The number of hemodialysis patients and dialysis facilities is increasing each year, but there are no surveillance programs validating that the services and equipment of each hemodialysis unit meet specified safety and quality standards. There is a concern that excessive competition and illegal activities committed by some dialysis facilities may violate patients' right to health. Contrastingly, developed countries often have their own survey program to provide initial certification and monitoring to ensure that these clinics continue to meet basic requirements. Because hemodialysis units provide renal replacement therapy to critical patients suffering from severe chronic renal failure, appropriate legal regulation is important for the provision of initial certification and maintenance of facility, equipment, and human resource quality. Therefore, several standards providing minimum requirements for the area of hemodialysis unit, equipment for emergency care, physician and nurse staffs, water purification and quality management are urgently needed.
Ambulatory Care Facilities/*standards ; Health Manpower ; Humans ; Renal Dialysis/*standards ; Republic of Korea

Freiberg's disease is a osteochondrosis of a metatarsal head that is recognized as primarily a disorder of the second metatarsal. It is seen more often in girls. Pain and limitation of motion of the affected joint is the predominant clincal feature. The radiographic appearance demonstrates from osteosclerosis in the early stage to osteolysis with collapse in the later stage. Conservative therapy may take the form of rest, a stiff shoe, and even a cast support to decrease the stress across the joint. Surgical intervention may also be of benefit. Surgery have been attempted either to modify the diseae process or to salvage the situation once the metatarsophalangeal joint develops degenerative changes. Metatarsophalangeal joint instability is common cause of forefoot pain that can develop in association with a traumatic episode and inflamatory tissue disorders as well as neighboring toe deformities. The second ray is by far the most frequently involved. The diagnosis can be made by clinical observation and physical examination including drawer test. Many surgical procedures have beem recommended when conservative treatment has failed. Procedures described range from soft tissue releases and tendon trasfer to the direct plantar plate repair combined with a Weil osteotomy.
Congenital Abnormalities ; Head ; Joints ; Metatarsal Bones ; Metatarsophalangeal Joint ; Metatarsus ; Osteochondritis ; Osteochondrosis ; Osteolysis ; Osteosclerosis ; Osteotomy ; Physical Examination ; Shoes ; Tendons ; Toes

Patients receiving hemodialysis have various complications with a high mortality rate and require specialized treatment at an institution equipped with an appropriate workforce, equipment, and facilities. The Korean Society of Nephrology (KSN) is conducting hemodialysis unit accreditation to manage the quality of hemodialysis institutions, present standard treatment guidelines, and establish a network between regional medical institutions for the safe treatment of hemodialysis patients. This study aimed to summarize the previous accreditation results and discuss future directions. Methods: After the proposal of hemodialysis unit accreditation in 2009, pilot projects were undertaken for hemodialysis units and dialysis subspecialist training hospitals in the metropolitan area for 5 years. Since 2016, five hemodialysis unit accreditation projects have been conducted. Results: The cumulative number of participating units was 599, and the number of accredited units was 473 (average accreditation rate, 79.0%). The participating units consisted of clinics (58.6%), non-university hospitals (28.2%), and university hospitals (13.2%). Overall, 92.4% of university hospitals, 81.2% of clinics, and 68.0% of non-university hospitals were accredited. Over 5 years, new units were added annually to apply for accreditation, and the rate of previous participants applying for reaccreditation was high (77.7%). However, considering that the total number of member institutions of the KSN is 637, the number of units with valid accreditation as of 2020 was low (267 [41.9%]). Conclusion: The efforts of the KSN and its members, as well as institutional support from the government, are required for quality management of hemodialysis units through hemodialysis unit accreditation.

PURPOSE: This study was designed to evaluate the clinical efficacy of temporary K-wire fixation in F-plate fixation for displaced intraarticular calcaneal fractures. MATERIALS AND METHODS: Two groups (group 1 with F-plate fixation only and group 2 with temporary K-wire fixation and F-plate fixation) of patients were included in this study. The temporary K-wire was removed six weeks after the operation. Each group consisted of 33 cases. Rotational axis angles were measured radiographically and the foot and ankle outcome score (FAOS) was used for clinical assessment. RESULTS: In group 1, the mean rotational axis angle was reduced from 27degrees preoperatively to 5.59degrees postoperatively and the angle at last follow-up was 9.94degrees. There was an increase in angle of 4.35degrees between postoperative and the last follow-up measurement. In group 2, the mean rotational axis angle was reduced from 21.2degrees preoperatively to 4.39degrees postoperatively and the angle at last follow-up was 5.91degrees. There was an increase in angle of 1.52degrees between postoperative and the last follow-up measurement. Significant difference in the changes of rotational axis angle was observed between the two groups. However, no significant difference in FAOS was observed between the two groups. CONCLUSION: Temporary K-wire fixation can prevent reduction loss when treating displaced intra-articular calcaneal fractures with an F-plate.
Ankle ; Axis, Cervical Vertebra ; Calcaneus ; Follow-Up Studies ; Foot ; Humans ; Intra-Articular Fractures

