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Temporal hollowing is most frequently an acquired deformity and can be caused by volume defects of bone, soft tissue, or both. Recently, surgical reconstruction with autogenous fat or allografts has been introduced, but these materials can be resorbed over time and may also lead to infection. Herein, the authors present 2 cases demonstrating the treatment of temporal hollowing with a superior gluteal artery perforator (SGAP) free flap. Both patients had a history of traffic accidents and subsequent craniectomy because of subdural hemorrhage, followed by cranioplasty. An SGAP free flap was selected to reconstruct the soft tissue temporal defect in both patients. Pre-operatively, computed tomography (CT) angiography was used to locate the superior temporal artery (STA). A preauricular incision provided surgical access to the STA, and a subcutaneous pocket was created. The STA and SGAP artery and vein anastomoses were performed. Before flap insetting, it was de-epithelized, and its volume and shape trimmed to fit into the temporal defect. The patients' post-operative courses were without complications, and facial symmetry was achieved. This is the first case report describing the microvascular reconstruction of temporal hollowing with an SGAP free flap. The SGAP free flap is permanent and highly vascularized with no risk of infection. These case reports illustrate a unique reconstruction technique that resulted in a satisfactory outcome for the patients.

Background Osteoarthritis (OA) holds significance as a highly prevalent disorder in elderly populations. Various studies have been conducted on the association between alcohol consumption and OA, but the results have often been conflicting. The aim of this study was to investigate the relationship between alcohol consumption and OA in a large-scale sample representative of the Korean population. Methods Among the 25,534 participants surveyed in the fifth Korean National Health and Nutrition Examination Survey (2010–2012), 7165 individuals aged ≥50 who responded to drinking-related items were analyzed. The Alcohol Use Disorders Identification Test (AUDIT) grade was calculated, and radiologic examination analysis included the Kellgren-Lawrence (KL) grade of the lumbar spine, hip, and knee joints. Logistic regression analysis was performed to evaluate the association between AUDIT grades and OA through estimation of odds ratios (ORs). Results In crude analyses, OA (KL grade ≥ 2) of the lumbar spine and knee was more prevalent towards Zone I, but following adjustment, knee OA prevalence significantly increased in Zone III and IV compared to Zone I (Zone III: OR 1.464, 95% confidence interval (CI) 1.027–2.088; Zone IV: OR 1.543, 95% CI 1.028–2.317, respectively). Meanwhile, adjusted hip and lumbar OA values showed positive associations towards Zone IV, but did not reach statistical significance. Additional analyses of the association between alcohol consumption and pain severity of knee OA patients were nonsignificant. Conclusions These results imply that radiological knee OA, rather than symptomatic knee OA, is associated with alcohol consumption.

ObjectiveTo determine the association of radiological and symptomatic osteoarthritis with sleep duration in a representative sample of the Korean population.MethodsUsing data from the national cross-sectional fifth Korea National Health and Nutrition Examination Survey 2010-2012. Of the 16,528 participants in KNHANES-V, 8,918 were adults aged≥ 50 years who had completed the survey questions on sleep duration and osteoarthritis, and had diagnostic X-ray results. We evaluated the association between sleep duration as the primary predictor for osteoarthritis involving the hip, knee, and spinal joints. A complex sample logistic regression analysis was performed to adjust for the covariates.ResultsProportions of participants with total daily sleep duration of ≤6 hours, 7-8 hours, and ≥9 hours were 47.1%, 45.2, and 7.7%, respectively. The rate of osteoarthritis diagnoses in the ≤6 hours, 7-8 hours, and ≥9 hours of sleep duration groups was 24.1%, 17.6%, and 21.8%, respectively (p ConclusionThis study confirmed the significant association between sleep duration and osteoarthritis in adults aged ≥50 years. Participants' positive for both radiological (KL grade ≥2) and symptomatic osteoarthritis showed a strong association between knee joint pain and not enough sleep duration.

It has been shown that a loudspeaker coupled to a long narrow pipe through which sound is radiated through a series of small spaced apertures can have narrow directivity. This paper describes a process by which this concept is practically applied for use in a soundbar for delivering sound to a listener indirectly by reflection from room surfaces. A model was developed and used to guide the process which revealed various sound quality issues for a basic design. With modifications a successful approach with narrow directional sound of an acceptable quality was found. Its architecture and performance are reported.

Introduction In overseas reports, temporomandibular disorders (TMDs) are said to affect 5–12% of the population, and the number of TMD patients seeking treatment in Korea is on the rise. Even though Korean medicine (KM) treatments are commonly used for TMDs in clinical practice, clinical practice guidelines (CPGs) for TMDs in traditional KM have not yet been established. This evidence-based KM CPG on TMDs was therefore established. Methods The key questions of the KM CPG on TMDs were determined based on clinical practice surveys on the use of KM for TMDs and expert opinion from the relevant academic societies by the CPG development committee. Then, a systematic literature review of KM treatments for TMDs was conducted for each key question, and the guideline draft was created in accordance with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) levels of evidence and grades of recommendation. Official consensus was achieved using the Delphi method on the draft, and the draft was further revised through external review to produce the final guideline, which was certified by the relevant academic societies. Results A total of 15 recommendations are established to address the 13 key clinical questions about the clinical efficacy of 9 types of KM treatments for TMD, including grades and levels of evidence. Conclusions The present guideline is expected to aid in the decision-making process of physicians and TMD patients, improve the overall quality of KM practice, and suggest subjects for future clinical research.

Background The reconstruction of complex defects in the posterior trunk is a challenging problem. Various surgical methods using local flap, propeller flap, and muscle flap have been reported. However, in case where a free flap is inevitable, due to the absence of usable recipient vessels, eventually it may fail to perform or the use of long vessel graft is mandatory. To overcome this problem, we investigated use of perforator as recipient vessel in posterior trunk region and here we report satisfactory outcomes of the cases. Patients and methods Eighteen cases with posterior trunk defects underwent reconstruction surgeries using various free flaps. Perforating vessels, from either the base or margin of the defect, were evaluated by preoperative computed tomography and hand-held Doppler. During the dissection, preoperatively marked perforators, with visual healthy pulsation and appropriate diameter for anastomosis, were selected and used for a recipient vessel for free flap. Results Perforating vessels from the posterior trunk (0.8-1.3 mm in diameter) were used as recipient vessels and the average size of the defect was 85.2 cm2 . In all cases, one artery and vein was used for anastomosis. No flap necrosis occurred. Hematoma developed in one case and partial wound disruption developed in 2 cases. Conclusion Surgical method using perforators as recipients for free flap reconstruction can be one of a good treatment option for posterior trunk reconstruction. We think that microsurgeons need not to hesitate when they use perforating vessel as a recipient vessel.

