Policy Analysis for Implementing Neuroethics in Korea’s Brain Research Promotion Act

In 1998, Korea implemented the Brain Research Promotion Act (BRPA), a law to revamp the field of neuroscience at the national level. However, despite numerous revisions including the definition and classification of neuroscience and the national plans for the training and education systems, the governance for neuroethics has not been integrated into the Act. The ethical issues raised by neuroscience and neurotechnology remain unchallenged, especially given the focus on the industrial purpose of the technology. In the current study, we analyzed the BRPA revision process by using Kingdon’s Multiple Streams Framework to determine the problems faced by the process. We propose a new strategy, including neuroethics governance and a national committee, to promote interdisciplinary neuroscience research and strengthen neuroethics in Korea.

The Effects of Stretching and Strengthening Exercise on the Pain, Pelvic Tilt, Functional Disability Index, and Balance Ability of Patients with Chronic Lower Back Pain

PURPOSE: This study examined the effects of stretching and strengthening exercises on the pain, pelvic tilt (PT), functional disability, and balance of patients with chronic lower back pain (CLBP). METHODS: A total of 42 patients with CLBP were randomly divided randomly into either experimental group I (EG I, n=21), who received stretching exercise, or experimental group II (EG II, n=21), who received strengthening exercise. Both interventions were applied three times a week for eight weeks. Assessments were made with a visual analogue scale (VAS), PT, Oswestry disability index (ODI), and Berg's balance scale (BBS) before and after the eight weeks intervention period. A paired t-test was conducted to compare the within-group changes before and after the intervention. An independent t-test was used compare the between-group difference. The statistical significance level was set to α=0.05 for all variables. RESULTS: The EG I and II showed significant within-group changes in the VAS, PT, ODI, and BBS (p<0.05). The changes in VAS, PT, ODI, and BBS were similar regardless of the exercise form. CONCLUSION: In this study, the application of stretching and strengthening exercise for subjects who complain of CLBP was effective in changing the level of pain, PT, functional disability, and balance.

A Systematic Review of Elastic Taping Effect of Patients with Stroke

This study was conducted to evaluate the effectiveness of taping intervention in patients with stroke through a review analysis of taping interventions used to enhance physical function and activity in patients with stroke. We searched randomized controlled trials using electronic databases. We also manually reviewed sources to identify additional relevant studies. Taping intervention is an approach to treat individuals with impaired physical function and activity. Taping interventions affect body functions by providing increased muscle strength, proprioceptive sensation, and range of motion, as well as decreased rigidity and pain. Taping interventions also improve walking, balance and arm functions, such as physical activity. Taping intervention for patients with stroke has been shown to be highly effective and is therefore strongly recommended; however, it is suggested that it be further developed to improve its efficacy as an intervention method and to create additional taping methods.

The Effects of Task-Oriented Exercise Program on Balance Ability in Patients with Acute Stroke

PURPOSE: This study aimed to identify the effects of a task-oriented exercise program on balance in patients with acute stroke. METHODS: Twenty participants with hemiparesis resulting from acute stroke volunteered to participate in this study. They were randomly assigned to either the experimental or control group, with 10 patients per group. Both groups underwent a task-oriented exercise program averaging 30 minutes daily for 4 weeks. Balance was assessed before and after the 4-week training period. Before and after the intervention, we conducted a paired t-test to compare the within-group changes and an independent t-test to compare the betweengroup differences. The statistical significance level was set at p=0.05 for all the variables. RESULTS: Both groups showed significant within-group and between-group changes in balance (p < 0.05) after the intervention. CONCLUSION: This study provides valuable information for future studies in this field. Further research using a larger sample and longer experiment spans can corroborate the results of our study.

