Search

Objective: The purpose of this study is to evaluate the clinical therapeutic effectiveness and applicability of the PEMF (pulsed electro-magnetic field) acupuncture. To verify this, we observe autonomic nervous system (ANS; such as the HRV and body temperature) variation for the manual acupuncture and the PEMF acupuncture. Method: 56 voluntary participants were divided into three groups; non-stimulation group, manual acupuncture group (MAG), and PEMF acupuncture group (PAG). BL15 (Bladder Meridian) was selected as the stimulation area, the PEMF parameters were chosen at 2 Hz and 46mT. The HRV and body temperature were measured before and after each stimulation. The HRV at low frequency (LF; 0.04 - 0.15 Hz) and high frequency (HF; 0.15 - 0.4 Hz) were analyzed to acquire LF/HF ratio. Results: The LF and the LF/HF ratio were found to be lower in the MAG (p = 0.026) and the PAG (p = 0.011), but higher in the non-stimulation group (p = 0.778). The HF was found to be higher in the MAG (p = 0.011) and the PAG (p = 0.013). In BL15, the non-stimulation group had very low body temperature variation. The temperature difference in the MAG before andafter the procedure was 0.37°C; there were no significant differences (p = 0.114). The temperature difference in the PAG was larger than that for the MAG, at 0.83°C; it was a significant difference (p = 0.001). Conclusion: We found that the manual acupuncture and the PEMF acupuncture at BL15 activated the parasympathetic nervous system. Therefore, we confirm that the PEMF acupuncture can be expected to have a similar effect as acupuncture and can be applied as a means of clinical acupuncture treatment.

BACKGROUND Lateral thigh pain is a common complaint in patients visiting a pain clinic. Herein, we describe the case of a patient with lateral thigh pain caused by an obturator hernia. CASE SUMMARY An 83-year-old woman visited the emergency room with suddenly aggravated right lateral thigh pain. Magnetic resonance imaging of the thigh revealed no abnormal findings in the lateral thigh area. However, an obturator hernia between the pectineus and obturator externus muscles was observed by chance. Retroperitoneal computed tomography revealed a herniated small bowel with an incarceration point at the right obturator canal and a dilated loop of the small bowel upstream. Ultrasonography of the right inguinal region revealed a distended bowel loop in the right pectineus muscle. CONCLUSION Our report provides clinicians with information that an obturator hernia can cause lateral thigh pain.

Background/aims For the management of hilar malignant biliary obstruction (HMBO), endoscopic biliary drainage (EBD) is preferred over percutaneous transhepatic biliary drainage (PTBD) because of its convenience. However, there is no established guideline for malignant hilar obstruction that requires multiple stenting. In this study, we compared the efficacy of bilateral metal stents (BMS) versus multiple plastic stents (MPS). Methods In this retrospective study, we analyzed 102 patients who underwent EBD with either BMS or MPS due to HMBO caused by hilar cholangiocarcinoma between 1996 and 2018 at Samsung Medical Center. We compared the successful drainage rates, cholangitis events, overall complications, mortality, and conversion rates to PTBD between the two groups. Results The successful drainage rates in the BMS group and the MPS group were 71.4% (25/35) and 65.6% (44/67), respectively, with no significant difference. The MPS group had a higher cholangitis risk (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.21 to 3.58) and higher 6-month mortality (HR, 2.91; 95% CI, 1.26 to 6.71) than the BMS group. There were no significant differences in overall complications or the conversion rate to PTBD between the groups. Conclusions In patients with malignant HMBO, the BMS group showed better outcomes in terms of the cholangitis rate and 6-month mortality than the MPS group. Therefore, if possible, bilateral metal stenting is recommended for HMBO caused by hilar cholangiocarcinoma.

We report the response process of the Laboratory Analysis Task Force (LATF) for Unknown Disease Outbreaks (UDOs) at the Korea Disease Control and Prevention Agency (KDCA) during January 2020 to coronavirus disease 2019 (COVID-19), which developed as a UDO in Korea. The advanced preparedness offered by the laboratory diagnostic algorithm for UDOs related to respiratory syndromes was critical for the rapid identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and enabled us to establish and expand the diagnostic capacity for COVID-19 on a national scale in a timely manner.

BACKGROUND: Hair follicles are among a handful of organs that exhibit immune privilege. Dysfunction of the hair follicle immune system underlies the development of inflammatory diseases, such as alopecia areata. METHODS: Quantitative reverse transcription PCR and immunostaining was used to confirm the expression of major histocompatibility complex class I in human dermal papilla cells. Through transcriptomic analyses of human keratinocyte stem cells, major histocompatibility complex class I was identified as differentially expressed genes. Organ culture and patch assay were performed to assess the ability of WNT3a conditioned media to rescue immune privilege. Lastly, CD8+ T cells were detected near the hair bulb in alopecia areata patients through immunohistochemistry. RESULTS: Inflammatory factors such as tumor necrosis factor alpha and interferon gamma were verified to induce the expression of major histocompatibility complex class I proteins in dermal papilla cells. Additionally, loss of immune privilege of hair follicles was rescued following treatment with conditioned media from outer root sheath cells. Transcriptomic analyses found 58 up-regulated genes and 183 down-regulated genes related in MHC class I+ cells. Using newborn hair patch assay, we demonstrated that WNT3a conditioned media with epidermal growth factor can restore hair growth. In alopecia areata patients, CD8+ T cells were increased during the transition from mid-anagen to late catagen. CONCLUSION: Identification of mechanisms governing epithelial and mesenchymal interactions of the hair follicle facilitates an improved understanding of the regulation of hair follicle immune privilege. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13770-021-00392-7.