Background: The purpose of this survey study was to understand how utilization of X-rays as an adjunct to Chuna manual therapy (CT) supports treatment, as assessed by Korean medicine doctors (KMDs). Methods: A survey was emailed to all 18,289 members of the Association of Korean Oriental Medicine (AKOM)to determine the implications of X-ray use in CT. Surveys were collected from September 22, 2017 to October 15, 2017. Results: Of the 18,289 KMDs 562 completed the survey. The implications of a radiological diagnosis (X-ray) with CT was assessed using 5 items in a questionnaire: time to diagnosis, accuracy of treatment, patient comprehension and satisfaction, CT effect, and safety of CT. Survey participants identified improvement in patient comprehension and satisfaction as the most important factor for X-ray use with CT, followed by increased safety of CT. From the determinant factors for selection of CT intensity and specific techniques, severity of clinical symptoms was shown to be the most influential factor. Degenerative changes of the spine and degree of spinal malposition were also reported to be highly influential. Conclusion: The KMDs’ that participated in this study indicated that utilization of X-rays in conjunction with CT administration improved patient comprehension and satisfaction, and CT safety. Installation of radiological equipment in Korean medicine clinics where CT is provided may increase safety and patients’ satisfaction.

This mini-review highlights cardiovascular studies that were presented during the 2018 Society of Nuclear Medicine and Molecular Imaging (SNMMI) annual meeting in Philadelphia. The aim of this review is to inform readers about several noteworthy studies reported at the meeting. Although cardiovascular application of PET and SPECT are not the primary focus of the SNMMI, several scientific teams working in this field presented their latest scientific findings at this meeting. The review therefore aims to inform the readers who did not attend the SNMMI annual meeting about some interesting new concepts presented this year at the conference.

This study analyzed advertisement images targeting international audiences of South Korean medical facilities (traditional Korean and conventional medicine) participating in Medical Korea 2015 using thematic content analysis. The image categories most often used in conventional medicine were medical procedures, facilities, and staff photos, while those for traditional Korean medicine were medical procedures, staff photos, and images. Conventional medicine consistently presented high SERVQUAL tangibility scores, whereas Korean medicine displayed distinct associations between SERVQUAL categories and image size. Analyses suggested specialty preference by language. These findings may be used to recognize key messages in medical tourism and contribute to its systematic promotion.Abbreviations: KHIDI: Korea health industry development institute; SERVQUAL: service quality

Introduction The aim of this systematic review was to assess the evidence from randomized controlled trials (RCTs) on the effectiveness and safety of pharmacopuncture in cervical spondylosis patients. Methods Seven databases were searched, including Chinese and Korean databases, through to January 2018. Eligible trials were those with intervention groups receiving pharmacopuncture for cervical spondylosis and control groups receiving other conventional treatments including acupuncture. Outcome measures included pain, disability, quality of life, and adverse events (AEs). For statistical pooling, the mean difference (MD) and 95% confidence intervals (CIs) were calculated using a random-effects model. Results Twenty RCTs were selected. Eight trials on pharmacopuncture as a single treatment reported significant pain decrease in patients with cervical spondylosis compared to acupuncture (MD −1.79, 95% CI −2.39, −1.19). Add-on pharmacopuncture treatment also showed significant effects in alleviating pain compared to the control (MD −1.79, 95% CI −2.24, −1.34). Add-on pharmacopuncture treatment significantly increased quality of life compared to the control, as shown with SF-36 scores (MD 18.31, 95% CI 13.33, 23.29). However, all analysis results were assessed to be low or very low quality evidence due to considerably high heterogeneity and high risk of bias. In addition, solid conclusions on safety could not be drawn as few studies reported on AEs related with pharmacopuncture. Conclusions Pharmacopuncture, both as a sole intervention and as an add-on treatment, was found to decrease pain in patients with cervical spondylosis. These results, however, should be interpreted with caution as the quality of evidence was found to be low.

Background Patients are free to choose conventional or Korean medicine treatment under the dual medical system in Korea, and the prevalence of patients who choose Korean medicine treatment for whiplash-associated disorders (WADs) is high. This study analyzed the sociodemographic characteristics and medical service use in this population to provide healthcare providers with basic usage information of complementary and alternative medicine for WAD. Methods A total of 8291 outpatients who registered under automobile insurance coverage and visited the main branch of Jaseng Hospital of Korean Medicine from April 1, 2014 to August 10, 2016 were included. Data on sociodemographic characteristics, symptoms, and accident and treatment-related details were collected from electronic medical records. Univariate and multivariate regression analyses were performed to identify baseline factors predictive of total treatment duration. Results The most prevalent demographic of patients who chose Korean medicine for WAD treatment was males in their thirties whose initial visit to the hospital was 16.1 ± 94.1 days from the accident. Neck pain accompanied by low back pain (57.0%) was the most common complaint, and for singular pain, neck pain (13.5%) was the most prevalent. Baseline numeric rating scale (NRS) pain levels were generally moderate (4–6) regardless of area. Patients received 7.2 ± 10.2 sessions of treatment for 32.6 ± 55.3 days. The most commonly prescribed treatment modalities in order of highest frequency were acupuncture, cupping, pharmacopuncture, and herbal medicine, which collectively accounted for > 90% of treatments. Acupuncture was administered 29.0 ± 40.8 times, and cupping 14.0 ± 18.7 times as the two highest frequency treatments. In multivariate regression analysis, longer treatment periods were found to be associated with higher NRS, older age, and delayed initial visits at baseline. Conclusions This study highlights the characteristics and Korean medicine use of WAD patients. These results are particularly relevant and informative for consideration of personal preferences and effective prioritization in further insurance coverage.

Antigenic variation in viral surface antigens is a strategy for escaping the host's adaptive immunity, whereas regions with pivotal functions for infection are less subject to antigenic variability. We hypothesized that genetically invariable and immunologically dormant regions of a viral surface antigen could be exposed to the host immune system and activated by rendering them susceptible to antigen-processing machinery in professional antigen-presenting cells (APCs). Considering the frequent antigen drift and shift in influenza viruses, we identified and used structural modeling to evaluate the conserved regions on the influenza hemagglutinin (HA) surface as potential epitopes. Mutant viruses containing the cleavage motifs of cathepsin S within HA were generated. Immunization of mice showed that the mutant, but not the wild-type virus, elicited specific antibodies against the cryptic epitope. Those antibodies were purified, and specific binding to HA was confirmed. These results suggest that an unnatural immune response can be elicited through the processing of target antigens in APCs, followed by presentation via the major histocompatibility complex, if not subjected to regulatory pathways. By harnessing the antigen-processing machinery, our study shows a proof-of-principle for designer vaccines with increased efficacy and safety by either activating cryptic, or inactivating naturally occurring, epitopes of viral antigens.-Lee, Y. J., Yu, J. E., Kim, P., Lee, J.-Y., Cheong, Y. C., Lee, Y. J., Chang, J., Seong, B. L. Eliciting unnatural immune responses by activating cryptic epitopes in viral antigens.

