Seojeon Byungwon, Jutlandia, and NORMASH: UN's Scandinavian Allies at the Korean War and Beyond (1950s-1960s).

The Korean War (1950-1953) was one of the most calamitous and brutal wars in modern history. It was fought by the post-colonial people of the peninsula, and it culminated in the creation of two ideologically opposed states, but the three years' military clash in East Asia (or the Far East) is often labelled simply as a "Forgotten War" in the West including North America. The ensuing ethnic division has been interpreted through the various geopolitical lenses of military strategy, politics, international relations, and power games. What about the situation of casualties? Which particular nations in the United Nations (UN) dispatched medical aid for the treatment of war victims? How did the Scandinavian allies participate the non-European war? What were their unique characteristics among non-military supporting nations? What legacy they left for the post-war Koreans? This paper explores the military-historical backgrounds by which each of the following Northern European nation, namely, Sweden, Denmark, and Norway, decided to send unarmed skilled personnel to aid South Korea. The paper argues the social voluntarism of the neutral group in the critical insight that the field activities of Swedish Seojeon Byungwon, Danish Jutlandia, and Norwegian NORMASH individually promoted the Red Cross spirit of advanced humanitarianism on the top of mandatory duty, in giving special attention on children (orphans), women, civilians, POWs, and medical education, as well as the post-war collaboration for the initial Korean public health system in the 1960s.

A large scale high-throughput screen identifies chemical inhibitors of phosphatidylinositol 4-kinase type II alpha.

The minor phospholipid, phosphatidylinositol 4-phosphate (PI4P), is emerging as a key regulator of lipid transfer in ER-membrane contact sites. Four different phosphatidylinositol 4-kinase (PI4K) enzymes generate PI4P in different membrane compartments supporting distinct cellular processes, many of which are crucial for the maintenance of cellular integrity but also hijacked by intracellular pathogens. While type III PI4Ks have been targeted by small molecular inhibitors, thus helping decipher their importance in cellular physiology, no inhibitors are available for the type II PI4Ks, which hinders investigations into their cellular functions. Here, we describe the identification of small molecular inhibitors of PI4K type II alpha (PI4K2A) by implementing a large scale small molecule high-throughput screening. A novel assay was developed that allows testing of selected inhibitors against PI4K2A in intact cells using a bioluminescence resonance energy transfer approach adapted to plate readers. The compounds disclosed here will pave the way to the optimization of PI4K2A inhibitors that can be used in cellular and animal studies to better understand the role of this enzyme in both normal and pathological states.

Lead optimization of a sulfonylurea-based piperazine pyridazinone series of glucan synthase inhibitors.

The structure-activity relationship studies of a novel sulfonylurea series of piperazine pyridazine-based small molecule glucan synthase inhibitors is described. The optimization of PK profiles within the series led to the discovery of several compounds with improved pharmacokinetic profiles which demonstrated in vitro potency against clinically relevant strains. However, the advancement of compounds from this series into a non-lethal systemic fungal infection model failed to show in vivo efficacy.

The optimization of pyridazinone series of glucan synthase inhibitors.

A detailed structure-activity relationship study of a novel series of pyridazine-based small molecule glucan synthase inhibitors is described. The optimization of the PK profile of this series led to the discovery of compound 11g, which demonstrated in vivo potency ip in a lethal fungal infection model.

The synthesis and structure-activity relationship of pyridazinones as glucan synthase inhibitors.

A structure-activity relationship study of the lead 5-[4-(benzylsulfonyl)piperazin-1-yl]-4-morpholino-2-phenyl-pyridazin-3(2H)-one 1 has resulted in the identification of 2-(3,5-difluorophenyl)-4-(3-fluorocyclopentyloxy)-5-[4-(isopropylsulfonyl)piperazin-1-yl]-pyridazin-3(2H)-one 11c as a ß-1,3-glucan synthase inhibitor. Compound 11c exhibited significant efficacy in an in vivo mouse model of Candida glabrata infection.

SAR studies of pyridazinone derivatives as novel glucan synthase inhibitors.

