No abstract available.
Craniopharyngioma* ; Magnetic Resonance Imaging*

PURPOSE: The purpose of this study was to evaluate the accuracy of Tc-99m DTPA diuretic renal scans in children upper urinary tract. MATERIALS AND METHODS: We reviewed diuretic renal scans of 14 pediatric patients (age range: 3 days to 4 years) with unilateral hydronephrosis diagnosed by ultrasonography. Diuretic renal scan was done using Tc-99m DTPA and standardized protocol. In 3 neonates, diuretic renal scans were performed within 1 week and 3-7 months after birth. RESULTS: Six patients required pyeloplasty and eight were managed conservatively. All 6 patients requiring pyeloplasty were diagnosed as having ureteropelvic junction obstruction in the diuretic renal scan. In these 6 patients, post-operative renal scans at 3-12 months after surgery were converted to nonobstructive pattern in 5 and a nonobstructive patterns in 1. In 3 patients who underwent diuretic renal scan within 1 week after birth., nonobstructive patterns of initial scan were coverted to obstructive patterns in the follow-up scan. However, all patients with nonobstructive diuretic renal scans performed after the neonatal period did well on serial ultrasonography and showed favorable clinical outcome without progression to obstruction. CONCLUSION: Tc-99m DTPA diuretic renal scan with standarized protocol is useful in assessing suspected ureteropelvic junction obstruction in children as an initial diagnostic or post-operative follow-up modality. Nonobstructive or indeterminate scan RESULTS in the neonatal period requires follow-up scan to monitor development of the obstructive pattern.
Child* ; Follow-Up Studies ; Humans ; Hydronephrosis ; Infant, Newborn ; Kidney Pelvis ; Parturition ; Pentetic Acid* ; Radioisotope Renography* ; Ultrasonography ; Urinary Tract*

Double outlet left ventricle (DOLV), even defined as origins of both great vessels from left ventricle,implies varieties of morphology in concern with loop pattern, location of ventricular septal defect, conotruncalanatomy, and presence or adsence of pulmonary stenosis. With the improvement of surgical tenchnique, correctivesurgery of DOLV became possible, and preoperative diagnosis and determination of the accurate anatomicalrelaltionship between great vessels, ventricular septal defect, and ventricles is very important in surgicalimplication. Authors have recently experienced two cases of DOLV. The one is with subpulmonic conus, subpulmonicventricular septal defect, patent ductus arteriosus, and preductal type coarctation of aorta. The other is withbilateral coni and subaortic ventricular septal defect. Loop patterns are [S,D,D] in both cases.
Aortic Coarctation ; Conus Snail ; Diagnosis ; Ductus Arteriosus, Patent ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Pulmonary Valve Stenosis

PURPOSE: To analyse complications and to review usefulness of large needle(18G) in percutaneous transhepatic biliary drainage(PTBD). MATERIALS AND METHODS: 46 patients underwent PTBD in 52 occassions using large needle. 44 of 46 patients had either definite or suspicious malignant biliary obstruction, and most patients were poor in general dondition. Complications were classified as acute type if developed within 30 days and as delayed type if developed after 30 days. Acute type was subdivided into severe and mild forms. RESULTS: Severe forms of complications were death(5.8%), septicemia(3.8%), and bile peritonitis(1.9%). There were not different from the rate of complication in PTBD using fine needle but the procedure was much more simple. CONCLUSION: We PTBD using large neddie is a simple and safe procedure for prompt bile decompression.
Bile ; Decompression ; Drainage* ; Humans ; Needles*

