Purpose: Complex traumatic upper extremity injuries often require microvascular free tissue transfer for adequate soft tissue coverage or functional reconstruction. The need for rapid coverage is acknowledged, but the optimal timing for reconstruction remains a subject of debate. Methods: A retrospective review was conducted of patients who underwent free flap reconstruction for upper extremity injuries after trauma from March 2012 to August 2018 in South Korea at a facility specializing in extremity trauma. Surgical timing was categorized according to the classification of Godina into early (within 72 hours after injury) and delayed (from 72 hours to 3 months after injury) reconstruction. Patients’ demographic characteristics, methods of free tissue transfer, flap failure rates, postoperative infections, total hospital stays, and the number of operations required were analyzed. Results: In total, 80 free tissue transfers were conducted on 76 patients. The demographics and characteristics of patients in the early and delayed reconstruction groups showed no significant differences. Early reconstruction was associated with a significantly lower infection rate, shorter average hospital stay, and a lower average number of operations, without showing a significant difference in the flap failure rate. Conclusion The results of this study indicate that early reconstruction within 72 hours after trauma significantly reduces infection rates, the length of hospital stays, and the number of required operations. This study underscores the importance of timely intervention in upper extremity free flap reconstruction for optimal patient outcomes.

PURPOSE: We present the clinical results and operative method of the immediate eponychium of nail fold set back for lengthening of nails caused by acute fingertip injuries. METHODS: The research was conducted with a total of 172 patients during the period from January 2014 to June 2016. The operation method was performed in a way to fold down the two sides of the nail eponychium and had suture. A survey of the patients' subjective satisfaction was conducted and the relative nail length was compared before and after the operation as well as the nail length of the uninjured contralateral finger. The mean follow-up period was 18.2 weeks. RESULTS: In all cases, the operation time was under 3 minutes. There were no specific complications such as nail eponychium's necrosis or congestion. The new nail did not have any additional deformation. On average, the extended nail length was 3.2 mm. Compared with preoperation, the average extension ratio of the nail length was 48%, even with 75% of nail length recovery in comparison with the uninjured contralateral finger. The subjective self-satisfaction score was 92.5 on average. The satisfaction score was higher for patients who had greater remnant nail length. CONCLUSION: Immediate nail lengthening with the eponychial folding is a simple, safe and useful method with high subjective satisfaction in aesthetics for the patients with acute fingertip injuries.
Esthetics ; Estrogens, Conjugated (USP) ; Fingers* ; Follow-Up Studies ; Humans ; Methods ; Necrosis ; Sutures

The confirmatory diagnosis of Moyamoya disease has been obtained by invasive angiographic examination. We report the results of MRI and transcranial doppler sonography of three cases ol Moyamoya disease, which ws disgnosed by clinical and angiography. We think that the diagnosis of Moyamoya disease can be made by noninvasive MRI and transcranial doppler sonography without conventional invasive angiography.
Angiography ; Diagnosis ; Magnetic Resonance Imaging* ; Moyamoya Disease* ; Ultrasonography, Doppler, Transcranial*

PURPOSE: To evaluate the outcome of ductal carcinoma in situ (DCIS) patients who underwent surgery followed by radiation therapy (RT). MATERIALS AND METHODS: We retrospectively reviewed 106 DCIS patients who underwent surgery followed by postoperative RT between 1994 and 2006. Ninety-four patients underwent breast-conserving surgery, and mastectomy was performed in 12 patients due to extensive DCIS. Postoperative RT was delivered to whole breast with 50.4 Gy/28 fx. Tumor bed boost was offered to 7 patients (6.6%). Patients with hormonal receptor-positive tumors were treated with hormonal therapy. RESULTS: The median follow-up duration was 83.4 months (range, 33.4 to 191.5 months) and the median age was 47.8 years. Ten patients (9.4%) had resection margin <1 mm and high-grade and estrogen receptor-negative tumors were observed in 39 (36.8%) and 20 (18.9%) patients, respectively. The 7-year ipsilateral breast tumor recurrence (IBTR)-free survival rate was 95.3%. Resection margin (<1 or > or =1 mm) was the significant prognostic factor for IBTR in univariate and multivariate analyses (p < 0.001 and p = 0.016, respectively). CONCLUSION: Postoperative RT for DCIS can achieve favorable treatment outcome. Resection margin was the important prognostic factor for IBTR in the DCIS patients who underwent postoperative RT.
Breast ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Estrogens ; Follow-Up Studies ; Humans ; Mastectomy ; Mastectomy, Segmental ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Outcome*

Pattern finding is one of the important tasks in a protein or DNA sequence analysis. Alignment is the widely used technique for finding patterns in sequence analysis. BLAST (Basic Local Alignment Search Tool) is one of the most popularly used tools in bio-informatics to explore available DNA or protein sequence databases. BLAST may generate a huge output for a large sequence data that contains various sequence patterns. However, BLAST does not provide a tool to summarize and analyze the patterns or matched alignments in the BLAST output file. BLAST lacks of general and robust parsing tools to extract the essential information out from its output. This paper presents a pattern summary system which is a powerful and comprehensive tool for discovering pattern structures in huge amount of sequence data in the BLAST. The pattern summary system can identify clusters of patterns, extract the cluster pattern sequences from the subject database of BLAST, and display the clusters graphically to show the distribution of clusters in the subject database.
Computational Biology ; Databases, Protein ; DNA ; Sequence Analysis* ; Sequence Analysis, DNA

