This column is a roundtable discussion featuring three U40 members who have been extensively involved in the organization and planning of hands-on training, along with Mr. Park, the CEO of EBM Corporation. The four participants discuss hands-on training in the field of cardiovascular surgery. Drawing on their experiences with programs such as the Cardiovascular Surgery Summer School, Basic Lecture Course (BLC), Online BLC, Advanced Lecture Course (ALC), and the coronary anastomosis competition “Challengers' Live Demonstrations,” they explore the essence of hands-on training, current challenges, and future prospects in this field.

[Background] Moxibustion has contributed to better health outcomes of the Japanese people. But only a small number of reports are available regarding the current practice of moxibustion in recent years. We therefore surveyed moxibustion practitioners.[Methods] Through academic societies, professional organizations, and other associations related to the disciplines of acupuncture and moxibustion, practitioners were asked to respond to the questionnaire via Google Forms. [Results] Valid responses were obtained from 1,507 practitioners with the following demographics: 67.8% had been engaged in clinical practice for less than 20 years; 71.9% ran their own clinics; 43.6% belonged to academic societies; 69.3% belonged to industrial organizations, etc. The proportion of practitioners conducting various methods of moxibustion were as follows: 66.3% warming moxibustion and 53.4% for heating-through moxibustion, and regarding processed moxibustion, 79.5% included moxibustion with tube and 37.0% used smokeless moxibustion. Regarding the effectiveness of moxibustion, 98.9% responded as "highly effective" or "moderately effective." The proportion of respondents who experienced "patient's refusal of moxibustion" was 45.6% before patients experienced moxibustion and 33.2% after their experience. The patients refused it primarily because of "heat," "burns," and "uncomfortableness with smoke." Regarding the activities necessary to promote the spread of self-care moxibustion, "proving effectiveness through clinical research" (75.6%), "providing scientific evidence through basic research" (68.3%), and "awareness-building activities" (63.9%) were indicated among 1,495 respondents.[Discussion] The survey revealed that, due to the shift in societal awareness, there is also a shift in the use of moxibustion from direct moxibustion to more indirect moxibustion. Many clinical practitioners of moxibustion conducted the therapy because they considered it effective. The survey reconfirmed that heat, burns, and smoke represent major reasons why patients do not want to receive the moxibustion therapy. The challenging issues to be addressed for the purpose of spreading and developing moxibustion include maintenance of "safety," research to prove "clinical efficacy" and provide "scientific evidence," and "awareness-building activities."

Background: Infantile hemangioma (IH) is a common benign vascular tumor that occurs during infancy. Oral propranolol is used as a first-line treatment. However, standardized guidelines for evaluating treatment efficacy, particularly the appropriate timing and parameters for Doppler ultrasound (US), have not been established. This study reports on the evaluation of therapeutic efficacy of oral propranolol solution in IH patients using Doppler US, and aims to propose the appropriate timing and parameters for using Doppler US based on this experience. Methods: A retrospective analysis was conducted on 120 patients with IH who were treated with oral propranolol solution and maintained for over 6 months from May 2017 to April 2023. Doppler US evaluation of IH was performed at diagnosis, 1-2 and 6-12 months after treatment initiation, and 6 months post-therapy cessation. A complete response (CR) was identified as a reduction in vascularity along with a decrease in longest diameter (LD) or thickness of 50% or more. Recurrence was evaluated based on increased vascularity or size 6 months after treatment discontinuation. Results: Of 120 patients with IH, 82 females and 38 males were analyzed. IH was first detected at a median age of 12 days (range, 1-240 days), and treatment began at 76 days (range, 27-570 days), continuing for an average of 10.4 months (range, 5-24 months). Initial Doppler US measurements showed an LD of 2.65±1.52 cm and a thickness of 0.79±0.55 cm, with prominent vascularity. After 1-2 months of treatment, LD and thickness decreased by 12.9% and 25.9%, respectively. By 6-12 months, reductions reached 37.2% and 53.6%. CR occurred in 77 patients (64.2%) after 6-12 months of treatment. Eleven patients (9.2%) experienced a recurrence. Conclusion Doppler US is a valuable modality for evaluating the characteristics, treatment response, and recurrence of IH treated with oral propranolol.

