Microneedles: A novel clinical technology for evaluating skin characteristics.

BACKGROUND: Current methods for evaluating efficacy of cosmetics have limitations because they cannot accurately measure changes in the dermis. Skin sampling using microneedles allows identification of skin-type biomarkers, monitoring treatment for skin inflammatory diseases, and evaluating efficacy of anti-aging and anti-pigmentation products. MATERIALS AND METHODS: Two studies were conducted: First, 20 participants received anti-aging treatment; second, 20 participants received anti-pigmentation treatment. Non-invasive devices measured skin aging (using high-resolution 3D-imaging in the anti-aging study) or pigmentation (using spectrophotometry in the anti-pigmentation study) at weeks 0 and 4, and adverse skin reactions were monitored. Skin samples were collected with biocompatible microneedle patches. Changes in expression of biomarkers for skin aging and pigmentation were analyzed using qRT-PCR. RESULTS: No adverse events were reported. In the anti-aging study, after 4 weeks, skin roughness significantly improved in 17 out of 20 participants. qRT-PCR showed significantly increased expression of skin-aging related biomarkers: PINK1 in 16/20 participants, COL1A1 in 17/20 participants, and MSN in 16/20 participants. In the anti-pigmentation study, after 4 weeks, skin lightness significantly improved in 16/20 participants. qRT-PCR showed significantly increased expression of skin-pigmentation-related biomarkers: SOD1 in 15/20 participants and Vitamin D Receptor (VDR) in 15/20 participants. No significant change in TFAP2A was observed. CONCLUSION: Skin sampling and mRNA analysis for biomarkers provides a novel, objective, quantitative method for measuring changes in the dermis and evaluating the efficacy of cosmetics. This approach complements existing evaluation methods and has potential application in assessing the effectiveness of medical devices, medications, cosmeceuticals, healthy foods, and beauty devices.

Effects and Safety of Wearable Exoskeleton for Robot-Assisted Gait Training: A Retrospective Preliminary Study.

BACKGROUND: Wearable devices for robot-assisted gait training (RAGT) provide overground gait training for the rehabilitation of neurological injuries. We aimed to evaluate the effectiveness and safety of RAGT in patients with a neurologic deficit. METHODS: Twenty-eight patients receiving more than ten sessions of overground RAGT using a joint-torque-assisting wearable exoskeletal robot were retrospectively analyzed in this study. Nineteen patients with brain injury, seven patients with spinal cord injury and two patients with peripheral nerve injury were included. Clinical outcomes, such as the Medical Research Council scale for muscle strength, Berg balance scale, functional ambulation category, trunk control tests, and Fugl-Meyer motor assessment of the lower extremities, were recorded before and after RAGT. Parameters for RAGT and adverse events were also recorded. RESULTS: The Medical Research Council scale scores for muscle strength (36.6 to 37.8), Berg balance scale (24.9 to 32.2), and functional ambulation category (1.8 to 2.7) significantly improved after overground RAGT (p < 0.05). The familiarization process was completed within six sessions of RAGT. Only two mild adverse events were reported. CONCLUSIONS: Overground RAGT using wearable devices can improve muscle strength, balance, and gait function. It is safe in patients with neurologic injury.

Cervical Fusion-Requiring Mineral and Bone Disorder Disguised as Osteoporosis in a Chronic Kidney Disease Patient on Hemodialysis: A Case Report.

Bony deformities and fragility fractures in end-stage renal disease (ESRD) patients on long-term hemodialysis can be caused by either osteoporosis or chronic kidney disease-mineral and bone disorder (CKD-MBD). Correct identification of the underlying mechanism is critical since the treatment methods differ, and one treatment approach could negatively affect the other. Cervical kyphosis, severe enough to require immediate surgical treatment, can be caused by uncontrolled CKD-MBD, albeit in limited cases. This report presents the case of a 61-year-old female with an 11-year history of hemodialysis treatment and severe cervical kyphosis with myelopathy, which required 2-stage spinal surgeries. Our report calls for a careful diagnostic approach in ESRD patients with skeletal disorders, the points to consider before calcium replacement, and early detection of fragility fractures in them. Moreover, early mobilization and weight-bearing after the surgical procedure may lead to better neurological and functional improvements.