This study aimed to evaluate the effect of Pulsed Electromagnetic Fields (PEMF) in improving blood flow reduction and tissue necrosis of ischemic animal induced by skin flap. In each experiment, twenty rats (280-320 g) were randomly divided into control group (n = 10) and PEMF (n = 10) group. All of the rats were performed skin flap in back. In the PEMF group, PEMF (1 Hz, 10 mT) was performed in each experiment. In Experiment-1 (n = 20), PEMF was performed for 90 minutes. In Experiment-2 (n = 20), additionally, a blocking film was inserted, and suture was performed to induce necrosis. PEMF was performed for 30 minutes each day for 7 days. As a result of Speckle-Flow Index (SFI) analysis, in the control group, blood flow continued to decrease immediately after the procedure. In the PEMF group, blood flow was remained constant after 30 minutes and increased after 60 minutes. The blood flow in a specific region substantially increased from the initial state. As a result of skin necrosis analysis, the progression rate in the PEMF group was slower than that of the control group. The rate of necrosis in the PEMF group decreased dramatically from the 6th day, and there was a statistically significant difference between the two groups at the 7th day (

Nevus comedonicus is a very rare skin disorder characterized by the presence of comedo-like dilated pores with keratinous plugs, rarely resulting in painful recurrent inflammatory nodules or cysts. It presents as localized or extensive form. It displays unilaterally or bilaterally segmental distribution. Histopathologically, it is characterized by keratin- filled epidermal invagination with bulbous proliferation of keratinocytes. The condition may be caused by fibroblast growth factor receptor 2 mutation. Although it may be controlled by a variety of therapeutic modalities, it is difficult to achieve complete resolution. We report a case of extensive nevus comedonicus with inflammatory nodules and cysts controlled with adalimumab. (Ann Dermatol 33(4) 361∼364, 2021)

Oxytocin (OXT) and serotonin (5-HT) are essential neurotransmitters associated with the behavior of animals. Recently, we found that the plasma concentration of OXT is positively correlated with horse docility and friendliness toward humans. However, the relationships between the neurotransmitters and other temperaments such as fearfulness, dominance, and trainability are unknown. This study aimed to identify whether the plasma concentration of OXT or 5-HT is correlated with fearfulness, dominance, and trainability of horses. Blood samples of 34 horses were collected at the Horse Industry Complex Center of Jeonju Kijeon College. The concentration of OXT and 5-HT was measured in the plasma samples using enzyme-linked immunosorbent assays. The fearfulness, dominance, and trainability of horses were scored by three professors who were very familiar with the horses. One-way analysis of variance with the least significant difference post-hoc analysis was used to compare the scores for fearfulness and dominance among groups. The trainability of horses was compared using the student t-test. The 5-HT was negatively correlated with dominance, but it had no relation with fearfulness. The OXT appeared to be negatively correlated with fearfulness and dominance in horses. Furthermore, OXT was positively correlated with the trainability of horses. Additionally, 5-HT appeared to enhance trainability. In conclusion, the concentration of OXT or 5-HT in horse blood plasma can be used as a biomarker to monitor the fearfulness, dominance, or trainability of horses.

Background Clinical information that distinguishes invasive nail unit melanoma from nail unit melanoma in situ before surgery would aid physicians in the decision-making process and estimating prognosis. However, limited information is available on the detailed demographic and dermoscopic features of invasive nail unit melanoma and nail unit melanoma in situ for differential diagnosis. Objective This study aimed to investigate the demographic data and dermoscopic features of invasive nail unit melanoma and nail unit melanoma in situ and establish a predictive model for differentiating these two forms of nail unit melanoma. Methods A retrospective observational study of ninety-seven patients diagnosed with nail unit melanoma (59 in situ and 38 invasive cases) in four healthcare centres in South Korea (three tertiary referral hospitals and one second referral hospital) from March 2014 to December 2019. Results A multivariable analysis revealed that ulcer (odds ratio = 21.6, confidence interval = 2.1-219.8, P = 0.009), total melanonychia (odds ratio = 17.6, confidence interval = 3.0-104.0, P = 0.002), nail plate destruction (odds ratio = 10.9, confidence interval = 2.0-59.4, P = 0.006) and polychromia (odds ratio = 5.3, confidence interval = 1.36-20.57, P = 0.016) were distinctive dermoscopic features of invasive nail unit melanoma. A predictive model with scores ranging from 0 to 6 points demonstrated a reliable diagnostic value (C-statistic = 0.902) in differentiating invasive nail unit melanoma from nail unit melanoma in situ. Conclusions Invasive nail unit melanoma and nail unit melanoma in situ have different dermoscopic features. A predictive model based on morphologic dermoscopic features could aid in differentiating invasive nail unit melanoma from nail unit melanoma in situ.

Peroral endoscopic myotomy (POEM) is one of the most clinically successful tunnel-based minimally invasive endoscopic treatments. The classic indications of POEM include achalasia of all types, including failed prior treatments, and expanded indications include the non-achalasia esophageal motility disorders, such as esophagogastric junction outflow obstruction, diffuse esophageal spasm, and jackhammer esophagus. For achalasia treatment, POEM has achieved a comparable surgical efficacy and a safety outcome and, therefore, has emerged as a first-line treatment. For non-achalasia esophageal motility disorders, POEM has also shown high clinical response rates. The complication rate of POEM for esophageal motility disorders is low and most complications are managed with conservative treatment. Currently, POEM is a representative procedure of natural orifice transluminal endoscopic surgery, which has shown a good clinical efficacy with low complication rates for esophageal motility disorders including achalasia. However, further studies are needed to treat non-achalasia motility disorder via POEM.

BACKGROUND Sentinel lymph node biopsy (SLNB) of primary cutaneous melanoma as an important staging method has not been popularly undertaken in Korea and only a few studies with small patient numbers have been published. AIM We examined the clinical feasibility and overall outcomes of SLNB in acral melanoma (AM) of Korean in Kyungpook National University Hospital (KNUH) over the past 13 years. METHODS SLNB in AM patients during 2006-2018 were analyzed retrospectively for sentinel lymph node (SLN) harvesting rate, positivity rate, positivity-relevant overall survival (OS) and disease-free survival (DFS), and its side effects. RESULTS A total of 109 AM patients who underwent SLNB were enrolled. Harvested nodes were identified from 107 patients and SLN harvesting rate was 98.2%. The mean Breslow thickness (±standard deviation) was 3.38 ± 3.03 mm, and the proportion of ulcerated melanomas was 64%. Twenty-two (20.6%) had a tumor-positive SLN and, among them, 82% (18/22) underwent immediate complete lymph node dissection (CLND). The metastasis-positive nodal basin after CLND was detected in 16.7% of cases (3/18). Tumor-negative SLN cohorts showed significantly better OS and DFS than tumor-positive ones (P = 0.006 and P

