Objectives : The aim of this study is to explore the types of pattern identification (PI, 辨證) and the differential points of PI used for the treatment of psoriasis in Traditional Chinese Medicine (TCM) based on the Chinese references and to provide the evidences applying PI for the treatment of psoriasis in clinical practice. Methods : This study extracted patterns of psoriasis through database CNKI (China National Knowledge Infrastructure) and analysis the patterns and classification criteria of the patterns. Those examined in the study are dermal symptoms, general symptoms, formula and herbs which are different depending on the patterns. Results : Total 60 studies were selected and 44 pattern types were extracted from them. We categorized the main pattern types on psoriasis used in TCM as 'blood-heat syndrome(BHS, 血熱證)', blood-stasis syndrome(BSS, 血瘀證), and 'blood-dryness syndrome(BDS, 血燥證)', 'dampness-heat syndrome(DHS, 濕熱證)' and 'yang-deficiency syndrome(YDS, 陽虛證)'. Among these patterns, BHS was the most common. In TCM, the pattern of BHS tended to have skin symptoms and signs related to inflammatory erythema and heat. Both BSS and BDS were characterized by long disease duration and poor healing. In addition, DHS tended to have the skin symptoms and signs such as oozing and severe itching. The symptoms and signs related to coldness mainly showed in YDS. For PI criteria, 'qi-blood-essence criteria(氣血津液辨證)' and 'eight-doctrine criteria(八鋼辨證) are commonly used. Conclusions : Our findings show that each PI on psoriasis in TCM has different characteristics related to dermal and general symptoms or signs. Further studies are needed to develop the diagnostic tool of PI on psoriasis reflecting on clinical practices in Korean Medicine by referring to the findings of this study about PI on psoriasis in TCM.
A microstructure analysis is carried out to optimize the process parameters of a randomly oriented discrete length hybrid carbon fiber reinforced carbon matrix composite. The composite is fabricated by moulding of a slurry into a preform, followed by hot-pressing and carbonization. Heating rates of 0.1, 0.2, 0.3, 0.5, 1, and $3.3^{\circ}C/min$ and pressures of 5, 10, 15, and 20 MPa are applied during hot-pressing. Matrix precursor to reinforcement weight ratios of 70:30, 50:50, and 30:70 are also considered. A microstructure analysis of the carbon/carbon compacts is performed for each variant. Higher heating rates give bloated compacts whereas low heating rates give bloating-free, fine microstructure compacts. The compacts fabricated at higher pressure have displayed side oozing of molten pitch and discrete length carbon fibers. The microstructure of the compacts fabricated at low pressure shows a lack of densification. The compacts with low matrix precursor to reinforcement weight ratios have insufficient bonding agent to bind the reinforcement whereas the higher matrix precursor to reinforcement weight ratio results in a plaster-like structure. Based on the microstructure analysis, a heating rate of $0.2^{\circ}C/min$, pressure of 15 MPa, and a matrix precursor to reinforcement ratio of 50:50 are found to be optimum w.r.t attaining bloating-free densification and processing time.
Objectives : The purpose of this study is to investigate the efficacy of external preparation containing herbal extract(Sophorae Radix, Aurantii Immaturus Fructus, Schizonepetae Spica, Forsythia fructus and Portulacea Herba) on atopic dermatitis patients. Methods : A total of 33 patients who visited the Dept. of Ophthalmology, Otolaryngology & Dermatology of Korean Medicine of Korean Medical hospital of Daejeon university from February 2012 to February 2013 were engaged in this study. Patients who corresponded the requirements were enrolled in the study. This study shows symptom comparisons before and after the use of this product. Effectiveness was evaluated through SCORAD(SCORing Atopic Dermatitis) Index, and the quality of life scale was conducted through Skindex-29. Results : 1. Comparison of the general changes through SCORAD Index indicated that the experimental group showed more statistically significant declines than the placebo group after the two-week use. 2. Comparison of changes in intensity criteria(Erythema, Edema, Oozing, Excoriation) through SCORAD Index indicated that the experimental group showed more statistically significant declines than the placebo group after the two-week use. 3. Comparison of changes in subjective symptoms through SCORAD Index indicated that the experimental group showed no statistically remarkable changes. 4. Comparison of changes in the body parts(Upperlimb) through SCORAD Index indicated the experimental group showed statistically significant changes after the two-week use. 5. Comparison of the general changes in quality of life through Skindex-29 indicated that the total score from experimental group showed statistically significant changes after the four-week use. Conclusions: This study, evaluated through SCORAD Index, indicated that the treatment with the external preparation containing herbal extract has a statistically marginal significance of efficacy on atopic dermatitis patients in the short term.