Surgical hip dislocation and varus derotation osteotomy for extra-articular cause of femoroacetabular impingement: a single case report.

Femoral retroversion is an extra-articular cause of cam-type femoroacetabular impingement (FAI) via early engagement with anterior rim. Valgus hip also causes extra-articular FAI by decreasing the range of motion. We present a case of valgus hip accompanied by femoral retroversion, which was refractory to prior arthroscopic femoroplasty. As a reasonable strategy, we have performed extra-articular correction via femoral subtrochanteric varus derotation osteotomy as well as intra-articular decompression by surgical hip dislocation. Femoral varus derotation osteotomy with surgical hip dislocation is a rational and appropriate solution in patients with extra-articular FAI, which is refractory to arthroscopic FAI surgery. Extra-articular causes of FAI should be suspected in every refractory case.

Carpal Tunnel Syndrome in Behçet's Disease.

PURPOSE: Behçet's disease (BD) is a chronic inflammatory disease characterized by orogenital ulcers, skin and ocular lesions, in addition to articular, vascular, and neurologic symptoms. Carpal tunnel syndrome (CTS), can also occur in BD patients secondary to inflammation in the connective tissues, vessels, and tendons, as well as nerve involvement in BD itself. However, reports of patients who have CTS in BD are rare. The aim of this study was to evaluate the clinical characteristics of CTS in BD patients. MATERIALS AND METHODS: Retrospective analysis of the medical records of 1750 BD patients, and 14 (0.8%) BD patients who were diagnosed with CTS was performed at the BD Specialty Clinic of Severance Hospital. Patient demographics, disease activity/severity for both diseases, and the clinical characteristics of CTS in BD were recorded and analyzed. RESULTS: All 14 BD patients with CTS were women. Twelve patients (85.7%) were diagnosed with active BD. The CTS was mild in 8 patients (57.2%), moderate in 3 patients (21.4%), and severe in 3 patients (21.4%). Ten patients (71.4%) had BD prior to the diagnosis of CTS, and these 10 patients all had active BD. CONCLUSION: CTS can occur as a result of the inflammation associated with BD and can also be the presenting symptom of nerve involvement in BD. CTS can also develop as the initial symptom of BD. Therefore, a higher degree of suspicion should be maintained for CTS in patients with BD and vice versa; however, the exact relationship is uncertain.

Open Surgical Treatment for Femoroacetabular Impingement in Patients over Thirty Years: Two Years Follow-up Results.

PURPOSE: We report short term results of open surgical treatment for symptomatic femoroacetabular impingement (FAI) in patients over the age of 30 years. MATERIALS AND METHODS: Between May 2011 and June 2012, thirteen FAI hips (11 patients) with hip pain persisting longer than 6 months were treated by either surgical hip dislocation (SHD) or anterior mini-open. They were followed up for longer than 2 years. The 11 patients included 7 females and 4 males with a mean age of 45 (range, 33-60) years. They were clinically evaluated for modified Harris hip score (MHHS) and University of California at Los Angeles (UCLA) activity level. Their lateral center-edge angle, acetabular index, and alpha angle were measured and compared. RESULTS: Acetabuloplasties were performed for seven cases. Femoral osteochondroplasty was performed for all thirteen cases. At minimum follow-up of two year (range, 24-29 months), all patients had substantial relief in preoperative pain with improvement in range of motion. The median MHHS was significantly (P<0.05) improved from 61 points preoperatively to 87 points at the last follow-up. The median UCLA activity level was 7 (range, 5-8) at last follow-up. Radiological indices improved. Two cases showed mild residual pain attributable to adhesion between capsule and reshaped femoral head-neck area. CONCLUSION: Open surgical treatment of FAI was a reliable and effective treatment method in symptomatic FAIs for patients over the age of 30 years without advanced arthritic change of hip joint at short term follow-up.