Objective Salmonella enterica serotype Kentucky ST198 (S. Kentucky) is frequently associated with human infections and has been identified in travellers to North Africa, South Asia, Europe, and North America. The antimicrobial resistance of this serotype to multiple drugs, including ciprofloxacin (CIP), is a growing concern. However, little information is available regarding the occurrence and characterization of S. Kentucky in Korea. Methods To investigate the characteristics and possible origin of these infections, we characterized highly CIP-resistant S. Kentucky isolates collected through a national surveillance program. Single-nucleotide polymorphisms (SNPs) were identified by whole-genome sequencing (WGS), and genome sequencing was performed to investigate the genetic relationships and resistance mechanisms of the isolates. Results Ten CIP-resistant S. Kentucky strains were isolated from diarrheal patients in Korea from 2008 to 2017. The travel histories of the patients indicated that seven had returned from Southeast Asia. WGS of all the isolates revealed the presence of Salmonella genomic island 1 (SGI1) and substitutions in the gyrA and parC genes, which are known to confer resistance to CIP. A multilocus sequence type (MLST) analysis revealed that the isolates belonged to ST198, which has been prevalent in Europe and Africa. Furthermore, a phylogenetic analysis showed that all 10 isolates shared close genetic relationships. Conclusions We report the identification of S. Kentucky in Korea through long-term surveillance. International travel, especially to Southeast Asia, has been a major risk factor for human infections of CIP-resistant S. Kentucky in Korea.

Background/Aims: A diagnosis of gastroesophageal reflux disease is challenging in patients who have reflux symptoms but do not respond to proton pump inhibitors nor have reflux esophagitis and hiatal hernia (HH) on endoscopy. This study examined the predictive role of the endoscopic findings, including the flap valve grade for pathologic acid exposure (PAE) to establish an endoscopic prediction model in patients with neither reflux esophagitis nor HH. Methods: Five hundred seventy-eight patients who underwent upper endoscopy and 24 hours pH monitoring for reflux esophageal symptoms without evidence of reflux esophagitis and HH were analyzed. The gastroesophageal flap valve (GEFV), esophageal metaplasia, and chronic atrophic gastritis were assessed. The association between the endoscopic parameters and PAE was evaluated. Results: Four hundred ninety-four patients were enrolled. The most common complaint was chest discomfort (42.3%) followed by globus (31.8%), dysphagia (7.9%), and heartburn (7.7%). PAE was present in 43 patients (8.7%). Multivariable analysis revealed PAE to be associated with the GEFV grade (p

Due to their target specificity and low-toxicity, insect growth regulators (IGRs) are regarded as promising alternatives to chemical insecticides. In this study, farnesol and farnesyl acetate exhibited juvenile hormone (JH)-based IGR activities. While farnesyl acetate showed JH agonist (JHA) activity in concentration-dependent manner, farnesol was identified as JH antagonist (JHAN) by interfering pyriproxyfen-mediated binding JH receptor complex. Both compounds showed mosquito larvicidal activities and caused retardation of ovarian growth of female Aedes albopictus by modulating the formation of JH receptor complex, expression of JH-inducible genes, and thereby disrupting JH-based endocrine regulations. These results suggested that farnesol and farnesyl acetate could be applicable for investigating underlying mechanisms of JH-regulated insect physiologies as well as developing novel eco-friendly insecticides.

BACKGROUND: The optimal technique for plate fixation to treat type B and C periprosthetic femoral fractures (PFFs) is unclear. The purpose of this study is to evaluate the radiographic results of inner-side-out limited contact dynamic compression plate (LC-DCP) to treat PFFs during or after total hip arthroplasty (THA). METHODS: This retrospective study comprised of four men and six women with an average age of 64.7 years who underwent open reduction and internal fixation with an inner-side-out LC-DCP technique to treat PFFs; the reduction was maintained preliminary with the use of contoured plate and cables, and the grooves on the undersurface of LC-DCP for limited contact was used to hold and prevent the cables from slippage during tightening the cables. There were five intraoperative and five postoperative PFFs after THA. According to the Vancouver classification, the intraoperative PFFs included type B2 in two, B3 in one and C3 in two patients while postoperative PFFs were categorized into type B1 in one, type B2 in two and type C in two patients. The mean follow-up duration was 5.9 years (range 1–10.4). We evaluated radiographic union and complications after index operation. RESULTS: All patients demonstrated radiographic bone union at an average follow-up duration of 4.4 months (range 3–8). Two patients showed stem subsidence after revision THA and one patient demonstrated a subsequent peri-implant fracture around the distal end of plate after union of the initial PPF; one patient underwent re-revision THA for stem loosening while another patient went through refixation for the peri-implant fracture. There was no nonunion, infection, nerve injury, or dislocation. CONCLUSION: The inner-side-out LC-DCP technique showed satisfactory radiographic outcome. In certain situations where locking plates are not available, this technique might be a useful alternative for treating type B and C PFFs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s43465-020-00200-9) contains supplementary material, which is available to authorized users.

The development of colistin resistance in carbapenem-resistant strains poses a serious public health problem. In this study, we collected 249 carbapenem-resistant Escherichia coli isolates from patients in Seoul in 2018, and screened all isolates for colistin resistance and for the presence of mobile colistin resistance (mcr) genes. Colistin-resistant strains were further analyzed using multilocus sequence typing, antimicrobial susceptibility testing, detection of antibiotic resistance determinants, plasmid transconjugation, and whole-genome sequencing. Three of the 249 carbapenem-resistant isolates were resistant to colistin, and mcr-1 was detected in one isolate (SECR18-0888), which belonged to sequence type 156 and was resistant to all antibiotics tested except tigecycline. The mcr-1.1 gene was located on an ~62 kb self-transferable IncI2 plasmid along with the blaCTX-M-55 gene, and the blaNDM-1, blaTEM, qepA1, and rmtB genes were additionally detected in SECR18-0888. As an extensively drug-resistant E. coli strain producing MCR-1 and NDM-1 was identified in Korea for the first time, continued monitoring of colistin resistance in carbapenem-resistant Enterobacteriaceae should be reinforced.

