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Background The vascularity of the nipple-areolar complex (NAC) is altered after reduction mammoplasty, increasing the risk of complications after repeat reduction or nipple-sparing mastectomy. Objectives The aim of this study was to evaluate angiogenesis of the NAC via serial analysis of magnetic resonance images. Methods Magnetic resonance images of breasts after reduction mammoplasty were analyzed for 35 patients (39 breasts) from 3-dimensional reconstructions of maximum-intensity projection images. All veins terminating at the NAC were classified as internal mammary, anterior intercostal, or lateral thoracic in origin. The vein with the largest diameter was considered the dominant vein. Images were classified based on the time since reduction: 2 years. Results The average number of veins increased over time: 1.17 (2 years). Within 6 months, the pedicle was the only vein. Veins from other sources began to appear at 6 to 12 months. In most patients, at least 2 veins were available after 1 year. After 1 year, the internal mammary vein was the most common dominant vein regardless of the pedicle used. Conclusions Repeat reduction mammoplasty or nipple-sparing mastectomy should be performed ≥1 year following the initial procedure. After 1 year, the superior or superomedial pedicle may represent the safest option when the previous pedicle is unknown.

Background This is the first clinical study conducted among Asian women using breast implants manufactured by an Asian company. Four-year data regarding the safety and efficacy of BellaGel breast implants have already been published, and we now report 6-year data. Methods This study was designed to take place over 10 years. It included 103 patients who underwent breast reconstruction or augmentation using BellaGel breast implants. The rates of implant rupture and capsular contracture were measured and analyzed to evaluate the effectiveness of the breast implant. Results At patients’ 6-year postoperative visits, the implant rupture and capsular contracture rates were 1.15% and 2.30%, respectively. The implant rupture rate was 3.77% among reconstruction cases and 0% among augmentation cases. The capsular contracture rate was 5.66% among reconstruction cases and 0.83% among augmentation cases. Conclusions The 6-year data from this planned 10-year study suggest that the BellaGel cohesive silicone gel-filled breast implant is an effective and safe medical device that can be used in breast reconstruction and augmentation.

Purpose To evaluate the impact of the age of onset of low vision on patients’ vision-related quality of life (VR-QoL) and mental health. Methods Low-vision patients who visited Chung-Ang University hospital from January 2012 to December 2014 were included. Patients were divided into the congenital low-vision (CLV) and acquired low-vision (ALV) groups according to the age of disease onset. People with normal visual function comprised the control group. VR-QoL was estimated with the National Eye Institute Visual Function Questionnaire (NEI VFQ-25), while mental health was assessed through the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The mean scores of each questionnaire were compared between the groups in independent t-tests. Results Overall, 125 low-vision patients (55 CLV and 70 ALV) and 71 control subjects were included. Although the subscale and composite scores of the NEI VFQ-25 were lower in the ALV group than in the CLV group, the differences were not significant. However, the BDI and BAI scores were significantly higher in the ALV group than in the CLV group (12.07 ± 11.97 vs. 7.67 ± 9.04, P = 0.021; 9.11 ± 10.51 vs. 5.69 ± 6.85, P = 0.030, respectively). Also, the number of patients requiring expert consultation for depression was higher in the ALV group than in the CLV group (P = 0.010). Conclusion ALV patients have more vulnerable mental health states than CLV patients. Therefore, assessment of the age of onset of low vision and mental health plays a critical role in successful rehabilitation.

The demand for high-quality silicone breast implants is rising. This was the first clinical study on implantation of Asian company-made silicone breast implants into Asian women. The authors report 4-year study data for BellaGel implants. This study is an ongoing 10-year study with 103 subjects undergoing augmentation or primary reconstruction with BellaGel implants. To assess effectiveness, rupture and capsular contracture rates were measured and Kaplan-Meier analysis was performed. Paired

We investigated the accuracy of pressure injury evaluation using tele-devices and examined the concordance between automatically generated recommendations and primary manual recommendations. Caregivers took photos and videos of pressure injuries using smartphones with built-in cameras and uploaded the media to the application. The wound team evaluated the wound using a specially modified version of the Pressure Sore Status Tool. This was compared with the Pressure Sore Status Tool score assessed during the actual examination of the patient. We developed an automatic algorithm for dressing based on the Pressure Sore Status Tool score, checking for consistency between this and the primary manual recommendation. A total of 60 patients diagnosed with pressure injuries were included. The κ coefficients indicated substantial agreement for wound size and total score, and excellent for all other items. We found that the overall concordance rates were statistically significant for all items (p < 0.001). For the primary dressing, the κ coefficient for the concordance rate of automatic algorithm and manual recommendation was 0.771, while that of teleconsultation system and manual recommendation was 0.971. For the secondary dressing, the figures were 0.798 and 0.989, respectively. All values were statistically significant (p < 0.001). We presented strong evidence documenting the utilization of a smartphone, patient-driven system, and demonstrated that the measurements obtained were comparable to the ones obtained by a trained, on-site, wound team. Furthermore, we confirmed agreement between automatically generated recommendations and primary manual recommendations.

Obesity induces oxidative stress by causing hyperglycemia and insulin resistance, while contributing to cognitive and memory decline by inducing insulin resistance in the brain and hyperphosphorylation of Tau proteins. We aimed to investigate the effects of treadmill exercise in improving these obesity-induced pathological phenomena. Sprague-Dawley rats aged 20 weeks were fed a high-fat diet (HFD) for 20 weeks to induce obesity. The rats were subsequently subjected to treadmill exercise (progressively increasing load intensity) for 8 weeks. The rats were divided into three groups: normal diet-control (n = 15), HFD-control (n = 15), and HFD-treadmill exercise (n = 15). We performed water maze and passive avoidance tests and assessed weight, area under the curve, homeostatic model assessment of insulin resistance, and abdominal visceral fat/body weight. Western blot was used to examine protein expression related to brain insulin signaling, tau hyperphosphorylation, and NADPH oxidase, and immunohistochemistry was performed to examine the immunoreactivity of p-Tau (Ser 202/Thr 205) and p22-phox. Treadmill exercise effectively rescued brain insulin signaling, hyperphosphorylation and aggregation of Tau protein, and NADPH oxidase activation in the high fat diet group. Furthermore, it improved insulin resistance inhibitors, decreased abdominal fat mass, inhibited weight gain, and rescued learning and memory. Obesity-induced insulin resistance contributes to cognitive decline, such as reduced learning and memory, but physical activity, such as treadmill exercise, was found to have a positive effect on brain function by improving thesepathological phenomena. Therefore, we suggest that treadmill exercise must be considered in the prevention and treatment of metabolic and neurodegenerative diseases.