Introduction Hand eczema is dermatitis that occurs on the hand and fingers. In this case, the patient had chronic hand eczema that had relapsed for 3 years, worsened for 6 months, and did not improve even with standard dermatological treatment. We report significant improvement of the patient with chronic hand eczema, diagnosed with Soeunmin Greater Yin Symptomatology based on Sasang Constitutional Medicine. Methods We prescribed herbal medicine, Sibimigwanjung-tang(十二味寬中湯), and the western medications were continued throughout the treatment period. To evaluate the treatment progression, we observed objective and subjective symptoms and took pictures of the patient's hands. Results At the first time of the outpatient visit, the patient complained of pain, oozing, scaling and severe itching even though she had taken dermatological medication for over 6 months. After 8 weeks of Korean medicine treatment, most symptoms showed improvement, and after about 47 weeks of treatment, the symptoms maintained 90% improvement even after stopping western medications and herbal medications. Conclusion The patient in this case showed a significant improvement of chronic hand eczema and the improvements have been maintained even stopping western medications and herbal medications during follow-up for 15 weeks. In addition, the patient showed improvement and maintenance of general conditions as well as skin-related symptoms. In this case, we can concern the effect of the Sasang Constitutional Medicine focused on treating the patient's general pathology as well as the patient's chief complaint at chronic hand eczema not responding to standard dermatological treatment.
Objectives : The purpose of this study is to report the effect of Hwangryeonagyo-tang and Mahwangbujasesin-tang(《Shanghanlun》 prescription) on whole-body nummular eczema. Methods : We treated a female patient in her early twenties who has whole-body nummular eczema with Korean medicine. She was treated from 2020.10.8 to 2020.12.11. In this period, she received admission treatments twice because of the recurrence of the symptoms after the first admission. During the treatment, the two herbal medicines were changed depending on the patient's condition. 'Hwangryeonagyo-tang' and 'Mahwangbujasesin-tang' were used as herbal medicine. In addition, herbal external preparations and acupuncture treatment were also performed. The evaluation was conducted by photo comparison, VAS, and DLQI. Blood tests were also conducted for safety assessments. Results : After two months of treatment, the patient's condition improved. The itching and heat sensation decreased, and scabs were placed on the lesion of the eczema, reducing the oozing. VAS of itching decreased from 8 to 0. DLQI was also improved, and the stability of the herbal medicines for liver and kidney was also confirmed through blood tests. Conclusions : Hwangryeonagyo-tang and Mahwangbujasesin-tang helped relieve the itching and heat of eczema in currency. Therefore, it is believed that the proper use of thoes herbal medicine can be expected to have a useful effect on nummular eczema.
It has been proposed that wide individual variation in response to heparin be not considered in the conventional set protocol for the control of heparin and protamine during extracorporeal circulation. In this paper, two protocol of heparin and protamine therapy were compared to assess the role of the Activated Clotting Time [ACT] in relation to heparin, protamine, and postoperative blood loss and transfusion. The study groups consisted of the 31 patients [adults 15 and children 16] anticoagulated with the conventional heparin protocol and the 31 patients [adults 15 and children 16] anticoagulated with ACT protocol during extracorporeal circulation. In the conventional heparin protocol, two mg of heparin per kg was administered initially with an additional 0.75 mg of heparin per kg every 30 minutes of extracorporeal circulation, and reversal was accomplished with protamine in a dose of 1.5 times the total milligram of heparin. In the ACT protocol, two mg of heparin per kg was administered initially with an additional dose of heparin enough to reach an ACT of 480 seconds [within safe zone 300 to 600 seconds] from the patient`s dose response curve every 1 hour of extracorporeal circulation, and reversal was done with protamine in a dose of 1.3 times the milligram of the residual heparin. The results were summarized as follows. After a dose of 2 mg per kg of heparin, the patient`s ACT varied from 240 to 600 seconds in adults and from 240 t~ 660 seconds in children. In the ACT group the total amount of heparin administered was markedly reduced when compared to the conventional group, and less protamine was required to neutralize heparin. The dose of heparin administered decreased from 7.07 [SE 0.42] mg/kg of the conventional group to 4.92 [SE 0.32] mg/k8 of the ACT group in adults and from 10.17 [SE 1.15] mg/kg to 5.23 [SE 0.24] mg/kg in children, which represent 30.4% and 48.6% decrease respectively. The dose of protamine administered for reversal decreased from 10.6 [SE 0.63] mg/kg of the conventional group to 3.35 [SE 0.35] mg/kg of the ACT group in adults and from 15.7 [SE 1.70] mg/kg to 3.26 [SE 0.27] mg/kg in children, which represent 68.4% and 79.2% respectively. The ratio of protamine to heparin administered in the conventional group was 1.50:1 in adults and 1.54:1 in children, but in the ACT group 0.68:1 in adults and 0.62:1 in children. Postoperative blood loss and transfusion revealed no statistically significant difference between the two groups. Although six patients in the conventional group and one in the ACT group needed re-exploration for continuous hemorrhage, no case of generalized oozing was encountered, and in each case a definite bleeding site was identified. Author would like emphasizing the value of the ACT protocol in controlling heparin and protamine administration during extracorporeal circulation.
