• Archives of Plastic Surgery
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• v.45 no.3
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• pp.229-238
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• 2018

Background Nipple-sparing mastectomies (NSMs) are increasingly performed to obtain the best aesthetic and psychological outcomes in breast cancer treatment. However, merely preserving the nipple-areolar complex (NAC) does not guarantee a good outcome. Darkly pigmented NACs and a tendency for poor scarring outcomes are particular challenges when treating Asian patients. Herein, we review the reconstructive outcomes following NSM at Singapore General Hospital. Methods All breasts reconstructed following NSM over an 11-year period from 2005 to 2015 were reviewed. Information was collected from the patients' records on mastectomy indications, operative details, and complications. Patient satisfaction, breast sensation, and aesthetic outcomes were evaluated in 15 patients. Sensation was quantified using the Semmes-Weinstein monofilament test. Results A total of 142 NSMs were performed in 133 patients for breast cancer (n=122, 85.9%) or risk reduction (n=20, 14.1%). Of the procedures, 114 (80.2%) were autologous reconstructions, while 27 (19.0%) were reconstructions with implants. Complications occurred in 28 breasts (19.7%), with the most common complication being NAC necrosis, which occurred in 17 breasts (12.0%). Four breasts (2.8%) had total NAC necrosis. The overall mean patient satisfaction score was 3.0 (good). The sensation scores were significantly diminished in the skin envelope, areola, and nipple of breasts that had undergone NSM compared to non-operated breasts (P<0.05). Half of the subset of 15 patients in whom aesthetic outcomes were evaluated had reduced nipple projection. Conclusions Immediate reconstruction after NSM was performed with a low complication rate in this series, predominantly through autologous reconstruction. Patients should be informed of potential drawbacks, including NAC necrosis, reduced nipple projection, and diminished sensation.

• Journal of Wetlands Research
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• v.20 no.1
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• pp.63-71
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• 2018

The particle filtration mechanisms in an infiltration trench should be varying due to the different hydraulic conditions during stormwater runoff. The understanding of these variations associated with different filtration mechanisms and their effect on the particle removal efficiency is of vital importance. Therefore, a LID (Low Impact Development) system comprising of an infiltration trench packed with gravel and woodchip was investigated during the monitoring of several independent rainfall events. A typical rainfall event was divided into separate regimes and their corresponding flow conditions as well as filtration mechanisms in the trench were analyzed. According to hydraulic conditions, it was found out that filtration changes between vertical and horizontal flows as well as between unsaturated, saturated, and partially-saturated flows. Particle separation efficiency was high (55-76%) and was mainly governed by physical straining during the unsaturated period. It was then enhanced by diffusion during the saturated period (75-95%). When the trench became partially saturated at the end of the rainfall event, the efficiency decreased which was believed to be due to the existence of a negatively charged air-water interface which limited the removal to positively charged particles.

• Anxiety and mood
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• v.4 no.1
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• pp.49-54
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• 2008

Objective : This article is a part of the Korean Medication Algorithm Project for Panic Disorder, which aims to build consensus regarding the diagnosis, treatment response and achievement of clinical remission for patients with panic disorder in Korea. Methods : The questionnaire used in this article had parts : 1) diagnosis, 2) treatment response, and 3) remission for patients with panic disorder. The questionnaire was completed by each of 54 Korean psychiatrists who had much experience in treating patients with panic disorder. We classified the experts' opinions into 3 categories (first-line, second-line, and third-line) using the ${\chi}^2$-test. Results : Five factors were considered in this research : panic attack, anticipatory anxiety, phobic avoidance, severity of illness, and psychosocial disability. Most reviewers agreed that the presence of a panic attack was the most important factor in the diagnosis of patients with panic disorder. Phobic avoidance was included in the first-line category, whereas the severity of illness and psychosocial disability were included in the second-line category. Most reviewers also agreed that the presence of a panic attack was the most important factor in determining the appropriate treatment response, and it was included in the first-line category along with several other items. To determine remission status, the patients' scores on tests pertaining to the severity of panic attack, anticipatory anxiety, phobic avoidance, severity of illness and psychosocial disability should be less than 3.0-3.3 on a 9-point Likert scale. Conclusion : We suggest useful information for making a diagnosisof panic disorder, determining the appropriate treatment response and identifying remission in panic disorder patients on the basis of the results of a nationwide survey of experts in Korea.