Artemisia capillaris Thunb. (Compositae) is a native herb of East Asian countries and has used for the treatment of jaundice, high liver fever, and digestive diseases for a long time, as well as being developed as the source of herbal preparations until now. The major components from A. capillaris were chlorogenic acid (1) and its derivatives substituted with caffeoyl moieties, such as 3,5-dicaffeoylquinic acid (2) and 4,5-dicaffeoylquinic acid (3), and coumarins, such as scoparone. In the study, four compounds, chlorogenic acid, 3,5-dicaffeoylquinic acid, 4,5-dicaffeoylquinic acid and scoparone (4) in the 70% ethanolic extract of A. capillaris were simultaneously determined by using HPLC-UVD system. This method was validated with the terms of linearity, precious and accuracy according to ICH guidelines. The developed method was successfully applied for the quantitative analysis of Artemisia genus, A. capillaris, A. iwayomogi, A. princeps, and A. argyi, distributed in Korea.
Artemisia ; Asian Continental Ancestry Group ; Chlorogenic Acid ; Coumarins ; Ethanol ; Fever ; Humans ; Jaundice ; Korea ; Liver ; Methods ; Plant Preparations

Objective: Among veterans, the prevalence of rapid eye movement sleep behavior disorder (RBD) is higher than among the general population, and some evidence suggests that this is related to post-traumatic stress disorder (PTSD). The purpose of this study was to determine whether the frequency of RBD differs depending on the presence of PTSD or trauma. Methods: Patients who underwent nocturnal polysomnography (PSG) and sleep-related questionnaire surveys at the Veteran Health Service Medical Center were reviewed retrospectively. Based on patients with PTSD (n=20; 100% male; 67.9±8.5 years of age), we matched patients exposed to trauma without PTSD (n23; 100% male; age 64.0±13.4) and patients without trauma (n=21; 100% male; age 59.86±10.9). Results: PTSD patients reported dream enactment behavior more than the trauma-exposed group without PTSD or the control group (p=0.006). After adjusting for age, there were more RBD patients in the PTSD group than in the trauma exposed group (p=0.049). Conclusion The results showed that RBD occurred significantly more in veterans with PTSD than those exposed to trauma, which suggests that there may be a pathophysiological association between PTSD and RBD.

Purpose: Medial soft tissue release in knee varus deformities during total knee arthroplasty (TKA) is necessary for adequate gap balancing.This study compared the clinical outcomes and complications of subperiosteal elevation (SE) and multiple needle puncturing (MNP) for superficial medial collateral ligament (sMCL) release and evaluated the effectiveness and safety of MNP. Materials and Methods: This study retrospectively analyzed 152 patients who underwent both TKA and sMCL release for degenerative osteoarthritis with varus alignment; one knee from each patient underwent SE and the other underwent MNP between April 2018 and April 2020. In SE, subperiosteal release was performed on the proximal tibia of the anterior portion of the sMCL using a curved osteotome. For MNP, an 18-gauge needle was used to puncture the sMCL. The clinical outcomes, including knee further flexion (FF), flexion contracture (FC), range of motion (ROM) and Knee Society (KS) scores, were compared. Surgical complications, including sMCL overrelease, were also evaluated. Results: For the SE and MNP groups, the preoperative KS scores (31.05 vs. 31.78), knee alignment (varus angle, 4.22° vs. 3.76°), FF (125.86° vs. 126.48°), FC (6.09° vs. 5.69°) and ROM (119.77° vs. 120.79°) did not differ preoperatively. At one-year follow-up, postoperative KS scores, FF, FC and ROM were similar in the two groups (93.01 vs. 92.64 points; 134.24° vs. 134.64°; 0.36° vs. 0.49°; 133.88° vs. 134.14°;p=0.662, 0.749, 0.493 and 0.835 respectively), and no statistically significant differences in terms of postoperative pain and KS pain score were observed between the two groups (66 vs. 58 patients and 43.31 vs. 43.04 points; p=0.473 and 0.745, respectively). In the SE group, five cases showed intraoperative over-release of the sMCL and a significant difference from the MNP group (p=0.024) but showed no medial instability at the final follow-up. Conclusion Compared with the SE technique, MNP showed no significant difference in the clinical outcomes and fewer complications, such as over-release of the sMCL, and could be a safer alternative to achieve a balanced TKA.

