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Objective Squamous cell carcinoma (SCC) is the most common malignancy on the lower lip. Surgical excision, the standard treatment for SCC, requires full-thickness excision. However, no consensus exists about appropriate surgical margin. Therefore, we investigated the appropriate surgical margin and excision technique by analyzing 23 years of surgical experience with lower-lip SCC. Methods We reviewed 44 patients with lower-lip SCC who underwent surgery from November 1997 to October 2020. Frozen biopsy was performed with an appropriate margin on the left and right sides of the lesion, and the margin below the lesion was the skin above the sulcus boundary. If the frozen biopsy result was positive, an additional session was performed to secure a negative margin. Full-thickness excision was performed until the final negative margin. In each patient, the total number of sessions performed, final surgical margin, and recurrence were analyzed. Results Forty-one cases ended in the first session, 2 ended in the second session, and 1 ended in the third session. The final surgical margins (left and right; n=88) were 5 mm (66%), 7 mm (9%), 8 mm (2.3%), 10 mm (20.4%), and 15 mm (2.3%). During an average follow-up of 67.4 months (range, 12-227 months), recurrence occurred in one patient. Conclusion The final surgical margin was 5 mm in 66% (58/88) of the cases, and 97.7% (86/88) were within 10 mm. Therefore, we set the first frozen biopsy margin to 5 mm, and we suggest that a 5-mm additional excision is appropriate when frozen biopsy results are positive

Despite its high incidence rate, vertebral fragility fracture (VFF) is frequently underdiagnosed due to the absence of marked symptoms. This study evaluated the diagnostic accuracy of our suggested physical examinations and compared them with that of plain radiographs. Patients over 65 years of age with sudden back pain within the preceding 3 weeks were enrolled. Physical examinations in three different positions and a closed-fist percussion test were performed, and the presence of VFF was evaluated through confirmatory radiographic tools. We assessed the diagnostic accuracy of each physical examination and compared them with the interpretation of plain radiographs and examined the patient-reported pain locations based on the VFF level. A total of 179 patients were enrolled. The forward bending in supine (FB-SU) test demonstrated superior diagnostic values (sensitivity: 90.6%, specificity: 71.2%), which outperformed those of plain radiographs (sensitivity: 68.9%, specificity: 71.9%). The location of patient-reported pain was generally close to or lower than the index fracture level. FB-SU showed the highest diagnostic accuracy and was more valuable than plain radiographs in diagnosing acute VFF. FB-SU is a simple and affordable screening test. If positive, physicians should highly suspect VFF even when based on vague evidence of acute fracture provided by plain radiographs.

Modular methods based on the use of prefabricated structures are increasingly popular for construction projects as they contribute to sustainability by reducing waste and maintenance costs as well as improving time efficiency. For short-term international events, the use of relocatable modular buildings is a potential solution to the problem of “White Elephant” structures built specially for the events that serve no useful purpose once the event is over. This paper focuses on a representative relocatable modular project created for the 2018 Winter Olympic Games in South Korea using a single case study approach to develop an in-depth understanding of the advantages and disadvantages of relocatable modular construction from a practitioner’s perspective and examine how this approach supports sustainability and the Olympic legacy. Important considerations are identified for each of the five main stages: 1) planning, 2) design and engineering, 3) manufacturing, 4) construction and 5) disassembly and reconstruction. These findings show how the use of relocatable modular facilities can be a useful approach for international events.

