Therapeutic potential of stem cell-derived extracellular vesicles in osteoarthritis: preclinical study findings / 한국실험동물학회지

Extracellular vesicles (EVs) are nano-sized particles secreted by almost all cell types, and they mediate various biological processes via cell-to-cell communication. Compared with parental cells for therapeutic purposes, stem cell-derived EVs have several advantages such as reduced risk of rejection, less oncogenic potential, ease of long-term storage, lower chance of thromboembolism, and readiness for immediate use. Recent studies have demonstrated that EVs from stem cells, mostly from mesenchymal stem cells (MSCs) from various tissues, have anti-inflammatory, anti-oxidative, anti-apoptotic, and proliferative role in injured organs including osteoarthritic lesions. Herein, we provide a review about the up-to-date studies in preclinical application of stem cell-derived EVs in osteoarthritis animal arthritis models.

Clinical Characteristics and Treatment Response of Peripheral Neuropathy in the Presence of Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome): Experience at a Single Tertiary Center

BACKGROUND AND PURPOSE: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic small-vessel vasculitis accompanied by asthma, eosinophilia, and eosinophilic inflammation of various tissues including the peripheral nerves. This study investigated the clinical course and long-term outcomes of peripheral neuropathy in patients with EGPA. METHODS: Seventy-one patients with physician-diagnosed EGPA were identified at Samsung Medical Center between January 1995 and April 2014. Sixty-one of these patients were followed-up for more than 1 year and received corticosteroid therapy with or without intravenous cyclophosphamide pulse therapy for 6 to 18 months. Medical records of the 61 patients including demographic data, clinical features, laboratory and pathological findings, treatments, and outcomes were reviewed. RESULTS: Peripheral neuropathy as a manifestation of EGPA was present in 46 (75%) of the 61 patients. The mean follow-up duration of the patients with neuropathy was 6.4 years (range 1.2–18.8 years). The scores on the neurological functional disability scale before and after the combination treatment with corticosteroid and cyclophosphamide were 2.43±0.86 and 0.54±0.95 (mean±SD; p<0.001), respectively. The peripheral neuropathy relapsed in one patient. CONCLUSIONS: The long-term clinical outcome of peripheral neuropathy in patients with EGPA receiving initial corticosteroid and cyclophosphamide combination therapy was favorable with a very low relapse rate.

Adrenal Gland Metastasis of a Gastrointestinal Stromal Tumor / 대한내과학회지

A 56-year-old male with a gastrointestinal stromal tumor (GIST) underwent surgical resection of the tumor. Nine months after surgery, imatinib therapy was initiated because of the discovery of metastatic tumors in the left adrenal gland and in a lymph node of the peritoneum. Seventeen months later, the patient achieved complete remission (CR) and imatinib therapy was continued. However, 48 months after initiation of imatinib therapy, computed tomography scans revealed a left adrenal gland metastasis and the patient underwent left adrenalectomy. Immunohistochemical staining indicated that the spindle-shaped cells of the resected tumor were positive for C-kit, thus confirming metastasis of the GIST. This is the first report from Korea of an adrenal gland metastasis from a GIST. Worldwide, only two such cases have been reported. Here, we describe the first case of a distant recurrence of a GIST in the left adrenal gland after CR had been achieved with the aid of surgical resection and imatinib therapy.

Bisacodyl Induced Severe Rectal Ulcer with Proctitis / 이화의대지

Constipation is a prevalent, often chronic, gastrointestinal motility disorder. Bisacodyl, a stimulant laxative, is widely used to treat constipation in adults and children. This drug is usually safe, but it has some side effects including diarrhea, abdominal pain, colitis, and proctitis. There have been reports that rectal administration of bisacodyl could cause injury to the rectal mucosa by mechanical and chemical mechanisms. However, there has been no report of severe proctitis with rectal ulcers in patients taking oral bisacodyl. In this report, we describe the case of an 80-year-old woman with severe rectal ulcers and proctitis after taking oral bisacodyl for several days, and review the literature.

