PURPOSE: The use of immediate breast reconstruction (IBR) has been debated because it may be a causative factor in adjuvant treatment delay and may subsequently increase the probability of recurrence. We investigated whether IBR was related to adjuvant treatment delay and survival outcomes. METHODS: We retrospectively analyzed the duration from operation to adjuvant treatment administration and survival outcomes according to IBR status among patients with breast cancer who underwent mastectomy followed by adjuvant chemotherapy from January 2005 to December 2014. Propensity score matching was performed to balance the clinicopathologic baseline characteristics between patients who did and did not undergo IBR. RESULTS: Of 646 patients, 107 (16.6%) underwent IBR, and the median follow-up was 72 months. The median duration from surgery to adjuvant chemotherapy was significantly longer in patients who underwent IBR than in those who did not (14 vs. 12 days, respectively, p = 0.008). Based on propensity score matching, patients who underwent IBR received adjuvant therapy 3 days later than those who did not (14 vs. 11 days, respectively, p = 0.044). The duration from surgery to post-mastectomy radiation therapy (PMRT) did not significantly differ between the 2 groups. Local recurrence-free survival, regional recurrence-free survival, systemic recurrence-free survival, and overall survival were also not significantly different between the 2 groups (p = 0.427, p = 0.445, p = 0.269, and p = 0.250, respectively). In the case-matched cohort, survival outcomes did not change. CONCLUSION: IBR was associated with a modest increase in the duration from surgery to chemotherapy that was statistically but not clinically significant. Moreover, IBR had no influence on PMRT delay or survival outcomes, suggesting that it is an acceptable option for patients with non-metastatic breast cancer undergoing mastectomy.
Breast Implants ; Breast Neoplasms ; Breast ; Chemotherapy, Adjuvant ; Cohort Studies ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Mastectomy ; Propensity Score ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies

“Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” is the 3rd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 2nd edition published in 2014. Forty-two specialists in stroke rehabilitation from 21 universities and 4 rehabilitation hospitals and 4 consultants participated in this update. The purpose of this CPG is to provide optimum practical guidelines for stroke rehabilitation teams to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. The recent two CPGs from Canada (2015) and USA (2016) and articles that were published following the 2nd edition were used to develop this 3rd edition of CPG for stroke rehabilitation in Korea. The chosen articles' level of evidence and grade of recommendation were decided by the criteria of Scotland (2010) and the formal consensus was derived by the nominal group technique. The levels of evidence range from 1++ to 4 and the grades of recommendation range from A to D. Good Practice Point was recommended as best practice based on the clinical experience of the guideline developmental group. The draft of the developed CPG was reviewed by the experts group in the public hearings and then revised. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” consists of ‘Chapter 1; Introduction of Stroke Rehabilitation’, ‘Chapter 2; Rehabilitation for Stroke Syndrome, ‘Chapter 3; Rehabilitation for Returning to the Society’, and ‘Chapter 4; Advanced Technique for Stroke Rehabilitation’. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” will provide direction and standardization for acute, subacute and chronic stroke rehabilitation in Korea.
Canada ; Consensus ; Consultants ; Humans ; Korea* ; Practice Guidelines as Topic ; Rehabilitation* ; Scotland ; Specialization ; Stroke*

Retinyl palmitate (RP)-loaded pectinate micro- and nano-particles (PMP and PNP) were designed for stabilization of RP that is widely used as an anti-wrinkle agent in anti-aging cosmeceuticals. PMP/PNP were prepared with an ionotropic gelation method, and anti-oxidative activity of the particles was measured with a DPPH assay. The stability of RP in the particles along with pectin gel and ethanolic solution was then evaluated. In vitro release and skin permeation studies were performed using Franz diffusion cells. Distribution of RP in each skin tissue (stratum corneum, epidermis, and dermis) was also determined. PMP and PNP could be prepared with mean particle size diameters of 593~843 mum (PMP) and 530 nm (i.e., 0.53 mum, PNP). Anti-oxidative activity of PNP was greater than PMP due largely to larger surface area available for PNP. The stability of RP in PMP and PNP was similar but much greater than RP in pectin bulk gels and ethanolic solution. PMP and PNP showed the abilities to constantly release RP and it could be permeated across the model artificial membrane and rat whole skin. RP was serially deposited throughout the skin layers. This study implies RP loaded PMP and PNP are expected to be advantageous for improved anti-wrinkle effects.
Animals ; Diffusion ; Epidermis ; Ethanol ; Gels ; Membranes, Artificial ; Nanoparticles ; Particle Size ; Rats ; Skin*

