• Journal of Chest Surgery
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• 제53권2호
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• pp.41-48
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• 2020

Background: Chylothorax after congenital heart surgery is not an uncommon complication, and it is associated with significant morbidity. However, consensus treatment guidelines are lacking. To improve the treatment outcomes of patients with postoperative chylothorax, we implemented a standardized management protocol at Severance Hospital in September 2014. Methods: A retrospective review of patients treated at a single center was done. All corrective and palliative operations for congenital heart disease performed at our institution between January 2008 and April 2018 were reviewed. The incidence and treatment outcomes of postoperative chylothorax were analyzed. Results: The incidence of chylothorax was 1.9%. Sixty-one percent of the patients could be managed with a low-fat diet, while 28% of the patients required complete restriction of enteral feeding. Thoracic duct embolization was performed in 2 patients and chest tube drainage decreased immediately after the procedure. No patient required thoracic duct ligation or pleurodesis. After implementation of the institutional management protocol, the number of chest tube drainage days decreased (median, 24 vs. 14 days; p=0.45). Conclusion: Implementing a strategy to reduce postoperative chylothorax resulted in an acceptable incidence of postoperative chylothorax. Instituting a clinical practice protocol helped to curtail the treatment duration and to decrease the requirement for surgical treatment. Image-guided embolization of the thoracic duct is an effective treatment for postoperative chylothorax.

• 대한약침학회지
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• 제18권3호
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• pp.42-48
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• 2015

Objectives: The aim of the study is to investigate both the single-dose intramuscular injection toxicity and the approximate lethal dose of water-soluble Carthami-flos and Cervi cornu parvum pharmacopuncture (WCFC) in male and female Sprague-Dawley (SD) rats. Methods: The study was conducted at Biotoxtech Co. according to the Good Laboratory Practice (GLP) regulation and the toxicity test guidelines of the Ministry of Food and Drug Safety (MFDS) after approval of the Institutional Animal Care and Use Committee. Dosages for the control, high dose, middle dose and low dose groups were 0.5 mL/animal of saline and 0.5, 0.25 and 0.125 mL/animal of WCFC, respectively. WCFC was injected into the muscle of the left femoral region by using a disposable syringe (1 mL, 26 gauge). The general symptoms and mortality were observed 30 minutes, 1, 2, 4, and 6 hours after the first injection and then daily for 14 days after the injection. The body weights of the SD rats were measured on the day of the injection (before injection) and on the third, seventh, and fourteenth days after the injection. Serum biochemical and hematologic tests, necropsy examinations, and histopathologic examinations at the injection site were performed after the observation period. Results: No deaths, abnormal clinical symptoms, or significant weight changes were observed in either male or female SD rats in the control or the test (0.125, 0.25, and 0.5 mL/animal) groups during the observation period. No significant differences in hematology and serum biochemistry and no macroscopic abnormalities at necropsy were found. No abnormal reactions at injection sites were noted on the topical tolerance tests. Conclusion: The results of this single-dose toxicity study show that WCFC is safe, its lethal doses in male and female SD rats being estimated to be higher than 0.5 mL/animal.

• 대한약침학회지
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• 제23권1호
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• pp.18-24
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• 2020

Objectives: Pain is considered as a cause of sickness and the most prevalent symptom which makes people visit a physician. Nowadays, combination therapy is becoming useful to relieve chronic and postsurgical pain. The aim of this study was to study the promethazine (as an antihistamine) interactions with antinociceptive effect of diclofenac (as a non-steroidal anti-inflammatory drugs). Methods: In initial part of the study, we investigate the analgesic effect of diclofenac. Using writhing test, we demonstrate that diclofenac significantly reduces writhe response induced by acetic acid in a dose-dependent manner. In this study, we evaluate the combination effect of promethazine on diclofenac analgesic effect. Results: We observed that diclofenac inhibited pain in the dose dependent manner which means that by increasing dose of diclofenac a significant decrease in pain was observed. This experimental setup allowed calculation of the dose that caused 50% antinociception (ED50) for diclofenac. The ED50 for diclofenac in this study was determined to be 9.1 mg/kg according our previous study. Additionally, promethazine was showed a dose-dependent inhibition of writhes. The combination of different doses of promethazine (2, 4, 6 mg / kg) with diclofenac ED50 (9.1 mg / kg) was injected to mice. Promethazine 4 and 6 mg / kg in combination with diclofenac had significantly led to increase analgesic effect of diclofenac. Conclusion: In conclusion, these results add important information to the existing knowledge on combination of diclofenac and antihistamine in pain therapies to be used in clinical practice and maybe helpful in designing the future guidelines.

