Locoregional flaps versus skin grafts in the nose: aesthetic considerations after cancer ablation

Background@#The annual incidence of skin cancer has been increasing, and surgical ablation is presently the treatment of choice for skin cancer. However, it leaves soft tissue defects that require reconstruction. The methods for reconstruction include locoregional flaps (LRFs) and full-thickness skin grafts (FTSGs). We compared these two surgical methods for reconstruction of defects in the nose, which is prominently visible and the most common site of facial skin cancer, and assessed the cosmetic results by evaluating the scars. @*Methods@#This retrospective study was conducted between July 2012 and January 2021. Patients were evaluated for scars after at least 6 months of follow-up. Patients were divided into LRF and FTSG groups. The scars were evaluated using the Vancouver Scar Scale. @*Results@#In total, 27 patients were included in this study. Their mean age was 66.8 years. Eighteen patients underwent LRF, and nine patients underwent FTSG. The average defect size was 1.55 cm² in the LRF group, and 1.38 cm² in the FTSG group. The average scar score was 1.44 points in the LRF group and 3.67 points in the FTSG group. The LRF group showed significantly lower total scores than the FTSG group. @*Conclusions@#Although LRFs and FTSGs are useful reconstructive methods for nasal soft tissue defects, this study showed that LRFs are superior to FTSGs in terms of aesthetic results.

Three-dimensional analysis of facial asymmetry after zygomaticomaxillary complex fracture reduction: a retrospective analysis of 101 East Asian patients

Background@#The zygomaticomaxillary complex (ZMC) has a protruded, convex shape and plays a vital role in determining the contour by affecting the width of the middle face. This study aimed to evaluate the efficiency of ZMC fracture reduction and explore detailed directions for outcome improvement. @*Methods@#We conducted a retrospective study of patients diagnosed with unilateral ZMC fracture who underwent ZMC reduction surgery at a single hospital between January 2015 and May 2020. The primary outcome variable was facial asymmetry using the difference in the bilateral malar eminence (ME) position measured by computed tomography scan. The 3-dimensional distance (IA, asymmetry index) and the distance in each dimension, Dx (anteroposterior distance), Dy (mediolateral distance), and Dz (superoinferior distance) were compared. @*Results@#A total of 101 patients with ZMC fractures and 54 non-fracture patients were enrolled in the study. The mean age of the study sample was 43.49 years (control sample, 43.35 years), and the male-to-female ratio was 66.3:33.7 (control sample, 64.8:35.2). There were 53 and 48 patients with right and left ZMC fractures, respectively. The IA was not statistically different between the two groups. In terms of position in each dimension, only Dx was significantly different between the two groups. @*Conclusion@#The results show that overall facial asymmetry was recovered after ZMC reduction, but in certain dimension significant difference in ME position has still remained. For further improvement, treatment should be performed to relieve malar depression in the anteroposterior dimension.

Three-dimensional analysis of facial asymmetry after zygomaticomaxillary complex fracture reduction: a retrospective analysis of 101 East Asian patients

Background@#The zygomaticomaxillary complex (ZMC) has a protruded, convex shape and plays a vital role in determining the contour by affecting the width of the middle face. This study aimed to evaluate the efficiency of ZMC fracture reduction and explore detailed directions for outcome improvement. @*Methods@#We conducted a retrospective study of patients diagnosed with unilateral ZMC fracture who underwent ZMC reduction surgery at a single hospital between January 2015 and May 2020. The primary outcome variable was facial asymmetry using the difference in the bilateral malar eminence (ME) position measured by computed tomography scan. The 3-dimensional distance (IA, asymmetry index) and the distance in each dimension, Dx (anteroposterior distance), Dy (mediolateral distance), and Dz (superoinferior distance) were compared. @*Results@#A total of 101 patients with ZMC fractures and 54 non-fracture patients were enrolled in the study. The mean age of the study sample was 43.49 years (control sample, 43.35 years), and the male-to-female ratio was 66.3:33.7 (control sample, 64.8:35.2). There were 53 and 48 patients with right and left ZMC fractures, respectively. The IA was not statistically different between the two groups. In terms of position in each dimension, only Dx was significantly different between the two groups. @*Conclusion@#The results show that overall facial asymmetry was recovered after ZMC reduction, but in certain dimension significant difference in ME position has still remained. For further improvement, treatment should be performed to relieve malar depression in the anteroposterior dimension.