Effects of Respiratory Muscle Training on the Respiratory Function, Balance, and Activities of Daily Living in Patients with Stroke

PURPOSE: This study evaluated the effects of respiratory muscle training on respiratory function, balance, and activities of daily living (ADL) in patients with stroke. METHODS: The study included 21 patients with stroke, divided into the experimental group and control group. Both groups underwent traditional physical therapy once a day for 30 minutes, five times weekly for 6 weeks. The experimental group underwent additional respiratory muscle training once a day, five times a week during the study period. Maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), Berg balance scale (BBS), and Korean-modified Barthel index (K-MBI) were measured before and after the study period. For statistical analysis, paired t-test was used to compare the difference between the pre and post values. Independent t-test was used compare the differences between groups. RESULTS: Both groups had significantly improved MIP, MEP, BBS, and K-MBI scores after the study period. The experimental group had significantly improved MIP, MEP, BBS, and K-MBI scores. CONCLUSION: These results suggest that respiratory muscle training improves respiratory function, balance, and ADL in patients with stroke.

US Diagnosis for Thyroid Nodules with an Indeterminate Cytology

PURPOSE: We wanted to assess the diagnostic efficacy of thyroid ultrasound (US) for evaluating thyroid nodules with indeterminate cytology. MATERIALS AND METHODS: Among 1865 nodules in 1278 patients who received a prospective US diagnosis of their thyroid nodule(s) and who subsequently underwent US-guided fine-needle aspiration, 130 nodules with indeterminate cytology were enrolled in the study. Each thyroid nodule was prospectively classified by a single radiologist into 1 of 5 diagnostic categories: "benign", "probably benign", "indeterminate", "suspicious for malignancy" and "malignant." The solid nodules were classified using all 5 categories and the partially cystic nodules classified using 4 categories ("indeterminate" was omitted). We calculated the diagnostic efficacy of thyroid US by comparing the US diagnoses with the pathology results. RESULTS: Of 130 nodules with indeterminate cytology (130/1865, 7.0%), 62 nodules were surgically removed. Nineteen nodules were assigned to the indeterminate category on US. The malignantly rate of the US-indeterminate category was 56.5% (35/62). The sensitivity, specificity and positive and negative predictive values were 81.0%, 81.8%, 81.0%, 81.8% and 81.4%, respectively, when US-indeterminate nodules were excluded. There was no significant difference of diagnostic efficacy when these nodules were reclassified as malignant, but there was a significant difference of diagnostic efficacy when these nodules were reclassified as benign. CONCLUSION: Our US classification may be a feasible method for managing thyroid nodules with indeterminate cytology.

Immediate Breast Reconstruction with Contralateral Pectoralis Major Myomammary Flap for Breast Conserving Surgery / 한국유방암학회지

PURPOSE: There has been much reported data showing that breast reconstruction surgery does not result in reduced patient survival if the accepted principles of cancer surgery are closely followed. The proper reconstructive technique can be selected according to diverse factors, but breast size and the site of tumor are mostly important. The latissimus dorsi musculocutaneous flap (LDMCF) is one of the most commonly used techniques for early breast cancer patients who have small breasts. But, it has difficulties for supplying enough tissues to the widely excised tumor site. Especially for ptosis patients, reduction mammoplasty by itself is not enough to achieve symmetry of the breast. We suggest that the pectoralis major myomammary flap (PMMF) is a useful technique for the patients with ptosis. METHODS: Seventeen patients with ptosis were treated with breast conserving surgery with PMMF reconstruction. A quadrantectomy rather than lumpectomy was performed through a planned skin incision, and axillary lymph node dissection was performed according to the results of sentinel lymph node biopsy. The PMMF is carefully harvested without perforating branch injury to the internal thoracic artery. Reconstruction was done via the PMMF through the medial tunnel between both breasts. RESULTS: Among the seventeen patients, seroma occurred in two patients and no necrosis occurred at all. The cosmetic result was fair in 15 patients and poor in two patients, based on the four-point scoring system of breast cosmetics. CONCLUSION: After performing enough quadrantectomy to adhere to the accepted principles of cancer surgery, PMMF was quite useful to supply enough proper tissues for breast reconstructions, and especially for the ptosis patients.