Development and validation of an electronic medical record-based disease activity index for Behçet's disease.

OBJECTIVES: The disease activity of Behçet's disease is inadequately defined, and there is no consensus on how it should be measured. The aim of this study was to verify the usefulness of a simplified electronic medical record (EMR)-based activity index (EMRAI) for Behçet's disease. METHODS: A total of 73 Korean patients with Behçet's disease participated in this study. Two dermatologists interviewed each participant independently using two activity scoring systems: the EMRAI and the Behçet's Disease Current Activity Form (BDCAF). Overall agreement between raters, correlation between activity scoring indices, and total interview run-time were evaluated. RESULTS: The EMRAI significantly correlated with the BDCAF (Spearman's correlation coefficient, r=0.835), physician-assessed overall activity score (r=0.782), erythrocyte sedimentation rate (r=0.520) and C-reactive protein level (r=0.422). The weighted kappa score for inter-rater agreement of EMRAI showed very good reliability compared with that of BDCAF (0.894 and 0.693, respectively). The mean total run-time for the EMRAI was shorter than that required to administer the BDCAF (95 s and 115 s, respectively). CONCLUSIONS: The EMRAI, an EMR-based simplified activity index of Behçet's disease, facilitates rapid and simple gathering of disease activity data and clinical information.

Dermoscopic findings in radiation-induced alopecia after angioembolization.

BACKGROUND: Cases of non-scarring alopecia after endovascular brain surgery have been reported, but dermoscopic findings of these lesions have rarely been published. OBJECTIVE: To report the dermoscopic findings for alopecic skin lesions that developed after radiation exposure during angioembolization. METHODS: Dermoscopic examination was used to evaluate alopecic skin lesions in 10 patients who presented with post-angioembolization alopecia. RESULTS: The male to female ratio was 1:4, mean age 55.0 ± 12.3 years and mean duration to lesion development 3.4 ± 2.5 weeks. The rectangular-shaped lesions mostly occurred at the occiput and temple areas. Both yellow and black dots were the predominant dermoscopic findings in 60% (6/10) of patients, followed by short vellus hair (50%), peripilar sign (20%), broken hair (10%), coiled hair (10%) and white dots (10%). CONCLUSIONS: Alopecic skin lesions induced by radiation exposure during angioembolization share characteristic dermoscopy findings with alopecia areata. They may be misdiagnosed if a precise history is not obtained.

Primary Cementless Hip Arthroplasty in Unstable Intertrochanteric Femur Fracture in Elderlys: Short-term Results.

PURPOSE: This study was aimed to explore and report the short term results of primary cementless hip arthroplasty in treatment of unstable intertrochanteric femur fracture in elderlys. MATERIALS AND METHODS: Between March 2009 and Feburary 2012, 35 arthroplasty cases performed by single surgeon and followed up for more than one year were evaluated. They were 21 females and 14 males with mean age of 78 years (range, 71-92 years). Preoperative evaluation was performed by American Society of Anesthesia score. Retrospective evaluation was performed by operative time, transfusion amount, time to operation days, hospital stay and time to full weight bearing. Clinically, ambulatory ability was checked by Parker and Palmer (P&P) score and function of hip was appraised by Harris hip score (HSS). Radiologically, bone healing of fractured trochanteric fragment and presence of subsidence, stress shielding or osteolysis were checked. RESULTS: Fracture type was 11 cases of A2.2, 18 cases of A2.3 and 6 cases of A3.3. Femoral stems used were 8 cases of rectangular tapered wedge type and 27 cases of fluted modular distal fixation type. P&P score improved from mean preinjury score of 7.1 to mean postoperative last follow-up score of 6.5. Median HHS at last follow-up was 75. Mean time to full weight bearing was 47 days (24-79 days). Postoperative complications were one case of linear periprosthetic femoral fracture and one case of postoperative dislocation. CONCLUSION: Cementless hip replacement arthroplasty could be a good option for unstable intertrochanteric femoral fracture in elderlys.

