A common goal in reconstructing the umbilicus is to achieve an aesthetically pleasing result. This single-subject study demonstrates the outcome of managing an umbilical keloid scar using a single excisional line. A patient presented with a large, oval keloid scar at the center of his abdomen. The scar, measuring 4×3 cm in diameter, was deformed to the extent that it completely obscured the umbilicus. The patient frequently experienced intermittent inflammation at the site of the scar. We planned a triangular incision around the keloid. The umbilical keloid was excised and reconstructed using a flap anchored along the lower edge of the triangle. The triangular flap was elevated and the deep dermis of its cephalic portion was attached to the linea alba. The remainder of the flap was sutured at the center to create a conical shape. Eleven months post-procedure, the umbilicus maintained an aesthetically pleasing appearance with proper depth, superior hooding, and a concave shape without protrusion. An advantage of this straightforward surgical method is that it allows for simultaneous resection and reconstruction without the need for additional flap design. This method is expected to be a useful option for reconstructing umbilical keloids the size of a fully developed umbilicus.

Purpose: This study aimed to compare tumor tissue DNA (ttDNA) and circulating tumor DNA (ctDNA) to explore the clinical applicability of ctDNA and to better understand clonal evolution in patients with metastatic colorectal cancer undergoing palliative first-line systemic therapy. Materials and Methods: We performed targeted sequencing analysis of 88 cancer-associated genes using germline DNA, ctDNA at baseline (baseline-ctDNA), and ctDNA at progressive disease (PD-ctDNA). The results were compared with ttDNA data. Results: Among 208 consecutively enrolled patients, we selected 84 (41 males; median age, 59 years; range, 35 to 90 years) with all four sample types available. A total of 202 driver mutations were found in 34 genes. ttDNA exhibited the highest mutation frequency (n=232), followed by baseline-ctDNA (n=155) and PD-ctDNA (n=117). Sequencing ctDNA alongside ttDNA revealed additional mutations in 40 patients (47.6%). PD-ctDNA detected 13 novel mutations in 10 patients (11.9%) compared to ttDNA and baseline-ctDNA. Notably, seven mutations in five patients (6.0%) were missense or nonsense mutations in APC, TP53, SMAD4, and CDH1 genes. In baseline-ctDNA, higher maximal variant allele frequency (VAF) values (p=0.010) and higher VAF values of APC (p=0.012), TP53 (p=0.012), and KRAS (p=0.005) mutations were significantly associated with worse overall survival. Conclusion While ttDNA remains more sensitive than ctDNA, our ctDNA platform demonstrated validity and potential value when ttDNA was unavailable. Post-treatment analysis of PD-ctDNA unveiled new pathogenic mutations, signifying cancer’s clonal evolution. Additionally, baseline-ctDNA’s VAF values were prognostic after treatment.

Korean ginseng (Panax ginseng C. A. Meyer) is one of the most popular medicinal herbs in the world. This plant is known to have many health benefits and contain a wide variety of bioactive components. However, the knowledge on its lipid compound is still far from being fully explored. Although glycosyl inositol phosphoceramides (GIPCs) are the main sphingolipids in plant tissues, GIPCs of P. ginseng are unknown. The present study employed nanoESI-MS n , which generated characteristic fragmentation pattern that were used for the structural identification of P. ginseng GIPCs. In addition to detecting a typical mass fragmentation pattern for GIPC in positive ion mode, novel fragmentation correlating with cleavage of the last carbohydrate and fatty acyl chain of the ceramide moiety was identified. In total, 42 GIPC species were detected in P. ginseng. The major P. ginseng GIPC structure was hexose (R 1 )-hexuronic acid-inositol phosphoceramide, with three types of R 1 (amine, N-acetylamine, or hydroxyl). The most intense peak was found at m/z 1136.3 ([M+H] + ion), corresponding to a GIPC (d18:0/h16:0, R 1 = OH). Only three GIPC subtypes showed significantly different levels in five- and six-year-old P. ginseng tap roots.

The circadian rhythm for mood (CRM) is a digital therapeutic, which aims to prevent mood episode and improve clinical course in patients with major mood disorders. Developed on the circadian rhythm hypothesis of mood disorder, CRM predicts the impending risk of mood episode with its built-in algorithm, utilizing wearable devices data and daily self-reports, and provides personalized feedback. In a pilot study of the CRM, the users experienced less frequent and shorter duration of mood episodes than the non-users. To investigate the efficacy of the upgraded CRM, a double-blind, randomized, sham-controlled, parallel-group trial is designed. Patients aged between 19 and 70, diagnosed with bipolar I disorder, bipolar II disorder, or major depressive disorder, in a euthymic state for more than two months, can participate. During this 12-month trial, participants are assessed for episode recurrence every three months, and the efficacy of the CRM as a potential digital therapeutic is evaluated. Trial registration: ClinicalTrials.gov Identifier: NCT05400785.

