A 70 year-old male visited with 1 month history of dark brown, hard, non-movable subcutaneous nodule on the anterior chest. Histopathologic findings were compatible with the metastatic transitional cell carcinoma of the urinary bladder.
Aged ; Carcinoma, Transitional Cell ; Humans ; Male ; Neoplasm Metastasis* ; Thorax ; Urinary Bladder*

OBJECTIVES: Amid the spread of coronavirus disease 2019 (COVID-19), with its high infectivity, we have relied on mathematical models to predict the temporal evolution of the disease. This paper aims to show that, due to active behavioral changes of individuals and the inherent nature of infectious diseases, it is complicated and challenging to predict the temporal evolution of epidemics. METHODS: A modified susceptible-exposed-infectious-hospitalized-removed (SEIHR) compartment model with a discrete feedback-controlled transmission rate was proposed to incorporate individuals’ behavioral changes into the model. To figure out relative uncertainties in the infection peak time and the fraction of the infected population at the peak, a deterministic method and 2 stochastic methods were applied. RESULTS: A relatively small behavioral change of individuals with a feedback constant of 0.02 in the modified SEIHR model resulted in a peak time delay of up to 50% using the deterministic method. Incorporating stochastic methods into the modified model with a feedback constant of 0.04 suggested that the relative random uncertainty of the maximum fraction of infections and that of the peak time for a population of 1 million reached 29% and 9%, respectively. Even without feedback, the relative uncertainty of the peak time increased by up to 20% for a population of 100,000. CONCLUSIONS It is shown that uncertainty originates from stochastic properties of infections. Without a proper selection of the evolution scenario, active behavioral changes of individuals could serve as an additional source of uncertainty.

OBJECTIVES: Amid the spread of coronavirus disease 2019 (COVID-19), with its high infectivity, we have relied on mathematical models to predict the temporal evolution of the disease. This paper aims to show that, due to active behavioral changes of individuals and the inherent nature of infectious diseases, it is complicated and challenging to predict the temporal evolution of epidemics. METHODS: A modified susceptible-exposed-infectious-hospitalized-removed (SEIHR) compartment model with a discrete feedback-controlled transmission rate was proposed to incorporate individuals’ behavioral changes into the model. To figure out relative uncertainties in the infection peak time and the fraction of the infected population at the peak, a deterministic method and 2 stochastic methods were applied. RESULTS: A relatively small behavioral change of individuals with a feedback constant of 0.02 in the modified SEIHR model resulted in a peak time delay of up to 50% using the deterministic method. Incorporating stochastic methods into the modified model with a feedback constant of 0.04 suggested that the relative random uncertainty of the maximum fraction of infections and that of the peak time for a population of 1 million reached 29% and 9%, respectively. Even without feedback, the relative uncertainty of the peak time increased by up to 20% for a population of 100,000. CONCLUSIONS It is shown that uncertainty originates from stochastic properties of infections. Without a proper selection of the evolution scenario, active behavioral changes of individuals could serve as an additional source of uncertainty.

BACKGROUND: Nitric oxide synthase (NOS) is known to mediate ultraviolet B (UVB)-induced skin inflammation However, there is still ambiguity as to which NOS isotype mediates the process in vivo. Furthermore, contradictory results have been reported on which cell types respond to UVB irradiation in vitro. OBJECTIVE: This study was performed to evaluate the change of inducible NOS (iNOS) expression in vivo as a result of UVB radiation on the skin of a rat. METHOD: To examine the time-course change in iNOS expression in the rat skin, the rats were exposed to 400 ml/cm2 of UVB radiation, and skin samples were taken at various time intervals up to 48 h. iNOS expression on the skin of a rat was evaluated by both Western blot analysis and immunohistochemical staining. RESULTS: From Western blot analysis, UVB irradiation induced inducible NOS (iNOS) expression in the epidermis at 12-48 h postirradiation with a peak expression at 24 h. Immunohistochemical staining revealed that UVB-induced iNOS expression was localized to the epidermis and infiltrating inflammatory cells in the upper dermis of the rat. CONCLUSION: iNOS was induced by UVB irradiation on the skin of a rat, mainly in the epidermis. Therefore, iNOS is supposed to be one of the major mediators with regard to inducing an inflammatory response in UVB-irradiated rat skin in vivo.
Animals ; Blotting, Western ; Dermis ; Epidermis ; Inflammation ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type II* ; Rats* ; Skin*

Crohn's disease is a chronic and insidious condition characterized by an inflammatory process that may extend across all layers of the entire gastrointestinal tract. The common sites involved by Crohn's disease are the terminal ileum and ascending colon. Crohn's disease limited to the appendix is uncommon. Since its first report in 1953 by Meyerding and Bertram, 156 cases of appendiceal Crohn's disease have been documented in the world literature. We experienced a case of Crohn's disease limited to the appendix in a-35year-old female who were performed an ileocecectomy.
Appendix* ; Colon, Ascending ; Crohn Disease* ; Female ; Gastrointestinal Tract ; Humans ; Ileum

