Vitiligo is an autoimmune disease in which CD8+ T-cells target and destroy melanocytes, leaving areas of skin without pigment production. Nonsegmental vitiligo, the classical form of the disease, results in symmetrical, bilateral white patches. Vitiligo is a chronic, unpredictable disease, characterized by flares, with depigmentation and periods of disease arrest alternating. This process can be stressful and negatively impact one’s quality of life. Various hypotheses have been offered, including cellular stress causing degeneration of melanocytes, chemical toxicity causing melanocyte death, and neural changes that influence melanocytes or their ability to produce melanin. Recently, the interaction between oxidative stress and autoimmune-mediated melanocyte loss has been proposed as the primary pathogenesis of vitiligo. It is now well accepted that interferon-γ and/or C-X-C motif chemokine ligand 10 axis is functionally required for both progression and maintenance of vitiligo, making this pathway a potential therapeutic target. Most therapeutic interventions in the management of vitiligo have been developed based on this immunopathogenesis. This article aims to review the current understanding of the vitiligo pathogenesis.

Vitiligo is an autoimmune disease in which CD8+ T-cells target and destroy melanocytes, leaving areas of skin without pigment production. Nonsegmental vitiligo, the classical form of the disease, results in symmetrical, bilateral white patches. Vitiligo is a chronic, unpredictable disease, characterized by flares, with depigmentation and periods of disease arrest alternating. This process can be stressful and negatively impact one’s quality of life. Various hypotheses have been offered, including cellular stress causing degeneration of melanocytes, chemical toxicity causing melanocyte death, and neural changes that influence melanocytes or their ability to produce melanin. Recently, the interaction between oxidative stress and autoimmune-mediated melanocyte loss has been proposed as the primary pathogenesis of vitiligo. It is now well accepted that interferon-γ and/or C-X-C motif chemokine ligand 10 axis is functionally required for both progression and maintenance of vitiligo, making this pathway a potential therapeutic target. Most therapeutic interventions in the management of vitiligo have been developed based on this immunopathogenesis. This article aims to review the current understanding of the vitiligo pathogenesis.

The normal function of the ureterovesical junction was fundamental to prevent vesicouretera1 reflux but the role of ureter in preventing vesicoureteral reflux has not been defined. To clarify the role of ureter in vesicoureteral reflux, a total 34 reimplanted juxta-vesical ureters from 22 patients were examined by light microscope, polarized microscope and computerized image analyzer. As the degree of reflux was increasing, the amount of ureteral muscle did not change significantly but that of ureteral collagen increased significantly In 6 patients with bilateral vesicoureteral reflux, which were different in grade each other, the amount of ureteral muscle and collagen were not different significantly between the lower grade and the higher grade. The amount of ureteral muscle tended to increase with grade of reflux in the dilated terminal ureters in excretory urography but not in the non-dilated. Inflammatory cell infiltration to ureteral wall gave no effect to the contents of ureteral muscle and collagen. It was suggested that the content of ureteral muscle decreased and the content of ureteral collagen increased with degree of reflux and the dilation of terminal ureter with muscle hypertrophy was a compensatory response to the increased workload.
Collagen ; Humans ; Hypertrophy ; Ureter* ; Urography ; Vesico-Ureteral Reflux*

BACKGROUND: Since dysthymia begins in late childhood or adolescence and has a chronic course, long-term pharmacotherapy may be required. New generation antidepressant, moclobemide, with more acceptable side effect profiles, is effective in the treatment of dysthymia. The main objective of this study was to determine whether they exhibit comparable efficacy and tolerability in dysthymia to amitriptyline. METHOD AND MATERIALS: The efficacy and tolerability of the moclobemide and amitriptyline, were compared in a eight-week single-centre double-blind study in patients(n=37) with dysthymia using he HAMD-17, the Clinical Global Impression Scale(CGI), the Montgomery-Asberg Depression Rating Scale(MADRS), Efficacy Index-Therapeutic Index(EITE), 4-point Index Side Effect Scale(4-PISES), and Efficacy Index-Side Effect Scale(EISE). RESULTS: A total of 37 patients entered the study, 19 were randomly assigned to the moclobemide group and 18 to be amitriptyline group. Demographic and illness characteristics were similar in both groups. There were no significant difference between two groups at the total 17-HDRS score, the HAMD-17% improvement, the total MADRS score, CGI response, and the EITE. In the comparison of EISE between two groups, the scores of the moclobemide group were relatively lower than the amitriptylinen group in full treatment. And the differences were significant(moclobemide group 1.39+/-0.61 ; amitriptyline group 2.00+/-0.85, p<.001). At the 4-PISE. There was no serious or treatment threatening side effects. And there was no specific difference in side effects between two groups. The moclobemide group reported higher EIR scores than the amitriptyline group at every follow up day, but the differences were not significant. And there was no significant differences in the scores of five HRQOL subcategories which is compared between two groups at every follow up days. CONCLUSIONS: In terms of 17-HDRS and MADRS, moclobemide and amitriptyline are equally effective at least in allevating dysthymic symptoms. But moclobemide tended to be less troubling and better tolerated than amitriptyline. Therefore, moclobemide treatment can be used as a safe, and higher satisfactory treatment strategy for the dysthymia.
Adolescent ; Amitriptyline* ; Depression ; Double-Blind Method ; Drug Therapy ; Dysthymic Disorder* ; Follow-Up Studies ; Humans ; Moclobemide*

