• Archives of Plastic Surgery
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• 제48권5호
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• pp.473-482
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• 2021

Background The increasing number of bilateral breast cancer patients has been accompanied by a growing need for bilateral mastectomy with immediate reconstruction. However, little research has investigated the complications and aesthetic outcomes related to bilateral reconstruction. Therefore, we analyzed retrospective data comparing the outcomes of bilateral reconstruction using deep inferior epigastric perforator (DIEP) flaps or implants. Methods This study included 52 patients (24 DIEP group and 28 implant group) who underwent bilateral mastectomy with immediate reconstruction between 2010 and 2020. Patient demographics, surgical characteristics, and complications were recorded. The difference between the left and right position of the nipple-areolar complex with respect to the sternal notch point at the clavicle was measured, and breast symmetry was evaluated. Results The average weight of breasts reconstructed with DIEP flaps (417.43±152.50 g) was higher than that of breasts with implants. The hospitalization period and operation time were significantly longer in the DIEP group. Early complications were significantly more common in the implant group (36.53%) than in the DIEP group. The angles between the nipples and the horizontal line were 1.09°±0.71° and 1.75°±1.45° in the DIEP and implant groups, respectively. Conclusions Although the surgical burden is lower, breast reconstruction using implants requires greater attention with respect to implant positioning, asymmetry, and complications than DIEP flap reconstruction. DIEP flap reconstruction has a prolonged operation time and a high risk of flap failure, but yields excellent cosmetic results and does not require intensive follow-up. Patients should be consulted to determine the most suitable option for them.

• Clinical and Experimental Pediatrics
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• 제64권3호
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• pp.130-135
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• 2021

Background: The clinical significance of lip-tie, or a tethered maxillary frenulum, remains under debate. Clinicians and parents are often perplexed when deciding whether procedures available to relieve a seemingly tight or severe maxillary frenulum are needed. Purpose: No previous studies have assessed the consequences of not subjecting a tethered maxillary frenulum in newborns to surgical intervention. This study aimed to contribute the first prospective trial on this topic with a relatively extended follow-up of these newborn infants. Methods: This prospective observational questionnaire-based cohort trial was performed in a community setting and aimed to determine whether lip-tie is associated with an increased likelihood of eventual feeding or oral disorders. Results: The convenience sample comprised of 61 consecutively arriving infants with concomitant tethered frenula who were treated at the clinic for various reasons. This cohort was compared with a random sample of 66 age-matched children for a mean follow-up period of 6.42 years. Infants undergoing oropharyngeal procedures were excluded. Awareness of a deviation in oral structures was reported by 18% of the study group versus 0% of the controls. Mothers participating in the study group (24.6%) less frequently recalled painful nipples or discomfort during breastfeeding than those in the control group (47.0%) (P<0.01). There were no intergroup differences in other types of feeding difficulty, dental hygiene, pronunciation, or speech development. Conclusion: Our findings suggest that a tethered labial frenulum is not associated with an increase in breastfeeding disturbances or oral disorders. These data encourage clinicians to question the need to intervene in cases of tethered maxillary frenula.

• Archives of Plastic Surgery
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• 제46권4호
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• pp.324-329
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• 2019

Background Multiple approaches for nipple reconstruction exist, and none is considered superior to all others. The star flap is one of the most popular methods for nipple reconstruction, but gradual height loss is a major concern. We present a new modification of the star flap that incorporates a de-epithelialized dermal flap, along with the associated surgical results. Methods We reviewed the medical records of patients who underwent nipple reconstruction using the modified star flap method. The design was different from the conventional star flap in that the lateral wings were changed into a trapezoidal shape and de-epithelialized dermal flaps were added. The patients were followed up at 2, 4, 6, and 12 months postoperatively, and nipple height was measured. The postoperative nipple height achieved using the modified method was compared with that obtained using the traditional method. Results From February 2013 to June 2017, 32 patients received surgery using the modified star flap, and 18 patients who underwent nipple reconstruction before 2013 comprised the conventional method group. All patients had undergone breast reconstruction with an abdominal tissue-based flap. The mean follow-up period was 14.4 months in the modified method group and 17.3 months in the conventional method group. The mean maintenance of projection at 12 months postoperatively was $56.28%{\pm}18.58%$ in the modified method group, and $44.23%{\pm}14.15%$ in the conventional method group. This difference was statistically significant (P<0.05). Conclusions The modified method using a de-epithelialized dermal flap provides reliable maintenance of projection in patients who have undergone abdominal tissue-based breast reconstruction.