Objective This study aimed to analyze the correlation of horizontal and sagittal planes used in two-dimensional diagnosis with lip canting by using threedimensional (3D) analysis. Methods Fifty-two patients (25 men, 27 women; average age: 24 years) undergoing treatment for dentofacial deformity were enrolled. Computed tomography images were acquired, and digital imaging and communication in medicine files were reconstructed into a 3D virtual model wherein horizontal and sagittal craniofacial planes were measured. Subsequently, the correlations of lip canting with these horizontal and sagittal planes were investigated. Results The mandibular symmetry plane, the occlusal plane, Camper's plane, the mandibular plane, Broadbent's plane, and the nasal axis plane were correlated with the amount of lip canting (Pearson's correlation coefficients: 0.761, 0.648, 0.556, 0.526, 0.438, and 0.406, respectively). Planes associated with the lower part of the face showed the strongest correlations; the strength of the correlations decreased in the midfacial and cranial regions. None of the planes showed statistically significant differences between patients with clinical lip canting (> 3°) and those without prominent lip canting. Conclusions The findings of this study suggest that lip canting is strongly correlated with the mandibular symmetry plane, which includes menton deviation. This finding may have clinical implications with regard to the treatment of patients requiring correction of lip canting. Further studies are necessary for evaluating changes in lip canting after orthognathic surgery.

The effectiveness of repetitive transcranial magnetic stimulation on the post-stroke motor recovery is not apparent. To perform an accurate evaluation, we adjusted for critical factors that determine motor outcomes, including lesion location and the state of the corticospinal tract. We only included patients with cerebral infarct in the corona radiata and with corticospinal tract interruption, apparent on diffusion tensor tractography. We retrospectively enrolled 34 patients whose diffusion tensor tractography corticospinal tract was interrupted by a cerebral infarct. The corticospinal tract state of each patient was evaluated using diffusion tensor tractography. Of the 34 patients whose corticospinal tract was interrupted on diffusion tensor tractography, 12 patients underwent repetitive transcranial magnetic stimulation treatment at the early stage after cerebral infarct (repetitive transcranial magnetic stimulation group). In comparison, 22 patients did not receive repetitive transcranial magnetic stimulation treatment (non-repetitive transcranial magnetic stimulation group). High-frequency repetitive transcranial magnetic stimulation (10 Hz) was performed on the primary motor cortex of the affected hemisphere. At the six month evaluation after the onset of the infarct, motor function was measured in each patient. In both groups, compared to their states during the initial evaluation, significant improvement was found in all measurements of motor function. However, six months after onset, no significant differences between the two groups were found in these measurement scores. When a patient's CST is interrupted, high-frequency repetitive transcranial magnetic stimulation treatment at the early stage after cerebral infarct might have no additional therapeutic effect on motor outcome. Qualified randomized controlled trials are needed to support our findings further.

Purpose Gastric cancer has a high mortality rate worldwide. Although treatments, such as molecular-targeted therapy, have been introduced, the resulting long-term survival and prognosis remain unsatisfactory. Downregulation of the target genes using lentivirus-mediated short hairpin RNA (shRNA) can be an effective therapeutic strategy for patients with gastric cancer. Overexpressed vascular endothelial growth factor A (VEGF) in human gastric cancer cells can be an effective novel therapeutic target for human gastric cancer. Thus, this study aimed to evaluate the therapeutic effects of lentivirus-mediated knockdown of VEGF gene expression in human gastric cancer growth. Materials and methods Specific shRNA sequences targeting VEGF were designed to construct a lentiviral expression vector. After human gastric carcinoma cells (cell line NCI-N87) were infected with the lentiviral vector, the therapeutic effects of the lentivirus-mediated shRNA targeting VEGF were analyzed both in vitro and in vivo. Results Stable suppression of VEGF gene expression in NCI-N87 cells using shRNA (ShVEGF) showed significant inhibition of cell proliferation, clonogenicity, and cell motility. ShVEGF also showed increased G0/G1 cell cycle arrest and apoptosis. In addition, in vivo results from nude mice xenografted ShVEGF showed significant inhibition of tumor growth. Assessing the therapeutic effects of intratumoral injection of lentivirus-targeting VEGF (Virus_VEGF) revealed that it significantly inhibited tumor growth compared to that in the Virus_Scramble or saline injection control groups. Conclusion The constructed ShVEGF showed significant inhibition of NCI-N87 gastric cancer cell growth both in vitro and in vivo. These experimental results suggest a novel therapeutic strategy for patients with gastric cancer using lentivirus-mediated shRNA targeting VEGF.