No abstract available.
Agranulocytosis* ; Granulocyte Colony-Stimulating Factor* ; Granulocytes* ; Humans*

PURPOSE: Esophageal tolerance is needed to guide the safe administration of stereotactic radiosurgery (SRS). We evaluated comprehensive dose-volume parameters of acute esophageal toxicity in patients with spinal metastasis treated with SRS. MATERIALS AND METHODS: From May 2008 to May 2011, 30 cases in 27 patients with spinal metastasis received single fraction SRS to targets neighboring esophagus. Endpoints evaluated include length (mm), volume (mL), maximal dose (Gy), and series of dose-volume thresholds from the dose-volume histogram (volume of the organ treated beyond a threshold dose). RESULTS: The median time from the start of irradiation to development of esophageal toxicity was 2 weeks (range, 1 to 12 weeks). Six events of grade 1 esophageal toxicity occurred. No grade 2 or higher events were observed. V15 of external surface of esophagus was found to predict acute esophageal toxicity revealed by multivariate analysis (odds radio = 1.272, p = 0.047). CONCLUSION: In patients with spinal metastasis who received SRS for palliation of symptoms, the threshold dose-volume parameter associated with acute esophageal toxicity was found to be V15 of external surface of esophagus. Restrict V15 to external surface of esophagus as low as possible might be safe and feasible in radiosurgery.
Esophagus ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Radiation Tolerance ; Radiosurgery*

Objectives: We aimed to investigate the demographics and medical management factors associated with dependence on hypnotics among outpatients with neurological disorders and insomnia. Methods: We reviewed electronic medical records of patients who received an initial hypnotic prescription between January 2014 and January 2016 and had later visited a neurological outpatient clinic before January 2018. We assessed patient demographics, the effectiveness of hypnotics, prescription periods, and hypnotic intake methods during the follow-up period. Results: Of 242 patients diagnosed with insomnia, we enrolled 114 patients (more women than men, at 61.4 versus 38.6%) who visited outpatient clinics regularly during the follow-up period. The mean age at onset was 65.8 ± 14.4 years. The most frequent neurological disorder was cerebrovascular disease, followed by neurodegenerative disease. During the 2-year period, 35.9% of participants remained hypnotics-free. Patients on zolpidem showed significantly greater insomnia improvement with hypnotic discontinuation than those on benzodiazepines and combination therapy (p=0.004). However, the type of hypnotics and demographic factors were not found to be independent risk factors. Multivariable analysis showed that longer periods between regular visits and a lower ratio of receiving number of pills to the time interval (days) between regular visits were independent risk factors for dependence on hypnotics. Conclusions: We found that low-dose and/or intermittent intake of hypnotics as well as frequent doctor visits could prevent dependence on hypnotics. It is important to establish the best practical guidelines for medical hypnotics management in outpatient primary care settings, including neurological clinics.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. A range of factors including tuberculous infection, beryllium exposure, and cold climate have been implicated in the pathogenesis of the condition. A 45-year-old woman presented with a 4-month history of an asymptomatic eyelid swelling and multiple erythematous papules on the neck. Histological examination of the neck, orbital soft tissue, and lacrimal gland was consistent with sarcoidosis. Ziehl−Neelsen stains and polymerase chain reactions (PCRs) for tuberculosis on the skin biopsy specimens were negative. However, the orbital soft tissue specimen was positive for non-tuberculous mycobacteria (NTM) PCR. The patient was finally diagnosed with sarcoidosis associated with NTM. Treatment with systemic steroid and hydroxychloroquine was started, resulting in an improvement of skin lesions. We herein report a case of sarcoidosis associated with NTM infection with review of the literature, as only little is known regarding the role of mycobacteria in sarcoidosis.

