Extracts of Flavoparmelia sp. Inhibit Receptor Activator of Nuclear Factor-κB Ligand-Mediated Osteoclast Differentiation

BACKGROUND: Osteoporosis is a geriatric disease with diminished bone density. The increase in the number of patients and medical expenses due to a global aging society are recognized as problems. Bone loss is the most common symptom of bone disease, not only osteoporosis but Paget's disease, rheumatoid arthritis, multiple myeloma, and other diseases. The main cause of this symptoms is excessive increase in the number and activity of osteoclasts. Osteoclasts are multinucleated giant cells that can resorb bone. They are differentiated and activation from monocytes/macrophages in the presence of macrophage colony-stimulating factor and receptor activator of nuclear factor-κB ligand (RANKL). METHODS: The effect of extract of Flavoparmelia sp. (EFV), a genus of lichenized fungi within the Parmeliaceae, on the differentiation of bone marrow-derived macrophages (BMMs) into osteoclasts was examined by phenotype assay and the cell cytotoxicity was evaluated by cell counting kit-8. The osteoclast differentiation-related genes and proteins were investigated by real-time polymerase chain reaction and immunoblotting. The functional activity of osteoclast in response to EFV treatment was evaluated by an Osteo Assay plate. RESULTS: In this study, we found that EFV, a genus of lichenized fungi within the Parmeliaceae, inhibited osteoclast formation. And we investigated its inhibitory mechanism. EFV reduced RANKL-mediated osteoclast formation and activation by inhibiting expression of nuclear factor of activated T cells 1, a key factor of osteoclastogenesis. CONCLUSIONS: Taken together, our results show that EFV is a promising candidate for health functional foods or therapeutic agents that can help treat bone diseases such as osteoporosis.

Obesity as a Risk Factor for Prostatic Enlargement: A Retrospective Cohort Study in Korea / 대한배뇨장애요실금학회지

PURPOSE: We aimed to evaluate obesity, a risk factor of metabolic syndrome, and its association with prostatic enlargement in a retrospective cohort in Korea. METHODS: Baseline data were obtained from the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population (KoGES-ARIRANG). Between March 2015 and November 2015, 2,127 male participants of KoGES-ARIRANG were invited to the Korean Prostate Health Council Screening Program, and 602 participants underwent urological examination, including serum prostate specific antigen measurement and transrectal ultrasonography, and completed the International Prostate Symptom Score questionnaire. The data for 571 participants were analyzed, after excluding 31 men who had a history of prostatic disease or testosterone replacement, or had undergone a prior prostatic surgery or procedure. RESULTS: Among components of metabolic syndrome, waist circumference had a statistically significant linear correlation with incremental increases in prostate volume (B=0.181, P=0.004). Abdominal obesity as determined by anthropometric measures including body mass index (odds ratio [OR], 1.205; 95% confidence interval [CI], 1.088–1.336), waist circumference (OR, 1.073; 95% CI, 1.032–1.115), body fat (OR, 1.126; 95% CI, 1.056–1.202), and visceral fat composition (OR, 1.667; 95% CI, 1.246–2.232) was significantly associated with the presence of high-volume benign prostatic hyperplasia (BPH) (prostate volume≥ 40 mL). Furthermore, the highest quartile of serum leptin (OR, 3.541; 95% CI, 1.103–11.365) and adiponectin levels (OR, 0.315; 95% CI, 0.102–0.971) were significantly correlated with high-volume BPH compared to the lowest quartile of levels. CONCLUSIONS: Abdominal obesity and serum leptin level are positively associated with prostate growth, whereas serum adiponectin level is inversely associated with the presence of prostatic enlargement.