Ultrasonography-guided Fine-needle Aspiration Biopsy for Thyroid Nodules: Effective Technique and a Peculiar Smear Method

PURPOSE: We wanted to evaluate the effective methods that are appropriate for an endemic area of thyroid disease and to compare the differences of cytologic diagnostic rates with and without using a peculiar smear technique. MATERIALS AND METHODS: We analyzed the incidence rate of insufficient results, complications and the total procedure times of 1,126 thyroid nodules in 776 patients who underwent US-FNAB (ultrasonography-guided fine-needle aspiration biopsy) from January to December 2005. We compared the diagnostic rate between the two groups; the groups' tests were performed with a peculiar smear technique (Group A, n = 313) or with a conventional smear technique (Group B, n = 250). RESULTS: According to the size of the thyroid nodule, the incidence rate of an insufficient result on US-FNAB and the mean total procedure time for 1126 thyroid nodules in 776 patients were measured as 16.9% (52/308) and 208 seconds for nodules under 0.5 cm, 9.8% (30/306) and 160 seconds for nodules between 0.5 cm-1.0 cm, and 6.0% (30/504) and 134 seconds for nodules over 1.0 cm. These 776 patients showed no significant complications, except for mild pain. In Group A, the incidence rate of an insufficient result was calculated as 15.1% (14/93) for the group with nodules under 0.5 cm, 5.3% (5/95) for the group with nodules between 0.5 cm-1.0 cm, 4.8% (6/125) for the group with nodules over 1.0 cm, and 8.0% (25/313) for the total A Group. In Group B, the incidence rate of an insufficient result was measured as 33.3% (15/45) for the group with nodules under 0.5 cm, 28.1% (25/89) for the group with nodules between 0.5 cm-1.0 cm, 21.4% (24/112) for the group with nodules over 1.0 cm, and 25.7% (63/245) for the total B group. There was a statistically significant correlation between the rate of an insufficient result and the peculiar smear technique or the size of the thyroid nodule. CONCLUSION: We consider that US-FNAB is very simple, safe and accurate diagnostic method for thyroid nodules, and US-FNAB with a peculiar smear technique is able to increase the diagnostic rate for thyroid nodules.

Genomic DNA Aberration Profiles in Paraffin-Embedded Breast Tumor Using Array-CGH on c-erbB-2 Overexpression

PURPOSE: Array-CGH is the technique for detecting multiple chromosomal abnormalities in the genomic DNA with using a single procedure. Compared with conventional CGH, there are many advantages for array-CGH such as high resolution, simplified image analysis and high throughput, and its oligo-strategy allows a genome based design. We analyzed the gene aberrations in breast cancer patient to discover the other genomic aberrations that are associated with c-erbB-2 amplification. METHODS: 10 cases of breast cancer patients, considering its c-erbB-2 status of the paraffin embedded tissues, were analyzed with performing array-CGH. RESULTS: The repeated aberrations in whole cases were found in 78 loci, of which repeatedly gained in 1p36.33, 19p13.13, and lost in 14q32.33, 4q32.3, 10p15.3, 14q21.1. The unsupervised dendrogram couldn't show significant classifier for its limited case number. Each tissue from one bilateral breast cancer patient showed a different aberration pattern. There were no BRCA1, 2 aberrations in this study. The concordance was 100% between the IHC and the a-CGH. By the supervised clustering on the c-erbB-2 factor, 18 aberrations (gained in 17q12-21.1, 17q12, 17q21.1, 17q11.2 and lost in 22q11.1, 15q11.2) were found in c-erbB-2 (+) group with the permutation t-test. The repeated aberrations of c-erbB-2 (+) group were found in 170 loci, of which repeatedly gained in 17q12, 17q21.1 and lost in 14q32.33, 22q11.1. CONCLUSION: Although the number of cases was small, performing a-CGH with paraffin embedded breast cancer tissue was a useful technique for rapidly identifying DNA aberrations with high throughput, and this technique showed significant aberrations for some clinical variables.

