• Archives of Plastic Surgery
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• v.49 no.5
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• pp.683-688
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• 2022

Background Reconstruction of large soft tissue defects of the lower extremity often requires the use of free flaps. The main limiting factor and potential for complications lie in the selection of proper donor and recipient vessels for microvascular anastomosis. While the superficial veins of the lower leg are easier to dissect, they are thought to be more vulnerable to trauma and lead to a higher complication rate when using them instead of the deep accompanying veins as recipient vessels. No clear evidence exists that proves this concept. Methods We retrospectively studied the outcomes of 97 patients who underwent free flap plasty to reconstruct predominantly traumatic defects of the lower extremity at our institute. The most used flap was the gracilis muscle flap. We divided the population into three groups based on the recipient veins that were used for microvascular anastomosis and compared their outcomes. The primary outcome was the major complication rate. Results Overall flap survivability was 93.81%. The complication rates were not higher when using the great saphenous vein as a recipient vessel when comparing to utilizing the deep concomitant veins alone or the great saphenous vein in combination to the concomitant veins. Conclusions In free flap surgery of the lower extremity, the selection of the recipient veins should not be restricted to the deep accompanying veins of the main vessels. The superficial veins, especially the great saphenous vein, offer an underrated option when performing free flap reconstruction.

• Journal of Korea Trade
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• v.25 no.2
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• pp.196-219
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• 2021

Purpose - We attempted to empirically verify the effects of managerial attributes on cost stickiness in exporters. Exporters are often affected not only by external factors such as exchange rate but also by internal factors such as managerial attributes regarding their business activities. Because cost stickiness is the product of a manager's decision-making, it has been considered that managerial attributes have a great influence on the behavior. Therefore, our study was intended to find out whether cost stickiness shows differentiated aspects depending on managerial attributes in exporters. Design/methodology - We considered two managerial attributes: CEO power and managerial overconfidence. First, CEO power was measured as CEO pay slice. In addition, managerial overconfidence was measured based on three methodologies presented by previous studies. To measure cost stickiness, we used multiple methodologies presented by prior research. Findings - The results of our empirical analysis are as follows. First, in export firms, the greater CEO power is, the greater cost stickiness is. This result suggested that export managers with great influence little respond to temporary sales decrease promptly, little reduce related production costs flexibly in preparation for future sales recovery, but leave room to endure costs for idle resources. Second, the greater managerial overconfidence is, the greater cost stickiness is. This result indicated that export managers with great overconfidence on their decision-making often view the prospect for sales recovery positively; therefore, they little respond to temporary sales decrease immediately, little reduce related production costs flexibly for future sales recovery, but leave room to endure costs for idle resources. Third, export managers with great influence in their businesses and great overconfidence in their decision-making tend to show relatively great cost stickiness. The results proposed that the combination of the two factors functions to make cost stickiness greater. Originality/value - Our study is differentiated from extant studies in that we provided empirical evidence of the effects of managerial attributes on their business activities in exporters. Specifically, we verified the effects of managerial attributes on cost stickiness in Korean exporters. The results of our study are expected to contribute to providing useful information for exporters and start-ups.

• Journal of Veterinary Clinics
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• v.39 no.1
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• pp.16-22
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• 2022

A 12-year-old spayed female beagle dog was presented with pollakiuria and stranguria. Abdominal ultrasonography identified irregular a marginated, hyperechoic mass in the urethra and trigon area of the bladder. Computed tomography (CT) revealed a heterogeneous mass in the trigone area leading to a urethra. There was no evidence of regional or distant metastasis. Cytologic analysis suspected transitional cell carcinoma (TCC). The patient was treated with piroxicam, mitoxantrone, and once weekly fractionated radiation therapy (RT) with volumetric modulated arc therapy (VMAT). A follow-up CT scan at 6 months after RT revealed a reduction in tumor size. At 17 months after the start of RT, the patient became severely anorectic and lethargic. Ultrasound examination revealed a hyperechoic mass in the apex area of bladder while the trigone area of the bladder and urethra appeared normal. Multiple hypoechoic nodules of various sizes were found in the liver and spleen. The patient was humanely euthanized at the request of the owner. A combination of piroxicam, mitoxantrone, and hypofractionated RT with VMAT protocol was well tolerated. This case described tumor response and survival time of a canine TCC treated with piroxicam, mitoxantrone, and once weekly palliative RT using computer-assisted planning and VMAT.

