Unfolded protein response (UPR) is a stress response that is specific to the endoplasmic reticulum (ER). UPR is activated upon accumulation of unfolded (or misfolded) proteins in the ER's lumen to restore protein folding capacity by increasing the synthesis of chaperones. In addition, UPR also enhances degradation of unfolded proteins and reduces global protein synthesis to alleviate additional accumulation of unfolded proteins in the ER. Herein, we describe a cell-based ultra-high throughput screening (uHTS) campaign that identifies a small molecule that can modulate UPR and ER stress in cellular and

Stevens-Johnson syndrome (SJS) is a rare disease in which extensive toxic epidermolysis occursafter medication. Skin and mucous membranes are involved in about 90% of SJS cases, and webbingof mouth corners (microstomia) may occur when they are affected. Few reports have been issuedon microstomia in SJS, and no consensus has been reached regarding treatment methods,timings, or results. We encountered a case of microstomia following SJS after ofloxacin medicationin a 22-year-old woman treated by commissuroplasty using a lozenge-shaped excision. Wepresent an appropriate correction method and surgical timing for microstomia following SJS.

Background: Microstomia is defined as a condition with a small sized-mouth that results in functional impairment such as difficulty with food intake, pronunciation, and poor oral hygiene and cosmetic problems. Several treatment methods for microstomia have been proposed. None of them are universally applicable. This study aims at analyzing the cases treated at our institution critically reviewing the pertinent literature. Methods: The medical records of all microstomia patients treated in our hospital from November 2015 to April 2018 were reviewed retrospectively. Of these, all patients who received surgical treatment for microstomia were included in the study and analyzed for etiology, chief complaint, surgical method, and outcomes. The functional outcomes of mouth opening and intercommissure distance before and after the surgery were evaluated. The cosmetic results were assessed according to the patients’ satisfaction. Results: Five patients with microstomia were corrected. Two cases were due to scar contracture after chemical burn, two cases derived from repeated excision of skin cancer, and one patient suffered sequela of Stevens-Johnson syndrome. The following surgical methods were applied: one full-thickness skin graft on the buccal mucosa, three buccal mucosal advancement flaps after triangular excision of the mouth corner, and one local buccal mucosal flap. Mouth opening was increased by 6.0 mm, and the intercommissure distance improved by 7.2 mm on average. Follow-up was 9.6 months (range, 5–14 months). Cosmetic assessment was as follows: two patients found the results excellent, three judged it as good. Conclusion Microstomia has several causes. In order to achieve optimal functional recovery and aesthetic improvement it is important to precisely evaluate the etiologic factors and the severity of the impairment and to carefully choose the appropriate surgical method.

Reconstruction method choice in recurrent head and neck cancer depends on surgical history, radiation therapy dosage, conditions of recipient vessels, and general patient condition. Furthermore, when defects are multiple or three dimensional in nature, reconstruction and flap choice aimed at rebuilding the functional structure of the head and neck are difficult. We experienced successful reconstruction of recurrent laryngeal cancer requiring reconstruction of esophageal and tracheostomy stroma defects using a chimeric two-skin anterolateral thigh flap with a single pedicle.
Esophagus ; Free Tissue Flaps ; Head ; Head and Neck Neoplasms ; Humans ; Laryngeal Neoplasms ; Methods ; Neck ; Thigh ; Tracheostomy

BACKGROUND: Various focal heating devices are popular in Korea under the cultural influence of the traditional ondol under-floor method of home heating. These devices can cause severe burn-like injuries resulting from device malfunction or extended with low heat contact. In addition to injuries under these high heat contact, burns can be occurred by low heat exposure with prolonged periods despite the devices are properly functioning. In order to develop strategies to reduce the duration of periods of illness due to low-temperature burns, we analyzed and compared treatment methods and therapeutic periods for this type of injury. METHODS: This retrospective study included 43 patients burned under low heat conditions. Patients were divided into an operative group and a conservative group. The patients in the operative group underwent at least one surgical excision, and were further subdivided into early and late visit groups. The conservative group was treated only with dressings. We compared the treatment periods between the operative group and the conservative group, and also compared the preparation periods and treatment periods between the two operative groups. RESULTS: The average treatment period was significantly shorter in the operative group (P=0.02). In the early visit operative group, both wound preparation and treatment were briefer than in the late visit group. CONCLUSIONS: We recommend that early proper burn care and early surgical intervention, including appropriate excision, are feasible ways to reduce the treatment period of low-temperature burn patients.
Ambulatory Care ; Bandages ; Burns* ; Early Intervention (Education)* ; Heating ; Hot Temperature ; Humans ; Korea ; Retrospective Studies ; Wounds and Injuries