Descriptions of Two Digenean Trematodes Found from a Chinese Sea Snake, Laticauda semifasciata, in Republic of Korea

We intended to describe 2 digenean trematodes found from a Chinese sea snake, Laticauda semifasciata, as the new fauna in the Republic of Korea. The snake was caught offshore of Aewol-eup, Jeju-do, in August 2017. Two species of fluke were found in the lung and intestinal tract of the snake in the process of necropsy. They were identified as Pulmovermis cyanovitellosus Coil and Kuntz, 1960 and Harmotrema laticaudae Yamaguti, 1933, respectively based on the morphological characters. Pulmovermis cyanovitellosus showed elongated body with well-developed and elongated male genital system and compact vitelline. And H. laticaudae was characterized by linguiform body with heavily armed cirrus with excretory system. This is the first time both species have been reported and described off the Korean coast. We provide morphological descriptions with some comments on their biology and geographical distribution. In addition, the taxonomic validity of the genus Hydrophitrema Sandars, 1960 was discussed, in terms of morphological descriptions and host ranges. This study provides novel insight into digenean fluke species existing off the coast of Korea.

Anomalous Retro-Psoas Iliac Artery: A Case Report

The anomalous retro-psoas iliac artery is an extremely rare congenital iliolumbar vascular anomaly. A 51-year-old woman presented to our emergency department with worsening right lower extremity pain and weakness for 3 months. CT angiography of the right lower extremity showed no evidence of stenosis in the lower extremity arteries and the incidental finding of an anomalous right retro-psoas iliac artery. Herein, we report a rare case of anomalous retro-psoas iliac artery. Surgeons and clinicians need to be aware of this rare congenital anomaly to avoid severe complications during pelvic or orthopedic surgery.

Artificial Intelligence in Health Care: Current Applications and Issues

In recent years, artificial intelligence (AI) technologies have greatly advanced and become a reality in many areas of our daily lives. In the health care field, numerous efforts are being made to implement the AI technology for practical medical treatments. With the rapid developments in machine learning algorithms and improvements in hardware performances, the AI technology is expected to play an important role in effectively analyzing and utilizing extensive amounts of health and medical data. However, the AI technology has various unique characteristics that are different from the existing health care technologies. Subsequently, there are a number of areas that need to be supplemented within the current health care system for the AI to be utilized more effectively and frequently in health care. In addition, the number of medical practitioners and public that accept AI in the health care is still low;moreover, there are various concerns regarding the safety and reliability of AI technologyimplementations. Therefore, this paper aims to introduce the current research and application status of AI technology in health care and discuss the issues that need to be resolved.

Infections of Two Isthmiophora Species (Digenea: Echinostomatidae) in Wild Mammals from Republic of Korea with Their Morphological Descriptions

Isthmiophora hortensis (Digenea: Echinostomatidae) is a dominant echinostome in animal reservoir hosts and humans in the Republic of Korea (Korea). We intended to investigate the infection status with this echinostome species in the several species of wild animals and describe the morphological characteristics in the faunistic view point. A total of 175 animal carcasses belonging to 3 families, i.e., Canidae, Felidae and Mustelidae, were collected from the southern regions of Korea from March 2010 to July 2017. Isthmiophora spp. worms were recovered from the small intestines of each animal under a stereomicroscope after washing of intestinal contents. Isthmiophora hortensis was recovered from 4 species of wild carnivores, i.e., Nyctereutes procyonoides (3/107: 2.8%), Mustela sibirica (11/31: 35.5%), Meles lucurus (2/3: 33.3%) and Martes flavigula (1/2: 50%). The other 3 carnivores comprising stray dogs, cat and leopard cat were negative for I. hortensis infection (0/2, 0/10 and 0/12, respectively). Specimens obtained from the Lutra lutra (6/8: 75%) were identified as a distinct species, I. inermis, by morphological comparison. Isthmiophora inermis has thinner body, elongate testes and different anterior limits of vitelline fields. Detailed morphological descriptions and comparisons with the morphological characteristics are provided. Conclusively, it was confirmed for the first time that 3 species of mustelid mammals, i.e., M. sibirica, M. lucurus, and M. flavigula, are to be the new definitive hosts of I. hortensis in Korea. Additionally, I. inermis is to be newly added in the Korean echinostome fauna.