• Clinical Pain
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• v.19 no.2
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• pp.90-96
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• 2020

Objective: To investigate the diagnostic accuracy of two physical examinations (straight leg raise [SLR] and Bragard test) and electromyography (EMG) in patients with lumbosacral monoradiculopathy in acute and chronic state on confirmation of different diagnostic criteria (MRI vs MRI and diagnostic selective nerve root block [DSNRB]). Method: We identified 297 participants retrospectively from the departmental database. MRI evidence of L5 or S1 nerve root compression and a positive result in diagnostic SNRB served as reference standards. They were divided into two groups by the symptom duration: lasting more than 12 weeks in the chronic group and less than 12 weeks in the acute group. The diagnostic value of clinical tests and EMG were compared. Results: The clinical tests (SLR and Bragard test) done in acute stage on detection by MRI and DSNRB had the highest sensitivity (68%) compared to the chronic stage (63%), but sensitivity was low (57%) on confirmation of MRI alone. However, there was no significant difference on sensitivity and specificity of EMG regardless of reference standards and symptom duration. Electromyography was a significant predictor of neuropathic abnormalities on both acute (OR, 6.3; 95% CI, 2.4 to 16.7; p<0.01) and chronic (OR, 6.8; 95% CI, 2.9 to 16.3; p<0.01). Conclusion: In general, individual physical tests are easy to do and a combination of those tests could be a sensitive indicator of L5 or S1 radiculopathy. Furthermore, the use of provocation tests could provide useful information, especially in proceeding therapeutic selective nerve root block.

• Journal of The Korean Society of Integrative Medicine
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• v.10 no.3
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• pp.73-84
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• 2022

Background : Lymphedema is a progressive disorder characterized by the impairment of lymph flow from tissues to the blood circulation system. This occurs as a result of damage to the lymphatic system. Complex decongestive therapy (CDT) is a multimodal, conservative therapeutic approach that is used for the management of lymphedema. CDT consists of a combination of compression therapy, manual lymphatic drainage, exercise, and skin care. Purpose : This study aimed to provide a review of available physical therapy interventions as well as general care guidelines for patients with lymphedema. Methods : The recommendations and guidelines for physical therapy management, medical management, and general information were reviewed from the following sources: 1) The American Physical Therapy Association, 2) The Norton School of Lymphatic Therapy, and 3) The International Society of Lymphology. This review contains general information, including the medical management and the importance of physical therapy in lymphedema. Physical therapy management should be based on an assessment of the patients' presenting impairments, including based on inclusion or exclusion of physical therapy interventions. This review also outlines a step-by-step approach that starts with disease diagnosis and progression all the way through to rehabilitation as an outpatient. Conclusion : Depending on the patients' journey to recovery and the requirement for rehabilitation, physical therapy interventions should focus on the patients' needs including pain, appearance, physical function and general rehabilitation. We hope that this review will provide information on evidence-based physical therapy and general care to patients with lymphedema.

• Journal of Microbiology and Biotechnology
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• v.32 no.12
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• pp.1605-1614
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• 2022

The strains associated with foodborne Salmonella enterica Thompson outbreaks in Korea have not been identified. Therefore, we characterized S. Thompson strains isolated from chocolate cakes linked to foodborne outbreaks in Korea. A total of 56 strains were isolated from preserved cake products, products in the supply chain distribution, the manufacturer's apparatus, and egg white liquid products used for cream preparation. Subsequently, serological typing, pathogenic gene-targeted polymerase chain reaction (PCR), pulsed-field gel electrophoresis (PFGE), and whole-genome multi-locus sequence typing (wgMLST) were performed to characterize these isolates. The antigen formula of all isolates was 7:k:1,5, namely Salmonella enterica subsp. enterica Serovar Thompson. All 56 isolates harbored invA, his, hin, and stn, and were negative for sefA and spvC based on gene-targeted PCR analyses. Based on PFGE results, these isolates were classified into one group based on the same SP6X01.011 pattern with 100% similarity. We selected 19 strains based on the region and sample type, which were subjected to wgMLST. Although the examined strains showed 100% similarity, they were classified into seven clusters based on allelic differences. According to our findings, the cause of these outbreaks was chocolate cake manufactured with egg white liquid contaminated with the same Salmonella Thompson. Additionally, comparative analysis of wgMLST on domestic isolates of S. Thompson from the three outbreaks showed genetic similarities of over 99.6%. Based on the results, the PFGE and wgMLST combination can provide highly resolved phylogeny and reliable evidence during Salmonella outbreak investigations.

• Journal of The Korean Society of Clinical Toxicology
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• v.20 no.2
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• pp.39-44
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• 2022

N-Acetylcysteine (NAC) is the standard antidote treatment for preventing hepatotoxicity caused by acetaminophen (AAP) poisoning. This review summarizes the recent evidence for the treatment of AAP poisoning. Several alternative intravenous regimens of NAC have been suggested to improve patient safety by reducing adverse drug reactions and medication errors. A two-bag NAC infusion regimen (200 mg/kg over 4 h, followed by 100 mg/kg over 16 h) is reported to have similar efficacy with significantly reduced adverse reactions compared to the traditional 3-bag regimen. Massive AAP poisoning due to high concentrations (more than 300-lines in the nomogram) needs to be managed with an increased maintenance dose of NAC. In addition to NAC, the combination therapy of hemodialysis and fomepizole is advocated for severe AAP poisoning cases. In the case of a patient presenting with an altered mental status, metabolic acidosis, elevated lactate, and an AAP concentration greater than 900 mg/L, hemodialysis is recommended even if NAC is used. Fomepizole decreases the generation of toxic metabolites by inhibiting CYP2E1 and may be considered an off-label use by experienced clinicians. Since the nomogram cannot be applied to sustained-release AAP formulations, all potentially toxic sustained-release AAP overdoses should receive a full course of NAC regimen. In case of ingesting less than the toxic dose, the AAP concentration is tested twice at an interval of 4 h or more; NAC should be administered if either value is above the 150-line of the nomogram.

