The Mechanisms of Anabolic Steroids, Selective Androgen Receptor Modulators and Myostatin Inhibitors / 대한스포츠의학회지

In the clinical setting, anabolic agents serve to ameliorate muscle- and bone-wasting diseases. However, many of these anabolic agents are also used by bodybuilders to surpass natural limits of body composition as performanceenhancing drugs (PEDs). The first generation of PEDs comprises testosterone-derived anabolic-androgenic steroids (AAS) which have demonstrated significant myotropic effects. However, AAS lack optimal tissue-selectively and thus, are prone to numerous adverse health consequences. Hence, a newer generation of PEDs, selective androgen receptor modulators (SARMs), was developed with the goal of achieving superior tissue-selectivity (i.e., exerting anabolic effects only in muscle and bone tissue, while minimally affecting other body systems). In general, AAS and SARMs enhance muscle growth primarily through androgen receptor (AR) agonism in target tissues. Despite multiple attempts, no single AAS nor SARM to date is completely risk free. As such, a significant portion of research efforts has been dedicated to manipulating anabolic pathways beyond the AR. Another class of PEDs, myostatin inhibitors, have shown to cause drastic muscle anabolism across multiple species by inhibiting myostatin, the primary deterrent to continuous muscle growth. The myostatin inhibitor, YK-11, blocks myostatin by upregulating its antagonist, follistatin. This effect appears to be mediated through the AR, suggesting a novel and promising gene-selective approach to engineering AR ligands that isolate benefits from risks. At any rate, the exact mechanisms by which these PEDs function is not well understood. Further pioneering regarding these topics is encouraged as it appears that the innovation of a truly tissue-selective anabolic agent is within reach.

Role of exercise on insulin sensitivity and beta-cell function: is exercise sufficient for the prevention of youth-onset type 2 diabetes?

Parallel with the current pediatric obesity epidemic, the escalating rates of youthonset type 2 diabetes mellitus (T2DM) have become a major public health burden. Although lifestyle modification can be the first-line prevention for T2DM in youths, there is a lack of evidence to establish optimal specific exercise strategies for obese youths at high risk for T2DM. The purpose of this narrative review is to summarize the potential impact of exercise on 2 key pathophysiological risk factors for T2DM, insulin sensitivity and β-cell function, among obese youths. The studies cited are grouped by use of metabolic tests, i.e., direct and indirect measures of insulin sensitivity and β-cell function. In general, there are an increasing number of studies that demonstrate positive effects of aerobic exercise, resistance exercise, and the 2 combined on insulin sensitivity. However, a lack of evidence exists for the effect of any exercise modality on β-cell functional improvement. We also suggest a future direction for research into exercise medical prevention of youth-onset T2DM. These suggestions focus on the effects of exercise modalities on emerging biomarkers of T2DM risk.

Role of exercise on insulin sensitivity and beta-cell function: is exercise sufficient for the prevention of youth-onset type 2 diabetes?

Parallel with the current pediatric obesity epidemic, the escalating rates of youthonset type 2 diabetes mellitus (T2DM) have become a major public health burden. Although lifestyle modification can be the first-line prevention for T2DM in youths, there is a lack of evidence to establish optimal specific exercise strategies for obese youths at high risk for T2DM. The purpose of this narrative review is to summarize the potential impact of exercise on 2 key pathophysiological risk factors for T2DM, insulin sensitivity and β-cell function, among obese youths. The studies cited are grouped by use of metabolic tests, i.e., direct and indirect measures of insulin sensitivity and β-cell function. In general, there are an increasing number of studies that demonstrate positive effects of aerobic exercise, resistance exercise, and the 2 combined on insulin sensitivity. However, a lack of evidence exists for the effect of any exercise modality on β-cell functional improvement. We also suggest a future direction for research into exercise medical prevention of youth-onset T2DM. These suggestions focus on the effects of exercise modalities on emerging biomarkers of T2DM risk.

A Pediatric Case of Dengue Fever with Extreme Hyperglycemia Developed in a Family Who Returned from India

Dengue fever (DF) is endemic throughout tropical and subtropical regions; however, it is not endemic in Korea. Imported infectious diseases should be suspected when encountering returned travelers with non-specific symptoms such as fever, rash, and headache. Persistent vomiting, abdominal pain, hemorrhagic tendency, hepatic enzyme abnormalities, and proteinuria are risk factors for the development of severe DF in a patient with DF. Severe hyperglycemia is also known to be related to poor prognosis in acute illness, and with certain underlying diseases that present with hyperglycemia, such as diabetes, it is related to the progression of severe DF. We report a DF case with severe hyperglycemia in an adolescent returning from India. Pediatric DF cases reported in Korea were also reviewed.

