Epigenetic Regulation of the Expression of T Cell Stimulatory and Inhibitory Factors by Histone H3 Lysine Modification Enzymes and Its Prognostic Roles in Glioblastoma

Background@#This study aimed to identify the specific T cell co-stimulatory and co-inhibitory factors that play prognostic roles in patients with glioblastoma. Additionally, the unique histone H3 modification enzymes that regulate the expression levels of these specific costimulatory and co-inhibitory factors were investigated. @*Methods@#The medical records of 84 patients newly diagnosed with glioblastoma at our institution from January 2006 to December 2020 were retrospectively reviewed.Immunohistochemical (IHC) staining for T cell co-stimulatory factors (CD27, CD28, CD137, OX40, and ICOS), T cell co-inhibitory factors (CTLA4, PD1, PD-L1, TIM3, and CD200R), and histone H3 lysine modification enzymes (MLL4, RIZ, EZH1, NSD2, KDM5c, JMJD1a, UTX, and JMJD5) was performed on archived paraffin-embedded tissues obtained by biopsy or resection. Quantitative real time-polymerase chain reaction (qRT-PCR) was performed for specific factors, which demonstrated causal relationships, in order to validate the findings of the IHC examinations. @*Results@#The mean follow-up duration was 27.5 months (range, 4.1–43.5 months). During this period, 76 patients (90.5%) died, and the mean OS was 19.4 months (95% confidence interval, 16.3–20.9 months). Linear positive correlations were observed between the expression levels of CD28 and JMJD1a (R2 linear = 0.982) and those of CD137 and UTX (R2 linear = 1.528). Alternatively, significant negative correlations were observed between the expression levels of CTLA4 and RIZ (R2 linear = −1.746) and those of PD-L1 and EZH1 (R2 linear = −2.118); relationships were confirmed by qRT-PCR. In the multivariate analysis, increased expression levels of CD28 (P = 0.042), and CD137 (P = 0.009), and decreased expression levels of CTLA4 (P = 0.003), PD-L1 (P = 0.020), and EZH1 (P = 0.040) were significantly associated with longer survival. @*Conclusion@#These findings suggest that the expression of certain T cell co-stimulatory factors, such as CD28 and CD 137, and co-inhibitory factors, such as CTLA4 and PD-L1 are associated with prognosis of glioblastoma patients.

The Pterional-Transsylvian Approach for Tumor in the Temporal Horn: A Case Report

A variety of surgical approaches to temporal horn tumors of the lateral ventricle have been described. Magnetic resonance imaging (MRI) and angiography are the preferred modalities for preoperative evaluation and provide important information for the choice of surgical approach. A 59-year-old man was referred to our hospital due to confusion and gait disturbance. On enhanced MRI, a homogeneous enhanced solitary mass was observed within the temporal horn of the left lateral ventricle with transependymal extension. The lesion was accompanied by increased hypervascular tumor blush on preoperative cerebral angiography. Subtotal removal of the temporal horn tumor was performed because the lesion was identified as lymphoma during surgery. The postoperative course was un-eventful. The patient was referred to the oncology department for conventional chemotherapy. Adjuvant chemotherapy improved the clinical outcome. The pterional-transsylvian approach was beneficial for partial removal of the tumor and tissue diagnosis in this case.

Epigenetic Role of Histone 3 Lysine Methyltransferase and Demethylase in Regulating Apoptosis Predicting the Recurrence of Atypical Meningioma

Alteration of apoptosis is related with progression and recurrence of atypical meningiomas (AMs). However, no comprehensive study has been conducted regarding histone modification regulating apoptosis in AMs. This study aimed to determine the prognostic values of certain apoptosis-associated factors, and examine the role of histone modification on apoptosis in AMs. The medical records of 67 patients with AMs, as diagnosed during recent 13 yr, were reviewed retrospectively. Immunohistochemical staining was performed on archived paraffin-embedded tissues for pro-apoptotic factors (CASP3, IGFBP, TRAIL-R1, BAX, and XAF1), anti-apoptotic factors (survivin, ERK, RAF1, MDM2, and BCL2), and the histone modifying enzymes (MLL2, RIZ, EZH1, NSD2, KDM5c, JMJD2a, UTX, and JMJD5). Twenty-six (38.8%) patients recurred during the follow-up period (mean duration 47.7 months). In terms of time-to-recurrence (TTR), overexpression of CASP3, TRAIL-R1, and BAX had a longer TTR than low expression, and overexpression of survivin, MDM2, and BCL2 had a shorter TTR than low expression (P<0.05). Additionally, overexpression of MLL2, UTX, and JMJ5 had shorter TTRs than low expression, and overexpression of KDM5c had a longer TTR than low expression. However, in the multi-variate analysis of predicting factors for recurrence, low expression of CASP3 (P<0.001), and BAX (P<0.001), and overexpression of survivin (P=0.007), and MDM2 (P=0.037) were associated with recurrence independently, but any enzymes modifying histone were not associated with recurrence. Conclusively, this study suggests certain apoptosis-associated factors should be associated with recurrence of AMs, which may be regulated epigenetically by histone modifying enzymes.