• Clinical and Experimental Emergency Medicine
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• v.3 no.3
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• pp.175-180
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• 2016

Objective Combination of ${\beta}_1-adrenergic$ receptor (AR) blockade and ${\beta}_2-AR$ activation might be a potential novel therapy for treating heart failure. However, use of ${\beta}-AR$ agonists and/or antagonists in the clinical setting is controversial because of the lack of information on cardiac inotropic or chronotropic regulation by AR signaling. Methods In this study, we performed hemodynamic evaluation by examining force frequency response (FFR), Frank-Starling relationship, and response to a non-selective ${\beta}-AR$ agonist (isoproterenol) in hearts isolated from 6-month-old transgenic (TG) mice overexpressing ${\beta}_1-$ and ${\beta}_2-ARs$ (${\beta}_1-$ and ${\beta}_2-AR$ TG mice, respectively). Results Cardiac physiologic consequences of ${\beta}_1-$ and ${\beta}_2-AR$ overexpression resulted in similar maximal response to isoproterenol and faster temporary decline of positive inotropic response in ${\beta}_2-AR$ TG mice. ${\beta}_1-AR$ TG mice showed a pronounced negative limb of FFR, whereas ${\beta}_2-AR$ TG mice showed high stimulation frequencies with low contractile depression during FFR. In contrast, Frank-Starling relationship was equally enhanced in both ${\beta}_1-$ and ${\beta}_2-AR$ TG mice. Conclusion Hemodynamic evaluation performed in the present showed a difference in ${\beta}_1-$ and ${\beta}_2-AR$ signaling, which may be due to the difference in the desensitization of ${\beta}_1-$ and ${\beta}_2-ARs$.

• The Journal of Traditional Korean Medicine
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• v.15 no.1
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• pp.128-144
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• 2006

This Study aims at looking into the use of oriental medical services in treating hypertension. The first objective to be explored through this study is the morbidity caused by the disease, classifying them by age, gender, and occupation. The second is to determine the regular use of anti-hypertensive medicine and their efficacy in controlling blood-pressure. The third is to investigate the use-rate and satisfaction of oriental medical service. 838 households across the country, were asked to answer questionnaires for the period of time from Apr. to Jun. 2005. The conclusion from the survey can be summarized as following. The age of which the first medical diagnosis of hypertension were made showed lower in males, those with higher education and income. The study showed females were more active in blood-pressure control, with their frequent monitoring of blood-pressure for the past year. With age, people in under 50 age group proved to be less active. The management of high blood pressure was more effective in group with regular dosage compared to group with irregular use of anti-hypertensive medication, but their difference was minimal. Also, group with no medication showed signs of blood-pressure control. The use of oriental medical service for the past year, were more frequent in groups with lower education, either low or high income, old age, females and occupations in agriculture, forestry and fishing industry. Results were similar in both general population and high blood-pressure patient group. Females, people over 51 years old and with lower education showed more intentions in utilizing oriental medical services in the future. Results were similar in both general population and high blood-pressure patient group. It is necessary to offer a more accurate information on oriental medical treatments. Also, a systematic reform to reduce the patient's share of the treatment cost, as well as, heightening public awareness on the infirmity of present blood-pressure management system is crucial.

• Clinical Psychopharmacology and Neuroscience
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• v.16 no.4
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• pp.434-448
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• 2018

Objective: The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was first published in 2002 through an expert consensus of opinion, and updated in 2006, 2010, and 2014. This study constitutes the fourth revision of the KMAP-BP. Methods: A 50-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for various phases of adult bipolar disorder and six items for pediatric bipolar disorder. The review committee included 84 Korean psychiatrists and 43 child and adolescent psychiatry experts. Results: The preferred first-step strategies for acute mania were the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP), MS monotherapy, and AAP monotherapy. A combination of a MS and an AAP, and AAP monotherapy were preferred for psychotic mania. The first-step strategies for mild to moderate bipolar depression were monotherapy with MS, AAP, or lamotrigine (LMT), and the combination of a MS and an AAP or LMT, or a combination of an AAP and LMT. The combination of two among a MS, AAP, and LMT were preferred for non-psychotic severe depression. A combination of a MS and an AAP or the combination of an AAP with an antidepressant or LMT were the first-line options for psychotic severe depression. Conclusion: The recommendations of the KMAP-BP 2018 have changed from the previous version by reflecting recent developments in pharmacotherapy for bipolar disorder. KMAP-BP 2018 provides clinicians with a wealth of information regarding appropriate strategies for treating patients with bipolar disorder.

