Status of Using Complementary and Alternative Medicine among Patients with Cancer in Korea: an Online Survey of Online Cancer Support Groups (KCSG PC21-20).

PURPOSE: An increasing number of patients with cancers are interested in complementary and alternative medicine (CAM), which lacks scientific evidence. This study aimed to determine how CAM was used and how media affected patients in online cancer support groups (OCSG). Materials and Methods: Between August 18 and September 12, 2021, an online survey was conducted among the members of OCSG. The survey consisted of five parts: baseline characteristics, attitudes toward and experience with CAM, source of information and reliabilities, experience with anthelmintics, and online health information literacy and usage. RESULTS: Among the 644 responders, a total of 221 patients with cancer completed the survey, and 78.2% (173/221) used CAM. The users' median age was 52 years; 46.8% were males, and 43.9% had metastatic disease. Fifty-three CAM users (30.6%) discussed their physicians about CAM. In addition, 16.2% (28/173) of CAM users had the experience of anthelmintics. The use of anthelmintics in patients with cancers was associated with younger age (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.84 to 0.95), metastatic disease (OR, 10.88; 95% CI, 3.39 to 34.86), previous exposure to CAM information (OR, 5.57; 95% CI, 1.01 to 30.72), experience with more types of CAM (OR, 1.98; 95% CI, 1.29 to 3.05), and side effects (OR, 5.10; 95% CI 1.46 to 17.75). CONCLUSION: Use of anthelmintics, a CAM of which information is widespread online, is affected by several factors. This study will provide essential information for developing a CAM management strategy in this digital age.

Relation of pandemics with solar cycles through ozone, cloud seeds, and vitamin D.

The global records of infectious diseases, including Western and Eastern documents from 1825 to 2020, during which sunspot observations are considered reliable, show that 27 of the 34 pandemic outbreaks were coincident with sunspot number maxima or minima. There is evidence that the intensity of galactic cosmic rays is anti-correlated with solar activity and that cloud seed formation is accelerated by galactic cosmic rays. There are a substantial number of research papers showing the relationship between COVID-19 and vitamin D deficiency. The data analysis of ozone thickness measured based on NASA satellite observations revealed that ozone thickness has 11-year and 28-month cycles. Because the 11-year cycles of ozone thickness and cloud seed attenuation are anti-correlated, when either one becomes extremely thick, such as at the maximum or minimum point of solar activity, UV radiation is over-attenuated, and human vitamin D deficiency is globally increased. This finding explains the coincidence of pandemic outbreaks with the extrema of the sunspot numbers. Vitamin D supplementation can be an effective countermeasure against the spread of infectious diseases, which is a paramount importance to global society. Future pandemic forecasting should include the 11-year and 28-month cycles of UV radiation. This founding completes the relationship between solar activity and human health through the earth's environment.

Genome-enabled discovery of anthraquinone biosynthesis in Senna tora.

Senna tora is a widely used medicinal plant. Its health benefits have been attributed to the large quantity of anthraquinones, but how they are made in plants remains a mystery. To identify the genes responsible for plant anthraquinone biosynthesis, we reveal the genome sequence of S. tora at the chromosome level with 526 Mb (96%) assembled into 13 chromosomes. Comparison among related plant species shows that a chalcone synthase-like (CHS-L) gene family has lineage-specifically and rapidly expanded in S. tora. Combining genomics, transcriptomics, metabolomics, and biochemistry, we identify a CHS-L gene contributing to the biosynthesis of anthraquinones. The S. tora reference genome will accelerate the discovery of biologically active anthraquinone biosynthesis pathways in medicinal plants.

Comparative Analysis of the Complete Chloroplast Genome of Mainland Aster spathulifolius and Other Aster Species.

Aster spathulifolius, a common ornamental and medicinal plant, is widely distributed in Korea and Japan, and is genetically classified into mainland and island types. Here, we sequenced the whole chloroplast genome of mainland A. spathulifolius and compared it with those of the island type and other Aster species. The chloroplast genome of mainland A. spathulifolius is 152,732 bp with a conserved quadripartite structure, has 37.28% guanine-cytosine (GC) content, and contains 114 non-redundant genes. Comparison of the chloroplast genomes between the two A. spathulifolius lines and the other Aster species revealed that their sequences, GC contents, gene contents and orders, and exon-intron structure were well conserved; however, differences were observed in their lengths, repeat sequences, and the contraction and expansion of the inverted repeats. The variations were mostly in the single-copy regions and non-coding regions, which, together with the detected simple sequence repeats, could be used for the development of molecular markers to distinguish between these plants. All Aster species clustered into a monophyletic group, but the chloroplast genome of mainland A. spathulifolius was more similar to the other Aster species than to that of the island A. spathulifolius. The accD and ndhF genes were detected to be under positive selection within the Aster lineage compared to other related taxa. The complete chloroplast genome of mainland A. spathulifolius presented in this study will be helpful for species identification and the analysis of the genetic diversity, evolution, and phylogenetic relationships in the Aster genus and the Asteraceae.

