Ultrasound Findings were Associated With Radiographic Changes, But Not Clinical and Functional Outcomes in Hand Osteoarthritis

Objective@#. There is a debate over the relevance of ultrasound abnormalities to the pain, functional impairment, and radiologic severity in hand osteoarthritis (OA). This study aims to determine the association between ultrasound abnormalities and clinical, functional, and radiographic measures in hand OA. @*Methods@#. A total of 66 patients was consecutively enrolled. All patients with gray-scale synovitis, joint effusion, and osteophytes were examined by ultrasound for 20 hand joints. Radiographic changes in both hands were evaluated by the Kellgren-Lawrence (K-L) grading system and were described as total radiographic severity score and number of affected joints. Other measures were also assessed, including each patient’s visual analogue scale for pain, the Functional Index for Hand Osteoarthritis for functional disability, and grip and pinch strength for hand muscle strength. @*Results@#. In total, 10 patients with gray-scale synovitis, 35 with joint effusion, and 66 with osteophytes were detected in hand OA scans on ultrasound. Osteophytes on ultrasound were significantly associated with total radiographic severity score and number of affected joint (r=0.293, p=0.003 and r=0.336, p＜0.001, respectively). In addition, there were weak associations of synovitis and joint effusion with radiographic changes. Patients with higher total radiographic severity score showed larger number of ultrasound-detected abnormalities, such as synovitis, joint effusion, and osteophytes (p=0.011, p=0.002, and p＜0.001, respectively). @*Conclusion@#. This study shows that ultrasound findings, especially osteophytes, were associated with radiographic changes based on K-L grade, but not clinical and functional status in hand OA.

Clinical Usefulness of Uric Acid as a Biomarker for Knee Osteoarthritis: A Comparative Analysis With Plain Radiography and Musculoskeletal Ultrasound

OBJECTIVE: The aim of this study was to determine the relationships of serum and urine uric acid with severity or activity in knee osteoarthritis (OA).METHODS: A total of 42 patients with knee OA was enrolled, together with 58 healthy controls. Serum uric acid and spot urine uric acid levels were assessed for all patients. The severity and activity of knee OA were assessed by musculoskeletal ultrasound (MSUS) and plain radiography of the knee joint. Ultrasonographic abnormalities in knee OA includedsynovial hypertrophy, suprapatellar effusion, cartilage degradation, and osteophyte formation. Kellgren-Lawrence (K-L) grade was used to evaluate radiological progression of knee OA.RESULTS: Patients with K-L grade III had a higher urine uric acid/creatinine ratio compared to those with K-L grade I (p=0.043). Patients with synovial hypertrophy had higher serum uric acid level compared to those without synovial hypertrophy (p=0.016). The urine uric acid/creatinine ratio was higher in patients with cartilage degradation compared to those without cartilage degradation (p=0.022). Serum uric acid was significantly associated with synovial hypertrophy thickness (r=0.375, p=0.018) but not with cartilage thickness after adjusting for age and body mass index. Lower urine uric acid was related with knee OA compared to healthy controls (odds ratio=0.974, 95% confidence interval 0.954~0.994, p=0.013).CONCLUSION: The results of our study suggest that serum and urine uric acid reflects synovial inflammation based on MSUS and radiographic progression and then is associated with the pathogenesis of knee OA.

Erratum: Clinical Usefulness of Uric Acid as a Biomarker for Knee Osteoarthritis: A Comparative Analysis With Plain Radiography and Musculoskeletal Ultrasound

The original version of this article contained a typographical error in the Abstract, Main text, and Figure 1. These errors have now been corrected in the online version of the Article.

The Effect of Mycophenolate Mofetil on Non-Renal Manifestations in Systemic Lupus Erythematosus: Results from Korean Lupus Network Registry