Prescription Pattern of NSAIDs and the Prevalence of NSAID-induced Gastrointestinal Risk Factors of Orthopaedic Patients in Clinical Practice in Korea

This is a cross-sectional observational study undertaken to explore the current prescription pattern of non-steroidal anti-inflammatory drugs (NSAIDs) and the prevalence of NSAID-induced gastrointestinal (GI) risk factors of orthopaedic patients in real clinical practice in Korea. Study cohort included 3,140 orthopaedic outpatients at 131 hospitals and clinics between January 2008 and August 2008. A self-administered questionnaire was completed by each patient and physician. A simplified risk scoring scale (the Standardized Calculator of Risk for Events; SCORE) was used to measure patients' risk for GI complications. The pattern of NSAIDs prescription was identified from medical recordings. Forty-five percents of the patients belonged to high risk or very high risk groups for GI complications. The cyclooxygenase-2 enzyme (COX-2) selective NSAID showed a propensity to be prescribed more commonly for high/very high GI risk groups, but the rate was still as low as 51%. In conclusion, physician's considerate prescription of NSAIDs with well-understanding of each patient's GI risk factors is strongly encouraged in order to maximize cost effectiveness and to prevent serious GI complications in Korea. Other strategic efforts such as medical association-led education programs and application of Korean electronic SCORE system to hospital order communication system (OCS) should also be accompanied in a way to promote physician's attention.

Treatment of Infected Total Knee Arthroplasty

Deep infection after total knee arthroplasty (TKA) represents a significant treatment challenge with the possibility of disastrous consequences. The rate of deep infection rate after TKA was reported to be 1.3~2.9% in the past. With the improvements of the operation environment and operative technique and the use of prophylactic antibiotics and antibiotic-mixed bone cement, the rate of deep infection was recently reported to be 0.5~1%. The goal of treatment of a periprosthetic TKA infection is the restoration of a painless, well-functioning joint, with eradication of the infection. Yet the outcome is not always favorable, and the end result could be an arthrodesis, amputation or a pseudoarthrodesis. In some instance, the only realistic option is to suppress the infection with continued oral antibiotics while simultaneously retaining the prosthesis. Two-stage resection arthroplasty remains the standard treatment for chronic periprosthetic infection. Early deep infection may be treated with aggressive debridement and intravenous antibiotics without removal of the implant. Two-stage reimplantation after removal of the implant is most important for the treatment of chronic infection.

Patterns and Clinical Significance of Nodal Metastasis in Squamous Cell Carcinoma of Hypopharynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the incidence and prognostic significance of cervical lymph node metastasis in squamous cell carcinoma (SCC) of the hypopharynx. SUBJECTS AND METHOD: A retrospective review of the 64 patients who were previously untreated for SCC of the hypopharynx and underwent surgery was performed from October 1993 to June 2008. Fifty-six patients had simultaneous bilateral neck dissection, whereas eight had unilateral neck dissection. RESULTS: The median age was 61.0 years (range, 34-75 years) for the study group consisting of 62 males and two females. Evaluating according to the N stages, there were 15 (23.4%), 10 (15.6%), 37 (57.8%), and 2 (3.1%) cases with N0, N1, N2 and N3, respectively. Forty-nine patients (76.6%) had pathologically proven cervical metastasis. Contralateral occult lymph node metastasis occurred in 20.5%. Ipsilateral and contralateral occult metastasis rates for clinically node negative patients were 41.2% and 11.8%, respectively. The most frequent sites for positive neck nodes occuring at each level were as follows: II (48.5%), level III (40.6%), level IV (26.6%), paratracheal node (21.4%), level V (9.4%), levels I (7.8%), and retropharyngeal node (6.3%). The 5-year overall survival and disease-specific survival rates were 50% and 53%, respectively. Cervical nodal metastasis (p=0.044) was statistically significant prognostic factors for disease-specific survival. CONCLUSION: Metastasis to the cervical lymph node group is very frequent and has an impact on survival in patients with hypopharyngeal SCC. Therefore, we advocate bilateral neck dissection in patients with hypopharyngeal SCC with clinically positive metastasis. Ipsilateral elective neck dissection may be needed for clinically node negative patients.