Comparison of Quality of Life among Patients with Mangled Trauma

PURPOSE: Mangled injury is defined as severe injury, including three or more tissues such as bones, nerves, vessels, muscles, and tendons in the upper or lower extremities. The choice of treatment results in different cosmetic and functional outcomes for mangled injury. In this study, we estimated patients' quality of life after treatment with the future intention of having patients make proper decisions at the time of injury. METHODS: Twenty patients were treated at Asan Medical Center from January, 2009 to November, 2011, and 11 patients were included who agreed with the questionnaire. We used 36-item short form health survey (SF-36) for estimating quality of life after treatments. RESULTS: Subjective satisfaction of cosmetic and functional aspects was higher in the reconstruction group than in the amputation group. However, in the estimation of specified satisfaction using SF-36, the amputation group was more satisfied than the reconstruction group. CONCLUSION: Among the many treatment considerations at the time of injury, expected cosmetic and functional outcomes were important parts determining the decision. In our study, the amputation group showed a better satisfaction level. This result could help patients make more appropriate decisions in the case of mangled injury.

A New Technique for Conchal Cartilage Harvest

The goal of auricular cartilage harvest is to obtain a sufficient amount for reconstruction and to minimize the change in ear shape. The cartilage can be harvested by a posterior or anterior approach, and each method has advantages and disadvantages. The posterior approach presents the advantage of scar concealment, but there are limits to the amount of cymba cartilage that may be harvested. In contrast, the anterior approach may cause a noticeable scar. However, as cartilage is collected, the anterior approach provides a view that facilitates the preservation ear structure. In addition, it is possible to obtain a greater amount of cartilage. From January 2014 to December 2015, we harvested auricular cartilage graft material in 17 patients. To prevent the development of trapdoor scars or linear scar contracture, short incisions were made on the superior border of the cymba and cavum. Two small and narrow incisions were made, resulting in suboptimal exposure of the surgical site, which heightens the potential for damaging the cartilage when using existing tools. To minimize this, the authors used a newly invented ball-type elevator. All patients recovered without complications after surgery and reported satisfaction with the shape of the ear.

Clinical Consideration of Chronic Radiodermatitis Caused by Coronary Intervention

PURPOSE: The number of coronary interventions is increasing in Korea. Medical team tend to underestimate the radiation that is used during coronary interventions. For this reason if a person who underwent coronary intervention are less likely to be diagnosed with chronic radiodermatitis. METHODS: From March 1, 2012 to February 28, 2017, patients who had a history of coronary intervention visited our plastic surgery clinic with chronic ulceration on the back, shoulders, and scapula. Subjects were classified by age, sex, lesion location, size, medication, time of exposure, onset after last exposure, treatment method, complication, and recurrence. RESULTS: 5 cases were reported, two in the left scapula, one in the right scapular, one in the mid back, and one in the below right axilla. Coronary interventions were performed twice in two patients and three times in a patient. The average exposure time was 84 minutes. The average elapsed time after for last exposure was three years and 3 months ago and ranged from 1 year to 10 years. The size of ulcer lesions was 11.1 cm² on average. All patients underwent debridement of the dead tissue and flap surgery. CONCLUSION: Patients with a history of coronary intervention should be aware of the possibility of chronic radiation dermatitis if they come with chronic scarring or ulcerative chronic wounds with a clear border at the back, shoulders and scapula. So accurate diagnosis based on the patient's medical history is important and awareness of medical team who perform coronary interventions is also necessary.

Gintonin, an exogenous ginseng-derived LPA receptor ligand, promotes corneal wound healing