• Archives of Plastic Surgery
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• 제47권1호
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• pp.3-8
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• 2020

Genital lymphedema (GL) is an uncommon and disabling disease that manifests as enlargement of the genital region resulting from the disturbance of lymphatic drainage. Although conservative treatment such as decompression is typically the first-line approach, surgical intervention has been shown to be effective in certain cases. This study aimed to systematically review studies evaluating available surgical alternatives for the treatment of male GL. A systematic search strategy using keyword and subject headings was applied to PubMed, Scopus, EMBASE, and Cochrane Library in May 2019. Studies investigating various surgical techniques to treat penile and scrotal lymphedema were included. The potential risk of bias of included trials was evaluated using the methodological index for non-randomized studies (MINORS). In total, 13 studies met the inclusion criteria, nine of which were determined to be high-quality. The average MINORS score was 12.45 for studies involving excision and 14 for studies involving lymphovenous anastomosis (LVA). The most common reason for a low score was a failure to describe the inclusion criteria. Recurrence of lymphedema during follow-up was reported in four studies involving excision and in no studies involving LVA. In general, the quality of the included literature was considered to be fair. Although surgical intervention might not always prevent the recurrence of lymphedema, all of the studies reported improved quality of life after the procedure. This study could be used as the basis for evidence-based guidelines to be applied in clinical practice for managing male GL.

• Journal of Genetic Medicine
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• 제9권1호
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• pp.1-10
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• 2012

About 7% of all breast cancer (BC) cases result from a genetic predisposition, and approximately 1,000 patients develop hereditary BC (HBC) every year in Korea. BRCA1 and BRCA2 are the primary genes underlying HBC. The average cumulative risks in BRCA1 mutation carriers at 70 years of age are 65% (95% confidence interval 44-78%) for BC and 39% (18-54%) for ovarian cancer (OC). The corresponding estimates for BRCA2 are 45% (31-56%) and 11% (2.4-19%), respectively. The penetrance of BRCA mutations is not the same between patients and can depend on factors such as race and birth-cohort. The Korean Hereditary Breast Cancer (KOHBRA) study is a large prospective nationwide study that includes 39 participating centers. Between May 2007 and May 2010, the first phase of the KOHBRA study was planned and fulfilled successfully. The primary aim of phase I was to estimate the prevalence of BRCA1/2 mutations and OC among a high-risk group of patients with HBC and their families. According to data collected during phase I of the study, the prevalence and penetrance of BRCA mutations were comparable to corresponding data from Western countries. For the second phase of the KOHBRA study, we are currently investigating a Korean BRCA mutation prediction model, prognostic factors in BRCA-related BC, environmental/genetic modifiers, and implementing a genetic counseling network. The final goal of the KOHBRA study is to create clinical practice guidelines for HBC in Korea. In this article, I review the genetics of HBC, summarize the characteristics of Korean HBC, and discuss current and future HBC research in Korea.

• Nutrition Research and Practice
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• 제11권4호
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• pp.290-299
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• 2017

BACKGROUND/OBJECTIVES: Spirulina is a known a functional food related to lipid profiles, immune functions, and antioxidant capacity. Circulating monocyte chemoattractant protein-1 (MCP-1) level is associated with inflammation markers. Single nucleotide polymorphism in the MCP-1 promoter region -2518 have been identified and shown to affect gene transcription. Gene variation may also impact functional food supplementary effects. The current study investigated the interaction of MCP-1 -2518 polymorphism with spirulina supplements on anti-inflammatory capacity in Korean elderly. SUBJECTS/METHODS: After genotyping, healthy elderly subjects (n = 78) were included in a randomized, double blind, and placebo controlled study. Baseline characteristic, body composition, and dietary intake were measured twice (baseline vs. week 16). For 16 weeks, subjects consumed 8 g either spirulina or placebo daily. Plasma MCP-1, interleukin (IL) -2, IL-6, tumor necrosis factor (TNF)-${\alpha}$, complement (C) 3, immunoglobulin (Ig) G, and Ig A concentrations and lymphocyte proliferation rate (LPR) were analyzed as inflammatory markers. RESULTS: In the placebo group with A/A genotype, MCP-1 level was significantly increased, but the spirulina group with A/A genotype was unchanged. IL-2 was significantly increased only in subjects with spirulina supplementation. TNF-${\alpha}$ was significantly reduced in subjects with the G carrier. C3 was significantly increased in the placebo group, particularly when A/A increased more than G, but not when spirulina was ingested. LPR was significantly different only in subjects with A/A genotype; there was a significant increase in phytohemagglutinin and lipopolysaccharide induced LPR in the spirulina group. CONCLUSION: In healthy Korean elderly, spirulina supplementation may influence different inflammatory markers by the MCP-1 genotype. These results may be useful for customized dietary guidelines to improve immune function in Koreans.

