Wall shear stress on vascular smooth muscle cells exerts angiogenic effects on extracranial arteriovenous malformations

Background@#In addition to vascular endothelial cells, vascular smooth muscle cells (VSMCs) are subject to continuous shear stress because of blood circulation. The angiogenic properties of VSMCs in extracranial arteriovenous malformations (AVMs) may exceed those of normal blood vessels if the body responds more sensitively to mechanical stimuli. This study was performed to investigate the hypothesis that rapid angiogenesis may be achieved by mechanical shear stress. @*Methods@#VSMCs were obtained from six patients who had AVMs and six normal controls. The target genes were set to angiopoietin-2 (AGP2), aquaporin-1 (AQP1), and transforming growth factor-beta receptor 1 (TGFBR1). Reverse-transcriptase polymerase chain reaction (RT-PCR) and real-time PCR were implemented to identify the expression levels for target genes. Immunofluorescence was also conducted. @*Results@#Under the shear stress condition, mean relative quantity values of AGP2, AQP1, and TGFBR1 in AVM tissues were 1.927±0.528, 1.291±0.031, and 2.284±1.461 when compared with neutral conditions. The expression levels of all three genes in AVMs were higher than those in normal tissue except for AQP1 under shear stress conditions. Immunofluorescence also revealed increased staining of shear stress-induced genes in the normal tissue and in AVM tissue. @*Conclusions@#Shear stress made the VSMCs of AVMs more sensitive. Although the pathogenesis of AVMs remains unclear, our study showed that biomechanical stimulation imposed by shear stress may aggravate angiogenesis in AVMs.

The Formation of Extragraft Bone Bridging after Anterior Cervical Discectomy and Fusion: A Finite Element Analysis

OBJECTIVE: In addition to bone bridging inside a cage or graft (intragraft bone bridging, InGBB), extragraft bone bridging (ExGBB) is commonly observed after anterior cervical discectomy and fusion (ACDF) with a stand-alone cage. However, solid bony fusion without the formation of ExGBB might be a desirable condition. We hypothesized that an insufficient contact area for InGBB might be a causative factor for ExGBB. The objective was to determine the minimal area of InGBB by finite element analysis. METHODS: A validated 3-dimensional, nonlinear ligamentous cervical segment (C3–7) finite element model was used. This study simulated a single-level ACDF at C5–6 with a cylindroid interbody graft. The variables were the properties of the incorporated interbody graft (cancellous bone [Young’s modulus of 100 or 300 MPa] to cortical bone [10000 MPa]) and the contact area between the vertebra and interbody graft (Graft-area, from 10 to 200 mm²). Interspinous motion between the flexion and extension models of less than 2 mm was considered solid fusion. RESULTS: The minimal Graft-areas for solid fusion were 190 mm², 140 mm², and 100 mm² with graft properties of 100, 300, and 10000 MPa, respectively. The minimal Graft-areas were generally unobtainable with only the formation of InGBB after the use of a commercial stand-alone cage. CONCLUSION: ExGBB may be formed to compensate for insufficient InGBB. Although various factors may be involved, solid fusion with less formation of ExGBB may be achieved with refinements in biomaterials, such as the use of osteoinductive cage materials; changes in cage design, such as increasing the area of polyetheretherketone or the inside cage area for bone grafts; or surgical techniques, such as the use of plate/screw systems.

Clinical and Laboratory Characteristics of Childhood Diabetes Mellitus: A Single-Center Study from 2000 to 2013 / 전남의대학술지

We examined the clinical and laboratory characteristics of children newly diagnosed with diabetes mellitus (DM) in a single-center study. We retrospectively reviewed the data of 155 children with DM between January 2000 and December 2013. Of 155 diabetic children, 87 (56.1%) were diagnosed with type 1 DM (T1DM) and 68 (43.9%) with type 2 DM (T2DM). Mean ages at diagnosis were 8.95+/-3.89 years (T1DM) and 13.76+/-2.23 years (T2DM), respectively (p3.59 ng/mL for 36 months. However, serum C-peptide levels in T1DM were slightly increased up to 6 months after onset and gradually decreased to 0.32 ng/mL for 36 months. The prevalence of children with DM has increased over the last 14 years, and the proportion of T2DM patients has rapidly increased since 2009. Because childhood DM is associated with several metabolic and cardiovascular complications, children should be screened for early detection of DM, especially asymptomatic T2DM in children and adolescents.

