A vanishing twin (VT) is the early demise of a twin fetus. It is estimated to occur in 20-30% of pregnancies associated with assisted reproductive technology. VT becomes increasingly prominent when assisted fertilization is used, because one or more embryos are transferred to the uterus. Maternal serum screening tests during pregnancy can screen for trisomy chromosomes 21, 18, and 13 and are divided into first- and second-trimester tests. In singleton pregnancies, the first trimester screening test is performed at 11-13 weeks and 6 days of gestation. It consists of two serum markers, pregnancy-associated plasma protein A and β-human chorionic gonadotropin (β-hCG), and measures nuchal translucency thickness. The second-trimester screening test was performed at 15-20 weeks and 6 days of gestation. It consists of four serum markers: alpha-fetoprotein, β-hCG, unconjugated estriol, and inhibin A. More effective screening for trisomy 21 in singleton pregnancies is achieved by analyzing cell-free DNA in the maternal blood. A VT includes a demise of the fetus. Although it affects maternal serum markers, it has not been corrected. Five studies examined the effect of VT on maternal serum markers, but the results were controversial. This study aimed to review the patterns of changes in maternal serum markers in VTs, interpret prenatal tests for pregnant women with VTs in clinical practice, and consider what information should be provided.

Isolated head and neck metastasis of renal cell carcinoma (RCC) is relatively rare and metastasis to the temple area is very rare. Here, we present the case of a 51-year-old man who was diagnosed with RCC 2 years earlier and had a contralateral metastatic temple area lesion. The patient who was diagnosed with renal cell cancer and underwent a nephrectomy 2 years ago was referred to the plastic surgery department for a temple mass on the contralateral side. In the operative field, the mass was located in the temporalis muscle with a red-to-purple protruding shape. Biopsy of the mass revealed a metastatic RCC lesion. Computed tomography imaging showed a lobulated, contoured enhancing lesion. Positron emission tomography/computed tomography imaging showed high-fluorodeoxyglucose uptake in the right temporalis muscle. The patient underwent wide excision of the metastatic RCC including the temporalis muscle at the plastic surgery department. Skeletal muscle metastasis of head and neck lesions is extremely rare in RCC. Isolated contralateral temporalis muscle metastasis in RCC has not been previously reported in the literature. If a patient has a history of malignant cancer, plastic surgeons should always consider metastatic lesions of head and neck tumors. Because of its high metastatic ability and poor prognosis, it is very important to keep this case in mind.

Background: The reconstruction of large full-thickness alar defects requires complex surgical procedures that are usually performed in two stages, with concomitant disadvantages in terms of patient trauma, surgical risk, and cost. This study presents a functional folded nasolabial island flap (FNIF) that can be used to repair large-sized full-thickness alar defects in a straightforward manner. Methods: This retrospective study included seven patients who received a FNIF for a full-thickness alar defect between January 2007 and December 2020. The FNIF is different from the conventional nasolabial flap in that it is folded and twisted to achieve nostril reconstruction with a satisfactory three-dimensional mucosal lining in a single stage. The cosmetic and functional results of FNIF were evaluated by both patients and physicians. Results: The age ranged from 51 to 82 years (mean, 65.6 years). The causes of the defects were squamous cell carcinoma, basal cell carcinoma, and trigeminal trophic syndrome. The nostril lining did not collapse, there was no hypertrophic scarring, and air movement through the nostrils on the flap side was normal. Overall, FNIF produced excellent aesthetic and functional outcomes, with minimal patient discomfort. There were no postoperative complications. Conclusion Compared with existing reconstruction methods for large full-thickness alar defects, FNIF can easily achieve aesthetic and functional success in a single-stage procedure. It provides satisfactory results for both the patient and the surgeon.

