Clinical efficacy of angiotensin receptor-neprilysin inhibitor in de novo heart failure with reduced ejection fraction

Background/Aims@#We aimed to analyze the efficacy of angiotensin receptor-neprilysin inhibitor (ARNI) by the disease course of heart failure (HF). @*Methods@#We evaluated 227 patients with HF in a multi-center retrospective cohort that included those with left ventricular ejection fraction (LVEF) ≤ 40% undergoing ARNI treatment. The patients were divided into patients with newly diagnosed HF with ARNI treatment initiated within 6 months of diagnosis (de novo HF group) and those who were diagnosed or admitted for HF exacerbation for more than 6 months prior to initiation of ARNI treatment (prior HF group). The primary outcome was a composite of cardiovascular death and worsening HF, including hospitalization or an emergency visit for HF aggravation within 12 months. @*Results@#No significant differences in baseline characteristics were reported between the de novo and prior HF groups. The prior HF group was significantly associated with a higher primary outcome (23.9 vs. 9.4%) than the de novo HF group (adjusted hazard ratio 2.52, 95% confidence interval 1.06–5.96, p = 0.036), although on a higher initial dose. The de novo HF group showed better LVEF improvement after 1 year (12.0% vs 7.4%, p = 0.010). Further, the discontinuation rate of diuretics after 1 year was numerically higher in the de novo group than the prior HF group (34.4 vs 18.5%, p = 0.064). @*Conclusions@#The de novo HF group had a lower risk of the primary composite outcome than the prior HF group in patients with reduced ejection fraction who were treated with ARNI.

Temporal Trend of the Incidence and Characteristics of Renal Infarction:Korean Nationwide Population Study

Background@#Large-scale studies about epidemiologic characteristics of renal infarction (RI) are few. In this study, we aimed to analyze the incidence and prevalence of RI with comorbidities in the South Korean population. @*Methods@#We investigated the medical history of the entire South Korean adult population between 2013 and 2019 using the National Health Insurance Service database (n = 51,849,591 in 2019). Diagnosis of RI comorbidities were confirmed with International Classification of Disease, Tenth Revision, Clinical Modification codes. Epidemiologic characteristics, distribution of comorbidities according to etiologic mechanisms, and trend of antithrombotic agents were estimated. @*Results@#During the 7-years, 10,496 patients were newly diagnosed with RI. The incidence rate increased from 2.68 to 3.06 per 100,000 person-years during the study period.The incidence rate of RI increased with age peaking in the 70s with 1.41 times male predominance. The most common comorbidity was hypertension, followed by dyslipidemia and diabetes mellitus. Regarding etiologic risk factor distribution, high embolic risk group, renovascular disease group, and hypercoagulable state group accounted for 16.6%, 29.1%, and 13.7% on average, respectively. For the antithrombotic treatment of RI, the prescription of antiplatelet agent gradually decreased from 17.0% to 13.0% while that of anticoagulation agent was maintained around 35%. The proportion of non-vitamin K antagonist oral anticoagulants remarkably increased from only 1.4% to 17.6%. @*Conclusion@#Considering the progressively increasing incidence of RI and high prevalence of coexisting risk factors, constant efforts to raise awareness of the disease are necessary. The current epidemiologic investigation of RI would be the stepping-stone to establishing future studies about clinical outcomes and optimal treatment strategies.

Comparison of Clinical Outcomes of Long Stent Implantation with First- and Second-Generation Drug-Eluting Stents Following Rotational Atherectomy