Background There are few studies on intensive care unit (ICU) patients in the Republic of Korea. We analyzed the characteristics and mortality changes of all ICU patients over the last 8 years. Methods This study used the cohort of the National Health Insurance Corporation, which provides medical care to all residents of the Republic of Korea. The cohort consists of patients aged 20 years or older between 2003 and 2010 with a history of ICU admission. We analyzed changes in sex, age, household income, number of hospital beds, emergency admissions, and reasons for admission using the Cochran-Armitage trend test. The adjusted hazard ratios (HRs) of mortality according to these variables and year of admission were calculated by Cox proportional hazards regression. Results The proportion of patients aged ≥70 years increased over that period, as did their average age (by 3.6 years). During the 8-year study period, the 3-year mortality rate was 32.91%-35.83%. The overall mortality was higher in males and older patients, in those with a lower household income and higher Charlson Comorbidity Index (CCI) score, those admitted to a hospital with a smaller number of beds, and those admitted via the emergency room. There was no significant change in crude mortality rate over the 8-year study period; however, the adjusted HR showed a decreasing trend. Conclusions Patients admitted to the ICU were older and had higher CCI score. Nevertheless, there was a temporal trend toward a decrease in the HR of long-term mortality.

Summary Background Only experienced surgeons can produce satisfactory results with most of the current surgical methods for bilateral cleft lip repair. The existing methods require not only preoperative orthodontic maneuvers but also accurate measurements for surgical design. We describe an easy-to-design and simple-to-execute general purpose surgical technique to repair most bilateral cleft lips. Methods A retrospective review was performed for the patients who underwent bilateral cleft lip repair using our novel method between 2003 and 2016. The authors collected data from medical records, and the aesthetic results were judged using the aesthetic result categories by three independent surgeons; indirect anthropometry was applied to patients over 9 years of age. In addition, we investigated the complications, the reoperation rate, and the reasons for reoperation. Results Bilateral cleft lip surgery was performed in 146 cases between 2003 and 2016. Seventy-eight patients had bilateral complete cleft lips, 47 patients had bilateral incomplete cleft lips, and 21 patients had bilateral complete and incomplete cleft lips (asymmetric patients). There were no acute complications requiring re-surgery, such as wound dehiscence, hematoma, and infection. According to aesthetic classification, 74 patients (51%) were classified into category I and 72 patients (49%) into category II; no patients were classified into categories III and IV. Seventy patients (48%) underwent secondary lip operations. In anthropometry, the measurements were observed to be symmetrical; left and right measurement data were not significantly different. The main purposes of the revision were excision of widened philtral scars (42 cases) and correction of lateral vermilion bulging (28 cases). Conclusions We have found our novel technique to be simple and capable of providing consistent, reproducible, and reliable results.

Release of fatty acids from lipid droplets upon activation of the sympathetic nervous system (SNS) is a key step in nonshivering thermogenesis in brown adipose tissue (BAT). However, intracellular lipolysis appears not to be critical for cold-induced thermogenesis. As activation of the SNS increases glucose uptake, we studied whether intracellular glycolysis plays a role in BAT thermogenesis. To stimulate BAT-innervating sympathetic nerves in vivo, we expressed channelrhodopsin-2 (ChR2) in catecholaminergic fibers by crossbreeding tyrosine hydroxylase-Cre mice with floxed-stop ChR2 mice. Acute optogenetic stimulation of sympathetic efferent fibers of BAT increased body temperature and lowered blood glucose levels that were completely abolished by the β-adrenergic receptor antagonist. Knockdown of the Ucp1 gene in BAT blocked the effects of optogenetic stimulation on body temperature and glucose uptake. Inhibition of glucose uptake in BAT and glycolysis abolished optogenetically induced thermogenesis. Stimulation of sympathetic nerves upregulated expression of the lactate dehydrogenase-A and -B genes in BAT. Optogenetic stimulation failed to induce thermogenesis following treatment with the LDH inhibitor. Pharmacological blockade and genetic deletion of the monocarboxylate transporter 1 completely abolished the effects of sympathetic activation. Our results suggest that intracellular glycolysis and lactate shuttle play an important role in regulating acute thermogenesis in BAT.

Background Numerous techniques have been used for lower blepharoplasty. The techniques can be classified into four principles: excision of excess fat, septal reset, orbital fat repositioning, and reinforcement of the attenuated orbital septum. Objectives We modified the conventional approach of septal reinforcement to utilize an inverted T-shaped plication with preservation of the orbital fat, repositioning the septum below the arcus marginalis to refine tear-trough deformity. Methods From April 2010 to September 2015, 93 individuals underwent bilateral lower blepharoplasty. Retrospective chart reviews were performed, and the results and complications during the follow-up period were recorded and photographed. Results The patients comprised 76 women and 17 men. Thirteen, 33, and 47 patients exhibited mild, moderate, and severe fat herniation, respectively, accompanied by tear-trough deformity. A total of 70 and 23 patients underwent lower blepharoplasty via subciliary and transconjunctival approaches, respectively. We performed inverted T-shaped plication of the orbital septum in mild and moderate cases and X-shaped plication in severe cases, and in moderate and severe cases, we performed septal repositioning simultaneously. The mean follow-up period was 25 months. When immediate mild lid retraction or lid malposition was observed, it recovered without specific treatment within 1 to 2 weeks. No permanent lid malposition or ectropion was observed in any of the patients. Conclusions Septal plication with inverted T-shape or X-shape can minimize the downward forces that affect postoperative eyelid malposition and ectropion. Further, these procedures provide sufficiently strong reinforcement of the orbital septum to restore infraorbital fat herniation.

Objective Bile acids have been implicated as important regulators of glucose metabolism via activation of FXR and GPBAR1. We have previously shown that FGF19 can modulate glucose handling by suppressing the activity of hypothalamic AGRP/NPY neurons. As bile acids stimulate the release of FGF19/FGF15 into the circulation, we pursued the potential of bile acids to improve glucose tolerance via a gut–brain axis involving FXR and FGF15/FGF19 within enterocytes and FGF receptors on hypothalamic AGRP/NPY neurons. Methods A 5-day gavage of taurocholic acid, mirroring our previous protocol of a 5-day FGF19 treatment, was performed. Oral glucose tolerance tests in mice with genetic manipulations of FGF signaling and melanocortin signaling were used to define a gut–brain axis responsive to bile acids. Results The taurocholic acid gavage led to increased serum concentrations of taurocholic acid as well as increases of FGF15 mRNA in the ileum and improved oral glucose tolerance in obese (ob/ob) mice. In contrast, lithocholic acid, an FXR antagonist but a potent agonist for GPBAR1, did not improve glucose tolerance. The positive response to taurocholic acid is dependent upon an intact melanocortinergic system as obese MC4R-null mice or ob/ob mice without AGRP did not show improvements in glucose tolerance after taurocholate gavage. We also tested the FGF receptor isoform necessary for the bile acid response, using AGRP:Fgfr1−/− and AGRP:Fgfr2−/− mice. While the absence of FGFR1 in AGRP/NPY neurons did not alter glucose tolerance after taurocholate gavage, manipulations of Fgfr2 caused bidirectional changes depending upon the experimental model. We hypothesized the existence of an endogenous hypothalamic FGF, most likely FGF17, that acted as a chronic activator of AGRP/NPY neurons. We developed two short peptides based on FGF8 and FGF17 that should antagonize FGF17 action. Both of these peptides improved glucose homeostasis after a 4-day course of central and peripheral injections. Significantly, daily average blood glucose from continuous glucose monitoring was reduced in all tested animals but glucose concentrations remained in the euglycemia range. Conclusions We have defined a gut–brain axis that regulates glucose metabolism mediated by antagonistic fibroblast growth factors. From the intestine, bile acids stimulate FGF15 secretion, leading to activation of the FGF receptors in hypothalamic AGRP/NPY neurons. FGF receptor intracellular signaling subsequently silences AGRP/NPY neurons, leading to improvements of glucose tolerance that are likely mediated by the autonomic nervous system. Finally, short peptides that antagonize homodimeric FGF receptor signaling within the hypothalamus have beneficial effects on glucose homeostasis without inducing hypoglycemia. These peptides could provide a new mode of regulating glucose metabolism., Highlights • Gut brain axis that controls glycemia in normal and obese, insulin resistant states. • Short term (days) taurocholate feeding can improve glucose tolerance in leptin-deficient mice. • A neuropeptide (AGRP) and its receptor (MC4R) are necessary for the effects of taurocholate on glucose metabolism. • Endogenous hypothalamic FGFs antagonize endocrine FGFs. Blockade of the endogenous hypothalamic FGFs with short peptides can improve glucose tolerance as well as daily average blood glucose.