The incidence and histological characteristics of intratubular germ cell neoplasia in postpubertal cryptorchid testis

PURPOSE: It is well known that testicular germ cell tumors arise with increased frequency in patients with cryptorchidism. In addition, intratubular germ cell neoplasia (ITGCN) is a precursor lesion to testicular germ cell tumor. Approximately 50% of patients with ITGCN will develop an invasive of testicular germ cell tumors within 5 years. Therefore, we evaluated that the incidence of ITGCN in postpubertal cryptorchidism. MATERIALS AND METHODS: Between January 2002 and August 2012, orchiectomy specimens from 31 postpubertalpatients (aged 12 or over) with cryptorchid testis were reviewed. The specimens were evaluated for ITGCN using immunohistochemical stains of placental-like alkaline phosphatase and Oct 3/4 with routine hematoxylin-eosin stain. Additionally, the degree of spermatogenesis was assessed using the Johnsen score. RESULTS: Mean age was 34 years (range, 17 to 74 years) at surgery. All patients were diagnosed as unilateral cryptorchidism. One patient (3.2%) of 20-year-old had ITGCN in surgical specimen with all positive markers. Histological assessment of spermatogenesis showed that mean Johnsen score was 3.42 (range, 1 to 9). Majority of patients (27 of 31) presented impaired spermatogenesis with low Johnsen score lesser than 5. CONCLUSIONS: Considering the risk of malignancy and low spermatogenesis, we should perform immunohistochemical stains and discuss preventative orchiectomy for the postpubertal cryptorchidism.

House-plant placement for indoor air purification and health benefits on asthmatics

OBJECTIVES: Some plants were placed in indoor locations frequented by asthmatics in order to evaluate the quality of indoor air and examine the health benefits to asthmatics. METHODS: The present study classified the participants into two groups: households of continuation and households of withdrawal by a quasi-experimental design. The households of continuation spent the two observation terms with indoor plants, whereas the households of withdrawal passed the former observation terms with indoor plants and went through the latter observation term without any indoor plants. RESULTS: The household of continuation showed a continual decrease in the indoor concentrations of volatile organic compounds (VOCs) during the entire observation period, but the household of withdrawal performed an increase in the indoor concentrations of VOCs, except formaldehyde and toluene during the latter observation term after the decrease during the former observation term. Peak expiratory flow rate (PEFR) increased in the households of continuation with the value of 13.9 L/min in the morning and 20.6 L/ min in the evening, but decreased in the households of withdrawal with the value of -24.7 L/min in the morning and -30.2 L/min in the evening in the first experimental season. All of the households exhibited a decrease in the value of PEFR in the second experimental season. CONCLUSIONS: Limitations to the generalizability of findings regarding the presence of plants indoors can be seen as a more general expression of such a benefit of human-environment relations.

Testicular Torsion as an Overlooked Cause of Acute Abdomen

Acute scrotal pain is a common urologic presentation and critical pathology due to the possibility of organ loss in the emergency department. Referred pain in the lower quadrant of the abdomen may accompany testicular torsion. Of 58 patients with testicular torsion between January 2001 and March 2011, three visited the emergency department with abdominal pain alone. The median age of the patients was 16 years (range, 13-19). Median duration of abdominal pain to first medical examination and proper diagnosis by an urologist was 14 hours (range, 2-168) and 77 hours (range, 57-240), respectively. All patients underwent orchiectomy. Due to symptomatic variations for testicular torsion, all clinicians providing emergency care to patients who have referred pain in the lower abdomen without scrotal pain should consider the constellation of symptoms in order to avoid superfluous diagnostic delay.

Testicular Torsion as an Overlooked Cause of Acute Abdomen

Acute scrotal pain is a common urologic presentation and critical pathology due to the possibility of organ loss in the emergency department. Referred pain in the lower quadrant of the abdomen may accompany testicular torsion. Of 58 patients with testicular torsion between January 2001 and March 2011, three visited the emergency department with abdominal pain alone. The median age of the patients was 16 years (range, 13-19). Median duration of abdominal pain to first medical examination and proper diagnosis by an urologist was 14 hours (range, 2-168) and 77 hours (range, 57-240), respectively. All patients underwent orchiectomy. Due to symptomatic variations for testicular torsion, all clinicians providing emergency care to patients who have referred pain in the lower abdomen without scrotal pain should consider the constellation of symptoms in order to avoid superfluous diagnostic delay.