BACKGROUND: The objective of this study was to identify the effects of mycophenolate mofetil (MMF) on non-renal manifestations in systemic lupus erythematosus (SLE). METHODS: The study population comprised 439 SLE patients from the Korean Lupus Network registry who were followed up annually and completed the baseline survey and two follow-up visits from 2014 to 2018. Disease activity, laboratory markers, and clinical manifestations including mucocutaneous lesions, arthritis, serositis, neurological disorders, and hematologic/immunologic abnormalities were assessed. All variables by group (MMF and non-MMF) effects with time (baseline, 1st follow-up, and 2nd follow-up) were analyzed by generalized estimation equation. RESULTS: Seventy-two patients were treated with MMF. There was significant difference in frequencies of malar rash, arthritis, renal disorder, and hematologic disorder between MMF and non-MMF groups in total SLE patients. In subgroup analysis of hematologic abnormalities in total patients, frequency of leukopenia was significantly different between the two groups during follow-up (P = 0.001), but frequencies of hemolytic anemia, lymphopenia, and thrombocytopenia were not. In addition, frequencies of leukopenia in patients without lupus nephritis were significantly decreased in MMF group compared to non-MMF group (P = 0.012). CONCLUSION: This study showed that MMF might be a beneficial treatment for hematologic abnormalities, especially leukopenia, in SLE.

Axillary Lymph Node Dissection Does Not Improve Post-mastectomy Overall or Disease-Free Survival among Breast Cancer Patients with 1-3 Positive Nodes / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Axillary lymph node dissection (ALND) may be avoidable for breast cancer patients with 1-2 positive lymph nodes (LN) after breast-conserving therapy. However, the effects of ALND after mastectomy remain unclear because radiation is not routinely used. Herein, we compared the benefits of post-mastectomy ALND versus sentinel node biopsy (SNB) alone for breast cancer patients with 1-3 metastatic LNs. MATERIALS AND METHODS: A total of 1,697 patients with pN1 disease who underwent mastectomy during 2000-2015 were identified from an institutional database. Outcomes were compared using the inverse probability of treatment weighted method. RESULTS: Patients who underwent SNB tended to have smaller tumors, a lower histology grade, a lower number of positive LNs, and better immunohistochemical findings. After correcting all confounding factors regarding patient, tumor, and adjuvant treatment, the SNB and ALND groups did not differ in terms of overall survival (OS) and disease-free survival (DFS), distant metastasis and locoregional recurrence. The 10-year DFS and OS rates were 83% and 84%, respectively, during a median follow-up period of 93 months. CONCLUSION: ALND did not improve post-mastectomy survival outcomes among patients with N1 breast cancer, even after adjusting for all histopathologic and treatment-related factors.

Tracheal pleomorphic adenoma with coexisting pulmonary tuberculoma / 영남의대학술지

Tracheal tumors are rare and difficult to diagnose. Moreover, delays in diagnosis are very common because the symptoms are nonspecific. As a result, tracheal tumors are commonly mistreated as chronic obstructive pulmonary disease or bronchial asthma. We report a case of a 49-year-old male who presented with a 3-month history of dyspnea and cough. Chest computed tomography scan showed a 1.5×1.3 cm homogenous tumor originating from the right lateral wall of the tracheobronchial angle into the tracheal lumen as well as a 0.5×0.4 cm round nodular lesion at the right upper lobe with multiple mediastinal lymph nodes enlargement. Bronchoscopic findings revealed a broad-based, polypoid lesion nearly obstructing the airway of the right main bronchus. The patient was diagnosed with pleomorphic adenoma which is the most common benign tumor of the salivary glands, but rarely appears in the trachea. Upon surgery, tracheal pleomorphic adenoma and co-existing active pulmonary tuberculoma that had been mistreated as bronchial asthma over 3 months was revealed. Following surgery, the patient underwent anti-tuberculosis treatment. No recurrence has been detected in the 3 years since treatment and the patient is now asymptomatic.

Tracheal pleomorphic adenoma with coexisting pulmonary tuberculoma / 영남의대학술지

Tracheal tumors are rare and difficult to diagnose. Moreover, delays in diagnosis are very common because the symptoms are nonspecific. As a result, tracheal tumors are commonly mistreated as chronic obstructive pulmonary disease or bronchial asthma. We report a case of a 49-year-old male who presented with a 3-month history of dyspnea and cough. Chest computed tomography scan showed a 1.5×1.3 cm homogenous tumor originating from the right lateral wall of the tracheobronchial angle into the tracheal lumen as well as a 0.5×0.4 cm round nodular lesion at the right upper lobe with multiple mediastinal lymph nodes enlargement. Bronchoscopic findings revealed a broad-based, polypoid lesion nearly obstructing the airway of the right main bronchus. The patient was diagnosed with pleomorphic adenoma which is the most common benign tumor of the salivary glands, but rarely appears in the trachea. Upon surgery, tracheal pleomorphic adenoma and co-existing active pulmonary tuberculoma that had been mistreated as bronchial asthma over 3 months was revealed. Following surgery, the patient underwent anti-tuberculosis treatment. No recurrence has been detected in the 3 years since treatment and the patient is now asymptomatic.

