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Background/Aims@#The use of a self-expandable metal stent (SEMS) is recommended for unresectable malignant biliary obstruction (MBO). Stent-related adverse events might differ according to the position of the stent through the ampulla of Vater (AOV). We retrospectively evaluated SEMS patency and adverse events according to the position of the SEMS. @*Methods@#In total, 280 patients who underwent endoscopic SEMS placement due to malignant distal biliary obstruction were analyzed retrospectively. Suprapapillary and transpapillary SEMS insertions were performed on 51 patients and 229 patients, respectively. @*Results@#Between the suprapapillary group (SPG) and transpapillary group (TPG), the stent patency period was not significantly different (median [95% confidence interval]: 107 days [82.3 to 131.7] vs 120 days [99.3 to 140.7], p=0.559). There was also no significant difference in the rate of adverse events. In subgroup analysis, the stent patency for an MBO located within 2 cm from the AOV was found to be significantly shorter than that for an MBO located more than 2 cm from the AOV in the SPG (64 days [0 to 160.4] vs 127 days [82.0 to 171.9], p<0.001) and TPG (87 days [52.5 to 121.5] vs 130 [97.0 to 162.9], p<0.001). Patients with an MBO located within 2 cm from the AOV in both groups had a higher percentage of duodenal invasion (SPG: 40.0% vs 4.9%, p=0.002; TPG: 28.6% vs 2.9%, p<0.001) than patients with an MBO located more than 2 cm from the AOV. @*Conclusions@#The SPG and TPG showed similar results in terms of stent patency and rate of adverse events. However, patients with an MBO located within 2 cm from the AOV had a higher percentage of duodenal invasion with shorter stent patency than those with an MBO located more than 2 cm from the AOV, regardless of stent position.
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Purpose@#There are no effective treatment methods with which to control complications of radiation proctitis with fistula or recurrent bleeding following radiation treatment for prostate, cervical, or rectal cancer. Mesenchymal stem cells (MSCs) can induce immune modification, resulting in tissue repair and regeneration. Therefore, we used a rat model of radiation-induced proctitis and observed the effects of using human placenta-derived (PD) and adipose tissue-derived (AD) MSCs. @*Materials and Methods@#Female Sprague Dawley rats were irradiated at the pelvic area with 25 Gy. We injected 1×10 6 cells of human PD-MSCs, human AD-MSCs, human foreskin fibroblasts, and control media into the rectal submucosa following irradiation. We sacrificed rats for pathologic evaluation. @*Results@#Fibrosis on the rectum was reduced in both MSC groups, compared to the control group. Mucosal Ki-67 indices of both MSC injected groups were higher than those in the control group. Although caspase-3 positive cells in the mucosa gradually increased and decreased in the control group, those in both MSC injected groups increased rapidly and decreased thereafter. @*Conclusion@#We demonstrated the effects of regional MSC injection treatment for radiation-induced proctitis in rats. MSC injection reduced fibrosis and increased proliferation in rat mucosa. Human AD-MSCs and PD-MSCs had similar effectiveness.
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Purpose@#The current drain tubes for preventing surgically biliary anastomotic stricture are not naturally and easily removed. If a drain tube using biodegradable material is easily available and the degradation time of the tube is well controlled, surgical anastomotic stricture and fibrosis could be prevented. The aim of this animal study was to evaluate the preventive effect of novel biodegradable stents (BS) on biliary stricture and fibrosis after duct-to-duct (DD) biliary anastomosis. @*Methods@#Ten mini-pigs were allocated to the control group (n = 5) and or the stent group (n = 5). The common bile duct was exposed through surgical laparotomy and then resected transversely. In the stent group, a 4-mm or 6-mm polydioxanone/ magnesium sheath-core BS was inserted according to the width of the bile duct, followed by DD biliary anastomosis. In the control group, DD biliary anastomosis was performed without BS insertion. @*Results@#In the stent group, stents were observed without deformity for up to 4 weeks in all animals. Eight weeks later, histopathologic examination revealed that the common bile duct of the anastomosis site was relatively narrower in circumference in the control group compared to the stent group. The degree of fibrosis in the control group was more marked than in the stent group (3.84 mm vs. 0.68 mm, respectively; P < 0.05). @*Conclusion@#Our study showed that novel BS maintained their original shape and radial force for an adequate time and then disappeared without adverse events. The BS could prevent postoperative complications and strictures after DD biliary anastomosis.