Background: Rotator cuff repair is a widely performed surgery, with the re-tear rate reportedly above 20%. To protect the repair site, patients are instructed to wear braces for 4-6 weeks, but the compliance is known to be poor. This study aimed to identify the risk factors for poor compliance and to determine whether poor compliance leads to complications such as re-tears. Additionally, we planned to determine the patients’ subjective factors for self-removal of the brace.Method: This study included 101 patients who underwent rotator cuff repair between June 2019 and August 2020. The patients could select from two types of braces, namely, the sling-type and hard-type abduction brace. They were then instructed to wear the brace for 6 weeks postoperatively. During the follow-up, ultrasonography was performed to evaluate the repair site, and a questionnaire was administered to evaluate the compliance. Result: The participants were categorized into three groups (Groups A, B, and C) according to the degree of self-removal. Compliance was found to be poor, and only 35 patients met the standard of Group A. There were no statistically significant patient factors affecting the compliance. Re-tears were noted in 4 patients. Only the surgery type (open versus arthroscopic surgery) was a statistically significant factor for re-tears. Among the subjective factors, discomfort while sleeping was the most common complaint and the most common reason for the actual removal of the brace.Conclusion: Although the risk factors for self-removal of the braces could not be identified clearly and statistically, catastrophic re-tears requiring re-operation were observed in patients with poor compliance. For better compliance, the postoperative guidelines and education of the patients should be reviewed. Furthermore, the braces need to be modified to a more comfortable design.

Study Design: Prospective observational study. Objectives: We aimed to analysis the distributional patterns of the intra- and extra-cage bridging bone (InCBB and ExCBB) and the significance of ExCBB using suggested lumbar interbody fusion criterion. Methods: This study included the patients with planned single-level transforaminal lumbar interbody fusion. We divided bridging bone into InCBB (in void of right or left cage) and ExCBB (outside of cages; anterior, posterior, intermediate, right, or left) and graded bridging scores from 0 to 2 on postoperative 1-year computed tomography. The fusion was defined as at least having one or more graded 2 and the evaluation were conducted twice by 2 raters. Results: Sixty-five patients were enrolled. All values of intra- and inter-rater reliability in left InCBB, anterior, and posterior ExCBB showed good agreements (≥0.75). Both InCBBs showed similar mean bridging scores (Rt:1.43 vs Lt:1.48), and in ExCBBs, the anterior was the highest (1.43), followed by the posterior (1.14); the right and left were the lowest (0.49 and 0.52 respectively). In subjects determined as fusion (85.4%), complete bridging was observed more in ExCBB (88.8%) than in InCBB (69.9%). Conclusions: Given the higher bridging scores in both InCBBs and Ant. ExCBB, bone grafting is important promoting factor to increase the interbody bridging bone regardless of outside or in void of cages. Based on our suggested criterion, ExCBB has a greater proportion compared to InCBBs for determining the fusion and extra-cage bone grafting should be considered as important procedures for interbody fusion.

Purpose To determine whether arthroscopic transosseous foveal repair of the triangular fibrocartilage complex (TFCC) results in significant and clinically relevant improvement in clinical outcomes including pain and function with low complication and reoperation rates. Methods We reviewed studies investigating the clinical outcomes of arthroscopic transosseous foveal repair of the TFCC through MEDLINE, Embase, and the Cochrane Library. Studies on TFCC repair performed with an open or capsular technique and combined with other procedures, such as ulnar shortening osteotomy and a wafer procedure, were excluded. Methodologic quality was assessed using the Methodological Index for Non-randomized Studies score. Clinical outcomes were assessed using range of motion, grip strength, and patient-reported outcomes. Clinically relevant improvement was determined using the minimal clinically important difference (MCID). Results A total of 443 unique studies were identified, of which 7 (131 patients) met the inclusion criteria. The mean age ranged from 27 to 37 years, and the mean follow-up period ranged from 23.5 to 31.1 months. The grip strength (as a percentage) increased after foveal repair of the TFCC in all studies (mean difference range, 11.8% to 22.3%). All studies also reported an improvement in the visual analog scale score (mean difference range, –9.8 to –1.88); Modified Mayo Wrist Score (mean difference range, 10.5 to 27); and Disabilities of the Arm, Shoulder and Hand score (mean difference range, –51.8 to –24.48). Considering clinically relevant improvements based on the MCID, 4 of 5 studies reporting the visual analog scale score showed improvements in this score (MCID, 2) and all studies reporting the Disabilities of the Arm, Shoulder and Hand score showed improvements in this score (MCID, 10). Most complications recovered without any treatment, and 3 patients (2.29%) needed a reoperation. Conclusions Arthroscopic transosseous foveal repair of the TFCC resulted in improvements in grip strength and functional outcomes with low complication and reoperation rates. However, the evidence for which technique produces better clinical outcomes remains limited. Level of Evidence Level IV, systematic review of Level III and IV studies.