Objective@#Rotational atherectomy (RA) and newly developed second-generation drug-eluting stent (DES) support the strategy of longer stent deployment in comparison to short stent implantations in the past. However, studies analyzing the outcome of patients who received long stent implantation following RA are few in number. The present study compared the clinical outcomes of patients with the coronary arterial disease (CAD) who underwent RA with long stent implantation using first- and second-generation DES. @*Methods@#A retrospective cohort study was performed at the single center from March 2003 to October 2019. Eighty-seven patients with CAD who underwent RA with ≥32 mm long stent implantation were enrolled in the study and divided into two groups according to the type of DES. As a primary endpoint, the cumulative 2-year incidence of major adverse cardiac events (MACE) including death, myocardial infarction (MI), target vessel revascularization, and stent thrombosis (ST) was compared by DES type. Adjusted interaction between the type of stent and clinical variables was estimated to determine the predictor variables of MACE. @*Results@#The second-generation DES group was associated with a shorter procedure duration and more common usage of intravascular ultrasound in procedural characteristics. In the second-generation DES group, a trend toward a lower rate of MI and ST existed. All-cause mortality and cardiovascular mortality were not significantly different. When combined with MACE, we could identify a significant reduction in the second-generation DES group. @*Conclusion@#In comparison to the first-generation DES group, the second-generation DES group was associated with a lower rate of MACE for 2 years in patients who underwent RA with long stent implantation.

A Comparison of Drinking, Emotional Characteristics and Their Correlations between Patients with Alcohol Use Disorder with and without Criminal Record / 생물치료정신의학

Objectives@#：In this study, socio-demographic, drinking and emotional characteristics, and their correlations were compared among patients with alcohol use disorder (AUD) according to the presence or absence of any type of criminal record. @*Methods@#：Among patients admitted to the hospital with AUD, 27 with and 31 without criminal records were included. Socio-demographic data and drinking characteristics such as first drinking age, average daily alcohol consumption were collected. In addition, the severity of alcohol problems, the degree of change readiness for drinking alcohol, depressive symptoms, anxiety symptoms, and impulsivity were evaluated using scales and statistically analyzed. Pearson’s correlation test was applied to reveal the differences in correlation of the characteristics according to the presence or absence of criminal records. @*Results@#：The first drinking age was significantly earlier in the AUD group with criminal records. Interestingly, the degree of change readiness regarding alcohol problem as shown in SOCRATES-K was significantly higher in the AUD group with criminal records. Anxiety symptoms were statistically significantly higher in the AUD group with criminal records. In AUD with criminal records, first drinking age negatively correlated with the degree of change readiness. In AUD without criminal records, first drinking age correlated negatively with the severity of alcohol problem, and the degree of change readiness, and the degree of change readiness negatively with age, and the degree of change readiness positively with the severity of alcohol problem. In Both groups, anxiety symptoms positively correlated with depressive symptoms. @*Conclusions@#：This study showed that AUD patients with criminal record had a faster first drinking age and the higher degree of change readiness regarding alcohol problem. Significantly higher symptoms of anxiety were also presented in AUD patients with criminal record than AUD patients who have no criminal records. Some differences were identified in correlations among characteristics between the two groups.

Current Trends in the Treatment of Hallux Valgus: Analysis of the Korean Foot and Ankle Society (KFAS) Member Survey / 대한족부족관절학회지

Purpose@#This study aimed to report the current trends in the management of the hallux valgus (HV) deformity over the last few decades through a survey of the Korean Foot and Ankle Society (KFAS) members. @*Materials and Methods@#A web-based questionnaire containing 34 questions was sent to all KFAS members in September 2021. The questions were mainly related to the preferred techniques and clinical experience in correction in patients with an HV deformity. Answers with a prevalence of ≥50% of respondents were considered a tendency. @*Results@#One hundred and nine (19.8%) of the 550 members responded to the survey. The most common symptom for determining surgical treatment was bunion pain (68.8%), and different surgical techniques were selected according to the following radiological parameters: HV angle 30 to 40 degrees and intermetatarsal angle 15 to 20 degrees. The two procedures most preferred by the respondents were distal chevron osteotomy (55.0%), and proximal chevron osteotomy (21.1%). In an average of 71.6% of respondents, Arkin osteotomy was performed simultaneously during HV surgery. HV accompanied by an overriding deformity of the second toe was most often addressed with a combination of second metatarsal osteotomy and soft tissue rebalancing procedure (35.8%). After HV surgery, the recurrence rate of HV deformity was found to be 12.2% on average and the surgeons who had performed minimally invasive surgery (MIS) for HV comprised 34.9% of the total respondents. @*Conclusion@#This study provides updated information on the current trends in the management of the HV deformity in Korea. Both consensus and variation in the approach to patients with HV were identified by this survey study. Although MIS for HV has increased, it appears the consensus for selecting this method has not yet been established.