Introduction In Korea, all traditional Korean medicine interventions for neck pain are actively used, including acupuncture, herbal medicine, Chuna, and pharmacopuncture; however, clinical practice guidelines do not exist. We aimed to develop a clinical practice guideline for treating neck pain in adults using traditional Korean medicine. Methods A committee comprising clinical and methodological experts was formed, and clinical questions were developed. A systematic review was conducted for each clinical question. The selected studies were analyzed and assigned a quality of evidence grade based on the Grading of Recommendations Assessment, Development, and Evaluation methodology. Recommendations were formulated considering the benefits and harms. A formal consensus was reached among the experts using the Delphi method. The final recommendations were recognized by relevant professional societies. Results In total, 25 recommendations were developed regarding traditional Korean medicine treatments (acupuncture, electroacupuncture, fire needling, miniscalpel acupuncture, herbal medicine, Chuna manual therapy, pharmacopuncture, bee-venom pharmacopuncture, cupping, thread-embedding acupuncture, and Doin therapy). Acupuncture (versus inactive control) and Chuna manual therapy and pharmacopuncture (versus usual care) are recommended for symptom alleviation in the clinical treatment of neck pain. Electroacupuncture (versus usual care) and cupping (versus inactive control) should be considered for the alleviation of symptoms in the clinical treatment of neck pain. Conclusions The guideline could assist traditional Korean medicine doctors in South Korea to provide evidence-based, standardized treatment for neck pain in adults. Consequently, implementing this guideline in traditional Korean- medicine practice could expand the scope of health-insurance coverage, thereby reducing the public burden of medical expenses.

The Morel-Lavallee lesion (MLL) is a post-traumatic closed soft tissue degloving injury. Common complaints of MLL patients are a haematoma or fluid collection on the trunk or the lower extremity. However, the authors introduce unique cases of MLL that present an atypical appearance. The fluid collection was not apparent, and the capsule formation was not detected on preoperative image study. The main complaint of patients was the uncomfortable mass-like lesion that was regarded as a simple benign lump. The purpose of this case study is to introduce the atypical cases of MLL and to help other physicians make accurate diagnosis based on trial and error of our cases.

Objectives The aim of this systematic review was to assess the evidence from randomised controlled trials (RCTs) on the efficacy, effectiveness and safety of acupuncture in women with polycystic ovarian syndrome (PCOS) undergoing in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Methods We searched a total of 15 databases through October 2015. The participants were women with PCOS (diagnosed using the Rotterdam criteria) undergoing IVF or ICSI. Eligible trials were those with intervention groups receiving manual acupuncture (MA) or electroacupuncture (EA), and control groups receiving sham acupuncture, no treatment or other treatments. Outcomes included the clinical pregnancy rate (CPR), live birth rate (LBR), ongoing pregnancy rate (OPR) and incidence of ovarian hyperstimulation syndrome (OHSS) and adverse events (AEs). For statistical pooling, the risk ratio (RR) and its 95% (confidence interval) CI was calculated using a random effects model. Results Four RCTs including 430 participants were selected. All trials compared acupuncture (MA/EA) against no treatment. Acupuncture significantly increased the CPR (RR 1.33, 95% CI 1.03 to 1.71) and OPR (RR 2.03, 95% CI 1.08 to 3.81) and decreased the risk of OHSS (RR 0.63, 95% CI 0.42 to 0.94); however, there was no significant difference in the LBR (RR 1.61, 95% CI 0.73 to 3.58). None of the RCTs reported on AEs. Conclusions Acupuncture may increase the CPR and OPR and decrease the risk of OHSS in women with PCOS undergoing IVF or ICSI. Further studies are needed to confirm the efficacy and safety of acupuncture as an adjunct to assisted reproductive technology in this particular population.

Background Treatment effectiveness holds considerable importance in the association between service quality and satisfaction in medical service studies. While complementary and alternative medicine (CAM) use grows more prominent, comprehensive evaluations of the quality of medical service at CAM-oriented hospitals are scarce. This study assesses the quality of medical services provided at a CAM-oriented hospital of Korean medicine using the service encounter system approach and analyzes the influence of treatment effectiveness on patient loyalty. Methods A survey study using one-on-one interviews was conducted using a cross-sectional design in outpatients visiting one of fifteen Korean medicine facilities located throughout Korea. A total of 880 surveys were completed from June to July, 2014, and 728 surveys were included in the final analysis after excluding incomplete or incorrect questionnaires. The reliability and validity of the surveys was confirmed using Cronbach’s alpha coefficient and confirmatory factor analysis, and a structural equation modeling analysis was performed to verify causality and association between factors (quality of medical service, treatment effectiveness, patient satisfaction, and intent to revisit). Results The measured factors of physician performance and quality of service procedures had a positive effect on treatment effectiveness. The impression of the facilities and environment directly impacted satisfaction rates for interpersonal-based medical service encounters, while treatment effectiveness positively affected satisfaction regarding quality of medical service. However, treatment effectiveness had a more significant effect on satisfaction compared to facilities and environment, and it indirectly affected satisfaction and directly influenced intent to revisit. Treatment effectiveness and satisfaction both positively influenced intent to revisit. Conclusions The importance of treatment effectiveness should be recognized when examining quality of medical services, and we hope that these findings may contribute to future studies. Electronic supplementary material The online version of this article (doi:10.1186/s12906-017-1691-6) contains supplementary material, which is available to authorized users.

Reduced tissue damage is a theoretical advantage of using an ultrasonic harmonic scalpel. We hypothesized that the harmonic scalpel would outperform electrocautery in deep inferior epigastric perforator flap surgery, possibly resulting in a shorter operative time and reduced postoperative drainage and pain. Between January and August 2015, 24 consecutive patients were assigned to immediate deep inferior epigastric perforator flap elevation (12 for bipolar electrocautery and 12 for harmonic scalpel). The main outcome variables were total operative time, flap elevation time (starting from the fascia incision), and drainage volume. We compared the number of perforators isolated and the Moon and Taylor classification of the pedicle. Data were tested for normality using the Kolmogorov-Smirnov test before analysis. Continuous variables were compared by Wilcoxon rank-sum test. Data were analyzed using the statistical software SAS, version 9.3 (SAS Institute, Cary, NC, USA). Both groups were comparable with respect to clinical characteristics (mean age, body mass index, and flap weights). There was a statistically significant difference in the operative time between dissection with the harmonic scalpel and electrocautery (305.2 vs. 380.3 min, respectively, p = 0.002). The flap elevation time was reduced, particularly when using the harmonic scalpel where its usage seems crucial for dissecting deep inferior epigastric perforators (59.8 vs. 145.9 min, respectively, p 0.0001). No statistical difference was observed in the drainage volume and length of hospital stay between the groups. We conclude that the harmonic scalpel may be more reliable and efficient as an alternative to electrocautery.