OBJECTIVE: Fetal heart rate in embryos(6-8 gestational weeks) have been significantly related to fetal outcome, but have rarely been studied. We attempted to identify fetal heart rate during 6-8 gestational weeks. Our purpose was to determine the lower limit of the heart rate associated with a favorable outcome and to evaluate the prognosis for those embryos with slow heart rates in early period. METHODS: We prospectively studied 798 singleton pregnancies between Jul. 1997-Dec. 1999 visiting our hospital. Gestational age was calculated from the beginning of the last menstrual period in the case of regular cycle and was confirmed by the crown-rump length. Other cases were measured by crown-rump length or mean gestational sac diameter. Color doppler sonography was used to calculate the fetal heart rate in beats per minute as the mean of 3 waves. RESULTS: Mean fetal heart rate (+/-SD) were 114.08+/-15.40 bpm for group 1, 126.49+/-18.78 for group 2, 139.83+/-19.92 for group 3, and 149.58+/-23.34 for group 4(p<0.001). Prognosis in the first trimester improved as heart rate increased to 100 bpm in group 1 and 120 bpm in group 2. In group 3 and 4, most of fetus with heart rates below 110 bpm died. CONCLUSIONS: The fetal heart rate during 6-8 gestational weeks is associated with fetal outcome at the end of the first trimester and we can identify the fetuses that are in risk.
Crown-Rump Length ; Embryonic Structures ; Female ; Fetal Heart* ; Fetus ; Gestational Age ; Gestational Sac ; Heart Rate ; Heart Rate, Fetal* ; Humans ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy* ; Prognosis ; Prospective Studies ; Ultrasonography*

BACKGROUND: In survivors of acute myocardial infarction(ANI), reduced heart rate variability(HRV) has been demonstrated to be an independent predictor of sudden cardiac death and mortality. The heart rate variability can be examined and analyzed non-invasively and quantitated with 24-hour ambulatory ECG monitoring. In general, the patency of infarct-related artery appears to be one of the most important prognostic factor after AMI. Therefor, the correlation between infarct artery patency and HRV was examined in survivors of AMI. METHODS: The 24-Hour ambulatory electrocardiogram was performed in 23 patients with AMI and 20 normal controls, and analyzed for frequency & time domain HRV. HRV was recorded dwithin 7 days after AMI, and coronary angiogram was performed at 7th day after AMI. The AMI patients were divided into two groups, depending upon patency of infarct-related artery and correlated to clinical manifestations. Thirteen patients had patent vessel(Group 1) and ten patients had non-patent vessel(Group 2). Parameters of frequency domain HRV include LF, HF & LF/HF ratio and time domain HRV include SDNN, SDANN, SD, rMSSD and pNN50. RESULTS: All parameters of HRV was depressed in patients of AMI than in normal control(p<0.05). The mean left ventricular ejection fraction(LVEF) was 54.1+/-10.6% in group 1 and 42.6+/-12.2% in group 2(p<0.05). The mean values of LF, SDNN, SDANN, and SD in group 1 and group 2 were 5.09+/-0.83msec2/Hz & 4.09+/-0.53msec2/Hz, 84.5+/-24.2msec & 59.0+/-11.8msec, 73.2+/-22.8msec & 50.5+/-12.6msec, and 37.8+/-13.1msec & 27.2+/-4.4msec(p<0.05), respectively. There was no difference between two groups in HF,rMSSD and pNN50. The location of infarction and thrombolytic therapy itself did not influence of HRV. The mean values of HF, SDANN, rMSSD and pNN50 in patients with LVEF<40% were reduced significantly than in patients with LVEF> or =40%. There was a significant correlation between LVEF and LF, between LVEF and HF and between LVEF and LF/HF ratio(r:0.55, p<0.05;r:0.67, p<0.05;r:-0.56, p<0.05). CONCLUSION: HRV was depressed due to reduced vagal activity in patients with AMI. The values of LF, SDNN, SDANN, and SD in group of patent infarct-related artery were reduced significantly than in non-patent group.
Arteries* ; Death, Sudden, Cardiac ; Electrocardiography ; Heart Rate* ; Heart* ; Humans ; Infarction ; Mortality ; Myocardial Infarction* ; Survivors ; Thrombolytic Therapy