Efficacy and Safety of Human Bone Marrow-Derived Mesenchymal Stem Cells according to Injection Route and Dose in a Chronic Kidney Disease Rat Model

Background and Objectives@#We compared the efficacy and safety of human bone marrow-derived mesenchymal stem cells (hBMSC), delivered at different doses and via different injection routes in an animal model of chronic kidney disease. @*Methods@#and Results: A total of ninety 12-week-old rats underwent 5/6 nephrectomy and randomized among nine groups: sham, renal artery control (RA-C), tail vein control (TV-C), renal artery low dose (RA-LD) (0.5×10 6 cells), renal artery moderate dose (RA-MD) (1.0×10 6 cells), renal artery high dose (RA-HD) (2.0×10 6 cells), tail vein low dose (TV-LD) (0.5×10 6 cells), tail vein moderate dose (TV-MD) (1.0×10 6 cells), and tail vein high dose (TV-HD) (2.0×10 6 cells). Renal function and mortality of rats were evaluated after hBMSC injection. Serum blood urea nitrogen was significantly lower in the TV-HD group at 2 weeks (p＜0.01), 16 weeks (p＜0.05), and 24 weeks (p＜0.01) than in the TV-C group, as determined by one-way ANOVA. Serum creatinine was significantly lower in the TV-HD group at 24 weeks (p＜0.05). At 8 weeks, creatinine clearance was significantly higher in the TV-MD and TV-HD groups (p＜0.01, p＜0.05) than in the TV-C group. In the safety evaluation, we observed no significant difference among the groups. @*Conclusions@#Our findings confirm the efficacy and safety of high dose (2×10 6 cells) injection of hBMSC via the tail vein.

Component Asymmetry in Bilateral Cementless Total Hip Arthroplasty

Background@#This study investigated the results of component asymmetry (CA) in bilateral cementless total hip arthroplasty (THA). @*Methods@#This study included 300 patients, who underwent bilateral cementless THA between April 2000 and December 2017. They were divided into the component symmetry (CS) and CA groups; CA group was sub-classified into acetabular component asymmetry (ACA) and femoral component asymmetry (FCA). Radiologic and clinical outcomes of the CA group were compared with those of the CS group. @*Results@#The incidence of CA was 25.7% (77/300 patients), including 55 patients with ACA, 34 patients with FCA, and 12 with both components asymmetric. The mean time interval between operations in the CA group was significantly longer than that in the CS group (p < 0.001). The mean differences in horizontal and vertical distances from teardrop to the center of rotation of the acetabular component between both hips in the ACA group were significantly larger than those in the CS group (p = 0.033 and p < 0.001, respectively). The mean femoral component alignment angle difference between both hips was significantly larger in the FCA group than in the CS group (p < 0.001). The mean Harris Hip Score at last follow-up of the CA group was similar to that of the CS group. @*Conclusions@#CA in patients undergoing bilateral cementless THA was not rare, especially with a longer time interval between operations. Regardless of CA, when stable fixation of the components was achieved, satisfactory radiologic and clinical outcomes were obtained.

Comparison of Cephalomedullary Nails with Sliding Hip Screws in Surgical Treatment of Intertrochanteric Fractures: A Cumulative MetaAnalysis of Randomized Controlled Trials