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Purpose@#Interleukin (IL)-17A has been suggested to play a role in the growth and organization of thrombi. We examined whether IL-17A plays a role in the early stages of thrombosis and whether there are sex differences in the effects of IL-17A. @*Materials and Methods@#We performed a blinded, randomized, placebo-controlled study to compare time to thrombotic occlusion and sex differences therein between mice treated with IL-17A and those treated with saline using a ferric chloride-induced model. We also assessed thrombus histology, blood coagulation, and plasma levels of coagulation factors. @*Results@#Time to occlusion values did not differ between the IL-17A group and the control group (94.6±86.9 sec vs. 121.0±84.4 sec, p=0.238). However, it was significantly shorter in the IL-17A group of female mice (74.6±57.2 sec vs. 130.0±76.2 sec, p=0.032). In rotational thromboelastometry, the IL-17A group exhibited increased maximum clot firmness (71.3±4.5 mm vs. 66.7±4.7 mm, p=0.038) and greater amplitude at 30 min (69.7±5.2 mm vs. 64.5±5.3 mm, p=0.040) than the control group. In Western blotting, the IL-17A group showed higher levels of coagulation factor XIII (2.2±1.5 vs. 1.0±0.9, p=0.008), monocyte chemoattractant protein-1 (1.6±0.6 vs. 1.0±0.4, p=0.023), and tissue factor (1.5±0.6 vs. 1.0±0.5, p=0.003). @*Conclusion@#IL-17A plays a role in the initial st ages of arterial thrombosis in mice. Coagulation factors and monocyte chemoattractant protein-1 may be associated with IL-17A-mediated thrombosis.
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Objectives@#Recent epidemiological data reported that young adults in their 20 ~ 30s are a vulnerable population with unhealthy dietary practices and a few signs of deteriorated health indicators. However, there are no dietary guidelines that are specifically developed for the young adult population. This study introduces some data collection tools that are mostly used in the service design field, and demonstrates how these tools can be used in nutrition research for developing dietary guidelines for specific target groups. @*Methods@#To understand the context of food choices among young people, 39 people were enrolled to complete a probes booklet. Thematic analysis and word cloud were performed to capture the main themes from the probes and a persona was developed based on the findings. @*Results@#Data from the probes enabled us to grasp the various contextual meanings of eating practices among young people. Most participants understand what a healthy diet is and often have a willingness to practice it. However, there were very few participants who were following the practices. We created four types of persona for developing dietary guidelines: healthy eating, emotional eating, convenient eating, and trendy eating. @*Conclusions@#Probes and persona were used in order to understand the lives of young adults and develop targeted messages. We hope that this introduction will be helpful to researchers who are looking for new ways of understanding their target population in the field of community nutrition.
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Background@#Fibroblasts produce collagen molecules that support the structure of the skin.The decrease and hypersynthesis of collagen causes skin problems such as skin atrophy, wrinkles and scars. @*Objective@#The purpose of this study is to investigate the mechanism of mitoxantrone on collagen synthesis in fibroblasts. @*Methods@#Cultured fibroblasts were treated with mitoxantrone, and then collagen synthesis was confirmed by reverse transcription-polymerase chain reaction and Western blot. @*Results@#Mitoxantrone inhibited the expression of type I collagen in fibroblasts at both the mRNA and protein levels. In the collagen gel contraction assay, mitoxantrone significantly inhibited gel contraction compared to the control group. Mitoxantrone inhibited transforming growth factor (TGF)-β-induced phosphorylation of SMAD3. Finally, mitoxantrone inhibited the expression of LARP6, an RNA-binding protein that regulates collagen mRNA stability. @*Conclusion@#These results suggest that mitoxantrone reduces collagen synthesis by inhibiting TGF-β/SMAD signaling and LARP6 expression in fibroblasts, which can be developed as a therapeutic agent for diseases caused by collagen hypersynthesis.
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Unlike classic pyoderma gangrenosum (PG), the bullous variant of PG is typically represented by a painful erythematous papule, plaque, and superficial bulla that progress into the ulceration with bullous margin. Generally, bullous PG is most commonly associated with myeloproliferative disorders, such as acute myeloid leukemia (AML). Bullous PG in AML patients rarely occurs, but once it does, it suggests a poor clinical prognosis. Although many cases of classic PG in AML patients have been reported, bullous PG is relatively rare. Therefore, we present a case of bullous PG that developed in a patient with AML and was successfully treated with high-dose systemic steroids.