A novel series of pyridazinone analogs has been developed as potent ß-1,3-glucan synthase inhibitors through structure-activity relationship study of the lead 5-[4-(benzylsulfonyl)piperazin-1-yl]-4-morpholino-2-phenyl-pyridazin-3(2H)-one (1). The effect of changes to the core structure is described in detail. Optimization of the sulfonamide moiety led to the identification of important compounds with much improved systematic exposure while retaining good antifungal activity against the fungal strains Candida glabrata and Candida albicans.

Modified retrograde approach to upper eyelid static loading.

OBJECTIVES/HYPOTHESIS: Upper eyelid static weight loading is a technique commonly used to treat paralytic lagophthalmos. The traditional approach using the pretarsal crease incision leads to interruption of the anterior levator muscle fibers that attach to the face of the tarsus at its upper two thirds. This disruption can lead to permanent upper eyelid blepharoptosis. The retrograde approach avoids this problem but results in an incision at the lid margin, the dependent aspect of the weight. This increases the risk of implant extrusion. We hypothesize that a newly described modified retrograde approach is a safe and effective approach that avoids the pitfalls of previously described techniques. STUDY DESIGN: Retrospective review. METHODS: Eight patients were evaluated with preoperative and 3 to 6 month postoperative photographs with the eyes in the open and closed positions for the degree of lagophthalmos and blepharoptosis present. Patients were also evaluated for development of complications such as implant extrusion, pain, or infection. The surgical technique uses a supratarsal skin crease incision, supramuscular dissection to the lid margin, entry into the tarsal plane at its inferior-most aspect, creation of a pocket for implant insertion, and layered closure. RESULTS: All patients had complete correction of lagophthalmos. No patients experienced infection, extrusion, or eye pain after surgery. All patients had less than 2-mm ptosis after surgery, with no patients experiencing any visual field disruption. CONCLUSIONS: The modified retrograde approach to upper eyelid static loading for paralytic lagophthalmos provides advantages over other techniques described. It is a safe, efficacious procedure, well tolerated by patients.

Cadaveric and engineering analysis of the septal L-strut.

OBJECTIVES: To identify patterns of failure of the L-strut, to identify elements of the nasal framework that support the L-strut, and to investigate the effect of altering L-strut design on its stability. STUDY DESIGN: Laboratory study with human cadaveric heads and computational modeling. METHODS: Directional forces were applied to cadaveric L-struts and patterns of failure with incremental force were noted. Computational modeling using the finite element method (FEM) was employed to determine quantitatively the effect of various modifications on the stability of the L-strut. RESULTS: The L-strut was found to respond to frontal force initially by buckling. This buckling was reversible until the force exceeded a certain threshold when the L-strut broke at the bony-cartilaginous junction. The threshold force varied depending on the length of the overlap with the bony vault. Intact mucoperichondrium provided significant stability. Modeling with FEM showed that the preservation of a triangular piece of cartilage at the dorsal anchor of a narrowed L-strut can offset some of the loss in mechanical stability. CONCLUSIONS: Intrinsic elasticity of the septal cartilage, the mucoperichondrial flap, and overlap with the bony vault all contribute to the stability of the L-strut, which is enhanced by preserving a small segment of cartilage at the bony-cartilaginous junction of the dorsal L-strut.

Upper blepharoplasty in the Asian eyelid.

Upper-eyelid blepharoplasty in the Asian patient poses unique challenges. The anatomy is complex and highly variable, and the esthetic goals vary from patient to patient. The surgeon must perform more complicated maneuvers than in Caucasian blepharoplasty in an anatomic field with features that predispose for complications. The successful surgeon must identify the features of the eyelid to be modified through a detailed consultation with the patient, formulate a sound surgical plan based on a mastery of the complex anatomy, and execute all maneuvers with conservatism and exact precision.

Applications of porcine dermal collagen (ENDURAGen) in facial plastic surgery.

