Purpose: To analyze the efficacy and safety of preservative-containing and preservative-free 0.2% brimonidine tartrate and 0.5% timolol maleate fixed combination drug in normal tension glaucoma. Methods: Fifty-one patients (84 eyes) who were diagnosed with normal tension glaucoma and with preservative-containing or preservative-free brimonidine-timolol fixed combinations alone were analyzed retrospectively from January 2017 to February 2020. Intraocular pressure (IOP) was measured four times a day (9 a.m., 11 a.m., 2 p.m., and 4 p.m.) before and at 6 months after applying eye drops. We analyzed and compared the effect of lowering IOP and the occurrence of intra or extra-ocular adverse effects. Results: A significant mean IOP reduction was shown in both groups: -1.95 ± 2.50 mmHg (-12.26 ± 15.87%) in the preservative-containing group and -1.60 ± 2.06 mmHg (-10.54 ± 13.94%) in the preservative-free group at 6 months after eyedrop instillation. The IOP was lowest in both groups at 11 a.m. There were no significant differences between the two groups in lowering IOP. Serious adverse effects causing discontinuation of the eye drops were not observed. Conclusions Both preservative-containing and preservative-free brimonidine-timolol fixed combinations are effective in lowering IOP in normal tension glaucoma patients and are considered to be effective as eye drops without serious adverse effects.

The purpose of current experiment is the generation of insulin-producing human mesenchymal stem cells as therapeutic source for the cure of type 1 diabetes. Type 1 diabetes is generally caused by insulin deficiency accompanied by the destruction of islet beta-cells. In various trials for the treatment of type 1 diabetes, cell-based gene therapy using stem cells is considered as one of the most useful candidate for the treatment. In this experiment, human mesenchymal stem cells were transduced with AAV which is containing furin-cleavable human preproinsulin gene to generate insulin-producing cells as surrogate beta-cells for the type 1 diabetes therapy. In the rAAV production procedure, rAAV was generated by transfection of AD293 cells. Human mesenchymal stems cells were transduced using rAAV with a various multiplicity of infection. Transduction of recombinant AAV was also tested using beta-galactosidse expression. Cell viability was determined by using MTT assay to evaluate the toxicity of the transduction procedure. Expression and production of Insulin were tested using reverse transcriptase-polymerase chain reaction and immunocytochemistry. Secretion of human insulin and C-peptide from the cells was assayed using enzyme-linked immunosorbent assay. Production of insulin and C-peptide from the test group represented a higher increase compared to the control group. In this study, we examined generation of insulin-producing cells from mesenchymal stem cells by genetic engineering for diabetes therapy. This work might be valuable to the field of tissue engineering for diabetes treatment.

OBJECTIVE: We examined the clinical relationship between human leukocyte antigen B27 (HLA-B27) and juvenile idiopathic arthritis (JIA). Additionally, we assessed the usefulness of the Assessment of SpondyloArthritis International Society (ASAS) criteria for diagnosing juvenile spondyloarthropathies (SpA). METHODS: We retrospectively reviewed medical records of 239 patients with JIA classified according to the International League of Associations for Rheumatology (ILAR) classification to analyze the features of the joint involvement site. Results were correlated with the presence of HLA-B27. After that, we classified the 239 JIA patients according to the ASAS criteria to diagnose juvenile SpA. The relationship between the ASAS criteria and a diagnosis of juvenile SpA was analyzed by a chi-squared test. RESULTS: Back pain was associated with HLA-B27 in boys (p=0.002) but not in girls (p=0.616). In both sexes, involvement of the small joints in the lower extremities was highly associated with HLA-B27 (p=0.001 for boys, p=0.021 for girls). In addition, HLA-B27 was associated with enthesitis (p=0.004 for boys, p=0.021 for girls). Eighty-seven (36.4%) patients with JIA fulfilled the ASAS criteria; 2 (0.8%) had axial SpA and 85 (35.6%) had peripheral SpA. HLA-B27 was the most significant factor for diagnosing juvenile SpA (sensitivity 80%, specificity 99.31%, positive likelihood ratio, 116). CONCLUSION: The ILAR criteria have some weaknesses for diagnosing HLA-B27-positive JIA patients in early stages. The use of the ASAS criteria for juvenile patients will enable pediatric rheumatologists to diagnose juvenile SpA patients earlier.
Arthritis, Juvenile* ; Back Pain ; Classification* ; Diagnosis ; Female ; HLA-B27 Antigen ; Humans* ; Joints ; Leukocytes* ; Lower Extremity ; Medical Records ; Retrospective Studies ; Rheumatology ; Sensitivity and Specificity ; Spondylarthropathies* ; Spondylitis, Ankylosing

