Neuronal maturation in the hippocampal dentate gyrus via chronic oral administration of Artemisa annua extract is independent of cyclooxygenase 2 signaling pathway in diet-induced obesity mouse model

Recently, we reported that Artemisia annua (AA) has anti-adipogenic properties in vitro and in vivo. Reduction of adipogenesis by AA treatment may dampen systemic inflammation and protect neurons from cytokine-induced damage. Therefore, the present study was undertaken to assess whether AA increases neuronal maturation by reducing inflammatory responses, such as those mediated by cyclooxygenase 2 (COX-2). Mice were fed normal chow or a high-fat diet with or without chronic daily oral administration of AA extract (0.2 g/10 mL/kg) for 4 weeks; then, changes in their hippocampal dentate gyri were measured via immunohistochemistry/immunofluorescence staining for bromodexoxyuridine, doublecortin, and neuronal nuclei, markers of neuronal maturation, and quantitative western blotting for COX-2 and Iba-1, in order to assess correlations between systemic inflammation (interleukin-6) and food type. Additionally, we tested the effect of AA in an Alzheimer's disease model of Caenorhabditis elegans and uncovered a potential benefit. The results show that chronic AA dosing significantly increases neuronal maturation, particularly in the high-fat diet group. This effect was seen in the absence of any changes in COX-2 levels in mice given the same type of food, pointing to the possibility of alternate anti-inflammatory pathways in the stimulation of neurogenesis and neuro-maturation in a background of obesity.

Multidirectional Vector Excision Leads to Better Outcomes than Traditional Elliptical Excision of Facial Congenital Melanocytic Nevus

BACKGROUND: The elliptical excision is the standard method of removing benign skin lesions, such as congenital melanocytic nevi. This technique allows for primary closure, with little to no dog-ear deformity, but may sacrifice normal tissue adjacent to the lesion, resulting in scars which are unnecessarily long. This study was designed to compare the predicted results of elliptical excision with those resulting from our excision technique. METHODS: Eighty-two patients with congenital melanocytic nevus on the face were prospectively studied. Each lesion was examined and an optimal ellipse was designed and marked on the skin. After an incision on one side of the nevus margin, subcutaneous undermining was performed in the appropriate direction. The skin flap was pulled up and approximated along several vectors to minimize the occurrence of dog-ear deformity. RESULTS: Overall, the final wound length was 21.1% shorter than that achieved by elliptical excision. Only 8.5% of the patients required dog-ear repair. There was no significant distortion of critical facial structures. All of the scars were deemed aesthetically acceptable based on their Patient and Observer Scar Assessment Scale scores. CONCLUSIONS: When compared to elliptical excision, our technique appears to minimize dogear deformity and decrease the final wound length. This technique should be considered an alternative method for excision of facial nevi.

A Retrospective Analysis of Eight Cases of Merkel Cell Carcinoma

BACKGROUND: Merkel cell carcinoma (MCC) is a rare locally aggressive cutaneous neuroendocrine carcinoma with a high incidence of local recurrence, regional lymph node metastasis, followed by distant metastasis. Because of shortage of the retrospective study, standard treatment has not been established. The purpose of this study was to present the surgical treatment and outcome of 8 patients with MCC. METHODS: We report our experiences with 8 patients who underwent treatment for MCC at our institution from 2000 through 2012. Two men and 6 women received treatment for MCC. The mean age was 76.4 years (range, 53 to 93 years). RESULTS: The follow-up period ranged from 7 to 26 months (mean, 22.9). During the follow-up period, three of 8 patients had a relapse (mean time before recurrence, 10 months; 1 month, 7 months, and 22 months). After primary surgery, 3 patients underwent radiotherapy, and 1 patient received chemotherapy. CONCLUSION: MCC is an aggressive skin cancer with a high rate of local recurrence. Complete surgical excision is the mainstay of local treatment, but adjuvant radiotherapy should be considered for better local control.

Myositis Ossificans Traumatica in the Temporalis Muscle

Myositis ossificans is a condition characterized by ossification within a muscle. It is a rare and unusual pathologic entity that has defied medical efforts to establish a definite etiology, pathogenesis, and satisfactory treatment of the disease. The condition predominantly affects the flexor muscles of the upper limbs and thighs, but rarely the head and neck area. A 53-year-old male patient visited our medical institution complaining of trismus, defined as limited mouth opening. The patient had a history of trauma to the facial bones and the computed tomography scans revealed calcification in the left temporalis muscle. The patient underwent surgical removal of the calcified mass with bilateral coronoidectomy under general anesthesia. Mouth opening at the end of post-operative 2 months was 28 mm. His oral intake of food was satisfactory. Myositis ossificans of the temporalis muscle is a very rare case. Satisfactory outcome was obtained by combining surgical excision of the affected muscle, coronoidectomy, and detachment of the insertion site of the ossified muscle.

