The occurrences of thyrotoxicosis in patients with myasthenia gravis have been reported before the knowledge of the pathogenesis of the two disease. Thytotoxicosis is known to occur in 3 to 6 percent of patients with myasthenia gravis and myasthenia gravis occurs in only a fraction of 1 percent of the thyrotoxic populatian. Myasthenia gravis is currently considered as a systemic autoimmune disorder of acetylcholine receptor and often presented with other autoimmune diseases such as SLE, Rheumatoid arthritis. We experienced a 18-year-old woman who presented with graves disease and isolated ocular myasthenia gravis. Chest CT didnot reveal enlarged thymus. The usual treatement of myasthenia gravis associated with thymtoxicosis consists of medical control of the thyrotoxicosis, then thymectomy and later subtotal thyroidectomy. Her ptosis and thyrotoxicosis have improved after the medicatian of anticholinesterase and propylthiourecil. A case of ocular myasthenia gravis with Gravesdisease was experienced, so we reported the case with a brief review of literature.
Acetylcholine ; Adolescent ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Female ; Graves Disease ; Humans ; Myasthenia Gravis ; Thymectomy ; Thymus Gland ; Thyroidectomy ; Thyrotoxicosis ; Tomography, X-Ray Computed

Eucommia ulmoides Oliv. Bark (EUE) is commonly used for the treatment of hypertension, rheumatoid arthritis, lumbago, and ischialgia as well as to promote longevity. In this study, we tested the effects of EUE aqueous extract in graded doses to protect and enhance cognition in scopolamine-induced learning and memory impairments in mice. EUE significantly improved the impairment of short-term or working memory induced by scopolamine in the Y-maze and significantly reversed learning and memory deficits in mice as measured by the passive avoidance and Morris water maze tests. One day after the last trial session of the Morris water maze test (probe trial session), EUE dramatically increased the latency time in the target quadrant in a dose-dependent manner. Furthermore, EUE significantly inhibited acetylcholinesterase (AChE) and thiobarbituric acid reactive substance (TBARS) activities in the hippocampus and frontal cortex in a dose-dependent manner. EUE also markedly increased brain-derived neurotrophic factor (BDNF) and phosphorylation of cAMP element binding protein (CREB) in the hippocampus of scopolamine-induced mice. Based on these findings, we suggest that EUE may be useful for the treatment of cognitive deficits, and that the beneficial effects of EUE are mediated, in part, by cholinergic signaling enhancement and/or protection.
Acetylcholinesterase ; Alzheimer Disease ; Animals ; Arthritis, Rheumatoid ; Brain-Derived Neurotrophic Factor ; Carrier Proteins ; Cognition ; Eucommiaceae* ; Hippocampus ; Hypertension ; Learning* ; Longevity ; Low Back Pain ; Maze Learning ; Memory Disorders* ; Memory* ; Memory, Short-Term ; Mice* ; Phosphorylation ; Scopolamine Hydrobromide

Shoulder pain presents with varying etiology and pathophysiology. At the time of initial evaluation, conservative management is applied in most cases. The therapeutic approach should be based on the cause of pain, which should be determined by the appropriate evaluation. Recovery of range of motion, strengthening of rotator cuffs and other shoulder muscles, and scapular stabilization are the main principles and purposes of shoulder rehabilitation. In this article, we introduce diagnosis-specific management approaches for common presentations of shoulder pain such as adhesive capsulitis, impingement syndrome or rotator cuff tendinosis, and calcific tendinitis.
Bursitis ; Muscles ; Range of Motion, Articular ; Rehabilitation ; Rotator Cuff ; Shoulder ; Shoulder Pain* ; Tendinopathy

Shoulder pain presents with varying etiology and pathophysiology. At the time of initial evaluation, conservative management is applied in most cases. The therapeutic approach should be based on the cause of pain, which should be determined by the appropriate evaluation. Recovery of range of motion, strengthening of rotator cuffs and other shoulder muscles, and scapular stabilization are the main principles and purposes of shoulder rehabilitation. In this article, we introduce diagnosis-specific management approaches for common presentations of shoulder pain such as adhesive capsulitis, impingement syndrome or rotator cuff tendinosis, and calcific tendinitis.
Bursitis ; Muscles ; Range of Motion, Articular ; Rehabilitation ; Rotator Cuff ; Shoulder ; Shoulder Pain* ; Tendinopathy