• 한국기계기술학회지
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• 제20권6호
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• pp.917-923
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• 2018

The drinking water supply system applicable to the laying hen consists of air-water heat pumps, drinking water tanks, heat stroage tank, circulation pumps, PE pipes, nipples, and control panels. When the heat pump system has power of 7.7 to 8.7 kW per hour, the performance coefficient is between 3.1 and 3.5. The supply temperature from the heat pump to the heat stroage tank was stabilized at about $12{\pm}1^{\circ}C$, but the return temperature showed a variation of from 8 to $14^{\circ}C$. Stratified temperature in the storage tank appeared at $12.^{\circ}C$, $13.5^{\circ}C$ and $14.4^{\circ}C$, respectively. The drinking water supply temperature remained set at $15^{\circ}C$ and $25^{\circ}C$, and the conventional tap water showed a variation for $23^{\circ}C$ to $30^{\circ}C$. As chickens grow older, the amount of food intake and drinking water increased. $y=-0.0563x^2+4.7383x+8.743$, $R^2=0.98$ and the feed intake showed $y=-0.1013x^2+8.5611x$. In the future, further studies will need to figure out the cooling effect on heat stress of livestock.

• Archives of Plastic Surgery
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• 제49권1호
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• pp.29-33
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• 2022

The application of minimal invasive mastectomy has allowed surgeons to perform nipples-paring mastectomy via a shorter, inconspicuous incision under clear vision and with more precise hemostasis. However, it poses new challenges in microsurgical breast reconstruction, such as vascular anastomosis and flap insetting, which are considerably more difficult to perform through the shorter incision on the lateral breast border. We propose an innovative technique of transcutaneous medial fixation sutures to help in flap insetting and creating and maintaining the medial breast border. The sutures are placed after mastectomy and before flap transfer. Three 4-0 nylon suture loops are placed transcutaneously and into the pocket at the markings of the preferred lower medial border of the reconstructed breast. After microvascular anastomosis and temporary shaping of the flap on top of the mastectomy skin, the three corresponding points for the sutures are identified. The three nylon loops are then sutured to the dermis of the corresponding medial point of the flap. The flap is placed into the pocket by a simultaneous gentle pull on the three sutures and a combined lateral push. The stitches are then tied and buried after completion of flap inset.

• 대한지역사회영양학회지
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• 제8권3호
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• pp.288-301
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• 2003

In order to obtain baseline data for the development of an educational program on breastfeeding, a survey was carried out to investigate infant feeding practices, the characteristics the subjects have in common, and the factors that influence the feeding methods among women in Seoul and the Chungbuk area. Subjects included 671 lactating mothers who visited public health centers or pediatric clinics between December 1999 and February 2000, and were interviewed using a questionnaire. The results were as follows : With respect to feeding methods, the incidence of breastfeeding, formula feeding, mixed feeding and formula feeding switched from breastfeeding was 20.6%, 29.8%, 11.6%, and 38.0%, respectively. With respect to the characteristics the subjects had in common, the incidence of women who planned their infants' feeding methods before pregnancy, during pregancy, and after delivery was 48.7%, 31.0％, and 20.3%, respectively. The incidence of women who started breastfeeding in the hospital after delivery was 38.8％. About seventy seven percet of the subjects had not previously attended an educational program on breastfeeding, and most of these wanted to participate in the future in an educational program to learn about breastfeeding. Some of the topics they were interested in were“Nutritional Management for Sufficient Breast Milk”(60.3%),“Breast Care”(25.0%), and“Correct Nursing Positions”(9.8%). Most (88.2%) of the women who breastfeed suffered from physical discomforts including discomfort of the waist, and legs and discomfort due to cracked or sore nipples. “Insufficient breast milk”was the main reason for breastfeeding cessation or for switching to formula feeding. With respect to formula feeding practices, the main reasons for selecting a specific brand of formula were“the same brand the hospital used after delivery”(34.3%) and“an advertised brand”(23.3%). The strongest factor for promoting breastfeeding was“the support of husband or parents”, next were “breastfeeding in the hospital after delivery”and“planning to breastfeed before pregnancy”in that order. The characteristics the subjects had in common relating to formula feeding were“mother's job”,“high economic level”,“Caesarian section”and “planning to breastfeed after delivery”. In conclusion, it is recommended that breastfeeding be pro-moted, and educational programs be developed and offered as soon as possible to each group which had unfavorable attitudes toward breastfeeding. In addition, the monitoring and supervision of formula advertisements is required to protect consumers from the adverse effects of exaggerated advertising.