Clinical and Laboratory Characteristics of Childhood Diabetes Mellitus: A Single-Center Study from 2000 to 2013 / 전남의대학술지

We examined the clinical and laboratory characteristics of children newly diagnosed with diabetes mellitus (DM) in a single-center study. We retrospectively reviewed the data of 155 children with DM between January 2000 and December 2013. Of 155 diabetic children, 87 (56.1%) were diagnosed with type 1 DM (T1DM) and 68 (43.9%) with type 2 DM (T2DM). Mean ages at diagnosis were 8.95+/-3.89 years (T1DM) and 13.76+/-2.23 years (T2DM), respectively (p<0.001). There were significant differences in HbA1c, C-peptide, and glutamic acid decarboxylase antibody levels between the T1DM and T2DM groups. Annual numbers of children with DM have increased, and since 2011 the number of children with T2DM has surpassed the number with T1DM. The most common clinical symptom in T1DM was polyuria, and 26.4% of children with T1DM presented initially with diabetic ketoacidosis. In contrast, 60.3% of T2DM children showed glucosuria in a school urine screening, and only 19.1% presented with polydipsia. The rate of positivity for at least more than one islet autoantibody was 77.1% in T1DM and 26.3% in T2DM. Serum C-peptide levels in T2DM were increased up to 12 months after onset and remained >3.59 ng/mL for 36 months. However, serum C-peptide levels in T1DM were slightly increased up to 6 months after onset and gradually decreased to 0.32 ng/mL for 36 months. The prevalence of children with DM has increased over the last 14 years, and the proportion of T2DM patients has rapidly increased since 2009. Because childhood DM is associated with several metabolic and cardiovascular complications, children should be screened for early detection of DM, especially asymptomatic T2DM in children and adolescents.

A Case of Pancreatic Pseudocyst Resolved by Transpapillary Drainage via the Main Pancreatic Duct / 대한소화기내시경학회지

A 68-year-old man was admitted due to abdominal pain. He was diagnosed as having recurrent pancreatitis with a pseudocyst, which is communicated through the main pan- creatic duct. An endoscopic pancreatic sphincterotomy and insertion of a nasopancreatic tube into the main pancreatic duct via transpapillary drainage were performed. As a result, the pseudocyst disappeared and the pain was relieved. Thus it was concluded that transpapillary drainage via the main pancreatic duct is a safe and effective treatment for pancreatic pseudocysts, which is communicated through the main pancreatic duct.

A Case of Recurred Primary Mediastinal Nonseminomatous Germ Cell Tumor Associated with Klinefelters Syndrome / 결핵

Primary mediastinal nonseminomatous germ cell tumor associated with Klinefelter's syndrome is a rare disorder. We experienced a case of recurred primary mediastinal nonseminomatous germ cell tumor developed in a 24-year-old patient with Klinefelter's syndrome. The patient had been treated with surgery and combination chemotherapy under the diagnosis of primary mediastinal nonseminomatous germ cell tumor before. A round mass was found on the right lower lung field in the chest X-ray during follow up. The patient was diagnosed as recurred primary nonseminomatous germ cell tumor and Klinefelter's syndrome through tumor markers, peripheral blood karyotyping, and other tests including hormonal assay and was treated with combination chemotherapy and surgery again. When the patient is diagnosed as primary mediastinal nonseminomatous germ cell tumor, Klinefelter's syndrome and hematologic malignancies should be considered to be associated diseases and vice versa.