Stimuli-responsive anisotropic microstructures and nanostructures with different physicochemical properties in discrete compartments, have been developed as advanced materials for drug delivery systems, tissue engineering, regenerative medicine, and biosensing applications. Moreover, their stimuli-triggered actuations would be of great interest for the introduction of the functionality of drug delivery reservoirs and tissue engineering scaffolds. In this study, stimuli-responsive bicompartmental nanofibers (BCNFs), with completely different polymer compositions, were prepared through electrohydrodynamic co-jetting with side-by-side needle geometry. One compartment with thermo-responsiveness was composed of methacrylated poly(N-isopropylacrylamide-co-allylamine hydrochloride) (poly(NIPAM-co-AAh)), while the counter compartment was made of poly(ethylene glycol) dimethacrylates (PEGDMA). Both methacrylated poly(NIPAM-co-AAh) and PEGDMA in distinct compartments were chemically crosslinked in a solid phase by UV irradiation and swelled under aqueous conditions, because of the hydrophilicity of both poly(NIPAM-co-AAh) and PEGDMA. As the temperature increased, BCNFs maintained a clear interface between compartments and showed thermally-induced actuation at the nanoscale due to the collapsed poly(NIPAM-co-AAh) compartment under the PEGDMA compartment of identical dimensions. Different model drugs, bovine serum albumin, and dexamethasone phosphate were alternately loaded into each compartment and released at different rates depending on the temperature and molecular weight of the drugs. These BCNFs, as intelligent nanomaterials, have great potential as tissue engineering scaffolds and multi-modal drug delivery reservoirs with stimuli-triggered actuation and decoupled drug release.

Background Alarm services in the Order Communication System improve awareness for related physicians including orthopaedic surgeons, internal medicine doctors, and other relevent doctors. This prospective observational multicenter study was to compare the diagnostic and treatment rates of osteoporosis between an alarm service group and a no alarm service group. Methods From January 2017 to december 2017, The subjects included patients aged 50 years or older with hip fractures from 16 hospital-based multicenter cohorts. Among the 16 hospitals, 5 university hospitals established an alarm service for osteoporosis management (i.e., Alarm group) and 11 university hospitals did not set-up alarm services (i.e., Control group). The rate of dual energy X-ray absorptiometry (DXA) test and the initiation rate of antiosteoporosis medications between the 2 groups were compared at enrollment and at 6 months follow-up. Results During the study period, 1,405 patients were enrolled. The DXA examination rate and initiation rate of osteoporosis treatment between the Alarm group and the Control group were 484 patients (89.8%) vs. 642 patients (74.1%) (P

Conducting polymers are excellent sensing materials in the design of bioanalytical sensors because of their electronic conductivity, low energy optical transitions, biocompatibility, and room temperature operation. Among them, Polypyrrole (Ppy) is one of the most extensively used conducting polymers because of a number of properties such as redox activity, rapid electron transfer, and ability to link a variety of biomolecules to pyrrole groups by chemical treatment. In this study, Ppy nanowires were synthesized by an electrospinning method. The nanowires were prepared from a solution mixture of Ppy and poly(ethylene oxide). The method of detection in such a device is based on the selective binding of antigen onto an antibody that is covalently attached to the nanowires. Thus, anti-IgG was immobilized on Ppy nanowires using an EDC {[N-(3-dimethyl aminopropyl)-N2-ethylcarbodiimide hydrochloride]}-NHS(N-hydrosuccinimide) modified technique. Fluorescence images of BSA–FITC (fluorescein isothiocyanate labeling of bovine serum albumin) conjugation demonstrated that antibody was functionalized on the Ppy nanowires without non-specific binding and facilitated selective detection of antigen. Current–voltage (I–V) characterization was used to monitor the change in the conductivity of nanowires while the specific binding interaction occurred. These results of electrical properties enable Ppy nanowire-based biosensors to detect biomolecules in real-time.

