Pulmonary arterial hypertension is a critical manifestation of systemic sclerosis (SSc) and is a main cause of death. Several treatment modalities for SSc have been identified, with effects that improve quality of life and mortality rates. However, whether these drugs can also normalize pulmonary arterial pressure, remains unclear. Here, we report the case of a woman with diffuse SSc with pulmonary arterial hypertension, who had a functional status equivalent to the New York Heart Association class III. The patient was treated with inhaled iloprost. After six years of inhaled iloprost therapy, echocardiography showed that pulmonary arterial pressure normalized, accompanied by improvement in functional capacity. Inhaled iloprost might not only normalize pulmonary arterial pressure, but also improve the functional status of patients with SSc with pulmonary arterial hypertension.
Arterial Pressure ; Cause of Death ; Echocardiography ; Female ; Heart ; Humans ; Hypertension* ; Hypertension, Pulmonary ; Iloprost* ; Mortality ; Quality of Life ; Scleroderma, Systemic*

BACKGROUND: Previous studies have reported that glypican-4 (GPC4) regulates insulin signaling by interacting with insulin receptor and through adipocyte differentiation. However, GPC4 has not been studied with regard to its effects on clinical factors in patients with type 2 diabetes mellitus (T2DM). We aimed to identify factors associated with GPC4 level in T2DM. METHODS: Between January 2010 and December 2013, we selected 152 subjects with T2DM and collected serum and plasma into tubes pretreated with aprotinin and dipeptidyl peptidase-4 inhibitor to preserve active gastric inhibitory polypeptide (GIP) and glucagon-like peptide 1 (GLP-1). GPC4, active GLP-1, active GIP, and other factors were measured in these plasma samples. We performed a linear regression analysis to identify factors associated with GPC4 level. RESULTS: The subjects had a mean age of 58.1 years, were mildly obese (mean body mass index [BMI], 26.1 kg/m2), had T2DM of long-duration (mean, 101.3 months), glycated hemoglobin 7.5%, low insulin secretion, and low insulin resistance (mean homeostatic model assessment of insulin resistance [HOMA-IR], 1.2). Their mean GPC4 was 2.0±0.2 ng/mL. In multivariate analysis, GPC4 was independently associated with age (β=0.224, P=0.009), and levels of active GLP-1 (β=0.171, P=0.049) and aspartate aminotransferase (AST; β=–0.176, P=0.043) after being adjusted for other clinical factors. CONCLUSION: GPC4 was independently associated with age, active GLP-1, and AST in T2DM patients, but was not associated with HOMA-IR and BMI, which are well known factors related to GPC4. Further study is needed to identify the mechanisms of the association between GPC4 and basal active GLP-1 levels.
Adipocytes ; Aprotinin ; Aspartate Aminotransferases ; Body Mass Index ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Gastric Inhibitory Polypeptide ; Glucagon-Like Peptide 1* ; Glypicans* ; Hemoglobin A, Glycosylated ; Humans ; Insulin ; Insulin Resistance ; Linear Models ; Multivariate Analysis ; Plasma ; Receptor, Insulin

OBJECTIVE: To observe the effect of complexity of unilateral hand activity or dominance of hand on ipsilateral motor cortex excitability. METHOD: Twenty healthy volunteers of right handedness were recruited. We applied the transcranial magnetic stimulation on right hemisphere, and measured motor evoked potential (MEP) at left first dorsal interossei (FDI). We observed the changes of MEP amplitude during the execution of three different complexities of right finger movement. We set the motor tasks as (1) relaxed state, (2) repetitive opposition of 3rd finger (simple exercise) and (3) opposition of 3rd, 5th, 2nd, 4th finger (complex exercise). These tasks were performed within one minute, and repeated 3 times. To observe the effect of hand dominance, we also measured MEP at right FDI during left hand movements. RESULTS: Ipsilateral motor cortex was significantly facilitated by ipsilateral voluntary hand activity (p<0.01). And the MEP amplitude was also increased by complexity of hand exercise. CONCLUSION: We found that the excitability of ipsilateral motor cortex was changed by unilateral hand exercise, and the excitability was increased by complexity of hand exercise.
Evoked Potentials, Motor ; Fingers ; Functional Laterality ; Hand* ; Healthy Volunteers ; Motor Cortex* ; Transcranial Magnetic Stimulation