Ginseng gintonin is an exogenous ligand of lysophosphatidic acid (LPA) receptors. Accumulating evidence shows LPA helps in rapid recovery of corneal damage. The aim of this study was to evaluate the therapeutic efficacy of gintonin in a rabbit model of corneal damage. We investigated the signal transduction pathway of gintonin in human corneal epithelium (HCE) cells to elucidate the underlying molecular mechanism. We next evaluated the therapeutic effects of gintonin, using a rabbit model of corneal damage, by undertaking histochemical analysis. Treatment of gintonin to HCE cells induced transient increases of [Ca²⁺](i) in concentration-dependent and reversible manners. Gintonin-mediated mobilization of [Ca²⁺](i) was attenuated by LPA1/3 receptor antagonist Ki16425, phospholipase C inhibitor U73122, inositol 1,4,5-triphosphate receptor antagonist 2-APB, and intracellular Ca²⁺ chelator BAPTA-AM. Gintonin facilitated in vitro wound healing in a concentration-dependent manner. When applied as an eye-drop to rabbits with corneal damage, gintonin rapidly promoted recovery. Histochemical analysis showed gintonin decreased corneal apoptosis and increased corneal cell proliferation. We demonstrated that LPA receptor activation by gintonin is linked to in vitro and in vivo therapeutic effects against corneal damage. Gintonin can be applied as a clinical agent for the rapid healing of corneal damage.

Sebaceoma Arising from Nevus Sebaceous with Early Focal Carcinomatous Area

No abstract available.

Temporal trends and in-hospital outcomes of primary percutaneous coronary intervention in nonagenarians with ST-segment elevation myocardial infarction

BACKGROUND/AIMS: Data regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in nonagenarians are very limited. The aim of the present study was to evaluate the temporal trends and in-hospital outcomes of primary PCI in nonagenarian STEMI patients. METHODS: We retrospectively reviewed data from the Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to January 2008, and from the Korea Working Group on Myocardial Infarction (KorMI) from February 2008 to May 2010. RESULTS: During this period, the proportion of nonagenarians among STEMI patients more than doubled (0.59% in KAMIR vs. 1.35% in KorMI), and the rate of use of primary PCI also increased (from 62.5% in KAMIR to 81.0% in KorMI). We identified 84 eligible study patients for which the overall in-hospital mortality rate was 21.4% (25.0% in KAMIR vs. 20.3% in KorMI, p = 0.919). Multivariate analysis identified two independent predictors of in-hospital mortality, namely a final Thrombolysis in Myocardial Infarction (TIMI) flow < 3 (odds ratio [OR], 13.7; 95% confidence interval [CI], 3.2 to 59.0; p < 0.001) and cardiogenic shock during hospitalization (OR, 6.7; 95% CI, 1.5 to 30.3; p = 0.013). CONCLUSIONS: The number of nonagenarian STEMI patients who have undergone primary PCI has increased. Although a final TIMI flow < 3 and cardiogenic shock are independent predictors of in-hospital mortality, primary PCI can be performed with a high success rate and an acceptable in-hospital mortality rate.

First Report of Web Blight of Rosemary (Rosmarinus officinalis) Caused by Rhizoctonia solani AG-1-IB in Korea

Herein, we report the first occurrence of web blight of rosemary caused by Rhizoctonia solani AG-1-IB in Gangneung, Gangwon Province, Korea, in August 2014. The leaf tissues of infected rosemary plants were blighted and white mycelial growth was seen on the stems. The fungus was isolated from diseased leaf tissue and cultured on potato dextrose agar for identification. The young hyphae had acute angular branching near the distal septum of the multinucleate cells and mature hyphal branches formed at an approximately 90degrees angle. This is morphologically identical to R. solani AG-1-IB, as per previous reports. rDNA-ITS sequences of the fungus were homologous to those of R. solani AG-1-IB isolates in the GenBank database with a similarity percentage of 99%, thereby confirming the identity of the causative agent of the disease. Pathogenicity of the fungus in rosemary plants was also confirmed by Koch's postulates.

Prevalence of Voiding Dysfunction and Constipation in Children with Attention Deficit Hyperactivity Disorder

PURPOSE: Attention deficit hyperactivity disorder (ADHD) has been associated with impairments in frontal inhibitory function and the catecholaminergic system. ADHD is diagnosed in 3-5% of children. Children with ADHD seem develop various forms of urinary problems such as nocturnal enuresis, dysfunctional voiding, and diurnal incontinence. However, no data exist to confirm the presence of these problems in Korean children with ADHD. We investigated the clinical findings of voiding dysfunction in children with ADHD. METHODS: Between October 2009 and March 2011, a total of 63 children (33 with ADHD, 30 with an upper respiratory infection, as a control group) were enrolled. ADHD was diagnosed using the diagnostic and statistical manual of mental disorders (DSM)-IV criteria. A comprehensive survey of voiding and defecation was administered. RESULTS: The patient group included 28 boys and 5 girls; the control group comprised 20 boys and 10 girls. The mean age was 9.09+/-2.8 years in the ADHD group and 8.58+/-3.1 years in the control group. Children with ADHD had a statistically significantly higher incidence of urgency (P=0.017), urge incontinence (P=0.033), and constipation (P=0.045). There was no significant difference in the incidence of straining, intermittency, holding maneuvers, or nocturnal enuresis. CONCLUSION: Children with ADHD in Korea have significantly higher rates of urgency, urge incontinence, and constipation than those without ADHD.

