• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.33 no.3
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• pp.99-114
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• 2020

Objectives : To investigate treatment approaches of psoriasis, and to provide universal and holistic standards to assist in optimizing patient care and future research. Methods : Review articles of psoriasis regarding pathophysiology, risk factor or treatment were searched from Pubmed (January 2016 to June 2020). Treatment approaches were investigated based on the searched articles. Additional data collecting was done for further discussion by searching Pubmed and Google scholar with keywords relevant to the approaches, and the relevant references of articles retrieved were manually inspected to be included. Results : Modalities to directly regulate the relevant helper T cell or inflammatory cytokines can constitute the treatment approaches of psoriasis. Modalities to treat gastrointestinal tract inflammation, to correct metabolic syndrome and to improve epidermal lipid abnormality via whole body lipid metabolism can also constitute the treatment approaches of psoriasis. Probable adverse effects of long term use of western medication should be addressed carefully, and alleviating the hazards of western medication can be a treatment approach of psoriasis. Conclusion : Treatment of psoriasis should take account of systemic aspects such as gastrointestinal tract and lipid metabolism. Treatment approaches of psoriasis established on the pathophysiological basis can serve as universal standards.

• The Korean Journal of Pain
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• v.27 no.2
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• pp.139-144
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• 2014

Background: To manage intractable cancer pain, an alternative to systemic analgesics is neuraxial analgesia. In long-term treatment, intrathecal administration could provide a more satisfactory pain relief with lower doses of analgesics and fewer side-effects than that of epidural administration. However, implantable drug delivery systems using intrathecal pumps in Korea are very expensive. Considering cost-effectiveness, we performed epidural analgesia as an alternative to intrathecal analgesia. Methods: We retrospectively investigated the efficacy, side effects, and complications of epidural morphine and local anesthetic administration through epidural catheters connected to a subcutaneous injection port in 29 Korean terminal cancer patients. Patient demographic data, the duration of epidural administration, preoperative numerical pain rating scales (NRS), side effects and complications related to the epidural catheterization and the drugs, and the numerical pain rating scales on the 1st, 3rd, 7th and 30th postoperative days were determined from the medical records. Results: The average score for the numerical pain rating scales for the 29 patients decreased from $7{\pm}1.0$ at baseline to $3.6{\pm}1.4$ on postoperative day 1 (P < 0.001). A similar decrease in pain intensity was maintained for 30 days (P < 0.001). Nausea and vomiting were the most frequently reported side effects of the epidural analgesia and two patients (6.9%) experienced paresthesia. Conclusions: Epidural morphine and local anesthetic infusion with a subcutaneous pump seems to have an acceptable risk-benefit ratio and allows a high degree of autonomy to patients with cancer pain.

• Nutrition Research and Practice
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• v.12 no.3
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• pp.222-232
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• 2018

BACKGROUND/OBJECTIVES: Since gain or loss of skeletal muscle mass is a gradual event and occurs due to a combination of lifestyle factors, assessment of dietary factors related to skeletal muscle is complicated. The aim of this study was to investigate the changes in total energy intake according to the level of skeletal muscle mass. SUBJECTS/METHODS: A total of 8,165 subjects ${\geq}30years$ of age from the Korean National Health and Nutrition Examination Surveys (KNHANES) 2008-2011 were included in the analysis, and multivariate-adjusted regression analyses were performed to analyze the association of the quartiles of sarcopenia index (SI) with energy intake of the study population after adjusting for age and metabolic parameters. RESULTS: The increase in SI quartile was in proportion to the gradual decrease in systemic lipids and the anthropometric measurement of fat accumulation (P < 0.001). Subjects in higher SI quartiles tended to consume more total energy and energy-producing nutrients than those in lower quartiles (P < 0.001). After age, body weight, alcohol consumption, and metabolic parameters were adjusted in the analysis, total energy intake gradually increased according to the increase in SI quartile, and the association between total energy intake and SI was more pronounced in men. However, the risk (odd ratio) of having a low SI was not affected by any single macronutrient intake. CONCLUSION: In this study, total energy intake was positively associated with SI and relative skeletal mass in both men and women. However, no significant association or a weak association was observed between any single macronutrient intake and skeletal muscle mass. The data indicated that acquiring more energy intake within the normal range of energy consumption may help to maintain skeletal muscle mass.