Background. Fingertips are a common site for hand injuries. The ideal substitute for fingertip pulp is tissue that matches texturally with minimal donor site morbidity. We described anatomical findings from cadaveric studies and the reliability of the palmar ulnar artery perforator (PUAP) free flap techniques for the reconstruction of fingertips injuries. Methods. The cadaveric study involving 8 hands was conducted to illuminate the anatomy of the hypothenar region. We investigated the emerging point of perforators, diameter of the artery at the origin, and the length of the pedicle. Forty-four patients with fingertip injuries underwent fingertip reconstruction using PUAP free flaps. Data on the baseline patient demographics, hospital courses, and flap sizes were obtained retrospectively. The 6-month postoperative sensory capacity was determined using a 2-point discrimination test. Results. The cadaveric study found that the PUAP pedicles arose from the superficial palmar arch, the mean length of pedicles, and the diameter and location of perforators were also analyzed. The PUAP flap sizes varied from 2.0 × 2.3 cm to 2.5 × 3.5 cm, and the mean operative time was 124 min. In all cases, we performed neurorrhaphy for fingertip sensory restoration. All donor sites were closed primarily, and the 2-point discrimination test result was 5.7±0.87 mm 6 months after surgery. Conclusions. We confirmed the anatomical consistency of the PUAP. Among the numerous reconstruction options available for fingertip injuries, the PUAP free flap is a useful fingertip reconstruction option.

Background: Anatomical variation and deficits of velocardiofacial syndrome patients are related to unsatisfactory treatment results in surgical correction of speech abnormalities. The main purpose of the article is to investigate the clinical significance of thinned levator veli palatini muscle in VCFS patients. Methods: The authors reviewed medical records of all children with velocardiofacial syndrome who received pharyngeal flap surgery between March 2007 and September 2015. Data including thickness of levator veli palatini in magnetic resonance examination; preoperative velopharyngeal gap size from nasoendoscopy; and preoperative and postoperative speech outcomes were collected. Results: Total of 36 velocardiofacial syndrome patients with preoperative objective data and postoperative speech outcomes were identified. Preoperative velopharyngeal gap showed significant correlation with thickness of levator veli palatini (correlation coefficient: 0.297/0.397, P = .02/.03) and gap size showed correlation with postoperative speech improvement (0.347/0.413, P = .04/.02). However, muscle thickness showed no correlation with speech outcomes (0.046/0.037, P = .77/.86). Conclusion: Thinned levator veli palatini muscle in velocardiofacial syndrome patients are related to widened velopharyngeal gap and production of hypernasal speech, and can give negative impact on postoperative surgical outcome of pharyngeal flap surgery.

Purpose Sporadic inclusion body myositis (sIBM), a muscular degenerative disease in the elderly, is an inflammatory myopathy characterized by muscle weakness in the wrist flexor, quadriceps, and tibialis anterior muscles. We aimed to identify the therapeutic effect of resistance exercise (RE) in improving sIBM symptoms in an sIBM animal model. Methods Six-week-old male Wistar rats were divided into a sham group (sham, n = 12), chloroquine-control group (CQ-con, n = 12), and chloroquine-RE group (CQ-RE, n = 12). The rats were subjected to 1 wk of exercise adaptation and 8 wk of exercise (three sessions per week). Protein expression was measured by Western blotting. Rimmed vacuoles (RV) were identified by hematoxylin and eosin staining and modified Gomori trichrome staining, and amyloid deposition was examined by Congo red staining. Results The effects of CQ and RE differed depending on myofiber characteristics. Soleus muscles showed abnormal autophagy in response to CQ, which increased RV generation and amyloid-β accumulation, resulting in atrophy. RE generated RV and decreased amyloid deposition in soleus muscles and also improved autophagy without generating hypertrophy. This reduced the atrophy signal transduction, resulting in decreased atrophy compared with the CQ-con group. Despite no direct effect of CQ, flexor hallucis longus muscles showed loss of mass because of reduced activity or increased inflammatory response; however, RE increased the hypertrophy signal, resulting in reduced autophagy and atrophy. Conclusions These results demonstrate that RE had a preventive effect on sIBM induced by CQ treatment in an animal model. However, because the results were from an animal experiment, a more detailed study should be conducted over a longer period, and the effectiveness of different RE programs should also be investigated.

Common side effects during hyaluronic acid filler injections are typically mild and reversible, but several reports of blindness have received attention. The present study focused on orbital symptoms combined with blindness, aiming to classify affected patients and predict their disease course and prognosis. From September of 2012 to August of 2015, nine patients with vision loss after filler injection were retrospectively reviewed. Ptosis, ophthalmoplegia, and enophthalmos were recorded over a 6-month follow-up, and patients were classified into four types according to periocular symptom manifestation. Two patients were categorized as type I (blindness without ptosis or ophthalmoplegia), two patients as type II (blindness and ptosis without ophthalmoplegia), two patients as type III (blindness and ophthalmoplegia without ptosis), and three patients as type IV (blindness with ptosis and ophthalmoplegia). The present study includes previously unpublished information about orbital symptom manifestations and prognosis combined with blindness caused by retinal artery occlusion after cosmetic filler injection.Therapeutic, V.

