• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.23 no.2
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• pp.111-118
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• 2012

Botulinum toxin is a potent neurotoxin that is produced by the bacterium Clostridium botulinum. The agent causes muscle paralysis by preventing the release of acetylcholine at the neuromuscular junction of striated muscle. Botulinum toxin A (Botox, AllerganInc., Irvine, California) is the most potent of seven distinct toxin subtypes that are produced by the bacterium. The toxin was initially used clinically in the treatment of strabismus caused by hypertonicity of the extraocular muscles and was sub-sequently described in the treatment of multiple disorders of muscular spasticity and dystonia. In treating patients with Botox for blepharospasm, Carruthers and Carruthers [5] noticed an improvement in glabellar rhytids. This ultimately led to the introduction and development of Botox as a mainstay in the treatment of hyperfunctional facial lines in the upper face. Since its approval by the U.S. Food and Drug Administration for the treatment of facial rhytids (2002), botulinum toxin A has expanded into wide-spread clinical use. Forehead, glabellar, and periocular rhytids are the most frequently treated facial regions. Indications for alternative uses for Botox in facial plastic and reconstructive surgery are expanding. These include a variety of well-established procedures that use Botox as an adjunctive agent to enhance results. In addition, Botox injection is finding increased usefulness as an independent modality for facial rejuvenation and rehabilitation. The agent is used beyond its role in facial rhytids as an effective agent in the management of dynamic disorders of the face and neck. Botox injection allows the physician to precisely manipulate the balance between complex and conflicting muscular interactions, thus resetting their equilibrium state and exerting a clinical effect. This article will address some of the new and unique indications on Botox injection in the face (the lower face and neck, combination with fillers). Important points in terms of its clinical relevance will be stressed, such as an understanding of functional facial anatomy, the importance of precise injections, and correct dosing all are critical to obtaining natural outcomes.

• Applied Microscopy
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• v.15 no.1
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• pp.71-85
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• 1985

The ultrastructure on the dorsal vessel of 5-day-old cabbage butterfly, Pieris rapae L., was carried out using the transmission and scanning electron microscope. The results are as follows. 1) The aorta. The aorta is simple tubular type and consists of the inner and outer membrane of the myocardium and thick myocardium is located between them. However the inner membrane with $0.26{\mu}m$ thickness and outer membrane with $0.08{\mu}m$ are composed of fibrous materials, the former is composed of low and high densed fibrous materials and the latter appears homogeneous layer. The myocardium consists of typical striated muscles. The sarcomere with $1.6{\mu}m$ length and in cross section, each thick filaments are surrounded by $7{\sim}8$ thin filaments. The intercalated disc is joining the end of the two muscle cells, desmosomes and septate junctions are appeared between the neighboring muscle cells. 2) The heart. The heart composing of myocardium enclosed by its inner and outer membrane as the aorta has a series of well formed segmental chamber. The arrangement of myofilaments, cell adhensions and membrane elements are observed as same as at the aorta. The inner membrane of the heart is deeply invaginated into the myocardium than the outer membrane and a lot of well developed mitochondria with rod shape are aggregated in the folds. The longitudinally and transversely oriented tubule system formed by invagnation of the sarcolemma into the muscle bundle is built up dyad with the sarcoplasmic reticulum as the aorta. The slit is formed by deeply invagination of the inner membrane of myocadium toward the muscle layer and then the inner and outer membrane of myocardium are fused. Therefore, the ostium is formed between the myocardium and situated at the lateral side of the myocardium.

• Journal of Trauma and Injury
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• v.32 no.1
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• pp.26-31
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• 2019