• Journal of Veterinary Clinics
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• v.34 no.2
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• pp.135-139
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• 2017

This study was performed to evaluate the clinical efficacy of alfaxalone for induction of inhalation anesthesia in small animal practice. Patient data were collected according to anesthetic records (136 dogs and 14 cats) presented to the Veterinary Medical Teaching Hospital of Seoul National University for surgeries and diagnostic imaging from July 2013 to March 2014. Anesthetic results included signalment, American Society of Anesthesiologists (ASA) grade, premedicated drugs, procedures, induction quality, and recovery after anesthesia. One hundred fifty anesthetic events were classified according to the ASA grade. Three patients were ASA grade I, 52 patients grade II, 86 patients grade III, and 9 patients grade IV, respectively. The most common premedication was midazolam and hydromorphone combination (n = 59, 39.3%) follow by acepromazine and hydromorphone combination (n = 22, 14.7%). The majority of anesthesia procedures were diagnostic imaging (n = 33, 22.0%) and ophthalmic surgeries (n = 31, 20.7%), followed by soft tissue surgeries (n = 27, 18.0%), and orthopedic surgeries (n = 20, 13.3%). Intravenous alfaxalone provided smooth induction for inhalation anesthesia in almost cases, but transient apnea and twitching/paddling were observed after induction and during recovery, respectively. In addition, alfaxalone did not show pain response during intravenous administration. Alfaxalone showed smooth induction of inhalation anesthesia in dogs and cats with mild to severe systemic disease (ASA 2-4). Alfaxalone was considered as an acceptable induction agent for patients with higher risk in small animal practice.

• The Journal of Internal Korean Medicine
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• v.41 no.3
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• pp.362-413
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• 2020

Objectives: The purpose of this research is to examine the recent clinical research trends on the efficiency of traditional herb medicine (THM) on gastroesophageal reflux disease (GERD), and to provide clinical evidence of herbal medicine, Banhasasin-tang or Banxiexin decoction by using a systemic review and meta-analysis of randomized trials (RCTs). Methods: In this study, randomized controlled trials (RCTs) were included that verified effects of traditional herbal medicine (THM), including a Banxia-xiexin-tang decoction, as a treatment for GERD. A study of the literature in Chinese and Korean databases was performed for papers published from January 1, 2010, to January 1, 2020. The selected literature was assessed by Cochrane's risk of bias (RoB). Results: A total of 90 RCTs met the inclusion criteria. Except for four RCT studies, all studies identified the effect of a Banxia-xiexin-tang decoction in the treatment of GERD. The effectiveness of treatment was significantly higher in the intervention group than in the control group, as shown through various evaluation indicators, including the reflux disease diagnostic questionnaire (RDQ). Adverse effects were reported in 22 articles (24.44%). Conclusions: Treatment with Banhasasin-tang, or a Banxia-xiexin-tang decoction, was found to be effective in treating GERD. However, due to the low quality of available studies, the significance of this conclusion is somewhat limited. This study could serve as a foundation for further clinical studies on the development of diagnosis and treatment methods for GERD based on Korean medicine.

• Journal of Preventive Medicine and Public Health
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• v.54 no.3
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• pp.161-165
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• 2021

Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads heterogeneously, disproportionately impacting poor and minority communities. The relationship between poverty and race is complex, with a diverse set of structural and systemic factors driving higher rates of poverty among minority populations. The factors that specifically contribute to the disproportionate rates of SARS-CoV-2 infection, however, are not clearly understood. Methods: We evaluated SARS-CoV-2 test results from community-based testing sites in Los Angeles, California, between June and December, 2020. We used tester zip code data to link those results with United States Census report data on average annual household income, rates of healthcare coverage, and employment status by zip code. Results: We analyzed 2 141 127 SARS-CoV-2 test results, of which 245 154 (11.4%) were positive. Multivariable modeling showed a higher likelihood of SARS-CoV-2 test positivity among Hispanic communities than among other races. We found an increased risk for SARS-CoV-2 positivity among individuals from zip codes with an average annual household income

• Journal of the Korea Society of Computer and Information
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• v.24 no.3
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• pp.175-179
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• 2019

This study is a descriptive research of paramedic students who could be exposed to blood and body fluids during the clinical practicum to analyze the risk factors. From June 1 to June 30, 2018, 172 paramedic students who attended the University in Jeolla-do region were analyzed. The collected data were analyzed by using the SPSS WIN 21.0 program. The general characteristics of subjects, the exposure level of blood and body fluids, and etc were obtained for frequency and percentage analysis. The study found that 72.7 percent of students had experience to blood or body fluids exposure during the clinical practicum. Except for any needle injury, 70.4 percent of student were exposed to blood or body fluids. 28.8 percent of them which was the highest percentage of injection injury were exposed during the venous blood draw. 36.5 percent of exposure were related to wound dressings which was the highest percentage related to clinical procedures. 71.2 percent of students mentioned that they did not report this exposure because 68.5 percent students thought that it has no danger. According to the survey on hepatitis B, 50.6% of students had antibodies, but 31.8 percent of students did not confirm that the antibodies were formed. Even though paramedic students do practical training in a hazardous environment with repeated exposure to blood and body fluids due to the nature of job characteristics, the systemic infection control education program is insufficient. In order to prevent exposure and to protect paramedic students who do practical training with patients, it is necessary to make more systematic and active efforts in the continuous monitoring and the preventive education.