De novo transcriptome sequence of Senna tora provides insights into anthraquinone biosynthesis.

Senna tora is an annual herb with rich source of anthraquinones that have tremendous pharmacological properties. However, there is little mention of genetic information for this species, especially regarding the biosynthetic pathways of anthraquinones. To understand the key genes and regulatory mechanism of anthraquinone biosynthesis pathways, we performed spatial and temporal transcriptome sequencing of S. tora using short RNA sequencing (RNA-Seq) and long-read isoform sequencing (Iso-Seq) technologies, and generated two unigene sets composed of 118,635 and 39,364, respectively. A comprehensive functional annotation and classification with multiple public databases identified array of genes involved in major secondary metabolite biosynthesis pathways and important transcription factor (TF) families (MYB, MYB-related, AP2/ERF, C2C2-YABBY, and bHLH). Differential expression analysis indicated that the expression level of genes involved in anthraquinone biosynthetic pathway regulates differently depending on the degree of tissues and seeds development. Furthermore, we identified that the amount of anthraquinone compounds were greater in late seeds than early ones. In conclusion, these results provide a rich resource for understanding the anthraquinone metabolism in S. tora.

The complete chloroplast genome of an economic plant, Chrysanthemum morifolium 'Baekma'.

Chrysanthemum morifolium (Dendranthema grandiflorum), known as florist's daisy is an important ornamental and medicinal plant of the Asteraceae family. The complete chloroplast genome sequence of one economic cultivar 'Baekma' was 151,060 bp in length with a large single copy (LSC) region (82,862 bp), a small single copy (SSC) region (18,294 bp) and two inverted repeats (IRs) (24,952 bp). It contained 130 genes, including 85 protein-coding genes, 8 rRNAs and 37 tRNAs. The overall GC content was 37%. Phylogenetic analysis showed that C. morifolium 'Baekma' was grouped together with other Chrysanthemum species.

The complete mitochondrial genome sequence of Chrysanthemum boreale (Asteraceae).

Chrysanthemum is an important ornamental, herbal, and medicinal plant. We report the complete mitochondrial genome (mitogenome) sequence of Chrysanthemum boreale. The mitogenome is 211,002 bp in length, has a GC content of 45.36%, and contains 58 genes, including 35 protein-coding genes, three ribosomal RNA genes, and 20 transfer RNA genes. A phylogenetic analysis based on mitogenome protein sequences from various plants confirmed that C. boreale belongs to the Asteraceae family. This mitogenome will be useful in evolutionary and phylogenetic studies of Chrysanthemum and Asteraceae.

Complete chloroplast genome and 45S nrDNA sequences of the medicinal plant species Glycyrrhiza glabra and Glycyrrhiza uralensis.

Glycyrrhiza uralensis and G. glabra, members of the Fabaceae, are medicinally important species that are native to Asia and Europe. Extracts from these plants are widely used as natural sweeteners because of their much greater sweetness than sucrose. In this study, the three complete chloroplast genomes and five 45S nuclear ribosomal (nr)DNA sequences of these two licorice species and an interspecific hybrid are presented. The chloroplast genomes of G. glabra, G. uralensis and G. glabra × G. uralensis were 127,895 bp, 127,716 bp and 127,939 bp, respectively. The three chloroplast genomes harbored 110 annotated genes, including 76 protein-coding genes, 30 tRNA genes and 4 rRNA genes. The 45S nrDNA sequences were either 5,947 or 5,948 bp in length. Glycyrrhiza glabra and G. glabra × G. uralensis showed two types of nrDNA, while G. uralensis contained a single type. The complete 45S nrDNA sequence unit contains 18S rRNA, ITS1, 5.8S rRNA, ITS2 and 26S rRNA. We identified simple sequence repeat and tandem repeat sequences. We also developed four reliable markers for analysis of Glycyrrhiza diversity authentication.

The complete chloroplast genome sequence of medicinal plant, Artemisia argyi.