A Case of Enchondral Pseudocyst of the Auricle / 대한이비인후과학회지

Endochondral pseudocyst of the ear is considered to be a benign, asymptomatic condition seen infrequently in clinical practice. It is an intracartilaginous cyst devoid of epithelial lining and filled with a sterile, viscous, straw-colored fluid. It is important to remove the pseudocyst to prevent recurrence and good esthetic outcome. We experienced a case of a 59-years-old man with an endochondral pseudocyst of his right auricle. To our knowledge, this is the first report in Korea, so we report this case with a review of the literature.

The Effects of Strontium Ions on Epidermal Permeability Barrier / 대한피부과학회지

BACKGROUND: Several ions, such as calcium or magnesium ions, are reported to have regulatory effects on epidermal permeability barrier homeostasis. Recently, it has been suggested that strontium ion can play a substitutive role for calcium ion in various cellular reactions. OBJECTIVE: This study was conducted to investigate the effects of strontium ion, either alone or in combination with calcium or magnesium ions, on epidermal permeability barrier homeostasis. METHODS: Female hairless mice were used to study the effects of various ions on epidermal permeability barrier recovery. Calcium chloride solution, magnesium chloride solution or strontium chloride solution were topically applied to barrier-disrupted skin, either alone or simultaneously. Change of transepidermal water loss, which represents permeability barrier function, was measured by TEWameter and morphological change was also observed by light and electron microscopy. RESULTS: Topical application of strontium chloride solution accelerated permeability barrier recovery rate, compared with vehicle-applied skin. Magnesium chloride solution also accelerated barrier recovery rate, as reported in previous studies. Interestingly, simultaneous application of strontium and calcium ions significantly accelerated barrier recovery rate, compared to application of strontium or calcium ion alone. Nile red staining confirmed the increased neutral lipid deposition in strontium ion applied skin. Electron microscopic observation also revealed an increased lamellar body secretion in strontium ion applied skin. CONCLUSION: Strontium ion can play a regulatory role in epidermal permeability barrier homeostasis due to, at least in part, its competitive action on calcium ion for the same ion channel.

Distal Radius Fracture Treated with Two Small Fragment Plates / 대한정형외과학회잡지

PURPOSE: To analyze functional and radiological results and early motion after the stable fixation of fractures of the distal radius by using two small fragment plates. MATERIALS AND METHODS: Thirty cases were analyzed clinically and radiographically. Internal fixation was achieved using two 2.7 mm stainless steel small fragment plates on the radial and intermediate columns angled 60 degrees C apart in all cases. For functional evaluation, Green and O'Brien scores were analyzed. For radiological evaluation, volar tilting angle, radial inclination, and ulnar variance were analyzed. Arthroscopy was performed in all cases concomitantly. RESULTS: Functional results were excellent or good in 24 patients (80%) according to the modified system of Green and O' Brien. Radiological analysis showed that volar tilting angle, radial inclination or ulnar variance during the immediate postoperative to bony union period had no significant difference. Complications occurred in two wrists, namely reflex sympathetic dystrophy (1) and delayed union (1) needing an additional palmar plate and a bone graft. No case experienced implant failure or extensor tendinitis. CONCLUSION: Two 2.7 mm small fragment plates fixations provided good stability, and allowed early function. We report a series of 30 fractures treated by this method of internal fixation with satisfactory results.

Triangular Fibrocartilage Complex and Lunotriquetral Ligament Injury of Distal Radius Fracture / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to assess the relationships between the pattern of fractures and associated intra-articular soft tissue injuries. MATERIALS AND METHODS: We performed a study of 31 patients treated for distal radius fracture. Radiographic evaluation included ulnar styloid process fracture, dorsal anglulation and ulnar variance. We observed TFCC injuries, scapholunate and lunotriquetral ligament injuries by arthroscopy. RESULTS: The incidence of TFCC radial rim tear and lunotriquetral ligament injuries were significantly higher in die punch fractures with lunate facet involvement than in fractures without lunate facet involvement (p0.05). CONCLUSION: The TFCC radial rim and the lunotriquetral ligament may be injured by axial compression loading of the ulnar head on the triquetrum. TFCC radial rim tear and lunotriquetral ligament injuries must be kept in mind in die punch fractures with lunate facet involvement.