PURPOSE: Surgical Treatment of hepatocellular carcinoma in patients with cirrhosis is not clearly defined. The objective of this study was to assess the patient long term survival and determine the prognostic factor. METHODS: 30 patients seen between 1985 and 2001 were identified in a prospective data-base. Data about the race, cause of cirrhosis, pre-transplant treatment, size, macrovascular invasion and long-term outcome were examined. RESULTS: Overall survival rate for 1, 3 and 5 year was 81.4%, 72.3% and 50.9% respectively. races, etiology of cirrhosis, pretransplant treatment, macrovascular invasion did not affect the outcome. Only the size of hepatocellular carcinoma (4 cm) influenced the survival. CONCLUSION: This study showed that overall survival rate of liver transplantation for cirrhosis associated heaptocellular carcinoma is similar to those with cirrhosis alone. Only the size of tumor affected the outcome.
Carcinoma, Hepatocellular* ; Continental Population Groups ; Fibrosis ; Humans ; Liver Transplantation* ; Liver* ; Prospective Studies ; Survival Rate

Seventy-nine patients of bladder neck suspension using an extraperitoneal variation of laparoscopic surgery were performed for the treatment of stress urinary incontinence. Using a balloon dissector the anterior vesical pelvic space is secured. The bladder neck suspension similar to the Burch operation was performed through a laparoscopic procedure. Symptoms of patients were assessed preoperatively and at one and six months following surgery. Operative times and complications were also evaluated. Success rate was 89.8% at six months. Complications such as bladder perforations were observed. Laparoscopic extraperitoneal bladder neck suspension-(LEBNS) is a viable option to the conventional methods of suspension, it has definite cosmetic advantages, is devoid of intraperitoneal dissection and adhesion, and has a comparable success rate.
Adult ; Aged ; Bladder/anatomy & histology/*surgery ; Female ; Human ; Laparoscopy/methods ; Length of Stay ; Middle Age ; Postoperative Complications ; Quality of Life ; Retrospective Studies ; Urinary Incontinence, Stress/*surgery

As in western countries, divorce rates in South Korea have recently been rising, and family disruption has become one of serious social problems. Parents are able to express their opinions and wishes confidently, but the thoughts and wishes of children, especially infants and young children, tend to be ignored. Children can also experience several emotional and behavioral problems during the process of and after their parents’ divorce. When South Korean family courts determine custody arrangements, they typically do not have a systematic strategy and process based on custody evaluation to help children and their parents overcome conflicts and build healthy parent-child relationships after divorce. Furthermore, under the current court system, it is difficult for mental health specialists and child psychiatrists to intervene in familial conflicts as mediators or therapists during the course of divorce proceedings. Acknowledging these limitations, the South Korean family court system implemented a formal program for custody evaluations by child psychiatrists and psychologists in 2017. However, they have faced challenges such as a shortage of experienced specialist and lack of a training system or instruments for evaluation. In this paper, the authors aim to share professional knowledge of and experiences with aspects of the custody evaluation process, such as indications, procedures, methods, psychological tests, resources, and final report writing, to better serve children and their parents undergoing a painful divorce process.

As in western countries, divorce rates in South Korea have recently been rising, and family disruption has become one of serious social problems. Parents are able to express their opinions and wishes confidently, but the thoughts and wishes of children, especially infants and young children, tend to be ignored. Children can also experience several emotional and behavioral problems during the process of and after their parents’ divorce. When South Korean family courts determine custody arrangements, they typically do not have a systematic strategy and process based on custody evaluation to help children and their parents overcome conflicts and build healthy parent-child relationships after divorce. Furthermore, under the current court system, it is difficult for mental health specialists and child psychiatrists to intervene in familial conflicts as mediators or therapists during the course of divorce proceedings. Acknowledging these limitations, the South Korean family court system implemented a formal program for custody evaluations by child psychiatrists and psychologists in 2017. However, they have faced challenges such as a shortage of experienced specialist and lack of a training system or instruments for evaluation. In this paper, the authors aim to share professional knowledge of and experiences with aspects of the custody evaluation process, such as indications, procedures, methods, psychological tests, resources, and final report writing, to better serve children and their parents undergoing a painful divorce process.

The hand coordinate systems for measuring vibration exposures and biodynamic responses have been standardized, but they are not actually used in many studies. This contradicts the purpose of the standardization. The objectives of this study were to identify the major sources of this problem, and to help define or identify better coordinate systems for the standardization. This study systematically reviewed the principles and definition methods, and evaluated typical hand coordinate systems. This study confirms that, as accelerometers remain the major technology for vibration measurement, it is reasonable to standardize two types of coordinate systems: a tool-based basicentric (BC) system and an anatomically based biodynamic (BD) system. However, these coordinate systems are not well defined in the current standard. Definition of the standard BC system is confusing, and it can be interpreted differently; as a result, it has been inconsistently applied in various standards and studies. The standard hand BD system is defined using the orientation of the third metacarpal bone. It is neither convenient nor defined based on important biological or biodynamic features. This explains why it is rarely used in practice. To resolve these inconsistencies and deficiencies, we proposed a revised method for defining the realistic handle BC system and an alternative method for defining the hand BD system. A fingertip-based BD system for measuring the principal grip force is also proposed based on an important feature of the grip force confirmed in this study.
Hand Strength ; Hand* ; Vibration*