Objective: Several studies have reported the therapeutic effects of phytoncides on various mental disorders. However, little is known about the therapeutic effects of phytoncides on mild cognitive impairment (MCI), a prodromal stage of dementia. In this pilot study, we aimed to clarify the effect of inhaled phytoncides on the cognitive function of patients clinically diagnosed with MCI. Methods: In total, 21 patients with MCI were randomly assigned to either a saline (no-odor) or phytoncide group and subsequently inhaled saline or phytoncide for 30 minutes indoors, respectively. To evaluate changes in cognitive function, we implemented functional near-infrared spectroscopy along with the Stroop task and compared task performance and hemodynamic responses in the dorsolateral/ventrolateral part of the prefrontal cortex (DLPFC/VLPFC) before and after inhalation. Results: While the saline group showed no significant difference in either task performance (Wilcoxon W = 18.50, p = 0.385) or hemodynamic response, a significant increase in Stroop task performance (Wilcoxon W = 1.50, p = 0.009) and hemodynamic attenuation in the left VLPFC (Wilcoxon W = 56.00, p = 0.042) were found in the phytoncide group after inhalation. Conclusion Since compensatory task-related prefrontal hyperactivation represents one of the neural indicators of cognitive dysfunction in MCI, our findings shed light on the beneficial effects of phytoncide on cognitive function in MCI.

Objective: Recently, various mental health promotion programs using virtual reality (VR) technology have been tried in the psychiatric field. Considering the importance of mental health in pregnant women, VR-assisted mental health promotion programs for pregnant women are needed to be developed. This study aimed to prospectively investigate the efficacy of a VR-assisted mental health promotion program for pregnant women. Methods: Fifty-five pregnant women were participated in this study. Mental health states such as depression, anxiety, perceived stress, and quality of life were assessed by Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Perceived Stress Scale, and World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF) before and after using VR program treatment. Based on the mental health types of pregnant women classified by cluster analysis, the effects of the VR program were analyzed by paired t test and Wilcoxon signed rank test. Results: The VR program significantly reduced PHQ-9 (p = 0.033) and GAD-7 (p = 0.046) scores, and significantly increased WHOQOL-BREF (p = 0.026) score of the participants. Additionally, when classifying the mental health types of pregnant women, the VR program was significantly effective to improve depression, anxiety, and quality of life in the most severe group based on the cluster analysis. Conclusion The results of this study suggest that VR program may be effective to improve the mental health of pregnant women. Particularly, VR programs for the high-risk group of depression might be the most effective. Therefore, VR-assisted mental health promotion programs could be useful for managing the mental health in pregnant women.

Pancreatic islet transplantation represents the optimal treatment for severe hypoglycemia, a serious complication experienced by patients with long-term type 1 diabetes who are undergoing insulin therapy. However, the limited availability of donor organs restricts its widespread use. Porcine pancreatic islets could offer a viable alternative to address this organ shortage. For successful pancreatic islet xenotransplantation using porcine pancreatic islets, efficacy and safety must first be demonstrated in pig-to-nonhuman primate (NHP) preclinical studies, as outlined in the consensus statement of the International Xenotransplantation Association. Our group has achieved long-term survival of wild-type porcine islet grafts in immunosuppressed NHPs by employing two immunosuppressive protocols: one based on CD40-CD40L blockade and another utilizing clinically available immunosuppressants. A clinical trial for pancreatic islet xenotransplantation, following the latter protocol, has received approval from the Korean Ministry of Food and Drug Safety (MFDS). This review aims to highlight the results of clinical trials involving porcine islet xenotransplantation to date, along with the age-specific and other characteristics of the porcine islets used in these trials and the preclinical NHP studies that support them. It offers insights into the perspectives around the first clinical islet xenotransplantation approved by the Korean MFDS, emphasizing improved long-term graft survival.