Head and neck cutaneous metastasis of advanced gastric cancer is uncommon, and scalp metastasis is particularly rare. We present the case of a 60-year-old man who was diagnosed with cutaneous metastasis on the scalp originating from advanced gastric cancer. The patient was referred to the plastic surgery department for a scalp mass near the hairline. He had been diagnosed with advanced gastric cancer and undergone total gastrectomy and Roux esophagojejunostomy 3 years previously. The differential diagnosis for a single flesh-colored nodule on the scalp included benign tumors such as epidermal cyst or lipoma; therefore, the patient underwent excision and biopsy. In the operative field, the mass was found to be located in the frontalis muscle. The biopsy result showed that the mass was a metastatic lesion of advanced gastric cancer. Whole-body computed tomography revealed a gastric tumor with blood vessel infiltration, peritoneal carcinomatosis, liver metastasis, and multiple disseminated subcutaneous metastases. Although scalp metastasis originating from an internal organ is extremely rare, plastic surgeons should always consider a metastatic lesion in the differential diagnosis if a patient with a scalp lesion has a history of malignant cancer.

A 51-year-old man was referred for a skin defect with paresthesia and decreased pain in his right ala. He had a history of herpes zoster infection 3 weeks previously. Excisional biopsy and culture showed no evidence of skin malignancy or infection. He was diagnosed with trigeminal trophic syndrome (TTS) after herpes zoster infection. A two-stage folded nasolabial flap was used to reconstruct the defect. The patient was satisfied with the cosmetic outcomes of surgery, and there was no evidence of recurrence during the follow-up. TTS, a rare skin condition that presents with paresthesia, anesthesia, and facial ulceration, occurs after trigeminal nerve injury, which can be caused by herpes zoster infection in rare cases. TTS is an often-persistent condition with a high recurrence rate, causing cosmetic problems. Some surgical methods have been attempted, but our case presents the first use of a folded nasolabial flap to treat TTS. The flap was symmetric, without any nostril collapse. It is also noteworthy that the outcome was excellent with only a skin flap that did not use a bony framework. Herein, we report a rare case of TTS that occurred after herpes zoster infection and was successfully treated with a folded nasolabial flap.

A 46-year-old female presented a mass on her right lower leg where she had a burn injury due to moxibustion 10 years ago. Physical examination revealed a 3 cm sized firm nodule with tenderness. Plain radiograph was performed and it revealed well-defined calcifications. According to the history of moxibustion burn injury and the result of plain radiograph, dystrophic calcinosis cutis caused by burn injury was suspected. The patient underwent excisional biopsy using pre-,intra-, and postoperative ultrasonography (USG). There was no sign of recurrence. Herein, we report a case of a 46-year-old healthy woman who presented with single hard nodule on the right lower leg. Our case is worthwhile in two respects. First, It is first case report of dystrophic calcinosis cutis due to moxibustion burn injury. In east asian culture, moxibustion is a commonly conducted procedure and it often induces burn injury. Second, USG was used pre-, intra-, and post-operatively to assess the shape, location, and depth of the calcinosis cutis and to determine the surgical margin.

Head and neck cutaneous metastasis of advanced gastric cancer is uncommon, and scalp metastasis is particularly rare. We present the case of a 60-year-old man who was diagnosed with cutaneous metastasis on the scalp originating from advanced gastric cancer. The patient was referred to the plastic surgery department for a scalp mass near the hairline. He had been diagnosed with advanced gastric cancer and undergone total gastrectomy and Roux esophagojejunostomy 3 years previously. The differential diagnosis for a single flesh-colored nodule on the scalp included benign tumors such as epidermal cyst or lipoma; therefore, the patient underwent excision and biopsy. In the operative field, the mass was found to be located in the frontalis muscle. The biopsy result showed that the mass was a metastatic lesion of advanced gastric cancer. Whole-body computed tomography revealed a gastric tumor with blood vessel infiltration, peritoneal carcinomatosis, liver metastasis, and multiple disseminated subcutaneous metastases. Although scalp metastasis originating from an internal organ is extremely rare, plastic surgeons should always consider a metastatic lesion in the differential diagnosis if a patient with a scalp lesion has a history of malignant cancer.