본 연구에서는 슬라이딩 문이 설치된 음압격리병실에서 슬라이딩 문의 개폐속도, 의료진의 이동속도 및 이동방향 그리고 실압차 및 배기구 위치에 따른 음압격리병실과 전실 간의 오염공기 유출 가능성에 대해 비교 분석하였다. 해석결과 다음과 같은 결론을 얻을 수 있었다. (1) 의료진의 이동이 없는 조건에서 슬라이딩 문의 개폐에 따른 오염공기 유출량과 의료진의 이동과 슬라이딩 문의 개폐가 이루어지는 조건에서의 오염공기 유출량을 비교하였다. 그 결과 슬라이딩 문의 개폐에 따른 오염공기 유출량보다 의료진의 이동에 의한 오염공기 유출량이 크다는 결과를 얻을 수 있었다. 이는 슬라이딩 문의 개폐에 따른 와류가 거의 발생되지 않아 오염공기 유출에 큰 영향을 미치지 못했던 반면, 의료진이 격리실에서 전실로 이동시 의료진의 이동에 의하여 유도되는 오염공기와 의료진이 전실에서 격리실로 이동시 의료진의 이동에 따른 후류의 발생으로 전실로 확산된 오염공기가 오염공기 유출에 영향이 크다고 볼 수 있다. (2) 슬라이딩 문의 개폐속도와 의료진의 이동속도에 따른 오염공기 유출량은 의료진의 이동속도가 느릴수록, 슬라이딩 문의 개폐속도는 빠를수록 오염공기 유출량이 감소되는 경향을 보였다. 이는 슬라이딩 문의 개폐에 따른 와류의 생성은 매우 약하기 때문에 문의 개폐에 의한 유출량보다는 문의 개방된 시간이 길어질수록 격리실에서 전실로 오염공기가 확산될 위험성이 높아진다고 볼 수 있다. 또한, 의료진의 이동속도가 빠를수록 의료진의 이동에 따른 후류의 발생 및 관성력의 영향이 커져 오염공기 유출량이 증가되는 것으로 보여진다. (3) 의료진의 이동방향에 따른 오염공기 유출량은 동일한 슬라이딩 문의 개폐속도와 의료진의 이동속도에서 의료진이 격리실에서 전실로 이동하는 경우가 전실에서 격리실로 이동하는 경우보다 증가하는 결과를 볼 수 있었다. 이는 의료진이 격리실에서 전실로 이동시 의료진의 이동에 유도되어 유출되는 오염공기가 전실에서 격리실로 이동시 의료진의 이동에 따른 후류 및 와류의 영향으로 발생되는 유출량보다 더 크다고 판단되며, 이에 따라 의료진의 이동방향이 오염공기의 확산에 영향을 미칠 수 있음을 보여주고 있다. (4) 따라서, 음압격리병실에서 오염공기의 유출을 최소화하기 위해서는 슬라이딩 문의 개폐속도를 빠르게 하여 문의 개방시간을 단축시키며, 의료진의 이동속도를 제한함으로써 의료진의 이동에 따른 오염공기 유출의 감소와 의료진이 격리실에서 전실로 이동시 행동절차에 대한 세부적인 기준이 필요할 것으로 판단된다. (5) 실압차에 따라 2.5 Pa의 경우에는 실압차에 의한 오염공기 유출량보다는 의료진의 이동에 따른 오염공기 유출량이 지배적인 요소라는 결과를 볼 수 있었지만, 반대로 15Pa의 경우 의료진의 이동에 따른 오염공기 유출량보다는 실압차에 따른 오염공기 유출량이 지배적인 요소라는 결과를 볼 수 있었다. 이는 슬라이딩 문이 개방된 이후 격리실과 전실 간의 압력차가 거의 사라짐에 따라 의료진의 이동이 없는 한 오염공기 유출에 영향을 미칠 수 있는 요소는 문이 개방된 이후 실간 급·배기의 풍량차로 인한 기류와 복도와 전실 사이의 문 틈새로 통하는 기류라고 볼 수 있다. 따라서 실압차가 2.5Pa의 경우 다소 적은 급·배기 풍량차와 전실과 복도 사이의 문 틈새를 통한 느리고 약한 기류로 인하여 의료진의 이동에 따른 후류 및 유도된 오염공기 유출량이 크게 영향을 미치는 것으로 보여진다. 또한, 15Pa의 경우 상대적으로 많은 급·배기 풍량차와 전실과 복도 사이의 문 틈새를 통한 빠르고 강해진 기류로 인하여 오염공기 유출량에 영향을 미치는 것으로 판단된다. (6) 실압차 2.5 Pa과 15 Pa 모두 배기구 위치에 따른 오염공기 유출량은 문과 바로 맞은편 중앙에 설치된 배기구가 측벽에 설치된 배기구보다 다소 높은 오염공기 유출량을 보였다. 이는 문과 바로 맞은편 중앙에 설치된 배기구의 경우 오염공기가 격리실 내에서 크게 확산된 반면, 배기구가 측벽에 설치된 경우 오염공기의 확산이 상대적으로 작게 나타남을 볼 수 있다. 이는 측벽에 설치된 배기구의 경우 문과 바로 맞은편 중앙에 설치된 배기구에 비해 비대칭성 기류가 형성되며, 오염공기를 한 방향으로 모이게 되어 오염공기의 확산을 상대적으로 감소시켰기 때문으로 판단된다. 위와 같은 해석결과 음압격리병실에서 의료진의 이동이 오염공기 유출에 큰 영향을 미칠 수 있으므로 의료진이 진료를 위해 병실을 출입할 경우 세부적인 행동절차에 대한 기준 설정 등이 필요하며, 슬라이딩 문의 개방 시간을 축소시키는 것이 중요하다는 것을 알 수 있다. 큰 압력차에 의해 생성되는 기류가 음압격리병실의 오염공기 유출량을 더욱 상승하게 한다는 해석결과를 바탕으로 음압격리병실의 적절한 압력차에 대한 더 세밀한 기준설정이 필요할 것으로 판단된다. 그리고 배기구의 위치에 따른 기류가 격리실 내부 오염공기의 분포에 영향을 미쳐 오염공기 유출량의 차이를 보일 수 있으므로 배기구 위치 선정 시 격리실 내부기류를 고려한 세밀한 검토가 요망된다. 향후 본 연구의 신빙성을 높이기 위해 병실 화장실, 침구류 및 환자의 위치 등 실제 음압격리병실과 동일한 조건에서 추가적인 해석연구를 진행할 예정이다.

Background and objectivesFTY720 ((2-amino-2-)2-[4-octylphenyl]ethyl)-1,3-propanediol) is an Food and Drug Administration (FDA)-approved immunomodulatory drug for treating multiple sclerosis. It inhibits lymphocyte egression from lymphoid tissues by downregulating sphingosine-1 phosphate receptor (S1PR). To date, there has been no study on the effects of FTY720 on the chronic stage of the complex regional pain syndrome (CRPS) rodent model, despite its antiallodynic effect in previous studies. Thus, the aim of this study is to investigate the effect of FTY720 in a chronic stage of the CRPS mouse model.MethodThe authors used a mouse model of CRPS, involving tibia fracture/cast immobilization, to test the efficacy of intrathecal FTY720 (2.5 or 25 ng daily; 6 days) or vehicle during the chronic (7 weeks after fracture) stage of CRPS.ResultsIntrathecal recombinant FTY720 administration was antiallodynic in the chronic stage of the CRPS mouse model, and such an effect of FTY720 developed by modulating astrocyte activation in the spinal cord. Additionally, according to the in vitro data, the FTY720 treatment inhibited S1P-induced increase in the nitric oxide production and suppression of the NF-κB pathway, by inhibiting the phosphorylation of NF-κB/p65 in astrocytes without toxic effect on astrocytes.ConclusionCollectively, these results demonstrate that intrathecally administered FTY720 attenuates mechanical allodynia in the chronic stage of the CRPS mouse model.