Purpose: Firefighting duties range from field roles such as suppression, rescue, and emergency medical services (EMS) to various administrative tasks. Despite these differences, they face uniform fitness standards in Korea. This study seeks to define distinct fitness needs for each duty and provide data for customized standards. Methods: One hundred seventy-six Korean male firefighters participated, categorized into suppression (n=76), rescue (n=22), administrative (n=27), and EMS (n=51) roles. All underwent maximal oxygen consumption (VO2 max) tests for aerobic capacity, with body composition measured using bioelectrical impedance and height recorded with a stadiometer. Results: The VO2 max (mL/kg/min) among Korean male firefighters varied across different job duties: suppression (39.96±5.84), rescue (44.84±4.85), administration (40.27±7.01), and EMS (40.51±6.75). Rescue had the highest VO2 max, which was significantly higher (p=0.013). The body mass index (BMI, kg/m2 ) values were as follows: suppression (25.07±2.55), rescue (24.95±1.71), EMS (24.33±3.21), and administration (25.10±2.48). There was no statistically significant difference in BMI values (p=0.464). Conclusion This study evaluated the VO2 max and BMI of South Korean male firefighters according to their job duties. It found that 54.5% did not meet the recommended VO2 max standard of 42 mL/kg/min for their activities, and 77.5% had a BMI indicating overweight or higher. However, it is important to note that not every firefighting duty requires high fitness levels. The key is ensuring firefighters possess the fitness necessary for their specific roles to maintain safety and efficiency. The study aims to provide data for creating fitness management guidelines tailored to the diverse duties of firefighters.

Purpose: Elderly people are particularly susceptible to burn injuries due to physiological and anatomical aging processes. As the elderly population is expected to grow, the number of burn injuries among this group is also likely to increase. Researchers and health professionals must analyze the causes of geriatric burn injuries, establish targeted preventive policies, and provide education on strategies to minimize burns. Methods: To understand the epidemiological causes of burns in the elderly, we retrospectively reviewed the medical records of patients admitted to our burn center in Korea between January 2019 and December 2021. Of 1,082 patients admitted with burn injuries, 323 (29.9%) were aged 65 years or older and were included in further examination. Results: The elderly patients included more women (64.1%) than men (35.9%), and the causes of burns differed according to gender. Flame burns were more common among men than women, and only men experienced electrical burns. Most older people live alone (54%); accordingly, the most common place of injury for these patients was home (77%), followed by the workplace (14%), with the causes of burns differing between those locations. Sixteen patients (4.9%) started medical treatment at least 2 weeks post-injury, while 29 patients (8.9%) began burn treatment after 1 month. Scalding (55.4%) was the most common cause of burn injury. Most injuries were deep second-(35%) or third-(39%) degree burns, and the most common treatment method was surgery (64.7%). The most frequently affected areas were the legs (24%) and feet (23%). Conclusion Through this analysis of the clinical profile of burns in the elderly, we endeavored to help establish suitable preventive policies.

Purpose: The hand and forearm are the common points of contact and entry for electrical burns. Wounds from electrical burns can range from small to large and superficial to deep. High-voltage electrical burns result in skin and/or soft-tissue defects owing to progressive necrosis caused by intravascular thrombosis, causing complications in the coverage of electrical burns.Various coverage methods have been used for electrical burns on the hands and forearms. Methods: Between 2017 and 2022, 61 patients were admitted for electrical burn treatment on the forearm and hand in our department; and 41 underwent coverage surgery. The range of motion was evaluated when feasible pre-and post-operatively. Results: Among the 41 patients who underwent coverage surgery, 16 and 25 suffered deep second-and third-degree burns, respectively. Wounds of the remaining 20 healed with wound dressings as they were superficial or small. Patients with deep second-degree burns required various procedures, including full-thickness skin graft (FTSG), advanced local flap, split-thickness skin graft (STSG), and STSG with acellular dermal matrix (ADM). Procedures for patients with third-degree burns include an advanced local flap, STSG with ADM, FTSG, and other flap surgeries. All the wounds healed without major complications. Conclusion We successfully treated 41 burn wounds using different wound coverage methods, such as STSG or STSG with ADM for deep second-degree burns and flap surgery for third-degree burns. Moreover, in third-degree burns, STSG with ADM could substitute for flap surgery if flap surgery is not performed.

Lifestyle is a critical aspect of diabetes management. We aimed to define a healthy lifestyle using objectively measured parameters obtained from a wearable activity tracker (Fitbit) in patients with type 2 diabetes. This prospective observational study included 24 patients (mean age, 46.8 years) with type 2 diabetes. Expectation–maximization clustering analysis produced two groups: A (n=9) and B (n=15). Group A had a higher daily step count, lower resting heart rate, longer sleep duration, and lower mean time differences in going to sleep and waking up than group B. A Shapley additive explanation summary analysis indicated that sleep-related factors were key elements for clustering. The mean hemoglobin A1c level was 0.3 percentage points lower at the end of follow-up in group A than in group B. Factors related to regular sleep patterns could be possible determinants of lifestyle clustering in patients with type 2 diabetes.

A debridement method that causes minimal damage to normal tissue during the removal of necrotic tissue is important for chronic wound healing. A new instrument based on low-frequency ultrasound, the Misonix SonicOne O.R. System ® (Bioventus, Farmingdale, NY, USA), creates 22.5 kHz ultrasound waves that cause cavitation or oscillating micro-gas bubbles to debride unhealthy tissue. The device was used for debridement on nine patients with chronic wounds of varying etiology: two patients with decubitus ulcers, one patient with a crush injury, and seven patients with burns. The eschar and unhealthy granulation tissue were removed effectively with no damage to normal skin and soft tissue. No bleeding complications occurred and postoperative analgesics were not required. Compared to surgical debridement, the low-frequency ultrasound device was effective, easy and safe to use, and caused less pain and bleeding. It can be recommended as a treatment method for chronic wounds, comparable to surgical wound debridement.

Deep electrical burn on the hand and forearm causes ischemic tissue damage due to increased compartment pressure by tight eschars. Early detection of ischemia and prompt release of eschars are necessary for prevention of ischemic tissue damage. Early escharotomy is a useful decompressive therapy for prevention of ischemia of the distal upper extremity.