Surgical Strategies for Achilles Tendinopathy / 대한족부족관절학회지

The surgical treatment of Achilles tendinopathy can be considered after the failure of conservative treatment, and the surgical methods may be divided into two groups; treatments for insertional and non-insertional tendinopathy. In the case of insertional tendinopathy, debridement including tendon and calcification of the diseased lesion, reattachment of the tendon, and calcaneal ostectomy of the Haglund lesion are the primary treatments. If reattachment is not possible, reconstruction should be performed by other methods such as tendon transfer. As a result of surgery for insertional tendinopathy, there is an improvement in the pain and function after surgery, but there are some patients whose pain does not completely disappear. Some residual pain may persist; therefore, the overall success rate of the surgery can be expected to be 80% to 90%. For the patients of non-insertional tendinopathy, conservative treatment through eccentric exercise is the primary treatment, and most of them have reported good results. In case of failure after various conservative treatments, debridement of the diseased lesion and repair of the remaining tendon would be the primary surgical treatments. If the remaining tendon is not sufficient, reconstruction such as tendon transfer should be considered.

Surgical Strategies for Achilles Tendinopathy / 대한족부족관절학회지

The surgical treatment of Achilles tendinopathy can be considered after the failure of conservative treatment, and the surgical methods may be divided into two groups; treatments for insertional and non-insertional tendinopathy. In the case of insertional tendinopathy, debridement including tendon and calcification of the diseased lesion, reattachment of the tendon, and calcaneal ostectomy of the Haglund lesion are the primary treatments. If reattachment is not possible, reconstruction should be performed by other methods such as tendon transfer. As a result of surgery for insertional tendinopathy, there is an improvement in the pain and function after surgery, but there are some patients whose pain does not completely disappear. Some residual pain may persist; therefore, the overall success rate of the surgery can be expected to be 80% to 90%. For the patients of non-insertional tendinopathy, conservative treatment through eccentric exercise is the primary treatment, and most of them have reported good results. In case of failure after various conservative treatments, debridement of the diseased lesion and repair of the remaining tendon would be the primary surgical treatments. If the remaining tendon is not sufficient, reconstruction such as tendon transfer should be considered.

Are Magnetic Resonance Imaging Findings of Ankle Instability Always Correlated with Operative and Physical Examination Findings? / 대한족부족관절학회지

Physical examination and surgical findings and symptoms are often inconsistent with magnetic resonance imaging (MRI) findings when diagnosing chronic ankle lateral ligament instability, and confirmed surgical findings are used as the gold standard in most clinical studies. Anterior drawer testing is considered unreliable because normal findings are highly variable, and its accuracy ranges from 50% to 100%. Furthermore, radiographic stress imaging, such as in anterior drawer stress view, is performed under manual stress or using a stress device, and its findings also vary widely and confuse when interpreting stress views. The average accuracy of MRI findings is around 85% (range, 66%~91.7%), and thus, cannot be used as a primary indicator for surgery. For patients with suspected lateral ankle ligament instability, based on symptoms and physical examination findings, MRI may be useful for identifying lesions in ankle joints and for differentiating them from other conditions.

