¹⁸FFET PET is a useful tool for treatment evaluation and prognosis prediction of anti-angiogenic drug in an orthotopic glioblastoma mouse model / 한국실험동물학회지

O-2-¹⁸F-fluoroethyl-l-tyrosine ([¹⁸F]FET) has been widely used for glioblastomas (GBM) in clinical practice, although evaluation of its applicability in non-clinical research is still lacking. The objective of this study was to examine the value of [¹⁸F]FET for treatment evaluation and prognosis prediction of anti-angiogenic drug in an orthotopic mouse model of GBM. Human U87MG cells were implanted into nude mice and then bevacizumab, a representative anti-angiogenic drug, was administered. We monitored the effect of anti-angiogenic agents using multiple imaging modalities, including bioluminescence imaging (BLI), magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET/CT). Among these imaging methods analyzed, only [¹⁸F]FET uptake showed a statistically significant decrease in the treatment group compared to the control group (P=0.02 and P=0.03 at 5 and 20 mg/kg, respectively). This indicates that [¹⁸F]FET PET is a sensitive method to monitor the response of GBM bearing mice to anti-angiogenic drug. Moreover, [¹⁸F]FET uptake was confirmed to be a significant parameter for predicting the prognosis of anti-angiogenic drug (P=0.041 and P=0.007, on Days 7 and 12, respectively, on Pearson's correlation; P=0.048 and P=0.030, on Days 7 and 12, respectively, on Cox regression analysis). However, results of BLI or MRI were not significantly associated with survival time. In conclusion, this study suggests that [¹⁸F]FET PET imaging is a pertinent imaging modality for sensitive monitoring and accurate prediction of treatment response to anti-angiogenic agents in an orthotopic model of GBM.

Recovery of Proprioception in the Upper Extremity by Robotic Mirror Therapy: a Clinical Pilot Study for Proof of Concept

A novel robotic mirror therapy system was recently developed to provide proprioceptive stimulus to the hemiplegic arm during a mirror therapy. Validation of the robotic mirror therapy system was performed to confirm its synchronicity prior to the clinical study. The mean error angle range between the intact arm and the robot was 1.97 to 4.59 degrees. A 56-year-old male who had right middle cerebral artery infarction 11 months ago received the robotic mirror therapy for ten 30-minute sessions during 2 weeks. Clinical evaluation and functional magnetic resonance imaging (fMRI) studies were performed before and after the intervention. At the follow-up evaluation, the thumb finding test score improved from 2 to 1 for eye level and from 3 to 1 for overhead level. The Albert's test score on the left side improved from 6 to 11. Improvements were sustained at 2-month follow-up. The fMRI during the passive motion revealed a considerable increase in brain activity at the lower part of the right superior parietal lobule, suggesting the possibility of proprioception enhancement. The robotic mirror therapy system may serve as a useful treatment method for patients with supratentorial stroke to facilitate recovery of proprioceptive deficit and hemineglect.

Change of Brain Functional Connectivity in Patients With Spinal Cord Injury: Graph Theory Based Approach

OBJECTIVE: To investigate the global functional reorganization of the brain following spinal cord injury with graph theory based approach by creating whole brain functional connectivity networks from resting state-functional magnetic resonance imaging (rs-fMRI), characterizing the reorganization of these networks using graph theoretical metrics and to compare these metrics between patients with spinal cord injury (SCI) and age-matched controls. METHODS: Twenty patients with incomplete cervical SCI (14 males, 6 females; age, 55+/-14.1 years) and 20 healthy subjects (10 males, 10 females; age, 52.9+/-13.6 years) participated in this study. To analyze the characteristics of the whole brain network constructed with functional connectivity using rs-fMRI, graph theoretical measures were calculated including clustering coefficient, characteristic path length, global efficiency and small-worldness. RESULTS: Clustering coefficient, global efficiency and small-worldness did not show any difference between controls and SCIs in all density ranges. The normalized characteristic path length to random network was higher in SCI patients than in controls and reached statistical significance at 12%-13% of density (p<0.05, uncorrected). CONCLUSION: The graph theoretical approach in brain functional connectivity might be helpful to reveal the information processing after SCI. These findings imply that patients with SCI can build on preserved competent brain control. Further analyses, such as topological rearrangement and hub region identification, will be needed for better understanding of neuroplasticity in patients with SCI.