Summary Background This study aims to determine whether a bar-like implant made of poly lactic- co -glycolic acid (PLGA) could be used for cartilage suspension and whether the implant would be suitable for rhinoplasty. Methods Three types of in vivo animal experiments were performed. First, the ear cartilage was incised in a full-thickness pattern, and the PLGA system was placed between the upper and lower cartilage to offer support to the tissue. Second, after the ear cartilage was forcibly bent, an implant was placed in the cartilage. For these rabbits, the outer aspect of the ear cartilage was assessed at 2, 4, 8, 10, and 12 weeks postoperatively. In addition, tissue samples were collected for histological evaluation 12 weeks after surgery. Third, the bar-like nasal implant was used for nasal septal suspension. We obtained micro-computed tomography (CT) images and evaluated the inflammatory reaction at 12 weeks postoperatively. Results The results of both the ear suspension and bending retention tests revealed that the characteristic shapes of the cartilage were well preserved at 12 weeks postoperatively. Moreover, no abnormal inflammatory reaction was present in any site in the experimental group. We successfully implanted the bar-like nasal implant in the rabbit's septum, and no complications occurred. Furthermore, the physical examination and the micro-CT images did not reveal any nasal obstruction or inflammation. Conclusions We confirmed that an implant made of PLGA can be maintained in the cartilage tissue and believe that this can be applied in rhinoplasty as an alternative to autologous cartilage.

Mild temperature hyperthermia (MTH) increases blood flow and oxygenation in tumours. On the other hand, high-dose-per-fraction irradiation damages blood vessels, decreases blood flow and increases hypoxia in tumours. The radiation-induced hypoxia in tumours activates hypoxia-inducible factor-1α (HIF-1α) and its target genes, such as vascular endothelial growth factor (VEGF), promoting revascularization and recurrence. In the present study, we examined the hypothesis that MTH inhibits radiation-induced upregulation of HIF-1α and its target genes by increasing tumour oxygenation.FSaII fibrosarcoma tumours grown subcutaneously in the legs of C3H mice were used. Tumours were irradiated with 15 Gy using aIrradiation of FSaII tumours with a single dose of 15 Gy led to significantly decreased blood perfusion, increased hypoxia and upregulation of HIF-1α and VEGF. On the other hand, MTH at 41 °C for 30 min increased blood perfusion and tumour oxygenation, thereby suppressing radiation-induced HIF-1α and VEGF in tumours, leading to enhanced apoptosis of tumour cells and tumour growth delay.MTH enhances the anti-tumour effect of high-dose irradiation, at least partly by inhibiting radiation-induced upregulation of HIF-1α.

Summary Background Submucous cleft palate is a congenital deformity that may present as velopharyngeal insufficiency. The degree of anatomical abnormality varies widely among patients and does not predict severity of symptom. We present our 10-year experience treating submucous cleft palate patients with double opposing z-plasty and explore the effect of age at surgery and compensatory articulation on speech. Methods Preoperative assessment included intraoral examination, nasoendoscopy, and perceptual speech evaluation. Age, gap size, and severity of hypernasality were assessed to determine the timing and type of surgery. A retrospective study of 74 submucous cleft palate patients undergoing double-opposing z-plasty from 2005 to 2016 by a single surgeon (Baek RM) was conducted. Double opposing z-plasty was modified to fully release all abnormal insertions of the levator veli palatini muscle. Postoperative velopharyngeal function was measured and statistical analyses were performed. Results The ages of patients at surgery ranged from 11 months to 19 years. Postoperatively 87 percent of the patients achieved velopharyngeal competency and 13 percent had remaining mild hypernasality. Age was a significant factor in predicting speech outcome, and patients receiving surgery prior to the age of 5.5 years had a higher normalization rate. Compensatory articulation did not have an impact on postoperative hypernasality. There were no cases of postoperative hyponasality or airway problems. Conclusion Satisfactory speech outcome was achieved with the authors' protocol and modification of the double-opposing z-plasty. A comprehensive assessment of patient age, intraoral findings, severity of hypernasality, and gap size, is necessary for proper treatment of submucous cleft palate patients.

PURPOSE To report the magnetic resonance imaging (MRI) appearance of a man with chronic hypotony caused by unexplained cyclodialysis clefts and the change after laser photocoagulation. METHODS A 19-year-old man with hypotonous maculopathy caused by cyclodialysis clefts in the right eye presented to our institution. The etiology and time of onset of the cyclodialysis clefts were obscure, and a MRI was performed to assess the possibility of compressive optic neuropathy. RESULTS MRI of the right eye showed a relative decrease in globe volume and diffuse enhancement of the ocular wall compared with the left eye. Conservative management showed no further improvement, and the patient underwent laser photocoagulation within the cyclodialysis clefts. During the 9-month follow-up period, both functional and anatomic reversal and an increase in total globe volume were observed, and the enhancement of the ocular wall was resolved. CONCLUSIONS This case demonstrates the specific magnetic resonance appearance of hypotony status caused by a cyclodialysis cleft and the change after laser photocoagulation cyclopexy.

Free radical oxygen generated by stress and oxygen deficiency causes problems such as heart disease and stroke. We propose mobile health monitoring system to solve this problem. Based on biofeedback technology used in psychiatry, meaningful parameters were identified by analyzing the autonomic nervous system and breathing patterns that change during deep breathing. As a result, PP-interval was increased (p < 0.05) during deep breathing and the average expiration value of the subject was unconsciously increased (p < 0.05). The deep breathing has been shown to be able to prevent stress and oxygen deficiency. After that, we developed an effective mobile health monitoring system using parameter that have significant result value. If personal health monitoring system that continuously induces deep breathing through the method of this study is developed, it can be used as a way to continuously manage and improve individual health.

The assessment of rupture probability is crucial to identifying at risk intracranial aneurysms (IA) in patients harboring multiple aneurysms. We aimed to develop a computer-assisted detection system for small-sized aneurysm ruptures using a convolutional neural network (CNN) based on images of three-dimensional digital subtraction angiography. A retrospective data set, including 368 patients, was used as a training cohort for the CNN using the TensorFlow platform. Aneurysm images in six directions were obtained from each patient and the region-of-interest in each image was extracted. The resulting CNN was prospectively tested in 272 patients and the sensitivity, specificity, overall accuracy, and receiver operating characteristics (ROC) were compared to a human evaluator. Our system showed a sensitivity of 78.76% (95% CI: 72.30%&ndash, 84.30%), a specificity of 72.15% (95% CI: 60.93%&ndash, 81.65%), and an overall diagnostic accuracy of 76.84% (95% CI: 71.36%&ndash, 81.72%) in aneurysm rupture predictions. The area under the ROC (AUROC) in the CNN was 0.755 (95% CI: 0.699%&ndash, 0.805%), better than that obtained from a human evaluator (AUROC: 0.537, p &lt, 0.001). The CNN-based prediction system was feasible to assess rupture risk in small-sized aneurysms with diagnostic accuracy superior to human evaluators. Additional studies based on a large data set are necessary to enhance diagnostic accuracy and to facilitate clinical application.