Clinical Significance of National Institutes of Health Classification in Patients With Chronic Prostatitis/Chronic Pelvic Pain Syndrome

PURPOSE: We determined the effects of alpha-blockers and quinolone in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) classified by National Institute of Health (NIH) consensus group. MATERIALS AND METHODS: Data from a total of 111 patients who were diagnosed with CP/CPPS between June 2010 and June 2012 were analyzed retrospectively. The patients were classified into group 1 (category IIIA, n=40) and group 2 (category IIIB, n=71). Treatment using alfuzosin and levofloxacin was given to both groups for 6 weeks. International Prostate Symptom Score (IPSS) and NIH Chronic Prostatitis Symptom Index were measured before and after therapy. RESULTS: Group 1 had a significant decrease in total IPSS score, CPSI pain score, CPSI quality of life (QoL) score, and total CPSI score (p=0.043, p=0.006, p=0.015, and p=0.006, respectively). Group 2 had a significant decrease in IPSS voiding symptom score, IPSS storage symptom score, total IPSS, CPSI pain score, CPSI voiding score, CPSI QoL score, and total CPSI score (p=0.002, p=0.004, p=0.001, p=0.001, p=0.006, p=0.001, and p=0.001, respectively). The CPSI score was reduced by 6 points or more in 50.0% of patients (n=18) in group 1 and in 51.6% of patients (n=32) in group 2. However, there was no statistically significant difference between the changes in IPSS and CPSI scores across the 2 groups. CONCLUSIONS: Although combination treatment reduced the CPSI score in both groups, there was no significant difference between the groups after combination treatment. We suggest that factors other than inflammation also contribute to symptoms associated with CP/CPPS.

Acute Epididymitis in Children: the Role of the Urine Test

PURPOSE: Acute epididymitis is considered to have an important role in children with scrotal pain. Recent reports have shown that urinalysis is not helpful for the diagnosis and treatment of acute epididymitis owing to negative microbiological findings. Therefore, we analyzed clinical and laboratory characteristics to examine the diagnostic yield of urinalysis in children. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 139 patients who were diagnosed with acute epididymitis from 2005 to 2011. Diagnosis was based on symptoms, physical findings, and color Doppler ultrasonography (DUS). To investigate the characteristics of epididymitis in children, the patients were divided into 3 groups: group A (aged less than 18 years, 76 patients), group B (18 to 35 years old, 19 patients), and group C (older than 35 years, 44 patients). RESULTS: There were statistically significant differences in age, symptom duration, hospital stays, and lesion location in each group. White blood cell count and serum C-reactive protein levels, pyuria, and positive urine culture results were statistically higher in the older age group. The most common cause of acute epididymitis in children was idiopathic (96.1%). CONCLUSIONS: In our group of children with epididymitis, 73 cases out of 76 (96.1%) resulted in negative pyuria in urinalysis. In addition, the most common cause of epididymitis was idiopathic. Because most urinalyses do not show pyuria, we believe that routine antibiotics may be not required in pediatric patients with epididymitis. If urinalysis shows pyuria with or without positive urine culture, antibiotics should be considered.

Penile Epidermal Cyst in a Patient With Augmentation Penoplasty

A 44-year-old male patient who had undergone augmentation penoplasty 20 years previously presented with a slowly growing penoscrotal mass. The penile mass was excised totally and the pathologic diagnosis was an epidermal cyst. Epidermal cysts are benign disorders that can occur in any part of the body. However, an epidermal cyst as a late complication of augmentation penoplasty is extremely rare. We report this case of a penile epidermal cyst that developed after augmentation penoplasty.