A Case of Thin Acral Lentiginous Melanoma with Lymph Node Metastasis and Regression / 대한피부과학회지

Contrary to general perception, thin acral lentiginous melanoma can metastasize. Sentinel lymph node metastases are found in a significantly greater proportion of patients with thin melanoma showing histological evidence of regression. In these cases, metastatic melanoma within lymph nodes may stimulate an immune response, resulting in regression of the primary lesion. However, a small number of thin acral lentiginous melanoma without regression also metastasize. We report a case of thin acral lentiginous melanoma with lymph node metastasis showing regression.

Clinical Studies of Xanthogranulomatous Pyelonephritis / 대한비뇨기과학회지

PURPOSE: Because the preoperative diagnosis of xanthogranulomatous pyelonephritis (XGP) is difficult due to its similarities to other renal diseases, the diagnosis is made postoperatively in most patients. The aim of this study was to improve preoperative diagnosis of this disease. MATERIALS AND METHODS: We reviewed clinical characteristics, laboratory and radiological findings, preoperative diagnoses, and operative methods of 6 patients with XGP who underwent operation from March 1991 to July 1998. Mean age was 49.8 years (range 28 to 80) and male to female ratio was 1 to 2. RESULTS: All 6 patients had flank pain and urinary tract infection. Among 6 patients, there were 3 patients (50%) with renal staghorn stone and 1 (16.7%) with ureteropelvic junction stricture. No patient was diagnosed as XGP preoperatively. Three patients (50%) diagnosed as pyonephrosis with staghorn stone preopratively underwent simple nephrectomy and 2 patients diagnosed as renal mass preoperatively underwent radical nephrectomy. One patient diagnosed as renal abscess extended to retroperitoneum and psoas muscle preoperatively was diagnosed as XGP through intraoperative frozen section biopsy of renal tissue and underwent partial nephrectomy and drainage. CONCLUSIONS: Preoperative diagnosis of XGP will be raised through better understanding of the clinical characteristics and radiologic findings of this disease.

Two Cases of Prolonged Priapism Caused by Abuse of Intracavernosal Self-injection / 대한남성과학회지

Priapism is a rare disease, but needs early intervention and appropriate management. We present 2 cases of ischemic low-flow priapism after intracavernosal injection of vasoactive drug. 43-year-old man and 61-year-old man visited our clinic complaining of continuous plan and erection persisting for several days after self cavernosal injection for increasing their erectile function. We performed blood gas analysis of cavernosal blood and color doppler ultrasound. And so we confirmed the diagnosis of low-flow priapism. Detumescence was finally achieved after the proximal shunt operation. Their erectile function was not recovered and they became permanent impotence.

Percutaneous Sclerotherapy of Simple Renal Cyst Using Minocycline HCl / 대한비뇨기과학회지

PURPOSE: Sclerotherapy is performed additionally to improve the outcome of aspiration in simple renal cyst. Ethanol has been used most commonly as a sclerosing agent, however, drainage is necessary which complicates the procedure. For this reason, we used minocycline HCl as a sclerosing agent without need to be drained and evaluated the results. MATERIALS AND METHODS: From June 1990 to May 1999, 140 patients who underwent percutaneous minocycline HCl sclerotherapy for simple renal cyst were evaluated. Among them, 10 patients were missed during follow-up and 7 patients had bilateral simple renal cysts. The simple renal cysts were aspirated under ultrasonography, and then minocycline HCl 100mg mixed with 5ml normal saline was injected into the cyst per 50ml of aspirated cyst fluid. The follow-up ultrasonography was performed at posttreatment 3, 6 and 12 months. The recurred cases were retreated with same procedure. RESULTS: Among 137 renal cysts of 130 patients who could be followed up, 70 renal cysts (51.1%) were totally collapsed and 53 renal cysts (38.7%) showed a 50% or more decrease in cyst volume after first treatment. All 14 persistent renal cysts (10.2%) showed a 50% or more decrease in cyst volume after second or third treatment. Catheterization for drainage of the sclerosing agent was not needed. There were only some minor complications such as nausea, vomitting and local pain that subsided within one day with only symptomatic treatment. CONCLUSIONS: These results shows that percutaneous minocycline HCl sclerotherapy is simple, safe and effective and can be a alternative first line therapy of simple renal cyst.