• Asian-Australasian Journal of Animal Sciences
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• 제21권2호
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• pp.198-203
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• 2008

This study was conducted to compare the effects of feeding high protein and low energy milk replacer (HPR; CP 25%, ME 3.6 Mcal/kg DM) with low protein and high energy milk replacer (HPR; CP 21%, ME 4.2 Mcal/kg DM) on feed consumption, body weight (BW) gain, health and selected blood metabolites in Holstein calves during the pre-weaning period. At each feeding, each milk replacer (MR) was prepared by mixing 0.125 kg of dry MR in 1L of warm ($60^{\circ}C$) water. The calves were fed either HPR (n = 10) or HER (n = 10) using mobile plastic bottles fitted with soft rubber nipples. All calves received 1.8L diluted MR at each feeding 3 times daily during the first 4 weeks of age; feeding frequency was reduced to 2 times daily for the next 2 weeks of age and then to once daily during the last week of the experiment. Jugular blood was sampled in calves at day 7, 14, 21, 35 and 49 of age to enumerate selected metabolites. Daily MR, starter and hay intake during the pre-weaning period were similar in calves fed HPR and HER. Consumption of starter, MGH and total DM steadily increased with the age of calves. Final BW, daily BW gain and feed efficiency of calves were not affected by treatments. Serum glucose, cholesterol, creatinine were decreased (p<0.05) and blood urea N was increased (p<0.05) in calves fed HER or HPR as they grew older. Serum glucose, total protein and albumin concentrations in calves were not affected by treatments. Serum GPT and GOT concentrations were higher (p<0.05) in calves on HPR than on HER. Scouring score, days scoured, respiratory score, rectal temperature and general appearance were similar in calves fed HPR and HER. Poor general appearance (dullness and droopy ears) of calves fed either HPR or HER reflected nutritional insufficiency and stress. In conclusion, energy and protein concentrations in MR did not affect feed intake and BW gain in Holstein calves during the pre-weaning period. Poor general appearance and lower BW gain of calves compared to those reported in the literature for milk fed calves prompt a demand for further research to improve the daily nutrient supply to MR-fed calves.

• 사상체질의학회지
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• 제14권1호
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• pp.51-66
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• 2002

The main purpose of this study is to differentiate Sasang Constitutions of men and women by measuring 5 parts of the body. By the definitions about Four Chos(四焦) in ${\ulcorner}$The Discourse on Viscera and Bowels(臟腑論)${\lrcorner}$, the body is divided into four parts and sets up the five borderlines. They are Top-line, Bosom-line, Stomach-line, Navel-line and Bottom-line. Top-line(第一線) is the horizontal distance between Rt. & Lt. Coracoid processes passing through the acupuncture point CV-22(天突穴) or the horizontal distance between Rt. & Lt. beginning points of Axillary lines. Bosom-line(第二線) is the horizontal distance passing through Rt.& Lt. Nipples. Stomach-line(第三線) is the horizontal distance passing through Rt.& Lt. acupuncture point ST-19(不容穴). Navel-line(第四線) is the horizontal distance passing through the navel(CV-8; 神闕穴) and the acupuncture point ST-25(天樞穴). Bottom-line(第五線) is the horizontal distance between Rt. & Lt. Anterior Superior Iliac Spine(ASIS). The measured numerical values of Five Lines are the most important factors to classify the Four Constitutions(Taeyangin, Taeumin, Soyangin, Soeumin). Among the five lines, Stomach-line(Middle-line) is the base line to decide Yin and Yang. As a result, I could differentiate the four Constitutions as follows. 1. Taeyangin's Top-line is more than 36cm long. Top-line is the longest. Bottom-line is the shortest. The length-difference between Top-line and Bottom-line is more or less 10cm long. 2. In case of Taeumin, Navel-line is the longest. The numerical values of Middle and Bottom lines are almost the same or Bottom-line is shorter than Middle-line by 1 or 2 cm long. In some special case, the five lines are all the same and the body just looks like a log. 3. In case of Soyangin, just like Taeyangin, Top-line is the longest. Bottom-line is the shortest. The length of Top-line is ranged between 30cm to 35cm long. From Top-line to Bottom-line, the length gradually diminishes each by 2cm: for example, 34-32-30-28-26. 4. In case of Soeumin, the longest one is Bottom-line. Specially, Navel-line is shorter than Middle-line. Bottom-line is longer than the Middle.

