Diagnosis of Lung Cancer in a Patient with Chronic Knee Pain Caused by Hypertrophic Osteoarthropathy

Patients with chronic knee pain are common, and symptoms are usually caused by degenerative disorders of the knee joint. Although hypertrophic osteoarthropathy (HOA) is a rare cause of knee pain in patients who visit the department of rehabilitation medicine, clinicians should consider this paraneoplastic syndrome. Herein, we report an uncommon case of hypertrophic pulmonary osteoarthropathy (HPO) in a patient with chronic knee pain who was finally diagnosed with lung cancer. A 49-year-old male was referred to the department of rehabilitation medicine from a local clinic for uncontrolled bilateral knee pain. The plain radiograph and magnetic resonance image (MRI) of the knee showed symmetric periosteal reaction and prepatellar bursitis. For additional evaluation, bone scan was done, and it revealed symmetric linear uptake along the diaphyseal and metaphyseal surfaces of both femurs and tibias, a typical feature of HPO. A plain chest radiograph was taken and showed a mass at the left hilar region. The patient was finally diagnosed with non-small cell lung cancer. After receiving chemotherapy for lung cancer, knee pain improved.

Bilateral Cerebral Ptosis in a Patient with Subdural Hemorrhage: a Case Report

Although cerebral ptosis is rare, it is commonly associated with unilateral right cerebral hemisphere lesions. We report a case of a 79-year-old woman who presented with bilateral complete ptosis after a traumatic right fronto-temporo-parietal subdural hemorrhage (SDH).Bilateral ptosis was the primary manifestation of the acute right SDH, and the patient had no parenchymal lesion. Her prognosis was good, and she made a complete recovery. Right hemispheric hypoperfusion, as demonstrated on brain perfusion single-photon emission computed tomography, implied that the lateralization of eyelid control was in the right hemisphere, in line with previous reports.

Tracheoesophageal Fistula by Chemoradiotherapy after a Total Laryngectomy in a Laryngeal Cancer Patient: A Case Report / 대한연하장애학회지

An acquired tracheoesophageal fistula (TEF) is a rare complication that can occur in the treatment of laryngeal cancer. Explosive coughing from the tracheostomy-opening site after swallowing is a warning sign of the TEF. A 68-year old male laryngeal cancer patient showed delayed TEF after chemoradiotherapy with a total laryngectomy.The clinicians carrying out a videofluoroscopic swallowing study should be familiar with the total laryngectomy state, as well as the findings and initial general management of TEF. This report discusses the pathophysiology and management of TEF and the needs for dysphagia care team after chemoradiation in laryngeal cancer patients.

Effect of the Awareness of a Good Death and Perceptions of Life-sustaining Treatment Decisions on Attitudes of Intensive Care Nurses toward Terminal Care / 중환자간호학회지

PURPOSE: The purpose of this study was to identify the extent to which intensive care unit (ICU) nurses' perceptions of life-sustaining treatment decisions and “a good death” affect attitudes toward terminal care.METHOD: Participants included 109 ICU nurses from three university hospitals. Data were collected using structured questionnaires, and collected data were analyzed using a t-test, ANOVA, the Scheffé test, Pearson correlation coefficients, and a multiple regression analysis (SPSS 24.0 program).RESULTS: Perceptions of life-sustaining treatment decisions and a sense of closeness (a constituent for the awareness of “a good death”) were positively correlated with terminal care attitudes. The factors affecting terminal care attitudes were a clinical career in ICU (β=.20, p=.035), a sense of closeness(β=.19, p=.041), and the perception of a life-sustaining treatment decision (β=.22, p=.017). This finding indicates that more than 10 years of experience in ICU, a greater sense of closeness, and a higher view of life-sustaining treatment decisions results in more positive attitudes toward terminal care. The explanatory power of these variables on terminal care attitudes was 14% (F=6.84, p < .001, Adj R2=.140).CONCLUSION: A sense of closeness and the perception of life-sustaining treatment decisions were identified as the factors affecting terminal care attitudes. Thus, various programs must be developed to raise awareness among ICU nurses of “a good death” and perceptions of life-sustaining treatment decisions.