PURPOSE: To determine (1) the relationship between the cortical defects seen on 99 mTc-DMSA renal scans and age, and (2) the presence and degree of vesicoureteral reflux, and then to depict the risk factors for cortical defects in children with acute urinary tract infection (UTI). Furthermore, to assess the diagnostic value of VCUG in predicting a defect on 99 mTc-DMSA renal scans. MATERIALS AND METHODS: We studied 134 kidneys in 67 children aged 15 days-10 years (M:F=39:28) in whom symptomatic UTI was present. In all these children, both DMSA renal scans and voiding cystourethrography (VCUG) were performed. Scanning took place within 7 days of diagnosis and VCUG was performed after one month of diagnosis. Scintigraphic findings were graded according to the extent and number of cortical defects. We evaluated the relationships between the cortical defects seen on DMSA scans and age, and the grade of vesicoureteral reflux. The diagnostic value of VCUG in predicting cortical defects was analysed. Results: The prevalence of cortical defects was greater in patients older than two years (38/54, 70%) than in those aged less than two (38/80, 48%). The frequency of cortical defects was related to vesicoureteral reflux (p<0.05) and grade of reflux (p<0.05). As this latter increased, the extent of cortical defects also increased (p<0.05), and DMSA scans revealed the presence of these in 76 of the 134 kidneys (57%) with acute UTI. In 30 of these 76 (39.5%), VCUG demonstrated the presence of vesicoureteral reflex. On the other hand, vesi-coureteral reflex was found in 36 of the 134 kidneys (27%), and in 30 of these 36 (83%), cortical defects were noted. The sensitivity of VCUG in predicting cortical defect was 39.5%, while specificity was 89.7%. The positive predictive value for defects was 83.3%, and the negative predictive value was 53.1%. The relative risk of cortical defect in the presence of vesicoureteral reflux was 1.78. CONCLUSION: Renal cortical defects are significantly related to age and grade of vesicoureteral reflux. Risk factors for developing cortical defects were older age (> or =2yrs) at the time of acute UTI, and high grade of vesicoureteral reflux. The specificity of VCUG in predicting cortical defects is relatively high but the sensitivitiy is low, and a significant proportion of cortical defects therefore occurred in the absence of vesicoureteral reflux.
Child* ; Diagnosis ; Hand ; Humans ; Kidney ; Prevalence ; Radionuclide Imaging* ; Reflex ; Risk Factors* ; Sensitivity and Specificity ; Succimer* ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

Informed consent (IC) should be a form of communication between a physician and patient in which information regarding all options of a medical procedure and the patient's preference is shared. The aim of this study was to create a standard for communication by IC for physicians. The IC standard was developed based on an analysis of a dialogue in our previous experience with a medical communication program and a review of the literature. The dialogue pattern of the IC standard had the following six elements: opening; orientation; disclosure of information; conforming and complementing; shared decision making; and closing. Factors that influenced effective IC-based communication included preparation, attitude, empathy, listening, a psychosocial factor, nonverbal communication, explanation, and understanding. The IC communication standard will be useful in improving the quality of communication between a physician and patient in obtaining IC. It will also be used as a guideline for communication educators and medical students. Innovative strategies and rigorous studies are needed to improve IC counseling to establish effective patient-centered interviews.
Complement System Proteins ; Counseling ; Decision Making ; Disclosure ; Empathy ; Humans ; Informed Consent* ; Nonverbal Communication ; Psychology ; Students, Medical

To overcome the difficulty of controlling stem cell fate and function in applications to regenerative medicine, a number of alternative approaches have been made. Recent reports demonstrate that a non-cellular niche modulating the biophysical microenvironment with chemical factors can support stem cell self-renewal. In our previous studies, early establishment was executed to optimize biophysical factors and it was subsequently found that the microgeometry of the extracellular matrix made huge differences in stem cell behavior and phenotype. We review here a three-dimensional, non-cellular niche designed to support stem cell self-renewal. The characteristics of stem cells under the designed system are further discussed.
Extracellular Matrix ; Phenotype ; Regenerative Medicine ; Stem Cells

PURPOSE: To find the effect of visual feedback of head angle with using a mobile posture-aware system on craniocervical angle and neck and shoulder muscles fatigue for preventing or decreasing the forward head posture. METHODS: Twenty-four healthy young adults in Chungbuk to participate in this study. The subjects started to watch a movie clip for 10 minutes with visual feedback in 0°, 30°, and 60° of head angles. During the task, surface electromyography (EMG) was used to collect data from the upper trapezius (UT), sternocleidomasetoid muscle (SCM), cervical erecter spinae (CES) during watching the smartphone. Craniocervical angles were measured using a sagittal-view photograph of the subject in a sitting posture. A one-way repeated analysis of variance with a significant level of 0.05 used for statistical analysis. RESULTS: Craniocervical angle with 0° visual feedback was significantly greater than 30°and 60°. Craniocervical angle with 30° visual feedback was significantly greater than 60°. In addition, MDF of UT muscles in 0° and 30° of visual feedback was significantly greater than 60°. CONCLUSION: We concluded that 0° visual feedback of head angle with using a mobile posture-aware system would be beneficial to prevent or decrease forward head posture during watching a smartphone. We also could recommend using of 30° visual feedback in case of caring UT muscle fatigue primarily.
Chungcheongbuk-do ; Electromyography ; Fatigue* ; Feedback, Sensory* ; Head* ; Humans ; Muscle Fatigue ; Muscles* ; Neck* ; Posture ; Shoulder* ; Smartphone* ; Superficial Back Muscles ; Young Adult