Background The authors investigated the synergistic effects of adipose-derived stem cells and fat graft on skin wrinkles in a nude mouse model of chronologic aging. Methods After 50 weeks of chronologic aging, 44 female BALB/c nude mice were classified into four groups: (1) negative control, (2) mice injected subcutaneously with fat on the back skin (0.5 cm), (3) mice injected with adipose-derived stem cells (1 × 10 cells in 0.5 cm Hanks balanced salt solution), and (4) mice injected with both fat (0.5 cm) and adipose-derived stem cells (1 × 10 cells in 0.5 cm Hanks balanced salt solution). The degree of wrinkling was evaluated using replica analysis, and skin biopsies were performed after 4 weeks. The dermal thickness and density of collagen were determined. Type I procollagen and matrix metalloproteinase levels were determined using real-time polymerase chain reaction and Western blot analysis. Tropoelastin, fibrillin-1, and CD31 levels were evaluated using immunohistochemistry. Results Based on the total wrinkle area, there was significant wrinkle reduction in the fat-treated and adipose-derived stem cell with fat-treated groups. Type I procollagen mRNA and collagen levels were significantly higher in the adipose-derived stem cell with fat-treated group than in the adipose-derived stem cell-treated and the fat-treated groups. In addition, the adipose-derived stem cells with fat graft group exhibited significantly higher CD31 expression level than the adipose-derived stem cell-treated and the fat-treated groups. Conclusion Both adipose-derived stem cells and fat graft have a wrinkle-reducing effect and synergistically affect collagen synthesis and neovascularization.

The purpose of this study is to suggest sound biofeedback, which is a new technique of early stress relief effect by observing change in the heart rate variability (HRV). The sound biofeedback imitating heart rate of the comfortable and stress state is termed parasympathetic stimulation sound (PSS) and sympathetic stimulation sound (SSS), respectively. Twelve subjects were selected without previous history of cardiovascular diseases and mental illness, such as arrhythmia, myocardial infarction, depression and panic disorder. To confirm the changes in the low-frequency (LF), high-frequency (HF) and LF/HF values of HRV as stress evaluation indicators, the HRV of subjects was measured by photoplethysmogram. Signals were processed using the peak detect algorithm, and fast Fourier transform. Results were obtained using power specific densities. During the PSS stimulation, the LF/HF tended to decrease generally. On the other hand, during the SSS stimulation, LF/HF tended to increase. The LF/HF Mean change value ([Formula: see text]) using the PSS stimulation is similar to the effect of Transcutaneous Vagal Nerve Stimulation (tVNS). In addition, the quantitative effect of sound biofeedback was confirmed by judging changes in the parasympathetic and sympathetic nerves in the autonomic nervous system (ANS) through [Formula: see text]-score normalized data. These experimental results suggest that sound biofeedback has the same stimulation location and clinical applicability as tVNS. As a result, sound biofeedback may be used as a new method for stress reduction.

There are few studies of mobile-Health (mHealth) device application with schizophrenic patients. We aimed to quantitatively assess patient's activity and the relationship between their physical activity and the severity of their psychopathologies. Then we attempted to identify the patients who required intervention and evaluated the feasibility of using the mHealth device. A total of 61 of the 76 available hospitalized patients with chronic schizophrenia who participated in the activity programs were enrolled. They wore a mHealth device for a week to assess their activity (steps/day). The Positive and Negative Syndrome Scale (PANSS) was completed by the subjects. As a result, the positive subscale of the PANSS and the positive and negative factors of the PANSS 5-factor structure showed a predictive value for low levels of physical activity. The group of subjects with a high total PANSS score had a significantly lower level of physical activity than the other groups. In conclusion, physical activity showed a significant association with positive symptoms as well as negative symptoms. The mHealth device showed relatively good feasibility for schizophrenic patients. We should pay more attention to the activity of patients with high PANSS scores.

We present our experience with calvarial bone framework insertion through an intraoral approach for a patient who was at risk for columellar necrosis due to a previous open rhinoplasty. A 58-year-old woman exhibited severe columellar contracture, so that the columellar tissue was too fragile to be touched. We could not incise the columella and insert a new nasal implant through the bilateral rim incision. Moreover, the patient had septal cartilage perforation and collapse. The patient needed columellar support as well as nasal dorsum reconstruction. The authors decided to graft an autogenous L-strut bone framework through an intraoral approach. Two pieces of 5-cm × 1-cm sized split calvarial bone were harvested and trimmed to fit the width and length of the nasal dorsum and columella. The right-angle-shaped bone framework was made with an absorbable plate and screws. Through a gingivobuccal incision, the bone framework graft was inserted and the graft was fixed with absorbable screws. The patient did not experience complications such as skin necrosis or inflammation. A bone framework grafted through an intraoral approach can be a good choice for patients who have experienced scar contracture in the columella, septal cartilage perforation, and collapse.

Renal cell carcinomas (RCCs) have a strong tendency to metastasize, and the most common sites are the lungs, bones and liver. Late recurrence is another feature of the RCC, with lesions appearing ≥10 years after surgical treatment. However, fibrosis has rarely been associated with the disease. The present study reports a case of recurrent RCC that manifested as a fibrotic mass within the thorax. A 48-year-old man presented with dyspnea that had persisted for 3 days. The patient had undergone a right radical nephrectomy for stage II clear cell carcinoma of the kidney 6 years previously. The patient was a current smoker, with a smoking history of 20 pack-years. Chest radiography showed pleural effusion in the right thorax with an egg-sized mass shadow within the right upper lung (RUL) field. Computed tomography (CT) showed a main mass, 7 cm in diameter, within the RUL, with heterogeneous enhancement and multiple nodules of various sizes in the lungs, suggestive of primary lung cancer or metastatic RCC. A CT-guided percutaneous needle aspiration biopsy was obtained from the main mass, but histology revealed dense fibrous tissue without any malignant cells. Positron emission tomography-CT demonstrated an irregular hypermetabolic RUL mass, with a standardized uptake value (SUV) of 5.0, along the right pleura, and small pulmonary nodules (SUV, 2.0). Ultrasound-guided biopsy was attempted for a smaller hypermetabolic pleural nodule and the result was clear cell adenocarcinoma, consistent with the previous renal histology. The present study describes the case, along with a review of the relevant literature.

There is increasing evidence that cancer contains cancer stem cells (CSCs) that are capable of regenerating a tumor following chemotherapy or radiotherapy. CD44 and CD133 are used to identify CSCs. This study investigated non-invasive in vivo monitoring of CD44-positive cancer stem-like cells in breast cancer by γ-irradiation using molecular image by fusing the firefly luciferase (fLuc) gene with the CD44 promoter. We generated a breast cancer cell line stably expressing fLuc gene by use of recombinant lentiviral vector controlled by CD44 promoter (MCF7-CL). Irradiated MCF7-CL spheres showed upregulated expression of CD44 and CD133, by immunofluorescence and flow cytometry. Also, gene expression levels of CSCs markers in irradiated spheres were clearly increased. CD44+ CSCs increased fLuc expression and tumor growth in vivo and in vitro. When MCF7-CL was treated with siCD44 and irradiated, CD44 expression was inhibited and cell survival ratio was decreased. MCF7-CL subsets were injected into the mice and irradiated by using a cobalt-60 source. Then, in vivo monitoring was performed to observe the bioluminescence imaging (BLI). When breast cancer was irradiated, relative BLI signal was increased, but tumor volume was decreased compared to non-irradiated tumor. These results indicate that increased CD44 expression, caused by general feature of CSCs by irradiation and sphere formation, can be monitored by using bioluminescence imaging. This system could be useful to evaluate CD44- expressed CSCs in breast cancer by BLI in vivo as well as in vitro for radiotherapy.