Reconstruction of Soft Tissue Defect of Knee Joint Area Using Anterolateral Thigh Perforator Flap

Reconstruction of soft tissue defect of knee joint area has been remained a challenging task for plastic surgeons. The earlier the normal tissue saved and the necrotic tissue removed, the less the patients had complications and functional disability. But such defects are difficult to manage for its poor vascularity, rigid tissue distensibility, easy infectability and a relatively long healing period. The goal of flap coverage in the knee joint should not only be satisfactory wound coverage, but also acceptable appearance and minimal donor site morbidity. We have treated five cases using the anterolateral thigh perforator flaps for reconstruction successfully. In conclusion, we believe that in cases of knee joint area soft tissue defects, flaps like anterolateral thigh perforator flap should be considered as the first line of treatment.

Cross-Cultural Adaptation and Validation of the Korean Version of the EQ-5D in Patients with Rheumatic Diseases / 대한류마티스학회지

OBJECTIVE: This study is to determine the cross-cultural adaptation and validation of the Korean version of the EQ-5D (KEQ-5D) in various rheumatic patients. METHODS: We performed translation, backward translation and cognitive debriefing by the guidelines of the EuroQol group. The validity was evaluated by using the KEQ-5D, Korean Short- Form 36 (KSF-36) and disease-specific measures on 508 out-patients with ankylosing spondylitis, fibromyalgia syndrome, rheumatoid arthritis, osteoarthritis or systemic lupus erythematosus. Construct validity were evaluated by testing a-priori hypotheses of the association between the KEQ-5D and other measures. For the verification of reliability, we gave the same questionnaires twice to another 57 patients 1-week apart, and intra-class correlations and Kappa statistics were estimated. To test responsiveness, 60 patients with RA repeated the KEQ-5D at 12-week intervals within the context of 12-week clinical trials of a TNF blocker, and we calculated the t-test, effect size and standardized response mean RESULTS: There were no major modifications on the cross-cultural adaptation. The relationships between the KEQ-5D and the generic or disease-specific measures were observed to be as we expected previously in a-priori hypotheses:higher KEQ-5Dindex and KEQ-5DVAS scores were correlated with generic or disease-specific measures on the better health status, and groups with a better functional class showed higher KEQ-5D scores. The intra-class correlations of the KEQ-5Dindex and KEQ-5DVAS were 0.751 and 0.767, respectively, and Kappa statistics for agreement ranged from 0.455 to 0.772 across five dimensions. The standardized response means of KEQ-5Dindex and KEQ-5DVAS were 0.649 and 0.410. CONCLUSION: The KEQ-5D had good validity and sensitivity in several rheumatic conditions. Also, its reliability and responsiveness were moderate to good.

Thiopurine S-methyltransferase Polymorphisms and the Relationship between the Mutant Alleles and the Adverse Effects in Systemic Lupus Erythematosus Patients Taking Azathioprine / 대한류마티스학회지

OBJECTIVES: To elucidate the genetic basis for Thiopurine methyltransferase (TPMT) polymorphism and investigate the relationship between TPMT mutant and the adverse effect in patients with systemic lupus erythematosis (SLE) taking azathioprine (AZA) in Korea. METHODS: The TPMT genotype was determined in two hundred healthy adults and 342 patients with SLE by MALDI-TOF and correlated with the effects of clinical exposure to AZA. RESUTLS: TPMT polymorphism were detected in 2/200 healthy adults (1%), which were heterozygotes with TPMT*3C and TPMT*6 allele, respectively, and 17/342 (4.97%), which were 12 heterozygotes with TPMT*3C and 5 heterozygotes with TPMT*6 allele, respectively, which had a higher frequency of TPMT mutant alleles compared to the healthy controls (p=0.015). Severe nausea occurred in 4 patient with TPMT*3C allele, and severe bone marrow toxicity in a patient with TPMT*6 allele taking AZA. Twenty three in 94 (24.47%) SLE patients taking AZA were suspicious of the adverse effects such as leucopenia (n=17), nausea (n=4) and abnormal liver function test (n=1). AZA was relatively well tolerated among the rest of them. CONCLUSION: The heterozygote with TPMT*3C and *6 were frequently detected in the patient with SLE compared to healthy adults and there was no statistical correlation between TPMT genotype and AZA toxicity. TMPT genotyping cannot replace regular blood monitoring in SLE patients on AZA treatment.

