Increased interleukin-6 and TP53 levels in rotator cuff tendon repair patients with hypercholesterolemia

Background@#A previous study reported that hyperlipidemia increases the incidence of tears in the rotator cuff tendon and affects healing after repair. The aim of our study was to compare the gene and protein expression of torn rotator cuff tendons in patients both with and without hypercholesterolemia. @*Methods@#Thirty patients who provided rotator cuff tendon samples were classified into either a non-hypercholesterolemia group (n=19, serum total cholesterol [TC] <200 mg/dL) and hypercholesterolemia group (n=11, serum TC ≥240 mg/dL) based on their concentrations of serum TC. The expression of various genes of interest, including COL1A1, IGF1, IL-6, MMP2, MMP3, MMP9, MMP13, TNMD, and TP53, was analyzed by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). In addition, Western blot analysis was performed on the proteins encoded by interleukin (IL)-6 and TP53 that showed significantly different expression levels in real-time qRT-PCR. @*Results@#Except for IGF1, the gene expression levels of IL-6, MMP2, MMP9, and TP53 were significantly higher in the hypercholesterolemic group than in the non-hypercholesterolemia group. Western blot analysis confirmed significantly higher protein levels of IL-6 and TP53 in the hypercholesterolemic group (p<0.05). @*Conclusions@#We observed an increase in inflammatory cytokine and matrix metalloproteinase (MMP) levels in hypercholesterolemic patients with rotator cuff tears. Increased levels of IL-6 and TP53 were observed at both the mRNA and protein levels. We suggest that the overexpression of IL-6 and TP53 may be a specific feature in rotator cuff disease patients with hypercholesterolemia.

Biological Enhancement of Healing with Kartogenin Injection at the Tendon-to-Bone Interface in a Rat Rotator Cuff Tear Model / 대한스포츠의학회지

Purpose@#The purpose of this study was to investigate the effects of kartogenin (KGN) on the tendon-bone interface in a rat rotator cuff tear model. @*Methods@#Twenty male rats were divided into two equal groups; group 1 (repair only) and group 2 (KGN single injection). A rat rotator cuff rupture model was prepared, and KGN (500 μM) was injected into the repair site. The specimens were collected after 8 weeks, and biomechanical and histological analyses were performed. We assessed the healing quality of the tendon-to-bone repair site using six aspects of tendon tissue. The histological findings were classified semiquantitatively into four grades (grade 0, the poorest appearance; grade 1, poorer; grade 2, better; and grade 3, marked regeneration). @*Results@#Group 2 showed a higher mean ultimate load to failure than the control group (group 1: 25.78±31.38 N, group 2: 55.64±36.02 N; p=0.011). On histological analysis, group 2 exhibited a significantly greater total score (group 1: 7.20±2.14, group 2: 9.50±1.84; p=0.019), collagen fiber continuity (group 1: 1.20±0.42, group 2: 1.70±0.48; p=0.024), and collagen fiber density (group 1: 1.50±0.52, group 2: 2.20±0.63; p=0.080). Metachromasia were more intense in group 2 than in the control group. @*Conclusion@#A single injection of KGN reinforces biomechanical strength and the formation of collagen and fibrocartilage at the tendon-to-bone interface in a rat rotator cuff tear model.

Neuro-ophthalmic Analyses of Head Trauma Patients

PURPOSE: To investigate the types and clinical features of neurological diseases after head trauma. METHODS: From March 2010 to December 2018, a total of 177 patients were enrolled in this study. We retrospectively reviewed the clinical features of neurological ophthalmic diagnoses and frequencies, the types of head injuries, and the prognoses. RESULTS: Cranial nerve palsy was the most common (n = 63, 35.6%), followed by traumatic optic neuropathy (n = 45, 25.4%), followed by optic disc deficiency, ipsilateral visual field defect, Nystagmus, skewing, ocular muscle paralysis between nuclei, and Terson syndrome. Neuro-ophthalmic deficits occurred in relatively strong traumas accompanied by intracranial hemorrhage or skull fracture. However, convergence insufficiency and decompensated phoria occurred in relatively weak trauma such as concussion. The prognoses of the diseases were poor (p < 0.05) for traumatic optic neuropathies and visual field defects. The prognoses of neurological diseases were poor if accompanied by intracranial hemorrhages or skull fractures (p < 0.05). CONCLUSIONS: After head trauma, various neuro-ophthalmic diseases can occur. The prognosis may differ depending on the type of the disease, and the strength of the trauma may affect the prognosis.