Background@#The primary objective of the present study was to compare surgical failures of intertrochanteric fractures of the femur through a meta-analysis of randomized controlled trials and to assess the change in surgical outcomes over time in a cumulative meta-analysis. @*Methods@#To identify studies evaluating the surgical outcomes of internal fixation using sliding hip screws (SHS) or cephalomedullary (CM) nails for the treatment of intertrochanteric fractures of the femur, all records until August 2021 in the PubMed, Embase, and Cochrane Library databases were searched. Studies with the following characteristics were considered eligible: patients who had an intertrochanteric fracture of the femur (population); patients who received surgical treatment using a CM nail (intervention); patients who received surgical treatment using SHS (comparator); surgical failures that required reoperation, including cut-out or cut-through of lag screws, varus collapse or posterior angulation of proximal fragments, loosening of lag screws or helical blades, and fracture nonunion (outcomes); and two reviewers independently reviewed the titles and abstracts of the randomized controlled trials and selected relevant studies for a full-text review (study design). @*Results@#Twenty-one studies were included in the final analysis consisting of 1,777 cases in the SHS group and 1,804 cases in the CM nail group. The cumulative standard mean difference was 0.87, indicating that CM nails had no significant effect in improving the surgical outcomes. There was no significant difference in surgical failure between SHS and CM nails for all intertrochanteric fractures (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.76–1.49). Pooled data showed no significant difference between the two groups in terms of surgical failure in unstable intertrochanteric fractures (OR, 0.80; 95% CI, 0.42–1.54). @*Conclusions@#Although the use of CM nails has become a current trend in the treatment of intertrochanteric fractures, there is no literature supporting their clinical superiority when compared with SHS.

Characteristics of Korean Employees Without Depression but Having Suicidal Ideation

Objective@#The aim of this study was to identify the factors related to suicidal ideation targeting the risk group showing suicidal ideation despite the absence of depression in Korean workers. @*Methods@#The data of 14,425 participants who were employees aged of 18 to 75 years who attended a mental health checkup program at the Workplace Mental Health Institute, Kangbuk Samsung Hospital from June 2015 to October 2019 were analyzed. A self-report questionnaire consisting of sociodemographic factors, suicidal ideation, job stress, levels of depression and anxiety, and resilience was administered. A Hierarchical logistic regression model was used with suicidal ideation as dependent variable. Separate analyses were conducted according to depressive symptoms using the 20-item Center for Epidemiological Studies Depression (CES-D) scale. @*Results@#Being women, older, and having low resilience, more perceived stress, more severe anxiety and less sleeping hours were associated with suicidal ideation in no-depression group (CES-D <16). In the subcategories of job stress, lack of reward was significantly associated with suicidal ideation in no-depression group. @*Conclusion@#This study identified the characteristics of a group that has no depression but has suicidal ideation in Korean workers. Among job stress items, lack of reward is a clear characteristic to be considered with caution in this group.

Photocoagulation Up to Ora Serrata in Diabetic Vitrectomy to Prevent Recurrent Vitreous Hemorrhage

Purpose@#To evaluate the role of performing photocoagulation up to ora serrata during vitrectomy in preventing recurrent vitreous hemorrhage (VH) in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). @*Methods@#This retrospective, nonrandomized study included 60 eyes from 60 patients who had undergone PPV for VH due to PDR. These patients were divided into two groups: group 1, those who underwent photocoagulation up to ora serrata using the scleral indentation technique during surgery; and group 2, those who did not undergo scleral indentation when photocoagulation and underwent photocoagulation up to vortex veins. Their hospital records were analyzed to investigate the recurrence rate of VH, the time until recurrence of VH after surgery, logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) measured before surgery and at 1, 2, and 3 years after surgery, and the occurrence of complications such as neovascular glaucoma (NVG) during follow-up. @*Results@#Group 1 exhibited lower recurrence rate of VH (2 of 30 [6.7%] vs. 10 of 30 [33.3%], p = 0.01) and lower occurrence of postoperative NVG (2 of 30 [6.7%] vs. 8 of 30 [26.7%], p = 0.038) compared with group 2. There were no statistically significant differences in logMAR BCVA measured at 1, 2, and 3 years between the two groups (at 1 year: 0.54 ± 0.43 vs. 0.54 ± 0.44, p = 0.954; at 2 years: 0.48 ± 0.47 vs. 0.55 ± 0.64, p = 0.235; at 3 years: 0.51 ± 0.50 vs. 0.61 ± 0.77, p = 0.200). Logistic regression analysis showed that among several factors that could affect recurrence rate of VH, only range of photocoagulation performed was a statistically significant factor (odds ratio, 0.119; 95% confidence interval, 0.022–0.659; p = 0.015). @*Conclusions@#Photocoagulation treatment over a wider range with scleral indentation could be a beneficial adjunct procedure for preventing postoperative recurrent VH following diabetic vitrectomy.

