Cerebral white matter changes (WMCs) and silent brain infarcts (SBIs) are common radiologic findings in neurologically asymptomatic elderly people, but are associated with an increased risk of subsequent stroke. We investigated the prevalence and risk factors for these cerebral changes on brain computed tomography (CT) in 480 community-dwelling healthy Korean adults without stroke or dementia, who were recruited for an early health program. Cerebral WMCs were defined as the presence of approximately 5 mm wide ill-defined and moderately hypodense lesions, and SBIs were defined as the presence of >2 mm wide well-defined hypodense lesions. Of the 480 patients, 49 (10.2%) had cerebral WMCs and SBIs findings on brain CT. The prevalence of WMCs and SBIs increased with age: the prevalence was 2.4%, 9%, and 32% for subjects in their 50, 60s, and 70s, respectively. In addition, hypertension, abdominal obesity, increased levels of homocysteine and high sensitivity C-reactive protein were significantly associated with cerebral WMCs and SBIs. Our study suggests that regular monitoring of risk factors is required to prevent cerebral WMCs and SBIs and decrease the incidence of stroke and dementia in healthy individuals.

The prevalence of respiratory symptoms and impairments of ventilatory capacity were studied in a group of 74 taxi drivers in Inchon area. As a reference group, 94 office workers of same area, matched with cigarette smoking, were also included in this study. Taxi drivers complained of respiratory symptoms much more than reference group. Those were cough, sputum production, chest tightness and shortness of breath. The ventilatory capacities, FVC (forced vital capacity), FEV(1.0) (forced expiratory volume 1 second), MMF (maximal mid flow) and PFR (peak flow rate), were measured. All measured values of ventilatory capacities of taxi driver were significantly decreased than those of reference group. The rate (56.8%) of ventilatory capacity impairment in taxi drivers was significantly larger than those (14.9%) of reference group, and the most of them were restrictive type impairments. Also, Job variable, prefessional driver or not, was selected as important determinant for ventilatory capacity impairment.
Cough ; Dyspnea ; Incheon ; Prevalence ; Smoking ; Sputum ; Thorax

Objective: To examine the association of inferior vena cava (IVC) diameter ratio measured using computed tomography with outcomes in patients with gastrointestinal bleeding (GIB). Methods: A single-center retrospective observational study was conducted on consecutive patients with GIB who presented to the emergency department. The IVC diameter ratio was calculated by dividing the maximum transverse and anteroposterior diameters perpendicular to it. The association of the IVC diameter ratio with outcomes was examined using multivariable logistic regression analysis. The primary outcome was in-hospital mortality. The area under the receiver operator characteristic curve (AUC) of the IVC diameter ratio was calculated, and the sensitivity and specificity, including the cutoff values, were computed. Results: In total, 585 patients were included in the final analysis. The in-hospital mortality rate was 4.6% (n=27). The IVC diameter ratio was significantly associated with higher in-hospital mortality in multivariable logistic regression analysis (odds ratio, 1.793; 95% confidence interval [CI], 1.239–2.597; P=0.002). The AUC of the IVC diameter ratio for in-hospital mortality was 0.616 (95% CI, 0.498–0.735). With a cutoff of the IVC diameter ratio (≥2.1), the sensitivity and specificity for predicting in-hospital mortality were 44% (95% CI, 26%–65%) and 71% (95% CI, 67%–75%), respectively. Conclusion The IVC diameter ratio was independently associated with in-hospital mortality in patients with GIB. However, the AUC of the IVC diameter ratio for in-hospital mortality was low.

The use of a fibula osteocutaneous flap is currently the mainstay of segmental mandibular reconstruction. This type of flap is used to treat tumors, trauma, or osteoradionecrosis of the mandible. However, a fibula osteocutaneous flap may also be a good option for reconstructing the mandible to preserve oropharyngeal function and facial appearance in cases of pathological fracture requiring extensive segmental bone resection. Chronic osteomyelitis is one of the various causes of subsequent pathologic mandibular fractures; however, it is rare, and there have been few reports using free flaps in osteomyelitis of the mandible. We share our experience with a 76-year-old patient who presented with a pathologic fracture following osteomyelitis of the mandible that was reconstructed using a fibula osteocutaneous flap after wide segmental resection.

The use of a fibula osteocutaneous flap is currently the mainstay of segmental mandibular reconstruction. This type of flap is used to treat tumors, trauma, or osteoradionecrosis of the mandible. However, a fibula osteocutaneous flap may also be a good option for reconstructing the mandible to preserve oropharyngeal function and facial appearance in cases of pathological fracture requiring extensive segmental bone resection. Chronic osteomyelitis is one of the various causes of subsequent pathologic mandibular fractures; however, it is rare, and there have been few reports using free flaps in osteomyelitis of the mandible. We share our experience with a 76-year-old patient who presented with a pathologic fracture following osteomyelitis of the mandible that was reconstructed using a fibula osteocutaneous flap after wide segmental resection.

Epidermoid cysts are commonly encountered benign lesions in the field of plastic surgery, but their malignant transformation into squamous cell carcinoma (SCC) is extremely rare. A 68-year old woman with a cystic mass on her left lower back presented to our department. We excised the lesion under the suspicion of an epidermoid cyst or metastatic colon cancer based on the patient’s medical history. The skin defect was covered with a split-thickness skin graft, and histopathological evaluation revealed the presence of SCC. Because of the low incidence of SCC arising from an epidermoid cyst, the mechanism of transformation of such cysts to SCC and the prognosis of this condition have not yet been well established. We therefore share the details of this rare case to contribute to the growing base of knowledge about SCC that arises from an epidermoid cyst.

Replication-independent incorporation of variant histone H3.3 has a profound impact on chromatin function and numerous cellular processes, including the differentiation of muscle cells. The histone chaperone HIRA and H3.3 have essential roles in MyoD regulation during myoblast differentiation. However, the precise mechanism that determines the onset of H3.3 deposition in response to differentiation signals is unclear. Here we show that HIRA is phosphorylated by Akt kinase, an important signaling modulator in muscle cells. By generating a phosphospecific antibody, we found that a significant amount of HIRA was phosphorylated in myoblasts. The phosphorylation level of HIRA and the occupancy of phosphorylated protein on muscle genes gradually decreased during cellular differentiation. Remarkably, the forced expression of the phosphomimic form of HIRA resulted in reduced H3.3 deposition and suppressed the activation of muscle genes in myotubes. Our data show that HIRA phosphorylation limits the expression of myogenic genes, while the dephosphorylation of HIRA is required for proficient H3.3 deposition and gene activation, demonstrating that the phosphorylation switch is exploited to modulate HIRA/H3.3-mediated muscle gene regulation during myogenesis.
Antibodies, Phospho-Specific ; Chromatin ; Histones* ; Muscle Cells* ; Muscle Development ; Muscle Fibers, Skeletal ; Myoblasts ; Phosphorylation* ; Phosphotransferases ; Transcriptional Activation