It has been more than three decades since the first assay assessing circulating 25 (OH)D in human subjects was performed That publication as well as several that followed it defined 'normal' nutritional vitamin D status in human populations. Recently, the wisdom by which 'normal' circulating 25 (OH)D levels in human subjects were assigned in the past has come under question. It appears that sampling human subjects, who appear to be free from disease, and assessing 'normal' circulating 25 (OH)D levels by plotting a Gaussian distribution is grossly inaccurate. There are many reasons why this method is inaccurate, including race, lifestyle habits, sunscreen usage, age, latitude, and inappropriately low dietary recommendations for vitamin D. For instance, a 400 IU/day. AI for vitamin D is insignificant when one considers that a 10-15 minute whole body exposure to peak summer sun will generate and release up to 20,000 IU vitamin $D_3$ into the circulation. Recent studies, which orally administered up to 10,000 IU/day vitamin $D_3$ to human subjects for several months, have successfully elevated circulating 25 (OH)D levels to those observed in individuals from sun-rich environments. Further, we are now able to accurately assess sufficient circulating 25 (OH)D levels utilizing specific biomarkers instead of guessing what an adequate level is. These biomarkers include intact parathyroid hormone (PTH), calcium absorption, bone mineral density (BMD), insulin resistance and pancreatic beta cell function. Using the data from these biomarkers, vitamin D deficiency should be defined as circulating levels of 25 (OH)D$\leq$30 ng/mL. In certain cases, such as pregnancy and lactation, significantly higher circulating 25 (OH)D levels would almost certainly be beneficial to both the mother and recipient fetus/infant.
Objective : Development of diagnostic tools has resulted in early detection of thoracic disc herniations[TDH] even when the herniated disc is soft in consistency. In some of the cases, it is considered better not to opt for surgical treatment due to the unduly high morbidity and potential complications associated with conventional approaches. The authors have applied percutaneous endoscopic thoracic discectomy[PETD] technique to soft TDHs in order to avoid the morbidity associated with conventional approaches. Methods : Eight consecutive patients [range, 31 to 75 years] with soft lateral or central TDH [from T2-3 to T11-12] underwent PETD between May 2001 and June 2004. The patient was positioned in a prone position with intravenous sedation and local anesthetic infiltration. The authors introduced a cannula into the thoracic intervertebral foramen using endoscopic foraminoplasty technique. Discectomy was performed with mechanical tools and a laser under continuous endoscopic visualization and flu oroscopic guidance. Functional status was assessed preoperatively and postoperatively using the Oswestry Disability Index[ODI]. Results : The mean ODI scores improved from 52.8 before the surgery to 25.8 at the final follow-up. In cases of myelopathy, long tract signs showed improvement. The mean operative time was 55 minutes, and no patient required conversion to open surgery. Conclusion : The technique allows a smaller incision and less morbidity. Soft TDH is amenable to this minimally invasive approach in selected patients with myeloradiculopathy.
Park, Ho-Young;Lee, Sun-Ho;Park, Se-Jun;Kim, Eun-Sang;Lee, Chong-Suh;Eoh, Whan
Journal of Korean Neurosurgical Society
/
v.57
no.1
/
pp.42-49
/
2015
Objective : The cervicothoracic junction (CTJ) is a biomechanically and anatomically complex region that has traditionally posed problems for surgical access. In this retrospective study, we describe our clinical experiences of the treatment of metastatic spinal tumors at the CTJ and the results. Methods : From June 2006 to December 2011, 23 patients who underwent surgery for spinal tumors involving the CTJ were enrolled in our study. All of the patients were operated on through the posterior approach, and extent of resection was classified as radical, debulking, and simple neural decompression. Adjuvant radiation therapy (RT) was also considered. Visual analog scale score for pain assessment and Medical Research Council (MRC) grade for motor weakness were used, while pre- and post-operative performance status was evaluated using the Eastern Cooperative Oncology Group (ECOG). Results : Almost all of the patients were operated using palliative surgical methods (91.3%, 21/23). Ten complications following surgery occurred and revision was performed in four patients. Of the 23 patients of this study, 22 showed significant pain relief according to their visual analogue scale scores. Concerning the aspect of neurological and functional recovery, mean MRC grade and ECOG score was significantly improved after surgery (p<0.05). In terms of survival, radiation therapy had a significant role. Median overall survival was 124 days after surgery, and the adjuvant-RT group (median 214 days) had longer survival times than prior-RT (63 days) group. Conclusion : Although surgical procedure in CTJ may be difficult, we expect good clinical results by adopting a palliative posterior surgical method with appropriate preoperative preparation and postoperative treatment.