• The Journal of Korean Obstetrics and Gynecology
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• v.36 no.2
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• pp.55-68
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• 2023

Objectives: The purpose of this study is to analyze the effectiveness of Guibi-tang that are used for postpartum depression. Methods: We searched on five databases [Korean studies Information Service (KISS), Oriental medicine advanced searching integrated system (OASIS), The Cochrane Library, PubMed, and China national knowledge infrastructure (CNKI)] with keywords for Postpartum depression (English, Korean, and Chinese) and evaluated the risk of bias. Meta-analysis was performed on the selected studies. Results: 8 potentially relevant articles were retrieved for further evaluation. There was evidence that Guibi-tang compared with Western medicine was significantly higher rate in total effect rate (RR 1.20, 95% CI 1.04, 1.39, p=0.01). Also, the combined therapeutic effects of Guibi-tang and Psychological intervention compared with Psychological intervention were statistically significant in total effect rate (RR 1.14, 95% CI 1.05, 1.24, p=0.002). And they showed improvement on scores of HAMD (Hamilton depression scale, HAMD) and SF-36 (36-Item short form health survey, SF-36). Conclusion: Guibi-tang appears to be more effective compared to Western medicine in the treatment of postpartum depression. The combination Guibi-tang and Psychological intervention was more effective than psychological intervention alone treated for postpartum depression. However, since unclear risk of bias, the result of this study should be considered carefully. Further clinical trials should be carried out in order to academical clinical progress regarding treatment of Postpartum Depression.

• Journal of Oriental Neuropsychiatry
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• v.34 no.3
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• pp.181-212
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• 2023

Objectives: To examine the efficacy and safety of cupping therapy for insomnia disorder and provide clinical evidence that could contribute to further research. Methods: We searched randomized controlled trials (RCTs) that verified effects of cupping therapy for insomnia disorder from 11 domestic and foreign databases. Included studies were evaluated using Risk of Bias (RoB). Results: Nineteen RCTs were selected. Wet cupping was more frequently used than dry cupping. Moving cupping was mostly used among dry cupping methods. Dry cupping was mainly performed in Bladder Meridian on the back. Wet cupping was mainly performed on BL18, LR14, and BL15. The most common treatment period was 4 weeks. The average number of treatments per week was about 2.4 times for all types of cupping, about 3.2 times for dry cupping and about 1.9 times for wet cupping. All selected studies showed a significant sleep improvement compared to the control group. As a result of the meta-analysis, in terms of effective rate, SAS score, and SDS score, the wet cupping in combination with acupuncture was significantly more effective than acupuncture alone, although the quality of selected RCTs was low. Conclusions: Cupping therapy is effective for insomnia disorder. Based on results of this study, it is reasonable to use wet cupping two times per week on BL18, LR14, and BL15 or use moving cupping three times per week in Bladder Meridian on the back for 4 weeks to treat insomnia disorder.

• Journal of Convergence Korean Medicine
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• v.5 no.1
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• pp.45-54
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• 2023

Objectives : Alcohol-induced liver disease advances as to reactive oxygen species (ROS) and cellular lipid peroxidation increase. We examined the hepatoprotective effects of Zingiber officinale Roscoe rhizome extract (ZR), Pueraria lobata Ohwi flower extracts (PF), and a newly developed herbal juice (HJ), which was a combination of ZR and PF extracts, against ethanol-induced hepatotoxicity. Methods: The study utilized the human hepatoma cell line HepG2 cells to validate the hepatoprotective effect of HJ (50~200 ㎍/mL) against ethanol (EtOH, 700 mM)-induced liver damage. Results: HJ effectively reduced the protein expression of sterol regulatory element-binding transcription factor 1, adiponectin, and AMP-activated protein kinase in EtOH-induced HepG2 cells. The levels of ROS, total cholesterol, and triglycerides, which are the result of various synthesis and lipogenesis processes induced by EtOH in the liver, were reduced by HJ. Furthermore, the activities of alcohol dehydrogenase and aldehyde dehydrogenase, enzymes linked to alcohol degradation, were more effectively downregulated by HJ treatment compared to treatment with ZR and PF alone, all without causing cytotoxic effects. Conclusions: HJ protects the liver by inhibiting EtOH-induced lipogenesis, lowering ROS generation, and improving alcohol degradation, which is more effective than ZR and PF alone. Further, in vivo experiments can offer additional evidence regarding the effectiveness, safety, and underlying mechanism of action of HJ.