Clinical Efficacy of Levonorgestrel-Releasing Intrauterine System (Mirena(R)) for Abnormal Uterine Bleeding / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to study the clinical efficacy of Levonorgestrel-releasing intrauterine system (Mirena(R)) for patients who have abnormal uterine bleeding before menopause or sustaining vaginal spotting during postmenopaual hormone replacement therapy. METHODS: Between June, 2001 and June, 2003, forty six premenopausal women with abnormal uterine bleeding such as menorrhagia and intermenstrual bleeding who did not prefer surgical treatment (Group 1) and twenty four postmenopausal patients with vaginal spotting (Group 2) were included in this study. The various parameters such as uterine bleeding, dysmenorrhea, volume changes of myoma or adenomyosis, and endometrial thickness were evaluated by transvaginal ultrasound examination before and after Levonorgestrel- releasing intrauterine system usage. RESULTS: A significant reduction in abnormal bleeding (26.3 vs 11.0) (p<0.0001) and dysmenorrhea (11.6 vs 6.1) (p<0.0001) were noticed. However, there was no significant change in volume of uterine myoma (40.0 vs 11.3) (p=0.282) and adenomyosis (103.0 vs 95.83) (p=0.266) before and after Mirena(R) insertion in Group 1. Vaginal spotting during hormone replacement therapy disappeared completely in 18/24. Also there was a significant reduction in endometrial thickness (6.3 vs 4.9) (p<0.0001) after Mirena(R) insertion in both group 1 and group 2. CONCLUSION: Levonorgestrel-releasing intrauterine system insertion was acceptable and convenient therapeutic modality for abnormal uterine bleeding of premenopausal abnormal uterine bleeding and vaginal spotting during the postmenopausal hormone replacement therapy.

Conservative Treatment of Stage of Pressure Ulcers with Ulmus

OBJECTIVE: To investigate the treatment effect of Ulmus, which has been traditionally used for the treatment of the pressure ulcers in Korea. METHOD: Thirteen cases with stage IV pressure ulcers (according to the National Pressure Ulcer Advisory Panel, 1989) were enrolled for the study. Seven cases were treated with Ulmus and 6 cases were treated with wet gauze as a control group. The sizes and stages of pressure ulcers were evaluated every 2 week for 12 weeks. RESULTS: After 12 weeks, the size of pressure ulcers decreased from 78.17+/-47.77 cm3 to 8.14+/-13.17 cm3 (mean S.D., n=7) in Ulmus treated group, whereas from 62.10+/-40.89 cm3 to 36.69+/-36.23 cm3 (mean+/-S.D., n=6)in wet gauze treated group. The size of pressure ulcers decreased more significantly (p<0.05) in Ulmus treated group than wet gauze dressed group. Among seven cases treated by Ulmus, 2 cases completely healed, 3 cases improved to stage II, and 2 cases remained to stage IV, whereas among 6 cases treated by wet gauze, 1 cases improved to stage II, 1 case to stage III, and 4 cases remained to stage IV. CONCLUSION: Ulmus was more effective in management of pressure ulcers than wet gauze. We suggest that Ulmus can be used as a useful method of conservative treatment for the stage IV pressure ulcers.

