[Background] Over the last thirty years, majority of researches on clinical effectiveness of acupuncture have been explanatory (or experimental) randomized controlled trial. The benefits of acupuncture in clinical trials are stillcontroversial and most studies concluded that further control studies were required. Standardized combinations of acupuncture points for all the experimental subjects in various past studies have been criticized because such treatments do not reflect current routine clinical treatment.
[Objective] This paper aims to review pragmatic clinical trials on the effect of acupuncture treatment and to develop the ideal clinical research methodology of acupuncture study.
[Method] Clinical studies of acupuncture relevant with pragmatic or individualized trials were searched mainly in Pubmed and Science direct databases. All articles were fully reviewed by researchers, and data were evaluated by usage of a standardized form.
[Results & Suggestion] Pragmatic acupuncture researches were tried for various symptoms (eg. low back pain, hypertension, depression during pregnancy, sleep quality in HIV disease, chronic poststroke leg spasticity, headache, etc). Individualized acupuncture treatments based on oriental disease pattern diagnosis reflexes practical treatments which is more effective than unified and fixed acupuncture treatments without any theoretical basis of oriental medical philosophy.
[Conclusion] To overcome the controversies and limitations of past explanatory acupuncture trials, more individualized and tailored acupuncture trials with the theoretical basis of oriental medical diagnosis is highly recommended. Also clear definition and categorization of pattern identification should be established for further active clinical researches and applications of acupuncture.

Charcot-Marie-Tooth disease (CMT) is the most common inherited motor and sensory neuropathy. Previous studies have found that, according to CMT patients, neuropathic pain is an occasional symptom of CMT. However, neuropathic pain is not considered to be a significant symptom associated with CMT and, as a result, no studies have investigated the pathophysiology underlying neuropathic pain in this disorder. Thus, the first animal model of neuropathic pain was developed by our laboratory using an adenovirus vector system to study neuropathic pain in CMT. To this end, glycyl-tRNA synthetase (GARS) fusion proteins with a FLAG-tag (wild type [WT], L129P and G240R mutants) were expressed in spinal cord and dorsal root ganglion (DRG) neurons using adenovirus vectors. It is known that GARS mutants induce GARS axonopathies, including CMT type 2D (CMT2D) and distal spinal muscular atrophy type V (dSMA-V). Additionally, the morphological phenotypes of neuropathic pain in this animal model of GARS-induced pain were assessed using several possible markers of pain (Iba1, pERK1/2) or a marker of injured neurons (ATF3). These results suggest that this animal model of CMT using an adenovirus may provide information regarding CMT as well as a useful strategy for the treatment of neuropathic pain.
Animals ; Charcot-Marie-Tooth Disease/*diagnosis/*physiopathology ; *Disease Models, Animal ; Glycine-tRNA Ligase/*genetics/metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Transgenic ; Mutagenesis, Site-Directed ; Mutation/genetics ; Neuralgia/*diagnosis/*physiopathology

Charcot-Marie-Tooth disease (CMT) is the most common inherited motor and sensory neuropathy. Previous studies have found that, according to CMT patients, neuropathic pain is an occasional symptom of CMT. However, neuropathic pain is not considered to be a significant symptom associated with CMT and, as a result, no studies have investigated the pathophysiology underlying neuropathic pain in this disorder. Thus, the first animal model of neuropathic pain was developed by our laboratory using an adenovirus vector system to study neuropathic pain in CMT. To this end, glycyl-tRNA synthetase (GARS) fusion proteins with a FLAG-tag (wild type [WT], L129P and G240R mutants) were expressed in spinal cord and dorsal root ganglion (DRG) neurons using adenovirus vectors. It is known that GARS mutants induce GARS axonopathies, including CMT type 2D (CMT2D) and distal spinal muscular atrophy type V (dSMA-V). Additionally, the morphological phenotypes of neuropathic pain in this animal model of GARS-induced pain were assessed using several possible markers of pain (Iba1, pERK1/2) or a marker of injured neurons (ATF3). These results suggest that this animal model of CMT using an adenovirus may provide information regarding CMT as well as a useful strategy for the treatment of neuropathic pain.
Animals ; Charcot-Marie-Tooth Disease/*diagnosis/*physiopathology ; *Disease Models, Animal ; Glycine-tRNA Ligase/*genetics/metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Transgenic ; Mutagenesis, Site-Directed ; Mutation/genetics ; Neuralgia/*diagnosis/*physiopathology

