Cemented and uncemented fixation are the two categories of fixation in hip arthroplasty (HA). While uncemented stems rely on biologic fixation, cemented HA uses PMMA (polymethylmethacrylate) to lend stability through an interlocking fit between the stem and the cancellous bone. The optimal choice of fixation in elderly patients is debatable. Although patients with poor bone quality have demonstrated good results with uncemented stems, recent improvements in cementing techniques have led to superior outcomes compared to those of older versions. We prefer fully cemented HA in elderly patients to achieve immediate stability that leads to early mobilization and minimal complications, such as intraoperative or postoperative periprosthetic femur fractures. This technical note describes cement fixation in HA.

Background: Primary cutaneous CD30+ lymphoproliferative disorders (pcCD30-LPDs) are a diseases with various clinical and prognostic characteristics. Objective: Increasing our knowledge of the clinical characteristics of pcCD30-LPDs and identifying potential prognostic variables in an Asian population. Methods: Clinicopathological features and survival data of pcCD30-LPD cases obtained from 22 hospitals in South Korea were examined. Results: A total of 413 cases of pcCD30-LPDs (lymphomatoid papulosis [LYP], n=237; primary cutaneous anaplastic large cell lymphoma [C-ALCL], n=176) were included. Ninety percent of LYP patients and roughly 50% of C-ALCL patients presented with multiple skin lesions. Both LYP and C-ALCL affected the lower limbs most frequently. Multiplicity and advanced T stage of LYP lesions were associated with a chronic course longer than 6 months. Clinical morphology with patch lesions and elevated serum lactate dehydrogenase were significantly associated with LPDs during follow-up in LYP patients. Extracutaneous involvement of C-ALCL occurred in 13.2% of patients. Lesions larger than 5 cm and increased serum lactate dehydrogenase were associated with a poor prognosis in C-ALCL. The survival of patients with C-ALCL was unaffected by the anatomical locations of skin lesions or other pathological factors. Conclusion The multiplicity or size of skin lesions was associated with a chronic course of LYP and survival among patients with C-ALCL.

Background/Aims: A poor prognostic factor for Crohn’s disease (CD) includes perianal fistulizing disease, including perianal fistula and/or perianal abscess. Currently, a tool to assess perianal symptoms in patients with CD remains nonexistent. This study aimed to develop a perianal fistulizing disease self-screening questionnaire for patients with CD. Methods: This prospective pilot study was conducted at three tertiary referral centers between January 2019 and May 2020. We formulated questions on perianal symptoms, including tenesmus, anal discharge, bleeding, pain, and heat. A 4-point Likert scale was used to rate each question. Patients with CD completed a questionnaire and underwent pelvic magnetic resonance imaging (MRI). Results: Overall, 93 patients were enrolled, with 51 (54.8%) diagnosed with perianal fistulizing disease, as determined by pelvic MRI. The Spearman correlation findings demonstrated that anal pain (p = 0.450, p < 0.001) and anal discharge (p = 0.556, p < 0.001) were the symptoms that most significantly correlated with perianal disease. For anal pain and discharge, the area under the receiver operating characteristic curve of the scores was significantly higher than that of the combined score for all five symptoms (0.855 vs. 0.794, DeLong’s test p = 0.04). For the two symptoms combined, the sensitivity, specificity, and positive predictive and negative predictive values were 88.2, 73.8, 80.4, and 83.8%, respectively, with 81.7% accuracy for detecting perianal fistulizing disease. Conclusions This study indicates that simple questions regarding anal pain and discharge can help accurately identify the presence of perianal fistulizing disease in patients with CD.

Background: The number of general cosmetic practitioners impersonating dermatologists in Korea has increased, leading to serious harm that is significant enough to attract the attention of health authorities, which dermatologists are deeply concerned about. Objective: We conducted a survey targeting dermatologists to gather their opinions on the behavior, problems, and countermeasures of general cosmetic practitioners disguising themselves as dermatologists. Methods: A total of 280 dermatologists completed the survey between January and February 2024. The questions covered demographic characteristics, experiences of cosmetic general practitioners falsely introduced themselves as dermatologists, complications experienced by patients who received treatment after being mistaken for a dermatologist, the seriousness of the problem for cosmetic general practitioners impersonating dermatologists, and the relationship between the shortage of essential medical personnel and the phenomenon of cosmetic general practitioners disguising themselves as dermatologists. Results: Despite cases in which cosmetic general practitioners impersonate dermatologists, most dermatologists have not responded appropriately in many instances. Dermatologists have reported many cases of complications after receiving dermatological treatment from such cosmetic general practitioners. Most dermatologists are concerned about the serious problems of general cosmetic practitioners, disguising themselves as dermatologists and anticipating many adverse effects. Conclusion We believe that we need to pool our wisdom to solve these problems and expect that this study will provide valuable basic data for solving these problems in the dermatology and medical environments of Korea.