OBJECTIVE: To evaluate the feasibility of a new position (internal rotation in hanging) in ultrasonography, we compared the length of the glenohumeral joint space and the effectiveness of steroid injection with the hanging position and with the commonly used abdomen or cross position. METHODS: A prospective, randomized controlled trial was performed in 42 patients with adhesive capsulitis of shoulder. We used three arm positions for the posterior approach as follows: the patient's palm on thigh, other hand on abdomen (abdomen position); hand on patient's opposite shoulder (cross position); arm in hanging position with internal rotation of shoulder (hanging position). The order of shoulder position was randomized and blinded. Real-time ultrasonography-guided intra-articular steroid injection was performed by posterior approach at the first position in each patient. The Brief Pain Inventory (BPI), the Shoulder Pain and Disability Index (SPADI), and range of motion (ROM) were measured before steroid injection and 2 weeks after injection. RESULTS: The lengths of the joint space were 2.88±0.75, 2.93±0.89, and 2.82±0.79 mm in abdomen, cross, and hanging position respectively, with no significant difference among the three positions (p=0.429). Treatment efficacy was significantly improved in ROM, total BPI, and SPADI in all three positions (p<0.001). The changes in ROM for shoulder abduction were 23.6°±19.7°, 22.2°±20.9°, and 10.0°±7.8° in abdomen, cross, and hanging position, respectively. Changes in total BPI scores were 25.1±15.7, 23.6.±18.0, 11.6±6.1, and changes in total SPADI score were 35.0±14.2, 30.9±28.9, and 16.5±10.3 in abdomen, cross, and hanging position, respectively. There were no significant difference among the three positions for all parameters (p=0.194, p=0.121, and p=0.108, respectively. CONCLUSION: For patients with adhesive capsulitis who cannot achieve or maintain abdomen or cross position, scanning and injection with the shoulder in internal rotation with hanging position may be a useful alternative.
Abdomen ; Adhesives* ; Arm ; Bursitis* ; Hand ; Humans ; Injections, Intra-Articular ; Joints ; Posture ; Prospective Studies ; Range of Motion, Articular ; Shoulder Joint ; Shoulder Pain ; Shoulder* ; Thigh ; Treatment Outcome ; Ultrasonography

OBJECTIVE: To evaluate the feasibility of a new position (internal rotation in hanging) in ultrasonography, we compared the length of the glenohumeral joint space and the effectiveness of steroid injection with the hanging position and with the commonly used abdomen or cross position. METHODS: A prospective, randomized controlled trial was performed in 42 patients with adhesive capsulitis of shoulder. We used three arm positions for the posterior approach as follows: the patient's palm on thigh, other hand on abdomen (abdomen position); hand on patient's opposite shoulder (cross position); arm in hanging position with internal rotation of shoulder (hanging position). The order of shoulder position was randomized and blinded. Real-time ultrasonography-guided intra-articular steroid injection was performed by posterior approach at the first position in each patient. The Brief Pain Inventory (BPI), the Shoulder Pain and Disability Index (SPADI), and range of motion (ROM) were measured before steroid injection and 2 weeks after injection. RESULTS: The lengths of the joint space were 2.88±0.75, 2.93±0.89, and 2.82±0.79 mm in abdomen, cross, and hanging position respectively, with no significant difference among the three positions (p=0.429). Treatment efficacy was significantly improved in ROM, total BPI, and SPADI in all three positions (p<0.001). The changes in ROM for shoulder abduction were 23.6°±19.7°, 22.2°±20.9°, and 10.0°±7.8° in abdomen, cross, and hanging position, respectively. Changes in total BPI scores were 25.1±15.7, 23.6.±18.0, 11.6±6.1, and changes in total SPADI score were 35.0±14.2, 30.9±28.9, and 16.5±10.3 in abdomen, cross, and hanging position, respectively. There were no significant difference among the three positions for all parameters (p=0.194, p=0.121, and p=0.108, respectively. CONCLUSION: For patients with adhesive capsulitis who cannot achieve or maintain abdomen or cross position, scanning and injection with the shoulder in internal rotation with hanging position may be a useful alternative.
Abdomen ; Adhesives* ; Arm ; Bursitis* ; Hand ; Humans ; Injections, Intra-Articular ; Joints ; Posture ; Prospective Studies ; Range of Motion, Articular ; Shoulder Joint ; Shoulder Pain ; Shoulder* ; Thigh ; Treatment Outcome ; Ultrasonography

Relapsing polychondritis is a relatively rare systemic disease characterized by episodic recurrent inflammation involving cartilaginous structure of auricle, joints, nose, eyes, respiratory tract, heart valve, and skin. The etiology is unknown but autoimmune mechanism has been thought to be its causative factor. Autoantibodies against cartilaginous collagen may play a crucial role in the pathogenesis of relapsing polychondritis. We have recently experienced a case of relapsing polychondritis with recurrent otitis media with effusion, so we report this case with a review of the literature.
Autoantibodies ; Collagen ; Heart Valves ; Inflammation ; Joints ; Nose ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; Polychondritis, Relapsing* ; Respiratory System ; Skin