The Use of Permeability of Potassium in the Diagnosis of Interstitial Cystitis

PURPOSE: The Aim of this study was to find the value of intravesical permeability of potassium as a diagnostic measure of the interstitial cystitis and to find importance of intravesical mucosal layer by intravesical instillation of potassium chloride solution. MATERIALS AND METHODS: 20 patients with interstitial cystitis and 20 normal subjects without UTI, frequency and urgency underwent intravesical challenge with 40ml water and 40ml of 400meq/L potassium chloride solution. After 5 minutes, patients were asked about increase or decrease of urgency or suprapubic pain and subjective response of urgency or suprapubic pain were recorded on a scale of 0 to 5. RESULTS: Neither normal subjects nor patients with interstitial cystitis reacted to water administered intravesically. There was marked sensitivity to intravesical potassium in 85% of patients with interstitial cystitis versus 10% of normal controls (p<0.05). CONCLUSIONS: Diffusion of urinary potassium ion into the bladder interstitium may induce sensory symptoms, damage the tissue and be a major toxic factor in the pathogenesis of interstitial cystitis. Intravesical potassium sensitivity can be a reliable method for detecting abnormal epithelial permeability and useful diagnostic test for interstitial cystitis.

100 case of pancreaticoduodenectmy in 1000 beds hospital, 10 years experience / 한국간담췌외과학회지

BACKGROUND/AIMS: The death rates of pancreaticoduodenectomy decreased dramatically in experienced centers and it depends on many variability including nutritional status, better patient selection, hospital volume. We reviewed our experience of 100 pancreaticoduodenectomy for 10 years, 1000 beds hospital METHOD: Between 1990 and 2000, 100 patients underwent a pancreaticoduodenectomy in Dong-A University hospital. Annual number of cases, the disease entity, operative procedures, operation time and transfusion, radicality, external or internal pancreatic stent methods, morbidity and mortality were analyzed retrospectively. RESULTS: 10 cases or less per year until 1998: thereafter, the number of cases increased reaching 24 cases per year recently. Diseases entities were 35 pancreas head carcinomas, 22 common bile duct carcinomas, 20 ampulla vater carcinomas, 8 duodenum carcinomas, 9 chronic pancreatitis, 3 gallbladder carcinomas etc. Operative procedures were 53 whipple's operations, 23 Total pancreaticoduodenectomy, 22 pylorus preserving pancreaticoduodenectomy, 2 hepatopancreaticoduodenectomy. Postoperative morbidity has been decreasing, however, pancreatic leakage is still unresolved problem. Under 10 case annually the overall mortality was 22%, over 15 case annually the mortality reduced 12%(P=0.242). There were no mortality consecutive 30 cases since June, 1999 after changing the internal pancreatic duct stent to external pancreatic duct stent with preoperative total parenteral nutrition, Indocyanine green (ICG) test. The death rate was reduced(P=0.156). CONCLUSION: Pancreaticoduodenectomy has been increasing due to increased incidence of indication and improved resectability. Also preoperative total parenteral nutrition, ICG test, external pancreatic duct stent, successful postoperative embolization techniques decreased mobidity & mortality. It was suggested, pancreaticoduodenectomy could be safely performed in centers with more than 15 pancreatoduodenectomy annually.

The Effect of Treatment of Erectile Dysfunction with Electrical Stimulation / 대한남성과학회지

