Digital chest radiography with a selenium-based flat-panel detector versus a storage phosphor system: comparison of soft-copy images

OBJECTIVE. We compared the soft-copy images produced by a digital chest radiography system that uses a flat-panel X-ray detector based on amorphous selenium with images produced by a storage phosphor radiography system for the visualization of anatomic regions of the chest. MATERIALS AND METHODS. Two chest radiologists and two residents analyzed 46 pairs of posteroanterior chest radiographs on high-resolution video monitors (2560 x 2048 x 8 bits). In each pair, one radiograph was obtained with a storage phosphor radiography system, and the other radiograph was obtained with a selenium-based flat-panel detector radiography system. Each pair of radiographs was obtained at the same exposure settings. The interpreter rated the visibility and radiographic quality of 11 different anatomic regions. Each pair of images was ranked on a five-point scale (1 = prefer image A, 3 = no preference, 5 = prefer image B) for preference of technique. Statistical significance of preference was determined using the Wilcoxon's signed rank test. RESULTS. The interpreters had a statistically significant preference for the selenium-based radiography system in six (unobscured lung, hilum, rib, minor fissure, heart border, and overall appearance) of 11 anatomic regions (p<0.001) and for the storage phosphor system in two regions (proximal airway and thoracic spine) (p<0.05). Chest radiologists strongly preferred selenium-based images in eight regions, and they did not prefer storage phosphor images in any region. CONCLUSION. The soft-copy images produced by the selenium-based radiography system were perceived as equal or superior to those produced by the storage phosphor system in most but not all anatomic regions.     

The "High-Riding" superior pericardial recess: CT findings

OBJECTIVE. We recently observed patients in whom the superior pericardial recess extended cephalad ("high-riding") into the right paratracheal region. In these patients, differentiation from mediastinal lymphadenopathy or mass was difficult. The purpose of this study was to assess the prevalence and CT features of the high-riding superior pericardial recess. CONCLUSION. Narrow-collimation CT with multiplanar reformations was useful for confidently diagnosing a high-riding superior pericardial recess and for distinguishing it from pathologic lesions.     

Graft replacement of transverse aortic arch using the arch vessels first technique

In surgical treatment of aortic arch aneurysm or aortic dissection, we have been employing retrograde cerebral perfusion (RCP). In the present study, we have developed "arch vessels first technique" to shorten perfusion time and achieved an excellent clinical outcome. The surgical procedure "arch vessels first technique" is outlined as follows. RCP is initiated following circulatory arrest, while a woven dacron graft (12 mm in diameter, the dacron graft must be prepared in advance) with two side arms (12 mm in diameter, i.e., with the same diameter) is anastomosed left subclavian artery, left common carotid artery and right brachiocepharic artery in a sequential manner. Then, brain circulation is initiated via one end of the dacron graft. Subsequently, in patients with aortic dissection, a 26 mm woven dacron tubular prosthesis is inserted, using an elephant trunk procedure, to perform "distal anastomose". A partial clamp is applied to the 12 mm woven dacron graft mentioned above, while this 26 mm graft is anastmosed to the 12 mm woven dacron graft side to side, thus reinitiating systemic circulation. While rewarming, the 26 mm woven dacron tubular prosthesis is proximal anastomosed. Mean RCP time was 79.4 minutes, using the conventional procedure "aortic arch distal anastomose", whereas the RCP time was shortened by this procedure "arch vessels first technique", as evidenced by mean RCP time of 57 minutes for patient with aortic dissection and of 39 minutes for patient with saccular aneurysm.     

Surgical treatment of intractable epilepsy accompanying cortical dysplasia

OBJECT: Surgical treatment of cortical dysplasia (CD) together with intractable seizures is challenging because both visualization and localization of the lesion are difficult, correlation with seizure foci requires comprehensive study, and the surgical outcomes reported thus far are unsatisfactory. The authors report their experience in the surgical treatment of CD classified according to a surgical point of view. METHODS: The definition of CD used in this study was a dysplastic lesion visible on magnetic resonance (MR) images or a lesion that, although not visible on MR images, was diagnosed as moderate-to-severe dysplasia by using pathological analysis. During the last 4.5 years, the authors treated 36 patients with intractable epilepsy accompanied by CD. They divided the 36 cases of CD into four characteristic groups: Group A, diffuse bilateral hemispheric dysplasia; Group B, diffuse lobar dysplasia; Group C, focal dysplasia; and Group D, a moderate to severe degree of CD with a normal appearance on MR images. All but one patient in Group C were monitored in the epilepsy monitoring unit by using subdural electrodes for seizure localization and functional mapping. The incidence of CD among a cohort of 291 patients who had undergone epilepsy surgery at the authors' center during the study period was 12.4%. The mean age of the 36 patients was 21.3 years and the mean age at seizure onset was 8.5 years. The mean follow-up period was 26 months. Twenty-six patients (72.2%) belonged to Engel Class I or II (20 and six, respectively). There were five cases in Group A, nine in Group B, nine in Group C, and 13 in Group D. Patients in Groups A and B were significantly younger at seizure onset and had significantly poorer surgical outcomes compared with patients in Groups C and D (p < 0.05). If outcome is compared on the basis of the extent of removal of CD, patients in whom CD was completely removed had significantly better outcomes than those in whom CD was only partially removed (p < 0.001). CONCLUSIONS: The authors conclude that intractable epilepsy accompanied by CD can be treated surgically using comprehensive preoperative approaches. Deliberate resective procedures aimed at complete removal of dysplastic tissue ensure excellent seizure control without permanent neurological deficit.     