PURPOSE: To compare the central corneal thickness (CCT) in eyes of Korean subjects with primary angle-closure glaucoma (PACG) to other patients with glaucoma and control subjects. METHODS: Medical records of patients who underwent examination for glaucoma and pre-operative examination for cataract surgery between March 2009 and August 2012 in our clinic were reviewed. CCT was compared in normal control eyes, primary open angle glaucoma (POAG) eyes and normal tension glaucoma (NTG) eyes. RESULTS: The mean CCT of POAG eyes was significantly larger than that of normal control eyes, NTG eyes and PACG eyes (p = 0.027, 0.009 and 0.008, respectively). There was no significant difference in mean CCT between normal control eyes, NTG eyes or PACG eyes. CONCLUSIONS: PACG eyes had a CCT similar to that of NTG or normal eyes in Korean subjects.
Cataract ; Glaucoma ; Glaucoma, Angle-Closure* ; Glaucoma, Open-Angle ; Humans ; Low Tension Glaucoma ; Medical Records

PURPOSE: Maintenance of the normal hydration state is one of the major purposes of hemodialysis therapy in patients with end-stage renal disease. Overhydration is an important and independent predictor of mortality in patients with end-stage renal disease on regular hemodialysis. BCM (body composition monitor, FMC, Germany) reliably enables quantitative assessment of hydration status and body composition. The aims of this study were to investigate the relationship between hydration status and clinical features and the risk factors of overhydration. METHODS: We measured hydration status and body composition of total 72 patients with end-stage renal disease on regular hemodialysis by BCM from June, 2009 to September, 2009. We also reviewed the clinical characteristics and laboratory findings and comorbidities retrospectively. RESULTS: The hydration status measured by BCM was correlated well with interdialytic weight gain after 48 hours and 72 hours from last hemodialysis treatment (r=0.42 p<0.001, r=0.38 p<0.01, respectively). There was no statistically significant difference in comorbidities, age, sex, BMI, blood pressure, hypotensive episodes between the patients with overhydrated state (relative hydration status > or =20%) and control patients (relative hydration status <20%). In overhydrated patients, serum iron level was lower than control patients 48 hrs after last hemodialysis (p<0.05). CONCLUSION: This cross-sectional study showed that hydration status measured by BCM was correlated well with interdialytic weight gain although there was no significant clinical difference between overhydrated and control patients with end-stage renal disease on regular hemodialysis.
Blood Pressure ; Body Composition ; Comorbidity ; Cross-Sectional Studies ; Humans ; Iron ; Kidney Failure, Chronic ; Organothiophosphorus Compounds ; Renal Dialysis ; Risk Factors ; Weight Gain

Renal diseases with organized deposits include amyloid, fibrillary, immunotactoid, and cryoglobulinemic glomerulopathies. AL amyloidosis and fibrillary glomerulonephritis are different in the composition of their immunoglobulin deposits. Fibrils of fibrillary glomerulonephritis are usually composed of polyclonal, occasionally oligoclonal or monoclonal, immunoglobin G, but amyloidosis consists of monoclonal light chains. Simultaneous occurrence of fibrillary glomerulonephritis and AL amyloidosis is very rare. We report a case of fibrillary glomerulonephritis combined with AL amyloidosis in a 71-yr-old man.
Amyloid ; Amyloidosis ; Glomerulonephritis ; Immunoglobulins ; Light ; Monoclonal Gammopathy of Undetermined Significance ; Paraproteinemias

PURPOSE: To describe the clinical presentations, management, and outcomes of patients with pilomatrixomas treated in a single institution, and to compare the clinicopathological features according to their location. METHODS: We reviewed the medical records of 57 patients treated between January 1986 and December 2007, retrospectively. RESULTS: The 57 patients had a total of 61 cases of pilomatrixomas. The mean age at diagnosis was 12.4 years, with most patients aged 0~10 years, followed by 10~20 years and 20~30 years. Mean tumor size was 1.46 cm, and most tumors were less than 2.0 cm in diameter. Forty-two tumors (68.9%) on the head and the neck were classified as Group I, and 19 tumors (31.1%) on the body were classified as Group II. The mean age at diagnosis was 9.4 years in Group I, and 19.8 years in Group II with significant statistical difference (P=0.009). The mean duration of symptoms was 26.4 months in Group I, and 7.2 months in Group II (P=0.001). All patients were treated surgically, and two patients relapsed (5 months and 3 years later). CONCLUSION: Pilomatrixoma is an uncommon benign skin tumor arising from hair follicle matrix cells. Diagnosis is usually easy based on clinical findings, and preoperative diagnosis may be improved with increased awareness of pilomatrixoma. Complete surgical excision is the treatment of choice, and recurrence after complete excision is rare.
Aged ; Hair Follicle ; Head ; Humans ; Medical Records ; Neck ; Pilomatrixoma ; Recurrence ; Skin