Non-ablative 1550 nm erbium-glass and ablative 10,600 nm carbon dioxide fractional lasers for various types of scars in Asian people: evaluation of 100 patients.

OBJECTIVE: We compared the efficacy and safety of treatments with photothermolysis systems (FPS) and carbon dioxide fractional laser system (CO2 FS) for various types of scars in Asians. BACKGROUND DATA: Concerns regarding the cosmetic outcomes of scar treatment are increasing, and non-ablative 1550 nm erbium-glass FPS and 10,600 nm CO2 FS have been effectively used to improve the appearance of various types of scars. METHODS: One hundred patients with various types of scars were enrolled. The laser devices were chosen individually, based on the characteristics of the scars. We used a quintile grading scale for evaluations. RESULTS: At 3 months after treatment, the mean grade of improvement based on clinical assessment was 2.64±0.76 for FPS, 2.60±0.68 for CO2 FS, and 2.94±0.83 for combination therapy (p=0.249). The mean grade of improvement was higher in patients who received treatment within 3 years of scar development (2.84±0.69) than in patients who received treatment >3 years after scar development (2.51±0.82; p=0.042). CONCLUSIONS: FPS and CO2 FS were both effective and safe for the treatment of scars, and can also be used together safely as a combination treatment. The proper laser device and proper treatment time should be decided considering various factors.

Immunopathogenic Role of Herpes Simplex Virus in Behçet's Disease.

The role of viral infections, such as herpes simplex virus (HSV) infection, in the pathogenesis of Behçet's disease (BD) has been investigated for many years. HSV has been detected in peripheral blood leukocytes, saliva, and genital ulcers of patients with BD. Various cell adhesion molecules on cultured endothelial cells have been induced by HSV in a TNF- α dependent manner. In addition, a BD-like animal model was developed by inoculating ICR mouse earlobes with HSV, and antiviral treatment was effective in improving BD-like symptoms in this model. Still, there are several incompletely characterized proteins that possess antiviral properties and are being investigated as mediators of viral infection-related chronic inflammatory reactions. Although the role of HSV in the pathogenesis of BD remains to be fully established, recent research findings regarding HSV in BD have expanded our understanding of the disease and will hopefully lead to the development of more effective therapeutic agents in the near future.

Clinical effects of non-ablative and ablative fractional lasers on various hair disorders: a case series of 17 patients.

BACKGROUND AND OBJECTIVES: Both ablative and non-ablative fractional lasers have been applied to various uncommon hair disorders. The purpose of this study was to demonstrate the clinical effects of fractional laser therapy on the course of primary follicular and perifollicular pathologies and subsequent hair regrowth. MATERIALS AND METHODS: A retrospective review of 17 patients with uncommon hair disorders - including ophiasis, autosomal recessive woolly hair/hypotrichosis, various secondary cicatricial alopecias, pubic hypotrichosis, frontal fibrosing alopecia, and perifolliculitis abscedens et suffodiens - was conducted. All patients had been treated with non-ablative and/or ablative fractional laser therapies. RESULTS: The mean clinical improvement score in these 17 patients was 2.2, while the mean patient satisfaction score was 2.5. Of the 17 subjects, 12 (70.6%) demonstrated a clinical response to non-ablative and/or ablative fractional laser treatments, including individuals with ophiasis, autosomal recessive woolly hair/hypotrichosis, secondary cicatricial alopecia (scleroderma and pressure-induced alopecia), frontal fibrosing alopecia, and perifolliculitis abscedens et suffodiens. Conversely, patients with long-standing ophiasis, surgical scar-induced secondary cicatricial alopecia, and pubic hypotrichosis did not respond to fractional laser therapy. CONCLUSION: Our findings demonstrate that the use of non-ablative and/or ablative fractional lasers promoted hair growth in certain cases of uncommon hair disorders without any remarkable side effects.