Human anisakiasis is a disease caused by an infestation of the third stage larvae of family anisakidae. The ingested larvae invade the gastrointestinal wall, causing clinical symptoms that include abdomen pain, nausea, and vomiting. Although enteric anisakiasis is extremely rare, it can induce intestinal obstruction. We report a case in which emergency surgery was needed due to intestinal obstruction that coincided with symptoms related to anisakiasis, along with a brief literature review.

BACKGROUND Liposuction provides further reduction of axillary sweating and malodor when combined with dermal curettage with sharp rasping cannulas. This aggressive approach is associated with relatively higher rate of hematoma formation when compared to the conventional simple liposuction. OBJECTIVE The aim of this prospective, randomized, controlled trial was to evaluate the effect of quilting sutures on the incidence of hematoma formation after liposuction-curettage for treatment of axillary hyperhidrosis (AH). MATERIALS AND METHODS The trial randomized 59 male patients (118 axillae) undergoing liposuction-curettage for AH to quilting procedures (61 axillae) or control group (57 axillae) for intention-to-treat analysis. Outcome measures included the incidence of hematoma formation, operative time, degree of postoperative pain, and amount of analgesics consumption. RESULTS Quilting sutures significantly reduced the incidence of axillary hematoma from 28.1% to 4.9%. Quilting was associated with the lengthening of operative time but did not affect the postoperative pain. CONCLUSION Considering its efficacy in reducing postoperative hematoma, quilting is recommended in combination with aggressive liposuction-curettage procedure for treating AH and osmidrosis.

E-mail: dlim@hanyang.ac.krReceived September 8, 2013, Accepted September 10, 2013Key Words : Environmental responsiveness, SERS substrates, Branched gold nanocrystals, High sensitivitySurface-enhanced Raman scattering (SERS) has been ofgrowing interest as a powerful tool to study vibrationalinformation of molecules adsorbed on metallic nanoparticles(MNPs).

Ghulam Jalani,* Chan Woo Jung,* Jae Sang Lee, Dong Woo Lim Department of Bionano Engineering, College of Engineering Sciences, Hanyang University, Education Research Industry Cluster at Ansan Campus, Ansan, South Korea*These authors contributed equally to this workAbstract: Stimuli-responsive, polymer-based nanostructures with anisotropic compartments are of great interest as advanced materials because they are capable of switching their shape via environmentally-triggered conformational changes, while maintaining discrete compartments. In this study, a new class of stimuli-responsive, anisotropic nanofiber scaffolds with physically and chemically distinct compartments was prepared via electrohydrodynamic cojetting with side-by-side needle geometry. These nanofibers have a thermally responsive, physically-crosslinked compartment, and a chemically-crosslinked compartment at the nanoscale. The thermally responsive compartment is composed of physically crosslinkable poly(N-isopropylacrylamide) poly(NIPAM) copolymers, and poly(NIPAM-co-stearyl acrylate) poly(NIPAM-co-SA), while the thermally-unresponsive compartment is composed of polyethylene glycol dimethacrylates. The two distinct compartments were physically crosslinked by the hydrophobic interaction of the stearyl chains of poly(NIPAM-co-SA) or chemically stabilized via ultraviolet irradiation, and were swollen in physiologically relevant buffers due to their hydrophilic polymer networks. Bicompartmental nanofibers with the physically-crosslinked network of the poly(NIPAM-co-SA) compartment showed a thermally-triggered shape change due to thermally-induced aggregation of poly(NIPAM-co-SA). Furthermore, when bovine serum albumin and dexamethasone phosphate were separately loaded into each compartment, the bicompartmental nanofibers with anisotropic actuation exhibited decoupled, controlled release profiles of both drugs in response to a temperature. A new class of multicompartmental nanofibers could be useful for advanced nanofiber scaffolds with two or more drugs released with different kinetics in response to environmental stimuli.Keywords: stimuli responsiveness, anisotropy, nanofibers, actuation, drug delivery, tissue engineering