Surgical Treatment of Osteoporotic Vertebral Fracture with Neurologic Deficits in Thoracolumbar Junction: Comparative Analysis of the Results According to the Surgical Methods / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze the clinical and radiological results of different surgical methods in osteoporotic vertebral fracture patients, with neurologic deficits in the thoracolumbar junction. SUMMARY OF LITERATURE REVIEW: Various surgical methods have been reported for osteoporotic vertebral fractures, with neurologic deficits, in the thoracolumbar junction. These are: anterior decompression, anterior decompression and anterior or posterior reconstruction, and Egg shell procedure. However, it is controversial as to which method is better. MATERIALS AND METHODS: 13 patients that had undergone surgical treatment for osteoporotic vertebral fractures, with neurologic deficits, With a mean age of 68+/-8.4, ranging from 51 to 79 years. Six of the cases were male and seven were female. The mean follow up period was 18 months. The patients were divided into two groups. Group A (n=8): Anterior decompression, anterior interbody fusion, with cage or autologous strut iliac bone block, and instrumentation (anterior or posterior). Group B (n=5): Posterior decompression and posterior reconstruction (egg shell procedure). The kyphotic angles, neurologic improvements and complications in each group were analyzed preoperatively, postoperatively and at final follow up. RESULTS: In group A, the mean kyphotic angles were 29+/-5.9 degrees, 18+/-6.7 degrees and 23+/-7.7 degrees preoperatively, postoperatively and at the final follow up, respectively. In group B, the mean kyphotic angles were 31+/-1.1 degrees, 12+/-6.3 degrees and 18+/-5.5 degrees preoperatively, postoperatively and at the final follow up, respectively. In group A, 3 and 5 patients were graded as Frankel grades C and D, respectively. In group B, 1, 1 and 3 patients were graded as Frankel grades B, C and D, respectively. The neurological status improved in all the patients, by mean 1.1 grades in group A and 1.2 grades in group B. In group A, postoperative transient dyspnea and screw loosening occurred in one and two patients, respectively. In group B, postoperative paralytic ileus and screw loosening occurred in one two patients, respectively. CONCLUSIONS: Posterior decompression and posterior reconstruction (egg shell procedure) was an effective surgical method, equivalent to an anterior or anterior and posterior procedure, for osteoporotic vertebral fracture patients, with neurologic deficits.

Surgical Treatment of Osteoporotic Vertebral Fracture with Neurologic Deficits in Thoracolumbar Junction: Comparative Analysis of the Results According to the Surgical Methods / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze the clinical and radiological results of different surgical methods in osteoporotic vertebral fracture patients, with neurologic deficits in the thoracolumbar junction. SUMMARY OF LITERATURE REVIEW: Various surgical methods have been reported for osteoporotic vertebral fractures, with neurologic deficits, in the thoracolumbar junction. These are: anterior decompression, anterior decompression and anterior or posterior reconstruction, and Egg shell procedure. However, it is controversial as to which method is better. MATERIALS AND METHODS: 13 patients that had undergone surgical treatment for osteoporotic vertebral fractures, with neurologic deficits, With a mean age of 68+/-8.4, ranging from 51 to 79 years. Six of the cases were male and seven were female. The mean follow up period was 18 months. The patients were divided into two groups. Group A (n=8): Anterior decompression, anterior interbody fusion, with cage or autologous strut iliac bone block, and instrumentation (anterior or posterior). Group B (n=5): Posterior decompression and posterior reconstruction (egg shell procedure). The kyphotic angles, neurologic improvements and complications in each group were analyzed preoperatively, postoperatively and at final follow up. RESULTS: In group A, the mean kyphotic angles were 29+/-5.9 degrees, 18+/-6.7 degrees and 23+/-7.7 degrees preoperatively, postoperatively and at the final follow up, respectively. In group B, the mean kyphotic angles were 31+/-1.1 degrees, 12+/-6.3 degrees and 18+/-5.5 degrees preoperatively, postoperatively and at the final follow up, respectively. In group A, 3 and 5 patients were graded as Frankel grades C and D, respectively. In group B, 1, 1 and 3 patients were graded as Frankel grades B, C and D, respectively. The neurological status improved in all the patients, by mean 1.1 grades in group A and 1.2 grades in group B. In group A, postoperative transient dyspnea and screw loosening occurred in one and two patients, respectively. In group B, postoperative paralytic ileus and screw loosening occurred in one two patients, respectively. CONCLUSIONS: Posterior decompression and posterior reconstruction (egg shell procedure) was an effective surgical method, equivalent to an anterior or anterior and posterior procedure, for osteoporotic vertebral fracture patients, with neurologic deficits.