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a potential cause of hyponatremia of the central nervous system (CNS). Although SIADH has been reported to be associated with many other central nervous disorders, its association with neuromyelitis optica (NMO) or NMO spectrum disorders are rare. NMO is a demyelinating disorder characterized by optic neuritis and transverse myelitis. Aquaporin-4 (AQP4), which is the target antigen for a NMO autoantibody, is the predominant CNS water channel. However, some NMO patients show seronegative AQP4 antibody results. The spectrum of NMO has been changed, and new findings about the disease have been reported. Here, we report a case of seronegative NMO spectrum disorder associated with SIADH.
Central Nervous System ; Demyelinating Diseases ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Myelitis, Transverse ; Neuromyelitis Optica* ; Optic Neuritis ; Water

Background/Aims: The major histocompatibility class II (MHC II) transactivator, known as CIITA, is induced by Interferon gamma (IFN-γ) and plays a well-established role in regulating the expression of class II MHC molecules in antigen-presenting cells. Methods: Primary human hepatocytes (PHH) were isolated via therapeutic hepatectomy from two donors. The hepatocellular carcinoma (HCC) cell lines HepG2 and Huh7 were used for the mechanistic study, and HBV infection was performed in HepG2-NTCP cells. HBV DNA replication intermediates and secreted antigen levels were measured using Southern blotting and ELISA, respectively. Results: We identified a non-canonical function of CIITA in the inhibition of hepatitis B virus (HBV) replication in both HCC cells and patient-derived PHH. Notably, in vivo experiments demonstrated that HBV DNA and secreted antigen levels were significantly decreased in mice injected with the CIITA construct. Mechanistically, CIITA inhibited HBV transcription and replication by suppressing the activity of HBV-specific enhancers/promoters. Indeed, CIITA exerts antiviral activity in hepatocytes through ERK1/2-mediated down-regulation of the expression of hepatocyte nuclear factor 1α (HNF1α) and HNF4α, which are essential factors for virus replication. In addition, silencing of CIITA significantly abolished the IFN-γ-mediated anti-HBV activity, suggesting that CIITA mediates the anti-HBV activity of IFN-γ to some extent. HBV X protein (HBx) counteracts the antiviral activity of CIITA via direct binding and impairing its function. Conclusions Our findings reveal a novel antiviral mechanism of CIITA that involves the modulation of the ERK pathway to restrict HBV transcription. Additionally, our results suggest the possibility of a new immune avoidance mechanism involving HBx.

There are several widely used combinations of angiotensin II receptor blocker (ARB)/thiazide. The complimentary mechanism of action for such anti-hypertensive therapies is that, while ARB inhibits the vasoconstricting and aldosterone-secreting effects of angiotensin II, hydrochlorothiazide affects the renal tubular mechanisms of electrolyte reabsorption and increases excretion of sodium and chloride in the distal tubule, consequently promoting water excretion. In addition, hypokalemia, which may be triggered by a hydrochlorothiazide-induced increase in urinary potassium loss, is resisted by the use of ARB. Hence, the ARB/thiazide combination is safe in terms of potassium imbalance. For these reasons, fixed-dose ARB/thiazide combination anti-hypertensive drugs have been widely used for the treatment of hypertension. However, there have not been many studies done regarding cases where patients under such regimens showed severe hyponatremia, even when the amount of thiazide included was low. Here we report two cases in which severe hyponatremia occurred following treatment with the ARB/thiazide combinations. Upon discontinuation of the regimen, both patients showed recovery from hyponatremia.
Angiotensin II Type 1 Receptor Blockers ; Angiotensin II* ; Angiotensins* ; Antihypertensive Agents ; Humans ; Hydrochlorothiazide ; Hypertension ; Hypokalemia ; Hyponatremia* ; Potassium ; Receptors, Angiotensin* ; Sodium ; Water