Orientia tsutsugamushi, a causative pathogen of Scrub typhus, is a gram-negative intracellular bacterium. Outer membrane vesicles (OMVs) are produced from the membrane of bacteria and play many roles related to the survival of the pathogen. However, there have been no reports confirming whether O. tsutsugamushi indeed produce OMVs. O. tsutsugamushi boryong was cultured in ECV-304 cells for the purification of OMVs. Western blot analysis and immunoenrichment using anti-O. tsutsugamushi monoclonal antibody and electron microscopy were employed for identification and characterization of OMVs. We confirm the presence of OMVs derived from O. tsutsugamushi, and also found that those OMVs contain a major surface antigen of 56-kDa protein and variant immunogenic antigens.
Antibodies, Monoclonal/*immunology ; Antigens, Bacterial/*immunology ; Antigens, Surface/*immunology ; Cell Line ; Cell Membrane/immunology ; Humans ; Microscopy, Electron ; Orientia tsutsugamushi/*immunology/metabolism ; Scrub Typhus/diagnosis/microbiology ; Secretory Vesicles/*immunology

PURPOSE: There has been much reported data showing that breast reconstruction surgery does not result in reduced patient survival if the accepted principles of cancer surgery are closely followed. The proper reconstructive technique can be selected according to diverse factors, but breast size and the site of tumor are mostly important. The latissimus dorsi musculocutaneous flap (LDMCF) is one of the most commonly used techniques for early breast cancer patients who have small breasts. But, it has difficulties for supplying enough tissues to the widely excised tumor site. Especially for ptosis patients, reduction mammoplasty by itself is not enough to achieve symmetry of the breast. We suggest that the pectoralis major myomammary flap (PMMF) is a useful technique for the patients with ptosis. METHODS: Seventeen patients with ptosis were treated with breast conserving surgery with PMMF reconstruction. A quadrantectomy rather than lumpectomy was performed through a planned skin incision, and axillary lymph node dissection was performed according to the results of sentinel lymph node biopsy. The PMMF is carefully harvested without perforating branch injury to the internal thoracic artery. Reconstruction was done via the PMMF through the medial tunnel between both breasts. RESULTS: Among the seventeen patients, seroma occurred in two patients and no necrosis occurred at all. The cosmetic result was fair in 15 patients and poor in two patients, based on the four-point scoring system of breast cosmetics. CONCLUSION: After performing enough quadrantectomy to adhere to the accepted principles of cancer surgery, PMMF was quite useful to supply enough proper tissues for breast reconstructions, and especially for the ptosis patients.
Breast ; Breast Neoplasms ; Cosmetics ; Female ; Humans ; Lymph Node Excision ; Mammaplasty ; Mammary Arteries ; Mastectomy, Segmental ; Necrosis ; Nitriles ; Pyrethrins ; Sentinel Lymph Node Biopsy ; Seroma ; Skin

The present study was undertaken to learn the outcome of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) in their only hearing ear. Timing to conduct a cochlear implantation was also determined in those who did not recover the hearing. The study group comprised 25 patients who confronted ISSNHL in their only hearing ear. A total of 192 patients, who had ISSNHL in one ear and had normal contralateral ear, served as the control. Demographically there were no significant differences between the groups. The recovery rate was similar between the groups: 64.0% in the experimental and 62.5% in the control group. The duration until the recovery of ISSNHL in the only hearing ear was 5-90 days (average 17.6 days). In the experimental group, 8 patients did not recover from ISSNHL, and underwent cochlear implantation in 6 with satisfactory results. These results suggest that the same treatment is applicable for patients with ISSNHL regardless of whether their contralateral ear is deaf or normal. For those who do not recover from ISSNHL in their only hearing ear, culminating in bilateral deafness, we may consider further definitive treatment including cochlear implantation as early as 3 months after initiating the treatment of ISSNHL.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; *Cochlear Implantation ; Demography ; Female ; Hearing Loss, Sudden/surgery/*therapy ; Hearing Loss, Unilateral/*diagnosis ; Humans ; Male ; Middle Aged ; Patient Selection ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome

Malignant biliary or pancreatic duct stricture is dilatated using dilatating catheter or balloon catheter but a high grade stricture is difficult to dilate by general dilatating methods. Using Soehendra stent retriever is an effective method for exchanging an impacted stent. Recently, high grade malignant biliary strictures have been dilatated by Soehendra stent retriever. We report 3 cases of successful biliary drainage in high grade malignant biliary strictures using 7 Fr Soehendra stent retriever.
Catheters ; Constriction, Pathologic* ; Drainage* ; Pancreatic Ducts ; Stents*

Intussusception can develop at any age but about 95% of patients are children under 2 years-old. Adult intussusception is a rare condition. Unlike children, nearly all adults with intussusception have a lead point such as benign or malignant small bowel tumors, intestinal tuberculosis, or Meckel's diverticulum. First case is a 48-year-old male who was admitted with 2 days of diffuse abdominal cramping pain and no other associated gastrointestinal symptoms. Barium enema revealed ileocolic intussusception with a round cecal mass after barium reduction. An ileocecectomy was performed electively. The pathologic report was cecal cyst, which was an intraluminal structure with an epithelial lining of colonic mucosa. The second case, a 53-year-old male, was admitted with 1 week of diffuse abdominal cramping pain and watery diarrhea. Barium enema revealed ileocecal intussusception. Emergency surgery (ileocecectomy), revealed a polypoid small bowel mass. The pathologic report was lipoma. Recently, we experienced two cases of adult intussusception and report these cases with a brief review of the literature.
Adult* ; Barium ; Child ; Child, Preschool ; Colic ; Colon ; Diarrhea ; Emergencies ; Enema ; Humans ; Intussusception* ; Lipoma ; Male ; Meckel Diverticulum ; Middle Aged ; Mucous Membrane ; Tuberculosis