Effect of SBAR-Collaborative Communication Program on the Nurses' Communication skills and the Collaboration between Nurses and Doctors / 간호행정학회지

PURPOSE: The purpose of this study was to investigate effect of the SBAR-Collaborative Communication Program on nurses' communication skills and on collaboration between nurses and doctors. METHODS: From March 11 to November 11, 2013, data were collected from 180 hospital nurses working in a university hospital in Gyeonggi province. Outcomes were measured at three time intervals; before, three and six months after the program was completed. RESULTS: After participating in this program, there was a significant increase in nurses'communication skills but not in collaboration between nurses and doctors. None of the participants' general categories influenced nurses'communication skills at pre-test, but age, education level, total years of working and work department significantly influenced scores at 3 and 6 months. Work department was the only category for which there was a significant difference in collaboration between nurses and doctors at pre-test, and education level and work department were related to significant improvement at 6 months. CONCLUSION: Findings indicate that this program can improve communication skills for nurses and also, collaboration between nurses and doctors, especially for nurses under 25 years of age. Thus nursing and hospital managers should provide SBAR-Collaborative Communication Programs to new nurses in their job training.

Perceptions on Fixed Night Shift System and Turnover Intention of General Hospital Nurses / 간호행정학회지

PURPOSE: This study was performed to identify perceptions on fixed night shift system and turnover intention of general hospital nurses and to explore a desirable application plan for a fixed night shift system. METHODS: This study was a cross-sectional survey. Participants were 300 nurses working at one general hospital in GyeongGi-Do, Korea. Data were collected from November 3 to 7, 2014, with a structured questionnaires and analyzed using SPSS/PC ver 20.0 programs. RESULTS: Of the participants 73.5% had thought about turnover because of night shifts and the preconditions for desirable fixed night shift system were a payment plan differentiated according to work conditions and an adequate number of nursing staff. Economic and administrative supports like 'raising extra-pay for night shift' and 'increasing the number of paid holidays' were very important for a desirable fixed night shift system. CONCLUSION: The results indicate that the most important factor for a desirable fixed night shift system to decrease nurses' turnover intention is economic and administrative support according to the needs of the nurses. So nursing managers need to find a desirable fixed night shift system considering nurses' demographic characteristics and organizational characteristics.

Thyroid Dysfunction in Obese Children in Jeonju, Korea

PURPOSE: The aim of this study was to evaluate thyroid dysfunction in obese children in Korea. METHOD: We measured body mass index and thyroid hormone in obese, overweight, and normal weight children who visited a pediatric clinic in Jeonju, Korea, from January 2009 to September 2012. RESULTS: The free thyroxoine (FT4) level of the obese group (16.35 +/- 2.79 pmol/L) was lower than levels of the overweight (17.65 +/- 2.31 pmol/L) and normal weight (17.28 +/- 2.35 pmol/L; P=0.012) groups. The average value of FT4 in severely obese children (15.71 +/- 1.68 pmol/L) was lower than those of mildly and moderately obese children (16.40 +/- 2.88 pmol/L). We found no significant difference in thyroid stimulating hormone level between the obese group and normal weight group. CONCLUSION: The FT4 level is lower in obese children than in normal weight children.