The Efficiency of Radiation Shielding Sheet to Reduce Radiation Exposure during C-arm Fluoroscopy

Purpose@#This study evaluates the radiation shielding performance of a new lead-free tungsten-based sheet to reduce the radiation exposure of operators and patients under C-arm fluoroscopy. @*Materials and Methods@#A non-lead radiation shielding sheet (ROO201128; Pentas, Korea) was fabri-cated using tungsten and bismuth. The dose measurements were conducted using a C-arm fluoroscopy machine at 64 kVp and 1.5 mA, assuming two possible scenarios according to the position of the sheet. In each scenario, measurements were conducted at three distances (30, 60, and 90 cm) away from the beam center and in three directions (cephal, caudal, and operator’s direction). @*Results@#In the area within a radius of 60 cm from the beam center, the measured doses were reduced by 66.3% on mean, and the doses measured at distances more than 60 cm were less than 0.1 mSv/h in both scenarios. The most beneficial utilization of the lead-free shielding sheet was verified during C-arm fluoroscopy by placing the sheet on the X-ray tube. The operator’s radiation exposure was reduced by 56.6% when the sheet was placed under the phantom, and by 81.0% when the sheet was placed on the X-ray tube. @*Conclusion@#The use of lead-free radiation shielding sheets under C-arm fluoroscopy was effective in reducing radiation exposure, and the most beneficial scenario in which the sheet can be utilized was verified when the sheet was placed on the X-ray tube.

Development and External Validation of a Machine Learning Model to Predict Pathological Complete Response After Neoadjuvant Chemotherapy in Breast Cancer / 한국유방암학회지

Purpose@#Several predictive models have been developed to predict the pathological complete response (pCR) after neoadjuvant chemotherapy (NAC); however, few are broadly applicable owing to radiologic complexity and institution-specific clinical variables, and none have been externally validated. This study aimed to develop and externally validate a machine learning model that predicts pCR after NAC in patients with breast cancer using routinely collected clinical and demographic variables. @*Methods@#The electronic medical records of patients with advanced breast cancer who underwent NAC before surgical resection between January 2017 and December 2020 were reviewed. Patient data from Seoul National University Bundang Hospital were divided into training and internal validation cohorts. Five machine learning techniques, including gradient boosting machine (GBM), support vector machine, random forest, decision tree, and neural network, were used to build predictive models, and the area under the receiver operating characteristic curve (AUC) was compared to select the best model. Finally, the model was validated using an independent cohort from Seoul National University Hospital. @*Results@#A total of 1,003 patients were included in the study: 287, 71, and 645 in the training, internal validation, and external validation cohorts, respectively. Overall, 36.3% of the patients achieved pCR. Among the five machine learning models, the GBM showed the highest AUC for pCR prediction (AUC, 0.903; 95% confidence interval [CI], 0.833–0.972).External validation confirmed an AUC of 0.833 (95% CI, 0.800–0.865). @*Conclusion@#Commonly available clinical and demographic variables were used to develop a machine learning model for predicting pCR following NAC. External validation of the model demonstrated good discrimination power, indicating that routinely collected variables were sufficient to build a good prediction model.