Epidemiology of violence in pediatric and adolescent nasal fracture compared with adult nasal fracture: An 8-year study

BACKGROUND: The epidemiology of nasal fractures varies according to factors such as the era and area of the study, as well as the age of the patient. We compared the characteristics and causes of pediatric nasal fractures. METHODS: A total of 2,321 patients with nasal fractures from 2010 to 2017 were examined. The patients were divided into age groups using the Korean school system of age classification. The causes of injury were divided into five groups: violence, fall or slip down, sports, road traffic accidents, and others. Fractures were classified using the Stranc and Robertson standard: vector of force and plane of fracture. RESULTS: Violence was the most common cause of nasal fracture in patients older than 12 years. Violence was a significantly less frequent cause among patients younger than 12 years old than among adolescent and adult patients. Nasal fractures due to violence were not observed in patients younger than 10 years. Plane 2 and lateral force fractures were the most common; however, in patients younger than 12 years, frontal force fractures were significantly more frequent than were lateral force fractures. CONCLUSION: As children may simply be injured due to a fall or slip down, it is important for the parents and guardians to ensure their safety. As they become older, children should abstain from violence and be monitored. It is therefore very important to ensure that the environment is free of violence in order to prevent such injuries.

Injuries and Illnesses of Korean Athletes during the Almaty Winter Universiade Games 2017 / 대한스포츠의학회지

PURPOSE: This study aimed to describe the pattern of injuries and illnesses among Korean athletes during the Almaty Winter Universiade 2017. METHODS: All medical staffs of Korean team recorded the daily occurrence of injuries and illnesses sustained during the Almaty Winter Universiade Games by using a standardized online form via kociss.com. The design of this study was a prospective study. RESULTS: In total, 98 athletes (68 men and 30 women) in 11 sports events from Korean Sport Olympic Committee participated in this study. Korean medical staffs reported 40 injuries (40.8%) and 26 illnesses (26.5%), equaling incidences of 6.3 injuries and 4.1 illnesses per 100 athletes. Men suffered more injury and illness than women (44.1% vs. 33.3%). The rate of Injury and illness in training was higher than the competition (13.3 vs. 2.0 athlete exposures). The risk of an athlete being injured was the highest in freestyle skiing, followed by snowboard and speed skating. Overall, the main common type and location of injury was the joint or ligaments sprain (13.3%) and knee (7.1%). The rate of main illness was 17.3% of the respiratory system with the main symptom of pain and the main cause of environment (22.4%). CONCLUSION: Injuries and illnesses occurred 40.8% and 26.5% during this winter game, and were higher during training than a competition. Based on the epidemiologic data of this study, it could provide the source for the injury prevention and improving the performance of the athlete and further develop scientific injury and illness surveillance systems.

The Effectiveness of Ultrasound-Guided Thoracic Paravertebral Block for Percutaneous Radiofrequency Ablation of Hepatic Tumors: A Pilot Study

PURPOSE@#The purpose of this study was to evaluate the effectiveness of thoracic paravertebral block (TPVB) for management of pain during and after percutaneous radiofrequency ablation (RFA) of hepatic tumor.@*MATERIALS AND METHODS@#All patients were divided into non-TPVB (4 patients, 4 sessions of RFA for 4 tumors) and TPVB group (5 patients, 7 sessions of RFAs for 7 tumors). Ultrasound (US)-guided TPVB was performed at T7 level. The 15 mL of 0.375% ropivacaine was injected into right paravertebral space before RFA. If patients complained pain and asked analgesics or experienced pain with verbal numerical rating scale (VNRS) of more than 4, fentanyl 25 µg (up to 100 µg), pethidine 25 mg, and midazolam 0.05 mg/kg (up to 5 mg) were sequentially given intravenously during RFA.@*RESULTS@#Total intravenous morphine equivalence of analgesics before, during, and after RFA was 129.1 mg and 0.0 mg in non-TPVB and TPVB group, respectively.@*CONCLUSION@#US-guided TPVB may be an effective and safe anesthetic method for decreasing or eliminating pain during and after RFA for hepatic tumor and helpful in decreasing the usage of opioids.