Vascular tumors of the breast are a rare disease. A hemangioma in the male breast is an extremely rare benign disease. We report a case of a 53-year-old-man with a capillary hemangioma of the breast.
Breast ; Capillaries ; Hemangioma ; Hemangioma, Capillary ; Humans ; Male ; Rare Diseases

Leprosy is an infectious disease caused by Mycobacterium leprae. Patients usually present with hypopigmented or erythematous plaques with central hypoesthesia or tenderness, and necessitate a differential diagnosis with eczema, granuloma annulare, sarcoidosis, syphilid, mycosis fungoides, erythema nodosum, and skin cancer. A 93-year-old woman presented with asymptomatic erythematous plaques and subdermal nodules on the face and extremities for 6∼ 7 months, and the lesions were suspicious for skin cancer. Histopathologic examination revealed diffuse infiltration of foamy histiocytes separated by a grenz zone. Acid-fast bacilli were seen in Ziehl−Neelsen stain with clumps called globi. Based on clinical and histopathological findings, she was finally diagnosed with lepromatous leprosy.The patient was diagnosed with leprosy at an advanced age; thus, we report the case in which dermatologists should consider leprosy as well as skin cancer in the elderly patients with unusual erythematous nodules, despite decreasing prevalence of leprosy.

Background/Aims: With increased life expectancy, the management of elderly hepatocellular carcinoma (HCC) patients became a crucial issue, yet it is still challenging due to comorbidities and high surgical risks. While surgical resection is considered as primary treatment for eligible HCC patients, systematic evidence on its outcomes in elderly patients remains scarce. In this review, we aimed to analyze the efficacy and safety outcomes of surgical resection in elderly HCC patients. Methods: The studies included in this meta-analysis were selected from Ovid-MEDLINE, OvidEmbase, CENTRAL, KoreaMed, KMbase, and KISS databases following a predefined protocol.Efficacy outcomes included overall survival and disease-free survival, while the safety outcomes included postoperative mortality and complications. Results: Patients in the elderly group (≥65 years) who underwent surgery exhibited non-inferior overall survival (hazard ratio [HR], 1.26; 95% confidence interval [CI], 0.92 to 1.74) and diseasefree survival (HR, 1.03; 95% CI, 0.99 to 1.08) compared to the non-elderly group. Overall postop-erative mortality exhibited no statistical difference (odds ratio [OR], 1.07; 95% CI, 0.87 to 1.31), but 30-day, 90-day, and in-hospital mortality were higher in the elderly group. The incidence of overall complications was higher in the elderly group (OR, 1.44; 95% CI, 1.22 to 1.69). Sensitivity analysis for the super elderly group (≥80 years) showed significantly higher in-hospital mortality compared to the non-super elderly group (OR, 2.51; 95% CI, 1.16 to 5.45). Conclusions The efficacy outcome of surgical resection in the elderly HCC patients was not worse than that in the non-elderly HCC patients, while in-hospital mortality and complications rates were higher. Therefore, surgical resection should be purposefully considered in the elderly population, with careful candidate selection.