• 치위생과학회지
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• 제19권1호
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• pp.9-22
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• 2019

Background: The purpose of this systematic review was to investigate the effects of topical fluoride gel application on dental caries prevention in the permanent teeth of children and adolescents. Methods: We searched the EMBASE, PubMed, and Cochrane Library databases for randomized controlled trials (RCTs) assessing the effects of self-applied or professionally applied topical fluoride gels in patients <18 years of age; the search was completed on April 1, 2018. All included trials involved an experimental group (fluoride gel application) and a control group (placebo or no treatment). The outcome measures were the D(M)FS and D(M)FT indices, which were compared between the two groups. Review Manager software was used for quantitative synthesis of the final selected articles, and a forest plot was generated via a meta-analysis conducted using a random effects model. Results: The results showed that the D(M)FS and D(M)FT indices were lower in the fluoride application group than in the control group, thus indicating that fluoride gel application was effective in dental caries prevention. We also performed a subgroup analysis to determine whether the effects of fluoride application differed if patients received oral prophylaxis (self or professional) before fluoride gel application. Therefore, the two groups showed slightly larger differences when studies without oral prophylaxis before fluoride gel application were considered; however, the difference was not statistically significant. Conclusion: These findings should be utilized to raise awareness about the caries-prevention effects of topical fluoride application among patients and guardians. Further RCTs should evaluate the effects of fluoride application with or without preceding oral prophylaxis, and appropriate fluoride application guidelines should be developed to maximize the effects of fluoride application in clinical practice.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제22권1호
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• pp.1-27
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• 2019

The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in South Korea and worldwide, and new guidelines were established in each area with the strength of recommendations based on the levels of evidence: 1) definition and diagnosis of overweight and obesity in children and adolescents; 2) principles of treatment of pediatric obesity; 3) behavioral interventions for children and adolescents with obesity, including diet, exercise, lifestyle, and mental health; 4) pharmacotherapy; and 5) bariatric surgery.

• 대한치과의사협회지
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• 제57권8호
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• pp.428-436
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• 2019

In cases of a patient referral, the general dentist should communicate the patient's dental information as clearly as possible to the specialist to whom he/she is referring his/her patient. For this reason, it is necessary to write a referral letter in an accurate and complete manner. The purpose of this study is to analyze the referral letters of patients who are referred to the department of conservative dentistry in a dental university hospital. From January, 2017 to December, 2018, we gathered the information of the patients who were referred to the department of conservative dentistry in a dental university hospital with referral letter. We evaluated the fidelity of a total of 750 referral letters and recorded the information of the referral dentist and the dental clinic. The relationship between each item and fidelity was analyzed using SPSS 18.0 program. The analysis of the contents of the referral letters yielded the following results: The fidelity of the referral letter was higher when the patient was referred during the root canal treatment, or when there was a root canal filling or when there was pain during chewing. The fidelity of referral letter was low in cases where the referring clinic is close to and has cooperative relationship with dental university hospital. Among the factors affecting the fidelity, the year of graduation of the referral dentist was the most influential. This study confirmed the fact that the clinical practice of writing patient referral letters still leaves much to be desired. In order to solve this problem, it is necessary to create more clear and standardized guidelines for writing referral letters.

• 사상체질의학회지
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• 제32권4호
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• pp.45-64
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• 2020

Purpose This study was to develop and study 'Diagnostic Index for the Ordinary Symptom of Soyangin'. Methods The main diagnosis and evaluation index symptoms of Soyangin were extracted based on 『Donguisusebowon』 and Clinical Practice Guidelines for Sasang Constitutional Medicine Symptomatology; CPG for soyangin. The selected ordinary symptoms were divided into 4 categories such as Exterior-Cold ordinary symptom (表寒素證), Exterior-Disease unfavorable's ordinary symptom (表病逆證素證), Interior-Heat ordinary symptom (裏熱素證), Interior-Disease unfavorable's ordinary symptom (裏病逆證素證) of Soyangin and translated into Korean. And the inclusion, importance and translation validity of major diagnosis and assessment indicators of Soyangin were surveyed online by a group of Sasang constitutional experts. Results & Conclusions 29 ordinary symptoms and pathological mechanism were selected from references and translated into 51 Korean symptoms. After inclusion yes or no survey by expert group, 45 symptoms were selected. The importance survey showed that 'Have a soft stool' of Exterior-Cold ordinary symptom indication, '(If you're stressed, if you're not in good health) Have a soft stool or diarrhea' of Exterior-Disease unfavorable's ordinary symptom, 'The feces harden easily' of Interior-Heat ordinary symptom and '(If you're stressed, if you're not in good health) Have an upset stomach' of Interior-Disease unfavorable's ordinary symptom were the most important. Finally, [Diagnostic Index for the Ordinary Symptom of Soyangin] was completed after survey of translation validity, reflection of individual opinions by the expert committee, and application of weighted value calculated from the importance survey.