Hydroxyapatite-coated implant: Clinical prognosis assessment via a retrospective follow-up study for the average of 3 years

PURPOSE: This research evaluated clinical outcomes of two types of hydroxyapatite (HA)-coated implants: OT (Osstem TS III-HA, Osstem implant Co., Busan, Korea) and ZM (Zimmer TSV-HA, Zimmer dental, Carlsbad, USA). MATERIALS AND METHODS: The research was conducted on 303 implants (89 of OT, 214 of ZM), which were placed from January 16, 2010 to December 20, 2012. The prognosis was evaluated in terms of success rates, survival rates, annual marginal bone loss, and implant stability quotients (ISQ). The samples were classified into immediate, early, conventional, and delayed groups according to the loading time. RESULTS: Overall, there were no significant differences between OT and ZM in success rates, survival rates, and annual marginal bone loss, except for the result of secondary stability. OT showed 77.83 ± 8.23 ISQ, which was marginally higher than 76.09 ± 6.90 ISQ of ZM (P 82.48 ± 3.69 ISQ) (P .05). CONCLUSION: OT (97.75%) and ZM (98.50%) showed relatively good outcomes in terms of survival rates. In general, OT and ZM did not show statistically significant differences in most indices (P>.05), although OT performed marginally better than ZM in the immediate loading and 1-stage surgery (P < .05).

Changes in skin reactivity and associated factors in patients sensitized to house dust mites after 1 year of allergen-specific immunotherapy

BACKGROUND: Allergen-specific immunotherapy (SIT) can significantly improve symptoms and reduce the need for symptomatic medication. OBJECTIVE: The aim of this study was to investigate changes in skin reactivity to house dust mites (HDMs) as an immunologic response and associated factors after 1 year of immunotherapy. METHODS: A total of 80 patients with allergic airway diseases who received subcutaneous SIT with HDMs from 2009 to 2014 were evaluated. The investigated parameters were basic demographic characteristics, skin reactivity and specific IgE for HDM, serum total IgE level, blood eosinophil counts, and medication score. RESULTS: The mean levels of skin reactivity to HDMs, blood eosinophil counts, and medication scores after 1 year were significantly reduced from baseline. In univariate comparison of the changes in skin reactivity to HDMs, age ≤30 years, HDMs only as target of immunotherapy, and high initial skin reactivity (≥2) to HDMs were significantly associated with the reduction in skin test reactivity. In multivariate analysis, high initial skin reactivity and HDMs only as target allergens were significantly associated with changes in skin reactivity to HDMs. In the receiver operating characteristic curve of the initial mean skin reactivity to HDMs for more than 50% reduction, the optimal cutoff value was 2.14. CONCLUSION: This study showed significant reductions in allergen skin reactivity to HDMs after 1 year of immunotherapy in patients sensitized to HDMs. The extent of initial allergen skin reactivity and only HDMs as target allergen were important predictive factors for changes in skin reactivity.

Acute Pseudogout of the Neck: "Crowned Dens" Revisited

Calcium pyrophosphate dihydrate crystal deposition disease is associated with an acute mono- or pauciarthritis, termed "pseudogout" in elderly patients, involving a large joint (including the knees, ankles) or a chronic arthropathy manifesting as mild joint pain and stiffness. Pseudogout is a crystal-deposition disease of peripheral joints, usually encountered in elderly patients. However, acute presentation of pseudogout around the odontoid process comprises a "crowned-dens" appearance, and requires contemplation of differential diagnoses. We recently experienced a case of pseudogout in the cervical spine presenting with fever and acute neck pain that was successfully treated with a colchicine and low-dose oral steroid. We reported this case with a review of the relevant literature.