Clinical Results of Surgical Treatment with Minimally Invasive Percutaneous Plate Osteosynthesis for Displaced Intra-articular Fractures of Calcaneus / 대한족부족관절학회지

Purpose@#This study evaluated the clinical results of surgical treatment with minimally invasive plate osteosynthesis for treating displaced intra-articular fractures of the calcaneus in comparison with conventional lateral extensile approach plate osteosynthesis. @*Materials and Methods@#Of 79 cases of Sanders type II or III calcaneus fractures, 15 cases treated with the minimally invasive calcaneal plate (group M) and 64 cases treated with lateral extensile approach calcaneal plate (group E) were identified. After successful propensity score matching considering age, sex, diabetes mellitus history, and Sanders type (1:3 ratio), 15 cases (group M) and 45 cases (group E) were matched and the demographic, radiologic, and clinical outcomes were compared between the two groups. @*Results@#The median time of surgery from injury was 2.0 days in group M and 6.0 days in group E (p=0.014). At the six months followup, group M showed results comparable with those of group E in radiographic outcomes. In the clinical outcomes, group M showed better postoperative American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores than did group E (p=0.001, p=0.008). A greater range of subtalar motion was achieved at the six months follow-up in group M (inversion 20.0° vs. 10.0°, p=0.002; eversion 10.0° vs. 5.0°, p=0.025). Although there were no significant differences in complications between the two groups (1 [6.7%] vs. 7 [15.6%], group M vs. group E; p=0.661), there was only one sural nerve injury and no wound dehiscence and deep infection in group M. @*Conclusion@#Minimally invasive plate osteosynthesis showed superior clinical outcomes compared with that of the conventional lateral extensile approach plate osteosynthesis in Sanders type II or III calcaneus fractures. We suggest applying minimally invasive plate osteosynthesis in Sanders type II or III calcaneus fractures.

Distal Fibular Rotational Plasty for Chronic Peroneal Tendon Recurrent Dislocation: A Technical Report / 대한족부족관절학회지

Chronic recurrent peroneal dislocation often responds poorly to conservative treatment. Surgical treatment has been reported to be more effective than conservative treatment, and various surgical treatment methods are available: superior peroneal retinaculum repair or reattachment, peroneal groove deepening procedures, rerouting procedures, or bone block procedures. Although various treatment options have been reported, there is no consensus regarding which treatment is better. This paper proposes a distal fibular rotational plasty that can prevent recurrent peroneal dislocations and recover its function well by securing a stable peroneal tendon excursion space.

Distal Fibular Rotational Plasty for Chronic Peroneal Tendon Recurrent Dislocation: A Technical Report / 대한족부족관절학회지

Chronic recurrent peroneal dislocation often responds poorly to conservative treatment. Surgical treatment has been reported to be more effective than conservative treatment, and various surgical treatment methods are available: superior peroneal retinaculum repair or reattachment, peroneal groove deepening procedures, rerouting procedures, or bone block procedures. Although various treatment options have been reported, there is no consensus regarding which treatment is better. This paper proposes a distal fibular rotational plasty that can prevent recurrent peroneal dislocations and recover its function well by securing a stable peroneal tendon excursion space.

Comparison of risk-assessment tools for cardio-cerebrovascular diseases (CVD) in male shipyard workers: a cross-sectional study