PURPOSE: The goal of this study was to assess the clinicopathologic and ultrasonographic features of thyroid nodules with nondiagnostic results on repeat ultrasonography (US)-guided fineneedle aspiration biopsy (FNAB) according to size and the number of suspicious findings and to determine the proper management of nodules with consecutive nondiagnostic results. METHODS: This retrospective study included 297 nodules with nondiagnostic results on repeat FNAB that were evaluated by US over the course of at least 12 months of follow-up, a follow-up biopsy, or an operation. We compared clinical and US variables between benign and malignant nodules in thyroid nodules with repeat nondiagnostic results. RESULTS: The comparison of benign and malignant nodules with repeat nondiagnostic results revealed that age, marked hypoechogenicity, irregular or microlobulated margins, microcalcifications, and nonparallel shape were significantly associated with malignancy. Multivariate logistic regression analysis in malignant nodules revealed that microcalcifications and irregular or microlobulated margins were independently associated with malignancy. Among them, only irregular or microlobulated margins were independently significant as a predictor of malignancy in repeatedly nondiagnostic nodules measuring >10 mm. Using receiver operating characteristic analysis, the best cutoff value for the "number of suspicious findings" between benign and malignant nodules was three in nodules of all sizes, three in nodules measuring ≤10 mm, and two in nodules measuring >10 mm. CONCLUSION: Irregular or microlobulated margins may be the most frequent US features in repeatedly nondiagnostic nodules >10 mm. The presence of "two or more suspicious findings" can be used as the cutoff for distinguishing benign and malignant nodules.
Biopsy* ; Biopsy, Fine-Needle* ; Biopsy, Needle ; Follow-Up Studies* ; Logistic Models ; Retrospective Studies ; ROC Curve ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography

PURPOSE: To evaluate the correlation between findings of dynamic magnetic resonance (MR) imaging of thetemporomandibular joint (TMJ) and clinical findings in patients with internal derangement of the TMJ. MATERIALS AND METHODS: Dynamic MR images of 130 joints of 65 patients (17 men and 48 women aged 14 to 74 ; mean age, 34)with internal derangement of the TMJ were obtained using a 1.5-T MR imaging system. MR findings of anteriordisplacement, disc deformity and degenerative change were correlated with clinical findings including joint pain,clicking sound, crepitation and maximal mouth opening (MMO). RESULTS: Among 62 joints with TMJ pain, 32 showedanterior displacement without reduction, 15 showed disc deformity and 19 showed degenerative change. Among 49joints in which there was a clicking sound, 24, 8 and 12 joints, respectively, showed the above-mentionedfindings, while in seven with crepitation, these same findings were evident in five, six and four joints,respectively. Bilateral and unilateral joint disorders were observed in 17 and five patients, respectively, among22 with MMO less than 30mm and in 11 and 18 of 42 patients with MMO between 30mm and 60mm. CONCLUSION: On MRimaging, patients with MMO less than 30mm usually showed bilateral joint disorders and those with crepitationshowed chronic change. This indicates that there is high association between clinical findings of internalderangement of TMJ and MR findings.
Congenital Abnormalities ; Female ; Humans ; Joints ; Magnetic Resonance Imaging* ; Male ; Mouth ; Temporomandibular Joint*

OBJECTIVE: We investigated the performance of North Korean refugees on attention tasks, and the relationship between that performance and psychiatric symptoms. METHODS: Sustained and divided attention was assessed using the computerized Comprehensive Attention Test in North Korean refugees and in South Koreans. All participants also completed the Beck Depression Inventory, the Beck Anxiety Inventory, the Impact of Event Scale-Revised and the Dissociative Experiences Scale-II (DES-II). RESULTS: The North Korean refugees showed slower reaction times (RTs) on the visual sustained attention task compared to the South Koreans after controlling for age and sex. North Korean refugees had a greater number of omission errors (OEs) on the divided attention task and a higher standard deviation (SD) of RT. Total DES-II scores of the North Korean refugees were associated with the number of OEs and the SD of RT on the sustained attention task, and with the number of OEs on the divided attention task. CONCLUSION: North Korean refugees showed poorer performance on computerized attention tasks. In addition, attention deficit among North Korean refugees was associated with their dissociative experiences. Our results suggest that refugees may have attention deficits, which may be related to their psychiatric symptoms, particularly dissociation.
Anxiety ; Depression ; Humans ; Reaction Time ; Refugees*