The First Report of Postharvest Stem Rot of Kohlrabi Caused by Sclerotinia sclerotiorum in Korea

In March 2014, a kohlrabi stem rot sample was collected from the cold storage room of Daegwallyong Horticultural Cooperative, Korea. White and fuzzy mycelial growth was observed on the stem, symptomatic of stem rot disease. The pathogen was isolated from the infected stem and cultured on potato dextrose agar for further fungal morphological observation and to confirm its pathogenicity, according to Koch's postulates. Morphological data, pathogenicity test results, and rDNA sequences of internal transcribed spacer regions (ITS 1 and 4) showed that the postharvest stem rot of kohlrabi was caused by Sclerotinia sclerotiorum. This is the first report of postharvest stem rot of kohlrabi in Korea.

First Report of Potato Stem-End Rot Caused by Fusarium oxysporum in Korea

In this study, we identified the causative agent of stem-end rot in potatoes that were grown in Gangwon alpine areas of Korea in 2013. The disease symptoms included appearance of slightly sunken circular lesion with corky rot on the potato surface at the stem-end portion. The fungal species isolated from the infected potatoes were grown on potato dextrose agar and produced white aerial mycelia with dark violet pigments. The conidiophores were branched and monophialidic. The microconidia had ellipsoidal to cylindrical shapes and ranged from 2.6~11.4 x 1.9~3.5 microm in size. The macroconidia ranged from 12.7~24.7 x 2.7~3.6 microm in size and had slightly curved or fusiform shape with 2 to 5 septate. Chlamydospores ranged from 6.1~8.1 x 5.7~8.3 microm in size and were present singly or in pairs. The causal agent of potato stem-end rot was identified as Fusarium oxysporum by morphological characterization and by sequencing the internal transcribed spacer (ITS1 and ITS4) regions of rRNA. Artificial inoculation of the pathogen resulted in development of disease symptoms and the re-isolated pathogen showed characteristics of F. oxysporum. To the best of our knowledge, this is the first study to report that potato stem-end rot is caused by F. oxysporum in Korea.

A Case of Herpes Simplex Virus Type 2 Encephalitis of a Newborn Delivered by a Mother without Prenatal Screening / 대한주산의학회잡지

Neonatal herpes simplex virus (HSV) encephalitis is a rare disease nowadays because of prenatal screening test and management. It shows progressive central nervous system manifestations affecting predominantly temporal and frontal lobes. Early diagnosis of HSV encephalitis is important since even with the early initiation of high-dose intravenous acyclovir therapy, it results in serious morbidity among survivors. A 14-day-old neonate with fever and poor oral intake was admitted via emergency department. The next day she had seizures and the brain was damaged with permanent sequelae despite of early administration of intravenous acyclovir on day 2 of admission. We report a serious case of HSV encephalitis diagnosed as type 2 HSV by polymerase chain reaction and culture of a newborn without proper prenatal screening test.

Interleukin-1beta, Calcium-Sensing Receptor, and Urokinase Gene Polymorphisms in Korean Patients with Urolithiasis

PURPOSE: There are various causes of ureter calculi, and genetic factors are known to play a role. Interleukin-1beta (IL-1beta) and calcium-sensing receptor (CaSR) genes are related to hypercalciuria, and urokinase is related to the formation of calcium oxalate stones. This study investigated polymorphisms in IL-1beta, CaSR, and urokinase in patients with urolithiasis and healthy controls. MATERIALS AND METHODS: Urolithiasis patients treated at Chung-Ang University Hospital were enrolled from January 2007 to December 2008. The control group of volunteers displayed normal urinalysis findings in the health screening, no stones identified by ultrasonography, and no history of urolithiasis. DNA extracted from peripheral blood was analyzed by the polymerase chain reaction. Patients were genetically screened for mutations in IL-1beta (484 urolithiasis patients, 208 controls), CaSR (433 urolithiasis patients, 197 controls), and urokinase (370 urolithiasis patients, 167 controls). Stone metabolic study was done to see the differences between the metabolic factors and to discern normal genes from polymorphic genes. RESULTS: According to the genotype frequency and allele frequency analysis, there were no statistically significant differences between IL-1beta, CaSR, and urokinase genes. Also, the analysis between genotypes and metabolic factors did not show statistically significant differences between the three genes. CONCLUSIONS: In Korean urolithiasis patients, IL-1beta, CaSR, and urokinase gene polymorphisms do not differ from those of healthy individuals. A larger-scale study is needed to confirm the need for other genetic markers of urolithiasis.