Gastric cancer is the most common malignancy in Korea. The most common cancers of the stomach are adenocarcinomas. Adenosquamous carcinoma of the stomach is very rare, constituting less than 0.1% of all the gastric cancers. Adenosquamous carcinoma is characterized by the presence of two different cell components, one adenomatous and the other squamous. It occurs more frequently in the upper stomach, and it sometimes invades the muscular layer. Adenosquamous carcinoma limited to the mucosa or submucosa is extremely rare and usually invades deeply into the muscular layer. Thus, it is found in an advanced stage at diagnosis and has a worse prognosis than adenocarcinoma. We report a case of early gastric cancer of adenosquamous carcinoma type on the basis of standard endoscopy in a 76-year-old woman. The patient received endoscopic submucosal dissection followed by subtotal gastrectomy to achieve complete resection. (Korean J Helicobacter Up Gastrointest Res 2014;14:207-210)

당뇨병성 족부 궤양(diabetic foot ulcer, DFU)은 당뇨병에 동반되는 매우 심각한 합병증으로 당뇨병 환자의 사망률을 2배 이상 증가시키며 비외상성 하지 절단 원인의 절반 이상을 차지한다[1,2]. 뼈, 인대 등이 노출되는 DFU는 전신상태가 불량한 사람에서 주로 발생하며 하지 절단이 필요한 경우가 많다[2]. DFU는 병태생리적으로 신경병증, 하지 허혈, 감염, 변형의 여러 원인이 복합적으로 동반되고[2-4], 치료에 오랜 시간과 많은 비용이 소요되어 심각한 보건학적 및 경제적 문제를 야기한다. 만성적인 DFU를 효과적으로 치료하기 위한 다양한 치료법이 개발되어 왔으며 그 중 진공보조 봉합 (Vacuum-Assisted Closure, VAC)을 이용한 음압 창상 치료법(Negative-Pressure Wound Therapy, NPWT)은 매우 주목할 만한 방법이다[5]. 다기관 무작위 대조군 연구에서 VAC-NPWT가 심각한 DFU에서 고식적인 치료방법만큼 안전하면서, 상처 치유 속도를 개선시키고, 하지 절단율을 줄였다[6-8]. 컴퓨터 조절 진공 펌프와 드레싱용 스폰지, 부착성 드레싱 제재, 배기 튜브 등으로 구성된 상품화된 시스템(V.A.CRATS; KCI, San Antonio, Texas, U.S.A)이 있으나 높은 비용으로 국내에서는 난치성 만성 창상이나 욕창, 심각한 외상 후 창상 등에 제한적으로 사용되고 있다[9,10]. 최근 국내 논문에서 비용 문제를 해결하기 위해 컴퓨터-조절 진공 펌프 대신 벽흡인기(wall suction)를 이용한 변형된 방법으로 만성 창상을 치료한 결과를 보고하였다 [11-13]. 이에 저자들은 세 명의 심각한 DFU 환자에서 고가의 Abstract Original Articles & Case Reports

Received: 26 March 2011, Accepted: 12 July 2011 Corresponding author: Ji Hye Suk Department of Internal Medicine, Maryknoll Medical Center, 12 Daecheong-dong 4-ga, Jung-gu, Busan 600-730, Korea Tel: +82-51-461-2693, Fax: +82-51-465-7470, E-mail: Jihyesuk@gmail.com Ophthalmopathy Induced by Bilateral Carotid Cavernous Fistula in a Patient with Graves’ Disease Jong Kun Ha, Ji Hye Suk, A Ra Jo, Chan Woo Jung, Bong Jae Kim, Seong Oh Park, Sang Su Kim, Mi Kyung Kim Departments of Internal Medicine and Ophthalmology, Maryknoll Medical Center, Busan, Korea