Angiosarcoma on the Right Upper Extremity in an Adolescent / 대한피부과학회지

Cutaneous angiosarcorriias occur most commonly on the face and scalp of elderly individuals and are characterized by poor prognosis. We present a case of angiosarcoma in a 17-year-old boy not associated with any predisposing factors. The patient had three, ill-defined, 3 to 5 cm sized, erythematous, indurated subcutaneous nodules on the right upper extremity with a duration of 3 months. On histological examination, there were extravasated erythrocytes and irregular vascular channels lined by atypical endothelial cells in the dermis and subcutaneous tissue. The tumor cells appeared to dissect the collagen bundles. The patient was treated by wide surgical excision and post operative radiation therapy. However, 16 months after the operation, local recurrence was found to involve the close areas to the excision site on the right upper extremity and right axillary lymph nodes.

The Iontophoresis Effect on Recovery After Acute Epidemal Barrier Disruption / 대한피부과학회지

BACKGROUND: The stratum corneum(SC) has a permeability barrier function which regulates percutaneous absorption by the inhibition of transepidermal water loss(TEWL). Acute mechanical or chemical disruption of the SC induces the impairment of the permeability barrier and so increases the TEWL. The calciumtion has been recognized as an important ion in the recovery of the skin barrier. Recently the main delivery pathway of iontophoretic drugs have been suggested by SC interstices. However the morphologic changes in the SC interstices and calcium after iontophoresis have not been reported. OBJECTIVE: The aim of our study is to confirm that iontophoresis may induce changes in the SC interstices and delay the recovery of the barrier after disruption. MATERIALS AND METHODS: After tape stripping the hairless mouse flank skin, the iontophoresis power supply (6V, 0.6mA) was connected to the patch atiached for 2.5 hours to the stripped site. We checked the THWL 0, 2.5, 6, 12, 18, 24 hours after the tape stripping and obtained specimens and performed osmium tetroxide, ruthenium tetroxide postfixation and calcium ion-capture cytochemical stains for electron microscopic study. RESULTS: The recovery rate of the TEWL in iontophoresis was lower than in the control. This was especially so in the anouse which had received anode iontophoresis for 6 hours. It showed statistically lower TEWL than in the control(p<0.05). Anode iontophoresis induced low calcium in stratum granulosum (SG), but cathode iontophoresis induced high calcium in SC. After iontophoresis there were changes in the SC interstices structures. CONCLUSION: Iontophoresis can induce changes in the SC interstices and calcium distribution and so may help the topical drug delivery system.

A Statistical analysis of Acne Patients who Visited University Hospitals Recently / 대한피부과학회지

BACKGROUND: Many patients with acne have little information about its cause, course, and treatment although it is one of the most common skin diseases seen at hospitals. OBJECTIVE: We would like to find out what acne patients think about the etiology of acne, what factors affect its course their treatment methods before going to hospital, and the psychological impact of acne. METHODS: We classified the clinical levels of acne patients who visited seven university hospitals for the first time. We distributed questionnaires to them and analysed the results statistically. RESULTS: 1) Patients were classified,according to their level of clinical severity : mild type(45.0%), moderate type(46.2%), and seuere type(8.8%). 2) The mean age at onset was 15.7 in males and 16.7 in females. 3) 69.3% of patients experienced that psychological stress had aggravated acne. 4) 42.8% of patients experienced that certain foods had aggravated acne. 5) 66.8% of female patients experienced aggravation of acne after starting to wear make-up. 6) 25.1% of female patients complained of a flare-up 1-7 days premenstrually. CONCLUSION: Acne is affected by many different factors, but there seems to be an especially close relationship between acne and the psychological factors which influence social life.