Three-Dimensional Evaluation of Similarity of Right and Left Knee Joints

PURPOSE: The purpose of this study was to evaluate the anatomical similarity of three-dimensional (3D) morphometric parameters between right and left knees. MATERIALS AND METHODS: Ten fresh-frozen paired cadaveric knees were tested. Following dissection, footprint areas of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were measured. Surface scanning was performed using a 3D scanner. Scanned data were reproduced and morphometric parameters were measured on specialized software. After making mirror models, we compared footprint center positions of the ACL and PCL of both sides and calculated the average deviation of 3D alignment between the right- and left-side models. RESULTS: No significant side-to-side differences were found in any morphometric parameters. Bony shapes displayed a side-to-side difference of < 1 mm. Distal femoral and proximal tibial volumes did not present side-to-side differences, either; the average 3D deviations of alignment between the right and left sides were 0.8±0.4/1.1±0.6 mm (distal femur/proximal tibia). Center-to-center distances between the right and left ACL footprints were 2.6/2.7 mm (femur/tibia) for the anteromedial bundle and 2.4/2.8 mm for the posterolateral bundle. They were 1.9/1.5 mm for the anterolateral bundle and 2.2/1.8 mm for the posteromedial bundle of the PCL. CONCLUSIONS: There was a remarkable 3D morphometric similarity between right and left knees. Our results might support the concept of obtaining morphologic reference data from the uninvolved contralateral knee.

Virtual Reality and Augmented Reality in Plastic Surgery: A Review

Recently, virtual reality (VR) and augmented reality (AR) have received increasing attention, with the development of VR/AR devices such as head-mounted displays, haptic devices, and AR glasses. Medicine is considered to be one of the most effective applications of VR/AR. In this article, we describe a systematic literature review conducted to investigate the state-of-the-art VR/AR technology relevant to plastic surgery. The 35 studies that were ultimately selected were categorized into 3 representative topics: VR/AR-based preoperative planning, navigation, and training. In addition, future trends of VR/AR technology associated with plastic surgery and related fields are discussed.

Risk Factors of Syme Amputation in Patients with a Diabetic Foot / 대한족부족관절학회지

PURPOSE: This study examined the factors affecting the treatment of diabetes mellitus foot patients who had undergone a Syme amputation. MATERIALS AND METHODS: This study included 17 patients diagnosed with a diabetes mellitus foot and who had undergone a Syme amputation from January 2010 to January 2014. Some of the risk factors (age, body mass index [BMI], disease duration, smoking, ankle brachial index [ABI], HbA1c, serum albumin, total lymphocyte, C-reactive protein [CRP], and serum creatine) that affect the successful Syme amputation were analyzed. RESULTS: The healing rate of a Syme amputation was significantly higher when the lymphocyte count was above 1,500 mm3 (p=0.029). The factors affecting the surgical outcome according to multivariate analysis were HbA1c and the BMI (p=0.014, p=0.013). Regarding reamputation, there was a significant difference with HbA1c, lymphocyte, and BMI (p=0.01, p=0.03, and p=0.01). No significant differences were observed with age, disease duration of diabetes mellitus, smoking, ABI, serum albumin, CRP, and serum creatine. CONCLUSION: The HbA1c level, BMI and total lymphocyte count are risk factors that must be considered for successful Syme amputation in patients with diabetic foot disease.