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Trichophyton tonsurans is an anthropophilic endothrix dermatophyte that has been the main causative organism of tinea capitis in the United States, Canada, Mexico, and other Latin American countries. In Korea, tinea capitis caused by T. tonsurans has been reported since 1995, but kerion celsi caused by T. tonsurans is rare. Kerion celsi is an inflammatory suppurative dermatophytosis of the scalp associated with hair loss. In this study, we report a case of kerion celsi occurring on the parietal scalp of a 6-year-old child diagnosed in a mycological study. T. tonsurans was identified and treated with oral itraconazole and topical epiconazole.
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Purpose@#The ferric chloride (FeCl3)-induced thrombosis model is widely used for thrombosis research. However, it lacks standardization with uncertainty in the exact mechanism of thrombosis. This study aimed to characterize thrombus formation in a mouse model. @*Materials and Methods@#We investigated thrombus formation and stability using various FeCl3 concentrations (10%, 20%, 30%, 40%, and 50%, w/v) in carotid arteries of the Institute of Cancer Research (ICR) and C57BL/6N mice using the FeCl3-induced thrombosis model. We also investigated thrombus histopathology using immunohistochemistry and electron microscopy. @*Results@#Higher FeCl3 concentrations induced dose-dependent, faster, larger, and more stable thrombus formation in both strains of mice. However, the ICR mice showed better dose-responses in thrombus formation and stability compared to the C57BL/6N mice. Thrombi were fibrin- and platelet-rich without significant changes across FeCl3 concentrations. However, the content of red blood cells (RBCs) increased with increasing FeCl3 concentrations (p for trend <0.001) and inversely correlated with time to occlusion (r=-0.65, p<0.001). While platelets and fibrin were evenly distributed over the thrombus, RBCs were predominantly located near the FeCl3 treatment area. Transmission electron microscopy showed that RBCs attached to and were surrounded by aggregates of degranulated platelets, suggesting their potential role in platelet activation. @*Conclusion@#Faster and larger thrombus formation is induced in a dose-dependent manner by a wide range of FeCl3 concentrations, but the stable thrombus formation requires higher FeCl3 concentrations. Mouse strain affects thrombus formation and stability. RBCs and their interaction with platelets play a key role in the acceleration of FeCl3-induced thrombosis.
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Primary cutaneous anaplastic large cell lymphoma is primary cutaneous lymphoma that is composed of large lymphoid cells with anaplastic and pleomorphic morphology and expresses the CD30 antigen. Generally, primary cutaneous anaplastic large cell lymphoma is represented by a single, erosive plaque located on the trunk or extremities, but rarely on the dorsum of the hand. A 36-year-old man visited our hospital with a plaque on the dorsum of his left hand for 2 months. The plaque was 6×5 cm in size and violet-colored, with erosion. Histopathological findings showed infiltration of large anaplastic cells in the dermis and subcutaneous fat tissue. Immunohistochemically, it showed positive results for CD3, CD4, and CD30 and negativity anaplastic lymphoma kinase. Imaging examination showed no additional lesions, and the diagnosis was confirmed as primary cutaneous anaplastic large cell lymphoma. The patient was treated with radiation therapy four times and the lesion completely disappeared.
ABSTRACT
Sweet syndrome is characterized by fever, tender, erythematous skin lesions, neutrophilia, high levels of serum inflammatory markers, and diffuse mature neutrophil infiltration typically localized to the upper dermis. Various drugs have been shown to be associated with Sweet syndrome. Bortezomib, a proteasome inhibitor approved for the treatment of multiple myeloma, has been reported to be associated with erythema, pruritus, eczemas, and, rarely, erythema multiforme-like skin changes or vasculitis. We describe a case involving a 65-year-old male who received bortezomib for the treatment of multiple myeloma. Over three cycles, multiple nodular lesions recurred through periods of aggravation and relief from symptoms. On the basis of the signs, symptoms, and biopsy results, the patient was diagnosed as showing Sweet syndrome. Skin lesions that occur during treatment of underlying disease can affect the patients’ treatment compliance. This case report indicates that a bortezomib rechallenge is an option for patients who develop sweet syndrome
ABSTRACT
Prurigo nodularis (PN) is a chronic cutaneous condition characterized by a papulonodular pruriginous eruption accompanied by pruritus. PN lesions are typically firm and itchy hyperkeratotic nodules and papules, which provoke a scratch response. PN may often represent an initial cutaneous manifestation of human immunodeficiency virus (HIV) infection. The association between PN and HIV is attributable to various etiopathogenetic mechanisms including cutaneous immunological abnormalities. Diagnosis of HIV infection in a patient with PN is challenging.We report a case of confirmed HIV infection in a patient with treatment-resistant PN, who was successfully treated using combination treatment that included HIV antiretroviral therapy and narrow-band ultraviolet-B radiation.