Neuron-specific enolase as a novel biomarker reflecting tuberculosis activity and treatment response

BACKGROUND/AIMS: It is not clear which tests are indicative of the activity and severity of tuberculosis (TB). This study aimed to investigate the predictive value of neuron-specific enolase (NSE) and to determine the origin of NSE in TB patients. METHODS: A single-center retrospective analysis was conducted on newly diagnosed TB patients between January and December 2010. Patients were categorized into one of two disease groups (focal segmental or extensive) based on chest X-ray. Pre- and post-treatment NSE concentrations were evaluated. To determine the origin of serum NSE concentration, NSE staining was compared with macrophage-specific CD68 staining in lung tissues and with a tissue microarray using immunohistochemistry and immunofluorescence. RESULTS: A total of 60 newly diagnosed TB patients were analyzed. In TB patients, NSE serum concentration was significantly increased and NSE level decreased after treatment (p < 0.001). In proportion to serum high-sensitivity C-reactive protein concentration, the mean serum concentration of NSE in the extensive group (25.12 ng/mL) was significantly higher than that in the focal segmental group (20.23 ng/mL, p = 0.04). Immunohistochemical staining revealed a large number of macrophages that stained positively for both NSE and CD68 in TB tissues. In addition, NSE signals mostly co-localized with CD68 signals in the tissue microarray of TB patients. CONCLUSIONS: Our results suggest that NSE may be a practical parameter that can be used to monitor TB activity and treatment response. Elevated serum NSE level originates, at least in part, from macrophages in granulomatous lesions.

A Case of Pulmonary Cryptococcosis Mimicking Bronchogenic Lung Cancer in an Immunocompetent Patient: A Review of the Literature / 대한의진균학회지

We experienced a 59-year-old immunocompetent female patient who complained progressive cough. A bronchoscopic examination revealed an endobronchial mass protruding from the left lower lobe and occluding anterior-basal segment bronchus. Bronchial biopsy and endobronchial ultrasound guided transbronchial needle aspiration were consistent with cryptococcal infection. However, the response of medical therapy was an unsuccessful. Finally, the patient underwent left lower lobectomy with lymph node dissection. We report a case of pulmonary cryptococcosis mimicking bronchogenic lung cancer, and surgical therapy with antifungal treatment resulted in successful resolution of the pneumonia.

Survey for Musculoskeletal Pain of Korean Junior Tennis Players / 대한스포츠의학회지

The aim of this survey was to analyze the characteristics of musculoskeletal pain of Korean junior tennis players and its effect on games and psychology of players. Surveys were administered to 30 healthy male junior tennis players who took part in a 50th national junior tennis meet in 2015. We analyzed the incidence, location, cause and preferred prevention or treatment method of musculoskeletal pain, the correlation between training time and musculoskeletal pain as well as the effect of musculoskeletal pain on games and psychology of players. Overall, 22 out of 30 (73.3%) responded the experience of musculoskeletal pain. The incidence of lower extremity pain (16 out of 30, 53.3%) were higher than upper extremity pain (9 out of 30, 30%) and low back pain (8 out of 30, 26.7%). The long training hours per day (r=0.574, p=0.001) and old age (r=0.390, p=0.033) were correlated with intermittent back pain in univariate anlaysis. In multivariate ananlysis, the long training hours per day was a single risk factor of intermittent low back pain (p=0.038, odds ratio 10.01). 43.3% of players responded that the insufficent preventive conditioning program was thought to be the cause of musculoskeletal pain. The most preferred treatment or prevention method for musculoskeletal pain was rehabilitation (55.3%). Twelve players reported the negative affection of musculoskeletal pain to the performance in game. Six players experienced the frustration, 9 players experienced the loss of interest and 9 players experienced the emotional avoidance of games due to the musculoskeletal pain.