ObjectiveThis study aimed to promote an understanding of spontaneous pneumothorax by analysing the prevalence rate and medical service use by patients with spontaneous pneumothorax according to sociodemographic characteristics.DesignA 12-year nationwide study.SettingData obtained from the Korean National Health Insurance Service Sharing Service.ParticipantsA total of 4658 participants who used medical services due to spontaneous pneumothorax between 2002 and 2013 in Korea.Outcome measuresFor those diagnosed with spontaneous pneumothorax, use of medical services, hospitalisation data, sociodemographics, comorbidity, treatment administered and medication prescribed were recorded.ResultsThe annual prevalence of spontaneous pneumothorax ranged from 39 to 66 per 100 000 individuals, while the prevalence of hospitalisation due to spontaneous pneumothorax ranged from 18 to 36 per 100 000 individuals. The prevalence rate of spontaneous pneumothorax in Korea has increased since 2002. The male to female ratio was approximately 4–10:1, with a higher prevalence rate in men. By age, the 15–34 years old group, and particularly those aged 15–19 years old, showed the highest prevalence rate; the rate then declined before increasing again for those aged 65 years or older. In total, 47%–57% of patients with spontaneous pneumothorax underwent hospitalisation. The average number of rehospitalisations due to pneumothorax was 1.56 per person, and more than 70% of recurrences occurred within 1 year. Chronic obstructive pulmonary disease was the most common comorbidity. The average treatment period was 11 days as an outpatient and 14 days in-hospital. The average medical costs were $94.50 for outpatients and $2523 for hospital admissions. The most common treatment for spontaneous pneumothorax was oxygen inhalation and thoracostomy, and the most commonly prescribed medications were analgesics, antitussives and antibiotics.ConclusionsWe here detailed the epidemiology and treatments for spontaneous pneumothorax in Korea. This information can contribute to the understanding of spontaneous pneumothorax.

This study aimed to assess the costs, health status, and medical service satisfaction with Korean and conventional medicine use before and after surgery of patients visiting Korean medicine hospitals for postsurgical musculoskeletal pain. The study population comprised patients who visited KM hospitals for the first time between June and November 2017 for persistent or recurrent pain and discomfort after low back, neck, shoulder, or knee surgery. Various validated questionnaires were used to collect data. A total of 100 participants were enrolled, and the majority had undergone low back surgery (n = 82). The participants had received 1.3 ± 0.7 magnetic resonance imaging (MRI) examinations and 2.4 ± 2.8 X-rays before surgery. Conventional interventions used before surgery were physical therapy (43%), medications (34%), and injections (28%), in descending order, while 48% of patients reported having received acupuncture 51.3 ± 81.1 times. The mean satisfaction score for surgery was 5.5 ± 2.8 points based on a 9-point Likert scale, while that for KM-based interventions was 6.3 ± 1.7 points. With respect to health-related information, the mean scores were 6.0 ± 2.2 points on the Numeric Rating Scale (NRS), 0.6 ± 0.2 points on the 5-Level EuroQol-5 Dimension (EQ-5D-5L), and 15.3 ± 10.2 on Beck’s Depression Index II (BDI-II). The mean score on the Oswestry Disability Index (ODI) in patients with low back pain was 40.1 ± 19.2 points. Work impairment, as measured using the Work Productivity and Activity Impairment Questionnaire: General Health (WPAI-GH), was 62.5 ± 47.8%, while activity impairment was 5.9 ± 2.6%. Participants tended to show low satisfaction regarding surgery and high preference for KM-based interventions. In particular, low back surgery patients reported high ODI scores, indicating high dysfunctional levels and poor prognosis after surgery. It can be inferred that it is therefore important to provide appropriate presurgical and postsurgical care for patients with musculoskeletal pain to improve pain, function, and quality of life.

Background Infrabrow blepharoplasty has become a common surgical method used to rejuvenate aged upper eyelids in Asians. In this paper, we describe the parallel excision method for infrabrow blepharoplasty as a useful alternative to the conventional elliptical excision method. The authors’ experience over a 3-year period is presented and reviewed. Methods A retrospective review of parallel excision infrabrow blepharoplasty cases at our hospital between 2014 and 2017 was performed. Three oculoplastic surgeons compared preoperative and postoperative photographs using the Strasser grading system. Results From the medical records of 123 patients, a total of 93 patients with moderate-to-severe bilateral dermatochalasis were selected as subjects. The exclusion criterion was levator function less than 8 mm. The total mean follow-up period was 2 years (range, 0.5–3.5 years). The mean skin excision height and width were 9.75 mm (range, 5–16 mm) and 58.51 mm (range, 42–75 mm), respectively. All patients who underwent surgery recovered without major complications, and all patients had high levels of satisfaction and improvements in their visual field. In the Strasser evaluation performed by the oculoplastic surgeons, most patients were found to have excellent results. Conclusions The parallel excision method for infrabrow blepharoplasty is a safe and effective technique that yields more natural- and youthful-looking eyelids than the conventional elliptical excision method. In our method, more effective manipulation of the orbicularis oculi muscle led to a reduction in frontalis compensation, resolution of sunken eyelids, and correction of lateral hooding.

Objective: Surgical treatment of neck pain often entails high costs and adverse events. The present cohort study investigated whether utilisation of acupuncture in neck pain patients is associated with a reduced rate of cervical surgery. Methods: The Korean National Health Insurance Service National Sample Cohort (NHIS-NSC) database was retrospectively analysed to identify the 2 year incidence of cervical surgery in Korean patients suffering neck pain from 2004 to 2010. The incidence was calculated and compared between patients receiving and not receiving acupuncture treatment using Cox proportional hazards models. Cumulative survival rates were compared using Kaplan-Meier survival analysis. Results: The acupuncture and control groups included 50 171 and 128 556 neck pain patients, respectively. A total of 50 161 patients were selected in each group following propensity score matching with regard to sex, age, income and Charlson comorbidity index. The hazard ratio (HR) for surgery within 2 years was significantly lower in the acupuncture group compared with the control group (HR 0.397, 95% CI 0.299 to 0.527). In addition, subgroup analyses according to gender, age and income revealed consistent results for both men (HR 0.337, 95% CI 0.234 to 0.485) and women (HR 0.529, 95% CI 0.334 to 0.836); the results were consistently observed across all age and income strata. Sensitivity analysis with varying numbers of acupuncture treatments and treatment course duration also consistently indicated lower HRs for surgery within 2 years in the acupuncture group compared with the control group. Conclusions: A significantly lower HR for cervical surgery was observed in neck pain patients following acupuncture treatment. Acupuncture treatment may therefore be an effective method for managing neck pain, and has the potential to mitigate unnecessary surgery. These findings need to be confirmed by prospective studies.