The facial plastic and reconstructive surgeon has a variety of options for tissue augmentation and soft tissue support. These options include autologous materials such as fat and cartilages, solid implant materials, and injectable materials. Recently, malleable sheets of collagen-based matrix have become available. This review focuses on the potential applications of acellular collagen matrices and their various applications in rhinoplasty, facial slings for static reanimation, scar revision, soft tissue volume restoration, and periorbital reconstruction.

Revision Functional Surgery: Salvaging Function.

Reduction rhinoplasty techniques include maneuvers that weaken the nasal osseocartilaginous framework. The structurally compromised anatomy remaining after reductive surgery may be left with inadequate strength to withstand postoperative contractile forces. Significant aesthetic and functional deformities requiring revision rhinoplasty may develop. This article reviews common causes of nasal obstruction after primary rhinoplasty. The discussion of etiology is based on both the anatomic description of nasal subsites (middle vault and lateral walls) as well as an explanation of why certain techniques lead to functional problems in these areas. Revision rhinoplasty techniques for correcting these problems are discussed in detail.

Metrics of nasal tip rotation: a comparative analysis.

OBJECTIVE: We introduce a new metric for measuring nasal tip rotation, the "columellar facial angle." The present study aimed to determine the degree of correlation of the nasolabial angle, the nostril axis, and the columellar-facial angle as metrics of nasal tip rotation in healthy volunteers. The study also aimed to identify any nasal or facial features unrelated to tip position, which consistently altered these values. METHODS: Lateral photographs in the Frankfort horizontal plane were taken of 100 volunteers. Measurements of tip rotation were then calculated for each model using three different methods: nasolabial angle, nostril axis, and columellar-facial angle. Data were analyzed for degree of correlation of the three values for all models. Facial features in those subjects with low correlation between measurement methods were analyzed. RESULTS: For all grouped data, both the nasolabial angle and the nostril axis showed moderate correlations with columellar facial angle but no correlation with each other. Individual subjects whose measurements did not correlate tended to display certain anatomic features: premaxillary deficiency, premaxillary excess, sloped upper lips, or vertical malposition of the nostrils. CONCLUSIONS: No one method of measurement of nasal tip rotation is reliable for all patients. Certain nasal and facial features are likely to alter these values. Of the three measurement methods presented, the columellar-facial angle is most likely to yield consistent measurements of nasal tip rotation.

Modification of the Zitelli bilobed flap: a comparison of flap dynamics in human cadavers.

OBJECTIVE: To investigate the effects on overall flap dynamics of altering the length of the primary flap in the Zitelli bilobed flap procedure, because the standard Zitelli design can result in distortion of the alar margin after repair of cutaneous nasal alar defects. METHODS: Identical 1.5-cm circular cutaneous defects were made on the nasal alae and cheeks of 6 fresh human cadavers. A rectangle was inked around each cheek defect in a standardized fashion. A standard-design Zitelli bilobed flap was used to close the nasal and cheek defects on 1 side of each specimen (n = 6). The contralateral defect was closed with a modified design in which the primary flap was either 10% longer (n = 3) or 10% shorter (n = 3) than the standard primary flap as measured from the pivot point. Alar margin retraction and cheek defect distortion were measured from standardized photographs obtained before and after the repair. RESULTS: The long-flap design resulted in alar retraction that was 1.33 mm less in the nasal reconstructions (P = .02) and distal defect distortion that was 2.17 mm less in the cheek reconstructions (P = .01) compared with the standard Zitelli bilobed flap. The short-flap design caused more distortion than did the standard design for both types of defect. CONCLUSION: Lengthening the primary flap in the Zitelli bilobed flap design may reduce distal wound distortion and alar retraction in the closure of certain cutaneous defects.

Concentric and eccentric carved costal cartilage: a comparison of warping.