Assessment on the Potential Role of Applying Cryoprobe for Tissue Ablation

BACKGROUND/AIMS: Cryotherapy is the therapeutic application for tissue ablation. Clinical applications of cryotherpy such as in pulmonology have increased. Until now, its development in gastroenterology has been insignificant. But, as clinical application such as mucosal ablation on Barrett's esophagus became possible, various applications have been developed. Therefore, it is important to make standards of tissue injury's extent in cryotherapy prior to clinical trial. We evaluated the tissue injury according to the application of cryoprobe with a pig model. METHODS: Cryoprobe was applied to several different segments of the esophagus and stomach for various lengths of time using various number of probe's contact in a pig model. After 48 hours, esophagus and stomach were harvested and histological tissue injury was assessed. The extent of tissue injury was decided by the injury of the deepest layer. RESULTS: Endoscopic application of cryoprobe on esophagus and stomach resulted in a dose-dependent injury: esophageal necrosis was limited to the submucosa after 10 seconds of cryotherapy, and extended to involve the transmural necrosis after over 15 seconds. Necrosis on stomach was extended to involve the transmural necrosis after over 20 seconds. CONCLUSIONS: Positive relationship was seen between the duration and frequency of cryoprobe application and the extent of tissue injury.

A Case of Neonatal Dual Ectopic Thyroid Glands with Congenital Hypothyroidism

An ectopic thyroid occurs when thyroid tissue has not properly migrated from the foramen cecum to the fourth tracheal ring along the midline of the ventral portion of the neck, but instead is located elsewhere. There are some cases of dual-site ectopic thyroid glands, usually involving adolescents or adults. Cases of neonatal dual ectopic thyroid glands are even rarer. We report a case of a dual ectopic thyroid with congenital hypothyroidism found during a neonatal screening of the lingual and upper cervical regions of a patient . The patient had no airway obstruction symptoms, such as dysphagia or grunting. The thyroxine (T4) level was 2.49 microg/dL (normal value: 6.2-22.0 microg/dL) and the thyroid-stimulating hormone (TSH) level was 217.85 microIU/mL (normal value: 1.7-9.1 microIU/mL). A dual ectopic thyroid was diagnosed based on a Tc-99m thyroid scan. After receiving thyroid hormone replacement therapy, the child has developed normally.

Sacral Herpes Simplex Infection Mimicking as Herpes Zoster in the Immune-Competent Patient

No abstract available.

Serum cystatin C level is a useful marker for the evaluation of renal function in patients with cirrhotic ascites and normal serum creatinine levels / 대한간학회지

BACKGROUND/AIMS: Several studies suggested that serum cystatin C (CysC) is more useful than serum creatinine (Cr) for the assessment of renal function in patients with liver cirrhosis. This study evaluated the clinical significance of CysC in patients with cirrhotic ascites and normal Cr level. METHODS: We enrolled patients with cirrhotic ascites and a normal serum Cr level (<1.2 mg/dL). GFR was measured by 99mTc-DTPA renal scan. Serum Cr, CysC, and Cr clearance (CCr) were measured on the same day. Significant renal impairment and severe renal impairment were defined as GFR <60 mL/min and GFR <30 mL/min, respectively. RESULTS: Eighty-nine patients with cirrhotic ascites were enrolled in the study (63 men and 26 women; age, 55+/-11 years). Forty-seven (52.8%) and 42 (47.2%) patients were in Child-Pugh grade B and C, respectively. Serum Cr and CysC levels and GFR were 0.8+/-0.2 mg/dL, 1.1+/-0.3 mg/L, and 73.4+/-25.5 mL/min, respectively. Significant and severe renal impairment were noted in 28 (31.5%) and 2 (2.2%) patients, respectively. GFR was well correlated with serum Cr, CysC, and e-GFRMDRD, while it was not correlated with e-GFRC&G. In multivariate analysis, only CysC was significantly correlated with GFR (beta, 45.620; 95% CI, 23.042-68.198; P<0.001). Serum CysC level was the only independent predictor for significant renal impairment. CONCLUSIONS: Significant renal dysfunction was not rare in patients with cirrhotic ascites, even their serum Cr level is normal. Serum CysC is a useful marker for detecting significant renal dysfunction in these patients.