Artemisia argyi, called wormwood, is widely distributed in northeastern Asia. The complete chloroplast genome sequence of A. argyi was generated by de novo assembly using whole genome next generation sequences. The complete chloroplast genome sequence of A. argyi is 151 192 bp in size. It is composed of a large single-copy (LSC), a small single-copy (SSC) and two inverted repeat (IR) regions of 82 930 bp, 18 344 bp and 24 959 bp, respectively. Overall GC contents of the genome were 37.46%. The A. argyi chloroplast genome has a total of 114 genes including 80 protein-coding genes, 30 tRNA genes and four rRNA genes. Phylogenetic analysis based on the chloroplast genome demonstrated that A. argyi is most closely related to Artemisia montana.

Effect of High-Dose Statin Therapy on Drug-Eluting Stent Strut Coverage.

OBJECTIVE: The influence of high-dose statin therapy on the serial stent healing process has not been fully investigated. Using optical coherence tomography, the effect of high-dose statin therapy on stent strut coverage was evaluated in drug-eluting stent-treated patients. APPROACH AND RESULTS: Sixty patients were randomly assigned to 2 groups according to the statin dose (atorvastatin 40 mg as high-dose statin therapy [n=29] versus pravastatin 20 mg as low-dose statin therapy [n=31]). Serial optical coherence tomographic evaluation post procedure and at the 3-month and 12-month follow-ups was performed in 50 patients with 54 stents (23 atorvastatin-treated patients versus 27 pravastatin-treated patients). The percentage of uncovered struts was defined as the ratio of uncovered struts/total struts. The primary end point was the percentage of uncovered struts at the 12-month follow-up. The secondary end point was the percentage of uncovered struts at the 3-month follow-up and the comparative percentage change (Δ) of uncovered struts at the 3- and 12-month follow-ups between the different dose statin therapies. The percentage of uncovered struts was 7.4% (range, 4.3%-10.4%) in atorvastatin-treated patients versus 10.6% (range, 5.7%-22.6%) in pravastatin-treated patients at the 3-month follow-up (P=0.13) and 1.3% (0.3%-3.8%) versus 2.5% (0.9%-9.7%), respectively, at the 12-month follow-up (P=0.01). The percentage Δ of uncovered struts from 3 to 12 months of follow-up was -7.9±8.5% in atorvastatin-treated patients versus -9.3±12.5% in pravastatin-treated patients (P=0.67). CONCLUSIONS: This study suggested that high-dose statin therapy might provide a beneficial effect for the vascular healing process after drug-eluting stent implantation.

Efficacy of early intensive rosuvastatin therapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (ROSEMARY Study).

The purpose of the study was to investigate whether early high-dose potent statin therapy in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention can reduce infarct size compared with conventional low-dose statin therapy. In a randomized placebo-controlled multicenter trial, 185 patients were assigned either to an early high-dose rosuvastatin group (n = 92, rosuvastatin 40 mg before treatment plus maintenance for 7 days) or to a conventional low-dose rosuvastatin group (n = 93, placebo before treatment plus rosuvastatin 10-mg maintenance for 7 days). Serial cardiac magnetic resonance imaging (MRI) was performed during the acute (3 to 7 days) and chronic (3 months) phases. The primary end point was relative infarct volume assessed by MRI at 3 months. Baseline characteristics were similar between the 2 groups, except hypertension, which was more prevalent in the high-dose group. Serial MRI data were available for 121 patients (high-dose group n = 54 and low-dose group n = 67). The relative infarct volumes in the acute (23.0 ± 9.5% vs 20.5 ± 11.7%, p = 0.208) and chronic (15.9 ± 8.3% vs 15.8 ± 9.7%, p = 0.943) phases were not different between the groups. No differences between groups were observed for periprocedural microvascular circulation evaluated by Thrombolysis In Myocardial Infarction flow grade, myocardial blush grade, ST-segment resolution, microvascular obstruction on cardiac MRI, or clinical outcomes. In conclusion, early high-dose rosuvastatin therapy in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention did not improve periprocedural myocardial perfusion or reduce infarct volume measured by MRI compared with the conventional low-dose rosuvastatin regimen.

A toxicological study of HangAmDan-B in mice.