Harvesting a DIEP flap based on bipedicled perforators can enhance vascular perfusion, which can reduce complication rates, minimize fat necrosis, and flap failure. This study summarizes our experience with using unipedicled and bipedicled DIEP flaps for breast reconstruction.A total of 168 consecutive patients undergoing unilateral breast reconstruction with DIEP flaps over a 3-year period were retrospectively reviewed. Primary microvascular anastomoses were performed to the thoracodorsal vessels in both unipedicled and bipedicled DIEP groups. In bipedicled DIEP flap cases, additional secondary microvascular anastomoses were performed either by extraflap or intraflap options. Clinical characteristics and outcomes were recorded.Unipedicled (n = 89; 53%) and bipedicled flaps were used. Both groups were comparable for mean age, diabetes mellitus, hypertension, smoking, and chemotherapy. BMI was 24.9 ± 3.6 in the unipedicled group and 22.8 ± 2.9 in the bipedicled group (p .001). The surgical duration was longer in bipedicled group (367 ± 86.5 minu vs 403.7 ± 65.6 min, p .05) but incidence of fat necrosis decreased in the bipedicle group (24 patients [27%] vs. 7 patients [8.9%] p .05). There was no flap loss or instance of abdominal hernia in any group.The bipedicled DIEP flaps may be a feasible option for large breast reconstruction in thin patients. However, the additional microsurgical technical complexity and longer operative time must be considered.

IntroductionDoin therapy is a manual therapy used in Korean rehabilitation medicine. Recently, the use of acupuncture with Doin has increased in clinics and clinical trials have demonstrated its effects. However, well-designed studies examining the efficacy and cost-effectiveness of acupuncture with Doin therapy are rare.Methods and analysisThis multicentre, assessor-blinded, randomised controlled trial with two parallel groups aims to evaluate the clinical effects and cost-effectiveness of acupuncture with Doin therapy. A total of 124 patients (with a neck pain duration of 6 months or longer and a Numeric Rating Scale ≥5) will be recruited at five Korean medicine hospitals. Patients will be randomly allocated to acupuncture with Doin therapy (n=62) and acupuncture alone (n=62) for 5 weeks of treatment. This study will be carried out with outcome assessor and statistician blinding. The primary outcome measure will consist of improvement in neck pain using the Visual Analogue Scale at 6 weeks. The secondary outcomes including measures of pain, functional disability, health-related quality of life and economic evaluation will be conducted at 6 weeks, and 3, 6, 9 and 12 months after treatmentEthics and disseminationThe project is approved by the Institutional Review Board (IRB) of the Jaseng Hospital of Korean Medicine and the Kyung Hee University Korean Medicine Hospital at Gangdong. Dissemination will occur after the findings from this study are published in other peer reviewed journals.Trial registration numbersNCT03558178; KCT0003068; Pre-results.

We tested the repeatability of myocardial blood flow (MBF) quantified usingTwenty-one patients referred for clinicalMC with LV-AIF did not change MBF (no MC: 1.01 ± 0.30 mL/min/g vs MC with LV-AIF: 1.01 ± 0.29, P = 0.70), whereas MC with LA-AIF showed significantly lower MBF assessments (0.95 ± 0.28 mL/min/g, P = 0.0006). We report significant improvement for test-retest reproducibility for global MBF following MC (CV; No MC: 16.0, MC (LV-AIF): 9.2, MC (LA-AIF): 8.8). Good inter-operator repeatability was observed for LV-AIF (CV = 4.7) and LA-AIF (CV = 5.6) for global MBF assessments.MC significantly improved the test-retest repeatability between operators and between scans. MBF obtained after MC with LV-AIF were comparable, whereas MBFs after MC and LA-AIF were significantly reduced.

The substrate potentials of antituberculosis drugs on solute carrier (SLC) transporters are not well characterized to date, despite a well-established understanding of their drug dispositions and pharmacokinetics. In this study, we investigated comprehensively the substrate potentials of the 22 currently available antituberculosis drugs for SLC family transporter-mediated uptake, using Xenopus laevis oocytes and stably transfected HEK-293 cells in vitro. The result suggested that ethambutol, isoniazid, amoxicillin, and prothionamide act as novel substrates for the SLC transporters. In addition, in the presence of representative transporter inhibitors, the uptake of the antituberculosis drugs was markedly decreased compared with the uptake in the absence of inhibitor, suggesting involvement of the corresponding transporters. A cellular uptake study was performed, and the K(m) values of ethambutol were found to be 526.1 ± 15.6, 212.0 ± 20.1, 336.8 ± 20.1, and 455.0 ± 28 μM for organic cation transporter 1 (OCT1), OCT2, OCTN1, and OCTN2, respectively. Similarly, the K(m) of prothionamide was 805.8 ± 23.4 μM for OCT1, while the K(m) values of isoniazid and amoxicillin for organic anion transporter 3 (OAT3) were 233.7 ± 14.1 and 161.4 ± 10.6 μM, respectively. The estimated in vivo drug-drug interaction indexes from in vitro transporter inhibition kinetics for verapamil, probenecid, and ibuprofen against ethambutol, prothionamide, isoniazid, and amoxicillin were found to show potential for clinical drug interactions. In conclusion, this is the first study that demonstrated 22 antituberculosis drug interactions with transporters. This study will be helpful for mechanistic understanding of the disposition, drug-drug interactions, and pharmacokinetics of these antituberculosis drugs.

Although collaborative treatment by traditional Korean medicine doctors (KMDs) and medical doctors occurs, it is mainly done by referral. As no survey of the general public's preference for the type of collaboration has ever been conducted, we aimed to investigate Koreans’ preferences for a collaborative treatment type. The responders were extracted by random digit dialing and then reextracted using the proportional quota sampling method by sex and age. From July to October 2017, telephone interviews were conducted and the participant responses regarding treatment history for spinal or joint diseases, experiences with collaborative treatment, and preferred type of collaborative treatment were recorded. Of the 1008 respondents, 44.64% reported a history of treatment for spinal or joint diseases at a medical institution. The concurrent collaborative treatment system, in which both KMDs and medical doctors are present in one location participating in the treatment concurrently, was the most preferred system among the respondents. Respondents who reported experience with traditional Korean medicine hospitals were more likely to prefer a one-stop treatment approach than those who did not have experience with traditional Korean medicine hospitals (adjusted odds ratio: 1.73; 95% confidence interval: 1.12–2.68). Respondents who were familiar with collaborative treatment but did not report any personal experience with it were more likely to prefer a one-stop treatment approach than those who were not familiar with collaborative treatment (adjusted odds ratio: 1.82; 95% confidence interval: 1.37–2.44). Koreans prefer a concurrent type of collaborative treatment system by KMDs and medical doctors. Therefore, efforts and support are needed to increase the application of the concurrent type of collaborative system.