New Record of Schistorophus cirripedesmi (Nematoda: Acuariidae) from a Bar-Tailed Godwit, Limosa lapponica baueri (Charadriformes: Scolopacidae) in Korea

In July 2014, a nematode species, Schistorophus cirripedesmi Rhizhikov and Khokhlova, 1964, was recovered from a bar-tailed godwit, Limosa lapponica baueri that was stored in a -20˚C freezer in the Chungnam Wild Animal Rescue Center. The bird was collected in 2012 from the coastal region of Pyeongtaek-si (City), Gyeonggi-do (Province) in the Republic of Korea, although the exact date is not clear. At necropsy, 9 nematodes were found in the gizzard of the bird. The parasites had 4 horn-like cephalic cuticular ornamentations. After morphometric comparison and morphological observations, including scanning electron microscopy, the nematodes were identified as S. cirripedesmi. This is the first description of a nematode species in a shorebird in Korea. This is also the first time this genus and species have been found in Korea.

Three Nematode Species Recovered from Terrestrial Snakes in Republic of Korea

The majority of parasitological studies of terrestrial snakes in Korea have focused on zoonotic parasites. However, in the present study, we describe 3 unrecorded nematode species recovered from 5 species of snakes (n=6) in Korea. The examined snakes, all confiscated from illegal hunters, were donated by the Chungnam Wild Animal Rescue Center and Korean Broadcasting System in July 2014 and February 2015. Light and scanning electron microscopies on the shapes of spicules that are either bent or straight (kalicephalids) and the presence of the intestinal cecum (ophidascarids) figured out 3 nematodes; Kalicephalus brachycephalus Maplestone, 1931, Kalicephalus sinensis Hsü, 1934, and Ophidascaris excavata Hsü and Hoeppli, 1934. These 3 species of nematode faunas are recorded for the first time in Korea.

Difference of Self-identity Levels between Strabismus Patients and Normal Controls

PURPOSE: To evaluate differences in self-identity in patients diagnosed with strabismus, patients who underwent strabismus surgery, and healthy control individuals. METHODS: Self-identity testing was done during a military service physical examination. There were three subject groups: subjects with strabismus (group 1), subjects who had undergone corrective strabismus surgery (group 2), and subjects free of strabismus (group 3). The self-identity test was comprised of six sub-sections (subjectivity, self-acceptance, future confidence, goal orientation, initiative, and familiarity). Statistical significance of the sub-sections was compared across the three groups. Correlations in age at the time of surgery and across the six sub-sections were investigated in group 2. RESULTS: A total of 351 subjects were enrolled in the study; 96 subjects were in group 1, 108 subjects were in group 2, and 147 subjects were in group 3. Significant differences were evident in subjectivity, self-acceptance, initiative and familiarity between groups 1 and 3. No significant differences were found between groups 2 and 3. In group 2, statistical significance was evident between age at surgery and initiative and familiarity (r = −0.333, p < 0.001; r = −0.433, p < 0.001, respectively). CONCLUSIONS: Self-identity is greater in non-strabismus subjects than strabismus subjects. Correction of strabismus may increase self-identity levels.

Three Echinostome Species from Wild Birds in the Republic of Korea

Three echinostome species, i.e., Patagifer bilobus, Petasiger neocomense, and Saakotrema metatestis, are newly recorded in the trematode fauna of the Republic of Korea. They were recovered from 3 species of migratory birds (Platalea minor, Podiceps cristatus, and Egretta garzetta), which were donated by the Wildlife Center of Chungbuk (WCC) and the Conservation Genome Resource Bank for Korean Wildlife (CGRB). Only 1 P. bilobus specimen was recovered from the intestine of a black-faced spoonbill (P. minor), and characterized by the bilobed head crown with a deep dorsal incision and 54 collar spines. Twenty P. neocomense were recovered from the intestine of a great crested grebe (P. cristatus), and they had a well-developed head crown with 19 spines and 2 testes obliquely located at the posterior middle of the body. Total 70 S. metatestis were collected from the bursa of Fabricius of 1 little egret (E. garzetta). It is characterized by stout tegumental spines covered in the entire leaf-shaped body, posterior extension of the uterus, presence of the uroproct and a well-developed head crown with 12 pairs of collar spines on each side. By the present study, these 3 echinostome species are newly added to the trematode fauna in Korea.