Background: Extensive spinal fusion inevitably results in loss of mobility, which may induce stiffness-related disability (SRD) during activities of daily living. Few studies have examined SRD after surgical correction for adolescent idiopathic scoliosis (AIS). This study aimed to investigate SRD following surgical treatment in AIS patients particularly with respect to the lowest instrumented vertebra (LIV). Methods: Patients who underwent surgical correction for AIS between 2014 and 2021 and were followed up for 2 years were included. The degree of SRD was evaluated using the Stiffness-Related Disability Index (SRDI), which consists of 4 categories, each containing 3 questions, giving a total of 12 components of the questionnaire. The SRDI scores were compared according to the LIV level. Correlation analysis was performed to examine the relationship between the SRDI and legacy health-related quality of life (HRQOL) measurements. Results: This study included 174 patients (47 men and 127 women) with a mean age of 13.8 years. Among the 12 items of the SRDI, the scores of 9 items showed a significant increase after surgery. The total sum of the SRDI scores also significantly increased after surgery. Pearson correlation analysis showed that the SRDI scores were significantly correlated with Oswestry disability index, nearly all domains, and the total sum of Scoliosis Research Society-22 questionnaire, and 36-Item Short Form Survey.No differences in the SRDI score were found among cases with the LIV between T12 and L3. However, the SRDI scores of patients with LIV at L4 were significantly higher than those of patients with other LIV levels. Conclusions Various degrees of SRD occurred after spinal fusion for AIS. The SRDI was significantly correlated with the HRQOL measurements. The SRDI score was highest in patients with the LIV at L4 when compared to those with other LIV levels. Fusion can be safely extended to L3 without significantly increasing SRD.

Background: Trapeziectomy with suspension arthroplasty is a reliable treatment for thumb carpometacarpal (CMC) osteoarthritis.We modified the suture suspension technique to add further support to maintain the arthroplasty space by interposition of the dermal allograft. Our aim was to investigate the surgical outcomes of our technique of suspension arthroplasty with dermal allograft interposition (SADI) compared with those of traditional ligament reconstruction with tendon interposition (LRTI) using a half-sling of the flexor carpi radialis (FCR) tendon. Methods: This retrospective study enrolled 26 patients (29 thumbs) with thumb CMC arthritis who underwent trapeziectomy with traditional LRTI using the FCR tendon (15 thumbs; LRTI group) or SADI (14 thumbs; SADI group) between January 2017 and May 2022. Patient-reported outcomes (visual analog scale; the Disabilities of the Arm, Shoulder and Hand score; and patient-rated wrist evaluation), grip strength, and scaphometacarpal distance were measured at baseline and 3 and 12 months postoperatively. The operation time was checked by reviewing medical records. All measurements were compared between the 2 groups. Results: Between baseline and 12-month postoperative follow-up, all patient-reported outcomes significantly improved in both groups. Patient-reported outcomes, grip strength, and scaphometacarpal distance showed no differences between the 2 groups at all follow-up assessments, except for the scaphometacarpal distance being significantly greater in the SADI group at 3 months postoperatively. The operation time was significantly shorter in the SADI group. No complication was observed in either group. Conclusions Our modified suture suspension arthroplasty technique using dermal allograft interposition results in markedly shorter surgical times with similar surgical outcomes compared with those of traditional LRTI using the FCR tendon. This procedure appears to be an effective alternative treatment for thumb CMC arthritis.