A case of obstructive jaundice due to limy bile in the cystic and common bile ducts / 대한내과학회지

Limy bile is a rare condition characterized by excessive precipitation of calcium carbonate in the gallbladder; limy bile in the common bile duct is also very rare. Limy bile was first described by Churchman in 1911. The etiology of limy bile is unclear, but complete cystic duct obstruction by gallstones is believed to be a prerequisite for the development of limy bile. Recently, we experienced a case with obstructive jaundice in which the initial simple radiograph showed limy bile in the cystic and common bile ducts, but not the gallbladder. Here, we report the case and review the literature.

Peritonitis due to Aspergillus niger in Two Continuous Ambulatory Peritoneal Dialysis Patients / 대한신장학회지

Aspergillus peritonitis is a rare but serious cause of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. We report 2 cases of peritonitis caused by Aspergillus niger in CAPD which were treated successfully with voriconazole and caspofungin, respectively, and catheter removal. Both patients initially received amphotericin B; however, they were not cured with the agent. We briefly discuss the proper selection of antifungal agent and the treatment duration. Previously reported cases of the CAPD peritonitis caused by A. Niger are also reviewed in this article.

A Case of Duodenobiliary Fistula Caused by a Metal Stent in a Patient with Hepatocellular Carcinoma / 대한소화기내시경학회지

Biliary drainage can improve the quality of life in a patient with obstructive jaundice caused by malignancy. Biliary metal stent insertion is a very useful method because it drains the bile physiologically and patients have little discomfort with the procedure. It has a few complications such as restenosis, liver perforation, bowel perforation, fistula formation and stent dislocation. Perforation and fistula formation are caused by pressure due to the self expanding characteristics of the metal stent. We report here on a case of duodenobiliary fistula that was caused by a biliary metal stent in a patient suffering with hepatocellula carcinoma, and we also include a review of the relevant literature.

A Case of the Facial Variant of Eruptive Vellus Hair Cyst / 대한피부과학회지

Eruptive vellus hair cysts (EVHC) are characterized by multiple, small, discrete red or brown colored papules that usually occur on the chest and extremities. Their etiology is unknown. A variant form of EVHC that occur exclusively on the face is rare and it is very characteristic for its location and color. We report here on a facial variant of EVHC that occurred on the face of 23-year-old woman with asymptomatic, skin-colored to bluish tiny papules. The lesions first appeared at the age of 22-years.

Polymorphism of a COLIA1 Gene Sp1 Binding Site in Korean Women with Pelvic Organ Prolapse

PURPOSE: To evaluate the possible influence of G-->T substitution at the Sp1-binding site of the COLIA1 gene on the risk of pelvic organ prolapse (POP). MATERIALS AND METHODS: The study group consisted of 15 women with advanced stage POP. Fifteen control subjects with uterine myomas among the postmenopausal women were matched for age and parity. DNA was obtained from peripheral blood leukocytes. The fragments of the first intron of the COLIA1 gene were amplified by real time polymerase chain reaction. The polymorphism was identified using LightCycler Technology with hybridization probes. Sequencing reactions were performed on each template using commercial primer. RESULTS: Two groups had no significant difference in medical history, surgical, and smoking history. The homozygous peaks in two groups were noted at 57degrees C on melting curve analysis. Sequencing reactions confirmed the G/G alleles in the 30 specimens tested. We could not find any polymorphism at the Sp1-binding site in COLIA1 gene with advanced stage POP. Statistical significance was considered to be p < .05. CONCLUSION: The polymorphism of the Sp1-binding site in the COLIA1 gene did not contribute to the development of POP in Korea.

A Case of Endoscopic Stenting for Anastomotic Leakage after Total Gastrectomy / 대한소화기내시경학회지

Anastomotic leakage after gastrectomy has significant morbidity and mortality, and the mortality rate has been reported to be over 60%. There have been very few reports concerning endoscopic stenting for the management of anastomotic leakage. Successful treatment of anastomotic leakage with covered self-expanding metallic stents (stent) has recently been reported. A 62-year-old man with melena was diagnosed with advanced gastric cancer and he underwent total gastrectomy. At the 3rd day after surgery, anastomotic leakage was found by an upper gastrointestinal series (UGI). He underwent laparoscopic primary repair on the 5th day after surgery. The leakage resumed thereafter. At the 12th day after the primary repair, the leakage was successfully managed by stent insertion and the patient improved thereafter. At the 11th week after stent insertion, the stent was removed without complications and the leakage was completely closed. At 1 year after stent removal, no stricture has been found on the anastomosis site. We report here on a case of anastomotic leakage after gastrectomy, and this was completely managed by stent insertion.