• Mood & Emotion
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• v.16 no.3
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• pp.123-128
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• 2018

Objectives : The fourth revision of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was performed to provide more proper guidelines for clinicians. In this study, we evaluated treatment strategies of elderly patients with bipolar disorders of KMAP-BP 2018. Methods : Sixty-one psychiatrists of the review committee with vast clinical experiences in treating bipolar disorders, completed the survey. An expert consensus was obtained, on pharmacological treatment strategies for elderly patients with bipolar disorder. The executive committee analyzed results, and discussed the results to produce the final algorithm. Results : In elderly patients with bipolar disorder, first-line treatment option for acute manic episode is monotherapy, with atypical antipsychotics or mood stabilizer, and a combination of mood stabilizer and atypical antipsychotics. First-line treatment option for acute depressive episode, was a combination of mood stabilizer and atypical antipsychotics, monotherapy with atypical antipsychotic or mood stabilizer, and atypical antipsychotics with lamotrigine. Conclusion : In KMAP-BP 2018, the recommendation for treatment option in elderly patients with bipolar disorder, was newly introduced. We expect this algorithm may provide valuable information, and facilitate treatment of elderly patients with bipolar disorder.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.32 no.3
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• pp.151-163
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• 2019

Objectives : The purpose of this study is to investigate the use of herbal medicine for the treatment of atopic dermatitis in cases and to find the general tendency of herbal medicine treatment and to establish the primary treatment direction of Atopic dermatitis. Methods : In the domestic databases, Oriental medicine Advanced Searching Integrated System(OASIS), Korean Traditional Knowledge Portal(KTKP), National Discovery for Science Leader(NDSL), Research Information Sharing Service(RISS), we selected among the papers published in the last 20 years using search terms related to "Atopic dermatitis & Cases". Reports based on Sasang constitutional medicine and Six meridian pattern identification were excluded and a total of 21 papers were finally selected. Results : 113 herbal medicines were retrieved from 21 papers. The most commonly used herbs are Scutellariae Radix(黃芩), Rehmanniae Radix(地黃), and Glycyrrhizae Radix et Rhizoma(甘草). Atractylodis Rhizoma(蒼朮), Akebiae Caulis(木通), Smilacis Rhizoma(土茯?), Paeoniae Radix(芍藥) used mostly when Oozing exists, Trichosanthis Radix (瓜蔞), Asparagi Radix(天門冬), Persicae Semen(桃仁), Carthami Flos(紅花) used mostly when Dryness, Lichenification, and Pigmentation exist. The average score of SCORAD index was improved after Herbal medicine treatment. Conclusion : Through this study, we could find out the tendency of herbal medicine to treat Atopic dermatitis along with Symptoms.

• Therapeutic Science for Rehabilitation
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• v.10 no.1
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• pp.53-61
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• 2021

Introduction : OMFT is a therapeutic technique based on sensorimotor, motor control and motor learning, and its major goal is to improve oral motor function. The oral motor conceptual hierarchical development is divided into 5 steps: 1) sensorimotor, 2) movement integration, 3) structural movement, 4) functional oral motor, and 5) comprehensive oral motor. Discussion : The OMFT consists of 3 techniques, 10 categories, and 50 sub-item. 1) Warming up technique: 2 categories, 12 sub-item, warming up by sensory awareness and adaptation, therapy situation adaptation, neck movement; 2) Key point technique: 7 categories, 30 sub-item, oral motor facilitation and increasing chewing skill by direct stroke of oral structures such as the face, lips, cheeks, gum, jaws, and tongue; 3) Application technique: 1 category, 8 sub-item, facilitate food intake and swallowing. Conclusion : The goal of this article is to introduce 3 techniques, 50 sub-item of OMFT, as a comprehensive oral motor therapy method, for application to clients. This article provides information that will help oral motor specialists in treating clients with oral motor problems more effectively and professionally.

• The Korean Society of Law and Medicine
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• v.23 no.2
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• pp.119-139
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• 2022

Brain stimulation technology that administers electrical and magnetic stimulation to a brain has shown a significant level of possibility for treating a wide range of various neurological and psychiatric disorders. Depending on its nature, the technology is defined either as invasive or non-invasive, and deep brain stimulation (DBS) is one of the most well-known invasive brain stimulation technologies. Currently categorized as grade 4 medical device in accordance with Guideline On Medical Devices And Their Grades, a Notification of Ministry of Food and Drug Safety (MFDS), the DBS has been used as a stable treatment for several diseases. At the same time, the DBS technology has recently achieved substantial advancement, encouraging active discussions for its use from various perspectives. On the contrary, debates over legal regulation related to the use of DBS has relatively been smaller in numbers. In this context, this article aims to 1) introduce the DBS technology and its safety in setting out the tone; 2) touch upon major legal issues that would potentially rise from its use for four different purposes of treatment, clinical study, areas of non-standard treatment where no other methods are available, and enhancement; and finally 3) highlight disputes concerning common emerging issues observed in the aforementioned four purposes from the viewpoint of legal responsibility and liability of using the DBS, which are benefit-risk assessment, physicians' duty of information, patients' capacity to consent, control for device, and insurance coverage.