The aim of the study was to define the toxicity of HangAmDan-B (HAD-B) in mice over the short and long term. HAD-B was studied in 1-week single and 5-week repeated oral dose toxicity tests on male Imprinting Control Region mice. Doses used in 1 week single oral dose toxicity tests were 0, 0.2, 1, 5, and 25 g/kg/day and those of repeated toxicity test were 0, 0.04, 0.2, 1, and 2 g/kg/day. Blood and urine samples were assayed and their morphology observed. Numerical data were compared using Mann-Whitney U test and analysis of variance. Significantly decreased red blood cell levels in mice from S2-HAD-B, S3-HAD-B, S4-HAD-B, and S5-HAD-B groups were observed in single oral dose toxicity tests. Hemoglobin, hematocrit, and mean cell hemoglobin values in mice from the S4-HAD-B and S5-HAD-B groups were also significantly decreased. No mortalities or significant differences in all factors were observed during the dosing period of the repeated dose toxicity test. Administering 2 g/kg/day of HAD-B in mice over a 5-week period showed no significant hematological changes. However, risk of anemia with more than 5 g/kg/ day administration of HAD-B was found. In general, HAD-B appears to be safe and nontoxic, and a no observed adverse effect level in mice was established at 2 g/kg/ day. This data serves as satisfactory preclinical evidence for the safety of HAD-B should a future clinical trial for HAD-B be launched. Further studies are required to confirm these safety results and to carry out a safety trial in humans.

Case series of non-small cell lung cancer treated with mountain Ginseng pharmacopuncture.

This study aims to observe the efficacy of mountain Ginseng (Panax ginseng C.A. Meyer) pharmacopuncture (MGP) on cancer patients using different delivery methods of acupoint injection and intravenous infusion. Six non-small cell lung cancer (NSCLC) patients who met the eligibility criteria were observed. Two patients were continuously infused with MGP (20 mL/day) intravenously, and the other two patients were injected with MGP (10 mL/day) on acupoint LU1 bi-lateral continuously. The remaining two patients received MGP therapy using both methods of delivery. Results were followed by computed tomography (CT) after every cycle; each cycle lasted for 28 days. Two patients infused intravenously showed stable disease and two patients injected on LU1 showed progressive disease. Two patients treated using both methods showed stable disease during the intravenous infusion period and progressive disease during the intraacupuncture injection period. One patient showed progressive disease in the latest chest CT in spite of receiving MGP intravenous infusion. We suggested that MGP may be more effective when used as an intravenous infusion rather than acupoint injection in NSCLC patients.

Evaluation of salicylic acid fatty ester prodrugs for UV protection.

The purpose of this study was to investigate the physicochemical properties and in vitro evaluation of fatty ester prodrugs of salicylic acid for ultraviolet (UV) protection. The physicochemical properties such as lipophilicity, chemical stability and enzymatic hydrolysis were investigated with the following fatty ester prodrugs of salicylic acid: octanoyl (C8SA), nonanoyl (C9SA), decanoyl (C10SA), lauroyl (C12SA), myristoyl (C14SA) and palmitoyl oxysalicylate (C16SA). Furthermore, their skin permeation and accumulation were evaluated using a combination of common permeation enhancing techniques such as the use of a lipophilic receptor solution, removal of stratum corneum and delipidization of skin. Their k' values were proportional to the degree of carbon-carbon saturation in the side chain. All these fatty esters were highly stable in 2-propanol, acetonitrile and glycerin, but unstable in methanol and ethanol. They were relatively unstable in liver and skin homogenates. In particular, C16SA was mostly hydrolyzed to its parent compound in hairless mouse liver and skin homogenates, suggesting that it might be converted to salicylic acid after its topical administration. In the skin permeation and accumulation study, C16SA showed the poorest permeation in all skins, suggesting that it could not be permeated in the skin. Furthermore, C14SA and C16SA were less accumulated in delipidized skin compared with normal skin or stripped skin, suggesting that these esters had relatively strong affinities for lipids compared with the other prodrugs in the skin. C16SA showed significantly higher dermal accumulation in all skins compared with its parent salicylic acid. Thus, the palmitoyl oxysalicylate (C16SA) might be a potential candidate for UV protection due to its absence of skin permeation, smaller uptake in the lipid phase and relatively lower skin accumulation.

Antitumor effect of skin of venenum bufonis in a NCI-H460 tumor regression model.