• Neurospine
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• v.15 no.4
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• pp.338-347
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• 2018

Objective: Patients with extradural spine tumors are at an increased risk for intraoperative cerebrospinal fluid (CSF) leaks and postoperative wound dehiscence due to radiotherapy and other comorbidities related to systemic cancer treatment. In this case series, we discuss our experience with the management of intraoperative durotomies and wound closure strategies for this complex surgical patient population. Methods: We reviewed our recent single-center experience with spine surgery for primarily extradural tumors, with attention to intraoperative durotomy occurrence and postoperative wound-related complications. Results: A total of 105 patients underwent tumor resection and spinal reconstruction with instrumented fusion for a multitude of pathologies. Twelve of the 105 patients (11.4%) reviewed had intraoperative durotomies. Of these, 3 underwent reoperation for a delayed complication, including 1 epidural hematoma, 1 retained drain, and 1 wound infection. Of the 93 uncomplicated index operations, there were a total of 9 reoperations: 2 for epidural hematoma, 3 for wound infection, 2 for wound dehiscence, and 2 for recurrent primary disease. One patient was readmitted for a delayed spinal fluid leak. The average length of stay for patients with and without intraoperative durotomy was 7.3 and 5.9 days, respectively, with a nonsignificant trend for an increased length of stay in the durotomy cases (p=0.098). Conclusion: Surgery for extradural tumor resections can be complicated by CSF leaks due to the proximity of the tumor to the dura. When encountered, a variety of strategies may be employed to minimize subsequent morbidity.

• Translational and Clinical Pharmacology
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• v.25 no.2
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• pp.63-66
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• 2017

Allopurinol-induced severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome are reportedly associated with the $HLA-B^{\star}58:01$ genotype. Three patients who developed SCARs after allopurinol administration were subjected to HLA-B genotyping and lymphocyte activation test (LAT) to evaluate genetic risk and to detect the causative agent, respectively. All three patients given allopurinol to treat gout were diagnosed with DRESS syndrome. Symptom onset commenced 7-24 days after drug exposure; the patients took allopurinol (100-200 mg/d) for 2-30 days. HLA-B genotyping was performed using a polymerase chain reaction (PCR)-sequence-based typing (SBT) method. All patients had a single $HLA-B^{\star}58:01$ allele: $HLA-B^{\star}13:02/^{\star}58:01$ (a 63-year-old male), $HLA-B^{\star}48:01/^{\star}58:01$ (a 71-year-old female), and $HLA-B^{\star}44:03/^{\star}58:01$ (a 22-year-old male). Only the last patient yielded a positive LAT result, confirming that allopurinol was the causative agent. These findings suggest that patients with $HLA-B^{\star}58:01$ may develop SCARs upon allopurinol administration. Therefore, HLA-B genotyping could be helpful in preventing serious problems attributable to allopurinol treatment, although PCR-SBT HLA-B genotyping is time consuming. A simple genotyping test is required in practice. LAT may help to identify a causative agent.

• Journal of Periodontal and Implant Science
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• v.48 no.6
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• pp.337-346
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• 2018

Purpose: Peripheral artery disease (PAD) is a form of arteriosclerosis that occurs in the extremities and involves ischemia. Previous studies have reported that patients with periodontitis are at high risk for PAD. However, the relationship between these 2 diseases has not yet been fully elucidated. In this cross-sectional study, we investigated this relationship by comparing patients with PAD to those with arrhythmia (ARR) as a control group. Methods: A large-scale survey was conducted of patients with cardiovascular disease who visited Tokyo Medical and Dental University Hospital. We investigated their oral condition and dental clinical measurements, including probing pocket depth, bleeding on probing, clinical attachment level, and number of missing teeth; we also collected salivary and subgingival plaque samples and peripheral blood samples. All patients with PAD were extracted from the whole population (n=25), and a matching number of patients with ARR were extracted (n=25). Simultaneously, ARR patients were matched to PAD patients in terms of age, gender, prevalence of diabetes, hypertension, dyslipidemia, obesity, and the smoking rate (n=25 in both groups). Real-time polymerase chain reaction was performed to measure the bacterial counts, while the enzyme-linked immunosorbent assay method was used to measure anti-bacterial antibody titers and proinflammatory cytokine levels in serum. Results: PAD patients had more missing teeth ($18.4{\pm}2.0$) and higher serum levels of C-reactive protein ($1.57{\pm}0.85mg/dL$) and tumor necrosis factor-alpha ($70.3{\pm}5.7pg/mL$) than ARR patients ($12.0{\pm}1.7$, $0.38{\pm}0.21mg/dL$, and $39.3{\pm}4.5pg/mL$, respectively). Meanwhile, no statistically significant differences were found in other dental clinical measurements, bacterial antibody titers, or bacterial counts between the 2 groups. Conclusions: Our findings suggested that PAD patients had poorer oral and periodontal state with enhanced systemic inflammation.