Novel Effect of Hyaluronan and Proteoglycan Link Protein 1(HAPLN1) on Hair Follicle Cells Proliferation and Hair Growth

Hair loss is a common condition that can have a negative impact on an individual’s quality of life. The severe side effects and the low efficacy of current hair loss medications create unmet needs in the field of hair loss treatment. Hyaluronan and Proteoglycan Link Protein 1 (HAPLN1), one of the components of the extracellular matrix, has been shown to play a role in maintaining its integrity. HAPLN1 was examined for its ability to impact hair growth with less side effects than existing hair loss treatments. HAPLN1 was predominantly expressed in the anagen phase in three stages of the hair growth cycle in mice and promotes the proliferation of human hair matrix cells. Also, recombinant human HAPLN1 (rhHAPLN1) was shown to selectively increase the levels of transforming growth factor-β receptor II in human hair matrix cells. Furthermore, we observed concomitant activation of the ERK1/2 signaling pathway following treatment with rhHAPLN1. Our results indicate that rhHAPLN1 elicits its cell proliferation effect via the TGF-β2-induced ERK1/2 pathway. The prompt entering of the hair follicles into the anagen phase was observed in the rhHAPLN1-treated group, compared to the vehicle-treated group. Insights into the mechanism underlying such hair growth effects of HAPLN1 will provide a novel potential strategy for treating hair loss with much lower side effects than the current treatments.

Management of Osteoporosis Medication after Osteoporotic Fracture / 대한고관절학회지

The aim of this study was to provide helpful information for use in selection of an appropriate medication after osteoporotic fractures through conduct of a literature review. In addition, a review of the recommendations of several societies for prevention of subsequent fractures was performed and the appropriate choice of medication for treatment of atypical femur fractures was examined. Clinical perspective was obtained and an updated search of literature was conducted across PubMed and MEDLINE and relevant articles were selected. The articles were selected manually according to relevance, and the references for identified articles and reviews were also evaluated for relevance. The following areas are reviewed: Commonly prescribed osteoporosis medications: BPs (bisphosphonates), denosumab, and SERMs (selective estrogen receptor modulators) in antiresorptive medications and recombinant human parathyroid hormone teriparatide, recently approved Romosuzumab in anabolic agents, clinical practice guidelines for the management of osteoporosis, osteoporotic fracture, and atypical femur fracture. Most medications for treatment of osteoporosis do not delay fracture healing and the positive effect of teriparatide on fracture healing has been confirmed. In cases where an osteoporotic fracture is diagnosed, risk assessment should be performed for selection of very high-risk patients in order to prevent subsequent fractures, and administration of anabolic agents is recommended.

Scientific Publications on Thyroid Ultrasound between 2001 and 2020: Differences in Research Characteristics by Disciplines

Objective@#To analyze the characteristics and trends of scientific publications on thyroid ultrasound (US) from 2001 to 2020, specifically examining the differences among disciplines. @*Materials and Methods@#The MEDLINE database was searched for scientific articles on thyroid US published between 2001 and 2020 using the PubMed online service. The evaluated parameters included year of publication, type of document, topic, funding, first author’s specialty, journal name, subject category, impact factor, and quartile ranking of the publishing journal, country, and language. Relationships between the first author’s specialty (radiology, internal medicine, surgery, otorhinolaryngology, and miscellaneous) and other parameters were analyzed. @*Results@#A total of 2917 thyroid US publications were published between 2001 and 2020, which followed an exponential growth pattern, with an annual growth rate of 11.6%. Radiology produced the most publications (n = 1290, 44.2%), followed by internal medicine (n = 716, 24.5%), surgery (n = 409, 14.0%), and otorhinolaryngology (n = 171, 5.9%). Otorhinolaryngology and internal medicine published significantly more case reports than radiology (p < 0.001, each). Radiology published a significantly higher proportion of publications on imaging diagnosis (p < 0.001 for all) and a significantly lower proportion of publications on biopsy (p < 0.001 for all) than the other disciplines. Publications produced by radiology authors were less frequently published in Q1 journals than those from other disciplines (p < 0.005 for internal medicine and miscellaneous disciplines and < 0.01 for surgery and otorhinolaryngology). China contributed the greatest number of publications (n = 622, 21.3%), followed by South Korea (n = 478, 16.4%) and the United States (n = 468, 16.0%). @*Conclusion@#Radiology produced the most publications for thyroid US than any other discipline. Radiology authors published more notably on imaging diagnosis compared to other topics and in journals with lower impact factors compared to authors in other disciplines.