BACKGROUND: Periodic revision of assessment tools is essential to ensure risk assessment reliability and validity. Despite the recent revision of the Korea Occupational Safety and Health Agency (KOSHA) 2018, there is no evidence showing that the revision is superior to other cardio-cerebrovascular diseases (CVDs) risk-assessment tools for workplace health management. We conducted a comparative analysis using the Framingham risk score (FRS) as a gold standard to identify the most relevant CVDs risk-assessment tool for workplace health management. METHODS: We included 4,460 shipyard workers who had undergone a workers' health examination during January–December 2016. Risk levels for CVDs were calculated based on the FRS, KOSHA 2013, KOSHA 2017, KOSHA 2018 (2 methods), National Health Screening Program health risk appraisal (NHS HRA) 2017, and NHS HRA 2018. Study participants were categorized into low-risk, moderate-risk, or high-risk groups. Sensitivity, specificity, correlation, and agreement of each risk-assessment tool were calculated compared with the FRS as a gold standard. For statistical analyses, Spearman's rank correlation coefficient and the linearly weighted kappa coefficient were calculated. RESULTS: Sensitivity of the risk assessments was highest in the KOSHA 2018 (health risk appraisal [HRA]). The FRS showed correlation coefficients of 0.354 with the KOSHA 2013, 0.396 with the KOSHA 2017, 0.386 with the KOSHA 2018, 0.505 with the KOSHA 2018 (HRA), 0.288 with the NHS HRA 2017, and 0.622 with the NHS HRA 2018. Kappa values, calculated to examine the agreement in relation to the KOSHA 2013, KOSHA 2017, KOSHA 2018, KOSHA 2018 (HRA), NHS HRA 2017, and NHS HRA 2018 with the FRS, were 0.268, 0.322, 0.352, 0.136, 0.221, and 0.559, respectively. CONCLUSIONS: The NHS HRA 2018 risk calculation method is a useful risk-assessment tool for CVDs, but only when appropriate classification criteria are applied. In order to enhance the risk-group identification capability of the KOSHA guideline, we propose to apply the classification criteria set in this study based on the risk group definition of the 2018 Korean Society of Hypertension guidelines for the management of hypertension instead of the current classification criteria of the KOSHA 2018.

Radiographic Risk Factors of Recurrent Hallux Valgus Deformity after Modified Scarf and Akin Osteotomy / 대한족부족관절학회지

PURPOSE@#This study investigated the recurrence rate after performing hallux valgus correction using scarf and Akin osteotomy, and also identified the correlation and cut-off values of both the preoperative and postoperative radiographic parameters as risk factors for the recurrence of hallux valgus.@*MATERIALS AND METHODS@#We reviewed 87 hallux valgus patients (122 feet) who received scarf and Akin osteotomy from January 2007 to August 2015. The clinical outcomes were evaluated using the visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores. The radiological outcome measures included the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) as determined on the serial weight bearing radiographs. Recurrence was defined as more than 20 degrees of HVA noted on the final follow-up radiograph. Those radiological factors associated with recurrence were evaluated and analyzed.@*RESULTS@#The mean follow-up duration was 20.6 months (12.0∼46.5 months) and the mean age was 44 years (13∼80 years). The VAS and AOFAS scores were significantly improved at the time of the final follow-up (7.0 to 2.0, p16.7 degrees, postoperative DMAA>13.9 degrees, and postoperative IMA>8.2 degrees showed statistically significant correlation with radiological recurrence at the last follow-up, and the odds ratio of each variable was high in order.@*CONCLUSION@#Our radiographic results indicated that postoperative HVA>16.7 degrees, postoperative DMAA>13.9 degrees, and postoperative IMA>8.2 degrees can be risk factors for hallux valgus recurrence. These risk factors may be helpful for modifying surgical procedures and preventing the recurrence of hallux valgus.

Complete Versus Culprit-Only Revascularization for ST-Segment Elevation Myocardial Infarction and Multivessel Disease in the 2(nd) Generation Drug-Eluting Stent Era: Data from the INTERSTELLAR Registry

BACKGROUND AND OBJECTIVES: We aimed to compare outcomes of complete revascularization (CR) versus culprit-only revascularization for ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) in the 2nd generation drug-eluting stent (DES) era. METHODS: From 2009 to 2014, patients with STEMI and MVD, who underwent primary percutaneous coronary intervention (PCI) using a 2nd generation DES for culprit lesions were enrolled. CR was defined as PCI for a non-infarct-related artery during the index admission. Major adverse cardiovascular event (MACE) was defined as cardiovascular (CV) death, non-fatal myocardial infarction, target lesion revascularization, or heart failure during the follow-up year. RESULTS: In total, 705 MVD patients were suitable for the analysis, of whom 286 (41%) underwent culprit-only PCI and 419 (59%) underwent CR during the index admission. The incidence of MACE was 11.5% in the CR group versus 18.5% in the culprit-only group (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.37–0.86; p<0.01; adjusted HR, 0.64; 95% CI, 0.40–0.99; p=0.04). The CR group revealed a significantly lower incidence of CV death (7.2% vs. 12.9%; HR, 0.51; 95% CI, 0.31–0.86; p=0.01 and adjusted HR, 0.57; 95% CI; 0.32–0.97; p=0.03, respectively). CONCLUSIONS: CR was associated with better outcomes including reductions in MACE and CV death at 1 year of follow-up compared with culprit-only PCI in the 2nd generation DES era.