Rotator cuff tear (RCT) is a common injury that causes pain and disability in adults. The quantitative diagnosis of the RCT can be crucial in determining a treatment plan or monitoring treatment efficacy. Currently, only a few diagnosis tools, such as magnetic resonance imaging (MRI) and ultrasound imaging (US), are utilized for the diagnosis. Specifically, US exhibited comparable performance with MRI while offering a readily available diagnosis of RCTs at a lower cost. However, three-dimensional(3D) US and analysis of the regions are necessary to enable a better diagnosis of RCTs. Therefore, we developed a wide-field 3D US platform with a semi-automatic 3D image segmentation algorithm for 3D quantitative diagnosis of RCTs. The 3D US platform is built based on a conventional 2D US system and obtains 3D US images via linear scanning. With respect to 3D segmentation algorithm based on active contour model, frequency compounding and anisotropic diffusion methods were applied, and their effects on segmentation were discussed. The platform was used for clinical examination after evaluating the platform via the RCT-mimicking phantoms. As verified by the Dice coefficient(average DC: 0.663, volume DC: 0.723), which was approximately up to 50% higher than that obtained with conventional algorithms, the RCT regions segmented by the developed algorithm significantly matched the ground truth. The results indicated that the wide-field 3D US platform with the 3D segmentation algorithm can constitute a useful tool for improving the accuracy in the diagnosis of RCTs, and can eventually lead to better determination of treatment plans and surgical planning.

Background: Based on clinical and genetic differences, atopic dermatitis (AD) and psoriasis have been classified in two different diseases, but recently, some authors regarded them as in one spectrum. The histological similarities including epidermal hyperplasia between chronic stages of AD and psoriasis supports the presence of two diseases in one spectrum. Objective: We investigated clinical and immunohistopatho-logical characteristics of adult Korean patients with AD showing psoriasiform chronic dermatitis on histopathology. Methods: In total, 59 Korean patients with chronic AD were enrolled. Clinical, laboratory, and histopathological features were compared between AD patients with psoriasiform features and those with non-psoriasiform chronic dermatitis features on histology. In addition, immunohistopathological characteristics were analyzed using antibodies for key regulatory and effector cytokines in psoriasis. Results: Fifteen patients (25.4%) showed a more “psoriasiform” histological appearance. The lesions in patients with psoriasiform features often showed clearer boundaries and noticeable scaling. The interleukin (IL)-23 expression in the psoriasiform chronic dermatitis group was not different from that in the psoriasis group, but the IL-17 expression was less than that in the psoriasis group. In the case of IL-12, multiple dermal inflammatory cells with dendrites were stained in the psoriasiform chronic dermatitis group compared with the 2 other non-psoriasiform subgroups. Conclusion: The results suggest that IL-12 secreted from dermal inflammatory cells might be one of the important factors associated with the formation of psoriasiform features in chronic AD. However, further studies are required to better define the specific role of IL-12. (Ann Dermatol 32(1) 31∼37, 2020)

Unilateral condylar hyperplasia (UCH) of the mandible is a disorder affecting the condyle size, resulting in facial asymmetry. This study was a retrospective review of 27 patients with UCH who underwent condylectomy between 2000 and 2017 at Yonsei University Dental Hospital. Patient demographic characteristics were summarized. UCH was divided into three subtypes: hemimandibular elongation (HE, n=15), hemimandibular hyperplasia (HH, n=4), and osteochondroma (OC, n=8). Of the 27 patients, only one with the HE type and five (18.5%) with the OC type complained of joint pain. Bone scans of all patients showed higher uptake on the UCH side. Lip and maxillary canting was prominent in the HH and HE types. Five patients (18.5%) underwent condylectomy alone, 13 (48.1%) underwent condylectomy with orthodontic treatment, and nine (33.3%) underwent adjunctive jaw surgery with orthodontic treatment. The treatment modalities varied according to the subtype. In all OC type patients, removal of the hyperplastic condyle treated the facial asymmetry. Additional post-surgical orthodontic treatment was necessary in only three cases (37.5%). All HH type patients required mandibuloplasty. All patients showed a stable occlusal outcome without relapse and an improvement in subjective symptoms, despite a decrease in mouth opening of 2.2mm. These findings might be useful in treatment planning for UCH patients.

Background Pattern hair loss is a very common skin disorder, but more therapeutic modalities for hair growth are still required. Objective We investigated the effect of a newly synthesized sphingolipid-mimetic compound (pseudo-ceramide: bis-oleamide isopropyl alcohol [BOI]) on the promotion of hair growth for patients with mild pattern hair loss. Methods A total of 58 patients with mild pattern hair loss participated in this clinical trial. A randomized, double-blind, placebo-controlled clinical trial was conducted for 6 months. Participants in the experimental group applied 1% BOI lotion (ceramide HS) on the whole scalp once a day for 6 months. Participants in the control group applied simulacrum using the same protocol. We evaluated daily hair loss, hair density, hair thickness, and hair length at intervals of 3 months; patient satisfaction and adverse events were evaluated at 6 months. Results At 6 months in the experimental group, daily hair loss at baseline (52.52 ± 33.98) decreased to 40.41 ± 24.78, vertex hair density at baseline (131.07 ± 43.73) increased to 156.00 ± 39.59, frontal hair density at baseline (104.21 ± 30.72) increased to 124.10 ± 28.28, thickness of vertex hair at baseline (0.067 ± 0.012 cm) increased to 0.075 ± 0.014 cm, thickness of frontal hair at baseline (0.070 ± 0.009 cm) increased to 0.076 ± 0.012 cm, and hair growth rate was 16.17 ± 1.89 mm/month. Conclusion Ceramide HS may be a new candidate for the treatment of pattern hair loss.

Genomic epidemiology is a core component in investigating the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this study, the efficacy of control strategies in South Korea was evaluated using genomic epidemiology based on viral genome sequences of 2,065 SARS-CoV-2 cases identified in South Korea from January 2020 to December 2020. Phylogenetic analysis revealed that the majority of viruses introduced from inbound travelers did not further spread throughout South Korea; however, four distinct subgroups (KR.1–4, belonging to B.1.497, B.1, K.1 and B.41) of viruses caused local epidemics. After the introduction of enhanced social distancing, the viral population size and daily case numbers decreased, and KR.2–4 subgroups were extinguished from South Korea. Nevertheless, there was a subsequent increase in KR.1 subgroups after the downgrading of social distancing level. These results indicate that the international traveler quarantine system implemented in South Korea along with social distancing measures efficiently reduced the introduction and spread of SARS-CoV-2, but it was not completely controlled. An improvement of control strategies will be required to better control SARS-CoV-2, its variants, and future pandemic viruses.