Initial Clinical Experience of Simultaneous Robot-Assisted Bilateral Partial Nephrectomy and Radical Prostatectomy

A 62-year-old male patient with prostate cancer and bilateral renal cell carcinoma underwent a simultaneous robot-assisted bilateral partial nephrectomy and radical prostatectomy. We describe our initial experience of combined operation with a port strategy allowing reuse of ports and surgical considerations because of prolonged pneumoperitoneum.

Face and Neck Lift with Thread (Won V Lift)

During the facial aging, a series of physical and biochemical changes leads to tissue hypotrpphy, sagging and wrinkles not only at the level of the skin but also in the soft tissue structure. There has been a recent trend toward minimally invasive procedures for facial rejuvenation. This trend is keeping with a general demand toward more effective procedure with less tissue injury and less down time for the patient. Suspending thread technique is a new innovation in plastic surgery. Fifty patients underwent a threadlift procedure in combination with fat injection or filler injection to the midface, lowface, jowl and neck. We used anchoring point with deep temporal fascia in cheek and low face lift and mastoid fascia in neck lift without any incision. The procedure outcome was assessed in each case through patient interviews. All patients demonstrated improvement and youthful appearance in the midface, lowface, jowl and neck with minimal complications. Threadlift is a safe procedure with limited scarring, rapid recovery and low complication rates. The combination of the threadlift and fat injection or filler injection enables the increase of volume of mid or low face and prevents the complication with great patient satisfaction.

Inhibitory Effects of 1',2'-Dihydrorotenone on Osteoclast Differentiation and Bone Resorption In Vitro and In Vivo / 체질인류학회지

It is important to identify therapeutic compounds with no adverse effects for use in the chemotherapy of patients with bone-related diseases. The aim of this study was to identify a new compound that inhibits osteoclast differentiation and bone resorption. Herein, we examined the effects of 1',2'-dihydrorotenone on osteoclast differentiation and bone resorption in vitro and in vivo. 1',2'-dihydrorotenone inhibited receptor activator of NF-kappaB ligand (RANKL)-induced osteoclast differentiation of cultured bone marrow macrophages (BMMs) in a dose-dependent manner. However, 1',2'-dihydrorotenone did not exert cytotoxic effect on BMMs. 1',2'-dihydrorotenone suppressed the expression of c-fos and NFATc1 as well as osteoclast-specific genes in BMMs treated with RANKL. Treatment with RANKL inhibited the expression of inhibitors of differentiation/DNA binding (Id)1, 2, and 3; however, in the presence of 1',2'-dihydrorotenone, RANKL did not suppress the expression of Id1, 2, and 3. Furthermore, 1',2'-dihydrorotenone inhibited bone resorption and considerably attenuated the erosion of trabecular bone induced by lipopolysaccharide treatment. Taken together, these results suggest that 1',2'-dihydrorotenone has the potential to be applied in therapies for bone-related diseases.

Comparative Analysis of Outcomes after Transurethral Resection of the Prostate according to Prostate Shape Shown by Transrectal Ultrasonography

PURPOSE: Transrectal ultrasonography (TRUS) is a non-invasive modality widely used in urology on an outpatient basis to measure the volume and anatomical structure of the prostate. However, the prostate volume measured by TRUS often varies from test to test. The aim of this study was to determine the clinical significance of the different shapes of the prostate, as shown by TRUS before and after transurethral resection of the prostate (TURP). MATERIALS AND METHODS: We evaluated 103 patients who underwent TURP. TRUS was performed preoperatively, and the International Prostatic Symptom Score (IPSS) and quality of life (QoL) were assessed preoperatively and at 6 months postoperatively. Patients were classified into two groups: patients with a bilaterally enlarged transitional zone were assigned to group A, and those with a protruding retrourethral zone were assigned to group B. RESULTS: There were no statistically significant differences between the two groups in preoperative variables. However, postoperative IPSS scores were lower in group A than group B (9.87+/-6.15 vs. 13.18+/-8.07, p=0.02). With regard to postoperative IPSS scores relative to preoperative IPSS scores, both groups showed a significant decrease, but group A experienced a significantly greater decrease than group B (13.43+/-7.47 vs. 8.67+/-8.33, p=0.005). CONCLUSIONS: Patients with a prostate protruding into the bladder have less of a decrease in their IPSS scores after TURP, compared to patients that do not have prostate protrusion, meaning that patients with protrusion experience less symptomatic relief.