Background: The number of general cosmetic practitioners impersonating dermatologists in Korea has increased, leading to serious harm that is significant enough to attract the attention of health authorities, which dermatologists are deeply concerned about. Objective: We conducted a survey targeting dermatologists to gather their opinions on the behavior, problems, and countermeasures of general cosmetic practitioners disguising themselves as dermatologists. Methods: A total of 280 dermatologists completed the survey between January and February 2024. The questions covered demographic characteristics, experiences of cosmetic general practitioners falsely introduced themselves as dermatologists, complications experienced by patients who received treatment after being mistaken for a dermatologist, the seriousness of the problem for cosmetic general practitioners impersonating dermatologists, and the relationship between the shortage of essential medical personnel and the phenomenon of cosmetic general practitioners disguising themselves as dermatologists. Results: Despite cases in which cosmetic general practitioners impersonate dermatologists, most dermatologists have not responded appropriately in many instances. Dermatologists have reported many cases of complications after receiving dermatological treatment from such cosmetic general practitioners. Most dermatologists are concerned about the serious problems of general cosmetic practitioners, disguising themselves as dermatologists and anticipating many adverse effects. Conclusion We believe that we need to pool our wisdom to solve these problems and expect that this study will provide valuable basic data for solving these problems in the dermatology and medical environments of Korea.

Background: The number of general cosmetic practitioners impersonating dermatologists in Korea has increased, leading to serious harm that is significant enough to attract the attention of health authorities, which dermatologists are deeply concerned about. Objective: We conducted a survey targeting dermatologists to gather their opinions on the behavior, problems, and countermeasures of general cosmetic practitioners disguising themselves as dermatologists. Methods: A total of 280 dermatologists completed the survey between January and February 2024. The questions covered demographic characteristics, experiences of cosmetic general practitioners falsely introduced themselves as dermatologists, complications experienced by patients who received treatment after being mistaken for a dermatologist, the seriousness of the problem for cosmetic general practitioners impersonating dermatologists, and the relationship between the shortage of essential medical personnel and the phenomenon of cosmetic general practitioners disguising themselves as dermatologists. Results: Despite cases in which cosmetic general practitioners impersonate dermatologists, most dermatologists have not responded appropriately in many instances. Dermatologists have reported many cases of complications after receiving dermatological treatment from such cosmetic general practitioners. Most dermatologists are concerned about the serious problems of general cosmetic practitioners, disguising themselves as dermatologists and anticipating many adverse effects. Conclusion We believe that we need to pool our wisdom to solve these problems and expect that this study will provide valuable basic data for solving these problems in the dermatology and medical environments of Korea.

Background: The number of general cosmetic practitioners impersonating dermatologists in Korea has increased, leading to serious harm that is significant enough to attract the attention of health authorities, which dermatologists are deeply concerned about. Objective: We conducted a survey targeting dermatologists to gather their opinions on the behavior, problems, and countermeasures of general cosmetic practitioners disguising themselves as dermatologists. Methods: A total of 280 dermatologists completed the survey between January and February 2024. The questions covered demographic characteristics, experiences of cosmetic general practitioners falsely introduced themselves as dermatologists, complications experienced by patients who received treatment after being mistaken for a dermatologist, the seriousness of the problem for cosmetic general practitioners impersonating dermatologists, and the relationship between the shortage of essential medical personnel and the phenomenon of cosmetic general practitioners disguising themselves as dermatologists. Results: Despite cases in which cosmetic general practitioners impersonate dermatologists, most dermatologists have not responded appropriately in many instances. Dermatologists have reported many cases of complications after receiving dermatological treatment from such cosmetic general practitioners. Most dermatologists are concerned about the serious problems of general cosmetic practitioners, disguising themselves as dermatologists and anticipating many adverse effects. Conclusion We believe that we need to pool our wisdom to solve these problems and expect that this study will provide valuable basic data for solving these problems in the dermatology and medical environments of Korea.