This study evaluated the efficacy and safety of Banha-sasim-tang (BST) in patients with functional dyspepsia (FD). BST (Banxia-xiexin-tang in traditional Chinese medicine and Hange-shashin-to in Kampo medicine) is traditionally prescribed for the treatment of dyspepsia with epigastric stiffness and gastric fullness in China, Japan, and Korea. Patients with FD were randomly administered an oral dose (10 g) of BST syrup or placebo, twice a day for 4 weeks. The primary outcome was the symptom checklist part of the Nepean dyspepsia index (NDI). The secondary outcomes were the quality of life (QoL) part of the NDI, functional dyspepsia-related QoL (FD-QoL), and visual analog scale (VAS). A total of 60 patients with FD were screened, and 50 were randomized into BST group (n = 25) and placebo group (n = 25). Two patients in the placebo group withdrew before the start of the treatment. Administration of BST syrup resulted in improvement in the symptom-related NDI score in the BST group compared with that in the control group; however, the difference was not significant. BST syrup significantly improved “fullness after eating” index of NDI at follow-up time point (2.88 ± 2.65 vs 4.78 ± 2.69, p = 0.0081). In the total score of the QoL section of the NDI and FD-QoL scales, there was no significant improvement in the BST group compared to that in the placebo group. With regard to improvement in overall FD symptoms, the VAS scale showed improvement in both groups, but the difference was not significant. Interestingly, follow-up investigation showed a significantly beneficial effect of BST on FD symptoms, when compared to placebo. Significant improvement observed in VAS score (39.60 ± 22.29 vs 52.17 ± 20.55, p = 0.048). This indicated that the effect of BST lasted even after the completion of the medication regimen. Overall, our data suggest that while BST showed no significant improvement in the symptom-related NDI score and the QoL related scores in NDI and FD-QoL after 4 weeks of treatment, it effectively improved the VAS score and fullness after eating-related symptoms in the follow-up visit.Clinical Trial Registration:https://cris.nih.go.kr; Identifier KCT 0002013

Specialized proresolving mediators are enzymatically oxygenated natural molecules derived from polyunsaturated fatty acids and are considered novel. These novel mediators include lipoxins from arachidonic acid, resolvins and protectins from omega-3 essential fatty acids, and new maresins. These mediators harbor potent dual proresolving and anti-inflammatory properties. Resolvins and protectins are known to be potent when administered to various inflammation-associated animal models of human diseases. Although psoriasis' etiology remains unknown, there is accumulating evidence indicating that cytokines, including tumor necrosis factor (TNF)-α, interleukin (IL)-23, and IL-17, play pivotal roles in its development. Experimentally, resolvins, maresins, and lipoxins downregulate the cytokine expression of the IL-23/IL-17 axis and inhibition of mitogen-activated protein kinases and nuclear factor kappa-light-chain-enhancer of activated B (NF-κB) cell signaling transduction pathways. Here, we assessed the effects of protectin D1 (PD1) on imiquimod (IMQ)-induced psoriasiform skin inflammation and keratinocytes. PD1 showed clinical improvement in skin thickness, redness, and scaling in psoriasis mouse models. Moreover, PD1 decreased IL-1β, IL-6, IL-17, and CXCL1 mRNA expressions and reduced STAT1 and NF-κB signaling pathway activation in lesions. Serum myeloperoxidase, IgG2a, IL-1β, IL-6, IL-17, and TNF-α and spleen CD4+IFN-γ+IL-17+ T lymphocytes were reduced after PD1 treatment in IMQ-induced psoriasiform mouse models. In addition, IL-1β, IL-6, IL-8, and IL-18BP gene expressions were decreased in PD1-treated keratinocytes. Moreover, a decrease in the expression levels of CCL17 and IL-6 and an inhibition of the STAT1 and NF-κB signaling transduction pathways was observed in keratinocytes. These PD1 anti-inflammatory effects suggest that it is a good therapeutic candidate for psoriasis.

Background Mouse hepatitis virus (MHV) A59 is a highly infectious pathogen and starts in the respiratory tract and progresses to systemic infection in laboratory mice. The complement system is an important part of the host immune response to viral infection. It is not clear the role of the classical complement pathway in MHV infection. Objectives The purpose of this study was to determine the importance of the classical pathway in coronavirus pathogenesis by comparing C1qa KO mice and wild-type mice. Methods We generated a C1qa KO mouse using CRISPR/Cas9 technology and compared the susceptibility to MHV A59 infection between C1qa KO and wild-type mice. Histopathological and immunohistochemical changes, viral loads, and chemokine expressions in both mice were measured. Results MHV A59-infected C1qa KO mice showed severe histopathological changes, such as hepatocellular necrosis and interstitial pneumonia, compared to MHV A59-infected wild-type mice. Virus copy numbers in the olfactory bulb, liver, and lungs of C1qa KO mice were significantly higher than those of wild-type mice. The increase in viral copy numbers in C1qa KO mice was consistent with the histopathologic changes in organs. These results indicate that C1qa deficiency enhances susceptibility to MHV A59 systemic infection in mice. In addition, this enhanced susceptibility effect is associated with dramatic elevations in spleen IFN-γ, MIP-1 α, and MCP-1 in C1qa KO mice. Conclusions These data suggest that C1qa deficiency enhances susceptibility to MHV A59 systemic infection, and activation of the classical complement pathway may be important for protecting the host against MHV A59 infection.

In this study, the effect of light on the regulation of flavonoid production in young barley leaves (YBLs) was investigated. YBLs following germination were illuminated with different light-emitting diode (LED) lights, i.e. blue, red, far-red light, along with fluorescence and dark conditions as controls, and as the main flavonoid, saponarin content of YBLs was analyzed quantitatively with HPLC. In addition, the antioxidant activities of the crude ethanoic extracts of YBLs were analyzed by several antioxidant assays. The content of saponarin in blue light-illuminated barley leaves is two or three times higher than those in barley leaves with other lighting conditions, i.e. red, far-red, and the content with fluorescence and even dark conditions as controls. However, the levels of saponarin among the leaves illuminated with other lighting systems show no significant difference. And, the antioxidant potentials of the extracts of YBLs demonstrated same tendency shown in saponarin levels. Our results suggested that blue lighting conditions might evoke the photoprotection changes in YBLs, leading elevated level of saponarin, consequently increasing their antioxidant potentials.