Comparative Analysis of Outcomes after Transurethral Resection of the Prostate according to Prostate Shape Shown by Transrectal Ultrasonography

PURPOSE: Transrectal ultrasonography (TRUS) is a non-invasive modality widely used in urology on an outpatient basis to measure the volume and anatomical structure of the prostate. However, the prostate volume measured by TRUS often varies from test to test. The aim of this study was to determine the clinical significance of the different shapes of the prostate, as shown by TRUS before and after transurethral resection of the prostate (TURP). MATERIALS AND METHODS: We evaluated 103 patients who underwent TURP. TRUS was performed preoperatively, and the International Prostatic Symptom Score (IPSS) and quality of life (QoL) were assessed preoperatively and at 6 months postoperatively. Patients were classified into two groups: patients with a bilaterally enlarged transitional zone were assigned to group A, and those with a protruding retrourethral zone were assigned to group B. RESULTS: There were no statistically significant differences between the two groups in preoperative variables. However, postoperative IPSS scores were lower in group A than group B (9.87+/-6.15 vs. 13.18+/-8.07, p=0.02). With regard to postoperative IPSS scores relative to preoperative IPSS scores, both groups showed a significant decrease, but group A experienced a significantly greater decrease than group B (13.43+/-7.47 vs. 8.67+/-8.33, p=0.005). CONCLUSIONS: Patients with a prostate protruding into the bladder have less of a decrease in their IPSS scores after TURP, compared to patients that do not have prostate protrusion, meaning that patients with protrusion experience less symptomatic relief.

Malignant Rhabdoid Tumor of the Kidney Combined with Multicystic Dysplasia in a 5-year-old Child

Multicystic dysplastic kidney (MCDK) is a relatively common developmental anomaly in infants and children and has a good prognosis. In contrast, a malignant rhabdoid tumor of the kidney (MRTK) is one of the most lethal neoplasms of early life. However, the presentation of such a lethal tumor combined with multicystic dysplasia has not been reported to date. In this report, we describe a case of MRTK in a 5-yr-old girl who also had multicystic dysplasia. She was previously diagnosed with MCDK at birth due to a huge palpable mass on the right side of the abdomen. The right kidney was extensively replaced by numerous grossly dilated, variable-sized cysts. Microscopically, the tumor cells show a diffusely infiltrative growth pattern, which revealed large non-cohesive, round-to-polygonal tumor cells with vesicular nuclei. Some tumor cells had eccentric nuclei and large, round, eosinophilic cytoplasmic inclusions. There were metanephrons present, with the central ureteric bud and peripheral branches surrounded by condensing mesenchyma, immature glomeruli, and metaplastic cartilage in the adjacent parenchyma. To our knowledge, this is the first combined case of the two aforementioned diseases and this case may, in fact, suggest a new disease entity.

A case of superior mesenteric artery thrombosis associated with antiphospholipid syndrome / 대한내과학회지

Antiphospholipid syndrome (APS) has received considerable attention due to its association with a thrombophilic disorder. Thrombotic events associated with this syndrome most often involve the venous system and occasionally the arterial system such as the cerebral, coronary, renal, and retinal arteries. Few reports on mesenteric artery thrombosis associated with APS are documented. We report a case of a 45 year old male diagnosed with superior mesenteric artery thrombosis associated with APS. The patient had symptoms of chronic mesenteric ischemia including postprandial abdominal pain, weight loss and diarrhea, and was positive for lupus anticoagulant antibody. An abdominal CT showed superior mesenteric arterial thrombosis and luminal narrowing. Symptoms were improved after anticoagulant therapy.