BACKGROUND: Surgical scars on the palmar surface of the hand may lead to functional and also aesthetic and psychological consequences. The objective of this study was to introduce a new incision technique for periarterial sympathectomy of the hand and to compare the results of the new two-step incision technique with those of a Koman incision by using an objective questionnaire. METHODS: A total of 40 patients (17 men and 23 women) with intractable Raynaud's disease or syndrome underwent surgery in our hospital, conducted by a single surgeon, between January 2008 and January 2013. Patients who had undergone extended sympathectomy or vessel graft were excluded. Clinical evaluation of postoperative scars was performed in both groups one year after surgery using the patient and observer scar assessment scale (POSAS) and the Wake Forest University rating scale. RESULTS: The total patient score was 8.59 (range, 6-15) in the two-step incision group and 9.62 (range, 7-18) in the Koman incision group. A significant difference was found between the groups in the total PS score (P-value=0.034) but not in the total observer score. Our analysis found no significant difference in preoperative and postoperative Wake Forest University rating scale scores between the two-step and Koman incision groups. The time required for recovery prior to returning to work after surgery was shorter in the two-step incision group, with a mean of 29.48 days in the two-step incision group and 34.15 days in the Koman incision group (P=0.03). CONCLUSIONS: Compared to the Koman incision, the new two-step incision technique provides better aesthetic results, similar symptom improvement, and a reduction in the recovery time required before returning to work. Furthermore, this incision allows the surgeon to access a wide surgical field and a sufficient exposure of anatomical structures.
Cicatrix ; Hand* ; Humans ; Male ; Raynaud Disease ; Sympathectomy* ; Transplants ; Trees

BACKGROUND: Variable methods have been introduced for reduction of the zygomatic fractures. The Dingman elevator is used widely to reduce these fractures but is inappropriate in certain types of fractures which require atypical traction vectors. We introduce and examine an alternate method of reducing zygomatic fractures using wire and hook traction. METHODS: A retrospective study was performed for all zygomatic fracture patients admitted between 2008 and 2014. Medially rotated fractures were reduced by using a wire looped through an intermaxillary screw secured on the medial side of the zygoma. Laterally rotated fractures were reduced using a hook introduced through an infrazygomatic skin incision. RESULTS: No accidental bleeding or incomplete reduction was observed in any of the cases. Postoperative imaging demonstrated proper reduction immediately after the operation. Follow-up computed tomography study at 1 month after operation also demonstrated proper reduction and healthy union across the previous site of fracture. CONCLUSION: The hook and wire method allowed precise application of traction forces across zygomatic fractures. The fractured bone fragment could be pulled in the direction precisely opposite to the vector of impact at the time of trauma. Soft tissue damage due to dissection was minimized. In particular, this method was effective in reducing rotated bone fragments and can be an alternative option to using the zygoma elevator.
Elevators and Escalators ; Facial Bones ; Follow-Up Studies ; Fracture Fixation ; Hemorrhage ; Humans ; Retrospective Studies ; Skin ; Traction* ; Zygoma ; Zygomatic Fractures*

No abstract available.
Free Tissue Flaps ; Scalp ; Thigh

BACKGROUND: Some diabetic feet heal without complication, but others undergo amputation due to progressive wounds. This study investigates the risk factors for amputation of diabetic feet. METHODS: A total of 55 patients who visited our institution from 2008 to 2012 were included in the study. The patients with abnormal fasting blood sugar levels, lower leg vascularity, and poor nutrition were excluded from the study group, and the wound states were unified. The patients were categorized into a treatment success group (n=47) and a treatment failure group (n=8), and their hemoglobin A1C (HgA1C), C-reactive protein (CRP), white blood cell count (WBC), and serum creatinine levels were analyzed. RESULTS: The initial CRP, WBC, and serum creatinine levels in the treatment failure group were significantly higher than that of the treatment success group, and the initial HgA1C level was significantly higher in the treatment success group. The CRP and WBC levels of both groups changed significantly as time passed, but their serum creatinine levels did not. CONCLUSIONS: The initial CRP, WBC, and serum creatinine levels were considered to be risk factors for amputation. Among them, the serum creatinine level was found to be the most important predictive risk factor. Because serum creatinine represents the renal function, thorough care is needed for the feet of diabetic patients with renal impairment.
Amputation ; Blood Glucose ; C-Reactive Protein ; Creatinine ; Diabetes Complications ; Diabetic Foot ; Fasting ; Foot ; Foot Ulcer ; Hemoglobins ; Humans ; Leg ; Leukocyte Count ; Risk Factors ; Treatment Failure ; Ulcer

PURPOSE: Dermoid cysts are benign neoplasms that are derived from both ectoderm and mesoderm. Approximately 7 percent of all dermoid cysts occur in the head and neck, as most common sites are the lateral ends of the eyebrows, the midline in the nasal root and neck. Rarely they can be found in the frontal sinus, temporal bone, maxilla and the floor of the mouth. Dermoid cysts in the temporal fossa are extremely rare. We experienced a characteristic dermoid cyst that occupied the temporal fossa. METHODS: A 16-year-old man had a progressive enlarging mass on the left eyebrow. Computerized tomographic scan showed a bulging mass in the temporal fossa, and it had the density similar to that of fat. The size of the mass was 3x3x2cm, and it was composed of high density of fat with clear margin. There was no bony invasion, but the mass was fixed on bone. RESULTS: We performed the surgery through coronal incision under general anesthesia. Because the mass was closely connected with temporal fat pads, we removed this mass with some portion of temporal fat pads, avoiding damage to the facial nerve. The postoperative course was ordinary without complication. CONCLUSION: The reports about dermoid cyst on the temporal fossa is uncommon. However, if there is a mass in the temporal fossa which has the density similar to that of fat in CT scan, we should consider the possibility of dermoid cyst. We suggest that excision through coronal incision with bewaring temporal fat pad can induce good result.
Adipose Tissue ; Adolescent ; Anesthesia, General ; Dermoid Cyst ; Ectoderm ; Eyebrows ; Facial Nerve ; Floors and Floorcoverings ; Frontal Sinus ; Head ; Humans ; Maxilla ; Mesoderm ; Mouth ; Neck ; Temporal Bone