Intracranial manifestations associated with autosomal dominant polycystic kidney disease (ADPKD) include arachnoid cysts, dolichoectasias, and subdural hematoma (SDH), although there are only a few reports of SDH in patients with ADPKD. We report a case of spontaneous SDH in a patient with ADPKD. A 33-year-old woman complained of severe nausea and vomiting for 10 days. She had suffered from a headache for several months. She was diagnosed with ADPKD and hypertension 6 years earlier, and the hypertension was well controlled. Her mental state was drowsy in the emergency room. Her blood pressure was 180/105 mmHg. There was no evidence of head trauma. Results of a peripheral blood CBC and blood chemistry analysis were within normal limits, as were the results of a blood coagulation test and urinalysis. She was pregnant and in the eighth week of gestation. Brain magnetic resonance imaging revealed SDH in the left lateral convexity and focally in the right lateral convexity, and brain herniation. Surgical drainage was performed through a burr hole, under general anesthesia. Intra-operatively, 62 mL of liquefied subdural hematoma were removed. She recovered completely without sequelae.
Adult ; Anesthesia, General ; Arachnoid Cysts ; Blood Coagulation Tests ; Blood Pressure ; Brain ; Craniocerebral Trauma ; Drainage ; Emergencies ; Female ; Headache ; Hematoma, Subdural ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Nausea ; Polycystic Kidney, Autosomal Dominant ; Pregnancy ; Urinalysis ; Vomiting

PURPOSE: Corrugator supercilii muscle pulls eyebrow to inferomedial direction and produces the vertical component of the glabellar line formation. Current techniques for eliminating of glabellar frown include direct resection of corrugators and botulinum toxin injection. Muscle resection in endoscopic face lift procedure is relatively complex and has many disadvantages such as possible nerve injury, postoperative edema, pain and a long recovery period. The Botox treatment on the other hand is much more simple in technique but has a short duration of action. The authors have attempted new ways of finding improved treatment of the glabellar frown by selectively blocking of motor nerves innervating the corrugator supercili muscle by using radiofrequency ablation technique. METHODS: A total of 80 patients were recruited in our study during the period from Feb. 2007 to June 2008. A probe was introduced from the supraorbital ridge and advanced to the corrugator supercilii muscle. Nerve stimulator was then used to locate the nerve innervating the corrugator and radiofrequency ablation of the nerve was done. RESULTS: In all patients, there were marked improvement in glabellar frown after treatment. There were no reported cases of any relapses during the follow up period. No complication was noted such as facial nerve injury. No patient complained of any adverse symptoms other than slight discomfort due to swelling of the operation site. CONCLUSION: The treatment of glabellar frown lines using selective nerve block with radiofrequency ablation was not only less invasive but also excellent in surgical outcomes.
Botulinum Toxins ; Botulinum Toxins, Type A ; Edema ; Eyebrows ; Facial Muscles ; Facial Nerve ; Facial Nerve Injuries ; Follow-Up Studies ; Hand ; Humans ; Muscles ; Nerve Block ; Recurrence ; Rhytidoplasty ; Surgery, Plastic

PURPOSE:Preconditioning due to activation of AMPK might reduce ischemia-reperfusion (I/R) injury in the kidney, based on the key role of AMPK in preserving ATP. To evaluate this possibility, the effect of preconditioning with 5-aminoimidazole-4-carboxamide ribonucleoside (AICAR), AMPK activator, before sustained ischemia was investigated. METHODS:Adult male Sprague-Dawley rats weighing approximately 220-250 g were used. To induce renal ischemia, a laparotomy was performed under ketamine and xylazine hydrochloride, and the blood supply to both kidneys was interrupted by placement of vessel clamps at the level of the renal pedicles. Reflow was initiated by removing the clamps. The following experimental groups were defined 1. Acute renal ischemia 0 sec, 10 min, 15 min, 2. AICAR treatment, 3. Sham group (S), 4. Ischemia/ Reperfusion group (I/R), 5. AICAR+I/R group (A+I/R), 6. AraA (Adenine-9-b-D-arabinofuranoside, an AMPK) inhibitor+AICAR+I/R group (AraA+A+I/R) RESULTS:There was only faint AMPK phosphorylation in the sham group. After 10 minutes of ischemia, or AICAR preconditioning however, Thr172 phosphorylation of AMPK was increased (p<0.05). The serum levels of BUN and creatinine were significantly decreased in AICAR preconditioning group (A+I/R). (128.0+/-7.33 mg/dL, 4.18+/-0.27 mg/dL vs. 90.2+/-11.13 mg/dL, 2.58+/-0.7 mg/dL, p<0.05), but these effects were attenuated by AMPK inhibitor, AraA (AraA+A+I/R group). In quantitative analysis of tubular injury, tubular injury score in AICAR preconditioning group significantly decreased (p<0.05). CONCLUSION:The AMPK activator AICAR has a protective effect against renal I/R injury.
Adenosine Triphosphate ; Aminoimidazole Carboxamide ; AMP-Activated Protein Kinases ; Creatinine ; Glycosaminoglycans ; Humans ; Ischemia ; Ketamine ; Kidney ; Laparotomy ; Male ; Phosphorylation ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; Ribonucleotides ; Salicylamides ; Xylazine