The Association Between Alcohol Use and Suicidal Ideation Among Employees

Objective@#The risk of suicide is assessed by identifying the relationship between alcohol-use patterns and suicidal ideation in Korean employees. @*Methods@#The study involved 13,858 employees who underwent workplace mental health screening at the Workplace Mental Health Institute of Kangbuk Samsung Hospital over a 6-year period between 2014 and 2019. Analysis was performed separately for Alcohol Use Disorders Identification Test-Korea (AUDIT-K) items related to the frequency/volume of alcohol consumption (items 1 to 3, AUDIT-C) and those regarding alcohol dependence/related problems (items 4 to 10, AUDIT-D/P). Subjects were then classified into three groups on the basis of the presence or absence of clinical depression and suicidal ideation. The groups’ sociodemographic factors and clinical features of depression, anxiety, and alcohol-use patterns were analyzed with a chi-square test as well as one-way analysis of variance, followed by a post hoc test using the Bonferroni correction. @*Results@#AUDIT-K and AUDIT-D/P scores were significantly associated with the presence or absence of clinical depression as well as the presence or absence of suicidal ideation (p<0.05). However, no significant differences were found among the three groups with regard to the AUDIT-C score (p=0.054). @*Conclusion@#Identifying or treating alcohol dependence/related problems can help lower the occurrence of mental health problems, and suicidal ideation in particular, in employees and reduce social costs.

Types of emergency patient analyzed using the geographic information system

Objective@#Predicting the incidence of emergency patients can be very important for the efficient use of emergency medical resources and the deployment of 119 centers in a pre-hospital setting. The study was conducted to analyze the occurrence of emergency patients using geographic information systems in a pre-hospital setting in Korea. @*Methods@#The basic data used in this study were collected from the 119 centers in Chuncheon-si, Korea, under the firefighting headquarters in Gangwon-do from January 2012 to December 2016. @*Results@#The total number of patients transferred by 119 paramedics was 72,362. Of these, 9,904 (14.7%) were emergency patients; 519 (0.7%) had cardiovascular diseases; 383 (0.5%) had cerebrovascular diseases; 3,043 (4.2%) were trauma patients; 58,413 (80.7%) were non-emergency patients. The occurrence of emergency diseases was slightly lower in the Hyoja-dong area, and it was slightly higher in the area of the outskirts of the city. The incidence of heart disease was low in the Hyoja-dong and Nam-myeon areas, but the incidence of heart disease was highly observed in other areas. The number of trauma patients was 1,265 (41.6%) in the outskirts of the city, a suburban area, showing a relatively higher incidence than other emerging diseases. @*Conclusion@#The deployment of ambulances in Chuncheon-si should be carried out considering demographic characteristics and patient occurrence.

Contributing Factors of Excessive Daytime Sleepiness in Morbid Obese Patients with Obstructive Sleep Apnea

Background@#Obesity, obstructive sleep apnea (OSA), and excessive daytime sleepiness (EDS) are common conditions and are interrelated. Obesity is a risk factor for OSA and independently associated with EDS. We aimed to evaluate frequency of EDS in morbid obese patients with OSA and to identify contribution factor for EDS. @*Methods@#This was a retrospective cross-sectional study in single sleep center. Consecutive patients with OSA (with apnea-hypopnea index 5/h or more) with morbid obesity (body mass index over 35 kg/m2) was enrolled. EDS were defined as Epworth Sleepiness Scale of 10 points or more. Clinical and polysomnographic variables were compared between those with and without EDS. @*Results@#Total 110 morbid obese patients with OSA were enrolled, and 34 (31%) of them had EDS. Those with EDS had higher subjective symptom of insomnia and depression. Rapid eye movement sleep latency was shorter and minimum saturation was lower for those with EDS. Multivariate logistic regression analysis identified insomnia severity (odds ratio, 1.117) and minimum saturation (odds ratio, 0.952) as independent contribution factor for EDS. @*Conclusions@#Result of this study suggest that 31.4% of morbid obese patients with OSA have EDS, and it can be affected by insomnia severity and desaturation during sleep.

