PURPOSE: The purpose was to evaluate fragment reduction feasilibty when applying extension block Kirschner-wire technique for bony mallet finger. METHODS: We treated 48 displaced mallet finger fractures by a two extension block Kirschner-wire technique. Among these operation group, we found dorsal rotation of fragment in 18 cases, making it difficult to get anatomical reduction. The patients were divided into two groups. One group of 30 patients did not show dorsal rotation of fragment and anatomical reduction was achieved easily. Another group of 18 patients showed dorsal rotation of fragment and additional methods was applied to achieve anatomical reduction. RESULTS: Joint surface involvement was significant greater in groups showing dorsal rotation of fragment than group which did not show (57.1% and 49.7%, respectively) (p=0.01). The groups whose joint surface involvement more than 50% had higher risk of dorsal rotation of fragment than the group less than 50%, with the odds ratio of 6.11. CONCLUSION: We could encounter the cases which showed dorsal rotation of the fracture fragment when treating the bony mallet finger with extension block K-wire technique especially the joint surface involvement was more than 50%. So if we can evaluate the extents of joint surface involvement and prepare additional method preoperatively when dorsal rotation of fragment is expected, it is possible to get more favorable results.
Fingers* ; Humans ; Joints ; Methods ; Odds Ratio

PURPOSE: Ibuprofen and indomethacin has been used in treatment of patent ductus arteriosus (PDA) in Korea. But, there were few reports about oral ibuprofen for the treatment of PDA. We aimed to evaluate the efficacy and safety of oral ibuprofen versus intravenous indomethacin for the treatment of PDA in very low birth weight (VLBW) infants. METHODS: A retrospective study of VLBW infants treated with oral ibuprofen or intravenous indomethacin for symptomatic PDA at Inje University Sanggye Paik Hospital between February 2002 and April 2012 was performed. RESULTS: We identified 43 infants that received oral ibuprofen and 9 infants that received intravenous indomethacin. There were no significant differences in the efficacy and safety between oral ibuprofen group and intravenous indomethacin group. There was no significant difference between the use of oral ibuprofen before 48 hours after birth and after 48 hours the efficacy and safety. CONCLUSION: In our study, oral ibuprofen appears to be as effective as intravenous indomethacin for the treatment of PDA in VLBW infants with similar complication rates.
Ductus Arteriosus, Patent ; Humans ; Ibuprofen ; Indomethacin ; Infant ; Infant, Very Low Birth Weight ; Korea ; Parturition ; Retrospective Studies

PURPOSE: To investigate the efficacy and safety of 0.4 mg of tamsulosin in patients with nocturia not responding to 0.2 mg.METHODS: Patients with intractable nocturia after treatment with 0.2 mg of tamsulosin for>1 month were included in a multicenter, prospective, observational, single-arm study. Patients were prescribed 0.4 mg of tamsulosin and followed up for 2 months to assess nocturnal voiding and nocturia-related bother. Changes in the mean number of nocturnal voids, the proportion of 50% responders, 3-day frequency-volume chart parameters, and questionnaire scores were assessed.RESULTS: Sixty-two patients were prescribed 0.2 mg of tamsulosin, of whom 56 were prescribed 0.4 mg of tamsulosin. Ten patients dropped out. A single case of orthostatic hypotension was reported. The mean age was 68 years. After 1 and 2 months of taking 0.4 mg of tamsulosin, 23.9% and 22.7% of patients demonstrated a>50% reduction of nocturia, and 16.1% and 19.4% of patients rated the treatment as “very effective,” respectively. Dose escalation to 0.4 mg of tamsulosin, compared to 0.2 mg, did not show an additional effect on reducing nocturnal urine volume. Multivariate logistic regression analysis showed that lower serum sodium levels (odds ratio [OR], 0.41, P=0.037) and the presence of urge incontinence (OR, 7.08, P=0.036) were predictors of a significant improvement of nocturia in response to 0.4 mg of tamsulosin.CONCLUSIONS: Dose escalation may yield a significant improvement of nocturia in>20% of patients, and may be especially helpful in patients with lower sodium levels and urge incontinence.
Adrenergic alpha-Antagonists ; Humans ; Hypotension, Orthostatic ; Logistic Models ; Male ; Nocturia ; Prospective Studies ; Sodium ; Urinary Incontinence, Urge

Objectives: Since protecting patients’ privacy is a major concern in clinical research, there has been a growing need for privacy-preserving data analysis platforms. For this purpose, a federated learning (FL) method based on the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) was implemented, and its feasibility was demonstrated. Methods: We implemented an FL platform on FeederNet, which is a distributed clinical data analysis platform based on the OMOP CDM in Korea. We trained it through an artificial neural network (ANN) using data from patients who received steroid prescriptions or injections, with the aim of predicting the occurrence of side effects depending on the prescribed dose. The ANN was trained using the FL platform with the OMOP CDMs of Kyung Hee University Medical Center (KHMC) and Ajou University Hospital (AUH). Results: The area under the receiver operating characteristic curves (AUROCs) for predicting bone fracture, osteonecrosis, and osteoporosis using only data from each hospital were 0.8426, 0.6920, and 0.7727 for KHMC and 0.7891, 0.7049, and 0.7544 for AUH, respectively. In contrast, when using FL, the corresponding AUROCs were 0.8260, 0.7001, and 0.7928 for KHMC and 0.7912, 0.8076, and 0.7441 for AUH, respectively. In particular, FL led to a 14% improvement in performance for osteonecrosis at AUH. Conclusions FL can be performed with the OMOP CDM, and FL often shows better performance than using only a single institution's data. Therefore, research using OMOP CDM has been expanded from statistical analysis to machine learning so that researchers can conduct more diverse research.