The Prostate Cancer Patient Had Higher C-Reactive Protein Than BPH Patient

PURPOSE: C-reactive protein (CRP) is a general marker for inflammation and it has been associated with prostate cancer. We hypothesized that a correlation may exist between CRP and prostate cancer in patients undergoing transrectal biopsy of the prostate because of rising prostate-specific antigen (PSA) levels. MATERIALS AND METHODS: From January 2009 to March 2012, we retrospectively reviewed 710 patients who visited our urology department and were diagnosed as having a PSA value over 4.0 ng/mL. Patients with acute infections, rheumatoid arthritis, gout, asthma, chronic lung disease, myocardial infarction, or apoplexy and those who had taken nonsteroidal anti-inflammatory drugs were exempted from the research because these variables could have impacted CRP. After we applied the exclusion criteria, we selected 63 patients with prostate cancer and 140 patients with benign prostatic hyperplasia (BPH). RESULTS: A total of 203 patients were observed: 140 patients had BPH, and 63 patients had prostate cancer. Prostate cancer patients were divided into two groups by tumor-node-metastasis classification. The patients below T2 were group A, and those above T3 were group B. The natural logarithm of C-reactive protein (lnCRP) differed between the BPH group and the prostate cancer group. The lnCRP also differed between the BPH group and prostate cancer groups A and B (p<0.05). CONCLUSIONS: The serum CRP level of the prostate cancer group was higher than that of the BPH group. Inflammation may be correlated with prostate cancer according to the serum CRP level.

A Retrospective Study of the Management of Vulvodynia

PURPOSE: Vulvodynia is characterized by chronic vulvar pain caused by sexual intercourse and often results in female sexual dysfunction. Because the causes of vulvodynia are not clear, many patients do not receive optimal treatment. Recently, gabapentin and botulinum toxin A have both been shown to be effective treatments for vulvodynia. In this study, we retrospectively analyzed the clinical outcomes of botulinum toxin A and gabapentin treatment for chronic pain in women with this condition. MATERIALS AND METHODS: Seventy-three women with vulvar pain were administered either gabapentin (n=62) or botulinum toxin A (n=11) injections. Effectiveness was measured by use of a visual analogue scale (VAS). We analyzed the treatment method, treatment duration, success of treatment, and side effects or adverse reactions. RESULTS: Pain levels in both groups significantly decreased after treatment. In the gabapentin group, the VAS score decreased from 8.6 before treatment to 3.2 after treatment (p<0.001). The VAS score in the botulinum toxin A group was reduced from 8.1 to 2.5 (p<0.001). Side effects for both therapies were few and subsided with treatment with general antibiotics and nonsteroidal antiinflammatory drugs. CONCLUSIONS: Gabapentin and botulinum toxin A are safe and effective treatments for vulvodynia. This condition can cause sexual dysfunction and affect quality of life. However, with proper management, satisfactory outcomes for women with vulvodynia can be achieved.

Mass spectrometry based cellular phosphoinositides profiling and phospholipid analysis: A brief review

Phospholipids are key components of cellular membrane and signaling. Among cellular phospholipids, phosphoinositides, phosphorylated derivatives of phosphatidylinositol are important as a participant in essential metabolic processes in animals. However, due to its low abundance in cells and tissues, it is difficult to identify the composition of phosphoinositides. Recent advances in mass spectrometric techniques, combined with established separation methods, have allowed the rapid and sensitive detection and quantification of a variety of lipid species including phosphoinositides. In this mini review, we briefly introduce progress in profiling of cellular phosphoinositides using mass spectrometry. We also summarize current progress of matrices development for the analysis of cellular phospholipids using matrix-assisted laser desorption/ionization mass spectrometry. The phosphoinositides profiling and phospholipids imaging will help us to understand how they function in a biological system and will provide a powerful tool for elucidating the mechanism of diseases such as diabetes, cancer and neurodegenerative diseases. The investigation of cellular phospholipids including phosphoinositides using electrospray ionization mass spectrometry and matrix-assisted laser desorption/ionization mass spectrometry will suggest new insights on human diseases, and on clinical application through drug development of lipid related diseases.