Background: Chronic stress at work is known to be associated with the risk of developing metabolic syndrome. Recent studies have evaluated stressand its association with metabolic syndrome in specific occupational groups. In the present study, we examined the relationship between stress andthe risk of developing metabolic syndrome in each occupational group. Methods: The present study examined 7,460 Korean workers, aged 20–65 years, whose data were collected from the Korea National Health andNutrition Examination Survey conducted between 2014 and 2016. The information on usual stress awareness was self-reported, and thebiochemical profile of the blood was conducted. The chi-square test and multiple logistic regression analysis were used to investigate therelationship between stress and metabolic syndrome in each occupational group. Results: The metabolic syndrome was prevalent in 26.3% of the study subjects. In the function-related job groups, the individuals with high stress levelsshowed a significantly higher risk of developing metabolic syndrome (odds ratio, 1.625; 95% confidence interval, 1.042–2.534) than those with lowstress levels. An increasing trend was observed, which suggested the increased risk of developing metabolic syndrome across increasing stress levelsin a stratified analysis in many occupational groups, specifically in function-related, viz., manager and expert, office worker, service worker, andsimple laborer (P for trend <0.001) groups. Conclusion The stress levels were significantly correlated with the risk of developing metabolic syndrome in function-related job groups. A differencebetween dose-response association of stress levels and metabolic syndrome existed in each occupational group.

Dural ectasia refers to the widening or ballooning of the dural sac surrounding the spinal cord. It can affect any plane of the spinal canal, but occurs primarily in the lumbosacral region. Dural ectasia is present in 63-92% patients who have Marfan syndrome, and is related to Ehlers-Danlos syndrome, neurofibromatosis type I, and ankylosing spondylitis. The most common symptoms are low back pain, headache, weakness, numbness above and below the affected limb, and occasional rectal and genital pain. However, in most patients, dural ectasia is usually asymptomatic. We report the case of a 5-year-old boy who presented with a severe headache who had been diagnosed with Marfan syndrome. During the evaluation, magnetic resonance imaging of the lumbar and sacral spine revealed dural ectasia. To our knowledge, this is the first report on Marfan syndrome with symptomatic dural ectasia in Korea. We concluded that dural ectasia should be suspected in patients diagnosed with Marfan syndrome who have a severe headache.
Child, Preschool ; Dilatation, Pathologic* ; Ehlers-Danlos Syndrome ; Extremities ; Headache ; Humans ; Hypesthesia ; Korea ; Low Back Pain ; Lumbosacral Region ; Magnetic Resonance Imaging ; Male ; Marfan Syndrome* ; Neurofibromatosis 1 ; Spinal Canal ; Spinal Cord ; Spine ; Spondylitis, Ankylosing

High ambient Ca2+ at bone resorption sites have been implicated to play an important role in the regulation of bone remodeling. The present study was performed to clarify the mode of high extracellular Ca2+ (Ca2+e)-induced modulation of osteoclastogenesis and the expression of receptor activator of nuclear factor-kB ligand (RANKL) and osteoprotegerin (OPG), thereby to define its role in osteoclast formation. Mouse bone marrow cells were cocultured with osteoblastic cells in the absence or presence of osteoclastogenic factors such as 1,25-dihydroxyvitaminD3 (1,25-(OH)2vitD3) and macrophage colony-stimulating factor/soluble RANKL. Ca2+ concentration in media (1.8 mM) was adjusted to 3, 5, 7 or 10 mM. Osteoclast formation was confirmed by the appearance of tartrate-resistant acid phosphatase (TRAP)-positive multinuclear cells and the expression of osteoclast phenotypic markers (calcitonin receptor, vitronectin receptor, cathepsin K, matrix metalloproteinase-9, carbonic anhydrase 2). High Ca2+e alone significantly stimulated osteoclast formation in a dose-dependent manner. However, in the presence of highly osteoclastogenic factors, high Ca2+e significantly inhibited osteoclastogenesis. High Ca2+e alone continuously up-regulated RANKL expression while only transiently increased OPG expression. However, in the presence of 1,25-(OH)2vitD3, high Ca2+e did not change the 1,25-(OH)2vitD3- induced RANKL expression while increased OPG expression. Taken together, these findings suggest that high Ca2+e alone increase osteoclastogenesis but inhibit in the presence of other osteoclastogenic factors. In addition, high Ca2+e-induced osteoclastogenesis may be mediated by osteoblasts via up-regulation of RANKL expression. Meanwhile up-regulated OPG might participate in the inhibitory effect of high Ca2+e on 1,25-(OH)2vitD3-induced osteoclastogenesis.
Animals ; Bone Marrow Cells/metabolism/physiology ; Bone Remodeling ; Calcium/*metabolism ; Carrier Proteins/biosynthesis ; Cations, Divalent ; Cells, Cultured ; Coculture ; Extracellular Space/*metabolism ; Glycoproteins/biosynthesis ; Membrane Glycoproteins/biosynthesis ; Mice ; Mice, Inbred ICR ; Osteoblasts/*cytology/metabolism ; Osteoclasts/*cytology/metabolism ; Receptors, Cytoplasmic and Nuclear/biosynthesis ; Vitamin D/*analogs & derivatives/pharmacology

A 65-year-old woman presented with a solid mass on the right temporal area. The mass had grown for over 2 years without any initiating event of trauma or inflammation. Before excision, the patient went through a computed tomography scan, revealing a calcified mass without bony connection. Under general anesthesia, an excisional biopsy was performed. Microscopic examination confirmed a diagnosis of soft tissue osteoma. Soft tissue osteoma is rare, especially in the head and neck region. Osteomas in the temporal region have not been reported yet. Due to its rarity, osteoma might be misdiagnosed as another soft tissue or bone origin tumor. Its treatment of choice is simple excision. In this review, we present an unusual clinical form of soft tissue osteoma.