This experimental study was performed to investigate the antitumor effect of skin of venenum bufonis (SVB) in NCI-H460 human lung cancer cell xenografted nude mice. NCI-H460 cell lines were cultured and then xenografted into nude mice. Mice were divided into four groups: SVB (0.25 mg/kg) given orally, SVB (0.25 mg/kg) interperitoneally, SVB (0.5 mg/kg) interperitoneally, and the untreated group. Mice were raised and treated for 28 days. Body weight and tumor weight and volumes were measured daily. Absolute organ weight, microhistological observations and biochemical blood analyses were performed on the final day of the study following the sacrificing of these animals. Tumor inhibition rate, mean survival time and percent increase in life span were also calculated. Tumor size decreased in all SVB treated mice. Increasing the dose of SVB attenuated the inhibition rate seen on the 11th day of this experiment. Furthermore, tumor weight and volume in the mice treated with the highest dose of SVB were the smallest. Mice treated with high-dose intraperitoneal SVB gained weight and had significantly smaller spleens compared with untreated mice. Mean survival time and percent increase in life span in the low-dose intraperitoneal SVB treatment group were higher than those of other groups. Biochemical blood analysis revealed that phosphatase and urea nitrogen levels were decreased significantly in 0.25 mg/kg SVB orally treated mice (p < 0.01). Blood level calcium and alanine transaminase significantly decreased with intraperitoneal SVB 0.5 mg/kg (p < 0.05). The findings of this in vivo study suggest that SVB may have potential as a tumor growth inhibitor. Further research that overcomes the limitations of this study to determine the antitumor mechanism of SVB is still required.

Efficacy of high-dose atorvastatin loading before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: the STATIN STEMI trial.

OBJECTIVES: This study sought to determine the efficacy of high-dose atorvastatin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). BACKGROUND: Previous randomized trials have demonstrated that statin pre-treatment reduced major adverse cardiac events (MACEs) in patients with stable angina pectoris and acute coronary syndrome. However, no randomized studies have been carried out with STEMI patients in a primary PCI setting. METHODS: A total 171 patients with STEMI were randomized to 80-mg atorvastatin (n = 86) or 10-mg atorvastatin (n = 85) arms for pre-treatment before PCI. All patients were prescribed clopidogrel (600 mg) before PCI. After PCI, both groups were treated with atorvastatin (10 mg). The primary end point was 30-day incidence of MACE including death, nonfatal MI, and target vessel revascularization. Secondary end points included corrected thrombolysis in myocardial infarction frame count, myocardial blush grade, and ST-segment resolution at 90 min after PCI. RESULTS: MACE occurred in 5 (5.8%) and 9 (10.6%) patients in the 80-mg and 10-mg atorvastatin pre-treatment arms, respectively (p = 0.26). Corrected thrombolysis in myocardial infarction frame count was lower in the 80-mg atorvastatin arm (26.9 +/- 12.3 vs. 34.1 +/- 19.0, p = 0.01). Myocardial blush grade and ST-segment resolution were also higher in the 80-mg atorvastatin arm (2.2 +/- 0.8 vs. 1.9 +/- 0.8, p = 0.02 and 61.8 +/- 26.2 vs. 50.6 +/- 25.8%, p = 0.01). CONCLUSIONS: High-dose atorvastatin pre-treatment before PCI did not show a significant reduction of MACEs compared with low-dose atorvastatin but did show improved immediate coronary flow after primary PCI. High-dose atorvastatin may produce an optimal result for STEMI patients undergoing PCI by improving microvascular myocardial perfusion. (Efficacy of High-Dose AtorvaSTATIN Loading Before Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction [STATIN STEMI]; NCT00808717).

Anti-inflammatory activity of Schizonepeta tenuifolia through the inhibition of MAPK phosphorylation in mouse peritoneal macrophages.

Schizonepeta tenuifolia (ST) is a well-known herb to treat the cold and its associated headache. However, the anti-inflammatory mechanism of ST in mouse peritoneal macrophages is not clear. In this study, we demonstrated that ST inhibited lipopolysaccaride (LPS)-induced tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 production. The maximal inhibition rate of TNF-alpha and IL-6 production by ST (2 mg/ml) was 48.01 +/- 2.8% and 56.45 +/- 2.8%, respectively. During the inflammatory process, cyclooxygenase (COX)-2 and inducible nitric oxide synthase (iNOS) were increased in mouse peritoneal macrophages. However, treated with ST decreased the protein level of COX-2 and iNOS, as well as the production of PGE(2) and NO in LPS-stimulated mouse peritoneal macrophages. In addition, ST inhibited the phosphorylation of MAPK. Taken together, the results of this study suggest an important molecular mechanism by which ST reduces inflammation, which may explain its beneficial effect in the regulation of inflammatory reactions.

Skin permeation enhancement of diclofenac by fatty acids.