Objectives : The goal of surgical management of cerebral arteriovenous malformation(AVM) is elimination of the lesion without development of new neurological deficits. To improve the management results of cerebral AVMs in the future, this article discusses about surgical complications of the AVM and their management. Material and Methods : During the past 18 years, 116 patients with cerebral AVMs were managed by surgery. Among these cases, 7 cases died, 7 cases developed new neurological deficits, 11 cases residual AVM and 5 cases intracerebral hematoma(ICH) after surgery. The author analyzes the causes of those complications and investigates the methods to minimized those complications based on the review of the literatures. Results : One stage removal of AVM and ICH in the poor neurological state were performed in 5 of 7 death cases. Subtotal removal of ICH followed by delayed AVM surgery after recovery is regard as one method to improve the outcome of patient with large ICH. Postoperative new neurological deficits developed owing to normal perfusion pressure breakthrough(NPPB) in 3, judgement error in 2, preoperative embolization in 1 and cortical injury in 1 case(s). Proper management of NPPB, accurate anatomical knowledge and physiological monitoring during operation, and well trained skill for embolization are regard as methods to minimize those complications. Residual AVMs after surgery were noticed in 11 cases, in which unintended 6 cases due to inaccurate dissection of peripheral margin of AVM, and intended 3 cases due to massive brain swelling during operation, 1 cases due to diffuse type and 1 case due to multiple type of AVM. Accurate dissection of peripheral margin of AVM and mild hypotension during operation may help to avoid this complication. Postoperative hemorrhage occurred in 3 cases due to rupture of the residual AVM and in 2 cases due to oozing from the AVM bed. Complete resection of AVM, complete control of bleeding points at AVM bed and mild hypotension during early postoperative period are the methods to avoid this complication. Conclusion : A precise but flexible therapeutic strategy and refined skill for endovascular, radiosurgical and microsurgical techniques are required to successful treatment of cerebral AVM. Adequate timing of AVM resection, accurate anatomical knowledge, proper management of NPPB and accurate dissection of peripheral margin of AVM are the key points for avoiding complications of the AVM surgery.
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.
Objectives : The purpose of this study is to report the Korean medicine treatment on whole-body nummular eczema. Methods : This case study was conducted with a 66-year-old female patient who has whole-body nummular eczema treated by Korean medicine. She was treated from 2021.3.30 to 2021.6.28. During the treatment, the two herbal medicines were changed depending on the patient's condition. We treated her with herbal medicine, herbal external preparations and acupuncture treatment. For the evaluation of the results, we used photo comparison, VAS, and DLQI. Results : After the treatment, the nummular eczema lesions of patient was remarkably improved. Also, the VAS grade of other symptoms such as pruritus, burning sense, oozing, crusting and erythema were decreased and DLQI score changed from 27 to 2. Conculsions : This study suggests that Korean medicine treatments are effective for patient with recurrent nummular eczema.
Purpose: The present study examined the effectiveness of the preoperative ischemia-modified albumin (IMA) levels in predicting the healing period of amputation wounds in patients with diabetes mellitus following a non-traumatic below-knee amputation (BKA). Materials and Methods: This study enrolled 41 diabetic foot ulcer patients who underwent BKA at the authors' hospital diabetic foot center from April 2016 to April 2022. Among the 41 patients, 29 (70.7%) were male and 12 (29.3%) were female. Their mean age was 64.54±11.38 years (41~81 years). The mean follow-up period was 19.48±5.56 weeks (14~48 weeks) after BKA. The patients were divided into two groups (high IMA group and normal IMA group), which evaluated the healing period, wound dehiscence, and revision operation rate using a Fisher's exact test and Mann-Whitney U test. Three orthopedic surgeons performed stump wound evaluation, and they were evaluated as healing when all sutures were fused without oozing. Results: Thirty patients (73.2%) (group A) showed a high level of IMA (median: 91.2 U/mL), and 11 (26.8%) patients (group B) showed a normal range of IMA (median: 82.7 U/mL). In group A, the median period for wound healing took 1.4 weeks longer, which was significant (p=0.001). No statistical relationship was observed between wound dehiscence, revision operation rate, and IMA value. There was no correlation between the other risk factors (estimated glomerular filtration rate, HbA1c) and the wound healing period. Conclusion: Although there was a limitation in using IMA as the sole factor to predict the healing period of amputation wounds in patients after BKA, this study revealed a significant positive correlation between IMA and the period of stump healing after BKA. Therefore, the preoperative IMA levels may help predict the period of stump healing after BKA.
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