3 (3.1%) compared to grade 4 (50%) (P<0.01). Conclusion : In patients with Cormack and Lehane grade 3, tracheal intubation using the Bonfils intubation fibrescope appears to be an effective technique for the management of a difficult intubation. However, the Bonfils intubation fibrescope can not always be used for the management of a difficult intubation in grade 4 patients; for these patients other effective instruments should be considered for difficult intubations.

• Journal of Yeungnam Medical Science
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• v.32 no.2
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• pp.71-79
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• 2015

Background: Recent studies have shown that the nontuberculosis mycobacterium (NTM) recovery rate in clinical cultures has increased within Korea. However, another study conducted by a secondary hospital within Daegu reported different results. Therefore, the purpose of this study is to understand and evaluate the microbiological distribution and clinical features of NTM in Daegu. Methods: A retrospective study was conducted on 11,672 respiratory specimens undergoing acid fast bacilli (AFB) culture from 6,685 subjects who visited Yeungnam University Respiratory Center from January 2012 to December 2013. Results: Of the 11,672 specimens undergoing AFB culture, 1,310 specimens (11.2%) showed positive results. Of these specimens, NTM was recovered from 587 specimens, showing a recovery rate of 44.8%. Identification test for NTM was performed on 191 subjects; the results were as follows: M. avium-intracellulare complex (MAC) 123 (64.4%), M. abscessus 20 (10.5%), M. kansasii 12 (6.3%), and 33 other NTM germ strains. Of the 382 subjects with NTM, 167 were diagnosed with pulmonary NTM disease (43.7%), however virulence differed depending on NTM strain. Multivariate analysis showed that nodular bronchiectasis, the nodules, and finding consistent with cavity under imaging study were statistically significant for triggering pulmonary NTM disease. AFB culture showing MAC and M. abscessus was statistically significant as well. Positive predictive value for NTM polymerase chain reaction (NTM-PCR) was 88.6%. Conclusion: Results for NTM recovery rate within the Daegu area were similar to those for the Seoul metropolitan area. We can assume that NTM infection is increasing in our community, therefore AFB-positive subjects (1) should undergo NTM-PCR, (2) should have their culture results checked for differentiation of mycobacterium tuberculosis complex (MTB) from NTM, and (3) undergo NTM identification test to confirm its type. Administration of treatment with the above results should be helpful in improving the patients' prognosis.

• Journal of Yeungnam Medical Science
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• v.28 no.1
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• pp.31-44
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• 2011

Background: The optimal timing of treatment with EGFR-tyrosine kinase inhibitors (EGFR-TKI) in NSCLC patients has not yet been determined. Methods: We separated 228 patients with advanced /metastatic NSCLC treated with gefitinib into an early gefitinib group (patients who received gefitinib as first- or second-line treatment) and a delayed gefitinib group (patients who received gefitinib as third or fourth-line treatment) and attempted to determine whether the timing of gefitinib treatment affected clinical outcomes. Results: Median overall survival (OS), progression free survival (PFS), and median OS from first-line treatment of advanced/metastatic disease (OSt) for 111 patients in the early gefitinib group were 6.2 months, 3.3 months, and 11.6 months. However, median OS, PFS, and OSt for 84 patients in the delayed gefitinib group were 7.8 months, 2.3 months, and 22.7 months. No differences in OS and PFS were observed between the 2 groups. However, OSt was significantly longer in the delayed gefitnib group. Timing of gefitinib therapy was one of the independent predictors of OSt. Hb ${\geq}$ 10 g/dl, and having never smoked, and ECOG performance status ${\leq}1$ were independent predictors of better PFS. Conclusion：Deferral of gefitinib therapy in patientswith advanced ormetastatic NSCLC may be preferable if they are able to tolerate chemotherapy.

• Journal of Yeungnam Medical Science
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• v.24 no.2
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• pp.287-295
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• 2007

Background : This study investigated and analyzed the life style of male white- collar workers and their perception of obesity to determine how to improve eating habits and prevent obesity. Materials and Methods : Using the questionnaires distributed to and collected from 300 male white-collar workers in Daegu, the survey was conducted from December 20, 2005 to February 28, 2006. Two hundred sets of collected questionnaires were used for the analysis, and SPSS WIN 12.0 was employed to analyze the data. Results : Forty-two percent of subjects had weights ranging between 71 kg and 80 kg; 39.5%, weighted between 61 kg and 70 kg. The waist measurements of 64.5% of all respondents were between 32 and 34 inches. The lifestyle questions found that 54% of respondents were smokers and 88.5% drank alcohol. In addition, 62.5% of all respondents reported doing exercise, whereas 37.5% reported no exercise. Conclusion : The height and weight of 200 respondents were used to calculate the body mass index (BMI). Only 31.6% had a normal BMI, whereas 32% were found to be overweight, a condition likely to lead to obesity. Meanwhile, 36.5% of respondents were obese or morbidly obese.

• Journal of Yeungnam Medical Science
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• v.24 no.2
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• pp.296-304
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• 2007

Background : The main aim of this study was to analyze the factors that could be used to predict job satisfaction of assistant nurses in general hospitals. Material and Methods : This study was based on a survey of assistant nurses in the Daegu region from January 1, 2006 to January 31, 2006. Originally 300 questionnaires were distributed and among them 291 were completed. The data was collected and used for the statistical analysis. Descriptive and inferential statistics, such as the frequency, t-test and one-way ANOVA were used for the analysis. Results : Among the respondents, the average score for job satisfaction was lowest in the university-trained nurses and highest in the nurses who had only graduated from high school. Conclusion : The working conditions, work place and motivation are significantly associated with job satisfaction. In particular, there was lower job satisfaction in those nurses who wanted to change their occupation.

• Journal of Yeungnam Medical Science
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• v.24 no.2
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• pp.107-118
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• 2007

Background : It is well known that non-rapid eye movement(NREM) sleep activates the occurrence of interictal epileptiform discharges(IED) in many epileptic syndromes. We performed this study to assess the effect of NREM sleep on IED in epileptic patients with organic brain lesions. Materials and Methods : We analyzed awake and sleep electroencephalopathy(EEG) recorded simultaneously after partial sleep deprivation in 50 patients. We calculated the awake and sleep spike index (ASI and SSI, spikes/epoch), and the percentage increase of ASI and SSI during sleep. Results : In the 50 patients, the IEDs were recorded exclusively during the awake state in 1 (2%) patient, and during the sleep state in 13(26%) patients. The SSI was higher in 44 (88%) patients, and the ASI was higher in 5 (10%) patients. The mean ASI and the SSI in patients with organic brain lesions were $0.058{\pm}0.121$ and $0.148{\pm}0.187$, and it was $0.081{\pm}0.150$ and $0.174{\pm}0.226$ in patients without organic brain lesions. There were significant increases in the spike index (P<0.05) during NREM sleep in both groups (n=36), but no significant difference in the percent increase of spike index (P>0.05). Conclusion : The IEDs were activated significantly during NREM sleep both in patients with and without organic brain lesions, but there were no differences in the degree of activation in both groups. The activating effect of NREM sleep was not correlated with clinical factors such as, frequent nocturnal seizures, frequent generalized tonic clonic seizures, type of epilepsy and taking anticonvulsants. We conclude that the routine EEG used to evaluate epileptiform discharges in epileptic patients should include sleep recordings after partial sleep deprivation.