Purpose: Rhabdomyolysis (RB) is a syndrome characterized by the decomposition of striated muscles and leakage of their contents into the bloodstream. Acute kidney injury (AKI) is the most significant and serious complication of RB and is a major cause of mortality in patients with RB. Severe RB (creatine kinase [CK] ${\geq}5,000$) has been associated with AKI. However, early prediction is difficult because CK can reach peak levels 1-3 days after the trauma. Hence, the aim of our study was to identify predictors of severe RB using initial patient information and parameters. Methods: We retrospectively analyzed 1,023 blunt trauma patients admitted to a single tertiary hospital between August 2011 and March 2018. Patients with previously diagnosed chronic kidney disease were excluded from the study. RB and severe RB were defined as a CK level ${\geq}1,000U/L$ and ${\geq}5,000U/L$, respectively. The diagnosis of AKI was based on RIFLE criteria. Results: The overall incidence of RB and severe RB was 31.3% (n=320) and 6.2% (n=63), respectively. On multivariable analysis, male sex (odds ratio [OR] 3.78, 95% confidence interval [CI] 1.43 to 10.00), initial base excess (OR 0.85, 95% CI 0.80 to 0.90), initial CK (OR 2.07, 95% CI 1.67 to 2.57), and extremity abbreviated injury scale score (OR 1.78, 95% CI 1.39 to 2.29) were found to predict severe RB. The results of receiver operating characteristic analysis showed that the best cutoff value for the initial serum CK level predictive of severe RB was 1,494 U/L. Conclusions: Male patients with severe extremity injuries, low base excess, and initial CK level >1,500 U/L should receive vigorous fluid resuscitation.

• Archives of Plastic Surgery
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• v.32 no.1
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• pp.85-92
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• 2005

Botulinum toxin type A is widely used for anti-wrinkling therapy, and correction of the square face. The toxin ultimately prevent the release of membrane-bound acetylcholine at the neuromuscular junction of striated muscles and thus produce chemical denervation and paralysis of the muscles. Our purpose of study is to know if application of botulinum toxin type A on calf reduction is effective, how much dosage is effective, and what are the possible complications. We reviewed data of 30 consecutive patients subjected to calf reduction in Dong-A University Hospital from February 2003 to April 2003. We injected normal saline 2cc on both calves region in 15 control group patients, and the other patients was divided 3 group. Group 1, Group 2, Group 3 was injected 50U, 100U, 150U botulinum toxin A on each calf region and followed up for 6 month. Maximal circumference of calf was not changed in the control group but an average of 0.7 cm reduction was noted in group 1, average 1.34 cm(right calf) and 1.26cm(left calf) in group 2, average 1.44cm(right calf) and 1.58cm(left calf) in group 3. Maximal area of calf was not changed in the control group but average reduction of 12.5%(right calf) and 12.7%(left calf) was obtained in group 1, average 19.4% (right calf) and 19.9%(left calf) in group 2, average 24.8%(right calf) and 21.07%(left calf) in group 3, as measured on CAT scan. Total fat amount and fat amount in the lower extremity was no change in all the groups, but lean body mass was decreased average 1.27%(right calf) and 1.15%(left calf) in group 1, average 3.47%(right calf) and 2.98%(left calf) in group 2, average 3.58%(right calf) and 3.95%(left calf) in group 3. Photography of the preoperative and postoperative 6 month state revealed higher satisfaction in Group 2, 3 compared to Group 1. Use of botulinum toxin type A in calf reduction is a very simple, safe, non-invasive method and effective in terms of calf contouring rather than reduction of calf circumference.

• Applied Microscopy
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• v.36 no.4
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• pp.299-305
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• 2006

Onuf's nucleus, which is located in the ventral horn, has been known to innervate the striated muscles of the urethral and anal sphincter muscles via the pudendal nerve Onuf's nuclei are resistant to pathologic condition such as poliovirus. The reason why the motor neurons in Onuf's nucleus are less degenerated is not certain until now. The present study aims at updating the microscopical characteristics including its location the Onuf's nucleus innervating the external urethral sphincter, and ultrastructures of the zinc-enriched (ZEN) terminals synaptically-contacting with Onuf's motor neurons in the rat spinal gray matter by using HRP tracing method and zinc selenium autometallography, respectively. Based on HRP tracing method, Onuf's nuclei were located adjacent lateral dendritic projections of the ventral horn. Their shape was almost round at lumbar level, but oval at sacral segment of spinal cord. In size, their somata were smaller than that of other motor nuclei. In AMG stained sections, Onuf's nuclei were innervated by highly concentrated ZEN terminals, and contained small and middle-sized ZEN, but totally void of large ZEN terminals. AMG silver grains were confined to presynaptic ZEN terminals against dendritic elements and somata of the Onuf's motor neurons. A majority of the ZEN terminals contained flattened synaptic vesicles and made symmetrical synaptic specializations.