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Acantholytic acanthoma is a rare benign neoplasm of epidermal keratinocytes that clinically presents as a solitary, asymptomatic keratotic papule or nodule on the trunk. A 40-year-old female visited our hospital with a 20-year history of a single papule on her right thigh. On physical examination, the lesion measured 0.5×0.4 cm in size and appeared brown in color with central hyperkeratosis. Histopathological evaluation showed hyperkeratosis, acanthosis, papillomatosis, dyskeratosis, and acantholysis. Only six cases of acantholytic acanthoma have been reported in Korea. We report a rare case of acantholytic acanthoma that occurred in a 40-year-old female who presented with a keratotic papule on her right thigh.
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Purpose@#To assess the predictive factors and describe the imaging features of mediastinal lymph node (MLN) metastases in patients with head and neck cancer. @*Materials and Methods@#We compared the clinical features and disease characteristics (sex, age, site of primary tumor, histologic type, history of prior treatments, TNM stages, and metastasis in cervical LNs) of patients with head and neck cancers between the MLN metastasis and no MLN metastasis groups. We also evaluated the chest CT (distribution and maximum dimension of the largest LN) and PET/CT (maximum standardized uptake value) features of MLN metastases based on the MLN classification. @*Results@#Of the 470 patients with head and neck cancer, 55 (11.7%) had MLN metastasis, involving 150 mediastinal stations. Hypopharynx cancer, recurrent tumor, T4 stage, N2/N3 stages, and M1 stage were found to be significant predicting factors for MLN metastasis. The most common location of MLN metastasis was ipsilateral station 2 (upper paratracheal LNs, 36.4%), followed by ipsilateral station 11 (interlobar LNs, 27.3%) and ipsilateral station 10 (hilar LNs, 25.5%). @*Conclusion@#Metastasis to MLNs should be considered in patients with head and neck cancer, especially in cases that are associated with a hypopharyngeal cancer, recurrent tumor, and high TNM stages.
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Purpose@#The ferric chloride (FeCl3)-induced thrombosis model is widely used for thrombosis research. However, it lacks standardization with uncertainty in the exact mechanism of thrombosis. This study aimed to characterize thrombus formation in a mouse model. @*Materials and Methods@#We investigated thrombus formation and stability using various FeCl3 concentrations (10%, 20%, 30%, 40%, and 50%, w/v) in carotid arteries of the Institute of Cancer Research (ICR) and C57BL/6N mice using the FeCl3-induced thrombosis model. We also investigated thrombus histopathology using immunohistochemistry and electron microscopy. @*Results@#Higher FeCl3 concentrations induced dose-dependent, faster, larger, and more stable thrombus formation in both strains of mice. However, the ICR mice showed better dose-responses in thrombus formation and stability compared to the C57BL/6N mice. Thrombi were fibrin- and platelet-rich without significant changes across FeCl3 concentrations. However, the content of red blood cells (RBCs) increased with increasing FeCl3 concentrations (p for trend <0.001) and inversely correlated with time to occlusion (r=-0.65, p<0.001). While platelets and fibrin were evenly distributed over the thrombus, RBCs were predominantly located near the FeCl3 treatment area. Transmission electron microscopy showed that RBCs attached to and were surrounded by aggregates of degranulated platelets, suggesting their potential role in platelet activation. @*Conclusion@#Faster and larger thrombus formation is induced in a dose-dependent manner by a wide range of FeCl3 concentrations, but the stable thrombus formation requires higher FeCl3 concentrations. Mouse strain affects thrombus formation and stability. RBCs and their interaction with platelets play a key role in the acceleration of FeCl3-induced thrombosis.