• Asian-Australasian Journal of Animal Sciences
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• 제21권1호
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• pp.120-123
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• 2008

This experiment was conducted to investigate the effect of different nipple angles on water disappearance in growing pigs, which is defined as the water which leaves the watering device but is not consumed by the pig. This water adds to the volume of the total waste slurry. Four crossbred pigs averaging $70.0{\pm}1.4$ kg were assigned into 1 of 4 treatments using a $4{\times}4$ Latin-square design. Treatments were distinguished by the angle between nipple terminal and the perpendicular wall. These angles were: 1) NA-30 (= Nipple Angle $30^{\circ}$), 2) NA-45 (= Nipple Angle $45^{\circ}$), 3) NA-60 (= Nipple Angle $60^{\circ}$) and 4) NA-90 (= Nipple Angle $90^{\circ}$). All of the nipples were fixed at shoulder height of each pig. After a 7-day adaptation period, samples were collected from each pig for 4 days, followed by a day for change-over. Pigs were fed a 0.8 kg diet twice daily at 08:00 and 20:00 and supplied water ad libitum. Throughout the experimental period, pigs in the NA-30 treatment group showed greater water disappearance than other treatments. Water disappearance was the lowest for the NA-60 treatment group (p<0.01). The percentage of water disappearance to the water supply was significantly reduced in the NA-60 treatment group (p<0.01). Water intake was the same for all the treatment groups. The rate of water disappearance per unit of water intake was significantly decreased in pigs in the NA-60 treatment group compared to other groups (p<0.01). These results suggested that the nipple angle for growing pigs should be $60^{\circ}$ to reduce water disappearance and, subsequently, the amount of waste generated.

• 대한약침학회지
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• 제21권3호
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• pp.139-150
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• 2018

Averagely 80% to 90% of breastfeeding women experience the nipple pain and fissures. The important factor for successful breastfeeding is to treat this problem. This study has done as a review with the aim of analysis of the clinical trials in the field of the prevention and treatment of the nipple fissures and pain due to the importance of breastfeeding. For this purpose, the key words of sore, nipples, fissure, trauma, wound, prevention, treatment, therapeutics, therapy, clinical trial, breastfeeding and their Persian synonyms and all of their possible combinations were searched in the national databases: SID and Iran Medex and Magiran, and in the international databases: PubMed, Scopus, Medline, Science direct by May 2017. The Jadad criterion was used to assess the quality of the articles and the articles with a score of 3 or more were included in this study. Finally, 48 clinical trials were reviewed that 17 of them (sample size 1801) scored 3 or more based on the Jadad criterion. Seven articles were also in the non- drug treatment group (sample size 491) and 2 articles in the drug treatment group (sample size 337) and 8 articles in the herbal treatment group (sample size 973).The results show that menthol and warm water compress as well as teaching the correct breastfeeding methods are effective treatments to prevent and treat the nipple pain and fissures. Moreover, applying the herbal medicine for prevention and treatment of the issues raised from breastfeeding may have beneficial such as Aloe vera, Portulaca olearacea. However, more studies with a great methodology are necessary to obtain more accurate evidence.