Background The use of immediate breast reconstruction and adjuvant radiation therapy is increasing in breast cancer patients. This study aimed to analyze the aesthetic outcome and changes in flap volume in patients with breast cancer undergoing radiation therapy of the surgical site after immediate autologous tissue reconstruction. Methods Immediate abdominal free flap breast reconstruction following unilateral mastectomy was performed in 42 patients; 21 patients received adjuvant radiation (study group) and 21 patients did not (control group). To compare flap volume, three-dimensional computed tomography (CT) was performed before and after radiation. Also, aesthetic analysis was performed in both groups to evaluate shape changes. Results There was a 12.3% flap volume reduction after the completion of radiation in the experimental group that was significantly greater than the 2.6% volume reduction observed in the non-radiation group (P

Studies focusing on the originating patterns of the deep inferior epigastric artery (DIEA) have not been conducted. Here, we analyzed the vascular anatomy of the DIEA with computed tomographic angiography (CTA) to provide assistance during proximal pedicle dissection of a DIEA-based flap. We conducted a retrospective study on patients who had undergone breast reconstruction with the transverse rectus abdominis musculocutaneous flap and the deep inferior epigastric perforator flap from March 2006 to October 2016. Preoperative three-dimensional computed tomographic angiograms of the abdominal wall (hemi-abdominal walls) were employed in this study, and three independent surgeons reviewed all CTA images. The originating angles and the distance from the originating point to the DIEA turning point were analyzed. Moreover, we assessed the relationship between the measured values and patients’ characteristics, such as abdominal surgery history. CTA data of 184 patients and 368 hemiabdomens were reviewed and analyzed. Most of the DIEAs originated from the external iliac artery in the medial direction, proceeded caudally, and curved in a cephalic direction. The average descending length was 11.29 mm. As the DIEA origin angle decreased (toward the caudal direction), the distance of the initial descent increased (r = 0.382, p

BACKGROUND: Schizophrenia subtypes were discarded because of their clinical insignificance. Correspondingly, DSM-5 presented a dimensional approach to rating severity for the core symptoms of psychosis, which consists of 8 items. The purpose of this study is to investigate the structure categorizing the items of dimensional assessment through factor analysis in patients with early psychosis and its usefulness for predicting the clinical course. METHODS: The subjects were 498 patients with early psychosis who were enrolled in the Korean Early Psychosis Cohort Study. They were between ≥18 years and ≤45 years of age who fulfill the criteria of DSM-5 for first episode schizophrenia and other psychotic disorders. The proportion of males was 41.9% and their mean age and age at onset were 28.7(SD=8.9) and 26.8(SD=9.1) years, respectively. An exploratory factor analysis(EFA) was conducted on the 8 items of dimensional assessment of psychosis in DSM-5 with principle components extracted by the varimax method. Also, we grouped the patients according to the factors listed in the factor structure and compared the data of baseline and 3-year longitudinal follow-up by the groups. RESULTS: Two factors were identified which were labeled as ‘psychotic’ and ‘deficit’ domain. The first factor included delusions, hallucinations, disorganization and abnormal psychomotor behavior. The second factor included negative symptoms and impaired cognition. Depression and mania were excluded in factor analysis due to the lack of communality. In deficit dominant group, the patients were younger in age, longer in duration of DUP, younger in onset and had higher rate of comorbidity and higher non-urban residential rate. The baseline severity represented by PANSS total score and CGI-S was higher in the psychotic dominant group, but the difference began to disappear from two months later. However, in the deficit-dominant group, the PANSS negative scale, deficit scale, and CGI-I remain constantly poorer for three years. DISCUSSION: The factor analysis demonstrates a factor structure of dimensional assessment of psychosis in DSM-5, which were labeled ‘psychotic’, and ‘deficit’ domain, respectively. It is meaningful that it is the first study to analyze patients with early psychosis. In addition, grasping the dominance according to the structure can also be helpful in predicting the clinical course of the patients.

Acute transverse myelitis (ATM) is a heterogeneous syndrome characterized by acute spinal cord dysfunction resulting in paresis and sensory and autonomic impairment below the level of the lesion. The etiology of ATM includes parainfectious, paraneoplastic, drug-induced, systemic autoimmune disorders, and acquired demyelinating diseases. ATM is very rare in patients with rheumatoid arthritis (RA). A 79-year-old woman with RA, a recurring peptic ulcer, and congestive heart failure presented with acute weakness of both upper and lower extremities. She was diagnosed with ATM based on the results of laboratory and radiological tests. ATM is usually treated with high-dose glucocorticoid. However, we treated her with intravenous immunoglobulin (IVIG) considering the adverse events of high-dose glucocorticoid, and she improved. We report a case of ATM in a patient with RA successfully treated with IVIG. (Korean J Med 2015;89:604-608)

Background We conducted this clinical study to compare the efficacy and safety between Neuramis Deep and Restylane in the correction of nasolabial folds. Methods In this phase III, randomized, multi-center, double-masked, matched-pairs, active-controlled trial (ClinicalTrials.gov Identifier: NCT01585220), we evaluated a total of 67 subjects (n=67). All the subjects underwent Neuramis Deep treatment on one side and Restylane on the contralateral side of the bilateral nasolabial folds at a ratio of 1:1. To compare the efficacy of Neuramis Deep and Restylane, we evaluated the Wrinkle Severity Rating Scale scores and those of the Global Aesthetic Improvement Scale. In addition, we compared the safety of Neuramis Deep and Restylane based on adverse events, physical examination, and clinical laboratory tests. Results Neuramis Deep was not inferior in improving the nasolabial folds as compared with Restylane. In addition, there was no significant difference in the efficacy between Neuramis Deep and Restylane. There were no significant differences in safety parameters between Neuramis Deep and Restylane. Conclusions In conclusion, our results indicate that Neuramis Deep may be a safe, effective material for improving the nasolabial folds. However, further studies are warranted to compare the tolerability of Neuramis Deep and Restylane based on histopathologic findings.

