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The aim of this study was to propose our rehabilitation protocol involving Korean medicine for patients with patellar fracture and report its effectiveness. Further, for the same patellar fracture patients, we created different protocols for those who underwent surgical treatment and those who required conservative treatment. Among patients who received inpatient treatment at our hospital for three years from August 2017 to August 2020, we included three patients who underwent surgical treatment for patellar fracture and one patient who required conservative treatment for patellar fracture. The degree of improvement of the patients was evaluated using physical examination findings of the knee joint, numeric rating scale, pain disability index, Lysholm knee score, and walking state. After each treatments, we observed that the range of motion of the knee joint, numeric rating scale, pain disability index, Lysholm knee score, and walking state improved in the patient groups. Even with the same patellar fracture, we observed that different rehabilitation treatments involving Korean medicine should be applied to patients who underwent surgical treatment and those who required conservative treatment. However, further studies are needed to design a rehabilitation protocol involving Korean medicine.

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Objectives In this study, we investigated the antimicrobial activity of a 70% ethanol extract of Maneung-hwan (MEH), which is prescribed by practitioners of oriental medicine for use against methicillin-resistant Staphylococcus aureus (MRSA). Methods The antibacterial activity of MEH against MRSA strains was evaluated using the disc diffusion method, broth microdilution method (minimal inhibitory concentration, MIC), checkerboard dilution test, and time-kill test. The mechanism of action of MEH was investigated by bacteriolysis using detergents or ATPase inhibitors Additionally, mRNA and protein expression were investigated by quantitative reverse transcription-polymerase chain reaction and western blot assay, respectively. Results The MIC of MEH was 25~1,600 μg/mL against all the tested bacterial strains. We showed that MEH extract exerts strong antibacterial activity. In the checkerboard dilution test, the fractional inhibitory concentration index of MEH in combination with antibiotics indicated synergism or partial synergism against S. aureus. The time-kill study indicated that the growth of the tested bacteria was considerably inhibited after a 24-h treatment with MEH and selected antibiotics. To measure the cell membrane permeability, MEH (3.9 μg/mL) was combined with Triton X-100 (TX) at various concentrations N,N-dicyclohexylcarbodimide (DCCD) was also tested as an ATPase inhibitor. TX and DCCD cooperation against S. aureus exhibited synergistic action. Accordingly, the antimicrobial activity of MEH in the context of cell membrane rupture and ATPase inhibition was assessed. Additionally, the expression of genes and proteins associated with resistance was reduced after exposing MRSA to MEH. Conclusions These results suggest that MEH possesses antibacterial activity and acts as a potential natural antibiotic against MRSA.

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