Streptococcus sanguinis and the sera of patients with Behçet's disease stimulate membrane expression of α-enolase in human dermal microvascular endothelial cells.

The glycolytic enzyme α-enolase is a plasminogen-binding protein that is generally found in the cytosolic compartment. However, α-enolase can also be expressed on cell surfaces following an inflammatory stimulus via an unknown mechanism. We investigated the effects of Streptococcus sanguinis (S. sanguinis) and the sera of patients with Behçet's disease (BD) on the expression and distribution of α-enolase in human dermal microvascular endothelial cells (HDMECs). HDMECs were stimulated with cultured S. sanguinis and the sera of active BD patients. HDMECs incubated for 6, 12 or 24 h were harvested, and the membrane and cytoplasmic fractions of proteins were extracted. The expression and distribution of α-enolase were analyzed using subcellular fractionation and immunoblotting. Subcellular localization of α-enolase was also assessed by immunocytochemistry. S. sanguinis stimulated the expression of α-enolase in the membranous compartment of HDMECs in a dose-dependent manner. This pattern was also observed in HDMECs incubated with BD patients' sera. Although incubation of HDMECs with sera from healthy controls increased membrane expression of α-enolase, incubation with BD sera resulted in earlier and higher expression of this glycoprotein in the cellular membrane of HDMECs. Immunocytochemistry revealed strong immunostaining of α-enolase in the cytoplasm and cytoplasmic membrane of HDMECs incubated with S. sanguinis or BD patients' sera. In conclusions, these results indicate that S. sanguinis infection and the sera of BD patients with active disease are inflammatory stimuli that can induce membranous α-enolase expression in endothelial cells. Membrane-expressed α-enolase could potentially react with anti-α-enolase antibodies in BD patients' sera, resulting in increased inflammation.

Renal manifestations in 2007 Korean patients with Behçet's disease.

PURPOSE: Behçet's disease (BD) theoretically affects all sizes and types of blood vessels and results in multi-organ involvement. However, renal BD has not been fully characterized, though the kidneys are histologically rich in blood vessels. MATERIALS AND METHODS: A total of 2007 patients who fulfilled the diagnostic criteria for BD were enrolled in this study. We reviewed the medical records and test results of the BD patients and used univariate and multivariate logistic regression analyses to determine the clinical significance of renal involvement in BD. RESULTS: Among the 2007 BD patients, we noted hematuria in 412 (20.5%) and proteinuria in 29 (1.4%). Univariate analysis showed that the BD patients with hematuria were predominantly female and older, had higher erythrocyte sedimentation rates (ESRs), and more frequently presented with genital ulcerations. BD patients with proteinuria had higher ESR levels compared to BD patients without proteinuria. In the multivariate analysis, age, sex, and ESR were found to be significantly associated with hematuria in BD patients, whereas only ESR was associated with proteinuria in BD patients. We also found that IgA nephropathy was the most common pathologic diagnosis in 12 renal BD patients who underwent renal biopsies. CONCLUSION: We suggest that routine urinalysis and serum renal function tests be performed for the early detection of renal BD, especially in older female BD patients with recurrent hematuria, high ESR levels, and frequent genital ulcers, as well as in BD patients with proteinuria and high ESR levels.

Unilateral nevoid telangiectasia associated with ipsilateral melorheostosis.

Melorheostosis is a rare disorder characterized by irregular, flowing hyperostosis in long bones, commonly described on radiographs as wax flowing down a candle. In addition to bony sclerosis, cutaneous manifestations overlying the involved bones have been reported including linear scleroderma, neurofibromatosis, and vascular and lymphatic malformations. Unilateral nevoid telangiectasia (UNT) is a rare primarily cutaneous condition characterized by linearly arranged small dilated blood vessels in dermatomal or Blaschkoid patterns on the skin. Here, we present the case of a nine-year-old Korean male with UNT associated with ipsilateral melorheostosis.