OBJECTIVE: To determine if a systematic, concentric graft-carving technique results in less warping than eccentric carving. METHODS: Costal cartilage from ribs 3 through 9 were harvested from fresh human cadavers. Concentric dorsal grafts were carved from cartilage obtained from one side of the cadaver (n = 7) and eccentric grafts were carved from the opposite side (n = 11). After carving, grafts were placed in saline sponges (isotonic sodium chloride) for 1 hour, and photographs were then taken from a lateral and a frontal view. Identical photographs were taken after 2 weeks of incubation in saline (36.7 degrees C). The angle of curvature was measured from the photographs. RESULTS: More warping occurred in the eccentric group than the concentric group on lateral view at 1 hour (4.4 degrees vs 0.4 degrees; P<.001) and at 2 weeks (5.8 degrees vs 1.4 degrees; P = .003). Eccentric grafts progressively warped between the 1-hour and 2-week points. CONCLUSION: Meticulous concentric carving of costal cartilage grafts may minimize the complication of graft warping.

Outcome of Nasal Valve Obstruction After Functional and Aesthetic-Functional Rhinoplasty.

INTRODUCTION: Nasal valve insufficiency is distinct from other anatomic causes of nasal obstruction. Functional rhinoplasty refers to the collective techniques used to reconstruct the lateral nasal wall, typically achieved with the use of spreader and alar grafts. Patients undergoing functional rhinoplasty can also have aesthetic desires and goals achievable with combined aesthetic-functional rhinoplasty. OBJECTIVE: To evaluate the improvement in nasal obstruction symptoms after cartilage graft reconstruction in patients with nasal valve insufficiency and to compare the postoperative improvement between patients undergoing functional and aesthetic-functional rhinoplasty. DESIGN, SETTING, AND PARTICIPANTS: In this prospective multicenter cohort study, 12 participating surgeons enrolled 79 consecutive patients diagnosed as having nasal valve insufficiency as the primary cause of nasal obstruction. Patients underwent functional or aesthetic-functional rhinoplasty. The study collected demographic, clinical, and surgical data from March 2006 to September 2008. Nasal symptoms were evaluated using a validated, disease-specific, quality-of-life instrument. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered to participants at baseline and 3, 6, and 12 months postoperatively. Follow-up was completed on September 2008, and data were analyzed in September 2009 and in September 2013. MAIN OUTCOMES AND MEASURES: Changes in NOSE scale score (range, 0 to 100, with a higher score indicating greater severity of obstruction) at 3 months between the functional and aesthetic-functional groups. RESULTS: Of the 79 patients, 31 underwent functional and 48 underwent aesthetic-functional rhinoplasty. Overall, an improvement was found in nasal breathing, with a mean decrease of 48.6 points (95% CI, 41.9-55.2; P < .001) at the 3-month assessment compared with the preoperative baseline NOSE scale score (mean [SD], 67.1 [19.7]). The improvement in nasal breathing was similar whether patients underwent functional or aesthetic-functional rhinoplasty (mean [95% CI] NOSE scale score change, 51.4 [42.1-60.7] and 46.6 [37.1-56.1], respectively; P = .49). CONCLUSIONS AND RELEVANCE: Nasal valve reconstruction with spreader and alar grafts is effective in treating patients with nasal valve insufficiency. Combining aesthetic interventions with functional rhinoplasty did not seem to affect the magnitude of improvement in nasal breathing outcome. LEVEL OF EVIDENCE: 2.

A novel intranasal stent for functional rhinoplasty and nostril stenosis.

OBJECTIVES/HYPOTHESIS: The surgical correction of nostril stenosis and external nasal valve collapse typically involves the addition of tissue to widen and strengthen these areas. However, over the ensuing months, postoperative scar contracture may act to reverse the surgical modifications. This study aimed to determine the safety and efficacy of the use of nasal stents fashioned from a nasopharyngeal airway tube to prevent postoperative contracture at these sites. STUDY DESIGN: Retrospective review of six patients who underwent functional rhinoplasty with alar batten graft placement for nasal valve collapse and one patient who underwent composite graft repair of unilateral nostril stenosis. METHODS: Patients completed a survey inquiring about the ease of use, discomfort, presence of infection, and ability to breathe with these nasal stents. Patients also completed the NOSE (nasal obstruction symptom evaluation) instrument to compare their overall level of preoperative and postoperative nasal breathing. The functional rhinoplasty patients were examined for degree of dynamic airway nasal wall collapse and position of the lateral nasal wall on intranasal examination. RESULTS: Six of seven patients overall reported no to minimal discomfort, easy application, and no to minimal obstruction of nasal breathing with the use of the stents. One patient reported difficulty with application. Preoperative NOSE scores averaged 67.1 (SD 10.4), 18.6 (SD 14.6) at the time of splint removal, and 21.4 (SD 15.2) at 3 months after stent removal. Paired t test analysis showed significant differences between the NOSE scores preoperatively as compared with the time of splint removal (P = .0002) or 3 months after splint removal (P = .0003). All patients demonstrated a significant reduction of lateral nasal wall collapse with inspiration on physical examination. CONCLUSIONS: The use of nasal stents made from nasopharyngeal airway tubes is a safe, convenient, and economic treatment for the prevention of contracture after surgical correction of nostril stenosis or nasal valve insufficiency.