This study systematically investigated the enhancing effect of fatty acids on the skin permeation of diclofenac. The fatty acids were evaluated in terms of their carbon-chain length, the degree of unsaturation, and their functional groups. The rat-skin permeation rates of diclofenac, saturated in propylene glycol (PG) containing 1% (w/v) fatty acid, were determined using the Keshary-Chien diffusion cells at 37 degrees C. The effect of fatty acids on the saturated solubility of diclofenac in PG was also determined at 37 degrees C using high-performance liquid chromatography. Among the saturated fatty acids tested, palmitic acid (C16:0) showed the most potent skin permeation-enhancing effect. A parabolic correlation was observed between the enhancement effect and the fatty acid carbon-chain length among these saturated fatty acids of C12-C20 units. For the monounsaturated fatty acid series, an increase in permeation was observed as the carbon-chain length increased, and oleic acid (C18:1) showed the highest permeation-enhancing effect. Increasing the number of double bonds in the octadecanoic acids resulted in a parabolic effect in the permeation of diclofenac, revealing oleic acid as the most effective enhancer used in this study. When the carboxylic acid moiety of oleic acid was changed to an amide (oleamide) or hydroxyl (oleyl alcohol) group, a decrease in permeation activity was observed. These results, therefore, suggest that the cis-monounsaturated configuration and the carboxylic acid moiety of an 18-carbon unit fatty acid in PG are the optimum requirements for the effective skin permeation of diclofenac.

Hirschsprung disease and hypoganglionosis in adults: radiologic findings and differentiation.

PURPOSE: To retrospectively evaluate the imaging features of adult Hirschsprung disease (HD) and adult hypoganglionosis (HG) and to compare these features with histopathologic findings. MATERIALS AND METHODS: This study was institutional review board approved, and the requirement for informed consent was waived. The imaging, medical, and histopathologic data of 10 patients (seven women, three men; mean age, 38 years) with histopathologically proved adult HD and/or adult HG were reviewed. Two radiologists reviewed 10 transverse computed tomographic (CT) scans and five double-contrast barium enema radiographs in consensus for the presence or absence and the location of the transition zone. The transverse diameter ratio of the most dilated colonic segment proximal to the transition zone to the narrowed colonic segment distal to the transition zone (ie, transition zone ratio), and the longitudinal length of the transition zone were also determined. The CT findings of HD and HG were compared by using the Mann-Whitney U test. RESULTS: All patients with lifelong or chronic constipation had a transition zone in the upper part of the rectum or rectosigmoid junction (n = 5) or in the descending colon (n = 5) on the CT scans and the double-contrast barium enema radiographs. The transition zone ratio was significantly different between the patients with HD (median ratio, 4.0) and the patients with HG (median ratio, 2.0) (P = .016). However, there was no significant difference in the longitudinal length of the transition zone between the two patient groups (median ratios, 4.4 cm for HD group and 6.0 cm for HG group; P = .190). CONCLUSION: A markedly dilated proximal colonic segment with a transition zone and a narrowed distal colonic segment on CT and double-contrast barium enema images in conjunction with chronic refractory constipation in an adult should suggest the diagnosis of adult HD or adult HG. The detection of a much higher transition zone ratio may help to establish the diagnosis of HD.

[New trends of medicine manifested at Naeuiwon in the late Chosun period].

Tonifying method has been used to treat various types of deficiency syndrome in traditional Korean medicine. Tonifying medicinal including ginseng and deer horns is one of the various methods of the treatments, but they are recognized as a representative of traditional Korean remedies nowadays in Korea. That is concerned with the new trends of medicine manifested at Naeuiwon (Royal Infirmary) in the late Chosun period. The period that manifested the tonifying method obviously was the reign of King Youngjo (r.1724-1776). King Youngjo who lived longest among Chosun kings considered tonifying yang very important in keeping him healthy. He had taken a large quantity of ginseng, he and others considered the reason for his longevity as taking ginseng. From that time, the method of tonifying yang became one of the principles in health care and treatment as well. In the 19th century, the theory of tonifying method had been changed, in that tonifying yin was considered more important among Naeuiwon physicians. Tonifying yang alone was thought to be harmful because of its warm and dry nature. The main cause of prevalence of tonifying method in Naeuiwon was the fact that it was safe and had little side effects. The method of health care and treatments of the kings was considered as an ideal model by the ordinary people at that time. The new trends of medicine manifested at Naeuiwon in the late Chosun period had a strong influence on traditional Korean medicine, which emphasized the importance of tonifying method.