A Preliminary Report with Anatomical Soft Cohesive Gel Implant in Augmentation mammoplasty in Korean Women

Augmentation mammoplasty with anatomical breast implant, which was first introduced in Korea in February 2012, is expected to increase along with the round implant. This study reports the early experience of a single surgeon with this implant to Korean female patients. A total of one hundred patients who performed augmentation mammoplasty with Replicon(R) (POLYTECH Health & Aesthetics, Dieburg, Germany), a kind of anatomical breast implant, from February 2012 to August 2012 were studied. Patient's satisfaction with breast shape and touch was assessed using linear analogue scales with a maximum score of 5. All of the patients received augmentation mammoplasty for cosmetic purpose. Ninety-one patients were satisfied with their results. Neither implant malrotation nor capsular contracture was checked during the average follow up period of 7.9 months. Even though it is a preliminary report of early studies, we can see that anatomical implant is suitable for Korean female patients who have small breast, mild ptotic breast and constricted lower pole, given that anatomical implant proved excellent results in this studies.

Shortening Foreheadplasty; Minimization of the Tension of Scalp Flap

People with ordinary faces want their faces more attractive, and thus various attempts have been made to reduce the size of the upper and lower face. We therefore have designed the shortening foreheadplasty, in which an excision was made on the part of the upper face skin using a trichophytic incision and the defect was widely avulsed and pulled forward down to be sutured. Participants included 115 patients who had visited our hospitals from January 2006 to June 2012. As a preoperative evaluation, we performed a gliding test to decide the size of the forehead skin laxity. As an operation method, a zigzag incision was designed and the skin was excised using a trichophytic incision, and the scalp flap was fixed using Endotine(R). Of a total of 115 patients, the shortening of forehead was in the range of 7mm to 20mm with the average 14.19mm. In order to help patients have small faces that meet the condition for the beauty, we performed a shortening foreheadplasty. In this surgery, the forehead skin was excised using a trichophytic incision and the scalp flap was dissected in the subgaleal plane, we could obtain favorable outcomes by minimizing the tension by sufficiently avulsing the scalp flap after the incision and fixing the flap with Endotine(R), and minimizing the formation of postoperative scar.

Non-incision Transconjuctival Muller Tucking in Blepharoptosis

The current method of blepharoptosis revision utilizes the aponeurosis and muscle incision in order to advance or shorten the Muller's muscle or the levator papebrae superioris muscle. However, this procedure commonly results in asymmetry, and the procedure to correct it or to have multiple revisions remains difficult. In replacement of this procedure, a microincision procedure was conducted using the conjunctival approach. With this method, mild to moderate cases are corrected with two to three 1mm incisions to pull the Muller's muscle or the levator papebrae superioris muscle. We have been fifthy cases with non-incision transconjunctival Muller tucking from October 2011 to December 2011. 49 patients in study show satisfatory. In only one patient, incomplete correction was observed. The results are similar to the previous method and the recovery period remains the same at one to two weeks. In the case of unilaterality, the results are far superior. In addition, revision procedures of under-correction or over-correction are easily done and the surgical techniques required for revisions are simple. Inexperienced doctors are also able to apply this method successfully, so it is a recommended procedure. This method is called the Non-incision transconjunctival Muller Tucking or the Reverse Muller Tucking.

Reconstruction of Fingertip Amputation by Using Digital Artery Perforator Flap

PURPOSE: Fingertip injuries are the most common hand injuries and may lead to significant disability. Knowledge of fingertip anatomy is mandatory to treat these injuries effectively. All surgical techniques used for coverage of fingertip injuries must be based on the nature of the injury and the patient's age. Many authors have studied the method of fingertip reconstruction because goals of these treatments should include maintaining length, sensibility, motions, and appearance. The purpose of this study is to evaluate the effect of digital artery perforator flap for fingertip reconstruction without aesthetic and functional problems. METHODS: From November 2006 to March 2007, the authors performed fingertip reconstruction on 3 fingers of 3 patients, aged between 41 to 54 years (average age, 47 years) using digital artery perforator flap. RESULTS: All fingers recovered successfully and there were no necrosis of the flap. We followed up 3 cases more than 5 months. Light touch and temperature sensation could be detected in all flaps and the static two-point discrimination test was 8 mm. CONCLUSION: This flap is an alternative choice for coverage of fingertip defects. This method also takes short time to procedure and to recovery. The digital artery perforator flap has never been reported in Korea, however it is considered as a useful method for treatment of fingertip injury.