A Case of Sensorineural Hearing Loss and Vertigo during Epidural Nerve Block / 대한평형의학회지

Epidural anesthesia has significantly advanced in neuraxial anesthesia and analgesia. It is used for surgical anaesthesia and treatment of chronic pain. Hearing loss during or after epidural anesthesia is rare, and it is known to occur by the change of the intracranial pressure. Cerebrospinal fluid is connected with perilymph in the cochlear and vestibule that is important to hearing and balance. If the intracranial pressure is abruptly transferred to the inner ear, perilymph can be leak, that called perilymphatic fistula, dizziness, and hearing loss can occur suddenly. We report a 65-year-old woman who presented with acute onset dizziness and hearing loss during the epidural nerve block for back pain, wherein we speculated a possibility of perilymphatic fistula as the mechanism of hearing loss and dizziness. The mechanism of dizziness and hearing loss was suspected with perilymphatic fistula.

Incidence of Progression into Ménière Disease from Idiopathic Sudden Sensorineural Hearing Loss: Midterm Follow-up Study / 대한평형의학회지

OBJECTIVES: Ménière disease is a clinical syndrome characterized by the four major symptoms of episodic vertigo, sensorineural hearing loss, tinnitus, and aural fullness. Sensorineural hearing loss, especially low frequency, is the characteristic type of audiogram in Ménière's disease. However, it is difficult to distinguish idiopathic sudden sensorineural hearing loss (ISSNHL) with vertigo from the first attack of Ménière disease. The purpose of this study was to investigate the incidence of progression into Ménière Disease from low frequency ISSNHL. METHODS: Two hundred eighty-three patients were included in this study. We classified the patients with ISSNHL according to the hearing loss in audiogram and analyzed how many of them actually progressed to Ménière disease based on diagnosis criteria. RESULTS: Among the 240 patients, 37.1% (89 patients) were confirmed low frequency ISSNHL and 14.6% (13 patients) of them were diagnosed with Meniere disease. CONCLUSIONS: This study showed that the progression from low frequency ISSNHL to Ménière disease was higher than other frequency ISSNHL, as in other studies.

Classify the Acute Drug Intoxication Patients with Poisoning Severity Score(PSS) and Calculate the Optimal Cutoff Value of PSS, PSSsum to Predict Poor Prognosis

PURPOSE: This study examined the Poisoning Severity Score (PSS) from acute poisoning patients, to determine the relationships among the PSS, PSSsum, the primary outcome (prolonged stay at the ER over 24 hours, general ward and ICU admission and the application of intubation and mechanical ventilator, and the administration of inotropes). METHODS: A retrospective study was conducted through the EMR for 15 months. The PSS grade was classified according to the evidence of symptoms and signs. The differences in the primary outcomes between the PSS of when a single organ was damaged, and the PSS, PSSsum combined with the grade of when multiple organs were damaged, were studied. The cutoff value was calculated using the receiving operating characteristics (ROC) curve. RESULTS: Of the 284 patients; 85 (29.9%) were men with a mean age of 48.8 years, and their average arrival time to the ER was 4.4±6.7 hours. The most frequently used drug was hypnotics. The number of patients with PSS grade 0, 1, 2, 3, and 4 was 17, 129, 122, 24, and one, respectively. No ICU admissions, application of intubation and mechanical ventilators, administration of inotropes were observed among the patients with PSS grades 0 and 1 but only on patients with PSS grades 2 to 4. At PSS, when separating the patients according to the number of damaged organs, 17 had no symptoms, 133 had one organ damaged, 75 had two organs damaged, 36 had three organs damaged, and 23 had four organs damaged. Significant differences were observed between increasing number of damaged organs and the primary outcome. CONCLUSION: Among the acute poisoning patients, the PSS was higher in severity when the grade was higher. The number of damaged organs and the primary outcome showed meaningful statistical differences. This study confirmed that when the patients' PSS>2 and PSSsum>5, the frequency of ICU admission was higher, and they were considered to be severe with an increased prescription risk of application of intubation and mechanical ventilator, and the administration of inotropes.