PURPOSE: In recent year, erectile dysfunction patients are increasing, and some of them want to increase their erectile function without using medication or surgical methods, In this study we attempted to find the value of electrical stimulation with electrical stimulation machine Hi-DREAM 328(TM) made in Korea as a treatment method of no definite underling disease caused erectile dysfunction patients. MATERIALS AND METHODS: In 22 cases erectile dysfunction patients we treated them two times per week for 4 weeks totally 8 times above mentioned machine, each session was spent for 1 hour 48 minutes. We checked IIEF-5 (International Index of Erectile Function-5) score repeatedly for comparing the change of IIEF-5 score pretreatment, 1 month after treatment and 3 month after treatment. And we compared the effect of treatment as comparing the IIEF-5 score changing each time. RESULTS: Total IIEF-5 score of pretreatment was 9.6+/-5.5, 1 month and 3 month after electrical stimulation were 17.9+/-2.9, 16.2+/-2.9, respectively. In the patients with venous leakage, IIEF-5 score was no increase definitely following electrical stimulation. But in the case of abnormal SPACE, pretreatment of IIEF-5 score was 12.1+/-5.2, 1 month and 3 month after electrical stimulation were 18.1+/-7.6, 16.5+/-7.4, respectively. We found that IIEF-5 score were increased in no definite organic caused erectile dysfunction patients, and there was significant correlation statistically (p<0.05) in erectile function, maintenance of erection, intercourse satisfaction, overall satisfaction. The remaining effect after treatment was decreased in time follow up. But the erectile function was preserved at comparing before treatment. CONCLUSIONS: We suggest that electrical stimulation is one of the treatment modalities in the treatment of no definite underling disease caused erectile dysfunction patients rather than vascular abnormalities as like venous leakage.

Experimental Study of the Molecular Index of Epidermal Growth Factor in Hepatic Development

BACKGROUND: Epidermal growth factor (EGF) is a 6Kd polypeptide hormone produced by the glands of the gastrointestinal tract, namely the salivary and Brunner's glands. In fetal and neonatal life, EGF appears to play an important role in the developement of the gastrointestinal tract and the liver. METHODS: EGF and EGFR (EGF receptor), which play important roles in the onset of liver regeneration, were investigated with regard to the proteins and mRNA according to the developmental periods of the livers of prenatal rats (24 female Spraque Dawley rats weighting from 200 to 250g) by using immunohistochemical stains, the solution reverse transcription polymerase chain reaction (RT PCR), and in-situ (IS) RT PCR. RESULTS: 1) On the immunohistochemical stains, the immunoreactivities for EGF started to be observed at an early stage of the developing rat liver. As the developmental stage progressed, the reactivites were observed in embryo tissues containing epithelial cells. The strongest reactivity for EGF was found from the 17th to the 19th day after pregnancy and decreased gradually till full term. The reactivities of EGFR were detected earlier than those of EGF. 2) In solution RT PCR studies, EGF and beta-actin (house keeping gene) were detected in all developmental stages, reached a peak level at the 18th day after pregnancy, and decreased gradually till the final developmental stage. The peak level of EGF beta-actin was about 4 times higher than the lowest level. 3) The expressions of EGF in IS RT PCR were detected mainly on hepatocytes rather than Kupffer cells and endothelial cells. CONCLUSIONS: The EGF expression was observed over the entire time of development for experimental rat livers and is related strongly to growth and developing rate of liver.

Utility of Preoperative Thyroid Ultrasonography in Surgical Treatment of Thyroid Nodules

Since March 1993, high resolution ultrasonography has been performed in Pusan National University hospital as a routine preoperative check for patients with suspected or malignant thyroid nodules, identified by initial screening with fine-needle aspiration biopsy. Our one-year experience with 66 cases from June 1993 to June 1994 is as follows: 1) On the permanent sections, the nodule was a papillary thyroid carcinoma in 45.5%, a follicular adenoma in 27.3%, a adenomatous goiter in 22.7%, and a cyst in 4.5% of the total 66 cases, respectively. 2) Ultrasonographically, additional smaller nodule(s) was present in 60% of cases with a papillary thyroid carcinoma; also, papillary carcinomas were present in 61.1% of the permanent sections. In 2 cases of follicular adenomas, the additional nodules were papillary carcinomas on the permanent sections. 3) Multiple small calcifications within the nodule were found in 50.0% of the cases with a papillary thyroid carcinoma. 4) Enlargement of the jugular chain of nodes was found in 21.2% of the 66 cases, and was microscopically positive in 92.9% of the cases. Although not an essential element in initial screening, an ultrasonographic study of the thyroid may be quite useful in patients with suspected or malignant thyroid nodule.