BACKGROUND: Melanogenesis is one of the characteristic parameters of differentiation in melanocytes and melanoma cells. Specific inhibitors of phosphatidylinositol 3-kinase (PI3K), such as wortmannin and LY294002, stimulate melanin production in mouse and in human melanoma cells, suggesting that PI3K and mammalian target of rapamycin (mTOR) might be involved in the regulation of melanogenesis. OBJECTIVE: The involvement of the mTOR pathway in regulating melanogenesis was examined using human MNT-1 melanoma cells, and the effects of the potent inhibitor of mTOR, rapamycin, in the presence or absence of alpha-melanocyte-stimulating hormone (alpha-MSH) were evaluated. METHODS: In cells treated with rapamycin, cell viability, melanin content, and tyrosinase (TYR) activity were measured and compared with untreated controls. Protein levels of TYR, tyrosinase-related protein (TYRP)-1, TYRP-2, and microphthalmia-associated transcription factor (MITF) were also analyzed by Western blot. RESULTS: In rapamycin-treated cells, the melanin content increased concomitantly with an elevation in TYR activity, which plays a major role in melanogenesis. There was also an up-regulation of TYR, TYRP-1, and MITF proteins. Combined treatment with rapamycin or wortmannin and alpha-MSH increased melanogenesis more strongly than alpha-MSH alone. CONCLUSION: Rapamycin-induced melanin formation may be mediated through the up-regulation of TYR protein and activity. Furthermore, rapamycin and wortmannin, inhibitors of mTOR and PI3K, respectively, have co-stimulatory effects with alpha-MSH in enhancing melanogenesis in melanocyte cells.
alpha-MSH ; Androstadienes ; Animals ; Cell Survival ; Chromones ; Humans ; Melanins ; Melanocytes ; Melanoma ; Mice ; Microphthalmia-Associated Transcription Factor ; Monophenol Monooxygenase ; Morpholines ; Phosphatidylinositol 3-Kinase ; Sirolimus ; Up-Regulation

PURPOSE: Most studies on immune tolerance of mesenchymal stem cells (MSCs) have been performed using MSCs derived from bone marrow, cord blood, or adipose tissue. MSCs also exist in the craniofacial area, specifically in teeth. The purpose of this study was to evaluate the mechanisms of immune tolerance of dental pulp-derived MSC (DP-MSC) in vitro and in vivo. MATERIALS AND METHODS: We isolated DP-MSCs from human dental pulp and co-cultured them with CD4⁺ T-cells. To evaluate the role of cytokines, we blocked TGF-β and IL-10, separately and together, in co-cultured DP-MSCs and CD4⁺ T-cells. We analyzed CD25 and FoxP3 to identify regulatory T-cells (Tregs) by fluorescence-activated cell sorting (FACS) and real-time PCR. We performed alloskin grafts with and without DP-MSC injection in mice. We performed mixed lymphocyte reactions (MLRs) to check immune tolerance. RESULTS: Co-culture of CD4⁺ T-cells with DP-MSCs increased the number of CD4⁺CD25⁺FoxP3⁺ Tregs (p<0.01). TGF-β or/and IL-10 blocking suppressed Treg induction in co-cultured cells (p<0.05). TGF-β1 mRNA levels were higher in co-cultured DP-MSCs and in co-cultured CD4⁺ T-cells than in the respective monocultured cells. However, IL-10 mRNA levels were not different. There was no difference in alloskin graft survival rate and area between the DP-MSC injection group and the non-injection group. Nonetheless, MLR was reduced in the DP-MSC injected group (p<0.05). CONCLUSION: DP-MSCs can modulate immune tolerance by increasing CD4⁺CD25⁺FoxP3⁺ Tregs. TGF-β1 and IL-10 are factors in the immune-tolerance mechanism. Pure DP-MSC therapy may not be an effective treatment for rejection, although it may module immune tolerance in vivo.
Adipose Tissue ; Animals ; Bone Marrow ; Coculture Techniques ; Cytokines ; Dental Pulp ; Fetal Blood ; Flow Cytometry ; Graft Survival ; Humans* ; Immune Tolerance* ; In Vitro Techniques ; Interleukin-10* ; Lymphocyte Culture Test, Mixed ; Mesenchymal Stromal Cells* ; Mice ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; T-Lymphocytes ; T-Lymphocytes, Regulatory* ; Tooth ; Transplants