This study was to examine the causal relationships among extraneous variables, social participation, and life satisfaction among the elderly persons. This study analyzed 4014 elderly persons out of 2010 KLoSA. The path analysis and mediating effects were examined by AMOS. Except educational level, family income, health status, functional capacities, K-MMSE, and CES-D10 were direct effects on the life satisfaction among the elderly persons. The mediating effects of causal meeting activities, leisure activities, and membership based activities were significant on life satisfaction. This study proposed implications of improving life satisfaction for the elderly through utilizing of social participation activities.
High glucose leads to physio/pathological alterations in diabetes patients. We investigated collagen production in human gingival cells that were cultured in high concentrations of glucose. Collagen synthesis and secretion were increased when the cells were exposed to high concentrations of glucose. We examined endoplasmic reticulum (ER) stress response because glucose metabolism is related to ER functional status. An ER stress response including the expression of glucose regulated protein 78 (GRP78), C/EBP homologous protein (CHOP), inositol requiring enzyme alpha (IRE-$1{\alpha}$) and phosphoreukaryotic initiation factor alpha (p-eIF-$2{\alpha}$) was activated in the presence of high glucose. Activating transcription factor 4 (ATF-4), a downstream protein of p-eIF-$2{\alpha}$ as well as a transcription factor for collagen, was also phosphorylated and translocalized into the nucleus. The chemical chaperone 4-PBA inhibited the ER stress response and ATF-4 phosphorylation as well as nuclear translocation. Our results suggest that high concentrations of glucose-induced collagen are linked to ER stress and the associated phosphorylation and nuclear translocation of ATF-4.
Capture-and-replay technique is a common automatic method for GUI testing. Testing applications on Android platform cannot use directly capture-and-replay technique due to the testing framework which is already set up and technical supported by Google and lack of automatic linking GUI elements to actions handling widget events. Without capture-and-replay testing tools testers must design and implement testing scenarios according to the specification, and make linking every GUI elements to event handling parts all by hand. This paper proposes a more improved and optimized approach than common capture-and-replay technique for automatic testing Android GUI widgets. XML is applied to extract GUI elements from applications based on tracing the actions to handle widget events. After tracing click events using monitoring in capture phase test cases will be created by communicating status of activated widget in replay phase with API events.
The objective of preventive dentistry is the maintenance of a healthy dentition for the life of a patient. Unfortunately, if an individual has not received the benefit of a comprehensive program of preventive dentistry and has finally reached the edentulous state, as a consequence, he receives a set of complete denture. Dentures are mechanical devices and subject to the principles of mechanics. In some cases, the general health and nutritional status of the patient are felt to be the causative factors. But, the most important thing in residual ridge resorption is felt to be caused by the unequal distribution of functional forces. This study was to analyze mandibular stresses of complete denture occlusion by three dimensional finite element method. The results were as follows ; 1. As deformation and stress distribution of the complete denture of the mandible were concentrated on the upper lingual side of the mandible, alveolar ridge resorption of the mandible occurred from lingual side to labio-buccal side. 2. Analyzing by three dimensional F. E. M., the mandible is a very effective form for tolerating stress and deformation biomechanically. 3. According to the concentration of stress distibution in the upper buccal side of the lower posteriors, buccal shelf area must be a primary stress bearing area in the lower complete denture. 4. Lower complete denture moved horizontally to the balancing side under lateral occlusal force. 5. Bilateral balanced occlusion should be constructed in the complete denture for denture stability, especially in the protrusive movement. 6. Physical property of the denture base material was as important for stress distribution in the denture base as or even more than that in the mandible. 7. Impression technique is very important because of most of stress was concentrated between them due to close contact of the mandible and the denture base.