Clinical Comparison of Drug-Eluting Stents and Bare Metal Stents in Large Coronary Arteries / 대한내과학회지

BACKGROUND/AIMS: Drug-eluting stents (DES) are superior to bare metal stents (BMS) in reducing restenosis rates across a wide range of patients and lesion subsets.This study compared the clinical outcomes of DES versus BMS in patients with large coronary arteries (> or = 3.5 mm). METHODS: The study compared 134 patients (59.9 +/- 10.6 years, 90 men, 44 women) who underwent single vessel angioplasty with DESimplantation in large vessels with 115 patients (60.3 +/- 8.9 years, 82 men, 33 women) who received BMS. The clinical outcomes at 12 months were compared between groups. The study end points were major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, and the need for target vessel and target lesion revascularization. RESULTS: The baseline clinical coronary angiography and procedural characteristics were similar in both groups. The duration of dual antiplatelet therapy was longer in the DES group than in the BMS group (240 +/- 2.7 vs. 348 +/- 1.7 days, p = 0.042). During the 12-month clinical follow-up, MACE were observed in 13 patients (11.3%) with BMS and 12 patients (9.0%) with DES (p = 0.486). CONCLUSIONS: For coronary stents implanted in large coronary arteries, DES seems to be more favorable, although no significant differences were observed in the clinical outcomes between DES and BMS during a 1-year clinical follow-up.

Decreased Glomerular Filtration Rate is an Independent Predictor of In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: Patients with renal dysfunction (RD) experience worse prognosis after myocardial infarction (MI). The aim of the present study was to investigate the impact of admission estimated glomerular filtration rate (eGFR) on clinical outcomes of patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation MI (STEMI). SUBJECTS AND METHODS: We retrospectively evaluated 4,542 eligible patients from the Korea Acute Myocardial Infarction Registry (KAMIR). Patients were divided into three groups according to eGFR (mL/min/1.73 m2): normal renal function (RF) group (eGFR > or =60, n=3,515), moderate RD group (eGFR between 30 to 59, n=894) and severe RD group (eGFR or =3, hypertension, diabetes, congestive heart failure, peak creatine kinase-MB, high sensitivity C-reactive protein, B-type natriuretic peptide, left ventricle ejection fraction, multivessel disease, infarct-related artery and rate of successful PCI were significantly different between the 3 groups (p<0.05). With decline in RF, in-hospital complications developed with an increasing frequency (14.1% vs. 31.8% vs. 45.5%, p<0.0001). In-hospital mortality rate was significantly higher in the moderate and severe RD groups as compared to the normal RF group (2.3% vs. 13.9% vs. 25.6%, p<0.0001). Using multivariate logistic regression analysis, adjusted odds ratio for in-hospital mortality was 2.67 {95% confidence interval (CI) 1.44-4.93, p=0.002} in the moderate RD group, and 4.09 (95% CI 1.48-11.28, p=0.006) in the severe RD group as compared to the normal RF group. CONCLUSION: Decreased admission eGFR was associated with worse clinical courses and it was an independent predictor of in-hospital mortality in STEMI patients undergoing primary PCI.

Erratum: Interleukin-1beta, Calcium-Sensing Receptor, and Urokinase Gene Polymorphisms in Korean Patients with Urolithiasis

No abstract available.

Case of Takotsubo Cardiomyopathy following Pacemaker Implantation

Takotsubo cardiomyopathy, also called apical ballooning syndrome or stress-induced cardiomyopathy, is a unique reversible cardiomyopathy that is frequently precipitated by a stressful event, and is described as a typical form of acute transient left ventricular dysfunction. The classic situation is postmenopausal women presenting with chest pain or dyspnea. The overall prognosis is favorable. We report a case of a 75-year-old female patient who came to our hospital with dizziness, which was found to be caused by transient apical ballooning following permanent pacemaker implantation.