A Comparative Analysis of Sagittal Spinal Balance in 100 Asymptomatic Young and Older Aged Volunteers / 대한척추외과학회지

STUDY DESIGN: A radiological analysis of the sagittal balance in younger and older aged volunteers. OBJECTIVES: To determine the normal range of the sagittal spinal alignment, and define significant spinopelvic compensations over the hip axis for the sagittal balance with aging. SUMMARY OF LITERATURE REVIEW: Normative data of the sagittal spinal alignment has wide variation and limited clinical usefulness. In addition, the extent to which the "normal"sagittal spinal contour changes with aging remains unknown. MATERIALS AND METHODS: Inclusion criteria were an age between 20 and 29 years (n=50), group A, and between 55 and 65 years (n=50), group B, for the asymptomatic subjects. Measurements made on the standing lateral radiographs included the following: thoracic kyphosis, lumbar lordosis and sagittal vertical axis. In addition, measurements of the sacropelvic translation, spinopelvic balance, pelvic incidence, pelvic tilting and sacral slope were made. RESULTS: The average thoracic kyphosis was 24 degrees, ranging from 3 to 42 degrees, in group A, and 33 degrees, ranging from 9 to 53 degrees, in group B (p0.05). The C7 plumb line, on average, fell 15.4 mm more anteriorly to the posterosuperior corner of S1 in group B than in group A (p<0.05). The anterior positioning of the C7 was also positively correlated with decreasing lordosis (p<0.001). The average sacropelvic translation was -41mm, ranging from -76 to 20 mm, and -48 mm, ranging from -76 to -17 mm, in groups A and B, respectively (p<0.05). The average spinopelvic balance was -57 mm, ranging from -104 to -4 mm, and -49 mm, ranging from -101 to -3 mm, in groups A and B, respectively. The C7 plumb line fell posterior to the hip axis in all cases. The average pelvic incidence was 46 degrees, ranging from 30 to 61 degrees, and 54 degrees, ranging from 28 to 76 degrees, in groups A and B, respectively (p<0.05). The average pelvic tilt was 14 degrees, ranging from 4 to 33 degrees, and 19 degrees, ranging from 3 to 37 degrees, in groups A and B, respectively (p<0.05). The average sacral slope was 32 degrees, ranging from 17 to 47 degrees, and 35 degrees, ranging from 25 to 50 degrees, in groups A and B, respectively (p<0.05). There was significant correlation between pelvic incidence and lumbar lordosis (p<0.001). CONCLUSIONS: The sagittal spinal balance is maintained by spinopelvic compensations over the hip axis with aging, and sacropelvic parameters over the hip axis are important for the evaluation of the sagittal spinal balance.

A Comparative Analysis of Sagittal Spinal Balance in 100 Asymptomatic Young and Older Aged Volunteers / 대한척추외과학회지

STUDY DESIGN: A radiological analysis of the sagittal balance in younger and older aged volunteers. OBJECTIVES: To determine the normal range of the sagittal spinal alignment, and define significant spinopelvic compensations over the hip axis for the sagittal balance with aging. SUMMARY OF LITERATURE REVIEW: Normative data of the sagittal spinal alignment has wide variation and limited clinical usefulness. In addition, the extent to which the "normal"sagittal spinal contour changes with aging remains unknown. MATERIALS AND METHODS: Inclusion criteria were an age between 20 and 29 years (n=50), group A, and between 55 and 65 years (n=50), group B, for the asymptomatic subjects. Measurements made on the standing lateral radiographs included the following: thoracic kyphosis, lumbar lordosis and sagittal vertical axis. In addition, measurements of the sacropelvic translation, spinopelvic balance, pelvic incidence, pelvic tilting and sacral slope were made. RESULTS: The average thoracic kyphosis was 24 degrees, ranging from 3 to 42 degrees, in group A, and 33 degrees, ranging from 9 to 53 degrees, in group B (p0.05). The C7 plumb line, on average, fell 15.4 mm more anteriorly to the posterosuperior corner of S1 in group B than in group A (p<0.05). The anterior positioning of the C7 was also positively correlated with decreasing lordosis (p<0.001). The average sacropelvic translation was -41mm, ranging from -76 to 20 mm, and -48 mm, ranging from -76 to -17 mm, in groups A and B, respectively (p<0.05). The average spinopelvic balance was -57 mm, ranging from -104 to -4 mm, and -49 mm, ranging from -101 to -3 mm, in groups A and B, respectively. The C7 plumb line fell posterior to the hip axis in all cases. The average pelvic incidence was 46 degrees, ranging from 30 to 61 degrees, and 54 degrees, ranging from 28 to 76 degrees, in groups A and B, respectively (p<0.05). The average pelvic tilt was 14 degrees, ranging from 4 to 33 degrees, and 19 degrees, ranging from 3 to 37 degrees, in groups A and B, respectively (p<0.05). The average sacral slope was 32 degrees, ranging from 17 to 47 degrees, and 35 degrees, ranging from 25 to 50 degrees, in groups A and B, respectively (p<0.05). There was significant correlation between pelvic incidence and lumbar lordosis (p<0.001). CONCLUSIONS: The sagittal spinal balance is maintained by spinopelvic compensations over the hip axis with aging, and sacropelvic parameters over the hip axis are important for the evaluation of the sagittal spinal balance.