We conducted a hospital case-control study by genotyping four potential functional single nucleotide polymorphisms (SNPs) to assess the association of Xeroderma pigmentosum complementation group F (XPF) with gastric cancer susceptibility, and role of XPF polymorphisms in combination with H.pylori infection in risk definition. A total of 331 patients with gastric cancer and 355 controls were collected. Four SNPs of XPF, rs180067, rs1799801, rs2276466 and rs744154, were genotyped by Taqman real-time PCR method with a 7900 HT sequence detector system. The gastric cancer patients were more likely to have smoking habit, a family history of cancer and H.pylori infection. We did not find any significant difference in the genotype distributions of XPF rs180067, rs1799801, rs2276466 and rs744154 between cases and controls. However, multivariate logistic analysis showed a non-significant decreased risk in patients carrying rs180067 G allele, rs1799801 T allele or rs2276466 T allele genotypes. A non-significant increased risk of gastric cancer was found in individuals carrying the rs744154 GG genotype. Stratification by H.pylori infection and smoking was not significantly different in polymorphisms of XPF rs180067, rs1799801, rs2276466 and rs744154. The four XPF SNPs did not show significant interaction with H.pylori infection and smoking status (P for interaction was 0.35 and 0.18, respectively). Our study indicated that polymorphisms in rs180067, rs1799801, rs2276466 and rs744154 may affect the risk of gastric cancer but further large sample size studies are needed to validate any association.
This study has been carried out to verify curative effect of lavender and lawn, a green space composition factor. Thus, the physiological index value of blood pressure, heart rate and salivary amylase were measured with object of 16 women in their 20~30s for stress relaxation effect at lavender garden and lawn square, and impression assessment upon SD method as for psychological value was performed in this study. And a survey was conducted on necessity and reason of urban green space with object of 345 men and women urban workers. As a result of variance analysis between groups and multi test of Turkey upon object place, the blood pressure was lowered the same at lavender garden and lawn square, and especially, high blood pressure was greatly lowered to 30 mmHG at lavender garden. On the other hand, low blood pressure group showed the tendency of a little increasing at the same places. And for the pulse, there was difference between high blood pressure group and normal group at the same places. To conclude, at lavender garden and lawn square the blood pressure was made to be lowered when it's high, and when it's low, the effect of returning to sound status, the function of increasing, was verified. In case of impression assessment upon SD method, the lawn square was assessed as resting place and lavender garden diversional place. And over 90% of urban workers responded to the green space's necessity and curative effect, diversion and resting place were adopted for the reason in high-ranking items. As above the green space pattern that urban workers require and curative effect of lavender garden and lawn square were verified. Therefore, the functional green space plan is required, which curative effect, diversion and resting place are considered, for the future green space plan design.
Background: Little data is available regarding hospitalized patients with nursing home-acquired pneumonia (NHAP). This is unfortunate because there is an increasing number of elderly persons who are living in nursing homes in Korea. The aim of this study was to compare clinical characteristics and treatment responses of NHAP with community-acquired pneumonia (CAP). Methods: Patients with pneumonia who were admitted from eight nursing homes or from their own homes were enrolled between May 2007 and April 2009. Their clinical characteristics and treatment responses were reviewed retrospectively, and differences between the two groups were analyzed. Results: Of 110 Patients with pneumonia, 66 (60%) were from nursing homes and their median age was 84. In the NHAP group, functional performance status was significantly poorer, classical symptoms of pneumonia were less severe, and multi-lobe involvement (on chest radiographs) was more frequent than in the CAP group. Patients with NHAP more frequently showed lymphocytopenia, anemia, hypoalbuminemia, hypoxemia, and elevated blood urea nitrogen on admission. The mean CURB-65 score was 2.2 in the NHAP group, higher than 1.7 in the CAP group (p=0.004), and multi-drug resistant pathogens were also highly identified in NHAP group (39% vs. 10%, p=0.036). The mean duration of antibiotic therapy was greater for the NHAP (12.6 days) than for the CAP group (6.6 days) (p<0.001). The mortality rate was 23% in NHAP group, which was significantly higher than 5% in the CAP group (p=0.014). Conclusion: NHAP should be more intensively investigated because of the higher frequency of multi-drug resistant pathogens and mortality than the CAP.
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