A Case of a Submucosal Ganglioneuroma of the Ampulla of Vater That Was Treated by Endoscopic Resection / 대한소화기내시경학회지

Submucosal tumors in the gastrointestinal tract are covered with a mucous membrane such as the surrounding tissue. Therefore, the use of endoscopic biopsy to diagnose submucosal tumors is not as effective as that for epithelial tumors. Although imaging tools such as ultrasonography or computed tomography have made great advances, it is still difficult to diagnose submucosal tumors before resection. The surgical resection of tumors is the most accurate diagnostic method, yet less invasive endoscopic resection has been preferred in recent years. We report herein on a rare case of ganglionueroma arising from the Ampulla of Vater and this lesion was incidentally found during performance of routine esohagogastroduodenoscopy. The lesion was diagnosed as a ganglioneuroma, and it was successfully removed through endoscopic resection.

Study for Usefulness of Ultrasonography in the Evaluation of Subcutaneous Nodules / 대한피부과학회지

BACKGROUND: Ultrasonographic imaging is very useful tool to determine various neoplasms and inflammatory changes of the human body. In addition, thanks to the use of various frequencies in ultrasonography, subcutaneous and some dermal lesions can be evaluated without invasive procedures such as a biopsy. OBJECTIVE: This study was performed to evaluate the usefulness of ultrasonography in the diagnosis of subcutaneous nodules. METHODS: We reviewed the medical records of 29 patients with subcutaneous nodules and analyzed the correlation between ultrasonographic findings and final biopsy findings. The HDI-5000 ultrasonography system (Philips, Eindhoven, Netherlands) with variable probes (from 5 to 12 MHz) was used in this study. RESULTS: In 27 patients, ultrasonographic findings were matched with final biopsy findings. One pilomatricoma was misdiagnosed as a cyst and one hemangioma as lipoma. It was very interesting to find that two malignant tumors and one subcutaneous granuloma annulare were detected by ultrasonographic examination in the absence of any clinical clues. CONCLUSION: Ultrasonography is a very useful, noninvasive, easy to apply, and relatively predictive tool for the evaluation of subcutaneous nodules. Although a skin biopsy is necessary for final diagnosis, ultrasonography would be a good substitute in the diagnosis of subcutaneous nodules when the patient refuses a skin biopsy and the nodule is located in a highly cosmetic area.

Spontaneous regression of the mild cervical dysplasia and its related factors / 대한산부인과학회지

OBJECTIVE: The aim of this study was to assess the regression rate of the mild cervical dysplasia and to examine the factors associated with the regression. METHODS: One hundred and nine women pathologically confirmed with mild cervical dysplasia were recruited into this study. They were followed up by cytology, colposcopy and human papillomavirus DNA test at 3 months and 6 months after the diagnosis. The participants filled out a questionnaire on their demographic characteristics and sexual history. RESULTS: The rate of spontaneous regression for the mild cervical dysplasia was 59.6%(65/109). Multivariate analysis showed that initial ASCUS cytology, negative HPV status, non-smoker, condom user and age under 40 years old were associated with higher regression rate. CONCLUSIONS: The rate of regression for mild cervical dysplasia seen in our study was particularly higher than the result in previous study. Therefore, we recommend that the patients with mild cervical dysplasia can be followed up by cytology and HPV DNA study without any intervention, especially in young patients. Initial ASCUS cytology, negative HPV status, non-smoker, condom user and age under 40 years old were good related factors for regression.