Measurement and Comparison of Hydration and Lipid Levels between Patients with Acne vulgaris and Patients with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Skin surtice lipids increase and decrease in tints with acne vulgaris and in patients with atopic dermatis, respectively. Notably, hydratior. in decreased in patients with atopic dermatitis. Clinically it is common for the two diseases to occur together. OBJECTIVE: We would like to find out the rate, clinical cteristics, and hydration and lipid levels when acne vulgaris and atopic dermatitis concur. METHODS: We classific the clinical levels and measured the hydration and lipid levels of the face and forearm area of patients with acne vulgaris, patients phatopic dermatitis, and patients with both diseases, who visited the Youngdong Severance Hospital. RESULTS: 1) 13.8% (14/102) of patients with acne vulgaris had at, epidermatitis. 31.1% (14/45) of patients with atopic dermatitis had acne vulgaris. 2) Patients with acne vulgaris had increased lipid levels and normal hydration levels. 3) Patients with atopie dermatitis had decreased lipid and iylration levels. 4) Patients withoth cnevulgaris and atopic dermatitis a no severe grade of acne vulgaris, and showed decreased hydration but normal lipid levels. CONCLUSION: In patients with both arne vulgaris and atoic dermatitis, clinically acne vulgaris was not severe and hydation levels were lower than normal controls.

Systemic Scleroderma in Childhood / 대한피부과학회지

The onset of systemic scleroderma in the first. decade of lif occurs in less than 1.5% of instances. Systemic sclerodrma in childhood have been characterized by less severe visceral involvement and a benign course We report a boy, aged 7 years, with a history of Raynaid; phenomenon and dysphagia. He had a mask-like face, flexion contracture of hands and knee joints, digital pitting scars, ichthyosiform skin change on leg and hyperpigrnented induration on all extremities and trunk. Antinuclear antibodies were positive in nucleolar type and Scl-70 antiocy was also present. On radiologie study, the pattern of reflux esophagitis and resorption of the listal ends of all phalanges were nated. Histopathological findings were compatible with sclerodma. He was treated with Penicillamine-D and oral corticosteroic with good improvernent.

Papular Tuberculid and Suppurative Lymphadenitis After BDG Vaccination / 대한피부과학회지

Various dermatological complications have been reported following the BCG vaccination although this vaccination has been recommended to all healthy infants in our country. A 4-months-old boy, who had a BCG vaccination three weeks after birth, developed erythematous papules and pustules on the whole body, especially on the face and upper extremities. Two erythematous subcutaneous soft nodules were also noted on the left side of the neck. A biopsy specimen from the right forearm revealed caseous necrosis surrounded by a granulomatous inflammation consisting of epithelioid cells and lymphocytes. It was centered along the axis of the damaged pilosebaceous follicle. No acid-fast bacilli could be demonstrated by AFB stain. A marked improvement of his skin eruptions was observed after anti-tuberculosis medication. However, nod-ules in the cervical area perforated spontaneously and healed leaving scars several months after the cutaneous eruptions subsided. The clinical and histologic findings and a good response to anti-tuberculous therapy support the diagnosis of papular tuberculid and suppurative lymphadenitis after BCG vaccination.

A Case of Infantile Nyofibromatosis / 대한피부과학회지

Infantile myofibromatosis is an uncommon, benign, probably hamai tomatous proliferation of myofibroblasts. This lesions are most often present before the age of 2 years, show a male predomenance and may be multiple or solitary. The solitary lesions arise in the dermis, subcutis, or deep soft tissue, most commonly in the head and neek region or trunk. The elinical coirse is benign and spontaneous regression is not infrequent. A female newborn presented with a turmr lesion on the upper portion of the right eyelid. Physical examination showed a firm, non-tender, fixed, erythematous, 3 x 3cm sized tumor. Histologic examinatign revealed a spindle cell tumor in the deimis with a whorled arrangemant and grouped fescicles. There was no evidence for potential visceval and bony involvement. Follow-up examination at 6 months of aige revealed a remarkable degree of spoitaneous involution.