A systematic review was conducted to evaluate the effectiveness of herbal medicine for neck pain. English, Chinese, Japanese, and Korean databases were searched for randomized controlled trials (RCTs) on the subject. The included literature was analyzed according to study design, and only studies in which herbal medicine was administered as the sole intervention or add-on treatment to standard care were included. Sixteen studies were identified; of these, 7 studies investigated herbal medicine as the sole intervention. The Visual Analogue Scale (VAS) of pain in these studies did not differ significantly from that of standard care. The mean difference (MD) was −0.52 (95 % confidence interval (CI) −1.28, 0.25). The level of evidence was evaluated as very low. Nine RCTs investigated herbal medicine as an add-on to standard treatment. The VAS of pain in these studies decreased significantly compared to standard care alone, yielding an MD of −1.23 (95 % CI −1.65, −0.80). One study reported Neck Disability Index (NDI) scores, and herbal medicine significantly improved function by an MD of −8.00 (95 % CI −8.82, −7.18) as an add-on treatment. The level of evidence was evaluated as low. Herbal medicine as an add-on treatment was found to achieve significantly better outcomes in neck pain patients compared to standard care alone, although the level of evidence was low. The possibility of herbal medicine use as a safe and effective method of pain management was indicated, but future large-scale clinical trials on herbal medicine treatment for neck pain are needed to explore this possibility.

In this study, a polyethylene glycol-based organic additive, with quaternary ammonium cation functional groups linked to a naphthalene rings at both ends was synthesized, for through silicon via (TSV) filling. The synthesized additive strongly suppressed Cu electrodeposition under convection and successfully bifurcated the deposition surface of TSVs into active and passive regions, allowing defect-free TSV filling. However, there was a variation in TSV filling uniformity depending on the additive chain length. The chain length was adjusted using polyethylene glycol of various molecular weights as a starting material for the additive. The electrochemical investigation revealed that the chain length was related to the re-adsorption rate during Cu electrodeposition, which is critical in TSV filling. At the optimal chain length, uniform and defect-free bottom-up TSV filling was successfully achieved and TSV filling time was reduced to 500 s.

Fundamental properties associated with the photocatalytic production of hydrogen from water by metal/semiconductor catalysts were studied by using Au@Void@TiO2 yolk–shell nanostructures. Independent control of the geometrical parameters of those nanostructures could be exercised during synthesis and used to systematically probe their effect on photocatalytic activity. Both shell thickness and shell diameter affect the rate of H2 production, with thicker and bigger shells displaying higher activity. The trends could be described by simple exponential decays in activity as a function of distance from the gold nanoparticle. However, each parameter yielded a different characteristic length: a 28 nm value was measured for the thickness, associated with the penetration of light into the titania, whereas a 186 nm estimate was obtained for the shell diameter, possibly related to the diffusion of hydrogen atoms on the titania surface toward the gold nanoparticles. The size of the gold nanoparticles does not signif...

Composite nanostructures with well-defined characteristics are often advantageous catalysts for highly efficient photocatalytic processes. Here, we report the tailored synthesis of C@TiO2 yolk–shell nanostructures and their photocatalytic applications in the degradation of organic dyes. The conductive carbon core serves as an electron-sink to promote the separation of electron–hole pairs photo-excited in the TiO2 shell, improve their lifetime, and enhance the photocatalytic performance of the system. The yolk–shell nanostructures were synthesized through a sol–gel coating of TiO2 on resorcinol-formaldehyde (RF) resin spheres followed by silica-protected calcination and ultimately NaOH etching to remove the silica layer and produce C@TiO2 yolk–shell nanostructures. In order to improve the crystallinity of the TiO2 shell, post-processing including acid treatment and re-calcination was also carried out. The resulting yolk–shell structures have many desirable properties for photocatalytic applications including the existence of a conductive core, well-maintained structural integrity, uniform particle dimensions, favorable mesoscale porosity, tunable crystallinity, and controllable crystalline phase of TiO2. As a result, we have been able to optimize the structure and property of the composite photocatalysts and achieve superior photocatalytic performance to commercial P25-TiO2 catalysts.

In our previous study, X-31ca-based H5N1 LAIVs, in particular, became more virulent in mice than the X-31ca MDV, possibly by the introduction of the surface antigens of highly pathogenic H5N1 influenza virus, implying that additional attenuation is needed in this cases to increase the safety level of the vaccine. In this report we suggest an approach to further increase the safety of LAIV through additional cold-adapted mutations in the hemagglutinin. The cold-adaptation of X-31 virus resulted in four amino acid mutations in the HA. We generated a panel of 7:1 reassortant viruses each carrying the hemagglutinins with individual single amino acid mutations. We examined their phenotypes and found a major attenuating mutation, N81K. This attenuation marker conferred additional temperature-sensitive and attenuation phenotype to the LAIV. Our data indicate that the cold-adapted mutation in the HA confers additional attenuation to the LAIV strain, without compromising its productivity and immune response.

A simple chemical process for the direct synthesis of a nitrogen (N)-doped carbon aerogel (NCA) with highly dispersed Pt nanoparticles via a poly(ethyleneimine) (PEI)-assisted strategy is described. A resorcinol-formaldehyde (RF) gel was treated with water soluble cationic PEI, which mainly functions as an anchoring site for metal ions. The functionalized PEI chains on the surface of the RF gel resulted in the unique formation of chemical complexes, with PtCl62⿿ anchored to the RF gel, and subsequent homogeneous metal nanoparticle growth. The abundant amino groups containing PEI grafted to the RF gel also allowed the nitrogen atoms to be incorporated into the carbon framework, which can directly be converted into a NCA. The spherical Pt nanoparticles in the resulting material (Pt/NCA) were highly dispersed on the surface of the NCA without any evidenced of agglomeration, even after a thermal annealing at 900 °C. Compared with a Pt/CA synthesized by a conventional reduction method, the Pt/NCA showed enhanced electrochemical performance with a high electrochemically active surface area (191.1 cm2 g⿿1) and electrocatalytic activity (Vonset = 0.95 V vs. RHE) with respect to oxygen reduction. The superior electrocatalytic activities of the Pt/NCA can be attributed to the synergistic effect of the highly dispersed Pt nanoparticles and the N-doped carbon supports that were prepared using the PEI-assisted strategy. The findings reported herein suggest that the use of PEI can be effectively extended to broad applications that require the homogeneous deposition of metal nanoparticles.