Genome Sequencing of Human Cytomegalovirus Strain LCW and Identification of Asia-specific Cluster

Human cytomegalovirus (HCMV) is a ubiquitous human pathogen and contains double stranded DNA genome with approximately 230 kbp. Molecular genomic studies of HCMV have been attempted in order to understand the pathogenesis and evolution of HCMV. However, studies on HCMV strains of Asian origin are limited. In this study, it was attempted to understand the genomics of HCMV isolated from Korea. Clinical strain LCW isolated from Korean patient was passaged in vitro cell culture, and subjected to next-generation sequencing. Complete genome sequence was obtained and compared with other HCMV strains. The LCW genome was found to contain 170 open reading frames (ORFs) and two ORF (RL5A and RL13) of the strain LCW were found to be truncated due to early stop codon. Phylogenetic analysis suggested that the strain LCW was closely related with Asian strains such as HCMV strains JHC and HAN. Common nucleotide sequences among the 3 Asian strains distinguishable from other strains were detected at 197 sites including 104 sites in ORFs.

Influence of the microwave sintering period on the 3 point flexural strength and shade of zirconia restoration / 대한치과재료학회지

In this study, we tried to confirm clinically applicable applicability by comparing the difference in 3 point flexural strength and shade of the prosthesis depending on microwave sintering time of dental CAD / CAM zirconia. 3 Point flexural strength specimens (n=30) and shade measurement specimens (n=28) were prepared and sintered at different sintering times. 3 point flexural strength and shade were measured and analyzed by independent t-test (α=0.05). Measurement result of 3 point flexural strength the average of short-term sintering (STS) was 245.47±29.89 MPa, the average of long-term sintering (LTS) was 284.27±31.56 MPa, and there was a statistically significant difference (p 0.05). The 3 point flexural strength of the zirconia restorations fabricated by short time and long time was high in long time sintering. However, other conditions may be required for clinical applications. Since the shade test did not show any significant color difference according to sintering time, it is considered to be sufficient for clinical application.

Gelidium amansii extract ameliorates obesity by down-regulating adipogenic transcription factors in diet-induced obese mice

BACKGROUND/OBJECTIVES: In this study, we investigated whether Gelidium amansii extract (GAE) ameliorates obesity in diet-induced obese (DIO) mice. MATERIALS/METHODS: The mice were maintained on a high-fat diet (HD) for 5 weeks to generate the DIO mouse model. And then mice fed HD plus 0.5% (GAE1), 1% (GAE2) or 2% (GAE3) for 8 weeks. RESULTS: After the experimental period, GAE-supplemented groups were significantly lower than the HD group in body weight gain and liver weight. GAE supplemented groups were significantly lower than the HD group in both epididymal and mesenteric adipose tissue mass. The plasma leptin level was significantly higher in the HD group than in GAE-supplemented groups. The leptin level of HD+GAE3 group was significantly lower than that of the HD+conjugated linoleic acid (CLA) group. In contrast, plasma adiponectin level of the HD group was significantly lower than those of HD+GAE2 and HD+GAE3 groups. The expression levels of adipogenic proteins such as fatty acid synthase, sterol regulatory element-binding protein-1c, peroxisome proliferator-activated receptor γ, and CCAAT/enhancer binding protein α in the GAE supplemented groups were significantly decreased than those in HD group, respectively. In addition, the expression levels of HD+GAE2 and HD+GAE3 groups are significantly decreased compared to those of HD+CLA group. On the contrary, the expression levels of hormone-sensitive lipase and phospho-AMP-activated protein kinase, proteins associated with lipolysis, were significantly increased in the GAE supplemented groups compared to those in the HD group. HD+GAE3 group showed the highest level among the GAE supplemented groups. CONCLUSIONS: These results suggested that GAE supplementation stimulated the expressions of lipid metabolic factors and reduced weight gain in HD-fed C57BL/6J obese mice.