BACKGROUND: Many companies have developed different methods and products for allergen-specific immunoglobulin E (IgE) tests. Because there is no standardised reference method, external quality assessment (EQA) is important for allergen-specific IgE test to ensure the comparability and reliability of the results from different laboratories. We prepared specimens for EQA of allergen-specific IgE tests and evaluated their stability. METHODS: Four pooled sera with 24 selected allergen-specific IgE levels were prepared and stored at −80℃. The stability of allergen-specific IgE levels was assessed on days 1, 7, and 14 at −20℃, 2℃ to 8℃, and 20℃ to 25℃, and then after 3 months at −80℃. Mock proficiency tests were performed with the four sets of prepared external quality controls for six laboratories, using the commercial multiple allergen simultaneous test (MAST) methodology. RESULTS: About 150 specimens (650 µL each) for EQA were prepared; randomly selected specimens showed similar IgE levels for the 24 allergens (±1 class). The levels of allergen-specific IgE remained stable throughout the study period (P>0.05). Although mock survey results from six laboratories using four MAST assays revealed some variability with a difference (2–3 class), no consistent differences were observed through the allergens or MAST methods. Qualitative results from the mock survey showed 85.4% (cut-off of class 1) and 81.3% (cut-off of class 2) concordance with the results from ImmunoCAP (Phadia, Sweden). CONCLUSIONS: The pooled sera prepared for allergen-specific IgE tests might be adequate and useful for EQA.
Allergens ; Immunoglobulin E* ; Immunoglobulins* ; Methods ; Quality Control*

Many individuals with short bowel syndrome (SBS) require long-term parenteral nutrition (PN) to maintain adequate nutritional status. Herein, we report a successful intestinal adaptation of a patient with SBS through 13 times intensive nutritional support team (NST) managements. A thirty-five-year-old woman who could not eat due to intestinal discontinuity visited Seoul National University Hospital for reconstruction of the bowel. She received laparoscopic Roux-en-Y gastric bypass (RYGB) due to morbid obesity in Jan 2013 at a certain hospital and successfully reduced her weight from 110 kg to 68 kg. However, after a delivery of the second baby by cesarean section in Jul 2016, most of small bowel was herniated through Peterson’s defect, and emergent massive small bowel resection was performed. Thereafter, she visited our hospital for the purpose of intestinal reconstruction. In Sep 2016, she received side–to-side gastrogastrostomy and revision of double barrel enterostomy. The remaining small bowel included whole duodenum, 30 cm of proximal jejunum, and 10 cm of terminal ileum. Pylorus and ileocecal valves were intact. The patient given only PN after surgery was provided rice-based soft fluid diet after 10 day of operation. Through intensive nutritional management care, she could start solid meals, and finally stop the PN and eat only orally at 45 days postoperatively. Three nutritional interventions were conducted over 2 months after the patient was discharged. She did not require PN during this period, and maintained her weight within the normal weight range. Similar interventions could be used for other patients with malabsorption problems similar to SBS.
Bariatric Surgery* ; Cesarean Section ; Diet ; Duodenum ; Enterostomy ; Female ; Gastric Bypass ; Humans ; Ileocecal Valve ; Ileum ; Jejunum ; Meals ; Nutritional Status ; Nutritional Support ; Obesity, Morbid ; Parenteral Nutrition ; Pregnancy ; Pylorus ; Seoul ; Short Bowel Syndrome*

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is a positive-sense singlestranded RNA (+ssRNA) that causes coronavirus disease 2019 (COVID-19). The viral genome encodes twelve genes for viral replication and infection. The third open reading frame is the spike (S) gene that encodes for the spike glycoprotein interacting with specific cell surface receptor – angiotensin converting enzyme 2 (ACE2) – on the host cell membrane. Most recent studies identified a single point mutation in S gene. A single point mutation in S gene leading to an amino acid substitution at codon 614 from an aspartic acid 614 into glycine (D614G) resulted in greater infectivity compared to the wild type SARS-CoV2. We were interested in investigating the mutation region of S gene of SARS-CoV2 from Korean COVID-19 patients. New mutation sites were found in the critical receptor binding domain (RBD) of S gene, which is adjacent to the aforementioned D614G mutation residue. This specific sequence data demonstrated the active progression of SARS-CoV2 by mutations in the RBD of S gene.The sequence information of new mutations is critical to the development of recombinant SARS-CoV2 spike antigens, which may be required to improve and advance the strategy against a wide range of possible SARS-CoV2 mutations.