Background/Aims: The aim of this study was to identify changes in left ventricular (LV) performance in patients with a myocardial bridge (MB) in the left anterior descending coronary artery during resting and in an inotropic state. Methods: Myocardial strain measurement by speckle-tracking echocardiography and conventional LV wall-motion scoring was performed in 18 patients with MB (mean age, 48.1 ± 1.7 years, eight female) during resting and intravenous dobutamine challenge (10 and 20 μg/kg/min). Results: Conventional LV wall-motion scoring was normal in all patients during resting and in an inotropic state. Peak re gional circumferential strain increased dose dependently upon dobutamine challenge. Longitudinal strains of the anterior and anteroseptal segments were, however, reduced at 20 μg/kg/min and showed a dyssynchronous pattern at 20 μg/kg/ min. Although there were no significant differences in radial strain and displacement of all segments at rest compared with under 10 μg/kg/min challenge, radial strain and displacement of anterior segments at 20 μg/kg/min were significantly re duced compared with posterior segments at the papillary muscle level (44.8 ± 14.9% vs. 78.4 ± 20.1% and 5.3 ± 2.3 mm vs. 8.5 ± 1.8 mm, respectively; all p < 0.001), and showed plateau (40%) or biphasic (62%) patterns. Conclusions: Reduced LV strain of patients with MB after inotropic stimulation was identified. Speckle-tracking strain echocardiography identified a LV myocardial dyssynchrony that was not demonstrated by conventional echocardiography in patients with MB.

Received: 26 October 2010, Accepted: 11 January 2011 Corresponding author: Ji Hye Suk Department of Internal Medicine, Maryknoll Medical Center, 4-12 Daecheong-dong, Jung-gu, Busan 600-730, Korea Tel: +82-51-461-2693, Fax: +82-51-465-7470, E-mail: Jihyesuk@gmail.com Central pontine myelinolysis (CPM) by complicating rapid correction of severe hyponatremia has been widely reported. Additionally, CPM was occasionally reported among patients with post-liver transplantation, burns, chronic renal failure with dialysis, or other diseases associated with or not associated with other electrolyte changes or hyperosmolarity. However, there have been a few reports of CPM occurring in diabetic patients without documented electrolyte changes. This report is, to the best of our knowledge, the first report of CPM in type 2 diabetic patients without electrolyte changes in Korea. A 40-year-old man with type 2 diabetes mellitus with abruptly developed dysarthria and ataxia was admitted to our facility. He suffered from poor glucose control and multiple diabetic complications. Brain magnetic resonance imaging (MRI) revealed a well-defined bilateral symmetric hyperintense lesion in the central portion of the pons on T2and diffusion-weighted images, which was consistent with CPM. After the patient’s blood glucose and blood pressure normalized, his dysarthria and ataxia improved. Six months after discharge, follow-up MRI showed a persistent, but greatly reduced symmetric lesion in the central pons. It is certainly possible for CPM to be overlooked clinically in diabetic patients, but more cases could be diagnosed if careful attention was paid to this syndrome. (Endocrinol Metab 26:263-267, 2011)

Cholesterol granuloma is a histological term used for the description of a tissue response to a foreign body such as cholesterol crystals. Cholesterol granuloma is histologically characterized as fibrous granulation tissue containing cholesterol crystals within surrounding giant cells. Cases of cholesterol granuloma of the pancreas are very rare. We report a case of a 47-year old male who had a cholesterol granuloma of the pancreas. Abdominal CT showed 24 mm-sized cyst in the pancreas and peri-pancreatic regional mass infiltrating to the stomach. PET-CT revealed increased 18F-FDG uptake at the cyst and peri-pancreatic mass. Thus, Whipple's operation was done. The disease was confirmed by surgical pathologic examination of the tissue. Pathologic examination of resected specimen showed numerous cholesterol crystals surrounded by multinucleated foreign body giant cells. We report on this case and give a brief review of the literature.

Green Building is rapidly becoming a strong momentum in the construction industry after recognizing many negative environmental issues & problems and potential social and economical benefits. In green building, all stakeholders including an architect, a contractor, engineers, etc. need to collaborate to successfully complete integrated green design and construction that can eventually achieve the goals of sustainability in construction. Since there are many negative environmental issues and problems as well as many opportunities, it is very important to develop an Integrated Construction Process (ICP) f that can help all stakeholders to successfully implement green building strategies and technologies at the construction phase of the project development. Thus, this study develops an ‘ICP’ including goals of green construction processes, step-by-step procedure, the roles and responsibilities of three main stakeholders such as an architect, a contractor, and subcontractor that can help all stakeholder to achieve sustainability at the construction phase.