ABSTRACT
Primary cutaneous anaplastic large cell lymphoma is primary cutaneous lymphoma that is composed of large lymphoid cells with anaplastic and pleomorphic morphology and expresses the CD30 antigen. Generally, primary cutaneous anaplastic large cell lymphoma is represented by a single, erosive plaque located on the trunk or extremities, but rarely on the dorsum of the hand. A 36-year-old man visited our hospital with a plaque on the dorsum of his left hand for 2 months. The plaque was 6×5 cm in size and violet-colored, with erosion. Histopathological findings showed infiltration of large anaplastic cells in the dermis and subcutaneous fat tissue. Immunohistochemically, it showed positive results for CD3, CD4, and CD30 and negativity anaplastic lymphoma kinase. Imaging examination showed no additional lesions, and the diagnosis was confirmed as primary cutaneous anaplastic large cell lymphoma. The patient was treated with radiation therapy four times and the lesion completely disappeared.
ABSTRACT
Sweet syndrome is characterized by fever, tender, erythematous skin lesions, neutrophilia, high levels of serum inflammatory markers, and diffuse mature neutrophil infiltration typically localized to the upper dermis. Various drugs have been shown to be associated with Sweet syndrome. Bortezomib, a proteasome inhibitor approved for the treatment of multiple myeloma, has been reported to be associated with erythema, pruritus, eczemas, and, rarely, erythema multiforme-like skin changes or vasculitis. We describe a case involving a 65-year-old male who received bortezomib for the treatment of multiple myeloma. Over three cycles, multiple nodular lesions recurred through periods of aggravation and relief from symptoms. On the basis of the signs, symptoms, and biopsy results, the patient was diagnosed as showing Sweet syndrome. Skin lesions that occur during treatment of underlying disease can affect the patients’ treatment compliance. This case report indicates that a bortezomib rechallenge is an option for patients who develop sweet syndrome
ABSTRACT
Prurigo nodularis (PN) is a chronic cutaneous condition characterized by a papulonodular pruriginous eruption accompanied by pruritus. PN lesions are typically firm and itchy hyperkeratotic nodules and papules, which provoke a scratch response. PN may often represent an initial cutaneous manifestation of human immunodeficiency virus (HIV) infection. The association between PN and HIV is attributable to various etiopathogenetic mechanisms including cutaneous immunological abnormalities. Diagnosis of HIV infection in a patient with PN is challenging.We report a case of confirmed HIV infection in a patient with treatment-resistant PN, who was successfully treated using combination treatment that included HIV antiretroviral therapy and narrow-band ultraviolet-B radiation.
ABSTRACT
Acantholytic acanthoma is a rare benign neoplasm of epidermal keratinocytes that clinically presents as a solitary, asymptomatic keratotic papule or nodule on the trunk. A 40-year-old female visited our hospital with a 20-year history of a single papule on her right thigh. On physical examination, the lesion measured 0.5×0.4 cm in size and appeared brown in color with central hyperkeratosis. Histopathological evaluation showed hyperkeratosis, acanthosis, papillomatosis, dyskeratosis, and acantholysis. Only six cases of acantholytic acanthoma have been reported in Korea. We report a rare case of acantholytic acanthoma that occurred in a 40-year-old female who presented with a keratotic papule on her right thigh.
ABSTRACT
Purpose@#To assess the predictive factors and describe the imaging features of mediastinal lymph node (MLN) metastases in patients with head and neck cancer. @*Materials and Methods@#We compared the clinical features and disease characteristics (sex, age, site of primary tumor, histologic type, history of prior treatments, TNM stages, and metastasis in cervical LNs) of patients with head and neck cancers between the MLN metastasis and no MLN metastasis groups. We also evaluated the chest CT (distribution and maximum dimension of the largest LN) and PET/CT (maximum standardized uptake value) features of MLN metastases based on the MLN classification. @*Results@#Of the 470 patients with head and neck cancer, 55 (11.7%) had MLN metastasis, involving 150 mediastinal stations. Hypopharynx cancer, recurrent tumor, T4 stage, N2/N3 stages, and M1 stage were found to be significant predicting factors for MLN metastasis. The most common location of MLN metastasis was ipsilateral station 2 (upper paratracheal LNs, 36.4%), followed by ipsilateral station 11 (interlobar LNs, 27.3%) and ipsilateral station 10 (hilar LNs, 25.5%). @*Conclusion@#Metastasis to MLNs should be considered in patients with head and neck cancer, especially in cases that are associated with a hypopharyngeal cancer, recurrent tumor, and high TNM stages.