Positive Effect of Baby-Friendly Hospital Initiatives on Improving Mothers' Intention for Successful Breastfeeding in Korea

BACKGROUND: In Korea, the breastfeeding (BF) rate of infants aged 6 months or more is drastically decreasing, and this phenomenon is particularly worrisome for the future health of the population. The present study aimed to identify an antenatal strategy for initiation and continuation of human BF, and to identify how Baby-Friendly Hospitals (BFHs) may positively influence the intention to breastfeed. METHODS: A total of 414 pregnant Korean antenatal women were surveyed using questionnaires to determine current knowledge of the benefits of human breast milk, whether they planned to breastfeed after delivery, to continue BF after reinstatement in the workforce, are willing to abide by rooming-in care for infants, and plan to give birth at BFHs. RESULTS: We found that planning room-in care, greater awareness of BF benefits for infant and mother, participation in antenatal education programs, and provision of BF facilities in the workplace were positively associated with plans for exclusive breastfeeding (EBF) and longer BF duration. The mothers who planned to give birth at BFHs also desired to breastfeed immediately after birth, implement in-room care, continue BF at their workplace, participate in antenatal BF educational programs, and were more aware of the benefits of BF. CONCLUSION: If the beneficial effects of BFHs were well known to individuals, these would enhance the success rate of BF in Korea. Antenatal education and consequent acquisition of better knowledge of the benefits of BF are important for increasing the rate of BF practices.

Effects of Beraprost Sodium Evaluated by Digital Infrared Thermal Imaging in Diabetic Patients with Peripheral Arterial Disease / 대한족부족관절학회지

PURPOSE: This study examined the effects of beraprost sodium on digital infrared thermal images in patients with peripheral arterial disease caused by type 2 diabetes mellitus. MATERIALS AND METHODS: Twenty-five diabetic patients with peripheral arterial disease were treated with beraprost sodium in a prospective, multicenter, cohort study from February 2013 to December 2014. Beraprost sodium (40 μg) was administered orally 3 times daily (120 μg/day) for 6 months. The visual analogue scale (VAS) and digital infrared thermal imaging (DITI) were performed to compare the blood flow improvement between before and after dosing. RESULTS: Among the 25 patients included in the evaluation, 22 patients completed the study. A significant increase in body temperature was observed in the front and left side, particularly in the plantar side in DITI compared to that before and after administration. An increase in body temperature was observed at the frontal part from 28.1℃±2.3℃ to 29.1℃±2.1℃ (p=0.021), at the left side from 27.8℃±2.4℃ to 28.6℃±1.9℃ (p=0.028), at the plantar part at 24.0℃±1.5℃, and at the plantar part at 27.1℃±2.4℃ (p < 0.01). The VAS decreased significantly from 5.4±1.3 to 2.7±2.0 after 6 months of treatment (p < 0.01). CONCLUSION: Beraprost sodium is a safe and easy-to use oral medication for diabetes peripheral arterial disease. It can be expected to increase the blood flow and decrease the lower extremity pain statistically after being taken for 6 months.

Chopart Joint Fracture and Dislocation: A Report of Three Cases / 대한족부족관절학회지

Chopart joint fracture and dislocation are rare injuries compared with other joint injuries with various clinical manifestations. Moreover, there is a lack of knowledge of the radiological findings of the joints, and thus, the extent of joint ligament damage may be underestimated, leading to improper treatment. This paper reports three cases of Chopart joint injury and seeks to reconsider the importance of Chopart joint evaluation and treatment.