Purpose: Medial soft tissue release in knee varus deformities during total knee arthroplasty (TKA) is necessary for adequate gap balancing.This study compared the clinical outcomes and complications of subperiosteal elevation (SE) and multiple needle puncturing (MNP) for superficial medial collateral ligament (sMCL) release and evaluated the effectiveness and safety of MNP. Materials and Methods: This study retrospectively analyzed 152 patients who underwent both TKA and sMCL release for degenerative osteoarthritis with varus alignment; one knee from each patient underwent SE and the other underwent MNP between April 2018 and April 2020. In SE, subperiosteal release was performed on the proximal tibia of the anterior portion of the sMCL using a curved osteotome. For MNP, an 18-gauge needle was used to puncture the sMCL. The clinical outcomes, including knee further flexion (FF), flexion contracture (FC), range of motion (ROM) and Knee Society (KS) scores, were compared. Surgical complications, including sMCL overrelease, were also evaluated. Results: For the SE and MNP groups, the preoperative KS scores (31.05 vs. 31.78), knee alignment (varus angle, 4.22° vs. 3.76°), FF (125.86° vs. 126.48°), FC (6.09° vs. 5.69°) and ROM (119.77° vs. 120.79°) did not differ preoperatively. At one-year follow-up, postoperative KS scores, FF, FC and ROM were similar in the two groups (93.01 vs. 92.64 points; 134.24° vs. 134.64°; 0.36° vs. 0.49°; 133.88° vs. 134.14°;p=0.662, 0.749, 0.493 and 0.835 respectively), and no statistically significant differences in terms of postoperative pain and KS pain score were observed between the two groups (66 vs. 58 patients and 43.31 vs. 43.04 points; p=0.473 and 0.745, respectively). In the SE group, five cases showed intraoperative over-release of the sMCL and a significant difference from the MNP group (p=0.024) but showed no medial instability at the final follow-up. Conclusion Compared with the SE technique, MNP showed no significant difference in the clinical outcomes and fewer complications, such as over-release of the sMCL, and could be a safer alternative to achieve a balanced TKA.

Purpose: Medial soft tissue release in knee varus deformities during total knee arthroplasty (TKA) is necessary for adequate gap balancing.This study compared the clinical outcomes and complications of subperiosteal elevation (SE) and multiple needle puncturing (MNP) for superficial medial collateral ligament (sMCL) release and evaluated the effectiveness and safety of MNP. Materials and Methods: This study retrospectively analyzed 152 patients who underwent both TKA and sMCL release for degenerative osteoarthritis with varus alignment; one knee from each patient underwent SE and the other underwent MNP between April 2018 and April 2020. In SE, subperiosteal release was performed on the proximal tibia of the anterior portion of the sMCL using a curved osteotome. For MNP, an 18-gauge needle was used to puncture the sMCL. The clinical outcomes, including knee further flexion (FF), flexion contracture (FC), range of motion (ROM) and Knee Society (KS) scores, were compared. Surgical complications, including sMCL overrelease, were also evaluated. Results: For the SE and MNP groups, the preoperative KS scores (31.05 vs. 31.78), knee alignment (varus angle, 4.22° vs. 3.76°), FF (125.86° vs. 126.48°), FC (6.09° vs. 5.69°) and ROM (119.77° vs. 120.79°) did not differ preoperatively. At one-year follow-up, postoperative KS scores, FF, FC and ROM were similar in the two groups (93.01 vs. 92.64 points; 134.24° vs. 134.64°; 0.36° vs. 0.49°; 133.88° vs. 134.14°;p=0.662, 0.749, 0.493 and 0.835 respectively), and no statistically significant differences in terms of postoperative pain and KS pain score were observed between the two groups (66 vs. 58 patients and 43.31 vs. 43.04 points; p=0.473 and 0.745, respectively). In the SE group, five cases showed intraoperative over-release of the sMCL and a significant difference from the MNP group (p=0.024) but showed no medial instability at the final follow-up. Conclusion Compared with the SE technique, MNP showed no significant difference in the clinical outcomes and fewer complications, such as over-release of the sMCL, and could be a safer alternative to achieve a balanced TKA.

BACKGROUND:The present study was designed to determine factors related to baseline peritoneal small solute transport rate (PSTR) from incident Korean peritoneal dialysis (PD) patients using modified peritoneal equilibration test (PET). METHODS:Incident PD patients whose duration of PD is between 4 weeks and 6 months were enrolled from four major university hospitals in Seoul. Modified PET with 3.86% glucose solution and adequacy test were performed. RESULT: 1) Our PET result from incident Korean PD patients showed results similar to that from the Caucacian patients. 2) The patients were divided into four groups based on the PSTR:serum albumin at time of PET, dip dialysate/plasma sodium, dialysate/plasma albumin ratio and peritoneal albumin excretion were significantly different among the four transport types (p<0.05). 3) D/PAlb was significantly higher in the high transport group than in the low transport. Serum albumin concentration before the onset of PD was not different among the four groups but was significantly different at the time of PET. 4) There was no difference of D/PCr4 between the diabetic (0.72+/-0.10) and the non-diabetic (0.72+/-0.11) groups. 5) PSTR in incidental PD patients was correlated with D/PAlb and dip D/P(Na). CONCLUSION:Our PET results from incidental Korean PD patients turned out to be showed results similar to those from Caucacian patients. There were no differences in age, BSA, BMI, nutrition index, CRP, residual renal function among four transport types in incidental PD patients. PSTR in incidental PD patients was correlated with D/PAlb and dip D/P(Na).
Glucose* ; Hospitals, University ; Humans ; Nutrition Assessment ; Peritoneal Dialysis* ; Seoul ; Serum Albumin ; Sodium