Romosozumab: A Novel Agent in the Management of Osteoporosis

With the discovery of screlostin as a pivotal player in bone metabolism, a novel medication targeting sclerostin has been introduced. Romosozumab, a humanized anti-sclerostin monoclonal antibody, is a unique approach to the treatment of osteoporosis that inhibits sclerostin, a key regulator that has the dual properties of promoting bone formation and inhibiting bone resorption. Romosozumab has been shown to be superior to conventional agents, in increasing bone mineral density and preventing osteoporotic fractures. Romosozumab may also be effective in the management of treatment-resistant osteoporosis and in the prevention of osteoporotic fractures in the very high risk population. However, further studies are necessary as there is insufficient data on its clinical efficacy and safety.

Study Characteristics Related to Citation Rates in Hip & Pelvis: An Analysis of Articles Published between 2009 and 2019 / 대한고관절학회지

Purpose@#We classified the articles published in the journal Hip & Pelvis and analyzed the relationship between study characteristics and citation rates. @*Materials and Methods@#All articles published in Hip & Pelvis from 2009 to 2019 were included. We classified the articles according to the type, language, listing in PubMed Central (PMC), treatment modality, material, design, anatomical focus, number of authors, and number of cases. We analyzed the citation rate according to this classification, with yearly citation rate reflecting the exposure period until March 2020. @*Results@#The yearly citation rate increased significantly after the language of the journal was changed from Korean to English in June 2014 (mean=0.96 vs. 1.63, P<0.05), and again after the journal was listed in PMC in March 2016 (mean=1.05 vs. 1.92, P<0.05). The yearly citation rates of review articles was highest, followed by those of editorials, original articles, and case reports (in this order). Among original articles, trauma-related articles had higher yearly citation rates than non-trauma-related articles (mean=1.00 vs. 0.68, P=0.034). Among clinical articles, studies focusing on the pelvis had higher yearly citation rates than studies on the hip or femur (mean=1.85 vs. 0.71 vs. 0.91, P=0.003). @*Conclusion@#The yearly citation rate of articles increased significantly after the language of Hip & Pelvis was changed to English and after the journal was listed in PMC. The mean yearly citation rate of articles focusing on the pelvis was significantly higher than that of articles focusing on the hip or femur.

Fungal Community Analyses of Endophytic Fungi from Two Oak Species, Quercus mongolica and Quercus serrata, in Korea

Fungal endophytes have been recorded in various plant species with a richness of diversity, and their presence plays an essential role in host plant protection against biotic and abiotic stresses. This study applied the Illumina MiSeq sequencing platform based on the amplification of fungal ribosomal ITS2 region to analyze fungal endophytic communities of two oak species (Quercus mongolica and Q. serrata) with different oak wilt disease susceptibilities in Korea. The results showed a total of 230,768 sequencing reads were obtained and clustered at a 97% similarity threshold into 709 operational taxonomic units (OTUs). The OTUs of Q. serrata were higher than that of Q. mongolica with the number of 617 OTUs and 512 OTUs, respectively. Shannon index also showed that Q. serrata had a significantly higher level of fungal diversity than Q. mongolica. Total of OTUs were assigned into 5 fungal phyla, 17 classes, 60 orders, 133 families, 195 genera, and 280 species. Ascomycota was the dominant phylum with 75.11% relative abundance, followed by Basidiomycota with 5.28%. Leptosillia, Aureobasidium and Acanthostigma were the most abundant genera detected in Q. serrata with the average relative abundance of 2.85, 2.76, and 2.19%, respectively. On the other hand, Peltaster, Cladosporium and Monochaetia were the most common genera detected in Q. mongolica with the average relative abundance of 4.83, 3.03, and 2.87%, respectively. Our results indicated that fungal endophytic communities were significantly different between two oak species and these differences could influence responses of host trees to oak wilt disease caused by Raffaelea quercus-mongolicae.