Biomechanical strength of human nasal septal lining: comparison of the constituent layers.

OBJECTIVE/HYPOTHESIS: Nasal septal perforation is a common complication following surgery involving the nasal septum. Septoplasty, septorhinoplasty, and submucosal resection may result in the inadvertent resection of perichondrium, which may predispose the patient to septal perforations. STUDY DESIGN: Controlled human cadaver study testing the biomechanical strength of the constituent layers of nasal septal lining. METHODS: Uniform samples of nasal septal mucosa, perichondrium, and a composite of both layers were obtained from five fresh human cadavers. The mechanical tensile strength of these layers was evaluated and compared with the Instron 4301 Mechanical Testing System (Canton, MA). RESULTS: Mixed-effects regression analysis demonstrated a significant difference in the tensile strength of the three groups (mean values +/- SD: mucosa, 662 +/- 308 g; perichondrium, 1370 +/- 798 g; composite, 2340 +/- 1252 g). All three pairwise comparisons among the three groups showed a significant difference in tensile strength. CONCLUSION: The perichondrial layer imparts the majority of the biomechanical strength to septal lining. Lining flaps containing both perichondrium and mucosa are stronger than flaps with either perichondrium or mucosa alone. Dissection in the subperichondrial plane during septal surgery provides a stronger septal flap and may prevent the development of nasal septal perforation during nasal surgery.

Current concepts in cheek reconstruction.

For cutaneous cheek defects, the reconstructive surgeon should strive to optimize tissue match and scar camouflage while minimizing the distortion to neighboring facial landmarks. The surgeon must have an intimate understanding of the local anatomy and must be able to use the appropriate flap for the given characteristics of each defect and patient. Knowledge of several types of flaps and versatility in modifying these flaps from their "textbook" geometry are required. This article highlights an approach to local flap reconstruction with a review of flap modification for particular situations.

Upper blepharoplasty in the Asian eyelid.

Upper eyelid blepharoplasty is a major component of cosmetic surgery in the Asian face. The complicated and variable anatomy of the Asian upper eyelid is reviewed, stressing the major differences between Asian and Caucasian eyes. The authors' preferred surgery for the creation of a double eyelid is discussed, including the preoperative assessment, intraoperative maneuvers, and laser techniques. The article concludes with a discussion of the complications specifically related to Asian blepharoplasty and strategies to avoid them.

Management of posttraumatic nasal deformities: the crooked nose and the saddle nose.

The crooked nose deformity and the saddle nose deformity represent two of the most challenging complications of nasal trauma. Optimal management requires careful preoperative analysis and thoughtful surgical planning. The surgeon must make the mental and philosophical commitment to address the difficult cosmetic components and the functional problems related to these deformities. Because these conditions result from disruptions of the nasal septum, their surgical correction mandates use of techniques that modify the septum, and they might require reconstruction of the sacrosanct dorsal-caudal strut. By understanding the three-dimensional anatomy of this L-shaped strut, how its relationship to the other structural components of the nose determines external nasal contour, and the techniques available to stabilize this structure into an optimal position, the surgeon can correct these difficult cosmetic problems effectively while maintaining the overall structural and functional integrity of the nose.