Background: This study investigated a safe and effective bolus dose and lockout time for patient-controlled sedation (PCS) with dexmedetomidine for dental treatments. The depth of sedation, vital signs, and patient satisfaction were investigated to demonstrate safety. Methods: Thirty patients requiring dental scaling were enrolled and randomly divided into three groups based on bolus doses and lockout times: group 1 (low dose group, bolus dose 0.05 µg/kg, 1-minute lockout time), group 2 (middle dose group, 0.1 µg/kg, 1-minute), and group 3 (high dose group, 0.2 µg/kg, 3-minute) (n = 10 each). ECG, pulse, oxygen saturation, blood pressure, end-tidal CO2 , respiratory rate, and bispectral index scores (BIS) were measured and recorded. The study was conducted in two stages: the first involved sedation without dental treatment and the second included sedation with dental scaling. Patients were instructed to press the drug demand button every 10 s, and the process of falling asleep and waking up was repeated 1-5 times.In the second stage, during dental scaling, patients were instructed to press the drug demand button. Loss of responsiveness (LOR) was defined as failure to respond to auditory stimuli six times, determining sleep onset. Patient and dentist satisfaction were assessed before and after experimentation. Results: Thirty patients (22 males) participated in the study. Scaling was performed in 29 patients after excluding one who experienced dizziness during the first stage. The average number of drug administrations until first LOR was significantly lower in group 3 (2.8 times) than groups 1 and 2 (8.0 and 6.5 times, respectively). The time taken to reach the LOR showed no difference between groups. During the second stage, the average time required to reach the LOR during scaling was 583.4 seconds. The effect site concentrations (Ce) was significantly lower in group 1 than groups 2 and 3. In the participant survey on PCS, 8/10 in group 3 reported partial memory loss, whereas 17/20 in groups 1 and 2 recalled the procedure fully or partially. Conclusion PCS with dexmedetomidine can provide a rapid onset of sedation, safe vital sign management, and minimal side effects, thus facilitating smooth dental sedation.

Background: To report the long-term clinical and radiologic results of impaction bone grafting and standard cemented polished stem for femoral revision arthroplasty in patients with extensive bone deficiency. Methods: We retrospectively reviewed 47 hips that underwent femoral revision hip arthroplasty using an impaction-morselized allograft with a standard cemented polished stem. The average age at the time of revision hip arthroplasty was 55 years (range, 39–75 years). The modified Harris hip score (HHS) was used for clinical evaluation. The radiologic evaluation focused on stem subsidence, stem position, progressive radiolucent lines, bone remodeling, and the incorporation of allografts. Results: The modified HHS improved from an average of 55.04 (range, 25–79.5) preoperatively to 90.1 (range, 81–93.2) at the last follow-up. The mean follow-up duration was 13.5 years (10.9–17.8 years). The radiographic analysis revealed stable stems.Femoral stems showed an average subsidence of 3.2 mm (range, 2–8 mm) in the cement mantle. However, there was no mechanical failure or subsidence of the cement mantle in the femurs. The stem position was neutral or varus less than 5°. No progressive radiolucent line or osteolysis was observed. Evidence of cortical and trabecular remodeling was observed in all cases. There were four cases of intraoperative cracks and four cases of distal femur splitting. Conclusions Initial stem stability using impaction bone grafting and a standard cemented polished stem in femoral revision arthroplasty resulted in good outcome. Delicate impaction grafting techniques and intraoperative crack and splitting fixation are the points that need attention for successful long-term results.

Purpose: Alpha-fetoprotein (AFP) is a prognostic marker for hepatocellular carcinoma (HCC). We investigated the prognostic value of AFP levels in patients who achieved complete response (CR) to transarterial chemoembolization (TACE) for HCC. Materials and Methods: Between 2005 and 2018, 890 patients with HCC who achieved a CR to TACE were recruited. An AFP responder was defined as a patient who showed elevated levels of AFP (>10 ng/mL) during TACE, but showed normalization or a >50% reduction in AFP levels after achieving a CR. Results: Among the recruited patients, 569 (63.9%) with naïve HCC and 321 (36.1%) with recurrent HCC after complete resection were treated. Before TACE, 305 (34.3%) patients had multiple tumors, 219 (24.6%) had a maximal tumor size >3 cm, and 22 (2.5%) had portal vein tumor thrombosis. The median AFP level after achieving a CR was 6.36 ng/mL. After a CR, 473 (53.1%) patients experienced recurrence, and 417 (46.9%) died [median progression-free survival (PFS) and overall survival (OS) of 16.3 and 62.8 months, respectively]. High AFP levels at CR (>20 ng/mL) were independently associated with a shorter PFS [hazard ratio (HR)=1.403] and OS (HR=1.284), together with tumor multiplicity at TACE (HR=1.518 and 1.666, respectively). AFP non-responders at CR (76.2%, n=359 of 471) showed a shorter PFS (median 10.5 months vs. 15.5 months, HR=1.375) and OS (median 41.4 months vs. 61.8 months, HR=1.424) than AFP responders (all p=0.001). Conclusion High AFP levels and AFP non-responders were independently associated with poor outcomes after TACE. AFP holds clinical implications for detailed risk stratification upon achieving a CR after TACE.