Recent Update on Treatment and Management of Rapid Eye Movement Sleep Behavior Disorder

Rapid eye movement sleep behavior disorder (RBD) is a parasomnia that is characterized by dream-enactment behavior, which can often result in sleep related injury. RBD is strongly associated with neurodegenerative disease especially with alpha-synucleinopathy. More than 70% of the patients convert to neurodegenerative disease including Parkinson’s disease or diffuse Lewy body dementia with a median period of 7.5 years. Treatment for RBD is currently focused on symptomatic treatment to prevent the injury. First step is establishing safe sleep environment to avoid injury. Clonazepam and melatonin are most commonly used medication for symptomatic treatment for RBD, however, well-designed randomized clinical trials are lacking. Prognostic counselling with longitudinal follow-up is also crucial in managing patients with RBD, which should be individualized for each patient with regular systematic follow-up evaluation.

Survey on Public Awareness of Neurology in Korea

Background@#Neurology in Korea is a field of clinical practice and research that has been developing for over 30 years, but due to its relatively short history, public awareness is low compared to other clinical fields. The Korean Neurological Association conducted a survey to evaluate the Korean public’s awareness of neurology and the necessity of a name change. This study details the second survey conducted on the topic, with the first being conducted in 2013. The two surveys were compared to identify how the public’s awareness of neurology has improved since 2013 and determine how this can be improved. @*Methods@#The survey was conducted by Gallup Korea, where 1,000 participants were randomly selected and interviewed through telephone surveys. @*Results@#Of the 1,000 participants, 78.5% were familiar with Neurology, similar to the results of the 2013 survey. Meanwhile, when asked about neurological diseases, only 27.9% of the participants recognized neurological diseases correctly. The most accurately recognized symptoms related to Neurology were tremors (57.8%), strokes (55.5%), and dizziness (49.7%). In 2013, 61.7% of the participants thought a name change was necessary. In comparison, only 38.4% responded it needed to change in the recent survey. @*Conclusions@#The preference for Neurology’s current name in Korea has improved since 2013 despite no significant change in the public’s awareness of neurology. More active public relations activities are needed to improve awareness of neurology in the future.

The Emblems of Sleep Societies in Asia and the Republic of Korea

An emblem is a symbolic representational image that stands for a certain organization, concept, team, or society. This study investigated the emblems of the sleep societies in South Korea and the international sleep societies in which they were registered as members. Three South Korean sleep societies were found by searching for the keyword ‘sleep’ in the Korea Citation Index. Subsequently, we identified three international societies in which the three South Korean conferences participate. The emblems can be classified according to their composition. Taegeuk patterns represent yin and yang, electroencephalography that stands for the objective indicator of sleep, and the acronym or abbreviation indicating the name of the society. All emblems in this study were combinations of pictorial images and letters. The pictorial image of the Korean Sleep Research Society is the only emblem representing an inset with Hangeul. The emblem is a medium that conveys diverse meanings beyond representation. The societies have attempted to embody the identity as well as their directions.

Symptomatic Os Paracuneiforme: A Case Report / 대한족부족관절학회지

An extremely rare accessory bone of the foot located in the distal portion of the navicular that articulates with the medial cuneiform was observed. Os paracuneiforme is usually located medial to the medial cuneiform or the naviculocuneiform joint. Although os paracuneiforme is often referred to as an accessory bone around the foot, few cases of this type of accessory bone have been reported. This paper reports a patient with a painful Os paracuneiform who underwent surgical excision of the accessory bone.