Chondroblastoma is an uncommon primary benign bone tumor that usually arises in the epiphyses of the long bones. Chondroblastoma of temporal bone is extremely rare. Its biological nature is often benign but is sometimes aggressive because of the local invasion. Recently, the authors have experienced two cases of chondroblastoma of temporal bone which were completely excised. We report these cases of chondroblastoma of the temporal bone with a review of literature.
Chondroblastoma* ; Epiphyses ; Temporal Bone*

BACKGROUND: In type 2 diabetes mellitus therapy, fixed-dose combination (FDC) can offer not only benefits in glucose control via the combined use of agents, but also increase patient compliance. The aim of this study was to assess the pharmacokinetic equivalence of the high dose of the FDC tablet (gemigliptin/metformin sustained release [SR] 50/1,000 mg) and a corresponding co-administered dose of individual tablets. METHODS: This study was randomized, open-label, single dose, two treatments, two-period, crossover study, which included 24 healthy subjects. Subjects received the FDC or individual tablets of gemigliptin (50 mg) and metformin XR (1,000 mg) in each period. Geometric mean ratios (GMRs) and 90% confidence intervals (CIs) of maximum plasma concentration (Cmax) and area under the plasma concentration-time curve from time zero to the time of the last quantifiable concentration (AUClast) of the FDC tablet and co-administration of individual tablet for both gemigliptin and metformin were calculated. RESULTS: The GMRs (FDC tablets/co-administration; 90% CIs) for Cmax and AUClast of gemigliptin were 1.079 (0.986–1.180) and 1.047 (1.014–1.080), respectively. For metformin, the GMRs for Cmax, and AUClast were 1.038 (0.995–1.083) and 1.041 (0.997–1.088), respectively. The 90% CIs for GMRs of Cmax and AUClast for gemigliptin and metformin fell entirely within bounds of 0.800–1.250. Both administration of FDC tablet and co-administration of individual tablets were well tolerated. CONCLUSION: FDC tablet exhibited pharmacokinetic equivalence and comparable safety and tolerability to co-administration of corresponding doses of gemigliptin and metformin XR as individual tablets. Trial registry at ClinicalTrials.gov, NCT02056600.
Cross-Over Studies ; Diabetes Mellitus, Type 2 ; Glucose ; Healthy Volunteers* ; Metformin* ; Patient Compliance ; Pharmacokinetics ; Plasma ; Tablets*

In the present study, we investigated the anti-inflammatory properties of Eucommia ulmoides Oliv. Bark. (EUE) in lipopolysaccharide (LPS)-stimulated microglial BV-2 cells and found that EUE inhibited LPS-mediated up-regulation of pro-inflammatory response factors. In addition, EUE inhibited the elevated production of pro-inflammatory cytokines, mediators, and reactive oxygen species (ROS) in LPS-stimulated BV-2 microglial cells. Subsequent mechanistic studies revealed that EUE suppressed LPS-induced phosphorylation of mitogen-activated protein kinases (MAPKs), phosphoinositide-3-kinase (PI3K)/Akt, glycogen synthase kinase-3β (GSK-3β), and their downstream transcription factor, nuclear factor-kappa B (NF-κB). EUE also blocked the nuclear translocation of NF-κB and inhibited its binding to DNA. We next demonstrated that EUE induced the nuclear translocation of nuclear factor erythroid 2-related factor 2 (Nrf2) and upregulated heme oxygenase-1 (HO-1) expression. We determined that the significant up-regulation of HO-1 expression by EUE was a consequence of Nrf2 nuclear translocation; furthermore, EUE increased the DNA binding of Nrf2. In contrast, zinc protoporphyrin (ZnPP), a specific HO-1 inhibitor, blocked the ability of EUE to inhibit NO and PGE2 production, indicating the vital role of HO-1. Overall, our results indicate that EUE inhibits pro-inflammatory responses by modulating MAPKs, PI3K/Akt, and GSK-3β, consequently suppressing NF-κB activation and inducing Nrf2-dependent HO-1 activation.
Cytokines ; Dinoprostone ; DNA ; Eucommiaceae* ; Glycogen Synthase ; Heme Oxygenase-1 ; Mitogen-Activated Protein Kinases ; Phosphorylation ; Reactive Oxygen Species ; Transcription Factors ; Up-Regulation ; Zinc