SummaryVelocardiofacial syndrome (VCFS) is associated with velopharyngeal insufficiency, which occurs in approximately 75% of VCFS patients. Surgical management of velopharyngeal insufficiency in VCFS patients is difficult with a high revision rate due to the anatomic and physiological abnormalities of the velopharynx. The aims of this study were to evaluate the thickness and symmetry of the levator veli palatini (LVP) muscle using magnetic resonance imaging (MRI), and to compare the findings in VCFS patients to those in patients with nonsyndromic submucous cleft palate.We conducted a prospective analysis of 17 VCFS patients (nine boys, eight girls; age range, 4–9 years) and nine patients with submucous cleft palate without VCFS (eight boys, one girl; age range, 4–13 years) who had undergone MRI between March 2009 and August 2013. The thickness of the LVP muscle was measured at six locations in both groups. The symmetry was determined by comparing the values between the average of the left three points and the right three points.The mean LVP muscle thickness was significantly thinner in VCFS patients (2.14 ± 0.73 mm) than in patients without VCFS (3.70 ± 1.08 mm) (p

Turnip (Brassica rapa L.) root ethanol extract (TRE) was prepared, and its chemical constituents were characterized by ultra-performance liquid chromatography and mass spectrometry. Thirteen glucosinolates (GSLs) were identified, comprising eight aliphatic, four indolic, and one aromatic compounds. The effects of these GSLs on bone formation were investigated in vitro by incubating human osteoblast-like MG-63 cells with TRE and then analyzing their viability, alkaline phosphatase (ALP) activity, collagen content, and mineralization and in vivo by administering TRE orally to normal young rats (500 mg/kg/day) and assessing subsequent changes in serum osteocalcin and bone microstructure in these animals. No TRE-related toxicity was found, and the levels of cell viability, ALP activity, collagen synthesis, and mineralization were significantly increased relative to the negative control. In particular, stimulatory effects on the differentiation of MG-63 cells were strongly enhanced as compared with a positive control (daidzein). Serum osteocalcin was also significantly increased, and some important bone microstructural parameters were improved in TRE-administered rats compared with their saline-administered counterparts. GSLs therefore appear to have a stimulatory effect on bone formation in both MG-63 cells and normal young rats. This is the first report on the usefulness of turnip root and its GSL compounds for bone formation. Copyright © 2015 John Wiley & Sons, Ltd.

We investigated the antiwrinkle effects of cultured human fibroblasts and adipose-derived stem cells (ADSCs) and the mechanisms underlying the reduction of wrinkles in photoaged skin. The fibroblasts and ADSCs were isolated from human tissue and cultured. A total of 28 6-week-old female BALB/c nude mice were classified into four groups, including the normal control group and three groups that were irradiated six times a week for 6-weeks using ultraviolet B radiation to induce photoaged wrinkles. ADSCs were injected into the wrinkles in the skin of the second group and fibroblasts were injected into the wrinkles in the skin of the third group. The fourth group was the irradiated negative control group (no therapy). After 4 weeks of injections, the wrinkles were compared by replica analysis, biopsies were performed, and the dermal thickness and collagen densities were measured. We determined the amounts of type 1 collagen and matrix metalloproteinases (MMPs) 1, 2, 3, 9, and 13 using real-time polymerase chain reaction and Western blot analysis, and we assessed tropoelastin and fibrillin-1 expression in the dermis by immunohistochemistry. Replica analysis showed significant wrinkle reduction in the fibroblast group and the ADSC group. ADSCs stimulated collagen expression and decreased MMP expression. Although fibroblasts stimulated more collagen expression than ADSCs, they also increased MMP expression. Overall, the ADSC group showed higher collagen density and had better outcomes in the tropoelastin and fibrillin-1 assessments. Both cultured fibroblasts and ADSCs could play an important role in wrinkle reduction despite differences in their mechanisms of action.

Various techniques have been reported for correcting inverted nipples; however, problems such as incomplete correction, recurrence, scarring and nerve or duct injury persist. To minimise the recurrence rate and reliably attain a well-projected nipple, we developed a technique involving a single suture that runs through both the periphery and the core of the nipple. After the dissection and release of fibrotic connective tissue, an absorbable monofilament suture was passed through the periphery and core to leave double tracks of the suture at all locations, creating the final shape of a cross inside a circle (resembling the sun-cross symbol). Finally, the suture was tied in a purse-string manner to push the nipple outward. We performed this surgery on 34 congenital cases, comprising 29 patients with bilateral inverted nipples, 5 patients with a unilateral inverted nipple and 12 patients with an acquired deformity. During a mean follow-up period of 22.4 months, all of the corrected nipples remained everted without reinvagination. We successfully corrected inverted nipples with the double-track sun-cross running suture technique, which provided long-lasting eversion and created an aesthetically pleasing nipple contour.

Superficial temporal artery pseudoaneurysm is rare and usually caused by trauma. Pseudoaneurysms have been reported to occur most frequently from 2 to 6 weeks after trauma and they range from 1 to 3 cm in diameter. The authors present a case of a patient with an atypical delayed rapid growing pseudoaneurysm, who had undergone neurosurgery after head trauma 20 years ago.A 72-year-old woman underwent craniotomy and extradural hemorrhage removal through a left temporoparietal incision caused by head trauma after a traffic accident 20 years prior. The mass of less than 1 cm in diameter was incidentally found by magnetic resonance imaging 8 years ago. However, the patient had no symptoms and the pseudoaneurysm was not considered a significant finding. Several weeks ago, the patient recognized a palpable mass by chance. She observed it without any medical evaluation and treatment. However, the size of the mass suddenly increased without the patient undergoing trauma. It presented as a soft, pulsating round mass of about 3 cm in diameter. Under general anesthesia, the mass was removed without problems. It was a round-shaped mass of 2.2 cm × 2.4 cm in diameter. The transverse cross-section evidenced it was filled with blood clots. The biopsy revealed a dilated vascular wall with an organized thrombus and neovascularization, which are characteristic for a thrombosed pseudoaneurysm.Thus, given that a pseudoaneurysm can grow at any time, medical doctors should strongly consider surgical removal as opposed to simple observation.

The Rejuran® is a new filler product made from purified polynucleotides. Here we present data from an animal study and a clinical trial to examine the durability, efficacy and safety of the Rejuran® on crow's feet. For the animal study, 25 mice were divided into three groups: Group 1 received phosphate buffered saline (PBS); Group 2 were treated with Yvoire®; and Group 3 were treated with Rejuran®. The durability and efficacy of each treatment were assessed by microscopy and staining. In the clinical trial, 72 patients were randomized to receive Rejuran® treatment for crow's feet on one side and Yvoire-Hydro® on the contralateral side, at a ratio of 1:1. Repeated treatments were performed every two weeks for a total of three times, over a total of 12 weeks' observation. All injections and observations of efficacy and safety were performed by the same two investigators. In the animal study, the Rejuran® group showed similar durability and inflammatory response to the Yvoire® group. Upon efficacy assessment, the Rejuran® group showed the greatest elasticity and collagen composition, and a significant difference in skin surface roughness and wrinkle depth. In the clinical trial, the primary and secondary objective efficacy outcome measure showed no statistical significance between the two groups, and in safety outcomes there were no unexpected adverse effects. Our data suggest that the Rejuran®, as a new regenerative filler, can be useful to reduce wrinkles, by showing evidence for its efficacy and safety. Graphical Abstract