Bilateral Frosted Branch Angiitis in Kikuchi-Fujimoto Disease

PURPOSE: A case of frosted branch angiitis in Kikuchi-Fujimoto disease is reported. CASE SUMMARY: A 33-year-old male complained of a sudden decrease in visual acuity that developed in both eyes 5 days prior. He suffered from a headache, chills, myalgia, and flank pain 1 week before. The initial best-corrected visual acuity (BCVA) was 0.1 in the right eye and 0.2 in the left eye. On slit lamp examination, no inflammatory finding was observed in the anterior chamber and vitreous body of both eyes. On fundus examination, a diffuse vascular sheathing-like frosted branch was found in the retinal vessels, and retinal hemorrhage was observed. Fluorescein angiography showed staining and leakage of dye along the vascular sheathing. Serological findings were negative, showing no evidence of an autoimmune disease or viral infection. Neck ultrasonography revealed non-tender left cervical lymph node enlargement >1 cm in diameter. Ultrasound-guided fine needle aspiration cytology showed findings compatible with Kikuchi-Fujimoto disease, including necrotic changes and pronounced karyorrhexis, plus histiocyte and lymphocyte infiltration without neutrophils. We started systemic steroid therapy. One month after treatment, the BCVA of both eyes improved to 1.0. CONCLUSIONS: In patients with frosted branch angiitis, systemic disease such as Kikuchi-Fujimoto disease should be considered.

Prognostic Indicators of Gross Motor Developmental Outcomes in Preterm Infants with Cerebral Insults as Detected by Neuroimaging

PURPOSE: To examine the developmental outcome of preterm infants with cerebral insults and to evaluate the prognostic indicators for gross motor development. METHODS: Forty-eight preterm infants less than 37 weeks of gestation, who had been born at Seoul National University Bundang Hospital between March, 2004 and September, 2008 where the subjects of this. The infants' charts were reviewed to obtain data, including gestational age, birth weight, gender, 1/5 minute Apgar scores, neuroimaging findings, and others. RESULTS: Of the 48 patients, 29 infants (60.4%) were put into a normal developmental group and 19 (39.6%) were put into developmental delay group. Univariate analysis of the two groups showed that P values less than 0.05 were observed with respect to gestational age, premature rupture of membrane (PROM), respiratory distress syndrome, bronchopulmonary dysplasia, and patent ductus arteriosus. PROM and antenatal steroid showed statistically significant differences on a multivariate analysis. The same analysis method was applied to preterm infants less than a corrected age of 32 weeks. Multivariate analysis suggested that PROM showed statistically significant differences. Also, 48 patients were analyzed with respect to neuroimage finding. Twenty-five infants (52.1%) were assigned to a germinal matrix hemorrhage (GMH) group and 23 infants (47.9%) were allocated to a non-GMH group. Cesarean section delivery showed statistically significant difference according to univariate analysis. CONCLUSION: In preterm infants with cerebral insults, PROM and antenatal steroids were independent risk factors for impaired gross motor development.

Clinical Characteristics of Neonatal Seizures

PURPOSE: Neonatal seizures are major morbidities of various neurological insults in neonates and have the predictive value for neurodevelopmental outcome. Nevertheless, it is difficult to detect seizures in this period and to verify underlying causes. In this study, we investigated the clinical features of neonatal seizures and proved the role of brain MRI in detection of underlying neurological insults. METHODS:Twenty-four patients(M:F=7:17) with neonatal seizures are recruited among 1,157 neonates born between Mar. 2004 and Jan. 2005. Seizure types are classified based upon Volpe's criteria. Retrospective reviews of medical records and interictal electroencephalograms are performed. RESULTS:Subtle seizure is the most common seizure type(9 patients:37.5%). In 4 patients, two types of seizures are noted. Among 20 patients with brain ultrasound, thirteen patients show normal findings. In contrast, out of 16 patients with brain MRI, fourteen patients have abnormal findings. Among 13 patients with normal brain ultrasound, seven patients have abnormal findings in brain MRI. Abnormal background activities of interictal electroencephalograms are noted in twenty one patients(87.5%). Subsequent seizures are detected in 3 patients. CONCLUSION:Clinical features of neonatal seizures are variable, and more than two types of seizures can be noted in one patient. Background activity of the electroencephalogram may help in diagnosis of neonatal seizures and Brain MRI should be considered in detection of underlying cause.