Comparison of Social Nicotine Dependence Using the KTSND-K Questionnaire between patients with lung cancer and non-cancer people / 고신대학교의과대학학술지

OBJECTIVES: Smoking is one of the most important leading causes of lung cancer. Smoking habit is recognized as nicotine dependence, which consists of physical and psychosocial dependence. To evaluate social nicotine dependence, the Kano Test for Social Nicotine Dependence (KTSND) working group developed a new questionnaire. We examined the social nicotine dependence among high school students, university students and patients with lung cancer. METHODS: We applied Korean version of KTSND(KTSND-K) questionnaire to high school students, university students and patients with lung cancer. Complete data obtained from the 1333 responders were analyzed. RESULTS: Among the responders, current smokers, past-smokers, and never-smokers were 17.3%, 16.4%, and 66.3% respectively. According to smoking status, the total KTSND-K scores of current smokers were significantly higher than those of past-smokers, and of never-smokers (17.7+/-6.6 versus 13.7+/-5.7, and 10.9+/-5.15, P<0.001). The total KTSND-K scores of males were higher than those of females, suggesting that males have a propensity for depending nicotine socially much more than females (13.2+/-6.2 and 11.7+/-5.7 respectively, P<0.05). And the total KTSND scores of the patients with lung cancer, medical students, nursing students, and high school students were 11.2+/-3.8, 14.9+/-4.8, 14.6+/-5.8 and 15.6+/-5.9 respectively. The scores of patients with lung cancer were significantly lower than non-cancer people(P<0.01). Our study suggested that the KTSND-K questionnaire could be a useful method to evaluate psychosocial aspects of smoking in patients with lung cancer and non-cancer people.

Effect of Formal Education Level on Measurement of Rheumatoid Arthritis Disease Activity

OBJECTIVE: The aim of this study is to analyze the capacity of three demographic variables - age, sex, and formal education level - as well as disease duration to explain variation in 7 Core Data Set variables and 4 indices used to assess rheumatoid arthritis (RA), in a cohort of Korean patients seen in usual care. METHODS: All RA Core Data Set measures were collected in usual care of 397 RA patients, including tender/swollen joint counts (TJC, SJC) 28, physician global estimate of status, erythrocyte sedimentation rate, C-reactive protein, and a multidimensional health assessment questionnaire to assess physical function, pain, and patient global estimate of status (PATGL). Four indices were computed: disease activity score with 28 joint count (DAS28), simplified disease activity index (SDAI), clinical disease activity index (CDAI), and routine assessment of patient index data 3 (RAPID3). Descriptive statistics and multivariate generalized linear models were used in data analysis. RESULTS: Patients with lower education had higher scores, indicating greater severity, for all 7 Core Data Set measures and 4 indices (significant for TJC, function, pain, PATGL, DAS28, SDAI, CDAI, RAPID3). In a series of regressions that included age, sex, disease duration, and education, formal education level was the only significant variable to explain variation in TJC, pain, PATGL, physician global estimate of status (DOCGL), DAS28, SDAI, CDAI, and RAPID3. CONCLUSION: Significant associations with education were found in Korean RA patients according to most RA Core Data Set measures and 4 indices. Education was more likely than age, sex, or disease duration to explain variation in most measures and indices.

Efficacy of Foreign Body Removal using a Cryoprobe in Flexible Bronchoscopy / 고신대학교의과대학학술지

OBJECTIVES: Endobronchial foreign body impaction is a medical emergency because of the air way obstruction. Therefore, immediate foreign body removal is crucial in such situations. Recently, there have been several reports about cryoprobe use as a tool for removal of foreign bodies. In this study, we determined the efficacy and complications of foreign body removal using a cryoprobe during flexible bronchoscopy. METHODS: This is a retrospective review of 27 patients who visited Kosin University Gospel Hospital from August 2007 to August 2010 with respiratory symptoms due to a foreign body in the airway. There were 17 males and 10 females, aged from 7 to 78 years. The foreign bodies were more frequently located (55%) in the right bronchus. The cryoprobe was inserted through the forceps channel of the flexible bronchoscope under local anesthesia. The lesion was quickly frozen for 5 seconds at -80degrees C, and the bronchoscope was removed with the probe after crystal formation on the contacted area. RESULTS: The success rate of removal of foreign bodies was 85% (23/27) using the cryoprobe. One case of broncholith did not undergo attempted removal because of the possibility of excessive hemorrhage by the tight bronchus impaction, and three cases (plastic,silicon,and implant) failed due to limited crystal formation. There were no severe hemorrhages, arrhythmias, or casualties during the procedure. CONCLUSIONS: The removal of foreign body using a cryoprobe during flexible bronchoscopy was shown to be safe and effective. The nature of the material should be attempted before removing a foreign body.

Studies on technology for seaweed forest construction and transplanted Ecklonia cava growth for an artificial seaweed reef.