A Study of the Sustainability of NutriPlus Program Effect - in Pohang Area - / 대한지역사회영양학회지

This study was conducted to investigate the effect of the NutriPlus+ Program and to observe how the improved statuses were maintained after the program's termination. The subjects were infants and their parents, who have participated in the NutriPlus+ Program conducted by South Healthcare Center in Po-hang for longer than six months, during the period 2007 - 2010. The survey was conducted with questionnaires, and scores were tabulated from each question. After the intervention of the program, scores representing degrees of nutrition knowledge and nutrition attitude increased. The rate of nutritional risk by anthropometric measurement decreased, and the prevalence rate of anemia was significantly decreased as well. The number of subjects lacking any nutrients, except for iron and vitamin C, decreased, which indicates that the NutriPlus+ Program was effective. After enough time had passed after the intervention's completion; however, the scores of nutrition knowledge and nutrition attitude decreased. The number of subjects with low height and weight (proportional to their age) relatively decreased, and the prevalence rate of anemia increased slightly. The number of subjects lacking in energy and calcium consumption increased as well, which indicates that the effect of the NutriPlus+ Program was not maintained after the program's termination.

Dementia Caused by Post-traumatic Hydrocephalus Showing Marked Improvement After a Shunt Operation

A few cases of dementia caused by posttraumatic hydrocephalus have been reported. A 75-year-old man was admitted to hospital for the evaluation of cognitive impairment and gait disturbance of 2 weeks duration. The patient had been involved in a car accident 50 days prior to his admission. A brain MRI revealed significant hydrocephalus. His score on the Korean version of the Mini Mental State Examination was 14/30, and a neuropsychological assessment revealed severe impairments in all domains. A lumboperitoneal shunt operation was performed. His global cognitive functions and daily activities were fully recovered after the procedure.

Methylation Abnormality in Body Fluid Cytology: A Supplemental Molecular Marker for the Diagnosis of Malignant Mesothelioma / 대한세포병리학회지

Malignant mesothelioma (MM) is a highly lethal neoplasm arising in pleura and the peritoneum and a rapid and accurate diagnosis is crucial for treatment of the disease. However, the sensitivity of cytological analysis using pleural or ascitic fluid is relatively low, yielding an accurate diagnosis in only 32~79% of cases. We tested the diagnostic value of epigenetic alterations in body fluid cytology as a supplement to conventional methods. Paraffin-embedded tissue blocks from 21 MM patients and associated body fluid cytology slides considered no evidence of malignancy were used to test for epigenetic alteration. Using methylation-specific PCR, we detected methylation of RASSF1A and p16 in 47.6% (10/21) of both surgically resected tumor samples, respectively. Body fluid samples of MM also showed abnormal methylation of RASSF1A and p16INK4a genes in 38.1% (8/21) and 33.3% (7/21) of cases. The concordance in the rates of RASSF1A and p16INK4a gene-methylation abnormalities determined from cytology samples and tissue samples were 61.9% (13/21) and 66.7% (14/21), respectively. Combining both genes increases the sensitivity of the test to 57.1% (12 of 21) of cases. Our results suggest that testing for methylation abnormalities in selected individual genes or gene combinations has diagnostic value as an alternative or adjunct method to conventional cytological diagnosis.

Can Diffusion-Perfusion Mismatch on Brain MRI in Acute Ischemic Stroke Patients Predict Clinical Outcome?: Preliminary Study Focused on rCBV

BACKGROUND: Diffusion-perfusion mismatch (DPM) on MRI has been considered an ischemic penumbra. However, several reports have demonstrated limitation of DPM on MRI as a predictable marker of the ischemic penumbra. In this study, we investigated the relationship between DPM and the clinical progression in acute ischemic stroke patients. METHODS: We consecutively recruited fifty-seven patients showing acute ischemic stroke (within 24 hours) in the middle cerebral artery (MCA) territory. The clinical outcomes were determined by serial measurement of National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) during 30 days after their ischemic event. We also evaluated the relationship among the parameters of perfusion MRI and the clinical worsening in patients with DPM on initial MRI. RESULTS: Nineteen (33.3%) patients had DPM on MRI within 24 hours after stroke onset. Even though the frequency of clinical worsening for 30 days after stroke onset was higher in DPM group (26%) than in non-DPM group (11%), it did not reach statistical significance (p=0.143). However, extent of MCA stenosis (p<0.001) and time to peak (TTP) delay on MRI (p<0.001) were significantly greater in patients with DPM than in those without DPM. Among several parameters of the perfusion MRI, only relative cerebral blood volume (rCBV) was significantly related to the clinical worsening (62.9+/-24.7% vs 96.1+/-19.2%, p=0.007) in patients with DPM. CONCLUSIONS: This study shows that DPM on MRI does not always predict the clinical worsening in acute ischemic stroke. To overcome this problem, we should analyze rCBV map based DPM as well as TTP map based DPM.