Purpose The purpose of this study was to investigate the long-term clinical course of normotensive preperimetric glaucoma (PPG). Methods The medical records of 71 eyes of 71 patients with normotensive PPG who underwent intraocular pressure (IOP)-lowering therapy were reviewed retrospectively. The patients had been regularly followed up at 3- to 6-month intervals between 1996 and 2011. Progression was evaluated by comparing the structural changes of serial stereoscopic colour disc and red-free retinal nerve fibre layer (RNFL) photographs and by comparing serial visual field (VF) test results for functional changes. Results Over an average follow-up period of 6.8 years, 41 eyes (57.7%) showed progression in either structural or functional evaluation. Disc haemorrhage (DH) was observed significantly more frequently in the progressing group (p

BackgroundThe aim of this study was to determine the efficacy of lateral intercostal artery perforator-based adipofascial free flaps for facial reconstruction in patients with facial soft tissue deficiency. MethodsWe conducted a retrospective study of five consecutive patients diagnosed with facial soft tissue deficiency who underwent operations between July 2006 and November 2011. Flap design included the area containing the perforators. A linear incision was made along the rib, which had the main intercostal pedicle. First, we dissected below Scarpa's fascia as the dorsal limit of the flap. Then, the adipofascial flap was elevated from the medial to the lateral side, including the perforator that pierces the serratus anterior muscle after emerging from the lateral intercostal artery. After confirming the location of the perforator, pedicle dissection was performed dorsally. ResultsDominant perforators were located on the sixth to eighth intercostal space, and more than four perforators were found in fresh-cadaver angiography. In the clinical case series, the seventh or eighth intercostal artery perforators were used for the free flaps. The mean diameter of the pedicle artery was 1.36 mm, and the mean pedicle length was 61.4 mm. There was one case of partial fat necrosis. No severe complications occurred. ConclusionsThis is the first study of facial contour reconstruction using lateral intercostal artery perforator-based adipofascial free flaps. The use of this type of flap was effective and can be considered a good alternative for restoring facial symmetry in patients with severe facial soft tissue deficiency.

The purpose of this study is to examine the psychological states and the stress levels of the Korean mothers who have cleft lip and palate child patients. The authors explored whether psychological assessments of the mothers with child patients could play a role in screening for psychiatric counseling. Thirty-six mothers of child patients admitted to receive cleft lip and palate surgery at Seoul National University Children's Hospital were recruited as subjects of this study. The 3 questionnaires included in the study were the Beck Depression Inventory, Beck Anxiety Inventory, and Parenting Stress Inventory. We compared these results with those of general population according to the domestic studies. The statistical significances of these results were analyzed using Mann-Whitney method. The average score from the Beck Depression Inventory was 8.89 with standard deviation of 6.08. The average score from the Beck Anxiety Inventory was 9.69 with standard deviation of 6.89. In the Parenting Stress Inventory, the average score was 55.06 and standard deviation was 16.45. However, there were no statistically significant differences between mothers whose children have underwent surgery versus no surgery and mothers whose children had visible versus invisible anomalies. The reliable psychological analysis of depression, anxiety, and stress levels of the mothers of child patients allowed the authors to assess the psychological states of the mothers of child patients. Such assessment can play a vital role in the screening of candidates who need psychiatric treatment or consultation.

Soft-tissue deficiency is a critical issue in facial cosmetic and reconstructive surgery. Harvesting autografts from other anatomical sites has been a common practice in overcoming soft-tissue insufficiency for many years. However, donor-site complications and visible scars are of important concerns. Therefore, we would like to introduce an alternative donor site of free-tissue grafts and its inherent advantages: the retroauricular mastoid area located along the mastoid hair line. From August 1991 to June 2011, we performed facial reconstructive surgeries for cosmetic correction of disfigurements from both congenital and complications of previous cosmetic procedures on a total of 213 patients. These patients had undergone either 1 or more facial cosmetic surgeries in the past. In this study, our primary goal focused on revising facial asymmetries or defects from previous surgical scars, tissue contraction, undercorrection, or underdevelopment. For autograft harvesting, we incised an elliptical shape along the retroauricular hairline. We then harvested sufficient amount of skin, dermal fat, fascia, or a piece of the mastoid bone if needed. After harvesting, we closed the incisional area and covered it with a compressive dressing. In evaluation of our results, we compared the preoperative photographs with postoperative and constructed a survey on patient satisfaction. Overall, the patients in this study were greatly satisfied with their surgical results. No major complications were reported. As a result of our long-term study, we believe that the retroauricular mastoid area has been shown to be an indispensable donor site for a variety of autograft tissues in terms of safety, convenience, and versatility of its unique structural composition consisting of skin, dermal fat, fascia, and bone.

The aim of this study was to report the treatment results and complications of cranial bone reconstruction in patients with craniosynostosis at the Seoul National University Children's Hospital over the 14-year period from 1996 to 2009. A retrospective study was undertaken on 96 cases of 94 consecutive patients diagnosed with craniosynostosis, operated on between 1996 and 2009. The authors collected the data regarding age at surgery, operative time, duration of hospitalization, and follow-up period. Surgical results including the amount of blood loss, signs related to increased intracranial pressure, aesthetic results, cranial index, and complications were evaluated. The authors compared these results with those of the past 10-year period from 1986 to 1995 at the same hospital. There were 81 patients with single synostosis and 13 patients with multiple synostoses. The age of patients ranged from 3 months to 130 months (mean, 27.9 months). The mean operative time was 7.54 ± 1.77 hours. The duration of hospital stay ranged from 5 to 70 days with a mean period of 8.97 days. The intraoperative loss of hemoglobin ranged from 0 to 9.2 g/dL (mean, 2.35 g/dL). The symptoms of increased intracranial pressure were improved after cranioplasty. With regard to aesthetic results, 94 patients were classified into category I and 2 into category IV. The cranial index decreased from 88.0% ± 1.2% to 86.9% ± 1.1% on average. There were 34 minor complications in 28 operations (29.2%). There were statistically significant differences in age at surgery, operative time, duration of hospital stay, and reoperation rate between the recent 14-year study and the past 10-year study. We observed good surgical results and low complications of cranial bone reconstruction in patients with craniosynostosis. The results of the recent 14-year operations were better than those of the past 10-year operations.

The kissing nevus is a rare form of congenital melanocytic nevus. We present a case of a 4-year-girl with kissing nevus on the right eyelids. As a treatment, we used a tissue expander. In the first operation, The 16 cc sized rectangular-shape tissue expander was inserted within the subcutaneous layer at the right zygomatic area. After expansion for 5 months, local advancement flap was performed for lower eyelid reconstruction, and interpolation flap was carried for the upper eyelid. The remnant interpolation flap was removed and trimmed after 3 weeks. We report here a rare case of the kissing nevus on the eyelids that showed good results after reconstruction using a tissue expander.