• Biomedical Science Letters
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• v.12 no.2
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• pp.73-79
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• 2006

Nebulin is a giant ($600{\sim}900$ kDa), modular sarcomeric protein proposed to regulate the assembly, and to specify the precise lengths of actin filamints in vertebrate skeletal muscles. Recently, There is an evidence that the nebulin also expressed in non muscle tissue, brain and liver. We identified a new isoform of nebulin from adult brain library by PCR screening. It contains two simple-repeats exon 165, 166 and linker-repeats exon $154{\sim}161$ except exon 159. The nebulin modules M160 to M170 (exon 150 to exon 161) has been shown to bind desmin. In mature striated muscle, desmin intermediate filaments surround Z-discs and link individual myofibrils laterally at their Z-discs and to other intracellular structures, including the costameres and the intercalated discs of the sarcolemma, sarcoplasmic reticulum, mitochondria, T-tubules, and nuclei. Therefore, it is an interesting possibility that the differential splice pathways within the linker region of nebulin modify the affinity of nebulin's interaction with desmin. The specific interactions of nebulin and desmin were confirmed in vivo by yeast two hybrid experiments. To verify in the cellular level the interaction between nebulin isoform and desmin, we transfected COS-7 cell with EGFP-tagged nebulin and DsRed-tagged desmin. Based on evidence showing that despite exon 159 was deleted, the new isoform of nebulin was interact with desmin. This suggest that nebulin in brain may interact with another intermediate filament. The conservation of these ligand-binding capacity in brain and skeletal nebulins suggest that nebulins may have conserved roles in brain and skeletal muscle.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1972.03a
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• pp.2.3-2
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• 1972

The vestibular function test reveals the objective findings of the impairment of the vestibular labyrinth. It's purpose is based on the analysis of the findings and detect the location and etiology of the labyrinthine impairment. In the vestibular function test, the vestibulo-spinal reflex has the clinical significance upon the tonus of the striated muscles by the labyrithine stimulation and contribute to regulating the posture and the position, at rest as well as in motion. The vestibulo-spinal reflex must performe as one of the routine vestivular function test because it can be evoked in man by such weak stimuli to the labyrinth as cannot induce vestibulo-ocular reflex. Authors performed the vestibular function test such as one leg test, gait test, stepping test and vertical writing test to one hundred of healthy and young male adult and received the following results. Results 1. One leg test: In 30 seconds, the frequency of dropping the leg on the ground was between 0 to 3 times in Rt., and 0 to 5 times in Lt. The mean frequency was 0.48 times in Rt., and 0.68 times in Lt. 2. Gait test: In forward gait; the range of the deviation was distributed 0 to 100 cm and mean range was 22.5cm to the Rt., 26.1cm to the Lt. In backward gait; the range deviation was distributed 0 to 140cm and mean range was 35.4cm to the Rt., 33.0cm to the Lt. 3. Stepping test: In normal head position; forward movement war 93% and backward 5%. The angle of displacement deviated to the Rt. side in 36%, and Lt. in 50%. The angle of rotation deviated to the Rt. side in 53 %, and Lt. in 36%. The mean values: angle of displacement was 22.05 degrees, angle of rotation was 24.40 degrees, distance of displacement was 48.95cm. In backward head position; Forward movement was 94% and backward was 3%. The angle of displacement deviated in 34%, and Rt. in 55%, to the Rt. side The angle of rotation deviated to the Rt. side in 50%, and Lt. in 42%. The mean values; angle of displacement was 29.72 degrees, angle of rotation was 39.53 degrees, distance of displacement was 44.17cm. 44.17cm. 4. Vertical writing test: The angle of deviation was between 0 to 16 degrees in all cases, and was between 0 to 12 degrees in the cases of normal head position. The mean angle of deviation was between 4.15 to 5.76 degrees on each side. The direction of deviation to the Rt. side was 54~69%, Lt. was 25~40% and 3~7% was vertical without deviation.