Exposure to ionizing radiation leads to severe damages in radiosensitive organs and induces acute radiation syndrome, including effects on the hematopoietic system and gastrointestinal system. In this study, the radioprotective ability of KMRC011, a novel toll-like receptor 5 (TLR5) agonist, was investigated in C57BL6/N mice exposed to lethal total-body gamma-irradiation. In a 30-day survival study, KMRC011-treated mice had a significantly improved survival rate compared with control after 11 Gy total-body irradiation (TBI), and it was found that the radioprotective activity of KMRC011 depended on its dosage and repeated treatment. In a 5-day short-term study, we demonstrated that KMRC011 treatment stimulated cell proliferation and had an anti-apoptotic effect. Furthermore, KMRC011 increased the expressions of genes related to DNA repair, such as Rad21, Gadd45b, Sod2 and Irg1, in the small intestine of lethally irradiated mice. Interestingly, downregulation of NF-κB p65 in the mouse intestine by KMRC011 treatment was observed. This data indicated that KMRC011 exerted a radioprotective activity partially by regulating NF-κB signaling. Finally, peak expression levels of G-CSF, IL-6, IFN-γ, TNF-α and IP-10 induced by KMRC011 treatment were different depending on the route of administration and type of cytokine. These cytokines could be used as candidate biomarkers for the evaluation of KMRC011 clinical efficacy. Our data indicated that KMRC011 has radioprotective activity in lethally irradiated mice and may be developed as a therapeutic agent for radioprotection.

The attrition of binary mixtures of iron powder, as a representative oxygen carrier, and limestone, as a CO2 sorbent, was investigated to examine the interactions of two different solid species. An air-jet apparatus based on ASTM D5757, with several improvements, was used to test particle attrition for various times (3, 6 and 12 h), temperatures (20, 250 and 500 °C), gas flow rates (6, 8 and 10 LPM) and particle mixture compositions (Iron:Limestone mass ratios 1:0, 0.75:0.25, 0.5:0.5, 0.25:0.75 and 0:1). Attrition was affected by the fluidization velocity in relation to the minimum fluidization velocities of the two species, and the mixture mass ratio. High temperature increased the generation of iron fines, while reducing the production of limestone fines. As expected, increasing the air flow rate led to the generation of more fines of both iron and limestone.

Streptococcus pneumoniae causes many people to suffer from pneumonia, septicemia, and other diseases worldwide. To identify the difference in susceptibility of and treatment efficacy against S. pneumoniae in three ICR mouse stocks (Korl:ICR, A:ICR, and B:ICR) with different origins, mice were infected with 2 × 106, 2 × 107, and 2 × 108 CFU of S. pneumoniae D39 intratracheally. The survival of mice was observed until three weeks after the infection. The three stocks of mice showed no significant survival rate difference at 2 × 106 and 2 × 107 CFU. However, the lung and spleen weight in the A:ICR stock was significantly different from that in the other two stocks, whereas the liver weight in B:ICR stock was significantly lower than that in the other two stocks. Interestingly, no significant CFU difference in the organs was observed between the ICR stocks. The level of interferon gamma inducible protein 10 in Korl:ICR was significantly lower than that in the other two stocks. The level of granulocyte colony stimulating factor in B:ICR was significantly lower than in the other two stocks. However, tumor-necrosis factor-alpha and interleukin-6 levels showed no significant difference between the ICR stocks. In the vancomycin efficacy test after the S. pneumoniae infection, both the single-dose and double-dose vancomycin-treated groups showed a significantly better survival rate than the control group. There was no significant survival difference between the three stocks. These data showed that Korl:ICR, A:ICR, and B:ICR have no susceptibility difference to the S. pneumoniae D39 serotype 2.

Background The incidence of facet tropism (FT) and its correlation with low back pain (LBP) have, to our knowledge, not yet been investigated among selected community-based populations who visited departments unrelated to LBP with their chief complaints unrelated to LBP. In this study, we aimed to evaluate the prevalence of FT among selected patients in whom LBP was not the chief complaint and the correlation between FT and LBP among these patients. Methods Among patients who underwent computed tomography during 2014 for reasons unrelated to LBP, we enrolled 462 patients who satisfied the inclusion and exclusion criteria. The degree of tropism was defined as grade 0, 1, and 2 for FT, FT+, and FT++, respectively. LBP was evaluated using a modified version of the Nordic low back pain questionnaire. For additional evaluation of dynamic LBP, the question, "Did your pain go away when lying down still or standing up straight, and did it also intensify when you bend or stretch your back?," was included in the questionnaire. Results The L4-5 intervertebral area was most frequently and severely affected by FT with an incidence rate of 46.3%, and severe FT was observed in 24.7% of the patients. FT increased with age at L2-3 and L5-S1 levels. FT at L2-3 level was correlated with LBP (p = 0.035) and dynamic LBP (p = 0.033). The FT grade at L2-3 level was correlated with dynamic LBP (p = 0.022) but not with LBP (p = 0.077). The relative risk of FT at L2-3 level was 1.614 for LBP and 1.724 for dynamic LBP. Conclusions The prevalence of FT among community-based populations was 46.3% and its severe form was more frequently observed at L4-5 level (24.7%). LBP was correlated with FT at L2-3 level. The relative FT-associated risk of LBP was 1.6 at L2-3 level, and the relative L2-3 FT-associated risk of dynamic LBP was 1.724.

Activated macrophages have the potential to be ideal targets for imaging inflammation. However, probe selectivity over non-activated macrophages and probe delivery to target tissue have been challenging. Here, we report a small molecule probe specific for activated macrophages, called CDg16, and demonstrate its application to visualizing inflammatory atherosclerotic plaques in vivo. Through a systematic transporter screen using a CRISPR activation library, we identify the orphan transporter Slc18b1/SLC18B1 as the gating target of CDg16., Attempts to image activated macrophages in vivo have been hampered by selectivity and delivery problems. Here the authors develop a small molecule fluorescent probe specific to activated M1 and M2 macrophages, identify the orphan receptor Slc18b1/SLC18B1 as the mechanism of uptake, and use it to image atherosclerosis in mice.