A Review on Randomized Controlled Clinical Study on Acupuncture Treatment of Breast Cancer PatientsYoon-Jae Lee 1 , Sung-Yeop Lee 1 , You-Hwa Jung 1 Seung-Yeol Lee 1 , Jun-Bock Jang 2 , Deok-Sang Hwang 21 Dept. of Korean Obstetrics & Gynecology, Gang-Nam Jaseng Hospital of Oriental Medicine 2 Dept. of Korean Medicine Obstetrics and Gynecology, College of Korean Medicine, Kyung-Hee UniversityObjectives: Breast cancer patients in Korea need to care about symptoms with complementary medicine in cluding acupuncture. We reviewed the randomized controlled studies using acupuncture in breast cancer patients to establish a basic knowledge of clinical practice guidelines. Methods: We searched the following databases through July 2015: the Coch rane Central Register of Controlled Trials, Ovid-Medline, Ovid-EMBAS E, the Allied and Complementary Medicine Databases and OASIS. The articles of RCTs using acupuncture in breast cancer for all symptoms were selected and analyzed. The acupoints, treatment period, incl usion criteria of participants, follow-up period and effectiveness were extracted. Results: Three hundred fifty five records after duplicate were screened , and 14 RCTs were selected. RCTs of Hot flush, pain, fatigue were revie wed. The adverse symptoms using medical treatment in breast cancer patients were targets of acupuncture in RCTs. The acupuncture treatment was decreased th e hot flush, pain and fatigue. However, the effect was not confirmed due to various study design. Conclusions: The analysis of the research would be conjugated to establish a basic knowledge of clinical practice guidelines. Well designed studies in Korea are needed to confirm the efficacy and safety of acupuncture in pat ients with breast cancer. Key Words: acupuncture, review, breast neoplasms

Background Neck pain is a common complaint in the general population. Despite the consistent ongoing pain and the resulting economic burden on affected individuals, there have only been a few studies investigating the treatment of acute neck pain. This study aims to evaluate the effectiveness, safety, and cost-effectiveness of the motion style acupuncture treatment (MSAT) and acupuncture treatment for acute neck pain. Methods This 2-armed, parallel, multi-centered randomized controlled trial will be conducted at 4 community-based hospitals in Korea. A total of 128 subjects will be randomly assigned, at a 1:1 ratio, to the MSAT and the acupuncture treatment groups. Treatment will be administered 2 to 3 times a week for 2 weeks. The primary outcome will be the visual analog scale of neck pain on movement. The secondary outcomes will be the numeric rating scale of the neck, neck disability index, Northwick Park questionnaire, patient global impression of change, range of motion of the neck, 5-level EuroQol-5 dimension, 12-item Short-Form Health Survey, and EuroQol visual analogue scale. This protocol has been registered at the Clinicaltrials.gov (NCT04539184). Discussion To our knowledge, this study is the first well-designed multi-centered randomized controlled trial to evaluate the effectiveness, safety, and cost-effectiveness of MSAT on acute neck pain. The results of this study will be useful for clinicians in primary medical institutions that frequently treat acute neck pain patients and for policymakers working with national health insurance.

Background: Stromal vascular fraction (SVF) has recently emerged as a potential therapeutic modality, due to its multipotent cellular components in tissue regeneration. Systemic sclerosis (SSc) is a progressive autoimmune disease that results in hand disability by skin fibrosis and microangiopathies. We performed an open-label study to investigate the efficacy and safety of SVF injection in SSc patients (Clinical Trial number: NCT03060551). Methods: We gathered 20 SSc patients with hand disability, planning for a 24-week follow-up period. SVF was extracted from autologous adipose tissues, processed by the closed system kit, and injected into each finger of SSc patients. We observed various efficacy and safety profiles at each follow-up visit. Results: Among the 20 initially enrolled patients, eighteen received SVF injection, and were completely followed-up for the whole study period. Patients received 3.61 × 106 mesenchymal stem cells into each finger on average. Skin fibrosis, hand edema, and quality of life were significantly improved, and 31.6% of active ulcers were healed at 24 weeks after injections. Semiquantitative results of nailfold capillary microscopy were ameliorated. There was no single serious adverse event related to the procedure. Conclusions: Injection of SVF derived from autologous adipose tissues is tolerable, and shows clinical efficacy in SSc patients.

Background Neck pain is a common musculoskeletal disorder that impacts individuals' daily life, and might sometimes lead to disability and increased medical costs. Pharmacopuncture combines acupuncture with herbal medicine, in which herbal extracts are administered on the acupoints. We designed a pragmatic randomized controlled trial (RCT) to compare the effectiveness of pharmacopuncture and physical therapy as a treatment for chronic neck pain. Methods This study is a 2-armed, parallel, multi-center RCT. The participants will be randomly assigned to pharmacopuncture or physical therapy group to receive their respective 8-session treatments for 4 weeks. The primary outcome is the visual analogue scale of neck pain. Secondary outcomes is the Northwick Park questionnaire, visual analogue scale of radiating arm pain, numeric rating scale of the neck and arm bothersomeness, neck disability index, patient global impression of change, short form-12 health survey version 2, and 5-level EuroQol-5 dimension. Discussion This is a protocol for a pragmatic RCT that would attempt to present evidence conducive to clinical decision or policy-making by investigating the effectiveness of pharmacopuncture therapy, a widely used approach in Korean medicine clinical practice, in comparison to the standard therapy.

We synthesize new triethylene glycol-based levelers containing quaternary ammonium groups with different terminal functional groups (allyl, propyl, benzyl, and naphthylmethyl) to investigate the structure-property relationship of the levelers. Though all the synthesized levelers indicate the convection-dependent adsorption behavior through the onset potential in linear sweep voltammetry, the inhibition strength depends considerably on the functional groups to some degree. The exchange current density of 0.40 mA/cm2 for Cu reduction in the naphthylmethyl case is the lowest among our levelers, owing to the π-cloud interactions of a large aromatic naphthylmethyl group with Cu. The naphthylmethyl leveler maintains the inhibition layer that is not deactivated even by the addition of bis(3-sulfopropyl) disulfide (SPS) unlike the other functional groups in chronopotentiometry. The complex inhibition layer composed of the leveler and a suppressor is retained, displaying a high potential difference of –157 mV between 100 and 1000 rpm. By using three-additives containing the naphthylmethyl leveler, microvias show the filling ratio of 100% within 50 min and a thin top thickness of only about 15 μm. These results provide the effectiveness of the naphthylmethyl terminal group as a functional leveler and can help the new design of electroplating additives.