A Case of a Primary Esophageal Bezoar after a Total Gastrectomy / 대한소화기내시경학회지

An esophageal bezoar, although uncommon, is now recognized as a distinct clinical entity. An esophageal bezoar is rare but can form due to regurgitation of a gastric bezoar, motor disorder or anatomical abnormality, or following a gastrectomy. In general, bezoars are most often found in the stomach, and are formed by the accumulation of foreign ingested materials, including vegetable material and hair. In Korea, no case of a primary esophageal bezoar has been reported after a total gastrectomy. We report a case of an endoscopically treated primary esophageal bezoar that occurred after a total gastrectomy, without complications.

A Case of Primary Melanoma of the Anus that Spread to the Submucosa of the Rectum / 대한소화기내시경학회지

Primary malignant melanoma of the anorectum is rare, representing about 1% of all colorectal carcinoma and less than 1% of all melanomas. The most common symptom of malignant melanoma of the anorectum is anal bleeding and this is often misdiagnosed as hemorrhoids. A 72-year-old female patient was admitted due to intermittent anal bleeding for 6 months. Colonoscopic examination showed a large exophytic mass with an irregularly ulcerated and greenish-brown pigmentation on the anus and the examination also simultaneously showed a submucosal tumor-like lesion in the rectum that was located 5 cm from the anal verge. Light microscopy of the tumor revealed malignant melanocytes and the tumor cells reacted positively for immunohistochemical staining with S-100 protein and HMB-45. Distant metastasis to the brain was detected on brain MRI.

Clinical Observation of Colorectal Polyps / 대한소화기내시경학회지

BACKGROUND/AIMS: The detection and removal of colorectal polyps are important for secondary prevention of colorectal cancer. We investigated the characteristics and histopathologic finding of polyps to better plan their management. METHODS: We analyzed 334 patients who underwent polypectomies for 770 colorectal polyps between October, 2005 and April, 2007 at Bong Seng Memorial Hospital. RESULTS: Colorectal polyps were frequent in the sixth decade in both sexes. The ratio of male to female patients was 1.72:1. Abdominal pain/discomfort was the most common symptom (34.4%), and the most common site of polyp localization was the rectosigmoid colon. Histopathologic examination showed tubular adenomas (54.6%), hyperplastic polyps (36.4%), and inflammatory polyps (5.6%). Adenomatous polyps were more common in patients with multiple polyps than in patients with a single polyp. Adenomatous polyps with villous histology were more common in patients with large polyps than in patients with small polyps. Non-neoplastic polyps were common before the fifth decade. Neoplastic polyps were common past the fifth decade. CONCLUSIONS: In this study, tubular adenomas were frequently found on histopathologic examination, sessile type were frequently found on gross examination, and colorectal polyps were found principally in the rectosigmoid colon. Neoplastic polyps were more frequent in patients beyond the fifth decade. There fore colonoscopy examination is recommended for secondary prevention of colon cancer.

A Case of a Gastric Metastasis of a Renal Cell Carcinoma / 대한소화기내시경학회지

A gastric metastasis is an extremely rare event accounting for 0.2 to 0.7% of gastric neoplasms seen at necropsy. Primary origins of a gastric metastasis are pancreatic cancers, colon cancers, lung cancers and malignant melanomas. A renal cell carcinoma is renowned for its metastatic potential to spread to almost any organ of the body. However, a gastric metastasis of a renal cell carcinoma is very rare. It is believed that a renal cell carcinoma metastasizes hematogenously and it spreads through a renal vein to the stomach via the inferior vena cava and hemiazygos vein. A metastasis to the stomach is frequently located in the greater curvature of body. Endoscopic findings of a gastric metastasis often resemble a submucosal tumor with or without ulcer. Presenting symptoms are bleeding, anemia, or pyloric obstruction, but often the patient is asymptomatic. We report a case and review of the literature of a metastatic renal cell carcinoma to the stomach in a 71-year-old man who complained of a palpable abdominal mass.