Developmental Expression of Epidermal Growth Factor in Rat Kidney / 대한해부학회지

Epidermal growth factor (EGF) is well known to be one of regulating factor in proliferation. The aims of the present study were to elucidate the expression time and localization of expression of EGF in developing rat (Sprague-Dawley) kidney. Kidneys of 16-, 18- and 20-day-old fetuses, 1-, 3-. 7-, 14-, and 21-day-old pups and adult (3months) were preserved for light and electron microscopic immunocytochemistry. In adult rat kidney, EGF immunoreactivity was well localized in thick ascending limb and distal convoluted tubule. In developing rat kidney, EGF-positive cells appeared first in cortical thick ascending limbs and distal convoluted tubules of juxtamedullary nephrons at 3 days and 7 days after birth respectively, in cortical thick ascending limbs and distal convoluted tubules of cortical nephrons at 14 days after birth, and in medullary thick ascending at 21 days after birth. These findings suggest that renal EGF synthesized and secreted from distal tubule may possibly accelerate not proliferation but differentiation of the renal tubular epithelium at least in neonatal rat kidney.

The Jaw Jerk in Normal Young Adults

OBJECTIVE: To obtain the mean value of parameters of the jaw jerk and to investigate gender difference on the jaw jerk in normal young adults in Korea. METHOD: In young 40 subjects (20 males and 20 females), the jaw jerks were elicited by chin tapping in the relaxed masseter muscles of both sides. RESULTS: The jaw jerks were recorded in 100% of the total number of chin-taps. The mean latency was 5.39 ms in the males and 5.14 ms in the females (p>0.05). The mean amplitude was 0.75 mV in the males and 0.59 mV in the females (p>0.05). The mean duration was 8.18 ms in the males and 7.85 ms in the females (p>0.05). CONCLUSION: No significant differences were found in the parameters of the jaw jerk between males and females in this study.

A Case of Colonic Diverticulum Presented as Recurrent Bleeding / 대한소화기내시경학회지

Colonic diverticulum is uncommon disease of gastrointestinal diverticulum, but as many as 20% of patients with colonic diverticula suffer at least one episode of bleeding in their lifetimes. Herein, we report a case of hemostasis by capping recurrent bleeding diverticulum of the colon with clips. A 36-year-old man presented recurrent hematochezia. Emergent colonoscopy was performed and showed bleeding diverticulum. Although hypertonic saline with epinephrine was injected, there was still oozing on diverticulum, and so hemostasis by hemoclip was performed. After that procedure, there have been no bleeding episode. Although further cases will be required to prove the usefulness of the technique, this endoscopic treatment is recommended in colonic diverticulum of a small amount of bleeding or post-treatment bleeding.

Local Steroid Injection in Carpal Tunnel Syndrome

OBJECTIVE: The purpose of this study was to evaluate therapeutic effect of local steroid injection in carpal tunnel syndrome, and to make a comparison between therapeutic effect in patients with and without diabetic neuropathy. METHOD: 30 patients (40 hands) with carpal tunnel syndrome diagnosed clinically and electrophysiologically were injected with 40mg of methylprednisone. Patients were evaluated with the visual analogue scale after 4 weeks and 8 weeks. According to the therapeutic responses, the patients were grouped into: excellent; good; poor; failed; recurrent. RESULTS: After 4 weeks, symptom relief was noted in the 95% of all cases: 100% of the patients without diabetic neuropathy; 82% of the patients with diabetic neuropathy. After 8 weeks, symptom relief was noted in the 82.5% of all cases: 86% of the patients without diabetic neuropathy; 73% of the patients with diabetic neuropathy. There was no statistically significant difference between the patients with and without diabetic neuropathy (p>0.05). CONCLUSION: We concluded that local steroid injection in carpal tunnel syndrome was an effective therapeutic modality for a short term and local steroid injection in the carpal tunnel syndrome with diabetic neuropathy diagnosed by palmar test also had a good effect.