Background Neck pain is a highly prevalent medical condition that incurs substantial social burden. Although manual therapy is widely used for treatment of neck pain, the body of evidence supporting its effectiveness and safety is not conclusive. The aim of this study is to examine the effect, safety, and cost-effectiveness of Chuna manual therapy, a traditional Korean manual therapy for treatment of various musculoskeletal complaints. Methods/Design This study is the protocol for a two-armed parallel, assessor-blinded, multicenter, randomized controlled trial. A total 108 patients with chronic neck pain (time to onset ≥ 3 months, numeric rating scale [NRS] of neck pain ≥ 5) will be recruited at five Korean medicine hospital sites. Participants will be allotted to one of two groups (n = 54, respectively): the Chuna manual therapy group, and the usual care (conventional physical therapy and medication treatment) group. Ten sessions of Chuna manual therapy or usual care will be administered twice a week for five weeks. Since the study design does not permit patient or physician blinding, the outcome assessor and statistician will be blinded. The primary outcome will be the visual analogue scale (VAS) of neck pain at 5 weeks after randomization. Secondary outcomes include the VAS of radiating arm pain, NRS of neck pain and radiating arm pain, Vernon-Mior neck disability index (NDI), Northwick Park neck pain questionnaire (NPQ), EuroQol-5 Dimension (EQ-5D), EQ-VAS, patient global impression of change (PGIC), economic evaluation, adverse effects, and drug consumption. Follow-up outcome assessments will be conducted at 3, 6, 9, and 12 months after randomization. Discussion This study will evaluate the comparative effectiveness of Chuna manual therapy and usual care on chronic neck pain. Adverse events, and costs and effectiveness (utility) data will be evaluated to assess safety and exploratory cost-effectiveness (economic evaluation). This study aims to provide evidence on the effectiveness, safety, and cost-effectiveness of Chuna manual therapy. Trial registration Clinical Research Information Service (CRIS), KCT0002732. Registered on 13 March 2018. ClinicalTrials.gov, NCT03294785. Registered on 27 September 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3016-6) contains supplementary material, which is available to authorized users.

ObjectivesNeck pain is a significant condition that is second only to depression as a cause of years lived with disability worldwide. Thus, identifying and understanding effective treatment modalities for neck pain is of heightened importance. This systematic review aimed to investigate the effects of cupping on neck pain from the current literature.DesignSystematic review and meta-analysis of randomised controlled trials (RCTs).SettingNine databases, including Chinese, Korean and Japanese databases, were searched for data up to January 2018 with no restrictions on publication language.ParticipantsPatients with neck pain.InterventionsCupping therapy as the sole or add-on intervention compared with no treatment or active controls.Primary and secondary outcome measuresPain severity, functional disability and quality of life.ResultsEighteen RCTs were selected. Compared with the no intervention group, the cupping group exhibited significant reduction in pain (mean difference (MD) −2.42(95% CI −3.98 to −0.86)) and improvement in function (MD −4.34(95% CI −6.77 to −1.19)). Compared with the active control, the cupping group reported significant reduction in pain (p=0.0009) and significantly improved quality of life (p=0.001). The group that received control treatment with cupping therapy (add-on group) displayed significant pain reduction compared with the active control group (p=0.001). Of the 18 studies, only 8 reported occurrence of adverse events, which were mostly mild and temporary.ConclusionsCupping was found to reduce neck pain in patients compared with no intervention or active control groups, or as an add-on treatment. Depending on the type of control group, cupping was also associated with significant improvement in terms of function and quality of life; however, due to the low quality of evidence of the included studies, definitive conclusions could not be drawn from this review. Future well-designed studies are needed to substantiate the effectiveness of cupping on neck pain.PROSPERO registration numberCRD42016047218.

Background Osteoporosis is a major health concern for both men and women, and associated fractures incur substantial economic burden. While there are a multitude of studies on bone mineral density (BMD) and liver diseases, not many studies have assessed the association between liver enzyme levels and BMD in homogeneous populations. Methods The current study investigated the association between serum liver enzyme levels and BMD at various sites in Koreans. Out of 21,517 surveyees of the 5th Korean National Health and Nutrition Examination Survey (2010–2012), 7160 participants’ data on BMD, serum liver enzymes, and full covariate data were included for cross-sectional analysis. BMD at the femoral neck, lumbar spine, entire femur, and whole body was assessed using dual energy X-ray absorptiometry (DEXA), and liver enzymes included aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma(γ)-glutamyl transferase (GGT) levels. Differences in participant characteristics by BMD and liver enzyme levels were analyzed, and complex sample design regression analysis adjusted for multiple covariates was performed to assess the relationship between liver enzymes and BMD. Results Negative associations were seen with GGT and BMD at all sites (P ≤ 0.02), ALT with lumbar spine (P = 0.0013), and AST with lumbar BMD (P = 0.0009). In particular, GGT presented strong negative associations with BMD in postmenopausal women and elder men. Conclusions This study demonstrates a negative relationship between liver enzyme levels and BMD, and suggests that a significant association exists between osteoporosis/decreased BMD and liver disorders. Electronic supplementary material The online version of this article (10.1186/s12891-018-2322-1) contains supplementary material, which is available to authorized users.

The substrate potentials of antituberculosis drugs on solute carrier (SLC) transporters are not well characterized to date, despite a well-established understanding of their drug dispositions and pharmacokinetics. In this study, we investigated comprehensively the substrate potentials of the 22 currently available antituberculosis drugs for SLC family transporter-mediated uptake, using Xenopus laevis oocytes and stably transfected HEK-293 cells in vitro The result suggested that ethambutol, isoniazid, amoxicillin, and prothionamide act as novel substrates for the SLC transporters. In addition, in the presence of representative transporter inhibitors, the uptake of the antituberculosis drugs was markedly decreased compared with the uptake in the absence of inhibitor, suggesting involvement of the corresponding transporters. A cellular uptake study was performed, and the Km values of ethambutol were found to be 526.1 ± 15.6, 212.0 ± 20.1, 336.8 ± 20.1, and 455.0 ± 28 μM for organic cation transporter 1 (OCT1), OCT2, OCTN1, and OCTN2, respectively. Similarly, the Km of prothionamide was 805.8 ± 23.4 μM for OCT1, while the Km values of isoniazid and amoxicillin for organic anion transporter 3 (OAT3) were 233.7 ± 14.1 and 161.4 ± 10.6 μM, respectively. The estimated in vivo drug-drug interaction indexes from in vitro transporter inhibition kinetics for verapamil, probenecid, and ibuprofen against ethambutol, prothionamide, isoniazid, and amoxicillin were found to show potential for clinical drug interactions. In conclusion, this is the first study that demonstrated 22 antituberculosis drug interactions with transporters. This study will be helpful for mechanistic understanding of the disposition, drug-drug interactions, and pharmacokinetics of these antituberculosis drugs.