Beneficial Effect of Chloroquine and Amodiaquine on Type 1 Diabetic Tubulopathy by Attenuating Mitochondrial Nox4 and Endoplasmic Reticulum Stress

Background@#Oxidative stress induced by chronic hyperglycemia is recognized as a significant mechanistic contributor to the development of diabetic kidney disease (DKD).Nonphagocytic nicotinamide adenine dinucleotide phosphate oxidase 4 (Nox4) is a major source of reactive oxygen species (ROS) in many cell types and in the kidney tissue of diabetic animals. We designed this study to explore the therapeutic potential of chloroquine (CQ) and amodiaquine (AQ) for inhibiting mitochondrial Nox4 and diabetic tubular injury. @*Methods@#Human renal proximal tubular epithelial cells (hRPTCs) were cultured in highglucose media (30 mM D-glucose), and diabetes was induced with streptozotocin (STZ, 50 mg/kg i.p. for 5 days) in male C57BL/6J mice. CQ and AQ were administered to the mice via intraperitoneal injection for 14 weeks. @*Results@#CQ and AQ inhibited mitochondrial Nox4 and increased mitochondrial mass in hRPTCs under high-glucose conditions. Reduced mitochondrial ROS production after treatment with the drugs resulted in decreased endoplasmic reticulum (ER) stress, suppressed inflammatory protein expression and reduced cell apoptosis in hRPTCs under high-glucose conditions. Notably, CQ and AQ treatment diminished Nox4 activation and ER stress in the kidneys of STZ-induced diabetic mice. In addition, we observed attenuated inflammatory protein expression and albuminuria in STZ-induced diabetic mice after CQ and AQ treatment. @*Conclusion@#We substantiated the protective actions of CQ and AQ in diabetic tubulopathy associated with reduced mitochondrial Nox4 activation and ER stress alleviation. Further studies exploring the roles of mitochondrial Nox4 in the pathogenesis of DKD could suggest new therapeutic targets for patients with DKD.

Personality Characteristics, Attachment Type and Communication Skills in Mothers of Children with Alopecia Areata / 신경정신의학

OBJECTIVES: Recent studies have suggested that the personality and communication style of the mother can affect the progress of disease in children with chronic illnesses. The current study assessed the characteristics, attachment type and communication skill of mothers who have children with alopecia areata that may concern their children. METHODS: The subjects of this study were 46 mothers of children with alopecia areata (alopecia children: mean age 7.52+/-3.41yrs ; 27 males, 19 females), who visited the alopecia clinic at the Dermatology Department of Chung-Ang University Hospital, and 42 mothers of normal children (control children : mean age 6.85+/-0.46 yrs; 20 males, 22 females). The Minnesota Multiphasic Personality Inventory (MMPI) subscale, the Revised Adult Attachment Scale (RAAS), the Parent Adolescent Communication Inventory (PACI), and the Campbell Index of Well-Being were administered to all the subjects for the purpose of comparing the mothers of the alopecia group with those of the normal controls. RESULTS: There were no differences in socio-demographic characteristics between the alopecia and control group mothers. The MMPI scores of both groups were within the normal profile ranges, but the scores of the mothers in the alopecia areata group were significantly lower than those in the control group mothers on the Pd(4), Mf(5), and Ma(9) subscales (p=0.028, p=0.001, p=0.005 respectively). There were significant differences in communication style between the two groups. Alopecia group mothers showed less open family communication (p=0.034) and more problems in family communication (p=0.000) than the control group mothers. The scores on problems in family communication were positively correlated with Pd(4) scores (r=0.48, p=0.03). An insecure attachment style was more common in the alopecia group mothers than in control group mothers (p=0.023). There was no difference between the two groups of mothers on the Index of Well-Being. CONCLUSION: Compared with the mothers of control group children, the mothers of children with alopecia areata had more depressed and suppressed personality characteristics not expressing their psychological conflicts directly (low Pd, Mf, and Ma scores), more problems in family communication with their children and more insecure attachment type. We suggest that these results should be considered in the treatment of children with alopecia, and that psychological intervention for their mothers is needed.

Breast Reconstruction with Free TRAM Flap in Patients with Abdominal Scars

Breast reconstruction with free TRAM flap is a common procedure. However patients with abdominal scars can be confronted with a challenging problem in performing flap reconstruction. The inadequate blood supply around the scar can result in various skin complications in flap or donor site, but there are no reported guidelines in our country. From May 1999 to March 2003, a total of 38 breast reconstructions using free TRAM flaps were performed for 37 patients, of whom 12 had abdominal scars from previous operations; 7 had midline vertical scars and 4 had low transverse scars from Cesarean section or total hysterectomy, 3 had right lower quadrant oblique scars from appendectomy (2 also had transverse scars from Cesarean section). We attempted to minimize flap and donor site complications by modifying classic free TRAM flap designs and procedures according to the characteristics of the abdominal scars and performed periodic follow-up observations of flaps and donor sites for presence of complications and also gave surveys for patient satisfaction on the reconstructed breast. All 38 patients underwent successful breast reconstructions with neither skin complications around the scar nor flap loss and 96.4% patients reported being very satisfied or satisfied with the results.

Traumatic Blindness Due to Injury of Internal Carotid Artery Associated with Craniomaxillofacial Fracture

A case of traumatic internal carotid artery injury associated with skull base fracture, Le Fort II fracture and mandible fracture after maxillofacial blunt trauma which resulted in delayed blindness is presented. This condition would appear to be a rare consquence of maxillofacial trauma. Internal carotid artery injury including dissection is an important consequence of blunt craniomaxillofacial trauma with potentially devastating consquences. It should be emphasized that skull base fracture involving the course of the internal carotid artery provides an important clue to significant vascular injury and, when present, provides the impetus for vascular imaging study.