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

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

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.

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

BACKGROUND AND PURPOSE: The use of decompressive hemicraniectomy (DHC) for the treatment of malignant cerebral edema can decrease mortality rates. However, this benefit is not sufficient to justify its use in elderly patients. We investigated the effects of therapeutic hypothermia (TH) on safety, feasibility, and functional outcomes in elderly patients with malignant middle cerebral artery (MCA) infarcts. METHODS: Elderly patients 60 years of age and older with infarcts affecting more than two-thirds of the MCA territory were included. Patients who could not receive DHC were treated with TH. Hypothermia was started within 72 hours of symptom onset and was maintained for a minimum of 72 hours with a target temperature of 33°C. Modified Rankin Scale (mRS) scores at 3 months following treatment and complications of TH were used as functional outcomes. RESULTS: Eleven patients with a median age of 76 years and a median National Institutes of Health Stroke Scale score of 18 were treated with TH. The median time from symptom onset to initiation of TH was 30.3±23.0 hours and TH was maintained for a median of 76.7±57.1 hours. Shivering (100%) and electrolyte imbalance (82%) were frequent complications. Two patients died (18%). The mean mRS score 3 months following treatment was 4.9±0.8. CONCLUSIONS: Our results suggest that extended use of hypothermia is safe and feasible for elderly patients with large hemispheric infarctions. Hypothermia may be considered as a therapeutic alternative to DHC in elderly individuals. Further studies are required to validate our findings.
Aged* ; Brain Edema* ; Cerebral Infarction ; Humans ; Hypothermia* ; Hypothermia, Induced ; Infarction ; Middle Cerebral Artery ; Mortality ; National Institutes of Health (U.S.) ; Shivering ; Stroke

BACKGROUND/OBJECTIVES: To encourage healthier food choices for children in fast-food restaurants, many initiatives have been proposed. This study aimed to examine the effect of disclosing nutritional information on parents' meal choices for their children at fast-food restaurants in South Korea. SUBJECTS/METHODS: An online experimental survey using a menu board was conducted with 242 parents of children aged 2-12 years who dined with them at fast-food restaurants at least once a month. Participants were classified into two groups: the low-calorie group (n = 41) who chose at least one of the lowest calorie meals in each menu category, and the high-calorie group (n = 201) who did not. The attributes including perceived empowerment, use of provided nutritional information, and perceived difficulties were compared between the two groups. RESULTS: The low-calorie group perceived significantly higher empowerment with the nutritional information provided than did the high-calorie group (P = 0.020). Additionally, the low-calorie group was more interested in nutrition labeling (P < 0.001) and considered the nutritional value of menus when selecting restaurants for their children more than did the high-calorie group (P = 0.017). The low-calorie group used the nutritional information provided when choosing meals for their children significantly more than did the high-calorie group (P < 0.001), but the high-calorie group had greater difficulty using the nutritional information provided (P = 0.012). CONCLUSIONS: The results suggest that improving the empowerment of parents using nutritional information could be a strategy for promoting healthier parental food choices for their children at fast-food restaurants.
Child* ; Food Labeling ; Humans ; Korea ; Meals* ; Nutritive Value ; Parents ; Power (Psychology) ; Restaurants*

The methylglyoxal (MGO) trapping constituents from onion (Allium cepa L.) peels were investigated using pre-column incubation of MGO and crude extract followed by HPLC analysis. The peak areas of MGO trapping compounds decreased, and their chemical structures were identified by HPLC-ESI/MS. Among major constituents in outer scale of onion, 2-(3,4-dihydroxybenzoyl)-2,4,6-trihydroxy-3(2H)-benzofuranone (2) was more effective MGO scavenger than quercetin (6) and its 4′-glucoside, spiraeoside (3). After 1 h incubation, compound 2 trapped over 90% MGO at a concentration of 0.5 mM under physiological conditions, but compounds 3 and 6 scavenged 45%, 16% MGO, respectively. HPLC-ESI/MS showed that compound 2 trapped two molecules of MGO to form a di-MGO adduct and compounds 3 and 6 captured one molecule of MGO to form mono-MGO adducts, and the positions 6 and 8 of the A ring of flavonoids were major active sites for trapping MGO.
Catalytic Domain ; Chromatography, High Pressure Liquid ; Flavonoids ; Methods* ; Onions* ; Pyruvaldehyde* ; Quercetin