Echocardiographic Evaluation of Left Ventricular Function in Patients with Dilated Cardiomyopathy

The term dilated(congestive) cardiomyopathy refers to a variety of cardiac disorders that have in common ventricular dilation and reduced myocardial contractility, and is derived from the common late clinical manifestation of congestive heart failure. Since echocardiography can evaluate several aspects of anatomical structures and cardiac function, it has provide a valuable contribution to the understanding of ventricular function and diagnosis of dilated cardiomyopathy. The purpose of this study is to perform the echocardiographic evaluation of left ventricular function in 44 patients with dilated cardiomyopathy and to compare the patients with normal individuals. The patients, 24 males and 20 females, had a mean age of 53.0 and body surface area of 1.61m2. Normal individuals as a control group, 10 males and 10 females, had a mean age of 47.2 and body surface area of 1.67m2. Among 44 patients with dilated cardiomyopathy, 22 cases had a history of heart failure and in 15 cases systolic murmur was heard at the apex. The cardiothoracic ratio was 0.7+/-0.1 on chest X-ray which showed significant difference when compared to normal control group, being 0.4+/-0.1(p<0.01) One case showed left ventricular thrombus and in 8 cases small mounts of pericardial effusion were noted. Among the 44 patients two had uremia, one had a history of myocarditis, one patient was young female whose illness began during the peripartum period and one had a diabetes mellitus. Results obtained were as follows; 1) Mitral valve echocardiogram (1) DE amplitude and EF slope of mitral valve(16.5+/-3.3mm and 83.5+/-3.65mm/sec respectively) showed significant decrease when compared to normal control group (20.1+/-3.0 mm and 102.4+/-28.9 mm/sec respectively) (p<0.01 and p<0.05). (2) EPSS (25.5+/-7.6mm) and the distance between posterior cusp of mitral valve and left ventricular posterior wall (9.1+/-2.1mm) showed significant increase (p<0.01) when compared to normal control group (7.1+/-2.1mm and 5.9+/-1.2mm). The ratio of the separation of two mitral leaflets to the left ventrticular diastolic dimension (0.4+/-0.1) showed significant showed significant decrease in patients when compared to normal control group (p<0.01) (3) Among 44 patients with dilated cardiomyopathy, 12 cases showed B-notch in mitral valve. 2) Echocardiographic findings of aortic valve. Left atrial size was markedly increased (37.7+/-7.5mm) when compared to nomal control group (29.1+/-4.9) (p<0.01). The ratio of left atrial size to aortic dimension was 1.3+/-0.3, showing significant increase when compared to normal control group (0.99+/-0.3) (<0.01). And 4 cases showed systolic notch in aortic valves. 3) Echocardiographic findings of left ventrcle and ventricular septum. (1) Left ventricular diastolic and systolic dimensions (41.8+/-7.8mm/m2 and 36.7+/-7.2mm/m2) were markedly increased in patient with dilated cardiomyopathy, when compared to normal control group (30.4+/-2.6mm/m2 and 11.4+/-3.2mm/m2) (p<0.1, both). Left ventricular diastolic and systolic volume (181.5+/-91.0ml/m2 and 136.6+/-69.7ml/m2) were also significantly higher in patients with dilated cardiomyopathy when compared to normal control group (79.1+/-23.8mm/m2 and 19.4+/-2.5ml/m2) (p<0.01, both). (2) Ejection fraction (0.32+/-0.10) percent fractional shortening (12.3+/-4.6) and mVcf (0.5+/-0.2 cric/sec) showed significant decrease in patients when compared to normal control group (0.74+/-0.05, 34.6+/-6.7 and 1.4+/-0.2) (p<0.01, all). Thus, We could find the reduced myocardial contractility in dilated cardiomyopathy. (3) Systolic amplitudes of venticular septum (LSa) and ventricular posterior wall (Ena) were markedly decreased (p<0.01). The sum of both values (LSa+ENa) also showed significant decrease (12.0+/-4.2mm) when compared to normal control group (p<0.01) (4) Thickness of ventricular septum and ventricular posterior wall showed slight increase in patients, but there was no significant changes when compared to normal group. 4) Systolic time interval Echocardiograms showed significant increase in ratio of preejection period to ejection time, when compared to normal group (p<0.01). Thus, the author observed that in dilated cardiomyopathy the contractility of left ventricle was significantly reduced and the left ventricular diameter and diastolic volume of left ventricle showed marked increase. And also the decreased motions of ventricular septum and posterior wall of left ventricle were noted.