We installed seaweed reef for restoration of barron ground coast. We hollowed out a U-shaped groove in a cross-shaped artificial seaweed reef and covered it with a zinc sheet (U-bar) to transplant Ecklonia cava growing on Dellenia wood by hand, installing the U-bar on the artificial seaweed reef, fixing it with concrete. Thus seaweed can be attached easily, with pre-installed stainless bolts and nuts. The length of Ecklonia cava leaf transplanted to the cross-shaped reef was 7.2 cm in February 2005 reached its maximum size, 35.9 cm (n=30) by July. Thereafter, it decreased to 18.9 cm in October due to shedding. The leaf weight after the experiment was 24.8 from the initial 0.4 cm (n=30). Regression analysis showed Y=0.7875X-4.6488 (R2=0.7225) for blade length and Y=0.0025X2.6733 (R2=0.8711) for leaf weight. The high values of the R2 values for the two measurements were highly reliable, with the reliability of the linear regression function higher than that of the functions of 2 variables. The artificial seaweed forest constructed in the barren ground was highly comparable with natural seaweed forest in terms of growth, indicating that the artificial seaweed construction can be done in an easy, efficient and economically viable way. This further indicates that the technology developed by the present study can be extensively used for the project for artificial seaweed forest construction.

Gefitinib in Selected Patients with Pre-Treated Non-Small-Cell Lung Cancer: Results from a Phase IV, Multicenter, Non-Randomized Study (SELINE) / 결핵및호흡기질환

BACKGROUND: This study was designed to analyze the efficacy of gefitinib as a second-line therapy, according to the clinical characteristics in Korean patients with non-small-cell lung cancer (NSCLC). METHODS: In this Phase IV observational study, we recruited patients, previously failed first-line chemotherapy, who had locally advanced or metastatic NSCLC, and who were found to be either epidermal growth factor receptor (EGFR) mutation-positive or satisfied 2 or more of the 3 characteristics: adenocarcinoma, female, and non-smoker. These patients were administered with gefitinib 250 mg/day, orally. The primary endpoints were to evaluate the objective response rate (ORR) and to determine the relationship of ORRs, depending on each patient's characteristics of modified intent-to-treat population. RESULTS: A total of 138 patients participated in this study. One subject achieved complete response, and 42 subjects achieved partial response (ORR, 31.2%). The subgroup analysis demonstrated that the ORR was significantly higher in patients with EGFR mutation-positive, compared to that of EGFR mutation-negative (45.8% vs. 14.0%, p=0.0004). In a secondary efficacy variable, the median progression-free survival (PFS) was 5.7 months (95% confidence interval, 3.9~8.4 months) and the 6-month PFS and overall survival were 49.6% and 87.9%, respectively. The most common reported adverse events were rash (34.4%), diarrhea (26.6%), pruritus (17.5%), and cough (15.6%). CONCLUSION: Gefitinib was observed in anti-tumor activity with favorable tolerability profile as a second-line therapy in these selected patients. When looking at EGFR mutation status, EGFR mutation-positive showed strong association with gefitinib by greater response and prolonged PFS, compared with that of EGFR mutation-negative.

Primary Malignant Melanoma of the Parotid Gland Metastasing to the Appendix / 대한이비인후과학회지

Malignant melanoma originates from melanocytes which are derived from the neural crest. These melanocytes are found in the basal layer of the epidermis. Malignant melanoma of the parotid gland is very rare, and when they are found, most of them are a metastasized form of a cutaneous primary lesion in the head region. We experienced one case of primary parotid melanoma which was metastasizing to the appendix two years later. We report it with a review of literature.

A Case of Tracheobronchopathia Osteochondroplastica / 대한이비인후과학회지

Tracheobronchopathia Osteochondroplastica (TO) is a rare disease of the trachea characterized by the development of submucosal cartilaginous and bony nodules. The nodules are usually located at the anterior and lateral walls and sometims on the posterior membranous wall. Clinically, the manifestations of TO vary from the incidentally detected asymptomatic to life threatening diseases with airway obstruction. Bronchoscopy is a useful diagnostic tool and radiographic studies also play an important role in the diagnosis of TO. The treatment of TO is reserved for the symptomatic lesion with severe airway narrowing and the prevention of recurrent respiratory infections.