A Case of Sjogren Syndrome in Parotid Gland

Sjogren syndrome is a chronic disorder characterized by immune-mediated destruction of exocrine glands predominantly but not exclusively on the lacrimal and salivary glands. The common clinical manifestations of Sjgren syndrome include xerophthalmia with secondary keratoconjunctivitis and xerostomia, with or without salivary gland enlargement. Minor salivary gland biopsy usually demonstrates heavy lymphocyte infiltration, although parotid gland biopsy may be more sensitive and specific. Rheumatoid factor and antinuclear antibodies are high in Sjgren syndrome patients. We report a case of Sjogren syndrome with parotid gland involvement in a 44-years-old female patient with xerostomia, xerophthalmia and Rheumatic arthritis. We did total parotidectomy in right parotid gland and superficial parotidectomy for left side parotid gland was done after 20 days. Histologic and immunohistochemical studies revelead multiple periductal lymphoid proliferation and chromic inflammation, lymphoid hyperplasia in parotid glands.

Differentiation of adult stem cell derived from buccal fat pad into osteoblast

For the repairing of bone defect, autogenous or allogenic bone grafting remains the standard. However, these methods have numerous disadvantages including limited amount, donor site morbidity and spread of diseases. Tissue engineering technique by culturing stem cells may allow for a smart solution for this problem. Adipose tissue contains mesenchymal stem cells that can be differentiate into bone, cartilage, fat or muscle by exposing them to specific growth conditions. In this study, the authors procured the stem cell from buccal fat pad and differentiate them into osteoblast and are to examine the bone induction capacity. Buccal fat-derived cells (BFDC) were obtained from human buccal fat pad and cultured. BFDC were analyzed for presence of stem cell by immunofluorescent staining against CD-34, CD-105 and STRO-1. After BFDC were differentiated in osteogenic medium for three passages, their ability to differentiate into osteogenic pathway were checked by alkaline phosphatase (ALP) staining, Alizarin red staining and RT-PCR for osteocalcin (OC) gene expression. Immunofluorescent and biochemical assays demonstrated that BFDC might be a distinguished stem cells and mineralization was accompanied by increased activity or expression of ALP and OC. And calcium phosphate deposition was also detected in their extracelluar matrix. The current study supports the presence of stem cells within the buccal fat pad and the potential implications for human bone tissue engineering for maxillofacial reconstruction.

The Clinical Experiences of Congenital Preauricular Fistulectomy including Cartilage Excision

The preauricular fistula is a congenital malformation of the ear with a small opening in the preauricular area. In general, this malformation should be treated by excision after its infection is brought under control with antibiotics. For cosmetic consideration, we performed a elliptic incision around opening, and then we dissected along the fistula tract to the cyst without sacrificing too much soft tissues. From March 2001 to March 2005, 90 patients with 102 cases of fistulas were excised including a small portion of auricular perichondrium and cartilage, where they adhered closely. Then, histologic findings of preauricular fistula were studied. The histologic findings reveal that the fistular tract is very close to auricular cartilage, and the thickness of fistular epithelium and perichondrium are about the same. There was no specific complications related to this procedure. The recurrence rate for the excision with cartilage was 2 out of 102(2%). Results of surgery in all cases were satisfactory. It is important, in preauricular fistular excision, perichondrium and auricular cartilage should be excised to prevent recurrence.

Balanced Tucking of the Levator Muscle and Muller's Muscle in Blepharoptosis

The levator and Muller's muscle balanced tucking was performed to correction myogenic or aponeurotic blepharoptosis. Through the blepharoplasty incision, the upper half of tarsal plate was exposed and the orbital was opened to show the levator aponeurosis. the Muller's muscle dissected from the upper border of the tarsal plate and from the posteriorly located conjunctiva with sharp scissors. Muller's muscle was advanced about 3 mm to 8 mm on anterior surface of the tarsal plate and fixed approximately upper one third of the tarsal plate with three horizontal 6-0 Nylon mattress sutures. The amount of tucking of Muller's muscle was controlled by the location of the upper eyelid margin 2 mm below the upper limbus in primary gaze after first temporary fixations suture in the maximum superior point of the limbus. The amount of advancement of levator aponeurosis was controlled by the location of the upper eyelid margin 1 mm below the upper limbus in primary gaze after first temporary fixations suture in the maximum superior point of the limbus. And then levator aponeurosis was fixed with three horizontal 6-0 Nylon mattress on beside the point that was tucked Muller's muscle. We have been thirty cases with levator and Muller's muscle balanced tucking from January 2004 to Jun 2005. 3 cases were traumatic blepharoptosis with 3-5 mm ptosis and poor levator function. 27 cases were myogenic or aponeurotic blepharoptosis with 2-5 mm ptosis with and more than 4 mm of levator function. the age of the patients ranged from 6 to 78 years. The levator aponeurosis and Muller's muscle tucking procedure can reduce the amount of the levator and Muller's muscle resection, and improve discomfort when the patients open eyes.