Hashimoto's encephalopathy is a steroid responsive relapsing disorder associated with high titers of thyroid-related autoantibodies that presents with subacute progressive dementia and myoclonus. Although most patients reported have been either euthyroid or hypothyroid at the time of presentation, we present a patient with Hashimoto's encephalopathy with thyrotoxicosis that was successfully managed with steroids and antihyperthyroid therapy. We recommend that encephalopathy presented in patients with hyperthyroidism should be tested with thyroid-related autoantibodies and managed with steroid and antihyperthyroid therapy.
Autoantibodies ; Dementia ; Humans ; Hyperthyroidism ; Myoclonus ; Steroids ; Thyrotoxicosis

Pyogenic granuloma is a benign vascular tumor related to trauma, infection, or hormonal changes. When it affects the oral cavity, the most frequent site is the gingiva and involvement of the tongue is very rare. Occurrence of pyogenic granuloma on the fissured tongue has not been reported yet. We present a rare case of pyogenic granuloma on the tongue in a 64 year old female patient in which the fissured tongue seemed to play important roles in the pathogenesis of occurrence of the pyogenic granuloma.
Female ; Gingiva ; Granuloma, Pyogenic* ; Humans ; Middle Aged ; Mouth ; Tongue ; Tongue, Fissured*

No abstract available.
Adult* ; Humans ; Neck*

No abstract available.

No abstract available.
Anesthesia, Local* ; Arthroscopy* ; Knee*

Background: To date, the clinical significance of visually equivocal amyloid positron emission tomography (PET) has not been well established. Objective: We studied the clinical significance of equivocal amyloid PET images from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Methods: Subjects with F-18 florbetapir PET scans at baseline who were followed up for 4 years were selected. Clinical characteristics, imaging biomarkers, cognitive function, and rate of conversion to AD were compared in subjects with visually equivocal findings. Results Of 249 subjects who completed the follow-up, 153 (61.4%), 20 (8.0%), and 129 (30.5%) were F-18 florbetapir-negative, -equivocal, and -positive, respectively. The mean standardized uptake value ratios (SUVR) of F-18 florbetapir PET were 0.75 ± 0.04, 0.85 ± 0.10, and 1.00 ± 0.09 for each group (p <0.001 between groups), and 15.0%, 70.0%, and 98.7% of patients were quantitatively above the positive threshold. The change in the SUVR of F-18 florbetapir PET was higher in the equivocal (6.09 ± 3.61%, p <0.001) and positive (3.13 ± 4.38%, p <0.001) groups than the negative group (0.88 ± 4.28%). Among the subjects with normal or subjective memory impairment and mild cognitive impairment, 5.3% with negative amyloid PET and 37.5% with positive amyloid PET converted to AD over the 4-year period. None of the equivocal amyloid PET subjects converted to AD during this period.

We report the experiences of pump-driven continuous venovenous hemofiltration therapy in three children with acute renal failure. The all three patients required mechanical ventilation and needed the support of vasopressors. Renal replacement therapy was needed to meet the metabolic and fluid balance, but intermittent hemodialysis and peritoneal dialysis were not feasible because of hemodynamic instability and concurrent infection. We instituted pump-driven continuous venovenous hemofiltration(CVVH), and immediate improvement of pulmonary edema and successful removal of retained fluid were observed. Urea clearance also was satisfactory. During the filter running time, significant thromboembolic event or rapid drop of systemic blood pressure were absent. We concluded that the CVVH is an effective and safe method of renal support for critically ill pediatric patient.
Acute Kidney Injury ; Blood Pressure ; Child ; Critical Illness ; Hemodynamics ; Hemofiltration* ; Humans ; Peritoneal Dialysis ; Pulmonary Edema ; Renal Dialysis ; Renal Replacement Therapy ; Respiration, Artificial ; Running ; Urea ; Water-Electrolyte Balance