The Influence of Physical Distancing,Sense of Belonging,and Resilience of Nursing Students on Their Viral Anxiety During the COVID-19 Era

ObjectiveWe aimed to explore how nursing students’ adherence to physical distancing, sense of belonging, or resilience may be associated with viral anxiety during the coronavirus disease (COVID-19) era in South Korea. MethodsWe conducted an online survey among nursing students from December 8–10, 2021. The survey gathered participants’ age, sex, grades, living area, and responses to questions on COVID-19. In addition, responses to Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), adherence to physical distancing, Sense of Belonging Instrument, Calling and Vocation Questionnaire, Patient Health Questionnaire-9 items (PHQ-9), and Connor-Davidson Resilience Scale-2 (CD-RISC2) items were gathered. ResultsThe SAVE-6 score was significantly correlated with adherence to physical distancing (r=0.29), PHQ-9 (r=0.26), and CD-RISC2 (r=-0.34, all p<0.01) similar to partial correlation analysis adjusting participants’ group (freshmen and sophomores vs. juniors and seniors). A linear regression analysis revealed that viral anxiety of nursing students was predicted by sex (female, β=0.20, p=0.001), adherence to physical distancing (β=0.25, p<0.001), sense of belonging (β=0.16, p=0.014), and CD-RISC2 score (β=-0.32, p<0.001) (adjusted R²=0.24, F=10.01, p<0.001). ConclusionWe observed that adherence to physical distancing, sense of belonging, and their resilience influenced nursing student’s viral anxiety. An appropriate support system to manage viral anxiety is needed for nursing students during the COVID-19 pandemic.     

Effect of Hearing Rehabilitation Therapy Program in Hearing Aid Users: A Prospective Randomized Controlled Study

ObjectivesDespite sufficient hearing gains, many patients with hearing loss have difficulty using hearing aids due to poor word recognition ability. This study was performed to introduce our hearing rehabilitation therapy (HRT) program for hearing aid users and to evaluate its effect on hearing improvement.MethodsIn this prospective randomized case-control study, 37 participants with moderate or moderate-severe sensorineural hearing loss who had used bilateral hearing aids for more than 3 months with sufficient functional hearing gain were enrolled in this study. Nineteen participants were randomly assigned to the control group (CG) and 18 patients were assigned to participate in our HRT program once a week for 8 consecutive weeks (hearing rehabilitation therapy group [HRTG]). Their hearing results and questionnaire scores for hearing handicap and hearing aid outcomes were prospectively collected and compared between the two groups.ResultsAfter completing 8 weeks of the HRT program, the HRTG showed a significantly greater improvement in scores for consonant-only and consonant-vowel sound perception than the CG (P<0.05). In addition, the HRTG showed a significant improvement in hearing ability as measured by two questionnaires (P<0.05), while no differences were observed in the CG. However, word and sentence recognition test results did not show significant differences between the two groups.ConclusionEven after short-term HRT, patients had subjectively better hearing outcomes and improved phoneme perception ability; this provides scientific evidence regarding a possible positive role for HRT programs in hearing aid users. Further validation in a larger population through a long-term follow-up study is needed.     

隔药灸治疗寒凝型痛经的疗效及对PGF2α、PGE2影响

目的探讨隔药灸治疗寒凝型痛经的作用机制。方法把60例寒凝型痛经患者按随机数字表分为两组,每组30例,隔药灸组采用隔药灸神阙穴,西药组采用内服西药,并设正常空白组30例不作任何治疗。结果隔药灸组总有效率（96．7％）优于西药组（83．3%）（P〈0．05）。隔药灸组治疗后PGF2α、PGEz与西药组比较差异有统计学意义（P〈0．01）。结论隔药灸治疗寒凝型痛经的疗效机制与调节PGF2α及PGE2有关,即可降低经期外周血PGF2α含量,升高PGE2含量。     

Expression of cyclooxygenase-2 in association with clinicopathological prognostic factors and molecular markers in epithelial ovarian cancer

OBJECTIVES: This study examines whether expression of COX-2 is associated with clinicopathological features and other molecular markers of ovarian cancer. METHODS: Sixty-four paraffin-embedded tissue specimens were obtained from patients with ovarian cancer who received cytoreductive surgery and combination chemotherapy. Tissue specimens were subjected to immunohistochemical analysis using antibodies to COX-2, p53, and VEGF. RESULTS: Increased COX-2 expression significantly correlated with histologic type (mucinous 5.6% vs. non-mucinous 65.2%, P<0.001). COX-2 expression was also significantly associated with stage, tumor grade, residual disease status, and presence of ascites. COX-2 expression correlated positively with expression of p53 (P=0.006) and VEGF (P=0.025). Although survival was lower in patients with high COX-2 expression than in those without high COX-2 expression (P<0.001), only tumor grade and stage were independent prognostic indicators. In patients with non-mucinous cancer, COX-2 expression correlated with stage (P<0.001) and presence of ascites (P=0.033). CONCLUSIONS: Our results suggest that expression of COX-2 in ovarian cancers is specific to histologic type of tumor and is associated with poor clinicopathologic prognostic factors. Expression of COX-2 also correlates well with expression of p53 and VEGF.