Synovial Osteochondromatosis Misdiagnosed as Simple Osteoarthritis of the Knee Joint / 대한류마티스학회지

No abstract available.

Tuberculous Arthritis in Peripheral Joints / 대한류마티스학회지

OBJECTIVE: We evaluated the clinical characteristics of tuberculous arthritis in peripheral joints and their relationship with rheumatologic disorders or other chronic illnesses. METHODS: One hundred and sixty seven patients who had suffered from skeletal tuberculosis were treated at Hanyang university medical center from January 1993 to December 2000. We retrospectively analyzed 39 patients who were diagnosed as tuberculous arthritis in peripheral joints. RESULTS: Thirty-nine (21 males, 18 females) patients with tuberculous arthritis in peripheral joints, aged 38.13+/-15.28, were found. All except one had a mono-articular feature. Affected joints were knee in 22 (56.4%), hip in 7 (17.9%), and wrist in 3 (7.7%). Extra-articular tuberculosis was noticed in 18 (46.2%) patients: lung involvement in 13 (33.3%), spine involvement in 4 (10.3%) and epididymis involvement in 1 (2.6%). One or more predisposing factors were found in 13 (33.3%) patients: 10 patients had a previous trauma history and 3 patients with previous intra-articular injections. Predisposing systemic conditions were present in 12 (30.8%) patients: 4 rheumatoid arthritis, 2 systemic lupus erythematosus, 1 juvenile rheumatoid arthritis, 4 liver cirrhosis, 2 breast cancer and 1 diabetes mellitus. CONCLUSION: Tuberculous arthritis in peripheral joints were evident in weight bearing joints, such as knee and hip, and were frequently associated with predisposing local or systemic factors. It is most important for the physician to make an early diagnosis and perform adequate treatments to prevent further complications.

The Secondary Amyloidosis in Rheumatic Diseases / 대한류마티스학회지

OBJECTIVE: To study the clinical features and outcomes in 10 cases of secondary amyloidosis with rheumatic disease. METHODS: The secondary amyloidosis associated with rheumatic disease was studied clinically in 10 patients (4 men and 6 women), who have suspicious tissue dysfunction. The diagnosis of amyloidosis was established by histological examination of biopsy materials. We evaluated them by medical record review; clinical features at onset, organ involvement, cause of death. RESULTS: The mean age and mean duration of rheumatic disease were 52.9+/-17.27 years and 10.9+/-10.33 years respectively. The common initial clinical features were generalized edema, diarrhea and abdominal pain. The mainly involved organs were kidney and colon. Causes of death were DIC due to sepsis and renal failure. CONCLUSION: Renal and gastrointestinal symptoms are cardinal features of secondary amyloidosis with rheumatic disease in Korea.

A Case of Cytomegalovirus Colitis with Colon Perforation in Systemic Lupus Erythematosus / 대한류마티스학회지

Cytomegalovirus (CMV) infection is a common human viral infection, affecting 40% to 100% of normal adult, especially in the immune compromised patients. CMV infection can produce variable gastrointestinal (GI) diseases in healthy adults, but can cause severe life-threatening illness involving many organs, including lung, retina, central nervous system, liver and GI tract in immunocompromised host. We experienced CMV colitis with colon perforation in a SLE patient during low dose steroid and azathioprine therapy, and she recovered after medical treatment without surgical interventions. A 33-year-old woman was diagnosed as SLE 7 years ago and treated with low dose, immunosuppressive therapy during 6 years. She complained of a severe abdominal pain and hematochezia. She was diagnosed as CMV colitis with colon perforation by pathologic, immunologic and image studies. After medical treatment, such as intravascular ganciclovir, there was progressive medical improvement, but has been a recurrent CMV colitis with lower GI bleeding.