Clinical Characteristics of Pediatric Multiple Sclerosis in Korea

PURPOSE: Multiple sclerosis(MS) is an autoimmune demyelinating disorder causing significant neurological impairment in early adulthood. Since 1980, childhood MS has increased and the characteristics of childhood MS has been reported. For investigation of the clinical characteristics of childhood MS in Korea, we reviewed clinical presentations, paraclinical features, prognosis, and responses to interferone treatment of childhood MS patients. METHODS: We retrospectively reviewed the medical records of patients who have been diagnosed as MS according to McDonald criteria in Seoul National University Children's Hospital. 13 patients(M:F=6:7) were included in the study from 1988 to 2005. RESULTS: The age of onset was 1-12 years-old(mean 7.1) and the duration from initial presentation to 1st relapse was 3-27 months(mean 10.3). Initial presenting symptoms were motor disturbance, visual disturbance, bladder dysfunction, fever, brainstem dysfunction, headache and encephalitis-like-symptoms. All patients were treated with corticosteroids and 8 patients were on interferone-alpha treatment. EDSS score were 0-10(mean 1.8). CONCLUSION: The clinical characteristics of childhood MS were similar to the result from other studies in Korea, Japan, and eastern countries. Increasing number of childhood MS in Korea reflects the change of the environmental susceptibility to MS in Korean pediatric population. Interferone-alpha therapy can be considered as safe and effective treatment for modulating the clinical course of MS.

A Case of Neurofibromatosis Type 1 with Cortical Dysplasia

Neurofibromatosis type 1(NF1) is the most common neurocutaneous syndrome which has an autosomal dominant pattern of inheritance. The NF1 gene is located on chromosome 17q11.2 and encodes for neurofibromin known as tumor suppressor protein. The disorder affects almost every organ and shows neurologic manifestations such as tumors, mental retardation and epilepsy. Epilepsy associated with NF1 occurs in about 4% and is known to have relatively good prognosis. Malformations of cortical development are less common in patients with NF1 than in other phakomatoses. To our knowledge, no report on NF1 with cortical dysplasia has been published in Korea. We report a child with NF1 associated with extensive cortical dysplasia, who presented initially infantile spasms and in the following months developed tonic seizures.

Merosin Deficient Congenital Muscular Dystrophy in Korea

PURPOSES:Congenital muscular dystrophies(CMDs) are an autosomal recessive and heterogeneous disorders. The classic forms of CMD are subclassified into two major categories:merosin positive and deficient. Merosin deficient congenital muscualr dystrophy (MDCMD) is rare in Asia and it has never been reported especially in Korea. So, we summarized the clinical features with neuroimaging findings of the patients, who were diagnosed as MDCMD, for the first time in Korea. METHODS: Twenty three patients were diagnosed as CMD in Seoul National University Children's Hospital over 3 years(2001-2004). Among them, four patients with MDCMD were proven by merosin immunohistochemical staining. We reviewed their clinical, pathologic features, EMG/NCS findings and brain MRIs. RESULTS: Among 23 patients with CMD, 4 patients(17.4%) were MDCMD. All of them were presented at birth or early infancy with hypotonia, muscle weakness and joint contracture. They all could not walk and had myopathic faces, developmental delay, poor weight gain and scoliosis. EMG/NCS showed myopathic motor unit action potential (MUP) and decreased compound motor unit action potential(CMAP). Merosin deficiency was demonstrated in muscle or skin tissues. All of them had diffuse or focal high signal intensity lesions of white matter in brain MR T2WI. However, they showed neither mental retardation nor seizure though one of them had right occipital polymicrogyria. CONCLUSION: We reported 4 children with MDCMD for the first time in Korea. The prevalence in Korea might be lower than in Europe but probably higher than in Japan. If CMD patients have sustained delayed motor milestone with normal intelligence, myopathic face, decreased CMAP and myopathic MUP in EMG/NCS, MDCMD should be suspected and further diagnostic work up such as brain MR and merosin immunohistochemistry will be needed.