Background: Allograft is predominantly used interbody spacers for anterior cervical discectomy and fusion (ACDF). The corticocancellous allograft has weaker mechanical strength as it is an artificial composite of the cancellous and cortical parts. Additionally, whether utilizing a firmer allograft, such as the cortical ring, leads to better outcomes is unclear. Therefore, we aimed to compare the surgical outcomes of cortical ring and cortico-cancellous allografts in ACDF. Methods: Patients who underwent ACDF using allograft and were followed up for > 1 year were retrospectively reviewed. Patient characteristics, including fusion rates (assessed by interspinous motion [ISM], intra-graft bone bridging, and extra-graft bone bridging), subsidence, allograft complications (e.g., allograft fracture and resorption), and patient-reported outcome measures (neck pain visual analog scale [VAS], arm pain VAS, and neck disability index), were assessed. Patients were divided into 2 groups based on the allograft used: cortical ring and cortico-cancellous allograft groups. Subgroup analysis was subsequently conducted in singleand multi-level operation groups. Results: A total of 227 patients were included. Of them, 134 (59.0%) and 93 (41.0%) underwent ACDF using cortical ring and corticocancellous allograft, respectively. In single-level operations, the cortico-cancellous allograft significantly frequented allograft resorption (24 / 66, 36.4%) than the cortical ring allograft (1 / 28, 3.7%) (p = 0.001). The cortico-cancellous allograft group demonstrated significantly greater subsidence. However, the fusion rates did not significantly differ between the 2 groups. In multi-level operations, the cortico-cancellous allograft (5 / 27, 18.5%) resulted in a significantly higher fracture rate than the cortical ring allograft (5 / 105, 4.7%) (p = 0.030). The fusion rate at 1-year postoperative assessed using ISM (63.2% vs. 55.5%) and intra-graft bone bridging (66.7% vs. 40.7%) was higher in the cortical ring group; however, the difference was not significant. The patient-reported outcomes at 1-year postoperative did not demonstrate significant intergroup differences both in single- and multi-level operations. Conclusions Allograft resorption or fracture occurs more frequently with cortico-cancellous than cortical ring allografts. Despite the frequent occurrence of allograft-related complications with cortico-cancellous allografts, the fusion rate was not significantly affected. Due to the higher rate of allograft resorption or fractures and greater subsidence with cortico-cancellous allografts, cortical ring allografts might yield more stable results in ACDF.

Background: Long-term use of bisphosphonate is a risk factor for atypical femoral fractures (AFFs). Femoral bowing is known to be associated with AFFs. However, whether femoral bowing quickens the occurrence of AFF is unknown. The purpose of this study was to determine whether AFF occurs earlier in patients with severe femoral bowing than in those without severe bowing. Methods: One hundred and sixty-four patients (186 AFFs) from January 2006 to December 2022 were included in this study.According to severity of femoral bowing, patients were divided into 2 groups: severe bowing group (26 femurs) and minimal to moderate bowing group (160 femurs). Age, sex, and completeness and location of AFF were compared between the 2 groups. We compared the time of AFF occurrence after bisphosphonate therapy using cumulative percentage between the 2 groups. Results: Age and sex were similar between the 2 groups, while body mass index (BMI) was lower (22.5 ± 3.0 kg/m 2 vs. 24.5 ± 3.5 kg/m 2 , p = 0.003) in the severe bowing group. The duration of bisphosphonate use was shorter in the severe bowing group than in the minimal to moderate bowing group (3.3 ± 3.8 years vs. 5.0 ± 4.0 years, p = 0.048). In the severe bowing group, 85% of AFFs were diaphyseal in contrast to the 46% in the minimal to moderate bowing group (p < 0.001). Cumulative percentage plot of AFFs in the severe bowing group was left-shifted compared to the minimal to moderate bowing group. Conclusions At the time of AFF diagnosis, the severe bowing group exhibited shorter duration of bisphosphonate use, lower BMI, and a higher incidence of diaphyseal location. Shortening the duration of bisphosphonate therapy may be advisable in patients with severe femoral bowing.