Chemokine Lkn-1/CCL15 enhances matrix metalloproteinase-9 release from human macrophages and macrophage-derived foam cells

Atherosclerosis is characterized by a chronic inflammatory disease, and chemokines play an important role in both initiation and progression of atherosclerosis development. Leukotactin-1 (Lkn-1/CCL15), a new member of the human CC chemokine family, is a potent chemoattractant for leukocytes. Our previous study has demonstrated that Lkn-1/CCL15 plays a role in the initiation of atherosclerosis, however, little is currently known whether Lkn-1/CCL15 is associated with the progression of atherosclerosis. Matrix metalloproteinases (MMPs) in human coronary atherosclerotic lesions play a crucial role in the progression of atherosclerosis by altering the vulnerability of plaque rupture. In the present study, we examined whether Lkn-1/CCL15 modulates MMP-9 release, which is a prevalent form expressed by activated macrophages and foam cells. Human THP-1 monocytic cells and/or human peripheral blood monocytes (PBMC) were treated with phorbol myristate acetate to induce their differentiation into macrophages. Foam cells were prepared by the treatment of THP-1 macrophages with human oxidized LDL. The macrophages and foam cells were treated with Lkn-1/CCL15, and the levels of MMP-9 release were measured by Gelatin Zymography. Lkn-1/CCL15 significantly enhanced the levels of MMP-9 protein secretion from THP-1 monocytic cells-derived macrophages, human PBMC-derived macrophages, as well as macrophage-derived foam cell in a dose dependent manner. Our data suggest that the action of Lkn-1/CCL15 on macrophages and foam cells to release MMP-9 may contribute to plaque destabilization in the progression of atherosclerosis.

Clinical Characteristics of Sleep Disorders in Parkinson's Disease

BACKGROUND: Sleep disturbances are very common in the patients with Parkinson's disease (PD) and several sleep disorders are known to have pathological associations with PD, such as REM sleep behavior disorder (RBD), restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). The authors conducted this study to find clinical characteristics and impact of sleep disorders in the patients with PD. METHODS: A total of 97 patients with PD (41 males, age 61.0+/-9.3 years, Hoehn and Yahr stage 1-4) were recruited. We interviewed bed partners of parkinsonian patients for sleep disorders with structured questionnaires and compared interview results with the clinical characteristics of Parkinson's disease and the results of cognitive function tests. RESULTS: RLS (24.7%), RBD (19.6%), sleep apnea (15.5%) and PLMD (13.4%) were frequently reported by bed partners of the patients. PLMD, RBD and apnea were significantly increased in male patients. Parkinsonian characteristics of the patients (dose of L-dopa, predominant motor symptom, duration of symptom and treatment, use of dopamine agonist, Hoehn and Yahr stage, and severity of motor symptoms) were not related with sleep disorders and daytime sleepiness, but the bed partners reported decreased arousal and increased daytime sleepiness in the patients with sleep disorders. The cognitive profiles of the patients showed impaired memory function in the sleepy patients. CONCLUSIONS: We could not find the correlations between sleep disorders and the clinical characteristics of PD. But, sleep disorders were prevalent in PD patients and caused daytime sleepiness and cognitive dysfunctions.

A Case of Propofol-Induced Delayed-Onset Refractory Myoclonic Seizures

Propofol, a GABA-mediated inhibitor of excitatory neurotransmitter, is a popular intravenous agent for general anesthesia and sedation. Its side effects reportedly include opisthotonus, seizures, and myoclonus, and are usually manageable. We present a patient who developed propofol-induced delayed-onset refractory myoclonic seizures that resisted antiepileptic drugs.

A Case of Propofol-Induced Delayed-Onset Refractory Myoclonic Seizures

Propofol, a GABA-mediated inhibitor of excitatory neurotransmitter, is a popular intravenous agent for general anesthesia and sedation. Its side effects reportedly include opisthotonus, seizures, and myoclonus, and are usually manageable. We present a patient who developed propofol-induced delayed-onset refractory myoclonic seizures that resisted antiepileptic drugs.

The Change of Anti-HBs Titer after Hepatitis B Vaccination in Newborn

No abstract available.

A Case of Transient Myeloproliferative Disorder in Down's Syndrome

No abstract available.