COX-2 Specific Inhibitor and Cognitive Function: a Pilot Study / 대한류마티스학회지

OBJECTIVE: New nonsteroidal anti-inflammatory drugs (NSAIDs) with highly selective cyclooxygenase-2 (COX-2) inhibition afford protection against gastropathy, but their acute and long-term effects on the central nervous system are unclear. Our aim was to investigate the influence of COX-2 specific inhibitor (celecoxib) on cognitive function. METHODS: Within the context of a randomized controlled parallel trial of NSAIDs for osteoarthitis (OA), we performed a battery of neuropsychological tests in consecutive 10 osteoarthritis patients with celecoxib (200 mg/day) and 13 osteoarthritis patients with diclofenac (100 mg/day) before and after 4 weeks by clinical psychologists who were not involoved in the study and unaware of study protocols and treatment allocation. The tests were performed randomly in sequence in order to minimize learning effect. The examed cognitive domains included memory, reasoning/problem solving, simple and complex attention, visual-spatial processing, and psychomotor speed. RESULTS: Demographic characteristcs (age, sex, disease duration, functional status measured by patient's and physician's global assessment and KWOMAC, CES depression score, education level) were not significantly different between both treatment groups. In all cognitive domains, we did not find out significant cognitive decline before and after treatments either with celecoxib or diclofenac. There was no difference in the change of cognitive function between both treatment groups. CONCLUSION: The short-term use of COX-2 specific inhibitor as well as conventional NSAID may not impair cognitive function. The long-term follow up study using large number of patients is in progress.

Korean Cost-Effectiveness of Low Dose Corticosteroids versus Nonsteroidal Anti-Inflammatory Drugs in the Long-Term Treatment of Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Low dose corticosteroids (steroid) (

Antibiotic Resistance for Common Hospital Acquired-pneumonia Pathogens in the Intensive Care Unit of Newly Opened Hospital / 결핵

BACKGROUND: Intensive care units (ICUs) are generally considered epicenters of antibiotic resistance and the principal sources of multi-resistant bacteria outbreaks. The antibiotic resistance in newly opened intens ive care unit that has no microbial colonization on and around the devices was investigated. METHODS: The authors analyzed the antibiotic resistance patterns for common hospital acquired-pneumonia pathogens in the ICUs(Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter spp.) at the newly opened ICU of Hanyang University Medical Center, Kuri Hospital during 6 years(1995-2000). RESULTS: 1) Regarding Staphylococcus aureus, the resistance rate to methicillin was 15% at 1995, 21% at 1996, 20% at 1997, 23% at 1998, 22% at 1999, 55% at 2000. 2) Regarding Pseudomonas aeruginosa, the resistance rate to 3rd cephalosporin was 50% at 1995, 50% at 1996, 78% at 1997, 40% at 1998, 77% at 1999, 39% at 2000. Imipenam was 0% at 1995, 27% at 1996, 65% at 1997, 12% at 1998, 16% at 1999, 12% at 2000. Ciprofloxacin was 0% at 1996, 56% at 1997, 36% at 1998, 57% at 1999, 58% at 2000. Tobramycin was 7% at 1995, 10% at 1996, 67% at 1997, 36% at 1998, 65% at 1999, 12% at 2000. Gentamycin was 14% at 1995, 36% at 1996, 67% at 1997, 36% at 1998, 65% at 1999, 12% at 2000. Amikacin was 14% at 1995, 30% at 1996, 61% at 1997, 16% at 1998, 39% at 1999, 18% at 2000. 3) Regarding Acinetobacter spp., the resistance rate to 3rd cephalosporin was 92% at 1996, 89% at 1997, 88% at 1998, 84% at 1999, 77% at 2000. Imipenem was 50% at 1996, 48% at 1997, 45% at 1998, 49% at 1999, 50% at 2000. Ciprofloxacin was 0% at 1996, 48% at 1997, 33% at 1998, 27% at 1999, 71% at 2000. Tobramycin was 67% at 1995, 100% at 1996, 93% at 1997, 95% at 1998, 89% at 1999, 77% at 2000. Gentamycin was 67% at 1995, 100% at 1996, 89% at 1997, 95% at 1998, 87% at 1999, 83% at 2000. Amikacin was 33% at 1995, 83% at 1996, 82% at 1997, 88% at 1998, 75% at 1999, 69% at 2000. CONCLUSIONS: The S.aureus resistance to methicillin, the Pseudomonas aeruginosa resistance to ciprofloxacin, and the A cinetobacter spp. resistance to ciprofloxacin have rapidly increased during 6 years. There is a need to pay special attention when using the the antibiotics for the above pathogens. This data may be useful in antibiotic therapy in newly opened intensive care units.