SUMMARY: A 21-year-old healthy Korean man worked on a building construction site every day for almost 2 months and exercised every day for 1 or 2 hours after working hard. He felt dizziness, nausea, and experienced vomiting and body aches immediately after exercise and immediately took cold medicines including acetaminophen, cimetidine, bepotastine, and Codenal? complex for the common cold symptoms for 2 days because he was scheduled to participate in navy training at that time. He complained of severe trapezius pain and aches in his left calf 3 days after joining the Navy training. Testing revealed creatine phosphokinase (CPK) 6260 U/L, myogloblin 176 mcg/L in the urine, liver enzymes increased, and oliguria, suggesting rhabdomyolysis. He recovered with intravenous fluids without any complications.
Acetaminophen ; Cimetidine ; Common Cold ; Creatine Kinase ; Dizziness ; Humans ; Liver ; Nausea ; Oliguria ; Rhabdomyolysis* ; Superficial Back Muscles ; Vomiting ; Young Adult

PURPOSE: Neurofibromas of neuroectodermal origin are commonly found in Von Recklinghausens disease or neurofibormatosis type 1. It is an autosomal dominant disease caused by mutation of the long arm of chromosome 17. It can present from small nodules to disfiguring giant tumor. Plexiform neurofibroma is benign in most cases, but it could be transformed into malignant tumor, which requires surgical excision. To cover the defects after the excision, a number of surgical correction methods are available. This study is to report a surgical correction of disfiguring plexiform neurofibroma using anterolateral thigh free flap for extensive defects after surgical excision of neurofibrona. METHODS: Data of five neurofibroma patients with an average age of 39 including medical history, physical examination, computed tomography, and magnetic resonance imaging were checked. No disease other than neurofibroma were detected. Biopsy on the excised tissues was performed. The follow-up period was 7 to 27 months. RESULTS: The average size of defects after complete excision of neurofibroma was 13x10~25x15cm. Defects were covered by anterolateral thigh free flap, while donor sites were covered by local flap, split thickness skin graft and regional flap. Throughout follow-up, there were no complication, relapse, or any abnormalities. CONCLUSION: Despite various surgical correction methods are applicable to defects after excision on disfiguring plexiform neurofibroma, coverage of massive defects is still challenging in plastic and reconstructive surgeon. We have made five successful cases of surgical correction of disfiguring plexiform neurofibroma using anterolateral thigh free flap.
Arm ; Biopsy ; Chromosomes, Human, Pair 17 ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Magnetic Resonance Imaging ; Neural Plate ; Neurofibroma ; Neurofibroma, Plexiform ; Neurofibromatosis 1 ; Physical Examination ; Plastics ; Recurrence ; Skin ; Thigh ; Tissue Donors ; Transplants

PURPOSE: High-pressure injection injury is caused by accidental injection of the high-pressure injection devices in industry. The initial benign appearance of the wound fools patients into delays in an adequate treatment. And it can result in disastrous outcomes such as necrosis and amputation. To avoid the poor prognosis, the injuries require a prompt surgical intervention. The purpose of this article is to recognize the poor outcome of the high-pressure injection injury and to introduce an adequate treatment in need. METHODS: We have 4 cases of the high-pressure injection injuries in the hand from April, 2005 to March, 2009. Average age is 39 years (30-49 years old), 2 cases are the palm of dominant hand, 1 case is the thumb of dominant hand, and 1 case is the palm of non-dominant hand, respectively. We followed up these patients for 20 months on average. In 3 cases, the immediate, aggressive surgical intervention was carried out, but the other one was delayed in early adequate treatment. The wounds were covered by local advancement flap, anterolateral thigh free flap, conservative treatment with antibiotics and dressing. RESULTS: No pathogens after culture were found nor any findings of fracture in imaging study. Conservative treatment, local advancement flap and anterolateral thigh free flap for the open wound resulted in a desirable aesthetic outcome. In a long-term follow up, functional capability of the patient was also satisfactory. CONCLUSION: Upon initial evaluation, most high-pressure injection injuries present as innocuous wounds with very few symptoms and result in delaying the proper management. And the majority of high-pressure injection injuries will produce significant morbidity to the hand, amputation. And the initial aggressive surgical debridement was needed to prevent the poor outcome. The key to success in treating high-pressure injection injuries of the hand is the prompt aggressive surgical intervention.
Amputation ; Anti-Bacterial Agents ; Bandages ; Debridement ; Follow-Up Studies ; Free Tissue Flaps ; Hand ; Humans ; Necrosis ; Prognosis ; Thigh ; Thumb